bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the potential cardiovascular risk reduction associated with achieving LDL-C levels recommended in the ESC/EAS guidelines for very high-risk patients? Data from 18 European countries
Authors: Ray K.K , Bray S , Catapano A.L , Poulter N , Villa G 
Published: November 2020

Abstract

Background/Introduction
For patients at very-high risk of cardiovascular (CV) events, the 2016 ESC/EAS dyslipidaemia guidelines recommended lipid-lowering therapy (LLT) to achieve an LDL-C level below 70 mg/dL. This was lowered to an LDL-C level below 55 mg/dL in the 2019 guidelines.

Purpose
To assess: 1) the risk profile of European patients with established atherosclerotic CV disease (ASCVD) receiving LLT; and 2) the treatment gap between the estimated risk and the population benefits if all patients were to achieve LDL-C levels of 70 mg/dL and 55 mg/dL.

Methods
We used data from Da Vinci, an observational cross-sectional study conducted across 18 European countries. Data were collected at a single visit between June 2017 and November 2018, for consented adults who had received any LLT in the prior 12 months and had an LDL-C measurement in the prior 14 months. LDL-C level was assessed at least 28 days after starting the most recent LLT (stabilised LLT). For each patient with established ASCVD receiving stabilised LLT, we: 1) calculated their absolute LDL-C reduction required to achieve LDL-C levels of 70 mg/dL and 55 mg/dL; 2) predicted their 10-year CV risk using the REACH score based on demographic and medical history; 3) simulated their relative risk reduction (RRR) by randomly sampling from the probability distribution of the rate ratio per 38.7 mg/dL (1 mmol/L) estimated by the Cholesterol Treatment Trialists Collaboration meta-analysis; and 4) calculated their absolute risk reduction (ARR) achieved by meeting LDL-C levels of 70 mg/dL and 55 mg/dL.

Results
A total of 2039 patients with established ASCVD were included in the analysis. Mean (SD) LDL-C was 83.1 (35.2) mg/dL. 40.4% and 19.3% of patients achieved LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. Mean (SD) 10-year CV risk calculated using the REACH score was 36.3% (15.4%). Mean absolute LDL-C reductions of 19.6 mg/dL and 30.4 mg/dL were needed to reach LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. When adjusted for the LDL-C reduction required to achieve an LDL-C level of 70 mg/dL, mean ARR was 3.0%, leaving a mean (SD) residual 10-year CV risk of 33.3% (15.5%). When adjusted for the LDL-C reduction required to achieve an LDL-C level of 55 mg/dL, mean ARR was 4.6%, leaving a mean (SD) residual 10-year CV risk of 31.7% (15.2%).

Conclusion(s)
In a contemporary European cohort with ASCVD receiving LLT, the 10-year risk of CV events is high and many patients do not achieve LDL-C levels of 55 mg/dL or even of 70 mg/dL. Moreover, even if all patients were to achieve recommended LDL-C levels, they would still remain at a high residual risk of CV events. These data suggest these patients require even more intensive LLT.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Amgen
How do physicians of different specialties assess smoking status in hospital and primary care
Authors: Bondar S , Konradi A , Salagay O 
Published: November 2020

Abstract

Background
Assessment of current smoking status and history of smoking is critically important for risk stratification and initiation of smoking cessation interventions. However, assessment of smoking status it not included in quality of care measurement, thus the information can be frequently missed in patient' records.

Purpose
To investigate how careful smoking status is recorded in hospital and primary care by physicians of different specialties.

Methods
Electronic records from 124097 hospital and primary care adult patients' case histories were analyzed. Records were made by physicians of different specialties in 2018 and reflected all database for one year form big national medical research Centre.

Results
Smoking status was assessed and recorded only in 33504 of all 124097 (27.0%) electronic records, in 4056 of 44007 (9.2%) hospital records and in 29448 of 80090 (36.8%) out-patient episodes (p&lt;0.001). The highest smoking status assessment rate was observed in nephrologists – 284 of 508 (55.9%), oncologists – 82 of 151 (54.3%), gynecologists – 4085 of 8147 (50.1%), cardiologists – 19591 of 40366 (48.5%) and hematologists – 2310 of 4891 (47.2%). The lowest smoking status recording rate was documented in surgery: cardiac surgeons – 243 of 4843 (5.0%), neurosurgeons – 449 of 10161 (4.4%), urologists – 24 of 1686 (1.4%), as well as by ophthalmologists – 5 of 3152 (0.2%). Radiologists, dermatologists, otolaryngologists, genetics and dentists did not include any records of smoking status at all. 72799 (58.7%) of assesses patients were women. Smoking status was more frequently recorded in women – 20780 of 72799 (28.5%) than in men – 12724 of 51298 (24.8%) (p&lt;0.001), and in young patients more often than in elderly patients, thus the reported smoking rate was maximal in the age group of 20–29 years. Among those records, where the status was assessed, smoking was more prevalent among men – 3746 of 12724 (29.4%) compared women – 1901 of 20780 (9.1%).

Conclusions
Smoking status and ex-smoking are indicated in medical records in less than one third of cases, especially low rate was observed in hospital records. No attention to smoking can influence correct risk assessment and lack of advice for smoking cessation. Even cardiologists indicate smoking status in less than 50% of patients' visits. Significant efforts should be made to emphasize the importance of risk factor assessment with a special attention to smoking as a potentially modifiable risk factor in order to decrease mortality and morbidity in Russia.

Funding Acknowledgement
Type of funding source: None
Cardiovascular risk of smoking in patients without obstructive coronary artery disease
Authors: Olesen K.K.W , Thrane P.G , Thim T , Wurtz M , Kristensen S.D , Maeng M 
Published: November 2020

Abstract

Background
Smoking increases risk of cardiovascular disease by increasing atherosclerosis and thrombogenesis.

Purpose
We examined the impact of smoking on cardiovascular risk in patients without obstructive coronary artery disease (CAD) after coronary angiography.

Methods
We conducted a cohort study in patients without obstructive CAD examined by coronary angiography from 2003–2016 in Western Denmark and no previous history of MI or coronary revascularization. Smokers were compared with non-smokers (former/never smokers) and with an age- and sex matched comparison group sampled from the Western Denmark general population without a history of CAD. The main outcome was myocardial infarction (MI). Other outcomes were ischemic stroke and death. Maximum follow-up was 10 years. Adjusted hazards ratios (aHRs) were estimated using Cox regression.

Results
We identified 46,462 patients without obstructive CAD, of whom 10,879 (23%) were active smokers and 35,583 (77%) were non-smokers at the time of angiography. Patients were matched with 234,648 individuals from the general population with no previous MI or coronary revascularization. Median follow-up was 7.0 years. Smokers had higher risks of MI (aHR 1.65, 95% CI: 1.41–1.93), ischemic stroke (aHR 1.49, 95% CI: 1.28–1.74), and death (aHR 1.77, 95% CI: 1.67–1.87) compared to non-smokers undergoing CAG. As shown in the Figure, the MI risk increased immediately after start follow-up and the curves continued to diverge. Compared to the general population, smokers without obstructive CAD had a similar risk of MI (aHR 0.96, 95% CI: 0.83–1.10), but an increased risk of ischemic stroke (aHR 1.36, 95% CI: 1.19–1.56) and death (aHR 1.49, 95% CI: 1.41–1.56), while non-smokers had reduced risks of MI (aHR 0.57, 95% CI: 0.51–0.63), ischemic stroke (aHR 0.85, 95% CI: 0.78–0.93), and death (aHR 0.78, 95% CI: 0.75–0.81).

Conclusions
In patients without obstructive CAD by coronary angiography, active smoking was associated with a 65% increased 10-year risk of MI compared to non-smokers, suggesting a prothrombotic effect of smoking. Compared to a general population, with unknown CAD and smoking status, smokers examined by CAG had a similar or higher risk of cardiovascular events despite the absence of CAD, while non-smokers had a lower risk.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
The association between late-adolescent smoking and long-term mortality: a dose-response relationship
Authors: Tiosano S , Afek A , Fink N , Avramovich E , Derazne E , Tzur D , Twig G 
Published: November 2020

Abstract

Introduction
Tobacco smoking has detrimental medical effects. However, whether late-adolescence tobacco smoking increases early mortality risk is unclear. The aim of our study was to determine the association between tobacco smoking among Israeli adolescents and mortality in young adulthood.

Methods
The Israeli Defense Forces (IDF) health survey enrolls annually random sample of 3–5% of IDF recruits who voluntarily report lifestyle and tobacco consumption habits (up to 10 cigarettes a day were defined as light smokers, 10–20 cigarettes a day and above 20 cigarettes a day as medium and heavy smokers respectively). Medical and sociodemographic variables (education, residential socioeconomic status, country of birth or origin) were included. Included in this study were 62,134 soldiers (56% men; average age 17.3 years) who enrolled in the study between 1981 and 2006. Data from the Israeli Ministry of Interior was obtained by linkage. Follow-up terminated at the earliest of December 31st 2018 or death. Cox proportional hazard models were applied.

Results
There were 42,013 (67.6%) never smokers, 2,108 (3.4%) past smokers, 6,886 (11.1%) light, 9,880 (15.9%) medium and 1,247 (2%) heavy smokers. During 1,348,517 person-years, 548 deaths were recorded (327 were never smokers, and 18,54,121 and 28 were past, light, medium and heavy smokers, respectively; mean age 31.3 years). The hazard ratios for all-cause mortality were 0.98 (0.61–1.58), 1.02 (0.76–1.36), 1.32 (1.06–1.64) and 1.53 (1.03–2.30) for past smokers, light, medium and heavy smokers, respectively, after adjustment for age, gender, BMI, enrollment year, education and intelligence score. There was no sex-specific association and mortality risk among heavy smokers persisted even when the outcome was set as death by the age of 30 years.

Conclusion
Late-adolescent smoking is associated with long-term all-cause mortality. A dose-response relationship was demonstrated between number of cigarettes consumed at the age of 17 and the future risk of death.
Kaplan-Meier Plot

Funding Acknowledgement
Type of funding source: None
Visceral fat accumulation and left atrial phasic function in the general population
Authors: Sawada N , Nakanishi K , Daimon M , Yoshida Y , Ishiwata J , Hirokawa M , Koyama K , Nakao T , Morita H , Di Tullio M , Homma S , Komuro I 
Published: November 2020

Abstract

Background
Obesity carries independent risk for incident atrial fibrillation (AF), although the impact of abdominal fat distribution on LA morphological and functional remodeling is not fully elucidated. Speckle-tracking echocardiography is a novel and sensitive tool that allows quantification and detection of subtle alterations in left atrial (LA) phasic function.

Purpose
This study aimed to investigate whether increased visceral adiposity is independently associated with impaired LA phasic function in a community-based cohort.

Methods
We included 527 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results
Mean age was 57±10 years and 362 of the participants (69%) were men. LA reservoir and conduit strain were decreased according to the VFA quartiles (both p&lt;0.05), whereas there was no significant difference in LA volume index and LA pump strain. When stratified by SFA, there was no significant differences in LA volume index and all LA phasic strain across the quartiles. In multivariable analysis, VFA as continuous variable was significantly associated with LA conduit strain, independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized b=−0.146, p=0.011). Representative cases are shown in the Figure.

Conclusion
In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Yamauchi Susumu Scholarship for Cardiovascular Research
Percutaneous transcatheter bariatric embolotherapy for weight loss in obesity: two year data from a prospective RCT
Authors: Reddy V.Y , Fried M , Neuzil P , Rosen R , Sramkova P , Kipshidze N , Kipshidze N 
Published: November 2020

Abstract

Background/Introduction
Obesity is an important risk factor associated with poor cardiovascular and metabolic outcomes. Dietary, medical, and surgical weight loss strategies are often unsuccessful, unsustainable or accompanied by risks. Pre-clinical and early case series reported that transcatheter bariatric embolotherapy (TBE) of the left gastric artery reduces weight, by reducing “hunger” hormones from the gastric fundus. We studied TBE in a double-blind, sham procedure, first in human RCT of patients (pts) with obesity, and following completion of the initial study we asked subjects to return after 2 years post-embolization for further evaluation.

Purpose
The purpose of this extension study was to assess the long-term weight loss and other outcomes in subjects who underwent TBE for weight loss.

Methods
In the initial RCT subjects were randomized 1:1 to either a Sham (skin nick & 1 hr wait) or TBE following IV Propofol sedation. All pts received Lifestyle Therapy (behavioral and diet education); these staff following the pts were also blinded to treatment. Subjects completed the initial study when reaching the 1 year-follow-up visit. Subjects were then invited to return to the weight loss clinic at 2 years post-embolization for further evaluation on weight loss, blood pressure, pre-diabetic clinical status, satiety, and quality of life.

Results
A total of 44 pts (age 45.5±9.8; 36/8 M/F; BMI 39.6±3.8) were enrolled, of which 40 pts were randomized equally to groups, with no major complications. Mild, transient epigastric pain was seen, but EGDs showed no major abnormalities. Weight loss was improved with TBE by 6 mo, and maintained over the full 12 mo by both intention-to-treat and per-protocol analyses. At 2 years post-embolization, subjects treated with TBE demonstrated a mean 9% TBWL and 25% EBWL.

Conclusion(s)
Bariatric embolization is safe and when used along with lifestyle therapy, results in clinically significant weight loss. Long-term data demonstrates evidence that subjects treated with TBE continue to maintain their weight loss up to 2 years post-treatment.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Endobar Solutions LLC
Ten-year cardiovascular risk in diabetes patients without of coronary artery disease – a Danish cohort study
Authors: Olesen K.K.W , Madsen M , Gyldenkerne C , Thrane P.G , Thim T , Jensen L.O , Botker H.E , Sorensen H.T , Maeng M 
Published: November 2020

Abstract

Background
Patients with diabetes without obstructive coronary artery disease (CAD) by coronary angiography (CAG) have a risk of myocardial infarction (MI) similar to that of non-diabetes patients without CAD. Their cardiovascular risk compared to the general population is unknown.

Purpose
We examined the 10-year risks of myocardial infarction (MI), ischemic stroke, and death in diabetes patients without CAD after CAG compared to the general population.

Methods
We included all diabetes patients without obstructive CAD examined by CAG from 2003–2016 in Western Denmark and an age and sex matched comparison group, sampled from the general population in Western Denmark without previous history of coronary heart disease. Outcomes were MI, ischemic stroke, and death. The 10-year cumulative incidences were estimated. Adjusted hazard ratios (HRs) were estimated by stratified Cox regression using the general population as the reference group.

Results
We identified 5,760 diabetes patients without obstructive CAD and 29,139 individuals from the general population. Median follow-up was 7 years with 25% of participants followed for up to 10 years. Diabetes patients without obstructive CAD had an almost similar 10-year risk of MI (3.2% vs 2.9%, adjusted HR 0.91, 95% CI 0.70–1.17, Figure) compared to the general population cohort. Diabetes patients had an increased risk of ischemic stroke (5.2% vs 2.2%, adjusted HR 1.88, 95% CI 1.48–2.39), and death (29.7% vs 17.9%, adjusted HR 1.41, 95% CI 1.29–1.54). The duration of diabetes was associated with increased cardiovascular risk.

Conclusions
Absence of obstructive CAD by CAG in patients with diabetes ensures a low MI risk similar to the general population, but diabetes patients still have an increased risk of ischemic stroke and all-cause death despite absence of CAD.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
Metabolic activity of visceral fat and immune-related organs evaluated by 18F-FDG PET/CT is associated with the metabolic syndrome
Authors: Pahk K , Kwon H.W , Eo J.S , Seo H.S , Kim S 
Published: November 2020

Abstract

Background
The risk of cardiovascular disease (CVD) is elevated in metabolic syndrome (MS) and is related to the inflammatory activity of visceral adipose tissue (VAT). We investigated whether the metabolic activity in VAT, assessed by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), is associated with systemic inflammatory status, and related to the number of MS components.

Methods
18F-FDG PET/CT was performed in a total of 203 subjects: 59 without an MS component; M(0), 92 with one or two MS components; M(1–2), and 52 with MS. Metabolic activity of VAT was evaluated using the mean standardized uptake value (SUVmean) and the maximum SUV (SUVmax). Metabolic activities of immune-related organs such as spleen and bone marrow (BM) were evaluated using the SUVmax.

Results
VAT SUVmax correlated with high-sensitivity C-reactive protein (hsCRP) and the SUVmax of spleen and BM, which reflect the status of systemic inflammation. Both hsCRP and the SUVmax of the spleen and BM were higher in the MS group than in the M(1–2) or M(0) groups. In VAT, SUVmax increased with increasing number of MS components, while SUVmean decreased.

Conclusions
The SUVmax of VAT assessed by 18F-FDG PET/CT could reflect the inflammatory activity of VAT which is increased in the MS patients with systemic inflammation.

Funding Acknowledgement
Type of funding source: None
Does high-normal 2-hour post load plasma glucose after myocardial infarction in patients with normal glucose tolerance adversely affect prognosis?
Authors: Chattopadhyay S , George A , John J , Sathyapalan T 
Published: November 2020

Abstract

Background
Type 2 diabetes mellitus (DM) and pre-DM, newly diagnosed after MI in patients without known DM adversely affects prognosis. 2-hour post-load glucose (2h-PG) predicts post-MI prognosis better than fasting plasma glucose (FPG). Plasma glucose below the conventional threshold for the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), affects post-MI prognosis.

Purpose
To test whether high-normal post-load plasma glucose in patients with normal glucose tolerance (NGT) would affect post-MI prognosis and whether FPG or 2h-PG increases this risk.

Methods
Retrospective cohort analysis of 425 MI survivors without known DM and with NGT followed up for (death and non-fatal MI) as MACE. MACE in patients with 2h-PG &gt; median for the whole cohort (Group 2), was compared with those at or below (Group 1). Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI&gt;0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices.

Results
Median 2h-PG was 6.3 mmol/l. 219 patients in Group 1 and 206 in Group 2. Group 2 had higher age, prevalence of hypertension, hypercholesterolaemia, ST-segment depression and higher heart rate and GRACE scores. Median follow-up was 40.6 months. MACE was more frequent in Group 2 than Group 1 (OR 2.82, 95% CI 1.55 to 5.16, p&lt;0.001). MACE-free survival was higher in Group 1 (HR 2.43, 95% CI 1.53 to 3.85, p&lt;0.001). Group 2 (HR 2.42, 95% CI 1.44 to 4.04, p&lt;0.001) predicted the MACE-free survival. 2h-PG, but not the FPG independently predicted of MACE (HR 1.73, 95% CI 1.31 to 2.30, p&lt;0.001). Addition of 2h-PG to models containing FPG and other variables improved their predictive performance (NRI&gt;0 0.5062, p&lt;0.001; IDI 0.0376, p=0.003). The c-statistic increased when 2h-PG was added to the GRACE score only model (δAUC 0.037, 95% CI 0.012 to 0.081, p=0.046).

Conclusion(s)
This study suggests that “high-normal” 2h-PG is an independent predictor of post-MI prognosis. Normoglycaemic patients with 2h-PG ≥6.4 mmol/l, had worse post-MI prognosis compared to those with 2h-PG ≤6.3 mmol/l. The risk of MACE increased with increasing 2h-PG within the normal range. FPG had no effect on prognosis.

Funding Acknowledgement
Type of funding source: None
Efficacy of an mHealth intervention using interactive voice response system in reducing cardiovascular risk in a rural population in India: cluster randomized trial
Authors: Gupta R , Sharma A.K , Ahuja J , Baig V.N 
Published: November 2020

Abstract

Objective
We evaluated efficacy of mHealth technology for reducing cardiovascular risk among metabolic syndrome individuals in India.

Methods
We screened 1012 adults in 10 villages (clusters) in north-west India for presence of metabolic syndrome. Participants with inclusion criteria were randomized. Ownership of cell-phone was essential. We developed user-friendly interactive voice response system in Hindi based on transtheoretical model of behavior change. Two messages for promotion of healthy lifestyle and medical treatments were broadcast daily over 12-months in intervention clusters and queries answered. Lifestyle and biochemical factors were assessed at baseline and at 12-months.

Results
1012 rural individuals aged 20–60y in 10 villages were screened, majority were women (53%) and less literate (76%). Metabolic syndrome was in 286 (28.3%). These were divided into 5 control (n=136) and 5 intervention (n=147) clusters. Baseline characteristics in participants in control and intervention clusters were similar. At 12 months, significantly greater participants in intervention clusters had better lifestyle features and lower waist circumference, body mass index, systolic BP, fasting glucose, cholesterol and triglycerides (Table).

Conclusion
An interactive voice response system based technology significantly reduced multiple cardiovascular risk factors in metabolic syndrome individuals in rural India.

Funding Acknowledgement
Type of funding source: None