1184 results found
Topriceanu C-C, Wong A, Moon JC, et al., 2021, Impact of lockdown on key workers: findings from the COVID-19 survey in four UK national longitudinal studies., J Epidemiol Community Health, Vol: 75, Pages: 955-962
BACKGROUND: Key workers played a pivotal role during the national lockdown in the UK's response to the COVID-19 pandemic. Although protective measures have been taken, the impact of the pandemic on key workers is yet to be fully elucidated. METHODS: Participants were from four longitudinal age-homogeneous British cohorts (born in 2001, 1990, 1970 and 1958). A web-based survey provided outcome data during the first UK national lockdown (May 2020) on COVID-19 infection status, changes in financial situation, trust in government, conflict with people around, household composition, psychological distress, alcohol consumption, smoking and sleep duration. Generalised linear models with logit link assessed the association between being a key worker and the above outcomes. Adjustment was made for cohort design, non-response, sex, ethnicity, adult socioeconomic position (SEP), childhood SEP, the presence of a chronic illness and receipt of a shielding letter. Meta-analyses were performed across the cohorts. FINDINGS: 13 736 participants were included. During lockdown, being a key worker was associated with increased chances of being infected with COVID-19 (OR 1.43, 95% CI 1.22 to 1.68) and experiencing conflict with people around (OR 1.19, 95% CI 1.03 to 1.37). However, key workers were less likely to be worse off financially (OR 0.32, 95% CI 0.24 to 0.65), to consume more alcohol (OR 0.88, 95% CI 0.79 to 0.98) or to smoke more (OR 0.60, 95% CI 0.44 to 0.80) during lockdown. Interestingly, being a key worker was not associated with psychological distress (OR 0.95, 95% CI 0.85 to 1.05). INTERPRETATION: Being a key worker during the first UK COVID-19 lockdown was a double-edged sword, with both benefits and downsides. The UK government had the basic duty to protect its key workers from SARS-CoV-2 infection, but it may have failed to do so, and there is an urgent need to rectify this in light of the ongoing third wave.
Feng L, Jehan I, de Silva HA, et al., 2021, Effect of a Multicomponent Intervention on Antihypertensive Medication Intensification in Rural South Asia: Post Hoc Analysis of a Cluster RCT., Am J Hypertens, Vol: 34, Pages: 981-988
BACKGROUND: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. METHODS: A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants. RESULTS: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin-angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05); P = 0.031), and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19); P = 0.016) was observed. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension. CLINICAL TRIALS REGISTRATION: Trial Number NCT02657746.
Khanolkar AR, Chaturvedi N, Kuan V, et al., 2021, Socioeconomic inequalities in prevalence and development of multimorbidity across adulthood: A longitudinal analysis of the MRC 1946 National Survey of Health and Development in the UK., PLoS Med, Vol: 18
BACKGROUND: We aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood. METHODS AND FINDINGS: Participants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories. Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards. Study limitations include that the NSHD cohort is co
Min JL, Hemani G, Hannon E, et al., 2021, Genomic and phenotypic insights from an atlas of genetic effects on DNA methylation., Nat Genet, Vol: 53, Pages: 1311-1321
Characterizing genetic influences on DNA methylation (DNAm) provides an opportunity to understand mechanisms underpinning gene regulation and disease. In the present study, we describe results of DNAm quantitative trait locus (mQTL) analyses on 32,851 participants, identifying genetic variants associated with DNAm at 420,509 DNAm sites in blood. We present a database of >270,000 independent mQTLs, of which 8.5% comprise long-range (trans) associations. Identified mQTL associations explain 15-17% of the additive genetic variance of DNAm. We show that the genetic architecture of DNAm levels is highly polygenic. Using shared genetic control between distal DNAm sites, we constructed networks, identifying 405 discrete genomic communities enriched for genomic annotations and complex traits. Shared genetic variants are associated with both DNAm levels and complex diseases, but only in a minority of cases do these associations reflect causal relationships from DNAm to trait or vice versa, indicating a more complex genotype-phenotype map than previously anticipated.
Torlasco C, D'Silva A, Bhuva AN, et al., 2021, Age matters: differences in exercise-induced cardiovascular remodelling in young and middle aged healthy sedentary individuals., Eur J Prev Cardiol, Vol: 28, Pages: 738-746
AIMS: Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing. METHODS: A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35). RESULTS: Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% (P = 0.020) and, especially in O35, also systemic vascular resistance (-4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial -4/-3 mmHg, central -4/-2 mmHg, all P < 0.001; O35: brachial -6/-3 mmHg, central -6/-4 mmHg, all P < 0.001). CONCLUSION: Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.
Aizawa K, Casanova F, Gates PE, et al., 2021, Reservoir-Excess Pressure Parameters Independently Predict Cardiovascular Events in Individuals With Type 2 Diabetes., Hypertension, Vol: 78, Pages: 40-50
[Figure: see text].
Goudswaard LJ, Harrison S, Van de Klee D, et al., 2021, Blood pressure variability and night-time dipping assessed by 24-hour ambulatory monitoring: Cross-sectional association with cardiac structure in adolescents, PLOS ONE, Vol: 16, ISSN: 1932-6203
Huang Y, Gu B, Salles II, et al., 2021, Fibrinogen-mimicking, multi-arm nanovesicles for human thrombus-specific delivery of tissue plasminogen activator and targeted thrombolytic therapy, Science Advances, Vol: 7, ISSN: 2375-2548
Clinical use of tissue plasminogen activator (tPA) in thrombolytic therapy is limited by its short circulation time and hemorrhagic side effects. Inspired by fibrinogen binding to activated platelets, we report a fibrinogen-mimicking, multi-arm nanovesicle for thrombus-specific tPA delivery and targeted thrombolysis. This novel system is based on the lipid nanovesicle coated with polyethylene glycol (PEG) terminally conjugated with a cyclic RGD (cRGD) peptide. Our experiments with human blood demonstrated its highly selective binding to activated platelets and efficient tPA release at a thrombus site under both static and physiological flow conditions. Its clot dissolution time in a microfluidic system was comparable to that of free tPA. Furthermore, we report a purpose-built computational model capable of simulating targeted thrombolysis of the tPA-loaded nanovesicle and with potential in predicting the dynamics of thrombolysis in physiologically realistic scenarios. This combined experimental and computational work presents a promising platform for development of thrombolytic nanomedicines.
Bruno RM, Spronck B, Hametner B, et al., 2021, Covid-19 Effects on ARTErial StIffness and Vascular AgeiNg: CARTESIAN Study Rationale and Protocol, ARTERY RESEARCH, Vol: 27, Pages: 59-68, ISSN: 1872-9312
Vyas MV, Chaturvedi N, Hughes AD, et al., 2021, Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort, HEART, Vol: 107, Pages: 996-1002, ISSN: 1355-6037
Comella A, Michail M, Chan J, et al., 2021, Patients with aortic stenosis exhibit early improved endothelial function following transcatheter aortic valve replacement: The eFAST study., Int J Cardiol, Vol: 332, Pages: 143-147
BACKGROUND: Patients with severe aortic stenosis (AS) exhibit systemic endothelial dysfunction, which can be associated with myocardial ischaemia in absence of obstructive coronary disease. Transcatheter aortic valve replacement (TAVR) is used to treat severe AS in patients with high or prohibitive surgical risk. However, it remains unknown whether endothelial function recovers post-TAVR. We therefore sought to assess the early and late changes in flow-mediated dilation (FMD), a measure of endothelial function, following TAVR. METHODS: Patients undergoing TAVR for severe AS had ultrasound assessment of brachial endothelial-independent and -dependent FMD. Measurements were performed pre-TAVR, at early follow-up (<48 h post-TAVR) and late follow-up (4-6 weeks post-TAVR). RESULTS: 27 patients (mean age 82.0 ± 7.0; 33.3% female) were recruited; 37.0% had diabetes mellitus and 59.3% had hypertension. Brachial artery FMD increased from 4.2 ± 1.6% (pre-TAVR) to 9.7 ± 3.5% at early follow-up (p < 0.0001). At late follow-up, improvement compared with early follow-up was sustained (8.7 ± 1.9%, p = 0.27). Resting brachial arterial flow velocities decreased significantly at late follow-up (11.24 ± 5.16 vs. 7.73 ± 2.79 cm/s, p = 0.003). Concordantly, at late follow-up, there was decrease in resting wall shear stress (WSS; 14.8 ± 7.8 vs. 10.6 ± 4.8dyne/cm2, p = 0.01), peak WSS (73.1 ± 34.1 vs. 58.8 ± 27.8dyne/cm2, p = 0.03) and cumulative WSS (3543 ± 1852 vs. 2504 ± 1089dyne·s/cm2, p = 0.002). Additionally, a favourable inverse correlation between cumulative WSS and FMD was restored at late follow-up (r = -0.21 vs. r = 0.49). CONCLUSION: Endothelial function in patients with AS improves early post-TAVR and this improvement is sustained. This likely occurs as a result of improved arterial haemodynamics, leading to lower localised WSS and release of vasoactive mediators that may also al
Robinson O, Carter AR, Aola-Korpela M, et al., 2021, Metabolic profiles of socioeconomic position: a multi-cohort analysis, International Journal of Epidemiology, Vol: 50, Pages: 768-782, ISSN: 0300-5771
BackgroundLow socioeconomic position (SEP) is a risk factor for multiple health outcomes, but its molecular imprints in the body remain unclear. MethodsWe examined SEP as a determinant of serum nuclear magnetic resonance metabolic profiles, in approximately 30,000 adults and 4,000 children across ten UK and Finnish cohort studies. ResultsIn risk factor-adjusted analysis of 233 metabolic measures, low educational attainment was associated with 37 measures including higher levels of triglycerides in small high-density lipoproteins (HDL) and lower levels of docosahexaenoic acid (DHA), omega-3 fatty acids, apolipoprotein A1, large and very large HDL particles (including levels of their respective lipid constituents), and cholesterol measures across different density lipoproteins. Among adults whose father worked in manual occupations, associations with apolipoprotein A1, large and very large HDL particles and HDL-2 cholesterol remained after adjustment for SEP in later life. Among manual workers, levels of glutamine were higher compared to non-manual workers. All three indicators of low SEP were associated with lower DHA, omega-3 fatty acids and HDL diameter. At all ages, children of manual workers had lower levels of DHA as a proportion of total fatty acids.ConclusionsOur work indicates that social and economic factors have a measurable impact on human physiology. Lower SEP was independently associated with a generally unfavorable metabolic profile, consistent across ages and cohorts. The metabolites we found associated with SEP, including DHA, are known to predict cardiovascular disease and cognitive decline in later life and may contribute to health inequalities.
Bann D, Villadsen A, Maddock J, et al., 2021, Changes in the behavioural determinants of health during the COVID-19 pandemic: gender, socioeconomic and ethnic inequalities in five British cohort studies., J Epidemiol Community Health
BACKGROUND: The COVID-19 pandemic is expected to have far-reaching consequences on population health. We investigated whether these consequences included changes in health-impacting behaviours which are important drivers of health inequalities. METHODS: Using data from five representative British cohorts (born 2000-2002, 1989-1990, 1970, 1958 and 1946), we investigated sleep, physical activity (exercise), diet and alcohol intake (N=14 297). We investigated change in each behaviour (pre/during the May 2020 lockdown), and differences by age/cohort, gender, ethnicity and socioeconomic position (childhood social class, education attainment and adult financial difficulties). Logistic regression models were used, accounting for study design and non-response weights, and meta-analysis used to pool and test cohort differences in association. RESULTS: Change occurred in both directions-shifts from the middle part of the distribution to both declines and increases in sleep, exercise and alcohol use. Older cohorts were less likely to report changes in behaviours while the youngest reported more frequent increases in sleep, exercise, and fruit and vegetable intake, yet lower alcohol consumption. Widening inequalities in sleep during lockdown were more frequent among women, socioeconomically disadvantaged groups and ethnic minorities. For other outcomes, inequalities were largely unchanged, yet ethnic minorities were at higher risk of undertaking less exercise and consuming lower amounts of fruit and vegetables. CONCLUSIONS: Our findings provide new evidence on the multiple changes to behavioural outcomes linked to lockdown, and the differential impacts across generation, gender, socioeconomic circumstances across life, and ethnicity. Lockdown appeared to widen some (but not all) forms of health inequality.
Seraphim A, Knott KD, Menacho K, et al., 2021, Prognostic Value of Pulmonary Transit Time and Pulmonary Blood Volume Estimation Using Myocardial Perfusion CMR., JACC Cardiovasc Imaging
OBJECTIVES: The purpose of this study was to explore the prognostic significance of PTT and PBVi using an automated, inline method of estimation using CMR. BACKGROUND: Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) (the product of PTT and cardiac index), are quantitative biomarkers of cardiopulmonary status. The development of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping permits their automated derivation, facilitating clinical adoption. METHODS: In this retrospective 2-center study of patients referred for clinical myocardial perfusion assessment using CMR, analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically (incorporating artificial intelligence techniques), allowing estimation of PTT and subsequent derivation of PBVi. Association with major adverse cardiovascular events (MACE) and all-cause mortality were evaluated using Cox proportional hazard models, after adjusting for comorbidities and CMR parameters. RESULTS: A total of 985 patients (67% men, median age 62 years [interquartile range (IQR): 52 to 71 years]) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR: 54% to 69%). PTT increased with age, male sex, atrial fibrillation, and left atrial area, and reduced with LVEF, heart rate, diabetes, and hypertension (model r2 = 0.57). Over a median follow-up period of 28.6 months (IQR: 22.6 to 35.7 months), MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both PTT and PBVi independently predicted MACE, but not all-cause mortality. There was no association between cardiac index and MACE. For every 1 × SD (2.39-s) increase in PTT, the adjusted hazard ratio for MACE was 1.43 (95% confidence interval [CI]: 1.10 to 1.85; p = 0.007). The adjusted hazard ratio for 1 × SD (118 ml/m2) increase in PBVi was 1.42 (95% CI: 1.13 to 1.78; p
Huang Z, Park C, Chaturvedi N, et al., 2021, Cardiorespiratory fitness, fatness, and the acute blood pressure response to exercise in adolescence, SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, Vol: 31, Pages: 1693-1698, ISSN: 0905-7188
Molinari M, de Iorio M, Chaturvedi N, et al., 2021, Modelling ethnic differences in the distribution of insulin resistance via Bayesian nonparametric processes: an application to the SABRE cohort study, INTERNATIONAL JOURNAL OF BIOSTATISTICS, Vol: 17, Pages: 153-164, ISSN: 2194-573X
Norris T, Mansukoski L, Gilthorpe MS, et al., 2021, Distinct Body Mass Index Trajectories to Young-Adulthood Obesity and Their Different Cardiometabolic Consequences, ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, Vol: 41, Pages: 1580-1593, ISSN: 1079-5642
Aizawa K, Casanova F, Mawson DM, et al., 2021, ELEVATED EXCESS PRESSURE INTEGRAL IS ASSOCIATED WITH VASCULAR BIOMARKERS OF SUBCLINICAL ATHEROSCLEROSIS IN OLDER ADULTS, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E314-E314, ISSN: 0263-6352
Park C, Taylor H, Rapala A, et al., 2021, SUBSTANTIAL CHANGES IN CARDIOVASCULAR HEALTH OCCUR FROM ADOLESCENCE TO EMERGING ADULTHOOD, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E4-E4, ISSN: 0263-6352
Parker RMA, Leckie G, Goldstein H, et al., 2021, Joint Modeling of Individual Trajectories, Within-Individual Variability, and a Later Outcome: Systolic Blood Pressure Through Childhood and Left Ventricular Mass in Early Adulthood, AMERICAN JOURNAL OF EPIDEMIOLOGY, Vol: 190, Pages: 652-662, ISSN: 0002-9262
Maher GM, Ryan L, McCarthy FP, et al., 2021, Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study, BMC MEDICINE, Vol: 19, ISSN: 1741-7015
Topriceanu C-C, Moon JC, Hardy R, et al., 2021, Longitudinal birth cohort study finds that life-course frailty associates with later-life heart size and function, SCIENTIFIC REPORTS, Vol: 11, ISSN: 2045-2322
Armstrong MK, Schultz MG, Hughes AD, et al., 2021, Physiological and clinical insights from reservoir-excess pressure analysis, JOURNAL OF HUMAN HYPERTENSION, ISSN: 0950-9240
Timmons JG, Greenlaw N, Boyle JG, et al., 2021, Metformin and carotid intima-media thickness in never-smokers with type 1 diabetes: The REMOVAL trial, DIABETES OBESITY & METABOLISM, Vol: 23, Pages: 1371-1378, ISSN: 1462-8902
Hughes AD, Chaturvedi N, 2021, Estimation of maximal oxygen consumption and heart rate recovery using the Tecumseh sub-maximal step test and their relationship to cardiovascular risk factors (vol 18, pg 29, 2017), ARTERY RESEARCH, Vol: 27, Pages: 51-51, ISSN: 1872-9312
Armstrong MK, Schultz MG, Hughes AD, et al., 2021, Excess pressure as an analogue of blood flow velocity, JOURNAL OF HYPERTENSION, Vol: 39, Pages: 421-427, ISSN: 0263-6352
Hughes AD, Chaturvedi N, 2021, Corrigendum to "Estimation of maximal oxygen consumption and heart rate recovery using the Tecumseh sub-maximal step test and their relationship to cardiovascular risk factors" [Artery Research 18 (June 2017) 29-35]., Artery Res, Vol: 27, ISSN: 1872-9312
Jones S, Schultz MG, Tillin T, et al., 2021, Sex differences in the contribution of different physiological systems to physical function in older adults, GEROSCIENCE, Vol: 43, Pages: 443-455, ISSN: 2509-2715
Picone DS, Schultz MG, Armstrong MK, et al., 2021, Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements, HYPERTENSION, Vol: 77, Pages: 632-639, ISSN: 0194-911X
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