bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-month results from a prospective experience on CAS using C-GUARD stent system: the IRONGUARD-2 study
Authors: Sirignano P , Stabile E , Stabile E , Mansour W , Mansour W , Speziale F , Speziale F 
Published: November 2020

Abstract

Objectives
To evaluate 30-day safety and efficacy of dual layered mesh covered carotid stent systems (DLS) for carotid artery stenting (CAS) in the clinical practice.

Background
When compared to carotid endarterectomy CAS has been associated to an higher rate of post procedural neurologic events; these could be related to plaque's debris prolapsing through stent's mesh. Consequently, the need for increased plaque coverage has resulted in the development of DLS.

Methods
From January 2017 to June 2019 a physician-initiated, prospective, multispecialty, registry enrolled 733 consecutive patients undergoing CAS using the CGuard Embolic Prevention System (EPS) in 20 centres. Primary endpoint was the stroke up to 30 days; secondary endpoints were the technical and procedural success; external carotid artery (ECA) occlusion; in-hospital and 30 days transient ischemic attack (TIA), acute myocardial infarction (AMI) and death rates.

Results
Symptoms were present in 131 patients (17.87%). An embolic protection device (EPD) was used in 731 patients (99.72%). Procedural success was 100%, technical success was obtained in all but one patient (99.86%), who died in-hospital due to a haemorrhagic stroke. Six TIAs, 2 minor strokes, and 1 AMI occurred during in-hospital stay, ECA occlusion was evident in 8 patients (1.09%). Between hospital discharge and 30-day, 2 TIAs, 1 minor stroke and 3 AMIs occurred. Therefore, the stroke rate at 30 days was 0.13.

Conclusion
This real-world registry suggests that use of CGuard EPS in clinical practice is safe and associated to a minimal occurrence of adverse neurological events up to 30 days follow up.

Funding Acknowledgement
Type of funding source: None
Long-term antihypertensive treatment improves ventricular-arterial interaction in hypertensive patients: a 3-year follow-up study
Authors: Ikonomidis I , Tzortzis S , Triantafyllidi H , Thymis J , Frogoudaki A , Vrettou A.R , Iliodromitis E 
Published: November 2020

Abstract

Background
We investigated the effects of antihypertensive treatment on vascular function, longitudinal deformation and ventricular-arterial interaction in hypertensives.

Methods
In 200 untreated patients with arterial hypertension (age 52.5±11.6 years, 56% females), we measured at baseline and after a 3-year of antihypertensive treatment (160 received ACEi± diuretics and 40 CCBs± diuretics): a) 24h ambulatory blood pressure b) Carotid-femoral pulse wave velocity (PWV) b) Coronary flow reserve (CFR), LV mass index (LVMI), the global longitudinal strain (GLS). We calculated the ratio of PWV/GLS (-m/sec%) reflecting the ventricular-arterial interaction.

Results
Compared to baseline, there was an improvement of GLS (−19.9±3.4 vs. −18.7±3.1%), post-treatment. In parallel, there were improvement in CFR (2.72±0.61 vs. 2.55±0.64), PWV (10.3±1.9 vs. 11.2±2.1 m/s), LVMI and PWV/GLS (−0.539±0.146 vs. −0.618±0.178 -m/sec%) (p&lt;0.01 for all comparisons). By multivariate analysis, the reduction of 24h meanBP as well as PWV independently determined the respective improvement of GLS (b=0.478, b=0.248, respectively, p&lt;0.001). By ANOVA, the interaction term between changes of all the above parameters and antihypertensive treatment (ACE inhibitors vs calcium channel blockers) was not significant (p&gt;0.05).

Conclusions
Long-term optimal blood pressure control with ACE inhibitors and CCBs improves LV longitudinal deformation along with reduction of arterial stiffness, leading to improved ventricular-arterial interaction in hypertensives.

Funding Acknowledgement
Type of funding source: None
Association between comorbidities and blood pressure trajectories in patients with hypertension
Authors: Canoy D , Tran J , Norton R , Ayala Solares R , Conrad N , Nazarzadeh M , Raimondi F , Salimi-Khorshidi G , Rodgers A , Rahimi K 
Published: November 2020

Abstract

Background
Our knowledge of how to better manage elevated blood pressure in presence of comorbidities is limited; in part due to exclusion or underrepresentation of multimorbid patients from major clinical trials.

Purpose
To investigate the burden and types of comorbidities in patients with hypertension, to assess how such comorbidities and other variables affect blood pressure levels over time.

Methods
The study was conducted using linked electronic health records from the UK Clinical Practice Research Datalink study from its inception on 1 January 1985 to 30 September 2015. Using linked electronic health records, we compared systolic blood pressure levels among 295,487 patients with diagnosed hypertension by type and numbers of major comorbidities from at least 5 years before to up to 10 years after hypertension diagnosis. We used a multiple landmark cohort design in order to investigate associations prospectively with time-updated information that takes advantage of the dynamic nature of electronic health records.

Results
Time-updated multivariable linear regression analyses showed that the presence of more comorbidities was independently associated with lower blood pressure during follow-up. This negative association was not specific to particular types of comorbidities; although associations were stronger in those with pre-existing cardiovascular disease. Tracking patients backwards to years prior to hypertension diagnosis revealed that the association between comorbidities and blood pressure were even more pronounced in years before hypertension diagnosis. Despite substantial declines in blood pressure in the first year after diagnosis, subsequent changes were modest, with no evidence of a more rapid decline in those with more or specific types of comorbidities.

Conclusions
Blood pressure levels at which patients were diagnosed with hypertension varied substantially and were lower when patients had more comorbidities. This early selection bias was a key determinant of long-term differences in blood pressure by comorbidity status and provides an additional explanation for the lower blood pressure in multimorbid patients.
Mean SBP (mmHg) over time

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research Oxford Biomedical Research Centre, Rhodes Trust and Clarendon Fund
Exercise duration as apredictor ofcardiovascular disease in arterial hypertension. Data from a 6-year follow-up study
Authors: Leontsinis I , Kasiakogias A , Mantzouranis M , Fragoulis F , Andrikou I , Tzorovili E , Tatakis F , Karaminas N , Kouremeti M , Manta E , Zammanis I , Antoniou C , Tousoulis D , Tsioufis C 
Published: November 2020

Abstract

Background
Current hypertension guidelines necessitate an individualized cardiovascular risk assessment through a process that includes several parameters and remains challenging. Exercise capacity has been strongly associated with prognosis in cardiovascular disease and can be easily assessed by the exercise treadmill test (ETT).

Purpose
The aim of the present study was to investigate theprognostic role of exercise capacity for future cardiovascular events in a cohort of essential hypertensive subjects.

Methods
We followed up 1037 hypertensive adults (mean age 56 years, 53% males) with no previous history of cardiovascular disease, for a mean period of 6±3 years. During the baseline visit all subjects underwent a complete echocardiographic study, office blood pressure measurements, ECG, routine blood testing and an ETT with a Bruce protocol.During follow-up, all subjects were reviewed at least annually. Exercise capacity was expressedwithexercise duration the distribution of which was split by the median (9min). Accordingly, the subjects were classified into those with high (51%) and low exercise capacity (49%). The cardiovascular endpoint of interest was the composite of coronary artery disease and stroke.

Results
The incidence of cardiovascular eventsduring the follow-up period was 4.1% (35 cases of coronary artery disease and 10 cases of stroke).Cox regression analysis revealed that high exercise capacity was associated with a lower risk for future cardiovascular events (HR = 0.35 (95% CI 0.172–0.741, p=0.006). In multivariate models adjusting for standard clinical and laboratory cardiovascular risk factors this association was sustained.

Conclusion
Exercise duration shows a significant prognostic value for future CV events among hypertensivepatients. Exercise capacity assessment by means of TTE could enhance the identification of asymptomatic hypertensives at higher risk.

Funding Acknowledgement
Type of funding source: None
Heart failure events in a clinical trial of arterial hypertension. The acquittal of the SPRINT trial
Authors: Sobieraj P , Kahan T , Nilsson P.M 
Published: November 2020

Abstract

Introduction
The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial showing that intensive lowering of systolic blood pressure (BP), as compared to standard treatment (i.e. &lt;120 vs &lt;140 mm Hg) was associated with a reduced risk (HR 0.75 [95% CI 0.64–0.79], p&lt;0.001) for the primary composite outcome (CE), defined as myocardial infarction, an acute coronary syndrome other than myocardial infarction, stroke, acute exacerbation of heart failure and cardiovascular death. primary outcome event in subjects at high cardiovascular risk. However, the primary endpoint events in the intensive treatment arm were only 76 fewer than in the standard treatment arm (243 vs 319 events), and he reduction in heart failure events was responsible for half of the effect (62 vs 100 events, i.e. 38 events fewer). Thus, several experts in hypertension argued that these results were mainly driven by a reduction of heart failure events, and questioned the main conclusion of the study.

Aim
To assess the effect of SPRINT intervention on a redefined CE: the primary SPRINT endpoint with HF events excluded.

Material and methods
We used limited SPRINT data, available from the NHLBI Biologic Specimen and Data Repository to assess the impact of BP intervention in SPRINT on a redefined CE excluding HF events. The Chi-square test, Cox proportional model and survival analysis were applied.

Results
Among 9361 SPRINT participants (mean age 67.9±9.5 years, 35.6% female, 20% with previous cardiovascular disease), there was 461 CE events. There were fewer CE events in the intensive treatment arm than in the standard treatment arm (204 [4.4%] vs 257 [5.5%], p=0.0117, respectively). Intensive systolic BP lowering was associated with lower risk for CE than standard treatment (HR 0.79 [95% CI 0.66–0.95], p=0.0115). Kaplan-Meier curves show that intensive treatment was associated with better outcome (Figure 1). Analyses in subgroups (age &gt;75 vs &lt;75 years, female vs male, black vs non-black, prior cardiovascular disease vs no cardiovascular disease, prior chronic kidney disease vs no chronic kidney disease) showed no difference in benefit of intensive treatment (p for interaction &gt;0.05 in all subgroup).

Conclusion
The reduction in cardiovascular events by intensive BP lowering in SPRINT was not explained by a difference in heart failure events. This supports the concept that more intensive BP reduction may provide benefit in reducing cardiovascular event risk.
Figure 1. Kaplan-Meier curves

Funding Acknowledgement
Type of funding source: None
Potential benefits of antihypertensive therapy in NAFLD: results from an experimental model
Authors: Soares Sturzeneker M.C , Precoma D.B , Noronha L , Olandoski M , Broday G.A , Scheidt B.J , Oliveira P.G.M , Viechineski F.N , Koscianski A.M 
Published: November 2020

Abstract

Background and introduction
Non-alcoholic fatty liver disease (NAFLD) is considered as the most frequent cause of chronic hepatic disease in adults. It is strictly correlated with insulin resistance. The renin-angiotensin system (RAS) has been correlated to the whole basic physiopathogenic mechanism of NAFLD in experimental models. Systemic arterial hypertension has been suggested to be associated with NAFLD in approximately 40% of the cases, and NAFLD has been independently associated with an increased risk of arterial hypertension in observational studies. Therefore, we can infer that treating arterial hypertension in NAFLD carriers will often be necessary and that the potential beneficial effects of the antihypertensive might, in this context, influence the choice of the respective drug.

Purpose
We aimed to evaluate the effects of the renin-angiotensin system blockade with angiotensin-converting enzyme inhibitor ramipril and angiotensin 2 type 1 receptor antagonist olmesartan, both used preventively, in NAFLD induced in rabbits fed a hypercholesterolemic diet and compared the results between the groups.

Methods
Forty-one rabbits were divided into four groups (normal, control, olmesartan and ramipril). The control, olmesartan and ramipril group were fed a hypercholesterolemic diet. Animals from olmesartan group were treated with olmesartan 1mg/kg/day and animals from ramipril group with ramipril 0.35 mg/kg/day. At the end of the 8th week, all rabbits underwent segmental hepatic resection and were euthanised. Blood samples were collected to determine glucose, creatinine, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and aminotransferase levels at baseline and euthanasia. Haematoxylin and eosin and Gomori trichrome stained slides were analysed based on the histological scoring system for NAFLD.

Results
The comparison between two groups (olmesartan with placebo and ramipril with placebo) showed that olmesartan and ramipril significantly diminished the development of steatosis (p=0.015, p=0.032), lobular inflammation (p&lt;0.001, p=0.006), hepatocellular ballooning (p&lt;0.001, p=0.023) and fibrosis (p=0.001, p=0.02). Based on NAFLD activity score, olmesartan and ramipril significantly reduced the development of nonalcoholic steatohepatitis (p&lt;0.001, p=0.003). The comparison between olmesartan and ramipril showed that results were similar in all histological parameters evaluated (p=1, p=0.454, p=0.454, p=0.195, p=0.078).

Conclusion(s)
The preventive use of olmesartan and ramipril attenuates similarly, the development of hepatic steatosis, lobular inflammation, hepatocellular ballooning and fibrosis in hypercholesterolemic rabbits and based on NAFLD activity score both significantly reduced the development of nonalcoholic steatohepatitis.

Funding Acknowledgement
Type of funding source: None
Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients: findings from the ESC-EORP EUROASPIRE V survey
Authors: Van De Luitgaarden I , Schrieks I , De Bacquer D , Van Oort S , Mirrakhimov E , Pogosova N , Davletov K , Dolzhenko M , Van Ballegooijen A , Kotseva K , Grobbee D , Beulens J 
Published: November 2020

Abstract

Introduction
Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant.

Purpose
To describe patterns of alcohol consumption across different European regions and adherence to the current drinking guidelines in coronary patients with a recent CHD.

Methods
The EUROASPIRE V survey has been conducted in 2016–2017 at 131 centers in 27 European countries in 9,018 patients with a recent CHD. Median alcohol consumption, as well as the proportions abstainers and excessive drinkers (i.e. &gt;70 grams of alcohol per week for women and &gt;140 grams per week for men, as recommended by the European guidelines on cardiovascular prevention), were calculated for each European region (Eastern, Southern, Northern and Western Europe). To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption, as well as the participants who were incorrectly not advised were calculated per European region.

Results
Mean age was 64 years (sd=9.5), 75% was male. Abstention rates were 51% in males and 74% in females, whereas excessive drinking was reported by 10% of the males (highest in Western Europe (18%) and lowest in Eastern Europe (5%)) and 6% of the females (also highest in Western Europe (12%) and lowest in Eastern Europe (1.4%)). Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% was incorrectly not advised (Figure 1), but this percentage differed by region with 9% in Western Europe as compared to 1% in Eastern Europe. In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption.

Conclusion
In this EUROASPIRE V survey the majority of patients with a recent CHD adhere to the current drinking guidelines and only a fraction of the population was incorrectly not advised to reduce consumption. However, substantial heterogeneity exists between European regions.
Figure 1. Distribution of advice given per region

Funding Acknowledgement
Type of funding source: None
Early growth and carotid intima-media thickness at midlife: Northern Finland 1966 Birth Cohort study
Authors: Korpela N , Kaikkonen K , Auvinen J , Tulppo M.P , Junttila J , Perkiomaki J , Jarvelin M.R , Huikuri H.V , Kiviniemi A.M 
Published: November 2020

Abstract

Background
Carotid intima-media thickness (CIMT) reflects atherogenesis and is a strong predictor of cardiovascular diseases. Although cardiovascular diseases have been shown to originate in foetal life and childhood, the information on the contribution of early growth to CIMT in adulthood remains limited.

Purpose
To assess the influence of early growth patterns on CIMT in midlife.

Methods
A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including CIMT evaluation by ultrasound (n=1155) at the age of 46 years. Maternal pre-pregnancy body mass index (BMI) was self-reported and birth weight and gestational age were measured after delivery. BMI growth curves were modelled based on frequent anthropometric measurements in infancy and childhood. Peak weight and height velocity in infancy (0–2 years of age, n=637) as well as age and BMI at adiposity peak (AP, mean age 9 months, n=461) and at adiposity rebound (AR, mean age 5.8 years, n=562) were established. Results are reported as unstandardized beta (β) with 95% confidence intervals for one standard deviation increase in early growth variable. Associations were adjusted for sex, birth weight, maternal pre-pregnancy BMI as well as adult weight, height, systolic blood pressure, low-density lipoprotein cholesterol, physical activity, diabetes, heart diseases and antihypertensive medication.

Results
Infant peak weight velocity (β=0.018 (0.011, 0.025), p&lt;0.001) was associated with a higher CIMT in midlife, independently of adjustments for sex, early life factors and adult cardiometabolic factors (β=0.011 (0.003, 0.019), p=0.010). Infant peak height velocity was also associated with adult CIMT, but only in females (β=0.012 (0.004, 0.021), p=0.004) and the association was attenuated after adjustments (β=0.010 (0.0, 0.021), p=0.055). Birth weight and gestational age were not associated with adult CIMT. BMI at AP (β=0.011 (0.003, 0.019), p=0.007) and BMI at AR (β=0.010 (0.003, 0.018), p=0.005) were directly associated with CIMT in midlife in univariate analysis, but not independently of adult cardiometabolic factors. Timing of AP and AR were not related to adult CIMT. Finally, maternal pre-pregnancy BMI (β=0.005 (0.0, 0.011), p=0.066) also tended to be associated with a higher CIMT in midlife.

Conclusions
Rapid growth in infancy was the most important early growth-related factor associating with CIMT in midlife, and this relationship was not fully mediated by adult anthropometrics, cardiometabolic risk factors and morbidity.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Yrjö Jahnsson Foundation, Aarne Koskelo Foundation
Characteristics of patients with at least one lipoprotein(a) [Lp(a)] assessment and those with Lp(a) levels equal to or greater than 70 mg/dL: a real-world study in the US
Authors: Laguna A , Lahoz R , Fonseca A.F , Amari D.T , Ferber P , Heo J.H , Ding Y , Studer R 
Published: November 2020

Abstract

Background and purpose
Elevated lipoprotein(a) [Lp(a)] has been associated with increased risk of cardiovascular disease (CVD). The objective of this real-world study was to characterize the patients in the United States (US) that have an Lp(a) assessment and those with Lp(a) levels ≥70 mg/dL.

Methods
This is a descriptive, non-interventional, retrospective cohort study of patients with at least one Lp(a) assessment and one-year continuous enrollment prior to index date (first Lp(a) assessment in the identification period i.e. 1/1/2008–30/6/2019) using the Optum® de-identified Electronic Health Record (EHR) dataset (2007–2019) in the US. Optum's longitudinal EHR repository include more than 700 Hospitals and 7000 Clinics; treating more than 95 million patients receiving care in the US.

Results
26,997 patients (50.8% females) with ≥1 Lp(a) assessment having a mean (SD) age of 52.6 (14.1) years were evaluated. Patient distribution across Lp(a) levels ≥30, ≥50, ≥70, and ≥90 mg/dL were 32.4%, 20.2%, 12.3%, and 6.6%, respectively. Patients with Lp(a) ≥70 mg/dL (N=3,314) had a mean (SD) age of 54.7 (13.2) years and 55.2% were female. The overall population that gets tested for Lp(a) and the subgroup of patients with Lp(a) ≥70 mg/dL had prior myocardial infarction (4.8% and 6.2%), prior ischemic stroke (2.2% and 2.5%), peripheral artery disease (6.7% and 8.4%), dyslipidaemia (72.6% and 80.9%), hypertension (53.0% and 60.9%), diabetes mellitus (23.5% and 26.8%) and chronic ischemic heart disease (19.6% and 24.6%) at index. The use of baseline medications included statins (37.3% and 49.1%), ACEi/ARBs (28.2% and 34.0%) and beta-blockers (19.0% and 23.6%) for the overall population and those patients with Lp(a) ≥70 mg/dL, respectively.
The mean (SD) low-density lipoprotein cholesterol, triglycerides and total cholesterol levels were 109.8 (39.8) mg/dL [n=7,371], 138.3 (119.3) mg/dL [n=8,179] and 190.5 (46.8) mg/dL [n=8,181], respectively for overall population and 114.8 (41.5) mg/dL [n=980], 129.6 (80.5) mg/dL [n=1,063] and 195.9 (47.6) mg/dL [n=1,056] for patients with Lp(a) ≥70 mg/dL.

Conclusions
Of patients with an Lp(a) assessment in the US, more than 10% had Lp(a) levels ≥70 mg/dL. These patients were frequently diagnosed with dyslipidaemia and when reported showed elevated LDL-C and total cholesterol values. Further analyses are required to better understand any differences in patient characteristics and treatment of patients across Lp(a) levels.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG