scholarly journals Elevated Serum Lipid Peroxidation and Reduced Vitamin C and Trace Element Concentrations Are Correlated With Epilepsy

2018 ◽  
Vol 50 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Abhijit Das ◽  
Md. Shahid Sarwar ◽  
Md. Shohel Hossain ◽  
Palash Karmakar ◽  
Mohammad Safiqul Islam ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Trace Elements ◽  
Vitamin C ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Control Group ◽  
Increased Risk ◽  
Study Results ◽  
Epileptic Patients

Background. Epilepsy is one of the chronic and heterogeneous epidemic neurological disorders leading to substantial mortality. The aim of the present study was to investigate the serum levels of malondialdehyde (MDA), vitamin C, and trace elements namely zinc (Zn), copper (Cu), and manganese (Mn) in epileptic patients of Bangladesh and to establish if there are any pathophysiological correlations. Methods. This was a case-control study with 40 generalized epileptic patients and 40 healthy subjects as controls. Epilepsy was determined by the presence of seizure events with an abnormal electroencephalography and magnetic resonance imaging report of brain. Results. Anthropometric parameters highlighted that age is a major risk factor of epilepsy and men are more prone to epilepsy than women. Blood serum analysis demonstrated significantly ( P < .001) higher values of MDA and lower level of vitamin C in the patient group (4.41 ± 0.76 μmol/mL and 18.31 ± 0.84 μmol/L, respectively) compared with control (1.81 ± 0.70 μmol/mL and 29.72 ± 1.06 μmol/L, respectively). Pearson’s correlation analysis revealed a negative correlation between the serum level of MDA and vitamin C for both patient ( r = −0.023, P = .887) and control group ( r = −0.142, P = .383). This study also revealed that the trace elements (Zn, Cu) were significantly ( P < .05) lower in epileptics (68.32 ± 4.59 and 50.81 ± 2.54 μg/dL, respectively) where the level of Mn in patients (187.71 ± 9.04 μg/dL) was almost similar to that of the control group ( P > .05). The univariate analysis demonstrated that zinc <70 μg/dL (odds ratio = 3.56, P < .05) and copper <50 μg/dL were associated (odds ratio = 14.73, P < .001) with an increased risk of epilepsy. Establishment of interelement relationship strongly supported that there was a disturbance in the element homeostasis of epileptic patients. Conclusions. The study results strengthen the role of lipid peroxidation, antioxidants and trace elements in the pathogenesis and warrant larger studies to investigate the association of these biochemical parameters with epilepsy.

Do Children Who Experience Laryngospasm Have an Increased Risk of Upper Respiratory Tract Infection?

1996 ◽  
Vol 85 (3) ◽  
pp. 475-480. ◽  
Author(s):  
Mark S. Schreiner ◽  
Irene O'Hara ◽  
Dorothea A. Markakis ◽  
George D. Politis
Keyword(s):  
Confidence Interval ◽  
Respiratory Infection ◽  
Odds Ratio ◽  
Signs And Symptoms ◽  
Control Group ◽  
Upper Respiratory Tract ◽  
Upper Respiratory Infection ◽  
Airway Surgery ◽  
Increased Risk ◽  
Upper Respiratory

Background Laryngospasm is the most frequently reported respiratory complication associated with upper respiratory infection and general anesthesia in retrospective studies, but prospective studies have failed to demonstrate any increase in risk. Methods A case-control study was performed to examine whether children with laryngospasm were more likely to have an upper respiratory infection on the day of surgery. The parents of all patients (N = 15,183) who were admitted through the day surgery unit were asked if their child had an active or recent (within 2 weeks of surgery) upper respiratory infection and were questioned about specific signs and symptoms to determine if the child met Tait and Knight's definition of an upper respiratory infection. Control subjects were randomly selected from patients whose surgery had occurred within 1 day of the laryngospasm event. Results Patients who developed laryngospasm (N = 123) were 2.05 times (95% confidence interval 1.21-3.45) more likely to have an active upper respiratory infection as defined by their parents than the 492 patients in the control group (P &lt; or = 0.01). The development of laryngospasm was not related to Tait and Knight's definition for an upper respiratory infection or to recent upper respiratory infection. Children with laryngospasm were more likely to be younger (odds ratio = 0.92, 95% confidence interval 0.87-0.99), to be scheduled for airway surgery (odds ratio = 2.08, 95% confidence interval 1.21-3.59), and to have their anesthesia supervised by a less experienced anesthesiologist (odds ratio = 1.69, 95% confidence interval 1.04-2.7) than children in the control group. Conclusion Laryngospasm was more likely to occur in children with an active upper respiratory infection, children who were younger, children who were undergoing airway surgery, and children whose anesthesia were supervised by less experienced anesthesiologists. Understanding the risk factors and the magnitude of the likely risk should help clinicians make the decision as to whether to anesthetize children with upper respiratory infection.

scholarly journals In Vivo Protective Effects of Gallic Acid Isolated from Peltiphyllum Peltatum Against Sodium Fluoride-Induced Oxidative Stress in Rat Erythrocytes

2013 ◽  
Vol 64 (4) ◽  
pp. 553-559 ◽  
Author(s):  
Seyed Fazel Nabavi ◽  
Solomon Habtemariam ◽  
Antoni Sureda ◽  
Akbar Hajizadeh Moghaddam ◽  
Maria Daglia ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Lipid Peroxidation ◽  
Superoxide Dismutase ◽  
Vitamin C ◽  
Gallic Acid ◽  
Sodium Fluoride ◽  
Enzyme Activities ◽  
Control Group ◽  
Rat Erythrocytes ◽  
Pre Treatment

Abstract Gallic acid has been identified as an antioxidant component of the edible and medicinal plant Peltiphyllum peltatum. The present study examined its potential protective role against sodium fluoride (NaF)-induced oxidative stress in rat erythrocytes. Oxidative stress was induced by NaF administration through drinking water (1030.675 mg m-3 for one week). Gallic acid at 10 mg kg-1 and 20 mg kg-1 and vitamin C for positive controls (10 mg kg-1) were administered daily intraperitoneally for one week prior to NaF administration. Thiobarbituric acid reactive substances, antioxidant enzyme activities (superoxide dismutase and catalase), and the level of reduced glutathione were evaluated in rat erythrocytes. Lipid peroxidation in NaF-exposed rats significantly increased (by 88.8 %) when compared to the control group (p<0.05). Pre-treatment with gallic acid suppressed lipid peroxidation in erythrocytes in a dose-dependent manner. Catalase and superoxide dismutase enzyme activities and glutathione levels were reduced by NaF intoxication by 54.4 %, 63.69 %, and 42 % (p<0.001; vs. untreated control group), respectively. Pre-treatment with gallic acid or vitamin C significantly attenuated the deleterious effects. Gallic acid isolated from Peltiphyllum peltatum and vitamin C mitigated the NaF-induced oxidative stress in rat erythrocytes.

The effects of desferrioxamine on cisplatininduced lipid peroxidation and the activities of antioxidant enzymes in rat kidneys

2004 ◽  
Vol 23 (1) ◽  
pp. 29-34 ◽  
Author(s):  
G Kadikoylu ◽  
Z Bolaman ◽  
S Demir ◽  
M Balkaya ◽  
N Akalin ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Enzymes ◽  
Vitamin C ◽  
Isotonic Saline ◽  
Control Group ◽  
Antioxidant Enzyme Activities ◽  
Group V ◽  
Super Oxide Dismutase ◽  
Cervical Dislocation ◽  
Rat Kidneys

Cisplatin-induced nephrotoxicity is associated with an increase in lipid peroxidation and oxygen free radicals in rat kidneys. In this study, the effects of desferrioxamine were compared to vitamin C and E on cisplatin-induced lipid peroxidation and antioxidant enzyme activities in rat kidneys. Rats were divided into five groups, with 15 Wistar rats in each group. In the control group, rats received 1 mL/100 g isotonic saline solution intraperitoneally (i.p.). In Group II, 10 mg/kg cisplatin i.p. was injected to rats. Thirty minutes before the same dosage of cisplatin administration, 100 mg/kg i.p. vitamin C or E was given to rats in groups III and IV, respectively. Rats in Group V received 250 mg/kg desferrioxamine i.p., before the same dose of cisplatin administration. All rats were killed by cervical dislocation after 72 hours. The kidneys were immediately removed and washed in cold saline. Spectrophotometric method was used for all analyses. While catalase, glutathione reductase (GR), and super oxide dismutase (SOD) levels were found to be significantly decreased (P B < 0.001), malondialdehyde (MDA) (P < 0.05) and hydrogen peroxide (H2O2) (P < 0.001) levels were significantly increased in the cisplatin group when compared to the controls. MDA levels were decreased by desferrioxamine (P < 0.005) as well as vitamin C and E (P < 0.05 and P < 0.001, respectively). These three compounds induced a significant increase in SOD levels (P B < 0.05), but only in the vitamin C group, were SOD levels not significantly different than the levels of the controls (P > 0.05). In the desferrioxamine (P < 0.05), vitamin C and E groups (P < 0.001 for both), the cisplatin elevated H2O2 levels were decreased. None of these drugs had any effect on GR and catalase levels (P > 0.05). Desferrioxamine is useful to prevent cisplatin-induced lipid peroxidation, however, vitamin C and E are more effective on antioxidant enzymes than desferrioxamine.

scholarly journals Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

2021 ◽  
Vol 67 (4) ◽  
pp. 409-415
Author(s):  
Köksal Sarıhan ◽  
Hülya Uzkeser ◽  
Akın Erdal
Keyword(s):  
Social Isolation ◽  
Fall Risk ◽  
Nottingham Health Profile ◽  
Risk Index ◽  
Control Group ◽  
Healthy Individuals ◽  
Increased Risk ◽  
Study Results ◽  
Significant Difference ◽  
Risk Of Falls

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

scholarly journals INCREASED URINARY 8-OXO-7,8-DIHYDRO-2′-DEOXYGUANOSINE EXCRETION IN A SAMPLE OF EGYPTIAN CHILDREN WITH BETA THALASSEMIA MAJOR: MARKER FOR LIPID PEROXIDATION-INDUCED DNA DAMAGE

2017 ◽  
Vol 10 (12) ◽  
pp. 171
Author(s):  
Mona A Elabd ◽  
Dina Abu Zeid ◽  
Marwa A Elhady ◽  
Maged A El Wakeel ◽  
Ghada M El-kassas ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Dna Damage ◽  
Urinary Excretion ◽  
Serum Ferritin ◽  
Negative Correlation ◽  
Significant Negative Correlation ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Increased Risk ◽  
Egyptian Children

Objective: The objective of this research was to evaluate oxidative stress status in children with β-thalassemia major.Methods: Our study was conducted in children with β-thalassemia aged from 5 to 15 years. Investigate the urinary excretion of human 8-oxo-7,8- dihydro-2′-deoxyguanosine, which will be analyzed by enzyme-linked immunosorbent assay. To investigate serum levels of antioxidant enzymes include glutathione s-transferase (GST) and catalase (CAT).Results: We found a significant elevation of the urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine level with p=0.001 compared to control group, a significant reduction of both GST and CAT p=0.05 and 0.03, respectively, compared to control group. There was a significant negative correlation between urinary 8-oxo-7,8-dihydro-2′-deoxyguanisine and CAT level, r=−0.378, p=0.016, hemoglobin - r=−0.610, p=0.001, hematocrit (%) - r=−0.478, p=0.002, while a significant positive correlation between urinary 8-oxo-7,8-dihydro-2′-deoxyguanisine and alanine aminotransferase - r=0.547, p=0.001, and serum ferritin - r=0.391, p=0.013. There was a significant negative correlation between CAT and serum ferritin - r=−0.320, p=0.44.Conclusion: We conclude that the strongly increased urinary excretion 8-oxo-7,8=dihydro-2′-deoxyguanisine indicates elevated lipid peroxidation induced DNA damage in internal organs such as the liver. These highly pro mutagenic lesions may contribute to the increased risk of thalassemia patients to develop hepatocellular carcinoma.

Increased Risk of Sternal Complications in Patients with Plasma Cell Dyscrasias (PCDs) Undergoing Coronary Artery Bypass Graft (CABG)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5319-5319
Author(s):  
Malini M Patel ◽  
Shams B Bufalino ◽  
Anai N Kothari ◽  
Paul C Kuo ◽  
Sucha Nand
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Increased Risk

Abstract Introduction: Skeletal events, including fractures, form an important part of the clinical spectrum of PCDs. Skeletal surveys, even though less sensitive than MRI, remain the usual method of screening for lytic lesions and fractures in these patients but may miss subtle abnormalities. Patients undergoing a CABG normally require a midline sternal incision, which may increase the risk of a skeletal event. Patients with PCDs also have an increased risk of infection, thrombosis, and renal failure. To our knowledge, there is no published data about complications of cardiothoracic surgery in these patients. We hypothesized that patients with PCDs will have a higher risk of complications when compared to those without such history. Methods: Data on patients who underwent non-urgent coronary artery bypass graft (CABG) surgery from 2007 to 2011 was obtained by querying the Healthcare Cost and Utilization State Inpatient Databases for Florida and California. Information was available only for the inpatient stay plus a 30-day follow-up period. Diagnoses of multiple myeloma and monoclonal gammopathy of unknown significance (MGUS) were identified using ICD-9-CM codes. Mixed-effects logistic models were used to measure the association between PCDs and postoperative sternal complications controlling for demographics and comorbidity. Secondary outcomes of study in bivariate analysis included postoperative complications and 30-day readmission rates. Results: A total of 54,422 patients who underwent non-urgent CABG were identified. Of those patients, 500 were known to have a PCD. Ninety two percent of those patients (462 out of 500) had a diagnosis of MGUS. Median age was 66.6 years for the control group and 65.4 years in the PCDs group, and the male to female ratio was equal in both cohorts. In the PCD group, there was a statistically significant higher incidence of anemia, obesity, and renal failure prior to surgical intervention. Sternal infections occurred in 519 (1%) of the patients in the control group versus 18 (3.6%) of the patients in PCDs group (p<0.001). The 30-day all cause readmission rate was similar between the two groups but the 30-day sternal complication rate was significantly higher in the PCDs group (6.8% vs 3.7%; p<0.001). The odds ratio of sternal infection was 3.84 (CI 2.38-6.20) and the odds ratio of sternal dehiscence was 3.87 (CI 1.98-7.57) in the PCDs group when compared to the control group, both of which are statistically significant. Similarly, the odds ratio of sternal complications at 30-days was 1.92 (CI 1.35-2.73) in the PCDs group when compared to the control group. There were no statistically significant differences in the rates of postoperative myocardial infarctions, strokes, urinary tract infections, acute kidney injury, pneumonias, deep venous thrombosis, and gastrointestinal complications between the two cohorts. Conclusions: Our data shows that patients with PCDs have a lower hemoglobin level, renal insufficiency, and are obese at the time of coronary bypass surgery. It is important to note that the majority of the subjects in our study population had MGUS, a condition usually associated with little morbidity. Nonetheless, our cohort of patients with PCDs had a significantly increased risk of sternal wound infection and dehiscence. The treating physicians should be aware of these risks and patients should be informed. Prospective studies will be necessary to confirm and extend these findings. Disclosures No relevant conflicts of interest to declare.

scholarly journals Effect of Menopause on Low Density Lipoprotein

2016 ◽  
Vol 4 (2) ◽  
pp. 32-36
Author(s):  
Shafeya Khanam ◽  
Nahid Reaz ◽  
Shahnaj Akter Jahan ◽  
Mirza Md Asaduzzaman ◽  
Ayesha Siddika Purabi ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Ldl Cholesterol ◽  
Elevated Serum ◽  
Premenopausal Women ◽  
Outcome Variable ◽  
Control Group ◽  
Case Group ◽  
Natural Menopause ◽  
Increased Risk ◽  
Significant Difference

Background and Objectives: The present study was done on postmenopausal and premenopausal women with an objective to evaluate the effect of menopause on LDL cholesterol. Patients & Methods: The cross-sectional analytical study was done in the Departments of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka over a period 1 year between July 2012 to June 2013. A total of 60 women who underwent natural menopause were consecutively included in the study as case, while an equal number of premenopausal women were included as control. The outcome variable was level of serum LDL cholesterol. Result: The study demonstrated that 60% of postmenopausal women were > 50years old with mean age being 51.2 ± 2.7 years, whereas 40% of premenopausal women were in their 4th decades life with mean age being 39.1 ± 8.1 years (p = 0.001). There was no significant difference between the groups in terms of BMI with mean BMI of the former and the later groups being 24.45 ± 3.43 and 23.76 ± 3.46 kg/m2. The mean serum cholesterol was observed to be significantly higher in case group than that in the control group (212.3 ± 50.1 vs. 186.3 ± 38.2 mg/dl, p = 0.002). The LDL cholesterol was also significantly higher in the case group than that in the control group (141.47 ± 47.9 vs. 124.2 ± 31.5 mg/dl, p < 0.001). However, the groups were almost homogeneous with respect to HDL cholesterol and triglycerides (38.2 ± 5.0 vs. 37.6 ± 5.3 mg/dl, p =0.526 and 167.0 ± 67.2 vs. 181.0 ± 82.6 3 mg/dl, p = 0.311 respectively). Nearly three-quarters (73.3%) of the cases exhibited elevated serum LDL cholesterol compared to one-third (33.3%) of the controls. The risk of having raised LDL in case is more than 5(95% CI = 2.5 – 12.1) times higher than that in controls. The correlation graph between duration of menopause and serum LDL level showed that the two variables bear linear relationship (r = +0.338, p = 0.008). Conclusion: The postmenopausal women are at increased risk of having higher LDL cholesterol than the premenopausal women and longer the duration of menopause the higher the level of LDL Cholesterol. Ibrahim Cardiac Med J 2014; 4(2): 32-36

The Association Between Serum Leptin Levels and Cardiovascular Events in Patients with Rheumatoid Arthritis

2020 ◽  
Vol 52 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Jiliang Chen ◽  
Zhiping Xie ◽  
Zou Bin
Keyword(s):  
Rheumatoid Arthritis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Confounding Factors ◽  
Serum Leptin ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Objective Cardiovascular diseases (CVDs) are important complications for patients with rheumatoid arthritis (RA). The study aimed to explore whether serum leptin is associated with a increased risk of cardiovascular (CV) events in patients with RA. Methods Two hundred twenty-three patients with RA were followed for a mean of 40 (range = 8-42) months. Serum leptin levels were measured at baseline. Cox regression analysis was performed to assess the association between leptin levels and the risk of CV events. Results The univariate analysis showed that patients with RA with higher serum leptin levels had higher rates of CV events and CV mortality, respectively (P &lt;.001). The logistic regression model showed that leptin was independently related to CVD history (odds ratio = 1.603, 95% confidence interval [CI], 1.329–2.195; P =.005) after adjusting for confounding factors in patients with RA at baseline. The multivariate Cox proportional hazard model suggested that leptin was an independent prognostic factor for CV events in patients with RA after adjustments were made for clinical confounding factors (hazard ratio = 2.467, 95% CI, 2.019–4.495; P &lt;.001). The Kaplan-Meier analysis showed that compared with patients with RA with leptin levels below the median value (≤15.4 mg/L), patients with leptin above the median value (&gt;15.4 μg/L) had a higher rate of CV events (P &lt;.001). Conclusion Leptin was significantly associated with CV events in patients with RA. Elevated serum leptin levels may be a reliable prognostic factor for predicting CV complications in patients with RA.

The relation between cigarette smoking with delivery outcomes. An evaluation of a database of more than nine million deliveries

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ido Feferkorn ◽  
Ahmad Badeghiesh ◽  
Haitham Baghlaf ◽  
Michael H. Dahan
Keyword(s):  
Pregnant Women ◽  
Odds Ratio ◽  
Perinatal Death ◽  
Post Partum ◽  
Mode Of Delivery ◽  
Control Group ◽  
Prenatal Smoking ◽  
Large Database ◽  
Delivery Outcomes ◽  
Increased Risk

Abstract Objectives Smoking in pregnancy is associated with an increased risk of preterm birth (PTB), intrauterine growth restriction, placental abruption and perinatal death. The association between smoking and other delivery outcomes, such as chorioamnionitis, mode of delivery or post partum hemorrhage (PPH), however, is insufficient as only few studies addressed these issues. The aim of the study was to evaluate the association between prenatal smoking and delivery outcomes in a large database, while controlling for confounding effects. Methods A retrospective population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP‐NIS). A dataset of all deliveries between 2004 and 2014 (inclusively) was created. Our control group included all pregnant women who did not smoke during pregnancy, which was compared to pregnant women who smoked. A multivariate logistic analysis was conducted, adjusting for any statistically significant confounding effects. Results Our study identified 9,096,788 births between 2004 and 2014. Of which, 443,590 (4.8%) had a documented diagnosis of smoking. A significantly higher risk was found for PTB (odds ratio 1.39, CI 1.35–1.43), preterm premature rupture of membranes (odds ratio 1.52, CI 1.43–1.62) and small for gestational age (SGA) neonates (odds ratio 2.27, CI 2.19–2.35). The risks of preeclampsia (odds ratio 0.82, CI 0.78–0.85), chorioamnionitis (odds ratio 0.88, CI 0.83–0.4), PPH (odds ratio 0.94 CI 0.9–0.98) and operative vaginal delivery (odds ratio 0.9, CI 0.87–0.94) were lower among smokers. Conclusions This large database confirms the findings of previous smaller studies, according to which smoking decreases the risk of preeclampsia while increasing the risk of PTB and SGA neonates. The current study also revealed a decreased risk for PPH as well as for chorioamnionitis among pregnant smokers.

The Risk of Venous Thrombosis Related to Increase in Body Mass Index Is Mediated by Factor VIII Induced APC-Resistance.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 453-453 ◽  
Author(s):  
Willem M Lijfering ◽  
Sverre C Christiansen ◽  
Inger-Anne Naess ◽  
Jens Hammerstrøm ◽  
Astrid van Hylckama Vlieg ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Blood Group ◽  
Odds Ratio ◽  
Reference Group ◽  
Control Group ◽  
Odds Ratios ◽  
Apc Resistance ◽  
Increased Risk ◽  
Fv Leiden ◽  
High Bmi

Abstract Abstract 453 Background: The reason why a high BMI predisposes to venous thrombosis is not clarified. People with overweight or obesity tend to be more immobile which may lead to clot formation through stasis. It is also possible that these subjects acquire a prothrombotic state. Factor (F) VIII can be released by adipose tissue through inflammatory cytokines, which consequently might induce APC-resistance. This APC-resistance could be aggravated in case FV Leiden is also present. In addition, presence of high levels of FVIII in non-O blood group subjects could worsen this further. Objective: To determine whether an association exists between BMI and APC-resistance, and whether the combination of both high BMI and APC-resistance increased the risk of venous thrombosis in the Leiden Trombophilia Study (LETS). Whether increasing FVIII levels induced APC-resistance was also studied. In a pooled analysis of LETS and a Norwegian case-cohort study (TROL), we verified if FV Leiden modified the risk of increasing BMI on the occurence of venous thrombosis and whether these risks were further increased by blood group non-O. Methods: Linear regression was used to determine the relation between increasing APC-resistance and BMI, increasing FVIII levels and BMI, increasing APC-resistance and FVIII levels, and between increasing APC-resistance and BMI adjusted for FVIII levels. Cut-off points needed to create tertile categories of APC-resistance were derived from the control-group of the LETS and the TROL population separately. Logistic regression was used to calculate odds ratios and their 95% confidence intervals, adjusted for age and sex. To make the TROL and LETS population more similar for the current analysis, we restricted the analysis in the TROL subjects to those who were younger than 70 and to those who had a DVT only (n=183 cases and n=696 controls). Results: APC-resistance increased linearly with increasing BMI. A same phenomenon was observed for FVIII, i.e. an increase of BMI led to higher FVIII levels. Increased APC-resistance was in its turn associated with an increase of FVIII levels. FVIII explained part of the relation between APC and BMI, as the slope of the regression line of APC-resistance on BMI levels decreased after adjustment for FVIII. To examine the effect of increasing BMI, independent of existing APC-resistance, on the risk of venous thrombosis, we restricted the analysis to subjects from the LETS in whom APC-resistance was not related to other factors such as FV Leiden or oral contraceptive use. In these subjects (n=237 cases and n=369 controls), the risk of venous thrombosis increased 1.4-fold for those with a BMI in the median tertile (odds ratio 1.4; 95% CI, 0.9-2.3) and 2.5-fold for those in the upper tertile (odds ratio 2.5; 95% CI, 1.6-3.9), as compared to subjects in the lowest tertile. Adjustment for APC-resistance or FVIII led to a slight decrease in these relative risk estimates. Non-FV Leiden-carriers with blood group O were only at risk of venous thrombosis when they had a BMI in the upper tertile compared to non-FV Leiden-carriers with blood group O and a BMI in the lowest tertile; (adjusted odds ratio 1.9). This risk was modestly increased when non FV Leiden carriers with non-O blood group were compared with this reference group, with adjusted odds ratios of 1.5, 2.4 and 3.4, respectively, within the BMI tertiles. This risk was strongly increased when FV Leiden carriers with blood group O were compared to the reference group, with adjusted odds ratios of 3.0, 8.3 and 9.7, respectively, within the BMI tertiles. Risk of FV Leiden carriers with non-O blood group showed the highest risk of venous thrombosis compared to the reference group, no longer in a dose-response way, with adjusted odds ratios of 40.6, 23.3 and 25.2, respectively, within the BMI tertiles. Conclusion: The increased risk of venous thrombosis in subjects with high BMI is mediated by FVIII induced APC-resistance. Subjects with FV Leiden and increasing BMI had a higher risk of venous thrombosis compared to non-carriers, and this risks was more than 20 fold increased in carriers of blood group non-O and FV Leiden. Future studies are needed to show if these risks can be downgraded by weight loss. Disclosures: No relevant conflicts of interest to declare.

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