ObjectivesWe conducted a systematic review and meta-analysis of studies that compared levels of molecular biomarkers in women with peripartum cardiomyopathy (PPCM) to those in healthy pregnant and postpartum women to: (1) assess the evidence for prolactin (PRL) metabolism in PPCM, (2) ascertain the evidence for biomarkers of iron deficiency in PPCM, (3) identify other biomarkers associated with PPCM.MethodsWe searched Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and the Global Health Library from inception without language restriction for studies that compared biomarkers levels in PPCM cases to healthy controls. Pooled standardised mean difference (SMD) was generated using a random effects model for the difference in levels of biomarkers.ResultsTwo studies assessed the association of PRL with PPCM, and reported that PPCM cases have higher levels of total PRL. No studies investigated iron metabolism in PPCM. Other biomarkers associated with PPCM included serum levels of natriuretic peptides (SMD=3.77, 95% CI 0.71 to 6.82), albumin (SMD=-0.67, 95% CI -1.01 to -0.32), C-reactive protein (SMD=1.67, 95% CI 0.22 to 3.12), selenium (SMD=-0.73, 95% CI -1.58 to 0.12), cardiac troponins (SMD=1.06, 95% CI 0.33 to 1.80), creatinine (SMD=0.51, 95% CI 0.33 to 0.69), white bloodcells (SMD=0.44, 95 % CI 0.07 to 0.82), haemoglobin (SMD=-0.45, 95% CI -0.64 to-0.26).ConclusionsMore robust molecular studies are needed to explore the association between prolactin and PPCM in human subjects and to determine the extent to which iron deficiency (with or without anaemia) contributes to the risk of PPCM.
Cardiovascular (CV) disease is the leading cause of death in the United States (Hoyert & Xu, 2012), and low-income and ethnic minorities are disproportionally affected. Relationship education (RE) interventions have been shown to improve relationship quality and reduce distress in individuals and couples, including low-income and ethnic minority populations. This study examined the effect of an evidenced-based, individual-oriented, RE intervention, within my reach, (WMR), on emotional distress in a population of mostly low-income and ethnic minority individuals with existing CV disease and/or CV disease risk factors (CVD) to those without disease or risk factors (non-CVD). Results showed significant improvements in overall distress for both the CVD and non-CVD groups, but neither group improved significantly more than the other. The authors found similar changes in distress levels when we examined a subset of the population that met the criteria for clinical distress. Also, data showed that CVD participants presented with significantly greater overall distress than non-CVD participants. These findings are consistent with prior research that showed the effectiveness of the WMR curriculum in stress reduction. Furthermore, this study contributes knowledge about a unique population, individuals with CV disease and/or CVD, who may greatly benefit from interventions focused on stress reduction.
Results Stroke event rates for baseline and Q20 cohorts were 3.1 and 8.4 per 1000 person years respectively. At baseline, healthier levels of three LS7 -BP, physical activity and smoking were associated with reduced risk of stroke. HRs [95% Confidence Intervals] for intermediate and ideal (vs poor) were 0.62 [0.49, 0.79] and 0.41 [0.24, 0.69] for BP; 0.68 [0.49, 0.95] and 0.55 [0.39, 0.79] for physical activity; and 0.68 [0.54, 0.86] and 0.57 [0.43, 0.77] for smoking. For exposures measured at Q20, only BP maintained a protective association (HRs 0.84 [0.66, 1.06] and 0.50 [0.30, 0.84] for intermediate and ideal levels respectively). Protection from each unit increase in overall CVH scores also weakened with age. With reference to the Low-Low trajectory, all trajectories were generally associated with reduced risk. The HRs were Low-High 0.57 (0.41, 0.79); High-Low 0.85 (0.61, 1.19) and High-High 0.77 (0.58, 1.03) respectively. Conclusion Not all components of CVH individually influence stroke. While the association between CVH and stroke weakens with age, improving overall CVH may bring some benefit even in later life.
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