BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS
2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration
URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.
The uptake of radioactive sulphate into chondroitin sulphate catalyzed by the hepatic enzyme system of normal and pancreatectomized diabetic male rats was examined. It was found that the enzymatic uptake of Iabeled sulphate into chondroitin sulphate was stimulated with low concentrations (less than 1.0 mg) of soluble enzyme prepared from livers of diabetic rats, whereas high concentrations (greater than 2.0 rng) of diabetic enzyme protein non-<:ompetitively inhibited radioactive sulphate uptake.
Dini A y cols. | Consenso de Revascularización de Miembros Inferiores del CACI 137 3. Diagnóstico Invasivo 4. Rol del Tratamiento Médico 4.1 Tratamiento antiplaquetario 4.2 Tratamiento post revascularización 5. Angioplastia en Territorio Aorto-Ilíaco 5.1 Consideraciones generales de la ATP en territorio Aorto-Ilíaco 5.2 Tipo de stent: balón expandible vs auto expandible 6. Angioplastia en Territorio Femoro-Poplíteo 6.1 Consideraciones Generales 6.2 Tratamiento mediante balón convencional 6.3 Tratamiento mediante stent convencional 6.4 Tratamiento mediante stent liberador de droga (DES) 6.5 Tratamiento mediante Angioplastia con Balón Liberador de Droga (DEB)
Numerous studies have indicated that the incorporation of sulfate into mucopolysaccharides is altered in diabetes (1-4), and it has been suggested that insulin has a regulatory action on sulfation (5). In a pervious communication, we reported that the enzymatic uptake of labeled sulfate into chondroitin sulfate was stimulated with low concentrations and noncompetitively inhibited with higher concentrations of soluble enzyme prepared from livers of diabetic male rats (6). I t was subsequently demonstrated that the enzymatic formation of the active sulfate carrier phosphoadenosine-phosphosulfate (PAPS) was enhanced with low concentrations (<0.5 mg) and depressed with higher concentrations ( > 1.0 mg) of enzyme from pancreatectomized male rats ( 7 ) . However, since sex differences in ester sulfate formation have been reported (8-10) , indicating that sulfotransferase activity is greater in females than in males ( l l ) , the present experiments were performed to study the uptake of labeled sulfate in to intermediate nucleotides and chondroitin sulfate in female rats, and to determine the effect of diabetes on these reactions in the female animal. Evidence is presented indicating that while the overall reaction is more efficient in normal female than in normal male rats, the uptake of sulinto PAPS and chondroitin sulfate is still inhibited at higher concentrations of enzyme from diabetic female rats.Materials and Methods. Enzyme pre paration. A 9570 pancreatectomy was performed on female white rats (Institute strain) weighing 80-120 ,g, and the development of diabetes was tested by blood sugar levels after 7 hr fasting. Operated animals were sacrificed when diabetes was well established (blood sugar 150-200 mg/100 ml), and were match-Nacional de Investigaciones Cien tificas y Tecnicas. *Aided by Grant No. 4290/70 from (the Consejo ed with control animals of the same age and sex. Soluble enzyme systems from livers of normal and diabetic rats were prepared as described by Hilz and Lipmann (12), through removal of the microsomes. The 30, 000 rpm supernatant was used as enzyme source after measurement of protein content Incubations. The standard incubation mixture consisted of: 40 pm Tris-HC1, pH 7.5; 6 pm cysteine-HC1; 50 pg chondroitin sulfate (Sigma Chem. Co.) ; 10 pCi (35S)Na&04 (sp act 358 mCi/mmole); and 0.25-5.0 mg of enzyme protein as indicated in a total volume of 1.0 ml. Incubations were carried out for 2 hr at 37" using air as the gas phase. Following incubation, the samples were placed in boiling water for 1 min and then centrifuged at low speed to remove coagulated protein.Separation of products. a. Labeled chondroitin sulfate. 1.0 ml each of 1 % cetylpyridinium chloride (CPC) and 0.1 % chondroitin sulfate (CS) were added to the low-speed supernatant, and the resultant precipitate was washed four times with 5 ml of 0.026 M Na2S04. After the last wash, the final CPC-CS precipitate was dissolved in 1.0 ml of the fO1lQWing solution : n-propanol-glacial acetic acid-methanol-water (40: 15:20:38.5, v/v) and 0.2-m...
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