bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of folic acid therapy for the association between high serum vitamin B12 level with all cause mortality among hypertensive population: the CSPPT randomized clinical trial post-hoc analysis
Authors: Cao T , Huang X , Huang X , Wang B Y , Wang B Y , Wu H Y , Wu H Y , Spence D , Spence D , Yong H Y , Yong H , Cheng X S , Cheng X S , Liu L S , Liu L S , Xu X P , Xu X P 
Published: October 2021

Abstract

Background
While higher vitamin B12 level was found to be co-related with mortality in various population, the effectiveness of folic acid therapy for this association remained unknown.

Purpose
1: Explore the association between high B12 level and all cause mortality in hypertensive population. 2: To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing all cause mortality than enalapril alone among targeted population.

Methods
Current study used post hoc analysis to examin data from the china stroke primary prevention trial (CSPPT), a randomized, double-blind, multi-center clinical trial. After excluded those lack of vitamin B12 data and with extreme B12 value, 20,204 participants (mean age 60 [SD. 8.54]; 59.16% male gender; total mean serum vitamin B12 level 410.51 [SD. 124.85] pg/ml) were included in present study.10,093 participants were treated with enalpril alone and 10,111 patients took the combine use of enalapril and folic acid. The primary outcome was all cause mortality, which collected based on hospital issued death certificate and investigation during follow up period.

Results
Over the medium follow-up time of 4.5 years, 308 death occurred in enalapril group and 295 death happened in enalapril-folic acid group. Differences were observed regarding sex, center, smoking & drinking status at baseline. In enalapril group, high vitamin B12 level presented positive linear association with all cause mortality and was found to be significantly differences (P=0.018). Whereas no association between high vitamin B12 level and all cause mortality were observed in enalapril and folic acid group. (P=0.448). KM curves and tertile analysis of vitamin B12 level also showed same finding. Sensitivity analysis were processed to ensure the accuracy of the study result.

Conclusion
The present study not only explored that higher vitamin B12 level will increase all cause mortality in hypertensive population, but also found that high vitamin B12 level loses its co-relationship with all cause mortality after folic acid therapy, which potentially reflected the benefits of long-term, low-dose folic acid supplementation.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Key R&D Projects, Jiangxi National Key Research and Development Program Smoothing curveKM curve
Burden of arrhythmias in patients with obstructive sleep apnea and its impact on mortality: a descriptive study from the National Inpatient Sample
Authors: Gopalakrishnan A , Dhulipala V , Grillo M , Ayala-Rodriguez C , Garyali S , Reddy S 
Published: October 2021

Abstract

Background
Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients.

Purpose
Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality.

Methods
All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations.

Results
OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p&lt;0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p&lt;0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p&lt;0.001) and sudden cardiac death (1.34% vs 0.4%; p&lt;0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p&lt;0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p&lt;0.001].

Conclusion
Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population.

Funding Acknowledgement
Type of funding sources: None.
Cardiovascular morbidity and mortality related to non-alcoholic fatty liver disease: a systematic review and meta-analysis of prospective studies
Authors: Bisaccia G , Ricci F , Melchiorre E , Tana C , Renda G , Khanji M Y , Fedorowski A , De Caterina R , Gallina S 
Published: October 2021

Abstract

Background
Whether non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiovascular (CV) events is still debated. Currently available evidence derives from non-homogeneous studies yielding conflicting results.

Purpose
We set out to assess the relationship between NAFLD and CV morbidity and mortality by pooling results of previous studies.

Methods
We performed a systematic review and meta-analysis of prospective observational studies published from 1966 through 2021 reporting summary-level outcome data in subjects with and without NAFLD. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for all-cause mortality, CV mortality, myocardial infarction (MI), stroke, major adverse cerebrocardiovascular events (MACCE) and atrial fibrillation (AF) were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. We performed post-hoc subgroup analysis stratified by geographical region and univariate mixed-effect model meta-regression analysis to address statistical heterogeneity.

Results
We identified a total of 29 studies pooling an overall population of 5,626,573 middle-aged individuals (mean age 56±8; male sex 53%; NAFLD 5.8%, n=326,389). Mean follow-up was 10±6 years. Compared with control population, presence of NAFLD was associated with similar risk of all-cause death (RR 1.17; 95% CI 0.89–1.52) and CV death (RR 0.84; 95% CI 0.64–1.10). When analysed by geographic location, pooled estimates of RR (95% CI) for all-cause death were 1.57 (1.00–2.48) for Western countries, and 0.81 (0.52–1.1.26) for Eastern countries (test for subgroup difference, P=0.04). Meta-regression analysis showed a stronger relationship between NAFLD and all-cause mortality proportional to increasing body mass index (P=0.048). NAFLD was associated with increased risk of myocardial infarction (RR 1.35; 95% CI 1.09–1.68), stroke (RR 1.20; 95% CI 1.06–1.35), MACCE (RR 2.09; 95% CI 1.57–2.78) and atrial fibrillation (RR 1.37; 95% CI 1.05–1.78).

Conclusion
NAFLD portends excess all-cause mortality but only in Western countries. CV mortality was similar in NAFLD and non-NAFLD groups. NAFLD is associated with increased risk of incident MI, stroke, MACCE and AF.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
A 10-year follow-up study of the cardiovascular risk factors in children aged 6–16 years
Authors: Triantafyllidi H , Dretsiou E , Benas D , Trivilou P , Pavlidis G , Ikonomidis I , Iliodromitis E 
Published: October 2021

Abstract

Background
Obesity and arterial hypertension in children represent well recognized risk factors for future cardiovascular (CV) events during early adult life. We aimed to investigate any changes regarding several parameters affecting the CV status of children aged 6–16 years after a 10-year follow-up period.

Methods
A cohort of 143 children 6–16 years old (79/64 boys/girls, mean age 9±2 years) was evaluated regarding food habits (fish/chicken/vegetables/fruit per week), obesity (BMI), office blood pressure (SBP/DBP), aortic stiffness (PWV), lipid profile (HDL, LDL) and sports activity (hours of exercise/week). After a 10-years follow-up period, we managed to re-evaluate 62/143 (43%) young adults (33/31 boys/girls, mean age 20±2 years) for the same parameters plus endothelial function estimated by endothelial glycocalyx integrity (PBR5–25).

Results
We found that after 10 years, young adults compared to themselves had increased BMI, SBP/DBP and PWV (p&lt;0.001), decreased HDL and LDL (p&lt;0.001 and p=0.004, respectively), increased consumption of chicken and vegetables (p&lt;0.001 and p=0.05, respectively) and decreased consumption of fish and fruits (p=0.004 and p=0.001, respectively) per week and finally increased weekly hours of sports activity (p=0.005). Mean PBR5–25 was 1.9±0.2 μm. Regarding obesity, the majority of children were overweight (20%) or obese (41%) while the majority of young adults were normoweight (60%) and only 11% obese. Regarding arterial hypertension (mean value of a triple office BP measurement), we measured BP &gt;95th percentile in 7% of the children (50% of children had finally white coat hypertension) while just one young adult (2%) had BP &gt;140 mmHg).

Conclusions
After 10 years, children became young adults with an improved status regarding obesity, normal BP levels, favorable lipid profile as for LDL levels, almost healthy food habits who also spend more hours in sport activities. However, HDL was decreased, aortic stiffness was increased while there are no comparable data regarding endothelial glycocalyx integrity. Overall, the profile of young adults seems protective against future CV events.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Relationship between morphometric parameters of epicardial adipose tissue and adipocytokine profile in patients with myocardial infarction
Authors: Belik E , Gruzdeva O V , Dyleva Y U A , Brel N K , Borodkina D A , Barbarash O L 
Published: October 2021

Abstract

Aims
To reveal the relationship between the thickness of epicardial adipose tissue (EAT) and the levels of adiponectin, leptin, interleukins (IL) IL-6, IL-10, IL-12, IL-33 in the blood serum of patients with myocardial infarction.

Materials and methods
A total of 119 patients with ST-segment elevation myocardial infarction (MI) who signed voluntary informed consent were examined. The thickness of the epicardial adipose tissue of the left and right ventricles (LV EAT and RV EAT, respectively) was assessed using magnetic resonance imaging on an Exelart Atlas 1.5 MR tomograph (Toshiba, Japan). The concentration of the studied parameters was determined in the blood serum of patients by the ELISA method on the 1st and 12th days of hospitalization: adiponectin and leptin (BioVendor, USA), IL-6, IL-10, IL-12, IL-33 (eBiosciens, USA). Statistical analysis was performed using Statistica 9.0.

Results
The thickness of the LV EAT was 6.3 (4.7; 9.5) mm, the thickness of the EAT RV was 6.8 (4.9; 0.6) mm. The concentrations of the studied parameters in the blood serum of patients on the 1st day of hospitalization: adiponectin 7.72 (6.5; 13.0) μg/ml, leptin 7.48 (5.98; 12.5) ng/ml, IL-6 14.5 (11.6; 21.8) pg/ml, IL-10 1.9 (0.7; 2.5) pg/ml, IL-12 128.7 (66.4; 182.0) pg/ml, IL-33 5.6 (3.4; 7.2) ng/ml. On the 12th day, there was an increase in the level of adiponectin and IL-33 by 1.5 times, IL-10 by 2 times, a decrease in leptin by 1.6 times, IL-6 by 1.4 times and IL-12 by 1.3 times. Correlation analysis revealed a relationship between the thickness of LV EAT and the following parameters in serum: adiponectin level 1st (r=−0.29; p=0.01), IL-10 12st (r=0.36; p=0.03), IL-6 1st (r=−0.64; p=0.046), IL-33 12st (r=0.24; p=0.04). The thickness of the RV EAT correlated with the concentration of IL-12 in the blood serum of patients 12st (r=−0.59; p=0.01).

Conclusions
The data obtained indicate the presence of a relationship between the morphometric characteristics of EAT and the serum parameters of the adipocytokine profile in patients with MI. Based on this, we can conclude about the ability of the markers under study to reflect the thickness of the EAT and their potential use for the development of methods for correcting pathological activation of adipose tissue in MI.

Funding Acknowledgement
Type of funding sources: None.
BNP/ NT-pro BNP thresholds for the assessment of the prognosis in patients without heart failure
Authors: Hendricks S , Mahabadi A A , Vogel L , Al-Rashid F , Luedike P , Totzeck M , Rassaf T , Dykun I 
Published: October 2021

Abstract

Background
Natriuretic peptides (BNP/NT-proBNP) are predominantly used for risk stratification, diagnosis and therapeutic monitoring in heart failure patients. A potential value of BNP/NT-proBNP serum levels for the prediction of prognosis in the general population and for non-heart failure patient cohorts is suggested in the literature. However, for non-heart failure patients, no thresholds are established. We aimed to determine cut-off levels that allow prediction of long-term survival in patients without known heart failure.

Methods
The present analysis is based on a registry of patients undergoing coronary angiography between 2004 and 2019. Patients with existing diagnosis of heart failure or elevated natriuretic peptides (BNP &gt;100pg/nl, NT-proBNP &gt;400pg/nl), with missing follow-up information or without BNP/NT-proBNP levels at admission were excluded. As either BNP or NT-proBNP was available for singular patients and to adjust for the skewed distribution, BNP/NT-proBNP levels ranked based on gender specific percentile from 0 to 99. The cohort was then divided into a derivation and a validation cohort using random sampling. Incidence of death of any cause during follow-up was recorded. In the derivation cohort, cox regression analysis was used to determine the association of natriuretic peptides with incident mortality per 1 standard deviation increase in BNP/NT-proBNP rank. Multivariable models controlled for age, sex, LDL-cholesterol, systolic blood pressure, smoking status, and family history of premature cardiovascular disease. Receiver operating characteristics curve analysis was performed, with corresponding area under the curve, along with Youden's J index assessment, to establish a threshold for prediction of survival. The association of this threshold with incident mortality was tested in the validation cohort.

Results
Overall, 3,687 patients (age 62.9±12.5 years, 71% male) were included. During a mean follow-up of 2.6±3.4 years, 169 deaths occurred. In the derivation cohort, BNP/NT-proBNP was significantly associated with mortality (Hazard ratio [95% confidence interval]: 1.25 [1.01–1.54], p=0.04). Based on Youden's J index, BNP-thresholds of 9.6 and 29pg/ml and NT-proBNP thresholds of 65 and 77pg/ml for men and women, respectively, were determined. In the derivation cohort, BNP/NT-proBNP levels above these thresholds were significantly associated with increased mortality (2.44 [1.32–4.53], p=0.005). The predictive value of the determined thresholds was confirmed in the validation cohort (2.78 [1.26–6.14], p=0.01).

Conclusion
We here describe gender-specific BNP/NT-proBNP thresholds that allow prediction of impaired survival in patients without heart failure. Utilization of these thresholds in clinical routine may qualify for risk prediction in non-heart failure cohorts, independent of traditional cardiovascular risk factors.

Funding Acknowledgement
Type of funding sources: None.
The prognostic impact of fibroblast growth factor-23 on cardiovascular death after cardiac surgery
Authors: Hofer F , Kluger F , Kazem N , Hammer A , Koller L , Laufer G , Andreas M , Steinlechner B , Hengstenberg C , Sulzgruber P , Niessner A 
Published: October 2021

Abstract

Background
Fibroblast growth factor 23 (FGF-23) participates in phosphate and vitamin D metabolism and proved to be associated with an increased risk for fatal events in individuals presenting with cardiovascular disease. In the era of personalized medicine and individualized prognostication, the identification of novel risk markers seems of major importance in terms of state-of-the-art patient care. Since data on the prognostic potential of FGF-23 in individuals undergoing cardiac valve and/or coronary artery bypass graft (CABG) surgery remain scarce, we aimed to investigate the impact of FGF-23 on cardiovascular (CV) death in an unselected patient population after cardiac surgery.

Methods
Within the present investigation, patients undergoing elective cardiac valve and/or CABG surgery were prospectively enrolled at the Department of Cardiac Surgery of our Medical University. Preoperative blood values were assessed immediately before the surgical intervention. FGF-23 concentrations were measured via FGF Quantikine ELISA Kit (R&D Systems, Minneapolis, USA). Patients were followed prospectively until the primary study endpoint (CV death) was reached. Cox regression models were calculated and adjusted for age, sex, diabetes, heart failure, body mass index, prior myocardial infarction, hypertension and coronary artery disease.

Results
In total, 462 patients were included in the present analysis and followed over a median of 3.9 years. During follow-up 67 (14.5%) patients died. The patients' median age was 70 years (interquartile range [IQR] 60 to 75) and 133 (28.8%) were female. The median FGF level in the entire study population was 1.9 pmol/L (IQR 1.2 to 3.5). After stratification into tertiles (T) of FGF-23 (median FGF-23 T1: 0.95 pmol/L [IQR 0.65 to 1.19], T2: 1.93 pmol/L [IQR 1.64 to 2.28] T3: 4.80 pmol/L [IQR 3.54 to 8.09]), patients in the highest FGF-23 tertile had highest rates of CV death (T1: 4.8%, T2: 6.8%, T3: 19.1%; P-logrank &lt;0.001; Figure A). Moreover, there was a strong association between FGF-23 and CV death (Adj. hazard ratio for 1-unit increase in standardized log-transformed biomarker 1.44, 95% CI: 1.19 to 1.75; P-value &lt;0.001). The risk of CV death increased within higher tertiles of FGF-23 (T3: adj. HR 3.59 [95% CI 1.48–8.71], P-value= 0.005) (T1 was chosen as reference). FGF23 also showed good discriminatory performance (area under the curve [AUC] 0.69, 95% CI 0.61–0.77).

Conclusion
FGF-23 proved to be a strong and independent predictor for CV death in individuals undergoing elective cardiac valve and/or CABG surgery. This biomarker may provide improved risk assessment and fosters individualized patient care in this highly vulnerable patient population in the era of personalized medicine.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan Meier curves
Current patterns of pharmacological treatment for coronary heart disease based on the Russian cohort of the hospital arm of the EUROASPIRE V survey
Authors: Pogosova N , Boytsov S A , Ausheva A K , Sokolova O Y , Pozdnyakov Y M , Salbieva A O , Karpova A V , Yusubova A I , Arutyunov A A 
Published: October 2021

Abstract

Background
Several drug classes have shown their ability to improve risk factors control and prognosis in coronary heart disease (CHD). Therefore, it is important to monitor the prescription patterns on a regular basis to ensure that all the eligible patients receive the potentially lifesaving medications.

Purpose
To describe prescription and uptake of main guideline-recommended drug classes in men and women with history of acute coronary syndromes (ACS) or cardiac revascularization enrolled into the hospital care arm of EUROASPIRE V (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) study in Russian centers vs the whole study population.

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

Results
A total of 399 pts (women, 27.1%) have been interviewed in Russia vs 8261 pts (women, 25.8%) in the whole survey. The mean age of the Russian cohort at interview was 62.8±8.7 years in Russia vs 63.6±9.6 years in all EUROASPIRE V pts. The table below represents the proportion of pts prescribed and actually receiving main drug classes. Both in the Russian cohort and in the whole study population the proportion of patients receiving essential drug classes didn't differ much by gender. In Russian centers, 95.9% of men and 91.7% of women received antiplatelets (vs 92.8% and 91.8%, respectively, in the whole study population). For statins the corresponding numbers were 86.9% for men and 91.7% for women in Russia (vs 82.2% and 76.8%), for beta-blockers – 82.5 in both genders (vs 80.8% and 81.8%), for ACE inhibitors and/or ARBs 78.0% in men and 80.6% in women (vs 75,3% and 75.0%).

Conclusion
Current prescription of guideline-recommended drug classes in the Russian cohort of EUROASPIRE V survey is close to the average European levels and doesn't demonstrate any obvious gender gaps. However, there is still room for improvement. In particular, this applies to the maintenance of prescriptions made at discharge, especially of statins, in the long term.

Funding Acknowledgement
Type of funding sources: None. Table 1