bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between napping and the risk of cardiovascular disease and all-cause mortality: a systematic review and dose-response meta-analysis
Authors: Pan Z , Huang M , Huang J , Yao Z 
Published: November 2020

Abstract

Background
Napping is a habit prevalent worldwide and occurs from an early age. Some sleep specialists have suggested it as a potential public health tool due to the prevalence of sleep disorder. However, the association between napping and the risk of cardiovascular disease (CVD) and all-cause mortality remains unclear.

Purpose
To assess the association between napping and the risk of CVD and all-cause mortality.

Methods
We conducted a systematic search of Medline, Embase and Cochrane databases from inception through December 2019 for prospective cohort studies investigating the association between napping and the risk of CVD and/or all-cause mortality. Overall estimates were calculated using random effect models with inverse variance weighting. Dose-response meta-analysis was performed using restricted cubic spline models. The results were reported as hazard ratio (HR) and 95% confidence interval (CI).

Results
A total of 313651 participants (57.8% female, 38.9% took naps) from 20 cohort studies were included in the analysis. Overall, pooled analysis detected no association between daytime nap and CVD (HR 1.13, 95% CI 0.99–1.28). However, in subgroup analysis including only participants who were female (HR 1.31, 95% CI 1.09–1.58), older (age&gt;65 years) (HR 1.36, 95% CI 1.07–1.72), or took a longer nap (nap time&gt;60 minutes) (HR 1.34, 95% CI 1.05–1.63), napping was significantly associated with a higher risk of CVD comparing to not napping. All-cause mortality was associated with napping overall (HR 1.19, 95% CI 1.12–1.26), and effect sizes were even more pronounced in females (HR 1.22, 95% CI 1.13–1.31), older participants (HR 1.27, 95% CI 1.11–1.45) and those who took a long nap (HR 1.30, 95% CI 1.12–1.47). Furthermore, after stratifying participants by night sleep time (&lt;6 and &gt;6h/day), no significant association was detected except those who slept &gt;6h/day at night and took a long nap (HR 1.13, 95% CI 1.03–1.24). Dose-response analysis showed a J-curve relation between nap time and CVD (Figure 1). The HR decreased from 0 to 25 min/day, followed by a sharp increase in the risk at longer times. A positive linear relationship between nap time and all-cause mortality was also observed.

Conclusion
Long napping over 60 minutes per day is associated with increased risks of CVD and all-cause mortality. Night sleep duration may play a role in the relation between napping and all-cause mortality. Further, large-scale prospective cohort studies need to confirm our conclusion and investigate the underlying mechanisms driving these associations.

Funding Acknowledgement
Type of funding source: None
Poor attainment of blood pressure, lipids and diabetes targets in people at high cardiovascular risk in Europe: a report from the ESC-EORP EUROASPIRE V Survey in 16 European countries
Authors: Kotseva K , De Backer G , De Bacquer D , Grobbee D , Hoes A , Jennings C , Maggioni A , Marques-Vidal P , Ryden L , Wood D 
Published: November 2020

Abstract

Introduction
The EUROASPIRE V survey in primary care was carried out by the European Society of Cardiology, EURObservational Research Programme in 2017–2018 and investigated the risk factor management in patients at high cardiovascular (CVD) risk in16 European countries.

Purpose
To provide an audit the implementation of the 2016 Joint European Societies' guidelines on CVD prevention in people at high risk of developing CVD in primary care and to see whether the practice of preventive cardiology had improved by comparison with the previous EUROASPIRE IV survey in 2014–2015.

Methods
All patients were free of coronary or other atherosclerotic diseasebut considered at high CVD risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy.

Results
2,759high CVD risk individuals (58% females), mean age 59 (SD 12) years, were interviewed and examined (participation rate 70%). The risk factor control was very poor, with less than half (47%) of patients on blood pressurelowering medication reaching the target of &lt;140/90 mmHg (&lt;140/85 mmHg in people with self-reported diabetes). Among treated dyslipidaemic patients only 47% attained LDL-cholesterol target of &lt;2.6 mmol/L. Among treated type 2 diabetic patients, 65% achieved the HbA1c target of &lt;7.0mmol/L. However, many patients on no antihypertensive or lipid-lowering medications had elevated blood pressure (43%) and elevated LDL-cholesterol (81%), respectively. The use of blood pressure lowering medication in people with hypertension was: ACE inhibitors/ARBs 79%, beta-blockers 37%, diuretics 36% and calcium channel blockers 32%; with 42% on one, 34% on two, 18% on three and 6% on ≥4 blood pressure lowering drugs. Among people on lipid-lowering medication, statins were prescribed in 97% and fibrates in 3%. Less than two-thirds of patients reported complete adherence with the intake of their blood pressure and lipid-lowering medications. The comparison with EUROASPIRE IV in the same centres that took part in both surveys showed no change in the BP management. There was a slight improvement in the control of LDL-cholesterol and glucose in patients with diabetes.

Conclusions
The results of EUROASPIRE V clearly demonstrate that the control of blood pressure, LDL-cholesterol and diabetes in patients at high CVD risk remains poor with large proportions not achieving the targets defined in the prevention guidelines. There is a considerable potential to raise the standards of preventive cardiology and to improve the management of patients at high CVD risk in Europe.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Society of Cardiology
Omega-6 fatty acids and risk of cardiovascular disease: insight from systematic review and meta-analysis of randomized controlled trials and a mendelian randomization study
Authors: Mazidi M , Shekoohi N , Katsiki N , Banach M 
Published: November 2020

Abstract

Background
Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in the Western countries. Their effects on several cardiovascular (CV) risk factors are still controversial.

Purpose
We performed a systematic review and meta-analysis of randomized control trials (RCTs) as well as a Mendelian randomization (MR) analysis to evaluate the links (or possible causality) between supplementation or serum levels of omega-6 PUFA, CV disease (CVD) and cardiometabolic risk factors.

Methods
Selected databases were searched until 31 August 2019 to identify prospective studies investigating the effects of omega-6 PUFAs supplementation on CVD events/mortality. Random-effects model meta-analysis was performed for quantitative data synthesis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 20% reduction in outcomes after administration of omega-6 PUFAs. Inverse variance weighted method (IVW), weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied for MR.

Results
In the meta-analysis of 9 studies with 4,433 participants we showed that omega-6 PUFAs supplementation was not associated with CVD event risk - RR 0.94 (95% CI: 0.77–1.15, heterogeneity p=0.031; I2=66.2%, n=4 studies). The pooled estimate (RR) of the effect of omega-6 PUFAs supplementation on CVD death was 1.06 (95% C:I 0.73–1.55, heterogeneity p=0.011; I2=66.2%, n=6 studies), on CHD events 0.84 (95% CI: 0.61–1.16, heterogeneity p=0.001; I2=79.4%), on MI 0.87 (95% CI: 0.74–1.01, heterogeneity p=0.381; I2=2.3%) (Figure), and on stroke 1.36 (95% CI: 0.45–4.07, heterogeneity p=0.082; I2=55.3%). In MR analysis we showed that individuals with genetically higher serum adrenic acid (AA; 22:4, n-6) levels had a greater risk of CHD events (IVW=Beta: 0.526, p=0.007), MI (IVW=Beta: 0.606, p=0.017) and stroke (IVW=Beta: 1.694, p=0.009), as well as higher levels of FBG (IVW=Beta: 0.417, p=1.0x10–3), LDL-C (IVW=Beta: 0.806, p=4.9x10–5), HDL-C (IVW=Beta: −0.820, p=4.3x10–17), whereas lower levels of TG (IVW=Beta: −1.064, p=1.2x10–12) and TC (IVW=Beta: −1.064, p=1.2x10–12).

Conclusions
In the pooled analysis different omega-6 PUFAs supplementation did not affect the risk of MI, stroke and CHD event/mortality or the serum concentration of cardiometabolic parameters (data not presented), however in MR analysis, higher AA levels significantly associated with the risk of CHD, MI and stroke, as well as with elevated levels of FBG, LDL-C and HDL-C and reduced levels of TC and TG. There is probably lack of class effect for omega-6 PUFAs, therefore further studies are needed to assess the effects of omega-6 PUFAs on cardiometabolic outcomes.

Funding Acknowledgement
Type of funding source: None
Severity of depression and its relationship with the parameters obtained in the cardiopulmonary exercise test in patients of a cardiac rehabilitation program
Authors: Ruiz Avalos J.A , Ortiz Calderon C.M , Rojano Castillo J , Ilarraza Lomeli H 
Published: November 2020

Abstract

Background
Cardiovascular diseases are the leading cause of global morbidity and mortality. Depression causes specific disorders such as autonomic nervous system dysfunction, neurohormonal axis imbalance, proinflammatory and prothrombotic states. The alteration profiles in the parameters measured in the cardiopulmonary exercise testing (CPET) associated with the different severities of depression have not yet been characterized.

Purpose
To determine the association of the degree of depression and the parameters obtained in the CPET in patients undergoing a cardiac rehabilitation program.

Methods
Observational, comparative, cross-sectional, retrospective study of adult patients examined in the period from January 1, 2010 to December 31, 2017. Independent variables were degrees of depression according to Beck depression inventory, dependent variables were parameters reported in the CPET. Categorical variables were reported in frequency and continuous variables as averages. The comparison between groups was made with x2, T test, ANOVA according to type and number of variables and their distribution. Pearson's correlation to determine association.

Results
From a total of 594 patients: 490 were men (82.4%), age 57.34±11.3. Maximum METs 7.49±2.42, heart rate (HR) response (percentage of theoretical maximum heart rate achieved) 82.79±12.69 and systolic blood pressure response (SBP) (ratio of peak SBP to resting SBP) 1.29±0.18. Bivariate analysis found significant differences between Beck's depression scale and study variables: Male (p&lt;0.0001), married (p=0.022), diabetes (p=0.012), surgical revascularization (p=0.05), use of angiotensin II receptor antagonists (p=0.027).

Conclusions
The present study found association of depressive symptoms with male gender, married marital status, diabetes, surgical myocardial revascularization and treatment with angiotensin II receptor antagonists. In the CPET, significant differences were found in exercise tolerance measured by METs, HR response and SBP response between subjects without depression and those with mild and moderate depression.
Depression and Exercise Tolerance

Funding Acknowledgement
Type of funding source: None
Sedentary behaviour in cardiovascular disease patients: risk factor identification and the impact of cardiac rehabilitation
Authors: Van Bakel B.M.A , Bakker E.A , Aengevaeren W.R.M , Meindersma E.P , Snoek J.A , Waskowsky W.M , Van Kuijk A.A , Jacobs M.M.L.M , Hopman M.T.E , Thijssen D.H.J , Eijsvogels T.M.H 
Published: November 2020

Abstract

Background
Cardiovascular disease (CVD) patients typically report low physical activity levels. Therefore sedentary behaviour (SB) is potentially an important target to improve survival and to reduce recurrence risk. However, information about SB in CVD patients is scarce.

Purpose
In this study, we 1) compared SB between CVD patients and age-matched controls, 2) identified patient- and disease characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation on SB.

Methods
For objective 1, we recruited 131 patients and 117 healthy, age-matched individuals. All participants were asked about their general characteristics and medical history. SB was assessed objectively by an accelerometer. For objective 2, 2,584 patients completed a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, SB was examined before, after and 2 months after cardiac rehabilitation among 131 patients using an accelerometer.

Results
Objective 1. Patients spent 10.4 hrs/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 hrs/day [Q25 8.4; Q75 10.29]). Similarly, patients reported more prolonged sedentary bouts (&gt;30 min) compared to controls (5.9 versus 4.8 bouts/day; P&lt;0.001). Objective 2. Patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of sedentary time (&gt;8 hrs/day). Objective 3. Cardiac rehabilitation significantly reduced sedentary time (−0.4 hrs/day [95% CI: −0.7; −0.1]), which remained lower at 2 months after cardiac rehabilitation (−0.3 hrs/day [95% CI: −0.6; −0.03]). In addition, prolonged sedentary bouts decreased significantly after cardiac rehabilitation (−0.4 bouts/day [95% CI: −0.7; −0.1]), but this effect diminished within 2 months after the programme (−0.2 bouts/day [95% CI: −0.5; 0.1]).

Conclusions
CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls, with more frequent engagement in prolonged sedentary bouts. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary cardiac rehabilitation programme slightly reduced sedentary time, but tailored interventions are needed to target the high amount of sedentary time in CVD patients.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Dutch Heart Foundation
Survival and factors associated with cardiovascular mortality in rural area of Russia. Results of a 7-year prospective study
Authors: Myrzamatova A , Kontsevaya A , Kashirin A , Sirotko M , Khudyakov M 
Published: November 2020

Abstract

Introduction
In Russia, mortality rates from CVD are one of the highest in the world. In recent decades, it has been demonstrated that the contribution of a modifying risk factors to cardiovascular mortality in different populations can vary significantly.

Aim
To evaluate the 7-year survival and association of risk factors with cardiovascular mortality among rural residents of Russia.

Materials and methods
This study was carried out as part of the international project InterEpid, which included a one-stage epidemiological study of the prevalence of major chronic noncommunicable diseases and their risk factors (n=1050), and a prospective stage among residents of rural areas of Russia. The analysis includes the results of a survey of representative samples of the rural population of the Samara Region of Russian Federation (n=919) aged 20–64, response rate 87,5%.The following endpoints are included in the analysis: 1. Cases of death from all causes; 2. Deaths from CVD.

Results
In Samara region 7-year survival was 92.7%. Cardiovascular diseases were most frequent cause of deaths (42%). Cardiovascular mortality was significantly associated with hypertension RR 2.11 (1.32; 2.94), p=0.004, low physical activity RR 1.82 (1.02; 2.41), p=0.009, high salt intake RR 1.28 (0.84; 2.21), p=0.03 and high processed meat intake RR 1.37 (0.91; 1.93), p=0.03. Smoking had a significant effect on cardiovascular mortality only among men RR 2.11 (1.14; 2.84), p=0.005.

Conclusion
7-year follow up demonstrated significant unfavorable effect of smoking on men's cardiovascular mortality; hypertension, low physical activity, high salt and processed meat intake on the risk of cardiovascular mortality in both sexes in rural areas of Russia. All this underlines the need to develop differentiated preventive and treatment and preventive programs adjusted to country specific of risk factors prevalence and its impact on the prognosis.
7-year survival (Samara region)

Funding Acknowledgement
Type of funding source: None
Real world cardiovascular risk assessment using reduced DAD, SCORE and Framingham equations in a German HIV cohort
Authors: Zhou Q , Usadel S , Kern W , Zirlik A , Mueller M.C 
Published: November 2020

Abstract

Introduction
People living with HIV are at increased risk for cardiovascular disease (CVD). Therefore, prevention of CVD should be integrated in HIV care. Although several risk scores exist to predict the risk of developing CVD, none of this specifically addresses the fact of HIV. Previously, the reduced Data Collection on Adverse Events of Anti-HIV Drug score (D:A:D-R) model has been proposed to assess the CVD risk for HIV patients. However, this score has not been validated in an independent cohort, or compared to traditional CVD prediction models established in the non-HIV population.

Purpose
We aim to compare the predictive value of the CVD risk scores D:A:D-R, SCORE and Framingham CVD in a German HIV population and evaluate their CVD risk in a real world setting.

Methods
This is a prospective, cross-sectional, single center study. Patients with HIV and older than 30 years were enrolled between January 2018 and December 2019. Exclusion criteria were preexisting CVD and statin therapy. CVD risk estimates were calculated using the D:A:D-R, Framingham CVD (FRS), and SCORE models. Agreement between estimates was assessed using Cohen's kappa coefficient. The indication for statin therapy was calculated using the AHA and EACS guidelines.

Results
488 patients with HIV and a median age of 47.8 years were included. Median time since HIV diagnosis was 9.9 years. All, but one Patient were on ART for a median time of 5.9 years. 61% were female. Using the D:A:D-R score, the highest proportion of patients with high or very high risk for CVD were identified (17.8%). In comparison, using SCORE and FRS only 4.7% and 13.7% of patients were identified as high or very high risk, respectively. There was a poor agreement between D:A:D-R and SCORE (k=0.11), and D:A:D-R and FRS (k=0.33). Based on the calculated CVD risk using the three models, indication for primary statin medication varied between 34.8% to 92%.

Conclusion
Our data demonstrate that standard CVD risk scores underestimate the CVD risk in patients with HIV. Using SCORE and FRS, a high proportion of patients with HIV and at high risk for CVD would be underestimated and miss the indication for statin medication. Therefore, using scores including HIV specific parameters should be considered in this patient population.

Funding Acknowledgement
Type of funding source: None
Usefulness of the coronary artery calcium (CAC) score for statin prescription in primary prevention: results in over 16.000 assessments
Authors: Keller M , Silber S 
Published: November 2020

Abstract

Background
The latest AHA/ACC cholesterol guidelines on primary prevention of coronary artery disease (CAD) recommend the use of the CAC-score to help in decision making for not using or using statins: If the CAC-score is 0, it is reasonable to withhold statin therapy (as long as higher conditions are absent). If CAC-score is 1 - 99, it is reasonable to initate statin therapy for patients ≥55 years of age. If the CAC-score is ≥100, it is reasonable to initiate statin therapy. Therefore, in the present analysis, we assessed the impact of these guidelines in everyday cardiology practice.

Methods
We analysed our data base with 16083 assessments of the CAC-score in persons with no known coronary or other cardiovascular disease and no exercise-dependent chest pain or shortness of breath. The CAC-score was determined with a multi-slice CT. Using the “step-and-shoot” acquisition protocol, the average dose was around 1 mSv.

Results
In the total group, a CAC-score of 0 was found in 35%, a CAC-score of &gt;0 up to &lt;100 in 36% and ≥100 in 29%. The percentage of the above mentioned 3 CAC-score groups depending on age and gender are listed in table 1.

Conclusion
With the support of the CAC-score, a prescription of statins can be avoided in up to appr. 60% of middle-aged male and up to appr. 80% of middle-aged female persons. On the other hand, the use of statin is reasonable in appr. two thirds of higher-aged male and one third of higher-aged female persons for primary prevention.

Funding Acknowledgement
Type of funding source: None
The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up
Authors: Cui X.T , Mandalenakis Z , Thunstrom E , Fu M , Svardsudd K , Hansson P.O 
Published: November 2020

Abstract

Background
High resting heart rate (RHR) is associated with increased adverse events. However, the long-term prognostic value in a general population is unclear. We aimed at investigating the impact of RHR, based on baseline as well as time-updated, on mortality in a middle-aged men cohort.

Methods
A random population sample of 852 men, all born in 1913 was followed from age 50 until age 98 with repeated examinations including RHR during 48 years. The impact of baseline and time-updated RHR on cause-specific mortality was assessed using Cox proportional hazards models and cubic spline models.

Results
Baseline RHR ≥90 beats per minute (bpm) was associated with higher all-cause mortality as compared to RHR 60–70 bpm (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.17–2.19, P=0.003), but not with cardiovascular (CV) mortality. A time-updated RHR &lt;60 bpm (HR 1.41, 95% CI 1.07–1.85, P=0.014) and a time-updated RHR of 70–80 bpm (HR 1.34, 95% CI 1.02–1.75, P=0.036) were both associated with higher CV mortality as compared with the RHR of 60–70 bpm after multivariable adjustment. Analyses using cubic spline models confirmed that the association of time-updated RHR with all-cause and CV mortality complied with a U-shaped curve with 60 bpm as a reference.

Conclusions
In this middle-aged men cohort, a time-updated RHR at 60–70 bpm was associated with lowest CV mortality, suggesting that time-updated RHR could be a useful long-term prognostic index in the general population.
RHR and Mortality

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): In recent years, funding has been received from the Swedish state under the agreement between the Swedish government and the county councils relating to the economic support of research and education under the ALF agreement (ALFGBG-721351).