bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial reservoir strain in relation to metabolic and inflammatory biomarkers: a community-based study
Authors: Kuznetsova T , Cauwenberghs N , Sabovcik F , Haddad F 
Published: November 2020

Abstract

Background
The pathophysiological mechanisms that underlie progressive left atrium (LA) remodelling and dysfunction are only partially understood. Metabolic disturbances and chronic inflammation might mediate LA dysfunction. To date, population data investigating the contribution of these processes to LA reservoir dysfunction remain scarce.

Purpose
In a large population sample, we investigated the association between LA reservoir function and a panel of 38 metabolic and inflammatory biomarkers.

Methods
In 1236 community-dwelling individuals (mean age, 51.0 years; 51.5% women), we echocardiographically assessed LA reservoir strain (LARS) using 2D speckle-tracking analysis. LA reservoir dysfunction was defined as having LARS &lt;23%. We applied partial least squares-discriminant analysis (PLS-DA) to identify biomarkers associated with LA dysfunction. We further explored the associations between LARS and selected biomarkers that were the most influential in PLS-DA, while adjusting for important clinical correlates such as age, sex, body mass index (BMI), heart rate, systolic blood pressure (BP) and antihypertensive treatment. We applied stepwise regression to identify the clinical features and circulating biomarkers most valuable for prediction of abnormal LARS.

Results
The three latent factors constructed from the panel of 38 biomarkers during PLS-DA explained 16.9% of the variation between the normal and the impaired LA function group. The PLS-DA model discriminated between normal and abnormal LA reservoir strain with 79% accuracy (P&lt;0.0001). In PLS-DA, serum uric acid, serum insulin, γ-glutamyl transferase, interleukin-6, D-dimer and triglycerides were the top biomarkers responsible for class discrimination. On average, these top biomarkers were higher in the LA dysfunction group as compared to their normal counterparts (P&lt;0.0001 for all). In multivariable-adjusted continuous analyses, LARS decreased significantly with the level of serum insulin, serum uric acid and γ-glutamyl transferase (P≤0.0035 for all). Of the clinical correlates and the top biomarkers selected in PLS-DA, stepwise regression models highlighted age, BMI, systolic BP, serum insulin, serum uric acid and interleukin-6 as the main predictors of an impaired LA reservoir function (see figure). Conjointly, these clinical and biochemical features identified LA reservoir dysfunction with an overall accuracy of 85%.

Conclusions
Circulating markers of insulin resistance, hyperuricemia and chronic inflammation were independently associated with impaired LA reservoir function. These markers may help to further unravel the pathophysiological processes behind LA maladaptation and improve the management of early LA dysfunction in the community.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders
Role of lipoprotein(a) and its autoantibodies in polyvascular atherosclerotic disease
Authors: Tmoyan N , Afanasieva O , Ezhov M , Chubykina U , Klesareva E , Afanasieva M , Pokrovsky S 
Published: November 2020

Abstract

Background
Lipoprotein(a) [Lp(a)] is an independent risk factor of cardiovascular disease. The role of Lp(a) and its autoantibodies in the development of atherosclerosis, depending on the severity of lesion, is uncertain.

Purpose
To define the relationship of Lp(a) level and autoantibodies to Lp(a) with atherosclerosis of different vascular beds.

Methods
The study included 1288 patients older than 18 years with instrumental examination of three vascular beds (coronary, carotid and lower limbs arteries). Patients were divided according to the number of affected vascular beds (stenosis ≥50%): 0 (n=339), 1 (n=470), 2 (n=315), 3 (n=164). Levels of lipids, Lp(a) and autoantibodies to Lp(a) were measured in serum of all patients.

Results
Lp(a) concentration steadily increased and the level of IgM autoantibodies decreased with the number of affected vascular beds (Figure). There was no any association between IgG autoantibodies to Lp(a) and stenotic atherosclerosis. In logistic regression analysis adjusted for age, sex, hypertension, diabetes mellitus, smoking, elevated Lp(a) level was an independent predictor of stenotic atherosclerosis and it was associated with severity of lesions (table).

Conclusions
Lipoprotein(a) is an independent risk factor of stenotic atherosclerosis and its concentration increases with the number of affected vascular beds, while IgM autoantibodies to Lp(a) possess cardioprotective properties.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation
Impact of smoking status and smoking cessation after coronary revascularization on long-term clinical outcomes: from a nationwide population-based study
Authors: Ki Y.J , Han J.K , Lee H.S , Chang M.O , Kang J.H , Yang H.M , Park K.W , Kang H.J , Koo B.K , Kim H.S 
Published: November 2020

Abstract

Background
There are many studies on emphasizing the importance of quitting smoking, but the smoking status was based on baseline status without subsequent status. Since a significant percentage of patients who have received coronary revascularization change their smoking status, it is necessary to confirm the clinical consequences of smoking status after revascularization.

Purpose
In this study, we aimed to investigate the impact of smoking status after revascularization on long-term clinical outcomes, using large population based study from the Korean National Health Insurance System.

Methods
Among 74,004 patients who received coronary revascularization (PCI or CABG) from 1 January 2007 to 21 December 2013 and underwent regular health check-up within 2 years after index PCI, examined for death, MI, revascularization and stroke.

Results
Within patients who underwent revascularization, 33,800 (45.7%) of patients were self-reported non-smoker, 28,603 (38.7%) were ex-smoker, 11601 (15.6%) were current smokers at first regular health check-up after revascularization. Current smokers were associated with higher risks for death (HR: 1.497; 95% CI: 1.366–1.641), MI (HR: 1.498; 95% CI: 1.302–1.723) and revascularization (HR: 1.088; 95% CI: 1.018–1.164) than non-smokers. Compared with non-smokers, more than 30PY ex-smokers and current smokers showed higher incidence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of death, MI, revascularization and stroke. Regarding smoking tendency, maintaining non-smokers were lower risk for MACCE than maintaining smokers (Figure 1). Quitters tended to lower MACCE compared to patients who continued to smoke (HR: 0.823; 95% CI: 0.762–0.888). Especially, maintaining non-smokers and quitters significantly showed lower mortality than patients who continued to smoke.

Conclusion
Smoking is associated with poor clinical outcomes after coronary revascularization especially more than 30PY ex-smokers and current smokers. These results also emphasized that smoking cessation after revascularization also important for mortality benefit.
Figure 1

Funding Acknowledgement
Type of funding source: None
Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial
Authors: Wienbergen H , Fach A , Meyer S , Schmucker J , Osteresch R , Michel S , Retzlaff T , Steckenborn M , Elsaesser A , Langer H , Hambrecht R 
Published: November 2020

Abstract

Background
The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after &gt;24 months (“prevention boost”) is effective.

Methods
In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control.
In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention.

Results
At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p&lt;0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p&lt;0.05, Figure 1).
A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p&lt;0.05 between the groups, Figure 1).

Conclusions
IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after &gt;24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)
Individuals with familial hypercholesterolemia have increased risk of re-hospitalization after acute myocardial infarction compared with controls
Authors: Svendsen K , Krogh H.W , Igland J , Tell G.S , Mundal L.J , Holven K.B , Bogsrud M.P , Leren T , Retterstol K 
Published: November 2020

Abstract

Background and aim
We have previously reported that individuals with familial hypercholesterolemia (FH) have a two-fold increased risk of acute myocardial infarction (AMI) compared with the general population. The consequences of having an AMI on re-hospitalization and mortality are however less known. The aim of the present study was to compare the risk of re-hospitalization with AMI and CHD and risk of mortality after incident (first) AMI-hospitalization between persons with and without FH (controls).

Methods
The original study population comprised 5691 persons diagnosed with FH during 1992–2014 and 119511 age and sex matched controls randomly selected from the general Norwegian population. We identified 221 individuals with FH and 1947 controls with an incident AMI registered in the Norwegian Patient Registry (NPR) or the Cardiovascular Disease in Norway Project during 2001–2017. Persons with incident AMI were followed until December 31st 2017 for re-hospitalization with AMI or coronary heart disease (CHD) registered in the NPR, and for mortality through linkage to the Norwegian Cause of Death Registry. Risk of re-hospitalization was compared with sub-hazard ratios (SHR) from competing risk regression with death as competing event, and mortality was compared using hazard ratios (HR) from Cox regression. All models were adjusted for age.

Results
Risk of re-hospitalization was 2-fold increased both for AMI [SHR=2.53 (95% CI: 1.88–3.41)] and CHD [SHR=1.82 (95% CI: 1.44–2.28)]. However, persons with FH did not have increased 28-day mortality following an incident AMI (HR=1.05 (95% CI: 0.62–1.78), but the longer-term (&gt;28 days) mortality after first AMI was increased in FH [HR=1.45 (95% CI: 1.07–1.95].

Conclusion
This study yields the important finding that persons with FH have increased risk of re-hospitalization of both AMI and CHD after incident AMI. These findings call for more intensive follow-up of individuals with FH after an AMI.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): University of Oslo and Oslo University Hospital
Successful lifestyle modification in older patients with coronary artery disease: results from the RESPONSE-2 trial
Authors: Jepma P , Jorstad H.T , Snaterse M , Ter Riet G , Kragten J.A , Lachman S , Minneboo M , Boekholdt S.M , Peters R.J.G , Scholte Op Reimer W.J.M 
Published: November 2020

Abstract

Introduction
Interventions to reduce lifestyle-related risk factors (LRFs) such as overweight, physical inactivity and smoking are effective in the secondary prevention of cardiovascular events. However, evidence of the effects of lifestyle-related secondary prevention programmes in older patients with coronary artery disease (CAD) is less conclusive than in younger patients.

Purpose
To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (&lt;65 years) patients with CAD in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial.

Methods
The RESPONSE-2 trial was a community-based lifestyle intervention trial (N=824) comparing nurse-coordinated referral to a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to care as usual. The primary outcome was the proportion of patients with improvement at 12 months follow-up (N=711) in at least 1 LRF (without deterioration in the other LRFs). In the current analysis, we assessed if the overall beneficial treatment effect of the RESPONSE-2 intervention varied by age.

Results
At baseline, older patients (n=245, 69.2±3.9) had significantly more serious cardiovascular risk profiles and comorbidities (hypertension, diabetes mellitus and peripheral artery disease) than younger patients (n=579, 53.7±3.9). The overall treatment effect did not vary by age (OR overall 1.67, 95% CI 1.22 - 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77–11.26 vs. OR young 1.57, 95% CI 0.98 - 2.49, P interaction=0.003) and younger patients were more likely to show non-improved individual LRFs (OR old 0.38, 95% CI 0.22–0.67 vs. OR young 0.88, 95% CI 0.61–1.26, P interaction=0.01).

Conclusion
Despite more serious cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to community-based lifestyle interventions was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.
LRFs at 12 months follow-up

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The RESPONSE-2 trial was sponsored by Weight Watchers International, Inc. (New York, New York) and Philips Consumer Lifestyle (the Netherlands). This work was also supported by the Netherlands Organisation for Scientific Research (NWO) to PJ.
Effect of caloric restriction and statins on the process of cholesterol transfer to HDL in women with premature CAD
Authors: Leal D.P , Tavoni T.M , Kawabara K.L , Faria N.F.O , Nascimento J.R.O , Cesar L.A.M , Strunz C.M.C , Mansur A.D.P 
Published: November 2020

Abstract

Introduction
Transfer of cholesterol to HDL from the other lipoprotein classes has an important role in HDL metabolism and function. Patients with premature CAD showed reduced rates of cholesterol transfer, which was not dependent on HDL-cholesterol levels. The effects of statin treatment and caloric restriction on anti-atherogenic properties of HDL, which are critical issues in CAD prevention, have been scarcely described.

Purpose
To evaluate the effect of caloric restriction associated or not with statin use on the transfer of cholesterol to HDL.

Methods
This randomized study analyzed the functionality of HDL in 26 women, aged ≤55 years, with CAD diagnosed angiographically. Patients were allocated in two groups: caloric restriction (CR) group (n=13) characterized by a diet that reduced 30% of their usual daily caloric intake, and CR plus atorvastatin (CR+A) group (n=13) characterized by the addition of 80 mg of atorvastatin daily to the CR diet. Blood samples were collected before and 60 days after starting interventions for analysis of lipid profile that included apoA-I and B, and to evaluate the anti-atherogenic functionality of HDL by the cholesterol transfer to HDL assay performed in vitro, using artificial donor lipid nanoparticles resembling lipoproteins labeled with radioactive lipids and incubated with total plasma.

Results
Body mass index reduced in both groups (p&lt;0.01). In the CR group, we observed a tendency of reduction of total cholesterol from 229±55 to 207±59 mg/dL (p=0.07), LDL-C from 143±40 to 129±49 mg/dL (p=0.07) and HDL-C 56±13 to 53±14 mg/dL (p=0.07). Apo B and apo A-I reduced, respectively, from 1.20±0.35 to 1.05±0.36 g/L (p=0.01) and 1.59±0.32 to 1.43±0.28 g/L (p=0.01). In the CR+A group, we observed reduction of total cholesterol from 253±97 to 169±47 mg/dL (p&lt;0.01), LDL-C from 147±57 to 97±39 mg/dL (p&lt;0.01), and apo B from 1.26±0.39 to 0.85±0.22 g/L (p&lt;0.01). HDL-C and apo A-I did not change. In CR group, the transfers of unesterified and esterified cholesterol to HDL did not change. In CR+A group, the percentage of transfer of unesterified cholesterol to HDL increased by almost 10%, from 3.4±0.6% to 3.7±0.7% (p=0.03), but no change in esterified cholesterol transfer.

Conclusion
CR and atorvastatin treatment was not only beneficial because of LDL-C lowering but also by increasing the transfer of unesterified cholesterol to the HDL fraction, an independent anti-atherogenic mechanism, that may be important in the treatment of women with premature CAD.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001
Risk for recurrent cardiovascular events and expected risk reduction with optimal treatment one year after an acute coronary syndrome
Authors: Zafeiropoulos S , Farmakis I.T , Kartas A , Arvanitaki A , Pagiantza A , Boulmpou A , Tampaki A , Kosmidis D , Nevras V , Markidis E , Papadimitriou I , Arvanitakis K , Ziakas A , Karvounis H , Giannakoulas G 
Published: November 2020

Abstract

Background
According to the latest ESC Guidelines for chronic coronary syndromes (CCS), patients who suffered an acute coronary syndrome (ACS) pass to a chronic stable phase after one year. In these patients the estimated 10-year risk for recurrent cardiovascular (CV) events varies considerably. We estimated this risk and the expected risk reduction after optimal control.

Methods
We applied the SMART risk score in 211 patients one year after an ACS to estimate the 10-year risk for recurrent CV events (subsequent non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death). We assessed the distribution of the estimated risk and the potential risk reduction that might be achieved with an optimal guideline-directed management of modifiable risk factors (systolic blood pressure, low-density lipoprotein cholesterol, smoking and body mass index).

Results
In our cohort, the median SMART score was 16% [interquartile range (IQR), 9.5–26]. If all modifiable risk factors met guideline-recommended targets, median SMART risk score would be 9.4% (IQR, 5.9–17.1), with 52% of the patients at a 10-year risk &lt;10%, while 10% and 11% at 20–30% and &gt;30% risk respectively. The total median reducible risk was 4.7% (IQR, 1.7–8.8).

Conclusions
The SMART score had a wide distribution among patients with CCS. Noteworthy, one out of five patients will remain at a &gt;20% 10-year risk, even with optimal risk factors management, clearly underlining that residual risk is an unmet clinical issue, which demands individualized patient care.
Baseline and total residual risk score

Funding Acknowledgement
Type of funding source: None
Guideline adherence is associated with long-term all-cause mortality in patients after an acute coronary syndrome
Authors: Farmakis I.T , Zafeiropoulos S , Pagiantza A , Boulmpou A , Arvanitaki A , Nevras V , Tampaki A , Markidis E , Papadimitriou I , Karvounis H , Giannakoulas G 
Published: November 2020

Abstract

Background/Introduction
Guideline-directed medical therapy (GDMT) remains the mainstay in the long-term management of patients after an acute coronary syndrome (ACS). Data on the association of adherence to GDMT with clinical outcomes are scarce.

Purpose
To assess the adherence to GDMT and its relation to all-cause mortality in a population of patients after an ACS.

Methods
In this post-hoc analysis of the prospective, randomised IDEAL-LDL trial (NCT02927808) we analyzed data of 360 ACS patients discharged from a cardiology clinic. Median follow-up period was 35.9 (IQR 25.7–41.6) months. GDMT was assessed at discharge and at the 1-year follow-up, at which time data was collected by telephone interviews or ambulant visits. GDMT was defined as compliance with secondary prevention therapies (statin, antiplatelet, b-blocker, angiotensin-converting enzyme inhibitor (ACE-i) or angiotensin II receptor blocker (ARB)), as per their respective indication in the 2017 STEMI and 2015 NSTE-ACS ESC Guidelines. Extended follow-up data for mortality was collected from the national health insurance electronic prescription system.

Results
Median age of the entire cohort was 60 (IQR-53–71) years, 18.6% were female and 55.6% suffered a STEMI. At discharge, 342 patients (95%) received statins, 331 (91.9%) proper antithrombotic therapy (86.4% on dual antiplatelet therapy (DAPT), 2.5% on antiplatelet plus anticoagulant and 3% on triple therapy), 309 (85.8%) β-blockers and 217 (60.3%) ACE-i or ARB. GDMT at discharge was prescribed to 272 (75.6%) patients. The 1-year mortality rate was 4.7% (IQR, 2.5–6.9) and there was no mortality benefit for GDMT (HR=0.77 95% CI 0.27 - 2.2) (Figure 1a). At the one-year follow up, 323 (94.2%) of 343 alive patients received statin treatment (72.4% of which a high-intensity statin), 330 (96.2%) any antithrombotic therapy (59.8% on DAPT, 5.2% on any anticoagulant), 263 (76.7%) a β-blocker and 194 (56.6%) an ACE-I or ARB. GDMT at one-year follow up was prescribed to 248 (72.3%) patients. Beyond one year, all-cause mortality was significantly reduced in patients receiving GDMT adjusted for age, STEMI, revascularization with percutaneous coronary angioplasty, history of diabetes mellitus and arterial hypertension. (1.6% vs 9.5%, aHR 0.3 95% CI 0.08 - 0.92) (Figure 1b).

Conclusions
Adherence to GDMT remains stable one year after an ACS. GDMT was associated with a significant decrease in long-term mortality, but not associated with one-year mortality.
Figure 1. GDMT at baseline, at 1 year and mortality

Funding Acknowledgement
Type of funding source: None