Chirapongsathorn, Sakkarin

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.

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.

Introduction: Obesity is a growing global health problem associated with substantial morbidity and mortality. The risk of obesity on incident new-onset heart failure is controversial. The aim of this systematic review and meta-analysis was to explore the association between overweight, obesity and incident new-onset heart failure. Methods: We systematically searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from database inception through April 2015. Prospective cohort studies were included if the studies reported hazard ratios (HRs) of the association between overweight or obesity and new-onset heart failure (HF) relative to individuals with normal weight. 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 ratio from the included studies. Subgroup analyses were performed to explore the potential sources of heterogeneity. Results: Out of 1,865 retrieved articles, we identified 10 relevant studies. Median follow-up was 12 years with a total of 82,167 individuals and 4,570 total HF events. Compared to normal body weight (body mass index (BMI) <25 kg/m2), overweight (BMI 25-29.9 kg/m2) was associated with 27% higher risk of new-onset heart failure events (pooled HR, 1.27; 95% confidence intervals (95% CI): 1.15-1.41; p<0.001; I 2 = 0%) and obesity (BMI ≥30 kg/m2) was associated with a two-fold increased risk for new-onset heart failure events (pooled HR, 2.09; 95% CI, 1.68-2.60; p<0.001; I 2 = 67.8%). Conclusions: Compared with normal-weight individuals, both overweight and obesity were independently associated with significantly higher incidence of heart failure. These results highlight the need for better understanding of mechanisms of obesity and heart failure.

AbstractBackground and AimBleeding from gastric varices is a catastrophic event and poses difficulty in management. The efficacy and safety of cyanoacrylate injection remain unclear. We performed a systematic review and meta‐analysis to evaluate the effect of endoscopic cyanoacrylate injection in the management of gastric varices.MethodsWe conducted a comprehensive search of MEDLINE, Embase, Web of Science, Scopus databases, and Cochrane Database of Systematic Reviews through November 2020 and manually reviewed the literature. Trial‐specific risk ratios (RRs) were estimated and pooled using random‐effect model meta‐analysis.ResultsWe included seven randomized controlled trials (six for secondary prophylaxis and one for primary prophylaxis) at low risk of bias in which 126 deaths were reported among 583 patients with gastric varices. All studies reported the use of N‐butyl‐2‐cyanoacrylate glue. Cyanoacrylate use was associated with significantly lower all‐cause mortality (RR, 0.59; 95% confidence interval [CI], 0.36–0.98; I2 = 41%) and rebleeding rate after hemostasis (RR, 0.49; 95% CI, 0.35–0.68, I2 = 0%) compared with any other treatment approach not involving cyanoacrylate. When cyanoacrylate was compared with each individual treatment approach (propranolol only, band ligation, sclerotherapy with alcohol or ethanolamine), data comprised sparse limited comparative conclusions. The use of cyanoacrylate injection was not associated with an increase in serious adverse events. The quality of evidence is moderate, graded down due to the small number of events and wide CIs.ConclusionThe use of endoscopic cyanoacrylate injection therapy for gastric varices may be associated with lower all‐cause mortality and better hemostasis compared with other therapies.

Introduction: At-work stress is rapidly becoming a significant contributory cause of occupational disease, while sedentary work and dietary indiscretion, taken together, have contributed to cardiovascular disease, known to be associated with substantial morbidity and mortality. The aim of the CV-Ecosystem Model is to provide an individual approach by systematic environmental modification of the work site. Methods and Results: Our model which we term the CV-Ecosystem Model includes two basic tenets: 1) Workstation technologic design 2) Flexible physiologic activity. Workstation technologic design utilizes the services of a certified Ergonomist to engineer a comfortable, safe, and effective work environment. It is tailored to the unique physiologic needs of the worker while enhancing productivity within different environments. Computer aided design software would evaluate ergonomics to maximally mitigate the risk and incidence of eye strain, musculoskeletal disorders, repetitive movement disorders such as Carpal Tunnel Syndrome, etc unique to that work activity. Flexible physiologic activity would permit a worker to actively focus on basic needs during work time, on site; this would include exercise activity and food intake, channeled into healthy options. Exercise time would provide a sense of calm during stressful projects and enhance emotional well-being. In this regard, a three hour period of time, weekly, could be allocated to fitness or meditation. Conveniently located food stations could provide a variety of healthy, plant-based, fresh food options. Both would come with flexible, relative control and scheduling of these activities, within a social environment and context. Conclusions: The CV Ecosystem Model, due to its simple technology and relative low cost, could be successfully implemented in a number of enterprises, including all healthcare facilities, with benefit to employee health, wellbeing, and favorable to the business bottom line.

We examined risks for first hospitalization and the rate, risk factors, costs, and 1‐year outcome of 30‐day readmission among patients admitted for complications of cirrhosis. Data were retrospectively analyzed for adult patients with cirrhosis residing in Minnesota, Iowa, or Wisconsin and admitted from 2010 through 2013 at both campuses of the Mayo Clinic Hospital in Rochester, MN. Readmission was captured at the two hospitals as well as at community hospitals in the tristate area within the Mayo Clinic Health System. The incidence of hospitalization for complications of cirrhosis was 100/100,000 population, with increasing age and male sex being the strongest risks for hospitalization. For the 2,048 hospitalized study patients, the overall 30‐day readmission rate was 32%; 498 (24.3%) patients were readmitted to Mayo Clinic hospitals and 157 (7.7%) to community hospitals, mainly for complications of portal hypertension (52%) and infections (30%). Readmission could not be predicted accurately. There were 146 deaths during readmission and an additional 105 deaths up to 1 year of follow‐up (50.4% total mortality). Annual postindex hospitalization costs for those with a 30‐day readmission were substantially higher ($73,252) than those readmitted beyond 30 days ($62,053) or those not readmitted ($5,719). At 1‐year follow‐up, only 20.4% of patients readmitted within 30 days were at home. In conclusion, patients with cirrhosis have high rates of hospitalization, especially among men over 65 years, and of unscheduled 30‐day readmission. Readmission cannot be accurately predicted. Postindex hospitalization costs are high; nationally, the annual costs are estimated to be more than $4.45 billion. Only 20% of patients readmitted within 30 days are home at 1 year. (Hepatology Communications 2018;2:188–198)

Background: A shorter sleep duration has been identified as a risk factor for cardiovascular diseases and increased mortality. It has been hypothesized that a short sleep duration may be linked to changes in ghrelin and leptin production, leading to an alteration of stress hormone production. Here, we conducted a systematic review and meta-analysis to investigate the potential relationship between a sleep duration and cardiovascular disease mortality. Methods: We conducted a comprehensive search of Ovid Medline In-Process and other non-indexed citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Scopus from database inception to March 2017. Observational studies were included if the studies reported hazard ratios or odds ratios of the associations between sleep durations (short and long) and cardiovascular disease mortality. Data were extracted by a reviewer and then reviewed by two separate reviewers. Conflicts were resolved through consensus. Using the DerSimonian and Laird random effects models, we calculated pooled hazard ratios and pooled odds ratios with 95% confidence intervals (CI). Subgroup analyses were performed to explore potential sources of heterogeneity. The quality of the included studies and publication bias were assessed. Results: In total, our meta-analysis included 19 studies (31 cohorts) with a total of 816,995 individuals with 42,870 cardiovascular disease mortality cases. In pooled analyses, both short (risk ratio 1.19; 95% CI 1.13 to 1.26, P<0.001, I2=30.7, Pheterogeneity=0.034), and long (risk ratio 1.37; 95% CI 1.23 to 1.52, P<0.001, I2=79.75, Pheterogeneity<0.001) sleep durations were associated with a greater risk of cardiovascular disease mortality. Conclusions: Both short (<7 hours) and long sleep durations (>9 hours) can increase the risk of overall cardiovascular disease mortality, particularly in Asian populations and elderly individuals. Future epidemiological studies would ideally include objective sleep measurements, rather than self-report measures, and all potential confounders, such as genetic variants.

AbstractBackground and AimThis study aims to determine the performance of models adding C‐reactive protein (CRP) and procalcitonin (PCT) to the model of end‐stage liver disease (MELD) score for mortality prediction in patients hospitalized with complications of cirrhosis.MethodsA prospective cohort study was carried out in consecutive cirrhotic patients admitted with complications of cirrhosis between September 2012 and December 2013 at Phramongkutklao Hospital, Bangkok, Thailand. All patients had venous CRP, PCT, and laboratory values for MELD score calculation measured at emergency room or admission. Cox regression analysis and the c‐statistic were used to predict mortality. The MELD‐CRP score was externally validated in 818 eligible patients from Mayo Clinic, Rochester, using data from 1288 cirrhotic patients diagnosed between 2010 and 2014.ResultsA cohort of 177 patients with cirrhosis was admitted during the study period. Seventy‐one patients were eligible for analysis. The MELD score was predictive of 90‐day mortality odds ratio (OR) 1.19 (95% confidence interval [CI] 1.09–1.32). Adding CRP and/or PCT to the MELD score improved the predictive of 90‐day mortality: MELD‐CRP OR 2.71 (95% CI 1.66–4.99); MELD‐PCT OR 2.72 (95% CI 1.66–4.99); MELD‐CRP‐PCT OR 2.71 (95% CI 1.67–4.92). The c‐statistics for MELD, MELD‐CRP, MELD‐PCT, and MELD‐CRP‐PCT were 0.81, 0.83, 0.84, and 0.85, respectively. Adding CRP and/or PCT to the MELD score also improved 30‐day mortality prediction. Similar results for the MELD‐CRP score were obtained from the Mayo Clinic external validation cohort.ConclusionThe MELD‐CRP, MELD‐PCT, and MELD‐CRP‐PCT scores may be superior to the MELD score alone in predicting mortality in patients hospitalized with complications of cirrhosis.

Globally, among infectious diseases, influenza is one of the leading causes of morbidity and mortality. Individuals with chronic conditions, including cardiovascular disease and diabetes, are particularly vulnerable to complications of an influenza infection. The European Society of Cardiology recommended annual influenza vaccinations for patients with cardiovascular disease. Numerous studies have suggested a link between influenza and increased risk of cardiovascular events. Despite its proven benefits, little is known about the reason for the underutilization of influenza vaccination. We present the findings of an assessment of patients’ perception of the influenza vaccine and the reason for its underutilization, by data mining from Twitter.