Cardiovascular outcomes of cancer patients in rural Australia

BackgroundCancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital.MethodsThis was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis.Results268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself.ConclusionThere is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors

The Role of Pathological Aging in Cardiac and Pulmonary Fibrosis

Aging promotes a range of degenerative pathologies characterized by progressive losses of tissue and/or cellular function. Fibrosis is the hardening, overgrowth and scarring of various tissues characterized by the accumulation of extracellular matrix components. Aging is an important predisposing factor common for fibrotic heart and respiratory disease. Age-related processes such as senescence, inflammaging, autophagy and mitochondrial dysfunction are interconnected biological processes that diminish the regenerative capacity of the aged heart and lung and have been shown to play a crucial role in cardiac fibrosis and idiopathic pulmonary fibrosis. This review focuses on these four processes of aging in relation to their role in fibrosis. It has long been established that the heart and lung are linked both functionally and anatomically when it comes to health and disease, with an ever-expanding aging population, the incidence of fibrotic disease and therefore the number of fibrosis-related deaths will continue to rise. There are currently no feasible therapies to treat the effects of chronic fibrosis therefore highlighting the importance of exploring the processes of aging and its role in inducing and exacerbating fibrosis of each organ. The focus of this review may help to highlight potential avenues of therapeutic exploration</p

Elevated parathyroid hormone predicts high asymmetric dimethylarginine (ADMA) concentrations in obese diabetic patients

Impaired vascular endothelial function has been suggested as a possible mechanism to explain the nexus between vitamin D deficiency and increased adverse cardiovascular outcomes. In addition, elevated PTH is also found associated with increased arterial stiffness and impaired endothelial function, improved after lowering of PTH with parathyroidectomy. Previously, we have shown that in an ageing population, low vitamin D levels are associated with elevated plasma concentrations of asymmetric dimethylarginine (ADMA). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), has been shown to be a critical circulating biomarker of endothelial function, and adverse cardiovascular outcomes. However, we did not assess the relationship between ADMA and PTH. Given, the high prevalence of low vitamin D and high parathyroid hormone (PTH) levels in obese diabetic patients, we sought to examine in this study, whether the relationship between ADMA and vitamin D is independent of PTH levels in obese diabetic

Elevated parathyroid hormone predicts high asymmetric dimethylarginine (ADMA) concentrations; independent of vitamin D status

Vitamin D deficiency and secondary hyperparathyroidism, either in combination or independently, have been associated with increased cardiovascular (CV) events. We have demonstrated that low 25-hydroxyvitamin D3 (25(OH)D3) concentrations are associated with increased concentrations of asymmetric dimethylarginine (ADMA), an eNOS inhibitor and biomarker of increased CV morbidity and mortality. It remains unclear if this relationship is independent of parathyroid hormone (PTH). Obese diabetic subjects frequently have low vitamin D and high parathyroid hormone (PTH) concentrations. We have currently sought to evaluate the PTH:ADMA relationship in normal subjects and compare this relationship with obese diabetics (a group characterized by vitamin D deficiency and high PTH levels)