bluuebunny/crossref_metadata_2025 huggingface dataset:
The orthostatic hypotension in patients with Stanford type A aortic dissection after surgery
Authors: Funaki T , Kanazawa M , Takahashi S , Seki T , Iguchi A , Kagaya Y , Sato K , Saito H , Kondo M , Miura M , Kawatsu S , Endo H , Oda K , Nakamura A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Orthostatic hypotension (OH) is sometimes observed during cardiac rehabilitation in patients with surgery for aortic dissection. However, little is known about the primary determinant of OH and influence of surgical range on incidence of OH.

Purpose

The aim of this study was to elucidate the incidence of OH in patients with surgery for aortic dissection, and compare it between the patients with ascending aortic replacement surgery (ascending group) and those with ascending aorta and hemiarch or total arch replacement surgery (arch group).

Methods

We analyzed 59 patients who underwent emergent surgery due to Stanford type A aortic dissection from January 2014 to March 2018, and compared the incidence of OH between ascending group (n = 28, age 69.8 ± 11.3 years) and arch group (n = 31, age 64.1 ± 13.0 years).

Results

The incidence of OH in total patients was 30.5%. There were no significant differences in patient characteristics including body tall, body weight, antihypertensive use and progress of rehabilitation between 2 groups. The arch group showed a significant higher incidence of OH as compared with ascending group (arch group: 46.4% vs. ascending group: 16.1%, p = 0.03). Moreover, the patients who occurred OH were significantly taller than those who did not occur OH.

Conclusions

OH was observed in about one third of patients with surgery for aortic dissection and it showed a close relationship with patient’s height and the range repaired by surgical operation. More careful cardiac rehabilitation is needed for tall patients with large area replacement of aorta.
Monocyte count to high-density lipoprotein cholesterol ratio and mean platelet volume may be related to the severity of carotid artery stenosis
Authors: Kuyumcu M S , Ayyildiz V A , Ulusan S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Objective

The pathophysiology of carotid artery stenosis (CAD) is not fully understood. Research has shown that mean platelet volume (MPV) is a potential marker for platelet activation and a key factor in the pathophysiology of atherosclerosis. Recently, the ratio of monocyte count to HDL (MHR) has been identified as a predictor of cardiovascular events in patients. In the light of these findings, the goal of this study was to evaluate the potential association of MPV and MHR with the severity of CAD.

Material-Method

The patients were divided into three groups: CAD≥ 60% (40 patients), CAD <60% (40 patients) and no carotid atherosclerotic disease (40 individuals). Patients' demographic characteristics, clinical features and laboratory findings were compared between the groups.

Results

MPV and MHR levels were lower in the control group than CAD <60 group and lower in CAD <60 group than CAD ≥60 group (p <0.001, p <0.001). Higher MPV (OR= 6.050; 95% CI: 2.946-12.427; p <0.001) and MHR (OR= 1.107; 95% CI: 1.045-1.159; p <0.001) levels were detected as an independent predictor for ≥60% carotid artery stenosis after multiple linear regression analysis. In the correlation analysis, a positive correlation was found between MPV and the rate of carotid artery stenosis (p<0.001, r=0.680).

Conclusion

In our study, a potential relationship between MPV and MHR with carotid artery disease was determined. Our study may make contributions to understanding the pathophysiology of carotid artery atherosclerosis and developing treatments for it.
Prognostic value of exercise stress echocardiography in patients with known coronary artery disease
Authors: Cardoso A , Lourenco MR , Von Hafe P , Dias G , Pereira T , Tinoco M , Fernandes M , Azevedo O , Lourenco A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Exercise stress echocardiography (EE) is useful for diagnosis and risk stratification in patients (pts) with suspected coronary artery disease (CAD). Pts with known CAD carry a high risk of events. Our aim was to assess the utility of EE in predicting outcomes in this population.

Methods

Single center retrospective study of consecutive pts with known CAD who performed an EE between 2018 and 2019. The primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.

Results

A total of 76 pts were included (mean age 59±9 years; 87% male). Fifty-nine (78%) pts had history of ACS, 51 (67%) of percutaneous coronary intervention (PCI) and 14 (18%) of coronary artery bypass graft. The majority of pts had 2 or more vessel disease (42 pts; 55%).

The main reason for performing EE was new onset of chest pain (38 pts; 50%) followed by functional assessment of coronary stenoses after incomplete revascularization (29 pts; 38%). The majority of pts had a preserved left ventricular ejection fraction (67; 88%). The exam was performed under beta-blocker effect in 35 (46%) pts.

The results of EE were positive for myocardial ischemia in 7 (9%) pts, negative in 37 (49%) pts and inconclusive in 32 (42%) pts. Mean exercise time was 8±3 minutes and mean METs achieved was 9.4±2.6. ST-segment depression fulfilling electrocardiographic criteria for ischemia occurred in 17 (22%) pts. Eleven (14%) pts complained of chest pain during the exam.

During a median follow up of 22 months (IQR 15-26), the primary endpoint occurred in 9 pts (admission for ACS in 5 pts; revascularization for chronic coronary syndrome in 4 pts). No cardiovascular death occurred. The positive predictive value of EE for the primary endpoint was 57.1% and the negative predictive value (NPV) 97.3%.

In a survival analysis, the predictors of the primary endpoint were lower exercise time, lower METs achieved, untreated significant coronary lesions and a positive EE (figure).

After adjustment in a multivariate analysis, a positive EE was an independent predictor of the primary endpoint (HR 4.6, 95%CI: 1.1-16.7, p=.044).

Conclusion

In pts with known CAD, EE had a high NPV and a positive result was an independent predictor of future cardiovascular events.
Modest association between peak exercise blood pressure and ambulatory hypertension in endurance athletes
Authors: Janssens K , Mitchell A , Foulkes S , Head G , Saner N , Howden E , Claessen G , La Gerche A
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

An exaggerated blood pressure (BP) response to exercise may be an early indicator of hypertension. However, it is common in endurance athletes and the association between systolic blood pressure (SBP) during exercise and hypertension is not well established in this group.

Purpose

To establish whether there is an association between exercise-induced hypertension (EIH) and clinical hypertension in endurance athletes.

Methods

250 current and former endurance athletes (16-80 years, 75% male) performed a maximal exercise test on a cycle ergometer with BP measured every 2 min. Athletes were diagnosed with EIH based on international guidelines (SBP ≥210mmHg males, ≥190mmHg females). The relationship between SBP and workload was determined by linear regression analysis. Office hypertension was identified from either supine SBP ≥140mmHg or diastolic BP ≥90mmHg, or if treated for hypertension. Gold-standard 24-hour ambulatory blood pressure monitoring (ABPM) was performed in a subset of 42 athletes with EIH and 9 athletes with a normotensive response to exercise (NRE).

Results

On average, peak exercise SBP values were universally high (221±26mmHg in males and 199±21mmHg in females). 71% of athletes (70% of males and 74% of females) met criteria for EIH of which 12% had a peak SBP≥250mmHg. EIH and NRE groups were of similar age, sex, body mass index (BMI) and fitness (Figure 1). The strongest determinant of peak exercise SBP was exercise workload (R=0.78, P<0.001), which remained significant after adjusting for age, sex, BMI and antihypertensive medication (p<0.001) In the full cohort, resting SBP was higher in the EIH group (EIH: 128±13mmHg vs NRE: 122±15mmHg, P=0.006 – Figure 1), however there was a similar prevalence of office hypertension between the EIH (19%) and NRE (15%) groups (P=0.59). This prevalence remained similar (EIH: 13% vs NRE: 10%, P=0.49) after excluding those being treated for hypertension (n=15). In the subset of athletes who underwent 24h ABPM (n=51), there were no diagnoses of clinical hypertension in NRE (n=9, Figure 1). Of the 42 athletes with EIH, a majority (n=32, 76%) were normotensive on ABPM. In the 10 athletes with EIH and hypertension on ABPM, the majority were classified with Grade 1 hypertension (n=5) or daytime hypertension (n=3). Interestingly only two of these athletes would have been identified with office BP measures (see Figure 2).

Conclusion

EIH is common in endurance athletes and is strongly associated with peak exercise workloads suggesting this may be a reflection of superior cardiovascular fitness. In a small proportion of athletes, EIH may be associated with mild hypertension.
Alternations in markers of insulin resistance: HOMA-IR, HOMA-B, QUICKI, after dual therapy combination with telmisartan/amlodipine in prediabetic hypertensive patients
Authors: Liontos A , Papathanasiou A , Biros D , Papagiannopoulos C , Tsourlos S , Athanasiou L , Veliani C , Kolios NG , Pappa C , Zarachi A , Christaki E , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction-Purpose

The combination of telmisartan and amlodipine in tablet form indicated for patients whose arterial blood pressure cannot be fully managed with monotreatment. The purpose of this study was to investigate the effect of the fixed combination telmisartan/amlodipine 80/5mg per day on arterial pressure levels and the variation of HOMA-IR, HOMA-B and QUICKI values in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-179 mmHg and/or diastolic blood pressure (DBP) 100-109 mmHg) and with prediabetes (IFG/IGT) before and after the 3-month treatment with the administration of the fixed combination.

Methods

Data collected from 51 patients who have visited our outpatient clinic for lipid metabolism disorders during the period 2014-2018. 51 persons with BMI: 29.32 [27.37-31.65] (25 male, 16 female) had been randomized in the group for telmisartan/amlodipine 80/5mg per day.

The median values for the study’s sample in SBP and DBP were: 163[158-168] and 100[95-106] mmHg, respectively. Their somatometric and demographic characteristics were recorded in the beginning of the study and are presented on Table 1Α.

Results

The results of the variations in SBP and DBP, as well as the variations in glucose, insulin, HOMA-IR, HOMA-B and QUICKI before and after the 3-month treatment are presented on Table 1B.

Conclusions

From the sampled patients it can be observed that the 3-month treatment with telmisartan/amlodipine statistically significantly improved (p=0.005) the HOMA-IR values while improving fasting glucose and insulin levels. Finally, there was a statistically significant reduction in QUICKI values and a statistically insignificant reduction in HOMA-B.
Changes in TRG/ApoA-1 ratio, TRG/HDL-C ratio and lipid serum profile after combination therapy with valsartan/amlodipine in prediabetic patients
Authors: Liontos A , Papathanasiou A , Biros D , Papagiannopoulos C , Tsourlos S , Athanasiou L , Zarachi A , Pargana E , Nasiou M , Veliani C , Christaki E , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction-Purpose

The combination of valsartan with amlodipine is a commonly administered combination of an agonist ATII (angiotensin receptor II) and CCB (calcium channel blocker) for the management of hypertension. There is already data from different studies that describe the effect of each of those medications in the lipidemic profile. Ratios TRG/ApoA-1, TRG/HDLC are useful markers of insulin resistance. The purpose of this study is to investigate the effect of the fixed combination of valsartan/amlodipine 160/5mg per day on the levels of serum lipids, as well as the levels of serum apolipoproteins and the TRG/ApoA-1, TRG/HDLC ratios, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-179 mmHg and/or diastolic blood pressure (DBP) 100-109 mmHg) and prediabetes (IFG/IGT), before and after the 3-month treatment.

Methods

Data from 54 patients who were referred to our outpatient clinic for lipid metabolism disorders during the period 2014-2018 and had been randomized in the valsartan/amlodipine group 160/5mg per day. Those patients (33 male/21 female from whom 14 were smokers and 8 alcohol users) all completed the study successfully with mean BMI: 28.09[26.81-29.89]. The median values of SBP and DBP for the sample group were: 162 [159.25-165] και 100 [92-103.75] mmHg, respectively. The levels of apolipoproteins B, A-1, Lp(a) and E were measured prior to the beginning of treatment and 3-months after its administration.

Results

The resulting alternations of SBP and DBP levels before and after the 3-month treatment, as well as the changes of serum lipid, apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios are presented in Table 1.

Conclusions

From the sample group it seems like that the 3-month therapy with valsartan/amlodipine improved statistically significant both SBP and DBP levels (decreased by -13.58% and -13% respectively, p<0.001 for both values). Concerning lipid levels, no significant variation was observed across the board. Finally, no significant change was observed in apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios.
Changes in TRG/ApoA-1 ratio, TRG/HDL-C ratio and lipid serum profile after combination therapy with telmisartan/amlodipine in prediabetic patients
Authors: Liontos A , Papathanasiou A , Biros D , Papagiannopoulos C , Tsourlos S , Athanasiou L , Zarachi A , Kolios NG , Pargana E , Nasiou M , Christaki E , Liberopoulos E , Elisaf M , Milionis H , Liamis G
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction-Purpose

The combination of telmisartan with amlodipine is a commonly administered combination of an agonist ATII (angiotensin receptor II) and CCB (calcium channel blocker) for the management of hypertension. The purpose of this study is to evaluate the effect of the fixed of combination telmisartan/amlodipine 80/5mg per day on the levels of serum lipids, as well as the levels of serum apolipoproteins and the TRG/ApoA-1, TRG/HDL-C ratios, in patients with stage 2 hypertension (systolic blood pressure (SBP) 160-180 mmHg and/or diastolic blood pressure (DBP) 100-110 mmHg) and with prediabetes (IFG/IGT), before and after the 3-month treatment.

Methods

Data from 51 patients who had visited our outpatient clinic for lipid metabolism disorders during the period 2014-2018 and had been randomized in the telmisartan/amlodipine group 80/5mg per day. The patients (35 male/16 female) had BMI: 29.32 [27.37-31.65]. The levels serum lipids and of apolipoproteins B, A1, Lp(a) and E were measured before the beginning of the treatment and 3-months after its administration.

Results

The resulting variations of SBP and DBP levels before and after the 3-month treatment, as well as the variations of serum lipid, apolipoprotein levels and TRG/ApoA-1, TRG/HDL-C ratios are presented on Table 1.

Conclusion

The 3-month telmisartan/amlodipine therapy seems to improved, statistically significant both SBP and DBP levels (decreased by -13.58 % and -13 % respectively, p<0.001, for both values). Serum lipid levels didn’t show any significant variation before and after treatment. Statistically significant changes were not present in apolipoprotein levels, also. Finally, there were no statistically significant variations in either TRG/ApoA-1 or TRG/HDL-C ratios.
Relationship between phytosterol intake and cardiovascular disease in the adult Polish population
Authors: Waskiewicz A , Witkowska AM , Cicha-Mikolajczyk A , Mironczuk-Chodakowska I , Zujko ME , Drygas W
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Plant sterols are compounds with multiple biological functions, mainly cholesterol-reducing. Although phytosterols lower LDL-cholesterol, their relationship to cardiovascular risk is unclear.

Purpose

To assess dietary total phytosterol, β-sitosterol, campesterol and stigmasterol and to determine the relationship between total plant sterols and the chance of cardiovascular disease (CVD) in the adult Polish population.

Methods

Within the frame of the National Multicenter Health Survey (WOBASZ II), a random sample of the whole Polish population aged 20 years and above was screened during the years 2013-2014. Dietary habits and an interview of a history of CVD were assessed in 2554 men and 3136 women. The international food databases were used to develop a database on plant sterols in the products consumed in Poland. Plant sterols were calculated from the amount of food consumed by the participants combined with the phytosterol content of the food. The subjects were divided according to the tertiles of total phytosterol intake – 1st tertile (mean [mg/day]); 153 (men 174; women 141); 2nd tertile – 257 (293; 233 respectively), and 3rd tertile 439 (496; 383). The logistic regression method was used to calculate the odds ratio (OR) of the occurrence of CVD in phytosterol tertiles after adjustment for age, BMI and consumption of lipid-lowering drugs, fiber, and alcohol.

Results

The average total plant sterol intake [mg/day] was significantly lower in subjects with CVD than in subjects without CVD (men 299 vs 326, p= 0.0016 and women 238 vs 256, p= 0.0016); β-sitosterol (186 vs 201, p= 0.0062 and 149 vs 160 p= 0.0016 respectively), campesterol (63.2 vs 70.6; p=0.0044 and 46.8 vs 51.9 p= 0.0015) and stigmasterol (24.2 vs 26.9; p=0.0017; 20.7 vs 23.1 p=0.0023).

In the whole group there was a significantly lower OR=0.695 (0.528-0.916) of developing CVD in the third tertile compared to the first. In men, the odds ratios of CVD were significantly lower in the second tertile OR=0.637 (95%CI 0.445-0.911) and in the third tertile OR=0.581 (95%CI 0.372-0.907) compared to the first tertile. In women, the trends were similar, although no significant differences were shown – in the second tertile OR = 0.927 (95% CI 0.695-1.237) and in the third tertile OR=0.843 (95%CI 0.600-1.184). In addition, there was a better overall quality of nutrition in people in the third tertile of phytosterol intake compared to the first tertile.

Conclusion

The content of phytosterols in the diet may determine the chance of developing CVD, especially in men.
Gender differences in acute cardiovascular mortality in France
Authors: Alami O , Alami M
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular diseases are usually known as men’s diseases, and many beliefs tend to assert that women are protected by their hormones before menopause. However, in France, women are suspected to die more than men due to acute cardiovascular disease.

Purpose

Our aim is to confirm this excess women mortality and to propose a new indicator in order to assess the probable delay in diagnosis and hospital care in acute cardiovascular settings among women.

Methods

We focused on major acute cardiovascular pathologies : Pulmonary Embolism (PE), Myocardial Infarction (MI) and Stroke. We compared males and females death numbers for these diseases. Deaths were age-standardized in order to assess mortality differences by sex. Then we suggested a new ratio which relates number of hospitalizations to number of deaths for each one of the three cardiovascular pathologies.

Results

Women died more than men from acute cardiovascular pathologies in France between 2000 and 2016. Stroke is the first cause of death from acute cardiovascular disease in women in 2016. Men’s Standardized Mortality Ratio (SMR) over women’s SMR was in favor of an excess man mortality when age bias is taken into account (SMR men/SMR women = 1,18 for PE, 1,25 for Stroke and 2,16 for MI). The new indicator (HD) was lower in women for Stroke and Myocardial Infarction (3,23 and 3,08 in females versus 5,05 and 4,72 in males, respectively).

Conclusion

Women in France die more than men from cardiovascular causes. This new indicator should contribute to a better understanding of delays in diagnoses and care in acute cardiovascular settings among women. Imperative measures should be taken in order to reverse the excess women mortality trend.
Combined environmental and educational intervention in hospital food service to increase patients attitude and intention about a healthy diet
Authors: De Frel DL , Janssen VR , Van Keulen N , Atsma DE
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The elimination of unhealthy risk behaviors such as unhealthy diet, smoking or physical inactivity can prevent at least 80% of cardiovascular disease.(1) Diet has been the number two in modifiable factors attributing to cardiovascular disease burden in the last thirty years.(2) In spite of this, adherence to dietary guidelines in The Netherlands is as low as 20-30%.(3) Clearly, more effective strategies towards healthier dietary behavior are needed.(1) According to the dual process theory, behavior can be influenced via the deliberate system and the intuitive system.(4) The food services on the cardiology ward were revised aiming to influence both systems in admitted patients to gear them towards healthier choices.

Purpose

To assess the impact of a combined environmental and rational intervention on patients’ attitude and intention towards a healthier diet.

Methods

A pre-post interventional study was conducted from June 2020 till November 2021 in patients admitted to the Cardiology ward. Patients’ attitude, self-efficacy and intention towards a healthy diet were evaluated through the validated Dietary Intention Evaluation Tool for In-hospitalized patients (DIETI). The intervention was aimed at intuitive and rational behavioral processes. The intuitive part consisted of posters, healthy standard options and a traffic light system on the menu. The rational part consisted of information about a healthy diet on the menu, emphasis on the importance of a healthy diet, a renewed website on lifestyle and an educational course on diet and nudging for nurses and food service employees. Also, at discharge, patients received two salt free spice mixes with healthy, easy and cheap recipes to prepare at home.

Results

A total of 512/853 (60%) complete responses were received. The intervention group reported to have learned significantly more during their admission than patients in the control group (4.58 vs. 4.80, p=0.009). However, our intervention does not influence patients’ attitude or intention regarding a healthy diet (p=0,41 and p=0,49 respectively).

Conclusions

A hospital admission of approximately 3 days is enough to make a significant impact on patients’ perceived learning. However, a combined environmental and educational intervention did not have an effect on patients’ attitude or intention regarding a healthy diet.
Sedentary behaviour and physical activity following multimodal exercise-based cardiac rehabilitation in patients with coronary artery disease
Authors: Kambic T , Sarabon N , Hadzic V , Lainscak M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background

Despite high levels of sedentary behaviour (SB) in patients with coronary artery disease (CAD), there is still limited evidence on the efficacy of multimodal exercise interventions combined with physical activity (PA) counselling on SB and PA in cardiac rehabilitation (CR). Such combined modalities in CR may provide additional benefits for PA and SB, although this remains to be investigated.

Purpose

The aim of our study was to investigate the effects of multimodal exercise training combined with brief PA counselling on PA and SB according to sedentary status of patients with CAD.

Methods

We randomised 79 patients with CAD to low-load (LL) resistance training (RT) + aerobic training (AT) (30%-40% of one repetition maximum [1-RM]), high load RT+AT (70%-80% of 1-RM) and AT alone. The study was completed by 57 patients, with [mean (SD)] age = 61 (8) years, height = 171.8 (8.5) cm, weight = 85.12 (15.59) kg and left ventricular ejection fraction = 53 % (45,60) [median (first, third quartile)]. During the study, each patient received an hour of PA counselling and written PA brochure. Step count, daily SB, light intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) were measured at baseline and post-training using triaxial accelerometer. Following baseline measurement, we stratified patients to quartiles based on their levels of SB: most sedentary, sedentary, less sedentary, least sedentary.

Results

Upon enrolment to CR patients have surpassed daily PA recommendation (+21 min, p < 0.001). All measures of PA and SB remained unchanged following training intervention (all p > 0.388). Patients classified as the most sedentary have decreased SB (-52 min/day, p = 0.001) and increased LIPA (+27 min/day, p = 0.009), while the least sedentary patients increased SB (+69 min/day, p = 0.006) and decreased LIPA (-25 min/day, p = 0.038) following the intervention. The improvement in PA was greater in the most sedentary patients (SB: +27%, p = 0.002; LIPA: +24%, p = 0.004) and in sedentary patients (SB: +24%, p = 0.009) compared to the least sedentary patients. After the training intervention, LIPA was improved more in less sedentary patients compared to the least sedentary patients (+19 %, p = 0.031). Two-way analysis of variance has demonstrated non-significant effect of time x training modality interaction on all PA and SB variables (p = 0.285-0.819).

Conclusions

The addition of RT and brief PA counselling to standard CR showed limited effects on post-training improvement in SB and MVPA. Individually tailored PA behavioural counselling based on patients’ sedentary status along with regular PA monitoring during CR should be implemented to enhance the effects of combined RT and AT in patients with CAD.
Comparison of the 2010 and 2020 World Health Organization guidelines on physical activity in patients with percutaneous coronary interventions early after hospital discharge
Authors: Eser P , Gonzalez-Jaramillo N , Weber S , Femiano R , Werner C , Casanova F , Bano A , Franco OH , Wilhelm M
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss heart foundation

Background

Physical activity (PA) is inversely associated with mortality and adverse outcome in patients with cardiovascular disease, and can be objectively measured by accelerometry. In 2020, the World Health Organization (WHO) has updated their recommendations on PA for adults including those with chronic conditions, omitting the 10 min bout criterion.[1] The aim of this study was to determine the proportions of cardiac patients immediately after hospital discharge from percutaneous coronary interventions (PCI) who fulfil the old [2] and updated WHO PA criteria, and compare the results with established step-based cut-off values.

Methods

Patients after PCI for acute or chronic coronary syndrome with a maximal age of 80 and eligible for ambulatory cardiac rehabilitation were recruited for this observational single centre study. They were provided with a wrist-worn tri-axial accelerometer without display that recorded movement data starting from the day following hospital discharge for the subsequent 18 days. Acceleration data was analysed with the widely used free GGIR package. The proportions of patients fulfilling recommendations for moderate to vigorous PA (MVPA) were determined according to the 2010 and 2020 WHO guidelines as well as 7,500 [3] and 10,000 steps.[4]

Results

159 patients (41%) participated in this study. Data from 135 patients (85%), who had at least 7 days of ≥12 h wear-time were included in the analyses. Their median age was 62 (1st quartile 56, 3rd quartile 68), 22 (16%) were women, and 15 and 120 patients had a CCS and ACS, respectively. Their median wear time was 18 (16, 18) days. 102 (75.6%) had at least 30 min of MVPA on an average day and hence fulfilled the 2020 WHO guidelines. When MVPA was determined using the 2010 WHO guidelines, which only counted MVPA of bouts of at least 10 min, only 23 patients (17.8%) achieved at least 30 min of MVPA on an average day (Figure 1). 67.4% of our patients achieved ≥7,500 steps/d and 71 patients (52.6%) performed ≥10,000 steps/d.

Conclusion

In cardiac patients early after PCI most of the MVPA was accumulated in bouts shorter than 10 min. Applying the 2010 and 2020 WHO PA criteria to objectively measured PA led to a fourfold discrepancy. The 7,500 step cut-off corresponded with the 2020 WHO recommendations. Since achievement of intensity- or step-based cut-offs is greatly dependent on device type, wearing location, data sampling and analysis, it is currently poorly defined and not suited for patient classification and counselling. The clinical implication of this observation will be assessed in a cardiovascular outcome analysis.
Association of socioeconomic status measures with physical activity and subsequent frailty in older adults
Authors: Kheifets M , Goshen A , Goldbourt U , Witberg G , Eisen A , Kornowski R , Gerber Y
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Despite increased recognition, frailty remains a significant public health challenge.

Methods

Using a population-based cohort of older adults, this study examined the relationship between socioeconomic status (SES) factors, physical activity and frailty. The study included 1,799 participants (mean [SD], age 75[6]; 53% women) from the "National Health and Nutrition Survey of Older Adults Aged 65 and Over in Israel", conducted in 2005-2006. A follow-up interview was performed 12-14 years later in a subgroup of 601 subjects (mean [SD], age 84[4]; 56% women). Extensive data including self-reported leisure time physical activity (LTPA) and SES measures were assessed at baseline. Frailty was measured at follow-up.

Results

All SES measures were strongly and positively associated with LTPA (all p<0.001). Eighty-two participants (14%) were classified as frail at follow-up. After age and sex adjustment and accounting for attrition bias using inverse probability weighting, baseline LTPA (OR=2.77, 95% CI: 1.57-4.90, for inactivity; OR=1.41, 95% CI: 0.75-2.68, for insufficient activity, compared with sufficient activity, Ptrend<0.001) was inversely associated with incident frailty. The association persisted after further adjustment for SES and comorbidity.

Conclusion

Among older individuals, multiple SES measures were positively associated with LTPA, which was a strong predictor of lower subsequent frailty risk.
Acute and long-term mortality rates among participants of mass-participation sport events versus the general population
Authors: Bakker EA , Aengevaeren VL , Eijsvogels TMH
Published: May 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The work of T.M.H.E is supported by the Netherlands Heart Foundation.

Background

Exercise training improves cardiovascular health and lowers the risk for morbidity and mortality. However, an acute bout of exercise transiently increases the risk for sudden death. It is unknown how participation in a mass-participation exercise event impacts mortality risk compared to non-participation.

Purpose

To assess the acute and long-term mortality risk among participants of mass-participation exercise events and to place these risks into perspective.

Methods

Data was collected among participants of Dutch running, cycling and long-distance walking events between 1995 and 2017. We retrieved age, sex, exercise type from the database of event organizers. The survival status and date of death were extracted from the Dutch Population Register (DPR). A time-stratified case-crossover design with an 8-day risk and reference period was used to examine if deceased athletes more frequently participated in mass-participation exercise events at 0 to 8 days before their death compared to the reference period (i.e., 14 to 21 weeks before death). Mixed-effects logistic regression was used to calculate the odds ratio (OR) with 95% confidence intervals (95% CI). We also retrieved controls (i.e., individuals not partaking in mass-participation exercise events) from the DPR (n=211,592) and compared long-term mortality risks between athletes and controls using stratified Kaplan-Meier curves and Cox regression models.

Results

547,014 athletes (age 41 years [Q25 31; Q75 50], 56% male, 72% runners, 11% cyclists) and 211,592 controls (age 41 years [Q25 31; Q75 50], 67% male) were included in this study. Participation in mass-participation exercise events was higher at 0 to 8 days before death (i.e., risk period, n=23 deceased athletes) compared to 14 to 21 days before death (i.e., reference period, n=12 deceased athletes), but the mortality risk was not significantly elevated after participation in an exercise event (OR 1.92; 95%CI 0.95-3.85). During a median follow-up of 3.3 years [Q25 1.1; Q75 4.8], 4,625 (0.8%) athletes and 2,494 (1.2%) controls died. Amateur athletes had a 30% lower risk of death (hazard ratio 0.70; 95% CI 0.67-0.74, Figure 1) compared to controls, after adjustment for age and sex.

Conclusion

Participants of a mass-participation exercise event had a non-significant increased odds of death within 8-days after the event. In contrast, mortality risk was significantly lower for amateur athletes compared to controls from the general population during long-term follow-up, emphasizing that the health benefits of exercise and participation in a mass-participation exercise event outweigh the risks.

Figure 1. Stratified Kaplan-Meier curves with hazard ratio (HR) adjusted for age and sex for amateur athletes compared to controls.
Postexercise hypotension in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials
Authors: Bersaoui M , Bisai A , Toelsie J , Goessler K , Baldew SM , Cornelissen VA
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Worldwide, raised blood pressure (BP) or hypertension (HT) is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African-origin populations. Post-exercise hypotension (PEH) defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management which can last up to 24 hours. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations.

Objectives

To systematically summarize the acute effects of a single bout of aerobic exercise on blood pressure in a population of African or Asian origin.

Methods

We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or HT published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random effect models fitted to estimate effect sizes.

Results

We identified 10 aerobic exercise trials of individuals of Asian origin (n= 156; mean age: 27.05 years: 72% male; baseline SBP/DBP: 114.93 [99,142] / 67.34 [61,74] mmHg) and 11 aerobic exercise trials involving individuals of African origin (n=112; mean age: 41.37 years; 62% male; baseline SBP/DBP: 125.77 [106.6,140.2] / 79.72 [69.9, 84.3] mmHg). Non-significant moderate reductions in office SBP and DBP at 30 minutes postexercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28 / -1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 minutes postexercise (-2.80 [-7.90, 2.28], p = 0.27 / -1.95, [-5.66, 1.75], p = 0.3) were observed compared to control group. No statistically significant differences were found between ethnic groups (p > 0.05). Ambulatory BP was reported only in the African groups. No effect was found on 24h-SBP post-exercise, but 24h-DBP was statistically signficantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise.

Conclusions

A single bout of aerobic exercise did not significantly reduce BP immediately in the African and Asian group. In the African group a small though statistically significant lower 24h-DBP was observed. Unfortunately, no data was found on the 24h-BP response in Asians. The low number of studies in both ethnic groups and lack of data on isometric and resistance exercise in African and Asian populations warrant more research to improve quality of evidence.
Correlation between maximal aerobic power and longitudinal vital signals during high-intensity activities of daily living
Authors: Frade MCM , Beltrame T , Linares SN , Petronilho A , Sanches GLA , Tonello SCGM , Gois MO , Catai AM
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): São Paulo Research Foundation (FAPESP);Coordination for the Improvement of Higher Education Personnel (CAPES)

Background

Higher activity levels are linked with better cardiovascular health. Maximum aerobic power (measured by the maximal oxygen uptake, VO2max) obtained during cardiopulmonary exercise testing (CPET) is an index of cardiovascular health and represents the maximum ability of the aerobic system to supply energy. Moreover, it is known that high-intensity activities of daily living (hiADL) are associated with higher VO2max, and were three times more beneficial than low-intensity activities, such as light walking. However, little is known about the physiological responses during these hiADL that are associated with better health outcomes. So far, only the levels and intensities of the physical activities have been investigated, but the physiological responses at these activities remain unclear.

Purpose

Verify the associations between VO2max and longitudinal vital signals from wearables during hiADL.

Methods

43 volunteers (32 males, 39.91±15.87 years; 75.41±13.12 kg; 173.67±9.04 cm) with different levels of VO2max (31.08±8.73 ml/kg/min) wore a wearable device (smart t-shirt, Hexoskin) with embedded cardiac, respiratory, and movement sensors to collect unobtrusive data for 7 days (9.31±1.36 hours per day). These sensors continuously measure heart rate (HR), breathing rate (BR), minute ventilation (VE), tidal volume (Vt), hip acceleration (ACC), and walking cadence (Cad). The hiADL were classified based on the Cad response where values higher than 124 steps per minute were labelled as hiADL. At hiADL, the average response for all variables was calculated. Finally, the Pearson or Spearman correlations were computed considering a statistical significance level of 5%.

Results

hiADL corresponded to just 1% of the physical activities (or 35.11±43.30 minutes per week). The average response of the vital signals at hiADL were: HR (118.2±20.36 bpm), BR (30.7±8.0 rpm), VE (52.21±35.54l), Vt (1.63±0.71 l/min), Acc (0.87±0.6g), and Cad (143.69±10.13). The correlations were statistically (p<0.05) high and positive between VO2max and BR, VE, Vt, and Cad; also, moderate, and positive between VO2max and HR and with the percentage of the time spent at hiADL, as described in figure 1.

Conclusion

The VO2max (or cardiovascular health) is related to the time spent in hiADL and with the hemodynamic and respiratory response magnitudes at these high-intensity activities.
Cholesterol and hypertension treatment but not time-dependent covariates or competing risks improve coronary risk prediction: the REGICOR study
Authors: Degano IR , Subirana I , Camps-Vilaro A , Elosua R , Marrugat J , Tizon H , Palomo I
Published: May 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute Agency for Management of University and Research Grants

Background

Cardiovascular (CV) risk functions are the recommended tool to identify high-risk individuals. However, discrimination of CV risk functions is not optimal. While the effect of biomarkers in CV risk prediction has been extensively studied, there is no data of CV risk functions including time-dependent covariates, competing risks and treatments.

Aim

To examine the effect of including time-dependent covariates, competing risks and treatments in CV risk prediction.

Methods

Participants from the REGICOR population cohorts (North-Eastern Spain) aged 35-74 years without previous history of cardiovascular disease were included (n=8,470). Coronary and stroke events, and mortality due to other CV causes or to cancer were recorded during the follow-up (median=12.6 years). A multi-state Markov model was constructed to include competing risks and time-dependent classical risk factors and treatments (2 measurements). This model was compared to Cox models with the basal measurement of classical risk factors, treatments or competing risks. Models were cross-validated and compared by their discrimination (area under the ROC curve), calibration (Hosmer-Lemeshow test) and reclassification (categorical net reclassification index).

Results

Cancer mortality was the event with the highest cumulative incidence. In coronary event prediction, cholesterol and hypertension treatment addition to classical risk factors, improved significantly discrimination by 2% and reclassification by 7-9%. In stroke event prediction, inclusion of time-dependent covariates decreased significantly discrimination by 3-5%.

Conclusion

Coronary risk prediction improves when cholesterol and hypertension treatment are included in risk functions. Coronary/stroke prediction does not improve with 2 measurements of covariates or with competing risks.
Contributing risk factors overview of high Castelli risk index-i of police officer: a cross-sectional study
Authors: Ardiana MEITY , Firmanda DWIKA , Sufiyah I , Harsoyo PM , Hermawan HO
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Dyslipidemia is a major risk factor of cardiovascular disease, many studies have shown that lipid ratios can be used to predict cardiovascular disease more effectively than individual lipid levels.

Objective/Aims

This study aims to evaluate the potential risk factors contributing to high Castelli Risk Index–I (CRI–I) in police officer.

Methods

This observational-descriptive with cross-sectional design study enrolled 3,018 members of East Java police officer. Data was obtained using physical and laboratory examinations that includes systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), low density lipoprotein-C (LDL–C), high density lipoprotein–C (HDL–C), triglyceride (TG), total cholesterol (TC). BMI was classified into < 25 (normal BMI) and > 25 (higher than normal BMI). High blood pressure (BP) was defined as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg. CRI-I was calculated using the formula of TC/HDL–C and was defined >5 as at risk and <5 as normal. Statistics were performed on SPSS version 25 and cross-tabulation test was performed on the CRI–I, BP, and BMI in a table form.

Result

927 (30.7%) respondents had a CRI–I score > 5. Result of the cross-tabulation test of the high CRI–I score with the physical examination showed association with high BP (OR=1.394; p=0.0), and higher than normal BMI (OR=1.184; p=0.043).

Conclusion

There was a significant associations between high CRI-I and high blood pressure and higher than normal BMI among a clinical sample of Police Officers.
The dietary approaches to stop hypertension diet effects on ventricular premature complexes
Authors: Kuyumcu M S , Kuyumcu A , Ulusan S
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Rhythm disturbances in the heart significantly affect the quality of life of the patients. The aim of this study was to evaluate the relationship between ventricular premature complexes (VPC) and The dietary approaches to stop hypertension diet (DASH) score.

Material-Method

This study was conducted on 50 patients with palpitations who were referred to the cardiology outpatient clinic and had more than 10000 VES per day as a result of a 24-hour holter, and 50 patients who presented with palpitations but had less than 10000 VES in the holter. Three-day food consumption records of the patients were questioned. DASH diet compliance scale was used for patients. The achievement of nine nutrients to the targeted quantities with food consumption records was evaluated by scoring method (between 0 and 9 points). All data were compared between groups.

Results

There was no difference between the two groups in terms of clinical and demographic characteristics. DASH scores were found to below in the VPC group (p<0.001). There was a significant negative correlation found between VPC and DASH diet score (p<0.001, r = -0.458).

Discussion

The protective role of DASH type nutrition on the frequency of VPC was observed in our study. This study, which is one of the limited number of studies examining the relationship between DASH diet and VPC, may be helpful in understanding the pathophysiology of VPC.
Clinical application of the new cardiovascular risk prediction algorithms SCORE2 and SCORE2-OP in patients with dyslipidemia
Authors: Barkas F , Sakkou SF , Styla C , Anastasiou G , Koutsogianni AD , Liamis G , Liberopoulos E
Published: May 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

European Society of Cardiology (ESC) has recently launched the SCORE2 and SCORE2-OP cardiovascular risk prediction algorithms.

Purpose

Cardiovascular risk assessment of patients with dyslipidemia according to SCORE2 and SCORE2-OP in comparison with the HELLENIC SCORE.

Methods

A retrospective observational study involving 1334 dyslipidemic patients followed-up for ≥3 years at our outpatient lipid clinic in our university general hospital. After excluding patients with established cardiovascular disease, diabetes mellitus, familial hypercholesterolemia, chronic renal disease, and those receiving hypolipidemic treatment, patients were categorized according to HELLENIC SCORE and SCORE2 / SCORE2-OP into the following cardiovascular risk groups: low-moderate, high and very high.

Results

A total of 532 patients were included in the present analysis (40% male, 17% smokers, mean age 55 [48-62] years, 8.6%> 70 years). Subjects’ mean cholesterol levels were 257 (228-291) mg/dL, triglycerides 136 (99-196) mg/dL, high-density lipoprotein cholesterol 52 (45-62) mg/dL, and low-density lipoprotein cholesterol 173 (149-200) mg/dL. According to SCORE calculation, 428 patients (80%) were classified into low-moderate, 87 (17%) high and 17 (3%) very high cardiovascular risk group. According to SCORE2 and SCORE2-OP algorithms, the proportion of those considered as high (n=230, 43%) and very high cardiovascular risk (n=89, 17%) increased (Figure).

Conclusions

The proportion of patients classified into high and very cardiovascular risk groups is anticipated to increase by implementing the new SCORE2 and SCORE2-OP.