bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of blood pressure lowering treatment on the risk of atrial fibrillation: an individual-participant data meta-analysis
Authors: Pinho-Gomes A.C , Azevedo L , Copland E , Canoy D , Nazarzadeh M , Remakrishnan R , Berge E , Sundstrom J , Kotecha D , Woodward M , Rahimi K
Published: November 2020

Background

Although observational studies have suggested an association between elevated blood pressure (BP) and increased risk of atrial fibrillation (AF), randomised evidence on the effects of pharmacological blood pressure lowering on the risk of new-onset AF remains limited.

Purpose

To investigate the effects of pharmacological BP lowering on the risk of AF overall and stratified by baseline risk of AF and by drug class.

Methods

We extracted individual participant data from trials with over 1,000 person-years of follow-up that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs vs placebo, or to more vs less intensive BP-lowering regimens. We investigated the effects of BP lowering on the risk of new-onset AF using fixed-effect one-stage individual participant data meta-analyses based on Cox proportional hazards models stratified by trial.

Results

Twenty-one trials were included with a total of 194,041 patients, in whom 6,357 new-onset and 516 recurrent AF events were recorded. The hazard ratio for new-onset AF was 1.01, 95% CI [0.95–1.07] per each 5-mmHg reduction in systolic BP, and meta-regression suggested that treatment effects were similar irrespective of the intensity of systolic BP reduction. Patients were overall at low risk of AF at baseline (median 2.3%, IQR [1.2–3.4%] at 5 years), and there was no evidence of heterogeneity in treatment effects across thirds of risk and 10-mmHg strata of baseline systolic BP (Figure). There was also no clear evidence that treatment effects differed between drug classes when renin-angiotensin-aldosterone system inhibitors and calcium channel blockers were compared with placebo and/or standard treatment.

Conclusion

In a low-risk population, pharmacological BP lowering did not reduce the risk of new-onset AF. Further research is needed to understand whether the effects would be different in high-risk individuals, and to better clarify the existence of class-specific effects.

Figure 1. Forest plot

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Angiotensin receptor blockers and mineralocorticoid receptor antagonists therapy reaches better central haemodynamic parameters and avoid the episodes of atrial fibrillation
Authors: Paterno Marchioli C.A
Published: November 2020

Introduction

The goal of antihypertensive therapy is to prevent complications. The harmful effects of aldosterone are innumerable: induced cardiac/renal fibrosis, sodium and water retention, inflammation, oxidative stress, among others, that are involved in arterial/myocardium stiffness, remodelling, heart failure and new-onset atrial fibrillation (AF). Thiazide diuretics can activate the neurohormonal system, impair glucose metabolism, increase new-onset diabetes, and are potentially arrhythmogenic. Protective effect of Angiotensin Receptor Blockers (ARB) on major cardiovascular events might be partly independent of the degree of blood pressure reduction. Mineralocorticoid Receptor Antagonists (MRA) therapy reduce arterial stiffness, plasma volume, collagen/elastin ratio and vascular/myocardial fibrosis.

Purpose

The objective was to assess the levels reached in central haemodynamic parameters (CHP) and the presence of episodes of AF during ARB+hydrochlorothiazide (Hct) versus ARB+MRA therapy in hypertensive patients with normal kidney function.

Methods

For this cross-sectional retrospective study, data were entered from 108 hypertensive patients, female 62 (ARBs+MRA/ARB+Hctz average age 67/71), male 46 (average age ARB+MRA/ARB+Hctz 67/71), both p=ns). The average doses of Hct among female/male were 16/19 mg and the duration of the ARB+Hctz therapy were 37/47 months, while the ARB+MRA therapy were 36/49 months. 24-hours Holter monitoring was used in all patients. The group ARB+MRA before therapy had a history of AF episodes. The CHP (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure, Augmentation Index) were registered by the SphygmoCor System PVX (AtCor-Medical, Australia), according system's standard methods. Also was measured the difference between the normal levels, and the observed values of Augmentation Index (Diff-AIx) according age.

Results

The results of CHP, Diff-AIx, systolic and diastolic blood pressure during association of ARB+MRA therapy compared to ARB+Hct, both genders, showed the lowest values with a highly statistically significant difference. The episodes of AF during 24-hours Holter monitoring in the group ARB+Hct therapy in female/male were 55%/71%; instead, in the ARB+MRA treated they were not found.

Conclusions

These findings suggest that the dual block with ARB+MRA therapy giving better CHP, reducing the stress to arterial-ventricular coupling, it could be helpful to prevent, the harmful effects of angiotensin-aldosterone system such as the development of heart failure and atrial fibrillation.

Funding Acknowledgement

Type of funding source: None
Electrophysiology-based assessment of the procedural success of radiofrequency renal denervation
Authors: Pekarskiy S , Baev A , Mordovin V , Falkovskaya A , Zubanova I , Sitkova E
Published: November 2020

Objective

To assess whether electrode temperature and impedance change that are typically monitored during radiofrequency renal denervation (RDN) for safety reason may also be used as measures of the procedural success of the intervention.

Methods

We conducted a prospective clinical study of the radiofrequency RDN in patients meeting criteria of true resistant hypertension. The RDN treatment included the trunk and major branches of the renal artery. To obtain simple easy-to-use electrophysiology measures of the procedural success of RDN we averaged the maximal values of the temperature and change of impedance across all single treatments with a full duration. Then we assessed the relation of the average change in impedance and average maximal electrode temperature during RDN to blood pressure (BP) lowering 6 month post-procedure using a linear regression analysis. Also, we compared the groups with “successful” and “unsuccessful” procedures according to whether the impedance decreased, on average, ≥10% during RDN, and, alternatively, on whether the average maximal temperature of the electrode was ≥50 C.

Results

Of 65 treated patients 52 with quality recordings of the electrophysiology parameters during RDN completed 6-month follow-up. The mean 24-h systolic BP decreased significantly after RDN by −14.3 mmHg [95% CI: −8.7; −19.9]. The BP lowering was positively and significantly related to the decrease in impedance during RDN, r=0.35, p=0.013 and to less extent to the maximal electrode temperature, r=0.29, p=0.044. The 10% average drop in impedance predicted -9.9 mmHg decrease in 24-h mean systolic BP. According to group analysis the decrease of mean 24-h systolic BP was powerful in those with average decrease in impedance ≥10% during RDN (“successful” procedure), but almost zero otherwise: −19.9 [95% CI: −13.7; −24.5] vs −0.5 [95% CI: −11.9; 12.9] mmHg, respectively (raw estimates), p=0.003. The difference in BP lowering was less pronounced and non-significant when the procedural “success” was defined according to the average maximal electrode temperature.

Conclusions

The impedance decrease during radiofrequency RDN treatment may be an effective criterion of the procedural success of the intervention. Guiding radiofrequency RDN by the impedance drop 10% or greater may significantly improve the efficacy of the procedure.

Funding Acknowledgement

Type of funding source: None
Effect of short-term exposure to indoor particulate matter on noctunal blood pressure dipping among hypertensive adults in ibadan: a pilot study
Authors: Adeoye A.M , Fakunle A , Aderonmu O , Tayo B
Published: November 2020

Introduction

While blunted nocturnal blood pressure is a major risk factor for cardiovascular events, limited information exist on the association between indoor particulate and circadian blood pressure variation. We report the association of short-time exposure to PM2.5 and PM10 with blunted nocturnal blood pressure among hypertensive adults in Ibadan.

Purpose

This study was to determine the association between short time exposure to air particulates and blunted nocturnal blood pressure among people of African descent.

Methods

We conducted a cross-sectional study among fifty hypertensive cases attending our University College Hospital. A 24-hours blood pressure (BP) monitoring was carried out at the same time as indoor particulate matter monitoring in their homes. Exposure to indoor fine particles (PM2.5) and thoracic particles (PM10) was estimated using a real-time particle counter and compared to the World Health Organization (WHO) 24-hours threshold of 25 μg/m3 and 50 μg/m3 for PM2.5 and PM10 respectively. All monitoring was carried out over a 24-hours period during the wet season. Linear regression model was fitted to determine predictors of non-dipping hypertension.

Results

Of the 50 hypertensive patients studied, 5 (10.0%), 39 (78.0%), 6 (12.0%) were reverse dippers, non-dippers and dippers respectively. The mean indoor PM2.5 (44.17±19.18 μg/m3) and PM10 (60.10±27.13 μg/m3) among the non-dippers were significantly higher than values obtained among dippers (PM2.5 = 22.97±10.19 μg/m3; PM10 = 29.51±12.74 μg/m3); p<0.0001, and the WHO threshold limit. More non-dippers than dippers (54.5% vs 37.8%) used unimproved fuel such as firewood for cooking. PM10 was an independent predictors of non-dipping status in our regression analysis.

Conclusion

Short-term exposure to indoor PM air pollution was associated with blunted nocturnal blood pressure. Therefore air pollution reduction strategies through improved cooking pattern is advocated in order to prevent future cardiovascular events.

Funding Acknowledgement

Type of funding source: None
Clinical genetics involved in monogenic forms of hypertension in Chinese patients with early-onset hypertension and hypokalemia
Authors: Fan P , Zhang D , Yang K.Q , Zhang Y , Lu Y.T , Luo F , Tian T , Liu Y.X , Zhou X.L
Published: November 2020

Background

Monogenic forms of hypertension are regarded as a group of conditions characterized by early-onset and resistant hypertension, electrolyte imbalance. These alterations stem from single mutations that lead to maladaptive excretion of potassium, and consequent hypokalemia.

Purpose

This study aimed to analyze genes involved in monogenic forms of hypertension and clinical features in Chinese patients with early-onset hypertension and hypokalemia.

Methods

A total of 129 unrelated Chinese patients (89 male and 40 females; average onset age of hypertension 25±5 years) with early-onset hypertension and hypokalemia. Patients with hypertension secondary to common causes, including renal disease and renovascular disease, aortic diseases, and obstructive sleep apnea were excluded. Genomic DNA were extracted from peripheral blood leucocytes of each subject. Using next-generation sequencing, we targeted and sequenced 42 genes related to monogenic forms of hypertension. All rare variants were confirmed by Sanger sequencing.

Results

We detected 63 rare variants in 23 genes in 52 patients (40.3%). The variants in genes associated with pseudohypoaldosteronism, familial aldosteronism, pheochromocytoma or paraganglioma, and pseudohyperaldosteronism accounted for 22.2%, 23.8%, 20.6% and 11.1% respectively. Patients with rare variants had a significantly lower serum potassium (2.94±0.21 vs. 3.30±0.24 mmol/L, P<0.001) and family history of hypertension (67.3% vs. 31.2%, P<0.001). During 24±7.9 months of follow-up, several complication occurred, including stroke in 22 patients, coronary heart disease in 10, and chronic renal failure in 10. Factors associated with stroke were carrying rare variants (HR=4.371, 95% CI: 1.709–11.181, P=0.002), systolic blood pressure (HR=1.015, 95% CI: 1.004–1.037, P=0.015).

Conclusions

This study revealed a wide genetic spectrum in Chinese patients with early-onset hypertension and hypokalemia. Genetic testing helps to differentiate the diagnosis of monogenic forms of hypertension in patients with hypertension and hypokalemia, and evaluates prognosis. Those patients carrying rare variants presented with a high risk of severe complications, stroke and needed close follow-up.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): CAMS Innovation Fund for Medical Sciences; the National Key Research and Development Program of China
Prediction of 10-year and lifetime risk of cancer in individual patients with established cardiovascular disease, results from UCC-SMART and CANTOS
Authors: Van 't Klooster C.C , Ridker P.M , Cook N.R , Aerts J.G.J.V , Westerink J , Asselbergs F.W , Van Der Graaf Y , Visseren F.L.J
Published: November 2020

Background

As treatment for cardiovascular disease (CVD) has improved substantially over the last decades, more patients survive acute CVD manifestations and are at risk for developing cancer as well as recurrent CVD. Due to similar risk factors, including smoking and obesity, patients with established CVD are at higher risk for cancer.

Objectives

The aim of this study was to develop and externally validate prediction models for the estimation of 10-year and lifetime risk for total, colorectal, and lung cancer in patients with established CVD.

Methods

Data from patients with established CVD from the UCC-SMART prospective cohort study (N=7,280) were used for model development, and data from the CANTOS trial (N=9,322) were used for model validation. Predictors were selected based on previously published cancer risk prediction models or cancer risk factors, easy clinical availability, and availability in the derivation dataset (UCC-SMART cohort). A Fine and Gray competing risk-adjusted lifetime model was developed for total, colorectal, and lung cancer.

Results

Selected predictors were age, sex, smoking status, weight, height, alcohol use, antiplatelet use, diabetes mellitus, and C-reactive protein. External calibration for 4-year risks of the total cancer, colorectal cancer, and lung cancer models was good (Figure 1), and C-statistics were 0.63–0.74 in the CANTOS trial population. Median predicted lifetime risks in CANTOS were 26% (range 1%-52%) for total cancer, 4% (range 0%-13%) for colorectal cancer, and 5% (range 0%-37%) for lung cancer.

Conclusions

Lifetime and 10-year risk of cancer can be estimated with easy to measure variables in patients with established CVD, showing a wide distribution of predicted lifetime risks for total cancer and lung cancer. Using these lifetime models in clinical practice could increase understanding of cancer risk and aid in emphasizing healthy lifestyle changes.

Figure 1. Calibration plots of cancer models

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): University Medical Center; Additional funding: CANTOS trial was funded by Novartis Pharmaceuticals.
Malaria and cardiovascular disease: a systematic review
Authors: Holm A , Gomes L.C , Biering-Soerensen T , Silvestre O , Brainin P
Published: November 2020

Background

Myocardial tissue appears to be a favored site for the malaria parasite, and several studies have suggested that malaria may lead to myocardial dysfunction. Therefore, we conducted a systematic review of clinical studies reporting on malaria and cardiac disease.

Methods

We searched PubMed and Embase through January 2020. We applied strict inclusion criteria (Figure 1A) and assessed studies reporting on verified cardiac disease by paraclinical tests, ECG, cardiac biomarkers and echocardiographic findings. Two reviewers independently screened articles, extracted data and assessed the PRISMA guidelines.

Results

Twenty-eight articles were identified (published 1954–2020; n=19 case-reports, n=5 cohort studies, n=4 cross-sectional studies; Figure 1B), of which most were conducted in India (n=11) and Germany (n=4). The studies included a total of 2,221 malaria cases (mean age 42 years; 67% men; 41% complicated infection) and the distribution of species were: Plasmodium falciparum (n=15), vivax (n=12) and knowlesi (n=1). The most commonly reported cardiac diagnoses in case-reports were myocarditis (n=9), pericarditis (n=3) and acute myocardial infarction (n=4). Although the cohort and cross-sectional studies reported on different cardiac parameters (Figure 1C), a majority showed that malaria cases more often had elevated levels of cardiac biomarkers, ECG alterations and reduced left ventricular ejection fraction when compared to controls (P<0.05 for all).

Conclusion

Studies reporting on malaria and cardiovascular disease display considerable heterogeneity in terms of study design, severity and outcome measurements. Despite this, the included studies demonstrate a potential link between malaria and cardiac disease. This should be explored in future and larger hypothesis generating clinical studies.

Figure 1

Funding Acknowledgement

Type of funding source: None
The association between napping and the risk of cardiovascular disease and all-cause mortality: a systematic review and dose-response meta-analysis
Authors: Pan Z , Huang M , Huang J , Yao Z
Published: November 2020

Background

Napping is a habit prevalent worldwide and occurs from an early age. Some sleep specialists have suggested it as a potential public health tool due to the prevalence of sleep disorder. However, the association between napping and the risk of cardiovascular disease (CVD) and all-cause mortality remains unclear.

Purpose

To assess the association between napping and the risk of CVD and all-cause mortality.

Methods

We conducted a systematic search of Medline, Embase and Cochrane databases from inception through December 2019 for prospective cohort studies investigating the association between napping and the risk of CVD and/or all-cause mortality. Overall estimates were calculated using random effect models with inverse variance weighting. Dose-response meta-analysis was performed using restricted cubic spline models. The results were reported as hazard ratio (HR) and 95% confidence interval (CI).

Results

A total of 313651 participants (57.8% female, 38.9% took naps) from 20 cohort studies were included in the analysis. Overall, pooled analysis detected no association between daytime nap and CVD (HR 1.13, 95% CI 0.99–1.28). However, in subgroup analysis including only participants who were female (HR 1.31, 95% CI 1.09–1.58), older (age>65 years) (HR 1.36, 95% CI 1.07–1.72), or took a longer nap (nap time>60 minutes) (HR 1.34, 95% CI 1.05–1.63), napping was significantly associated with a higher risk of CVD comparing to not napping. All-cause mortality was associated with napping overall (HR 1.19, 95% CI 1.12–1.26), and effect sizes were even more pronounced in females (HR 1.22, 95% CI 1.13–1.31), older participants (HR 1.27, 95% CI 1.11–1.45) and those who took a long nap (HR 1.30, 95% CI 1.12–1.47). Furthermore, after stratifying participants by night sleep time (<6 and >6h/day), no significant association was detected except those who slept >6h/day at night and took a long nap (HR 1.13, 95% CI 1.03–1.24). Dose-response analysis showed a J-curve relation between nap time and CVD (Figure 1). The HR decreased from 0 to 25 min/day, followed by a sharp increase in the risk at longer times. A positive linear relationship between nap time and all-cause mortality was also observed.

Conclusion

Long napping over 60 minutes per day is associated with increased risks of CVD and all-cause mortality. Night sleep duration may play a role in the relation between napping and all-cause mortality. Further, large-scale prospective cohort studies need to confirm our conclusion and investigate the underlying mechanisms driving these associations.

Funding Acknowledgement

Type of funding source: None
Poor attainment of blood pressure, lipids and diabetes targets in people at high cardiovascular risk in Europe: a report from the ESC-EORP EUROASPIRE V Survey in 16 European countries
Authors: Kotseva K , De Backer G , De Bacquer D , Grobbee D , Hoes A , Jennings C , Maggioni A , Marques-Vidal P , Ryden L , Wood D
Published: November 2020

Introduction

The EUROASPIRE V survey in primary care was carried out by the European Society of Cardiology, EURObservational Research Programme in 2017–2018 and investigated the risk factor management in patients at high cardiovascular (CVD) risk in16 European countries.

Purpose

To provide an audit the implementation of the 2016 Joint European Societies' guidelines on CVD prevention in people at high risk of developing CVD in primary care and to see whether the practice of preventive cardiology had improved by comparison with the previous EUROASPIRE IV survey in 2014–2015.

Methods

All patients were free of coronary or other atherosclerotic diseasebut considered at high CVD risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy.

Results

2,759high CVD risk individuals (58% females), mean age 59 (SD 12) years, were interviewed and examined (participation rate 70%). The risk factor control was very poor, with less than half (47%) of patients on blood pressurelowering medication reaching the target of <140/90 mmHg (<140/85 mmHg in people with self-reported diabetes). Among treated dyslipidaemic patients only 47% attained LDL-cholesterol target of <2.6 mmol/L. Among treated type 2 diabetic patients, 65% achieved the HbA1c target of <7.0mmol/L. However, many patients on no antihypertensive or lipid-lowering medications had elevated blood pressure (43%) and elevated LDL-cholesterol (81%), respectively. The use of blood pressure lowering medication in people with hypertension was: ACE inhibitors/ARBs 79%, beta-blockers 37%, diuretics 36% and calcium channel blockers 32%; with 42% on one, 34% on two, 18% on three and 6% on ≥4 blood pressure lowering drugs. Among people on lipid-lowering medication, statins were prescribed in 97% and fibrates in 3%. Less than two-thirds of patients reported complete adherence with the intake of their blood pressure and lipid-lowering medications. The comparison with EUROASPIRE IV in the same centres that took part in both surveys showed no change in the BP management. There was a slight improvement in the control of LDL-cholesterol and glucose in patients with diabetes.

Conclusions

The results of EUROASPIRE V clearly demonstrate that the control of blood pressure, LDL-cholesterol and diabetes in patients at high CVD risk remains poor with large proportions not achieving the targets defined in the prevention guidelines. There is a considerable potential to raise the standards of preventive cardiology and to improve the management of patients at high CVD risk in Europe.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): European Society of Cardiology
Omega-6 fatty acids and risk of cardiovascular disease: insight from systematic review and meta-analysis of randomized controlled trials and a mendelian randomization study
Authors: Mazidi M , Shekoohi N , Katsiki N , Banach M
Published: November 2020

Background

Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in the Western countries. Their effects on several cardiovascular (CV) risk factors are still controversial.

Purpose

We performed a systematic review and meta-analysis of randomized control trials (RCTs) as well as a Mendelian randomization (MR) analysis to evaluate the links (or possible causality) between supplementation or serum levels of omega-6 PUFA, CV disease (CVD) and cardiometabolic risk factors.

Methods

Selected databases were searched until 31 August 2019 to identify prospective studies investigating the effects of omega-6 PUFAs supplementation on CVD events/mortality. Random-effects model meta-analysis was performed for quantitative data synthesis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 20% reduction in outcomes after administration of omega-6 PUFAs. Inverse variance weighted method (IVW), weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied for MR.

Results

In the meta-analysis of 9 studies with 4,433 participants we showed that omega-6 PUFAs supplementation was not associated with CVD event risk - RR 0.94 (95% CI: 0.77–1.15, heterogeneity p=0.031; I2=66.2%, n=4 studies). The pooled estimate (RR) of the effect of omega-6 PUFAs supplementation on CVD death was 1.06 (95% C:I 0.73–1.55, heterogeneity p=0.011; I2=66.2%, n=6 studies), on CHD events 0.84 (95% CI: 0.61–1.16, heterogeneity p=0.001; I2=79.4%), on MI 0.87 (95% CI: 0.74–1.01, heterogeneity p=0.381; I2=2.3%) (Figure), and on stroke 1.36 (95% CI: 0.45–4.07, heterogeneity p=0.082; I2=55.3%). In MR analysis we showed that individuals with genetically higher serum adrenic acid (AA; 22:4, n-6) levels had a greater risk of CHD events (IVW=Beta: 0.526, p=0.007), MI (IVW=Beta: 0.606, p=0.017) and stroke (IVW=Beta: 1.694, p=0.009), as well as higher levels of FBG (IVW=Beta: 0.417, p=1.0x10–3), LDL-C (IVW=Beta: 0.806, p=4.9x10–5), HDL-C (IVW=Beta: −0.820, p=4.3x10–17), whereas lower levels of TG (IVW=Beta: −1.064, p=1.2x10–12) and TC (IVW=Beta: −1.064, p=1.2x10–12).

Conclusions

In the pooled analysis different omega-6 PUFAs supplementation did not affect the risk of MI, stroke and CHD event/mortality or the serum concentration of cardiometabolic parameters (data not presented), however in MR analysis, higher AA levels significantly associated with the risk of CHD, MI and stroke, as well as with elevated levels of FBG, LDL-C and HDL-C and reduced levels of TC and TG. There is probably lack of class effect for omega-6 PUFAs, therefore further studies are needed to assess the effects of omega-6 PUFAs on cardiometabolic outcomes.

Funding Acknowledgement

Type of funding source: None
Severity of depression and its relationship with the parameters obtained in the cardiopulmonary exercise test in patients of a cardiac rehabilitation program
Authors: Ruiz Avalos J.A , Ortiz Calderon C.M , Rojano Castillo J , Ilarraza Lomeli H
Published: November 2020

Background

Cardiovascular diseases are the leading cause of global morbidity and mortality. Depression causes specific disorders such as autonomic nervous system dysfunction, neurohormonal axis imbalance, proinflammatory and prothrombotic states. The alteration profiles in the parameters measured in the cardiopulmonary exercise testing (CPET) associated with the different severities of depression have not yet been characterized.

Purpose

To determine the association of the degree of depression and the parameters obtained in the CPET in patients undergoing a cardiac rehabilitation program.

Methods

Observational, comparative, cross-sectional, retrospective study of adult patients examined in the period from January 1, 2010 to December 31, 2017. Independent variables were degrees of depression according to Beck depression inventory, dependent variables were parameters reported in the CPET. Categorical variables were reported in frequency and continuous variables as averages. The comparison between groups was made with x2, T test, ANOVA according to type and number of variables and their distribution. Pearson's correlation to determine association.

Results

From a total of 594 patients: 490 were men (82.4%), age 57.34±11.3. Maximum METs 7.49±2.42, heart rate (HR) response (percentage of theoretical maximum heart rate achieved) 82.79±12.69 and systolic blood pressure response (SBP) (ratio of peak SBP to resting SBP) 1.29±0.18. Bivariate analysis found significant differences between Beck's depression scale and study variables: Male (p<0.0001), married (p=0.022), diabetes (p=0.012), surgical revascularization (p=0.05), use of angiotensin II receptor antagonists (p=0.027).

Conclusions

The present study found association of depressive symptoms with male gender, married marital status, diabetes, surgical myocardial revascularization and treatment with angiotensin II receptor antagonists. In the CPET, significant differences were found in exercise tolerance measured by METs, HR response and SBP response between subjects without depression and those with mild and moderate depression.

Depression and Exercise Tolerance

Funding Acknowledgement

Type of funding source: None
Sedentary behaviour in cardiovascular disease patients: risk factor identification and the impact of cardiac rehabilitation
Authors: Van Bakel B.M.A , Bakker E.A , Aengevaeren W.R.M , Meindersma E.P , Snoek J.A , Waskowsky W.M , Van Kuijk A.A , Jacobs M.M.L.M , Hopman M.T.E , Thijssen D.H.J , Eijsvogels T.M.H
Published: November 2020

Background

Cardiovascular disease (CVD) patients typically report low physical activity levels. Therefore sedentary behaviour (SB) is potentially an important target to improve survival and to reduce recurrence risk. However, information about SB in CVD patients is scarce.

Purpose

In this study, we 1) compared SB between CVD patients and age-matched controls, 2) identified patient- and disease characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation on SB.

Methods

For objective 1, we recruited 131 patients and 117 healthy, age-matched individuals. All participants were asked about their general characteristics and medical history. SB was assessed objectively by an accelerometer. For objective 2, 2,584 patients completed a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, SB was examined before, after and 2 months after cardiac rehabilitation among 131 patients using an accelerometer.

Results

Objective 1. Patients spent 10.4 hrs/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 hrs/day [Q25 8.4; Q75 10.29]). Similarly, patients reported more prolonged sedentary bouts (>30 min) compared to controls (5.9 versus 4.8 bouts/day; P<0.001). Objective 2. Patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of sedentary time (>8 hrs/day). Objective 3. Cardiac rehabilitation significantly reduced sedentary time (−0.4 hrs/day [95% CI: −0.7; −0.1]), which remained lower at 2 months after cardiac rehabilitation (−0.3 hrs/day [95% CI: −0.6; −0.03]). In addition, prolonged sedentary bouts decreased significantly after cardiac rehabilitation (−0.4 bouts/day [95% CI: −0.7; −0.1]), but this effect diminished within 2 months after the programme (−0.2 bouts/day [95% CI: −0.5; 0.1]).

Conclusions

CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls, with more frequent engagement in prolonged sedentary bouts. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary cardiac rehabilitation programme slightly reduced sedentary time, but tailored interventions are needed to target the high amount of sedentary time in CVD patients.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation
Survival and factors associated with cardiovascular mortality in rural area of Russia. Results of a 7-year prospective study
Authors: Myrzamatova A , Kontsevaya A , Kashirin A , Sirotko M , Khudyakov M
Published: November 2020

Introduction

In Russia, mortality rates from CVD are one of the highest in the world. In recent decades, it has been demonstrated that the contribution of a modifying risk factors to cardiovascular mortality in different populations can vary significantly.

Aim

To evaluate the 7-year survival and association of risk factors with cardiovascular mortality among rural residents of Russia.

Materials and methods

This study was carried out as part of the international project InterEpid, which included a one-stage epidemiological study of the prevalence of major chronic noncommunicable diseases and their risk factors (n=1050), and a prospective stage among residents of rural areas of Russia. The analysis includes the results of a survey of representative samples of the rural population of the Samara Region of Russian Federation (n=919) aged 20–64, response rate 87,5%.The following endpoints are included in the analysis: 1. Cases of death from all causes; 2. Deaths from CVD.

Results

In Samara region 7-year survival was 92.7%. Cardiovascular diseases were most frequent cause of deaths (42%). Cardiovascular mortality was significantly associated with hypertension RR 2.11 (1.32; 2.94), p=0.004, low physical activity RR 1.82 (1.02; 2.41), p=0.009, high salt intake RR 1.28 (0.84; 2.21), p=0.03 and high processed meat intake RR 1.37 (0.91; 1.93), p=0.03. Smoking had a significant effect on cardiovascular mortality only among men RR 2.11 (1.14; 2.84), p=0.005.

Conclusion

7-year follow up demonstrated significant unfavorable effect of smoking on men's cardiovascular mortality; hypertension, low physical activity, high salt and processed meat intake on the risk of cardiovascular mortality in both sexes in rural areas of Russia. All this underlines the need to develop differentiated preventive and treatment and preventive programs adjusted to country specific of risk factors prevalence and its impact on the prognosis.

7-year survival (Samara region)

Funding Acknowledgement

Type of funding source: None
Real world cardiovascular risk assessment using reduced DAD, SCORE and Framingham equations in a German HIV cohort
Authors: Zhou Q , Usadel S , Kern W , Zirlik A , Mueller M.C
Published: November 2020

Introduction

People living with HIV are at increased risk for cardiovascular disease (CVD). Therefore, prevention of CVD should be integrated in HIV care. Although several risk scores exist to predict the risk of developing CVD, none of this specifically addresses the fact of HIV. Previously, the reduced Data Collection on Adverse Events of Anti-HIV Drug score (D:A:D-R) model has been proposed to assess the CVD risk for HIV patients. However, this score has not been validated in an independent cohort, or compared to traditional CVD prediction models established in the non-HIV population.

Purpose

We aim to compare the predictive value of the CVD risk scores D:A:D-R, SCORE and Framingham CVD in a German HIV population and evaluate their CVD risk in a real world setting.

Methods

This is a prospective, cross-sectional, single center study. Patients with HIV and older than 30 years were enrolled between January 2018 and December 2019. Exclusion criteria were preexisting CVD and statin therapy. CVD risk estimates were calculated using the D:A:D-R, Framingham CVD (FRS), and SCORE models. Agreement between estimates was assessed using Cohen's kappa coefficient. The indication for statin therapy was calculated using the AHA and EACS guidelines.

Results

488 patients with HIV and a median age of 47.8 years were included. Median time since HIV diagnosis was 9.9 years. All, but one Patient were on ART for a median time of 5.9 years. 61% were female. Using the D:A:D-R score, the highest proportion of patients with high or very high risk for CVD were identified (17.8%). In comparison, using SCORE and FRS only 4.7% and 13.7% of patients were identified as high or very high risk, respectively. There was a poor agreement between D:A:D-R and SCORE (k=0.11), and D:A:D-R and FRS (k=0.33). Based on the calculated CVD risk using the three models, indication for primary statin medication varied between 34.8% to 92%.

Conclusion

Our data demonstrate that standard CVD risk scores underestimate the CVD risk in patients with HIV. Using SCORE and FRS, a high proportion of patients with HIV and at high risk for CVD would be underestimated and miss the indication for statin medication. Therefore, using scores including HIV specific parameters should be considered in this patient population.

Funding Acknowledgement

Type of funding source: None
Usefulness of the coronary artery calcium (CAC) score for statin prescription in primary prevention: results in over 16.000 assessments
Authors: Keller M , Silber S
Published: November 2020

Background

The latest AHA/ACC cholesterol guidelines on primary prevention of coronary artery disease (CAD) recommend the use of the CAC-score to help in decision making for not using or using statins: If the CAC-score is 0, it is reasonable to withhold statin therapy (as long as higher conditions are absent). If CAC-score is 1 - 99, it is reasonable to initate statin therapy for patients ≥55 years of age. If the CAC-score is ≥100, it is reasonable to initiate statin therapy. Therefore, in the present analysis, we assessed the impact of these guidelines in everyday cardiology practice.

Methods

We analysed our data base with 16083 assessments of the CAC-score in persons with no known coronary or other cardiovascular disease and no exercise-dependent chest pain or shortness of breath. The CAC-score was determined with a multi-slice CT. Using the “step-and-shoot” acquisition protocol, the average dose was around 1 mSv.

Results

In the total group, a CAC-score of 0 was found in 35%, a CAC-score of >0 up to <100 in 36% and ≥100 in 29%. The percentage of the above mentioned 3 CAC-score groups depending on age and gender are listed in table 1.

Conclusion

With the support of the CAC-score, a prescription of statins can be avoided in up to appr. 60% of middle-aged male and up to appr. 80% of middle-aged female persons. On the other hand, the use of statin is reasonable in appr. two thirds of higher-aged male and one third of higher-aged female persons for primary prevention.

Funding Acknowledgement

Type of funding source: None
The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up
Authors: Cui X.T , Mandalenakis Z , Thunstrom E , Fu M , Svardsudd K , Hansson P.O
Published: November 2020

Background

High resting heart rate (RHR) is associated with increased adverse events. However, the long-term prognostic value in a general population is unclear. We aimed at investigating the impact of RHR, based on baseline as well as time-updated, on mortality in a middle-aged men cohort.

Methods

A random population sample of 852 men, all born in 1913 was followed from age 50 until age 98 with repeated examinations including RHR during 48 years. The impact of baseline and time-updated RHR on cause-specific mortality was assessed using Cox proportional hazards models and cubic spline models.

Results

Baseline RHR ≥90 beats per minute (bpm) was associated with higher all-cause mortality as compared to RHR 60–70 bpm (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.17–2.19, P=0.003), but not with cardiovascular (CV) mortality. A time-updated RHR <60 bpm (HR 1.41, 95% CI 1.07–1.85, P=0.014) and a time-updated RHR of 70–80 bpm (HR 1.34, 95% CI 1.02–1.75, P=0.036) were both associated with higher CV mortality as compared with the RHR of 60–70 bpm after multivariable adjustment. Analyses using cubic spline models confirmed that the association of time-updated RHR with all-cause and CV mortality complied with a U-shaped curve with 60 bpm as a reference.

Conclusions

In this middle-aged men cohort, a time-updated RHR at 60–70 bpm was associated with lowest CV mortality, suggesting that time-updated RHR could be a useful long-term prognostic index in the general population.

RHR and Mortality

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): In recent years, funding has been received from the Swedish state under the agreement between the Swedish government and the county councils relating to the economic support of research and education under the ALF agreement (ALFGBG-721351).
Left atrial reservoir strain in relation to metabolic and inflammatory biomarkers: a community-based study
Authors: Kuznetsova T , Cauwenberghs N , Sabovcik F , Haddad F
Published: November 2020

Background

The pathophysiological mechanisms that underlie progressive left atrium (LA) remodelling and dysfunction are only partially understood. Metabolic disturbances and chronic inflammation might mediate LA dysfunction. To date, population data investigating the contribution of these processes to LA reservoir dysfunction remain scarce.

Purpose

In a large population sample, we investigated the association between LA reservoir function and a panel of 38 metabolic and inflammatory biomarkers.

Methods

In 1236 community-dwelling individuals (mean age, 51.0 years; 51.5% women), we echocardiographically assessed LA reservoir strain (LARS) using 2D speckle-tracking analysis. LA reservoir dysfunction was defined as having LARS <23%. We applied partial least squares-discriminant analysis (PLS-DA) to identify biomarkers associated with LA dysfunction. We further explored the associations between LARS and selected biomarkers that were the most influential in PLS-DA, while adjusting for important clinical correlates such as age, sex, body mass index (BMI), heart rate, systolic blood pressure (BP) and antihypertensive treatment. We applied stepwise regression to identify the clinical features and circulating biomarkers most valuable for prediction of abnormal LARS.

Results

The three latent factors constructed from the panel of 38 biomarkers during PLS-DA explained 16.9% of the variation between the normal and the impaired LA function group. The PLS-DA model discriminated between normal and abnormal LA reservoir strain with 79% accuracy (P<0.0001). In PLS-DA, serum uric acid, serum insulin, γ-glutamyl transferase, interleukin-6, D-dimer and triglycerides were the top biomarkers responsible for class discrimination. On average, these top biomarkers were higher in the LA dysfunction group as compared to their normal counterparts (P<0.0001 for all). In multivariable-adjusted continuous analyses, LARS decreased significantly with the level of serum insulin, serum uric acid and γ-glutamyl transferase (P≤0.0035 for all). Of the clinical correlates and the top biomarkers selected in PLS-DA, stepwise regression models highlighted age, BMI, systolic BP, serum insulin, serum uric acid and interleukin-6 as the main predictors of an impaired LA reservoir function (see figure). Conjointly, these clinical and biochemical features identified LA reservoir dysfunction with an overall accuracy of 85%.

Conclusions

Circulating markers of insulin resistance, hyperuricemia and chronic inflammation were independently associated with impaired LA reservoir function. These markers may help to further unravel the pathophysiological processes behind LA maladaptation and improve the management of early LA dysfunction in the community.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders
Role of lipoprotein(a) and its autoantibodies in polyvascular atherosclerotic disease
Authors: Tmoyan N , Afanasieva O , Ezhov M , Chubykina U , Klesareva E , Afanasieva M , Pokrovsky S
Published: November 2020

Background

Lipoprotein(a) [Lp(a)] is an independent risk factor of cardiovascular disease. The role of Lp(a) and its autoantibodies in the development of atherosclerosis, depending on the severity of lesion, is uncertain.

Purpose

To define the relationship of Lp(a) level and autoantibodies to Lp(a) with atherosclerosis of different vascular beds.

Methods

The study included 1288 patients older than 18 years with instrumental examination of three vascular beds (coronary, carotid and lower limbs arteries). Patients were divided according to the number of affected vascular beds (stenosis ≥50%): 0 (n=339), 1 (n=470), 2 (n=315), 3 (n=164). Levels of lipids, Lp(a) and autoantibodies to Lp(a) were measured in serum of all patients.

Results

Lp(a) concentration steadily increased and the level of IgM autoantibodies decreased with the number of affected vascular beds (Figure). There was no any association between IgG autoantibodies to Lp(a) and stenotic atherosclerosis. In logistic regression analysis adjusted for age, sex, hypertension, diabetes mellitus, smoking, elevated Lp(a) level was an independent predictor of stenotic atherosclerosis and it was associated with severity of lesions (table).

Conclusions

Lipoprotein(a) is an independent risk factor of stenotic atherosclerosis and its concentration increases with the number of affected vascular beds, while IgM autoantibodies to Lp(a) possess cardioprotective properties.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation
Impact of smoking status and smoking cessation after coronary revascularization on long-term clinical outcomes: from a nationwide population-based study
Authors: Ki Y.J , Han J.K , Lee H.S , Chang M.O , Kang J.H , Yang H.M , Park K.W , Kang H.J , Koo B.K , Kim H.S
Published: November 2020

Background

There are many studies on emphasizing the importance of quitting smoking, but the smoking status was based on baseline status without subsequent status. Since a significant percentage of patients who have received coronary revascularization change their smoking status, it is necessary to confirm the clinical consequences of smoking status after revascularization.

Purpose

In this study, we aimed to investigate the impact of smoking status after revascularization on long-term clinical outcomes, using large population based study from the Korean National Health Insurance System.

Methods

Among 74,004 patients who received coronary revascularization (PCI or CABG) from 1 January 2007 to 21 December 2013 and underwent regular health check-up within 2 years after index PCI, examined for death, MI, revascularization and stroke.

Results

Within patients who underwent revascularization, 33,800 (45.7%) of patients were self-reported non-smoker, 28,603 (38.7%) were ex-smoker, 11601 (15.6%) were current smokers at first regular health check-up after revascularization. Current smokers were associated with higher risks for death (HR: 1.497; 95% CI: 1.366–1.641), MI (HR: 1.498; 95% CI: 1.302–1.723) and revascularization (HR: 1.088; 95% CI: 1.018–1.164) than non-smokers. Compared with non-smokers, more than 30PY ex-smokers and current smokers showed higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, MI, revascularization and stroke. Regarding smoking tendency, maintaining non-smokers were lower risk for MACCE than maintaining smokers (Figure 1). Quitters tended to lower MACCE compared to patients who continued to smoke (HR: 0.823; 95% CI: 0.762–0.888). Especially, maintaining non-smokers and quitters significantly showed lower mortality than patients who continued to smoke.

Conclusion

Smoking is associated with poor clinical outcomes after coronary revascularization especially more than 30PY ex-smokers and current smokers. These results also emphasized that smoking cessation after revascularization also important for mortality benefit.

Figure 1

Funding Acknowledgement

Type of funding source: None