scholarly journals Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

2019 ◽  
Vol 8 (7) ◽  
pp. 1084 ◽  
Author(s):  
Sophie I. Mavrogeni ◽  
George Markousis-Mavrogenis ◽  
Olga Karapanagiotou ◽  
Konstantinos Toutouzas ◽  
Panagiotis Argyriou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Angiography ◽  
High Sensitivity ◽  
Silent Myocardial Ischemia ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Hs Crp ◽  
Stress Cmr ◽  
Stress Cardiovascular Magnetic Resonance

Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.

The Relationships of High-Sensitivity C-Reactive Protein and Homocysteine Levels With Disease Activity, Damage Accrual, and Cardiovascular Risk in Systemic Lupus Erythematosus

2019 ◽  
Vol 22 (2) ◽  
pp. 169-177 ◽  
Author(s):  
Gabriela Pocovi-Gerardino ◽  
Maria Correa-Rodríguez ◽  
José-Luis Callejas Rubio ◽  
Raquel Ríos Fernández ◽  
María Martín Amada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
High Sensitivity ◽  
Cvd Risk Factors ◽  
Systemic Lupus ◽  
Cvd Risk ◽  
Damage Accrual ◽  
Hs Crp

Chronic inflammation coupled with cardiovascular disease (CVD) risk factors influences the progression of atherosclerosis in systemic lupus erythematosus (SLE). High-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) are associated with the risk of CVD in the general population, but their associations with CV risk and disease activity in SLE are unclear. In this cross-sectional study ( N = 139 SLE patients, mean age = 45.27 ± 13.18 years), we investigated associations between hs-CRP and Hcy levels and disease activity, damage accrual, and CVD risk in SLE. Disease activity and damage accrual were measured with the SLE Activity Index 2000 (SLEDAI-2K), the Systemic Lupus Erythematosus International Collaborating Clinics Group/American College of Rheumatology damage index (SDI), and anti-double-stranded DNA antibodies (anti-dsDNA). CVD risk factors of obesity, diabetes mellitus, hypertension, blood lipids, and ankle–brachial index were collected. Linear regression analysis and one-way analysis of variance were used to analyze relationships of hs-CRP and Hcy with SLE activity, damage accrual, and CVD risk factors. Results: hs-CRP correlated significantly with SLEDAI-2K ( p = .036), SDI ( p = .00), anti-dsDNA titers ( p = .034), diabetes ( p = .005), and obesity ( p = .027). hs-CRP and Hcy correlated with triglyceride (TG) levels ( p = .032 and p < .001, respectively), TG/high-density lipoprotein cholesterol index ( p = .020 and p = .001, respectively), and atherogenic index of plasma ( p = .006 and p = .016, respectively). hs-CRP levels >3 mg/L correlated with SDI score ( p = .012) and several CVD risk factors. Discussion: Findings suggest SLE patients with elevated hs-CRP and/or Hcy have a higher prevalence of CVD risk factors.

scholarly journals Effect of a High Protein Weight Loss Diet on Weight, High-Sensitivity C-Reactive Protein, and Cardiovascular Risk among Overweight and Obese Women: A Parallel Clinical Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Leila Azadbakht ◽  
Vajihe Izadi ◽  
Pamela J. Surkan ◽  
Ahmad Esmaillzadeh
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Weight Loss ◽  
Control Diet ◽  
High Sensitivity ◽  
High Protein ◽  
Obese Women ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Hs Crp

Studies regarding the effects of high protein (HP) diets on cardiovascular (CVD) risk factors have reported contradictory results. We aimed to determine the effects of an HP diet on CVD risk factors and high-sensitivity C-reactive protein (hs-CRP) among overweight and obese women. In this randomized controlled trial, we recruited 60 overweight and obese women, aged 20–65, into an HP or energy-restricted control diet for three months (protein, carbohydrate, and fat: 25%, 45%, and 30% versus 15%, 55%, and 30%, resp.). Total protein was divided between animal and plant sources in a 1 : 1 ratio, and animal sources were distributed equally between meats and dairy products. Fasting blood samples, hs-CRP, lipid profile, systolic and diastolic blood pressure, and anthropometric measurements were assessed using standard guidelines. Percent change was significantly different between the two diet groups for weight (standard protein (SP): −3.90 ± 0.26 versus HP: −6.10 ± 0.34%; , resp.) and waist circumference (SP: −3.03 ± 0.21 versus HP: −5.06 ± 0.28%; , resp.). Percent change of fasting blood glucose (FBG) substantially decreased in the control group compared to the HP group (−9.13 ± 0.67 versus −4.93 ± 1.4%;P= 0.01, resp.). Total cholesterol, systolic blood pressure (SBP), and diastolic blood pressure (DBP) decreased both in the HP and in the control diet groups (P= 0.06,P= 0.07, andP= 0.09, resp.); however, the results were marginally significant. Serum levels of hs-CRP were reduced both in the control (−0.08 ± 0.11%,P= 0.06) and in the high protein groups (−0.04 ± 0.09%,P= 0.06). The energy-restricted HP diet resulted in more beneficial effects on weight loss and reduction of waist circumference. CVD risk factors may improve with HP diets among overweight and obese women. When using isoenergetic weight loss diets, total cholesterol, hs-CRP, and SBP were marginally significantly reduced, independent of dietary protein content. This trial is registered with ClinicalTrials.govNCT01763528.

Abstract 12788: Adiponectin Modulates the Cardiovascular Risk Associated With Obesity: Results From the Framingham Offspring Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Pimjai Anthanont ◽  
Yanhua Zhou ◽  
Bela F Asztalos ◽  
Masumi Ai ◽  
Seiko Otokozawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Plasma Lipids ◽  
Density Lipoprotein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Men And Women ◽  
Hdl Subfractions ◽  
Obese Subjects ◽  
Hs Crp

Objectives: Our objective was to examine the interrelationships of cardiovascular disease (CVD) risk factors with obesity, lipoproteins and their subfractions, markers of glucose homeostasis, and the inflammation markers adiponectin, and C reactive protein (hs-CRP). Methods: We measured fasting plasma lipids, low-density lipoprotein (LDL)-C, small dense LDL-C (sdLDL-C), high-density lipoprotein (HDL)-C, HDL subfractions, triglycerides, glucose, insulin, adiponectin, and hs-CRP in 2,691 male and female participants (median age 58 years) in cycle 6 of the Framingham Offspring Study. We carried out univariate and multivariate statistical analyses. Results: In both men and women the presence of obesity compared to those of normal weight was significantly (P<0.05) associated with: 1) a 60% increase in the prevalence of CVD, 2) a two to three fold higher prevalence of major CVD risk factors (hypertension, diabetes, and low HDL-C < 40 mg/dL), 3) a doubling of plasma levels of hsCRP, insulin, and triglycerides, 4) increased sdLDL-C, and 5) significant decreases in adiponectin and the levels of apoA-I in very large protective α-1 HDL. Surprisingly there was no relationship of obesity with levels of LDL-C in men. By multivariate analysis, in both men and women, adiponectin level emerged as the statistically most important parameter determining the variability of HDL-C and apoA-I levels in very large α-1 HDL, and sdLDL-C, while for systolic blood pressure age was the most important determinant, and for hsCRP levels it was plasma insulin levels. Interestingly over half of obese subjects were not hypertensive or prediabetic, and less than 20% had premature CVD or diabetes. By tertile analysis in obese subjects, low adiponectin was associated with a doubling of the prevalence of diabetes, and significant increases in triglycerides, and sdLDL-C (men only), and significant decreases in HDL-C and apoA-I in large α-1 HDL. Conclusions: Our data indicate that the prevalence of CVD and its risk factors increases with body mass index, and that the level of circulating adiponectin is a significant determinant of cardiovascular risk, especially diabetes prevalence, and levels of LDL and HDL subfractions in obese subjects.

Effect of Obesity on Cardiovascular Disease Risk Factors in African American Women

2011 ◽  
Vol 14 (2) ◽  
pp. 171-179 ◽  
Author(s):  
Queen Henry-Okafor ◽  
Patricia A. Cowan ◽  
Mona N. Wicks ◽  
Muriel Rice ◽  
Donna S. Husch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
African American ◽  
African American Women ◽  
Normal Weight ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
American Women ◽  
History Of ◽  
Hs Crp

Obesity is a growing health care concern with implications for cardiovascular disease (CVD). Obesity and CVD morbidity and mortality are highly prevalent among African American women. This pilot study examined the association between obesity and the traditional and emerging CVD risk factors in a sample of African American women. Participants comprised 48 women (27 obese, 21 normal weight) aged 18–45. with no known history of CVD. The women completed demographic and 7-day physical activity recall questionnaires. Height and weight were used to determine body mass index (BMI). Hypertension risk was assessed using the average of two resting blood pressure (BP) measurements. Lipid profile, blood glucose, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (sICAM-1), and E-selectin (eSel) levels were assessed using fasting blood samples. Laboratory findings were interpreted using the American Diabetes Association (ADA) and Adult Treatment Panel (ATP) III reference guidelines as well as manufacturers’ reference ranges for the novel CVD risk factors. The most common traditional risk factors were physical inactivity (72.9%), positive family history of CVD (58.3%), and obesity (56.3%). Obese individuals had elevated systolic BP ( p = .0002), diastolic BP ( p = .0007) and HDL-cholesterol ( p = .01), triglyceride ( p = .02), hs-CRP ( p = .002), and fibrinogen ( p = .01), when compared with normal-weight women. The findings suggest an association between obesity and higher prevalence of both traditional and emerging CVD risk factors in young African American women.

scholarly journals Cancer Survivorship and Subclinical Myocardial Damage

2019 ◽  
Vol 188 (12) ◽  
pp. 2188-2195 ◽  
Author(s):  
Roberta Florido ◽  
Alexandra K Lee ◽  
John W McEvoy ◽  
Ron C Hoogeveen ◽  
Silvia Koton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Troponin T ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
Cancer Therapies ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Cross Sectional

Abstract Cancer survivors might have an excess risk of cardiovascular disease (CVD) resulting from toxicities of cancer therapies and a high burden of CVD risk factors. We sought to evaluate the association of cancer survivorship with subclinical myocardial damage, as assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT) test results. We included 3,512 participants of the Atherosclerosis Risk in Communities Study who attended visit 5 (2011–2013) and were free of CVD (coronary heart disease, heart failure, or stroke). We used multivariate logistic regression to evaluate the cross-sectional associations of survivorship from any, non-sex-related, and sex-related cancers (e.g., breast, prostate) with elevated hs-cTnT (≥14 ng/L). Of 3,512 participants (mean age, 76 years; 62% women; 21% black), 19% were cancer survivors. Cancer survivors had significantly higher odds of elevated hs-cTnT (OR = 1.26, 95% CI: 1.03, 1.53). Results were similar for survivors of non-sex-related and colorectal cancers, but there was no association between survivorship from breast and prostate cancers and elevated hs-cTnT. Results were similar after additional adjustments for CVD risk factors. Survivors of some cancers might be more likely to have elevated hs-cTnT than persons without prior cancer. The excess burden of subclinical myocardial damage in this population might not be fully explained by traditional CVD risk factors.

scholarly journals Association of Repeatedly Measured High-Sensitivity–Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study

2017 ◽  
Vol 63 (1) ◽  
pp. 334-342 ◽  
Author(s):  
Maria F Hughes ◽  
Francisco Ojeda ◽  
Olli Saarela ◽  
Torben Jørgensen ◽  
Tanja Zeller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
General Population ◽  
Repeated Measures ◽  
Troponin I ◽  
Cox Model ◽  
High Sensitivity ◽  
Joint Model ◽  
Cvd Risk Factors ◽  
Cvd Risk

Abstract BACKGROUND High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined. METHODS We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30–60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics. RESULTS Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15–1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744). CONCLUSIONS The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.

scholarly journals High Sensitivity C-Reactive Protein as Atherogenic Marker Among Type 2 Diabetes

2017 ◽  
Vol 13 (33) ◽  
pp. 403
Author(s):  
Abdelmarouf H. Mohieldein ◽  
Marghoob Hasan ◽  
Mahmoud I. El-Habiby
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Diabetic Patients ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Vascular Events ◽  
Apo B ◽  
Hs Crp

Background: People with type 2 diabetes are threefold affected by cardiovascular disease (CVD) compared with non-diabetics. Many studies reported the absence of traditional CVD risk factors in a substantial portion of individuals experiencing clinical vascular events. Novel risk markers for CVD are often said to add independent predictive value for risk prediction. Objective: In the present study we evaluated different CVD risk factors based on highsensitivity C-reactive (hs- CRP) protein quartiles among diabetics and nondiabetics population. Methods: In this population- based cross- sectional study, we recruited a total of onehundred and nine participants (64 type 2 diabetics and 45 healthy controls). Venous blood sample collected from each subject. Body weight and height were measured and body mass index (BMI) was calculated. Biochemical analytes were measured according to standard procedures. Data analyzed using SPSS software. Results: Mean serum hs-CRP levels were significantly higher among diabetics (2.3 mg/l) compared to controls (1.8 mg/l; P = 0.019). Moreover, the 3rd & 4th quartiles of hs-CRP were characterized by more frequency of diabetes as well as hypertension. The percent of participants with diabetes or hypertension seemed positively related to hs CRP concentrations. Lipid profile analysis revealed the highest levels of LDL-C and Apo B in 4th quartile hs-CRP. In addition, participants in the 4th quartile hs-CRP were characterized by the highest age, BMI, plasma glucose. However, there was European Scientific Journal November 2017 edition Vol.13, No.33 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 404 no clear association between levels of hs-CRP and the HbA1c, TC, TG, HDL-C, and Apo A1. Conclusion: Measurement of hs-CRP in diabetic patients might provide useful information for development of atherosclerosis and cardiovascular disease and help in early intervention.

scholarly journals Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.Q Wu ◽  
X Li ◽  
J.P Lu ◽  
B.W Chen ◽  
Y.C Li ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Blood Pressure ◽  
Population Based ◽  
Staple Food ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Food Factor ◽  
Rural And Urban ◽  
Activity Factor

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p&lt;0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p&lt;0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

scholarly journals FRI0420 ASSOCIATION BETWEEN RED BLOOD CELLS DISTRIBUTION WIDTH AND CARDIOVASCULAR RISK IN OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 808.2-808
Author(s):  
N. Hammam ◽  
G. Salem ◽  
D. Fouad ◽  
S. Rashad
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Functional Limitations ◽  
Functional Limitation ◽  
C Reactive Protein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Distribution Width ◽  
Reactive Protein ◽  
Lipid Panel

Background:Osteoarthritis (OA) is the most common joint disease that results in patient’s morbidity and disabilities. There is strong evidence that OA is a significant risk factor for cardiovascular disease (CVD). Red cell distribution width (RDW) blood test is a measure of the variation in red blood cell volume and size. Elevated RDW has recently been found to correlate with CVD risk in patients with and without heart disease and autoimmune diseases. RDW may be a marker for factors driving CVS risk.Objectives:: To investigate whether RDW can serve as a potential parameter for indicating cardiovascular risk in OA patients.Methods:A subsample of 819 OA patients was extracted from 2003-2006 National Health & Nutrition Examination Survey in a cross-sectional study. 63.7% of them were females. Their mean age was 66.4 ± 14.1 yrs. Demographic, medical data, inflammatory markers & lipid panel were obtained. Only patients with Haemoglobin>12 mg/dl were included. Functional limitations were assessed using a physical function questionnaire.Results:Elevated levels of RDW were associated with CVD risk factors in OA patients. 532 (65.8%) OA patients had functional limitations, while 78 (9.5%) and 63 (7.6%) known to have heart attacks or stroke ever. Mean RDW was 12.9±1.1fL. There was a positive significant correlation between RDW & CVD risk factors including body mass index (r=0.17, p<0.001), C-reactive protein (r=0.29, p<0.001), serum uric acid (r=0.12, p<0.001), and functional limitation (0.16, p<0.001). No significant association between RDW & lipid panel was found. In multiple regression analysis controlling for age, sex as covariates, body mass index (β =0.02, 95%CI: 0.01, 0.03, p=0.002), C-reactive protein (β =0.35, 95%CI: 0.26, 0.45, p<0.001), and functional limitation (β =0.18, 95%CI: 0.13, 0.35, p=0.03).Conclusion:In addition to known CVD risk in OA patients, elevated RDW levels should prompt physicians to aggressively screen and treat their patients for modifiable CVS risk factors, in addition to OA.Disclosure of Interests:None declared

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