bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative survival efficacy of mechanical and biological heart valve in dialysis patients: a meta-analysis with the subgroup analysis of valve positions
Authors: Chi K.Y , Chiang M.H , Kang Y.N , Wang S.T , Li S.J , Chan Y.T , Chen Y.C , Chen W.C
Published: November 2020

Background

To date, the optimal selection of prosthetic heart valve for dialysis patients still remains controversial.

Purpose

Since previous meta-analyses on survival outcomes were with substantial heterogeneity, we attempted to investigate the potential sources and update the comparative survival efficacy of mechanical prosthesis (MP) and bioprosthesis (BP) in dialysis patients.

Methods

We systematically reviewed PubMed, Embase, Cochrane library, Web of Science, and ClinicalTrials.gov from inception to February 1, 2020 for relevant studies. Randomized controlled trials, prospective or retrospective cohorts that involved dialysis patients undergoing heart valve replacement were included. Studies that did not report comparative survival outcome of two prostheses were excluded. To explore the potential sources of heterogeneity, we conducted a subgroup analysis based on valve positions. We also performed a meta-regression to delve into the effects of study-level covariates on mid/long-term survival, which was defined as at least 4-year follow-up.

Results

A total of 20 retrospective cohorts involving 8,398 participants (MP= 5900, BP= 2498) were included in our study. Overall, MP was associated with a significant 16% reduction in all-cause mortality, compared to BP (HR, 0.84; 95% CI, 0.73 to 0.98; I2=43%; Figure). In the subgroup analysis, patients undergoing isolated-aortic valve replacement (iso-AVR) with MP further exhibited an even better mid/long-term survival efficacy with no statistical heterogeneity being observed (HR, 0.64; 95% CI, 0.47 to 0.86; I2= 0%; Figure). The involvement of mitral valve replacement (MVR) was a strong mortality contributor (HR, 1.79; 95% CI, 1.40 to 2.28; I2= 0%). Moreover, our meta-regression demonstrated that MVR proportion was the only covariate that significantly affected mid/long-term survival (β= 0.8473, p=0.046; Table).

Conclusions

Compared to BP, MP might be a reasonable choice for dialysis patients requiring AVR due to its better mid/long-term survival efficacy.

Funding Acknowledgement

Type of funding source: None
The impact of day-by-day blood pressure variability on neurological functional outcome after acute ischemic stroke
Authors: Yang C.Q , Chen X.P
Published: November 2020

Background

Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and neurological functional outcome have yielded inconsistent results.

Purpose

We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on neurological functional outcome at 3 months after acute ischemic stroke.

Methods

Total 367 patients hospitalized for ischemic stroke within 48 hours of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to neurological functional outcome. A baseline severity-adjusted analysis was performed using 3-month modified Rankin Scale score as the neurological functional outcome. Unfavorable outcome was defined as mRS≥3.

Results

The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41±4.59 VS 13.42±3.95mmHg for SD, P<0.001; 11.54±3.23 VS 10.41±2.82 for CV, P=0.001). Multivariable logistic regression analysis revealed that Systolic BPV was significantly and independently associated with the 3-month neurological functional outcome (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.07–1.22, P<0.001 for SD; OR=1.15, 95% CI: 1.06–1.26, P=0.001 for CV). In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top versus bottom quartile of systolic BP variability (OR=3.33, 95% CI: 1.41–7.85, P=0.006 for SD; OR=2.27, 95% CI: 1.04–4.94, P=0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BP variability. More importantly, incorporating SD of systolic BP into the conventional prediction model significantly increased the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs 0.86; P=0.041).

Conclusions

Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of mean blood pressure. Combining SD of systolic BP with conventional risk factors could thus improve the prediction of unfavorable outcome.

Funding Acknowledgement

Type of funding source: None
Genetic markers for hypertension – a genetic epidemiological study of 5000 Romanian individuals
Authors: Ursu R.I , Iordache P , Radoi V.E , Ursu G.F , Cucu N , Chirica V , Iacob D , Sima C , Dragoi O.D , Poenaru E , Bohiltea L.C , Manolescu A , Jinga V
Published: November 2020

Background

During the past decades, genetic research has reached new heights as next generation sequencing has rapidly taken over and genome-wide association studies (GWAS) have broug.

The purpose of the research is to determin high-risk variants (Single-Nucleotide-Variants,SNVs) associated with hypertension (HTA) in the Romanian population.

The current presentation asseses the final results of a 3 part study comprising the first and the largest GWAS on hypertension in Romanians.

Material

Methods The total cohort includes a number of 5690 individuals, of which 2190 with hypertension and 3500 heathy controls.

Genetic testing was performed at in Iceland.

A multiple GWAS assay has been performed for the identification of variants associated with hypertension, hypertension risk factors and hypertension comorbidities.

Results

Environmental (lifestyle) risk factors, such as smoking, alcohol consumption and coffee consumption, and also pathological risk factors, as are obesity and ageing, were analyzed in association with hypertension.

Tissue-specific protein expression, gene function and gene-gene interactions have been analyzed for assessing a possible biological explanation of the association between the identified related variants and HTA. Expression quantitative trait loci (eQTL) were assessed for variants in the reported locations for a better understanding of their involvement in HTA.

The results of the analysis revealed a number of over 5000 genetic variants statistically correlated with hypertension in the studied cohort, some well documented and in genes known to be involved in hypertension pathophysiology (clusters on chromosomes 1p36, 1q24, 3q24, 4p16, 5q12, 7q36, 12p12, 15q, 17q, 20q12, a.o. or CRNKL1, C19Orf12, CCDC51, C20Orf26, ZNF420, ZNF571, a.o. intragenic variants). Approx. 4100 SNVs were identified in correlation with diabetes mellitus and obesity.

Variants correlated with both hypertension and DM were identified (TBX20,ANK2, a.o. genes). Two other variant clusters (p=10–4–10–3) on chromosomes 19 (19q12) and 20 (20p11.21) revealed statistical correlations with both hypertension and obesity.

Conclusions

The present study found some important loci and clusters associated with HTA, which migh provide insights into the genetic architecture of this pathology.

The validity of these results for the Romanian population need to be confirmed by replication studies.

The current research is part of the EU ProMark, ROMCAN and AppGenEdu projects.

Funding Acknowledgement

Type of funding source: None
Is 24 hour central aortic pressure superior to single measurement of central aortic pressure in well controlled hypertensive patients
Authors: Georgieva N , Borizanova-Petkova A , Kinova E , Goudev A
Published: November 2020

Background

Non-invasive measurements of 24 h ambulatory central aortic systolic pressure (24hCASP) is now feasible method than single measurement of CASP. There is growing interest in CASP as cardiovascular risk marker beyond conventional brachial blood pressure (BP). Pulse wave velocity estimates arterial stiffness, whereas CASP is representative of the BP in major organs.

Purpose

To evaluate non- invasive parameters for arterial stiffness using oscillometric method and to compare 24hCASP with single measurement of CASP in well-controlled hypertensive patients to detect target organ damage (TOD).

Methods

A total 95 patients (57±14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (EA) and ventricular elastance (Ees)) and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo-arterial coupling. EA and Ees were calculated as and – systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Parameters for arterial stiffness – 24hCASP, ambulatory central systolic pressure (CASP), 24-hour pulse wave velocity (PWV24h) and ambulatory PWV were measured non-invasively with oscillometric method by Mobil-O-graph PWA.

Results

Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo-arterial coupling in comparison with disturbed EA/Ees: 24hCASP (107.64±9.19 vs. 116.64±16.7 mm Hg, p=0.02), CAP (117.45±9.26 vs. 128.42±16.15 mm Hg, p<0.0001). There were no statistically significant differences in PWV and PWV24h. Multiple regression analysis demonstrated that CAP (B=−0.264 p=0.003; 95% CI: −0.003–0.014) is independent predictor of TOD in hypertensive patients, than 24 hour central aortic pressure.

Conclusion

There is no superiority of 24hCASP than single measurment of CASP. CASP could predict preclinical damage and cardiovascular outcome.

Funding Acknowledgement

Type of funding source: None
Association arterial stiffness reduction with improved left ventricular longitudinal and torsional deformation after 3 years of antihypertensive treatment
Authors: Tzortzis S , Ikonomidis I , Triantafyllidi H , Thymis J , Frogoudaki A , Vrettou A.R , Iliodromitis E
Published: November 2020

Background

We investigated the effects of antihypertensive treatment on vascular function, longitudinal and torsional deformation in hypertensives.

Methods

In 200 untreated patients with arterial hypertension (age 52.5±11.6 years, 56% females), we measured at baseline and after a 3-year of antihypertensive treatment (160 received ACEi± diuretics and 40 CCBs± diuretics): a) 24h ambulatory blood pressure b) Carotid-femoral pulse wave velocity (PWV) b) Coronary flow reserve (CFR), LV mass index (LVMI), the global longitudinal strain (GLS) and diastolic (LongSRSE) strain rate, peak twisting (Tw-deg) and untwisting at mitral valve opening (UtwMVO), at peak E (UtwE) and at the end of the E wave (UtwendE) of the mitral inflow as well as twisting (TwVel-deg/sec) velocity using speckle tracking imaging. We calculated the % change of LV untwisting as difference between peakTw and UtwMVO, UtwpeakE and UtwendE.

Results

Compared to baseline, there was an improvement of GLS (−19.9±3.4 vs. −18.7±3.1%), LongSRS (−1.08±0.22 vs. −0.98±0.26 1/s), LongSRE (1.09±0.36 vs. 0.99±0.31 1/s), peak Tw (16.2±5.1 vs. 18.7±5.9 deg), Tw velocity, and the %LV untwisting (31.04±19.28 vs 26.02±15.69% at MVO, 60.04±19.78 vs 53.96±19.76% at peakE and 79.98±14.24 vs 75.90±17.01% at endE) post-treatment. In parallel, CFR (2.72±0.61 vs. 2.55±0.64), PWV (10.34±1.93 vs. 11.2±2.08 m/s) and LVMI were improved (p<0.01 for all comparisons). By ANOVA, the interaction term between changes of all the above parameters and antihypertensive treatment (ACE inhibitors vs calcium channel blockers) was not significant (p>0.05). By multivariate analysis, the reduction of 24h meanBP and PWV independently determined the respective improvement of GLS (b=0.478 and b=0.248 respectively), LongS (b=0.428 and b=0.201 respectively) as well as Twisting (b=0.449 and b=0.294 respectively) after adjusting for changes in LV mass, CFR and atherosclerotic risk factors (p<0.05).

Conclusions

Long-term optimal blood pressure control with ACE inhibitors and CCBs improves LV longitudinal and torsional mechanics in hypertensives in parallel with arterial stiffness and blood pressure. This improvement in LV deformation and twisting was independently related to changes in arterial blood pressure and arterial stiffness.

Funding Acknowledgement

Type of funding source: None
Motivational interviewing to reduce blood pressure in hypertensive patients: randomized clinical trial
Authors: Silveira L.C.J , Aliti G , Vellone E , De Souza R.H , Rabelo-Silva E.R
Published: November 2020

Background

Uncontrolled hypertension is the leading risk factor for cardiovascular disease. This factor is often due to poor self-care; however, patients find lifestyle modifications difficult to achieve. Motivational interviewing has been proposed as an approach to enhance intrinsic motivation to change, develop autonomy, and promote healthy behaviors, but few randomized controlled trials have explored this approach, especially in hypertension.

Purpose

To evaluate the effectiveness of motivational interviewing in reducing blood pressure and improving self-care behaviors and medication adherence in patients with hypertension.

Methods

Single-center, parallel, randomized clinical trial with outcome-assessor blinding. The study included 120 adult patients diagnosed with hypertension who received regular follow-up in an outpatient hypertension clinic in Southern Brazil. Patients were allocated to one of two groups: the intervention group (IG), which received motivational interviewing by a trained nurse, and the control group (CG), which received standard care. All patients in the IG and the CG were assessed face-to-face once monthly for 6 months. The primary outcome was the reduction in systolic blood pressure and changes in mean blood pressure measured by 24-hour ambulatory blood pressure monitoring; secondary outcomes included self-care behaviors, measured with the Self-Care of Hypertension Inventory, and medication adherence, measured with Medication Assessment Questionnaire. Outcomes of interest were measured at baseline and at 6-month follow-up.

Results

The sample consisted largely of white (72%) females (70%), with a mean age of 62 years (SD=10), and a median duration of hypertension of ≥13 years. There were no statistically significant differences between groups at baseline. Over time, a statistically significant decrease in blood pressure levels occurred in the motivational interviewing group, except for daytime systolic blood pressure. The magnitude of change was greatest for nighttime systolic blood pressure (−6.4 mmHg) and 24h systolic blood pressure (−5.3 mmHg). Furthermore, patients in the IG showed improvement in all dimensions of the self-care score (P<0.05). Medication adherence improved in the IG (within-group analysis), but not in controls (P>0.05).

Conclusion

Motivational interviewing is effective in reducing blood pressure and improving self-care and medication adherence in patients with hypertension.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior- Brasil (CAPES)- Finance code 001.
Fitness is associated with lower inflammatory markers in obesity: the FATCOR study
Authors: Midtboe H , Ulvik A , Meyer K , Ueland P.M , Halland H , Gerdts E
Published: November 2020

Background

Obesity is associated with chronic low-grade inflammation, but exercise has anti-inflammatory properties. It is unknown whether the anti-inflammatory effects of fitness may influence the obesity-associated inflammation.

Purpose

To assess levels of inflammatory markers in fit vs. unfit overweight and obese subjects without known cardiovascular disease.

Methods

Peak oxygen uptake (VO2max) was measured by treadmill cardiopulmonary exercise testing in 566 subjects (mean age 48±9 years, 60% women) with body mass index >27.0 kg/m2 in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Fitness was defined from age- and sex adjusted reference levels of VO2max. Serum levels of C-reactive protein (CRP), serum amyloid A (SAA) and calprotectin were assessed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF) mass spectrometry and log transformed before inclusion in analyses.

Results

Fit subjects (n=147) were older and had less metabolic syndrome, obesity and hypertension compared to unfit subjects (n=419) (all p<0.05). Serum levels of CRP and SAA were lower in fit subjects vs. unfit (p<0.01), while serum calprotectin showed no difference (p=0.06). In multivariable logistic regression analyses, lower CRP (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.61–0.87, p<0.001) and SAA (OR 0.61, 95% CI 0.40–0.93, p=0.02) remained associated with being fit after adjusting for age, sex, obesity, metabolic syndrome and hypertension. When looking at obese (n=357, fit n=53) and overweight subjects (n=209, fit n=94) separately, lower CRP (OR 0.60, 95% CI 0.46–0.78, p<0.001) and SAA (OR 0.44, 95% CI 0.24–0.83, p=0.01) remained associated with being fit in obese, but not in overweight subjects after adjustment for age, sex and metabolic syndrome.

Conclusion

Fitness was associated with lower circulatory inflammatory markers in obesity independent of cardiometabolic risk factors. Our results suggest that fitness may promote cardiovascular benefit through the anti-inflammatory properties of exercise also in obesity.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Western Norway Regional Health Authority
Associations of grip strength with cardiovascular disease and all-cause mortality in people with and without hypertension: findings from the Prospective Urban Rural Epidemiology (PURE) China Study
Authors: Liu W , Li W , Wang C.S , Hu B , Wang Y , Liu X.Y
Published: November 2020

Background

Hypertension and grip strength (GS) are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to affect both CVD and all-cause mortality is unknown. The study aimed to examine whether the associations between hypertension and GS with the risk of major CVD incidence, CVD mortality, and all-cause mortality differed between people with and without hypertension.

Methods

GS was measured using a Jamar dynamometer in participants aged 35–70 years from 12 provinces in the Prospective Urban Rural Epidemiology (PURE) China study. Hypertension was defined as a baseline systolic and diastolic blood pressure of at least 140/90 mm Hg, a self-reported history of hypertension, or treatment with antihypertensive medications. Cox proportional hazards models were used to examine the associations of GS and hypertension and with the outcomes of all-cause mortality and CVD incidence/mortality, and to test the multiplicative interactions between hypertension and GS.

Results

Among 39,862 participants included in this study, 15,964 reported having hypertension at baseline and 9095 had high GS. After a median follow-up of 8.9 years [interquartile range (IQR) 6.7–9.9 years], 1822 participants developed major CVD, and 1250 deaths occurred (388 as a result of CVD). Compared with normotensive participants with high GS, hypertensive patients with high GS had a higher risk of major CVD incidence (HR 2.36 [95% CI: 1.84–3.02]; P<0.0001) or CVD mortality (HR 3.05 [95% CI: 1.56–5.95]; P<0.0001) but did not have a significantly increased risk of all-cause mortality (HR 1.23 [95% CI: 0.91–1.67]; P=0.181); these risks were further increased if hypertensive participants whose GS level was low (major CVD incidence (HR 3.33 [95% CI: 2.61, 4.24]; P<0.0001), CVD mortality (HR: 5.20 [95% CI: 2.76, 9.82]; P<0.0001), and all-cause mortality (HR 2.00 [95% CI: 1.53, 2.62]; P<0.0001)).

Conclusions

The present study demonstrates that hypertensive patients with low GS are associated with the highest risk of major CVD incidence, CVD mortality, and all-cause mortality. High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Association of adverse outcomes

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies. Besides funding from global PURE, this work was also sponsored by CAMS Innovation Fund for Medical Sciences (CIFMS): 2016-I2M-2-004, Construction of Basic Information Technology Support System and Platform for National Prevention and Treatment of Cardiovascular Diseases.
Chlortalidone and bumetanide in advanced chronic kidney disease: HEBE-CKD Trial
Authors: Solis-Jimenez F , Valdez-Ortiz R , Perez-Navarro L.M , Reyes-Tovilla J.E
Published: November 2020

Introduction

Current treatment for hypertension and volume overload in chronic kidney disease consists of loop diuretics, nevertheless, chronic use leads to adaptive changes at the distal nephron, which in turn decreases their efficacy. The use of thiazide diuretics could be another treatment option in these patients, notwithstanding, there's not enough evidence to justify their use in this population.

Purpose

To evaluate the efficacy and safety of treatment with bumetanide plus chlorthalidone in in patients with advanced chronic kidney disease.

Methods

A double-blind randomized controlled trial was conducted at our hospital. Thirty-two patients with hypertension, chronic kidney disease stage IV/V, and chronic loop diuretic use where divided in two groups. The dual treatment group received bumetanide (4 mg QD) plus chlorthalidone (100 mg QD), while the control group was given bumetanide (4 mg QD) plus placebo, both for twenty-eight days. Systemic blood pressure, bioimpedance, and urinary electrolytes were measured at seven and twenty-eight days of treatment.

Results

There was a significant decrease of systemic blood pressure in the dual treatment group when compared with the control group; systolic blood pressure −26.1±15.3 vs. −10±23.3 mmHg (p=0.028), diastolic blood pressure −13.5±10.7 vs. −3.4±11.9 mmHg (p=0.018), and mean arterial pressure −18.1±8.7 vs. −5.4±14.3 mmHg (p=0.006). There was also a significant decrease of volume overload in the dual treatment group when compared to the control group; total body water −4.36±3.29 vs. +0.075±1.78 litres (p<0.001), extracellular water −2.55±1.1 vs. +0.150±1.2 litres (p<0.001), and extracellular water to total body water ratio −2.92±4.76 vs. −0.24±1.42 (p=0.039). The treatment group increased its fractional excretion of sodium, while the control group demonstrated an increase, though differences were non-significant. As for adverse effects, there was a non-significant increase of urea and creatinine levels in the dual treatment group when compared with controls.

Conclusions

In advanced chronic kidney disease plus hypertension patients whose treatment with loop diuretics is insufficient, combined use of bumetanide plus chlorthalidone can be useful for systemic blood pressure and volume overload control.

Figure 1

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital General de México
sST2 is a promising biomarker in hypertensive patients undergoing renal denervation
Authors: Topf A , Paar V , Grueninger J , Wernly B , Weber T , Mahfoud F , Lichtenauer M , Hoppe U , Brandt M , Motloch L.J
Published: November 2020

Introduction

Therapy resistant arterial hypertension (raHTN) is a major clinical burden. While therapeutic alternatives are still missing, novel interventional procedures like renal denervation (RD) are still evolving. Indeed, despite discoursing results of the Simplicity HTN-3 trial, new promising results resulted in a revival of this procedure. Therefore, predictors for the success of future interventions would be of great clinical benefit. The novel biomarker sST2 shows promising results for risk stratification of cardiovascular patient. While, sST2 belongs to the IL-1 receptor family, it has an influence on immunologic processes with consequent cardioprotective effects including prevention of myocardial hypertrophy and fibrosis indicating predictive potential in hypertensive heart disease. Nevertheless, clinical implementation of this promising biomarker was not investigated in patients with raHTN undergoing RD.

Purpose

To investigate a potential clinical relevance of sST2 in patients with raHTN undergoing RD.

Methods

We evaluated 58 patients with raHTN (age: 63±11 years, systolic blood pressure at baseline: 178±24mmHg) undergoing bilateral RD. If available, serum levels of sST2 were analyzed at baseline as well as at follow-up at one and/or three month.

Results

While RD was able to decrease blood pressure levels after one month (systolic blood pressure at one month: 158±21mmHg, p<0.01), on echocardiography a reduction of left ventricular mass (LVM) was observed at one month with a further significant reduction at three month (LVM at baseline: 233±68g, LVM at one month: 218±59g and LVM at three month: 181±59, p<0.01). This observation was accompanied by a significant decrease of sST2 levels at three month (sST2 baseline: 6322±3578pg/ml vs. sST2 three month: 4704±1586pg/ml, p=0.02). Furthermore, baseline sST2 was positively correlated with systolic blood pressure at one month, measured either at office (r=0.57, p<0.01) or invasively in the aorta (r=0.49, p=0.03) indicating a potential predictive value of this biomarker.

Conclusion

In patients with raHTN, RD is associated with a significant decrease of sST2 levels, indicating sST2 to be involved in remodeling processes after RD. Furthermore, sST2 levels at baseline might be a potential predictor of intervention success of RD. Further, studies need to investigate the association of sST2 levels and RD.

Funding Acknowledgement

Type of funding source: None
When to expect cognitive disorders in hypertension
Authors: Khomazyuk T , Krotova V.U
Published: November 2020

In large-scale clinical studies, age, arterial hypertension (AH), multi-focal atherosclerosis, and cognitive disorders (CD) are interrelated, affecting the level of disability, quality of life, and social adaptation of patients with cardiovascular diseases.

Aim of the study

To determine the prognostic criteria for cognitive disorders in patients with hypertension.

Methods

To achieve the aim of the study, the examinations were performed in 182 outpatients with AH II stage, 34–68 years, in 164 of them were CD according to neuropsychological tests of MMSE and MoCA, mostly of mild and moderate degree. The relationship between clinical data, cognitive function characteristics and daily monitoring data of hypertension were evaluated. The data obtained were analyzed using medical methods statistics.

Results

Among factors such as age (>60 years), gender (male / female), disease duration (>10 years), waist circumference, overweight or obesity, hypercholesterolemia, no influence on the development of CD was detected (p>0.05)). Risk factors for the development of CD in hypertension were an burdensome history of CD in closest relatives (2.79 (95% CI 1.15–6.77) relative to practically healthy individuals and 2.41 (1.01–5.88)), high vegetative index (rs +0,15; p<0,05).

The correlation between CD and high rates of blood pressure variability according to daily monitoring of blood pressure in patients with hypertension, even under conditions of blood pressure control, is confirmed by the results of correlation and one-factor logit analysis. Thus, elevated levels of systolic blood pressure variability in the day and at night increased the chances of developing CD in patients with hypertension by 2.11 times, (rs = +0.57 and rs = +0.61; p<0.001). It was found that the likelihood of developing cognitive impairment exceeds 50% (high risk) if the level of systolic blood pressure variability is above 12 mm Hg in the day (area under ROC curve AUC = 0.891; 95% CI 0.883–0.940. (AUC = 0.891; 95% CI 0.883–0.940; ST = 82.5% and SP = 92.9%) and at night over 10 mm Hg (AUC = 0.922; 95% CI 0.861–0.963; ST = 82.5% and SP = 85.7%) according to daily blood pressure monitoring.

Conclusion

The prognosis for the development of cognitive impairment in arterial hypertension is influenced by: evidence of family CD history, autonomic nervous system index and variability of day and night blood pressure characteristics, according to ambulatory daily monitoring data.

Funding Acknowledgement

Type of funding source: None
Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study
Authors: Ogawa H , Sekiguchi H , Jujo K , Kawada-Watanabe E , Arashi H , Yamaguchi J , Hagiwara N
Published: November 2020

Background

There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial.

Methods

HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up.

Results

During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP.

Conclusions

The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD.

Figure 1

Funding Acknowledgement

Type of funding source: None
Non-psychotic mental disorders in adolescent men and risk of myocardial infarction: a national cohort study
Authors: Bergh C , Oasti Z , Montgomery S
Published: November 2020

Background/Purpose

Recent studies show that early life stress is associated with later risk of cardiovascular disease (CVD) and stress may also increase the risk of psychiatric disease. We investigated the association between non-psychotic mental disorders in adolescence and subsequent myocardial infarction, and the role of stress resilience and physical fitness in this association.

Method

This is a register-based cohort study with 238 013 males born between 1952 and 1956 followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semi-structured interview with a psychologist. Physical fitness was measured at conscription examination with a cycle ergometer test. A total of 34 503 men were diagnosed with a non-psychotic mental disorder at conscription. Using Cox regression, we estimated the association of mental disorders with myocardial infarction after adjustment for other established CVD risk factors in adolescence. Stress resilience and physical fitness were included in the adjusted model in a second set of analyses.

Results

A total of 5891 diagnoses of first myocardial infarction were identified. Non-psychotic mental disorders were associated with an increased risk of myocardial infarction, with a hazard ratio (HR) and confidence interval (CI) of 1.51 (1.41–1.62). The association remained statistically significant after adjustment for other important potential confounders in adolescence such as systolic and diastolic blood pressure, body mass index, inflammation, cognitive function, parental socioeconomic index and a summary disease score (HR 1.24 (CI 1.13–1.35)). The association was further explained by stress resilience and lifestyle factors assessed with a cardiovascular fitness test in adolescence, as the association attenuated but remained statistically significant when further adjusting for stress resilience and physical fitness (HR 1.18 (CI 1.08–1.29)).

Conclusion

A non-psychotic mental disorder in adolescences may increase the risk of developing myocardial infarction later in life. This association was partly but not completely explained by poorer stress resilience and physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress in early life.

Funding Acknowledgement

Type of funding source: None
Phenotypic difference of sarcopenia in the prediction of mortality for elderly patients with heart failure: from CURE-HF registry
Authors: Kanai M , Motoki H , Okano T , Kimura K , Minamisawa M , Yoshie K , Kato T , Saigusa T , Ebisawa S , Okada A , Kuwahara K
Published: November 2020

Background

Sarcopenia and malnutrition are associated with mortality in elderly patients with heart failure (HF). However, impact of phenotypic difference of sarcopenia on mortality is not well investigated. We hypothesized that evaluation using both body mass index (BMI) and free-fat mass index (FFMI) enabled distinction of phenotypic difference of sarcopenia and risk stratification for mortality in elderly patients with heart failure.

Methods

In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Body mass index and FFMI was evaluated. Free-fat mass index was calculated dividing the square of the patients' heights in meters into lean body mass. All-cause mortality was followed-up. Patients were divided into 3 subgroups according to BMI and FFMI values, and compared incidence of mortality among them.

Results

In our study cohort (median age, 78 [range 72–87]), BMI was 21.1 [18.9, 23.8] and FFMI was 16.7 [15.2, 18.0]. 211 patients were experienced all-cause mortality during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower BMI and lower FFMI was associated with all-cause mortality (Log-rank p<0.001, p<0.001, respectively). Furthermore, FFMI was an independent predictor of adverse events after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, comparing with low-BMI and low-FFMI subgroup, better prognosis was observed in the other 2 subgroups (Log-rank p<0.001, p=0.022, Figure 1).

Conclusions

Phenotypic difference was evident in elderly patients with HF. A combination of BMI and FFMI would be useful for risk stratification of mortality in those patients.

Figure 1

Funding Acknowledgement

Type of funding source: None
A U-shape trend between total and red meat consumption and depressive symptomatology in apparently healthy women: highlights from the ATTICA prospective (2002–2012) study
Authors: Kouvari M , Panagiotakos D.B , Chrysohoou C , Yannakoulia M , Georgousopoulou E.N , Pitsavos C , Tousoulis D
Published: November 2020

Background/Introduction

Increasing amount of evidence currently suggests that in the context of vegetarianism, where meat is completely excluded from daily diet, the risk to develop depression-related symptoms is impressively high.

Purpose

The aim of the present work was to evaluate the association of meat consumption with prevalent depressive symptomatology in apparently healthy individuals.

Methods

ATTICA study was conducted during 2001–2012 including n=1,514 men and n=1,528 women (aged >18 years old) from the greater of our region in Greece. At baseline, depressive symptomatology through Zung Self-Rating Depression Scale (range 20–80) and meat consumption (total meat, red, white and processed meat) through validated semi-quantitative food frequency questionnaire were assessed. Follow-up (2011–2012) was achieved in n=2,020 participants (n=317 cases); n=845 participants with complete psychological metrics were used for the primary analysis.

Results

Ranking from 1st to 3rd total meat consumption (low to high) tertiles, participants assigned in 2nd tertile had the lowest depressive-symptomatology scoring (p<0.001). This trend was retained in multi-adjusted logistic regression analysis; participants reporting moderate total and red meat consumption had ∼20% lower likelihood to be depressed (i.e. Zung scale<45) compared with their 1st tertile counterparts (Odds Ratio (OR)total meat 0.82, 95% Confidence Interval (95% CI) (0.60, 0.97) and ORred meat 0.79 95% CI (0.45, 0.96)). Non-linear associations were revealed; 2–3 serving/week total meat and 1–2 servings/week red meat presented the lowest odds of depressive symptomatology (all ps<0.05). All aforementioned associations were more evident in women (all ps for sex-related interaction<0.05).

Conclusions

The present findings generate the hypothesis that moderate total meat consumption and impressively, red meat may be more beneficial to prevent depressed mood and probably in turn hard CVD endpoints.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): This work was supported by a research grant from Hellenic Atherosclerosis Society. The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients
Authors: Ehara M , Yamada S , Shibata K , Kameshima M , Fujiyama H , Matsui Y , Higashida Y , Shimada A , Ito T , Sano T , Okumura H , Masaoka K , Okawa Y
Published: November 2020

Background

Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.

Purpose

We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.

Methods

This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.

Results

The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001).

Conclusion

Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.

Funding Acknowledgement

Type of funding source: None
Artificial neural networks to compare the contribution of basic clinical factors, ESC SCORE, and multidimensional risk factors for cardiovascular event prediction performance: an observational study
Authors: Kim K , Park S.M
Published: November 2020

Background/Introduction

Despite the recent increase in the availability of different data sources that can be used for prediction models for cardiovascular disease (CVD), it remains unclear to what extent such data could contribute to improving performance of the models in data-driven cardiovascular research.

Purpose

To compare the contribution of different data types in basic clinical factors, the European Society of Cardiology Systematic Coronary Risk Evaluation (ESC SCORE), and multidimensional risk factors for CVD prediction performance of artificial neural networks (ANN) using the relevant input features derived from a large-scale medical claims database.

Methods

We abstracted data through the National Health Insurance Sharing Service and collected information on 258,896 middle-aged individuals free of CVD at baseline (2009–2010) who were followed up for incident CVD until 2013. Multidimensional risk factors identifiable from the database were chosen from a systematic review of published articles. Input features in ANN were classified as follows: basic clinical factors (age, sex, and body mass index), ESC SCORE (age, sex, total cholesterol, systolic blood pressure, and cigarette smoking), and multidimensional risk factors (sociodemographic, lifestyle behavior, underlying medical conditions, dental health, medication use, etc). The data were partitioned into the training and test sets with 7:3 ratio and the performance of each ANN model was evaluated with area under the curve (AUC).

Results

The ANN model with multidimensional risk factors had higher prediction performance (AUC: 0.692) compared to the models with basic clinical factors (AUC: 0.671) and ESC SCORE (AUC: 0.684). Within the multidimensional risk factors, atrial fibrillation, family history, chronic kidney disease, retinal vein occlusion, dental caries, antipsychotics, and corticosteroid use were some of the strong predictors. However, adding multidimensional risk factors only showed marginal improvement (increase in 1.17% of AUC) compared with the ESC SCORE model.

Conclusions

Adding multidimensional risk factors as input features in the ANN only showed marginal improvement in the CVD prediction performance. When assessing cardiovascular risk from the large-scale healthcare data, variables included in the ESC SCORE should primarily be considered in the model.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Kyuwoong Kim received a scholarship from the BK21-plus education program provided by the National Research Foundation of the Republic of Korea. This work is a part of Kyuwoong Kim's PhD dissertation.
Validation of the ESC/EASD cardiovascular risk stratification model in diabetic patients
Authors: Prausmueller S , Resl M , Arfsten H , Spinka G , Wurm R , Neuhold S , Bartko P , Goliasch G , Strunk G , Pavo N , Clodi M , Huelsmann M
Published: November 2020

Background

Recently, the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) introduced a new cardiovascular (CV) risk stratification model to aid further treatment decisions in individuals with diabetes. Our study aimed to validate the ESC/EASD CV risk assessment in type 2 diabetes mellitus (T2DM) patients for the first time and to compare the prognostic significance of NT-proBNP with the ESC/EASD CV risk stratification model.

Methods and results

We prospectively included 2186 T2DM patients with a follow-up of 60 months. Patients were stratified according to ESC/EASD CV risk criteria, 33 (1.5%) were classified as moderate, 321 (14.9%) high and 1453 (67.6%) very high risk. Both, the ESC/EASD risk stratification model and NT-proBNP were associated with CV outcome (CV events: adj. HR: 1.47 [1.09–1.98], p=0.011 and adj. HR per IQR: 2.61 [2.27–3.01], p<0.0005; cardiac events: adj. HR: 1.57 [1.09–2.25], p=0.016 and adj. HR per IQR: 2.94 [2.50–3.47], p<0.0005; respectively) but only NT-proBNP proved to independently predict all-cause mortality (adj. HR per IQR: 2.32 [1.93–2.80], p<0.0005). NT-proBNP outperformed the ESC/EASD CV risk stratification model as determined by C-statistic (CV events: 0.74 vs 0.55, p<0.001; cardiac events: 0.76 vs 0.54, p<0.001; all-cause mortality: 0.73 vs 0.52, p<0.001; Figure 1) and net reclassification improvement of 69% for CV events, 73% for cardiac events and 67% for all-cause death (p<0.001 for all).

Conclusion

NT-proBNP measurement provides a valid tool to identify T2DM patients at risk and shows superiority in terms of risk prediction and discriminatory power compared to the ESC/EASD CV assessment.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant from the Austrian Science Fund