مقاله شماره ۲۲
#Cardiology
#Neurology
#BasicSciences
عنوان:
Acquired Cardiac Channelopathies in Epilepsy
نوع مطالعه:
Review
مجله:
Epilepsia
تاریخ انتشار:
01, Sep, 2019
چکیده:
There is growing evidence that cardiac dysfunction in patients with chronic epilepsy could play a pathogenic role in sudden unexpected death in epilepsy (SUDEP). Recent animal studies have revealed that epilepsy secondarily alters the expression of cardiac ion channels alongside abnormal cardiac electrophysiology and remodeling. These molecular findings represent novel evidence for an acquired cardiac channelopathy in epilepsy, distinct from inherited ion channels mutations associated with cardiocerebral phenotypes. Specifically, seizure activity has been shown to alter the messenger RNA (mRNA) and protein expression of voltage-gated sodium channels (Nav 1.1, Nav 1.5), voltage-gated potassium channels (Kv 4.2, Kv 4.3), sodium-calcium exchangers (NCX1), and nonspecific cation-conducting channels (HCN2, HCN4). The pathophysiology may involve autonomic dysfunction and structural cardiac disease, as both are independently associated with epilepsy and ion channel dysregulation. Indeed, in vivo and in vitro studies of cardiac pathology reveal a complex network of signaling pathways and transcription factors regulating ion channel expression in the setting of sympathetic overactivity, cardiac failure, and hypertrophy. Other mechanisms such as circulating inflammatory mediators or exogenous effects of antiepileptic medications lack evidence. Moreover, an acquired cardiac channelopathy may underlie the electrophysiologic cardiac abnormalities seen in chronic epilepsy, potentially contributing to the increased risk of malignant arrhythmias and sudden death. Therefore, further investigation is necessary to establish whether cardiac ion channel dysregulation similarly occurs in patients with epilepsy, and to characterize any pathogenic relationship with SUDEP.
DOI: https://dx.doi.org/10.1111/epi.16301
توضیحات مهم:
✅ نویسندگان در این مرور انتقادی عالی به بررسی نقش کانال های قلبی ، به ویژه از دیدگاه SUDEP و اختلال عملکرد قلبی پرداخته اند.
✔️ نویسندگان بیشتر به نقش جهش های کانال یونی ارثی که به طور مشترک در مغز و قلب بیان می شوند و رابطه بین صرع ، اختلال عملکرد قلبی و تغییرات مولکولی را برجسته می کنند، پرداختند.
✔️ نویسندگان در این مطالعه نشان دادند که یک کانالوپاتی قلبی اکتسابی ممکن است تا حدودی حالت پیش آریتمی که در صرع دیده می شود را تسهیل کند و به خطر مرگ ناگهانی کمک کند.
مجموعه مدیتورها خواندن این مقاله مروری ارزشمند را به همه دوستان علاقمند به علوم پایه، نورو و قلب پیشنهاد می دهد.
🔎 @Meditorha
#Cardiology
#Neurology
#BasicSciences
عنوان:
Acquired Cardiac Channelopathies in Epilepsy
نوع مطالعه:
Review
مجله:
Epilepsia
تاریخ انتشار:
01, Sep, 2019
چکیده:
There is growing evidence that cardiac dysfunction in patients with chronic epilepsy could play a pathogenic role in sudden unexpected death in epilepsy (SUDEP). Recent animal studies have revealed that epilepsy secondarily alters the expression of cardiac ion channels alongside abnormal cardiac electrophysiology and remodeling. These molecular findings represent novel evidence for an acquired cardiac channelopathy in epilepsy, distinct from inherited ion channels mutations associated with cardiocerebral phenotypes. Specifically, seizure activity has been shown to alter the messenger RNA (mRNA) and protein expression of voltage-gated sodium channels (Nav 1.1, Nav 1.5), voltage-gated potassium channels (Kv 4.2, Kv 4.3), sodium-calcium exchangers (NCX1), and nonspecific cation-conducting channels (HCN2, HCN4). The pathophysiology may involve autonomic dysfunction and structural cardiac disease, as both are independently associated with epilepsy and ion channel dysregulation. Indeed, in vivo and in vitro studies of cardiac pathology reveal a complex network of signaling pathways and transcription factors regulating ion channel expression in the setting of sympathetic overactivity, cardiac failure, and hypertrophy. Other mechanisms such as circulating inflammatory mediators or exogenous effects of antiepileptic medications lack evidence. Moreover, an acquired cardiac channelopathy may underlie the electrophysiologic cardiac abnormalities seen in chronic epilepsy, potentially contributing to the increased risk of malignant arrhythmias and sudden death. Therefore, further investigation is necessary to establish whether cardiac ion channel dysregulation similarly occurs in patients with epilepsy, and to characterize any pathogenic relationship with SUDEP.
DOI: https://dx.doi.org/10.1111/epi.16301
توضیحات مهم:
✅ نویسندگان در این مرور انتقادی عالی به بررسی نقش کانال های قلبی ، به ویژه از دیدگاه SUDEP و اختلال عملکرد قلبی پرداخته اند.
✔️ نویسندگان بیشتر به نقش جهش های کانال یونی ارثی که به طور مشترک در مغز و قلب بیان می شوند و رابطه بین صرع ، اختلال عملکرد قلبی و تغییرات مولکولی را برجسته می کنند، پرداختند.
✔️ نویسندگان در این مطالعه نشان دادند که یک کانالوپاتی قلبی اکتسابی ممکن است تا حدودی حالت پیش آریتمی که در صرع دیده می شود را تسهیل کند و به خطر مرگ ناگهانی کمک کند.
مجموعه مدیتورها خواندن این مقاله مروری ارزشمند را به همه دوستان علاقمند به علوم پایه، نورو و قلب پیشنهاد می دهد.
🔎 @Meditorha
Wiley Online Library
Acquired cardiac channelopathies in epilepsy: Evidence, mechanisms, and clinical significance
There is growing evidence that cardiac dysfunction in patients with chronic epilepsy could play a pathogenic role in sudden unexpected death in epilepsy (SUDEP). Recent animal studies have revealed t...
مقاله شماره ۲۴
#Cardiology
#Neurology
#Pharmacology
#BasicSciences
#Psychology
عنوان:
No Association Between Statin Use and Memory, Cognition, or Brain Volume in the Elderly
نوع مطالعه:
Prospective observational study
مجله:
JACC
تاریخ انتشار:
Nov, 2019
چکیده:
BACKGROUND
There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline.
OBJECTIVES
This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined.
METHODS
Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. Interactions were sought between statin use and dementia risk factors.
RESULTS
Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein Eε4 carriage. There was no difference in brain volume changes between statin users and never users.
CONCLUSIONS
In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.
DOI: 10.1016/j.jacc.2019.09.041
توضیحات مهم:
✅ این مطالعه مشاهده ای آینده نگر ، نتایج شناختی و مغزی در 1037 سالمند ساکن جامعه استرالیا (سنین 70-90 ساله) طی یک دوره 6 ساله با توجه به قرار گرفتن در معرض استاتین مقایسه کرده است.
✔️ افراد شرکت کننده در این مطالعه شامل 395 نفر بودند که هرگز از استاتین (never users) استفاده نکرده بودند و 642 نفر در برخی موارد از استاتین استفاده کرده بودند (ever users).
✔️ همه شرکت کنندگان هر 2 سال یکبار تحت آزمایش neuropsychological قرار گرفتند ، و 526 نیز تحت ارزیابی MRI قرار گرفتند تا حجم مغز ، هیپوکامپ و پاراهیپوکامپ را ارزیابی کنند.
✔️ هیچ مدرکی مبنی بر تفاوت در میزان کاهش شناخت گلوبال یا حافظه بین گروه های never user و ever user مشاهده نشد.
✔️ در مقایسه با never user ها ، در 99 شرکت کننده که در طول مطالعه شروع به درمان استاتین کردند ، میزان کاهش حافظه ضعیف بود ، اما در شناخت global هیچ تفاوتی نداشتند.
✔️ تغییرات حجم مغز بین گروهها مشابه بود.
✔️✔️ با اینکه این مطالعه دارای محدودیت از نظر حجم نمونه و مشاهده ای بودن می باشد، اما به بیماران سالمند تا حدودی اطمینان خاطر می دهد که نگران اثرات #استاتین روی شناخت نباشند.
🔎 @Meditorha
#Cardiology
#Neurology
#Pharmacology
#BasicSciences
#Psychology
عنوان:
No Association Between Statin Use and Memory, Cognition, or Brain Volume in the Elderly
نوع مطالعه:
Prospective observational study
مجله:
JACC
تاریخ انتشار:
Nov, 2019
چکیده:
BACKGROUND
There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline.
OBJECTIVES
This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined.
METHODS
Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. Interactions were sought between statin use and dementia risk factors.
RESULTS
Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein Eε4 carriage. There was no difference in brain volume changes between statin users and never users.
CONCLUSIONS
In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.
DOI: 10.1016/j.jacc.2019.09.041
توضیحات مهم:
✅ این مطالعه مشاهده ای آینده نگر ، نتایج شناختی و مغزی در 1037 سالمند ساکن جامعه استرالیا (سنین 70-90 ساله) طی یک دوره 6 ساله با توجه به قرار گرفتن در معرض استاتین مقایسه کرده است.
✔️ افراد شرکت کننده در این مطالعه شامل 395 نفر بودند که هرگز از استاتین (never users) استفاده نکرده بودند و 642 نفر در برخی موارد از استاتین استفاده کرده بودند (ever users).
✔️ همه شرکت کنندگان هر 2 سال یکبار تحت آزمایش neuropsychological قرار گرفتند ، و 526 نیز تحت ارزیابی MRI قرار گرفتند تا حجم مغز ، هیپوکامپ و پاراهیپوکامپ را ارزیابی کنند.
✔️ هیچ مدرکی مبنی بر تفاوت در میزان کاهش شناخت گلوبال یا حافظه بین گروه های never user و ever user مشاهده نشد.
✔️ در مقایسه با never user ها ، در 99 شرکت کننده که در طول مطالعه شروع به درمان استاتین کردند ، میزان کاهش حافظه ضعیف بود ، اما در شناخت global هیچ تفاوتی نداشتند.
✔️ تغییرات حجم مغز بین گروهها مشابه بود.
✔️✔️ با اینکه این مطالعه دارای محدودیت از نظر حجم نمونه و مشاهده ای بودن می باشد، اما به بیماران سالمند تا حدودی اطمینان خاطر می دهد که نگران اثرات #استاتین روی شناخت نباشند.
🔎 @Meditorha
مقاله شماره ۲۹
#Cardiology
#VascularSurgery
#Internal_medicine
#Pharmacology
#Rheumatology
عنوان:
Use of direct oral anticoagulants in antiphospholipid syndrome.
مجله:
Journal of Thromb Haemost
نوع مطالعه:
Review
تاریخ انتشار:
2018
سایتیشن:
Cohen et al.
چکیده:
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constitute the conventional therapy for the treatment and secondary thromboprophylaxis of thrombotic antiphospholipid syndrome (APS), but are often problematic, owing to the variable sensitivity of thromboplastins to lupus anticoagulant. Thus, the International Normalized Ratio may not accurately reflect anticoagulation intensity, or be clinically effective. Definition of the current role of DOACs in the treatment of APS is based on limited clinical trial data and information from other sources, including manufacturers' data, case series or cohort studies, and expert consensus. The Rivaroxaban in Antiphospholipid Syndrome (RAPS) randomized controlled trial (RCT), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard-intensity anticoagulation. However, further studies, in particular to provide better long-term efficacy and safety data, are needed before it can be widely recommended. APS patients are clinically heterogeneous, with the risk of recurrent thrombosis and the intensity of anticoagulation being influenced by their clinical phenotype and risk profile. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Ongoing and emerging DOAC RCTs should provide further information to guide the use of DOACs in APS patients. Optimal identification of APS patients is a key step in working towards improved therapeutic strategies in these individuals.
DOI: https://doi.org/10.1111/jth.14017
🔎 @Meditorha
#Cardiology
#VascularSurgery
#Internal_medicine
#Pharmacology
#Rheumatology
عنوان:
Use of direct oral anticoagulants in antiphospholipid syndrome.
مجله:
Journal of Thromb Haemost
نوع مطالعه:
Review
تاریخ انتشار:
2018
سایتیشن:
Cohen et al.
چکیده:
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constitute the conventional therapy for the treatment and secondary thromboprophylaxis of thrombotic antiphospholipid syndrome (APS), but are often problematic, owing to the variable sensitivity of thromboplastins to lupus anticoagulant. Thus, the International Normalized Ratio may not accurately reflect anticoagulation intensity, or be clinically effective. Definition of the current role of DOACs in the treatment of APS is based on limited clinical trial data and information from other sources, including manufacturers' data, case series or cohort studies, and expert consensus. The Rivaroxaban in Antiphospholipid Syndrome (RAPS) randomized controlled trial (RCT), which had a laboratory surrogate primary outcome measure, suggests that rivaroxaban has the potential to be an effective and convenient alternative to warfarin in thrombotic APS patients with a single venous thromboembolism event requiring standard-intensity anticoagulation. However, further studies, in particular to provide better long-term efficacy and safety data, are needed before it can be widely recommended. APS patients are clinically heterogeneous, with the risk of recurrent thrombosis and the intensity of anticoagulation being influenced by their clinical phenotype and risk profile. DOAC trials involving homogeneous thrombotic APS populations, with the antiphospholipid antibody status well defined, will help to optimize the appropriate treatment in APS patient subgroups. Ongoing and emerging DOAC RCTs should provide further information to guide the use of DOACs in APS patients. Optimal identification of APS patients is a key step in working towards improved therapeutic strategies in these individuals.
DOI: https://doi.org/10.1111/jth.14017
🔎 @Meditorha
Wiley Online Library
Use of direct oral anticoagulants in antiphospholipid syndrome
Summary
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constit...
The direct oral anticoagulants (DOACs) are therapeutic alternatives to warfarin and other vitamin K antagonists (VKAs), and constitute the standard of care for many indications. VKAs constit...
مقاله شماره ۳۲
#Cardiology
#Pharmacology
عنوان:
Selenium Deficiency Associated With Worse Outcomes in Patients With Heart Failure
مجله:
European Journal of Heart Failure
نوع مطالعه:
cohort study
تاریخ انتشار:
06 December 2019
سایتیشن:
Bomer et al.
چکیده:
AIMS
Severe deficiency of the essential trace element selenium can cause myocardial dysfunction although the mechanism at cellular level is uncertain. Whether, in clinical practice, moderate selenium deficiency is associated with worse symptoms and outcome in patients with heart failure is unknown.
METHODS AND RESULTS
BIOSTAT-CHF is a multinational, prospective, observational cohort study that enrolled patients with worsening heart failure. Serum concentrations of selenium were measured by inductively coupled plasma mass spectrometry. Primary endpoint was a composite of all-cause mortality and hospitalization for heart failure; secondary endpoint was all-cause mortality. To investigate potential mechanisms by which selenium deficiency might affect prognosis, human cardiomyocytes were cultured in absence of selenium, and mitochondrial function and oxidative stress were assessed. Serum selenium concentration (deficiency) was <70 μg/L in 485 (20.4%) patients, who were older, more often women, had worse New York Heart Association class, more severe signs and symptoms of heart failure and poorer exercise capacity (6-min walking test) and quality of life (Kansas City Cardiomyopathy Questionnaire). Selenium deficiency was associated with higher rates of the primary endpoint [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.06-1.42] and all-cause mortality (HR 1.52; 95% CI 1.26-1.86). In cultured human cardiomyocytes, selenium deprivation impaired mitochondrial function and oxidative phosphorylation, and increased intracellular reactive oxygen species levels.
CONCLUSIONS
Selenium deficiency in heart failure patients is independently associated with impaired exercise tolerance and a 50% higher mortality rate, and impaired mitochondrial function in vitro, in human cardiomyocytes. Clinical trials are needed to investigate the effect of selenium supplements in patients with heart failure, especially if they have low plasma concentrations of selenium.
DOI: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1644
توضیحات مهم:
✅ این مطالعه آینده نگر با استفاده از داده های مطالعه کوهورت بین المللی BIOSTAT-CHF، به بررسی ارتباط بین غلظت سلنیوم و پیامدهای آن در 2516 بیمار با بدتر شدن نارسایی قلبی پرداخته است.
✔️ از بین شرکت کنندگان ، ۲۰/۴٪ غلظت سرمی سلنیوم کمتر از حد نرمال بود (<70 میکروگرم بر لیتر).
✔️ در مقایسه با بیمارانی که سطح سلنیوم بالاتری دارند ، این بیماران بیشتر در زنان و افراد مسن بود. علاوه بر این ، آنها علائم و نشانه های شدیدتری از نارسایی قلبی ، بدتر شدن کلاس NYHA ، کیفیت پایین تر زندگی داشتند.
✔️ مرگ و میر (mortality) در بیماران مبتلا به کمبود سلنیوم بیشتر بود.
👈 اگر چه آزمایشات بالینی بیشتری برای تعیین اینکه آیا مکمل سلنیوم نتایج بیماران مبتلا به نارسایی قلبی را بهبود می بخشد ، لازم است ، اما این داده ها نشان می دهد که بیماران با سطح سلنیوم پایین پیامدهای بدتری دارند (از جمله نرخ مرگ و میر بالاتر).
🔎 @Meditorha
#Cardiology
#Pharmacology
عنوان:
Selenium Deficiency Associated With Worse Outcomes in Patients With Heart Failure
مجله:
European Journal of Heart Failure
نوع مطالعه:
cohort study
تاریخ انتشار:
06 December 2019
سایتیشن:
Bomer et al.
چکیده:
AIMS
Severe deficiency of the essential trace element selenium can cause myocardial dysfunction although the mechanism at cellular level is uncertain. Whether, in clinical practice, moderate selenium deficiency is associated with worse symptoms and outcome in patients with heart failure is unknown.
METHODS AND RESULTS
BIOSTAT-CHF is a multinational, prospective, observational cohort study that enrolled patients with worsening heart failure. Serum concentrations of selenium were measured by inductively coupled plasma mass spectrometry. Primary endpoint was a composite of all-cause mortality and hospitalization for heart failure; secondary endpoint was all-cause mortality. To investigate potential mechanisms by which selenium deficiency might affect prognosis, human cardiomyocytes were cultured in absence of selenium, and mitochondrial function and oxidative stress were assessed. Serum selenium concentration (deficiency) was <70 μg/L in 485 (20.4%) patients, who were older, more often women, had worse New York Heart Association class, more severe signs and symptoms of heart failure and poorer exercise capacity (6-min walking test) and quality of life (Kansas City Cardiomyopathy Questionnaire). Selenium deficiency was associated with higher rates of the primary endpoint [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.06-1.42] and all-cause mortality (HR 1.52; 95% CI 1.26-1.86). In cultured human cardiomyocytes, selenium deprivation impaired mitochondrial function and oxidative phosphorylation, and increased intracellular reactive oxygen species levels.
CONCLUSIONS
Selenium deficiency in heart failure patients is independently associated with impaired exercise tolerance and a 50% higher mortality rate, and impaired mitochondrial function in vitro, in human cardiomyocytes. Clinical trials are needed to investigate the effect of selenium supplements in patients with heart failure, especially if they have low plasma concentrations of selenium.
DOI: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1644
توضیحات مهم:
✅ این مطالعه آینده نگر با استفاده از داده های مطالعه کوهورت بین المللی BIOSTAT-CHF، به بررسی ارتباط بین غلظت سلنیوم و پیامدهای آن در 2516 بیمار با بدتر شدن نارسایی قلبی پرداخته است.
✔️ از بین شرکت کنندگان ، ۲۰/۴٪ غلظت سرمی سلنیوم کمتر از حد نرمال بود (<70 میکروگرم بر لیتر).
✔️ در مقایسه با بیمارانی که سطح سلنیوم بالاتری دارند ، این بیماران بیشتر در زنان و افراد مسن بود. علاوه بر این ، آنها علائم و نشانه های شدیدتری از نارسایی قلبی ، بدتر شدن کلاس NYHA ، کیفیت پایین تر زندگی داشتند.
✔️ مرگ و میر (mortality) در بیماران مبتلا به کمبود سلنیوم بیشتر بود.
👈 اگر چه آزمایشات بالینی بیشتری برای تعیین اینکه آیا مکمل سلنیوم نتایج بیماران مبتلا به نارسایی قلبی را بهبود می بخشد ، لازم است ، اما این داده ها نشان می دهد که بیماران با سطح سلنیوم پایین پیامدهای بدتری دارند (از جمله نرخ مرگ و میر بالاتر).
🔎 @Meditorha
Wiley Online Library
Selenium and outcome in heart failure
<em>European Journal of Heart Failure</em> is an ESC journal dedicated to improving the understanding, prevention, investigation and treatment of heart failure.
مقاله شماره ۳۴
#Internal_medicine
#Diabete
#Cardiology
عنوان:
2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes
مجله:
Diabetes Care
نوع مطالعه:
Original Research
تاریخ انتشار:
October 15, 2019
سایتیشن:
Buse et al.
چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
https://doi.org/10.2337/dci19-0066
توضیحات مهم:
✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.
🔎 @Meditorha
#Internal_medicine
#Diabete
#Cardiology
عنوان:
2019 ADA and EASD Guidelines for the Management of Hyperglycemia in Type 2 Diabetes
مجله:
Diabetes Care
نوع مطالعه:
Original Research
تاریخ انتشار:
October 15, 2019
سایتیشن:
Buse et al.
چکیده:
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperglycemia, based on important research findings from large cardiovascular outcomes trials published in 2019. Important changes include: 1) the decision to treat high-risk individuals with a glucagon-like peptide 1 (GLP-1) receptor agonist or sodium–glucose cotransporter 2 (SGLT2) inhibitor to reduce major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), cardiovascular death, or chronic kidney disease (CKD) progression should be considered independently of baseline HbA1c or individualized HbA1c target; 2) GLP-1 receptor agonists can also be considered in patients with type 2 diabetes without established cardiovascular disease (CVD) but with the presence of specific indicators of high risk; and 3) SGLT2 inhibitors are recommended in patients with type 2 diabetes and heart failure, particularly those with heart failure with reduced ejection fraction, to reduce hHF, MACE, and CVD death, as well as in patients with type 2 diabetes with CKD (estimated glomerular filtration rate 30 to ≤60 mL min–1 [1.73 m]–2 or urinary albumin-to-creatinine ratio >30 mg/g, particularly >300 mg/g) to prevent the progression of CKD, hHF, MACE, and cardiovascular death.
https://doi.org/10.2337/dci19-0066
توضیحات مهم:
✔ The ADA and EASD have updated their guidelines for the management of hyperglycemia in type 2 diabetes to include the use of GLP-1 receptor agonists or SGLT2 inhibitors in high-risk patients.
✔ The update also includes the consideration of GLP-1 receptor agonist use in those diabetic patients without cardiovascular disease and the use of SGLT2 inhibitors in type 2 diabetes patients with heart failure and chronic kidney disease.
🔎 @Meditorha
American Diabetes Association
2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA)…
The American Diabetes Association and the European Association for the Study of Diabetes have briefly updated their 2018 recommendations on management of hyperg
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مقاله شماره ۲۴
#Cardiology
#Neurology
#Pharmacology
#BasicSciences
#Psychology
عنوان:
No Association Between Statin Use and Memory, Cognition, or Brain Volume in the Elderly
نوع مطالعه:
Prospective observational study
مجله:
JACC
تاریخ انتشار:
Nov, 2019
چکیده:
BACKGROUND
There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline.
OBJECTIVES
This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined.
METHODS
Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. Interactions were sought between statin use and dementia risk factors.
RESULTS
Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein Eε4 carriage. There was no difference in brain volume changes between statin users and never users.
CONCLUSIONS
In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.
DOI: 10.1016/j.jacc.2019.09.041
توضیحات مهم:
✅ این مطالعه مشاهده ای آینده نگر ، نتایج شناختی و مغزی در 1037 سالمند ساکن جامعه استرالیا (سنین 70-90 ساله) طی یک دوره 6 ساله با توجه به قرار گرفتن در معرض استاتین مقایسه کرده است.
✔️ افراد شرکت کننده در این مطالعه شامل 395 نفر بودند که هرگز از استاتین (never users) استفاده نکرده بودند و 642 نفر در برخی موارد از استاتین استفاده کرده بودند (ever users).
✔️ همه شرکت کنندگان هر 2 سال یکبار تحت آزمایش neuropsychological قرار گرفتند ، و 526 نیز تحت ارزیابی MRI قرار گرفتند تا حجم مغز ، هیپوکامپ و پاراهیپوکامپ را ارزیابی کنند.
✔️ هیچ مدرکی مبنی بر تفاوت در میزان کاهش شناخت گلوبال یا حافظه بین گروه های never user و ever user مشاهده نشد.
✔️ در مقایسه با never user ها ، در 99 شرکت کننده که در طول مطالعه شروع به درمان استاتین کردند ، میزان کاهش حافظه ضعیف بود ، اما در شناخت global هیچ تفاوتی نداشتند.
✔️ تغییرات حجم مغز بین گروهها مشابه بود.
✔️✔️ با اینکه این مطالعه دارای محدودیت از نظر حجم نمونه و مشاهده ای بودن می باشد، اما به بیماران سالمند تا حدودی اطمینان خاطر می دهد که نگران اثرات #استاتین روی شناخت نباشند.
🔎 @Meditorha
#Cardiology
#Neurology
#Pharmacology
#BasicSciences
#Psychology
عنوان:
No Association Between Statin Use and Memory, Cognition, or Brain Volume in the Elderly
نوع مطالعه:
Prospective observational study
مجله:
JACC
تاریخ انتشار:
Nov, 2019
چکیده:
BACKGROUND
There is widespread consumer concern that statin use may be associated with impaired memory and cognitive decline.
OBJECTIVES
This study sought to examine the association between statin use and changes in memory and global cognition in the elderly population over 6 years and brain volumes over 2 years. Interactions between statin use and known dementia risk factors were examined.
METHODS
Prospective observational study of community-dwelling elderly Australians age 70 to 90 years (the MAS [Sydney Memory and Ageing Study], n = 1,037). Outcome measures were memory and global cognition (by neuropsychological testing every 2 years) and total brain, hippocampal and parahippocampal volumes (by magnetic resonance) in a subgroup (n = 526). Analyses applied linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. Interactions were sought between statin use and dementia risk factors.
RESULTS
Over 6 years there was no difference in the rate of decline in memory or global cognition between statin users and never users. Statin initiation during the observation period was associated with blunting the rate of memory decline. Exploratory analyses found statin use was associated with attenuated decline in specific memory test performance in participants with heart disease and apolipoprotein Eε4 carriage. There was no difference in brain volume changes between statin users and never users.
CONCLUSIONS
In community-dwelling elderly Australians, statin therapy was not associated with any greater decline in memory or cognition over 6 years. These data are reassuring for consumers concerned about statin use and risk of memory decline.
DOI: 10.1016/j.jacc.2019.09.041
توضیحات مهم:
✅ این مطالعه مشاهده ای آینده نگر ، نتایج شناختی و مغزی در 1037 سالمند ساکن جامعه استرالیا (سنین 70-90 ساله) طی یک دوره 6 ساله با توجه به قرار گرفتن در معرض استاتین مقایسه کرده است.
✔️ افراد شرکت کننده در این مطالعه شامل 395 نفر بودند که هرگز از استاتین (never users) استفاده نکرده بودند و 642 نفر در برخی موارد از استاتین استفاده کرده بودند (ever users).
✔️ همه شرکت کنندگان هر 2 سال یکبار تحت آزمایش neuropsychological قرار گرفتند ، و 526 نیز تحت ارزیابی MRI قرار گرفتند تا حجم مغز ، هیپوکامپ و پاراهیپوکامپ را ارزیابی کنند.
✔️ هیچ مدرکی مبنی بر تفاوت در میزان کاهش شناخت گلوبال یا حافظه بین گروه های never user و ever user مشاهده نشد.
✔️ در مقایسه با never user ها ، در 99 شرکت کننده که در طول مطالعه شروع به درمان استاتین کردند ، میزان کاهش حافظه ضعیف بود ، اما در شناخت global هیچ تفاوتی نداشتند.
✔️ تغییرات حجم مغز بین گروهها مشابه بود.
✔️✔️ با اینکه این مطالعه دارای محدودیت از نظر حجم نمونه و مشاهده ای بودن می باشد، اما به بیماران سالمند تا حدودی اطمینان خاطر می دهد که نگران اثرات #استاتین روی شناخت نباشند.
🔎 @Meditorha