bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel index of arterial reflected waves, Arterial Velocity pulse Index, relates to muscle sympathetic nerve activity independent of Arterial Pressure volume Index in patients with hypertension
Authors: Sugimoto H , Murai H , Hamaoka T , Mukai Y , Inoue O , Okabe Y , Tokuhisa H , Takashima S , Kato T , Usui S , Sakata K , Talamura M
Published: November 2020

Background

Arterial reflected wave is determined by not only atherosclerosis but also sympathetic nerve activity. Recently, Arterial Velocity pulse Index (AVI), which is an index of arterial reflected waves, and Arterial Pressure volume Index (API), which is an index of volume of a conductive blood vessel, have been proposed as new index of arterial stiffness. However, it is unclear whether API and AVI would be associated with muscle sympathetic nerve activity (MSNA) in hypertensive subjects.

Purpose

The purpose of this study was to evaluate the correlation between AVI, API and MSNA in hypertensive subjects.

Method

41 hypertensive patients and 40 non-hypertensive subjects were included in this study. We performed a cross-sectional, observational study. Hypertension (HT) was defined as systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg or medical treatment for HT. AVI and API was measured by NAS-1000 (Nihon Koden, Japan). MSNA, central sympathetic outflow to peripheral muscle, was recorded directly from peroneal nerve. MSNA was expressed by burst frequency (bursts/minute) and burst incidence (bursts/100heartbeats). Blood pressure, heart rate and MSNA were recorded simultaneously.

Results

Age, systolic and diastolic pressure were significantly higher in hypertensive patients compared to control (40±15 vs 61±13 years, p<0.001; 142±16 vs 113±9 mmHg, p<0.001; 81±14 vs 67±9 mmHg, p<0.001). MSNA and AVI were significantly augmented in hypertensive patients compared to control (34±11 vs. 23±6 bursts/min, p<0.05; 26±7 vs. 16±4, p<0.05). AVI was correlated with MSNA in each group (hypertension: r=0.59, P<0.001, non-hypertension: r=0.51, p<0.001). However, no correlation was shown between API and MSNA in each group (hypertension: r=0.22, p=0.15, non-hypertension: r=0.07, p=0.63). Multiple regression analysis also showed MSNA was significantly related with AVI but was not with API.

Conclusion

Our finding showed that AVI relates to MSNA independent of API in patients with hypertension. It suggested that Novel index of arterial reflected waves, AVI, is helpful to estimate augmented SNA in hypertensive subjects regardless of volume of a conductive blood vessel.

Funding Acknowledgement

Type of funding source: None
The lower the better? Optimal achieved blood pressure for patients with coronary artery disease undergoing percutaneous coronary interventions and kidney failure
Authors: Yang Y , Leu H.B
Published: November 2020

Background

This study investigates the ideal achieved blood pressure (BP) in ethnic Chinese patients with coronary disease (CAD) and kidney failure (eGFR<15 ml/min/1.73m2).

Methods

A total of 575 kidney failure patients who had undergone percutaneous coronary interventions (PCI) were enrolled and divided into 6 to 4 groups according to blood pressure range were analyzed. The clinic outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (Total CV event).

Results

The mean systolic BP was 135.02±24.73 mmHg and diastolic BP was 70.74±13.05 mmHg. Systolic BP 140–149mmHg and diastolic BP 80–89mmHg had lowest MACE/CV event incidence rate (11%/23%; 13.2%/21.1%) compare to other groups. Patients with systolic BP<120mmHg had a higher risk MACE (HR: 2.014; 95% CI: 1.172–3.462, p=0.008) when compared to those with systolic BP 140–149 mmHg. Patients with systolic BP≥160mmHg (HR: 1.838; 95% CI, 3.266–1.035, p=0.038). And diastolic blood BP ≥90mmHg (HR: 2.191; 95% CI: 1.147–4.188, p=0.018) had a higher risk of total cardiovascular events when compared to those with systolic BP 140–149 mmHg and diastolic BP 80–89 mmHg.

Conclusions

A J-shaped BP association of systolic (140–149 mmHg) and diastolic (80–89 mmHg) was found with decreased cardiovascular events for coronary artery disease with kidney failure after undergoing PCI in non-western population.

Funding Acknowledgement

Type of funding source: None
Increased carotid cross-sectional area is a marker of organ damage in young hypertensive patients
Authors: De Marco M , Mancusi C , Canciello G , Losi M.G , Trimarco B , De Luca N , De Simone G , Izzo R
Published: November 2020

Background

Common Carotid artery (CA) cross sectional area (CCSA) is strictly related to vessel remodelling stimulated by mechanical stress due to arterial hypertension. Accordingly, increased CCSA might represent an early marker of vascular target organ damage independently of presence of atherosclerotic plaque.

Purpose

To assess early correlates and prognostic impact of CCSA in a large population of young treated HTN patients.

Methods

We selected 970 hypertensive patients, 18 to 40 years old (mean age 34±5 yrs; 30% women) of the Campania Salute Network registry with available CA ultrasound and follow-up data, free of overt cardiovascular (CV) disease. CCSA was computed as:

CCSA = π [(CAd/2 + IMT)2 – (CAd/2)2]

where CAd = CA diameter and IMT = mean intima media thickness. Participants were compared by CCSA tertiles.

Results

Compared to the lowest and intermediate tertiles, patients in the highest tertile were more often male, smokers, older, and had higher body mass index (BMI), diastolic blood pressure (BP), higher fasting glucose, triglycerides, LDL cholesterol and uric acid, with lower level of HDL cholesterol. They also exhibited higher left ventricular mass index and IMT and had more often carotid atherosclerotic plaque (all p<0.05). During a median follow-up of 45 months, 22 incident composite CV events occurred. In Cox-Regression analyses, adjusting for the above covariates, presence of carotid plaque and classes of antihypertensive medications, increased CCSA was significantly associated with increased CV risk (HR 1.08/mm2; 95% CI 1.02–1.13; p<0.01).

Conclusions

In a population of young hypertensive patients, increased CCSA is related to metabolic and atherosclerotic disease and is associated with increased CV risk, also independently of overt carotid plaque.

Funding Acknowledgement

Type of funding source: None
Correlations of attended and unattended blood pressure with sympathetic nervous system activity in essential hypertension
Authors: Manta E , Kouremeti M , Kakouri N , Kasiakogias A , Konstantinidis D , Papakonstantinou P , Kalos T , Liatakis I , Tousoulis D , Tsioufis C
Published: November 2020

Background/Introduction

Measurement of unattended blood pressure (BP) may provide additional information over conventionally attended BP. Moreover, hypertension is related to sympathetic drive while there are scarce data on the diverse links of attended and unattended BP with muscle sympathetic nerve activity (MSNA) in hypertensive patients.

Purpose

The aim of this study was to appraise the relation of BP levels in the attended and unattended setting with MSNA in patients with essential hypertension.

Methods

We studied 117 patients with essential hypertension (age: 58±11 years, 60 males, office BP: 142/85±17/10 mmHg, 24-hour BP: 133/80±11/9 mmHg). In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes) and attended BP were measured with the same device, on the same day of MSNA recording, in random order. Patients were divided into the combined attended and unattended hypertensive group when BP≥140/90 mmHg in both attended and unattended BP estimations and to the attended hypertensive group when only attended BP≥140/90 mmHg.

Results

Patients with combined attended and unattended hypertension (n=70) compared to those with attended hypertension (n=47) did not differ regarding 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index (p=NS for all). Moreover, patients with combined attended and unattended hypertension compared to those with attended hypertension were characterized by greater levels of MSNA (43.7±9.9 vs 37.7±9.7 bursts per minute, p=0.032). In all participants, sympathetic nerve traffic as assessed by resting MSNA was related to attended systolic BP (r=0.270, p=0.003), attended diastolic BP (r=0.344, p=0.001), unattended systolic BP (r=0.263, p=0.004) and unattended diastolic BP (r=0.274, p=0.003).

Conclusions

The phenotype of combined attended and unattended hypertension compared to attended hypertension is accompanied by higher sympathetic nervous system activation. Moreover, the close association of MSNA with attended and unattended BP levels in essential hypertension, further supports the key role of sympathetic drive in modulating BP.

Funding Acknowledgement

Type of funding source: None
Comparison of medication adherence between fixed-dose combination of angiotensin receptor blockers and statin and free-combination therapy
Authors: Choi J.H , Choi J.M , Jang Y.J , Kang M , Lee S.H
Published: November 2020

Background

Non-adherence to angiotensin receptor blockers (ARB) or statin is one of major reasons of insufficient treatment for patients with hyperlipidemia and hypertension. We investigated whether fixed-dose combination (FDC) of ARB and statin improved adherence compared to traditional free combination (FC).

Methods

In this retrospective nationwide cohort study, adherence of 128,369 patients who started ARB and stain including atorvastatin or rosuvastatin between July 2014 and June 2015 was investigated. Primary endpoint was proportion of days covered (PDC) per 180 days up to day 540. Good compliance defined by PDC≥80% and persistency rate defined by patients remaining on medication were also investigated.

Results

Patients were 62.9 years of mean age with 48.2% female gender. Compared to FC (N=90,759, 70.7%), FDC (N=37,610, 29.3%) showed higher PDC at day 180 (86% vs 70%), 360 (77% vs 62%), and 540 (74% vs 55%, p<0.001, all). Frequency of patients with PDC≥80% was also higher in FDC compared to FC at day 180 (80.1% vs 51.8%), 360 (71.7% vs 54.2%), and 540 (69.2% vs 49.3%, p<0.001, all). Persistency rate at day 540 was higher in FDC compared to FC (50.4% vs 27.3%, p<0.001). The mean decline in PDC per 180 days were significantly lower in FDC compared to FC per 180 days (6.0% vs. 7.5%, p<0.001).

Conclusions

In this real-world data analysis, FDC resulted in higher medication adherence and persistence compared to FC among patients who started both ARB and atorvastatin or rosuvastatin.

Persistence rate btw FDC and FC

Funding Acknowledgement

Type of funding source: None
Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries
Authors: Borghi C , Wang J.G , Rodionov A.V , Rosas M , Sohn I.S , Alcocer L , Valentine W , Deroche-Chibedi D , Granados D , Croce D
Published: November 2020

Background

It is well established that single pill combination (SPC) therapies have the potential to improve patient adherence versus multi-pill regimens, thereby improving blood pressure control and clinical outcomes in populations with hypertension.

Purpose

To develop a microsimulation model, capturing different treatment pathways, to project the impact on clinical outcomes of using single pill combination therapies for the management of hypertension in five countries (Italy, Russia, China, South Korea and Mexico).

Methods

The model was designed to project health outcomes between 2020 and 2030 for populations with hypertension managed according to four different treatment pathways: current treatment practices [CTP], single drug with dosage titration first then sequential addition of other agents [start low and go slow, SLGS], free choice combination with multiple pills [FCC] and combination therapy in the form of a single pill [SPC]. Model inputs were derived from Global Burden of Disease 2017 dataset, including demographics, health status/risk factors, transition probabilities and treatment attributes/healthcare utilization, and the model incorporated real-world challenges to healthcare delivery such as access to care, SBP measurement error, adherence and therapeutic inertia. Simulated outcomes of mortality, incidence of chronic kidney disease (CKD), stroke and ischemic heart disease (IHD), and disability-adjusted life years (DALYs) due to these conditions were estimated for population of 1,000,000 simulated patients for each treatment pathway and country.

Results

SPC therapy was projected to improve health outcomes over SLGS, FCC and CTP over 10 years in all five countries. SPC was forecast to reduce mortality by 5.4% (Italy), 4.9% (Russia), 4.5% (China), 2.3% (South Korea) and 3.6% (Mexico) versus CTP and showed greater projected reductions in mortality than SLGS and FCC. DALYs were projected to be reduced with SPC therapy by between 5.7% (Italy) and 2.2% (South Korea) compared with CTP and reductions in the incidence of clinical events were also projected with SPC therapy, with decreases in the range of 11.5% (Italy) to 4.9% (South Korea) versus CTP.

Conclusions

Ten-year projections of clinical outcomes associated with different anti-hypertensive treatment pathways in five countries indicated that both combination therapies (FCC and SPC) are likely to reduce the disease burden of hypertension compared with conventional management approaches, with SPC showing the greatest overall benefits due to improved adherence.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Sanofi, Gentilly, France
Bilateral sphenopalatine ganglion block reduces blood pressure and blood pressure variability in never treated patients with essential hypertension
Authors: Triantafyllidi H , Arvaniti C , Benas D , Schoinas A , Voutsinos D , Ikonomidis I , Lekakis J
Published: November 2020

Background

Sphenopalatine ganglion (SPG) area is connected through sympathetic fibers with the central nervous system. It is already known that SPG infiltration by lidocaine reduced blood pressure in naïve hypertensive patients. Blood pressure variability (BPV) has been associated with an increased risk of cardiovascular events and mortality, independently of elevated BP levels. We aimed to study the effect of SPG block in BPV in never treated patients with stage I–II essential hypertension.

Methods

We performed bilateral SPG block with lidocaine 2% in 47 newly diagnosed and never treated hypertensive patients (study group, mean age 50±12 years, 31 men) and a sham operation with water for injection in 11 patients (control group, mean age 51±12 years, 8 men). All patients have been subjected to 24 hour ambulatory blood pressure monitoring (ABPM) prior and a month after the SPG block in order to estimate any differences in BP parameters derived from ABPM (BP, BPV). We defined as responders to SBG block those patients with a 24h average SBP decrease >5 mmHg.

Results

We noticed the following significant differences in the study group: a. 24h average DBP and daytime DBP were reduced by 1.6±5 mmHg (p=0.04) and 1.9±5 mmHg (p=0.01) respectively and b. systolic BPV during daytime (11±2 mmHg vs. 10±2 mmHg, p<0.05). Interestingly, in the responders group (14/47, 30%, 9 men, age = 47±8 mmHg) and a month after SPG block we noticed that: a. 24h average, daytime, night-time SBP and 24h average, daytime, night-time DBP were reduced by 9±4 mmHg (p<0.001), 9±3 mmHg (p<0.001), 7±7 mmHg (p=0.002) and 6.5±3 mmHg (p<0.001), 6.5±3 mmHg (p<0.001), 4±7 mmHg (p=0.02), respectively and b. systolic BPV during daytime (13±2 mmHg vs. 9±2 mmHg, p=0.01). No differences regarding BPV were found in the non-responders and the sham operation group.

Conclusions

SPG block is a promising, minimally invasive option of significant BP and BPV decrease in never treated hypertensive patients, especially during daytime activities when SNS is activated. It acts probably through SNS modulation. Since its effect is only anesthetic and non-permanent, SPG block might permit the selection of the hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.

SPG block reduces BP variability

Funding Acknowledgement

Type of funding source: None
First-in-man experience with ultrasound renal denervation for treatment of recurrent ventricular arrhythmias
Authors: Millenaar D.N , Mahfoud F , Pavlicek V , Lauder L , Boehm M , Ukena C
Published: November 2020

Background/Introduction

Ventricular arrhythmias (VA) are common in patients with chronic heart failure (CHF) and can be refractory to drugs and catheter ablation. Promising results of sympathomodulatory treatment have been reported in these patients.

Purpose

This first in man study aims at investigating catheter-based renal denervation (RDN) using ultrasound energy for treatment of refractory VA in patients with CHF.

Methods

Four patients (age 65±10 years, all male, left ventricular ejection fraction 36±7%, global longitudinal strain (GLS) −10±3%) with CHF (n=1 ischemic cardiomyopathy, n=3 non-ischemic cardiomyopathy) and refractory VA were treated with RDN using ultrasound energy. All patients had undergone endo- or epicardial catheter ablation for recurrent ventricular tachycardia (VT) or fibrillation (VF) in the past and were on at least 2 antiarrhythmic drugs. Computer tomography angiography was performed at baseline, duplex ultrasound of renal arteries, ambulatory blood pressure monitoring (ABPM) and ICD interrogations were performed before, 1 day and 3 months post RDN.

Results

Bilateral RDN using an ultrasound-based catheter were performed with at least 2 sonications in each main branch of the left and right renal artery. In this analysis, mean follow-up time was 113±12 days. All RDN procedures were performed without any complications. No renal artery stenoses during follow-up. Arrhythmic burden (measured as VT/VF episodes) within 3 months before RDN requiring ICD therapy was reduced from 3 [1.5–54.5] episodes of anti-tachycardia pacing (ATP) and 0.5 [0–1.25] adequate ICD shocks to 1 [0.75–1] episode of ATP. There were no adequate ICD shocks after 3 months. Mean 24-hour ABP before RDN was 94±8/65±9 mmHg with no change in BP following 3 months (SBP 92±1 mmHg, DBP 62±6 mmHg after 3 months). There was no change in left ventricular GLS (−10±3% before, −9±4% after RDN) or ejection fraction (36±7% before and after RDN).

Conclusions

RDN using ultrasound energy in patients with CHF and refractory VA was safely performed with no changes in blood pressure and reduced the arrhythmic burden after 3 months follow-up.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ReCor Medical Inc.
Superior hypertension control with betablockade in the European Sleep Apnea Database
Authors: Svedmyr S , Hedner J , Zou D , Parati G , Ryan S , Hein H , Pepin J.L , Tkacova R , Marrone O , Schiza S , Basoglu O.K , Grote L
Published: November 2020

Background

Arterial hypertension is highly prevalent and frequently difficult to control in patients with obstructive sleep apnea (OSA). High sympathetic activity is a hallmark physiological phenomenon in OSA. We hypothesized that antihypertensive drugs with sympathetic inhibitory properties, in particular beta blockers (BB), may be particularly efficacious in OSA patients.

Methods

Hypertensive OSA patients receiving blood pressure lowing treatment in the European Sleep Apnea Database (ESADA) were analyzed (n=5818, 69% men, age 58±11 years, body mass index 33±7 kg/m2, apnea hypopnea index 34±26 events/h). Antihypertensive medications (BB, diuretic, renin-angiotensin blocker [RAB], calcium channel blocker [CCB], and centrally acting antihypertensive [CAH]) were classified according to ATC code. Office blood pressure was compared in patients with mono- or combination therapy controlling for confounders.

Results

Poorly controlled systolic blood pressure according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 [95% CI, 1.4–3.0], 3.0 [1.9–4.1] and 3.0 [1.7–4.7] mmHg higher systolic blood pressure compared with those on BB (adjusted model, p=0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, systolic blood pressure was 3.3 [2.4–4.3], 2.2 [1.3–4.3] and 2.3 [1.4–3.3] mmHg higher in those on CCB/RAB, diuretic/RAB or BB/RAB compared with those on BB/diuretic (adjusted model, p<0.001, 0.019 and 0.001, respectively).

Conclusions

Uncontrolled blood pressure was common in OSA patients with antihypertensive medication. Patients treated with BB alone or in combination with diuretic was associated with a lower systolic pressure in this large clinical cohort.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)
Effect of advancing age on dietary salt intakes: a 10-year follow-up study
Authors: Takase H , Machii M , Nonaka D , Ohno K , Takayama S , Sugiura T , Ohte N , Dohi Y
Published: November 2020

Background/Introduction

The National Nutrition Survey in Japan indicated that dietary salt intake of the Japanese is gradually decreasing for the last several decades, while salt intakes are higher in elderly than young people. There is no survey on the alteration of salt intakes with advancing age in individuals.

Purpose

The present study investigated effects of aging on salt intakes in individuals.

Methods

A total of 2600 subjects (men; 1787, age; 30 to 79 years-old at 2008) who participated in our physical check-up program both in 2008 and 2018 were enrolled. Individual dietary salt intakes in 2008 and 2018, which were estimated using a spot urine by a previously reported method, were compared.

Results

The mean age and salt intakes at 2008 were 53.9±10.0 years and 12.2±3.2 g/day in men and 54.4±9.2 years and 8.3±2.1 g/day in women, respectively. Salt intake increased to 13.2±3.3 g/day in men and 8.8±2.2 g/day in women during the 10 years. Salt intakes were higher in hypertensive than normotensive subjects both at 2008 and 2018, but changes of blood pressure category were not associated with those of salt intakes during the 10 years (table). Changes in salt intakes in each decade are shown in Figure. Salt intakes in each decade increased with advancing age both in men and women until their 70s. Salt intakes in people in their 60s and 70s at 2018 were higher than those at 2008. Similar results were obtained in subjects without any anti-hypertensive medications (n=1667) (data not shown).

Conclusions

The observational follow-up study revealed that salt intakes in each individual increased after the interval of 10 years in both men and women. The results suggest that the sense of taste changes with advancing age in young adults as well as elderly persons, which may be related with alterations of lifestyle.

Age difference in changes of salt intake

Funding Acknowledgement

Type of funding source: None
Role of colchicine in stroke prevention: an updated meta-analysis
Authors: Lobo L.M , Masson G , Molinero G , Masson G , Lavalle Cobo A , Losada P , Benincasa F , Suarez F , Huerin M
Published: November 2020

Background

Colchicine is a microtubule inhibitor with anti-inflammatory proprieties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events.

Methods

A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from stroke, myocardial infarction, cardiovascular mortality and all-cause mortality, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A random-effects meta-analysis model was then applied.

Results

Nine eligible trials of colchicine therapy, involving a total of 6630 patients, were considered eligible for analysis (3359 subjects were allocated to receive colchicine while 3271 subjects were allocated to the respective control arms). The stroke incidence was lower in the colchicine group compared with placebo arm (OR, 0.33; 95% CI, 0.15–0.70; six studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality.

Conclusion

Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significantly reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease. The tolerability and benefits should be confirmed in ongoing clinical trials.

Forest Plot Primary endpoint

Funding Acknowledgement

Type of funding source: None
Additive prognostic value of vascular aging and coronary artery calcium for all-cause mortality in the Heinz Nixdorf Recall Study
Authors: Weber T , Wassertheurer S , Hametner B , Mayer C.C , Moebus S , Schramm S , Roggenbuck U , Lehmann N , Joeckel K.H , Erbel R
Published: November 2020

Background

Vascular aging, defined by aortic pulse wave velocity (aoPWV), as well as coronary artery calcium (CaC), are emerging risk predictors.

Purpose

To investigate the prognostic role of functional (vascular aging) and structural (CaC) arterial parameters in individuals without established cardiovascular disease.

Methods

We utilized our recently established population-based reference values for healthy (HVA), normal (NVA) and early (EVA) vascular aging in the poipulation-based Heinz Nixdorf Recall (HNR) study. HVA was the lowest, and EVA the highest age- and sex-specific decile of estimated aoPWV, derived from radial waveforms with a validated regression formula. CaC was measured with electron beam computed tomography (Agatston-score). The additive prognostic value of both parameters for all-cause mortality was tested, using Kaplan Meier curves and Cox Regression models. The latter included age, sex, diastolic blood pressure, cholesterol, and diabetes as covariates.

Results

We included 1805 participants (976 women), mean age was 68.2 years (range 55–85), mean blood pressure 129/76 mm Hg. 64.7% were hypertensives, 17.0% diabetics. The percentage of participants with CaC = 0 was 44.8, 40.6, amd 33.5 in HVA, NVA, and EVA, respectively. During a mean follow up of 4.7 years, 67 participants died. Mortality was 0% / 2.2%, 1.8% / 4.8%, 3.5% / 7.1% in participants with HVA: CaC 0 / >0, NVA: CaC 0 / >0, EVA: CAC 0 / >0, respectively (p=0.003, log rank test) – Figure. In Cox regression analysis, vascular aging (HR for HVA: 0.18, CI 0.04–0.73, and HR for NVA: 0.48, CI 0.27–0.88; both compared to EVA), CaC, as well as age (directly related) and diastolic blood pressure (inversely related) were independently associated with all-cause mortality.

Conclusion

Aortic stiffness, expressed as vascular aging, as well as coronary artery calcium, provide additive and independent prognostic information regarding all-cause mortality in a middle-aged and elderly primary -prevention population.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heinz Nixdorf Foundation, German Ministry of Education and Science (BMBF)
Increased particle size of triglyceride remnant lipoproteins, but not their plasma concentration or lipid content, augment risk prediction of incident diabetes: prospective results from ELSA-Brasil
Authors: Carvalho L.S , Bensenor I.M , Lotufo P.A , Duncan B.B , Blaha M.J , Toth P.P , Jones S.R , Santos R.D , Sposito A.C
Published: November 2020

Importance

Predicting risk of Type 2 Diabetes Mellitus (T2DM) accurately allows allocation of resources to prevent its development. Fasting blood triglycerides are highly predictive for T2DM. Triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and inflammation. We hypothesized TRL-related factors could improve risk prediction for development of T2DM.

Methods

We included individuals aged 35–74 years from the ELSA-Brasil cohort who had HbA1c and an oral glucose tolerance test at baseline. Regression models were used to predict incident T2DM, starting with medical history, metabolic syndrome traits (age, sex, hypertension, waist circumference [WC], HbA1c, triglycerides) and hsCRP, adding TRL-related measurements, including plasma concentration, particle size, as well as cholesterol and triglyceride content. TRL features were measured by NMR spectroscopy. Discrimination was assessed with area under receiver operator curves (AUROCs).

Results

Among 4,466 individuals at-risk, there were 353 new cases of T2DM after 3.7 (SD=0.6) years follow-up. We derived an 8-variable model with AUROC 0.891 (95% CI: 0.870–0.913). Overall TRL-related markers did not improve predictive capacity for T2DM. However, TRL particle diameter (TRLZ) increased AUROC, particularly in individuals without glucose abnormalities at baseline (Hba1c <5.7%). In this subgroup, AUROC increased from 0.761 (95% CI: 0.739–0.798 – Baseline-model) to 0.823 (95% CI: 0.783–0.862 – TRLZ model) (p-value=0.00006). Consistently, the net reclassification improvent (NRI) of the model with TRLZ improved by 10.27% (95% CI: 1.0–24.1, p=0.00041). In subjects with pre-diabetes at baseline, TRLZ is highly correlated with obesity, insulin resistance and inflammation (sum of z-scores for WC + HOMA-IR + hsPCR: R2=0.25), but this was less important in individuals with Hba1c <5.7% (R2=0.15). Sensitivity analyzes confirmed the results with different inclusion criteria (pre-diabetes defined with TTGO only) and excluding patients diagnosed with DM2 incident based only on fasting blood glucose.

Conclusions

TRL particle diameter improves prediction of T2DM, particularly in subjects with no glycemic abnormalities at baseline.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Brazilian Ministry of Health (Department of Science and Technology), Ministry of Science, Technology and Innovation, and the National Council for Scientific and Technological Development (CNPq)
Longitudinal changes in anthropometric measures and new-onset atrial fibrillation among men and women from general population
Authors: Lu Z , Geurts S , Tilly M.J , Ikram M.A , Arshi B , Kavousi M
Published: November 2020

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia of clinical significance. Recent evidence suggests differences in epidemiology and risk factors of AF between women and men. Obesity and body size are established risk factors for AF. However, anthropometric measures tend to change over time. Few studies have investigated the impact of longitudinal changes in anthropometric measures on incident AF among men and women.

Purpose

To assess the association between longitudinal changes in different anthropometric measures and new-onset AF among community-dwelling men and women.

Methods

Among 12,848 participants free of AF at baseline were included in this large prospective population-based cohort study, each anthropometric measure was measured at least once and up to five times. Anthropometric measures included weight, height, waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). Anthropometric measures were standardized for direct comparisons. Joint models were used to assess the association of each anthropometric factor and their longitudinal changes with incident AF. Models were adjusted for age and traditional cardiovascular risk factors.

Results

A total of 5,266 men and 7,218 women (mean age 63.87 years for men and 64.94 years for women) were followed up for a median of 10.5 years. AF occurred in 630 (12.0%) men and 692 (8.7%) women. Longitudinal increases in weight, height, WC, HC and BMI increased the risk for new-onset AF in a linear manner. The age-adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.38 (1.26–1.51) for weight, 1.41 (1.26–1.59) for height, 1.26 (1.13–1.41) for WC, 1.36 (1.19–1.55) for HC and 1.22 (1.11–1.35) for BMI among men. Among women, the age-adjusted HRs (95% CI) were 1.41 (1.30–1.52) for weight, 1.21 (1.07–1.38) for height, 1.39 (1.27–1.52) for WC, 1.29 (1.19–1.40) for HC and 1.28 (1.19–1.37) for BMI. Further, longitudinal increase in WHR was significantly associated with increased risk of AF in women [HR (95% CI): 1.42 (1.21–1.66)] but not in men [HR (95% CI): 1.11 (0.96–1.30)].

Conclusions

Longitudinal changes in anthropometric measures were associated with the increased risk for new-onset AF among men and women in the general population. An increase in measures of central obesity over time showed a stronger association with incident AF among women, compared to men. Our findings underscore the importance of a sex-specific approach for screening and monitoring of anthropometric measures for AF prevention.

Main results among men and women

Funding Acknowledgement

Type of funding source: None
Recommendations and associated levels of evidence for statin use in primary prevention of cardiovascular disease: a comparison at population level of the ESC, ACC/AHA, USPSTF, and CCS Guidelines
Authors: Pavlovic J , Franco O.H , Kavousi M , Ikram M.K , Deckers J.W , Ikram M.A , Leening J.G
Published: November 2020

Background

It is unclear to what extent the 2019 European Society of Cardiology (ESC), 2018 American College of Cardiology/ American Heart Association (ACC/AHA), 2016 US Preventive Services Task Force (USPSTF), and 2016 Canadian Cardiovascular Society (CCS) guidelines differ in assigning levels of evidence and classes of recommendations (LOE/class) to lipid-lowering treatment recommendations in primary prevention of cardiovascular disease (CVD).

Purpose

To compare LOE/class from four commonly used guidelines at population level.

Methods

A total of 7262 participants, aged 45–75 years of age and without history of CVD, from the prospective population-based Rotterdam Study were included. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity, and numbers needed to treat at 10 years (NNT10y) were calculated.

Results

Mean age was 61.1 (SD 6.9) years, and 58.2% were women. ESC, ACC/AHA, USPSTF and CCS strongly recommended statin use for a respective 33.8%, 48.1%, and 40.2% and 73.0% of the eligible population based on high-quality evidence, while in an additional 55.3%, 7.1%, 8.4% and 9.2% of participants statins use could or should be considered based on varying LOE/class. The sensitivity for treatment recommendations supported with strong, high quality evidence was 61.6% for ESC (“IA”), 74.6% for ACC/AHA (“IA or IB”), 69.4% for USPSTF (“USPSTF-B”) and 92.5% for CCS (“strong”). Specificity was highest for the ACC/AHA at 46.8% and lowest for ESC at 11.4%. Estimated NNT10y for those with the strongest LOE/class were comparable across all guidelines, ranging from 18 to 26 for moderate-intensity statin use, and 11 to 16 for high-intensity statin use. NNT10y reflective of recommendations supported with moderate strength of LOE/class varied substantially among guidelines for both moderate-intensity and high-intensity statin use, ranging from 33 for ESC and USPSTF to 91 for CCS.

Conclusions

Assigned LOE/class varied greatly among four clinical practice guidelines for primary prevention of CVD. Efforts for harmonized and comparable evidence grading system for clinical practice guidelines in primary prevention of CVD may reduce ambiguity, and reinforce updated evidence-based recommendations for appropriate treatment of populations for whom clear evidence for benefit of statin use is available.

Funding Acknowledgement

Type of funding source: None
The prevalence of cardiovascular risk factors and cardiovascular disease among primary care patients in Poland: results from the LIPIDOGRAM2015 study
Authors: Jozwiak J , Studzinski K , Tomasik T , Windak A , Banach M
Published: November 2020

Background

Cardiovascular disease (CVD) is currently one of the leading cause of mortality in the European Union. Well-established, modifiable cardiovascular (CV) risk factors include hypertension (HTN), hypercholesterolaemia, diabetes mellitus (DM), obesity, low activity levels, poor diet and smoking. There are no current estimates on the prevalence of CV risk factors among Polish patients solely in the primary care setting.

Methods

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the 4th quarter of 2015 and 1st and 2nd quarters of 2016. 438 primary care physicians enrolled 13,724 adult patients that sought medical care for any medical reason in primary health care practices.

Results

Nearly 19% of men and approximately 12% of women had CVD. Over 60% of the recruited patients had HTN, >80% had dyslipidaemia and <15% of patients were previously diagnosed with DM. All of these disorders were more frequent in men. Overweight and obesity were present in more than 75% of patients with 80% of them exceeding the waist circumference norm for the European population. Slightly less than half of the patients were current smokers or had smoked in the past. Patients with CVD had significantly higher blood pressure and glucose levels but lower low density lipoprotein-cholesterol level (LDL-C). In patients with CVD, HTN and dyslipidaemia were twice as frequent and DM three times more so than in patients without it (Figure 1).

Conclusions

The incidence of CVD and CV risk factors among patients attending primary healthcare in Poland is high. CVD is more common in men than in women. The most common CV risk factors are excess waist circumference, dyslipidaemia and HTN. Family physicians working in primary health care, as well as health authorities should conduct activities to prevent, diagnose early and treat CVD in the primary health care population.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The present study was an initiative of the Polish Lipid Association (PoLA) and the College of Family Physician in Poland (CFPiP). The present study was funded by an unrestricted educational grant from Valeant.
Nutritional risk index is an independent predictor of one-year mortality after primary angioplasty for ST-segment elevation myocardial infarction, regardless of age, frailty and clinical severity
Authors: Arroyo-Espliguero R , Silva-Obregon A , Viana-Llamas M.C , Estrella-Alonso A , Saboya-Sanchez S , Marian-Crespo C , Arriero-Fernandez N.G , Eguileor-Marin Z , Tirado-Fernandez M.A , Ruiz De Santaquiteria-Torres V , Castillo-Sandoval A , Toran-Martinez C , Uribe-Heredia G , Garcia-Magallon B , Perez-Sanchez A
Published: November 2020

Background

Undernutrition is a common feature of elderly and hospitalized patients with cardiovascular diseases and is associated with adverse events.

Purpose

Assess the impact of nutritional risk index (NRI) in one-year mortality in ST-segment elevation myocardial infarction (STEMI) patients following primary angioplasty (PA).

Methods

Cohort of 319 consecutive patients (64.4 years [54.3–75.2]; 21.9% women) admitted to a general ICU after a PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Patients were dichotomized in no to mild (NRI ≥97.5) and moderate to severe (NRI <97.5) nutritional risk. We used Kaplan-Meier and Cox survival models.

Results

Patients with NRI <97.5 were older, mainly women, had a higher GRACE 2.0 and required more inotropic agents (P=0.001) and mechanical ventilation (P=0.002) during admission. They had lower CK and higher BNP levels, despite the lack of differences in LVEF and MI location (P=0.164) (Table 1). One-year mortality rate was higher in patients with NRI <97.5 (P<0.001), mainly from cardiogenic shock (P<0.001) (Table). After Cox regression analysis, moderate to severe nutritional risk showed a 3.10-fold higher risk of one-year mortality (95% confidence interval [CI], 1.21 to 7.90, P=0.018), independently of age, female gender, frailty (Clinical Frailty Scale ≥4), GRACE 2.0 and LVEF (Figure 1).

Conclusion

Moderate to severe NRI was associated with one-year all-cause mortality in patients undergoing PA for STEMI, regardless of age, female gender, frailty and clinical severity. The prognostic impact of NRI in mortality suggests the need to include its assessment in clinical examination of STEMI patients.

Figure 1. Kaplan-Meier and Cox survival curves

Funding Acknowledgement

Type of funding source: None
Association of habitual alcohol consumption with carotid atherosclerotic lesions: results from the Corinthia study
Authors: Theofilis P , Oikonomou E , Vogiatzi G , Lazaros G , Tsalamandris S , Mystakidi V.C , Goliopoulou A , Chasikidis C , Miliou A , Fountoulakis P , Papaioannou N , Papakonstantinou M , Tousoulis D
Published: November 2020

Introduction

Alcohol is implicated in the pathophysiology of cardiovascular diseases. However, it is also believed to play a cardioprotective role if consumed in appropriate amounts.

Purpose

To assess the association between alcohol consumption and carotid atherosclerosis.

Methods

In the setting of the cross-sectional Corinthia study, volunteers filled in questionnaires regarding drinking habits and were characterized as social drinkers (SD) or habitual alcohol consumers (HAC). Furthermore, they underwent carotid ultrasonography examination to evaluate the carotid intima-media thickness (cIMT). Thickness of cIMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque.

Results

HAC consumers were usually male (HAC: 61.1%, SD: 24.9%, p<0.001), smokers (HAC: 33.3%, SD: 23.5%, p<0.001) and frequently had a history of hypertension (HAC: 72.8%, SD: 67.5%, p=0.02) when compared to SD (Table 1). However, no significant differences were noted regarding other risk factors of atherosclerosis (Table). Notably, HAC had a greater extent of carotid atherosclerosis as demonstrated by an increased cIMT (HAC: 1.03±0.45mm, SD: 0.96±0.39mm, p<0.001) and carotid plaque burden (HAC: 27.7%, SD: 21.3%, p=0.004). Importantly, when taking into account the number of alcoholic drinks (in wine glasses), alcohol consumption of more than 1 wine glass resulted in significantly higher values of cIMT (1 wine glass: 1.00±0.42mm, >1 wine glass: 1.06±0.45mm, p=0.04) (Figure 1A) and extensive amount of carotid plaques (1 wine glass: 22.7%, >1 wine glass: 30.4%, p=0.02) when compared to consumption of 1 wine glass (Figure 1B).

Conclusion

Habitual alcohol consumption of more than one wine glass is associated with a higher carotid atherosclerotic burden.

Figure 1

Funding Acknowledgement

Type of funding source: None
Salt Intake in Nigeria: a nationwide population survey
Authors: Odili A.N , Chori B.S , Danladi B , Nwakile P.C , Ogedengbe J.O , Nwegbu M.M , Isiguzo G.C
Published: November 2020

Background

Population wide salt reduction programmes are cost effective strategies for control of cardiovascular diseases (CVDs). Obtaining a nationwide salt consumption data in a multi-cultural setting as Nigeria's is key for proper implementation and monitoring of such strategy.

Methods

We measured sodium in 24-hour urine of free-living adult Nigerians selected from an urban and a rural site each from the 6 geopolitical zones of Nigeria to evaluate patterns of salt intake and its associations with blood pressures (BP).

Results

Across the 12 sites, sodium intake ranged from 97.9 in the rural South-South to 210 mmol/day in the urban site of the same zone. Overall, the median (IQR) daily sodium intake was 143.5 (97.8) mmol; with higher (p=0.0028) levels among the urban 149.7 (113.8) compared to the rural 133.1 (105.2) dwellers. Overall, 20% of the subjects consumed less than the recommended 2g (86mmol) of sodium daily. After adjustment for age, sex and BMI; sodium intake and BP (systolic and diastolic) were positively associated in 8 out of the 12 sites; significantly so in 2 (p<0.05) for systolic. Within population analysis; which included 973 individuals, increasing sodium intake tended (not significantly) to increase SBP but decrease DBP. However, among subjects whose sodium intake was in excess of 257mmol/day, a 100 mmol/day increase in sodium intake was significantly (p=0.04) associated with a 3.3 mmHg increase in SBP.

Conclusion

Salt intake among Nigerians is higher than the recommended. The impact of sodium intake on BP appears to be evident only among individuals with high salt intake.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Wellcome Trust
Impact of cardiovascular health status on the dose-response relationship between physical activity and incident morbidity and mortality
Authors: Bakker E.A , Oymans E.J , Hopman M.T.E , Thijssen D.H.J , Eijsvogels T.M.H
Published: November 2020

Background

Although the health benefits of a physically active lifestyle are well-known, there is ongoing discussion about the dose-response relationship between physical activity (PA) and incident morbidity/mortality, and whether this association may be affected by cardiovascular health status.

Purpose

We compared the dose-response relationship of PA, incident major cardiovascular events (MACE) and all-cause mortality between healthy individuals and individuals with cardiovascular disease risk factors (CVRF) or cardiovascular diseases (CVD).

Methods

This study used data from Lifelines, which is a multi-disciplinary population-based cohort including 167,729 participants from the northern population of the Netherlands. Adults (>18 yrs old) without severe illnesses or limited life expectancy (<5 yrs) were included (N=143,059). PA volumes were presented as Metabolic Equivalent of Task (MET) minutes/week, and divided into quartiles (Q1-Q4). The primary outcome was a composite endpoint of incident MACE (i.e. myocardial infarction, stroke, heart failure, CABG or PCI) and all-cause mortality.

Results

Age (42±12 yrs) and proportion of male (40%) was lower in healthy individuals compared to individuals with CVRF (54±11 yrs, 45% male) or with CVD (57±13 yrs, 62% male). During a median follow-up of 7 years (IQR 6–9), 2,485 events occurred in healthy individuals (2% of n=112,018), 2,214 in individuals with CVRF (8% of n=27,982) and 1,100 (36% of n=3,059) in those with CVD. Higher PA volumes were associated with a lower risk of adverse outcomes in healthy individuals and in individuals with CVRF (Table 1). In contrast, only the highest PA quartile was associated with a risk reduction for adverse outcomes in individuals with CVD (Table 1). Also, effect-modification was present in the dose-response relationship between PA volumes and health outcomes for CVD (P-interaction<0.05), but not for healthy or CVRF.

Conclusions

Cardiovascular health status impacts the dose-response relationship between PA volumes and adverse outcomes. These findings indicate that PA recommendations should be adjusted to an individual's health status for achieving maximal health benefits from a physically active lifestyle.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): The work of T.M.H.E is supported by the Netherlands Heart Foundation. The Lifelines Biobank initiative received a subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen [UMCG], University Groningen and the Northern Provinces of the Netherlands.