bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in initiation of GLP-1 RA in patients with type 2 diabetes during 2014–2019: a US database study
Authors: Kosiborod M , Aroda V R , Broe Honore J , Husemoen L L N , Jensen A B , Matthiessen K S , Lingvay I 
Published: October 2021

Abstract

Background/Introduction
Evidence of cardiovascular (CV) benefit of certain glucagon-like peptide 1 receptor agonists (GLP-1 RAs) from CV outcomes trials (CVOTs) resulted in updates to international guidelines and label indications in patients with type 2 diabetes (T2D) at high CV risk.

Purpose
To evaluate the impact of new evidence, we investigated the incidence of new GLP-1 RA use and trends in prescriber and patient characteristics over a 5-year period encompassing key CVOT publications and an updated label indication.

Methods
Data from consecutive cross-sectional cohorts of patients with T2D and no GLP-1 RA prescription for ≥1 year prior to the start date, corresponding to each year between 2014 and 2019, were extracted retrospectively from US Optum's de-identified Clinformatics® Data Mart Database (2004–2020). For each year, incidence of new GLP-1 RA use, overall and according to prescriber speciality and the proportion of patients with atherosclerotic CV disease (ASCVD) among the new users were evaluated. Speciality was categorised using prescriber information within the database, while ASCVD was identified with ICD-9 CM or 10 CM codes reported prior to GLP-1 RA prescription or year-start date.

Results
During the study period, 2,966,970 eligible patients with T2D were identified, 108,541 of whom were new users of GLP-1 RAs. Overall incidence of new GLP-1 RA use increased each year, with a 3-fold increase in prescriptions from 727 to 2045 per 100,000 patient years between 2014 and 2019 (Figure a). Among new GLP-1 RA users, mean age was 60.1 years, increasing from 56.8 to 61.7 years. Mean HbA1c was 8.6% and was stable over time. Further analysis of new GLP-1 RA prescriptions identified family medicine as the greatest contributor to the absolute increase in incidence between 2014 and 2019, comprising nearly 40% of total prescriptions each year, whereas cardiology contributed the least, at &lt;1% each year. The overall proportion of patients with ASCVD among those newly initiated on a GLP-1 RA and those initiated by a cardiology specialist increased after 2015, from 30.8–44.3% and 45.2–57.9% in 2019, respectively (Figure b). However, this increase in the proportion of patients with ASCVD was also observed among the total population of patients with T2D without new GLP-1 RA use (Figure b).

Conclusion
New use of GLP-1 RAs in patients with T2D increased in absolute terms between 2014 and 2019. Interestingly, the proportion of patients with ASCVD among those newly initiating the class has not changed relative to non-GLP-1 RA users over time, highlighting a gap in adoption of CVOT data in clinical practice by all specialities and the potential opportunity to further reduce CV risk in these patients.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novo Nordisk
Christmas holiday triggers of myocardial infarction
Authors: Olsson A , Thoren I , Mohammad M , Rylance R , Platonov P , Sparv D , Erlinge D 
Published: October 2021

Abstract

Background
Christmas holidays have been associated with the highest incidence of myocardial infarction (MI). We wanted to assess possible triggers of MI during Christmas.

Method
A nationwide, retrospective postal survey with case-control design. All individuals suffering a MI during the Christmas holidays 2018 and 2019 in Sweden were identified through the SWEDEHEART registry and a control group matched in age and gender with chronic coronary syndrome who did not seek medical attention during Christmas, were asked for participation. Subjects completed a questionnaire asking them to rate 27 potential MI-triggers as having occurred more or less than usual.

Results
A total of 189 patients suffering a MI on Christmas Eve, Christmas Day, or Boxing Day and 157 patients in control-group responded to the questionnaire, representing response rates of 66% and 62%, respectively. Patients with MI on Christmas experienced more stress (36.7% vs 20.9%, p=0.002), depression (20.9% vs 10.5%, p=0.024) and worry (25.9% vs 10.1%, p&lt;0.001) compared to the control-group. The food and sweets-consumption were increased in both groups, but to a greater extent in the control-group (33.0% vs 49.7%, p=0.002 and 32.4% vs 43.3, p=0.031). There were no increases in quarrels, anger, economic worries or reduced compliance with medication.

Conclusions
Patients suffering MI on Christmas holiday experienced higher levels of stress and emotional distress compared to patients with chronic coronary syndrome, possibly explaining the phenomenon of holiday heart attack. Understanding what factors increase the number of MI on Christmas may help reduce the excess number of MIs and cardiovascular burden.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Kund FoundationSwedish Scientific Research Council
Fully automatic detection and measurement of abdominal aortic aneurysm using artificial intelligence
Authors: Fujiwara J F , Orii O M , Araki K A , Ogura M O , Ito T I , Oyamada K O , Morino Y M , Yoshioka K Y 
Published: October 2021

Abstract

Background
Abdominal aortic aneurysm (AAA) is a life-threatening disease, and the decision to treat relies on the exact detection and size of AAA, which is time-consuming and prone to high inter-reader variability. Artificial intelligence (AI) has revealed new insights into the management of AAA, but it needs large amounts of contrast-enhanced CT data. Moreover, there has been few studies about the fully automatic detection and measurement of AAA.

Purpose
The aim of this study is to evaluate the accuracy of AI for the detection and measurement of AAA using small amounts of non-contrast CT.

Methods
We retrospectively collected 145 non-contrast CT scans of suspected AAA. The first step was to manually segment the 30 non-contrast CT scans to create training data for the AI, and the second step was to improve accuracy using 9 of non-contrast CT scans. Image processing is used to identify the AAA area and automatically measure the size. The AAA region was identified from the amount of change in the minor-axis, and the maximum minor-axis diameter was calculated using elliptical fitting. To evaluate the diagnostic utility of AI for the detection of AAA, the sensitivity and positive predictive value were calculated referred for the diagnostic report. The reproducibility in the size of AAA was assessed using intraclass correlation coefficients (ICCs) between the diagnostic report and AI.

Results
Among 145 of non-contrast CT scans, 111 had AAA. The sensitivity and positive predictive value of AI for the detection of AAA were 94.6% and 53.8%, respectively (Picture 1). The size of AAA calculated by the AI (42.5±8.8 mm) showed a strong correlation with the those of diagnostic reports (44.6±8.4 mm; ICCs = 0.97) (Picture 2).

Conclusions
AI represents a useful tool in the fully automatic detection and measurement of AAA using small amounts of non-contrast CT.

Funding Acknowledgement
Type of funding sources: None. Picture 1Picture 2
Readiness of cardiosurgical patients for digital rehabilitation programs
Authors: Pomeshkina S , Zvereva T N , Krupyanko E V , Pomeshkina E E , Barbarash O L 
Published: October 2021

Abstract

Introduction
To date, the methods of remote rehabilitation using the mobile applications for smartphones are increasingly introduced for a particular category of cardiac patients worldwide. Such programs are of a particular relevance due to a higher accessibility for a patient which is provided by the flexibility of the patients' home training schedule and the possibility of constant communication with a cardiologist and rehabilitation therapist.

Purpose
To study the readiness of the patients to participate in the remote digital cardiac rehabilitation program.

Methods
265 patients (180 (68%) men and 85 (32%) women) undergone a cardiac surgery and staying at the cardiac surgery department were examined. The mean age of the patients was 67±11.9 years. 157 (59%) patients undergone coronary artery bypass grafting (CABG), 73 (34%) patients – heart valves surgery, 13 (5%) patients – simultaneous CABG and heart valves surgery and 5 (2%) – hybrid CABG with carotid endarterectomy.
Prior to the discharge from the first inpatient rehabilitation stage (10–12 days after cardiac surgery), all the patients underwent a survey. The survey was conducted using a designed questionnaire including 5 questions, the answers to which determined the patients' awareness of the necessity and the structure of postoperative remote rehabilitation using the digital technologies, as well as the willingness and the possibility to participate in these programs.

Results
Analyzing the results obtained from the survey it turned out that the majority of patients (258 (97%)) believe that they need cardiac rehabilitation. However, only 86 (32%) patients answered positively to the question about their readiness to participate in remote digital rehabilitation programs. When analyzing the reasons for such a low readiness of patients to participate in remote programs it turned out that 98 (37%) patients didn't have smartphones. 10 (4%) patients despite the presence of a smartphone, refused to participate referring to their inability to use considering themselves incapable of learning it. 71 (27%) patients simply refused claiming that they don't understand the necessity for remote cardiac rehabilitation.

Conclusions
Thus, only a small number of the patients (32%) are ready to participate in remote digital programs of cardiac rehabilitation. A considerable amount of the patients (37%) can't afford to participate in a remote rehabilitation program only due to the absence of the smartphone and 27% of the patients are not ready to participate in a remote cardiac rehabilitation program not understanding the importance of distance cardiac rehabilitation for them.

Funding Acknowledgement
Type of funding sources: None.
Sex differences in cardiovascular research
Authors: Millenaar D N , Dillmann M , Fehlmann T , Flohr A , Mehran R , Al-Lamee R , Lauder L , Ukena C , Boehm M , Keller A , Mahfoud F 
Published: October 2021

Abstract

Background
Women are underrepresented in cardiovascular publications. We sought to investigate sex-specific differences in cardiovascular research over the last decade.

Methods and results
All 387,463 cardiovascular publications between 2010–2019 were retrieved from Web-of-Science and analyzed regarding the authors' sex, the average impact factor (IF), the number of citations, co-authors per article, and international collaborations. The number of cardiovascular research articles increased between 2010–2019 from 19,960 to 29,604 articles per year. The number of articles written by female first authors increased by 48.3% (6434 articles in 2010 and 11,343 articles in 2019) and by 35.0% for male first authors (13,526 articles in 2010 and 18,261 articles in 2019). The last/senior author was more likely to be female in articles with female first authors compared with male first authors (28.2% vs. 14.1%; odds ratio 2.48, 95% confidence interval 2.43–2.53, p&lt;0.001). The average IF for articles by female first authors was lower compared to male (3.1±3.8 vs. 3.5±4.9, p&lt;0.001). Likewise, the H-Index was lower for female than male first authors (1.07±0.74 vs. 1.25±0.98, p&lt;0.001), as was the number of citations per articles (14.0±31.1 vs. 18.0±68.8 citations, p&lt;0.001). Female first authors had fewer co-authors per article than their male peers (7.4±19.6 vs. 8.2±35.2; p&lt;0.001) and were less represented in articles with &gt;15 co-authors (3,623 articles by female and 8,941 by male first authors; ratio female to male 0.41). Scientific advancement as the ratio between female to male first authorships was highest in publications from Latin America (ratio 0.92) and lowest in Asia (ratio 0.40). Female authorship articles reached the highest IF in North America (average IF 3.7), the lowest Africa (average IF 1.8).

Conclusions
Publications in cardiovascular research have increased over the last decade, particularly by female authors. Female researchers are cited less often compared with their male peers and publish with fewer co-authors. The IF remains lower for articles by female researchers. Efforts to further increase women-led research activities are needed

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Cardiac SocietyGerman Research Foundation (DFG)
Genetic deletion of aryl hydrocarbon receptor activates cardiac NLRP3-inflammasome and suppresses apoptosis in mice with acute myocardial infarction
Authors: Tamayo M , Martin Nunes L , Piedras M J , Badosa M , Gil Fernandez M , Fernandez Velasco M , Delgado C 
Published: October 2021

Abstract

Background and purpose
There is great interest in understanding the role of immune cells in the inflammatory mechanisms associated with acute myocardial infarction (AMI). Resident cardiac immune cells are activated by damage-associated molecular patterns interacting with specific pattern recognition receptors (PRRs), triggering inflammatory responses. Activated immune cells and fibroblasts then promote prohypertrophic and profibrotic signalling, which induces cardiac hypertrophy, fibrosis and remodelling after AMI. Nucleotide-binding domain leucine-rich repeat-containing proteins (NLRs) are PRRs that have emerged as key therapeutic targets in cardiovascular disease. NLRP3 assembles the inflammasome, which serves as molecular signalling platform to activate caspase-1 and regulate maturation of the potent proinflammatory cytokine IL-1β.
The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor of the basic Helix-Loop-Helix-PER-ARNT-SIM superfamily that mediates responses against environmental pollutants. Beyond its role in metabolising exogenous toxins as part of an adaptive chemical response, there is growing evidence that AhR is activated by endogenous ligands under physiological conditions. AhR has been proposed as a negative regulator of NLRP3-inflammasome activation. Here we studied the effects of defective AhR signalling on apoptosis, NLRP3-inflammasome activation and survival in a mouse model of AMI.

Methods and results
AMI was induced in 8–10-weeks-old AhR+/+ and AhR−/− mice by ligation of the left anterior descending coronary artery. Immunofluorescence analysis revealed that the number of TUNEL-positive nuclei and the expression of the apoptotic effector cleaved caspase-3 was higher in hearts from infarcted AhR+/+ mice than from sham-operated AhR+/+ mice 24 h after surgery. A similar analysis in AhR−/− mice revealed the absence of apoptotic markers after AMI. Gene analysis showed that cardiac levels of Nlrp3, apoptosis-associated speck-like protein (Asc) and Il1b were all significantly higher in AhR−/− mice than in AhR+/+ mice 24 h after AMI. Finally, survival analysis showed that 25% of AhR+/+ mice died 72 h after AMI surgery whereas the mortality in AhR−/− mice was 100%.

Conclusion
Our results show that loss of AhR inhibits cardiac apoptosis and increases NLRP3-mediated inflammation 24 h after AMI, highlighting a possible role for this nuclear receptor in cardiac remodelling post-AMI.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund
Calcific aortic valve disease: from molecular and cellular mechanisms to medical therapy
Authors: Kraler Simon , Blaser Mark C , Aikawa Elena , Camici Giovanni G , Lüscher Thomas F 
Published: October 2021

Abstract
Calcific aortic valve disease (CAVD) is a highly prevalent condition that comprises a disease continuum, ranging from microscopic changes to profound fibro-calcific leaflet remodelling, culminating in aortic stenosis, heart failure, and ultimately premature death. Traditional risk factors, such as hypercholesterolaemia and (systolic) hypertension, are shared among atherosclerotic cardiovascular disease and CAVD, yet the molecular and cellular mechanisms differ markedly. Statin-induced low-density lipoprotein cholesterol lowering, a remedy highly effective for secondary prevention of atherosclerotic cardiovascular disease, consistently failed to impact CAVD progression or to improve patient outcomes. However, recently completed phase II trials provide hope that pharmaceutical tactics directed at other targets implicated in CAVD pathogenesis offer an avenue to alter the course of the disease non-invasively. Herein, we delineate key players of CAVD pathobiology, outline mechanisms that entail compromised endothelial barrier function, and promote lipid homing, immune-cell infiltration, and deranged phospho-calcium metabolism that collectively perpetuate a pro-inflammatory/pro-osteogenic milieu in which valvular interstitial cells increasingly adopt myofibro-/osteoblast-like properties, thereby fostering fibro-calcific leaflet remodelling and eventually resulting in left ventricular outflow obstruction. We provide a glimpse into the most promising targets on the horizon, including lipoprotein(a), mineral-binding matrix Gla protein, soluble guanylate cyclase, dipeptidyl peptidase-4 as well as candidates involved in regulating phospho-calcium metabolism and valvular angiotensin II synthesis and ultimately discuss their potential for a future therapy of this insidious disease.
The effect of smoking and smoking cessation on arterial stiffness: a systematic review and meta-analysis
Authors: Saz-Lara Alicia , Martínez-Vizcaíno Vicente , Sequí-Domínguez Irene , Álvarez-Bueno Celia , Notario-Pacheco Blanca , Cavero-Redondo Iván 
Published: October 2021

Abstract

Aims
One of the most important mechanisms by which smoking contributes to cardiovascular disease is endothelial dysfunction, including arterial stiffness. However, the effects of smoking and smoking cessation on arterial stiffness remain unclear. This meta-analysis aimed to evaluate the effect of smoking and smoking cessation on arterial stiffness in the adult population.

Methods and results
Random effects models were used to compute pooled estimates of effect size (ES) and their respective 95% confidence intervals (95% CIs) and %change in pulse wave velocity (PWv) (m/s) for the acute and chronic effect of smoking and smoking cessation, and for the effect of smoking cessation vs. the pooled ES estimate for the effect of smoking cessation vs. maintaining this behaviour. Thirteen studies were included in the meta-analysis. Smoking cessation decreased the PWv (ES −0.52, 95% CI −1.02 to −0.03, 3.5% m/s) compared to those maintaining this behaviour. Pooled estimates of both smoking conventional cigarettes and vaping significantly increased the PWv (ES 0.68, 95% CI 0.39–0.98, 10.0% m/s; and ES 0.37, 95% CI 0.14–0.61, 4.7% m/s, respectively). In addition, smoking cessation was effective in reducing arterial stiffness but only in healthy subjects (ES −0.95, 95% CI −1.85 to −0.05, −6.7% m/s). The chronic effect of smoking showed non-significant results on arterial stiffness.

Conclusion
Our results show that arterial stiffness levels decrease after smoking cessation. These findings are of clinical importance, as smoking cessation partially reverses the effects of smoking on arterial stiffness.
Focusing on inequalities and assessing vulnerabilities in the field to combat COVID-19
Authors: Lionis Christos 
Published: October 2021

Abstract
The COVID-19 pandemic exacerbated the existing health inequalities and highlighted many gaps in the European health care systems. This contribution will focus on the concepts of vulnerability and multiple vulnerability, as both have been discussed in the European Commission's Expert Panel on effective ways of investing in health (EXPH). The EXPH is the interdisciplinary expert group established by the European Commission to provide non-binding independent advice on matters related to effective, accessible and resilient health systems, to inform national policy making in improving the quality and sustainability of health systems, and to foster EU level cooperation towards improving information, expertise and the exchange of best practices. The equitable distribution of COVID-19 vaccines, will be discussed as a public health and policymaking challenge, incl. in the context of socioeconomic determinants in relation to vaccination hesitancy. A list of actions to minimize the effect of pandemic in terms of health inequalities and vulnerabilities, including the role the integration of public health with primary care, with due consideration to the perception of risk, health literacy and risk communication. Special mention will also be made to the European Commissions' effort to develop comprehensive expert reports to inform policy making on key topics with due consideration to vulnerable populations and multiple determinants.
Stress and perceived discrimination among Israeli Arabs: the mediation role of threat and trust
Authors: Satran C , Ali Selah O , Mashiach-Aizenberg M , Bord S 
Published: October 2021

Abstract

During pandemics, minorities may experience high stress levels, which could harm their health. This study explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect=0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β=-0.52), which, in turn, was negatively associated with stress (β=-0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. Our findings could assist policymakers in developing fair policies, that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving their mental and physical health.

Key messages
The results highlight the relationships between discrimination, trust, perceived threat and stress. To reduce minorities’ stress, it is vital to create a credible and fair atmosphere during pandemics.