bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of arterial hypertension on the functional capacity of morbidly obese diabetics
Authors: Ostojic M , Ostojic M L , Simic J , Petrovic O , Giga V , Beleslin B , Nedeljkovic I
Published: June 2024

Introduction

Morbid obesity represents a major health problem, in particular, associated with type 2 diabetes mellitus (DMT2). It is a significant risk factor for adverse cardiovascular events, especially for surgical procedures. Bariatric surgery is the ultimate treatment for weight reduction, but at the same time, as a major abdominal surgery, it has a higher risk. The cardiopulmonary exercise test (CPET) has been included in the preoperative assessment to evaluate the functional status and eligibility for surgical treatment, also examining the effect of comorbidities like hypertension (HTN).

Purpose

To evaluate the effect of HTN associated with DMT2 on the functional capacity of morbidly obese patients scheduled for bariatric surgery.

Methods

We assessed 87 morbidly obese patients with T2DM (mean age 44.33±9.38, 32 males) during preoperative evaluation for bariatric surgery. All patients underwent multidisciplinary clinical examinations, laboratory analysis, and echocardiography. Also, we evaluated the function of the cardiovascular, pulmonary, and circulatory systems by CPET (Treadmill, maximal Bruce protocol). We assessed the effects of arterial HTN and its effects on glycemic control and CPET parameters.

Result

The mean BMI of the morbid obese diabetics was 44.48±7.09 kg/m2. There was a significantly higher BMI in female vs. male patients (62.77±4.05 kg/m2 vs. 57.56±13,23 kg/m2 p=0,001). The mean glucose level was 7.18±2.54 mmol/L, whereas the mean glycosylated hemoglobin (HbA1c) was 7.21±1.55 % without differences regarding gender. All echocardiographic parameters were within normal limits, with the mean global systolic function of the left ventricle at 60.34±9.76 %. There were 55 patients with arterial HTN, and they had significantly lower peak oxygen consumption (peakVO2) in comparison to normotensive patients (17.62 ± 4.16 vs. 18.23±4.16 ml/kg/min, CI 16.69-18.53, p=0.001). Furthermore, patients with HTN had significantly lower VO2 at the ventilatory anaerobic threshold (VAT/VO2) compared to normotensive, 15.20±3.15 vs. 15.35±4.31 ml/kg/min. There was no difference in the ventilatory parameters in patients with or without HTN.

Conclusions

The presence of HTN in morbidly obese individuals with T2DM has an additional effect on reducing functional capacity, which can increase the risk for bariatric surgery. Therefore, evaluating the risk, CPET points to the need for optimal medical therapy and pressure regulation, among other measures, for improving the state of fitness.
The relationship between cardiovascular risk factors and cardiovascular fitness and physical activity in patients with T2DM and prediabetes
Authors: Calik Kutukcu E , Durukan B N , Bozdemir Ozel C , Arikan H , Dagdelen S
Published: June 2024

Introduction

Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are known to be associated with several adverse cardiovascular disease (CVD) risk factors, including hypertension, obesity, central obesity, hyperinsulinemia and serum lipid and lipoprotein abnormalities. Despite reduced exercise capacity is a strong predictor of CVD mortality in subjects with T2DM, there is limited evidence about the relation between CVD risk, exercise capacity and physical activity (PA).

Objective

The aim of the study was to investigate CVD risk factors and cardiovascular fitness and physical activity (PA) in patients with T2DM and prediabetes.

Methods

Prediabetes is defined as IGT. Patients with heart failure and history of CVD events last two years were excluded. The total number of coronary artery disease (CAD) risk factors was defined as the number of the following that were present: advanced age (>45 for men, >55 for women), hypercholesterolemia, hypertension, diabetes mellitus (DM), family history of CAD, and tobacco use. SCORE2 that is a new algorithm validated to predict 10-year risk of first-onset CVD in European populations was also used. Cardiovascular fitness was determined by cardiopulmonary exercise test (CPET) and incremental shuttle walking test (ISWT). PA and energy consumption (metabolic equivalent-METs) during PA and exercise tests were measured using SenseWear Armband activity monitor.

Results

Twenty-six patients (T2DM: 16 patients, prediabetes: 10 patients) were included in the study. The median age of participants were 49.5 (39-58) years. The median CAD risk factors were 3 (2-6), the median 10 year CVD risk were 3 (1-8) according to SCORE2 algorithm. The number CAD risk factors was significantly related with mean METs during ISWT (r=-0.469, p=0.032), mean METs during one-week (r=-0.476, p=0.022), ∆glucose during ISWT (r=0.532, p=0.011), time to reach anaerobic threshold during CPET (r=-0.442, p=0.024).

Conclusion

As the CAD risk factors increase, energy consumption during maximal exercise performance and daily PA decrease, resulting greater decline in glucose levels and early transition to anaerobic metabolism in patients with T2DM and prediabetes. These findings express the importance of individualized exercise training for decreasing CVD risk in these patient population during cardiac rehabilitation programmes.
Is the six-minute step test an alternative to six-minute walking test to assessment the functional capacity in elderly?
Authors: Lopes Do Nascimento L L N , Rossi J C , Antunes L , Leite Y A , Coelho G G , Pacheco M P , Santos G F , Carvalho Y F , Silva R E N S , Oliveira L C M
Published: June 2024

Background

The assessment of cardiorespiratory functional capacity can contribute to the prognosis of cardiovascular, chronic respiratory and musculoskeletal system diseases, considering loss of functional capacity and the presence of comorbidities. This assessment can be done through maximal tests such as the cardiopulmonary exercise test, exercise test and submaximal tests such as the 6-minute walk test (6MWT) and the 6-minute step test (6MST). There are few studies that compare both tests and can validate the replacement of the 6MWT by the 6MST, since the 6MWT is a test that requires a large space to be performed, unlike the 6MST, which only needs a 20 cm high step.

Purpose

The objective of the present study was to verify the correlation between the 6MST and the 6MWT in the evaluation of the functional capacity of elderly people.

Methods

Cross-sectional descriptive study with voluntary non-probabilistic sampling, consisting of 30elderly people who are part of the Cardiovascular Physiotherapy in Primary Care study. The sample was submitted to the 6MWT and 6MST, and the beginning and end parameters were collected to be compared. Submaximal exercise capacity was evaluated by the distance covered in the walking test and by the number of steps taken up and down, and equations were performed to obtain the VO2max of both tests.

Results

The sample was predominantly female (75%), with an average age of 69.86 (±7.34) years. There was a positive and moderate correlation between the estimated values for VO2max in the walk and step test (p = 0.01 and r = 0.57) and between the distance covered in the walk test and the number of ascents and descents in the step test (p = 0.02 and r = 0.43).

Conclusion

The six-minute step test can be an alternative to assess the functional capacity of the elderly.
The use of eHealth interventions in vascular disease patients with lower limb amputation: a scoping review
Authors: Sousa P , Santos I M S C
Published: June 2024

Background

Individuals with a non-traumatic amputation have unique needs and require specialized management expertise to facilitate optimal outcomes. Empowerment is needed to enhance the confidence and coping skills of these patients, however, access to rehabilitation services is still limited. eHealth is considered an effective approach for delivering self-management programs. The delivery of remote rehabilitation care to patients with amputation may contribute to reduced patient travel burden, enhanced access to specialized services, and improved continuity of care.

Purpose

To assess the scientific evidence regarding the use of eHealth interventions among vascular disease patients with lower limb amputation, namely the intervention components, delivery mode and impact.

Methods

We systematically searched PubMed and Cumulative Index to Nursing and Allied Health Literature during October 2023, to identify relevant publications, according to previously defined criteria. We also searched for grey literature in scholar google. Two authors independently screened records and assessed risk of bias. We conducted a narrative synthesis of evidence and followed the JBI recommendations for the scoping reviews.

Results

We identified 10 adequate publications on eHealth interventions in these patients. The sample size, interventions components and duration were very diverse. eHealth interventions addressed wound management, mobility assessment, falls detection, walking capacity and gait training, as well as management of health symptoms, engagement in health promoting activities and promotion of lifestyle behaviors. Regarding the delivery of the intervention to the patients with lower limb amputation, we found telerehabilitation systems, Wii Fit devices, telephone-based interventions, and mobile phones sensors. The effectiveness evidence of these interventions is still scarce.

Conclusions

Our review address a knowledge gap on the implementation of eHealth interventions for Vascular Disease Patients with lower limb amputation. Although some promising effects was shown, weak evidence limits the development of definitive clinical recommendations.
Effects of remote cardiac rehabilitation using wearable devices with and without weekly online coaching in patients with coronary artery disease: J-CARP FIT study
Authors: Nishio R , Dohi T , Yokoyama M , Nakade T , Takahashi N , Chikata Y , Endo H , Nishiyama H , Okai I , Iwata H , Okazaki S , Miyauchi K , Daida H , Minamino T
Published: June 2024

Aim

Cardiac rehabilitation (CR) is effective for preventing cardiovascular diseases, but the impact of remote-CR with wearable devices and online coaching is not well understood. The aim of this study was to investigate its effects on exercise capacity by interactive communication between healthcare providers and patients.

Methods

This randomized controlled trial enrolled 50 coronary artery disease (CAD) patients participating in a remote-CR program (phase III). After baseline cardiopulmonary exercise test (CPET), all patients were given a CPET-based home exercise program and were provided wearable device with real-time monitoring system. They were randomly assigned to an intervention group with online coaching (OLC, n=25) or a control group (CON, n=25). Primary outcomes were changes in peak VO2 and anaerobic threshold (AT) VO2 at 12 weeks, while secondary outcomes were changes in CPET parameters, daily activity, anxiety level, and health-related quality of life (HR-QOL).

Results

Peak VO2 and AT VO2 increased significantly from baseline to 12 weeks in the OLC (+1.6 mL/kg/min, p<0.001; +1.0 mL/kg/min, p=0.001) and CON (+0.6 mL/kg/min, p=0.008; +1.3 mL/kg/min, p=0.002) without significant between-group differences (p=0.65; p=0.9). In the latter half of the intervention, daily distance, and highly active time in the OLC group significantly increased compared to the CON group (all p<0.05).

Conclusion

Exercise tolerance improves with appropriate exercise coaching and the use of wearable devices in CAD patients participating in a remote-CR program. However, the benefits of online coaching using real-time monitoring might be more pronounced in a long-term perspective. Timeline  Graphical abstract
Differentiating between circulatory versus non-circulatory causes of exercise intolerance in HFpEF using in vivo 31P magnetic resonance spectroscopy of exercising leg muscle
Authors: Voorrips S N , Jeneson J A L , Dams O C , Sibeijn-Kuiper A J , Renken R J , Van Der Meer P , Westenbrink B D
Published: June 2024

Background

Heart failure with preserved ejection fraction (HFpEF) is characterized by severe limitations in exercise capacity. Identifying the etiology of exercise intolerance in HFpEF remains challenging due to heterogeneity of the disease and the presence of several comorbidities.

Purpose

This trial aimed to determine whether we could differentiate between circulatory versus non-circulatory causes of exercise intolerance using 31 phosphorus magnetic resonance spectroscopy (31P MRS) exercise testing.

Methods

This observational trial included 18 HFpEF patients and 6 healthy controls who performed a supine, in-magnet cardiopulmonary exercise test using a prototype LODE MR-compatible cycle ergometer with an incremental workload protocol. Non-invasive in vivo 31P MRS measurements were collected from the quadriceps muscle to quantify dynamics in oxidative skeletal muscle metabolism. Primary outcome measures were end-exercise inorganic-phosphate/phosphocreatine ratio (Pi/PCr) and intramuscular pH. Evidence of circulatory-limited exercise intolerance was defined as increased end-exercise Pi/PCr ratio or decreased intramuscular pH (cut-off values 2.0 and 6.8, respectively).

Results

Patients with HFpEF were 50% female, aged 73 [64 - 76] years, had a mean BMI of 28.0 [25.0 – 29.6] kg/m2. Median LVEF was 51% [48 – 54%] and median NT-pro BNP levels were 626 [343-1931] pg/mL. Control patients were also 50% female, had a median age of 58 [56 - 65] years and a BMI of 22.7 [21.9 – 25.7] kg/m2. Nine patients in the HFpEF cohort exhibited circulatory insufficiency to support skeletal muscle oxidative metabolism, as indicated by acidification of the quadriceps muscle during exercise (Figure). In a subset of 5 HFpEF patients, no evidence for circulatory failure was found despite achieving maximum workload and exertion scores. Four patients were not able to reach a sufficient level of exercise intensity, which could correspond to a pattern of deconditioning. In controls, quadriceps Pi/PCr ratio increased to 1.1±0.8 while intramuscular pH remained neutral during exercise.

Conclusion

This pilot study suggests that dynamics in skeletal muscle metabolism measured by 31P MRS can be used to differentiate between circulatory versus non-circulatory causes of exercise intolerance in HFpEF. Future research is needed to evaluate whether these patterns in oxidative skeletal muscle metabolism could help to unravel the heterogeneity in HFpEF.  End-exercise parameters
Evaluation of the pulmonary and muscle oxygen kinetics in heart failure patients with reduced and preserved ejection fraction
Authors: Gerson Cipriano Junior G C J , Gaspar R Chiappa G R C , Luz Goulart C , Marianne Lucena Da Silva M L S , Edson Marcio Negrao E M N , Luciana Bartolomei Orru Davila L B O D , Sergio Henrique Rodolpho Ramalho S H R R , Nadia Oliveira Gomes N O G , Graziella F Bernardelli Cipriano G F B C , Dominique Hansen D H , Lawrence Patrick Cahalin L P C
Published: June 2024

Introduction

Possible differences in the oxygen supply and the dynamics may impact the exercise's response between heart failure (HF) with reduced ejection fraction (HFrEF) and preserved (HFpEF), mainly due to body composition differences. Thus, our study was designed to determine whether pulmonary and muscle oxygen kinetics responses may be present in HFpEF, which may help understand the phenotype differences in muscle microvascular perfusion on exercise capacity and stimulate future investigations.

Objective

I) To assess the kinetics of pulmonary oxygen uptake (V'O2p), skeletal muscle deoxygenation ([HHb]), and O2 microvascular delivery (QO2mv) in HFrEF and HFpEF; and II) To assess the pulmonary and muscle kinetic association with exercise performance and body composition variables.

Methods

10 HFpEF and 11 HFrEF underwent cardiopulmonary exercise tests to assess V′O2 kinetics and near-infrared spectroscopy (NIRS) for [HHb]. Microvascular O2 delivery (QO2mv) was calculated using the Fick principle, and body composition via dual-energy x-ray absorptiometry (DEXA).

Results

Regarding the V′O2 kinetics, time constant (t) was slower in HFrEF (63±10.8 vs. 45.4±7.9s; P<0.05) while the [HHb] were faster (t = 12.4±9.9 vs. 25±11.6s, P<0.05). In addition, QO2mv were greater in HFrEF (3.6±1.2 vs 1.7±0.8, P<0.05) (Figure 1) while time to exercise intolerance shorter (281.6±84 vs. 405.3±96s, P<0.05). Time to exercise tolerance correlated to QO2mv (rho= -0.51; P<0.05) and tV′O2 (rho= -0.63, P<0.05) in both groups. We found that body adiposity negatively correlates with [HHb] amplitude (rho =-0.78) and peak V’O2 (rho =-0.54) in both groups, while lean muscle percentage positively correlates with [HHb] amplitude and tau (rho= 0.74 and 0.57; P<0.05).

Conclusions

Along with oxygen uptake (V'O2p) kinetics reduction, deoxy-hemoglobin kinetics, and microvascular O2 delivery are also more severely affected in HFrEF than HFpEF. We also demonstrated that greater adiposity and less lean mass are related to a reduced oxygen diffusion capacity and poor oxygen uptake kinetics.
Effectiveness of a hybrid cardiac rehabilitation program: a comparative study with standard supervised exercise training
Authors: Naessens S , Van Mechelen M , De Bliek E , Vorlat A , De Cock L , Hens W
Published: June 2024

Introduction

Cardiac rehabilitation (CR) is globally recognized as an effective secondary prevention strategy for heart patients. However, low referral and participation rates persist due to accessibility challenges. This study investigates the effectiveness of a novel Hybrid CR (HCR) program, combining facility-based exercise sessions and home-based exercise sessions facilitated by a smartphone application.

Purpose

The study aims to evaluate the HCR program's effectiveness for a selected population of heart patients. A comparison is made between the HCR program and the standard of care involving solely supervised centre-based cardiac rehabilitation (CBCR). The research focuses on exercise capacity and body composition.

Methods

Participants were allocated to receive either conventional care or the HCR program. The intervention comprised a blend of supervised and home-based exercise sessions, while the control group exclusively received supervised CBCR. VO2 peak, peak load and fat percentage were measured through Cardiopulmonary Exercise Testing (CPET) and multi-frequency bioelectrical impedance analysis. Assessments were conducted at baseline, after a 12-week rehabilitation period, and, for a subset of patients, at one-year follow-up (1YFU).

Results

Eighty-four cardiac patients met the inclusion criteria to be enrolled in the study. Both the HCR group as the CBCR group showed statistically significant (p<0.05) improvements in VO2 peak (mean +3.9 mlO2/kg/min vs +3.2 mlO2/kg/min respectively), peak load (mean +37.7W vs +24.9W respectively) and fat percentage (mean -2.14% vs -1.17% respectively) over the 12-week rehabilitation period. At 1YFU no statistically significant changes have been found. The HCR group exhibited no statistically significant differences compared to CBCR group, indicating comparable effectiveness.

Conclusion

This research supports the integration of hybrid rehabilitation models tailored to individual patient needs, emphasizing their potential to overcome accessibility challenges and enhance the impact of cardiac rehabilitation. Further studies should explore optimal populations and protocols for HCR, acknowledging their equal effectiveness alongside centre-based programs.
User needs and preferences of athletes in cardiac(tele)rehabilitation: a qualitative study
Authors: Fruytier L A , Serban I B , Van De Sande D A J P , Kemps H M C
Published: June 2024

Background

Cardiac (tele)rehabilitation (CTR) is the core strategy in the secondary prevention of coronary artery disease (CAD). Research on patient-specific needs and preferences of athletes within cardiac rehabilitation (CR) is scarce. CTR is a promising approach for tailored rehabilitation in this specific population at risk for exercise-related events.

Purpose

To define the user needs and preferences of the athletic population in cardiac (tele)rehabilitation.

Methods

In this qualitative study we included fifteen athletes with established CAD who participated in a CR program, and twelve health care professionals. All athletes engaged in sports for at least four hours per week. This study consists of four phases: a stakeholder identification session, twenty-five semi-structured individual interviews, six card-sorting focus groups and a data analysis phase with thematic analysis.

Results

Fourteen male and one female athlete (mean age 63 ± 10.6 years) participated in cardiac rehabilitation after acute coronary syndrome, percutaneous coronary intervention and/or coronary bypass surgery. Healthcare professionals invited to participate included cardiac nurse practitioners, cardiologists, sports physicians, physiotherapists, and a clinical psychologist. User needs for athletes in CR encompass personalised exercise plans featuring clear and quantifiable exercise recommendations and limitations; Additionally, there is a need for monitoring health and exercise data, measuring progression and performance longitudinally, easy-to-use, and reliable healthcare information systems with accurate sensors and data; as well as clinical supervision and validation of information and data. Social support from both peers and family is also identified as a crucial need. The preferred technological features for a CTR system tailored for athletes include periodic digital consultations with clinicians, home-based training specific to one’s sport, utilization of technology to monitor workouts, data sharing and remote feedback, personalised exercise recommendations and online educational materials.

Conclusion

Enhancing CR for athletes’ necessities adopting a personalised and sport-specific methodology. The integration of various technological features within a CTR program can play a pivotal role in assisting athletes with CAD to regain their previous athletic performance levels and mitigate the risk of adverse cardiovascular events.
The integration of a hybrid cardiac rehabilitation program for a selected patient population in a clinical setting: a feasibility study
Authors: Hens W , Naessens S , De Cock L , Van Mechelen M , De Bliek E , Vorlat A
Published: June 2024

Background and Aim

Although worldwide participation rates among patients eligible for cardiac rehabilitation are low due to accessibility challenges and conflicting commitments, traditional cardiac rehabilitation programs have a centre-based group approach.

The feasibility of implementing a hybrid cardiac rehabilitation program (HCR) for a selected patient population in a clinical setting of centre-based cardiac rehabilitation (CBCR) was assessed with the aim to bridge the participation gap.

Methods

With the goal of keeping weaker, more unstable or less motivated patients from unsupervised training, inclusion criteria for the HCR were established. A cardiopulmonary exercise test (CPET) and anamnesis were used to get insight in the patient’s exercise capacity, potential risks, motivation and barriers to home-based exercise sessions.

In the HCR, a four-week introductory period with three supervised exercise sessions per week was followed by a combination of supervised sessions (2/w) and home workouts (1/w) for nine weeks. During the introduction period, the patient's response to exercise was examined by monitoring heart rate response and training was provided in the use of the smartphone Polar Beat application. Feedback on the training volume of the home workouts was provided by the physical therapist using the data from the smartphone application.

Results

Between March 2021 and September 2022, 227 cardiac patients were referred to the University Hospital’s cardiac rehabilitation centre. Seventy-four patients (33%) were allocated in the novel HCR and 153 patients (67%) were allocated to the traditional CBCR group. The dropout rate in the HCR group was comparable with the dropout rate in the CBCR group (16% vs. 15%). Since feedback on the training volume of the home-based sessions was provided during a supervised exercise session in the same week, the additional workload was limited for the physical therapist.

There was overlap between the patient flow of the HCR and CBCR program which facilitated clinical implementation.

Conclusions

Integrating a hybrid cardiac rehabilitation program for a selected patient population within the traditional offering of a supervised exercise program may be a possible way to bridge the participation gap with a limited additional workload. Patient flow at the CR centre.
Mortality risk in bodybuilding: a call for action to promote safe sport participation
Authors: Vecchiato M , Da Col M , Berton G , Palermi S , Aghi A , Ermolao A , Niebauer J , Drezner J , Neunhaeuserer D
Published: June 2024

Introduction

Sudden Cardiac Death (SCD) is the leading non-traumatic cause of death in young athletes. Bodybuilding is a sport discipline that exposes the athlete to a series of health risks, including SCD, although studies investigating the associated mortality risk are lacking.

Purpose

The objective of this study was to analyze mortality data in a large worldwide population of male bodybuilders.

Methods

Male athletes who performed in competitions of the International Federation of Bodybuilding and Fitness (IFBB) between 2005 and 2020 were identified by an unofficial but extensive database as well as the event-results of the official IFBB website. A standardized web search tailored to detect deaths was performed for each athlete with specific keywords, providing a follow-up analysis through July 2023.

Results

A total of 19'411 athletes were identified. During the study period, 121 deaths were reported. The leading cause of death was from cardiovascular diseases, with 35 (29%) presumed or confirmed SCD detected. The incidence of SCD was 21 cases per 100'000 athletes per year (AY). Although master athletes (>40 years) had a higher mortality rate than younger athletes (119 vs 60 per 100'000 AY; p=0.001), no differences in incidence rate of SCD were shown (21 vs 22 per 100'000 AY; p=0.912). Professional bodybuilders had a higher risk of SCD than amateurs (180 vs 11 per 100'000 AY; p<0.001).

Conclusions

The risk of SCD is considerably high in bodybuilding athletes, particularly when compared with other sport specific mortality rates. The outcomes obtained from this study should alert the bodybuilding but also medical community, leading to a collective "call for action" to implement and improve preventive measures for the promotion of safe sport participation. Table 1  Figure 1
Effect of metabolic syndrome on mean platelet volume and relationship to extent of coronary artery disease
Authors: Vogiatzis I , Sdogkos E , Spahiu A , Roditis P , Georgakopoulos A , Konstantinou T , Pittas S
Published: June 2024

Introduction

Metabolic Syndrome (MS) is a bundle of cardiometabolic risk factors leading to metabolic, clinical and hemodynamic disorders. It begins as insulin resistance and is followed by systemic disorders, such as abdominal obesity, Diabetes Mellitus (DM), dyslipidemia, hypertension and Coronary Artery Disease (CAD). Mean platelet volume (MPV) is an indicator of thrombotic risk and a predictor of CAD.

The study aims to correlate MS with MPV and the extent and severity of CAD.

Material and Methods

We studied 151 patients (124 males – 27 females, mean age 63.56±11.28 years) who underwent coronary angiography. The existence of MS was defined according to the criteria set by the respective scientific societies. According to these, the patients were classified into Group A (46 patients with MS – 35 males, 11 females – mean age 62.07±11.35 years) and Group B (105 patients without MS – 89 males, 16 females – mean age 65.06±12.54 years). Obstructive coronary artery stenosis was considered at the existence of >50% stenosis in at least one vessel, and severe CAD when there was an obstructive session at the left main coronary artery or disease of all three coronary vessels. Several biochemical and hematological parameters were assessed.

Results

Group A patients had a higher incidence of multivascular disease (20 patients – 43.48% vs. 16 patients – 16.8%, p=0.02), reduced Ejection Fraction (42.4±9.6 vs. 53, 5±6.54 - p=0.01) and higher Syntax Score (19.52±7.68 vs. 9.64±5.32 - p=0.01). They also showed abnormalities in lipid values (total cholesterol, triglycerides, LDL, HDL - p=0.01), higher blood glucose and HbA1c values, and higher values of fibrinogen and MPV (11.91±1.93 vs. 9.84±1.06), which is considered a significant prognostic factor in patients with Acute Coronary Syndrome and congestive Heart Failure. In addition, a significant correlation was observed between MPV and Syntax Score (r=0.64 – p<0.001).

Conclusion

MS and MPV are associated with more severe CAD clinically and angiographically. Addressing and regulating MS factors is essential for the proper management of CAD.
Age-related distribution of cardiovascular risk factors in a Corporate Wellness Program: a case study of occupational cardiology at Ferrari
Authors: Palermi S , Vecchiato M , Brusiani S , De Martino L , Cavarretta E , Biffi A
Published: June 2024

Introduction

Corporate Wellness Programs (CWPs) in workplaces play a crucial role in the primary prevention of chronic non-communicable diseases, especially for early cardiovascular (CV) risk screening in apparently healthy individuals.

Aim

This study explores the prevalence and age-related distribution of CV risk factors among Ferrari car manufacturer employees through a CWP.

Methods

Ferrari employees in Maranello participated in the "Ferrari Formula Benessere" CWP, made by comprehensive medical evaluations, including personal and family history assessments, anthropometric measurements, blood samples, and blood pressure evaluation.

Results

In 2019, 1992 workers (82% male, average age 40 ± 9 years) were evaluated: 693 were overweight, 145 were smokers, and 861 were physically inactive. 6.4% had high fasting glycemia (100-125 mg/dL), 3.8% had high cholesterol (250-299 mg/dL) and 6.8% had high blood pressure (systolic blood pressure ≥140-159 mmHg): almost none of them (98%) were on treatment (Table 1). 799 employees (39.1%) had a medium CV risk according to SCORE2. The distribution of risk factors was spread in all age classes, being more present in older people (Table 2).

Conclusions

The CWP at Ferrari significantly identified crucial CV risk factors in a population not regularly screened, emphasizing the vital role of CWPs in primary CV prevention.
Shared and distinct pathways from anxiety disorder and depression to cardiovascular disease: a mediation analysis of the UK Biobank prospective cohort study
Authors: Nakada S , Celis C , Pell J , Ho F
Published: June 2024

Introduction

Although anxiety disorder and depression increase the risk of cardiovascular disease, no studies have examined their underlying mechanisms systematically, particularly contrasting the difference between the two of them.

Purpose

We aimed to explore the extent to which lifestyle, physical and metabolic factors mediate the associations of diagnosed anxiety disorder and depression with incident cardiovascular disease in the UK general population.

Methods

A prospective cohort study was conducted using UK Biobank. Diagnosed anxiety disorder, depression, and incident cardiovascular diseases were ascertained through linkage to hospital and death records. A causal mediation analysis was performed for anxiety disorder and depression separately examining multiple potential lifestyle (physical activity, TV viewing, diet quality, smoking status and sleep duration), physical (waist-hip ratio, body mass index, and grip strength), and metabolic mediators (systolic blood pressure, haemoglobin A1c, low-density lipoprotein-cholesterol, and C-reactive protein), adjusted for sociodemographic confounders (sex, age, ethnic group, and deprivation level). Cox proportional hazard models and modified quasi-Poisson models were used to derive indirect effect estimates and proportions mediated. Subsequently, the parametric g-formula was used to investigate whether upstream factors (e.g., lifestyle factors) bias downstream mediators (e.g., physical and metabolic factors) as exposure-affected confounders.

Results

Of more than 500,000 UK Biobank participants, 254,695 participants were included, of whom 53.6% were female, with a mean age (standard deviation) of 56.6 (8.1) years (Figure 1). The strongest lifestyle and physical mediators were current smoking and higher waist-hip ratio which accounted for 12.2% and 12.8% of the excess risk from anxiety disorder, and 17.2% and 13.8% from depression, respectively (Figure 2). The strongest metabolic mediators were systolic blood pressure for anxiety disorder (10.2%) and C-reactive protein (10.7%) for depression. Systolic blood pressure was the weakest mediator for depression (4.0%). Adjusting for exposure-affected lifestyle factors only slightly lowered all estimates and little changed overall trends, suggesting mediating roles of physical and metabolic factors were independent of lifestyle factors. Similarly, mediating roles of metabolic factors were independent of any physical factors.

Conclusions

Lifestyle and physical pathways to incident cardiovascular disease may be common to both anxiety disorder and depression, but shared metabolic pathways seem unlikely. Our findings inform which risk factors to target among people with anxiety disorder or depression in order to reduce their higher risk of developing cardiovascular disease.  Bar chart of proportions mediated.
Potentially avoidable hospitalizations for diabetes in Switzerland
Authors: Maung K , Gouveia A L E X , Mauron C H A R L È , Marques-Vidal P E D R O
Published: June 2024

Background

Timely and appropriate outpatient care can prevent potentially avoidable hospitalizations (PAH) for diabetes. We analysed the trends, determinants, and consequences of PAH for diabetes in Switzerland over two decades.

Methods

Hospital discharge data for years 1998 to 2018 were used. PAH were defined according to the Organization for Economic Cooperation and Development criteria.

Results

Overall, 90,853 admissions were considered as PAH, of which 25,376 (27.8%), 9,789 (10.8%) and 55,688 (61.4%) represented uncontrolled diabetes, short-term and long-term complications, respectively. The number of PAH increased from 2,600 in 1998 to 5,730 in 2018, mostly due to long-term complications. Compared to PAH for long-term complications, admissions for uncontrolled diabetes and short-term complications were more frequently women, in the younger age categories, more frequently non-Swiss, without health insurance, were more frequently admitted in an emergency setting, at the patient’s initiative or via emergency services (ambulance, police), and had a lower comorbidity index. PAH for uncontrolled diabetes and short-term diabetic complications were more frequent in the non-German speaking regions. Patients with PAH for short-term diabetic complications were more frequently admitted to the intensive care unit, and their length of stay was shorter. In 2018, PAH for diabetes represented 56,255 days, corresponding to 155 hospital beds occupied yearly, and an estimated cost of 76 million CHF.

Conclusion

In Switzerland, the number PAH for diabetes increased during the period 1998-2018. PAH types differ according to geographic region and to the patient’s characteristics, and a sizable fraction is related to uncontrolled diabetes or likely preventable short-term complications.
Efficacy of oral hypolipidemic therapies in a real world population
Authors: Garcia A , Martins A , Oliveira C , Abrantes A , Raposo M , Gregorio C , Alves Da Silva P , Cunha N , Aguiar Ricardo I , Abreu A , Pinto F
Published: June 2024

Introduction

Hypolipidemic therapies are a cornerstone in the management of patients (pts) after an acute ST segment elevation myocardial infarction (STEMI). The efficacy of such therapies is based on clinical trials where pts are highly selected and closely monitored, perhaps not entirely reflecting a real world scenario.

Purpose

To evaluate efficacy of hypolipidemic therapy in a real world population of young pts with STEMI from an intermediate CV risk country.

Methods

Retrospective, single-center study of consecutive pts, aged below 50 years, who were admitted with STEMI and discharged under hypolipidemic therapy, between 2017 and 2021. Demographics, clinical characteristics, and outcomes were analyzed. Parametric and non-parametric tests were performed as appropriate.

Results

We included 306 pts, 81.7% men, mean age was 43.9 years, 52% had hypertension, 76% dyslipidemia, 20% diabetes, 70% were smokers and 63.8% were overweight. Most pts had one vessel disease, mainly anterior descending coronary artery.

Only 26pts were previously under statin therapy; at discharge, 63% of pts received high intensity statin, 33% moderate intensity and 4% ezetimibe concomitantly. During a mean follow-up (FUP) of 3.8 years, 35% of pts intensified medication, 55% received high intensity statin and 22% combination of high intensity statin and ezetimibe.

Patients under high intensity statin presented a significant reduction of cLDL (119±39 vs 82±33, p<0.001) with a mean reduction of 30±41% - 20 percentual points inferior to the expected average reduction of 50%. Furthermore, only 26% of pts presented a 50% reduction of baseline cLDL and only 21.5% met the cLDL<55mg/dl goal. Similarly, when analyzing pts under high intensity statin plus ezetimibe, a significant cLDL reduction was observed (118.7±33.5 vs 69.9±49.8, p=0.004), with an average reduction of 33±48%. Only 23.7% of these pts reached cLDL goal and 27% reduced cLDL above 50%.

During FUP 19 pts had a second coronary event, of these 21% were under high intensity statin strategy and 47.4% high intensity statin plus ezetimibe. Statin intolerance was present in only 2 pts and rhabdomyolysis was not reported. .

Conclusion

In this real-world population hypolipidemic therapy proved to be safe and effective in lowering cLDL, however average reduction was inferior to the one previously reported. Early up titration and aggressive LDL control with PCSK9i or inclisiran has to be implemented such as lifestyle measures.
The association between the remnant cholesterol and non-HDL-C with subclinical carotid atherosclerosis in patients with metabolic syndrome
Authors: Kostic S , Djordjevic D , Tasic I , Deljanin Ilic M , Stoickov V
Published: June 2024

Objective

This study evaluated the association between RC and Non-HDL-C with subclinical carotid atherosclerosis in patients with metabolic syndrome (MetSy) without cardiovascular disease.

Method

The study included 130 participants, without manifested cardiovascular disease. The patients were divided into 2 groups. The first group consisted of subjects with MetSy, n=65 (mean age: 53,92±8,36), the second group is control, without MetSy, n=65. For all patients was determined: presence of risk factors for cardiovascular disease (hypertension, hyperlipidemia, smoking, diabetes, obesity), laboratory analysis and anthropometric measurements. The carotid artery intima-media thickness and carotid atherosclerotic plaques were measured by B-mode ultrasound. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol (TC). RC was calculated by subtracting LDL-C and HDL-C from TC.

Results

C-IMT were significantly higher in the group with MetSy (0,80±0,21 vs. 0,64±0,12, p<0,001). The high C-IMT values (≥0.90) were observed in 26% patients with MetSy, p<0,001. Patients with MetSy had more frequently one or more carotid plaques (p<0,001), higher average number of carotid plaques (p<0,001) and percentage of stenosis (p<0,001). In MetSy group plaques were mostly fibrocalcified (28%), followed by fibrous (22%) and calcified, in non MetSy group were fibrous (14%). Subjects with MetSy had higher values of glycemia and glycated hemoglobin (HgA1C) in serum, higher levels of lipid parameters – total cholesterol, LDL-C, oxidized LDL-C, Non-HDL-C (5,70±1,31 vs. 4,59±1,07, p<0,001), Remnant-C (1,21±0,75 vs. 0,55±0,31, p<0,001) and triglycerides and lower values of HDL cholesterol (p<0.001). Univariate regression analysis showed that C-IMT was significantly associated with lipid paremeters: Remnant-C (p<0,05), oxidized LDL-C (p<0,05), triglycerides (p<0,01), HDL-C (p<0,001), glycemia and HgA1C (p<0,001). As the most important factors associated with carotid plaque regression analysis singled out: TC (p<0,05), LDL-C (p<0,05), Non-HDL-C (p<0,01), Remnant-C (p<0,1), HDL-C (p<0,01), HgA1C (p<0,05).

Conclusions

Our study showed a significant association between the RC and carotid intima-media thickness in patients without clinically evident cardiovascular disease. Elevated Non-HDL-C was associated with the presence of carotid plaques.
Cross-sectional associations between device-measured physical activity and atrial fibrillation
Authors: Heitmann K A , Loechen M L , Johansen K R , Morseth B
Published: June 2024

Background

Atrial fibrillation (AF) may lead to thrombosis and increased risk of stroke, myocardial infarction, heart failure, and premature death. AF increases substantially with age, and estimates indicate that one in three individuals ≥55 years in Europe will develop AF. Physical activity (PA) may contribute to the prevention of AF, as it improves overall cardiovascular health. However, the positive effect of PA on AF is mainly based on subjective self-reports of PA and the pattern of the association is still unclear. To our knowledge, few studies have so far examined the association between accelerometry-measured PA and AF.

Purpose

The aim of this study is to explore the association between accelerometry-measured PA and self-reported AF.

Methods

The seventh survey of a large population-based study was conducted in 2015-2016 and included 21083 men and women aged ≥40 years (65% attendance). Of these, a random sample of 5194 participants wore a triaxial accelerometer for at least ≥10 hours/day for ≥4 days to measure PA, in addition to having valid data on all covariates. Based on validated cut-points, the counts were averaged and categorized into moderate-to-vigorous PA (MVPA, ≥2690 counts/min). Steps were collected from accelerations on the vertical axis. AF was self-reported and dichotomized into no AF or current/previous AF. The associations between PA and AF were estimated by univariable and multivariable logistic regression analyses and are presented as odds ratio (OR) with 95% confidence intervals (CI). The multivariable model was adjusted for age, sex, body mass index, systolic blood pressure, alcohol, heart attack, and heart failure. The present study was approved by the Regional Committee of Health Research Ethics and was carried out in accordance with the Declaration of Helsinki.

Results

In an unadjusted model, the odds of having AF was reduced with 10% for every 10-minute increase in MVPA/day (OR 0.90, 95% CI 0.87-0.94), and 13% for every 1000 steps/day (OR 0.87, 95% CI 0.84-0.90) in a linear association. After adjustment, there was no significant association between MVPA and AF (OR 0.97, 95% CI 0.93-1.01), whereas the odds of having AF was reduced by 5% for every 1000 steps/day (OR 0.95, 95% CI 0.91-0.998) in a linear association. When stratified by sex, the odds of having AF was reduced by 10% for every 1000 steps/day in females (OR 0.90, 95% CI 0.84-0.97) in a linear association, whereas no statistical association between steps/day and AF was observed in males (OR 0.98, 95% CI 0.93-1.04), or between MVPA and AF in females (OR 0.94, 95% CI 0.87-1.02) or males (OR 0.99, 95% CI 0.94-1.03).

Conclusion

These results from a large population-based study showed that the odds of having AF decreased as the dose of PA increased, although not significantly in males. Further studies exploring longitudinal associations between PA and AF using objectively measured PA are warranted.
Prevalence of non-cardiometabolic chronic conditions between sexes in patients enrolled in cardiac rehabilitation
Authors: Gomes P , Miller S A , Chacin-Suarez A , Olson T P
Published: June 2024

Background

Patients enrolled in cardiac rehabilitation (CR) demonstrate a greater burden of co-occurring chronic conditions (CC) compared to the general population. Studies have shown that the prevalence of multimorbidity among noninstitutionalized, civilian US adults is higher among women compared to men. These CC are often grouped and categorized as Cardiometabolic, Somatic, and Mental Health based on the origin and organ system the condition affects. Importantly, sex differences between categorizations of CC in patients undergoing CR has not been examined.

Purpose

Because patients enrolled in CR are known to have multiple Cardiometabolic conditions, the aim of this study is to examine sex differences in the prevalence of non-cardiometabolic conditions in the CR population.

Methods

We extracted data on all 21 CC defined by the US Department of Health and Human Services using the local Epidemiology Project records-linkage system. Our study population included participants who attended (≥1) CR sessions from 1995 to 2019. The CC were categorized into cardiometabolic (CMC), Somatic, and Mental health groups (Table 1), and as CMC only, CMC + Somatic only, CMC + Mental health only, and CMC + Somatic + Mental health groups (Table 2). The sex differences in the number of CC within these groups were analyzed by Kruskal-Wallis test and prevalence were analyzed by Pearson’s Chi-squared test, where p<0.05 was significant.

Results

We identified 13,056 CR patients (68.5% males) who were ≥18 years old with a mean age of 65.7±12.7 yrs (67.6±13.6 yrs in females and 64.8±12.1 yrs in males). Median [Q1, Q3] number of CC was 7 [5,9], with females having a greater number (7 [5, 9]) than males (6 [5,8]), p<0.001. Both sexes had at least 1 CMC with a median of 5 [3,5] CMC and no differences between sexes (p>0.05); however, females demonstrated more somatic and mental health conditions compared to males (p<0.001, for both, Table 1). When grouping categories of CC, females demonstrated a higher number of CC in CMC + Somatic + Mental health as well as CMC + Somatic only groups (p<0.001, for both, Table 2), with a higher prevalence in the former group only. While the number of CC in CMC + Mental health group was similar between sexes, the prevalence was lower in females. In contrast, the CMC only grouping demonstrated a higher number of CC and prevalence among males (p<0.05).

Conclusion

Our data suggest that females enrolled in CR demonstrate a significantly higher number of CC compared to males. Although males have a higher prevalence of CMC, the prevalence of Somatic ± Mental health conditions in addition to CMC is significantly greater in females. These data demonstrate the importance of considering sex differences in the prevalence of non-CMC when formulating individualized treatment plans for CR patients.