scholarly journals Meta-regression analysis of the effect of lifestyle interventions on mediators of inflammation in postmenopausal breast cancer women with cardiovascular risk factors

2019 ◽  
Author(s):  
Jean Paul Muambngu Milambo ◽  
Maritha Kotze ◽  
Erasmus Rajiv ◽  
John Akudugu ◽  
Tamuzi Lukenze Jacques
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cochrane Library ◽  
Lifestyle Interventions ◽  
Mediators Of Inflammation ◽  
The Mean ◽  
Meta Regression ◽  
Shared Risk

Abstract Background: Chronic inflammation is associated with obesity, dyslipidemia, and different types of malignancies that may play a complex role in the risk of breast cancer (BC) recurrence and therapy related side effects. The purpose of this review was to determine the effects of lifestyle interventions on mediators of inflammation (C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α)) and other therapy related adverse events in postmenopausal BCS with cardiovascular related risk factors. Methods: A systematic search for relevant articles was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis criteria using available databases (PubMed, Scopus, The Cochrane Library, OpenGrey, Google Scholar and CENTRAL). Results: Twelve eligible randomized controlled trials (RCT) met the inclusion criteria. The mean ages of postmenopausal BC women ranged from 49 to 56 years. The meta-regression revealed that there was moderate evidence that MSE decreased the mean difference (MD) of inflammatory markers in BCS, with CVD risk factors (MD: 0.31; 95% CI: 0.05 to 0.57, P=0.02; heterogeneity: Tau² = 0. 12; Chi² = 106.30, df = 19, I² = 0. 50.4%). Conclusion: There is a moderate level of evidence on the effects of MSE on mediators of inflammation in postmenopausal BCS with cardiovascular risk factors. A number of shared risk factors between postmenopausal status and CVD should be considered, while treating postmenopausal BCS.

scholarly journals The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report

2019 ◽  
Vol 31 (4) ◽  
pp. 249-255 ◽  
Author(s):  
Yohane Gadama
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Acute Stroke ◽  
Cardiovascular Risk Factors ◽  
Management Practices ◽  
Vital Signs ◽  
Central Hospital ◽  
Stroke Management ◽  
The Mean ◽  
Queen Elizabeth Central Hospital

BackgroundThe Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention.MethodsFrom April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison.ResultsFifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7–66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and <10% had their vital signs checked more than three times within the first 24 hours. Essential blood tests including random blood sugar (RBS), full blood count (FBC), urea/creatinine, and lipid profiles were performed in 72%, 68%, 48%, and 4%, respectively. An electrocardiogram was performed on 34 patients (68%). Blood pressure on admission was >140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mmHg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6–15.2), and case fatality was 18%. The modified Rankin scale at discharge was ≤2 in 32% of patients. Only four patients (8%) were transferred to a rehabilitation centre. At the time of discharge, only 32% of patients received education on stroke.ConclusionAcute stroke care is less than optimal in this setting. Simple interventions such as reducing the delay in making a stroke diagnosis, early swallow assessments, and closer monitoring of vital signs could make a significant difference in stroke outcome. Furthermore, treating cardiovascular risk factors and setting up health education programmes to improve secondary prevention represent key priorities.

scholarly journals High prevalence of obesity in rheumatoid arthritis patients: association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study

2019 ◽  
Vol 59 (1) ◽  
Author(s):  
Maria Fernanda Brandão de Resende Guimarães ◽  
Carlos Ewerton Maia Rodrigues ◽  
Kirla Wagner Poti Gomes ◽  
Carla Jorge Machado ◽  
Claiton Viegas Brenol ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Laboratory Data ◽  
Premature Cardiovascular Disease ◽  
Prevalence Of Obesity ◽  
The Mean

Abstract Introduction Rheumatoid arthritis (RA) is a well-documented independent risk factor for cardiovascular disease. Obesity may provide an additional link between inflammation and accelerated atherosclerosis in RA. Objective To evaluate the association between obesity and disease parameters and cardiovascular risk factors in RA patients. Method Cross-sectional study of a cohort of RA patients from three Brazilian teaching hospitals. Information on demographics, clinical parameters and the presence of cardiovascular risk factors was collected. Blood pressure, weight, height and waist circumference (WC) were measured during the first consultation. Laboratory data were retrieved from medical records. Obesity was defined according to the NCEP/ATPIII and IDF guidelines. The prevalence of obesity was determined cross-sectionally. Disease activity was evaluated using the DAS28 system (remission < 2.6; low 2.6–3.1; moderate 3.2–5.0; high > 5.1). Results The sample consisted of 791 RA patients aged 54.7 ± 12.0 years, of whom 86.9% were women and 59.9% were Caucasian. The mean disease duration was 12.8 ± 8.9 years. Three quarters were rheumatoid factor-positive, the mean body mass index (BMI) was 27.1 ± 4.9, and the mean WC was 93.5 ± 12.5 cm. The observed risk factors included dyslipidemia (34.3%), type-2 diabetes (15%), hypertension (49.2%) and family history of premature cardiovascular disease (16.5%). BMI-defined obesity was highly prevalent (26.9%) and associated with age, hypertension and dyslipidemia. Increased WC was associated with diabetes, hypertension, dyslipidemia and disease activity. Conclusion: Obesity was highly prevalent in RA patients and associated with disease activity.

scholarly journals Feasibility of Aerobic Interval Training in Nonambulant Persons after Stroke

2019 ◽  
Vol 8 (3) ◽  
pp. 97-101
Author(s):  
Sarah R. Valkenborghs ◽  
Kirk I. Erickson ◽  
Michael Nilsson ◽  
Paulette van Vliet ◽  
Robin Callister
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Cardiovascular Risk ◽  
Aerobic Exercise ◽  
Cardiovascular Risk Factors ◽  
Interval Training ◽  
Cycle Ergometer ◽  
Recovery Interval ◽  
Aerobic Interval Training ◽  
The Mean

ABSTRACT Background: Modifiable cardiovascular risk factors are prevalent and poorly managed in people after stroke. Aerobic exercise is effective in reducing many modifiable cardiovascular risk factors after stroke but is challenging and under-researched in nonambulant persons. This pilot study aimed to investigate the feasibility of aerobic interval training in nonambulant persons after stroke. Methods: Aerobic exercise was performed on an upright or semi-recumbent cycle ergometer. Participants were prescribed 4 × 4-min intervals of exercise at 85% maximum age-predicted heart rate (APHRmax) with a 3-min active recovery at 70%APHRmax per 30-min session, 3 times per week for 10 weeks. Heart rate, rating of perceived exertion, workload, cadence, and duration of exercise achieved were recorded for each interval. Results: Nine participants (mean ± SD; age 62 ± 12 y; 5 males) unable to walk without assistance after stroke (2.9 ± 3.9 y) were recruited. There were no adverse events reported, but there was one dropout (due to bronchitis). Attendance for the remaining participants was 93 ± 6%. The mean training %APHRmax was 72 ± 14% for the higher intensity interval and 57 ± 21% for the recovery interval. The mean increase in training workload between weeks 1 and 10 was 11.2 ± 11.6 W (27 ± 28%) for the higher intensity interval and 4.0 ± 7.7W (17 ± 33%) for the recovery interval. The mean increase in VO2peak was 2.3 ± 2.9 mL·kg−1·min−1 (18 ± 22%) over the 10-week intervention. Conclusion: Aerobic interval training at a moderate-vigorous intensity on an upright or recumbent cycle ergometer is feasible for nonambulant persons after stroke. Aerobic interval training should be further investigated to determine its potential to improve cardiorespiratory fitness after stroke and risk factors for recurrent stroke.

Abstract WP241: Prevalence of Subclinical Extracranial Carotid Atherosclerosis Detected by Ultrasound Among Amerindians: A Population Study in Rural Ecuador

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Victor J Del Brutto ◽  
Jose G Romano ◽  
Robertino M Mera ◽  
Jonathan P Amodio ◽  
Tatjana Rundek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
High Blood Pressure ◽  
Carotid Atherosclerosis ◽  
Male Gender ◽  
Rural Setting ◽  
Carotid Plaques ◽  
The Mean

Background: Epidemiological information on extracranial carotid atherosclerosis (ECA) among Amerindians is limited. We aim to determine the prevalence of subclinical ECA and its correlation with cardiovascular risk factors in community-dwelling adults of Amerindian ancestry living in a rural Ecuadorian village. Methods: Utilizing a population-based design, stroke-free individuals aged ≥40 years were invited to undergo carotid ultrasound. Subclinical ECA was defined as an intima-media thickness (cIMT) >1mm and/or the presence of carotid plaques (focal intima thickening >1.5mm that protrudes into the lumen). Degree of luminal stenosis was calculated and considered significant if >50%. We investigated the association between these biomarkers and cardiovascular risk factors. Results: Of 728 candidates, 559 (77%) stroke-free individuals underwent carotid sonographic evaluation and were included. The mean age was 62.3 ±12.5 and 238 (43%) were men. The mean value of the cIMT was 0.85 ± 0.17mm (median cIMT: 0.83mm; IQ range: 0.74-0.92 mm). The prevalence of increased cIMT, carotid plaques, and increased cIMT and/or carotid plaques were 14%, 23.8%, and 26.1%, respectively. Table depicts the association of these biomarkers with cardiovascular risk factors. A multinomial logistic regression model, using individuals with normal carotids as the referent category, showed significant associations of ECA with increasing age, male gender, smoking and high blood pressure. Significant carotid stenosis was found in 19 subjects (3.4%). Conclusions: About one-fourth of Amerindians living in a rural setting have subclinical ECA. Increasing age, male gender, smoking and high blood pressure were independent determinants of the burden of ECA, while elevated glucose and total cholesterol showed no significant association. Obesity was inversely associated with ECA in univariate analysis, but such association disappeared in the multivariate model.

Acupuncture and related techniques for obesity and cardiovascular risk factors: a systematic review and meta-regression analysis

2020 ◽  
Vol 38 (4) ◽  
pp. 227-234
Author(s):  
Jianrong Chen ◽  
Dongping Chen ◽  
Qing Ren ◽  
Weifeng Zhu ◽  
Sheng Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Weight ◽  
Cardiovascular Risk ◽  
Blood Glucose ◽  
Cardiovascular Risk Factors ◽  
Density Lipoprotein ◽  
Moderate Quality ◽  
Meta Regression ◽  
Quality Evidence

Objective: To assess how acupuncture and related techniques affect weight-related indicators and cardiovascular risk factors compared with non-acupuncture interventions in overweight and obese patients. Methods: We searched PubMed, Embase and CENTRAL up to 19 April 2018 and included relevant randomised controlled trials (RCTs). Weighted mean differences (WMDs) and 95% confidence intervals (CI) were pooled using the inverse variance method with random-effects model. Prespecified hypotheses were tested in meta-regression to investigate the source of heterogeneity. Statistical software packages used were RevMan 5.3.5 and Stata 14.0. Results: Thirty-three RCTs were included (n=2503 patients). Compared with non-acupuncture interventions, acupuncture produced a greater reduction in body weight (WMD −1.76 kg, 95% CI −2.22 to −1.30, I2=77%; moderate quality), body mass index (WMD −1.13 kg/m2, 95% CI −1.38 to −0.88, I2=85%; low quality) and waist circumference (WMD −2.42 cm, 95% CI −3.22 to −1.62, I2=75%; moderate quality). Acupuncture plus lifestyle intervention resulted in a greater reduction in body weight than acupuncture alone (MD −1.94 kg, 95% CI −3.17 to −0.70). Acupuncture also led to a greater reduction in total cholesterol (WMD −12.87 mg/dL, 95% CI −22.17 to −3.57, I2=87%; very low quality) and low-density lipoprotein cholesterol (WMD −13.52 mg/dL, 95% CI −21.47 to −5.58, I2=74%; low quality). The differences were not statistically significant for blood glucose or blood pressure. Conclusion: In the short term, acupuncture and related techniques may produce a small but statistically significant degree of weight loss based on moderate- to low-quality evidence, and improve serum lipid parameters based on low- to very-low-quality evidence. Their effects on blood glucose and blood pressure remain uncertain.

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