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2. The obesity paradox in surgical patients

Author

Galal, W. (Wael) and Galal, W. (Wael)

Abstract

In the Netherlands, 16 million inhabitants undergo about 1 million surgical procedures annually. The percentage of serious adverse advents is a burden to society and stresses the need for adequate preoperative assessment in order to select and optimize surgical patients. The clinical course of surgical patients have been the subject of research focusing on perioperative outcome. [1-6] The influenced time frame expanded from merely improving the direct postoperative surgical outcome to infl uencing the long term outcome of the surgical patient. [7-14] Consequently, advances in perioperative care emphasize a more important role of the preoperative evaluation and a more comprehensive risk stratifi cation by the anesthesiologist. Recognition and optimization of chronic disease processes prior to surgery could prove benefi cial by reducing the risk of complications, not only in the perioperative stage, but also on longer-term follow up. With the growing number of surgical procedures performed yearly in modern societies we believe anesthesiologists have a golden opportunity to infl uence the health and quality of life of their patients not only during the perioperative phase, but also in order to lower the incidence of long-term adverse outcomes

Published
2016

7. The obesity paradox in patients with peripheral arterial disease

Author

Galal, W. (Wael), Gestel, Y.R.B.M. (Yvette) van, Hoeks, S.E. (Sanne), Sin, D.D., Winkel, T.A. (Tamara), Bax, J.J. (Jeroen), Verhagen, H.J.M. (Hence), Awara, A.M.M. (Adel), Klein, J. (Jan), Domburg, R.T. (Ron) van, Poldermans, D. (Don), Galal, W. (Wael), Gestel, Y.R.B.M. (Yvette) van, Hoeks, S.E. (Sanne), Sin, D.D., Winkel, T.A. (Tamara), Bax, J.J. (Jeroen), Verhagen, H.J.M. (Hence), Awara, A.M.M. (Adel), Klein, J. (Jan), Domburg, R.T. (Ron) van, and Poldermans, D. (Don)

Abstract

Background: Cardiac events are the predominant cause of late mortality in patients with peripheral arterial disease (PAD). In these patients, mortality decreases with increasing body mass index (BMI). COPD is identified as a cardiac risk factor, which preferentially affects underweight individuals. Whether or not COPD explains the obesity paradox in PAD patients is unknown. Methods: We studied 2,392 patients who underwent major vascular surgery at one teaching institution. Patients were classified according to COPD status and BMIs (ie, underweight, normal, overweight, and obese), and the relationship between these variables and all-cause mortality was determined using a Cox regression analysis. The median follow-up period was 4.37 years (interquartile range, 1.98 to 8.47 years). Results: The overall mortality rates among underweight, normal, overweight, and obese patients were 54%, 50%, 40%, and 31%, respectively (p < 0.001). The distribution of COPD severity classes showed an increased prevalence of moderate-to-severe COPD in underweight patients. In the entire population, BMI (continuous) was associated with increased mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94 to 0.98). In addition, patients who were classified as being underweight were at increased risk for mortality (HR, 1.42; 95% CI, 1.00 to 2.01). However, after adjusting for COPD severity the relationship was no longer significant (HR, 1.29; 95% CI, 0.91 to 1.93). Conclusions: The excess mortality among underweight patients was largely explained by the overrepresentation of individuals with moderate-to-severe COPD. COPD may in part explain the "obesity pa

Published
2008
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8. P001 * Reversal of endothelial dysfunction after AF cardioversion

Author

Allam, R., primary, Galal, W., additional, El-Damnhoury, H., additional, Mortada, A., additional, Guo, R., additional, Fang, F., additional, Xie, J. M., additional, Zhang, Q., additional, Chan, Y. S., additional, Fung, W. H., additional, Razali, O., additional, Azlan, H., additional, Lam, K. H., additional, Chan, C. K., additional, Yu, C. M., additional, Wong, F. M. F., additional, Sit, J. W. H., additional, Wong, E. M. L., additional, Lee, V., additional, Hemingway, H., additional, Harb, R., additional, Crake, T., additional, Lambiase, P., additional, Zhao, Q. Y., additional, Yu, S. B., additional, Huang, H., additional, Qin, M., additional, Cui, H. Y., additional, Huang, T., additional, Huang, C. X., additional, Leung, Y. W., additional, Yue, C. S., additional, Leung, K. F., additional, Fung, C. Y. R., additional, Mak, Y. M. W., additional, Chow, K. S., additional, Tang, S. K., additional, Sperzel, J., additional, Tscheliessnigg, K., additional, Bucx, J. J. J., additional, Silvestre, J., additional, Oza, A. L., additional, Yu Mironov, N., additional, Golitsyn, S. P., additional, Sokolov, S. F., additional, Yuricheva, Y. A., additional, Maikov, E. B., additional, Shlevkov, N. B., additional, Mareev, Y. V., additional, Rosenstraukh, L. V., additional, Chazov, E. I., additional, Li, B. N., additional, Qin, J., additional, Xiang, K., additional, Pang, W. M., additional, Wang, L. S., additional, Wu, H. S., additional, Wong, T. T., additional, Heng, P. A., additional, Clatot, J., additional, Ziyadeh-Isleem, A., additional, Coulombe, A., additional, Maugenre, S., additional, Dilanian, G., additional, Hatem, S., additional, Denjoy, I., additional, Neyroud, N., additional, Guicheney, P., additional, Plameras, G. B., additional, Valentin, M. V., additional, Ramirez, M., additional, Suga, C., additional, Hirahara, T., additional, Sugawara, Y., additional, Nakajima, J., additional, Wakaba, H., additional, Ako, J., additional, Momomura, S., additional, Ye Volkov, D., additional, Karpenko, Y. I., additional, Lopin, D. A., additional, Chair, S. Y., additional, Lee, J. C. K., additional, Choi, K. C., additional, Wong, E. M., additional, Chan, C. W. H., additional, So, W. K. W., additional, Cheng, A. H. Y., additional, Hamid, A. K., additional, Lainchbury, J. G., additional, Troughton, R. W., additional, Yandle, T. G., additional, Frampton, C. M., additional, and Richards, A. M., additional

Published
2012
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9. Poster Session 4

Author

Tada, H., primary, Yamasaki, H., additional, Sekiguchi, Y., additional, Igarashi, M., additional, Kuroki, K., additional, Machino, T., additional, Yoshida, K., additional, Aonuma, K., additional, Heinzel, F. R., additional, Forstner, H., additional, Lercher, P., additional, Bisping, E., additional, Rotman, B., additional, Fruhwald, F. M., additional, Pieske, B. M., additional, Dabrowski, R., additional, Kowalik, I., additional, Borowiec, A., additional, Smolis-Bak, E., additional, Trybuch, A., additional, Sosnowski, C., additional, Szwed, H., additional, Baturova, M. A., additional, Lindgren, A., additional, Shubik, Y. V., additional, Olsson, B., additional, Platonov, P. G., additional, Van Den Broek, K. C., additional, Denollet, J., additional, Widdershoven, J., additional, Kupper, N., additional, Allam, R., additional, Allam, R. A. G. A. B., additional, Galal, W. A. G. D. Y., additional, El-Damnhoury, H. A. Y. A. M., additional, Mortada, A. Y. M. A. N., additional, Jimenez-Candil, J., additional, Martin, A., additional, Hernandez, J., additional, Martin, F., additional, Gallego, M., additional, Martin-Luengo, C., additional, Quintanilla, J. G., additional, Moreno Planas, J., additional, Molina-Morua, R., additional, Archondo, T., additional, Garcia-Torrent, M. J., additional, Perez-Castellano, N., additional, Macaya, C., additional, Perez-Villacastin, J., additional, Saiz, J., additional, Tobon, C., additional, Rodriguez, J. F., additional, Hornero, F., additional, Ferrero, J. M., additional, Ito, K., additional, Date, T., additional, Kawai, M., additional, Hioki, M., additional, Narui, R., additional, Matsuo, S., additional, Yoshimura, M., additional, Yamane, T., additional, Tabatabaei, N., additional, Lin, G., additional, Powell, B. D., additional, Smairat, R., additional, Glockner, J. F., additional, Brady, P. A., additional, Fichtner, S., additional, Czudnochowsky, U., additional, Estner, H., additional, Reents, T., additional, Jilek, C., additional, Ammar, S., additional, Hessling, G., additional, Deisenhofer, I., additional, Shah, D. C., additional, Kautzner, J., additional, Saoudi, N., additional, Herrera, C., additional, Jais, P., additional, Hindricks, G., additional, Neuzil, P., additional, Kuck, K. H., additional, Wong, K. C. K., additional, Jones, M., additional, Qureshi, N., additional, Muthumala, A., additional, Betts, T. R., additional, Bashir, Y., additional, Rajappan, K., additional, Vogtmann, T., additional, Wagner, M., additional, Schurig, J., additional, Hein, P., additional, Hamm, B., additional, Baumann, G., additional, Lembcke, A., additional, Saad, B., additional, Slater, C., additional, Oliveira, L. A., additional, Elias, R., additional, Camiletti, A., additional, Moura, D., additional, Maldonado, P., additional, Camanho, L. E., additional, Bulava, A., additional, Hanis, J., additional, Sitek, D., additional, Novotny, A., additional, Chik, W. B., additional, Lim, T. W., additional, Choon, H. K., additional, See, V. A., additional, Mccall, R., additional, Thomas, L., additional, Ross, D. L., additional, Thomas, S. P., additional, Chen, J., additional, De Bortoli, A., additional, Rossvoll, O., additional, Hoff, P. I., additional, Solheim, E., additional, Sun, L. Z., additional, Schuster, P., additional, Ohm, O. J., additional, Ardashev, A. V., additional, Zhelyakov, E., additional, Rybachenko, M. S., additional, Konev, A. V., additional, Belenkov, Y. U. N., additional, Gunawardene, M., additional, Chun, K. R. J., additional, Schulte-Hahn, B., additional, Windhorst, V., additional, Kulikoglu, M., additional, Nowak, B., additional, Schmidt, B., additional, Albina, G. A., additional, Rivera, R. S., additional, Scazzuso, F., additional, Laino, R. L., additional, Giniger, G. A., additional, Arbelo, E., additional, Calvo, N., additional, Tamborero, D., additional, Andreu, D., additional, Borras, R., additional, Berruezo, A., additional, Brugada, J., additional, Mont, L., additional, Stefan, L., additional, Eisenberger, M., additional, Celentano, E., additional, Peytchev, P., additional, Bodea, O., additional, Geelen, P., additional, De Potter, T., additional, Oliveira, M. M., additional, Silva, N., additional, Cunha, P. S., additional, Feliciano, J., additional, Lousinha, A., additional, Toste, A., additional, Santos, S., additional, Ferreira, R. C., additional, Matsuda, H., additional, Harada, T., additional, Soejima, K., additional, Ishikawa, Y., additional, Mizukoshi, K., additional, Sasaki, T., additional, Mizuno, K., additional, Miyake, F., additional, Adragao, P. P., additional, Cavaco, D., additional, Miranda, R., additional, Santos, M., additional, Morgado, F., additional, Reis Santos, K., additional, Candeias, R., additional, Marcelino, S., additional, Zoppo, F., additional, Grandolino, G., additional, Zerbo, F., additional, Bertaglia, E., additional, Schlueter, S. M., additional, Grebe, O., additional, Vester, E. G., additional, Miracle Blanco, A. L., additional, Arenal Maiz, A., additional, Atienza Fernandez, F., additional, Datino Romaniega, T., additional, Gonzalez Torrecilla, E., additional, Eidelman, G., additional, Hernandez Hernandez, J., additional, Fernandez Aviles, F., additional, Fukumoto, K., additional, Takatsuki, S., additional, Kimura, T., additional, Nishiyama, N., additional, Aizawa, Y., additional, Sato, T., additional, Miyoshi, S., additional, Fukuda, K., additional, Richter, B., additional, Gwechenberger, M., additional, Socas, A., additional, Zorn, G., additional, Albinni, S., additional, Marx, M., additional, Wojta, J., additional, Goessinger, H., additional, Deneke, T., additional, Balta, O., additional, Paesler, M., additional, Buenz, K., additional, Anders, H., additional, Horlitz, M., additional, Muegge, A., additional, Shin, D.- I., additional, Natsuyama, K., additional, Yamaguchi, K. M., additional, Nishida, Y. N., additional, Kosiuk, J., additional, Bode, K., additional, Arya, A., additional, Piorkowski, C., additional, Gaspar, T., additional, Sommer, P., additional, Bollmann, A., additional, Wichterle, D., additional, Peichl, P., additional, Simek, J., additional, Havranek, S., additional, Bulkova, V., additional, Cihak, R., additional, Jurado Roman, A., additional, Salguero Bodes, R., additional, Lopez Gil, M., additional, Fontenla Cerezuela, A., additional, De Riva Silva, M., additional, Arribas Ynsaurriaga, F., additional, Fernandez Herranz, A. I., additional, De Dios Perez, S., additional, Revishvili, A. S., additional, Dishekov, M., additional, Tembotova, Z., additional, Barsamyan, S., additional, Vaccari, D., additional, Alvarenga, C., additional, Jesus, I., additional, Layher, J., additional, Takahashi, A., additional, Singh, N., additional, Siot, P., additional, Elkaim, J. P., additional, Savelieva, I., additional, Mcclelland, L., additional, Lovegrove, A., additional, Jones, S., additional, Camm, J., additional, Folino, A. F., additional, Breda, R., additional, Calzavara, P., additional, Comisso, J., additional, Borghetti, F., additional, Iliceto, S., additional, Buja, G., additional, Mlynarski, R., additional, Mlynarska, A., additional, Sosnowski, M., additional, Wilczek, J., additional, Mabo, P., additional, Carrault, G., additional, Bordachar, P., additional, Makdissi, A., additional, Duchemin, L., additional, Alonso, C., additional, Neri, G., additional, Masaro, G., additional, Vittadello, S., additional, Gardin, A., additional, Barbetta, A., additional, Di Gregorio, F., additional, Sciaraffia, E., additional, Ginks, M. R., additional, Gustafsson, J. S., additional, Hollmark, M. C., additional, Rinaldi, C. A., additional, Blomstrom Lundqvist, C., additional, Brusich, S., additional, Tomasic, D., additional, Ferek-Petric, B., additional, Mavric, Z., additional, Kutarski, A., additional, Malecka, B., additional, Kolodzinska, A., additional, Grabowski, M., additional, Dovellini, E. V., additional, Giurlani, L., additional, Cerisano, G., additional, Carrabba, N., additional, Valenti, R., additional, Antoniucci, D., additional, Opolski, G., additional, Tomassoni, G., additional, Baker, J., additional, Corbisiero, R., additional, Martin, D., additional, Niazi, I., additional, Sheppard, R., additional, Sperzel, J., additional, Gutleben, K., additional, Petru, J., additional, Sediva, L., additional, Skoda, J., additional, Mazzone, P., additional, Ciconte, G., additional, Vergara, P., additional, Marzi, A., additional, Paglino, G., additional, Sora, N., additional, Gulletta, S., additional, Della Bella, P., additional, Pietura, R., additional, Czajkowski, M., additional, Cabanelas, N., additional, Martins, V. P., additional, Alves, M., additional, Valente, F. X., additional, Marta, L., additional, Francisco, A., additional, Silva, R., additional, Ferreira Da Silva, G., additional, Huo, Y., additional, Holmqvist, F., additional, Carlson, J., additional, Wetzel, U., additional, Platonov, P., additional, Nof, E., additional, Abu Shama, R., additional, Kuperstein, R., additional, Feinberg, M. S., additional, Eldar, M., additional, Glikson, M., additional, Luria, D., additional, Kubus, P., additional, Materna, O., additional, Gebauer, R. A., additional, Matejka, T., additional, Gebauer, R., additional, Tlaskal, T., additional, Janousek, J., additional, Muessigbrodt, A., additional, Richter, S., additional, Stockburger, M., additional, Boveda, S., additional, Defaye, P., additional, Stancak Branislav, P., additional, Kaliska, G., additional, Rolando, M., additional, Moreno, J., additional, Ohlow, M.- A. G., additional, Lauer, B., additional, Buchter, B., additional, Schreiber, M., additional, Geller, J. C., additional, Val-Mejias, J. E., additional, Ouali, S., additional, Azzez, S., additional, Kacem, S., additional, Ben Salem, H., additional, Hammas, S., additional, Neffeti, E., additional, Remedi, F., additional, Boughzela, E., additional, Miyazaki, H., additional, Miyanaga, S., additional, Shibayama, K., additional, Tokuda, M., additional, Kudo, T., additional, Coppola, B., additional, Shehada, R. E. N., additional, Costandi, P., additional, Healey, J., additional, Hohnloser, S. H., additional, Gold, M. R., additional, Capucci, A., additional, Van Gelder, I. C., additional, Carlson, M., additional, Lau, C. P., additional, Connolly, S. J., additional, Bogaard, M. D., additional, Leenders, G. E., additional, Maskara, B., additional, Tuinenburg, A. E., additional, Loh, P., additional, Hauer, R. N., additional, Doevendans, P. A., additional, Meine, M., additional, Thibault, B., additional, Dubuc, M., additional, Karst, E., additional, Ryu, K., additional, Paiement, P., additional, Farazi, T., additional, Puetz, V., additional, Berndt, C., additional, Buchholz, J., additional, Dorszewski, A., additional, Mornos, C., additional, Cozma, D., additional, Ionac, A., additional, Petrescu, L., additional, Mornos, A., additional, Pescariu, S., additional, Benser, M., additional, Roscoe, G., additional, De Jong, S., additional, Roberts, G., additional, Boileau, P., additional, Rec, A., additional, Folman, C., additional, Morttada, A., additional, Abd El Kader, M., additional, Samir, R., additional, Roushdy, R., additional, Khaled, S., additional, Abo El Maaty, M., additional, Van Gelder, B., additional, Houthuizen, P., additional, Bracke, F. A., additional, Osca Asensi, J., additional, Tejada, D., additional, Sanchez, J. M., additional, Munoz, B., additional, Cano, O., additional, Rodriguez, M., additional, Sancho-Tello, M. J., additional, Olague, J., additional, Hou, W., additional, Rosenberg, S., additional, Koh, S., additional, Poore, J., additional, Snell, J., additional, Yang, M., additional, Nirav, D., additional, Bornzin, G., additional, Deering, T., additional, Dan, D., additional, Wickliffe, A. C., additional, Cazeau, S., additional, Karimzadeh, K., additional, Mukerji, S., additional, Loghin, C., additional, Kantharia, B., additional, Jones, M. A., additional, Lamba, J., additional, Simpson, C. S., additional, Redfearn, D. P., additional, Michael, K. A., additional, Fitzpatrick, M., additional, Baranchuk, A., additional, Heinke, M., additional, Ismer, B., additional, Kuehnert, H., additional, Surber, R., additional, Haltenberger, A. M., additional, Prochnau, D., additional, Figulla, H. R., additional, Delarche, N., additional, Bizeau, O., additional, Couderc, P., additional, Chapelet, A., additional, Amara, W., additional, Lazarus, A., additional, Krupickova, S., additional, Van Deursen, C. J. M., additional, Strik, M., additional, Vernooy, K., additional, Van Hunnik, A., additional, Kuiper, M., additional, Crijns, H. J. G. M., additional, Prinzen, F. W., additional, Islam, N., additional, Gras, D., additional, Abraham, W., additional, Calo, L., additional, Birgersdotter-Green, U., additional, Clyne, C., additional, Herre, J., additional, Klein, N., additional, Kowalski, O., additional, Lenarczyk, R., additional, Pruszkowska, P., additional, Sokal, A., additional, Kukulski, T., additional, Zielinska, T., additional, Pluta, S., additional, Kalarus, Z., additional, Schwab, J. O., additional, Gasparini, M., additional, Anselme, F., additional, Clementy, J., additional, Santini, M., additional, Martinez Ferrer, J., additional, Burrone, V., additional, Santi, E., additional, Nevzorov, R., additional, Porter, A., additional, Kusniec, J., additional, Golovchiner, G., additional, Ben-Gal, T., additional, Strasberg, B., additional, Haim, M., additional, Rordorf, R., additional, Savastano, S., additional, Sanzo, A., additional, Vicentini, A., additional, Petracci, B., additional, De Amici, M., additional, Striuli, L., additional, Landolina, M., additional, Tolosana, J. M., additional, Martin, A. M., additional, Hernandez-Madrid, A., additional, Macias, A., additional, Fernandez-Lozano, I., additional, Osca, J., additional, Quesada, A., additional, Tada, H., additional, Noguchi, Y., additional, Shahrzad, S., additional, Karim Soleiman, N., additional, Tavoosi, A., additional, Taban, S., additional, Emkanjoo, Z., additional, Fukunaga, M., additional, Goya, M., additional, Hiroshima, K., additional, Ohe, M., additional, Hayashi, K., additional, Iwabuchi, M., additional, Nosaka, H., additional, Nobuyoshi, M., additional, Doiny, D., additional, Perez-Silva, A., additional, Castrejon Castrejon, S., additional, Estrada, A., additional, Ortega, M., additional, Lopez-Sendon, J. L., additional, Merino, J. L., additional, Garcia Fernandez, F. J., additional, Gallardo, R., additional, Pachon, M., additional, Almendral, J., additional, Martin, J., additional, Yahya, D., additional, Al-Mogheer, B., additional, Gouda, S., additional, Eweis, E., additional, El Ramly, M., additional, Abdelwahab, A., additional, Kassenberg, W., additional, Wittkampf, F. H. M., additional, Hof, I. E., additional, Heijden, J. H., additional, Neven, K. G. E. J., additional, Hauer, R. N. W., additional, Baratto, F., additional, Bignami, E., additional, Pappalardo, F., additional, Maccabelli, G., additional, Nicolotti, D., additional, Zangrillo, A., additional, Nagashima, M., additional, An, Y., additional, Okreglicki, A., additional, Russouw, C., additional, Tilz, R., additional, Yoshiga, Y., additional, Mathew, S., additional, Fuernkranz, A., additional, Rillig, A., additional, Wissner, E., additional, Ouyang, F., additional, De Sisti, A., additional, Tonet, J., additional, Gueffaf, F., additional, Touil, F., additional, Aouate, P., additional, Hidden-Lucet, F., additional, Makimoto, H., additional, Satomi, K., additional, Yamada, Y., additional, Okamura, H., additional, Noda, T., additional, Shimizu, W., additional, Aihara, N., additional, Kamakura, S., additional, Perez Silva, A., additional, Castrejon, S., additional, Gonzalez Vasserot, M., additional, Senges, J., additional, Brachmann, J., additional, Andresen, D., additional, Hoffmann, E., additional, Schumacher, B., additional, Willems, S., additional, Springer, B., additional, Kolb, C., additional, Akca, F., additional, Bauernfeind, T., additional, De Groot, N. M. S., additional, Schwagten, B., additional, Witsenburg, M., additional, Jordaens, L., additional, Szili-Torok, T., additional, Hata, Y., additional, Nakagami, R., additional, Watanabe, T., additional, Sato, A., additional, Watanabe, H., additional, Kabutoya, T., additional, Mituhashi, T., additional, Theuns, D. A. M. J., additional, Smith, T., additional, Pedersen, S. S., additional, Dabiri-Abkenari, L., additional, Prull, M. W., additional, Unverricht, S., additional, Bittlinsky, A., additional, Wirdemann, H., additional, Sasko, B., additional, Wirdeier, S., additional, Trappe, H. J., additional, Zorio Grima, E., additional, Rueda, J., additional, Medina, P., additional, Jaijo, T., additional, Sevilla, T., additional, Arnau, M. A., additional, Salvador, A., additional, Starrenburg, A. H., additional, Kraaier, K., additional, Scholten, M. F., additional, Van Der Palen, J., additional, De Haan, S., additional, Commandeur, J., additional, De Boer, K., additional, Beek, A. M., additional, Van Rossum, A. C., additional, Allaart, C. P., additional, Berne, P., additional, Porres, J. M., additional, Arnaiz, J. A., additional, Brugada, R., additional, Man, S., additional, Maan, A. C., additional, Thijssen, J., additional, Van Der Wall, E. E., additional, Schalij, M. J., additional, Burattini, L., additional, Burattini, R., additional, Swenne, C. A., additional, Bonny, A., additional, Ditah, I., additional, Larrazet, F., additional, Frank, R., additional, Fontaine, G., additional, Van Der Voort, P. H., additional, Alings, M., additional, Shimane, A., additional, Okajima, K., additional, Kanda, G., additional, Yokoi, K., additional, Yamada, S., additional, Taniguchi, Y., additional, Hayashi, T., additional, Kajiya, T., additional, Santos, M. C., additional, Wright, J., additional, Betts, J., additional, Denman, R., additional, Dominguez-Perez, L., additional, Arias Palomares, M. A., additional, Toquero, J., additional, Diaz-Infante, E., additional, Tercedor, L., additional, Valverde, I., additional, Napp, A., additional, Joosten, S., additional, Stunder, D., additional, Zink, M., additional, Marx, N., additional, Schauerte, P., additional, Silny, J., additional, Trucco, M. E., additional, Arce, M., additional, Palazzolo, J., additional, Femenia, F., additional, Glad, J. M., additional, Szymkiewicz, S. J., additional, Fernandez-Armenta, J., additional, Camara, O., additional, Mont, L. L., additional, Diaz, E., additional, Silva, E., additional, Frangi, A., additional, Brembilla-Perrot, B., additional, Laporte, F., additional, Morinigo, J., additional, Ledesma, C., additional, Hadid, C., additional, Ortiz, M., additional, Wolpert, C., additional, Cobo, E., additional, Navarro, X., additional, Arribas, F., additional, Miki, Y., additional, Naitoh, S., additional, Kumagai, K., additional, Goto, K., additional, Kaseno, K., additional, Oshima, S., additional, Taniguchi, K., additional, Rivera, S., additional, Albina, G., additional, Klein, A., additional, Laino, R., additional, Sammartino, V., additional, Giniger, A., additional, Muggenthaler, M., additional, Raju, H., additional, Papadakis, M., additional, Chandra, N., additional, Bastiaenen, R., additional, Behr, E. R., additional, Sharma, S., additional, Samniah, N., additional, Radezishvsky, Y., additional, Omari, H., additional, Rosenschein, U., additional, Perez Riera, A. R., additional, Ferreira, M., additional, Hopman, W. M., additional, Mcintyre, W. F., additional, Baranchuk, A. R., additional, Wongcharoen, W., additional, Keanprasit, K., additional, Phrommintikul, A., additional, Chaiwarith, R., additional, Yagishita, A., additional, Hachiya, H., additional, Nakamura, T., additional, Tanaka, Y., additional, Higuchi, K., additional, Kawabata, M., additional, Hirao, K., additional, Isobe, M., additional, Stoickov, V., additional, Ilic, S., additional, Deljanin Ilic, M., additional, Aagaard, P., additional, Sahlen, A., additional, Bergfeldt, L., additional, Braunschweig, F., additional, Sousa, A., additional, Lebreiro, A., additional, Sousa, C., additional, Oliveira, S., additional, Correia, A. S., additional, Rangel, I., additional, Freitas, J., additional, Maciel, M. J., additional, Asensio Lafuente, E., additional, Aguilera, A. A. C., additional, Corral, M. A. C. C., additional, Mendoza, K. L. M. C., additional, Nava, P. E. N. D., additional, Rendon, A. L. R. C., additional, Villegas, L. V. C., additional, Castillo, L. C. M., additional, Schaerf, R., additional, Develle, R., additional, Oliver, C., additional, Zinzius, P. Y., additional, Providencia, R. A., additional, Botelho, A., additional, Trigo, J., additional, Nascimento, J., additional, Quintal, N., additional, Mota, P., additional, Leitao-Marques, A. M., additional, Borbola, J., additional, Abraham, P., additional, Foldesi, C. S., additional, Kardos, A., additional, Almeida, S., additional, Santos, M. B., additional, Quaresma, R., additional, Morgado, F. B., additional, Adragao, P., additional, Fatemi, M., additional, Didier, R., additional, Le Gal, G., additional, Etienne, Y., additional, Jobic, Y., additional, Gilard, M., additional, Boschat, J., additional, Mansourati, J., additional, Zubaid, M., additional, Rashed, W., additional, Alsheikh-Ali, A., additional, Almahmeed, W., additional, Shehab, A., additional, Sulaiman, K., additional, Asaad, N., additional, Amin, H., additional, Boersma, L. V. A., additional, Swaans, M., additional, Post, M., additional, Rensing, B., additional, Jarverud, K., additional, Broome, M., additional, Noren, K., additional, Svensson, T., additional, Hjelm, S., additional, Hollmark, M., additional, Bjorling, A., additional, Maeda, K., additional, Takagi, M., additional, Suzuki, K., additional, Tatsumi, H., additional, Yoshiyama, M., additional, Simeonidou, E., additional, Michalakeas, C., additional, Kastellanos, S., additional, Varounis, C., additional, Nikolopoulou, A., additional, Koniari, C., additional, Anastasiou-Nana, M., additional, Furukawa, T., additional, Maggi, R., additional, Bertolone, C., additional, Fontana, D., additional, Brignole, M., additional, Pietrucha, A. Z., additional, Wnuk, M., additional, Bzukala, I., additional, Mroczek-Czernecka, D., additional, Konduracka, E., additional, Kruszelnicka, O., additional, Piwowarska, W., additional, Nessler, J., additional, Edvardsson, N., additional, Rieger, G., additional, Garutti, C., additional, Linker, N., additional, Jorge, C., additional, Silva Marques, J., additional, Veiga, A., additional, Cruz, J., additional, Correia, M. J., additional, Sousa, J., additional, Miltenberger-Miltenyi, G., additional, Nunes Diogo, A., additional, Matic, D., additional, Mrdovic, I., additional, Stankovic, G., additional, Asanin, M., additional, Antonijevic, N., additional, Matic, M., additional, Kocev, N., additional, Vasiljevic, Z., additional, Ramirez-Marrero, M. A., additional, Perez-Villardon, B., additional, Delgado-Prieto, J. L., additional, Jimenez-Navarro, M., additional, De Teresa-Galvan, E., additional, De Mora-Martin, M., additional, Sztefko, K., additional, Malek, A., additional, De Groot, N., additional, Shalganov, T., additional, Schalij, M., additional, Rivas, N., additional, Casaldaliga, J., additional, Roca, I., additional, Pijuan, A., additional, Perez-Rodon, J., additional, Dos, L., additional, Garcia-Dorado, D., additional, Moya, A., additional, Baruteau, A.- E., additional, Behaghel, A., additional, Chatel, S., additional, Schott, J. J., additional, Daubert, J. C., additional, Le Marec, H., additional, Probst, V., additional, Navarro-Manchon, J., additional, Molina, P., additional, Igual, B., additional, Bermejo, M., additional, Giner, J., additional, Bourgonje, V. J. A., additional, Vos, M. A., additional, Ozdemir, S., additional, Doisne, N., additional, Van Der Heyden, M. A. G., additional, Van Veen, A. A. B., additional, Sipido, K., additional, Antoons, G., additional, Altieri, P. I., additional, Escobales, N., additional, Crespo, M., additional, Banchs, H. L., additional, Sciarra, L., additional, Bloise, R., additional, Allocca, G., additional, Marras, E., additional, Lioy, E., additional, Delise, P., additional, Priori, S., additional, and Calo', L., additional

Published
2011
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17. Relation between preoperative and intraoperative new wall motion abnormalities in vascular surgery patients: a transesophageal echocardiographic study.

Author

Galal W, Hoeks SE, Flu WJ, van Kuijk JP, Goei D, Galema T, den Uil C, van Gestel YR, Bax JJ, Verhagen HJ, Poldermans D, Galal, Wael, Hoeks, Sanne E, Flu, Willem Jan, van Kuijk, Jan Peter, Goei, Dustin, Galema, Tjebbe, den Uil, Corstiaan, van Gestel, Yvette R B M, and Bax, Jeroen J

Abstract

Background: Coronary revascularization of the suspected culprit coronary lesion assessed by preoperative stress testing is not associated with improved outcome in vascular surgery patients. Methods: Fifty-four major vascular surgery patients underwent preoperative dobutamine echocardiography and intraoperative transesophageal echocardiography. The locations of left ventricular rest wall motion abnormalities and new wall motion abnormalities (NWMAs) were scored using a seven-wall model. During 30-day follow-up, postoperative cardiac troponin release, myocardial infarction, and cardiac death were noted. Results: Rest wall motion abnormalities were noted by dobutamine echocardiography in 17 patients (31%), and transesophageal echocardiography was noted in 16 (30%). NWMAs were induced during dobutamine echocardiography in 17 patients (31%), whereas NWMAs were observed by transesophageal echocardiography in 23 (43%), kappa value = 0.65. Although preoperative and intraoperative rest wall motion abnormalities showed an excellent agreement for the location (kappa value = 0.92), the agreement for preoperative and intraoperative NWMAs in different locations was poor (kappa value = 0.26-0.44). The composite cardiac endpoint occurred in 14 patients (26%). Conclusions: There was a poor correlation between the locations of preoperatively assessed stress-induced NWMAs by dobutamine echocardiography and those observed intraoperatively using transesophageal echocardiography. However, the composite endpoint of outcome was met more frequently in relation with intraoperative NWMAs. [ABSTRACT FROM AUTHOR]

Published
2010
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18. P001Reversal of endothelial dysfunction after AF cardioversion.

Author

Allam, R., Galal, W., El-Damnhoury, H., and Mortada, A.

Abstract

Objective: Flow abnormalities which occur in AF patient due to irregular heart rate which resultant turbulent flow both in left atrium and systemically may lead to endothelial dysfunction. The purpose is to detect endothelial dysfunction in non rheumatic AF patient. And test the hypothesis that endothelial dysfunction is reversible upon restoration of normal sinus rhythm and correction of the blood flow dynamics. Method: Endothelium-dependent (flow-mediated dilation) vasodilator function of brachial artery was measured using high resolution ultrasound in 30 patients with persistent non rheumatic AF who were scheduled for elective electrical cardioversion and in 10 control subjects. In patients who remained in sinus rhythm after cardioversion, these measurements were repeated after one month and two months. Result: Compared with control subjects, patients showed lower FMD during AF (6.66Â ± 1.62% vs 14.29Â ± 2.93%, p < 0.001). In patients who remained in sinus rhythm, FMD increased at both one month (6.66Â ± 1.62% vs 10.71Â ± 2.81%, p < 0.001) and two months (6.66Â ± 1.62% vs 14.28Â ± 3.48%, p < 0.001). Conclusion: There is endothelial dysfunction associated with non rheumatic persistent AF patients which is reversible upon restoration of normal sinus rhythm and correction of blood flow dynamics. [ABSTRACT FROM PUBLISHER]

Published
2012

20. Impact of obesity on postoperative and long-term outcomes in a general surgery population: a retrospective cohort study.

Author

Valentijn TM, Galal W, Hoeks SE, van Gestel YR, Verhagen HJ, and Stolker RJ

Subjects
Body Mass Index, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Neoplasms mortality, Netherlands epidemiology, Postoperative Complications mortality, Retrospective Studies, Risk Factors, Survival Rate, Treatment Outcome, General Surgery, Obesity complications
Abstract

Background: The obesity paradox has been demonstrated postoperatively in several surgical populations, but only a few studies have reported long-term survival. This study evaluates the presence of the obesity paradox in a general surgery population, reporting both postoperative and long-term survival., Methods: This retrospective study included 10,427 patients scheduled for elective, noncardiac surgery. Patients were classified as underweight (body mass index (BMI) < 18.5 kg/m(2)); normal weight (BMI 18.5-24.9 kg/m(2)); overweight (BMI 25.0-29.9 kg/m(2)); obesity class I (BMI 30.0-34.9 kg/m(2)); obesity class II (BMI 35.0-39.9 kg/m(2)); and obesity class III (BMI ≥ 40.0 kg/m(2)). Study endpoints were 30-day postoperative and long-term mortality, including cause-specific mortality. Multivariable analyses were used to evaluate mortality risks for each BMI category., Results: Within 30 days after surgery, 353 (3.4 %) patients died. Overweight was the only category associated with postoperative mortality, showing improved survival [odds ratio 0.7; 95 % confidence interval (CI) 0.6-0.9]. During the long-term follow-up 4,884 (47 %) patients died. Underweight patients had the highest mortality risk [hazard ratio (HR) 1.4; 95 % CI 1.2-1.6), particularly due to high cancer-related deaths. In contrast, overweight and obese patients demonstrated improved survival (overweight: HR 0.8, 95 % CI 0.8-0.9; obesity class I: HR 0.7, 95 % CI 0.7-0.8; obesity class II: HR 0.7, 95 % CI 0.6-0.9; obesity class III: HR 0.7, 95 % CI 0.5-1.0), mainly because of a strongly reduced risk of cancer-related death., Conclusions: In this surgical population the obesity paradox was validated at the long term, mainly because of decreased cancer-related deaths among obese patients.

Published
2013
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21. The obesity paradox in the surgical population.

Author

Valentijn TM, Galal W, Tjeertes EK, Hoeks SE, Verhagen HJ, and Stolker RJ

Subjects
Comorbidity, Global Health, Humans, Morbidity trends, Risk Factors, Survival Rate trends, Body Mass Index, Obesity, Morbid epidemiology, Surgical Procedures, Operative
Abstract

Background: Despite the medical hazards of obesity, recent reports examining body mass index (BMI) show an inverse relationship with morbidity and mortality in the surgical patient. This phenomenon is known as the 'obesity paradox'. The aim of this review is to summarize both the literature concerned with the obesity paradox in the surgical setting, as well as the theories explaining its causation., Methods: PubMed was searched to identify available literature. Search criteria included obesity paradox and BMI paradox, and studies in which BMI was used as a measure of body fat were potentially eligible for inclusion in this review., Results: The obesity paradox has been demonstrated in cardiac and in non-cardiac surgery patients. Underweight and morbidly obese patients displayed the worse outcomes, both postoperatively as well as at long-term follow-up. Hypotheses to explain the obesity paradox include increased lean body mass, (protective) peripheral body fat, reduced inflammatory response, genetics and a decline in cardiovascular disease risk factors, but probably unknown factors contribute too., Conclusions: Patients at the extremes of BMI, both the underweight and the morbid obese, seem to have the highest postoperative morbidity and mortality hazard, which even persists at long-term. The cause of the obesity paradox is probably multi-factorial. This offers potential for future research in order to improve outcomes for persons on both sides of the 'optimum BMI'., (Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Published
2013
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22. Formation of dAMP-glycerol and dAMP-Tris derivatives by Thermococcus kodakaraensis DNA primase.

Author

Chemnitz Galal W, Pan M, Giulian G, Yuan W, Li S, Edwards JL, Marino JP, Kelman Z, and Hurwitz J

Subjects
Archaeal Proteins chemistry, Catalysis, DNA Primase chemistry, Deoxyadenine Nucleotides chemistry, Glycerol chemistry, Thermococcus enzymology, Tromethamine chemistry
Abstract

In the presence of dATP, glycerol, and Tris buffer, the DNA primase isolated from Thermococcus kodakaraensis catalyzed the formation of dAMP and two products that were identified as dAMP-glycerol and dAMP-Tris. These products were formed by the T. kodakaraensis p41 catalytic subunit alone and the T. kodakaraensis p41-p46 complex in the absence of a DNA template. They were not formed with preparations containing the catalytically inactive p41 subunit. Similar glycerol and Tris derivatives as well as dNMPs were also formed with dGTP, dCTP, or dTTP. The mechanism contributing to the formation of these products and its implications in the initiation reaction catalyzed by the T. kodakaraensis primase are discussed.

Published
2012
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23. Characterization of DNA primase complex isolated from the archaeon, Thermococcus kodakaraensis.

Author

Chemnitz Galal W, Pan M, Kelman Z, and Hurwitz J

Subjects
Archaeal Proteins genetics, DNA Primase genetics, DNA, Archaeal genetics, Multiprotein Complexes genetics, Protein Subunits genetics, RNA, Archaeal genetics, RNA, Archaeal metabolism, Thermococcus genetics, Archaeal Proteins metabolism, DNA Primase metabolism, DNA Replication physiology, DNA, Archaeal biosynthesis, Multiprotein Complexes metabolism, Protein Subunits metabolism, Thermococcus enzymology
Abstract

In most organisms, DNA replication is initiated by DNA primases, which synthesize primers that are elongated by DNA polymerases. In this study, we describe the isolation and biochemical characterization of the DNA primase complex and its subunits from the archaeon Thermococcus kodakaraensis. The T. kodakaraensis DNA primase complex is a heterodimer containing stoichiometric levels of the p41 and p46 subunits. The catalytic activity of the complex resides within the p41 subunit. We show that the complex supports both DNA and RNA synthesis, whereas the p41 subunit alone marginally produces RNA and synthesizes DNA chains that are longer than those formed by the complex. We report that the T. kodakaraensis primase complex preferentially interacts with dNTP rather than ribonucleoside triphosphates and initiates RNA as well as DNA chains de novo. The latter findings indicate that the archaeal primase complex, in contrast to the eukaryote homolog, can initiate DNA chain synthesis in the absence of ribonucleoside triphosphates. DNA primers formed by the archaeal complex can be elongated extensively by the T. kodakaraensis DNA polymerase (Pol) B, whereas DNA primers formed by the p41 catalytic subunit alone were not. Supplementation of reactions containing the p41 subunit with the p46 subunit leads to PolB-catalyzed DNA synthesis. We also established a rolling circle reaction using a primed 200-nucleotide circle as the substrate. In the presence of the T. kodakaraensis minichromosome maintenance (MCM) 3' → 5' DNA helicase, PolB, replication factor C, and proliferating cell nuclear antigen, long leading strands (>10 kb) are produced. Supplementation of such reactions with the DNA primase complex supported lagging strand formation as well.

Published
2012
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24. The influence of polyvascular disease on the obesity paradox in vascular surgery patients.

Author

van Kuijk JP, Flu WJ, Galal W, Chonchol M, Goei D, Verhagen HJ, Bax JJ, and Poldermans D

Subjects
Aged, Atherosclerosis complications, Atherosclerosis mortality, Body Mass Index, Cardiovascular Agents therapeutic use, Chi-Square Distribution, Female, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Netherlands epidemiology, Obesity mortality, Prevalence, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Thinness mortality, Time Factors, Treatment Outcome, Atherosclerosis surgery, Obesity complications, Thinness complications, Vascular Surgical Procedures adverse effects, Vascular Surgical Procedures mortality
Abstract

Background: Obesity is a risk factor for atherosclerosis, a polyvascular process associated with reduced survival. In nonvascular surgery populations, a paradox between body mass index (BMI) and survival is described. This paradox includes reduced survival in underweight patients, whereas overweight and obese patients have a survival benefit. No clear explanation for this paradox has been given. Therefore, we evaluated the presence of the obesity paradox in vascular surgery patients and the influence of polyvascular disease on the obesity paradox., Methods: In this retrospective study, 2933 consecutive patients were classified according to their preoperative BMI (kg/m(2)) and screened for polyvascular disease and cardiovascular risk factors before surgery. In addition, medication use at the time of discharge was noted. Outcome was all-cause mortality during a median follow-up of 6.0 years (interquartile range, 2-9 years)., Results: BMI (kg/m(2)) groups included 68 (2.3%) underweight (BMI <18.5), 1379 (47.0%) normal (BMI 18.5-24.9, reference), 1175 (40.0%) overweight (BMI 25-29.9), and 311 (10.7%) obese (BMI ≥ 30) patients. No direct interaction between BMI, polyvascular disease, and long-term outcome was observed. Underweight was an independent predictor of mortality (hazard ratio, 1.65; 95% confidence interval, 1.22-2.22). In contrast, overweight protected for all-cause mortality (hazard ratio, 0.79; 95% confidence interval, 0.700-0.89). Cardioprotective medication usage in underweight patients was the lowest (P < .001), although treatment targets for risk factors were equally achieved within all treated groups., Conclusion: Overweight patients referred for vascular surgery were characterized by an increased incidence of polyvascular disease and required more extensive medical treatment for cardiovascular risk factors at discharge. Long-term follow-up showed a paradox of reduced mortality in overweight patients., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Published
2011
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25. Prevalence and pharmacological treatment of left-ventricular dysfunction in patients undergoing vascular surgery.

Author

Flu WJ, van Kuijk JP, Galal W, Kuiper R, van de Ven LL, Verhagen HJ, Bax JJ, and Poldermans D

Subjects
Adrenergic beta-Antagonists therapeutic use, Aged, Analysis of Variance, Angiotensin II Type 1 Receptor Blockers therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Antihypertensive Agents therapeutic use, Confidence Intervals, Echocardiography, Female, Humans, Male, Multivariate Analysis, Netherlands epidemiology, Practice Guidelines as Topic, Preoperative Care, Prevalence, Proportional Hazards Models, Risk Factors, Stroke Volume, Surveys and Questionnaires, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Function, Left, Vascular Surgical Procedures, Ventricular Dysfunction, Left drug therapy, Ventricular Dysfunction, Left epidemiology
Abstract

Aims: This study evaluated the prevalence of left-ventricular (LV) dysfunction in vascular surgery patients and pharmacological treatment, according ESC guidelines., Methods and Results: Echocardiography was performed pre-operatively in 1,005 consecutive patients. Left ventricular ejection fraction (LVEF)

Published
2010
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26. The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients.

Author

Goei D, Flu WJ, Hoeks SE, Galal W, Dunkelgrun M, Boersma E, Kuijper R, van Kuijk JP, Winkel TA, Schouten O, Bax JJ, and Poldermans D

Subjects
Aged, Anemia blood, Biomarkers blood, Electrocardiography, Female, Heart Diseases blood, Heart Diseases mortality, Hemoglobins metabolism, Humans, Linear Models, Male, Middle Aged, Odds Ratio, Predictive Value of Tests, ROC Curve, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Troponin T blood, Vascular Surgical Procedures mortality, Anemia complications, Heart Diseases etiology, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Vascular Surgical Procedures adverse effects
Abstract

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery., Methods: A detailed cardiac history, resting echocardiography, and hemoglobin and NT-proBNP levels were obtained in 666 patients before vascular surgery. Anemia was defined as serum hemoglobin <13 g/dL for men and <12 g/dL for women. Troponin T measurements and 12-lead electrocardiograms were performed on postoperative days 1, 3, 7, and 30 and whenever clinically indicated. The primary end point of the study was the composite of 30-day postoperative cardiovascular death, nonfatal myocardial infarction, and troponin T release. Receiver operating characteristic curve analysis was used to assess the optimal cutoff value of NT-proBNP for the prediction of the composite end point. Multivariable regression analysis was used to assess the additional value of NT-proBNP for the prediction of postoperative cardiac events in nonanemic and anemic patients., Results: Anemia was present in 206 patients (31%) before surgery. Hemoglobin level was inversely related with the NT-proBNP levels (beta coefficient = -2.242; P = 0.025). The optimal predictive cutoff value of NT-proBNP for predicting the composite cardiovascular outcome was 350 pg/mL. After adjustment for clinical cardiac risk factors, both anemia (odds ratio [OR] 1.53; 95% confidence interval [CI]: 1.07-2.99) and increased levels of NT-proBNP (OR 4.09; 95% CI: 2.19-7.64) remained independent predictors for postoperative cardiac events. However, increased levels of NT-proBNP were not predictive for the risk of adverse cardiac events in the subgroup of anemic patients (OR 2.16; 95% CI: 0.90-5.21)., Conclusions: Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients.

Published
2009
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27. Preoperative oral glucose tolerance testing in vascular surgery patients: long-term cardiovascular outcome.

Author

van Kuijk JP, Dunkelgrun M, Schreiner F, Flu WJ, Galal W, van Domburg RT, Hoeks SE, van Gestel YR, Bax JJ, and Poldermans D

Subjects
Aged, Diabetes Mellitus blood, Elective Surgical Procedures methods, Female, Follow-Up Studies, Heart Diseases blood, Humans, Incidence, Male, Netherlands epidemiology, Prognosis, Prospective Studies, Risk Factors, Survival Rate, Time Factors, Vascular Diseases blood, Blood Glucose metabolism, Diabetes Mellitus diagnosis, Glucose Tolerance Test methods, Heart Diseases epidemiology, Preoperative Care methods, Vascular Diseases surgery, Vascular Surgical Procedures methods
Abstract

Background: Diabetes mellitus (DM) is an important risk factor in vascular surgery patients, influencing late outcome. Screening for diabetes is recommended by fasting glucose measurement. Oral glucose tolerance testing (OGTT) could enhance the detection of patients with impaired glucose tolerance (IGT) and DM., Aim: To assess the additional value of OGTT on top of fasting glucose levels in vascular surgery patients to predict long-term cardiovascular outcome., Methods: A total of 404 patients without signs or histories of IGT (plasma glucose 7.8-11.1 mmol/L) or DM (glucose >/=11.1 mmol/L) were prospectively included and subjected to OGTT. Cardiac risk factors were noted. Primary outcome was the occurrence of late cardiovascular events (composite of cardiovascular death, angina pectoris, myocardial infarction, percutaneous coronary intervention/coronary artery bypass grafting, or cerebral vascular accident/transient ischemic attack), and secondary outcome included all-cause and cardiovascular mortality rates, in survivors of vascular surgery. Median follow-up was 3.0 (interquartile range 2.4-3.8) years., Results: Impaired glucose tolerance (n = 104) and DM (n = 43) were detected by fasting glucose levels in 26 (25%) and 12 (28%) patients, and by OGTT in 78 (75%) and 31 (72%) patients, respectively. During follow-up, 131 patients experienced a cardiovascular event. With multivariable analysis, patients with IGT showed a significant increased risk for cardiovascular events (hazard ratio 2.77, 95% CI 1.83-4.20) and mortality (hazard ratio 2.06, 95% CI 1.03-4.12). Patients with DM showed a nonsignificant increased risk for cardiovascular events., Conclusion: Vascular surgery patients with IGT or DM detected by preoperative OGTT have an increased risk of developing cardiovascular events and mortality during long-term follow-up. It is recommended that nondiabetic vascular surgery patients should be tested for glucose regulation disorders before surgery.

Published
2009
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28. The obesity paradox in patients with peripheral arterial disease.

Author

Galal W, van Gestel YRBM, Hoeks SE, Sin DD, Winkel TA, Bax JJ, Verhagen H, Awara AMM, Klein J, van Domburg RT, and Poldermans D

Subjects
Aged, Arterial Occlusive Diseases etiology, Arterial Occlusive Diseases physiopathology, Body Mass Index, Cause of Death trends, Female, Follow-Up Studies, Forced Expiratory Volume, Humans, Male, Middle Aged, Netherlands epidemiology, Obesity mortality, Obesity physiopathology, Prevalence, Prognosis, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive physiopathology, Retrospective Studies, Risk Factors, Severity of Illness Index, Survival Rate trends, Arterial Occlusive Diseases mortality, Obesity complications, Pulmonary Disease, Chronic Obstructive complications
Abstract

Background: Cardiac events are the predominant cause of late mortality in patients with peripheral arterial disease (PAD). In these patients, mortality decreases with increasing body mass index (BMI). COPD is identified as a cardiac risk factor, which preferentially affects underweight individuals. Whether or not COPD explains the obesity paradox in PAD patients is unknown., Methods: We studied 2,392 patients who underwent major vascular surgery at one teaching institution. Patients were classified according to COPD status and BMIs (ie, underweight, normal, overweight, and obese), and the relationship between these variables and all-cause mortality was determined using a Cox regression analysis. The median follow-up period was 4.37 years (interquartile range, 1.98 to 8.47 years)., Results: The overall mortality rates among underweight, normal, overweight, and obese patients were 54%, 50%, 40%, and 31%, respectively (p < 0.001). The distribution of COPD severity classes showed an increased prevalence of moderate-to-severe COPD in underweight patients. In the entire population, BMI (continuous) was associated with increased mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94 to 0.98). In addition, patients who were classified as being underweight were at increased risk for mortality (HR, 1.42; 95% CI, 1.00 to 2.01). However, after adjusting for COPD severity the relationship was no longer significant (HR, 1.29; 95% CI, 0.91 to 1.93)., Conclusions: The excess mortality among underweight patients was largely explained by the overrepresentation of individuals with moderate-to-severe COPD. COPD may in part explain the "obesity paradox" in the PAD population.

Published
2008
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29. Relation of body mass index to outcome in patients with known or suspected coronary artery disease.

Author

Galal W, van Domburg RT, Feringa HH, Schouten O, Elhendy A, Bax JJ, Awara AM, Klein J, and Poldermans D

Subjects
Adult, Aged, Analysis of Variance, Body Weight, Coronary Artery Disease epidemiology, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Netherlands epidemiology, Obesity epidemiology, Obesity physiopathology, Predictive Value of Tests, Proportional Hazards Models, Research Design, Retrospective Studies, Risk Factors, Survival Analysis, Time Factors, Body Mass Index, Coronary Artery Disease mortality, Coronary Artery Disease physiopathology
Abstract

Increased body mass index (BMI), a parameter of total body fat content, is associated with an increased mortality in the general population. However, recent studies have shown a paradoxic relation between BMI and mortality in specific patient populations. This study investigated the association of BMI with long-term mortality in patients with known or suspected coronary artery disease. In a retrospective cohort study of 5,950 patients (mean age 61 +/- 13 years; 67% men), BMI, cardiovascular risk markers (age, gender, hypertension, diabetes, current smoking, angina pectoris, old myocardial infarction, heart failure, hypercholesterolemia, and previous coronary revascularization), and outcome were noted. The patient population was categorized as underweight, normal, overweight, and obese based on BMI according to the World Health Organization classification. Mean follow-up time was 6 +/- 2.6 years. Incidences of long-term mortality in underweight, normal, overweight, and obese were 39%, 35%, 24%, and 20%, respectively. In a multivariate analysis model, the hazard ratio (HR) for mortality in underweight patients was 2.4 (95% confidence interval [CI] 1.7 to 3.7). Overweight and obese patients had a significantly lower mortality than patients with a normal BMI (HR 0.65, 95% CI 0.6 to 0.7, for overweight; HR 0.61, 95% CI 0.5 to 0.7, for obese patients). In conclusion, BMI is inversely related to long-term mortality in patients with known or suspected coronary artery disease. A lower BMI was an independent predictor of long-term mortality, whereas an improved outcome was observed in overweight and obese patients.

Published
2007
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30. Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease.

Author

Feringa HH, van Waning VH, Bax JJ, Elhendy A, Boersma E, Schouten O, Galal W, Vidakovic RV, Tangelder MJ, and Poldermans D

Subjects
Female, Humans, Male, Middle Aged, Prospective Studies, Survival Rate, Time Factors, Atherosclerosis drug therapy, Atherosclerosis mortality, Peripheral Vascular Diseases drug therapy, Peripheral Vascular Diseases mortality, Protective Agents therapeutic use
Abstract

Objectives: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD)., Background: Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined., Methods: In this prospective observational cohort study, 2,420 consecutive patients (age, 64 +/- 11 years, 72% men) with PAD (ankle-brachial index < or =0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics, nitrates, coumarins, and digoxin were calculated. Cox regression models were used to analyze the relation between cardiac medication and long-term mortality., Results: Medical history included diabetes mellitus in 436 patients (18%), hypercholesterolemia in 581 (24%), smoking in 837 (35%), hypertension in 1,162 (48%), coronary artery disease in 1,065 (44%), and a history of heart failure in 214 (9%). Mean ankle-brachial index was 0.58 (+/-0.18). During a median follow-up of eight years, 1,067 patients (44%) died. After adjustment for risk factors and propensity scores, statins (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers (HR 0.68, 95% CI 0.58 to 0.80), aspirins (HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors (HR 0.80, 95% CI 0.69 to 0.94) were significantly associated with a reduced risk of long-term mortality., Conclusions: On the basis of this observational longitudinal study, statins, beta-blockers, aspirins, and ACE inhibitors are associated with a reduction in long-term mortality in patients with PAD.

Published
2006
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