bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bilateral sphenopalatine ganglion block reduces blood pressure and blood pressure variability in never treated patients with essential hypertension
Authors: Triantafyllidi H , Arvaniti C , Benas D , Schoinas A , Voutsinos D , Ikonomidis I , Lekakis J 
Published: November 2020

Abstract

Background
Sphenopalatine ganglion (SPG) area is connected through sympathetic fibers with the central nervous system. It is already known that SPG infiltration by lidocaine reduced blood pressure in naïve hypertensive patients. Blood pressure variability (BPV) has been associated with an increased risk of cardiovascular events and mortality, independently of elevated BP levels. We aimed to study the effect of SPG block in BPV in never treated patients with stage I–II essential hypertension.

Methods
We performed bilateral SPG block with lidocaine 2% in 47 newly diagnosed and never treated hypertensive patients (study group, mean age 50±12 years, 31 men) and a sham operation with water for injection in 11 patients (control group, mean age 51±12 years, 8 men). All patients have been subjected to 24 hour ambulatory blood pressure monitoring (ABPM) prior and a month after the SPG block in order to estimate any differences in BP parameters derived from ABPM (BP, BPV). We defined as responders to SBG block those patients with a 24h average SBP decrease &gt;5 mmHg.

Results
We noticed the following significant differences in the study group: a. 24h average DBP and daytime DBP were reduced by 1.6±5 mmHg (p=0.04) and 1.9±5 mmHg (p=0.01) respectively and b. systolic BPV during daytime (11±2 mmHg vs. 10±2 mmHg, p&lt;0.05). Interestingly, in the responders group (14/47, 30%, 9 men, age = 47±8 mmHg) and a month after SPG block we noticed that: a. 24h average, daytime, night-time SBP and 24h average, daytime, night-time DBP were reduced by 9±4 mmHg (p&lt;0.001), 9±3 mmHg (p&lt;0.001), 7±7 mmHg (p=0.002) and 6.5±3 mmHg (p&lt;0.001), 6.5±3 mmHg (p&lt;0.001), 4±7 mmHg (p=0.02), respectively and b. systolic BPV during daytime (13±2 mmHg vs. 9±2 mmHg, p=0.01). No differences regarding BPV were found in the non-responders and the sham operation group.

Conclusions
SPG block is a promising, minimally invasive option of significant BP and BPV decrease in never treated hypertensive patients, especially during daytime activities when SNS is activated. It acts probably through SNS modulation. Since its effect is only anesthetic and non-permanent, SPG block might permit the selection of the hypertensive patients with an activated SNS before any other invasive antihypertensive procedure.
SPG block reduces BP variability

Funding Acknowledgement
Type of funding source: None
First-in-man experience with ultrasound renal denervation for treatment of recurrent ventricular arrhythmias
Authors: Millenaar D.N , Mahfoud F , Pavlicek V , Lauder L , Boehm M , Ukena C 
Published: November 2020

Abstract

Background/Introduction
Ventricular arrhythmias (VA) are common in patients with chronic heart failure (CHF) and can be refractory to drugs and catheter ablation. Promising results of sympathomodulatory treatment have been reported in these patients.

Purpose
This first in man study aims at investigating catheter-based renal denervation (RDN) using ultrasound energy for treatment of refractory VA in patients with CHF.

Methods
Four patients (age 65±10 years, all male, left ventricular ejection fraction 36±7%, global longitudinal strain (GLS) −10±3%) with CHF (n=1 ischemic cardiomyopathy, n=3 non-ischemic cardiomyopathy) and refractory VA were treated with RDN using ultrasound energy. All patients had undergone endo- or epicardial catheter ablation for recurrent ventricular tachycardia (VT) or fibrillation (VF) in the past and were on at least 2 antiarrhythmic drugs. Computer tomography angiography was performed at baseline, duplex ultrasound of renal arteries, ambulatory blood pressure monitoring (ABPM) and ICD interrogations were performed before, 1 day and 3 months post RDN.

Results
Bilateral RDN using an ultrasound-based catheter were performed with at least 2 sonications in each main branch of the left and right renal artery. In this analysis, mean follow-up time was 113±12 days. All RDN procedures were performed without any complications. No renal artery stenoses during follow-up. Arrhythmic burden (measured as VT/VF episodes) within 3 months before RDN requiring ICD therapy was reduced from 3 [1.5–54.5] episodes of anti-tachycardia pacing (ATP) and 0.5 [0–1.25] adequate ICD shocks to 1 [0.75–1] episode of ATP. There were no adequate ICD shocks after 3 months. Mean 24-hour ABP before RDN was 94±8/65±9 mmHg with no change in BP following 3 months (SBP 92±1 mmHg, DBP 62±6 mmHg after 3 months). There was no change in left ventricular GLS (−10±3% before, −9±4% after RDN) or ejection fraction (36±7% before and after RDN).

Conclusions
RDN using ultrasound energy in patients with CHF and refractory VA was safely performed with no changes in blood pressure and reduced the arrhythmic burden after 3 months follow-up.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ReCor Medical Inc.
Superior hypertension control with betablockade in the European Sleep Apnea Database
Authors: Svedmyr S , Hedner J , Zou D , Parati G , Ryan S , Hein H , Pepin J.L , Tkacova R , Marrone O , Schiza S , Basoglu O.K , Grote L 
Published: November 2020

Abstract

Background
Arterial hypertension is highly prevalent and frequently difficult to control in patients with obstructive sleep apnea (OSA). High sympathetic activity is a hallmark physiological phenomenon in OSA. We hypothesized that antihypertensive drugs with sympathetic inhibitory properties, in particular beta blockers (BB), may be particularly efficacious in OSA patients.

Methods
Hypertensive OSA patients receiving blood pressure lowing treatment in the European Sleep Apnea Database (ESADA) were analyzed (n=5818, 69% men, age 58±11 years, body mass index 33±7 kg/m2, apnea hypopnea index 34±26 events/h). Antihypertensive medications (BB, diuretic, renin-angiotensin blocker [RAB], calcium channel blocker [CCB], and centrally acting antihypertensive [CAH]) were classified according to ATC code. Office blood pressure was compared in patients with mono- or combination therapy controlling for confounders.

Results
Poorly controlled systolic blood pressure according to the ESC/ESH guidelines was found in 66% of patients. Patients receiving monotherapy with RAB, CCB or CAH had 2.2 [95% CI, 1.4–3.0], 3.0 [1.9–4.1] and 3.0 [1.7–4.7] mmHg higher systolic blood pressure compared with those on BB (adjusted model, p=0.007, 0.008 and 0.017, respectively). In those with a combination of two antihypertensive drugs, systolic blood pressure was 3.3 [2.4–4.3], 2.2 [1.3–4.3] and 2.3 [1.4–3.3] mmHg higher in those on CCB/RAB, diuretic/RAB or BB/RAB compared with those on BB/diuretic (adjusted model, p&lt;0.001, 0.019 and 0.001, respectively).

Conclusions
Uncontrolled blood pressure was common in OSA patients with antihypertensive medication. Patients treated with BB alone or in combination with diuretic was associated with a lower systolic pressure in this large clinical cohort.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Respiratory Society funded Clinical Research Collaboration (2015-2020)
Effect of advancing age on dietary salt intakes: a 10-year follow-up study
Authors: Takase H , Machii M , Nonaka D , Ohno K , Takayama S , Sugiura T , Ohte N , Dohi Y 
Published: November 2020

Abstract

Background/Introduction
The National Nutrition Survey in Japan indicated that dietary salt intake of the Japanese is gradually decreasing for the last several decades, while salt intakes are higher in elderly than young people. There is no survey on the alteration of salt intakes with advancing age in individuals.

Purpose
The present study investigated effects of aging on salt intakes in individuals.

Methods
A total of 2600 subjects (men; 1787, age; 30 to 79 years-old at 2008) who participated in our physical check-up program both in 2008 and 2018 were enrolled. Individual dietary salt intakes in 2008 and 2018, which were estimated using a spot urine by a previously reported method, were compared.

Results
The mean age and salt intakes at 2008 were 53.9±10.0 years and 12.2±3.2 g/day in men and 54.4±9.2 years and 8.3±2.1 g/day in women, respectively. Salt intake increased to 13.2±3.3 g/day in men and 8.8±2.2 g/day in women during the 10 years. Salt intakes were higher in hypertensive than normotensive subjects both at 2008 and 2018, but changes of blood pressure category were not associated with those of salt intakes during the 10 years (table). Changes in salt intakes in each decade are shown in Figure. Salt intakes in each decade increased with advancing age both in men and women until their 70s. Salt intakes in people in their 60s and 70s at 2018 were higher than those at 2008. Similar results were obtained in subjects without any anti-hypertensive medications (n=1667) (data not shown).

Conclusions
The observational follow-up study revealed that salt intakes in each individual increased after the interval of 10 years in both men and women. The results suggest that the sense of taste changes with advancing age in young adults as well as elderly persons, which may be related with alterations of lifestyle.
Age difference in changes of salt intake

Funding Acknowledgement
Type of funding source: None
Role of colchicine in stroke prevention: an updated meta-analysis
Authors: Lobo L.M , Masson G , Molinero G , Masson G , Lavalle Cobo A , Losada P , Benincasa F , Suarez F , Huerin M 
Published: November 2020

Abstract

Background
Colchicine is a microtubule inhibitor with anti-inflammatory proprieties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events.

Methods
A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from stroke, myocardial infarction, cardiovascular mortality and all-cause mortality, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A random-effects meta-analysis model was then applied.

Results
Nine eligible trials of colchicine therapy, involving a total of 6630 patients, were considered eligible for analysis (3359 subjects were allocated to receive colchicine while 3271 subjects were allocated to the respective control arms). The stroke incidence was lower in the colchicine group compared with placebo arm (OR, 0.33; 95% CI, 0.15–0.70; six studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality.

Conclusion
Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significantly reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease. The tolerability and benefits should be confirmed in ongoing clinical trials.
Forest Plot Primary endpoint

Funding Acknowledgement
Type of funding source: None
Additive prognostic value of vascular aging and coronary artery calcium for all-cause mortality in the Heinz Nixdorf Recall Study
Authors: Weber T , Wassertheurer S , Hametner B , Mayer C.C , Moebus S , Schramm S , Roggenbuck U , Lehmann N , Joeckel K.H , Erbel R 
Published: November 2020

Abstract

Background
Vascular aging, defined by aortic pulse wave velocity (aoPWV), as well as coronary artery calcium (CaC), are emerging risk predictors.

Purpose
To investigate the prognostic role of functional (vascular aging) and structural (CaC) arterial parameters in individuals without established cardiovascular disease.

Methods
We utilized our recently established population-based reference values for healthy (HVA), normal (NVA) and early (EVA) vascular aging in the poipulation-based Heinz Nixdorf Recall (HNR) study. HVA was the lowest, and EVA the highest age- and sex-specific decile of estimated aoPWV, derived from radial waveforms with a validated regression formula. CaC was measured with electron beam computed tomography (Agatston-score). The additive prognostic value of both parameters for all-cause mortality was tested, using Kaplan Meier curves and Cox Regression models. The latter included age, sex, diastolic blood pressure, cholesterol, and diabetes as covariates.

Results
We included 1805 participants (976 women), mean age was 68.2 years (range 55–85), mean blood pressure 129/76 mm Hg. 64.7% were hypertensives, 17.0% diabetics. The percentage of participants with CaC = 0 was 44.8, 40.6, amd 33.5 in HVA, NVA, and EVA, respectively. During a mean follow up of 4.7 years, 67 participants died. Mortality was 0% / 2.2%, 1.8% / 4.8%, 3.5% / 7.1% in participants with HVA: CaC 0 / &gt;0, NVA: CaC 0 / &gt;0, EVA: CAC 0 / &gt;0, respectively (p=0.003, log rank test) – Figure. In Cox regression analysis, vascular aging (HR for HVA: 0.18, CI 0.04–0.73, and HR for NVA: 0.48, CI 0.27–0.88; both compared to EVA), CaC, as well as age (directly related) and diastolic blood pressure (inversely related) were independently associated with all-cause mortality.

Conclusion
Aortic stiffness, expressed as vascular aging, as well as coronary artery calcium, provide additive and independent prognostic information regarding all-cause mortality in a middle-aged and elderly primary -prevention population.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heinz Nixdorf Foundation, German Ministry of Education and Science (BMBF)
Increased particle size of triglyceride remnant lipoproteins, but not their plasma concentration or lipid content, augment risk prediction of incident diabetes: prospective results from ELSA-Brasil
Authors: Carvalho L.S , Bensenor I.M , Lotufo P.A , Duncan B.B , Blaha M.J , Toth P.P , Jones S.R , Santos R.D , Sposito A.C 
Published: November 2020

Abstract

Importance
Predicting risk of Type 2 Diabetes Mellitus (T2DM) accurately allows allocation of resources to prevent its development. Fasting blood triglycerides are highly predictive for T2DM. Triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and inflammation. We hypothesized TRL-related factors could improve risk prediction for development of T2DM.

Methods
We included individuals aged 35–74 years from the ELSA-Brasil cohort who had HbA1c and an oral glucose tolerance test at baseline. Regression models were used to predict incident T2DM, starting with medical history, metabolic syndrome traits (age, sex, hypertension, waist circumference [WC], HbA1c, triglycerides) and hsCRP, adding TRL-related measurements, including plasma concentration, particle size, as well as cholesterol and triglyceride content. TRL features were measured by NMR spectroscopy. Discrimination was assessed with area under receiver operator curves (AUROCs).

Results
Among 4,466 individuals at-risk, there were 353 new cases of T2DM after 3.7 (SD=0.6) years follow-up. We derived an 8-variable model with AUROC 0.891 (95% CI: 0.870–0.913). Overall TRL-related markers did not improve predictive capacity for T2DM. However, TRL particle diameter (TRLZ) increased AUROC, particularly in individuals without glucose abnormalities at baseline (Hba1c &lt;5.7%). In this subgroup, AUROC increased from 0.761 (95% CI: 0.739–0.798 – Baseline-model) to 0.823 (95% CI: 0.783–0.862 – TRLZ model) (p-value=0.00006). Consistently, the net reclassification improvent (NRI) of the model with TRLZ improved by 10.27% (95% CI: 1.0–24.1, p=0.00041). In subjects with pre-diabetes at baseline, TRLZ is highly correlated with obesity, insulin resistance and inflammation (sum of z-scores for WC + HOMA-IR + hsPCR: R2=0.25), but this was less important in individuals with Hba1c &lt;5.7% (R2=0.15). Sensitivity analyzes confirmed the results with different inclusion criteria (pre-diabetes defined with TTGO only) and excluding patients diagnosed with DM2 incident based only on fasting blood glucose.

Conclusions
TRL particle diameter improves prediction of T2DM, particularly in subjects with no glycemic abnormalities at baseline.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Brazilian Ministry of Health (Department of Science and Technology), Ministry of Science, Technology and Innovation, and the National Council for Scientific and Technological Development (CNPq)
Longitudinal changes in anthropometric measures and new-onset atrial fibrillation among men and women from general population
Authors: Lu Z , Geurts S , Tilly M.J , Ikram M.A , Arshi B , Kavousi M 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia of clinical significance. Recent evidence suggests differences in epidemiology and risk factors of AF between women and men. Obesity and body size are established risk factors for AF. However, anthropometric measures tend to change over time. Few studies have investigated the impact of longitudinal changes in anthropometric measures on incident AF among men and women.

Purpose
To assess the association between longitudinal changes in different anthropometric measures and new-onset AF among community-dwelling men and women.

Methods
Among 12,848 participants free of AF at baseline were included in this large prospective population-based cohort study, each anthropometric measure was measured at least once and up to five times. Anthropometric measures included weight, height, waist circumference (WC), hip circumference (HC), waist to hip ratio (WHR), and body mass index (BMI). Anthropometric measures were standardized for direct comparisons. Joint models were used to assess the association of each anthropometric factor and their longitudinal changes with incident AF. Models were adjusted for age and traditional cardiovascular risk factors.

Results
A total of 5,266 men and 7,218 women (mean age 63.87 years for men and 64.94 years for women) were followed up for a median of 10.5 years. AF occurred in 630 (12.0%) men and 692 (8.7%) women. Longitudinal increases in weight, height, WC, HC and BMI increased the risk for new-onset AF in a linear manner. The age-adjusted hazard ratios (HRs) and 95% confidence interval (95% CI) were 1.38 (1.26–1.51) for weight, 1.41 (1.26–1.59) for height, 1.26 (1.13–1.41) for WC, 1.36 (1.19–1.55) for HC and 1.22 (1.11–1.35) for BMI among men. Among women, the age-adjusted HRs (95% CI) were 1.41 (1.30–1.52) for weight, 1.21 (1.07–1.38) for height, 1.39 (1.27–1.52) for WC, 1.29 (1.19–1.40) for HC and 1.28 (1.19–1.37) for BMI. Further, longitudinal increase in WHR was significantly associated with increased risk of AF in women [HR (95% CI): 1.42 (1.21–1.66)] but not in men [HR (95% CI): 1.11 (0.96–1.30)].

Conclusions
Longitudinal changes in anthropometric measures were associated with the increased risk for new-onset AF among men and women in the general population. An increase in measures of central obesity over time showed a stronger association with incident AF among women, compared to men. Our findings underscore the importance of a sex-specific approach for screening and monitoring of anthropometric measures for AF prevention.
Main results among men and women

Funding Acknowledgement
Type of funding source: None
Recommendations and associated levels of evidence for statin use in primary prevention of cardiovascular disease: a comparison at population level of the ESC, ACC/AHA, USPSTF, and CCS Guidelines
Authors: Pavlovic J , Franco O.H , Kavousi M , Ikram M.K , Deckers J.W , Ikram M.A , Leening J.G 
Published: November 2020

Abstract

Background
It is unclear to what extent the 2019 European Society of Cardiology (ESC), 2018 American College of Cardiology/ American Heart Association (ACC/AHA), 2016 US Preventive Services Task Force (USPSTF), and 2016 Canadian Cardiovascular Society (CCS) guidelines differ in assigning levels of evidence and classes of recommendations (LOE/class) to lipid-lowering treatment recommendations in primary prevention of cardiovascular disease (CVD).

Purpose
To compare LOE/class from four commonly used guidelines at population level.

Methods
A total of 7262 participants, aged 45–75 years of age and without history of CVD, from the prospective population-based Rotterdam Study were included. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity, and numbers needed to treat at 10 years (NNT10y) were calculated.

Results
Mean age was 61.1 (SD 6.9) years, and 58.2% were women. ESC, ACC/AHA, USPSTF and CCS strongly recommended statin use for a respective 33.8%, 48.1%, and 40.2% and 73.0% of the eligible population based on high-quality evidence, while in an additional 55.3%, 7.1%, 8.4% and 9.2% of participants statins use could or should be considered based on varying LOE/class. The sensitivity for treatment recommendations supported with strong, high quality evidence was 61.6% for ESC (“IA”), 74.6% for ACC/AHA (“IA or IB”), 69.4% for USPSTF (“USPSTF-B”) and 92.5% for CCS (“strong”). Specificity was highest for the ACC/AHA at 46.8% and lowest for ESC at 11.4%. Estimated NNT10y for those with the strongest LOE/class were comparable across all guidelines, ranging from 18 to 26 for moderate-intensity statin use, and 11 to 16 for high-intensity statin use. NNT10y reflective of recommendations supported with moderate strength of LOE/class varied substantially among guidelines for both moderate-intensity and high-intensity statin use, ranging from 33 for ESC and USPSTF to 91 for CCS.

Conclusions
Assigned LOE/class varied greatly among four clinical practice guidelines for primary prevention of CVD. Efforts for harmonized and comparable evidence grading system for clinical practice guidelines in primary prevention of CVD may reduce ambiguity, and reinforce updated evidence-based recommendations for appropriate treatment of populations for whom clear evidence for benefit of statin use is available.

Funding Acknowledgement
Type of funding source: None