Gregory Y H Lip

Aalborg University, Ålborg, North Denmark, Denmark

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Publications (1000)6066.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Up to 40% of atrial fibrillation (AF) patients are asymptomatic. Despite this, scarce data are available about asymptomatic AF, with regard to its clinical profile and relationship to cerebrovascular and cardiovascular risks. Our objective was to conduct a systematic review and meta-analysis was to study the relationship between age and gender with asymptomatic AF and to establish whether patients with asymptomatic AF have a higher risk of death (all-cause and cardiovascular) and stroke/systemic thromboembolism, when compared to symptomatic AF patients. After a comprehensive search, 6 studies (2 randomized clinical trials and 4 observational studies) were entered in the meta-analysis. Despite significant heterogeneity, our data show that the prevalence of females amongst asymptomatic AF group was significantly less compared to the symptomatic AF group (RR, 0.57; 95% CI: 0.52-0.64). No difference in age between asymptomatic and symptomatic AF patients (P=0.72) was seen. No differences were found in all-cause death between patients with asymptomatic and symptomatic AF (RR, 1.38; 95% CI: 0.82-2.17), nor in cardiovascular death (RR, 0.85; 95% CI: 0.53-1.36) or stroke/thromboembolism (RR, 1.72 95% CI: 0.59-5.08). Asymptomatic AF is more associated with male sex, irrespective of age. Both general and cardiovascular death risks as well as thromboembolic risk do not seem to be affected by the asymptomatic clinical status. Symptomatic status should not determine our approach to stroke prevention and other cardiovascular prevention therapies, amongst patients with AF. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 05/2015; 191:172-177. DOI:10.1016/j.ijcard.2015.05.011 · 6.18 Impact Factor
  • Allan J Walkey, D Kyle Hogarth, Gregory Y H Lip
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    ABSTRACT: Atrial fibrillation (AF) that newly occurs during critical illness presents challenges for both short- and long-term management. During the critical illness, patients with new-onset AF are clinically evaluated for hemodynamic instability due to the arrhythmia, as well as for potentially reversible arrhythmia triggers. Hemodynamically significant AF that persists during critical illness may be treated with heart rate or rhythm control strategies. Recent evidence suggests that patients who develop AF during acute illness (eg., sepsis, post-operatively) have high long-term risks for AF recurrence and for AF-associated complications such as stroke, heart failure and death. Therefore, we suggest increased efforts to improve communication of AF events between inpatient and outpatient providers, and to reassess patients who had experienced new-onset AF during critical illness after they transition to the post-ICU setting. We describe various strategies for the assessment and long-term management of patients with new-onset AF during critical illness.
    Chest 05/2015; DOI:10.1378/chest.15-0358 · 7.13 Impact Factor
  • Keitaro Senoo, Gregory Y H Lip
    04/2015; 2(4). DOI:10.1016/S2352-3026(15)00041-1
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    ABSTRACT: The impact of statin therapy on plasma asymmetric dimethylarginine (ADMA) levels has not been conclusively studied. Therefore the aim of the meta-analysis was to assess the effect of statins on circulating ADMA levels. We searched selected databases (up to August 2014) to identify randomized controlled trials (RCTs) that investigate the effect of statins on plasma ADMA concentrations. A weighted meta-regression (WMD) using unrestricted maximum likelihood model was performed to assess the impact of statin dose, duration of statin therapy and baseline ADMA concentrations as potential variables on the WMD between statin and placebo group. In total, 1134 participants in 9 selected RCTs were randomized; 568 were allocated to statin treatment and 566 were controls. There was a significant reduction in plasma ADMA concentrations following statin therapy compared with placebo (WMD: -0.104 µM, 95% confidence interval: -0.131 to -0.077, Z= -7.577, p<0.0001). Subgroups analysis has shown a significant impact of hydrophilic statins (WMD: -0.207 µM, 95%CI: -0.427 to +0.013, Z= -7.250, p<0.0001) and a non-significant effect of hydrophobic statins (WMD: -0.101 µM, 95%CI: -0.128 to -0.074, Z= -1.845, p=0.065). In conclusion, this meta-analysis of available RCTs showed a significant reduction in plasma ADMA concentrations following therapy with hydrophilic statins.
    Scientific Reports 04/2015; 5(1). DOI:10.1038/srep09902 · 5.58 Impact Factor
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    ABSTRACT: Data on the use of oral anticoagulation (OAC) and antiplatelet therapy and the risk of bleeding and stroke amongst Asian patients with atrial fibrillation (AF) are limited. We investigated the risks of bleeding and stroke with use of oral anticoagulation (OAC) and antiplatelet therapy as mono- or combination therapy, in patients with AF from a Chinese nationwide cohort study. We studied a cohort of 10384 patients (57.2% men, age 67.8 ± 13.2 yrs) between 1999 and 2010 from the National Health Insurance Research Database in Taiwan. Records of prescriptions were obtained during follow-up. The main outcome was a recurrent stroke during the follow-up period. Time-dependent Cox proportional hazards models were used for this analysis. We documented 1009 events for bleeding, as well as 224 hemorrhagic stroke and 1642 ischemic stroke events during a median 3.2 (interquartile range, 1.05-6.54) years' follow-up. Compared with warfarin users, patients with antiplatelet therapy had a lower risk of bleeding (adjusted relative risk [RR], 0.59, 95% confidence interval [CI], 0.49-0.71, p<0.001) whilst combination therapy had a non-statistically significant higher bleeding risk (RR, 1.33, 95%, 0.91-1.94, p = 0.20). Patients on antiplatelet monotherapy had a similar risk for ischemic stroke compared with OAC (RR 1.05, 95% CI, 0.89-1.25, p = 0.50), whilst those on combination therapy had a significantly higher risk (RR 1.90, 95% CI, 1.34-2.70, p<0.001). In a national representative cohort, antiplatelet therapy had no significant difference in ischemic stroke risk to warfarin. For bleeding, aspirin had a lower risk compared to warfarin. This may reflect poor anticoagulation control, highlighting important missed opportunities for improved stroke prevention, especially in countries where anticoagulation management is suboptimal.
    PLoS ONE 04/2015; 10(4):e0125257. DOI:10.1371/journal.pone.0125257 · 3.53 Impact Factor
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    ABSTRACT: The purpose of the present study was to compare acute changes in oxidative stress and inflammation in response to steady state and low volume, high intensity interval exercise (LV-HIIE). Untrained healthy males (n = 10, mean ± s: age 22 ± 3 years; VO2MAX 42.7 ± 5.0 ml · kg(-1) · min(-1)) undertook three exercise bouts: a bout of LV-HIIE (10 × 1 min 90% VO2MAX intervals) and two energy-matched steady-state cycling bouts at a moderate (60% VO2MAX; 27 min, MOD) and high (80% VO2MAX; 20 min, HIGH) intensity on separate days. Markers of oxidative stress, inflammation and physiological stress were assessed before, at the end of exercise and 30 min post-exercise (post+30). At the end of all exercise bouts, significant changes in lipid hydroperoxides (LOOH) and protein carbonyls (PCs) (LOOH (nM): MOD +0.36; HIGH +3.09; LV-HIIE +5.51 and PC (nmol · mg(-1) protein): MOD -0.24; HIGH -0.11; LV-HIIE -0.37) were observed. Total antioxidant capacity (TAC) increased post+30, relative to the end of all exercise bouts (TAC (µM): MOD +189; HIGH +135; LV-HIIE +102). Interleukin (IL)-6 and IL-10 increased post+30 in HIGH and LV-HIIE only (P < 0.05). HIGH caused the greatest lymphocytosis, adrenaline and cardiovascular response (P < 0.05). At a reduced energy cost and physiological stress, LV-HIIE elicited similar cytokine and oxidative stress responses to HIGH.
    Journal of Sports Sciences 04/2015; DOI:10.1080/02640414.2015.1035666 · 2.10 Impact Factor
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    ABSTRACT: Atrial tachyarrhythmias (ATs) detected by implanted devices are often atrial fibrillation or flutter (AF) associated with stroke. We hypothesized that introduction and termination of anticoagulation based upon AT monitoring would reduce both stroke and bleeding. We randomized 2718 patients with dual-chamber and biventricular defibrillators to start and stop anticoagulation based on remote rhythm monitoring vs. usual office-based follow-up with anticoagulation determined by standard clinical criteria. The primary analysis compared the composite endpoint of stroke, systemic embolism, and major bleeding with the two strategies. The trial was stopped after 2 years median follow-up based on futility of finding a difference in primary endpoints between groups. A total of 945 patients (34.8%) developed AT, 264 meeting study anticoagulation criteria. Adjudicated atrial electrograms confirmed AF in 91%; median time to initiate anticoagulation was 3 vs. 54 days in the intervention and control groups, respectively (P < 0.001). Primary events (2.4 vs. 2.3 per 100 patient-years) did not differ between groups (HR 1.06; 95% CI 0.75-1.51; P = 0.732). Major bleeding occurred at 1.6 vs. 1.2 per 100 patient-years (HR 1.39; 95% CI 0.89-2.17; P = 0.145). In patients with AT, thromboembolism rates were 1.0 vs. 1.6 per 100 patient-years (relative risk -35.3%; 95% CI -70.8 to 35.3%; P = 0.251). Although AT burden was associated with thromboembolism, there was no temporal relationship between AT and stroke. In patients with implanted defibrillators, the strategy of early initiation and interruption of anticoagulation based on remotely detected AT did not prevent thromboembolism and bleeding. IMPACT ClinicalTrials.gov identifier: NCT00559988 http://clinicaltrials.gov/ct2/show/NCT00559988?term=NCT00559988&rank=1. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    European Heart Journal 04/2015; DOI:10.1093/eurheartj/ehv115 · 14.72 Impact Factor
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    ABSTRACT: -The aim of this study is to examine the relationship between time in therapeutic range (TTR) and clinical outcomes in heart failure (HF) patients in sinus rhythm (SR) treated with warfarin. -We used data from the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction Trial (WARCEF) to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death); with death alone; ischemic stroke alone; major hemorrhage alone; and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin patients, with TTR being treated as a time-dependent covariate. 2,217 patients were included in the analyses, among whom 1,067 were randomized to warfarin and 1,150 were randomized to aspirin. The median (IQR) follow-up duration was 3.6 (2.0-5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted p<0.001), death alone (adjusted p=0.001), and improved net clinical benefit (adjusted p<0.001). A similar trend was observed for the other two outcomes but significance was not reached (adjusted p=0.082 for ischemic stroke, adjusted p=0.109 for major hemorrhage). -In HF patients in SR, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00041938.
    Circulation Heart Failure 04/2015; 8(3). DOI:10.1161/CIRCHEARTFAILURE.114.001725 · 5.95 Impact Factor
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    ABSTRACT: Introduction Numerous studies have suggested that oral supplementation with resveratrol exerts cardioprotective effects, but evidence of the effects on C-reactive protein (CRP) plasma levels and other cardiovascular (CV) risk factors is inconclusive. Therefore, we performed a meta-analysis to evaluate the efficacy of resveratrol supplementation on plasma CRP concentrations and selected predictors of CV risk. Methods The search included PUBMED, Cochrane Library, Web of Science, Scopus, and EMBASE (up to August 31, 2014) to identify RCTs investigating the effects of resveratrol supplementation on selected CV risk factors. Quantitative data synthesis was performed using a random-effects model, with weighted mean difference (WMD) and 95% confidence intervals (CI) as summary statistics. Results Meta-analysis of data from 10 RCTs (11 treatment arms) did not support a significant effect of resveratrol supplementation in altering plasma CRP concentrations (WMD: -0.144 mg/L, 95%CI: -0.968-0.680, p = 0.731). Resveratrol supplementation was not found to alter plasma levels of total cholesterol (WMD: 1.49 mg/dL, 95%CI: -14.96-17.93, p = 0.859), low density lipoprotein cholesterol (WMD: -0.31 mg/dL, 95%CI: -9.57-8.95, p = 0.948), triglycerides (WMD: 2.67 mg/dL, 95%CI: -28.34-33.67, p = 0.866), and glucose (WMD: 1.28 mg/dL, 95%CI: -5.28-7.84, p = 0.703). It also slightly reduced high density lipoprotein cholesterol concentrations (WMD: -4.18 mg/dL, 95%CI: -6.54- -1.82, p = 0.001). Likewise, no significant effect was observed on systolic (WMD: 0.82 mmHg, 95%CI: -8.86-10.50, p = 0.868) and diastolic blood pressure (WMD: 1.72 mmHg, 95%CI: -6.29-9.73, p = 0.674). Conclusions This meta-analysis of available RCTs does not suggest any benefit of resveratrol supplementation on CV risk factors. Larger, well-designed trials are necessary to confirm these results.
    International Journal of Cardiology 04/2015; 189. DOI:10.1016/j.ijcard.2015.04.008 · 6.18 Impact Factor
  • Tatjana S Potpara, Deirdre A Lane, Gregory Y H Lip
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    ABSTRACT: This editorial refers to 'Non-vitamin K antagonist oral anticoagulants: considerations on once-vs. twice-daily regimens and their potential impact on medication adherence' by B. Vrijens and H. Heidbuchel, on page 514-523. This editorial refers to 'Drug persistence with rivaroxaban therapy in atrial fibrillation patients-results from the Dresden non-interventional oral anticoagulation registry' by J. Beyer-Westendorf et al., on page 530-538.
    Europace 04/2015; 17(4):507-8. DOI:10.1093/europace/euv041 · 3.05 Impact Factor
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    ABSTRACT: Introduction Numerous studies have suggested that oral supplementation with resveratrol exerts cardioprotective effects, but evidence of the effects on C-reactive protein (CRP) plasma levels and other cardiovascular (CV) risk factors is inconclusive. Therefore, we performed a meta-analysis to evaluate the efficacy of resveratrol supplementation on plasma CRP concentrations and selected predictors of CV risk. Methods The search included PUBMED, Cochrane Library, Web of Science, Scopus, and EMBASE (up to August 31, 2014) to identify RCTs investigating the effects of resveratrol supplementation on selected CV risk factors. Quantitative data synthesis was performed using a random-effects model, with weighted mean difference (WMD) and 95% confidence intervals (CI) as summary statistics. Results Meta-analysis of data from 10 RCTs (11 treatment arms) did not support a significant effect of resveratrol supplementation in altering plasma CRP concentrations (WMD: -0.144 mg/L, 95%CI: -0.968-0.680, p = 0.731). Resveratrol supplementation was not found to alter plasma levels of total cholesterol (WMD: 1.49 mg/dL, 95%CI: -14.96-17.93, p = 0.859), low density lipoprotein cholesterol (WMD: -0.31 mg/dL, 95%CI: -9.57-8.95, p = 0.948), triglycerides (WMD: 2.67 mg/dL, 95%CI: -28.34-33.67, p = 0.866), and glucose (WMD: 1.28 mg/dL, 95%CI: -5.28-7.84, p = 0.703). It also slightly reduced high density lipoprotein cholesterol concentrations (WMD: -4.18 mg/dL, 95%CI: -6.54- -1.82, p = 0.001). Likewise, no significant effect was observed on systolic (WMD: 0.82 mmHg, 95%CI: -8.86-10.50, p = 0.868) and diastolic blood pressure (WMD: 1.72 mmHg, 95%CI: -6.29-9.73, p = 0.674). Conclusions This meta-analysis of available RCTs does not suggest any benefit of resveratrol supplementation on CV risk factors. Larger, well-designed trials are necessary to confirm these results.
    International journal of cardiology 04/2015; · 6.18 Impact Factor
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    ABSTRACT: Microparticles are markers for cell activation and apoptosis and could provide valuable information that is not available from clinical data. This study assesses the clinical and biological relationship of small-sized microparticles in different forms of ischemic systolic heart failure and their relation to markers of inflammation and repair.
    Revista Espa de Cardiologia 03/2015; DOI:10.1016/j.recesp.2014.11.020 · 3.34 Impact Factor
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    ABSTRACT: Microparticles are markers for cell activation and apoptosis and could provide valuable information that is not available from clinical data. This study assesses the clinical and biological relationship of small-sized microparticles in different forms of ischemic systolic heart failure and their relation to markers of inflammation and repair. We compared 49 patients with acute heart failure, 39 with stable heart failure and 25 patients with stable coronary artery disease. Small-size microparticles counts were determined by high-resolution flow cytometry. Moreover, 3 different monocyte subpopulations and their expression of inflammatory and adhesive scavenger receptors were analyzed using a conventional flow cytometer. Endothelial CD144+ microparticle counts were decreased in heart failure groups (P=.008). Annexin V-binding microparticle counts were found increased in heart failure (P=.024) and in patients with lower functional class (P=.013). Platelet CD42b+ microparticle counts positively correlated with left ventricular ejection fraction (P=.006), and annexin V-binding microparticle counts with interleukin-6 levels in stable heart failure (P=.034). Annexin V-binding microparticle counts in the acute status strongly correlated with toll-like receptor-4 expression on all monocyte subsets (all P<.01). Three months after admission with acute heart failure, annexin V-binding microparticle counts were positively correlated with receptors for interleukin-6, CD163 and CD204 (all P<.05). Annexin V-binding microparticle counts constitute valuable hallmarks of acute decompensated state in systolic heart failure. The observed relationship between small-size annexin V-binding microparticles and scavenger receptors supports their involvement in the progression of the acute response to injury, and thus their contribution to the pathogenesis of acute decompensated heart failure. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
    Revista Espanola de Cardiologia 03/2015; DOI:10.1016/j.rec.2014.11.016 · 3.34 Impact Factor
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    ABSTRACT: -Our aim was to describe the incidence and predictors of stroke in heart failure (HF) patients without atrial fibrillation (AF). -We pooled two contemporary HF trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiac- Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with and in 206 patients (3.4%) without AF (rates 16.8 per 1000 patient-years and 11.1 per 1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by chi-square value): age (hazard ratio [HR] 1.34, 95% CI 1.18-1.63 per 10 years), NYHA class (1.60, 1.21-2124 class III/IV vs II), diabetes treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5kg/m(2) up to 30) and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (NT-proBNP, available in 2,632 patients) was also an independent predictor of stroke (HR 1.31, 1.11-1.57 per log unit) when added to this model. Using a risk-score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated to the risk in patients with AF. -A small number of demographic and clinical variables identified a subset of HF patients without AF at high risk of stroke.
    Circulation 03/2015; 131:1486-1494. DOI:10.1161/CIRCULATIONAHA.114.013760 · 14.95 Impact Factor
  • Qinmei Xiong, Yee C Lau, Gregory Yh Lip
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    ABSTRACT: Non-vitamin K antagonist oral anticoagulants (NOACs) have been developed to prevent ischemic stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. Owing to their predictable pharmacological profiles, they can be given in fixed doses without the need for routine coagulation monitoring. However, their distinctive pharmacological properties also raise issues about potential drug interactions. Areas covered: A literature search was conducted to extract published studies on the pharmacodynamics and drug interactions involving NOACs. Available data from US FDA and European Medicine Agency were also included. As these agents are substrates of permeability glycoprotein (P-gp) efflux transporter and/or CYP3A4 enzymes, articles focusing on the co-administration of NOACs and drugs affecting these pathways are discussed. Concomitant use of NOACs with antiplatelet agents may potentially increase bleeding risk. Expert opinion: Measurement of anticoagulant effects is desired to evaluate the risk of thromboembolism or bleeding for patients with NOACs. Prescribers should be vigilant against combination prescription of NOACs with strong inhibitors (such as ketoconazole) or inducers of P-gp and/or CYP3A4 (such as rifampicin). Potential benefit of concurrent use of these agents with antiplatelet drugs should be cautiously balanced against latent risk in specific clinical situations.
    Expert Opinion on Drug Metabolism &amp Toxicology 03/2015; 11(6):1-12. DOI:10.1517/17425255.2015.1027683 · 2.93 Impact Factor
  • Keitaro Senoo, Gregory Y H Lip
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    ABSTRACT: Atrial fibrillation (AF) confers a substantial risk of stroke and thromboembolism, which is effectively reduced by oral anticoagulation (OAC), whether as a vitamin K antagonist (VKA, eg, warfarin) or one of non-VKA oral anticoagulants (NOACs). With the use of OACs, the risk of bleeding remains a problem associated with these agents. Thus, a clinical dilemma remains in the optimal management of patients with AF who are at high risk of stroke but have a history of bleeding. Among patients with non-valvular AF, over 90% of the thrombus is formed in the left atrial appendage (LAA).1 Thus, the exclusion of LAA could greatly decrease the risk of stroke in patients with AF, given that blood stasis in a fibrillating LAA is likely to lead to thrombus formation. Interventional devices to occlude the LAA are not ‘new’ and various LAA closure devices have been available for years. More recently, the Watchman (Atritech) and Amplatzer Cardiac Plug (ACP) device (St Jude Medical) are the more widely used ones in clinical practice. The PROTECT AF … [Full text of this article]
    Heart (British Cardiac Society) 03/2015; 101(11). DOI:10.1136/heartjnl-2015-307451 · 6.02 Impact Factor
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    ABSTRACT: The purpose of this study was too describe the associated baseline features of AF patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Secondly, we assessed symptomatic status and their clinical correlates. Finally, we examined independent predictors for 'heart failure' at the 1-year follow-up period. A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation (EORP-AF Pilot), was carried out. Of the whole cohort of 2972 patients, 1411 (47.5%) had a diagnosis of HF. Of the AF patients with HF, oral anticoagulants were prescribed to 82.1% and antiarrhythmic drugs in 36.7%. Independent predictors of HFpEF were high body mass index, high heart rate, high systolic blood pressure, low diastolic blood pressure, high CHA2 DS2 -VASc score, and absence of chronic kidney disease, sleep apnoea, or ischaemic cardiomyopathy. On multivariate stepwise regression analysis, independent predictors of the development of HF were mode of AF presentation, diuretic use, prior HF, COPD, and valvular disease. At 1 year, HF was associated with a greater risk of all-cause mortality (log-rank test, P < 0.001). When HFrEF was compared with HFpEF at 1 year, crude rates were significant for the composite endpoint of 'stroke/thrombo-embolism/transient ischaemic attack and death' (15.9% vs. 11.1%, P = 0.043). We provide insights into the clinical characteristics and outcomes in AF patients with HF, who were managed by European cardiologists. Despite a high prevalence of oral anticoagulant use, 1-year mortality and morbidity remained high in AF patients with HF, whether HFrEF or HFpEF. Such patients require a holistic approach to cardiovascular risk management. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 03/2015; 17(6). DOI:10.1002/ejhf.254 · 6.58 Impact Factor
  • Eduard Shantsila, Luke D. Tapp, Gregory Y.H. Lip
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    ABSTRACT: We assessed changes of serum combined free immunoglobulin light chains (cFLC) levels, which are associated with increased all-cause mortality, in ST-elevation myocardial infarction (STEMI) in relation to inflammation and renal function indices. cFLC were measured in 48 patients with STEMI on days 1, 3, 7 and 30 with assessment of their relationships with monocyte subsets, high sensitivity C-reactive protein (hsCRP), and cystatin C. Day 1 levels in STEMI patients were compared to 40 patients with stable coronary artery disease, and 37 healthy controls. There were no significant differences in cFLC levels between the study groups. In STEMI patients, cFLC values peaked on day 7 post-MI and remained elevated on day 30 (p<0.001 vs. day 1 for both). hsCRP concentrations peaked on day 3 of STEMI followed by their gradual reduction to the levels seen in the controls (p<0.001). In STEMI cFLC correlated with cystatin C (r=0.55, p<0.001), and negatively correlated with counts of CD14++CD16- monocytes (r=-0.55, p<0.001). On multivariate Cox regression analysis, cFLC concentrations were associated with increased need for future percutaneous coronary intervention (PCI) (p=0.019). cFLC levels increase during STEMI with peak values on day 7 after presentation and predict the need for future PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 03/2015; 185. DOI:10.1016/j.ijcard.2015.03.105 · 6.18 Impact Factor
  • Adrian M. Shields, Gregory Y. H. Lip
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    ABSTRACT: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is a growing health problem that is associated with a significantly increased risk of stroke and thromboembolism. Oral anticoagulant (OAC) therapy reduces the risk of stroke and all-cause mortality in patients with AF. OAC therapy is commonly given as a well-controlled vitamin K antagonist (VKA; e.g. warfarin) and can reduce the risk of stroke in AF patients by almost two-thirds. However the widespread use of VKAs has been hampered by the unpredictable pharmacokinetic and pharmacodynamic properties of the drugs and justifiable concerns about the consequent risk of haemorrhage. The non-VKA OACs (NOACs) have revolutionised thromboprophylaxis in AF by providing therapeutic options with predictable pharmacodynamic and pharmacokinetic properties that are as efficacious as warfarin in the prevention of stroke and thromboembolism but are more convenient to use. In this review, we provide a patient-centred framework to assist clinicians in recommending the right OAC therapy to fit the individual patient with AF, including methods for stratifying the risk of stroke and haemorrhage and the chances of achieving tight control of VKA anticoagulation, and we discuss the properties of the NOACs that favour their use in particular patient cohorts. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Internal Medicine 03/2015; DOI:10.1111/joim.12360 · 5.79 Impact Factor
  • British Journal of General Practice 03/2015; 65(632):117. DOI:10.3399/bjgp15X683905 · 2.36 Impact Factor

Publication Stats

25k Citations
6,066.02 Total Impact Points

Institutions

  • 2012–2015
    • Aalborg University
      • Faculty of Medicine
      Ålborg, North Denmark, Denmark
    • University of Iowa
      Iowa City, Iowa, United States
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
  • 1996–2015
    • University of Birmingham
      • • Centre for Cardiovascular Sciences
      • • Department of Primary Care Clinical Sciences
      • • School of Sport and Exercise Sciences
      Birmingham, England, United Kingdom
  • 1995–2015
    • Birmingham City University
      Birmingham, England, United Kingdom
    • University of Glasgow
      • School of Medicine
      Glasgow, Scotland, United Kingdom
  • 2013
    • University of Belgrade
      • Chair of Pharmacology, Clinical Pharmacology and Toxicology
      Beograd, Central Serbia, Serbia
    • Sapienza University of Rome
      Roma, Latium, Italy
    • Queen Mary, University of London
      • Centre for Primary Care and Public Health
      London, ENG, United Kingdom
  • 2012–2013
    • Chinese PLA General Hospital (301 Hospital)
      Peping, Beijing, China
  • 2011–2013
    • Klinički centar Srbije
      • Institute for Cardiovascular Diseases
      Beograd, Central Serbia, Serbia
    • Universitätsklinikum Münster
      Muenster, North Rhine-Westphalia, Germany
    • Alexandra Regional General Hospital
      Athínai, Attica, Greece
  • 2010–2013
    • Aston University
      • School of Life and Health Sciences
      Birmingham, England, United Kingdom
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Department of Vascular Medicine
      Amsterdam, North Holland, Netherlands
  • 2002–2012
    • McMaster University
      • Department of Medicine
      Hamilton, Ontario, Canada
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005–2011
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
    • University of Oslo
      Kristiania (historical), Oslo, Norway
    • Hamilton Health Sciences
      Hamilton, Ontario, Canada
  • 1997–2011
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, England, United Kingdom
    • University Hospital Of South Manchester NHS Foundation Trust
      Manchester, England, United Kingdom
  • 2009
    • University Hospitals Coventry and Warwickshire NHS Trust
      • Department of Cardiology
      Coventry, England, United Kingdom
  • 2008
    • University of Murcia
      • Faculty of Medicine
      Murcia, Murcia, Spain
  • 2007–2008
    • University Hospital of Heraklion
      Irákleio, Attica, Greece
    • University of Texas at San Antonio
      San Antonio, Texas, United States
  • 1998–2008
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2006
    • Saint Luke's Hospital (NY, USA)
      New York, New York, United States
  • 2002–2005
    • Hospital General Universitario de Alicante
      Alicante, Valencia, Spain
  • 2003
    • Medical University of Vienna
      • Universitätsklinik für Klinische Pharmakologie
      Vienna, Vienna, Austria
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
    • The University of Edinburgh
      • Division of Clinical Neurosciences
      Edinburgh, SCT, United Kingdom
  • 2001
    • Beaumont Hospital
      Dublin, Leinster, Ireland
  • 1999
    • Birmingham Children's Hospital NHS Foundation Trust
      Birmingham, England, United Kingdom