bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between central ambulatory blood pressure and end-organ damage
Authors: Lu I N , Yu S K , Smith J , Woodcock-Smith J , Jalaludeen N , Cheriyan J , Wilkinson I , McEniery C 
Published: October 2021

Abstract

Background/Introduction
Central blood pressure (BP) measured in the clinic relates more strongly to end-organ damage and may be superior to brachial BP in predicting cardiovascular events. Measurement of central ambulatory BP (ABP) is now possible and emerging data suggest that central ABP is better correlated with left ventricular mass index (LVMI) than brachial ABP.1,2 However, the association between central ABP and other measures of end-organ damage remains unclear.

Purpose
We investigated the association between brachial or central ABP and end-organ damage, in a large community-based population of untreated individuals.

Method
1091 participants (mean age 45±18 years; 589 females) had simultaneous measurements of brachial and central ABP over 24 hours, using the Mobil-O-Graph device. Central ABP was derived using two waveform calibration methods (1: mean/diastolic BP; 2: systolic/diastolic BP). Participants also underwent measurement of aortic pulse wave velocity (aPWV; SphygmoCor device) in the clinic. In a subset of 675 individuals, LVMI was assessed by echocardiography and in 610 individuals, carotid intima-media thickness (CIMT) was measured, using ultrasound. 24-hour and daytime brachial and central ambulatory systolic BP (ASBP) and pulse pressure (APP) were considered.

Results
The Pearson's coefficient for each correlation is listed in Table 1. LVMI was most strongly correlated with 24-hour central ASBP, using calibration method 1 (MAP/DBP; r=0.403, P&lt;0.001). CIMT was most strongly correlated with daytime central ASBP, again derived from calibration method 1 (r=0.341, p&lt;0.001), whereas aPWV measured in the clinic, was most strongly correlated with 24-hour central ASBP, derived from calibration method 2 (SBP/DBP; r=0.441, P&lt;0.001). Based on z statistics, all correlations reported above were significantly stronger than equivalent correlations using brachial ASBP (P&lt;0.001 for all three comparisons of correlation coefficients).

Conclusion
Measurement of central ABP relates more closely to end-organ damage than equivalent measures based on brachial ABP. Central ABP may provide valuable additional information concerning cardiovascular risk above and beyond brachial ABP.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation
External validation of prediction models for obstructive coronary artery disease in patients with suspected stable coronary artery disease
Authors: Bjerking L , Winther S , Hansen K W , Galatius S , Boettcher M , Prescott E 
Published: October 2021

Abstract

Background
Pre-test probability (PTP) is an important tool in the diagnostic work-up for obstructive coronary artery disease (CAD) but must be calibrated to the declining disease prevalence in patients referred to diagnostic testing.

Purpose
To externally validate the published basic and clinical PTP models in a contemporary angina cohort with low prevalence of CAD and to compare with the reference European Society of Cardiology 2019 PTP (ESC 2019 PTP).

Methods
The validation cohort consisted of 42.328 patients (54% women, age ≥30 years, no previous CAD) with symptoms of CAD referred for cardiac computed tomography angiography in the western region of Denmark from 2008–2017 (3.3 million inhabitants). Obstructive CAD was defined from either invasive angiography as stenosis &gt;50%, or when performed, from FFR &lt;0.8 in coronary arteries with diameters &gt;2 mm.
The basic prediction model included type of angina, sex, and age, and the clinical model added diabetes, family history of CAD, and dyslipidemia. The ESC 2019 PTP was calculated from age, sex, and angina symptoms. Discrimination, calibration, and negative predictive value (NPV) were measured for all three models.

Results
Obstructive CAD was present in 3718 (8.8%). In the ESC 2019 PTP model, the basic model, and the clinical model 19.5%, 48.5%, and 55.7% were classified as very low risk and only 1.6%, 3.7%, and 3.5% of these had obstructive CAD, respectively (figure 1). Discrimination was similar for the three models with AUC of 0.76 (95% CI 0.75–0.77), 0.74 [0.73–0.75], and 0.76 [0.75–0.76], for the ESC 2019 PTP, basic, and clinical model, respectively. At the clinically relevant very low predicted probability (≤5%) of CAD, the clinical and basic model were very well calibrated, whereas the ESC 2019 PTP model overestimated the CAD prevalence. NPV at cut-off ≤5% were 98.4% [98.1–98.7] for the ESC 2019 PTP model, 96.3% [96.1–96.6] for the basic model, and 96.5% [96.3–96.7] for the clinical model. At cut-off &lt;15%, NPVs were 96.1% [95.8–96.3] for the ESC 2019 PTP model, 94.5% [94.2–94.7] for the basic model, and 94.2% [94.0–94.5] for the clinical model.

Conclusion
In a population with a prevalence of 8.8% obstructive CAD, a clinical prediction model including diabetes, family history of CAD, and dyslipidemia in addition to the variables of the ESC 2019 PTP model ruled out 36.2% more patients than the ESC 2019 PTP model (23.592 vs. 8245 patients) while only overlooking 1.9% more cases of obstructive CAD when choosing a cut-off ≤5%. Use of this model is therefore potentially cost saving.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
The associations of serum homoarginine to long-term prognosis in patients with chronic coronary syndrome and non-obstructive coronary artery disease
Authors: Storesund S K , Ueland P M , Svingen G , Lonnebakken M T , Nygard O , Pedersen E R 
Published: October 2021

Abstract

Background
Although generally at lower risk than those with obstructive CAD, patients with non-obstructive CAD (NOCAD) are heterogeneous concerning long-term prognosis. Notably, reversible ischemia due to vascular dysfunction is a frequent finding in NOCAD patients (1). The endogenous, non-proteinogenic amino acid homoarginine (hArg) increases the availability of nitric oxide (NO) and thereby the NO-dependent vasodilatation (2). Several studies have reported a strong inverse relation between serum hArg levels and cardiovascular disease (CVD) risk among patients with obstructive CAD. However, the prognostic implications of serum hArg levels in NOCAD patients have not been explored previously.

Purpose
We evaluated serum hArg as a predictor of long-term risk of CVD mortality among patients with NOCAD.

Methods
1046 patients with chronic coronary syndrome (CCS) underwent elective coronary angiography during 2000–2004, with the findings of NOCAD. Serum hArg was measured by liquid chromatography-tandem mass spectrometry in samples that had been frozen and stored at −80°C. The association of serum hArg to CVD mortality risk was visualized in a generalized additive regression plot and further explored using Cox regression. The models included age, sex, body mass index, hypertension, diabetes, smoking status, serum LDL cholesterol and estimated glomerular filtration rate as independent covariables. We evaluated model discrimination and risk classification by calculating C-statistics and net reclassification improvement (NRI &gt;0), respectively.

Results
Median (25th-75th percentiles) age at inclusion was 57 (51–65) years, 48.5% were women and median (25th-75th percentiles) level of serum hArg was 1.87 (1.47–2.38) μmol/L. During median (25th- 75th percentiles) 14.1 (13.2–15.4) years of follow-up 5.7% of the patients died from CVD. The multivariable adjusted hazard ratio (95% confidence interval) per SD increment of (log transformed) hArg was 0.53 (0.40–0.70) in relation to CVD mortality. The multivariable model without biomarker provided a C- statistics for CVD mortality of 0.79 which increased to 0.82 by the addition of serum-hArg to the model (Δ area =0.03, P=0.01). Further, serum hArg provided a high NRI (95% CI) of 0.53 (0.40–0.70), P&lt;0.001.

Conclusion
We demonstrated a strong inverse relationship between serum hArg and long-term risk of CVD mortality among patients with NOCAD. Our study adds to previous literature linking low hArg with vascular dysfunction and adverse CVD prognosis. The potential clinical usefulness of serum hArg measurements for the identification of a high-risk phenotype in NOCAD warrants further evaluation.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Western Norway Regional Health Authority
Impact of cumulative exposure to LDL cholesterol on cardiovascular events in patients with familial hypercholesterolemia
Authors: Tada H , Okada H , Nohara A , Yamagishi M , Takamura M , Kawashiri M 
Published: October 2021

Abstract

Aims
Recent studies suggest that cumulative exposure to LDL-cholesterol (LDL-C) leads to the development of atherosclerotic cardiovascular disease (ASCVD). However, few studies have investigated whether this link extends to individuals with familial hypercholesterolemia (FH), a relevant patient population. We aimed to determine whether cholesterol-year-score, an indicator of cumulative exposure to LDL-C, is associated with ASCVD events among Japanese patients with FH

Methods and results
We retrospectively investigated the health records of 1,050 patients with clinical FH diagnosis who were referred to our institute between April 1990 and March 2019. We used Cox proportional hazards models adjusted for established ASCVD risk factors to assess the association between cholesterol-year-score and major adverse cardiovascular events (MACEs), including death from any cause or hospitalization due to ASCVD events. Cholesterol-year-score was calculated as LDL-C max × [age at diagnosis / statin initiation] + LDL-C at inclusion × [age at inclusion − age at diagnosis / statin initiation]. The median follow-up period for MACE evaluation was 12.3 (interquartile range, 9.1–17.5) years, and 177 patients experienced MACEs during the observation period. Cholesterol-year-score was significantly associated with MACEs (hazard ratio [HR], 1.35; 95% confidence interval, 1.07–1.53; P=0.0034, per 1,000 mg-year/dL), independent of other traditional risk factors including age and LDL-C, based on cross-sectional assessment. Cholesterol-year-score improved the discrimination ability of other traditional risk factors for ASCVD events (C-index, 0.901 versus 0.889; P=0.00473).

Conclusion
Cumulative LDL-C exposure was strongly associated with MACEs in Japanese patients with FH, warranting early diagnosis and treatment initiation in these patients.

Funding Acknowledgement
Type of funding sources: None.
Potential cardiovascular risk reduction with evolocumab in the real world: a simulation in patients with a history of myocardial infarction from the HEYMANS register
Authors: Ray K , Bridges I , Bruckert E , Perrone-Filardi P , Annemans L , Sibartie M , Dhalwani N , Villa G 
Published: October 2021

Abstract

Background/Introduction
FOURIER included 22,351 patients with a history of myocardial infarction (MI) and a median low-density lipoprotein cholesterol (LDL-C) of 2.4 mmol/L. Reducing LDL-C with evolocumab reduced the risk of major cardiovascular (CV) events by 1.3%, in absolute terms, over 2.2 years. Whether similar benefits might be observed in real-world evidence from evolocumab use is unknown.

Purpose
Simulate CV risk and assess the potential CV risk reduction among a large European cohort of evolocumab users with a history of MI.

Methods
We used interim data from HEYMANS, a register of patients initiating evolocumab in routine clinical practice across 12 European countries, from August 2015 with follow-up through July 2020. Demographic and clinical characteristics, lipid-lowering therapy (LLT), and lipid values were collected from routine medical records (6 months prior to evolocumab initiation through 30 months post initiation). Patients with a history of MI were considered and two sub-cohorts were created: recent MI (MI ≤1 year before evolocumab initiation) and remote MI (MI &gt;1 year before evolocumab initiation). For each patient, we 1) simulated their CV risk using three different sources, correcting for age and LDL-C: i) the REACH equation, ii) FOURIER, iii) an observational study including FOURIER-like patients; 2) calculated their absolute LDL-C reduction on evolocumab; 3) simulated their relative risk reduction (RRR) by randomly sampling from the inverse probability distribution of the rate ratio per 1 mmol/L from the key secondary endpoint in the FOURIER landmark analysis; 4) calculated their absolute risk reduction (ARR) and number needed to treat (NNT) over 2 years (recent MI) or 10 years (remote MI).

Results
Our analysis included 90 recent MI and 489 remote MI patients initiating evolocumab in clinical practice per local reimbursement criteria, with up to 24 months follow-up. Median (inter-quartile range) age was 59 (53–67) and 61 (53–68) years in recent MI and remote MI patients, respectively. LDL-C before evolocumab was 3.8 (3.2–4.6) and 3.6 (3.0–4.5) mmol/L. Absolute LDL-C reduction on evolocumab was 2.2 (1.4–2.8) and 2.2 (1.6–2.8) mmol/L, meaning relative LDL-C reduction of 60% (44%-73%) and 62% (47%-72%), respectively. Predicted ARR with evolocumab was substantial, whether over 2 years (recent MI) or over 10 years (remote MI). See Table 1.

Conclusions
This cohort of evolocumab users in clinical practice had a higher baseline LDL-C and CV risk than patients enrolled in FOURIER. LDL-C reduction and RRR were very similar in recent MI and remote MI patients. However, patients with a recent MI had a higher short-term CV risk and therefore showed a larger ARR on evolocumab.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen
Impact of smoking cessation on depression after acute coronary syndrome
Authors: Krasieva K , Clair C , Gencer B , Carballo D , Klingenberg R , Raber L , Windecker S , Rodondi N , Matter C M , Luscher T F , Mach F , Muller O , Nanchen D 
Published: October 2021

Abstract

Background
Smoking and depression are two risk factors for acute coronary syndrome (ACS) that often go hand-in-hand, as smokers are more likely to be depressed and people that are depressed are more likely to be smokers. Smoking cessation in depressed patients with ACS may worsen depressive symptoms, which could increase the risk of recurrence of cardiac events and decrease adherence to other cardiac risk-reducing lifestyle changes.

Purpose
We aimed to investigate the evolution of depression according to smoking cessation one-year after ACS. Furthermore, we investigated if there was a higher incidence of one-year depression among ACS smokers who quit in comparison to continuous smokers.

Method
Data from 1,822 patients with ACS of the Swiss multicenter SPUM-ACS cohort study were analysed over a one-year follow-up period. Participants were classified in three groups based on smoking status one-year post-ACS – continuous smokers, smokers who quit within the year post-ACS, and non-smokers. Depression status at baseline and at one-year after the index ACS event was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A multivariate adjusted logistic regression model was used to calculate the risk ratio (RR) between groups.

Results
In comparison to depressed smokers who continued to smoke one year post-ACS, depressed smokers who quit smoking had an adjusted RR of 2.02 (95% CI 1.04–3.92) of improving their depression. Among 543 non-depressed ACS smokers, new depression at one-year was found in 57/266 (21.4%) smokers who quit, and 68/277 (24.6%) continuous smokers, with an adjusted RR of 0.89 (95% CI 0.58–1.36) of incidence of new depression.

Conclusion
Smokers with depression at the time of ACS who quit smoking improved more frequently their depression compared to those who continued smoking. Although not statistically significant, there was a smaller incidence of new depression among smokers who quit after ACS in comparison to continuous smokers.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation
Increased prevalence of premature coronary atherosclerosis after preeclampsia
Authors: Hauge M G , Damm P , Kofoed K F , Ersboell A S , Johansen M , Sigvardsen P E , Fuchs A , Kuhl J T , Nordestgaard B G , Koeber L , Gustafsson F , Linde J J 
Published: October 2021

Abstract

Background
Women with preeclampsia have increased risk of manifest coronary artery disease later in life. However, it remains unknown if and when premature coronary atherosclerotic stages can be identified. This knowledge could enable early intervention in women considered at high risk for future manifest coronary artery disease.

Purpose
Using cardiac computed tomography, we aimed to investigate the prevalence of premature coronary atherosclerosis in women with previous preeclampsia in comparison with women from the general population.

Methods
Women, aged 40–55 years, with previous preeclampsia were recruited in the CPH-PRECIOUS study and compared 1:1 with age- and parity-matched women from the CGPS. Both groups underwent a cardiac computed tomography, including a contrast-enhanced coronary computed tomography angiography and a non-contrast coronary artery calcium scoring, as well as an overall assessment of cardiovascular risk factors imbedded in an extensive questionnaire. Cardiac computed tomography examinations were analysed blindly. The main outcome of the study was the prevalence of any coronary atherosclerosis defined as any plaque at coronary computed tomography angiography or a calcium score &gt;0 in case of a non-diagnostic coronary computed tomography angiography.

Results
A total of 1,424 women were included (715 women with previous preeclampsia and 709 controls from the general population). Women with previous preeclampsia were more likely to have cardiovascular risk factors (hypertension, dyslipidaemia, diabetes mellitus). The prevalence of any coronary atherosclerosis was significantly higher in the preeclampsia group (27.4% vs. 20.0%) (P=0.001). A calcium score &gt;0 was also more prevalent in the preeclampsia group (16.6% vs. 11.8%) (P=0.009). Preeclampsia remained an independent risk factor for the presence of any coronary atherosclerosis after adjusting for cardiovascular risk factors (age, hypertension, dyslipidaemia, diabetes, smoking, body mass index, parity) (OR=1.37, 95% CI (1.05–1.79), P=0.021).

Conclusion
Women with previous preeclampsia are more likely show premature signs of coronary atherosclerosis compared with an age- and parity matched control group from the general population. Preeclampsia is an independent risk factor for premature coronary atherosclerosis.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationSkibsreder Per Henriksen, R og Hustrus FondKong Christian den Tiendes FondBrødrene Hartmanns FondHans og Nora Buchards FondArvid Nilssons FondAnita og Tage Therkelsens FondLægefondenAase og Ejnar Danielsens FondHjertecentrets Forskningsudvalg (Rigshospitalet)Direktør Kurt Bønnelycke og Hustru Fru Grethe Bønnelyckes FondLægeforeningens ForskningsfondTorben & Alice Frimodt FondHenry og Astrid Møllers Fond
Low-dose rivaroxaban associated with lower incidence of all-cause mortality and bleeding complications in older patients with non-valvular atrial fibrillation
Authors: Chiou W R , Su M I , Lee Y H , Lin P L , Liu C W 
Published: October 2021

Abstract

Background
Low-dose rivaroxaban 10mg daily was used in the J-ROCKET AF trial, and it demonstrated the safety in Asian population. It remains unclear whether low-dose rivaroxaban vs. standard dose 20mg daily is associated with efficacy, safety, and net-clinical outcomes in older Asian patients with non-valvular atrial fibrillation.

Purpose
To evaluate the effects of low-dose rivaroxaban on efficacies and safeties in the old patients age more than 85 years.

Methods
We retrospectively enrolled the patients from medical records between Oct 2012 and Nov 2016. We used 2x2 factorial design by age of 85 years and use of low-dose rivaroxaban. The study outcomes were one-year all-cause mortality and bleeding complications.

Results
The study cohort consisted of 2,386 patients with the mean age 76.6 years (SD 10.5), 51.8% male, CHA2DS2Vsc 4.4 (SD 1.7) and HASBLED 1.6 (SD 1.0). In the age ≥85 group (n=593), low vs. standard dose rivaroxaban had a lower incidence of all-cause mortality (5.3% vs. 10.6%, P=0.021), whereas the incidence of all-cause mortality was greater in the low dose rivaroxaban compared with the standard dose in the age &lt;85 group (3.7% vs. 1.8%, P=0.012). No significant differences of bleeding complication rates were found between the low- and standard-dose rivaroxaban regarding age &lt;85 or ≥85 years. After adjusting for potential confounders, low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the age ≥85 group (adjusted HR: 0.400 95% CI: 0.215–0.743, P=0.004), but the significant association was not found in the age &lt;85 group (adjusted HR: 1.101 95% CI: 0.557–2.174, P=0.782).

Conclusion
Low dose rivaroxaban was associated with a decreased risk of all-cause mortality in the patients with non-valvular atrial fibrillation and age ≥85 years.

Funding Acknowledgement
Type of funding sources: None.
Prevalence of cardiovascular risk in HIV positive patients
Authors: Pinto Velasquez J M , Velasquez Padilla J P 
Published: October 2021

Abstract

Introduction
HIV is considered a chronic disease which increases cardiovascular risk due to factors intrinsic to the patient, associated with HIV itself, such as immune activation, inflammation and immunodeficiency, as well as factors associate with antiretroviral therapy, mainly due to metabolic alterations. Coronary and/or cardiovascular risk is the probability of developing coronary or cardiovascular disease in a given period of time, usually 5 or 10 years, which can be estimated through different scales, which can be qualitative or quantitative.

Purpose
To determine cardiovascular risk according to Framingham and Q-risk scales in low (0 – 10%), intermediate (10.1 – 12%), and high (&gt;20%), clinically characterized to patients with higher risk, relating and comparing vascular age with chronological age, and to assess cardiovascular risk according to antiretroviral therapy used.

Methods
A database was created using SPSS 25, summarizing data through frequencies and percentages, organized and presented in frequency and contingency tables. The association was evaluated through the chi-square test, being considered statistically significant when the p-value was &lt;0.005, with a confidence interval of 95%, cross-sectional descriptive study whose population was HIV-positive patients attending the clinic for comprehensive care of HIV and chronic infections, conducted in 2019.

Results
301 patients were included, all presented cardiovascular risk, low (218), intermediate (75), high (8). Females (215 patients) higher risk than male (p 0.006), this risk increased gradually with age (p 0.005). The main associated comorbidities: diabetes mellitus (p 0.005), arterial hypertension (p 0.004) and smoking (p 0.006). The main clinical factors that determined cardiovascular risk: total cholesterol greater than 200 mg/dl (p 0.006), high density cholesterol &lt;35mg/dl, (p 0.004) systolic blood pressure &gt;130mmHG (p 0.004) and diastolic blood pressure &gt;80mmHG (p 0.004). Patients using protease inhibitors as antiretroviral therapy had a higher cardiovascular risk (p 0.006). In all age groups, vascular age was higher than chronological age (2 years).

Conclusion
All HIV-positive patients included in the study presented a 10-year cardiovascular risk (low, intermediate and high), 86.7% of patients on protease inhibitors were at intermediate cardiovascular risk.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital infectiuos disease clinic