bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome
Authors: Gavina C , Seabra D , Afonso-Silva M , Freitas A S , Costa I , Taveira-Gomes T , Lourenco-Silva N , Araujo F 
Published: October 2024

Abstract

Introduction
After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce the risk of recurrence. Moreover, despite 2016/2019 ESC/EAS guidance on lipid management according to risk, several studies indicate that most patients do not attain low-density lipoprotein-cholesterol (LDL-C) goals. The present study aims to describe LLT prescription patterns after a non-fatal acute coronary syndrome (ACS) and identify opportunities for improvement in secondary preventive measures, namely LDL-C control.

Methods
Retrospective cohort study featuring adults aged 40-80 residing in a Portuguese municipality Portugal, using Electronic Health Records between 2016 and 2022. Selected patients had ≥1 general practice appointment three years before the occurrence of an ACS, which was considered an index date. Sub-analysis was made based on patients’ age (under and high or equal to 65 years), gender, and whether their LDL-C levels were controlled according to gradual upper thresholds of 100 mg/dL in the period before the ACS event and 55 mg/dL at one-year post-ACS.

Results
Among the 544 selected patients, 270 were younger than 65 years. Females comprised 30% (164 patients) of the total cohort, 27% of the under-65 group, and nearly 38% of the 65 and older group. In younger patients, LDL-C levels were higher at presentation (132 mg/dL) and had a significantly greater decrease during the follow-up period compared to the older group. In the period before the ACS, 71.1% of men and 56.7% of women had no previous prescription of LLT, and younger patients had worse levels of LDL-C control (24.1%) compared to older patients (46.0%). One year post-ACS, the pattern of LLT revealed a substantial drop in patients without any LLT prescription from 66.7% to 13.6% and an increase in high-intensity LLT from 2.4% to 16.5%. Still, moderate-intensity LLT (66%) remained the most frequently used LLT. An increase in LLT potency was observed in the follow-up, although there was a decrease in patients achieving LDL-C control. Previous to the ACS event, 35.3% of men and 34.8% of women had initially controlled LDL-C levels according to defined thresholds, which significantly reduced to 11.3% and 8.5%, respectively, at one-year post-ACS.

Conclusion
Despite initiating or intensifying LLT after ACS, LDL-C goals were not achieved in approximately 9 out of 10 patients at 1-year follow-up, highlighting that the LLT adjustment was insufficient. Therefore, there is a need for better optimisation of LLT after ACS, unveiling an alarming gap in guideline implementation in clinical practice.
Mediterranean-type diet trajectories and 20-year cardiovascular disease incidence: the ATTICA study (2002-2022)
Authors: Damigou E , Chrysohoou C , Barkas F , Vafia C , Dalmyras D , Vlachopoulou E , Anastasiou G , Koutsogianni A D , Loukina A , Kravvariti E , Tsioufis C , Pitsavos C , Liberopoulos E , Sfikakis P P , Panagiotakos D B 
Published: October 2024

Abstract

Background/Introduction
The protective effects of the Mediterranean-type diet (MTD) against cardiovascular disease (CVD) are well-known. However, based on a recent systematic review of 57 studies with 1,125,560 participants, MTD adherence has declined worldwide, even in the Mediterranean region, compared to the past, especially in the last decade. Moreover, studies evaluating changes in diet and CVD risk are scarce.

Purpose
The aim of this study was to longitudinally evaluate MTD adherence and changes in MTD adherence during 20-years of follow-up and its relation to 20-year CVD incidence.

Methods
Participants initially free-of-CVD from the ATTICA study were used (n=1,986). At 2002 and 2022, CVD events were assessed according to WHO-ICD-10 and MTD adherence was assessed via MedDietScore (range: 0-55). Hence, MTD trajectories were defined according to MTD adherence in 2002 and in 2022 as: low-low, low-high, high-low, high-high (i.e., high: MedDietScore &gt;27/55).

Results
During the 20-year follow-up, 30.2% (n=600) of the participants were always away (i.e., low-low), 30.0% (n=596) went away (high-low), 21.4% (n=424) were always close (high-high) and 22% got closer (low-high) to the MTD. The 20-year CVD incidence was: 38.8% (n=233), 87.7% (n=321), 10.2% (n=61) and 24.3% (n=103) in those in the low-low, low-high, high-low and high-high trajectory, respectively (p-value&lt;0.001). In multi-adjusted models, adjusted for socio-economic, clinical and lifestyle parameters, it was found that compared to those who were always away from the MTD, those who were always close had 68% lower CVD risk [Hazard Ratio-HR: 0.32, 95%Confidence Interval-CI: 0.14, 0.72], while those who went away during the 20-year follow-up had 47% lower CVD risk [HR: 0.53, 95%CI: 0.32, 0.86].

Conclusion
Our study findings highlight the long-lasting effects of the MTD adherence early in the life-course. Public health measures to prevent CVD should focus on facilitating MTD adherence, as early in life as possible.
Ultra-processed food consumption and risk of cardiovascular mortality in Australia: preliminary results from prospective observational study
Authors: Gauci S , Machado P , Hodge A , Gamage E , Levy R B , Louzada M L C , Redfern J , O'neil A , Marx W , Lane M M 
Published: October 2024

Abstract

Background/Introduction
A large proportion of the Australian population emigrated from countries where traditional dietary patterns are protective of cardiovascular health. Yet, recent evidence suggests that 42% of a modern Australian diet's total energy intake is comprised of ultra-processed foods. This is concerning as previous meta-analyses and umbrella reviews based on population studies have found an association between ultra-processed food consumption and adverse health outcomes, including cardiovascular disease and mortality. However, this has yet to be explored in an Australian population.

Purpose
To determine the association between ultra-processed food consumption and the risk of cardiovascular mortality in an Australian cohort.

Methods
Prospective data from the Melbourne Collaborative Cohort Study (MCCS; n = 38054) were analysed. UPF consumption at baseline (1990 to 1994) was assessed in accordance with the NOVA food classification system using data from a 121-item food frequency questionnaire. Energy-adjusted ultra-processed food consumption was then categorised into quartiles. Cardiovascular mortality was obtained through data linkage with national and local registries up to 2015 and 2019, respectively. This was done using the International Classification of Diseases (ICD) codes (390-459 and I00-I99). Unadjusted and adjusted multivariate logistic regression models were fitted to estimate associations between ultra-processed food consumption (exposure) and cardiovascular mortality (outcome).

Results
A total of 4,242 incident cardiovascular deaths occurred (2,272 for males and 1,970 for females) during the follow-up period. After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, higher UPF consumption was associated with a higher risk of cardiovascular mortality (aOR high (quartile 4) vs. low (quartile 1) category = 1.26, 95%CIs 1.14 to 1.39, ptrend &lt; 0.001).

Conclusion(s)
In this large prospective cohort of Australian adults, higher ultra-processed food consumption was associated with an increased risk of cardiovascular mortality. These findings support previous research and guidelines recommending the reduction of ultra-processed food consumption as part of a heart-healthy diet.
Incremental prognostic value of combined information of arterial stiffness and the result of treadmill exercise test in patients with suspected coronary artery disease
Authors: Chung J 
Published: October 2024

Abstract

Background
The effectiveness of diagnostic tools can be enhanced by their combination. We aimed to investigate whether arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events.

Methods
A total of 1,788 consecutive subjects (mean age 55.8 ± 10.7 years, 59.1% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiac and cerebrovascular event (MACCE), a composite of cardiac death, non-fatal myocardial infarction, coronary revascularization and ischemic stroke.

Results
During a mean follow-up period of 875 days (interquartile range, 116–2,212 days), there were 88 cases of MACCE (4.9%). The elevated baPWV (≥ 1,440 cm/s) (hazard ratio [HR] 5.18; 95% confidence interval [CI] 2.68–10.0; P &lt; 0.001) and positive ETT result (HR 2.81; 95% CI 1.77–4.47; P &lt; 0.001) were associated with MACCE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects’ risk (low baPWV and negative ETT result vs. high baPVW and positive ETT result; HR 16.44; 95% CI 6.17–43.78; P &lt; 0.001).

Conclusions
Arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. baPWV can serve as a useful clinical tool for risk stratification in this high-risk patient population.Kaplan-Meier survival curveMultivariable cox analysis
Study of lipoprotein(a) and its impact on atherosclerotic cardiovascular disease: design, rationale, and first results of the Zabrze-Lip(a)R Registry
Authors: Dyrbus K , Medrala Z , Konsek K , Nowowiejska-Wiewiora A , Trzeciak P , Skrzypek M , Ciesla D , Banach M , Gasior M 
Published: October 2024

Abstract

Aims
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. Increased Lp(a) concentration &gt;30 mg/dl may cause faster atherosclerosis. There is a need to characterize further the clinical phenotypes in patients at risk for ASVD with high Lp(a) levels.

Material
The Zabrze-Lip(a)R Registry was created on the basis of data from 2,001 patients with high- and very high cardiovascular risk treated in a tertiary hospital, and the Registry patients will be followed for many years. Mortality and cardiovascular events, such as known death, MI, and stroke, will be assessed.

Results
The median Lp(a) concentration in the entire population was 6.6 mg/dl (mean 14.3 ± 19.4 mg/dl). Preliminary results of the study group showed that 540 (27%) patients had elevated Lp(a) levels above 30 mg/dl, mainly in patients with established ASCVD after MI and/or coronary revascularization. Patients with elevated Lp(a) levels are older and have higher hematocrit and NT-proBNP and CRP levels.

Conclusions
Extensive observational studies are essential for further work that objectively collects information on the risks associated with Lp(a) values and cardiovascular disease. Additionally, developing a deeper understanding of the impact of Lp(a) on prognosis will be valuable in how Lp(a) interacts with other established risk factors in improving cardiovascular risk prediction.Distribution of Lp(a) concentrationsComparison of pts with different Lp(a)
The association between cardiovascular health and physiologic age as determined by artificial intelligence-enabled electrocardiography
Authors: Ortega Aviles L , Medina-Inojosa B J , Medina-Inojosa J R , Attia I Z , Lopez-Jimenez F 
Published: October 2024

Abstract

Background
The concept of ideal cardiovascular health (CVH) was developed by the American Heart Association (AHA) as a composite of seven health factors and behaviors labeled as the Life’s Simple 7 (LS7). Ideal CVH has been associated with complex measures of cardiovascular aging. We hypothesized that physiologic aging, as determined by a simple, routinely used tool such as the electrocardiogram (ECG) enabled by an artificial intelligence algorithm to predict an individual’s physiologic age (ECG age), will be associated with poor CVH as defined by an adapted version of the AHA LS7.

Methods
We conducted an observational retrospective study of consecutive patients aged ≥18 years who sought care between June 2019 and March 2022, self-reported behavioral history through a validated intake questionnaire in clinical outpatient visits, had a clinically indicated ECG within one year, and provided research authorization. We applied a previously developed AI-ECG convolutional neural network to derive the ECG-Age. We excluded patients with missing data, those with body mass index (BMI) &lt;18.5 kg/m2, previous history of left-bundle branch block, atherosclerotic cardiovascular disease events, atrial fibrillation, heart failure, and non-skin cancer. An adapted version of the LS7 was used to define CVH, which includes anthropometrics (e.g., BMI), behavioral history (e.g., smoking, physical activity, and diet), vital signs (e.g., blood pressure), and laboratory values (e.g., total cholesterol, and fasting glucose). CVH was stratified as ideal, intermediate, and poor if the LS7 score had values of 9-14, 7-8, and 0-6, respectively, constructed by adding 2,1 or 0 points to each metric that met each category criteria, respectively. Accelerated aging was defined as having a Delta-Age ≥1SD above the mean, whereas Delta-age was defined as ECG minus chronological age. Logistic regression models tested the association between CVH categories and positive Delta-Age while adjusting for chronological age and sex.

Results
We included 114,214 individuals (53.3% females, 86.9% Caucasian). Mean chronological age was 57.7±14 years and mean AI-ECG- Age was 58 ± 12.44 years (R2 0.80, p-value &lt;0.001). Mean Delta-Age was 0.28 ±8.8 years. LS7 average score was 8.3 ± 2.23; 46.8% had ideal, 31.5% intermediate, and 21.7% had poor CVH (Figure A). Compared to those with ideal CVH, those with poor CVH were more than 50% more likely to have Delta-Age ≥1SD (OR 1.61, CI 95% 1.54-1.69, p-value: &lt;0.001), independent of chronological age and sex. (Figure B).

Conclusion
Poor CVH, defined by the AHA LS7, is linked with biological aging as determined by AI-enabled ECG, highlighting the importance of promoting CVH in adults as a strategy to decelerate biological aging and reduce its associated mortality.
Cancer-specific Heart Failure (HF) risk score - a new risk score developed specifically to predict HF among cancer survivors
Authors: Soh C , Takeuchi F , Marwick T 
Published: October 2024

Abstract

Background
Heart failure (HF) is an important long-term complication in cancer survivors, especially in breast and haematological malignancies treated with anthracylines. However, screening for left ventricular dysfunction in all survivors is impractical due to potential low cost-efficiency. So we sought to develop a cancer-specific risk scoring system for HF (CRS-HF).

Methods
Cancer survivors (n=43,720) participating in the UK-Biobank were evaluated in this study (age 59.9 ± 7.4 years, 62.4% female). Participants were randomized into training and testing dataset with a 7:3 split. A Random Forest algorithm was applied to identify key variables that are predictive for HF incidence among cancer survivors.

Results
Incident HF developed in 4.3% over a median of 12.9 years. The random forest algorithm identified demographic (age, sex and body mass index), clinical (heart rate, blood pressure and cardiac history), pathology (lipids) results and other patient reported outcome measures (PROMS) that predicted HF with an accuracy of 0.872 (95%CI: 0.867-0.877) in the training set. In the testing set, the accuracy was 0.840 (95%CI: 0.832-0.848) and a reported sensitivity and specificity of 62.42% and 84.93% respectively. Our study also demonstrated that the CRS-HF performed better in ruling out non-HF incidence among survivors from breast cancer and lymphoma (accuracy: 0.858) than other cancer types (accuracy: 0.836).

Conclusion
The CRS-HF score is a prove-of-concept that appears to be an effective means of identifying HF risk in cancer survivors. Although initial findings demonstrate promising accuracy in forecasting HF occurrences among cancer survivors, comprehensive validation and potential refinements are warranted across diverse population cohorts.
Association of Life's Essential 8 metrics with mortality outcomes in US cancer survivors
Authors: Chen W H , Zhao Y , Li Z Y , Huang R C 
Published: October 2024

Abstract

Aims
The increased in global cancer survivors and treatment complications has created an unmet need for effective long-term health strategies. This study aimed to evaluate the relationship between LE8 and all-cause, cancer-specific, and non-cancer mortality in cancer survivors in the US.

Methods
A prospective cohort study was conducted using a nationally representative sample of cancer survivors, age 40 years or older (n = 2205), derived from the US. Cancer diagnoses were determined through face-to-face interviews, while health status was gauged using the LE8 score on a scale of 0-100. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of overall and individual component of LE8 with overall, cancer-specific, and noncancer mortality, respectively.

Result
Among the 2205 participants (mean [SE] age, 66.4 [0.4] years; 54.1% females; 87.4% non-Hispanic White ethnicity), the average LE8 score was 65.5 ± 0.4, with diet having the lowest (45.5 ± 1.0) and the highest scores attributed to sleep (85.1 ± 0.7). During the up to 5.7 years follow-up period, 526 deaths were documented, comprising 174 cancer-related, 123 cardiovascular disease-related, and 229 from other causes. A high LE8 score was linked to a 71% reduction in all-cause mortality risk (HR: 0.29, 95% CI: 0.16-0.54) as well as significant reduction in the risk of cancer deaths (HR: 0.34, 95% CI: 0.13-0.88) and non-cancer deaths (HR: 0.26, 95% CI: 0.13-0.52). Higher LE8 scores were still correlated with reduced mortality in cancer survivors without cardiovascular conditions, while adherence to certain health behaviors was tied to a lower death risk.

Conclusions
In this study, high LE8 scores, especially the health behaviors component, were strongly associated with extended life expectancy and lower mortality rates.
Genetic and lifestyle risks for coronary artery disease and risk of incident dementia
Authors: Sittichokkananon A , Garfield V , Chiesa S T 
Published: October 2024

Abstract

Background
Lifestyle risk factors for coronary artery disease (CAD) have been associated with neurodegeneration and dementia. Whether an underlying genetic risk for the development of CAD further increases this risk, however, remains unclear.

Purpose
To examine whether an increased genetic risk for CAD is associated with an increased risk of dementia, and to investigate whether lifestyle factors modify these associations.

Methods
A prospective cohort study of 457,353 participants of European ancestry without dementia at baseline (mean [SD], age 57 [8] years; 55% were female) was conducted within the UK Biobank study. Exposures were a genome-wide polygenic risk score (PRS) for CAD and a modified version of the American Heart Association’s Life’s Essential 8 (LE8) cardiovascular health score comprising four biological (BMI, BP, lipids, glucose) and four lifestyle (smoking status, diet, physical activity, and sleep duration) risk factors previously linked to both CAD and dementia. Dementia diagnoses were obtained from death register and inpatient records.

Results
9,337 cases of all-cause dementia were observed over a median 13.9-year follow-up. There were no significant interactions between genetic risk for CAD and lifestyle factors for all-cause dementia, or any other dementia subtype. After adjusting for potential demographic confounders, a higher genetic risk for CAD was associated with elevated risk of developing all-cause dementia (hazard ratio (HR) per 1-SD increase in PRS = 1.08 [95% CI, 1.05-1.10]), Alzheimer’s disease (HR 1.08 [1.03-1.12]), and vascular dementia (HR 1.13 [1.06-1.19]). An unfavourable LE8 cardiovascular health score was also associated with an increased risk of developing all-cause dementia (HR 1.05 [1.02-1.08]), predominantly through its association with vascular dementia (HR 1.14 [1.06-1.22]), as we found no evidence for any associations between LE8 and Alzheimer’s disease (HR 1.00 [0.97-1.02]).

Conclusion
These findings indicate that a high genetic risk for CAD is associated with an increased risk of developing major dementia subtypes. Regardless of this underlying genetic risk, however, our results suggest that lifestyle interventions designed to reduce the risk of CAD may also reduce one’s risk of developing dementia, particularly in those with underlying vascular pathology.
Coronary artery calcium scans powered by artificial intelligence (AI-CAC) predicts atrial fibrillation and stroke comparably to cardiac magnetic resonance imaging: MESA
Authors: Naghavi M , Reeves A P , Atlas K , Zhang C , Li D , Atlas T , Henschke C , Wong N D , Roy S K , Budoff M J , Yankelevitz D 
Published: October 2024

Abstract

Background
AI-CAC provides more actionable information than the Agatston coronary artery calcium (CAC) score. We have recently shown in the Multi-Ethnic Study of Atherosclerosis (MESA) that AI-CAC automated left atrial (LA) volumetry enabled prediction of atrial fibrillation (AF) as early as one year. In this study we evaluated the performance of AI-CAC LA volumetry versus LA measured by human experts using cardiac magnetic resonance imaging (CMRI) for predicting AF and stroke, and compared them with CHARGE-AF risk score, Agatston score, and NT-proBNP.

Methods
We used 15-year outcomes data from 3552 asymptomatic individuals (52.2% women, age 61.7±10.2 years) who underwent both CAC scans and CMRI in the MESA baseline examination. CMRI LA volume was previously measured by human experts. Data on BNP, CHARGE-AF risk score and the Agatston score were obtained from MESA. Discrimination was assessed using the time-dependent area under the curve (AUC).

Results
Over 15 years follow-up, 562 cases of AF and 140 cases of stroke accrued. The AUC for AI-CAC versus CMRI for AF and stroke were not significantly different (0.802 vs. 0.798 and 0.762 vs. 0.751 respectively, p=0.60). AI-CAC significantly improved the continuous Net Reclassification Index (NRI) for prediction of AF and stroke when added to CHARGE-AF risk score (0.28, 0.21), NT-proBNP (0.43, 0.37), and Agatston score (0.69, 0.41) respectively (p for all&lt;0.0001).

Conclusion
AI-CAC automated LA volumetry and CMRI LA volume measured by human experts similarly predicted incident AF and stroke over 15 years. Further studies to investigate the clinical utility of AI-CAC for AF and stroke prediction are warranted.