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Background: Stroke has significant direct medical costs, and direct oral anticoagulants (DOACs) are better alternatives to warfarin for stroke prevention in atrial fibrillation (AF). This study aimed to determine the direct medical costs of stroke, with emphasis on AF stroke and the cost-effectiveness of DOACs among stroke patients in a tertiary hospital in Malaysia. Methods: This study utilised in-patient data from the case mix unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 2011 and 2018. Direct medical costs of stroke were determined using a top-down costing approach and factors associated with costs were identified. Incremental cost effectiveness ratio (ICER) was calculated to compare the cost-effectiveness between DOACs and warfarin. Results: The direct medical cost of stroke was MYR 11,669,414.83 (n = 3689). AF-related stroke cases had higher median cost of MYR 2839.73 (IQR 2269.79–3101.52). Regression analysis showed that stroke type (AF versus non-AF stroke) (p = 0.013), stroke severity (p = 0.010) and discharge status (p < 0.001) significantly influenced stroke costs. DOACs were cost-effective compared to warfarin with an ICER of MYR 19.25. Conclusions: The direct medical cost of stroke is substantial, with AF-stroke having a higher median cost per stroke care. DOACs were cost effective in the treatment of AF-related stroke in UKMMC.

Prolonged consumption of heated palm oil causes detrimental effects on cardiovascular system, liver and kidneys. The detrimental effects of heated oils are associated with oxidative stress; hence the role of antioxidants in attenuating heated oil-induced effects has been widely studied. The aim of the present study was to determine the effects of polyphenol-rich Citrus leaf extract (CLE) on renal oxidative stress parameters, renal function and kidney histological changes in rats fed with heated palm oil. Fifty-six male Sprague-Dawley rats (n=56) were divided into seven groups. The control group was given normal rat chow, while other groups were fed with 15% weight/weight (w/w) palm oil-enriched diet of either fresh palm oil (FPO), five-time-heated palm oil (5HPO) or ten-time-heated palm oil (10HPO); with or without the addition of CLE (0.15%, w/w) supplementation. After 16 weeks, the rats were sacrificed and the kidneys were harvested for analysis. CLE supplementation improved heated palm oil-induced oxidative stress parameters in the kidneys, shown by reduced levels of renal thiobarbituric acid (TBARS) and renal nicotinamide adenine dinucleotide phosphate (NADPH) oxidase in 5HPO and 10HPO groups. Renal haem oxygenase levels were restored with CLE supplementation in the heated oil groups. Decreased serum creatinine was observed in 5HPO group with CLE supplementation, but not in 10HPO group. Heated oil caused mild interstitial inflammation with vascular congestion in 5HPO and 5HPO+CLE groups, while 10HPO group had moderate inflammation and vascular congestion. CLE supplementation in 10HPO group was able to reduce these changes as only mild interstitial inflammation and congestion was observed. CLE has the potential to reduce renal oxidative stress parameters, improve renal function and reduce renal inflammation possibly mediated via its antioxidant properties.

Tocotrienol (T3) is a subfamily of vitamin E known for its wide array of medicinal properties. This review aimed to summarize the health benefits of T3, particularly in prevention or treatment of non-communicable diseases (NCDs), including cardiovascular, musculoskeletal, metabolic, gastric, and skin disorders, as well as cancers. Studies showed that T3 could prevent various NCDs, by suppressing 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) in the mevalonate pathway, inflammatory response, oxidative stress, and alternating hormones. The efficacy of T3 in preventing/treating these NCDs is similar or greater compared to tocopherol (TF). TF may lower the efficacy of T3 because the efficacy of the combination of TF and T3 was lower than T3 alone in some studies. Data investigating the effects of T3 on osteoporosis, arthritis, and peptic ulcers in human are limited. The positive outcomes of T3 treatment obtained from the preclinical studies warrant further validation from clinical trials.

The use of repeatedly heated vegetable oil for cooking is commonly practiced to reduce the cost of food preparation. This practice is not only restricted in domestic use but by also by food vendors. Repeatedly heated oil may have detrimental effects on health as heating produces harmful products of lipid peroxidation, which have been believed to be responsible in the pathogenesis of many diseases like cardiovascular disease and cancer. Consumption of heated vegetable oil may increase the risk of cardiovascular disease via affecting serum lipid profiles, blood pressure, and promoting atherosclerosis. The use of repeatedly heated oil may cause hypertension, promote atherosclerosis, osteoporosis, and may affect liver and kidney structure and function. Studies have reported that fresh palm and soy oils had no detrimental effects on cardiovascular-related risk factors, bone, kidney, and liver. Fresh palm and soy oils help to protect vascular and bone structures in estrogen-deficient subjects; however, the protective effect is lost when the oil is repeatedly heated. Furthermore, heated oil increases the levels of total cholesterol and LDL-cholesterol, blood pressure, vascular, liver and kidney inflammation, vascular and bone structural changes that predispose to atherosclerosis and osteoporosis. Thus, these findings suggest that intake of repeatedly heated oil is detrimental to health as it may increase risk of cardiovascular disease, osteoporosis, steatosis, and renal histological changes.

Background Newer oral anticoagulants (NOACs) are considered as better alternatives compared to warfarin for stroke prevention in atrial fibrillation (AF) in terms of clinical effectiveness although the drug acquisition cost is more substantial. Aim This study determined the direct stroke costs based on inpatient hospitalization in a subgroup of the National Health Service (NHS) Grampian, Scotland, stroke patients, to evaluate the differences in costs related to AF stroke, and to ascertain whether the use of NOACs within this study population would produce greater cost savings. Methods Hospitalization records over 5 years involving 3,601 stroke patients were analyzed. Direct costs were based on the costs of inpatient length of stay per day. The potential cost savings if AF patients had been on NOACs were estimated using efficacy data from a landmark clinical trial involving rivaroxaban. Results Out of the total stroke cases, 29.5% of total stroke cases were secondary to AF, and these cases were more severe with longer hospitalizations. Only 254 patients (39.4%) with confirmed AF were anticoagulated with warfarin prior to admission. AF patients incurred higher median costs (£4,719 (interquartile range (IQR) £1,815 - £12,452) compared to non-AF patients (£3,267 (IQR £1,175 - £11,368)), although the association was statistically insignificant. The use of NOACs in AF-related patients with ischemic strokes would potentially prevent more strokes (leading to 58 fewer cases in comparison to warfarin), resulting in 17.1% in total cost reduction. Conclusion AF stroke patients incurred higher total direct costs compared to non-AF cases. However, more cost savings were evident with NOACs, due to more strokes being prevented through the use of NOACs compared to warfarin. .

Cardiovascular disease (CVD) is one of the leading major causes of morbidity and mortality worldwide. It may result from the interactions between multiple genetic and environmental factors including sedentary lifestyle and dietary habits. The quality of dietary oils and fats has been widely recognised to be inextricably linked to the pathogenesis of CVD. Vegetable oil is one of the essential dietary components in daily food consumption. However, the benefits of vegetable oil can be deteriorated by repeated heating that leads to lipid oxidation. The practice of using repeatedly heated cooking oil is not uncommon as it will reduce the cost of food preparation. Thermal oxidation yields new functional groups which may be potentially hazardous to cardiovascular health. Prolonged consumption of the repeatedly heated oil has been shown to increase blood pressure and total cholesterol, cause vascular inflammation as well as vascular changes which predispose to atherosclerosis. The harmful effect of heated oils is attributed to products generated from lipid oxidation during heating process. In view of the potential hazard of oxidation products, therefore this review article will provide an insight and awareness to the general public on the consumption of repeatedly heated oils which is detrimental to health.

Cardiovascular disease (CVD) is one of the leading major causes of morbidity and mortality worldwide. It may result from the interactions between multiple genetic and environmental factors including sedentary lifestyle and dietary habits. The quality of dietary oils and fats has been widely recognised to be inextricably linked to the pathogenesis of CVD. Vegetable oil is one of the essential dietary components in daily food consumption. However, the benefits of vegetable oil can be deteriorated by repeated heating that leads to lipid oxidation. The practice of using repeatedly heated cooking oil is not uncommon as it will reduce the cost of food preparation. Thermal oxidation yields new functional groups which may be potentially hazardous to cardiovascular health. Prolonged consumption of the repeatedly heated oil has been shown to increase blood pressure and total cholesterol, cause vascular inflammation as well as vascular changes which predispose to atherosclerosis. The harmful effect of heated oils is attributed to products generated from lipid oxidation during heating process. In view of the potential hazard of oxidation products, therefore this review article will provide an insight and awareness to the general public on the consumption of repeatedly heated oils which is detrimental to health.