bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6223Relationship between platelet indices and future cardiovascular events: results from a population-based cohort study
Authors: Ricci F , Patti G , Di Martino G , Renda G , Hamrefors V , Melander O , Sutton R , Gallina S , Engstrom G , De Caterina R , Fedorowski A 
Published: October 2019

Abstract

Background
Studies evaluating the relationship between platelet indices and cardiovascular outcome yielded conflicting results. In particular, the evidence from large, population-based, prospective studies with extended follow-up duration is scarce.

Purpose
We investigated the incidence of major adverse events in relation to baseline values of platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) in the prospective cohort of the Malmö Diet and Cancer Study.

Methods
A total of 30,314 middle-aged individuals (mean age 57±8 years; 40% men) were overall included and followed up for a median of 16 years (in total, 468,490 person-years). The following outcome measures were considered: all-cause death, myocardial infarction (MI) and ischemic stroke.

Results
There was no relationship between increase in MPV or PDW values and adverse events during follow-up. In particular, the incidence of all-cause death, MI and stroke in patients in the 4thquartile of MPV was 19.8% (vs. 20.7% in the 1stquartile; p=0.08), 8.5% (vs. 8.2%; p=0.78) and 7.9% (vs. 7.1%; p=0.09), respectively. The rates of all-cause death, MI and stroke in patients in the 4thquartile of PDW were 20.1% (vs. 20.7% in the 1stquartile; p=0.16), 8.7% (vs. 8.1%; p=0.30) and 8.1% (vs. 7.2%; p=0.09), respectively. There was a significant rise in mortality by platelet count increase (log-rank p<0.001). In multivariable analysis, patients in the 4thquartile of platelet count (>264 x 109/L) showed a significantly higher incidence of all-cause death (HR 1.17, 95% CI 1.07–1.28; p=0.001), MI (HR 1.24, 95% CI 1.08–1.43; p=0.003) and stroke (HR 1.20, 95% CI 1.04–1.39; p=0.014) vs the 1stquartile. The higher mortality in the 4thquartile of platelet count was independent of the history of previous stroke, was significant in patients without prior MI (HR 1.18, 95% CI 1.08–1.29; p<0.001) and non-significant in those with prior MI (HR 0.86, 95% CI 0.56–1.33; p=0.51). The risk of MI in the 4thquartile of platelet count was higher regardless of the history of previous MI (p for interaction=0.11). The risk of stroke in the 4thquartile of platelet count was higher regardless of the history of previous stroke (p for interaction=0.15).

Conclusions
In this population-based, prospective, cohort study there was no difference in the incidence of adverse events across various strata of baseline platelet morphology. However, patients with highest platelet count at baseline showed a significantly higher risk of all-cause death, MI and stroke. Whether or not these individuals should be targeted by more aggressive primary prophylactic measures including antiplatelet treatment, remains to be proven.
P6229Potato consumption is associated with total and cause-specific mortality: a population-based cohort study and pooling of prospective studies with 73,717 participants
Authors: Mazidi M , Mikhailidis D P , Katsiki N , Pella D , Banach M 
Published: October 2019

Abstract

Background
The long-term effect of potato consumption on mortality and cardiometabolic risk factors is still largely unknown.

Purpose
Using the National Health and Nutrition Examination Surveys (NHANES) 1999–2010, we evaluated the long-term impact of potato intake on total and cause-specific (cardiovascular disease [CVD],cerebrovascular disease and cancer] mortality, and the results were next validated in the systematic review and meta-analysis of cohort studies investigating pooled associations of potato consumption with all-cause and cause-specific death.

Methods
Vital status through December 31, 2011 was ascertained. Cox proportional hazards were applied to determine the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality for each quartile of the potato intake, with the lowest quartile (Q1 – with the lowest intake) used as reference. We used adjusted Cox regression to determine the risk ratio (RR) and 95% CI, as well as random effects models and generic inverse variance methods to synthesize quantitative and pooled data, followed by a leave-one-out method for sensitivity analysis.

Results
Among the 24,856 participants included, 3433 deaths occurred during the mean follow-up of 6.4 years. In multivariate adjusted Cox models, total (42%), CVD (65%), cerebrovascular (26%) and cancer (52%) mortality risk was greater in individuals with higher potato consumption than those with the lowest intake (p<0.001 for all comparisons). However this link disappeared after adjustment for confounding factors (see Table below). Results from pooling current prospective studies with 73,717 participants revealed a non-significant association between total (RR: 1.25, 0.98–1.60, p=0.066), CVD (RR: 0.99, 0.90–1.08, p=0.845) and stroke mortality (RR: 0.94, 0.85–1.03, p=0.214) with potato consumption. Individuals with a higher potato intake had a less favorable profile of cardiometabolic factors, including greater WC (97.2 vs. 99.5 cm, p<0.001) and a less favorable profile of systolic and diastolic blood pressure, levels of triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratio (p<0.001 for all comparisons).
HRs for mortality across potato intake.

Conclusions
Our results highlighted the neutral effect of potato intake on long-term mortalities; whereas potato consumption was adversely related to cardiometabolic risk factors. These findings should be taken into consideration for public health strategies, establishing the position for potatoes in the food pyramid.

Acknowledgement/Funding
None
P6230Gender disparities in serum uric acid levels associated increased cardiovascular risk. The Czech Post-MONICA study
Authors: Krajcoviechova A , Bruthans J , Wohlfahrt P , Sulc P , Cifkova R 
Published: October 2019

Abstract

Background
Recent European Society of Hypertension (ESH) guidelines have implemented serum uric acid (SUA) levels as cardiovascular (CV) risk factor and recommend routine SUA levels measurement in hypertensive patients. However, what is the appropriate SUA level threshold and whether all patients with so called asymptomatic hyperuricemia should be treated remain unclear.

Objective
To evaluate longitudinal trends and determinants of mean serum uric acid (SUA) levels in two representative Czech population surveys (2006–09 and 2015–18) and to determine the SUA levels associated with increased 10-year risk of cardiovascular (CV) death.

Methods
Two independent cross-sectional surveys of major CV risk factors were performed in the Czech Republic in 2006–09 and 2015–18; 1% percent random samples aged 25–64 years stratified by age and gender were examined. The number of participants was 3612 in 2006–09, and 2621 in 2015–18. Ten-year risk of CV death was categorized using the SCORE algorithm as low (<1%), intermediate (1% to <5%), high (≥5% to 10%), and very high (≥10%).

Results
Final analyses included 3542 individuals (48.2% men; mean age 47.1±11.3) in 2006–09, and 2304 individuals (47.4% men; mean age 47.9±10.9) in 2015–18. Over the past decade, there was a highly significant increase in SUA levels (μmol/l) from 344.6±81.1 to 374.4±73.3 in men, and from 250.1±73.8 to 278.9±66.1 in women. In gender-specific multivariate linear regression analyses conducted in the 2015–18 survey, SUA levels increased with use of diuretics, an increase in waist-to-height ratio, serum triglycerides, and aspartate aminotransferase, and a decrease in estimated glomerular filtration rate in both genders, whereas in men SUA levels increased also with an increase in quartiles of alcohol intake and gamma-glutamyl transferase, and a decrease in glycated haemoglobin. When analysing pooled data of the two surveys, mean SUA levels increased with each increase in 10-year CV risk category in women (P<0.001), but not in men (P=0.21). In receiver operating characteristic (ROC) curve analysis, the cut-off value of SUA levels discriminating between low/intermediate and high/very high CV risk category in women was 306 μmol/l (sensitivity 53%; specificity 82%; area under the ROC curve 0.713 [95% CI 0.683–0.743]).

Conclusions
Over the past decade, there was a significant increase in uricemia in the Czech adult population. However, increasing SUA levels were associated with increased 10-year CV death risk only in women. The SUA levels associated with high/very high CV risk were substantially lower in Czech women than the currently used cut-off values for hyperuricemia.

Acknowledgement/Funding
Grant number 15-27109A from Czech health research council
P6232Exploring the bottom of J-shaped curve association between serum uric acid and cardiovascular risks: description using a large Japanese general population
Authors: Kawasoe S , Kubozono T , Ojima S , Miyahara H , Maenohara S , Ohishi M 
Published: October 2019

Abstract

Background
The J-shaped association between serum uric acid (SUA) and cardiovascular risks is known. However, the bottom of the J-shaped curve has not been elucidated because of the lack of epidemiological knowledge about hypouricemia.

Purpose
To explore the SUA levels related to the most preferable cardiovascular risks using data from a Japanese general population.

Methods
Data from 246,923 individuals (111,117 men and 135,806 women) who underwent routine health checkups between January 2001 and December 2015 were analyzed. The participants were divided into quartiles according to their SUA levels, and patients with hypouricemia (SUA level <2.0 mg/dL) were subdivided into two groups according to their distributions. We compared their characteristics, including their cardiovascular risks.

Results
The prevalence of hypouricemia was 0.46% overall, 0.21% for men, and 0.66% for women (P<0.001). The subjects with hypouricemia were divided into two groups according to SUA level: a lower hypouricemia group (0.4–1.1 mg/dL, which included a peak at 0.7–0.8 mg/dL) and a higher hypouricemia group (1.4–2.0 mg/dL). The two groups exhibited significanly different characteristics in several variables: body mass index and triglyceride in men, and age, body mass index, triglyceride, low-density lipoprotein cholesterol, and renal function in women. Furthermore, several cardiovascular risk factors showed the most preferable values in subjects with SUA 1.4–2.0 mg/dL (Figure).

Conclusions
There were two independent distributions in subjects with SUA ≤2.0 mg/dL. The individuals with SUA 1.4–2.0 mg/dL exhibited the most preferable values for several cardiovascular risk factors, suggesting an association with the bottom of the J-shaped curve between SUA and cardiovascular risks.
P6235Normal Body Mass index (BMI) can rule out metabolic syndrome
Authors: Kobo O , Karban A M I R , Leiba R , Avizohar O 
Published: October 2019

Abstract

Objective
To assess whether BMI can be used as a simple and reliable survey test for metabolic syndrome.

Methods
Observational, cohort study, among patients who visited Periodic Examinations Institute [PEI]. We analysed the correlation between obesity indices and presence of metabolic syndrome. We identified the ideal value of BMI for identification of patients at risk for MS. We also described the correlation between different BMI values and its' negative predictive value for metabolic syndrome.

Results
During study years, 23,993 patients visited the PEI, 12.5% of them fulfilled the criteria for metabolic syndrome. Women with metabolic syndrome had higher proportion of obesity, when compared to men (89.9% vs 52.6%, p<0.0001). Normal BMI had very high negative predictive value to rule out metabolic syndrome among men and women (98% and 96% respectively).Using ROC curve, we found BMI 27 to be the ideal value for identification of metabolic syndrome for the entire cohort (AUC 0.767, 95% CI 0.758–0.775, p<0.0001), for men (AUC 0.726, CI [0.715–0.738], p<0.0001) and for women (AUC 0.843, CI [0.831–0.855], p<0.0001). BMI below 30, provide negative predictive value of 91.1% to rule out metabolic syndrome.

Conclusions
BMI as single survey measurement of obesity offers high negative predictive value for metabolic syndrome and can be used by physician and patients for this purpose.
P6237Clinical utility of echocardiographic left-ventricular ejection fraction monitoring for cardiotoxicity risk assessment in patients with HER2+ early breast cancer undergoing trastuzumab-based therapy
Authors: Posch F , Glantschnig T , Firla S , Smolle M , Balic M , Moik F , Stoeger H , Zirlik A , Pichler M , Rainer P 
Published: October 2019

Abstract

Background
Monitoring left-ventricular ejection fraction (LVEF) is a routinely-practiced strategy to survey patients with breast cancer (BC) towards cardiotoxic treatment effects. However, whether the LVEF as a single measurement or as a trajectory over time is truly sufficient to identify patients at high risk for cardiotoxicity is currently debated.

Purpose
To quantify the prognostic impact of LVEF and its change over time for predicting cardiotoxicity in women with HER2+ early BC.

Methods
We analyzed 1,136 echocardiography reports from 185 HER2+ early BC patients treated with trastuzumab ± chemoimmunoendocrine therapy in the neoadjuvant/adjuvant setting (Table 1). Cardiotoxicity was defined as a 10% decline in LVEF below 50%.

Results
Median baseline LVEF was 64% (25th-75th percentile: 60–69). Nineteen patients (10%) experienced cardiotoxicity (asymptomatic n=12, symptomatic n=7, during treatment n=19, treatment modification/termination n=14), Median time to cardiotoxicity was 6.7 months, and median LVEF decline in patients with cardiotoxicity was 18%. One-year cardiotoxicity risk was 7.6% in the 35 patients with a baseline LVEF≥60% and 24.5% in the 150 patients with a baseline LVEF<60% (Hazard Ratio (HR)=3.45, 95% CI: 1.35–8.75, Figure 1). During treatment, LVEF declined significantly faster in patients who developed cardiotoxicity than in patients without cardiotoxicity (1.3%/month vs. 0.1%/month, p<0.0001). A higher rate of LVEF decrease predicted for higher cardiotoxicity risk (HR per 0.1%/month higher LVEF decrease/month=2.50, 95% CI: 1.31–4.76, p=0.005), and cardiotoxicity risk increased by a factor of 1.7 per 5% absolute LVEF decline from baseline to first follow-up (HR=1.70, 95% CI: 1.30–2.38, p<0.0001). Thirty-six patients (19%) developed an LVEF decline of at least 5% from baseline to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and a baseline LVEF≥60% (n=117), 15.7% in those without an early LVEF decline and a baseline LVEF<60% (n=65), and 66.7% in those with an early LVEF decline and a baseline LVEF<60% (n=3), respectively (log-rank p<0.0001).
Table 1. Baseline characteristics Age (years, median [IQR]) 55 [49–65] Estrogen receptor positive (n, %) 124 (67%) Neoadjuvant setting (n, %) 103 (56%)
Figure 1. Risk of Cardiotoxicity.

Conclusion
Both a single LVEF measurement and the rate of LVEF decrease strongly predict cardiotoxicity in early BC patients undergoing HER2-targeted therapy. Routine LVEF monitoring identifies individuals at high risk of cardiotoxicity that may benefit from more sensitive screening techniques such as strain imaging.
P6240The impact of stress myocardial blood flow as a very strong predictor for all-cause mortality, cardiovascular mortality and adverse cardiac and cerebrovascular event in hemodialysis population
Authors: Umemoto N , Ooshima S , Katou M , Kajiura H , Inoue S , Iio Y , Itou R , Sakakibara T , Ishii H , Shimizu K , Murohara T 
Published: October 2019

Abstract

Background
In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic device for IHD. Although coronary flow reserve is the most important index in IHD diagnosis, there are limited data about stress myocardial blood flow (MBF). We investigated the prognosis predictability of stress MBF in all-cause mortality, cardiovascular (CV) mortality and adverse cardiac and cerebrovascular event (MACCE).

Methods and results
A total 438 of HD patients who undergone 13NH3PET for suspected IHD were enrolled. 29 cases were excluded due to revascularization therapy in 60 days. In total we collected 409 eligible cases. All patients were undergone13NH3PET at Nagoya Radiological Diagnosis Foundation. Patients were divided into two group according to the median value of stress MBF levels; low stress MBF group (<2.12) and high stress MBF group (≥2.12). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their all-cause mortality, CV mortality and MACCE. Kaplan-Meyer analysis shows that intergroup difference in all-cause mortality (log rank p=0.001, hazard ratio [HR] 0.411, 95% confident interval [CI] 0.261–0.632), CV mortality (log rank p=0.002, HR 0.324, 95% CI 0.157–0.625) and MACCE (log rank p<0.001, HR 0.465, 95% CI 0.324–0.657). Multiple cox analysis that include established risk factors shows CFR is an independent risk factor for all-cause mortality (HR 0.261, 95% CI 0.154–0.442), CV mortality (HR 0.172, 95% CI 0.079–0.374) and MACCE (HR 0.329, 95% CI 0.213–0.503). As a result of the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors, each indicator shows adding stress MBF on established risk factors improve the predictability in all-cause mortality, CV mortality and MACCE (all-cause mortality; NRI 0.642, p<0.001, IDI 0.091, p<0.001, CV mortality NRI 0.809, p<0.001, IDI 0.116, p<0.001, MACCE; NRI 0.646, p<0.001, IDI 0.072, p<0.001).

Conclusion
Considering prognosis of HD population, stress MBF is an important and independent predictor for all-cause mortality, CV mortality and MACCE. As a result of our investigation, stress MBF is one of most strong predictors in HD population.
P6248High use of direct oral anticoagulants in elderly patients with non valvular atrial fibrillation: results of REFLEJA study
Authors: Torres Llergo J , Fernandez Olmo M R , Carrillo Bailen M , Puentes Chiachio M , Martin Toro M , Herruzo Rojas M , Fernandez Guerrero J C 
Published: October 2019

Abstract

Background
Older patients with atrial fibrillation (AF) have a higher thromboembolic and hemorrhagic risk, however oral anticoagulation (OAC) continues to be underutilized.

Purpose
To analyze the use of direct oral anticoagulant (DOAC) in patients older than 80 years.

Methods
The REFLEJA study is a single-centre prospective observational registry including 1039 consecutive outpatients with nonvalvular AF.

Results
Among ≥80 years patients (n=376) there were more women (57.7% vs 41.5%; p<0.001), permanent AF (66.5 vs 42%; <0.001), heart failure (HF) (29.8 vs 20.2%, p<0.001) and vascular disease (19.7 vs 12.8%, p=0.003), although without differences in bleeding (5.9 vs 3,8%, p=0.12) and previous strokes (9.3 vs 7.1%, p=0.20). Despite a higher CHA2DS2-VASc score (4.4±1.1 VS 2.9±1.6, p<0.001), HASBLED score >2 (34.6 vs. 23.7%; p<0.001) and chronic kidney disease (CKD) (51.5 vs. 22.6%, p<0.001), total use of OAC was higher among those older (94.9% vs 90%, p=0.005). There were no differences in the prescription of DOAC (64.1% vs 69.3%, p=0.08), although lower doses (45.8 vs. 12.2%, p<0.005) were more frecuent among older patients. In multivariate analysis, HF (OR 0.60, CI 0.40–0.90; p=0.013) and CKD (OR 0.55, CI 0.41–0.76; p<0.001) were independent risk factors for the prescription of DOAC, but not age ≥80 years (OR 1.16, CI 0.58–2.31, P=0.67).
Baseline characteristics Total <80 years ≥80 years p value Hypertension (%) 81.5 77.9 88 <0.001 Diabetes mellitus (%) 26.3 25.7 26.7 0.71 Malignancy (%) 6.6 6.5 6.9 0.78 Coronary artery disease (%) 12.1 10.8 14.4 0.08 Anemia (%) 16.3 12.5 23.2 <0.001 DOAC (%) 67.6 69.3 64.1 0.08 Low doses DOAC (%) 15.9 12.2 45.8 <0.001 CHA2DS2-VASc score 3.4±1.6 2.9±1.6 4.4±1.1 <0.001 HAS-BLED score 1.2±0.8 1.1±0.8 1.4±0.7 <0.001 Glomerular filtration rate (ml/min) 70.9±24.9 76.2±23.1 61.5±25 <0.001 Antiarrhythmic treatment (%) 7.3 9.6 3.1 0.005 Permanent AF 50.5 41.7 66.2 <0.001 DOAC: direct oral anticoagulants; HAS-BLED score: without INR lability; AF: atrial fibrillation.

Conclusion
The proportion of elderly anticoagulated patients in our environment is very high and advanced age was not associated with a lower use of DOAC.
P6249Markers of early myocardial damage in steinert's disease
Authors: Kounka Z , Roque Rodriguez B , Lezcano Gort L E , Romero Castro M J , Chipayo Gonzales D A , Perez Espejo P , Chamorro Fernandez A I , Gomez Barrado J J , Marcos Gomez G , Mogollon Jimenez M V , Ortiz Cortes C , Sanchez Calderon P , Porras Ramos M Y , Vega Fernandez J M 
Published: October 2019

Abstract

Introduction
Myotonic dystrophy type 1 (DM 1), also known as Steinert's disease (SD), is the most common muscular dystrophy in adults. It is characterized by multisystemic involvement and the cardiac affectation is the second leading cause of death after the respiratory one.

Purpose
The objective of our work was to study the cardiac involvement by transthoracic echocardiography (TTE) including systolic function, diastolic function and myocardial deformation with global longitudinal strain (GLS) by speckle tracking and trough biomarkers of myocardial damage with high-sensitive cardiac troponin T (hs-cTnT) and NT-proBNP.

Methods
24 patients affected by SD were included. The TTE machine used has software to perform GLS with reference values: −20±2%. The normal values of hs-cTnT and NT-proBNP of our central laboratory are: <14 ng/L and 0–250 pg/ml, respectively.

Results
The mean age of patients was 52,08±12,14 years and the average age of diagnosis was 31,42 years. There was no gender predilection (12 women, 12 men).
In the TTE 55% of patients had a GLS <−18% with a global average of −17,72±4,02%. The 50% of patients with LVEF >50% had a GLS <−18% and the 27,77% had a GLS between −18 and −20%. The diastolic dysfunction assessed by pulsed wave doppler and tissue doppler imaging was present in 26.82%.
The 95,83% of the patients had levels of hs-cTnT≥14 ng/L with median of 34,93 ng/L (minimum 3,96 and maximum 429), however only 30,4% of these had values of NT-proBNP above 250 pg/ml with a median of 71,83 pg/ml (minimum 9,37 and maximum 8771).

Conclusions
According to our experience GLS and hs-cTnT could be markers of early myocardial damage in patients with SD. We therefore need to develop protocols for the follow-up including these markers in the usual cardiac assessment.