159 research outputs found
Do We Need Another Look at Serum Uric Acid in Cardiovascular Disease? Serum Uric Acid as a Predictor of Outcomes in Acute Myocardial Infarction
On-admission serum uric acid predicts outcomes after acute myocardial infarction: systematic review and meta-analysis of prognostic studies
AIM:
To evaluate the prognostic value of serum uric acid (SUA) in acute myocardial infarction (AMI) patients. ----- METHODS:
Systematic review and random-effects meta-analysis of prognostic studies assessing AMI outcomes (death, major adverse cardiac events, MACE) in relation to on-admission SUA. ----- RESULTS:
Nine studies (7655 patients) were identified, 6 in the ST-segment elevation AMI patients treated with invasive revascularization and three in mixed AMI type cohorts with variable reperfusion strategies. "High" SUA (vs "low," different cut-offs) was univariately associated with higher short-term mortality (8 studies/6805 patients; odds ratio [OR], 3.24; 95% confidence interval [CI], 2.47-4.27) and incidence of MACE (7/6467; OR, 2.46; 95% CI, 1.84-3.27, moderate heterogeneity, mild bias), and with higher medium-term mortality (5/5194; OR, 2.69; 95% CI, 2.00-3.62, moderate heterogeneity, mild bias) and MACE (4/4299; OR, 1.93; 95% CI, 1.36-2.74, high heterogeneity, mild bias). It was independently associated with a higher short-term (4/3625; OR, 2.26, 95% CI, 1.85-2.77) and medium/long-term (3/2683; hazard ratio [HR], 1.30; 95% CI 1.01-1.68, moderate heterogeneity, mild bias) occurrence of poor outcomes (death/MACE). As a continuous variable (by 50 μmol/L), higher SUA was also independently associated with poorer medium/long-term outcomes (4/3533; HR, 1.19; 95% CI, 1.03-1.37, high heterogeneity, mild bias). All individual study effects (unadjusted or adjusted) were in the same direction, but differed in size. Heterogeneity was mainly due to the included AMI type and/or definition of MACE. All bias-corrected pooled effects remained significant. ----- CONCLUSION:
Based on the available data, high(er) on-admission SUA independently predicts worse short-term and medium/long-term outcomes after AMI. However, the number of data are modest and additional prospective studies are warranted
Oxidative stress parameters in plasma of Huntington's disease patients, asymptomatic Huntington's disease gene carriers and healthy subjects : a cross-sectional study
BACKGROUND : Animal data and postmortem studies suggest a role of oxidative stress in the Huntington's disease (HD), but in vivo human studies have been scarce. ----- AIM : To assess the presence of oxidative stress in HD patients and its occurrence relative to clinical symptoms. ----- METHODS : Oxidative stress markers were determined in plasma of HD patients (n = 19), asymptomatic HD gene carriers (with > 38 CAG repeats) (n = 11) and their respective sex and agematched healthy controls (n = 47 and n = 22) in a cross-sectional study. ----- RESULTS : With adjustment for age and sex, HD patients had higher plasma lipid peroxidation (LP) levels (ratio 1.20, 95% CI 1.09 to 1.32, p < 0.001) and lower reduced glutathione (GSH) levels (ratio 0.72, CI 0.55 to 0.94, p = 0.011) than their age and sex-matched controls. Although considerably younger, HD gene carriers did not differ from HD patients regarding LP and GSH levels, and had higher plasma LP (ratio 1.16, CI 1.02 to 1.32, p = 0.016) and lower GSH than their matched controls (ratio 0.73, CI 0.5 to 1.05). They had higher LP (ratio 1.18, CI 1.02 to 1.34, p = 0.019) and lower GSH (ratio 0.75, CI 0.51 to 1.11) than the healthy subjects matched to HD patients. ----- CONCLUSIONS : Oxidative stress is more pronounced in HD patients and asymptomatic HD gene carriers than in healthy subjects. Differences in plasma LP and GSH are in line with the brain findings in animal models of HD. Data suggest that oxidative stress occurs before the onset of the HD symptoms
Efficacy and tolerability of monocompound topical treatments for reduction of intraocular pressure in patients with primary open angle glaucoma or ocular hypertension: an overview of reviews
Aim To evaluate the existing evidence on relative efficacy
and tolerability of topical mono-compound intraocular
pressure (IOP)-lowering drugs in treatment of primary open
angle glaucoma (POAG) and ocular hypertension (OHT).
Methods In this systematic review of systematic reviews/
meta-analyses of randomized controlled trials a thorough
and sensitive search of PubMed, Embase and Cochrane
Databases was performed. Individual study methodological
quality and quality of evidence were assessed using
the AMSTAR checklist and the GRADE system, respectively.
The relationships between individual drugs were evaluated
based on the best available evidence.
Results Of the 133 initial non-duplicate records, 16 studies
met the inclusion criteria. Five achieved an overall
“moderate” (none achieved “high”) quality of evidence and
evaluated prostaglandin analogues (PGAs) – latanoprost,
travoprost, and bimatoprost; timolol; “other beta-blockers;”
carbonic anhydrase inhibitors (CAI) as a group or dorzolamide
separately; and brimonidine. “Moderate quality” refers
to efficacy and incidence of conjunctival hyperemia.
Quality of evidence regarding other tolerability aspects was
low. PGAs should be considered equivalent regarding efficacy,
but latanoprost was relevantly better tolerated than
the other two. Non-PGA compounds did not relevantly differ
between each other in either efficacy or safety. Timolol
and brimonidine were relevantly less effective than all PGAs.
The same was true for CAI vs bimatoprost. Regarding tolerability,
timolol was superior to all PGAs and brimonidine and
CAI were superior to bimatoprost.
Conclusion No high quality evidence on relative efficacy
and tolerability of the most commonly used mono-compound
IOP-lowering drugs for POAG/OHT exists. Moderate
quality evidence indicates latanoprost as a treatment with
the most favorable trade-off between benefits and harm
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