bluuebunny/crossref_metadata_2025_split huggingface dataset:
Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients
Authors: Mader A , Maechler M , Larcher B , Sprenger L , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Vonbank A , Drexel H , Saely C H 
Published: October 2021

Abstract

Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals.
The purpose of this study was to investigate whether Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM).
Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged &lt;65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years.
At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07–1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12–1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63–1.38]; p=0.731). An interaction term Lp(a) x T2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events.
We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients &lt;65 years.

Funding Acknowledgement
Type of funding sources: None.
Cardiac troponin as major mortality risk factor in SARS-CoV-2 infection
Authors: Gonzalez Leal A , Antonana Ugalde S , Arteagoitia Bolumburu A , Monteagudo Ruiz J M , Martinez Moya R R , Ortega Perez R , Rivas Garcia S , Sanroman Guerrero M A , Lorente Ros A , Rincon Diaz L M , Zamorano Gomez J L 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has collapsed the health system, making it necessary to identify factors that help to predict and stratify the risk of patients on admission. Many factors have been used in clinical practice, but the scientific evidence available to date is limited.

Purpose
The objective of this study was to identify clinical and analytical predictors of 30-day mortality in SARS-CoV- 2 infection.

Methods
A total of 1708 consecutive patients hospitalized in our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Cox regression analysis was performed to assess whether sex and race, smoking habit, chronic kidney disease, D-dimer, heart disease (defined as a history of acute myocardial infarction, heart failure, atrial fibrillation) and troponin at admission (cTnI levels greater than the 99th percentile of a healthy population) were related to the 30-day mortality of these patients.

Results
Baseline characteristic are shown in the table 1. Median hospital length of stay was 9 days (IQR 5 to 16). A total of 338 patients (19.8%) died within 30 days and 153 (9.0%) were admitted to the ICU. Furthermore, 52.1% of patients developed ARDS and 9.3% required non-invasive ventilation. A troponin at admission greater than the 99th percentile of a healthy population (HR 1.9, 95% CI 1.4–2.5, p&lt;0.001) and a Charlson Comorbidity Index above 4 (HR 2.6, 95% CI 1.9–3.6, p&lt;0.001) were independent predictors of 30-day mortality in patients admitted due to COVID- 19 infection.

Conclusions
At admission time, troponin values and patient comorbidity (Charlson Comorbidity Index ≥4) can be useful as prognostic markers of SARS-CoV-2 infection.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Ramon y Cajal
Remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects
Authors: Mader A , Sprenger L , Vonbank A , Larcher B , Maechler M , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Drexel H , Saely C H 
Published: October 2021

Abstract

Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk.
The purpose of this study was to investiage whether remnant cholesterol has the power to predict cardiovascular events in patients with established cardiovascular disease.
We enrolled 1822 consecutive patients with established cardiovascular disease, including 1472 with angiographically proven stable CAD, 350 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 6.2±3.2 years.
At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=608) than in non-diabetic subjects (27±25 vs. 21±21 mg/dl; p&lt;0.001). During follow-up, 584 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (45.4 vs. 32.2%; p&lt;0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07–1.23]; p&lt;0.001), and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.17 [1.03–1.34]; p=0.013 and 1.12 [1.01–1.23]; p=0.028, respectively).
From our data we conclude that remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with T2DM and among non-diabetic subjects.

Funding Acknowledgement
Type of funding sources: None.
Residual cardiovascular risk of patients with dyslipidemia receiving multifactorial cardiovascular prevention therapy
Authors: Barkas F , Anastasiou G , Adamidis P , Koutsogianni A D , Liamis G , Elisaf M , Liberopoulos E 
Published: October 2021

Abstract

Background
Few studies have reported on the incidence and risk factors of cardiovascular disease (CVD) in patients with dyslipidemia receiving multifactorial treatment.

Purpose
To record CVD incidence and risk factors in patients with dyslipidemia receiving multifactorial CVD prevention therapy.

Methods
This was a retrospective observational study including consecutive adult patients with dyslipidemia who were followed for ≥3 years at the outpatient Lipid Clinic of our University General Hospital. We recorded CVD incidence and compared it with ATTICA study, an epidemiological prospective cohort assessing the 10-year cardiovascular risk in a representative sample of the general population in Greece. Factors that were significantly associated with incident CVD were additionally identified.

Results
A total of 1,334 individuals were included and followed-up for 6 (4–10) years. Lipid-lowering treatment was overall prescribed to 94% of study participants, while 70% were on antihypertensive and 20% on glucose-lowering therapy. During follow-up, 95 subjects (7%) developed CVD events. Despite higher baseline cardiovascular risk, CVD incidence rate in this study was lower compared with ATTICA (10.4 vs 15.7/1,000 person-years, respectively). Diabetes (HR: 2.09, 95% CI: 1.18–3.70, p&lt;0.001), established CVD at baseline (HR: 2.04, 95% CI: 1.21–3.43, p&lt;0.001), smoking (HR: 1.82, 95% CI: 1.17–2.84, p&lt;0.001) and age (HR: 1.07, 95% CI: 1.4–1.9, p&lt;0.001) were independently associated with incident CVD.

Conclusions
CVD incidence rate of high-risk dyslipidemic patients receiving multifactorial treatment was lower compared with general population. Diabetes, smoking, age, and baseline CVD remain the residual CVD risk factors in dyslipidemic patients receiving prevention therapy.

Funding Acknowledgement
Type of funding sources: None.
Key aspects of statin intolerance leading to treatment discontinuation: a patient perspective
Authors: Catapano A L , Wiklund O , Bushnell D M , Martin M L , Sidelnikov E , Vrablik M 
Published: October 2021

Abstract

Background and aims
Statins are the standard of care for patients with dyslipidemia, but some patients develop intolerance to treatment. The experience of statin intolerant (SI) patients is poorly understood. The objective of this study was to identify key aspects of SI that may be associated with treatment discontinuation.

Methods
Using a previously created questionnaire, we conducted a pilot cross-sectional survey to identify items important for describing patient-centric aspects of SI. The study recruited adult (18+) patients with a history of statin-associated side effects from 9 clinics in 6 countries (France, Italy, Norway, Spain, Sweden, and the United Kingdom), who had received statin treatment within the previous two years.

Results
We surveyed 104 patients (mean age 61.5 SD=11.2 years, 63.5% men, 50% currently on statins). Patients most frequently reported muscle-related symptoms: pain (90.9%), cramps (63.7%), and stiffness (58.2%). Using a 0–10 point scale, significant differences were found between those continuing versus discontinuing their statins for being bothered by side effects (7.5 vs 9.2, p=0.001), for an inability to tolerate side effects (6.7 vs 9.0, p&lt;0.001), and those having too much side effects interference with their daily life (5.7 vs 8.6, p&lt;0.001; see figure). For patients whose doctors worked on adjusting statin regimen, 67% stayed on treatment; for those whose doctors did not, only 10% continued treatment.

Conclusions
Results of this pilot survey suggest patients who experience greater side effects severity and interference with daily activity, along with lower efforts by clinicians to work with adjusting their statin regimen, are at greater risk for discontinuing treatment. A wider survey and larger study population is needed to confirm the results of this pilot study.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was sponsored by Amgen Inc.
Liver steatosis, metabolically healthy obesity and ten-year cardiovascular disease risk: results from a population based cohort study
Authors: Kouvari M , Chrysohoou C , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos D B , Mantzoros C S 
Published: October 2021

Abstract

Background/Introduction
Inclusion of non-alcoholic fatty liver disease (NAFLD) as a component of metabolic syndrome (MetS) and/or a criterion for defining metabolically healthy vs. unhealthy obese (MHO vs MUO) status remains to be decided.

Purpose
The present work evaluated the role of NAFLD at baseline in the transition of MHO to MUO status, and its role in predicting cardiovascular disease (CVD) incidence ten years later.

Methods
A prospective longitudinal study was performed between 2001 and 2012 studying 1,514 (49·8%) men and 1,528 (50.2%) women (&gt;18 years old) free of CVD at baseline and residing in the greater Athens area, Greece. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices.

Results
Among obese participants, MHO prevalence was 9.8% (n=277). Only half of the MHO subjects retained their metabolically healthy status one decade later. NAFLD was an important predictor of this transition; MHO participants with NAFLD at baseline had about two times higher odds to develop unhealthy metabolic status compared with their non-NAFLD counterparts. Subsequently, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio=2.90 95%Confidence Interval (1.35, 5.40)) in contrast to their non-NAFLD MHO counterparts. C-statistics revealed that NAFLD significantly increased the discriminative ability of the standardly defined metabolic status (p for C-index change=0.002), yet in the total sample its contribution to the model seemed to be similar with the common metric of central obesity i.e. waist circumference (CNAFLD=0.711 vs. Cwc=0.710). When the analysis was restricted to the obese subset, it was revealed that the discriminative ability of the model adjusted for NAFLD was significantly higher compared with the one adjusted for waist circumference (CNAFLD=0.719 vs. Cwc=0.702).

Conclusions
Taking under consideration NAFLD – via validated indices – in the clinical assessment of an apparently healthy obese individual contributes to better defining future risk of conversion to metabolically unhealthy obesity and future cardiometabolic risk.

Funding Acknowledgement
Type of funding sources: None.
Early results on the efficacy and acceptability of a cardiac rehabilitation programme that transitioned to a fully virtual platform with adoption of wearable technology for covid era
Authors: Connolly S B , Jones J L , Jennings C , Neubeck L , Wood D A 
Published: October 2021

Abstract

Background/Introduction
Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology.

Methods
The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) – nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required.
The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan.
The subsequent 12 programme is comprised of

Results
Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good.

Conclusions
Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Funded under Transformation Funding Programme, Department of Health, Northern Ireland Table 1
Rehabilitation in post-COVID patients. A single center experience
Authors: Villani G Q , Villani M , Halasz G , Rosi A , Piepoli M F 
Published: October 2021

Abstract

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients.
The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment.
In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p&lt;0.005, SMWT admission 146±25 vs 318±18 m, p&lt;0.005) and in clinical complexity (RCS admission 10.9±1.1 vs discharge 5.3, p&lt;0.05).
At admission the comparison between Group A vs B has show:
1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005)
2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns)
3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05)
After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups:
1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns
2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns)

Conclusions
Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative.

Funding Acknowledgement
Type of funding sources: None.
SLCO1B1 and ABCB1 genetic variations – possible players in management of dyslipidemia: CoLaus (PsyCoLaus) study
Authors: Chekanova V , Marques-Vidal P 
Published: October 2021

Abstract

Aims
To find genetic markers associated with response to statins in a general population.

Methods
Data from baseline (2003–2006), first (2009–2012) and second (2014–2017) follow-ups of a population-based, prospective cohort study in Lausanne, Switzerland. Management of dyslipidemia was assessed according to the Swiss GSLA or European ESC/EAS guidelines based on LDL-cholesterol levels. The associations between 51 SNPs and dyslipidemia control using statins was performed.

Results
617, 844 and 798 participants of the baseline, first and second follow-ups (UPs) were included. Prevalence of adequately managed dyslipidemia was 70%, 68.5% and 83.6% at baseline, first and second FUs, respectively. Out of the 51 SNPs, most statistically significant (p&lt;0.05) associations with dyslipidemia control were found for SNPs related with SLCO1B1 (Solute Carrier Organic Anion Transporter Family Member 1B1) and ABCB1 (ATP Binding Cassette Subfamily B Member1), see Table. Still, most associations failed to replicate within survey periods or guidelines.

Conclusion
SLCO1B1 and ABCB1 polymorphisms might interact with response to statins. The use of genetic markers to guide statin prescription is not recommended, but for the future studies the impact of SLCO1B1 and ABCB1 in statin therapy should be further explored investigated.

Funding Acknowledgement
Type of funding sources: None. Table 1. SNPs and dyslipidemia: their association
Population genomic screening of all young adults in Australia to detect familial hypercholesterolemia: a cost-effectiveness analysis
Authors: Ademi Z , Marquina C , Lacaze P , Tiller J , Riaz M , Sturm A C , Nelson M , Ference B A , Pang J , Watts G F , Nicholls S J , Zoungas S , Liew D , McNeil J 
Published: October 2021

Abstract

Background
Heterozygous familial hypercholesterolemia (FH) is a highly-penetrant, autosomal dominant monogenic disorder that causes elevated plasma low-density cholesterol (LDL-C) levels and risk of premature coronary heart disease (CHD). To date, the cost-effectiveness of the emerging strategy of genomic screening of adult populations for FH has not been investigated.

Purpose
To assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolemia (FH).

Methods
We designed a decision analysis model to compare the current standard of care for heterozygous FH diagnosis in Australia (opportunistic cholesterol screening and genetic cascade testing) with population genomic screening of adults aged 18–40 years to detect pathogenic variants in the LDLR/APOB/PCSK9 genes. The model captured morbidity/mortality due to coronary heart disease (CHD) over a lifetime horizon, from a healthcare perspective. Risk of CHD, treatment effects, prevalence, and healthcare costs were estimated from published studies. Outcomes included quality adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER), discounted 5% annually. Sensitivity analyses were undertaken to explore the impact of key input parameters on the robustness of the model. The model structure was designed to be transferable to countries with different healthcare systems.

Results
Over the lifetime of the population (4,167,768 men; 4,129,961 women), the model estimated a gain of 62,722 years of life lived and 73,959 QALYs due to CHD prevention. Population genomic screening for FH would be cost-effective from a healthcare perspective if the cost per test was ≤AU$300 (∼US$233) which would yield an ICER AU$28,000 cost-saving.

Conclusion
Based on our model, offering population genomic screening to all young adults to detect FH could be cost-effective in the Australian healthcare system, at testing costs that are currently feasible.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Australian National Heart Foundation and Monash University Faculty of Medicine, Nursing and Health Sciences Results from scenario analysesResults from Monte Carlo simulations
Increasing prevalence of diabetic peripheral angiopathy and complications in hospitalized patients in the United States
Authors: Jiang D , Kuchta K , Amundson J , Tafur A , Morcos O , Lind B , Qamar A , Lee C J 
Published: October 2021

Abstract

Objectives
We aim to assess prevalence of diabetes related peripheral arterial disease and associated outcomes in hospitalized patients in the United States.

Methods
Trends in hospitalizations in diabetic patients with PAD were determined using the 2003–2017 National Inpatient Sample database. Hospital outcomes including diabetic ulcer incidence, amputations, and revascularizations were analyzed.

Results
The analysis included 10,303,673 hospitalizations in diabetic patients with PAD (DMPAD) during the study period. Prevalence of PAD among patients with diabetes increased over time (p&lt;0.001). The prevalence of foot ulcers in diabetics have also increased over time (p&lt;0.001). The incidence of amputations in patients with diabetes showed a decreasing trend with increasing prevalence of revascularizations from 2003 to 2009. Since 2010 however, rising rates of amputations, both minor and major are seen, especially in younger populations (age 18–49). Hospital costs for amputations have increased ($6.6 billion in 2003 vs $ 14.8 billion in 2017) as well as the costs for revascularization (6.1 billion in 2003 vs $13 billion in 2017) during the study period (p&lt;0.001).

Conclusions
In this analysis of patients with DMPAD, an alarming rate of disease prevalence and in-hospital limb outcomes, including costs, are realized in the current era.

Funding Acknowledgement
Type of funding sources: None.