bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse coronary plaque characteristics are more common in patients with diabetes
Authors: Simon J , Hahn V , Jermendy G Y , Kolossvary M , Kardos A , Szilveszter B , Boussoussou M , Vattay B , Merkely B , Maurovich-Horvat P
Published: October 2021

Introduction

Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. However, there is a lack of data about the prevalence of adverse coronary artery plaques characteristics in patients with DM.

Purpose

In our study we aimed to compare the prevalence of adverse atherosclerotic coronary artery plaque characteristics between patients with and without DM.

Methods

We have analyzed the data of patients who underwent coronary computed tomography angiography (CCTA) between October 2012 and December 2020. Our exclusion criteria were coronary anomaly, congenital or other structural heart disease, previous revascularization or heart transplantation, non-diagnostic image quality and no available data on the presence of DM. Patients were divided into two groups based on the presence of DM.

Results

In total, 11,357 patients were included in our study. Prevalence of DM was 14.5%. There were significant differences in age (63.2±9.5 vs 58.1±12.2 years, p<0.001) and major cardiovascular risk factors such as hypertension, dyslipidemia and smoking between the two groups (all p<0.05). We have measured higher coronary artery calcium score in patients with DM vs. without DM (424.3±744.0 vs 174.2±794.6, p<0.001). Obstructive coronary artery disease (stenosis >70%) was more frequent in the DM group (24.6% vs 10.5%, p<0.001). While 29.6% of patients without DM had at least one plaque with adverse characteristics, this rate was 38.9% in those with DM (positive remodeling: 19.6% vs 26.1%, low attenuation: 7.6% vs 10.2%, spotty calcium: 16.9% vs 21.6%, napkin-ring sign: 1.7% vs 2.6%, all p<0.05).

Conclusions

The prevalence of severe coronary artery stenosis and coronary plaques with adverse characteristics was higher in patients with DM. Multivariate analysis is needed to further explore this association.

Funding Acknowledgement

Type of funding sources: None.
Education and lifestyle measures for awareness of syncope prodroms to prevent syncope recurrence in schoolchildren
Authors: Mair V , Santos F R A , Pereira H G , Pastore C A , Samesima N , Diniz L J , Takada J Y , Mansur A P , Nakagawa N K
Published: October 2021

Background

Syncope is a transient loss of consciousness secondary to cerebral hypoperfusion and is characterized by a sudden onset, short duration and spontaneous recovery. The prevalence of syncope is between 30 to 50% in children and adolescents, 75% of them could corresponding to neuromediated reflex syncope (NRS) and to postural orthostatic tachycardic syndrome (POTS). The efficacy of education and lifestyle measures to prevent syncope prodromes in schoolchildren is still little known.

Objective

The aim of this study was to assess the education and lifestyle measures (syncope prodromes recognition, frequent water intake, counter-pressure maneuvers and physical activity) for preventing syncope prodromes in schoolchildren over 12 months.

Methods

We included 123 children and, at baseline, we assessed clinical parameters such as heart rate (HR), and systolic and diastolic blood pressure (SBP and DBP, respectively), and oriented how to recognize syncope prodromes and triggers as well as to take lifestyle and other measures (frequent water intake, counter-pressure maneuvers and physical activity). We performed statistical analysis using ANOVA for continuous variables and Qui-Square Test or Fisher Exact Test for categorical variables, when appropriate.

Results

Children were divided in three groups: no NRS-POTS (noNRS-POTS; n=103, mean age: 10.0 years, 49 male, height: ∼1.42 m, weight: ∼60.9 kg, HR: ∼63 bpm, SBP: ∼100,1 mmHg and DBP: ∼65.8 mmHg), NRS (n=5, mean age: 10.4 years, 2 male, height: ∼1.39 m, weight: ∼63.9 kg, HR: ∼68 bpm, SBP: ∼107,2 mmHg and DBP: ∼69.8 mmHg), and POTS (n=15, mean age: 10.47 years, 6 male, height: ∼1.39 m, weight: ∼69.0 kg, HR: ∼53 bpm, SBP: ∼100,7 mmHg and DBP: ∼63.6 mmHg). From 123 children, 95% (n=117) had history of syncope prodromes and 13.8% (n=17) had syncope history. Over the 12-month, only 10.6% of them (n=13) continued to have syncope prodromes and, most interesting, none of them had a new syncope event.

Conclusion

Education and lifestyle measures were effective to significantly reduce syncope prodromes and to prevent any new syncope event.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Sao Paulo
COVID-19 infection impact on cardiovascular and thrombotic events during acute phase and medium-term of the disease
Authors: Varela Lopez A , Diaz Argueso L , Broco Fernandez C , Cacho Antonio C E , Antunez Muinos P J , Otero Garcia O , Jimenez Ramons V , Gonzalez Ferreiro T , Perez-Poza M , Bastos Fernandez M , Garcia Campos A , Varela Roman A , Lopez Pais J , Lopez Otero D , Gonzalez Juanatey J R ,   CARDIOVID
Published: October 2021

Background

Coronavirus disease (COVID-19) was labelled a global pandemic in April 2020 by the World Health Organisation. By December of the same year the disease caused by SARS-COV-2, known as COVID-19 (Coronavirus disease 2019), had spread over 200 countries, infecting more than 70 million people, causing more that 1.5 million of deaths.

Recent studies suggest SARS-CoV-2 infection may be related to cardiovascular and thrombotic events although the strength of association remains unclear.

Aims

Evaluate the emergence of cardiovascular and thrombotic events (such as major acute cardiovascular events, ictus and other thrombosis) in the acute moment and in medium-term follow-up in COVID-19 patients.

Methods

Single-Center, retrospective, observational study of cohorts based on all the inhabitants of the health area. Survival analysis of main outcomes (mortality, heart failure [HF], and major acute cardiovascular events – MACE - [a composite of cardiovascular mortality, myocardial infarction and stroke]) were adjusted by multivariate logistic regression.

Results

Of the total population studied, 447,979 inhabitants, 1,030 (0.23%) were diagnosed with COVID-19 infection, of which 14,8% were smokers, 31,2% had high blood pressure (HTA), 12,8% had diabetes, 29,2% had dyslipidaemia, 2,7% had peripheral artery disease, 4,7% had ischemic heart disease, 3,3% had had a previous transient ischemic attack, 10% were in anti-aggregation treatment and 5,8% were in anticoagulation treatment at the time of diagnosis. Concerning the analytics middle values, the group treated with ACEI/ARAB had higher troponins and ferritin than the group without ACEI/ARAB treatment, whereas higher reactive C protein and D-dimer were found in this last group. The main results showed that COVID-19 infection had no effect regarding to cardiovascular and thrombotic disease on mortality (OR: 1.64, 95% CI 0.98 2.76, p=0.062), heart failure (OR: 0.98, 95% CI 0.53 1.79, p=0.942), thrombotic events (OR: 1.02, 95% CI 0.22 4.83, p=0.98) and major acute cardiovascular events (OR: 0.88, 95% CI 0.48 1.60, p=0.665).

Conclusions

In conclusion, COVID-19 infection had no effect on the emergence of cardiovascular or thrombotic events taking into account the 6-month prognosis, defined as mortality, heart failure, or major acute cardiovascular events.

Funding Acknowledgement

Type of funding sources: None.
COVID-19 pandemic triggers acute myocardial infarction, stroke, and out-of-hospital cardiac arrest in non-infected individuals: the final results of the JoCORE study
Authors: Alhaddad I , Hammoudeh A , Mdanat E , Makhamreh H , Ibdah R , Fakhri M , Tabbalat R ,   JoCORE Study Investigators
Published: October 2021

Introduction

The relentless COVID-19 pandemic caused a devastating sickness and loss of life at a global level. The stress related to the pandemic lockdown and near total paralysis of most human activities was associated with behavioral changes. It is largely unknown if these stresses could trigger acute cardiovascular events among non-infected individuals.

Purpose

To explore the relation between COVID-19 associated stresses and acute cardiovascular events among non-infected individuals.

Methods

Adult patients presented with acute myocardial infarction (AMI), stroke or out-of-hospital cardiac arrest (OHCA) at 11 hospitals in Jordan from March 2020 through February 2021 were assessed for potential exposure to stressful life events related to the COVID-19 pandemic. None of the patients was COVID-19 infected or a health care worker.

Results

Of 297 patients enrolled (mean age 58.4±13.1 years, 18.5% females), 267 patients (89.8%) had AMI, 15 patients (5.1%) had stroke, and 15 patients (5.1%) had OHCA. Cigarette smoking was present in 59.6%, hypertension in 50.5%, dyslipidemia in 42.8%, diabetes in 37.4%, and 35% had prior diagnosis of cardiovascular disease. Coronary revascularization was performed in 228 (85.4%) of AMI patients. In-hospital mortality among the AMI and stroke patients was 4.3% and none of the OHCA patients survived. The most common stresses preceded these events included financial hardships (50.8%), lockdown stress (25.9%), fears from the pandemic (24.9%), anger (22.6%), loneliness (19.2%), smoking binges (19.9%), death of a significant person (6.4%), and food binges (3.4%).

Conclusions

The COVID-19 pandemic and lockdown caused immense psychosocial and financial stresses that triggered life threatening acute cardiovascular events in non-infected individuals. Early recognition of stress-related symptoms during this unremitting pandemic warrants proper referral and evaluation.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): ABDEL HAMEED SHOMAN FOUNDATION (AHSF) RESEARCH FUND
Resilience of the hellenic navy SEALs assessed by heart rate variability during cognitve tasks
Authors: Mourtakos S , Vasiliou G , Papageorgiou C , Konotangelos K , Philippou A , Bersimis F , Geladas N , Koutsilieris M , Sidossis L , Tsirmpas C , Papageorgiou C
Published: October 2021

Background

The interaction between high physical performance under extreme conditions and simultaneous control of the cognitive executive functioning has been a subject of research in literature for the past few decades. Stroop test and Heart-rate variability (HRV), have been verified clinical tools for the assessment of cerebral and autonomic/ cardiovascular stress responses respectively.

Purpose

The investigation of HRV adaptive response to stress and cognitive stress resilience under extremely strenuous conditions.

Methods

34 consecutive subjects were enrolled. Of them, 18 were candidates under intense preparation for their enlistment in the Hellenic Navy SEALs (HNS) and 16 were healthy controls (HC). All subjects underwent stroop tasks, along with mental state and personality examination. HRV variables in time and frequency domains recordings were acquired, during each aforementioned cognitive testing procedure.

Results

HNS's performance on both cognitive and emotion stroop tasks were equivalent to controls. During the size comparison of the number stroop and emotion stroop, HC had statistically significantly higher power content at different HRV frequency bands compared to HNS participants (p=0.036 and p=0.06 respectively). Finally, in a between group comparison of the psychometric tools, HNS had significantly higher somatization (p<0.01), anxiety (p=0.037) and neuroticism (p=0.047) than HC. Correlation was conducted for each group separately, between the psychometric tools and the measurements of HRV for both number and emotion stroop. Moderate negative correlations were found between SDNN (Standard deviation of normal-to-normal RR-intervals) during the size comparison of number stroop and three out of nine categories of psychometric questionnaire; somatization (r(23)=−0.452, p<0.05), anxiety (r(23)=−0.457, p<0.05) and hostility (r(23)=−0.445, p<0.05)

Conclusion

The above findings suggest that HNS display flexibility in their autonomic regulation during cognitive and emotional tasks. This characteristic is closely related to problem solving or adaptability skills. Additionally, HRV can be a promising clinical index regarding the assessment of psychophysiological resilience especially in the neurovisceral integration (NVI) model.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region of Attica
Influence of depressive disorders on quality of life and three-year survival of patients with coronary heart disease
Authors: Nonka T G , Lebedeva E V , Repin A N
Published: October 2021

Background/Introduction

Depressive disorders (DD) affect more than 350 million people in the general population, especially among patients with cardiovascular diseases. World Health Organization predicts that by 2030 coronary heart disease (CHD) and DD will become the leading causes of disability in the civilized countries of the world. This fact indicates the need to identify DR at the early stages of examination of patients with CHD for timely correction and improvement of prognosis.

Purpose of the work

To assess the quality of life and three-year survival rate of patients with CHD in combination with DR.

Methods

122 patients with chronic CHD (with exertional angina of II-III functional classes) were included in the study on the basis of the cardiology department. The presence and level of depression, anxiety, and social adaptation were assessed using the Beck Depression Scales (BDI), Sheehan Anxiety (ShARS), Social Adaptation (Bosc). The three-year survival rate was also investigated. Two groups were formed: the first – 58 patients with CHD with DD and the second – 64 patients with CHD without DD. Data were presented as M ± SD. The difference was considered statistically significant at p<0.05. The 3-year survival rate of patients was assessed using the Kaplan-Meier method with the determination of differences between groups using the Wilcoxon-Gehan test.

Results

The groups were comparable in terms of the main clinical and demographic characteristics and concomitant therapy. In patients with depression, compared with patients without it, was identified an increased level of depression (BDI – 7.3±4.3 points vs 2.3±1.6 points, p=0.ehab724.275201) and anxiety (Shikhana – 37.6±20.3 points vs 18.3±12.4 points, p=0.0002); lower level of social functioning (Bosc – 35.0±7.3 points vs 39.3±5.8 points, p=0.04). The 3-year survival rate was 92.6% (113 people), of which in the first group – 87.9% (51 people), in the second – 96.9% (62 people). The worst survival rate (Gehan-Wilcoxon test, p=0.03) was noted in the group of CHD with DD.

Conclusion(s)

In patients with chronic CHD in combination with DD, an increased level of anxiety and a lower quality of life were revealed, which can worsen the course of CHD. The 3-year survival rate is significantly worse in patients with CHD with a DD in comparison with patients without mental disorders.

Funding Acknowledgement

Type of funding sources: None.
Association of body mass index with non-achievement of target low-density lipoprotein level in older patients at very high cardiovascular risk: a multicentre study
Authors: Nguyen H T , Nguyen A H , Lam H M , Nguyen T T
Published: October 2021

Introduction

Low-density lipoprotein cholesterol (LDL-c) is a well-established risk factor for atherosclerotic cardiovascular disease. Nonetheless, the association of body mass index (BMI) with non-achievement of target LDL-c level in older patients with type 2 diabetes (T2D) at very high cardiovascular risk is unknown.

Purpose

To investigate whether BMI is associated with non-achievement of target LDL-c level in older patients with T2D at very high cardiovascular risk.

Methods

From December 2019 to June 2020, in this multicentre prospective cross-sectional study, we enrolled 733 consecutive outpatients aged ≥60 years with T2D at very high cardiovascular risk in whom LDL-c levels could be measured after any stable lipid-lowering therapy for ≥6 months. Achievement of target lipid level was assessed based on the 2019 guidelines of the European Society of Cardiology for dyslipidaemia. Factors associated with non-achievement of target LDL-c level were determined using logistic regression analysis.

Results

Of the total cases (age, 68.6±7.2 years; men, 51.3%), 654 patients (89.2%) did not achieve an aggressive target LDL-c level of <1.4 mmol/L. Target non-high-density lipoprotein cholesterol level of <2.2 mmol/L and triglyceride level of <1.7 mmol/L were not achieved in 87.9% and 56.2% of the patients, respectively. In the multivariate model, BMI was the only factor associated with failure to achieve target LDL-c level, but not other factors such as age, sex, education level, smoking, and comorbidities. The adjusted odds ratio were 0.88 (95% confidence interval [95% CI], 0.24–3.21; P=0.84) for underweight, 1.57 (95% CI, 0.87–2.81; P=0.13) for overweight, and 2.63 (95% CI, 1.43–4.83; P=0.002) for obesity (normal weight was set as reference) status.

Conclusions

Non-achievement of target LDL-c level is highly prevalent in older patients with T2D at very high cardiovascular risk. Obesity, defined by BMI, can be a factor associated with non-achievement of the target. The findings highlight the importance of management of lipid levels in older patients with T2D.

Funding Acknowledgement

Type of funding sources: None. Figure 1
In-hospital bleeding in elderly patients with acute coronary syndrome: are potent antiplatelet agents safe?
Authors: Keskin K , Sigirci S , Gurdal A , Sumerkan M , Ser O S , Kilci H , Kalender E , Alyan O
Published: October 2021

Background

Despite implementation of newer interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome continue to be prone to in-hospital bleeding compared to their younger patients.

Purpose

To investigate in-hospital bleeding events, define the bleeding sites, characteristics and associated factors in elderly patients with acute coronary syndrome.

Methods

Patients 75 years or over who were admitted with acute coronary syndrome were included in the study. The definition of in-bleeding was defined as any bleeding requiring transfusion or clinically significant bleeding that altered the treatment course. The main outcome of the study was to find out the incidence of in-hospital bleeding events and associated risk factors. We also wanted to define the bleeding sites, characteristics as well as 1-year all-cause mortality with respect to in-hospital bleeding.

Results

Overall, 539 patients were included in the study. Mean age was 82.5±4.8 years and 282 (52.3%) patients were female. Of these patients 69 (12.8%) developed in-hospital bleeding. The most common site for bleeding was urinary tract followed by access site bleeding. Factors that were independently related with in-hospital bleeding were age (OR: 1.08; 1.01–1.14 CI 95%; p=0.01), acute kidney injury (OR: 3.66; 2.01–6.69 CI 95%; p<0.01), tirofiban (OR: 4.43; 1.78–10.99 CI 95%; p<0.01) and ticagrelor (OR: 1.93; 1.01–3.73 CI 95%; p=0.04) administration. The patients who developed in-hospital bleeding had also higher one-year all-cause mortality (p [log-rank] = 0.01).

Conclusion

In-hospital bleeding continues to be a frequent problem among older patients with acute coronary syndrome. Ticagrelor and tirofiban should be used cautiously. In addition to access site bleeding, urinary tract bleeding events were also common.

Funding Acknowledgement

Type of funding sources: None. Table 1Table 2
The new myokine myonectin is significantly associated with type 2 diabetes in elderly patients
Authors: Leiherer A , Muendlein A , Geiger K , Saely C H , Larcher B , Mader A , Maechler M , Sprenger L , Mutschlechner B , Benda M , Fraunberger P , Drexel H
Published: October 2021

The novel myokine myonectin is predominantly expressed in skeletal muscle and is involved in the regulation of metabolic homeostasis. A putative association between myonectin and type 2 diabetes mellitus (T2DM) has been discussed controversially in current literature.

The purpose of this study was to investigate the association between myonectin and T2DM at different ages.

We measured myonectin in 410 vascular risk patients with a mean age of 66 years.

Myonectin did not correlate with age (r=−0.19; p=0.697). From our patients 219 (53%) were >65 years, with a mean age of 74 years and 191 ≤65 years, with a mean age of 57 years. The prevalence of T2DM was 40.6% vs. 42.4% in the older as compared to the younger age group. Myonectin concentrations were significantly decreased in elderly patients with T2DM compared to non-diabetic subjects (1.8 vs. 4.2 ng/ml; p=0.002), whereas no significant difference was observed in younger patients (2.6 vs. 2.3 ng/ml; p=0.183). Concordantly, regression analysis revealed an unadjusted odds ratio (OR) of 0.24 [0.07–0.81] (p=0.021) for the association between myonectin and T2DM in elderly patients but not in younger patients (OR=1.08 [0.80–1.45]; p=0.609). The association between myonectin and T2D; remained significant after adjusting for sex, body mass index, LDL cholesterol, HDL cholesterol, current smoking, as well as statin intake in elderly but remained non-significant in younger patients (OR=0.23 [0.07–0.81]; p=0.021 vs. OR=1.05 [0.76–1.46]; p=0.769).

We conclude that plasma myonectin levels are significantly associated with T2DM, particularly in elderly vascular risk patients.

Funding Acknowledgement

Type of funding sources: None.
Ipilimumab and Nivolumab exertes cardiotoxic and pro-fibrotic effects in mice through the overexpression of NLRP3 inflammasome, chemokines and leukotrienes
Authors: Quagliariello V , Passariello M , Rea D , Barbieri A , Buccolo S , Iovine M , Bonelli A , Caronna A , Botti G , De Lorenzo C , Maurea N
Published: October 2021

Background

Several strategies based on immune checkpoint inhibitors (ICIs) have been developed for cancer therapy, opening to advantages in cancer outcomes. However, several ICIs-induced side effects emerged in these patients, especially a rare but clinically significant cardiotoxicity with high rate of mortality.

Purpose

We studied cytotoxic and pro-inflammatory properties of Ipilimumab and Nivolumab in cellular and preclinical models

Methods

Co-cultures of human cardiomyocytes and hPBMCs were exposed to Ipilimumab or Nivolumab at 100 nM; cell viability and expression of leukotrienes, NLRP3 inflammasome, MyD88 (myddosome) and p65/NF-kB were performed. C57 mice were untreated (Sham; n=6) or treated with Ipilimumab (IPI, n=6) (15 mg/kg); analysis of fractional shortening, ejection fraction, radial and longitudinal strain were made before and after treatments through 2D-echocardiography (Vevo 2100). Expression of NLRP3, MyD88, p65/NF-kB, leukotrienes and 12 cytokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IFN-γ, TNF-α, G-CSF, and GM-CSF) have been analyzed in murine myocardium.

Results

Nivolumab and Ipilimumab induced cell death and apoptosis in cardiomyocutes. Both ICIs increased NLRP3, MyD88 and p65/NF-kB expression compared to untreated cells, however the most pro-inflammatory and cardiotoxic effects were seen after exposure to Ipilimumab. Mice treated with Ipilimumab showed a significant decrease of fractional shortening and radial strain compared to untreated mice. Metabolic studies clearly indicates that ipilimumab increases leukotrienes production and NLRP3 expression in heart tissues, probably due to increased iROS content (iROS are key inductors of leukotrienes expression). High expression of IL-6, IL-1 and IL-17 were also seein in mice treated with ipilimumab (p<0,001).

Conclusions

Nivolumab and Ipilimumab exert cytotoxic effects mediated by NLRP3 inflammasome, leukotrienes and pro-inflammatory cytokines in heart tissues.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero della Salute, Ricerca Corrente Project
Early increase of high-sensitivity cardiac troponin predicts mortality in cancer patients undergoing chemotherapy
Authors: Nowakowska M A , Chrzanowski L , Miskowiec D , Wdowiak-Okrojek K , Wejner-Mik P , Lipiec P , Krakowska M , Potemski P , Plonska-Gosciniak E , Kasprzak J D
Published: October 2021

Introduction

High-sensitivity cardiac troponin test (hs-TnT) reveals subclinical myocardial damage in many cardiac conditions. We hypothesized that elevated hs-TnT may predict a development of cancer therapy-related cardiac dysfunction and clinical outcomes linked with antineoplastic therapies. We aimed to evaluate the predictive value of hs-TnT for all-cause mortality in a group of patients (pts) with recent diagnosis of cancer.

Material and methods

We included 80 pts (mean age 57±13 years; 98% women) with recently diagnosed cancer (78 breast cancer, 1 colon cancer, 1 DLBCL lymphoma). Transthoracic echocardiography and hs-TnT tests were performed at baseline and after 3, 6 and 12-months. Pts with LVEF <50% and significant valvular disease were excluded.

Results

In the study group 44% pts had arterial hypertension, 54% dyslipidemia, 9% diabetes mellitus; 94% pts were treated with anthracyclines, 30% with trastuzumab, 54% with hormone therapy, 71% with radiotherapy. A significant decrease of LVEF were observed during follow-up (LVEF at baseline, 3, 6 and 12 months: 61.7±2.0%; 60.9±2.0%*; 60.8±2.9%*; 59.9±2.9%*; *p<0.05 vs baseline). A significant reduction of global longitudinal strain was found only at 6-month follow-up (−19,2±2,2% vs −18,6±2,0%; p=0,003). In 38 pts at least a twofold (fourfold in37) increase in hs-TnT >99th percentile was observed. A rise of hs-TnT was most often seen at 3 month (n=35; 43,8%). During median 1056 (221–1906) days off follow-up 18 (24%) pts died and ROC curve analysis revealed that early (0–3 months) hs-TnT increase more than 10 pg/ml [AUC=0,693 (0,545–0,806); p=0,017)] represented a predictor of death [OR=3,4 (1,99–11,87)].

Conclusions

Increase in hs-TnT in cancer patients detected at 3rd month of chemotherapy predicts mortality.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Cardiovascular outcomes in hospitalized patients with COVID-19 and history of cancer: a CORONA-VTE analysis
Authors: Khairani C D , Barns B M , Rizzo S M , Pfeferman M B , Snyder J E , Goldhaber S Z , Piazza G ,   Thrombosis Research Group
Published: October 2021

Background

In hospitalized patients with COVID-19, active cancer has been identified as a potential risk factor for adverse cardiovascular outcomes, including thrombosis. However, the impact of COVID-19 on outcomes in patients with a remote history of cancer is poorly understood. We evaluated hospitalized patients with a history of remote cancer and COVID-19 to examine whether a history of cancer contributes to 30-day major adverse cardiovascular outcomes among patients with COVID-19.

Methods

Using a retrospective cohort of 1114 patients from CORONA-VTE (Registry of Arterial and Venous Thromboembolic Complications in Patients With COVID-19), we looked at 399 hospitalized patients diagnosed with polymerase chain reaction (PCR)-confirmed COVID-19 within a large heath care network that consists of two large academic medical centers and several community hospitals. Twenty-six patients with active cancer or receiving cancer treatment within 1-year of COVID-19 diagnosis and five patients with unknown cancer history were excluded. We assessed 46 patients with a history of cancer and 322 patients without any history of cancer. The primary endpoint was the frequency of adjudicated major adverse cardiovascular outcomes, defined as myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, and mortality.

Results

Among the 46 hospitalized patients with COVID-19 and a history of cancer, 23.9% were non-white and 43.48% women. Compared to patients without any history of cancer, patients with a history of cancer were older (median 59.0 vs. 75.5 years, p<0.001) and had higher BMI (median 26.4 vs. 29.6 kg/m2, p<0.05). Patients with a history of cancer had higher rates of underlying CVD than those without (42.4% vs. 23.2%). Rates of major adverse cardiovascular events were similar in patients with and without a history of cancer (28.3% vs. 23.6%, respectively). Those with a history of cancer had a higher mortality rate (28.9% vs. 11.2%, p<0.05). Acute Respiratory Distress Syndrome (ARDS) and preexisting CVD were independently associated with mortality in this patient cohort (OR 19.7, 95% CI 7.5–51.7 and OR 2.9, 95% CI 1.2–6.9). History of remote cancer was not independently associated with mortality (OR 2.39, 95% CI 0.93–6.15, p=0.07).

Conclusion

Our findings indicate that a history of remote cancer is not independently associated with increased mortality in hospitalized COVID-19 patients. These data suggest that the cause of death among hospitalized patients with COVID-19 and history of cancer is most likely multifactorial, with a strong contribution from cardiovascular disease.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Janssen Pharmaceuticals
Rates of cardiovascular events are significantly different across cancer types
Authors: Mitchell J D M , Laurie M L , Xia Q X , Jain N J , Jain A J , Lane D L , Lenihan D J L
Published: October 2021

Background

As a result of the effects of both cancer treatment and underlying cardiovascular (CV) risk factors, patients with cancer have a 2 to 6-fold higher CV mortality rate than the general population. Certain cancer types appear to be associated with a greater CV risk, although much of our current understanding is limited to breast and pediatric cancer survivors. We sought to characterize the CV risk factor burden and incidence of CV events across different cancer types.

Methods

We included all patients diagnosed with 9 different cancer types (breast, lung, prostate, melanoma, myeloma, kidney, colorectal cancer, leukemia, or lymphoma) after June 1, 2011 in a large US administrative claims database (PharMetrics). Patients had continuous enrollment in the database for ≥12 months prior to cancer diagnosis, and were followed until they had a specified CV event or were disenrolled. Incidence rates for CV events were calculated and Cox proportional hazard multivariable models were used for time-to-event analysis for each cancer type, accounting for baseline CV risk factors.

Results

Over 800,000 patients with cancer were identified across the 9 cancer types. The incidence of CV events was generally >5-fold higher in lung cancer than in breast cancer. The adjusted hazard ratio for the combined CV events of myocardial infarction, stroke, unstable angina, and heart failure was 2.7 (95% confidence interval 2.6–2.7) for lung cancer relative to breast cancer, with a cumulative incidence of 25% by 4 years. Multiple myeloma and leukemia had the next highest cumulative incidence of CV events, while breast cancer and melanoma had the lowest (Table 1 and Figure 1).

Conclusion

CV events were significantly increased in certain cancer types, especially lung, multiple myeloma and leukemia, even after accounting for baseline CV risk factors. Patients with lung cancer had a 25% cumulative incidence of combined CV events within 4 years. Understanding the wide variation of CV events in patients with cancer can help inform CV risk factor modification and strategies to minimize CV toxicity, with the aim of reducing the risk of future CV events and improving the morbidity and mortality of cancer survivors.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Bristol Meyers Squibb
Association between baseline ldl-c and prognosis among patients with coronary artery disease and advanced kidney disease
Authors: Wang B , Liu J , Chen S Q , Luo Q H , Liu Y , Tan N
Published: October 2021

Background

Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. There are currently no studies examining the association of low baseline LDL-C concentration (<1.8 mmol/L) with mortality among patients with CAD and advanced kidney disease (AKD). We aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients.

Methods

In this observational study, 803 CAD patients complicated with AKD (eGFR <30 mL/min/1.73 m 2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C <1.8 mmol/L, n=138; LDL-C ≥1.8 mmol/L, n=665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality.

Results

Among 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (<1.8mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89).

Conclusions

Our data demonstrated that among patients with CAD and AKD, a lower baseline LDLC level (<1.8mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): This study was supported by the National Natural Science Foundation of China (Grant No. 81670339 and Grant No. 81970311), Cardiovascular Research Foundation Project of the Chinese Medical Doctor Association (SCRFCMDA201216) and Beijing Lisheng Cardiovascular Health Foundation (LHJJ20141751).
Conservative management of acute coronary syndromes in chronic kidney disease patients: a deadly sin
Authors: Gkini K.-P , Terentes-Printzios D , Aznaouridis K , Georgakopoulos C , Oikonomou D , Ioakeimidis N , Gardikioti V , Kallikazaros I , Tsioufis K , Vlachopoulos C
Published: October 2021

Background/Introduction

Chronic kidney disease (CKD) is associated with worse prognosis in acute coronary syndromes (ACS).

Purpose

We sought to investigate the prognostic effect of non-invasive management of ACS in CKD patients in a tertiary University Hospital.

Methods

Two hundred and one patients (mean age 66.5±13.6 years, 150 males) admitted to our Hospital with ACS from 2016–2017 were included in the study. Patients were followed for a median of 2 years post the index event. CKD was defined by an estimated glomerular filtration rate (eGFR) <60 ml/min/m2, as assessed by the Modification of Diet in Renal Disease (MDRD) equation. We grouped patients into four groups according to their CKD status and whether they underwent coronary angiography or not. The primary outcome was all-cause death and secondary outcomes were cardiovascular and non-cardiovascular death.

Results

The majority of patients (n=120, 60%) presented with non-ST elevation ACS (NSTE-ACS), whereas 81 patients as ST-elevation myocardial infarction (STEMI) (40%). Fifty-four patients (27%) were identified as CKD patients (of whom 5 were on dialysis). Overall, 29 patients (14.4%) did not undergo coronary angiography. Patients at a higher age and with CKD were more likely to not undergo angiography. Thirty-seven (18.4%) died during follow-up (25 non-cardiovascular deaths and 12 cardiovascular deaths). Patients with conservative treatment and CKD had the worse prognosis (Hazard ratio [HR] =11.00, 95% Confidence intervals [CI] 4.00 to 30.24, p<0.001) followed by non-CKD patients with conservative treatment (HR=4.37, 95% CI 1.20 to 15.90, p=0.025) compared to non-CKD patients treated invasively (reference group) after adjusting for age, gender, STEMI/NSTE-ACS diagnosis (Figure). Results were similar for non-cardiovascular death, whereas regarding cardiovascular death only the group with CKD and conservative treatment had a lower survival compared to the reference group (HR=26.5, 95% CI 2.9 to 241.7, p=0.004)

Conclusions

Patients with ACS and CKD are less likely to receive invasive management and have higher mortality from both cardiovascular and non-cardiovascular causes than patients without CKD. Conservative management of ACS was associated with higher long-term mortality versus invasive management in all patients, regardless of CKD status.

Funding Acknowledgement

Type of funding sources: None.
PCSK9 inhibitors associated hyperglycemic disorders: a real world, pharmacovigilance study
Authors: Goldman A G , Raschi E R , Cukierman-Yaffe T Y , Dankner R D , Shouval R S , Shechter M D , Ben-Zvi I B Z , Maor E M
Published: October 2021

Background

Initial genetic and biological studies indicated an association between proprotein-convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and hyperglycemic disorders. However, subsequent clinical trials yielded inconsistent results, and real-world data are scant.

Purpose

We sought to assess the association of PCSK9i and hyperglycemic events in a real-world setting, using the FDA adverse event reporting system (FAERS).

Methods

The FAERS database (2015–2020) was retrospectively queried to assess reporting of PCSK9i-associated hyperglycemic events. Disproportionality analyses were performed using an adjusted odds ratio (adj.ROR), and the lower bound of the information component (IC) 95% credibility interval (IC025>0 is deemed significant).

Results

The full database included 7,295,624 eligible patients, among them 71,748 reports of evolocumab and 15,976 of alirocumab. Compared to the full database, treatment with evolocumab, but not alirocumab, was associated with increased reporting of hyperglycemic events (n=1,587 [2.21%], adj.ROR = 1.24 [1.15–1.32], IC025 = 0.20; n=254 [1.59%], adj.ROR = 0.73 [0.60–0.88], IC025 = −0.38, respectively). Hyperglycemic events were primarily mild hyperglycemic disorders (n=1,262 [1.76%], adj.ROR = 1.56 [1.42–1.71], IC025 = 0.58), whereas diabetes was not over-reported (n=325 [0.45%], adj.ROR = 0.73 [0.63–0.86], IC025 = −0.82). Hyperglycemic events were over-reported with evolocumab versus ezetimibe (adj.ROR = 1.81 [1.06–3.07]), albeit were less frequently reported versus statins (adj.ROR = 0.44 [0.40–0.49]). Most of the hyperglycemic events occurred during the first six months of treatment and were reversible.

Conclusion

In a real-world setting, evolocumab (but not alirocumab) was consistently associated with mild hyperglycemic disorders, but not diabetes. Although initial monitoring is warranted, the favorable glycemic safety profile compared to statins supports their essential role in the management of lipid disorders. Potential different effects of evolocumab and alirocumab on glucose metabolism should be further evaluated prospectively.

Funding Acknowledgement

Type of funding sources: None.
The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis
Authors: Patoulias D , Boulmpou A , Papadopoulos C E , Siskos F , Stavropoulos K , Tranidou A , Mouselimis D , Bakatselos S , Damianidis G , Doumas M
Published: October 2021

Background

Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure.

Purpose

We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs).

Methods

We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM.

Results

After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2).

Conclusions

Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Impact of antidiabetic treatment with dipeptidyl peptidase-4 inhibitors on the risk of cardiac arrhythmias among patients with type 2 diabetes mellitus
Authors: Boulmpou A , Patoulias D , Teperikidis E , Tsavousoglou C , Vergopoulos S , Toumpourleka M , Doumas M , Fragakis N , Vassilikos V , Papadopoulos C E
Published: October 2021

Introduction

Type 2 diabetes mellitus (T2DM) is considered as a global pandemic, comprising a significant, independent cardiovascular risk factor. Besides major adverse cardiovascular events, patients with T2DM experience an increased risk of heart rhythm disorders, nevertheless the exact mechanisms of arrhythmogenesis in the context of diabetes mellitus are still being under investigation. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel class of antidiabetic regimens with proved safety and efficacy among patients with T2DM and a series of randomized controlled trials (RCTs) addressing cardiovascular outcomes with DPP-4 inhibitors have been published. The exact effect of DPP-4 inhibitors on the arrhythmic burden among diabetic individuals is yet to be identified.

Purpose

In the present meta-analysis, we sought to determine the impact of antidiabetic treatment with DPP-4 inhibitors on the risk of various cardiac arrhythmias.

Methods

We searched PubMed for all published RCTs assessing cardiovascular outcomes after antidiabetic treatment with DPP-4 inhibitors. We extracted data regarding the risk for the following cardiac arrhythmias: atrial fibrillation, atrial flutter, atrial tachycardia, ventricular fibrillation, ventricular tachycardia, ventricular extrasystoles, supraventricular tachycardia, sinus node dysfunction, second degree atrioventricular block, complete atrioventricular block.

Results

Following a meticulous assessment of the available literature, we pooled data from 6 trials in a total of 52,520 patients. Antidiabetic treatment with DPP-4 inhibitors did not significantly affect the risk for atrial fibrillation (RR=0.95, 95% CI: 0.78–1.17, I2=0%) (Figure 1a). Of note, DPP-4 inhibitors were associated with a significant increase in the risk for atrial flutter, equal to 52% (RR=1.52, 95% CI: 1.03–2.24, I2=0%), as shown in Figure 2. Finally, DPP-4 inhibitors did not have a significant impact on the risk for any of the rest assessed major cardiac arrhythmias.

Conclusions

DPP-4 inhibitors do not seem to be associated with a significant risk for any major cardiac arrhythmias, except for atrial flutter.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
The effect of one year treatment with GLP1-RA, SGLT2i and their combination on plasma levels of oxidative and antioxidative biomarkers
Authors: Ikonomidis I , Thymis J , Pavlidis G , Birba D , Kalogeris A , Kousathana F , Kountouri A , Korakas E , Kostelli G , Triantafyllou C , Triantafyllidi H , Andreadou I , Lambadiari V
Published: October 2021

Background/Introduction

Biomarkers of oxidative stress burden are found increased in Type-2 diabetes mellitus (T2DM) patients. An imbalance between oxidative and antioxidative plasma factors is implicated in the pathway of cardiovascular disease in diabetics. Novel antidiabetic agents with cardioprotective effects are glucagon like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i).

Purpose

We investigated the effect of liraglutide (GLP1-RA),empagliflozin (SGLT-2i) and their combination on plasma levels of oxidative and antioxidative factors.

Methods

A hundred-sixty T2DM patients were randomly assigned and received: a) insulin (n=40), b) liraglutide (n=40), c) empagliflozin (n=40) and d) the combination liraglutide and empagliflozin (n=40) for 1 year. We measured at baseline and after 1 year of treatment the following antioxidative markers: a) Reducing Power (RP), b) 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), c) Total Antioxidant Capacity (TAC) and also Thiobarbituric acid reactive substances (TBARS) as a marker of oxidative burden.

Results

After 1 year of treatment all subjects achieved successful glycemic regulation, as estimated by Hemoglobin A1c (HbA1c) levels (8±0.5 vs 6.65±0.5, p<0.05). Patients on the combination GLP1-RA + SGLT2i displayed greater reduction of TBARS (8.66±0.42 μmol/l vs 7.92±0.35 μmol/l, p<0.05) and increase of ABTS (17.49 ±0.63 mmol/l vs 19.14 ±0.64 mmol/l, p<0.05) compared with insulin-treated participants (8.85±0.41 μmol/l vs 8.83±0.44 μmol/l and 17.07 ±0.58 mmol/l vs 17.22 ±0.49 mmol/l, p=NS respectively). Patients treated on GLP1-RA or SGLT2i separately showed the same improving trend with the combination group in the abovementioned biomarkers but the changes were not so prominent. In the insulin group worsening of TAC was also noticed (0.92±0.02 mmol/l vs 0.89±0.01 mmol/l, p<0.05). In the other biomarkers nonsignificant changes were observed for all groups. Furthermore the absolute change of HbA1c was correlated with the relative change of TBARS (r=0.419, p<0.05)

Conclusion

One year treatment with the GLP1-RA liraglutide and SGLT2i empagliflozin resulted in improvement of plasma levels of oxidative and antioxidative biomarkers compared to administration of insulin and the changes were more outstanding in patients that received the combination of GLP1-RA and SGLT2i, despite similar glycemic regulation in all participants. Thus the favorable cardiovascular effects of these novel factors may be partly explained by alterations in equilibrium between oxidative and antioxidative circulating biomarkers.

Funding Acknowledgement

Type of funding sources: None.