bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterial stiffness in adolescence predicts elevated blood pressure in young adulthood: the ALSPAC study
Authors: Agbaje A O , Barker A R , Tuomainen T P 
Published: October 2021

Abstract

Background
The American Heart Association's scientific statement on the importance of arterial stiffness recommended that future studies investigate whether increasing arterial stiffness with advancing age results from the age-associated increase in systolic blood pressure (BP). The statement also recommended investigating the natural history of arterial stiffness and BP vis-à-vis the rate at which arterial stiffness and BP increase with age. These questions remain largely unanswered in a population sample of apparently healthy adolescence and young adults.

Purpose
To investigate whether carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, during adolescence predicts increased systolic and diastolic blood pressure in young adulthood.

Methods
We studied 3862 British (56% females) participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, Bristol, UK. cfPWV was measured by Vicorder device ultrasound scan, total fat mass and lean mass were measured by dual-energy Xray absorptiometry, and systolic and diastolic BP by Omron BP/pulse monitor. We conducted multivariable linear regression analyses and adjusted for baseline covariates such as age, sex, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, high sensitivity C-reactive protein, fasting blood glucose, fasting insulin concentration, heart rate, moderate to vigorous physical activity, smoking status, family history of cardiometabolic diseases, total fat mass, lean mass and systolic or diastolic BP depending on the outcome. All variables were measured both at age 17.7 and 24.5 years.

Results
Participants mean (SD) age in years at different time points were [17.72 (0.33) and 24.54 (0.73)]. Over a 7-year follow-up period, cfPWV was directly and independently associated with systolic BP [β = 10.762 (CI: 3.107 to 18.417); p=0.006] and diastolic BP [19.535 (12.879 to 26.191); p&lt;0.0001].

Conclusion
Our findings showed that increasing arterial stiffness independently predicts higher systolic and diastolic BP with advancing age. Besides, a 0.1 m/s increase in arterial stiffness at age 17.7 years may result in a 1 mmHg increase in systolic BP and a 2 mmHg increase in diastolic BP seven years later. Therefore, public health effort should be targeted at preventing or reducing arterial stiffness during adolescence in order to decrease the risk of elevated BP in later life.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Jenny and Antti Wihuri Foundation and the Finnish Cultural Foundation
Features of gene polymorphism in comorbid patients with arterial hypertension and coronary heart disease
Authors: Drobotya N V , Shlyk S V , Khaisheva L A , Aruyunyan L V , Pirozhenko A A 
Published: October 2021

Abstract

The problem of cardiovascular comorbidity becomes particularly relevant in the context of a pandemic, since it is known that cardiovascular diseases (especially arterial hypertension – AH and coronary heart disease – CHD) significantly increase the frequency of hospitalizations and fatal outcomes in patients with COVID-19. From these positions, it is fundamentally important to identify a group of individuals with a high prognostic probability of developing combined cardiovascular pathology in the cohort of patients with hypertension.
There is a hypothesis about the genetic relationship between different diseases, which helps to identify their common genetic variants, which in turn makes it possible to determine new loci of susceptibility for each of the comorbid conditions. Recent data indicate the feasibility of developing this problem from the standpoint of genetic polymorphism.

Material and methods
The work is based on the results of a comprehensive examination of 100 patients with AH. A molecular genetic study to determine the main variants of gene polymorphism was performed on a DT 96 amplifier manufactured by DNA Technology (Russia). The method for determining the variants of gene polymorphism was a polymerase chain reaction with real-time detection of the results.

Results
All patients included in the study were divided into 2 groups: patients with AH without CHD – 62% (62 people) and patients with AH with CHD – 38% (38 people). The relationships of polymorphism of 9 main variants of genes involved in the pathogenesis of isolated AH and in combination with CHD were studied. When analyzing the frequency of the studied genes in patients with hypertension with and without CHD, statistically significant differences were obtained for the NOS3 T-786C polymorphic gene, which was significantly more common in comorbid patients. Patients with a combination of AH and CHD are characterized by the presence of the CC genotype and the C allele of the VOS3 gene (p=0.040 and p=0.035), while the TT genotype of the T-786C polymorphic marker of the NOS3 gene is characteristic of patients with isolated AH. It should be noted that the carrier of the “mutant” allele C of the T-786C polymorphism of the NO3S gene, according to our calculated statistical data, increases the risk of CHD in patients with hypertension by 5 times (OR=5.242, p=0.035).

Conclusion
The study of the genetic aspects of comorbidity is theoretically important for understanding the mechanisms of its formation. From a practical point of view, it is valuable to use modern genetic approaches for early detection of a prognostically unfavorable category of AH patients with a high risk of comorbid pathology developing.

Funding Acknowledgement
Type of funding sources: None.
Predictors of antihypertensive efficiency of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus
Authors: Manukyan M , Falkovskaya A , Mordovin V , Zyubanova I , Tsoi E , Ryabova T , Pekarskiy S 
Published: October 2021

Abstract

Background
Currently, one of the actively studied interventional methods for the treatment of resistant hypertension (RHTN) is renal denervation (RDN). Despite the safety of the procedure and the long-lasting antihypertensive effect, a significant decrease in systolic blood pressure (SBP) ≥10 mmHg is observed only in 60–80% of patients. According to the Global SYMPLICITY Registry (GSR) study, patients with diabetes mellitus could benefit from lower blood pressure after renal denervation due to initially higher sympathetic activity. The indicators associated with the processes of sympathetic hyperactivation include impaired diastolic function and total peripheral resistance (TPR), reflecting the resistance of arterioles (resistive vessels) to blood flow.

Purpose
To identify predictors of the antihypertensive efficacy of renal denervation in patients with RHTN and type 2 diabetes mellitus (DM) based on the results of a six-month follow-up.

Methods
The study included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61,4±6,4 years, 14 men, mean 24-hour (24-hr) blood pressure (BP) (systolic/diastolic) 158,6±15,2/79,8±12,7 mmHg, mean HbA1c 7,2±1,2%). The prospective interventional study with renal denervation (NCT02667912 and NCT01499810 at ClinicalTrial.gov) enrolled 30 patients. Office BP and ABPM, diastolic function and TPR assessment were performed in all patients at baseline and 6 months after RDN. 29 patients completed 6-month follow-up.

Results
RDN led to a significant reduction in systolic and diastolic 24-hr BP (−10.9/−5.7 mmHg, p=0.002/0.003). Depending on the degree of decrease in 24-hr systolic BP, the patients were retrospectively divided into 2 groups: “responders” (persons with a decrease in 24-hr SBP by 10 or more mmHg) and “non-responders” (with a lesser degree of decrease in 24-hr SBP). The proportion of respondents to the intervention was 48.3%. Initially, the group of “responders” differed from the group of “non-responders” by higher average E/e' values (15.1 and 11.9, respectively, p=0.049) and TPR indicators (2.39±0.45 and 1.93±0.35 dyn s cm–5, respectively, p=0.003). These indicators were included in a logistic model to predict the antihypertensive efficacy of renal denervation. The sensitivity was 78.6% (11 correct predictions out of 14 cases), specificity – 80% (12 correct predictions out of 15 cases), (p=0.020).

Conclusion
Estimation of the total peripheral resistance and the average ratio E/e' allows predicting the antihypertensive efficacy of renal denervation in patients with resistant hypertension and type 2 diabetes mellitus.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research
Premature atherosclerotic cardiovascular disease: association of clinical factors with form of atherosclerosis onset
Authors: Rogozhina A A , Averkova A O , Zubova E A , Minushkina L O , Chichkova M A , Khasanov N R , Kosmacheva E D , Boeva O I , Zateyshchikov D A 
Published: October 2021

Abstract

Background
The cardiovascular death rate significantly declined last decades. But premature atherosclerosis burden remains an unresolved problem.

Purpose
The study aimed to assess the association of clinical factors with types of premature atherosclerosis onset.

Methods
Date of 702 patients (pts) (523 men and 179 women) with premature atherosclerosis (men ≤55 (48.6±6.2), women ≤60 (52.7±7.0) years of age) were analyzed with decision tree method using SPSS 23.0 program with the Python GUI module. Clinical and instrumental variables (n=109) were used. The test sample was formed by the cross-validation method.

Results
Myocardial infarction at the onset of atherosclerosis (n=542, 77.2%) was associated with the presence of peripheral atherosclerosis (1st order node, p&lt;0.0001, F=93.174). The 2nd order node was a uric acid level (p&lt;0.0001, F=26.493) in pts without peripheral atherosclerosis. In pts with uric acid level, less than 225 mmol/L-the left ventricle posterior wall thickness more than 10 mm was a 3d order node (p&lt;0.0001, F=30.143). Area under the ROC-curve 0.916, p=0.011. Multivessel lesion according to coronary angiography data (102 patients) was associated with family history of cardiovascular disease (p=0.001, F=13.238), the area under the ROC-curve was 0.667, p=0.041. For pts. with peripheral atherosclerosis (n=66, 9,4%) the aortic root diameter obtained by an echo was the 1st order node (p&lt;0.0001, F=36.057). In pts with aortic root diameter over 27 mm, a 2nd order node was creatinine level above 90 mmol/L (p=0.036, F=9.945) and in pts with a smaller diameter of aortic root was the history of hypertension emergency (p=0.001, F=13.897). Area under the ROC-curve 0.676, p=0.02. For pts. with ischemic stroke (n=26, 3,7%) as atherosclerosis onset 1st order node was brachiocephalic atherosclerosis lesion (p&lt;0.0001, F=30.259). Among them, untarget BP level was 2nd order node (p=0.033, F=4.958). For pts without atherosclerosis age over 46.7 yrs was a 2nd order node (p&lt;0.0001, F=24.515), and for pts younger than 46.7 yrs admission glucose higher than 11.06 mmol/L was a 3rd order node (p=0.026, F=12.382). This model had high predictive accuracy (area under the ROC-curve 0.963, p&lt;0.0001).

Conclusion
Thus multiple clinical variants of premature atherosclerotic cardiovascular disease onset appeal to develop an individualized approach to early diagnosis and management of this kind of patient.

Funding Acknowledgement
Type of funding sources: None.
Effect of revascularization on exercise-induced changes in cardiac and pro-thrombotic biomarkers in patients with coronary artery disease
Authors: Hansen C H , Cwikiel J , Bratseth V , Arnesen H , Flaa A , Seljeflot I 
Published: October 2021

Abstract

Introduction
Exercise-induced increase in cardiac and pro-thrombotic biomarkers have previously been shown in patients with coronary artery disease (CAD) before revascularization, which may be due to myocardial ischemia.

Purpose
We aimed to examine whether resting levels and exercise-induced changes of high sensitive cardiac Troponin T (cTnT), NT-proBNP, pro-thrombin fragment (F) 1+2, D-dimer, tissue factor pathway inhibitor (TFPI) and endogenous thrombin potential (ETP) were affected by revascularization in patients with CAD. We hypothesized that resting and exercise-induced levels of the biomarkers would be reduced after revascularization.

Methods
Patients presenting with symptoms of CAD were included. A maximal exercise ECG stress test (EST) (EST1) was performed, and venous blood samples were drawn at rest and within five min after termination. All patients underwent coronary angiography. Patients (n=20) with confirmed CAD, fully revascularized with percutaneous coronary intervention (PCI) and without symptoms of angina, were invited to perform a second EST (EST2), at the same workload (median 145W), at a median of 66 days after revascularization. Mean exercise duration at both time points were 11:30 min:sec. Of the total population 15 patients were treated with PCI on stenosis located on LAD and 5 patients with stenosis on RCA.

Results
Significant increase in cTnT and NT-proBNP from resting to post exercise levels at EST1 was found as expected (p&lt;0.001, both). Also at EST2, increased levels were observed (p&lt;0.01, both), however, not significantly different from the changes at EST1. Resting levels of cTnT at EST2 compared to EST1 were significantly higher (median 8.1 vs 7.1 ng/L, p=0.02). At both visits significant increase in D-dimer (p=0.008 and &lt;0.001), F1+2 (p=0.009 and 0.001) and TFPI (p&lt;0.001 and 0.001) during exercise were demonstrated, with no difference in these changes. There were no significant changes in ETP during exercise at any visit, but resting levels were reduced at EST2 vs EST1 (p&lt;0.01). Also resting levels of TFPI were reduced at EST2 (p&lt;0.01).

Conclusion
After revascularization there was still significant increase in exercise-induced release of cardiac and pro-thrombotic biomarkers, thus revascularization does not affect the ability to release these biomarkers. Also, the higher resting levels of cTnT after revascularization indicate that revascularization per se does not affect secretion of cardiac biomarkers, probably due to the disease state. The lower resting levels of ETP and TFPI after revascularization may, however, be indicative of reduced thrombin generation potential and endothelial activation.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Stein Erik Hagens Foundation for Clinical Heart Research, Oslo, Norway
“Actua” project: secondary prevention in patients at high-cardiovascular risk
Authors: Prieto Lobato A , Corbi Pascual M J , Redondo Prieto M , Cubells Pastor M , Muros Ortega A , Carrasco Carrasco E , Cordoba Soriano J G , Martinez Pastor A , Division Garrote J A 
Published: October 2021

Abstract

Introduction
It is acknowledged that secondary prevention for patients at high cardiovascular risk is suboptimal. Data from EUROASPIRE V registry showed that less than 50% of cardiovascular risks factors were controlled in this population.

Purpose
“Actua” study was designed to identify potential gaps regarding secondary prevention for patients at very-high cardiovascular risk. The main objective was to assess differences between scientific evidence and clinical practice through an agreement/disagreement analysis of a questionnaire with statements based on clinical guidelines and expert recommendations.

Methods
A qualitative analysis based on Delphi methodology was conducted. The study was divided into 2 phases. In phase 1, doctors were asked to show agreement or disagreement with the statements presented by the scientific committee through a Likert 5-points-scale. Consensus was stablished according to consensus method of Tastle. Results were expressed as a percentage (%CNS) which shows power of agreement or disagreement consensus. CNS&gt;70% were considered as consensus. In phase 2, same doctors were asked again about the statements with no consensus or high dispersion in previous phase, after disclosing results in phase 1. In addition, a third questionnaire was conducted to asses socio-demographic data of the sample.

Results
246 and 265 questionnaires were conducted in phase 1 and 2 respectively. 90% of respondents in phase 1 and 94,3% in phase 2 answered all the questions. Statements which showed consensus among participants are represented in table 1. As reported, there was consensus in goals for blood pressure (&lt;130/80mmHg), cLDL (&lt;70mg/dl), chronic use of acetylsalicylic acid in secondary prevention for coronary artery disease, stroke and peripheral artery disease. Doctors also agreed with the fact that 40mg atorvastatin can achieve 50% cLDL reduction levels from baseline. Scarce resources in secondary prevention were reported as main reason for medical attendants not following the best standards of care. Besides, most respondents agreed with the statement that a simpler treatment regime could improve therapeutical adherence in most patients. In phase 2, consensus was achieved in the statements showed in table 2.

Conclusion
Doctors admitted that complex recommendations and lack of following-up were the main causes of low adherence to treatment among patients at high cardiovascular risk.

Limitations
The study was conducted following recommendations from 2016 ESC/EAS guidelines for the management of dyslipaemias.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Grupo Ferrer Internacional, S.A. Table 1. Questions phase 1Table 2. Questions phase 2
Lipoprotein (a) and cardiovascular risk in familial combined hyperlipidaemia: does it exist?
Authors: Dima I , Skoumas I , Vavouranaki G , Ioakeimidis N , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background
Previous studies suggest there is an association between levels of lipoprotein a [Lp (a)] and increased cardiovascular risk in general population and familial hypercholesterolaemia patients. The purpose of this study was to define the exact relationship between the levels of Lp (a) and cardiovascular risk in a Familial Combined Hyperlipidaemia (FCH) population.

Methods
We enrolled 1094 (615 males, mean age 49 years old) patients who fulfilled the FCH criteria, from the outpatient lipid clinic of our hospital. Lp (a) levels were measured and information were obtained regarding demographic characteristics, the presence of coronary artery disease (CAD) and CAD risk factors. Patients were categorized initially according to baseline Lp (a) levels to quintile 1 (≤30mg/dl) (N=769), quintile 2 (&gt;30 mg/dl, ≤50mg/dl) (N=149), quintile 3 (&gt;50mg/dl, ≤100mg/dl) (N=124), quintile 4 (&gt;100mg/dl, ≤150mg/dl) (N=31), and quintile 5 (&gt;150mg/dl) (N=21). We calculated the percentage of patients with CAD in each quintile. Additionally, we performed logistic regression analysis to predict the presence of CAD based on the levels of Lp (a) and other CAD risk factors, age, sex, the presence of diabetes mellitus, hypertension and smoking.

Results
Mean value for Lp (a) in the whole population was 29.67mg/dl. The percentages of CAD were 13.1%, 16.8%, 15.3%, 22.6%, and 23.8% respectively for quintiles 1–5 (Figure 1). The number of CAD patients increases as baseline Lp (a) levels increase. To further support the finding, regression analysis revealed that age, gender and Lp (a) added significantly to the model. Lp (a) could predict CAD, independently of other factors.

Conclusions
The correlation between Lp (a) and Familial Combined Hyperlipidaemia is unclear. There is an increasing trend for the presence of CAD in higher Lp (a) levels and a positive relationship, indicating a straightforward correlation between these two parameters.

Funding Acknowledgement
Type of funding sources: None.
Cardiovascular benefit of lowering LDL-C below 1 mmol/L (40 mg/dl)
Authors: Marston N A , Giugliano R P , Park J G , Ruzza A , Sever P S , Keech A C , Sabatine M S 
Published: October 2021

Abstract

Background
The 2019 ESC/EAS Dyslipidemia Guidelines recommend an LDL-C goal of &lt;1.4 mmol/L (∼55 mg/dl) for patients with very high-risk ASCVD, and &lt;1 mmol/L (∼40 mg/dl) for those with recurrent events within 2 years despite taking maximally tolerated statin therapy. The addition of PCSK9 inhibitors to statin therapy can achieve LDL-C levels well below 1 mmol/L in many patients, yet the clinical benefit of LDL-C lowering beyond this level has recently been questioned.

Methods
FOURIER was a cardiovascular outcomes trial comparing evolocumab vs. placebo in patients with stable ASCVD on optimized statin therapy with a median follow-up of 2.2 years. We performed an exploratory analysis to determine the consistency of CV risk reduction with LDL-C lowering below ∼1 mmol/L (40 mg/dl) with evolocumab. We modeled the achieved LDL-C at 48 weeks in the two treatment arms as well as the percentage of LDL-C difference between the two arms that was due to LDL-C below ∼1 mmol/L (40 mg/dl) as a function of baseline LDL-C. We then modeled the hazard ratio (HR) for the composite of CV death, MI or stroke (per 1 mmol/L reduction in LDL-C) with evolocumab vs. placebo as a function of baseline LDL-C.

Results
All 27,564 patients from FOURIER were included in this analysis. Patients with lower baseline LDL-C achieved lower LDL-C levels following evolocumab therapy, with achieved LDL-C typically being below 1 mmol/L (40 mg/dl) once the baseline LDL-C was below 2.4 mmol/L (94 mg/dl) and reaching levels approaching 0.5 mmol/L (∼20 mg/dl). Accordingly, the further baseline LDL-C levels were below 2.4 mmol/L (94 mg/dl), the greater the proportion of the difference in achieved LDL-C between the evolocumab and placebo arms was due to LDL-C levels below ∼1 mmol/L (40 mg/dl), reaching nearly 40% of the difference in LDL-C between treatment arms (Upper Panel). Despite this, the clinical benefit of LDL-C lowering was not attenuated (p=0.78) (and even appeared greater), with robust reductions in risk of CV death, MI or stroke even when LDL-C was lowered to nearly 0.5 mmol/L (∼20 mg/dl) and having close to 40% of the LDL-C difference between treatment arms due to LDL-C lowering below ∼1 mmol/L (40 mg/dl) (Lower Panel).

Conclusion
PCSK9 inhibitors added to statin therapy can achieve LDL-C well below 1 mmol/L (40 mg/dl). There is no evidence for attenuation of the clinical benefit of lowering LDL-C below this threshold. These data support lowering LDL-C to below 1 mmol/L (40 mg/dl) in patients with ASCVD.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health