bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional differences in outpatient care of peripheral artery diseases in Germany
Authors: Petrikhovich O , Messiha D , Lortz J , Mahabadi A A , Hering R , Schulz M , Rassaf T , Rammos C
Published: October 2021

Background

Peripheral arterial disease (PAD) is one of the most common diseases worldwide and affected patients have an increased risk for cardiovascular events. The main goals of PAD treatment include modification of risk factors and prevention of cardiovascular events by means of guideline-recommended and specialized ambulatory care. Knowledge on treatment regimens and outpatient care structures in different German states is essential to improve the overall quality of medical care as well as patient outcome.

Aim

The aim of this study was to analyze the care of PAD patients with emphasis on pharmacotherapy and outpatient treatment patterns with special focus on regional differences in Germany.

Methods

This study included data of 17.633.970 patients collected in Germany between 2009 and 2018. This data was provided by analyzing all statutory health insured patients with PAD in Germany. Ambulatory care structure included treatments by vascular surgeons, angiologists, cardiologist, internal medicine physician and primary care physicians. Furthermore, prescription of guideline-recommended pharmacotherapy (statins and antiplatelets) was analyzed for the period of 2012–2016. For our analysis we used chi-squared test and two-way Anova.

Results

Nationwide, prescription frequency of statins increased from 40% in 2009 to 50% (p<0,0001) in 2016. Similar results were seen in the prescription frequency of antiplatelet agents, which increased from 26% in 2009 to 30% (p<0,0001) in 2016. In fact, prescription frequency of both statins and antiplatelet drugs remained insufficient in every federal state (p>0,05), despite wide access to general practitioners. Nevertheless, there is a significant difference between rural and urban regions (Bavaria 46% vs. North Rhine-Westphalia 44%, p<0,05). However, in every federal state, treatment by the vascular specialist is low. In 2018 only 10% of patients were treated by vascular surgeons and 9% by angiologists.

Conclusion

Our study shows that, for PAD patients, outpatient care as well as prescription frequency of guideline-based therapy is insufficient in every federal German state. According to our data, there is a need to establish regional structures for PAD patients that can improve current care and ultimately reduce mortality in this high-risk population.

Funding Acknowledgement

Type of funding sources: None.
Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome
Authors: Ikonomidis I , Pavlidis G , Mavroeidi I , Katogiannis K , Varoudi M , Thymis J , Kostelli G , Vlastos D , Plotas P , Bamias A , Parissis J , Peppa M
Published: October 2021

Background/Introduction

Turner syndrome (TS) is associated with increased cardiovascular risk.

Purpose

We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS.

Methods

Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilatation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes-namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep)-and left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography. Ten healthy female of similar age and BMI served as control group.

Results

Compared to controls, women with TS on HRT had higher PWV (9.1±2.4 vs. 7.5±0.5m/s), cSBP (130±15 vs. 121±6mmHg), cIMT (0.66±0.06 vs. 0.55±0.05mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2±4 vs. 10.5±2.3%), Ao strain, Ao distensibility and GLS (−18.8±2.7 vs. −21.9±1.5%) (P<0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7±6 vs. 7.2±4%) and reduced PWV (7.8±1.7 vs. 9.1±2.4m/s) and cSBP (123±14 vs. 130±15mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P>0.05 for all comparisons). The percent decrease of cSBP was associated with the percent decrease of PWV (r=0.54) and reversely related with the percent increase of FMD (r=−0.57) (P<0.05 for all comparisons).

Conclusion

HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

Funding Acknowledgement

Type of funding sources: None.
Implications of ESC-high tthrombotic risk features and ARC-high bleeding risk criteria on clinical outcomes in all-comer patients undergoing PCI
Authors: Wang H Y , Dou K F , Mo R A N , Guan C D , Yin D , Xu B
Published: October 2021

Background

High thrombotic risk (HTR) and high bleeding risk (HBR) features after PCI can occur in the same patient. The individualized risks of ischemic vs. bleeding events are needed to be considered for determining the optimal duration of DAPT. We aimed to evaluate long-term ischemic and bleeding outcomes in patients who are at both HTR and HBR after DES implantation.

Methods

All consecutive patients who underwent PCI with DES were prospectively enrolled in Fuwai PCI Registry. HTR criteria based on 2017 ESC DAPT guidelines were defined as: diffuse multivessel diabetic CAD patients, chronic kidney disease, ≥3 stents implanted, ≥3 stents lesions treated, bifurcation with two stents implanted, total stent length >60 mm, or chronic total occlusion. Patients were defined as HBR if they met at least 1 major or 2 minor Academic Research Consortium (ARC)-HBR criteria. The primary ischemic outcome was major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis.

Results

Among 10,167 patients, 4,430 (43.6%) qualified as HTR. The rate of HBR patients was significantly higher in the HTR group than in the non-HTR group (18.9% versus 12.2%, P<0.001). Compared to those having non-HTR., Patients with ESC-HTR had higher 30-month rates of MACE (hazard ratio [HR] adjust: 1.56, 95% confidence interval [CI]: 1.34–1.82; P<0.001), device-oriented composite endpoint (composite of cardiac death, target-vessel MI, and target lesion revascularization) (HRadjust: 1.52 [1.27–1.83]; P<0.001), cardiac mortality, myocardial infarction, stent thrombosis, any revascularization, and stroke, without increasing the risk of BARC type 2, 3, or 5 bleeding. MACE rates at 30 months among those without HTR or HBR, HBR alone, HTR alone, and both HTR and HBR were 5.1%, 6.0%, 8.3%, and 8.8%, respectively (P<0.001). Associations between HTR and adverse events were similar in HBR and no HBR groups, without evidence of interaction; however, adverse event rates were highest among subjects with both HBR and HTR.

Conclusions

A combination of ESC-HTR and ARC-HBR may increase the risk of long-term ischemic events, including cardiac mortality, emphasizing the importance of considering the net clinical benefit including high ischemic and bleeding features. Our data suggest that ESC-HTR criteria was useful for stratifying post-PCI patients into risk strata for future ischemic events.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant No. 2020-1-4032) Kaplan-Meier event rates
Impact of left ventricular ejection fraction on clinical outcomes in females undergoing percutaneous coronary intervention with drug-eluting stents
Authors: Nicolas J , Cao D , Giustino G , Sartori S , Snyder C , Tavenier A , Chiarito M , Nardin M , Pivato C , Razuk V , Baber U , Windecker S , Stone G , Dangas G , Mehran R ,   WIN-DES Investigators
Published: October 2021

Background

Reduced left ventricular ejection fraction (LVEF) is associated with increased risk of adverse events among patients undergoing percutaneous coronary intervention (PCI). Due to under-enrollment of females in randomized trials, there is limited data on the impact of LVEF on post-PCI outcomes in female patients.

Purpose

To evaluate the impact of varying degrees of LVEF impairment on 3-year outcomes in female patients undergoing PCI with drug-eluting stents (DES).

Methods

We pooled patient-level data of female patients from 26 randomized trials of coronary stents. The study population was stratified into three groups according to the 2016 European Society of Cardiology Heart Failure guidelines: LVEF ≥50% (normal), LVEF 40–49% (mid-range), and LVEF <40% (reduced). The primary outcome was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), or stent thrombosis (ST) at 3-year follow-up. The Kaplan-Meier method was used for time-to-event analyses, with comparative risks being assessed using Cox regression.

Results

Out of 5672 female patients with available LVEF values at baseline, 4427 (78.1%) had normal LVEF, 602 (10.6%) had mid-range LVEF, and 643 (11.3%) had reduced LVEF. Patients with reduced LVEF were older and had a higher prevalence of smoking, prior MI, and multi-vessel disease. There was a stepwise increase in 3-year event rates moving from normal, to mid-range and reduced LVEF (Figure 1). After multivariable adjustment, hazard ratio (HR) for MACE was 1.45 (95% CI: 1.10–1.92) in patients with mid-range LVEF and 2.43 (95% CI: 1.84–3.22) in patients with reduced LVEF (trend p-value <0.0001). The risk of ST was more than doubled in both mid-range LVEF (HR 2.30, 95% CI: 1.30–4.06, p=0.004) and reduced LVEF patients (HR 2.18, 95% CI: 1.11–4.28, p=0.02), as compared with normal LVEF.

Conclusion

The presence of an even mild degree of LVEF impairment confers an increased risk of ischemic events, including ST, among females undergoing PCI with DES.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Comparison of valve durability among different transcatheter and surgical aortic valve prostheses: a network meta-analysis
Authors: Ueyama H , Kuno T , Takagi H , Kobayashi A , Misumida N , Baeza C , Kini A , Lerakis S , Latib A , Sondergaard L A R S , Attizzani G
Published: October 2021

Background

Durability of different transcatheter heart valve (THV) is critical as the indication of transcatheter aortic valve replacement (TAVR) expands to patients with longer life-expectancy.

Purpose

We aimed to compare the durability of THV systems (balloon-expandable [BE] and self-expandable [SE]) and surgical aortic valve replacement (SAVR) prosthesis.

Methods

PUBMED and EMBASE were searched through February 2021 for randomized trials investigating parameters of valve durability after TAVR and/or SAVR in severe aortic stenosis. A network meta-analysis using random-effect model was performed. Synthesis was performed with 5-year follow-up data for echocardiographic outcomes and longest available follow-up data for clinical outcomes.

Results

Ten trials with a total of 9,388 patients (BE-THV: 2,562; SE-THV 2,863; SAVR:3,963) were included. Follow-up ranged from 1–6 years. SE-THV demonstrated significantly larger effective orifice area, lower mean aortic valve gradient (AVG), and less increase in mean AVG at 5-years compared to BE-THV and SAVR (Figure 1). Structural valve deterioration (SVD) was less frequent in SE-THV compared to BE-THV and SAVR (HR 0.14, 95% CI 0.07–0.27; HR 0.34, 95% CI 0.24–0.47, respectively) (Figure 1). Total moderate-severe aortic regurgitation and re-intervention was more frequent in BE-THV (HR 4.21, 95% CI 2.40–7.39; HR 2.22, 95% CI 1.16–4.26, respectively) and SE-THV (HR 7.51, 95% CI 3.89–14.5; HR 2.86, 95% CI 1.59–5.13, respectively) compared to SAVR.

Conclusion

TAVR with SE-THV demonstrated favorable forward-flow hemodynamics and lowest risk of SVD compared to BE-THV and SAVR at mid-term. However, both THV systems suffer an increased risk of aortic regurgitation and re-intervention, and long-term data from newer generation valve is warranted.

Funding Acknowledgement

Type of funding sources: None.
Atrial fibrillation screening on holter monitoring after percutaneous patent foramen ovale closure: a prospective study
Authors: Leclercq F , Odorico X , Arquizan C , Macia J C , Lattuca B , Schmutz L , Roubille F , Pages L , Marin G , Cayla G , Akodad M
Published: October 2021

Background

An increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials. However, systematic screening of AF was not performed in these studies.

Purpose

We aimed to evaluate incidence of AF in patients undergoing percutaneous PFO closure with serial 24-hours ambulatory electrocardiogram (AECG) monitoring during a 6-months follow-up.

Methods

All consecutive patients undergoing PFO closure for cryptogenic stroke or decompression sickness (DSC) were prospectively included in 2 centers. AF was defined as an irregular rhythm without discernible P waves lasting at least 30 seconds on 24-hours AECG performed at day 0, 1 month and 6-months follow-up. Primary endpoint was incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes (hospitalization for cardiovascular causes, new stroke or bleeding) within 6-months follow-up.

Results

Between February 2018 and March 2019, a total of 62 patients underwent PFO closure: 59 (95.2%) for cryptogenic stroke and 3 (4.8%) for DSC. In the overall population, 40 were male (64.5%) and the mean age was 48±9.5 years. An atrial septal aneurysm was present in 37 patients (64.9%). The PFO device mean size was 26±5.0 mm. After a mean follow-up of 33.3±12.2 weeks, new-onset AF occurred in 3 patients (4.8%), all within 1-month after closure and paroxysmal. While symptomatic ectopic atrial heart beats occurred in one fourth of patients, all AF episodes asymptomatic. Two patients (3.2%) required oral anticoagulant therapy according to CHA2DS2-VASc score. No adverse outcomes occurred. Age (RR 1.26 [0.98; 1.61] p=0.3), male sex (p=0.6) and device (p=1.0) were not associated with occurrence of AF but all patients with AF were men and received an Amplatzer device.

Conclusion

Incidence of AF, evaluated with serial systematic 24-hours AECG during a 6-months follow-up after PFO closure, was relatively low (<5%). Always paroxysmal, AF always occurred within one month after the procedure and was not associated with adverse outcomes.

Funding Acknowledgement

Type of funding sources: None.
Current applications and outcomes of venoarterial extracorporeal membrane oxygenation based on six years of experience. Risk factors for in-hospital mortality
Authors: Celinska-Spodar M , Kusmierczyk M , Zielinski T , Jasinska M , Kolsut P , Litwinski P , Sitkowska-Rysiak E , Sobieszczanska-Malek M , Szymanski J , Zaleska-Kociecka M , Stepinska J
Published: October 2021

Introduction

The data about use of venoarterial ECMO as a temporary circulatory support system in cardiogenic shock (CS) for Central Europe are scarce.

Objectives

The aim was to disclose the indications, in-hospital and long-term (1 year) mortality along with risk factors.

Patients and methods

The study is a retrospective investigation of patients who underwent VA ECMO support for the CS in the cardiac and cardiosurgical tertiary centre, from January 2013 to June 2018. We tested a broad spectrum of pre– and post-implantation factors along with their impact on mortality using univariate logistic regression analysis.

Results

198 patients met the inclusion criteria. The median duration of support was 207 (IQR 91–339) hours, with no significant disparity in the length of support among hospital survivors and nonsurvivors (p=0.09). 40,4% of all patients deceased during ECMO support, while the joined in-hospital and six-month mortality progressed to 65,2% and one-year mortality to 67,2%. 9% underwent subsequent heart transplantation. The most frequent adverse events were bleeding (76%), infection (56%), neurologic injury (15%) and limb ischemia (15%). Multi-organ failure was identified as the most decisive risk factor of in-hospital mortality (OR 4,45, p<0,001). Patients with postcardiotomy cardiogenic shock had a significantly lower out-of-hospital survival rate than those with decompensated heart failure (32,3% vs 45%, log-rank p=0,037). The learning curve of our centre is noted with the lowest survival in the first two years of ECMO employment in comparison to the following 6-year period.

Conclusion

The outcomes of the study reinforce the clear survival benefit, despite frequent complications.

The protocol focusing on proper candidate selection and timing can positively impact patients survival. The additional risk reduction can be achieved with the further increase of the team experience with ECMO.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology in Warsaw, Poland - research grant. Figure 1Figure 2
Prevalence of target organ damage in subjects with high-normal blood pressure without known cardiovascular and kidney disease
Authors: Ruzzenenti G , Maloberti A , Rebora P , Occhino G , Alloni M , Musca F , Belli O , Spano' F , Santambrogio G M , Casadei F , Moreo A , Valsecchi M G , Giannattasio C
Published: October 2021

Background

Heterogeneous results have been obtained regarding the presence of Target Organe Damage (TOD) in subjects with high-normal Blood Pressure (BP) value (sistoly 130–139, diastolic 85–89 mmHg).

Purpose

Aim of our study was to assess the prevalence of TOD in healthy subjects with high-normal BP comparing them with subjects with BP values that are considered normal (<130/85 mmHg) or indicative of hypertension (≥140/90 mmHg).

Methods

755 otherwise healthy subjects participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT) and plaque.

Results

When subjects were classified according to BP levels we found that high-normal BP group showed intermediate values of PWV and LMVI with higher value of IMT. This corresponds to intermediate prevalence of arterial stiffness (PWV>10 m/s: 3.4% vs 2.3% for normal and 9.6% for high BP groups, p=0.0014), Left Ventricular Hypertrophy – LVH (32.4% vs 25.7% for normal and 46.6% for high BP groups, p=0.0001) while there were no differences for IMT>0.9 or carotid plaque. At multivariable analysis the odds of having a PWV>10 m/s (OR=1.75, 95% C.I. 0.59–5.16), an IMT>0.9 mm (OR=1.81, 95% C.I. 0.60–5.00) or a LVH (OR=1.1, 95% C.I. 0.72–1.67) in the high-normal group resulted not different to the normal group.

Conclusions

In our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac TOD.

Funding Acknowledgement

Type of funding sources: None.
Magnetic resonance imaging of the aortic wall as a risk index for acute ischemic stroke in patients with resistant arterial hypertension
Authors: Ryumshina N , Sukhareva A E , Mochula O V , Shelkovnikova T A , Maksimova A S , Ussov W Y U , Falkovskaya A Y U
Published: October 2021

Aim

To value the possible relationship between the intensity of neoangiogenesis in the aortic wall in patients with resistant arterial hypertension and the subsequent development of ischemic cerebral disorders in them over a three-year follow-up.

Materials and methods

This study comprised 36 patients with resistant hypertension, in whom the renal denervation was carried out. MRI of the brain and also with contrast enhancement of the aorta and kidneys were examined. MRI studies included T2 and T1 spin-echo MRI, and also coronal slices, with suppression of the signal from adipose tissue (TR=150 ms, TE = 4 ms), before and in 12–15 minutes after contrast-enhanced. The diameter and thickness of the wall of the descending aorta were measured. Index of the enhancement of the aortic wall was calculated as the ratio of intensities of the wall after, and before contrast-enhanced. 9 according to MRI data - developed an acute ischemic stroke during this period, and 27 had no cerebral circulation disorders. The control group consisted of individuals without hypertension (n=12).

Results

After renal denervation, the systolic blood pressure significantly decreased in all patients for more than 15 mm Hg. In groups of patients with ischemic stroke, and without it, the diameter of the aortic lumen at the level above the renal arteries was 22,1±2,4 mm and 22,8±2,7 mm, respectively; the aortic wall thickness was 3,9±0,7 mm and 3,7±0,8 mm. In control subjects without hypertension, the wall thickness was less than 2,7 mm (on average 2,2±0,4 mm), with an aortic diameter of 21,3±0,9. As to the index of enhancement (as a marker of neoangiogenesis intensity) in the control group, in everybody, the IE was <1,12. In patients with stroke within 3 years after renal denervation, IE = 2,12±0,31, and in patients without stroke IE = 1,66±0,19. The value of IE = 1,82 was the best for separating groups with and without stroke in the three years endpoint, as from the ROC analysis.

Conclusion

Contrast enhancement of the aortic wall in MRI is associated with the risk of brain ischemic stroke in patients with resistant arterial hypertension, even when blood pressure control is achieved by renal denervation. This makes it possible to predict the risk of stroke in these patients more reliably and encourages the inclusion of agents that reduce the activity of inflammation and pathological neoangiogenesis in the aortic wall, to the spectrum of antihypertensive therapy.

Funding Acknowledgement

Type of funding sources: None. Brain MRI T2WIMRI of the kidneys and aorta, T1WI
Evaluation of the effectiveness of statin and spironolactone by the influence on indicators of vascular stiffness in patients with arterial hypertension
Authors: Fedorishina O , Protasov K , Torunova A
Published: October 2021

Introduction

The possibility of slowing down vascular remodeling in hypertensive patients with the combined effect of antihypertensive drugs and statins has been studied in unitary studies. The effect of spironolactone on vascular stiffness in relation to the severity of the hypotensive effect in combination therapy has also been insufficiently studied.

The aim of the research was to study the dynamics vascular stiffness parameters in hypertension patients of high/very high cardiovascular risk in addition rosuvastatin or spironolactone to combined two-component amlodipine and lisinopril therapy.

Methods

90 patients (46 men and 44 women aged 51.6±8.5) with hypertension were randomized into groups: the first group received a fixed combination of amlodipine/lisinopril, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin, the third - in addition to the combination of amlodipine / lisinopril received 25 mg of spironolactone. The office and ambulatory blood pressure (BP), central (aortic) BP, augmentation index (AIx), carotid-femoral and carotid-radial pulse wave velocity (PWV) were evaluated before and after a 24-week follow-up period.

Results

The office and average daily blood pressure decreased against the background of all therapy regimens (all p<0.0001). The degree of decrease in the above parameters was more pronounced under the influence of spironolactone, compared with taking a combination of amlodipine / lisinopril (office systolic BP (SBP) p=0.04 and diastolic BP (DBP) p=0.002, average daily SBP p=0.02 and DBP p=0.014) and office DBP in comparison with the group of additional administration of rosuvastatin (p=0.02). A decrease in central BP and AIx was noted in all groups. A more pronounced decrease in AIx occurred in the statin supplementation group relative to the standard treatment group (−5.8% and −9.0%, respectively, p=0.036). Carotid-femoral PWV significantly decreased in all groups (−0.9±1.5 m/s, −0.7±1.4 m/s, −2.2±2.6 m/s, respectively), in greater degree in the spironolactone addition group compared with the statin supplementation group (p=0.036). Carotid-radial PWV to the same extent significantly decreased only in the second (from 9.5±1.8 to 8.8±1.1 m/s (p=0.034)) and the third (from 9.8±1.3 to 8.4±1.3 m/s (p=0.0002)) groups.

Conclusions

The addition of a statin to a two-component combination of amlodipine / lisinopril in the treatment of hypertensive patients had an additional effect on the elastic properties of the aorta, in the form of a decrease in the augmentation index, and peripheral arteries, in the form of a decrease in PWV. The addition of spironolactone to standard therapy was accompanied by a significant increase in the antihypertensive effect and a decrease in aortic stiffness in the form of a more pronounced decrease in PWV in the carotid-femoral and carotid-radial areas.

Funding Acknowledgement

Type of funding sources: None.
Reasons for antihypertensive medication nonadherence influence physician preferences for hypertension management
Authors: Schmieder R E , Kandzari D E , Wang T.-D , Lee Y.-H , Haro C , Pathak A
Published: October 2021

Background/Introduction

Patient nonadherence to prescribed antihypertensive medications is a major contributor to low global hypertension control rates. Attitudes toward renal denervation vary between physicians and patients, with recent data showing that side effects from medications is a key factor influencing both patient nonadherence to prescribed medications and preferences for interventional treatment. The influence of patient nonadherence on physician recommendations for renal denervation is not well understood.

Purpose

To examine whether specific reasons for patient nonadherence influence physician preferences for renal denervation as a treatment option for hypertension.

Methods

Online surveys were fielded to general and interventional cardiologists in Europe and the United States. Physicians were asked to position their willingness to recommend renal denervation in the hypertension management pathway based on three factors of nonadherence: patients' preference not to take antihypertensive medications, medication side effects, and nonspecific nonadherence to medication. The surveys followed the highest industry standards ISO 20252. Results were compared using two-tailed Z tests.

Results

Over two-thirds of 501 physicians surveyed stated that they would recommend renal denervation for uncontrolled hypertension irrespective of the reason for nonadherence. This recommendation was significantly more common in the scenario of patient reported medication side effects as compared with desire not to take medications or other nonspecific reasons for nonadherence (p<0.001 for both; Figure)

Conclusions

Surveyed physicians were more likely to recommend renal denervation to patients reporting side effects with their antihypertensive medications than for other reasons of nonadherence. These findings underscore the influence of patient-specific reasons for medication nonadherence on provider recommendations as part of a shared decision-making process when evaluating different options for hypertension management.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Hypertension as a prognostic factor in the prediction of mortality in patients with COVID-19: a systematic review and meta-analysis
Authors: Pagdanganan C D P , Juangco J ,   UERMMMCI College of Medicine
Published: October 2021

Background

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) brought the majority of the world into a halt when it started to spread outside the virus epicenter in Wuhan, China. With the alarming increase in the number of cases and deaths worldwide, the possible risk factors should be determined in order to have a general idea on those who are more susceptible to have this disease. Hypertension, being one of the world's leading causes of noncommunicable diseases, was identified by the CDC to be one of underlying medical conditions that might pose an increased risk for severe illness from COVID-19.

Objective

The aim of this study is to determine the predictive value of hypertension as a comorbidity in COVID-19 mortality.

Materials and methods

Participants included all patients clinically diagnosed with COVID-19, and have hypertension as their pre-existing medical condition. Studies were selected based on study design, participants, exposure, outcome, timing, setting and language. The following databases were searched from June to August 2020 for case control and cohort studies on MEDLINE and CINAHL, ScienceDirect, Clinical Key, OVID database, Wiley Online library, and UpToDate. The criteria for evaluation of risk of bias were based on the selection bias, comparability bias and outcome bias. All information gathered were collated and evaluated using the Newcastle-Ottawa Quality Assessment Scale and CEBM.

Results

Individual studies all showed a significant relationship between hypertension and mortality in COVID-19 patients. Odds ratio ranging from 1.75 to 28.88, and hazard ratio ranging from 1.49 to 3.32 are present in the studies. For the data analysis, Mantel Haenszel method and random effects model was used for case control studies with odds ratio as effect measure; while Inverse variance method and fixed model was used for cohort studies with hazard ratio as effect measure. Both groups showed significant positive association between mortality and hypertension as a prognostic factor. Overall odds ratio is 5.25 (2.42–11.40) with a p value of <0.ehab724.23931, and the pooled hazard ratio is 2.21 (1.75–2.80) with a p value of <0.ehab724.23931. This shows that there is an increased risk of mortality among COVID-19 patients with hypertension as a comorbid condition.

Conclusions

Hypertension as a comorbid condition is a prognostic factor in the prediction of mortality in hospitalized COVID-19 patients. The ten included studies showed that there is a significant positive association suggesting an increased risk of mortality in COVID-19 patients with hypertension.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): University of the East Ramon Magsaysay Memorial Medical Center College of Medicine Forest Plot HR Hypertension COVID
Arterial stiffness measured according to the cardio-ankle vascular index in the persons with pre-diabetes and diabetes mellitus in the population sample of the Russian Federation
Authors: Bezdenezhnykh N A , Sumin A N , Bezdenezhnykh A V , Pervushkina A S , Fokin F A , Artamonova G V ,   "Research Institute for Complex Issues of Cardiovascular Diseases"
Published: October 2021

Aims

To study the characteristics of the cardio-ankle vascular index (CAVI) and predictors of increased arterial stiffness in patients with carbohydrate metabolism disorders (CMD).

Methods

A cross-sectional study was conducted within the framework of the multicenter epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation” (ESSE-RF) from March to October 2013. The object was a random population sample of the adult male and female population of the Kemerovo region (Western Siberia, Russia) aged of 25–64 years. The standard protocol of the ESSE-RF has been expanded with investigation of peripheral arteries wall stiffness (VaSeraVS-1000, Fukuda Denshi, Japan) with automatic CAVI calculation. A total of 1617 subjects were divided into three groups: group 1 – patients with type 2 diabetes mellitus (n=272), group 2 – patients with pre-diabetes (n=44), group 3 –without any confirmed CMD (n=1301).

Results

A trend for the similarity of clinical, instrumental (including arterial stiffness measured by CAVI) and laboratory characteristics in patients with type 2 diabetes and prediabetes was revealed, with a significant difference from patients without CMD. A direct correlations of CAVI with age (p<0.001), male gender (p<0.001), type 2 diabetes (p<0.001), prediabetes (p=0.002), visceral obesity (p<0.001), level of total cholesterol (p<0.001), triglycerides (p<0.001), low density lipoprotein cholesterol (p<0.001), and inverse correlations of CAVI with the glomerular filtration rate (GFR) using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula (p<0.001) were revealed in the general sample.

Further, the patients were divided into 2 groups - with disorders of carbohydrate metabolism (prediabetes and diabetes) and normoglycemia, and in each group, predictors of increased arterial stiffness (pathological CAVI) were analyzed. According to the results of multivariate regression analysis in both groups, age, arterial hypertension, systolic and diastolic blood pressure, and a decrease in GFR CKD-EPI were predictors of pathological CAVI (Table). Male gender became a predictor of increased arterial stiffness only among patients with normoglycemia, and there was no effect among patients with CMD (Table).

Conclusions

An increase in CAVI is associated with diabetes mellitus 2, prediabetes, increasing age, systolic and diastolic blood pressure and decreased GFR. An increase in arterial stiffness occurs already in the prediabetes stage. Identifying of prediabetes is important because prediabetes and type 2 diabetes are similar in many ways.

Funding Acknowledgement

Type of funding sources: None. Correlations of CAVIPredictors of pathological CAVI
Risk factors, subsequent disease onset and prognostic impact of myocardial infarction and atrial fibrillation
Authors: Camen S , Csengeri D , Geelhoed B , Gianfagna F , Soderberg S , Kee F , Blankenberg S , Lochen M L , Iacoviello L , Tunstall-Pedoe H , Joergensen T , Salomaa V , Linneberg A , Kuulasmaa K , Schnabel R B ,   BiomarCaRE-consortium
Published: October 2021

Background

Myocardial infarction (MI) is a known risk factor for incident atrial fibrillation (AF), while AF frequently complicates acute MI. Although both diseases share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence and mortality are not completely understood.

Purpose

Our goal was to define the temporal relationship of MI and AF and the association of cardiovascular risk factors with disease incidence in order to determine whether common clinical risk factors show different associations with incident MI or AF. We further aimed to investigate predictors of subsequent disease onset and the impact of subsequent disease diagnosis on mortality.

Methods

In pooled multivariable Cox regression analyses we examined temporal relations of disease onset and identified predictors of MI, AF and subsequent all-cause mortality in 108,363 individuals (median age 46.0 years, 48.2% men) free of MI and AF at baseline from six European population-based cohorts.

Results

Over a maximum follow-up of 10.0 years 3558 (3.3%) individuals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) individuals developed both MI and AF. Association of male sex, systolic blood pressure, antihypertensive treatment and diabetes mellitus appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. The combined population attributable fraction of the cardiovascular risk factors was over 70% for incident MI, whereas it was only about one quarter for incident AF. Subsequent MI after incident AF (hazard ratio1.68, 95% CI 1.03–2.74) and subsequent AF after MI (hazard ratio 1.75, 95% CI 1.31–2.34) both significantly increased overall mortality risk.

Conclusions

Subsequent diagnosis of MI and AF was associated with a significant increase in mortality, irrespective of the first event. We found different associations of common cardiovascular risk factors with incident MI and AF indicating distinct pathophysiological pathways in disease development.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme (grant agreement No 847770, AFFECT-EU) European Union's Horizon 2020 research and innovation programme (grant agreement No 648131)
Ultra-processed foods and ten-year cardiovascular disease incidence in a Mediterranean population: results from a population-based cohort study
Authors: Kouvari M , Chrysohoou C , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos D B
Published: October 2021

Background/Introduction

Although cardiovascular disease (CVD) guidelines emphasize consuming minimally processed foods, such as fruits, vegetables, whole grain products, nuts and seeds, less attention has been given to the importance of minimizing ultra-processed foods, probably due to the paucity of studies that exist.

Purpose

The aim of the present work was to investigate the association between the consumption of ultra-processed foods and ten-year first fatal/non fatal CVD event in a sample from Greece.

Methods

A prospective study was conducted during 2001–2012 studying n=1,514 men and n=1,528 women (>18 years old) free of CVD. Baseline dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Ultra-processed foods were defined according to a standardized procedure and included among others sweets and desserts, beverages, salty snacks, breakfast cereals and fast foods. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Cox proportional hazards models were constructed to determine the multiadjusted association between ultra-processed food intake (energy-adjusted servings per week) and incident fatal/non fatal CVD.

Results

On average, participants consumed about 15 servings of ultra-processed foods per week. Ranking from 1st to 3rd ultra-processed food consumption tertile (low to high level of intake) CVD incidence was 8.1%, 12.2%, 16.6% (p=0.006). Each additional weekly serving of ultra-processed food was associated with 10% higher CVD risk within the decade (Hazard Ratio (HR)=1.10, 95% Confidence Interval (95% CI) (1.02, 1.21), p=0.04). This association was reexamined according to participants' level of adherence to a cardiac friendly dietary pattern i.e. Mediterranean diet (defined through MedDietScore, range 1–55). In particular, the aggravating effect of ultra-processed foods was retained and only slightly attenuated even in the subset of participants with moderate to high level of adherence to Mediterranean diet (defined as MedDietScore>27) (HRper 1 serving/week=1.08, 95% CI (0.98, 1.19), p=0.09). On the other side, it became even stronger in case of low level of adherence to this pattern (HRper 1 serving/week=1.19, 95% CI (1.12, 1.25), p=0.02).

Conclusions

Current findings support that even in a population with Mediterranean origins and easy access to healthy least processed choices, systematic consumption of ultra-processed foods on a weekly basis was associated with increased risk of hard CVD events. Tailor-made public health initiatives and nutrition policies are demanded to promote healthy and sustainable dietary patterns with less-processed foods of high nutritional value.

Funding Acknowledgement

Type of funding sources: None.
2MACE score predicts cardiovascular adverse events in real-world atrial fibrillation patients under rivaroxaban therapy. Data from EMIR study
Authors: Esteve Pastor M , Marin F , Anguita M , Sanmartin M , Rafols C , Arribas Ynsaurriaga F , Baron Esquivas G , Barrios V , Cosin Sales J , Freixa Pamias R , Perez Cabeza A , Vazquez Rodriguez J M , Lekuona Goya I ,   EMIR study investigators
Published: October 2021

Background

Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet.

The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs.

Methods

EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed.

Results

We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR<60 ml/min). After 2.5 (2.2–2.6) years of follow-up, we observed patients with 2MACE score ≥3 had higher rate of adverse events (Table), specially of higher rate of cardiovascular mortality and MACE. Patients with 2MACE score ≥3 had RR 4.09 (2.59–6.45; p<0.001) for MACE. Indeed, patients with 2MACE score ≥3 had around 6-fold risk of cardiovascular death due heart failure than patients with 2MACE score <3 (0.17%/year vs 1.09%/year; p=0.003). 2MACE score had suitable predictive performance for MACE (AUC 0.638 [(0.534–0.742); p=0.010).

Conclusion

In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE
Assessing the clinical utility of a genetic risk score associated with type 2 diabetes in a southern European population
Authors: Santos M , Mendonca M I , Temtem M , Sousa J A , Mendonca F , Sousa A C , Freitas S , Henriques E , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Background

The development of personalized susceptibility profiles based on genetic information to aid prediction, early detection and prevention of type 2 diabetes (T2D) with potential clinical application, begins to awaken interest in the scientific community. However, its clinical translation is controversial.

Objective

Evaluate the clinical utility of a genetic risk score (GRS) created with the GWAS-derived genetic variants associated to T2D to predict and discriminate the susceptibility to Type 2 diabetes, in a Southern European population with and without T2D.

Methods and results

We studied through a case-control with 3,139 subjects (772 with T2D and 2,367 without) the usefulness of implementing a GRS in clinical practice. We constructed a multiplicative GRS (mGRS) calculated using 10 SNPs of genetic loci robustly associated to T2D (HNF4A rs1884613, IGF2BP2 rs4402960, PPARG rs1801282, TCF7L2 rs7903146, SLC30A8 rs1326634, MC4R rs17782313, ADIPOQ rs266729, FTO rs8050136, TAS2R50 rs1376251 and APO E rs7412 and rs429358), to evaluate the prediction and discrimination of T2D. Two logistic regression models were performed the first with age, sex and BMI. The second with these three risk factors plus hypertension, LDL >130mg/dl and physical inactivity. Logistic regression models, receiver operating characteristic analyses (ROC curve) were used. Each model was analysed individually and added with mGRS to calculate the area under the ROC curve (AUC), which may be considered a global estimate of each model's predictive power. The inclusion of GRS in the first model increased the discriminative power of T2D (AUC=0.669 to 0.692; p<0.0001. In the second model, the increase was AUC=0.712 to 0.729; p<0.0001.

Conclusions

Adding genomic information to traditional models improves the ability to predict and discriminate type 2 Diabetes slightly, compared to traditional models alone. Nevertheless, this increase is not sufficiently robust for translation in clinical practice. However, clinicians should be conscious that T2D genetic research is experiencing a dramatic revolution and stay optimistic that these innovative studies translate into improved care for diabetic patients.

Funding Acknowledgement

Type of funding sources: None.
Comparison between a genetic risk score and the European SCORE in cardiovascular events prediction in a primary prevention population
Authors: Soares C , Temtem M , Mendonca M I , Sousa J A , Santos M , Sousa A C , Rodrigues M , Henriques E , Freitas S , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Background

The risk for Coronary Artery Disease (CAD) can be estimated using different scores, such as the European SCORE (Systematic Coronary Risk Evaluation) scale or genetic risk score (GRS). The addition of GRS to the European SCORE may increase the precision of predicting MACE (Major Adverse Cardiovascular Events).

Purpose

This study aims to compare the European SCORE and the multiplicative genetic risk score (mGRS) in predicting MACE.

Methods and results

The study included 1110 asymptomatic individuals without known CAD from GENEMACOR prospective registry. We defined the primary endpoint of all-cause cardiovascular events.

The study population had mean age of 51.6 years, 74.1% male and had risk factors of diabetes (11.6%), dyslipidemia (67.5%), hypertension (48.1%) and smoking (22.9%). Using C-index methodology, mGRS score was superior to SCORE in predicting MACE (mGRS = 0.832 Vs SCORE = 0.615; p=0.014).

Conclusions

The mGRS score was superior to SCORE in predicting MACE in an asymptomatic and free of CAD population. Genetic information may improve cardiovascular risk stratification in primary prevention.

Funding Acknowledgement

Type of funding sources: None.