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1.
Int Heart J ; 61(5): 872-878, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921669

RESUMO

In-stent restenosis (ISR) still exists after drug-eluting stent (DES) implantation, even up to one year. The incidence and risk factors for neoatherosclerosis in patients with early ISR have not yet been elucidated. Here, we used optical coherence tomography (OCT) to evaluate the incidence and predictors of neoatherosclerosis in patients with early ISRs.OCT was performed on ISR lesions in 185 patients in order to detect neoatherosclerosis. The median follow-up was 180 days, and neoatherosclerosis was detected in 37% of early ISR lesions. According to the presence of neoatherosclerosis, patients with ISR were divided into two groups: neoatherosclerosis (group A, n = 69) and non-neoatherosclerosis (group B, n = 116) groups.The risk factors were similar, except for hypercholesterolemia. Moreover, the tissue characteristics were not significantly different between patients with and without neoatherosclerosis. Follow-up low-density lipoprotein-cholesterol (LDL-C) levels were divided into three grades (LDL < 70 mg/dL, 70 mg/dL≤ LDL < 100 mg/dL, and LDL ≥ 100 mg/dL). The incidence of neoatherosclerosis was significantly lower (23% versus 57%, P < 0.0001) in the LDL < 70 mg/dL group. There was no significant difference in the incidence of neoatherosclerosis in patients with lipid levels between 70 and 100 mg/dL (P = 0.53). However, neoatherosclerosis was significantly more common in patients with a follow-up LDL-C level > 100 mg/dL (45% versus 15%, P < 0.0001).In patients with early ISR lesions, the LDL-C levels may be related to the formation and progression of early neoatherosclerosis, and poor LDL-C control may be a risk factor for the occurrence of early-stage neoatherosclerosis following DES implantation.


Assuntos
LDL-Colesterol/sangue , Doença da Artéria Coronariana/epidemiologia , Reestenose Coronária/epidemiologia , Stents Farmacológicos , Hipercolesterolemia/epidemiologia , Neointima/epidemiologia , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/diagnóstico por imagem , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/sangue , Hipercolesterolemia/tratamento farmacológico , Incidência , Masculino , Pessoa de Meia-Idade , Neointima/diagnóstico por imagem , Fatores de Risco , Tomografia de Coerência Óptica
2.
PLoS One ; 15(8): e0238079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845916

RESUMO

BACKGROUND: Sitosterolemia is an inherited lipid disorder which presents with elevated serum sitosterol and can result in an increased risk of premature cardiovascular disease. However, sitosterol cannot be accurately measured by routine diagnostic assays, meaning that sitosterolemia diagnosis can often be difficult, especially with many clinical features overlapping with familial hypercholesterolemia. With such complications resulting in increasing reports of misdiagnosis, the prevalence of sitosterolemia is predicted to be much higher than previously reported. METHODS: Gas chromatography-mass spectrometry was utilized to measure sitosterol levels of normocholesterolemic and hypercholesterolemic children. Subsequently, an epidemiologically determined cutoff level of sitosterol was calculated and applied to estimate the prevalence of children with increased sitosterol and identify potential sitosterolemia patients. Massively parallel sequencing was used to confirm the diagnosis in suspected patients. RESULTS: Samples from 109 normocholesterolemic and 220 hypercholesterolemic were tested for phytosterols. Sitosterol and campesterol levels were significantly increased in hypercholesterolemic children (mean 22.0±45.9 µmol/L for sitosterol and 26.0±32.8 µmol/L for campesterol) compared to normocholesterolemic children (mean 12.1±4.9 µmol/L for sistosterol and 14.8±6.7 µmol/L for campesterol). Via application of a cutoff of 35.9 µmol/L, the prevalence rates for increased and overtly increased sitosterol in hypercholesterolemic children were 6.4% and 1.4% respectively. Furthermore, 3 suspected sitosterolemia patients were identified, with 2 patients receiving molecular confirmation for sitosterolemia diagnosis. CONCLUSIONS: Our findings reaffirm that the prevalence of sitosterolemia is probably much higher than previously reported, which also indicates the significant risk of misdiagnosis of sitosterolemia with familial hypercholesterolemia. Special lipid testing including sitosterol, especially in children with uncontrolled hypercholesterolemia, is recommended in children in order to identify potential sitosterolemia patients that would otherwise be neglected.


Assuntos
Hipercolesterolemia/diagnóstico , Sitosteroides/análise , Membro 5 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 8 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Adolescente , Criança , Pré-Escolar , Colesterol/análogos & derivados , Colesterol/análise , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Lactente , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/genética , Erros Inatos do Metabolismo Lipídico/diagnóstico , Erros Inatos do Metabolismo Lipídico/epidemiologia , Erros Inatos do Metabolismo Lipídico/genética , Lipoproteínas/genética , Masculino , Linhagem , Fitosteróis/efeitos adversos , Fitosteróis/análise , Fitosteróis/genética , Prevalência
3.
Am J Cardiol ; 132: 59-65, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773228

RESUMO

Severe hypercholesterolemia (SH) includes individuals with LDL-C ≥ 190 mg/dl, regardless of cause. These individuals have a fivefold increased long-term risk for coronary artery disease. Although systematic SH screening can trigger early treatment, current treatment guidelines may not be fully implemented or followed by patients. To further understand this treatment gap, we used electronic health record data to retrospectively assess SH prevalence, characteristics, and treatment in a midwest US healthcare system, between 2009 and 2020. Comorbidities, tobacco exposure, and prescribed lipid-lowering therapies were assessed. Statistical analyses were conducted to identify differences between individuals with primary SH (LDL-C ≥ 190 mg/dl, group 1) and those without primary SH (LDL-C < 190 mg/dl, group 2). Of 265,220 records analyzed, 7.4% met the definition for primary SH. These group 1 cases had more comorbidities than group 2 cases, including premature coronary artery disease (5.8% vs 2.7%). Results showed most individuals in group 1 were treated by primary care providers (43.2% to 45.7%), than by specialty providers (2.5% to 3.3%), and these primary care providers prescribed mainly moderate-intensity statins. Seventy-seven percent of group 1 individuals were treated with a statin, 27% were treated with a high-intensity statin, and 4% were treated with ezetimibe. Fewer young patients (< 40 years) were treated with statins (50% to 58.3%) than older patients (74.0% to 76.3%). Although use of general statins, high-intensity statins, and ezetimibe was higher in individuals with SH than those without SH, treatment remains below guideline recommendations, especially in younger individuals.


Assuntos
LDL-Colesterol/sangue , Assistência à Saúde/estatística & dados numéricos , Hipercolesterolemia/epidemiologia , Biomarcadores/sangue , Estudos Transversais , Feminino , Seguimentos , Humanos , Hipercolesterolemia/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estados Unidos
4.
PLoS One ; 15(7): e0235542, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645054

RESUMO

BACKGROUND: Long-term antiretroviral therapy has modified the clinical course of HIV infection to a chronic condition associated with increased risk of developing non-communicable diseases (NCDs). Information is scant, from sub-Saharan Africa, on the prevalence of NCDs and associated factors among individuals on ART. METHODOLOGY: We consecutively enrolled individuals with HIV infection who were ART naïve and those on ART for ≥5 years (LTART) attending health facilities in Dar es Salaam. Participant's blood pressure, anthropometric measurements, and fasting blood glucose were recorded. Participants with impaired fasting blood glucose underwent an oral glucose tolerance test. A venous blood sample was sent to the lab for biochemical tests. Chi-square test was used to compare proportions, Poisson regression with robust standard errors was used to determine associations between variables. RESULTS: Overall, 612 individuals with HIV infection were enrolled, half of whom were ART naïve. Females comprised 71.9% and 68.0% of participants in the LTART and ART naïve study arms, respectively, p = 0.290. The mean age (±SD) was 44.9 ± 12.7 years and 37.5 ± 11.8 years among LTART and ART naïve participants, respectively, p<0.001. Hypertension was documented in 25.2% in those on LTART compared to 6.9% among ART naïve subjects, p<0.001. Impaired glucose tolerance was found in 22.9% and 4.6% among LTART compared to ART naïve subjects, p<0.001. Diabetes mellitus was detected in 17.0% of those on LTART compared to 3.9% ART naïve participants, p<0.001. Hypercholesterolemia was found in 30.4% of individuals on LTART compared to 16.7% of ART naïve subjects, p<0.001, and hypertriglyceridemia was found in 16.0% of participants on LTART compared to 9.5% of ART naïve, p = 0.015. LTART use, age ≥40 years, history of smoking, and body mass index were independently associated with NCDs. CONCLUSION: Hypertension, impaired glucose tolerance, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were associated with long-term use of antiretroviral drugs.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Intolerância à Glucose/epidemiologia , Infecções por HIV/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Hipertrigliceridemia/epidemiologia , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Prevalência , Tanzânia
5.
Am J Cardiol ; 128: 28-34, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650921

RESUMO

Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to patient outcomes. The study was a retrospective analysis of 10,297 patients who underwent coronary revascularization, categorized as having CAD alone (83.1%) or with multisite artery disease (MSAD) (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or all-cause death) according to vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed. Patients with MSAD were older with higher burden of co-morbidities. The rate of MACE (myocardial infarction, ischemic stroke, or all-cause death) and its individual components increased with the number of affected vascular beds. Adjusted HR (95% confidence interval) for MACE was 1.41 (1.24 to 1.59) in patients with CAD and CBVD, 1.46 (1.33 to 1.62) in CAD and PAD, and 1.69 (1.49 to 1.92) in those with CAD and CBVD and PAD, compared with CAD alone. Most-recent low-density lipoprotein cholesterol (LDL-C) levels <55 mg/dl and <70 mg/dl were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in MSAD. Compared with patients with most-recent LDL-C > 100 mg/dl, attaining LDL-C < 70 mg/dl had an adjusted HR for MACE of 0.52 (0.47 to 0.57) in CAD only patients and 0.66 (0.57 to 0.78) in MSAD patients. In conclusion, the presence of CBVD and/or PAD in patients with CAD is associated with higher burden of co-morbidities and progressive increase in long-term MACE. More than half of CAD patients with or without MSAD do not achieve lipid goals, which are associated with a significantly lower risk for adverse events.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Doença da Artéria Coronariana/cirurgia , Hipercolesterolemia/terapia , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica , Doença Arterial Periférica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angina Instável/epidemiologia , Angina Instável/cirurgia , Aneurisma da Aorta Abdominal/epidemiologia , Causas de Morte , LDL-Colesterol/sangue , Comorbidade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Incidência , Israel/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
6.
Anticancer Res ; 40(7): 4137-4145, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620663

RESUMO

BACKGROUND/AIM: Lung diseases are common in patients with abdominal aortic aneurysms (AAA). This study evaluates the prevalence of lung cancer (LC) in high-risk patients screened for AAA. PATIENTS AND METHODS: Six hundred and one male patients (≥65 years of age, cardiovascular high-risk profile) were enrolled and followed prospectively over a median of 16.5 months. RESULTS: In 29 patients (4.8%) LC and in another 50 patients (8.3%) AAA were found. The prevalence of LC among patients with AAA was even higher (9 of 50, 18.0%). Twenty-one patients had an initial diagnosis of LC, with an incidence of 12.0% (6 of 50) in patients with AAA. During follow-up, 14 of 70 patients with AAA and/ or LC (20.0%) deceased. The highest mortality was found in patients with LC only (8 of 20, 40.0%), followed by patients with both AAA and LC (3 of 9, 33.3%), while patients with AAA only had the lowest mortality rate (3 of 41, 7.3%). CONCLUSION: In patients with a high cardiovascular risk profile, a high prevalence of both AAA and LC were found, whereby the prognosis is largely determined by the LC. Therefore, LC is of particular importance in the setting of screening and surveillance of AAA.


Assuntos
Aneurisma da Aorta Abdominal/epidemiologia , Neoplasias Pulmonares/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Incidência , Masculino , Programas de Rastreamento , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Fumar/epidemiologia
7.
Nature ; 582(7810): 73-77, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32494083

RESUMO

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.


Assuntos
LDL-Colesterol/sangue , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Internacionalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , HDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/epidemiologia , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Triglicerídeos/sangue , Adulto Jovem
8.
PLoS One ; 15(5): e0232845, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32392239

RESUMO

BACKGROUND: Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy. METHODS: There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25-64 years). RESULTS: Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001). CONCLUSIONS: The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.


Assuntos
Doenças Cardiovasculares/epidemiologia , Adulto , Anti-Hipertensivos/uso terapêutico , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Fumar Cigarros/epidemiologia , Estudos Transversais , República Tcheca/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Mortalidade/tendências , Obesidade/epidemiologia , Política , Fatores de Risco , Mudança Social
9.
Stroke ; 51(5): 1546-1554, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312223

RESUMO

Background and Purpose- The PCSK9 (proprotein convertase subtilisin-kexin type 9) monoclonal antibody evolocumab lowered LDL (low-density lipoprotein) cholesterol by 59% to 0.8 (0.5-1.2) mmol/L and significantly reduced major vascular events in the FOURIER trial (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk). Herein, we report the results of a prespecified analysis of cerebrovascular events in the overall trial population and in patients stratified by prior stroke. Methods- FOURIER was a randomized, double-blind trial comparing evolocumab versus placebo in patients with established atherosclerosis, additional risk factors, and LDL cholesterol levels ≥1.8 (or non-HDL [high-density lipoprotein] ≥2.6 mmol/L) on statin therapy. The median follow-up was 2.2 years. We analyzed the efficacy of evolocumab to reduce overall stroke and stroke subtypes, as well as the primary cardiovascular composite end point by subgroups according to a history of stroke. Results- Among the 27 564 patients, 469 (1.7%) experienced a total of 503 strokes of which 421 (84%) were ischemic. Prior ischemic stroke, diabetes mellitus, elevated CRP (C-reactive protein), history of heart failure, older age, nonwhite race, peripheral arterial disease, and renal insufficiency were independent predictors of stroke. Evolocumab significantly reduced all stroke (1.5% versus 1.9%; hazard ratio, 0.79 [95% CI, 0.66-0.95]; P=0.01) and ischemic stroke (1.2% versus 1.6%; hazard ratio, 0.75 [95% CI, 0.62-0.92]; P=0.005), with no difference in hemorrhagic stroke (0.21% versus 0.18%; hazard ratio, 1.16 [95% CI, 0.68-1.98]; P=0.59). These findings were consistent across subgroups, including among the 5337 patients (19%) with prior ischemic stroke in whom the hazard ratios (95% CIs) were 0.85 (0.72-1.00) for the cardiovascular composite, 0.90 (0.68-1.19) for all stroke, and 0.92 (0.68-1.25) for ischemic stroke (P interactions, 0.91, 0.22, and 0.09, respectively, compared with patients without a prior ischemic stroke). Conclusions- Inhibition of PCSK9 with evolocumab added to statin in patients with established atherosclerosis reduced ischemic stroke and cardiovascular events in the total population and in key subgroups, including those with prior ischemic stroke. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01764633.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Aterosclerose/tratamento farmacológico , Hipercolesterolemia/tratamento farmacológico , Infarto do Miocárdio/epidemiologia , Doença Arterial Periférica/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Aterosclerose/epidemiologia , LDL-Colesterol/sangue , Método Duplo-Cego , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
10.
PLoS One ; 15(4): e0231209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251440

RESUMO

As survival of acute lymphoblastic leukemia (ALL) exceeds 90%, limiting therapy-related toxicity has become a key challenge. Cardio-metabolic dysfunction is a challenge during and after childhood ALL therapy. In a single center study, we measured triglycerides (TG), total cholesterol (TC), high (HDL) and low density lipoproteins (LDL) levels at diagnosis and assessed the association with BMI, early therapy response, on-therapy hyperlipidemia and the toxicities; thromboembolism, osteonecrosis and pancreatitis. We included 127 children (1.0-17.9 years) all treated according to the NOPHO ALL2008 protocol. Dyslipidemia was identified at ALL-diagnosis in 99% of the patients, dominated by reduced HDL levels (98%) and mild hypertriglyceridemia (61%). Hypertriglyceridemia was not associated with body mass index (P = 0.71). Five percent of patients had mild hypercholesterolemia, 14% had mild hypocholesterolemia, 13% had decreased and 1% elevated LDL-levels. Increased TG and TC levels at ALL-diagnosis were not associated with any on-therapy lipid levels. Lipid levels and BMI were not associated to MRD after induction therapy; However, BMI and hypercholesterolemia were associated with worse risk group stratification (P<0.045 for all). The cumulative incidence of thromboembolism was increased both for patients with hypo- (20.0%) and hypercholesterolemia (16.7%) compared to patients with normal TC levels (2.2%) at diagnosis (P = 0.0074). In conclusion, dyslipidemic changes were present prior to ALL-therapy in children with ALL but did not seem to affect dysmetabolic traits during therapy and were not predictive of on-therapy toxicities apart from an association between dyscholesterolemia at time of ALL-diagnosis and risk of thromboembolism. However, the latter should be interpreted with caution due to low number in the groups.


Assuntos
Dislipidemias/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Adolescente , Asparaginase/metabolismo , Índice de Massa Corporal , Criança , Pré-Escolar , Dislipidemias/epidemiologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/epidemiologia , Hipertrigliceridemia/complicações , Hipertrigliceridemia/epidemiologia , Lactente , Masculino , Osteonecrose/complicações , Pancreatite/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos Retrospectivos , Risco , Esteroides/metabolismo , Tromboembolia/complicações , Resultado do Tratamento
11.
Nutr Metab Cardiovasc Dis ; 30(6): 907-914, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32249143

RESUMO

BACKGROUND AND AIM: General population awareness about cardiovascular risk factors is usually low. The aim of the present study was to evaluate the vascular aging of subjects aware and not aware to be hypertensive, hypercholesterolemic, hypertriglyceridemic or diabetics in a general population sample. METHODS AND RESULTS: We interviewed 1652 subjects without atherosclerotic cardiovascular diseases (M: 46.6%, F: 53.4%) about their awareness of hypertension, hypercholesterolemia, hypertriglyceridemia or type 2 diabetes. Then we compared the augmentation index and pulse wave velocity of subjects aware and not aware of the investigated cardiovascular risk factors. 1049 participants declared not to be hypertensive, while 32 were not sure. Among them, respectively, 23.5% and 50% were hypertensive. Subjects not aware of their hypertension had significantly higher aortic blood pressure than aware ones (p < 0.001). 841 participants declared not to be hypercholesterolemic, while 60 were not sure. Among them, respectively, 18.1% and 40% were hypercholesterolemic. Subjects not aware of their hypercholesterolemia had significantly higher augmentation index than the aware ones (p < 0.05). 1226 participants declared not to be hypertriglyceridemic, while 200 were not sure. Among them, respectively, 19.2% and 44% were hypertriglyceridemic. Subjects not aware of their hypertriglyceridemia had significantly higher TG levels aware ones (p < 0.05), although this seemed to not related to increased arterial stiffness. 1472 participants declared not to be diabetic, while 20 were not sure. Among them, respectively, 2.0% and 25.0% were diabetics. Subjects not aware of their diabetes had significantly higher augmentation index than the aware ones (p < 0.05). CONCLUSIONS: In conclusion, the lack of awareness of hypertension and hypercholesterolemia is relatively frequent in the general population and is associated to significantly higher arterial stiffness.


Assuntos
Envelhecimento , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Hipertrigliceridemia/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Colesterol/sangue , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertrigliceridemia/sangue , Hipertrigliceridemia/diagnóstico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Triglicerídeos/sangue , Rigidez Vascular , Adulto Jovem
12.
Acta Diabetol ; 57(10): 1169-1180, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32314018

RESUMO

OBJECTIVE: We conducted a meta-analysis on the effect of plant protein or animal protein on body weight (BW), body mass index (BMI) and blood lipid profiles in patients with hypercholesterolemia. MATERIALS AND METHODS: We used subject and free words to search PubMed, Embase and Cochrane Library databases. The risk-of-bias evaluation tool was used to assess literature quality. Data merging and statistical analyses were carried out using Review Manager 5.3 and Stata 13.0. All indicators were expressed as the mean difference (MD) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I2 and Q tests. We used Egger's test to evaluate publication bias quantitatively. RESULTS: This was a meta-analysis of intervention trials. Thirty-two studies (1562 patients) were included. The quality of the included studies was acceptable. Compared with consumption of animal protein, plant protein reduced total cholesterol (TC) (MD = - 0.19 mmol/L, 95% CI - 0.26, - 0.12), triglyceride (MD = - 0.07 mmol/L, 95% CI - 0.13, - 0.02), low-density lipoprotein cholesterol (LDL-C) (MD = - 0.19 mmol/L, 95% CI - 0.26, - 0.13), very low-density lipoprotein cholesterol (MD = - 0.05 mmol/L, 95% CI - 0.09, - 0.01), TC/LDL-C ratio (MD = - 0.17, 95% CI - 0.32, - 0.02) and LDL-C/HDL-C ratio (MD = - 0.20, 95% CI - 0.33, - 0.06) significantly and increased high-density lipoprotein cholesterol (HDL-C) (MD = 0.03 mmol/L, 95% CI 0.01, 0.06) levels, but had no effect on BW (MD = - 0.41 kg, 95% CI - 2.14, 1.33) or BMI (MD = 0.11 kg/m2, 95% CI - 0.51, 0.73). CONCLUSION: Compared with animal protein, consumption of plant protein could improve lipid profile in patients with hypercholesterolemia.


Assuntos
Proteínas Animais da Dieta/farmacologia , Índice de Massa Corporal , Peso Corporal/efeitos dos fármacos , Hipercolesterolemia/sangue , Lipídeos/sangue , Proteínas de Vegetais Comestíveis/farmacologia , Proteínas Animais da Dieta/administração & dosagem , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Comportamento Alimentar/fisiologia , Humanos , Hipercolesterolemia/dietoterapia , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/metabolismo , Metabolismo dos Lipídeos/efeitos dos fármacos , Proteínas de Vegetais Comestíveis/administração & dosagem , Comportamento de Redução do Risco , Triglicerídeos/sangue
13.
Gac Med Mex ; 156(1): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32026882

RESUMO

Introduction: In the United States, information on the Mexican-American population is available through the Health and Aging Brain among Latino Elders (HABLE) study; in Mexico, the results of the Mexican Health and Aging Study (MHAS) are available. Objective: To compare the prevalence of cardiovascular risk factors between men and women of the HABLE and MHAS studies. Method: The prevalence of hypertension, diabetes, hypercholesterolemia and abdominal obesity was transversely analyzed in 559 HABLE participants and compared with data from 13,663 MHAS participants. The comparison was made using Student's t-test and the chi-square test, according to the type of variable. Results: The analysis showed that the prevalence of hypertension (50 %, 95 % CI = 41.8-51.8), diabetes (35.5 %, 95 % CI = 27.6-43.8) and abdominal obesity (59.3 %, 95 % CI = 50.5-68.1) were significantly higher in HABLE males, whereas females had a higher prevalence of diabetes (36.8 %, 95 % CI = 32.2-41.5) and abdominal obesity (89.6 %, 95 % CI = 86.6-92.5). Hypercholesterolemia had a higher prevalence in MHAS females (53.3%, 95% CI = 50.3-56.2). Conclusion: The prevalence of cardiovascular risk factors was higher in Mexican American HABLE participants, than in Mexican MHAS participants.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade Abdominal/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etnologia , Estudos Transversais , Diabetes Mellitus/etnologia , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Hipercolesterolemia/etnologia , Hipertensão/etnologia , Estudos Longitudinais , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Obesidade Abdominal/etnologia , Fatores de Risco , Distribuição por Sexo , Estados Unidos/epidemiologia
14.
Cancer ; 126(6): 1330-1338, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31923330

RESUMO

BACKGROUND: The objective of this study was to characterize chronic disease, health-related quality of life (HRQOL), emotional distress, and social attainment among long-term survivors of neuroblastoma. METHODS: Chronic health conditions among 136 ≥10-year neuroblastoma survivors (median age, 31.9 years; range, 20.2-54.6 years) and 272 community controls (median age, 34.7 years; range, 18.3-59.6 years) were graded with a modified version of the Common Terminology Criteria for Adverse Events (version 4.03). HRQOL and emotional distress were assessed with the Medical Outcomes Study 36-Item Short Form Health Survey and the Brief Symptom Inventory-18. Log-binomial regression and logistic regression were used to compare the prevalence of chronic conditions and the frequency of reduced HRQOL, distress, and social attainment between survivors and controls. The cumulative burden approach was used to estimate multimorbidity. RESULTS: By the age of 35 years, survivors had experienced, on average, 8.5 grade 1 to 5 conditions (95% confidence interval [CI], 7.6-9.3), which was higher than the average for controls (3.3; 95% CI, 2.9-3.7). Compared with controls, survivors had a higher prevalence of any pulmonary (P = .003), auditory (P < .001), gastrointestinal (P < .001), neurological (P = .003), or renal condition (P < .001); were more likely to report poor physical HRQOL (P = .01) and symptoms of anxiety (P = .01) and somatization (P = .01); and were less likely to live independently (P = .01) or marry (P = .01). In analyses limited to survivors, those with 1 or more grade 3 to 5 conditions were more likely to report reduced general health (odds ratio [OR], 6.6; 95% CI, 1.6-26.9), greater bodily pain (OR, 4.2; 95% CI, 1.0-17.0), and unemployment (OR, 3.2; 95% CI, 1.2-8.5). CONCLUSIONS: Because of the high burden of chronic diseases and the associations of these morbidities with reduced HRQOL and social attainment, screening and interventions that provide opportunities to optimize health are important among neuroblastoma survivors.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Neuroblastoma/complicações , Qualidade de Vida , Adulto , Ansiedade/epidemiologia , Sobreviventes de Câncer/psicologia , Doença Crônica/epidemiologia , Intervalos de Confiança , Feminino , Perda Auditiva/induzido quimicamente , Perda Auditiva/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Hipertrigliceridemia/epidemiologia , Vida Independente/estatística & dados numéricos , Masculino , Casamento/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Neuroblastoma/psicologia , Obesidade/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Dor/epidemiologia , Angústia Psicológica , Classe Social , Transtornos Somatoformes/epidemiologia , Desemprego/estatística & dados numéricos , Adulto Jovem
15.
Am J Med ; 133(1): 95-99.e6, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301293

RESUMO

BACKGROUND: The relationship between cholesterol levels and stroke has been much less clear than the relationship between cholesterol levels and coronary heart disease. This is likely mostly due to the inadequate power of older studies and the low intensity of cholesterol-lowering interventions available at the time. Because a reduction in stroke has been, conversely, clearly observed in trials with statins, for long "pleiotropic" effects of such drugs, unrelated to cholesterol lowering, have been invoked. In a previous analysis of all randomized trials of cholesterol-lowering treatments reporting on stroke we had, however, reached the conclusion that any cholesterol lowering is related to a significant reduction of stroke, in a relationship that appeared to exist for both statin and nonstatin cholesterol-lowering interventions. Outcome results of the FOURIER trial with evolocumab, SPIRE-1 and -2 with bococizumab, and ODYSSEY OUTCOMES trial with alirocumab now offer the opportunity of clearly confirming or confuting this concept. METHODS: We here report on an updated meta-regression of the relationship of total cholesterol changes that occur with various drugs or treatments and changes in the risk of stroke compared with control. RESULTS: Relative risk (RR) figure found in FOURIER, SPIRE-1/2, and ODYSSEY OUTCOMES (0.79, 0.60, and 0.79) are extremely close to the RRs of 0.79, 0.79, and 0.84, respectively, predicted by our new meta-regression. CONCLUSIONS: These findings offer definitive proof that the pure total (and low-density lipoprotein) cholesterol lowering, with any available lipid-lowering intervention, reduces stroke risk proportional to the extent of cholesterol reduction, without the need of invoking "pleiotropic" effects of any such treatment.


Assuntos
Anticolesterolemiantes/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Pró-Proteína Convertase 9/antagonistas & inibidores , Acidente Vascular Cerebral/epidemiologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Colesterol/sangue , LDL-Colesterol/sangue , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Fatores de Proteção
16.
J Thorac Cardiovasc Surg ; 159(3): 1142-1150, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31839224

RESUMO

BACKGROUND: Deep vein thrombosis (DVT) remains a common complication following lung transplantation despite universal routine DVT screening. Moreover, many of the previously reported risk factors are incompletely defined. We sought to explore the influence of DVT screening and to more definitively assess predisposing risk factors. METHODS: A single-institution, retrospective, cohort study of 1141 patients undergoing lung transplantation from January 1, 2005, to December 31, 2014, was performed evaluating for the rate of DVT. Patients were given prophylactic subcutaneous heparin postoperatively. DVT events were noted if they occurred before 90 days after transplant. We compared DVT rates before and after 2008 when universal screening was implemented. We also evaluated the timing of DVT event and location (above the knee vs below the knee). DVTs were treated with standard anticoagulation therapy or an inferior cava filter when patients were unable to tolerate anticoagulation treatment. Univariable and multivariable models were used to identify risk factors for occurrence. A propensity match was performed to match groups across the eras, and a Cox regression was performed to identify differences in 1-year survival trajectory between cohorts. RESULTS: The rates of DVT before and after routine screening were 8.8% (36 DVT out of 412 transplants) and 17.3% (126 out of 729 transplants), respectively. These 2 rates were significantly different (P < .01); moreover, the observed DVT incidence per year was not significantly different across the 6 years after universal DVT screening was implemented (P > .90 for all comparisons). Observed DVT incidence at day 0 and day 14 were 3.8% and 3.8%, respectively, for the cohort before DVT protocols were established. Observed DVT incidence for the cohort after protocols were established at the same time points was 8.7% and 3.7%, respectively. Univariable analysis revealed that significant factors associated with a DVT include hypercholesterolemia (odds ratio [OR], 6.90; 95% confidence interval [CI], 1.82-26.13; P < .01), the number of days in the intensive care unit (OR, 1.03; 95% CI, 1.00-1.01; P < .01), and the length of stay in the hospital (OR, 1.01; 95% CI, 1.01-1.02; P < .01), whereas having quit smoking (vs never smoked) was associated with a decrease in DVT development (OR, 0.50; 95% CI, 0.33-0.75; P < .01). Multivariable analysis revealed 2 significant variables: hypercholesterolemia (OR, 8.13; 95% CI, 1.22-54.37; P = .03) and length of stay (OR, 1.03; 95% CI, 1.01-1.05; P < .01). There was a trend for better 1-year survival in the post-2008 era (Exp[ß], 1.49; P = .09). CONCLUSIONS: The rate of DVT diagnosis significantly increased after universal DVT screening was implemented. Furthermore, those patients undergoing lung transplantation with extended length of stay and hypercholesterolemia were prone to increased rates of DVT. There was a trend toward better 1-year survival in DVT-screened patients, suggesting DVT screening may result in beneficial outcomes.


Assuntos
Transplante de Pulmão/efeitos adversos , Programas de Rastreamento/métodos , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Adulto , Idoso , Anticoagulantes/administração & dosagem , Esquema de Medicação , Feminino , Heparina/administração & dosagem , Humanos , Hipercolesterolemia/epidemiologia , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Filtros de Veia Cava , Trombose Venosa/epidemiologia , Trombose Venosa/prevenção & controle
17.
Public Health ; 178: 167-178, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31698139

RESUMO

OBJECTIVES: Elevated blood cholesterol (hypercholesterolemia) is a significant cause of cardiovascular disease. We aimed to estimate national and zonal prevalence of hypercholesterolemia in Nigeria to help guide targeted public health programs. STUDY DESIGN: This is a systematic review and synthesis of publicly available epidemiologic data on hypercholesterolemia in Nigeria. METHODS: We systematically searched MEDLINE, EMBASE, Global Health, and Africa Journals Online for studies on the prevalence of hypercholesterolemia in Nigeria published between 1990 and 2018. We used a random-effects meta-analysis (Freeman-Tukey double arcsine transformation) and meta-regression model to estimate the prevalence of hypercholesterolemia in Nigeria in 1995 and 2015. RESULTS: In total, 13 studies (n = 16,981) were retrieved. The pooled crude prevalence of hypercholesterolemia in Nigeria was 38% (95% confidence interval: 26-51), with prevalence in women slightly higher (42%, 23-63) compared with men (38%, 20-58). The prevalence was highest in the South-south (53%, 38-68) and lowest in the South-west (3%, 2-4) and North-east (4%, 2-7). Urban dwellers had a significantly higher rate (52%, 24-79) compared with rural dwellers (10%, 6-15). We estimated over 8.2 million persons (age-adjusted prevalence 16.5%) aged 20 years or more had hypercholesterolemia in Nigeria in 1995, increasing to 21.9 million persons (age-adjusted prevalence 25.9%) in 2015. CONCLUSIONS: Our findings suggest a high prevalence of hypercholesterolemia in Nigeria. Urbanization, lifestyles, diets, and culture appear to be driving an increasing prevalence, especially among women. Population-wide awareness and education on reducing elevated cholesterol levels and associated risks should be prioritized.


Assuntos
Hipercolesterolemia/epidemiologia , Humanos , Nigéria/epidemiologia , Prevalência , Fatores de Risco
18.
Clin Exp Hypertens ; 42(1): 8-15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30563368

RESUMO

Background: Fast resting heart rate (RHR) is easily neglected in clinical practice of hypertension treatment.Aims: We aimed to investigate the prevalence of fast RHR and associated factors in hypertensive and normotensive individuals.Methods: We retrospectively analyzed data from two cross-sectional studies conducted in China. A total of 6763 hypertensive patients and 2807 age and sex-matched normotensive subjects with complete data on resting electrocardiogram and medical history were included. Fast RHR was defined as RHR > 85 bpm.Results: The prevalence of fast RHR was higher in hypertensive patients as compared with the normotensives (14.4% vs 7.1%, P < 0.01). In both hypertensive and normotensive subjects, fast RHR appeared as a "U-type" distribution as aging and a "inverted J type" trend as body mass index (BMI) increasing. Multivariate regression analysis showed that fast RHR was associated with age >65 or <25 years old (OR = 1.32, 95% CI 1.08-1.61), BMI <18.5 kg/m2 (OR = 2.94, 95%CI 1.47-5.87) and hypercholesterolemia (OR = 1.30, 95%CI 1.10-1.53) in hypertensive patients. Fast RHR in the normotensives was associated with female (OR = 1.78, 95%CI 1.27-2.48), pre-hypertensive state (OR = 2.38, 95%CI 1.61-3.52), and rural area origin (OR = 1.50, 95%CI 1.01-2.42). Stroke and diabetes conferred closer relevance to fast RHR in both hypertensive (OR = 1.31, 95%CI 1.02-1.69 and OR 2.26, 95%CI 1.60-3.21) and normotensive individuals (OR = 2.67, 95%CI 1.36-5.21 and OR = 2.77, 95%CI 1.47-5.23).Conclusion: Fast RHR might be common in patients with hypertension. Prior stroke and diabetes history is common associated with fast RHR. Other factors associated with fast RHR seem to be different between hypertensive patients and normotensive subjects.Abbreviations: BMI: body mass index; CI: Confidence Interval; DBP: diastolic blood pressure; ECG: electrocardiogram; OR: odd ratio; RHR: resting heart rate; SBP: systolic blood pressure.


Assuntos
Diabetes Mellitus/fisiopatologia , Frequência Cardíaca , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Fatores Etários , Idoso , Pressão Sanguínea , Estudos de Casos e Controles , China/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Eletrocardiografia , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/epidemiologia , Pré-Hipertensão/fisiopatologia , Prevalência , Descanso/fisiologia , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia
19.
Nutrients ; 11(12)2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31783560

RESUMO

The association of dietary cholesterol intake with dyslipidemia and subtypes is controversial. This study aimed to examine the association of dietary cholesterol intake with dyslipidemia and subtypes in Chinese adults. Using data from the China Health and Nutrition Survey (CHNS) in 2015, the present study selected 4383 participants aged 18-59 years who were free of diabetes, apoplexy, and myocardial infarction disease. Information was obtained on dietary intake, anthropometric measurements, and blood laboratory measurements. Dietary cholesterol intake was calculated based on the data collected by consecutive 3 days 24 h recalls combined with the weighing of household seasonings and categorized by 11 levels: The first 10 levels in ranges of 50 mg/day and the 11th level at ≥500 mg/day. Dyslipidemia, hypercholesterolemia, hypertriglyceridemia, low-density lipoprotein (LDL)-hypercholesterolemia, and high-density lipoprotein (HDL)-hypocholesterolemia were defined based on the Chinese adult dyslipidemia prevention guide (2016 edition). Multivariable logistic regressions were performed to examine the association of dietary cholesterol intake levels with dyslipidemia and subtypes. The prevalence of dyslipidemia was 37.5% among Chinese adults in 2015 (hypercholesterolemia 9.6%, HDL-hypocholesterolemia 21.1%, LDL-hypercholesterolemia 12.7%, and hypertriglyceridemia 15.2%). The lowest prevalence of hypercholesterolemia and LDL-hypercholesterolemia was 6.7% and 9.4%, respectively, which was relative to a dietary cholesterol intake level of 100.0 to <150.0 mg/day. After adjusting for all potential confounders, adults with the highest dietary cholesterol intake level of ≥500 mg/day compared with the dietary cholesterol intake of 100.0 to <150.0 mg/day showed one-time higher odds of hypercholesterolemia (odds ratios (OR) 2.0, 95% confidence intervals (CI) 1.3-3.3), as well as LDL-hypercholesterolemia (OR 2.0, 95% CI 1.3-3.0), but a null association of dietary cholesterol intake with dyslipidemia, hypertriglyceridemia, and HDL-hypocholesterolemia. The study suggested that a dietary cholesterol intake level of 500 mg/day and above may be a threshold point for high odds of hypercholesterolemia and LDL-hypercholesterolemia.


Assuntos
Colesterol na Dieta/administração & dosagem , Dislipidemias/epidemiologia , Inquéritos Nutricionais , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Registros de Dieta , Humanos , Hipercolesterolemia/epidemiologia , Hipertrigliceridemia/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , Adulto Jovem
20.
Medicine (Baltimore) ; 98(51): e18354, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860991

RESUMO

Many cancer patients develop diabetes, which may result in reduction of chemotherapy effectiveness and increased infection risk and cardiovascular mortality. Diabetes may also increase the risks of chemotherapy-related toxicity and post-operative mortality, or represent an obstacle to optimal cancer treatment. However, the clinical predictors of diabetes in cancer patients remain largely unknown. Therefore, the aim of our study was to evaluate the risk factors for developing diabetes and construct a nomogram to predict diabetes in cancer patients.We investigated patients from a national sample cohort obtained from the Korea National Health Insurance Service (KNHIS), which included 2% of the Korean population. Patients who had undergone routine medical evaluation by the KNHIS between 2004 and 2008 and been hospitalized due to cancer (ICD-10 codes C00-97) during the past 3 years were included. After excluding patients with type 2 diabetes and missing data, 10,899 patients were enrolled and followed-up until 2013. A total of 7630 (70%) patients were assigned as the training cohort and used to construct the nomogram which was based on a multivariable logistic regression model. The remaining patients (n = 3269) were used as the validation cohort.The incidence rate of diabetes was 12.1 per 1000 person-years over a mean follow-up of 6.6 ±â€Š1.8 years. Significant risk factors for developing diabetes were age, sex, obesity, fasting plasma glucose, hypertension, and hypercholesterolmia. A nomogram was constructed using these variables and internally validated. The area under the curve was 0.70 (95% confidence interval, .666-.730, P < .0001) and the calibration plot showed agreement between the actual and nomogram-predicted diabetes probabilities.The nomogram developed in this study is easy to use and convenient for identifying cancer patients at high-risk for type 2 diabetes, enabling early type 2 diabetes screening and management.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Neoplasias/epidemiologia , Medição de Risco , Fatores Etários , Idoso , Glicemia/análise , Estudos de Coortes , Feminino , Seguimentos , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Incidência , Masculino , Nomogramas , Obesidade/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais
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