bluuebunny/crossref_metadata_2025_split huggingface dataset:
The epicardial adipose tissue volume is in patients with type 2 diabetes mellitus associated with a lowered myocardial perfusion reserve
Authors: Johansen A O , Eldin A S , Bojer A S , Soerensen M H , Gaede P H , Madsen P L 
Published: October 2024

Abstract

Introduction
The epicardial adipose tissue (EAT) has unobstructed vascular connection to the myocardium and has a secretome very different from that of other fat depots. The EAT fat pad and its paracrine and vasocrine secretion of pro-inflammatory and profibrotic cytokines is suggested to contribute to heart failure with preserved ejection fraction (HFpEF) pathogenesis albeit via unknown mechanisms. Animal studies and magnetic resonance imaging studies in patients with type 2 diabetes mellitus (T2DM) have documented that important myocardial changes linking diabetic cardiomyopathy to systolic and diastolic dysfunction are myocardial microvascular dysfunction and myocardial fibrosis.

Purpose
To investigate whether a high volume of EAT is associated with impaired myocardial perfusion reserve (MPR) or disperse fibrosis in patients with T2DM.

Methods
198 patients with T2DM but without ischemic heart disease were identified from a cross-sectional cardiovascular magnetic resonance imaging cohort study. 25 healthy controls were included for characterization of baseline characteristics. With gadolinium for contrast, MPR was determined by perfusion sequences and disperse fibrosis was determined from the myocardial extracellular volume (ECV). Volumes of EAT and pericardial adipose tissue (PAT) were determined from cine images.

Results
The T2DM patients (69% male) had a median age 59 IQR [50, 67] yrs, BMI 30.7 IQR [27.8, 33.7] kg/m2, and EAT of 17.3 IQR [14.2, 22.4] cm2. All patients had normal left ventricle ejection fraction. Compared to the healthy controls, patients with T2DM had higher BMI, abdominal circumference, ECV, EAT, and PAT volumes, and lower MPR (all p&lt;0.001). In univariable regression analysis, EAT and PAT were both associated with higher BMI, abdominal circumference, and age (all p&lt;0.02). In multivariable regression analysis, however, with adjustments for age, sex, BMI, and T2DM-duration, only EAT and MPR were significantly associated (P&lt;0.01), whereas EAT and ECV were not. The PAT volume was not associated with MPR nor ECV. High-sensitive CRP was associated with the EAT volume (p&lt;0.001), but hs-CRP was not associated with MPR or ECV.

Conclusion
An increased epicardial adipose tissue volume is in patients with T2DM associated with myocardial microvascular dysfunction. Irrespective of a generally heightened inflammatory level, the mechanism by which EAT contribute to development of HFpEF is therefore possibly via an EAT-induced impairment of the myocardial perfusion reserve. Randomized studies targeting a decreased epicardial adipose tissue volume are needed to demonstrate if this will improve myocardial microvascular dysfunction and hence limit development of HFpEF in patients with T2DM.Univariable analysis of EAT and ECVUnivariable analysis of EAT and MPR
Persistence and Adherence to GLP-1 RA treatment in Type 2 Diabetes Mellitus: a Nationwide registry study
Authors: Lassen M C H , Johansen N D , Modin D , Catarig A M , Vistisen B K , Amadid H , Zimmermann E , Gislason G , Biering-Soerensen T 
Published: October 2024

Abstract

Background
The use of glucagon-like peptide-1 receptor agonsists (GLP-1 RA) continues to rise and is increasingly important in the treatment of type-2 diabetes mellitus (T2DM). Though the use of GLP-1 RA continues to increase, persistence and adherence to therapy remains suboptimal.

Purpose
We aimed to assess the level of adherence and persistence to GLP-1 RA using real-world data and to investigate sociodemographic and clinical factors associated with discontinuation of GLP-1 RA therapy.

Methods
In this retrospective cohort study, all first-time users of GLP-1 RA with T2DM ≥18 years from 2007-2020 were identified using the Danish registries (Figure 1A-1B). All participants had 18 months of follow-up. Medication possession ratio (MPR) was calculated by summing days of medication supply from all dispensed prescription made during the study period divided by number of days in study period. MPR ≥0.80 was used to define adherence. Discontinuation was defined as &gt;90 days between the last day of prescription coverage and the first day of a new dispensed prescription. Adherence to GLP-1 RA therapy and the risk of discontinuing therapy was estimated at 6- and 12-months of follow-up. Multivariable logistic regression was used to identify sociodemographic and clinical factors associated with discontinuing GLP-1 RA therapy.

Results
In total, 44,343 first-time users of GLP-1 RA with T2DM were identified (mean age: 58.6 years, 42.7% female, 21.3% had cardiovascular disease, median duration of T2DM was 6.8 years, median HbA1c was 65 mmol/mol). The absolute risk of discontinuing GLP-1 RA at 6 and 12 months was 14.2% (95%CI: 13.9-14.6) and 21.4% (95%CI: 21.1-21.8), respectively (Figure 2A). Of the 9,520 (21.5%) who discontinued therapy during the 12-month follow-up, 1,947 (20.5%) occurred within the first 31 days of treatment. At 6 months, 58.5% were adherent to GLP-1 RA therapy with a median MPR of 0.84 [IQR: 0.70-0.95]. At 12 months, 61.1% were adherent to therapy with a median MPR of 0.85 [IQR: 0.71, 0.94]. In the multivariable model, low (&lt;40 years) and high age (&gt;75 years), lower household income, educational level, longer diabetes duration, and higher comorbidity burden were associated with a higher risk of discontinuing GLP-1 RA whereas baseline HbA1c was not (Figure 2B-2E).

Conclusion
Approximately one in five patients discontinued therapy within 12 months and a little over 60% were adherent. Sociodemographic factors, including household income, age, and comorbidity burden were associated with risk of discontinuing GLP-1 RA therapy. Given the changing landscape of who should be treated with GLP-1 RA, the cardio-renal benefits reported in recent trials, and the ongoing trials in the field, future research into adherence and persistence to GLP-1 RA and possible interventions to improve these, are needed.
Association of insulin resistance with cardiovascular disease and all-cause mortality in type 1 diabetes mellitus: systematic review and meta-analysis
Authors: Sun R , Wang J , Li M , Lip G Y H , Liu B , Pan Y , Zhang L , Sun R 
Published: October 2024

Abstract

Background
Insulin resistance (IR) is a key factor in the pathogenesis of type 2 diabetes mellitus (T2DM) and is associated with a higher risk of cardiovascular disease (CVD) and mortality. However, the association between IR and these outcomes in type 1 diabetes mellitus (T1DM) is less clear. This systematic review and meta-analysis aimed to investigate the associations between CVD outcomes and IR in T1DM.

Methods
PubMed, EMBASE, and the Cochrane Library databases were searched from inception to 15 March 2023 and updated on 31 October 2023. Observational studies (cohort studies or post hoc analysis of clinical trials) reporting the associations between IR measured by estimated glucose disposal rate (eGDR) level and the risk of CVD and all-cause mortality in individuals with T1DM were eligible. Data, pooled by random effects models, were presented as hazard ratios (95% confidence intervals, CI). The primary outcomes were the composite CVD outcome and all-cause mortality.

Results
Eight studies involving 21,930 individuals were included, of which five studies involving 19,960 T1DM individuals reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78–0.90, I2 = 58.9%). Five studies involving 19,403 T1DM individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, a total of 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81–0.87, I2 = 0%).

Conclusions
IR as measured by eGDR may be an additional risk factor for cardiovascular disease and all-cause mortality in individuals with T1DM. Modification of IR by lifestyle interventions or pharmacological treatments could be a viable therapeutic target to lower the risk of CVD in T1DM.Figure 1 Literature flowchartFigure2 Forest plot
Influence of urban noise exposure on early-onset myocardial infarction risk prediction
Authors: Kerniss H , Mata Marin L A M M , Clemens K C , Litfin C L , Seidel A S , Ruehle S R , Osteresch R O , Fach A F , Hambrecht R H , Wienbergen H W 
Published: October 2024

Abstract
Results from the DECIBEL-MI (Determination of Environmental CIty-noise's Burden, Exposure, and Link to Myocardial Infarction) Study

Background
Urban noise has not been incorporated into existing risk scores for cardiovascular events. The present study endeavors to explore the impact of noise exposure on the individual risk of early-onset myocardial infarction (MI).

Methods
All consecutive patients aged ≤ 50 years with acute MI who were admitted to a heart center between 2015 and 2023 and were residing in our city were included. The LIFE-CVD model was used to predict the 10-year cardiovascular risk of the patients based on traditional risk factors at the time of MI. The Geoportal Bremen was used to calculate both the daytime (Lden) and nighttime (Lnight) residential noise exposure levels.

Results
Among the 430 patients aged 50 years or younger diagnosed with MI, an elevated incidence of noise exposure compared to the general population in the same region was observed. This result was observed in both Lden (65% vs. 53%, p &lt; 0.01) and Lnight (55% vs. 41%, p &lt; 0.01).
Patients with MI and a low LIFE-CVD score (≤2.5%) exhibited significantly higher noise exposure in comparison to those with a high LIFE-CVD score (2.32 vs. 1.36, p &lt; 0.01 for Lden, and 1.72 vs. 1.00, p &lt; 0.01 for Lnight).
The average noise exposure increased with decreasing traditional risk factors exposure (see Figure 1). This inverse relationship persisted significantly in a linear regression analysis, even after adjusting for potential confounding factors such as socioeconomic status, PM10 and renal function (p &lt; 0.01). Consequently, the incorporation of urban noise exposure contributes to optimizing the stratification of risk groups within LIFE-CVD risk categories.

Conclusion
Young patients with myocardial infarction (MI) who had fewer traditional risk factors were exposed to higher noise levels. Through comprehensive multivariate analysis, we identified a consistent inverse association between residential noise and the estimated cardiovascular risk based on traditional risk factors. Incorporating noise exposure into clinical care considerations has the potential to enhance the accuracy of MI prediction.
Figure 1: Comparison of Lden in patients with MI ≤ 50 years with different 10-year LIFE-CVD risk categories (based on traditional risk factors)
Life course cumulative PM2.5 exposure since childhood and albuminuria in midlife: a 30-year prospective cohort study
Authors: Li Y , Lu Y A O 
Published: October 2024

Abstract

Background
Previous studies have confirmed the adverse effect of ambient fine particulate matter (PM2.5) on kidney and cardiovascular diseases. However, the effects of long-term cumulative PM2.5 exposure on albuminuria, particularly from childhood to middle age, remains uncertain.

Purposes
We aimed to investigate the association between cumulative PM2.5 exposure and albuminuria across three distinct time frames using data from the 30-year population-based cohort study.

Methods
Using data from the ongoing cohort of Hanzhong Adolescent Hypertension study, 1643 children and adolescents were followed with 6 visits over 30 years. The annual mean PM2.5 concentration for the period 1987-2017, at the address of each participant, was obtained from the MERRA-2 and CHAP datasets in China. We assessed cumulative PM2.5 exposure as the area under the curve (AUC) and used the linear regression models to estimate the association between cumulative PM2.5 exposure and urinary albumin-to-creatinine ratio (uACR) in 2017.

Results
In full adjustment for potential confounders, childhood and life course cumulative PM2.5 exposure was positively associated with uACR in midlife [childhood: β=0.103 (95%CI: 0.003, 0.202); life course: β=0.078 (95%CI: 0.004, 0.153)]. However, the relationship between adulthood cumulative PM2.5 exposure and uACR in middle age was not statistically significant. In addition, the associations of adulthood and life course cumulative PM2.5 exposure with uACR in middle age were only observed in non-smokers [β=0.109 (95% CI: 0.002, 0.216)], but not in smokers.

Conclusions
Cumulative PM2.5 exposure during childhood and over the life course is associated with higher uACR in midlife, especially for children and non-smokers. Lowering PM2.5 pollution early in life could prevent the development of renal dysfunction and cardiovascular disease in later life.
Blood pressure and renal function responses in workers exposed to lead for up to six years
Authors: Yu Y , An D W , Yang W Y , Verhamme P , Allegaert A , Nawrot T S , Staessen J A 
Published: October 2024

Abstract

Background
Lead is a widespread environmental toxicant. However, there is currently no consensus whether low-level lead exposure raises blood pressure (BP) or induces kidney dysfunction.

Purpose
The Study for Promotion of Health in Recycling Lead (SPHERL) assessed the BP and renal function (RF) responses for up to six years in the workers without previous occupational lead exposure.

Methods
BP was the average of 5 consecutive readings and the estimated glomerular filtration rate was derived from serum creatinine (eGFRcrt) and cystatin C (eGFRcys). Blood lead (BL) was measured by inductively coupled plasma mass spectrometry (detection limit 0.5 mg/dL). The statistical methods included multivariable-adjusted mixed models and interval-censored Cox regression analysis.

Results
The 234 workers analyzed were on average 28.5 years old and included 91.9% men. The baseline BL concentration was 4.35 µg/dL and increased 3.17-fold over follow-up (median: 2.03 years; range: 0.92-6.45 years). The changes in BP and RF were not significantly correlated with the follow-up-to-baseline BL ratio (p≥0.51 and p≥0.18, respectively). The fully-adjusted changes in systolic/diastolic BP associated with a doubling of BL were -0.25/-0.12 mm Hg (CI: -0.94 to 0.44/-0.66 to 0.42 mm Hg). Accordingly, the incidence of stage-1 or -2 hypertension was not associated with the BL change (p≥0.063). Similarly, the changes in eGFRcrt and eGFRcys associated with a 3-fold BL increment were not significant, amounting to -0.70 mL/min/1.73 m2(CI: -1.70 to 0.30 mL/min/1.73 m2) and -1.06 ml/min/1.73 m2 (-2.16 to 0.03 mL/min/1.73 m2).

Conclusion
The BP and RF responses to an over 3-fold BL increment were small and not significant confirming the safety of modern lead-handing facilities operating under current safety rules.Figure 1Figure 2
Development of a predictive model for adherence to pharmacological treatment in ischemic heart disease: consideration of psychosociocultural, neuropsychological, and mental health variables
Authors: Flores-Mendoza J B , Salvador-Cruz J , Robles-Garcia R , Aceves Chimal J L , Diaz-Loving R 
Published: October 2024

Abstract

Introduction
Adherence to pharmacological treatment recommendations is the main preventable cause of rehospitalization and premature mortality in patients diagnosed with ischemic heart disease, which in turn, is permeated by modifiable psychosocial risk factors such as anxiety, depression, stress, type A behavior pattern, inhibitory control, attitudes and behavioral beliefs towards the disease and treatment. The objective of this study was to develop and test a model to predict adherence to pharmacological treatment in patients with ischemic heart disease undergoing coronary revascularization surgery based on psychosocial, neuropsychological and mental health variables.

Material and Methods
Cross-sectional study with a sample of 691 patients between 45 and 82 years of age (M= 52 years, SD= 12.15), 46% women and 54% men, diagnosed with ischemic heart disease and undergoing coronary revascularization surgery. Anthropometric, cardiovascular and psychosocial risk factors were evaluated. The scales were designed and validated to assess adherence to pharmacological treatment in ischemic heart disease by means of EFA and CFA, which showed adequate internal consistency indicators and psychometric properties.

Results
Using the AMOS v.24 statistical package, a path analysis was performed for the variable of adherence to pharmacological treatment, with attitudes toward the disease and treatment, behavioral beliefs, and inhibitory control (executive function) as direct predictors, explaining 54% of the variance in adherence to pharmacological treatment in ischemic heart disease, and the model fit indices were: χ2(33) =261. 19; CMIN/DF= 7.91; TLI= .893; NFI= .815; IFI= .901; CFI= .900; AGFI= .822, SRMR= 2.727; RMSEA=.053.

Conclusions
The findings of this research contribute to the understanding of adherence to pharmacological treatment in ischemic heart disease as a process and not only as an isolated construct, in which mental health intervenes interacting with psychosocial and cultural aspects of the patient with respect to their disease and pharmacological treatment and in turn provides evidence that inhibitory control as an executive function. This provides evidence that inhibitory control as an executive function is useful for understanding adherence to pharmacological treatment, which shows the need to incorporate in the hospital setting comprehensive psychological evaluations and interventions that allow us to predict adherence to pharmacological treatment of ischemic heart disease in order to intervene in the processes involved, which could contribute to the prevention of rehospitalization and premature mortality.
Correlation analysis of self-rated health and net adverse clinical events in patients with acute myocardial infarction
Authors: Cao S , Liu J Y , Gu T S , Hu S T , Zhang Y K , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Backgrounds
Self-rated health (SRH） is a recognized standard risk factor for myocardial infarction, but its impact on prognosis remains uncertain.

Purpose
This study aims to investigate the impact of self-rated health on the long-term clinical outcomes of myocardial infarction patients.

Methods
The data for this study were derived from a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023, Patients were divided into satisfied and unsatisfied groups based on their responses to an SRH questionnaire. Propensity score matching (PSM) was utilized to balance covariates between the two groups and analyze the relationship between SRH and clinical outcomes. The primary endpoint was net adverse clinical events (NACE), comprising cardiac death, recurrent myocardial infarction, revascularization, ischemic stroke, and bleeding events (BARC ≥3). The secondary endpoint comprised the individual components of the primary endpoint.

Results
The study included a total of 55,054 AMI patients, with 54,049 rating their health as satisfactory and 1,005 patients as unsatisfactory. In the satisfactory group, patients tended to be younger, had fewer females, better Killip classification, a higher proportion of STEMI cases, a higher rate of undergoing PCI, and a lower prevalence of concomitant disease such as diabetes, hypertension, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, thyroid disease, and chronic lung disease. Additionally, patients in the satisfactory group had a higher proportion of antiplatelet therapy use (aspirin, ticagrelor). 1,005 pairs were well matched after PSM. After a median follow-up of 1626 days, the proportion of all-cause death, cardiac death, and recurrent myocardial infarction in the satisfied group was significantly lower than that in the unsatisfied group. Multivariable Cox regression analysis revealed that satisfactory SRH was associated with a reduced risk of NACE (aHR 0.809, 95%CI 0.704-0.930, P=0.002), cardiac death (aHR 0.790, 95%CI 0.665-0.939, P=0.007), and recurrent myocardial infarction (aHR 0.734, 95%CI 0.563-0.955, P=0.021).

Conclusions
Good SRH can decrease the risk of NACE in myocardial infarction patients, underscoring the importance of considering SRH in clinical assessment.
Association of pulsatile venous waveform pattern in the venous studies of lower extremities to 2d-echocardiographic parameters for right heart function and right atrial pressure
Authors: Maderazo D , Sindiong M K 
Published: October 2024

Abstract

Introduction
To date, the detection of pulsatile venous waveform (PVW) pattern in venous duplex scans are read as suggestive of increased central venous pressure (CVP) and/or right-sided heart failure. In the advent of point of care ultrasound, non-invasive measures can be used to determine systemic hemodynamics in emergent clinical settings.

Purpose
This study aims to determine the association of PVW pattern to echocardiographic parameters of right ventricular (RV) function and right atrial pressure (RAP).

Methods
A single center retrospective study of adult patients with venous studies of the lower extremities and 2d-echocardiogram done from January 2019 to October 2023. Logistic regression analyses were performed to determine the association of PVW pattern with RV dysfunction based on TAPSE, S’ and FAC, as well as with increased RAP.

Results
A total of 2086 adult patients were included with median for age of 67 years of which 1141 (55%) were females, and 728 (35%) were hypertensive. PVW pattern was noted from 163 participants (7.8%) of which a higher proportion had heart failure, kidney disease, COVID-19, pneumonia and valvular heart disease. Patients with PVW pattern had a significantly lower median TAPSE [18 (IQR 15-20) vs 20 (IQR 18-22)] and median S’ [11.1 (IQR 8.6-13.20) vs 12.3 (IQR 10.6-14.40)] with FAC 27.1 + 11.9%. Increased RAP was noted in 7% of the study population. Patients with PVW pattern had a higher median inferior vena cava (IVC) diameter [1.9 ( IQR 1.5-2.3) vs 1.5 (IQR 1.3-1.8)] and lower median IVC collapsibility [39.9 (IQR 23.5-51.4) vs 50 (IQR 38.9-58.80]. PVW pattern is significantly associated with TAPSE (crude OR 3.89; CI 2.67-5.66, p&lt;0.0001), S’ (crude OR 3.26, CI 2.30-4.62, p&lt;0.0001) and increased RAP (adjusted OR 6.06, CI 4.02-9.14, p&lt;0.0001).

Conclusion
Patients with PVW pattern had about 4 times and 3 times higher odds of developing RV systolic dysfunction based on TAPSE and S’, respectively. Its presence confers about 6 times higher odds of developing increased RAP. These parameters can direct further diagnostic work-up and guide assessment of response to decongestive therapy in critical units and other areas where 2d-echocardiogram is not readily accessible.