bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do European patients with peripeheral arterial disease receive optimal lipid lowering therapy and achieve LDL-C goals? Results from the DA VINCI study
Authors: Ray K.K , Feudjo Tepie M , Catapano A.L , Giovas P , Bray S , Masana L , Weiss N , Poulter N 
Published: November 2020

Abstract

Background
2016 and 2019 EAS/ESC dyslipidemia guidelines recommend lipid lowering therapy (LLT) to reduce LDL-C in patients with peripheral arterial disease (PAD) with or without established cardiovascular (CV) disease, and recommend target LDL-C goals based on individual CV risk. Data regarding the implementation of these guidelines in clinical practice across Europe is currently lacking.

Purpose
Describe LLT and achievement of the target LDL-C goals recommended in EAS/ESC dyslipidemia guidelines in patients with PAD.

Methods
The cross-sectional Da Vinci study enrolled consenting adults who had received LLT in the 12 months prior to the study visit and had at least one LDL-C measurement in the 14 months prior to the study visit, seen in a primary or secondary care setting across 18 European countries. Patients with coronary, peripheral and cerebral disease were enrolled at a ratio of 1:2:2. FH patients with prior CV events were excluded. Data were collected from medical records at a single visit between Jun '17–Nov '18, including LLT and most recent LDL-C. Primary outcome was LDL-C goal attainment ≥28 days after starting most recent LLT (treatment-stabilised LLT).

Results
Of 5888 patients enrolled, 2794 met our definition of atherosclerotic cardiovascular disease (ASCVD). Of these ASCVD patients, 1036 (37%) had PAD. 31% (323/1036) of PAD patients were female and mean (SD) age was 69 (9.4) years. Concomitant CV risk factors included diabetes mellitus (473/1036 patients [46%]), hypertension (809/1036 [78%]) and smoking (794/1036 [77%]). 26% (271/1036) of patients with PAD also had coronary vascular disease and 12% (122/1036) also had cerebrovascular disease. At the visit date, approximately half (497/1036 [48%]) of all PAD patients were receiving moderate intensity statins and 41% (421/1036) were receiving high intensity statins. 818 (73%) of the PAD patients had a treatment-stabilised LDL-C measurement (median, 2.20 mmol/L), of whom 40% (326/818) achieved the 2016 EAS/ESC LDL-C goal of 1.8 mmol/L and only 19% (159/818) achieved the 2019 goal of 1.4mmol/L.

Conclusions
European patients with PAD are not treated as per EAS/ESC recommendations, with a large proportion receiving suboptimal LLT and fewer than half achieving target LDL-C levels.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Amgen
Baseline triglycerides and non-HDL-C and apoB goal attainment in the ORION-10 and ORION-11 trials
Authors: Ray K.K , Kallend D , Raal F.J , Stoekenbroek R , Koenig W , Leiter L.A , Landmesser U , Schwartz G.G , Wijngaard P.L.J , Kastelein J.J.P , Wright R.S 
Published: November 2020

Abstract

Introduction
Elevated triglyceride (TG) levels contribute to the total burden of circulating atherogenic lipoprotein levels and are associated with increased cardiovascular (CV) risk. LDL-C underestimates risk in patients with elevated TG. Therefore, 2019 ESC/EAS guidelines recommend apoB or non-HDL-C as secondary lipid goals for patients with TG &gt;150mg/dL.

Purpose
To assess the impact of inclisiran on apoB and non-HDL-C goal attainment across a range of TG levels among patients with atherosclerotic CV disease (ASCVD).

Methods
The ORION-10 and ORION-11 trials included 3178 patients with ASCVD and LDL-C &gt;70mg/dl despite maximally tolerated statins randomized to inclisiran or placebo (1:1). Pre-specified secondary endpoints were placebo-corrected changes in lipids at Day 510. For this analysis patients were stratified by TG quartiles at baseline within each trial. The proportion of individuals attaining apoB &lt;55 mg/dL or non-HDL-C &lt;70mg/dl within each trial were assessed across TG strata and the likelihood of goal attainment within TG strata assessed using logistic regression.

Results
In ORION-10, TG quartiles were ≤94, 94 to ≤128, 128 to ≤181 and &gt;181mg/dl respectively and in ORION-11 corresponding values were ≤101, 101 to ≤135, 135 to ≤183 and &gt;183mg/dl. As compared to placebo a significantly greater proportion of patients randomised to inclisiran attained apoB goals within each TG strata (Table). Similar results were observed for non-HDL-C.

Conclusion
Among patients with ASCVD on maximally tolerated statin and high TG levels, attainment of apoB and non-HDL-C secondary lipid targets was more likely with inclisiran than placebo. Inclisiran may be a useful therapeutic option for patients with atherogenic dyslipidaemia.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The Medicines Company
Adiposity mediates the association between bilirubin, glucose/insulin homeostasis and inflammation
Authors: Mazidi M , Katsiki N , Mikhailidis D.P , Banach M 
Published: November 2020

Abstract

Background and purpose
The exact contribution of adiposity on the link between bilirubin and glucose/insulin homeostasis and inflammatory factors has not been defined. We aimed to quantify the role of adiposity on this association.

Methods
The variables of interest were extracted from the National Health and Nutrition Examination Survey (NHANES 2005–2010). We assessed the role of body mass index (BMI) as an adiposity factor. Analysis of co-variance and causal mediation analysis were conducted based on survey design and sample weights.

Results
Overall, 10,880 men and 11,462 women were included in the present analysis (mean age=47.2 years). Mean circulating bilirubin for the overall population, men and women was 0.74±0.02, 0.83±0.03 and 0.65±0.03 mg/dl, respectively (p&lt;0.001, for the comparison between sexes). In an adjusted model, glucose/insulin homeostasis and inflammatory factors were more favorable for participants with a higher level of bilirubin in both sexes (p&lt;0.001 for all). The extent of the mediation was maximal between the homeostatic model assessment of insulin resistance and bilirubin (men: 45%, women: 58%). In post-menopausal women, 47 and 13% of the changes in insulin and triglyceride-glucose index in response to bilirubin levels could be explained by alterations in BMI. In smokers, BMI could mediate 53% of the association between bilirubin and insulin (p&lt;0.001). Similar results were obtained when participants with normal liver function were analyzed separately (see Figure).

Conclusions
Using advanced statistical techniques we analyzed the complex link of bilirubin with inflammation and glucose/insulin homeostasis and identified a role for adiposity. We also suggest that bilirubin has an anti-inflammatory role.

Funding Acknowledgement
Type of funding source: None
Estimating cardiovascular disease-free life-years with the addition of semaglutide in people with type 2 diabetes using pooled data from SUSTAIN 6 and PIONEER 6
Authors: Westerink J , Sommer Matthiessen K , Nuhoho S , Fainberg U , Lyng Wolden M , Visseren F , Sattar N 
Published: November 2020

Abstract

Introduction
Cardiovascular disease (CVD) is the leading cause of disability and death in people with type 2 diabetes (T2D). In a post hoc analysis of pooled data (POOLED cohort) from two phase 3, randomized CV outcomes trials, SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716), the addition of the glucagon-like peptide-1 analogue semaglutide to standard of care (SoC) in people with T2D at high risk of CVD significantly reduced the risk of major adverse CVD events (3-point MACE: CV death, non-fatal stroke and non-fatal myocardial infarction).

Purpose
To estimate the effect of adding semaglutide to SoC on CVD-free life-years and 10-year CVD risk in patients with T2D by predicting individual patient-level risk of CVD events in the POOLED cohort using the DIAL CVD risk model.

Methods
The 3-point MACE hazard ratio from the POOLED cohort (N=6480; HR = 0.76 [95% confidence interval [CI]: 0.62–0.92]) was applied to the patient-level lifetime risk of CVD events derived from the DIAL model. CVD-free life-years and 10-year CVD risk were then calculated based on the age-specific risks of CVD events and non-vascular mortality, using standard actuarial methods. Both new and recurrent CVD events were considered. The DIAL model was validated by comparing the predicted and observed number of CVD events after 1 year. The DIAL model was previously developed using data from people with T2D in the Swedish National Diabetes Registry and validated across geographical regions.

Results
The DIAL model was considered valid for use in the POOLED cohort because the predicted number of CVD events at 1 year was within 5% of the number observed. Adding semaglutide to SoC was associated with a mean reduction in 10-year CVD risk of 20.0% (95% CI: 6.4–32.6%) and a mean increase of 1.72 (95% CI: 0.52–2.96) CVD-free life-years. The number of mean CVD-free life-years gained ranged from 0.62–2.91 years between age groups (Table). For a 60-year-old male with baseline characteristics matched to the average male from the POOLED cohort, adding semaglutide to SoC reduced 10-year CVD risk by 20.8% and provided 2.53 additional CVD-free life-years. The number of CVD-free life-years decreased when baseline age was increased (Figure).

Conclusions
The addition of semaglutide to SoC was associated with a gain in CVD-free life-years. This analysis helps contextualize the results of CV outcomes trials and may help to inform clinical decision-making.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novo Nordisk A/S
Chronotropic incompetence and exercise capacity after mitral valve surgery: the importance of blood hemoglobin level
Authors: Kanazawa M , Toyoda M , Seki T , Iguchi A , Takahashi S , Kagaya Y , Sato K , Saito H , Ito K , Miura M , Kondo M , Kawatsu S , Endo H , Oda K , Nakamura A 
Published: November 2020

Abstract

Background
Chronotropic incompetence (CI) is sometimes observed during exercise training of cardiac rehabilitation in patients with cardiac surgery, however, little is known concerning the differences between patients with mitral valve (MV) and aortic valve (AV) surgery.

Purpose
Because the possibility exists that cardiac sympathetic nerves might be impaired by left atrium incision, we hypothesized that the incidence of CI was higher in patients with MV surgery (Mitral Valve Replacement and Mitral Valvuloplasty) as compared with patients with AV surgery (Aortic Valve Replacement). And if so, which factor determines the exercise capacity of patients after MV surgery. We thus aimed this study to elucidate the hypothesis with cardiopulmonary exercise testing (CPX).

Methods
We performed CPX by ramp loading with ergometer exercise in total 61 patients who had undergone elective cardiac valve operation (25 patients with MV surgery, age 59.2±9.9 years; 36 patients with AV surgery, age 64.6±12.3 years). We analyzed chronotropic response index (CRI), peak oxygen uptake (peak VO2/W), anaerobic threshold (AT), and peak oxygen pulse (peak VO2/HR) with CPX, and blood hemoglobin concentration (Hb).

Results
The value of CRI was significantly decreased in the patients with MV surgery compared with those with AV surgery (MV; 0.19±0.10 vs. AV; 0.41±0.17, p&lt;0.001). Peak VO2, peak VO2/HR and Hb were not significantly different between patients with MV and those with AV surgery. Patients with MV surgery showed correlations between peak VO2 and Hb (r=0.45, p&lt;0.05), AT and Hb (r=0.52, p&lt;0.01), and a strong correlation between peak VO2 and peak VO2/HR (r=0.63, p&lt;0.001), but not in those with AV surgery.

Conclusions
The present study demonstrated that higher incidence of CI was shown in patients with MV surgery as compared with those with AV surgery. The exercise capacity of patients with MV surgery was determined by peak VO2/HR and Hb. These results suggest that 1) left atrium incision impairs cardiac sympathetic nerves and causes CI, 2) peak VO2/HR which is consisted of arterio-venous oxygen difference and Hb is critical indicator for exercise capacity in patients with MV surgery with CI.
Main results

Funding Acknowledgement
Type of funding source: None
Impact of body mass index on the clinical outcomes in heart failure patients undergoing cardiac rehabilitation
Authors: Kunimoto M , Shimada K , Yokoyama M , Fujiwara K , Honzawa A , Yamada M , Matsubara T , Matsumori R , Abulimiti A , Asai T , Amano A , Morisawa T , Takahashi T , Daida H 
Published: November 2020

Abstract

Background
Increased body mass index (BMI) has recently shown to have a favorable effect on the prognosis in heart failure (HF) patients. However, the impact of BMI on clinical events and mortality in HF patients who underwent cardiac rehabilitation (CR) remains unclear.

Purpose
This study aimed to investigate whether the obesity paradox is present in HF patients who have undergone CR.

Methods
This study enrolled 238 consecutive HF patients who had undergone CR at our university hospital between November 2015 and October 2017. The clinical characteristics and anthropometric data of these patients, including BMI, were collected at the beginning of the CR. The major adverse cardiovascular event (MACE) was defined as a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data regarding the primary endpoints were collected until November 2018.

Results
Patients (mean age 68.7 years, male 61%) were divided into four groups as per BMI quartiles. More patients in the highest BMI group were women, were significantly younger, and had a higher prevalence of hypertension, dyslipidemia, and diabetes mellitus; however, no significant differences were observed in the prevalence of chronic kidney disease, left ventricular ejection fraction, and brain natriuretic peptide levels of the four groups. During a median follow-up duration of 583 days, 28 patients experienced all-cause mortality, and 42 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the highest BMI quartiles had lower rates of MACE (Log-rank P&lt;0.05) (Figure 1). After adjusting for confounding factors, Cox regression multivariate analysis revealed that BMI was negatively and independently associated with the incidence of MACE (hazard ratio: 0.89, 95% confidence interval: 0.83–0.96, P&lt;0.05).

Conclusion
Increased BMI was associated with better clinical prognosis even in HF patients who have undergone CR Therefore, BMI assessment may be useful for risk stratification in HF patients who have undergone CR.
Figure 1. Kaplan-Meier survival curve

Funding Acknowledgement
Type of funding source: None
National quality indicators to promote cardiac rehabilitation service effectiveness in Australia
Authors: Gallagher R , Astley C , Thomas E , Zecchin R , Ferry C , Woodruffe S 
Published: November 2020

Abstract

Background/Introduction
Comprehensive exercise-based cardiac rehabilitation (CR) has well-established efficacy and effectiveness for improving patients' outcomes. There is substantial variability in terms of clinical effectiveness and quality measurement of CR programs internationally which limits service improvement initiatives. In Australia in 2018 a the Australian Cardiovascular Health and Rehabilitation Association (ACRA) and the National Heart Foundation of Australia (NHFA) combined forces to develop nationally-agreed, internationally-consistent, locally-relevant quality indicators (QI).

Purpose
To provide a minimum set of standardised national-level QI that should be collected and reported on by CR programs to determine the quality of delivery and associated outcomes, benchmark performance and support improvement processes.

Methods
We formed the National Cardiac Rehabilitation Measurement (NCRM) Taskforce led by ACRA and NHF and used the National Institute for Health and Care Excellence (NICE) UK guidelines to develop high quality QIs. The process included topic overview, prioritising areas for quality improvement, drafting and consultation, validation and consistency checking.

Results
Eleven preliminary QIs were circulated for ranking and comment to all ACRA members (predominately multidisciplinary CR providers) (68 responses), and to leading national multidisciplinary CR experts from cardiology, research, physiotherapy, nursing, epidemiology and register backgrounds (7 responses). Ratings, comments and suggestions were collated and discussed by the NCRM Taskforce, and the indicators rated most important, useful and feasible were retained, resulting in 10 QIs. These 10 QIs were presented at the ACRA national conference and then discussed at a workshop (55 participants) for this purpose. Ten QIs and accompanying data dictionary with definitions, evidence and allowable values is the final product.

Conclusions
A minimum set of locally relevant, internationally recognised, national QIs for CR is now available for CR providers, health service managers and researchers in Australia, which may be relevant internationally. The QIs will best serve national interests incorporated within a national cardiac registry but will also be useful for site audits and have strong potential to be aggregated across sites, health districts and states. The definitive test of the QIs will be how useful they are for CR program coordinators and funders of such programs; a key consideration for building sustainable business models and ensuring long-term implementation.

Funding Acknowledgement
Type of funding source: None
Impact of cardiac remodelling on physical fitness measured by VO2 max in preadolescent and adolescent endurance athletes
Authors: Bjerring A.W , Landgraff H.E.W , Leirstein S , Haugaa K.H , Hallen J , Edvardsen T , Sarvari S.I 
Published: November 2020

Abstract

Background
Endurance training is associated with both physiological cardiac remodelling and increased maximal oxygen uptake. The relationship between VO2 max and cardiac dimension has not been described in young athletes or in longitudinal studies.

Aims
This study aims to explore the impact of cardiac remodelling on VO2 max in a cohort of young athletes assessed at age 12, 15 and 18.

Methods
Seventy-six promising young cross country skiers were examined at age 12 with echocardiography, including 3D and cardiopulmonary exercise test (CPX). Forty-six (61%) participated in the first follow-up at age 15 and 36 (47%) athletes completed the second follow-up at age 18. The impact of left ventricular (LV) mass and LV end-diastolic volume (EDV) on VO2 max at each time point was assessed using mixed model analysis. Correlation coefficients were calculated at each time point.

Results
There were moderate to very strong correlations between the cardiac parameters and VO2 max at all time points (Figure). In the full model, each improvement in VO2 max of 1000 mL/min at age 15 was associated with an increase in LV mass of 18 g (p&lt;0.001) and an increase in LV EDV of 36 mL (p&lt;0.001), while each improvement in VO2 max of 1000 mL/min at age 18 was associated with an increase in LV mass of 19 g (p&lt;0.001) and LV EDV of 31 mL (p&lt;0.001).

Conclusion
Physical fitness measured by VO2 max is strongly correlated to LV mass and volume in adolescent athletes, suggesting a strong link between cardiac adaption and VO2 max in young athletes.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Health Authority
Heart involvement in type 1 and type 2 myotonic dystrophy. Insights from a 10-year follow-up study
Authors: Fioravanti F , Golzio P.G , Carbone M.L , Panarelli A , Gagliardi M , Mazzilli S , Colopi M , Ferraro I , Castagno D , Giustetto C , De Ferrari G.M 
Published: November 2020

Abstract

Background and aim
Myotonic Dystrophy (MD) is the most common inherited muscular dystrophy of the adult. Cardiac manifestation, including arrhythmias and conduction disorders, contributes significantly to the morbidity and mortality of the disease. The transition from a subclinical form of cardiac involvement to potentially life-threating manifestations is highly variable and not yet entirely understood. Aim of this work is to evaluate whether PQ interval (PQi) prolongation could be a reliable marker to predict left and right ventricle impairment and the necessity of a stricter monitoring.

Methods
In this retrospective cohort study, we selected all consecutive patients with a confirmed diagnosis of MD (type 1 and type 2) referred to our Centre. We performed clinical, laboratoristic and instrumental assessments (every 3, 6 or 12 months), tailored on each patient's features. Every patient was treated according to the latest guidelines for pharmacological and device therapy. ECG (recorded at 25 and 50 mm/sec), 24h ECG Holter and transthoracic echocardiography were performed at least yearly. Cardiac Magnetic Resonance was requested to better stratify intermediate risk patients to implantable device therapy.

Results
A total of 72 patients (age 48±15 years, 39% female) were included in the analysis. Patients with MD type 1 and type 2 were referred to our Centre after a mean period of 12 years (SD ±8 years) from initial diagnosis. After a mean follow-up of 5 years (±4 years), 8 patients died (mean age at death: 60±12.4 years), all of them for respiratory insufficiency. We evaluated PQ interval (PQi) evolution and type I AVB onset. No statistically significant differences emerged when stratifying for type I AVB. Nevertheless, a PQi increase of more than 20 ms during the follow-up (even if PQ &lt;200 ms) is significantly associated with lower values of TAPSE and greater LVEDD, while no differences emerged for LVEF, dyastolic function and other echocardiographic parameters. Moreover, the evolution of PQ interval is associated with an increasing number of supraventricular arrhythmias and a worse prognosis (shorter interval from first cardiac symptom to death, p 0.025), despite optimal medical therapy.

Conclusions
Although relatively rare, MD is a challenge for present Cardiologists. How and when to treat those patients is not codified in guidelines or consensus papers. This study suggests PQi variation as a proxy for critical evolution of MD cardiac involvement. ECG and its modification during lifetime seem pivotal for these patients' care, qualifying as a red flag for stringent follow-up. Further evidences, on larger cohorts, are needed to validate these findings.

Funding Acknowledgement
Type of funding source: None