Objective This longitudinal case‐control study evaluated serum proteomics prior to a clinical diagnosis of rheumatoid arthritis (i.e. pre‐RA) to evaluate biologic pathways of disease development and inform prediction of timing of onset of future disease. Methods Patients (cases, n=213) meeting the 1987 American College of Rheumatology (ACR) classification criteria for RA, and matched controls without RA (n=215) were identified in the Department of Defense Serum Repository. Serum samples from cases pre‐ and post‐RA diagnosis and controls were tested for RA‐related autoantibodies (anti‐cyclic citrullinated peptide [anti‐CCP3], rheumatoid factor [RF] isotypes immunoglobulin [Ig] M and A, and 197 proteins using a commercial platform (Olink). We applied linear mixed effect models to identify biomarkers distinguishing cases from controls prior to RA diagnosis and analyzed longitudinal patterns of enriched pathways; in addition, models were developed to classify the time of a sample in relationship to the time of RA diagnosis. Results Levels of anti‐CCP3, RFIgA, and RFIgM demonstrated the greatest differences between cases and controls ≤5 years prior to RA diagnosis. Longitudinal analyses identified 104 proteins that were differentially expressed between cases and controls; 60 were differentially expressed ≤5 years prior to diagnosis, 42 within and prior to 5 years of diagnosis, and 2 >5 years prior. KEGG analyses identified that these proteins were associated with 32 pathways, including 21 pathways that were enriched ≤5 years prior to diagnosis. Within the ACPA positive samples from prior to RA diagnosis and controls, a set of features classified if that sample was from a period <3 years prior to RA diagnosis with an area under the curve (AUC) of 0.78 [0.67, 0.89] in a training set, and 0.80 [0.68, 0.92] in a validation set. Conclusion Autoantibodies and protein signatures evolve in distinct stages prior to a diagnosis of RA. Furthermore, protein biomarkers may identify biologic pathways relevant to specific stages. These can be further explored to potentially improve prediction of disease onset and identify stage‐specific biological pathways to target with preventive interventions.
Current research showed that the triglyceride glucose (TyG) index is a cheap clinical marker associated with coronary artery calcium (CAC) score and atherosclerotic cardiovascular disease (ASCVD). Nevertheless, its relationship with the occurrence of early ASCVD events remains uncertain. We intend to evaluate the association between the TyG index and CAC score, a marker of subclinical atherosclerosis, in a normal population free of apparent Cardiovascular disease (CVD). After that, we investigated whether this marker is a good tool to identify early CV events in an asymptomatic population. We performed a prospective study with 1,284 subjects aged 51.8±8.3, 73.5% male, without apparent coronary artery disease. CAC score was performed by cardiac computed tomography and reported as Agatston units. The TyG index was calculated as ln[TG (mg/dL) × FBG (mg/dL)/2] and was subdivided into terciles. Outcome variables were myocardial infarction, unstable angina, stroke, peripheric disease and CV death. The incidence of outcomes was estimated for each TyG tercile. All outcomes were investigated by Cox proportional hazards regression analysis adjusting for baseline covariates. Using Spearman´s correlation, we obtain a positive correlation between TyG index and CAC (r=0.201; p<0.0001). CV events were diagnosed in 47 participants during the follow-up period. In the low tercile (<8.49), there were 20% of total ASCVD events, on the medium tercile [8.49-8.97[ there were 42.2%, and in the high (≥8.97) 37.8% ASCVD events (p=0.145). Multivariate-adjusted hazard ratios (HRs) for subjects in the medium/highest TyG index tercile confirmed that these patients were at higher risk for CV events compared with participants in the lowest TyG index tercile after adjusting for smoking, hypertension, and dyslipidemia (HR = 2.552; 95% CI-1.144-5.693; p=0.022). A higher TyG index is associated with a higher risk of ASCVD events using a representative cohort of a Portuguese population. TyG index, which is inexpensive and easy to calculate, reflects insulin resistance and may be potentially helpful in identifying individuals at high risk of suffering early CV events. Thus, it could be beneficial in primary CVD prevention.Baseline characteristics populationVariables associated with CV events
The use of calculated formulas for plasma volume based on hemoglobin and hematocrit (H&H) and other physiologic parameters is being increasingly used to gauge prognosis in patients with heart failure. Many formulas exist, but they can be simplified into those which rely solely on H&H, and others which rely on H&H plus parameters such as weight and sex. The formulas that rely solely on H&H are the Strauss and Duarte formulas, while those which incorporate other parameters include the Hakim and Kaplan formulas. There is now a large body of evidence that demonstrates these simple formulas can convey prognosis and may be valuable as a prospective measurement to guide therapy. This review lays out the evidence for using plasma volume calculations in patients with heart failure and the benefits that can be derived from utilizing them in the management of heart failure.
Background: In Portugal 44% of higher education students have an inadequate or problematic level of health literacy (HL). This generation is more literate than the previous ones and has grown in a digital world, which means that the internet is their main source of information, posing some advantages but also some risks. Methods: Narrative review of scientific publications conducted in Portugal and internationally, using the MeSH terms [health literacy], [digital], [young people], [education], and [social media]. Discussion: It is important to stimulate the active participation of young people in the creation of HL-promoting projects, listening to their ideas, and giving them visibility and feedback. Communication and information disclosure may be potentially more effective via social and digital media while engaging the groups young people belong to. Including HL in the pre- and postgraduate programs of all scientific academic areas is a goal to achieve. Conclusion: Integrating young people's perspectives in HL projects leads to the creation of public policies that better reflect their real needs. The abilities they acquire in this context contribute to better results regarding individual and community health.
