bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is genetic information helpful in predicting recurrent events in young patients after acute coronary syndrome?
Authors: Sousa F , Mendonca M I , Sa D , Abreu G , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra G , Drumond A , Sousa A C , Palma Dos Reis R 
Published: October 2024

Abstract
Coronary Artery Disease (CAD) shares environmental and genetic factors. Young patients with acute coronary syndrome (ACS) carry a poor long-term prognosis. The clinical utility of genetic information in predicting CAD events remains unknown.

Aim
Evaluate the clinical utility of a multiplicative Genetic Risk Score (mGRS) to predict lifelong residual risk in CAD patients below 55 years with few risk factors.

Methods
475 non-diabetic patients with LDL cholesterol levels below 100mg/dL at the first admission who suffered a prior MI at age ≤55 years were followed prospectively for a mean of 5.6±5.3 years. A mGRS was performed with nine variants associated with CAD but not with traditional risk factors (TRF): CDKN2B-AS1 (rs1333049 and rs4977574), TCF21 (rs12190287), PHACTR1 (rs1332844), MIA3 (rs17465637), ADAMTS7 (rs3825807), ZC3HC1 (rs11556924), SMAD3 (rs17228212) and GJA4 (rs618675). The mGRS was subdivided into terciles. Using Cox regression analysis, the predictive and discriminative score ability for events was evaluated. C-statistic discriminated cardiovascular events occurrence. Whether mGRS was included in the TRF model, Net Reclassification Improvement (NRI), or Integrated Discrimination Improvement (IDI) reclassified patients. Kaplan-Meier method estimated survival curves.

Results
There were 153 patients with at least one cardiovascular event. The bivariate analysis showed the strongest correlation with second and third mGRS tercile, multivessel disease, left ventricular dysfunction, and inflammation. Multivariate Cox regression HR adjusted for events was 1.44 (p=0.103) for the intermediate and 2.00 (p=0.001) for the high-risk tercile. The mGRS inclusion improved C-statistic (∆C-index=0.010; p=0.004), NRI (35.4%; p&lt;0.0001) and IDI (2.7%; p=0.0005).

Conclusions
Our 9-SNP mGRS better identified and reclassified younger CAD patients with a high probability of cardiovascular events, improving clinical decision-making and reducing costs for therapeutic strategies.
A systematic review and meta-analysis on the predictive value of the C2HEST score to predict new onset atrial fibrillation in &gt;11 million Western and Asian subjects
Authors: Pastori D , Menichelli D , Li Y G , Brogi T , Pignatelli P , Farcomeni A , Lip G Y H 
Published: October 2024

Abstract

Background
The incidence of new-onset atrial fibrillation (NOAF) is increasing in the last decades. NOAF is associated with worse long-term prognosis. The C2HEST score has been recently proposed to stratify the NOAF risk. The C2HEST score includes coronary artery disease or chronic obstructive pulmonary disease (1 point each), hypertension (1 point), elderly (age ≥ 75 years, 2 points), systolic heart failure (2 points), thyroid disease (1 point). Pooled data on the performance of the C2HEST score are lacking, as well as its performance in different subgroups of patients.

Methods
Systematic review and metanalysis of observational studies reporting data on NOAF according to the C2HEST score. We searched PubMed, Web of Science and Google scholar databases. Metanalysis of the area under the curve (AUC) with 95% confidence interval (95%CI) was performed. We performed a sensitivity analysis on 1) subjects from the general population/primary care and 2) patients with cardiac disease, 3) Asian patients, 4) Western patients. The risk of bias (RoB) analysis was performed with the Cochrane RoBINS tool for observational studies, evaluating the following domains: bias due to confounding, to selection of participants, in classification of interventions, to deviations from intended interventions, due to missing data, in measurement of outcomes and in selection of the reported result.

Results
Strategy search retrieved 360 articles. Of these, 17 studies were included, accounting for 11,067,496 subjects/patients with 307,869 NOAF cases. Mean age ranged from 41.3 to 71.2 years. The pooled analysis gave an AUC of 0.70 (95%CI 0.66-0.74) with high heterogeneity. A subgroup analysis on studies from general population/primary care yielded an AUC of 0.69 (95%CI 0.64-0.75). In the subgroup of patients with cardiovascular disease, the AUC for the C2HEST score was 0.71 (0.69-0.79). The C2HEST score performed similarly in Asian (AUC 0.72, 95%CI 0.68-0.77), and in Western patients (AUC 0.68, 95%CI 0.62-0.75).
We also performed a metanalysis of the Hazar ratios (HR) for different cut-offs of the C2HEST score. A C2HEST score &gt;1 yielded an HR of 3.98 (95%CI 2.40-6.60), a C2HEST score &gt;2 an HR of 5.63 (95%CI 2.78-11.42) and a C2HEST score &gt;3 an HR of 5.02 (95%CI 2.64-9.54).

Conclusion
The C2HEST score shows a good performance in predicting NOAF in primary and secondary prevention studies. Furthermore, its predictive value is similar between Western and Asian subjects, making it widely usable in clinical practice. More data in other high-risk subgroups of patients such as those with stroke and after cardioversion-ablation patients are needed.
The MADIT-ICD benefit risk score for Japanese patients -from Nippon Storm study-
Authors: Kondo Y , Takanashi Y , Nada T , Nitta T , Aizawa T , Ohe T , Kurita T 
Published: October 2024

Abstract

Background
Implantable cardioverter-defibrillators (ICDs) play a crucial role in preventing sudden death due to lethal arrhythmias such as ventricular tachycardia and ventricular fibrillation. However, like any medical intervention, ICD implantation is not without its complications. It is essential to carefully consider the risks and benefits, and appropriately stratify the risk of sudden death in order to make informed decisions. In 2020, the MADIT-ICD benefit risk score was proposed to utilize personalized integrated assessment of the competing risk of lethal arrhythmias vs. non-arrhythmic mortality in implantable cardioverter-defibrillator (ICD) candidates.

Purpose
To evaluate the risk stratification of using the MADIT-ICD benefit risk score in Japanese patients.

Methods
We analyzed the data of 451 patients, enrolled in the Nippon Storm Study, with left ventricular ejection fraction (LVEF) ≤35% who underwent ICD implantation for primary prophylaxis of sudden cardiac death (men, 78%; age, 65±12 years; LVEF, 25±6.4%; cardiac resynchronization therapy, 73%; ischemic cardiomyopathy (ICM), 33%).

Results
A total of 336 patients were enrolled iln this study. The MADIT-ICD benefit risk scores, except systolic blood pressure, was calculated (Figure 1). These patients were classified into 3 groups (Lowest, Intermediate, Highest). There were no significant differences between the three groups in all-cause mortality, cardiovascular death, non-arrhythmic death, and appropriate ICD therapy (Figure 2). The multivariate analysis demonstrated that LVEF ≤25% was significantly associated with all-cause mortality, cardiovascular death, non-arrhythmic death (p=0.0487, 0.0150, 0.0387).

Conclusion
The MADIT-ICD benefit risk score may not be appropriate to risk stratification in Japanese patients using ICD for primary prophylaxis.Figure 1Figure 2
Enhancing primary prevention: the incremental predictive value of high-sensitivity cardiac troponin T beyond ASCVD risk assessment
Authors: Andraz S , Massa Pereira J , Costa H , Espirito Santo M , Hamann L , Fernandes R , Bispo J , Carvalho D , Bento D , Azevedo P , Mimoso J 
Published: October 2024

Abstract

Background
Atherosclerotic cardiovascular disease (ASCVD) is a global health challenge, prompting widespread use of conventional risk assessment tools (SCORE2 in Europe and the ASCVD Risk calculator in the United States) to guide preventive strategies. Emerging evidence indicates that high-sensitivity cardiac troponin (hsTn) may refine risk stratification.

Objective
We investigate whether measuring hsTnT in primary prevention correlates with mortality and enhances prediction compared to conventional risk score stratification.

Methods
Utilizing National Health and Nutrition Examination Survey (NHANES) data (1999 to 2004) linked to the National Death Index, our cohort included individuals without a history of CVD at baseline and suitable for assessment of the ASCVD ACC/AHA risk score. Individuals were grouped based on computed 10-year risk (low: &lt;5%; borderline: 5-7.5%; intermediate: 7.5-20%; high: ≥ 20%). hsTroponin T levels were measured (Roche assay, 99 th percentile 22ng/L for men and 17ng/L for women). Cox regression estimated association between ASCVD risk categories, with or without hsTnT, and all-cause and cardiovascular mortality.

Results
Among 5257 adults, 47% male, mean age 54 ± 9.1 years, the mean 10-year ASCVD risk was 8.17 ± 8.2%, grouped as: low: 53.3%; borderline: 11.5%; intermediate: 23.9%; and high: 11.3%. hsTnT above the 99 th percentile was measured in 1.1%, 2.7%, 4.9% and 13.4%, respectively (p &lt; 0.001). Over 16.2 ± 3.4 years, all-cause and cardiovascular death was 22.3% and 5.6%, respectively. Compared to low-risk, the hazard ratio (HR) for all-cause death increased to 2.85 (2.2-3.7), 5.6 (4.2-7.5), and 15.3 (11.7-19.9) for borderline, intermediate, and high-risk, respectively. A significant interaction with hsTnT above 99 th percentile was observed (low: HR 3.5 (1.3-9.2); borderline: HR 4.75 (2.1-10.8); intermediate: HR 2.6 (1.8-3.7), high: HR 2.2 (1.7-2.9), p&lt;0.01 for all interactions, see Fig. 1). For cardiovascular death, a significant interaction occurred in intermediate (HR 3.3 (2-5.4), p&lt;0.001) and high-risk (HR 3.6 (2.2-6), p&lt;0.001) groups.

Conclusion
Our findings suggest that hsTnT provides incremental predictive value, at least doubling the hazard of all-cause death across all risk categories, and tripling the hazard of CV death in intermediate and high-risk groups, compared to ASCVD risk stratification alone. The integration of troponin measurements into risk assessment strategies could refine primary prevention approaches.
A direct comparison of non-invasive blood markers of liver fibrosis as associates of cardiovascular risk. The Athens cardiometabolic registry
Authors: Georgiopoulos G , Athanasopoulos S , Mavraganis G , Konstantaki C , Papaioannou M , Delialis D , Angelidakis L , Alexandropoulos A , Kalogeropoulos A , Zervas G , Moustou C , Stellos K , Stamatelopoulos K 
Published: October 2024

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is associated with increased risk of cardiovascular disease (CVD). This risk increases further with advanced liver fibrosis. To date, non-invasive tests (NIT) for liver fibrosis risk have not been established as diagnostic or prognostic biomarkers of CVD.

Purpose
The purpose of the study was to compare NIT of liver fibrosis with respect to their associations with vascular injury and cardiovascular (CV) events.

Methods
Individuals without clinically overt CVD and patients with CVD (total n=1,692), consecutively recruited in the Athens Cardiometabolic Registry, were analysed in this study. We retrospectively evaluated the association of NIT (i.e. Fibrosis-4 index (FIB-4), NAFLD Fibrosis score (NFS), BARD score) with indices of subclinical arterial injury (i.e. carotid wall thickness and atherosclerotic plaque for subclinical atherosclerosis, pulse wave velocity (PWV), for arterial stiffness) and the incidence of CV events. Patients were followed-up for CV events for a median time of 39 months.

Results
Elevated FIB-4 (&gt;2.67) was associated with vascular damage [adjusted odds ratio (aOR)=2.97, 95% confidence intervals (CI)= 1.71-5.78 for maximal wall thickness (maxWT) and aOR=4.58, 95% CI=2.44-8.60 for PWV] across the entire study population, including those with or without clinically overt CVD. NFS&gt; 0.675 showed similar associations but lacked significant correlation with arterial stiffness in coronary artery disease patients. FIB-4&gt; 2.67 and BARD&gt; 2 were associated with increased risk of the composite endpoint of CV death, acute myocardial infarction, or coronary revascularization [adjusted hazard ratio, (aHR)=2.00, 95% CI= 1.12-3.55 and aHR=3.36, 95% CI=1.03-11.0 for FIB-4 (n=842) and BARD (n=887) respectively]. FIB-4 and BARD as continuous variables confered incremental prognostic value compared to European Systematic Coronary Risk Evaluation 2 (SCORE2).

Conclusion
In a population with a wide range of cardiometabolic risk, FIB-4 was associated with both markers of atherosclerotic disease and arterial stiffness as well as with adverse CV events. These data support further investigation of FIB-4 as a biomarker of CV risk.
Ventricular-arterial coupling as assessed by the PWV/GLS ratio in the general population: reference values, correlates and predictive value
Authors: Cauwenberghs N , Vanwinkel H , Ntalianis E , Santana E , Sabovcik F , Budts W , Haddad F , Kuznetsova T 
Published: October 2024

Abstract

Purpose
Ventricular-arterial coupling (VAC) reflects global cardiovascular efficiency. We may assess VAC state non-invasively by combining the non-invasive gold standards for arterial stiffness (carotid-femoral pulse wave velocity or PWV) and left ventricular systolic function (LV global longitudinal strain or GLS). To gain insight in the clinical value of the PWV to GLS ratio, we conducted a general population study to determine its reference values, clinical correlates and predictive value.

Methods
We measured PWV by applanation tonometry and GLS by echocardiography in 1026 individuals (mean age 50.3 years; 52% women). We derived age- and sex-specific reference values for PWV/GLS from a low-risk subsample. Clinical correlates of PWV/GLS were determined by stepwise regression. We calculated multivariable-adjusted hazard ratios (HR) for incident cardiovascular (CV) events (median follow-up time: 10.1 years).

Results
Upper limits of normality for PWV/GLS varied with sex and age, ranging from 0.41 m/sec% in young women up to 0.64 m/sec% in older men. Higher PWV/GLS correlated with male sex and higher age, heart rate, pulse pressure, mean arterial pressure and left ventricular mass (P&lt;0.05 for all). On a continuous scale, only GLS was a significant predictor of CV events after adjustment (HR per 1% decrease: 1.24; P=0.0030). A PWV/GLS ratio above the median (&gt;0.37 m/sec%) did predict future CV events after adjustment (HR versus below median: 2.02; P=0.0067). However, abnormal PWV/GLS defined by reference limits or by cutoffs from literature did not independently predict CV events (P≥0.31 for all).

Conclusion
Age- and sex-specific reference values for PWV/GLS were reported. PWV/GLS relates to age, sex and blood pressure. In contrast to GLS, PWV/GLS does not hold value for CV event prediction in the community.
Comparative efficacy of colchicine and intensive LDL-C lowering in patients with ASCVD receiving statins: a network meta-analysis of randomised controlled trials
Authors: Ou Z , Wang F , Chen Y , Liu X , Ran B , Yin Y , Cui K 
Published: October 2024

Abstract

Background
Adding intensive low-density lipoprotein cholesterol (LDL-C) lowering treatments or colchicine to statins resulted in additional cardiovascular benefits. However, the relative efficacy and priority of these agents are unclear.

Purpose
We aimed to compare the effects of these supplementary agents on cardiovascular outcomes in patients with atherosclerotic cardiovascular diseases (ASCVD) receiving statins.

Methods
We performed a systematic review and frequentist network meta-analysis on randomized controlled trials. The primary efficacy endpoint was the main adverse cardiovascular event (MACE), and the secondary efficacy endpoints were myocardial infarct, stroke, coronary revascularization, cardiovascular death and all-cause mortality. The safety endpoints were treatment discontinuation and non-cardiovascular death. Colchicine was used as reference treatment. Random-effects model was used in case of high heterogeneity, the fixed-effects model was preferred otherwise. We ranked the comparative effects of all drugs with surface under the cumulative ranking (SUCRA) probabilities.

Results
17 trials totaling 85823 participants treated with colchicine, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, Niemann-Pick C1-like 1 protein (NPC1L1) inhibitor and ATP citrate lyase (ACL) inhibitor were included. Compared with colchicine, NPC1L1 inhibitor was associated with increased risk of MACE (risk ratio [RR]: 1.39, 1.21-1.59), stroke (RR: 1.81, 1.09-3.00) and coronary revascularization (RR: 1.36, 1.11-1.68), and PCSK9 inhibitor was associated with increased risk of MACE (RR: 1.27, 1.10-1.46). However, NPC1L1 inhibitor (RR: 0.68, 0.48-0.96) and PCSK9 inhibitor (RR: 0.64, 0.44-0.93) were associated with reduced risk of non-cardiovascular death in comparison to colchicine. PCSK9 inhibitors had a lower risk of MACE (RR: 0.91, 95% CI: 0.85-0.98) and coronary revascularization (RR: 0.89, 95% CI: 0.81-0.97) compared with NPC1L1 inhibitor. Although no regimen prolonged survival, colchicine had the lowest rank at non-cardiovascular death and the worse performance on all-cause mortality.

Conclusions
In patients with ASCVD receiving statins, inflammation-inhibiting with colchicine seems to be superior to intensive LDL-C lowering therapy with PCSK9 inhibitor or NPC1L1 inhibitor in cardiovascular prevention. However, using colchicine as an alternative to intensive lipid-lowering therapy may need to be weighed against the greater cardiovascular benefits and the potential harms of higher non-cardiovascular death. Given the worse performance of colchicine on survival based on current evidence, colchicine may be more appropriate for patients who have been treated with intensive LDL-C-lowering agents but still have recurrent cardiovascular events.Forest plots of included agentsRadar plot of treatments based on SUCRA
Effectivess of non-pharmacological interventions on physical activity and sedentary behaviour among patients with coronary heart disease: a systematic review and meta-analysis
Authors: Miu Y N , Xu M Q , Cheng H Y 
Published: October 2024

Abstract

Background
Coronary heart disease (CHD) is the leading cause of death worldwide. Adequate physical activity has been firmly established as a protective factor against recurrent CHD events. However, emerging evidence highlights sedentary behaviour as an independent contributor to cardiovascular health. It is thereby imperative to identify effective strategies that promote adequate physical activity while currently reducing sedentary behaviour among patients with CHD.

Purpose
This systematic review aims to identify the best available evidence on the effectiveness of non-pharmacological interventions (NPIs) on promoting physical activity and/or sedentary behaviours among patients with CHD.

Methods
This review included randomized controlled trials that examine the effects of NPIs on physical activities or sedentary behaviours or both among patients with CHD. Systematic search was conducted in eight electronic databases (Scopus, MEDLINE, Embase, PsycINFO, Web of Science, CENTRAL, CNKI and WanFang) from inception to December 2023. The version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias of included studies. Meta-analysis was performed by using the Review Manager 5.4, when deem appropriate. A narrative summary was conducted to address studies that could not be included in the meta-analysis.

Results
A total of 24 articles of 22 studies, involving 5454 patients with CHD were included. The interventions were categorised as motivational interventions (k=6) and behavioural change technique-based interventions (k=18). The findings of this review involved pooling the results from 18 studies through meta-analysis, while a narrative summary was conducted for the remaining 4 studies. Results showed that both motivational interventions (SMD 0.34, 95% CI: 0.24, 0.45, P= 0.02, I2= 48%) and behavioural change techniques-based interventions (SMD 0.23, 95% CI: 0.10, 0.37, P= 0.0008, I2= 0%) increased the total physical activity time. Additionally, motivational interventions improve the moderate-to-vigorous physical activity time (SMD 0.42, 95% CI: 0.19, 0.65, P= 0.0004, I2= 41%). However, no significant improvement on sedentary behaviours was found from the meta-analysis.

Conclusions
The findings of this review suggests that motivational interventions have the potential effects to enhance total physical activity time and increase the duration of moderate-to-vigorous physical activity. Further studies on effective intervention that improve the physical activity and concurrently reduce sedentary behaviour are warranted for CHD population.Table 1.Charateristics of studiesFigure 1.Forest plot of outcomes
A retrospective analysis of patients with very HIGH level of LDL-C and the predictors of mortality (HIGH-LDL-PM Registry)
Authors: Deniz M F , Nayir A , Ozkan E P , Ebeoglu A O , Gul O B , Sinan U Y 
Published: October 2024

Abstract

Introduction
Elevated levels of LDL cholesterol (LDL-C) significantly contribute to the development and progression of cardiovascular diseases (CVDs). In HIGH-LDL-PM Registry, we aimed to investigate the demographics and clinical characteristics of patients with very high level of LDL-C and the predictors of mortality, retrospectively.

Methods
We retrospectively searched the electronic database of Istanbul University-Cerrahpasa Institute of Cardiology and included patients with very high level of LDL-C (&gt;190 mg/dl) in HIGH-LDL-PM registry. The study group were classified as patients with high probability of familial hypercholesterolemia (FH) and low probability of FH according to Dutch Lipid Clinic Network Score (DLCNS).

Results
The study group were consisted of 1127 patients and almost two thirds (61.5%) were female. The mean age was 56.5 12.2 years. Hypertension, diabetes, chronic kidney disease (CKD) were seen in 55.8%, 23.5% and 3.7%, respectively. One third of study group (31.1%) had coronary artery disease (CAD) and rest of them were primary prevention patients. the main rhythm was sinus in most of the patients (92,2) and 7.8% patients had atrial fibrillation (AF). Only minority of patients (3.9%) had stigmata for elevated cholesterol levels. While 41.8% of patients had high clinical probability for FH, 58.2% of them had low probability according to DLCNS. While 69% of patients were using lipid lowering treatments (LLTs), 42% of them had drug adherence. High dose (HD) statins (atorvastatin 40-80 and rosuvastatin 20-40 mg) were prescribed in more than half (55.2%) of patients with LLTs. Ezetimibe was the preferred agent as combination therapy in 6.9% and PCSK-9is were prescribed only in 2.5% of patients with LLTs. In 38.8% of study population, ASA was prescribed. 50% decrease in LDL-C levels or decreasing LDL-C below 70 or 100 mg/dl as a treatment goal were achieved in 37.1% and 15% of study population. MACE (MI, stroke, PCI or peripheral revascularization) was recorded in 21% of study population and the mortality rate was 10.4% at 12-years FU (6-145 months). Patients with low probability of FH had better survival than patient with high probability (91.4% vs 88.4%). The age, low dose statin use and higher level of LDL-C at FU were predictors of mortality in Cox-regression analysis.

Conclusion
Our retrospective analysis of patients with very high levels of LDL-C underscores the multifaceted nature of dyslipidemia management and its impact on cardiovascular outcomes. Despite advancements in pharmacotherapy, suboptimal adherence to lipid-lowering treatments remains a significant challenge, contributing to a notable burden of major adverse cardiovascular events and mortality. Identification of predictors of mortality, such as age, statin dosage, and LDL-C levels, highlights the importance of individualized risk assessment and tailored treatment approaches in this high-risk population.