Gregory Y H Lip

Birmingham City Council, Birmingham, England, United Kingdom

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Publications (1000)6260.44 Total impact

  • Keitaro Senoo · Marco Proietti · Deirdre A Lane · Gregory Y.H. Lip ·
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    ABSTRACT: Introduction: Various bleeding risk prediction schemes, such as the HAS-BLED, ATRIA and ORBIT scores have been proposed in patients with atrial fibrillation (AF). We compared the relative predictive values of these bleeding risk scores for clinically relevant bleeding, as well as the relationship of ATRIA and ORBIT scores to the quality of anticoagulation control on warfarin, as reflected by time in therapeutic range (TTR). Methods: A post-hoc ancillary analysis of 'clinically relevant bleeding' and 'major bleeding' events amongst 2293 patients on warfarin therapy in the AMADEUS trial. Results: Only HAS-BLED was significantly predictive for clinically relevant bleeding, and all 3 risk scores were predictive for major bleeding. The predictive performance of HAS-BLED was modest, as reflected by c-indexes of 0.59 (p<0.001) and 0.65 (p<0.002), for clinically relevant bleeding and major bleeding, respectively. The HAS-BLED score performed better than ATRIA (P=0.002) or ORBIT (P=0.001) in predicting any clinically relevant bleeding. Only the HAS-BLED score was significantly associated with the risk for both bleeding outcomes on Cox regression analysis (any clinically relevant bleeding; hazard ratio [HR] 1.85, 95%CI 1.43-2.40, p<0.001, and major bleeding; HR 2.40, 95%CI 1.28-4.52, p=0.007). There were strong inverse correlations of ATRIA and ORBIT scores to TTR as a continuous variable ('low risk' ATRIA, r= -0.96; P=0.003; ORBIT, r= -0.96; p=0.003). Improvement in the predictive performance for both ATRIA and ORBIT scores for any clinically relevant bleeding was achieved by adding TTR to both scores, with significant differences in c-indexes (p=0.001 and p=0.002, respectively), NRI and IDI (both p<0.001). Conclusion: All three bleeding risk prediction scores demonstrated modest predictive ability for bleeding outcomes, although the HAS-BLED score performed better than either the ATRIA or ORBIT scores. Significant improvements in both ATRIA and ORBIT score prediction performances were achieved by adding TTR to both scores.
    The American journal of medicine 10/2015; DOI:10.1016/j.amjmed.2015.10.001 · 5.00 Impact Factor
  • Keitaro Senoo · Gregory Y.H. Lip ·
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    ABSTRACT: Background and purpose: The prevalence of atrial fibrillation increases with age, but age-specific data on the incidence of stroke and death in anticoagulated patients with atrial fibrillation are more limited, particularly with regard to comparisons of relative risks of clinical outcomes between the different age strata in relation to quality of anticoagulation control among warfarin users. Methods: We investigated the incidence of adverse outcomes between tertiles of age groups (age, <67 [n=722]; age, 67-74 [n=747]; and age, ≥75 [n=824]) in 2293 patients with atrial fibrillation participating in warfarin arm in the AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) trial. The average time in therapeutic range was calculated as a measure of anticoagulation control and related to clinical outcomes. Results: Absolute rates for stroke/systemic embolism (SSE), cardiovascular death, or any clinically relevant bleeding increased with increasing age strata. The combined end point of cardiovascular death and SSE was the highest in the top tertile (adjusted hazard ratio, 2.63; 95% confidence interval, 1.23-5.63) compared with the middle and lowest tertiles (P for trend=0.01). For bleeding, there was no significant difference in relative risks between the age strata (P for trend=0.55 in the warfarin group and in the warfarin group with time in therapeutic range ≥60%, P for trend=0.60). The quality of anticoagulation control (time in therapeutic range) significantly correlated with any clinically relevant bleeding (r=-0.91; P<0.001) and cardiovascular death/SSE rates (r=-0.76; P=0.01). Conclusions: Elderly patients with atrial fibrillation have higher absolute risks of cardiovascular death, SSE, and bleeding, but relative risks of clinically relevant bleeding are not significantly different with increasing age strata. A significant inverse relationship between time in therapeutic range and bleeding and cardiovascular death/SSE emphasizes the importance of good quality anticoagulation control.
    Stroke 10/2015; DOI:10.1161/STROKEAHA.115.010614 · 5.72 Impact Factor
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    ABSTRACT: To identify novel cell ageing markers in order to gain insight into ageing mechanisms, we adopted membrane enrichment and comparison of the CD4(+) T cell membrane proteome (purified by cell surface labelling using Sulfo-NHS-SS-Biotin reagent) between healthy young (n=9, 20-25y) and older (n=10; 50-70y) male adults. Following two-dimensional gel electrophoresis (2DE) to separate pooled membrane proteins in triplicates, the identity of protein spots with age-dependent differences (p<0.05 and >1.4 fold difference) was determined using liquid chromatography-mass spectrometry (LC-MS/MS). Seventeen protein spot density differences (ten increased and seven decreased in the older adult group) were observed between young and older adults. From spot intensity analysis, CD4(+) T cell surface α-enolase was decreased in expression by 1.5 fold in the older age group; this was verified by flow cytometry (n=22) and qPCR with significantly lower expression of cellular α-enolase mRNA and protein compared to young adult CD4(+) T cells (p<0.05). In an independent age-matched case-control study, lower CD4(+) T cell surface α-enolase expression was observed in age-matched patients with cardiovascular disease (p<0.05). An immune-modulatory role has been proposed for surface α-enolase and our findings of decreased expression suggest that deficits in surface α-enolase merit investigation in the context of immune dysfunction during ageing and vascular disease.
    Mechanisms of ageing and development 10/2015; 152. DOI:10.1016/j.mad.2015.09.005 · 3.40 Impact Factor
  • Eduard Shantsila · Gregory Y.H. Lip ·
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    ABSTRACT: Heart failure (HF) is associated with an increased risk of thrombotic events, particularly if this condition is accompanied by atrial fibrillation (AF). Many HF patients have background coronary artery disease (CAD) making them prone to coronary thrombosis resulting in myocardial infarction or sudden death. Oral anticoagulation is essential in the vast majority of HF patients with AF with non-vitamin K based anticoagulants being a suitable alternative to warfarin. In contrast, aspirin alone does not provide adequate stroke prevention in such patients. In HF without AF, oral anticoagulation should not be routinely used, and antiplatelet agents should be prescribed in patients with background CAD. This review provides an overview of prothrombotic factors and antithrombotic management of patients with HF.
    10/2015; DOI:10.1016/j.pcad.2015.09.005

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    ABSTRACT: Atrial fibrillation (AF) is associated with cognitive decline and may contribute to an increased risk of dementia. The goal of the present study was to investigate whether statin use prevented non-vascular dementia in subjects with AF. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study group comprised 51,253 AF subjects aged ≥60years who had received statin treatment. For each study patient, four age- and sex-matched AF subjects without statin exposure were selected as the control group (n=205,012). The risk of non-vascular dementia was compared between the statin and control groups. During the follow-up period, 17,201 patients experienced non-vascular dementia. The annual incidence of non-vascular dementia was lower in the statin group than in the control group (1.89% vs. 2.20%; p<0.001). Statin use exhibited a protective effect on the occurrence of non-vascular dementia, with an adjusted hazard ratio (HR) of 0.832 (95% confidence interval=0.801-0.864). Among statin types, the use of rosuvastatin was associated with the largest risk reduction (adjusted HR=0.661). Statin exposure duration was related inversely to the risk of non-vascular dementia. In this large-scale nationwide cohort study, statin use was associated with a lower risk of non-vascular dementia in AF. Use of more potent statin and longer exposure time may be associated with greater benefits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 10/2015; 196. DOI:10.1016/j.ijcard.2015.05.159 · 4.04 Impact Factor
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    ABSTRACT: Background: It remains uncertain whether patients with atrial fibrillation (AF) and a single additional stroke risk factor (CHA2DS2-VASc score = 1 in males, 2 in females) should be treated with oral anticoagulation (OAC). We investigated the risk of ischemic stroke, systemic embolism and death in a community-based cohort of unselected AF patients with a 0-1 stroke risk factors, based on the CHA2DS2-VASc score. Methods: Among 8962 patients with AF seen between 2000 and 2010, 2177 (24%) had 0 or 1 additional stroke risk factor, of which 53% were prescribed OAC. Results: Over a follow-up of 979±1158 days, 151 (7%) had a major adverse event (stroke/systemic thromboembolism/death). Prescription of OAC was not associated with a better prognosis for stroke/systemic thromboembolism/death for 'low risk' patients (ie. CHA2DS2-VASc score = 0 for men or 1 for women) [adjusted Hazard Ratio(HR) 0.68, 95% CI 0.35-1.31, p=0.25 ]. OAC use was independently associated with a better prognosis in AF patients with a single additional stroke risk factor (ie. CHA2DS2-VASc score = 1 in males, 2 in females) [adjusted HR 0.59, 95% CI 0.40-0.86, p=0.007]. Conclusion: Among AF patients with one single additional stroke risk factor (CHA2DS2-VASc score = 1 in males, 2 in females), OAC use was associated with an improved prognosis for stroke/systemic thromboembolism/death.
    Chest 10/2015; DOI:10.1378/chest.15-1622 · 7.48 Impact Factor
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    ABSTRACT: Elevated LDL concentration in mid-life increases the risk of developing Alzheimer's disease (AD) in later life. Increased oxidative modification (oxLDL) and nitration is observed during dementia and hypercholesterolemia. We investigated the hypothesis that statin intervention in mid-life mitigates the inflammatory effects of oxLDL on the microvasculature. Human microvascular endothelial cells (HMVEC) were maintained on transwells to mimic the microvasculature and exposed to patient and control LDL. Blood was obtained from statin-naïve, normo- and hyperlipidaemic subjects, AD with vascular dementia (AD-plus) and AD subjects (n=10/group) at baseline. Only hyperlipidaemic subjects with normal cognitive function received 40mg simvastatin intervention/day for three months. Blood was re-analysed from normo- and hyper-lipidaemic subjects after three months. LDL isolated from statin-naïve hyperlipidaemic, AD and AD-plus subjects was more oxidised (agarose gel electrophoretic mobility, protein carbonyl content and 8-isoprostane F2α) compared to control subjects. Statin intervention decreased protein carbonyls (2.5±0.4 Vs 3.95±0.2nmol/mg; P<0.001) and 8-isoprostane F2α (30.4±4.0 pg/ml Vs 43.5±8.42 pg/ml; P<0.05). HMVEC treatment with LDL-lipids from hyperlipidaemic, AD and AD-plus subjects impaired endothelial tight junction expression and decreased total glutathione levels (AD; 18.61±1.3, AD-plus; 16.5±0.7nmol/mg protein) compared to untreated cells (23.8±1.2 vs nmol/mg protein). Basolateral IL-6 secretion was increased by LDL-lipids from hyperlipidaemic (78.4±1.9 pg/ml), AD (63.2±5.9 pg/ml) and AD-plus (80.8±0.9 pg/ml) groups compared to healthy subject lipids (18.6±3.6 pg/ml). LDL-Lipids isolated after statin intervention did not affect endothelial function. In summary, LDL-lipids from hypercholesterolaemic, AD and AD-plus patients are inflammatory to HMVEC. In vivo intervention with statins reduces the damaging effects of LDL-lipids on HMVEC.
    Clinical Science 09/2015; DOI:10.1042/CS20150351 · 5.60 Impact Factor
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    ABSTRACT: Objective: Non-vitamin K antagonist oral anticoagulants (NOACs) have been proposed as alternatives to vitamin K antagonists (VKAs). The aim of this study is to examine the efficacy and safety of NOACs compared with warfarin with composite end points in patients with atrial fibrillation. Methods: This semi-systematic review performed a study of Phase III randomized controlled trials comparing NOACs with vitamin K antagonists (VKAs) in patient with atrial fibrillation using composite end points (combination of various clinical events). The use of composite end points allowed for combining efficacy and safety outcomes, thereby comparing the differences between NOAC and warfarin therapy from a clinical perspective. Results: Treatment with NOAC compared with warfarin was associated with a significant reduction in the sum of stroke or non-CNS, systemic embolism and major bleeding (odds ratio 0.87; 95% CI: 0.82-0.91). Conclusion: Generally, NOACs were associated with a more favorable efficacy and safety profile compared with warfarin with regard to composite end points.
    Expert Review of Cardiovascular Therapy 09/2015; 13(10):1155-1163. DOI:10.1586/14779072.2015.1086643
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    ABSTRACT: Background: Recent studies from Asia have suggested that the risk of ischemic stroke for patients with atrial fibrillation (AF) with a "low-risk" congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female (CHA2DS2-VASc) score of 0 (for males) or 1 (for females) might be higher than that for non-Asians. Objectives: This study hypothesized that the age threshold (65 years) used in the CHA2DS2-VASc system for initiating oral anticoagulants (OACs) might be lower in Taiwanese AF patients than in non-Asians. Methods: We used the National Health Insurance Research Database in Taiwan to study 186,570 nonanticoagulated AF patients. There were 9,416 males with a CHA2DS2-VASc score of 0 and 6,390 females with a CHA2DS2-VASc score of 1. Their risk of ischemic stroke was analyzed with stratification on the basis of age. Results: The annual risks of ischemic stroke for males (score 0) and females (score 1) were 1.15% and 1.12%, respectively, and continuously increased from younger to older age groups, with an increment in stroke risk evident for patients >50 years of age. At a cutoff of 50 years, patients could be further stratified into 2 subgroups with different stroke risks (>50 years of age: 1.78%/year; vs. <50 years of age: 0.53%/year). This observation was consistent for males (1.95%/year vs. 0.46%/year, respectively) and females (1.58%/year vs. 0.64%/year, respectively) with AF. In a subgroup analysis, the annual risks of ischemic stroke for males and females with AF 50 to 54 years of age were 1.47% and 1.07%, respectively. Conclusions: For Taiwanese patients 50 to 64 years of age, the annual stroke risk was 1.78%, which may exceed the threshold for OAC use for stroke prevention. The annual risk of ischemic stroke for AF patients <50 years of age was 0.53%, which was truly low-risk, and OACs could be omitted. Whether resetting the age threshold to 50 years could refine current clinical risk stratification for Asian AF patients deserves further study.
    Journal of the American College of Cardiology 09/2015; 66(12):1339-47. DOI:10.1016/j.jacc.2015.07.026 · 16.50 Impact Factor
  • Qinmei Xiong · Sisi Chen · Keitaro Senoo · Marco Proietti · Kui Hong · Gregory Y.H. Lip ·
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    ABSTRACT: Both the CHADS2 and CHA2DS2-VASc scores are well-validated in Western populations for predicting risk of stroke among patients with atrial fibrillation (AF). There is some uncertainty as to which risk score is best to guide optimal anticoagulant therapy among Asian populations with AF. A systemic literature search of Cochrane library, Scopus, and PubMed databases was conducted using search terms: atrial fibrillation, CHADS2 and CHA2DS2-VASc. Stroke/thromboembolism (TE) outcome events at low, moderate, and high risk groups were compared in relation to both scores. Statistical analyses were performed using Revman 5.3 software. 493 records were retrieved, of which 6 cohort studies focusing on patients from Asian regions were finally appraised and included. Absolute event rates were usually lower when patients were categorized as CHA2DS2-VASc of 0-1, rather than CHADS2 of 0-1, respectively. Meta-analysis revealed that when compared with the CHA2DS2-VASc score, there was a 1.71-fold elevated risk of stroke when patients were stratified as 'low risk' using a CHADS2 score=0, or a 1.40-fold increase with a CHADS2 score=1. A 1.19-fold elevated event rate was observed among CHADS2 score ≥2 compared to CHA2DS2-VASc, but the total stroke/TE events were numerically higher in patients categorized as CHA2DS2-VASc ≥2. The CHA2DS2-VASc score is superior to the CHADS2 score in identifying 'low risk' East Asian AF patients. Rather than a categorical approach, Asian guidelines should adopt a 2 step approach, by initially identifying the truly low risk patients, following which effective stroke prevention can be offered to those with ≥1 additional stroke risk factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 09/2015; 195(16). DOI:10.1016/j.ijcard.2015.05.115 · 4.04 Impact Factor
  • Gregory Y H Lip ·

    European Heart Journal 09/2015; DOI:10.1093/eurheartj/ehv431 · 15.20 Impact Factor
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    ABSTRACT: Following a haemorrhagic stroke, it is uncertain whether this event scores 1 point (either for Stroke or Bleeding) or 2 points (1 point each for Stroke and Bleeding) on the HAS-BLED score. We investigated the value of a recalibration of the HAS-BLED score to account for 2 points from a haemorrhagic stroke.
    Chest 09/2015; DOI:10.1378/chest.15-1509 · 7.48 Impact Factor
  • Gregory Y.H. Lip · Deirdre A Lane ·

    European Heart Journal 09/2015; DOI:10.1093/eurheartj/ehv415 · 15.20 Impact Factor
  • Qinmei Xiong · Yee Cheng Lau · Keitaro Senoo · Deirdre A Lane · Kui Hong · Gregory Y.H. Lip ·
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    ABSTRACT: No pooled analysis has been undertaken to assess the efficacy and safety of the non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin in the subgroup of patients with atrial fibrillation (AF) and heart failure (HF), including edoxaban data from recent randomized controlled trials (RCTs). Comprehensive literature searches were conducted using the Cochrane Library, MEDLINE, and Scopus databases from inception to April 2015. Statistical analyses were performed using RevMan 5.3 software. Four RCTs were included: 19 122 of 32 512 AF patients with HF were allocated to a NOAC (13 384 receiving single-/high-dose NOAC regimens), and 13 390 to warfarin. Among AF patients with HF, single/high-dose NOACs significantly reduced the risk of stroke/systemic embolic (SE) events by 14% [odds ratio0.86, 95% confidence interval (CI) 0.76-0.98), and had a 24% lower risk of major bleeding(OR 0.76, 95% CI 0.67-0.86). For low-dose NOAC regimens, comparable efficacy to warfarin for stroke or SE events (OR 1.02, 95% CI 0.86-1.21) and a non-significant trend for lower major bleeding was observed. Regardless of high- or low-dose NOAC, the incidences of both major bleeding and stroke/SE in AF patients with HF were similar to those without HF. Atrial fibrillation patients with HF on NOACs had a 41% lower risk of intracranial haemorrhage compared with those without HF (OR 0.59, 95% CI 0.40-0.87). Among AF patients with HF, single-/high-dose NOAC regimens have a better efficacy and safety profile, but low-dose regimens had similar efficacy and safety to warfarin. NOACs were similarly effective or even safer (less intracranial haemorrhage) in AF patients with HF compared with those without HF. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
    European Journal of Heart Failure 09/2015; 66(16). DOI:10.1002/ejhf.343 · 6.53 Impact Factor
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    ABSTRACT: The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application. © 2015 American Heart Association, Inc.
    Stroke 09/2015; 46(9):2491-7. DOI:10.1161/STROKEAHA.115.009912 · 5.72 Impact Factor
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    ABSTRACT: Objective To compare the efficacy and safety of dual antiplatelet therapy (DAPT) and triple therapy (TT, dual antiplatelet plus warfarin) in patients with myocardial infarction (MI) or PCI with stenting (PCI-S) who also require chronic oral anticoagulation. Background: Recommendations for the optimal antiplatelet/anticoagulant treatment regimen for patients undergoing PCI-S or MI who also require oral anticoagulation are largely based on evidence from observational studies and expert opinions. Methods: A systematic search was performed for studies comparing TT vs. DAPT in patients post PCI-S or MI and requiring chronic anticoagulation. Primary outcome was all-cause mortality. Secondary outcomes were ischemic stroke, major bleeding, MI, and stent thrombosis. Pooled relative risks (RR) were calculated using random effects model. Results: A total of 17 studies were included, with 14,921 patients [TT: 5,819(39%) and DAPT: 9,102(61%)] and a mean follow-up of 1.6 years. The majority of patients required oral anticoagulation for atrial fibrillation. Compared to DAPT, patients treated with TT had no significant difference in all-cause mortality [RR: 0.81, 95% confidence interval (CI): 0.61–1.08, P = 0.15], MI [RR 0.74, 95% CI: 0.51–1.06, P = 0.10], and stent thrombosis [RR 0.67, 95% CI: 0.35–1.30, P = 0.24]. Patients treated with TT had significantly increased risk of major bleeding [RR 1.20, 95% CI: 1.03–1.39, P = 0.02], whereas the risk for ischemic stroke was significantly lower [RR 0.59, 95% CI: 0.38-0.92, P = 0.02]. Conclusions: All-cause mortality appears similar in patients treated with TT or DAPT although TT was associated with higher rates of major bleeding and a lower risk for ischemic stroke. © 2015 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 09/2015; DOI:10.1002/ccd.26234 · 2.11 Impact Factor
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    ABSTRACT: Introduction: A previous meta-analysis has not suggested any benefit of CoQ10 supplementation in improving muscle pain and plasma creatine kinase (CK) levels, two main measures of statin-induced myopathy (SIM). However, new studies have been published. Purpose: To re-evaluate the efficacy of CoQ10 supplementation on SIM. Methods: We searched the MEDLINE, Cochrane Library, Scopus, and EMBASE databases (up to 10 February 2015) to identify RCTs investigating the impact of CoQ10 on muscle pain and plasma CK activity. Results: We included 10 RCTs with 446 participants. The results of the metaanalysis did not provide compelling evidence as to a significant effect of CoQ10 supplementation in reducing either the severity of myopathic pain (SMD: −0.36, 95% CI: −0.82–0.09, p=0.117) (figure) or plasma CK activity (WMD: 3.47 U/L, 95% CI: −2.32–9.26, p=0.240). These findings were robust in the leave-one-out analysis, and the calculated effect sizes were not sensitive to any single study included in the meta-analysis. A subgroup analysis was performed to assess the impact of dose (<200 vs ≥200 mg/day) and duration (<12 weeks vs ≥12 weeks) of supplementation with CoQ10 on the calculated effect sizes. The results suggest that changes in both efficacy measures were independent of dose and duration of supplementation. Likewise, large doses of CoQ10 - <400 and ≥400 mg - had also no significant effect both on myalgia and plasma CK activity (SMD −0.45, 95% CI: −1.02–0.13; p=0.13 and −0.08; 95% CI: −0.52–0.36; p=0.721, and WMD 5.06 U/L, 95% CI: −5.34–15.46; p=0.34, and −3.52 U/L −72.04–65.00; p=0.92, respectively). Conclusion: The results of this meta-analysis support the lack of any significant benefit of CoQ10 supplementation in improving statin-induced myopathy, even using higher CoQ10 doses.
    European Heart Journal 09/2015; 36(Suppl. 1):1047. · 15.20 Impact Factor
  • Gregory Y H Lip · Deirdre A Lane ·

    JAMA The Journal of the American Medical Association 09/2015; 314(9):949-50. DOI:10.1001/jama.2015.8995 · 35.29 Impact Factor
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    Kang-Ling Wang · Gregory Y.H. Lip · Shing-Jong Lin · Chern-En Chiang ·
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    ABSTRACT: The use of vitamin K antagonists (VKAs), the cornerstone treatment for stroke prevention in patients with atrial fibrillation, is limited by the perceived risk of serious bleeding in Asia. Non-VKA oral anticoagulants (NOACs) are safer alternatives. Here, we evaluate performance differences of NOACs between Asians and non-Asians. We compared efficacy and safety of NOACs between patients enrolled in Asian and non-Asian countries using aggregative data from phase III clinical trials. The odds ratios (ORs [95% confidence interval]) were calculated by a random effects model. Comparing with VKAs, standard-dose NOACs reduced stroke or systemic embolism (OR=0.65 [0.52-0.83] versus 0.85 [0.77-0.93], P interaction= 0.045) more in Asians than in non-Asians and were safer in Asians than in non-Asians about major bleeding (OR=0.57 [0.44-0.74] versus 0.89 [0.76-1.04], P interaction=0.004), hemorrhagic stroke (OR=0.32 [0.19-0.52] versus 0.56 [0.44-0.70], P interaction=0.046) in particular, whereas gastrointestinal bleeding was significantly increased in non-Asians (OR=0.79 [0.48-1.32] versus 1.44 [1.12-1.85], P interaction=0.041). Generally, low-dose NOACs were safer than VKAs without heterogeneity in efficacy and safety between Asians and non-Asians, except for ischemic stroke, major, and gastrointestinal bleeding. Our findings suggest that standard-dose NOACs were more effective and safer in Asians than in non-Asians, whereas low-dose NOACs performed similarly in both populations. © 2015 The Authors.
    Stroke 09/2015; 46(9):2555-61. DOI:10.1161/STROKEAHA.115.009947 · 5.72 Impact Factor

Publication Stats

28k Citations
6,260.44 Total Impact Points


  • 2015
    • Birmingham City Council
      Birmingham, England, United Kingdom
  • 2012-2015
    • Aalborg University
      • Department of Clinical Medicine
      Ålborg, North Denmark, Denmark
    • University of Iowa
      Iowa City, Iowa, United States
  • 1996-2015
    • University of Birmingham
      • • Centre for Cardiovascular Sciences
      • • School of Sport and Exercise Sciences
      Birmingham, England, United Kingdom
    • Sandwell and West Birmingham Hospitals NHS Trust
      Birmingham, England, United Kingdom
  • 2013
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cardiología
      Murcia, Murcia, Spain
    • Chinese PLA General Hospital (301 Hospital)
      Peping, Beijing, China
  • 2010-2013
    • Aston University
      • School of Life and Health Sciences
      Birmingham, England, United Kingdom
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • Academic Medical Center
      Amsterdamo, North Holland, Netherlands
  • 1995-2013
    • University Hospitals Birmingham NHS Foundation Trust
      • Department of Medicine
      Birmingham, England, United Kingdom
  • 2008
    • University of Murcia
      • Faculty of Medicine
      Murcia, Murcia, Spain
  • 2007-2008
    • University Hospital of Heraklion
      Irákleio, Attica, Greece
    • Università degli Studi di Milano-Bicocca
      Milano, Lombardy, Italy
  • 1995-2007
    • Birmingham City University
      Birmingham, England, United Kingdom
  • 2006
    • The Royal Orthopaedic Hospital NHS Foundation Trust
      Birmingham, England, United Kingdom
    • Saint Luke's Hospital (NY, USA)
      New York, New York, United States
  • 1998-2006
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2003
    • Hospital General Universitario de Alicante
      Alicante, Valencia, Spain
    • Medical University of Vienna
      • Universitätsklinik für Klinische Pharmakologie
      Vienna, Vienna, Austria
  • 2002
    • Harvard University
      Cambridge, Massachusetts, United States
    • McMaster University
      • Department of Medicine
      Hamilton, Ontario, Canada
  • 2001
    • Beaumont Hospital
      Dublin, Leinster, Ireland
  • 1999
    • Birmingham Children's Hospital NHS Foundation Trust
      Birmingham, England, United Kingdom
  • 1997
    • University Hospital Of South Manchester NHS Foundation Trust
      Manchester, England, United Kingdom