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Jadoon, Adil, Anna V. Mathew, Jaeman Byun, Crystal A. Gadegbeku, Debbie S. Gipson, Farsad Afshinnia, and Subramaniam Pennathur. "Gut Microbial Product Predicts Cardiovascular Risk in Chronic Kidney Disease Patients." American Journal of Nephrology 48, no. 4 (2018): 269–77. http://dx.doi.org/10.1159/000493862.
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Background: The gut microbiota is altered in patients with chronic kidney disease (CKD), and cardiovascular risk increases with progressive CKD. This study examined the potential link between short chain fatty acids (SCFAs), which are produced by the gut microbiota, and cardiovascular outcomes in patients with CKD. Methods: SCFAs were measured using a targeted liquid chromatography-mass spectrometry platform in baseline plasma samples from 214 patients with CKD enrolled in the Clinical Phenotyping Resource and Biobank Core; 81 patients with coronary artery disease (CAD) and 133 without CAD were randomly assigned to training and validation subsets. The primary outcome was a history of CAD and the secondary outcome was a composite history of cardiovascular disease (CVD) at enrollment. Results: We found significantly higher levels of the SCFA valerate among patients with CAD as compared with patients without CAD in the training set (p < 0.001). The valerate concentrations were also significantly higher among subjects with composite outcomes of CVD compared to those without CVD (p = 0.006). These results were subsequently replicated in the validation set. Logistic regression analysis revealed a strong independent association between plasma valerate levels and CVD in both training and validation sets. When valerate was added to the base clinical model comprising of diabetes, hypertension, urinary protein-creatinine ratio, and estimated glomerular filtration rate, it increased the c-statistics for predicting CVD from 0.68 to 0.79 (p = 0.02) in the training set, an observation which was confirmed in the validation set. Conclusion: This study provides evidence for alterations in gut-microbiota-derived SCFAs with advancing CKD, demonstrates the association of higher plasma valerate levels with pre-existing CVD, and reveals areas for future exploration of cardiovascular risk in patients with CKD.
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Butcko, Andrew J., Ashley K. Putman, and Emilio P. Mottillo. "The Intersection of Genetic Factors, Aberrant Nutrient Metabolism and Oxidative Stress in the Progression of Cardiometabolic Disease." Antioxidants 13, no. 1 (January 10, 2024): 87. http://dx.doi.org/10.3390/antiox13010087.
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Cardiometabolic disease (CMD), which encompasses metabolic-associated fatty liver disease (MAFLD), chronic kidney disease (CKD) and cardiovascular disease (CVD), has been increasing considerably in the past 50 years. CMD is a complex disease that can be influenced by genetics and environmental factors such as diet. With the increased reliance on processed foods containing saturated fats, fructose and cholesterol, a mechanistic understanding of how these molecules cause metabolic disease is required. A major pathway by which excessive nutrients contribute to CMD is through oxidative stress. In this review, we discuss how oxidative stress can drive CMD and the role of aberrant nutrient metabolism and genetic risk factors and how they potentially interact to promote progression of MAFLD, CVD and CKD. This review will focus on genetic mutations that are known to alter nutrient metabolism. We discuss the major genetic risk factors for MAFLD, which include Patatin-like phospholipase domain-containing protein 3 (PNPLA3), Membrane Bound O-Acyltransferase Domain Containing 7 (MBOAT7) and Transmembrane 6 Superfamily Member 2 (TM6SF2). In addition, mutations that prevent nutrient uptake cause hypercholesterolemia that contributes to CVD. We also discuss the mechanisms by which MAFLD, CKD and CVD are mutually associated with one another. In addition, some of the genetic risk factors which are associated with MAFLD and CVD are also associated with CKD, while some genetic risk factors seem to dissociate one disease from the other. Through a better understanding of the causative effect of genetic mutations in CMD and how aberrant nutrient metabolism intersects with our genetics, novel therapies and precision approaches can be developed for treating CMD.
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Wang, Hanghang, Patrick H. Pun, Lydia Kwee, Damian Craig, Carol Haynes, Megan Chryst-Ladd, Laura P. Svetkey, et al. "Apolipoprotein L1 Genetic Variants Are Associated with Chronic Kidney Disease but Not with Cardiovascular Disease in a Population Referred for Cardiac Catheterization." Cardiorenal Medicine 7, no. 2 (December 29, 2016): 96–103. http://dx.doi.org/10.1159/000453458.
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Background: While the association between APOL1 genetic variants and chronic kidney disease (CKD) has been established, their association with cardiovascular disease (CVD) is unclear. This study sought to understand CKD and cardiovascular risk conferred by APOL1 variants in a secondary cardiovascular prevention population. Methods: Two risk variants in APOL1 were genotyped in African-Americans (n = 1,641) enrolled in the CATHGEN biorepository, comprised of patients referred for cardiac catheterization at Duke University Hospital, Durham, NC, USA (2001-2010). Individuals were categorized as noncarriers (n = 722), heterozygote (n = 771), or homozygote carriers (n = 231) of APOL1 risk alleles. Multivariable logistic regression and Cox proportional hazards models adjusted for CVD risk factors were used to assess the association between APOL1 risk variants and prevalent and incident CKD, prevalent coronary artery disease (CAD), incident CVD events, and mortality. Results: The previously identified association between APOL1 variants and prevalent CKD was confirmed (OR: 1.85, 95% CI: 1.33-2.57, p = 0.0002). No statistically significant associations were detected between APOL1 variants and incident CKD or prevalent CAD, incident CVD events or mortality. Age, type 2 diabetes, and ejection fraction at baseline were significant clinical factors that predicted the risk of incident CKD in a subgroup analysis of APOL1 homozygous individuals. Conclusion:APOL1 genetic variants are not associated with CAD or incident CVD events in a cohort of individuals with a high burden of cardiometabolic risk factors. In individuals with homozygous APOL1 status, factors that predicted subsequent CKD included age, presence of type 2 diabetes, and ejection fraction at baseline.
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Solmi, M., N. Veronese, B. Beatrice, R. Stella, S. Paolo, G. Davide, E. Collantoni, et al. "Prevalence, incidence and comparative meta-analysis of all-cause and specific-cause cardiovascular disease in patients with serious mental illness." European Psychiatry 41, S1 (April 2017): S319—S320. http://dx.doi.org/10.1016/j.eurpsy.2017.02.238.
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Patients with severe mental illness (SMI) have been described at higher risk of cardiovascular disease (CVD). The aim of this systematic review and meta-analysis was to quantify prevalence, incidence, cross-sectional association and longitudinal increased risk of coronary heart disease (CHD), stroke, transient ischemic attack and cerebrovascular disease (CBVD), heart failure (HF), peripheral vascular disease (PVD), death due to CVD, and any CVD in patients with SMI. We included 92 studies, with a total population of 3,371,461 patients (BD = 241,226, MDD = 476,102, SCZ = 1,721,586, SMI = 932,547) and 113,925,577 controls. Pooled prevalence of any CVD in SMI was 9.9% (95% CI = 7.4–13.3) (33 studies, 360,144 patients). Compared to controls, after adjusting for a median of 7 confounders, SMI was associated with higher risk of CVD in cross-sectional studies, OR:1.53 (95% CI = 1.27–1.83) (11 studies), with CHD OR: 1.51 (95% CI = 1.47–1.55) (5 studies), with CBVD OR: 1.42 (95% CI = 1.21–1.66) (6 studies), and tended to be associated with HF OR: 1.28 (95% CI = 0.99–1.65) (4 studies). Cumulative incidence was 3.6 CVD events in a median follow-up period of 8.4 years (range: 1.76–30). After considering a median of 6 confounders, SMI was associated with higher longitudinal risk of CVD in longitudinal studies HR: 1.78 (95% CI = 1.6, 1.98) (31 studies), of CHD: HR: 1.54 (95% CI 1.30–1.82) (18 studies), of CBVD HR: 1.64 (95% CI 1.26–2.14) (11 studies), of HF HR:2.10 (95% CI 1.64–2.70) (2 studies), of PVD, unadjusted RR: 3.11 (95% CI 2.46–3.91) (3 studies), of death due to CVD, HR 1.85 (95% CI 1.53–2.24) (16 studies). In this meta-analysis, the association between SMI and CVD has been quantified in a world representative sample; we suggest prevention of CVD should be warranted as standard care in SMI.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gujral, Unjali P., Ram Jagannathan, Siran He, Minxuan Huang, Lisa R. Staimez, Jingkai Wei, Nanki Singh, and K. M. Venkat Narayan. "Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis." BMJ Open Diabetes Research & Care 9, no. 1 (April 2021): e001776. http://dx.doi.org/10.1136/bmjdrc-2020-001776.
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IntroductionWe conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.Research design and methodsWe identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.ResultsImpaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110–125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100–125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%–6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%–6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).ConclusionPrediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.
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Liu, Yu-Jie, Meng-Yuan Miao, Jia-Min Wang, Quan Tang, Wen-Wen Han, Yi-Ping Jia, Hao-Wei Tao, et al. "Coffee Consumption and Incidence of Cardiovascular and Microvascular Diseases in Never-Smoking Adults with Type 2 Diabetes Mellitus." Nutrients 15, no. 18 (September 8, 2023): 3910. http://dx.doi.org/10.3390/nu15183910.
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The relationship between coffee consumption and diabetes-related vascular complications remains unclear. To eliminate confounding by smoking, this study assessed the relationships of coffee consumption with major cardiovascular disease (CVD) and microvascular disease (MVD) in never-smokers with type 2 diabetes mellitus (T2DM). Included were 9964 never-smokers with T2DM from the UK Biobank without known CVD or cancer at baseline (7781 were free of MVD). Participants were categorized into four groups according to daily coffee consumption (0, 0.5–1, 2–4, ≥5 cups/day). CVD included coronary heart disease (CHD), myocardial infarction (MI), stroke, and heart failure (HF). MVD included retinopathy, peripheral neuropathy, and chronic kidney disease (CKD). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidential intervals (CIs) of total CVD and MVD and the component outcomes associated with coffee consumption. During a median of 12.7 years of follow-up, 1860 cases of CVD and 1403 cases of MVD were identified. Coffee intake was nonlinearly and inversely associated with CVD (P-nonlinearity = 0.023) and the component outcomes. Compared with no coffee intake, HRs (95% CIs) associated with a coffee intake of 2 to 4 cups/day were 0.82 (0.73, 0.93) for CVD, 0.84 (0.73, 0.97) for CHD, 0.73 (0.57, 0.92) for MI, 0.76 (0.57, 1.02) for stroke, and 0.68 (0.55, 0.85) for HF. Higher coffee intake (≥5 cups/day) was not significantly associated with CVD outcomes. Coffee intake was linearly and inversely associated with risk of CKD (HR for ≥5 vs. 0 cups/day = 0.64; 95% CI: 0.45, 0.91; P-trend = 0.0029) but was not associated with retinopathy or peripheral neuropathy. Among never-smoking individuals with T2DM, moderate coffee consumption (2–4 cups/day) was associated with a lower risk of various CVD outcomes and CKD, with no adverse associations for higher consumption.
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Spanuchart, Ittikorn, Arkom Nongnuch, and Youg Liu. "Nontraditional Biomarkers for Cardiovascular Disease in Patients With Chronic Kidney Disease." Ramathibodi Medical Journal 43, no. 2 (June 30, 2020): 51–60. http://dx.doi.org/10.33165/rmj.2020.43.2.230208.
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Cardiovascular disease (CVD) is the leading cause of death among patients who have chronic kidney disease (CKD). Nowadays, CKD per se is considered one of the coronary heart disease (CHD) risk equivalents. Apart from traditional CVD risk factors, there are several possible determinants for CVD in patients with CKD, for example, uremic toxins, increased inflammatory stage, abnormal bone mineral metabolism, and positive calcium balance. In this narrative review, we offer a summary of the extensively studied biomarkers for CVD in patients with CKD, including uremic toxins (p-cresol, indoxyl sulfate, and advanced glycated end products), and a novel indicator of arterial stiffness, cardio-ankle vascular index (CAVI), which is an independent prognostic predictor for CVD. For the uremic toxins, we reviewed their metabolisms, particularly, how the reduced renal function in CKD patients affect their clearance and their clearance with dialysis. Also, we pay attention to the recent evidence on how those uremic toxins contribute to CVD and their clinical associations. We do not include the possible treatment targeting at those uremic toxins. As for the novel indicator of arterial stiffness, we reviewed the clinical application of CAVI in comparison to the standard indicator for arterial stiffness, pulse wave velocity.
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Shifris, I. M., I. O. Dudar, Е. К. Krasiuk, and А. Yu Shymova. "Predictors of cardiovascular disease in patients with chronic kidney disease VD stage treated with hemodialysis." Medicni perspektivi (Medical perspectives) 26, no. 2 (June 18, 2021): 59–66. http://dx.doi.org/10.26641/2307-0404.2021.2.234513.
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The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р<0.001) was stated, more than twice – of coronary artery disease (CAD; р<0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.
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Anderson, R. David, John W. Petersen, Puja K. Mehta, Janet Wei, B. Delia Johnson, Eileen M. Handberg, Saibal Kar, et al. "Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation–Coronary Vascular Dysfunction (WISE-CVD)." Journal of Interventional Cardiology 2019 (March 11, 2019): 1–8. http://dx.doi.org/10.1155/2019/7169275.
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Objective. In a separate, contemporary cohort, we sought to confirm findings of the original Women’s Ischemia Syndrome Evaluation (WISE). Background. The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. Methods. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). Results. In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. Conclusions. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.
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Kosmas, Constantine E., Shanna Rodriguez Polanco, Maria D. Bousvarou, Evangelia J. Papakonstantinou, Edilberto Peña Genao, Eliscer Guzman, and Christina E. Kostara. "The Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease." Diagnostics 13, no. 5 (March 1, 2023): 929. http://dx.doi.org/10.3390/diagnostics13050929.
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Atherosclerosis is an immunoinflammatory pathological procedure in which lipid plaques are formed in the vessel walls, partially or completely occluding the lumen, and is accountable for atherosclerotic cardiovascular disease (ASCVD). ACSVD consists of three components: coronary artery disease (CAD), peripheral vascular disease (PAD) and cerebrovascular disease (CCVD). A disturbed lipid metabolism and the subsequent dyslipidemia significantly contribute to the formation of plaques, with low-density lipoprotein cholesterol (LDL-C) being the main responsible factor. Nonetheless, even when LDL-C is well regulated, mainly with statin therapy, a residual risk for CVD still occurs, and it is attributable to the disturbances of other lipid components, namely triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). Increased plasma TG and decreased HDL-C levels have been associated with metabolic syndrome (MetS) and CVD, and their ratio, TG/HDL-C, has been proposed as a novel biomarker for predicting the risk of both clinical entities. Under these terms, this review will present and discuss the current scientific and clinical data linking the TG/HDL-C ratio with the presence of MetS and CVD, including CAD, PAD and CCVD, in an effort to prove the value of the TG/HDL-C ratio as a valuable predictor for each aspect of CVD.
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Gosmanova, Elvira O., and Ngoc-Anh Le. "Cardiovascular Complications in CKD Patients: Role of Oxidative Stress." Cardiology Research and Practice 2011 (2011): 1–8. http://dx.doi.org/10.4061/2011/156326.
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Starting with the early stages, patients with chronic kidney disease (CKD) experience higher burden of cardiovascular disease (CVD). Moreover, CVD complications are the major cause of mortality in CKD patients as compared with complications from chronic kidney failure. While traditional CVD risk factors, including diabetes, hypertension, hyperlipidemia, obesity, physical inactivity, may be more prevalent among CKD patients, these factors seem to underestimate the accelerated cardiovascular disease in the CKD population. Search for additional biomarkers that could explain the enhanced CVD risk in CKD patients has gained increasing importance. Although it is unlikely that any single nontraditional risk factor would fully account for the increased CVD risk in individuals with CKD, oxidative stress appears to play a central role in the development and progression of CVD and its complications. We will review the data that support the contribution of oxidative stress in the pathogenesis of CVD in patients with chronic kidney failure.
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Sheer, Richard, Radhika Nair, Margaret K. Pasquale, Thomas Evers, Meghan Cockrell, Alain Gay, Rakesh Singh, and Niklas Schmedt. "Predictive Risk Models to Identify Patients at High-Risk for Severe Clinical Outcomes With Chronic Kidney Disease and Type 2 Diabetes." Journal of Primary Care & Community Health 13 (January 2022): 215013192110637. http://dx.doi.org/10.1177/21501319211063726.
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Introduction/Objective: Predictive risk models identifying patients at high risk for specific outcomes may provide valuable insights to providers and payers regarding points of intervention and modifiable factors. The goal of our study was to build predictive risk models to identify patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) at high risk for progression to end stage kidney disease (ESKD), mortality, and hospitalization for cardiovascular disease (CVD), cerebrovascular disease (CeVD), and heart failure (HF). Methods: This was a retrospective observational cohort study utilizing administrative claims data in patients with CKD (stage 3-4) and T2D aged 65 to 89 years enrolled in a Medicare Advantage Drug Prescription plan offered by Humana Inc. between 1/1/2012 and 12/31/2017. Patients were enrolled ≥1 year pre-index and followed for outcomes, including hospitalization for CVD, CeVD and HF, ESKD, and mortality, 2 years post-index. Pre-index characteristics comprising demographic, comorbidities, laboratory values, and treatment (T2D and cardiovascular) were evaluated and included in the models. LASSO technique was used to identify predictors to be retained in the final models followed by logistic regression to generate parameter estimates and model performance statistics. Inverse probability censoring weighting was used to account for varying follow-up time. Results: We identified 169 876 patients for inclusion. Declining estimated glomerular filtration rate (eGFR) increased the risk of hospitalization for CVD (38.6%-61.8%) and HF (2-3 times) for patients with eGFR 15 to 29 mL/min/1.73 m2 compared to patients with eGFR 50 to 59 mL/min/1.73 m2. Patients with urine albumin-to-creatinine ratio (UACR) ≥300 mg/g had greater chance for hospitalization for CVD (2.0 times) and HF (4.9 times), progression to ESKD (2.9 times) and all-cause mortality (2.4 times) than patients with UACR <30 mg/g. Elevated hemoglobin A1c (≥8%) increased the chances for hospitalization for CVD (21.3%), CeVD (45.4%), and death (20.6%). Among comorbidities, history of HF increased the risk for ESKD, mortality, and hospitalization for CVD, CeVD, and HF. Conclusions: The predictive models developed in this study could potentially be used as decision support tools for physicians and payers, and the risk scores from these models can be applied to future outcomes studies focused on patients with T2D and CKD.
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Villain, Cédric, Marie Metzger, Christian Combe, Denis Fouque, Luc Frimat, Christian Jacquelinet, Maurice Laville, et al. "Prevalence of atheromatous and non-atheromatous cardiovascular disease by age in chronic kidney disease." Nephrology Dialysis Transplantation 35, no. 5 (August 28, 2018): 827–36. http://dx.doi.org/10.1093/ndt/gfy277.
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Abstract Background Although chronic kidney disease (CKD) and age are major risk factors for cardiovascular disease (CVD), little is known about the relative proportions of atheromatous and non-atheromatous CVD by age in CKD patients. Methods We used baseline data from the French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort of 3033 patients (65% men) with CKD Stages 3–4 to study crude and adjusted associations between age, the estimated glomerular filtration rate (eGFR), atheromatous CVD (coronary artery disease, peripheral artery disease and stroke) and non-atheromatous CVD (heart failure, cardiac arrhythmia and valvular heart disease). Results Mean age was 66.8 and mean Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR was 32.9 mL/min/1.73 m2. In the <65, (65–74), (75–84) and ≥85 year age groups, the prevalence was, respectively, 18.7, 35.5, 42.9 and 37.8% for atheromatous CVD, and 14.9, 28.4, 38.1 and 56.4% for non-atheromatous CVD. After adjusting for albuminuria, sex and CVD risk factors, the odds ratio (OR) [95% confidence interval (CI)] for (65–74), (75–84) and ≥85 age groups (compared with the <65 group) was, respectively, 1.99 (1.61–2.46), 2.89 (2.30–3.62), 2.72 (1.77–4.18) for atheromatous CVD and 2.07 (1.66–2.58), 3.15 (2.50–3.97), 7.04 (4.67–10.61) for non-atheromatous CVD. Compared with patients with an eGFR ≥30 mL/min/1.73 m2, those with an eGFR <30 mL/min/1.73 m2 had a higher OR for atheromatous CVD [1.21 (1.01–1.44)] and non-atheromatous CVD [1.16 (0.97–1.38)]. Conclusions In this large cohort of CKD patients, both atheromatous and non-atheromatous CVD were highly prevalent and more frequent in older patients. In a given age group, the prevalence of atheromatous and non-atheromatous CVD was similar (except for a greater prevalence of non-atheromatous CVD after 85).
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Adiyanti, Sri Suryo, Yusra Yusra, Suzanna Immanuel, Diana Aulia, Fify Henrika, and July Kumalawati. "The Role of Neutrophil Lymphocyte Ratio , Vitamin D, and NGAL as Cardiovascular Disease Marker in Chronic Kidney Disease." eJournal Kedokteran Indonesia 9, no. 3 (January 31, 2022): 192–6. http://dx.doi.org/10.23886/ejki.9.35.192-6.
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Chronic kidney disease (CKD) patients have higher risk to develop cardiovascular disease (CVD) than non-CKD patients. Neutrophil lymphocyte ratio (NLR) in CKD patients reflects inflammation status and role as complementary prognostic marker to evaluate cardiovascular risk in stage 3 to 5 CKD. High prevalence of vitamin D deficiency commonly found in CKD patients, leads to endothelial dysfunction and increase inflammation. NGAL is used as renal injury biomarker but nowadays NGAL has been known plays important role in CVD pathophysiology. CVD identification in CKD patients is necessary to obtain CVD risk and to stratify mortality earlier in CKD patients. This study aimed to obtain the differences and continued to obtain cut off of NLR, vitamin D and NGAL in CKD patients undergoing hemodialysis (HD) with and without CVD if the differences was significantly. A cross-sectional study was conducted in dr. Cipto Mangunkusumo National Hospital Jakarta, in December- February 2020. Total subjects were 83, consists of two groups with and without the CVD. There were no significant differences of NLR and vitamin D in CKD patients undergoing hemodialysis (HD) with and without CVD. The significant difference was found only in NGAL with cut off 5.64 ng/ml. NLR was lower, meanwhile vitamin D and NGAL were higher in CKD patients undergoing HD with and without CVD.
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Wijnands, K. P. J., S. A. Obermann-Borst, E. J. G. Sijbrands, M. F. Wildhagen, W. A. Helbing, and R. P. M. Steegers-Theunissen. "Cardiovascular diseases in grandparents and the risk of congenital heart diseases in grandchildren." Journal of Developmental Origins of Health and Disease 5, no. 2 (February 19, 2014): 152–58. http://dx.doi.org/10.1017/s2040174414000026.
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Hyperglycemia, dyslipidemia and hyperhomocysteinemia are associated with both adult cardiovascular disease (CVD) and having a child with a congenital heart disease (CHD). We investigated associations between CVD in grandparents and the risk of CHD in grandchildren. In a case–control family study, we obtained detailed questionnaire information on CVD and CHD in 247 families with a CHD child and 203 families without a CHD child. Grandparents with CVD or intermittent claudication (IC) were significantly associated with an increased risk for CHD in grandchildren [OR 1.39 (95% CI 1.03–1.89) and OR 2.77 (95% CI 1.02–7.56), respectively]. The risk of CHD grandchildren was particularly increased in paternal grandfathers with CVD [OR 1.85 (95% CI 1.01–3.37)]. Overall, having a grandparent with CVD increased the risk for CHD in the grandchild by 1.65 (95% CI 1.12–2.41). After adjustment for potential maternal confounders, this risk was 1.44 (95% CI 0.94–2.21). Having two or more grandparents with CVD was associated with an approximately threefold risk for CHD grandchildren [OR adjusted 2.72 (95% CI 1.08–6.89)]. Our data suggest that CVD and IC in grandparents are associated with an increased risk of having a CHD grandchild. These first findings may be explained by shared causality of derangements in metabolic pathways and are in line with the fetal origins of health and disease.
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Kosmas, Constantine E., Delia Silverio, Christiana Tsomidou, Maria D. Salcedo, Peter D. Montan, and Eliscer Guzman. "The Impact of Insulin Resistance and Chronic Kidney Disease on Inflammation and Cardiovascular Disease." Clinical Medicine Insights: Endocrinology and Diabetes 11 (January 2018): 117955141879225. http://dx.doi.org/10.1177/1179551418792257.
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There is extensive evidence showing that insulin resistance (IR) is associated with chronic low-grade inflammation. Furthermore, IR has been shown to increase the risk for cardiovascular disease (CVD), even in nondiabetic patients, and is currently considered as a “nontraditional” risk factor contributing to CVD by promoting hypertension, oxidative stress, endothelial dysfunction, dyslipidemia, and type 2 diabetes mellitus. However, chronic kidney disease (CKD) is also considered a state of low-grade inflammation. In addition, CKD is considered an IR state and has been described as an independent risk factor for the development of CVD, as even early-stage CKD is associated with an estimated 40% to 100% increase in CVD risk. There is also strong evidence indicating that inflammation per se plays a crucial role in both the initiation and progression of CVD. Given the above, the combined effect of IR and CKD may significantly increase the risk of inflammation and CVD. This review aims to focus on the complex interplay between IR, CKD, inflammation, and CVD and will present and discuss the current clinical and scientific data pertaining to the impact of IR and CKD on inflammation and CVD.
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Chacko, Manas, P. Sankara Sarma, Sivadasanpillai Harikrishnan, Geevar Zachariah, and Panniyammakal Jeemon. "Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study." Wellcome Open Research 5 (April 16, 2020): 70. http://dx.doi.org/10.12688/wellcomeopenres.15829.1.
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Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7–17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Chacko, Manas, P. Sankara Sarma, Sivadasanpillai Harikrishnan, Geevar Zachariah, and Panniyammakal Jeemon. "Family history of cardiovascular disease and risk of premature coronary heart disease: A matched case-control study." Wellcome Open Research 5 (June 12, 2020): 70. http://dx.doi.org/10.12688/wellcomeopenres.15829.2.
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Background: Self-reported family history of cardiovascular disease (CVD) is an independent risk factor for future coronary heart disease (CHD) events. However, inclusion of family history of CVD in the traditional risk scores failed to improve risk prediction of CHD. It is proposed that family history of CVD may substantially increase the risk of CHD among younger individuals. Methods: We conducted a matched case-control study with 170 hospital-based premature CHD patients (<55 years in men and <65 years in women) from a tertiary care centre in Thiruvananthapuram, Kerala and age and sex matched community-based controls in 1:1 ratio. Conditional logistic regression analysis was conducted to assess the independent association of family history of cardiovascular disease (CVD) and premature CHD. We estimated McNemar's odds ratios and their 95 percent confidence intervals. Results: The prevalence of any family history of CVD and CHD in the control population was 24% and 21%, respectively. The family history of CVD was independently associated with premature CHD (odds ratio (OR) = 9.0; 95% confidence interval (CI) 4.7–17.3). There was a dose-response relationship between family history and premature CHD as the risk increased linearly with increase in number of affected family members. Conclusions: Family history of CVD is an independent risk factor for premature CHD. The risk of premature CHD increases linearly with increase in number of affected family members. Collecting family history beyond parental history of CVD is important for risk stratification. Targeting young individuals with family history of CVD for intensive risk reduction interventions may help to prevent future events.
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Song, Jenn-Yeu, Ta-Chung Shen, Yi-Chou Hou, Jia-Feng Chang, Chien-Lin Lu, Wen-Chih Liu, Po-Jui Chen, Bo-Hau Chen, Cai-Mei Zheng, and Kuo-Cheng Lu. "Influence of Resveratrol on the Cardiovascular Health Effects of Chronic Kidney Disease." International Journal of Molecular Sciences 21, no. 17 (August 31, 2020): 6294. http://dx.doi.org/10.3390/ijms21176294.
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Cardiovascular disease (CVD) is closely related to chronic kidney disease (CKD), and patients with CKD have a high risk of CVD-related mortality. Traditional CVD risk factors cannot account for the higher cardiovascular risk of patients with CKD, and standard CVD interventions cannot reduce the mortality rates among patients with CKD. Nontraditional factors related to mineral and vitamin-D metabolic disorders provide some explanation for the increased CVD risk. Non-dialyzable toxins, indoxyl sulfate (IS) and p-cresol sulfate (PCS)—produced in the liver by colonic microorganisms—cause kidney and vascular dysfunction. Plasma trimethylamine-N-oxide (TMAO)—a gut microbe-dependent metabolite of dietary L-carnitine and choline—is elevated in CKD and related to vascular disease, resulting in poorer long-term survival. Therefore, the modulation of colonic flora can improve prospects for patients with CKD. Managing metabolic syndrome, anemia, and abnormal mineral metabolism is recommended for the prevention of CVD in patients with CKD. Considering nontraditional risk factors, the use of resveratrol (RSV), a nutraceutical, can be helpful for patients with CVD and CKD. This paper discusses the beneficial effects of RSV on biologic, pathophysiological and clinical responses, including improvements in intestinal epithelial integrity, modulation of the intestinal microbiota and reduction in hepatic synthesis of IS, PCS and TMAO in patients with CVD and CKD.
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Mamdouh, Doaa, Hanan Shawky, Nihal Moustafa El-Assaly, Samia El-Shishtawy, Nevine Sherif, Amna Metwaly, and Asmaa Mohamed Fteah. "Role of Transcription Factor 7 like 2 and Silent Information Regulator 1 Genes in the Development of Cardiovascular Complications in a Group of Egyptian Patients with Chronic Kidney Disease." Open Access Macedonian Journal of Medical Sciences 10, A (January 1, 2022): 16–24. http://dx.doi.org/10.3889/oamjms.2022.8107.
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BACKGROUND: Sirtuins silent information regulator 1 (SIRT) is histone deacetylases that act as antioxidants and involved in the pathogenesis of cardiovascular diseases (CVD) which are the major complications of chronic kidney disease (CKD). Transcription factor 7-like 2 (TCF7L2) genetic polymorphisms could contribute to the risk of CVD as TCF7L2 proteins regulate vascular remodeling. AIM: We tried to demonstrate the role of genetic polymorphisms: rs7069102 and rs10823108 in SIRT1 gene and rs7903146 in TCF7L2 gene in the development of CVD in CKD Egyptian patients. METHODS: This study included 120 CKD patients (60 with CVD and 60 without CVD) and 60 age and sex-matched healthy subjects as a control group. Routine laboratory investigations were performed and genotyping for candidate single nucleotide polymorphisms was done by Taqman-real-time polymerase chain reaction. RESULTS: The frequency of the C allele of rs7069102 was significantly higher in CKD patients with CVD as compared to the normal control group (p < 0.001) and as compared to CKD patients without CVD (p < 0.001). Percentages of AG and GG genotypes of rs10823108 were significantly higher in CKD patients with CVD as compared to the normal control group (p = 0.002, 0.035, respectively). The frequency of the T allele of rs7903146 was significantly higher in CKD patients with CVD as compared to the normal control group (p < 0.001). CONCLUSION: We found that C allele of rs7069102, GG and AG genotypes of rs10823108 in the SIRT1 gene and T allele of rs7903146 in TCF7L2 gene have a potential role in the pathogenesis and the risk of CVD development in CKD Egyptian patients.
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Obialo, Chamberlain, Elizabeth Ofili, and Keith Norris. "Statins and Cardiovascular Disease Outcomes in Chronic Kidney Disease: Reaffirmation vs. Repudiation." International Journal of Environmental Research and Public Health 15, no. 12 (December 4, 2018): 2733. http://dx.doi.org/10.3390/ijerph15122733.
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Cardiovascular disease (CVD) burden is several-fold higher in patients with chronic kidney disease (CKD). Although statins have been shown to provide significant CVD benefits in both the general population and patients with CKD, this has not translated into survival advantage in patients with advanced CKD or on dialysis. It has been reported that CVD risk continues to escalate as CKD progresses to end-stage kidney disease (ESKD); however, the CVD risk reduction by statins appears to decline as patients’ progress from the early to later stages of CKD. Statins have also been associated with a higher incidence of stroke in ESKD patients. Thus, the CVD benefits of statins in ESKD remain questionable.
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Pagliano, G., L. Orlando, and A. Gravina. "Detección y caracterización del complejo de viroides de los cítricos en Uruguay." Agrociencia 2, no. 1 (June 1998): 74–83. http://dx.doi.org/10.31285/agro.02.1143.
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Plantas de cidro Etrog Arizona 861 (Citrus medica L.) fueron inoculadas con cortezas provenientes de árboles de campo presentando síntomas de enanismo y descortezado del portainjerto y de árboles asintomáticos. A los 3 y 4 meses expresaron reducción del crecimiento, epinastia en hojas, necrosis de nervaduras, puntuaciones en peciolo y síntomas de shock. El análisis de ácidos nucleicos mediante sPAGE, slot blot e hibridación molecular, permitió detectar la presencia de tres grupos de viroides, CVd-I, CVd-II y CVd-III comunicados por primera vez a nivel nacional, asociados al agente causal de la exocortis de los citrus (CEVd). Los viroides caracterizados fueron CVd-Ia, CV-IB, CVd-IIa, CVd-IIIa y CVd-IIIb. No se ha detectado la presencia del viroide perteneciente al grupo CVd-IV. Todas las fuentes de campo analizadas presentaron una mezcla del CEVd con viroides pertenecientes a los grupos CVd-I, CVd-II y CVd-III.
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Yew, Sheng Qian, Yook Chin Chia, and Michael Theodorakis. "Assessing 10-Year Cardiovascular Disease Risk in Malaysians With Type 2 Diabetes Mellitus: Framingham Cardiovascular Versus United Kingdom Prospective Diabetes Study Equations." Asia Pacific Journal of Public Health 31, no. 7 (September 19, 2019): 622–32. http://dx.doi.org/10.1177/1010539519873487.
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In this study, we evaluated the performance of the Framingham cardiovascular disease (CVD) and the United Kingdom Prospective Diabetes Study (UKPDS) risk equations to predict the 10-year CVD risk among type 2 diabetes mellitus (T2DM) patients in Malaysia. T2DM patients (n = 660) were randomly selected, and their 10-year CVD risk was calculated using both the Framingham CVD and UKPDS risk equations. The performance of both equations was analyzed using discrimination and calibration analyses. The Framingham CVD, UKPDS coronary heart disease (CHD), UKPDS Fatal CHD, and UKPDS Stroke equations have moderate discrimination (area under the receiver operating characteristic [aROC] curve = 0.594-0.709). The UKPDS Fatal Stroke demonstrated a good discrimination (aROC curve = 0.841). The Framingham CVD, UKPDS Stroke, and UKPDS Fatal Stroke equations showed good calibration ( P = .129 to .710), while the UKPDS CHD and UKPDS Fatal CHD are poorly calibrated ( P = .035; P = .036). The UKPDS is a better prediction equation of the 10-year CVD risk among T2DM patients compared with the Framingham CVD equation.
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Swamy, Sowmya, Sahibzadi Mahrukh Noor, and Roy O. Mathew. "Cardiovascular Disease in Diabetes and Chronic Kidney Disease." Journal of Clinical Medicine 12, no. 22 (November 8, 2023): 6984. http://dx.doi.org/10.3390/jcm12226984.
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Chronic kidney disease (CKD) is a common occurrence in patients with diabetes mellitus (DM), occurring in approximately 40% of cases. DM is also an important risk factor for cardiovascular disease (CVD), but CKD is an important mediator of this risk. Multiple CVD outcomes trials have revealed a greater risk for CVD events in patients with diabetes with CKD versus those without. Thus, reducing the risk of CKD in diabetes should result in improved CVD outcomes. To date, of blood pressure (BP) control, glycemic control, and inhibition of the renin-angiotensin system (RASI), glycemic control appears to have the best evidence for preventing CKD development. In established CKD, especially with albuminuria, RASI slows the progression of CKD. More recently, sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP1RA) have revolutionized the care of patients with diabetes with and without CKD. SGLT2i and GLP1RA have proven to reduce mortality, heart failure (HF) hospitalizations, and worsening CKD in patients with diabetes with and without existing CKD. The future of limiting CVD in diabetes and CKD is promising, and more evidence is forthcoming regarding combinations of evidence-based therapies to further minimize CVD events.
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Quan, Stuart, Rohit Budhiraja, Sogol Javaheri, Sairam Parthasarathy, and Richard Berry. "The Association Between Obstructive Sleep Apnea Defined by 3 Percent Oxygen Desaturation or Arousal Definition and Self-Reported Cardiovascular Disease in the Sleep Heart Health Study." Southwest Journal of Pulmonary and Critical Care 21, no. 4 (October 19, 2020): 86–103. http://dx.doi.org/10.13175/swjpcc054-20.
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Background: Studies have established that OSA defined using a hypopnea definition requiring a >4% oxygen desaturation (AHI4%) is associated with cardiovascular (CVD) or coronary heart (CHD) disease. This study determined whether OSA defined using a hypopnea definition characterized by a >3% oxygen desaturation or an arousal (AHI3%A) is associated with CVD/CHD. Methods: Data were analyzed from 6307 Sleep Heart Health Study participants who had polysomnography. Self-reported CVD included angina, heart attack, heart failure, stroke or previous coronary bypass surgery or angioplasty. Self-reported CHD included the aforementioned conditions but not stroke or heart failure. The association between OSA and CVD/CHD was examined using logistic regression models with stepwise inclusion of demographic, anthropometric, social/behavioral and co-morbid medical conditions. A parsimonious model in which diabetes and hypertension were excluded because of their potential to be on the causal pathway between OSA and CVD/CHD also was constructed. Results: For CVD, the odds ratios and 95% confidence intervals for AHI3%A >30/hour were 1.39 (1.03-1.87) and 1.45 (1.09-1.94) in the fully adjusted and parsimonious models. Results for CHD were 1.29 (0.96-1.74) and 1.36 (0.99-1.85). In participants without OSA according to more stringent AHI4% criteria but with OSA using the AHI3%A definition, similar findings were observed. Conclusion: OSA defined using an AHI3%A is associated with both CVD and CHD. Use of a more restrictive AHI4% definition will misidentify a large number of individuals with OSA who have CVD or CHD. These individuals may be denied access to therapy, potentially worsening their underlying CVD or CHD.
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Vallianou, Natalia G., Shah Mitesh, Agathoniki Gkogkou, and Eleni Geladari. "Chronic Kidney Disease and Cardiovascular Disease: Is there Any Relationship?" Current Cardiology Reviews 15, no. 1 (December 11, 2018): 55–63. http://dx.doi.org/10.2174/1573403x14666180711124825.
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Introduction: Chronic Kidney Disease is a growing health burden world wide. Traditional and mutual risk factors between CVD and CKD are age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, family history and male gender. In this review, we will focus on whether or not early CKD is an important risk factor for the presence, severity and progression of CVD. Specifically, we will examine both traditional and novel risk factors of both CKD and CVD and how they relate to each other. Conclusion: We will also assess if early treatment of CKD, intensive compared to standard, has an important effect on the halt of the development of CKD as well as CVD. Insights into the pathogenesis and early recognition of CKD as well as the importance of novel kidney biomarkers will be pointed out. Also, common pathogenetic mechanisms between CKD and CVD will be discussed.
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Al-Makhamreh, Hanna, Amro Alkhatib, Ahmed Attarri, Ahmad A. Toubasi, Aya Dabbas, Basel Al-Bkoor, Zaid Sarhan, and Osama Alghafri. "Knowledge of cardiovascular disease risk factors among caregivers of cardiology patients attending Jordan University Hospital." PeerJ 12 (January 31, 2024): e16830. http://dx.doi.org/10.7717/peerj.16830.
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Cardiovascular disease (CVD) is an umbrella term that includes various pathologies involving the heart and the vasculature system of the body. CVD is the leading cause of death worldwide, accounting for an estimated 32% of all deaths. More than 40% of annual deaths in Jordan are due to CVD; this number is further expected to rise, particularly in the Eastern Mediterranean region where Jordan is located. Due to the chronic nature of CVD, the presence of a caregiver who can help mitigate the challenges patients face is essential, and their level of knowledge determines the quality of care they can provide. Hence, this cross-sectional study was conducted in the cardiology clinics at Jordan University Hospital (JUH). Questionnaires were distributed to 469 participants, defined in this study as the caregivers escorting patients with established coronary heart disease (CHD). The self-administered questionnaire included three sections: sociodemographic and health factors, knowledge of CVD risk factors, and CHD symptoms. The mean age of the study population was 44.38 years ± 15.92 and 54.2% of participants were males. Regarding knowledge of CVD risk factors, 84.6% of participants answered more than 70% of the questions correctly. More than 95% knew that chest pain is a symptom of an acute cardiovascular event. However, only 53.5% and 74.8% of the participants reported that jaw pain and arm pain are symptoms of an acute event, respectively. Several factors influenced the caregiver’s knowledge, such as age, income, frequent health checkups, having a history of CVD, CKD, or DM, and their relationship to the patient. This study sheds light on the importance of caregiver knowledge in patient care. By improving the caregivers’ knowledge, identifying their role in patient care, and raising CVD awareness in susceptible populations, healthcare professionals can improve the patients’ quality of life. Overall, assessing caregivers’ knowledge pertaining to CVD can provide invaluable data, which may enhance patient care by educating their caregivers.
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Tohidi, Maryam, Arash Derakhshan, Samaneh Akbarpour, Atieh Amouzegar, Ladan Mehran, Aidin Baghbani-Oskouei, Fereidoun Azizi, and Farzad Hadaegh. "Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study." Hormone and Metabolic Research 50, no. 01 (November 13, 2017): 37–43. http://dx.doi.org/10.1055/s-0043-121031.
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AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.
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Crawford, Andrew A., Stefan Soderberg, Clemens Kirschbaum, Lee Murphy, Mats Eliasson, Shah Ebrahim, George Davey Smith, et al. "Morning plasma cortisol as a cardiovascular risk factor: findings from prospective cohort and Mendelian randomization studies." European Journal of Endocrinology 181, no. 4 (October 2019): 429–38. http://dx.doi.org/10.1530/eje-19-0161.
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Objective The identification of new causal risk factors has the potential to improve cardiovascular disease (CVD) risk prediction and the development of new treatments to reduce CVD deaths. In the general population, we sought to determine whether cortisol is a causal risk factor for CVD and coronary heart disease (CHD). Design and methods Three approaches were adopted to investigate the association between cortisol and CVD/CHD. First, we used multivariable regression in two prospective nested case-control studies (total 798 participants, 313 incident CVD/CHD with complete data). Second, a random-effects meta-analysis of these data and previously published prospective associations was performed (total 6680 controls, 696 incident CVD/CHD). Finally, one- and two-sample Mendelian randomization analyses were performed (122,737 CHD cases, 547,261 controls for two-sample analyses). Results In the two prospective nested case–control studies, logistic regression adjusting for sex, age, BMI, smoking and time of sampling, demonstrated a positive association between morning plasma cortisol and incident CVD (OR: 1.28 per 1 SD higher cortisol, 95% CI: 1.06–1.54). In the meta-analysis of prospective studies, the equivalent result was OR: 1.18, 95% CI: 1.06–1.31. Results from the two-sample Mendelian randomization were consistent with these positive associations: OR: 1.06, 95% CI: 0.98–1.15. Conclusions All three approaches demonstrated a positive association between morning plasma cortisol and incident CVD. Together, these findings suggest that elevated morning cortisol is a causal risk factor for CVD. The current data suggest strategies targeted at lowering cortisol action should be evaluated for their effects on CVD.
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Ravid, Jonathan D., and Vipul C. Chitalia. "Molecular Mechanisms Underlying the Cardiovascular Toxicity of Specific Uremic Solutes." Cells 9, no. 9 (September 2, 2020): 2024. http://dx.doi.org/10.3390/cells9092024.
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Mounting evidence strongly suggests a causal link between chronic kidney disease (CKD) and cardiovascular disease (CVD). Compared with non-CKD patients, patients with CKD suffer disproportionately from CVD and derive suboptimal benefits from interventions targeting conventional CVD risk factors. Uremic toxins (UTs), whose plasma levels rapidly rise as CKD progresses, represent a unique risk factor in CKD, which has protean manifestations on CVD. Among the known UTs, tryptophan metabolites and trimethylamine N-oxide are well-established cardiovascular toxins. Their molecular mechanisms of effect warrant special consideration to draw translational value. This review surveys current knowledge on the effects of specific UTs on different pathways and cell functions that influence the integrity of cardiovascular health, with implication for CVD progression. The effect of UTs on cardiovascular health is an example of a paradigm in which a cascade of molecular and metabolic events induced by pathology in one organ in turn induces dysfunction in another organ. Deciphering the molecular mechanisms underlying such cross-organ pathologies will help uncover therapeutic targets to improve the management of CVD in patients with CKD.
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Bhargava, Seema, Arif Ali, Mamta Kankra, Sabari Das, Anjali Manocha, Flora Gupta, and Lalit Mohan Srivastava. "Differential expression of lipid peroxidation and total antioxidant status in Indian patients with cardiovascular and cerebrovascular disease." Canadian Journal of Physiology and Pharmacology 92, no. 7 (July 2014): 592–97. http://dx.doi.org/10.1139/cjpp-2013-0481.
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Data from studies examining lipid peroxidation as a mechanism involved with hyperhomocysteinemia (HHcy)-induced vascular remodeling in patients with occlusive vascular disease have been contradictory. It has not yet been studied in Indians within the context of atherogenesis. Therefore, we measured the levels of homocysteine (Hcy), malondialdehyde (MDA) as a measure of lipid peroxides (LPOs), and total antioxidant status (TAS) in the serum of 167 patients with occlusive vascular disease [coronary artery disease (CAD) = 43; cerebrovascular disease (CVD) = 82; peripheral vascular disease (PVD) = 42]. Each of these groups was further divided into groups of individuals with or without HHcy. In the case of CAD and CVD, patients with HHcy had significantly higher LPOs than those without HHcy (p = 0.009, 0.001, respectively). TAS was significantly lower in CVD patients with HHcy than in those without (p = 0.014). In patients with CAD or CVD, Hcy directly correlated with LPOs (p = 0.002, 0.001, respectively). Lipid peroxidation is a significant mechanism in HHcy-induced vascular remodeling in CAD and CVD, but not in PVD, probably because it is not relevant in thrombosis (38 of 42 patients of PVD had deep-vein thrombosis). To explain the significantly lower TAS in CVD, we hypothesized that CVD patients present very early with grave symptoms, whereas CAD and PVD occur over a longer period of time. Therefore, when CVD presents, TAS is still overwhelmed by HHcy-induced oxidative stress. Hence, adjuvant therapy with antioxidants would benefit patients with CVD.
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Vernière, C., X. Perrier, C. Dubois, A. Dubois, L. Botella, C. Chabrier, J. M. Bové, and N. Duran Vila. "Interactions Between Citrus Viroids Affect Symptom Expression and Field Performance of Clementine Trees Grafted on Trifoliate Orange." Phytopathology® 96, no. 4 (April 2006): 356–68. http://dx.doi.org/10.1094/phyto-96-0356.
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Citrus exocortis viroid (CEVd), Citrus bent leaf viroid (CBLVd), a noncachexia variant of Hop stunt viroid (HSVd), Citrus viroid III (CVd-III), and Citrus viroid IV (CVd-IV) were co-inoculated as two-, three-, four-, and five-viroid mixtures to Clementine trees grafted on trifoliate orange to evaluate their effect on symptom expression, tree growth, and fruit yield. Most trees infected with CEVd-containing viroid mixtures developed exocortis scaling symptoms, as did CEVd alone, whereas most trees infected with HSVd- or CVd-IV-containing mixtures developed bark-cracking symptoms. Trees infected with mixtures containing both CEVd and CVd-IV revealed the existence of antagonism between these two viroids in terms of the expected bark-scaling and cracking symptoms. Synergistic interactions also were identified in trees infected with certain viroid combinations that, in spite of lacking CEVd, expressed exocortis-like scaling symptoms. Viroid interactions also affected the expected response of trees in terms of vegetative growth and fruit yield. Trees infected with viroid combinations containing CEVd or CVd-III were smaller and produced less fruit than trees infected with mixtures not containing these viroids. Viroid interactions on scion circumference and cumulative fruit yield, in terms of additivity of their effects, were statistically confirmed using a factorial analysis of variance model with two mean estimation approaches. In single-viroid infections, CEVd, CVd-III, and, to a lesser extent, CBLVd consistently and significantly reduced tree size and fruit yield. Conversely, HSVd and CVd-IV slightly increased fruit yield and reduced scion circumference. Rare and not consistent significant interactions were detected with the five-, four-, and three-viroid combinations. Antagonistic interactions between CEVd and CVd-III or CBLVd and CVd-III were revealed over the years with consistent significance. The antagonistic interaction between CEVd and CVd-IV was highly significant over the years when additional viroids were present; however, this antagonism appeared much later in the case of an exclusive interaction. HSVd and CVd-IV showed a consistent and significant synergistic interaction on yield only when both viroids were exclusively present. These results demonstrate antagonistic or synergistic relationships between citrus viroids depending on the viroid mixtures present in the host.
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Karangizi, A. H. K., D. Chanouzas, A. Fenton, P. Moss, P. Cockwell, C. J. Ferro, and L. Harper. "Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease." QJM: An International Journal of Medicine 113, no. 4 (October 15, 2019): 253–57. http://dx.doi.org/10.1093/qjmed/hcz258.
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Abstract Background Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established. Aim Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD. Design A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. Methods We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD. Results Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19–32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P < 0.001), ischaemic heart disease (P < 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231–3.242, P = 0.005]. Conclusions In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.
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Wong, Chun Wai, Chun Shing Kwok, Aditya Narain, Martha Gulati, Anastasia S. Mihalidou, Pensee Wu, Mirvat Alasnag, Phyo Kyaw Myint, and Mamas A. Mamas. "Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis." Heart 104, no. 23 (June 19, 2018): 1937–48. http://dx.doi.org/10.1136/heartjnl-2018-313005.
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BackgroundThe influence of marital status on the incidence of cardiovascular disease (CVD) and prognosis after CVD is inconclusive. We systematically reviewed the literature to determine how marital status influences CVD and prognosis after CVD.MethodsA search of MEDLINE and Embase in January 2018 without language restriction was performed to identify studies that evaluated the association between marital status and risk of CVD. Search terms related to both marital status and CVD were used and included studies had to be prospective in design. The outcomes of interest were CVD, coronary heart disease (CHD) or stroke incidence and mortality. We performed random effects meta-analysis stratified by the types of population by calculating odds ratios (OR) and 95% confidence intervals (95% CI).ResultsOur analysis included 34 studies with more than two million participants. Compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42; 95% CI 1.00 to 2.01), CHD (OR 1.16,95% CI 1.04 to 1.28), CHD death (OR 1.43,95% CI 1.28 to 1.60) and stroke death (OR 1.55,95% 1.16 to 2.08). Being divorced was associated with increased odds of CHD (P<0.001) for both men and women while widowers were more likely to develop a stroke (P<0.001). Single men and women with myocardial infarction had increased mortality (OR 1.42, 95% CI 1.14 to 1.76) compared with married participants.ConclusionsMarital status appears to influence CVD and prognosis after CVD. These findings may suggest that marital status should be considered in the risk assessment for CVD and outcomes of CVD based on marital status merits further investigation.
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Maas, Sanne L., Marjo M. P. C. Donners, and Emiel P. C. van der Vorst. "ADAM10 and ADAM17, Major Regulators of Chronic Kidney Disease Induced Atherosclerosis?" International Journal of Molecular Sciences 24, no. 8 (April 15, 2023): 7309. http://dx.doi.org/10.3390/ijms24087309.
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Chronic kidney disease (CKD) is a major health problem, affecting millions of people worldwide, in particular hypertensive and diabetic patients. CKD patients suffer from significantly increased cardiovascular disease (CVD) morbidity and mortality, mainly due to accelerated atherosclerosis development. Indeed, CKD not only affects the kidneys, in which injury and maladaptive repair processes lead to local inflammation and fibrosis, but also causes systemic inflammation and altered mineral bone metabolism leading to vascular dysfunction, calcification, and thus, accelerated atherosclerosis. Although CKD and CVD individually have been extensively studied, relatively little research has studied the link between both diseases. This narrative review focuses on the role of a disintegrin and metalloproteases (ADAM) 10 and ADAM17 in CKD and CVD and will for the first time shed light on their role in CKD-induced CVD. By cleaving cell surface molecules, these enzymes regulate not only cellular sensitivity to their micro-environment (in case of receptor cleavage), but also release soluble ectodomains that can exert agonistic or antagonistic functions, both locally and systemically. Although the cell-specific roles of ADAM10 and ADAM17 in CVD, and to a lesser extent in CKD, have been explored, their impact on CKD-induced CVD is likely, yet remains to be elucidated.
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Tucker, Patrick S., Michael I. Kingsley, R. Hugh Morton, Aaron T. Scanlan, and Vincent J. Dalbo. "The Increasing Financial Impact of Chronic Kidney Disease in Australia." International Journal of Nephrology 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/120537.
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The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set atP<0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia’s healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted.
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Tain, You-Lin, and Chien-Ning Hsu. "Cardiovascular Risks of Hypertension: Lessons from Children with Chronic Kidney Disease." Children 9, no. 11 (October 28, 2022): 1650. http://dx.doi.org/10.3390/children9111650.
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Hypertension is the most common complication of chronic kidney disease (CKD) in children, having a strong association with subsequential cardiovascular disease (CVD). In pediatric CKD, a considerable percentage of children with hypertension are undiagnosed or undertreated. Prior research has evaluated structural and functional markers of subclinical CVD and biomarkers in adults with CKD, while ideal biomarkers in pediatrics are still insufficiently studied. The ultimate goal of this review is to summarize what is currently known about state of hypertension, cardiovascular risk factors, and potential CVD markers/biomarkers in children with pre-dialysis CKD. We discuss omics-related biomarkers and the pathophysiologic processes of endothelial dysfunction, kidney injury, oxidative stress and inflammation that are classified by specific biomarkers. Moreover, we illustrate the existing challenges and highlight the paucity of pediatric CKD research to evaluate these CVD biomarkers for future clinical pediatric practice. Thus, achieving clinical utility of CVD biomarkers for use in pediatric CKD remains a significant challenge requiring additional efforts.
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Chang, Horng-Jinh, Kuan-Reng Lin, Junn-Liang Chang, and Meng-Te Lin. "Risk Factors for Chronic Kidney Disease in Older Adults with Hyperlipidemia and/or Cardiovascular Diseases in Taipei City, Taiwan: A Community-Based Cross-Sectional Analysis." International Journal of Environmental Research and Public Health 17, no. 23 (November 25, 2020): 8763. http://dx.doi.org/10.3390/ijerph17238763.
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This cross-sectional study aimed to compare risk factors for chronic kidney disease (CKD) in older adults with or without dyslipidemia and/or cardiovascular diseases (CVD) in Taipei City, Taiwan. The data on 2912 participants with hyperlipidemia and/or CVD and 14,002 healthy control participants derived from the Taipei City Elderly Health Examination Database (2010 to 2011) were analyzed. The associations between conventional CKD risk factors and CKD were comparable between participants with and without hyperlipidemia. Participants with high uric acid and BUN had a higher risk of CKD if they also had hyperlipidemia and CVD [odds ratio (OR) in uric acid = 1.572, 95% CI 1.186–2.120, p < 0.05; OR in BUN = 1.271, 95% CI 1.181–1.379, p < 0.05]. The effect was smaller in participants with hyperlipidemia only (OR in uric acid = 1.291, 95% CI 1.110–1.507, p < 0.05; OR in BUN = 1.169, 95% CI 1.122–1.221, p < 0.05). The association between uric acid/BUN and CKD was also observed in the healthy population and participants with CVD only. In conclusion, older adults with hyperlipidemia and CVD are at high of CKD. Physicians should be alert to the potential for CKD in older patients with hyperlipidemia and CVD.
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Moskaleva, Natalia E., Ksenia M. Shestakova, Alexey V. Kukharenko, Pavel A. Markin, Maria V. Kozhevnikova, Ekaterina O. Korobkova, Alex Brito, et al. "Target Metabolome Profiling-Based Machine Learning as a Diagnostic Approach for Cardiovascular Diseases in Adults." Metabolites 12, no. 12 (November 27, 2022): 1185. http://dx.doi.org/10.3390/metabo12121185.
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Metabolomics is a promising technology for the application of translational medicine to cardiovascular risk. Here, we applied a liquid chromatography/tandem mass spectrometry approach to explore the associations between plasma concentrations of amino acids, methylarginines, acylcarnitines, and tryptophan catabolism metabolites and cardiometabolic risk factors in patients diagnosed with arterial hypertension (HTA) (n = 61), coronary artery disease (CAD) (n = 48), and non-cardiovascular disease (CVD) individuals (n = 27). In total, almost all significantly different acylcarnitines, amino acids, methylarginines, and intermediates of the kynurenic and indolic tryptophan conversion pathways presented increased (p < 0.05) in concentration levels during the progression of CVD, indicating an association of inflammation, mitochondrial imbalance, and oxidative stress with early stages of CVD. Additionally, the random forest algorithm was found to have the highest prediction power in multiclass and binary classification patients with CAD, HTA, and non-CVD individuals and globally between CVD and non-CVD individuals (accuracy equal to 0.80 and 0.91, respectively). Thus, the present study provided a complex approach for the risk stratification of patients with CAD, patients with HTA, and non-CVD individuals using targeted metabolomics profiling.
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Guo, Guangying, Aoran Huang, Xin Huang, Tianhua Xu, and Li Yao. "Prognostic Value of Soluble Suppression of Tumorigenicity 2 in Chronic Kidney Disease Patients: A Meta-Analysis." Disease Markers 2021 (January 25, 2021): 1–11. http://dx.doi.org/10.1155/2021/8881393.
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Objective. Previous studies have controversial results about the prognostic role of soluble suppression of tumorigenicity 2 (sST2) in chronic kidney disease (CKD). Therefore, we conduct this meta-analysis to access the association between sST2 and all-cause mortality, cardiovascular disease (CVD) mortality, and CVD events in patients with CKD. Methods. The publication studies on the association of sST2 with all-cause mortality, CVD mortality, and CVD events from PubMed and Embase were searched through August 2020. We pooled the hazard ratio (HR) comparing high versus low levels of sST2 and subgroup analysis based on treatment, continent, and diabetes mellitus (DM) proportion, and sample size was also performed. Results. There were 15 eligible studies with 11,063 CKD patients that were included in our meta-analysis. Elevated level of sST2 was associated with increased risk of all-cause mortality (HR 2.05; 95% confidence interval (CI), 1.51–2.78), CVD mortality (HR 1.68; 95% CI, 1.35–2.09), total CVD events (HR 1.88; 95% CI, 1.26–2.80), and HF (HR 1.35; 95% CI, 1.11–1.64). Subgroup analysis based on continent, DM percentage, and sample size showed that these factors did not influence the prognostic role of sST2 levels to all-cause mortality. Conclusions. Our results show that high levels of sST2 could predict the all-cause mortality, CVD mortality, and CVD events in CKD patients.
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Bakhunchhen, Rojina, Raju Kumar Dubey, Archana Jayan, Santosh Kumar Shah, and Prabin Khatri. "Product of Serum Calcium and Phosphorus (Ca x Pi) as a Predictor of Cardiovascular Disease Risk in Patients with Chronic Kidney Disease." Journal of Universal College of Medical Sciences 8, no. 1 (July 2, 2020): 23–26. http://dx.doi.org/10.3126/jucms.v8i1.29829.
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INTRODUCTION: Most of the chronic kidney disease (CKD) patients develop cardiovascular disease (CVD) in their later stages. Various traditional CVD risk factors are highly prevalent in CKD but mortality of these patients cannot be fully justified by these CVD markers. So this study was designed to determine serum calcium and phosphorus product (Ca×Pi) to predict CVD risk in CKD patients.
MATERIAL AND METHODS We followed the guidelines of NKF-KDOQI for CKD diagnosis and staging. Further the patients were classified into 3 different groups based on Ca×Pi product; <40 mg2/dl2 (group 1), 40-55 mg2/dl2 (group 2) and >55 mg2/dl2 (group 3). We then evaluated CVD risk by various traditional risk factors like age, BMI, BP, smoking history, dyslipidemia, previous history of CVD, LVH, arrhythmia, VHD, cardiomyopathy, and IHD.
RESULTS: Higher level of Ca×Pi was associated with presence of LVH (32.30% in group 1, 31.42% in group 2 and 46.66% in group 3), Arrythemia (13.84% in group 1, 28.57% in group 2 and 46.67% in group 3), VHD (5.71% in group 2 and 10.00% in group 3), Cardiomyopathy (1.53% in group 1, 8.57% I group 2 and 6.66% in group 3), IHD (6.15% in group1, 11.42% in group 2 and 13.33% in group 3) and hypercholesterolemia, hypertriglyceridemia and increased LDLc.
CONCLUSION: This study found that higher Ca×Pi increases with decline in glomerular filtration rate (GFR) and associated with CVD risks and CVD. So, this study raise a potential need to evaluate the level of calcium and phosphorus in all CKD patients and the level should be monitored more thoroughly to prevent CVD.
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Matsushita, Kunihiro, Josef Coresh, Yingying Sang, John Chalmers, Caroline Fox, Areef Ishani, Tazeen Jafar, et al. "Abstract 55: Kidney Measures Beyond Conventional Risk Factors for Predicting Incident Cardiovascular Disease: A Collaborative Meta-Analysis of 16 Cohorts." Circulation 129, suppl_1 (March 25, 2014). http://dx.doi.org/10.1161/circ.129.suppl_1.55.
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Introduction: Despite the high risk of cardiovascular disease (CVD) in those with chronic kidney disease (CKD), there are conflicting data as to whether two key kidney measures, estimated glomerular filtration rate (eGFR) and albuminuria, contribute to better CVD prediction, beyond conventional risk factors, warranting a more comprehensive investigation over a broad range of populations. Methods: We studied 127,825 participants without history of CVD from 12 general population, 3 high risk and 1 CKD cohorts with data on eGFR (based on the CKD-EPI creatinine equation) and urinary albumin-creatinine ratio (ACR) and at least 4 years of median follow-up for CVD mortality (4,133 deaths from 15 cohorts), coronary heart disease (CHD) (5,420 events from 9 cohorts), stroke (2,651 events from 9 cohorts), or heart failure (2,507 events from 8 cohorts). To compare eGFR and ACR with conventional predictors independently of the order of modeling, we examined the worsening of 5-year prediction of CVD outcomes by omitting each predictor in turn compared to a full model with all kidney and conventional predictors. Results: C-statistics for full models ranged from 0.759-0.836 in general population and high risk cohorts and 0.712-0.796 in the CKD population (Table). All the conventional and kidney measures contributed to better prediction of CVD outcomes. The contribution of ACR was greater than that of any conventional modifiable risk factors except in predicting CHD in both general/high-risk cohorts and CKD population. Although weaker than ACR, eGFR also contributed significantly to better prediction of CVD mortality (especially in CKD populations) and CHD. Largely similar results were observed for categorical net reclassification index. Conclusion: The two key kidney measures (particularly albuminuria) contribute as much as some or all of the conventional risk factors to CVD prediction, supporting their use for CVD risk classification in certain circumstances.
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Hirabayashi, Ken, Hideki Fujii, Keiji Kono, Satoshi Yamatani, Mao Shimizu, Kentaro Watanabe, Kazuo Sakamoto, Shunsuke Goto, and Shinichi Nishi. "#2496 ASSOCIATION OF ABNORMALITIES IN ELECTROCARDIOGRAPHY AND ECHOCARDIOGRAPHY WITH THE OCCURRENCE OF CARDIOVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE." Nephrology Dialysis Transplantation 38, Supplement_1 (June 2023). http://dx.doi.org/10.1093/ndt/gfad063c_2496.
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Abstract Background and Aims In chronic kidney disease (CKD), the incidence of cardiovascular disease (CVD) increases along with CKD progression. Although coronary artery disease (CAD) is one of the most critical CVDs, it is difficult to identify CAD because its symptom is usually atypical in CKD. Consequently, appropriate screening tests for CVD are important in this population. Electrocardiography (ECG) and transthoracic echocardiography (TTE) are commonly performed in daily clinical practice, and we researched whether these abnormalities are risk factors for CVD including CAD in patients with advanced CKD. Method This study included patients with CKD stage G4-5 who were admitted to our hospital from 2010 to 2019. Depending on the presence of ECG and/or TTE-indicated abnormalities, the study patients were divided into four groups: those without both ECG and TTE abnormalities (group A: ECG-, TTE-), those with only ECG abnormalities (group B: ECG+, TTE-), those with only TTE abnormalities (group C: ECG-, TTE+), and those with both ECG and TTE abnormalities (group D: ECG+, TTE+). The clinical characteristics, the occurrence of CVD events, their prognosis, and the prevalence of positive screening tests for CAD were compared among the four groups. CVD events were defined as CVD death and non-fatal CVD events. Results The number of study patients was 607, and they were divided into four groups as follows: 333 in group A, 106 in group B, 76 in group C, and 92 in group D, respectively. The median observational period was 21 months. The incidence of CVD events was highest in group D: 45 patients (13.5%) in group A, 25 patients (23.6%) in group B, 19 patients (25.0%) in group C, and 37 patients (40.2%) in group D, respectively. Multivariate analysis showed that the hazard ratios (HR) for CVD events was significantly higher in group C and D compared to group A as reference (HR: 1.620 in group B, p = 0.116; HR: 2.848 in group C, p = 0.001, and 4.111 in group D, p<0.001, respectively). Furthermore, group D had a higher positive rate of screening tests for CAD compared to the other three groups. Conclusion In patients with advanced CKD, ECG and TTE abnormalities were significantly associated with the occurrence of CVD events. Additionally, those with both ECG and TTE abnormalities may be at high risk for the presence of CAD.
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Kanneganti, Radha, Zeina Dardari, Roger S. Blumenthal, Ron Blankstein, Arthur S. Agatston, Matthew J. Budoff, Karol E. Watson, et al. "Abstract 13711: Coronary Artery Calcium, Ankle-brachial Index, High Sensitivity C-reactive Protein, and a Family History of Coronary Artery Disease as Predictors of Incident Cardiovascular Events at Different Stages of Hypertension: The Multi-ethnic Study of Atherosclerosis." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.13711.
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Background: Coronary artery calcium (CAC), ankle-brachial index (ABI), high-sensitivity CRP (hsCRP), and family history (FHx) of coronary artery disease (CAD) are used as complementary aids in cardiac risk stratification. The 2017 ACC/AHA hypertension guideline’s new Stage I hypertension group has created uncertainty regarding intensity of blood pressure (BP) treatment in this group. We evaluated the comparative utility of CAC, ABI, hsCRP and FHx CAD as risk predictors of cardiovascular (CVD) events within different BP strata. Methods: The MESA cohort was followed for a median of 13 years with regards to incident coronary heart disease (CHD) and CVD events. BP was categorized per ACC/AHA guideline: normal- <120/<80, elevated 120-129/<80, stage I 130-139/80-89, and stage II ≥140/≥90. Participants on BP medications were assigned stage II. Cox regression was used to compare prediction of CHD and CVD events by CAC>300, CAC>75 t h %, ABI<0.9, hsCRP>2 mg/L and FHx CAD, stratifying by BP groups after adjusting for demographics, CVD risk factors and use of BP and cholesterol medications. Results: Of 6268 persons, 539 incident CHD events and 572 incident CVD events were noted. CAC>300 and CAC>75 th % predicted an increased CHD event risk throughout all BP groups. ABI<0.9 was predictive of CHD events in stage I and II, while hsCRP was not predictive in any group. CAC>300 predicted a 2-fold increased CVD risk in all BP groups after adjustment. In the Stage I group, CAC>300, CAC>75 th % and ABI<0.9 showed additive predictive value in incident CHD and CVD events. Using the adjusted model to predict CHD survival, CAC>300 had a consistently higher C-statistic throughout all BP categories compared to other risk markers. Conclusion: CAC>300 was associated with increased CHD and CVD risk in all BP groups and demonstrated superior prognostic utility compared to other risk markers. CAC>300, CAC>75 th % and ABI<0.9 showed potential as risk modifiers in the new Stage I hypertension group.
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Peng, Bo, Hong Yu Wang, Decontee Kaye, Yeonjoo Cho, Delaney Goulet, Matthew Hansen, and Dennis Goulet. "Abstract 11522: The Risk of Cardiovascular Diseases in Women with Recurrent Pregnancy Loss: A Systematic Review and Meta-Analysis." Circulation 144, Suppl_1 (November 16, 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.11522.
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Introduction: Recurrent pregnancy loss (RPL) is defined as two or more ultrasound confirmed pregnancy losses or three or more pregnancy losses at any location. Evidence suggests that women with a history of RPL have an increased risk of coronary heart disease. However, the association between cardiovascular diseases (CVD) and RPL remains unclear. We aim to conduct a systematic review and meta-analysis to investigate whether RPL is a risk factor for CVD. Methods: Population-based studies on MEDLINE, CINAHL, Web of Science, and Embase that investigated the risk of CVD in women with or without a history of RPL were included. The incidences of CVD events and its composite endpoints myocardial infarction/coronary heart diseases (MI/CHD), stroke/cerebrovascular diseases (stroke/CeVD), circulatory system diseases (CSD) were extracted and presented with odds ratio (OR) with 95% confidence interval (CI). Heterogeneity was analyzed with I 2 . Results: A total of 809 articles were retrieved and 6 studies were included. The incidences of CVD events was significantly increased (OR=1.49, 95% CI 1.11 to 1.99, P=0.008, I 2 =96%) in 13176 women with RPL (≥2 pregnancy losses) compare to 403278 controls; a borderline increase of MI/CHD risk was also found (OR=1.45, 95% CI 1.00 to 2.08, P=0.05, I 2 =78%), whereas no significant differences of stroke/CeVD (OR=1.25, 95% CI 0.79 to 1.98, P=0.35, I 2 =73%) and CSD risks (OR=1.17, 95% CI 0.83 to 1.67, P=0.05, I 2 =93%) were observed. In 1594 women with three or more pregnancy losses, an increased incidence of CVD events was found compared to 311385 women without (OR=1.59, 95% CI 1.04 to 2.40, P=0.03, I 2 =71%). The risks of MI/CHD (OR=3.03, 95% CI 1.45 to 6.35, P=0.003, I 2 =78%) and stroke/CeVD (OR=1.63, 95% CI 1.38 to 1.93, P<0.00001, I 2 =0%) were significantly increased in these women but not CSD (OR=1.27, 95% CI 0.92 to 1.76, P=0.13, I 2 =57%). Conclusion: Our study suggested an association between RPL and increased risks of CVD and MI/CHD. The risks of stroke/CeVD may be elevated in women with three or more pregnancy losses. Our work provides a better understanding of the sex-specific risk factors of CVD. Further research may help to identify the causal link between RPL and CVD and determine the need for early screening and intervention in women at risk.
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Gibbs, Sophia, Adrian Bacong, Lily Amaturo, Timothy Frankland, Ana Rosales, Jiang Li, Yihe Daida, Stephen P. Fortmann, and Latha Palaniappan. "Abstract P303: Investigating the Relationship Between Cardiovascular Diseases and Major Depressive Disorder Among Asians and Pacific Islanders." Circulation 149, Suppl_1 (March 19, 2024). http://dx.doi.org/10.1161/circ.149.suppl_1.p303.
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Background: Poorer mental health is associated with greater cardiovascular disease (CVD) morbidity, recovery, and mortality. Experiencing CVD is also associated with poorer mental health after a CVD event. What has been less examined, is how these associations differ among disaggregated Asian and Pacific Islander (API) groups who have a lower burden of both CVD and poor mental health relative to other racial groups. Objective: To examine the association between CVD diagnosis and experiencing major depressive disorder (MDD) among API people and how it differs between racial groups. Methods: We used survey data (n=5,229) from a study of API patients in Hawai’i and California with a linked electronic health record (EHR) data. Race, sex, body mass index (BMI) and CHD, Stroke, and PVD diagnosis were obtained from EHR while MI and CAD diagnoses were from the survey. Data on health behaviors and social determinants were obtained from the survey. Multivariate logistic regression models were used to determine the association between CVD and MDD. Results: Overall prevalence of MDD was 9.2%. Non-Hispanic White people (6.1%) had the lowest prevalence while “Pacific Islander and White” people had the highest prevalence (12.8%). In the fully adjusted models (Table), people who had a stroke (OR = 1.34, p < .001), CHD (OR = 1.32, p = .01), CAD (OR = 1.35, p = .016) or PVD (OR = 1.49, p < .001) had increased odds of MDD. There was a significant interaction between CAD and increased MDD that differed for Filipino, Asian Indian, “Pacific Islander and Asian”, “Asian and White”, and “Pacific Islander and White” groups compared to Non-Hispanic White people. Conclusion: Diagnosis of certain CVDs could increase the risk of experiencing MDD with potential race group differences for CAD. Further efforts should be made to protect the mental health of patients that have experienced a diagnosis of CVD as MDD can further harm their health outcomes. Moreover, research and treatment should consider potential racial differences in the experience of depression and CVD.
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Cardarelli, Francesca, Antonio Bellasi, Stephen J. Onufrak, Leslee J. Shaw, Charles A. Herzog, Emir Veledar, Viola Vaccarino, and Paolo Raggi. "Abstract 3502: Serum Phosphorus Levels are Associated with Incident Fatal and Non-Fatal Coronary Disease in Men but not in Women in the Community." Circulation 116, suppl_16 (October 16, 2007). http://dx.doi.org/10.1161/circ.116.suppl_16.ii_793-a.
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Mineral metabolism disorders are associated with coronary atherosclerosis and poor outcomes in chronic kidney disease (CKD) and cardiovascular disease (CVD) patients. A recent study suggested that elevated levels of serum phosphorus are associated with increased risk of CVD in subjects free from CKD and CVD. However, data suggest that the distribution of serum phosphorus differs by gender and it is not known whether phosphorus carries the same prognostic significance in men and in women. We tested the association of baseline serum phosphorus levels with incidence of CHD (myocardial infarction or fatal coronary disease) in 13,998 subjects 45 to 64 years old free of CHD, stroke, or CKD from the Atherosclerosis Risk in Communities (ARIC) study with public use data. The mean follow up was 12.5 years. Serum phosphorus was classified according to quintiles. Elevated phosphorus was significantly associated with age, female gender, smoking, hypercholesterolemia, and fibrinogen levels (p < 0.0001 for each), but was inversely associated with hypertension and not associated with estimated glomerular filtration rate (eGFR). We observed a j-shaped relationship of serum phosphorus with CHD among men but not among women. Compared to men in the 2nd quintile, men in the 1st quintile experienced a 30% increased rate of CHD (multivariable adj. HR: 1.30, 95% CI: 1.01, 1.68) while HRs increased incrementally from 1.17 (95% CI: 0.89, 1.54) to 1.51 (95% CI: 1.09, 2.09) from the 3rd through 5th quintiles. This relationship in men remained significant after adjustment for classic CVD risk factors and estimated GFR (table ). Among women, serum phosphorus was not significantly associated with CHD (table ). In conclusion, this study suggests a j-shaped association of serum phosphorus with CHD risk in men but not women free of CKD and CHD at baseline. Table
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Arai, Hidenori, Yoshihiro Kokubo, Makoto Watanabe, Tatsuya Sawamura, Tomonori Okamura, and Yoshihiro Miyamato. "Abstract 8706: Impact of Small Dense Low-Density Lipoproteins Cholesterol on Cardiovascular Disease in an Urban Japanese Cohort: The Suita Study." Circulation 124, suppl_21 (November 22, 2011). http://dx.doi.org/10.1161/circ.124.suppl_21.a8706.
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Aim: Increased plasma low-density lipoprotein cholesterol (LDL-C) concentrations have been shown to be one of the major risk factors for cardiovascular disease (CVD). Clinical evidence also indicates that small dense LDL (sd-LDL) particles are more atherogenic than large buoyant LDL particles. Because there was no easy assay to measure the amount of sd-LDL-C, few studies have addressed the association between sd-LDL-C and CVD. In this study, we hypothesized that higher sd-LDL-C is associated with increased risk for CVD. To this end, we examined the association between sd-LDL-C and CVD in Japanese by using a new kit to measure sd-LDL-C. Methods: We studied 2034 Japanese individuals (30 to 79 years old without stroke or coronary heart disease (CHD)) in the Suita Study, who completed measurement of direct LDL-C and sd-LDL-C by a kit based on the precipitation method with filtration, and then followed for 11.7 years on average. We calculated the Cox proportional adjusted hazard ratios (HRs) of LDL-C, sd-LDL-C, and sd-LDL-C/LDL-C ratio quartiles for incident CAD, stroke, and CVD (CHD + stroke) adjusting for age, sex, body mass index, diabetes, blood pressure category (defined on the basis of the ESH-ESC 2007 criteria), smoking and drinking at baseline. Results: The mean age of this cohort was 59.3 years old and 52.4% was women. The HR of the 4th quartile of sd-LDL-C for the development of CAD was 3.35 (95% confidence intervals: 1.38 to 8.13), which was higher than that in the analysis using LDL-C quartiles. In multivariable adjustment, the HR of the 4th quartile was almost similar. When we used the quartiles of sd-LDL/LDL ratio, increased sd-LDL/LDL ratio was associated with the incidence of CVD, CAD, and stroke. Sex-specific analysis showed that the association of sd-LDL-C with CAD and CVD was statistically significant in men, but not in women. Conclusions: We demonstrated that increased levels of sd-LDL-C are significantly associated with the development of CVD. Our data indicate that sd-LDL-C is a better risk factor for CVD than LDL-C for risk assessment.
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Hubbard, Demetria, Lisandro D. Colantonio, Robert S. Rosenson, Todd M. Brown, Elizabeth A. Jackson, Lei Huang, Kate K. Orroth, et al. "Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease." Cardiovascular Diabetology 20, no. 1 (March 1, 2021). http://dx.doi.org/10.1186/s12933-021-01247-0.
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Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.
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Qing, Li, and Ling Wenhua. "Association of Serum Magnesium and Calcium - Magnesium Ratio with Mortality in Patients with Coronary Artery Disease (P18-090-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz039.p18-090-19.
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Abstract Objectives Low serum magnesium (Mg) and high serum calcium (Ca) levels have been linked to increased mortality and cardiovascular disease (CVD) in the general population. This prospective study assessed whether there were independent associations of serum Mg levels and Ca-Mg ratio with all-cause and CVD mortality among patients with coronary artery disease (CAD). Methods A prospective cohort study of 3380 CAD patients was conducted. Cox regression models were used to estimate the association of serum Mg levels and Ca-Mg ratio with the risk of mortality. Results During a median follow-up of 7.59 years, there were 562 deaths recorded and 331 of them were CVD deaths. Spline plots displayed U-shaped associations between serum Mg levels and Ca-Mg ratio and all-cause as well as CVD mortality among CAD patients. Patients in the low serum Mg group had a 1.63-fold (95% confidence interval [CI] 1.32–2.00) risk of all-cause mortality and a 1.82-fold (95% CI 1.40–2.36) risk of CVD mortality compared with those in medium serum Mg group. Patients in high Ca-Mg ratio group had a 1.30-fold (95% CI 1.05–1.61) risk of all-cause mortality and a 1.50-fold (95% CI 1.13–1.98) risk of CVD mortality compared with those in medium Ca-Mg group. This inverse association between serum Mg and the risk of mortality did not change when participants were stratified by sex, age, types of CHD, history of diabetes and estimated glomerular filtration rate. Conclusions Low serum Mg concentrations and high Ca-Mg ratio were significantly associated with an increased risk of all-cause and CVD mortality in Chinese patients with CAD, independent of traditional CVD risk factors. Funding Sources The National Natural Science Fund.