bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular outcomes in acute coronary syndrome patients with cancer: a statewide population-linkage study
Authors: Yu C , Teber E , Hyun K , Kritharides L , Negishi K , Ng A C C , Brieger D 
Published: October 2024

Abstract

Background
Advances in oncology treatment have led to an increase in the number of cancer survivors. As a result, the number of acute coronary syndrome (ACS) patients with cancer is increasing and the outcomes of these patients are not well described.

Purpose
This study aimed to examine revascularisation strategies and all cause and cardiovascular death in ACS patients with and without cancer.

Methods
Hospitalised patients in New South Wales, Australia, from July 2006 to December 2020 with a primary diagnosis of ACS were identified from the statewide Admitted Patient Data Collection database. Patients were stratified into those with or without a history of cancer (non-melanoma skin cancers excluded). Propensity scoring matching (PSM) for the variables of age, gender and cardiovascular risk factors was performed with each cancer patient matched to two non-cancer patients. Cox proportional hazards regression model was used to evaluate the hazard ratios of all-cause mortality between individuals with a history of cancer in the 5 years preceding their hospital admission, and those without. Additionally, Fine-Gray competing risk analysis was performed for cardiovascular death with non-cardiovascular mortality as the competing event.

Results
During the study period, 193,848 patients were admitted with ACS. 12,543 patients had a history of cancer and were PSM to 25,085 patients without cancer. The median age was 75 (Q1-Q3 67-82) years with 69% male and hypertension the most prevalent risk factor (55%) (Table 1). ACS patients with cancer had clinically comparable, rates of percutaneous revascularisation (36 vs 37%, p=0.07) and coronary artery bypass grafting (11 vs 13%, p&lt;0.001) with ACS patients without cancer. During a median follow up of 8.6 (95% CI 8.4-8.8) years, ACS patients with a history of cancer had a significant higher risk of all cause death (HR 1.42 95% CI [1.38-1.46]) and cardiovascular death (SHR 1.14 [1.11-1.18]). The cumulative incidence function demonstrated cardiovascular death in those with a cancer history occurred in 20% by approximately 1.4 years follow up compared to 2.5 years in those without cancer (Figure 1).

Conclusion
ACS patients with cancer have a higher risk of all cause death and cardiovascular death compared to those without a history of cancer with clinically comparably revascularisation rates. Further studies to determine the cause of increased cardiovascular death in ACS patients with cancer are required.Figure 1
Association between PCSK9 inhibitor with cause-specific morality amongst cancer survivors
Authors: Zhang N , Gu T , Hu S , Li G , Tse G , Liu T , Chen K 
Published: October 2024

Abstract

Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor has emerged as a novel pharmacotherapy for dyslipidemia and been shown to be effective in reducing the risks of atherosclerotic cardiovascular diseases. PCSK9 is aberrantly expressed in a broad spectrum of cancers and has been demonstrated to contribute to cancer prognosis. However, no prior study has investigated the associations between PCSK9 inhibitors (PCSK9i) with cardiovascular and cancer mortality amongst cancer survivors.

Purpose
This study investigated the effects of PCSK9i on cause-specific mortality amongst cancer survivors.

Methods
This retrospective study used data from the Tianjin Coronary Artery Disease Cohort, which included medical data from 71 secondary or tertiary hospitals in Tianjin, China. Adult patients with coronary artery disease (CAD) diagnosed with incident cancer between 2017 and 2023 were enrolled in this study. Propensity score matching with a 1:3 ratio for PCSK9i users versus non-users was performed. The primary outcomes included all-cause mortality, cardiovascular mortality, and cancer mortality. Multivariable Cox regression was used to test associations between PCSK9i with outcomes, adjusting for age, gender, cardiovascular and non-cardiovascular comorbidities, lipid-lowing agents and other medication use, lipid level, as well as cancer characteristics. Multivariable competing risk analysis was used as sensitivity analysis.

Results
A total of 62,341 incident cancer patients were identified. After matching, 424 PCSK9i users and 1,272 non-users were included in this study. During a median follow-up of 1,009 days, 315 patients died, among which 98 died due to cardiovascular cause, 146 died due to cancer cause. Compared to non-users, cancer patients treated with PCSK9i presented with significantly lower risk of all-cause mortality (hazard ratio [HR], 0.33; 95% confidence interval [CI] 0.23-0.47; p &lt;0.001), after adjusting for potential confounders. In addition, PCSK9i therapy was associated with a 63% lower risk of cardiovascular mortality (HR, 0.37; 95%CI 0.20-0.69; p=0.002) and a 75% lower risk of cancer-related mortality (HR, 0.25; 95%CI 0.14-0.45; p&lt;0.001), in relation to non-PCSK9i group. Sensitivity analysis using multivariable competing risk model also suggested a significant association between PCSK9i treatment with reduced risk of cardiovascular mortality (HR, 0.41; 95%CI 0.22-0.76; p=0.005) and cancer mortality (HR, 0.26; 95%CI 0.15-0.48; p&lt;0.001) among cancer survivors.

Conclusion
The use of PCSK9i was associated lower risks of all-cause, cardiovascular-related, and cancer-related mortality amongst cancer survivors. These findings potentially indicate benefits of PCSK9i beyond adverse cardiovascular events related to atherosclerosis.
ACE inhibitor and angiotensin receptor blocker use during pregnancy: data from the ESC Registry of pregnancy and cardiac disease (ROPAC)
Authors: Van Der Zande J A , Ramlakhan K , Prokselj K , Munoz-Ortiz E , Baroutidou A , Lipczynska M , Nagy E , Rutz T , Franx A , Hall R , Johnson M , Roos-Hesselink J W 
Published: October 2024

Abstract

Background and Aims
Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester due to the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and to evaluate the impact on perinatal outcomes.

Methods
The Registry of Pregnancy and Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. In addition, the perinatal outcomes of patients who stopped ACE-Is and/or ARBs before pregnancy were assessed.

Results
ACE-I (n=35) and/or ARB (n=8) were used in 42 (0.7%) of the 5739 ROPAC pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p=0.021), had chronic hypertension (31% vs 6%, p&lt;0.001), or a left ventricular ejection fraction &lt;40% (33% vs 4%, p&lt;0.001). No pregnancy terminations due to fetal anomaly were reported. ACE-I use during the first trimester was independently associated with an increased risk of congenital anomaly (OR 3.1; 95% CI 1.0-9.3). No adverse fetal or neonatal effects were seen when ACE-I and/or ARB were discontinued prior to pregnancy.

Conclusions
ACE-Is and ARBs are seldom used during pregnancy and based on our data, ACE-Is should also be avoided in the first trimester due to a higher risk of congenital anomalies. Preconception counseling is crucial to discuss the potential risks of these medications, and to evaluate the clinical condition and, if possible, the woman can be switched to an alternative medication.
Postpartum cardiac reverse remodeling is reflected in urine proteome
Authors: Ferreira A F , Trindade F , Azevedo M J , Morais J , Douche T , Diaz S O , Saraiva F A , Sousa C , Machado A P , Matondo M , Leite-Moreira A , Ramalho C , Vitorino R , Falcao-Pires I , Barros A S 
Published: October 2024

Abstract

Background
The impact of postpartum cardiac reverse remodeling (RR) on urinary proteome, particularly in pregnant women with cardiovascular risk (CVR) factors who show long-term increased risk of cardiovascular disease and mortality is unknown.

Purpose
To profile the urinary proteome in pregnant women with/without CVR factors to identify proteins associated with postpartum RR.

Methods
Our study included a prospective cohort of 32 healthy and 27 obese and/or hypertensive and/or diabetic pregnant women who underwent transthoracic echocardiography, pulse-wave-velocity, and urine collection at the 3rd trimester and 6-months postpartum. Shotgun HPLC-MS/MS profiled proteins. Generalized linear mixed-effects models were used to identify associations between urinary proteins and left ventricle mass (LVM), a surrogate of RR.

Results
The presence of at least one CVR factor was associated with worse LVM RR. We identify 6 (alpha-galactosidase A [GLA], sialate O-acetylesterase [SIAE], trans-golgi network integral membrane protein 2 [TGOLN2], sortilin [SORT1], desmoglein-2 [DSG2] and neuroblast differentiation-associated protein [AHNAK]) and 11 (serotransferrin [TF], inter-α-trypsin inhibitor heavy chain 4 [ITIH4], complement C3 [C3], transketolase [TKT], fibronectin [FN1], ubiquitin-like modifier-activating enzyme 1 [UBA1], cell division control protein 42 homolog [CDC42], glutathione s-transferase P1 [GSTP1], sodium/potassium-transporting ATPase subunit alpha-1 [ATP1A1], ADP-ribosylation factor 1 [ARF1] and pro-cathepsin H [CTSH]) proteins associated with high and low LVM regression, respectively. These proteins were functionally linked with insulin-like growth factor (IGF) transport and uptake regulation by IGF binding-proteins, platelet activation, signaling and aggregation and the immune system’s activity. The concentration of IGF-1 in urine samples was associated with low LVM regression after delivery.

Conclusions
Urine proteome reflects postpartum cardiac RR. Specifically, eight urine proteins (GSTP1, ARF1, FN1, SORT1, SIAE, GLA, ITIH4 and DGS2) show clinical value in identifying women at higher risk for incomplete postpartum RR. In addition, the association between IGF and postpartum LVM regression was validated.
Cardiovascular (reverse) remodelling induced by pregnancy: looking at the right side of the heart
Authors: Ferreira A F , Araujo J , Azevedo M J , Saraiva F A , Diaz S O , Sousa C , Machado A P , Sampaio-Maia B , Ramalho C , Leite-Moreira A , Barros A S , Santos M , Falcao-Pires I 
Published: October 2024

Abstract

Introduction
Many studies have focused on pregnancy-induced left ventricular remodelling, overlooking the changes in right cardiac chambers.

Purpose
To characterize the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of CV risk (CVR) factors on these processes.

Methods
This prospective cohort was recruited at two tertiary centers from 2019 to 2022, including 51 healthy and 79 obese and/or hypertensive and/or with gestational diabetes and/or smoking habits pregnant women (cardiovascular risk [CVR] group). Women were evaluated by transthoracic echocardiography at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy, as well as one-month (PP1), six-months (PP2), and one-year postpartum (PP3). Generalized linear mixed-effects models were used for the analysis of right CV remodelling and RR and to evaluate the impact of CVR factors on these processes.

Results
This study included 130 pregnant women, 60.8% primiparous, with a median age of 33 years. Despite all echocardiographic results being within the normality range, we describe the progression of right heart adaptations throughout pregnancy and postpartum (Table 1), namely: 1) Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions throughout pregnancy, recovering at PP2 except for RA in the CVR group; 2) Preserved RV systolic function throughout pregnancy in both groups, while the postpartum hemodynamic normalization triggers a reduction of (TAPSE) and tricuspid S' wave velocity; 3) Reduced RA strain in both groups during pregnancy, more evident in CVR group, which had a slower postpartum recovery; 4) Preserved RV global longitudinal strain (GLS) throughout follow-up time, being significantly reduced in 3T of CVR group and recovering at PP2; 5) Reduction of tricuspid E/A ratio from 1T to 3T in both groups with an early recovery at PP1, being these values significantly higher in the healthy group, and 6) Steady pulmonary artery systolic pressure (PASP) values throughout follow-up time, showing consistently higher values in the CVR group.

Conclusion
This study describes the subclinical right cardiac functional and structural changes within the physiological range, which recover 6 months after delivery. CVR factors impact the magnitude of the subclinical RV diastolic function changes, PASP and myocardial deformation (strain) without any impact on classic RV systolic function.
HIV and cardiovascular risk: should we use other targets for cholesterol control? Brazilian data compared to major studies
Authors: De Souza Murta A , Lagonegro E R , Wolf P J W 
Published: October 2024

Abstract
In daily clinical practice, cardiologists are confronted with patients with HIV/AIDS and this population needs special attention due to their higher cardiovascular risk. Studies show an increase in cardiovascular disease (CVD) among people with HIV/AIDS and one of the main causes of death in this group. HIV is associated with dyslipidaemia and endothelial damage, which have been proposed as a cause of the increased risk of events, and HIV replication is a determining factor in endothelial dysfunction. With antiretroviral therapy (ART) there has been a reduction in morbidity and mortality from HIV/AIDS, however, several studies have shown an increase risk factors for CVD in this population, both in individuals on ART and those not on it. Two high-impact studies related to cardiovascular risk in the HIV population are Start and Smart. Studies are important for understanding this occurrence and its relationship with the presence of the virus and the use of antiretroviral therapy in this population. In view of the higher cardiovascular risk of these patients and the question of whether they deserve a different cholesterol target from other populations.

Methods
A retrospective, observational study was carried out on a sample of HIV patients from the Brazilian STD/AIDS Reference Centre (CRT), selected by lottery using their registration number, from 1 January 2011 to February 2023, aged over 18. 148 medical records were assessed and the following were collected population characteristics. Discussion: the CRT data were compared with the Start and Smart studies. The Reprieve study showed benefits earlier than expected with patients receiving a statin. An interim analysis revealed a 35 per cent reduction in serious adverse cardiovascular events in the statin group, leading to the placebo group stopping earlier. The viral load varied between the studies, with CRT having an average of 500,000 copies/ml, Start 12,759 copies/ml and Smart less than 400 copies/ml. Studies have associated HIV infection and higher viral loads with impaired endothelial function and vasodilation. Despite the data in the literature, all the patients with heart disease had undetected viral loads and CD4+ cell counts above 500 cells/mm³. Those with a high viral load in the study were not the ones with CVD.

Conclusions
In CRT, the percentage of primary events attributable to serious conditions unrelated to AIDS was 1.3 per cent. Analysing biomarkers could elucidate the effects of antiretroviral therapy on arterial disease. Another fact that probably justifies the low occurrence of cardiovascular and cerebral events in CRT is the multidisciplinary care given to patients, providing intensive primary and secondary prevention through counselling and follow-up. We suggest better control of cardiovascular risk factors with multi-professional intervention and more aggressive targets for the control of comorbidities.Characteristics and Cardiovascular risk
The use of myocardial perfusion scintigraphy to screen for asymptomatic coronary artery disease prior to kidney transplantation
Authors: Dirir O , Khwaja A 
Published: October 2024

Abstract

Background and Objectives
Advanced chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease (CVD), including significant asymptomatic coronary artery disease (CAD) [1], compared to the general general public. Additionally, CVD is the leading cause of mortality in kidney transplant recipients [2].
Given the relative scarcity of available organs, individuals are commonly screened for CAD with non-invasive cardiac testing such as Myocardial Perfusion Scintigraphy (MPS). However, the benefits of screening for asymptomatic CAD are unproven and in the absence of an established screening protocol, investigations vary centre to centre and can result in uncertain interpretation of results and unnecessary delays in transplantation.
The objective of this study was to assess the benefits of asymptomatic CVD screening of potential kidney transplant recipients, and its impact on transplantation outcomes.

Methods
This retrospective analysis included all MPS requested by the transplant team during patients’ assessment process between 2015 and 2023. Any resultant coronary angiograms (CA) were reviewed for evidence of significant CAD. Transplant decisions were reviewed to assess the impact of CVD screening on individuals’ transplant status.

Results
689 individuals underwent MPS. Of these, 90% required no further cardiovascular investigations. 6% (42 individuals) had subsequent CA. &lt;1% (5) required percutaneous intervention (PCI) whilst the rest (37) were deemed to have no significant CAD. A further 4% (29) required coronary angiography at a later date (&gt;2 years after their MPS), with similar rates of PCI (1%). All three outcome groups (negative MPS, CA referral, CA in the future) had similar rates of diabetes (40%) and previous diagnoses of CAD (14%). The average wait for CA was 283 days post-MPS. Transplant decisions took a further 286 days after CA, which in combination with the delays associated with CA resulted in average delays of 1.5 years.

Conclusions
The use of MPS to screen for significant asymptomatic CAD identifies only a small proportion of individuals requiring intervention prior to kidney transplantation and significantly delays transplant decisions. These results suggest transplant centres should review their use of CVD screening prior to listing.
Comprehensive risk factor analysis for sick sinus syndrome: an analysis of genetic, sociodemographic, clinical and laboratory data from the UK Biobank
Authors: Kim H J , Yang P S , Kim D H , Sung J H , Jang E S , Yu H T , Pak H N , Lee M H , Joung B Y , Lee C H 
Published: October 2024

Abstract

Background
Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and interact bidirectionally, often to initiate and perpetuate each other. The polygenic risk score (PRS) assesses the cumulative risk of disease onset based on variations at multiple genetic loci. To date, no specific PRS has been established for SSS. This study investigates the impact of clinical, sociodemographic, laboratory, and genetic factors, which were represented by PRS for AF due to the absence of a specific PRS for SSS on predicting the incidence of SSS.

Methods
The UK biobank enrolled 502,421 individuals, aged 38 to 73, across 22 centres in the UK locations, from 2006 to 2010. After excluding cases with incomplete data, prior history of AF, and valvular heart disease, 405,869 participants without AF (median age, 58.0 [interquartile range (IQR), 50.0–64.0] years; 213,684 [45.2%] male) were analyzed. Participants were categorized into three groups according to a validated PRS for AF: the first quintile the middle three quintiles, and the fifth quintile. Throughout the observation period, the incidence of SSS event was documented.

Results
During a follow-up period of 11.9 (IQR 11.1-12.6) years, a total of 769 cases of Sick sinus syndrome were identified. The Kaplan-Meier analysis demonstrated a progressive increase in the incidence of SSS as the quintiles of AF-related PRS increased. (Log-rank: P &lt;0.001) Among 24 variables, statistically significant hazard ratios were observed with age, male sex, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), previous myocardial infarction (MI), history of malignant neoplasm, hypertension, diabetes mellitus, cystatin C, and AF PRS. In the prediction model for Sick Sinus Syndrome, the C-index for the sociodemographic model was 0.753. This increased to 0.764 with the addition of clinical factors, to 0.765 with the inclusion of biomarkers, and further to 0.769 upon adding genetic factors.

Conclusion
Our study found significant associations between the incidence of SSS and a range of sociodemographic, clinical, laboratory, and genetic factors, including age, male sex, BMI, blood pressure, and medical history. Notably, the AF PRS also showed relevance, suggesting its potential utility in developing one for SSS in the absence of a dedicated PRS for SSS.