The Mediterranean diet has long been reported to be protective against the occurrence of several different health outcomes.
We aimed to update our previous meta-analysis of published cohort ...prospective studies that investigated the effects of adherence to the Mediterranean diet on health status.
We conducted a comprehensive literature search through electronic databases up to June 2010.
The updated review process showed 7 prospective studies published in the past 2 y that were not included in the previous meta-analysis (1 study for overall mortality, 3 studies for cardiovascular incidence or mortality, 1 study for cancer incidence or mortality, and 2 studies for neurodegenerative diseases). These recent studies included 2 health outcomes not previously investigated (ie, mild cognitive impairment and stroke). The meta-analysis for all studies with a random-effects model that was conducted after the inclusion of these recent studies showed that a 2-point increase in adherence to the Mediterranean diet was associated with a significant reduction of overall mortality relative risk (RR) = 0.92; 95% CI: 0.90, 0.94, cardiovascular incidence or mortality (RR = 0.90; 95% CI: 0.87, 0.93), cancer incidence or mortality (RR = 0.94; 95% CI: 0.92, 0.96), and neurodegenerative diseases (RR = 0.87; 95% CI: 0.81, 0.94). The meta-regression analysis showed that sample size was the most significant contributor to the model because it significantly influenced the estimate of the association for overall mortality.
This updated meta-analysis confirms, in a larger number of subjects and studies, the significant and consistent protection provided by adherence to the Mediterranean diet in relation to the occurrence of major chronic degenerative diseases.
To update previous meta-analyses of cohort studies that investigated the association between the Mediterranean diet and health status and to utilize data coming from all of the cohort studies for ...proposing a literature-based adherence score to the Mediterranean diet.
We conducted a comprehensive literature search through all electronic databases up to June 2013.
Cohort prospective studies investigating adherence to the Mediterranean diet and health outcomes. Cut-off values of food groups used to compute the adherence score were obtained.
The updated search was performed in an overall population of 4 172 412 subjects, with eighteen recent studies that were not present in the previous meta-analyses.
A 2-point increase in adherence score to the Mediterranean diet was reported to determine an 8 % reduction of overall mortality (relative risk = 0·92; 95 % CI 0·91, 0·93), a 10 % reduced risk of CVD (relative risk = 0·90; 95 % CI 0·87, 0·92) and a 4 % reduction of neoplastic disease (relative risk = 0·96; 95 % CI 0·95, 0·97). We utilized data coming from all cohort studies available in the literature for proposing a literature-based adherence score. Such a score ranges from 0 (minimal adherence) to 18 (maximal adherence) points and includes three different categories of consumption for each food group composing the Mediterranean diet.
The Mediterranean diet was found to be a healthy dietary pattern in terms of morbidity and mortality. By using data from the cohort studies we proposed a literature-based adherence score that can represent an easy tool for the estimation of adherence to the Mediterranean diet also at the individual level.
This study sought to compare the action of prasugrel and ticagrelor in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
It has ...been documented that prasugrel and ticagrelor are able to provide effective platelet inhibition 2 h after a loading dose (LD). However, the pharmacodynamic measurements after prasugrel and ticagrelor LD have been provided by assessing only healthy volunteers or subjects with stable coronary artery disease.
Fifty patients with STEMI undergoing PPCI with bivalirudin monotherapy were randomized to receive 60 mg prasugrel LD (n = 25) or 180 mg ticagrelor LD (n = 25). Residual platelet reactivity was assessed by VerifyNow at baseline and 2, 4, 8, and 12 h after LD.
Platelet reactivity units (PRU) 2 h after the LD (study primary endpoint) were 217 (12 to 279) and 275 (88 to 305) in the prasugrel and ticagrelor groups, respectively (p = NS), satisfying pre-specified noninferiority criteria. High residual platelet reactivity (HRPR) (PRU ≥240) was found in 44% and 60% of patients (p = 0.258) at 2 h. The mean time to achieve a PRU <240 was 3 ± 2 h and 5 ± 4 h in the prasugrel and ticagrelor groups, respectively. The independent predictors of HRPR at 2 h were morphine use (odds ratio: 5.29; 95% confidence interval: 1.44 to 19.49; p = 0.012) and baseline PRU value (odds ratio: 1.014; 95% confidence interval: 1.00 to 1.03; p = 0.046).
In patients with STEMI, prasugrel showed to be noninferior as compared with ticagrelor in terms of residual platelet reactivity 2 h after the LD. The 2 drugs provide an effective platelet inhibition 2 h after the LD in only a half of patients, and at least 4 h are required to achieve an effective platelet inhibition in the majority of patients. Morphine use is associated with a delayed activity of these agents. (Rapid Activity of Platelet Inhibitor Drugs Study, NCT01510171).
Increasing evidence suggests an association between insomnia and cardiovascular disease. We performed a systematic review with meta-analysis of all the available prospective studies that investigated ...the association between insomnia and risk of developing and/or dying from cardiovascular disease.
Systematic review and meta-analysis of prospective cohort studies.
We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library and bibliographies of retrieved articles up to December 2011. Studies were included if they were prospective, had assessment of insomnia or sleep complaints at baseline, evaluated subjects free of cardiovascular disease at baseline and measured the association between insomnia and risk of developing and/or dying from cardiovascular disease.
After the review process 13 prospective studies were included in the final analysis. These studies included 122,501 subjects followed for a time ranging from three to 20 years. A total of 6332 cardiovascular events occurred during the follow-up. Insomnia was assessed through questionnaire and defined as either difficulty of initiating or maintaining sleep or presence of restless, disturbed nights. The cumulative analysis for all the studies under a random-effects model showed that insomnia determined an increased risk (+45%) of developing or dying from cardiovascular disease during the follow-up (relative risk 1.45, 95% confidence interval 1.29-1.62; p < 0.00001), with no evidence of heterogeneity across the studies (I 2: 19%; p = 0.14).
Insomnia is associated with an increased risk of developing and/or dying from cardiovascular disease.
Atherosclerosis is the main cause of morbidity and mortality in the Western world. Inflammation and blood flow alterations are new markers emerging as possible determinants for the development of ...atherosclerotic lesions. In particular, blood flow exerts a shear stress on vessel walls that alters cell physiology. Shear stress arises from the friction between two virtual layers of a fluid and is induced by the difference in motion and viscosity between these layers. Regions of the arterial tree with uniform geometry are exposed to a unidirectional and constant flow, which determines a physiologic shear stress, while arches and bifurcations are exposed to an oscillatory and disturbed flow, which determines a low shear stress. Atherosclerotic lesions develop mainly in areas of low shear stress, while those exposed to a physiologic shear stress are protected. The presence of areas of the arterial tree with different wall shear stress may explain, in part, the different localization of atherosclerotic lesions in both coronary and extracoronary arteries. The measurement of this parameter may help in identifying atherosclerotic plaques at higher risk as well as in evaluating the efficacy of different pharmacological interventions. Moreover, an altered shear stress is associated with the occurrence of both aortic and intracranial aneurysms, possibly leading to their growth and rupture. Finally, the evaluation of shear stress may be useful for predicting the risk of developing restenosis after coronary and peripheral angioplasty and for devising a coronary stent with a strut design less thrombogenic and more conducive to endothelization.
Anxiety is one of the uprising psychiatric disorders of the last decades and lavender administration has been traditionally suggested as a possible treatment. The objective of this review is to ...assess the efficacy of lavender, in any form and way of administration, on anxiety and anxiety-related conditions.
The PRISMA guidelines were followed. Retrieved data were qualitatively and quantitatively synthesized. Randomized Controlled Trials (RCTs) and Non-Randomized Studies (NRSs) which investigated the efficacy of lavender, in any form and way of administration, on patients with anxiety, involved in anxiety-inducing settings or undergoing anxiety-inducing activities, compared to any type of control, without language restrictions, were identified through electronic database searches. Medline via PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Google Scholar were systematically searched. All databases were screened up to November 2018. Risk of bias was assessed with the Cochrane risk-of-bias tool and the following domains were considered: randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.
65 RCTs (7993 participants) and 25 NRSs (1200 participants) were included in the qualitative synthesis and 37 RCTs (3964 participants) were included in the quantitative synthesis. Overall, the qualitative synthesis indicated that 54 RCTs and 17 NRSs reported at least a significant result in favor of lavender use for anxiety. The quantitative synthesis showed that lavender inhalation can significantly reduce anxiety levels measured with any validated scale (Hedges’ g = −0.73 95% CI −1.00 to −0.46, p < 0.00001, 1682 participants), as well as state anxiety (Spielberger's state-trait anxiety inventory (STAI)-State mean difference = −5.99 95% CI −9.39 to −2.59, p < 0.001, 901 participants) and trait anxiety (STAI-Trait mean difference = −8.14 95% CI −14.44 to −1.84, p < 0.05, 196 participants). Lavender inhalation did not show a significant effect in reducing systolic blood pressure as a physiological parameter of anxiety. A significant effect in diminishing anxiety levels was also found in favor of the use of oral Silexan® 80 mg/die for at least 6 weeks (Hamilton Anxiety Scale mean difference = −2.90 95% CI −4.86 to −0.95, p = 0.004, 1173 participants; Zung Self-rating Anxiety Scale mean difference = −2.62 95% CI −4.84 to −0.39, p < 0.05, 451 participants) or of the administration of massage with lavender oil (Hedges’ g = −0.66 95% CI −0.97 to −0.35, p < 0.0001, 448 participants).
The most important limitation of this review is the low average quality of available studies on the topic. The majority of included RCTs were characterized by a high overall risk of bias. Another limitation regards the heterogeneity of study designs, especially with regard to non-oral ways of administration. Overall, oral administration of lavender essential oil proves to be effective in the treatment of anxiety, whereas for inhalation there is only an indication of an effect of reasonable size, due to the heterogeneity of available studies. Lavender essential oil administered through massage appears effective, but available studies are not sufficient to determine whether the benefit is due to a specific effect of lavender. Further high-quality RCTs with more homogeneous study designs are needed to confirm these findings. Available information outlines a safe profile for lavender-based interventions, although more attention should be paid to the collection and reporting of safety data in future studies. Considering these findings, since treatments with lavender essential oil generally seem safe, and, in the case of inhalation, also simple and inexpensive, they are a therapeutic option which may be considered in some clinical contexts.
The present systematic review was not funded and was registered in PROSPERO under the following number: CRD42019130126.
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...to confirm enhanced drug absorption, a pharmacokinetic analysis could also have been performed. ...unmeasured confounder and overfitting risks cannot be excluded in our multivariable model.
Natural History of Tako-Tsubo Cardiomyopathy Parodi, Guido, MD, PhD; Bellandi, Benedetta, MD; Del Pace, Stefano, MD ...
Chest,
04/2011, Letnik:
139, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Background Stress-induced or tako-tsubo cardiomyopathy (TTC) is a rare acute cardiac syndrome characterized by transient left ventricular (LV) dysfunction of uncertain cause and outcome. This study ...sought to assess the long-term outcome of patients with TTC. Methods One-hundred sixteen consecutive patients were prospectively included in the study and observed at long-term follow-up. Primary end points were death, TTC recurrence, and hospitalization from any cause. Results Mean initial LV ejection fraction (LVEF) at admission was 36% ± 9%. Two patients died of refractory heart failure during hospitalization. Of the patients who were discharged alive all except one showed complete LV functional recovery. At follow-up (2.0 ± 1.3 years), only 64 (55%) patients were asymptomatic. Rehospitalization rate was high (25%), with chest pain (n = 6) and dyspnea (n = 5) as the most common causes. Only two patients had a recurrence of TTC. Eleven patients died (seven from cardiovascular cause). There was no significant difference in mortality (12% vs 7%; P = .284) and in the other clinical events between patients with and without severe LV dysfunction at presentation (LVEF ≤ 35%). Mortality observed in patients with TTC was compared with age and sex-specific mortality of the general population using the standardized mortality ratio (SMR) method. The SMR was 3.40 (95% CI, 1.83-6.34) in the TTC population. The only independent predictor of death at Cox analysis was Charlson comorbidity index (hazard ratio, 1.786; P = .0001), but the degree of initial LV dysfunction was not an independent predictor of death. Conclusions The recurrence of TTC is rare, but recurrences of chest pain or dyspnea are common in patients with TTC and frequently lead to hospital readmission. Long-term mortality is higher as compared with the control general population and at least in part related to patients' comorbidities. Initial LV dysfunction severity does not seem to impact long-term event rates.
Impact of Platelet Reactivity After Clopidogrel Administration on Drug-Eluting Stent Thrombosis Piergiovanni Buonamici, Rossella Marcucci, Angela Migliorini, Gian Franco Gensini, Alberto Santini, ...Rita Paniccia, Guia Moschi, Anna Maria Gori, Rosanna Abbate, David Antoniucci A total of 804 patients who had sirolimus- or paclitaxel-eluting stent were assessed for post-treatment platelet reactivity after a loading dose of 600 mg of clopidogrel. The incidence of stent thrombosis was 8.6% in patient who were nonresponsive to clopidogrel and 2.3% in those who were (p < 0.001). By multivariate analysis, the predictors of stent thrombosis were as follows: non-responsiveness to clopidogrel (p = 0.009), left ventricular ejection fraction (p = 0.001), total stent length (p = 0.010), and ST-segment elevation acute myocardial infarction (p = 0.041). Nonresponsiveness to clopidogrel is a strong independent predictor of stent thrombosis in patients receiving drug-eluting stents.
Chest shape might affect myocardial strain parameters. However, the relationship between myocardial strain parameters and chest conformation has not been previously investigated in subjects with ...mitral valve prolapse (MVP). Between April 2019 and May 2020, 60 healthy subjects (50.1 ± 8.6 year/old, 46.6% females) with MVP and mild-to-moderate mitral regurgitation, and 60 controls matched by age, sex, and cardiovascular risk factors were consecutively studied. Participants underwent modified Haller index (MHI) assessment (ratio of chest transverse diameter over the distance between sternum and spine), and transthoracic echocardiography implemented with 2D-speckle tracking analysis. MHI was significantly greater in MVP group than controls (2.6 ± 0.35 vs 2.1 ± 0.23, p < 0.0001). Left ventricular (LV) ejection fraction was similar in MVP and controls (63.5 ± 3.7% vs 64.3 ± 3.9%, p = 0.25). LV regional and global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) parameters and LV peak twist were all significantly lower in MVP compared to controls (all p < 0.0001). MVP subjects with a tight chest (MHI > 2.5, n = 30), and those with MHI ≤ 2.5 (n = 30) were then separately analyzed. A significant impairment in myocardial strain parameters and LV peak twist was documented in MVP subjects with MHI > 2.5, but not in those with MHI ≤ 2.5. MHI showed a strong inverse correlation with LV-GLS (r = − 0.85), GCS (r = − 0.84), GRS (r = − 0.84) and LV peak twist (r = − 0.94). In MVP subjects, impairment of myocardial strain parameters is not due to intrinsic reduction of cardiac contractility function, but it appears to be related to the degree of chest deformity.
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