Krittanawong, Chayakrit

Introduction: Current dietary guidelines no longer recommend against egg consumption despite the high cholesterol content. However, considerable controversy remains on the relationship between high egg consumption and cardiovascular disease (CVD) risk. The objective of this systematic review and meta-analysis was to explore the association between egg consumption and CVD events. Methods: We systematically searched PubMed, Scopus, and the Cochrane Database of Systematic Reviews from database inception through April 2015 for observational studies with hazard ratio (HRs) or relative risks (RRs) and 95% confidence intervals (95% CI) that reported the association between egg consumption and CVD events which included coronary heart disease (CHD) and stroke. Data were extracted by one reviewer followed by independent screening and extraction of study characteristics and outcome data by two other reviewers. Conflicts were resolved through consensus. Random-effects meta-analyses were used to pool the hazard ratios or relative risks from the included studies. Subgroup analyses were performed to explore the potential sources of heterogeneity. The quality of the included studies and publication bias were assessed. Results: We identified 5 cross-sectional and 6 prospective studies with median follow-up of 13.1 years. A total of 301,339 individuals and 10,262 total CVD events were included with 7,225 CHD and 3,037 stroke cases. Compared to consumption of less than 1 egg/day, higher egg consumption was associated with an increased risk of CVD events (pooled HR, 1.43; 95% CI, 1.01-2.03; p=0.012; I 2 = 65.7% and pooled RR, 1.09; 95% CI, 0.89-1.34; p=0.145; I 2 = 41.4%). Conclusions: Our analysis suggests that higher consumption of eggs (more than 1 egg/day) may be associated with increased risk of cardiovascular disease. Large and diverse prospective community-based cohorts will be necessary to establish optimal dietary recommendations for public health.

AbstractBackground and ObjectivesSince publishing successful clinical trial results of mRNA coronavirus disease 2019 (COVID‐19) vaccines in December 2020, multiple reports have arisen about cardiovascular complications following the mRNA vaccination. This study provides an in‐depth account of various cardiovascular adverse events reported after the mRNA vaccines' first or second dose including pericarditis/myopericarditis, myocarditis, hypotension, hypertension, arrhythmia, cardiogenic shock, stroke, myocardial infarction/STEMI, intracranial hemorrhage, thrombosis (deep vein thrombosis, cerebral venous thrombosis, arterial or venous thrombotic events, portal vein thrombosis, coronary thrombosis, microvascular small bowel thrombosis), and pulmonary embolism.MethodsA systematic review of original studies reporting confirmed cardiovascular manifestations post‐mRNA COVID‐19 vaccination was performed. Following the PRISMA guidelines, electronic databases (PubMed, PMC NCBI, and Cochrane Library) were searched until January 2022. Baseline characteristics of patients and disease outcomes were extracted from relevant studies.ResultsA total of 81 articles analyzed confirmed cardiovascular complications post‐COVID‐19 mRNA vaccines in 17,636 individuals and reported 284 deaths with any mRNA vaccine. Of 17,636 cardiovascular events with any mRNA vaccine, 17,192 were observed with the BNT162b2 (Pfizer−BioNTech) vaccine, 444 events with mRNA‐1273 (Moderna). Thrombosis was frequently reported with any mRNA vaccine (n = 13,936), followed by stroke (n = 758), myocarditis (n = 511), myocardial infarction (n = 377), pulmonary embolism (n = 301), and arrhythmia (n = 254). Stratifying the results by vaccine type showed that thrombosis (80.8%) was common in the BNT162b2 cohort, while stroke (39.9%) was common with mRNA‐1273 for any dose. The time between the vaccination dosage and the first symptom onset averaged 5.6 and 4.8 days with the mRNA‐1273 vaccine and BNT162b2, respectively. The mRNA‐1273 cohort reported 56 deaths compared to the 228 with BNT162b2, while the rest were discharged or transferred to the ICU.ConclusionAvailable literature includes more studies with the BNT162b2 vaccine than mRNA‐1273. Future studies must report mortality and adverse cardiovascular events by vaccine types.

Background: It is known that hypokalemia, hypocalcemia and hypomagnesemia cause a prolonged QTc interval and are associated with an increased risk of ventricular arrhythmias. However, there are limited data on optimal serum electrolytes for patients admitted to the coronary care unit (CCU). Objective: Here, we aimed to evaluate the relationship between serum potassium, ionized calcium and magnesium levels and in-hospital mortality in the CCU setting. Methods: This retrospective cohort study included 8,498 consecutive patients admitted to the CCU at an academic tertiary medical center from 2004 through 2013. The mean of serum electrolytes was categorized as <3.5, 3.5-<4.0, 4.0-<4.5 (reference), 4.5-<5.0, and ≥5.0 mEq/L for potassium; <4.4, 4.4-<4.6, 4.6-<4.8, 4.8-<5.0 (reference), and ≥5.0 mg/dL for ionized calcium; and <1.8, 1.8-<2.0, 2.0-<2.2 (reference), 2.2-<2.4, and ≥2.4 mg/dL for magnesium. Multivariate logistic regression analysis was used to determine the association between the mean of serum electrolytes and in-hospital mortality. Results: Of the 8,498 patients, 599 (7%) died during hospitalization. Relationship between mean serum potassium (U-shaped), ionized calcium (inverted J-shape) and magnesium (J-shaped) and in-hospital mortality was present in Figure. Serum potassium levels <3.5, 4.5-<5.0 and ≥5.0 mEq/L were independently associated with an increased risk of in-hospital mortality (adjusted OR 1.7 95% CI 1.1-2.5, OR 1.7 95% CI 1.3-2.2, and OR 3.4 95% CI 2.4-4.8, respectively), compared to the reference group. As for serum ionized calcium, the levels of <4.4, 4.4-<4.6, and 4.6-<4.8 mg/dL independently increased risk of mortality (adjusted OR 3.0 95% CI 2.3-4.0, OR 2.0 95% CI 1.5-2.6, and OR 1.4 95% CI, 1.1-1.8, respectively). As for serum magnesium, an only level above 2.4 mg/dL was associated with an increased mortality risk (OR 1.6 95% CI, 1.1-2.2). Conclusions: In the CCU setting, serum potassium 3.5-<4.5 mEq/L, ionized calcium ≥5.0 mg/dL and magnesium <2.4 mg/dL are associated with the lowest in-hospital mortality. These findings do not support supratherapeutic repletion of potassium and magnesium.

Introduction: Current proposed Dietary Guidelines for Americans, 2015 suggested replacing refined grains (e.g., white rice) with whole grains (e.g., brown rice) for improved health outcomes; however, the association between white rice consumption and risk of cardiovascular disease (CVD) was not fully investigated. The purpose of this study was to explore the associations between rice consumption, metabolic syndrome and cardiovascular disease. Methods: We conducted a comprehensive search of MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from database inception through May 2015. Observational studies were included if the studies reported hazard ratios (HRs) or odd ratios (ORs) of the associations between rice consumption, metabolic syndrome and cardiovascular disease. Data were extracted by one reviewer and then reviewed by two independent reviewers. Conflicts were resolved through consensus. Using the DerSimonian and Laird random effects models, we calculated pooled HRs and pooled ORs with 95% confidence intervals (95% CIs). Subgroup analyses were performed to explore potential sources of heterogeneity. The quality of the included studies and publication bias were assessed. Results: Out of 343 retrieved articles, we identified 6 cross-sectional and 9 prospective studies with a total of 575,852 individuals with 24,649 total CVD events and 4,409 metabolic syndrome cases. The highest category of white rice consumption (≥5 times/week) was associated with a 37% higher risk of metabolic syndrome (pooled OR, 1.37; 95% CI: 1.03-1.84; p<0.001; I 2 = 78.7%) but not a higher risk of cardiovascular disease (pooled HR, 1.01; 95% CI: 0.95-1.08; p=0.65; I 2 = 0%), compared to the lowest category (≤1 time/month). Conclusions: Higher white rice consumption has not been shown to increase the risk of cardiovascular diseases but may be associated with increased risk of metabolic syndrome.

Cardiovascular disease (CVD) is the most common cause of death worldwide. Cardiac rehabilitation (CR) is increasingly recognised as an essential part of clinical care for patients with CVD. CR is a complex intervention that encompasses a multidisciplinary approach that focuses on health education, modification of cardiovascular risk factors, exercise training, physical activity and stress management. In the current American Heart Association/American College of Cardiology guidelines, cardiac rehabilitation is a class IA recommendation for secondary prevention of acute myocardial infarction, percutaneous coronary intervention and cardiac surgery and Class II recommendation for chronic stable heart failure. Despite proven effectiveness, however, participation in traditional CR remains low. Although the reasons for participation and non-participation in CR have been well described, the use of Twitter to explore public perceptions of CR has not yet been formally reported. To the best of our knowledge, the analysis of Twitter for insights on CR is a novel investigation that is relevant for addressing significant problems related to CR awareness in the digital age. We performed data mining of Twitter to assess patients’ perceptions regarding CR and the reasons for their participation and non-participation in CR between 23 July 2015 and 22 October 2017. We analysed a total of 5515 Twitter messages. Tweets associated with CR were often used to self-report on health status either before or after participating in CR or contained emotional language with positive or negative comments, advertisements or updated news. Twitter users wrote mainly positive comments about CR, suggesting the platform has the potential to disseminate both the benefits of CR and its research to the public on the worldwide scale.