scholarly journals Genetic Variation in LRP1 Associates with Stanford Type B Aortic Dissection Risk and Clinical Outcome

2022 ◽  
Vol 9 (1) ◽  
pp. 14
Author(s):  
Philipp Erhart ◽  
Daniel Körfer ◽  
Caspar Grond-Ginsbach ◽  
Jia-Lu Qiao ◽  
Moritz S. Bischoff ◽  
...  
Keyword(s):  
Genetic Variation ◽  
Risk Factor ◽  
Clinical Outcome ◽  
Independent Risk Factor ◽  
Reference Group ◽  
Type B ◽  
Aortic Dissections ◽  
The Impact ◽  
Stanford Type B

Genetic variation in LRP1 (low-density lipoprotein receptor-related protein 1) was reported to be associated with thoracic aortic dissections and aneurysms. The aims of this study were to confirm this association in a prospective single-center patient cohort of patients with acute Stanford type B aortic dissections (STBAD) and to assess the impact of LRP1 variation on clinical outcome. The single nucleotide variation (SNV) rs11172113 within the LRP1 gene was genotyped in 113 STBAD patients and 768 healthy control subjects from the same population. The T-allele of rs11172113 was more common in STBAD patients as compared to the reference group (72.6% vs. 59.6%) and confirmed to be an independent risk factor for STBAD (p = 0.002) after sex and age adjustment in a logistic regression model analyzing diabetes, smoking and hypertension as additional risk factors. Analysis of clinical follow-up (median follow-up 2.0 years) revealed that patients with the T-allele were more likely to suffer aorta-related complications (T-allele 75.6% vs. 63.8%; p = 0.022). In this study sample of STBAD patients, variation in LRP1 was an independent risk factor for STBAD and affected clinical outcome.

Adherence to recommended imaging surveillance of acutely presenting Stanford type-B aortic dissections

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 524-534
Author(s):  
Sachin Doshi ◽  
Naomi Eisenberg ◽  
Shawn Bailey ◽  
Ganesan Annamalai ◽  
Graham Roche-Nagle
Keyword(s):  
Smoking History ◽  
Acute Type ◽  
Type B ◽  
Rank Analysis ◽  
Kaplan Meier ◽  
Imaging Surveillance ◽  
Medical Histories ◽  
Aortic Dissections ◽  
Stanford Type B

Objective Acutely presenting Stanford type B aortic dissections (type-B AD) primarily receive medical or endovascular management and require lifelong imaging surveillance. CT and MR imaging are the best modalities to assess early indications of potentially fatal developments. Published guidelines recommend that imaging occur at 1, 3, 6, and 12 months following acute presentation, and annually thereafter. This study evaluates adherence to recommended imaging surveillance for newly presenting type-B AD patients at a tertiary hospital. Methods A retrospective review of patients presenting with a new, acute type-B AD between January 2010 and March 2017 was performed. Patient demographics, type-B AD admission details, and medical histories were obtained from electronic and paper chart reviews. CT and MR images were reviewed, and aortic sizes were measured by two independent radiologists. Patients without a clinical visit or type-B AD surveillance imaging for greater than 15 months were considered lost to follow-up after their last appointment. Overall clinical follow-up and adherence to recommended were analyzed using Kaplan–Meier graphs. Log-rank analysis assessed factors increasing risk of poor clinical follow-up and adherence to surveillance guidelines. Results Sixty-two patients (38 male, 24 female) were included. At the time of index admission, median age was 62 (SD 14), and median aortic diameter was 45 mm (SD 11.2). Median duration of overall follow-up was 24 months. Kaplan–Meier analysis of overall follow-up, censoring death, and external follow-up, indicated clinical follow-up rates of 87.1% (SE = 4.3%) at 3 months, 85.2% (SE = 4.6%) at 6 months, 77.5% (SE = 5.6%) at 12 months, and 63.8% (SE = 8.1%) at 60 months. Similar analysis of adherence to recommended imaging surveillance revealed rates of 56.5% (SE 6.3%) at 3 months, 36.9% (6.7%) at 6 months, 21.5% (6.5%) at 12 months, and 12.9% (6.1%) at 24 months. Log-rank analysis indicated that specialty arranging follow-up – medical ( n = 24) versus surgical ( n = 38) – did not impact overall follow-up or adherence to recommended guidelines. Similarly, none of patient distance to hospital, medical versus endovascular intervention, initial dissection size, smoking history, or additional medical/demographic impacted these outcomes. Conclusions At our institution, we identified a gap between imaging surveillance following type-B AD and adherence to recommended, published guidelines. This was consistent across all type-B AD patients with no subset in isolation. Multiple opportunities for quality improvement exist to facilitate improved compliance with published guidelines.

scholarly journals Hyperuricemia is a Risk Factor for One-Year Overall Survival in Elderly Female Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Shi Tai ◽  
Xuping Li ◽  
Zhaowei Zhu ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Elderly Patients ◽  
Independent Risk Factor ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Elderly Female ◽  
All Cause Mortality ◽  
The Impact

Background. Hyperuricemia is a risk factor for cardiovascular diseases, but the impact of hyperuricemia and sex-related disparities is not fully clear in elderly patients with acute coronary syndrome (ACS). Objective. To investigate the association between hyperuricemia and 1-year all-cause mortality in elderly patients with ACS. Methods. This retrospective cohort study included 711 consecutive ACS patients aged ≥75 years, hospitalized in our center between January 2013 and December 2017. Serum uric acid (sUA), in-hospital events, and 1-year follow-up were analyzed. Multivariable logistic regression models were used to explore the risk factors for in-hospital events and 1-year all-cause mortality. Results. sUA levels were higher in males than in females (381.4 ± 110.1 vs. 349.3 ± 119.1 μmol/l, P<0.001). Prevalence of hypertension (80.5% vs. 72.6%, P=0.020), atrial fibrillation (16.2% vs. 9.5%, P=0.008), and severe heart failure (61.0% vs. 44.2%, P<0.001) were higher in patients with hyperuricemia than in patients with normal sUA. During the 1-year follow-up, 135 patients died (19.0%); all-cause mortality was higher in patients with hyperuricemia than in patients with normal sUA (23.1% vs. 16.7%, P=0.039). Hyperuricemia is related to in-hospital ventricular tachycardia and 1-year all-cause mortality (OR = 1.799, 95% CI 1.050–3.081, P=0.033; OR = 1.512, 95% CI 1.028–2.225, P=0.036, respectively). Multivariable regression analysis models showed that hyperuricemia was an independent risk factor of 1-year all-cause mortality in women (OR = 2.539, 95% CI 1.001–6.453, P=0.050), but not in men (OR = 0.931, 95% CI 0.466–1.858, P=0.839) after adjustment for confounding variables. Conclusions. Hyperuricemia is an independent risk factor for 1-year all-cause mortality in elderly female patients with ACS.

scholarly journals Preoperative Opioid Use is Associated with Inferior Patient Reported Outcomes and Prolonged Opioid Use after Patellofemoral Stabilization Surgery

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0050
Author(s):  
Zain Khazi ◽  
Christina Hajewski ◽  
Natalie Glass ◽  
Brian Wolf ◽  
Kyle Duchman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Patellar Instability ◽  
Independent Risk Factor ◽  
Opioid Use ◽  
Patient Reported ◽  
Opioid Users ◽  
The Impact

Objectives: The purpose of the study was to investigate the association between preoperative opioid use and persistent postoperative use, and determine the impact of preoperative opioid use on patient reported outcomes (PROs) in patients undergoing patellofemoral stabilization surgery. Methods: A retrospective analysis of 60 patients after patellofemoral stabilization surgery with a minimum of 2-year follow-up was performed using a prospectively-collected patellar instability registry. Patients were categorized as opioid naïve (n=48) or preoperative opioid users (n=12). Postoperative opioid use was assessed for all patients at 2 and 6 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala questionnaires were administered at baseline, and 6 months and 2 years postoperatively. Results: Preoperative opioid use was identified as an independent risk factor for postoperative opioid use at 2- and 6-weeks following surgery (p=0.0023 and p<0.0001, respectively). Preoperative opioid use was associated with significantly lower KOOS and Kujala scores at baseline, 6 months and 2 years postoperatively. Both groups significantly improved from baseline KOOS and Kujala scores at 6 months and 2 years postoperatively. Regardless of preoperative opioid use, opioid use at 6 weeks after surgery was associated with worse KOOS scores at 6 months and 2 years postoperatively. Conclusion: In patients undergoing patellofemoral stabilization surgery, preoperative opioid use was predictive of postoperative use. Additionally, preoperative opioid use was associated with worse PROs at 6 months and 2 years following surgery. [Table: see text][Table: see text]

scholarly journals A synbiotic intervention modulates meta-omics signatures of gut redox potential and acidity in elective caesarean born infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christophe Lay ◽  
Collins Wenhan Chu ◽  
Rikky Wenang Purbojati ◽  
Enzo Acerbi ◽  
Daniela I. Drautz-Moses ◽  
...  
Keyword(s):  
Risk Factor ◽  
Gut Microbiome ◽  
Reference Group ◽  
Mode Of Delivery ◽  
Controlled Study ◽  
Double Blind ◽  
Lipopolysaccharide Biosynthesis ◽  
Infant Gut Microbiome ◽  
Stool Samples ◽  
The Impact

Abstract Background The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. Results As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. Conclusions This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. Trial registration The study was registered in the Dutch Trial Register (Number: 2838) on 4th April 2011.

scholarly journals A longitudinal study over 40 years to study the metabolic syndrome as a risk factor for cardiovascular diseases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lars Lind ◽  
Johan Sundström ◽  
Johan Ärnlöv ◽  
Ulf Risérus ◽  
Erik Lampa
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
Longitudinal Study ◽  
Clinical Intervention ◽  
The Elderly ◽  
Adult Men ◽  
The Metabolic Syndrome ◽  
The Impact ◽  
Over 40 Years

AbstractThe impact of most, but not all, cardiovascular risk factors decline by age. We investigated how the metabolic syndrome (MetS) was related to cardiovascular disease (CVD) during 40 years follow-up in the Uppsala Longitudinal Study of Adult Men (ULSAM, 2,123 men all aged 50 at baseline with reinvestigations at age 60, 70, 77 and 82). The strength of MetS as a risk factor of incident combined end-point of three outcomes (CVD) declined with ageing, as well as for myocardial infarction, ischemic stroke and heart failure when analysed separately. For CVD, the risk ratio declined from 2.77 (95% CI 1.90–4.05) at age 50 to 1.30 (95% CI 1.05–1.60) at age 82. In conclusion, the strength of MetS as a risk factor of incident CVD declined with age. Since MetS was significantly related to incident CVD also at old age, our findings suggest that the occurrence of MetS in the elderly should not be regarded as innocent. However, since our data were derived in an observational study, any impact of MetS in the elderly needs to be verified in a randomized clinical intervention trial.

Chronic rhinosinusitis is an independent risk factor for sleeping problems – a 10-year-follow-up study

2017 ◽  
Vol 40 ◽  
pp. e30 ◽  
Author(s):  
C. Bengtsson ◽  
C. Janson ◽  
L. Jonsson ◽  
M. Holmström ◽  
J. Theorell-Haglöw ◽  
...  
Keyword(s):  
Risk Factor ◽  
Chronic Rhinosinusitis ◽  
Independent Risk Factor ◽  
Follow Up Study ◽  
Sleeping Problems

Abstract MP25: Obesity, Heart Failure Risk & Cardiorespiratory Fitness

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Peter F Kokkinos ◽  
Puneet Narayan ◽  
Charles Faselis ◽  
Jonathan Myers ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Capacity ◽  
Cardiorespiratory Fitness ◽  
Reference Group ◽  
Normal Weight ◽  
Entire Cohort ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
The Impact

Introduction: Obesity, defined as body mass index (BMI) ≥30 kg/m 2 , is associated with increased incidence of heart failure (HF). Increased cardiorespiratory fitness (CRF), as indicated by increased exercise capacity, is associated with lower risk of cardiovascular disease and HF. However, the CRF-BMI-HF interaction has not been fully explored. Hypothesis: We assessed the hypothesis that the risk of HF associated with increased BMI is moderated by increased CRF. Methods: We identified 19,881 Veterans (mean age: 58.0±11.3 years) who completed an exercise tolerance test (ETT) to assess either CRF status or suspected ischemia at two VA Medical Centers (Washington DC and Palo Alto, CA). None had documented HF at baseline or evidence of ischemia during the ETT. We established four BMI categories: <25 kg/m 2 ; 25-29.9 kg/m 2 ; 30-34.9 kg/m 2 ; and ≥35 kg/m 2 . In addition, we established four CRF categories based on age-stratified quartiles of peak metabolic equivalents (METs) achieved (mean ± SD): Least-Fit (4.5±1.2 METs; n=4,743); Low-Fit (6.6±1.3; n=5,103); Moderate-Fit (8.0±1.3 METs; n=5,084); and High-Fit (11.1±2.4 METs; n=4,951). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of HF across BMI categories for the entire cohort, using BMI 25-29.9 kg/m 2 (lowest HF rate) as the reference group. We then stratified the cohort by the four BMI categories and assessed HF risk across CRF categories within each stratum, using the Least-fit category as the reference group. The models were adjusted for age, race, gender, cardiac risk factors, sleep apnea, alcohol dependence, medications. Results: During follow-up (median=11.8 years), 2,193 developed HF (10.5 per 1,000 person-years of follow-up). The HF risk for normal weight individuals (18.5-24.9 kg/m2) was 10% higher (p=0.93). For obese individuals, the HF risk was 22% higher in those with BMI 30-34.9 kg/m 2 (HR=1.22; 95% CI: 1.09-1.35) and 50% higher (HR=1.50, 95% CI: 1.32-1.72) for those with BMI ≥35 kg/m 2 . When CRF (peak METs achieved) was introduced in the model, the risk for those with BMI 30-34.9 was reduced from 22% to 16% (HR=1.16; 95% CI: 1.04-1.29) and from 50% to 29% (HR=1.29; 95% CI: 1.13-1.48) among those with ≥35 kg/m 2 . For every 1-MET increase in exercise capacity, HF risk was 15% lower (HR=0.85; 95% CI: 0.83-0.87). We then assessed the impact of CRF on the risk of HF within each of the four BMI categories. The HF risk declined progressively (range: 25% to 69%; p<0.01) with increasing fitness within all BMI categories. Conclusions: The obesity-associated increased risk of HF was attenuated by increased CRF. The HF risk was progressively decreased with increased CRF within all BMI categories.

Abstract 141: Impact of an Aggressive Medical Management Protocol on Early Risk Factor Measures in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tanya N Turan ◽  
Azhar Nizam ◽  
Michael J Lynn ◽  
Colin P Derdeyn ◽  
David Fiorella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Medical Management ◽  
Intracranial Stenosis ◽  
Patient Specific ◽  
Early Risk ◽  
Aggressive Medical Management ◽  
The Impact ◽  
Early Risk Factor

Purpose: SAMMPRIS is the first stroke prevention trial to include protocol-driven aggressive management of multiple vascular risk factors. We sought to determine the impact of this protocol on early risk factor control in the trial. Materials and Methods: SAMMPRIS randomized 451 patients with symptomatic 70%-99% intracranial stenosis to aggressive medical management or stenting plus aggressive medical management at 50 USA sites. For the primary risk factor targets (SBP < 140 mm/Hg (<130 if diabetic) and LDL < 70 mg/dL), the study neurologists follow medication titration algorithms and risk factor medications are provided to the patients. Secondary risk factors (diabetes, non-HDL, weight, exercise, and smoking cessation) are managed with assistance from the patient’s primary care physician and a lifestyle modification program (provided). Sites receive patient-specific recommendations and feedback to improve performance. Follow-up continues, but the 30-day data are final. We compared baseline to 30-day risk factor measures using paired t-tests for means and McNemar tests for percentages. Results: The differences in risk factor measures between baseline and 30 days are shown in Table 1. Conclusions: The SAMMPRIS protocol resulted in major improvements in controlling most risk factors within 30 days of enrollment, which may have contributed to the lower than expected 30 day stroke rate in the medical group (5.8%). However, the durability of this approach over time will be determined by additional follow-up.

Sign in / Sign up

Export Citation Format

Share Document