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1.
JAMA Netw Open ; 2(3): e190318, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848806

RESUMO

Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear. Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence. Design, Setting, and Participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018. Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 µm [PM2.5] and ≤1.0 µm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 µm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]). Main Outcomes and Measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods. Results: Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) µg/m3 (for NO2) to 123.1 (14.6) µg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-µg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-µg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-µg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia). Conclusions and Relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.


Assuntos
Doenças Cardiovasculares , Hiperlipoproteinemia Tipo II , Exposição por Inalação , Material Particulado , Adulto , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , China/epidemiologia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/epidemiologia , Exposição por Inalação/efeitos adversos , Exposição por Inalação/análise , Exposição por Inalação/prevenção & controle , Masculino , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Material Particulado/análise , Prevalência , Fatores de Risco , Tempo
2.
Diabetes Metab Syndr ; 13(1): 612-615, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641775

RESUMO

AIM: Data on prevalence of chronic kidney disease (CKD) among US adults with type 2 diabetes (T2D) and cardiovascular diseases (CVD) are limited. The aim of this study was to provide such estimates for T2D, both overall and in those with CVD. MATERIALS AND METHODS: Using the NHANES 2007-2014 data, we conducted a cross-sectional analysis of an adult sample with diagnosed and undiagnosed T2D, aged ≥18 years. CVD was defined based on self-reported personal interview data on a broad range of health conditions-congestive heart failure, coronary heart disease, angina, stroke, or heart attack. T2D was defined as diagnosed T2D (self-reported provider diagnosis) and undiagnosed T2D (FPG ≥126 mg/dL or HbA1c ≥ 6.5% without self-reported diagnosis). Participants who started insulin within a year of T2D diagnosis, or were pregnant at the time of health examination were excluded. Appropriate sample weights were used to provide a national estimate. RESULTS: The prevalence of moderate to severe renal impairment based on eGFR below 60 ml/min/1.73 m2 among T2D was 18.0%. The prevalence of mild renal impairment was 36.9%: 28.3% with UACR<30 mg/g, 7.0% with UACR ≥30-300 mg/g and 1.6% with UACR >300 mg/g. For T2D and CVD subgroup, the prevalence was 33.6% for moderate to severe renal impairment and 42.8% for mild renal impairment. CONCLUSIONS: This study confirms the high prevalence of CKD in patients with multiple comorbidities: T2D and CVD. It also provides estimates of the prevalence of CKD categories based on KDIGO 2012 classification for US adults with T2D.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Inquéritos Nutricionais/métodos , Insuficiência Renal Crônica/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/diagnóstico , Estudos Transversais , Diabetes Mellitus Tipo 2/classificação , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/classificação , Insuficiência Renal Crônica/diagnóstico , Estados Unidos/epidemiologia , Adulto Jovem
3.
Diabetes Care ; 42(3): 457-465, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30617142

RESUMO

OBJECTIVE: To estimate the long-term absolute risk for cardiovascular disease (CVD) according to fasting glucose (FG) levels below the threshold of diabetes. RESEARCH DESIGN AND METHODS: We pooled data from seven observational cohorts of U.S. black and white men and women followed from 1960 to 2015. We categorized FG as follows: <5.0, 5.0-5.5, 5.6-6.2, 6.3-6.9 mmol/L, and diabetes (FG ≥7.0 mmol/L or use of diabetes medications). CVD was defined as fatal/nonfatal coronary heart disease and fatal/nonfatal stroke. We estimated the risk of CVD by FG category at index age 55 years using a modified Kaplan-Meier survival analysis, adjusted for the competing risk of non-CVD death. We also assessed risk for incident CVD according to change in FG before 50 years of age, specifically among the categories <5.6 mmol/L, 5.6-6.9 mmol/L, and diabetes. RESULTS: Our sample included 19,630 individuals (6,197 blacks and 11,015 women) without a prior CVD event. Risk for CVD through 85 years of age ranged from 15.3% (<5.0 mmol/L) to 38.6% (diabetes levels) among women and from 21.5% (5.0-5.5 mmol/L) to 47.7% (diabetes levels) among men. An FG of 6.3-6.9 mmol/L was associated with higher long-term CVD risk compared with the lowest FG among men but not women. Increases in glucose during midlife with conversion to diabetes were associated with higher cardiovascular risk (1.3- to 3.6-fold) than increases in glucose below the diabetes threshold. CONCLUSIONS: Middle-age individuals with diabetes have high long-term absolute risk for CVD. These data strongly support the importance of blood glucose monitoring in midlife for CVD prevention.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/sangue , Angiopatias Diabéticas/sangue , Adulto , Idoso , Glicemia/análise , Automonitorização da Glicemia , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/classificação , Angiopatias Diabéticas/epidemiologia , Jejum , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia
4.
Heart ; 105(6): 439-448, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30538094

RESUMO

OBJECTIVE: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers. METHODS: Cross-sectional data from 7404 employed individuals, aged 18-74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models. RESULTS: Hispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures. CONCLUSIONS: Our results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.


Assuntos
Cardiotoxinas , Doenças Cardiovasculares , Metais/toxicidade , Exposição Ocupacional , Praguicidas/toxicidade , Aculturação , Adulto , Idoso , Cardiotoxinas/análise , Cardiotoxinas/toxicidade , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
5.
BMJ ; 367: l6572, 2019 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888884

RESUMO

OBJECTIVE: To estimate the risks of daily hospital admissions for cause specific major cardiovascular diseases associated with short term exposure to ambient fine particulate matter (aerodynamic diameter ≤2.5 µm; PM2.5) pollution in China. DESIGN: National time series study. SETTING: 184 major cities in China. POPULATION: 8 834 533 hospital admissions for cardiovascular causes in 184 Chinese cities recorded by the national database of Urban Employee Basic Medical Insurance from 1 January 2014 to 31 December 2017. MAIN OUTCOME MEASURES: Daily counts of city specific hospital admissions for primary diagnoses of ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke among different demographic groups were used to estimate the associations between PM2.5 and morbidity. An overdispersed generalised additive model was used to estimate city specific associations between PM2.5 and cardiovascular admissions, and random effects meta-analysis used to combine the city specific estimates. RESULTS: Over the study period, a mean of 47 hospital admissions per day (standard deviation 74) occurred for cardiovascular disease, 26 (53) for ischaemic heart disease, one (five) for heart failure, two (four) for heart rhythm disturbances, 14 (28) for ischaemic stroke, and two (four) for haemorrhagic stroke. At the national average level, an increase of 10 µg/m3 in PM2.5 was associated with a 0.26% (95% confidence interval 0.17% to 0.35%) increase in hospital admissions on the same day for cardiovascular disease, 0.31% (0.22% to 0.40%) for ischaemic heart disease, 0.27% (0.04% to 0.51%) for heart failure, 0.29% (0.12% to 0.46%) for heart rhythm disturbances, and 0.29% (0.18% to 0.40%) for ischaemic stroke, but not with haemorrhagic stroke (-0.02% (-0.23% to 0.19%)). The national average association of PM2.5 with cardiovascular disease was slightly non-linear, with a sharp slope at PM2.5 levels below 50 µg/m3, a moderate slope at 50-250 µg/m3, and a plateau at concentrations higher than 250 µg/m3. Compared with days with PM2.5 up to 15 µg/m3, days with PM2.5 of 15-25, 25-35, 35-75, and 75 µg/m3 or more were significantly associated with increases in cardiovascular admissions of 1.1% (0 to 2.2%), 1.9% (0.6% to 3.2%), 2.6% (1.3% to 3.9%), and 3.8% (2.1% to 5.5%), respectively.According to projections, achieving the Chinese grade 2 (35 µg/m3), Chinese grade 1 (15 µg/m3), and World Health Organization (10 µg/m3) regulatory limits for annual mean PM2.5 concentrations would reduce the annual number of admissions for cardiovascular disease in China. Assuming causality, which should be done with caution, this reduction would translate into an estimated 36 448 (95% confidence interval 24 441 to 48 471), 85 270 (57 129 to 113 494), and 97 516 (65 320 to 129 820), respectively. CONCLUSIONS: These data suggest that in China, short term exposure to PM2.5 is associated with increased hospital admissions for all major cardiovascular diseases except for haemorrhagic stroke, even for exposure levels not exceeding the current regulatory limits.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Material Particulado/análise , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/classificação , China/epidemiologia , Cidades , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado/efeitos adversos , Adulto Jovem
6.
Conf Proc IEEE Eng Med Biol Soc ; 2018: 486-489, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30440440

RESUMO

Cardiovascular disease clinical diagnosis is an essentially problem of pattern recognition. In the traditional intelligent diagnosis, the evaluation of classification algorithm is based on the final accuracy of the disease diagnosis. In this paper, a new classification method called Softmax regression model is proposed and it uses the known state data of two-layer neural network structure of the Softmax regression model for training and learning, and then calculate the probability of reclassification data belonging to each category. These categories are corresponding to the maximum probability and the classification result of the data to be classified. It provides a new method for classification of disease with higher speed and higher accuracy. Experiment is designed to compare with the K-nearest neighbours and BP neural networks, and also verify the classification accuracy of Softmax regression model. ECG data from MIT-BIH open database is considered for the experiment. The correct classification rate of the diagnosis reaches 94.44% which outperforms than K- nearest neighbor method (77.78%) and BP neural network (72.27%) in regards to the detection of the Cardiovascular disease.


Assuntos
Algoritmos , Doenças Cardiovasculares/classificação , Análise por Conglomerados , Humanos , Análise de Regressão
8.
Curr Probl Pediatr Adolesc Health Care ; 48(5-6): 151-160, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-30049477

RESUMO

Sudden cardiac death (SCD) in a young athlete is a rare but tragic occurrence. The goal of this article is to provide information about the risks of sudden cardiac death in athletes by reviewing the epidemiology and describing the current screening recommendations of the American Heart Association/American College of Cardiology. 1 The specifics of and reasons for differences between screening guidelines in the United States and the screening guidelines in Europe are highlighted. Electrocardiogram (ECG) changes that can be expected in the setting of conditioning vs pathology are described. Intrinsic cardiac pathologies and disorders, with related cardiac findings, are reviewed, including prevalence and inheritance patterns. Also included is a brief medical-legal discussion about physician liability in the course of making sports clearance decisions. In an area in which there is no single national standard but in which there is an expectation by almost all states for a clearance examination, this article aims to help physicians make thoughtful decisions when evaluating a seemingly healthy patient in order to detect those rare athletes who may be at increased risk of succumbing to a sudden cardiac death during sports participation. 21.


Assuntos
Atletas , Doenças Cardiovasculares/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Predisposição Genética para Doença , Fidelidade a Diretrizes , Programas de Rastreamento/normas , Prática Profissional/normas , Medicina Esportiva , Adolescente , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/fisiopatologia , Criança , Protocolos Clínicos , Tomada de Decisões , Diagnóstico Precoce , Feminino , Predisposição Genética para Doença/classificação , Fidelidade a Diretrizes/legislação & jurisprudência , Humanos , Responsabilidade Legal , Masculino , Programas de Rastreamento/métodos , Anamnese , Guias de Prática Clínica como Assunto , Prática Profissional/legislação & jurisprudência , Esportes , Estados Unidos
9.
J Gen Intern Med ; 33(9): 1461-1468, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29948806

RESUMO

BACKGROUND: There is a lack of comprehensive view of the association between acute exacerbation of COPD (AECOPD) and the risk of acute cardiovascular events. OBJECTIVE: To determine the association of AECOPD with 30-day and 1-year incidences of acute cardiovascular event. DESIGN: Self-controlled case series analysis using population-based datasets from three US states from 2005 through 2011. PARTICIPANTS: Patients aged ≥ 40 years with AECOPD. MAIN MEASURES: The primary outcome was a composite of an ED visit or hospitalization for acute cardiovascular events, including acute myocardial infarction, heart failure, atrial fibrillation, pulmonary embolism, and stroke. We compared the incidence of each patient's acute cardiovascular event during the first 30-day period before the index AECOPD (30-day reference period) in comparison with that during the 30-day period after the index AECOPD. Likewise, with the 1-year period before the index AECOPD as reference, we also estimated incidence rate ratios (IRRs) for each patient's outcomes during 1-year period after the index AECOPD. KEY RESULTS: Overall, there were 362,867 patients with an ED visit or hospitalization for AECOPD. Compared with the 30-day reference period, the incidence of acute cardiovascular event in the 30-day period after the AECOPD was significantly higher (IRR, 1.34; 95%CI, 1.30-1.39; P < 0.001). Likewise, compared with the 1-year reference period, the incidence during the 1-year period after the AECOPD was also higher (IRR, 1.20; 95%CI, 1.18-1.22; P < 0.001). For each of acute cardiovascular conditions, the associations remained significant (all P < 0.05). CONCLUSIONS: AECOPD was associated with increased 30-day and 1-year incidences of acute cardiovascular event.


Assuntos
Doenças Cardiovasculares , Doença Pulmonar Obstrutiva Crônica , Doença Aguda , Idoso , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Correlação de Dados , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Exacerbação dos Sintomas , Estados Unidos/epidemiologia
10.
Adv Ther ; 35(7): 899-927, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29949039

RESUMO

INTRODUCTION: Numerous important cardiology clinical trials have been published or presented at major international meetings during 2017. This paper aims to summarize these trials and place them in clinical context. METHODS: The authors reviewed clinical trials presented at major cardiology conferences during 2017 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, European Association for the Study of Diabetes, Transcatheter Cardiovascular Therapeutics, and the American Heart Association. Selection criteria were trials with a broad relevance to the cardiology community and those with potential to change current practice. RESULTS: A total of 75 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data include left main bifurcation treatment strategy, multivessel disease management in cardiogenic shock, drug-eluting balloons for in-stent restenosis, instantaneous wave-free physiological assessment, new-generation stents (COMBO, Orsiro), transcatheter aortic valve implantation, and closure devices. New preventative cardiology data include trials of liraglutide, empagliflozin, PCSK9 inhibitors (evolocumab and bococizumab), inclisiran, and anacetrapib. Antiplatelet data include the role of uninterrupted aspirin therapy during non-cardiac surgery and dual antiplatelet therapy following coronary artery bypass grafting. New data are also included from fields of heart failure (levosimendan, spironolactone), atrial fibrillation (apixaban in DC cardioversion), cardiac devices (closed loop stimulation pacing for neuromediated syncope), and electrophysiology (catheter ablation for atrial fibrillation). CONCLUSION: This paper presents a summary of key clinical cardiology trials during the past year and should be of practical value to both clinicians and cardiology researchers.


Assuntos
Cardiologia , Doenças Cardiovasculares , Cardiologia/métodos , Cardiologia/organização & administração , Cardiologia/tendências , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/terapia , Ensaios Clínicos como Assunto , Congressos como Assunto , Humanos , Internacionalidade
11.
Circ Genom Precis Med ; 11(6): e001975, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29848613

RESUMO

BACKGROUND: Clinical genetic testing for heritable cardiovascular disease has become a widely used tool to aid in the management of patients and their families. A 5-category variant classification system is commonly used for genetic test results, but some laboratories further subclassify variants of uncertain significance. How and whether patients perceive differences among the variant categories or subclassifications of variants of uncertain significance is unknown. METHODS: We tested whether participants perceived differences in genetic variant subclassifications on outcomes including risk comprehension, risk perception, worry, perceived uncertainty, and intentions. Order-randomized hypothetical cardiovascular genetic results were given to 289 participants enrolled in a genome sequencing study. Three categories of variants were presented to participants: variants of uncertain significance, possibly pathogenic, and likely pathogenic. Responses to the first variant presented were analyzed in a between-groups analysis, and responses to all 3 variants were analyzed in a within-groups analysis. RESULTS: When presented with all 3 results, participants distinguished among the subclassifications on all outcomes (P<0.001). When given only a possibly pathogenic result, their risk perceptions were similar to those of variants of uncertain significance, but they were more worried and intended to behave as if they had received a likely pathogenic result. Individuals depended more on their affective responses such as worry when they received only one result (P<0.05). CONCLUSIONS: Participants are better able to distinguish pathogenicity subclassifications when presented with multiple categories. Individuals who receive a single uncertain result in a cardiovascular disease gene may benefit from interventions to decrease worry, calibrate risk perceptions, and motivate variant-appropriate behaviors.


Assuntos
Doenças Cardiovasculares/genética , Doenças Cardiovasculares/patologia , Testes Genéticos/métodos , Variação Genética , Genômica/métodos , Participação do Paciente , Doenças Cardiovasculares/classificação , Feminino , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Masculino , Análise de Sequência de DNA/métodos
12.
Crit Rev Biomed Eng ; 46(1): 53-82, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29717677

RESUMO

Cardiovascular disease (CVD) accounts for 30% of all global deaths and is predicted to dominate in the coming years, despite vast improvements in medical technology. Current clinical methods of assessing an individual's cardiovascular health include blood tests to monitor relevant biomarker levels as well as varying imaging modalities such as electrocardiograms, computed tomography, and angiograms to assess vasculature. As informative as these tools are, they each require lengthy scheduling, preparation, and highly trained personnel to interpret the results before any information is accessible to patients, often leading to delayed treatment, which can be fatal. A point-of-care (POC) sensor platform is thus paramount in rapid and early diagnosis of CVD. Among the many POC detection platforms, including established optical and mechanical methods, electrochemical-based detection mechanisms have become increasingly desirable because of their superior sensitivity, low cost, and label-free detection. Specifically, electrochemical impedance spectroscopy (EIS) has demonstrated remarkable abilities in low-level (femtomolar) detection of several clinically useful biomarkers and has been reported in CVD diagnostic applications. In this review, we provide an in-depth overview of prevalent CVD diseases and clinically relevant proteomic biomarkers for assessing them. Subsequently, we discuss the ongoing development of POC sensors for CVD, highlighting the current clinical gold standard, potential alternative modalities, and electrochemical methodologies previously successful in quantifying specific biomarkers approved by the Food and Drug Administration (FDA). A discussion of EIS highlighting the attributes and capabilities of novel analysis algorithms is included to showcase the possibility of simultaneous dual-marker detection.


Assuntos
Técnicas Biossensoriais/métodos , Doenças Cardiovasculares/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Algoritmos , Biomarcadores/análise , Técnicas Biossensoriais/normas , Técnicas Biossensoriais/tendências , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/epidemiologia , Diagnóstico Precoce , Impedância Elétrica , Técnicas Eletroquímicas/métodos , Técnicas Eletroquímicas/tendências , Humanos , Sistemas Automatizados de Assistência Junto ao Leito/normas , Sistemas Automatizados de Assistência Junto ao Leito/tendências
13.
Nutr Metab Cardiovasc Dis ; 28(5): 524-530, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29571590

RESUMO

BACKGROUND AND AIMS: The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS: A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION: Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.


Assuntos
Doenças Cardiovasculares/sangue , Nível de Saúde , Síndrome Metabólica/sangue , Obesidade Pediátrica/sangue , Peroxidase/sangue , Inibidor 1 de Ativador de Plasminogênio/sangue , Terminologia como Assunto , Fatores Etários , Biomarcadores/sangue , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Resistência à Insulina , Masculino , Síndrome Metabólica/classificação , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade Pediátrica/classificação , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
14.
BMJ Open ; 8(3): e019434, 2018 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-29567845

RESUMO

OBJECTIVES: Mounting evidence links positive psychological functioning to restorative health processes and favourable medical outcomes. However, very little is known about the relationship between optimism, an indicator of psychological functioning and the American Heart Association (AHA)-defined concept of cardiovascular health (CVH), particularly in Hispanics/Latinos of diverse backgrounds. To address limitations of existing literature, this study investigated the association between dispositional optimism and CVH in a heterogeneous sample of Hispanics/Latinos residing in the USA. DESIGN: Cross-sectional study. PARTICIPANTS AND SETTING: Data were analysed from 4919 adults ages 18-75 of the Hispanic Community Health Study/Study of Latinos parent study and the Sociocultural Ancillary Study. MAIN OUTCOME MEASURES: Optimism was assessed using the 6-item Life Orientation Test-Revised (range from 6 to 30). AHA classification standards were used to derive an additive CVH score with operationalisation of indicators as Ideal, Intermediate and Poor. The overall CVH score included indicators of diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose and smoking status. Multivariate linear and logistic regressions were used to examine associations of optimism with CVH (Life's Simple 7), after adjusting for sociodemographic factors and depressive symptoms. RESULTS: Each increase in the optimism total score was associated with a greater CVH score (ß=0.03 per unit increase, 95% CI 0.01 to 0.05). When modelling tertiles of optimism, participants with moderate (ß=0.24 to 95% CI 0.06 to 0.42) and high (ß=0.12, 95% CI 0.01 to 0.24) levels of optimism displayed greater CVH scores when compared with their least optimistic peers. CONCLUSION: This study offers preliminary evidence for an association between optimism and CVH in a large heterogeneous group of Hispanic/Latino adults. Our study adds scientific knowledge of psychological assets that may promote CVH and suggests a novel therapeutic target for consideration. Future studies are needed to explore causality and potential mechanism underlying the relationship between positive emotion and heart health.


Assuntos
Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/etnologia , Depressão/etnologia , Hispano-Americanos/psicologia , Otimismo , Adolescente , Adulto , Idoso , American Heart Association/organização & administração , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Colesterol/sangue , Estudos Transversais , Dieta , Exercício , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Índice de Gravidade de Doença , Fumar/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
15.
Sci Rep ; 8(1): 4802, 2018 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-29555916

RESUMO

The evaluation of cardiovascular (CV) risk is based on equations derived from epidemiological data in individuals beyond the limits of middle age such as the Framingham and SCORE risk assessments. Lifetime Risk calculator (QRisk®), estimates CV risk throughout a subjects' lifetime, allowing those. A more aggressive and earlier intervention to be identified and offered protection from the consequences of CV and renal disease. The search for molecular profiles in young people that allow a correct stratification of CV risk would be of great interest to adopt preventive therapeutic measures in individuals at high CV risk. To improve the selection of subjects susceptible to intervention with aged between 30-50 years, we have employed a multiple proteomic strategy to search for new markers of early CV disease or reported CV events and to evaluate their relationship with Lifetime Risk. Blood samples from 71 patients were classified into 3 groups according to their CV risk (healthy, with CV risk factors and with a previously reported CV event subjects) and they were analyzed using a high through quantitative proteomics approach. This strategy allowed three different proteomic signatures to be defined, two of which were related to CV stratification and the third one involved markers of organ damage.


Assuntos
Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/classificação , Sistema Cardiovascular/metabolismo , Medição de Risco/métodos , Adulto , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteômica , Fatores de Risco
16.
Neural Netw ; 100: 70-83, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29471197

RESUMO

Cardiac characteristics underlying the time/frequency domain features are limited and not comprehensive enough to reflect the temporal/dynamical nature of ECG patterns. This paper proposes a dynamical ECG recognition framework for human identification and cardiovascular diseases classification via a dynamical neural learning mechanism. The proposed method consists of two phases: a training phase and a test phase. In the training phase, cardiac dynamics within ECG signals is extracted (approximated) accurately by using radial basis function (RBF) neural networks through deterministic learning mechanism. The obtained cardiac system dynamics is represented and stored in constant RBF networks. An ECG signature is then derived from the extracted cardiac dynamics along the periodic ECG state trajectories. A bank of estimators is constructed using the extracted cardiac dynamics to represent the trained gait patterns. In the test phase, recognition errors are generated and taken as the similarity measure by comparing the cardiac dynamics of the trained ECG patterns and the dynamics of the test ECG pattern. Rapid recognition of a test ECG pattern begins with measuring the state of test pattern, and automatically proceeds with the evolution of the recognition error system. According to the smallest error principle, the test ECG pattern can be rapidly recognized. This kind of cardiac dynamics information represents the beat-to-beat temporal change of ECG modifications and the temporal/dynamical nature of ECG patterns. Therefore, the amount of discriminability provided by the cardiac dynamics is larger than the original signals. This paper further discusses the extension of the proposed method for cardiovascular diseases classification. The constructed recognition system can distinguish and assign dynamical ECG patterns to predefined classes according to the similarity of cardiac dynamics. Experiments are carried out on the FuWai and PTB ECG databases to demonstrate the effectiveness of the proposed method.


Assuntos
Doenças Cardiovasculares/classificação , Eletrocardiografia/classificação , Processamento de Sinais Assistido por Computador , Algoritmos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Bases de Dados Factuais , Eletrocardiografia/métodos , Antropologia Forense , Marcha , Humanos
17.
Sleep ; 41(3)2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29315434

RESUMO

Study Objectives: A recent study of patients with moderate-severe obstructive sleep apnea (OSA) in Iceland identified three clinical clusters based on symptoms and comorbidities. We sought to verify this finding in a new cohort in Iceland and examine the generalizability of OSA clusters in an international ethnically diverse cohort. Methods: Using data on 972 patients with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15 events per hour) recruited from the Sleep Apnea Global Interdisciplinary Consortium (SAGIC), we performed a latent class analysis of 18 self-reported symptom variables, hypertension, cardiovascular disease, and diabetes. Results: The original OSA clusters of disturbed sleep, minimally symptomatic, and excessively sleepy replicated among 215 SAGIC patients from Iceland. These clusters also generalized to 757 patients from five other countries. The three clusters had similar average AHI values in both Iceland and the international samples, suggesting clusters are not driven by OSA severity; differences in age, gender, and body mass index were also generally small. Within the international sample, the three original clusters were expanded to five optimal clusters: three were similar to those in Iceland (labeled disturbed sleep, minimal symptoms, and upper airway symptoms with sleepiness) and two were new, less symptomatic clusters (labeled upper airway symptoms dominant and sleepiness dominant). The five clusters showed differences in demographics and AHI, although all were middle-aged (44.6-54.5 years), obese (30.6-35.9 kg/m2), and had severe OSA (42.0-51.4 events per hour) on average. Conclusions: Results confirm and extend previously identified clinical clusters in OSA. These clusters provide an opportunity for a more personalized approach to the management of OSA.


Assuntos
Internacionalidade , Apneia Obstrutiva do Sono/classificação , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Análise por Conglomerados , Estudos de Coortes , Comorbidade , Diabetes Mellitus/classificação , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/classificação , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Feminino , Humanos , Hipertensão/classificação , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Islândia/epidemiologia , Masculino , Pessoa de Meia-Idade , Apneia Obstrutiva do Sono/epidemiologia
18.
Diabetes Care ; 41(2): 293-302, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29150530

RESUMO

OBJECTIVE: Reductions in heart attack and stroke hospitalizations are well documented in the U.S. population with diabetes. We extended trend analyses to other cardiovascular disease (CVD) conditions, including stroke by type, and used four additional years of data. RESEARCH DESIGN AND METHODS: Using 1998-2014 National (Nationwide) Inpatient Sample (NIS) data, we estimated the number of discharges having acute coronary syndrome (ACS) (ICD-9 codes 410-411), cardiac dysrhythmia (427), heart failure (428), hemorrhagic stroke (430-432), or ischemic stroke (433.x1, 434, and 436) as first-listed diagnosis and diabetes (250) as secondary diagnosis. Hospitalization rates for adults aged ≥35 years were calculated using estimates from the population with and the population without diabetes from the National Health Interview Survey (NHIS) and age-adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and calculate an average annual percentage change (AAPC) with 95% confidence limits (CLs). RESULTS: From 1998 to 2014, in the population with diabetes, age-adjusted hospitalization rates declined significantly for ACS (AAPC -4.6% per year [95% CL -5.3, -3.8]), cardiac dysrhythmia (-0.7% [-1.1, -0.2]), heart failure (-3.6% [-4.6, -2.7]), hemorrhagic stroke (-1.1% [-1.4, -0.7]), and ischemic stroke (-2.9% [-3.9, -1.8]). In the population without diabetes, rates also declined significantly for these conditions, with the exception of dysrhythmia. By 2014, rates in the population with diabetes population remained two to four times as high as those for the population without diabetes, with the largest difference in heart failure rates. CONCLUSIONS: CVD hospitalization rates declined significantly in both the population with diabetes and the population without diabetes. This may be due to several factors, including new or more aggressive treatments and reductions in CVD risk factors and CVD incidence.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/epidemiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/classificação , Doenças Cardiovasculares/terapia , Diabetes Mellitus/terapia , Angiopatias Diabéticas/terapia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
19.
Int Urol Nephrol ; 50(2): 321-329, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29196930

RESUMO

PURPOSE: Cardiovascular (CV) events are the first cause of death in patients with chronic renal disease (CKD) and in patients with type 2 diabetes mellitus (DM2). The combination of CKD and DM2 elevates the risk of both cardiovascular disease (CVD) and death in this high-risk population. Besides traditional risk factors, such as dyslipidemia, smoking, obesity, and carotid atherosclerosis, novel factors are under investigation such as genetic polymorphisms. Lipoxygenases (LOXs) and their genes are of critical importance in oxidative stress, inflammation, and atherosclerosis. The aim of the study is to clarify a potential ALOX12 role in CVD presence and progress of diabetic patients in different stages of nephropathy. METHODS: We studied 145 patients with a documented history of DM2 for at least 10 years and diabetic nephropathy (DN), mean age 68 ± 9 years, body mass index 31 ± 5 kg/m2, and different stages of renal disease, depending on glomerular filtration rate. The sample population consisted of two groups: 108 DM2 patients with DN in all five stages of CKD and 37 DM2 patients as controls. Anthropometric and clinical characteristics, interview for history of previous CV event, and assessment of carotid intima-media thickness (cIMT) were recorded at baseline. All patients were genotyped for ALOX12 polymorphisms with focus on rs14309. Genotypes (AA, AG, and GG) were evaluated for any possible role in CVD, and grouping was performed on A genotype, which is the dominant model. All participants were followed over a period of 7 years, and the end points studied were all-cause mortality, CV mortality, and CV events. CV events were defined as myocardial infarction (MI), stroke, or peripheral artery disease. RESULTS: The GG genotype has been significantly associated with cIMT levels above 0.86 mm and with history of MI. Regarding the presence of an atherosclerotic plaque in either carotid artery, no significant association was found when the genotypes were assessed on their own. After grouping, though, GG genotype revealed a significant association between carotid plaque formation and atheromatosis. Kaplan-Meier analysis revealed that ALOX12 gene GG genotype predicted all-cause mortality, CV mortality, and CV events. Similarly, when AA and AG genotypes were grouped, Kaplan-Meier analysis showed that patients with GG genotype presented an even more significant higher all-cause mortality, CV mortality, and CV events compared with AA and AG genotypes combined. After adjustment for several traditional risk factors, multivariate Cox proportional hazard analysis showed that patients with the GG genotype had a significant higher risk of all-cause mortality, a threefold increase in CV mortality, and a twofold increased risk for CV events compared to patients with the AA or the AG genotype. CONCLUSION: ALOX12 rs14309 GG genotype expression was found to be significantly associated with MI, higher cIMT, increased CV events, CV, and overall mortality. This phenomenon could be partially explained by the increased platelet proaggregatory activity of AA products and the control they exert in thrombotic occurrence and plaque formation.


Assuntos
Araquidonato 12-Lipoxigenase/genética , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Idoso , Doenças Cardiovasculares/classificação , Causas de Morte , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/etiologia , Nefropatias Diabéticas/genética , Progressão da Doença , Feminino , Seguimentos , Grécia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Gravidade do Paciente , Polimorfismo Genético
20.
In. Ramires, José Antonio Franchini; Kalil Filho, Roberto; Santos Filho, Raul Dias dos; Casella Filho, Antonio. Dislipidemias e prevenção da Aterosclerose / Dyslipidemias and prevention of Atherosclerosis. Rio de janeiro, Atheneu, 2018. p.249-260.
Monografia em Português | LILACS | ID: biblio-881276
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