bluuebunny/crossref_metadata_2025 huggingface dataset:
Hemoglobin, maximal heart rate and work capacity, as well as time to exhaustion are significantly improved with combined hypoxia and aerobic exercise training in healthy adults: a meta-analysis
Authors: Cahalin L , Landis E , Formiga M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Hypoxic conditions have been used for a variety of reasons and have been implemented in multiple ways in an attempt to improve physiologic performance. Hypoxic conditions are administered via real or simulated altitude or by breathing lower levels of oxygen via facemask to improve different physiologic processes. Maximal work capacity (MWC) and time to exhaustion (TTE) are important factors related to sports performance. It is unclear how aerobic exercise (AE) with hypoxia effects MWC, TTE, and maximal heart rate (MHR) as well as hemoglobin (Hgb) and hematocrit (Hct) concentrations.

Purpose

Examine the effects of chronic AE with and without hypoxia on MWC, TTE, MHR, Hgb, and Hct.

Methods

A comprehensive search using PubMed, Cochrane, and PEDro was performed using a variety of keyword permutations on "hypoxia" and "aerobic exercise" in healthy adults. Inclusion criteria were studies with both a control and experimental group in which chronic AE was performed with and without hypoxia and MWC and TTE were provided in Watts and seconds, respectively. Study quality was assessed using the PEDro scale. Statistical analyses were performed using R with sub-analyses examining changes in Hgb, Hct, and MHR.

Results

A total of 16 studies met the inclusion criteria yielding a total sample size of 389 healthy adults. Study quality ranged from 4 to 6 out of 10 (mode=5). Significant tests for the overall effect of AE with hypoxia compared to AE without hypoxia on MWC and TTE were found under random-effects models (Z=2.83, p<.001, 95% C.I. = 0.29-1.60 and Z=2.94, p<.001, 95% C.I. = 0.80-4.00, respectively). A significant test for the overall effect of AE with hypoxia compared to AE without hypoxia on Hgb was also found (Z=2.06, p=.03, 95% C.I. = 0.01-0.60; fixed-effects model), but a non-significant overall effect on Hct was observed (Z=1.24, p=.21, 95% C.I. = -0.19-0.85; random-effects model). A significant test for the overall effect of AE with hypoxia compared to AE without hypoxia on MHR was also found (Z=2.84, p<.001, 95% C.I. = 0.19-1.04). Substantial heterogeneity was observed in all analyses (I2 range of 64% - 89%).

Conclusions

Chronic AE with hypoxia elicits a significantly greater increase in MWC and TTE compared to AE without hypoxia in healthy adults. The significant improvement in Hgb and increased MHR provides a rationale for the improvement in MWC and TTE associated with chronic AE combined with hypoxia. Improvements in MWC and TTE have the capacity to improve sport performance. Further investigation of AE with and without hypoxia on specific sports and on other physiologic measures is warranted.
Electrical and structural remodelling in female athlete's heart: a study in women practising competitive sports
Authors: Cavigli L , D'ascenzi F , Marchese A , Taddeucci S , Cappelli E , Roselli A , Bastone G , Lemme E , Squeo M R , Serdoz A , Maestrini V , Pelliccia A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Athlete’s heart is associated with a physiological electrical and structural remodelling induced by training. While several data have been published in male athletes, data on female competitive athletes, and their comparison with male counterparts or sedentary women, are still inconclusive.

Objectives

This study aimed to analyze the electrical, structural, and functional cardiac remodelling in female and male competitive athletes and sedentary controls.

Methods

Competitive athletes were evaluated by 12-lead resting ECG and echocardiography and compared to the sedentary controls.

Results

The study population was composed of 1,096 individuals (360 female Olympic athletes, 410 male Olympic athletes, 130 sedentary women and 196 sedentary men). Female athletes had lower resting heart rate, longer PR interval, higher voltage of P, R, and T waves and more frequently incomplete RBBB, left ventricular (LV) hypertrophy, early repolarization, and anterior T-wave inversion as compared with non-athletes. Biventricular dimensions and LV wall thickness were greater in female athletes as compared to non-athletes. However, women showed a lower degree of training-induced structural remodelling than men. A progressive increase in biventricular dimensions and LV wall thickness was observed from athletes engaged in skill and power to those practicing mixed and endurance disciplines. However, in women, but not in men, the type of sport did not significantly influence ECG remodelling.

Conclusions

Highly-trained women demonstrate a relevant training-induced electrical and structural remodelling. However, the type of sport did not influence ECG parameters in women while it impacted on biventricular remodelling, with female endurance athletes showing the greatest degree of adaptation.
New biomarkers in peripheral artery disease cardiovascular rehabilitation - keep it simple
Authors: Adam C A , Marcu D T M , Anghel R A , Mitu O , Mitu F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Cardiac rehabilitation (CR) plays an essential role in the management of patients with peripheral artery disease (PAD) [1]. Patients enrolment in an integrative and multidisciplinary program, can improve the functional status, quality of life, and long-term morbidity and mortality [2]. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a long-term mortality prognostic index in PAD [3], we enrolled two groups of patients: low and low-intermediate risk (group 1, n=45) versus high-intermediate and high risk (group 2, n=52). We analyzed demographics, clinical, and paraclinical parameters, focusing on novel inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), white blood cells-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR). The 6 months follow-up showed that a minimum 50% decrease compared to initial levels was associated with both short and long-term clinical and functional improvement. A decrease in NLR (p < 0.001), PLR (p = 0.028), WMR (p = 0.009) and LCR (p = 0.036) levels correlated positively with improved metabolic profile - low-density lipoprotein cholesterol (p= 0.015), triglycerides (p= 0.041) , fasting glucose (p=0.011) -, as well as improved exercise capacity - assessed through peak oxygen uptake (p = 0.008), pain-free walking distance (p = 0.024) and maximum walking distance (p = 0.032) at 6 months follow-up for group 1. Assessment of these inflammatory biomarkers had a statistically significant prognostic role in our study, being an accessible tool for clinical cardiologists in evaluating CR programs effectiveness in patients with PAD.
History of acute myocardial infarction in patients with acute coronary syndrome: population characterization and impact on prognosis
Authors: Carias M , Paralta M , Almeida A , Claudio F , Rocha R , Picarra B , Bento A , Trinca M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with a history of Acute Myocardial Infarction (AMI) continue to be underrepresented in large studies on Acute Coronary Syndromes (ACS).

Purpose

To characterize patients with ACS and previous AMI and to evaluate their impact on the therapeutic approach, complications and in-hospital mortality.

Methods

We studied 722 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous AMI and patients without previous AMI. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EF), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, re-infarction, mechanical complications, stroke and major hemorrhage. In-hospital mortality was compared between both groups.

Results

Patients with previous AMI constituted 26.8% (194 patients) of the population studied. These had a higher prevalence of arterial hypertension (92.8% vs 71.2%; p<0.001), diabetes (47.9% vs 30.4%, p<0.001), dyslipidemia (73.6% vs 49 .2%, p<0.001), previous angioplasty (62.1% vs 0.0%; p<0.001), heart failure (14.0% vs 4.7%, p<0.001), arterial disease (13.5% vs 3.6%, p<0.001), chronic renal failure (18.7% vs 9.6%, p=0.009) and previous bleeding (5.3% vs 1.3 %, p=0.002). The D with previous AMI presented more frequently with AMI without ST elevation (62.4% vs 40.7%; p<0.001) and Unstable Angina (10.3% vs 5.3%, p=0.02 ) and less with ST-elevation AMI (22.2% vs 47.3%, p<0.001). At admission, patients with previous AMI received less therapy with unfractionated heparin (20.6% vs 30.7%; p=0.007) and more therapy with angiotensin-2 antagonists (6.2% vs 2.3% , p=0.009), nitrates (62.9% vs 49.2%, p=0.001), ivabradine (5.2% vs 1.7%, p=0.01) and diuretics (34.5% vs 22 .3%, p=0.009). The coronary angiography rate was similar between the groups, however patients with previous AMI underwent more coronary angiography via the femoral route (36.9% vs 15.7%, p<0.0001) and fewer angioplasties (58.5% vs 69 .5%, p=0.006). EF was slightly lower in patients with previous AMI (45.7 ± 9.3% vs 48.3 ± 10.4%, p=0.04). However, there were no differences in the presence of any of the complications considered, as well as in in-hospital mortality.

Conclusion

Patients with previous AMI have a higher prevalence of co-morbidities and a higher prevalence of AMI without ST elevation and Unstable Angina. The presence of previous AMI was not per se a predictor of in-hospital complications or mortality.
Impact of a cardio-oncology rehabilitation framework among high cardiovascular risk cancer survivors: results from the CORE trial
Authors: Viamonte S , Joaquim A , Alves A J , Vilela E , Capela A , Ferreira C , Teixeira M , Guedes H , Rato N , Duarte B , Tavares A , Santos M , Ribeiro F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cancer survivors are challenging patients, as they often present increased cardiovascular (CV) risk. In this background, cardio-oncology rehabilitation frameworks for specific cancer patients have been proposed. However, optimal program designs, as well as their overall safety and efficacy in different subsets of patients, are not fully ascertained.

Purpose

To assess the impact of a cardio-oncology rehabilitation based framework for cancer patients at increased CV risk, compared to a community-based exercise training (CBET), on cardiorespiratory fitness (CRF) and cardiovascular risk factor (CVRF) control.

Methods

The CORE study was a single-center, prospective, randomized controlled trial enrolling adult cancer survivors exposed to cardiotoxic cancer treatment (anthracycline, radiotherapy on thoracic wall, anti-human epidermal growth factor receptor-type 2 drugs) and/or with previous CV disease. Participants were randomized to an 8-week center-based CR program (CBCR) or CBET, twice a week. Primary endpoint was CRF (assessed by the VO2peak, derived from a symptom-limited cardiopulmonary exercise test, performed on a treadmill); secondary endpoints were physical activity [International Physical Activity Questionnaire (IPAQ)], psychosocial parameters [Hospital Anxiety and Depression Scale (HADS)], blood pressure, body composition, lipid profile and health literacy [Newest Vital Sign (NVS) questionnaire].

Results

80 patients were included (mean age 54.5±14,12, 61 women; 66% breast cancer, 27.5% lymphoma); 75 patients completed the intervention (CBCR N= 38; CBET N=37). There was a significant improvement in the CBCR compared to the CBET group in VO2peak (∆ +2.1±2.8 vs +0.8±2.5 mL.kg-1.min-1, p=0.033) and in the following outcomes: resting systolic blood pressure (p<0.0001); body mass index (p<0.0001), lean and fat body mass (p<0.0001), waist circumference (p<0.0001); total cholesterol (p =0.001), triglycerides (p =0.008) and LDL cholesterol (p =0.003); HADS Anxiety score (p =0.003) and Depression score (p =0.009), weekly physical activity levels (p<0.0001) and health literacy scores (p<0.0001). No major CV events were reported.

Conclusion

The CORE trial demonstrates superior results of a CBCR regarding CRF and CVRF control. Given the higher cardiovascular risk in several groups of cancer patients, our data provides novel insights into optimized preventive strategies in this complex patient population.
Left atrial dyssynchrony in veteran athletes with paroxysmal atrial fibrillation
Authors: Sorensen E , Myrstad M , Solberg M G , Oie E , Tveit A , Aaronaes M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): A Ph.D. grant from the DAM Foundation and a grant from the Raagholt foundation.

Background

Prolonged endurance exercise is associated with an increased risk of atrial fibrillation (AF) in men. Increased left atrial (LA) size is associated with AF in the general population. LA dilation in athletes is viewed mainly as a physiological response to exercise, and functional atrial parameters may help distinguish pathological from physiological atrial remodeling in this group. LA mechanical dispersion (LA MD) is a novel marker of LA mechanical dyssynchrony. It is yet to be evaluated whether LA MD could be a marker of pathological remodeling in veteran athletes.

Purpose

To describe LA MD measured by speckle tracking echocardiography in male veteran athletes who had regularly participated in the 54 kilometer cross-country (XC) ski race Birkebeinerrennet in Norway with and without AF, and men with and without AF from a background population.

Methods

In total, 295 men, veteran XC skiers with (n=57) and without (n=88) paroxysmal AF, and men from a non-athletic population with paroxysmal AF (n=62) and without AF (n=88) were examined with echocardiography while in sinus rhythm. LA MD was defined as the standard deviation of time to peak strain (SD-TPS) including all accepted atrial segments, and stated both in milliseconds, and corrected by the cycle length ((SD-TPS(ms)/Cycle length(ms))x100)). The average of three consecutive loops was computed. A two-way between-groups analysis of variance was performed to explore the main effects of AF status, athletic status, and the interaction between AF status and athletic status in LA echocardiographic parameters.

Results

XC skiers (mean age 70.9±5.7 years) reported an average of 40-50 years of regular endurance exercise and had completed an average of 17 annual Birkebeiner races. LA volumes were associated with both AF and athletic status. LA MD in milliseconds was associated with AF, but not associated with athletic status.

Conclusion

LA MD was associated with paroxysmal AF both in veteran endurance athletes and non-athletes, and less affected by athletic status than atrial volumes. This implies that LA MD could be a useful marker when trying to distinguish physiological from pathological atrial remodeling in endurance athletes.
Consequences of diabetes and high-risk dyslipidemia
Authors: Eliche Mozas P , Cruz Romero L , Cubillas Quero A , Huertas Escribano M J , Rus Mansilla C , Cortez Quiroga G A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Diabetic patients develop both, microvascular and macrovascular long-term complications, and have double the risk of cardiovascular (CV) disease being the main cause of death. The 97% of diabetic patients are classified as high or very high CV risk. The 2019 ESC guidelines for the managment of dyslipidaemia, classified patients with LDL-c >190 mg/dL as high-risk patients, with the indication of high-intensity statins (LDLc reduction greater than 50% and LDLc below 70 mg/dL).

Objective

To analyze, in a group of patients with high risk dyslipidaemia (HRD, LDLc >190 mg/dL without secondary cause), the consecuences of its association with type 2 diabetes.

Methods

Observational retrospective cohort of 153 patients with HRD. We compared 35 diabetic patients (G1) vs 118 non diabetic patients (G2), and we analysed clinical characteristics, cardiovascular risk factor’s (CVRF), tase of cardiovascular disease, the baseline blood test with maximum LDL-c (BT1), lipid profile on the last blood test (BT2) and the effects of lipid-lowering treatment.

Results

There were no differences in relation to sex. G1 were older (69.2 (±12.8) vs 56.8 (±12.5) years old, p=0.001), had a higher body mass index (BMI) (31.4 (±5.9) vs 28.9 (±4.4) kg/m2, p=0.018), higher number of CVRF (3 CVRF, 54.3% vs 10.2%, p<0.0001, and 4 CVRF, 37.1% vs 0%, p<0.0001). Regarding mayor CV events, 80% develop CV disease vs 38.1% (p<0.0001), and 40% develop early coronary disease (ECD) vs 25% (p<0.0001).

In the BT1, G1 presented a more atherogenic lipidogram, lower HDL-c <40-45mg/dL values (22.9% vs 9.3%, p=0.033), higher proportion of triglycerides >150mg/dL (74.3% vs 46.6%, p=0.001), higher proportion of small and dense LDL-c (88.6% vs 62.7%, p=0.004) and a higher proportion of VLDL-c >30mg/dL (74.3% vs 45.8%, p=0.003). There were no differences in lipid-lowering treatment (statin 88.6% vs 86.4%, p= 0.7; ezetimibe 68.6% vs 53.4%, p=0.1) or in the lipid-lowering power of LDL reduction >50% (77.1% vs 70.3%, p=0.4), except for a greater prescription of fibrates in G1 (11.4% vs 1.7%, p=0.027). In BT2, lower rates of HDL-c <40-45mg/dL (34.3% vs 16.1%, p= 0.019) and small and dense LDL-c (80% vs 50.9%) persisted in G1, p=0.002) and a higher proportion of chronic kidney disease (25.8% vs 2.6%, p<0.0001).

Conclusions

Patients with HRD and diabetes have higher CVRF, a more atherogenic lipid profile that persists despite lipid-lowering treatment, and double the rate of CV disease, were half of these events occurs at early age. This association of CVRF should alert us, implementing an early and agressive prevention treatment of all CVRF.
What influences the regional variation of heart failure in Poland?
Authors: Roszkowska S , Kuzma Ł , Swieczkowski M
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Science Center, Poland.

In Poland, more than 1.5 million people suffer from chronic heart failure (HF), and the rate of hospitalization for HF is one of the highest in Europe The risk of hospitalization of patients with HF is related not only to lifestyle, but also to environmental, economic, social factors and the organization of the health care system.

The main purpose of the research is an assessment the impact of environmental and socioeconomic factors on hospitalized heart failure prevalence.

We analyzed age- and gender-standardized data on the frequency of hospitalizations due to CHF in Poland in 2012-2019.

In addition, using data from the National Institute of Public Health, the Central Statistical Office and Provincial Environmental Inspectorates, as well as panel data regression techniques, the impact of environmental and socioeconomic factors on HF in Poland in 2012-2019 was estimated.

During the period analyzed, there were 1,618,734 hospitalizations due to CHF (51.3% male; 82.6% over 65 years of age). An increase in the number of physicians by 10/10000 population resulted in a 3% decrease in hospitalizations due to CHF (β=-0.029; 95%Cl -0.004 - -0.013; P=0.001). In addition, the development of a network of outpatient health care facilities resulted in a 0.3% decrease in hospitalizations for each newly established unit per 1,000 residents (β=-0.031; 95%Cl -0.048 - -0.014; P=0.000). The main environmental factors reducing hospitalized prevalence due to CHF were the proportion of green areas in the analyzed environment (2.7% decrease for a percentage point increase in the proportion of green areas; β=-0.027; 95%Cl -0.053 - -0.001; P=0.047) and pollution levels (a 10 µg/m3 increase in PM2.5 and PM10 concentrations in the province resulted in a county-wide increase in hospitalizations of 7.5% [β=0.075, 95%CI 0.013-0.137, P=0.017] and 6% [β=0.060; 95%CI 0.012 -0.108, P=0.015]). The opposite relationship was observed for the number of cars; an increase of 100 cars per 1,000 residents was associated with a 6% increase in hospitalizations due to CHF (β=0.064; 95%Cl (0.008 - 0.121; P=0.026). An injection of PLN 100 per capita per year into the health sector by local governments results in a 3.5% decrease in hospitalizations (β=-0.003; 95%Cl (-0.006 - -0.001; P=0.002). Also, the situation in local labor markets translates into hospitalizations due to CHF - a 1 pp increase in the unemployment rate results in an average one percent increase in HF.

The number of hospitalizations for heart failure has been increasing in the last decade and this trend is most noticeable in regions with low levels of socioeconomic development and poor medical facilities. Health policy measures using environmental and socioeconomic instruments can result in no less positive health effects than the use of health care tools alone.
Doctor-patient communication about personal cardiovascular risk: a missing piece of the prevention puzzle?
Authors: Petrovic J , Radomirovic M , Petrovic Djordjevic I , Petrovic A , Markovic M , Todorovic J , Santric-Milicevic M , Ivanovic B
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Widespread awareness of modifiable cardiovascular risk factors (MCRF) may be fundamental to reduce the burden of cardiovascular diseases (CVD). However, the lack of doctor-patient communication (DPC) about personal cardiovascular risk (pCVR) could affect prevention achievement.

Purpose

To assess the frequency of DPC about pCVR as potential target for preventive strategy improvement in a very high risk country.

Methods

The pilot study included convenience sample of 795 adults from Serbia divided in two groups, depending on the presence of at least one of five MCRF (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking). They were compared according to demographics (age, gender, education, incomes, place of residence), awareness of MCRF as contributing factors to CVD, interest in pCVR, preferable source of information about pCVR and frequency of DPC about pCVR. The data were collected by voluntary filling of survey with multiple choice questions from April 1st to June 30th 2022.

Results

There were significantly more respondents with MCRF (75% vs 25%, p<0.01). Those with MCRF were older (50±14 vs 39±11, p<0.01), less educated (49% vs 22% with only high school or less, p<0.01) and had lower incomes (53% vs 40% with less than average incomes, p<0.01). No significant difference was observed according to gender (43% vs 38% of males, p>0.05) and place of residence (85% vs 90% from urban area, p>0.05). The majority in both groups showed high awareness of MCRF as contributing factors to CVD (95% vs 96% for hypertension, 95% vs 95% for hyperlipidemia, 89% vs 85% for diabetes mellitus, 93% vs 91% for obesity, 83% vs 84% for smoking; p>0.05). Both groups were very interested in pCVR (89% vs 89%, p>0.05) and opted for their doctors as the most preferable source of information about pCVR (89% vs 91%, p>0.05). On contrary, only the minority in both groups had DPC about their pCVR, although it was higher in the group with MCRF (34% vs 14%, p<0.01) and increased proportionally to the number of present MCRF.

Conclusions

The study showed high awareness of MCRF and high interest in pCVR, independently of MCRF presence or demographic characteristics. Despite that, there is a notable lack of DPC about pCVR. Since doctors have been chosen as the most desirable source of information, they should make efforts to discuss pCVR with patients, as this may be the crucial part of the preventive strategy.
Hypertensive patients are more likely to develop coronary artery disease on computed tomography coronary angiography
Authors: Tserioti E , Chana H , Salmasi A M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Systemic hypertension (HTN) is the strongest cause for morbidity and mortality all over the world for its association with target organ damage including coronary artery disease (CAD). It creates a great challenge in medical field because it is often asymptomatic. CT coronary angiography (CTCA) being a non-invasive tool can be used to assess the presence of CAD successfully. In this study we aimed to identify the association between HTN and CAD.

Methods

The individual electronic health records of 566 consecutive patients who underwent CTCA between July and November 2020, were retrospectively reviewed. TAVI studies and graft assessment studies were excluded. A total of 485 patient (mean age 60.4) reports were analysed. All risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were also recorded.

Results

Of the 170 patients with moderate-severe CAD, 127 (74.7%) had hypertension, and of the 100 patients with severe CAD, 78 (78%) had hypertension. Univariate analysis for comparison of patients with none (n = 222), mild (n = 93), moderate (n = 70) and severe (n = 100) CAD revealed that hypertension (P < 0.001), diabetes (P = 0.007), gender (P < 0.001), dyslipidaemia (P < 0.001) and smoking (P = 0.005), were all significantly associated with the presence of CAD on CTCA. However, multivariate analysis using a multiple logistic regression model, confirmed a significant association between hypertension and CAD (OR = 1.26, P < 0.001). SHAP-values for model interpretation revealed that hypertension has the strongest impact on CAD presence on CTCA.

Conclusions

Hypertension is the strongest independent predictor for the presence of CAD detected on CTCA, amongst diabetes, gender, dyslipidaemia, positive family history and smoking. These results suggest that hypertension and the other risk factors associated with CAD, should form the main parameters on consideration for CTCA referral. Further studies relating our results to the CTCA reports of same patients after a longer period of aggressive hypertension treatment, would prove essential in establishing the role of blood pressure management in the progress of angiographic coronary disease.
Role of risk assessment using lipid ratios and adiposity markers in young patients with a first acute coronary syndrome
Authors: Fernandez Ruz L , Mora Robles J , Claros Ruiz A , Alcala Ramirez Del Puerto M , Urbano Carrillo C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Low-density lipoprotein cholesterol (LDL-C) remains the gold standard for lipid assessment in atherosclerotic cardiovascular disease (ASCVD). Recent guidelines remark the importance of non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (ApoB) in lipid risk assessment. Moreover, lipid ratios (LR) add information about small, dense LDL-C and other atherogenic lipoproteins. The presence of adiposity confers a higher metabolic and lipidic risk.

Purpose

To describe ApoB, non-HDL-C, remnant cholesterol (RC) and lipid ratios (LR) in young patients admitted for a first acute coronary syndrome (ACS); and to correlate those values with body mass index (BMI) and glycated haemoglobin (HbA1c) as adiposity and metabolic syndrome markers.

Methods

We performed a descriptive and retrospective study including 51 patients under 65 years old, admitted to hospital between July 2022 and October 2022, for an ACS irrespective of the onset (unstable angina, non-ST-segment or ST-segment elevation myocardial infarction (NSTEMI, STEMI)). We assessed a basic lipid profile including, HbA1c, total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG) and ApoB. Non-HDL-C, RC and the following LR (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, non-HDL-C/HDL-C, LDL-C/ApoB, TC/ApoB and TG/ApoB) were estimated.

Results

In our study. 76,5% were male. Mean age was 56,1 years (± 7,3). The percentage of history of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%). Mean BMI and HbA1c were 29,46 kg/m2 (±5,9) and 6,1% (±1,07), respectively. Mean waist circumference was 98 cm (±13,95) Mean values of the lipid profile were: LDL-C 89,74 mg/dL (±35,58), HDL-C 33,8 mg/dL (±8,4), TG 161,14 mg/dL (±66,26), non-HDL-C 122,28 mg/dL (±38,96), RC 32,54 mg/dL (±14,86), ApoB 97,6 mg/dL (±26,88). Mean LR were: TG/HDL-C 5,04 (±2,33), LDLc/ApoB 0,92 (±0.2). The rest of the characteristics and results are shown in Table 1.

We found statistically significant positive correlation between: TG and ApoB (r: 0,345; P=0,014); TG and TC/HDL-C ratio (r:0,326; P=0,21); TG and HbA1c (r: 0,349; P=0,02); TG an RC (r: 0,978; P<0,001); HbA1c and TG/ApoB ratio (r: 0,392; P<0,01); BMI and HbA1c (r: 0,572; P=0,013); TG/HDL-C and BMI (r: 0,493; P=0,032).

Conclusions

Lipid ratio assessment plays a key role in patients with adiposity, remarkably high in our serie. In our cohort, these patients had TG/HDL-C ratio > 2 and LDL-C/ApoB ratio < 1.3, meaning small and dense circulating lipoproteins. Our results support the implementation of LR in clinical practice as they may guide the intensification of lipid lowering therapies beyond LDL-C.
Nutritional status, body image satisfaction, and self-esteem in adolescents from the SI program for secondary school trial
Authors: Bodega P , Fernandez-Alvira J M , De Cos-Gandoy A , Moreno L A , De Miguel M , Rodriguez C , Tresserra-Rimbau A , Martinez-Gomez J , Ramirez-Garza S , Laveriano-Santos E , Estruch R , Lamuela-Raventos R M , Fernandez-Jimenez R , Santos-Beneit G
Published: May 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): 1. SHE Foundation and "la Caixa" 2. Fondo de Investigación Sanitaria - Instituto de Salud Carlos III.

Background/Introduction

Adolescence is a sensitive period regarding self-esteem and body image. In particular, nutritional status could affect self-esteem levels and body image satisfaction.

Purpose

To evaluate the distribution of body image satisfaction by nutritional status, and to assess the relationship between body image satisfaction and self-esteem over adolescence.

Methods

1315 adolescents from the SI! Program for Secondary Schools trial were assessed at baseline (12.5 (0.4) years, 48.2% girls), first follow-up (1-FU) (13.9 (0.4) years, 47.6% girls) and second follow-up (2-FU) (15.8 (0.4) years, 48.4% girls). Adolescents were classified as having underweight, normal weight or overweight/obesity according to Center for Disease Control (CDC) standards for body mass index (BMI). Body image satisfaction and self-esteem were assessed with Stunkard's figure rating scale and self-esteem domain of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) questionnaire, respectively. The association between both variables was estimated using linear and logistic mixed models.

Results

Overall, only 14.6% of adolescents were systematically satisfied with their body image. Most adolescents with overweight/obesity desired to lose weight (89.7% at baseline, 84.9% at 1-FU, and 83.9% at 2-FU), while most adolescents with underweight desired to gain weight (76.3% baseline, 80.0% 1-FU, 84.0% 2-FU). The percentage of girls with normal weight desiring to lose weight increased from 33.4% at ~12 years of age to 45.9% at ~16 years of age, while the desire to gain weight increased in boys with normal weight (32.3% at baseline vs 38.2% at 2-FU) (Figure 1). Satisfied adolescents consistently presented higher self-esteem over time compared to unsatisfied adolescents, especially girls (Table 1).

Conclusion(s)

Body image satisfaction was consistently related to nutritional status over adolescence. The desire to lose weight in girls with normal weight increased over time, while the desire to gain weight increased in boys with normal weight. Data suggests that body image satisfaction could determine self-esteem levels. These results show how gender stereotypes may affect body image and self-esteem, and therefore eating and exercise behaviors, highlighting the importance to reinforce body acceptance through school-based health promotion interventions.
Persistent hypovitaminosis D among Italian patients with myocardial infarction
Authors: Aleksova A , Zandona' L , Beltrami A P , Pierri A , Stenner E , D'errico S , Sinagra G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Previously we have demonstrated that hypovitaminosis D is common in the Italian population and it has a comparable deleterious effect to diabetes mellitus on survival after an acute myocardial infarction (AMI).

Aim

Here, we sough to evaluate if the prevalence of hypovitaminosis D changed over time, considering also frequent lockdowns in the last years due to COVID-19 pandemic.

Methods

Our large population of 1042 patients hospitalized for AMI, were divided into three groups, according to the year of enrollment: group 1 included 368 patients enrolled between 2014-2016, group 2 with 470 patients enrolled between 2017- 2019, and group 3 from 204 patients enrolled in the last three years, 2020-2022). We determined Vitamin D level at hospital admission and we evaluated whether the concentration of vitamin D changed in the last decade.

Results

The median concentration of vitamin D in our cohort of patients with AMI was 18.2 (11.48-25.73) ng/ml). Throughout the three groups (2014-2016, 2017-2019, 2020-2022), the median plasma vitamin D showed a trend toward an increase (17.3 (10.33 – 24.2) ng/ml, 18.95 (11.6 – 26.73) ng/ml, and 19.05 (12.5 – 27.3) ng/ml respectively), which was significant between the group 1 vs 2 and 3 (p = 0.033 and p = 0.004, respectively), while between the group 2 and 3 did not. Despite the trend of increase, the percentage of patients with hypovitaminosis D in each group remained high (61.4%, 53.8% and 52.0% respectively). As expected, samples taken between May and September have significantly higher vitamin D values compared to ones taken from October to April for each group (the group 1: 21.80 (15.55 – 31.23) ng/ml vs 15.8 (9.22 – 23.98) ng/ml, p < 0.0001; the group 2: 22.05 (14.10 – 30.98) ng/ml vs 16.50 (11.03 – 23.90) ng/ml, p < 0.0001); the group 3: 20.00 (11.90 – 26.90) ng/ml vs 16.30 (9.75 – 22.30) ng/ml, p = 0.001). In all three groups, low levels of Vitamin D were associated with worse outcome as previously we have shown.

Conclusions

There has been a trend of increasing vitamin D values over the years, but insufficient vitamin D levels persists. We did not observed a decrease of Vitamin D levels, over the pandemic, possibly due to media awareness that emphasized the significance of vitamin D administration against viral infection.
Exercise systolic blood pressure indexed to work rate predicts future risk of incident stroke
Authors: Carlen A , Lindow T , Cauwenberghs N , Elmberg V , Brudin L , Ekstrom M , Hedman K
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): 1) The CircM network, Linköping University 2) The Swedish Stroke Association.

Background

Hypertension is a major risk factor for stroke. Exaggerated peak systolic blood pressure (SBP) during exercise is associated with increased risk of hypertension in normotensive subjects, whereas low, rather than high, peak exercise SBP predicts cardiovascular and all-cause mortality.

Purpose

We aimed to study the risk of incident fatal and non-fatal stroke in relation to absolute and work rate indexed exercise SBP, in patients referred for exercise testing.

Methods

We cross-linked clinical data from 14,428 bicycle ergometer exercise tests with data from the National Patient Registry and the Registry of Prescribed Medications up until December 2019. Subjects with a history of cerebrovascular disease were excluded, as well as subjects with submaximal tests, a drop in SBP during exercise, or with missing SBP data at the end of exercise. Baseline comorbidity was defined as diagnosis of, or treatment for, hypertension, diabetes, hyperlipidemia, and coronary artery disease (CAD). Work rate indexed SBP response (SBP/Watt-slope) was calculated as the increase in SBP during exercise divided by the increase in work rate. We applied Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (95% CI) for the risk of incident stroke in association to peak SBP and the SBP/Watt-slope. We used absolute values as well the upper limit of normal (≥2 Z scores) of a recently published reference population, with reference equation including age, sex, SBP at rest, Wmax (for SBP peak only) and height (for SBP/W-slope only). Analyses were adjusted for age, sex, and baseline comorbidity.

Results

In total, 7,946 subjects (54% male, age 55±13 years) were included, with baseline comorbidity of hypertension (28%), diabetes (7%), hyperlipidemia (16%), and CAD (13%). During a median follow-up of 8.4 years (inter quartile range 5.8-11.5), 3.1% developed ischemic (2.2%) or hemorrhagic (1.0%) stroke. There were positive associations to future stroke with absolute peak exercise SBP (HR: 1.08 [1.03 – 1.13] per 10 mmHg increase) and with SBP/Watt-slope (HR: 1.09 [1.05 – 1.14] per 1 mmHg/10 Watt increase), but not after adjustment for sex, age and baseline comorbidity. However, having a SBP/Watt-slope ≥2 Z scores was associated with an increased risk for stroke (HR: 1.56 [1.08 – 2.25)] after adjustment for baseline comorbidity, whereas an adjusted SBP peak ≥2 Z scores was not (HR: 0.62 [0.32 – 1.21]).

Conclusion

A workload-indexed SBP response (SBP/Watt-slope) above the upper limit of normal may help to identify subjects with no history of cerebrovascular disease at risk of future stroke. In contrast, the absolute exercise SBP response to exercise does not add substantial information to the risk estimation above age, sex, and baseline comorbidity.
Psychological well-being and illness perception in hypertrophic cardiomyopathy patients undergoing hybrid cardiac rehabilitation
Authors: Mierzynska A , Sadowski K , Piotrowicz R , Klopotowski M , Wolszakiewicz J , Lech A , Witkowski A , Smolis-Bak E , Kowalik I , Piotrowska D , Dobrowolski P , Dabrowski M , Sadowy E , Piotrowicz E
Published: May 2023

Funding Acknowledgements

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

Background

Hypertrophic cardiomyopathy (HCM) is a congenital heart disease influencing patients' physical capacity and quality of life and increasing the risk of sudden cardiac death. For many years patients with HCM were advised to avoid physical activity and intense psychological stress. Current studies suggest that cardiac rehabilitation (CR) could be safe and beneficial for somatic and psychological status in HCM patients.

Method

In the RCT study assessing the efficacy of hybrid CR patients with HCM from rehabilitation (R) and control (C) groups were asked to fill the questionnaires regarding their psychosocial well-being (GHQ-28) and illness perception (Brief IPQ) at every stage of the study (baseline, 3, 6, 9, and 15 months).

Results

There was a significant improvement in the overall distress level in the R group (p=0,003), but not in the C group (p=0.559). There were no significant differences in the illness perception (p=0.200 for the R group and p=0.090 for the C group), although the R group showed significant short-term improvement after three months (p=0.032).

Conclusions

Cardiac rehabilitation can enhance the psychological well-being of HCM patients and their adjustment to illness. However, significant improvement is observed only in the first months after the rehabilitation.
Apolipoprotein B and cardiovascular risk in asymptomatic patients: need for systematic evaluation?
Authors: Halatiu V B , Rodean I P , Benedek I , Benedek T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The involvement of apolipoprotein B (apoB) in atherogeneis is well known because of its role in the metabolism of lipids. Elevated levels of apoB have been found not only to be correlated with clinical atherosclerosis, but also with sub-clinical forms. Cardiovascular risk can be estimated based on clinical risk scores. However, the main limitation of these risk score models is to estimate only traditional risk factors and not other important factors such as apoB.

Purpose

To assess the interactive effects of apoB in asymptomatic patients, and its link to cardiovascular risk.

Methods

This prospective observational study included 811 asymptomatic participants. According to the median apoB value (set at 130 mg/ dl) the study population was divided into two groups as follows: group 1 – 713 patients with low apoB values and group 2 – 98 patients with high apoB. Also, for each patient personal data, such as family history of premature cardiovascular disease, smoker status, personal history of heart failure or atherosclerotis were obtained. Regarding the subclinical atherosclerosis the carotid thickness of intima-media was measured.

Results

Patients with high apoB are more frequent males (p=0.008) with a mean age of 57.6 ± 11.9 years old (p<0.0001) and smokers (p=0.01). The apoB level was not higher in patients with known atherosclerosis or with traditional risk factors such as diabetes melitus, history of stroke, myocardial infarction, or hypertension. Although, subclinical atherosclerosis, expressed by the presence of carotid plaques is more frequent found in patients with elevated apoB levels (p=0.0001). A higher total cholesterol (p<0.0001), triglycerides (p<0.0001) and LDL-cholesterol levels (p<0.0001) were identified in patients from group 2 compared with those form group 1. Moreover, the uric acid was observed to be correlated with the apoB serum level (5.2 ±1.5 vs. 6.2 ±1.7, p=0.001). The risk of diabetes melitus was also found to be higher in group 2 compared with group 1, expressed by the glycosylate haemoglobin (5.6 ± 0.7 vs 5.9 ± 1.1, p<0.0001).

Conclusions

Apolipoprotein B level is correlated with subclinical atherosclerosis and worse outcomes expressed by a higher lipid profile and risk of diabetes melitus development. These findings highlighted that the determination of the apoB is therefore mandatory for a better stratification of cardiovascular risks in primary prevention of atherosclerosis.
Clinical outcomes after a home cardiac rehabilitation program
Authors: Parada Barcia J , Maria Sol Bravo Amaro M B A , Iria Sanchez I S , Maria Concepcion Abreu Pazo M C A , Antonio Chamorro Comesana A C C , Cristina Prieto Fernandez C P F , Cristina Fernandez Caamano C F C , Maria Jesus Garrido Ferrero M J G , Marisol Samartin Ucha M S U , Isabel Caride Gonzalez I C G , Inmaculada Gonzalez Bermudez I G B , Noa Pineiro Fernandez N P F , Eduardo Pena E P , Enrique Cespon Outeda E C , Andres Iniguez Romo A I N
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation programs (CRP) still do not reach all patients with this indication. In the context of COVID-19 pandemic, the new home CRP model has been introduced.

Purpose

To evaluate the results in terms of control of cardiovascular risk factors (CVRF) and changes in functional capacity with home CRP.

Methods

Cross-sectional observational study that included 173 patients, ≥ 18 years, after acute coronary syndrome or after coronary revascularization, included in home PRHC. Electronic medical records were analyzed to collect data on baseline clinical variables at the entrance and exit after 2 months of the home CRP: smoking habit, weight, abdominal perimeter, total cholesterol, LDLc, HDLc, triglycerides, HBA1c, METS in stress test and employment status.

Results

A total of 173 patients has been studied. Mean age was 51.6 (SD: 7.94), 15.6% women. Indication for home CRP was non-ST-elevation myocardial infarction (NSTEMI) in 45.7% of patients, 31.8% had STEMI, 17.9% after elective coronary interventions, 3.5% after cardiac arrest, and 1.2% corresponded to other causes. Patients were at low risk in 50%, 48% moderate and 2% high risk. With 1, 2, or 3 vessels disease in 38.1%, 28.3%, and 33.5% respectively. Coronary revascularization was obtained by percutaneous interventions in 80.9% while 14.5% by surgery. Baseline 45.7% of patients were hypertensive, 71.7% dyslipidemic, 33.5% obese, 15.7% diabetic, and 14 % smoked at index admission. After two months of home CRP we obtained a reduction of 85.5% in smoking (p<0.001), improvement in lipid control (p<0.001), with a mean LDLc of 54.5 mg/dl, a loss of 4.6 kg of weight in obese people and improvement in 1.50 METS (p<0.0001).

Conclusions

The present study indicates that home cardiac rehabilitation programs are a valid alternative in low- and moderate-risk patients after acute coronary syndrome.
Cardiac rehabilitation can change the destiny of the patient with ST-elevation acute coronary syndrome
Authors: Padilla Rodriguez G , Gomez Gonzalez A , Lucas Garcia M , Lopez Flores M C , Martinez Quesada M M , Garcia Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac rehabilitation (CR) has become a basic element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors.

Purpose

We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a Cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE).

Methods

Observational prospective study where a total of 664 STEMI patients admitted to a Coronary Unit during the years 2017-2020 were included. They were classified according to their participation in a CR program. We compared medical history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of achievement of lipid targets. MACE (mortality, reinfarction, coronary revascularisation and restenosis) were observed at 2-year follow-up.

Results

From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 years; 81% male), 55.3% were included in the CR program. This group had a lower mean age (55.46±8.7 vs 65.39±11.5, P<0.001), as well as a higher frequency of early ischaemic heart disease history and smoking, with a lower frequency of hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR, there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year follow-up (126.2±27 vs 137.2±34, P=0.002; 57.8±23 vs 67.5±26, P<0.001) and a greater reduction in LDLc (41.4% vs 20.86%, P<0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc<70 being achieved in a greater number of cases (81.5% vs 59.3%, P<0.001). At 1-year follow-up, the new lipid reduction target (LDLc<55 + 50% reduction) was achieved in only 26.8% of patients, with a greater reduction in the CR group (34.1% vs 17.9%; P=0.02). Although differences were observed in the follow-up in terms of mortality and new events, in favor of the CR group, these did not reach statistical significance.

Conclusions

Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programmes represent a basic tool for achieving lipid and cardiovascular risk factor targets and improved long-term clinical outcomes.