44 results on '"Angela J. Woodiwiss"'
Search Results
2. Proximal aortic stiffness modifies the relationship between heart rate and backward wave and hence central arterial pulse pressure
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Nonhlanhla Mthembu, Vernice R. Peterson, Gavin R. Norton, Eitzaz Sadiq, Andrea Kolkenbeck-Ruh, Ravi Naran, Suraj M. Yusuf, Grace Tade, Hamza Bello, Adamu Bamaiyi, Carlos D. Libhaber, Patrick Dessein, Ferande Peters, Taalib Monareng, Talib Abdool-Carrim, Ismail Cassimjee, Pinhas Sareli, Girish Modi, and Angela J. Woodiwiss
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heart rate ,aortic pressure ,flow ,forward waves ,backward waves ,age ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AimsA lower heart rate (HR) increases central blood pressure through enhanced backward wave pressures (Pb). We aimed to determine whether these relationships are modified by increases in aortic stiffness.MethodsUsing non-invasive central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we assessed the impact of aortic stiffness on relationships between HR and arterial wave morphology in 603 community participants < 60 years of age, 221 ≥ 60 years, and in 287 participants with arterial events [stroke and critical limb ischemia (CLI)].ResultsAs compared to community participants < 60 years, those ≥ 60 years or with events had increased multivariate adjusted proximal aortic characteristic impedance (Zc) and carotid femoral pulse wave velocity (PWV) (p < 0.05 to < 0.0001). Community participants ≥ 60 years and those with events also had a greater slope of the inverse relationship between HR and Pb (p < 0.001 for comparison). While in community participants < 60 years, no interaction between indexes of aortic stiffness and HR occurred, in those ≥ 60 years (p < 0.02) and in those with arterial events (p = 0.001), beyond aortic root diameter, an interaction between Zc and HR, but not between PWV and HR independently associated with Pb. This translated into stepwise increases in the slope of HR-Pb relationships at incremental tertiles of Zc. Although HR was inversely associated with the systemic reflection coefficient in community participants ≥ 60 years (p < 0.0001), adjustments for the reflection coefficient failed to modify HR-Pb relations.ConclusionBeyond the impact on systemic wave reflection, increases in proximal aortic stiffness enhance the adverse effects of HR on Pb and hence central BP.
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- 2022
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3. Associations between circulating resistin concentrations and left ventricular mass are not accounted for by effects on aortic stiffness or renal dysfunction
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Glenda Norman, Gavin R. Norton, Vernice Peterson, Monica Gomes, Carlos D. Libhaber, Pinhas Sareli, and Angela J. Woodiwiss
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Obesity ,Inappropriate left ventricular mass ,Resistin ,Aortic stiffness ,Renal function ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Although, in-part through an impact on left ventricular mass (LVM), resistin (an adipokine) may contribute to heart failure, whether this is explained by the adverse effects of resistin on aortic stiffness and renal function is unknown. Methods Relationships between circulating resistin concentrations and LVM index (LVMI), and LVM beyond that predicted by stroke work (inappropriate LVM [LVMinappr]) (echocardiography) were determined in 647 randomly selected community participants, and in regression analysis, the extent to which these relations could be explained by aortic pulse wave velocity (PWV) or estimated glomerular filtration rate (eGFR) was evaluated. Results Independent of confounders, resistin concentrations were independently associated with LVMI, LVMinappr, LV hypertrophy (LVH), PWV and eGFR. Furthermore, independent of confounders, LVMI, LVMinappr and LVH were independently associated with PWV and eGFR. However, adjustments for either PWV or eGFR failed to modify the relationships between resistin concentrations and LVMI, LVMinappr or LVH. Moreover, in multivariate regression analysis neither PWV nor eGFR significantly modified the contribution of resistin to LVMinappr or LVMI. Conclusions Independent relationships between circulating concentrations of the adipocytokine resistin and LVM are not explained by the impact of resistin on ventricular-vascular coupling or renal dysfunction. Resistin’s effects on LVM are therefore likely to be through direct actions on the myocardium.
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- 2020
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4. Cardiovascular Risk Factor Profiles and Disease in Black Compared to Other Africans with Chronic Kidney Disease
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Hon-Chun Hsu, Chanel Robinson, Angela J. Woodiwiss, Gavin R. Norton, and Patrick H. Dessein
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background and Objectives. The extent to which chronic kidney disease (CKD) impacts cardiovascular disease (CVD) in black Africans is uncertain. We compared cardiovascular risk factors and CVD between black and other African CKD patients. Methods. Cardiovascular risk factors, aortic and cardiac function, atherosclerosis extent, and cardiovascular event rates were assessed in 115 consecutive predialysis (n = 67) and dialysis patients (n = 48) including 46 black and 69 other (32 Asian, 28 white, and 9 mixed race) participants. Data were analysed in multivariable regression models. Results. Overall, black compared to other African CKD patients had less frequent carotid artery plaque (OR (95% CI) = 0.38 (0.16–0.91)) despite an increased cardiovascular risk factor burden. In receiver operator characteristic curve analysis, the Framingham score performed well in identifying non-black but not black CKD patients with carotid plaque (area under the curve (AUC) (95% CI) = 0.818 (0.714–0.921) and AUC (95% CI) = 0.556 (0.375–0.921), respectively). Black compared to other African predialysis patients experienced larger Framingham scores and more adverse nontraditional cardiovascular risk factors, impaired arterial and diastolic function but similar cardiovascular event rates (OR (95% CI) = 0.93 (0.22 to 3.87)). Among dialysis patients, black compared to other Africans had an overall similar traditional and nontraditional cardiovascular risk factor burden, similar arterial and diastolic function but increased systolic function (partial R = 0.356, p = 0.01 and partial R = 0.315, p = 0.03 for ejection fraction and stroke volume, respectively) and reduced cardiovascular event rates (OR (95% CI) = 0.22 (0.05 to 0.88)). Conclusion. Black compared to other African CKD patients have less frequent very high risk atherosclerosis and experience weaker cardiovascular risk factor-atherosclerotic CVD relationships. These disparities may be due to differences in epidemiological health transition stages. Among dialysis patients, black compared to other Africans have less cardiovascular events, which may represent a selection bias as previously documented in black Americans.
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- 2021
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5. The relationship between the nitric oxide synthase gene and the risk of hypertension defined according to ambulatory blood pressures
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Geoffrey Candy, Danelle Badenhorst, Elena Libhaber, Pinhas Sareli, Gavin R. Norton, Richard Brooksbank, and Angela J. Woodiwiss
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nitric oxide ,hypertension ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although nitric oxide (NO) plays an important role in blood pressure (BP) control, whether variation of genes involved in regulating the synthesis of NO influences BP is uncertain. As the heritability of BP is stronger for ambulatory than it is for conventional BP, we assessed the independent association of the well described functional exon 7 Glu298Asp variant of the eNOS gene with the presence of hypertension in 511 randomly selected normotensive control participants and 503 hypertensives with a diagnosis of hypertension confirmed with 24-hour ambulatory BP profiles whilst off therapy. We also assessed the relationship between eNOS genotype and 24 hour ambulatory BP. Comparisons of genotype and allele frequencies indicated a lack of association of the exon 7 Glu298Asp gene variant with hypertension (Odds ratio of genotype predicting the presence of hypertension=0.97, confidence interval=0.70-1.30, p=0.92). However, patients with the Glu/Glu genotype of the Glu298Asp variant (n=424) had increased 24-hour systolic and diastolic blood pressures (152±1/97±1 mm Hg) in comparison to patients heterozygous for the Glu298Asp variant or homozygous for the 298Asp allele (n=79) (145±1/94±1 mm Hg, p‹0.005 for systolic BP and p‹0.001 for diastolic BP after multiple adjustments including age, gender, body mass index and the presence of diabetes mellitus). Differences in systolic and diastolic BP between genotype groups were noted during the day as well as at night. The association of eNOS genotype with ambulatory BP translated into an increased risk of more severe grades of hypertension in patients with the Glu/Glu genotype (grade II and III vs. grade I, Odds ratio=2.20, confidence interval=1.34-3.59, p‹0.0002). In conclusion, a functional gene variant (Glu298Asp) at the eNOS locus contributes ~1.4-2.5% to the variation in ambulatory blood pressure within hypertensives, but is not associated with the presence of hypertension in patients in whom the diagnosis has been confirmed by 24-hour ambulatory BP values. The relationship between eNOS genotype and 24-hour ambulatory BP and the severity of hypertension warrants further study.
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- 2017
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6. Impact of dietary-induced obesity on adrenergic-induced cardiomyocyte damage in rats
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Leanda Vengethasamy, Olebogeng H.I. Majane, Eugene F. du Toit, Gavin R. Norton, and Angela J. Woodiwiss
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obesity ,heart failure ,cardiomyocyte apoptosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although obesity is an independent risk factor for heart failure and even mild-to-moderate forms of obesity are associated with myocardial systolic dysfunction the mechanisms of the myocardial dysfunction have not been identified. We assessed whether dietary-induced obesity is associated with an increased sensitivity of the myocardium to ß-adrenergic-induced cardiomyocyte apoptosis or fibrosis. To induce obesity, rats were fed a diet that promotes an increased caloric intake. Adrenergic-induced cardiomyocyte apoptosis was determined by injecting rats for 5 days with isoproterenol (0.01 mg/kg/day for 3 days and 0.02 mg/kg/day for 2 days) and then studying the degree of cardiomyocyte damage using a TUNEL assay and assessing the pathological score. Five months of feeding rats a diet that promoted the development of an increased body weight (Control=481±4.3 g, Diet=550±7.8 g, p‹0.001) and visceral fat content (Control=19.6±0.8 g, Diet=33.0±1.2 g, p‹0.0001), did not alter baseline cardiomyocyte apoptosis. However, 5 days of ß-adrenergic activation resulted in an enhanced cardiomyocyte apoptosis in rats receiving the experimental diet as compared to rats receiving a normal diet (p‹0.01). No changes in the myocardial pathological score (fibrosis) were noted. The enhanced adrenergic-induced cardiomyocyte apoptosis in obese rats could not be explained by dietary-induced increases in baseline left ventricular internal diameters, decreases in systolic function (endocardial or midwall fractional shortening) or differences in the response of the heart to adrenergic-induced increases in inotropic or chronotropic function. In conclusion, the present study suggests that obesity may contribute to myocardial dysfunction by increasing the sensitivity of the myocardium to adrenergic-induced cardiomyocyte damage.
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- 2017
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7. Hypertension in Africa: Redressing the burden of cardiovascular disease using cost-effective nonpharmacological approaches
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Gavin R. Norton and Angela J. Woodiwiss
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hypertension ,cardiovascular disease ,africa ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Hypertension may affect approximately one fifth or more of all adult South Africans. Despite the considerable evidence derived from economically developed countries to indicate the extent to which hypertension contributes to cardiovascular disease (CVD), it is only more recently that data has emerged from the African continent to support a contention that hypertension is the principal risk factor for CVD in African populations and that CVD accounts for a major proportion of deaths in the elderly and in younger adults in rural Africa. Active engagement in the harsh realities of managing this complex clinical trait should therefore be foremost on the minds of the healthcare sector in Africa. In this regard there are unique challenges. In the present personal review we synthesise the evidence for or against the view that at a public health level, the answer to significantly reducing the burden of CVD produced by hypertension in African populations, may lie in something as simple as generating a healthier lifestyle. In this regard, we place recent evidence obtained from South African studies of the importance of modifiable cardiovascular risk factors related to hypertension, including salt intake and obesity, in the context of previously published evidence. We highlight the very recent and the first substantive evidence derived from an African community to show that salt intake indeed contributes to a significant portion of blood pressure (BP) variability in African populations, but this effect may be hidden because the impact is largely on central (aortic) rather than brachial BP. We also discuss the increasing evidence to show that in African populations, the adverse effects of the epidemic of obesity that faces emerging communities is likely to account for a substantial proportion of cardiovascular risk not through marked effects on brachial BP, but through indirect effects by promoting the adverse effects of BP on the heart. In the present review we therefore argue that despite limited absolute effects of salt intake and obesity on brachial BP, a marked benefit could be gained by the BP effects of salt restriction and body weight reduction in African communities.
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- 2017
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8. Limited contribution of insulin resistance and metabolic parameters to obesity-associated increases in ambulatory blood pressure in a black African community
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Adamu J. Bamaiyi, Gavin R. Norton, Glenda Norman, Olebogeng HI. Majane, Pinhas Sareli, and Angela J. Woodiwiss
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Obesity ,Ambulatory blood pressure ,Insulin resistance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n = 798) BP. In separate models, waist circumference (p
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- 2019
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9. The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis
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Lebogang Mokotedi, Sulé Gunter, Chanel Robinson, Gavin R. Norton, Angela J. Woodiwiss, Linda Tsang, Patrick H. Dessein, and Aletta M. E. Millen
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Diseases of the musculoskeletal system ,RC925-935 - Abstract
This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = -0.28±0.09, p=0.0002) and lateral e′ (standardised β (SE) = 0.26±0.09, p=0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = -0.16±0.08, p=0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p
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- 2017
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10. Adiponectin and Atherosclerosis in Rheumatoid Arthritis
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Patrick H. Dessein, Linda Tsang, Ahmed Solomon, Angela J. Woodiwiss, Aletta M. E. Millen, and Gavin R. Norton
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Pathology ,RB1-214 - Abstract
In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range) = 6.47 (1.23–34.54) versus 8.38 (0.82–85.30) ng/mL, P=0.02, resp.); both total and high molecular weight (HMW) adiponectin concentrations were larger in patients with compared to those without joint deformities (7.97 (0.82–85.30) and 3.51 (0.01–35.40) versus 5.36 (1.29–19.49) and 2.34 (0.01–19.49) ng/mL, P=0.003 and 0.02, resp.). Total and HMW adiponectin concentrations were associated with carotid artery plaque in patients with MetS waist (odds ratio (95% CI) = 0.87 (0.76–0.99) and 0.92 (0.85–0.99) per 1-standard deviation increment, P=0.02 for both) and those without joint deformities (odds ratio (95% CI) = 0.94 (0.88–0.99) and 0.94 (0.89–0.99), P=0.03 for both). Plaque prevalence was lower in patients without compared to those with joint deformities (23.4% versus 42.6, P=0.004 in multivariable analysis). In RA patients with abdominal obesity or no clinically evident joint damage, adiponectin concentrations are reduced but nevertheless associated with decreased carotid atherosclerosis.
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- 2014
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11. Rheumatoid Arthritis Impacts on the Independent Relationships between Circulating Adiponectin Concentrations and Cardiovascular Metabolic Risk
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Patrick H. Dessein, Gavin R. Norton, Margaret Badenhorst, Angela J. Woodiwiss, and Ahmed Solomon
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Pathology ,RB1-214 - Abstract
Adiponectin and leptin are likely involved in the pathophysiology of rheumatoid arthritis (RA) and therefore potential new therapeutic targets. Adiponectin inhibition could be expected to enhance cardiovascular metabolic risk. However, it is unknown whether RA changes the influence of adipokines on cardiovascular metabolic risk. We determined whether RA impacts on the independent relationships of circulating leptin and adiponectin concentrations with cardiovascular risk factors and carotid intima-media thickness (cIMT) in 277 black African subjects from a developing population; 119 had RA. RA impacted on the relationships of adiponectin concentrations with lipid concentrations and blood pressure, independent of confounders including adiposity (interaction P
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- 2013
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12. Marked Independent Relationship between Circulating Interleukin-6 Concentrations and Endothelial Activation in Rheumatoid Arthritis
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Patrick H. Dessein, Ahmed Solomon, Angela J. Woodiwiss, Gavin R. Norton, Linda Tsang, and Miguel A. Gonzalez-Gay
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Pathology ,RB1-214 - Abstract
We examined the potential impact of conventional compared with nonconventional cardiovascular risk factors including interleukin-6 levels on endothelial activation in RA. Circulating soluble E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, and monocyte chemoattractant protein-1 concentrations were measured in 217 African patients (112 black and 105 white) with RA. In comprehensive confounder adjusted mixed regression models, 5 conventional and 4 nonconventional cardiovascular risk factors were associated (P=0.05 to
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- 2013
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13. Uric Acid, Ferritin, Albumin, Parathyroid Hormone and Gamma-Glutamyl Transferase Concentrations are Associated with Uremic Cardiomyopathy Characteristics in Non-Dialysis and Dialysis Chronic Kidney Disease Patients
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Grace Tade, Hon-Chun Hsu, Angela J Woodiwiss, Ferande Peters, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Ahmed Solomon, Gavin R Norton, and Patrick H Dessein
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Nephrology ,International Journal of Nephrology and Renovascular Disease - Abstract
Grace Tade,1,* Hon-Chun Hsu,1,2,* Angela J Woodiwiss,1 Ferande Peters,1 Chanel Robinson,1 Noluntu Dlongolo,3 Gloria Teckie,4 Ahmed Solomon,5 Gavin R Norton,1 Patrick H Dessein1,5,6 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Nephrology Unit, Milpark Hospital, Johannesburg, South Africa; 3Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa; 4Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 5Rheumatology Department, University of the Witwatersrand, Johannesburg, South Africa; 6Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa*These authors contributed equally to this workCorrespondence: Patrick H Dessein, Departments of Medicine, Rheumatology and Physiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannnesburg, 2193, South Africa, Tel +27 662491468, Email patrick.dessein22@gmail.comIntroduction: Circulating uric acid, ferritin, albumin, intact parathyroid hormone and gamma-glutamyl transferase each participate in biochemical reactions that reduce or/and enhance oxidative stress, which is considered the final common pathway through which pathophysiological mechanisms cause uremic cardiomyopathy. We hypothesized that the respective biomarkers may be involved in the development of uremic cardiomyopathy characteristics and can be useful in their identification among chronic kidney disease patients.Methods: We assessed traditional and non-traditional cardiovascular risk factors including biomarker concentrations and determined central systolic blood pressure using SphygmoCor software and cardiac structure and function by echocardiography in 109 (64 non-dialysis and 45 dialysis) patients. Associations were evaluated in multivariate regression models and receiver operator characteristic (ROC) curve analysis.Results: Each biomarker concentration was associated with left ventricular mass beyond stroke work and/or inappropriate left ventricular mass in all, non-dialysis and/or dialysis patients. Ferritin, albumin and gamma-glutamyl transferase levels were additionally associated with E/eâ in all, non-dialysis and/or dialysis patients. Dialysis status influenced the relationship of uric acid concentrations with inappropriate left ventricular mass and those of gamma-glutamyl transferase levels with left ventricular mass and inappropriate left ventricular mass. In stratified analysis, low uric acid levels were related to inappropriate left ventricular mass in dialysis but not non-dialysis patients (interaction p=0.001) whereas gamma-glutamyl transferase concentrations were associated with left ventricular mass and inappropriate left ventricular mass in non-dialysis but not dialysis patients (interaction p=0.020 to 0.036). In ROC curve analysis, uric acid (area under the curve (AUC)=0.877), ferritin (AUC=0.703) and albumin (AUC=0.728) concentrations effectively discriminated between dialysis patients with and without inappropriate left ventricular hypertrophy, left ventricular hypertrophy, and increased E/e,â respectively.Conclusion: Uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase were associated with uremic cardiomyopathy characteristics and could be useful in their identification. Our findings merit validation in future longitudinal studies.Keywords: uremic cardiomyopathy, uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase
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- 2022
14. The International Database of Central Arterial Properties for Risk Stratification: Research Objectives and Baseline Characteristics of Participants
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Jessica Barochiner, José Boggia, Antti Jula, Jan Filipovský, Yan Li, Zhenyu Zhang, Kalina Kawecka-Jaszcz, Augustine N. Odili, Jesus D. Melgarejo, Dong-Mei Wei, Natasza Gilis-Malinowska, Chang-Sheng Sheng, Gavin R. Norton, Edoardo Casiglia, Aletta E. Schutte, Qi-Fang Huang, Lucas S Aparicio, Angela J. Woodiwiss, Teemu J. Niiranen, Krzysztof Narkiewicz, Wen-Yi Yang, Lutgar de Thijs, Valérie Tikhonoff, Jan A. Staessen, Ji-Guang Wang, Katarzyna Stolarz-Skrzypek, Daniel Ackermann, Fang-Fei Wei, Murielle Bochud, International Database of Central Arterial Properties for Risk Stratification (IDCARS) Investigators, Aparicio, L.S., Barochiner, J., Wei, D.M., Melgarejo, J.D., Thijs, L., Staessen, J.A., Wei, F.F., Yang, W.Y., Zhang, Z.Y., An, D.W., Cheng, Y.B., Guo, Q.H., Huang, J.F., Huang, Q.F., Li, Y., Sheng, C.S., Wang, J.G., Filipovský, J., Seidlerová, J., Juhanoja, E.P., Jula, A.M., Lindroos, A.S., Niiranen, T.J., Sivén, S.S., Casiglia, E., Pizzioli, A., Tikhonoff, V., Chori, B.S., Danladi, B., Odili, A.N., Oshaju, H., Kucharska, W., Kunicka, K., Gilis-Malinowska, N., Narkiewicz, K., Sakiewicz, W., Swierblewska, E., Kawecka-Jaszcz, K., Stolarz-Skrzypek, K., Rajzer, M., Mels, C., Kruger, R., Mokwatsi, G., Schutte, A.E., Norton, G.R., Woodiwiss, A.J., Ackermann, D., Bochud, M., Ehret, G., Álvarez-Vaz, R., Américo, C., Baccino, C., Borgarello, L., Florio, L., Moliterno, P., Noboa, A., Noboa, O., Olascoaga, A., Parnizari, P., and Pécora, M.
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Male ,Ajhype/Ajh-08 ,medicine.medical_specialty ,Percentile ,cardiovascular outcome ,hypertension ,Epidemiology ,Original Contributions ,pulse wave velocity ,central blood pressure ,Hemodynamics ,Disease ,030204 cardiovascular system & hematology ,hemodynamics ,Cardiovascular outcome ,pulse wave analysis ,blood pressure ,03 medical and health sciences ,0302 clinical medicine ,International database ,Diabetes mellitus ,Internal Medicine ,Medicine ,Humans ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,610 Medicine & health ,Pulse wave velocity ,business.industry ,Middle Aged ,medicine.disease ,3. Good health ,Blood pressure ,Cross-Sectional Studies ,Cardiovascular Diseases ,Emergency medicine ,AcademicSubjects/SCI00960 ,Female ,business ,Cohort study - Abstract
OBJECTIVE To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th–95th percentile interval, 1.3–12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension., Graphical Abstract Graphical Abstract
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- 2022
15. Associations between circulating resistin concentrations and left ventricular mass are not accounted for by effects on aortic stiffness or renal dysfunction
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Carlos D. Libhaber, Pinhas Sareli, Vernice R. Peterson, Glenda Norman, Angela J. Woodiwiss, Gavin R. Norton, and Monica Gomes
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,endocrine system diseases ,030204 cardiovascular system & hematology ,Kidney ,Ventricular Function, Left ,0302 clinical medicine ,Risk Factors ,Resistin ,Pulse wave velocity ,0303 health sciences ,Ventricular Remodeling ,Confounding ,Aortic stiffness ,Middle Aged ,Inappropriate left ventricular mass ,Echocardiography ,Cardiology ,cardiovascular system ,Female ,Hypertrophy, Left Ventricular ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,hormones, hormone substitutes, and hormone antagonists ,Glomerular Filtration Rate ,Research Article ,Adult ,medicine.medical_specialty ,Adipokine ,Renal function ,Pulse Wave Analysis ,Risk Assessment ,03 medical and health sciences ,Vascular Stiffness ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Obesity ,030304 developmental biology ,Angiology ,business.industry ,nutritional and metabolic diseases ,medicine.disease ,Cross-Sectional Studies ,lcsh:RC666-701 ,Heart failure ,business ,Biomarkers - Abstract
Background Although, in-part through an impact on left ventricular mass (LVM), resistin (an adipokine) may contribute to heart failure, whether this is explained by the adverse effects of resistin on aortic stiffness and renal function is unknown. Methods Relationships between circulating resistin concentrations and LVM index (LVMI), and LVM beyond that predicted by stroke work (inappropriate LVM [LVMinappr]) (echocardiography) were determined in 647 randomly selected community participants, and in regression analysis, the extent to which these relations could be explained by aortic pulse wave velocity (PWV) or estimated glomerular filtration rate (eGFR) was evaluated. Results Independent of confounders, resistin concentrations were independently associated with LVMI, LVMinappr, LV hypertrophy (LVH), PWV and eGFR. Furthermore, independent of confounders, LVMI, LVMinappr and LVH were independently associated with PWV and eGFR. However, adjustments for either PWV or eGFR failed to modify the relationships between resistin concentrations and LVMI, LVMinappr or LVH. Moreover, in multivariate regression analysis neither PWV nor eGFR significantly modified the contribution of resistin to LVMinappr or LVMI. Conclusions Independent relationships between circulating concentrations of the adipocytokine resistin and LVM are not explained by the impact of resistin on ventricular-vascular coupling or renal dysfunction. Resistin’s effects on LVM are therefore likely to be through direct actions on the myocardium.
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- 2020
16. May Measurement Month 2019: The Global Blood Pressure Screening Campaign of the International Society of Hypertension
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Beaney, Thomas, Schutte, Aletta E, Stergiou, George S, Borghi, Claudio, Burger, Dylan, Charchar, Fadi, Cro, Suzie, Diaz, Alejandro, Damasceno, Albertino, Espeche, Walter, Jose, Arun Pulikkottil, Khan, Nadia, Kokubo, Yoshihiro, Maheshwari, Anuj, Marin, Marcos J, More, Arun, Neupane, Dinesh, Nilsson, Peter, Patil, Mansi, Prabhakaran, Dorairaj, Ramirez, Agustin, Rodriguez, Pablo, Schlaich, Markus, Steckelings, Ulrike M, Tomaszewski, Maciej, Unger, Thomas, Wainford, Richard, Wang, Jiguang, Williams, Bryan, Poulter, Neil R, Michael H Olsen, Kristin T West-Gustave, Phillip D Levy, Vivian W. Y. Lee, Kenneth L Connell, Naima N. H. Hammoudi, Pascal Bovet, Bharathi Viswanathan, Sabine Perl, Bernard K Kramer, Adrian J. B. Brady, Olulola O Oladapo, Jephat Chifamba, Dejuma Y Goshu, Desalew M Kassie, Sintayehu A Gebru, Toure A Ibrahim, Soumana Kabirou, Elham Tavassoli, Mahsa Zolfaghari, Vahideh Yavari, Larysa Mishchenko, Olena Matova, Tetiana Kolenyk, Liliiya Zelenenka, Sergiy Fedorov, Maria Dorobantu, Alexandra Paval, Jesse Bittman, Biri Mangat, Sarah Melville, Alexander Leung, Neusa Jessen, Eamon Dolan, Hiroshi N. A. Itoh, Atul Pathak, Tine L. M. De Backer, Arman S Postadzhiyan, Osiris V Valoy-Tiburcio, Angel R Gonzalez-Medina, Laura G Valdez-Valoy, Fernando S Wyss, Erkin Mirrakhimov, Sunil K Nadar, Ana I Barrientos, Chukwuemeka R Nwokocha, Magdalene I Nwokocha, Dean Picone, Jun Yang, Yook C Chia, Siew M Ching, Bertrand F Ellenga Mbolla, Christian M Kouala Landa, Corine Y Houehanou, Kolawole W Wahab, Ayodele B Omotoso, Jose Ortellado, Graciela Gonzales, Luis M Ruilope, Enrique Rodilla, Ana Molinero, Angela J Woodiwiss, Ane Orchard, Ruan Kruger, Jana Brguljan, Nina Bozic, Aleksandra O Konradi, Oxana P Rotar, Irian Chazova, Tiny K Masupe, John T Tlhakanelo, Keneilwe Motlhatlhedi, George Stergiou, Michalis Doumas, Pantelis Zebekakis, Francesco P Cappuccio, Carolina Barciela, Tricia Tay, Naranjargal Dashdorj, Khulan Tuvdendarjaa, Khatantuul Boldbaatar, Fernando T Lanas, Melanie Paccot, Mohammed Ishaq, Saulat Sidique, Feroz Memon, Robert N Najem, Ali K Abu Alfa, Samir M. J. Mallat, Jacek J Jozwiak, Maciej Banach, Piotr Janowski, Betty Twumasi-Ankrah, Gustavus A Myers-Hansen, Elliot K Tannor, Marisa F Neto, Sudhirsen Kowlessur, Bhooshun Ori, Jaysing Heecharan, Hatem A Fageh, Hawa A Derbi, Omara M Msalam, Fastone M Goma, Charity Syatalimi, Penias Jr Tembo, Musawa Mukupa, Henry L Ndhlovu, Maureen L Chirwa, Mary M Mbeba, Parounak H Zelveian, Zoya N Hakobyan, Svetlana Gourgenyan, Myeong-Chan Cho, Hae-Young Lee, Jinho Shin, Gianfranco Parati, Guido Grassi, Claudio Ferri, Bezhan Tsinamdzgvrishvili, Amiran Gamkrelidze, Dali Trapaidze, Eduardo C. D. Barbosa, Weimar S Barroso, Audes M Feitosa, Vanda M Azevedo, Luis A Dias, Glenda N Garcia, Isaulina Delgado, Genc Burazeri, Gentiana Qirjako, Alban Ylli, Rudina Cumashi, Antonieta P Costantini-Olmos, Igor Morr, Elias Chuki, Tzung-Dau Wang, Wen-Jone Chen, Hung-Ju Lin, Fazila-Tun-Nesa Malik, Sohel R Choudhury, Mohammad Abdullah Al Mamun, Mir Ishraquzzaman, Ghadeer S Aljuraiban, Fatima Y Al Slail, Shatha K Aldhwailea, Ann A Badawi, Nguyen L Viet, Hoang A Tien, Nguyen T. A. Dong, Cao T Sinh, Huynh V Minh, Tran K Son, Fortunat K Katamba, Nathan B Buila, Anastase Dzudie, Samuel Kingue, Njume Epie, Armel Njomou, Marie S Ndom, Afzalhussein M Yusufali, Nooshin M Bazargani, Buthaina A. Bin Belaila, Amrish Agrawal, Aisha M Suhail, Elijah N Ogola, Bernard M Gitura, Lilian Mbau, Hellen K Nguchu, Felix A Barasa, Enrique Gomez, Luis A Alcocer, Martin Rosas, Silvia Palomo, Alfredo J Estrada, Patricio Lopez-Jaramillo, Gregorio Sanchez-Vallejo, Maria E Casanova, Edgar Arcos, Gustavo Aroca, Bhagawan Koirala, Harikrishna Bhattarai, Ghanashyam Pandey, Surya Devkota, Sweta Koirala, Kamal Ranabhat, Pratik Khanal, Tara B Adhikari, Dolores D Bonzon, Deborah Ignacia D Ona, Leilani M Asis, Benjamin A Balmores Jr, Rafael C Castillo, Diego J Stisman, Walter G Espeche, Marcos J Marin, Irene L Ennis, Xin Chen, Hongyu Wang, Min Liu, Xinhua Yin, Xiaolong Wang, Sandeep Bhalla, Priyanka Gupta, Narsingh Verma, Bal K Gupta, Shehla Sheikh, Gregoire Wuerzner, Laura Garré, José Boggia, Dédonougbo M Houenassi, José A OctavioSeijas, Jean-René M'buyamba-Kabangu, Trésor M Tshiswaka, Dénes Páll, Zoltán Járai, Rafael Hernández, Fortunato Garcia Vásquez, Jesús A Lopez-Rivera, Monica L Gúzman-Franolic, Savarino Victoria Pereira, Mário J Fernandes, Maria S Garcia, Teresa Gijon, Vitoria V. B. Meira Da Cunha, Beaney T, Schutte AE, Stergiou GS, Borghi C, Burger D, Charchar F, Cro S, Diaz A, Damasceno A, Espeche W, Jose AP, Khan N, Kokubo Y, Maheshwari A, Marin MJ, More A, Neupane D, Nilsson P, Patil M, Prabhakaran D, Ramirez A, Rodriguez P, Schlaich M, Steckelings UM, Tomaszewski M, Unger T, Wainford R, Wang J, Williams B, Poulter NR, Thomas, B, Aletta E, S, George S, S, Claudio, B, Dylan, B, Fadi, C, Suzie, C, Alejandro, D, Albertino, D, Walter, E, Arun Pulikkottil, J, Nadia, K, Yoshihiro, K, Anuj, M, Marcos J, M, Arun, M, Dinesh, N, Peter, N, Mansi, P, Dorairaj, P, Agustin, R, Pablo, R, Markus, S, Ulrike M, S, Maciej, T, Thomas, U, Richard, W, Jiguang, W, Bryan, W, Neil R, P, H Olsen, M, T West-Gustave, K, D Levy, P, Lee, V, L Connell, K, Hammoudi, N, Bovet, P, Viswanathan, B, Perl, S, K Kramer, B, Brady, A, O Oladapo, O, Chifamba, J, Y Goshu, D, M Kassie, D, A Gebru, S, A Ibrahim, T, Kabirou, S, Tavassoli, E, Zolfaghari, M, Yavari, V, Mishchenko, L, Matova, O, Kolenyk, T, Zelenenka, L, Fedorov, S, Dorobantu, M, Paval, A, Bittman, J, Mangat, B, Melville, S, Leung, A, Jessen, N, Dolan, E, Itoh, H, Pathak, A, De Backer, T, S Postadzhiyan, A, V Valoy-Tiburcio, O, R Gonzalez-Medina, A, G Valdez-Valoy, L, S Wyss, F, Mirrakhimov, E, K Nadar, S, I Barrientos, A, R Nwokocha, C, I Nwokocha, M, Picone, D, Yang, J, C Chia, Y, M Ching, S, F Ellenga Mbolla, B, M Kouala Landa, C, Y Houehanou, C, W Wahab, K, B Omotoso, A, Ortellado, J, Gonzales, G, M Ruilope, L, Rodilla, E, Molinero, A, J Woodiwiss, A, Orchard, A, Kruger, R, Brguljan, J, Bozic, N, O Konradi, A, P Rotar, O, Chazova, I, K Masupe, T, T Tlhakanelo, J, Motlhatlhedi, K, Stergiou, G, Doumas, M, Zebekakis, P, P Cappuccio, F, Barciela, C, Tay, T, Dashdorj, N, Tuvdendarjaa, K, Boldbaatar, K, T Lanas, F, Paccot, M, Ishaq, M, Sidique, S, Memon, F, N Najem, R, K Abu Alfa, A, Mallat, S, J Jozwiak, J, Banach, M, Janowski, P, Twumasi-Ankrah, B, A Myers-Hansen, G, K Tannor, E, F Neto, M, Kowlessur, S, Ori, B, Heecharan, J, A Fageh, H, A Derbi, H, M Msalam, O, M Goma, F, Syatalimi, C, Jr Tembo, P, Mukupa, M, L Ndhlovu, H, L Chirwa, M, M Mbeba, M, H Zelveian, P, N Hakobyan, Z, Gourgenyan, S, Cho, M, Lee, H, Shin, J, Parati, G, Grassi, G, Ferri, C, Tsinamdzgvrishvili, B, Gamkrelidze, A, Trapaidze, D, Barbosa, E, S Barroso, W, M Feitosa, A, M Azevedo, V, A Dias, L, N Garcia, G, Delgado, I, Burazeri, G, Qirjako, G, Ylli, A, Cumashi, R, P Costantini-Olmos, A, Morr, I, Chuki, E, Wang, T, Chen, W, Lin, H, Malik, F, R Choudhury, S, Abdullah Al Mamun, M, Ishraquzzaman, M, S Aljuraiban, G, Y Al Slail, F, K Aldhwailea, S, A Badawi, A, L Viet, N, A Tien, H, Dong, N, T Sinh, C, V Minh, H, K Son, T, K Katamba, F, B Buila, N, Dzudie, A, Kingue, S, Epie, N, Njomou, A, S Ndom, M, M Yusufali, A, M Bazargani, N, Bin Belaila, B, Agrawal, A, M Suhail, A, N Ogola, E, M Gitura, B, Mbau, L, K Nguchu, H, A Barasa, F, Gomez, E, A Alcocer, L, Rosas, M, Palomo, S, J Estrada, A, Lopez-Jaramillo, P, Sanchez-Vallejo, G, E Casanova, M, Arcos, E, Aroca, G, Koirala, B, Bhattarai, H, Pandey, G, Devkota, S, Koirala, S, Ranabhat, K, Khanal, P, B Adhikari, T, D Bonzon, D, D Ona, D, M Asis, L, A Balmores Jr, B, C Castillo, R, J Stisman, D, G Espeche, W, J Marin, M, L Ennis, I, Chen, X, Wang, H, Liu, M, Yin, X, Wang, X, Bhalla, S, Gupta, P, Verma, N, K Gupta, B, Sheikh, S, Wuerzner, G, Garré, L, Boggia, J, M Houenassi, D, A OctavioSeijas, J, M'buyamba-Kabangu, J, M Tshiswaka, T, Páll, D, Járai, Z, Hernández, R, Garcia Vásquez, F, A Lopez-Rivera, J, L Gúzman-Franolic, M, Victoria Pereira, S, J Fernandes, M, S Garcia, M, Gijon, T, Meira Da Cunha, V, and RS: CARIM other
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Male ,Population level ,Comorbidity ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Prevalence ,adults ,Medicine ,Mass Screening ,awareness ,030212 general & internal medicine ,1102 Cardiorespiratory Medicine and Haematology ,Aged, 80 and over ,Aspirin ,treatment ,adults, awareness, blood pressure, hypertension, risk factor, screening, treatment ,blood pressure ,Middle Aged ,Lifestyle factors ,risk factor ,Female ,Life Sciences & Biomedicine ,medicine.drug ,Adult ,medicine.medical_specialty ,hypertension ,Adolescent ,awarene ,Opportunistic Sampling ,Elevated blood ,1117 Public Health and Health Services ,03 medical and health sciences ,Young Adult ,Internal Medicine ,Humans ,Risk factor ,Antihypertensive Agents ,Aged ,Science & Technology ,business.industry ,screening ,Blood Pressure Determination ,1103 Clinical Sciences ,Mean blood pressure ,Blood pressure ,Peripheral Vascular Disease ,Cardiovascular System & Hematology ,Emergency medicine ,Cardiovascular System & Cardiology ,business ,MMM Investigators - Abstract
Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to
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- 2020
17. Associations of inflammatory markers with impaired left ventricular diastolic and systolic function in collagen-induced arthritis
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Monica Gomes, Aletta M.E. Millen, Lebogang Mokotedi, Frederic S. Michel, Angela J. Woodiwiss, Conrad Mogane, and Gavin R. Norton
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Male ,Physiology ,Interleukin-1beta ,Hemodynamics ,Arthritis ,Blood Pressure ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Systemic inflammation ,Biochemistry ,Vascular Medicine ,Ventricular Function, Left ,Rats, Sprague-Dawley ,0302 clinical medicine ,Immune Physiology ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Immune Response ,Innate Immune System ,Multidisciplinary ,Ejection fraction ,Physics ,Classical Mechanics ,Deformation ,C-Reactive Protein ,Physical Sciences ,Cardiology ,Cytokines ,Collagen ,medicine.symptom ,Research Article ,medicine.medical_specialty ,Science ,Immunology ,Diastole ,Rheumatoid Arthritis ,Inflammation ,Autoimmune Diseases ,03 medical and health sciences ,Signs and Symptoms ,Rheumatology ,Diagnostic Medicine ,Internal medicine ,Animals ,Collagen Type II ,Echocardiography, Doppler, Pulsed ,Damage Mechanics ,Tumor Necrosis Factor-alpha ,business.industry ,Myocardium ,Body Weight ,Biology and Life Sciences ,Proteins ,Molecular Development ,medicine.disease ,Arthritis, Experimental ,Rats ,Blood pressure ,Immune System ,Cattle ,Clinical Immunology ,Clinical Medicine ,business ,Collagens ,Biomarkers ,Developmental Biology ,Ejection Fraction - Abstract
Background High-grade inflammation may play a pivotal role in the pathogenesis of left ventricular (LV) dysfunction. Evidence to support a role of systemic inflammation in mediating impaired LV function in experimental models of rheumatoid arthritis (RA) remains limited. The aim of the present study was to determine the effects of high-grade systemic inflammation on LV diastolic and systolic function in collagen-induced arthritis (CIA). Methods To induce CIA, bovine type-II collagen emulsified in incomplete Freund’s adjuvant was injected at the base of the tail into 21 three-month old Sprague Dawley rats. Nine-weeks after the first immunisation, LV function was assessed by pulsed Doppler, tissue Doppler imaging and Speckle tracking echocardiography. Cardiac collagen content was determined by picrosirius red staining; circulating inflammatory markers were measured using ELISA. Results Compared to controls (n = 12), CIA rats had reduced myocardial relaxation as indexed by lateral e’ (early diastolic mitral annular velocity) and e’/a’ (early-to-late diastolic mitral annular velocity) and increased filling pressures as indexed by E/e’. No differences in ejection fraction and LV endocardial fractional shortening between the groups were recorded. LV global radial and circumferential strain and strain rate were reduced in CIA rats compared to controls. Higher concentrations of circulating inflammatory markers were associated with reduced lateral e’, e’/a’, radial and circumferential strain and strain rate. Greater collagen content was associated with increased concentrations of circulating inflammatory markers and E/e’. Conclusion High-grade inflammation is associated with impaired LV diastolic function and greater myocardial deformation independent of haemodynamic load in CIA rats.
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- 2020
18. Limited contribution of insulin resistance and metabolic parameters to obesity-associated increases in ambulatory blood pressure in a black African community
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Pinhas Sareli, Olebogeng H.I. Majane, Glenda Norman, Gavin R. Norton, Adamu J. Bamaiyi, and Angela J. Woodiwiss
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Ambulatory blood pressure ,Waist ,business.industry ,Diastole ,Insulin resistance ,medicine.disease ,Obesity ,Blood pressure ,lcsh:RC666-701 ,Internal medicine ,Ambulatory ,Internal Medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Abdominal obesity ,Research Paper - Abstract
Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n = 798) BP. In separate models, waist circumference (p
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- 2019
19. Disease severity impacts the relationship of apelin with arterial function in patients with rheumatoid arthritis
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Gavin R. Norton, Patrick H Dessein, Chanel Robinson, Aletta M.E. Millen, Sule Gunter, Linda Tsang, Angela J. Woodiwiss, and Clinical sciences
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Male ,rheumatoid arthritis ,medicine.medical_specialty ,Arterial function ,Wave reflection ,Blood Pressure ,030204 cardiovascular system & hematology ,Pulse Wave Analysis ,Severity of Illness Index ,Ventricular Function, Left ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Vascular Stiffness ,Rheumatology ,Internal medicine ,medicine ,Humans ,Pulse wave velocity ,Aged ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Pressure pulsatility ,medicine.disease ,Apelin ,Pulse pressure ,Blood pressure ,arterial stiffness ,Rheumatoid arthritis ,Erythrocyte sedimentation rate ,Arterial stiffness ,Cardiology ,Female ,business - Abstract
Apelin can improve arterial function by enhancing the expression of endothelial nitric oxide synthase but this effect depends markedly on endothelial integrity. We hypothesized that inflammation influences the potential impact of apelin on arterial function in rheumatoid arthritis (RA). We assessed the associations of apelin concentrations with arterial stiffness (pulse wave velocity), wave reflection (augmentation index, reflected wave pressure, and reflection magnitude), and pressure pulsatility (central systolic pressure (CSP), central pulse pressure (CPP), peripheral pulse pressure (PPP), pulse pressure amplification (PPamp), and forward wave pressure (Pf)) among 170 RA patients without cardiovascular disease. In multivariable regression models, apelin concentrations were not independently associated with arterial function measures (p ≥ 0.15) in all patients. Inflammation markers were not consistently associated with apelin levels but joint deformity counts, Disease Activity Score in 28 joints (DAS28), and erythrocyte sedimentation rate (ESR) impacted apelin-pressure pulsatility relations (interaction p ≤ 0.05). In stratified analysis, apelin was associated with CSP (partial r = − 0.33, p = 0.01), CPP (partial r = − 0.26, p = 0.04), PPamp (partial r = 0.27, p = 0.03), and Pf (partial r = − 0.33, p = 0.01) in patients without but not with joint deformities; apelin was related to CSP (partial r = − 0.24, p = 0.05) in those with a DAS28 joint
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- 2018
20. Cardiovascular Risk Factors and Disease Characteristics Are Consistently Associated with Arterial Function in Rheumatoid Arthritis
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Patrick H Dessein, Linda Tsang, Chanel Robinson, Angela J. Woodiwiss, Aletta M.E. Millen, Gavin R. Norton, Sule Gunter, and Rheumatology
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Adult ,Male ,medicine.medical_specialty ,Pulse Wave Analysis ,Immunology ,Hemodynamics ,Vascular Stiffness/physiology ,Blood Pressure ,Hemodynamics/physiology ,030204 cardiovascular system & hematology ,Arthritis, Rheumatoid ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Rheumatology ,Arthritis, Rheumatoid/complications ,Internal medicine ,Arteries/physiopathology ,medicine ,Immunology and Allergy ,Rheumatoid factor ,Humans ,risk factors ,Cardiovascular Diseases/etiology ,Pulse wave velocity ,Blood Pressure/physiology ,Body mass index ,Aged ,030203 arthritis & rheumatology ,business.industry ,Blood Flow Velocity/physiology ,Arteries ,Middle Aged ,medicine.disease ,Pulse pressure ,Surgery ,Reflection Magnitude ,Blood pressure ,Cardiovascular Diseases ,Arterial stiffness ,Cardiology ,Female ,business ,Blood Flow Velocity - Abstract
Objective.Arterial properties influence cardiovascular disease (CVD) risk. We identified potential determinants of arterial function in patients with rheumatoid arthritis (RA).Methods.Relationships of traditional cardiovascular risk factors and RA characteristics with arterial stiffness (pulse wave velocity), wave reflection (augmentation index, reflected wave pressure, and reflection magnitude), and pressure pulsatility (central systolic and pulse pressure, peripheral pulse pressure, pulse pressure amplification, and forward wave pressure) were identified in multivariable backward regression models among 177 patients without established CVD (118 white, 32 Asian, 22 black, 5 mixed ancestry).Results.Recorded characteristics explained 37% (pulse wave velocity) to 71% (reflected wave pressure) of the variability in arterial function. These factors were particularly associated with wave reflection and pressure pulsatility: RA duration (p = 0.04), rheumatoid factor status (p = 0.01 to 0.03), leukocyte counts (p = 0.02 to 0.05), and total cholesterol (p < 0.01 to 0.03). Body mass index (p < 0.01 to 0.02) and insulin resistance (p < 0.01 to 0.01) were related to reduced wave reflection and peripheral pulse pressure. Exercise (p = 0.02) and alcohol consumption (p < 0.01) were associated with increased pulse pressure amplification and decreased peripheral pulse pressure, respectively. Tumor necrosis factor-α inhibition (p < 0.01) was related to reduced pulse wave velocity, and tetracycline use (p = 0.02) to decreased peripheral pulse pressure.Conclusion.Traditional cardiovascular risk factors and disease characteristics are consistently associated with vascular hemodynamic alterations in RA. The relative effect of arterial stiffness, wave reflection, and pressure pulsatility on CVD risk in RA needs further study.
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- 2017
21. The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis
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Chanel Robinson, Angela J. Woodiwiss, Linda Tsang, Lebogang Mokotedi, Gavin R. Norton, Patrick H Dessein, Aletta M.E. Millen, Sule Gunter, and Clinical sciences
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rheumatoid arthritis ,medicine.medical_specialty ,Diastolic Dysfunction ,lcsh:Diseases of the musculoskeletal system ,Article Subject ,Immunology ,Cardiovascular risk factors ,Diastole ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Left atrial ,Internal medicine ,medicine ,Diastolic function ,030203 arthritis & rheumatology ,Medicine(all) ,Pulsed doppler ,business.industry ,medicine.disease ,Blood pressure ,Rheumatoid arthritis ,Cardiology ,lcsh:RC925-935 ,business ,Low diastolic blood pressure ,Research Article - Abstract
This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = -0.28±0.09, p=0.0002) and lateral e′ (standardised β (SE) = 0.26±0.09, p=0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = -0.16±0.08, p=0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p<0.0001). One SD increase in waist-hip ratio was associated with diastolic dysfunction when applying current criteria (OR = 2.61 (95% CI = 1.51–4.52), p=0.0006), whereas one SD increase in diastolic blood pressure was inversely related to diastolic dysfunction upon using previous criteria (OR = 0.57 (95% CI = 0.40–0.81), p=0.002). In conclusion, application of current and previous diastolic dysfunction criteria markedly alters the prevalence and risk factors associated with diastolic dysfunction in RA.
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- 2017
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22. Ethnic differences in proximal and distal tubular sodium reabsorption are heritable in black and white populations
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Robert C. Elston, Michel Burnier, Murielle Bochud, Angela J. Woodiwiss, Tatiana Kuznetsova, Marc Maillard, Gavin R. Norton, Muzi J. Mazeko, Lutgarde Thijs, Tom Richart, and Jan A. Staessen
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Adult ,Male ,medicine.medical_specialty ,Metabolic Clearance Rate ,Physiology ,Sodium ,Black People ,chemistry.chemical_element ,Nephron ,Lithium ,030204 cardiovascular system & hematology ,White People ,Article ,Absorption ,Nuclear Family ,Kidney Tubules, Proximal ,Excretion ,South Africa ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Belgium ,African Continental Ancestry Group/genetics ,Creatinine/blood ,Creatinine/pharmacokinetics ,European Continental Ancestry Group/genetics ,Female ,Genetics, Population ,Humans ,Kidney Tubules, Distal/physiology ,Kidney Tubules, Proximal/physiology ,Lithium/blood ,Lithium/pharmacokinetics ,Middle Aged ,Nephrons/drug effects ,Nephrons/physiology ,Nuclear Family/ethnology ,Sodium/blood ,Sodium/metabolism ,Internal medicine ,Internal Medicine ,Medicine ,Kidney Tubules, Distal ,Creatinine ,Renal sodium reabsorption ,business.industry ,Nephrons ,Amiloride ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Renal physiology ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Negroid ,medicine.drug - Abstract
BACKGROUND: Segmental handling of sodium along the proximal and distal nephron might be heritable and different between black and white participants. METHODS: We randomly recruited 95 nuclear families of black South African ancestry and 103 nuclear families of white Belgian ancestry. We measured the (FENa) and estimated the fractional renal sodium reabsorption in the proximal (RNaprox) and distal (RNadist) tubules from the clearances of endogenous lithium and creatinine. In multivariable analyses, we studied the relation of RNaprox and RNadist with FENa and estimated the heritability (h) of RNaprox and RNadist. RESULTS: Independent of urinary sodium excretion, South Africans (n = 240) had higher RNaprox (unadjusted median, 93.9% vs. 81.0%; P < 0.001) than Belgians (n = 737), but lower RNadist (91.2% vs. 95.1%; P < 0.001). The slope of RNaprox on FENa was steeper in Belgians than in South Africans (-5.40 +/- 0.58 vs. -0.78 +/- 0.58 units; P < 0.001), whereas the opposite was true for the slope of RNadist on FENa (-3.84 +/- 0.19 vs. -13.71 +/- 1.30 units; P < 0.001). h of RNaprox and RNadist was high and significant (P < 0.001) in both countries. h was higher in South Africans than in Belgians for RNaprox (0.82 vs. 0.56; P < 0.001), but was similar for RNadist (0.68 vs. 0.50; P = 0.17). Of the filtered sodium load, black participants reabsorb more than white participants in the proximal nephron and less postproximally. CONCLUSION: Segmental sodium reabsorption along the nephron is highly heritable, but the capacity for regulation in the proximal and postproximal tubules differs between whites and blacks.
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- 2009
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23. Intrafamilial Aggregation and Heritability of Left Ventricular Geometric Remodeling Is Independent of Cardiac Mass in Families of African Ancestry
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Olebogeng H.I. Majane, Michelle Redelinghuys, Angela J. Woodiwiss, Richard Brooksbank, Muzi J. Maseko, Gavin R. Norton, Carlos D. Libhaber, and Vernice R. Peterson
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Adult ,Male ,medicine.medical_specialty ,Megalencephalic leukoencephalopathy with subcortical cysts ,Heart Ventricles ,Diastole ,Black People ,Blood Pressure ,Left ventricular hypertrophy ,Coronary artery disease ,South Africa ,Framingham Heart Study ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Risk factor ,Retrospective Studies ,Ventricular Remodeling ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Surgery ,Echocardiography, Doppler, Color ,Pedigree ,Blood pressure ,Heart failure ,Cardiology ,Original Article ,Female ,Hypertrophy, Left Ventricular ,business ,Follow-Up Studies - Abstract
As acknowledged by all guidelines, left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular events independent of conventional risk factors and coronary artery disease. In addition, compared to a normal LV geometry, concentric LV remodeling (an increased relative wall thickness (RWT) without an increase in LV mass (LVM)) is associated with a worse prognosis.1–4 Although LVM rather than concentric LV remodeling predicts incident heart failure,3 concentric LV remodeling without LVH is associated with the development of diastolic dysfunction, and concentric rather than eccentric LVH is associated with greater increases in indices of LV filling pressures.5 Thus, the extent of concentric LV remodeling may determine whether progression from LVH to heart failure with a preserved rather than reduced systolic chamber function occurs. The factors that determine LV remodeling are therefore of considerable interest. Although the impact of age, sex, blood pressure, and obesity on LV geometric remodeling has been well described, there is nevertheless uncertainty as to the role of genetic factors independent of LVM, a major determinant of LV wall thickness, and a change that itself is well recognized as being inherited.6–14 Compared to age-, and sex-matched controls, siblings of those with LVH have a greater risk of concentric, but not eccentric LVH.9 However, in that study,9 whether siblings were also at risk for concentric LV remodeling is uncertain and hence LVM may have made a major contribution to the inheritance of concentric LVH. Moreover, in the Framingham Heart Study, the risk for concentric LV remodeling was only modestly increased in related compared to unrelated individuals, whereas the risk for concentric LVH was markedly augmented.15 Hence, again, LVM may have been the major determinant of the inheritance of LV remodeling. Although alternative studies indicate that RWT is indeed inherited,10–12,16 none of these studies reported on the inheritance of RWT independent of LVM. To address the aforementioned uncertainty as to the extent to which genetic factors contribute toward concentric LV remodeling beyond LVM, in the present study, we aimed to evaluate the intrafamilial aggregation and heritability of RWT independent of LVM and additional confounders. We hypothesized that RWT would show intrafamilial aggregation and heritability independent of LVM and additional confounders.
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- 2014
24. Effect of traditional cardiovascular risk factors on the independent relationship of leptin with atherosclerosis in rheumatoid arthritis
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Patrick H Dessein, Linda Tsang, Ahmed Solomon, Angela J. Woodiwiss, and Clinical sciences
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cardiovascular risk factors ,rheumatoid arthritis ,medicine.medical_specialty ,media_common.quotation_subject ,Immunology ,Cardiovascular risk factors ,Adipokine ,Context (language use) ,Rheumatology ,Internal medicine ,Immunology and Allergy ,Medicine ,media_common ,Medicine(all) ,business.industry ,Leptin ,digestive, oral, and skin physiology ,Appetite ,medicine.disease ,Atherosclerosis ,Pathophysiology ,medicine.anatomical_structure ,Endocrinology ,Rheumatoid arthritis ,business ,Artery - Abstract
To the Editor: Leptin is an adipokine that regulates appetite and energy expenditure1. Both high and low leptin production can further increase cardiovascular (CV) risk1. Leptin is also produced in inflamed joints and implicated in the pathophysiology of rheumatoid arthritis (RA)2. Whether leptin increases CV risk in RA is currently uncertain. Two studies reported a lack of association between leptin concentrations and carotid artery intima-media thickness (cIMT) in RA3,4. Leptin concentrations were also found to be unrelated to coronary artery classification scores in RA5. However, we recently reported an independent relationship between leptin concentrations and surrogate markers of early atherogenesis in young patients with RA2. Importantly, in the present context, carotid artery plaque is a more reliable indicator of atherosclerosis than cIMT6. In our present study, we examined the independent relationships of leptin concentrations with cIMT and plaque in 217 (112 black and 105 white) patients with RA. Because the production and effects of adipokines on CV risk depend on pathophysiological context1,2,7, we also determined whether the presence of conventional and nonconventional CV risk factors modified leptin concentrations and their associations with atherosclerosis. … Address correspondence to Prof. P.H. Dessein, P.O. Box 1012, Melville 2109, Johannesburg, South Africa. E-mail: dessein{at}telkomsa.net
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- 2014
25. Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification
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Gavin R. Norton, Angela J. Woodiwiss, Linda Tsang, Ahmed Solomon, Patrick H Dessein, Aletta M.E. Millen, and Clinical sciences
- Subjects
medicine.medical_specialty ,Article Subject ,Population ,Adipokine ,Black People ,lcsh:Medicine ,Disease ,Review Article ,General Biochemistry, Genetics and Molecular Biology ,Endothelial activation ,Arthritis, Rheumatoid ,Adipokines ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Epidemiology ,medicine ,Humans ,education ,African Continental Ancestry Group ,Medicine(all) ,education.field_of_study ,General Immunology and Microbiology ,business.industry ,lcsh:R ,General Medicine ,medicine.disease ,Cardiovascular Diseases ,Rheumatoid arthritis ,Physical therapy ,Endothelium, Vascular ,business ,Developed country - Abstract
Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients.
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- 2014
26. Retinol binding protein 4 concentrations relate to enhanced atherosclerosis in obese patients with rheumatoid arthritis
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Angela J. Woodiwiss, Patrick H Dessein, Ahmed Solomon, L. Tsang, Gavin R. Norton, and Clinical sciences
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Blood Glucose ,Male ,lcsh:Medicine ,Blood Pressure ,Biochemistry ,Vascular Medicine ,Diagnostic Radiology ,Arthritis, Rheumatoid ,chemistry.chemical_compound ,Endocrinology ,Risk Factors ,Medicine and Health Sciences ,lcsh:Science ,Abdominal obesity ,Medicine(all) ,Multidisciplinary ,biology ,Radiology and Imaging ,Middle Aged ,Rheumatoid arthritis ,Female ,medicine.symptom ,E-Selectin ,Research Article ,Adult ,medicine.medical_specialty ,Immunology ,Cardiology ,Adipokine ,Rheumatoid Arthritis ,Autoimmune Diseases ,Endothelial activation ,Rheumatology ,Diagnostic Medicine ,Internal medicine ,E-selectin ,medicine ,Humans ,Obesity ,Aged ,Retinol binding protein 4 ,Cholesterol ,business.industry ,lcsh:R ,Biology and Life Sciences ,medicine.disease ,Atherosclerosis ,Blood pressure ,Metabolism ,chemistry ,Metabolic Disorders ,biology.protein ,Clinical Immunology ,lcsh:Q ,business ,Retinol-Binding Proteins, Plasma ,Biomarkers - Abstract
Background Retinol binding protein 4 (RBP) enhances metabolic risk and atherogenesis. Whether RBP4 contributes to cardiovascular risk in rheumatoid arthritis (RA) is unknown. Methods We assessed RBP4 concentrations and those of endothelial activation molecules including E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and monocyte chemoattractant protein-1 by ELISA, and the common carotid artery intima-media thickness (cIMT) and carotid artery plaque by ultrasound in 217 (112 black and 105 white) patients with RA. Relationships were identified in potential confounder and mediator adjusted mixed regression models. Results RBP4 concentrations were associated with systolic and mean blood pressure, and those of glucose and E-selectin (partial R = −0.207 (p = 0.003), −0.195 (p = 0.006), −0.155 (p = 0.03) and −0.191 (p = 0.007), respectively in all patients); these RBP4-cardiovascular risk relations were mostly reproduced in patients with but not without adverse traditional or non-traditional cardiovascular risk profiles. RBP4 concentrations were not associated with atherosclerosis in all patients, but related independently to cIMT (partial R = 0.297, p = 0.03) and plaque (OR (95%CI) = 2.95 (1.31–6.68), p = 0.008) in those with generalized obesity, as well as with plaque in those with abdominal obesity (OR (95%CI) = 1.95 (1.12–3.42), p = 0.01). Conclusion In the present study, RBP4 concentrations were inversely associated with metabolic risk and endothelial activation in RA. This requires further investigation. RBP4 concentrations were related to enhanced atherosclerosis in patients with generalized or/and abdominal obesity.
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- 2014
27. Adiponectin and Atherosclerosis in Rheumatoid Arthritis
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Angela J. Woodiwiss, Linda Tsang, Ahmed Solomon, Gavin R. Norton, Patrick H Dessein, Aletta M.E. Millen, and Clinical sciences
- Subjects
Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Waist ,Article Subject ,Immunology ,Gastroenterology ,Arthritis, Rheumatoid ,Internal medicine ,lcsh:Pathology ,Medicine ,Humans ,In patient ,Abdominal obesity ,Metabolic Syndrome ,Medicine(all) ,Adiponectin ,adiponectin ,business.industry ,Metabolic Syndrome X ,Cell Biology ,Odds ratio ,Middle Aged ,medicine.disease ,Atherosclerosis ,Carotid artery plaque ,Endocrinology ,Rheumatoid arthritis ,Female ,medicine.symptom ,Metabolic syndrome ,business ,Research Article ,lcsh:RB1-214 - Abstract
In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range) = 6.47 (1.23–34.54) versus 8.38 (0.82–85.30) ng/mL,P=0.02, resp.); both total and high molecular weight (HMW) adiponectin concentrations were larger in patients with compared to those without joint deformities (7.97 (0.82–85.30) and 3.51 (0.01–35.40) versus 5.36 (1.29–19.49) and 2.34 (0.01–19.49) ng/mL,P=0.003and 0.02, resp.). Total and HMW adiponectin concentrations were associated with carotid artery plaque in patients with MetS waist (odds ratio (95% CI) = 0.87 (0.76–0.99) and 0.92 (0.85–0.99) per 1-standard deviation increment,P=0.02for both) and those without joint deformities (odds ratio (95% CI) = 0.94 (0.88–0.99) and 0.94 (0.89–0.99),P=0.03for both). Plaque prevalence was lower in patients without compared to those with joint deformities (23.4% versus 42.6,P=0.004in multivariable analysis). In RA patients with abdominal obesity or no clinically evident joint damage, adiponectin concentrations are reduced but nevertheless associated with decreased carotid atherosclerosis.
- Published
- 2014
28. Age impacts on the independent relationships of leptin with cardiometabolic risk and surrogate markers of enhanced early atherogenesis in black and white patients with rheumatoid arthritis
- Author
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Ahmed Solomon, Patrick H Dessein, Gavin R. Norton, Angela J. Woodiwiss, L. Tsang, and Clinical sciences
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Adult ,Male ,medicine.medical_specialty ,Aging ,Waist ,Heart diseases ,Immunology ,European Continental Ancestry Group ,Black People ,Vascular Cell Adhesion Molecule-1 ,leptin ,White People ,Endothelial activation ,Arthritis, Rheumatoid ,chemistry.chemical_compound ,Rheumatology ,Metabolic Diseases ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,risk factors ,Risk factor ,Chemokine CCL2 ,African Continental Ancestry Group ,Aged ,Medicine(all) ,business.industry ,Cholesterol ,Leptin ,Confounding ,Cholesterol, HDL ,Age Factors ,biomarkers ,Middle Aged ,Atherosclerosis ,Intercellular Adhesion Molecule-1 ,comorbidity ,Endocrinology ,Cross-Sectional Studies ,chemistry ,Quartile ,Female ,business ,E-Selectin ,Body mass index - Abstract
We examined the potential impact of demographic characteristics on the independent leptin-metabolic cardiovascular risk factor and leptin–endothelial activation relationships in black and white patients with RA. Leptin concentrations and those of endothelial activation molecules including soluble E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and monocyte chemoattractant protein-1 were measured in 217 RA patients (51.6 % black). We determined associations in potential confounder and mediator-adjusted mixed regression models. No independent associations between leptin concentrations and cardiovascular risk were present in all patients and either women and men or black and white patients. However, age impacted on several leptin–cardiovascular risk relations (interaction P < 0.05). In patients aged
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- 2014
29. Chronic diseases are not being managed effectively in either high-risk or low-risk populations in South Africa
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Hendrik L. Booysen, Angela J. Woodiwiss, Gavin R. Norton, Frederic S. Michel, Olebogeng H.I. Majane, Martin Brand, Muzi J. Maseko, and Martin Veller
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Adult ,Male ,medicine.medical_specialty ,Coronary Disease ,Vascular risk ,Risk Assessment ,Tertiary care ,South Africa ,Risk Factors ,Diabetes mellitus ,Outcome Assessment, Health Care ,Health care ,Diabetes Mellitus ,Humans ,Medicine ,Health Services Needs and Demand ,Primary Health Care ,Health management system ,business.industry ,Critical limb ischaemia ,Case-control study ,Disease Management ,General Medicine ,Middle Aged ,Vascular surgery ,medicine.disease ,body regions ,Case-Control Studies ,Chronic Disease ,Hypertension ,Emergency medicine ,Physical therapy ,Female ,business - Abstract
Background. Primary healthcare is the foundation of a country’s healthcare system. Without an efficient and cost-effective programme, the level of healthcare offered across all levels of health management is adversely affected. Objective. To analyse the effectiveness of the management of hypertension and diabetes mellitus (DM) among two distinct patient populations, one with significant cardiovascular risk factors and the other without. Method. We performed a case control study of a high-risk group of patients presenting with chronic critical limb ischaemia (CLI) to the Divisions of Vascular Surgery at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital, and a randomly selected group of ‘healthy’ community participants from Johannesburg’s South Western Townships (Soweto). Results. We assessed 217 patients with CLI and 1 030 participants from the community. We assessed the number of patients who were not achieving their therapeuatic targets, among those known to be hypertensive (CLI: 44.7%; community: 59.9%) and diabetic (CLI: 83.5%; community: 66%). Undiagnosed diabetes affected 10.8% of patients with CLI and 11% of the community sample. Conclusion. Traditional vascular risk factors are managed poorly at both primary healthcare and at tertiary care levels. There is a need to identify factors that will address this issue.
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- 2013
30. Rheumatoid arthritis impacts on the independent relationships between circulating adiponectin concentrations and cardiovascular metabolic risk
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Patrick H Dessein, Gavin R. Norton, Angela J. Woodiwiss, Margaret Badenhorst, Ahmed Solomon, and Clinical sciences
- Subjects
Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Article Subject ,Immunology ,Population ,Arthritis ,Adipokine ,Carotid Intima-Media Thickness ,leptin ,Arthritis, Rheumatoid ,chemistry.chemical_compound ,Adipokines ,Internal medicine ,lcsh:Pathology ,medicine ,Humans ,risk factors ,Arterial Pressure ,education ,Aged ,Medicine(all) ,education.field_of_study ,Adiponectin ,Triglyceride ,adiponectin ,Cholesterol ,business.industry ,Leptin ,Cholesterol, HDL ,Cell Biology ,Middle Aged ,medicine.disease ,Atherosclerosis ,Endocrinology ,Blood pressure ,Cardiovascular diseases ,chemistry ,Female ,business ,lcsh:RB1-214 ,Research Article - Abstract
Adiponectin and leptin are likely involved in the pathophysiology of rheumatoid arthritis (RA) and therefore potential new therapeutic targets. Adiponectin inhibition could be expected to enhance cardiovascular metabolic risk. However, it is unknown whether RA changes the influence of adipokines on cardiovascular metabolic risk. We determined whether RA impacts on the independent relationships of circulating leptin and adiponectin concentrations with cardiovascular risk factors and carotid intima-media thickness (cIMT) in 277 black African subjects from a developing population; 119 had RA. RA impacted on the relationships of adiponectin concentrations with lipid concentrations and blood pressure, independent of confounders including adiposity (interactionP<0.05). This translated into an association of adiponectin concentrations with more favorable lipid variables including HDL cholesterol (P=0.0005), non-HDL cholesterol (P=0.007), and triglyceride (P=0.005) concentrations, total cholesterol-HDL cholesterol (P=0.0002) and triglycerides-HDL cholesterol (P=0.0003) ratios, and higher systolic (P=0.0006), diastolic (P=0.0004), and mean blood pressure (P=0.0007) in RA but not non-RA subjects. Leptin was not associated with metabolic risk after adjustment for adiposity. The cIMT did not differ by RA status, and adipokine concentrations were unrelated to atherosclerosis. This study suggests that leptin and adiponectin inhibition may not alter overall cardiovascular risk and disease in RA.
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- 2013
31. The carotid artery atherosclerosis burden and its relation to cardiovascular risk factors in black and white Africans with established rheumatoid arthritis
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Belinda A. Stevens, Ahmed Solomon, Patrick H Dessein, Angela J. Woodiwiss, Abu T Abdool-Carrim, Gavin R. Norton, and Clinical sciences
- Subjects
Adult ,Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Cross-sectional study ,Carotid arteries ,Immunology ,Cardiovascular risk factors ,Population ,European Continental Ancestry Group ,Arthritis ,Black People ,Carotid Intima-Media Thickness ,White People ,Arthritis, Rheumatoid ,South Africa ,Rheumatology ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,risk factors ,education ,African Continental Ancestry Group ,Medicine(all) ,education.field_of_study ,Framingham Risk Score ,business.industry ,blood pressure ,Middle Aged ,medicine.disease ,Atherosclerosis ,Surgery ,Blood pressure ,Carotid Arteries ,Cross-Sectional Studies ,Rheumatoid arthritis ,Cardiology ,Female ,business - Abstract
Objective.Black Africans currently experience a distinctly low frequency of atherosclerotic cardiovascular disease. Whether this protection persists in those with rheumatoid arthritis (RA) is unknown. We compared the carotid atherosclerosis burden and its relationships with cardiovascular (CV) risk factors between Africans with RA from a developing black and developed CV population.Methods.We performed high resolution B-mode ultrasonography and assessed CV risk factors in 243 patients with established RA, of whom 121 were black and 122 white. Data were analyzed in age, sex, and healthcare center-adjusted regression models.Results.The mean ± SD common carotid intima-media thickness (cIMT) was 0.694 ± 0.097 mm in black and 0.712 ± 0.136 mm in white patients (adjusted p = 0.8). Plaque prevalence was also similar in black compared to white cases (35.5% and 44.3%, respectively; adjusted OR 0.83, 95% CI 0.32–2.20, p = 0.7). Interactions between population grouping and several CV risk factors were independently associated with cIMT and plaque. In stratified analysis, that is, in each population group separately, risk factors associated with cIMT or/and plaque comprised the systolic blood pressure (p = 0.02), serum cholesterol/high-density lipoprotein cholesterol ratio (p = 0.004), C-reactive protein concentrations (p = 0.01), and the presence of extraarticular manifestations (p = 0.01) in whites but, contrastingly, the Arthritis Impact Measurement Scales tension score (p = 0.04) and use of nonsteroidal antiinflammatory agent (p = 0.03) in black patients. The Framingham score was significantly associated with atherosclerosis only in whites (p < 0.0001).Conclusion.The carotid atherosclerosis burden is similar in black compared to white Africans with RA, but relationships between modifiable CV risk factors and atherosclerosis vary substantially among Africans with RA.
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- 2012
32. Aminotransferases are associated with insulin resistance and atherosclerosis in rheumatoid arthritis
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Barry I Joffe, Angela J. Woodiwiss, Gavin R. Norton, and Patrick H Dessein
- Subjects
Carotid Artery Diseases ,Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Abdominal Fat ,Arthritis ,Models, Biological ,Risk Assessment ,Arthritis, Rheumatoid ,Cohort Studies ,Insulin resistance ,Downregulation and upregulation ,Risk Factors ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Aspartate Aminotransferases ,Risk factor ,Ultrasonography ,biology ,business.industry ,Alanine Transaminase ,Odds ratio ,Middle Aged ,medicine.disease ,digestive system diseases ,Up-Regulation ,Logistic Models ,Methotrexate ,Endocrinology ,Alanine transaminase ,Cardiovascular Diseases ,lcsh:RC666-701 ,Antirheumatic Agents ,Rheumatoid arthritis ,biology.protein ,Female ,Insulin Resistance ,Cardiology and Cardiovascular Medicine ,business ,Research Article ,medicine.drug - Abstract
Background Serum aminotransferase concentrations are reportedly strongly associated with insulin resistance, an established cardiovascular risk factor that is not routinely assessed in clinical practice. We therefore explored the possibility that serum aminotransferase concentrations are as closely related to large artery disease as insulin resistance in rheumatoid arthritis (RA). Methods Carotid artery plaque (ultrasonography), insulin resistance and liver enzymes (prior to methotrexate (MTX) were determined in 77 consecutive patients with RA (43 with and 34 without MTX). Results Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were associated with insulin resistance in univariate analysis (R = 0.54, p < 0.0001 and R = 0.36, p = 0.001, respectively) and after adjustment for age, gender and waist circumference (partial R = 0.43, p = 0.0001 and partial R = 0.37, p = 0.001, respectively). ALT and AST concentrations were higher in patients with plaque as compared to in those without plaque (ALT (u/l): 27 2223242526272829303132 versus 20 181920212223, p = 0.02; AST (u/l): 25 2122232425262728 versus 20 19202122, p = 0.02). The odds ratios [95% CI] for plaque were 1.92 [1.14–3.24] (p = 0.01), 1.93 [1.17–3.16] (p = 0.009) and 1.82 [1.13–2.93] (p = 0.01) for 1 SD increase in ALT (~10 u/l) and AST (~6 u/l) concentrations and in logarithmically transformed homeostasis model assessment of insulin resistance (HOMA-IR) (~0.2 uU.mmol/ml.l), respectively. After adjustment for the potentially confounding characteristics of age, sex, hypertension and hypothyroidism in logistic regression models, ALT (p = 0.049) and AST concentrations (p = 0.027) remained associated with plaque whereas the HOMA-IR did not (p = 0.08). AST concentrations (p = 0.049) were associated with plaque independent of insulin resistance whereas the HOMA-IR (p = 0.1) was not associated with plaque independent of AST concentrations. Conclusion Within currently recommended reference ranges, serum aminotransferase concentrations may be strongly associated with insulin resistance and atherosclerosis in patients with RA. The measurement of aminotransferase concentrations could be a useful tool in cardiovascular risk stratification in patients with RA.
- Published
- 2007
33. Context dependency of serum and urinary lithium: implications for measurement of proximal sodium reabsorption
- Author
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Murielle Bochud, Angela J. Woodiwiss, Gavin R. Norton, Marc Maillard, Jan A. Staessen, and Michel Burnier
- Subjects
Adult ,medicine.medical_specialty ,Lithium (medication) ,Sodium ,Urinary system ,chemistry.chemical_element ,Endogeny ,Context (language use) ,Urine ,Absorption (skin) ,030204 cardiovascular system & hematology ,Lithium ,Absorption ,Kidney Tubules, Proximal ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Renal sodium reabsorption ,Chemistry ,Middle Aged ,Endocrinology ,medicine.drug - Abstract
To the Editor: As reported previously in this journal, the endogenous lithium clearance is a marker of proximal tubular sodium handling.1,2 To investigate the context dependency of the endogenous lithium clearance, we measured by electrothermal atomic absorption spectrophotometry the lithium concentrations in serum and in exactly timed urine samples in 745 whites (51.5% women) and …
- Published
- 2007
34. Functional variants of the angiotensinogen gene determine antihypertensive responses to angiotensin-converting enzyme inhibitors in subjects of African origin.
- Author
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Angela J Woodiwiss
- Published
- 2006
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35. Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure
- Author
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Rafique Essop, Ngalulawa Kone, John Kachope, Carlos Libhaber, Gavin R. Norton, Karen Sliwa, Angela J. Woodiwiss, Pinhas Sareli, and G.P. Candy
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Heart disease ,Adrenergic beta-Antagonists ,Carbazoles ,Angiotensin-Converting Enzyme Inhibitors ,Blood Pressure ,Nerve Tissue Proteins ,Radionuclide ventriculography ,Ventricular Function, Left ,Propanolamines ,Heart Rate ,Internal medicine ,Natriuretic Peptide, Brain ,Idiopathic dilated cardiomyopathy ,Perindopril ,medicine ,Humans ,Prospective Studies ,Carvedilol ,Aged ,Heart Failure ,Ejection fraction ,Dose-Response Relationship, Drug ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Peptide Fragments ,Treatment Outcome ,Heart failure ,ACE inhibitor ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine ,Follow-Up Studies ,medicine.drug - Abstract
Objectives The purpose of this research was to evaluate the therapeutic value of initiating a beta-blocker before an angiotensin-converting enzyme inhibitor (ACEI) in the treatment of heart failure. Background Although ACEI and carvedilol produce benefits in heart failure, whether the order of initiation of therapy determines the impact on left ventricular (LV) function and New York Heart Association functional class (NYHA FC) has not been determined. Methods A single-center, prospective, randomized, open-label study was performed. We evaluated whether initiation of therapy with carvedilol either before (n = 38) or after (n = 40) perindopril therapy in newly diagnosed patients in NYHA FC II to III heart failure with idiopathic dilated cardiomyopathy, with the addition of the alternative agent after six months, determined subsequent changes in NYHA FC and LV function (echocardiography and radionuclide ventriculography). Study drugs were titrated to maximum tolerable doses. Results There were no differences in baseline characteristics between the study groups. After 12 months 11 patients died (6 in the group where the ACEI was initiated). At 12 months the group receiving carvedilol as initial therapy achieved a higher tolerable dose of carvedilol (43 ± 17 mg vs. 33 ± 18 mg, p = 0.03); a lower dose of furosemide (p l 0.05); and better improvements in symptoms (NYHA FC, p l 0.002), LV ejection fraction (radionuclide: 15 ± 16% vs. 6 ± 13%, p l 0.05; echocardiographic, p l 0.01), and plasma N-terminal pro-brain natriuretic peptide concentrations (p l 0.02). Conclusions As opposed to the conventional sequence of drug use in the treatment of heart failure, initiation of therapy with carvedilol before an ACEI results in higher tolerable doses of carvedilol and better improvements in FC and LV function.
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36. Independent associations of total and high molecular weight adiponectin with cardiometabolic risk and surrogate markers of enhanced early atherogenesis in black and white patients with rheumatoid arthritis: a cross-sectional study
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Gavin R. Norton, Angela J. Woodiwiss, L. Tsang, Ahmed Solomon, Patrick H Dessein, and Clinical sciences
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,European Continental Ancestry Group ,Immunology ,Arthritis ,Black People ,Vascular Cell Adhesion Molecule-1 ,White People ,Arthritis, Rheumatoid ,lipids ,High molecular weight adiponectin ,Rheumatology ,Internal medicine ,medicine ,Humans ,risk factors ,Immunology and Allergy ,Chemokine CCL2 ,African Continental Ancestry Group ,Aged ,Cardiometabolic risk ,Medicine(all) ,Adiponectin ,adiponectin ,business.industry ,biomarkers ,blood pressure ,Middle Aged ,medicine.disease ,Atherosclerosis ,Intercellular Adhesion Molecule-1 ,Molecular Weight ,Blood pressure ,Endocrinology ,Cross-Sectional Studies ,Logistic Models ,Rheumatoid arthritis ,Female ,Endothelium, Vascular ,business ,E-Selectin ,hormones, hormone substitutes, and hormone antagonists ,Research Article - Abstract
INTRODUCTION: Whether adiponectin levels associate with atherogenesis in RA is uncertain. We examined the independent relationships of total and high molecular weight (HMW) adiponectin concentrations with cardiometabolic risk and surrogate markers of enhanced early atherogenesis in black and white patients with RA. METHODS: We determined total and HMW adiponectin concentrations and those of endothelial activation molecules including soluble E-selectin, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and monocyte chemoattractant protein-1 (MCP-1), in 210 (119 black and 91 white) RA patients. Associations were determined in potential confounder and mediator adjusted mixed regression models. RESULTS: Total and HMW adiponectin concentrations related similarly to metabolic risk factors and endothelial activation. In all patients, total and HMW adiponectin concentrations associated paradoxically with high systolic, diastolic and mean blood pressure (partial R = 0.155 to 0.241, P ≤ 0.03). Ethnic origin did not impact on these relationships (interaction P ≥ 0.09). Total and HMW adiponectin concentrations associated with those of glucose in white and black patients respectively (partial R = -0.304, P = 0.006 and -0.246, P = 0.01). In black but not white participants, total and HMW adiponectin concentrations also related favorably to lipid profiles (partial R = 0.292 to 0.360, P ≤ 0.003 for HDL cholesterol concentrations, -0.269 to -0.299, P ≤ 0.006 for triglyceride concentrations and -0.302 to -0.390, P ≤ 0.002 for total-HDL cholesterol ratio) and the number of metabolic risk factors (partial R = -0.210 to -0.238, P ≤ 0.03). In white but not black patients, total and HMW adiponectin concentrations associated paradoxically with overall endothelial activation as estimated by a standard z-score of endothelial activation molecule concentrations (partial R = 0.262, P = 0.01 and 0.252, P = 0.02); in the respective models, the extent of effect of total and HMW adiponectin concentrations on endothelial activation was larger in white compared to black participants (standardized β (SE) = 0.260 (0.107) versus -0.106 (0.107), P = 0.01 and 0.260 (0.120) versus -0.100 (0.111), P = 0.02). The HMW-total adiponectin ratio related inconsistently to metabolic risk factors and not to endothelial activation. CONCLUSION: In this study, total and HMW adiponectin concentrations associated with increased blood pressure parameters, and in white patients additionally with endothelial activation. The potential mechanism(s) underlying these paradoxical relationships between adiponectin concentrations and cardiovascular risk in RA merit further investigation.
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37. Rheumatoid arthritis is associated with reduced adiposity but not with unfavorable major cardiovascular risk factor profiles and enhanced carotid atherosclerosis in black Africans from a developing population: a cross-sectional study
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Ahmed Solomon, Gavin R. Norton, Angela J. Woodiwiss, Patrick H Dessein, and Clinical sciences
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Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Pathology ,Cross-sectional study ,Population ,Immunology ,Black People ,Inflammation ,Disease ,Systemic inflammation ,Arthritis, Rheumatoid ,Rheumatology ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Immunology and Allergy ,Risk factor ,education ,Developing Countries ,African Continental Ancestry Group ,Adiposity ,Medicine(all) ,education.field_of_study ,business.industry ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Cardiovascular Diseases ,Rheumatoid arthritis ,Female ,medicine.symptom ,business ,Research Article - Abstract
INTRODUCTION: Rheumatoid arthritis (RA) is characterized by inflamed joint-derived cytokine-mediated high-grade systemic inflammation that enhances cardiovascular metabolic risk and disease in developed populations. We investigated the potential impact of RA on cardiovascular risk factors including systemic inflammation and atherosclerosis, and their relationships in black Africans from a developing population. METHODS: We evaluated demographic features, adiposity indices, major traditional cardiovascular risk factors, circulating C-reactive protein and interleukin-6 concentrations and ultrasound determined carotid intima-media thickness (cIMT) in 274 black Africans; 115 had established RA. Data were analyzed in confounder-adjusted mixed regression models. RESULTS: The body mass index and waist-height ratio were lower in RA compared to non-RA subjects (29.2 (6.6) versus 33.7 (8.0), P < 0.0001 and 0.58 (0.09) versus 0.62 (0.1), P = 0.0003, respectively). Dyslipidemia was less prevalent in patients with RA (odds ratio (OR) (95% confidence interval (CI) = 0.54 (0.30 to 1.00)); this disparity was no longer significant after further adjustment for reduced adiposity and chloroquine use. RA was also not associated with hypertension, current smoking and diabetes. The number of major traditional risk factors did not differ by RA status (1.1 (0.8) versus 1.2 (0.9), P = 0.7). Circulating C-reactive protein concentrations were similar and serum interleukin-6 concentrations reduced in RA (7.2 (3.1) versus 6.7 (3.1) mg/l, P = 0.7 and 3.9 (1.9) versus 6.3 (1.9) pg/ml, P < 0.0001, respectively). The cIMT was 0.700 (0.085) and 0.701 (0.111) mm in RA and non-RA subjects, respectively (P = 0.7). RA disease activity and severity parameters were consistently unrelated to systemic inflammation, despite the presence of clinically active disease in 82.6% of patients. In all participants, adiposity indices, smoking and converting angiotensin inhibitor non-use were associated with increased systemic inflammation, which related to more atherogenic lipid profiles, and circulating low density lipoprotein concentrations were associated with cIMT (partial R = 0.153, P = 0.032); RA did not impact on these relationships (interaction P ≥0.1). CONCLUSIONS: Among black Africans, patients with established RA experience reduced overall and abdominal adiposity but no enhanced major traditional risk factor and atherosclerosis burden. This study further suggests that an absent interleukin-6 release by inflamed RA joints into the circulation may account for this unaltered cardiovascular disease risk.
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38. Associations of inflammatory markers with impaired left ventricular diastolic and systolic function in collagen-induced arthritis.
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Lebogang Mokotedi, Frederic S Michel, Conrad Mogane, Monica Gomes, Angela J Woodiwiss, Gavin R Norton, and Aletta M E Millen
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Medicine ,Science - Abstract
BACKGROUND:High-grade inflammation may play a pivotal role in the pathogenesis of left ventricular (LV) dysfunction. Evidence to support a role of systemic inflammation in mediating impaired LV function in experimental models of rheumatoid arthritis (RA) remains limited. The aim of the present study was to determine the effects of high-grade systemic inflammation on LV diastolic and systolic function in collagen-induced arthritis (CIA). METHODS:To induce CIA, bovine type-II collagen emulsified in incomplete Freund's adjuvant was injected at the base of the tail into 21 three-month old Sprague Dawley rats. Nine-weeks after the first immunisation, LV function was assessed by pulsed Doppler, tissue Doppler imaging and Speckle tracking echocardiography. Cardiac collagen content was determined by picrosirius red staining; circulating inflammatory markers were measured using ELISA. RESULTS:Compared to controls (n = 12), CIA rats had reduced myocardial relaxation as indexed by lateral e' (early diastolic mitral annular velocity) and e'/a' (early-to-late diastolic mitral annular velocity) and increased filling pressures as indexed by E/e'. No differences in ejection fraction and LV endocardial fractional shortening between the groups were recorded. LV global radial and circumferential strain and strain rate were reduced in CIA rats compared to controls. Higher concentrations of circulating inflammatory markers were associated with reduced lateral e', e'/a', radial and circumferential strain and strain rate. Greater collagen content was associated with increased concentrations of circulating inflammatory markers and E/e'. CONCLUSION:High-grade inflammation is associated with impaired LV diastolic function and greater myocardial deformation independent of haemodynamic load in CIA rats.
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- 2020
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39. Kidney function, endothelial activation and atherosclerosis in black and white Africans with rheumatoid arthritis.
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Patrick H Dessein, Hon-Chun Hsu, Linda Tsang, Aletta M E Millen, Angela J Woodiwiss, Gavin R Norton, Ahmed Solomon, and Miguel A Gonzalez-Gay
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Medicine ,Science - Abstract
To determine whether kidney function independently relates to endothelial activation and ultrasound determined carotid atherosclerosis in black and white Africans with rheumatoid arthritis (RA).We calculated the Jelliffe, 5 Cockcroft-Gault equations, Salazar-Corcoran, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (EGFR) equations in 233 (112 black) RA patients.The CKD-EPI eGFR was 0.1 for comparisons of AUC (SE)) for the other 8 equations. Based on optimal eGFR cutoff values with sensitivities and specificities ranging from 42 to 60% and 70 to 91% respectively, as determined in ROC curve analysis, a low eGFR increased the odds ratio for plaque 2.2 to 4.0 fold.Reduced kidney function is independently associated with atherosclerosis and endothelial activation in black and white Africans with RA, respectively. CKD is highly prevalent in black Africans with RA. Apart from the MDRD, eGFR equations are useful in predicting carotid plaque presence, a coronary heart disease equivalent, amongst black African RA patients.
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- 2015
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40. Retinol binding protein 4 concentrations relate to enhanced atherosclerosis in obese patients with rheumatoid arthritis.
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Patrick H Dessein, Linda Tsang, Gavin R Norton, Angela J Woodiwiss, and Ahmed Solomon
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Medicine ,Science - Abstract
Retinol binding protein 4 (RBP) enhances metabolic risk and atherogenesis. Whether RBP4 contributes to cardiovascular risk in rheumatoid arthritis (RA) is unknown.We assessed RBP4 concentrations and those of endothelial activation molecules including E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and monocyte chemoattractant protein-1 by ELISA, and the common carotid artery intima-media thickness (cIMT) and carotid artery plaque by ultrasound in 217 (112 black and 105 white) patients with RA. Relationships were identified in potential confounder and mediator adjusted mixed regression models.RBP4 concentrations were associated with systolic and mean blood pressure, and those of glucose and E-selectin (partial R = -0.207 (p = 0.003), -0.195 (p = 0.006), -0.155 (p = 0.03) and -0.191 (p = 0.007), respectively in all patients); these RBP4-cardiovascular risk relations were mostly reproduced in patients with but not without adverse traditional or non-traditional cardiovascular risk profiles. RBP4 concentrations were not associated with atherosclerosis in all patients, but related independently to cIMT (partial R = 0.297, p = 0.03) and plaque (OR (95%CI) = 2.95 (1.31-6.68), p = 0.008) in those with generalized obesity, as well as with plaque in those with abdominal obesity (OR (95%CI) = 1.95 (1.12-3.42), p = 0.01).In the present study, RBP4 concentrations were inversely associated with metabolic risk and endothelial activation in RA. This requires further investigation. RBP4 concentrations were related to enhanced atherosclerosis in patients with generalized or/and abdominal obesity.
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- 2014
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41. Large vessel adventitial vasculitis characterizes patients with critical lower limb ischemia with as compared to without human immunodeficiency virus infection.
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Martin Brand, Angela J Woodiwiss, Frederic Michel, Simon Nayler, Martin G Veller, and Gavin R Norton
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Medicine ,Science - Abstract
Whether a human immunodeficiency virus (HIV)-associated vasculitis in-part accounts for occlusive large artery disease remains uncertain. We aimed to identify the histopathological features that characterize large vessel changes in HIV sero-positive as compared to sero-negative patients with critical lower limb ischemia (CLI).Femoral arteries obtained from 10 HIV positive and 10 HIV negative black African male patients admitted to a single vascular unit with CLI requiring above knee amputation were subjected to histopathological assessment. None of the HIV positive patients were receiving antiretroviral therapy.As compared to HIV negative patients with CLI, HIV positive patients were younger (p
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- 2014
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42. Circulating resistin concentrations are independently associated with aortic pulse wave velocity in a community sample.
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Norman G, Norton GR, Gomes M, Michel F, Majane OH, Sareli P, Millen AM, and Woodiwiss AJ
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- Adiponectin, Adult, Arterial Pressure physiology, Black People, Body Mass Index, C-Reactive Protein, Female, Humans, Hypertension physiopathology, Insulin Resistance physiology, Male, Middle Aged, Obesity physiopathology, South Africa, Waist Circumference, Young Adult, Aorta physiopathology, Pulse Wave Analysis, Resistin blood, Vascular Stiffness
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Aims: The role of the adipokine, resistin in mediating increases in aortic stiffness is uncertain. We aimed to determine independent relations between circulating resistin concentrations and aortic pulse wave velocity (PWV) and wave reflection in a community-based sample with a high prevalence of untreated hypertension and obesity., Methods: Plasma resistin, adiponectin, and C-reactive protein concentrations (ELISA); carotid-femoral (aortic) PWV and the aortic reflected wave index (applanation tonometry and SphygmoCor software) were determined in 683 randomly selected participants of African ancestry from SOWETO, South Africa who had never received antihypertensive therapy., Results: Resistin concentrations were not independently associated with office or 24-h (n = 492) blood pressure (BP). In a stepwise regression model with BMI included in the model, age (P < 0.0001), mean arterial pressure (P < 0.0001), plasma resistin concentrations (P < 0.005), female sex (P = 0.01), and creatinine concentrations (P < 0.01) contributed independently to variations in PWV. Independent relations between resistin concentrations and PWV persisted with further adjustments for C-reactive protein concentrations (P < 0.005), and the homeostasis model of insulin resistance (P < 0.02). Similar relations were noted with waist circumference rather than BMI in the model. Resistin concentrations were not independently associated with aortic reflected wave index or aortic BP., Conclusion: Resistin is independently and directly associated with aortic stiffness and these effects occur beyond BP, insulin resistance, and general inflammation.
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- 2016
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43. Reflected rather than forward wave pressures account for brachial pressure-independent relations between aortic pressure and end-organ changes in an African community.
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Sibiya MJ, Woodiwiss AJ, Booysen HL, Raymond A, Millen AM, Maseko MJ, Majane OH, Sareli P, Libhaber E, and Norton GR
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- Adult, Blood Pressure Determination, Carotid Intima-Media Thickness, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Organ Size, Aorta physiology, Arterial Pressure physiology, Black People, Brachial Artery physiology, Heart Ventricles pathology, Pulse Wave Analysis methods
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Aims: To determine whether brachial blood pressure (BP)-independent relations between aortic pressure and cardiovascular damage are better explained by reflected (backward) (Pb) or forward (Pf) wave pressure effects., Methods: In 1174 participants from a community of African ancestry, we assessed central aortic pulse pressure (PPc), Pb, and Pf (radial applanation tonometry, SphygmoCor) as well as left ventricular mass index (LVMI) (n = 786), aortic pulse wave velocity (PWV) (n = 1019), carotid intima-media thickness (IMT) (n = 578), transmitral early-to-late left ventricular diastolic velocity (E/A) (n = 779) and estimated glomerular filtration rate (eGFR) (n = 1174)., Results: Independent of mean arterial pressure and confounders, PPc, and both Pb and Pf were associated with end-organ measures or damage (P < 0.05 to P < 0.0001). With adjustments for brachial PP and confounders, Pb remained directly associated with LVMI (partial r = 0.09, P < 0.01), PWV (partial r = 0.28, P < 0.0001), and IMT (partial r = 0.28, P < 0.0001), and inversely associated with E/A (partial r = -0.31, P < 0.0001) and eGFR (partial r = -0.14, P < 0.0001). Similar relations were noted with the presence of end-organ damage (P < 0.05 to P < 0.0001). In contrast, with adjustments for brachial PP and confounders, Pf no longer retained direct relations with LVMI, PWV, and IMT or inverse relations with E/A and eGFR. Adjustments for Pb, but not Pf, diminished brachial PP-independent relationships between PPc and end-organ measures. Independent relations between Pb, but not Pf and end-organ measures, were largely attributed to Pb accounting for most of the variation in brachial-to-aortic PP amplification., Conclusions: In communities of African ancestry, brachial BP-independent relations between aortic pressure and end-organ changes are largely attributed to an impact of reflected rather than forward wave pressures.
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- 2015
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44. Relative impact of blood pressure as compared to an excess adiposity on left ventricular diastolic dysfunction in a community sample with a high prevalence of obesity.
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Millen AM, Libhaber CD, Majane OH, Libhaber E, Maseko MJ, Woodiwiss AJ, and Norton GR
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- Blood Flow Velocity, Community Health Services, Diastole, Echocardiography, Female, Humans, Male, Middle Aged, South Africa, Ventricular Dysfunction, Left diagnostic imaging, Waist Circumference, Adiposity, Blood Pressure, Obesity, Morbid, Ventricular Dysfunction, Left physiopathology
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Aim: To determine whether blood pressure (BP) or an excess adiposity, both frequently observed comorbidities that independently relate to left ventricular diastolic dysfunction (LVDD), have a greater impact on LVDD at a community level., Methods: We assessed the relative independent impact of an excess adiposity versus BP on indices of LVDD as determined from the ratios of early-to-late transmitral blood flow velocity (E/A) and E/the mean of lateral and septal wall myocardial tissue lengthening at the level of the mitral annulus (e'; (E/e') in 417 randomly recruited participants of a community-based study with a high prevalence of excess adiposity (43% obese and 25% morbidly obese)., Results: In multivariate adjusted models, including adjustments for appropriate BP values (SBP for E/e' and DBP for E/A), waist circumference was independently associated with E/A (partial r = -0.12, P < 0.02) and E/e' (partial r = 0.15, P < 0.005). In contrast, BMI was independently associated with E/e' (partial r = 0.11, P < 0.05), but not E/A (partial r = -0.09, P = 0.08). In multivariate models, SBP had a greater impact on E/e' (standardized β-coefficient = 0.32 ± 0.05, P < 0.0001) than did waist circumference (standardized β-coefficient = 0.16 ± 0.05, P < 0.005; P < 0.05 for comparison), whereas DBP had a similar impact on E/A (standardized β-coefficient = -0.10 ± 0.03, P < 0.005) as did waist circumference (standardized β-coefficient = -0.10 ± 0.04, P < 0.05). Importantly, whereas SBP was the main factor independently associated with an increased E/e' (≥10) (P < 0.0005), waist circumference was not independently associated with either a decreased E/A (≤0.75) (P = 0.82) or an increased E/e' (≥10; P = 0.15)., Conclusion: In a community sample with a high prevalence of excess adiposity, BP exceeds obesity as the most important modifiable risk factor for LVDD. These data suggest that in communities with a high prevalence of obesity, if weight loss programmes fail to produce sustainable target body weights, rigorous BP management to lower than normal thresholds may be sufficient to prevent LVDD.
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- 2014
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