bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weekend compensatory sleep is associated with reduced risk of heart disease: a prospective UK Biobank-based cohort study
Authors: Liu Z , Song Y J 
Published: October 2024

Abstract

Background and Aims
Influenced by the demands of school or work, people often fall out of sync with their circadian rhythms, which leads to sleeping in on days off. Despite this phenomenon, there is a lack of research examining whether compensatory weekend sleep has positive effects on heart health.

Methods and results
Our prospective cohort study utilized data from the UK Biobank (UKB) and encompassed 90,903 participants. To evaluate the relationship between compensated weekend sleep and heart disease. The sleep data was recorded by Axivity AX3 accelerometer from UKB and grouped by quartiles. Hospitalization records and cause of death registry information were used to diagnose various cardiac diseases including IHD, HF, AF, and stroke. Then multivariate Cox proportional hazard modeling was used to examine the potential impact of compensated sleep on the risk of heart disease.
At a median follow-up time of up to 13.8 years, we found that participants in the compensatory sleep group(Q4) had a lower risk of having heart disease in the fully adjusted model (HR: 0.809, 95%CI: 0.766,0.854), which was not influenced by the effect of genetic risk for IHD, HF, or AF. These relationships were even more pronounced in the subgroup with daily sleep deprivation (HR:0.801, 95%CI: 0.718,0.894).

Conclusion
Sufficient compensatory sleep on weekends is linked to a low risk of heart disease, including IHD, AF, HF, and stroke, which is independent of genetic risk. And the association becomes even more pronounced among individuals who regularly experience inadequate sleep on weekdays.Visual abstract
Association between adherence to LS7 and frailty among older US adults
Authors: Wu S , Yang Y , Zhu J 
Published: October 2024

Abstract

Objective
The Life's Simple 7 (LS7) metrics were developed by the American Heart Association to define ideal cardiovascular health. The impact of LS7 on frailty among older adults remains unclear. Our objective was to examine the association between the cardiovascular health score and risk of frailty among older adults.

Designs, Settings, and Participants
Data from the National Health and Nutrition Examination Surveys (NHANES) 1999-2018 was used. We included 9242 community-dwelling adults aged ≥ 65 years. The LS7 score was calculated for all participants. Frailty was measured with the 40-item frailty index, and a frailty index score of &gt; 0.21 was defined as ‘frailty’. Log-binominal regression and negative binomial regression were conducted to estimate the association between LS7 and frailty. Mediation analysis was used to estimate the mediating effects of inflammatory indicators on the association.

Results
The weighted average of frailty index score was 0.18, and 3206 participants (34.8%) were identified as ‘frailty’. Participants with high LS7 scores had significantly lower frailty index score and prevalence of frailty than those with low LS7 scores. In fully adjusted log-binominal regression models, with total score &lt; 6 as a reference, the ORs (95% CIs) for frailty were 0.79 (0.65, 0.96), 0.66 (0.54, 0.80), 0.50 (0.39, 0.65), and 0.39 (0.29, 0.52) for total score = 6, total score = 7, total score = 8, and total score &gt; 8, respectively. When LS7 score analyzed as a continuous variable, per 1-point increase in the LS7 score was associated with a 16% decrease in the risk of frailty (P &lt; 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for frailty were 0.96 (0.93, 1.00), 0.94 (0.91, 0.97), 0.91 (0.87, 0.95), and 0.85 (0.82, 0.88) for total score = 6, total score = 7, total score = 8, and total score &gt; 8, respectively. For each 1-point increase in the LS7 score, the risk of frailty decreased by 3% (P &lt; 0.001). No significant interactions were observed in subgroups stratified by age, sex, race, body mass index, smoking status, alcohol consumption, and self-reported health status. Causal mediation analysis indicated that inflammatory factors including blood cell count, neutrophil count, and C-reactive protein positively mediated the association of LS7 with frailty, with a mediating proportion of 0.0357 (P = 0.01), 0.0741 (P &lt; 0.001), and 0.0524 (P = 0.012), respectively.

Conclusions
In a nationally representative sample of U.S. adults, increased exposure to EO was independently related to an increased prevalence of frailty.Association between LS7 and frailtySubgroup analysis
The association between the dietary salt intake and glucose intolerance in healthy populations: from the Korean National Health and Nutritional Examination Survey (KNHANES)
Authors: Rha S , Choi B G , Choi S Y , Cha J , Hyun S , Kang J , Chu W , Park S , Choi C U , Park C G 
Published: October 2024

Abstract

Background
Diabetes is known to be a strong risk factor for cardiovascular disease (CVD), and controlling salt intake in patients with type 2 diabetes may be a strategy to reduce the risk of CVD. However, the clear interaction between salt intake and glucose homeostasis has yet to be investigated. Our study evaluated the frequency and risk of glucose intolerance (pre-diabetes) according to dietary salt intake in a healthy population in Korea.

Methods
The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). A total of 72,751 subjects were enrolled in the KNHANES database from 2010 to 2018. The subjects were categorized into the following: normal fasting glucose (i.e., no pre-diabetes; FPG &lt; 100 mg/dL), stage 1 pre-diabetes (FPG 100–109 mg/dL), stage 2 pre-diabetes (FPG 110–125 mg/dL). All subjects were divided into 8-equal groups according to their sodium intake: Group 1: ≤ 3.5 g, Group 2: 3.5 to 5.0 g, Group 3: 5.0 to 6.3 g, Group 4: 6.3 to 7.8 g, Group 5: 7.8 to 9.5 g, Group 6: 9.5 to 11.8 g, Group 7: 11.8 to 15.5 g, Group 8: &gt; 15.5 g. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status assessment at the same time.

Results
Of the total 36,782 healthy adults, 17.6% (6,481 subjects) were pre-diabetic, of which 14.7% (5,397 subjects) were stage I pre-diabetic, and 2.9% (1,084 patients) were stage II pre-diabetic. From the lowest salt intake group (group 1, salt intake &lt;3.5g) to the highest salt intake group (group 8, salt intake&gt;.5g), the pre-diabetes prevalence continuously increased from 9.2% to 22.8%. The range of stage 1 pre-diabetes was 7.3% to 18.3%, and stage 2 diabetes was 1.9% to 4.5%. The odds ratio (OR) of pre-diabetic risk according to salt intake in the non-diabetic population, compared with group 1, group 2 was 1.46 (95% confidence interval [CI]: 1.30-1.68), group 3 was 1.84 (95% CI: 1.62 -2.08), group 4 was 2.24 (95% CI: 1.99-2.54), group 5 was 2.43 (95% CI: 2.15-2.75), group 6 was 2.49 (95% CI: 2.20-2.81), group 7 was 2.83 (95% CI: 2.51-3.19), group 8 was 2.90 (95% CI: 2.57-3.27).

Conclusions
High salt intake is significantly associated with pre-diabetes prevalence in healthy Korean population.
Vaccination status and long COVID symptoms among patients hospitalized with COVID-19: the WHF COVID-19 Long-term Study
Authors: Singh K , Prabhakaran D , Nikhare K , Raspail L , Banerjee A , Narula J , Pineiro D , Perel P , Sliwa Hahnle K 
Published: October 2024

Abstract

Background
COVID-19 vaccinations have been found to be effective in reducing the severity of COVID-19 infection and in-hospital deaths; however, insufficient evidence exists about the effect of vaccination on long term morbidity and mortality after hospitalization in patients from low- and middle-income countries.

Methods
The global WHF COVID-19 Long-Term Follow-up Study recruited 2,504 COVID-19 hospitalized patients from 26 collaborating sites in 16 countries between January 2022 - June 2023. Patients were followed up , at 1, 3, 6, and 9-12 months post-discharge to examine short- and long-term physical and psycho-social outcomes. A standardised questionnaire was used to collect data on demographics, pre-existing comorbidities, COVID-19 symptoms on admission, vaccination status, and outcomes at discharge, including persisting symptoms, new onset hypertension or diabetes, major adverse cardiovascular events (MACE), and mortality. We compared persistent long COVID symptoms, MACE, and mortality outcomes up to one year by COVID-19 vaccination status.

Results
The majority of study participants were Asians (78%), males (56%) with a mean (SD) age of 59.2 (19.9) years and from low- and middle-income (65%), upper middle-income (20%) and high-income (15%) countries. The most commonly reported comorbidities were hypertension: 54% and diabetes: 38%. Approximately two-thirds of the patients had received at least one dose of COVID-19 vaccination prior to hospitalization. Unvaccinated patients were more likely to present with dyspnea (60% vs 53%, p-value&lt;0.001) and acute respiratory infection (15% vs 9%, p-value&lt;0.001) during hospitalization. Unvaccinated patients also had twice the in-hospital mortality rate, compared with vaccinated patients (6% vs 3%, p-value&lt;0.001). Unvaccinated patients had a greater incidence of MACE (23% vs 18%, p-value=0.016) during hospitalization and across all follow-up visits. Unvaccinated patients also had a higher mortality rate across all follow-up visits (mortality at one year post-discharge 14% vs 10%, p&lt;0.001). At the 9-12 month follow-up, about a quarter of the patients had at least one long COVID symptom, but unvaccinated patients had a higher rate of long COVID symptoms, including fatigue (23% vs 14%, p&lt;0.001), palpitations (17% to 7%, p-value&lt;0.001), and anxiety (13% to 7%, p=0.002).

Conclusions
Our data highlight the long-term protective effect of COVID-19 vaccination on reducing morbidity and mortality among COVID-19 patients after hospital discharge. However, a substantial proportion of COVID-19 vaccinated patients still showed persistent long COVID symptoms (22%) and mortality (10%). Future research is needed to investigate individual- and health system-level factors contributing to poor health outcomes post-COVID-19 infection.
All-cause, cancer and cardiovascular mortality among South Asians living in the UK: Follow-up of the London Life Sciences Population (LOLIPOP) cohort
Authors: Kooner I , Zhang W , Geoghegan F , Kooner A S , Scott J , Elliott P , Chambers J C , Kooner J S 
Published: October 2024

Abstract

Background
Although South Asians are the largest ethnic minority group in the UK, and the largest ethnic group worldwide, few studies have investigated patterns of mortality in South Asians.

Methods
We investigated 16,391 South Asian and 6,970 European men and women living in the UK, and participating in the London Life Sciences Prospective Population study. Participants were recruited in 2002-2008, and survival determined to 2019. We examined relationships of clinical, anthropometric, and lifestyle risk factors to mortality outcomes.
Findings: Compared to Europeans, South Asians had higher prevalence of diabetes, cardiovascular disease, and hypertension, higher waist-hip ratio, fasting glucose, insulin and triglycerides, but lower smoking rates and HDL cholesterol (all P&lt;0.001). Age and sex adjusted all-cause mortality was lower (Hazard Ratio (HR): 0.75 [0.68-0.81], P&lt;0.001), all-cancer mortality was lower (HR 0.50 [0.43-0.58], P&lt;0.001), and coronary heart disease (CHD) mortality was higher (HR 1.29 [1.05-1.60], P&lt;0.01) in South Asians compared to Europeans. Mortality rates were ~50% lower for 9 of the 10 most common cancers in South Asians. After adjusting for risk factors, ethnic differences were attenuated only for CHD mortality.
Interpretation: All-cause and cancer mortality are lower, but CHD mortality is higher, in South Asians compared to Europeans. Measured risk factors do not explain lower all-cause and all-cancer mortality, but do account for higher CHD mortality. Our findings provide evidence for population-specific exposures protective against cancers in South Asians, as well as the motivation to further improve cardiovascular risk reduction in this major ethnic group.
Short-term effects of ambient temperature variability on myocardial infarction hospitalizations in Sweden: A nationwide case-crossover study
Authors: Ni W , Stafoggia M , Zhang S , Ljungman P , Breitner S , Bont J D , Jernberg T , Atar D , Schneider A , Agewall S 
Published: October 2024

Abstract

Background
Climate change threatens human health and general welfare via multiple dimensions. However, the short-term effect of temperature variability, a crucial aspect of climate change, on myocardial infarction (MI) remains largely unexplored.

Purpose
We aimed to assess the short-term effects of temperature variability on MI hospitalizations within the nationwide SWEDEHEART registry.

Methods
This population-based nationwide study involved 228,897 MI patients from the SWEDEHEART registry in Sweden from 2005 to 2019. High-resolution (1 km × 1 km) daily mean ambient temperature was estimated using a spatiotemporal machine learning methodology and assigned to patients’ home addresses. Temperature variability was calculated as the difference between the same-day (as the MI event) ambient temperature and the average temperature recorded over the preceding seven days. Specifically, an upward temperature shift represents a rise in the current day’s temperature relative to the seven-day average, while a downward temperature shift indicates a corresponding decrease. A time-stratified case-crossover design incorporating a conditional logistic regression model with distributed lag non-linear model was applied to estimate the association between ambient temperature variability and total MI, ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Moreover, we assessed potential effect modification by sex and medication intake. The results were expressed as odds ratio (OR, with their 95% confidence intervals [CIs]) per 1°C increase in temperature variability.

Results
Our study found that a 1°C increase in upward temperature shift was significantly associated with increased risks for total MI, STEMI, and NSTEMI (OR [95% CI]: 1.010 [1.006-1.015], 1.014 [1.006-1.022], and 1.009 [1.004-1.014], respectively). Furthermore, a 1°C greater in downward temperature shift was significantly associated with decreased risks for total MI and NSTEMI (OR [95% CI]: 0.995 [0.991-0.999], and 0.993 [0.988-0.998], respectively). Moreover, we found that males and patients who were on any heart medication, particularly digitalis, were at a higher risk of MI associated with exposure to higher upward temperature shifts compared to females and their counterparts not taking these medications.

Conclusions
This nationwide case-crossover study provides novel evidence that short-term exposure to increasing upward temperature shift is associated with an increased risk of MI hospitalization. Our finding highlights the cardiovascular health threats posed by upward temperature shifts, which are anticipated to increase in frequency and intensity due to climate change.
Cost-effectiveness analysis of implementing the Nagasaki Acute Myocardial Infarction (AMI) secondary prevention clinical pathway
Authors: Kurobe M , Yamanaka Y , Uda A , Mori K , Inoue S , Yoshimura M , Ikeda S , Maemura K 
Published: October 2024

Abstract

Background/Introduction
Because of the poor prognosis associated with acute coronary syndromes (ACS), intensive low-density lipoprotein cholesterol (LDL-C) management therapy is recommended as early as possible after the onset of ACS, with the goal of lowering plasma LDL-C to &lt;70 mg/dL.
In Nagasaki City, a council was formed comprising all hospitals performing percutaneous coronary intervention along with general physicians, and an initiative to manage LDL-C using a region-wide LDL-C management clinical pathway (Figure 1) was launched in July 2022. The rate of intensive statin therapy at discharge increased from 34.5% to 79.8%, and the rate of patients achieving LDL-C &lt;70 mg/dL at discharge increased from 37.2% to 54.6% following the implementation of the clinical pathway. However, the cost-effectiveness of implementing the clinical pathway remains to be determined.
Purpose: The purpose of this study was to evaluate the cost-effectiveness of implementing the Nagasaki AMI Secondary Prevention Clinical Pathway.
Methods: To evaluate the cost-effectiveness of implementing the clinical pathway compared with no implementation, a lifetime simulation was performed using mathematical models. The models consisted of a decision tree model to model the flow of the clinical pathway (Figure 2) and a Markov model to consider the risks of developing cardiovascular disease (CVD) events. The quality-adjusted life year (QALY) was used as the outcome. Drug costs and treatment costs for each CVD event were included. Drug costs were calculated from actual prescriptions. Treatment costs and utility scores for each event were based on the literature. The risk of each CVD event was calculated using baseline risks estimated using commercial claims data (DeSC Healthcare, Inc.) and patients' LDL-C levels at discharge and 1 month after discharge. LDL-C levels at each time point were set separately for the groups that achieved or did not achieve a discharge LDL-C &lt; 70 mg/dL, for patients with and without implementing the clinical pathway.
Results: Implementing the clinical pathway was evaluated as dominant, with an incremental gain of 0.079 QALYs per person and expected cost savings of JPY 103,124 per person. Implementing the clinical pathway was shown to not only provide additional health benefits by preventing CVD, but also to reduce future health care costs. In the analysis with a 10-year time horizon, the result remained dominant, and the same level of cost savings was expected.
Conclusions: Implementing the Nagasaki AMI Secondary Prevention Clinical Pathway can be expected to reduce costs, in addition to increasing QALYs by preventing CVD. Further clinical and economic evaluation of long-term follow-up with a collaborative pathway to the general physician after discharge from the hospital is expected.
The Waiting 4 Surgery study: burden of in-hospital care
Authors: Campos I , Oliveira I , Lopes R G , Braganca B , Cruz I , Monteiro J P , Goncalves I , Andrade A 
Published: October 2024

Abstract

Introduction
Patients with coronary artery and valvular diseases with surgical indication represent a significant proportion of hospitalizations. The Waiting 4 Surgery study (W4S) aims to better study this group of patients, their burden of hospital care and identify those with event-free admissions.

Purpose
In this work, we analyze both the economical and hospital-care burden of this group of patients.

Methods
Retrospective study of consecutive patients admitted between 2019 and 2021 with coronary artery and/or aortic valve diseases waiting for coronary artery bypass graft (CABG), aortic valve replacement (AVR; surgical or percutaneous) or both. Total admission time and the cost associated with the hospitalization were analyzed.
For event-free hospitalization, the following events were considered: death, re-infarction, cardiac pulmonary arrest (CPA), stroke, ventricular tachycardia, acute heart failure (AHF), rest chest pain and reintroduction of intravenous (IV) drugs. We performed a secondary cost analysis for patients with event-free hospitalization after the first 5 days of admission.

Results
Total of 184 patients were included, mean age 67.9 years, 70.1% male, 71.2% submitted to CABG and 20.7% to AVR (6.5% to both). During admission 23.9% of patients reintroduced IV drugs, 20.1% had chest pain, 5.4% had AHF and 2.2% had CPA. No deaths, strokes of re-infarctions were observed.
The total time of hospitalization was 3 259 patients/days, representing an occupation rate of 18.6% and a total cost of 1 898 447€ (10 318€/patient and 632 816€/year). Mean admission time was 17.6 days. Total cost for CABG and AVR patients was 1 479 613€ and 594 562€, respectively.
Total of 115 patients had an event-free hospitalization (62.5%). The total time of event-free hospitalization was 1 650 patients/days, representing an occupation rate of 9.42% and a total cost of 979 710€ (6 575€/patient and 326 570€/year). Mean event-free admission time was 14.3 days. Total cost for CABG and AVR in event-free patients was 863 155€ and 223 258€, respectively.

Conclusion
The W4S study demonstrates the impact patients waiting for surgery represent in hospital care: a very high economic and logistic burden. The majority of patients showed an event-free admission, and identifying such patients for early discharge and ambulatory management together with surgical centers should be a priority.
Implementation of sodium-glucose co-transporter 2 inhibitors in patients with heart failure through a new digital strategy (EMAIL-HF): a randomised clinical trial study design
Authors: Elmegaard M , Koeber L , Mouridsen M R , Lauridsen T K , Dridi N P , Wolsk E , Thune J J , Ersboell M K , Petersen M , Lamberts M K , Stride N O , Barasa A , Bonfils P , Tuxen C D , Schou M 
Published: October 2024

Abstract

Introduction
Delayed implementation of new medical discoveries remains a global healthcare challenge and is mainly due to the complexity of cross-institutional patient care. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors is the latest medical discovery in heart failure (HF) and have recently been added to clinical guidelines as they have proven to reduce the risk of adverse cardiovascular outcomes in patients with HF across the ejection fraction spectrum. Whether a new digital strategy can optimise and accelerate the implementation of SGLT2 inhibitors in patients living with HF is of great importance for public health.

Purpose
To evaluate whether a new and streamlined digital strategy can optimise and accelerate the implementation of SGLT2 inhibitors in patients with HF.
Design and methods: The trial is a multicentre, parallel group, register-based randomised clinical study, evaluating the effect and potential of a new digital strategy to implement new guideline therapies to patients living with a chronic disease, specifically SGLT2 inhibitors to patients with HF (figure 1). The setup employs data from nationwide health registers and official digital letters to inform patients about the new therapy option and invite them to have their eligibility evaluated by a HF specialist and start therapy. A total of ~10,000 patients with HF across the ejection fraction spectrum (with and without diabetes), who have not yet been started on SGLT2 inhibitors, are identified through Danish nationwide health registers, and randomised 1:1 to receive the digital letter (figure 2). The primary outcome is the proportion of patients redeeming a prescription of a SGLT2 inhibitor within six months. Secondary outcome is a composite HF endpoint consisting of all-cause death or HF hospitalisation. Other outcome measures are renal failure, stroke and myocardial infarction, safety outcomes, adherence to therapy and proportion of vulnerable patient groups initiating therapy including immigrants, elderly, frail patients, patients with lower socioeconomic level and lower educational level. A total of 4689 patients have been randomised (February 2024) and data will be presented in 2025.

Conclusions
The trial will determine the efficacy and safety of a new and streamlined digital strategy to implement SGLT2 inhibitors to patients with chronic HF. The setup has the potential to be used in a broad spectrum of patients living with chronic diseases and is expected to be highly cost-effective.Figure 1.Study hypothesisFigure 2.Study design