Helserelatert livskvalitet og komplikasjoner hos pasienter etter hjertetransplantasjon : En longitudinell observasjonsstudie

Formål: Evaluere helserelatert livskvalitet (HQoL) longitudinelt etter hjertetransplantasjon og i tillegg undersøke sammenhenger mellom kliniske og sosiodemografiske variabler og endring i HQoL. Samtidig å evaluere prognostiske faktorer for utvikling av komplikasjoner og død i forløpet etter HTx. Teoretisk forankring: Wilson & Cleary’s livskvalitetsmodell ble brukt for å undersøke sammenheng mellom ulike forklaringsvariabler og HQoL. Teori om HQoL etter HTx, SF-36, samt teori om prognose og forløp etter hjertetransplantasjon ble anvendt. Metode: En longitudinell observasjonsstudie ble gjennomført for å studere endring i HQoL over seks år, målt med SF-36 i en gruppe fulgt opptil 22 år etter HTx. Bivariat og multippel lineær regresjonsanalyse ble brukt for å evaluere assosiasjoner mellom kliniske og sosiodemografiske variabler og endring i HQoL. I tillegg ble prognostiske variabler assosiert som prediktorer for koronarsykdom, redusert nyrefunksjon, kreft og død, evaluert med bivariat og multippel logistisk regresjon, samt Cox regresjonsanalyse. Resultater: I en longitudinell studie og repeterte målinger, fant vi at pasienter etter HTx viste en signifikant reduksjon i fysiske helse (PCS) (p = 0.001), mens mental helsestatus (MCS) viste ingen signifikant reduksjon. Reduksjonen i PCS var mer markant for pasienter ≥ 57 år. Vi fant at alder var assosiert med reduksjon i fysisk funksjon (PF) og generell helse (GH). Kreatinin og donoralder var assosiert med reduksjon i henholdsvis PF og GH. Fysisk helse (PCS) var signifikant assosiert med redusert risiko for koronarsykdom (OR = 0.96, p = 0.018) og død (HR = 0.97, p = 0.011) i multivariate analyser justert for andre forklaringsvariabler. Ingen HQoL-variabler var assosiert med risiko for kreft eller redusert nyrefunksjon. Konklusjon: Pasientene viste en reduksjon i HQoL med størst reduksjon i fysiske variabler. Fysisk helse (PCS) var en prediktor for koronarsykdom og total dødelighet. Denne studien viste at HQoL kan være et viktig supplement i oppfølgingen og behandling av pasienter etter transplantasjon med en viktig prognostisk verdi

Index of microvascular resistance to assess the effect of rosuvastatin on microvascular function in women with chest pain and no obstructive coronary artery disease: A double-blind randomized study

Introduction - Many women undergoing coronary angiography for chest pain have no or only minimal coronary artery disease (CAD). However, despite the lack of obstructive CAD, they still have an increased risk of major adverse cardiovascular events. Pleiotropic effects of statins may influence microvascular function, but if statins improve microvascular function in unselected chest pain patients is not well studied. This study assessed microvascular function by using the thermodilution‐derived test “the index of microvascular resistance” (IMR) with the aim of determining the (i) IMR level in women with chest pain and non‐obstructive CAD and if (ii) IMR is modified by high‐dose statin treatment in these patients. Additional objectives were to identify the influence of statins on the health status as assessed with generic health questionnaires and on biomarkers of endothelial activation. Materials and methods - The study was a randomized, double‐blind, single‐center trial comparing 6 months of rosuvastatin treatment with placebo. In total, 66 women without obstructive CAD were included. Mean age was 52.7 years and 55.5 years in the placebo and rosuvastatin group, respectively. Microvascular function was assessed using the IMR, health status was assessed using the SF‐36 and EQ‐5D questionnaires, and biochemical values were assessed at baseline and 6 months later. Results and conclusions - In the placebo group IMR was 14.6 (SD 5.7) at baseline and 14.4 (SD 6.5) at follow‐up. In the rosuvastatin group IMR was 16.5 (SD 7.5) at baseline and 14.2 (SD 5.8) at follow‐up. IMR did not differ significantly between the two study groups at follow‐up controlled for preintervention values. C‐reactive protein (CRP) was comparable between the groups at baseline, while at follow‐up CRP was significantly lower in the rosuvastatin group compared to placebo [0.6 (±0.5) mg/L vs. 2.6 (±3.0) mg/L; p = 0.002]. Whereas rosuvastatin treatment for 6 months attenuated CRP levels, it did not improve microvascular function as assessed by IMR (Clinical Trials.gov NCT 01582165, EUDRACT 2011‐002630‐39.3tcAZ)

Rosuvastatin alters the genetic composition of the human gut microbiome

The gut microbiome contributes to the variation of blood lipid levels, and secondary bile acids are associated with the effect of statins. Yet, our knowledge of how statins, one of our most common drug groups, affect the human microbiome is scarce. We aimed to characterize the effect of rosuvastatin on gut microbiome composition and inferred genetic content in stool samples from a randomized controlled trial (n = 66). No taxa were significantly altered by rosuvastatin during the study. However, rosuvastatin-treated participants showed a reduction in the collective genetic potential to transport and metabolize precursors of the pro-atherogenic metabolite trimethylamine-N-oxide (TMAO, p p p < 0.05). Our data suggest that while rosuvastatin has a limited effect on gut microbiome composition, it could exert broader collective effects on the microbiome relevant to their function, providing a rationale for further studies of the influence of statins on the gut microbiome