bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex-related trends of cardiovascular risk perception and prevention behaviors: results from the italian society of cardiovascular survey
Authors: Polimeni A , Sorrentino S , Crea P , Spaccarotella C , Mongiardo A , De Rosa S , Zangara S , Bruschi G , Lopera Quijada M.J , Cenci C , Mercuro G , Indolfi C 
Published: November 2020

Abstract

Background
Recent reports evidenced gender differences in the knowledge, perception and awareness of cardiovascular risk factors and cardiovascular diseases.

Purposes
To evaluate trends in awareness of cardiovascular risk, as well as knowledge of symptoms and preventive behaviors related to cardiovascular disease (CVD).

Methods
As part of Vivi con il Cuore (campaign with the goal of raising awareness about women's heart disease) a nationwide survey was conducted. Standardized questions on awareness of CVD risk, as well as prevention behaviors and barriers, were provided through a computer-assisted web interviewing platform to a large sample of Italians citizens ranging from 40 to 70 years old. The sample was representative of the population by age, sex, and area of geographical residence.

Results
A total of 1,000 subjects were included in this survey, of which 511 (51%) female. About 60% of women indicated cancer as the leading cause of death among female sex, while only 22% indicated cardiovascular disease. Similarly, when the same question was asked to men, 44% indicated cancer and 21% cardiovascular disease, observations that were consistent across age categories. Although a well sizable part of the population (90% of the interviewees) have consulted the general practitioner in the last year, only 45% of women and 56% of men declared to receive information about CVD risk. Almost 84% among men and women, recognized the importance of knowing how to understand the symptoms of a heart attack due to the possibility of survival. An additional survey was conducted among young cardiologists under 40 years old, including a total of 200 young cardiologists, similarly distributed among men and women (47% and 53% respectively). About 24% of young cardiologists indicated breast cancer as the leading cause of death in women, while only 70% reported cardiovascular diseases. Furthermore, 35% of participants reported that they did not have adequate training on the risks of heart disease in women.

Conclusions
In this survey, only 22% of women were aware that cardiovascular disease is the number one killer of women. Likewise, a well sizable part of young cardiologists (30%) does not recognize cardiovascular disease as the leading cause of death in women. These data should inform public health campaigns to focus on evidence-based strategies to prevent CVD and to help target messages that resonate and motivate women to take action.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
Oestradiol and the risk of myocardial infarction in women: a cohort study of UK Biobank participants
Authors: Peters S , Woodward M 
Published: November 2020

Abstract

Background
It is commonly assumed that high oestradiol levels in women are cardioprotective. We assessed the association between oestradiol and the risk of incident myocardial infarction in women.

Methods
We used data from 263,295 female UK Biobank participants (mean age 56.2; SD 8.0 years) without prior cardiovascular disease. Associations of oestradiol with age and other cardiovascular risk factors were assessed. Cox proportional hazards models estimated crude, age, and multiple-adjusted hazard ratios (HR) for MI associated with oestradiol levels.

Results
After a mean follow-up of 9 years, 2,206 incident cases of MI had been recorded, including 230 events among the 57,204 women (mean age 48) with detectable oestradiol levels. In the unadjusted analyses, a unit higher in log-transformed oestradiol was associated with a HR (95% CI) for MI of 0.73 (0.58; 0.92). After adjusting for age this HR became 0.94 (0.75; 1.17), and after further adjusting for classical CVD risk factors, 1.05 (0.83; 1.31. Results were similar in subgroup analyses defined by age, menopausal status, socioeconomic status, pill use, and the use of hormone replacement therapy. The multivariable adjusted HR for the 171,431 women (mean age 59) with undetectable levels of oestradiol, compared to those with detectable levels, was 0.97 (0.92; 1.02).

Conclusion
Higher levels of oestradiol were not associated with a decreased risk of MI. The presumed cardioprotective effects of oestradiol seem to be largely confounded by age, and further confounded by other cardiovascular risk factors.
Figure 1

Funding Acknowledgement
Type of funding source: None
Does arterial stiffness increase in patients with early surgical menopause?
Authors: Akcay M , Coksevim M , Gedikli O , Ulubasoglu H , Yilmaz O 
Published: November 2020

Abstract

Introduction
Surgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.

Method
We included 40 patient early surgical menopause and 40 control group patients with clinically and demographically similar characteristics. Oscillometric measurement method with Mobil-O-Graph 24h-ABPM NG® arteriography was used to measure the arterial stiffness and cardiovascular hemodynamic parameters.

Results
Of the 40 patients who underwent surgical early menopause, 27 (67.5%) had malignancy, 11 (27.5%) with myoma and 2 (5%) with bleeding. There were no differences in baseline demographic, laboratory, echocardiographic parameters and coronary artery disease risk factors.In terms of arterial stiffness parameters, PWV were significantly higher in the early surgical menopause group than in the control group (6.5±0.8; 5.6±1.2 p&lt;0.001), but there was no statistically significant difference in Alx (28.3±10.9; 27.4±9.0 p=0.69).Also, there was no statistically significant difference in terms of cardiac hemodynamic parameters and central aortic pressures.

Conclusion
When arterial stiffness is noninvasively evaluated by oscillometric method, it is significantly increased in surgical early menopause patients independent of other risk factors.

Funding Acknowledgement
Type of funding source: None
Anti-Mullerian hormone concentrations are inversely associated with subclinical atherosclerosis in premenopausal women
Authors: Delialis D , Lamprinoudaki I , Stergiotis S , Patras R , Chatzivasileiou P , Augoulea A , Anagnostis P , Armeni E , Rizos D , Kaparos G , Alexandrou A , Georgiopoulos G , Kontogiannis C , Fotellis D , Stamatelopoulos K 
Published: November 2020

Abstract

Background
Anti-Müllerian hormone (AMH) constitutes a marker of ovarian reserve and appears to have a predictive role regarding the time of menopause. Moreover, AMH is associated with adverse cardiac events. History of premature menopause and early onset of menopause have been associated with increased risk of cardiovascular (CV) disease. In addition, menopausal transition and duration of menopause have been associated with increased burden of subclinical atherosclerosis. However, the association between AMH as a marker of female reproductive age with atherosclerosis in premenopausal women is currently unknown.

Purpose
To investigate whether AMH concentrations are associated with markers of early atherosclerosis in healthy, normally menstruating women.

Methods
In a cross-sectional study, vascular structure and function were assessed by measurement of carotid and femoral intima-media thickness (IMT), lipid profile and serum AMH concentrations were assessed. Exclusion criteria were clinically overt CV disease, abnormal ovulatory cycles, polycystic ovarian syndrome, acute infection or chronic inflammatory disease, risk factors for CV disease and any medication

Results
Seventy premenopausal women, aged 32.7±6.5 years, were included. Mean AMH levels were lower in smokers than in non-smokers and negatively associated with total cholesterol (TC) levels. An inverse association between mean AMH concentrations and IMT in all segments was observed. No correlation with other markers of subclinical atherosclerosis or traditional CV risk factors was found. After multi-variable adjustment for traditional CV risk factors, the association between AMH concentrations combined IMT and carotid bulb IMT, remained significant.

Conclusions
In healthy, normally ovulating women, low AMH concentrations are associated with an adverse lipid profile and subclinical atherosclerosis, independently of traditional CV risk factors. This finding suggest a role of decreased follicular reserve with atherosclerotic disease.

Funding Acknowledgement
Type of funding source: None
Diabetic cardiovascular autonomic neuropathy in children
Authors: Gumeniuk O.L.G.A , Bolotova N , Averianov A , Chernenkov I.U 
Published: November 2020

Abstract

Diabetic cardiovascular autonomic neuropathy (CAN) encompasses damage to the autonomic nerve fibers innervating the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics.
Clinical symptoms associated with CAN include resting tachycardia, postural hypotension, dizziness, syncope, exercise intolerance, silent myocardial infarction.
The earliest finding of CAN, even at the subclinical stage, is a decrease in heart rate variability (HRV)

Purpose
To study CAN prevalence and understand the diagnostic capabilities of HRV - tests of diabetic cardiovascular autonomic neuropathy in children with type 1 diabetes.

Methods
100 children with type 1 diabetes were assessed for CAN (age 15.2 yrs [9.0–17.8], duration 6.5 yrs [4.0–10.6], HbA1c 8.1% 6.3–9.7]). The degree of compensation of diabetes was estimated according to criteria ISPAD Consensus Guidelines, 2018. Optimal level (HbA1c &lt;7.0%) of compensation was revealed in 62% of children (group I) and nonoptimal in 38% of children (group II). For evaluation of the CAN we used HRV - tests: RR 30:15 ratio, ΔRR quiet breath, ΔRR deep breath, BP response to standing.

Results
Diabetic cardiovascular autonomic neuropathy was diagnosed in 41 children: in group I – in 6 (29%) and in group II – 35 (71%) children (p=0.00001). The prevalence of DCN correlated with HbA1c level in children and adolescents (groups I and II): ΔRR quiet breath r=−0.47 & r=−0.9; ΔRR deep breath r=−0.65 & r=−0.85; RR30:15 r=−0.77 & r=−0.88 respectively. Prevalence of CAN increased parallel to type 1 diabetes duration (p&lt;0.01).

Conclusions
Diabetic cardiovascular autonomic neuropathy in children with type 1 diabetes was diagnosed in 41%. Prevalence of diabetic cardiovascular autonomic neuropathy increases parallel to type 1 diabetes duration (p&lt;0.01). In this study we found an association between HRV indexes and HbA1c level. This provides support for HRV - testing to assess diabetic cardiovascular autonomic neuropathy in children.

Funding Acknowledgement
Type of funding source: None
Vascular ring surgery – can we do better?
Authors: Amir G , Soffair N , Frenkel G , Bruckheimer E , Nachum E , Rotshtein A , Sheinfeld T , Birk E 
Published: November 2020

Abstract

Background
Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery.

Methods
Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery.

Results
In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up

Conclusions
Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms.

Funding Acknowledgement
Type of funding source: None
Predicting non-elective hospital readmission or death using a composite assessment of cognitive impairment and frailty in elderly inpatients with cardiovascular diseases
Authors: Yao S , Wang H , Yang J , Sun N 
Published: November 2020

Abstract

Background
Cardiovascular disease (CVD) and related complications are significant healthcare problems in the growing elderly population. Metabolic factors are the predominant risk factors for CVD, sedentary behaviour and physical inactivity are major modifiable risk factors for CVD. Age-associated cognitive decline and impairment are associated with an increased mortality. Cognitive and physical components of frailty have pathophysiologic rationale as risk factors for CVD. There is a clinical need to identify more practical screens that can assist us to definite cognitive impairment and physical frailty, then to determine which patients with CVD are at high risk of adverse outcomes, early management of these high-risk patients can reduce readmission rates, healthcare spending, and improve quality of care.

Purpose
We aimed to assess the utility of a combination developed using the mini-mental state examination + clock drawing test and the Fried phenotype for predicting non-elective hospital readmission or death within 6-month in elderly inpatients with CVD.

Methods
A single center prospective cohort was conducted between September 2018 and February 2019. Inpatients aged 65 years or older were recruited. All enrolled patients received a comprehensive geriatric assessment during hospitalization. The Kaplan-Meier curves were used to estimate the cumulative incidence of events. The multivariate Cox regression model was used to analyze the association between frailty and cognitive status and the non-elective hospital readmission or death.

Results
A total of 542 patients were included; and a total of 113 patients (20.9%) died or were readmitted at 6-month. Overall 20% screened positive for cognitive impairment, including 8% were cognitive impairment combined with physical frailty, which were more older, more common in women and non-married group, had a lower education and a higher risk of malnutrition. Frail participants with normal (hazard ratio [HR]: 1.73, 95% confidence intervals [CI]: 1.06–2.82, P=0.028) and impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P=0.008) had a higher risk of non-elective hospital readmission or death than robust patients, after adjustment for age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and previous stroke.

Conclusions
The presence of physical frailty and cognitive frailty were powerful predictors of non-elective hospital readmission or death in elderly inpatients with CVD, and taking cognitive impairment into account in the frailty model may allow better prediction of adverse outcomes of frailty in the short time.
Kaplan-Meier survival curves

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Beijing Municipal Science & Technology Commission, Chinese Academy of Medical Sciences
Outcomes of nonagenarians with acute coronary syndrome
Authors: Echarte Morales J , Cepas Guillen P.L , Caldentey G , Martinez Gomez E , Borrego-Rodriguez J , Vidal P , Llagostera M , Viana Tejedor A , Benito Gonzalez T , Flores-Umanzor E , Quiroga X , Perez De Prado A , Freixa X , Sabate M , Fernandez-Vazquez F 
Published: November 2020

Abstract

Background
Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials.

Objective
The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management.

Methods
We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed.

Results
523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p&lt;0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p&lt;0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p&lt;0.01) or STEMI groups (p&lt;0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03).

Conclusion
An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age.
Figure 1

Funding Acknowledgement
Type of funding source: None
Thromboembolic events and major bleeding in frail patients with incident atrial fibrillation: a nationwide cohort study
Authors: Hojen A.A , Soegaard M , Nielsen P.B , Skjoeth F , Coleman C.I , Lip G.Y.H , Larsen T.B 
Published: November 2020

Abstract

Background
Growing evidence suggests that frail patients presenting with atrial fibrillation (AF) are less likely to receive adequate oral anticoagulant therapy (OAC) despite high thromboembolic risk. There is a paucity of evidence investigating clinical outcomes in different antithrombotic strategies.

Purpose
To assess thromboembolic events, bleeding, and all-cause mortality according to OAC treatment regimen in a Danish nationwide cohort of frail patients with AF

Method
We included all patients with non-valvular AF between 2011 and 2018 who were aged ≥64 years and had a frailty risk score &gt;5 according to the ICD-10 based Hospital Frailty Risk Score. Patients with an OAC indication other than atrial fibrillation were excluded. The cohort was stratified by treatment regimen: warfarin, NOACs standard dose, NOACs reduced dose, or no OAC, determined by treatment status within 60 days before and 30 days after AF diagnosis. Patients were followed from 30 days after AF diagnosis (index date) for the occurrence of thromboembolic events and major bleeding. Cumulative incidence functions were used to depict development of outcome risk over time using on the Aalen–Johansen estimator assuming death as competing risk.

Results
We identified 31,745 frail AF patients (mean age 80.7 years, 53.8% female); 16540 (52.1%) received no OAC, 2993 (9.4%) received warfarin, 6181 (19.5%) received standard dose NOACs, and 6031 (19.0%) revived reduced dose NOACs. Risk of developing the outcomes over time is depicted in Figure 1. At 1-year follow-up, the absolute risk of thromboembolic events was 5.0% for patients with no OAC, 4.2% for reduced dose NOACs, 4.1% for warfarin, and 3.4% for standard dose NOACs. Bleeding risk was 6.1% for warfarin, 5.4% for reduced dose NOACs, 5.2% for No OAC, and 5.1% for standard dose NOACs.

Conclusions
Most patients in this nationwide cohort of elderly frail AF patients received no OAC, which was associated with a high risk of thromboembolism. The associated risk of thromboembolism was lower in patients receiving other studied treatment modalities, which might suggest a benefit of OAC across different antithrombotic strategies in frail AF patients. However, differences in risk profile and patient specific factors are likely to influence our observations, and studies investigating the comparative effectiveness and safety of NOACs including dosage regimens in frail AF patients are warranted.
Figure 1. Cumulative risk of events

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer AG
Differential impact of obstructive and restrictive ventilatory patterns on incident heart failure with preserved versus reduced ejection fraction in late-life
Authors: Ramalho S , Claggett B.L , Kitzman D.W , Chang P.P , Cipriano Junior G , Solomon S.D , Skali H , Shah A.M 
Published: November 2020

Abstract

Background
Subclinical pulmonary dysfunction predicts cardiovascular (CV) outcomes, especially heart failure (HF). However, the impact of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC on different incident HF phenotypes in late-life is unclear.

Purpose
Determine the associations of FEV1/FVC and ppFVC with incident HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in late-life.

Methods
In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 HF-free participants who underwent echocardiography and spirometry at the fifth study visit (2011–2013). The relation between pulmonary function and incident adjudicated HFpEF and HFrEF were examined using multivariable Cox proportional hazards models adjusted for demographics, body mass index, coronary artery disease, atrial fibrillation, hypertension, diabetes, and NT-proBNP.

Results
Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. At a median follow-up of 5.6 years, lower ppFVC was independently associated with incident HFpEF, but not HFrEF (Table). Lower FEV1/FVC ratio was associated with higher risk of incident HFrEF but not HFpEF in models adjusted for demographics, which did not persist after further adjustment for clinical risk factors.

Conclusion
The relationships of reduced ppFVC and FEV1/FVC with incident HF differ significantly by HF phenotype.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services