bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive blood pressure lowering in older people with hypertension: a systematic review and meta-analysis
Authors: Ahmad F , Nguyen T 
Published: November 2023

Abstract

Background
Hypertension is a prevalent chronic disease associated with increased risk of ischaemic heart disease, stroke, and heart failure, especially in older people. Recommendations on blood pressure target in older patients are not consistent among guidelines. While most guidelines suggested the target of systolic blood pressure (SBP) &lt;140 mmHg or a more relaxing target of 150 mmHg in older people, several guidelines suggested a more intensive target of &lt;130 mmHg or &lt;120 mmHg.

Purpose
The objective of this study is to evaluate the benefits and adverse side effects of intensive blood pressure targets, defined as SBP &lt;130mmHg, compared to standard blood pressure targets, defined as SBP &lt;140mmHg, in older people with hypertension.

Methods
We performed a systematic review and meta-analysis of randomised controlled trials comparing intensive blood pressure targets (SBP &lt;130mmHg) with standard blood pressure targets in older people (aged≥60 years). Pooled odds ratios (ORs) and 95% Confidence Intervals (95%CI) were estimated using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The study outcomes include all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACE), acute coronary syndrome, stroke, heart failure, and adverse side effects including hypotension, syncope, falls and acute kidney injury.

Results
A total of 485 articles were identified, of these, 4 studies were included in this analysis. These 4 trials randomised 12,456 patients to either intensive blood pressure targets or standard blood pressure targets. Intensive blood target was defined as SBP &lt;120 mmHg in 2 trials, and as SBP &lt;130 mmHg in 2 trials. The meta-analysis showed that intensive blood pressure control was associated with reduced MACE (OR 0.69, 95%CI 0.58-0.83), acute coronary syndrome (OR 0.70, 95% CI 0.55-0.90), heart failure (OR 0.55, 95% CI 0.37-0.80), and stroke (OR 0.65, 95% CI 0.49-0.86). Similar trend was observed with all-cause mortality (OR 0.81, 95%CI 0.64-1.01) and cardiovascular mortality (OR 0.67, 95%CI 0.44-1.02), although not statistically significant. In terms of adverse effects, intensive blood pressure control was significantly associated with increased hypotension compared to standard blood pressure targets: OR 1.32 (95% CI 1.06-1.65, p=0.01). However, there was no significant difference in falls, syncope, or acute kidney injury between the two groups.

Conclusion
While the evidence base is limited, this analysis suggests that intensive blood pressure target may be a beneficial strategy in reducing the risk of cardiovascular events in the elderly population with hypertension. More studies are needed to evaluate the impact of this strategy on mortality and on the adverse side effects in older populations.Outcome: strokeOutcome: mortality
The risk of severe coronary artery disease in prediabetes among the hypertensions --UPPDATE STUDY
Authors: Bao L W , Yong L , Ying S H A N 
Published: November 2023

Abstract

Backgrounds and Objectives
Hypertension and type 2 diabetes (DM) have become the major public health problems around the world and the concurrence of both diseases leads to more than triple risks developing ASCVD. However, in addition to type 2 diabetes, the diagnosis and treatment of prediabetes (preDM) status acquires more attention in these years. Among these issues, the risks of severe coronary artery disease in prediabetes concurrent with hypertension remains unknown. We sought to evaluate the association of prediabetes and severe coronary artery disease in hypertensions and to propose treatment suggestions using UPPDATE study data.

Methods
The national cross-sectional study-UPPDATE comprised of 8548 eligible hypertension subjects from 36 cities in China during 2017 to 2019. After consent form assigned, all enrolled hypertensives would undergo a clinical survey and clinical assessment, patients were also required to provide biomedical reports within one-year from his/her visit to outpatient department. Patients with severe coronary stenosis was defined as more than 70% stenosis in more than one coronary artery and underwent percutaneous coronary intervention (PCI). Diagnosis of preDM was based on patients’ HA1bc level ranging from 5.7% to 6.4%. Stata 13.0 was used for statistical analysis.

Results
Among 8548 hypertensives, 20.38% were diagnosed with diabetes and treated on hypoglycemic therapy,19.2% with HA1bc recorded (1658) can be classified into preDM according to previous definition. 1.76% of 4268 patients who reported ASCVD history had PCI before and 1123 of them provide HA1bc data within one-year from visit. Compared with patients without diabetes, preDM(Odds ratio 6.27, p=0.09 (95%CI 0.81-52.82)) and DM(Odds ratio 5.72, p=0.12 (95%CI 0.62-51.14)) showed significant association with severe coronary artery disease with PCI treatment. 63% preDM and 73% DM patients were undergoing anti-lipid therapy (p&lt;0.05) and LDL-C level was 2.81±0.69mmol/L and 2.79±0.51mmol/L respectively (p=0.82). In multivariate regression analysis, systolic and diastolic blood pressure greater than 140mmHg and 80mmHg had higher risks of PCI treatment in preDM patients compared with the hypertensives without DM.

Conclusion
Compared with patients without diabetes, hypertension patients with preDM were associated with higher risks of severe coronary artery disease. Systolic and diastolic blood pressure should be controlled more strictly in preDM patients with hypertension to prevent severe coronary artery disease.
Cardiovascular and metabolic effects of MANP. a novel GC-A activator, in human hypertension with metabolic syndrome
Authors: Ma X , Mckie P , Iyer S , Scott C , Bailey K , Johnson B , Benike S , Chen H , Miller W , Cabassi A , Burnett J , Cannone V 
Published: November 2023

Abstract

Background/Introduction
Hypertension (HTN) and metabolic syndrome (MetS) are both leading risk factors for major cardiovascular diseases, which frequently coexist as a complicated cardiometabolic disorder. The cardiac hormone atrial natriuretic peptide (ANP) plays a key role in both blood pressure and metabolic regulation through activation of the guanylyl cyclase-A receptor (GC-A) and the second messenger 3’,5’ cyclic guanosine monophosphate (cGMP). Indeed, ANP decreases blood pressure, induces lipolysis by increasing plasma levels of non-esterified fatty acids (NEFA) and improves insulin-sensitivity. MANP is a new Mayo Clinic designed natriuretic peptide consisting of the native ANP with a 12-amino-acid C-terminus extension and its biological actions are mediated by the GC-A/cGMP pathway. MANP is less susceptible to neprilysin degradation and exert more sustained cGMP dependent biological actions than ANP.

Purpose
In a proof-of-principle human study, for the first time we aimed to determine the cardiovascular and metabolic properties of MANP, a novel ANP analog, in the clinical setting of HTN with MetS.

Methods
We conducted a double-blind, placebo-controlled trial in 22 patients (17 receiving MANP) with HTN and MetS involving single subcutaneous injection of MANP (2.5 µg/kg) or placebo (NCT03781739). Blood pressure (BP) and circulating cGMP were monitored for 24 hours post treatment. Circulating metabolic parameters including insulin, glucose, non-esterified fatty acids (NEFA) and insulin resistance (HOMA-IR) and insulin sensitivity (HOMA-IS) indexes were assessed for the first 4 hours post treatment.

Results
Compared to baseline, MANP increased plasma cGMP at 30 minutes (delta: 4.8 ± 2.0 pmol/mL, P = 0.02) and 1 hour (delta: 2.9 ± 1.3 pmol/mL, P = 0.03) post injection. At 6 hours, systolic BP decreased by 5.7 ± 2.9 mmHg (P = 0.06) in the MANP group, whereas no reduction in BP was observed in placebo group. Among the 17 subjects receiving MANP, lower baseline cGMP levels were associated with greater mean reductions in systolic BP (ρ = 0.66, P = 0.005). After MANP injection, glucose levels decreased at 2 (delta: -4.7 ± 2.1 mg/mL, P = 0.04) and 4 hours (delta: -13.1 ± 3.9 mg/mL, P = 0.003) compared to baseline while insulin levels remained stable. During the first 4 hours post injection, we also observed a trend of increase in insulin sensitivity index (HOMA2-IS) and decrease in insulin resistance index (HOMA2-IR) with MANP, both were opposite to the trends in placebo. At 1 hour post MANP administration, NEFA increased by 108.2 ± 37.4 µM compared to baseline (P = 0.01).

Conclusion(s)
Our findings support the favorable cardiovascular and metabolic actions of MANP as a potential therapeutic strategy for HTN with MetS.
The association of non-alcoholic fatty liver disease and advanced hepatic fibrosis with cardiovascular mortality in Taiwanese adults: a longitudinal cohort study
Authors: Wei X , Yu T , Bo Y , Ho K , Lao X 
Published: November 2023

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is prevalent in adults, and advanced hepatic fibrosis (AHF) occurs in the more progressive stage of NAFLD. Despite the known risk of cardiovascular diseases among NAFLD patients, the effect of NAFLD and AHF on cardiovascular mortality (CVM) in general populations remains understudied.

Purpose
This study aims to examine the association of NAFLD and AHF with CVM in a general population.

Methods
Participants were enrolled in the Taiwan MJ cohort and attended regular medical check-ups. We derived the death dates and causes up to 31 May 2019 from Taiwan Death Registry and linked them to participants by identity number. CVM included death from heart diseases, hypertension, or atherosclerosis defined by the International Classification of Diseases (ICD) codes (ICD 9: 390-414, 420-429, 440; ICD 10: I01-I02.0, I05-I25, I27, I30-I52, and I70). We excluded regular alcohol drinkers and participants with cardiovascular diseases, hepatitis, cirrhosis, or liver cancer at baseline. The fatty liver index (FLI) was calculated to identify participants with NAFLD, among whom the BARD score was estimated to determine AHF. Cox proportional hazards models with time-varying covariates were applied in the analysis. We also conducted a stratified analysis by sex and age subgroups.

Results
404,948 participants were recruited from 1997 to 2016 and followed until 31 May 2019, with a median follow-up duration of 15.1 (IQR: 10.1–19.5) years. There were 2,560 cardiovascular deaths, with an incidence of four deaths per 10,000 person-years. FLI was positively associated with CVM, with a hazard ratio (HR) of 1.301 (95%CI: 1.255–1.348) per standard deviation increase. We identified 41,807 participants with NAFLD (FLI≥60). NAFLD was related to a significantly higher risk of CVM [HR: 1.871 (95%CI: 1.688–2.073)]. Moreover, 17,274 participants with NAFLD developed AHF (BARD≥2). AHF elevated the risk of CVM among participants with NAFLD [HR: 1.388 (95%CI: 1.135–1.698)]. In stratified analysis, significant positive associations were observed in each sex or age subgroup. The CVM hazards of NAFLD were more pronounced in females (HR: 1.921) than in males (HR: 1.741) and higher in adults under 40 years of age at baseline (HR: 4.905) than in older adults (HR: 1.772). Similarly, AHF had a higher HR in females versus males (HR: 1.684 vs. 1.281) and a much higher HR in adults with a NAFLD onset age under 40 versus adults with older onset age (HR: 2.246 vs. 1.258).

Conclusions
NAFLD remarkably increases CVM in the general population across different sex and age groups. Among people with NAFLD, AHF aggravates the risk of CVM. These adverse effects are relatively prominent in females and adults under middle age.The forest plot of hazard ratios
Dietary fruits and vegetables and risk of cardiovascular diseases in elderly Chinese
Authors: Wang K , Chen Z L , Shen M Q , Chen P F , Xiao Y C , Fang Z F , Hu X Q , Tang J J , Liu Q M , Zhou S H 
Published: November 2023

Abstract

Background
Evidence regarding the potential effect of fruit and vegetable consumption on cardiovascular diseases (CVD) was limited and inconsistent among Asian people.

Purpose
We aimed to investigate the association between fruit and vegetable consumption and risk of CVD, including total CVD, hypertension, heart disease and stroke.

Methods
We followed 9,740 Chinese elderly population (≥65 years, mean baseline age: 88 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during a follow-up of 10 years (2008-2018). Dietary data were collected using a validated food frequency questionnaire. We examined the associations of fruit and vegetable consumption with risk of CVD using Cox proportional hazard models.

Results
During 37,366 person-years of follow-up, a total of 3,738 CVD cases were recorded. After adjusting for demographics, dietary, lifestyle, and economical social factors, higher intakes of total fruits and vegetables were associated with lower risk of CVD (comparing with extreme quintiles, hazard ratio (HR) and 95%CI: 0.84 (0.74, 0.95)). The inverse association was mainly driven by vegetable consumption (0.86 (0.77, 0.95)). Furthermore, the inverse association was stronger for risk of hypertension (0.84(0.72, 0.98)). These associations were consistent across age, sex, BMI, residence, exercise status, smoking, drinking and health status.

Conclusion
This study suggests that higher intakes of total fruits and vegetables are associated with lower risk of CVD among elderly Chinese people, supporting the current recommendations of increasing fruit and vegetable consumption as part of healthy diet for the prevention of CVD.
Lower cardiorespiratory fitness is associated with left atrial structural, functional and electrical remodelling in patients with symptomatic atrial fibrillation
Authors: Elliott A , Ariyaratnam J A , Mishima R S , Gallagher C , Kuklik P , Sanders P 
Published: November 2023

Abstract

Background
Preserved cardiorespiratory fitness (CRF) is associated with improved rhythm control in patients with symptomatic atrial fibrillation (AF). However, the pathophysiological features associated with low cardiorespiratory fitness are not well described.

Purpose
Evaluate the association between cardiorespiratory fitness and structural, functional and electroanatomical features of the left atrium (LA) amongst patients with symptomatic AF.

Methods
Consecutive patients with symptomatic paroxysmal or persistent AF undergoing AF ablation were recruited. CRF was assessed objectively by peak oxygen consumption (VO2peak) assessed during maximal cycle ergometry. Invasive assessment of LA remodelling involved direct assessment of resting LA pressures (LAP), LA stiffness during saline infusion and LA electrical function using high-density electroanatomical maps. Non-invasive assessment involved 2D transthoracic echocardiography at rest and during exercise. The association between VO2PEAK and atrial parameters were determined using multivariable linear regression models adjusted for age and sex.

Results
In total, 110 participants were recruited. Mean age was 63±11 and 74.5% of the cohort was male. In adjusted analyses, higher VO2PEAK was associated with lower mean LAP (p&lt;0.001) and invasively assessed LA stiffness (p=0.005). On non-invasive testing, VO2PEAK was positively associated with left atrial emptying fraction (LAEF) (p=0.001) and reservoir strain (p&lt;0.001) at rest. During exercise, VO2PEAK remained associated with LAEF (p&lt;0.001) and LA reservoir strain (p=0.007). Higher VO2peak was positively associated with LA bipolar voltages (p=0.035) but not LA conduction velocities (p=0.131) or LA fractionation (p=0.452)

Conclusions
In patients with symptomatic AF, lower cardiorespiratory fitness is independently associated with extensive LA remodelling involving impaired LA haemodynamics, increased LA stiffness, LA mechanical dysfunction and LA electrical remodeling.
Influence of Lp(a) and systemic inflammation on all-cause mortality in a primary prevention population: data from our clinic database
Authors: Cho L , Brennan D , Costa-Scharplatz M , Itani T , Nissen S 
Published: November 2023

Abstract

Background
Epidemiological, pathophysiological, and genetic studies have established Lp(a) as a causal risk factor for development of cardiovascular (CVD) and valvular heart disease. However, there is controversy about how inflammation can modulate Lp(a) risk and major adverse cardiovascular events. We aim to investigate the influence of elevated Lp(a) and systemic inflammation on all-cause mortality in a primary prevention setting.

Method
We analyzed data obtained from the Preventive Cardiology Information System (PreCis), a database of clinical and laboratory information on 8,136 primary prevention patients seen at our clinic preventive cardiology clinic between 1st Jan 1999-12th Dec 2018. Primary prevention was defined as having no history of coronary artery disease (CAD), coronary and peripheral arterial revascularization, nor atherosclerosis. Lp(a) ≥50 mg/dL was considered as clinically elevated. The association between Lp(a) and the demographic and clinical variables of interest was examined using the student’s t-test or Chi-squared test. All-cause mortality was assessed using Kaplan-Meier estimates, and adjusted Cox proportional hazards models. All statistical analyses were conducted using SAS version 9.4.

Result
In the overall primary prevention population (n=8,136), the median age was 54 years, with 56.9% women and 84.8% being Caucasian. In this cohort, 21% had hypertension, and 5.5% had diabetes. The median Lp(a) was 21 mg/dL (interquartile interval 7-57 mg/dL). Lp(a) was ≥50 mg/dL in 29% of the population. Of those with elevated Lp(a) (n=2,368), 1,751 (73.9%) patients had hsCRP drawn. In this group, 782 patients (44.7%) had hsCRP &lt;2 mg/L and 969 (55.3%) had hsCRP ≥2 mg/L. The all-cause mortality rate in individuals with elevated Lp(a) and hsCRP ≥2mg/L was 9.2% compared to 4.2% in those with elevated Lp(a) and hsCRP &lt;2mg/L. In a multivariable Cox proportional hazard regression model adjusted for age and gender, in patients with elevated Lp(a), hsCRP ≥2 mg/L was significantly associated with all-cause mortality (HR 2.35, 95% CI (1.57-3.53), p&gt;0.001) (Figure 1).

Conclusion
In a primary prevention population without established atherosclerosis, elevated Lp(a), increased systemic inflammation was associated with increased all-cause mortality. This finding supports the need for risk classification and targeted primary prevention management of higher risk patients with elevated Lp(a).
Predicting the death caused by cardiovascular and/or cerebrovascular disease within 7 years follow-up using machine learning models
Authors: Tsarapatsani K , Sakellarios A I , Tsakanikas V , Marz W , Trampisch H J , Rudolf H , Fotiadis D I 
Published: November 2023

Abstract

Background
Cardiovascular and cerebrovascular disorders, which are now the leading and second causes of death in the majority of the world's countries, affect human life and health. Moreover, the prediction of death caused by these is deemed necessary to prevent it and reduce its rate.

Purpose
We employ machine learning models for the prediction of cardiovascular and/or cerebrovascular death within 7 years follow-up using clinical and laboratory features.

Methods
We analyzed the dataset of German epidemiological trial on ankle brachial index (getABI) study, including 5,587 patients (mean age 71.14 years, 40.7 % male, 359 deceased patients and 5,228 alive patients). Recursive feature elimination with cross-validation selected 11 features from a set of 55 features: diabetes mellitus, ABI index before exercise, vitamin D, troponin I, triglycerides, potassium, LDL cholesterol, HDL cholesterol, the flow noise of the right and left carotid artery and the pulse status of the right popliteal artery. Additionally, the handling of missing values was achieved by SimpleImputer. Random Forest (RF), Adaptive Boosting (AdaBoost), LightGBM classifiers were applied to predict death and were trained and tested using 5-fold cross-validation. Moreover, GridSearchCV tuned the hyperparameters of the models.

Results
LightGBM was the most accurate model, achieving 87.56 % mean balanced accuracy and 90.63 % mean value of the area under (AUC) the Receiver Operating Characteristic Curve (ROC). The mean ROC-AUC value of the RF, and AdaBoost were equal to 87.25 % and 89.52 %, respectively. Τhe mean ROC-AUC value, its standard deviation and the mean balanced accuracy of the models are presented in Figure 1. Moreover, Figure 2 indicates the ROC-AUC values for each k-fold and the mean value of them which achieved by the best classifier, the LightGBM.

Conclusion
Machine learning models achieved accurate prediction of cardiovascular and cerebrovascular death in 5,587 patients within 7 years follow-up utilizing basic medical data.
Genetic risk score and epicardial adipose tissue: the new tools with impact on cardiovascular risk assessment
Authors: Temtem M , Mendonca M I , Sousa J A , Serrao M , Santos M , Sa D , Sousa F , Henriques E , Rodrigues M , Freitas S , Borges S , Guerra G , Drumond A , Sousa A C , Palma Dos Reis R 
Published: November 2023

Abstract

Background
Cardiovascular disease (CVD) remains the leading cause of death worldwide. One of its main contributors is coronary artery disease (CAD), a complex multifactorial disease influenced by hereditary and environmental factors. A better cardiovascular risk assessment is a real challenge in our daily clinical practice. Evidence points to high Epicardial Adipose Tissue (EAT) volume as an essential player in the pathophysiology of CAD. On the other hand, genetic predisposition to CAD remains crucial to improve cardiovascular risk assessment and treatment. It is unknown whether the association between these two risk markers improved the ability to predict CV events.

Objective
Evaluate whether a high EAT volume added to a Genetic Risk Score (GRS) improves the predictive ability to discriminate CV events in an asymptomatic population without known CVD.

Methods
A prospective cohort was performed with 1024 participants (mean age 51.6±8.2 years, 75.6% male) selected from controls of the GENEMACOR Study. The GRS was created from 33 genetic variants associated with CAD by GWAS, choosing those with a hazard ratio (HR) higher than 1. EAT volume was measured with a quantitative semi-automated procedure using a postprocessing workstation-TeraRecon Aquarius Workstation (version 4.4.7, TeraRecon, Inc., San Mateo, CA, USA). We evaluated the discriminative ability of the GRS model without (model 1) and with EAT volume (model 2) using the Harrel C statistics. Categorical free Net Reclassification Improvement (cfNRI) and Integrated Discrimination Index (IDI) reclassified patients.

Results
Cox regression analysis showed that GRS and EAT remained in the equation with an HR of 1.140 (p=0.002) and HR of 1.221 (p=0.002), respectively. C-statistic demonstrated that the predictive value for MACE was 0.588 (95%CI 0.445-0.731) for GRS and increased to 0.689 (95%CI 0.577-0.801) when EAT volume was added to GRS, showing a better discrimination capacity for MACE. The difference between the two C indexes was significant (p=0.003). CfNRI reclassified 58.9% of the population (p=0.001), and IDI improved the discrimination when EAT was included in the GRS model (IDI=0.012; p=0.015).

Conclusion
Our results displayed that the GRS associated with a high EAT volume increased the discriminative ability to predict MACE occurrence. Improving the identification of high-risk patients at a subclinical stage could avoid atherosclerosis progression and events occurrence through more rigorous and earlier preventive and even therapeutic measures.