bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beta-blockers are associated with incident heart failure: a secondary analysis of the systolic blood pressure intervention (SPRINT) trial
Authors: Silverman D.N , De Lavallaz J.D.F , Plante T.B , Goyal P , Infeld M.M , Meyer M 
Published: November 2020

Abstract

Background
The Systolic Blood Pressure Intervention Trial (SPRINT) evaluated whether a blood pressure (BP) goal of less than 120mmHg versus less than 140mmHg would reduce cardiovascular outcomes in subjects with at least one cardiovascular risk factor and without heart failure. Participating investigators were encouraged to use any antihypertensive medication class with a strong evidence base. The SPRINT trial was halted early due to a lower rate of the composite primary outcome in the 120mmHg group, which was mainly driven by a reduction in heart failure (HF).

Objective
As there is a concern that beta-blocker use may be associated with an excess risk for incident HF in subjects with a normal left ventricular systolic function, we evaluated the association between beta-blocker use and HF. Beta-blockers were compared with other major classes of antihypertensive medications. We also studied the association of antihypertensive class with loop-diuretic initiation.

Methods and results
In the 9,012 subjects, without HF at baseline, the association of beta-blocker exposure and incident HF was examined using time-variant competing risk analysis. Beta-blocker exposure was associated with an increased HF risk (HR 1.18; CI 1.07–1.30; p&lt;0.001) and more frequent and earlier loop diuretic-use compared to other antihypertensive agents (both p&lt;0.01). Sensitivity analyses of propensity-score matched cohorts confirmed a strong association of beta-blocker use and HF. Other major antihypertensive medication classes did not show this association.

Conclusions
Beta-blocker exposure was associated with a higher incidence of HF in hypertensive subjects without HF at baseline.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health
External applicability of blood pressure-lowering drug trials to real-world patients with manifest cardiovascular disease
Authors: Bonekamp N.E , Spiering W , Nathoe H.M , Kappelle L.J , De Borst G.J , Visseren F.L.J , Westerink J 
Published: November 2020

Abstract

Background
Randomised controlled trials (RCTs) are the main source of evidence for clinical treatment guidelines. However, there are concerns that strict eligibility criteria for participant selection may limit applicability of trial results to real-world patients.

Purpose
To assess the applicability of blood pressure-lowering drug trials in real-world secondary preventive care in stable coronary artery disease, peripheral artery disease and cerebrovascular disease.

Methods
Eligibility criteria from the largest guideline-informing RCTs on blood pressure-lowering drugs, the EUROPA, PEACE, HOPE-PAD, PRoFESS and PROGRESS trials, were applied to three subcohorts within the UCC-SMART study with coronary artery disease (n=5155), peripheral artery disease (n=1487) and cerebrovascular disease (n=2515). Baseline differences between would-be trial eligible and ineligible patients were estimated. Differences in all-cause mortality and a composite major adverse cardiovascular event (MACE) outcome of cardiovascular death, myocardial infarction and stroke were calculated and adjusted for age, sex and cardiovascular risk factors using Cox proportional hazard models.

Results
Seventy-five percent of UCC-SMART patients with the appropriate cardiovascular disease were eligible for EUROPA, 84% for PEACE, 59% for HOPE-PAD, 17% for PRoFESS and 100% for PROGRESS. Across trials, the main reasons for UCC-SMART patients' ineligibility were age younger than 50 or 55 years and cardiovascular history. On average, eligible patients were older (range 1.4–14.6 years across trials). Incidence rates for all-cause mortality and MACE were higher for trial eligible patients (Figure 1). After adjustment for age and sex, EUROPA and PEACE eligible patients had a lower risk of mortality (EUROPA: hazard ratio (HR) 0.68 95% confidence interval (CI) 0.59–0.77, PEACE: HR 0.52 95% CI 0.43–0.64) and MACE (EUROPA: HR 0.88 95% CI 0.76–1.01, PEACE: 0.56 95% CI 0.46–0.69), while differences between HOPE-PAD and PRoFESS eligible and ineligible patients were not statistically significant.

Conclusion
The results from the landmark trials on blood pressure-lowering drugs, specifically RAASi, in patients with peripheral artery and cerebrovascular disease are widely applicable to real-world patient populations. Although the majority of coronary artery disease patients is eligible for the EUROPA and PEACE trial, the results of these trials should be applied to trial ineligible patients with caution.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): UMC Utrecht
HFpEF score discriminates severity of cardiovascular profile in asymptomatic treated hypertensive patients: the campania salute network
Authors: Losi M.A , Grieco F , Canciello G , Mancusi C , Izzo R , Manzi M.V , De Luca N , Trimarco B , De Simone G , Barbato E 
Published: November 2020

Abstract

Background
The heart failure with preserved ejection fraction (HFpEF) score is easy to use and potentially useful to discriminate HFpEF from noncardiac causes of dyspnea. HFpEF score may be expressed also as probability to have HFpEF.

Purpose
We investigated whether a high HFpEF score can identify specific cardiovascular (CV) profile in treated hypertensive patients even without dyspnea.

Methods
From September to December 2019, we consecutively enrolled treated hypertensive patients without dyspnea, with normal left ventricular (LV) ejection fraction (&gt;50%), and chronic kidney disease of no more than stage III. In addition to standard echocardiographic parameters we evaluated: 1) inappropriate LV mass, identified as a percent of predicted LV mass &gt;128%, 2) myocardial energetic efficiency as the ratio of stroke volume to heart rate normalized by LV mass (MEEi), and 3) an estimate of arterial stiffness, i.e. the ratio of pulse pressure and stroke index (by allometric normalization by height), as previously reported. The probability of HFpEF was calculated from the HFpEF score, using body mass index, pulmonary systolic pressure, mitral E/E' ratio, age, and history or evidence of atrial fibrillation.

Results
188 patients with complete data were analyzed (42% women, age 61±14 years, 9% diabetic). Patients were then divided into 3 groups according to HFpEF probability tertiles and compared by ANOVA and trend analysis (Table 1).

Conclusions
Probability of HFpEF using HFpEF score and non-standard echocardiographic parameters identify worse CV profile in treated hypertensive patients without dyspnea.

Funding Acknowledgement
Type of funding source: None
Clinical and psychological aspects of true arterial hypertension and white coat hypertension
Authors: Legkonogov A , Sokolovskaya E 
Published: November 2020

Abstract

Purpose
To compare the clinical and psychological features, as well as echocardiographic and ambulatory blood pressure monitoring (ABPM) data in patients with true arterial hypertension (AH) and white coat hypertension (WCH).

Methods
Were studied 154 subjects (58 men and 96 women, average age 52.9±0.7 years) with increased office blood pressure. The control group consisted of 31 healthy individuals (12 men and 19 women, average age 51.5±2.4 years). All individuals underwent ABPM, Doppler echocardiography, and psychological status studies using the MMPI and Spielberger tests.

Results
ABPM confirmed the presence of AH in 127 (47 men and 80 women, average age 53.3±0.8 years) of 154 examined patients. 27 patients (17.5%) were diagnosed with WCH - 11 men and 16 women, the average age of 50.8±1.4 years. Among healthy individuals, dippers prevailed, while among AH patients the proportion of dippers was significantly lower (p&lt;0.001) compared with the control group, and a larger number of non-dippers, over-dippers and night-peakers was noted (p&lt;0.01). The distribution of patients with WCH by the type of the daily profile of blood pressure (BP) did not significantly differ from that in healthy individuals (p&gt;0.05). Patients with AH compared with healthy patients had higher average values of the left ventricular (LV) posterior wall as well as interventricular septum thickness, left atrium diameter, and LV myocardial mass index. We found no signs of LV hypertrophy in WCH patients and healthy individuals. The correlation analysis confirmed a reliable relationship between most echocardiographic parameters and ABPM in AH patients (p&lt;0.05). The results of the MMPI and Spielberger tests revealed higher levels of reactive and personal anxiety in patients with AH compared with healthy individuals. Patients with WCH were characterized by disharmonious personality profiles and, in comparison with the control group, more pronounced hypochondriac, hysteroid, and psychasthenic features. Compared with AH patients, subjects with WCH were characterized by less pronounced depression, isolation, rigidity of anxious affect, as well as a more pronounced demonstrative behavior.

Conclusions
In people with AH patients the structural and functional characteristics of the heart there correlate with the ABPM results. In contrast, echocardiographic findings in individuals with WCH do not significantly differ from those in healthy subjects. Individuals with WCH have more pronounced hypochondriacs, anxious-suspicious and hysteroid personality traits, while for patients with AH depression, isolation, and rigidity of anxious affect are more common.

Funding Acknowledgement
Type of funding source: None
Cerebral hemodynamics in patients with arterial hypertension of the older age groups with orthostatic hypotensive reactions
Authors: Atyunina I , Oschepkova E , Rogoza A , Lazareva N 
Published: November 2020

Abstract

Objective
To study cerebrovascular autoregulation in pts with arterial hypertension (AH) with orthostatic hypotensive reactions (OHR) during an active orthostatic test (AOT).
50 pts with AH (40 g, 10 m), 68.5±5.3 years, I-III gr. were examined. Blood pressure monitoring (BPM) by “BP Lab”, Russia. AOT was performed with continuous measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the digital artery (“Task Force Monitor”, “CNSystems” Austria). The criteria for the OHR were evaluated according to guidelines ESC, 2018. Cerebral hemodynamics in the middle cerebral artery (MCA) was monitored during the AOT (Angiodin-2K (BIOSS company, Russia), using a transcranial sensor with a freq. of 2 MHz. In the MCA, systolic (Vs), diastolic (Vd), average cerebral blood flow velocity (Vm), pulsation index (Pi), and vascular resistance index (Ri), the difference ΔVm30s,% and ΔVm30s, were recorded. Statistical analysis was performed using the non-parametric Mann-Whitney method using Statistica 6.0

Results
In 17 (34%) pts with AH, OHR was detected. BP in pts with OHR compared with pts without OHR (mmHg), SBP: 131.7±12.2 vs 131.3±13.8, p&gt;0.05; DBP 74.3±11.8 vs 75.3±8.9, p&gt;0.05). In AOT in pts with OHR, the Vm in the orthostasis significantly decreased compared to pts without OHR, both in the first 30 s. and at 3 min. (Tabl.1).

Conclusions
In pts with AH of older age groups with OHR, in comparison with the same category of pts without OHR, there is a change in cerebral autoregulation in the form of a more pronounced decrease in cerebral blood flow velocity in MCA in the orthostatic position.

Funding Acknowledgement
Type of funding source: None
Combined effect of fasting glucose and body mass index on mortality by age and sex in over 15 million adults: a cohort study
Authors: Jung M , Yi S.W , An S.J , Ihm S.H 
Published: November 2020

Abstract

Background
We aimed to elucidate whether synergic combined association of body mass index (BMI) and fasting blood glucose (FBG) on mortality exist and to identify FBS-BMI subgroups with higher mortality according to sex and age.

Methods
A total of 15,149,275 Korean adults participated in health examinations during 2003–2006 and were followed up until December 2018. Hazard ratios (HRs) of 40 BMI-FBG combined groups for mortality were assessed by Cox proportional hazards models.

Results
During mean 13.7 years of follow-up, 1,213,401 individuals died. The association between hyperglycemia and mortality was stronger in leaner than more obese individuals and these effects were more prominent in younger than older adults. Compared with overweight (BMI 25–27.4kg/m2) normoglycemic (FBG 80–94mg/dL), age, sex-adjusted HRs of leanest (BMI &lt;20kg/m2) normoglycemic, overweight diabetes (FBG ≥180mg/dL), and leanest diabetes were 1.66, 2.17, and 4.77, respectively. Corresponding HRs in those aged 18–44 years were 1.29, 2.59, and 11.18, respectively, while corresponding HRs in those aged 75–99 years were 1.56, 1.72, and 2.87, respectively (Figure 1). The interpretation of BMI-FBG subgroups associated with higher mortality was not straightforward. For example, prediabetes (FBG 110–125 mg/dL) with BMI 20–22.4 kg/m2 had similar or higher mortality than low diabetes (FBG 126–179 mg/dL) with BMI ≥22.5 kg/m2. In non-diabetic women aged &lt;45 years, BMI ≥27.5 kg/m2 was associated with the highest mortality, whereas the leanest had the worst mortality in each given FBG level in other age-sex groups.

Conclusions
Leanness and hyperglycemia interact together to increase mortality supra-multiplicatively, especially in younger adults, while complex interaction of BMI, FBG, sex and age on mortality exist.
Figure 1

Funding Acknowledgement
Type of funding source: None
Subclinical measures of peripheral atherosclerosis and risk of new-onset atrial fibrillation in men and women from general population
Authors: Geurts S , Brunborg C , Ikram M.A , Kavousi M 
Published: November 2020

Abstract

Background
Limited data on the link between peripheral vascular atherosclerosis measures and the risk of new-onset atrial fibrillation (AF) in the general population exists. Moreover, comprehensive assessment of the association between the two conditions among men and women is sparse.

Purpose
To determine the association between baseline and longitudinal measures of carotid intima-media thickness (cIMT), carotid plaque, and ankle-brachial index (ABI) with new-onset AF.

Methods
12840 participants free of AF at baseline were included in this large prospective population-based cohort study. Among the 12840 included participants, 11998 had at least one available measure for cIMT and 8532 for ABI. Presence of carotid plaque was only measured at baseline (n=11766). Three repeated measurements for cIMT and two repeated measurements for ABI were available during follow-up. The association between baseline cIMT, carotid plaque, and ABI as well as longitudinal changes in cIMT and ABI with incident AF were assessed using Cox regression and joint models respectively. Models were adjusted for age and traditional cardiovascular risk factors.

Results
During a median follow-up of 9.1 years, 1362 incident AF occurred. Baseline cIMT (adjusted hazard ratio–HR; 95% confidence interval–CI: 3.46; 1.97–6.05) and longitudinal changes in cIMT (adjusted HR; 95% CI: 3.35; 1.89–5.95) showed strong independent associations with incident AF among women (Figure 1). Baseline ABI showed a significant association with incident AF among men (adjusted HR; 95% CI: 0.61; 0.38–0.97) and a borderline significant association among women (adjusted HR; 95% CI: 0.65; 0.41–1.02). Longitudinal changes in ABI were not associated with the risk of incident AF independent of traditional risk factors.

Conclusions
Carotid atherosclerosis at baseline and progression of carotid atherosclerosis during follow-up were strongly associated with new-onset AF among women. Lower extremity peripheral atherosclerosis at baseline, but not its longitudinal changes during follow-up, was significantly associated with incident AF, in particular among men. Our findings imply that screening and monitoring for carotid atherosclerosis carry a potential for prevention of AF among women.
Figure 1. HR of baseline cIMT and AF

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE)
Sex-specific reference values and determinants of infra-renal abdominal aortic diameter among women and men from general population
Authors: Zhu F , Arshi B , Ikram M , De Knegt R , Kavousi M 
Published: November 2020

Abstract

Introduction
Abdominal aortic diameter has shown to be a marker of adverse cardiovascular outcomes. Among the non-aneurysmal populations, studies regarding abdominal aortic diameter normal reference values are sparse. Moreover, data regarding the associations between cardiovascular risk factors and aortic diameter among men and women are limited.

Purpose
To establish age- and sex-specific distribution of the infra-renal abdominal aortic diameters among non-aneurysmal older adults from the general population and to investigate the associations between cardiovascular risk factors and aortic diameters in men and women.

Methods
From a population-based cohort, 4032 participants (mean age, 67.2 years; 60.4% women) with infra-renal diameter assessment and without history of cardiovascular disease were included. Mean and quantile values of diameters were calculated in different age groups. Multiple linear regression analysis was used to detect the association of cardiovascular risk factors with diameters in men and women.

Results
The mean crude diameter was larger in men [mean (SD): 19.5 (2.6) mm] compared to women [17.0 (2.4)mm] but after adjustment for body surface area (BSA), the differences were small. There was a non-linear relationship between age and diameter (p&lt;0.001). After 66 years of age, the increase in diameter with increasing age was attenuated. After age 74 years in women and 71 years in men, the relationship between age and infra-renal aortic diameter was no longer statistically significant (Figure). Waist [standardized β (95% CI): 0.02 (0.0–0.04) in women and 0.03 (0.01–0.06) in men] and diastolic blood pressure [0.04 (0.02–0.05) in women and 0.02 (0.0–0.04) in men] were the risk factors for diameters in both sexes. Body mass index [0.02 (0.01–0.09)], systolic blood pressure [−0.01 (−0.02 to −0.01)], smoking status [0.21 (0.02–0.39)], cholesterol [−0.19 (−0.29 to −0.09)], and lipid-lowering medication [−0.47 (−0.71 to −0.23)] were significantly associated with aortic diameter only in women.

Conclusion
The differences in the crude abdominal aortic diameter between women and men diminished after taking into account the BSA. The abdominal aortic diameter increased steeply with advancing age and up to 66 years of age. However, after 74 years in women and 71 years in men, the diameter values reached a plateau. We also observed sex differences in the associations of cardiovascular risk factors with abdominal aortic diameter.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE)
Longitudinal changes of left ventricular systolic function and risk of heart failure and mortality among men and women from a general population
Authors: Arshi B , Papageorgiou G , Rueda-Ochoa O.L , Ikram M.A , Rizopoulos D , Kavousi M 
Published: November 2020

Abstract

Background
The incidence and characteristics of heart failure (HF) differ between men and women. However, evidence regarding sex differences in determinants and changes of cardiac function in association with incidence of HF remains scarce.

Purpose
To study the evolution and determinants of left ventricular ejection fraction (LVEF) over time and its association with incident mortality and HF among men and women.

Methods
From a population-based cohort, we included 7923 participants, 3319 men and 4604 women, free of heart failure (HF) and atrial fibrillation with up to 3 repeated echocardiographic measurements. Using joint models, we analyzed the evolution of LVEF and its associated traditional cardiovascular risk factors among men and women. Second, we studied the association of LVEF changes with incident HF and mortality as a composite outcome adjusted for age (time-varying covariate) and traditional cardiovascular risk factors. We then performed the analyses with HF and mortality as competing events.

Results
Mean (SD) age was 65.7 (9.6) in men and 66.5 (10) in women. During a median follow-up of 9 years, 988 events in men and 840 events in women occurred. LVEF had a one-directional nonlinear declining with increasing age among men and women (Figure). Up to age of 70, LVEF showed a sharper decline per year among men compared to women. Every unit increase in systolic blood pressure (SBP) was associated with 0.03% (0.05% to 0.02%) decrease in LVEF per year in men. Among women, SBP had an inverse J-shaped association with LVEF changes (P&lt;0.001). Diastolic blood pressure (DBP) also showed a non-linear association with LVEF in both sexes. Prevalent diabetes was not associated with LVEF change. In the survival analysis, every 5% decrease in LVEF was associated with 35% and 30% increase in the risk of the composite outcome among men [HR (95% CI): 1.35 (1.26 to 1.43)] and women [HR (95% CI): 1.30 (1.22 to 1.40)].

Conclusion(s)
Despite a similar risk of LVEF decline for the composite outcome, the evolution of LVEF, especially before 70 years of age, differ between men and women. Cardiovascular risk factors, especially blood pressure, play diverse roles in the evolution of left ventricular systolic function among men and women.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam.