bluuebunny/crossref_metadata_2025_split huggingface dataset:
2MACE score predicts cardiovascular adverse events in real-world atrial fibrillation patients under rivaroxaban therapy. Data from EMIR study
Authors: Esteve Pastor M , Marin F , Anguita M , Sanmartin M , Rafols C , Arribas Ynsaurriaga F , Baron Esquivas G , Barrios V , Cosin Sales J , Freixa Pamias R , Perez Cabeza A , Vazquez Rodriguez J M , Lekuona Goya I ,   EMIR study investigators
Published: October 2021

Abstract

Background
Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet.
The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs.

Methods
EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed.

Results
We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR&lt;60 ml/min). After 2.5 (2.2–2.6) years of follow-up, we observed patients with 2MACE score ≥3 had higher rate of adverse events (Table), specially of higher rate of cardiovascular mortality and MACE. Patients with 2MACE score ≥3 had RR 4.09 (2.59–6.45; p&lt;0.001) for MACE. Indeed, patients with 2MACE score ≥3 had around 6-fold risk of cardiovascular death due heart failure than patients with 2MACE score &lt;3 (0.17%/year vs 1.09%/year; p=0.003). 2MACE score had suitable predictive performance for MACE (AUC 0.638 [(0.534–0.742); p=0.010).

Conclusion
In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE
Assessing the clinical utility of a genetic risk score associated with type 2 diabetes in a southern European population
Authors: Santos M , Mendonca M I , Temtem M , Sousa J A , Mendonca F , Sousa A C , Freitas S , Henriques E , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Abstract

Background
The development of personalized susceptibility profiles based on genetic information to aid prediction, early detection and prevention of type 2 diabetes (T2D) with potential clinical application, begins to awaken interest in the scientific community. However, its clinical translation is controversial.

Objective
Evaluate the clinical utility of a genetic risk score (GRS) created with the GWAS-derived genetic variants associated to T2D to predict and discriminate the susceptibility to Type 2 diabetes, in a Southern European population with and without T2D.

Methods and results
We studied through a case-control with 3,139 subjects (772 with T2D and 2,367 without) the usefulness of implementing a GRS in clinical practice. We constructed a multiplicative GRS (mGRS) calculated using 10 SNPs of genetic loci robustly associated to T2D (HNF4A rs1884613, IGF2BP2 rs4402960, PPARG rs1801282, TCF7L2 rs7903146, SLC30A8 rs1326634, MC4R rs17782313, ADIPOQ rs266729, FTO rs8050136, TAS2R50 rs1376251 and APO E rs7412 and rs429358), to evaluate the prediction and discrimination of T2D. Two logistic regression models were performed the first with age, sex and BMI. The second with these three risk factors plus hypertension, LDL &gt;130mg/dl and physical inactivity. Logistic regression models, receiver operating characteristic analyses (ROC curve) were used. Each model was analysed individually and added with mGRS to calculate the area under the ROC curve (AUC), which may be considered a global estimate of each model's predictive power. The inclusion of GRS in the first model increased the discriminative power of T2D (AUC=0.669 to 0.692; p&lt;0.0001. In the second model, the increase was AUC=0.712 to 0.729; p&lt;0.0001.

Conclusions
Adding genomic information to traditional models improves the ability to predict and discriminate type 2 Diabetes slightly, compared to traditional models alone. Nevertheless, this increase is not sufficiently robust for translation in clinical practice. However, clinicians should be conscious that T2D genetic research is experiencing a dramatic revolution and stay optimistic that these innovative studies translate into improved care for diabetic patients.

Funding Acknowledgement
Type of funding sources: None.
Comparison between a genetic risk score and the European SCORE in cardiovascular events prediction in a primary prevention population
Authors: Soares C , Temtem M , Mendonca M I , Sousa J A , Santos M , Sousa A C , Rodrigues M , Henriques E , Freitas S , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Abstract

Background
The risk for Coronary Artery Disease (CAD) can be estimated using different scores, such as the European SCORE (Systematic Coronary Risk Evaluation) scale or genetic risk score (GRS). The addition of GRS to the European SCORE may increase the precision of predicting MACE (Major Adverse Cardiovascular Events).

Purpose
This study aims to compare the European SCORE and the multiplicative genetic risk score (mGRS) in predicting MACE.

Methods and results
The study included 1110 asymptomatic individuals without known CAD from GENEMACOR prospective registry. We defined the primary endpoint of all-cause cardiovascular events.
The study population had mean age of 51.6 years, 74.1% male and had risk factors of diabetes (11.6%), dyslipidemia (67.5%), hypertension (48.1%) and smoking (22.9%). Using C-index methodology, mGRS score was superior to SCORE in predicting MACE (mGRS = 0.832 Vs SCORE = 0.615; p=0.014).

Conclusions
The mGRS score was superior to SCORE in predicting MACE in an asymptomatic and free of CAD population. Genetic information may improve cardiovascular risk stratification in primary prevention.

Funding Acknowledgement
Type of funding sources: None.
Low levels of dihomo-gamma-linolenic acid are associated with all-cause death in elderly patients with a recent myocardial infarction
Authors: Nilsen D W , Myhre P L , Kalstad A A , Schmidt E B , Arnesen H , Seljeflot I ,   OMEMI investigators
Published: October 2021

Abstract

Background
In a previous study*, low levels of the omega-6 fatty acid (FA) dihomo-gamma (γ)-linolenic acid (DGLA; C20:3w6), were independently associated with poor 7-year outcome in elderly patients after acute coronary syndrome.

Aim
In order to further evaluate DGLA as a predictor of outcome, we measured n-6 FAs including DGLA in serum samples from elderly subjects with a recent acute myocardial infarction (AMI).

Methods
Baseline samples from the OMEMI (Omega-3 Fatty acids in Elderly with Myocardial Infarction) trial* in which a total of 1027 patients, aged 70 to 82 years, were included 2–8 weeks after an MI, were used. The pre-specified primary outcome during 2 years follow-up was major adverse cardiac events (MACE), which consisted of nonfatal MI, unscheduled coronary revascularization, stroke, all-cause death, or hospitalization for heart failure. Cox regression analysis was used to relate serum n-6 FA levels, measured by gas chromatography and reported as % weight of total FA (%wt) to the risk of incident cardiovascular events. Three models were employed in the multivariable analysis, adjusting for: 1) age, sex and body mass index; 2) + baseline omega-3 FA supplementation; 3) + prevalent hypertension.

Results
Median DGLA levels at baseline (n=1.002) were 2.89 (Q1–Q3 2.43–3.38) %wt. After 2 years follow-up, 152 patients experienced incident MACE, including n=55 all-cause death.
The univariate hazard ratio (HR) for MACE, employing continuous DGLA values was 0.89 (95% CI 0.72–1.08) per %wt increase in DGLA, p=0.24, and for all-cause death 0.72 (95% CI 0.48–1.07), p=0.11. In the multivariable Cox regression models for MACE, concentrations of DGLA did not reach statistical significance; p=0.12, 0.09 and p=0.07 in Models 1, 2 and 3, respectively.
In univariate analysis, HR for total death in the three higher quartiles of DGLA as compared to the lowest quartile was 0.51 (95% CI 0.30–0.80), p=0.016. Results remained statistically significant in all the multivariable models. Model 1: HR 0.54 (0.31–0.95), p=0.03; Model 2: HR 0.50 (0.28–0.91) p=0.02; Model 3: HR 0.49 (0.27–0.88), p=0.017.

Conclusion
Low serum levels of DGLA were associated with increased risk of all-cause death after AMI in elderly patients, thus, suggesting DGLA to be protective.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Stein Erik Hagen Foundation for Clinical Heart Research, Oslo, Norway.
Epicardial adipose tissue volume improves cardiovascular risk reclassification: the Framingham Risk Score example
Authors: Sousa J A , Mendonca M I , Santos M , Temtem M , Mendonca F , Sousa A C , Rodrigues M , Freitas S , Henriques E , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Abstract

Introduction
Epicardial adipose tissue (EAT) volume can be noninvasively detected by CT and has been suggested to predict major adverse cardiovascular events (MACE). Framingham Risk Score is one of a number of scoring systems used to determine an individual's chances of developing cardiovascular disease, hence identifying who is most likely to benefit from prevention.

Objectives
The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on EAT volume, in comparison to a traditionally known cardiovascular risk score, such as the Framingham.

Methods
895 asymptomatic volunteers were prospectively enrolled in a single Portuguese center (mean age 51.9±7.7, 78.5% male) and underwent a median follow-up time of 3.7 years (IQR 5.0). EAT volume was measured by Cardiac Computed Tomography (CCT) using a modified simplified method. For NRI assessment, EAT volume as a continuous variable was added to the Framingham Risk Score.

Results
After 3.7 median years of follow-up, 27 patients developed a MACE. Using NRI, the net proportion of events (netNRIe) that assigned a higher risk was 33.3% (better reclassified), and the net ratio of non-events (netNRIne) was 24.7%, resulting in a net reclassification index (netNRI) of 58.0%. When the new marker was included in the model, 58.0% of patients were better reclassified. In our work, a total of 33.3% of patients who suffered events (n=27) were correctly reclassified and assigned a higher risk.

Conclusion
EAT volume results in a high reclassification rate in an asymptomatic, low-risk population, demonstrating the benefit of this marker beyond traditional risk assessment models. Our study supports its application, especially in carefully selected individuals.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Role of statins in patients with MINOCA. A systematic review and meta-analysis
Authors: Lobo L M , Masson W , Molinero G , Levalle Cobo A , Benincasa F , Wehit G , Delgado J , Losada P , Suarez F , Barbagelata L 
Published: October 2021

Abstract

Background
Given the complex etiology and a limited amount of evidence, the medical treatment (including statin use) of myocardial infarction with non-obstructive coronary artery disease (MINOCA) remains uncertain. The objective of the present study was to evaluate the effect of statin therapy on major cardiovascular events (MACE) and mortality in MINOCA patients.

Methods
A systematic review and meta-analysis of time-to-event outcomes were performed from statin's studies therapy on MINOCA patients, reporting data from MACE or mortality, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases.
The Meta-analysis Of Observational Studies (MOOSE) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used to check the reporting of observational studies. The quality of the included studies was assessed by two independent review authors using the Newcastle-Ottawa Scale (NOS). The summary effect of statin therapy on the endpoints were calculated. Measures of effect size were expressed as HRs, and the I2 statistic was calculated to quantify between-studies heterogeneity and inconsistency. A fixed-effects meta-analysis model and sensitivity analysis was then applied. The level of statistical significance was set at a 2-tailed alpha of 0.05.

Results
Six observational studies of statin therapy on MINOCA, involving a total of 11171 patients, were identified and considered eligible for analysis (9129 subjects received statin therapy while 2042 patients were part of the respective control arms). Quantitative analysis (5 studies were included) showed that statin use was associated with lower mortality (HR: 0.65; 95% CI: 0.56–0.75, I2: 0%). Also, the meta-analysis showed that statin therapy was associated with a lower incidence of MACE (HR: 0.78; 95% CI: 0.69–0.88, I2: 27%).

Conclusion
Our data suggest that in a population with MINOCA, the use of statin therapy results in significant reduction on MACE and mortality. These results must be confirmed in future clinical trials.

Funding Acknowledgement
Type of funding sources: None. Mortality and MACESensitivity analysis
Traditional risk factor control in the Russian cohort of the hospital arm of EUROASPIRE V survey as compared to the whole study population
Authors: Pogosova N , Boytsov S A , Ausheva A K , Sokolova O Y , Salbieva A O , Karpova A V , Yusubova A I , Pozdnyakov Y M 
Published: October 2021

Abstract

Background
Regular monitoring of risk factors control in patients (pts) with atherosclerotic cardiovascular diseases is of paramount importance for interventions and policies targeting secondary prevention settings.

Purpose
To describe traditional risk factors control in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

Methods
The hospital arm of EUROASPIRE V was a cross sectional survey covering multiple European countries including Russia. Within each country one or more hospitals were selected where consecutive pts (both genders, ≥18 and &lt;80 years of age) hospitalized for myocardial revascularization procedures or for ACS were retrospectively identified. Identified patients were invited for interview, which had to take place ≥6 months and &lt;2 years after the index hospitalization. The risk factors control was assessed during the interview.

Results
A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The proportion of pts with uncontrolled risk factors in Russia vs the whole survey population was as follows: current smokers 19.0% vs 18.7%, obesity 47.0% vs 37.7%, abdominal obesity 60.4% vs 58.5%, uncontrolled diabetes 52.9% vs 45.6%, blood pressure (BP) not at goal 36.0% vs 46.3% and uncontrolled LDL cholesterol in 72.4% vs 71.0%, respectively. The table below represents uncontrolled risk factors by gender in Russian pts and in the whole study population.

Conclusion
Both in Russian centers and in the whole survey participants there was a considerable room for improvement o risk factors control. Smoking seemed to be a more common issue in men whereas obesity, uncontrolled diabetes and low physical activity were more prevalent in women.

Funding Acknowledgement
Type of funding sources: None. Table 1
Novel insights into the management of German patients with very high cardiovascular risk eligible for PCSK9 inhibitor treatment: baseline characteristics from the PERI-DYS study
Authors: Laufs U , Birkenfeld A L , Fraass U , Hohenstein B , Siegert C , Klotsche J , Parhofer K G , Pittrow D , Dexl S , Salmen S , Schettler V J J , Steinhagen-Thiessen E ,   PERI-DYS Study Group
Published: October 2021

Abstract

Background
The reasons why patients are treated or not with PCSK9 inhibitors (PCSK9i) are incompletely understood. In Germany, access to PCSK9i is limited by local regulations and many high-risk cardiovascular patients do not receive these therapies. The PERI-DYS study aims to describe and compare two groups of dyslipidaemia patients at very high CV risk: those treated with PCSK9i compared with patients qualifying for but not treated with PCSK9i.

Methods
Observational study with up to 2000 consented patients, documented mainly by office-based cardiologists or physicians in lipid ambulances with data extracted from patient charts. Lipid lowering treatment (LLT) at enrolment includes ongoing PCSK9i use, newly initiated PCSK9i, statins, ezetimibe, and lipoprotein apheresis. Patients are followed for up to 3 years, with visits every 6±2 months to record LLT (drugs, dosing), other CV medications, lipid and glucose values, blood pressure, clinical events (major adverse cardiac and cerebrovascular events) and adverse drug reactions.

Results
As of 05 March 2021, 1488 patients have been enrolled across 70 sites. The majority of patients (91.5%) had heterozygous familial or non-familial hypercholesterolemia or mixed dyslipidaemia. At enrolment, 49.4% of patients were receiving PCSK9i (35.4% ongoing and 14.0% newly treated). Among PCSK9i users, the majority were receiving evolocumab 140 mg (n=567, 38.1% of all enrolled patients). There were no major differences in demographics and non-lipid lowering medication, with the exception of more females in the PCSK9i group.
The estimated untreated LDL-C based on “back-calculation” was higher in patients who were on ongoing PCSK9i therapy than in those not on PCSK9i or newly treated with PCSK9i (Table 1). Physician-reported statin intolerance was much more common in the two PCSK9i groups compared with the non-PCSK9i group (67% versus 14%). Patients in the PCSK9i groups received fewer concomitant statins. Mean on-treatment total cholesterol and LDL-C were considerably lower in patients who were on ongoing PCSK9i compared to non-PCSK9i. Overall, nicotinic acid, fibrates, cholestagel, and omega-3 fatty acids were rarely used (data not shown).

Conclusions
Patients treated with PCSK9i and those qualifying for but not treated with PCSK9i had similar baseline characteristics, but the former had higher estimated untreated LDL-C values and a higher rate of statin intolerance. Ongoing follow-up will determine the prognostic importance of these findings.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen GmbH Germany
Increased lipoprotein(a) multiplies coronary heart disease risk in patients with familial hypercholesterolemia
Authors: Barkas F , Anastasiou G , Adamidis P , Koutsogianni A D , Rizos C , Liamis G , Elisaf M , Liberopoulos E 
Published: October 2021

Abstract

Background
Familial hypercholesterolemia (FH) and elevated lipoprotein(a) (Lp[a]) are individually associated with increased coronary heart disease (CHD) risk.

Purpose
To determine the independent and joint associations of FH and Lp(a) with CHD.

Methods
This was a cross-sectional study including adult patients with dyslipidemia followed at our University General Hospital, Greece. FH diagnosis was based on the Dutch Clinic Lipid Network Criteria (score ≥5), while elevated Lp(a) levels were defined as &gt;30 mg/dL. Independent and joint associations of FH and Lp(a) with CHD prevalence were determined using binary logistic regression models adjusted for traditional cardiovascular risk factors.

Results
Among 941 participants (49 years, 47% males, 54% with FH, 36% with increased Lp[a]), the prevalence of CHD was 7.7% (n=72). Compared with subjects without FH and non-elevated Lp(a) (n=296), those with either FH (adjusted OR: 3.21, 95% CI: 1.35–7.62, n=271) or elevated Lp(a) (adjusted OR: 1.89, 95% CI: 0.76–4.69, n=180) were at higher CHD risk. The patients with both FH and elevated Lp(a) had the highest CHD risk (adjusted OR: 7.31; 95% CI: 3.09–17.32, n=195). Among FH patients, increased Lp(a) doubled CHD risk (adjusted OR: 2.22, 95% CI: 1.02–4.83), whereas among patients with elevated Lp(a), FH was associated with a 5-fold increase in CHD risk (adjusted OR: 4.96, 95% CI: 1.83–13.43).

Conclusions
FH and elevated Lp(a) have independent and additive associations with CHD prevalence. This may have therapeutic implications regarding treatment intensity.

Funding Acknowledgement
Type of funding sources: None.