Endothelial function is impaired in coronary artery disease and may contribute to its clinical manifestations. Increased oxidative stress has been linked to impaired endothelial function in ...atherosclerosis and may play a role in the pathogenesis of cardiovascular events. This study was designed to determine whether endothelial dysfunction and vascular oxidative stress have prognostic impact on cardiovascular event rates in patients with coronary artery disease.
Endothelium-dependent and -independent vasodilation was determined in 281 patients with documented coronary artery disease by measuring forearm blood flow responses to acetylcholine and sodium nitroprusside using venous occlusion plethysmography. The effect of the coadministration of vitamin C (24 mg/min) was assessed in a subgroup of 179 patients. Cardiovascular events, including death from cardiovascular causes, myocardial infarction, ischemic stroke, coronary angioplasty, and coronary or peripheral bypass operation, were studied during a mean follow-up period of 4.5 years. Patients experiencing cardiovascular events (n=91) had lower vasodilator responses to acetylcholine (P<0.001) and sodium nitroprusside (P<0.05), but greater benefit from vitamin C (P<0.01). The Cox proportional regression analysis for conventional risk factors demonstrated that blunted acetylcholine-induced vasodilation (P=0.001), the effect of vitamin C (P=0.001), and age (P=0.016) remained independent predictors of cardiovascular events.
Endothelial dysfunction and increased vascular oxidative stress predict the risk of cardiovascular events in patients with coronary artery disease. These data support the concept that oxidative stress may contribute not only to endothelial dysfunction but also to coronary artery disease activity.
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting ...myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 IQR 43/64, 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3
lymphocytes/mm
and/or ≥ 35.0 Mac1 macrophages/mm
and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 95%CI 1.160-3.397; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 1.215-7.464; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 0.873-3.757; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74-0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Aims
The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular ...disease (CVD) in German childhood cancer survivors (CCS).
Methods and results
In the CVSS-study (NCT02181049), 1002 CCS (age range 23–48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German population-based cohorts. Using log-binomial regression models, an increased risk for occurrence of arterial hypertension relative risk (RR) 1.38, 95% confidence interval (95% CI 1.21–1.57) and dyslipidaemia RR 1.26 (95% CI 1.12–1.42) was found. This indicates a premature occurrence compared to the general population of approximately 6 and 8 years, respectively rate advancement period estimator, RAPhypertension 5.75 (95% CI 3.5–8.0) and RAPdyslipidaemia 8.16 (95% CI 4.4–11.9). Overall, no differences were observed for obesity and diabetes. Overt CVD was present in 4.5% (95% CI 3.0–6.6%) of CCS RR 1.89 (95% CI 1.34–2.66), RAPCVD 7.9 (95% CI 4.1–11.7), of which the most frequent entities were congestive heart failure and venous thromboembolism. Prevalences of CVRF and CVD increased with age without reaching a plateau over time.
Conclusion
This large CCS screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature CVD. The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term.
Clinicaltrials. gov-Nr
NCT02181049.
Purpose
To determine the frequency of cataract surgery in Germany and to evaluate its impact on visual function in an adult population.
Methods
The population-based Gutenberg Health Study was ...conducted in Germany with its baseline examination between 2007 and 2012 and a 5-year follow-up examiantion. An ophthalmological examination including slit-lamp examination, ocular biometry, and Scheimpflug imaging was carried out. Overall and age-specific frequencies of unilateral and bilateral cataract surgery within 5 years were computed including the 95% confidential intervals 95%-CI. Association analyses were conducted to determine social and ocular associated factors using multivariable logistic regression analysis. Vision-related quality of life was assessed using NEI VFQ-25.
Results
A total of 10,544 people aged 35 to 74 years were bilateral phakic at baseline and had information on lens status at the 5-year examination. Of these, 168 had unilateral cataract surgery (1.6% 1.4–1.9%), and 448 had bilateral cataract surgery (4.2% 3.9–4.7%) in the following 5 years. The frequency of cataract surgery increased with age: 45–54-year-old subjects had twice as often cataract surgery (in at least on eye: OR = 2.32) than at age 35–44 years. The frequency further strongly increases with age (55–64 years: OR = 10.5; 65–74 years: OR = 43.8,
p
< 0.001). Subjects with glaucoma were more likely to have cataract surgery (OR = 2.52,
p
< 0.001). Visual function increased when undergoing bilateral cataract surgery.
Conclusions
The frequency of cataract surgery is low at younger ages and increases up to 26% at age 70–74 years. Persons with glaucoma are more likely to undergo cataract surgery at population-based level in Germany.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective Depression is related to worse outcomes in individuals with cardiovascular disease. Reduced heart rate variability (HRV), as a marker for autonomic dysfunction, is proposed to mediate the ...relation between mental stress and cardiovascular health.This study aims to identify HRV parameters in subjects with HF that are related to somatic and cognitive-affective dimension of depression. Methods We examined the association between depressiveness as assessed by PHQ-9 with HRV parameters from 24 h Holter ECG recording in the MyoVasc study (NCT04064450; N = 3289), a prospective cohort study on chronic HF. HRV parameters related to PHQ-9 have been selected via elastic net regression. Multivariable linear regression analysis adjusted for age, sex, established cardiovascular risk factors, comorbidities and medication had been performed. Results In the analysis sample (HRV analysis in N = 1001), 29.8% had mild depressive symptoms (PHQ-9 = 5–9) and 10.2% had major depressive symptoms (PHQ-9 ≥ 10). In AHA B-D MADRR (β = 0.041, 95% CI: 0.0021, 0.079, p = 0.039), ULF (β = −0.038, 95% CI: −0.076, −0.0011, p = 0.044) and Max. Lyapunov exponent (r = 20) (β = 0.041, 95% CI: 0.0034, 0.079, p = 0.033) correlated with somatic dimension of PHQ-9. Cognitive dimension of PHQ-9 in AHA C/D correlated with triangular Index (HRVi) (β = −0.049, 95% CI: Conclusions HRV parameters were consistently more reduced in individuals with more depressive symptoms. Interestingly, HRV parameters differ regarding the cognitive and somatic dimension of depression in individuals with HF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective Depression is common in individuals with heart failure (HF) and associated with adverse outcomes. The effect of depression, especially the somatic and cognitive dimension of depression, on ...endpoints worsening of HF (WoHF), all cause-death, and cardiac death are still uncertain. Methods Association between depressiveness, as assessed by the Patient-Health-Questionnaire-9 (PHQ-9), and outcomes were examined in the MyoVasc study (NCT04064450; N = 3289), a prospective cohort study on chronic HF. Participants on antidepressants were excluded. Results In 2801 participants, 27.4% showed mild depressive symptoms (PHQ-9 = 5-9). Major depressive symptoms (PHQ-9 £ 10) was present in 7.3%. During follow-up at 6 years 13% (n = 365) died of whom 125 were reported to have died of a cardiac cause. After adjustment for age and sex, those with depressive symptoms had higher risk for all-cause death (HR 1.06, 95% CI: 1.03-1.09, p = 0.00021) and WoHF (HR 1.05, 9SXCI: 1.03-1.08, p<0.0001). For cardiac death, we found no significant correlation (HR 1.02, 95% CI: 0.98-1.07, p = 0.29). In a multivariate model including the clinical profile, depression remained an independent predictor for all-cause death (HR 1.04. 95% CI: 1.01-1.07, p = 0.018) and WoHF (HR 1.04. 95% CI: 1.01-1.06, p-0.0036). The somatic component of PHQ-9 showed a stronger relation to outcome all-cause death (HR: 1.08, 95%CI: 1.03-1.14, p = 0.0033), compared to the cognitive component of PHQ-9 (HR: 1.05, 95% CI: 1.00-1.10 p = 0.31). Conclusions Depressive symptoms are associated with increased risk of WoHF and all-cause mortality. Depression was not related to cardiac death. The findings underline the importance of psychosocial research in HF populations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective Depression in chronic heart failure (HF) leads to worse outcomes. Analysing proteomic profile might explain the underlying molecular pathomechanisms. Methods Depressiveness was assessed by ...the Patient-Health-Questionnaire-9 (PHQ-9) in the MyoVasc study (NCT04064450; N = 3289), a prospective cohort study on chronic HF. Total of 358 proteins was quantified in EDTA plasma by targeted immuno-PCR (Olink, Sweden). Elastic net linear regression was used to identify proteins associated with somatic and cognitive component of PHQ-9. Subsequent pathway analysis was conducted with STRING. Based on the selected proteins, protein scores for PHQ-9 were generated with linear regression and evaluated for the prediction of outcome. Results PHQ-9 scores and protein biomarkers were available in 2725 participants (AHA Stages A-D). 29 proteins (10-fold CV R2 = 0.08) and 75 proteins (10-fold CV R2 = 0.09) were identified for cognitive and somatic dimension of PHQ-9. Protein-protein network analyses revealed that the selected proteins are involved in inflammatory and metabolic pathways. In Cox regression analyses, the somatic PHQ-9 protein score was a predictor of all-cause death (HR 1.43, 95% CI: 1.24-1.66, p <0.0001) and worsening of HF (WoHF) (HR 1.19,95% CI 1.05-1.35, p = 0.0066), independent of age, sex, clinical profile and medication. The cognitive PHQ-9 protein score was as well predictive of all-cause death (HR 1.52, 95% CI: 1.21-1.91, p = 0.00027), but less predictive of WoHF (HR 1.03. 95% CI: 0.84-1.26, p = 0.77). Conclusions Molecular mechanisms associated with dimensions of depressiveness in the context of heart failure were identified. These mechanisms were prognostic for worsening of HF and death, indicating their clinical relevance.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective Depersonalization and derealization (DP) are an underresearched clinical phenomenon. We compared participants with DP and depression to participants without DP and depression. Further, we ...observed the impact of DP on depressiveness after 5 years. Methods We investigated cross-sectional data of 10,422 participants of the Gutenberg Health Study (GHS), a population-based, prospective, single-center cohort study in Germany (age 35–74 years). Depression and anxiety were measured by PHQ-9 and GAD-2, DP by Cambridge Depersonalization Scale (CDS-2). In logistic regression models, we adjusted for age, sex, socio-economic status, somatic disease and medication. Results At follow up (FU) 2.2% of 7792 without depression and without DP at baseline (BL), 39.7% of 458 with depression and without DP at BL, and 59.7% of 390 with depression and DP at BL had depression at FU (PHQ9 > 9). Participants with depression and DP (CDS-2 > 0) (n = 522) were more likely male, smokers, had lower SES, had more troubles with colleagues and family, had lack of social support, were more likely to suffer from anxiety (GAD-2 > 2), suffer from back and chest pain and tinnitus. Odds Conclusions Participants with DP and depression at baseline showed a high risk for depression after 5 years. DP may represent an important indicator and independent marker for severity and chronicity of depression.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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