bluuebunny/crossref_metadata_2025_split huggingface dataset:
PowerAI-CVD: Chinese-specific artificial intelligence-powered predictive model for cardiovascular disease
Authors: Li L , Chou O H I , Lu L , Lee Q , Kaur N , Wong W T , Chang C , Liu H , Wai A K C , Cheung B M Y , Liu T , Tse G , Zhou J 
Published: June 2024

Abstract

Background
The main risk stratification tools for identifying high-risk individuals of cardiovascular disease (CVD) are based on Western populations. Few models are developed specifically for Asian populations and are not enhanced by artificial intelligence (AI). The aim of this study is to develop the first AI-powered quantitative predictive tool for CVD (PowerAI-CVD) incorporate physiological blood pressure measurements, existing diseases and medications, and laboratory tests from Chinese patients.

Methods
The study analysed patients who attended family medicine clinics between 1st January 2000 and 31st December 2003. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attack (TIA)/stroke or cardiovascular mortality, with follow-up until 31st December 2019. The performance of AI-driven models (CatBoost, XGBoost, Gradient Boosting, Multilayer Perceptron, Random Forest, Naïve Bayes, Decision Tree, k-Nearest Neighbor, AdaBoost, SVM-Sigmod) for predicting MACE was compared. Predicted probability (ranging between 0 and 1) of the best model (CatBoost) was used as the baseline in-silico marker to predict future MACE events during follow-up.

Results
A total of 154,569 patients were included. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) suffered from MACE (annualised risk: 1.28%). The machine learning in-silico marker captured MACE risk from established risk variables (sex, age, mean systolic and diastolic blood pressure, existing cardiovascular diseases, medications (anticoagulants, antiplatelets, antihypertensive drugs, and statins) and laboratory tests (NLR, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL)). MACE incidences increased quantitatively with ascending quartiles of the in-silico marker. The CatBoost model showed the best performance with an area under the receiver operating characteristic curve of 0.869. The CatBoost model based in-silico marker shows significant prediction strength for future MACE events, across subgroups (age, sex, prior MACE, etc) and different follow-up durations.

Conclusions
The AI-powered risk prediction tool can accurately forecast incident CVD events, allowing personalised risk prediction at the individual level. A dashboard for predictive analytics was developed, allowing real-time dynamic updates of risk estimates from new data. It can be easily incorporated into routine clinical use to aid clinicians and healthcare administrators to identify high-risk patients.
Joint consideration of LDL-C and polygenic risk for incident coronary heart disease in a multi-ethnic cohort of 48,881 individuals
Authors: Iribarren C , Lu M , Elosua R , Rana J S 
Published: June 2024

Abstract

Background
Elevated concentrations of LDL-cholesterol (LDL-C) are a major independent modifiable risk factor for coronary heart disease (CHD). However, the degree to which background polygenic risk can modulate the effect of high LDL-C remains unclear.

Methods
We utilized data from a subset of the Genetic Epidemiology Resource in Adult Health and Aging (GERA) multi-ethnic cohort (n=48,881; mean ± SD age = 58.1 ± 10.3 years; 63% female; 18% non-European ancestry) who were non-diabetic and not taking cholesterol lowering medication at baseline in 2003-2007. We stratified the cohort into three groups of CHD genetic risk (low=quintile 1; intermediate=quintiles 2, 3 and 4; and high=quintile 5) using a 12-SNP Polygenic Risk Score (PRS) for CHD (CARDIO inCode-Score, GENinCode Plc). Incident CHD consisted of primary in-patient codes for angina pectoris, myocardial infarction, revascularization procedures or CHD death through 12/31/2022 (n=1,725); mean follow-up was 14.3 years. Age-adjusted CHD rates per 10,000 person-years were estimated using Poisson regression (accounting for death and health plan disenrollment) according to polygenic risk and LDL-C level. Hazard ratios and 95% confidence intervals for 1 standard deviation (SD) increment of LDL-C in each PRS group were obtain using Cox regression adjusting for 10 principal components of ancestry plus traditional risk factors. We tested for formal interaction LDL-C*PRS as continuous variables in the fully adjusted model. As a complimentary approach we tested interaction between high PRS (quintile 5 vs. lower) and LDL ≥190 (vs lower). Finally, we calculated number needed treat (NNT) to prevent 1 CHD event in each PRS group.

Results
After multivariate adjustment, each 1 SD increment of LDL-C was associated with 1.07 (95% CI, 0.95-1.21; p=0.24), 1.22 (95% CI, 1.15-1.29; p=0&lt;0.0001) and 1.14 (95% CI, 1.03-1.26; p=0.009) increased hazard of CHD among low, intermediate, and high PRS groups, respectively. There was no interaction between linear effects of LDL-C and PRS (p=0.34). On the other hand, we found evidence of interaction (p=0.002) between high PRS and LDL ≥ 190. The NNT was lowest in the high PRS group and highest in the low PRS group (see Figure below).

Conclusions
Our results are consistent with a multiplicative model of high polygenic risk and high LDL on CHD risk. While all patients with elevated LDL-C ought to be treated, our data suggest that an earlier and more aggressive lipid lowering therapy may be directed towards those with high polygenic risk. Figure.
Clinical determinants of the macrovascular reactivity response as assessed by flow mediated slowing in people at risk for cardiovascular disease
Authors: Decorte E , Cauwenberghs N , Claes J , De Wilde C , Michielsen M , Bekhuis Y , Hansen D , Van Craenenbroeck E , Goetschalckx K , Claessen G , De Smedt D , Kutznetsova T , Cornelissen V 
Published: June 2024

Abstract

Background
Non-invasive methods that assess endothelial function may improve the evaluation of cardiovascular risk in primary care. Previous research showed that flow-mediated slowing (FMS) of the brachial-radial pulse wave velocity reflects cardiovascular risk, but larger studies on the FMS response in at-risk populations are required to further unravel its clinical and added value for cardiovascular risk stratification.

Purpose
We investigated the clinical determinants of the full FMS response in people at risk for cardiovascular disease.

Methods
We collected baseline FMS data from a subsample of 157 participants enrolled in the PRIORITY trial (Personalized remotely guided preventive exercise therapy for a healthy heart). Participants had at least one of following risk factors at baseline: systolic blood pressure (BP) / diastolic BP between 130/80 – 159/99 mmHg and/or on antihypertensive treatment, prediabetes with either fasting plasma glucose 100-125mg/dL or HbA1c 5.7%-6.4%, diabetes mellitus, obesity (BMI &gt;30 kg/m2), or evidence of subclinical diastolic dysfunction.
We continuously recorded the brachial-radial PWV using a Vicorder device in supine position at rest and after 5-minutes of supra-systolic occlusion of the upper arm (Figure 1). Stepwise linear regression analyses were performed to assess clinical determinants of the FMS response. We illustrated the effect of important determinants on the FMS response by plotting the estimated marginal means of the final models for each FMS post-occlusion interval by the mean and one standard deviation changes of each determinant.

Results
The study sample was on average 60.2 +/- 11.23 years old and included 74 women (47.1%). Until 180 seconds post-occlusion, a lower FMS response was significantly associated with higher diastolic BP and higher triglycerides levels (P&lt;0.05 for all 0-180s intervals). Higher age only correlated with less decline in brachial-radial PWV in the 60 to 90 seconds post-occlusion interval (P=0.050). Participants with elevated triglycerides or elevated DBP or both exhibited significantly less decline in brachial-radial PWV as compared to those with average or below average levels (Figure 2, panels A to C).

Conclusion
In individuals at increased risk for cardiovascular disease, worse macrovascular reactivity was associated with hypertriglyceridemia and high diastolic BP. Our findings suggest that the use of FMS may have clinical value for cardiovascular risk evaluation and highlight the importance of an optimal control of triglycerides and diastolic BP for adequate cardiovascular risk management. More studies are needed for assessing the additive value of such testing for cardiovascular disease prediction and management beyond current strategies.
The impact of risk factor modification on asymptomatic atherosclerosis in patients with metabolic syndrome
Authors: Tasic I , Tasic I S , Petrovic D , Kostic S , Djordjevic D , Stoickov V , Vukojcic N 
Published: June 2024

Abstract

Introduction
Metabolic syndrome (MetS) is one of the main risk factors for atherosclerosis. Current research indicates the impact of its components to the progression of atherosclerosis and higher frequency of major cardiovascular (CV) events and mortality.

The Aim
Determining the components of MetS that correlate most with asymptomatic atherosclerosis (AA) and the effect its modification has on the progression of atherosclerosis.

Material and Мethods
The paper compares the results of 113 monitored patients with arterial hypertension in the period 2022-2023, divided into groups with and without MetS. In both groups the presence of subclinical carotid artery damage was assessed by measuring the thickness of tunica intima and media (IMT), the presence of plaques and stenosis, with analysis of the occurrence of major CV events from 2009 until the last control.

Results
After the last follow-up examination, the number of major CV events (40.70% vs. 11.86%) and cancer (22.00% vs. 6.77%) were significantly more frequent in the group of patients with MetS. Total mortality was higher but not statistically significant in the group with MetS. Lipid status and blood pressure were improved in both groups. After a 13-year follow-up, IMT increased (0.97 to 1.30 in patients with MetS and 0.85 to 0.99 in patients without MetS), along with the degree of stenosis in both groups (from 29.9% to 40.35% in the group with MetS and 37.80% to 42.40% without MetS). The group with MetS reached the target values in a smaller percentage for all components of MetS, especially triglycerides (45.7% in the group with MetS compared to 86% in the group without MetS).

Conclusion
Early identification of individuals with AA can prevent cardiac events in patients with MetS, but more intensive therapy and lifestyle changes are necessary to reach target values of its components and prevent progression to major CV events.
Reaming at resistant hypertension: old weapons brought back
Authors: Gregorio Antunes Coelho R , Esteves A , Sa C , Calcada A , Louzada R , Silva Ferreira J , Quintal J , Bernardes P , Goncalves S , Santos R , Seixo F 
Published: June 2024

Abstract

Background
High blood pressure (BP) is the most prevalent cardiovascular risk factor and remains the leading modifiable cause of death. In many patients, pharmacological therapy is insufficient to adequately control blood pressure. Multiple clinical trials have demonstrated the safety and efficacy of renal sympathetic denervation in reducing BP.

Purpose
The aim of this study is to present our center’s initial experience with a radiofrequency renal denervation technique, describing the characteristics of the first patients submitted to this procedure, as well as to evaluate its safety and effectiveness in our population.

Methods
An observational study with all patients who were treated with renal denervation, between January and September 2023, was performed. For this procedure we selected patients with resistant Hypertension, defined as elevated BP values despite treatment with at least 3 different classes of anti-hypertensive medications (including one diuretic). Patients with secondary hypertension and with eGFR &lt;40 mL/min/1.73m2 were excluded. Baseline patient characteristics were evaluated as well as ABPM/AMPA values prior to the procedures and at least 3 months after. The Wilcoxon test was used to compare median blood pressure values before and after the procedure. A p-value &lt;0.05 was considered statistically significant.

Results
Nine patients underwent renal denervation, 7 (78%) male with a median age of 66 [50;70] years.
Three (33%) patients had grade 1 arterial hypertension, four (44%) had grade 2 and two (22%) had grade 3. Six patients (67%) had diabetes mellitus, seven (78%) had dyslipidemia, four (44%) were smokers and six (67%) had obstructive sleep apnea syndrome.
All patients were taking renin-angiotensin-aldosterone system inhibitors, dihydropyridine calcium channel blockers and diuretics. Six patients (67%) were taking spironolactone and all but one were taking beta-blockers. Five patients (56%) were taking rilmenidine and one (11%) methyldopa. Patients were taking a mean of 5 (± 1) pharmacological classes. After renal denervation, previously ongoing pharmacological therapy was maintained.
There was no statistically significant difference in renal function before (GFR 90 [61;125] ml/min/m2) and after (GFR 96 [70;130] ml/min/m2) renal denervation (p = 0.770). There were no complications.
Comparing BP values prior and after the procedure, renal denervation was associated with a significant reduction in systolic (reduction of 18 [15;23] mmHg; p = 0.008), diastolic (9 [5;10] mmHg; p = 0.011) and mean BP (13 [9;15] mmHg, p = 0.008).

Conclusions
Renal denervation proved to be a safe and effective procedure in reducing blood pressure in this first group of patients with resistant hypertension who was submitted to procedure in our center. Further patients need to be included and a longer follow-up is needed to assess the benefit of this technique.
Cardiovascular disease risk factors among physicians, nurses, and administrative staff: data analysis from a tertiary trauma center hospital
Authors: Kachrimanidis I , Apostolos A , Vlachakis P K , Mantzouranis E , Iliakis P , Drogkaris S , Katsaros O , Ktenopoulos N , Oikonomou G , Kalafatis E , Drakopoulou M , Toutouzas K , Kyriazis I , Tsioufis C 
Published: June 2024

Abstract

Background
Several studies have shown that hospital workers are at a higher risk for burnout and mental health issues. However, scant data exist about cardiovascular disease risk factors among them. Moreover, it remains unknown whether there are differences among physicians, nurses, and administrative staff working in a hospital. The purpose of our study is to explore the risk factors for developing cardiovascular disease among physicians, nurses, and administrative staff working in a tertiary trauma center hospital and to identify the group of workers under higher risk for developing cardiovascular disease.

Methods
Physicians, nurses, and administrative staff of a tertiary hospital trauma center located in an urban location participated in our study. Baseline demographical, somatometric, and pharmaceutical characteristics were collected prospectively through a questionnaire after a personal interview with a physician–investigator of our study. Cardiovascular risk was estimated according to Heart Score and the most recent European Guidelines.

Results
Between May 2023 and December 2023, a total of 354 hospital workers completed our questionnaire, participated in our study, and were analyzed. One hundred and eight were physicians (30.5%), 128 were nurses (36.2%), and the remaining 118 (33.3%) were administrative staff. Their mean age was 45.8±10.6, 48.4±8.4, and 51.9±8.5 years old, respectively (p-values &lt; 0.001). The majority of the physicians were male (N=58, 53.7%), in contrast with nurses (N=32, 25%) and administrative staff (N=22, 18.6%). No significant differences were observed regarding body mass index (BMI) among physicians, nurses, and the remaining hospital workers (25.8±4.5, 27.0±6.1, and 28.1±14.9, respectively). The incidence of coronary artery disease, diabetes mellitus, and hypertension was significantly higher in nurses (4.7%, 26.6%, and 10.9%) compared to physicians (1.9%, 13.0%, and 3.7%) and administrative staff (0%, 11.9%, and 3.4%); paradoxically, no significant difference was observed in dyslipidemia incidence (p=0.33). Estimating cardiovascular risk using Heart Score, we identified that administrative staff were at a higher risk compared with physicians and nurses (p&lt;0.005). (See Figure) This could be attributed to the higher age of this group and the significantly higher levels of total and LDL-cholesterol (See Figure 2).

Conclusion
Our analysis showed that administrative staff is at a higher risk of developing cardiovascular disease compared to physicians and nurses. This could be attributed to the older age of administrative staff, as well as the higher levels of total and LDL-cholesterol. Further studies are required for the better risk stratification of hospital workers. Risk for CVD. Risk Factors.
Potentially avoidable hospitalizations for heart failure in Switzerland
Authors: Maung K , Mauron C H A R L È , Gouveia A L E X , Marques-Vidal P E D R O 
Published: June 2024

Abstract

Background
Timely and appropriate outpatient care can prevent potentially avoidable hospitalizations (PAH) for heart failure. We analysed the trends, determinants, and consequences of PAH for heart failure in Switzerland over two decades.

Methods
Hospital discharge data from Switzerland for the years 1998 to 2018. PAH was defined according to the Organization for Economic Cooperation and Development criteria (OECD).

Results
The number of PAH for heart failure increased from 2,633 in 1998 to 111,338 in 2018. However, expressed as percentage of total admissions for heart failure, there was a slight decrease in the prevalence of such admissions, declining from approximately 80% in 1998 to 78% in 2018. Compared to non-PAH, PAH for heart failure were more frequently in the middle age to older age categories, non-Swiss, without health insurance, with lower comorbidities as per Charlson’s index, and more frequently observed in the Zurich, Eastern, Central and Tessin regions of Switzerland (table). PAH for heart failure were more frequently admitted as an emergency, via the patient’s (table). Conversely, patients with PAH for heart failure stayed less frequently in the ICU (14.1% vs. 8.9%, p&lt;0.001) and were mostly discharged home (25.57% vs. 70.0%, p&lt;0.001) than patients without PAH. The length of stay was longer in PAH than non-PAH cases (9.4±1.0 vs. 8.7±1.0 days, p=0.001), but their cost was lower (11,404 vs. 12,954 CHF, p&lt;0.001). In 2018, the overall financial burden associated with PAH for heart failure was estimated at 120.5 million CHF.

Conclusion
In Switzerland, the number of PAH for heart failure has increased considerably. The medical and financial burden due to the PAH for heart failure could be reduced with timely and appropriate outpatient care.
Cardiac rehabilitation current landscape in Romania - A new chapter for the heart
Authors: Narcisa Flavia L , Olteanu G , Ciuca-Pana M A , Serbanoiu L I , Busnatu S S 
Published: June 2024

Abstract

Background
In the year 2023, cardiovascular diseases persist as a significant global challenge, casting an immense burden over Europe and particularly affecting Romania, where elevated mortality rates position the country prominently within the European context. Despite concerted global efforts, progress in reducing the incidence of cardiovascular diseases has encountered stagnation. This research endeavors to shed light on and address the underutilization of cardiac rehabilitation (CR) in Romania in comparison to other therapeutic approaches.

Purpose
Our aim is to comprehensively centralize information on CR centers in Romania, assess population coverage, evaluate costs and accessibility, and propose improvement strategies. Building on existing reports, we conducted a comparative analysis to uncover patient difficulties and explore potential solutions.

Methods
We extensively searched for cardiac recovery centers using Google and conducted telephone interviews to gather information on program details, costs, and the subvention status by the National Health Insurance House. Additionally, we mined specialized medical databases for relevant articles in cardiac recovery. Thorough analysis of the collected data offers insights into the landscape of cardiac recovery facilities in Romania.

Results
Despite COVID-19 challenges and the lack of an integrated model for network centers, along with insufficient financial support from the National Health Insurance House for cardiac rehabilitation services exceeding 16 days, the private sector managing 61.90% of centers, the total number of cardiac rehabilitation centers in Romania increased by 16.67% in the past 6 years. Some centers haven't fully resumed post-lockdown. Our investigation revealed a significant concentration of these centers in large cities, with 33.33% situated in the capital, indicating a geographical disparity. Lack of specialist endorsement is attributed to a lack of popularization in the sector. The pandemic worsened existing accessibility limitations; however, telerehabilitation emerged as a smart and effective alternative, overcoming geographical and logistical barriers. While only one center in Romania currently offers digital technology for remote monitoring, it signifies a significant evolution in cardiac rehabilitation. Proposed strategies include partnerships and health insurance expansion to improve access and affordability, with a focus on promoting telerehabilitation as a cost-effective alternative.

Conclusions
The gap between international recommendations and limited national coverage highlights potential restrictions in Romanian patients' access to the full benefits of CR programs. However, the expansion of cardiac telerehabilitation offers a convenient and accessible pathway for the development of this health sector.