234 results found
Moussa O, Ardissino M, Eichhorn C, et al., 2021, Atrial fibrillation and obesity: long-term incidence and outcomes after bariatric surgery, European Journal of Preventive Cardiology, Vol: 28, Pages: e22-e24, ISSN: 2047-4873
Webb CM, Collins P, 2021, Medical management of anginal symptoms in women with stable angina pectoris: A systematic review of randomised controlled trials, International Journal of Cardiology, ISSN: 0167-5273
BackgroundMedical therapies are used to improve stable anginal symptoms and quality of life in clinical practice however the evidence for the use of antianginal medication in women is largely unknown. We conducted a systematic review to investigate the extent of the evidence-base for the medical management of anginal symptoms in women with stable angina.MethodsMEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases were searched to the end of December 2019. Retrieved papers were hand searched. Included were randomised controlled trials with at least one week of follow-up that included women with stable angina pectoris, with or without significant coronary atherosclerosis, randomised to conventional antianginal medication or/and a comparator, with a primary or secondary endpoint of angina frequency or glyceryl trinitrate (GTN) consumption.ResultsA total of 397 eligible publications were included in a qualitative analysis, with women comprising up to 20–30% of the study populations. No publication that included women and men reported all data separately for each sex. Twenty-six publications reported any female data separately from male data but only 18 reported angina data for women, 12 of which included fewer than 10 women.ConclusionsSubstantially fewer women than men were included in randomised trials of antianginal medications reporting effects on anginal symptoms, and reporting of data by sex was infrequent. As a result, there is little evidence on which to base treatment recommendations for anginal symptoms in women. Our results provide a platform for future studies to fill this void in the evidence.
Stevenson JC, Collins P, Hamoda H, et al., 2021, Cardiometabolic health in premature ovarian insufficiency, CLIMACTERIC, ISSN: 1369-7137
Moussa O, Ardissino M, Vincent M, et al., 2021, Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity score matched cohort study, European Heart Journal - Cardiovascular Pharmacotherapy, ISSN: 2055-6845
Aims:The rising prevalence of obesity and its associated comorbidities represent a growing public health issue; in particular, obesity is known to be a major risk factor for cardiovascular disease. Despite the evidence behind the efficacy of orlistat in achieving weight loss in patients with obesity, no study thus far has quantified its long-term effect on cardiovascular outcomes. The purpose of this study is to explore long-term cardiovascular outcomes after orlistat therapy.Methods and results:A propensity-score matched cohort study was conducted on the nation-wide electronic primary and integrated secondary healthcare records of the Clinical Practice Research Datalink (CPRD). The 36 876 patients with obesity in the CPRD database who had completed a course of orlistat during follow-up were matched on a 1:1 basis with equal numbers of controls who had not taken orlistat. Patients were followed up for a median of 6 years for the occurrence of the primary composite endpoint of major adverse cardiovascular events (fatal or non-fatal myocardial infarction or ischaemic stroke), and a number of secondary endpoints including primary endpoint components individually, the occurrence of new-onset heart failure, coronary revascularization, new chronic kidney disease stage III+ (CKD3+), and all-cause mortality. During the median study follow-up of 6 years, the occurrence of major adverse cardiovascular events was lower in the orlistat cohort [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.66–0.83, P < 0.001]. Patients who took orlistat experienced lower rates of myocardial infarction (HR 0.77; 95% CI 0.66–0.88, P < 0.001) and ischaemic stroke (HR 0.68; 95% CI 0.56 to −0.84, P < 0.001) as well as new-onset heart failure (HR 0.79; 95% CI 0.67–0.94, P = 0.007). There was no differences in revascularization rates (HR 1.12; 95% CI 0.91–1.38, P = 0.27)
Moussa O, Ardissino M, Tang A, et al., 2021, Long-term cerebrovascular outcomes after bariatric surgery: A nationwide cohort study, CLINICAL NEUROLOGY AND NEUROSURGERY, Vol: 203, ISSN: 0303-8467
Maas A, Rosano G, Cifkova R, et al., 2021, Cardiovascular health after menopause transition, pregnancy disorders and other gynaecologic conditions. A consensus document from European cardiologists, gynaecologists and endocrinologists, European Heart Journal, Vol: 42, Pages: 967-984, ISSN: 0195-668X
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).
Perrino C, Ferdinandy P, Bøtker HE, et al., 2021, Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart, Cardiovascular Research, Vol: 117, Pages: 367-385, ISSN: 0008-6363
Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here.
Ardissino M, Watson F, Amin R, et al., 2021, Atherosclerotic disease burden after bariatric surgery in patients with obesity and type 2 diabetes, JOURNAL OF DIABETES, Vol: 13, Pages: 640-647, ISSN: 1753-0393
Khan TZ, Haskard D, Hartley A, et al., 2021, Oxidised LDL and Anti-Oxidised LDL Antibodies Are Reduced by Lipoprotein Apheresis in a Randomised Controlled Trial on Patients with Refractory Angina and Elevated Lipoprotein(a), Antioxidants, Vol: 10, ISSN: 2076-3921
Aims: An abundance of epidemiological evidence demonstrates that elevated lipoprotein(a) (Lp(a)) represents a significant contributing risk factor towards the development of cardiovascular disease. In particular, raised Lp(a) may play a mechanistic role in patients with refractory angina. Studies have also shown a correlation between oxidised LDL (oxLDL) levels and atherosclerotic burden as well as rates of cardiovascular events. Antibodies against oxLDL (anti-oxLDL) are involved in the removal of oxLDL. Lipoprotein apheresis (LA), which removes lipoproteins using extra-corporeal processes, is an established means of reducing Lp(a), and thereby reduces cardiovascular events. The aim of this study was to investigate the effect of LA on oxLDL and anti-oxLDL levels amongst those with refractory angina in the context of raised Lp(a). Methods: We performed a sub-study within a randomised controlled crossover trial involving 20 patients with refractory angina and raised Lp(a) > 500 mg/L, comparing the effect of three months of blinded weekly LA or sham, followed by crossover to the opposite study arm. We utilized enzyme-linked immunosorbent assays (ELISA) to quantify oxLDL and IgG/ IgM anti-oxLDL antibody levels at baseline and following three months of active LA or sham sessions. Results: Following three months of LA, there was a 30% reduction in oxLDL from 0.37 ± 0.06 to 0.26 ± 0.04 with a mean drop of −0.11 units (U) (95% CI −0.13, −0.09) compared to no significant change with sham therapy (p < 0.0001 between treatment arms). LA also led to a 22% reduction in levels of IgG and IgM anti-oxLDL, again with no significant change demonstrated during sham (p = 0.0036 and p = 0.012, respectively, between treatment arms). Conclusion: Amongst patients with refractory angina in the context of elevated Lp(a), LA significantly lowers levels of oxLDL and anti-oxLDL antibodies, representing potential mechanisms by which LA yields symptomatic and
Moussa O, Ardissino M, Muttoni S, et al., 2021, Long-term incidence and outcomes of obesity-related peripheral vascular disease after bariatric surgery, LANGENBECKS ARCHIVES OF SURGERY, Vol: 406, Pages: 1029-1036, ISSN: 1435-2443
Watson F, Ardissino M, Amin RJ, et al., 2020, Bariatric Surgery is Associated With Reduced Atherosclerotic Cardiovascular Disease Burden in Obese Patients With Type 2 Diabetes: A Propensity-matched Cohort Study, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Gaudino M, Benedetto U, Fremes S, et al., 2020, Association of Radial Artery Graft vs Saphenous Vein Graft With Long-term Cardiovascular Outcomes Among Patients Undergoing Coronary Artery Bypass Grafting, JAMA, Vol: 324, Pages: 179-179, ISSN: 0098-7484
Importance Observational studies have suggested that the use of radial artery grafts for coronary artery bypass grafting may improve clinical outcomes compared with the use of saphenous vein grafts, but this has not been confirmed in randomized trials.Objective To compare clinical outcomes between patients receiving radial artery vs saphenous vein grafts for coronary artery bypass grafting after long-term follow-up.Design, Setting, and Participants Patient-level pooled analysis comparing radial artery vs saphenous vein graft in adult patients undergoing isolated coronary artery bypass grafting from 5 countries (Australia, Italy, Serbia, South Korea, and the United Kingdom), with enrollment from 1997 to 2009 and follow-up completed in 2019.Interventions Patients were randomized to undergo either radial artery (n = 534) or saphenous vein (n = 502) grafts for coronary artery bypass grafting.Main Outcomes and Measures The primary outcome was a composite of death, myocardial infarction, or repeat revascularization and the secondary outcome was a composite of death or myocardial infarction.Results A total of 1036 patients were randomized (mean age, 66.6 years in the radial artery group vs 67.1 years in the saphenous vein group; 376 [70.4%] men in the radial artery group vs 351 [69.9%] in the saphenous vein group); 942 (90.9%) of the originally randomized patients completed 10 years of follow-up (510 in the radial artery group). At a median (interquartile range) follow-up of 10 (10-11) years, the use of the radial artery, compared with the saphenous vein, in coronary artery bypass grafting was associated with a statistically significant reduction in the incidence of the composite outcome of death, myocardial infarction, or repeat revascularization (220 vs 237 total events; 41 vs 47 events per 1000 patient-years; hazard ratio, 0.73 [95% CI, 0.61-0.88]; P < .001) and of the composite of death or myocardial infarction (188 vs
Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, et al., 2020, Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?, Osteoporosis International, Vol: 31, Pages: 2271-2286, ISSN: 0937-941X
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
Moussa O, Ardissino M, Heaton T, et al., 2020, Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study, European Heart Journal, Vol: 41, Pages: 2660-2667, ISSN: 0195-668X
AIMS: This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. METHODS AND RESULTS: A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274-0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280-0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164-1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181-0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183-0.353; P < 0.001). CONCLUSION: The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.
Gaudino M, Benedetto U, Fremes SE, et al., 2020, Angiographic outcome of coronary artery bypass grafts: Radial Artery Database International Alliance, Annals of Thoracic Surgery, Vol: 109, Pages: 688-694, ISSN: 0003-4975
BACKGROUND: We used a large patient-level dataset including six angiographic randomized trials (RCTs) on coronary artery bypass conduits to explore incidence and determinants of coronary graft failure. METHODS: Patient-level angiographic data of six RCTs comparing long-term outcomes of the radial artery and other conduits were joined. Primary outcome was graft occlusion at maximum follow-up. The analysis was divided as follows: 1) left anterior descending coronary (LAD) distribution, 2) non-LAD distribution (circumflex and right coronary artery). To identify predictors of graft occlusion, mixed model multivariable Cox regression including all baseline characteristics with stratification by individual trials was used. RESULTS: 1091 patients and 2281 grafts were included (921 left internal mammary arteries, 74 right internal mammary arteries, 710 radial artery and 576 saphenous veins; all left internal mammary arteries were used on the LAD, the other conduits were used on the non-LAD distribution; mean angiographic follow up: 65±29 months). Occlusion rate was 2.3%, 13.5%, 9.4%, 17.5% for the left internal mammary arteries, right internal mammary arteries, radial artery and saphenous veins, respectively. At multivariable analysis type of conduit used, age, female gender, left ventricular ejection fraction<50% and use of the Y graft were significantly associated with graft occlusion in the non-LAD distribution. CONCLUSIONS: Our analyses showed that failure of the left internal mammary arteries to LAD bypass is a very uncommon event. For the non-LAD distribution, the non-use of radial artery, age, female gender, left ventricular ejection fraction<50% and use of the Y graft configuration were significantly associated with mid-term graft failure.
Collins P, Maas A, Prasad M, et al., 2020, Endothelial Vascular Function as a Surrogate of Vascular Risk and Aging in Women, MAYO CLINIC PROCEEDINGS, Vol: 95, Pages: 541-553, ISSN: 0025-6196
Gaudino M, Benedetto U, Fremes S, et al., 2019, The RADial artery International ALliance (RADIAL) extended follow-up study: rationale and study protocol, European Journal of Cardio-Thoracic Surgery, Vol: 56, Pages: 1025-1030, ISSN: 1010-7940
It is generally accepted that radial artery (RA) grafts have better mid-term patency rate compared to saphenous vein grafts. However, the clinical correlates of the improved patency rate are still debated. Observational studies have suggested increased survival and event-free survival for patients who receive an RA rather than a saphenous vein, but they are open to bias and confounders. The only evidence based on randomized data is a pooled meta-analysis of 6 randomized controlled trial comparing the RA and the saphenous vein published by the RADial artery International Alliance (RADIAL). In the RADIAL database, improved freedom from follow-up cardiac events (death, myocardial infarction and repeat revascularization) was found at 5-year follow-up in the RA arm. The most important limitation of the RADIAL analysis is that most of the included trials had an angiographic follow-up in the first 5 years and it is unclear whether the rate of repeat revascularization (the main driver of the composite outcome) was clinically indicated due to per-protocol angiographies. Here, we present the protocol for the long-term analysis of the RADIAL database. By extending the follow-up beyond the 5th postoperative year (all trials except 1 did not have angiographic follow-up beyond 5 years), we aim to provide data on the role of RA in coronary artery bypass surgery with respect to long-term outcomes.
Ardissino M, Moussa O, Heaton T, et al., 2019, Bariatric Surgery and Cerebrovascular Outcomes in Patients With Obesity, Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Moussa O, Ardissino M, Muttoni S, et al., 2019, Long-term effect of bariatric surgery on the incidence and outcomes of obesity-related peripheral vascular disease, Scientific Sessions of the American-Heart-Association, Publisher: Lippincott, Williams & Wilkins, Pages: 1-2, ISSN: 0009-7322
Background: Patients with obesity are at high risk of suffering from both arterial and venous peripheral vascular disease. Bariatric surgery is an effective and increasingly popular strategy to achieve weight reduction and for patients with obesity. The long-term impact of bariatric surgery on obesity-related morbidity is a subject of increasing research interest.Hypothesis: The aim of this study is to ascertain the impact of bariatric surgery on the long-term occurrence of peripheral vascular disease in patients with obesity.Design: The study cohort consisted of 7,892 patients in theClinical Practice Research Datalink. This a prospectively collected nation-wide database containing primary and secondary care records of consenting patients. The intervention cohort were the 3,946 patients who had undergone bariatric surgery during follow-up; their controls were 3,946 age, gender and BMI-matched controls. The primary endpoint was considered to be the development of any peripheral vascualr disease: arterial or venous. Secondary endpoints included were peripheral arterial disease alone, peripheral venous disease alone, and amputation of a limb due to any cause. The median follow-up achieved in the study was 11.5 years.Results: A total of 1,244 patients suffered a primary endpoint during follow up; bariatric surgery was associated with a reduction in primary event rates (HR=0.651, 95%CI 0.558-0.758, p<0.001); this was driven by a reduction in both arterial and venous disease. The protective effect observed was strongest in women (p int<0.001), those with diabetes (p int<0.001) and those of WHO BMI Categories I and II (p int=0.003). Amputation rates were also non-significantly reduced in the bariatric surgery cohort HR=0.443, 95%CI 0.181-1.085, p=0.075).Conclusion: Bariatric surgery was associated with a reduction in the occurrence of both arterial and venous peripheral vascular disease in patients with obesity.
Collins P, Moussa O, Ardissino M, et al., 2019, Effect of bariatric surgery on long-term cardiovascular outcomes A nation-wide nested cohort study, European Heart Journal, Vol: 40, ISSN: 0195-668X
BackgroundObesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined.PurposeThe aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity.MethodsA nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates.ResultsPatients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153).ConclusionThe results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducin
Ardissino M, Moussa OM, Tang AR, et al., 2019, Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study, European Heart Journal, Vol: 40, ISSN: 0195-668X
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined.</jats:p> </jats:sec> <jats:sec> <jats:title>Purpose</jats:title> <jats:p>The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surge
Ambrosio G, Collins P, Dechend R, et al., 2019, StaBle Angina: PeRceptIon of NeeDs, Quality of Life and ManaGemEnt of Patients (BRIDGE Study)-A Multinational European Physician Survey, ANGIOLOGY, Vol: 70, Pages: 397-406, ISSN: 0003-3197
Kotecha D, Flather MD, Atar D, et al., 2019, B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease, BMC Medicine, Vol: 17, ISSN: 1741-7015
BackgroundRisk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust ‘real-world’ evidence for their use.MethodsProspective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression.ResultsFive hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45–3.19; p = 0.0001) and 1.27 for composite events (1.04–1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years afte
Chadeau M, van Veldhoven C, Kiss A, et al., 2019, Impact of short-term traffic-related air pollution on the metabolome – results from two metabolome-wide experimental studies, Environment International, Vol: 123, Pages: 124-131, ISSN: 0160-4120
Exposure to traffic-related air pollution (TRAP) has been associated with adverse health outcomes but underlying biological mechanisms remain poorly understood. Two randomized crossover trials were used here, the Oxford Street II (London) and the TAPAS II (Barcelona) studies, where volunteers were allocated to high or low air pollution exposures. The two locations represent different exposure scenarios, with Oxford Street characterized by diesel vehicles and Barcelona by normal mixed urban traffic. Levels of five and four pollutants were measured, respectively, using personal exposure monitoring devices. Serum samples were used for metabolomic profiling. The association between TRAP and levels of each metabolic feature was assessed. All pollutant levels were significantly higher at the high pollution sites. 29 and 77 metabolic features were associated with at least one pollutant in the Oxford Street II and TAPAS II studies, respectively, which related to 17 and 30 metabolic compounds. Little overlap was observed across pollutants for metabolic features, suggesting that different pollutants may affect levels of different metabolic features. After observing the annotated compounds, the main pathway suggested in Oxford Street II in association with NO2 was the acyl-carnitine pathway, previously found to be associated with cardio-respiratory disease. No overlap was found between the metabolic features identified in the two studies.
Halliday BP, Gulati A, Ali A, et al., 2018, Sex and age-based differences in the natural history and outcome of dilated cardiomyopathy, European Journal of Heart Failure, Vol: 20, Pages: 1392-1400, ISSN: 1388-9842
Aims: To evaluate the relationship between sex, age and outcome in dilated cardiomyopathy (DCM). Methods & Results: We used proportional hazard modelling to examine the association between sex, age and all-cause mortality in consecutive patients with DCM. Overall, 881 patients (290 women, median age 52 years) were followed for a median of 4.9 years. Women were more likely to present with heart failure (64.0% vs 54.5%; p=0.007) and had more severe symptoms (p<0.001) compared to men. Women had smaller left ventricular end-diastolic volume (125ml/m2 vs 135ml/m2, p<0.001), higher left ventricular ejection fraction (40.2% vs 37.9%, p=0.019) and were less likely to have mid-wall late gadolinium enhancement (23.0% vs 38.9%, p<0.0001). During follow-up 149 (16.9%) patients died, including 41 (4.7%) who died suddenly. After adjustment, all-cause mortality (HR 0.61; 95%CI 0.41:0.92; p=0.018) was lower in women, with similar trends for cardiovascular (HR 0.60; 95%CI 0.35-1.05; p=0.07), non-sudden (HR 0.63; 95%CI 0.39-1.02; p=0.06) and sudden death (HR 0.70, 95%CI 0.30:1.63; p=0.41). All-cause mortality (per 10 yrs: HR 1.36, 95%CI 1.20-1.55; p<0.00001) and non-sudden death (per 10 yrs: HR 1.51, 95%CI 1.26 – 1.82; p<0.00001) increased with age. Cumulative incidence curves confirmed favourable outcomes, particularly in women and those <60 years. Increased all-cause mortality in patients >60 years of age was driven by non-sudden death. Conclusion: Women with DCM have better survival compared to men, which may partly be due to less severe left ventricular dysfunction and a smaller scar burden. There is increased mortality driven by non-sudden death in patients >60 years of age that is less marked in women. Outcomes with contemporary treatment were favourable, with a low incidence of sudden death.
Richards T, Collins P, Webb C, 2018, Factors affecting participation in cardiovascular clinical research – a comparison of men and women, British Association for Cardiovascular Prevention & Rehabilitation
Zheng SL, Collins P, 2018, Cardiovascular outcomes with the incretin-based therapies GLP-1 agonists and DPP-4 inhibitors in type 2 diabetes participants with and without heart failure, Publisher: WILEY, Pages: 202-203, ISSN: 1388-9842
Krauskopf J, Caiment F, van Veldhoven K, et al., 2018, The human circulating miRNome reflects multiple organ disease risks in association with short-term exposure to traffic-related air pollution, Environment International, Vol: 113, Pages: 26-34, ISSN: 0160-4120
Traffic-related air pollution is a complex mixture of particulate matter (PM) and gaseous pollutants, such as nitrogen dioxide (NO2). PM exposure contributes to the pathogenesis of many diseases including several types of cancer, as well as pulmonary, cardiovascular and neurodegenerative diseases. Also exposure to NO2 has been related to increased cardiovascular mortality. In search of an early diagnostic biomarker for improved air pollution-associated health risk assessment, recent human studies have shown that certain circulating miRNAs are altered upon exposure to traffic-related air pollutants. Here, we present for the first time a global analysis of the circulating miRNA genome in an experimental cross-over study of a human population exposed to traffic-related air pollution. By utilizing next-generation sequencing technology and detailed real-time exposure measurements we identified 54 circulating miRNAs to be dose- and pollutant species-dependently associated with PM10, PM2.5, black carbon, ultrafine particles and NO2 already after 2 h of exposure. Bioinformatics analysis suggests that these circulating miRNAs actually reflect the adverse consequences of traffic pollution-induced toxicity in target tissues including the lung, heart, kidney and brain. This study shows the strong potential of circulating miRNAs as novel biomarkers for environmental health risk assessment.
Liu S, Grigoryan H, Edmands WMB, et al., 2018, Cys34 Adductomes Differ between Patients with Chronic Lung or Heart Disease and Healthy Controls in Central London, Environmental Science and Technology (Washington), Vol: 52, Pages: 2307-2313, ISSN: 0013-936X
Oxidative stress generates reactive species that modify proteins, deplete antioxidant defenses, and contribute to chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). To determine whether protein modifications differ between COPD or IHD patients and healthy subjects, we performed untargeted analysis of adducts at the Cys34 locus of human serum albumin (HSA). Biospecimens were obtained from nonsmoking participants from London, U.K., including healthy subjects (n = 20) and patients with COPD (n = 20) or IHD (n = 10). Serum samples were digested with trypsin and analyzed by liquid chromatography-high resolution mass spectrometry. Effects of air pollution on adduct levels were also investigated based on estimated residential exposures to PM2.5, O3 and NO2. For the 39 adducts with sufficient data, levels were essentially identical in blood samples collected from the same subjects on two consecutive days, consistent with the 28 day residence time of HSA. Multivariate linear regression revealed 21 significant associations, mainly with the underlying diseases but also with air-pollution exposures (p-value < 0.05). Interestingly, most of the associations indicated that adduct levels decreased with the presence of disease or increased pollutant concentrations. Negative associations of COPD and IHD with the Cys34 disulfide of glutathione and two Cys34 sulfoxidations, were consistent with previous results from smoking and nonsmoking volunteers and nonsmoking women exposed to indoor combustion of coal and wood.
Sinharay R, Gong J, Barratt B, et al., 2017, Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study, Lancet, Vol: 391, Pages: 339-349, ISSN: 0140-6736
BackgroundLong-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.MethodsIn this randomised, crossover study, we recruited men and women aged 60 years and older with angiographically proven stable ischaemic heart disease or stage 2 Global initiative for Obstructive Lung Disease (GOLD) COPD who had been clinically stable for 6 months, and age-matched healthy volunteers. Individuals with ischaemic heart disease or COPD were recruited from existing databases or outpatient respiratory and cardiology clinics at the Royal Brompton & Harefield NHS Foundation Trust and age-matched healthy volunteers using advertising and existing databases. All participants had abstained from smoking for at least 12 months and medications were taken as recommended by participants' doctors during the study. Participants were randomly assigned by drawing numbered disks at random from a bag to do a 2 h walk either along a commercial street in London (Oxford Street) or in an urban park (Hyde Park). Baseline measurements of participants were taken before the walk in the hospital laboratory. During each walk session, black carbon, particulate matter (PM) concentrations, ultrafine particles, and nitrogen dioxide (NO2) concentrations were measured.FindingsBetween October, 2012, and June, 2014, we screened 135 participants, of whom 40 healthy volunteers, 40 individuals with COPD, and 39 with ischaemic heart disease were recruited. Concentrations of black carbon, NO2, PM10, PM2.5, and ul
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