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1.
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, of which amino-terminal
pro-brain natriuretic peptide (NT-proBNP) is a predictor. The objective of the study was to investigate associations between
NT-proBNP and age, gender, markers of inflammation, disease activity, and kidney function in RA patients, without co-morbidities
potentially influencing NT-proBNP concentration. The study group consisted of 90 patients with RA, without clinically relevant
coronary heart disease, hypertension, diabetes, advanced chronic kidney disease. The comprehensive assessment of clinical
and laboratory parameters of inflammation, disease activity, and kidney function was performed. Plasma samples were frozen
for NT-proBNP analysis. Carotid intima media thickness (cIMT) was determined by high-resolution B-mode ultrasonography. The
mean NT-proBNP concentrations were significantly higher in a group of RA patients with high disease activity (DAS28 > 5.1)
and in a group of patients with subclinical atherosclerosis diagnosed by cIMT ≥ 0.6 mm. In all RA patients, NT-proBNP correlated
positively with the age, C-reactive protein, erythrocyte sedimentation rate, cIMT, tricipital skin fold and negatively with
hand-grip strength, hemoglobin, red blood cell count, albumin. In the group of women with RA, we found significant positive
correlation between NT-proBNP and cystatin-C. Also, patients with NT-proBNP level ≥ 100 pg/ml had significantly higher cystatin-C
than those with lower NT-proBNP. NT-proBNP level, in RA patients without co-morbidities potentially influencing this level,
is correlated with age, disease activity markers of inflammation, and subclinical renal impairment. It means that risk of
CV disorders is higher in older patients with more active RA. 相似文献
2.
Fatima Ezzahra Abourazzak Samia Mansouri Adil Najdi Latifa Tahiri Chakib Nejjari Taoufik Harzy 《Clinical rheumatology》2014,33(11):1549-1555
Rheumatoid arthritis (RA) is associated with an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)—a major contributor to CVD—in RA seems to be increased, suggesting that systemic inflammation and antirheumatic therapy may contribute to its presence. We aimed to determine the prevalence of MetS in RA, to identify the potential factors associated with its presence, and to evaluate the influence of antirheumatic drugs on the occurrence of MetS in a cohort of Moroccan patients with RA. The prevalence of MetS was assessed cross-sectionally in 179 patients with RA over a period of 17 months (July 2011–December 2012). Three definitions of MetS were used (National Cholesterol Education Program/Adult Treatment Panel III 2005, International Diabetes Federation 2005, and American Association of Clinical Endocrinologists 2003). All statistical analyses were done using the SPSS software version 18.0. Multivariate logistic regression model was constructed to identify independent predictors of MetS in patients with RA. The prevalence of MetS in RA varied from 24.6 to 30.7 % according to the definitions used. In a multivariate logistic regression model, the severity of RA and less methotrexate use were identified as significant independent predictors of the presence of MetS in RA patients. Our study suggests that MetS is common among Moroccan patients with severe RA. Methotrexate therapy was identified as an independent factor associated with a reduced risk of having MetS in these patients, suggesting a drug-specific mechanism and making methotrexate a first-line disease-modifying antirheumatic drug in RA patients who are at high risk of developing MetS. 相似文献
3.
Zajc Petranović M Skarić-Jurić T Smolej Narančić N Tomas Z Krajačić P Miličić J Barbalić M Tomek-Roksandić S 《Age (Dordrecht, Netherlands)》2012,34(3):583-595
The human angiotensin converting enzyme (ACE) gene is one of the most investigated candidate genes for cardiovascular diseases
(CVD), but the understanding of its role among the elderly is vague. Therefore, this study focuses at: (a) testing the association
of ACE polymorphism with CVD risk factors among the elderly, and (b) detecting the possible unequal distribution of ACE genotypes
between senescent and younger segments of the European populations. The association of ACE I/D polymorphism with CVD health
status [hypertension (HT), obesity, dislypidemia] in 301 very old subjects (88.2 ± 5 years; F/M = 221/80) was tested by means
of logistic regression analysis. The meta-analysis of D allele frequency in general vs. elderly (80+ years) groups was conducted
using all publicly available data for European populations comprising both age cohorts. Multiple multinomial logistic regression
revealed that within this elderly sample, age (younger olds, 80–90 years), female sex (OR = 3.13, 95% CI = 1.59–6.19), and
elevated triglycerides (OR = 2.53, 95% CI = 1.29–4.95) were positively associated with HT, while ACE polymorphism was not.
It was also established that the DD genotype was twice as high in 80+ cohort compared to general population of Croatia (p < 0.00001). This trend was confirmed by the meta-analysis that showed higher D allele frequencies in olds from nine of ten
considered European populations (OR = 1.19, 95% CI = 1.08–1.31). The data in elderly cohort do not confirm previously reported
role of ACE DD genotype to the development of HT. Moreover, meta-analysis indicated that ACE D allele has some selective advantage
that contributes to longevity in majority of European populations. 相似文献
4.
Gómez-Vaquero C Robustillo M Narváez J Rodríguez-Moreno J González-Juanatey C Llorca J Nolla JM González-Gay MA 《Clinical rheumatology》2012,31(1):35-39
To assess the impact of the application of the European League against Rheumatism (EULAR) task force recommendations in the
cardiovascular (CV) risk of a series of Spanish patients diagnosed with rheumatoid arthritis (RA). Two hundred consecutive RA patients seen at the rheumatology outpatient clinics of Bellvitge Hospital, Barcelona, were studied.
Information on clinical features of the disease, classic CV risk factors, and history of CV events was assessed. Both the
systematic coronary risk evaluation (SCORE) CV risk index and the modified SCORE (mSCORE) according to the last EULAR recommendations
were calculated. Based on the classic CV risk factors, the mean ± standard deviation SCORE was 2.1 ± 2.3% (median, 2; interquartile
range [IQR], 1–3). Twenty-three (11%) patients were above the threshold of high CV risk for the Spanish population (≥5%).
Following the EULAR recommendations, a change in the score was required in 119 (59%) patients. Therefore, the mean mSCORE
was 2.7 ± 2.9% (median, 2; IQR, 1–3) and, due to this, 28 (14%) patients were above the threshold of high CV risk. Nine (5%)
had at least one ischemic CV event. Patients with CV events were older and had more CV risk factors and higher SCORE and mSCORE
than those without CV events. Although a large proportion of patients from this series fulfilled the criteria for the application
of the EULAR recommendations, the final impact on the calculated CV risk was low and clinically significant in only a few
patients. However, an association between the mSCORE and the presence of ischemic CV events was observed. 相似文献
5.
Impaired lung function is a risk factor for cardiovascular (CV) events. However, it has not been well established whether FVC reduction even within normal range is associated with cardiovascular disease (CVD) risk and whether reduced FVC is an independent relationship of CVD irrespective of metabolic syndrome. Thus, we aimed to explore the relationship between FVC and CV-event risk using the FRS beyond the presence of metabolic syndrome or abdominal obesity in a representative Korean population based on data from the nationwide Korea National Health and Nutrition Examination Survey (KNHANES IV).The study population included 9688 subjects ≥ 30 years of age with no previous diagnosis of CVD and obstructive lung disease. Using a logistic regression model and area under the curve (AUC) analysis, we evaluated the relationship between FVC quintiles and CV-event risk using the Framingham Risk Score (FRS; ≥ 10% or ≥ 20%). In addition, we examined the effect of FVC on CV-event risk based on the presence of metabolic syndrome (MetS) and abdominal obesity.After adjusting for covariates, comparison of subjects in the lowest FVC (% pred) quintile (Q1) with those in the highest quintile (Q5) yielded an odds ratio (OR) of 2.27 (95% CI, 1.91–2.71) for intermediate and high risk, and 2.89 (95% CI, 2.31–3.61) for high risk. The ORs for cardiovascular risk using FRS also increased irrespective of the presence of abdominal obesity and MetS without significant interaction. Furthermore, the addition of FVC status to MetS status and abdominal obesity status significantly increased the AUC of the model predicting CV-event risk (P < 0.001 and P < 0.001).Our study demonstrates that FVC is inversely associated with 10-year CV-event risk, irrespective of MetS and abdominal obesity in the general population without obstructive lung disease. Furthermore, the addition of FVC to MetS or abdominal obesity increased prediction of CVD event risks, implying a potential role of FVC to predict CV events. 相似文献
6.
Sodium Intake and Mortality Follow-Up in the Third National Health and Nutrition Examination Survey (NHANES III)
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Background Sodium restriction is commonly recommended as a measure to lower blood pressure and thus reduce cardiovascular disease (CVD)
and all-cause mortality. However, some studies have observed higher mortality associated with lower sodium intake.
Objective To test the hypothesis that lower sodium is associated with subsequent higher cardiovascular disease (CVD) and all cause mortality
in the Third National Health and Nutrition Examination Survey (NHANES III).
Design Observational cohort study of mortality subsequent to a baseline survey.
Participants Representative sample (n = 8,699) of non-institutionalized US adults age ≥30, without history of CVD events, recruited between
1988–1994.
Measurements and main results Dietary sodium and calorie intakes estimated from a single baseline 24-h dietary recall. Vital status and cause of death were
obtained from the National Death Index through the year 2000. Hazard ratio (HR) for CVD mortality of lowest to highest quartile
of sodium, adjusted for calories and other CVD risk factors, in a Cox model, was 1.80 (95% CI 1.05, 3.08, p = 0.03). Non-significant
trends of an inverse association of continuous sodium (per 1,000 mg) intake with CVD and all-cause mortality were observed
with a 99% CI of 0.73, 1.06 (p = 0.07) and 0.86, 1.04 (p = 0.11), respectively, while trends for a direct association were
not observed.
Conclusion Observed associations of lower sodium with higher mortality were modest and mostly not statistically significant. However,
these findings also suggest that for the general US adult population, higher sodium is unlikely to be independently associated
with higher CVD or all-cause mortality. 相似文献
7.
Zuhair Allebban Nathan D. Wong Renee L. Bess Harrihar A. Pershadsingh 《Metabolism: clinical and experimental》2010,59(11):1551-1555
Metabolic syndrome (MetS) is associated with increased risk for cardiovascular disease (CVD). Mexican Americans (MA) exhibit increases in CVD risk factors compared with non-Hispanic whites (NHW), but few data exist comparing the relation of MetS to subclinical CVD, for example, left ventricular (LV) mass. Asymptomatic subjects (104 MA and 101 NHW, 52.2% female, aged 48 ± 12 years) were studied by echocardiography (echo) and by blood and urine tests. Metabolic syndrome was defined based on the American Heart Association/National Heart, Lung, and Blood Institute definition. Echo LV mass was compared with the presence or absence of MetS and with the number of MetS components. Multiple linear regression also examined the association of MetS with LV mass adjusted for non-MetS risk factors. Left ventricular mass was lower in MA (145.5 ± 43.9 g) compared with NHW (160.2 ± 49.9 g) (P < .05), although this difference was attenuated after adjusting for MetS and other risk factors. Left ventricular mass was higher in those with vs without MetS in both MA and NHW men and women (P < .05 to P < .01). There was a significant (P < .001) graded increase in echo LV mass with increasing number of MetS components both in MA (108.3 to 153.8 g) and NHW (144.3 to 215.1 g). In multiple regression analysis, male sex and MetS remained independently associated (P < .0001) with LV mass; however, body mass index explained much of this association, indicating the strong association of obesity with LV mass. Mean LV mass in both MA and NHW adults was higher in those with vs without MetS and with increasing number of MetS components, with body mass index the principal component of MetS associated with LV mass. The prognostic significance of LV mass in persons with MetS requires further study. 相似文献
8.
Benhatchi K Jochmanová I Habalová V Wagnerová H Lazúrová I 《Clinical rheumatology》2011,30(10):1319-1324
Autoimmune thyroid diseases frequently overlaps with rheumatoid arthritis (RA). Among genetic factors, the role of the HLA
antigens and CTLA4 gene polymorphisms in the overlapping has been suggested. The aim of this study was to investigate the
alleles and genotypes frequency of the CTLA4 exon1 A49G polymorphism in Slovak patients with RA, Hashimoto thyroiditis (HT),
both (RA + HT) and in healthy controls. Fifty-seven unrelated adults with RA, 57 patients with HT, 34 patients with both (RA
+ HT), and 51 normal subjects were studied. All were ethnic Slovaks living in the same geographical area. The CTLA4 exon1
A49G polymorphism was genotyped by using small amplicon melting analysis after real-time PCR. The CTLA4 49GG genotype and
G allele frequency in the group with RA was not significantly higher in comparison with controls (10.53% vs. 9.8%, p = 0.62, OR 1.39, 95% CI 0.35–5.74 and 39.47% vs. 34.31%, p = 0.43, OR 1.25, 95% CI 0.72–2.18). The frequency of GG genotype was slightly but not significantly higher in patients with
HT as compared with control group (19.3% vs. 9.8%, p = 0.17, OR 2.27, 95% CI 0.67–8.45). However, the frequency of GG genotype and G allele in patients with both RA and HT was
significantly higher than that in controls (29.41% vs. 9.8%, p = 0.02, OR 4.49, 95% CI 1.20–18.54 and 51.47% vs. 34.31%, p = 0.03, OR 2.02, 95% CI 1.08–3.81). The frequency of GG genotype of CTLA4 A49G gene polymorphism in Slovak patients with
RA is not significantly higher in comparison to control group. However, carriers of GG genotype with RA may be susceptible
to develop HT. 相似文献
9.
Kirla Wagner Poti Gomes Ana Joicy Pinheiro Luz Marcos Rainier de Brito Felipe Lara Amorim Beltrão André Xenofonte Cartaxo Sampaio Carlos Ewerton Maia Rodrigues 《Modern rheumatology / the Japan Rheumatism Association》2018,28(2):258-263
Objectives: To determine the prevalence of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) and controls from Northeastern Brazil and to verify its association with specific RA parameters and cardiovascular risk factors.Methods: The prevalence of MetS was assessed cross-sectionally in 338 RA patients from a single center and 84 age and gender-matched controls from the local community. MetS was defined according to NCEP/ATPIII guidelines. Disease activity was assessed with CDAI, SDAI and DAS28 scores. Independent risk factors for MetS in RA patients were identified by multivariate logistic regression.Results: The prevalence of MetS was higher in RA patients than in controls (51.3% vs. 21.8%; p?.001). RA patients had a higher frequency of hypertension and type-2 diabetes mellitus, greater waist circumference (WC), higher blood glucose levels and lower HDL levels. DAS28, CDAI and SDAI scores were higher and high disease activity was more frequent in MetS patients. The multivariate logistic regression identified BMI (OR?=?1.12, 95% CI?=?1.05–1.20; p?.001) and disease activity (OR?=?1.23, 95% CI?=?1.04–1.47; p?=?.016) as independent risk factors for MetS in patients with RA.Conclusion: RA in patients from Northeastern Brazil was found to be associated with increased WC, high prevalence of MetS (one of the highest in the world) and disease activity. Patients with MetS displayed a higher frequency of cardiovascular risk factors, indicating the need for better control of disease activity and modifiable risk factors for cardiovascular disease (CVD). 相似文献
10.
Jorge?Rojas-Serrano Rubén?Burgos-Vargas Leticia?Lino Pérez Conrado?García García Francisco?Moctezuma Janitzia?Vázquez-Mellado
The objective of this study is to identify baseline factors associated with rheumatoid arthritis (RA) diagnosis at the end
of 1-year follow-up in a cohort of patients with very recent onset arthritis. Incident cases with self-reported arthritis
(≤12 weeks) referred by primary care physicians were assessed by a designated rheumatologist who predicted in those with ≥1
swollen joint the diagnosis of RA at the end of follow-up. Patients were regularly seen and diagnosed through follow-up by
staff rheumatologists who were blind to diagnostic prediction. Of 119 referrals, 78 (65.5%; age 35.5 ± 13.5 years; 69 females)
were diagnosed at baseline as very recent onset arthritis (median duration 6 weeks (0–12 weeks)); of 75 patients completing
1-year follow-up, 51 (66.5%) were classified as RA; 12 (16%) had self-limited arthritis; and 13 (17.5%) other diagnoses. The
characteristics of patients with RA as final diagnosis were polyarthritis, morning stiffness ≥1 h, high counts of swollen
joints, and low frequency of systemic symptoms. Rheumatologist prediction of RA and anti-cyclic citrullinated peptide (anti-CCP)
antibodies was strongly associated with RA as a final diagnosis in the logistic regression analysis. Sensitivity and specificity
of the rheumatologist prediction were 94% and 74%, for anti-CCP antibodies, 56% and 96%; the combination of both variables
had a specificity of 100% and a sensitivity of 53%, and a positive predictive value of 98%. The combination of RA as predicted
diagnosis by a rheumatologist and anti-CCP antibodies is highly specific for RA diagnosis in patients with very early arthritis. 相似文献
11.
Hamada M. M. Sayed Ahmed Mahmoud Youssef Youssef M. Mosaad 《Clinical rheumatology》2010,29(11):1237-1243
Rheumatoid arthritis (RA) patients have increased mortality largely as a result of cardiovascular diseases (CVD) that cannot
be explained by traditional risk factors, suggesting that systemic inflammation may accelerate atherosclerosis. We investigated
the presence of subclinical atherosclerosis in early RA (<12 months) and the possible association of RA-related risk factors.
Forty patients with early RA and 40 controls matched for age, sex, and traditional risk factors for CVD were selected. Carotid
US examination, assay of lipogram, C-reactive protein (CRP), and oxidized low-density lipoprotein antibodies (OxLDL-ab) were
done. RA patients had significantly higher carotid intima-media thickness (cIMT) values and more plaque than the control (P < 0.001 and P = 0.0122, respectively). CRP and OxLDL-ab were significantly higher in RA patients than controls. Traditional risk factors
and RA-related risk factors (disease duration, DAS-28, duration of treatment with steroids, erythrocyte sedimentation rate,
and CRP) as well as OxLDL and cIMT were significantly higher in RA with plaques compared to those without plaques. Regression
analysis identified the age of patients, CRP, and OxLDL-ab as an independent risk factor associated with the presence of atherosclerosis.
Conclusion: there is increased prevalence of carotid plaques in patients with recent-onset RA compared to matched controls.
The accelerated atherosclerosis is predicted by age, CRP, and oxLDL-ab. The association of plaques with elevated CRP and OxLDL-ab
support the hypothesis that chronic systemic autoimmune inflammatory process is probably a driving force for premature atherosclerosis. 相似文献
12.
Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis 总被引:2,自引:0,他引:2
Panoulas VF Douglas KM Milionis HJ Stavropoulos-Kalinglou A Nightingale P Kita MD Tselios AL Metsios GS Elisaf MS Kitas GD 《Rheumatology (Oxford, England)》2007,46(9):1477-1482
OBJECTIVES: Rheumatoid arthritis (RA) associates with excessive cardiovascular morbidity and mortality. Hypertension (HT) contributes significantly to the development of cardiovascular disease (CVD). Little is known about the factors that influence blood pressure (BP) in patients with RA. In this study, we assessed the prevalence of HT in a secondary care cohort of RA patients, and aimed to identify factors associated with its presence and inadequate control. METHODS: A total of 400 consecutive RA patients were studied. HT was defined as systolic BP >/=140 mmHg and/or diastolic BP >/=90 mmHg or current use of antihypertensive drugs. The association of HT with several demographic and RA-related factors, comorbidities and drugs was evaluated using logistic regression. RESULTS: HT was present in 282 (70.5%) patients. Of those, 171 (60.6%) received anti-hypertensive therapy, but 111 (39.4%) remained undiagnosed. Of those treated, only 37/171 (21.8%) were optimally controlled. Multivariable logistic regression revealed age (OR = 1.054, CI: 1.02 to 1.07, P = 0.001), body mass index [BMI (OR = 1.06, CI: 1.003-1.121, P = 0.038)] and prednisolone use (OR = 2.39, CI: 1.02-5.6, P = 0.045) to be independently associated with the presence of HT. BMI (OR = 1.11, CI: 1.02-1.21, P = 0.002) and the presence of CVD (OR = 4.01, CI: 1.27-12.69, P = 0.018) associated with uncontrolled HT. CONCLUSIONS: HT is highly prevalent in RA, under-diagnosed particularly in the young, and under-treated particularly in old RA patients with CVD. RA patients receiving steroids should be specifically targeted for screening and treatment; those with any cardiovascular comorbidity may require particularly aggressive monitoring and treatment strategies. 相似文献
13.
Kadowaki S Okamura T Hozawa A Kadowaki T Kadota A Murakami Y Nakamura K Saitoh S Nakamura Y Hayakawa T Kita Y Okayama A Ueshima H;NIPPON DATA Research Group 《Diabetologia》2008,51(4):575-582
Aims/hypothesis High fasting blood glucose is one of the well-known risk factors for CHD. However, in certain settings, patients cannot always
be expected to fast. For example, community screenings for cardiovascular disease (CVD) risk factors in Japan are performed
under non-fasting conditions to achieve high participation rates. Thus, we examined a representative cohort of the Japanese
population (n = 9,444, follow-up period 17.3 years) to clarify whether high casual blood glucose (CBG) can predict CVD mortality.
Methods We defined CBG groups as follows: high CBG ≥ 11.1 mmol/l or participants with a history of diabetes mellitus; borderline high,
7.77 ≤ CBG < 11.1 mmol/l; higher normal, 5.22 ≤ CBG < 7.77 mmol/l); and lower normal, CBG < 5.22 mmol/l. The multivariate-adjusted
hazard ratios (HRs) for CHD, CVD and all-cause mortality were calculated.
Results The crude CHD mortality rate was 0.84 per 1,000 person-years. Age- and sex-adjusted HRs for CHD mortality were high among
participants with CBG levels ≥ 7.77 mmol/l, regardless of time since last meal. Multivariate-adjusted HRs (95% CI) of CHD
mortality in high and borderline high CBG groups were 2.62 (1.46–4.67) and 2.43 (1.29–4.58), respectively. Similar results
were observed for both CVD and all-cause mortality. Even within the normal blood glucose range, each 1 mmol/l increase in
CBG was associated with a statistically significant increase in the HR for CVD mortality (1.12, 95% CI 1.02–1.22). Population-attributable
fractions of the combined groups of high and borderline high CBG for CHD, CVD and all-cause mortality were 12.0, 4.9 and 3.5%,
respectively.
Conclusions/interpretation Increases in CBG, even within the normal range, predict CVD mortality.
Electronic supplementary material The online version of this article (doi:) contains a full list of the NIPPON DATA research group members, which is available to authorised users. 相似文献
14.
《Seminars in arthritis and rheumatism》2021,51(1):292-298
ObjectiveTo determine the incidence of dementia in patients with rheumatoid arthritis (RA) 65 years and older, and compare the incidence of dementia in patients with RA with prevalent cardiovascular (CV) disease (CVD), CV risk factors but no prevalent CVD and neither (referent group).MethodsWe analyzed claims data from the Center for Medicare & Medicaid Services (CMS) from 2006–2014. Eligibility criteria included continuous medical and pharmacy coverage for ≥ 12 months (baseline period 2006), > 2 RA diagnoses by a rheumatologist and at least 1 medication for RA. CVD and CV risk factors were identified using codes from the Chronic Condition Data Warehouse. Incident dementia was defined by 1 inpatient or 2 outpatient claims, or one dementia specific medication. Age-adjusted incident rates were calculated within each age strata. Univariate and multivariate Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals.ResultsAmong 56,567 patients with RA, 11,789 (20.1%) incident cases of dementia were included in the main analysis. Age adjusted incident rates were high among all groups and increased with age. After adjustment for age, sex, comorbidities and baseline CV and RA medications, patients with CVD and CV risk factors between 65 and 74 years had an increased risk for incident dementia compared to those without CVD and without CV risk factors (HR 1.18 (95% CI 1.04–1.33) and HR 1.03 (95% CI 1.00–1.11), respectively). We observed a trend towards increased risk in patients between 75 and 84 years with CVD at baseline.ConclusionPatients with RA with both CVD and CV risk factors alone are at an increased risk for dementia compared to those with neither CVD nor CV risk factors; however, this risk is attenuated with increasing age. The impact of RA treatment and CV primary prevention strategies in the prevention of dementia in patients with RA warrants further studies. 相似文献
15.
Background Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk.
Objective The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association
between caregiving and CVD lifestyle and psychosocial risk factors among family members of recently hospitalized CVD patients.
Design and Participants Participants in the NHLBI Family Intervention Trial for Heart Health (FIT Heart) who completed a 6-month follow-up were included in this analysis (n = 263; mean age 50 ± 14 years, 67%
female, 29% non-white).
Measurements At 6 months, standardized information was collected regarding depression, social support, and caregiver strain (high caregiver
strain = ≥7). Information on lifestyle risk factors, including obesity, physical activity, and diet, were also collected using
standardized questionnaires. Logistic regression models on the association between caregiving and CVD risk factors were adjusted
for significant confounders.
Results The prevalence of serving as a CVD patient’s primary caregiver or caring for the patient most of the time was 50% at 6 months.
Caregivers (primary/most) were more likely to be women (81% vs 19%, p < .01), married/living with someone (p < .01), >50 years
old (p < .01), have ≤ high school education (p < .01), be unemployed (p < .01), get less physical activity (p < .01), and
have a higher waist circumference (p < .01) than non-caregivers (some/occasional/none). Mean caregiver strain scores were
significantly higher among those with depressive symptoms (p < .01) and low social support (p < .01) in a multivariable adjusted
model.
Conclusions Caregivers of cardiac patients may be at increased risk themselves for CVD morbidity and mortality compared to non-caregivers
due to suboptimal lifestyle and psychosocial risk factors. 相似文献
16.
Aims/hypothesis Coffee has been linked to both beneficial and harmful health effects, but data on its relationship with cardiovascular disease
and mortality in patients with type 2 diabetes are sparse.
Methods This was a prospective cohort study including 7,170 women with diagnosed type 2 diabetes but free of cardiovascular disease
or cancer at baseline. Coffee consumption was assessed in 1980 and then every 2–4 years using validated questionnaires. A
total of 658 incident cardiovascular events (434 coronary heart disease and 224 stroke) and 734 deaths from all causes were
documented between 1980 and 2004.
Results After adjustment for age, smoking and other cardiovascular risk factors, the relative risks were 0.76 (95% CI 0.50–1.14) for
cardiovascular diseases (p trend = 0.09) and 0.80 (95% CI 0.55–1.14) for all-cause mortality (p trend = 0.05) for the consumption of ≥4 cups/day of caffeinated coffee compared with non-drinkers. Similarly, multivariable
RRs were 0.96 (95% CI 0.66–1.38) for cardiovascular diseases (p trend = 0.84) and 0.76 (95% CI 0.54–1.07) for all-cause mortality (p trend = 0.08) for the consumption of ≥2 cups/day of decaffeinated coffee compared with non-drinkers. Higher decaffeinated
coffee consumption was associated with lower concentrations of HbA1c (6.2% for ≥2 cups/day versus 6.7% for <1 cup/month; p trend = 0.02).
Conclusions These data provide evidence that habitual coffee consumption is not associated with increased risk of cardiovascular diseases
or premature mortality among diabetic women.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users. 相似文献
17.
Serum adiponectin concentrations correlate with severity of rheumatoid arthritis evaluated by extent of joint destruction 总被引:1,自引:0,他引:1
Kosuke Ebina Atsunori Fukuhara Wataru Ando Makoto Hirao Tadashi Koga Kazuya Oshima Morihiro Matsuda Kazuhisa Maeda Tadashi Nakamura Takahiro Ochi Iichiro Shimomura Hideki Yoshikawa Jun Hashimoto 《Clinical rheumatology》2009,28(4):445-451
Adiponectin is a hormone released by adipose tissue with antidiabetic, antiatherogenic, and anti-inflammatory properties.
The present observational study focused on the relation between serum adiponectin level and the disease severity of established
rheumatoid arthritis (RA). Ninety patients with more than 5-year diagnosis of RA and 42 age- and BMI-matched control were
enrolled. The severity of RA was evaluated according to the number of destructed joints of overall 68 joints on plain radiographs
(37 patients had mild RA and 53 had severe RA). Serum adiponectin level was significantly higher in the severe RA group (17.7 ± 6.7 μg/ml)
than in the control (9.1 ± 3.8 μg/ml) and mild RA groups (13.9 ± 6.5 μg/ml) (control vs. mild RA group, P < 0.001; mild RA vs. severe RA group, P < 0.01). These results suggest that increased number of joint destruction is associated with hyperadiponectinemia in established
RA patients. 相似文献
18.
Aims/hypothesis The aim of this study was to investigate the impact of using a non-diabetes-specific cardiovascular disease (CVD) risk calculator
to determine eligibility for statin therapy according to current UK National Institute for Health and Clinical Excellence
(NICE) guidelines for those patients with type 2 diabetes who are at an increased risk of CVD (10 year risk ≥20%).
Methods The 10 year CVD risks were estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine and the Framingham equation
for 4,025 patients enrolled in the Lipids in Diabetes Study who had established type 2 diabetes and LDL-cholesterol <4.1 mmol/l.
Results The mean (SD) age of the patients was 60.7 (8.6) years, blood pressure 141/83 (17/10) mmHg and the total cholesterol:HDL-cholesterol
ratio was 3.9 (1.0). The median (interquartile range) diabetes duration was 6 (3–11) years and the HbA1c level was 8.0% (7.2–9.0%). The cohort comprised 65% men, 91% whites, 4% Afro-Caribbeans, 5% Asian Indians and 15% current
smokers. More patients were classified as being at high risk by the UKPDS Risk Engine (65%) than by the Framingham CVD equation
(63%) (p < 0.0001). The Framingham CVD equation classified fewer men and people aged <50 years old as high risk (p < 0.0001). There was no difference between the UKPDS Risk Engine and Framingham classification of women at high risk (p = 0.834).
Conclusions/interpretation These results suggest that the use of Framingham-derived rather than UKPDS Risk Engine-derived CVD risk estimates would deny
about one in 25 patients statin therapy when applying current NICE guidelines. Thus, under these guidelines the choice of
CVD risk calculator is important when assessing CVD risk in patients with type 2 diabetes, particularly for the identification
of the relatively small proportion of younger people who require statin therapy. 相似文献
19.
To determine the rate of true tuberculin skin test (TST) response in a cohort of patients with rheumatic disease treated with
tumor necrosis factor inhibitors (TNFi). The study population included consecutive patients with rheumatoid arthritis (RA),
ankylosing spondylitis (AS), and psoriatic arthritis (PsA) treated with TNFi for at least 3 months. Patients with a positive
TST at screening who began Tb prophylaxis before the beginning of TNFi therapy were excluded. All patients underwent a second
TST. True TST response was defined as an increase of 6 mm of induration between the screening test and the second test. Forty
patients (12 men and 28 women) were included. Mean age was 51.2 years. Of them, 27 (67.5%) had RA, eight (20%) had PsA, and
five patients (12.5%) had AS. At pre-treatment TST, 15 patients had a TST ≥ 5 mm. A significantly higher percent of patients
with TST ≥ 5 mm was seen among men compared with women (75% vs. 21%, p = 0.012) and patients with PsA compared with patients with RA (75% vs. 22%, p = 0.014). At the second test, eight (20%) had an increase of 6 mm between readings with four having an increase of 10 mm
or more. Four patients received infliximab and the other four were treated with etanercept. Seven of these eight patients
had RA and one was a patient with PsA. Patients with true TST response were significantly older and non-smokers with elevated
sedimentation rate and a higher rate of anemia. Nationality, comorbid conditions, treatment with immunosuppressives, and BCG
vaccination status had no significant influence on the TST response. Serial TST testing in patients receiving TNFi is indicated
to identify patients with reactivation of latent tuberculosis infection or those exposed to mycobacterium. 相似文献
20.
Ibn Yacoub Y Amine B Laatiris A Wafki F Znat F Hajjaj-Hassouni N 《Clinical rheumatology》2012,31(3):479-482
We aimed to estimate the prevalence of overweight in Moroccan patients with rheumatoid arthritis (RA) and its relationships
with disease activity, functional disability, structural damage, and immunological status. Two hundred fifty patients with
RA were consecutively included. Patients’ characteristics were specified. The following data were collected: age, disease
duration, disease activity (evaluated with physical examination data, biological tests (erythrocyte sedimentation rate and
C-reactive protein), and the disease activity score (DAS28)), radiographic changes (assessed by the Sharp’s method), functional
disability (assessed by using the Health Assessment Questionnaire), extra-articular manifestations, immunological status,
and treatment details. Overweight was defined according to the body mass index (BMI) values: underweight, <18.5; normal weight,
18.5–24.9; overweight, 25–29.9; and obesity, ≥30. The mean age of patients was 46.31 ± 12.64 years. The mean disease duration
was 9.46 ± 8.43 years. Seventy-five patients (30%) were overweight, 42 (16.8%) were obese, and 133 (53.2%) were normal. Increased
BMI was associated with the activity of disease (DAS28) (r = 0.426), structural damage (Sharp total score) (r = 0.297), the rate of rheumatoid factor (r = 0.311), and with the rate of anti-cyclic citrullinated protein antibodies (for all p ≤ 0.01). There were no statistically significant differences in BMI according to gender, dose and duration of corticosteroids,
or functional impairment. In our sample, overweight seems to be prevalent in our RA patients. Overweight seems to occur independently
of treatment and shown to be mainly associated to disease activity, structural damage, and immunological status. Large studies
are needed to confirm those results. 相似文献