1.
Dose-related effect of secondhand smoke on cardiovascular disease in nonsmokers: Systematic review and meta-analysis.
Zhang, D, Liu, Y, Cheng, C, Wang, Y, Xue, Y, Li, W, Li, X
International journal of hygiene and environmental health. 2020;:113546
Abstract
BACKGROUND Despite the positive association between secondhand smoke (SHS) and cardiovascular diseases (CVD), no comprehensive assessment on the dose-response relationship between SHS and CVD has yet been reported. Therefore, a meta-analysis was conducted to update the binary association, and to elucidate the dose-response relationship of both self-reported and objectively measured SHS exposure with CVD. METHODS PubMed and Embase databases were searched for articles published up to November 12, 2019. Random-effects models were used to assess the summary odds ratios (ORs) of CVD with SHS exposure. Restricted cubic splines were used to fit the dose-response relationship. RESULTS Fifty-five eligible observational studies were included in this meta-analysis to investigate the association between SHS exposure and CVD. Based on the meta-analysis, the pooled OR of CVD was 1.22 (95% CI 1.17-1.28) for the self-reported SHS individuals as comparing to the non-exposed group. The result of restricted cubic splines showed a risk plateau of SHS exposure at 15 cigarettes per day (Pnon-linearity = 0.042), while other characteristics s of SHS exposure (amount, daily and cumulative duration, and cotinine) were in linear relationships with CVD (Pnon-linearity >0.05). In addition, an estimated of 6.77% (95% CI: 5.31%-8.46%) of all CVD cases in men and 7.15% (95% CI: 5.62%-8.93%) in women might be attributed to SHS exposure worldwide. CONCLUSIONS Exposure to SHS is associated with an increased risk of CVD regardless of the modes. And thus, well-enforced smoke-free laws could possibly reduce a substantial risk of CVD caused by SHS.
2.
Proprotein convertase subtilisin/kexin 9 inhibitors in reducing cardiovascular outcomes: a systematic review and meta-analysis.
Du, H, Li, X, Su, N, Li, L, Hao, X, Gao, H, Kwong, JS, Vandvik, PO, Yang, X, Nemeth, I, et al
Heart (British Cardiac Society). 2019;(15):1149-1159
Abstract
BACKGROUND To evaluate the effects of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors on major adverse cardiovascular events (MACE). METHODS Our systematic review included randomised controlled trials if they studied PCSK9 inhibitors in patients for primary and/or secondary prevention of cardiovascular diseases or with hypercholesterolaemia/hyperlipidaemia. Dichotomous variables from individual studies were pooled by relative risks (RR) and their 95% CIs using the random-effect model. Risk difference (RD) in the 10-year frame was also estimated using the pooled RR and the estimated baseline risk using the control group. Grading of Recommendation Assessment, Development and Evaluation was used to assess the quality of evidence. RESULTS We included 54 trials with 97 910 patients in the analysis. Compared with controls, PCSK9 inhibitors significantly reduced the risk of MACE by 16% (RR, 0.84; 95% CI 0.79 to 0.89; RD: 47 fewer per 1000 vs 286 as the baseline risk; 95% CI 32 to 59 fewer), non-fatal myocardial infarction (MI) by 17% (RR, 0.83; 95% CI 0.74 to 0.93; RD, 35 fewer per 1000 vs 207 as the baseline; 95% CI 13 to 53 fewer) and any stroke by 25% (RR, 0.75; 95% CI 0.65 to 0.85; RD, 16 fewer per 1000 vs 61 as the baseline; 95% CI 9 to 21 fewer) with moderate quality evidence. No significant differences were found between PCSK9 inhibitors and control groups in all-cause mortality, cardiovascular death, heart failure or unstable angina with low-quality evidence. CONCLUSIONS This study demonstrated that PCSK9 inhibitors could significantly reduce the risk of MACE, non-fatal MI and stroke. TRIAL REGISTRATION PROSPERO; CRD42017073904.
3.
Relationships between cardiometabolic disorders and obstructive sleep apnea: Implications for cardiovascular disease risk.
Zhao, X, Li, X, Xu, H, Qian, Y, Fang, F, Yi, H, Guan, J, Yin, SK
Journal of clinical hypertension (Greenwich, Conn.). 2019;(2):280-290
Abstract
Previous studies have reported the effects of obstructive sleep apnea (OSA) and cardiometabolic disorders on cardiovascular disease (CVD), but associations between cardiometabolic biomarkers and two cardinal features of OSA (chronic intermittent hypoxia and sleep fragmentation) and their interactions on CVD in OSA populations remain unclear. A total of 1727 subjects were included in this observational study. Data on overnight polysomnography parameters, biochemical biomarkers, and anthropometric measurements were collected. Metabolic syndrome (MS), including blood pressure, waist circumference (WC), fasting glucose, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C), was diagnosed based on modified criteria of the Adult Treatment Panel III. WC, mean arterial pressure, TG and low-density lipoprotein cholesterol (LDL-C) were independently associated with apnea-hypopnea index (AHI) after adjustment for confounding factors (β = 0.578, P = 0.000; β = 0.157, P = 0.001; β = 1.003, P = 0.019; and β = 4.067, P = 0.0005, respectively). Furthermore, the interaction analysis revealed joint effects between hypertension, obesity, hyperglycemia, and LDL-C dyslipidemia and AHI on CVD. The relative excess risks of CVD due to the interactions with OSA were 2.06, 1.02, 0.48, and 1.42, respectively (all P < 0.05). In contrast, we found no independent effect of the microarousal index (MAI) on CVD. However, LDL-C level and some MS components (WC, TG) were associated with MAI. Our findings indicate that hypoxemia and cardiometabolic disorders in OSA may potentiate their unfavorable effects on CVD. Sleep fragmentation may indirectly predispose patients with OSA to an increased risk of CVD. Thus, cardiometabolic disorders and OSA synergistically influence cardiometabolic risk patterns.