bluuebunny/crossref_metadata_2025 huggingface dataset:
New protein biomarkers associated with risk of myocardial infarction in women: the CorFemina project
Authors: De Martin T V , Saether J C , Langaas M , Bye A
Published: June 2024

Background

The burden of cardiovascular disease (CVD) is extremely large in terms of morbidity and mortality worldwide, and it is the leading cause of death in women. Several traditional CVD risk factors are modifiable through lifestyle interventions and medical therapy, and thus, early identification of risk is of great importance to prevent CVD. However, current CVD risk prediction models fall short in risk stratification, particularly for women. Therefore, the discovery of new CVD biomarkers holds the promise to improve the prediction of CVD risk in women.

Purpose

This pilot study aimed to identify new protein biomarkers associated with risk of myocardial infarction (MI) in women.

Methods

The study adopted a retrospective nested case-control design with incidence of MI as endpoint during a 5-year follow-up. Cases and controls were drawn from women (45-74 years old) with a low 10-year risk of acute MI calculated using the NORRISK2 model and available serum samples in the Trøndelag Health study (HUNT) biobank. Using registry data, 24 cases that experienced MI or coronary event requiring percutaneous coronary intervention were selected, and 25 age-matched women that remained CVD-free served as controls. The Olink Cardiometabolic panel II was used to quantify 96 proteins in serum samples. Differences between case and control groups were tested using a two-sample t-test at nominal significance level .05 for every protein and the results were corrected for multiple testing using the Benjamini-Hochberg method (controlling the false discovery rate, FDR).

Results

In total, 10 protein biomarkers had a nominal significant lower concentration in cases compared to controls. Differences were observed in biomarkers of inflammation (i.e., interleukin 18, interleukin 27, interleukin-1 receptor-like 2, lymphotactin), as well as in proteins associated with atherosclerosis, extracellular matrix remodelling, cell proliferation, plaque progression and instability (i.e., matrilysin, dickkopf-related protein 1, bone morphogenetic protein 6). We found a dysregulation in V-set and immunoglobulin domain-containing protein 2, a transmembrane protein with immunosuppressive properties, and alpha-L-iduronidase, an essential enzyme for the breakdown of glycosaminoglycans (GAGs). Accumulation of GAGs has previously been linked to atherosclerosis, clot formation, and myocardial fibrosis. However, none of the biomarkers was significantly different between groups after adjustment for multiple testing (adjusted FDR, p=.293). Results are presented in Figure 1 and 2.

Conclusions

Several protein biomarkers were significantly different at baseline between women that had a cardiovascular event within a 5-year follow-up and women that remained healthy. These biomarkers point toward a pivotal role of inflammation and immune dysregulation in CVD pathway in women. The differences were not significant after adjustment likely owing to the small sample size of this pilot study.
Intima-media thickness measured at the common carotid artery, carotid bifurcation, and internal carotid artery in cardiovascular risk assessment
Authors: Seekircher L , Tschiderer L , Willeit P
Published: June 2024

Background

Current guidelines recommend measuring carotid intima-media thickness (IMT) at the common carotid artery (CCA), because these measurements are considered to have a higher precision and reproducibility than IMT values assessed at the carotid bifurcation (BIF) or the internal carotid artery (ICA). However, available evidence from prospective cohort studies on the association with disease risk is conflicting.

Purpose

We aimed to reliably quantify associations of CCA-, BIF- and ICA-IMT with the risk for atherosclerotic cardiovascular disease and their added predictive values.

Methods

We analysed participant-level data of 20 prospective studies from the Proof-ATHERO consortium. We pooled study-specific hazard ratios for cardiovascular disease (CVD, defined as coronary heart disease or stroke) using random-effects meta-analysis.

Results

Individual records were available for 47,358 participants. The mean age was 56 years (standard deviation [SD] = 11), 49% were female, 10% had a history of CVD, 7,115 CVD events were recorded, and the median follow-up was 6.1 years. Mean IMT baseline values were 0.80 mm (SD 0.25) at the CCA, 1.04 mm (SD 0.44) at the BIF, and 0.86 mm (SD 0.42) at the ICA and differed by a mean of 0.07 mm (95% confidence interval [CI]: 0.03-0.10 mm; P<0.001) between CCA and ICA, 0.26 (0.21-0.32, P<0.001) between CCA and BIF, and 0.20 (0.17-0.23, P<0.001) between BIF and ICA. Correlation coefficients between segment-specific IMT values were moderately strong (CCA-BIF: 0.47 [95% CI: 0.43-0.51]; BIF-ICA: 0.49 [0.42-0.55]; CCA-ICA: 0.39 [0.34-0.44]). CCA-, BIF- and ICA-IMT were approximately linearly associated with CVD risk. Hazard ratios per SD higher IMT were 1.20 (95% CI: 1.15-1.26; I²=36.2%) for CCA-IMT, 1.20 (1.12-1.28; I²=65.5%) for BIF-IMT, and 1.16 (1.11-1.21; I²=32.4%) for ICA-IMT when adjusted for age, sex, and history of CVD and did not differ significantly between the three segments (CCA-BIF: P=0.775; CCA-ICA: P=0.077; BIF-ICA: P=0.134). In a multivariable adjusted model, hazard ratios attenuated to 1.15 (1.13-1.18) for CCA-IMT, to 1.11 (1.04-1.19) for BIF-IMT, and to 1.12 (1.10-1.15) for ICA-IMT but remained statistically significant. Adding IMT at all three segments to a model containing conventional CVD risk factors provided a greater C-index improvement than adding IMT at one segment only (+0.0071 vs. +0.0056 for CCA-IMT [P<0.001] or +0.0053 for BIF-IMT [P<0.01] or +0.0038 for ICA-IMT [P<0.001].

Conclusion

The associations of CCA-, BIF- and ICA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when IMT was measured at all three segments.
Optimization and validation of high, intermediate and low risk cut-off points in risk functions for primary cardiovascular prevention. The ORESTES project
Authors: Herrera Marin N , Subirana I , Camps-Vilaro A , Palomo I , Sanchis J , Serrano J , Tizon-Marcos H , Degano I R , Garcia-Lledo A , Gil M , Marrugat J
Published: June 2024

Background

Medical societies recommend strategies based on the identification of high-risk individuals using mathematical functions that provide risk scores for ischemic heart disease (IHD) or cardiovascular disease (CVD) at 10 years or more. Each function suggests its cut-off points (generally multiples of 5) that classify patients into low, intermediate and high/very high-risk levels. The proportion of general population classified in the low-, intermediate- and high-risk groups may vary significantly depending on the risk function used. Therefore, we postulate that cut-off points can be setup in such a way that the distribution of the population (percentile distribution) among the risk groups is the same regardless of the risk function.

Purpose

To determine the risk cut-off points that produce the same population distribution in the low (65%), intermediate (20%) and high-risk (15%) categories, for the most commonly IHD and CVD scores: Framingham IQ, REGICOR-IHD, FRESCO-IHD, SCORE2, FRESCO-CVD, CUORE and AHA. And to compare and evaluate their performance according to the proposed percentile distribution cut-off points.

Methods

We used a population-based cohort of 816,834 residents aged 45 to 74 years in Catalonia, Spain, with a median of a following-up greater than 10 years including fatal and non-fatal cardiovascular events and all-cause fatal events. Individuals baseline characteristics, i.e. age, sex, cholesterol, diabetes, smoking status, blood pressure and lipid-lowering and hypertension treatments, were obtained from the Primary Care Center Registries. Fatal and non-fatal events were obtained from Mortality and Hospital discharge records, respectively. The number of individuals with complete data was 437,734. The cut-off points were calculated using the percentile distribution. Performance and concordance of the risk functions are assessed by the categorical Net Reclassification Index (cNRI) and the Number Needed to Treat (NNT), and by Kappa index, respectively.

Results

Table 1 shows the cut-off points in the risk (%) of IHD and CVD necessary to obtain an equivalent population distribution of 65% at low risk, 20% at intermediate and 15% at high risk with the considered functions (percentile cut off-points), and the performance measurements (cNRI and NNT). Table 2 shows the pairwise Kappa index in assigning individuals in one of the three risk groups defined by the percentile cut-off points.

Conclusions

The ORESTES project successfully establish cut-off points in the risk of IHD and CVD calculated using 7 risk functions commonly used in Europe, which define equivalent population groups for low, intermediate and high risk.
The Relationship between updated Systemic Coronary Risk Estimation (SCORE 2) and markers of subclinical atherosclerosis and target organ damage in asymptomatic population with metabolic syndrome
Authors: Kostic S , Djordjevic D , Deljanin Ilic M , Tasic I , Stoickov V
Published: June 2024

The updated SCORE algorithm (SCORE2) estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in apparently healthy people aged 40-69 years with risk factors that are untreated or have been stable for several years.

Aim of study

This study evaluated the association between SCORE 2 and markers of subclinical atherosclerosis and target organ damage in asymptomatic patients with metabolic syndrome (MetSy).

Method

The study included 131 participants, without manifested cardiovascular disease. The patients were divided into 2 groups. The first group (I) consisted of subjects with MetSy, n=67 (age: 53,5 ± 8,00), the second (II) group is control, without MetSy, n=64. For all patients was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidaemia, smoking, diabetes, obesity, age), SCORE and SCORE 2, laboratory analysis, anthropometric measurements, fatty liver index (FLI), microalbuminuria, echocardiographic examination, carotid ultrasound (with measurement intima-media thickness (C-IMT), analysis carotid atherosclerotic plaques), exercise stress testing.

Results

Subjects with MetSy had a higher average number of risk factors, SCORE and SCORE 2 level (p<0,0001), body mass index (p<0,0001), FLI (p<0,0001), more often present fatty liver (83 vs. 21%, p<0,0001). C-IMT were significantly higher in the group with MetSy (0,80 ± 0,20 vs. 0,60 ± 0,09, p<0,0001). The high C-IMC values (≥0.90) were observed in 26% patients with MetSy, p<0,0001. Patients with MetSy had more frequently one or more carotid plaques (p<0,0001), higher average number of carotid plaques (p = 0,01) and percentage of stenosis (p=0,001). In MetSy group plaques were mostly fibrocalcified (28%), followed by fibrous (22%) and calcified, in non MetSy group were fibrous (14%). Subjects with MetSy had a higher average left ventricular mass (p=0,001); more frequently had diastolic dysfunction (p<0,0001) and left atrial dilation (p<0,0001); 9 subjects (15 %) from the I group had a positive stress test. There was no difference in the frequency of microalbuminuria between the two groups. There is a correlation between SCORE 2 and very high risk level with carotid intima-media thickness and carotid plaques (p<0,0001), left ventricular mass (p=0,01), diastolic dysfunction (p<0,0001), microalbuminuria (p=0,03) and positive stress test (p=0,01). Multivariable logistic regression analysis showed that SCORE 2 was associated with presence of carotid plaques and C-IMT (95 % CI 0,007-0,019; p<0,001).

Conclusion

Our study showed a significant association between the SCORE 2 and markers of subclinical atherosclerosis and target organ damage in asymptomatic population with metabolic syndrome.
Laboratory parameters associated with elevated coronary artery calcium burden in patients with newly diagnosed type 2 diabetes mellitus
Authors: Bakalli A , Hyseni V , Gjikolli B , Krasniqi X , Elezi S
Published: June 2024

Introduction

Cardiovascular complications are not exclusive to long-standing diabetes mellitus (DM); newly diagnosed type 2 diabetes mellitus (NDT2DM) may also be associated with cardiac problems, although this aspect has been less thoroughly explored. The computed tomography calcium score (CTCS) in the coronary arteries has become a widely available, accurate, and dependable tool for determining the risk of major cardiovascular events, particularly in asymptomatic individuals. Individuals with DM are expected to undergo regularly routine laboratory examinations.

Purpose

The objective of this study was to determine the laboratory parameters related to occurrence of subclinical atherosclerotic plaques in coronary arteries, as detected by Computed Tomography (CT), in patients with NDT2DM.

Methods

In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT, with a thickness of 2-5 mm. Calcification was identified as a structure >1 mm attached to or located within the lumen of a coronary vessel with intensity >130 HU. The Agatston method was used to determine the CTCS. Patients were categorized into five groups based on their calcium levels (0, 0-.

10, 11-100, 101-400 and >400), and all obtained parameters were subsequently compared between the five groups. With Spearman’s correlation test we also analyzed the relationship between laboratory parameters and the level of CTCS. Exclusion criteria were: stable angina pectoris, acute coronary disease, severe anemia, patients with history of stroke, moderate/severe renal insufficiency, liver insufficiency, claustrophobic patients, and pregnant women.

Results

Of the 101 asymptomatic patients with NDT2DM, 53 (52.5%) were males, with mean age of 54.4 ± 11.6 years and mean duration of diabetes of 2.8 ± 5.3 months. In table 1 the differences between the 5 groups regarding laboratory parameters are presented. Statistical significance is shown for erythrocyte sedimentation rate (ESR) (P=0.044). With Spearman's correlation, we obtained a significant correlation between the CTCS and the following laboratory parameters: ESR [r= 0.280 (95% CI 0.083-0.455), P=0.0046] and triglyceride level [r= 0.196 (95% CI -0.005 - 0.382), P=0.049].

Conclusions

Individuals diagnosed with NDT2DM who exhibit elevated erythrocyte ESR and triglyceride levels may be susceptible to an increased burden of coronary artery calcium. Consequently, these patients should undergo careful management, focusing on both glycemic control and cardiovascular prevention. Comparison between the five groups.
Real-world evaluation of performance and practical utility of multi-biomarker risk report for cardiovascular and other chronic diseases
Authors: Kerminen S
Published: June 2024

Introduction

Identifying individuals at high risk for cardiovascular disease (CVD) and other chronic diseases is the key to most effectively use targeted preventative interventions to reduce individual disease risks and the burden on the healthcare system. In current clinical practice, risk estimation is based on calculators like SCORE2 require information from multiple sources (physical measurements and questions). Estimating risk of other diseases (e.g. diabetes or liver disease) requires separate calculators that require non-overlapping inputs. Thus multi-disease risk prediction is rarely deployed at scale.

Purpose

To improve the accuracy and efficacy of primary prevention in clinical practice, we developed and tested a risk report that is based on biomarkers from a single blood sample, age and sex, and estimates risks for 8 chronic diseases.

Methods

To identify disease risks, we utilise nuclear magnetic resonance (NMR) spectroscopy to measure 39 clinically validated metabolic biomarkers from a single blood sample. We trained multi-biomarker risk scores (including age and sex) for CVD, myocardial infarction (MI), type two diabetes, chronic kidney disease, and 2 liver and 2 lung diseases using over 60,000 samples from UK Biobank and tested score performance on a separate testing set as well as independent data from two other large biobanks. We designed a report that shows both an individual’s absolute risk and relative risk compared to others of their sex and age for all 8 diseases. To enable large-scale usage in healthcare, we implemented an automated protocol for blood sample measurements, generating and returning the risk reports, and obtained regulatory approval. During an implementation pilot in Finnish clinics we assessed the quality of returned results and collected feedback from healthcare professionals.

Results

For all diseases, the performance of multi-biomarker scores was similar to or better than the selected existing risk tool. E.g., for MI, multi-biomarker score resulted an AUC of 0.72 (0.71-0.73, 95% confidence interval) while the national risk calculator for MI, FINRISK 2.0, showed AUC of 0.73 (0.72-0.74). A total of 185 patients participated in the implementation pilot. The results of the quality assessment of biomarker concentrations and disease risks demonstrated a good concordance with the expected values and rates from population specific research cohorts. According to feedback obtained from the healthcare professionals, the risk report was deemed clear and understandable, as well as easy to communicate with patients. These reports have now been adopted in routine use for nation-wide occupational health screens with a Finnish private healthcare provider.

Conclusions

We presented a real-world application for preventative health care to assess disease risk for 8 common chronic diseases in one go and demonstrated its performance and feasibility for large-scale risk assessment in a clinical setting.
Air pollution associates with poor mental health and amplifies the premature cardiovascular death in the United States: longitudinal nationwideanalysis
Authors: Abohashem S , Aldosoky W , Civieri G , Goudot G , Dar T
Published: June 2024

Background

While air pollution (i.e., particulate matter with aerodynamic diameter ≤2.5mm-PM2.5) and poor mental health (PMH) are linked to premature all-cause mortality, their interrelationship and joint impact on premature cardiovascular mortality (PCVM) in the United States, is unknown.

Purpose

Herein we sought to test the hypothesis that high exposure to PM2.5 associates with heightened PMH and an amplified PCVM risk related to PMH.

Methods

We analyzed annual PM2.5 levels and average PMH (days) data from the Center for Disease Control and Prevention (CDC) PLACES databases across 3047 U.S. counties. PM2.5 exposure was dichotomized (high/low) per World Health Organization standards; PMH was categorized into tertiles. Age adjusted PCVM rates (<65 years of age) were obtained from the CDC WONDER databases. County characteristics were sourced from County Health Rankings project. Using generalized linear mixed models with gamma distribution, we calculated rate ratios (RR).

Results

Among 315,720,938 residents lived in 3047 counties in 2013, 1,079,656 (0.34%) PCVM deaths recorded during study period (2013-2019). In the fully adjusted analyses*, high PM2.5 associated with elevated PMH (RR [95%CI]: 1.10 [1.08, 1.11], p<0.001]. In counties with high PM2.5 (≥10 µm2), PMH (T3 vs. T1) associated with a 3-fold increase in PCVM (RR: 1.15 [1.12, 1.18]) compared to low PM2.5 (1.05 [1.01, 1.08]), with p interaction <0.001. This trend persisted across PCVM subtypes (Figure1).

Conclusion

High PM2.5 worsens PMH, significantly amplifying the PCVM burden across the United States, beyond other social determinants of health. Targeted public health strategies must urgently address the interconnected pollution-mental health crisis to mitigate rising PCVM.
Potentially avoidable hospitalizations for hypertension in Switzerland
Authors: Maung K , Marques-Vidal P E D R O , Gouveia A L E X
Published: June 2024

We assessed the trends, characteristics. and consequences of potentially avoidable hospitalizations (PAH) for hypertension in Switzerland, for period 1998 to 2018. Hospital discharge data from the Swiss federal office of statistics. Hospitalizations with hypertension as the main cause for admission were eligible. PAH for hypertension was defined according to the Organization for Economic Cooperation and Development criteria. Overall, data from 117’507 hospitalizations (62.1% women) was used. The number of PAH increased between 1998 (n=1685) and 2018 (n=3410), and their frequency among hospitalizations for hypertension increased from 36.9% in 2008 to 73.0% in 2018. Compared to non-PAH, patients with PAH for hypertension were younger, more frequently women (66.9% vs. 56.7%), non-Swiss nationals (15.9% vs. 10.9%), were more frequently admitted as an emergency (78.9% vs. 59.5%), and by the patient’s initiative (33.1% vs. 14.1%). Patients with PAH had also less comorbidities, as per the Charlson’s index. Patients with PAH for hypertension were more frequently hospitalized in a semi-private or private setting, stayed less frequently in the ICU (4.6% vs. 7.3%), were discharged more frequently home (91.4% vs. 73.0%), and had a shorter LOS than patients with non-PAH for hypertension: median and [interquartile range] 5 [3-8] vs. 9 [4-15] days. In 2018, the total costs of PAH were estimated at 16.5 million CHF, corresponding to a median cost of 4936 (4445-4961] CHF per stay. We conclude that in Switzerland, PAH represent a considerable fraction of hospitalizations for hypertension, and carry a non-negligible health cost.
Changes in mortality due to cardiovascular diseases among people aged 65 and over in Poland from 2000 to 2019
Authors: Monika Burzynska M B , Malgorzata Pikala M P
Published: June 2024

Background

Demographic forecasts predict that in 2050 the percentage of people aged 65 years and over in Poland will be nearly 40%. The main cause of death in this age group is cardiovascular disease, accounting for 41.1% of all deaths. The risk of developing the disease increases with age which poses a challenge to the health care system and public health.

Purpose

The aim of the study was to assess changes in mortality due to cardiovascular diseases among people aged 65 and over in Poland from 2000 to 2019.

Methods

The study used a database of all deaths of Polish residents aged 65+ due to cardiovascular diseases (I00-I99). Trends have been analysed in two age groups: early old age (65-74 years) and late old age (over 75 years). The analysis has been carried out with the use of joinpoint models. The Annual Percentage Change (APC) for each segments of broken lines, the Average Annual Percentage Change (AAPC) for the whole study period (95% CI), and standardized death rates (SDRs) were calculated.

Results

Diseases of the circulatory system were the most common major group of causes of death among Polish residents aged over 65 years. The percentage of deaths due to diseases of the circulatory system decreased in all the studied subgroups in analysed period. The fastest percentage decline was observed in the group of women in early old age. The standardized death rate in this group decreased from 1027.3 in 2000 to 471.5 in 2019 (AAPC=-4.1%, p<0.05). Among cardiovascular diseases, ischemic heart diseases were the most common cause of death, except for women in late old age, where it was diseases of arteries, arterioles and capillaries. The third most common cause of death in the cardiovascular disease group was cerebrovascular diseases. In each of these mentioned subgroups of causes of death among diseases of the circulatory system, in all the analysed gender and age subgroups, decreasing trends were observed in the analysed period. However, more detailed analyse show that SDRs due to ischemic heart disease have been increasing for a few years. In the early old age group of women and men, the upward trend began in 2015 and 2016 (APC=2.1% and 2.0%). In the late old age group of women and men, the increase in SDR between 2014 and 2019 was statistically significant. APC was 3.5% in the female group and 2.5% in the male group (p<0.05).

Conclusions

In the population of elderly people, the greatest health risks are cardiovascular diseases, primarily ischemic heart disease. This indicates the need to focus on health education, prevention, mainly in the areas of modifiable risk factors such as physical activity, eating habits, alcohol and tobacco consumption, and health promotion from an early age.
Cardiopulmonary exercise test registry for patients with obesity: comparison of cardiorespiratory fitness prediction equations and generation of a new predictive model for patients with obesity
Authors: Vecchiato M , Aghi A , Nerini R , Borasio N , Gasperetti A , Quinto G , Battista F , Bettini S , Di Vincenzo A , Neunhaeuserer D , Busetto L , Ermolao A
Published: June 2024

Introduction

Cardiorespiratory fitness (CRF) is a critical marker of overall health and a key predictor of morbidity and mortality, but the existing prediction CRF equations are primarily derived from general populations and may not be suitable for patients with obesity (PwO).

Purpose

This study examined the use of non-exercise prediction equations for estimating CRF (pCRF) in PwO and evaluated their accuracy compared to directly measured CRF (mCRF) through cardiopulmonary exercise testing (CPET).

Methods

pCRF from different non-exercise prediction equations was compared with mCRF of PwO who underwent maximal CPET. Multiple linear regression was used to develop a non-exercise prediction model for treadmill including age, sex, BMI, and physical activity level.

Results

660 PwO underwent CPET during the study period (age = 44.2 ± 11.3 years, female = 69%, BMI = 41.8 ± 6.8 kg/m2). R2 values had a range of 0.24-0.46 with standard error of estimate ranged from 2.84-3.26 ml/kg/min. pCRF was statistically different from mCRF for 19 included equations. Only 50% of PwO were correctly classified into the mCRF categories according to pCRF. A multivariable model for a treadmill CRF prediction was generated (R2 = 0.57; standard error of estimate = 1.12 ml/kg/min) and validated using two cross-validation methods.

Conclusions

Most used equations provided inaccurate estimates of CRF in PwO, particularly in cases of severe obesity and low CRF. Therefore, a new prediction equation was developed and validated for PwO, offering a more precise tool for clinical CPET interpretation and risk stratification in this specific population. Figure 1  Figure 2
Association between the obesity and outcomes after out-of-hospital cardiac arrest - does sex matter?
Authors: Czapla M , Domenech-Briz V , Lewandowski L , Juarez-Vela R , Smerka J , Gea-Caballero V , Martinez-Sabater A
Published: June 2024

Introduction

Out-of-hospital cardiac arrest (OHCA) is a global public health problem. Obesity is one of the factors that reduces the odds of a return of spontaneous circulation (ROSC). The aim of this study was to assess whether there are sex differences in the prognostic impact of obesity on ROSC in OHCA patients.

Methods

A retrospective study and analysis of 33,636 (female: 12,000 and male: 21,636) medical records of patients with OHCA (ICD 10-I46) in Poland from 01.2021 to 06.2022 was performed. Patient comorbidity, information on: obesity, location of OHCA and initial rhythm were collected. Statistical analysis was performed using Python 3.9.13.

The study was approved by the Independent Bioethics Committee of the Medical University of Wroclaw (No KB-895/2022).

Results

There was no difference in age between the two sexes. Upon subsequent stratification of the two sexes by obesity status, a markedly higher incidence of diabetes(p<0.001), hypertension(p<0.001), and heart failure(p<0.001) was observed, regardless of sex. In the univariate model, obesity decreased the odds of ROSC by 25.47% among women (p ≈ 0.034) and 19.76% (p ≈ 0.035) among men. In full model, obesity became insignificant (p ≈ 0.051) (Table 1). In models with all factors, the individuals with the VF/pVT initial rhythm were 4.204-fold more likely (vs. Asystole/PEA) to develop ROSC among the female individuals, but only 3.655-fold more likely among male individuals. If OHCA happened in a public place, both sexes showed similar, over 2-fold increase in odds of ROSC (2.204 among females, 2.130 among males). The impact of age on these odds was similar among the two sexes, decreasing the odds for ROSC (by 1.21% and 1.52% in women and men, respectively, per one-year increase in age). After stratification by both sex and obesity (Table 2), several factors appeared to have a different influence on the odds for ROSC. Although the public place location greatly increased the odds for ROSC among both sexes, women showed to have significantly lower location-associated OR if they were obese (2.126 vs. 4.264 in obese and non-obese women, respectively). Moreover, exclusively among non-obese women, hypertension decreased the odds of ROSC by 11.11% (p ≈ 0.032).

Conclusion

In both men and women, OHCA in a public place and an initial VF/pVT rhythm increased the odds of ROSC, while age (per one-year increase in age) decreased the odds. However, in women without obesity, VT/pVT increased the odds of ROSC by more than 4.2 times and in women with obesity by 2.7 times. In men without obesity, the initial VF/pVT rhythm increased the odds of ROSC by 3.7-fold and in men with obesity by only 1.9-fold. No such discrepancies were observed for OHCA location and age, where the odds of ROSC were similar. Prevention of obesity should be a global health priority.
Fat mass index in coronary artery disease patients and its associations with risk factors
Authors: Novakovic M , Salgueiro D , Pires M , Borges M , Sa G , Pinto F J , Fras Z , Abreu A , Pinto R
Published: June 2024

Introduction

Cardiac rehabilitation (CR) after a coronary artery disease (CAD) event is recommended to improve risk factor control, as some of them remain poorly controlled (e.g. obesity, physical activity), while new ones are emerging (e.g. sedentary behaviour). The aim of our study was to examine how traditional risk factors, physical activity and sedentary behaviour affect body fat mass in CAD patients.

Methods

In this cross-sectional study, CAD patients entering a community-based phase III CR were assessed for the following: a) fat mass index (FMI) assessed by dual-energy radiographic absorptiometry; b) physical activity level and sedentary behaviour wearing an accelerometer; c) cardiopulmonary exercise testing; d) lipid profile.

Results

There were 111 CAD patients, their average age was 61.7 ± 9.8 years, 15 (13.5%) were female. Patients were divided into three groups, based on the FMI: normal (n=19), overweight (n=62) and obese (n=30). Obese patients, compared to patients with normal FMI, had significantly higher systolic blood pressure (120 (112-130) vs. 104 (94-120) mmHg, p=0.019), total sedentary time (4773 (4315-5196) vs. 4372 (4188-4612) minutes/week, p=0.029) non-HDL and triglycerides levels (97 (80-129) vs. 78 (63-96) mg/dL, p=0.024, and 100 (79-160) vs. 91 (69-110) mg/dL, p=0.032, respectively). On the contrary, there were no significant differences in physical activity level, diastolic blood pressure, total cholesterol, HDL and LDL cholesterol. In a multivariate linear regression analysis, sedentary time emerged as an independent predictor of FMI, while physical activity level was not.

Conclusion

Obese CAD patients have poorer control of blood pressure, lipid status and sedentary behaviour when compared to normal and overweight CAD patients. New strategies are needed to reduce sedentary behaviour in this population, which may induce a parallel reduction in body fat.
Carotid intima-media thickness progression and plaque formation in recreational male endurance athletes - a 10-year follow-up study
Authors: Schoenfeld J , Schindler M J , Fegers-Wustrow I , Pressler A , Wolfarth B , Haller B , Halle M , Scherr J
Published: June 2024

Background

Lifelong endurance exercise is associated with increased arteriosclerosis and, in particular, an accelerated rate of coronary artery calcification (CAC) and higher plaque burden. The mechanisms underlying the progression of CAC remain incompletely understood.

Purpose

We aimed to determine the potential pathomechanism for carotid artery plaque formation or accelerated carotid intima-media thickness (cIMT) progression in recreational male endurance athletes after a follow-up of 10 years.

Methods

Middle-aged (43±8 years) former participants (healthy male marathon runners) of the Beer, Marathon, Genetics, Inflammation, and the Cardiovascular System (Be-MagIC) study who ran>10 km/week or cycled >20 km/week and participated in >5 endurance competitions during the last 10 years underwent baseline and 10-year morphological assessment using carotid ultrasound. Sporting characteristics were assessed via a questionnaire and cardiopulmonary exercise tests. Plaque formation and cIMT progression were defined as follows: Plaque at baseline and/or after 10 years of follow-up. Progression in cIMT was calculated from baseline to 10-year follow-up. Linear and logistic regression analyses were performed to determine the association between age, body fat, resting systolic blood pressure, fasting glucose, total cholesterol at baseline, loading systolic blood pressure max. at 10-year follow-up, km per week during the last 10 years and cIMT progression/plaque formation.

Results

A total of 96 former male marathon runners were included. Former runners ran for a median of 30 [interquartile range, IQR 20-40] km per week and participated in an average of 26 (min-max: 5–508) endurance events during the last 10 years. After 10 years, the V02peak amounted to 42.8±7.9 mL/min/kg. cIMT increased from 0.57mm [0.51 – 0.66mm] to 0.62mm [0.55 – 0.73mm] (p<0.001) after 10 years. Plaque was present in 21% at baseline and 37% after 10 years (p<0.001). In total, 20% of the previous plaque-free participants developed new plaque during the 10-year follow-up. No significant association in the progression of cIMT with the investigated variables was observed (Figure 1). Plaque formation showed an independent significant association with age, body fat, and km per week (odds ratio [95%CI]: 1.24 [1.12 to 1.36], p<0.001; 1.15 [1.02 to 1.31], p=0.019 and 0.97 [0.94 to 0.99], p=0.016, respectively, Figure 1). Furthermore, no indications of non-monotonic correlations were found.

Conclusion

The mean progression of cIMT in male recreational athletes was 0.05mm per year. The percentage change of plaque in recreational endurance athletes after 10 years was 76%. Furthermore, age, body fat, and km per week were associated with plaque progression during the 10-year follow-up in male endurance athletes.
Exercise behavior and its impact on structural and functional parameters in patients with arrhythmogenic (right ventricular) cardiopathy
Authors: Blaettler R , Bohm P , Brunckhorst C , Niederseer D , Duru F , Saguner A , Schmied C
Published: June 2024

Introduction

The impact of exercise on patients with Arrhythmogenic (Right Ventricular) Cardiopathy (ARVC/VC) is particular and comprises two crucial factors: Beside a massively increased risk for exercise-induced arrhythmia, there is evidence that exercise may worsen structural and functional cardiac parameters. However, regular exercise leads to undisputed health benefits, particularly in the prevention of cardiovascular disease. The aim of our study was to assess exercise behavior in a cohort of ARVC/AC patients and to analyse its impact on arrhythmia and other cardiac parameters.

Methods

44 patients with ARVC/AC, carrying an ICD, were assessed regarding their exercise behavior during the last 5 years and their aims and fears when it comes to regular sport. The results of two established questionnaires (modified GPAQ und IPAQ) were correlated with data from ICD, echocardiography and laboratory examinations during this period.

Results

Only one third (35.2%) of the ARVC/AC patients (average age 52.7, 29.5% females) met the current recommendations for regular exercise of the World Health Organisation (WHO). Although 79% of the patients expressed the wish to do more sport, 50% had fear for sudden cardiac arrest, in 35.3% physician’s restrictions and in 14.7% a lack of physical capacity prohibited sufficient physical activity. During a 5 year observational period, no significant correlation with negative structural or functional cardiac affections or relevant arrhythmia could be found.

Conclusion

The exercise behavior of ARVC/AC patients is insufficient and most of the patients not even reach the lower cut-off for health benefits. Although most of the patients wish to do exercise and perform regular sport, there are widespread fears of a fatal outcome or restrictions, even on the basis of daily life physical efforts. Despite the fact that concise exercise recommendations for ARVC/AC patients still have to be defined, the lack of sufficient physical activity is alarming and patients should be motivated and reassured for adequate exercise behavior in everyday life.
Measuring and monitoring VO2max with an innovative, noninvasive and time efficient device before, during and after a 5 month sports program
Authors: Beier C , Wicharz J
Published: June 2024

Background/Introduction

In recent years, the scientific importance of measuring, estimating, and monitoring cardiorespiratory fitness has increased due to new methods and applications of noninvasive measurement techniques like seismocardiography (SCG). In our study, we have used a noninvasive seismographic device (figure 1) to measure and monitor the change in VO2max achieved by a sports program in healthy volunteers as a measure of cardiovascular fitness.

Purpose

The aim of the study was to show that the usage of a noninvasive seismographic device allows for an intuitive and quick way of determining the personal individual fitness level by VO2max measurement. Furthermore, the study aimed at showing that improvements in cardiorespiratory fitness due to training programs can be measured by the noninvasive and intuitive seismographic device.

Methods

The device measures vibrations that arise from heart beats and are transmitted to the chest. The sensor communicates with an accompanying app via Bluetooth® (subject height, weight, age and gender are entered). The recording of the signal takes about 45 seconds. The signal is transferred to secure servers and being analyzed. The estimated VO2max is being calculated. The tool’s validity and reliability have been proven in previous trials. We recruited a total of n = 30 healthy German volunteers between 46 and 65 years of age (ø 57.4 ± 5.3 years, 43.33% female) who voluntarily participated in a 5-month training program with the goal of running a half-marathon at the end of the program. VO2max (ø 30.56 mlO2/min/kg ± 6.75) was measured at each visit with the device to allow for comparisons over time. As control variables, weight (ø 79.9 kg ± 18.34), BMI (ø 26.8 kg/m² ± 4.37) and resting heart rate (ø 67.17 bpm ± 10.57) were also recorded at baseline and at each of the 9 training visits.

Results

All 30 participants completed the training program, and n = 25 (83.33%) finished the half-marathon. At the final measurement after 5 months of training initiation VO2max measured by the device increased by 2.59 mlO2/min/kg (± 4.89, p = 0.007) as compared to baseline. The participants also reported improvements in weight (- 2.82 kg ± 3.21, p < 0.001), BMI (- 1.07 kg/m² ± 1.13, p < 0.001) and resting heart rate (- 4.28 bpm ± 10.59, p = 0.035). Measurements of VO2max with the intuitive seismographic device were rated as uncomplicated and easy by all participants.

Conclusion(s)

The device (figure 2) proved to be an intuitive and time efficient method of noninvasive VO2max measurement. The results confirmed that VO2max is an indicator of cardiovascular fitness as participants showed improvements not only in VO2max, but also weight, BMI and resting heartrate. We promote the use of the intuitive seismographic device to measure and monitor VO2max as an indicator of cardiovascular fitness. seismographic device and necessary input.  results displayed on the mobile phone.
The assessment of the impact of physical exercise level on the quantity of endothelial cell precursor progenitor cells in patients after ACS on the background of cardiac rehabilitation measures
Authors: Kovalchuk Y , Tereshchenko N , Shumakov V , Malynovska I , Belyaeva D
Published: June 2024

Introduction

At the present stage, there are discussions about the predictive value of the level of progenitor cells of endothelial cell precursors (EPCs) in peripheral blood for cardiovascular complications in high-risk patients, particularly after acute myocardial infarction. Since endothelial dysfunction is one of the initiating mechanisms of myocardial infarction, it is important to assess the risks of recurrent cardiovascular events in patients during cardiac rehabilitation with increased physical exercise.

Objective

To identify the correlation between the restoration of physical exercise tolerance (PET) level and the quantity of EPCs in peripheral blood of patients after acute coronary syndrome (ACS).

Materials and methods

Ninety male patients were examined, including 79 (87.8±6.8%) with a diagnosis of myocardial infarction, of which 65 (82.3±8.4%) had STEMI and 14 (17.7±8.4%) had NSTEMI, and 11 (12±6.8%) with unstable angina. Among the comorbidities, hypertension was present in all patients (100±4.1%), diabetes mellitus in 23 (25.6±9.0%), obesity in 25 (27.8±9.3%), and overweight in 29 (32.2±9.7%). Grade II heart failure was observed in 65 patients (72.2±9.3%). The mean age of the examined patients was (56.5±10.5) years. Coronary angiography revealed atherosclerotic involvement of one vessel in 23 patients (25.6±9.0%), two vessels in 26 (28.9±9.4%), and three vessels in 41 (45.6±10.3%). Hemodynamically significant three-vessel involvement was found in 24 patients (26.7±9.1%), two-vessel involvement in 31 (34.4±9.8%), and one-vessel involvement in 35 (38.9±10.1%).

All patients underwent exercise testing using the graded exercise method, assessment of intracardiac hemodynamics using two-dimensional and Doppler echocardiography, coronary angiography, biochemical and general clinical blood tests, and quantification of EPCs levels in peripheral blood. The results are presented as the mean value with standard deviation or frequency with a 95% confidence interval.

Results

The obtained data indicate that there is an associative relationship between better restoration of PET levels after acute coronary syndrome and the restoration of endothelial function in patients with a favorable course of the post-infarction period during repeated examination, compared to patients whose PET levels did not exceed 50 watts (low PET). This is evidenced by a statistically significant higher number of EPCs after physical exercise in the group with a favorable course and high PET (Group A) compared to the group with an unfavorable course and low PET (Group B).

Conclusions

Studying the response in terms of changes in EPCs quantity in response to physical exercise can help determine the progression of systemic endothelial dysfunction, which affects the patient's prognosis.
Sex differences in the prevalence of individual chronic conditions in a cardiac rehabilitation population
Authors: Miller S , Gomes P F , Chacin-Suarez A , Olson T P
Published: June 2024

Background

The United States Department of Health and Human Services has defined 21 chronic conditions lasting one year or greater and which require ongoing medical treatment. The presence of multiple chronic conditions (multimorbidity) is closely linked to greater physical disability, increased health care utilization, reduced quality of life, and higher mortality rates. In the general population, studies have shown the prevalence of multimorbidity to be greater in females compared to males. Recently, data has suggested that patients enrolled in cardiac rehabilitation (CR) have a significantly greater number of chronic conditions compared to the general population. Whether these same sex differences in the prevalence of individual chronic conditions are present in the CR population has not been examined.

Purpose

The purpose of this study is to determine whether differences exist in the prevalence of individual chronic conditions between male and female CR patients. We hypothesize that female CR patients will demonstrate greater prevalence of individual chronic conditions compared to men.

Methods

Using the local Epidemiology Project records-linkage system, we identified patients who attended (≥1) CR sessions from 1995-2019. The prevalence of 21 chronic conditions was extracted from the patients’ medical records at the time of enrollment in CR (Table 1). We conducted chi-squared analysis to identify differences in the prevalence of each individual chronic condition between the sexes. Statistical significance was defined by p≤0.05.

Results

Of the 13,056 CR patients identified (age: 65.7±12.8 yrs old), 4,107 (31.5%) were female. Male CR patients were significantly younger compared to female counterparts (64.8±12.1 yrs old vs. 67.6±13.6 yrs old; p≤0.001). Females demonstrated a greater number of total chronic conditions compared to males (median (IQR): 7.0 (5.0, 9.0) vs 6.0 (5.0, 8.0); p≤0.001). Females demonstrated a greater prevalence of the following 12 individual chronic conditions compared to males: HTN, CHF, ARR, STR, ART, CAN, CPD, HEP, OST, ANX, DEM, and DEP (p≤0.05, for all). There was a trend for greater prevalence of ARR in females compared to males (p=0.07). In contrast, males experienced a greater prevalence of the following four chronic conditions compared to females: CAD, LIP, AST, and SUB (p≤0.001, for all). There were no differences between sexes for CKD (p=0.87), SZO (p=0.70), or AUT (p=0.31).

Conclusion

Our data suggest the trend for greater prevalence of chronic conditions in females in the general population is consistent within the CR population. Specifically, 12 of 21 (57%) individual chronic conditions were significantly more prevalent in female CR patients whereas only 4 (19%) conditions were more prevalent in males. These data emphasize the need to better understand the relationship between sex and risk for individual chronic conditions, particularly in patients enrolled in CR.