20 research outputs found
Albuminuria and cardiovascular events in patients with acute coronary syndromes: Results from the TRACER trial
No full textBACKGROUND: Albuminuria is associated with cardiovascular (CV) outcomes. We evaluated albuminuria, alone and in combination with estimated glomerular filtration rate (eGFR), as a predictor of mortality and CV morbidity in 12,944 patients with non-ST-segment elevation acute coronary syndromes. METHODS: Baseline serum creatinine and urinary dipsticks were obtained, with albuminuria stratified into no/trace albuminuria, microalbuminuria (≥30 but <300 mg/dL), or macroalbuminuria (≥300 mg/dL). Kaplan-Meier rates and proportional Cox hazards models of CV death, overall mortality, CV death or myocardial infarction (MI), and bleeding were calculated. Incidence of acute kidney injury, identified by adverse event reporting and creatinine increase (absolute ≥0.3 mg/dL or relative ≥50%), was descriptively reported. RESULTS: Both dipstick albuminuria and creatinine values were available in 9473 patients (73.2%). More patients with macroalbuminuria, versus no/trace albuminuria, had diabetes (66% vs 27%) or hypertension (86% vs 68%). Rates for CV death and overall mortality per strata were 3.1% and 4.8% (no/trace albuminuria); 5.8% and 9.0% (microalbuminuria); and 7.7% and 12.6% (macroalbuminuria) at 2 years of follow-up. Corresponding rates for CV death or MI were 12.2%, 16.9%, and 23.5%, respectively. Observed acute kidney injury rates were 0.6%, 1.2%, and 2.9% (n = 79), respectively. Adjusted HRs for macroalbuminuria on CV mortality were 1.65 (95% CI 1.15-2.37), and after adjustment with eGFR, 1.37 (95% CI 0.93-2.01). Corresponding HRs for overall mortality were 1.82 (95% CI 1.37-2.42) and 1.47 (95% CI 1.08-1.98). CONCLUSIONS: High-risk patients with non-ST-segment elevation acute coronary syndromes and albuminuria have increased morbidity and increased overall mortality independent of eGFR.sponsorship: The TRACER trial was supported by Merck & Co., Inc. (Merck Co., Inc.)status: Publishe
Eptifibatide is Non-inferior to Abciximab in Acute Coronary Syndromes: Results From the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) in CIRCULATION, vol 120, issue 18, pp S1027-S1027
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Outcome and causes of renal deterioration evaluated by serial cystatin C measurements in acute coronary syndrome patients : results from the PLATelet inhibition and patient Outcomes (PLATO) study
No full textAbstract: Background To investigate if ticagrelor treatment and other clinical characteristics were associated with increased cystatin C concentrations and if a deterioration in estimated renal function was associated with worse outcome in patients with acute coronary syndromes (ACS). Methods Plasma cystatin C concentrations were determined within 24 hours of admission (baseline), at discharge, 1 month, and 6 months in the PLATO trial. The changes over time in relation to randomized treatment were analyzed by analysis of covariance. C-statistics and the relative Integrated Discrimination Improvement of the cystatin C concentrations regarding the primary outcome (cardiovascular death or myocardial infarction) was evaluated by multivariable analysis including background characteristics and biomarkers: N-terminal-pro-B-type natriuretic peptide and Troponin I. Results Mean cystatin C concentrations in 2133 ticagrelor- and 2162 clopidogrel-treated patients were at baseline (0.86 mg/L and 0.86 mg/L), discharge (1.01 mg/L and 0.98 mg/L) (P < .0005), 1 month (1.00 mg/L and 0.98 mg/L) (P = .12), and 6 months (1.00 mg/L and 0.99 mg/L) (P = .17), respectively. Age, heart failure, and type of ACS were major determinants of the cystatin C concentration. c Statistics and the relative Integrated Discrimination Improvement of the primary outcome for the baseline cystatin C concentration were 0.687 and 5.2%, compared to 0.684 and 4.5% at discharge (n = 4034) and 0.693 and 5.1% at one month (n = 3096), respectively. Conclusions Mean cystatin C concentrations increased in ACS patients, most importantly determined by age. The initial greater increase in ticagrelor-treated patients was not sustained over time. Risk prediction did not improve with serial measurements of renal markers. (Am Heart J 2012;164:728-34.
Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
No full text<p>Objectives The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with percutaneous coronary intervention (PCI) in an unselected nationwide cohort over the past 2 decades.</p><p>Background Over the last 20 years, treatment with PCI has evolved dramatically, but the change in patient characteristics has not been well described.</p><p>Methods We included all patients undergoing a PCI procedure for the first time between January 1990 and December 2010 from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). Patients were divided into different cohorts on the basis of the year of the first PCI procedure.</p><p>Results A total of 144,039 patients was included. The mean age increased from 60.1 +/- 9.9 years in 1990 to 1995 to 67.1 +/- 11.2 years in 2009 to 2010. The proportion of patients presenting with unstable coronary artery disease and ST-segment elevation myocardial infarction increased from 27.4% and 6.2% to 47.7% and 32.5%, respectively. Diabetes mellitus and multivessel disease were more often present in the later-year cohorts. The 1-year mortality increased from 2.2% in 1990 to 1995 to 5.9% in 2009 to 2010, but after adjustment for age and indication, a modest decrease was shown, mainly in ST-segment elevation myocardial infarction patients.</p><p>Conclusions Characteristics of PCI patients have changed substantially over time, reflecting the establishment of new evidence. The increasing age and proportion of patients undergoing PCI for acute coronary syndromes greatly influence outcome. Understanding the changing patient characteristics is important for the translation of evidence to real-world clinical practice. (J Am Coll Cardiol 2013; 61: 1222-30) (C) 2013 by the American College of Cardiology Foundation</p>
Breastfeeding Promotion Research: The ES/WIC Nutrition Education Initiative and Economic Considerations
No full textEducating low-income women about the advantages of breastfeeding their babies increases the number who breastfeed. This report summarizes the results of four projects that focused primarily on promoting breastfeeding, which is considered to be the most healthful and beneficial feeding method for most infants. Research has shown that breastfeeding improves the general health, growth, and development of infants and significantly reduces the risk of several health problems both during early life and in later years. Lower income women have been less likely to breastfeed than higher income women. One step the USDA has taken to promote breastfeeding is the ES/WIC Nutrition Education Initiative. This combines the strengths of two nutrition programs for low-income families, the Cooperative Extension System's Expanded Food and Nutrition Education Program and the Food and Nutrition Service's Special Supplemental Nutrition Program for Women, Infants, and Children. This report shows that breastfeeding education before delivery increases the initiation of breastfeeding among low-income women. The results also indicate that breastfeeding support soon after delivery increases the duration of breastfeeding.Food Consumption/Nutrition/Food Safety,
Investigation of a rapid screening method to study the effects of the snowdrop lectin (Galanthus nivalis Agglutinin) on plant pathogens
No full textTwo Tobravirus expression vectors were evaluated for the use as a rapid screening method for anti-nutritional proteins against plant pathogens. Accumulation of green fluorescent protein (GFP) and snowdrop lectin gene (Galanthus nivalis agglutinin, LECGNA2, M55556) in Nicotiana benthamiana by Tobacco rattle virus expression vectors was characterized. Virally expressed proteins were detected in leaves (3-14 days post-inoculatiion) and roots (6-24 dpi) by UV (GFP), western blotting and tissue printing. 25 -50 ng of GNA was detected in root extracts. Cross protection was induced by TRV-GFP. Foreign genes inserted in place of TRV RNA2 non-structural genes (2b and 2c) were stably maintained over serial passages. But recombination at remaining 'cross-over' sites may occur. 2D iso-electricfocusing detected a 50-kDa GNA molecule in root and leaf extract. GNA did not confer resistance to root-knot nematodes, although gall by root-knot nematodes (mixed Meloidogyne spp. and M.javanica Crete line 17) were significantly reduced by 22% in roots infected by TRV-GNA (3.83 sqrt galls and 4.5 sqrt galls respectively) compared to virus-free roots treatment (4.94 sqrt galls, sed 0.398; p<.025 and 5.273 sqrt galls, sed 0.2403; <.003 respectively). Effects of GNA on Aulacorthum solani was delayed to the second nymph generation (N2). Mean N2 weights feeding on TRV-GNA (0.246 mg ±0.0159; p <05) and TRV-fsGNA (0.212 mg ±0.018; p<.001) infected plants were significantly smaller by 15.2% and 26.6% respectively, compared to virus-free treatments (0.290 mg ±0.014). Similar trends were detected for total nymph weights. Low toxicity was related to high quality phloem and ingestion of smaller volumes for normal development (i.e. concentration effect). Decrease in gall by the mixed Meloidogyne population and an unexpected toxicity to A solani indicated that truncated GNA was a protein with merolectin properties. The viability of this system as a rapid 'm planta' expression system is discussed
Long-Term Results Following Switch From Abciximab to Eptifibatide During Percutaneous Coronary Intervention
No full textBackground: The usage of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors improves the outcome during high-risk percutaneous coronary interventions (PCI). The aim of this study was to evaluate the long-term effects after a planned switch from abciximab to eptifibatide during PCI. Hypothesis: A switch from the general use of abciximab to eptifibatide as a GP IIb/IIIa in connection with PCI would not have any negative effects on long-term clinical outcomes. Methods: To reduce costs, a general switch from abciximab to eptifibatide was instituted in 2004 in 2 university hospitals in Sweden. All patients treated 6 months before and 6 months after the switch were followed for 30 months. During the study period, 1038 patients underwent PCI and received a GP IIb/IIIa receptor inhibitor, 481 (46%) before the switch (Group A) and 557 (54%) after the switch (Group B). The 2 groups had similar baseline characteristics. The primary endpoint was the composite of death, myocardial infarction, stroke, or new coronary revascularization (percutaneous or surgical); secondary endpoints were the individual components of this composite. A separate analysis was performed on patients treated for ST-segment elevation myocardial infarction, non ST-segment elevation myocardial infarction/unstable angina, and diabetes, respectively. Data were collected from the Swedish Coronary Angiography and Angioplasty Registry. Results: There were no differences between the groups in the primary endpoint (29.7% in Group A vs 29.3% in Group B; P = 0.48) or in any of the secondary endpoints. Conclusions: A switch from the general usage of abciximab to eptifibatide as a GP IIb/IIIa receptor inhibitor in connection with PCI did not seem to have any negative effects on long-term clinical outcomes.</p
An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome
No full textBACKGROUND: Studies have suggested a relationship between higher baseline serum uric acid (sUA) levels and an elevated risk of subsequent ischemic cardiovascular outcomes among acute coronary syndrome (ACS) patients; this relationship may be modified by a clinical history of gout and has not been studied in large patient cohorts. We sought to understand the effect of sUA and gout on ACS outcomes. METHODS: Using PLATO and TRACER data on 27,959 ACS patients, we evaluated baseline sUA levels in relation to a composite of cardiovascular death, myocardial infarction (MI), or stroke. We assessed interaction terms to determine if a baseline clinical diagnosis of gout modified this putative relationship; 46% (n = 12,882) had sUA levels elevated >6.0 mg/dL. RESULTS: Patients with elevated levels were more often male with a history of prior MI, diabetes, and heart failure compared with those with sUA <6.0 mg/dL. The unadjusted risk of the composite endpoint increased with corresponding elevations in sUA levels (per 1 mg/dL increase) (HR = 1.23 [95% CI: 1.20–1.26]) above the statistical inflection point of 5.0 mg/dL. After adjustment, the association between sUA level and the composite outcome remained significant(HR = 1.07 [95% CI: 1.04–1.10]), and baseline gout did not modify this relationship. CONCLUSIONS: In patients with ACS, increasing levels of sUA are associated with an elevated risk of cardiovascular events, regardless of a clinical diagnosis of gout. Further investigation is warranted to determine the mechanism behind this relationship and to delineate whether sUA is an appropriate therapeutic target to reduce cardiovascular risk
Ionizing and non-ionizing radiation and the risk of childhood cancer-illustrated with domestic radon and radio frequency electromagnetic field exposure
No full textBackground
Children are exposed to many different environmental factors, including exposure to low-dose ionizing radiation and to non-ionizing radiation.
Low-dose ionizing radiation comprises anthropogenic modified radiation and natural ionizing radiation from cosmic rays from the atmosphere, terrestrial gamma radiation from radionuclides in rocks and soils and radiation from radon.
Non-ionizing radiation comprises optical radiation and radiation from electromagnetic fields. The latter comprises radiation from extremely low-frequency electromagnetic fields (ELF-EMF; high voltage power lines, electrical installations) and radiofrequency electromagnetic fields (RF-EMF; broadcast transmitters, mobile phone base stations, mobile and cordless phones).
Both ionizing and non-ionizing radiation are assumed to be associated with childhood cancer.
Aims
Within this dissertation, we primarily aimed to assess whether there is an association between domestic radon exposure and childhood cancers. We further investigated whether there is an association between low-dose ionizing gamma radiation and childhood cancers. We finally assessed whether there is an association between RF-EMF exposure from broadcast transmitters and childhood cancers.
Methods
We performed prospective census-based cohort designs, considering all children, aged less than 16 years and living in Switzerland at the date of census 2000 (December 5th 2000). Time at risk was set to begin at census and lasted until the date of diagnosis, death, emigration, a child’s 16th birthday or until the end of the year 2008. In terms of non-ionizing radiation from far-field RF-EMF sources from broadcast transmitters, we carried out a further prospective cohort analysis, considering all children, aged less than 16 years and living in Switzerland between 1985 and 2008.
We assessed exposure at baseline (date of census 2000) for each child’s home address. For the analyses on RF-EMF exposure to broadcast transmitters and childhood cancers where a longer follow-up was considered, we considered exposure at the time of diagnosis.
For the analyses on domestic radon exposure and childhood cancers, exposure assessment was based on a nationwide radon prediction model. For the analyses on low-dose ionizing gamma radiation and childhood cancers, exposure assessment was based on modelled and measured dose rates from outdoor gamma radiation. For the analyses on RF-EMF exposure to broadcast transmitters and childhood cancers, exposure assessment was based on modeled field strengths.
Results
We estimated arithmetic mean radon concentrations to be 85.7 Bq/m³ (range: 6.9-337.2 Bq/m³) for childhood cancer cases and 85.9 Bq/m³ (range: 0.7-490.1 Bq/m³) for the rest of the study population. Despite relative high radon levels in Switzerland, we found no evidence for an association between domestic radon exposure and childhood cancers.
We found increased leukaemia risk (including acute lymphoblastic leukaemia) with respect to gamma radiation for children who lived at the same address between 1995 and 2000.
Finally, we found no increased leukaemia risk but increased central nervous system (CNS) tumour risks with respect to RF-EMF exposure from broadcast transmitters.
Conclusions and Outlook
The findings of our analyses, indicating no association between domestic radon exposure and childhood cancers were consistent with past studies that estimated doses of domestic radon concentrations for different body organs (lung, red bone marrow, brain).
The results of the analyses on gamma radiation and childhood cancers indicate that low dose ionizing gamma radiation might be relevant in terms of childhood leukaemia. These results were also found to be consistent with dose estimations for different body organs (red bone marrow, brain). They indicated that the same gamma radiation dose to the red bone marrow over a longer time period is probably necessary for gamma radiation to lead to childhood leukaemia.
The findings from the analyses on RF-EMF exposure from broadcasting and childhood leukaemia were found to be consistent with results from animal, in-vitro and laboratory studies. On the contrary, the findings indicating increased CNS tumours from RF-EMF exposure to broadcast transmitters contradict results from former studies. Our results are further in contradiction to a previous case-control study on wireless phones. This study could not find an increased risk for CNS tumours from the use of wireless phones that lead to substantially higher exposure to the head.
Although no evidence for an association with childhood cancers was found, domestic radon exposure is of public health relevance with regard to lung cancer in adults.
The findings from the analyses on gamma radiation and childhood cancers indicate that gamma radiation is of public health relevance as well, especially when children are exposed to the same gamma radiation dose over a longer time period.
Statements on possible public health relevance concerning non-ionizing radiation of RF-EMF from broadcasting on the other hand are not yet possible, as the results for CNS tumours need further clarification
Effects of 6 weeks of treatment with dapagliflozin, a sodium- glucose co-transporter-2 inhibitor, on myocardial function and metabolism in patients with type 2 diabetes: A randomized, placebo-controlled, exploratory study
No full textAim: To explore the early effects of dapagliflozin on myocardial function and metabolism in patients with type 2 diabetes without heart failure.Materials and methods: Patients with type 2 diabetes on metformin treatment were randomized to double-blind, 6-week placebo or dapagliflozin 10 mg daily treatment. Investigations included cardiac function and structure with myocardial resonance imaging; cardiac oxygen consumption, perfusion and efficiency with [11 C]-acetate positron emission tomography (PET); and cardiac and hepatic fatty acid uptake with [18 F]-6-thia-heptadecanoic acid PET, analysed by ANCOVA as least square means with 95% confidence intervals.Results: Evaluable patients (placebo: n = 24, dapagliflozin: n = 25; 53% males) had a mean age of 64.4 years, a body mass index of 30.2 kg/m2 and an HbA1c of 6.7%. Body weight and HbA1c were significantly decreased by dapagliflozin versus placebo. Dapagliflozin had no effect on myocardial efficiency, but external left ventricular (LV) work (-0.095 [-0.145, -0.043] J/g/min) and LV oxygen consumption were significantly reduced (-0.30 [-0.49, -0.12] J/g/min) by dapagliflozin, although the changes were not statistically significant versus changes in the placebo group. Change in left atrial maximal volume with dapagliflozin versus placebo was -3.19 (-6.32, -0.07) mL/m2 (p = .056). Peak global radial strain decreased with dapagliflozin versus placebo (-3.92% [-7.57%, -0.28%]; p = .035), while peak global longitudinal and circumferential strains were unchanged. Hepatic fatty acid uptake was increased by dapagliflozin versus placebo (0.024 [0.004, 0.044] μmol/g/min; p = .018), while cardiac uptake was unchanged.Conclusions: This exploratory study indicates reduced heart work but limited effects on myocardial function, efficiency and cardiac fatty acid uptake, while hepatic fatty acid uptake increased, after 6 weeks of treatment with dapagliflozin.</p
