bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel electrocardiogram-based model for prediction of dementia: the Atherosclerosis Risk in Communities (ARIC) study
Authors: Chen D , Yao Y , Moser E , Wang W , Soliman E , Mosley T , Pan W E I 
Published: October 2024

Abstract

Background
Current dementia prediction models, such as the UK Biobank Dementia Risk Score (UKBDRS, 12 variables), are limited by having variables that are difficult to obtain, subjectively measured, and self-reported. Although individual ECG parameters are linked to higher dementia risk, no study has combined multiple ECG parameters to create an ECG model for dementia prediction.

Purpose
Using data from the ARIC study, a prospective community-based cohort of Black and White participants in the USA that started in 1987-89, we created an ECG model (based on 7 pre-defined ECG parameters linked to dementia) and compared its model discrimination with the UKBDRS.

Methods
Participants without prevalent dementia from 2 baselines were included: Visit 4 (V4, 1996-98) and V5 (2011-13). Seven ECG parameters were examined: heart rate, abnormal P-wave terminal force in lead V1 (PTFV1), prolonged P wave duration, abnormal P wave axis, advanced interatrial block, left ventricular hypertrophy (LVH, Cornell voltage criteria), and corrected QT interval (QTc). Dementia cases were identified through 2019 using in-person and phone cognitive assessments, hospitalisation codes, and death certificates. Using a backward selection method (keeping variables with P&lt;0.10 and age, since it is an important dementia risk factor), parsimonious Cox regression models were constructed for prediction of dementia over the longest available follow-up (V4: 23 years, V5: 8 years). Model discrimination of the ECG models and UKBDRS variables was evaluated by the Harrell’s C-statistic (95% CI).

Results
At V4, 11,520 participants (mean age, 62.8 ± 5.7 years; 56% women; 22% Black) were included; 2,427 developed dementia. At V5, 5,667 participants (mean age, 75.4 ± 5.1 years; 59% women; 22% Black) were included; 830 developed dementia. Figures 1 and 2 show the C-statistic (95%) and area under the ROC curve for the ECG model and UKBDRS variables at V4 and V5, respectively. The C-statistic (95% CI) for both ECG models were &gt;0.70 and comparable with the corresponding UKBDRS models.

Conclusion
For middle-aged and older adults, a dementia prediction model comprising age and 4 ECG variables has good discrimination for dementia that is comparable with the 12-variable UKBDRS model. Since ECG variables are easily obtainable and objectively measured, these ECG models will be easier to adopt than the UKBDRS model. Further work to validate this model in an external cohort and develop a risk score will facilitate clinical translation.
Heterogeneous associations of traditional atherosclerotic risk factors and long-term events in different arterial territories: the EPIC Norfolk prospective population cohort
Authors: Van Den Bogaart M , Snaterse M , Van Trier T J , Martens F M A C , Peters R J G , Boekholdt S M , Jorstad H T 
Published: October 2024

Abstract

Background
Atherosclerotic risk factors have been associated with cardiovascular disease (CVD) events in specific arterial territories. However, these observations are limited by relatively short-term follow-up (i.e. ten years) and a focus on a limited number of outcome events. We therefore investigated associations between atherosclerotic risk factors and territory-specific cardiovascular events in a large cohort with ≥20 years follow-up.

Methods
We included participants without baseline CVD from the European Prospective Investigation of Cancer (EPIC) Norfolk prospective population cohort. The strengths of associations between CVD risk factors (smoking, low-density lipoprotein cholesterol (LDL-c), and systolic blood pressure (SBP)) and the first occurrence of a CVD event were evaluated using a competing risk-adjusted regression model. CVD events were defined as hospitalisations or death due to ischemic heart disease (IHD), ischemic stroke, haemorrhagic stroke, peripheral arterial disease (PAD) or aortic aneurysm (AA). Patients were followed-up until the first event, non-CVD death (competing risk) or end of study (15-03-2018). The model was adjusted for sex, age, diabetes, HDL-c, kidney function and body mass index. LDL-c and SBP were analysed by comparing highest versus lowest quartiles. Smoking (at baseline) was compared to never smoking.

Results
We included 23,581 participants (56% women) with a median baseline age of 58 years [interquartile range (IQR) 51-66]. During median follow up of 21.3 years (IQR 19.0-22.8), 26.4% of individuals experienced ≥1 CVD event. The first event of occurrence was IHD in 17.3%, ischemic stroke in 3.6%, haemorrhagic stroke in 1.4%, PAD in 3.1% and AA in 1.4%. LDL-c was strongest associated with IHD [adjusted hazard rate (aHR) 1.7, 95% confidence interval (CI) 1.5-1.9], SBP with ischemic stroke (aHR 1.9, 95%CI 1.5-2.5) and smoking with AA (aHR 4.8, 95%CI 3.5-6.5) (Figure 1).

Conclusions
There is considerable heterogeneity in the associations between atherosclerotic risk factors and long-term, first, territory-specific cardiovascular events. Knowledge of these differences may assist in personalised treatment decisions and risk communication.
Burden and sociodemographic disparities in cardiovascular mortality rates associated with hypercholesterolemia in united states: a nationwide county-level analysis from 2010 to 2019
Authors: Abohashem S , Civieri G , Dar T , Goudot G , Aldosoky W 
Published: October 2024

Abstract

Background
Hypercholesterolemia (HC), a major public health concern, has seen a rising prevalence in US adults and globally, leading to increased morbidity and mortality. Despite well-established links between HC and cardiovascular mortality (CVM), the specific impacts and disparities at the population level remain poorly understood.

Purpose
This study aims to assess the independent effects of HC on VM across the overall US population, examining variations across sociodemographic groups and geographic locations.

Methods
Age-adjusted county-level CV rates (ACVM per 100,000 individuals) between 2010 to 2019 were obtained using the Center for Disease Control and Prevention (CDC) database. Using the CDC surveillance system, HC rates per county were assessed as the proportion of adults (+18) with high total blood cholesterol. County health ranking project databases were utilized to acquire county characteristics and demographics. Poison generalized estimating equation models were employed to assess incidence rate ratios (IRR).

Results
Of 307,045,656 residents who lived in 3142 US counties in 2010, a total of 8,157,580 (2.7%) CV deaths occurred between 2010-2019. In a fully adjusted model*, high HC rates associated with high ACVM (Standardized IRR: 1.049; Figure 1). In subgroup analyses, HC rates associated with a greater ACVM among counties with high minority (IRR: 1.070) versus low (IRR: 1.043), and in rural areas (IRR: 1.052) versus urban (IRR: 1.041). Notably, this association was prominent in areas with high poverty (Q4 vs. Q1) (IRR: 1.062 vs. 1.035; p interaction &lt;0.001; Figure 1). Further, higher ACVM rates related to HC were observed in the South and Northeast U.S. regions.

Conclusions
HC rates are independently associated with high ACVM across most sociodemographic groups and locations, with the most pronounced effect in areas with high poverty levels and minority populations. These findings call on targeted interventions and policymaking aimed at mitigating the prevalence of HC and cardiovascular burden, particularly in vulnerable populations.
The effect of 6-month treatment with coenzyme Q10 on endothelial, vascular and myocardial function in patients with nonalcoholic fatty liver disease
Authors: Ikonomidis I , Katogiannis K , Vrentzos E , Pavlidis G , Korakas E , Kountouri A , Pliouta L , Pelekanou A , Michalopoulou E , Katsanaki E , Vlachomitros D , Lambadiari V 
Published: October 2024

Abstract

Background
Patients with Non-alcoholic fatty liver disease (NAFLD) hold an increased cardiovascular risk and present impaired markers of vascular, endothelial and myocardial function. Coenzyme Q10 (CQ10) is a powerful antioxidant that enhances mitochondrial function.
Patients/methods: 52 patients (52±10 years old) with NAFLD were randomized to 240 mg CQ10 (n=25) or placebo (n=27). We measured at baseline and at six months post-treatment: i) Perfused boundary Region (PBR) of the sublingual arterial microvessels (Microscan, Glycocheck), ii) Carotid femoral pulse wave velocity - PWV (Complior ALAM), iii) Flow-mediated dilation (FMD) of the brachial artery, iv) Global left ventricular longitudinal strain (GLS) by speckle tracking imaging, v) Controlled attenuation parameter (CAP) measurement (FibroScan, Echosens).

Results
Six months post treatment with cQ10, values of PBR (2.12±0.19 vs. 2.28±0.23 μm), PWV (9.5±2.3 vs. 10.5±2.4m/s), CAP score (278.1±50, 2 vs. 305.3±44.5dB/m), FMD (6.61±4 vs. 5.02±2.6 %) and GLS (-19.3±1.9 vs -18.2±2 %) were improved (p&lt;0.05 for all comparisons). On the contrary, the patients who were treated with placebo did not show statistically significant differences in PBR, PWV, CAP score, FMD and GLS after from 6 months (p&gt;0.05). In the patients who received cQ10, the percentage reduction of CAP score at 6 months was directly proportional to the percent reduction in PWV (r=0.31, p=0.045) and inversely proportional to the percentage increase in FMD (r=-0.58, p=0.014).

Conclusion
Six-month treatment with CoQ10 reduces liver steatosis in patients with NAFLD. CoQ10 is associated with improved endothelial, vascular and LV myocardial function in patients with NAFLD.
Regular supervised exercise training improves endothelial function, early atherosclerosis, arterial stiffness and endothelial progenitor cells in PCI patients
Authors: Park J , Lim S B , Kim J H , Lim D S , Cha J J , Joo H J , Hong S J , Yu C W 
Published: October 2024

Abstract

Backgrounds
A disrupted balance between endothelial injury and repair induces endothelial dysfunction and endothelial progenitor cells (EPC) augment vascular repair. So, exercise improves endothelial function through increased numbers of EPC. We investigated the effect of training on vascular health by measuring the number of circulating EPC, and assessing flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) in patients with percutaneous coronary intervention (PCI).

Methods
Fifty-nine patients who were done PCI recently were randomized to full medical treatments or additional 3 months regular supervised exercise program (4 times a week, 1 hr a day). FMD, baPWV, carotid IMT, HOMA, hs-CRP and lipid profiles were measured and circulating CD34/KDR, CD34/CD117 and CD34/CD133 EPC were quantified by flow cytometry at baselines and after 3 months.

Results
Finally 23 patients joined exercise program(control, N=28). There was no significant difference of baseline characteristics and medication between 2 groups. After 3 months, FMD improved significantly in exercise group (6.62% to 11.48%) compared with control group (7.61% to 8.45%) (P&lt;0.001) (fig 1). Carotid IMT reduced significantly in exercise group (0.759mm to 0.707mm) compared with control group (P=0.015) (fig 2). ba-PWV reduced significantly in exercise group (1529cmm/s to 1455 cmm/s) compared with control group (P=0.016) (fig 3). Numbers of CD34/KDR, CD34/CD117 and CD34/CD133 EPCs increased significantly after exercise compared with control group (P= 0.041, 0.011, 0.022, respectively) (fig 4). We also could see to reduce waist to hip ratio in exercise group compared with control group (P&lt;0.001).

Conclusions
Three months regular supervised exercise improved FMD, ba-PWV, carotid IMT and waist to hip ratio in PCI patients. and it augmented numbers of circulating EPCs. Our results showed that exercise contributes to additional improvement of vascular health in PCI patients with optimal medical treatments.
Effect of physical activity level on the association of LBBB, heart failure, and mortality
Authors: Loutati R , Luria D , Amir O , Biton Y 
Published: October 2024

Abstract

Background
The beneficial effect of physical activity (PA) on adverse cardiovascular outcomes in patients with heart failure (HF) and left bundle branch block (LBBB) is well established. Yet, the impact of PA on individuals with LBBB without evident HF remains unexplored. Our objective is to investigate how PA modifies the outcomes of new-onset LBBB patients concerning HF-related hospitalizations and mortality.

Methods
Among the UK Biobank participants without a diagnosis of HF, we identified individuals with new-onset LBBB and available PA quantification. Patients were dichotomized into normal QRS and LBBB groups, following by stratification according to summed minutes of PA per week. The primary outcome was all-cause mortality, and HF-related hospitalizations. Cox proportional hazard model and Kaplan-Meier survival analysis were applied.

Results
The final cohort comprised 367,934 individuals, with a mean age of 56.6±8.2 years and 47% male. Among them, 3,427 (0.9%) developed new-onset LBBB, characterized by advanced age, male predominance, and higher rates of comorbidities. Median summed PA minutes per week were 100 (IQR: 125-180), with no significant difference between normal QRS and LBBB patients. Over a median follow-up of 13.8 years (IQR: 13-14.5), 26,304 patients (7.15%) died. Kaplan-Meier analysis revealed higher mortality risk with reduced PA level and/or LBBB (log-rank p&lt;0.001 for both). Multivariate Cox analysis adjusted for age, sex, and comorbidities showed LBBB patients had over 3.5-fold increased risk of death (HR 3.67, 95% CI 3.39-3.97, p&lt;0.001) compared to normal QRS. The association of LBBB with mortality was modified by weekly PA minutes; those with &lt;150 minutes had nearly 40% higher risk compared to those with ≥150 minutes (HR 3.78, 95% CI 3.43–4.15, p&lt;0.001; HR 3.4, 95% CI 2.93–3.95, p&lt;0.001; p for interaction=0.035). The protective effect of PA was 6% among normal QRS patients, compared to 22% among individuals with LBBB (HR 0.94, 95% CI 0.91 – 0.96, p&lt;0.001 vs. HR 0.78, 95% CI 0.66 – 0.93, p=0.004). Similar findings were observed for HF hospitalizations.

Conclusions
Although the correlation between LBBB and adverse cardiovascular outcomes remained consistent across both levels of physical activity (PA), it was more pronounced among patients with low PA levels. When assessing the risk in patients with newly diagnosed LBBB, particular attention should be directed towards their PA status.
Pregnancy complications and long-term risk of cardiovascular events in women with heart disease
Authors: Taufer Cederlof E , Lindhagen L , Lundgren M , Lindahl B , Christersson C 
Published: October 2024

Abstract

Background/Introduction
Women with congenital heart or acquired heart disease are at increased risk of atherosclerotic cardiovascular disease. Pregnancy complications are established risk factors for cardiovascular disease in the general population, but their prognostic value for cardiovascular outcomes in the population with congenital or acquired heart disease is unknown.

Purpose
To determine the frequency and prognostic value of pregnancy complications for the risk of cardiovascular outcomes in women with congenital or acquired heart disease.

Methods
This nationwide registry-based cohort study included women in Sweden with heart disease (pulmonary arterial hypertension, congenital heart disease or acquired valvular heart disease) with singleton births registered in the national Medical Birth Register between 1973 and 2014. Exposures of pregnancy complications (preeclampsia/gestational hypertension, preterm birth or birth of an infant small for gestational age) were collected from the Medical Birth Register, and cardiovascular outcomes (mortality and hospitalizations) from the Cause of Death Register and the National Inpatient Register. Cox regression models were performed with time-dependent covariates, to determine the possible prognostic value of the studied pregnancy complications for cardiovascular outcomes including atherosclerotic cardiovascular disease, heart failure and arrythmias after adjustment for major confounding including smoking and body mass index.

Results
Among the total of 2,134,239 women included from the Medical Birth Register, 2,554 women with 5,568 singleton births were affected by heart disease. Preeclampsia/gestational hypertension affected 5.8% of pregnancies, preterm birth 9.7%, and birth of an infant small for gestational age 2.8%. Preterm birth (adjusted HR 1.91 (95% CI 1.38-2.64)) was associated with an increased risk of maternal all-cause mortality. Preeclampsia/gestational hypertension (adjusted HR 1.64 (95% CI 1.18-2.29)) and preterm birth (adjusted HR 1.56 (95% CI 1.19-2.04)) were associated with an increased risk of hospitalizations for atherosclerotic cardiovascular disease.

Conclusions
Pregnancy complications were frequent in women with congenital or acquired heart disease. With a median follow-up time of 22 years, preterm birth was associated with a higher risk of cardiovascular mortality, and preeclampsia/gestational hypertension and preterm birth were associated with cardiovascular morbidity. In women with heart disease, pregnancy complications may provide additional information for the risk assessment of future cardiovascular outcomes.Overview of study designPrevalence and risk estimation
Identification of premature cardiovascular disease using a family-based strategy: a feasibility pilot study
Authors: Charleux P , Procopi N , Rahoual G , Rouanet S , Brugier D , Barthelemy O , Kerneis M , Vicaut E , Silvain J , Montalescot G , Zeitouni M 
Published: October 2024

Abstract

Background
Current guidelines fail to identify and effectively prevent cardiovascular disease (CVD) in young adults.

Purpose
To assess the feasibility of a systematic cardiovascular risk assessment in first-degree relatives of individuals with premature coronary artery disease (CAD).

Method
Index patients with obstructive CAD aged ≤ 45 years or ≤ 55 years without standard modifiable cardiovascular risk factor or ≤ 55 years with a 3-vessel coronary disease were prospectively identified among admissions. Pre-existing cases of CVD and prior cardiovascular check-ups were assessed among their first-degree relatives. Siblings and adult-children (≥25 years) without known CVD or active cardiology follow-up were eligible for a first cardiovascular evaluation. Index patients were encouraged to invite their eligible relatives to contact the Cardiology service for consultation. The primary endpoint was the relative’s eligibility for a cardiovascular prevention consultation.

Result
From September 2022 to June 2023, 137 patients with premature CAD, with 55.5% aged ≤ 45, were invited to initiate cardiovascular screening among their first-degree relatives. Of the 626 identified relatives, 153 (24.4%) had known atherosclerotic disease, primarily CAD (19.6%). Premature onset (before the age of 45) occurred in 5% of first-degree relatives. Among the 352 siblings and adult-children, 48 (13.6%) were already diagnosed with CVD, 68 (19.3%) were treated or followed for primary prevention, and 226 (64.2%) lacked active cardiovascular monitoring or treatment and were eligible for a first cardiovascular check-up (Figure 1). Within 10 months, 11.1% (25/226) of eligible relatives attended a first cardiovascular evaluation.

Conclusion
This family-based screening strategy for premature CVD demonstrated 1) a significant familial dimension, with 33% of siblings & adult-children already monitored for CVD prevention, and 2) an opportunity for cardiovascular prevention in two out of three young relatives.
Lp(a) testing and LDL-C levels among australian ASCVD patients in 2022: a cross-sectional study from the advara heartcare network (PREVAIL)
Authors: Eccleston D , Deans R , Berry P , Rahman M , Santani R , Truong B , Chowdhury E 
Published: October 2024

Abstract

Background
The proportion of Australians with atherosclerotic cardiovascular disease (ASCVD) who meet secondary prevention low-density lipoprotein cholesterol (LDL-C) targets is uncertain, particularly among those undergoing lipoprotein(a) (Lp(a)) testing. This study describes the characteristics and achievement of LDL-C targets in ASCVD patients, both with and without Lp(a) tests.

Methods
A cross-sectional study was performed utilising secondary data from the Advara HeartCare cardiology network electronic medical records (EMR). Natural language processing (NLP) was used to extract data from clinical letters between 2011 and 2022 for patients attended during 2022. The 2022 baseline report captures clinical characteristics (i.e,. comorbidities, medications, lab values) in those with and without Lp(a) tests.

Results
In 2022, a total of 55,427 ASCVD patients were identified, predominantly male (65.1%) with a mean age of 71.2 (12.3). 61% had dyslipidaemia, 58.6% had hypertension, and 21.4% had diabetes. 72.7% were on statins, 19.4% on ezetimibe and 5.6% on PCSK9i. LDL-C information was available for 60.2% (33,381) of all ASCVD patients, with a mean LDL-C of 2.0 mmol/dL. 47.6% and 21.4% had LDL-C levels &lt;1.8 mmol/dL and &lt;1.4 mmol/dL respectively. Lp(a) test results were available for 2.6% (n=1,460) of ASCVD patients, with 87.7% having LDL-C information available, and a mean LDL-C of 1.9 mmol/dL. Among this group, 54.5% and 25.1% had LDL-C levels &lt;1.8 mmol/dL and &lt;1.4 mmol/dL respectively.

Conclusions
The study highlights suboptimal achievement of LDL-C targets among both ASCVD patients and those tested for Lp(a), underscoring the need to improve secondary prevention strategies and Lp(a) measurement in the ASCVD population.
The change of paradigm: high HDL-c levels could not mean a long lifespan
Authors: Sousa F , Mendonca M , Sa D , Abreu G , Henriques E , Freitas S , Rodrigues M , Borges S , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R 
Published: October 2024

Abstract

Background
It is known that a low HDL-c level is associated with a high risk of overall mortality. Consequently, it was presumed that achieving higher levels of high-density lipoprotein cholesterol (HDL-c) would reduce the risk or even extend the lifespan. However, clinical trials with medical intervention failed to find clinical benefits.

Aim
We aimed to investigate the association between (HDL-c) levels and overall mortality using a prospective cohort from Portugal.

Methods
A prospective sub-study (2001-2022) was performed in a cohort of 1718 participants without coronary artery disease (CAD) of the control arm of the ongoing GENEMACOR study. The participants &lt;65 years were followed during a mean follow-up of 7.0±5.7 years. All demographic, biochemical, and clinical data were collected. Participants were stratified into six levels of HDL-c. Kaplan-Meier estimated differences in the survival probability of each HDL-c level. Cox proportional analysis models (unadjusted and adjusted) were used to assess the association between HDL-c levels and overall mortality.

Results
The HDL-c levels with the lowest overall mortality rate were 60 to 70 mg/dl, set as the reference level. Total HDL-c strata were associated with overall mortality with a U-shaped relationship: in the control group, the first level (&lt;40 mg/dl) was independently associated with increased risk of overall mortality (HR of 3.533; 95% CI: 1.738-7.178; p&lt;0.0001). This risk drops and falls to the reference level (the lower risk) and rises again to an HR of 3.875 (95% CI: 1.472-10.201; p=0.006) in the very high HDL-c levels (≥80 mg/dl).

Conclusions
Our results, based on a large Portuguese cohort, suggest that very high HDL-c levels in the normal population may not represent a good prognosis, especially in women. Future research may confirm these findings and investigate the underlying mechanisms.