Background: The physiological ratio of T<sub>3</sub>:T<sub>4</sub> is essential to trigger the biological actions, since the T<sub>3</sub>:T<sub>4</sub> ratio is efficie...Background: The physiological ratio of T<sub>3</sub>:T<sub>4</sub> is essential to trigger the biological actions, since the T<sub>3</sub>:T<sub>4</sub> ratio is efficiently regulated by extrathyroidal selenodeiodinases. Thr92Ala is a common variant in the DIO2 gene, which may have an implication in decreased phenotypic expression, but previous studies had conflicting outcomes. Consequently, we have undertaken this study to understand the effect of this SNP on CVD risk among type 2 diabetics. Methods: We included 130 T2DM patients without signs of CVD as controls and 106 proved CVD patients with T2DM as cases. The entire subjects were genotyped for Thr92Ala of DIO2 gene. FBG, lipid & thyroid profile, HDL sub-fractionations, type II deiodinase, malondialdehyde, paraoxonase, and superoxide dismutase were measured according to standard procedures. Results: The mean DIO2 levels in Ala/Ala genotypes were significantly lower than Thr/Thr + Thr/Ala genotypes (122 ± 39 ng/ml & 161 ± 32 ng/ml respectively). The thyroid profile was normal in all the subjects;merely it was altered significantly among the Ala/Ala genotypes when compared with Thr/Thr + Thr/Ala genotypes. Remarkably, there is a significant decrease in T<sub>3</sub>:T<sub>4</sub> and HDL<sub>3</sub>:HDL<sub>2</sub> ratios and paraoxonase activity among Ala/Ala genotypes when compared with Thr/Thr + Thr/Ala genotypes. TSH and T<sub>4</sub> levels were near to upper normal levels among Ala/Ala genotype. HDL<sub>3</sub>:HDL<sub>2</sub> ratio is positively correlated with paraoxonase activity among Thr/Thr + Thr/Ala genotypes (r = 0.36, p < 0.05). Conclusion: Phenotype expression of DIO2 gene, thyroid profile, HDL<sub>2</sub>:HDL<sub>2</sub> ratio and paraoxonase activity are altered among the Ala/Ala genotype. Thus, Ala/Ala genotype plays a key role in thyroid dysfunction, dyslipidemia and the development of CVD risk among type 2 diabetics.展开更多
Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD...Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS) heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA) 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed public health education efforts.展开更多
Objective The study aims to predict 10-year cardiovascular disease(CVD)risk and explore its association with sleep duration among Chinese urban adults.Methods We analyzed part of the baseline data of a cohort that rec...Objective The study aims to predict 10-year cardiovascular disease(CVD)risk and explore its association with sleep duration among Chinese urban adults.Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling.The simplified Pittsburgh Sleep Quality Index(PSQI)and Framingham 10-year risk score(FRS)were used to measure sleep duration and CVD risk.Demographic characteristics,personal history of chronic diseases,lifestyle factors were collected using a questionnaire.Height,weight,total cholesterol(TC),and high-density lipoprotein cholesterol(HDL-C)were also measured.Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk.Results We included 31,135 participants(median age 44 years,53.02%males)free of CVD,cerebral stroke,and not taking lipid-lowering agents.Overall,14.05%,and 25.55%of participants were at medium and high predicted CVD risk,respectively.Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males(OR=1.10;95%CI:1.01–1.19)and increased odds of medium to high and high risk of predicted 10-year CVD among females(OR=1.23;95%CI:1.08–1.40;OR=1.27;95%CI:1.11–1.44).In contrast,long sleep had no association with cardiovascular risk.Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk.Short sleep was associated with increased odds of predicted CVD risk.展开更多
Hypertension, obesity, smoking, dyslipidemia, and type 2 diabetes (T2D) are the major risk factors for developing cardiovascular diseases (CVD). Recent studies revealed that taxi-motorbike drivers (TMDs) in Cotonou ha...Hypertension, obesity, smoking, dyslipidemia, and type 2 diabetes (T2D) are the major risk factors for developing cardiovascular diseases (CVD). Recent studies revealed that taxi-motorbike drivers (TMDs) in Cotonou had higher rates of CVD risk factors, but their impacts on cardiovascular events have rarely been studied. The Framingham risk score (FRS) is an algorithm that considers CVD risk factors and estimates the risk of developing CVD in the next 10 years. Our objectives were to assess the 10-year CVD risk predicted by the FRS, and to examine the relationships of 10-year CVD risk with plasma iron and potassium levels among TMDs. We included 134 TMDs (22 - 59 years old) who had no prior diagnosis of CVD or T2D, and not taking medications affecting iron and potassium homeostasis. Conventional cardiovascular risk factors were used to calculate the 10-year CVD risk, which was categorized as low (20%). FRS > 2%, which corresponded to the 75th percentile of FRS distribution in our study population, was used as a cut-off value to classify participants into two groups. Plasma iron and potassium levels were segregated into tertiles and their associations with 10-year CVD risk were quantified by multivariate-adjusted logistic regression to calculate the odd ratios (ORs) to being above the 75<sup>th</sup> percentile of 10-year CVD risk with the corresponding 95% confidence intervals (CIs). We found that 62.0% of participants had at least one of cardiovascular risk factors. Approximately 97.8% of TMDs had 10-year CVD risk 4.8 mmol/L led to an 83% risk reduction of having 10-year CVD risk > 2% (OR = 0.17, 95% CI: 0.04 - 0.82, P = 0.027). In conclusion, our findings showed that high plasma potassium levels associate with reduced 10-year CVD risk among TMDs. Interventions focused on monitoring of plasma potassium, particularly in those with existing cardiovascular risk factors, may help prevent CVD.展开更多
Cardiovascular disease (CVD) risk assessment is an important instrument to enhance the clinical decision in the daily practice as well as to improve the preventive health care promoting the transfer from the hospital ...Cardiovascular disease (CVD) risk assessment is an important instrument to enhance the clinical decision in the daily practice as well as to improve the preventive health care promoting the transfer from the hospital to patient’s home. Due to its importance, clinical guidelines recommend the use of risk scores to predict the risk of a cardiovascular disease event. Therefore, there are several well known risk assessment tools, unfortunately they present some limitations.This work addresses this problem with two different methodologies:1) combination of risk assessment tools based on fusion of Bayesian classifiers complemented with genetic algorithm optimization;2) personalization of risk assessment through the creation of groups of patients that maximize the performance of each risk assessment tool. This last approach is implemented based on subtractive clustering applied to a reduced-dimension space.Both methodologies were developed to short-term CVD risk prediction for patients with Acute Coronary Syndromes without ST segment eleva-tion (ACS-NSTEMI). Two different real patients’ datasets were considered to validate the developed strategies:1) Santa Cruz Hospital, Portugal, N=460 patients;2)LeiriaPombal Hospital Centre, Portugal, N=99 patients.This work improved the performance in relation to current risk assessment tools reaching maximum values of sensitivity, specificity and geometric mean of, respectively, 80.0%, 82.9%, 81.5%. Besides this enhancement, the proposed methodologies allow the incorporation of new risk factors, deal with missing risk factors and avoid the selection of a single tool to be applied in the daily clinical practice. In spite of these achievements, the CVD risk assessment (patient stratification) should be improved. The incorporation of new risk factors recognized as clinically significant, namely parameters derived from heart rate variability (HRV), is introduced in this work. HRV is a strong and independent predictor of mortality in patients following acute myocardial infarction. The impact of HRV parameters in the characterization of coronary artery disease (CAD) patients will be conducted during hospitalization of these patients in the Leiria-Pombal Hospital Centre (LPHC).展开更多
Various Cardiovascular Diseases (CVDs) can be catastrophic and can lead to irreversible outcomes. Despite improved interventions for CVD prevention awareness, there continues to be discussion and research on diet-rela...Various Cardiovascular Diseases (CVDs) can be catastrophic and can lead to irreversible outcomes. Despite improved interventions for CVD prevention awareness, there continues to be discussion and research on diet-related CVD and mortality without addressing the problem. Instead of prioritizing public guidelines and policies, policymakers should understand CVD and address population barriers to adhering to a healthy diet that decreases CVD risk. Therefore, this project aims to analyze federal healthy food incentive policies to promote healthy diet behaviors that reduce CVD risk. The method used was existing data for a comparative policy analysis that included a policy proposal process: phases of progression, measures, and a policy model with data collection and requirements. This analysis compared a current federal food incentive program versus the proposed program. Results of the final analysis derived from the literature review and collected data stated consuming foods from the Mediterranean and other low-fat and low-salt diets reduced CVD risks that also reduced other risks secondary to CVD, such as obesity, diabetes, and Cerebrovascular Accident (CVA). Comparatively, combined healthy food incentives and disincentives were more effective for improving healthy behaviors than, in some cases, even after incentives were removed. Therefore, this policy analysis supports the indication for incentive policy change. However, the lack of federal stakeholders’ response to key policy changes upon proposal submission may require other methods of proposal dissemination. Nonetheless, focusing analysis on various Food Insecurity Nutrition Incentive (FINI) programs instead of one, multi-state program, which may have improved analysis outcomes, was the lesson learned.展开更多
文摘Background: The physiological ratio of T<sub>3</sub>:T<sub>4</sub> is essential to trigger the biological actions, since the T<sub>3</sub>:T<sub>4</sub> ratio is efficiently regulated by extrathyroidal selenodeiodinases. Thr92Ala is a common variant in the DIO2 gene, which may have an implication in decreased phenotypic expression, but previous studies had conflicting outcomes. Consequently, we have undertaken this study to understand the effect of this SNP on CVD risk among type 2 diabetics. Methods: We included 130 T2DM patients without signs of CVD as controls and 106 proved CVD patients with T2DM as cases. The entire subjects were genotyped for Thr92Ala of DIO2 gene. FBG, lipid & thyroid profile, HDL sub-fractionations, type II deiodinase, malondialdehyde, paraoxonase, and superoxide dismutase were measured according to standard procedures. Results: The mean DIO2 levels in Ala/Ala genotypes were significantly lower than Thr/Thr + Thr/Ala genotypes (122 ± 39 ng/ml & 161 ± 32 ng/ml respectively). The thyroid profile was normal in all the subjects;merely it was altered significantly among the Ala/Ala genotypes when compared with Thr/Thr + Thr/Ala genotypes. Remarkably, there is a significant decrease in T<sub>3</sub>:T<sub>4</sub> and HDL<sub>3</sub>:HDL<sub>2</sub> ratios and paraoxonase activity among Ala/Ala genotypes when compared with Thr/Thr + Thr/Ala genotypes. TSH and T<sub>4</sub> levels were near to upper normal levels among Ala/Ala genotype. HDL<sub>3</sub>:HDL<sub>2</sub> ratio is positively correlated with paraoxonase activity among Thr/Thr + Thr/Ala genotypes (r = 0.36, p < 0.05). Conclusion: Phenotype expression of DIO2 gene, thyroid profile, HDL<sub>2</sub>:HDL<sub>2</sub> ratio and paraoxonase activity are altered among the Ala/Ala genotype. Thus, Ala/Ala genotype plays a key role in thyroid dysfunction, dyslipidemia and the development of CVD risk among type 2 diabetics.
文摘Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS) heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA) 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed public health education efforts.
基金the National Key R&D Program in the Thirteenth Five-year Plan from the Chinese Ministry of Science and Technology[No.2016YFC0900600,2016YFC0900604]。
文摘Objective The study aims to predict 10-year cardiovascular disease(CVD)risk and explore its association with sleep duration among Chinese urban adults.Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling.The simplified Pittsburgh Sleep Quality Index(PSQI)and Framingham 10-year risk score(FRS)were used to measure sleep duration and CVD risk.Demographic characteristics,personal history of chronic diseases,lifestyle factors were collected using a questionnaire.Height,weight,total cholesterol(TC),and high-density lipoprotein cholesterol(HDL-C)were also measured.Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk.Results We included 31,135 participants(median age 44 years,53.02%males)free of CVD,cerebral stroke,and not taking lipid-lowering agents.Overall,14.05%,and 25.55%of participants were at medium and high predicted CVD risk,respectively.Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males(OR=1.10;95%CI:1.01–1.19)and increased odds of medium to high and high risk of predicted 10-year CVD among females(OR=1.23;95%CI:1.08–1.40;OR=1.27;95%CI:1.11–1.44).In contrast,long sleep had no association with cardiovascular risk.Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk.Short sleep was associated with increased odds of predicted CVD risk.
文摘Hypertension, obesity, smoking, dyslipidemia, and type 2 diabetes (T2D) are the major risk factors for developing cardiovascular diseases (CVD). Recent studies revealed that taxi-motorbike drivers (TMDs) in Cotonou had higher rates of CVD risk factors, but their impacts on cardiovascular events have rarely been studied. The Framingham risk score (FRS) is an algorithm that considers CVD risk factors and estimates the risk of developing CVD in the next 10 years. Our objectives were to assess the 10-year CVD risk predicted by the FRS, and to examine the relationships of 10-year CVD risk with plasma iron and potassium levels among TMDs. We included 134 TMDs (22 - 59 years old) who had no prior diagnosis of CVD or T2D, and not taking medications affecting iron and potassium homeostasis. Conventional cardiovascular risk factors were used to calculate the 10-year CVD risk, which was categorized as low (20%). FRS > 2%, which corresponded to the 75th percentile of FRS distribution in our study population, was used as a cut-off value to classify participants into two groups. Plasma iron and potassium levels were segregated into tertiles and their associations with 10-year CVD risk were quantified by multivariate-adjusted logistic regression to calculate the odd ratios (ORs) to being above the 75<sup>th</sup> percentile of 10-year CVD risk with the corresponding 95% confidence intervals (CIs). We found that 62.0% of participants had at least one of cardiovascular risk factors. Approximately 97.8% of TMDs had 10-year CVD risk 4.8 mmol/L led to an 83% risk reduction of having 10-year CVD risk > 2% (OR = 0.17, 95% CI: 0.04 - 0.82, P = 0.027). In conclusion, our findings showed that high plasma potassium levels associate with reduced 10-year CVD risk among TMDs. Interventions focused on monitoring of plasma potassium, particularly in those with existing cardiovascular risk factors, may help prevent CVD.
文摘Cardiovascular disease (CVD) risk assessment is an important instrument to enhance the clinical decision in the daily practice as well as to improve the preventive health care promoting the transfer from the hospital to patient’s home. Due to its importance, clinical guidelines recommend the use of risk scores to predict the risk of a cardiovascular disease event. Therefore, there are several well known risk assessment tools, unfortunately they present some limitations.This work addresses this problem with two different methodologies:1) combination of risk assessment tools based on fusion of Bayesian classifiers complemented with genetic algorithm optimization;2) personalization of risk assessment through the creation of groups of patients that maximize the performance of each risk assessment tool. This last approach is implemented based on subtractive clustering applied to a reduced-dimension space.Both methodologies were developed to short-term CVD risk prediction for patients with Acute Coronary Syndromes without ST segment eleva-tion (ACS-NSTEMI). Two different real patients’ datasets were considered to validate the developed strategies:1) Santa Cruz Hospital, Portugal, N=460 patients;2)LeiriaPombal Hospital Centre, Portugal, N=99 patients.This work improved the performance in relation to current risk assessment tools reaching maximum values of sensitivity, specificity and geometric mean of, respectively, 80.0%, 82.9%, 81.5%. Besides this enhancement, the proposed methodologies allow the incorporation of new risk factors, deal with missing risk factors and avoid the selection of a single tool to be applied in the daily clinical practice. In spite of these achievements, the CVD risk assessment (patient stratification) should be improved. The incorporation of new risk factors recognized as clinically significant, namely parameters derived from heart rate variability (HRV), is introduced in this work. HRV is a strong and independent predictor of mortality in patients following acute myocardial infarction. The impact of HRV parameters in the characterization of coronary artery disease (CAD) patients will be conducted during hospitalization of these patients in the Leiria-Pombal Hospital Centre (LPHC).
文摘Various Cardiovascular Diseases (CVDs) can be catastrophic and can lead to irreversible outcomes. Despite improved interventions for CVD prevention awareness, there continues to be discussion and research on diet-related CVD and mortality without addressing the problem. Instead of prioritizing public guidelines and policies, policymakers should understand CVD and address population barriers to adhering to a healthy diet that decreases CVD risk. Therefore, this project aims to analyze federal healthy food incentive policies to promote healthy diet behaviors that reduce CVD risk. The method used was existing data for a comparative policy analysis that included a policy proposal process: phases of progression, measures, and a policy model with data collection and requirements. This analysis compared a current federal food incentive program versus the proposed program. Results of the final analysis derived from the literature review and collected data stated consuming foods from the Mediterranean and other low-fat and low-salt diets reduced CVD risks that also reduced other risks secondary to CVD, such as obesity, diabetes, and Cerebrovascular Accident (CVA). Comparatively, combined healthy food incentives and disincentives were more effective for improving healthy behaviors than, in some cases, even after incentives were removed. Therefore, this policy analysis supports the indication for incentive policy change. However, the lack of federal stakeholders’ response to key policy changes upon proposal submission may require other methods of proposal dissemination. Nonetheless, focusing analysis on various Food Insecurity Nutrition Incentive (FINI) programs instead of one, multi-state program, which may have improved analysis outcomes, was the lesson learned.
