1.
Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.
Mantovani, A, Targher, G, Temporelli, PL, Lucci, D, Gonzini, L, Nicolosi, GL, Marchioli, R, Tognoni, G, Latini, R, Cosmi, F, et al
Metabolism: clinical and experimental. 2018;:205-215
Abstract
BACKGROUND The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. CLINICAL TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT00336336. METHODS We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF. RESULTS Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively. CONCLUSIONS Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
2.
Primary prevention of psychosis through interventions in the symptomatic prodromal phase, a pragmatic Norwegian Ultra High Risk study.
Joa, I, Gisselgård, J, Brønnick, K, McGlashan, T, Johannessen, JO
BMC psychiatry. 2015;:89
Abstract
BACKGROUND Evidence has been accumulating that it may be possible to achieve prevention in psychotic disorders. The aim of the Prevention Of Psychosis (POP) study is to reduce the annual incidence of psychotic disorders in a catchment area population through detection and intervention in the prodromal phase of disorder. Prodromal patients will be recruited through information campaigns modelled on the Scandinavian early Treatment and Intervention in Psychosis (TIPS) study and assessed by low-threshold detection teams. METHODS/DESIGN The study will use a parallel control design comparing the incidence of first episode psychotic disorders between two Norwegian catchment areas with prodromal detection and treatment (Stavanger and Fonna) with two catchment areas without a prodromal intervention program (Bergen and Østfold). The primary aim of the current study is to test the effect of a Prodromal Detection and Treatment program at the health care systems level. The study will investigate: 1) If the combination of information campaigns and detection teams modelled will help in identifying individuals (age 13-65, fulfilling study inclusion criteria) at high risk of developing psychosis early, and 2) If a graded, multi-modal treatment program will reduce rates of conversion compared to the rates seen in follow-along assessments. DISCUSSION Positive results could potentially revolutionize therapy by treating risk earlier rather than disorder later and could open a new era of early detection and intervention in psychosis. Negative results will suggest that the potential for psychosis is determined early in life and that research should focus more on genetically linked neurodevelopmental processes. If we can identify people about to become psychotic with high accuracy, we can track them to understand more about how psychosis unfolds. Appropriate intervention at this stage could also prevent or delay the onset of psychosis and/or subsequent deterioration, i.e., social and instrumental disability, suicide, aggressive behavior, affective- and cognitive deficits. TRIAL REGISTRATION Current Controlled Trials ISRCTN20328848 . Registered 02 November 2014.