197 research outputs found
Dilatation in the femoral vascular bed does not cause retrograde relaxation of the iliac artery in the anaesthetized pig
No full textNetworks for improving care in patients with acute coronary syndrome: A framework
No full textIn recent years, it has become evident that the level of guideline adherence in patients presenting with acute coronary syndrome (ACS) is highly correlated with patient outcomes. Unfortunately, guideline adherence is low in some geographic areas and especially in those patients at high-risk. Regional networks including ambulance systems and hospitals with catheterization laboratories are able to increase guideline adherence and patient outcomes by streamlining the critical pre- and intra-hospital processes as well as improving timely access to invasive procedures and recommended medication. Successful organization of an ACS network requires engagement of multiple stakeholders to create effective solutions for the specific local setting. There is no 'one-size-fits all' strategy to set-up and successfully run an ACS network. We present a framework for how to set up and organize an effective ACS network, delivering guideline-based care to improve patient outcomes. Copyright © 2014 Informa UK, Ltd
Increased arterial stiffness in HIV-infected children: risk factors and antiretroviral therapy
No full textBackground: Recent evidence suggests that both the HIV virus and antiretroviral therapy (ART) are associated with premature atherosclerosis in adults. Increased arterial stiffness as assessed by pulse wave velocity (PWV) has been associated with adverse cardiovascular outcome in adults. The relationship between HIV infection and treatment and arterial stiffness has not been evaluated in children. Methods: We studied 83 HIV-infected children with a mean &ÏλÏÏÎ1⁄4Î1⁄2;SD age of 11.0 &Ïλ ÏÏÎ1⁄4Î1⁄2;3.1 years and 59 controls aged 12.2 &Ïλ ÏÏÎ1⁄4Î1⁄2;2.8 years. Among the HIV-infected children, 48 were receiving ART (23 including a protease inhibitor). Arterial stiffness was assessed non-invasively by carotid-radial PWV. Disease severity was defined according to the CDC classification. Results: PWV was significantly increased in HIV-infected children compared with controls (P&λÏ;0.05). A significant association between age and PWV was noted in HIV-infected children but not in controls. HIV-infected children receiving ART had significantly increased total cholesterol levels and PWV compared with non-treated children (P&λÏ;0.001 and P&λÏ;0.05, respectively). CDC stage was greater in ART-treated compared with non-treated HIV-infected children (P&λÏ;0.001). No differences in other cardiovascular risk factors were noted in the two groups. After multivariable analysis, ART, systolic blood pressure, disease severity and total cholesterol remained independent predictors of PWV. Conclusions: HIV-infected children have increased arterial stiffness compared with healthy children. These changes were more pronounced with increasing age in HIV-infected children particularly in those who were receiving ART. ©2009 International Medical Press
Ready-to-use supplementary food supplements improve endothelial function, hemoglobin and growth in Tanzanian children with sickle cell anaemia: the Vascular Function Intervention Study (V-FIT), a random order crossover trial
No full textIntroduction: Endothelial function is impaired in sickle cell anemia (SCA) and may be prognostic of severity of pathophysiology underlying many complications. Poor nutritional status is documented in SCA in all income settings, yet no strategies exist to improve nutrition. Poor nutritional status and hemoglobin predict death and hospitalization in Tanzanian SCA patients (Cox, et al. Haematologica 96, 2011, Makani et al. PloSONE 6, 2011). The objectives are to determine the combined effect of two ready-to-use-supplementary food (RUSF) interventions on the primary endpoints of endothelial function, assessed by flow mediated dilatation (FMD), growth and body composition and hemoglobin (secondary endpoint).
Methods: Tanzanian children (N=119) (HbSS) aged 8-11.9 years were enrolled in V-FIT (ISRCTN74331412/NCT01718054) in Aug to Nov 2012. Children received in random order a daily RUSF providing 500 kcal, 1 RDA of vitamins and minerals & 1mg folate (Nutriset, France), plus weekly anti-malarial prophylactic chloroquine syrup (150/225mg base) (Wallace manufacturing chemicals, UK), or a vascular-RUSF (RUSFv) fortified with arginine and citrulline (average 0.2g/kg/d & 0.1g/kg/d) plus daily chloroquine syrup (3mg base/kg/d). Patients and investigators were blind to the different interventions. Each intervention was received for 4 months with 4 month washout periods on either side (Figure 1A). Clinic visits were conducted at baseline and at the end of each intervention/washout period when endothelium-dependent and -independent vasodilatation were assessed (Donald et al. JACC 51, 2008), plus height, weight and body composition by impedance (Tanita BC418). Random effects models were used, adjusting for repeated measures within individuals. In multivariable analyses models were a priori adjusted for gender. Possible temporal effects were modelled via Fourier transformation of visit dates and included in models for growth and hemoglobin. Effects of the interventions on FMDmax were adjusted for arterial diameter before vasodilation induction, which was negatively correlated with FMDmax and for magnitude of reactive hyperaemia during induction of vasodilation, which was not correlated with FMDmax.
Results: 115/119 (60% male; mean age at enrolment 10.0, 95% CI 9.8 – 10.2 years) enrolled patients completed the trial and all clinic visits. Endpoints at baseline and the adjusted and unadjusted effects of the interventions are shown in Table 1. FMDmax, baseline brachial diameter, absolute change in blood flow velocity during reactive hyperemia, hemoglobin, height velocity, weight and lean mass gain all increased on the RUSF (Fig 1B-F).
Discussion: We demonstrate that providing extra protein, energy and micronutrients improves hemoglobin, vascular endothelial function and growth. It is possible that the effects observed are limited to the RUSFv, and/or from unadjusted for temporal effects. Unblinded analysis of the effect of RUSFv vs. RUSF on these endpoints, plasma amino acids and arginase are planned. Currently the only intervention for children with SCA is hydroxyurea, which although it improves hemoglobin and reduces hemolysis, does not appear to affect growth while its effect on vascular physiology is unknown (Wang et al. J Pediatr 140, 2002). In addition to specific nutrients, general improvement in nutrition may result in improvement in important intermediate endpoints in SCA. Future research should investigate effects of nutritional supplementation on clinical endpoints
Reclassification of cardiovascular risk in Europe: application of the updated Systematic COronary Risk Evaluation (SCORE) algorithm incorporating high-density lipoprotein levels
No full textPurpose: Cardiovascular disease (CVD) imposes a significant health burden throughout Europe. Cardiovascular risk can be assessed using validated risk prediction models, such as the European Systematic COronary Risk Evaluation (SCORE) algorithm that assesses 10-year risk of cardiovascular mortality. This is also recommended for guiding treatment options. Recently, the SCORE algorithm has been updated to incorporate high-density lipoprotein cholesterol (HDL-C) levels (SCORE-HDL), thus providing a more accurate estimate of risk. We have investigated the proportion of patients who would have their risk classification changed with the SCORE-HDL algorithm when compared to the original SCORE.
Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, diabetes mellitus, smoking or obesity). We calculated risk using international SCORE and SCORE-HDL algorithms in patients aged 50–65 years without diabetes and not receiving lipid-lowering therapy.
Results: In total, risk was assessed in 2321 patients. According to SCORE, 447 were at low risk (LR), 1409 were at intermediate risk (IR) and 465 were at high risk (HR) of CVD mortality (LR: < 1%; IR: 1–5%; HR ≥ 5% 10-year risk). According to SCORE-HDL, 597 were at LR, 1328 were at IR and 396 were at HR. Of the 447 patients at LR according to SCORE, 11.9% were reclassified by SCORE-HDL as IR and none as HR. Of the 1409 patients at IR according to SCORE, 14.3% and 2.9% were reclassified as LR and HR, respectively. Of the 465 patients at HR according to SCORE, 23.4% and 0.2% were reclassified as IR and LR, respectively. Comparable proportions of males and females at IR according to SCORE were reclassified as HR by SCORE-HDL (3.6 and 2.4%, respectively). However, only 1.9% of males were reclassified from IR to LR, in contrast to 24.9% of females.
Conclusions: Assessment of CVD risk using SCORE-HDL in our patient population (aged 50–65 years, with at least one cardiovascular risk factor but no history of CVD, without diabetes and not receiving lipid-lowering therapy) often resulted in cardiovascular risk reclassification when compared with the original SCORE. Reclassification into a lower risk category was more common than into a higher risk category, especially amongst females at IR according to SCORE. Most of our study cohort were categorized as LR or IR by both algorithms
Use of lipid lowering therapy in primary care across Europe: results from the European study on cardiovascular risk prevention in daily practice (eurika)
No full textPurpose: Current European guidelines recommend that patients free from cardiovascular disease (CVD) but estimated to be at high (≥ 5%) 10-year risk of CVD mortality should be more vigorously pharmacologically treated than those at lower risk. The recommended target level of low-density lipoprotein cholesterol (LDL-C) is < 2.5 mmol/l, or < 1.8 mmol/l for those at very high risk (VHR; those with diabetes mellitus [DM] or a ≥ 10% 10-year mortality risk). We examined the use of lipid lowering therapy (LLT) and achievement of LDL-C level targets in routine clinical practice in Europe.
Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries from May 2009 to January 2010, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, DM, smoking or obesity). Ten-year CVD mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE) algorithm. LDL-C levels were measured and use of LLT was noted, including the agents and doses used. Statin therapy was classified as low-intensity (LIS; pravastatin, simvastatin, lovastatin, fluvastatin, atorvastatin < 40 mg or rosuvastatin < 20 mg) or high-intensity (HIS; atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg).
Results: We identified 3278 individuals who were receiving any form of LLT, of whom 3040 (92.7%) were receiving a statin. Of the 4363 patients not receiving LLT, 1741 (39.9%) had DM or a SCORE risk ≥ 5%. LDL-C levels were available for 3151 participants receiving LLT, for whom LDL-C levels were not at target (< 2.5 mmol/l) in 1931 (61.3%). Only 8.9% of patients on LLT were receiving HIS. Of the patients receiving LIS, only 39.8% had LDL-C levels < 2.5 mmol/l. A subset of 2970 patients were at VHR, of whom only 1469 (49.5%) were receiving any form of LLT. LDL-C levels were at target (< 1.8 mmol/l) in 17.1% of these patients. Only 9.1% of the VHR patients on LLT were receiving HIS. Of the VHR patients receiving LIS, only 17.1% had
Conclusion: Approximately 40% of patients aged ≥ 50 years with at least 1 cardiovascular risk factor who are not currently receiving LLT are at high risk of CVD (DM or SCORE ≥ 5%). Furthermore, well over half of all those receiving LLT and more than 80% of VHR patients receiving LLT did not achieve recommended LDL-C levels. These results demonstrate that there is potential for major improvements in lipid level management in patients at risk of CVD in Europe
Achievement of lipoprotein goals among patients with metabolic syndrome at high
No full textOBJECTIVE: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe.
METHODS: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥50years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥2 additional major cardiovascular risk factors).
RESULTS: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol<70mg/dl, non-HDL-cholesterol<100mg/dl, and apolipoprotein B<80mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol<100mg/dl, non-HDL-cholesterol<130mg/dl, and apolipoprotein B<90mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals.
CONCLUSION: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvemen
A dose-response study of hormone replacement in young hypogonadal women: effects on intima media thickness and metabolism
No full textAchievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study.
No full textAIMS: Most studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk.
METHODS AND RESULTS: This study was conducted with 7641 outpatients aged ≥50 years, free of clinical CVD and with at least one major CVD risk factor, selected from 12 European countries in 2009. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Cholesterol fractions and glycated haemoglobin (HbA1c) were measured in a central laboratory. Cardiovascular disease risk was estimated with the SCORE equation. Patients' mean age was 63 years (48% men), and 40.1% had a high CVD risk. Among treated hypertensives (94.2%), only 38.8% achieved the blood pressure target of <140/90 mmHg [between-country range (BCR): 32.1-47.5%]. Among treated dyslipidaemic patients (74.4%), 41.2% attained both the total- and LDL-cholesterol target of <5 and <3 mmol/L, respectively (BCR: 24.3-68.4%). Among treated type 2 diabetic patients (87.2%), 36.7% achieved the <6.5% HbA1c target (BCR: 23.4-48.4%). Among obese patients on non-pharmacological treatment (92.2%), 24.7% reached the body mass index target of <30 kg/m(2) (BCR: 12.7-37.1%). About one-third of controlled patients on treatment were still at high remaining CVD risk. Although most patients were advised to reduce excess weight and to follow a low-calorie diet, less than half received written recommendations.
CONCLUSIONS: In Europe, a large proportion of patients in primary prevention have CVD risk factors that remain uncontrolled, and lifestyle counselling is not well implemented; moreover, there is substantial between-country variation, which indicates additional room for improvement. Raised residual CVD risk is relatively frequent among patients despite control of their primary risk factors and should be addressed
ORIGINAL RESEARCH—PEYRONIE'S DISEASE: Systemic Vascular Endothelial Dysfunction in Peyronie's Disease
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