bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefit of high cardiovascular health for incident cardiovascular events and mortality in elderly population
Authors: Joung B , Yang P.S , Sung J.H , Jang E.S , Yu H.T , Kim T.H , Uhm J.S , Kim J.Y , Pak H.N , Lee M.H 
Published: November 2020

Abstract

Background
There is consistent evidence of the association between ideal cardiovascular health and lower incident cardiovascular disease (CVD); however, most studies used a single measure of cardiovascular health.

Purpose
To examine the association of change in cardiovascular health with subsequent incident CVD and mortality in elderly population.

Methods
In the Korea National Health Insurance Service-Senior (≥60 years) cohort, 312,736 participants who received national health check-ups between 2005–2012 were assessed for eligibility. Using the 7metrics of the American Heart Association (nonsmoking; and ideal levels of body mass index, physical activity, diet, blood pressure, fasting blood glucose, and total cholesterol), participants with 0 to 2, 3 to 4, and 5 to 7 ideal metrics were categorized as having low, moderate, and high cardiovascular health. Change in cardiovascular health over 2 years between 2005 and 2006 was considered.

Results
The study population included 162,149 participants without prior CVD or malignancy (median age at baseline, 69 [IQR 66–73] years; 91,408 [56.2%] women), of whom 59,887 had data about cardiovascular health change. Over a median follow-up of 5.8 (5.5–8.0) years, 5346 incident CVD events and 6035 death occurred. In multivariable analysis and compared with individuals with persistently low cardiovascular health (consistently low group, 7.9% of participants; CVD incident rate per 1000 person-years, 21.1 [95% CI, 19.4–23.0]), a lower CVD risk was observed in the consistently moderate group (38.7% of participants; absolute rate difference per 1000 person-years, −4.8 [95% CI, −5.5 to −4.1]; HR, 0.77 [95% CI, 0.70–0.85]), the moderate to high group (11.6% of participants; absolute rate difference per 1000 person-years, −7.7 [95% CI, −8.8 to −5.5]; HR, 0.62 [95% CI, 0.55–0.70]), the high to moderate group (11.2% of participants; absolute rate difference per 1000 person-years, −7.2 [95% CI, −8.3 to −5.9]; HR, 0.64 [95% CI, 0.56–0.72]), and the consistently high group (11.3% of participants; absolute rate difference per 1000 person-years, −10.2 [95% CI, −11.2 to −9.1]; HR, 0.51 [95% CI, 0.44–0.58]). A lower mortality risk was observed in the consistently moderate group, the moderate to high group, and the high to moderate or high groups.

Conclusion
Among a group of elderly participants without CVD, there was benefit of moderate or high cardiovascular health for incident cardiovascular events and mortality.

Funding Acknowledgement
Type of funding source: None
Updated treatment thresholds in the 2019 ESC/EAS dyslipidaemia guidelines substantially expand indications for statin use for primary prevention at population level: results from the Rotterdam Study
Authors: Pavlovic J , Kavousi M , Ikram M.A , Leening J.G 
Published: November 2020

Abstract

Background
In the recent update of the ESC/EAS practice guidelines for the management of dyslipidaemias, indications for statin treatment in primary prevention have been expanded to those at lower cardiovascular disease (CVD) risk and with lower LDL levels, as well as to those 65 to 75 years of age according to their level of predicted CVD risk.

Purpose
To compare the implications of the 2016 and 2019 ESC/EAS guidelines and determine the extent to which these updates affect treatment recommendations at population level.

Methods
We calculated 10-year CVD risk following the 2016 and 2019 ESC/EAS guideline recommendations and proportions of individuals qualifying for statin treatment categories per guideline. The study population included 7262 participants free of CVD, aged 45 to 75 years, from the Dutch prospective population-based Rotterdam Study.

Results
Mean (SD) age was 61.1 (6.9) years and 58.2% were women. Diabetes was present in 8.4% of the participants, 24.7% were smokers, mean LDL was 3.7 (0.9) mmol/L, and mean blood pressure was 137/80 (20/11) mmHg. Next to lifestyle changes, the 2016 and 2019 ESC/EAS guidelines recommend statin treatment in 13.2% (N=961) and 37.7% (N=2738) of the total population and consider statin treatment in 37.0% (N=2689) and 51.4% (N=3733), respectively. When stratified by 5-year age groups, the 2016 and 2019 ESC/EAS guidelines overall suggest a respective 29.7% (N=411) and 60.7% (N=839) of adults aged 45–55 years to be considered for statin treatment. While adults with an estimated 10-year SCORE risk of fatal CVD &lt;1% and LDL &lt;4.9 mmol/L were deemed to be at sufficiently low risk in the 2016 ESC/EAS guidelines and hence were suggested only lifestyle advice to modify their cardiovascular risk, in the 2019 update, 517 individuals (i.e. 37.4% of 1383 adults aged 45–55 years) were considered for statin treatment. The 2016 ESC/EAS guidelines did not provide treatment recommendations for individuals aged &gt;65 years, while the 2019 ESC/EAS guidelines recommend statin treatment in 69.2% (N=1430) and considers treatment in another 27.7% (N=571) among the study population aged 65–75 years (N=2065).

Conclusions
Updated treatment recommendations in the 2019 ESC/EAS dyslipidaemia guideline substantially expand statin treatment to asymptomatic individuals aged 45–55 at low risk, and individuals aged 65–75 years. Whether the broadening of statin indications in asymptomatic low-risk individuals and those aged 65–75 years will lead to greater uptake of primary prevention efforts and thereby long-term lowering of the burden of CVD in Europe, remains to be investigated.

Funding Acknowledgement
Type of funding source: None
The role of lipopolisaccharide and antibodies to the lipopolysaccharide in the systemic circulation to the cardiovascular risk group determination
Authors: Pokusaeva D 
Published: November 2020

Abstract

The inflammatory concept of atherogenesis is the leading one. Its finds development in the endotoxin theory of atherosclerosis, confirmed by numerous experimental studies and a several of clinical observations. But the involvement of lipopolysaccharide (LPS) in atherogenesis in humans has been studied without assessing the morphological changes in the structure of the vascular wall and not included an antibodies response. Existing scales for assessing the risk of developing cardiovascular diseases have a maximum error for patients with an average level risk. We examined 113 patients belonging to one group of cardiovascular risk (&lt;5% on the SCORE scale). We evaluated such indicators, which can be attribution to risk factors and can be application in practice, as the level of LPS in blood plasma, the level of antibodies to the LPS Salmonella minnnesota RE 595 (AB-LPS-1) and LPS Escherichia coli O55 (AB-LPS-2) in serum. A duplex scanning of extracranial brachiocephalic arteries (BCA) and a testing for lipid profile were made. It was revealed that the lipid profile do not allow to evaluate the condition of the BCA wall prior duplex scanning. A significant difference was found in the concentration and frequency of occurrence of LPS and AB-LPS indicators among patients with varying degrees of severity of atherosclerotic lesions of BCA (table). Thus, the inclusion of as risk factors the level of LPS, the concentration of AB-LPS can help in predicting the condition of the carotid arteries wall and, accordingly, in changing the degree of risk in patients at the primary diagnosis level without the participation of high-tech expensive imaging techniques. Simple binary models with high specificity and sensitivity were constructed using cluster analysis to predict the severity of BCA atherosclerosis using concentration of LPS and AB-LPS adapted for practical (figure).
Comparison risk factors between groups Parameter Group (by arterial wall state) p-value Intact wall Thickening of TIM ASP Cholesterol, mmol/L 6.43 [6.04; 6.82] 5.81 [4.75; 8.28] 6.63 [5.68; 7.51] 0.2750 LDL, mmol/L 4.43 [4.03; 4.78] 3.64 [3.04; 4.98] 4.74 [3.74; 5.28] 0.0558 HDL, mmol/L 1.09 [0.94; 1.29] 1.21 [1.07; 1.51] 1.13 [0.98; 1.35] 0.3198 Triglycerides, mmol/L 1.72 [1.23; 2.54] 1.21 [0.91; 1.92] 1.48 [0.99; 2.07] 0.2752 Atherogenicity index 4.23 [3.45; 6.32] 3.67 [2.91; 4.48] 4.93 [3.92; 5.68] 0.3532 LPS, EU/ml 0.90 [0.60; 1.52] 0.60 [0.41; 0.98]* 1.20 [0.60; 1.8]* 0.0067* AB-LPS-1, c.o.u.d. 216.0 [132.5; 248.5]* 127.5 [105.75; 221.5] 123.0 [91.00; 187.0]* 0.0444* AB-LPS-2, c.o.u.d. 374.0 [199.0; 481.0] 399.5 [195.75; 451.0] 265.0 [200.0; 399.0] 0.1991 *Result was significant at p&lt;0.05 at post-hoc pairwise comparisons.
“Decision tree” for a group of patients

Funding Acknowledgement
Type of funding source: None
Risk factor management in coronary patients: results from the EUROASPIRE V survey
Authors: Vynckier P , Gevaert S , Kotseva K , Tokgozoglu L , De Bacquer D , De Smedt D 
Published: November 2020

Abstract

Background
Previously, there has been a misperception that cardiovascular disease (CVD) mainly affects males. Although lately, there is increasing awareness about the risk of CVD in women, evidence suggests that the management of women with CVD is suboptimal.

Purpose
The aim of this study is to look at gender differences in treatment and risk factor control after a coronary event across countries with varying income levels.

Methods
Analyses were based on the ESC-EORP EUROASPIRE V survey, including patient information from 27 European countries. Patients included (18–80 years), were hospitalised for an ischaemic coronary event. Information on medical treatment, risk factors and behavioural changes were obtained during patient interviews (6 months to 2 years after hospitalization). Findings on treatment and risk factor control were compared with the European guidelines on CVD prevention (2016). Country classification by income level (low/medium income vs. high income) was done according to the World Bank Atlas method. Logistic regression analyses adjusted for sex, age, education level, country income, surgical intervention, stroke, heart failure and diabetes were performed.

Results
Data from 8261 coronary patients, of which 25.8% women, were included in the analyses. Mean (SD) age at the interview was 62.95 (9.72) years for men and 65.36 (9.21) years for women. First, when looking at the evidence based medication intake, no gender differences were seen in the prescription of antiplatelets/aspirin, whereas statins were more often prescribed in men (82.8% vs. 77.7%; p=0.002). A closer look by country income revealed that this difference is entirely due to the higher statin use among men from low/medium income countries (79.6% vs. 72.3%; p=0.004). Second, the risk factor profile differed substantially between genders. Overall, a worse risk factor profile was seen in women. Although, men were more likely to smoke (20.7% vs. 12.8%; p&lt;0.001), women were less physically active (63.2% vs. 72.5%; p&lt;0.001), had more obesity (34.9% vs. 45.7%; p&lt;0.001) and central obesity (51.8% vs. 78.0%; p&lt;0.001), and had a worse lipid control (65.9% vs. 74.3%; p&lt;0.001). Overall, no gender differences were seen in diabetes prevalence and blood pressure control. A closer look at country income level showed that the gender difference in smoking prevalence dissolved in high income countries. In addition, women in low income countries were more likely to suffer from diabetes (26.7% vs. 38.9%; p&lt;0.001).

Conclusion
These findings suggest a worse risk factor profile in women despite little to no gender differences in medical treatment. Further research is needed to understand the gender-differential in risk factor control.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Fonds voor hartchirurgie - Fonds pour la Chirurgie Cardiaque
Prognostic impact of cascade screening for familial hypercholesterolemia on cardiovascular events
Authors: Tada H , Okada H , Nomura A , Nohara A , Yamagishi M , Takamura M , Kawashiri M 
Published: November 2020

Abstract

Background
Early diagnosis and timely treatment for the patients with familial hypercholesterolemia (FH) can substantially lower the risk of atherosclerotic cardiovascular disease (ASCVD). In this sense, cascade screening could be one of the most useful options. However, few data exist regarding the impact of cascade screening for FH on the reduction of risk of ASCVD events.

Objectives
We aimed to evaluate the prognostic impact of cascade screening for FH.

Methods
We retrospectively investigated the health records of 1,050 patients with clinically diagnosed FH, including probands and their relatives who were cascade-screened. We used Cox models that were adjusted for established ASCVD risk factors to assess the association between cascade screening and major adverse cardiovascular events (MACE). The median period of follow-up was 12.3 years (interquartile range [IQR] = 9.1–17.5 years), and MACE included death from any causes or hospitalization due to ASCVD events.

Results
During the observation period, 246 participants experienced MACE. The mean age of patients identified through cascade screening was 18-years younger than that of the probands (38.7 yr vs. 57.0 yr, P&lt;0.001), with a lower proportion of ASCVD risk factors. Interestingly, patients identified through cascade screening under milder lipid-lowering therapies were at reduced risk for MACE (hazard ratio [HR] = 0.36; 95% CI = 0.22 to 0.60; P&lt;0.001) when compared with the probands, even after adjusting for those known risk factors.

Conclusions
The identification of patients with FH via cascade screening appeared to result in better prognoses.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Scientific research grants from the Ministry of Education, Science and Culture of Japan (no. 16K19394, 18K08064, and 19K08575)
A real-world assessment of the distribution of lipid levels across increasing lipoprotein(a) levels in patients with established cardiovascular disease in the United States
Authors: Fonseca A.F , Lahoz R , Ferber P , Laguna A , Amari D.T , Heo J.H , Ding Y , Studer R 
Published: November 2020

Abstract

Background and purpose
Measurements of lipid levels are frequently used to assess the risk of developing cardiovascular disease (CVD), including future myocardium infarction (MI) and ischemic stroke. Lipoprotein(a) [Lp(a)] has been established as an independent risk factor for developing CVD, however it is not widely measured. This real-world study assessed the distribution of lipid (Total Cholesterol [TC], low-density cholesterol [LDL-C], high-density cholesterol [HDL-C] and Triglycerides [TGs]) levels across different Lp(a) strata of patients with established CVD and at least one Lp(a) assessment.

Methods
This was a descriptive, non-interventional, retrospective cohort study of patients with established CVD and at least one Lp(a) assessment in the Optum® de-identified Electronic Health Record dataset (2007–2019). The index date was defined as the date of the first established CVD (MI, ischemic stroke or peripheral artery disease diagnosis) in the identification period (1/1/2008–30/6/2018) following one-year continuous enrollment. Patients were followed for up to one year, until death or transfer out of the dataset, whichever occurred first.

Results
5,434 patients (55.5% males) with established CVD and at least one Lp(a) assessment having a mean (SD) age of 62.5 (12.6) years were evaluated. During the 12 months pre-index period, 49.9%, 46.1%, 48.1% and 49.8% of these patients had a measurement of TC, LDL-C, HDL-C and TGs, respectively. Overall, the mean (SD) TC, LDL-C, HDL-C and TGs levels were 182.1 (47.0) mg/dL [n=2,712], 102.6 (40.1) mg/dL [n=2,503], 52.7 (16.7) mg/dL [n=2,614], and 140.3 (108.8) mg/dL [n=2,707], respectively. More than half of these patients were treated with at least one lipid lowering drug (includes statins, ezetimibe, fibrates, niacin or PCSK9is) during the pre-index period. The mean (SD) levels of TC, LDL-C, HDL-C and TG in patients with Lp(a) &lt;30 mg/dL, 30–50] mg/dL, 50–70 mg/dL, 70–90 mg/dL and ≥90 mg/dL are presented in Figure 1.

Conclusions
Overall, no trends in the levels of total cholesterol, LDL-C, HDL-C or triglycerides were observed across increasing levels of lipoprotein(a). These findings suggest the measurement of lipoprotein(a) is required to ensure a complete characterization of a patient lipid profile.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Usage of a new pharmacological agent of ultra-small phospholipid nanoparticles (micelles) in the treatment of combined hyperlipidemia
Authors: Zubareva M , Kudinov V , Malyshev P , Rozhkova T , Markin S , Kukharchuk V 
Published: November 2020

Abstract

Background and aims
Based on the developed technology of prerparation of ultra small size phospholipid nanoparticles without the use of detergents/surfactants and stabilizers drug preparation, exhibiting hypolipidemic properties has been obtained. Preclinical studies have shown that phospholipid nanoparticles of 20–30 nm (PLN) activate reverse cholesterol transport. PLN is now at the stage of clinical trials (Phase II study completed). The aim of the study was to compare the efficacy, safety and tolerability of PLN relative to placebo in the treatment of combined hyperlipidemia.

Methods
This Phase III, multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted at 4 centers. The patients (pts) received PLN or placebo (1:1), powder for oral solution preparation (in an aqueous environment is a nanoemulsion with a particle size of 20–30 nm), 500 mg (sachet) orally 2 times a day for 12 weeks. Lipid parameters, safety and tolerability were measured. The data is presented in M (s), Me (lq; hq). Mann-Whitney U Test was to compare the significant difference of groups. P value &lt;0.05 was considered statistically significant.

Results
A total of 100 pts with combined hyperlipidemia were randomized (age 35–70 years, males 58%).The mean age of patients was 56.4 (10.2) years. Mean total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), TG, and apolipoprotein B 100 (apoB) levels at baseline were 5.59 (0.8) mmol/l, 4.51 (0.75) mmol/l, 2.38 (0.6) mmol/l and 114.26 (24.96) mg/dl, respectively (n=100). Mean high-density lipoprotein cholesterol (HDL-C) and Lp(a) levels at baseline were 1.0 (0.25) mmol/l and 21.1 (3.9; 20.3)mg/dl, respectively (n=100). At Week 12, PLT significantly reduced total cholesterol, non-HDL-C levels, TG and apo B compared to placebo (p=0.02, p=0.03, p=0.001 and p=0.02, respectively). At the same time, the mean HDL-C level was significantly increased (p=0.03). The drug was well tolerated and no clinically significant laboratory abnormalities were detected.

Conclusions
This study demonstrates that therapy with PLT is well tolerated in additional beneficial effects on key lipid parameters in patients with moderate combined hyperlipidemia.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Ministry of industry and trade
Clinical outcomes related to fasting plasma glucose variability, history of diabetes mellitus and antidiabetic regimens in patients with atrial fibrillation: a subgroup analysis from the SPORTIF trial
Authors: Proietti M , Gumprecht J , Farcomeni A , Romiti G.F , Lip G.Y.H 
Published: November 2020

Abstract

Introduction
The role of diabetes mellitus in determining of major adverse outcomes in patients with atrial fibrillation (AF) is well-established. Little is known about fasting plasma glucose (FPG) visit-to-visit variability (VVV) and its impact on outcomes.

Aim
To analyse the role of FPG-VVV in determining major adverse outcomes in AF patients. Second, to evaluate the prognostic impact of history of diabetes mellitus and antidiabetic regimens.

Methods
Warfarin-treated patients from the SPORTIF trials were considered for analysis if they had FPG evaluation at baseline and at least 4 determinations throughout follow-up. Standard deviation (SD) of the mean of FPG throughout follow-up was the main measure of VVV, according to its quartiles (SD-Qs). A composite of cardiovascular events and the occurrence of all-cause death was the adverse outcome considered.

Results
Among the 3665 patients originally included, 3415 (93.2%) were included in this analysis. Throughout a mean (±SD) of 577.59 (±122.09) days of follow-up patients in the highest SD-Q (SD-Q4) had the highest rate of the composite outcome and all-cause death [Figure]. A Cox multi-regression analysis confirmed that SD-Q4 had a significant independent association with occurrence of composite outcome (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.10–2.35) [Figure, Upper Panel], with a non-significant trend for all-cause death, [Figure, Lower Panel]. If no significant impact of history of diabetes mellitus was found, there was a significant impact on the composite outcome of the various antidiabetic regimes: there was no difference found in patients treated with oral antidiabetics, compared to no antidiabetic treatment, but those patients treated with insulin (±oral antidiabetics) were independently associated with the occurrence of composite outcome (HR: 2.38, 95% CI: 1.05–5.38) (Table).

Conclusion
In AF patients treated with warfarin, patients with the highest FPG-VVV had an increased rate of outcomes and the largest FPG-VVV being significantly associated with the composite outcome of adverse clinical events. In diabetic patients, use of insulin is independently associated with an increased risk of the composite outcome, reflecting the more severe disease in determining adverse events amongst AF patients.
Major Adverse Outcomes

Funding Acknowledgement
Type of funding source: None
Cardiovascular determinants of exercise capacity in people with type 2 diabetes
Authors: Gulsin G , Henson J , Brady E.M , Sargeant J , Swarbrick D.J , Athithan L , Htike Z.Z , Biglands J.D , Kellman P , Khunti K , Webb D , Davies M.J , Yates T , McCann G.P 
Published: November 2020

Abstract

Background
The determinants of exercise capacity in people with type 2 diabetes (T2D), a group at high risk of heart failure, are unknown.

Purpose
To assess the relationship between subclinical cardiovascular dysfunction and peak VO2 in adults with T2D.

Methods
We enrolled asymptomatic adults with T2D and no prevalent cardiovascular disease. Matched controls were recruited for comparison. Subjects underwent echocardiography, cardiopulmonary exercise testing and adenosine stress cardiac MRI. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2 (Figure 1).

Results
247 adults with T2D (age 52±12y, 55% males, A1c 7.4±1.1%) and 78 controls were included. Subjects with T2D had increased concentric LV remodelling (LV mass/volume 0.84±0.14 vs. 0.76±0.11g/mL, p&lt;0.001), reduced global longitudinal strain (−16.4±2.4 vs. −17.4±1.9%, p&lt;0.001), lower aortic distensibility (2.75 (1.74–4.03) vs. 4.92 (2.65–7.13) mmHg-1x10–3, p&lt;0.001), reduced myocardial perfusion reserve (2.60±1.24 vs. 3.54±1.15, p&lt;0.001), and lower peak VO2 (19.0±5.6 vs. 28.0±9.1mL/kg/min, p&lt;0.001) than controls. In a model containing age, sex, ethnicity, smoking status and systolic blood pressure, aortic distensibility (β=−0.466, p=0.033), E/e' (β=−0.344, p=0.001) and myocardial perfusion reserve (β=0.903, p=0.005) were independently associated with peak VO2 in subjects with T2D (Table 1).

Conclusions
In asymptomatic people with T2D, aortic stiffening, diastolic filling, and myocardial perfusion reserve are key determinants of peak VO2, independent of age, sex, ethnicity, smoking status, or blood pressure.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research - Career Development Fellowship (G P McCann, CDF-2014-07-045). British Heart Foundation - Clinical Research Training Fellowship (G S Gulsin)