bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of periodic fasting lifestyles with survival and incident major adverse cardiovascular events in patients undergoing cardiac catheterization
Authors: Bartholomew Ciera L , Muhlestein Joseph B , Anderson Jeffrey L , May Heidi T , Knowlton Kirk U , Bair Tami L , Le Viet T , Bailey Bruce W , Horne Benjamin D 
Published: January 2021

Abstract

Aims
Animal models repeatedly show fasting increases longevity. Human data, though, are limited to anecdotal claims. This study evaluated the association of routine fasting with survival and, secondarily, with incident major adverse cardiovascular events.

Methods and results
Cardiac catheterization patients enrolled in the Intermountain INSPIRE longitudinal cohort (n = 2785) during 2013–2015 were followed through March 2019. A fasting survey was completed in n = 2025 (73%) of this cohort and 1957 were included in the final data analysis after 68 participants were removed (24 for data issues and 44 for fasting less than 5 years). Self-reported routine fasting behaviour, years of participation in fasting, and other fasting characteristics were surveyed. Mortality was the primary outcome and incident myocardial infarction (MI), stroke, and heart failure (HF) were secondary. Routine fasters (n = 389, mean age 64 ± 14 years, 34% female) averaged 42 ± 18 years of routine fasting (minimum 5 years). Non-fasters (n = 1568, aged 63 ± 14 years, 36% female) included never fasters (n = 1120 with 0 years of fasting) and previous fasters (n = 448 who averaged 32 ± 21 years of prior fasting but had stopped prior to enrolment). Routine fasters had greater survival vs. non-fasters [adjusted hazard ratio (HR) = 0.54, 95% confidence interval (CI) = 0.36–0.80; P = 0.002] and lower incidence of HF (adjusted HR = 0.31, CI = 0.12–0.78; P = 0.013), but not MI or stroke after adjustment.

Conclusions
Routine fasting followed during two-thirds of the lifespan was associated with higher survival after cardiac catheterization. This may in part be explained by an association of routine fasting with a lower incidence of HF.

Clinical study registration
The Intermountain INSPIRE registry https://clinicaltrials.gov/, NCT02450006.
Antithrombotic therapy in patients undergoing transcatheter aortic valve replacement: the complexity of the elderly
Authors: Bencivenga Leonardo , Sepe Immacolata , Palaia Maria Emiliana , Komici Klara , Corbi Graziamaria , Puzone Brunella , Arcopinto Michele , Cittadini Antonio , Ferrara Nicola , Femminella Grazia Daniela , Rengo Giuseppe 
Published: January 2021

Abstract
Along with epidemiologic transitions of the global population, the burden of aortic stenosis (AS) is rapidly increasing and transcatheter aortic valve replacement (TAVR) has quickly spread; indeed, it is nowadays also employed in treating patients with AS at intermediate operative risk. Nonetheless, the less invasive interventional strategy still carries relevant issues concerning post-procedural optimal antithrombotic strategy, given the current indications provided by guidelines are not completely supported by evidence-based data. Geriatric patients suffer from high bleeding and thromboembolic risks, whose balance is particularly subtle due to the presence of concomitant conditions, such as atrial fibrillation and chronic kidney disease, that make the post-TAVR antithrombotic management particularly insidious. This scenario is further complicated by the lack of specific evidence regarding the ‘real-life’ complex conditions typical of the geriatric syndromes, thus, the management of such a heterogeneous population, ranging from healthy ageing to frailty, is far from being defined. The aim of the present review is to summarize the critical points and the most updated evidence regarding the post-TAVR antithrombotic approach in the geriatric population, with a specific focus on the most frequent clinical settings.
Long-term secondary cardiovascular prevention programme in patients subjected to coronary artery bypass surgery
Authors: Werba José Pablo , Bonomi Alice , Giroli Monica , Amato Manuela , Vigo Lorenzo , Agrifoglio Marco , Alamanni Francesco , Cavallotti Laura , Kassem Samer , Naliato Moreno , Parolari Alessandro , Penza Eleonora , Polvani Gianluca , Pompilio Giulio , Porqueddu Massimo , Roberto Maurizio , Salis Stefano , Zanobini Marco , Amato Mauro , Baldassarre Damiano , Veglia Fabrizio , Tremoli Elena 
Published: January 2021

Abstract

Aims
Patients with coronary heart disease (CHD) are at very high risk of recurrent events. A strategy to reduce excess risk might be to deliver structured secondary prevention programmes, but their efficacy has been mostly evaluated in the short term and in experimental settings. This is a retrospective case–control study aimed at assessing, in the real world, the efficacy of a secondary prevention programme in reducing long-term coronary event recurrences after coronary artery bypass surgery (CABG).

Methods and results
Programme participants (henceforth ‘cases’) were men and women aged &lt;75 years subjected to CABG between 2002 and 2014, living within 100 km of the hospital. Key programme actions included optimization of treatments according to the most updated European preventive guidelines, surveillance of therapy adherence, and customized lifestyle counselling. Controls were analogous patients not involved in the programme because living farther than 100 km away, matched 1:1 with cases for gender, age at CABG, and year of CABG. Both groups (n = 1248) underwent usual periodic cardiology follow-up at our centre. Data on symptomatic or silent CHD recurrences were obtained from the hospital electronic health records. Cox analysis (adjusted for baseline differences between groups) shows that programme participation was associated with a significantly lower incidence throughout 5 years post-CABG of symptomatic [hazard ratio (95% confidence interval): 0.59 (0.38–0.94)] and silent [0.53 (0.31–0.89)] coronary recurrences.

Conclusion
In a real-world setting, taking part in a structured longstanding secondary prevention programme, in addition to usual cardiology care, meaningfully lowers the risk of coronary recurrences.
Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction, and estimating benefits from novel interventions
Authors: Welsh Paul , Welsh Claire , Celis-Morales Carlos A , Brown Rosemary , Ho Frederick K , Ferguson Lyn D , Mark Patrick B , Lewsey James , Gray Stuart R , Lyall Donald M , Gill Jason M R , Pell Jill P , de Lemos James A , Willeit Peter , Sattar Naveed 
Published: January 2021

Abstract

Aims
To investigate the population attributable fraction due to elevated lipoprotein (a) (Lp(a)) and the utility of measuring Lp(a) in cardiovascular disease (CVD) risk prediction.

Methods and results
In 413 734 participants from UK Biobank, associations of serum Lp(a) with composite fatal/non-fatal CVD (n = 10 066 events), fatal CVD (n = 3247), coronary heart disease (CHD; n = 18 292), peripheral vascular disease (PVD; n = 2716), and aortic stenosis (n = 901) were compared using Cox models. Median Lp(a) was 19.7 nmol/L (interquartile interval 7.6–75.3 nmol/L). About 20.8% had Lp(a) values &gt;100 nmol/L; 9.2% had values &gt;175 nmol/L. After adjustment for classical risk factors, 1 SD increment in log Lp(a) was associated with a hazard ratio for fatal/non-fatal CVD of 1.12 [95% confidence interval (CI) 1.10–1.15]. Similar associations were observed with fatal CVD, CHD, PVD, and aortic stenosis. Adding Lp(a) to a prediction model containing traditional CVD risk factors in a primary prevention group improved the C-index by +0.0017 (95% CI 0.0008–0.0026). In the whole cohort, Lp(a) above 100 nmol/L was associated with a population attributable fraction (PAF) of 5.8% (95% CI 4.9–6.7%), and for Lp(a) above 175 nmol/L the PAF was 3.0% (2.4–3.6%). Assuming causality and an achieved Lp(a) reduction of 80%, an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above 175 nmol/L may reduce CVD risk by 20.0% and CHD by 24.4%. Similar benefits were also modelled in the whole cohort, regardless of baseline CVD.

Conclusion
Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs, if such drugs prove efficacious, to those with markedly elevated levels.
A computerized decision support system did not improve personalization of exercise-based cardiac rehabilitation according to latest recommendations
Authors: Vromen Tom , Peek Niels B , Abu-Hanna Ameen , Kornaat Marion , Kemps Hareld M 
Published: January 2021

Abstract

Aims
Recent studies showed that exercise-based cardiac rehabilitation (ECR) programmes are often not personalized to individual patient characteristics according to latest recommendations. This study investigates whether a computerized decision support (CDS) system based on latest recommendations and guidelines can improve personalization of ECR prescriptions. Pseudo-randomized intervention study.

Methods and results
Among participating Dutch cardiac rehabilitation centres, ECR programme characteristics of consecutive patients were recorded during 1 year. CDS was used during a randomly assigned 4-month period within this year. Primary outcome was concordance to latest recommendations in three phases (before, during, and after CDS) for 12 ECR programme characteristics. Secondary outcome was variation in training characteristics. We recruited ten Dutch CR centres and enrolled 2258 patients to the study. Overall concordance of ECR prescriptions was 59.9% in Phase 1, 62.1% in Phase 2 (P = 0.82), and 59.9% in Phase 3 (P = 0.56). Concordance varied from 0.0% to 99.9% for the 12 ECR characteristics. There was significant between-centre variation for most training characteristics in Phases 1 and 2. In Phase 3, there was only a significant variation for aerobic and resistance training intensity (P = 0.01), aerobic training volume (P &lt; 0.01), and the number of strengthening exercises but no longer for the other characteristics. Aerobic training volume was often below recommended (28.2%) and declined during the study.

Conclusion
CDS did not substantially improve concordance with ECR prescriptions. As aerobic training volume was often lower than recommended and reduced during the study, a lack of institutional resources might be an important barrier in personalizing ECR prescriptions.
Takeaway food, sugar-sweetened beverages and preclinical cardiometabolic phenotypes in children and adults
Authors: Saraf Shweta , Grobler Anneke , Liu Richard S , Liu Mengjiao , Wake Melissa , Olds Tim , Lycett Kate , Juonala Markus , Ranganathan Sarath , Burgner David , Kerr Jessica A 
Published: January 2021

AbstractAimsTo investigate relationships between takeaway food and sugar-sweetened beverage (SSB) consumption with cardiometabolic phenotypes during childhood and mid-adulthood.MethodDesign: Cross-sectional Child Health CheckPoint within the national population-representative Longitudinal Study of Australian Children. Participants: 1838 children (mean age 11.5 years; 49.1% female) and 1846 adults (mean age 43.7 years; 87.6% female). Exposures: Self-reported takeaway food and SSB consumption (‘frequent’: ≥ weekly). Outcomes: Functional (pulse wave velocity (PWV), blood pressure (BP)) and structural (carotid intima-media thickness, retinal microvascular calibre) preclinical cardiovascular phenotypes; lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides). Analysis: Linear regression (exposure: takeaway or SSB consumption, individually or together) adjusted for age, sex and socio-economic position; and mediation analysis for body mass index (BMI).ResultsAssociations were small among children (standardized mean difference (SMD) ≤0.15). In adults, associations were stronger with functional, but not structural, cardiovascular phenotypes and lipids, particularly for frequent takeaway food consumption (e.g. PWV (0.20 m/s; 95% confidence interval (CI) 0.03 to 0.37); systolic (3.3 mmHg; 95% CI 1.3 to 5.3) and diastolic BP (1.4 mmHg; 95% CI 0.2 to 2.6); LDL (0.10 mmol/L; 95% CI 0.02 to 0.18); HDL (−0.14 mmol/L; 95% CI −0.19 to −0.10) and triglycerides (0.30 mmol/L; 95% CI 0.12 to 0.48)]. BMI mediated associations between takeaway food consumption and PWV, BP, HDL and TG (proportion of mediation 34% to 75%), while mediation effects were smaller for SSB consumption.ConclusionsFrequent takeaway food consumption in adults was associated with adverse blood lipids and vascular function (mainly via BMI). Lack of strong associations in children highlights opportunities for prevention.
Sex-based approach for the clinical impact of polycythaemia on cardiovascular outcomes in the general population
Authors: Kim In-Soo , Lee Byoung Kwon , Yang Pil-Sung , Joung Boyoung , Kim Jong-Youn 
Published: January 2021

Abstract

Aims
Although the adverse cardiovascular effect of anaemia has been well described, the effect of polycythaemia on the cardiovascular outcomes of the general population remain unclear. The primary objective is to identify the association between polycythaemia and major adverse cardiovascular events (MACE), and the secondary objective is to identify the specific haemoglobin concentration more associated with an increased risk for MACE.

Methods and results
This was a retrospective cohort study, 451 107 subjects were enrolled who underwent national health examinations from the Korean National Sample Cohort. We estimated the risk of MACE, a composite of cardiovascular mortality, incident myocardial infarction (MI), and stroke according to haemoglobin-based four categories. During 3.8-year of follow-up, polycythaemia group showed higher MACE [hazard ratio (HR) = 1.27 (1.13–1.44) and HR = 1.76 (1.08–2.88); in men and women, respectively], incident MI [HR = 1.37 (1.05–1.79) and HR = 3.46 (1.06–14.00)], and incident ischaemic stroke [HR = 1.27 (1.10–1.46) and HR = 1.72 (1.02–2.91)] than normal haemoglobin group (P &lt; 0.001 in all cases). In the normal haemoglobin and polycythaemia groups, a 1 g/dL increase in haemoglobin level was associated with increased risks of MACE [HR = 1.04 (1.01–1.07) and HR = 1.05 (1.01–1.10) in men and women, each P &lt; 0.05]. To investigate the specific haemoglobin concentration related to greater MACE incidence, we analysed the sensitivity/specificity of different haemoglobin levels: ≥16.5 g/dL in men and ≥15.0 g/dL in women showed the highest Youden’s index (sensitivity + specificity − 1), with c-indices of 0.82 (0.81–0.83) and 0.83 (0.82–0.84), respectively.

Conclusion
Even in the Korean general population, polycythaemia was significantly associated with higher rates of MACE, incident MI, and incident ischaemic stroke. Especially, subjects with haemoglobin levels ≥15.0 g/dL in women and ≥16.5 g/dL among men were associated with increased risks of MACE.
Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring
Authors: Muchira James M , Gona Philimon N , Mogos Mulubrhan F , Stuart-Shor Eileen , Leveille Suzanne G , Piano Mariann R , Hayman Laura L 
Published: January 2021

Abstract

Background
Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring.

Methods and results
The study consisted of a total of 5967 offspring–mother–father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association’s CVH metrics attained at ideal levels: poor (0–2), intermediate (3–4), and ideal CVH (5–7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan–Meier plots, and Irwin’s restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring’s CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3–10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P &lt; 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50–2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories.

Conclusions
We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring’s CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.
Novel antidiabetic drugs and risk of cardiovascular events in patients without baseline metformin use: a meta-analysis
Authors: Masson Walter , Lavalle-Cobo Augusto , Lobo Martín , Masson Gerardo , Molinero Graciela 
Published: January 2021

AbstractAimsTo evaluate the effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on major cardiovascular events (MACE) in metformin-naïve patients with type 2 diabetes (T2D).Methods and resultsA meta-analysis was performed of randomized controlled clinical trials of GLP-1RAs and SGLT-2 inhibitors on T2D populations, after searching the PubMed/MEDLINE, Embase, and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoint, explored in the subgroup of SGLT-2 inhibitors studies, was cardiovascular death or hospitalization for heart failure. A random-effects meta-analysis model was applied. Six eligible trials (three studies of SGLT-2 inhibitors and three trials of GLP-1RAs), including 13 049 patients, were identified and considered eligible for the analyses. The new antidiabetic drugs were associated with a significant reduction in MACE [odds ratio (OR): 0.80, 95% confidence interval: 0.70–0.93; I2: 53%]. The subgroup analysis showed the following findings: GLP-1RAs group, OR: 0.77 (95% confidence interval 0.67–0.88); SGLT-2 inhibitors, OR: 0.85 (95% confidence interval 0.63–1.15). SGLT-2 inhibitors were associated with a significant reduction in hospitalization for heart failure or cardiovascular mortality incidence (OR: 0.67, 95% confidence interval: 0.47–0.95; I2: 78%).ConclusionIn this meta-analysis, new antidiabetic drugs reduced the incidence of MACE in metformin-naïve T2D patients. The beneficial effect was especially observed in the GLP-1RAs subgroup. The use of SGLT-2 inhibitors was associated with a reduction in cardiovascular death or hospitalization for heart failure. These results support the fact that metformin would not be indispensable to obtain positive cardiovascular effects when new antidiabetic drugs are administered.
Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era
Authors: Ambrosetti Marco , Abreu Ana , Cornelissen Veronique , Hansen Dominique , Iliou Marie Christine , Kemps Hareld , Pedretti Roberto Franco Enrico , Voller Heinz , Wilhelm Mathias , Piepoli Massimo Francesco , Beccaluva Chiara Giuseppina , Beckers Paul , Berger Thomas , Davos Costantinos H , Dendale Paul , Doehner Wolfram , Frederix Ines , Gaita Dan , Gevaert Andreas , Kouidi Evangelia , Kraenkel Nicolle , Laukkanen Jari , Maranta Francesco , Mazza Antonio , Mendes Miguel , Neunhaeuserer Daniel , Niebauer Josef , Pavy Bruno , Gil Carlos Peña , Rauch Bernhard , Sarzi Braga Simona , Simonenko Maria , Cohen-Solal Alain , Sommaruga Marinella , Venturini Elio , Vigorito Carlo 
Published: January 2021

AbstractThis Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from −5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 ‘for’ and 10 ‘against’ respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.
Cardiovascular effectiveness of human-based vs. exendin-based glucagon like peptide-1 receptor agonists: a retrospective study in patients with type 2 diabetes
Authors: Longato Enrico , Di Camillo Barbara , Sparacino Giovanni , Tramontan Lara , Avogaro Angelo , Fadini Gian Paolo 
Published: January 2021

Abstract

Aims
Glucagon like peptide-1 (GLP-1) receptor agonists (GLP-1RA) are effective to control type 2 diabetes (T2Ds) and can protect from adverse cardiovascular outcomes. GLP-1RA are based on the human GLP-1 or the exendin-4 sequence. We compared cardiovascular outcomes of patients with T2D who received human-based or exendin-based GLP-1RA in routine clinical practice.

Methods and results
We performed a retrospective study on the administrative database of T2D patients from the Veneto Region (North-East Italy). We identified patients who initiated a human-based or exendin-based GLP-1RA from 2011 to 2018. The primary outcome was occurrence of major adverse cardiovascular events (MACE). Secondary outcomes were individual MACE components, revascularization, hospitalization for heart failure, or for cardiovascular causes. From 330 193 patients with diabetes, 6620 were new users of GLP-1RA. After propensity score matching, we analysed 1098 patients in each group, who were on average 61 years old, 59.5% males, 13% with established cardiovascular disease, had an estimated diabetes duration of 8.4 years, and a baseline HbA1c of 7.9%. During a median follow-up of 18 months, patients treated with human-based GLP-1RA as compared to those treated with exendin-based GLP-1RA, showed lower rates of MACE [hazard ratio 0.61; 95% confidence interval (CI) 0.39–0.95], myocardial infarction (0.51; 95% CI 0.28–0.94), and hospitalization for cardiovascular causes (0.66; 95% CI 0.47–0.92).

Conclusion
We observed better cardiovascular outcomes among patients treated with human-based vs. exendin-based GLP-1RA under routine care. In the absence of comparative trials and in view of the limitations of retrospective studies, this finding provides a moderate level of evidence to guide clinical decision.