bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening and health education in barbershop centers for hypertension (SALOON-HTN)
Authors: Addad F , Bahri F , Zaghib H , Abdellatif N , Bennour E , Bouzouita M , Ben Jemaa N , Ladhib W , Abid L , Abdesslem S , Kachboura S
Published: November 2020

Background

Hypertension is a major concern of public health policy in Tunisia. However hypertension is both highly prevalent (almost 35% of the Tunisian population) and insufficiently treated and controlled, which is partly due to unawareness. Historically, barbershops previously have been used for blood pressure screening and to improve hypertension controlled rate

Objective

This study aimed to screen hypertension in barbershops.

Study design

SALOON-HTN is a cross-sectional, descriptive, non-interventional, multicenter survey aiming to screen hypertension by measuring blood pressure in barbershops, located in Metline Township (limited contact with the healthcare system). Twenty-seven barbershops hairdressers were trained by a medical staff to measure the blood pressure by an ambulatory device. All subjects willing to participate in the survey were asked to measure their blood pressure after at least 5 minutes rest. Three measures were performed by the Hairdressers, with an interval of 1 minute between each measure. The mean of the last two measures was considered. If the mean blood pressure level exceeded 135 and/or 85 mmHg the subject was referred to physician.

Patients

Adults aged more than 18 years were included.

Results

A total of 1 536 patients were included in the study. The mean age was 40.7±15 years; 57% were men. Among them, 54.2% had never measured their blood pressure; 439 (28.5%) participants had hypertension, only 136 (8.9%) of those with hypertension were aware of their condition, 95 participants (69.9% of those who were aware of their condition) were receiving treatment, and hypertension was controlled in 43.2% participants of those being treated. Overall control was worst in our study (8.9%).

Conclusion

Saloon-htn confirmed the poor control and unawareness of hypertension. There is an obvious need for programs to increase access to primary care physicians.

Funding Acknowledgement

Type of funding source: None
Hemodynamic and metabolic disorders in obese patients with resistant hypertension
Authors: Shalimova A , Psarova V , Kochuieva M , Kolesnikova O , Isaieva A , Prosolenko K
Published: November 2020

Resistant hypertension (RH) is an important cause of cardiovascular morbidity and mortality. Both true and pseudo-resistant arterial hypertension (AH) represent a big problem not only in blood pressure (BP) control, but also in those possible adverse cardiovascular events, the development of which is associated with failure to achieve target BP levels.

The aim of the study was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant AH.

Material and methods

The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target BP levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug. Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy.

Results

After 6 months of therapy, patients with RH had higher body mass index (BMI) and higher BP levels compared to patients without this condition. Patients with RH also had more pronounced cardiovascular remodeling, higher levels of triglycerides, insulin, HbA1c, more pronounced insulin resistant (IR), which was confirmed by greater HOMA-IR, greater imbalance of adipokines, proinflamation activity and higher activity of the renin-angiotensin-aldosterone system (RAAS). A comparative assessment of pseudo-resistance and true resistance showed that patients with true resistance differed from pseudo-resistant patients with significantly lower BMI (p=0.02). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p=0.04), higher activity of oxidative stress (malonic dialdehyde, p=0.01 and diene conjugates, p=0.03), a lower level of total antioxidant protection (p=0.00), a higher level of adiponectin (p=0.00), and a lower level of leptin (p=0.00), compared with pseudo-resistant patients.

Conclusions

Patients with resistant hypertension differed from hypertensive obese patients without resistance with higher BMI and BP, higher levels of triglycerides, insulin, HbA1c, more pronounced IR, cardiovascular remodeling, imbalance of oxidative stress - antioxidant protection system, higher proinflammatory and RAAS activity. Patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress - antioxidant protection and less pronounced adipokines imbalance.

Funding Acknowledgement

Type of funding source: None
A new odissey for the clinical cardiologist: the difficult application of arterial hypertension guidelines in patients with chronic coronary syndrome
Authors: Cosmi D , Mariottoni B , Cosmi F
Published: November 2020

Introduction

In hypertensive patients with chronic coronary syndrome (CCS), the 2018 European Society of Cardiology (ESC) arterial hypertension guidelines recommend target pressure ranges that can be difficult to apply, leading to possible medico-legal and other not insignificant problems.

Methods

In 2019 we evaluated blood pressure values measured according to the ESC 2018 recommendations in 2,456 patients. We focused on 505 asymptomatic patients with CCS, already undergoing antihypertensive drug treatment.

Patients with secondary hypertension, heart failure, atrial fibrillation, malignancies or life expectancy <1 year were excluded. We analyzed the incidence of high systolic pressure coexisting with diastolic pressure lower than the indicated target and the incidence of blood pressure below the targets indicated in asymptomatic patients in the various age groups considered.

Results

In 24% of patients aged ≥80 years we found an office systolic blood pressure ≥140 mmHg together with a diastolic <70 mmHg, confirmed at the 2- and 4-week control. These values were also recorded in 18% of patients aged 65–79 years and in 5% of those aged 18–65 years.

In asymptomatic patients aged 18–65 years old we found a systolic blood pressure <120 mmHg (considered not safe in the guidelines) in 4% of cases; SBP was <130 mmHg in 14% of patients aged 65–79 years and in 7% of those aged ≥80 years (considered not safe in the guidelines in these age group) (See table 1).

Conclusions

The daily application of the ESC 2018 guidelines is challenging, due to contradictory suggestions (is it necessary to reduce a high systolic pressure ≥140 mmHg in the presence of a diastolic below the level considered dangerous <70 mmHg?; in an asymptomatic patient should therapy be reduced or suspended if blood pressure levels are not within the range considered optimal and safe?). This problem does not occur in American and NICE guidelines. We think that this topic should be largely reconsidered; guidelines writers should ask themselves these questions in order not to make hypertension treatment difficult or arbitrary.

Funding Acknowledgement

Type of funding source: None
Vitamin D plasma concentration and VDR gene polymorphisms in patients with non-dipper hypertension
Authors: Tatarnikova I.S , Shpagina L.A , Gerasimenko O.N
Published: November 2020

The study of the effects of vitamin D today has a high interest in the scientific community.

We determined the plasma level of vitamin D and the polymorphisms of the vitamin D receptor gene (VDR rs1544410, VDR rs2228570) in patients with non-dipper hypertension.

In our clinic, we examined 160 patients aged 30–60, among which a group of hypertensive patients with dipper status included 52 people, a group of hypertensive patients with non-dipper status - 53 people, a control group of 55 people without hypertention, correlating in gender and age with study groups.

The 25 OH vitamin D level was lower in the hypertension groups, both dipper status - 20.5 (14.0; 23.3) ng / ml and non-dipper status 15.0 (12.0; 18.0) ng / ml compared with the control group - 26.0 (19.5; 30.5) ng / ml, p=0.003 and p<0.001.

The results of genotyping showed the presence of genetic features in hypertensive patients with non-dipper status compared with the hypertensive patients with dipper status and the control group at the rs2228570 locus of the VDR gene, p<0.001. The total frequency of genotypes in the following groups: in the non-dipper group the G / A genotype accounts for 49.1% (26), A/A – 41.5% (22), G/G – 9.4% (5); in the dipper group the G/A genotype was 65.4% (34), A/A – 19.2% (10), G/G – 15.4% (8); in the control group G/A – 47.3% (26), A/A – 10.9% (6), G/G – 41.8% (23) for rs2228570 of the VDR gene. Statistical differences from the dipper group and the control group were not obtained in rs1544410 of the VDR gene.

Further studies are needed to clarify the association between rs2228570 of the VDR gene, vitamin D levels and non-dipper status in hypertension.

Funding Acknowledgement

Type of funding source: None
Relationship between country income, socioeconomic factors and control of cardiovascular disease risk factors in patients with type 2 Diabetes: insights from the global DISCOVER registry
Authors: Malik A , Chen H , Cooper A , Gomes M , Hejjaji V , Ji L , Khunti K , Kosiborod M , Nicolucci A , Peri-Okonny P , Shestakova M , Tang F , Vora J , Watada H , Arnold S
Published: November 2020

Background

In patients with type 2 diabetes (T2D), optimal management of cardiovascular (CV) risk factors is critical for primary prevention of CV disease.

Purpose

To describe the association of country income and patient socioeconomic factors with risk factor control in patients with T2D.

Methods

DISCOVER is a 37-country, prospective, observational study of 15,983 patients with T2D enrolled between January 2016 and December 2018 at initiation of 2nd-line glucose-lowering therapy and followed for 3 years. In patients without known CV disease with sub-optimally controlled risk factors at baseline, we examined achievement of risk factor control (HbA1c <7%, BP <140/90 mmHg, appropriate statin) at the 3 year follow-up. Countries were stratified by gross national income (GNI)/capita, per World Bank report. We explored variability across countries in risk factor control achievement using hierarchical logistic regression models and examined the association of country- and patient-level economic factors with risk factor control.

Results

Among 9,613 patients with T2D but without CV disease (mean age 57.2 years, 47.9% women), 83.1%, 37.5%, and 66.3% did not have optimal control of glucose, BP, and statins, respectively, at baseline. Of these, 40.8%, 55.5%, and 28.6% achieved optimal control at 3 years of follow-up. There was substantial variability in achievement of risk factor control across countries (Figure) but no association of country GNI/capita on achievement of risk factor control (Table). Insurance status, which differed substantially by GNI group, was strongly associated with glycemic control, with no insurance and public insurance associated with lower odds of patients achieving HbA1c <7%.

Conclusions

In a global cohort of patients with T2D, a substantial proportion do not achieve risk factor control even after 3 years of follow-up. The variability across countries in risk factor control is not explained by the GNI/capita of the country.

Proportion of patients at goal

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The DISCOVER study is funded by AstraZeneca
Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction and estimating benefits from novel interventions
Authors: Welsh P , Welsh C , Celis-Morales C.A.C , Brown R , Ferguson L.D , Gray S , Mark P , Lewsey J , Lyall D.M , Gill J.M.R , Pell J , Jhund P.S , De Lemos J.A , Willeit P , Sattar N
Published: November 2020

Background

Lipoprotein (a) (Lp(a)) measurement may help guide CVD risk prediction, is thought to be causal in several CVD outcomes, and phase 3 intervention trials of Lp(a) lowering agents are underway. We aimed to investigate the population attributable fraction due to elevated Lp(a) and its utility in CVD risk prediction.

Methods

In 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated.

Results

Median Lp(a) was 19.7nmol/L (interquartile interval 7.6–75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95% CI 1.07–1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may be expected to reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%.

Conclusions

Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs to those with markedly elevated levels, if such drugs prove efficacious.

Population attributable fractions: Lp(a)

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Chest, Heart, and Stroke Association Scotland and British Heart Foundation
Cardiovascular health metrics of 122,788 couples: analysis of a nationwide epidemiological database
Authors: Itoh H , Kaneko H , Kiriyama H , Kamon T , Michihata N , Jo T , Morita H , Yasunaga H , Komuro I
Published: November 2020

Introduction

The American Heart Association suggests that cardiovascular health (CVH) metrics based on established risk factors and behaviors to reduce the morbidity and mortality of cardiovascular disease. Couples share environmental and lifestyle habits, and therefore, there can be an intra-couple correlation of CVH metrics. However, the clinical data on the association of the CVH metrics among couples are limited.

Purpose

We aimed to explore the intra-couple relationship of the AHA-defined cardiovascular health metrics using a nationwide epidemiological database.

Methods

This study is a retrospective observational cross-sectional analysis using the health claims database of the Japan Medical Data Center between January 2005 and December 2016. We modified the American Heart Association CVH metrics and defined ideal CVH component as following: 1) nonsmoking, 2) body mass index <25 kg/m2, 3) physical activity at goal, 4) untreated blood pressure <120/80 mm Hg, 5) untreated fasting glucose <100 mg/dL, and 6) untreated total cholesterol <200 mg/dL.

Results

We analyzed 122,788 heterosexual couples enrolled in the Japan Medical Data Center database. The average age of participants was 50.2±9.5 years in men and 48.6±8.9 years in women. Good correlation was observed between couples in terms of the modified ideal CVH metrics (Figure 1A). The prevalence of meeting ≥5 ideal components in the female partners increased from 31% in the male partners meeting no ideal components to 55% in those meeting 6 ideal components. The concordance ratio is particularly higher in the component of smoking status, blood pressure, and fasting glucose level. A man who meets ≥5 ideal components probably had a woman partner who meets ≥5 ideal components (Odds ratio 1.6, 95% CI: 1.6–1.7, p<0.001). The P value for the McNemar test was significant for all components, indicating that women apparently met ideal metrics for metrics in discordant Couples (Figure 1B).

Conclusion

Our investigation showed that there was a good intra-couple correlation of the ideal modified CVH metrics, suggesting the potential of couple-based assessment and management for improving CVH status.

Funding Acknowledgement

Type of funding source: None
Healthy diet and telomerase activity in patients with uncomplicated arterial hypertension
Authors: Pavlova O , Karabko I , Liventseva M , Barbuk O , Shafranovskaya E , Ogurtsova S , Mrochek A
Published: November 2020

Introduction

Telomere length is considered as a novel biomarker indicating the risk of a cell's age, metabolic disturbances and age-related diseases. The available evidence suggests that healthy diet with antioxidant nutrients, fruits and vegetables, Mediterranean diet can influence on telomere length. Telomerase enzyme answers the end replication problem that counters telomere shortening. The effects of the nutrition on telomere length and telomerase activity required further study.

Objective

To evaluate the association of the healthy diet with relative telomere length (RTL) and telomerase activity (TA) in patients (pts) with uncomplicated arterial hypertension (AH).

Material and method

The clinical and genetic examinations were performed in 90 people (42 patients with uncomplicated arterial hypertension (AH) and 48 normotensive individuals). Mean age of hypertensive pts was 51.5±9.3 and of normotensives was 48.5±10.2 years. RTL of peripheral blood leukocytes performed by previously validated real-time PCR. TA was determined by enzyme immunoassay method. Dietary habits, alcohol intake, smoking, level of physical activity, body mass index, waist circumference, presence of obesity, blood pressure (BP), glucose and cholesterol levels, depressive episodes and psychological stress according the international questionnaires were evaluated.

Results

Mean RTL was 0.86±0.14 in group of hypertensive pts and 0.91±0.10 in normotensives, p=0.139. The median TA was higher in normotensives – 5.9 ng/ml (IQR 4.1–9.6) than hypertensive pts – 4.0 ng/ml (IQR 3.3–7.3), p=0.004.The association was found between TA and more frequent consumption per week of vegetable and fish in both groups (r=0.501, p=0.005 and r=0.447, p=0.013 in hypertensive pts; r=0.297, p=0.045 and r=0.316, p=0.036 in normotensives, accordingly). In hypertensive pts also was found relation TA with daily fruit intake (r=0.493; p=0.006) and trend toward to dietary salt consumption (r=−0.316; p=0.08). Among normotensives there was negative trend to relation TA with daily consumption of meat (r=−0.291; p=0.056). There were no association RTL, TA with age, alcohol intake, smoking, levels of glucose and cholesterol, BP, obesity and psychological risk factors in two groups except for the relation TA with waist circumference in normotensives (r=−0.427; p=0.003).

Conclusion

The data suggests that the healthy diet with regular intake of fish, vegetable and fruit can influence on telomerase activity in patients with uncomplicated AH as well as in normotensive individuals.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Budget
Ultra-marathon training induces vasculoprotector microRNA-125a-5p expression
Authors: Postula M , Eyileten C , Soplinska A , Zareba L , Jarosz-Popek J , Fitas Z , Czajka P , Malek L
Published: November 2020

Introduction

Cardiovascular diseases are the leading cause of death worldwide. According to the World Health Organization data, they are responsible for approximately 31% of deaths annually. It is estimated that nearly 80% of premature CVDs are preventable by modification of lifestyle including regular physical activity. Endurance training can be described as long-time activity characterized by high dynamic and low to high power and was proven beneficial in CVD prevention. Several miRNAs, including miR-125a-5p had been reported to be regulated in response to exercise in healthy humans. Additionally, Let-7 family members are involved in initiation and development of inflammatory response and up-regulated after training.

Aim of study

Our aim was to determine the differences in inflammatory-related miRNA expression between ultramarathon runners and healthy controls.

Materials and methods

Three circulation inflammation-related miRNA related were chosen based on literature search. RNA was extracted from plasma samples using the mirVANA PARIS Kit and quality of extracted material was assessed using a fluorometric assay. RT-PCR was performed using the Taqman advance protocol on a high throughput thermal cycler. Mann Whitney U test was used for unpaired comparison and Spearman's Correlation was used for the database analysis with miRNA expressions, p<0.05.

Results

Let-7e, miR-125a-5p, and miR-126 were measured in 40 patients (31 ultra-marathon runners vs 9 control volunteers) We found that control volunteers had significantly lower miR-125a-5p expression levels than ultra-marathon runners (p=0.03). Additionally, miR-125a-5p showed strong positive correlation with number of ultra-marathons run in life, and number of runs exceeding 100km (r=0.473, p=0.01 and r=0.403, p=0.03, respectively). Besides, Let-7e was positively correlated with VE max (maximum ventilation) (r=0.449, p=0.01).

Conclusions

Our study showed that endurance training can increase the miR-125a-5p expression and this result is in the line of previous observation since miR-125a-5p reported as vasculoprotector and were elevated in response to all-out high-intensity running.

Figure 1. MicroRNAs expression comparison

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): “Preludium” from the National Science Center, Poland
Physical activity in patients with coronary heart disease: results from the EUROASPIRE V Survey
Authors: Fras Z , Jankowski P , Jug B , Gaita D , Wood D.A , De Bacquer D , Kotseva K
Published: November 2020

Background

Physical inactivity is common in patients with coronary heart disease (CHD) and associated with an unfavorable prognosis. The study aim was to assess the physical activity levels as well as the intention to become physically active in patients with stable CHD with an additional focus on the association with their risk profile.

Methods

Analyses are based on the cross-sectional EUROASPIRE V survey, conducted under the auspices of the ESC EURObservational Research Project in 2016–2017. The survey encompassed 8,261 CHD patients, included in 27 countries, with a mean age of 62.4 years (±9.6, range 18 - 80 years), 25.8% of them were female. Physical activity level according to the overall patients' risk profile and their medical management was assessed, and the intention to become physically active in order to reduce their risk for recurrent events was investigated.

Results

The physical activity status found in CHD patients included was far from satisfactory in general, since only 34.4% of those interviewed were regularly physically active (for more than 30 minutes duration on average 5 times a week). Nearly half (47.3%) of the patients reported they are performing more everyday physical activity in general after the index event; while only every fifth patient (21.4%) reported to follow the specific exercise advice from a health or exercise professional, every tenth (11.3%) attending the fitness club or leisure centre, and only 6.1% joining the community walking groups. Regular exercise to increase physical fitness (defined as planned physical activity performed 3–5 times per week for 20–60 minutes) was confirmed by 34.8%, while interestingly 40.4% of patients declared regular physical activity as part of the self-reported lifestyle change in order to lose their body weight. A better cardiovascular risk profile as well as receiving physical activity advice or weight loss advice was associated with better physical activity levels.

Conclusions

Although an increase in the proportion of patients being adequately physical active after their index event, physical activity levels remain suboptimal in many CHD patients. There is an obvious need for improvement, with regards to both finding more effective ways of advice and encouraging our patients to increase the amount of their everyday exercise, as well regularly to monitor their lifestyle change.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The survey was supported through research grants to the European Society of Cardiology from Amgen, Eli Lilly, Sanofi (Gold Sponsors), Pfizer (Silver Sponsor), and Ferrer and Novo Nordisk (Bronze Sponsors).
QT interval dynamicity during exercise test in adolescent athletes
Authors: Balykova L , Makarov L.M , Komolyatova V.N , Shchekina N.V , Ivyanskij S.A , Soldatov Y.O
Published: November 2020

In search of predictors of the life-threatening arrhythmias, the objective of this research was to study repolarization dynamics and reveal the signs of myocardial electrical instability in young athletes during exercise test (ET).

Methods

124 young athletes including 78 boys 11–16 years old and 50 healthy untrained boys were enrolled into the study. All the children underwent ET with ECG recording and manually evaluated durations of QT interval and its derivatives –QTc interval, calculated by Basett and Fridericia formulas (QTc, FQTc), QTc and FQTc interval dispersion. Rate-dependent QT interval parameters (“QT dynamics”) were measured using of linear regression formula for determining slope, intercept, and correlation (r) between QT and RR intervals (Zareba W, Bayes de Luna A, 2005).

Results

Initially and on low and moderate loading (25–100 Wt) the athletes had lower heart rate (HR) than in untrained, and quicker (3 min) restoration to initial level (<450 ms) during recovery. The athletes had higher absolute QT interval duration at rest due to bradycardia and myocardial hypertrophy. Beginning step II QTc and FQTc intervals and their dispersions shortening up to minimal in both athlete and untrained groups. Maximal QTc interval in athletes as well as in untrained was recorded at stage I (25 Wt) and did not exceed 460 ms in boys and 470 ms in girls versus 450 and 440 ms, respectively. Maximal QTc prolongation (δQTc) during ET (QTcmax − QTcmin) in athletes did not exceed 80 ms. A shorter FQTc duration compared to QTc was noted. More efficient rate-dependent QT interval reduction (“QT/RR hyperadaptation”) was noted in athletes at peak load: the upper limits of normal QTc, FQTc and dQTc were 400, 330 and 14 ms, respectively. These parameters increasing along with other (echocardiographic and biochemical) signs may serve as myocardial remodeling markers. Decreased (“flat”) slope QT/RR and lower level of QT/RR correlation (“hypoadaptation of QT to RR”) were recorded in athletes at rest and at the initial stages of load, probably due to a higher vagal tone. At the peak load increase both in slope (“steep slope”) and correlation QT/RR (“QT/RR hyper-adaptation”) was noted. Absence of this phenomenon was observed in athletes with cardiac remodeling.

Conclusions

Repolarization dynamics during ET test was similar in athletes and untrained children. Maximal QTc interval in athletes during ET was higher than in untrained and QTc shortening at peak load was more efficient. Complete restoration of HR and QTc intervals to the initial level in athletes occurred at an early recovery period (3 min). Absence of such dynamics gave evidence of myocardial remodeling.

Funding Acknowledgement

Type of funding source: None
Fib4 index is a more relevant marker for pulse wave velocity but not for carotid intima-media thickness in a men population
Authors: Ojima S , Kubozono T , Kawasoe S , Kawabata T , Miyahara H , Tokushige K , Ohishi M
Published: November 2020

Background

Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) are useful markers for predicting cardiovascular disease not only in patients with cardiovascular disease but also in the general population. On the other hand, liver disease due to obesity has become a problem and has been reported to be associated with the progression of atherosclerosis. Recently, an indicator of liver stiffness, the Fibrosis-4 index (Fib4 index), has been used to detect the pre-stage liver diseases. However, there is no report to investigate the association between atherosclerotic parameters such as IMT and PWV, and Fib4 index. The Fib4 index is a simple index calculated from age and three blood sample data, and it will be useful for screening for an early stage of atherosclerosis if we can show the association between Fib4 index and these parameters.

Purpose

To investigate the association between atherosclerotic parameters such as IMT or PWV and Fib4 index

Methods

We recruited 3, 128 men participants who underwent health checkup. IMT was evaluated by carotid ultrasonography, and branchial-ankle PWV (baPWV) was measured by an automatic device. We analysed the association of IMT or baPWV with Fib4 index and atherosclerotic risk factors such as age, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) and fasting blood sugar (FBS). baPWV ≥1,600 cm/s was defined high baPWV and we performed the receiver operating characteristics (ROC) analysis to demonstrate the significance of Fib4 index for baPWV.

Results

Mean Fib4 index was 1.39±0.68. In the univariate linear regression analysis, all factors such as age, SBP, LDL-C, FBS, Fib4 index were significantly associated with IMT or baPWV. On the other hand, in the multivariate linear regression analysis, Fib4 index was an independent factor for baPWV but not for IMT (IMT, p=0.498; baPWV, p=0.023). Figure 1 showed the result of ROC analysis to predict the high baPWV by Fib4 index. The area under curve (AUC) was 0.73, with the highest discriminating sensitivity and specificity at 0.71 and 0.65, respectively at Fib4 index = 1.27.

Conclusions

Fib4 index was significantly related to baPWV and could be the useful screening marker for arterial stiffness in a general men population.

Figure 1. ROC curve analysis

Funding Acknowledgement

Type of funding source: None
TCF21 variant is a risk factor for coronary artery disease and will it be a prognostic marker?
Authors: Temtem M , Serrao M , Pereira A , Santos M , Mendonca F , Sousa J.A , Monteiro J , Sousa A.C , Freitas S , Henriques E , Guerra G , Ornelas I , Drumond A , Palma Dos Reis R , Mendonca M.I
Published: November 2020

Background

TCF21 gene, encodes a basic-helix- loop- helix transcription factor, playing a critical action in the development of epicardial progenitor cells that give rise to coronary artery smooth muscle cells (SMC) and cardiac fibroblasts. Recent data suggest that TCF21 may play a role in the state of differentiation of SMC precursor cells that migrate to vascular lesions and contribute to fibrous cap.

Purpose

Investigate the association of TCF21 rs12190287G>C variant with coronary artery disease (CAD) in a Portuguese population and its role on the prognosis.

Methods

Case-control study with 3120 participants, 1687 coronary patients with at least 75% obstruction of a major coronary artery and 1433 controls. Genotyping used the TaqMan technique (Applied Biosystems) and then a univariate and multivariate logistic regression analysis were performed. After a mean follow-up of 5.01±4.2 years (interquartile range 1.96–7.57), the occurrence of the combined Major Adverse Cardiovascular Events (MACE) (Cardiovascular Mortality, non-fatal Myocardial Infarction, new Revascularization, Cerebrovascular Disease and Peripheric Vascular Disease) were registered and analysed by Cox regression. Finally, Kaplan-Meier survival estimate was performed.

Results

In the total population, GC+CC genotype was found to be associated with CAD with an OR of 1.285; CI: 1.022–1.614; p=0.031. After multivariate logistic regression, adjusted to traditional risk factors, the association with CAD remained significant for this genotype (OR=1.340; CI: 1.042–1.723; p=0.022).After Cox regression adjusted for confounding variables (age and sex, hypertension, diabetes, smoking, dyslipidemia, eGFR, Ejection fraction <55) the mutated genotype remained a significant predictor of MACE (HR=1.420; CI: 1.032–1.953; p=0.031). The individuals carrying the mutated allele (GC+CC) at the mean follow-up showed an event probability of 36.1%, whereas the wild population (GG) presented only 23.4%. The Log-Rank test showed significant differences between the two curves (p=0.019).

Conclusion

The mutated TCF21 variant can provide a new marker to identify patients at high cardiovascular risk and may representa potential target for gene therapy in future.

Figure 1

Funding Acknowledgement

Type of funding source: None
Does coronary calcium scoring adds value to cardiovascular risk prediction in asymptomatic population?
Authors: Serrao M , Temtem M , Pereira A , Monteiro J , Santos M , Sousa A.C , Henriques E , Freitas S , Ornelas I , Drumond A , Palma Dos Reis R , Mendonca M.I
Published: November 2020

Background

Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction, in asymptomatic population. The inclusion of CAC scoring in traditional risk models may help in decision-make providing better cardiovascular risk stratification.

Purpose

The aim of our study is to estimate the impact of CAC scoring in cardiovascular events risk prediction in a model based on traditional risk factors (TRFs).

Methods and results

The study consisted of 1052 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for the CAC scoring assessment. A cohort of 952 was followed for a mean of 5.2±3.2 years for the primary endpoint of all-cause of cardiovascular events. The following traditional risk factors were considered: (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary heart disease. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high CAC (CAC≥400 or P>75). Two Cox regression models were created, the first only with TRFs and the second adding the CAC severity categories. When including CAC categories to the TRFs, the higher severity level presented a significant risk of MACE occurrence with an HR of 4.39 (95% CI 1.83–10.52; p=0.001).

Conclusion

Our results point to the importance of the inclusion of CAC in both primary and secondary prevention to an improved risk stratification. Larger prospective multicentre cohorts with longer follow-up should reproduce and validate these findings.

Funding Acknowledgement

Type of funding source: None
Lower levels of low-density lipoprotein cholesterol are associated with lower prevalence of thin-cap fibroatheroma in statin-treated patients with coronary artery disease
Authors: Hashimoto T , Minami Y , Asakura K , Katamine M , Kato A , Katsura A , Muramatsu Y , Sato T , Kameda R , Meguro K , Shimohama T , Ako J
Published: November 2020

Background

Lowering low-density lipoprotein cholesterol (LDL-C) with statins slows progression of atherosclerotic plaques and reduces cardiovascular events. The 2019 European Society of Cardiology guideline for the management of dyslipidaemias recommends the absolute LDL-C treatment target as <55mg/dL for very high-risk patients, <70 mg/dL for high-risk patients and <100 mg/dL for moderate-risk patients. However, the difference in plaque composition of coronary lesions according to these LDL-C levels remains to be elucidated.

Purpose

To investigate plaque morphologies according to LDL-C levels in statin-treated patients with coronary artery disease (CAD).

Methods

A total of 685 consecutive statin-treated patients with CAD, who underwent optical coherence tomography (OCT) imaging of culprit lesions were enrolled. The prevalence of vulnerable compositions in culprit plaques evaluated by OCT was compared among the groups of patients classified by LDL-C levels (<55, 55–70, 70–100, ≥100 mg/dL).

Results

LDL-C levels <55 mg/dL, <70 mg/dL and <100 mg/dL were observed in 6.3%, 21.8% and 63.9% of patients, respectively. The prevalence of thin-cap fibroatheroma was significantly different among the groups (P=0.014, Figure) with a trend toward lower prevalence in the lower two LDL-C groups than in the higher two LDL-C groups. A gradient with lower prevalence of thrombus in lower LDL-C groups was observed, although the statistical significance was not demonstrated (Figure). There was no significant difference in the prevalence of macrophage or cholesterol crystal among the groups.

Conclusions

Lower LDL-C level was associated with a trend toward lower prevalence of thin-cap fibroatheroma and thrombus in statin-treated patients with CAD.

Funding Acknowledgement

Type of funding source: None
Potential determinants of coronary calcium score in a population at intermediate cardiovascular risk
Authors: Brusq C , Bongard V , Berard E , Taraszkiewicz D , Ferrieres J
Published: November 2020

Background

Understanding determinants of coronary calcium score could lead to the development of new preventive actions for reducing cardiovascular risk. Our hypothesis is that major cardiovascular risk factors are linked with coronary calcium score, but the parameters associated with moderate or high scores could be different.

Purpose

The aim of our study was to explore the potential determinants of moderate and high elevation of coronary calcium score in a population of patients at intermediate cardiovascular risk.

Methods

We conducted a cross-sectional analysis, using data from a prospective cohort. Our study population was composed of people presenting with cardiovascular risk factors, who were referred by their attending physician for a complete assessment of their risk factors and for screening for silent cardiovascular disease. People in secondary prevention could also be referred. Coronary calcium score was assessed by cardiac CT scan. We used the following categories for classifying patients according to their coronary calcium score: low (0–100 AU (Agatston units)); moderate (101–300 AU) and high calcium score (greater than 300 AU). We performed a descriptive analysis and then we built a multinomial logistic regression model, using the low calcium score category as reference.

Results

Among the 1585 patients included in the database, we analyzed data from 1402 individuals who beneficiated from coronary calcium scoring. The sample included 714 (51%) men, and 144 (10%) people with a history of cardiovascular disease. Mean age was 59 yrs. Data from the multivariate analysis showed that age (OR=1.07; 95% CI [1.054–1.091] for 1-year increase), gender (OR=0.461; 95% CI [0.330–0.643] for women versus men) and smoking more than 20 cigarettes per day (OR=2.893; 95% CI [1.207–6.935]) were associated with a moderate calcium score. Variables associated with a high calcium score were: age (OR=1.097; 95% CI [1.076–1.119] for 1-year increase), gender (OR=0.221; 95% CI [0.151–0.323] for women vs men), treated dyslipidemia (OR=2.108; 95% CI [1.467–3.027]), treated hypertension (OR=2.199; 95% CI [1.523–3.175]), and history of cardiovascular disease (OR=4.138; 95% CI [2.510–6.823]).

Conclusions

In this study, well-known and modifiable cardiovascular risk factors are associated with calcium score. However, our results highlight that determinants of moderate and high scores may be different. While tobacco is associated with a higher risk of moderate calcium score, hypertension and dyslipidemia appear to be preferentially linked with the highest scores. It is thus appropriate that the 2019 ESC/EAS guidelines for dyslipidemias have classified patients with hypertension and dyslipidemia in the high risk category.

Funding Acknowledgement

Type of funding source: None
Socioeconomic status, secondary prevention activities during the first year after a myocardial infarction and target attainments
Authors: Ohm J , Skoglund P.H , Habel H , Sundstrom J , Hambraeus K , Jernberg T , Svensson P
Published: November 2020

Background

Socioeconomic status (SES) is a strong predictor of recurrent events post-myocardial infarction (MI) with unclear underlying mechanisms. To what extent SES is associated with secondary prevention activities (SPAs) and attainment of quality-of-care treatment goals is unknown.

Purpose

We aimed to assess the association between SES and SPAs during the first year post-MI and attained treatment targets at the 1-year follow-up.

Methods

Nationwide Swedeheart registry-based cohort study on 30,191 18–76 year old 11–15 month survivors of a first MI (8,180 women) 2006–2013. Complementary individual-level clinical data and data on SES (age and gender stratified quintiles of disposable income, level of education, and marital status), were linked from other national registries. Associations between SES and the outcomes were estimated in multivariable logistic regression models with basic adjustment for potential registry-related confounding.

Results

The associations between all indicators of SES and attendance to patient education and physical training programs were strong, moderate for dietary program attendance but absent for participation in smoking cessation program (Table 1). Higher SES was also associated with repeated lipid profile measurements and the highest vs lowest income with intensified statin therapy.

Correspondingly, higher SES was associated with having achieved target levels of LDL-C, blood pressure, and HbA1c as well as with persistence to and being on high intensity statin treatment (Figure 1). Further, higher SES was strongly associated with having quit smoking. No association with income was however observed regarding the weekly physical activity goal.

Conclusions

Higher SES was strongly associated with most SPAs including programs aiming at life style change and risk factor control as well as with attainment of corresponding secondary prevention targets. This may be explanatory for higher long-term risk of recurrent disease.

Figure 1. Target Attainment Forest Plots

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Stockholm City Council and The Swedish Heart and Lung Association
Non-statin lipid-lowering therapy in coronary atherosclerosis regression: a meta-analysis and meta-regression
Authors: Lobo L.M , Molinero G , Masson W , Siniawski D , Masson G , Huerin M , Nogueira J.P , Benincasa F , Losada P , Suarez F
Published: November 2020

Introduction

Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. However, the studies were mostly small and their results were not always robust.

Objectives

(1) to define if a dual lipid-lowering therapy (statin ± non-statin drugs) is associated with coronary atherosclerosis regression, estimated by intravascular ultrasound (IVUS); (2) to assess the association between dual lipid-lowering-induced changes in LDL-C and non-HDL-C levels and atherosclerosis regression.

Methods

We performed a meta-analysis including trials of non-statin lipid-lowering therapy, reporting C-LDL, non-HDL-C and total atheroma volume (TAV) with a minimum of 6 months of follow-up. The primary endpoint was defined as the change in TAV measured from baseline to follow-up, comparing groups of subjects on statins alone versus combination of statin and non-statin drugs. The random-effects model and meta-regression were performed.

Results

Eight eligible trials of non-statin lipid-lowering drugs (1759 patients) were included. Overall, the dual lipid-lowering therapy was associated with a significant reduction in TAV [−3.5 mm3 (95% CI: −4.5 to −2.6)]; I2=11%]. In the analysis stratified according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors), the findings were similar. In a meta-regression, a 10% decrease in LDL-C or non-HDL-C levels, was associated, respectively, with 0.92 mm3 and 1.05 mm3 regressions in TAV.

Conclusion

Our data suggest the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in significantly increased regression of TAV. When the LDL-C and non-HDL-C levels reached were lower, the observed effect was also greater.

Forest Plot by Drugs Group

Funding Acknowledgement

Type of funding source: None
Drug related metabolites and genetic polymorphisms predict low low-density lipoprotein cholesterol response to atorvastatin treatment in patients with coronary heart disease
Authors: Munkhaugen J , Sverre E , Kristiansen O , Fagerland M.W , Peersen K , Bergan S , Gullestad L , Husebye E , Vethe N.T
Published: November 2020

Background

There is considerable individual variation in the low-density lipoprotein cholesterol (LDL-C) reduction at all classes and doses of statins. Knowledge of the determinants of individual variation LDL-C response upon statin treatment may pave the way for personalized and optimized statin treatment.

Purpose

We aimed to determine clinical and drug related predictors of variability of LDL-C response to atorvastatin 40 mg in patients with coronary heart disease.

Methods

This is an explorative study among 70 patients enrolled in the MUscle Side-Effects of atorvastatin in coronary patients (MUSE) randomized double blinded cross-over trial. Absolute and relative changes in LDL-C after 7 weeks treatment with atorvastatin 40 mg/day and 7 weeks treatment with placebo, were calculated for each patient. Linear regression analyses were applied to investigate the association between clinical (10 variables) and drug related (atorvastatin and/or metabolites, 18 variables) predictors and changes in LDL-C.

Results

Adherence to allocated treatment was high as confirmed by atorvastatin levels in blood and a mean proportion of days covered of 99% (range 91–100%). Mean reduction in LDL-C on atorvastatin treatment (LDL-C atorvastatin – LDL-C placebo) was 2.1 (SD 0.7, range 0.3 to 3.4) mmol/L. Mean percentage reduction in LDL-C was 51.1 (SD 11.2, range 29 to 60)%, and 37 patients (52.9%) had <50% LDL-C reduction. Genetic polymorphisms in SLCO1B1 or CYP3A (B 0.06, 95% CI 0.01 to 0.12, p=0.026), increasing number of coronary events (B 0.06, 95% CI 0.002 to 0.10, p=0.005), increasing trough concentration of 4-OH atorvastatin lactone (B 0.05, 95% CI 0.01 to 0.08, p=0.005) and increasing trough concentration of 4-OH atorvastatin acid (B 0.05, 95% CI 0.01 to 0.08, p=0.006) were the significant determinants of lower relative change (%) in LDL-C, in adjusted analyses. Age, gender, somatic comorbidity, cardiovascular risk factors, statin dependent muscle side-effects and other clinical and drug related determinants were not associated with changes in LDL-C.

Conclusions

There is considerable inter-individual variation in the LDL-C response upon treatment with atorvastatin despite confirmed high statin adherence. This is the first study reporting that genetic polymorphisms involved in the metabolism of statins and atorvastatin metabolites predict lower LDL-C response.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Association of Health, Grant/Award