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1.
Efficacy of a Low-Dose Diosmin Therapy on Improving Symptoms and Quality of Life in Patients with Chronic Venous Disease: Randomized, Double-Blind, Placebo-Controlled Trial.
Serra, R, Ielapi, N, Bitonti, A, Candido, S, Fregola, S, Gallo, A, Loria, A, Muraca, L, Raimondo, L, Velcean, L, et al
Nutrients. 2021;(3)
Abstract
Chronic Venous Disease (CVD) is a common medical condition affecting up to 80% of the general population. Clinical manifestations can range from mild to more severe signs and symptoms that contribute to the impairment of the quality of life (QoL) of affected patients. Among treatment options, venoactive drugs such as diosmin are widely used in the symptomatic treatment in all clinical stages. The aim of this study is to determine the effectiveness of a new formulated diosmin in relieving symptoms and improving QoL in patients suffering from CVD. In this randomized, double-blind, placebo-controlled, multicenter clinical study, CVD patients with a Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system between C2 and C4 were randomized to receive a bioavailable diosmin (as μsmin® Plus) 450 mg tablet once daily or a placebo for 8 weeks. Clinical symptoms and QoL were monitored using the measurement of leg circumference, visual analogue scale (VAS) for pain, Global Index Score (GIS) and Venous Clinical Severity Score (VCSS). A total of 72 subjects completed the study. From week 4, leg edema was significantly decreased in the active group (p < 0.001). An improvement in the VAS score was observed in the active group compared to placebo at the end of treatment (p < 0.05). GIS and VCSS scores were significantly improved in the active group at week 8 (p < 0.001). No treatment related-side effects were recorded. The results of this study showed that the administration of low-dose μsmin® Plus was safe and effective in relieving symptoms and improving QoL in subjects with CVD.
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2.
Preventing spasm of the radial artery conduit during coronary artery bypass grafting: Nicardipine versus verapamil.
Özdemir, HI, van Dijk, CHB, Özdemir, AB, van Straten, BHM, Haanschoten, M, Soliman-Hamad, MA
Journal of cardiac surgery. 2019;(12):1505-1510
Abstract
BACKGROUND AND AIM OF THE STUDY In vitro studies have shown a reduction in radial artery spasm with the use of calcium antagonists. The purpose of this study was to evaluate the efficacy of topical treatment of the radial artery conduit using either verapamil or nicardipine before the anastomoses. METHODS This prospective randomized study included 131 patients, who underwent coronary artery bypass grafting surgery with the use of the radial artery as a conduit. In 65 patients, the harvested radial artery was topically treated with verapamil and in 66 patients with nicardipine. After harvesting the radial artery, the direct flow through the conduit was measured in vitro before 5-minute incubation in nicardipine or verapamil and measured again after incubation. The flow before and after incubation was compared. Postincubation flow was also compared in the two groups. After performing the anastomosis, the flow through the radial artery was measured in vivo. RESULTS The mean flow after NaCl incubation was 19.93 ± 12.66 mL/min and after incubation in the Ca+ channel blocker 47.16 ± 14.58 mL/min (P < .001). No significant difference in postincubation free flow was found between verapamil (46.29 ± 15.43 mL/min) and nicardipine (48.01 ± 13.77 mL/min; P = .503). CONCLUSION Topical treatment with Ca+ channel blockers reduces radial artery spasm and significantly increases the free flow through the radial artery conduit. Nicardipine is a safe and effective alternative of verapamil in preventing spasm of radial artery conduit.
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3.
Workplace Strategies to Prevent Sitting-induced Endothelial Dysfunction.
Kruse, NT, Hughes, WE, Benzo, RM, Carr, LJ, Casey, DP
Medicine and science in sports and exercise. 2018;(4):801-808
Abstract
UNLABELLED Prolonged sitting induces endothelial dysfunction in healthy young adults, which has been demonstrated to be offset by intermittent fidgeting and standing. No information exists on the effect of sitting and endothelial dysfunction in sedentary middle-age adults, and whether common workplace counterinterventions (i.e., desk standing/desk pedaling) mitigate sitting-induced endothelial dysfunction. PURPOSE The objective of this study was to examine whether breaking up prolonged sitting with intermittent standing or underdesk pedaling prevents sitting-induced popliteal artery endothelial dysfunction in middle-age sedentary, overweight/obese office workers. HYPOTHESIS We tested the hypothesis that sitting-induced leg endothelial dysfunction would be prevented by intermittent standing or desk pedaling. METHODS Thirteen middle-age, sedentary overweight/obese subjects (10 men, 3 women; age, 38 ± 3 yr; body mass index, 29.7 ± 2 kg·m) participated in three separate testing sessions in a randomized order: 1) 4 h of uninterrupted sitting, 2) 4 h of sitting interrupted with four 10-min bouts of standing, and 3) 4 h of sitting interrupted with four 10-min bouts of light-intensity desk pedaling. Doppler ultrasound-measured popliteal artery flow-mediated dilation and associated measures (e.g., shear rate, blood velocity) were measured immediately before and immediately after each intervention (sit, stand, and desk pedaling). RESULTS Four hours of uninterrupted sitting induced a significant impairment in popliteal artery flow-mediated dilation (baseline: 3.1% ± 0.3%, post: 1.6% ± 0.5%; P < 0.05). Interestingly, neither intermittent standing (baseline: 3.2% ± 0.4%, post: 1.9% ± 0.5%; P < 0.05) nor intermittent desk pedaling (baseline: 3.2% ± 0.4%, post: 1.9% ± 0.4%; P < 0.05) was effective at preventing excessive sitting-induced endothelial dysfunction. CONCLUSIONS Prolonged sitting-induced leg endothelial dysfunction cannot be prevented by brief intermittent bouts of standing or desk pedaling in middle-age sedentary overweight/obese adults.
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4.
Whole-body CT angiography with low tube voltage and low-concentration contrast material to reduce radiation dose and iodine load.
Kanematsu, M, Goshima, S, Miyoshi, T, Kondo, H, Watanabe, H, Noda, Y, Bae, KT
AJR. American journal of roentgenology. 2014;(1):W106-16
Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the contrast enhancement, vascular depiction, image quality, and radiation dose of low-tube-voltage whole-body CT angiography (CTA) performed with low-concentration iodinated contrast material. SUBJECTS AND METHODS Whole-body CTA was performed on 109 patients with a 64-MDCT scanner. Patients were randomized into three groups: CTA with 240-mg/mL contrast material at 80 kVp (240-80 group), 300-mg/mL at 80 kVp (300-80 group), and 370-mg/mL at 120 kVp (370-120 group). Signal-to-noise ratio (SNR), arterial depiction, image quality, and radiation dose were assessed. Figure of merit was computed to normalize signal-to-noise ratio, estimated effective dose, and iodine weight. RESULTS In the 240-80 group, the mean load of administered iodine was 21.6 g; for the 300-80 group, 26.8 g; and the 370-120 group, 34.0 g (p < 0.05). The ranges of mean vascular enhancement were 508-521 HU, 546-593 HU, and 435-442 HU (p < 0.05). Arterial depiction and image quality were comparable for the 240-80 and 370-120 groups and were greater for the 300-80 group than the other two groups in selected arteries (p < 0.05). Effective dose was higher (p < 0.05) in the 370-120 group (2.8-5.4 mSv) than in the others (2.3-4.3 mSv). The figure of merit in the 240-80 group was greater than (p < 0.05) or comparable to that in the 370-120 group. CONCLUSION Use of 240-mg/mL contrast material at 80 kVp seems appropriate for routine whole-body CTA and beneficial for reduction of iodine load and radiation dose, whereas use of 300-mg/mL contrast material may marginally improve delineation of selected small arteries.
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5.
Effects of early exercise engagement on vascular risk in patients with transient ischemic attack and nondisabling stroke.
Faulkner, J, Lambrick, D, Woolley, B, Stoner, L, Wong, LK, McGonigal, G
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;(8):e388-96
Abstract
The objective of this study was to conduct a randomized, parallel-group clinical trial assessed the efficacy of a health-enhancing physical activity program (exercise and education) on vascular risk factors and aerobic fitness in patients who have experienced a transient ischemic attack (TIA) or nondisabling stroke. Sixty patients (69±11 years) completed a baseline (BL) vascular risk stratification and aerobic fitness examination (cycle test) within 2 weeks of symptom onset. Subjects were then randomized to either an 8-week, twice weekly exercise program or to a usual-care control (CON) group. Postintervention (PI) assessments were completed immediately after the intervention and at 3-month follow-up. A series of primary (systolic blood pressure [SBP]) and secondary (vascular risk factors like total cholesterol [TC], high-density lipoproteins, etc.; Framingham risk score; peak oxygen uptake) outcome measures were assessed. Significantly greater reductions in SBP (mean change±SD; -10.4±9.2 mm Hg) and TC (-.53±.90 mmol/L) were observed between BL and PI assessments for the exercise group compared with the CON group (-1.9±15.4 mm Hg and -.08±.59 mmol/L, respectively) (P<.05). These improvements were maintained between the PI and the 3-month follow-up assessment (P>.05). Significant improvements in aerobic fitness were also observed and maintained at the 3-month follow-up assessment after regular exercise participation (P<.05). The early engagement in exercise resulted in significant improvements in vascular risk factors and fitness in those diagnosed with TIA. As these beneficial effects were maintained up to 3 months after completing the exercise program, exercise should be considered a useful additive treatment strategy for newly diagnosed TIA patients. Future research should examine the long-term efficacy of such programs.
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6.
Factors influencing participation in a vascular disease prevention lifestyle program among participants in a cluster randomized trial.
Laws, RA, Fanaian, M, Jayasinghe, UW, McKenzie, S, Passey, M, Davies, GP, Lyle, D, Harris, MF
BMC health services research. 2013;:201
Abstract
BACKGROUND Previous research suggests that lifestyle intervention for the prevention of diabetes and cardiovascular disease (CVD) are effective, however little is known about factors affecting participation in such programs. This study aims to explore factors influencing levels of participation in a lifestyle modification program conducted as part of a cluster randomized controlled trial of CVD prevention in primary care. METHODS This concurrent mixed methods study used data from the intervention arm of a cluster RCT which recruited 30 practices through two rural and three urban primary care organizations. Practices were randomly allocated to intervention (n = 16) and control (n = 14) groups. In each practice up to 160 eligible patients aged between 40 and 64 years old, were invited to participate. Intervention practice staff were trained in lifestyle assessment and counseling and referred high risk patients to a lifestyle modification program (LMP) consisting of two individual and six group sessions over a nine month period. Data included a patient survey, clinical audit, practice survey on capacity for preventive care, referral and attendance records at the LMP and qualitative interviews with Intervention Officers facilitating the LMP. Multi-level logistic regression modelling was used to examine independent predictors of attendance at the LMP, supplemented with qualitative data from interviews with Intervention Officers facilitating the program. RESULTS A total of 197 individuals were referred to the LMP (63% of those eligible). Over a third of patients (36.5%) referred to the LMP did not attend any sessions, with 59.4% attending at least half of the planned sessions. The only independent predictors of attendance at the program were employment status - not working (OR: 2.39 95% CI 1.15-4.94) and having high psychological distress (OR: 2.17 95% CI: 1.10-4.30). Qualitative data revealed that physical access to the program was a barrier, while GP/practice endorsement of the program and flexibility in program delivery facilitated attendance. CONCLUSION Barriers to attendance at a LMP for CVD prevention related mainly to external factors including work commitments and poor physical access to the programs rather than an individuals' health risk profile or readiness to change. Improving physical access and offering flexibility in program delivery may enhance future attendance. Finally, associations between psychological distress and attendance rates warrant further investigation. TRIAL REGISTRATION ACTRN12607000423415.
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7.
Predictors of primary care referrals to a vascular disease prevention lifestyle program among participants in a cluster randomised trial.
Passey, ME, Laws, RA, Jayasinghe, UW, Fanaian, M, McKenzie, S, Powell-Davies, G, Lyle, D, Harris, MF
BMC health services research. 2012;:234
Abstract
BACKGROUND Cardiovascular disease accounts for a large burden of disease, but is amenable to prevention through lifestyle modification. This paper examines patient and practice predictors of referral to a lifestyle modification program (LMP) offered as part of a cluster randomised controlled trial (RCT) of prevention of vascular disease in primary care. METHODS Data from the intervention arm of a cluster RCT which recruited 36 practices through two rural and three urban primary care organisations were used. In each practice, 160 eligible high risk patients were invited to participate. Practices were randomly allocated to intervention or control groups. Intervention practice staff were trained in screening, motivational interviewing and counselling and encouraged to refer high risk patients to a LMP involving individual and group sessions. Data include patient surveys; clinical audit; practice survey on capacity for preventive care; referral records from the LMP. Predictors of referral were examined using multi-level logistic regression modelling after adjustment for confounding factors. RESULTS Of 301 eligible patients, 190 (63.1%) were referred to the LMP. Independent predictors of referral were baseline BMI ≥ 25 (OR 2.87 95%CI:1.10, 7.47), physical inactivity (OR 2.90 95%CI:1.36,6.14), contemplation/preparation/action stage of change for physical activity (OR 2.75 95%CI:1.07, 7.03), rural location (OR 12.50 95%CI:1.43, 109.7) and smaller practice size (1-3 GPs) (OR 16.05 95%CI:2.74, 94.24). CONCLUSIONS Providing a well-structured evidence-based lifestyle intervention, free of charge to patients, with coordination and support for referral processes resulted in over 60% of participating high risk patients being referred for disease prevention. Contrary to expectations, referrals were more frequent from rural and smaller practices suggesting that these practices may be more ready to engage with these programs. TRIAL REGISTRATION ACTRN12607000423415.
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8.
How feasible are lifestyle modification programs for disease prevention in general practice?
Schütze, H, Rix, EF, Laws, RA, Passey, M, Fanaian, M, Harris, MF
Australian journal of primary health. 2012;(2):129-37
Abstract
Vascular disease is a leading cause of death and disability. While it is preventable, little is known about the feasibility or acceptability of implementing interventions to prevent vascular disease in Australian primary health care. We conducted a cluster randomised controlled trial assessing prevention of vascular disease in patients aged 40-65 by providing a lifestyle modification program in general practice. Interviews with 13 general practices in the intervention arm of this trial examined their views on implementing the lifestyle modification program in general practice settings. Qualitative study, involving thematic analysis of semi-structured interviews with 11 general practitioners, four practice nurses and five allied health providers between October 2009 and April 2010. Providing brief lifestyle intervention fitted well with routine health-check consultations; however, acceptance and referral to the program was dependent on the level of facilitation provided by program coordinators. Respondents reported that patients engaged with the advice and strategies provided in the program, which helped them make lifestyle changes. Practice nurse involvement was important to sustaining implementation in general practice, while the lack of referral services for people at risk of developing vascular disease threatens maintenance of lifestyle changes as few respondents thought patients would continue lifestyle changes without long-term follow up. Lifestyle modification programs to prevent vascular disease are feasible in general practice but must be provided in a flexible format, such as being offered out of hours to facilitate uptake, with ongoing support and follow up to assist maintenance. The newly formed Medicare Locals may have an important role in facilitating lifestyle modification programs for this target group.
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9.
Early vitamin C and E supplementation and cardiac allograft vasculopathy: 10-year follow-up from a randomized, controlled study.
Ujeyl, A, Fang, JC, Desai, AS, Mudge, GH, Givertz, MM
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2011;(10):1200-1
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10.
Ultrasound measurement of peripheral endothelial dysfunction in type 2 diabetic patients: correlation with risk factors.
Bosevski, M, Georgievska-Ismail, L
Bosnian journal of basic medical sciences. 2010;(2):84-8
Abstract
The purpose of the study was to assess the endothelial dysfunction (ED) in type 2 diabetic patients ultrasonographically and estimate the correlation of ED with glycemia and other cardio-metabolic risk factors. 171 patient (age 60.0 + 8.5 years) with diagnosed type 2 diabetes and coronary artery disease (CAD) were randomly included in a cross sectional study. B-mode ultrasound system with a linear transducer of 7.5 MHz was used for evaluation of flow-mediated vasodilation in brachial artery (FMV). FMV was presented as a change of brachial artery diameter at rest and after limb ischemia, previously provoked by cuff inflation. Peripheral ED was found in 77.2% (132 patients). Multivariate logistic regression model defined: age (OR 1.071, 95% CI 1.003 1,143) and plasma cholesterol (OR 4.083 95% CI 1.080 17,017) as determinants for ED. Linear multivariate analysis presented duration of diabetes (Beta 0.173, Sig 0.024), and glycemia (Beta 0.132, Sig 0.044) to be associated independently with FMV value. Estimated factors influencing FMV, might be potential therapeutic targets for presented endothelial dysfunction in type 2 diabetic patients with coronary artery disease.