bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR SCREENING IN ASYMPTOMATIC TYPE 1 DIABETES PATIENTS: PRELIMINARY RESULTS AND MODEL PROPOSAL FOR A COST-EFFECTIVENESS ANALYSIS
Authors: Helleputte Simon , Lapauw Bruno , Calders Patrick , De Backer Tine
Published: April 2021

Objective:

Background: Type 1 diabetes (T1DM) is an independent risk factor for cardiovascular disease (CVD), with patients being considered as a high or even very high risk group. However, routine screening for CVD in an asymptomatic T1DM population is currently not recommended. Moreover, the cost-effectiveness of such screening programs has been subject of debate.

Objectives:

Discuss results and perform a cost-effectiveness (CEA) and cost-utility (CUA) analysis of a CVD screening program (2013–2019) in a Belgian cohort of asymptomatic T1DM patients.

Setting:

Ghent University Hospital (Flanders, Belgium).

Methods:

Adult T1DM patients with a minimum disease duration (DD) of 10 years and without known macrovascular disease were enrolled in a CVD screening program, including: coronary artery calcium (CAC) scoring, cyclo-ergometry, transthoracic echocardiography, 24-hour Holter monitoring, and carotid ultrasound. A decision-analytic Markov model is applied to compare estimated costs and health outcomes (i.e. CVD events and quality-adjusted life years or QALYs) of the screening program vs. usual care (i.e. no screening). After screening, patients were categorised in five possible Markov states: (1) “No additionally increased risk” in case of no significant abnormalities being detected; (2) “Soft attention” in case of mild to moderate alterations or doubtful findings; (3) “Hard attention” if CAC > P90 or absolute > 400 Agatston score, i.e. subclinical high atherosclerotic burden; (4) “Unequivocally documented CVD on imaging” if presence of significant carotid plaque; and (5) “Documented clinical CVD” if patients were referred for coronary revascularization. The Markov model further includes stroke, myocardial infarction (MI) and death. Time horizon of the model is 10 years and a healthcare payer perspective will be applied. Results of the CEA will be expressed in incremental costs per event avoided (stroke and MI), and the CUA in incremental costs per QALY gained. Both one-way and probabilistic sensitivity analyses will be performed. To report on CUA, a willingness-to-pay threshold of €40 000 per QALY will be applied.

Preliminary results:

97 patients (M/F: 61/36; age: 45 ± 10.0 years; DD: 24 ± 10.1 years; HbAc1: 7.7 ± 0.75%, BMI: 25 ± 3.0 kg/m2) were included. The CVD screening program yielded the following results: (1) “No additionally increased risk after screening”: n = 68/97 (70.1%); (2) “Soft attention”: n = 16/97 (16.5%); (3) “Hard attention”: n = 8/97 (8.2%); (4) “Unequivocally documented CVD on imaging”: n = 2/97 (2.1%); and (5) “Documented clinical CVD”: n = 3/97 (3.1%). Up to now, one event (MI) has occurred during follow-up (being a patient from group 1).
DISTURBED LEFT ATRIAL CONDUIT FUNCTION IN HYPERTENSIVE PATIENTS
Authors: Georgieva Neli , Borizanova-Petkova Angelina , Krastev Bozhidar , Poroyliev Nikolay , Kinova Elena , Goudev Assen
Published: April 2021

Objective:

Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left atrial remodeling and arterial stiffness in middle – aged hypertensive patients.

AIM:

To investigate the early changes in left atrial (LA) mechanical function and parameters of arterial stiffness in a population of asymptomatic hypertensive individuals.

Design and method:

A total 95 patients (57 ± 14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees))and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling (VAC). All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) strain. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24 h) and central pulse pressure (cPP24 h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA.

Results:

RESULTS: Statistically significant differences in parameters of vascular stiffness were found in patients with normal VAC in comparison with disturbed EA/Ees: cSys24 h (107.64 ± 9.19 vs. 116.64 ± 16.7 mm Hg, p = 0.02), cPP24 h (40.23 ± 11.84 vs. 48.08 ± 10.51 mm Hg, p = 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.86 ± 1.94 vs. 19.49 ± 1.35 %, p < 0.001), LASr (30.22 ± 3.26 vs. 31.81 ± 5.32 %, p = 0.007) and LAVI (30.95 ± 9.22 vs. 36.65 ± 8.83 ml/m2, p = 0.007). There was positive correlation between LAScd with EA/Ees (r = 0.272, p < 0.008) and negative E/Em (r = -0.264, p < 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.407, p < 0.0001) and negatively with LAScd (r = - 0.410, p < 0.0001).

Conclusions:

LA mechanical deformation is dependent to arterial stiffness. Reduced LAScd could play a key role in early stages of atrial remodeling. These findings could be used for the prediction of cardiovascular events in this population.
HIGH WATTAGE VAPING SHIFTS URINE METABOLOME TOWARD A HEALTHIER PROFILE: A RANDOMIZED CROSSOVER STUDY
Authors: Chaumont Martin , Communi David , Tagliatti Vanessa , Colet Jean-Marie , Van de Borne Philippe
Published: April 2021

Objective:

We previously demonstrated in young and healthy occasional tobacco smokers that acute exposure to high wattage vaping with and without nicotine decreases transiently transcutaneous oxygen tension and arterial oxyen tension. Propylene glycol and glycerol are e-cigarette constituents that facilitate liquid vaporization and nicotine transport. As these small hydrophilic molecules have a short serum/urine half-live, we hypothesized that short-term cessation of vaping in regular users would change urine metabolic signatures.

Design and method:

Thirty regular e-cigarette users were enrolled in this randomized, investigator-blinded, three-period crossover-study. The periods consisted of nicotine-vaping (nicotine-session), nicotine-free vaping (nicotine-free-session), and complete cessation of vaping (stop-session), all maintained for five days before the session began. Multiparametric metabolomic analyses on urine and serum were used to verify subjects’ protocol compliance. Metabolomic analysis was performed on urine samples by proton nuclear magnetic resonance.

Results:

Partial least squares discriminant analysis (PLS-DA) performed on baseline serum metabolome did not allow to split up any of the three experimental session. PLS-DA performed on baseline urine metabolome allowed to split up the nicotine and the stop sessions (Figure 1.C), the nicotine-free and the stop-sessions (Figure 1.D) but not the nicotine from the nicotine-free session (Figure 1.B) as well as all three sessions (Figure 1.A). Heatmap outlines the main metabolites with variables of importance values > 1 of both session as well as those identified by the PLS-DA. Baseline urine propylene glycol was lower in the stop-session compared to the nicotine-and nicotine-free sessions (all-p < 0.0001). Baseline urine 3-hydroxyisovalerate and urine-pyruvate were higher in the nicotine-session vs. the nicotine-free and the stop-sessions (all-p < 0.05). Compared to the stop-session, baseline urine trimethylamine-oxide and hippurate were lower in the nicotine-session (all-p < 0.05). Finally, baseline N-Phenylacetyl-glycine was lower in the nicotine-session when compared to the stop-session (p < 0.05).

Conclusions:

In conclusion, our study reveals that short-term e-cigarette cessation in regular users modified the urine metabolomic signature in a way signature in a way that suggests several modulations in hypoxia related pathways. This will need further researches focusing on cellular and molecular alterations (i.e., hypoxia-inducible Factors-1, nuclear factor-kappa B), in cell and animal models.
A NEW VISION OF NON-ALCOHOLIC FATTY LIVER DISEASE: A “CARDIAC” DISEASE PER SE AND A “VASCULAR” DISEASE ONLY WITH HYPERTENSION
Authors: Cattazzo Filippo , Dalbeni Andrea , Mantovani Anna , Bevilacqua Michele , Dell’atti Davide , Zoncapè Mirko , Paon Veronica , Ieluzzi Donatella , Prat Laura Iogna , Roccarina Davide , Sacerdoti David , Tsochatzis Emmanouil , Fava Cristiano
Published: April 2021

Objective:

Non-alcoholic fatty liver disease (NAFLD) is associated with an increased cardiovascular (CV) risk. However, it is still not clear whether NAFLD contributes independently to the development and progression of CV disease. This study aimed to assess the differences between NAFLD patients with or without hypertension (HT) and patients with HT but no NAFLD through markers of subclinical and clinical atherosclerosis, cardiac function and morphology and liver fibrosis.

Design and method:

Eighty-seven participants (51,9 ± 9y; males = 83,7%) were divided according to the presence of NAFLD and essential HT in three groups: only-NAFLD, only-HT and NAFLD + HT. Patients with BMI > 35 and type II diabetes were excluded. Blood pressure (BP) measurement, carotid ultrasonography, echocardiography and transient elastography were performed. Carotid intima–media thickness (cIMT), Carotid Distensibility (CD) and Carotid-femoral pulse wave velocity (cf-PWV) were measured as markers of subclinical atherosclerosis and arterial stiffness.

Results:

The prevalence of atherosclerotic plaques was significantly higher in NAFLD + HT group compared with only-NAFLD group (40% vs 5,7%; p < 0,001). Belonging to NAFLD + HT group, rather than other clinical variables, was independently associated with atherosclerotic plaques in stepwise multiple logistic regression analysis (beta ± SEM = 2.083 ± 0.958; p = 0,01). No differences in cIMT, CD, cf-PWV, echocardiographic parameters and liver stiffness were found among the three groups; nevertheless, a significant prevalence of concentric cardiac remodeling (RWT > 0,42) was detected in all groups (only-HT, NAFLD + HT and only-NAFLD group at 40,9%, 35,7% and 33,3%, respectively; p = not significant).

Conclusions:

Overt atherosclerosis, rather than subclinical atherosclerosis and arterial stiffness, was more evident in NAFLD + HT patients. A surprising finding was the high prevalence of concentric cardiac remodelling in all groups, including in the only-NAFLD one, suggesting a possible direct involvement of NAFLD in cardiac structural changes. Therefore, the impact of NAFLD on vascular and cardiac structure could be different and partially dependent on the presence of HT.
CARDIOVASCULAR PROFILE OF CROATIAN MILITARY VETERANS WITH HISTORY OF PTSD
Authors: Cuti Edina Catic , Kovacevic Idriz , Kolaric Ivan , Jelakovic Bojan
Published: April 2021

Objective:

The purpose of this analysis was to evaluate cardiovascular profile of military veterans with confirmed diagnosis of PTSD

Design and method:

We evaluated cardiovascular risk of military veterans in relation to their history of combat exposure and targeted a specific group of veterans with confirmed diagnosis of PTSD. All subjects underwent physical examination which included measurement of vital signs. Blood pressure was measured using Omron M6 device, central BP and PWV were determined by MobiloGraph. CV risk was calculated using Heart Score chart for high-risk countries.

Results:

Mean age was 53,40 ± 6,95. 90,0% were active or former tobacco users, while 20,0% drank alcohol. Mean cholesterol level was 5,89 ± 1,36; mean levels of LDL and triglycerides were 3,65 ± 1,35 and 1,81 ± 0,75 respectively. Body mass index mean was 28,25 ± 4,02. 10,0% of all subjects had left ventricular hypertrophy. Mean value for Pulse Wave Velocity was 8,90 ± 1,03. Average value measured in estimated glomerular filtration rate (eGFR) was 98,20 ± 11,73. 30,0% had diabetes; 10,0% had coronary heart disease; 10,0% had previous myocardial infarction.

Analysis showed 40,0% of PTSD veterans had hypertension, 20,0% had well controlled hypertension with pharmacotherapy while10% had uncontrolled but treated hypertension.

60,0% of PTSD military veterans had resting heart rate below 80/min, 10,0% had heart rate between 80 and 84/min and 30,0% had heart rate equal or higher than 85/min.

Conclusions:

There is limited data regarding cardiovascular risk in veterans with history of PTSD. A possible explanation for insufficient data is veterans’ avoidance of Croatian healthcare system due to social stigma associated with PTSD. Veterans prefer to obtain support and assistance through various veterans’ associations and religious organizations. Eliminating stigma around PTSD, its’ early detection and appropriate treatment could improve registration of veterans with Croatian healthcare system and allow better understanding of their cardiovascular profile while ensuring optimal management of their cardiovascular risks.
PREDICTORS OF THE SUPERNOVA (SUPERNORMAL VASCULAR AGING) PHENOMENON IN POPULATION-BASED SAMPLE
Authors: Boyarinova Maria , Rotar Oxana , Tolkunova Kristina , Alieva Asiiat , Moguchaya Ekaterina , Solntsev Vladislav , Vasilieva Elena , Baranova Elena , Konradi Alexandra
Published: April 2021

Objective:

It is known that chronological age can be different from biological age. Supernormal vascular aging (SUPERNOVA) - can be diagnosed in subjects who present an exceptionally low arterial stiffness for their age. The aim of our study was to identify the factors associated with the SUPERNOVA in subjects from population-based Saint Petersburg sample.

Design and method:

As a part of all-Russian epidemiology survey ESSE-RF random sampling of 1600 Saint-Petersburg inhabitants stratified by age and sex was recruited. Anthropometry, blood pressure measurement and fasting blood-tests: glucose, lipids, C-reactive protein, insulin was performed according to standard protocols. HOMA IR was used as a marker of insulin resistance. Carotid–femoral pulse wave velocity (PWV) was performed by SphygmoCor (AtCor). SUPERNOVA phenomenon was detected in case of equal or less than 10 percentile of PWV for healthy individuals in each age group [European Heart Journal. 2010. Vol. 31. P. 2338–2350].

Results:

PWV was performed in 524 individuals, SUPERNOVA was revealed in 55 (10.5%). Cardiovascular (CV) risk predictors were compared in different age groups. In the group of people 25–39 years old, there were no significant differences in CV risk factors between subjects with the SUPERNOVA and other persons. In the group of 40–49 years old, individuals with SUPERNOVA had significantly lower SBP (p = 0.036), BMI (p = 0.042), HDL (p = 0.021) comparing with others. In the 50–59 years old, among SUPERNOVA subjects there were more often females (p = 0.029), significantly lower were: SBP (p = 0.032), BMI (p = 0.009), HDL (p = 0.002), HOMA IR (p = 0.039) and higher adiponectin (p = 0.045). In the oldest age group: 60–69 years old, those with SUPERNOVA also had significantly lower SBP (p = 0.006) and DBP (p = 0.005), total cholesterol (p = 0.009), LDL (p = 0.016), triglycerides (p = 0.025) and significantly higher adiponectin (p = 0.014).

Conclusions:

It seems that at young age the presence of the SUPERNOVA phenomenon is not determined by the presence of traditional CV risk factors. Starting from middle age (> = 40 years old) such factors as female gender, SBP, BMI, HDL and adiponectin is associated with supernormal vascular aging. In the oldest group the levels of both SBP and DBP, lipids acquire the greatest importance for the presence of SUPERNOVA.
ANNOYANCE DUE TO NOISE TRIGGERS VASCULAR CHANGES IN THE RENAL HEMODYNAMIC
Authors: Bosch Agnes , Kannenkeril Dennis , Ott Christian , Harazny Joanna M. , Striepe Kristina , Karg Marina V. , Jung Susanne , Kolwelter Julie , Schmieder Roland E.
Published: April 2021

Objective:

There is evidence from epidemiological and animal studies that noise exposure is associated with an increased incidence of arterial hypertension and cardiovascular disease. We recently investigated the influence of annoyance due to noise on the renal hemodynamic and found a lower renal plasma flow in patients subjectively annoyed in every-day life compared to not-annoyed patients. We now further explored the pathophysiological mechanisms of this finding.

Design and method:

We analysed the influence of annoyance due to noise on the renal and systemic hemodynamic in 110 subjects, who were either healthy or presented with drug-naive hypertension (HT) without evidence of end-organ damage. Renal hemodynamic was measured using steady state input clearance with infusion of paraaminohippuric acid and inulin, respectively. Intraglomerular pressure and resistances of the afferent (RA) and efferent (RE) arterioles were calculated according to the Gomez equation. The systemic hemodynamic was recorded by the SphygmoCor System (AtCor Medical). All subjects ranked subjective annoyance due to noise in everyday life on a 7 grade likert scale. The median of all rankings was used as cut off point to divide the group into annoyed and non-annoyed subjects.

Results:

Annoyed subjects (n = 55) showed lower renal plasma flow (596 ± 108 vs 646 ± 130 ml/min, p = 0.030), higher filtraction fraction (22.9 ± 3.3 vs 21.6 ± 3.2, p = 0.036), higher renal vascular resistance (93.4 ± 27.5 vs 81.0 ± 25.7 mmHg/(ml/min), p = 0.021), higher RA (4565 ± 1744 vs 3792 ± 1676, p = 0.024) and a trend to higher RE (2442 ± 480 vs 2288 ± 411, p = 0.076) compared to not-annoyed subjects (n = 55). There was no difference in glomerular filtration rate (133 ± 12 vs 136 ± 15 ml/min, p = 0.307) and intraglomerular pressure (37.1 ± 2.5 vs 37.6 ± 3.1 mmHg, p = 0.325) between annoyed and not-annoyed subjects.

There was also no difference in office blood pressure (133 ± 13/79 ± 10 vs 131 ± 13/78 ± 11 mmHg, p = 0.429/p = 0.527), central blood pressure (115 ± 13/79 ± 11 vs 112 ± 12.8/75 ± 12 mmHg, p = 0.317/p = 0.092), central pulse pressure (36.3 ± 6.9 vs 37.6 ± 6.3 mmHg, p = 0.304) and heart rate (66 ± 8.4 vs 65 ± 10 bpm, p = 0.680) between annoyed and not-annoyed subjects.

Conclusions:

Annoyance due to noise in everyday life was associated with a vasoconstrictive response in the renal hemodynamic. Our data suggest the hypothesis that annoyance due to noise may trigger early renal vascular changes potentially leading to hypertension.
PSYCHOLOGICAL DISTRESS, PSYCHOSOMATIC SYNDROMES AND PSYCHOLOGICAL WELL-BEING IN MASKED HYPERTENSION
Authors: Bernardini Francesco , Gostoli Sara , Rafanelli Chiara , Roncuzzi Renzo , Veronesi Maddalena , Borghi Claudio
Published: April 2021

Objective:

In patients affected by masked hypertension psychological variables have been poorly investigated so far. Some authors found an association of masked hypertension with hypochondria and/or depression. Studies on the relationship between masked hypertension and stress focused on stressors at work ignoring chronic/acute stressful life events related to other contexts. This research aims to understand psychological, psychosomatic and well-being characteristics among patients with masked hypertension.

Design and method:

10 patients with masked hypertension, enrolled at the Division of Internal Medicine, were assessed. They were administered both observer- (interviews on clinical psychological distress and psychosomatic syndromes) and self-rated (questionnaires on subclinical distress and well-being) measures.

Results:

40% of patients reported at least one depressive disorder (30% past major depressive episode and 20% persistent depressive disorder) and 40% at least one anxiety disorder (30% generalized anxiety, 10% panic and 10% social anxiety). 50% showed illness behaviour, 20% psychological manifestations and 20% personality syndrome. Only 30% of patients did not report a diagnosis of either Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or Diagnostic Criteria for Psychosomatic Research (DCPR). 20% of the sample reported only one psychosomatic syndrome (somatization and conversion syndromes). The mean levels of psychological well-being were significantly lower in masked hypertension patients than those of the general population: autonomy (29.9 ± 6.87 versus 37.14 ± 6.96), environmental mastery (26.70 ± 2.75 versus 38.15 ± 7.41), personal growth (32.10 ± 3.93 versus 38.40 ± 6.93), positive relations (31.20 ± 4.92 versus 40.57 ± 6.96), purpose in life (26.72 ± 5.32 versus 38.40 ± 6.98) and self-acceptance (25.80 ± 5.37 versus 38.12 ± 8.20). The mean scores Psychosocial Index subscales were significantly higher than those reported by the general population: psychological distress (13 ± 6.43 versus 5.54 ± 3.60), abnormal illness behavior (1.10 ± 1.20 versus 0.50 ± 0.82) and stress (4.40 ± 1.51 versus 2.30 ± 1.81). On the contrary, the mean scores of well-being dimension were significantly lower (6 ± 1.33 versus 7.42 ± 1.64).

Conclusions:

A high percentage of patients with masked hypertension showed high levels of psychological and psychosomatic distress. A psychosomatic assessment including both distress and psychological well-being impairments should be implemented in patients with masked hypertension in order to recognize potential vulnerability factors for both medical and psychiatric syndromes.
MATERNAL ESTROGEN-PROGESTIN IMPROVES CARDIAC GLUCOSE-6-PHOSPHATE DEHYDROGENASE ACTIVITY BUT AGGRAVATES TRIGLYCERIDE IN GESTATIONAL GLUCOCORTICOID-EXPOSED RATS
Authors: Badmus Olufunto , Olatunji Lawrence
Published: April 2021

Objective:

Glucocorticoids (GCs) are used in pregnant women to treat numerous medical disorders. Oral estrogen-progestin, a means of contraception that has been associated with cardiometabolic disturbances is widely used as a method of maternal contraception. We therefore sought to investigate the effects of maternal COC on dams that were exposed to late gestational GC.

Design and method:

Twenty-four female rats were mated to achieve timed pregnancy and delivery. They were randomly allotted into 4 groups of 6 rats each. Dams received COC (combination of 1.0 microgram ethinylestradiol and 5.0 microgram levonorgestrel) between 3rd and 11th week maternal with or without prior exposure to GC (dexamethasone; 0.2 mg/kg) between gestational days 14–19. Plasma corticosterone and insulin were determined by using ELISA. Triglyceride (TG), was measured by standardized enzymatic colorimetric method. Plasma and cardiac levels of glucose-6-phosphate dehydrogenase (G6PD), nicotinamide adenine dinucleotide phosphate (NADPH), oxidized glutathione (GSSG), reduced glutathione (GSH), glutathione peroxidase (GPx), xanthine oxidase (XO), adenosine deaminase (ADA), uric acid, FFA, lactate, lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were measured by spectrophotometric method using assay kit

Results:

Data showed that late-gestational GC exposure led to insulin resistance (IR), increased cardiac ADA, XO, lactate, LDH, and disrupted cardiac G6PD-dependent antioxidant defenses. On the other hand, maternal COC treatment in dams not exposed to gestational GC led to IR, increased cardiac XO, LDH and defective cardiac G6PD-dependent antioxidant defenses. However, maternal COC with prior gestational GC exposure led to attenuated IR, cardiac ADA, UA, LDH, and improved cardiac G6PD-dependent antioxidant defenses but worsened cardiac TG accumulation when compared with dam with gestational GC exposure without maternal COC. Circulating corticosterone was comparatively elevated in the three experimental groups compared to dam without prior GC exposure and maternal COC treatment.

Conclusions:

The result provides evidence that late gestational GC exposure programs IR that is accompanied with increased ADA, lactate production and defective cardiac G6PD-dependent antioxidant defense, whereas maternal COC use resulted in IR and defective cardiac G6PD-dependent antioxidant defense. The study further suggests that maternal COC improves GC-programmed cardiovascular risk factors with enhanced cardiac TG accumulation.
DEPRESSION AND RISK OF NEW-ONSET CARDIOVASCULAR DISEASE: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Alnakhli/Anwar Anwar , Bazuhair Mohammed , Padmanabhan Sandosh , Smith Daneil
Published: April 2021

Objective:

There is growing evidence indicating a bidirectional relationship between depression and cardiovascular diseases (CVDs). Among the limitations of previous studies include the use of a single baseline measure of depressive symptoms.

Objective: To establish whether an independent association with CVD exists for depression either measured at baseline or at multiple instances in a population free of CVD and cerebrovascular diseases.

Design and method:

Bibliographic databases were searched from 2005 up to 2019 using Medline, EMBASE, Web of Science and PsycINFO without language restrictions. Prospective cohort studies which reported the association between depression and incidence of three CVD outcomes (stroke, coronary heart disease (CHD), myocardial infarction (MI) and heart failure (HF)) were included. Pooled hazard ratios (HR) were calculated using inverse variance method in random effect models.

Results:

Twenty-two prospective cohorts with 43 independent reports were identified, of which twenty were suitable for meta-analysis with a total of 3,642,913 participants and an average follow-up of 10 years. Participants with depressive symptoms at baseline had a 25% higher risk of stroke (HR = 1.25 95%CI 1.11–1.40, I2 = 67%), a 20% higher risk of CHD (HR = 1.20 95%CI 1.08–1.32, I2 = 82%) and a 24% higher risk of MI (HR 1.24 95%CI 1.20–1.28, I2 = 0%) comparing to participants without depressive symptoms at study entry. Similar associations were observed after restricting analysis to studies that measured depression as a time-varying exposure - stroke (HR = 1.32 95%CI 1.10–1.59, I2 = 0%) and CHD (HR = 1.21 95%CI 1.02–1.43, I2 = 34%). Two studies reported HF outcomes and this showed a similar association (HR = 1.18 95%CI 1.08–1.29, I2 = 0%). In subgroup-analysis by type of depression assessment, clinical depression appeared to be a stronger predictor than depressive symptoms for stroke and CHD.

Conclusions:

Depression is associated with increased risk for the development of CVDs.
RISK STRATIFICATION IN LOW-RISK HYPERTENSIVE INDIVIDUALS IN A COHORT STUDY
Authors: Valencia-Hernández Carlos A. , Mceniery Carmel , Wilkinson Ian B. , Lindbohm Joni , Shipley Martin J. , Brunner Eric J.
Published: April 2021

Objective:

To assess the risk of Major Cardiovascular Risk Events (MACE) using carotid-femoral Pulse Wave Velocity (cf-PWV) in borderline hypertensive participants from the Whitehall II study, an ongoing cohort of British civil servants.

Design and method:

The Whitehall II study is an ongoing occupational cohort. The study started in 1985 with 10,308 participants. 67% males and 33% females. The subsample used for this analysis is the collection phase 9 (2008-9) and includes participants with a measurement of cf-PWV and a follow-up in Hospital Episode Statistics over 12 years. Participants included in this analysis have a 10-year atherosclerotic cardiovascular risk classification (ASCVD) <10, systolic and diastolic blood pressure below 140/90 respectively, not using antihypertensive medication and with no previous MACE. The total sample for this analysis includes 1169 participants. The statistical analysis included Cox-proportional hazard models that were fitted to compare the time to develop MACE events according to different levels of cf-PWV. Sociodemographic models included age, sex and ethnicity. Body composition measurements as Body Mass Index and waist circumference and health behaviours as alcohol consumption and physical activity were also included in further models.

Results:

Mean age at baseline is 65.4 (5.7) and median PWV in the sample was 8.07 m/s. Out of 1169 low-risk participants of the cohort who had a measurement of cf-PWV at baseline, 61 presented a MACE event during follow-up. 892 participants were below the median PWV and 277 were above it. After fitting a crude Cox model, the hazard for a MACE event was 1.72 times higher in participants above median PWV compared with those below (95%CI: 0.99; 2.95). Significance of the model remained after adjusting for covariates.

When survival models were fitted using cf-PWV as a continuous measurement, a HR of 1.32 per each unit increase in PWV was found (95% CI: 1.12; 1.53).

Figure. Survival probability free of MACE according to median PWV.

Conclusions:

These results underline the potential of cf-PWV as a CVD risk predictor even in low-risk normotensive participants. This could have implications in current clinical practice.
CARDIOVASCULAR RISK AND OUTCOME IN PATIENTS WITH HYPERTENSIVE EMERGENCIES AND URGENCIES IN AN EMERGENCY DEPARTMENT. AN ITALIAN GREEK COLLABORATION
Authors: Muiesan ML , Salvetti M , Fragoulis C , Paini A , Aggiusti C , Bertacchini F , Stassaldi D , Tarozzi L , Dimitriadis K , Konstantinidis D , Kasiakogias A , Kalos T , Andrikou I , Siafi E , Leontsinis I , Iliakis P , Tousoulis D , Tsioufis K
Published: April 2021

Objective:

Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED).

The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies.

Design and method:

Methods: medical records of patients aged > 18 yrs, admitted to the ED with blood pressure values > = 180 mmHg (SBP) and/or > = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”).

Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years.

Results:

Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded.

A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p < 0.0001 for all-cause and for CV mortality, respectively).

The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events.

Conclusions:

Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.
ESTIMATED PULSE WAVE VELOCITY (EPWV) AND MORTALITY IN SUBJECTS WITH HEALTHY VASCULAR AGEING (HVA) AND EARLY VASCULAR AGEING (EVA) IN GENERAL POPULATION. EH-UH STUDY
Authors: Blagus Luka , Bosnjak Vito , Frkanec Stjepan , Katic Luka , Domislovic Viktor , Matasin Marija , Glavic Mihaela Marinovic , Kos Jelena , Vrkic Tajana Zeljkovic , Pecin Ivan , Jelakovic Ana , Premuzic Vedran , Dika Zivka , Karanovic Sandra , Kriksic Valentina , Capak Krunoslav , Stevanovic Ranko , Jelakovic Bojan
Published: April 2021

Objective:

Arterial stiffness (cfPWV) is acknowledged biomarker of ageing having significant predictive value for cardiovascular (CV) events in hypertensive patients. It was observed that ePWV calculated by equation using age and mean blood pressure (MBP) improved risk prediction compared with traditional risk scores in healthy subjects, untreated hypertensives and very high risk patients. Our aim was to analyze association of ePWV with mortality in subjects with EVA and HVA in general Croatian population.

Design and method:

In a stratified random sample of 1087 subjects from the general Croatian adult population which was enrolled in a nationwide survey (EH-UH 1) from 2000–2005 analyses on ePWV were done and subjects were followed-up for 17years. ePWV was calculated using formula: ePWV = 9.587–0.402 × age+4.560 × 10-3 × age2–2.621 × 10-5 × age2 × MBP+3.176 × 10-3 × age × MBP-1.832 × 10-2 × MBP. MBP = (DBP)+0.4(SBP-DBP). HVA was defined as the lowest 10%, EVA as the highest10% of the standardized PWV distribution, adjusted for age quintiles. Subjects with MI, stroke/TIA, DM were excluded. Mortality data were collected from National Public Health Institute records.

Results:

At the end of follow up period 228 deaths (20.9%) were recorded in the whole group (CV43.4%, stroke10.5%, cancer28.5%, dementia and degenerative diseases5.2%, COPD3.1%). There were 16.5% and 14.2% deaths in EVA and HVA groups, respectively (p > 0.05). Significantly more CV/stroke deaths were observed in EVAvs.HVA (X2 = 5.488;p = 0.0019). In a subgroup of subjects who died, at basal EVA subjects were older, obese, more frequently hypertensives, had higher BMI, BP, heart rate and ePWV compared to HVA (13.8 ± 1.1vs.10.5 ± 2.5;p < 0.0001). Both died HVA and EVA were at basal less physically active than survivors. In a subgroup of EVA subjects, those who died, at basal were older, had higher systolic BP, lower eGFR and higher ePWV (13.8 ± 1.1vs.9.9 ± 2.3;p < 0.0001) and were less physically active (X2 = 1.54;p = 0.01) compared to survivors. We failed to find differences between dead and alive EVA in basal diastolic BP, BMI, heart rate, prevalence of hypertension.

Conclusions:

Age, systolic BP, eGFR and ePWV were associated with mortality risk in EVA subjects. Physical inactivity was associated with higher mortality both in EVA and HVA participants. Comparing to HVA, in addition to aforementioned parameters, EVA subjects had higher BMI, diastolic BP and heart rate.
BURDEN OF RISK FACTORS IN THE PREVENTION OF CARDIOVASCULAR DISEASE AMONG ADULTS IN AKTOBE AND AKTOBE REGION, REPUBLIC OF KAZAKHSTAN
Authors: Chernokurova Yelena , Assembekov Batyrbek , Davletov Kairat , Mereke Alibek , Dushpanova Anara
Published: April 2021

Objective:

The overall goal of the survey was to evaluate the current health status of population one of the regions of Kazakhstan and its components, prevalence of main risk factors of CVDs using a standard WHO methodology designed to assess risk factors prevalence and renew preventive activities on CVDs using the collected and analyzed data.

Design and method:

A cross-sectional study was conducted to assess the prevalence and risk factors of CVDs using the WHO STEPS questionnaire survey, physical measurements and biochemical measurements.

Sample size was 1,500 people aged 18–69 years. Samples composition: 900 urban and 600 rural population according to the overall urban/rural residents ratio specific for the region.

Results:

Based on the interview results and physical and biochemical measurements, the following risk factors were used:

The percentage of respondents with 0, 1–2 or 3–5 risk factors by age group and sex are presented in table. In 3.56% (95% CI: 2.71–4.41) of the study population, none of the abovementioned five risk factors were identified; 52.54% (95% CI: 51.69–53.39) of the respondents had 1–2 risk factors; and 12.01% (95% CI: 11.16–12.86) has 3–5 of the risk factors listed. Prevalence of 3–5 combined risk factors was much higher in the age group 55–69 years (17.28, 95% CI:16.44–18.12), while prevalence of 1–2 risk factors was higher in the age group 18–34 years (58.95%, 95% CI: 58.15–59.75). Differences were statistically significant. A higher proportion of men had 3–5 risk factors (22.06%, 95% CI: 21.18–22.94) than women (9.01%, 95% CI: 8.20–9.82). In addition, the percentage of women with 1–2 risk factors (54.37, 95% CI: 53.56–55.18) was higher than that of men (46.42%, 95% CI: 45.54–47.30).

Conclusions:

Primary prevention continues to evolve and with greater availability of long-term data comes improved understanding of the means by which we can reduce CVD risk.
SAGE SCORE THAT PREDICTS HIGH PWV APPLIED TO LATIN AMERICAN HYPERTENSIVE PATIENTS EVALUATED WITH OSCIILOMETRIC DEVICES
Authors: Oliveira Adriana Camargo , Barroso Weimar Kunz Sebba , Vitorino Priscila Valverde O. , Sousa Ana Luiza Lima , Fagundes Rayne Ramos , Guimarães Gilberto Campos , De Deus Gilcimar Divino , Barbosa Eduardo , Xaplanteris Panagiotis , Vlachopoulos Charalambos
Published: April 2021

Objective:

Objective: Pulse wave velocity (PWV) analysis represents an important tool to identify subclinical hypertension-mediated organ damage and, carotid-femoral PWV is the gold standard method for measuring large artery stiffness. SAGE is a validated clinical score and it uses four clinical parameters (office SBP, Age, Fasting Glucose and eGFR categories) to identify hypertensive patients with high likelihood of nigh PWW and thus high risk of a major risk of cardiovascular events. We have applied this score to Latin American hypertensive patients evaluated with oscilometric devices.

Design and method:

Methods: A retrospective analysis of patients submitted to central blood pressure measurement using the validated oscilometric Mobil-O-Graphâ. We have then selected those with hypertension and with all the SAGE parameters available. The score was divided into 18 categories (0 to 17) and, to each of them, a PWV greater 10m/sec analysis of sensitivity, specificity, positive and negative predictive value was done. A ROC curve using Youden index was constructed to define better score to identify these patients with high risk for elevated PWV

Results:

Results: A total of 1266 patients were selected and 837 have reached predefined criteria of SAGE parameters. Mean age was 58 ± 15 years and 49,3% were male. Diabetes was found in 17% of the sample, smoking 18% and 582 (70%) patients were using anti-hypertensive drugs. Mean office blood pressure was 129 ± 18,2 mmHg for systolic and 82 ± 13,1 mmHg for diastolic. PWV median was 8,3 m/sec ± 2,1 m/sec. According to ROC curves a cut-off >7 was the best one to identify high risk of PWV greater 10 m/sec (sensibility 67,19% CI 95%: 60,1–73,8, specificity 93,95% CI 95%: 91,8–95,7). With this cut-off point 1 in each 5 hypertensive patients would be referred to PWV measurement. This value is close to one that the Original SAGE score identified (>8).

Conclusions:

Conclusion: SAGE score that identifies patients with high PWV is operational when applied to hypertensive Latin American population with oscilometric device measurement. Yielded cut-off values are similar to those in the original cohort that was validated with carotid-femoral PWV measurements in a European population.
ASSESSMENT OF SMOKING STATUS IN PATIENTS WITH HYPERTENSION IN HOSPITAL AND PRIMARY CARE
Authors: Bondar Svetlana , Salagay Oleg , Konradi Alexandra
Published: April 2021

Objective:

1) to investigate how careful smoking status of patients with hypertension is recorded in hospital and primary care; 2) to evaluate the hypothesis that smoking can be more often assessed by physicians with PhD (Doctor of Philosophy) and DMs (Doctor of Medical Science) degrees.

Design and method:

Electronic records from 10 776 hospital and primary care case histories of adult patients aged >18 years with the primary diagnosis of hypertension were collected in one year.

Results:

The mean age of the patients was 57.9 ± 15.1 year. 6785 (63.0%) of the patients were women. Smoking status was recorded in 8632 of all 10776 (80.1%) electronic records, in 1735 of 2059 (84.3%) hospital records and in 6897 of 8717 (79.1%) of primary care episodes (p < 0.001). The current, former and never smoking rate in the total group was 11.2% (n = 963), 3.7% (n = 316) and 85.2% (n = 7353), respectively. Smoking status was more frequently recorded in men – 3295 of 3991 (82.6%), than in women – 5337 of 6785 (78.7%) (p < 0,001). Patients were treated by physicians of 17 different specialties, most frequently by cardiologists – 9200 of 10776 (85.4%) and internal medicine physicians – 882 of 10776 (8.2%) patients. Cardiologists more often recorded the smoking status in hospital 950 of 1030 (92.2%) than in primary care – 6611 of 8171 (80.9%) records (p < 0.001), internal medicine physicians are also more frequently assessed smoking status in hospital – 475 of 545 (87.2%) records than outpatient episodes – 127 of 337 (37.7%) (p < 0.001), but the difference was much more pronounced. 2363 of 10776 records were performed by physicians with PhD and DMs degrees, and rate of assessment of patients’ smoking status by this group of physicians was higher than that of other physicians – 2009 of 2363 (85.0%) versus 6623 of 8413 (78.7%) (p < 0.001), odds ratio 1.53, 95% CI 1.35–1.74, p < 0.001.

Conclusions:

Smoking status of patients with hypertension was relatively well recorded in hospital and primary care, more frequently in hospital. Physicians with PhD and DMs degrees assessed smoking status better than physicians without PhD and DMs degrees.
RADIAL-DIGITAL PULSE WAVE VELOCITY: A NON-INVASIVE METHOD FOR ASSESSING STIFFNESS OF PERIPHERAL SMALL ARTERIES
Authors: Obeid Hasan , Garneau Charles-Antoine , Fortier Catherine , Pare Mathilde , Boutouyrie Pierre , Agharazii Mohsen
Published: April 2021

Objective:

Pulse wave velocity (PWV) is used to evaluate arterial stiffness of large and medium-sized arteries. Here, we examine the feasibility and reliability of radial-digital PWV (RD-PWV) as a measure of stiffness of smaller arteries, and its response to changes in hydrostatic pressure.

Design and method:

In 29 healthy subjects, we used Complior Analyse piezoelectric probes to record arterial pulse wave at radial artery and tip of the index. We determined transit time by second-derivative and intersecting-tangents using the device-embedded algorithms, in house Matlab-based analyses of only reliable waves, and by numerical simulation using a one dimensional (1-D) arterial tree model coupled with heart model.

Results:

Second-derivative RD-PWV were 4.68 ± 1.18, 4.69 ± 1.21, 4.32 ± 1.19 m/s for device-embedded, Matlab-based and numerical simulation analyses, respectively. Intersecting-tangents RD-PWV were 4.73 ± 1.20, 4.45 ± 1.08, 4.50 ± 0.84 m/s for device-embedded, Matlab-based and numerical simulation analyses, respectively. Intersession coefficients of variation were 7.0 ± 4.9% and 3.2 ± 1.9% (P = 0.04) for device-embedded and Matlab-based second derivative algorithms. In 15 subjects, we examine the response of RD-PWV to changes in local hydrostatic pressure by vertical displacement of the hand. For an increase of 10 mm Hg in local hydrostatic pressure RD-PWV increased by 0.28 m/s (95% CI: 0.16 to 0.40; P < 0.001).

Conclusions:

This study shows that RD-PWV can be used for the non-invasive assessment of stiffness of small-sized arteries. This finding allows for an integrated approach for assessing arterial stiffness gradient from aorta, to medium-sized arteries, and now to small-sized arteries.
EFFECTS OF INSOMNIA AND RESTLESS LEGS SYNDROME ON NIGHTTIME ARTERIAL BLOOD PRESSURE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Maiolino Giuseppe , Bisogni Valeria , Soranna Davide , Pengo Martino Francesc , Pucci Giacomo , Fava Cristiano , Colussi Gian Luca , Bilo Grzegorz , Lombardi Carolina , Parati Gianfranco , Rossi Gian Paolo , Silvani Alessandro
Published: April 2021

Objective:

Nocturnal hypertension and blunted blood pressure (BP) dipping during nighttime sleep are associated with increased cardiovascular risk. Chronic insomnia and restless legs syndrome (RLS) are highly prevalent disorders that might affect the 24 hours BP profile including nocturnal dipping, but data on this issue are still controversial. In this systematic review and meta-analysis we aimed at evaluating the association of insomnia and RLS with nighttime and daytime BP values and the BP dipping pattern.

Design and method:

We searched for relevant articles in 4 different databases using the following inclusion criteria: 1) observational studies and randomized clinical trials, comparing patients with either chronic insomnia or RLS with matched control subjects free of sleep disorders; 2) evaluation of OSA comorbidity; 3) nighttime BP measured by means of either 24-hour ambulatory or nocturnal beat-to-beat BP monitoring; 4) English language; 5) full-length retrievable papers.

Results:

Of the 811 studies originally retrieved, 6 were selected. Three studies enrolled insomnia subjects, who at meta-analysis displayed a reduced diastolic BP dipping compared to controls (-1.66%, 95% confidence interval (CI) -2.80 - -0.52), while no difference was found on daytime and nighttime blood pressure levels. Three studies enrolled RLS patients, who showed increased nighttime systolic BP (5.61 mm Hg, 95% CI 0.13–11.09) compared to controls, with no difference in daytime BP, nighttime diastolic BP, and dipping pattern.

Conclusions:

The limited available evidence suggests that insomnia and RLS are both associated with altered nocturnal BP control. Further clinical studies are warranted to replicate and clarify this association.
META-ANALYSIS ASSESSING THE EFFECTS OF ALLOPURINOL ON LEFT VENTRICULAR MASS AND OTHER INDICES OF LEFT VENTRICULAR REMODELING AS EVALUATED BY CARDIAC MAGNETIC RESONANCE IMAGING
Authors: Patoulias Dimitrios , Katsimardou Alexandra , Stavropoulos Konstantinos , Imprialos Konstantinos , Toumpourleka Maria , Kalogirou Maria -Styliani , Tegou Zoi , Koutsampasopoulos Konstantinos , Mavridou Maria , Siskos Fotios , Papadopoulos Christodoulos , Doumas Michael
Published: April 2021

Objective:

Hyperuricemia is a relatively common morbidity, featuring a close relationship with cardiovascular disease, hypertension, heart failure and chronic kidney disease, while it is also related to the development of type 2 diabetes mellitus. Allopurinol remains the mainstay of treatment. We sought to determine whether allopurinol affects left ventricular (LV) mass and other measures of LV remodeling, as assessed by cardiac magnetic resonance imaging (cMRI).

Design and method:

We performed a systematic search in two major electronic databases, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), for eligible randomized controlled trials (RCTs), from their inception to September 2020, along with grey literature sources.

Results:

Our search yielded 84 results in total. Finally, 4 records were included in our quantitative synthesis. Our analysis in a total of 225 patients showed that allopurinol treatment produced a non-significant decrease in LV mass by 1.42 g (MD = -1.42, 95% CI -6.34 to 3.50, I2 = 90%), and a non-significant decrease in LV mass index by 1.47 g/m2 (MD = -1.47, 95% CI -3.91 to 0.96, I2 = 91%). In addition, allopurinol did not decrease significantly neither LV end systolic volume (MD = -0.45 mL, 95% CI -5.53 to 4.64, I2 = 56%) nor LV end diastolic volume (MD = -2.98 mL, 95% CI –9.39 to 3.43, I2 = 35%). Finally, allopurinol did not affect significantly LV stroke volume (MD = 2.06 mL, 95% CI –2.02 to 6.14, I2 = 0%). We consider as major limitations of the present meta-analysis the small number of included RCTs and enrolled participants, which did not permit us to perform subgroup analyses in order to investigate the sources of heterogeneity.

Conclusions:

Conclusion: Allopurinol does not exert a significant effect on LV mass and other indices of LV remodeling, as quantified by cMRI, in a broad population with significant cardiovascular co-morbidities.