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Background

Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited.

Objectives

The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and to determine its association with long-term outcomes.

Methods

The study retrospectively analyzed records of patients presenting with a type 1 MI at ≤50 years at 2 academic hospitals from 2000 to 2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week before MI or substance detection on toxicology screen. Vital status was identified by the Social Security Administration’s Death Master File. Cause of death was adjudicated using electronic health records and death certificates. Cox modeling was performed for survival free from all-cause and cardiovascular death.

Results

A total of 2,097 patients had type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), with median follow-up of 11.2 years (interquartile range: 7.3 to 14.2 years). Use of cocaine and/or marijuana was present in 224 (10.7%) patients; cocaine in 99 (4.7%) patients, and marijuana in 125 (6.0%). Individuals with substance use had significantly lower rates of diabetes (14.7% vs. 20.4%; p = 0.05) and hyperlipidemia (45.7% vs. 60.8%; p < 0.001), but they were significantly more likely to use tobacco (70.3% vs. 49.1%; p < 0.001). The use of cocaine and/or marijuana was associated with significantly higher cardiovascular mortality (hazard ratio: 2.22; 95% confidence interval: 1.27 to 3.70; p = 0.005) and all-cause mortality (hazard ratio: 1.99; 95% confidence interval: 1.35 to 2.97; p = 0.001) after adjusting for baseline covariates.

Conclusions

Cocaine and/or marijuana use is present in 10% of patients with an MI at age ≤50 years and is associated with worse all-cause and cardiovascular mortality. These findings reinforce current recommendations for substance use screening among young adults with an MI, and they highlight the need for counseling to prevent future adverse events.  相似文献   
14.

Aims

This study aimed to evaluate the association between baseline bilirubin (TBiL) and follow-up TBiL changes for diabetic kidney disease (DKD) incidence and progression based on a 5?years' cohort study.

Methods

This cohort study was conducted in Beijing between 2009 and 2013. The subjects were consisted of 5342male diabetic patients with baseline retinopathy. Cox proportional risk model was used to calculate hazards ratio (HR).

Results

The mean age of the 5342 diabetic patients was 78.68?±?8.40 (65–102?yrs). The total five year incidence was 8.7% (95%CI: 7.9%–9.4%) for DKD and 10.5% (95%CI: 9.7%–11.3%) for eGFR decrease. The HR of baseline TBiL showed a decreasing trend for both DKD incidence and eGFR decrease. The HRs of baseline TBiL (per μmol/L increase) for DKD and eGFR decrease were 0.967(95%CI: 0.946–0.988) and 0.955(95%CI: 0.936–0.975) respectively. For follow-up TBiL changes, after adjusted for related co-variables and baseline TBiL levels (as continuous variable) in the model, the HRs (per μmol/L of follow-up TBiL changes) for DKD and eGFR decrease were 0.973(95%CI: 0.952–0.995) and 0.991(95%CI: 0.974–0.998) respectively. The results were similar when baseline TBiL and follow-up TBiL changes were used as tertiary variable.

Conclusion

Not only baseline TBiL, but also follow-up changes were significantly associated with DKD incidence and progression.  相似文献   
15.

Aims

To assess whether an integrated hospital-community diabetes management program could improve major cardiovascular risk factor control among patients with diabetes in real-world clinical settings.

Methods

985 adults with diabetes in the Shanghai Taopu community health service center were enrolled at baseline and 907 subjects completed the follow-up. The follow-up levels of the metabolic profiles were assessed by their averages during the follow up period.

Results

After a mean 7-year follow-up period, heamoglobin A1c, systolic and diastolic blood pressure levels decreased by 0.6%, 5.7 mmHg, and 1.5 mmHg, respectively (all P < 0.001). There was a non-significant difference in low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol increased 1.9 mg/dL and triglycerides decreased 28.3 mg/dL, respectively (all P < 0.001). The percentage of patients with diabetes who met any one of three Chinese Diabetes Society goals (heamoglobin A1c <7.0%, blood pressure <140/80 mmHg, and low-density lipoprotein cholesterol <100 mg/dL) increased from 58.2% to 70.1%. The chronic diabetes complication screening rates (diabetic retinopathy, diabetic neuropathy, diabetic nephropathy) have significantly increased, from almost zero to 12–78%.

Conclusions

This long-term program has increased the proportions of attaining major cardiovascular risk factors control goals and diabetic chronic complication screening rates among patients with diabetes.  相似文献   
16.
We have recently demonstrated that apolipoprotein E (APOE)-varepsilon4 allele is a risk factor for Alzheimer disease (AD) in Tehran, Iran. The current study specifically aimed to examine whether APOE polymorphism in association with serum lipids-apolipoprotein level is a risk factor for AD in a population from Tehran, Iran. APOE polymorphism and plasma lipids, apoA1, apoB and lipoprotein (a) (Lp(a)) levels were determined in 94 AD patients and 111matched controls. Our study demonstrated a significant association between APOE polymorphism and the level of plasma lipids and apolipoprotein with AD in this population. The AD subjects had significantly lower apoA1 (p<0.001) and HDL-C (p<0.01) and higher apoB (p=0.01) and LDL-C (p=0.02) levels than that of the control group. The AD subjects carrying APOE-varepsilon4 allele had lower plasma apoA1 (t=5.2, p<0.002) and HDL-C level (t=2.7, p=0.01) but had higher plasma apoB (t=-5.4, p<0.002), LDL-C (t=-4.6, p=0.005) and total cholesterol (TC) (t=-2.7, p=0.01) than that of the non APOE-varepsilon4 carriers. These results indicated that AD patients with APOE-varepsilon4 allele has a distinct plasma lipid profile and carrier of this allele with low levels of apoA1 and HDL-C may be more susceptible to AD.  相似文献   
17.

Objective

To investigate the role of small dense low density lipoprotein cholesterol (sd-LDL-C) in the mechanism of decreased incidence of cardiovascular disease in Gilbert's syndrome (GS).

Design and methods

sd-LDL-C, ox-LDL, and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n = 42) and compared to healthy controls (n = 52).

Results

Age, gender and body mass index (BMI) distributions were similar between the two groups. sd-LDL-C, ox-LDL and hs-CRP levels were lower in GS than the healthy controls (p < 0.001, p < 0.001 and p = 0.001, respectively). Unconjugated bilirubin was negatively correlated with sd-LDL-C, ox-LDL and hs-CRP (r = −0.594, p < 0.001; r = −0.249, p = 0.016 and r = − 0.373, p < 0.001 respectively). In addition, sd-LDL-C was positively correlated with ox-LDL (r = 0.307, p = 0.003).

Conclusions

The findings of this preliminary study suggest that reduced sd-LDL-C, ox-LDL and hs-CRP levels may have a role in preventing atherosclerosis in subjects with GS.  相似文献   
18.

Objectives

The goal of our study was to determine the prevalence of metabolic syndrome (MetS) and all its components, in a population of postmenopausal women aged over 45 years, consecutively accessed to our Heart Station, during 2014, for their first cardiac examination,furthermore to estimate their cardiovascular risk and the achievement of target blood values of main risk factors, according to current Guidelines.

Methods

We screened 1257 postmenopausal women. MetS was assessed according to the National-Cholesterol-Education-Program-Adult-Treatment-Panel III definition. Cardiovascular risk was calculated by the Systematic Coronary Risk Evaluation (<65 years).

Results

MetS was assessed on 834 women (66.4%). Prevalence of each component was: hypertension on 767 women (91.9%), central obesity 758 women (90.9%), low high-density lipoproteins cholesterol (HDLc) increased levels 612 women (73.3%), high triglyceride levels 428 women (51.3%), glucose levels higher than 110 mg/dl or diabetes 404 women (48.5%). Cardiovascular risk was moderate until 65 years, but it increases after. Metabolic control in postmenopausal women was poor for glucose, only 82 women (9.8%) presented glucose levels lower than 110 mg/dl, it was better for systolic blood pressure, that was normal in 564 women (67.6%) and worse for lipid levels.

Conclusion

The prevalence of metabolic syndrome in our population of postmenopausal women is high. Hypertension and central obesity are the more common components. The cardiovascular risk is moderate-high, the achievement of target values for glycemic and lipid levels is unsatisfactory, while systolic blood pressure is enough well controlled but however it is mandatory to improve this goal. An early MetS diagnosis and an early educational intervention are useful to decrease cardiovascular risk of postmenopausal women affected by metabolic syndrome.  相似文献   
19.

Objective

Plasma fractalkine (FRACT) is involved in the development of numerous inflammatory conditions including atherosclerosis. It is associated with type 2 diabetes mellitus and adipose inflammation. However, whether FRACT is associated with major risk factors for cardiovascular disease, in particular obesity, metabolic syndrome and blood lipids, is virtually unknown.

Methods

The study included a large community-based sample of 3306 middle-aged women drawn from the general UK population. Blood samples were analyzed for circulating levels of FRACT, leptin, insulin, glucose, LDL-C, HDL-C, Apo-A, ApoB and IL-6. Obesity was assessed by fat body mass (FBM) using dual-energy x-ray absorptiometry and by body mass index (BMI).

Results

We found no association between FRACT and body composition, in particular adiposity. Obese and non obese subjects with metabolic syndrome tended to have higher levels of FRACT compared with non-obese subjects without metabolic syndrome but this did not reach statistical significance. Most importantly we report significant correlations between FRACT and circulating IL-6, Apo-B, LDL-C and insulin. The associations with IL-6 and Apo-B were particularly significant (P-value < 0.001), and survived correction for multiple testing and adjustment for age and other covariates.

Conclusion

Higher FRACT levels correlated with elevated levels of IL-6, Apo-B, LDL-C and insulin, all known risk factors for several clinical related diseases suggesting a potential role of FRACT in inflammation and tissue injury. Variations of FRACT levels are not influenced by body composition and are not correlated with leptin indicating that fat mass alone is not responsible for elevation of FRACT seen in obese individuals.  相似文献   
20.

Objective

In familial hypercholesterolemia (FH), the metabolism and anti-atherogenic functions of HDL can be affected by the continuous interactions with excess LDL amounts. Here, lipid transfers to HDL, an important step for HDL intravascular metabolism and for HDL role in reverse cholesterol transport (RCT) were investigated in FH patients.

Methods

Seventy-one FH patients (39 ± 15 years, LDL-cholesterol = 274 ± 101; HDL-cholesterol = 50 ± 14 mg/dl) and 66 normolipidemic subjects (NL) (38 ± 11 years, LDL-cholesterol = 105 ± 27; HDL-cholesterol = 52 ± 12 mg/dl) were studied. In vitro, lipid transfers were evaluated by incubation of plasma samples (37 °C, 1 h) with a donor lipid nanoemulsion labeled with 3H-triglycerides (TG) and 14C-unesterified cholesterol (UC) or with 3H-cholesteryl ester (EC) and 14C-phospholipids (PL). Radioactivity was counted at the HDL fraction after chemical precipitation of apolipoprotein (apo) B-containing lipoproteins and the nanoemulsion. Data are % of total radioactivity measured in the HDL fraction.

Results

Transfer of UC to HDL was lower in FH than in NL (5.6 ± 2.1 vs 6.7 ± 2.0%, p = 0.0005) whereas TG (5.5 ± 3.1 vs 3.7 ± 0.9%, p = 0.018) and PL (20.9 ± 4.6 vs 18.2 ± 3.7 %, p = 0.023) transfers were higher in FH. EC transfer was equal. By multivariate analysis, transfers of all four lipids correlated with HDL-cholesterol and with apo A-I.

Conclusion

FH elicited marked changes in three of the four tested lipid transfers to HDL. The entry of UC into HDL for subsequent esterification is an important driving force for RCT and reduction of UC transfer to HDL was previously associated to precocious coronary heart disease. Therefore, in FH, HDL functions can be lessened, which can also contribute to atherogenesis.  相似文献   
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