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1.
Cell Metab ; 33(10): 1911-1925, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34562355

RESUMO

High levels of cholesterol are generally considered to be associated with atherosclerosis. In the past two decades, however, a number of studies have shown that excess cholesterol accumulation in various tissues and organs plays a critical role in the pathogenesis of multiple diseases. Here, we summarize the effects of excess cholesterol on disease pathogenesis, including liver diseases, diabetes, chronic kidney disease, Alzheimer's disease, osteoporosis, osteoarthritis, pituitary-thyroid axis dysfunction, immune disorders, and COVID-19, while proposing that excess cholesterol-induced toxicity is ubiquitous. We believe this concept will help broaden the appreciation of the toxic effect of excess cholesterol, and thus potentially expand the therapeutic use of cholesterol-lowering medications.


Assuntos
Aterosclerose/metabolismo , COVID-19/metabolismo , Colesterol/metabolismo , Hipercolesterolemia/metabolismo , Animais , Anticolesterolemiantes/uso terapêutico , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Aterosclerose/epidemiologia , Biomarcadores/metabolismo , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , Prognóstico , Fatores de Risco
2.
Curr Atheroscler Rep ; 23(10): 58, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34345940

RESUMO

PURPOSE OF REVIEW: In this review, we discuss strategies for managing dyslipidemia in pregnant women with ASCVD. RECENT FINDINGS: Cardiovascular disease (CVD) is the leading cause of mortality in women as well as the leading cause of pregnancy-related mortality in the USA. It is paramount to screen, identify, counsel, and treat women of childbearing age who have existing atherosclerotic disease to mitigate the risks of complications and mortality. Dyslipidemias, including hypercholesterolemia and hyperlipidemia, can further enhance the risk for future CVD events. Treating hypercholesterolemia during pregnancy is crucial, and this is an opportune time for cross-collaboration of subspecialties in cardiology, obstetrics, and gynecology.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Dislipidemias , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Aterosclerose/complicações , Aterosclerose/epidemiologia , Aterosclerose/terapia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Gravidez , Gestantes , Fatores de Risco
3.
Nutr Metab Cardiovasc Dis ; 31(10): 2766-2778, 2021 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-34353704

RESUMO

AIMS: The DASH diet was designed for helping control of blood pressure but, fortunately, it can also be prescribed for many other chronic conditions. The current study intended to assess the potential effects of DASH diet on metabolic risk factors in patients with chronic disease. DATA SYNTHESIS: We carried out a systematic literature search for RCTs from inception until July 2020. A total of 54 clinical trials were included in the final analysis. Compared to control groups, a significant lower effect of the DASH diet was noted for body weight (-1.59 kg; p < 0.001), BMI (-0.64 kg/m2; p < 0.001), and WC (-1.93 cm; p < 0.001) as well as for SBP (-3.94 mmHg; p < 0.001) and DBP (-2.44 mmHg; P < 0.001). The DASH diet significantly decreased TC (-5.12 mg/dl; p = 0.008) and LDL-C levels (-3.53 mg/dl; p = 0.041), but not HDL-C (0.30 mg/dl; p = 0.510), TG (-4.22 mg/dl; p = 0.067), and VLDL-C (-2.16 mg/dl; p = 0.062). No significant effect of the DASH diet was noted for blood glucose (-0.38 mg/dl; p = 0.216), insulin (-0.03 µIU/mL; p = 0.817), HOMA-IR (-0.15; p = 0.132), and CRP (-0.33 mg/l; p = 0.173). CONCLUSIONS: The DASH diet is a feasible approach to weight loss and to control blood pressure and hypercholesterolemia.


Assuntos
Abordagens Dietéticas para Conter a Hipertensão , Hipercolesterolemia/dietoterapia , Hipertensão/dietoterapia , Obesidade/dietoterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Pressão Sanguínea , Fatores de Risco Cardiometabólico , Colesterol/sangue , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento , Perda de Peso , Adulto Jovem
4.
Mymensingh Med J ; 30(3): 651-656, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34226451

RESUMO

The present cross-sectional analytical study was carried out to observe blood pressure and serum total cholesterol in patients with type-2 diabetes mellitus. This observational study was carried out in the department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2016 to December 2016. For this purpose, 200 subjects of both sexes and age ranged from 30-60 years were selected; among them 100 were type-2 diabetic person and 100 were apparently healthy. Blood pressure and serum total cholesterol was significantly higher (p<0.0001) in both male and female of the study group in comparison to healthy control group. From this study, it may conclude that type-2 persons are considered to have significant positive relation for formation of hypertension, hypercholesterolemia and metabolic abnormalities that have high morbidity and mortality. So, prevention of type-2 diabetes mellitus by taking necessary steps like regular physical exercise, intake of healthy diet and behavior therapy may help in prevention of type-2 diabetes mellitus related complication.


Assuntos
Diabetes Mellitus Tipo 2 , Hipercolesterolemia , Hipertensão , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade
5.
PLoS One ; 16(7): e0253792, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288948

RESUMO

N-terminal pro B-type natriuretic peptide (NT-proBNP), a cardiac disease biomarker, has been demonstrated to be a strong independent predictor of cardiovascular events in patients without heart failure. Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular events and death. In this study, we investigated levels of NT-proBNP in patients with PAD compared to non-PAD controls. A total of 355 patients were recruited from outpatient clinics at a tertiary care hospital network. Plasma NT-proBNP levels were quantified using protein multiplex. There were 279 patients with both clinical and diagnostic features of PAD and 76 control patients without PAD (non-PAD cohort). Compared with non-PAD patients, median (IQR) NT-proBNP levels in PAD patients were significantly higher (225 ng/L (120-363) vs 285 ng/L (188-425), p- value = 0.001, respectively). Regression analysis demonstrated that NT-proBNP remained significantly higher in patients with PAD relative to non-PAD despite adjusting for age, sex, hypercholesterolemia, smoking and hypertension [odds ratio = 1.28 (1.07-1.54), p-value <0.05]. Subgroup analysis showed elevated NT-proBNP levels in patients with PAD regardless of prior history of CHF, CAD, diabetes and hypercholesteremia (p-value <0.05). Finally, spearmen's correlation analysis demonstrated a negative correlation between NT-proBNP and ABI (ρ = -0.242; p-value < 0.001). In conclusion, our data shows that patients with PAD in an ambulatory care setting have elevated levels of NT-proBNP compared to non-PAD patients in the absence of cardiac symptoms.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Doença Arterial Periférica/sangue , Idoso , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar , Pacientes Ambulatoriais , Doença Arterial Periférica/epidemiologia , Fumar/epidemiologia
6.
Xenobiotica ; 51(8): 949-959, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34154510

RESUMO

Statins, the standard treatment for hypercholesterolaemia, among the most widely prescribed, have been associated with side effects, including statin intolerance. The aim of this study was to determine the background prevalence of SLCO1B1 SNVs in a randomly selected sample and to investigate if there are associations between SLCO1B1 SNVs and hypercholesterolaemia patients on statin therapy.Using Polymerase Chain Reaction - Restriction Fragment Length Polymorphism, the presence of SLCO1B1 SNVs (rs4149056, rs2306283 and rs4363657) was identified, while ELISA was used to quantify serum CK levels. Statin intolerance risk was calculated using a quantitative questionnaire.The risk of developing statin intolerance was found to be low (in 36%), moderate (in 49%), or high (in 15%) in the statin-treated group. The prevalence of the rs4149056 variant was 16% in (controls) and 20% in (statin) group; rs2306283 variant was present in 31.5% (controls), 10.5% in (statin) group; while the prevalence of the rs4363657 variant was similar in each. No association between the presence of any one of the SNVs and the statin intolerance severity risk score or CK elevation was found.These findings will facilitate a more personalized approach to statin therapy, especially relevant within the diverse South African population.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Doenças Musculares , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Transportador 1 de Ânion Orgânico Específico do Fígado/genética , Nucleotídeos , Polimorfismo de Nucleotídeo Único , Prevalência , África do Sul/epidemiologia
7.
J Alzheimers Dis ; 81(4): 1493-1504, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967045

RESUMO

BACKGROUND: There is significant interest in understanding the role of modifiable vascular risk factors contributing to dementia risk across age groups. OBJECTIVE: Risk of dementia onset was assessed in relation to vascular risk factors of hypertension and hypercholesterolemia among cognitively normal APOEɛ4 carriers and non-carriers. METHODS: In a sample of prospectively characterized longitudinal cohort from the National Alzheimer's Coordinating Center database, 9,349 participants met criteria for normal cognition at baseline, had a CDR-Global (CDR-G) score of zero, and had concomitant data on APOEɛ4 status and medical co-morbidities including histories of hypertension and hypercholesterolemia. Multivariable Cox proportional hazards models adjusted for well-known potential confounders were used to compare dementia onset among APOEɛ4 carriers and non-carriers by young (≤65 years) and old (> 65 year) age groups. RESULTS: 519 participants converted to dementia within an average follow up of 5.97 years. Among older APOEɛ4 carriers, hypercholesterolemia was related to lower risk of dementia (HR (95% CI), 0.68 (0.49-0.94), p = 0.02). Among older APOEɛ4 non-carriers, hypertension was related to higher risk of dementia (HR (95% CI), 1.44 (1.13-1.82), p = 0.003). These results were corroborated among a subset with autopsy data characterizing underlying neuropathology. Among younger participants, vascular risk factors did not impact dementia risk, likely from a lower frequency of vascular and Alzheimer's as etiologies of dementia among this cohort. CONCLUSION: A history of hypercholesterolemia related to a lower risk of dementia among older APOEɛ4 carriers, while hypertension related to a higher risk of dementia among older APOEɛ4 non-carriers.


Assuntos
Apolipoproteína E4/genética , Demência/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Demência/genética , Feminino , Humanos , Hipercolesterolemia/genética , Hipertensão/genética , Incidência , Masculino , Pessoa de Meia-Idade , Risco
8.
Aging (Albany NY) ; 13(9): 12833-12848, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33946042

RESUMO

We constructed a radiomics-clinical model to predict intraventricular hemorrhage (IVH) growth after spontaneous intracerebral hematoma. The model was developed using a training cohort (N=626) and validated with an independent testing cohort (N=270). Radiomics features and clinical predictors were selected using the least absolute shrinkage and selection operator (LASSO) method and multivariate analysis. The radiomics score (Rad-score) was calculated through linear combination of selected features multiplied by their respective LASSO coefficients. The support vector machine (SVM) method was used to construct the model. IVH growth was experienced by 13.4% and 13.7% of patients in the training and testing cohorts, respectively. The Rad-score was associated with severe IVH and poor outcome. Independent predictors of IVH growth included hypercholesterolemia (odds ratio [OR], 0.12 [95%CI, 0.02-0.90]; p=0.039), baseline Graeb score (OR, 1.26 [95%CI, 1.16-1.36]; p<0.001), time to initial CT (OR, 0.70 [95%CI, 0.58-0.86]; p<0.001), international normalized ratio (OR, 4.27 [95%CI, 1.40, 13.0]; p=0.011), and Rad-score (OR, 2.3 [95%CI, 1.6-3.3]; p<0.001). In the training cohort, the model achieved an AUC of 0.78, sensitivity of 0.83, and specificity of 0.66. In the testing cohort, AUC, sensitivity, and specificity were 0.71, 0.81, and 0.64, respectively. This radiomics-clinical model thus has the potential to predict IVH growth.


Assuntos
Hemorragia Cerebral Intraventricular/mortalidade , Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia/diagnóstico , Hipercolesterolemia/epidemiologia , Processamento de Imagem Assistida por Computador/métodos , Idoso , Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/etiologia , Hidrocefalia/mortalidade , Hipercolesterolemia/sangue , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios X
9.
BMJ ; 373: n776, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947652

RESUMO

First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.


Assuntos
Aterosclerose/prevenção & controle , Cálcio/análise , Vasos Coronários/química , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Literatura de Revisão como Assunto , Medição de Risco/métodos , Fatores de Risco
10.
BMJ Open ; 11(4): e045375, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827840

RESUMO

OBJECTIVES: To evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia. DESIGN: A population-based retrospective cohort study. SETTING: This study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea. PARTICIPANTS: This study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation. RESULTS: Early statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30). CONCLUSIONS: Among statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
11.
Pan Afr Med J ; 38: 102, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889268

RESUMO

Introduction: some studies reported that 25.5% of African population presents hypercholesterolemia; however, epidemiology of hypercholesterolemia in Africa is poorly described. Mozambique is experiencing a constant growth of non-communicable diseases, but scarce data are available about hypercholesterolemia. Our study aims at describing the prevalence of hypercholesterolemia in patients with diabetes and hypertension in Mozambique and investigate possible risk factors. Methods: we conducted a cross-sectional study involving all the patients diagnosed with hypertension and/or diabetes from June 2018 to November 2020 in the Zimpeto DREAM Centre (Maputo, Mozambique). For each patient, anthropometric, clinical and laboratory data were collected. Hypercholesterolemia was defined as total blood cholesterol >200 mg/dL. Univariable and multivariable analysis were perfumed. Results: a total of 885 patients were included, 76.2% (n=674) female. Hypertension alone was diagnosed in 670 (75.7%) patients, diabetes in 109 (12.3%) patients and 106 (11.9%) both diseases. Hypercholesterolemia was present in 410 (46.3%) patients and it was more prevalent in patients diagnosed with both diabetes and hypertension (52.8%), as compared to the patients diagnosed with hypertension (46.9%) or diabetes alone (36.7%). In the multivariable analysis, the only factors independently associated with hypercholesterolemia were female sex (aOR 1.77, 95% CI 1.26-2.48, p=0.001) and a body mass index >25kg/m2 (aOR 1.50, 95% CI 1.11-2.04, p=0.008). Conclusion: our results highlight the need for a specific focus on female and obese/overweight patients, especially if diagnosed with both hypertension and diabetes, to promptly detect metabolic disorders and establish temporary preventive measures for cardiovascular events.


Assuntos
Diabetes Mellitus/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Fatores Sexuais
12.
Nutr Metab Cardiovasc Dis ; 31(5): 1564-1568, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33810965

RESUMO

BACKGROUND AND AIMS: Apoliprotein B (ApoB) has been associated with hypercholesterolemia and ischemic coronary disease. This study was aimed to determine the effect of two APOB gene variants in the risk of developing early-onset coronary artery disease (EO-CAD) in a Spanish population. The association of these polymorphisms with hypercholesterolemia was also analysed. METHODS AND RESULTS: The study involved a total of 889 healthy population controls (397 male) and 790 EO-CAD cases (636 male; EO-CAD was defined as male <60 years and women <65 years). All the patients had at least one vessel with angiography documented atherosclerotic lesion. Patients and controls were genotyped for the APOB variants rs1801701 A/G (p.R3638Q) and rs1367117 C/T (p.T98I). Allele and genotype frequencies were compared between the groups (patients vs. controls, hyper-vs. normo-cholesterolemia) by logistic regression. The rs1801701 was significantly associated with EO-CAD in male (OR = 1.44, 95%CI = 1.05-1.99) and female (OR = 2.22, 95%CI = 1.58-3.14). This SNP was significantly associated with hypercholesterolemia in female, with a trend in male. The association with EO-CAD was independent of hypercholesterolemia (multiple logistic regression). CONCLUSION: A common APOB polymorphism (rs1801701) was an independent risk factor for EO-CAD in our population. The risk-effect was more significant in female than in male.


Assuntos
Apolipoproteína B-100/genética , Doença da Artéria Coronariana/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Masculino , Pessoa de Meia-Idade , Fenótipo , Medição de Risco , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
13.
Epidemiol Health ; 43: e2021028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33872481

RESUMO

OBJECTIVES: We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program. RESULTS: The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change. CONCLUSIONS: Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.


Assuntos
Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/prevenção & controle , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Obesidade/epidemiologia , Obesidade/prevenção & controle , Adulto , Idoso , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Fatores de Risco
14.
Am J Med ; 134(8): 992-1001.e4, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33872584

RESUMO

BACKGROUND: There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. METHODS: We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia. RESULTS: The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64). CONCLUSION: In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.


Assuntos
Hospitalização/estatística & dados numéricos , Hipercolesterolemia/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Hipercolesterolemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
15.
Cien Saude Colet ; 26(4): 1207-1219, 2021 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33886751

RESUMO

This paper aims to compare the self-reported prevalence measured by laboratory tests and the false positive and negative values for diabetes, chronic kidney disease, and hypercholesterolemia. We used information from the interview and laboratory tests of the National Health Survey (2013, 2014-2015). Sensitivity and specificity were calculated by gender, age, schooling, having health insurance, and time since the last medical visit. We used logistic regression to analyze associated factors with false positives and negatives. Sensitivity was higher for diabetes and among older adults and those who had a medical visit more recently. Specificity was high for all diseases, with better performance among younger people, those with high schooling, and a visit more than one year ago. The likelihood of false positives and negatives decreased with schooling and increased with age. Low sensitivity suggests that prevalence might be higher than indicated by self-reported measures.


Assuntos
Diabetes Mellitus , Hipercolesterolemia , Insuficiência Renal Crônica , Idoso , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Laboratórios , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Autorrelato
16.
J Am Coll Cardiol ; 77(11): 1439-1450, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33736827

RESUMO

BACKGROUND: In cholesterol guidelines, low-density lipoprotein (LDL) cholesterol remains the primary target while apolipoprotein B (apoB) and non-high-density lipoprotein (non-HDL) cholesterol are secondary targets. OBJECTIVES: This study sought to determine if elevated apoB and/or non-HDL cholesterol are superior to elevated LDL cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction. METHODS: In total, 13,015 statin-treated patients from the Copenhagen General Population Study were included with 8 years median follow-up. Cox regressions among apoB, non-HDL cholesterol, and LDL cholesterol, respectively, and all-cause mortality or myocardial infarction were examined on continuous scales by restricted cubic splines and by categories of concordant and discordant values defined by medians. RESULTS: High apoB and non-HDL cholesterol were associated with increased risk of all-cause mortality and myocardial infarction, whereas no such associations were found for high LDL cholesterol. Compared with concordant values below medians, discordant apoB above the median with LDL cholesterol below yielded hazard ratios of 1.21 (95% confidence interval [CI]: 1.07 to 1.36) for all-cause mortality and 1.49 (95% CI: 1.15 to 1.92) for myocardial infarction. Corresponding values for high non-HDL cholesterol with low LDL cholesterol were 1.18 (95% CI: 1.02 to 1.36) and 1.78 (95% CI: 1.35 to 2.34). In contrast, discordant high LDL cholesterol with low apoB or non-HDL cholesterol was not associated with increased risk of all-cause mortality or myocardial infarction. Also, discordant high apoB with low non-HDL cholesterol yielded hazard ratios of 1.21 (95% CI: 1.03 to 1.41) for all-cause mortality and of 0.93 (95% CI: 0.62 to 1.40) for myocardial infarction. Furthermore, dual discordant apoB and non-HDL cholesterol above the medians with LDL cholesterol below presented hazard ratios of 1.23 (95% CI: 1.07 to 1.43) for all-cause mortality and 1.82 (95% CI: 1.37 to 2.42) for myocardial infarction. CONCLUSIONS: In statin-treated patients, elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction. Discordance analysis demonstrates that apoB is a more accurate marker of all-cause mortality risk in statin-treated patients than LDL cholesterol or non-HDL cholesterol, and apoB in addition is a more accurate marker of risk of myocardial infarction than LDL cholesterol.


Assuntos
Apolipoproteínas B/sangue , LDL-Colesterol/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia , Infarto do Miocárdio , Idoso , Biomarcadores/sangue , Causalidade , Dinamarca/epidemiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , Masculino , Mortalidade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos
17.
Am J Public Health ; 111(5): 890-895, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33734841

RESUMO

Community-based risk factor modification is today an established approach to chronic disease control and public health practice. This article analyzes the shaping of the North Karelia Project (NKP), an early and influential formulation of the community approach that focused on coronary heart disease prevention in Finland. Instead of targeting only high-risk individuals, NKP aimed to change the culture of the local community. On the basis of archival material and interviews, I first trace the multiple origins of the notion of community in NKP, which combined "internal" factors (local risk factor distribution, the role given to the social environment in chronic disease prevention) and "external" influences (regional origin of the initiative, World Health Organization and national policy concepts of community control and primary health care). Second, I describe the shape of the community intervention in NKP. The project foregrounded social relationships as a way to educate the public and influence norms guiding individual behaviors while subordinating environmental changes of a more structural nature.


Assuntos
Doença das Coronárias/epidemiologia , Doença das Coronárias/prevenção & controle , Promoção da Saúde/organização & administração , Estilo de Vida , Doenças Cardiovasculares/prevenção & controle , Características Culturais , Finlândia/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/prevenção & controle , Hipertensão/prevenção & controle , Fatores de Risco , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Fatores Socioeconômicos
18.
Sci Rep ; 11(1): 6966, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33772056

RESUMO

We analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/epidemiologia , Hipertensão/terapia , Doença Crônica/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipercolesterolemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , República da Coreia/epidemiologia
19.
Virol J ; 18(1): 64, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766078

RESUMO

BACKGROUND: Variation in host genetic factors may result in variation in the host immune response to the infection. Some chronic diseases may also affect individuals' susceptibility to infectious diseases. The aim of this study was to evaluate the association of the host genetic factors mostly involved in inflammation, as well as hypercholesterolemia and diabetes with mild flu in an Iranian population. METHODS: In this cross-sectional study, nasopharyngeal swab samples were collected from 93 patients referred to primary care centers of Markazi, Semnan, and Zanjan provinces (central Iran) due to flu-like symptoms between March 2015 and December 2018. Of these, PCR test identified 49 influenza A/H1N1 and 44 flu-negative individuals. Twelve single-nucleotide polymorphisms (SNPs) in RPAIN, FCGR2A, MBL-2, CD55, C1QBP, IL-10, TNF-α and an unknown gene were genotyped using iPLEX GOLD SNP genotyping analysis. Hypercholesterolemia and diabetes status was determined based on the physician diagnosis. Association of the host genetic variants, hypercholesterolemia and diabetes with mild A/H1N1 flu was assessed with univariable and multivariable logistic regression analysis as implemented in Stata software (v.14). Statistical tests were considered as significant at 0.05 levels. RESULTS: Frequency of diabetes and hypercholesterolemia, as well as participants mean age was significantly higher in the flu-negative rather than the flu-positive group. Of 12 SNPs, nine did not show any significant association with mild flu in our study (rs1801274, rs1800451, rs2564978, rs361525, rs1800450, rs1800871, rs1800872, rs1800896, rs1800629). Possessing G vs. A allele in two SNPs (rs3786054 and rs8070740) was associated with a threefold increase in the chance of mild flu when compared to flu-negative patients (95% CI: 1.1, 22.0). Possessing C allele (vs. A) in the rs9856661 locus also increased the chance of mild flu up to 2 folds (95% CI: 1.0, 10.0). CONCLUSION: The results showed that possessing the G allele in either rs3786054 or rs8070740 loci in C1QBP and RPAIN genes, respectively, increased the risk of H1N1 infection up to 3.3 folds, regardless of the patient's age, BMI, diabetes, and hypercholesterolemia. Complementary functional genomic studies would shed more light on the underlying mechanism of human immunity associated with these genetic markers. The identified genetic factors may have the same role in susceptibility to similar respiratory infections with RNA viruses, like SARS, MERS and COVID-19. Future genetic association studies targeting these RNA viruses, especially COVID-19 is recommended. Studies on other ethnic groups would also shed light on possible ethnic variations in genetic susceptibility to respiratory RNA viruses. Trial registry IR.PII.REC.1399.063.


Assuntos
Diabetes Mellitus/genética , Diabetes Mellitus/virologia , Estudos de Associação Genética , Hipercolesterolemia/genética , Hipercolesterolemia/virologia , Influenza Humana/genética , Influenza Humana/virologia , Adulto , Idoso , Alelos , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Hipercolesterolemia/epidemiologia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Análise de Regressão , Adulto Jovem
20.
J Clin Endocrinol Metab ; 106(5): e2005-e2014, 2021 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-33524107

RESUMO

PURPOSE: In resistance to thyroid hormone due to mutations in thyroid hormone receptor ß, peripheral tissues are variably refractory to the action of circulating thyroid hormones. We evaluated parameters contributing to atherosclerotic risk in this disorder. METHODS: We measured low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), nonesterified fatty acids (NEFA), intrahepatic lipid (IHL) and intramyocellular lipid (IMCL), Homeostasis-model assessment of insulin resistance (HOMA-IR), augmentation index (AIx) and pulse wave velocity (PWV), flow-mediated dilatation, and carotid intima-media thickness (cIMT) in an unselected, genetically confirmed cohort of adult RTHß patients (n = 27-77) and compared these with measurements in healthy subjects (up to n = 100) and thyrotoxic patients (n = 40). RESULTS: Resistance to thyroid hormone beta (RTHß) patients exhibited higher LDL-C (P = 0.008) and TG (P = 0.002) and lower HDL-C concentrations (P = 0.015 × 10-2) than control subjects, with LDL-C being higher than in thyrotoxic patients with comparable hyperthyroxinemia. Proprotein convertase subtilisin/kexin 9 (P = 0.002) and apolipoprotein B (P = 0.0009) levels were reduced in thyrotoxic patients but not lower in RTHß patients or control subjects. Intrahepatic lipid (P = 0.02 × 10-4), IMCL (P = 0.002), HOMA-IR (P = 0.01 × 10-2), and NEFA (P = 0.04 × 10-6) were significantly higher in RTHß patients than control subjects. Flow-mediated dilatation was increased (P = 0.04) but cIMT (P = 0.71), PWV P = 0.81), and AIx (P = 0.95) were unaltered in RTHß patients. CONCLUSIONS: We have documented mixed dyslipidemia with hepatic and IMCL accumulation in RTHß, suggesting that surveillance for these metabolic abnormalities is warranted. How they combine with enhanced endothelial function and unaltered vessel wall thickness and compliance to determine overall cardiometabolic risk in this disorder remains to be defined.


Assuntos
Dislipidemias/epidemiologia , Hipercolesterolemia/epidemiologia , Resistência à Insulina , Lipídeos/análise , Mutação , Receptores beta dos Hormônios Tireóideos/genética , Hormônios Tireóideos/metabolismo , Adulto , Biomarcadores/análise , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Dislipidemias/metabolismo , Dislipidemias/patologia , Feminino , Seguimentos , Humanos , Hipercolesterolemia/metabolismo , Hipercolesterolemia/patologia , Masculino , Prognóstico , Reino Unido/epidemiologia
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