bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of SELECT-eligibility and incidence of 5-year major adverse cardiovascular outcomes in non-diabetic patients with myocardial infarction
Authors: Maeng M , Gyldenkerne C , Thrane P , Hansen M K , Olesen K K W 
Published: November 2023

Abstract

Background
The ongoing Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity (SELECT) trial has randomized 17,605 non-diabetic patients with a body mass index (BMI) ≥27 kg/m2 to treatment with semaglutide versus placebo. Follow-up will be terminated on March 31, 2023. In consecutive myocardial infarction (MI) patients representing daily clinical practice, the prevalence of SELECT-eligible patients and the incidence of the three-point major adverse cardiovascular events (MACE; MI, ischemic stroke, and cardiovascular death) are not known.

Purpose
To assess the prevalence of SELECT-eligibility and the incidence of 5-year MACE in SELECT-eligible patients in a contemporary semi-nationwide European MI cohort representing daily clinical practice.

Methods
We identified 34,385 patients with a first-time MI and followed the in- and exclusion criteria for the SELECT trial as outlined in the Figure. Concordant with the SELECT trial, follow-up started on day 60 and maximum follow-up time was 5 years. We estimated adjusted hazard ratios (aHR) for the SELECT-eligible cohort using patients with a BMI from 20 to &lt;27 kg/m2 as reference group. Moreover, we stratified the SELECT-eligible cohort by BMI ≥27 to &lt;33 kg/m2 and ≥33 kg/m2.

Results
As depicted in the Figure, 10,769 patients with a BMI ≥27 kg/m2 were eligible for SELECT (SELECT-eligible cohort), which corresponds to a prevalence of 31% in the entire 34,385 MI cohort. The normoweight reference group included 11,011 patients. At baseline, the median age was 64 years for the SELECT-eligible cohort and 68 years for the reference group. Stratification of the SELECT-eligible cohort showed median age of 65 years for the BMI ≥27 to &lt;33 kg/m2 and 63 years for the BMI ≥33 kg/m2 subgroups. The cumulative 5-year incidence of MACE was 10.7% for SELECT-eligible and 13.2% for reference patients (aHR 0.96, 95% CI 0.88-1.04). When stratifying the SELECT-eligible cohort, those with BMI ≥27 to &lt;33 and ≥33 kg/m2 had cumulative 5-year incidence of 10.9% (aHR 0.95, 95% CI 0.87-1.04) and 9.9% (aHR 0.99, 95% CI 0.84-1.16).

Conclusions
In a large contemporary semi-nationwide cohort of consecutive MI patients, approximately 3 out of 10 were eligible for the SELECT trial and the estimated 5-year MACE incidence in SELECT-eligible patients was just above 10%. SELECT-eligible patients experienced the index MI up to 7 years earlier than the reference group. However, the 5-year incidence of MACE did not suggest that overweight/obese patients fulfilling SELECT eligibility criteria were associated with an excess MACE risk when compared to a normoweight reference group.
Association between intensity of glycemic control with GLP-1 receptor agonists and risk of atherosclerotic cardiovascular disease: a systematic review and meta-regression
Authors: Gomes D , Presume J , Ferreira J , De Araujo Goncalves P , Sousa Almeida M , Mendes M 
Published: November 2023

Abstract

Background
Several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown to reduce major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (DM). However, this reduction has not been consistent among different GLP-1 RAs. We conducted a systematic review and meta-regression analyses to evaluate the association between the intensity of glycemic control achieved byGLP-1 RAs therapy in patients with type 2 DM and the reduction of MACE as well as to identify potential mechanisms involved.

Methods
Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through November 2022. Studies were considered eligible if they were cardiovascular outcomes randomized trials (CVOTs) comparing GLP-1 RAs versus placebo in type 2 DM patients. Trials including non-diabetic patients and GLP-1 RAs refused by European Medicines Agency or US Food and Drug Administration were excluded. The outcome of interest was 3-point MACE (CV death, MI, or stroke). Random-effects meta-analyses and meta-regression evaluated associations between glycemic control withGLP-1 RAs and study outcomes. Secondary meta-regression analyses were performed for body weight and blood pressure (BP) variation.

Results
Overall, 8 CVOTs were included, with a total of 60080 patients (30694 treated withGLP-1 RAs). GLP-1 RAs were associated with a lower incidence of 3P-MACE (RR 0.876; 95% CI 0.821-0.935, p&lt;0.001). Mean HbA1C reduction was 0.57% in patients treated withGLP-1 RAs vs. placebo. Meta-regression showed that higher reductions of HbA1C levels were associated with lower risk of 3P-MACE (Log RR -0.286 [95% CI-0.512; -0.056], p=0.015), which translates into an estimated relative risk reduction of 25% for each 1% reduction in HbA1C (Figure 1A). There was a non-significant association between glycemic control and each of the 3P-MACE outcomes analysed separately. Body weight reduction was also associated with a lower risk of 3P-MACE (Log RR -0.067 [95% CI-0.134; 0.001], p=0.053), despite not meeting statistical significance (Figure 1B). Systolic BP decrease was not associated with reduced risk of 3P-MACE.

Conclusions
The better the glycemic control withGLP-1 RAs in type 2 DM patients, the greater the reduction in 3P-MACE. Body weight reduction may also play a potential role.Figure 1
Insulin pump treatment vs. multiple daily insulin injections in patients with poorly controlled type 2 diabetes mellitus: a comparison of cardiovascular effects
Authors: Tremamunno S , Tartaglione L , Telesca A , Rizzi A , Felici T , Mazzotta F , De Vita A , Rizzo G E , Cambise N , Belmusto A , Lanza G A , Pitocco D 
Published: November 2023

Abstract

Background
Both hyper- and hypo-glycaemia, as well as large glycaemic variability (GV) are associated with increased cardiovascular events in patients with type 2 diabetes mellitus (T2DM); possible contributing mechanisms of the increased cardiovascular risk include endothelial dysfunction and cardiac sympatho-vagal imbalance. Recent studies suggest that continuous subcutaneous insulin infusion (CSII) improves glycaemic control compared to multiple daily insulin injections (MDI).

Purpose
In this study, we assessed whether CSII may improve cardiac autonomic and vascular dilation function compared to MDI.

Methods
We enrolled in a small randomized pilot study consecutive T2DM patients without cardiovascular disease with poor glycaemic control, despite optimized MDI therapy. Patients were randomized to CSII (Group 1) or to continue MDI (Group 2); insulin dose was adjusted to achieve optimal glycaemic target ranges. Patients were studied at baseline and after 6 months by: 1) assessment of flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of the brachial artery; 2) heart rate variability (HRV) by 24-hour ECG Holter monitoring; 3) a 7-day continuous glucose monitoring (CGM) was performed at baseline and follow-up in 8 and 7 patients of Group 1 and 2, respectively.

Results
Overall, 21 patients were enrolled, 12 randomized to CSII and 9 to MDI. Daily insulin dose, glycated hemoglobin levels and CGM parameters did not differ significantly between the 2 groups, both at baseline and at follow-up. Both FMD (6.7±2.5 vs 4.6±2.0 %, p=0.51) and NMD (8.9±3.1 vs 7.0±3.0 %, p=0.18), as well as HRV parameters, showed no significant differences between the 2 groups at 6-month follow-up. No relation between GV and both peripheral dilator function and cardiac autonomic function was also detected.

Conclusions
In this small, randomized pilot study we show that, in T2DM patients, CSII achieves similar medium-term glycaemic control compared to MDI, without any significant adverse effect on the cardiovascular system.
Elevated remnant cholesterol in atherosclerotic cardiovascular disease in diabetes: a population-based prospective cohort study
Authors: Nilsson Wadstrom B , Monsted Pedersen K , Berg Wulff A , Gronne Nordestgaard B 
Published: November 2023

Abstract

Background
Elevated remnant cholesterol is observationally and causally associated with increased risk of atherosclerotic cardiovascular disease (ASCVD) in the general population; the association in individuals with diabetes is not known.

Purpose
We tested the hypothesis that elevated remnant cholesterol is associated with increased risk of peripheral artery disease, myocardial infarction, ischemic stroke, and any ASCVD in individuals with diabetes.

Methods
We studied 4,569 individuals with diabetes and 102,674 individuals without diabetes from the Copenhagen General Population Study (2003-2015). In those with diabetes, during up to 15 years of follow-up, 236 were diagnosed with peripheral artery disease, 234 with myocardial infarction, 226 with ischemic stroke, and 498 with any ASCVD in national Danish health registries. Remnant cholesterol was calculated from a standard lipid-profile as total cholesterol minus HDL cholesterol minus LDL cholesterol.

Results
Individuals with diabetes had higher levels of remnant cholesterol, but lower levels of LDL cholesterol, compared to individuals without diabetes (Figure 1). Statin use could explain the lower levels of LDL cholesterol but did not associate with levels of remnant cholesterol.
Multivariable adjusted hazard ratios (95% confidence interval) per doubling of remnant cholesterol and LDL cholesterol were 1.8 (1.2-2.5) and 0.9 (0.6-1.2) for peripheral artery disease, 1.8 (1.3-2.6) and 1.0 (0.7-1.4) for myocardial infarction, 1.6 (1.1-2.3) and 1.1 (0.8-1.6) for ischemic stroke, and 1.7 (1.4-2.2) and 0.9 (0.7-1.1) for any ASCVD, respectively.
Excess risk conferred by diabetes was 2.5-fold for peripheral artery disease, 1.6-fold for myocardial infarction, 1.4-fold for ischemic stroke, and 1.6-fold for any ASCVD. Elevated remnant cholesterol explained 14% (95% confidence interval: 6-23%) of excess risk of PAD; corresponding numbers were 26% (10-41%) for myocardial infarction, 34% (5-64%) for ischemic stroke, and 24% (12-36%) for any ASCVD (Figure 2). LDL cholesterol was lower in individuals with diabetes than in individuals without diabetes and could therefore not explain excess risk.

Conclusions
Elevated remnant cholesterol was associated with increased risk of ASCVD in individuals with diabetes and explained 24% of their excess risk of ASCVD. Clinical trials should determine if remnant cholesterol lowering can prevent ASCVD in individuals with diabetes.
Metabolic disorders predict future impairment of kidney function in the Japanese general population
Authors: Kin F , Takase H , Hayashi K , Nakano S , Isogaki T , Takayama S , Dohi Y 
Published: November 2023

Abstract

Background/Introduction
Metabolic syndrome (MetS) which is defined as accumulation of visceral fat followed by a cluster of metabolic disorders is one of the most important risk factors of cardiovascular morbidity and mortality. Although the close relationship between kidney dysfunction and cardiovascular events have also been reported, the association of kidney dysfunction with MetS remains unidentified.

Purpose
The present study investigated whether MetS or its components predict future deterioration of kidney function in the general population.

Methods
Consecutive 14917 subjects with normal estimated glomerular filtration rate (eGFR; ≥60mL/min/1.73m²) who visited our hospital for a physical check-up from 2008 to 2018 (male=8876, 51.3±12.4 year-old) were enrolled and followed up until 2019 for 1847 days (median) with the endpoint being the development of impaired kidney function (eGFR&lt;60mL/min/1.73m²). Metabolic syndrome was defined based on the Japanese diagnostic criteria (2005; waist circumference ≥85 cm for males and ≥90 cm for females and ≥2 of the following three criteria: (1) triglyceride≥150 mg/dL and/or high-density lipoprotein cholesterol &lt; 40 mg/dL; (2) systolic blood pressure≥130 mmHg and/or diastolic blood pressure ≥85 mmHg; and (3) fasting plasma glucose ≥110 mg/dL). Participants who had medication for each metabolic disorder were considered to meet each criterion.

Results
During the follow-up, 2150 subjects (25.9 per 1000 person-year) developed impaired kidney function. The incidence was more frequent in subjects with (39.3 per 1000 person-year) than without MetS (24.2 per 1000 person-year, p&lt;0.001). Moreover, each component of MetS showed a significant impact on the incident impaired kidney function (obesity 23.0 vs. 31.2, lipid 23.3 vs. 34.2, blood pressure 19.9 vs. 35.9, glucose 24.8 vs. 35.2 per 1000 person-year) and the incidence was increased with increasing the number of metabolic disorders in individuals at baseline (0, 1, 2 and ≥3 factor(s); 17.3, 26.9, 32.9 and 39.7 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of MetS for the new onset of impaired kidney function was 1.619 (1.447-1.810). In multivariate Cox hazard analysis adjusted for sex, age, pulse rate, serum creatinine, uric acid, hemoglobin, current smoking and frequent alcohol consumption, MetS was an independent predictor of the development of impaired kidney function (HR=1.312, 95%CI [1.167-1.475]). Similar results were obtained in sub-analysis using subjects without any medications (n=11963) (data not shown).

Conclusions
Metabolic syndrome and its components are important predictors for the development of impaired kidney function in the general population. Prediction of the deterioration of kidney function may lead to effective prevention of chronic kidney disease and relating cardiovascular disease.
Combined therapy with SGLT2i and GLP-1ra improves cardiovascular prognosis in a population with diabetes and overweigh or obesity. A real-world clinical practice study
Authors: Garcia Vega D , Cinza-Sanjurjo S , Gonzalez-Juanatey J R , Eiras S 
Published: November 2023

Abstract

Background
Prior clinical trials found diabetic patients treated with SGLT2i and/or GLP1ra had lower rates of cardiovascular complications.

Purpose
This study (CardioCHUS-T2D) sought to determine the association between initiation of SGLT2i, GLP1ra or both, and major cardiovascular complications or death in high risk diabetic patients.

Materials and methods
The CardioCHUS-T2D study was an observational study in which adults with type 2 diabetes, older than 65 years old and overweight or obesity were identified in a Galician health area. Patients prescribed an SGLT2i, GLP1ra or both over the last 5 years were matched base on antidiabetic treatment, duration of treatment, sex, age, diabetes duration, arterial hypertension, hyperlipidemia, CAD, HF, atrial fibrillation, CVA and peripheral artery disease (PAD) and were included on a regression Cox for determining the main variables associated with outcomes.
After score matching, we selected 5132 patients who were taking SGLT2i, GLP-1ra or both. The data records were obtained from shared electronic patient dossier (EPD). Patients were classified in 3 groups according antidiabetic drugs, SGLT2i or/and GLP-1ra. During follow-up, after treatment intake, the main outcomes were recorded (hospitalization for coronary artery disease (CAD), heart failure (HF) or cerebrovascular accident (CVA) events, overall and cardiovascular death.

Results
The main clinical characteristics of patients regarding antidiabetic treatment are represented on table 1. No clinical relevant differences were observed between the group of patients treated with any of the monotherapies (SGLT2i or GLP-1ra) and the patients treated with the combined therapy. During the period of observation, the group of patients receiving the combined therapy (SGLT2 + GLP-1ra) were associated with a significant reduction in the risk of suffering heart failure (HF) events (composite of HF hospitalization and HF-related death): HR: 0,651 (95%CI: 0,457-0,927; p=0,017), and all-cause mortality (HR: 0,602 (95%CI:0,443-0,817; p=0,001) (Figure 1) without significative differences in cerebrovascular events.

Conclusions
In a real-world practice observational study (CardioCHUS-T2D) combined therapy with SGLT2i + GLP1ra in patients with T2D older than 65 years with overweight or obesity was associated with a significative reduction in major cardiovascular complications.Clinical characteristics of patientsKaplan-Meier curves
Comparison of plaque characteristics among different age groups in patients with acute coronary syndromes with or without diabetes
Authors: Suzuki K , Niida T , Yuki H , Kinoshita D , Lee H , Mcnulty I , Takano M , Kakuta T , Mizuno K , Jang I 
Published: November 2023

Abstract

Background
It has been reported that young patients with diabetes mellitus (DM) had a higher mortality rate after myocardial infarction. However, plaque characteristics among different age groups in patients with acute coronary syndromes (ACS) with or without DM are unknown.

Purpose
The aim of this study was to investigate the plaque characteristics among different age groups in ACS patients with or without DM in a large population.

Methods
Patients who presented with ACS and underwent preintervention OCT imaging were included. The culprit plaque was categorized as plaque rupture (PR), plaque erosion (PE) or calcified plaque (CP), and stratified by 5 age groups. Features of plaque vulnerability were also analyzed.

Results
Among 1394 patients, 482 (34.6%) had DM. DM patients had a higher prevalence of lipid-rich plaque (71.2% vs. 64.8%, p=0.016), macrophage (72.0% vs. 62.6%, p&lt;0.001), and cholesterol crystal (27.6% vs. 19.7%, p&lt;0.001) than non-DM patients. Non-DM patients showed a significant ascending trend with age in PR (p=0.004), lipid-rich plaque (p=0.018), whereas DM patients had a high prevalence of these vulnerable features at early age, which plateaued across the different age groups. Both DM and non-DM groups showed a significant decreasing trend in PE with age (non-DM patients, p&lt;0.001; DM patients, p=0.020).

Conclusions
DM patients had a high prevalence of lipid-rich plaque and a high incidence of plaque rupture at early age. This pattern persisted across the different age groups.
Associations of built environment characteristic using NEWS questionnaires with major cardiovascular diseases and all-cause mortality
Authors: Li M , Li W 
Published: November 2023

Abstract

Background
The WHO of 2016 reports that cardiovascular diseases (CVDs) represent the leading cause of death in most countries and China has one of the highest prevalence of CVDs[1-2]. In order to reduce the burden of CVD risk factors, environmental interventions have become increasingly recognized as necessary approaches to health promotion and diseases prevention[3]. Pervious evidence mainly from the western countries, examined the effects of built environment on health (i.e. physical activity, mental health, self-reported health scale and CVD risk factors) , while the potential impact on CVDs has not been fully explored[4]. Thus, the aim of this study is to evaluate the longitudinal relationships between perceived built environment attributes using neighborhood environment walkability scale (NEWS) questionnaire and the CVDs in Chinese adults, to explore the different between urban and rural areas, and to provide a logical foundation for both research and policy making.

Methods
PURE-China is a prospective cohort study, recruiting participants aged 35–70 years from 115 urban and rural communities in 12 provinces of China between 2005 and 2009[5]. Baseline including NEWS information was collected using standardized questionnaires. Participants without any NEWS data and with baseline CVDs were excluded. The primary outcome is the composite of major CVD events and all-cause mortality. The main exposure variables including land use mix-diversity, land use-access, streets connectivity, infrastructure for walking and cycling, aesthetics, safety from traffic, safety from crime, and community satisfaction. Cox frailty model with random intercepts to account for cluster were used to assess the association between total built environment score/ subscales score and the time to occurrence of events. Based and fully-adjusted model were estimated and presented as HR and 95%CI. Interactions and stratified subgroup analysis were also tested.

Results
A total of 32,534 PURE participants were included with averaged 51 years old and 59.9% females. During a median follow-up period of 11.7 years (IQR 9.4 – 12.2), we documented 3298 (10.2%) new CVD events and 1639 (5.1%) all cause deaths. Table 1 summarizes based models and adjusted models results. For composite outcomes, higher level of land use access (HR, 1.06; 95%CI, 1.01-1.11), aesthetics (HR, 1.07; 95%CI, 1.02-1.12), safety from crime (HR, 1.06; 95%CI, 1.01-1.10), community satisfaction (HR, 1.04; 95%CI, 1.00-1.09), combined BE metrics (HR, 1.05; 95%CI, 1.01-1.10) were associated with a lower risk of composite outcome in adjusted model. For major CVD events more statistically significant differences were observed.

Conclusions and Relevance
High level of specific BE characteristics were associated with lower risk of all-cause mortality and CVD in China. Our findings may guide policy makers on how to implement BE measures to easing the burden of CVDs and premature deaths.Table 1