Additive influence of genetic predisposition and conventional risk factors in the incidence of coronary heart disease: a population-based study in Greece

Objectives: An additive genetic risk score (GRS) for coronary heart disease (CHD) has previously been associated with incident CHD in the population-based Greek European Prospective Investigation into Cancer and nutrition (EPIC) cohort. In this study, we explore GRS-‘environment’ joint actions on CHD for several conventional cardiovascular risk factors (ConvRFs), including smoking, hypertension, type-2 diabetes mellitus (T2DM), body mass index (BMI), physical activity and adherence to the Mediterranean diet. Design: A case–control study. Setting: The general Greek population of the EPIC study. Participants and outcome measures 477 patients with medically confirmed incident CHD and 1271 controls participated in this study. We estimated the ORs for CHD by dividing participants at higher or lower GRS and, alternatively, at higher or lower ConvRF, and calculated the relative excess risk due to interaction (RERI) as a measure of deviation from additivity. Results: The joint presence of higher GRS and higher risk ConvRF was in all instances associated with an increased risk of CHD, compared with the joint presence of lower GRS and lower risk ConvRF. The OR (95% CI) was 1.7 (1.2 to 2.4) for smoking, 2.7 (1.9 to 3.8) for hypertension, 4.1 (2.8 to 6.1) for T2DM, 1.9 (1.4 to 2.5) for lower physical activity, 2.0 (1.3 to 3.2) for high BMI and 1.5 (1.1 to 2.1) for poor adherence to the Mediterranean diet. In all instances, RERI values were fairly small and not statistically significant, suggesting that the GRS and the ConvRFs do not have effects beyond additivity. Conclusions: Genetic predisposition to CHD, operationalised through a multilocus GRS, and ConvRFs have essentially additive effects on CHD risk

Kortykosteroidy a ryzyko złamania szyjki kości udowej u osób w podeszłym wieku cierpiących na choroby układu oddechowego: wyniki analizy greckiej kohorty badania EPIC

WSTĘP: Wraz ze starzeniem się populacji w najbliższych latach należy spodziewać się wzrostu częstości występowania osteoporozy i chorób układu oddechowego. Kortykosteroidy — leki zwiększające ryzyko osteoporozy, są stosowane w różnych postaciach u chorych na schorzenia układu oddechowego, bez względu na zaawansowany wiek i zwiększone ryzyko złamań. Celem badania była ocena ryzyka złamania szyjki kości udowej u osób w wieku podeszłym, leczonych kortykosteroidami ze wskazań pulmonologicznych, z uwzględnieniem leków wziewnych. MATERIAŁ I METODY: Dane na temat nowych złamań szyjki kości udowej zbierano za pomocą aktywnej obserwacji prospektywnej uczestników greckiego segmentu badania EPIC-Greece (EPIC-Greece, European Prospective Investigation into Cancer and Nutrition), którzy w momencie rekrutacji osiągnęli wiek co najmniej 60 lat i deklarowali chorobę układu oddechowego rozpoznaną przez lekarza. Dane na temat statusu socjoekonomicznego, stylu życia, stanu zdrowia oraz stosowania kortykosteroidów gromadzono za pomocą kwestionariuszy na początku i końcu badania. W celu oceny współczynnika ryzyka (HR) zastosowano model regresji Coxa, z uwzględnieniem czynników zakłócających. WYNIKI: Stwierdzono wzrost ryzyka złamania szyjki kości udowej związany ze stosowaniem kortykosteroidów (HR: 1,68; 95% CI: 0,85–3,34). Zwiększone ryzyko utrzymywało się, gdy analizę ograniczono do osób przyjmujących jakiekolwiek kortykosteroidy z powodu chorób obturacyjnych (HR: 1,40; 95% CI: 0,64–3,06) oraz do osób przyjmujących wyłącznie leki wziewne (HR: 1,58; 95% CI: 0,71–3,50). Ta pozytywna zależność nie osiągnęła jednak poziomu istotności statystycznej, prawdopodobnie z powodu małej liczby osób ze złamaniami. WNIOSKI: Ryzyko złamania szyjki kości udowej powinno być brane pod uwagę w sytuacji, gdy zaleca się stosowanie kortykosteroidów ze wskazań pulmonologicznych osobom w podeszłym wieku. Problem ten dotyczy również leków wziewnych.WSTĘP: Wraz ze starzeniem się populacji w najbliższych latach należy spodziewać się wzrostu częstości występowania osteoporozy i chorób układu oddechowego. Kortykosteroidy — leki zwiększające ryzyko osteoporozy, są stosowane w różnych postaciach u chorych na schorzenia układu oddechowego, bez względu na zaawansowany wiek i zwiększone ryzyko złamań. Celem badania była ocena ryzyka złamania szyjki kości udowej u osób w wieku podeszłym, leczonych kortykosteroidami ze wskazań pulmonologicznych, z uwzględnieniem leków wziewnych. MATERIAŁ I METODY: Dane na temat nowych złamań szyjki kości udowej zbierano za pomocą aktywnej obserwacji prospektywnej uczestników greckiego segmentu badania EPIC-Greece (EPIC-Greece, European Prospective Investigation into Cancer and Nutrition), którzy w momencie rekrutacji osiągnęli wiek co najmniej 60 lat i deklarowali chorobę układu oddechowego rozpoznaną przez lekarza. Dane na temat statusu socjoekonomicznego, stylu życia, stanu zdrowia oraz stosowania kortykosteroidów gromadzono za pomocą kwestionariuszy na początku i końcu badania. W celu oceny współczynnika ryzyka (HR) zastosowano model regresji Coxa, z uwzględnieniem czynników zakłócających. WYNIKI: Stwierdzono wzrost ryzyka złamania szyjki kości udowej związany ze stosowaniem kortykosteroidów (HR: 1,68; 95% CI: 0,85–3,34). Zwiększone ryzyko utrzymywało się, gdy analizę ograniczono do osób przyjmujących jakiekolwiek kortykosteroidy z powodu chorób obturacyjnych (HR: 1,40; 95% CI: 0,64–3,06) oraz do osób przyjmujących wyłącznie leki wziewne (HR: 1,58; 95% CI: 0,71–3,50). Ta pozytywna zależność nie osiągnęła jednak poziomu istotności statystycznej, prawdopodobnie z powodu małej liczby osób ze złamaniami. WNIOSKI: Ryzyko złamania szyjki kości udowej powinno być brane pod uwagę w sytuacji, gdy zaleca się stosowanie kortykosteroidów ze wskazań pulmonologicznych osobom w podeszłym wieku. Problem ten dotyczy również leków wziewnych

Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure

Background: During COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure. // Methods: We retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models. // Results: One hundred thirty-two patients with a median (IQR) PaO2/FiO2 ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO2/FiO2 ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL]. // Conclusions: HFNC treatment was successful in almost half of the patients with severe COVID-19- related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure

Prevalence of Overweight and Obesity and Associated Diet-Related Behaviours and Habits in a Representative Sample of Adolescents in Greece

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages

Weight Change and the Onset of Cardiovascular Diseases: Emulating Trials Using Electronic Health Records.

BACKGROUND: Cross-sectional measures of body mass index (BMI) are associated with cardiovascular disease (CVD) incidence, but less is known about whether weight change affects the risk of CVD. METHODS: We estimated the effect of 2-y weight change interventions on 7-y risk of CVD (CVD death, myocardial infarction, stroke, hospitalization from coronary heart disease, and heart failure) by emulating hypothetical interventions using electronic health records. We identified 138,567 individuals with 45-69 years of age without chronic disease in England from 1998 to 2016. We performed pooled logistic regression, using inverse-probability weighting to adjust for baseline and time-varying confounders. We categorized each individual into a weight loss, maintenance, or gain group. RESULTS: Among those of normal weight, both weight loss [risk difference (RD) vs. weight maintenance = 1.5% (0.3% to 3.0%)] and gain [RD = 1.3% (0.5% to 2.2%)] were associated with increased risk for CVD compared with weight maintenance. Among overweight individuals, we observed moderately higher risk of CVD in both the weight loss [RD = 0.7% (-0.2% to 1.7%)] and the weight gain group [RD = 0.7% (-0.1% to 1.7%)], compared with maintenance. In the obese, those losing weight showed lower risk of coronary heart disease [RD = -1.4% (-2.4% to -0.6%)] but not of stroke. When we assumed that chronic disease occurred 1-3 years before the recorded date, estimates for weight loss and gain were attenuated among overweight individuals; estimates for loss were lower among obese individuals. CONCLUSION: Among individuals with obesity, the weight-loss group had a lower risk of coronary heart disease but not of stroke. Weight gain was associated with increased risk of CVD across BMI groups. See video abstract at, http://links.lww.com/EDE/B838

Garlic consumption in relation to colorectal cancer risk and to alterations of blood bacterial DNA

PURPOSE: Garlic consumption has been inversely associated to intestinal adenoma (IA) and colorectal cancer (CRC) risk, although evidence is not consistent. Gut microbiota has been implied in CRC pathogenesis and is also influenced by garlic consumption. We analyzed whether dietary garlic influence CRC risk and bacterial DNA in blood. METHODS: We conducted a case-control study in Italy involving 100 incident CRC cases, 100 IA and 100 healthy controls matched by center, sex and age. We used a validated food frequency questionnaire to assess dietary habits and garlic consumption. Blood bacterial DNA profile was estimated using qPCR and16S rRNA gene profiling. We derived odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of IA and CRC according to garlic consumption from multiple conditional logistic regression. We used Mann-Whitney and chi-square tests to evaluate taxa differences in abundance and prevalence. RESULTS: The OR of CRC for medium/high versus low/null garlic consumption was 0.27 (95% CI = 0.11-0.66). Differences in garlic consumption were found for selected blood bacterial taxa. Medium/high garlic consumption was associated to an increase of Corynebacteriales order, Nocardiaceae family and Rhodococcus genus, and to a decrease of Family XI and Finegoldia genus. CONCLUSIONS: The study adds data on the protective effect of dietary garlic on CRC risk. Moreover, it supports evidence of a translocation of bacterial material to bloodstream and corroborates the hypothesis of a diet-microbiota axis as a mechanism behind the role of garlic in CRC prevention

Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort

OBJECTIVE: To evaluate antithrombotic (AT) use in individuals with atrial fibrillation (AF) and at high risk of stroke (CHA2DS2-VASc score ≥2) and investigate whether pre-existing AT use may improve COVID-19 outcomes. METHODS: Individuals with AF and CHA2DS2-VASc score ≥2 on 1 January 2020 were identified using electronic health records for 56 million people in England and were followed up until 1 May 2021. Factors associated with pre-existing AT use were analysed using logistic regression. Differences in COVID-19-related hospitalisation and death were analysed using logistic and Cox regression in individuals with pre-existing AT use versus no AT use, anticoagulants (AC) versus antiplatelets (AP), and direct oral anticoagulants (DOACs) versus warfarin. RESULTS: From 972 971 individuals with AF (age 79 (±9.3), female 46.2%) and CHA2DS2-VASc score ≥2, 88.0% (n=856 336) had pre-existing AT use, 3.8% (n=37 418) had a COVID-19 hospitalisation and 2.2% (n=21 116) died, followed up to 1 May 2021. Factors associated with no AT use included comorbidities that may contraindicate AT use (liver disease and history of falls) and demographics (socioeconomic status and ethnicity). Pre-existing AT use was associated with lower odds of death (OR=0.92, 95% CI 0.87 to 0.96), but higher odds of hospitalisation (OR=1.20, 95% CI 1.15 to 1.26). AC versus AP was associated with lower odds of death (OR=0.93, 95% CI 0.87 to 0.98) and higher hospitalisation (OR=1.17, 95% CI 1.11 to 1.24). For DOACs versus warfarin, lower odds were observed for hospitalisation (OR=0.86, 95% CI 0.82 to 0.89) but not for death (OR=1.00, 95% CI 0.95 to 1.05). CONCLUSIONS: Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF