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- Maisel, Alan, et al.
(författare)
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Effect of Spironolactone on 30-Day Death and Heart Failure Rehospitalization (from the COACH Study)
- 2014
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Ingår i: American Journal of Cardiology. - : Elsevier. - 0002-9149 .- 1879-1913. ; 114:5, s. 737-742
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Tidskriftsartikel (refereegranskat)abstract
- The aim of our study is to investigate the effect of spironolactone on 30-day outcomes in patients with acute heart failure (AHF) and the association between treatment and outcomes stratified by biomarkers. We conducted a secondary analysis of the biomarker substudy of the multicenter COACH (Co-ordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) trial involving 534 AHF patients for 30-day mortality and HF rehospitalizations. Spironolactone therapy was initiated and terminated at the discretion of the treating physician; 30-day outcomes were compared between patients who were treated with spironolactone and those who were not. Outcomes with spironolactone therapy. were explored based on N-terminal pro-B-type natriuretic peptide, ST2, galectin-3, and creatinine levels. Spironolactone was prescribed to 297 (55.6%) patients at discharge (158 new and 139 continued). There were 19 deaths and 30 HF rehospitalizations among 46 patients by 30 days. Patients discharged on spironolactone had significantly less 30-day event (hazard ratio 0.538, p = 0.039) after adjustment for multiple risk factors. Initiation of spironolactone in patients who were not on spironolactone before admission was associated with a significant reduction in event rate (hazard ratio 0.362, p = 0.027). The survival benefit of spironolactone was more prominent in patient groups with elevations of creatinine, N-terminal pro B-type natriuretic peptide, ST2, or galectin-3. In conclusion, AHF patients who received spironolactone during hospitalization had significantly fewer 30-day mortality and HF rehospitalizations, especially in high-risk patients.
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- Maisel, Alan, et al.
(författare)
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State of the art : Using natriuretic peptide levels in clinical practice
- 2008
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 10:9, s. 824-839
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Tidskriftsartikel (refereegranskat)abstract
- Natriuretic peptide (NP) levels (B-type natriuretic peptide (BNP) and N-terminal proBNP) are now widely used in clinical practice and cardiovascular research throughout the world and have been incorporated into most national and international cardiovascular guidelines for heart failure. The role of NP levels in state-of-the-art clinical practice is evolving rapidly. This paper reviews and highlights ten key messages to clinicians:•NP levels are quantitative plasma biomarkers of heart failure (HF).•NP levels are accurate in the diagnosis of HF.•NP levels may help risk stratify emergency department (ED) patients with regard to the need for hospital admission or direct ED discharge.•NP levels help improve patient management and reduce total treatment costs in patients with acute dyspnoea.•NP levels at the time of admission are powerful predictors of outcome in predicting death and re-hospitalisation in HF patients.•NP levels at discharge aid in risk stratification of the HF patient.•NP-guided therapy may improve morbidity and/or mortality in chronic HF.•The combination of NP levels together with symptoms, signs and weight gain assists in the assessment of clinical decompensation in HF.•NP levels can accelerate accurate diagnosis of heart failure presenting in primary care.•NP levels may be helpful to screen for asymptomatic left ventricular dysfunction in high-risk patients.
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- Melander, Olle, et al.
(författare)
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Validation of plasma proneurotensin as a novel biomarker for the prediction of incident breast cancer.
- 2014
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Ingår i: Cancer Epidemiology Biomarkers & Prevention. - 1538-7755. ; 23:8, s. 1672-1676
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Tidskriftsartikel (refereegranskat)abstract
- Background: High fasting plasma proneurotensin concentration was associated with the development of breast cancer in the Malmö Diet and Cancer Study (MDCS). Here we aimed at replicating the initial finding in an independent second cohort. Methods: The Malmö Preventive Project (MPP) is a population study and comprised 18 240 subjects when examined 2002-2006. Of women without history of breast cancer at examination, we included all who developed breast cancer during follow-up (n=130) until December 31st 2010 and a random sample of women without breast cancer until end of follow-up (n=1439) for baseline plasma proneurotensin assessment (mean age 70.0±4.4 years). Proneurotensin was measured in fasted plasma samples and was related to the risk of later breast cancer development using multivariate logistic regression. Results: Proneurotensin (odds ratio [OR] per SD increment of log-transformed proneurotensin) was significantly related to incident breast cancer (OR, 2.09; 95% CI, 1.79-2.44; P < 0.001; adjusted for age, BMI, smoking and hormone replacement therapy). The effect estimate in MPP was larger than in the discovery cohort (MDCS) with the main difference between the two cohorts being that women of the MPP study were on the average about 10 years older and follow-up time shorter compared to the MDCS. Conclusion: As initially found in the MDCS, fasting plasma proneurotensin was significantly associated with the development of breast cancer also in the MPP study. Impact: Measurement of plasma proneurotensin warrants further investigation as a blood based marker for early breast cancer detection.
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