BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct ...BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.展开更多
AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, &...AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the ab-dominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis ofinterobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.展开更多
BACKGROUND Liver transplant(LT)is becoming increasingly common with improved life expectancy.Joint replacement is usually a safe procedure;however,its safety in LT recipients remains understudied.AIM To evaluate the m...BACKGROUND Liver transplant(LT)is becoming increasingly common with improved life expectancy.Joint replacement is usually a safe procedure;however,its safety in LT recipients remains understudied.AIM To evaluate the mortality,outcome,and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.RESULTS A total of 5046119 hip and knee replacement surgeries were identified.3219 patients had prior LT.Mean age of patients with no history of LT was 67.51[95%confidence interval(CI):67.44-67.58],while it was 64.05(95%CI:63.55-64.54)in patients with LT.Patients with history of LT were more likely to have prolonged length of hospital stay(17.1%vs 8.4%,P<0.001).The mortality rate for patients with no history of LT was 0.22%,while it was 0.24%for patients with LT(P=0.792).Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization:11.4%as compared to 6.2%in patients without history of LT(P<0.001).The mortality rate between both groups during readmission was not statistically different(1.9%vs 2%,P=0.871)respectively.CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality;increased readmissions were more frequent in this cohort of patients.Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.展开更多
Given the broad application of aspirin as antiplatelet drug, availability of standardized methodology to assess potential interaction with any co-medication on platelet aggregation is desired. We characterized the eff...Given the broad application of aspirin as antiplatelet drug, availability of standardized methodology to assess potential interaction with any co-medication on platelet aggregation is desired. We characterized the effect of aspirin (ASA) therapy on collagen-induced platelet aggregation in whole blood to define such methodology. Collagen-induced platelet whole blood aggregation was assessed in 6 healthy male volunteers on 2 occasions (Day 1, Day 7) using the Chronolog aggregometer. From Day 2 up to Day 7, subjects received a daily oral dose of 75 mg ASA. The relationship between collagen dose and platelet aggregation response was assessed. On Day 1, maximal aggregation was observed at 1 μg/mL collagen (15.3 ± 4.6 Ω) and higher. Reproducible results were obtained without any indication of intra-subject fluctuations. ASA treatment decreased maximal aggregation by 80% and 38% at 0.5 and 2.0 μg/mL collagen, respectively. Power calculations were performed based on the observed intra-subject variability and demonstrated minimal sample sizes of 9 - 11 subjects for future cross-over ASA-drug interaction studies exploring effects on platelet aggregation, which demonstrates that the proposed collagen-induced ex vivo whole blood platelet aggregation is a feasible methodology to evaluate ASA-drug interactions in healthy volunteers.展开更多
Context: Children with familial hypercholesterolemia have endothelial d ysfunct ion and increased carotid intimamedia thickness(IMT), which herald the premature atherosclerotic disease they develop later in life. Alth...Context: Children with familial hypercholesterolemia have endothelial d ysfunct ion and increased carotid intimamedia thickness(IMT), which herald the premature atherosclerotic disease they develop later in life. Although intervention thera py in the causal pathway of this disorder has been available for more than a dec ade, the long-term efficacy and safety of cholesterol-lowering medication have not been evaluated in children. Objective: To determine the 2-year efficacy an d safety of pravastatin therapy in children with familial hypercholesterolemia. Design: Randomized, double-blind, placebo-controlled trial that recruited chil dren between December 7, 1997, and October 4, 1999, and followed them up for 2 y ears. Setting and Participants: Two hundred fourteen children with familial hype rcholesterolemia, aged 8 to 18 years and recruited from an academic medical refe rral center in the Netherlands. Intervention: After initiation of a fat-restric ted diet and encouragement of regular physical activity, children were randomly assigned to receive treatment with pravastatin, 20 to 40 mg/d (n=106), or a plac ebo tablet (n=108). Main Outcome Measures: The primary efficacy outcome was the change from baseline in mean carotid IMT compared between the 2 groups over 2 ye ars; the principal safety outcomes were growth, maturation, and hormone level me asurements over 2 years as well as changes in muscle and liver enzyme levels. Re sults: Compared with baseline, carotid IMT showed a trend toward regression with pravastatin (mean <<SD>>, -0.010 <<0.048>> mm; P=.049), whereas a trend toward pro gression was observed in the placebo group (mean <<SD>>, +0.005 <<0.044>> mm; P=.28 ). The mean (SD) change in IMT compared between the 2 groups (0.014 <<0.046>> mm) was significant (P=.02). Also, pravastatin significantly reduced mean low-densi ty lipoprotein cholesterol levels compared with placebo (-24.1%vs +0.3%, res pectively; P< .001). No differences were observed for growth, muscle or liver en zymes, endocrine function parameters, Tanner staging scores, onset of menses, or testicular volume between the 2 groups. Conclusion: Two years of pravastatin th erapy induced a significant regression of carotid atherosclerosis in children wi th familial hypercholesterolemia, with no adverse effects on growth, sexual matu ration, hormone levels, or liver or muscle tissue.展开更多
Background-Prospective epidemiological studies have shown that low plasma levels of HDL cholesterol(HDL-C) are associated with an increased risk for cardiovascular disease(CVD). Despite nearly 40 years of research, ho...Background-Prospective epidemiological studies have shown that low plasma levels of HDL cholesterol(HDL-C) are associated with an increased risk for cardiovascular disease(CVD). Despite nearly 40 years of research, however, it is unclear whether this also holds true for individuals with severely reduced levels of HDL-C due to mutations in the lecithin: cholesterol acyltransferase(LCAT) gene. Better insight into CVD risk in these individuals may provide clues toward the potential of LCAT as a pharmaceutical target to raise HDL-C levels. Methods and Results-Lipids, lipoproteins, high-sensitivity C-reactive protein(CRP), and carotid artery intima-media thickness(IMT) were assessed in 47 heterozygotes for LCAT gene mutations and 58 family controls. Compared with controls, heterozygotes presented with a mean 36%decrease in HDL-C levels(P< 0.0001), a 23%increase in triglyceride levels(P< 0.0001), and a 2.1-fold increase in CRP levels(P< 0.0001). Mean carotid IMT was significantly increased in heterozygotes compared with family controls(0.623±0.13 versus 0.591±0.08 mm). After adjustment for age, gender, and alcohol use, this difference proved statistically significant(P< 0.0015). Conclusions-The data show that heterozygosity for LCAT gene defects is associated with low HDL-C levels and elevated concentration of triglycerides and CRP in plasma. This phenotype underlies increased IMT in carriers versus controls, which suggests that LCAT protects against atherosclerosis. This in turn indicates that targeting LCAT to raise HDL-C may reduce CVD risk.展开更多
Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 20...Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 2020,the more inclusive term metabolic dysfunction-associated fatty liver disease(MAFLD)was proposed to replace the term non-alcoholic fatty liver disease(NAFLD).The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD.However,to date,there is no appropriate guidance on CKD in individuals with MAFLD.Furthermore,there has been little attention paid to the link between MAFLD and CKD in the Nephrology community.Methods and Results:Using a Delphi-based approach,a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD.Conclusions:This Delphi-based consensus statement provided guidance on the epidemiology,mechanisms,management and treatment of MAFLD and CKD,as well as the relationship between the severity of MAFLD and risk of CKD,which establish a framework for the early prevention and management of these two common and interconnected diseases.展开更多
Diederick J.van Doorn1,Adriaan G.Holleboom2,R.Bart Takkenberg1,Joanne Verheij3,Marten A.Lantinga11Department of Gastroenterology and Hepatology,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrin...Diederick J.van Doorn1,Adriaan G.Holleboom2,R.Bart Takkenberg1,Joanne Verheij3,Marten A.Lantinga11Department of Gastroenterology and Hepatology,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;2Department of Vascular Medicine,Internal Medicine,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;3Department of Hepatopanc Metabolic dysfunction-associated steatotic liver disease(MASLD)-until recently termed non-alcoholic fatty liver disease(NAFLD)-is a rising cause of chronic liver disease with an estimated global prevalence of 30%(1).展开更多
Lipid lowering is the cornerstone in the prevention of cardiovascular disease(CVD),which is based on a plethora of data bolstering the causal role of low-density lipoprotein cholesterol(LDL-C)in the process of atheros...Lipid lowering is the cornerstone in the prevention of cardiovascular disease(CVD),which is based on a plethora of data bolstering the causal role of low-density lipoprotein cholesterol(LDL-C)in the process of atherosclerosis.However,a concern that has been raised in this regard is whether LDL-C lowering agents,or the subsequent low LDL-C levels,result in cognitive impairment,offsetting the beneficial effect of LDL-C lowering on CVD outcomes.展开更多
Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of...Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of such on the prevalence of MAFLD is clearly understudied.Here,we investigated the Fatty Liver Index(FLI),a proxy of steatosis in MAFLD,after migration of Ghanaian subjects.Methods:Cross-sectional data of 5282 rural,urban and migrant participants from the Research on Obesity and Diabetes among African Migrants(also known as RODAM)study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus(T2DM),waist-to-hip ratio,and 10-year predicted risk of atherosclerotic cardiovascular disease(ASCVD).Results:Both FLI and the proportion with an FLI indicative of MAFLD steatosis(FLI≥60)were higher in migrants compared with non-migrants.Prevalence of elevated FLI(FLI≥60)in non-migrant males was 4.2%compared to 28.9%in migrants.For females,a similar gradient was observed,from 13.6%to 36.6%respectively.Compared to rural residents,the odds for a FLI≥60 were higher in migrants living in urban Europe(odds ratio[OR]9.02,95%confidence interval[CI]:5.02–16.20 for men,and 4.00,95%CI:3.00–5.34 for women).Compared to controls,the ORs for FLI≥60 were 2.43(95%CI:1.73–3.41)for male T2DM cases and 2.02(95%CI:1.52–2.69)for female T2DM cases.One-unit higher FLI was associated with an elevated(≥7.5%)10-year ASCVD risk(OR:1.051,95%CI:1.041–1.062 for men,and 1.020,95%CI:1.015–1.026 for women).Conclusions:FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas,through urban areas,to Europe.Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.展开更多
文摘BACKGROUND The utility of D-dimer(DD)as a biomarker for acute aortic dissection(AD)is recognized.Yet,its predictive value for in-hospital mortality remains uncertain and subject to conflicting evidence.AIM To conduct a meta-analysis of AD-related in-hospital mortality(ADIM)with elevated DD levels.METHODS We searched PubMed,Scopus,Embase,and Google Scholar for AD and ADIM literature through May 2022.Heterogeneity was assessed using I2 statistics and effect size(hazard or odds ratio)analysis with random-effects models.Sample size,study type,and patients’mean age were used for subgroup analysis.The significance threshold was P<0.05.RESULTS Thirteen studies(3628 patients)were included in our study.The pooled prevalence of ADIM was 20%(95%CI:15%-25%).Despite comparable demographic characteristics and comorbidities,elevated DD values were associated with higher ADIM risk(unadjusted effect size:1.94,95%CI:1.34-2.8;adjusted effect size:1.12,95%CI:1.05-1.19,P<0.01).Studies involving patients with a mean age of<60 years exhibited an increased mortality risk(effect size:1.43,95%CI:1.23-1.67,P<0.01),whereas no significant difference was observed in studies with a mean age>60 years.Prospective and larger sample size studies(n>250)demonstrated a heightened likelihood of ADIM associated with elevated DD levels(effect size:2.57,95%CI:1.30-5.08,P<0.01 vs effect size:1.05,95%CI:1.00-1.11,P=0.05,respectively).CONCLUSION Our meta-analysis shows elevated DD increases in-hospital mortality risk in AD patients,highlighting the need for larger,prospective studies to improve risk prediction models.
文摘AIM: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE). METHODS: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images. Interobserver agreement of abdominal aortic size was determined by the correlation coefficient and paired t test. Interobserver reliability for each cardiologist was assessed using Bland-Altman plots. RESULTS: Ninety patients were studied. The mean age of patients was 72 ± 10 years and 48% were male. The mean aortic diameter was 2.31 ± 0.50 cm and 5 patients (5.5%) had an abdominal aortic aneurysm (AAA). The additional time required for the ab-dominal aortic images was 4.4 ± 0.9 min per patient. Interobserver agreement between the 2 cardiologist interpreters and the vascular medicine specialist was excellent (P > 0.05 for all comparisons). On Bland-Altman analysis ofinterobserver reliability, the 95% lower and upper limits for measurement by the cardiologists were 84% and 124% of that of the vascular specialist. CONCLUSION: The assessment of the abdominal aorta during a routine TTE performed by a cardiologist is accurate in comparison to that of a vascular medicine specialist. In selected patients undergoing TTE, the detection rate of AAA is significant. Additional time and effort required to perform imaging of the abdominal aorta after TTE is less than 5 min.
文摘BACKGROUND Liver transplant(LT)is becoming increasingly common with improved life expectancy.Joint replacement is usually a safe procedure;however,its safety in LT recipients remains understudied.AIM To evaluate the mortality,outcome,and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.RESULTS A total of 5046119 hip and knee replacement surgeries were identified.3219 patients had prior LT.Mean age of patients with no history of LT was 67.51[95%confidence interval(CI):67.44-67.58],while it was 64.05(95%CI:63.55-64.54)in patients with LT.Patients with history of LT were more likely to have prolonged length of hospital stay(17.1%vs 8.4%,P<0.001).The mortality rate for patients with no history of LT was 0.22%,while it was 0.24%for patients with LT(P=0.792).Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization:11.4%as compared to 6.2%in patients without history of LT(P<0.001).The mortality rate between both groups during readmission was not statistically different(1.9%vs 2%,P=0.871)respectively.CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality;increased readmissions were more frequent in this cohort of patients.Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.
文摘Given the broad application of aspirin as antiplatelet drug, availability of standardized methodology to assess potential interaction with any co-medication on platelet aggregation is desired. We characterized the effect of aspirin (ASA) therapy on collagen-induced platelet aggregation in whole blood to define such methodology. Collagen-induced platelet whole blood aggregation was assessed in 6 healthy male volunteers on 2 occasions (Day 1, Day 7) using the Chronolog aggregometer. From Day 2 up to Day 7, subjects received a daily oral dose of 75 mg ASA. The relationship between collagen dose and platelet aggregation response was assessed. On Day 1, maximal aggregation was observed at 1 μg/mL collagen (15.3 ± 4.6 Ω) and higher. Reproducible results were obtained without any indication of intra-subject fluctuations. ASA treatment decreased maximal aggregation by 80% and 38% at 0.5 and 2.0 μg/mL collagen, respectively. Power calculations were performed based on the observed intra-subject variability and demonstrated minimal sample sizes of 9 - 11 subjects for future cross-over ASA-drug interaction studies exploring effects on platelet aggregation, which demonstrates that the proposed collagen-induced ex vivo whole blood platelet aggregation is a feasible methodology to evaluate ASA-drug interactions in healthy volunteers.
文摘Context: Children with familial hypercholesterolemia have endothelial d ysfunct ion and increased carotid intimamedia thickness(IMT), which herald the premature atherosclerotic disease they develop later in life. Although intervention thera py in the causal pathway of this disorder has been available for more than a dec ade, the long-term efficacy and safety of cholesterol-lowering medication have not been evaluated in children. Objective: To determine the 2-year efficacy an d safety of pravastatin therapy in children with familial hypercholesterolemia. Design: Randomized, double-blind, placebo-controlled trial that recruited chil dren between December 7, 1997, and October 4, 1999, and followed them up for 2 y ears. Setting and Participants: Two hundred fourteen children with familial hype rcholesterolemia, aged 8 to 18 years and recruited from an academic medical refe rral center in the Netherlands. Intervention: After initiation of a fat-restric ted diet and encouragement of regular physical activity, children were randomly assigned to receive treatment with pravastatin, 20 to 40 mg/d (n=106), or a plac ebo tablet (n=108). Main Outcome Measures: The primary efficacy outcome was the change from baseline in mean carotid IMT compared between the 2 groups over 2 ye ars; the principal safety outcomes were growth, maturation, and hormone level me asurements over 2 years as well as changes in muscle and liver enzyme levels. Re sults: Compared with baseline, carotid IMT showed a trend toward regression with pravastatin (mean <<SD>>, -0.010 <<0.048>> mm; P=.049), whereas a trend toward pro gression was observed in the placebo group (mean <<SD>>, +0.005 <<0.044>> mm; P=.28 ). The mean (SD) change in IMT compared between the 2 groups (0.014 <<0.046>> mm) was significant (P=.02). Also, pravastatin significantly reduced mean low-densi ty lipoprotein cholesterol levels compared with placebo (-24.1%vs +0.3%, res pectively; P< .001). No differences were observed for growth, muscle or liver en zymes, endocrine function parameters, Tanner staging scores, onset of menses, or testicular volume between the 2 groups. Conclusion: Two years of pravastatin th erapy induced a significant regression of carotid atherosclerosis in children wi th familial hypercholesterolemia, with no adverse effects on growth, sexual matu ration, hormone levels, or liver or muscle tissue.
文摘Background-Prospective epidemiological studies have shown that low plasma levels of HDL cholesterol(HDL-C) are associated with an increased risk for cardiovascular disease(CVD). Despite nearly 40 years of research, however, it is unclear whether this also holds true for individuals with severely reduced levels of HDL-C due to mutations in the lecithin: cholesterol acyltransferase(LCAT) gene. Better insight into CVD risk in these individuals may provide clues toward the potential of LCAT as a pharmaceutical target to raise HDL-C levels. Methods and Results-Lipids, lipoproteins, high-sensitivity C-reactive protein(CRP), and carotid artery intima-media thickness(IMT) were assessed in 47 heterozygotes for LCAT gene mutations and 58 family controls. Compared with controls, heterozygotes presented with a mean 36%decrease in HDL-C levels(P< 0.0001), a 23%increase in triglyceride levels(P< 0.0001), and a 2.1-fold increase in CRP levels(P< 0.0001). Mean carotid IMT was significantly increased in heterozygotes compared with family controls(0.623±0.13 versus 0.591±0.08 mm). After adjustment for age, gender, and alcohol use, this difference proved statistically significant(P< 0.0015). Conclusions-The data show that heterozygosity for LCAT gene defects is associated with low HDL-C levels and elevated concentration of triglycerides and CRP in plasma. This phenotype underlies increased IMT in carriers versus controls, which suggests that LCAT protects against atherosclerosis. This in turn indicates that targeting LCAT to raise HDL-C may reduce CVD risk.
文摘Background:With the rising global prevalence of fatty liver disease related to metabolic dysfunction,the association of this common liver condition with chronic kidney disease(CKD)has become increasingly evident.In 2020,the more inclusive term metabolic dysfunction-associated fatty liver disease(MAFLD)was proposed to replace the term non-alcoholic fatty liver disease(NAFLD).The observed association between MAFLD and CKD and our understanding that CKD can be a consequence of underlying metabolic dysfunction support the notion that individuals with MAFLD are at higher risk of having and developing CKD compared with those without MAFLD.However,to date,there is no appropriate guidance on CKD in individuals with MAFLD.Furthermore,there has been little attention paid to the link between MAFLD and CKD in the Nephrology community.Methods and Results:Using a Delphi-based approach,a multidisciplinary panel of 50 international experts from 26 countries reached a consensus on some of the open research questions regarding the link between MAFLD and CKD.Conclusions:This Delphi-based consensus statement provided guidance on the epidemiology,mechanisms,management and treatment of MAFLD and CKD,as well as the relationship between the severity of MAFLD and risk of CKD,which establish a framework for the early prevention and management of these two common and interconnected diseases.
文摘Diederick J.van Doorn1,Adriaan G.Holleboom2,R.Bart Takkenberg1,Joanne Verheij3,Marten A.Lantinga11Department of Gastroenterology and Hepatology,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;2Department of Vascular Medicine,Internal Medicine,Amsterdam UMC,University of Amsterdam,Amsterdam Gastroenterology Endocrinology Metabolism,Amsterdam,The Netherlands;3Department of Hepatopanc Metabolic dysfunction-associated steatotic liver disease(MASLD)-until recently termed non-alcoholic fatty liver disease(NAFLD)-is a rising cause of chronic liver disease with an estimated global prevalence of 30%(1).
文摘Lipid lowering is the cornerstone in the prevention of cardiovascular disease(CVD),which is based on a plethora of data bolstering the causal role of low-density lipoprotein cholesterol(LDL-C)in the process of atherosclerosis.However,a concern that has been raised in this regard is whether LDL-C lowering agents,or the subsequent low LDL-C levels,result in cognitive impairment,offsetting the beneficial effect of LDL-C lowering on CVD outcomes.
基金This work was supported by the European Commission under the Framework Programme(Grant No.278901)The study sponsor was not involved in the design of the study+3 种基金the collection,analysis and interpretation of datawriting the reportnor the decision to submit the report for publication.AGH was supported by the Amsterdam UMC Fellowship grant,a Holland Health TKI-PPP grant and by research grants from Gilead and Novo Nordisk.KACM was supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health(CRGGH)The CRGGH was supported by the National Human Genome Research Institute,the National Institute of Diabetes and Digestive and Kidney Diseases,the Center for Information Technology,and the Office of the Director at the National Institutes of Health(No.1ZIAHG200362).
文摘Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of such on the prevalence of MAFLD is clearly understudied.Here,we investigated the Fatty Liver Index(FLI),a proxy of steatosis in MAFLD,after migration of Ghanaian subjects.Methods:Cross-sectional data of 5282 rural,urban and migrant participants from the Research on Obesity and Diabetes among African Migrants(also known as RODAM)study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus(T2DM),waist-to-hip ratio,and 10-year predicted risk of atherosclerotic cardiovascular disease(ASCVD).Results:Both FLI and the proportion with an FLI indicative of MAFLD steatosis(FLI≥60)were higher in migrants compared with non-migrants.Prevalence of elevated FLI(FLI≥60)in non-migrant males was 4.2%compared to 28.9%in migrants.For females,a similar gradient was observed,from 13.6%to 36.6%respectively.Compared to rural residents,the odds for a FLI≥60 were higher in migrants living in urban Europe(odds ratio[OR]9.02,95%confidence interval[CI]:5.02–16.20 for men,and 4.00,95%CI:3.00–5.34 for women).Compared to controls,the ORs for FLI≥60 were 2.43(95%CI:1.73–3.41)for male T2DM cases and 2.02(95%CI:1.52–2.69)for female T2DM cases.One-unit higher FLI was associated with an elevated(≥7.5%)10-year ASCVD risk(OR:1.051,95%CI:1.041–1.062 for men,and 1.020,95%CI:1.015–1.026 for women).Conclusions:FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas,through urban areas,to Europe.Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.
