scholarly journals SAT-LB76 Impact of Glucocorticoid Cosecretion in Primary Aldosteronism on Thyroid Autoantibody Titers During the Course of Disease

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Laura Handgriff ◽  
Christian Adolf ◽  
Daniel Heinrich ◽  
Leah Braun ◽  
Roland Ladurner ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Thyroid Autoantibody ◽  
Late Night ◽  
Cerebrovascular Events ◽  
Late Night Salivary Cortisol ◽  
Increased Risk ◽  
Mineralocorticoid Antagonist ◽  
Urinary Cortisol Excretion ◽  
Suppression Test ◽  
The Impact

Abstract Context: Excess aldosterone is associated with the increased risk of cardio- and cerebrovascular events as well as metabolic comorbidities not only due to its hypertensive effect but also due to its proinflammatory action. Autonomous cortisol secretion (ACS) in the setting of primary aldosteronism (PA) is known to worsen cardiovascular outcome and potentially exhibit immunosuppressive effects.The aim of this study was to determine the impact of ACS status in patients with PA on kinetics of thyroid autoantibodies (anti-TPO, anti-TG) pre and post therapy initiation. Patients and Methods: 97 PA patients (43 with unilateral, 54 with bilateral PA) from the database of the German Conn’s Registry were included. Anti-TPO and anti-TG levels were measured pre and 6 to 12 months post therapeutic intervention. Patients were assessed for ACS according to their 24h urinary cortisol excretion, late night salivary cortisol and low-dose dexamethason suppression test. Results: Abnormal test results in line with ACS were identified in 74.2% of patients. Significant increases in anti-TPO levels were observed in adrenalectomized patients with at least one abnormal test (p = 0.049), adrenalectomized patients with at least two pathological ACS tests (p = 0.015) and adrenalectomized patients with pathologic dexamethasone suppression tests (p = 0.018). No antibody increases were observed in unilateral PA patients without ACS and in patients with bilateral PA receiving mineralocorticoid antagonist therapy. Conclusion: ACS appears to be a relevant factor in PA affecting thyroid autoimmune disease. The biochemical and clinical course maybe be exacerbated after resolution of hypercortisolism by adrenalectomy in PA.

scholarly journals The Impact of Glucocorticoid Co-Secretion in Primary Aldosteronism on Thyroid Autoantibody Titers During the Course of Disease

2020 ◽  
Vol 52 (06) ◽  
pp. 404-411
Author(s):  
Laura Handgriff ◽  
Christian Adolf ◽  
Daniel A. Heinrich ◽  
Leah Braun ◽  
Nina Nirschl ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Thyroid Autoantibody ◽  
Late Night ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Mineralocorticoid Antagonist ◽  
Urinary Cortisol Excretion ◽  
Suppression Test ◽  
The Impact ◽  
Dexamethasone Suppression

AbstractExcess aldosterone is associated with the increased risk of cardio-/cerebrovascular events as well as metabolic comorbidities not only due to its hypertensive effect but also due to its proinflammatory action. Autonomous cortisol secretion (ACS) in the setting of primary aldosteronism (PA) is known to worsen cardiovascular outcome and potentially exhibit immunosuppressive effects. The aim of this study was to determine the impact of ACS status in patients with PA on kinetics of thyroid autoantibodies (anti-TPO, anti-TG) pre and post therapy initiation. Ninety-seven PA patients (43 unilateral, 54 with bilateral PA) from the database of the German Conn’s Registry were included. Anti-TPO and anti-TG levels were measured pre and 6–12 months post therapeutic intervention. Patients were assessed for ACS according to their 24- hour urinary cortisol excretion, late night salivary cortisol and low-dose dexamethasone suppression test. Abnormal test results in line with ACS were identified in 74.2% of patients with PA. Following adrenalectomy, significant increases in anti-TPO levels were observed in patients with at least one abnormal test (p = 0.049), adrenalectomized patients with at least two pathological ACS tests (p = 0.015) and adrenalectomized patients with pathologic dexamethasone suppression tests (p = 0.018). No antibody increases were observed in unilateral PA patients without ACS and in patients with bilateral PA receiving mineralocorticoid antagonist therapy (MRA). Our data are in line with an immunosuppressive effect of mild glucocorticoid excess in PA on thyroid autoantibody titers. This effect is uncovered by adrenalectomy, but not by MRA treatment.

scholarly journals 625 Cluster analysis of weather and pollution features and its role in predicting acute cardiac or cerebrovascular events

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alberto Testa ◽  
Sabrina Anticoli ◽  
Francesca Romana Pezzella ◽  
Marilena Mangiardi ◽  
Alessandro Di Giosa ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cluster Analysis ◽  
Hierarchical Clustering ◽  
Metropolitan Area ◽  
Unsupervised Machine Learning ◽  
Large Metropolitan Area ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
The Impact ◽  
Cluster 2

Abstract Aims The impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised. The aim of this study was to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events. Methods and results Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from three tertiary care centre from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for environmental protection, and from the Meteorologic Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rate of acute cardiac and cerebrovascular events with Poisson models. As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated four separate clusters: Cluster 1, including 60 (5.1%) days, Cluster 2 with 419 (35.8%) days, Cluster 3 with 673 (57.6%) days, and Cluster 4 with 17 (1.5%) days, with significant between-cluster differences in weather and pollution features. Notably, Cluster 1 was characterized by low temperatures and high ozone concentrations (P < 0.001). Overall cluster-wise comparisons showed significant overall differences in adverse cardiac and cerebrovascular events (P < 0.001), as well as in cerebrovascular events (P < 0.001) and strokes (P = 0.001). Between-cluster comparisons showed that Cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to Cluster 2, Cluster 3, and Cluster 4 (all P < 0.05), as well as AMI in comparison to Cluster 3 (P = 0.047). In addition, Cluster 2 was associated with a higher risk of strokes in comparison to Cluster 4 (P = 0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events, and strokes for Cluster 1 and Cluster 2. Conclusions Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increases risk of acute cardiovascular events, especially cerebrovascular events.

scholarly journals Diagnostic value of salivary cortisol in 1-mg dexamethasone suppression test

2020 ◽  
Vol 17 (1) ◽  
pp. 13-21
Author(s):  
Zhanna E. Belaya ◽  
Anastasia A. Malygina ◽  
Tatiana A. Grebennikova ◽  
Aleksandr V. Il'yin ◽  
Liudmila Ya. Rozhinskaya ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Salivary Cortisol ◽  
Serum Cortisol ◽  
Dexamethasone Suppression Test ◽  
Histological Evaluation ◽  
Diagnostic Study ◽  
Late Night ◽  
Late Night Salivary Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression

BACKGROUND: Late-night salivary cortisol and serum cortisol measurements after 1-mg Dexamethasone Suppression Test (1-mg DST) are routinely used to diagnose Cushings syndrome (CS). Measuring morning salivary instead of serum cortisol after 1-mg DST would make the diagnostics of CS fully non-invasive. AIM: To evaluate the diagnostic accuracy of salivary cortisol in 1-mg DST as measured by electrochemiluminescence assay (ECLIA). MATERIALS AND METHODS: We combined a cohort diagnostic study, including 164 participants (132 females, 32 males) aged from 18 to 77 years: 110 were overweight or obese as increased BMI is the most common sign of Cushings Syndrome (CS), and 54 healthy volunteers. In each cohort late-night salivary cortisol was measured (at 23:00) followed by 1-mg DST and blood and salivary sampling for cortisol measurement the next morning at 08:00-09:00. Cortisol in saliva and serum were measured on automatic analyzer Cobas е 601 by F. Hoffmann-La Roche Ltd, using ECLIA. The final diagnosis was confirmed by the histological evaluation after surgery or using a follow-up observation in patients with obesity to exclude Cushings syndrome manifestation. RESULTS: Among 110 patients, 54 subjects were finally confirmed as having Cushing's syndrome. Reference interval for salivary cortisol after 1-mg DST was estimated to be 0,512,7 nmol/l (595 procentile). Maximal salivary cortisol level in 1-mg DST registered in healthy person was 29,6 mmol/l. Areas under the curve (AUC) were as following: for salivary cortisol in 1-mg DST 0,838 (95% СI 0,7720,905), for blood cortisol in 1-mg DST 0,965 (95% CI 0,9390,992) and for late-night salivary cortisol 0,925 (95% CI 0,8820,969). The optimal cut-off point for salivary cortisol after 1-mg DST was estimated as 12.1 nmol/l (sensitivity 60%, specificity 92,9%) among CS versus healthy subjects; 12,6 (sensitivity 58,2%, specificity 96,2%) among patients with obesity and CS; and 12,2 nmol/l (sensitivity 60,7%, specificity 93,4%) among CS and both obese and healthy control subjects. Considering small difference between cut-off points, the recommended cut-off value for salivary cortisol after 1-mg DST is recommended to be 12,0 nmol/l if measured by ECLIA. CONCLUSION: Although salivary cortisol after 1-mg DST is inferior to serum cortisol after 1-mg DST in the diagnostic performance and diagnostic accuracy, it can be used as a low-invasive screening test with superior specificity.

scholarly journals Effects of medical and surgical treatment on the risk of major adverse cardiovascular and cerebrovascular events in Asian women with endometriosis

2019 ◽  
Author(s):  
Hsin-Ju Chiang ◽  
Kuo-Chung Lan ◽  
Yao-Hsu Yang ◽  
John Y. Chiang ◽  
Fu-Tsai Kung ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
General Population ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Asian Women ◽  
Study Cohort ◽  
Research Database ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
The Impact

Abstract Background: Endometriosis is linked to major adverse cardiovascular and cerebrovascular events (MACCE). However, whether this finding can be applied to the Asian population remained unanswered. Additionally, results are still inconsistent for the impact of endometriosis treatment on incidental MACCE. Thus, we intended to investigate the association between endometriosis and MACCE, and study the effect of endometriosis therapies on the risk of MACCE among Asian women. Methods: The Taiwan National Health Insurance Research Database was used for this retrospective population-based cohort study from 1997 to 2013. A total of 17 543 patients with endometriosis aged between 18 and 50 years were identified from a general population of 1 million after excluding diagnoses of major cardiovascular disease (CVD) and cerebrovascular accident (CVA) prior to endometriosis. The comparison group (n = 70 172) without endometriosis was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. Demographic data and the frequency of comorbidities between groups were compared using the independent t test and chi-square test. The incidence and risk of MACCE were analyzed using the log-rank test and a multivariate Cox proportional hazards model. Results: During a median follow-up period of 9.2 years, Asian women with endometriosis had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-endometriosis counterparts (2.76% vs 2.18%, P < .001). After adjustment for comorbidities, patients with endometriosis had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .005) and a higher cumulative incidence of MACCE compared with the normal population. Among women with endometriosis, neither medical nor surgical treatment increased the risk of MACCE, including major CVD and CVA. Furthermore, medical treatment for endometriosis appeared to be protective against MACCE in the endometriosis females. Conclusion: Asian women with endometriosis not only had a higher frequency of comorbidities but also an increased risk of MACCE compared with the general population. In addition, the safety concern about medical or surgical treatment of endometriosis on the risk of MACCE was not evident in this study.

Abstract P82: The Impact of SARS-COV-2 on Stroke Epidemiology and Care: A Meta-Analysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Aristeidis H Katsanos ◽  
Lina Palaiodimou ◽  
Ramin Zand ◽  
Shadi Yaghi ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Cryptogenic Stroke ◽  
Infection Status ◽  
Stroke Patients ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
The Impact ◽  
Historical Controls

Background: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducted a systematic review and meta-analysis to evaluate the aforementioned considerations. Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI). Results: We identified 16 cohort studies including 44,004 patients. Among patients with SARS-CoV-2, 1.3% (95%CI: 0.9-1.8%; I 2 =88%) were hospitalized for cerebrovascular events, 1.2% (95%CI: 0.8-1.5%; I 2 =85%) for ischemic stroke, and 0.2% (95%CI: 0.1-0.4%; I 2 =69%) for hemorrhagic stroke. Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3.58, 95%CI: 1.43-8.92; I 2 =43%) and cryptogenic stroke (OR=3.98, 95%CI: 1.62-9.77; I 2 =0%). Odds for in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical stroke patients (OR=5.60, 95%CI: 3.19-9.80; I 2 =45%). SARS-CoV-2 infection status was not associated to the likelihood of receiving intravenous thrombolysis (OR=1.42, 95%CI: 0.65-3.10; I 2 =0%) or endovascular thrombectomy (OR=0.78, 95%CI: 0.35-1.74; I 2 =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls (OR=1.39, 95%CI: 1.04-1.86; I 2 =0%). Conclusion: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, particularly the cryptogenic subtype. SARS-CoV-2 infection in stroke substantially increases the mortality risk.

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Lea Weingarz ◽  
Marc Schindewolf ◽  
Jan Schwonberg ◽  
Carola Hecking ◽  
Zsuzsanna Wolf ◽  
...  
Keyword(s):  
Factor V Leiden ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Younger Patients ◽  
Risk Of Recurrence ◽  
G20210a Mutation ◽  
Increased Risk ◽  
The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

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