bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients
Authors: Endo A , Kagawa Y , Sato H , Morita Y , Kawahara H , Yasuda Y , Ouchi T , Watanabe N , Yamaguchi K , Yoshitomi H , Tanabe K 
Published: November 2020

Abstract

Background
In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) &lt;100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting &lt;70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear.

Purpose
The purpose of the present study was to evaluate whether the strict management of LDL-C targeting &lt;70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods
We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C &lt;70mg/dL (n=53), 70 to &lt;100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results
During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C &lt;70mg/dL than in those with LDL-C 70 to &lt;100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to &lt;100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C &lt;70mg/dL and in those with LDL-C 70 to &lt;100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p&lt;0.001, respectively), however, no difference was found between patients with LDL-C &lt;70mg/dL and LDL-C 70 to &lt;100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C &lt;100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL.

Conclusions
LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to &lt;70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention.
Incidence of late coronary events

Funding Acknowledgement
Type of funding source: None
Gender differences in the effects of weight reduction on future blood pressure elevation in the overweight middle-aged population
Authors: Kawasoe S , Kubozono T , Ojima S , Kawabata T , Miyahara H , Tokushige K , Ohishi M 
Published: November 2020

Abstract

Background
The effectiveness of weight loss (WL) to prevent blood pressure (BP) elevation is common knowledge; however, the effect of gender differences on this efficacy is not known. We aimed to investigate whether there were gender differences in the degree of BP increase and the prevalence of hypertension in the future when middle-aged obese participants achieved slight WL.

Methods
We analyzed the annual health checkup data for the general Japanese population collected from January 2001 through December 2015. Middle-aged participants (40–49 years old) with overweight (body mass index [BMI], 25.0–29.9 kg/m2) who had examination data for two follow-up time-points (after 3 and 10 years) were included. The participants with a BMI decrease ≥1.0 kg/m2 in 3 years (WL group) were propensity score (PS)-matched to those with a BMI decrease &lt;1.0 kg/m2 or weight gain (non-WL group) based on the data of the first examination, including age, BMI, smoking and drinking status, eGFR, systolic BP and diastolic BP, and hypertension (defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg). We compared the BMI, systolic BP, and hypertension prevalence after 10 years in both groups.

Results
There were 17,554 individuals, aged 40–49 years, with overweight. After excluding subjects who did not satisfy the inclusion criteria and PS matching, we identified 232 men and 160 women in both WL and non-WL groups. The BMI in the WL group after 3 years was significantly lower than that in the non-WL group (men, 25.2±1.4 kg/m2 vs. 27.1±1.6 kg/m2, P&lt;0.001; women, 24.9±1.4 kg/m2 vs. 27.1±1.5 kg/m2, P&lt;0.001), and the significance persisted even after 10 years among both men and women (men, 25.5±1.8 kg/m2 vs. 26.8±2.1 kg/m2, P&lt;0.001; women, 25.3±2.0 kg/m2 vs. 26.8±2.2 kg/m2, P&lt;0.001). Among women, the systolic BP and hypertension prevalence after 10 years were significantly lower in the WL group than in the non-WL group (systolic BP, 124.8±16.3 mmHg vs. 130.3±19.0 mmHg, P&lt;0.01; hypertension prevalence, 35.0% vs. 48.1%, P&lt;0.05). In contrast, there were no significant differences in the SBP and hypertension prevalence after 10 years among men between the groups (systolic BP, 129.0±17.7 mmHg vs. 129.0±17.5 mmHg, P=0.96; hypertension prevalence, 46.1% vs. 48.7%, P=0.57).

Conclusions
There were gender differences in the effectiveness of WL to prevent future BP elevation in overweight middle-aged participants. WL could prevent future BP elevation and the hypertension onset in women but not in men.

Funding Acknowledgement
Type of funding source: None
RV function in obesity: before and after laparoscopic gastric sleeve
Authors: Iancu M , Badea G , Craciunescu I , Vasile S , Popa O , Alecu L , Tulin A 
Published: November 2020

Abstract

Left ventricular (LV) changes associated with obesity, including LV hypertrophy and impaired LV function, have been shown to be reverted by bariatric surgery. Little is known about the effect of bariatric procedures on right ventricle (RV) function.

Aim
We analyzed RV functional changes, as assessed by echocardiography, after laparoscopic gastric sleeve (LGS) bariatric surgery.

Methods
22 consecutive obese subjects with good acoustic windows (mean age 40.2±6.7 years, 41% men, mean body mass index (BMI) 43.5±6 kg/m2) scheduled for LGS were prospectively studied before and 12 months after surgery.
RV function was assessed by RV Fractional Area Change (FAC), TDI RV free wall S wave (RV S) and free wall RV longitudinal strain (LS) and strain rate (L-SR), calculated by 3D speckle tracking echocardiography (STE). The estimated systolic pulmonary artery pressure (sPAP) was evaluated by tricuspid regurgitation velocity.

Results
Preoperative and postoperative obesity measures, as well as RV function measures significantly improved 12 months postoperatively versus baseline (all p&lt;0.05 vs baseline): BMI decreased from 43.5±2.8 to 30.3±2.9 kg/m2, abdominal circumference from 124.8±4.7 to 98.4±5 cm, RV S changed from 12.8±1.1 to 13.4±1.3 cm/s, FAC from 44.2±3.8 to 52.8±2.8%, 3D LS from 15±1.3% to 17.8±2.2% and 3D L-SR from −1.1±1.4 to −2±0.9 s–1.
Patients had similar sPAP before and after surgery.

Conclusion
By successful weight loss, 12 months after LGS, subclinical RV function parameters improved, in association with favorable metabolic changes. These findings may contribute to the cardioprotective effects of bariatric surgery.

Funding Acknowledgement
Type of funding source: None
Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs
Authors: Haxha S , Pedersen-Bjergaard U , Nielsen J.B , Pallisgaard J , Devereux R.B , Okin P.M , Gislason G.H , Torp-Pedersen C , Bang C.N 
Published: November 2020

Abstract

Background
Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients.

Purpose
The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients.

Method
A retrospective cohort study of individuals age &gt;40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c&gt;48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years.

Results
Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p&lt;0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p&lt;0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p&gt;0.45).

Conclusion
Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy.
Figure 1. LVH and all-cause mortality

Funding Acknowledgement
Type of funding source: None
The inverse association between lipoprotein(a) levels and metabolic syndorome and its components on coronary artery disease patients
Authors: Kasahara T , Endoh S , Ohtahara A , Kawatani S , Amisaki R , Mizuta E , Adachi M , Osaki S 
Published: November 2020

Abstract

Purpose
Neele DM (Diabetologia 1999) showed that insulin suppressed apolipoprotein(a) synthesis by primary cultures of cynomolgus monkey hepatocytes. Therefore, there is a possibility that inverse association exists between lipoprotein(a) [Lp(a)] and metabolic syndorome (Mets) with insulin resistance/hyperinsulinemia for coronary atherosclerosis. Sung KC (Nutr Metab Cardiovasc Dis 2013) described the inverse association between Lp(a) levels and Mets and its components on an asian occupational cohort. And high levels of Lp(a) were associated with preclinical atherosclerosis, as evaluated by coronary calcium score with cardiac computed tomography. There is no similar examination on coronary artery disease (CAD) patients. The purpose is to examine similar considerations on CAD patients.

Method
610 subjects with angiographically demonstrated CAD were enrolled. The patients who receiving medication for dyslipidemia and Insulin administration were excluded. The blood samples for laboratory tests were collected after an over night fast. Subjects were divided into four groups according to quartiles of Lp(a) levels (mg/dL). Ranges of quartile groups of Lp(a) were Q1: &lt;9.0, Q2: 9.0–&lt;16.0, Q3: 16.0–&lt;30.0, Q4: ≥30.0.

Results
The inverse association Lp(a) levels and Mets and its component. The comparison of Q1 (bottom quartile) versus Q4 (top quartile) was shown below; the comorbidity rate of Mets 19.5% versus 8.0% (p&lt;0.01), BMI (kg/m2) 23.5 versus 22.7 (p&lt;0.05), trigyceride (mg/dL) 144.0 versus 107.5 (p&lt;0.0001), HDL cholesterol (mg/dL) 46.8 versus 50.7 (p&lt;0.05), the comorbidity rate of hypertension 60.4% versus 50.7% (p=0.084), glucose (mg/dL) 107.1 versus 100.6 (p&lt;0.05), insulin (μU/mL) 8.49 versus 5.85 (p&lt;0.0001), HOMA-R 2.26 versus 1.44 (p&lt;0.0001). The mean number of diseased coronary vessel was higher in the Q4 group (2.07) than in the Q1 group (1.87) (p&lt;0.05).

Conclusion
There was the inverse association between Lp(a) levels and Mets and its components on CAD patients. The robust association was found between Lp(a) levels and severity of coronary atherosclerosis despite this inverse correlation.

Funding Acknowledgement
Type of funding source: None
Metabolic syndrome and mortality prediction in the seven countries' study: single or multifactorial
Authors: Parapid B , Danchin N , Bande M , Simic D.V , Kircanski B , Blackburn H , Jacobs D , Menotti A , Adachi H , Kromhout D , Nissinen A , Moschandreas J , Nedeljkovic-Arsenovic O.M.S , Ostojic M.C , Kanjuh V 
Published: November 2020

Abstract

Introduction
The metabolic syndrome (Met Sy) is a known cluster of risk factors (HTA, HLP, DM, BMI) that promotes overall vascular disease, however its real impact on overall, ischemic heart disease (IHD) and cerebrovascular disease (CVD) mortality remains debated.

Material and methods
The Seven Countries Study encompassed 12,763 participants who were healthy men over 40y at baseline and who underwent regular check ups every 5 years throughout over a 4 decades' span. Morbidity and mortality was adjudicated according to valid ICD and LPH coding.

Results
Using the IDF definition of the Metabolic Syndrome, 9,09% of participants were identified. In a multivariate analysis predictors for overall Mt were hypertension (p&lt;0.0001) and BMI (p&lt;0.029), while HLP had a weak prediction value (p=0.083), where as MetSy and DM had not at all. Hypertension (p&lt;0.0001) remained a strong predictor for IHD mortality together with HLP (p&lt;0.0001), while diabetes was of weak predictive value (p=0.065), whereas MetSy failed to. Although HTA was a strong predictor for CVD mortality, so did MetSy (p&lt;0.050), while DM and HLP haven't while BMI had a low impact (p=0.070).

Conclusion
Metabolic syndrome's role in atherosclerotic burden remains important, however whether its power is due to its respective components or their interactions remains to be an issue. The described results belong to an era where both IHD and CVD were considered a “male disease” women were spared of, so, further validation in the described cohorts is needed in an offspring fashion, however hypertension remains the driving force of both overall mortality as well as specific IHD and CVD ones, also previously demonstrated in the very same cohort to be more important in the setting of maternal family history of hypertension, than paternal one.
MetSy in the SCS

Funding Acknowledgement
Type of funding source: None
Metabolic changes following transcatheter bariatric embolotherapy for weight loss in obesity: secondary outcomes from a prospective RCT
Authors: Fried M , Reddy V.Y , Neuzil P , Rosen R , Sramkova P , Kipshidze N , Kipshidze N 
Published: November 2020

Abstract

Background/Introduction
Obesity and its comorbid conditions (i.e. type II diabetes mellitus, atrial fibrillation, coronary artery disease, hypertension, etc...) is a growing burden globally, however, the current treatments (i.e. bariatric surgery, intragasrtic balloons and/or pharmaceutical therapy) pose substantial risks or are contraindicated for various populations. Transcatheter bariatric embolotherapy of left gastric artery by reducing “hunger” hormones from the gastric fundus is a procedure for weight loss that has been growing in prominence over the last several years, however, to date no randomized-controlled trial has been conducted until our study. We studied TBE in a double-blind, sham procedure, first in human RCT of patients (pts) with obesity.

Purpose
The purpose of this study was to assess the safety and efficacy of TBE for weight loss in obese patients as well as to evaluate metabolic changes.

Methods
After IV propofol, eligible pts (age 21–60; BMI 35–50 kg/m2) were randomized 1:1 to Sham (skin nick & 1 hr wait) or TBE. All pts received Lifestyle Therapy (behavioral and diet education). Study staff following the pts were also blinded to treatment. Blood samples for gastrointestinal hormones were collected in EDTA tubes containing a protease inhibitor cocktail and frozen per local laboratory standards. All collected samples were assessed together in two batches at the end of the study. The hormones analyzed included ghrelin, GIP, GLP-1, Visfatin, resistin, PAI-1 (total), Leptin, and C-Peptide. An Oral Glucose Tolerance Test (OGTT) and a diabetes assay was performed at baseline and at 6- and 12-months post-intervention. Note, while diabetes was an exclusion criterion for this study, pre-diabetes was not.

Results
44 pts were enrolled, of which 40 pts were randomized equally to the groups, with no major complications in either group. TBE demonstrated superior weight loss over the control group at 6- and 12-months post-intervention in both intention-to-treat and per-protocol analyses. At 6 and 12 months, the TBE group demonstrated a clinically meaningful decrease in glucose 1-hour post-fasting by OGTT. GIP levels in the TBE group increased at a mean of 21%, indicative of an improvement in pre-diabetic milieu. Circulating plasma visfatin levels decreased 20% at 6 months and 26% at 12 months in the TBE group indicating a decrease in body fat. C-Peptide levels were noticeably increased in the TBE group at 6 months possibly indicating improvements in insulin sensitivity and beta-cell function.

Conclusion(s)
TBE is safe and results in clinically significant weight loss and demonstrated a positive effect on glucose homeostasis in pre-diabetic patients.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Endobar Solutions, LLC
Dyspnea on exertion is an independent predictor of mortality in patients with no baseline cardiovascular or respiratory disorders
Authors: Poosala A , Sydo N , Allison T.G 
Published: November 2020

Abstract

Background
Dyspnea on exertion (DOE) is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations (Effort/work of breathing, Chest tightness, Air hunger) that vary in intensity elicited by physical activity. Although DOE is a common presenting symptom in patients pertaining to cardiovascular and respiratory disorders, its prognostic importance in patients with no prior cardiovascular (CV) or respiratory disorders is unclear.

Purpose
The purpose of this study is to determine the prognostic significance of dyspnea on exertion (DOE) in patients with no prior diagnosis of CV or respiratory disorders.

Methods
We reviewed the Mayo Integrated Stress Center database for the period September 1993 through November 2010. Residents of Minnesota with no known heart disorders and no known history of COPD or other respiratory disorders were included in the study. Patients with abnormal ECG findings were excluded to rule out possible undiagnosed CV disorders. Limiting symptoms of DOE with reduced exercise capacity (FAC&lt;90%). Our primary outcome was mortality which was adjusted for age, sex, smoking history, diabetes, hypertension, obesity, negative chronotropic medications. Statistical analysis was performed to evaluate hazard ratio using Cox regression models in SAS Studio.

Results
A total of 101,455 exercise tests were reviewed to identify 18960 patients (female = 6755, 35.6%) who met the study criteria. Mean age at the time of referral was 51.2±10 years (mean ± SD) and mean follow-up was 12±10 years (mean ± SD). There were 1331 (7%) deaths from all causes, out of which 368 (27.6%) deaths are from DOE patients, and there were 428 (2.2%) deaths from cardiac causes, out of which 141 (32.9%) deaths are from DOE patients. We found that DOE was an independent predictor of mortality from all causes with hazard ratio [95% CI] = 1.690 [1.488–1.918], p≤0.0001, and from cardiac causes with hazard ratio [95% CI] = 1.997 [1.613–2.473], p≤0.0001. Product-limit survival estimates of patients with and without DOE are shown in Figure 1.

Conclusion
Based on our study findings, we conclude that dyspnea on exertion is an independent predictor of mortality in patients with no baseline CV or respiratory disorders. Patients presenting with dyspnea alone as a presenting compliant should be evaluated thoroughly and treated accordingly to reduce the associated mortality outcomes.
Figure 1. Kaplan-Meier Plot

Funding Acknowledgement
Type of funding source: None
Is there a gender difference in endothelial response on exercise training in heart failure patients with preserved ejection fraction?
Authors: Deljanin Ilic M , Ilic S , Simonovic D , Kocic G , Pavlovic R , Petrovic D , Saric S , Mitic V 
Published: November 2020

Abstract

Purpose
To examine the reaction of endothelium, assess through changes of circulating blood markers of endothelial function: the stable end products of nitric oxide (NOx), S – nitrosothiols (RSNO – reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) that promotes exercise training in female and male patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods
A total of 78 pts with HFpEF were enrolled in the study: 43 male (M group) and 35 female (F group). In all pts, before and after a short-term supervised 3 weeks exercise training at residential center values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results
After 3 weeks of exercise training NOx increased significantly in both groups: in M group (from 34.4±7.5 to 42.3±9.5 μmol/l, P&lt;0.001), and in F group (from 31.3±6.8 to 41.5±7.2 μmol/l, P&lt;0.001), as well as RSNO: In M group RSNO increased from 3.6±1.7 to 4.6±1.9 μmol/l (P&lt;0.05) and in F group from 3.1±1.5 to 4.2±2.2 μmol/l (P&lt;0,05). Increase in NOX and RSNO after exercise training was higher in F than in M group: NOx 32,6% vs 22,9%; RSNO 35,1% vs 27%. Value of ADMA as well of SDMA decreased in both groups after 3 weeks: ADMA in M group from 0.315±0.09 to 0.278±0.12 μmol/l (by 11.7%; ns), and in F group from 0.342±0.08 to 0.297±0.13 μmol/l (by 13.1%; ns); SDMA in M group from 0.269±0.08 to 0.234±0.09 μmol/l (by 13%; ns), and in F group from 0.285±0.09 to 0.245±0.10 μmol/l (by 14%; ns). After 3 weeks, level and duration of exercise test were significantly higher in M (both P&lt;0,001), as well as, in F group (both P&lt;0.001), compared to baseline values.

Conclusions
There was no gender difference in the way of endothelial response on exercise training in pts with HFpEF. Exercise training induced favorable modification of endothelial function, expressed through significant increased of NOx, RSNO and decreased of ADMA, SDMA in male as well as in female pts. Those positive changes in endothelial function were associated with significant improvement in exercise capacity. Some higher percentage of NOx and RSNO increase in women suggests that they have more pronounced benefit of exercise training than men.

Funding Acknowledgement
Type of funding source: None