1,721,008 research outputs found
Troponin I after Cardiac Surgery and 30-Day Mortality
No full textDevereaux et al. corroborate the independent negative prognostic effect of increased levels of cardiac troponin I after cardiac surgery,1 reinforcing the notion derived from a meta-analysis of earlier studies2 that the predictive thresholds of 5670 ng per liter after coronary-artery bypass grafting (CABG) and aortic-valve replacement or repair and of 12,981 ng per liter after other cardiac surgery are much higher than the cut-off points endorsed in guidelines3 and provide sufficient prognostic information for identifying those patients with levels below these thresholds for whom there is a low likelihood of a complicated course. Although the authors were unable to differentiate ischemic myocardial damage from procedural injury, it is well recognized that levels of cardiac troponin I increase almost universally after cardiac surgery, and the magnitude of this increase varies depending on the surgical procedure performed and the anesthesia and cardioplegia used.1,4 We believe that their data beg the question of what is now the truly abnormal value of cardiac troponin I after cardiac surgery, because they have moved the threshold bar to particularly high values, thereby suggesting that caution has to be paid as to the clinical judgment used when integrating the variable elevated cardiac troponin I levels into the complex puzzle of other known powerful independent predictors of worse postoperative outcome.
Authors' reply to Zhang et al
No full textWe would like to thank Zhang et al. [1] for their interest in our observational study, showing a significant positive association between circulating levels of serum uric acid (SUA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with coronary artery dis- ease and without overt heart failure [2]. Specifically, Zhang et al. asked if in our study the association between SUA levels and NT-proBNP concentrations was different between men and women [1]. Among the 171 patients included in our study [2], there were 120 men and 51 women. Levels of SUA did not differ significantly between men and women (mean ± SD: 0.41 ± 0.11 vs. 0.39 ± 0.13 mmol/L, p = 0.43). Similarly, the results were comparable when we examined the association between SUA and NT-proBNP levels in men and women, separately. In men, we found that patients in the 3rd SUA tertile had a significantly higher risk of having elevated NT-proBNP concentrations (standardized β coefficient 0.331, p = 0.002) compared to those in 1st SUA tertile. In women, we found that patients in the 3rd SUA tertile had a significantly higher risk of having increased NT-proBNP concentra- tions (standardized β coefficient 0.569, p < 0.001). Both of these results remained unchanged after adjustment for age (standardized β coeffi- cient 0.328, p = 0.001 for men, and standardized β coefficient 0.532, p < 0.001 for women). Overall, therefore, these additional statistical analyses clearly sug- gest that in our study the significant positive association we observed between SUA and NT-proBNP concentrations was consistent in both sexes
Do Sex and Gender-Related Differences Account to Different Risk of Developing Heart Failure in Middle-Aged People with Metabolic Syndrome?
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Does high LDL-cholesterol cause cardiovascular disease?
No full textWe read with interest the narrative review article written by Ravnskov et al. (1), who had already reiterated in published letters over the past decade their doubts and claims on both the validity of the ‘cholesterol hypothesis’ and the beneficial effects of statin treatment on risk of incident cardiovascular disease (CVD) events. The authors claim in the final “Key issues” of their review article that (1) the hypothesis that high LDL-cholesterol levels cause atherosclerosis and CVD has been shown to be false by numerous observations and experiments; (2) the assertion that statin treatment is beneficial has been kept alive by individuals who have ignored the results from trials with negative outcomes and by using deceptive statistics; and (3) clinicians should abandon the use of statins and PCSK-9 inhibitors, and instead identify and target the actual causes of CVD. As with most disagreements in life, there is some truth on both sides. It is well recognized that CVD is a complex and multifactorial disease. So, how much the LDL-cholesterol is increased is important and furthermore increased LDL-cholesterol concentrations per se are not the only important issue. Plasma LDL-cholesterol needs to be incorporated into atherosclerotic plaques and that may happen for different reasons in different people. Some people are more resistant to the negative effects of their high LDL-cholesterol than others. That is why the concept of absolute risk is valuable. As clinicians, we would treat middle-aged patients with diabetes, who were smokers and who were hypertensive with a statin, even if their plasma LDL-cholesterol concentrations were considered fairly ‘normal’, because their absolute risk of CVD events would be considered high enough to intervene with a treatment (a statin) to attempt to lower that absolute risk. In contrast, most clinicans would not treat a teenager without familial hypercholesterolaemia with a modestly high LDL-cholesterol concentration because their absolute risk of CVD is low. As we say in situations like this ... ’the devil is in the detail’! We strongly believe that it is not sufficient to say ‘a high LDL-cholesterol level always or never causes CVD events and mortality!’. Binary interpretations of the data in biology and medicine are far too simplistic an approach
Left Atrial Volume Provides Independent and Incremental Information Compared With Exercise Tolerance Parameters in Patients With Heart Failure and Left Ventricular Systolic Dysfunction.
No full textOBJECTIVE: Left atrial volume (LAV) is a powerful predictor of outcome in patients with chronic heart failure (CHF) independently of symptomatic status, age and left ventricular (LV) function. It is unknown whether LAV provides independent and incremental information compared with exercise tolerance parameters.
METHODS: 273 patients with CHF (mean (SD) 62 (9) years; 13% female) prospectively underwent echocardiography and exercise testing with maximal oxygen consumption (Vo(2)). The primary end point was composite and included cardiac death, hospitalisation for worsening heart failure or cardiac transplantation.
RESULTS: At Cox proportional hazard analysis, LAV normalised for body surface area (LAV/BSA) was strongly associated with mortality (hazard ratio (HR) = 1.027 (95% CI 1.018 to 1.04), p63 ml, EF <30% and Vo(2) <16 ml/kg/min were considered to be risk factors. Patients with three risk factors had an HR of 38 (95% CI 11 to 129) compared with patients with no risk factors.
CONCLUSION: LAV provides powerful prognostic information incrementally and independently of Vo(2). LAV, EF and Vo(2 )can be used to build a risk prediction model, which can be used clinically
A new plasma ceramide 24-based risk score predicts overall mortality and nonfatal myocardial infarction in patients with suspected or known coronary artery disease
No full textBackground and aim: Plasma ceramides (Cer) are associated with adverse cardiovascular outcomes in patients with coronary artery disease (CAD). We examined whether a newly developed plasma ceramide-based risk score (CER24 score) performs better than CERT1 risk score in predicting adverse cardiovascular outcomes in patients with known or suspected CAD. Methods and results: We followed 167 ambulatory patients undergoing stress myocardial perfusion scintigraphy (MPS) for clinical reasons for a median of 6 years. For the CER24 risk score calculation, we measured plasma Cer(d16:1/24:1)/Cer(d16:1/24:0), Cer(d18:0/24:1)/Cer(d18:0/24:0), Cer(d18:1/24:1)/Cer(d18:1/24:0), Cer(d18:2/24:1)/Cer(d18:2/24:0), and Cer(d20:1/24:1)/Cer(d20:1/24:0), both before and after stress MPS, using a targeted liquid chromatography-tandem mass spectrometry assay. Pre-stress CER24 risk categories (high vs. low/moderate risk) at baseline were associated with a ∼3-fold higher risk of developing the primary composite outcome (defined as all-cause mortality or nonfatal myocardial infarction) even after adjustment for age, sex, smoking, diabetes, pre-existing CAD, left ventricular ejection fraction, and stress-induced inducible myocardial ischemia on MPS (adjusted-hazard ratio 3.06, 95 %CI 1.63-5.77; p = 0.001). Post-stress CER24 risk categories yielded similar results. CER24 high-risk category performed better than CERT1 high-risk category in predicting the primary composite outcome (AUCs = 0.647 vs. 0.580; p = 0.048). Conclusions: The CER24 score is associated with a higher risk of the composite outcome and performs better than CERT1 score in predicting the risk of dying or developing nonfatal cardiovascular events
Association between KLF6 rs3750861 polymorphism and plasma ceramide concentrations in post-menopausal women with type 2 diabetes
No full textBackground and aim: Based on the emerging role of Kruppel-like factor 6 (KLF6) in lipid metabolism, we examined whether there is a relationship between the KLF6 rs3750861 genetic variant and plasma ceramide levels in people with type 2 diabetes mellitus (T2DM). Methods and result: We measured six previously identified plasma ceramides, which have been associated with increased cardiovascular risk [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0) and Cer(d18:1/24:1)] amongst 101 Caucasian post-menopausal women with T2DM, who consecutively attended our diabetes outpatient service during a 3-month period. Plasma ceramides were measured by targeted liquid chromatography-tandem mass spectrometry assay. Genotyping of the KLF6 rs3750861 polymorphism was performed by TaqMan-Based RT-PCR system. Overall, 87 (86.1%) patients had KLF6 rs3750861 C/C genotype and 14 (13.9%) had C/T or T/T genotypes. After adjustment for age, diabetes-related variables, use of lipid-lowering drugs and other potential confounders, patients with C/T or T/T genotypes had higher plasma Cer(d18:1/18:0) (0.159 ± 0.05 vs. 0.120 ± 0.04 μmol/L, p = 0.012), Cer(d18:1/20:0) (0.129 ± 0.04 vs. 0.098 ± 0.03 μmol/L, p = 0.008), and Cer(d18:1/24:1) (1.236 ± 0.38 vs. 0.978 ± 0.36 μmol/L, p = 0.032) compared with those with C/C genotype. Conclusions: The C/T or T/T genotypes of rs3750861 in the KLF6 gene were closely associated with higher levels of specific plasma ceramides in post-menopausal women with T2DM
Association between specific plasma ceramides and high-sensitivity C-reactive protein levels in postmenopausal women with type 2 diabetes
No full textAIM: Emerging evidence suggests that specific plasma ceramides are involved in the pathophysiology of cardiovascular disease (CVD) and other inflammation-associated diseases. However, only scanty information is currently available on the association between distinct plasma ceramides (those associated with increased cardiovascular morbidity and mortality) and plasma high-sensitivity C-reactive protein (hs-CRP) concentrations in patients with type 2 diabetes mellitus (T2DM), a group at high risk of developing CVD and other chronic inflammation-related conditions. METHODS: Previously, six high-risk plasma ceramide species [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0), Cer(d18:1/24:1)] were identified in 92 postmenopausal women with T2DM attending a diabetes outpatients service over a 3-month period. Plasma ceramide levels were measured using targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. RESULTS: Plasma hs-CRP levels were positively associated with all measured ceramides on univariable linear regression analyses, but only plasma Cer(d18:1/16:0) (standard β coefficient: 0.27, P = 0.015), Cer(d18:1/22:0) (standard β coefficient: 0.25, P = 0.032) and Cer(d18:1/24:1) (standard β coefficient: 0.30, P = 0.007) remained significantly associated with increased plasma hs-CRP levels after adjusting for age, adiposity measures, diabetes duration, HbA1c, insulin resistance, smoking, hypertension, plasma LDL cholesterol, estimated glomerular filtration rate, preexisting ischaemic heart disease and use of lipid-lowering, antihypertensive, antiplatelet or hypoglycaemic drugs. CONCLUSION: In postmenopausal women with T2DM, elevated levels of specific plasma ceramides are associated with higher plasma hs-CRP levels independent of established cardiovascular risk factors, diabetes-related variables and other potential confounding factors
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