13 research outputs found
Menopausal status and distensibility of the common carotid artery
Although several studies have shown that exogenous estrogens have
beneficial effects on arterial characteristics, the effect of endogenous
estrogen on the vascular system is still unknown. In this study,
distensibility, an indicator of arterial elasticity, of the common carotid
artery was compared in pre- and postmenopausal women. The study comprised
93 premenopausal and 93 postmenopausal women of similar age (range, 43 to
55 years). Women were selected from respondents to a mailed questionnaire
about the menopause, which was sent to all women aged 40 to 60 years in
the Dutch town of Zoetermeer (n=12 675). Postmenopausal women who were at
least 3 years past natural menopause or whose menses had stopped naturally
before age 48, were age-matched with premenopausal women with regular
menses and without menopausal complaints. The selection aimed at
maximizing the contrast in estrogen status between pre- and postmenopausal
women of the same age. Distensibility of the carotid artery was measured
noninvasively with B-mode ultrasound and a vessel wall movement detector
system. Arterial distensibility is expressed as the change in arterial
diameter (distension, DeltaD) with the cardiac cycle, adjusted for lumen
diameter, pulse pressure, and mean arterial blood pressure. Compared with
premenopausal women, postmenopausal women had significantly lower arterial
distension (DeltaD 370.5 microm [SE 9.5] versus 397.3 microm [SE 9.6]).
These results suggest that the distensibility of the common carotid artery
is negatively affected by natural menopause in presumed healthy women
Association between arterial stiffness and atherosclerosis: the Rotterdam Study
BACKGROUND AND PURPOSE: Studies of the association between arterial
stiffness and atherosclerosis are contradictory. We studied stiffness of
the aorta and the common carotid artery in relation to several indicators
of atherosclerosis. METHODS: This study was conducted within the Rotterdam
Study in >3000 elderly subjects aged 60 to 101 years. Aortic stiffness was
assessed by measuring carotid-femoral pulse wave velocity, and common
carotid artery stiffness was assessed by measuring common carotid
distensibility. Atherosclerosis was assessed by common carotid
intima-media thickness, plaques in the carotid artery and in the aorta,
and the presence of peripheral arterial disease. Data were analyzed by
ANCOVA with adjustment for age, sex, mean arterial pressure, and heart
rate. RESULTS: Both aortic and common carotid artery stiffness were found
to have a strong positive association with common carotid intima-media
thickness, severity of plaques in the carotid artery, and severity of
plaques in the aorta (P: for trend <0.01 for all associations). Subjects
with peripheral arterial disease had significantly increased aortic
stiffness (P:=0.001) and borderline significantly increased common carotid
artery stiffness (P:=0.08) compared with subjects without peripheral
arterial disease. Results were similar after additional adjustment for
cardiovascular risk factors and after exclusion of subjects with prevalent
cardiovascular disease. CONCLUSIONS: This population-based study shows
that arterial stiffness is strongly associated with atherosclerosis at
various sites in the vascular tree
PIRCHE-II is related to graft failure after kidney transplantation
Individual HLA mismatches may differentially impact graft survival after kidney transplantation. Therefore, there is a need for a reliable tool to define permissible HLA mismatches in kidney transplantation. We previously demonstrated that donor-derived Predicted Indirectly ReCognizable HLA Epitopes presented by recipient HLA class II (PIRCHE-II) play a role in de novo donor-specific HLA antibodies formation after kidney transplantation. In the present Dutch multi-center study, we evaluated the possible association between PIRCHE-II and kidney graft failure in 2,918 donor-recipient couples that were transplanted between 1995 and 2005. For these donors-recipients couples, PIRCHE-II numbers were related to graft survival in univariate and multivariable analyses. Adjusted for confounders, the natural logarithm of PIRCHE-II was associated with a higher risk for graft failure [hazard ratio (HR): 1.13, 95% CI: 1.04-1.23, p = 0.003]. When analyzing a subgroup of patients who had their first transplantation, the HR of graft failure for ln(PIRCHE-II) was higher compared with the overall cohort (HR: 1.22, 95% CI: 1.10-1.34, p < 0.001). PIRCHE-II demonstrated both early and late effects on graft failure in this subgroup. These data suggest that the PIRCHE-II may impact graft survival after kidney transplantation. Inclusion of PIRCHE-II in donor-selection criteria may eventually lead to an improved kidney graft survival
Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer
Introduction Cardiovascular disease (CVD) is an
important cause of death in breast cancer survivors.
Some breast cancer treatments including anthracyclines,
trastuzumab and radiotherapy can increase the risk of
CVD, especially for patients with pre-existing CVD risk
factors. Early identification of patients at increased CVD
risk may allow switching to less cardiotoxic treatments,
active surveillance or treatment of CVD risk factors. One of
the strongest independent CVD risk factors is the presence
and extent of coronary artery calcifications (CAC). In
clinical practice, CAC are generally quantified on ECGtriggered cardiac CT scans. Patients with breast cancer
treated with radiotherapy routinely undergo radiotherapy
planning CT scans of the chest, and those scans could
provide the opportunity to routinely assess CAC before a
potentially cardiotoxic treatment. The Bragatston study
aims to investigate the association between calcifications
in the coronary arteries, aorta and heart valves (hereinafter
called âcardiovascular calcificationsâ) measured
automatically on planning CT scans of patients with breast
cancer and CVD risk.
Methods and analysis In a first step, we will optimise
and validate a deep learning algorithm for automated
quantification of cardiovascular calcifications on
planning CT scans of patients with breast cancer.
Then, in a multicentre cohort study (University Medical
Center Utrecht, Utrecht, Erasmus MC Cancer Institute,
Rotterdam and Radboudumc, Nijmegen, The Netherlands),
the association between cardiovascular calcifications
measured on planning CT scans of patients with breast
cancer (nâ16 000) and incident (non-)fatal CVD events
will be evaluated. To assess the added predictive value of
these calcifications over traditional CVD risk factors and
treatment characteristics, a case-cohort analysis will be
performed among all cohort members diagnosed with a
CVD event during follow-up (nâ200) and a random sample
of the baseline cohort (nâ600).
Ethics and dissemination The Institutional Review
Boards of the participating hospitals decided that the
Medical R
Antibodies against ARHGDIB are associated with long-term kidney graft loss
The clinical significance of nonâHLA antibodies on renal allograft survival is a matter of
debate, due to differences in reported results and lack of largeâscale studies incorporating analysis of multiple nonâHLA antibodies simultaneously. We developed a multiplex nonâHLA antibody assay against 14 proteins highly expressed in the kidney. In
this study, the presence of pretransplant nonâHLA antibodies was corre
Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients
Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient\'s HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals
Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients
Whereas regular allocation avoids unacceptable mismatches on the donor organ, allocation to highly sensitized patients within the Eurotransplant Acceptable Mismatch (AM) program is based on the patient's HLA phenotype plus acceptable antigens. These are HLA antigens to which the patient never made antibodies, as determined by extensive laboratory testing. AM patients have superior long-term graft survival compared with highly sensitized patients in regular allocation. Here, we questioned whether the AM program also results in lower rejection rates. From the PROCARE cohort, consisting of all Dutch kidney transplants in 1995-2005, we selected deceased donor single transplants with a minimum of 1 HLA mismatch and determined the cumulative 6-month rejection incidence for patients in AM or regular allocation. Additionally, we determined the effect of minimal matching criteria of 1 HLA-B plus 1 HLA-DR, or 2 HLA-DR antigens on rejection incidence. AM patients showed significantly lower rejection rates than highly immunized patients in regular allocation, comparable to nonsensitized patients, independent of other risk factors for rejection. In contrast to highly sensitized patients in regular allocation, minimal matching criteria did not affect rejection rates in AM patients. Allocation based on acceptable antigens leads to relatively low-risk transplants for highly sensitized patients with rejection rates similar to those of nonimmunized individuals
Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium
Aims: Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear. Methods and results: An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration (n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events. Conclusion: Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints
Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands
Objectives:\ud
Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the perspective of the healthcare payer in The Netherlands.\ud
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Methods:\ud
A previously constructed Markov state-transition model was adapted and updated with costs and utilities relevant to the Dutch setting. The cost-effectiveness of RDN was compared with standard of care (SoC) for patients with resistant hypertension. The efficacy of RDN treatment was modeled as a reduction in the risk of cardiovascular events associated with a lower systolic blood pressure (SBP).\ud
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Results:\ud
Treatment with RDN compared to SoC gave an incremental quality-adjusted life year (QALY) gain of 0.89 at an additional cost of âŹ1315 over a patientâs lifetime, resulting in a base case incremental cost-effectiveness ratio (ICER) of âŹ1474. Deterministic and probabilistic sensitivity analyses (PSA) showed that treatment with RDN therapy was cost-effective at conventional willingness-to-pay thresholds (âŹ10,000â80,000/QALY).\ud
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Conclusion:\ud
RDN is a cost-effective intervention for patients with resistant hypertension in The Netherlands