bluuebunny/crossref_metadata_2025 huggingface dataset:
What change in BMI is required to improve cardiovascular outcomes in childhood and adolescent obesity lifestyle interventions: a meta-regression
Authors: El-Medany A , Birch L , Hunt LP , Matson RIB , Chong AHW , Beynon R , Hamilton-Shield J , Perry R
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol

Background

There is minimal evidence regarding the change of body mass index (BMI) needed to improve cardiovascular health in obese children. This paper aims to establish the minimum change in body mass index standard deviation score (BMI-SDS) needed to improve lipid profile and blood pressure (BP) of obese children and adolescents, to aid future trials and guidelines.

Methods

Studies with participants involved in lifestyle interventions, aged 4–19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and/or triglycerides (TG). Random effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes.

Results

Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analysed; reporting change in SBP, HDL, LDL, and TG respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG respectively although an equivalent value for HDL improvement was indeterminate.

Conclusions

Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions.  Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.
Factors of cardiometabolic risk in various phenotypes of overweight and obesity among young adults
Authors: Chulkov V , Gavrilova E , Chulkov VL , Pankova E
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): South Ural State Medical University

Introduction. The interaction of metabolic and cardiovascular factors, united by common mechanisms of mutual interference, determines the modern concept of cardiometabolic risk. It is important to study the determinants of cardiometabolic risk factors in different phenotypes of overweight and obesity among young adults.

Purpose. To study cardiometabolic risk factors in various phenotypes of overweight and obesity among young adults.

Methods. Study design: cross-sectional study. The study included 251 patients. All patients were divided into 4 groups: gr. 1 - metabolically healthy individuals with normal body weight (n = 62), aged 24.5 [22-31] years; gr. 2 - metabolically unhealthy individuals with normal body weight (n = 57), aged 28 [23-38] years; gr. 3 - metabolically healthy overweight/obesity (n = 16), aged 30 [24-36] years; gr. 4 - metabolically unhealthy overweight/obesity (n = 116), aged 36 [28.5-41] years. Statistical methods: MedCalc statistical software package (2020). p < 0.05 were taken as statistically significant.

Results. The most significant changes of carbohydrate and lipid metabolism and some hemostasis parameters with adipokine imbalance were found in metabolically unhealthy overweight/obesity (gr. 4): the highest concentrations of leptin (ng/ml): 37.9 [13.0-63.4] vs 10.0 [5.1-15.5] – gr.1; 9.5 [5.5-21.5] – gr. 2; 25.7 [4.7-37.2] – gr. 3, p4-1.2.3 < 0.05; fibrinogen (g/l): 4.0 [3.5-4.6] vs 3.4 [2.9-4.0] – gr. 1, 3.4 [3.1-4.0] – gr. 2, 3.4 [2.6-3.8] – gr. 3, p4-1.2.3 < 0.001; plasminogen activator inhibitor-1 (ng/ml): 464.5 [285.1-628.5] vs 308.2 [211.7-415.7] – gr. 1; 342.3 [222.2-490.0] – gr. 2; 371.0 [273.1-621.0] – gr. 3, p4-1 < 0.001, as well as the lowest concentrations of adiponectin (μg/ml): 7.9 [4.9-10.2] – gr. 3 and 7.9 [5.2-12.4] – gr. 4 compare to gr. 1 – 9.1 [7.5-12.2]) and gr. 2 – 8.7 [7.2-10.5], p3.4-1.2 < 0.05. In young individuals the most significant correlations were found between waist circumference, systolic and diastolic blood pressure - on the one hand, and serum concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, leptin, fibrinogen, and type 1 plasminogen activator inhibitor, on the other hand.

Conclusion. Disorders of lipid and carbohydrate metabolism with adipokine imbalance in young adults determine a higher cardiometabolic risk both in overweight/obese patient and individuals with normal body mass index.
The impact of legs fat mass and legs lean fat mass on thigh circumference according cardiovascular risk: a population-based study
Authors: Chlabicz M , Paniczko M , Jamolkowski J , Sowa P , Lapinska M , Szpakowicz M , Drobek N , Zalewska M , Raczkowski A , Kaminski K,A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Bialystok, Poland

Introduction A low thigh circumference is associated with an increased risk of high blood pressure, diabetes, cardiovascular diseases, and total mortality.

Objectives The aim of the study was to investigate the relationship between the thigh circumference and cardiovascular (CV) risk classes, and to assess what type of tissue, adipose tissue or muscle tissue affects the thigh circumference.

Methods The longitudinal, population-based, Polish study was conducted in 2017-2020. A total of 931 individuals aged 20-79 were analyzed. Pol-SCORE system was used to assess the 10-year risk of fatal CV based on the following risk factors: age, gender, smoking, systolic blood pressure, and total cholesterol for individuals aged 40-70.  Then, CV risk classes were assessed using the 2019 ESC/EAS guidelines. The measurement of thigh circumference were performed directly below the gluteal fold of the thigh. Both thighs were measured and the mean value was calculated as the final thigh circumference. Body composition was assessed using Dual Energy X-ray Absorptiometry (DEXA).

Results The mean age was 49.1 ± 15.5 years and 43.2% male. The mean thigh circumference was 58.2 ± 5.9 cm, the mean legs fat mass was 7.7 ± 2.8kg, and the mean legs lean mass was 16.9 ± 4.0kg. Lower thigh circumference was associated with higher CV risk classes in univariate linear regression analysis (β -0.516, p = 0.002), as well adjusted by age and sex (β -0.839, p = 0.008), adjusted by age, sex, BMI (β -0.886, p <0.001), and age, sex, WHR (β -0.988, p <0.001). In linear regression analysis legs adipose tissue and muscle tissue were related to the thigh circumference independently of CV risk classes (Model 1) and Pol-SCORE value (Model 2). However, fatty tissue (Model 1: β 0.746, p < 0.001; Model 2: β 0.749, p < 0.001) affects the thigh circumference more than the muscle tissue (Model 1: β 0.479, p < 0.001; Model 2: β 0.442, p < 0.001) (Fig. 1).

Conclusion Smaller thigh circumference was associated with higher CV risk classes. Thigh circumference was more influenced by adipose tissue than by muscle tissue, regardless of the Pol-SCORE  or CV risk classes.

Table 1. Variable Model 1 Model 2 Beta p R2 Beta p R2 Legs fat mass 0.746 <0.001 0.785 0.749 <0.001 0.760 Legs lean mass 0.479 <0.001 0.785 0.442 <0.001 0.760 Model 1: adjusted for Cardiovascular risk classesModel 2: adjusted for Pol-SCOREResults of the linear regression analysis thigh circumference in the general population

Abstract Figure 1.
Long-term effects (>24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high risk subjects: a meta-analysis
Authors: Bergum H , Sandven I , Klemsdal TO
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Norwegian health department

Background

The evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk.

Methods

 Eligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient- and study-level variables.

Results

 Small-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of -0.13, 95% confidence interval (CI): -0.21 to -0.04, with moderate heterogeneity (I² = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = -1.86, 95% CI: -3.14 to -0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI: -0.08 to 0.11). For the outcome total cholesterol SMD was -0.06, 95% CI: -0.13 to 0.00, with no heterogeneity (I² = 0%), indicating no effect of the intervention.

Conclusion

 Lifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.
Dipper pattern in arterial hypertension: is there a correlation with ageing?
Authors: Neto V
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Dipper pattern in arterial hypertension

is there a correlation with aging?

Background

Systemic arterial hypertension is an important cardiovascular risk factor. Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality.

Purpose

Study the effect of aging in the dipper pattern, in patients submitted at 24-Hour Ambulatory Blood Pressure Monitoring.

Methods

Retrospective study based on patients submitted at 24-Hour Ambulatory Blood Pressure Monitoring on the first trimester of 2020. Patients were divided into categories based on percentage of nighttime blood pressure drop: 0% Reverse Dipper, 0-10% Non-Dipper, 10-20% Dipper e >20% Extreme Dipper. The sample was dived into two groups: group A (GA) with age between 18- and 60-years vs group B (GB) with age between 60- and 90-years.

Results

This study included 91 hypertensive patients, whom 46.2% were male and with a mean age of 56 ± 15 years. GA represented 60.4% of study sample, whom 43.6% were male and with a mean age of 46 ± 10 years. In the group B, 50% were male with a mean age of 71 ± 6 years. GB patients had more history of diabetes (7.8% vs 26.5%, p = 0.022). No significant difference was found between the two groups in history of kidney chronic disease, obesity or sleep apnea syndrome. In terms of medical treatment, GB had more prescription of loop diuretics (3.9% vs 22.9%, p = 0.010) and angiotensin-converting enzyme (ACE) inhibitors (58.8% vs 88.6%, p = 0.028). No significant differences were found in the prescription of other hypertension therapies or the use of drug combinations. No significant difference was found in the number of Dippers in both groups (63.6% vs 58.3%, p = 0.386). GB had more reverse dippers (1.8% vs 16.7%, p = 0.014). GA had more extreme dippers (12.7% vs 2.8%, p = 0.024).

Conclusion

There is no difference in the rate of dipper pattern accordingly to age. The prevalence of reverse dippers in older patients was superior, leading to increased risk of cardiovascular events in this group. The younger group had more prevalence of extreme dippers, which, by some authors, can lead to increased risk of a silent cerebrovascular event.
Health-related quality of life among cardiovascular patients enrolled in adult cardiology clinic in a tertiary hospital
Authors: Pedreso EJ , Alamban L , Faderan B
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Determining the level of health-related quality of life among cardiovascular patients and looking into the demographic factors and clinical characteristics that might influence the dynamics of their physical and mental health are highly essential for health practitioners to improve current management procedures and interventions.

Objective

The study was conducted to evaluate the level of health-related quality of life among cardiac patients seen in adult cardiology clinic. 

Methods

This study used a descriptive research design. A total of 117 cardiac patients at the adult Cardiology Clinic in a Tertiary Hospital were interviewed using the MOS-SF – 36 Questionnaire. Statistical correlation analysis was then performed.

Results

The results showed that the patients are challenged in their physical functioning and general mental health with an average score of 33.33 ± 33.33 aside from their average median score of 55 ± 0.0 in  their role limitations due to physical health. In terms of mental health, higher score was reflected for vitality (75 ± 12.5), followed by emotional well-being (67.5 ± 20.0). Demographic and clinical factors that affect their quality of life were also determined. Marital status, family income, educational attainment and participation on cardiac rehabilitation program affect their quality of life. Married, income above Php10,000, college level, college graduate or with post graduate degree and those who participated in the cardiac rehabilitation program have higher level of physical health (W = 1127; p=.007; W = 1729.5; p=.024; W = 1300; p=.043).  Consistently, those who are married, a family income of above Php10,000 and are aware on cardiac rehabilitation  have higher level of mental health (W = 1189; p=.019; W = 1895; p=.001; W = 1187; p=.005). Although not statistically significant, an increase in age is associated with decrease in the physical health (r=-.176; p=.058). It should not also be discounted that those patients who are employed have higher level of physical health than those who were unemployed (W = 1729.5; p=.052). Moreover, health change are higher for those who participated in the cardiac rehabilitation program (W = 960; p=.003). On clinical characteristics, those who underwent interventions have higher level of health change than those who only received medical management (W = 100.0; p<.001). Mental health was also seen to be higher in those patients with no history of smoking and with >40% left ventricular ejection fraction (W = 264.5; p=.005).

Conclusion

This study concludes that those patients who are married, employed, with income above Php10,000, who have higher educational status, non-smoker,  LVEF of more than 40%, who received interventions and who underwent cardiac rehabilitation have higher level of quality of life.
Control of cardiovascular risk factors in a vascular retinopathy population and its long-term impact
Authors: Aguila Gordo D , Marina Breysse M , Piqueras Flores J , Martinez Del Rio J , Mateo Gomez C , Salas Bravo D , Moron Alguacil A , Frias Garcia R , Munoz Garcia M , Perez Diaz P , Negreira Caamano M , Perez Soto M , Cubides Novoa AF
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Control of cardiovascular risk factors is the cornerstone of secondary prevention. However, in patients with retinopathy of vascular etiology (hypertensive, diabetic or atherosclerotic) the benefit of stricter control of lipid in the long term has been little studied.

Methods

Prospective study of a cohort of 107 patients who underwent fundus and coronary angiography, of which 42 (39.3%) required percutaneous revascularization. During the follow-up, new cardiovascular events and analytical control of cardiovascular risk factors were recorded.

Results

Mean age was 75.19 ± 11.53 years. 60.7% were men, 78.5% were hypertensive, 32.7% were diabetic, and dyslipidemia was observed in 57%. Initially, 28% had 1-vessel disease, 14% 2-vessel, 8.4% 3-vessel, and 3.8% left common trunk. 0.9% had diabetic retinopathy, 3.7% had hypertensive retinopathy, 1.9% atherosclerotic, 70.1% had a combination of hypertensive and atherosclerotic retinopathy, and 7.5% signs compatible with all types. Initial and final mean values of LDL-c and HDL-c by type of retinopathy are in Table 1.  During follow-up, a significant improvement in LDL-c and HDL-c levels was observed in total patients and in patients with hypertensive and atherosclerotic retinopathy, however globally lipid control was poor and only 18.9% of the total of the sample reached the recommended levels for very high-risk people (<55 LDL-C).  Advanced hypertensive retinopathy patients with a greater reduction in LDL-C during follow-up, recorded lower mortality (p = 0.004). Besides, patients with previous percutaneous revascularization showed a greater decrease in LDL levels at the end of follow-up (69.5 ± 26.1 vs 103 ± 41.47; p <0.001); without significant changes in the rest of parameters. 

Conclusions

In patients with vascular etiology retinopathy, long-term lipid control is poor. However, patients with hypertensive retinopathy and a greater reduction in LDL-c had lower long-term mortality.

Hypertensive retinopathy Initial Final Sig. LDL-Cholesterol (mg / dl) 102,8+/-35,5 75,65+/-28,9 <0,001 HDL-Cholesterol (mg / dl) 42,1+/-10,3 43,46+/-13,1 0,04 Atherosclerotic retinopathy LDL-Cholesterol (mg / dl) 101,2+/-36,8 79,8+/-32,98 <0,001 HDL-Cholesterol (mg / dl) 42,8+/-11,6 45,73+/-13,9 0,03 Diabetic retinopathy LDL-Cholesterol (mg / dl) 89,1+/-35,8 69,8+/-18 0,73 HDL-Cholesterol (mg / dl) 35,2+/-8,7 31,51+/-12,7 0,73
Temporal changes in the implementation of secondary prevention of coronary artery disease in every day practice
Authors: Peksa JW , Jankowski P , Koziel P , Bogacki P , Gomula P , Mirek-Bryniarska E , Nessler J , Podolec P , Wisniewski AK , Rajzer M , Czarnecka D , Pajak A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

-

Introduction

Patients with coronary artery disease (CAD) are at high risk of recurrent cardiovascular events and control of their risk factors is crucial.

Objectives

Comparison of risk factors control in patients with CAD in 2016–2017 and 2011–2013.

Patients and methods

Five hospitals with cardiology departments serving the city and surrounding districts participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or a myocardial revascularization procedure were interviewed 6–18 months after hospitalization. The surveys were carried out in 2011–2013 and 2016–2017.

Results

We examined 616 patients in 2011–2013 and 388 in 2016–2017 (mean age: 64.7 ± 8.8 vs. 66.4 ± 8.4, P <0.01). After adjusting for covariates the proportion of patients with high blood pressure decreased by 8.9% (95% confidence intervals: -2.1% – -15.6%) and proportion of patients with high LDL cholesterol decreased by 9.5% (-2.2% – -16.7%) in 2016/2017 compared to 2011/2013, whereas the proportion of smoking patients (-0.2% [-6.0% – 5.5%]) and those with high glucose level (3.9% [-2.2% - 10.0%]) and with body mass index ≥25 kg/m2 (3.8% [-3.9% – 11.6%]) did not change significantly. The proportion of patients prescribed antiplatelets (6.5% [2.6% - 10.3%]), β-blockers (7.4% [2.2% - 12.6%]), angiotensin converting enzyme inhibitors or sartans (8.6% [2.9% – 14.3%]), calcium antagonists (8.1% [1.3 – 15.0]) and anticoagulants (5.5% [0.7% - 10.2%]) increased significantly.

Conclusions

In CAD patients, there was an increase of the proportion of patients with cardiovascular drugs prescribed and a slight improvement in the control of blood pressure and LDL cholesterol between 2011–2013 and 2016–2017. However, no significant changes were found for the other main risk factors.

Patients who do not reach treatment goal Survey Smoking, % BP not at goal, %a BP ≥140/90 mmHg, % LDL cholesterol ≥1.8 mmol/l, % HbA1c ≥7.0%b, % Fasting glucose ≥7.0 mmol/l, % BMI≥25 kg/m2, % BMI≥30 kg/m2, % 2011-2013 19.0 50.3 43.0 71.9 14.1 15.9 81.2 33.8 2016-2017 16.2 40.7 39.2 60.3 14.9 20.2 83.4 38.3 P value 0.26 <0.01 0.24 <0.001 0.76 0.09 0.37 0.14 Differences adjusted for age, sex, index diagnosis, duration of education, professional activity (95% confidence intervals) 2016-2017 vs 2011-2013 -0.2(-6.0 - 5.5) -8.9(-15.6 - -2.1) -6.7(-14.3 - 1.0) -9.5(-16.7 - -2.2) 2.0(-3.4 - 7.4) 3.9(-2.2 - 10.0) 3.8(-3.9 - 11.6) 1.6 (-5.8 - 9.0) Abbreviations BMI, body mass index; BP, blood pressure; LDL, low-density lipoprotein a BP goal of <140/90mmHg (<130/80 mmHg in diabetics) in 2011–2013 and <140/90 mmHg (<140/85 mmHg in diabetics) in 2016–2017 b available for 362 patients in 2011-2013 and 383 patients in 2016-2017
The impact of lipid profile in acute coronary syndrome: young patient vs old patient
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 suggested a relationship between dyslipidemia and atherogenesis, which displays a main role in the pathophysiology of Acute Coronary Syndrome (ACS).

Aim

To compare the lipid profile between younger (<55 years) and older (≥55 years) patients admitted due to ACS.

Methods

A single-centre retrospective study was conducted, with inclusion of all consecutive patients admitted in the Cardiology Department due to ACS. Several analytical parameters were evaluated, including total cholesterol (CT), HDL cholesterol (HDL), LDL cholesterol (LDL) and triglycerides (TG) and CT/HDL, LDL/HDL and TG/HDL ratios were calculated. All parameters are presented in mg/dL. Afterwards, comparison of these data between younger (age < 55 years, Group-A) and older (age≥55 years, Group-B) patients was done. Statistical analysis was performed with SPSS and a p value < 0.05 was considered statistically significant.

Results

1168 patients (70.1% male, mean age 69 ±12 years) were included in this study. 15.8% of patients were from Group-A. Mean levels of the analysed parameters were the following: CT 176 ± 55, LDL 111 ± 45, HDL 40 ± 12 and TG 137 ± 102. The following mean ratios were obtained: CT/HDL 4.6 ± 1.9, LDL/HDL 2.9 ± 1.4 and TG/HDL 3.8 ± 3.5. Comparison of the analysed parameters and calculated ratios is exhibited in table 1.

Conclusion

Overall, a worse lipid profile was observed in younger patients. This data reveals the role of dyslipidemia in coronary heart disease, which displays a main role in atherosclerosis at a younger age. This fact highlights the importance of adopting a healthy lifestyle and the adherence to primary and secondary prevention measures of cardiovascular events.

Lipid profile: young vs old patient Group A Group B Total Cholesterol 199 ± 44 170 ± 56 p < 0.001 LDL Cholesterol 128 ± 37 107 ± 46 p < 0.001 HDL Cholesterol 39 ± 10 40 ± 12 p = 0.307 Triglycerides 195 ± 189 125 ± 66 p < 0.001 CT/HDL 5.3 ± 1.5 6.8 ± 2.0 p < 0.001 LDL/HDL 3.4 ± 1.1 2.8 ± 1.4 p < 0.001 TG/HDL 5.6 ± 6.3 3.5 ± 2.5 p < 0.001
Association of altered lipid profile with disease activity, duration, and glucocorticoid treatment in patients with idiopathic inflammatory myopathies
Authors: Oreska S , Storkanova H , Spiritovic M , Hermankova B , Vrablik M , Pavelka K , Senolt L , Mann H , Vencovsky J , Tomcik M
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): AZV CR, Czech health research council MHCR, Ministry of Health Dzech republic

Background

Systemic inflammation, limited mobility, and glucocorticoid treatment in Idiopathic inflammatory myopathies (IIM) can have a negative impact on intermediate metabolic pathways, especially on lipid metabolism.

Purpose

The aim of this study was to assess the differences in the lipid profile of IIM patients and healthy controls (HC) and the association with disease-specific features.

Methods

133 patients with IIM (106 females; mean age 60.3; disease duration 2.2 years; dermatomyositis, DM 47 / polymyositis, PM 41 / immune-mediated necrotizing myopathy, IMNM 45) and 133 age-/sex-matched HC (106 females, mean age 60.2) were included. Data are presented as median (IQR).

Results

Several differences in disease activity, the dose of glucocorticoids, prevalence of comorbidities, and serum lipid levels were observed among the three subtypes of IIM. Lipid profile parameters, especially levels of negative cardiovascular predictive markers such as TC, TG, LDL-C, Apo-B, and the atherogenic index were significantly higher compared to HC. The most significant changes were observed in IMNM compared to age-/sex-matched HC. Levels of TC, TG, LDL-C, apo-B, and non-HDL negatively correlated with disease duration but positively with laboratory markers of disease activity and the current prednisone equivalent dose. Higher levels of HDL-C were associated with decreased levels of CRP, which is in line with the negative correlation of apo-A levels with CRP, CK, and myoglobin. Conclusions: We have observed significant alterations in serum lipid parameters in our IIM patients compared to healthy age-/sex-matched individuals. Differences were also found among the three IIM subtypes. These alterations were associated with laboratory parameters of disease activity and the current dose of corticosteroids.

Abstract Figure. Results - lipidogram in IIM and HC
Lipid profile analyses of patients with and without type-2 diabetes in a cardiac rehabilitation population
Authors: Mannion J , Nagle N , Wassell G , Brassill MJ
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Type 2 diabetes mellitus (T2DM) can double your risk of coronary artery disease (CAD). SGLT2 inhibitors reduce all-cause mortality for patients with T2DM and CAD, targeting metabolic syndrome components like HbA1c, blood pressure and weight. Lipid profiles are intrinsically linked to obesity however the secondary effects of SGLT2 inhibitors remain unclear, with studies showing a rise in HDLc and LDLc with these medications.

Propose

To compare the effect of cardiac rehabilitation and guideline directed statin therapy on lipid panels of those with diabetes to those without, and to conduct a sub-analysis on SGLT2 inhibited patients to assess for increased HDLc and LDLc.

Methods

We retrospectively reviewed our cardiac rehab records. Data was collected on sequential patients over age 18 who completed cardiac rehab, until 90 diabetics and 90 non-diabetics were identified. Statistical analyses performed using SPSS v.26.

Results

Diabetics had significantly lower total cholesterol, HDL and LDL prior to commencing rehab (Table 1). Diabetics also showed less reduction in total cholesterol and LDL than non-diabetics. Groups had similar follow-up time and anti-lipid therapy. N = 12 (13.3%) diabetics were on SGLT2 inhibitors. This group showed the greatest mean increase of HDL and lowest mean decrease of LDL levels, however, did start with the lowest initial lipid levels.

Conclusions

Diabetics had lower LDL and HDL prior to rehab, which may have led to reduced change in their profiles compared to non-diabetics. Interestingly however, patients on SGLT2 inhibitors showed a trend towards least reduction in mean LDL and the greatest increase in mean HDL compared to other diabetics.

Table 1 Category(Lipids in mmol/L) Non-Diabetics, n = 90 (Mean ± SD) Diabetics, n = 90 (Mean ± SD) p-value SGLT2 cohort, n = 12 (Mean ± SD) Age (Years) 66.1 ± 8.73 67.73 ± 8.88 0.21 66.41 ± 7.8 Max. statin (%) 92.2% 90% 0.16 100% Pre-Total Chol. 4.21 ± 1.29 3.57 ± 0.9 <0.01* 3.36 ± 0.62 Pre-Triglyceride 1.6 ± 0.85 1.87 ± 1.02 0.054 1.63 ± 0.6 Pre-HDL 1.33 ± 0.48 1.12±.029 <0.001* 1.03 ± 0.22 Pre-LDL 2.14 ± 1.03 1.68 ± 0.93 0.002* 1.60 ± 0.57 Change- Total Chol. -0.75 ± 1.13 -0.26 ± 0.09 0.9 -0.09 ± 0.45 Change-HDL -0.01 ± 0.42 +0.03 ± 0.19 0.33 +0.19 ± 0.13 Change- LDL -0.61 ± 0.96 -0.28 ± 0.75 0.01* -0.24 ± 0.63 Lipids rechecked (months) 8.4 ± 0.25 7.9 ± 0.26 0.14 8.25 ± 2.26 Pre-intervention lipid profiles, followed by change in levels over time. *Denotes significance.
The effects of preventive counseling with remote support via e-mail on illness perception in patients with paroxysmal atrial fibrillation after catheter ablation
Authors: Pogosova N , Ovchinnikova AI , Yufereva YM , Sokolova OY , Davtyan KV , Ausheva AK
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Illness perception (IP) affects health behaviors and coping strategies in chronic diseases, but our knowledge about IP in atrial fibrillation (AF) patients (pts) after catheter ablation (CA) is limited.

Purpose

To assess the impact of preventive counseling on IP in pts after AF catheter ablation.

Methods

A prospective randomized controlled study with 2 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1) into 2 groups. Before discharge, both groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge pts from intervention group received 6 sessions of biweekly remote preventive counseling via e-mail over the first 3 months. Control group received usual care. IP was assessed using The Brief Illness Perception Questionnaire (BIPQ) at baseline and at 3, 6 and 12 months.

Results

A total of 90 pts aged 35 to 80 years were enrolled (mean age, 57.4 ± 9.9 years, men, 52.2%). The groups were well balanced according to demographic and clinical features. At 6 and 12 months of follow-up there was a significant improvement of the overall IP score in the intervention group vs control (table). 

Conclusions

Preventive counseling with remote support via e-mail improves IP in AF pts after CA which may contribute to better long term outcomes.

The overall score of IP Intervention group Control group P for change vs baseline Baseline (points) mean ± SD 42.2 ± 10.2 44.4 ± 9.5 n/s Mе (25%; 75%) 44 (35; 48.5) 45 (37; 51.5) At 3 months (points) mean ± SD 36.8 ± 8.1* 39.7 ± 7.9* 0.055 Mе (25%; 75%) 37 (33; 41) 41 (33.5; 47) Δ% after 3 months, Ме (25%; 75%) -14.3 (-23.2; 5.2) -13.0 (-16.8; -4.6) n/s At 6 months (points) mean ± SD 32.4 ± 7.3* 37.7 ± 8.7* 0.008 Mе (25%; 75%) 33 (27; 38) 37 (31; 44.5) Δ% after 6 months, Ме (25%; 75%) -24.2 (-33.7; -5.9) -18.4 (-24.0; -5.9) 0.040 At 12 months (points) mean ± SD 29.4 ± 7.6* 36.9 ± 8.2* <0.001 Mе (25%; 75%) 29 (24.5; 33.5) 36 (31; 43) Δ% after 12 months, Ме -33.3 (-42.5; -17.1) -18.4 (-26.4; -7.5) <0.001 SD – standard deviation, Me – median;* p <0.001 vs baseline within group
Rising patients" adherence to CVD preventive treatment via medical and psychological counseling using remote technologies
Authors: Kopylova OV , Sirota NA , Yaltonsky VM
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Low adherence to healthy lifestyle and CVD preventive medical treatment is a seriouse problem in lowering of CVD morbidity and mortality. Using modern medical, psychological and remote technologies may help to increase patients" adherence.

Purpose

To study the efficacy of medical and psychological counselling using remote technologies in rising patients" adherence to CVD preventive treatment.

Methods

The study included 140 patients with risk factors for cardiovascular disease (RF CVD), who were divided into two comparable groups: group of medical and psychological counselling with the use of remote technologies (n = 70) and group of control (n = 70).  The study lastet 12 months. Level of adherence was measured via standard Morisky-Green"s 4-item questionnaire as well as via additional questionnaire developed by authors for this study.

Results

Comparative analysis of the level of adherence in the two groups did not reveal statistically significant differences at baseline. After 12 months, the experimental group showed a statistically significant increase in adherence to preventive treatment compared with the control group (р=0,001)

Conclusion(s)

Medical and psychological counselling using remote technologies is an effective method for rising patients" adherence to CVD preventive medical treatment
Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study
Authors: Buckley B , Harrison S , Fazio-Eynullayeva E , Underhill P , Sankaranarayanan R , Wright D , Thijssen D , Lip G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF).

Methods

A retrospective cohort study was conducted which utilised a global federated health research network. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of exercise-based CR within 6-months of a HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, co-morbidities, medications, and procedures. We ascertained 2-year incidence of all-cause mortality, hospitalisation, stroke, and atrial fibrillation.

Results

Following propensity score matching, a total of 40,364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality (odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62), 26% lower odds of hospitalisation (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to matched controls. The beneficial association of exercise-based CR on all-cause mortality was consistent across stratification for sex, older age, included comorbidities, and HF subtype (all P < 0.0001), including patients with HFpEF (0.65, 95% CI 0.60-0.71).

Conclusions

Exercise-based CR was associated with lower odds of all-cause mortality, hospitalisations, incident stroke and incident atrial fibrillation at 2-years follow-up for patients with HF. The beneficial association of CR and lower mortality was consistent for patients with HFrEF and HFpEF.
Cardiac rehabilitation is associated with lower 1-year all-cause mortality in primary pulmonary hypertension
Authors: Kleinnibbelink G , Buckley BJR , Harrison SL , Williams N , Fazio-Eynullayeya E , Underhill P , Van Dijk APJ , Lip GYH , Thijssen DHJ
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Despite introduction of pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains present. Cardiac rehabilitation may be an alternative strategy to improve survival. However, no study directly linked CR to mortality in PH patients. Therefore, adopting a retrospective observational study using a large electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with CR versus a propensity-matched control group of PH without CR.

Methods. The retrospective analysis was conducted on December 14, 2020 using anonymized data within TriNetX, a global federated health research network with access to EMRs from participating academic medical centres, specialty physician practices, and community hospitals, predominantly in the United States. All patients were aged ≥18 years with primary PH recorded in EMRs at least 18-months before the search date to allow for 1-year follow-up from CR. Using logistic regression, patients with PH with an EMR of CR were 1:1 propensity score-matched with PH patients without CR for age, sex, race, diseases of the respiratory system, disease of the circulatory system, hypertensive disease, heart failure, diabetes mellitus, chronic kidney disease, cerebrovascular disease, cardiovascular procedures and cardiovascular medications.

Results. In total, 70,875 patients with primary PH met the inclusion criteria for the control group and 637 patients with primary PH met the inclusion criteria for the CR and exercise cohort (Table 1). Using the propensity score-matched cohort, and excluding patients with outcomes outside the measurement window, mortality at 1-year from CR was proportionally lower with mortality of 13.9% (n = 87 of 628 patients) in the CR and exercise cohort compared to 21.0% (n = 133 of 632 patients) in the controls (OR 0.60, 95% CI 0.45-0.81).

Conclusion. In conclusion, the present study of 1,264 patients with primary PH suggests that CR is associated with 40% lower odds of 1-year mortality, when compared to propensity score-matched patients without CR or exercise programmes.

Abstract Figure.
Factors associated with return to work after coronary artery bypass grafting (CABG)
Authors: Raynaldo A
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background.

Postoperative CABG patients will generally experience improvement in symptoms and functional capacity. Post-CABG patients are expected to be productive again in order to have a positive impact on both patient and the society socio-economically, in addition to other parameters such as morbidity, mortality and serious adverse events.

Purpose

to determine the factors that associated with return to work in CABG patients in one General Hospital.

Methods.

We analyzed data from Adam Malik Hospital registry of 68 patients who had undergone CR after coronary artery bypass graft (CABG) in 2017-2020. The outcomes assessed were work status in 6 month after CABG. Patients’ characteristics, sociodemographic, clinical parameters of functional capacity using 6 minutes of walk test (6MWT), T2DM, Hypertension and cholesterol level were assessed. Factors associated with return to work were identified using multivariable logistic regression.

Results

We identified 68 patients undergoing isolated CABG (2017–2020). One year after discharge for CABG, 40 (58.8%) patients had returned to the workforce. Factors associated with return to work  were identified using bivariate logistic regression. Diabetes mellitus (odds ratio, 10.192; 95% confidence interval, 0.063–0.515).

Conclusion

Almost 2 from 3 patients after CABG returned to work within 6 months. Diabetes mellitus and functional capacity were associated with a lower likelihood of returning to work.
Anxiety and depression; influence on information needs in patients receiving cardiac rehabilitation
Authors: Tenbult - Van Limpt N , Traa SJC , Brouwers R , Kemps HMC
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Educational interventions on healthy lifestyle and cardiovascular risk factors are important elements of Cardiac Rehabilitation (CR), and may increase patients’ self-efficacy, satisfaction and health-promoting behaviour. However, these interventions are often not tailored to individual needs of patients, thereby reducing their effectiveness. In order to tailor educational interventions to individuals, it"s important to identify determinants of information needs. Depression and anxiety are highly prevalent in cardiac patients and negatively influence prognosis. Additionally, depression and anxiety may prevent people from seeking information due to lack of initiative and withdrawal from social situations. Little is known on information needs for anxious and depressed patients entering CR. This study evaluated the influence of anxiety and depression on information needs of patients entering CR.

Methods

Prospective observational study. Patients were asked to complete questionnaires on anxiety and depression and on information needs and information seeking behaviour before start of CR. Primary endpoint was the association between information needs and risk of anxiety and depression.

Results

We included 259 patients, predominantly male (76%), mean age 64.8 ± 10.4 year. Two thirds of patients were diagnosed with MI (68%), 163 patients underwent PCI (63%), 71 patients underwent CABG (27%) and 22 patients were treated by medication only (9%). At baseline 19 patients were current smokers (8%). Patients with moderate to high risk of anxiety or depression more often had questions on mood than patients with low risk of anxiety and depression. Patients with moderate to high anxiety risk also more often had questions on nutrition than low risk patients.

Discussion

In patients entering CR, moderate to high risk of anxiety and depression was associated with higher degree of information needs on mood than their low risk counterparts. This indicates that CR programme and educational interventions should be more specifically tailored to patients’ information needs, taking into account anxiety and depression risk.

Information needs before start CR Anxiety risk Depression risk Low (HADS score 0-7) Moderate to high (HADS score 8-21) p-value Low (HADS score 0-7) Moderate to high (HADS score 8-21) p-value Questions on physical activity 71 (37%) 25 (44%) 0.34 78 (38%) 17 (39%) 0.96 Questions on nutrition 49 (26%) 26 (45%) 0.02 57 (28%) 18 (40%) 0.28 Questions on mood 29 (15%) 37 (65%) <0.001 43 (21%) 23 (52%) <0.001 Questions on smoking 3 (23%) 4 (50%) 0.35 5 (33%) 2 (33%) 1.00
Neuromuscular electrical stimulation in early rehabilitation of patients with postoperative complications after cardiovascular surgery
Authors: Oleinik P , Sumin AN , Bezdenezhnykh AV
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Federal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases

Introduction

The purpose was to evaluate the effectiveness of NMES in patients with complications after cardiac surgery.

Methods

This study was 37 patients who had significant postoperative complications after cardiovascular surgery. Participants were randomly - NMES group, n = 18; control, n = 19. It was not possible to blind the investigator. Analyzed basic clinical data. The dynamometry of the muscles upper and lower extremities was carried out, as well as a 6-minute walk test (6MWT). Also, the thickness of the quadriceps was measured using ultrasound.The patients underwent NMES on the quadriceps femoris muscle, daily from the third postoperative day, until discharge. The duration session was 90 minutes.

Outcomes

No differences were found in the baseline characteristics of the groups, including the results of laboratory and instrumental studies. Groups were comparable in the surgery and perioperative parameteres. The initial strength indicators also had no significant differences in the groups.

At discharge knee extensors strength (KES) was significantly higher in the NMES group. The knee flexor strength (KFS) and handgrip strength (HF) increased the same in both groups. The quadriceps crosssectional area (CSA) muscle increased more in the NEMS group than in the control to the time of discharge. Average KES increased to a greater extent in the NMES group. At the same time, average and maximum KFS increased equally in both groups. A 6MWT before discharge did not show a difference between groups (P=.166). The NMES course did not affect the duration of hospitalisation (P=.429).

Discussion

This pilot study show beneficial effects of NMES on muscle strength in patients with complications after cardiovascular surgery.

Physical tests initially and in dynamics NEMS Group (n = 18) Control group (n = 19) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 20,3 [17,9; 26,1] 28,05 [23,8; 36,2] * 20,1 [18,6; 25,4] 22,3 [20,1; 27,1] * 0,004 Left knee extensors strength (kg) 17,75 [15,5; 27,0] 27,45 [22,3; 33,1] * 20,8 [17,5; 24,2] 22,5 [20,1; 25,9] * 0,017 Right knee flexors strength (kg) 14,85 [11,7; 19,5] 17,5 [14,1; 23,4] * 16,9 [13,1; 23,8] 19,2 [12,5; 26,4] * 0,971 Left knee flexors strength (kg) 14,7 [12,6; 19,6] 19,75 [15,9; 24,2] * 16,2, [10,4; 25,1] 18,8 [13,1; 27,7] * 0,889 6-MWT (m) 148,5 [108,5; 174,0] 288,0 [242,0; 319,0] * 169,0 [115,0; 217,0] 315,0 [277,0; 400,0] * 0,166 Right handgrip strength (kg) 24,5 [15,0; 33,0] 25,5 [19,0; 36,0] * 27,0 [18,0; 32,0] 30,0 [20,0; 35,0] * 0,795 Left handgrip strength (kg) 17,0 [12,0; 27,0] 21,0 [15,0; 31,0] * 19,0 [14,0; 29,0] 23,0 [16,0; 30,0] * 0,541 * - p-level from baseline data < 0,05 ** - p-level from baseline data ≥ 0,05
Effects of the use neuromuscular electrical stimulation of the lower extremities in the prehabilitation of patients in a before cardiac surgery
Authors: Oleinik P , Sumin AN , Bezdenezhnykh AV
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Research Institute for Complex Issues of Cardiovascular Diseases

Aim

To evaluate the effects of neuromuscular electrostimulation in the prehabilitation and prevention of muscle weakness in patients awaiting cardiac surgery.

Materials and methods

122 patients waiting for elective cardiac surgery were included. Exclusion criteria: age less than 25 and more than 80 years; emergency and urgent surgical interventions; arthropathies; low pain threshold; rhabdomyolysis and other myopathies; cognitive dysfunction. Routine laboratory and instrumental examinations were performed in all patients upon admission to the hospital, as part of a standard examination. 62 patients were randomly selected for the preoperative NMES group, in addition to the standard preoperative preparation and treatment program. The standard program included 60 control patients. Patients of the NMES group underwent quadriceps stimulation for at least 5 sessions, lasting 90 minutes, daily before surgery.

Results.

The groups were comparable and did not have significant differences in gender and age characteristics, according to the main clinical and anamnestic data and types of operations. Initially, there were no differences in the state of the muscles of the lower extremities, the distance of the six-minute walking test (6MWT), and the strength of the hand grip.

After NMES, there was an increase in muscle strength relative to the control group, both stimulated muscle groups and unstimulated antagonist muscles, as well as a greater 6MWT distance and hand compression force. All the differences were significant.

Conclusions

The course of pre-rehabilitation of NMES before surgery, allowed to maintain, and in some cases improve the condition of the muscle frame of the lower extremities. A positive effect was observed not only in stimulated muscle groups, but also in antagonist muscles

Indicators of muscle status NMES (n = 62) Control group (n = 60) Baseline Discharge Baseline Discharge P-level Right knee extensors strength (kg) 24,4 [18,3; 31,4] 30,4 [23,8; 36,2]* 24,7 [20,1; 33,2] 22,25 [18,9; 30,4] <0,001 Left knee extensors strength (kg) 23,8 [19,3; 31,3] 29,2 [23,6; 35,4]* 25,75 [19,2; 31,3] 22,9 [18,9; 27,8] <0,001 Right knee flexors strength (kg) 18,9 [13,3; 24,0] 21,7 [16,6; 25,1] 19,55 [13,1; 26,0] 16,7 [12,1; 23,3] 0,006 Left knee flexors strength (kg) 19,3 [14,3; 24,5] 21,9 [17,3; 26,7] 19,5 [13,0; 24,3] 18,2 [13,4; 22,2] 0,005 6-MWT (m) 300,0 [261,0; 371,0] 331,0 [280,0; 375,0] 304,5 [253,0; 380,0] 285,5 [246,0; 342,0] 0,006 Right handgrip strength (kg) 28,5 [20,5; 34,0] 31,5 [22,0; 34,0] 29,0 [19,0; 34,0] 27,0 [19,0; 33,0] 0,054 Left handgrip strength (kg) 25,0 [18,0; 31,0] 25,0 [18,0; 32,0] 24,0 [15,0; 31,0] 22,0 [14,0; 28,0] 0,062 * - p-level from baseline data < 0,05

Abstract Figure. dynamics of stimulated muscles