bluuebunny/crossref_metadata_2025_split huggingface dataset:
HbA1c, coronary atheroma progression and cardiovascular events
Authors: Dykun I , Bayturan O , Carlo J , Nissen S E , Nicholls S J , Puri R 
Published: October 2021

Abstract

Background
Hemoglobin A1c (HbA1c) reflects long-term glycemic control and is associated with an increased risk of cardiovascular events among diabetic and non-diabetic patients. The specific impact of HbA1c upon atheroma progression and incident cardiovascular events relative to the presence of other cardiovascular risk factors remains uncertain.

Purpose
We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression measured with serial intravascular ultrasonography (IVUS) and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates.

Methods
We performed a post-hoc pooled analysis of data from eight prospective, randomized trials involving serial coronary IVUS. HbA1c was measured at baseline and the average of the follow-up values was taken. The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque, throughout the segment of interest. Using multivariable mixed modeling, we determined the association of HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE.

Results
Among 2,791 patients, mean age was 58.9±9 years and 29.1% were women. Mean on-treatment low-density lipoprotein (LDL)-cholesterol was 80.2±33.7 mg/dl and median on-treatment triglycerides (TG) were 125.5 (94.7, 170.2) mg/dl. Mean baseline and follow-up HbA1c was 6.2±1.2% and 6.3±1.2%, respectively. Overall, there was no net significant annualized change in PAV (0.15±0.21, p=0.47). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index (BMI), systolic blood pressure, smoking, LDL- and high-density lipoprotein cholesterol, TG levels, peripheral artery disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13 (0.07, 0.19), p&lt;0.001]. On-treatment HbA1c levels were significantly and independently associated with incidence of MACE [hazard ratio (95% confidence interval): 1.17 (1.07, 1.28), p&lt;0.001].

Conclusions
Independent of achieved cholesterol levels, vascular risk factors and BMI, greater HbA1c levels significantly associate with coronary atheroma progression and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon the natural history of coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Iryna Dykun was supported by the German Research Foundation
Anticipating recurrent ischemic events after an acute coronary syndrome: validation and application of the SMART-REACH score
Authors: Gomes D , Presume J , Albuquerque F , Lopes P , Sousa Paiva M , Reis Santos R , Aguiar C , Ferreira J , Trabulo M , Mendes M 
Published: October 2021

Abstract

Background
The SMART-REACH score (SRS) was developed to predict the risk of major adverse cardiovascular events in ambulatory patients with established cardiovascular disease, although it has not been extensively validated. Patients at higher risk of recurrent ischemic events may benefit from novel, more intensive treatment options, and earlier identification of these patients can potentially improve outcomes.

Purpose
We aimed to validate the SRS and evaluate its performance in a population recently admitted with acute coronary syndrome.

Methods
In this single-centre retrospective cohort, we included 320 patients aged 45 to 80 years, who were discharged following admission for an acute coronary syndrome between 2016 and 2018. To calculate the SRS for each patient, we considered clinical data on admission (age, gender, smoking, diabetes, prior history of vascular disease, heart failure or atrial fibrillation), lipid values obtained within the first 24 hours of hospitalization, serum creatinine level at baseline and once the patient was deemed clinically stable, and discharge medication. The outcome of interest was defined as stroke, myocardial infarction or cardiovascular death (MACE) at two years of follow-up. SRS was assessed for discrimination and calibration.

Results
Mean age was 63±9 years, and 240 (75%) were male. There was high prevalence of cardiovascular risk factors: 71% had hypertension, 32% had diabetes mellitus, 42% were active smokers and 25% had previously established cardiovascular disease. The outcome of interest was observed in 38 patients (22 cardiovascular deaths, 6 strokes and 14 myocardial infarctions). SRS showed good discrimination of the estimated MACE risk with overall C-statistic of 0.646 (95% CI, 0.554–0.737, p=0.004) (picture 1) and calibration (p-value for the goodness-of-fit test of 0.544). The global estimated risk of MACE at 2-years was 4.8% (3.8%-6.8%). The expected/ observed ratio was 0.56 for the occurrence MACE (picture 2).

Conclusions
Over the first two years after discharge from an acute coronary syndrome, one of every 8 patients developed a potentially fatal recurrent ischemic event. The SRS performed reasonably well in discriminating those at highest risk of MACE, suggesting that this score may help select patients at discharge for ad initium more intensive pharmacological therapy.

Funding Acknowledgement
Type of funding sources: None. ROC curve for the SMART-REACH scoreExpected versus observed MACE
Prediction of congestive heart failure in patients using artificial intelligence: proof of concept
Authors: Pana M , Vasilescu E I , Busnatu S S , Andrei C , Popescu N A , Sinescu C J 
Published: October 2021

Abstract

Introduction
Due to the aging of the population we are confronting ourselves with an increased number of patients with chronic heart failure which stands a prevalence of over 37,7 million cases worldwide, being a major public health issue, first by the substantial morbidity and mortality that carries and second by the economic burden it brings annually upon the health-care system.
The main purpose of this study is to test a machine learning algorithm which can predict, through voice analysis the acutisation of heart failure, considering the particularities of the patient's voice.

Methods
The data we have used has been collected from a total of 16 patients, 9 men and 7 women, ages between 65 and 91 years old, who have agreed to take part in the study.
The selective criteria of inclusion has been the cause of hospitalization, selecting only the patients presented with cardiogenic acute pulmonary edema, regardless the precipitation cause or other known cardiovascular comorbidities. With the same electronic device we have recorded each patient's voice, twice a day, starting from the day one of hospitalization, when their general status was critical, until the day of discharge, when they were clinically stable.
Each voice recording containing specific keywords has been associated to the most used classification system for heart failure, the New York Heart Association Functional Classification and introduced into the machine learning algorithm.

Results
After integrating the information from 15 patients, the algorithm has classified correctly the 16th patient into the third NYHA stage, based only on his voice recording.

Conclusion
Voice is a cheap and easy way to monitor a patient's health status. The algorithm we have used for analyzing the voice provides high accuracy results, but for a larger dataset it might not be the best choice as it is computationally expensive. We are looking to obtain larger datasets and to compute more complex voice analyzer algorithms.

Funding Acknowledgement
Type of funding sources: None.
Prevalence, genotype and phenotype of familial hypercholesterolemia in 10,194 Finnish men
Authors: Korhonen L , Maria M , Vangipurapu J , Laakso M , Kuusisto J 
Published: October 2021

Abstract

Background
Familial hypercholesterolemia (FH) is the most frequent monogenic disease with an estimated prevalence of 1:250. The prevalence of different variants varies widely between the populations. According to previous studies, the prevalence of heterozygous FH in Finland has been reported to be 1:400–650, seven Finnish LDLR founder mutations having been considered to cause 80% of FH.

Purpose
To investigate the genetics of FH in the large Finnish population-based study.

Methods
The whole exome sequencing using Next Generation Sequencing method was performed for 10,194 men from eastern Finland who participated in the METSIM (Metabolic Syndrome in Men) study. The findings were confirmed by Sanger sequencing. The coding regions of the FH causing genes LDLR, APOB and PCSK9 were sequenced. The pathogenicity of the variants was classified according to the ACMG guidelines, and using the Genome Aggregation Database (gnomAD), and the ClinVar archive.

Results
Total 22 individuals of 10,194 carry 8 different pathogenic/likely pathogenic (P/LP) FH variants (7 LDLR variants, 1 APOB variant and 0 PCK9 variants). Seven LDLR gene variants classified as P/LP were detected in 21 individuals. Two of the seven variants are founder mutations (p.Pro309Lysfs*59, p.Arg595Gln), four are other previously reported variants (p.Arg124Trp, p.Glu228*, p.Asp266Asn, p.Asp445Glu) and one is a novel variant (p.Gly396Ala). Of the 21 individuals carrying P/LP LDLR variants, 16 carry founder mutations and five other P/LP LDLR variants. Of individuals carrying any P/LP LDLR variant, 28.6% had premature (men &lt;55 years, women &lt;60 years) atherosclerotic cardiovascular disease (CVD): coronary artery disease (CAD) 28.6%, peripheral artery disease (PAD) 0.0%, and stroke or TIA 0.0%. CVD at any age was diagnosed in 38.1% (CAD 33.3%, PAD 4.8%, stroke or TIA 9.5%). Only one individual from 10,194 carry APOB variant which is classified as P/LP. The detected APOB variant is a previously reported variant (p.Gln4494del). None of the 10,194 individuals carry P/LP PCSK9 variants. Thus, the prevalence of P/LP FH variants in the population from eastern Finland was 0.22%, 1 in 463.4 (LDLR variants 0.21%, 1 in 485; APOB variants 0.01%, 1 in 10 194). Of the P/LP variant carriers, 72.7% carry founder mutation of the LDLR, and 27.3% carry other LDLR and APOB variants.

Conclusions
The prevalence of heterozygous FH in the population-based study of 10,194 men from eastern Finland was 1 in 463.4, which is about the same as previously reported. LDLR variants accounted for the majority of FH cases, and although previously reported Finnish LDLR founder mutations were common, about 30% of the mutations detected were other LDLR and APOB variants. Pathogenic/likely pathogenic APOB variants were, however, rare and PCSK9 variants were not found.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Kuopio university hospital
The frequency and profile of lipid lowering treatment in a contemporary Russian population
Authors: Ryabikov A , Mazdorova E , Shapkina M , Avdeeva E , Simonova G , Hubacek J A , Bobak M , Malyutina S ,   The HAPIEE Group
Published: October 2021

Abstract

Background
Despite of guidelines for management of dyslipidemias (DLP) and the availability of effective and safe lipid lowering drugs (LLD), about one half of CVD patients do not reach the target lipid levels. The knowledge on DLP management in Russian population is limited.

Objective
To analyze the frequency and profile of LLD therapy in subjects with DLP and cardiometabolic diseases in a contemporary Russian population.

Methods
A random population sample of men and women 55–84 years old (n=3898) was examined in 2015–17 in the Russian arm of the HAPIEE project. A composite dysmetabolic group included DLP (total cholesterol, TC ≥5 mmo/l or low-density lipoprotein cholesterol, LDLC ≥3 mmol/l or triglycerides, TG ≥1.7 mmol/l) and/or coronary heart disease (CHD) and/or diabetes mellitus type 2 (DM2). Regular medication intake for 12 months was coded by ATC.

Results
In studied population sample 88% of subjects had dysmetabolic disorders (DLP - 83.1%, CHD - 14.9%, DM2- 20.8%); among them 32.8% subjects received LLD therapy (21.2% in men vs. 39.4% in women, p&lt;0.001) and 17.1% did not report the status of LLD receiving. The frequency of LLD use in CHD group was 48,3%, in DM2 – 35,0%, in DLP – 29.4%. Among named LLD, statins were predominantly used (98%). Lipids control was achieved among subjects with CHD in 18.3% (37.9% among those receiving LLD); among DM2 - in 9.0% (25.6%); among DLP without CHD or DM2 – in 7.3% (24.8%).

Conclusion
In an urban population sample aged 55–84 examined in 2015–17, more than one half of subjects with dysmetabolic disorders (CHD, DM2, DLP) did not receive LLD. Among those receiving lipid-lowering therapy, the lipid control was achieved in about 40% of participants with CHD, and in every forth participant with DM2 or DLP. The lack of lipid control is likely to contribute high rate of atherosclerotic CVD in studied population.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Russian Foundation of Basic Research; Russian Academy of Sciences
Obesity strongly predicts COVID-19-related major clinical adverse events in Coptic Clergy
Authors: Henein M Y , Bytyci I , Nicoll R , Rafik S , Ayad S , Vanchari F 
Published: October 2021

Abstract

Background and aims
The Coptic Clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and identify predictors of clinical adverse events.

Methods
Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt and Group III: Southern Egypt. Participants' demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management and major adverse events (MAEs), comprising death, re-infection or mechanical ventilation, were assessed.

Results
Out of the 1,570 clergy serving in 25 dioceses, 226 (14.39%) were infected. Their mean age was 49.5±12 years and mean weekly number of liturgies was 3.44±1.0. The overall prevalence rate was 14.7% and did not differ between Egypt as a whole and overseas (p=0.23). Disease prevalence was higher in Northern Egypt clergy compared to Europe and USA combined (18.4% vs 12.1%, p=0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p=0.09). Ten priests (4.42%) died of COVID-19 related complications, 2 (0.9%) had re-infection and 27 (11.9%) suffered a MAE. The clergy from Southern Egypt were more obese but the remaining risk factors were less prevalent compared to those in Europe and USA (p=0.01). In multivariate analysis, obesity OR 4.184 (2.483 to 12.14; p=0.01); age OR 1.070 (0.014 to 1.130; p=0.02), and systemic hypertension OR 0.932 (0.874 to 0.994; p=0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p&lt;0.05 for both).

Conclusion
Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events.

Funding Acknowledgement
Type of funding sources: None. Prevalence of SARS-CoV2 among Clergy
Prognosis of diabetes mellitus and timing of heart failure in patients with acute myocardial infarction. An analysis of a French nationwide hospital database
Authors: Fauchier L , Semaan C , Fauchier G , Herbert J , Genet T , Ivanes F , Ducluzeau P H , Angoulvant D , Danchin N 
Published: October 2021

Abstract

Background
Diabetes mellitus (DM) is a factor of increased mortality in patients with acute myocardial infarction (AMI). DM is also associated with a higher risk of heart failure (HF) in patients with coronary artery disease as in the general population. The aim of the present study was to assess the incidence of HF developing at the acute stage of MI and of HF occurring in the year following hospital discharge, according to presence of DM. We also assessed the association between DM, HF and long-term mortality in this AMI population.

Methods
We used the French administrative hospital-discharge database, including all patients without history of HF admitted for AMI between 2010 and 2019 (n=797,212, mean age 69 years, 66% male). Among them, 520,258 patients (65%) had ST-segment elevation myocardial infarction (STEMI), 276,954 (35%) had non-STEMI, 192,456 patients (24%) had a history of DM. Occurrence of HF during the initial hospital stay was analysed in the whole population. In patients without HF during the index hospitalisation, discharged and alive at day 8 (n=535,813), we collected all hospitalisations for HF occurring during the year after discharge and analysed subsequent long-term mortality in those alive at one year (n=270,534) (length of follow-up 2.0±2.5 years, median 0.9, IQR 0.1–3.5).

Results
Overall, DM patients were older than non-DM patients (71±12 vs 67±15 years) and had more frequent comorbidities. At the acute stage, DM was associated with a higher risk of HF (28.7% vs 20.5% adjusted OR 1.40, 1.38–1.42, p&lt;0.0001). In patients without HF at the acute stage and discharged alive at day 8, DM was associated with a higher risk of being hospitalised with HF in the first year (5.6% vs 2.8%, adjusted HR 1.52, 1.49–1.56, p&lt;0.0001). In patients alive at one year, rates of all-cause death per year during subsequent follow-up were 2.2% in those without DM or HF during the first year (reference), 3.4% in those with DM and no HF during the first year (adjusted HR 1.22, 1.18–1.25, p&lt;0.0001), 7.7% in those without DM and with HF during the first year (adjusted HR 1.92, 1.83–2.02, p&lt;0.0001) and 8.9% in those with DM hospitalised with HF during the first year (adjusted HR 2.23, 2.09–2.37, p&lt;0.0001) (see figure).

Conclusion
After AMI, patients with diabetes are at increased risk of heart failure both at the acute stage and in the year following myocardial infarction, compared with non-diabetic patients. Non-fatal HF developing in the year following discharge is associated with noticeably higher subsequent mortality, and the combination of DM and HF is particularly at risk. Improved management is needed in diabetic patients following an AMI to avoid development of heart failure and its longer-term consequences.

Funding Acknowledgement
Type of funding sources: None.
Impact of thrombophilia and waist circumference on the risk of venousthromboembolism
Authors: Kondratieva T B , Popova L V , Khlevchuk T V , Kanevskaya M Z , Aksenova M B , Bokarev I N , Belenkov Y N , Golub A V , Ptrushev L I , Kovalenko T F , Gerasimov A N 
Published: October 2021

Abstract

Background
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) represents a major health problem. In the general population, the absolute risk of any kind of VTE is 0.1%–0.2% per year, and it increases with age. VTE is an important and preventable cause of morbidity and mortality, with almost a third of survivors experiencing long term effects. Obesity is well-known risk factor of VTE. The extent of the effects of obesity on VTE depends not only on total body fat, but also on the distribution of adipose tissue (e.g., central obesity) and the interplay among risk factors for VTE, such as genetic mutations, and other risk factors.
Thrombophilia, venous thromboembolism, obesity, waist circumference

Purpose
The aim of this study is to investigate the impact of waist circumference on the risk of venous thromboembolism

Methodology
The study involved 68 patients with VTE (33 females and 34 males, mean age 56.8 years ±15.3) and 84 patients without VTE (38 males and 46 females, 44.4 years±18.6). From 2015 to 2017, data have been collected from records of patients admitted to department of internal medicine. All subjects were recruited to the study during their stay in the hospital. The reasons for hospitalization were: acute event of DVT or PE for the main group, the absence of acute event or history of VTE for the control group. DVT was diagnosed by ultrasonic Doppler examination, and PE was confirmed by intravenous radiocontrast computed tomography. Anthropometric measures were performed with subjects wearing short-sleeved garments and no shoes; waist circumference was measured in centimeters at the umbilical line. For all patients genetic testing for inherited thrombophilia – Factor V Leiden G1691A, Prothrombin G20210A, MTHFR C677T polymorphism, PAI-1 (SERPIN1) 4G/5G polymorphism – was performed by real-time PCR technique.

Results
Factor V Leiden G1691A increase the risk of VTE in 2.11 (CI: 1.79–2.48), p=0.049, prothrombin G20210A in 3.21 (CI: 1.66–6.211), p=0.049. MTHFR C677T polymorphism, PAI-1 (SERPIN1) 4G/5G polymorphism also increase the risk of VTE, but it was no significant. Study have shown that waist circumference &gt;80 cm increase the risk of VTE in 3.19 (CI: 1.35–7.58), p=0.019. Combination of inherited thrombophilia (Factor V Leiden G1691A, Prothrombin G20210A, MTHFR C677T polymorphism, PAI-1 (SERPIN1) 4G/5G polymorphism) and waist circumference &gt;80 cm increase the risk of VTE in 3.51 (CI: 1.76–7.04), p&lt;0.001.

Conclusion
Previous results of our work indicate influence of waist circumference &gt;80 cm on the risk of VTE, especially risk of thrombosis is higher in patients with combination inherited thrombophilia and waist circumference &gt;80 cm.

Funding Acknowledgement
Type of funding sources: None.