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Huber M.,Charite - Medical University of Berlin | Lezius S.,University of Hamburg | Reibis R.,Cardiological Outpatient Clinic Am Park Sanssouci | Treszl A.,University of Hamburg | And 6 more authors.
International Journal of Molecular Sciences | Year: 2015

Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% ± 9.3%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%–12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Bestehorn K.,TU Dresden | Jannowitz C.,MSD Sharp and Dohme GmbH | Horack M.,University of Heidelberg | Karmann B.,MSD Sharp and Dohme GmbH | And 2 more authors.
Vascular Health and Risk Management | Year: 2011

Background: After the acute hospital stay, most cardiac patients in Germany are transferred for a 3-4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university). Methods: Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline- Oriented Risk Factor Management) were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results: In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7%) were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6%) or coronary bypass surgery (39.5%). Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol < 100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes, hypertension, and peripheral arterial disease, had lower exercise capacity, and received less treatment with statins and guideline-orientated therapy in general. In the multivariate model, good control was significantly more likely in men (odds ratio 1.38; 95% confidence interval 1.30-1.46), less likely in patients of higher age (0.99; 0.99-0.99), with diabetes (0.90; 0.85-0.95), or peripheral arterial disease (0.88; 0.82-0.95). Compared with a low level education, a mid level education was associated with poor control (0.94; 0.89-0.99), while high education did not have a significant effect (1.08; 0.99-1.17). Conclusion: Patients with different levels of education treated in cardiac rehabilitation did not differ relevantly in terms of demographics, but did differ in some clinical aspects. With respect to the ultimate goal of cardiac rehabilitation, ie, optimal control of risk factors, education level does not play an important role. © 2011 Bestehorn et al, publisher and licensee Dove Medical Press Ltd.

Englert H.,Charite - Medical University of Berlin | Englert H.,Nurnberg University of Applied Sciences | Muller-Nordhorn J.,Charite - Medical University of Berlin | Seewald S.,Charite - Medical University of Berlin | And 7 more authors.
Journal of Public Health | Year: 2010

Background: To determine the accuracy of patient self-reports of specific cardiovascular diagnoses and to identify individual patient characteristics that influence the accuracy. Methods: This investigation was conducted as a part of the randomized controlled ORBITAL study. Patients with hypercholesterolemia were enrolled in 1961 primary-care centers all over Germany. Self-reported questionnaire data of 7640 patients were compared with patients' case report forms (CRFs) and medical records on cardiovascular diseases, using κ statistics and binomial logit models. Results: κ values ranged from 0.89 for diabetes to 0.04 for angina. The percentage of overreporting varied from 1 for diabetes to 17 for angina, whereas the percentage of underreporting varied from 8.0 for myocardial infarction to 57 for heart failure. Individual characteristics such as choice of individual general practitioner, male gender and age were associated with the accuracy of self-report data. Conclusion: Since the agreement between patient self-report and CRFs/medical records varies with specific cardiovascular diagnoses in patients with hypercholesterolemia, the adequacy of this tool seems to be limited. However, the authors recommend additional data validation for certain patient groups and consideration of individual patient characteristics associated with over- and underreporting. © 2010 The Author, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Huber M.,Institute of Clinical Pharmacology and Toxicology | Voller H.,Institute of Clinical Pharmacology and Toxicology | Voller H.,Rehabilitation Center for Cardiovascular Diseases | Jakob S.,Institute of Clinical Pharmacology and Toxicology | And 10 more authors.
Journal of Hypertension | Year: 2010

Objective: A genetic polymorphism in the angiotensin II type 2 receptor (AGTR2 +1675G/A) has been associated with left ventricular hypertrophy (LVH). We tested whether this polymorphism affects LVH and left ventricular geometry parameters in patients with essential hypertension and cardiovascular disease who are treated according to guidelines. Methods: We analyzed a cohort of 208 women and 1030 men with essential hypertension, associated cardiovascular disease and left ventricular ejection fractions 40% or more. Previous cardiac diseases included coronary heart disease (81%) and myocardial infarction (MI; 52%). Ten parameters of left ventricular mass, geometry and function were determined by echocardiography. Genotyping was performed by PCR. Due to the X chromosomal location of AGTR2, genotype-phenotype analysis was separated for women and men. Statistical analysis was performed by univariate and multivariate analysis accounting for confounding factors. Results: The mean age was 58.4 ± 10 years. In the overall cohort, mean left ventricular mass index was 54 ± 23.6 g/h2.7 without significant differences between patients with and without MI. The frequency of LVH (49% overall) was also similar in patients with or without MI. In men, AGTR2 +1675G/A had no influence on echocardiographic parameters. Similar findings were obtained in women, with the exception that the thickness of the interventricular septum was significantly lower in A allele carriers (-11%) in both crude (P = 0.002) and multivariate analysis (P = 0.044). Conclusion: In treated patients with arterial hypertension, cardiac disease and preserved left ventricular systolic function AGTR2 (+1675G/A) exhibits only a minor effect on left ventricular geometry in women and none in men. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Voller H.,University of Potsdam | Voller H.,Rehabilitation Center for Cardiovascular Diseases | Salzwedel A.,University of Potsdam | Nitardy A.,Rehabilitation Center for Cardiovascular Diseases | And 3 more authors.
European Journal of Preventive Cardiology | Year: 2015

Background: Transcatheter aortic-valve implantation (TAVI) is an established alternative therapy in patients with severe aortic stenosis and a high surgical risk. Despite a rapid growth in its use, very few data exist about the efficacy of cardiac rehabilitation (CR) in these patients. We assessed the hypothesis that patients after TAVI benefit from CR, compared to patients after surgical aortic-valve replacement (sAVR). Methods: From September 2009 to August 2011, 442 consecutive patients after TAVI (n=76) or sAVR (n=366) were referred to a 3-week CR. Data regarding patient characteristics as well as changes of functional (6-min walk test. 6-MWT), bicycle exercise test), and emotional status (Hospital Anxiety and Depression Scale) were retrospectively evaluated and compared between groups after propensity score adjustment. Results: Patients after TAVI were significantly older (p<0.001), more female (p<0.001), and had more often coronary artery disease (p=0.027), renal failure (p=0.012) and a pacemaker (p=0.032). During CR, distance in 6-MWT (both groups p≤0.001) and exercise capacity (sAVR p≤0.001, TAVI p0.05) significantly increased in both groups. Only patients after sAVR demonstrated a significant reduction in anxiety and depression (p≤0.001). After propensity scores adjustment, changes were not significantly different between sAVR and TAVI, with the exception of 6-MWT (p=0.004). Conclusions: Patients after TAVI benefit from cardiac rehabilitation despite their older age and comorbidities. CR is a helpful tool to maintain independency for daily life activities and participation in socio-cultural life.

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