bluuebunny/crossref_metadata_2025 huggingface dataset:
KNOWLEDGE ASSESSMENT OF CORONARY ARTERY DISEASE USING THE FILIPINO CORONARY ARTERY DISEASE QUESTIONNAIRE VERSION II, CARARAYAN NAGA CITY BICOL PHILIPPINES
Authors: Pado Mark Angelo , Santy Theo Jay
Published: May 2024

Objective:

The researcher intends to identify these dilemmas in awareness of coronary artery disease at the community level to improve morbidity and mortality rates in the clinical setting significantly. This undertaking is consistent with the principal goal of disease prevention, which is to reduce exposure to health-related risks among Filipinos and empower them to improve their health.

Design and method:

The present study utilized a quantitative descriptive method using the Filipino version of Coronary Artery Disease Education-Questionnaire II, which involved five (5) domains of knowledge: medical condition, risk factors, exercise, nutrition, and psychosocial risk. The translated version of the CADE-Q II has an excellent internal consistency with a Cronbach's alpha of 0.75.

Results:

Respondents included in the study were found to be at low risk for coronary artery disease. Also, the study found that respondents obtained great rating in the medical condition domain. The nutrition domain had an overall acceptable, good, and poor rating based on study participants’ responses. On the other hand, study participants obtained insufficient rating for the exercise domain of the CADE-Q II. Females were found to be more knowledgeable about the medical condition domain of coronary artery disease than male patients. Other domains of the coronary artery disease questionnaire, specifically nutrition, risk factors, exercise, and psychosocial aspects, did not show any statistical significance.

Conclusions:

In low-risk cohort, the clinical importance of adherence to lifestyle modifications to reduce risk factors is recommended. Knowledge assessment on coronary artery disease will significantly impact decision-making for primary prevention and initiation of non-pharmacologic treatment options to decrease the risk of developing cardiovascular diseases in the community. The data indicate that respondents were familiar with coronary artery disease. However, results also showed they had poor knowledge of the importance of nutrition and food to consider and avoid. Regardless of the study participants’ demographic factors, such as age, sex, and educational attainment, they all shared similar ratings on the domains of the coronary artery disease questionnaire, and no variations were observed statistically.
ASSOCIATIONS BETWEEN GENETICALLY PREDICTED PULSE PRESSURE AND TARGET ORGAN DAMAGE: A MENDELIAN RANDOMIZATION STUDY
Authors: Dib Marie -JOE , Zagkos Loukas , Meena Devendra , Azzo Joe David , Salman Oday , Gan Sushrima , Pourmussa Bianca , Kun Seavmeiyin , Tzoulaki Ioanna , Gill Dipender , Burgess Stephen , Chirinos Julio
Published: May 2024

Objective:

Large-artery stiffness (LAS) leads to an increased pulse pressure (PP) and is thought to induce target organ damage (TOD). However, causal associations of PP have not been unequivocally assessed in humans. We aimed to investigate the bi-directional associations between genetically predicted increased PP and phenotypes of TOD using Mendelian randomization (MR).

Design and method:

Bi-directional MR analyses were performed to investigate associations between genetically predicted PP and: left ventricular mass (LVM), myocardial interstitial fibrosis, heart failure (HF), chronic kidney disease (CKD), cognitive performance, brain white matter hyperintensities (WMH), type 2 diabetes (T2D) and preeclampsia (PrE). Multivariable MR was conducted to investigate the effect of PP on significant outcomes, independently of mean arterial pressure (MAP).

Results:

For a 10-mmHg increase in genetically-predicted PP, the odds ratios (ORs) were 1.113 (95%CI=1.085-1.137, P<0.001) for HF, 1.075 (95%CI=1.048-1.103, P<0.001) for CKD, 1.137 (95%CI=1.102-1.173, P<0.001) for T2D, and 1.435 (95%CI=1.256-1.638, P<0.001) for PrE. Similarly, a 10-mmHg increase in genetically-predicted PP was associated with a greater LVM (beta estimate=3.527 g/m2, 95%CI=3.026-4.028, P<0.001). The association of genetically predicted PP on risk of HF, CKD and T2D was independent of genetically-predicted MAP. Bidirectional MR also supported a causal effect of genetically predicted log-odds of T2D on PP (beta estimate=0.527 mmHg, 0.396-0.658, P<0.001), and PrE on PP (beta estimate=2.365 mmHg, 0.783-3.947, P=0.003) indicating a potential bidirectional relationship.

Conclusions:

We provide evidence supporting causal associations between PP and T2D, CKD, HF and increased risk of LV hypertrophy in humans, consistent with the deleterious effects of LAS on LV afterload and on microvascular integrity in low-resistance target organs. Early interventions aimed at lowering LAS may lead to lowering the risk of adverse outcomes.
PROGNOSTIC SIGNIFICANCE OF FATTY LIVER INDEX FOR THE DEVELOPMENT OF HYPERTENSION AND CARDIOVASCULAR EVENTS IN POPULATIONS WITH SUBOPTIMAL BLOOD PRESSURE
Authors: Bok Youngnam , An Soo Yeon , Kim Ji -YEON , Jin Seon -AH , Kim Jun Hyug , Roh Jae -HYUNG , Jeong Jin -OK
Published: May 2024

Objective:

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder with an increasing incidence and a known association with cardiovascular disease (CVD). The positive relationship between fatty liver index (FLI), a validated marker of NAFLD, and the development of hypertension has been studied in the general population. However, there is little evidence in prehypertensive groups. We investigated the association of FLI with incident hypertension and cardiovascular disease outcomes in a large cohort of adults with prehypertension.

Design and method:

We included 179,028 healthy Korean subjects from the National Health Insurance Service-National Sample Cohort without traditional risk factors who underwent a health examination between 2009 and 2014. Primary outcomes were new-onset hypertension and major adverse cardiac and cerebrovascular events (MACCE) in prehypertensive adults. Multivariate Cox proportional hazards regression analysis was used to assess the association between the FLI and the primary outcome.

Results:

During a median follow-up of 8.3 years, 34,667 subjects (19.36%) had new-onset hypertension. All subjects were divided into two groups based on BP, and categorized into quartile groups based on FLI. New-onset hypertension was significantly greater in ‘high normal BP’ group than in ‘normal BP’ group (25.95% vs 14.25%, p<0.0001). The incidence of the new-onset hypertension was significantly greater in the subjects with higher FLIs according to the FLI quartile values in both groups (p<0.0001).

In a median follow-up of 9.1 years, 3,339 cases (1.87%) of MACCE occurred. MACCE occurred more frequently in ‘high normal BP’ group than in ‘normal BP group’ (2.33% vs. 1.51%, p<0.0001). In ’high normal BP’ group, MACCE was also associated with FLI quartiles. With increasing FLI quartile, subjects had significantly more events. In the multivariable models adjusted for factors, the hazard ratio for MACCE comparing the highest vs. lowest quartiles of the FLI was 1.640 (95% confidence interval [CIs], 1.409–1.910) and 1.363 (95% CIs, 1.141–1.627) in the ‘high normal BP’ group and ‘normal BP’ group, respectively.

Conclusions:

Higher FLI was independently associated with development of hypertension and MACCE in prehypertensive Korean adults without traditional risk factors. FLI may be an important predictor of new-onset hypertension and adverse CV outcomes.
COMPARISON OF CARDIAC STRUCTURAL AND FUNCTIONAL CHANGES BETWEEN SURGERY AND MEDICATION TREATMENT IN PATIENTS WITH PRIMARY ALDOSTERONISM BASED ON ECHOCARDIOGRAPHY
Authors: Zhang Yong , Yu Heng , Zhang Fangjing , Zhang Kefan , Di Xiaofan , Bai Feng , Yu Jing , Wang Qiongying
Published: May 2024

Objective:

Conducted a systematic meta-analysis on the changes in follow-up parameters of echocardiography in patients with primary aldosteronism after surgery and drug treatment, in order to explore their differences.

Design and method:

We conducted the PubMed, Embase, and Cochrane library databases for English full-text articles on the follow-up study of echocardiography parameters in PA patients before and after surgery and drug treatment published from its establishment until June 1, 2023,Perform meta-analysis on the included studies using RevMan software.

Results:

A total of 515 PA patients (>18 years old) were included in 4 studies, including the surgical group (n=303) and the medication group (n=212), 2 short-term follow-up studies (average follow-up time of 1 year), and 2 long-term follow-up studies (average follow-up time of 3.7 years). Surgery treatment had better performance in improving cardiac contractile function, The main manifestation is the reversal of left ventricular hypertrophy (LVMI: M=-2.6, p=0.047), while there is no significant improvement in cardiac diastolic function (E/A: M=+0.06, p=0.51); In long-term follow-up studies, surgery and medical treatment still showed significant benefits in reducing blood pressure (surgical group: -14 ± 6 mm Hg/-9 ± 10 mm Hg, p<0.001; drug group: -10 ± 12mmHg/-11 ± 9mmHg, p<0.001). Interestingly, the surgical group and drug group did not show better blood pressure control effects than short-term follow-up (p=0.56), Surgery (LVMI: M=-12.6, p=0.01)and medication (LVMI: M=-11.9, p=0.01])can significantly improve left ventricular hypertrophy in patients, with no significant difference (P=0.143). Although surgery (E/A: M=+0.14, p=0.125) and medication (E/A: M=+0.09, p=0.2) can numerically improve diastolic function, there is no statistically significant difference.

Conclusions:

Both medication and surgical treatment can reverse the damage to the heart structure and function in PA patients. In the short term, surgical treatment has a more significant reversal of cardiac function, especially in left ventricular hypertrophy, but in the long term, there is no significant difference between medication and surgical treatment.
FEASIBILITY OF SUBTYPING OF PRIMARY ALDOSTERONISM BY ADRENAL VEIN SAMPLING DURING MINERALOCORTICOID RECEPTOR ANTAGONIST TREATMENT
Authors: Pintus Giovanni , Teresa Seccia Maria , Domenico Bagordo , Brasilina Caroccia , Giulio Ceolotto , Livia Lenzini , Giacomo Rossitto , Paolo Rossi Gian
Published: May 2024

Objective:

Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRA) before primary aldosteronism (PA) subtyping by adrenal venous sampling (AVS), but this practice can cause severe hypokalemia and/or uncontrolled high blood pressure (BP) values in PA patients.

The aim of the study was to investigate if identification of unilateral PA (uPA) by means of AVS is feasible in patients on MRA treatment.

Design and method:

We compared the rate of uPA identification between patients with and without MRA treatment in two large datasets of patients who were submitted to AVS from 2000 to 2023 without renin-angiotensin system blockers and beta-blockers. In sensitivity analyses, the between-groups differences of lateralization index (LI) values after propensity score matching and the rate of uPA identification in subgroups with undetectable (< 2 mUI/L), suppressed (< 8.2 mUI/L) and unsuppressed (> 8.2 mUI/L), direct renin concentration (DRC) levels were also evaluated.

Results:

A minority of the PA patients (n = 61, 7.3%) underwent AVS on MRA treatment, while the majority were off MRA (n = 779, 92.7%). Compared to non-MRA patients, those with MRA showed a higher daily drug dose (2.25 vs 1.5, p = 0.001), a higher rate of adrenal nodules at imaging (82 vs 67, p = 0.022) and of adrenalectomy (72 vs 54%, p = 0.01). The AUROC of lateralization index (LI) showed no significant differences between groups, either under unstimulated conditions (0.960 vs 0.937, p = 0.590) or after cosyntropin (0.923 vs 0.917, p = 0.938). Sensitivity analyses confirmed these results after propensity score matching in several adjusted models and in patients with undetectable, suppressed or unsuppressed renin levels.

Conclusions:

MRAs, at doses that controlled blood pressure and potassium levels in PA patients, did not preclude the identification of uPA at AVS.
BLOOD PRESSURE AND RENAL FUNCTION CHANGES AFTER REVASCULARIZATION OF RENAL ARTERY STENOSIS IN 3 DIFFERENT COHORTS OF PATIENTS
Authors: Pérez Juan Luís Martínez , Clarà Albert , Vázquez Susana , Mascaró Maria , Galceran Isabel , Oliveras Anna
Published: May 2024

Objective:

To analyze the effects at 12 months on blood pressure (BP) and renal function in patients with renal artery stenosis (RAS) undergoing percutaneous transluminal angioplasty (PTA), recruited from 3 different sources (Vascular Surgery Department, Hypertension Unit and Renal Transplantation Department).

Design and method:

Observational, retrospective study of patients undergoing PTA because of RAS mostly detected when screening patients with peripheral artery disease (G.1, n=20), when studying patients with resistant hypertension or with clinical suspicion of RAS (G.2, n=28) or in kidney transplant patients (G.3, n=21) with renal function impairment and/or elevation of BP. RAS is defined as a reduction of >70% of the renal artery lumen.

Results:

Sixty-nine patients were analyzed (mean age: 67±12yr, 64% male). Overall, mean±S.D. SBP/DBP (mmHg) was 147.4±20.6 and 75.7±11.8, and the estimated glomerular filtration rate (eGFR) was 48.7±27.0 mL/min/1.73m2. At baseline, G.1 had a higher prevalence of smoking patients (90%) and patients with a history of major vascular events (100%), lower DBP (70.0±9.8 mmHg) and better renal function (eGFR: 62.5±23.2 mL/min/1.73m2), compared to G.2 and G.3.

12-months after PTA, patients in G.2 and G.3 (but not those in G.1) showed a decrease in BP: variation (δ) SBP(mmHg): mean (95%CI)= -18.9 (-26.7 to -11.0) and -20.0 (-29.8 to -10.1), respectively; p<0.001 for both; δDBP (mmHg): mean (95%CI)= -6.6(-10.7 to -2.4),p=0.003 and -6.3 (-11.7 to -0.8), p=0.027. Regarding renal function, it only improved in G.3 group: δeGFR (mL/min/1.73m2): mean (95%CI)= 8.9(1.5 to 16.4),p=0.022, and showed a trend to become worst in G.1 group: -6.5(-13.4 to 0.3),p=0.061. After adjusting for confounding variables, δSBP was associated with baseline SBP (r= -0.709,p<0.001) and the origin group (Rho = -0.362,p = 0.003); δeGFR was associated with baseline eGFR (r= -0.508,p<0.001) and the origin group (Rho= 0.356, p= 0.004).

Conclusions:

BP decreased 12-months after PTA in patients with suspected RAS because of resistant hypertension. BP and renal function improved after PTA in kidney transplant patients with diagnosis of RAS. Higher BP levels and lower eGFR correlated with better results. Patients with peripheral artery disease screened for RAS showed no change in BP or renal function after PTA.
COMPOSITE PHEOCHROMOCYTOMA (WITH ASSOCIATED GANGLIONEUROMA) AS A CAUSE OF SECONDARY ENDOCRINOLOGICAL HYPERTENSION
Authors: Kuzior Agnieszka , Hernandez-lazaro Alba , De Leon-durango Ricardo Jose , Rios-gomez Carlos , Santana-ojeda Borja , Molinero-marcos Inmaculada , Santana-suarez Ana Delia , Fernandeztrujillo-comenge Paula Maria , Arnas-leon Claudia , Acosta-merida Asuncion , Acosta-calero Carmen , Camacho-galan Rafael , Redondo-martinez Maria Elena , Martinez-martin Francisco Javier
Published: May 2024

Objective:

To illustrate and understand a rare variant of pheochromocytoma, its clinical implications and prognosis, based on a clinical case of secondary hypertension.

Design and method:

Review of the patient's clinical record and the relevant literature.

Results:

Composite paraganglioma or pheochromocytoma is a rare tumour (<100 reported cases) composed of paraganglioma or pheochromocytoma plus another neurogenic tumour, most often (∼75%) ganglioneuroma, a typically benign tumour derived from the sympathogonia of the neural crest. It can be associated with neurofibromatosis type I, von Hippel-Lindau disease, or MEN2.

Our patient is a 64-year-old woman with uncontrolled hypertension, without a history of hypertensive crises. During follow-up for breast adenocarcinoma, a CT scan revealed bilateral adrenal nodules consistent with metastases. PET-CT showed increased metabolic uptake suggesting malignancy in the right adrenal. Plasma metanephrines were very high and MIBG scintigraphy was consistent with a right pheochromocytoma. Following doxazosin blockade, robotic adrenalectomy was performed, and a month later plasma metanephrines and blood pressure were normal. Pathology revealed a single mass of 4x3x2 cm labelled as composite pheochromocytoma (30%) - ganglioneuroma (705). There was no vascular invasion or necrosis, S-100 staining was preserved, and mitotic activity was minimal.

In addition to the PASS scale for prognosis of malignancy in pheochromocytoma, there is a specific COPPS scale for composite pheochromocytoma, based on necrosis, loss of S100, loss of SDHB, vascular invasion, and size >7 cm (5/2/1/1/1 points, respectively), with low risk if <3; our patient scores 0-1 (pending SDHB). The patient continues oncological follow-up for breast pathology, but her secondary hypertension is clinically resolved and the risk of pheochromocytoma-ganglioneuroma metastases is apparently low. There are no clinical signs of neurofibromatosis type 1, von Hippel-Lindau, or MEN2.

Conclusions:

Composite pheochromocytoma is a rare cause of secondary hypertension, often indistinguishable clinically from simple pheochromocytoma, except occasionally due to the larger lesion size. Diagnosis is typically confirmed through histopathological examination. In the most common association (with ganglioneuroma), additional malignancy implications are rare, unlike with other neurogenic tumours such as neuroblastoma or ganglioneuroblastoma. Due to insufficient current knowledge of its natural history, close monitoring is required.
HIGH SENSITIVITY C-REACTIVE PROTEIN MAY BE A BIOMARKER FOR PREDICTING CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS WITH OSA: A COHORT STUDY
Authors: Liu Shasha , Zhu Qing , Li Nanfang
Published: May 2024

Objective:

Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular disease (CVD). The association of high-sensitivity C-reactive protein (hsCRP) with vascular disease (VD) events are less studied among the hypertensive patients with obstructive sleep apnea (OSA). We determined whether the infammatory marker, hsCRP, could be a useful prognostic biomarker.

Design and method:

The participants were from a population with high-sensitivity C-reactive protein (hsCRP) results and OSA in UROSAH from 2011 to 2013, and were followed up until 2021. Outcome events include CVD and CVD related deaths. Analyzing the relationship between continuity, classification of hsCRP and cardiovascular events using cox regression analysis. The dose-response relationship between hsCRP and the probability of cardiovascular disease occurrence calculated using restricted spline regression

Results:

In total, we enrolled 2340 patients, with 68.6% men, mean age of 48 years and BMI of 28.08 kg/m2. During a follow-up period of 6.58 years, a total of 228 cardiac events occurred, including 18 cardiovascular deaths; And 138 cerebrovascular events, including 7 cerebrovascular related deaths. Compared to the first quartile, the third quartile has a higher risk of the CVD composite event (HR=1.54, 95%: 1.14 - 2.08, P=0.005) after adjusting for confounders. A similar tendency was observed for fatal or nonfatal stroke (HR=1.76, 95%: 1.07 - 2.90, P=0.027). Dose-response relationship between hsCRP and the probability of CVD composite event show that the cut-off value is 2.18, the same results were also observed in all factor adjustment.

Conclusions:

hsCRP may be a biomarker predicting an increased risk of cardiovascular and cerebrovascular events in hypertensive patients with OSA. When hsCRP is greater than 2.18, the probability of CVD events in hypertension increases, requiring timely attention and treatment by clinical physicians.
DISSECTION AND ANEURYSM IN PATIENTS WITH FIBROMUSCULAR DYSPLASIA
Authors: Kang Yuan -Yuan , Xu Jianzhong , Jiang Xiong -Jing , Wang Ji -Guang
Published: May 2024

Objective:

Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without.

Design and method:

Consecutive hypertensive patients with renal artery stenosis caused by FMD underwent catheter-based angiography, followed at two Chinese referral centers in China between January 2000 and Ouctober 2023.

Results:

Aneurysm occurred in 71 patients (24.6%) and dissection in 13 patients (4.5%); in total, 84 patients (29.0%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were elder at presentation (37.6 vs. 26.5 years of age, respectively; p < 0.0001) and experienced more eurological symptoms and other end-organ ischemic events than those without dissection. One-fifth of aneurysm patients (14 of 71) underwent therapeutic intervention for aneurysm repair.

Conclusions:

Chinese patients with renal artery FMD had a lower prevalence of dissection at the time of FMD diagnosis than Caucasians, but similar prevalence of aneurysm. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.
PREVALENCE AND CLINICAL CHARACTERISTICS OF PRIMARY ALDOSTERONISM IN PATIENTS WITH HYPERTENSION COMORBID WITH OBSTRUCTIVE SLEEP APNEA
Authors: Hu Zhe , Chen Xin
Published: May 2024

Objective:

The prevalence of primary aldosteronism (PA) in patients with hypertension combined with obstructive sleep apnea (OSA) has been inconsistent in previous studies, and some patients are intolerant to drug washout in clinical practice. Hence, a cohort of patients with hypertension combined with OSA was established and investigated.

Design and method:

316 hypertensive patients diagnosed with OSA by polysomnography were screened for PA. If screen test was positive, confirmatory test was perfomred to confirm or exclude PA. If PA was ultimately confirmed, subtype diagnosis was further implemented. They were included in the OSA and PA (OSAPA) group. Those who were unable to undergo drug washout were included in the OSA and suspected PA (OSAsusPA) group if they were highly suspected PA in clinical practice. All patients underwent collection of general information, biochemical indexes, renin-angiotensin-aldosterone system indexes, target organ damage and concomitant clinical diseases, and office blood pressure and ambulatory blood pressure measurements.

Results:

A total of 41 patients with OSA combined with PA, accounting for 13.0%. If only one obstructive sleep apnea screening indication was met, the diagnostic rate of PA was 5.3%, and the diagnostic rate was 40.7% for the coexistence of OSA and hypokalemia. Compared with pure OSA group, OSAPA group had a longer duration of hypertension, a lower proportion of smoking, a lower serum potassium, a higher serum aldosterone concentration and urine aldosterone excretion, and a lower renin level. A total of 22 patients with OSA combined with suspected PA, accounting for 13.0%. Compared with OSA group, OSAsusPA group also had a longer duration of hypertension, and a lower proportion of smoking. OSAsusPA group had a greater number of types of antihypertensive medications, and a higher proportion of stroke. Aldosterone levels were higher in OSAsusPA group compared with OSA group, and did not differ from OSAPA group.

Conclusions:

In hypertensive patients with OSA, screening for PA should be considered, especially in the case of comorbid hypokalemia. Additionally, patients with suspected PA should be given additional attention in clinical practice.
ASSOCIATIONS OF THE NLR WITH THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Aimudula Adilakezi , Zhu Qing , Zhang Delian , Liu Shasha , Cai Xintian , Luo Qin , Wang Menghui , Dang Yujie , Wu Ting , Mayire Maiturouzi , Hong Jing , Li Nanfang
Published: May 2024

Objective:

To explore the associations of the NLR with the Risk of Cardiovascular Disease in patients with Primary Aldosteronism

Design and method:

We conducted a retrospective cohort study enrolling 3039 participants from the People's Hospital of Xinjiang Uygur Autonomous Region. The NLR was computed by dividing the neutrophil count by the lymphocyte count. We assessed the association of NLR with the risk of CVD and CVD subtypes.

Results:

A total of 3039 patients with a mean age of 49.64±9.16years were included in this study, of which 55% were male.During a median follow-up of 2 years, 217 incident CVD were identified, including 182 incident stroke and 46 incident coronary heart disease (CHD). After adjusting for confounding variables, the higher NLR values(NLR>2.2) was positively associated with the risk of new-onset CVD (hazards ration [HR]: 1.434, 95% confidence interval [CI]: 1.085-1.897, P = 0.014), and new-onset stroke (hazards ration [HR]: 1.533, 95% confidence interval [CI]: 1.137-2.068, P = 0.005),but was not statistically significant with new-onset CHD (hazards ration [HR]: 1.255, 95% confidence interval [CI]: 0.687-2.292, P = 0.277). The RCS curve demonstrated a linear association between the NLR

Conclusions:

There was a positive association between NLR levels and the risk of CVD in patients with PA. This Finding suggests NLR may be a marker for predicting cardiovascular events in patients with primary aldosteronism
HIGH-SALT INTAKE DURING PREGNANCY AFFECTS MATERNAL ENDOTHELIUM-DEPENDENT VASODILATION AND INCREASES OXIDATIVE STRESS
Authors: Stupin Ana , Vulin Martina , Stupin Marko , Drenjancevic Ines , Muller Andrijana , Mihaljevic Zrinka , Susnjara Petar
Published: May 2024

Objective:

This study aimed to investigate the impact of dietary salt intake during third trimester of normal pregnancy on maternal micro- and macrovascular endothelial function, and oxidative stress level.

Design and method:

This was a cross-sectional study involving 65 women with singleton pregnancies between 37 and 40 weeks of gestation. Based on estimated daily salt intake from 24-hour urinary excretion subjects were divided in three groups: normal salt (NS; <5.75 g of salt/day, N=12), high salt (HS; 5.75-10.25 g of salt/day, N=36), and very high salt (VHS; >10.25 g of salt/day, N=17). Laser Doppler flowmetry was used to measure microvascular reactivity in response to vascular occlusion (PORH), iontophoresis of acetylcholine (AChID) and sodium nitroprusside (SNPID), and local heating (LTH), while for macrovascular endothelium-dependent vasodilation was assessed by flow mediated dilation (FMD) of brachial artery. Serum nitric oxide (NO) and endocan concentration, as well as 8-iso prostaglandin F2alpha (8-iso-PGF2alpha), thiobarbituric acid reactive substances (TBARS) and ferric reducing ability of plasma assay (FRAP) were measured as biomarkers of endothelial function/activation and oxidative stress, respectively.

Results:

Brachial artery FMD as well as microvascular AChID and LTH were significantly decreased in VHS compared to NS group of pregnant women, while LTH was also decreased in NS compared to HS group. PORH and SNPID did not significantly differ between groups. Serum NO was significantly decreased in both HS and VHS groups compared to NS. Endocan, 8-iso-PGF2alpha and TBARS were significantly increased in VHS compared to the NS group.

Conclusions:

High dietary salt intake is associated with decreased NO-mediated endothelium-dependent vasodilation in both peripheral micro- and the macrocirculation of healthy pregnant women. In addition, this attenuated endothelial vasodilator capacity could be associated with higher oxidative stress level that was measured in pregnant women who had high dietary salt intake compared to those with a normal one.
TRANSCRIPTIONAL REGULATION OF HEXOKINASE-2 BY BRD4 DRIVES PERIVASCULAR ADIPOSE TISSUE META-INFLAMMATION IN CARDIOMETABOLIC DISEASE
Authors: Mengozzi Alessandro , Costantino Sarah , Mongelli Alessia , Duranti Emiliano , Mohammed Shafeeq A , Gorica Era , Telesca Marialucia , Armenia Silvia , Cappelli Federica , Matter Christian M , Taddei Stefano , Masi Stefano , Ruschitzka Frank , Paneni Francesco , Virdis Agostino
Published: May 2024

Objective:

To investigate BRD4-related transcriptional programmes and therapeutic modulation in mouse and human models of cardiometabolic disease.

Design and method:

Small arteries (0.1-0.3 mm) from healthy subjects (n=16) and patients with obesity and hypertension (n=16) were dissected from visceral fat biopsies and mounted on a pressurised myograph to assess the ex-vivo effects of BRD4 inhibition on vascular function. Vasorelaxation to acetylcholine and acetylcholine+L-NAME was evaluated, in the presence or in the absence of perivascular adipose tissue (PVAT), at baseline and after incubation with the BRD4 inhibitor RVX-208 and with selective anti-inflammatory and anti-metabolic drugs. A cardiometabolic mouse (high-fat diet+L-NAME supplementation) was orally administered RVX-208 (150 mg/kg) to test in vivo effect of chronic BRD4 inhibition. ROS and nitric oxide were assessed by confocal microscopy; protein and gene expression were measured by Western blot and qPCR. Transcriptional changes upon BRD4 inhibition were investigated by a custom qPCR array, confirmed by ChIP, qPCR and Western blot and further characterised by metabolomics, lipidomics and mitochondrial swelling assays.

Results:

Endothelial-dependent vasorelaxation and tissue levels of TNF-alpha, IL-1beta, and IL-6 were altered in the vessel wall and PVAT from cardiometabolic patients and mice. RVX-208 substantially attenuated ex-vivo vascular dysfunction, with an impact greater when compared to anti-IL-1beta, anti-IL-6 receptor and anti-TNF-alpha. The effect was more pronounced in vessels with intact PVAT, suggesting a restoration of the PVAT anti-contractile phenotype. Gene expression profiling in PVAT from cardiometabolic mice unveiled hexokinase-2 (HK2) - a glycolytic enzyme implicated in mitochondrial dysfunction and inflammation - as the top downregulated gene by RVX-208 treatment. Increased binding of BRD4 to HK2 promoter in PVAT samples from cardiometabolic mice was confirmed by ChIP assays. Metabolomics assays further validate the findings, showing a PVAT glycolytic shift in condition of disease. Finally, ex-vivo selective inhibition of HK2 restored vascular dysfunction.

Conclusions:

Targeting the deleterious BRD4-HK2 interplay restores cardiometabolic-related vascular dysfunction reversing the PVAT meta-inflammatory shift. Epigenetic modulators of meta-inflammatory pathways might represent a promising strategy to prevent and reverse vascular dysfunction, key signature of cardiometabolic disease.
CENTRAL BLOOD PRESSURE AND ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS WITH AORTIC ANEURYSM. AN ACTIVE TILT-TEST STUDY
Authors: Ionov Mikhail , Gurevich Alexandra , Sagynbaeva Ay -Churek , Emelyanov Igor , Vanyurkin Almaz , Chernyavskiy Mikhail , Konradi Alexandra
Published: May 2024

Objective:

To assess the pulse wave velocity (PWV) and the orthostatic changes of peripheral (brachial) and central blood pressure (P/CBP) in patients with ascending aortic aneurysm (AAA) and thoracoabdominal AA (TAAA).

Design and method:

A total of 79 patients with AAA (n =41, 28 males; 54±13 y.o.) and TAAA (n =38; 33 males; 68±8 y.o.) were examined prior to surgical treatment. Brachial BP, CBP and PWV were measured in the supine position after 10 min of rest and then after 5 min of active standing using OMRON M3 EXPERT (Japan) and SphygmoCor (Australia). Ambulatory BP monitoring (ABPM) and calculation of 24-h CBP were performed with BPLab (Russia).

Results:

At baseline, 10 patients with AAA and 17 patients with TAAA exceeded the target BBP. The TAAA group exhibited a higher PWV compared to AAA (10.8±1.9 vs. 8.4±2.5 m/s, p <0.001). Systolic CBP decreased during active standing in 14 AAA and in 19 TAAA patients (p =0.001). The 24-hour systolic CBP was similar in both groups, the 24-hour diastolic CBP was higher in TAAA (76±9 and 63±11 mm Hg, p =0.004). Patients experiencing a BP drop (>10 mm Hg) while standing had higher values of systolic and diastolic CBP than those without orthostatic hypotension (systolic CBP 133±18 vs 123±17 mm Hg, p =0.01; diastolic CBP 82±13 vs 75±13 mm Hg, p =0.04). The PWV exhibited a strong correlation with age (r=0.594, p=0.0001), systolic CBP (r=0.308, p=0.008), diastolic CBP (r=0.340, p=0.004), orthostatic systolic CBP (r=0.262, p=0.031), and orthostatic diastolic CBP (r=0.253, p=0.037). A higher percentage of patients diagnosed with AAA were prescribed beta-blockers, loop diuretics, and aldosterone antagonists.

Conclusions:

Patients with TAAA had higher arterial stiffness compared to those with AAA. The reduction of both systolic and diastolic blood pressure during active orthostasis was more frequent in TAAA patients. This was despite the fact that AAA patients were treated more intensively.
RETINAL MICROVASCULAR ASSESSMENT IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES
Authors: De Ciuceis Carolina , Famà Francesca , Rosei Claudia Agabiti , Zammarchi Irene , Salvotti Francesca , Petroboni Beatrice , Rossini Claudia , Lemoli Matteo , Bevacqua Cristina , Cattaneo Chiara , Sinaimeri Gerta , Buso Giacomo , Porteri Enzo , Rizzoni Damiano , Ricci Chiara , Muiesan Maria Lorenza
Published: May 2024

Objective:

Inflammatory bowel diseases (IBD), comprised of Crohn's disease (CD) and ulcerative colitis (UC), are chronic mucosal inflammation associated to intestinal and extra-intestinal complications. Inadequate inflammation control produces dramatic alterations in gut microvascular function which contribute to perpetuating the inflammatory damage leading to an unfavorable prognosis, both for the disease itself and for the increased risk of cardiovascular events. Gut microvascular dysfunction seems to play the major role; however, no data are available about the presence of alterations in peripheral microvasculature, that are a prognostic element in cardiovascular risk. The aim of the study was to investigate retinal microcirculation in patients with quiescent IBD.

Design and method:

Twenty-four patients were included in the study: 14 IBD patients in clinical remission (78% with CD and 22% UC, average age of 50.9±9.8 years, 10 females, 11±9 years from diagnosis) and 10 control patients with similar demographic and clinical characteristics without IBD; 75% of IBD patients were under treatment oral mesalazine. All patients underwent an evaluation of retinal arteriole structural morphology (i.e. wall to lumen ratio, WLR) by Adaptive Optics and assessment of basal and total capillary density by video-capillaroscopy.

Results:

Baseline characteristics (sex, age, cardiovascular risk factors and main comorbidities) did not differ between the two groups. No significant differences in the structure of the retinal arterioles and in capillary density were observed in patients with quiescent IBD compared to control patients (Table). The retinal arteriole WLR was higher in patients with IBD duration above 10 years, with values bordering on statistical significance (p=0.06). A significant direct correlation was observed between WLR and both systolic and diastolic blood pressure values (p<0.05, r=0.507 and p<0.01, r=0.598, respectively) whereas an inverse correlation was found between retinal arteriole internal diameter and age (p<0.05, r=-0.424) and with BMI (p<0.05, r=-0.426).

Conclusions:

Patients with quiescent IBD show similar retinal and skin microvascular structure to matched controls, suggesting that control of inflammation is crucial for microvascular health. Further studies are needed to evaluate the presence of microvascular damage in patients with IBD at the onset of the disease or in moderate-severe activity.
RETINAL MICROVASCULAR ALTERATIONS IN PATIENTS WITH ERECTILE DYSFUNCTION
Authors: Lemoli Matteo , Rosei Claudia Agabiti , Rossini Claudia , Delbarba Andrea , Laera Nicola , Facondo Paolo , Nardin Matteo , Malerba Paolo , Baresi Mattia , Leidi Francesca , Porteri Enzo , Rizzoni Damiano , Ferlin Alberto , De Ciuceis Carolina
Published: May 2024

Objective:

The presence of erectile dysfunction (ED) is related with the subsequent occurrence of cardiovascular (CV) disease, in ED forms with a predominantly vascular component. The presence of penile arterial damage, assessed by dynamic penile echo color doppler, doubles the risk of a subsequent CV event. Microvascular alterations, and in particular the increase in the tunica-media-to-lumen ratio (M/L) of subcutaneous small arteries or in the wall-to-lumen ratio (WLR) of retinal arterioles, are present in several clinical conditions, including hypertension, and are predictors of CV events. The aim of this study is to evaluate the possible presence of structural alterations of the retinal microcirculation in patients with vascular ED assessed through dynamic penile echo color doppler.

Design and method:

Patients attending the Endocrinology outpatient clinics of the ASST Spedali Civili in Brescia undergoing dynamic penile echo color doppler to determine the vascular or non-vascular etiology of ED were included in the study. The patients underwent an evaluation of the capillary density at the dorsum of the fourth finger, by capillaroscopy, and an evaluation of the retinal microcirculation through Adaptive Optics to assess the WLR and the wall cross-sectional area (WCSA) of the retinal arterioles.

Results:

A total of 33 patients were included in the study: 10 patients (30.3%) had vascular ED and 23 (69.7%) had non vascular ED. The characteristics of the patients are shown in the Table. A higher prevalence of the main cardiovascular risk factors was observed in patients with vascular ED, although none of them reached statistical significance. No difference in basal or total (after venous congestion) capillary density was observed. Evaluation of the retinal arteriole morphology showed a significantly increased WLR in patients with vascular-based ED compared to patients with non vascular ED (0.29 vs. 0.26, p=0.031) with no difference in WCSA, thus indicating eutrophic remodeling.

Conclusions:

Our preliminary data highlight a potential correlation between arterial vascular changes present in the penile circulation and retinal microcirculation, suggesting the possibility of common damage mechanisms and new potential elements of population risk stratification.
A HIGHER BLOOD PRESSURE DURING EARLY PREGNANCY IN WOMEN WITH PREECLAMPSIA PREDICTS CHRONIC HYPERTENSION
Authors: Voskamp Lotte , Verdonk Koen , Van Lennep Jeanine E Roeters , Duvekot Johannes J , Willemsen Sten P , Danser Ah Jan , Steegers-theunissen Regine Pm , Rousian Melek
Published: May 2024

Objective:

Preeclampsia affects 2-8% of pregnancies and although it resolves after delivery, women still face a 2- to 6- fold higher risk of chronic hypertension and cardiovascular disease. Early identification of these high-risk women and personalized interventions will mitigate these risks. However, reliable predictors of chronic hypertension after preeclampsia are lacking. We aimed to analyze blood pressure patterns during pregnancy in women with preeclampsia in relation to chronic hypertension 1-3 years postpartum.

Design and method:

This study combines data from the Rotterdam Periconception Cohort and the Follow-up After Preeclampsia Outpatient Clinic cohort, two prospective cohorts embedded in patient care. Women with preeclampsia who were treated at the Erasmus Medical Center between 2010 and 2022 and had follow-up visits 1 and/or 3 years after pregnancy were included. Maternal characteristics, pregnancy outcomes and blood pressure measurements from the first trimester of pregnancy up to the first week postpartum were obtained from electronic health records and study databases. Chronic hypertension was defined as blood pressure >140/>90 mmHg or use of antihypertensive drugs at one or both follow-up visits. We used linear mixed regression models for analysis of blood pressure patterns throughout pregnancy. Additionally, we analyzed postpartum antihypertensive drug use utilizing standardized Defined Daily Doses.

Results:

Chronic hypertension was present in 39 of 72 patients included (54.2%). A significantly higher blood pressure was observed between week 8 and 24 of pregnancy in women with chronic hypertension at follow-up, with the largest difference in systolic blood pressure at week 18: 131 mmHg vs. 117 mmHg. While postpartum blood pressure patterns were comparable among groups, women with chronic hypertension at follow-up used higher doses of antihypertensive drugs during the first 5 days after delivery (mean difference 1.44 dose, p<0.001).

Conclusions:

Women that develop chronic hypertension within 3 years after a pregnancy complicated with preeclampsia have higher blood pressures and a distinctive blood pressure pattern up to 24 weeks of gestation, compared to women who do not develop chronic hypertension. The patterns presented in this study are promising predictors of chronic hypertension and warrant further validation.
PRE-ECLAMPSIA AND YOUNG-ONSET DEMENTIA: TIME TO SOUND THE ALARM?
Authors: Olié Valérie , Lailler Gregory , Torres Marion , Regnault Nolwenn , Carcaillon-bentata Laure , Blacher Jacques
Published: May 2024

Objective:

Pre-eclampsia remains a major cause of maternal and foetal morbidity and mortality worldwide, affecting 2–5% of pregnancies. Many studies have shown the cardiovascular and renal impacts of this disorder to last decades after pregnancy. Recently, an association between pre-eclampsia and neurological disorders has been described with a three-fold higher risk of late-onset vascular dementia after a mean follow-up of 20 years. The aim of our study was to estimate the impact of pre-eclampsia and gestational hypertension in the first years after pregnancy on young-onset dementia.

Design and method:

The Conception study, a nationwide prospective study including all deliveries occurring in France between 2010 and 2018, with an ongoing follow-up included 1,966,323 women aged over 29 years with no history of dementia. Dementia were identified using primary diagnosis for hospitalization during the follow-up. Hazard Ratios with maternal age as time scale were calculated using crude and adjusted Cox-proportional regression models. Models were adjusted for obesity, diabetes mellitus, tobacco smoking, drug and alcohol addiction and social deprivation.

Results:

Pre-eclampsia and gestational hypertension occurred in 2.9% and 5.9% of pregnancy respectively. Dementia occurred in 128 women during an average follow-up of 7 years. Pre-eclampsia (but not gestational hypertension) was associated with a 2.7-fold increased risk of young-onset dementia compared with pregnancy without hypertensive disorders (Table 1). The risk of young-onset dementia was even higher when pre-eclampsia occurred early (before 34 weeks of gestation) (4.15 [1.30-13.14]) or was superimposed on chronic hypertension (4.76 [1.49-15.22).

Conclusions:

While some studies have already reported cognitive function impairment and white matter lesions, our results are the first to show a short-term increase of early-onset dementia. This highlights a need for close follow-up among women who have experienced pre-eclampsia, covering neurological health as well as the metabolic, cardiovascular and renal systems. Moreover, this finding further adds to our currently limited knowledge about risk factors of young-onset dementia.

Improving coordination between obstetricians and general practitioners is relevant to enable long-term follow-up of women and to avoid delays in diagnosis due to doctors’ knowledge gaps in their obstetrical history.
A HIGH-RISK GROUP IN THE MIDDLE EAST: YOUNG WOMEN WITH HYPERTENSION AND HYPERTENSIVE DISEASE OF PREGNANCY: ANALYSIS FROM THE ANCORS YW STUDY
Authors: Hammoudeh Ayman , Abuhalimeh Raghad , Bani Baker Mohammad , Amairi Lina , Al-abdallat Tala
Published: May 2024

Objective:

Young women, who were once thought to be immune against atherosclerotic cardiovascular disease (ASCVD), are now considered a high-risk group. This is due to higher prevalence of classical and novel risk factors (RFs) including hypertension (HTN) and hypertensive disease of pregnancy (HDP). Unfortunately, studies about clinical outcomes and prevalence of these two risk factors have not been previously studied in Middle Eastern (ME) young women with ASCVD.

Aim:To evaluate the clinical and socioeconomic profiles of ME young women with HTN and HDP, compared with women who do not have these two RFs. Comparing differences between these two groups will help develop better management and earlier diagnosis of unwanted sequelae.

Design and method:

Young women (18-50 years) with ASCVD and age-matched controls were consecutively enrolled in 12 centers (August 2021 to October 2023). Profiles of women with HTN/HDP were contrasted with those who did not have these RFs.

Results:

Of 618 young women enrolled (mean age 44.0±4.5 years), 305 (48.6%) had HTN and/or HDP, and 322 (51.4%) did not have HTN/HDP. Compared with women with no HTN/HDP, the HTN/HDP group had more ASCVD (44.9% vs. 22.4%), diabetes (33.1% vs. 9.6%), and obesity (52.1% vs. 35.7%), all p values<0.05. Of the novel RFs studied, in addition to the higher prevalence of HDP, there was a higher prevalence of preterm delivery in the hypertensive group. However, gestational diabetes, persistent weight gain, premature menopause, and polycystic ovary syndrome were of no significant difference. Regarding the psychosocial factors, less education and less physical activity were observed in the HTN/HDP group. On multivariate analysis, HTN was found to be an independent predictor of ASCVD (Odds ratio 2.15, 95% CI 1.41-3.30, p<0.001). Based on these findings, HTN in women can be considered an important risk factor for predicting outcomes and prognosis.

Conclusions:

ME young women with HTN/HDP are more likely to have a worse clinical and psychosocial profile compared with those who do not. These women should be targeted for early screening and management in all cardiovascular prevention programs in our region.