bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical features and predictors of masked uncontrolled hypertension: from Korean ambulatory blood pressure monitoring (Korabp) registry
Authors: Lee Y , Kim H.J , Shin J.H , Shin J , Lim Y.H , Park J.K , Heo R , Park S , Ihm S.H , Pyun W.B 
Published: November 2020

Abstract

Background
Clinical characteristics of patients with masked uncontrolled hypertension (MUCH) are poorly defined, and few studies have reported on clinical predictors of MUCH. We investigated demographic, lifestyle, clinical and blood pressure (BP) characteristics in patients with MUCH and proposed a prediction model for MUCH.

Method
We analyzed 2044 subjects taking antihypertensive medication enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, who were categorized into controlled hypertension (n=481, normal office BP, normal 24-hour ABP), pseudo-uncontrolled hypertension (n=131, high office BP, normal 24-hour ABP), MUCH (n=380, normal office BP, high 24-hour ABP), and sustained uncontrolled hypertension (n=1,052; high office BP and high 24-hour ABP).

Result
The prevalence of MUCH increased with office systolic BP (SBP) and diastolic BP (DBP), whereas it was not associated with the numbers of antihypertensive drugs. But in patients with a high office SBP (≥130 mmHg), the prevalence of MUCH increased with decreasing numbers of antihypertensive drugs (interaction p=0.008; Figure 1A). Multiple logistic regression analysis identified high office SBPs and DBPs, prior stroke, dyslipidemia and single anti-hypertensive agent use as independent predictors of MUCH (Table 1). A prediction model using these predictors showed a high diagnostic accuracy (C-index 0.833) and a goodness of fit for the presence of MUCH (Figure 1B).

Conclusion
MUCH is associated with the borderline increase in office BP and the underuse of anti-hypertensive drugs as well as dyslipidemia and prior stroke, which underscores the importance of achieving the optimal BP control level in the high risk patients. The proposed model would accurately predict MUCH in patients with controlled office BP.
Figure 1

Funding Acknowledgement
Type of funding source: None
Genetically, dietary sodium intake is causally associated with salt-sensitive hypertension risk in a community-based cohort study: a Mendelian randomization approach
Authors: Choi J.R 
Published: November 2020

Abstract

Excessive dietary salt intake is associated with an increased risk of hypertension. Salt sensitivity, i.e., an elevation in blood pressure in response to high dietary salt intake, has been associated with a high risk of cardiovascular disease and mortality. We investigated whether a causal association exists between dietary sodium intake and hypertension risk using Mendelian randomization (MR). We performed an MR study using data from a large genome-wide association study comprising 15,034 Korean adults in a community-based cohort study. A total of 1,282 candidate single nucleotide polymorphisms associated with dietary sodium intake, such as rs2960306, rs4343, and rs1937671, were selected as instrumental variables. The inverse variance weighted method was used to assess the evidence for causality. Higher dietary sodium intake was associated with salt-sensitive hypertension risk. The variants of SLC8E1 rs2241543 and ADD1 rs16843589 were strongly associated with increased blood pressure. In the logistic regression model, after adjusting for age, gender, smoking, drinking, exercise, and body mass index, the GRK4 rs2960306TT genotype was inversely associated with hypertension risk (OR = 0.356, 95% CI = 0.236–0.476). However, the 2350GG genotype (ACE rs4343) exhibited a 2.11-fold increased hypertension risk (OR = 2.114, 95% CI = 2.004–2.224) relative to carriers of the 2350AA genotype, after adjusting for confounders. MR analysis revealed that the odds ratio for hypertension per 1 mg/day increment of dietary sodium intake was 2.24 in participants with the PRKG1 rs12414562 AA genotype. Our findings suggest that dietary sodium intake may be causally associated with hypertension risk.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2017R1D1A3B03034119, 2014M3C9A3064552), and the KRIBB Initiative program. This research was also supported by the Medical Research Center Program (2017R1A5A2015369). This work was supported (in part) by the Yonsei University Research Fund 2017. Bioresources for this study were provided by the National Biobank of Korea and the Centers for Disease Control and Prevention, Republic of Korea (2017-009).
Associations of sodium intake with central hemodynamics and changes in vascular structure and function at high altitude localities
Authors: Zhang Z , Chen X 
Published: November 2020

Abstract

Objectives
To investigate the associations of sodium intake with central hemodynamics and changes in vascular structure and function at high altitude localities.

Methods
A total of 383 Buddhists were enrolled in four temples with an average elevation of 3,800 meters from December 2018 to January 2019. Estimated 24-hour urinary sodium excretion was measured by the Kawasaki formula using the urinary sodium/creatinine ratio of the second fasting spot urine in the morning. Central hemodynamics, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), augmentation index (AI), were evaluated by applanation tonometry using the SphygmoCor analyzer. Vascular structure and function were quantified by carotid intima media thickness (cIMT) and brachial ankle pulse wave velocity (BaPWV), respectively. Pearson correlation and multiple linear regression were used to analyze the associations between 24h urinary sodium with central arterial hemodynamic parameters, cIMT and BaPWV.

Results
The estimated 24h urinary sodium excretion of the Buddhists in such area was (5.26±1.61)g and the estimated salt intake was (13.36±4.09)g. There was no significant correlation between 24h urinary sodium with CDBP, AP and cIMT (P&gt;0.05). After adjusting for gender, age, CSBP, body mass index (BMI), fasting blood glucose (FBG), estimated glomerular filtration rate (eGFR), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL), the estimated 24h urine sodium was positively correlated with CSBP (β=1.313, P=0.018) and CPP (β=1.311, P&lt;0.001), the estimated 24h urinary sodium was significantly negatively correlated with AIX75 and BaPWV (β=−1.124, P=0.028 and β=−37.530, P&lt;0.001, respectively). The line graph of means across the 24h urinary sodium quartiles and the cubic fitting curve showed that the associations between 24h urinary sodium excretion with AIX75 and BaPWV presented an approximate “J” shape.

Conclusions
24h urinary sodium was positively correlated with CSBP and CPP and negatively correlated with AIX75 and BaPWV in the Buddhists in this high altitude area. The associations between 24h urinary sodium with AIX75 and BaPWV resembled a “J” shape.

Funding Acknowledgement
Type of funding source: None
Assessment of cardiovascular risk in patients with chronic periodontitis
Authors: Lipatova T.E , Eremin A.V 
Published: November 2020

Abstract

Introduction
To effective prevention of cardiovascular morbidity and mortality in populations with an unfavorable cardiovascular profile, it is important to analyze the occurrence and severity of traditional risk factors and the calculated risks of cardiovascular events.

Aim
Estimation of cardiovascular risk in patients with chronic periodontitis (CP) different severity.

Methods
We examined 2400 person (65.6% male, aged from 40 to 64 years), of these 466 had health periodontium (HP), 1934 had CP different severity. Considered exclusion criteria were known diabetes and cardiovascular diseases. The 10-year risk of a cardiovascular event was calculated using SCORE (Systematic Coronary Risk Evaluation) and Reynolds Risk Score (RRS).

Results
There were no differences between the groups with HP and mild CP in the incidence of calculated 10-year risk of a cardiovascular event. Severity of periodontitis was associated with a higher cardiovascular risk on the SCORE. High risk on the SCORE in the group with HP was found in 10.3%, and in patients with moderate and severe CP-in 34.1%, 48.5% respectively. Using the RRS among 538 patients with moderate risk on the SCORE was showed the results: 48 (8.9%) patients were classified as low risk, 258 (48%) - the moderately low risk category (5% to 10%), 192 (35.7%) patients -a moderately high risk (10% to 20%) and 40 (7.4%) - high risk (≥20%). There was an association between SCORE index with the number of missing teeth (Spearman's R=0.591) and the loss of periodontal bone according to panoramic x-ray (R = 0.46). RRS index correlated with the severity of periodontal inflammation: the periodontal index (R=0.43), and the depth of periodontal pockets (R=0.38).

Conclusion
The relationship between the results of severe CP as missing teeth, loss of periodontal bone and the risk of fatal cardiovascular events is important for clinical use and can be an additional cardiovascular risk marker for patients with CP.

Funding Acknowledgement
Type of funding source: None
Thromboxane metabolite excretion is associated with serious vascular events in diabetes mellitus: a sub-study of the ASCEND trial
Authors: Rocca B , Buck G , Petrucci G , Parish S , Pagliaccia F , Baigent C , Mafham M , Bowman L , Armitage J , Patrono C 
Published: November 2020

Abstract

Background
Platelet activation plays a major role in the atherothrombotic complications of diabetes. Thromboxane (TX)A2 is a pro-thrombotic prostanoid, synthesized via cyclooxygenase-1 and released by activated platelets. The metabolism of TXA2 in vivo leads to a major stable end-product, 11-dehydro-TXB2 (TXM), measurable in urine and reflecting the whole-body rate of TXA2 biosynthesis. In two large trials of high-risk, aspirin-treated (mostly, without diabetes) patients, (CHARISMA and HOPE trials), the baseline rate of urinary TXM excretion was an independent predictor of future cardiovascular events.

Purpose
The aim of the ASCEND (A Study of Cardiovascular Events in Diabetes) TXM sub-study was to investigate the association between baseline urinary TXM and future serious vascular events or revascularization (SVE-R), major bleeds and incident cancer independent of other risk factors and treatment, in people with diabetes and no manifest cardiovascular disease at trial entry.

Methods
Urinary TXM was measured by a previously GC/MS-validated, immunoassay in 6,487 participants with eligible baseline samples. Analyses excluded 539 participants using NSAIDs. TXM appeared log-normally distributed, so analyses were by quintiles and per SD (=0.622) of continuous loge TXM. The association of loge TXM with outcome was adjusted by basic factors (age, sex, sample volume and randomized treatment allocation) and by the predictors of log TXM (smoking, type 2 diabetes treated with insulin or oral hypoglycaemics, HDL cholesterol, body mass index, urinary albumin/creatinine ratio, eGFR). The association of log TXM with non-vascular, non-cancer MedDRA outcomes was investigated to determine whether TXM had a general effect on outcome. During a mean of 6.6 years follow-up there were 618 SVE-Rs, 206 bleeds and 700 cancers among these patients.

Results
Log TXM correlated significantly with SVE-R, hazard ratio (HR) per 1 SD of log TXM: 1.13 (1.04–1.23), p=0.003 (Figure 1, panel a), non-significantly with major bleeds [HR 1.15 (1.00–1.32), p=0.055] (Figure 1, panel b), and marginally significantly with cancer [HR 1.09 (1.01–1.17), p=0.03] (Figure 1, panel c). There was no association of log TXM with non-vascular non-cancer MedDRA outcomes (HR per 1 SD, 0.99; 99% CI, 0.94–1.05).

Conclusion
The rate of urinary TXM excretion, a non-invasive biomarker of TXA2-mediated platelet activation in vivo, is log-linearly associated with serious vascular events independent of other risk factors in people with diabetes. Its potential association with cancer must be viewed as hypothesis-generating and needs confirmation.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): IMI1: Surrogate markers for micro- and macro-vascular hard endpoints for innovative diabetes tools (SUMMIT).
Cardiac functional consequences of stroke induced by transient middle cerebral artery occlusion in a rodent model
Authors: Olah A , Matyas C , Barta B.A , Sayour A.A , Ruppert M , Braun S , Kovacs A , Merkely B , Nagy Z , Radovits T , Nardai S 
Published: November 2020

Abstract

Background
The cardiac functional consequences of ischaemic stroke are still need to be elucidated, while according to ethical issues only non-inasive measurents were carried out in patients underwent transient cerebral ischaemia.

Purpose
We aimed at investigating left ventricular function using non-invasive and invasive modalities in a rat model of transient focal ischaemia.

Methods
Age-matched, young adult rats were used for this study. Serial left ventricular echocardiographic measurements and speckle-tracking analysis were performed in rats (n=9) underwent transient middle cerebral artery occlusion (MCAO) before, during and immediately after the induction of stroke, with a follow-up at 24, 48, 72 hours; 7, 11 and 14 days. In another experimental setting, 48 hours after stroke induction (MCAO group, n=9) we characterized left ventricular function by pressure-volume analysis, that was compared to sham-operated controls (Co group, n=9).

Results
Serial echocardiographic measurements showed impaired systolic function, that was most severe 48 hours after MCAO (global circumferential strain, GCS: −14.8±2.6% 48 hours after MCAO vs. −19.3±2.4% baseline, p&lt;0.05). A complete recovery of systolic functional deterioration was observed after 14 days (GCS: −19.2±2.5% 14 days after MCAO vs. −19.3±2.4% baseline, n.s.). Heart weight (normalized to tibial weight) did not differ between MCAO and Co animals. Pressure-volume analysis revealed unaltered diastolic function and showed unchanged load-independent contractility index values (slope of end-systolic pressure-volume relationship, ESPVR: 2.56±0.29mmHg/μl MCAO vs. 2.55±0.59 mmHg/μl Co, n.s.) after MCAO. There was a tendency towards increased systolic pressure and deteriorated ventriculo-arterial coupling in animals underwent stroke.

Conclusions
Our data suggests that MCAO is associated with reversible impairment of systolic function during echocardiographic measurements, however without alteration of intrinsic myocardial contractility. The tendency towards increased afterload might explain the observed alterations in rats underwent stroke.

Funding Acknowledgement
Type of funding source: None
Coronary artery calcification and cardiovascular outcomes after chest radiation therapy in breast cancer patients
Authors: Abu Rmilah A , Anevakar N.A , Jouni H.A , Lin G.R , Laack N.A , Herrmann J.O 
Published: November 2020

Abstract

Introduction
Coronary artery calcification (CAC) is associated with and identifies patients at higher risk of major adverse cardiovascular events (MACE). However, the prevalence, characteristics, and outcomes of cancer patients with CAC on CT before or after chest radiation therapy (RT) are not well addressed.

Methods
Retrospective cohort study of all breast cancer patients who underwent chest RT at Mayo Clinic Rochester in 2010. All pre-RT CTs were reviewed and the extent of CAC was recorded in addition to history of pre-RT atherosclerotic risk factors (hypertension (HTN), diabetes mellitus (DM), dyslipidemia, and smoking), history of pre-RT cardiovascular disease (CVD), and RT dosage. MACE (sudden cardiac death (SCD), acute coronary syndrome (ACS), and stroke), and CAC progression in follow-up were recorded. CAC extent was quantified before and on 5-year follow-up CT scan in all patients, and a positive change was considered progression. Patients were divided into 2 groups based on the presence of CAC before RT: present (group 1) or absent (group 2).

Results
Our cohort was comprised of 244 breast cancer patients who received chest RT. A total of 39 patients (16.9%) had evidence of CAC on CT prior to RT. Compared with patients without CAC before RT (n=205), those with CAC before RT were found to be older (71.8±7.7 vs 58.9±11.3, p&lt;0.01), had higher pre-RT history of HTN (84.6% vs 47.8%); p&lt;0.01), DM (20.5% vs 4.4%; p&lt;0.01), dyslipidemia (74.2% vs 40%; p&lt;0.01), CAD (23.1% vs 3.9%; p&lt;0.01), and stroke (7.69% vs 1.45%; p=0.04). Following RT, patients in group 1 were more likely to exhibit ACS (33.3% vs 2.9%; p&lt;0.01), and stroke (22.6% vs 5.2%; p&lt;0.01). Multinomial logistic regression identified pre-RT CAD pre-RT CAC (β=1.01 (0.33–1.69), OR=7.60 (1.93–29.93); p=0.02) pre-RT CAD (β=0.78 (0.06–1.49), OR=4.74 (1.14–19.74); p=0.03) as independent predictors for the development of MACE after RT. Progression in CAC after RT was found in 61.9% of all patients (13/21) who developed MACE.

Conclusion
MACE in breast cancer patients undergoing RT can be predicted before RT based on the CV risk factor and disease profile. The strongest predictor for MACE, however, is evidence of CAC before RT. These data provide a unique window for the identification and follow-up of breast cancer RT patients who have a risk of MACE.

Funding Acknowledgement
Type of funding source: None
Treatment of HIV-associated pulmonary arterial hypertension: single-center experience
Authors: Goncharova N , Zlobina I , Berezina A , Moisseva O 
Published: November 2020

Abstract

Introduction
Currently there is no evidence-based strategy for PAH drug application adjusted for patients with HIV-associated PAH. Data regarding the use of sildenafil and endothelin receptors antagonists (ERA) are limited case series.

Purpose
To present the long-term data on treatment with sildenafil, macitentan and ambrisentan in pts with HIV-PAH.

Material and methods
In prospective study were consecutively enrolled 18 treatment-naïve pts with HIV-PAH (7 males, 34.5 yrs; 29; 53 yrs), mean follow-up was 1.64yrs; 0,16–59–9.28 yrs. 4 pts were in IV FC, 5-III FC and 9 in II FC PAH (WHO). RHC, ECHO, 6MWT, ergospirometry and NTproBNP level were evaluated at a baseline. Intravenous drug abuse reported in 72% pts, all of them were co-infected with hepatitis. Nine pts (50%) treated with HAART therapy at a baseline. Five pts did not have PAH-specific therapy, 11 pts received sildenafil, 1 IV FC PAH pt with HAART – sildenafil+macitentan and 1 III FC PAH pt with HAART-sildenafil+ambrisentan. Follow-up data (FC, 6MWT, ECHO, ergospirometry, NT-proBNP) were available for 8 PAH-treated pts.

Results
Pts on PAH therapy had achieved improvement in 6 MWT with mean distance increase 69.3±52 m (p=0.01); NTproBNP level decrease (p=0.018) and FC PAH improvement in 7 pts. In pts with PAH therapy the size of right atrium decreased (56.4±7.8 vs 47.8±6.7 mm, p=0.027). The combinations of sildenafil and macitentan and sildenafil with ambrisentan were well tolerated and resulted 6MWT increase, low NTproBNP and FC improvement. Nevertheless there was no significant changes in peak VO2 consumption. Two pts with sildenafil therapy lost for follow up. Three pts with sildenafil but without HAART therapy dead: in one case due to pneumonia, other 2 cases due to pulmonary embolism. Four pts without HAART and PAH therapy dead. In our population strong association between survival and HAART therapy presence was revealed (p=0.01).

Conclusion
No adverse reactions of PAH-specific therapy were reported in pts on HAART. PAH therapy had a positive influence on FC, exercise capacity, heart remodeling and NT-proBNP level. There were no deaths in pts who receive HAART and PAH therapy. Nevertheless in our population strong association between survival and HAART therapy presence was revealed.

Funding Acknowledgement
Type of funding source: None
Markers of cholesterol metabolism and cardiovascular outcomes in patients with chronic kidney disease
Authors: Emrich I , Rogacev K , Boehm M , Schulze P.C , Fliser D , Heine G.H , Luetjohann D , Weingaertner O 
Published: November 2020

Abstract

Background
In dialysis patients statins are less effective than in other high risk patients due to a shift from cholesterol synthesis towards cholesterol absorption. The CARE FOR HOMe study investigates whether a shift towards cholesterol absorption occurs in non-dialysis chronic kidney disease (CKD), and whether the ratio of campesterol-to-lathosterol predicts cardiovascular outcomes in non-dialysis CKD patients.

Methods
In this analysis 251 participants suffering from CKD (KDIGO 2–4) without lipid-lowering drugs were included and followed for major atherosclerotic events (MACE). Additionally, all-cause death and the composite endpoint MACE and all-cause death were explored. We performed univariate and multivariate Cox regression analysis, adjusting for age, gender, estimated glomerular filtration rate (eGFR), log-transformed albuminuria, prevalent cardiovascular disease, current smoking, diabetes mellitus, systolic blood pressure and body mass index. The primary hypothesis was that patients with a high campesterol-to-lathosterol ratio had a higher event rate.

Results
Neither lathosterol-to-cholesterol (r=0.022; p=0.730), nor campesterol-to-cholesterol (r=0.041; p=0.519) nor campesterol-to-lathosterol (r=−0.103; p=0.105) correlated with eGFR. During follow-up of 5.1±2.1 years, 47 participants suffered from MACE, 46 participants died and 61 reached the composite endpoint of MACE or all-cause death. In univariate Cox regression analysis, campesterol-to-lathosterol did not predict atherosclerotic cardiovascular events (HR 0.740; 0.368–1.487), all-cause death (HR 0.564; 0.277–1.145) or the composite endpoint (HR 0.652; 0.355–1.196). After full adjustment: campesterol-to-lathosterol was not associated with all three endpoints; MACE (HR 1.064; 0.507–2.231), all-cause death (HR 0.818; 0.420–1.594) and MACE and all-cause death (HR 0.956; 0.525–1.744).

Conclusion
Markers of cholesterol metabolism were not associated with eGFR in patients with impaired renal function (KDIGO 2–4). Campesterol-to-lathosterol did not predict future MACE or all-cause death in non-dialysis CKD. These findings do not support the concept that patients with impaired renal function (KDIGO 2–4) benefit in particular from ezetimibe treatment. Further research is required to address this hypothesis in dialysis patients.

Funding Acknowledgement
Type of funding source: None