bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study
Authors: Hassan A , Lip G , Bisson A , Herbert J , Bodin A , Fauchier L , Harris R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors.

Purpose
To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF.

Methods
A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR).

Results
In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p &lt; 0.01).

Conclusions
An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions.
Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) &lt;0.0001 1.076 (1.075-1.076) &lt;0.0001 Gender (male) 1.640 (1.629-1.651) &lt;0.0001 1.0498 (1.487-1.509) &lt;0.0001 Hypertension 2.849 (2.829-2.869) &lt;0.0001 1.114 (1.487-1.509) &lt;0.0001 Diabetes mellitus 1.951 (1.935-1.968) &lt;0.0001 1.106 (1.096-1.116) &lt;0.0001 Heart failure 3.893 (3.857-3.930) &lt;0.0001 1.434 (1.416-1.452) &lt;0.0001 Ischaemic stroke 2.289 (2.23902.340) &lt;0.0001 1.140 (1.114-1.165) &lt;0.0001 smoker 0.903 (0.891-0.917) &lt;0.0001 1.052 (1.036-1.069) &lt;0.0001 Liver disease 1.141 (1.119-1.164) &lt;0.0001 1.082 (1.059-1.105) &lt;0.0001 Previous myocardial infarction 2.128 (2.082-2.176) &lt;0.0001 0.903 (0.880-0.926) &lt;0.0001 Inflammatory disease 1.036 (1.020-1.052) &lt;0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) &lt;0.0001 0.821 (0.807-0.836) &lt;0.0001 Illicit drug use 0.288 (0.263-0.317) &lt;0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years).
Abstract Figure. Flow Chart of the study patients
Impact of Proteinuria and Low eGFR on Lifetime Risk of Cardiovascular Disease Death: A Pooled Analysis of Data From the Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Study
Authors: Imai Y , Sakurai M , Nakagawa H , Hirata A , Murakami Y , Kiyohara Y , Ninomiya T , Ishikawa S , Saitoh S , Irie F , Sairenchi T , Kiyama M , Miura K , Ueshima H , Okamura T 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): H20–Junkankitou [Seishuu]–Ippan–013; H23–Junkankitou [Seishuu]–Ippan–005; H26-Junkankitou [Seisaku]-Ippan-001; H29–Junkankitou–Ippan–003 and 20FA1002

OnBehalf
EPOCH-JAPAN

Introduction
Absolute risk of Lifetime risk (LTR) is useful estimate for risk communication compared with short term risk or relative risk especially for young people. Proteinuria is leading cause of end-stage kidney disease (ESKD) and independent risk factor for cardiovascular disease (CVD). Although nonproteinuric renal disease is global burden of ESKD, it has been poorly focused. To date, there have been no reports of impact of proteinuria and low eGFR on LTR with the outcome of CVD death in Asian population.

Purpose
We aimed to estimate LTR of CVD death stratified by the status of proteinuria and low eGFR.

Methods
We used modified Kaplan-Meier approach to estimate the remaining lifetime risk of cardiovascular death based on EPOCH-JAPAN(Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) database. LTR was estimated at each index age starting from 40 years for those with proteinuria and without proteinuria stratified by low eGFR, which is defined as eGFR &lt;60 ml/min/1.73 m². Participants were classified into three groups, which were those with proteinuria (Proteinuria (+)), those without proteinuria with low eGFR (Proteinuria (-)/Low eGFR (+)), those without proteinuria without low eGFR (Proteinuria (-)/Low eGFR (-)).

Results
A total of 47,292 participants from 9 cohorts was included in the analysis. Mean follow-up period was 14.6 years with 690,463 person years and total CVD death was 1,075 in men and 1,193 in women. The LTRs at the index age of 40 years were as follows: 17.7% (95% confidence interval: 15.4 – 19.0%) in Proteinuria (-)/Low eGFR (-) group, 26.2% (20.2 – 31.1%) in Proteinuria (-)/low eGFR (+) group, 24.5% (15.1 – 29.3%) in Proteinuria (+) group for men; 15.3%(13.7 – 16.5%), 29.9%(14.7 – 46.8%) , 28.3%(19.4 – 34.7%) for women.

Conclusions
We observed that those without proteinuria with low eGFR have equivalently high LTR with those with proteinuria. These results indicate that even in the absence of proteinuria, low eGFR has high impact on LTR. Lifestyle modification from young age is necessary to prevent from renal dysfunction.
Identifying the prevalence of undiagnosed cardiovascular disease risk factors in healthy Indians
Authors: Thanvi S , Thakkar P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction

Cardiovascular disease (CVD) including heart disease and stroke, is the leading cause of death globally and in India.
The importance of primary prevention, defined as interventions designed to modify adverse risk factors with the goal of preventing an initial CVD event has been established beyond doubt by several population based studies in healthy individuals.
While there have been many studies defining the high prevalence in CVD risk factors in Indian population, this study sought to determine the prevalence of undiagnosed modifiable CVD risk factors in healthy individuals.

Methods
The cross sectional, analytical study was carried out at the hospitals, from 1st April 2015 to 31st dec 2017. Subjects between 18 - 70 years of age who were healthy and were undergoing health checkup were included in the study. A total of 5000 patients were screened, those having existing CVD risk factors were excluded from the study.
This study was approved by the institutional ethics committee of the hospital. Written informed consent was obtained from all subjects. The data collection record sheet was prepared based on validated and standardized questionnaires which was used to enter all data.
Physical examination for vitals and BMI was done by qualified physicians. Blood investigations were done for diabetes and dyslipidemia and thyroid dysfunction. ACC/AHA criteria was used for diagnosis of hypertension, ADA criteria for diabetes. Joint British society 3 risk score and ASCVD risk score was calculated using standard calculators.

Results
At screening, 4998 participants aged ≥18 years were approached to participate in study. The study population included 2705 men (68.1%) and 1265 women (31.9%) with a mean age of 68± 18.8 years. The most prevalent risk factor was overweight and obesity (71.2%).
The prevalence of undiagnosed HTN was 73.3%, undiagnosed pre-diabetes was 24.9% and undiagnosed diabetes was 28.3%. Out of total, 44.3% subjects had high level of low-density lipoprotein and 36.6% subjects had low level of high-density lipoprotein, 20.1% subjects had high level of very-low density lipoprotein (VLDL) and 17.3% subjects had high level of triglyceride.
Tobacco smoking was present in 7.7% of the population. The risk estimation predicted 29.1% of the study participants to have more than 10% risk of heart attack/stroke risk at 10 years.

Conclusion
Our study reveals a fairly good snapshot of CVDs risk factors in healthy general population. Increased prevalence of high BMI, undiagnosed HTN, diabetes, dyslipidemia was present in our study population.
The population had significantly high predicted risk of heart attack/stroke. These findings warrant the need of community based life style modifications, regular health checkup for healthy population for early detection and modification of CVD risk factors.
Systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms in patients with coronary artery disease
Authors: Doyle F , Freedland KE , Carney RM , De Jonge P , Dickens C , Pedersen S , Sorensen J , Dempster M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.

Methods
We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis synthesized the evidence. GRADE was used to assess evidence quality.

Results
Thirty-three RCTs (7240 participants) provided analysable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low.

Conclusions
All treatments were equally acceptable, while antidepressants appeared to have the most robust evidence base for post-CAD depression. The evidence base was limited and biased; conclusions based on this literature should be drawn cautiously and considered to be tentative. Rigorous, multi-arm intervention trials, including trials of combination therapies and exercise, are urgently needed.
A diet-related microsimulation modelling approach in the context of cardiovascular disease prevention: the ATTICA and GREECS epidemiological studies
Authors: Kouvari M , Tsiampalis T , Chrysohoou C , Notara V , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos DB 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].
Background/Introduction: Among all behaviors, nutrition makes the largest contribution to cardiovascular disease (CVD) morbidity across Europe. Purpose: The aim of the present work was to quantify the changes in 10-year CVD onset or recurrence or mortality, in relation to transitioning from low to higher level of adherence to Mediterranean diet. Methods: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of level of adherence to Mediterranean diet were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Results: Improving the level of adherence to the Mediterranean diet, even in 10% of the population, a significant relative percentage reduction was observed in the 10-year risk for CVD onset, recurrence and mortality, with the observed reductions being higher among women. In particular, at least 851 first CVD events, 374 recurrent CVD events and 205 CVD deaths per 100,000 of population could be averted or delayed. Additionally, Mediterranean diet clustering revealed that high consumption of fruits, vegetables, whole wheat products and legumes was more important than low consumption of meat and full fat dairy products against CVD. Conclusion: This microsimulation process confirms the added value of Mediterranean diet in primary and secondary CVD prevention having great achievements even with small modifications on a population basis, while challenges the orientation of a Mediterranean-diet intervention giving higher weights to plant-based part.
Moderate and vigorous physical activity levels are associated with circulating CD34+ progenitor cells which are predictive of all-cause and cardiovascular mortality
Authors: Ross M , Muggeridge D , Dodd J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Edinburgh Napier University Research Excellence Grant

Background
Circulating progenitor cells (CPCs) play an important role in vascular repair and may influence cardiovascular (CV) health and longevity. Physical activity is known to promote vascular health and may do so by modulating CPC counts.

Purpose
The primary aims of this study were to evaluate the association of CPCs with mortality and explore the association between physical activity (PA) and CPCs.

Methods
We studied 1,751 individuals from the Framingham Offspring cohort (66 ± 9 years, 54% female). CPCs (CD34+, CD34 + CD133+, CD34 + CD133 + KDR+) were measured from blood samples by flow cytometry. Multivariable cox regression analyses were performed to investigate the relationship of CPCs with future CV event, mortality, and all-cause mortality. Multivariate regression analyses were performed to determine the relationship between self-reported PA and CPC counts.

Results
Following adjustment for standard risk factors, there was an inverse association between CD34+ CPCs and all-cause mortality (hazard ratio (HR) per unit increase in CD34+, 0.79; 95% CI 0.64 – 0.98). CD34 + CD133+ CPCs were inversely associated with CV mortality (HR 0.63, 95% CI 0.44 – 0.91, P = 0.013). Associations of CD34+ and CD34 + CD133+ with mortality were strongest in participants with pre-existing CVD. PA was associated with CD34+ CPCs only in CVD participants. This relationship was maintained after adjustment for confounding variables.

Conclusions
Higher number of CD34+ and CD34+ CD133+ CPCs were inversely associated with all-cause and CV mortality. These associations were strongest in participants already diagnosed with CVD. PA is independently associated with CD34+ CPCs in individuals with CVD only, suggestive of greater benefit for this population group.
Correlation of STOP-bang obstructive sleep apnoea screening tool to apnoea-hypopnea index in a general cardiology population
Authors: Mannion J , Binalialsharabi W , Caples N , Rogan M , Foley S , Owens P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The link between obstructive sleep apnoea (OSA) and cardiovascular disease is well known. Prevalence can be very high in this population, sharing many pathophysiological drivers in addition to being a risk factor. More concerning however is the increasing number of patients with undiagnosed OSA, who are at higher risk of long-term complications such as coronary artery disease, hypertension, atrial fibrillation, heart failure or stroke. There are several OSA screening tools available to clinicians, with variable sensitivities and specificities depending on patient demographics.
Predictive efficacy of the STOP-Bang screening tool in a general cardiology population with mixed cardiovascular disease has not been established.

Proposal
To identify the correlation between the STOP-Bang assessment score (1-8) and real-world Apnoea-Hypopnoea Index (AHI) in a general cardiology clinic population.

Methods
250 successive patients in a general cardiology clinic were asked to complete a STOP-Bang assessment. Of those, 50 patients with a variety of STOP-Bang scores were randomly selected to undergo sleep studies. A STOP-Bang value of ≥ 5 was taken as high-risk for moderate-severe OSA. Statistical linear regression analysis was performed in IBM SPSS version 26.

Results
Of n = 50 patients, mean STOP-Bang score =3.7 (SD +/-2.17) with mean AHI =15.8, (SD +/- 14.3). See Table 1 for categories 1-8. N = 44 (88%) had AHI ≥ 5 (At least mild OSA). N = 18 (36%) had an AHI ≥ 15 (Moderate-severe OSA). N = 29 (58%) had symptoms such as sleepiness, loud snoring or witnessed apnoea. Correlation between STOP-Bang score and AHI was high, with an R value of 0.704, R2 = 0.496 (p &lt; 0.01). A STOP-Bang score increase of 1 corresponded with a mean AHI rise of 4.648. When taking a STOP-Bang value of ≥ 5 as "positive", we demonstrated a sensitivity of 83.33% (95% C.I. 58.58-96.42) and specificity of 93.94% (95% C.I. 79.77-99.26%) for moderate-severe OSA (AHI ≥ 15).

Conclusion
We discovered a very high number of patients with undiagnosed OSA of at least mild severity. We found a strong correlation between STOP-Bang score and real-world AHI in a general cardiology population with mixed cardiovascular disease with 5 as an acceptable screening score for moderate-severe OSA.
Table 1 STOP-Bang Value 1 2 3 4 5 6 7 8 Patients (N=) 12 5 7 9 5 5 5 2 AHI (Mean) 6.67 6.62 9.97 11.95 24.44 22.20 39.54 35.25 Standard Deviation (±) 3.29 2.74 3.45 4.63 12.87 5.69 27.2 6.72 Summary of mean apnoea-hypopnoea index and standard deviation for each STOP-Bang patient category.
Abstract Figure 1
Ttrimetyllysine and risk of new-onset atrial fibrillation in two large norwegian cohorts
Authors: Svenningsson MM , Dhar I , Svingen GFT , Pedersen EKR , Nilsen D , Ueland PM , Ulvik A , Tell GS , Bjoernestad E , Nygaard OK 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Aim
Increased plasma trimetyllysine (TML), a methylated amino acid, has recently been linked to higher risk of acute myocardial infarction (AMI). TML is also a precursor of trimethylamine-N oxide (TMAO), which has been linked to increased cardiovascular risk, including that of atrial fibrillation (AF). We investigated the association between TML and new-onset AF in two large Norwegian cohorts.

Methods
The primary cohort consisted of 6396 participants in the community-based Hordaland Health Study (HUSK). The validation cohort consited of 2027 patients who underwent coronary angiography due to suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). Information on new-onset AF was obtained by linking patient data to Norwegian public health registries. Risk associations were explored by Cox regression.

Results
During median (25th-75th percentile) follow-up of 10.9 (10.6-11.3) and 7.0 (6.3-8.6) years, 560 (8.8%) patients in the HUSK and 210 (10.4%) in the WECAC was diagnosed with AF.
In the HUSK, the age and gender adjusted HR (95 % CI) for the 4th vs. 1st plasma TML quartiles 1.84 (1.37-2.48) p &lt; 0.001. In multivariable models the association was only slightly attenuated. Correspondingsly, the age and gender adjusted HR (95% CI) for the 4th vs. 1st TML quartiles in the WECAC was 1.48 (0.96-2.27) p = 0.07.
Testing for collinearity between TMAO and TML revealed variance inflation factors between 1.0-1.1 in HUSK and WECAC, thus ruling out collinearity.

Conclusion
Plasma TML was associated with new-onset AF among subjects from the general population, and the relationship was independent from established AF risk factors. A similar trend was also seen in patients with suspected stable angina pectoris, strengthening our findings, which motivate further studies to explore potential pathophysiological relationships between one-carbon metabolism and cardiac arrhythmias
Lower perception of pharmacological treatment increases risk of non-adherence to medication
Authors: Graversen CB , Valentin JB , Larsen ML , Riahi S , Holmberg T , Zinckernagel L , Johnsen SP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background
A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data.

Purpose
To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD.

Methods
This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega.

Results
Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67).

Conclusion
Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class.
Abstract Figure. Figre: Multiple adjusted analyses