bluuebunny/crossref_metadata_2025 huggingface dataset:
Traditional media or chatbot: how can we reach older adults with the COVID-19 information they need?
Authors: Olszewski R , Cwiklinska K , Brzezinski J , Owoc J , Manczak M , Zaremba M , Targowski T , Jeziorski K
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): WHO Reference, 2022/1216167-0, Promoting health and well-being and Flagship initiative- Empowerment through Digital Health. “Older people and COVID-19- new challenges for public health in Poland”.

Background

The current epidemiological situation related to the COVID-19 pandemic is one of the biggest public health challenges and is associated with many negative phenomena such as the spread of misinformation. Older adults (especially with cardiovascular diseases) with their specific needs, concerns and preferred sources of information are the most vulnerable group in the rapidly evolving world.

Objective

Identify areas of interest, preferred sources of information related to the COVID-19 pandemic among older adults and verify their e-health competencies.

Material and method

The study was conducted between February 2022 and July 2022. Both groups of older and younger adults completed a self-administered questionnaire that addressed respondents' interests, questions and sources of information about COVID-19 that they used. Additionally, respondents filled out the PL- eHEALS questionnaire to measure e-health competencies.

Results

The study included a total of 573 participants (older adults - 303 participants, young adults - 270). The three issues that attracted the largest interest among the elderly were COVID-19 treatment methods (45.5%) COVID-19 symptoms (36.6%) and the impact of COVID-19 on chronic diseases (35%). The main source of information about COVID-19 was television (84.5%). As much as 84% of the elderly have never interacted with a chatbot and only 18% believe it could be a reliable source of information on COVID-19. The e-health competencies of the elderly were significantly lower than the younger generation’s (Fig. 1).

Conclusions

This study found intergenerational differences in COVID-19 information needs. Older adults need basic information about COVID-19 and prefer using traditional media.
Echocardiography in the pre-participation screening: an old topic revisited
Authors: Palermi S , Donati F , Guicciardi C , Lodi E , Fernando F , Modena M G , Biffi A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Preparticipation screenings (PPs) have been conceived for the potential to prevent sudden cardiac death (SCD) in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include family history collection, physical examination and resting electrocardiogram (ECG). Transthoracic echocardiography has been hypothesized to have a primary role in the PPs. The aim of the present study was to evaluate the additional role of echocardiogram in identifying cardiovascular (CV) abnormalities that might be undetected by commonly used PPS.

Methods

We retrospectively reviewed Ferrari Formula Benessere, a corporate wellness program - database and analyzed data recorded from 2017 to 2022 to compare two medical models: a "standard" PPS including medical history, physical examination, ECG and exercise stress testing (EST) versus an "advanced" PPS comprising history, physical examination, ECG, EST and echocardiography.

Results

From an initial sample size of 7500 subjects, we included 500 subjects (420 male, 33.69 ± 7.9 mean aged) enrolled for the first time in the corporate wellness program between 2017 and 2022. 339 (67.8%) subjects had no abnormal findings at "standard" PPS and, even if would have not required further evaluation, performed an echocardiography anyway ("advanced" PPS): 31 (9.1%) showed some abnormal CV findings at echocardiography, such as patent foramen ovalis or bicuspid aortic valve.

Conclusions

Screening echocardiogram showed an additional value in detect subjects with CV abnormalities, otherwise undiagnosed with "standard" PPS protocol.
Sleep well, but be active. Effect of sleep and sedentariness on incidence of diabetes
Authors: Liu K , Marques-Vidal P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Faculty of Biology and Medicine of Lausanne, the Swiss National Science Foundation.

Background

Both long/short sleep and inactivity have been associated with the development of diabetes. However, their effects have seldom been jointly assessed.

Purpose

We aimed to determine the individual effect of long/short sleep and of inactivity on diabetes risk using data from a population-based prospective study in Switzerland.

Methods

Participants devoid of diabetes were included. Incident diabetes was defined based on either fasting plasma glucose (FPG), or glycated hemoglobin (HbA1c), or any diagnostic criterion (FPG, HbA1c or medical diagnosis). Sleep and sedentary levels were assessed by questionnaire. Sleep was categorized into short (<7 hours/day), adequate (7-9 hours/day) and long (>9 hours/day). Follow-up was conducted for 10 years.

Results

Data from 3355 participants was analyzed. There were 136, 110 and 142 incident cases of diabetes as defined by FPG, HbA1c or any diagnostic criterion, respectively. On bivariate analysis, participants who developed diabetes had a higher level of sedentariness but no differences were found regarding sleep duration or prevalence of short or long sleepers. Similar results were obtained after adjusting for age, gender, education, smoking and body mass index (see table).

Conclusion

The findings of the study revealed that being sedentary, but not long hours sleep, is related to a higher risk of developing diabetes.
Genotyping of patients with severe dyslipidemia in a screening program for familial hypercholesterolemia. Studio Gioconda
Authors: Fernandez Olmo R , Marchal Martinez J , Martin Alcolea M , Torres Llergo J , Fernandez Anguita M , Garcia Ruano A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Familial hypercholesterolemia (FH) is one of the diseases of genetic origin that produces early cardiovascular disease (CVD), because the levels of low-density lipoproteins (LDL) are increased from an early age. In addition, when there are genetic variants in certain genes, the cardiovascular prognosis worsens. The objective of our work, was to evaluate those conditions that influence the genotyping of severe dyslipidemia in the context of a FH detection program.

Material and methods

We prospectively included all patients in the HF screening program at our center from February 1 to September 30, 2022. It was performed from Clinical Analysis, with an alarm system to detect severe dyslipidemia in patients over 18 years of age (LDL >190 mg/dl) in coordination with the Cardiology and Genetics Cardiovascular Prevention Unit, to select cases suitable for genetic study (Lipid Score of the Dutch Guidelines ³6 points).

Results

n = 353. Mean age 52.2 years. 51.6% women. 30% were hypertensive, 6% diabetic, 36% obese and 24% smokers. 33% had a family history (FaH) of CVD, 60% FaH of severe dyslipidemia and 10% FaH<18 years-LDLhigh. 2.6% had had a previous coronary event. Only 13% were on lipid-lowering treatment. The mean LDL-C levels were 207mg/dl and the rest of the lipid profile are shown in Table 1. 26.4% of patients underwent genetic study, 6.2% had pathogenic variants and 14% variants of uncertain significance (VUS). Patients with some genetic variant had higher levels of LDL (217 vs209 mg/dl;p0.016), Lp(a) (92vs40mg/dl;p0.003) and Non-HDL (248 vs 236 mg/dl;p0.015), were younger (45 vs. 52 years; p0.019) and FaH<18 years-LDLhigh (43vs8%;p<0.001). Patients with pathogenic variants had higher levels of LDL (219vs201 mg/dl;p0.008), Lp(a) (102vs43mg/dl;p<0.001) and Non-HDL (270vs236mg/dl;d<0.001), were younger (32vs52years;p0.003), FaH of<18 years-LDLhigh (100% vs9%:p<0.001) and CVD FaH (100% vs32%;p<0.014), with no differences between patients with pathogenic variants and VUS in terms of lipid levels, but if age [pathogenic variants (32 years) vs VUS (50 years);p 0.016].

Conclusions

In our study, 20% of probable diagnoses of FH present some type of genetic variant, influenced by age, LDL levels, Lp(a), Non-HDL and FaH of CVD and dyslipidemia.
Relationship between NT-proBNP and myocardial deformation in obese patients with acute myocardial infarction
Authors: Tomoaia R , Beyer R S , Zdrenghea D , Dadarlat-Pop A , Cismaru G R , Gusetu G R , Minciuna I A , Fringu F I , Simu G R , Gurzau D , Caloian B , Comsa D H , Rosu R , Pop D
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania, grant number 1529/66/18.01.2019.

Introduction

In addition to promoting coronary artery disease, obesity increases the risk of cardiovascular complications. The obesity paradox, however, refers to the observation that a high body mass index (BMI) may be protective of outcomes following an acute myocardial infarction (AMI). In patients with AMI, both NT-proBNP and novel echocardiographic markers (global longitudinal strain - GLS) provide additional information; nevertheless, there is limited research on the association between these parameters and obesity in this clinical setting.

Material and methods

This was a prospective study that included 55 patients admitted with AMI and preserved or mildly reduced LVEF (>40%), which all underwent successful percutaneous revascularization. At 48 hours after PCI, echocardiography was performed using a Vivid E95 scanner and the automated function-imaging (AFI) tool was used to determine GLS. NT-proBNP was measured using ELISA. All patients were divided into two groups according to their BMI (group 1 included 18 patients with normal BMI<25 kg/m2, and group 2 included 37 obese patients, with a BMI>30 kg/m2).

Results

The mean age of the patients was of 66±14 years, 58% were male and 65.5% had STEMI. Other than obesity, there was no difference between groups in the other cardiovascular risk factors (smoking, dyslipidemia, arterial hypertension, diabetes, age, gender). In both groups, the anterior descending coronary artery was the most frequent culprit vessel (44% vs. 40%, p=0.9). The majority of the patients had single- or two- vessel coronary artery disease (72% vs. 73%), but there were no differences between groups (p=0.74). The values of NT-proBNP were significantly lower in the obese group (300 [117-713] vs. 756 [450-1800] pg/mL, p=0.02). However, regarding the echocardiographic evaluation of myocardial function, there was no difference between the values of GLS (-10.5% vs. -10.8%, p=0.77) or LVEF (56.7% vs. 49.2%, p=0.27) among groups. GLS showed a stronger correlation to NT-proBNP values in the normal weight group (r=0.63) than in the obese group (r=0.27).

Conclusion

Despite the fact that increased BMI is linked to lower values of NT-proBNP following AMI, non-obese patients do not demonstrate more impaired myocardial longitudinal function. These findings might offer more insights on the perspectives of obese AMI patients.
Performance of the 2-minute stand up test and the association with peak oxygen consumption in cardiopathes
Authors: Nascimento De Almeida C N A , Cristiane Maria Costa Dias C M C , Mauricio Milani M M , Fernanda Matos Oliveira F M O , Marlus Karsten M K , Eduardo Sahade Darze E S D , Luiz Eduardo Fonteles Ritt L E F R
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fundo de amparo a pesquisa do estado da Bahia.

Introduction

The two minute sit-to-stand test (STST) quantifies the getting up and sitting down movement in 2 minutes. Its use has not yet been well established in patients with heart disease.

Purpose

To develop and validate an equation to estimate peak oxygen uptake (peak VO2) based on performance in STST.

Methods

Cross-sectional study with patients over 18 years with heart disease referred to a cardiovascular rehabilitation program, who were submitted to STST and Cardiopulmonary Exercise Test. Pearson's correlation analysis, multiple linear regression and ROC curve were used for statistical analysis. The association between determined and estimated peak VO2 was evaluated by the Bland-Altman analysis. p <0.05 was adopted as statistically significant.

Results

158 participants were included, with a mean age of 60±14 years, 75.3% male, 75.6% with coronary artery disease and 24.4% with chronic heart failure. The average left ventricular ejection fraction was 57±16 %. The tests resulted in mean peak VO2 of 19.2±6.4 mL.kg-1.min-1, and mean STST performance was 32±12 repetitions. There was a correlation between peak VO2 and STST (r=0.65; R2=0.57; p<0.001). Performance on STST ≥ 32 was the best cutoff point to predict peak VO2 ≥ 20mL-kg-1min-1 (AUC = 0.80; 95%CI 0.74-0.87; p<0.001), sensitivity 71% (CI95 %; 0.58-0.81) and specificity 81% (95% CI; 0.69-0.89). The resulting equation was: peak VO2 = 21.4 - (0.16*age) + (0.26* STST) - (3.1*sex); male=0, female=1. The peak VO2 estimated by the equation (19.3±5.1 mL-kg-1min-1) was not different (p>0.05) from the peak VO2 determined (19.71±6.8 mL-kg-1min-1).

Conclusions

STST was moderately correlated with peak VO2. The validated equation accurately estimated the peak VO2. The STST is useful in the assessment of patients with heart disease, helping to estimate peak VO2 and identify patients with peak peak VO2peak ≥ 20mL-kg-1min-1.
Does inclusion of cognitive measures improve the predictive performance of SCORE2 for future cardiovascular events in older adults?
Authors: Bobak M , Dalecka A , Pikhart H , Lu W
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union – Next Generation EU.

Introduction

The cardiovascular disease (CVD) risk prediction model SCORE2 uses several biomedical and behavioural factors. It is likely that other factors also contribute to CVD risk prediction. Cognitive impairment and CVD are associated and share several risk factors. While the causality of this relationship remains unclear, adding cognitive measures to risk prediction may improve the prediction of future CVD events.

Objective

We tested the hypothesis that including simple measures of cognitive functions improve the prediction of SCORE2 for future CVD events among middle aged and older subjects.

Methods

We used data on 13,391 Polish, Lithuanian and Czech adults without CVD at baseline (45–69 years) from the Health, Alcohol and Psychosocial factors In Eastern Europe cohort. Incident cases of myocardial infarction (MI), stroke, CVD mortality and composite (fatal and non-fatal) CVD events were identified over a 10-year follow-up. Baseline cognitive measures included immediate and delayed word recall (verbal memory and learning), animal naming (verbal fluency) and letter cancellation (attention, mental speed and concentration). Using competing-risks regression, relationships between cognitive functions and CVD outcomes were examined. Improvement in Area Under Curve Receiver Operator Characteristic (AUC-ROC) was used to compare predictive performance for CVD events of models including SCORE2 variables combined with cognitive tests vs SCORE2 alone.

Results

The incidence rates of MI, stroke, CVD mortality and composite CVD events were 5%, 4%, 4% and 11%, respectively. In multivariable analyses, all four cognitive measures were inversely associated with CVD outcomes; e.g. one standard deviation increase in immediate word recall score was associated with a 28% and 17% reduction in risk of CVD mortality and composite CVD events, respectively (all p-values <0.001). Adding cognitive measures to SCORE2 variables slightly improved the AUC-ROC for prediction of MI, CVD mortality and composite CVD events. For example, for the composite CVD measure, inclusion of all four cognitive measures increased the AUC-ROC from 0.6948 to 0.7030 (p<0.001) and similar improvement was seen for word recall. The results were consistent across countries.

Conclusion

Inclusion of a simple cognitive test in the assessment of cardiovascular health is feasible and it may improve prediction of future CVD risk, although in our data the improvement was not clinically important (despite being statistically significant). Further studies are needed to assess this proposition in larger prospective datasets.
Prevalence of left atrial thrombus in anticoagulated patients undergoing elective electrical cardioversion
Authors: Aguila Gordo D , Piqueras Flores J , Negreira Caamano M , Mateo Gomez C , Martinez Del Rio J , Soto Perez M , Blanco Lopez E , Cubides Novoa A F , Soto Martin P , Concepcion Suarez R , Freites Esteves A , Moron Alguacil A , Andres Sierra M , Jimenez Rubio B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction and objectives

The prevalence of left atrial (LA) thrombus in patients with atrial fibrillation (AF) or atrial flutter (AFL) on guideline-directed anticoagulation is nor well known, moreover, evidence on the presence of left atrial thrombus with different anticoagulation therapies provides heterogeneous results.

Methods

Ambispective, observational, single-center study that consecutively included 271 patients undergoing elective electrical cardioversion (ECV) for AF or AFL >48 hours of onset. A transoesophageal echocardiogram (TOE) was performed in all patients within 24 hours prior to ECV. Patients with <3 weeks of anticoagulation and those in sinus rhythm on admission were excluded, and the clinical characteristics and presence of atrial thrombus were analyzed in 172 patients.

Results

The main baseline characteristics are shown in Picture 1. A total of 66.5% of the patients were receiving treatment with direct oral anticoagulants (NOAC) dabigatran (15.9%); rivaroxaban (28.3%); apixaban (31.2%) and edoxaban (23.9%). The remaining 33.5% were anticoagulated with vitamin K antagonists (VKA). Eight thrombi were detected in the left atrial appendage (prevalence 4.7%), and on 2 occasions the presence of thrombus could not be ruled out, and CVE was also suspended. No statistically significant differences were observed between the prevalence of thrombus and the type of anticoagulant (NOAC vs VKA 4.5% vs 4.9%; p= 0.56) or between the different NOACs (p=0.61). Of the 8 patients with left atrial thrombus, anticoagulant treatment was modified in 3 of them. Control TOE was performed (median until new TOE 64 days), and resolution was verified in 3 cases (all under treatment with NOAC), of which 2 patients had maintained their previous anticoagulant treatment.

Conclusions

Anticoagulated patients scheduled for elective ECV present a prevalence of left atrial thrombus close to 5%. No differences were observed with respect to the anticoagulation treatment received.
One year results on a Spanish cardiac rehabilitation center
Authors: Sanchez Gimenez R , Peiro O , Carrasquer A , Camprubi M , Torla R , San Segundo R , Bardaji A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation programs (CRP) after myocardial infarction have an I-A recommendation level, according to European clinical guidelines, but in real life their implementation is very low. To improve secondary prevention, post-infarction CRP needs to be implemented and made it accessible to the public Spanish Health-care services.

Purpose

The aim of this study is to analyze the results after one year of CPR program in a tertiary Spanish hospital.

Methods

An observational study was performed on cardiac rehabilitation patients from October 2021 to November 2022. Patients were included in an individualized exercise program consisting in 3-days-supervised workout, self-home workout, life-style and nutrition lessons and medical treatment optimization. Demographics and analytic data were collected on the first visit and the last visit before discharge.

Results

One hundred patients were included (73.7% male, median age 60.9 years (SD 8.69)). Principal cardiovascular risk factors were arterial hypertension (55.5%), diabetes (29.3%), dyslipidemia (62.9%) and smoking (37.4%). ST-elevation myocardial infarction was the main prior diagnosis (47.5%) followed by non-ST myocardial infarction (39.4) and unstable angina (10.1%). Patients improved weight control - 1.67 kg (SD 2.89), abdominal circumference -2.7 cm (SD 2.6), exercise capacity 1.84 METS (SD 2.3), diet (PREDIMET scale) 1.6 points (SD 2.3) and anxiety and depression scale -1.05 points (SD 2.07). 85,7% of patient give up smoking. LDL-cholesterol reduction was -60.3 mg/dl (SD 38.58), reaching the LDL-cholesterol target by 66.3% (levels<55mg/dl) and on diabetic patients, glycated hemoglobin (HbA1c) achieves an 11.5% mean reduction from basal levels, reaching target levels (Hb A1c < 7%) on 68.2%.

Conclusion

CRP programs are an essential in secondary prevention and their implementation should be extensive to the majority of hospitals and primary care centers to promote life-style hacks and control cardiovascular risk factors.
Eicosapentaenoic acid (EPA) reduced expression of neutrophil activation proteins in endothelial cells during challenge with angiotensin II (Ang II) and cytokines
Authors: Sherratt S C R , Libby P , Bhatt D L , Mason P
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Amarin Pharmaceutical, Inc. Elucida Research LLC.

Background

Neutrophil degranulation contributes to atherogenesis and tissue injury in response to cytokine release and activation of the renin-angiotensin system (RAS), along with its effector angiotensin II (Ang II). Mixed omega-3 fatty acid (n3-FA) formulations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have not shown reduction in CV events compared to EPA-only formulations (REDUCE-IT), but the mechanisms of atheroprotection with EPA are not well understood.

Purpose

We measured the effects of EPA on expression of proteins related to neutrophil activation in vascular endothelial cells (ECs) under various inflammatory challenges, specifically exposure to Ang II and the cytokine IL-6 in vitro.

Methods

Human umbilical vein ECs (HUVECs) were challenged with the cytokine IL-6 at (12 ng/mL) and Ang II (100 nM) for 2 h, then treated with EPA (40 µM) for 24 h. Global proteomic analysis was performed using LC/MS to measure relative expression levels of over 2,500 proteins simultaneously. Only significant (p<0.05) changes in expression between treatment groups >1-fold (100%) were analyzed by differential enrichment analysis of proteomics data (DEP) and included in gene set enrichment analyses (GSEA).

Results

EPA significantly down/up-regulated expression of 507/505 and 544/472 proteins, respectively, compared with Ang II and IL-6 alone. The GSEA revealed EPA treatment significantly modulated expression of 88 and 80 proteins within the neutrophil degranulation pathway (Gene Ontology ID: 0043312), compared to Ang II and IL-6, respectively. Of these proteins, 20 were similarly modulated by EPA relative to each stimulus (13 decreased, 7 increased expression). This included a 110% decrease in expression of heat shock protein 90 (110%) and HSP 86 (110%) and a 140% and 110% increase in junction plakoglobin relative to Ang II and IL-6, respectively, which is also involved in endothelial cell-cell adhesion.

Conclusion

EPA modulated expression of multiple proteins linked to neutrophil degranulation following challenge with either Ang II or IL-6. The effects of EPA on neutrophil protein expression may lead to reduced inflammation and risk for patients with CV disease as demonstrated in outcome trials.
Motivational aspects of the cardiac rehabilitation programme
Authors: Coto Morales B , Del Castillo Carnevalli H , Basabe Velasco M E , Gomez Sanchez M I , Marti Sanchez D , Molinos A C , Rodriguez Biedma M F , Fuertes Pereiro J , Casanova Lopez L P , De Juan Bitria C , Delgado Cavia F A , Duarte Torres J , Biscotti Rodil M B , Rodriguez Gamero M A , Alvarez Anton A S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction/Background

Cardiac rehabilitation programmes have proven to be effective in many ways in patients with cardiovascular disease. In fact, its implementation has acquired a relevant role in the European Clínical Practice Guidelines. The reasons why the programmes are successful are diverse, including motivating patients to improve their lifestyle. But, what specific aspects keep the patient motivated in the cardiac rehabilitation programme?.

Method

An anonymous survey was administered to patients who completed cardiac rehabilitation programme and who were considered by their physicians as successul in terms of lifestyle changes. A 13-question questionnaire was distributes (Table 1) including baseline characteristics. Patients were asked to rate from 1 to 5 (being 5 the highets rating) how important each of thes items had been in terms of motivation.

Results

170 questionnaires correct completed were analyzed. Mean age was 66+/- 12 y.o. and 43 women (25%). The mode of studies level was primary school. Mean Value of Question (Q) 5: 4,68, Q6: 4,25 Q7: 4,54 Q8: 4,67, Q9:4,58 Q10: 3,91 Q11:3,962 Q12: 4,58 Q13:4,53.

Conclusions

Although many items were valued similarly, the most popular items were the trust in the information given by healthcare professionals( Q5) and the importance of feeling better and improving self-esteem (Q8), being scored over 4,5. On the other hand, the last popular items were the posibility of having a relapse (Q11) and the impact on social life (Q10) . The population who fulfilled the survey considered the programme valuable in terms of making them improve their lifestyle, being Q13 scored over 4,5 (4,53).
Potential for optimizing management of overweight and obesity in patients with established atherosclerotic coronary artery disease
Authors: Burazor I , Djokic O , Peric M , Bilic T , Subic O , Rankovic-Nenezic T , Tasic N , Tasic D , Otasevic P , Micovic S , Vukovic P , Nikolic A , Ostojic M , Bojic M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Obesity and overweight play a key role in the development of cardiovascular disease or myocardial ischemia, particularly today, as does their relationship to traditional and non-traditional risk factors. Despite, diet and weight management are grossly under-met per desired body mass index (BMI) threshold goals among very high-risk patients with established atherosclerotic cardiovascular disease (ASCVD). Thus, we aimed to investigate the presence of overweight and obesity in patients with established atherosclerotic cardiovascular disease who were admitted to our center.

Patients and methods: Out of 790 patients admitted in our center between May and October 2021, we analyzed 341 patients who underwent isolated coronary artery by-pass surgery. Risk factors were noted as well as previous drug therapy, previous COVID 19 infection and vaccination. Anthropometric data were measured and BMI was determined. Obesity was defined as a BMI >_30 kg/m2 and overweight as a BMI between 25 and 30 kg/m2 . Patients with a BMI >_40 kg/m2 were considered morbidly obese. Early cardiac rehabilitation (phase 1) was performed by using personalized approach in all patients.

Results

Out of 341 patients (64.68±7.91 years of age), 275 were males (80.6%). The total of 97 (28.44%) had previous myocardial infarction. Blood pressure was well controlled. Majority of the patients reached the step 2 goals according to EAPC Guidelines on prevention (130.7±6.45/75.27±6.54mmHg), and were adherent to prescribed drugs. Mean heart rate was 65±5.65/minute. Only 27% of females and 22% of males had normal weight with BMI between 18.5 and 24.9.kg/m2. The mean BMI was 27.76 kg/m2. 50% of males and females were overweight. Obesity was noted in 23% of females and 27% of males (0.7% morbidly obese. Early cardiac rehabilitation was performed in all patients and they were all referred to participate the phase 2 programs.

Conclusions

Diet and body weight reduction in overweight and obese ASCVD patients should continue to be a priority given the impact on cardiovascular risk. There is a potential for optimizing management of overweight and obesity in patients. In addition to a better risk factor profile, weight loss also leads to a better quality of life. Cardiovascular prevention and rehabilitation programs should include weight loss intervention. Different forms of self-support and use of digital health might be used as a specific component of a comprehensive intervention to reduce total cardiovascular risk, extend life expectancy, and improve quality of life.
Causal associations of alcohol with ECG-derived cardiovascular phenotypes in chinese adults
Authors: Ho A , Im B , Clarke R , Turnbull I , Chen Z M , Millwood I
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heavy alcohol consumption is associated with increased risk of stroke, but its role, especially moderate drinking, in other types of cardiovascular disease (CVD) remains inconclusive. Understanding how alcohol intake affects cardiac traits measured by electrocardiogram (ECG) can improve our understanding of the relationships between alcohol intake and risk of different types of CVD.

Purpose

This study aims to assess the causal associations of alcohol and ECG-derived cardiovascular phenotypes in Chinese adults, where two genetic variants which alter alcohol metabolism and greatly affect alcohol intake can be used in a Mendelian randomisation approach.

Methods

The prospective China Kadoorie Biobank recruited 512,715 adults from ten diverse regions in China between 2004-2008 and recorded baseline alcohol use and other characteristics. 151,035 participants were genotyped for two genetic variants that affected alcohol metabolism (ALDH2-rs671 and ADH1B-rs1229984), and 25,041 participants had ECG measurements taken at the 2013-2014 resurvey, broadly defined into phenotypes (ischaemia, left ventricular hypertrophy (LVH), arrhythmia) and continuous traits. Self-reported alcohol intake (conventional analysis) and genotype-predicted alcohol intake (genetic analysis) were related to the odds of ECG-derived cardiovascular phenotypes and the mean values of ECG continuous traits using multivariable logistic and linear regression models respectively.

Results

Among men, 35.0% drank alcohol regularly. There was a J-shaped association between ECG-defined ischaemia with self-reported alcohol intake, with a clear dose-response among current drinkers (OR 1.56, 95%CI 1.25-1.94 per 280g/week increase in alcohol intake (Figure 1)). However, there was no clear causal association in genetic analysis (1.02, 0.82-1.27 per 280g/week (Table 1)). There were no associations between alcohol intake and LVH or arrhythmia in conventional or genetic analysis. Among women, only 2.3% drank alcohol regularly, and there were no clear associations between alcohol intake and ECG measurements and derived phenotypes in either the conventional or genetic analyses. Genotype-predicted alcohol intake was associated with smaller P, QRS, and T-axis, and longer QRS and QTc duration in men, and marginally associated with ventricular rate in women.

Conclusion

This study found no clear causal associations of alcohol with ECG-derived cardiovascular phenotypes and continuous traits, and no evidence of a cardioprotective effect of moderate drinking on myocardial ischaemia.
Exercise and prevalence of cardiovascular disease in older female endurance athletes during 10 years follow-up
Authors: Johansen K , Sorensen E , Hylen Ranhoff A , Myrstad M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PhD student Kristoffer Johansen is funded by the Northern Norway Regional Health Authority (grant number HNF1568-21). The Birkebeiner Ageing Study has been funded by the Kavli research center for ageing and dementia and the Norwegian ExtraFoundation.

Background

Although research suggests that the health benefits of endurance sport practice is larger in female compared to male athletes, women are underrepresented in sports cardiology research. Furthermore, previous studies on endurance sport practice in women have mostly included younger to middle aged athletes. Thus, prospective studies addressing endurance sport practice and health among older female endurance athletes is lacking.

Purpose

The purpose of this study was to characterise how older recreational female cross-country skiers maintained exercise and cardiovascular health during 10-years follow up.

Method

Forty-six women aged ≥65 years that completed the 54-km Birkebeiner cross country ski race in Norway in 2009/2010 were included. The Birkebeiner race includes about 1000 uphill altitude meters and is considered one of the world's most challenging ski races. Participants answered a questionnaire addressing exercise habits and health issues at baseline in 2009/10 and at follow-up in 2014 and 2020. Thirty-five (76%) participants attended follow-up in 2014 and 36 (78%) participants attended follow-up in 2020. Descriptive statistics are given as mean ± SD for continuous variables and as percentages for categorical variables.

Results

Skiers (age 67.5 ± 2.2 years at baseline) reported a cumulative exposure to regular endurance exercise of 26 ± 15 years. The proportion reporting moderate- to vigorous exercise during the past year was 86% at baseline and 61% at follow-up in 2020. One woman died during follow up. During 10-years follow-up the cumulative prevalence of atrial fibrillation (AF) was 15.6%, more than twice as high as for other cardiac diseases (7.1%) and stroke (7.1%).

Conclusion

Most female athletes sustained a physically active and healthy lifestyle with advancing age. Notably, the prevalence of AF was twice as high as for other cardiac diseases and stroke. Thus, although previous literature indicates that the risk of AF in female athletes is reduced, our findings suggest that additional research is needed to draw more firm conclusions. Future studies aiming to further clarify the female athlete and AF association would greatly benefit from including older athletes that has accumulated several decades of endurance sport practice. In conclusion, further research aiming to close the knowledge gap between female and male athletes are highly warranted.
Effect of the phaleria macrocarpa extract on proprotein convertase subtilisin/kexin type-9 levels in healthy population
Authors: Desandri D R , Witarsa T R , Sukmawan R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Phaleria macrocarpa fruit extract was reported in decreasing the low-density lipoprotein cholesterol (LDL-C) level as well as increasing the high-density lipoprotein cholesterol (HDL-C) level in animal studies. Currently, proprotein convertase subtilisin/kexin type 9 (PCSK-9) has become a novel target for lipid modification, as it enhances the degradation of LDL-C receptors in hepatocytes. However, the effect of Phaleria macrocarpa fruit extract on PCSK-9 levels in humans remains unclear.

Purpose

To evaluate the effect of Phaleria macrocarpa fruit extract on PCSK9 levels in a healthy population.

Method

This is a randomised, double-blind, placebo-controlled clinical trial. A total of 40 healthy participants were included and randomised into two treatment groups, consisting of 2 x 500 mg of Phaleria macrocarpa extract (n = 20) and placebo (n = 20). Participants were followed for eight weeks. Clinical and laboratory parameters, including PCSK9 levels, were measured on the baseline and the eighth week. Intention-to-treat analysis was performed with a p-value of <0.05 was considered statistically significant.

Results

There was no loss-to-follow-up in each treatment group and the analysis was conducted according to the original group. Compared to the placebo group, the baseline features in the Phaleria macrocarpa extract group were not significantly different, except for the PCSK9 levels (21.1 ± 2.5 ng/mL and 23.9 ± 1.0 ng/mL respectively, p=0.000). After eight weeks of administration of the treatment, Phaleria macrocarpa extract failed to show any remarkable effect on the PCSK9 concentration in humans, as the PCSK9 level was not significantly different at the final evaluation compared to the baseline (23.7 ± 1.3 ng/mL and 23.9 ± 1.0 ng/mL respectively, p=0.455).±.

Conclusion

Phaleria macrocarpa fruit extract did not affect PCSK9 levels in a healthy population after eight weeks of administration.
Evolution of smoking-attributable cardiovascular mortality in Germany 1992-2020
Authors: Mons U
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Marga and Walter Boll Foundation, Kerpen, Germany.

Background

Despite comparatively weak tobacco control, smoking has steadily declined in Germany over the last 30 years. At the same time, while cardiovascular mortality rates have generally been decreasing in recent decades, population ageing leads to increasing numbers of deaths.

Purpose

To explore the impact of smoking prevalence on cardiovascular mortality against the background of these different trends at a population level, this study sought to quantify trends in smoking-attributable cardiovascular mortality (SACVM) in Germany over the past three decades.

Methods

Smoking and mortality statistics from 1992 to 2020 were obtained from the German Statistical Office, from which absolute and relative SACVM was calculated separately for each cardiovascular cause of death causally associated with smoking. The impact of population ageing was explored by comparing crude and age-standardized SACVM, respectively. To estimate the impact of population ageing on future SACVM, a forward projection until 2035 was modelled assuming constant mortality rates and a continuation of smoking trends.

Results

Results show that total absolute SACVM strongly declined over time, from about 71,900 cases in 1992 to about 42,000 cases in 2020, with a stronger drop in men (from about 51,200 to 26,400 cases) than in women (from about 20,700 to 15,600 cases). Somewhat stronger declines were seen for age-adjusted SACVM, with differences between crude and age-standardized SACVM being somewhat more distinct in men. Relative SACVM decreased overall, from 17.3% in 1992 to 14.6% in 2020. Sex-specific relative SACVM however showed differing trends: a strong decrease in men (from 29.3% to 18.8%) and a slight increase in women (8.6% to 10.6%). The forward projection of SACVM indicates a slight decline among men and a marked increase in women.

Conclusions

Results indicate that SACVM has strongly declined over the past three decades, even though being partly compensated by opposing trends in population ageing. The marked decrease in absolute SACVM seems to be mostly due to the general drop in cardiovascular mortality rates, and only partly due to declining smoking rates, particularly in women, where relative SACVM has even slightly increased. Over the next 15 years, population ageing and the increasing trend in relative SACVM among women might halt the recent declining trend in absolute SACVM. Hence, there is tremendous potential to curb the smoking-associated public health burden by implementing a comprehensive set of evidence-based tobacco control polices. Additionally, given still significant smoking rates in middle and old age, smoking cessation programs should be intensified.
Prognosis of various atrial fibrillation patterns in the general population
Authors: Tilly M J , Lu Z , Geurts S , Stricker B H , Labrecque J A , Ikram M K , De Maat M P M , De Groot N M S , Kavousi M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Senior Scientist Grant from the Dutch Heart Foundation.

Aims

Due to their dependence on temporality, current atrial fibrillation (AF) classifications are inaccurate and impractical in large cohort studies, resulting in scarce evidence on prognostic differences between AF patterns in the general population. Using our recently developed AF classification, we investigated potential differences in cardiovascular prognosis among participants with various AF patterns and matched non-AF individuals from the general population.

Methods

1,111 individuals from the general population were classified as 'single-documented AF episode' (sAF), 198 as 'multiple-documented AF episodes' (mAF), and 52 as 'longstanding persistent AF' (lpAF). Each group was independently matched with non-AF participants through propensity score matching. Participants were followed for the development of coronary heart syndrome (CHD), stroke, heart failure (HF), and cardiovascular mortality. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for each AF pattern.

Results

Stroke risk was 1.01; 0.82-1.28 (HR; 95% CI) for sAF, 1.36; 0.87-2.11 for mAF, and 1.44; 0.79-3.54 for lpAF, as compared to their matched participants. HF risk was larger in all AF patterns, with the gradient corresponding to AF severity: 3.48; 1.61-7.55 for lpAF, 2.78; 1.94-3.98 for mAF, and 1.71; 1.44-2.03 for sAF. Compared to non-AF participants, cardiovascular mortality risk was larger in the sAF (1.56; 1.37-1.79) and mAF (1.53; 1.11-2.12) categories, but not for lpAF (0.85; 0.40-1.82).

Conclusion

More severe AF patterns in the general population carried a larger HF risk. We observed a trend regarding a larger stroke risk in more severe AF patterns, albeit statistically not significant. Our new AF classification method may benefit comorbidity and mortality risk stratification associated with AF in a general population.
Stricter blood pressure control reduces rate of left ventricular hypertrophy and diastolic dysfunction in ethnic minority groups in the UK:E-ECHOES study
Authors: Shantsila A , Shantsila E , Lip G Y H , Gill P S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation (PG/05/036) Primary Care Research Network-Central England.

Background

Blood pressure (BP, mmHg) targets have been mainly determined based on the white ethnic group. Optimal BP levels have been less established in people of South Asian and African Caribbean origin. There is less data on how different office BP values influence the presence of cardiac target organ damage, left ventricular hypertrophy (LVH) and diastolic dysfunction (DD).

Methods

This study is based on the large prospective UK community Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES, South Asian and African-Caribbean origin, age ≥45 years). Echocardiography was used to diagnose LVH and DD following British Echocardiographic Society criteria. Optimal receiver operator curves (ROC) cut-off values for predicting LVH and DD were determined using the Leu method. Multivariable logistic regression, adjusted for age and sex, was used to determine the effects of different BP values for LVH and DD, using SBP 130-<140 and DBP 80-<90 as comparators (STATA 13).

Results

The study included 3200 South Asians (age 59±10, 52% women), of whom 1568 (49%) had LVH, and 1497 (47%) had diastolic dysfunction. Of people with LVH, 869 (55%) had SBP >140, and 372 (24%) had DBP >90. The optimal BP cut-off for ROC analysis was 139/80.5 for LVH and 139/80.5 for diastolic dysfunction. SBP <130 and DBP <80 were both associated with a 31% reduction in diastolic dysfunction (Table). BP ≥140/90 was strongly predictive of LVH and DD.

The study included 1922 African Caribbeans (62±12 age, 55% women), of whom 1186 (62%) had LVH and 1124 (58%) had DD. Of people with LVH, 778 (66%) had SBP >140, and 333 (28%) had DBP >90. The optimal BP cut-off for ROC analysis were 139/81.5 for LVH and 138/80.5 for DD. DBP <80 mmHg 27% reduction in LVH and 24% in DD (Table). BP ≥140/90 was strongly predictive of LVH and DD.

Conclusions

People of South Asian origin may benefit from stricter SBP (<130) control, and both ethnic groups may benefit from stricter DBP (<80) control.
Results of a new scale for the assessment of exercise intensity in cardiac rehabilitation programs
Authors: Gomez Sanchez M I , Fuertes Pereiro J , Basabe Velasco M E , Delgado Calva F A , Marschall A F , Duarte Torres J , Biscotti Rodil M B , Dejuan Bitria C , Tapia Martinez M , Ramos Alejos-Pita C , Casanova Lopez M A , Molinos Laita A C , Rodriguez Biezma M F , Alvarez Anton S A , Coto Morales B M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The intensity of exercise that patients perceive is difficult to measure objectively. In most Cardiac Rehabilitation Units (CRH) they use the Borg scale to try to objectify the intensity of the exercise session perceived by the patients. However, in most cases, patients find it difficult to qualify the intensity with a numerical value, and the values they provide are not usually high.

Purpose

To make a new scale to assess whether it could be more adapted to the intensity perceived by the patients.

Methods

The CRH team of the Gomez Ulla Central Defense Hospital developed a new scale (image 1) and it was used in a random sample of 26 patients, performing a descriptive analysis of the scores obtained in the initial training session, session 6, session 12, session 18, session 24 and final session. These results were compared with another group of 27 people who had completed the cardiac rehabilitation program and in which the modified Borg scale had been used.

Results

A total of 53 patients were included and they were subdivided into two groups, one group with 26 patients in which the new scale was used and another with 27 patients who used the modified Borg scale. The mean age in both groups was similar, 65 ± 10 in the first group and 64 ± 10 in the second, as was the percentage of the males (70% and 68%, respectively). In 73.5% of the cases, ischemic heart disease was the main reason for inclusion.

In both cases, the initial METS in ergometry (7.5 ± 2.5 in the first group and 6.3 ± 1.9 in the second) and the final METS (8.9 ± 3 and 8.4 ± 2.5, respectively) were similar. However, the exercise intensity assessment scores offered by the group of patients with the new scale in sessions 6, 12, 18, 24 and final, were significantly higher (image 2).

Conclusions

In cardiac rehabilitation, the intensity of exercise perceived by the patients is an important assessment to evaluate the quality of physical training. Providing patients with scales that are easier to understand and use helps us in the training planning and in their self-knowledge. With the elaboration of this scale we try to help them identify the intensity in a more objective way.