Atrial Fibrillation: Are Associated Risk Factors Surrogates for an Inflammatory State?

2021 ◽  
Author(s):  
Curtis D Samuels
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Predominantly White ◽  
Racial Differences ◽  
Oxygen Species ◽  
Inflammatory State ◽  
Atherosclerotic Process ◽  
Associated Risk Factors ◽  
Risk Factor Burden

Today’s understanding of the inflammatory process has evolved far beyond what was initially described by Celsus in the 1st Century A.D [1]. Terms like oxidative stress, reactive oxygen species (ROS), cytokines, and fibrosis have been thrown around in everyday scientific discussions for some time now. Well-known pathways of the “inflammatory state” have underpinned many common cardiovascular diseases such as the atherosclerotic process. However, there are less recognized entities where inflammation seems to play a key role in their mechanisms of origin. The concept of inflammation in atrial fibrillation (AF) is not a novel one, but this characteristic of its pathophysiology seems to have been overshadowed by the inherent dangers of its complications. More emphasis has been placed instead on its associated risk factors, which alone, or in combination, contribute to the development of AF. The risk factor burden and the arrhythmia it produces are generally considered uniform in a presentation in most studies. Some researchers, however, allude to ethnic or racial differences in AF [2,3]. This small retrospective study of an Afro-Mestizo Caribbean cohort of patients with AF will corroborate findings of associated risk factors with those commonly encountered globally in predominantly White populations. It will also point out, through numerous bibliographical references, how an “inflammatory state” may be identified in each AF-associated risk factor. If it holds true that the whole is nothing more than a sum of its parts, we should then accept the oversimplified view that AF, like atherosclerosis, is indeed inflammatory in nature. To this end, a fresh focus could be placed on new upstream therapeutic opportunities designed to complement our current downstream interventions, in an effort to prevent the occurrence and recurrence of AF.

Knowledge, awareness and perceptions of diabetes mellitus among the Saudi population

2020 ◽  
Vol 9 (6) ◽  
pp. 413-422
Author(s):  
Muhammad H Mujammami ◽  
Abdulaziz A Alodhayani ◽  
Mohammad Ibrahim AlJabri ◽  
Ahmad Alhumaidi Alanazi ◽  
Sultan Sayyaf Alanazi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Social Media ◽  
Risk Factor ◽  
Healthcare Workers ◽  
Health Workers ◽  
Saudi Population ◽  
Limited Data ◽  
High Prevalence ◽  
Associated Risk Factors

Background: High prevalence of undiagnosed cases of diabetes mellitus (DM) has increased over the last two decades, most patients with DM only become aware of their condition once they develop a complication. Limited data are available regarding the knowledge and awareness about DM and the associated risk factors, complications and management in Saudi society. Aim: This study aimed to assess knowledge of DM in general Saudi society and among Saudi healthcare workers. Results: Only 37.3% of the participants were aware of the current DM prevalence. Obesity was the most frequently identified risk factor for DM. Most comparisons indicated better awareness among health workers. Conclusion: A significant lack of knowledge about DM in Saudi society was identified. Social media and educational curriculum can improve knowledge and awareness of DM.

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Funding Source ◽  
Additional Risk Factor ◽  
Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

scholarly journals Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
C Verdicchio ◽  
A Elliott ◽  
R Mahajan ◽  
D Linz ◽  
D Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cardiorespiratory Fitness ◽  
Meta Analysis ◽  
Exercise Stress ◽  
Inverse Association ◽  
Exercise Interventions ◽  
Increased Risk ◽  
Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p < 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p < 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

scholarly journals Vascular risk at younger ages most strongly associates with current and future brain volume

Neurology ◽  
2018 ◽  
Vol 91 (16) ◽  
pp. e1479-e1486 ◽  
Author(s):  
Matthew P. Pase ◽  
Kendra Davis-Plourde ◽  
Jayandra J. Himali ◽  
Claudia L. Satizabal ◽  
Hugo Aparicio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Brain Volume ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cross Sectional ◽  
Strength Of Association ◽  
Risk Factor Burden

ObjectiveGiven the potential therapeutic effect of vascular disease control timing to reduce dementia risk, we investigated the age-related influences of vascular risk factor burden on brain structure throughout the lifespan.MethodsWe studied participants from the community-based prospective Framingham Heart Study. Overall vascular risk factor burden was calculated according to the Framingham Stroke Risk Profile, a validated algorithm that predicts stroke risk. Brain volume was estimated by MRI. We used cross-sectional data to examine how the strength of association between vascular risk factor burden and brain volume changed across each age decade from age 45–54 years through to 85–94 years (N = 2,887). Second, we leveraged up to 40 years of longitudinal data to determine how the strength of association between vascular risk factor burden and brain volume changed when vascular risk factors were examined at progressively earlier ages (N = 7,868).ResultsIn both cross-sectional and longitudinal analyses, higher vascular risk factor burden was associated with lower brain volume across each age decade. In the cross-sectional analysis, the strength of this association decreased with each decade of advancing age (p for trend < 0.0001). In longitudinal analysis, the strength of association between vascular risk factor burden and brain volume was stronger when vascular risk factors were measured at younger ages. For example, vascular risk factor burden was most strongly associated with lower brain volume in later life when vascular risk factors were measured at age 45 years.ConclusionVascular risk factors at younger ages appear to have detrimental effects on current and future brain volume.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

scholarly journals Weight Loss Improves Cardio-Metabolic and Inflammatory State in Subjects with Metabolic Syndrome.

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Matteo Della Porta ◽  
Gabriele Piuri ◽  
Micaela Garziano ◽  
Michela Barichella ◽  
Fulvio Muzio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Weight Loss ◽  
Chemical Composition ◽  
Weight Reduction ◽  
Inflammation Markers ◽  
Tnf Α ◽  
Cytokine Levels ◽  
Inflammatory State ◽  
Associated Risk Factors

AbstractMetabolic syndrome (MetS) is a condition characterized by a constellation of reversible major risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2DM). While it has been widely demonstrated that weight reduction by 5–10% decreases CVD and T2DM risk factors, including atherogenic dyslipidemia, on the other hand, its effects on comprehensive serum cytokine profile and endotoxemia are less investigated. Furthermore, the impact of weight loss on these parameters was studied especially in subjects with morbid obesity, often after bariatric surgery; while the studies on the effects of a physiological weight reduction with a balanced hypocaloric diet in overweight and moderately obese subjects showed contradictory results.The aim of this pilot study was to investigate in overweight and obese men with MetS the effects of caloric restriction on the MetS-associated risk factors, chemical composition of lipoproteins and serum concentration of a wide spectrum of inflammation markers. In addition, the second purpose of this work was to study the possible correlation between lipoprotein chemical composition and these inflammation markers.Eighteen adult Caucasian males (25 kg/m2 < BMI < 35 kg/m2) with MetS losing at least 5% of their initial weight after six months of a Mediterranean-style balanced hypo-caloric diet were included in the study. Lipoproteins were isolated from plasma by ultracentrifugation in a discontinuous KBr gradient. Lipoprotein concentrations of proteins, cholesterol, phospholipids, and triacylglycerols were determined by colorimetric assays. Peripheral cytokine levels (IL-2, IL-6, IL-7, IL-8, IL-10, IL-12, IL-17, GM-CSF, MCP-1, MIP-1b, IL1-b, IL-4, IL-5, IL-13, G-CSF, INF-g, TNF-a) were determined by Bioplex multiplex immunoassay. Endotoxemia was measured by Limulus Amebocyte lysate assay. The effects of weight-loss were analysed by Wilcoxon's test, the correlations between covariates by Spearman's test (significance: p-value ≤ 0.05).After weight loss, we observed an improvement of MetS-associated risk factors and changes in lipoproteins composition. In particular, together with a reduction of triglyceridemia, we detected a massive transfer of triacylglycerols from HDLs toward LDLs. Furthermore, a significant decrease of IL-6 (0.9 ± 0.7 vs 0.5 ± 0.6), TNF-α (0.7 ± 0.3 vs 0.3 ± 0.18), IL-8 (1.6 ± 0.7 vs 1.3 ± 0.3) and MIP-1β (19.2 ± 1.5 vs 18.5 ± 1.5) was observed. Finally, peripheral levels of TNF-α and IL-8 were directly correlated with all lipid species of VLDL, whereas the concentration of MIP-1β and endotoxin with HDL lipids.Weight loss improved cardio-metabolic risk factors and decreased inflammatory state by reduction of cytokine levels. The relationships between lipoprotein composition and serum inflammation markers deserve to be deepened by studying broader populations.

scholarly journals Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study

2021 ◽  
Author(s):  
Wendy Wang ◽  
Faye L. Norby ◽  
Michael J. Zhang ◽  
Jorge L. Reyes ◽  
Amil M. Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Racial Differences ◽  
Left Atrial ◽  
Future Research ◽  
Atrial Remodeling ◽  
Black And White ◽  
The Difference

Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2‐week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%–47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.

scholarly journals Effect of Acute Limb Ischemia on the Mortality of Patients with Extracorporeal Membrane Oxygenation Established by Femoral Vein-Arterial Catheterization and Analysis of Related Risk Factors

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiang Li ◽  
Guang Chen ◽  
Sheng Zhang ◽  
Xinting Zheng ◽  
Wenjun Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Cardiopulmonary Failure ◽  
Va Ecmo ◽  
Associated Risk Factors

Extracorporeal membrane oxygenation (ECMO) is a common treatment for cardiopulmonary failure. Although it can effectively reduce the mortality of patients with cardiopulmonary failure, it still has a high mortality rate, such as acute limb ischemia (ALI), stroke, liver and kidney failure, and other related complications and related causes of death. This study aims to explore the impact of ALI on the mortality of VA-ECMO patients in hospital and 6 months after discharge and analyze the occurrence of ALI and related factors that affect the mortality of VA-ECMO in hospital and 6 months after discharge. The results showed that the smoking history was an independent risk factor for ALI, and age, diabetes, cardiac arrest, first time of ECMO, and hyperbilirubinemia were associated risk factors for in-hospital mortality. Cardiac arrest and ALI were associated risk factors for mortality at 6 months after discharge. Although ALI is not significantly associated with VA-ECMO in-hospital mortality, it is a risk factor for mortality at 6 months after discharge, and medical personnel should therefore strive to reduce and avoid ALI.

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