scholarly journals Metabolic syndrome and cardiovascular disease after haematopoietic cell transplantation (HCT) in adults: an EBMT cross-sectional non-interventional study

2021 ◽  
Author(s):  
D. M. Greenfield ◽  
N. Salooja ◽  
C. Peczynski ◽  
S. van der Werf ◽  
H. Schoemans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Cell Transplantation ◽  
Interventional Study ◽  
Cross Sectional ◽  
Haematopoietic Cell ◽  
Age Related ◽  
Randomised Controlled

AbstractMetabolic syndrome (MetS) is associated with cardiovascular disease in the general population and is also a potential cardiovascular risk factor in survivors of haematopoietic cell transplantation (HCT). We report an EBMT cross-sectional, multi-centre, non-interventional study of 453 adult HCT patients surviving a minimum of 2 years post-transplant attending routine follow-up HCT and/or late effects clinics in 9 centres. The overall prevalence of MetS was 37.5% rising to 53% in patients >50 years of age at follow-up. There were no differences in rates of MetS between autologous and allogeneic HCT survivors, nor any association with graft-versus-host disease (GvHD) or current immunosuppressant therapy. Notably, there was a significantly higher occurrence of cardiovascular events (CVE, defined as cerebrovascular accident, coronary heart disease or peripheral vascular disease) in those with MetS than in those without MetS (26.7% versus 9%, p < 0.001, OR 3.69, 95% CI 2.09–6.54, p < 0.001), and, as expected, MetS and CVE were age-related. Unexpectedly, CVE were associated with occurrence of second malignancy. Screening for and management of MetS should be integrated within routine HCT long-term follow-up care for both allogeneic and autologous HCT survivors. Further research is warranted, including randomised controlled trials of interventional strategies and mechanistic studies of cardiovascular risk in HCT survivors.

scholarly journals Metabolic Syndrome Is Common Following Haematopoietic Cell Transplantation (HCT) and Is Associated with Increased Cardiovascular Disease and Second Cancers: An EBMT Cross-Sectional Non-Interventional Study

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 251-251
Author(s):  
Diana M Greenfield ◽  
Nina Salooja ◽  
Christophe Peczynski ◽  
Steffie van der Werf ◽  
Helene Schoemans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Logistic Regression ◽  
Waist Circumference ◽  
Cardiovascular Events ◽  
Research Funding ◽  
Interventional Study ◽  
Cross Sectional

Abstract Metabolic syndrome (MetS) is defined as a clustering of five factors including (1) fasting hyperglycaemia (2) hypertriglyceridaemia (3) low HDL cholesterol (4) hypertension (5) obesity (high waist circumference). According to the International Diabetes Federation harmonised definition, a large waist circumference plus any other two features meet criteria for diagnosis of MetS. It is associated with raised risk of cardiovascular disease (CVD) by 3-fold and is increasingly recognised in patients after HCT. Recent guidelines for long-term HCT survivors recommend screening for MetS. We performed a large cross-sectional service evaluation of HCT survivors in centres working in accordance with international screening guidelines. We have previously presented interim results regarding the prevalence of MetS and associated risk factors and now present the final results. This was an EBMT approved cross-sectional, non-interventional study of consecutive HCT patients (allo and auto) aged 18+ years and a minimum of 2 year post-transplant attending routine follow-up HCT and/or late effects clinics in 9 centres. Centres completed proformas incorporating routine recording of the MetS parameters (given above) as well as performance status (ECOG); evidence of cardiovascular events; family history of premature CVD; and relevant drug history. Univariate comparison of patients and HCT characteristics between the 2 groups (MetS vs no MetS) was performed using non-parametric Mann-Witney U test for continuous variables and Chi-square test or Fisher test for categorical variables. All tests were two-sided. Multivariate logistic regression analyses were performed to predict MetS and cardiovascular events. Variables with a p-value <0.2 in univariate analysis were included. Table 1 gives the population demographic, age, primary disease and transplant details. The prevalence of MetS was 30.4% (allo 29%, auto 35.6% ns). There was a significant difference in prevalence by age at follow-up (p<0.001 with increasing age) with 39% having MetS in those aged 50+. ECOG status was not significantly different between those with or without MetS. No relationship between presence or degree of acute or chronic GvHD was observed and no difference in current use of immunosuppressant therapy. Notably, there was a significantly higher prevalence of cardiovascular events in those with MetS than those without (22.6.vs 10.7%, P=0.006). Logistic regression analysis confirmed that MetS is a predictor of cardiovascular events (OR 4.72, 95%CI 2.11-10.57). CVE were also associated with occurrence of a second malignancy (OR 7.93, 95%CI 2.91-21.61). There was an influence of increasing age both in the prevalence of metabolic syndrome (OR 7.3, 95% CI 3.2,16.8) and CVE (OR 3, 95%CI 0.8-11.32) for the over 50s compared with those aged 18-29. This large study in HCT survivors confirms high prevalence of metabolic syndrome following both allogeneic and autologous HCT of 30.4% overall rising to 39% in those aged over 50 years at follow-up. The data support MetS being an age-related late effect of HCT that is strongly associated with not only cardiovascular events but also the occurrence of second cancers. Further analysis examining the relationship between intensity of treatment and prevalence of MetS and CVE is needed. The data supports routine screening for MetS of both allo and auto HCT patients. Early intervention of reversible features of MetS with lifestyle and medical management may reduce the risk of cardiovascular events, but this needs be tested in a randomised controlled trial setting. Meanwhile, screening and management should be robustly integrated within routine HCT long-term follow-up care. Table 1. Table 1. Disclosures Cortelezzi: janssen: Consultancy; novartis: Consultancy; roche: Consultancy; abbvie: Consultancy. Mohty:Jazz Pharmaceuticals: Honoraria, Research Funding, Speakers Bureau; Servier: Consultancy; Sanofi: Consultancy, Honoraria, Research Funding, Speakers Bureau; MaaT Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Speakers Bureau; Bristol Myers: Consultancy, Research Funding; Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Molmed: Consultancy; Janssen: Honoraria, Research Funding, Speakers Bureau. Kroeger:Novartis: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Riemser: Honoraria, Research Funding; JAZZ: Honoraria; Sanofi: Honoraria; Neovii: Honoraria, Research Funding. Snowden:Jazz & Sanofi: Other: Speaker fees at ASH; Jannssen/J&J: Other: Speaker fees.

Cardiovascular Risk Assessement in Osteoporotic Patients Using Osteoprotegerin as a Reliable Predictive Biochemical Marker

2018 ◽  
pp. 253
Author(s):  
Noora Wael Rasheed ◽  
Ooroba Jameel Taresh
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Serum Level ◽  
Biochemical Markers ◽  
Hdl Cholesterol ◽  
Predictive Marker ◽  
Serum Levels ◽  
Arterial Calcification ◽  
The Metabolic Syndrome

       Some studies indicated a relationship between increased serum levels of osteoprotegerin with arterial calcification and as a result, it leads to the risk of cardiovascular disease. In our study group we selected patients with osteoporosis, with similar age and body mass index for the assessment of the relationship between cardiovascular disease and osteoprotegerin serum level. We took into account the analysis of correlation and association between the presence of distinct patterns of atherosclerosis and associated diseases like high blood pressure,  diabetes mellitus, low HDL cholesterol, increased LDL cholesterol, increased triglycerides and was the case of presence of any type of dyslipidemia, in case of pre-existent treatment. Objective of study was the assessment of osteoprotegerin value as predictive marker for cardiovascular and metabolic risk in osteoporotic patients. Our results showed significant correlations of parathyroid hormone, osteocalcin and biochemical markers of bone with glucose metabolism and lipid were found in our research, maintaining crosstalk between calcium and biochemical markers of bone and cardiovascular risk. The serum level of Osteoprotegerin has been shown to have a large predictive value for the metabolic syndrome as a cardiovascular risk standard in patients with osteoporosis. The osteoprotegerin serum levels were increased in the patients with metabolic syndrome as a protective response facing the atherosclerotic lesions.

scholarly journals Vitamin D and Hospital Admission in Older Adults: A Prospective Association

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 616
Author(s):  
Avril Beirne ◽  
Kevin McCarroll ◽  
James Bernard Walsh ◽  
Miriam Casey ◽  
Eamon Laird ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Hospital Admission ◽  
Cross Sectional Study ◽  
Vitamin D Supplementation ◽  
Inverse Association ◽  
Cross Sectional ◽  
Prospective Association ◽  
Randomised Controlled

The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996; 95% Confidence Interval (CI) 0.995–0.998; p < 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p < 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996; 95% CI 0.994–0.998; p < 0.001) and length of stay (LOS) (β = −0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.

scholarly journals Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

2020 ◽  
Vol 21 (24) ◽  
pp. 9768
Author(s):  
Eleni Gavriilaki ◽  
Ioanna Sakellari ◽  
Panagiota Anyfanti ◽  
Ioannis Batsis ◽  
Anna Vardi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cell Transplantation ◽  
Vascular Injury ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Coagulant Activity

(1) Background: survivors of allogeneic hematopoietic cell transplantation (alloHCT) suffer from morbidity and mortality due to cardiovascular events. We hypothesized that vascular injury and pro-coagulant activity are evident in alloHCT survivors without existing alloHCT complications or relapse. (2) Methods: we enrolled consecutive adult alloHCT survivors without established cardiovascular disease and control individuals matched for traditional cardiovascular risk factors (January–December 2019). Circulating microvesicles (MVs) of different cellular origins (platelet, erythrocyte, and endothelial) were measured by a standardized flow cytometry protocol as novel markers of vascular injury and pro-coagulant activity. (3) Results: we recruited 45 survivors after a median of 2.3 (range 1.1–13.2) years from alloHCT, and 45 controls. The majority of patients suffered from acute (44%) and/or chronic (66%) graft-versus-host disease (GVHD). Although the two groups were matched for traditional cardiovascular risk factors, alloHCT survivors showed significantly increased platelet and erythrocyte MVs compared to controls. Within alloHCT survivors, erythrocyte MVs were significantly increased in patients with a previous history of thrombotic microangiopathy. Interestingly, endothelial MVs were significantly increased only in alloHCT recipients of a myeloablative conditioning. Furthermore, MVs of different origins showed a positive association with each other. (4) Conclusions: endothelial dysfunction and increased thrombotic risk are evident in alloHCT recipients long after alloHCT, independently of traditional cardiovascular risk factors. An apparent synergism of these pathophysiological processes may be strongly involved in the subsequent establishment of cardiovascular disease.

scholarly journals Associations of n-3 Fatty Acids and Fish Consumption with the Metabolic Syndrome in College Students (P18-022-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Nicole Karazurna ◽  
Caitlin Porter ◽  
Jesse Stabile Morrell ◽  
Sherman Bigornia
Keyword(s):  
Risk Factors ◽  
College Students ◽  
Metabolic Syndrome ◽  
Young Adults ◽  
Fish Consumption ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Age Related

Abstract Objectives Evidence suggests that omega-3 fatty acid (n-3 FA) and fish consumption may reduce the risk of the metabolic syndrome (MetS) in older adults. We previously reported that MetS components are prevalent among college students. Identifying modifiable risk factors of developing MetS and its components in young adults will inform potential targets to reduce the risk of age-related health conditions. Our objectives were to measure the cross-sectional impacts of n-3 FA and fish consumption on ≥2 or ≥3 MetS criteria and individual criteria among college students. Methods The College Health and Nutrition Assessment Survey is an on-going cross-sectional study at a public New England college. We examined data from Jan 2008 – May 2017. After excluding those with missing data our final sample size was n = 4271 for n-3 FA & n = 2072 for fish intake analyses. Diet was assessed by a 3 day food record; MetS criteria were collected in fasted state. We expressed n-3 FAs as g/1000 kcals/d. Servings of fish/week was obtained via an online survey. Individuals were categorized as consuming ≥ 2 servings/week or not. MetS was defined as meeting ≥ 3 criteria: elevated glucose, triglycerides, blood pressure, waist circumference, and low HDL. Analyses were conducted by logistic regression. Results The average n-3 FA intake was 0.4 g/1000 kcal/d ± 0.25 & 40% consumed ≥ 2 servings of fish/week. Prevalence estimates for meeting ≥ 2 criteria was 18.8% and 4.8% for MetS. In sex- and energy- adjusted models, n-3 FA consumption was inversely associated with MetS (OR = 0.38; 95%CI: 0.20, 0.71) and ≥2 MetS criteria (OR = 0.67; 95%CI: 0.49, 0.91). Associations were no longer significant after considering additional confounders. Fish consumption was not significantly associated with MetS or ≥2 criteria in any model. Further n-3 FAs and fish consumption was not associated with any individual MetS criteria. Conclusions In this cross-sectional study among college students, n-3 FA and fish consumption were not significantly associated with MetS outcomes. Further research is needed in this population using longitudinal study designs to understand long-term impact of n-3 consumption on the development of MetS and associated cardio metabolic risk factors in young adults. Funding Sources New Hampshire Agriculture Experiment Station and USDA National Institute of Food and Agriculture Hatch Project 1010738.

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