bluuebunny/crossref_metadata_2025 huggingface dataset:
Life"s simple 7 and the risk of stroke in Finnish men: a prospective cohort study
Authors: Isiozor N , Kunutsor SK , Voutilainen A , Kurl S , Kauhanen J , Laukkanen JA
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): North Savo Regional Fund and Finnish Foundation for Cardiovascular Research

Background

Population-wide preventive measures constitute important approaches toward reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association’s (AHA) Life’s Simple7 (LS7) score and the risk of stroke in men.

Methods

The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline. LS7 was computed from AHA’s cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke.

Results

During a median follow-up of 26years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2 to 6. Men with optimal LS7 had 48% (HR: 0.52; 95%CI: 0.32–0.86) lower risk of total stroke when compared with those with inadequate LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29–0.87) lower risk among men with an optimal LS7 compared with those with inadequate LS7.

Conclusion

LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Caucasian population.

Life’s Simple 7 and the risk of stroke Total Stroke Ischaemic Stroke LS7 score 0-2† (inadequate) 3-4 (average) 5-7 (optimal) 0-2† (inadequate) 3-4 (average) 5-7 (optimal) n/N 224/1109 187/1273 17/138 192/1109 156/1273 14/138 Model 1 HR (95%CI) 1 0.65 (0.53 - 0.79) 0.49 (0.30 - 0.81) 1 0.63 (0.51 - 0.78) 0.47 (0.27 - 0.82) p value* <0.001 0.005 <0.001 0.007 Model 2 HR (95%CI) 1 0,69 (0.56 - 0.84) 0.52 (0.32 - 0.86) 1 0.67 (0.54 - 0.84) 0.50 (0.29 - 0.87) p value* <0.001 0.01 <0.001 0.014 n/N, number of events/Total; HR, hazard ratio; CI, Confidence interval *p-values for the HRs <0.05 are considered statistically significant †Reference category Model 1: adjusted for age, alcohol consumption and socioeconomic status Model 2: Model 1 plus history of coronary heart disease and history of type 2 diabetes mellitus
An increase in blood levels of vascular endothelial growth factor and highly sensitive C-reactive protein in patients with hypertension and obesity is associated with the left ventricular hypertrophy
Authors: Koval S , Mysnychenko OV , Penkova M YU
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with essential hypertension (H) in combination with abdominal obesity (АО), there is a more frequent and earlier development of asymptomatic hypertension-mediated organ damage (HMOD). One of the prognostically unfarable HMODs is left ventricular hypertrophy (LVH). According to modern concepts, in the mechanisms of HMOD formation, a significant place is given to subclinical inflammation and disturbances in the processes of angio-arteriogenesis.

Purpose

To study blood levels of one of the powerful proangiogenic and proinflammatory factors vascular endothelial growth factor (VEGF) and a marker of inflammation highly sensitive C-reactive protein(hsCRP) in patients with H and AO and their relationship with asymptomatic HMOD.

Methods. The study involved 64 patients with grade 2 H and grade I-II AO (38 men and 26 women aged 35 to 60 years) and 23 practically healthy individuals in the control group (14 men and 9 women aged 18 to 50 years).The survey included standard clinical, anthropometrical, biochemical and instrumental methods. The blood levels of VEGF and hsCRP were determined by the enzyme immunoassay. Diagnostics of H, risk factors and HMOD was performed in accordance with the recommendations of the ESC/ESH (2018).

Results. There was a significant increase in the blood levels of VEGF (162,31 [102,67; 226,41] pg / ml) and hsCRP (3,11[1,17;5,82] mg/L) in patients with H and AO in general by group in comparison with practically healthy individuals (89,07 [61,43; 135,57] pg/ml (р=0,004) and 1,07 [0,46;2,99] mg/L (р=0,016), respectively). At the same time, the blood levels of VEGF (238,53 [138,31; 294,84] pg/ml) and hsCRP (3,94 [1,89;5,82] mg/L) were significantly higher in patients with LVH than in patients without LVH (149,96 [75,18; 174,96] pg/ml (р=0,035) and 2,30 [0,65; 5,31] mg/L (р=0,042), respectively). The following direct correlations were found: between the blood levels of VEGF and hsCRP (р =0,0018), between the blood levels of EGF, hsCRP and LV mass index  (р =0,016, р =0,021, respectively), between the blood levels of VEGF and systolic blood pressure (р =0,035), as well as left atrial volume index (р =0,037).

Conclusion. In patients with H in combination with AO, there are manifestations of the activation of the production of proangiogenic and proinflammatory factors -VEGF and hsCRP, which can play an important role in the development of both LVH and in the progression of H in general.
Should we redifine Hypertensive response in stress test to better predict cardiovascular risk?
Authors: Silverio Antonio P , Alves Da Silva P , Valente Silva J , Brito J , Rodrigues T , Couto Pereira S , Cunha N , Santos R , Rigueira J , Aguiar-Ricardo I , David D , J Pinto J , G Almeida A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Systolic blood pressure (SBP) rise during exercise is normal, but some patients present with hypertensive response to exercise (HRE). The clinical implication of such phenomenon is not fully elucidated, and treatment strategies are still uncertain.

Purpose

To evaluate the relationship between HRE and the development of major cardiovascular events (MACE) - death, acute coronary syndrome (ACS) and stroke.

Methods

Single-center retrospective study of consecutive patients submitted to exercise test (ET) from 2012 to 2015. Patient’s demographics, baseline clinical characteristics, vital signs during ET and MACE occurrence during follow-up were analysed. HRE was defined as a peak systolic blood pressure (PSBP) >210 mmHg in men and >190 mmHg in women, or a rise of the SBP of 60 mmHg in men or 50 mmHg in women or as a diastolic blood pressure >90 mmHg or a rise of 10 mmHg.

Results

We included 458 patients with HRE (76% men, 57.5 ± 10.83 years). The most frequent comorbidities were hypertension (83%) and dyslipidaemia (61%). During a mean follow-up of 60 ± 2 months, the incidence of MACE was 9.2% with ACS being the most frequent (4.2%), followed by mortality (3.8%) and stroke (2.1%). Patients with inconclusive ET had a fourfold higher risk of acute coronary events (OR 4.1, CI 95% 1.55-11.14, p = 0.005). Baseline SBP and PSBP were predictors of MACE occurrence (OR 1.022, CI 95% 1.004-1.04, p = 0.016, OR 1.031 CI 95% 1.012-1.051, p = 0.001, respectively) and were both associated with cardiovascular hospitalization (p = 0.006; p < 0.001, respectively). PSBP had moderate ability to predict hospitalization of cardiovascular (CV) cause (AUC 0.71, p < 0.001) with a cut-off of 193 mmHg (sensibility 91%, specify 40%) and had moderate ability to predict MACE (AUC 0.67, p < 0.001) with a cut-off of 198 mmHg (sensibility 78.6%, specify 46.1%). Regarding mortality, antihypertensive therapy prior to ET was protective (p = 0.042), with no difference between different classes of drugs.

Conclusion

Our data reveal a high rate of MACE occurrence between patients with HRE. The finding of diagnosed hypertension as a protective factor of stroke may be explained by the cardioprotective effect of antihypertensive drugs. An increased risk of ACS between patients with an inconclusive ET should lead to consider then for further investigation. HRE should be considered as part of CV risk assessment and adjusted lower HRE cut-off values should be considered in order to better predict MACE occurrence, particularly in high risk patients.

Abstract Figure.
Is a single bout of exercise also a viable tool for blood pressure management in African and Asian populations? The HYPE2X trial protocol and design
Authors: Bersaoui M , Baldew SM , Toelsie J , Buys R , Cornelissen VA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Current national and international guidelines recommend exercise as the first line treatment (class IA recommendation) for hypertension. These guidelines are based on research performed in predominantly Caucasian populations, yet the potency of exercise for lowering blood pressure (BP) is less studied in non-Caucasian populations. It is well-known that a great variability exists in the response to pharmacological antihypertensive treatments among ethnic groups. However, it is not clear whether this variability is also present regarding the BP response to exercise.  The ‘Hypertension, Ethnicity and Exercise’ (HYPE²X ) trial will i) investigate whether a short bout of isometric strength or endurance exercise lowers blood pressure in African and Asian populations; ii) evaluate and compare differences in acute response to exercise between the Africans and Asians, and iii) increase our understanding on mechanisms related to blood pressure responses to exercise in these non-Caucasian populations.

Methods and analyses

A randomized controlled crossover trial will be conducted in 60 adults of African (n = 30; 50% female) or Asian (n = 30, 50% female) origin, ≥ 18 years. Healthy individuals with high to normal blood pressure (SBP: 130 – 139 mmHg or and DBP: 85 – 89 mmHg) or grade I hypertension (grade 1, SBP: 140 – 159 mmHg or DBP: 90 – 99 mmHg) will be recruited at outpatient clinics in Suriname between November 2020 – February 2021. Patients will complete three experimental sessions in a randomized order: a 30 minute walking/running bout at 40-60% of heart rate reserve; an isometric handgrip session at 30% of maximal handgrip strength and a sitting control session. (See Figure 1). Measurements will be performed before and immediately after each session. The primary outcome is daytime blood pressure measured by means of 24h blood pressure monitoring.  Secondary outcomes include office BP, autonomic function (heart rate variability), cardiac function (left ventricle function), vascular function (pulse wave velocity and flow-mediated dilation) and the renin-angiotensin aldosterone system (plasma renin and aldosterone levels). Analyses will be performed using mixed models for repeated measures. A two-tailed p-value <0.05 will be considered statistically significant.

Conclusion

It is anticipated that the HYPE²X trial will contribute to a better understanding of the response of non-Caucasians to lifestyle interventions, in particular exercise therapy.

Abstract Figure 1. Flowchart of the RCOT
Health education: the effects of an educational program on the health of hypertensive patients with low educational level
Authors: Sousa LAP , Campos APP , Araujo CM , Moreira IGS , Santos G , Costa JM , Vasconcellos JAC , Leal S , Souza AC , Ribeiro ALP
Published: May 2021

Funding Acknowledgements

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

Introduction

Health education is one of the most complete practices for supporting of patients with chronic diseases such as hypertension. It is important, however, to investigate which strategies would be more assertive in this process, depending on the objective and profile of the patient. Objective: The aim of this study was to evaluate the effect of an interactive educational program on the health of hypertensive patients with low educational level in a Basic Health Unit in Brazil.  Methods: This is an almost experimental study, with a multidisciplinary approach, with 6 months of duration. Interactive workshops were held where topics related to hypertension, such as: pathophysiology, complications, drug and non-drug therapeutic approach and lifestyle change. It is important to emphasize that the work used interactive and playful sessions, such as games, videos and group dynamics.  The sample consisted of 35 hypertensive individuals submitted to blood pressure (systolic = SBP and diastolic = DBP) measurement, quality of life (Minichal), adherence to treatment (Martín-Bayarre-Grau), level of knowledge of the disease, physical activity (IPAQ) and anthropometric study evaluation. In addition, for analysis of the data, the sample was divided into two subgroups, according to the participation in the activities: adhered (n = 11) or not adhered (n = 24). Initially, descriptive statistics were used to present the study variables. Subsequently, the WILCOXON test was used to compare before and after and MANN-WHITNEY to compare the two groups, p = 0.05 was considered significant. Results: No significant difference was found relating the initial data in the two subgroups. After the educational program, a significant reduction was observed in relation to the SBP values: 9.8 mmHg in the adherent subgroup. On the other hand, there was increased 0.7 mmHg among non-adherents. The other evaluations did not change. It should be emphasized that the studied population demonstrated a satisfactory level of knowledge of the pathology and the therapeutic process necessary since the initial evaluation in both groups. Such finding, however, was not related to adherence to treatment. Conclusion: the findings suggest that an adapted educational approach could help to control blood pressure levels of hypertensive patients with low educational level. In addition, it was observed that knowledge does not seem to be associated with action, and it is necessary to develop strategies that can increase adherence to therapeutic interventions.
Ramadan and blood pressure: importance of chronotherapy
Authors: Bejar MA , Zairi I , Ben Mrad I , Besbes B , Mzoughi K , Kraiem S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

During Ramadan, alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients.

The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily.

Methods

The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of our   Hospital. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan.

Results

We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2).

Average 24hour blood pressure in the whole group was 129 ± 18/74 ± 10 mmHg before Ramadan and 129 ± 19/74 ± 10 mmHg during Ramadan (p > 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender.

However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p < 0.05).

Conclusion

In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed.

Average values of BP and heart rate Group 1 Group 2 p 24 hour SBP (mmHg) 134 ± 23 122 ± 6 0.017 24 hour DBP (mmHg) 76 ± 12 70 ± 5 0.052 Awake SBP (mmHg) 138 ± 23 125 ± 6 0.012 Awake DBP (mmHg) 79 ± 12 73 ± 5 0.044 Asleep SBP (mmHg) 127 ± 26 114 ± 12 0.030 Asleep DBP (mmHg) 71 ± 13 65 ± 7 0.045 24 hour average heart rate (bpm) 71 ± 7 70 ± 6 0.524 Awake average heart rate (bpm) 76 ± 7 74 ± 7 0.322 Asleep average heart rate (bpm) 65 ± 7 65 ± 7 0.931 Average values of blood pressure and heart rate in both groups

Abstract Figure. 24hour course of blood pressure
Sex differences in leptin and cardiometabolic profile after exercise intervention in physically inactive adults with primary hypertension and obesity
Authors: Maldonado-Martin SMM , Corres PC , Martinezaguirre-Betolaza AMAB , Jurio-Iriarte BJI , Tous-Espelosin MTE , Gorostegi-Anduaga IGA
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of the Basque Country

OnBehalf

GIKAFIT

PURPOSES. To analyse the change on leptin, body composition, blood pressure (BP), cardiorespiratory fitness (CRF) and some biochemical parameters in physically inactive women and men with primary hypertension (HTN) and obesity, and to evaluate the potential sex differences in the change after intervention.

METHODS. Participants (n = 37 women, n= 40 men, 52.9 ± 6.9 yrs) from the EXERDIET-HTA study were randomized into attention control group (physical activity recommendations) or one of three supervised aerobic exercise groups [two days/week: high-volume (HV) with 45 min of moderate-intensity continuous training, HV and high-intensity interval training (HV-HIIT), and low volume-HIIT (LV-HIIT, 20 min)]. All participants received the same hypocaloric diet. All variables were assessed pre and post intervention (16 weeks). 24 h ambulatory BP monitoring was used to analyze systolic and diastolic BP. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO2peak).

RESULTS. Following the intervention, there were increments (P < 0.01) in CRF by VO2peak (Women, W = 21.1 ± 3.7 vs. 24.6 ± 4.4 mL·kg-1·min-1, Men, M = 26.3 ± 6.0 vs. 33.1 ± 10.2 mL·kg-1·min-1) and decreases (P < 0.05) in leptin (W = 49.5 ± 23.0 vs. 41.8 ± 19.9 ng/mL, M = 20.5 ± 14.8 vs. 12.9 ± 18.6 ng/mL), body mass (W = 84.7 ± 12.1 vs. 80.3 ± 11.5 kg, M = 97.9 ± 14.4 vs. 91.5 ± 13.3 kg), waist perimeter (W = 97.3 ± 10.7 vs. 94.3 ± 10.9 cm, M = 107.9 ± 8.7 vs. 101.5 ± 7.9 cm), fat mass (W = 42.3 ± 5.1 vs. 38.6 ± 8.4 %, M = 31.2 ± 5.0 vs. 28.0 ± 4.4 %), systolic BP (M = 136.5 ± 12.1 vs. 129.3 ± 12.5 mmHg), diastolic BP (W = 76.2 ± 8.9 vs. 74.1 ± 8.7 mmHg, M = 79.3 ± 7.2 vs. 75.0 ± 8.2 mmHg), total cholesterol (M = 216.1 ± 44.5 vs. 196.1 ± 35.0 mg/dL), insulin (W = 13.4 ± 7.9 vs. 9.4 ± 4.2 mU/L) values. There were significant between-sex differences in body mass (W=-5.2%, M=-6.5%, effect size, ES = 0.073), waist circumference (W=-3.1%, M=-5.9%, ES = 0.114), and VO2peak (W = 14.2%, M = 20.5%, ES = 0.059).

CONCLUSIONS. Aerobic exercise along with hypocaloric diet is an effective non-pharmacological tool to induce beneficial changes in women and men in BP and leptin as a mediator of obesity-induced HTN, and other regulatory mechanisms such as body composition, CRF and biochemical profile. The found sex-related differences could confirm the need of individual non-pharmacological strategies.
Factors associated with the practice of minimal counseling by medical residents
Authors: Bargaoui Z , Mzoughi K , Zairi I , Aouina O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Smoking is a public health problem. Doctors have an important role in the fight against smoking, in particular through the minimum advice they can give.

Purpose

The aim of this work was to study the prevalence of the application of minimal advice by medical residents and to identify factors that may influence its practice.

Methods

We conducted a descriptive and analytical study with a prospective data collection that included 302 residents practicing in Tunisia and who agreed to respond to an online questionnaire submitted between February and March 2020.

Results

Residents mean age was of 28 ± 2 years and the gender ratio was 0.65. Sixty-four percent of residents were non-smokers. During their practice, 94% of residents systematically identified the patient"s smoking status and 61.9% were unfamiliar with the concept of minimal advice. The rate of application of the minimum advice by residents was 57.6%.

In multivariate analysis, the factors influencing the application of minimum counseling were: gender (OR =0.321, p = 0.0001), knowledge of minimum counseling (OR = 2.808, p = 0.002) and having attended the minimum advice given by a senior (OR = 2.328, p = 0.0001).

Conclusion

The rate of application of the minimum advice remains low. Improving one"s theoretical and practical teaching during medical studies is essential.
Exposure to air pollution and renal function - an underestimated threat?
Authors: Kuzma L , Malyszko J , Kurasz A , Bachorzewska-Gajewska H , Dobrzycki S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed not only in respiratory, circulatory, and nervous systems but also in renal function.

Purpose

Our goal was to investigate the hypothesis indicating that we can observe the long-term and also short-term impact of air pollution on kidney function.

Methods

We reviewed medical notes of patients hospitalized between 2007-2016. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration with 95% confidence intervals (CI).

Results

3,554 patients were included into the final analysis. The median age was 66 (IQR 15) and men were in the majority (53.2%, N = 1891). Chronic kidney disease (CKD) was diagnosed in 21.5% (N = 764). The long-term increase in annual average concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01 – 1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05;95% CI 1.01 – 1.10, P = 0.047) resulted in an increased number of patients with CKD. In short-term observation the IQR increase in weekly PM2.5 concentration was associated with a 2% reduction in eGFR (OR = 0.98, 95%CI 0.97 – 0.99, P = 0.03)

Conclusions

The effects of air pollution on renal function were observed. Long- and short–term exposure to elevated air pollution levels was associated with a decrease in eGFR. The main pollutant affecting the kidneys was PM2.5.
The effects of smoking and alcoholism in acute coronary syndrome
Authors: Correia J , Neto V , Santos J , Pires I , Goncalves L , Costa A , Cabral J
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Several studies have concluded that smoking increases mortality in patients with coronary disease. On the other hand, a J-shaped dose-effect curve has been used to describe the relationship between alcohol and cardiovascular mortality. According to the majority of studies, a moderate intake of alcohol is associated with a decrease in mortality, while an excessive alcohol intake appears to increase mortality.

Aim

To evaluate the effect of smoking and excessive alcohol intake in hospital mortality and 1-year mortality in patients hospitalized due to acute coronary syndrome (ACS).

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Follow-up started after hospital admission and ended upon hospital death, death within the following 12 months or 12 months after study entry. Patients were divided in two groups: smokers (Group-A) and non-smokers (Group-B), to analyse the effect of smoking in hospital mortality and 1-year mortality. To analyse the effect of excessive alcohol intake, patients were also divided in other two groups: Group-C (excessive drinkers) and Group-D (non-excessive drinkers). Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1120 patients (68.9% male, mean age 69.12 ± 12.67 years) were included in this study. 20.5% were smokers and 3.2% had a previous excessive alcohol intake.

Between Group-A and Group-B, a statistically significant difference was observed in gender (93.1% male in Group-A vs 62.9% male in Group-B, p = 0.002), but not in age (p = 0.116). Hospital mortality rates in Group-A and Group-B were respectively 6.0% and 8.7% (p = 0.191) and 1-year mortality rates were 3.1% vs 5.1% (p = 0.239).

Between Group-C and Group-D, a statistically significant difference was observed in gender (94.4% male in Group-C vs 69.8% male in Group-B, p < 0.001), but not in age (p = 0.730). Hospital mortality rates in Group-C and Group-D were respectively 25% and 9.6% (p = 0.003) and 1-year mortality were 3.8% vs 6.6% (p = 0.577).

Conclusions

Smoking did not have a positive or negative effect in hospital mortality and 1-year mortality. However, excessive alcohol intake was associated with increased hospital mortality in this population.
Adherence to the Mediterranean lifestyle in patients after myocardial infarction
Authors: Novakovic M , Tasic J , Krevel B , Rajkovic U , Bozic Mijovski M , Kosuta D , Trsan J , Fras Z , Jug B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

ReKoBo study group

INTRODUCTION

Adherence to the Mediterranean diet is associated with decreased cardiovascular and overall mortality, and is recommended by the relevant preventive cardiology guidelines. However, besides specific dietary intake, Mediterranean lifestyle includes a series of eating habits and social behaviours. All these aspects are summed in the Medlife questionnaire.

PURPOSE

The aim of our study was to assess adherence to the Mediterranean lifestyle and examine associations with clinically relevant variables, in patients after myocardial infarction referred to cardiac rehabilitation.

METHODS

This was a single-centre cross-sectional study. Mediterranean lifestyle pattern was assessed using a validated Medlife questionnaire, which includes 28 questions (15 questions on the Mediterranean diet adherence, 6 questions on the eating habits and behaviour, and 7 questions on the social pattern of the Mediterranean lifestyle). Associations of the Medlife score with the exercise performance (assessed by the cardiopulmonary exercise testing), clinical data, demographics, lipid status, and quality of life (assessed by the HeartQol questionnaire) were assessed using Spearman’s correlation coefficient, while differences between two groups were determined with the independent-samples t-test.

RESULTS

There were 111 patients included in the study, mean age 55 +/- 10 years, 20% of them were women. Adherence to the Mediterranean lifestyle was not associated with age, BMI, peak VO2, total or LDL cholesterol. Also, there were no differences in terms of Medlife score between women vs. men, and between patients living in urban vs. rural areas. There were, however, significant associations between Medlife score and HDL (r = 0.239, p = 0.012), triglyceride level (r=-0.383, p < 0.001) and blood glucose level (r=-0.214, p = 0.024), and with the emotional aspects of the quality of life (r = 0.245, p = 0.017). Also, higher-educated were significantly more adherent to the Mediterranean lifestyle as compared to lower-educated patients (16.2 vs. 14.7 points, p = 0.018).

CONCLUSION

Poorer adherence to the Mediterranean lifestyle is associated with substandard control of lipid status and glucose level. Improvement in the Mediterranean lifestyle adherence might be a cornerstone in the cardiac rehabilitation beyond exercise training programmes.
Prehabilitation program for coronary artery bypass grafting patients and perioperative myocardial injury
Authors: Argunova Y , Belik E , Moskin E , Gruzdeva O , Pomeshkina S , Barbarash O
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

To evaluate morphological and functional cardiac parameters and to assess changes in markers of perioperative myocardial injury in patients undergoing different prehabilitation program before elective coronary artery bypass grafting (CABG).

Methods

60 male patients with stable coronary artery disease (CAD) underwent screening in the preoperative period and were randomized into two groups. Group 1 (n = 30, mean age 61.5 [56; 63]) underwent supervised treadmill exercises at intensity corresponding to 80% of VO2 peak during the preoperative management. Group 2 (n = 30, mean age 62.0 [56; 64]) patients did not undergo any additional trainings.

Patients underwent a standard echocardiographic (ECHO-CG) study in the preoperative period and at days 5-7 after CABG. Serum markers of myocardial injury (troponin I, NT-proBNP) were measured in both groups of patients in the preoperative period before training (point 1), at the end of exercise training session (point 2) and at days 5-7 (point 3) after CABG.

Results

Left ventricular end-systolic dimension (p = 0.039) and left ventricular end-systolic volume (p = 0.039) increased by 8.5% and 18% in patients who underwent supervised exercise trainings as compared to the baseline values. An increase in these parameters was more pronounced in the control group (17% (p = 0.00029) and 41% (p = 0.00028), respectively).

Both groups were comparable in troponin I levels at three study points. Troponin I values were within the reference range.

NT-proBNP levels showed a downward trend in patients with prehabilitation at the end of the training sessions, while in the control group NT-proBNP levels increased. An increase in NT-proBNP levels was reliable in patients without exercise trainings (p = 0.003) after CABG compared to the preoperative values. However, changes in NT-proBNP levels were insignificant in patients who underwent prehabilitation (p > 0.05).

Conclusion

The safety of high-intensity exercise trainings in the prehabilitation program for CABG had been confirmed by laboratory markers indicative for myocardial injury. The obtained data proved the efficiency of active prehabilitation for optimizing morphological and functional cardiac parameters as well as inducing cardioprotection.
Assessment of physical function and health related quality of life according to the likelihood of adverse cardiac events in type 2 diabetic women
Authors: Demirtas RN , Kebapci N , Efe B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Diabetes mellitus is a risk factor for cardiovascular disease. In women, one of the strongest and most consistent estimators of cardiac prognosis is functional capacity which is an important component affecting the predictive value of exercise testing. The Duke Activity Status Index (DASI) is a questionnaire and it correlates with a woman’s capabilities to perform adequate levels of exercise stress testing and predicts prognosis to a similar degre. The every unit increase in the DASI MET subsets (4.8-7-4, 7.5-9.9 and >9.9 METs) related to Bruce protocol, were associated with a 25% decrease in adverse cardiac events.

Purpose

To appreciate the  physical function and health related quality of life according to the  likelihood of adverse cardiac events using estimeted function capasity in type 2 diabetic women

Methods

Forty nine type 2 diabetic women (mean age: 61.48 ± 8.42 years) completed the DASI questionnaire for  the functional capacity and SF-36 for  health related quality of life. They  also underwent two minute walk test, Up and Go test and one leg standing test. The women were divided into two groups according to functional capacity by their estimated MET capacity at < 7.5 (group 1 who had higher risk for adverse cardiac events) and  ≥7.5 (group 2, who had lower adverse cardiac events risk) using DASI.

Results

The age, BMI, diabetes duration, HgA1c and SF-36 mental health weren’t different between the groups (p>.05).  The education duration (p=.031), comorbidity number ((p=.035), the scores of  two minute walk test (p=.000), Up and Go test (p=.000), one leg standing test (p=.001) and vitality (p=.002), physical functioning (p=.000), bodily pain (p=.040), physical role functioning (p=.003), emotional role functioning (p=.040) domains of SF-36 were greater in Group 2.

Conclusions

In the type 2 diabetic womens who had higher risk for adverse cardiac events, physical function was lower and quality of life was worse than those in the womens who had lower adverse cardiac events risk. The physical activity as a contributing factor to reduce the  likelihood of adverse cardiac events and to increase the health related quality of life, should be improved.
The effects of preventive counseling followed by remote support via phone on physical activity in patients with high cardiovascular risk
Authors: Pogosova N , Yusubova AI , Yufereva YM , Sokolova OY , Karpova AV , Ausheva AK
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Education may increase physical activity (PA) in patients (pts) with high cardiovascular (CV) risk.

Objectives

To assess the effects of preventive counseling with focus on diet modification with remote support by phone on PA levels in high CV risk pts.

Methods

This is a randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (Systematic Coronary Risk Evaluation scale [SCORE], ≥5%) and any 2 metabolic syndrome criteria.  Pts were randomized into 2 groups in 1:1 ratio. Intervention group received comprehensive preventive counseling with focus on healthy diet followed by 3 months of biweekly remote counseling by phone (a total of 6 sessions). Control group received usual care including basic preventive counseling. PA was assessed by International Questionnaire on Physical Activity (IPAQ) at baseline, at 6 and 12 months. 

Results

A total of 100 pts (women, 80%, aged 59.85 ± 4.47 years) were randomized. Demographics and clinical features were balanced across groups. Despite the study intervention not focusing on PA, total PA, moderate PA and walking significantly increased in the intervention group vs control at 6 and 12 months.

Conclusion

The study intervention provided a significant increase of PA in high CV risk pts.

Intervention group, mean ± standard deviation Control group, mean ± standard deviation P for change from baseline Total physical activities, МЕТ-min/week Baseline 1317.94 ± 1455.4 2029.42 ± 2811.84 After 6 months 2217.58 ± 1813.95*** 1793.26 ± 1863.54 <0.001 After 12 months 2240.2 ± 1991.47*** 1629.48 ± 1629.02 <0.001 Vigorous physical activities, МЕТ-min/week Baseline 92.8 ± 407.72 220.8 ± 881.49 After 6 months 96 ± 557.08 0 ± 0 n/s After 12 months 132.8 ± 425.66 27.2 ± 109.15 n/s Moderate physical activities, МЕТ-min/week Baseline 268.8 ± 455.28 714 ± 1390.22 After 6 months 522.4 ± 570.54*** 518.8 ± 1075.79* <0.001 After 12 months 766.8 ± 1176.38** 481.6 ± 874.97* <0.001 Walking, МЕТ-min/week Baseline 956.34 ± 1071.49 1094.62 ± 1344.46 After 6 months 1599.18 ± 1404.88*** 1294.46 ± 1208.88 <0.05 After 12 months 1339.8 ± 1230.51** 1120.68 ± 1067.09 <0.05 *р<0,05;**р<0,01;***р<0,001 for within group comparisons vs baseline
Gender differences in risk of myocardial infarction and stroke in population with sleep disorders in Russia / Siberia: population-based study MONICA-psychosocial
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objectives

To determine the gender differences in the effect of sleep disorders on risk of myocardial infarction (MI) and stroke in population 25-64 years over 16 years of follow-up.

Methods

Under the third screening of WHO program MONICA -Psychosocial a random representative sample of both gender aged 25- 64 years in Novosibirsk was examined in 1994 (n = 1346, male 48.8%, mean age 44,9 ± 0,4 years). The sleep assessment was performed using the Jenkins Sleep Questionnaire. There were 15 cases of new-onset MI in women and 30 in men, new-onset stroke 35 cases in women and 22 in men from 1994 to 2010.

Results

In an open population aged 25-64 years 48.6% of men and 65.9% of women had sleep disorders (p< 0.001). Univariate analysis showed 2.4-fold risk of MI in those males with SD over 16-year of follow-up (95%CI 1.1-5.3; p< 0.05) but not for women. MI risk was higher in those men who were never married, divorced or widowed (p for all <0.01) compared to married ones. Risk of stroke was higher in men HR = 3 (95%CI 1.2-7.6;p < 0.05) than in women HR = 1.9 (95%CI 1.03-3.7; p < 0.05). Multivariate analysis revealed 2.8-fold risk of stroke (95%CI 1.1-7.1; p < 0.05) in men and HR = 2.7 in women (95%CI 1.4-5.42;p < 0.01) with SD. Stroke risk was higher in men with lower educational level and in women with college degree in those with SD.

Conclusions

Sleep disorders is a risk factor of MI in men only and stroke for both gender and negative social gradient increases cardiovascular risk.
Galectin-3 is inversely associated with cardiorespiratory fitness in the general population
Authors: Haid M , Bahls M , Doerr M , Felix S , Zylla S , Markus M , Friedrich N , Ewert R , Glaeser S
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Low cardiorespiratory fitness (CRF) is associated with high mortality and morbidity. Galectin-3 (Gal-3) is a prognostic biomarker for fibrosis, different cancers, renal impairment and, in particular, for heart failure. Further, higher Gal-3 levels are associated with increased cardiovascular mortality. Whether Gal-3 is related with the protective effects of a high CRF is unclear.

Purpose

The present study examined the relation between Gal-3 and CRF as determined by body weight adjusted peak oxygen uptake (VO2peak/kg), oxygen uptake at the anaerobic threshold (VO2@AT) and maximal workload (Wmax).

Methods

We used data of the population-based Study of Health in Pomerania (SHIP-TREND) from Northeast Germany. A total of n = 1,483 participants with a median age of 49 (IQR: 39 – 59 years, male 48%) were included in the analysis. CRF parameters were measured using standardized cardiopulmonary exercise testing on a bicycle ergometer. Plasma galectin-3 concentrations were determined using a quantitative sandwich enzyme immunoassay. Individuals with left ventricular ejection fraction < 40%, previous myocardial infarction, atrial fibrillation, chronic lung disease, severe renal disease (eGFR < 30 ml/min/mm2), a history of cancer, and extreme values for Gal-3 were excluded. Linear regression models adjusted for age, sex and lean mass were used to analyze the association between Gal-3 and CRF.

Results

A one ml/min/kg greater VO2peak was related to a 0.32 ng/ml (95% confidence interval [CI] -0.45 to -0.18, p <.001) lower Gal-3. Further, a one Watt larger power output was also associated with a 1.32 ng/ml (95% CI -2.10 to – 0.54, p <.001) lesser Gal-3. VO2@AT was not related to Gal-3 (β: -3.31 95% CI -8.68 to 2.05, p = .23).

Conclusions

In the general population Gal-3 is inversely associated with CRF. Further studies should investigate whether lower Gal-3, beyond its importance as a biomarker for heart disease, may even play a role in the protective effect of the CRF.
Age-standardized prevalence of social determinants of health and associated race-ethnic disparities in stroke survivors
Authors: Parekh T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Stroke is the third leading cause of death in the United States, with evident differences in health outcomes by race and socioeconomic factors. We aim to focus on social determinants of health by race/ethnicity and education level that greatly influences the health-related quality of life in stroke survivors.

Method

Using the 2017 Behavior Risk Factor Surveillance System (BRFSS) survey data, the direct age-adjusted prevalence was standardized to the 2000 projected US population. Multivariable weighted logistic regression models were post-estimated to calculate marginal effects of age, gender, education, and race on social determinants of health (housing insecurity, food insecurity, healthcare access hardship) at mean values of other predictors for stroke survivors. Models were adjusted for demographics, socioeconomic position, and stroke risk factors. Marginal effects (ME) reported as predicted probabilities.

Result

Among stroke survivors, nearly 27% reported housing insecurity and healthcare access hardship, and 48% reported food insecurity. The prevalence of housing insecurity was significantly higher among female (31.69%) than male (21.98%) survivors, and of race, highest among Non-Hispanic-Black (37.49%), lower among Non-Hispanic-Whites (23.83%), and lowest among Hispanics (17.20%) stroke survivors. In contrast, food insecurity was highest among Hispanics (63.71%). Healthcare access hardship was similar across the group with a comparatively lower prevalence in Non-Hispanic-White stroke survivors (25.32%). The predicted probability of housing insecurity was significantly higher among young adults compared to older adults aged 65 or above [ME 26.8 (95CI: 14.5-39.1 vs. ME 1.4 (95CI: 0.9-2.0)]. Of race, Black, NH stroke survivors showed a higher probability of housing insecurity [ME 12.4 (95CI: 6.3-18.3)], while the probability of food insecurity [ME 39.3 (95CI: 11.1-67.6)] and healthcare access was higher among other Non-Hispanic groups. The probability of any insecurities was similar among male and female stroke survivors. Stroke survivors with less than high school education showed a significantly higher probability of housing and food insecurity, in addition to healthcare access.

Conclusion

Social inequalities along with racial disparities in stroke survivors necessitate tailored intervention to reduce the burden of stroke. It is crucial to address socioeconomic factors such as housing, food, and healthcare access that promote the development of stroke risk factors.

Abstract Figure.
Association of cardiovascular risk factors with biological age
Authors: Zaprovalna O , Kolesnikova O , Radchenko A , Potapenko A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical Sciences of Ukraine

Background

Identifying reliable biomarkers of early ageing is an important goal for the prevention of cardiovascular disease (CVD).  Chronological age  (CA) is an essential risk factor for age-related disease including CVD. Biological age (BA) may be a more accurate metric for the risk of CVD and prediction of early vascular ageing, atherosclerosis. Available data allow us to judge the relationship of early ageing with all-cause mortality, healthspan and CVD. There is a hypothesis that BA can be used into models of risk prediction and stratification of CVD for personalized treatment.

Purpose

to determine the relationship between BA and factors of risk CVD in patients of different ages without clinical manifestations CVD.

Methods

We selected 102 patients aged 31–60 years with moderate cardiovascular risk without clinical symptoms of CVD. The patients did not receive regular drug therapy. Consenting subjects had a physical assessment, anthropometric measurements, electrocardiogram recording, blood sampling for laboratory analyses, including analysis of telomerase activity, telomere length in leukocytes and  buccal epithelium by a polymerase chain reaction in real-time. The SCORE scale was used for evaluation of the 10-year risk of fatal stroke and fatal myocardial infarction. In addition, 40 control individuals aged 31–60 years (20 men and 20 women), were also included in the study. BA was determined by 3 methods: PhenoAge, Voitenko’s method and Gorelkin-Pinhasov’s method. Multiple logistic regression analysis was used to develop a prediction of the early ageing model.

Results

The comparing patients of the control and main groups of the same CA shows, that patients with CVD risk have significantly higher BA, higher levels of proatherogenic lipids and shorter telomere length of the buccal epithelium. It was determined that body mass index, blood pressure, glucose levels are associated with an increase in BA in the main and the control groups. The increase of BA in the control group was associated with smoking, telomere length and telomerase activity and the level of antioxidant protection, in patients of the main group premature aging was associated with impaired lipid metabolism.

Conclusion

The biomarkers of biological aging can have benefits of the early identification of persons who age "faster" than others. The possibility of measuring biological aging can allow the assessment of health status at a time when there are still no symptoms, and interventions are more likely to be effective.
Cardiovascular and behavioural risk factors in families with elevated lipoprotein(a)[Lp(a)]
Authors: Chakraborty A , Pang J , Chan D , Watts G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Elevated lipoprotein(a)[Lp(a)] is an inherited and independent risk factor for atherosclerotic cardiovascular diseases (ASCVD). However, it is an under detected condition with no specific therapy available at present for lowering Lp(a). Hence, identifying the distribution of modifiable cardiovascular and behavioural risk factors is important for implementing an effective intervention programme to mitigate the overall risk of ASCVD in high-risk individuals with elevated Lp(a).

Purpose

The primary aim was to describe and compare the distribution of modifiable cardiovascular and behavioural risk factors in both index cases and their relatives with elevated Lp(a) identified through cascade testing at the Lipid Disorders Clinic, Royal Perth Hospital.

Methods

We studied 51 index cases and 71 relatives cascade tested with elevated Lp(a) (≥0.5 g/L).  Questionnaires were completed concerning aspects of cardiovascular health (cholesterol level, blood pressure and blood glucose level) and behavioural health metrics (diet, smoking, physical activity, body-mass-index [BMI]). Lp(a) was measured by an immunoassay having minimal dependence on apolipoprotein(a) isoform size. The health metrics were described as proportions and statistical analyses performed using Student’s t-test or Chi-square where appropriate.

Results

Compared with the index cases, a higher proportion of their affected relatives were female (62% vs 43%, p = 0.039), younger (43 years vs 53 years, p < 0.001) and had lower Lp(a) levels (1.03 g/L vs 1.12 g/L, p = 0.003). A lower proportion of the affected relatives were treated for dyslipidaemia (31% vs 96%, p < 0.001). The affected relatives also had a lower incidence of ASCVD events (3% vs 37%, p < 0.001), hypertension (21% vs 43%, p = 0.003), and lower HbA1c levels (5.3% vs 5.9%, p = 0.031) compared with index cases. Additionally, a larger proportion of the affected relatives had ideal cardiovascular health (35% vs 14%, p = 0.008) compared with their index cases. However, more than half of the index cases and their relatives did not maintain a healthy diet (59% and 69%, respectively) and an ideal BMI (68% and 59%, respectively).

Conclusion(s)

Although the younger affected relatives with elevated Lp(a) have a lower cardiovascular risk compared with the index cases, a focus on modifiable behavioural changes, such as a healthy diet and an ideal body weight, is still required to mitigate the overall risk of ASCVD.