bluuebunny/crossref_metadata_2025 huggingface dataset:
Fixed dose combination of olmesartan and amlodipine in patients with hypertension and abdominal obesity. Data of 3-month observation of efficacy and adherence to therapy
Authors: Koval S , Mysnychenko OV , Penkova M YU , Starchenko TG , Lytvynova OM , Lytvynov VS
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Essential hypertension (H), which is combined with abdominal obesity (AO), is characterized by the early formation of refractoriness to antihypertensive therapy. In this regard, it is urgent to search for the most effective therapy regimens, among which fixed combinations (FC) of drugs have recently attracted considerable interest.

Purpose

To study the efficacy of FC olmesartan (O) and amlodipine (F) and adherence to it in patients with H and AO.

Methods. 60 patients with grade 2 H with AO of I-II degrees (36 men and 24 women aged 48 to 62 years) were examined using standard clinical, biochemical and instrumental methods. Before enrollment in the study, all patients received various non-FC two-component combinations of antihypertensive drugs, however, target blood pressure (BP) levels were not achieved by any patient. After inclusion in the study, all patients were transferred to FC O and A, which was prescribed once a day , taking into account BP levels in the following daily doses: 20/5 mg; 40/5 mg and 40/10 mg. The examination was carried out for 3 months with dose adjustments every 7-10 days.

Results. The use of FC O and A made it possible to achieve the target BP level after 3 month of therapy in 72% of patients with H and AO. At the same time, high adherence to this therapy was also noted: 80% of patients continued to receive this therapy for 3 months. It was found that in order to achieve target BP levels, in 84% of patients it was necessary to use O and A in a daily dose of 40/10 mg, in 16% of patients -in a dose of 40/5 mg. The tested FC was characterized by a low incidence of side effects, the most frequent of which was leg edema (in 7% of patients) and good tolerability (therapy withdrawal rate was 3%).

Conclusion. The established high antihypertensive efficacy and tolerability of FC O and A in patients with H and AO indicates the promise of its widespread use in this category of patients.
Effect of bariatric surgery on blood pressure and workload-indexed pressure during submaximal and maximal exercise
Authors: Battista F , Baldan M , Quinto G , Foccardi G , Vecchiato M , Centanini A , Bettini S , Gasperetti A , Busetto L , Neunhaeuserer D , Ermolao A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Obesity is a disease characterized by an increase of resting blood pressure and by an increased risk of developing hypertension and cardiovascular events. Exaggerated blood pressure during exercise increases risk of cardiovascular events independently from the baseline blood pressure levels.

Purpose

to evaluate the blood pressure response and the Workload-indexed blood pressure, during a cardio-pulmonary exercise test (CPET) before and after bariatric surgery (BS).

Methods

257 patients with severe obesity performed maximal incremental CPET one month before and six months after BS under the same experimental protocol. The systolic blood pressure was measured at rest (SBPrest), at the submaximal effort (SBPsubmax) at the same exercise intensity (3 METs), at the exercise peak (SBP max) and lastly in the recovery phase (SBPrec). The submaximal and maximal Workload-indexed Sistolic Blood Pressure (W-SBPsubmax and W-SBPmax, respectively) were calculated with the formula: ΔBP/ΔMETs. Diastolic blood pressure was analysed at rest (DBPrest) and during the recovery phase (DBPrec).

Results

Age was on average 45 ± 10.3 years, BMI before BS was equal to 43.9 ± 6.4 Kg/m2 and 73.5% were females. After BS, there was a significant weight loss (-25.9 ± 6.2%). SBPrest and DBPrest decrease significantly after BS (ΔSBP: -10.2 ± 15.8 and -5.2 ± 11.6 mmHg; p <0.001, respectively), also when considering percentage variation of pre BS values (ΔSBP%: -7.4 ±12.3% and -5.9 ± 15.9%; p< 0.001, respectively). Submaximal and maximal systolic blood pressure showed significant reduction after BS both as ΔSBP (-15.0 ± 19.7 mmHg and -10.3 ± 25.1mmHg; p < 0.001, respectively) and ΔSBP% (-9.6 ± 13.0% and -5.0 ± 14.0%; p < 0.001, respectively). Furthermore, W-SBP decreased significantly during submaximal exercise (-3.0 ± 12.2 mmHg/METs; p 0.001) and at peak of exercise (-2.1 ± 4.8 mmHg/METs; p < 0.001). Lastly, also systolic and diastolic blood pressure during the recovery phase showed a significant reduction (-7.5 ± 7.0 mmHg and -3.3 ± 6.0 mmHg; p < 0.001). A Spearman’s correlation analysis showed a significant but weak correlation between ΔSBP%submax and % of weight loss (rho = 0.138; p = 0.027).

Conclusions

After BS, a marked reduction of all blood pressure values was detectable in all phases of CPET. W-SBPsubmax and W-SBPmax, as expression of load independent pressure response, decreased significantly. The reduction in the submaximal blood pressure was significantly but only weakly correlated with changes in body weight, suggesting its substantial independence from weight loss. These findings also support a potential role of CPET in detecting, high risk patients and adequate treatment effectiveness in patients with severe obesity.

Abstract Figure. Exercise SBP before and after BS
Lipid profile in a population with coronary artery disease in Madeira Island
Authors: Santos MR , Pereira A , Temtem M , Mendonca F , Sousa JA , Monteiro JP , Sousa AC , Freitas S , Henriques E , Ornelas I , Drumond A , Mendonca MI , Palma Dos Reis R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. We know that plasma level of LDL cholesterol (LDL-C) is strongly associated with atherosclerosis, and its reduction with statins has led to a decrease in the incidence and complications of CAD. According to the 2019 ESC guidelines, in high-risk patient the aim is to achieve an absolute LDL-C treatment goal of <55mg/dL. 2016 ESC guidelines purposed, in the same patients, a LDL-C level of <70mg/dL.

Objective

To evaluate the degree of LDL-C control in coronary artery disease patients according to ESC guidelines.

Materials and Methods

Study analyses of 1687 patients selected from GENEMACOR study population, with at least one > 75% coronary stenosis by angiography (median age 53.3 ± 3 years and 54.8% men).

LDL-C was determined by chemical methods and all patients were statin treated. The population was divided in four groups according to LDL-C levels: inferior to 55mg/dL, inferior to 70mg/dL, inferior to 115mg/dL and superior to 115mg/dL.

Results

LDL-C mean value was 108.7mg/dL, median 105.1mg/dL (P25 83.0 and P75 127.4mg/dL). 150 (8.9%) patients had LDL-C < 55mg/dL vs 1537 (91.1%) with LDL-C ≥ 55 mg/dl. 275 (16.3%) patients had LDL-C < 70 mg/dL vs 1412 (83.7%) with LDL-C ≥ 70 mg/dL.  1084 (64.3%%) patients had LDL < 115 mg/dL vs 603 (35.7%) with LDL-C  ≥ 115 mg/dL.

Conclusion

In our population LDL-C control levels was low, with 91.1% patients with LDL-C ≥ 55mg/dL and 83.7% patients with LDL ≥ 70 mg/dL. It is interesting to note that most of our patients have LDL-C levels above the recommend by the newest and, surprisingly, the 2016 dyslipidemia guidelines. It is therefore important to implement a more intensive treatment strategy of dyslipidemia in coronary patients.
Risk factors for coronary heart disease among Lebanese women: a case-control study
Authors: Ghaddar F , Zeidan RK , Salameh P , Tatari S , Achkouty G , Maupas-Schwalm F
Published: May 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medilab SARL

Backgroung

Given the expected epidemic rise of coronary heart disease (CHD) in healthcare system and the potential severity of disease, CHD remains underestimated in women. Early identification of risk factors (RFs) will be important for their health promotion.

Purpose

The aim of this study is to evaluate the RFs for CHD among Lebanese women aged 40 years and above.

Methods

A case-control study was carried out in 6 hospitals in the regions of Beirut and Mount-Lebanon, from December 2018 to December 2019 with a total of 1500 patients. Anthropometric and laboratory data were collected from the medical records of patients and structured questionnaire were used.

Results

CHD was positively associated with hyperlipidemia (aOR 2.852, 95% CI: 2.021–4.023), hypertension (2.715, 1.598–4.614), family history of CHD (2.645, 1.925–3.634), smoking (1.888, 1.393–2.558) and interestingly presence of joint pain (1.513, 1.107–2.068). While, residence in Mount-Lebanon seemed negatively associated with CHD (0.669, 0.467–0.959), as well as adherence to Mediterranean diet (0.964, 0.938–0.992) and physical activity (0.491, 0.259–0.930 and 0.718, 0.530–0.972, for high and moderate activity, respectively).

Conclusion

In our study, most of RFs associated with CHD in women are modifiable and preventable, highlighting the need of lifestyle interventions and appropriate control strategies and measures.
Modifiable risk factors of cardiovascular diseases in university students
Authors: Pomeshkina E , Bazdyrev E
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Currently, the risk factors are known for many diseases, including cardiovascular diseases. A part of the risk factors are modifiable, and therefore depend on health behaviour of every person. Young student age is the time to build the habits for a healthy lifestyle.

Purpose. To study the modifiable risk factors for cardiovascular disease such as sedentary lifestyle, unhealthy diet, alcohol abuse and smoking in young university students.

Material and methods. The study included 136 university students (24 males and 112 females), median age was 20 (20; 21). The risk factors such as sedentary lifestyle, unhealthy diet, alcohol abuse and smoking were assessed using a questionnaire developed with the help of the adapted international methodologies. 

Results. The research revealed that 91 (67 %) students have never smoked, 29 (21 %) quit smoking and 16 (12 %) are current smokers. The physical activity analysis showed that 58 (43 %) students have 150 or more minutes of walking activity a week (excluding a way to the study place). 47 (35 %) students have workouts 2-3 times a week and 9 (7 %) do it 5-7 times a week. 50 (37 %) students do not drink alcohol. Almost half of the students (66 (46 %) people) rarely drink alcohol (up to once a week), 10 (7 %) students drink alcohol 2-3 times a week; 10 (7 %) students drink alcohol often (4-6 times per week). The assessment of the eating habits showed that only 26 (19 %) students include vegetables and fruits into their regular diet (6-7 times a week). 78 (57 %) students eat vegetables and fruits rarely (up to 2 times a week). The rest of students (32 (24 %)) almost never eat vegetables and fruits (0-1 times a week). The bratwursts and sausages are included in the daily diet in 20 (14 %) students. 62 (46 %) students eat bratwursts and sausages very often (up to 3-5 times a week). A considerable part of the students (54 (40 %)) completely refuse or rarely eat these products. Most of the students (98 (72 %)) do not drink or drink rarely (1-2 times a week) sweet carbonated soft drinks. 6 (4 %) students often (up to 6-7 times a week) drink sweet carbonated soft drinks, the median daily consumption is 500 (250; 500) ml. 50 (37 %) students refuse to visit fast food restaurants. 40 (29 %) students visit them rarely (0-1 times a week). The rest of the students (46 (34 %)) visit fast food restaurants quite often (2-3 times a week).

Conclusions. The research allows to conclude that the university students don"t have the habits for keeping a healthy lifestyle. The proportion of the students who smoke is 12 %, and the number of students who often drink alcohol (more than 3 times a week) is 14 %. More than half of the students (58 %) lead a sedentary lifestyle, most of the students (60 %) eat bratwursts and sausages daily or very often. 34 % of the students often visit fast-food restaurants. But a considerable part of the students (72 %) refuse to drink sweet carbonated beverages.
What must we know about cardiovascular prevention in medical school freshmen?
Authors: Venevtseva Y , Golubeva ELENA , Putilin LEV
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction. Medical students have been found to report high levels of perceived stress that may be influenced on health status and academic performance. Digital era and e-learning produce novel risk factors for cardiovascular disease (CVD) including arterial hypertension. In real life clinical practice in large healthy populations it is quite difficult to follow guidelines for hypertension screening due to the time deficit.

Purpose. The aim of the study was to examine prevalence of CVD risk factors and impact of casual blood pressure on cognitive function in 1st and 6th year medical male students.

Methods. Cross-sectional study was conducted during the period from 2014 to 2020. 222 first year (age (M ± m) 18.5 ± 0.1 years) and 207 6th year male medical students (age 23.5 ± 0.3 years) completed 45-item questionnaire about habitual life-behavior and performed 9 cognitive tasks. Blood pressure (BP) was self-measured by electronic device just prior to testing.

Results. In freshmen mean body height was (M ± m) 180.3 ± 0.5 cm; weight – 76.8 ± 1.1 kg, body mass index (BMI) – 23.6 ± 0.3 kg/m2; heart rate – 82.1 ± 0.9 bpm; casual systolic BP (SBP) -131.9 ± 2.3 and diastolic BP (DBP) – 77.6 ± 0.6 mm Hg. 6th year male students had similar height (179.6 ± 0.5 cm), but were heavier (80.5 ± 1.0 kg; p < 0.01; BMI =24.9 ± 0.3 kg/m2; p < 0.01). Heart rate (78.7 ± 0.8 bpm; p < 0.05) and casual SBP (126.7 ± 0.8 mm Hg; p < 0.05) were lower. No difference was found in DBP (77.8 ± 0.6 mm Hg).

Excessive body weight was detected in 16.6 % of 1st and in 36.2 % of 6th year students, obesity – in 8.5 and 6.8 % of students. 3 first year males and 1 – from 6th year group had morbid obesity (BMI > 40.0). Low physical activity reported 22.1% and 29.9%. Current smokers were 16.1 % of 1st and 33.3 % of 6th year students, but only 9.4 and 18.8 % smoked permanently. Casual SBP lay in high normal range in 27.4 % of 1st and in 34.3% of 6th year, and above 140 mm Hg – in 21.5 and 14%.

Correlation analysis revealed in both groups significant positive correlations SBP and DBP to weight and BMI, SBP to height (p < 0.05) and screen time (p < 0.01) and DBP - to heart rate. Only in freshmen SPB was related to cognitive functions: 17-18 year’s ones with elevated BP made tests faster may be due to their greater arousal, whereas 19-20 year’s – slower, but had better working vision memory. Only in 17-18 year group existed negative association SBP to subjective vision value and smoking status.

Conclusions. Modern medical male students are at high risk of CVD: casual BP within the normal range was only in 49 % of 1st and in 48 % of 6th year students, 25 % of freshmen and 43 % of 6th year males were overweight or obese, and one quarter was physically inactive. Besides healthy lifestyle and nutrition promotion quite necessary is also to limit screen time.
Association of a favorable cardiovascular health profile (Life"s Simple 7 and Fuster-BEWAT scores) with the presence of a newly proposed 4-tiered left ventricular hypertrophy
Authors: Wang HY , Sun YX
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

AHA"s Life"s Simple 7 cardiovascular health score is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT score (FBS) (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]), are also available.

Purpose

This study sought to compare the effectiveness of Life"s Simple 7 and FBS in predicting the newly proposed 4-tiered left ventricular hypertrophy (LVH) classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV]0.67) in the general Chinese population.

Methods

Participants from Northeast China Rural Cardiovascular Health study who underwent cardiac echocardiography (n = 11,261) were enrolled. Patients with LVH were divided into 4 groups—eccentric nondilated (normal M/EDV and EDV), eccentric dilated (increased EDV, normal M/EDV), concentric nondilated (increased M/EDV, normal EDV), and concentric dilated (increased M/EDV and EDV)—and compared with patients with normal LVM.

Results

With poor Life"s Simple 7 and FBS as references, individuals with ideal Life"s Simple 7 and FBS showed lower adjusted odds of having eccentric nondilated (Life"s Simple 7, odds ratio [OR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.34 vs. FBS, OR: 0.28; 95% CI: 0.20 to 0.38), eccentric dilated (OR: 0.73 [0.57-0.94] vs. OR: 0.57 [0.43-0.76]), concentric nondilated (OR: 0.12 [0.04-0.38] vs. OR: 0.19 [0.07-0.52]), and concentric dilated LVH (OR: 0.12 [0.03-0.37] vs. OR: 0.26 [0.10-0.72]). Taken together, the odds for these 4 LV geometric phenotypes decreased in a graded manner in subjects with intermediate and ideal ICHS and FBS compared with subjects with poor ICHS and FBS (p for trend <0.01). For the total ICHS and FBS on a continuous scale from 0 (all 7 poor) to 7 (all 7 ideal), risk reductions of the 4 distinct LVH patterns were of comparable magnitude for each 1-point increment of ICHS and FBS. Similar levels of significantly discriminating accuracy were found for Life"s Simple 7 and FBS with respect to the eccentric nondilated (C-statistic: 0.737; 95% CI: 0.725 to 0.750 vs. 0.731; 95% CI: 0.718 to 0.744, respectively), eccentric dilated (0.684 [0.670-0.699] vs. 0.686 [0.671-0.701]), concentric nondilated (0.658 [0.624-0.692] vs. 0.650 [0.615-0.684]), and concentric dilated LVH (0.711 [0.678-0.744] vs. 0.698 [0.663-0.733]).

Conclusions

 Our findings demonstrate that the FBS appears capable of performing just as well as does the Life"s Simple 7 in predicting the novel 4-group classification of LVH, making the FBS particularly suited as a reliable low-cost indicator of CV health in settings where access to laboratory analysis is limited and health care resources are constrained.

Abstract Figure.
A nationwide cross-sectional epidemiological study of cardiovascular risk factors as a tool for management of primary and secondary prevention in Latvia
Authors: Bajare I , Dzerve V , Luguzis A , Barzdins J , Apinis P , Jegere S , Erglis A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EUROPEAN SOCIAL FUND MINISTRY OF HEALTH, LATVIA

Background.

An increasing prevalence (PREV.) of noncomunicable diseases is a major public health concern  in Latvia. Regular nationwide epidemiological studies present an opportunity to estimate the dinamics of PREV of health risk factors (RF) and thus assist in planning resources and improving prevention strategies at national level.

Objective.  The aim  was to analyze the PREV of cardiovascular  RF identified in a  epidemiological study in 2019-2020. To assess changes in RF prevalence, the results were compared to data from a similar study in 2009-2010.

Methods. 4070 inhabitants (age 25-74) of Latvia  enrolled. The statistical sample (6000 pers.) was random selected from the Housing Register, Central Statistical Bureau (1’209’756 INDV). The survey included an interview, physical examination (body mass index (BMI), arterial pressure etc.) and venous blood sample collection for fasting glucose (Glu), total cholesterol (TC), high and low-density lipoprotein cholesterol (LDL-C), triglycerides (Tg) measurement.  The data were processed using Microsoft Excel and SPSS.

Results. The mean number of  RF ((AH, TC, LDL-C, Tg, BMI, smoking, arterial hypertension) was 2,93 ±0.1 (mean ± SE) per person for the overall study population. The men group had a significantly greater  number of RF than  the female group  (3.15 ± 0.15 vs.2.55 ± 0.12). A positive correlation between age and the number of RF was found. In the age group 65 and more, the mean number of RF decreased in men and stabilized in women. Although the mean number of RFs has decreased statistically insignificantly over 10 years, changes in the PREV of individual RFs are significant  (see table).  Decrease of PREV of elevated TC, LDL-C, Glu ≥3.0 mmol/L, as well as a decrease in the PREV of young smokers, men, should be noted.

Conclusion. The nationwide data can be used as the baseline characteristics against which other measurements can be compared down the road including of health prevention activities

Prevalence of most important RF (%) 2019-2020 2009-2010 RF All Men Women All Men Women TC≥5.0 mmol/L 63.2× 60.7× 65.4× 75,2 72.0 78.0 LDL-C≥3.0 mmol/L 62.0× 63.1× 61.1× 73.7 73.1 73.9 Glucose 5.6-6.99 mmol/L 22.1× 27.1× 17.8× 28.7 35.3 24.9 Arterial Hypertension 38.0× 41.1× 35.3× 44.8 52.9 40.2 BMI≥30.0 kg/m² 29.1 28.1 29.8 30.7 25.6 32.6 Daily smokers 25-34 y 30.3× 21.8 46.3 22.3 (x) p below 0.05 comparing years 2019-20 and 2009-10
Physical activity recommendation by cardiologists
Authors: Davolos I , Franchella J , Iglesias D , Paz I , Sayavedra G , Sotelo B , Gelormini A , Pappalettere C , Bucay C , Castiello G , Gonzalez Naya E , Stuart P , Filosa E , Pais De Almeida M , Diaz Babio G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Exercise Cardiology Council

Background. Large number of studies confirm benefits of physical activity (PA) to improve health. Recommendation guidelines lack tools for health professionals training in PA prescription.

Purpose. To show cardiologists knowledge degree and attitude regarding existing recommendations on PA.

Methods. Observational and cross-sectional study. n = 299. A virtual survey describes cardiologist profile, knowledge degree, planning and satisfaction while making PA recommendation.

Results. Cardiologists profile in Table 1. Mean age 47.27 (SD 11.92). Sedentary lifestyle is considered a cardiovascular risk factor (CVRF) by 93.24%. 70% report performing PA complying with the recommendations of world health organization. 98.99% recommend PA while 80.74% also prescribe it. Prescribing PA, cardiologists self-rating is adequate-very adequate in 83%. Instruments used are guidelines (57.33%), self-perception (32%), expert opinion (25.33%). Most suggested mode of exercise is walking or jogging. Only 25.67% combine resistance and strength exercises. Only 13% choose to combine four parameters (heart rate, time, mode, intensity). Only 31.85% have undergone postgraduate training or education on PA prescription. 

Conclusions. Approximately 25% of cardiologists use valid or formal indicators to prescribe PA. Cardiologist with CVRF perform less PA than the rest. It is observed that PA prescription is influenced by PA degree performed by the physician. Lack of training seems to be the biggest obstacle to PA prescription generalization.

n % Cardiologists 299 100 MaleFemale 195104 65,2234,78 Sector Private 172 58,11 Public 26 8,78 Both 98 33,11 Cardiovascular risk factors Hypertension 61 20,33 Dyslipidemia 59 19,67 Diabetes 15 5,00 Smoking 23 7,67 Overweight 84 28 Coronary heart disease 11 3,67
Impact of cardiovascular health status on the association between changes in physical activity and major cardiovascular events and mortality among 88,320 adults: outcomes of the Lifelines Cohort Study
Authors: Bakker EA , Lee DC , Hopman MTE , Thijssen DHJ , Eijsvogels TMH
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Lifelines Biobank initiative received funding from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen [UMCG], University Groningen and the Northern Provinces of the Netherlands. The work of T.M.H.E is supported by the Netherlands Heart Foundation [Senior E-Dekker grant #2017T051].

Background. Regular physical activity (PA) improves health. Many observational studies investigated the association between PA and health at a single time-point, but PA might change over time.

Purpose. To examine the association between change in PA and major adverse cardiovascular events (MACE) and all-cause mortality, and to investigate the impact of cardiovascular health status at baseline on these outcomes.

Methods. This study used data from the Lifelines Cohort Study (N = 88,320). Self-reported PA volumes were presented as Metabolic Equivalent of Task (MET) min/week. Change in PA was calculated by subtracting MET-min/week at the first assessment from the second assessment (median interval: 4 yrs), and 5 groups were created; large reduction (< -1500), moderate reduction (-1500 to -250), no change (-250 to 250), moderate improvement (-250 to 250) and large improvement (>1500). The outcome was a combination of MACE and all-cause mortality.

Results. During a median follow-up of 7 years, 667 events occurred among healthy individuals (43 ± 12 yrs, 1% of 69,818) and 599 in individuals with CVRF (55 ± 11 yrs, 3% of 18,502). Adjusted for confounders and baseline PA, healthy individuals with a large reduction in PA had a greater risk of incident MACE and mortality (Table). In CVRF, moderate to large improvements in PA were associated with reductions in adverse outcomes. Risk estimates became stronger in individuals with lower baseline PA (<2000 MET-min/week), Table).

Conclusions. Maintaining PA in healthy individuals and increasing PA in individuals with CVRF over time is important to prevent MACE and mortality. The impact of changes in PA was stronger for individuals with lower baseline PA.

Table. Change of PA, MACE and mortality. Changes in PA Healthy CVRF Large reduction 1.40 [1.02;1.93] 1.27 [0.95;1.70] Moderate reduction 1.22 [0.89;1.68] 0.97 [0.72;1.30] No changes Ref Ref Moderate improvement 1.04 [0.74;1.44] 0.65 [0.47;0.91] Large improvement 0.96 [0.71;1.31] 0.69 [0.51; 0.94] Individuals with lower baseline PA Large reduction 2.24 [0.96;5.21] 2.85 [1.44;5.63] Moderate reduction 1.77 [1.10;2.84] 1.33 [0.89;1.98] No changes Ref Ref Moderate improvement 1.16 [0.73;1.83] 0.49 [0.31;0.76] Large improvement 0.77 [0.48;1.23] 0.58 [0.39;0.86]
Impact of regular physical activity awareness sessions by primary care physicians in rural India
Authors: Inamdar A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Regular physical activity is associated with improved physical and mental health. Studies have shown that regular physical activity reduces the risk of cardiovascular diseases, diabetes mellitus, osteoporosis, depression and obesity. Patients frequently identify their family physicians as an important source of constant encouragement for physical activity.

Purpose

We wanted to assess the impact of regular awareness sessions about physical activity by Primary care physicians in adults. 

Methods

73 participants between the age group 30 to 60 years were recruited in this single center study in rural India.70 participants completed this 6 month intervention study whereas 3 participants dropped out of study. Once in a month audio visual awareness session of one hour were conducted from August 2017 to January 2018 by primary care physicians to educate the participants about ill effects of sedentary lifestyle and benefits of regular physical activity. Pre and post intervention data were collected by using validated Godin leisure time exercise questionnaire from all 70 participants. Paired t test and Wilcoxon test were used to compare pre- and post-intervention data. Percentage increase in physical activity score was also calculated.

Results

In this study baseline Godin score pre intervention were 38.82 ± 12.22 (Mean ± SD) and post intervention were 65.98 ± 11.25 (Mean ± SD). Participants significantly improved Godin score post intervention which were statistically significant (p: < 0.001) . Compared to baseline pre intervention score, there was 170% increase in physical activity score post intervention.

Conclusions

Results of this intervention suggest that regular awareness sessions using modern technology is cost effective in changing physical activity behavior in people. Active involvement of primary care physician in this intervention will further help in establishing and continuing physical activity behavior. Physicians can play a major role in promotion of physical activity. As primary care physicians have direct regular contact with their patients and their families, their role in promotion of physical activity will have more impact and long-lasting effect on patient’s behavior. We assume that similar studies are needed to promote physical activity in the people.
Sleep insufficiency and incidence of cardiovascular disease among adults in Greece
Authors: Fountoulakis PN , Terzoudi A , Tsiptsios D , Triantafyllis AS , Matziridis A , Leontidou E , Manolis A , Tsamakis K , Ouranidis A , Steiropoulos P , Vorvolakos T , Tripsianis G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Sleep disorders are an increasing and modifiable risk factor for cardiovascular disease (CVD).

Purpose

The aim of our study was to investigate potential associations between sleep insufficiency and incident CVD.

Methods

In this cross-sectional study, 957 participants, (mean age 49.62 ± 14.79) from the region of Thrace, Greece were enrolled and classified into three groups [short (<6 h), normal (6-8 h) and long (>8 h) sleep duration]. CVD was assessed by a positive response to the following questions: "Have you been told by a doctor that you have had a heart attack or angina (chest pain or exertion that is relieved by medication)?" or "Have you been told by a doctor that you have had a stroke?". Participants’ sleep quality was estimated with the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire.

Results

The overall prevalence of CVD was 9.5%. The population with CVD exhibited reduced sleep duration and efficiency reduced by 33 min and 10%, respectively. After adjusting for all possible cofounders, short sleep duration was 3.07-times more frequent in patients with CVD and sleep duration of less than 5:33 hours could be a potential risk factor for CVD, especially among females. Additionally, CVD was significantly associated with excessive increased daytime sleepiness, insomnia, poor sleep quality and increased risk of obstructive sleep apnea.

Conclusion(s): Our study depicts a strong correlation of sleep insufficiency with CVD and promotes early pharmacological or cognitive behavioral interventions in order to protect cardiovascular health.

Abstract Figure. Results
Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea
Authors: Hnatiak J , Ludka O , Batalik L , Winnige P , Dosbaba F
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705

Background

Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine.

Purpose

This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour.

Methods

This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.
Cardio-metabolic risk factors among healthcare staff: a cross-sectional study at the hospitals in six cities of Ukraine dedicated to World Heart Day 2020
Authors: Sulska I , Mishchenko L , Sorokolietova A , Hordina M , Zhulinska S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. There is a little information on the prevalence of cardio-metabolic risk factors in the Ukrainian medical staff. The aim of investigation was to determine the abundance of certain risk factors for cardiovascular (CV) diseases among the medical personnel in the six cities of Ukraine, a study dedicated to World Heart Day 2020.

Purpose. To establish the presence of cardio-metabolic risk factors among medical workers in Ukraine.

Materials and methods. A hospital-based cross-sectional study including 471 participants (415 female and 56 male) between the age of 19 and 79 years surveyed. The cardio-metabolic risk markers assessed were non-modifiable risk factors (family history) and modifiable risk factors (obesity, hypertension, dyslipidemia, diabetes, prediabetes, smoking status).

The prevalence of hypertension (HTN) estimated by ESC 2018 recommendations, diabetes and prediabetes by ADA 2019, ESC 2019 and body mass index WHO criteria for obesity classifications. Using standard methods were assessed: fasting glucose concentration, glycosylated hemoglobin (HbA1c) and blood lipids (total cholesterol, LDL-C, triglycerides, HDL-C).

Results

The median age of participants was 53,3 ± 11,77 years. Positive smoking status reported by 66 persons (14,0%). Analysis of family history showed that 51,4% of the participants had of HTN, 14,9% of myocardial infarction and 25,1% of stroke. The prevalence of modifiable risk factors: HTN registered in 51,4% cases. Around 34,8% of participants were overweight, and 34,6% were obese, 70,7% had waist circumference more than 94 cm (men) and > 80 cm (woman). Prediabetes glycemic levels and diabetes incidence were 42,8% and 12,6%, accordingly. Atherogenic dyslipidemia estimated by increased level of LDL-C more than 4,9 mmol/l, which determinate high risk of CV disorders, estimated in 13,6% participants. Also high triglycerides levels were defined as those of at least 2,3 mmol/l were in 14,9%. Low level of aerobic activity (less than 150 min in week) had 33,4% participants. 30,7% of participants older than 40 years presented high CV risk and 23,9% were in very high risk.

Conclusion. Cardio-metabolic risk factors prevail among medical workers in Ukraine. The results point to the relevance of public health recommendations to contribute lifestyle changes and early identification of risk factors for prevention of CV outcomes.
Association between retinopathy and development of long-term cardiovascular events. Results of the follow-up of RETICARD cohort
Authors: Aguila Gordo D , Marina Breysse M , Piqueras Flores J , Negreira Caamano M , Mateo Gomez C , Martinez Del Rio J , Moron Alguacil A , Perez Diaz P , Perez Soto R , Cubides Novoa AF , Munoz Garcia M , Frias Garcia R , Salas Bravo D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although the association between retinopathy and cardiovascular disease is known, the usefulness of retinopathy as a risk predictor has not been well studied yet.

Methods

Prospective study of a cohort of 107 patients with a medical indication for coronary angiography, who underwent a fundus study to assess the presence of retinopathy. The appearance of major cardiovascular events defined by cardiovascular mortality, acute coronary syndrome, cerebrovascular accident, new revascularization, hospital readmission for cardiovascular causes and development of atrial fibrillation (AF) was recorded in a follow-up with a mean of 110, 96 + / -19.74 months.

Results

The mean age was 75.19 ± 11.53 years. 39.3% were women, 78.5% suffered from hypertension, 32.7% diabetes, and 57% dyslipidaemia. 84.1% had some type of retinopathy at the beginning of follow-up: 0.9% diabetic, 3.7% hypertensive, 1.9% atherosclerotic, and 70.1% hypertensive-atherosclerotic.

During the follow-up, all causes mortality was 16.8% and cardiovascular mortality 2.8%. 5.6% of the sample presented an acute ischemic event. 6.5% required new myocardial revascularization. The proportion of patients who developed AF was 11.2%. The readmission rate for all causes 60.7% (cardiovascular cause 28%).

Grade ≥ 2 hypertensive retinopathy was associated with a greater need for myocardial revascularization (p = 0.016), being performed earlier than the rest of the patients (108.6 ± 3.9 vs 118.8 ± 0.2 months; p = 0, 01). Atherosclerotic retinopathy was related to a greater development of AF (p = 0.04), appearing in 21.2% of these patients compared to 6.75% in the rest. A greater trend to readmission for cardiovascular causes (p = 0.66) was observed in patients with diabetic retinopathy; 16.13% compared to 5.26% in patients who did not suffer from it.

Conclusions

The presence of retinopathy, in its different types, is associated with the early development of major cardiovascular events, therefore, the inclusion of the fundus in the initial study of cardiovascular risk may be beneficial to improve risk stratification.
Very similar cardiometabolic profile in the moderate and high cardiovascular risk classes: a population-based study
Authors: Chlabicz M , Jamolkowski J , Laguna W , Sowa P , Paniczko M , Lapinska M , Szpakowicz M , Drobek N , Raczkowski A , Kaminski K,A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Bialystok, Poland

Background

Cardiovascular disease (CVD) is a major, worldwide problem and remain the dominant cause of premature mortality in the word. Simultaneously the metabolic syndrome is a growing problem. The aim of this study was to investigate the cardiometabolic profile among cardiovascular risk classes, and to estimate CV risk using various calculators.

Methods

The longitudinal, population-based study, was conducted in 2017-2020. A total of 931 individuals aged 20-79 were included. Anthropometric and biochemical profiles were measured according to a standardized protocols. The study population was divided into CV risk classes according to the latest recommendation. Comparisons variables between subgroups were conducted using Dwass-Steele-Critchlow-Fligner test. To estimate CV risk were used: the  Systematic Coronary Risk Estimation system, Framingham Risk Score and LIFEtime-perspective model for individualizing CardioVascular Disease prevention strategies in apparently healthy people (LIFE-CVD).

Results

The mean age was 49.1± 15.5 years, 43.2% were male. Percentages of low-risk, moderate-risk, high-risk and very-high CV risk were 46.1%, 22.8%, 13.5%, 17.6%, respectively. Most of the analyzed anthropometric, body composition and laboratory parameters did not differ between the moderate and high CV risk participants, whereas the low risk group differed significantly. In the moderate and high-risk groups, abdominal distribution of adipose tissue dominated with significantly elevated parameters of insulin resistance. Interestingly, estimating lifetime risk of myocardial infarction, stroke or CV death using LIFE-CVD calculator yielded similar results in moderate and high CV risk classes.

Conclusion

The participants belonging to moderate and high CV risk classes have a very similar unfavorable cardiometabolic profile which may result in the similar lifetime CV risk. This may imply the need for more aggressive pharmacological and non-pharmacological management of CV risk factors in the moderate CV risk population. It would be advisable to consider combining the moderate and high risk classes into one high CV risk class, or it may be worth adding one of the parameters of abdominal fat distribution to the CV risk calculators as an expression of increased insulin resistance.

Abstract Figure 1.
The association between S1P and vascular disease markers in the general population
Authors: Rotheudt L , Moritz E , Markus M , Voelzke H , Friedrich N , Rauch B , Schwedhelm E , Buelow R , Schminke U , Felix S , Doerr M , Bahls M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction 

Sphingosine-1-phosphate (S1P) is a lipid mediator of the immune system and vascular bed. However, cross-sectional analyses of S1P and parameters of vascular health in the population are sparse.

Purpose 

We explored the relation between S1P concentrations and several parameters of vascular health, i.e. ankle-brachial index (ABI), carotid intima-media thickness (cIMT), presence of carotid atherosclerotic plaques/stenosis, brachial artery flow-mediated dilation (FMD) as well as aortic wall thickness (AWT).

Methods

S1P was measured by liquid chromatography-tandem mass spectrometry in the population-based Study of Health in Pomerania (SHIP-TREND-0). ABI was calculated as the ratio of systolic blood pressure in arms and ankles. For cIMT, the distance between the lumen-intima and media-adventitia interfaces in longitudinal scans were measured. Carotid plaques were defined as a focal protrusion of the carotid vessel wall. Carotid stenosis was assessed with Doppler ultrasonography. FMD was evaluated by measuring the increase in brachial artery diameter after transient forearm ischemia. AWT was assessed by Magnetic Resonance Imaging.  Subjects with cancer, severe renal insufficiency, previous myocardial infarction and extreme values for S1P (< 1st and > 99th percentile) were excluded. Sex stratified linear regression models adjusted for age, smoking, waist-to-hip ratio and platelets were used to assess the relation between S1P and vascular disease parameters.

Results

A total of n = 3,643 participants (48% male, median age 51, 25th and 75th percentile 39 and 63 years) could be included in the analyses. The median S1P concentration was 0.788 µM (25th and 75th percentile 0.679 and 0.906, respectively). In men a 1 standard deviation higher S1P was associated with a significantly greater cIMT (β: 0.0057 95% confidence interval [CI]: 0.00027 to 0.0112 mm; p = 0.0396) and a lower ABI (β: -0.0090 (95% confidence interval [CI]: -0.0153 to -0.0029; p = 0.0038. In women S1P was significantly associated with cIMT (β: 0.0044 95% confidence interval [CI]: 0.0001 to 0.0086 mm; p = 0.0445) while no significant association was found for the relation of S1P with ABI. For both men and women S1P was not associated with FMD, the presence of carotid plaques/stenosis and AWT.

Conclusions

We found that S1P concentrations were positively related to a thicker cIMT in both sexes and lower ABI values in men. There was no association of S1P with any of the other vascular markers of interest. Future studies need to validate our results in other populations.
Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis
Authors: Simantiris S , Antonopoulos AS , Angelopoulos A , Papanikolaou P , Oikonomou EK , Vamvakaris K , Koumpoura A , Farmaki M , Trivella M , Vlachopoulos C , Tsioufis K , Antoniades C , Tousoulis D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance.

Methods

We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome.

Results

We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D)

Conclusions

The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication.

Abstract Figure.