S Berliner

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (347)826.21 Total impact

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    ABSTRACT: Neutrophil/lymphocyte ratio (NLR) is a novel biomarker that can single out individuals at risk for vascular events. We assessed whether NLR provides additive prognostic value in patients with ST-elevation myocardial infarction (STEMI).
    The Canadian journal of cardiology 05/2014; · 3.12 Impact Factor
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    ABSTRACT: Background An increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress-related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia.HypothesisHyperglycemia in patients undergoing coronary angiography is related to background dysglycemia.Methods Blood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c >6.5% were excluded to avoid patients with chronic glucose levels above 135 mg/dL. A logistic regression model was created to assess the influence of different variables on hyperglycemia (glucose levels above 140 mg/dL). We also evaluated the effect of glucose levels above 140 mg/dL on major adverse cardiovascular events (MACEs) up to 36 months.ResultsThere were 2554 consecutive patients prospectively recruited. Serum glucose levels above 140 mg/dL was a strong predictor of MACE (hazard ratio: 2.2, 95% confidence interval [CI]: 1.3-3.6, P = 0.002). Both diabetes mellitus and ACS were associated with hyperglycemia (glucose levels above 140 mg/dL). Nevertheless, the incidence of hyperglycemia was doubled in diabetic patients (odds ratio [OR]: 9.4, 95% CI: 3.9-22.4, P < 0.001) compared with patients with ACS (OR: 4.6, 95% CI: 2.3-9.0, P < 0.001). Combining both conditions was associated with a high likelihood of elevated glucose levels (OR: 15.5, 95% CI: 7.4-32.9, P < 0.001).Conclusions Hyperglycemia in patients undergoing cardiac catheterization is a strong predictor of adverse outcome. It is mainly related to background dysglycemia and to a lesser extent to the acute stress accompanying ACS.
    Clinical Cardiology 05/2014; · 1.83 Impact Factor
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    ABSTRACT: The phenomenon of slow coronary flow (SCF) in the presence of normal coronary arteries may indicate endothelial dysfunction, which is characteristic of an early stage in the development of atherosclerosis. Measurement of the Carotid Intima-Media Thickness (CIMT) allows identification of early stages of atherosclerosis. CIMT might offer a non-invasive method of diagnosing SCF patients. Previous studies demonstrated conflicting results regarding the relationship between these two phenomena. In the present study, we examined the association between coronary flow velocity and the degree of CIMT in patients with angiographically normal coronary arteries. Coronary arterial blood flow velocity was measured using two methods - Corrected Thrombolysis in Myocardial Infarction (TIMI) Frame Count (CTFC) and Coronary Clearance Frame Count (CCFC). In addition, we measured the level of the CIMT using a special automated computerized software. Seventy Five consecutive patients were prospectively recruited. No correlation was found between CIMT and mean CTFC (r = -0.08, p = NS) or mean CCFC (r = -0.07, p = NS). In addition, CIMT values did not differ between the SCF and the Normal coronary flow (NCF) groups (0.796 mm vs. 0.805 mm, respectively, p = 0.733). Patients with SCF had higher levels of hematocrit (39.9% vs. 36.1%, p < 0.001), LDL cholesterol (101.1 mg/dl vs. 85.8 mg/dl, p = 0.01) and higher rate of current smokers (28.9% vs. 10.8%, p = 0.05). Patients with angiographically normal coronary arteries and SCF do not have increased CIMT values. However, current smoking, higher LDL cholesterol and hematocrit levels are all related to slower coronary blood flow.
    Clinical hemorheology and microcirculation 01/2014; · 3.40 Impact Factor
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    ABSTRACT: Background Neutrophil/lymphocyte ratio (NLR) is a novel biomarker that can single out individuals at risk for vascular events. We assessed whether NLR provides additive prognostic value in patients with ST elevation myocardial infarction (STEMI). Materials and methods NLR was computed from the absolute values of neutrophils and lymphocytes from the complete blood count of patients undergoing primary coronary angioplasty for STEMI. The cohort was divided into 2 groups according to NLR (NLR ≥6.5%, NLR<6.5%) using CHAID and CART methods. The association between NLR and in-hospital clinical complications and left ventricular ejection fraction (EF) was assessed by logistic regression. The association between NLR, 30 days and 5-year all-cause mortality were analyzed using Cox regression models, adjusting for potential clinical, metabolic, and inflammatory confounders. Results In a group of 538 consecutive STEMI patients, high NLR (NLR ≥6.5%) was independently associated with increased 30-day and 5-years mortality rates (OR= 15.8, CI 95% 1.6 – 154, p=0.018, and HR=2.2, CI 95% 1.04-4.8, p=0.039, respectively). High NLR was also independently associated with lower EF (49 ± 8 vs. 46 ± 8, p<0.001) and in hospital complications. Conclusion In patients presenting with STEMI, high neutrophil/lymphocyte ratio is independently associated with lower EF, in hospital complications, and higher mortality rates up to 5 years. NLR value appears additive to conventional risk factors and commonly used biomarkers.
    The Canadian journal of cardiology 01/2014; · 3.12 Impact Factor
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    ABSTRACT: Introduction High RDW values are associated with adverse prognosis in many clinical conditions including short and medium term outcome of patients with ST Elevation Myocardial Infarction (STEMI). The aim of the present study was to evaluate the association between RDW and long term mortality in STEMI patients undergoing primary angioplasty (PPCI). Material and methods A cohort of 535 STEMI patients undergoing PPCI were divided into two groups (RDW > 14%, RDW ≤ 14%) using CHAID and CART methods. The association between RDW and 5-year all-cause mortality was assessed using Cox’s proportional hazards analysis. Results A total of 37 patients died during follow up of 5 years (mean: 1059, median: 1013, range 2–2130 days). RDW > 14% was associated with increased risk of all-cause mortality (HR = 5, CI 95% 2.7– 9.9, p < 0.001). In multivariate analysis, RDW > 14 remained significantly associated with increased risk for all-cause mortality (HR = 3.8, CI 95% 1.8– 7.99, p < 0.001). Patients with RDW above 14% did not have lower ejection fraction, higher CPK or more conventional risk factors. Conclusion RDW value above 14 is independently associated with increased long term all-cause mortality in patients with STEMI undergoing PPCI.
    Thrombosis Research 01/2014; · 3.13 Impact Factor
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    ABSTRACT: Background Sub-clinical systemic inflammation has been implicated in the pathophysiology of obesity. In addition to impacting body weight, dietary modification may modulate markers of inflammation. Methods Overweight/obese adults were recruited to an eight-week dietary intervention characterized by energy restriction and increased complex carbohydrate intake. Blood samples for inflammatory and metabolic markers as well as anthropometric measurements were taken before and following the intervention. Results The study included 72 overweight or obese participants (BMI 31.8±5.8 kg/m2). Significant reductions from baseline weight, BMI, waist and hip circumference were observed following dietary intervention. Levels of inflammatory markers hs-CRP, ESR, WBC, and ICAM decreased significantly from baseline following the 8-week intervention. Metabolic measures including serum triglycerides, total and low density lipoprotein cholesterol significantly declined from baseline. Insulin and HOMA-IR declined in the subgroup of hyperinsulinemic participants. Conclusion An energy-restricted diet rich in complex carbohydrates is associated with weight loss, reduction of inflammatory markers and improved metabolic profile.
    Bioactive Carbohydrates and Dietary Fibre. 01/2014;
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    ABSTRACT: Background The “Slow Coronary Flow” (SCF) phenomenon in the presence of angiographically normal coronaries is attributed to microvascular and endothelial dysfunction. The microcirculation can be non-invasively assessed by measuring retinal blood flow velocity. The aim of the present study was to evaluate the efficacy of the “Retinal Functional Imager” (RFI) device as a noninvasive method of diagnosing patients with slow coronary flow. Methods Coronary blood flow velocity assessed by corrected TIMI Frame Count and retinal arterioles blood flow assessed by RFI were measured in 28 consecutive patients with normal coronary arteries. The patients were divided into 2 groups: a slow coronary flow (SCF) and a normal coronary flow (NCF) groups. Results Inverse correlation was found between retinal and coronary blood flows so that higher retinal arterial flow velocity was observed in the SCF group (3.8 ± 1.1 mm/s vs. 2.9 ± 0.61 mm/s, respectively, p = 0.022). RFI provided 73% sensitivity and 77% specificity for diagnosing SCF using ROC analysis. Additionally, patients with SCF had higher values of serum LDL cholesterol (104.7 ± 18.93 mg/dl vs. 81.55 ± 14.62 mg/dl in NCF, p = 0.005), Glucose (96.9 ± 23.0 mg/dl vs. 83.55 ± 9.7 mg/dl in NCF, p = 0.024), and lower percentage of statin consumption (40.0% vs. 76.9% in NCF, p = 0.049). Conclusions Slow coronary blood flow can be non-invasively diagnosed with Retinal Functional Imager. Patients with normal coronary arteries and slow coronary blood flow have high retinal arteriolar blood flow. Early non-invasive diagnosis of SCF might help detect individuals who are at higher risk to develop coronary atherosclerosis, and to provide them with early preventive measures.
    Atherosclerosis 01/2014; 232(1):149–154. · 3.71 Impact Factor
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    ABSTRACT: Parasympathetic activity influences long-term outcome in patients with cardiovascular disease, but the underlying mechanism(s) linking between parasympathetic activity and the occurrence of major adverse cardiovascular events (MACE) are incompletely understood. The aim of this pilot study was to evaluate the association between serum cholinesterase activities as parasympathetic biomarkers and the risk for the occurrence of MACE. Cholinergic Status (CS) was determined by measuring the cumulative capacity of serum Acetylcholinesterase (AChE) and Butyrylcholinesterase (BChE) to hydrolyze the selective AChE substrate acetylthiocholine. CS was evaluated in randomly selected patients undergoing cardiac catheterization. The patients were divided into 2 groups of 100 patients in each group, with or without occurrence of MACE during a follow up period of 40 months. Cox regression models adjusted for potential clinical, metabolic, and inflammatory confounders served to evaluate association with clinical outcome. We found that patients with MACE presented lower CS and AChE values at catheterization (1127±422, 359±153 nmol substrate hydrolyzed/min*ml) than no-MACE patients (1760±546, 508±183, p<0.001, p<0.001) whose levels were comparable to those of matched healthy controls (1622±303, 504±126). In multivariate analysis, patients with AChE or total CS values below median showed conspicuously elevated risk for MACE (HR=1.85 (CI 95% 1.09-3.15, p=0.02) and 2.21 (CI 95% 1.22-4.00, p=0.009)) compared to those above median, even after adjusting for potential confounders. We conclude that parasympathetic dysfunction expressed as decreased serum AChE and BChE activities, together constituting CS decline and predicting up to 40 months MACE. Monitoring these parasympathetic parameters might help in the risk stratification of patients with cardiovascular disease.
    Molecular Medicine 12/2013; · 4.47 Impact Factor
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    ABSTRACT: Pre-diabetic state is a major risk factor for the development of diabetes and cardiovascular events. Admission glucose, fasting glucose and HbA1c levels have an effect on prognosis in patients with pre-diabetes and in non-diabetic individuals. The aim of the present study was to investigate which of the following glucometabolic markers (admission glucose, fasting glucose and HbA1c levels) is correlated with the severity of coronary artery disease (CAD) in non-diabetic patients. CAD severity according to SYNTAX score was prospectively evaluated in 226 non-diabetic patients hospitalized with myocardial infarction or stable angina and underwent coronary angiography. Glucose intolerance was assessed by serum admission glucose, fasting glucose and HbA1c levels. Logistic regression analysis was used to evaluate which glucometabolic factor has the strongest correlation with CAD severity. HbA1c was the only glucometabolic factor associated with SYNTAX score above 22 (OR = 3.03, CI 95 % 1.03-8.9, p = 0.04). HbA1c was also significantly associated with CAD severity in subgroup analysis (MI and stable angina). In non-diabetic patients with myocardial infarction or stable angina, HbA1c levels correlate with CAD severity as measured by the SYNTAX score. No correlation was found between admission glucose or fasting glucose levels and CAD severity.
    Clinical Research in Cardiology 11/2013; · 3.67 Impact Factor
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    ABSTRACT: Accumulating evidence suggests parasympathetic dysfunction and elevated inflammation as underlying processes in multiple peripheral and neurological diseases. Acetylcholine, the main parasympathetic neurotransmitter and inflammation regulator, is hydrolyzed by the two closely homologous enzymes, acetylcholinesterase and butyrylcholinesterase (AChE and BChE, respectively), which are also expressed in the serum. Here, we consider the potential value of both enzymes as possible biomarkers in diseases associated with parasympathetic malfunctioning. We cover the modulations of cholinesterase activities in inflammation-related events as well as by cholinesterase-targeted microRNAs. We further discuss epigenetic control over cholinesterase gene expression and the impact of single-nucleotide polymorphisms on the corresponding physiological and pathological processes. In particular, we focus on measurements of circulation cholinesterases as a readily quantifiable readout for changes in the sympathetic/parasympathetic balance and the implications of changes in this readout in health and disease. Taken together, this cumulative know-how calls for expanding the use of cholinesterase activity measurements for both basic research and as a clinical assessment tool.
    Journal of Molecular Neuroscience 11/2013; · 2.89 Impact Factor
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    ABSTRACT: Red blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and all-cause mortality in the largest community cohort to date.We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35-6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49-4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03-1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82-1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.
    Thrombosis and Haemostasis 10/2013; 111(2). · 5.76 Impact Factor
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    ABSTRACT: Anemia on admission and during hospitalization is associated with poor short and long term prognosis among patients with acute coronary syndrome (ACS). Our objective was to examine the prognostic implications of longitudinal hemoglobin (Hb) levels following a first acute myocardial infarction (AMI). We utilized data obtained from the computerized database of a large community based health care maintenance organization to identify patients who survived for at least 6months following a first AMI, during the years 2003-2010. Hazard ratios were calculated using Cox proportional regression models with various Hb measurements as dependent variables, and net reclassification improvement (NRI) was applied to evaluate the prognostic usefulness of these Hb measurements. Last Hb measurement during a 6-24month follow-up period was found to have the highest prognostic power. In males, Hb levels below 13g/dL were gradually associated with a higher risk of events, reaching a HR of 4.13 at Hb levels <11g/dL. In females, only Hb levels lower than 11g/dL were significantly associated with a higher event rate (HR=2.42, p=0.003). Hb decrease was significantly associated with an increased risk in both genders, even among non-anemic patients at baseline. Anemia and Hb decrement following a first AMI are associated with worse prognosis and elevated risk of combined all cause mortality and recurrent cardiac events.
    International journal of cardiology 10/2013; · 6.18 Impact Factor
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    ABSTRACT: Obesity has become an epidemic in modern society. However, there is a paucity of research about how job context affects obesity. To enhance our knowledge we used a large, heterogeneous sample of apparently healthy employees (n = 1,949) across two time periods with an average of close to 3.5 years between measures. We tested a hypothesized curvilinear effect of job enrichment on changes in two stress related indicators of abdominal obesity over time: waist circumference (WC) and waist-hip ratio (WHR). Job enrichment consisted of the job dimensions of variety, identity, significance, autonomy, and feedback, and in our analysis we controlled for demographics and health related behaviors, including weekly sports activity, number of cigarettes smoked per day, and weekly alcohol consumption. The results supported the hypothesized U-shaped relationship between job enrichment and changes in both indicators of abdominal obesity over time, such that the level of abdominal obesity was reduced when job enrichment was moderate and was increased when job enrichment was either high or low. As expected, no such association was observed for the general obesity measure of body mass index (BMI). We discuss the theoretical and practical implications of these results. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Journal of Occupational Health Psychology 09/2013; · 2.07 Impact Factor
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    ABSTRACT: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder of unknown etiology, predominantly affecting obese women of childbearing age. IIH is uncommon in men, with a reported female-to-male ratio of 8:1. The pathogenesis of IIH is poorly understood. Several mechanisms have been suggested, but no one mechanism has been able to account for all manifestations of the disease. This research aims to characterize the obesity phenotype(s) of men with IIH in order to find potential inducers for this disease. This is a cross-sectional study based on subjects' medical records. It compared anthropometric parameters between 22 men with IIH, 60 healthy men, and 44 females with IIH. One-way analysis with age and body mass index included as covariates was applied for the assessment of the difference in fat distribution among the three groups. No significant differences were observed between the male IIH cohort and healthy males for age, BMI, and waist measurements, whereas hip circumference was significantly larger in the IIH cohort (114 ± 13 vs. 104 ± 16 cm; respectively, p < 0.001). Consequently, waist-to-hip ratio (WHR) was significantly lower in the male IIH cohort (0.88 ± 0.08 vs. 0.95 ± 0.12; p < 0.001). While no significant differences were observed for age and hip measurements between male IIH and female IIH cohorts, waist circumference and waist-to-hip ratio (WHR) were significantly larger in the male cohort (102 ± 19 cm vs. 95 ± 13 cm, p < 0.001; 0.88 ± 0.08 vs. 0.78 ± 0.06, p < 0.001, respectively). All these results maintained after adjustment for age and BMI. This is the first report of body fat distribution patterns in men with IIH. Whereas male IIH have larger central fat deposition than female IIH patients, abdominal fatness is less accentuated in IIH men compared to normal obese men. The later observation is in agreement with similar results regarding female IIH patients. We believe that these findings justify further investigation into the involvement of various fat depots in the pathogenesis of IIH in men and women alike.
    Albrecht von Graæes Archiv für Ophthalmologie 08/2013; · 1.93 Impact Factor
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    ABSTRACT: Objective: Chronic medical illnesses (CMIs) are prevalent in nearly half the working population and are associated with a two-fold risk for developing depression. Burnout is a chronic affective state comprised of symptoms of emotional exhaustion, physical fatigue, and cognitive weariness. It is an outcome of depletion of energetic resources resulting from prolonged exposure to work and life stresses. Building upon the Conservation of Resources theory (Hobfoll, 1989), this prospective study was designed to test the hypothesis that CMI interacts with burnout to facilitate the development of depressive symptoms. Method: Participants were 4,861 employed men and women, aged 19 to 67 years, who came for routine health examinations and were followed for 18 months on average. Forty-seven percent reported having one or more diagnosed CMIs. Results: Burnout was found to predict an increase in depressive symptoms in apparently healthy individuals. Furthermore, the coexistence of burnout in employees with a CMI accelerates the process of developing depressive symptoms within a relatively short period. Burnout was also found to be associated with intensification of preexisting depressive symptoms in employees suffering from different chronic medical conditions (other than cancer), independent of medical comorbidities and other potent confounding variables. Conclusions: Among employees, coexistence of burnout and at least one CMI predicts an increase in depressive symptoms with time. Health care professionals should be made aware of such at-risk employees and follow and manage them closely. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Health Psychology 07/2013; · 3.83 Impact Factor
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    ABSTRACT: Anemia and inflammation are both associated with unfavorable outcomes in patients with ischemic heart disease and might be pathophysiologically linked. We aimed to analyze the additive value of anemia and inflammation on the outcomes of patients undergoing percutaneous coronary intervention. Cox regression models were fitted for hemoglobin and C-reactive protein (CRP) cut-offs and performed separately for myocardial infarction (MI) and angina pectoris patients undergoing catheterization at a tertiary hospital between 2006 and 2011. Major adverse cardiovascular events (MACEs) were defined as all-cause mortality, MI and stroke. Included were 1976 patients (825 with angina pectoris and 1151 with MI). The median follow-up in the MI and the angina pectoris groups was 14 and 13 months, respectively (maximal follow-up of 4 years). In the MI group, the risk of MACE during follow-up was increased with the presence of either anemia (hazard ratio 2.1, P = 0.07) or of elevated CRP (hazard ratio 1.9, P = 0.04), whereas the presence of both increased the risk even further (hazard ratio 3.4, P < 0.01). In the angina pectoris group, the risk of MACE was increased only in patients who had both anemia and elevated CRP (hazard ratio 2.9, P < 0.01). Inflammation and anemia are independently and additively associated with MACE in MI patients.
    Journal of Cardiovascular Medicine 07/2013; · 2.66 Impact Factor
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    ABSTRACT: Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is a novel, independent predictor of prognosis in patients with cardiovascular diseases. The aim of the present study was to evaluate the significance of this biomarker in a relatively large cohort of patients, and to assess its association with a more severe underlying cardiovascular disease. A cohort of 3,222 consecutive patients undergoing coronary angiography was divided according RDW median. The association between RDW and 3-year outcome in the context of other predictors was assessed using Cox's proportional hazards analysis. Patients with elevated RDWs were older, had higher body mass indices, and had more cardiovascular risk factors and more cardiovascular diseases. The total rate of mortality, MI and stroke (MACE) was 7.7 % (120 events) in the lower RDW group, and 18.2 % (303 events) in the higher RDW group, p < 0.001. Following adjustment for multiple background risk factors, medications, and laboratory results, the RDW value was independently associated with worse outcome (HR = 1.12, 95 % CI 1.07-1.18, p < 0.001, for each 1 % increase in RDW). Elevated RDW values are independently associated with adverse 3-year outcome in patients undergoing coronary angiography.
    Journal of Thrombosis and Thrombolysis 07/2013; · 1.99 Impact Factor
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    ABSTRACT: AIM: Lower socioeconomic status (SES) is associated with reduced cardio-respiratory fitness (CRF) and predicts adverse cardiovascular outcomes. We questioned whether this association remains significant among an apparently healthy population with a presumed higher SES. METHODS: This cross-sectional study enrolled attendees of a health screening program between September 2002 and November 2010. Linear regression models included the metabolic equivalents achieved during an exercise treadmill stress test as the dependent variable and adjusted for self-reported SES parameters (level of education, occupational status, financial strain and a combined variable), cardiovascular risk factors, as well as to multiple potential confounders. RESULTS: Data on 8471 individuals (5463 men and 3008 women) with a mean (SD) age of 44 (11) years were collected. We found a statistically significant difference in mean exercise capacity between the categories of SES, especially for the level of education and occupation, when adjusted for age, sex, cardiovascular risk factors, SES variables and multiple confounders. CONCLUSIONS: Multiple factors affect CRF in apparently healthy screened individuals. When adjusted for those factors, SES correlates with CRF even within a more specific highly educated cohort.
    Journal of Cardiovascular Medicine 05/2013; · 2.66 Impact Factor
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    ABSTRACT: BACKGROUND: Concerns about an inhibitory effect of proton pump inhibitors (PPIs) on clopidogrel metabolism have been raised. Because the pharmacological effect of clopidogrel is dependent on genetically determined activity of the hepatic cytochrome P450 isoenzymes system, it is important to examine the interaction between different PPIs and high on-treatment platelet reactivity (HPR) after controlling for genetic variability. The aim of the study was to assess the effect of 2 PPIs and a histamine-2 (H2) receptor-blocker on platelet reactivity in a crossover trial where each patient was alternately treated with each drug. HYPOTHESIS: Omeprazole reduces HPR more than other PPI or H2 blockers. METHODS: Patients treated with aspirin and clopidogrel for at least 1 month were assigned to 3 consecutive 1-month treatment periods during which they were treated with each of the 3 study medications twice daily: omeprazole 20 mg, famotidine 40 mg, and pantoprazole 20 mg. At the end of each treatment phase, platelet function was evaluated with the Verify Now system using 2 cutoff values (>208 P2Y12 reaction units [PRUs] and >230 PRUs) for the definition of HPR. RESULTS: Patients with HPR were older than those without HPR (62 ± 10 vs 55 ± 8 years, respectively, P = 0.03). HPR was more prevalent during omeprazole therapy compared to famotidine or pantoprazole (48%, 33%, and 31%, respectively, for the 208 PRU cutoff, P= 0.04; and 37%, 17%, and 23%, respectively, for the 230 PRU cutoff, P= 0.003). CONCLUSIONS: After eliminating the effects of interindividual variability in clopidogrel metabolism, omeprazole therapy was associated with substantially more HPR than famotidine or pantoprazole.
    Clinical Cardiology 04/2013; · 1.83 Impact Factor
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    ABSTRACT: Prior toxicological exposure reports demonstrated the decremental effect of several air pollutants on the metabolic equivalents achieved during exercise testing (METs). There are no prior large scale epidemiological reports about the effect of environmental air pollution exposure on those parameters. We analyzed a cohort of apparently healthy individuals attending a screening survey program held between 2003 and 2009. Participants were included if residing within an 11 km radius from the nearest air pollution monitoring station. Linear regression models were fitted for the metabolic equivalents and adjusted to short- and long-term air pollutant exposure (particulate matter under 10 micron, sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone). The models were adjusted for possible confounders that affect air pollution and stress testing measurements. The study population comprised 6,612 individuals (4,201 males and 2,411 females). We found a statistically significant short- and long-term negative correlation between air pollutants, mainly CO and NO2 and between the metabolic equivalents achieved. A similar short-term effect was found for SO2. We conclude that exposure to combustion-derived air pollutants has a short- and long-term decremental effect on cardiorespiratory fitness as measured by exercise stress testing. Our epidemiological data support previous toxicological reports.
    Clinical Research in Cardiology 04/2013; · 3.67 Impact Factor

Publication Stats

3k Citations
826.21 Total Impact Points


  • 1981–2014
    • Tel Aviv University
      • • Department of Internal Medicine
      • • Faculty of Management
      • • Faculty of Medicine
      • • Department of Ophthalmology
      Tell Afif, Tel Aviv, Israel
  • 1992–2013
    • Tel Aviv Sourasky Medical Center
      • • Department of Neurology
      • • Division of Internal Medicine
      • • Department of Ophthalmology
      Tell Afif, Tel Aviv, Israel
  • 2009
    • University of Texas at Arlington
      Arlington, Texas, United States
    • Ministry of Health (Israel)
      Yerushalayim, Jerusalem District, Israel
  • 2003–2004
    • Shaare Zedek Medical Center
      • • Department of Medicine
      • • Department of Pediatrics
      Yerushalayim, Jerusalem District, Israel
  • 1999
    • Sheba Medical Center
      • Department of Pathology
      Gan, Tel Aviv, Israel
  • 1997
    • Hadassah Medical Center
      • Department of Neurology
      Jerusalem, Jerusalem District, Israel