bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal trends over 20 years of smoking prevalence in patients with acute myocardial infarction. Data from the RICO survey
Authors: Chague F , Bichat F , Saint Jalmes M , Maza M , Cottin Y , Zeller M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté

Background

Over the last 2 decades, tobacco smoking, a major cardiovascular (CV) risk factor, has decreased in France, but remains among the highest in European countries.

Aim

From a large database of patients with acute myocardial infarction (MI), we aimed to investigate the evolution of smoker’s prevalence and characteristics over a 20-y period.

Methods

From the RICO survey, 18,769 patients hospitalized from 2001 to 2020 for an acute MI in one region of France were included. Current smokers were compared with ex-smokers or non-smokers and according to gender.

Results

Temporal trends showed that smoking rate did not decrease in men and dramatically increased in women by 50% (figure). Rate of smoking was higher in men than in women (34% vs 18%, p<0.001). Median age increased across the year groups whatever the smoking status. When compared with ex or non-smokers, smokers were much younger (54 vs 71 y for men and 56 vs 79 y for women, p<0.001), had more frequent family history of CAD but less modifiable risk factors such as diabetes and hypertension. ST-segment elevation MI was more common in smokers, for both sex. Although in-hospital adjusted mortality was similar for both groups, smokers had more common ventricular arrhythmias (VF/VT).

Conclusions

Over the last 2 decades, tobacco use remains common in patients with acute MI and is associated with a younger age of occurrence and severe acute complications. Our findings also reveal an alarming increasing prevalence of smoking in women. More effective prevention strategies are necessary to reduce tobacco use, in particular in women.
Does pre-diabetes predict the extent of coronary artery disease?
Authors: Soman B , Cheong MLH , Makuloluwa K , Salem A , Agarwal M , Chattopadhyay S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Extensive coronary artery disease (CAD) is common in diabetes mellitus. This relation between the extent of CAD and prediabetes (pDM)is less well established.

Purpose

To explore whether non-diabetic hyperglycaemia, assessed by HbA1c, is associated with extent of angiographic CAD, independent of traditional cardiovascular risk factors.

Methods

Retrospective cohort analysis of consecutive patients, without known DM undergoing coronary angiography for stable angina, who were screened for hyperglycaemia over 18 months. HbA1c was measured; pre-diabetes was defined as HbA1c 5.7-6.4%.Extent of CAD was assessed using the SYNTAX score. Presence of CAD was defined as visually estimated ≥50% luminal obstruction in arteries ≥1.5 mm diameter. Age, BMI, risk factors for CAD, HbA1c, total and LDL-cholesterol were recorded. The pre-diabetes and normal groups were compared using Mann-Whitney test for continuous variables and chi-squared test for categorical variables. Multiple logistic and linear regressions were used to assess the effect variables on SYNTAX score. Spearman rank correlation was used to assess the relation between HbA1c and SYNTAX score.

Results

1071 patients had angiograms done. 207 had DM, 19 had new diagnosis of DM and 181 missed the screening leaving 664 who had HbA1c measured. 51 poor quality angiograms were excluded from SYNTAX calculation. Data was analysed for 613 (306 normal, 307 pDM) patients. The patients with prediabetes were older, had higher prevalence of risk factors, BMI, fasting glucose and SYNTAX score. HbA1c (OR 2.07, 95% CI 1.32 to 3.25, p=0.002) and the presence of pDM (OR 1.89, 95% CI 1.32 to 2.69, p<0.001) independently predicted the presence of CAD. HbA1c (Coefficient 2.42, SE 1.09, p=0.027) and the presence of pDM (Coefficient 2.25, SE 0.92, p=0.015) independently predicted the SYNTAX score. The correlation between HbA1c and SYNTAX score was weak but significant (Spearman's coefficient 0.206, 95% CI 0.129 to 0.281, p<0.0001).

Conclusion

HbA1c predicts the extent of CAD as measured by SYNTAX score in patients without known diabetes. Presence of pre-diabetes is an independent predictor of extent of CAD.
Can we prevent the occurrence of stroke in patients admitted with non-ST-segment elevation myocardial infarction?
Authors: Paula S , Santos M , Santos H , Almeida I , Figueiredo M , Almeida S , Almeida L
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardio-cerebral vascular diseases are a leading cause of deaths worldwide.

Stroke is a potential complication in high-risk patients who had non-ST-segment elevation myocardial infarction (NSTEMI).

Purpose

Identify high-risk patients with stroke and their prognosis in the setting of NSTEMI.

Methods

Based on a multicenter retrospective study, data collected from admissions between January 2013 and January 2020. Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Patients were divided in 2 groups (G): G1 – patients who suffered stroke; G2 - patients without stroke. Logistic regression and survival analysis were performed.

Results

7180 patients were admitted with NSTEMI, stroke occurred in 35 patients (0.49%). Regarding epidemiological and past history G1 was older (72±9 vs 66±12, p= 0.004), had more females (54.3% vs 45.75, p<0.001), had higher rates of type 2 diabetes mellitus (51.3% vs 35.2%, p=0.05), previous strokes / transient ischemic attack (24.2% vs 7.0%, p=0.007) and dementia (3.3% vs 0.8%, p<0.001). Arterial hypertension (77.1 vs 72.8%, p=0.56), dyslipidaemia (61.8% vs 63.0%, p=0.88) and smoking (17.6% vs 26.0%, p=0.27) were similar between groups. Patients who presented with chest pain (72.7% vs 92.0%, p<0.001) and patients who were not revascularized were more likely to suffer a stroke (43.3% vs 17.5%, p<0.001).

Logist regression only confirmed that females were more likely to have a stroke (p<0.001, OR 4.13, CI 1.87-9.15) and patients who presented with chest pain (p=0.001, OR 0.23, CI 0.10-0.54). One year event-free survival was higher in patients who did not have stroke (95.3% vs 80.0%, p=0.005, OR 4.50, CI 1.43-14.15)

Conclusion

Since sex gender and form of presentation of NSTEMI are not modifiable factors we cannot prevent strokes from happening in the context of NSTEMI.
Secondary prevention of acute coronary syndrome by reducing depression and anxiety
Authors: Liblik K , Theberge E , Menon N , Gomes Z , Gobran J , Burbidge E , Johri AM
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Cardiovascular disease is expected to reach an annual mortality rate of 23 million individuals by 2030, primarily due to acute coronary syndrome (ACS) and cerebrovascular events. Simply stating the mortality associated with cardiovascular disease underrepresents its true burden considering the associated disability, healthcare expenditure, and loss of quality of life. Specifically, there has been increasing interest in the prevalence of depression and anxiety post-ACS as depressive and anxious symptoms are seen in up to 45% and 30% of patients, respectfully. These symptoms are associated with increased morbidity and mortality as well as decreased quality of life. Thus, it is crucial that secondary prevention be prioritized in this population with a specific focus on psychological wellbeing.

Purpose

The purpose of the present systematic review is to summarize the current literature on secondary prevention following ACS via interventions aimed at reducing depression and anxiety.

Methods

A systematic review was conducted of the databases PubMed, EMBASE, Web of Science, ClinicalTrials.gov, and Cochrane for studies which implemented an intervention to improve depression or anxiety in patients following ACS.

Results

The initial literature search identified 6,536 studies, of which 97 were added for inclusion with a total of 23,965 participants. Study design comprised 83 randomized control trials, two quasi-experimental studies, and 12 non-randomized experimental studies. The majority of interventions which significantly reduced symptoms of post-ACS anxiety involved modified cardiac rehabilitation programs (20%), aromatherapy (13%), and initiation of a new therapeutic (11%). Conversely, the majority of post-ACS interventions which significantly improved depressive symptoms involved therapy (24%), modified cardiac rehabilitation (24%), and initiation of a new therapeutic (20%). Notably, all aromatherapy (n=6), arts-based (n=3), exercise (n=7), meditation (n=3), and nature therapy (n=1) intervention studies extracted reported significant improvement in either depression or anxiety scores.

Conclusions

Depressive and anxious symptoms following ACS are associated with increased risk of death, rehospitalization, and poor quality of life. Programs which involve modified cardiac rehabilitation programs, aromatherapy, therapeutic agents, and therapy may increase secondary prevention of ACS by improving symptoms of depression and anxiety. Due to the heterogeneity of the programs identified, significant differences in sample size across studies, and the variety of depression/anxiety scales used, a large-scale randomized control trial comparing intervention efficacy is needed. Such a trial, as well as the present systematic review, may improve secondary prevention of ACS by identifying strategies to reduce depression and anxiety in this population.
Does allopurinol improve inflammatory biomarkers and post-revascularization coronary blood flow in Non-STEMI patients?
Authors: Kermani-Alghoraishi M , Heshmat-Ghahdarijani K , Sanei H , Sadeghi M , Asadi A , Safaei A
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Isfahan University of Medical Sciences, isfahan, Iran.

Background

Medical evidence suggests inflammatory processes responsible for the incidence of cardiovascular events including acute coronary syndrome and increased oxidative stress have a substantial role in cardiac events pathogenesis and prognosis. In the recent studies, usage of allopurinol has shown promising outcomes in favor of reducing oxidative processes responsible for atherogenic-related cardiovascular events and ischemia-reperfusion injury.

Purpose

This study aims to assess the effects of allopurinol bolus on the inflammatory biomarkers and post-revascularization coronary blood flow according to Thrombolysis in Myocardial Infarction (TIMI) flow grading in patients with non-ST segment elevated myocardial infarction (NSTEMI).

Methods

In this randomized double blind clinical trial, Eighty NSTEMI patients were randomly divided into two groups, including the case group (n=40) medicated with a high loading dose of 600 mg allopurinol before the coronary angiography and angioplasty, while the control group (n=40) received the same shape medication as a placebo. The highly sensitive C-reactive protein (hs-CRP) was measured at baseline and within 24 hours after the cardiac interventions and compared between the case and control groups. Post percutaneous coronary intervention (PCI) TIMI flow grading was also evaluated as a revascularization outcome and coronary blood flow. The patients were also monitored for incidence of ischemic symptoms and occurrence of major adverse cardiac events (MACEs) as well as ventricular and supra-ventricular arrhythmia.

Results

The mean age of study population was 60.03 (10.02) and 62.78 (11.37) in case and control groups respectively (P-value=0.22). The two groups of the study were similar in terms of demographic, clinical, laboratory and angiographic characteristics (P-value>0.05). TIMI flow grading assessments as the revascularization endpoint revealed insignificant difference between cases versus controls in both prior to (P-value=0.14) and after (P-value=0.39) the PCI.

Post-angiographic assessment of adjusted hs-CRP revealed an insignificant statistically difference between the cases and the controls (P-value=0.104). The incidence of ischemic symptoms, arrhythmia and MACEs were similar between the groups (P-value>0.05).

Conclusion

Our findings showed that, premedication with high dose allopurinol bolus in NSTEMI patients did not affect on hs-CRP, as an inflammatory biomarker, as well as revascularization outcome (according to TIMI flow). Further long-term studies on more extended biomarkers are strongly recommended.
Cardiac biomarker release following myocardial infarction: role of exercise
Authors: De Koning IA , Van Bakel BMA , Rotbi H , Van Geuns RJM , Eijsvogels TMH , Thijssen DHJ
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw

Background

Regular exercise training is an important factor in the prevention of myocardial infarction (MI) and engagement in exercise training is associated with reduced mortality risks following MI. However, the relation between exercise engagement and the magnitude of cardiac biomarker release following MI have not been investigated yet.

Purpose

To explore the relation between exercise engagement and cardiac biomarker release following a MI. We hypothesized that exercise engagement is associated with lower peak concentrations of cardiac biomarker following MI compared to their non-exercising peers.

Methods

In this cohort study, we recruited hospitalised MI patients and retrospectively assessed the amount of exercise engagement in the seven days preceding MI onset. Exercise levels were evaluated using a validated questionnaire during a bedside interview. Patients were assigned to the exercise group if they performed any moderate-to-vigorous intensity exercise in the week prior MI and to the control group if they did not perform exercise. Maximum concentrations of cardiac troponin T (max-cTnT), in ng/mL, and creatine kinase (max-CK), in U/L, during hospital stay were extracted from digital health records. Both cardiac biomarker data were classified into 3 groups; 0-499 (small), 500-1499 (medium), and ≥1500 (large). The association of exercise engagement on post-MI cardiac biomarkers was analysed using the Mann-Witney U-test and the chi-square test.

Results

We included 200 MI patients (male: 64.5%, age 65.2 ± 10.4, 49% STEMI, 51% NSTEMI) of which 39 (19.5%) patients were allocated to the exercise group and 161 (80.5%) to the control group. No differences in time from symptom onset to coronary angiography (565 [136-2048] min versus 581 [135-2059] min, p=0.767) or incident hospital-based major adverse cardiac events (5.6% vs 5.1%, p=0.910) was found across groups. Albeit lower, those engaged in exercise do not significantly differ from controls in post-MI max-cTnT concentrations (788 [326-1344] ng/mL vs 1197 [340-3590] ng/mL, p=0.103) and max-CK concentrations (382 [211-744] U/L vs 564 [203-1374] U/L, p=0.147). The magnitude of max-cTnT was more often classified as ‘small’ in the exercise versus control group (x² (2) = 7.71, p=0.021), whilst a trend was found for max-CK levels (x² (2) = 4.97, p=0.083).

Conclusion

Engagement in exercise prior to MI may be associated with lower cardiac biomarker release. This could add novel insights into the potential protective effects of exercise engagement in the severity of MI.
Prevalence of metabolic dysfunction-associated fatty liver disease and its association with physical function in patients with acute coronary syndrome
Authors: Noda T , Kamiya K , Hamazaki N , Nozaki K , Ichikawa T , Yamashita M , Uchida S , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Ako J
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Background

It is widely known that patients with acute coronary syndrome (ACS) are at increased risk of nonalcoholic fatty liver disease (NAFLD), which is linked to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction remains unclear.

Purpose

The purpose of this study was to investigate the prevalence of MAFLD in patients with ACS to assess the relationship between MAFLD and muscle strength, walking speed, and 6-minute walking distance (6 MWD).

Methods

We reviewed patients with ACS who were assessed for hepatic steatosis using the fatty liver index, and the results were further assessed to determine the presence of MAFLD. Multiple regression analysis was used to examine the association between MAFLD and physical function.

Results

Among 479 enrolled hospitalized patients, MAFLD was identified in 234 (48.9%) patients. We conducted a multiple regression analysis in which MAFLD was independently associated with lower leg strength, gait speed, and 6 MWD (leg strength, P = 0.023; gait speed, P = 0.002 and 6 MWD, P = 0.017). Furthermore, having more metabolic impairment was still associated with lower physical function decline (leg strength, P for trend = 0.002; gait speed, P for trend = 0.019 and 6 MWD, P for trend = 0.003).

Conclusions

MAFLD is common in hospitalized patients with ACS, and most patients with MAFLD have many overlapping metabolic abnormalities. MAFLD is associated with impaired physical function, and the greater the number of overlapping metabolic abnormalities, the worse the motor function.
Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF
Authors: Porcari A , Merlo M , Baggio C , Gagno G , Andreis A , Rosmini S , Raafs A , Bromage D , Cannata' A , Di Bella G , Nucifora G , Perazzolo Marra M , Heymans S , Imazio M , Sinagra G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization (1).

Purpose

Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF (2,3).

Methods

Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized vs. diffuse, subepicardial vs midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%.

Results

Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 [2-12] days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, patients experiencing ACEs had lower median LV-GLS values (-13.9% vs -17.5%, p=0.001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as >-20% or quartiles), diffuse and midwall LGE were associated with ACEs (Figure 1). Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for diffuse and midwall LGE.

Conclusions

In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort (Figure 2).
The role of electrocardiographic findings in pulmonary embolism risk assessment
Authors: Devesa Neto V , Correia J , Pires INÊS , Santos JOÃO , Cabral C
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The electrocardiogram (ECG) is helpful in patients (P) with pulmonary embolism (PE), but it is not present in the existing risk prediction tools, such as the Pulmonary Embolism Severity Index (PESI). Intermediate risk PE encompasses a heterogeneous group of P, with different prognoses, some of whom will need fibrinolytic treatment.

This study aims to determine the prognostic impact of ECG in intermediate-risk PE.

Methods

All P admitted for intermediate-risk PE in an Intensive Cardiac Care Unit between 2007 and 2016 were included. P were followed up for two years for all-cause mortality. Clinical and analytical variables, ECG, echocardiographic, and computed tomography (CT), were collected. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, Kaplan-Meier curves, and Cox regression.

Results

This study included 209 P: mean age 63±18years; 38.5% male. T-wave inversion in leads V1-V3 was present in 81 (38.8%), S1Q3T3 pattern in 51 (24.4%), incomplete right bundle branch block (RBBB) in 27 (12.9%), and complete RBBB in 22 (10.5%). T-wave inversion in leads V1-V3 was associated with syncope at presentation (p=0.032); presence of echocardiographic right ventricle dilation (p=0.003) and abnormal interventricular septal (IVS) motion (p=0.001). S1Q3T3 pattern was associated with syncope (p=0.028); higher heart rate at admission (p=0.001); higher troponin (p=0.013) and BNP (p=0.010) levels; abnormal IVS motion (p=0.004); and increased CT-derived right-to-left ventricle diameter (RV/LV) ratio (p=0.014). RBBB were associated with syncope (p=0.020); higher troponin and BNP levels (p=0.001); and increased RV/LV ratio (p=0.029). For each increase in the number of these ECG findings, there was an increase in the odds of fibrinolytic treatment (OR 1.573, 95%CI 1.150-2.151, p=0.005), and the number of ECG findings was a predictor of fibrinolysis independently from PESI (OR 1.535, p=0.008).

In survival analysis, T-wave inversion in leads V1-V3 was associated with decreased survival during follow-up (x2=4.398; p=0.036), even after adjustment for PESI (OR 0.322, p=0.041).

Conclusions

ECG findings of PE were associated with clinical, analytical and imagiological risk features. They were also predictors of fibrinolysis, and T-wave inversion in leads V1-V3 was associated with decreased survival after adjustment for PESI. Therefore, in the future, incorporation of ECG findings in risk scores might allow better risk assessment in intermediate-risk PE.
The angiotensin 1-7 blood levels decreasing in the patients with arterial hypertension and type 2 diabetes is associated with the development of the hypertensive heart disease
Authors: Koval S , Snihurska I , Yushko K
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Angiotensin 1-7 (Ang-(1–7) - one of the components of the renin-angiotensin system, is the main counterparty of Аngiotensin II (AII). It implements protective effects opposite to the action of AII. Ang-(1–7) induces vasodilatory, anti-inflammatory, antifibrotic, antiangiogenic and antihypertensive effects. Alterations in left ventricle (LV) geometry such as LV dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the mechanisms are still not well-understood in patients with arterial hypertension (AH) and type 2 diabetes (T2D)

The aim of the work was to study the Ang-(1–7) levels in blood plasma of patients with arterial hypertension (AH) with hypertensive heart disease (HHD) and concomitant T2D.

Methods

A total of 70 patients with grade 2–3 AH and HHD with concomitant T2D aged 42 to 69 years (48 patients had LV diastolic dysfunction (DD) and 22 patients had normal LV diastolic function) and 20 practically healthy individuals of comparable gender and age were examined. The survey included standard clinical, laboratory and instrumental methods. Diagnosis of AH and HHD was carried out according to the 2018 ESC/ESH recommendations. LV DD was determined according to the 2016 ASE/EACVI recommendations. The blood levels of Ang-(1–7) were determined by the enzyme immunoassay.

Results

We have found that in patients with AH and T2D plasma Ang-(1–7) levels were significantly lower than in practically healthy individuals – 105,51(89,13;121,17) ng/l versus 128,77(120,02;276,49) ng/l, p<0,05. Among patients with АН and T2D the following types of l LV ventricular remodeling were identified: 35 patients had concentric LV hypertrophy, 25 patients had eccentric LV hypertrophy, 10 patients had concentric remodeling of LV. The patients with concentric LV hypertrophy and eccentric LV hypertrophy had significant lower levels of Ang-(1-7) than in patients with concentric remodeling of LV - 107,5(88,2;119,6) ng/l and 101,4(84,2;111,8) ng/l versus 129,3(117,5;136,8) ng/l (р<0,01 and р<0,01 respectively) but did not differ between themselves (p<0,05). In all this among patients with LV DD levels of Ang-(1-7) were significantly lower than in patients with normal diastolic function - 101,1(87,9;116,6) ng/l versus 121,1(105,5;128,9) ng/l, р<0,01. In the in patients with AH and T2D there was a statistically significant negative relationship between plasma Ang-(1-7) level and next LV parameters: LV mass index (R = −0.41, p < 0.001 and LV mass (R=-0,40, p<0,001).

Conclusion

The findings suggest the significant role of decreased Ang-(1-7) levels in blood plasma of patients with AH and concomitant T2D in the development and progression of HHD.
Long-term impact of different triple antihypertensive drug treatments on blood pressure control, metabolic pattern and incident events: data from the Brisighella Heart Study
Authors: Cicero A , Fogacci F , Rizzoli E , D'addato S , Borghi C
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Bologna

Purpose

The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized population cohort.

Methods

We considered data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2008 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with <3 or ≥3 high blood pressure (BP) medications without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with ACE-inhibitors/CCBs/Thiazide, ARBs/CCBs/Thiazide or Perindopril/Amlodipine/Indapamide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive medications. The long term effects of the different antihypertensive medications were compared among the pre-defined groups.

Results

On the long-term, combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with better control of diastolic BP and lipid pattern than other triple combination antihypertensive medication. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow-up they neither developed type 2 diabetes nor had a need for a greater number of antihypertensive drugs to improve BP control.

Conclusion

Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other combination antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/amlodipine/indapamide is associated with better lipids’ profile than any other considered combination antihypertensive medication.
Long-term effect of obstructive sleep apnea and CPAP treatment on blood pressure control in patients after acute coronary syndrome
Authors: Aldoma A , Manuel Sanchez-De-La-Torre M , Gracia-Lavedan E , Benitez ID , Zapater A , Torres G , Sanchez-De-La-Torre A , De Batlle J , Targa A , Minguez O , Pascual L , Cortijo A , Martinez D , Dalmases M , Barbe-Illa F
Published: May 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Instituto de Salud Carlos III (ISCIII) (PI10/02763, PI10/02745, PI18/00449, PI19/00907), co-funded by FEDER “Una manera de hacer Europa”, SEPAR, Catalonian Cardiology Society, ResMed Ltd. (Australia), EsteveTeijin (Spain), Oxigen Salud (Spain), Associació Lleidatana de Respiratori (ALLER), CIBERES. MS received financial support from a "Ramón y Cajal" grant (RYC2019-027831-I) from the“Ministerio de Ciencia e Innovación - Agencia Estatal de Investigación” co-funded by the European Social Fund (ESF)/“Investing in your future”. AZ held the predoctoral fellowship “Ajuts 2021 de Promoció de la Recerca en Salut-9ª edició” from IRBLleida/Diputació de Lleida. JdB acknowledges receiving financial support from ISCIII (Miguel Servet 2019: CP19/00108), co-funded by the European Social Fund (ESF), “Investing in your future”.

Rationale

Obstructive sleep apnea (OSA) is prevalent in acute coronary syndrome (ACS) patients and is a cause of secondary hypertension.

Objectives

To evaluate the long-term effects of OSA and CPAP treatment on blood pressure (BP) control in patients discharged after an ACS.

Methods

Post hoc analysis of the ISAACC study included 1803 patients admitted for ACS (NCT01335087). Patients with OSA (apnea-hypopnea index ≥15 events/h) were randomly assigned to receive either CPAP or/and usual care and followed up for one to 5 years. Office BP was determined at each visit.

Measurements and Main Results

We included 596 patients without OSA, 605 patients in the CPAP group, and 602 patients in the usual care group. 52% of the patients had a diagnosis of hypertension at baseline. Median age and body mass index were 59 [52.0;67.0] years and 28.2 [25.6;31.2] kg/m2, respectively. After a median [25th;75th percentile] follow-up of 41.2 [18.3;59.6] months, BP changes were similar between OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI>40 events/h) with a maximum difference in mean BP of +3.3 mmHg at 30 months. OSA patients with good CPAP adherence (≥4 hours/night) reduced mean BP after 18 months compared to non-OSA and poor CPAP adherence patients, maximum mean difference (95% CI) of -4.7 (-6.7,-2.7) mmHg. In patients with severe OSA we observed a maximum mean difference of -7.1 (-10.3,-3.8) mmHg.

Conclusions

In patients discharged after an ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence.
Unhealthy behaviours of patients with cardiovascular diseases during the second COVID-19 lockdown in Northern Greece
Authors: Ioannidis A , Pechlevanis A , Paraskelidou M , Fragkiskou A , Giakoumi V , Lakias D
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Unhealthy behaviours can be amplified during lockdown and organisations, like WHO and CDC, campaign on how to stay healthy at home. Lifestyle choices are of paramount importance for primary and secondary prevention of cardiovascular diseases (CVDs). Northern Greece was forcefully hit by the second wave of the COVID-19 pandemic and a hard lockdown was implemented in November 2020.

Purpose

The aim of the study was to assess the (un)healthy behaviours of patients with CVDs during the second COVID-19 lockdown in Northern Greece.

Methods

This is a cross-sectional short questionnaire telephone-based survey conducted in February 2021. Responders with known CVDs were primarily questioned (using a Likert-like scale) about smoking, diet and physical activity, along essential medical history. Beliefs about COVID-19 pandemic and vaccination were also considered. Sociodemographic details were noted. Patients who were placed under quarantine were excluded in this analysis.

Results

The response rate was high (247 out of 400 calls, 61.8%) with the majority of the participants willing to speak for longer time than initially estimated. In total, answers by 216 patients (female 132/61.1%, mean age 56.6 years old) were incorporated. There were 119 active smokers questioned, half of whom (56, 47.1%) reported increased smoking with a minority of them (18, 15.1%) smoking less. None of the questioned participants attempted to quit smoking. The mean BMI was 27.5 ± 4.3 kg/m² (vs. 26.8 ± 3.8 kg/m² before lockdown) corresponding to a mean weight gain of about 2 kg. The rise in mean BMI could be explained, partly, by the increased eating as reported by almost half of the participants (121, 56.0%). Almost half of the responders (113, 52.3%) reported increased alcohol consumption during the lockdown, while one fifth reported unchanged drinking. One in four patients stated lower alcohol consumption mainly due to difficult supply and bar closure. The majority of the participants (177, 81.9%) answered that they exercised similarly or less in comparison to their pre-lockdown habits, while only 39 (18.1%) have been more physically active. There was no difference between the patients who were favourable about vaccination (had already been vaccinated/ had arranged an appointment/ were willing to get) and those who objected/ were hesitant. Sample size would not allow thorough comparison between age groups or socioeconomic status. Nevertheless, younger patients reportedly adopted healthier choices than older patients (who were also more like to be pensioners).

Conclusion

The hard lockdown in Greece during the second wave of the COVID-19 pandemic was accompanied with an aggravation of unhealthy choices by patients with CVDs. Further research is warrant to assess the clinical impact of these behaviours. Public campaigns are anxiously needed to promote healthy behaviours.
Time trends in cardiovascular risk factors across levels of education in a general population
Authors: Hagen A , Eggen AE , Hanssen TA , Lappegard KT , Lochen ML , Njolstad I , Wilsgaard T , Hopstock LA
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Northern Norway Health Authority

Background

Favourable changes over time in population cardiovascular disease (CVD) risk has not benefitted all socioeconomic groups equally. Social inequality in health also exists in high-income countries with an egalitarian welfare system.

Purpose

We aimed to study CVD risk factors across educational groups over time in a Norwegian general population.

Methods

We used multivariable linear regression and generalised estimating equation models with age-adjusted means and proportions to examine CVD risk (smoking, physical activity level, obesity [body mass index ≥30 kg/m2], blood pressure, total- and low-density lipoprotein [LDL] cholesterol, and total risk of CVD [estimated 10-year risk with NORRISK 2]) across four levels of education: Primary/partly secondary up to 10 years of schooling, upper secondary, tertiary <4 years, tertiary ≥4 years in women and men aged 40-79 years attending a population-based study with two consecutive surveys in 2007-2008 (N=11,941) and 2015-2016 (N=20,322).

Results

In women, the difference between the lowest and the highest education level in risk factors in 2007-2008 versus 2015-2016 was for smoking 22.0 vs 19.2 percentage points (pp), obesity 8.7 vs 8.8 pp, sedentary physical activity level 10.5 vs 11.5 pp (p=0.012), systolic blood pressure 5.5 vs 3.4 mmHg (p=0.001), total cholesterol 0.2 mmol/L vs no difference (p<0.001), LDL cholesterol 0.3 vs 0.1 mmol/L (p<0.001), and total CVD risk 0.9 vs 1.8 (p<0.001), respectively. In men, the corresponding numbers were for smoking 20.1 vs 16.8 pp, obesity 9.9 vs 12.9 pp, sedentary physical activity level 10 vs 11.5 pp (p=0.027), systolic blood pressure 1.7 vs 1.7 mmHg, total cholesterol 0.2 mmol/L vs no difference (p<0.001), LDL cholesterol 0.1 mmol/L vs no difference (p<0.001), and total CVD risk 1.2 vs 0.9, respectively. No difference across educational levels and time regarding blood pressure or total- or LDL cholesterol in users of antihypertensives and lipid-lowering drugs was found, except for an educational difference in the first but not the second time period in female antihypertensive users.

Conclusion

We found a clinically relevant educational gap in CVD risk factors, with more favourable levels with higher education. Over time, the educational gap increased in physical activity in both sexes, and in total CVD risk in women. Further, the educational gap declined in blood lipids in both sexes, and in systolic blood pressure in women. While medication use seems to contribute to weaken the educational gradient in blood pressure and lipid levels, a stronger emphasis on lifestyle interventions is needed to reduce the educational inequalities in behavioural CVD risk factors.
Cardiovascular health trajectories among adolescents enrolled in the SI Program in Spain: a longitudinal study
Authors: Martinez-Gomez J , De Cos-Gandoy A , Santos-Beneit G , Tresserra-Rimbau A , Bodega P , De Miguel M , Laveriano-Santos EP , Ramirez-Garza SL , Fernandez-Alvira JM , Orrit X , Carvajal I , Estruch R , Lamuela-Raventos RM , Fuster V , Fernandez-Jimenez R
Published: May 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation.

Background

There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories.

Purpose

To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables.

Methods

This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership.

Results

Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory.

Conclusions

In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.
No association between serum phytosterols and inflammatory marker levels in a population-based study
Authors: Stanasila L , Marquez Vidal PM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Background

The association between inflammation and dietary sterols remains poorly assessed at the population level.

Aims

To assess the possible association between serum levels of various phytosterols (PS) and inflammatory markers.

Methods

Serum levels of six PS (campesterol, campestanol, stigmasterol, sitosterol, sitostanol, brassicasterol), four cholesterol synthesis markers (lathosterol, lanosterol, desmosterol, dihydrolanosterol) and one cholesterol absorption marker (cholestanol) were measured together with levels of CRP, IL-6 and TNF-alpha in two cross-sectional surveys of a population-based, prospective study.

Results

PS levels and their ratios to cholesterol were significantly positively correlated to other PS and cholesterol absorption marker and negatively correlated to cholesterol synthesis markers, with a good agreement between follow-ups. Bivariate correlations showed a generally negative, sometimes significant, association between PS levels (or PS:total cholesterol ratio) and CRP in both follow-ups. The association between PS (or PS:total cholesterol) and IL6 or TNF alpha was mostly negative and, for some PS, significant in the second follow-up (Figure). These associations did not withstand adjusting for confounding factors such as sex, age, BMI and statin administration.

Conclusion

In this population-based study, PS serum levels were not significantly associated with inflammatory markers.
The level of the awareness of the population of the Republic of Kazakhstan about the levels of cholesterol, glucose in the blood, as well as about the factor of heredity
Authors: Mukhtarkhanova D , Junusbekova G , Tundybayeva M , Baglanova L , Leonovich T
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The prevalence of risk factors for cardiovascular diseases is very high, including in Kazakhstan: obesity, high cholesterol levels, diabetes mellitus, as well as impaired glucose tolerance. That is why it is important to urge the population to be aware of and control the levels of cholesterol and glucose in the blood, as well as the hereditary factor.

Purpose

To assess the awareness of the population of the Republic of Kazakhstan about the levels of cholesterol, glucose in the blood, as well as about the factor of heredity.

Methods

A prospective cross-sectional study with the sample of 1374 adults was conducted from August 2021 to November 2021 in four regions of Kazakhstan. There were both sexes (838 women (61%) and 536 men (39%)) of mean age - 39±10 years. Respondents were questioned by the special questionnaire performed to assess cardiovascular risk factors, blood pressure and heart rate measurements. Statistical test was performed by the StatTech, Russia.

Results

According to the data obtained, a 488 female respondents (58.2%) and 235 male respondents (43.8%) are aware of blood glucose levels, while 44 (5.3%) women and 39 (7.3%) men are aware of an increase in indicators, it should be noted that the majority of men (262, 48.9% ) do not know the glucose level (p <0.001).

Regarding blood cholesterol parameters, there is no statistically significant difference between women and men: most female and male respondents are unaware of their cholesterol levels: 474 (56.6%) and 329 (61.4%), respectively (p = 0.077).

However, with regard to the factor of heredity for cardiovascular diseases, it was not possible to establish a statistically significant difference between the sexes: the overwhelming majority of both women and men are aware of their hereditary history, while 297 female (35.4%) and 176 male (32.8%), respectively, report aggravated heredity.

There were no statistically significant differences in the prevalence of diabetes mellitus among male and female respondents (p = 0.875): 47 (5.6%) among women and 29 (5.4%) among men.

Conclusion

There is significant difference between female and male regarding to awareness about glucose blood levels; women are more likely to be aware about their own health. The overwhelming majority of both men and women are aware of the heredity factor.
Gaming for better health? Comparison of cardiorespiratory and hemodynamic responses of exergaming with moderate endurance exercise
Authors: Ketelhut S , Ketelhut R , Kircher E , Roeglin L , Hottenrott K , Martin-Niedecken AL , Ketelhut K
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Exergames are interactive video games that require the player to move their body to progress through the game. Even though numerous studies have determined a higher exercise intensity in exergames compared to sedentary videogames, the literature remains equivocal as to whether exergames elicit intensity levels that result in relevant physiological responses. The aim of the present study was to assess whether an exergaming session (ES) in an innovative exergame represents a physiological relevant exercise stimulus capable of producing favorable hemodynamic responses similar to moderate endurance exercise (MEE). Therefore, cardiovascular responses during and after an ES and an ET were assessed and compared.

Methods

Twenty-seven healthy young adults aged 25±4 years (48% female; BMI 23.0±2.1 kg/m2) participated in the study. The Maximum heart rate (HRmax) and the maximum oxygen consumption (VO2max) were determined during a cardiopulmonary exercise test on a treadmill. Furthermore, participants completed both a typical MEE (35 minutes, 65% of HRmax) on a treadmill and an ES (28 minutes). Heart rate (HR) and oxygen consumption were recorded during both training sessions. Both before and during the 45 minutes after the training sessions, the peripheral and central blood pressure (BP) were assessed.

Results

HR and oxygen consumption were significantly higher during ES than during MEE (p<0.001). Throughout the ES, the participants achieved a mean HR of 86±4 % of HRmax. Mean oxygen consumption reached 66±5 % of VO2max. 45 Minutes after the ES, there was a significant decrease in peripheral systolic (-6.2±2.9 mmHg; p<0.001) and diastolic (-4.8±5.7 mmHg; p<0.001), as well as in central systolic (-4.9±5.4 mmHg; p<0.001) and diastolic (-4.8±5.2 mmHg; p<0.001) BP compared to baseline. After MEE, only the peripheral diastolic (-2.3±3.4 mmHg; p=0.003), and central diastolic (-2.2±3.8 mmHg; p=0.006) pressure were significantly lower than the resting values before the exercise. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p=0.05).

Conclusion

The ES represents a vigorous exercise stimulus that triggers relevant peripheral and central BP reactions that are more pronounced than after an MEE. Exergaming may therefore be a promising tool for the prevention of cardiovascular diseases.