[Show abstract][Hide abstract] ABSTRACT: This study analyses the effect of active participation in a sports club, physical activity and social networks on the development of lung cancer in patients who smoke. Our hypothesis is that study participants who lack social networks and do not actively participate in a sports club are at a greater risk for lung cancer than those who do.
Data for the study were taken from the Cologne Smoking Study (CoSmoS), a retrospective case-control study examining potential psychosocial risk factors for the development of lung cancer. Our sample consisted of n = 158 participants who had suffered lung cancer (diagnosis in the patient document) and n = 144 control group participants. Both groups had a history of smoking.Data on social networks were collected by asking participants whether they participated in a sports club and about the number of friends and relatives in their social environment. In addition, sociodemographic data (gender, age, education, marital status, residence and religion), physical activity and data on pack years (the cumulative number of cigarettes smoked by an individual, calculated by multiplying the number of cigarettes smoked per day by the number of years the person has smoked divided by 20) were collected to control for potential confounders. Logistic regression was used for the statistical analysis.
The results reveal that participants who are physically active are at a lower risk of lung cancer than those who are not (adjusted OR = 0.53*; CI = 0.29-0.97). Older age and lower education seem also to be risk factors for the development of lung cancer. The extent of smoking, furthermore, measured by pack years is statistically significant. Active participation in a sports club, number of friends and relatives had no statistically significant influence on the development of the cancer.
The results of the study suggest that there is a lower risk for physically active participants to develop lung cancer. In the study sample, physical activity seemed to have a greater protective effect than participation in a sports club or social network of friends and relatives. Further studies have to investigate in more detail physical activity and other club participations.
[Show abstract][Hide abstract] ABSTRACT: Depression, anxiety, and Type-D pattern are associated with the earlier development and faster progression of cardiovascular disease (CVD). The aim of the randomized controlled PreFord trial was to improve multiple biological and psychosocial risk factors in the primary prevention of CVD. A total of 447 women and men with an ESC risk score >5% were randomly assigned to either multimodal or routine care groups. Somatic and psychosocial variables (HADS, DS-14) were assessed before and after the intervention, and annually for 2 years thereafter. The intervention showed no significant effects on the symptoms of depression, anxiety, and type D personality, either in the whole sample or in those with elevated scores at baseline. Thus, our study did not provide evidence that symptoms of depression, anxiety, or Type D personality can be effectively treated by multimodal behavioral interventions for the primary prevention of CVD.
[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus ist eine komplexe Stoffwechselerkrankung, die sowohl direkt als auch indirekt über arteriosklerotische Gefäßveränderungen
zu einer Schädigung des Myokards führen kann.Koronare Herzerkrankung (KHK) und Herzinsuffizienz sind mit ca. 75% die häufigsten
Todesursachen bei Diabetikern in Europa. Die Therapie der verschiedenen Herzerkrankungen unterscheidet sich heute noch nicht
zwischen Diabetiker und Nichtdiabetiker. Aufgrund des sehr hohen Ausgangsrisikos werden Diabetiker aber grundsätzlich aggressiver
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Diabetes mellitus is associated with a high risk for heart failure, which is further increased in the presence of coronary heart disease. So far no clinical risk score for development of heart failure exists for patients with type 2 diabetes and macrovascular disease. METHODS: Independent clinical predictors for heart failure events were identified by Cox regression in a post-hoc analysis of the PROactive trial and were used for calculating a risk prediction score. RESULTS: 233 of 4951 patients with available baseline data suffered a serious adverse heart failure event during a mean follow-up of 34.5 (±2.3) months. Age, renal dysfunction, diuretic use, HbA1c, duration of diabetes, LDL-cholesterol, heart rate, right and left bundle branch block, microalbuminuria, previous myocardial infarction and pioglitazone treatment were independent predictors of heart failure. The risk score showed a good calibration and moderate discrimination (AUC 0.75). Patients were accurately stratified with an actual risk of 1.0%, 3.2% and 9.7% in the bottom, middle and top tertile of the score, respectively, with corresponding hazard ratios of 3.5 (95% CI 2.0-6.2) and 10.5 (95% CI 6.3-17.6) for the middle and top tertile compared to the bottom tertile (both p<0.0001). The score stratified well in subgroups defined by pioglitazone treatment, prior myocardial infarction, obesity, poor glycemic control and microalbuminuria. CONCLUSION: A risk score based on routinely assessed clinical variables proved a good stratification for future heart failure events in diabetic patients with macrovascular disease. Strategies targeting specific interventions and monitoring of high risk patients need further evaluation.
International journal of cardiology 05/2011; · 7.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although a resting electrocardiograph is broadly applied in clinical practice for evaluating patients with Type 2 diabetes and cardiovascular disease, the independent prognostic relevance of electrocardiographic signs has not thoroughly been examined.
Baseline 12-lead electrocardiographs available in 5231 of the 5238 participants of the PROactive trial were analysed for heart rate, heart rate corrected QT-interval, presence of atrial fibrillation/flutter, left axis deviation, right and left bundle branch block. The association of electrocardiographic signs with total mortality, the principal secondary composite endpoint (death, myocardial infarction and stroke) and serious adverse heart failure events was examined by Cox-regression analysis.
Two hundred and twenty-three (4.3%) patients showed atrial fibrillation/flutter, 213 (4.1%) patients had right bundle branch block, 111 (2.1%) patients had left bundle branch block and 706 (13.5%) patients had left axis deviation. Mean cQT-interval was 418 ms (± 25 ms) and mean heart rate was 72/min (± 14/min). In multivariate adjusted analyses, heart rate and cQT-interval were significantly associated with mortality, the composite secondary endpoint and heart failure, whereas right and left bundle branch blocks were significantly associated with heart failure only. Left axis deviation was associated with heart failure and atrial fibrillation/flutter was associated with mortality and heart failure in univariate but not multivariate analyses.
Easily assessable electrocardiographic signs such as heart rate, cQT-interval and bundle branch blocks were predictive for adverse outcome independently of multiple risk factor adjustment and should be considered in clinical care.
Diabetic Medicine 03/2011; 28(10):1206-12. · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung Diabetes mellitus und Herzinsuffizienz zeigen eine hohe Koexistenz und begünstigen sich gegenseitig in der Entstehung. Die
Koexistenz der beiden Erkrankungen ist mit einer sehr ungünstigen Prognose assoziiert. Es existiert praktisch keine Evidenz
für Behandlungsempfehlungen zur Prävention der Herzinsuffizienz bei Diabetes und zur antihyperglykämischen Therapie bei manifester
Herzinsuffizienz. Die allgemein empfohlene Herzinsuffizienztherapie scheint hingegen bei Diabetikern genauso effektiv zu sein
wie bei Nichtdiabetikern und sollte konsequent durchgeführt werden.
Der Diabetologe 01/2011; 7(4):247-253. · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Single clinical parameters are inaccurate for diagnostic and prognostic estimation in patients with syncope. The cardiac marker NT-pro-BNP has not thoroughly been evaluated for this application.
NT-pro-BNP was assessed in 161 consecutive patients (median age 69 years, 58% male) hospitalized for syncope in a cardiological university department and association (odds ratio: OR, 95% confidence interval: CI) with diagnosis of cardiac cause and 6-months outcome was analyzed.
NT-pro-BNP levels were significantly higher in patients with cardiac (n=78) compared to non-cardiac syncope (n=83). At a cutoff of 156 pg/ml, NT-pro-BNP showed a sensitivity of 89.7%, a specificity of 51.8% and a negative predictive value of 84.3% for the diagnosis of cardiac syncope. Increasing NT-pro-BNP was a significant predictor of cardiac syncope (OR 3.7, 95% CI 2.3-5.8 per standard deviation of Log NT-pro-BNP, p<0.001) and addition of NT-pro-BNP significantly improved a predictive model including heart rate, history of structural heart disease and abnormal ECG. Adding left-ventricular ejection fraction to the model did not change results. Sixty-three patients had an adverse event during hospitalization or 6-months follow-up. NT-pro-BNP>156 pg/ml significantly predicted an adverse outcome (OR 2.7, 95% CI 1.04-6.9, p=0.04) after multivariate adjustment.
In patients hospitalized for syncope, NT-pro-BNP was a strong and independent diagnostic and prognostic marker and addition to conventional criteria of history and examination improved the discriminatory performance. Randomized trials must clarify the benefit and position of NT-pro-BNP in the management algorithm of patients with syncope.
International journal of cardiology 11/2010; 155(2):268-72. · 7.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Microalbuminuria (MAU) and heart rate are established predictors of an adverse cardiovascular outcome. Recently, heart rate was described as an independent predictor of MAU in hypertensive patients, raising the question of a causal link.
In post-hoc analysis of the PROactive trial we examined the association of the baseline heart rate and MAU in diabetic patients with cardiovascular disease (n = 5,110, mean age 62 ± 8, 66% male) using logistic regression. Cox regression analysis was used to examine the independent impact of heart rate and MAU on the composite endpoint of all-cause mortality, myocardial infarction and stroke.
Baseline heart rate was not associated with a significantly increased risk for MAU at baseline (OR 1.01 per 10 bpm, 95% CI 0.97-1.06, p = 0.48) or MAU at the final visit (OR per 10 bpm 1.04, 95% CI 0.98-1.11, p = 0.20). Similar results were observed in subgroups of patients with hypertensive blood pressure at baseline (OR 0.98 per 10 bpm, 95% CI 0.93-1.03, p = 0.42) or patients with a history of hypertension (OR 1.02 per 10 bpm, 95% CI 0.98-1.07, p = 0.31), respectively. Stratification by use of an ACE inhibitor/AT1-receptor blocker did also not change the results. In multivariate analysis, both heart rate and MAU were significantly predictive of a cardiovascular outcome.
There was no evidence of an association between heart rate and MAU in diabetic patients with cardiovascular disease, independently of whether hypertension was present or not, but both markers were independently predictive of a cardiovascular outcome. These results do not support a causal link between heart rate and MAU.
Journal of atherosclerosis and thrombosis 11/2010; 18(1):65-71. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Heart failure is a common complication of type 2 diabetes and bears a poor prognosis. For patients with diabetes and heart failure the commonly accepted standards for diagnosis and treatment of heart failure are to be applied, although prospective diabetes- specific trials are lacking. The optimum HbA(1c) target value as well as the optimum blood glucoselowering treatment are not known. Due to an absence of prospective randomized trials the treatment should follow general therapeutic principles (low incidence of side effects, combination therapy, patient-friendly dosage, costs).
[Show abstract][Hide abstract] ABSTRACT: Worsening renal function (WRF) is frequently observed in patients with heart failure and is associated with worse outcome. The aim of this study was to examine the association of the cardiac serum marker N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and WRF.
A total of 125 consecutive patients of a tertiary care outpatient clinic for heart failure prospectively underwent evaluation of renal function every 6 months. The association of baseline NT-pro-BNP with WRF was analysed during a follow up of 18 months.
Twenty-eight (22.4%) patients developed WRF (increase in serum creatinine ≥0.3 mg/dL). Patients with WRF (2870 pg/mL, interquartile range (IQR) 1063-4765) had significantly higher baseline NT-pro-BNP values than patients without WRF (547 pg/mL, IQR 173-1454). The risk for WRF increased by 4.0 (95% CI 2.1-7.5) for each standard deviation of log NT-pro-BNP. In multivariable analysis including age, baseline renal function, ejection fraction, New York Heart Association class and diuretic dose, only NT-pro-BNP and diabetes were independent predictors of WRF. At a cut-off level of 696 pg/mL, NT-pro-BNP showed a sensitivity of 92.9% and a negative predictive value of 96.4% for WRF.
NT-pro-BNP is a strong independent predictor of WRF within 18 months in patients with systolic heart failure with a high negative predictive value. Further studies are needed to evaluate reno-protective strategies in patients with elevated NT-pro-BNP.
Internal Medicine Journal 02/2010; 41(6):467-72. · 1.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A single measurement of glycated hemoglobin (HbA1c) is a weak predictor for cardiovascular events in patients without Type 2 diabetes mellitus. We hypothesized that dynamic changes in HbA1c (Delta-HbA1c) would better predict cardiovascular outcome than a single value.
In 99 consecutive patients with stable coronary artery disease (CAD) and without diabetes mellitus who were seen twice in our outpatient clinic (4-6 months apart) in 1998, Delta-HbA1c (follow-up HbA1c--baseline HbA1c) was assessed. Between August and September 2007 (mean observation period 9.1 yr), patients and their physicians were contacted by telephone to evaluate the incidence of cardiovascular endpoints. The combined primary endpoint of our study was defined as the incidence of myocardial infarction, stroke or death from any cause. The endpoints were validated by chart review.
Multivariate analysis demonstrated that the change of HbA1c between first and second examination in 1998 was the most powerful parameter for prediction of the combined primary endpoint in the next 9 yr. The hazard ratio was 5.03 [95% confidence interval (CI) 1.4-17.9] for any increase in HbA1c and 1.99 (95%CI 1.3-3.0) for an HbA1c increase of 0.3%. In addition, Kaplan-Meier survival analysis showed a significant association between endpoint-free survival and dynamic changes in HbA1c.
Hence, changes in the glucometabolic milieu within 4-6 months calculated by the difference of two values of HbA1c affect the long-term prognosis of patients with CAD but without diabetes mellitus.
Journal of endocrinological investigation 07/2009; 32(7):564-7. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low-T3 syndrome is highly prevalent and independently prognostic in cardiovascular patients. The relationship and prognostic impact with the cardiac marker NT-pro-BNP have not been thoroughly investigated.
Thyroid hormone levels and NT-pro-BNP were assessed in 615 consecutive patients hospitalized for cardiovascular disease. Patients with primary overt or latent thyroid disorder, hormone replacement, thyreostatic and amiodarone therapy were excluded. The association with and predictive impact on mortality were examined.
36 (7.1%) patients had low-T3 syndrome. After adjustment for known confounders, NT-pro-BNP was significantly associated with fT3 and low-T3 syndrome. fT3 (HR 0.58, 95%CI 0.34-0.98) and low-T3 syndrome (HR 3.0, 95%CI 1.4-6.3) were predictive for mortality after adjustment for NT-pro-BNP levels and other cardiovascular prognostic variables. In patients with fT3 levels within the normal range, fT3 and NT-pro-BNP stratified by median values showed complementary prognostic information with the highest risk for mortality in patients with low normal fT3 and high NT-pro-BNP (HR 10.5, 95%CI 3.2-34.6).
fT3 and low-T3 syndrome are significantly related to NT-pro-BNP in patients with cardiovascular disease, but are predictors of mortality independently of NT-pro-BNP and other known cardiovascular risk parameters.
International journal of cardiology 06/2009; 144(2):187-90. · 7.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die gutachterliche Beurteilung in der Medizin verlangt neben medizinischer Fachkompetenz, Berufserfahrung und sozialmedizinischen
Kenntnissen die Fähigkeit und den Willen, einen Sachverhalt unparteiisch und unvoreingenommen zu beurteilen. Der Gutachter
ist dabei in seiner Beurteilung unabhängig und in seiner Entscheidung nur seinem Gewissen verpflichtet. Aus dieser verantwortungsvollen
Position erwächst die Verpflichtung des Gutachters zur selbstständigen, gründlichen Erhebung von Anamnese und körperlichem
Untersuchungsbefund, zur systematischen Analyse von Vorbefunden sowie zur kritischen Würdigung der Gesamtbefunde im Licht
des aktuellen medizinischen Wissenstands.
[Show abstract][Hide abstract] ABSTRACT: Multi-marker risk scores accurately predict prognosis in heart failure patients but calculation is complex.
To compare the prognostic accuracy of the Seattle Heart Failure Survival Score (SHFS) and a model derived from the CHARM programme, with laboratory parameters NT-proBNP and glomerular filtration rate (GFR).
In a sample of 290 heart failure patients, 39 patients died, 22 were hospitalised with acute heart failure and 4 underwent urgent cardiac transplantation during a median follow-up of 498 days. NT-proBNP, GFR, CHARM and SHFS showed an AUC for an endpoint during 1-year of 0.80, 0.72, 0.79 and 0.69, respectively. The hazard ratio for an endpoint during follow-up was 2.1, 2.6, 1.9 and 2.1 per 1 SD increase of log NT-proBNP and CHARM and per 1 SD decrease of GFR and SHFS, respectively. In multivariate analysis, log NT-proBNP and GFR added independent prognostic information to CHARM and SHFS, respectively.
NT-proBNP and GFR independently predicted endpoint-free survival in systolic heart failure patients, with NT-proBNP being superior and equally predictive to the SHFS and CHARM score, respectively. Assessment of both laboratory markers can simplify prognostic stratification, addition to multi-marker scores should be evaluated.
European Journal of Heart Failure 04/2008; 10(3):315-20. · 5.25 Impact Factor