bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel direct method to determine adherence to simvastatin therapy in patients with coronary heart disease
Authors: Vethe N , Husebye E , Andersen AM , Bergan S , Kristiansen O , Fagerland MW , Munkhaugen J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): National Association of Health

OnBehalf
NORCOR

Background
Poor adherence to statin therapy remains a public health concern associated with adverse clinical outcome. Reliable classification and detection of statin adherence is needed in clinical practice and for clinical studies with overall aim to improve the lipid management. Simvastatin is a frequently used statin in cardiovascular disease prevention.

Purpose
To develop a feasible test based on spot blood samples to monitor the adherence to simvastatin therapy in coronary heart disease (CHD) patients.

Methods
Eighteen CHD patients on an evening dose of simvastatin 20 mg (n = 7), 40 mg (n = 5) and 80 mg (n = 6) were studied at steady-state pharmacokinetics. Ten patients were instructed to avoid simvastatin dosing and return for blood sampling the subsequent three days. Dose-normalized plasma concentrations of simvastatin lactone, simvastatin acid and the sum of the two were evaluated as discriminators between adherent dosing and dose avoidance. Bioanalytical quantifications were performed with liquid chromatography tandem mass spectrometry.

Results
The dose-normalized plasma concentrations at steady-state demonstrated 23-fold and 39-fold interindividual variabilities for simvastatin lactone and simvastatin acid. A simvastatin acid cut-off at 1.0·10^-2 nmol/L/mg identified 100% of those omitting 2 doses and 60% of those omitting a single dose (Figure 1). Simvastatin acid showed superior ability to discriminate dose avoidance from adherence, and also the best agreement between samples handled at ambient and cool temperature (median deviation 3.5%, interquartile range -2.5 to 13%). A cut-off for morning dose schedule, with similar ability to discriminate, was estimated at 2.0·10^-3 nmol/L/mg.

Conclusion
A novel method discriminating between good and poor adherence to simvastatin therapy in CHD patients has been developed. The sample handling is feasible for routine practice, and the assessment of adherence can be performed by direct measurements in spot blood samples, according to specific cut-off values.
Abstract Figure 1 Drug levels vs dose avoidance
Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis
Authors: Abdul Razzack A , Pothuru S , Adeel Hassan S , Mandava S , Theja Reddy K , Missael Rocha Castellanos D , Rocha Castellanos D , Lilian Contreras Gallegos G , Sanchez Alfaro A , Arshad J , Sattar Y 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM.
Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05.The primary outcome was all-cause mortality.
Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p &lt; 0.00001, I2 = 36)as opposed to patients without T2DM.
Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery.
Abstract Figure.
Impact of perceived stress into mortality among the elderly population
Authors: Imaeva A , Shalnova S , Kapustina A , Balanova Y , Shkolnikov V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. According to the results of the recent studies, high levels of perceived stress were the potent risk factors for all-cause and cardiovascular mortality among the middle-aged population. However, there were few studies on the impact of this factor to mortality among the older males and females.
Purpose. To investigate the association between perceived stress and all-cause and CVD mortality among the population of 75 years and older.
Methods. This study was a part of the prospective cohort survey "Stress, aging and health." Data of 455 adults 75 years and older (287 males and 168 females) was used. We evaluated perceived stress Cohen"s Stress Scale. All items were scored on a 5-point scale, high scores indicated high levels of stress. Perceived Stress Scale sum scores were categorized into quintiles; we considered scores in the highest quintile (&gt;19) as abnormal. The mean follow-up was 12 years, 292 deaths occurred, including 200 from cardiovascular diseases (CVD). Association between perceived stress and all-cause and CVD mortality was evaluated by Cox regression model after adjustment for age.
Results. High levels of stress were significantly associated with all-cause and CVD mortality among elderly males (HR = 1,48 95% CI: 1,09-1,99; p = 0,01; HR = 1,65; 95% CI: 1,15-2,36; p = 0,007) after adjusting for age. At the same time, among females aged 75 years and older no significant associations of perceived stress scale high scores with all-cause and CVD mortality were found (HR = 1,28; 95% CI: 0,84-1,96; p = 0,25; HR = 1,19; 95% CI: 0,73-1,95; p = 0,48).
Conclusions. Perceived stress contributed significantly to higher mortality rates among males aged 75 years and older. While among females of the same age, no significant associations between high stress levels and all-cause and CVD mortality were found.
The effects of preventive counseling followed by remote support via phone on the motivation to change lifestyle in patients with high cardiovascular risk
Authors: Pogosova N , Yusubova AI , Yufereva YM , Sokolova OY , Karpova AV , Ausheva AK , Arutyunov AA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Personal motivation for lifestyle change plays a fundamental role in modifying unhealthy habits. It can be improved, for example, through education.

Objectives
To assess the effects of preventive counseling with focus on diet modification followed by remote support via telephone on the motivation to change lifestyle in patients (pts) with high cardiovascular risk in a long-term follow-up.

Methods
This is a prospective randomized controlled study of pts aged 40 to 65 years with high/very high CV risk (≥5% according to the Systematic Coronary Risk Evaluation scale [SCORE]) and any 2 criteria of metabolic syndrome. Pts were randomized into 2 groups in 1:1 ratio. The intervention group received comprehensive preventive counseling with focus on diet modification followed by remote preventive counseling by phone every two weeks for the first 3 months after enrollment (a total of 6 sessions). The control group received usual care in Health centers which also included basic preventive counseling. A specially designed questionnaire was used to evaluate the motivation to change lifestyle at baseline and 12 months.

Results
A total of 100 pts (women - 80%, aged 59.85 ± 4.47 years) were randomized. At baseline 81% pts had high and 19% - very high CV risk. The groups were well balanced according to demographic and clinical features. At 1 year of follow-up the intervention group experienced significant improvement in motivation for lifestyle changes vs control. The proportion of pts achieving advanced stages of change process was 38% vs. 12% in the control group where 82% of pts only continued to think of lifestyle modification.

Conclusion
Preventive counseling followed by remote support via phone provided a significant improvement in motivation to change lifestyle.
Intervention group Control group P for change from baseline Baseline After 12 months Baseline After 12 months Not ready yet, % 0 0 0 0 &lt;0.05 Often think of lifestyle changes, % 62 46 86 82 Ready to do changes if provided specific advices, % 32 16 12 6 Are in process of successful changes, % 6 38 2 12
Cardiac rehabilitation uptake in ESC member countries: heterogeneity and obstacles
Authors: Alves Da Silva P , Ruivo JA , Abreu A , Perk J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiac Rehabilitation (CR) is a multidisciplinary intervention with proved results in patients with cardiovascular (CV) disease. CR penetration status and implementation strategies differ among ESC various members, with different uptake performance according to the results from the latest Overview of CR in ESC member countries (OCRE) report.

Purpose
To analyse possible implementation factors influencing differential CR phase II uptake after myocardial infarction across OCRE countries.

Methods
An online survey was sent to all National CV Prevention Coordinators of 51 ESC member countries (champion physicians with deep understanding of their national CR state and easy access to all CR centres for information), to cover important CR demographic, structural and quality control topics. Chi-Square test of independence was performed to find possible statistical associations among surveyed topics with reported average post-MI uptake rate per country.

Results
Forty-two ESC-affiliated countries answered the survey (82% participation rate): 57% were from the South (n = 24); 62% high income countries, 24% upper middle, 14% lower middle, as defined by the ESC Atlas; 65% (n = 28) followed ESC related guidelines. CR uptake was reported at 0-25% (n = 17), 25-50% (n = 14), 50-75% (n = 7), 75-100% (n = 4).
There was a significant correlation between geographic localization and CR patient enrolment, with Northern countries having a higher rate of uptake [X2 (3, n = 42) p = 0,012]. Country wealth did not correlate with CR uptake, but patient low socio-economic status per se, reported as an obstacle by 50% of all countries, showed a positive correlation trend with lower CR enrolment [X2 (3, N = 42), p = 0,07]. A positive association trend between CR predominantly funded by public means and uptake rate was also noted [X2 (3, N = 42), p = 0,08]. Other factors, such as in or outpatient CR delivery predominance or coordination of the program by a cardiologist did not influence the uptake rate. Forty-one percent of the countries reported lack of preventive culture as an obstacle at healthcare level and 16% of them stated cultural issues at patient-level, although no distinct correlation with CR uptake was shown.

Conclusions
Our analysis shows regional differences between Northern and Southern countries in terms of CR uptake following myocardial infarction. The positive exploratory correlation trends may suggest that social/cultural/financial aspects may play a role in the uptake asymmetries. Specifically powered studies and interaction analysis should be sought in the future concerning those variables in particular.
Hemodynamic response to high and low load resistance exercise in patients with coronary artery disease: a crossover, randomised, clinical trial
Authors: Kambic T , Hadzic V , Lainscak M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background
Low loads resistance exercise (LL-RE) is advised as an adjunct therapy to aerobic exercise in cardiac rehabilitation (CR), while the implementation of high loads (HL) RE in the early phase of CR is limited by the scarce body of evidence on the safety associated with hemodynamic response during the exercise.

Purpose
The aim of this study was to evaluate hemodynamic response during HL-RE and LL-RE in patients with coronary artery disease (CAD) prior to enrollment in CR.

Methods
A total of 43 patients were enrolled into the study, age, mean (SD), 61 (10) years, height 172.3 (7.8) cm, weight 88.09 (16.66) kg and left ventricular ejection fraction 53 (10) %. After the initial ambulatory screening by cardiologist and cardiopulmonary exercise test, patients were familiarised with proper lifting and breathing technique, and performed one repetition maximum (1-RM) test on leg press machine during the first visit to CR. During the second and third visit to CR, hemodynamic response (measured as heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and blood oxygen saturation) to LL-RE (3 sets, 16 repetitions per set at 40 % of 1-RM) and HL-RE (3 sets, 8 repetitions per set at 80 % of 1-RM) was measured in a crossover randomised manner. A lifting cadence of 1 s of concentric contraction and 1 s of eccentric contraction was used with 90 s of rest between sets, and 48-72 hours of rest between both RE sessions. Rating of perceived exertion (RPE, 0-10 Borgs` scale) was assessed at baseline and after each set of LL-RE and HL-RE.

Results
Both types of RE were shown to be safe, without any reported cardiovascular events. Forty-one patients completed LL and HL-RE, and two were excluded from the final analysis (one due to failure in measurement and one was unable to complete the last set of HL-RE). Compared to baseline, HR and SBP increased during LL-RE [+21 bpm, p &lt; 0.001; +17 mm Hg, p &lt; 0.001] and HL-RE [+18 bpm, p &lt; 0.001; +16 mm Hg, p &lt; 0.001]. Increase in HR compared to baseline was greater after the last set of LL-RE compared to HL-RE (32 % vs. 28 %, p = 0.015), without significant changes in SBP and DBP between RE. RPE increased during LL-RE and HL-RE (both p &lt; 0.001), with higher rating after the 1st set of HL-RE compared to LL-RE (Median (interquartile range), 6 (5-7) vs. 6 (5-6), p = 0.009).

Conclusions
LL-RE and HL-RE were shown to be safe and well tolerable among patients with CAD. HL-RE induced similar hemodynamic response compared to LL-RE. Future trials should aim to compare the safety and efficacy of LL and HL resistance training in out-patient CR.
The efficacy of cardiac rehabilitation on exercise performance in men and women
Authors: Kambic T , Lainscak M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency

Background
Over the last years exercise training has gained IA class recommendation as a core component of cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). Despite the strong evidence of higher mortality and rehospitalisation rates in women compared with men with CAD, women are less frequently enrolled in CR programs and show lower exercise adherence. However, when enrolled women showed similar improvement as men, but this remains to be further elucidated.

Purpose
The aim of this study was to examine the gender differences in improvement of exercise performance in patients with CAD following CR programme.

Methods
A total of 91 patients with CAD (74 men and 17 women, mean (SD), aged 59 (11) years and 60 (10) years, p &gt; 0.05; median (interquartile range), height 177 (173, 181) cm and 159 (158, 167) cm, p &lt; 0.001; weight 92.1 (82.4, 98.6) kg and 72.3 (69.1, 79.6) kg, p = 0.001, respectively) participated in out-patient CR. Each patient completed 36 exercise sessions comprised of general warm up with calisthenics, followed by 5 aerobic intervals of cycling on stationary bikes (5 minutes of loaded cycling at the intensity of 50 %-70% of peak power separated by 2 minutes intervals of unloading cycling) and finished with stretching and breathing exercises. Training load and target training heart rate were increased every two weeks. The exercise test was performed at baseline and after CR.

Results
At baseline, there was a significant difference between men and women in peak power (P max) (men 122 (25) W vs. women 74 (19) W, p &lt; 0.001), maximum oxygen consumption (VO2 max; men 19.45 (3.60) ml/kg/min vs. women 16.00 (3.35) ml/kg/min, p &lt; 0.001) and exercise test time (men 658 (150) s vs. women 363 (115) s, p &lt; 0.001). During the training both genders increased training intensity (men: +34 (12) W and women: +25 (9) W, both p &lt; 0.001) and target heart rate (men: +10 (5, 19) bpm and women: +10 (5, 20) bpm, both p &lt; 0.001), whereas training intensity was increased more in men than women (+9 W, p = 0.003). Exercise training led to improvement in P max (men: +15 (20) W, p &lt; 0.001, women: +14 (12) W, p &lt; 0.001), VO2 max (men: +1.87 (2.52) ml/kg/min, p &lt; 0.001, women: +2.47 (2.05) ml/kg/min, p &lt; 0.001) and exercise test time (men: +99 (134) s, p &lt; 0.001, women +95 (90) s, p &lt; 0.001). In addition, after adjusting for baseline values there were no sex differences in post training P max, VO2 max and exercise test time.

Conclusions
CR improved the exercise performance similarly in men and women, thus, more women should be encouraged to enrol into CR programmes. Still, larger and adequately powered randomised studies are warranted to further elucidate this issue.
Exercise training early after acute ST-elevation myocardial infarction and its effect on ventricular remodeling
Authors: Sigl A , Esefeld K , Latsch F , Halle M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Deterioration of left ventricular function after acute myocardial infarction is common, particular in ST-elevation myocardial infarction (STEMI). This often leads to heart failure with reduced ejection fraction (HFrEF). Exercise training has shown to be beneficial in stable chronic heart failure patients. However, effects of exercise training have been rarely investigated during very early phases of STEMI.

Purpose
The Exercise in Acute Myocardial Infarction (Ex-AMI) pilot study wanted to investigate whether exercise training has beneficial effects on ventricular remodeling under the following conditions:
a) started early after myocardial infarction
b) exclusively after STEMI
c) performed with higher intensity.
The hypothesis of this study was that exercise training early after acute myocardial infarction performed for 24 weeks is superior to usual care, regarding the improvement of echocardiographic parameters. It was also assumed that higher-intensity interval training is more effective than moderate continuous training.

Methods

Therefore, we randomized 19 patients with STEMI (58.0 ± 7.1 years, 5% female) and left ventricular ejection fraction (LVEF) &lt;55% to:
1. Moderate continuous training (MCT; 50-60% VO2peak; n = 6)
2. Higher intensity interval training (HIIT; MCT interspersed by intervals of 80-85% VO2peak; n = 6)
3. Usual care (UC; n = 7)
Exercise groups (EG: MCT and HIIT) started seven days after STEMI (run-in period for two weeks, followed by a tailored supervised exercise program for 22 weeks). Three-dimensional echocardiography and cardiopulmonary exercise testing were performed at the beginning and at the end of the training period. Patients were also continuously monitored for adverse events.

Results
At baseline, LVEF (46.3 ± 6,5%) as well as exercise capacity (VO2peak: 17.8 ± 4.4·kg-1·min-1) were impaired. In both exercise groups (EG: MCT and HIIT) LVEF improved significantly more than in the control group (mean change +7.3 ± 3.5% in EG vs. 2.3 ± 2.3% in UC; p = 0.007). Furthermore HIIT was not superior to MCT (mean change 7.6 ± 3.6% in HIIT vs. 6.7 ± 4.1% in MCT; p = 0.78) in terms of LVEF. There were no training associated adverse events.

Conclusion
Exercise training early after acute STEMI seems to have anti-remodeling effects. There is a need for more randomized controlled trials to confirm these findings, in order to find the optimal timing and dose of exercise after STEMI.
Abstract Figure. Changes in LVEF (in %) after 24 weeks
The importance of first and second ventilatory thresholds to define aerobic exercise intensity in cardiac patients and in healthy subjects: what is essential can be visible to the eyes
Authors: Anselmi F , Cavigli L , Pagliaro A , Valente S , Valentini F , Cameli M , Focardi M , Mochi N , Mondillo S , Dendale P , Hansen D , Bonifazi M , Halle M , D"ascenzi F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1) and second ventilatory threshold (VT2) in cardiac patients, sedentary subjects and athletes comparing VT1 and VT2 with EI defined by recommendations.
Methods. We prospectively enrolled 350 subjects (mean age: 50.7 ± 12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2, peak heart rate (HR), and HR reserve were obtained at VT1 and VT2, and compared with EI definition proposed by the recommendations.
Results. VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and in 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most of cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory-thresholds and recommended EI domains was observed in healthy subjects and in athletes (90% and 93.9%, respectively).
Conclusions. EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable in order to define an appropriate level of EI.
Abstract Figure.