Symptoms of Depression, Anxiety, and Posttraumatic Stress among Patients with Cardiac Pacemakers

Despite being a prerequisite for tailoring specific therapeutic interventions, knowledge of pattern and prevalence of clinically significant psychiatric symptomatology among patients with cardiac pacemakers (PMs), especially of symptoms of posttraumatic stress, is limited. We studied symptoms of depression, anxiety, and posttraumatic stress among PM patients (PM due to syncope or presyncope) compared to participants of (i) a cardiac, (ii) a chronic disease, and (iii) a healthy control group. Symptoms of depression, anxiety and posttraumatic stress were measured by validated self-report scales at least 6 months after implantation of the PM (PM group; n = 38), percutaneous coronary intervention (PCI; PCI control group; n = 23), and first dialysis (Dialysis control group; n = 17). Blood donors constituted the Healthy control group (n = 42). Both PM, PCI, and dialysis patients reported depressive symptoms above clinical cut-off more frequently than the healthy controls (16.2, 26.1, 41.2, and 0%, respectively; p < 0.001). Self-report of symptoms of anxiety and posttraumatic stress did not differ significantly across study groups. However, a non-negligible proportion of PM patients reported on symptoms of posttraumatic stress of anticipated clinical relevance. Identification and treatment of depression deserves attention in clinical routine in all three patient populations. Further study of posttraumatic stress in PM patients seems advisable

High-density lipoprotein subfractions: Much ado about nothing or clinically important?

High-density lipoproteins (HDL) are a heterogenous group of plasma molecules with a large variety in composition. There is a wide specter in lipid content and the number of different proteins that has been associated with HDL is approaching 100. Given this heterogeneity and the fact that the total amount of HDL is inversely related to the risk of coronary heart disease (CHD), there has been increasing interest in the function of specific HDL subgroups and in what way measuring and quantifying these subgroups could be of clinical importance in determining individual CHD risk. If certain subgroups appear to be more protective than others, it may also in the future be possible to pharmacologically increase beneficial and decrease harmful subgroups in order to reduce CHD risk. In this review we give a short historical perspective, summarize some of the recent clinical findings regarding HDL subclassifications and discuss why such classification may or may not be of clinical relevance

Plasma Lipopolysaccharide Is Closely Associated With Glycemic Control and Abdominal Obesity: Evidence from bariatric surgery

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Telemonitoring and quality of life in patients after 12 months following a pacemaker implant: The Nordland study, a randomised trial

Source at https://doi.org/10.3390/ijerph16112001. The purpose of this study was to analyse the health-related quality of life (HRQoL) of patients followed up using a remote device-monitoring system (TM) compared to patients followed up through standard outpatient visits (HM), 12 months after the implantation of a pacemaker. This was a trial design that used the EuroQol-5D Questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHF). The HRQoL of a cohort of 50 consecutive patients randomly allocated to one of the two follow-up modalities was measured at baseline and then during follow-up, 12 months after the pacemaker implantation. Eventually, 23 patients were followed-up through standard outpatient visits, while 23 used a remote monitoring system. Results: The baseline clinical characteristics and health-related quality of life of the patients from both groups were observed to be statistically similar. Twelve months after the pacemaker implantation, both groups showed statistically significant improvements in the baseline parameters based on the MLHF. The patients followed up through hospital visits showed a greater increase in MLHF-HRQoL after 12 months, although the increase was not significantly greater than that of the TM group. Furthermore, the frequencies of emergency visits and re-hospitalisations did not differ between the groups

Granulocyte and monocyte CD11b expression during plasma separation is dependent on complement factor 5 (C5) – an ex vivo study with blood from a C5-deficient individual

This is the pre-peer reviewed version of the following article: Hardersen, R., Enebakk, T., Christiansen, D., Bergseth, G., Brekke, L.-O., Mollnes, T.E., ... Hovland, A.W. (2018). Granulocyte and monocyte CD11b expression during plasma separation is dependent on complement factor 5 (C5) ? an ex vivo study with blood from a C5-deficient individual. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 126(4), 342-352, which has been published in final form at https://doi.org/10.1111/apm.12821. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.The aim of the study was to investigate the role of complement factor 5 (C5) in reactions elicited by plasma separation using blood from a C5‐deficient (C5D) individual, comparing it to C5‐deficient blood reconstituted with C5 (C5DR) and blood from healthy donors. Blood was circulated through an ex vivo plasma separation model. Leukocyte CD11b expression and leukocyte–platelet conjugates were measured by flow cytometry during a 30‐min period. Other markers were assessed during a 240‐min period. Granulocyte and monocyte CD11b expression did not increase in C5D blood during plasma separation. In C5DR samples granulocytes CD11b expression, measured by mean fluorescence intensity (MFI), increased from 10481 ± 6022 (SD) to 62703 ± 4936, and monocytes CD11b expression changed from 13837 ± 7047 to 40063 ± 713. Granulocyte–platelet conjugates showed a 2.5‐fold increase in the C5DR sample compared to the C5D sample. Monocyte–platelet conjugates increased independently of C5. In the C5D samples, platelet count decreased from 210 × 109/L (201–219) (median and range) to 51 × 109/L (50–51), and C3bc increased from 14 CAU/mL (21–7) to 198 CAU/mL (127–269), whereas TCC formation was blocked during plasma separation. In conclusion, up‐regulation of granulocyte and monocyte CD11b during plasma separation was C5‐dependent. The results also indicate C5 dependency in granulocyte–platelet conjugates formation

Major increase in microbiota-dependent proatherogenic metabolite TMAO one year after bariatric surgery

Background: Trimethylamine-N-oxide (TMAO) is formed in the liver from trimethylamine (TMA), a product exclusively generated by the gut microbiota from dietary phosphatidylcholine and carnitine. An alternative pathway of TMAO formation from carnitine is via the microbiota-dependent intermediate γ-butyrobetaine (γBB). Elevated TMAO levels are associated with cardiovascular disease (CVD), but little is known about TMAO in obesity. Given the proposed contribution of microbiota alterations in obesity and type 2 diabetes (T2D), we investigated the potential impact of obesity, lifestyle-induced weight loss, and bariatric surgery on plasma levels of TMAO, its microbiota-dependent intermediate γBB, and its diet-dependent precursors carnitine and choline. Methods: TMAO, γBB, carnitine, and choline were measured by high-performance liquid chromatography in 34 obese individuals (17 with and 17 without T2D) undergoing bariatric surgery and 17 controls. Results: TMAO was not elevated in obese patients or reduced by lifestyle interventions but increased approximately twofold after bariatric surgery. Similar to TMAO, plasma levels of γBB were not influenced by lifestyle interventions but increased moderately after bariatric surgery. In contrast, carnitine and choline, which are abundant in nutrients, such as in red meat and eggs, and not microbiota dependent, were reduced after lifestyle interventions and rebounded after bariatric surgery. Conclusions: The major increase in TMAO after bariatric surgery was unexpected because high TMAO levels have been linked to CVD, whereas bariatric surgery is known to reduce CVD risk. Prospective studies of gut microbiota composition and related metabolites in relation to long-term cardiovascular risk after bariatric surgery are warranted.publishedVersio

Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: The Tromsø Study 2015-2016

Aims - To compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017. Methods - We included participants from the Norwegian population-based Tromsø Study (2015–2016) aged 40–69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg). Results - The total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk. Conclusion - The population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines

Achievements of primary prevention targets in individuals with high risk of cardiovascular disease: an 8-year follow-up of the Tromsø study

Aims To study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among individuals with high CVD risk in a general population. Methods and results We followed 2524 women and men aged 40–79 years with high risk of CVD attending the population-based Tromsø study in 2007–08 (Tromsø6) to their participation in the next survey in 2015–16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol <5 mmol/L, 27.3% for LDL cholesterol <3 mmol/L, 43.4% for BP <140/90 (<135/85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement. Conclusion We found an overall improvement in CVD risk factors among high-risk individuals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge

Intestinal fatty acid binding protein is associated with cardiac function and gut dysbiosis in chronic heart failure

Background: The gut microbiota in patients with chronic heart failure (HF) is characterized by low bacterial diversity and reduced ability to synthesize beneficial metabolites. These changes may facilitate leakage of whole bacteria or bacterial products from the gut into the bloodstream, which may activate the innate immune system and contribute to the low-grade inflammation seen in HF. In this exploratory cross-sectional study, we aimed to investigate relationships between gut microbiota diversity, markers of gut barrier dysfunction, inflammatory markers, and cardiac function in chronic HF patients. Methods: In total, 151 adult patients with stable HF and left ventricular ejection fraction (LVEF) < 40% were enrolled. We measured lipopolysaccharide (LPS), LPS-binding protein (LBP), intestinal fatty acid binding protein (I-FABP), and soluble cluster of differentiation 14 (sCD14) as markers of gut barrier dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above median was used as a marker of severe HF. LVEF was measured by 2D-echocardiography. Stool samples were sequenced using 16S ribosomal RNA gene amplification. Shannon diversity index was used as a measure of microbiota diversity. Results: Patients with severe HF (NT-proBNP > 895 pg/ml) had increased I-FABP (p < 0.001) and LBP (p = 0.03) levels. ROC analysis for I-FABP yielded an AUC of 0.70 (95% CI 0.61–0.79, p < 0.001) for predicting severe HF. A multivariate logistic regression model showed increasing I-FABP levels across quartiles of NT-proBNP (OR 2.09, 95% CI 1.28−3.41, p = 0.003). I-FABP was negatively correlated with Shannon diversity index (rho = −0.30, p = <0.001), and the bacterial genera Ruminococcus gauvreauii group, Bifidobacterium, Clostridium sensu stricto, and Parasutterella, which were depleted in patients with severe HF. Conclusions: In patients with HF, I-FABP, a marker of enterocyte damage, is associated with HF severity and low microbial diversity as part of an altered gut microbiota composition. I-FABP may reflect dysbiosis and may be a marker of gut involvement in patients with HF

Long-Term Socioeconomic Impact of Informal Care Provided to Patients with Pacemakers: Remote vs. Conventional Monitoring

The impact of informal care immediately after pacemaker (PM) implantation has been well established; however, not much is known about its long-term effects. The present study compared personal characteristics, associated problems, workloads, time, and costs related to informal care provided to patients with PM under remote monitoring (RM) vs. conventional monitoring (CM) in the hospital, five years after implantation. The PONIENTE study was a controlled, non-randomized or masked clinical trial conducted with information obtained from the perspective of informal caregivers. Data were collected at 12 and 60 months after PM implantation. The patients in the study were assigned to two different groups: remote monitoring (RM) and conventional monitoring (CM). The “Disability, personal autonomy, and dependency situations survey” (EDAD) was administered to collect information on sociodemographic characteristics, time, care difficulties, health status, professional aspects, and impact on economic, family, or leisure aspects of the main caregivers providing care to patients with pacemakers. After five years, 55 patients completed the study (RM = 21; CM = 34). The average age was 63.14 years (SD = 14.90), 96% of them were women, and the most predominant marital status was married (72%). Informal caregivers lived in the homes of the patients in 70% of cases, and 88% indicated that they had to provide care six to seven days a week. The average cost per patient during the monitoring period studied was 13.17% lower in the RM group than in the CM group, and these differences were not statistically significant (p = 0.35). This study found similar results in the two groups under study with respect to sociodemographic characteristics, workload, time, and problems associated with health, leisure and family members. The costs associated with care were higher in the CM group; however, these differences were not statistically significant