bluuebunny/crossref_metadata_2025_split huggingface dataset:
Solvation dynamics
Authors: Nitzan Abraham 
Published: June 2024

Abstract
This chapter analyses the important role of solvation and solvation dynamics in the determination of the course of chemical processes in condensed phases. (1) Dielectric solvation. (2) Continuum dielectric model of solvation—dielectric relaxation and the Debye model. (3) Linear response theory of solvation. (4) Quantum solvation.
Double product reserve is associated with waist circumference but not body mass index in overweight or obese individuals
Authors: Yigit S , Akinci B , Eksi B , Calikoglu F , Satman I 
Published: June 2024

Abstract

Background
Obesity is an independent risk factor for cardiovascular disease (CVD). Excessive accumulation of adipose tissue in the myocardium leads to structural and functional changes. Body mass index (BMI) is a parameter used to classify overweight and obesity, but it does not distinguish fat-free mass from fat mass and cannot be used to assess body fat distribution. Recent research suggests that abdominal obesity, as measured by waist circumference, is a risk factor for CVD independent of BMI.

Purpose
In this study, we aimed to investigate the relationship between double product (DP) reserve as a marker of cardiac workload and body composition in overweight and obese individuals.

Methods
One hundred and forty-one overweight or obese individuals aged 35-65 years (F:105, M:36, mean age=51.48±7.41/years) were included. Body composition (BMI, (mean±SD=35.61±23.31 kg/m2), waist circumference, body fat percentage, waist/hip ratio) was measured. DP was calculated according to the 6-minute walk test (6MWT), which is a submaximal exercise test to estimate myocardial work. It was calculated by multiplying heart rate (HR) by systolic blood pressure (SBP) at rest and after completion of the 6 MWT. DP reserve was calculated as the difference before and after 6MWT.

Results
DP reserve was not significantly different according to obesity classification (p=0.210, eta-squared=0.032, 95% CI=0.00-0.09) (Table1). DP reserve showed a weakly correlation with waist circumference (r=0.188, p=0.026). No significant relationship was observed between DP reserve and BMI, waist-to-hip ratio and body fat percentage (p&gt;0.05).

Conclusion
The results of this study showed that cardiac workload estimated with DP reserve was associated with abdominal obesity but not with other body composition parameters. This finding can be interpreted as increased cardiac stress after submaximal exercise in subjects with increased waist circumference regardless of BMI or body fat percentage in overweight or obese subjects.
Health behaviors and adherence levels of patients with hypertension and type 2 diabetes
Authors: Swiatoniowska-Lonc N 
Published: June 2024

Abstract

Introduction
Diabetes (DM) and hypertension (HA) are one of the most commonly diagnosed chronic diseases. Both conditions are treated with pharmacotherapy but also with lifestyle changes and maintenance of health-promoting behaviors. Failure to adhere to therapeutic recommendations can result in a lack of control of these diseases and an increase in acute and chronic complications.
The aim of this study was to assess the degree of compliance with therapeutic recommendations of patients with HA.

Material and methods
The study included 117 patients with HA. The Adherence to Refills and Medications Scale (ARMS) and the Health Behavior Inventory (IZZ) were used.

Results
The mean level of overall adherence was (17.1±5.2). The group of patients with high adherence scored better in health behavior in the domains: IZZ-sum scores (p&lt;0.001), proper eating habits (p&lt;0.001), preventive behaviors (p&lt;0.001) and health practices (p=0.028). No differences were found for the domain of positive mental attitude (p=0.353). Predictors having a negative effect on adherence and the results of the preventive behavior and health practices domains of the IZZ questionnaire were the absence of comorbidities (r=-0.233, p=0.004) and hyperglycemic episodes (r=-0.180, p=0.027).

Conclusions
Patients adhering to pharmacological recommendations have higher adherence to non-pharmacological recommendations. Patients adhering to both pharmacological and non-pharmacological recommendations achieve better control of diabetes compensation. Independent predictors negatively affecting adherence are the absence of comorbidities and episodes of hyperglycemia.
Efficacy and safety of direct oral anticoagulants versus warfarin in obese patients: a systematic review and meta-analysis of 31 studies
Authors: Karakasis P , Ktenopoulos N , Pamporis K , Sagris M 
Published: June 2024

Abstract

Background
Based on current guidelines and consensus documents, the use of direct oral anticoagulants (DOACs) in obese patients (body mass index [BMI] &gt;30 kg/m2) is not advised, with warfarin being the indicated anticoagulant in this population.

Purpose
The present systematic review (SR) and meta-analysis (MA) aimed to synthesize the existing evidence on the efficacy and safety of DOACs versus warfarin in obese patients with non-valvular atrial fibrillation (AF) or venous thromboembolism (VTE). The primary efficacy outcomes were the composite endpoint of all cause-mortality, stroke, systemic embolism (SE) and myocardial infarction (MI), as well as all-cause mortality. The primary safety outcome was major bleeding.

Methods
A systematic search was performed in MEDLINE, SCOPUS and Cochrane databases from inception to October 3, 2023. Double independent study selection, data extraction and quality assessment was performed. Data were pooled and risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effects MA.

Results
Totally, 31 studies with 613,968 participants were analyzed. The use of DOACs was significantly associated with reductions in the composite outcome (RR=0.80, 95% CI [0.65, 0.98], I2=95%), hemorrhagic stroke (RR=0.58, 95% CI [0.38, 0.88], I2=92%), major bleeding (RR=0.80, 95% CI [0.67, 0.97], I2=94%), gastrointestinal bleeding (RR=0.59, 95% CI [0.49, 0.72], I2=88%) and intracranial bleeding (RR=0.45, 95% CI [0.34, 0.60], I2=44%) compared to warfarin. Non-significant benefit of DOACs was observed in all-cause mortality (RR=0.78, 95% CI [0.49, 1.23], I2=97%), MI (RR=0.82, 95% CI [0.51, 1.32], I2=88%), the composite of stroke or SE (RR=0.90, 95% CI [0.71, 1.15], I2=94%), ischemic stroke (RR=0.94, 95% CI [0.72, 1.22], I2=93%), SE (RR=0.81, 95% CI [0.63, 1.05], I2=26%), VTE (RR=0.80, 95% CI [0.61, 1.03], I2=89%) and minor bleeding (RR=0.88, 95% CI [0.71, 1.09], I2=77%) compared to warfarin. The subgroup analysis indicated no effect modification based on the indication for anticoagulation or the study design.

Conclusion(s)
The DOACs were associated with significant reductions in clinically relevant efficacy and safety outcomes in obese patients with non-valvular AF or VTE compared to warfarin. Our findings suggest that their use could possibly be safely extended in this patient subgroup.
Diabetic ketoacidosis in patients with type 2 diabetes mellitus receiving sodium-glucose co-transporter-2 inhibitors: The Hong Kong Diabetes Study
Authors: Jing F , Law Q P S , Rafiee H , Chou O H I , Wong W T , Leung B K H , Pui H H H , Wai A K C , Yip C , Liu T , Cheung B M Y , Tse G , Zhou J 
Published: June 2024

Abstract

Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with increased risks of diabetic ketoacidosis in some studies, but not others. Also, few studies have analysed the characteristics of DKA cases nor have they developed risk models to predict DKA.

Methods
This was a population-based cohort study of patients with type 2 diabetes mellitus (T2DM) who were prescribed a SGLT2i between 1st January 2015 and 31st December 2020, with follow-up until 2022.

Results
A total of 28,814 patients (59.54% male, mean age 57.9±11.3 years old) were included. Over 159,000 person-years, 494 patients suffered from DKA and 855 patients died. Multivariable Cox regression identified seven significant predictors of incident DKA: need for financial aid, prior DKA, insulin use, acarbose use, time-weighted mean of HbA1c, fasting glucose and coefficient of variation for fasting glucose. The same predictors remained significant after excluding patients with prior DKA before SGLT2I use. Altogether, it was possible develop a multivariable score-based system, with weightings for risk stratification of incident DKA.

Conclusions
Significant predictors of DKA of SGLT2I use were identified with development of a score-based system for risk stratification. This enables clinicians to identify high-risk patients early and monitor them more closely. Multivariable Cox regression Risk score for DKA prediction
Statin adherence in coronary outpatients: a novel direct method compared with pharmacy registry data
Authors: Pivoriunas J , Engebretsen I , Vethe N T , Kristiansen O , Dammen T , Fagerland M W , Husebye E , Munkhaugen J , Sverre E 
Published: June 2024

Abstract

Introduction
An optimal method to assess adherence to statin therapy is needed. We have developed a novel test analysing atorvastatin, simvastatin and their metabolites in blood, to identify reduced adherence (≥2 consecutively omitted doses). The association between statin adherence measured in blood and long-term adherence is yet to be defined.

Purpose
To compare statin adherence measured by a single blood test with pharmacy registry data.

Methods
In a cross-sectional study including 451 patients using either atorvastatin or simvastatin, a spot blood sample was collected 2-35 (median 18) months after a coronary heart disease event. Participants were unaware of the forthcoming statin analyses. Reduced adherence to atorvastatin and simvastatin was determined by drug concentration measurements using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Study data was linked to the pharmacy registry. Indirect adherence was defined by a statin treatment gap exceeding 90 days; i. the three months period prior to the blood test, and ii. from six months before until six months after the blood test. We accounted for overlapping prescriptions of statins.

Results
Mean age was 61 (SD 9) years, and 19% were women. Thirty-nine (9%) out of 412 patients had reduced adherence to statins, determined by the direct method. The non-adherent patients had higher LDL-cholesterol levels, higher rates of multiple coronary events, lower participation rates at cardiac rehabilitation, and were more often smokers compared with the adherent patients (Table 1). Among patients classified as adherent by the blood test, only one (0.2%) had a treatment gap exceeding 90 days during the preceding three months (Table 2). Correspondingly, of 39 patients with reduced adherence by the blood test, 11 (28%) had treatment gaps exceeding 90 days. The negative agreement between the methods was 97% and the positive agreement 43%. Among patients classified as adherent by the blood test, 21 (5%) had treatment gaps exceeding 90 days from six months before until six months after the blood test. Correspondingly, of 39 patients with reduced adherence by the blood test, 15 (39%) had at least one treatment gap exceeding 90 days. The negative agreement between measurements was 95% and the positive agreement 40%.

Conclusions
Of 412 coronary outpatients classified adherent by the statin blood test, registry data only identified one patient (0.2%) with a treatment gap exceeding 90 days. The novel blood test emerges as a promising tool to identify patients adherent to statins, and thus may improve lipid management in clinical practice.
Impact of a myocardial infarction emergency management network on population 28-day myocardial infarction case-fatality trends 2008-2019
Authors: Camps-Vilaro A , Tizon-Marcos H , Degano I R , Subirana I , Cainzos-Achirica M , Puig T , Mauri J , Lidon R M , Arbelo E , Marrugat J 
Published: June 2024

Abstract

Introduction
The implementation of emergency care networks (Codi IAM, in our case) has reduced time to treatment of ST-elevation acute myocardial infarction (AMI).

Purpose
We analyzed the hypothesis that the implementation of the Codi IAM should translate into a reduction in population AMI 28-day case-fatality, as more sudden death patients are expected to be reached earlier and appropriately reperfusioned.

Methods
We linked the databases of the Codi IAM registry, the Catalan hospital discharge data and the mortality registry. More than 97,000 AMI patients aged 35-84 years hospitalized or dead between 2008 and 2019 were included. The trends in pre-hospital, in-hospital, and overall 28-day standardized case-fatality 2008-2010, prior to the implementation of the Codi IAM network and in the implementation period (2011-2019) are compared. The Annual Percentage Change (APC) and Spline trends were calculated.

Results
The incidence of AMI decreased after 2011 (p=0.001). In that period, the mean patients’ age decreased from 70 to 67 years, p&lt;0.001, and the percentage of women from 29,2% to 25.7%, p&lt;0.001). Patient comorbidity increased: hypertension (38.8% to 49.9%, p&lt;0.001), diabetes (23.9% to 31.9%, p&lt;0.001) and history of cardiovascular disease (26.5% to 28.5%, p&lt;0.001). Overall 28-day AMI case-fatality decreased significantly after 2010 (p&lt;0.001): mainly due to a significant decrease in pre-hospital case-fatality after that year (p&lt;0.001) (Table 1). Conversely in-hospital case-fatality significantly decreased until 2011 (p&lt;0.001) and remained steady thereafter (p=0,12) (Figure 1).

Conclusions
The observed AMI 28-day pre-hospital case-fatality decreasing trends paralleling the implementation of the emergency network Codi IAM in Catalonia strongly suggest that Codi IAM successfully transferred out-of-hospital otherwise sudden death patients, to treating hospitals, with barely any change in in-hospital case-fatality.
Prognostic value of computational pressure-flow dynamics derived fractional flow reserve among non-ST-elevation myocardial infarction and unstable angina patients
Authors: Sze H , Leung K L C , Yiu K H 
Published: June 2024

Abstract
Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index to assess the severity of coronary artery stenoses without requirement of invasive pressure wire and hyperaemic stimulus in fractional flow reserve (FFR) measurement. Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) is the most and second most common acute coronary syndrome, respectively. However, whether selective PCI guided by caFFR in addition to angiography can provide further clinical benefit is unclear for patients presenting with NSTEMI and UA. The aim of this study is to investigate the prognostic value of caFFR among NSTEMI and UA patients.
A total of 1449 vessels in 483 patients that presented with NSTEMI or UA (mean age=67.0±12.3, 67.9% male) were retrospectively analysed for caFFR. Patients had undergone PCI according to the angiographic and clinical data available at the time. Vessels were said to be adherent to caFFR if ischemic vessels, defined by caFFR≤0.8 had been treated with PCI and non-ischemic vessels, defined by caFFR&gt;0.8 had not been treated by PCI. Otherwise, they were considered non-adherent to caFFR. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as vessel-related cardiovascular mortality, vessel-related myocardial infarction (MI) and unplanned revascularisation at median 4.4 years follow-up. Survival curves were constructed using Kaplan-Meier estimates and differences between groups were tested using the log-rank test. Cox proportional hazards model was used to evaluate the association between adherence to caFFR and the risk of VOCE, with parameters with P&lt;0.1 upon univariate analysis entered into multivariable Cox model.
Among the 1449 vessels, caFFR was analysable in 1020 (70.4%) vessels, with 802 (78.6%) vessels that received treatment adherent to caFFR and 218 (21.4%) vessels that received treatment non-adherent to caFFR. Adherent vessels had significantly lower incidence rates of VOCE (11.2% vs 18.3%; P=0.005) and MI (2.0% vs 9.2%, P&lt;0.001) compared to non-adherent vessels. This was primarily driven by reductions in the incidence of VOCE (18.0% vs 28.9%; P=0.026) and MI (2.4% vs 15.7%; P&lt;0.001) in ischemic vessels that underwent PCI compared to ischemic vessels that did not undergo PCI. After multivariate adjustment, adherent vessels had a significantly lower risk than non-adherent vessels in terms of VOCE (HR 0.59; 95%[Cl] 0.41-0.86; P=0.006) and vessel-related MI (HR 0.22; 95%Cl 0.11-0.42; P&lt;0.001).
In patients presenting with NSTEMI or UA, revascularization that was adherent to caFFR guidelines was associated with a significant reduction in VOCE. The findings support the potential use of caFFR in treatment guidance of NSTEMI and UA patients. Kaplan-Meier plots for VOCE Kaplan-Meier plots for vessel-related MI
Assessing the impact of air pollution on major adverse cardiovascular events. Insights from the EP-PARTICLES Cohort Study in Eastern Poland
Authors: Kuzma L , Kurasz A , Swieczkowski M , Gajewska-Bachorzewska H , Tomaszuk-Kazberuk A , Dobrzycki S , Lip G H 
Published: June 2024

Abstract

Introduction
Exposure to air pollution (AP) is a modifiable risk factor for cardiovascular diseases (CVD).

Objective
To analyze the short-term and long-term health effects of AP on the occurrence of major adverse cardiovascular events (MACE).

Methods
A spatio-temporal analysis was conducted on the EP-PARTICLES cohort during the years 2011-2020 (N=80,077,671 patients-years), residents of Eastern Poland. The MACE endpoint included the occurrence of STEMI, NSTEMI, or CVD mortality. The sources of medical data were NFZ (National Health Fund) and GUS (Central Statistical Office). The analysis utilized data from the GEM-AQ air quality modeling system and panel-time methods. Analyses were conducted at the municipality level (LAU -2) for an increase of interquartile range in AP concentrations. In the second stage we pooled municipality-specific estimates with a random-effects meta-analysis. To estimate the overall shape of the associations between air pollutant concentrations and MACE at the national level, we plotted meta concentration–response curves.

Results
Between 2011-20, there were 139,697 cases of ACS (45.2% STEMI); 831,246 deaths (including 45.4% CVD N=377,344), with a median age of 79 [67–86], and 50.5% male. WHO air pollution concentration standards were exceeded annually with a decreasing trend in concentrations (Kendall's tau -0.778, P&lt;0.001). The main triggers for MACE were PM2.5 (RR LAG0-1 1.04 95%CI 1.028-1.053) and BaP (RR LAG0-1 1.021 95%CI 1.01-1.032). An increase of up to 10% in MACE related to the monthly increase in concentration was noted: PM2.5 (RR LAG0-30 1.098 95%CI 1.043-1.154), BaP (RR LAG0-30 1.033 95%CI 1.026-1.041). The percentage of hospitalizations that can be linked to air pollution is 20% for STEMI (N=12,500), after 13% of CVD deaths (N=47,474) and NSTEMI (N=10,200), which translates into 71,440 lost years of life (YLL) over the analyzed decade. These effects were 5% higher in the female group vs. male and 9% in the group &lt;65 vs. &gt;65 years of age (p&lt;0.001).

Conclusions
Particulate matter and BaP are significant factors associated with the occurrence of MACE, with young women being the most at-risk group. Exposure to air pollution should be included in CVD prevention models. The losses associated with premature mortality and living with illness indicate an urgent need for systemic changes in public health.
Differences in blood pressure and heart rate variability between individuals with and without coronary artery calcification during prolonged high-intensity endurance exercise
Authors: Svane J , Wiktorski T , Eftestol T C , Orn S 
Published: June 2024

Abstract

Background
Physical exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of myocardial infarction and cardiac death during high-intensity exercise. This study compares cardiovascular hemodynamic measures and heart rate variability (HRV), which may impact cardiac function, during prolonged high-intensity exercise in individuals with and without CAC.

Methods
A total of 56 healthy, middle-aged (51.0 [43.0-58.0] years [median, (Q1-Q3)]) individuals (41 men/15 women) participating in a 91-km (251.2 [217.2-271.6] minutes) leisure sport mountain bike race were included in this study. Computer tomography coronary angiography after the race demonstrated CAC in 25 participants (20 men/5 women), defining them as CAC+. The other participants without CAC were defined as CAC-. The study subjects were assessed using hemodynamic measures and HRV at the top of the hardest hill (THH) towards the end of the race.

Results
Comparing hemodynamic measures after THH demonstrated that CAC+ individuals had significantly higher systolic blood pressure (235.0 [225.0-245.0] mmHg vs 220.0 [192.5-237.5] mmHg, p=0.008), higher diastolic blood pressure (DBP) (105.0 [95.0-110.0] mmHg vs 95.0 [85.0-110.0] mmHg, p=0.006), higher pulse pressure (130.0 [125.0-140.0] mmHg vs 123.0 [110.0-130.0] mmHg, p=0.039), higher mean rate pressure product (33882 [30872-35053] bpm×mmHg vs 31028 [27392-33047] bpm×mmHg, p=0.028), and larger increase in DBP from baseline (20.0 [20.0-30.0] mmHg vs 10.0 [0.0-20.0] mmHg, p=0.001), compared with CAC- individuals. The CAC+ individuals had a significant reduction in the low frequency (LF) component of HRV (6.3 [2.4-11.5] ms² vs 12.4 [6.8-20.2] ms², p=0.044). In multivariate analysis, LF was an independent predictor of presence of CAC even after adjusting for established risk factors of atherosclerosis.

Conclusion
Individuals with calcified plaques had significant alterations in hemodynamic measures and LF following prolonged high-intensity exercise compared to individuals without CAC. LF was an independent predictor of presence of CAC suggesting a potentially pathological autonomic response to high intensity exercise in individuals with CAC.