bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthy vascular ageing protects community dwelling elderly from all-cause mortality: 5-year evidence from the North Shanghai Study
Authors: Ren Z , Jia R N , Zhang Y , Xu Y W 
Published: November 2023

Abstract

Background
Healthy vascular ageing (HVA) defined by normal pulse wave velocity (PWV) has been recognized as a valuable indicator of vascular status. And HVA strongly correlates with preclinical targeted organ damage (TOD). While the long-term benefit of HVA remains to be investigated.

Aims
To investigate the long-term outcome of population with HVA based on large registered North Shanghai Study.

Methods
Since Jun. 2014, 3363 community-dwelling elderly Chinese (age ≥65 years) were enrolled in the Northern Shanghai Study. HVA was defined as normal carotid femoral PWV that stratified by age and blood pressure. TOD was measured and categorized as vascular TOD indicated by carotid-femoral PWV and ankle-brachial index, cardiac TOD indicated by left ventricular hypertrophy and diastolic dysfunction, and renal TOD indicated by estimated glomerular filtration rate and urinary albumin/creatinine ratio. Follow-up outcome including all-cause mortality, cardiovascular and non-cardiovascular mortalities were evaluated.

Results
1016 participants (30.2%) with HVA were identified. Compared with non-HVA group, although no gender difference, HVA group had younger age, lower blood pressure, lower body mass index (BMI), and milder TODs. Through a follow-up period of 5.7±1.8 years, 233 (6.9%) all-cause deaths, including 94 (2.8%) cardiovascular deaths were observed. Participants with HVA showed significantly higher survival from all-cause deaths (Log-rank P=0.002) and cardiovascular deaths (Log-rank P=0.003), but statistically non-significant survival from non-cardiovascular deaths (Log-rank P=0.098).Subgroup analysis showed that HVA was a significant protective factor in female (HR 0.412 (0.245, 0.692), P=0.002), participants aged 65-70 (HR 0.417 (0.194, 0.897), P=0.025), participants with BMI&lt;25 (0.570 (0.386, 0.842) P=0.005), and participants with at least 1 TOD (HR 0.634 (0.444, 0.907), P=0.013). Moreover, the protective value of HVA was only significant in participants without cardiac TOD (0.681, (0.464, 0.998), P=0.049), participants with renal TOD (0.547, (0.354, 0.844), P=0.006), and participants with vascular TOD (0.461 (0.251, 0.848), P=0.013).

Conclusion
In community-dwelling elderly, HVA could be a significant protective factor for all-cause deaths, especially in subpopulation of female, age 65-70, BMI&lt;25 and with renal and/or vascular TOD.
Effect of hypertensive response to exercise on aortic diameters
Authors: Van Der Stouwe J G , Schmied C M , Niederseer D 
Published: November 2023

Abstract

Background
The diameters of the sinus of Valsalva as well as the ascending aorta are related to age, sex, and body size. There are conflicting data regarding the effect of arterial hypertension and a scarcity of data on the effect of a hypertensive response to exercise on aortic diameters.

Purpose
In this prospective cohort study, we aimed to evaluate the relationship between the growth rates of the sinus of Valsalva and ascending aorta in individuals with a hypertensive response to exercise.

Methods
Our analysis included follow-up data of 649 patients from our cohort study. Participants with known connective tissue disease were excluded. Sinus of Valsalva and ascending aorta diameters were measured by transthoracic echocardiography using leading edge to leading edge convention at end-diastole. Maximum systolic and diastolic blood pressure response to exercise was measured during a standardized exercise test.

Results
At baseline, median age, max. systolic BP, BMI, diameter of the sinus of Valsalva, and diameter of the ascending aorta were 62 years, 208 mmHg, 26.9 kg/m2, 35mm, and 35mm respectively. 32% of patients were female and 67% had known arterial hypertension. After a median follow-up of 7.1 years, mean growth rate of the sinus of Valsalva and ascending aorta were 0.09 mm and 0.13 mm per year respectively. In univariate and multivariable regression models, there was a small but significant association between baseline aortic diameters and max. systolic BP, as shown in the Table 1. No significant associations were observed between growth rate of aortic diameters and max. systolic BP, as shown in the Table 2. Similar findings were obtained for max. diastolic BP and when considering only individuals with a baseline diameter ≥ 40mm.

Conclusion
In this large prospective cohort study, there was a small inverse relationship between max. systolic BP during exercise and baseline aortic diameters. However, max. systolic BP during exercise showed no influence on growth rates of aortic diameters. Furthermore, the mean growth rates of aortic diameters per year in this population were in line with growth rates in a normal population.Table 1.Table 2
Ten year follow-up study regarding treatment compliance and cardiovascular events in young first diagnosed and never treated hypertensives of a European Society of Hypertension Excellence Center
Authors: Triantafyllidi H , Benas D , Sioula K , Fambri A , Birmpa D , Ikonomidis I 
Published: November 2023

Abstract

Background
Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Treatment is based on the estimation of CV risk in each hypertensive patient. The compliance of each individual hypertensive in proposed life style changes and medical treatment is paramount. We aimed to investigate the compliance in medical treatment and we set as primary endpoint of the study the incidence of any CV events [CV death, acute myocardial infarction (AMI), stroke] and all-cause death of a cohort of young first diagnosed and never treated hypertensives of a European Society of Hypertension (ESH) Excellence Center.
Population and Methods: We studied 220 young, non-diabetic (&lt;50 years old) first diagnosed and never treated hypertensive patients (42+7 years, 70% males, 41% smokers, BMI=29+5, 24-h ambulatory blood pressure monitoring (ABPM) =142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had &gt;1 HMOD) visiting our ESH Excellence Center (2004-2021). All patients were apparently healthy with no co-morbidities. In each patient, the presence of hypertension mediated organ damage (HMOD) was evaluated at baseline (aortic stiffness, left ventricular hypertrophy, coronary flow reserve, diastolic dysfunction. The cohort was re-evaluated at 10+4 years post-medical treatment initiation regarding compliance as well as the primary endpoint of the study.

Results
191/220 (87%) young hypertensives (at baseline, 42+7 years, 70% males, 40% smokers, BMI=29.5, 24-h ABPM=142+10/91+9 mmHg, LDL=133+36 mg/dl, 49% had&gt;1 HMOD) participated in the follow-up study while 29 (13%) patients were lost. We found that 17/191 (9%) quit medical treatment. Home or office BP was confirmed as controlled (&lt;140/90 mmHg) in 151/191 (79%) patients. Regarding CV events, 7/191 (4%) hypertensive patients (at baseline, 44+4 years, 86% males, 71% smokers, BMI= 30+4, 24-h ABPM=142+12/89+10 mmHg, LDL=175+33 mg/dl, 87% had&gt;1 HMOD) had an acute myocardial infarction (AMI) at 6+4 years post-treatment initiation while 1/191 (0.5%) patient died due to lung cancer. Hypertensive patients with CV events differed regarding increased LDL levels at baseline (168+35 vs.131+36, p=0.007), more smokers (p=0.04) and HMOD &gt;1 (p=0.02) compared to the rest of the young hypertensive population.

Conclusions
Compliance regarding medical treatment was sustained in 9/10 young hypertensive patients during the 10-year follow-up. Just 4% of the population, smokers with increased LDL and HMOD&gt;1, suffered an AMI despite compliance in medical antihypertensive treatment. Subsequently, treating AH in young people needs both life style changes (quit smoking) and medical treatment (hypertension plus hyperlipidemia) in order to prevent future CV events.CV events in young hypertensives
High-normal systolic blood pressure in early midlife is a stronger risk factor for incident hypertension later in life for women than men
Authors: Ohldieck A E , Kringeland E K , Midtboe H B M , Gerdts E G 
Published: November 2023

Abstract

Background
We have previously found that having high-normal blood pressure (BP) in early midlife is a stronger risk factor for incident hypertension later in life for women than for men. Whether this risk is related both to high-normal systolic and diastolic BP is not known.

Purpose
To explore whether there is a sex difference in risk of incident hypertension related to high-normal systolic and diastolic BP in early midlife.

Methods
In the community-based Hordaland Health Study, 1025 women and 703 men were examined at age 42 years (baseline) and re-examined after 26 years. Patients with hypertension at baseline were excluded. Attended BP was measured in triplets, and clinic BP taken as the average of the two last measurements. High-normal systolic BP was identified as systolic BP of 130-139 mmHg and high normal diastolic BP as diastolic BP 85-89 mmHg. Incident hypertension was identified as BP ≥140/90 mmHg or patient reported use of antihypertensive drugs on the follow-up visit. The associations of systolic and diastolic BP at baseline with incident hypertension at follow-up were explored in sex specific multivariable logistic regression analyses. Multivariable analysis looking at high-normal diastolic BP was adjusted for baseline BMI, systolic BP, high-normal diastolic BP , heart rate, physical activity, daily smoker, cholesterol, triglycerides. Multivariable analysis looking at high-normal systolic BP was adjusted for baseline BMI, diastolic BP, high normal systolic BP , heart rate, physical activity, daily smoker, cholesterol, triglyceride. Results are presented as odds ratios (OR), 95% confidence intervals (CI) and p-values.

Results
At baseline, average BP was 119/73 mmHg in women and 126/76 mmHg in men (p&lt;0.001). A high-normal systolic BP was found in 16% of women and 35% of men (p&lt; 0.001). A high-normal diastolic BP was found in 7% of women and 11% of men(p=0.008). After 26 years of follow-up, 39% of women and 45% of men had developed hypertension (p&lt;0.05). In multivariable logistic regression analyses, high-normal systolic and diastolic BP at baseline predicted incident hypertension at follow up in both sexes (Table 1). High-normal systolic BP was a significantly stronger predictor for incident hypertension in women (OR 2.32, CI 1.5-3.5) with p&lt;0.01 for sex interaction (Table 1). In men, high-normal diastolic BP at baseline, was the strongest predictor of incident hypertension (OR 2.1, 95% CI 1.2-3.7), but no sex-interaction was found for high-normal diastolic BP, possibly due to low numbers.

Conclusions
Having a high-normal systolic BP in early midlife is a greater risk for developing hypertension later in life for women than men.Table 1
Aspirin overuse in primary prevention: nationwide temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in adults with and without diabetes
Authors: Kristensen A M D , Pareek M , Kragholm K , Torp-Pedersen C , Mcevoy J W , Prescott E 
Published: November 2023

Abstract

Background
Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial. European Society of Cardiology guideline recommendations have changed in the last decades, and aspirin is currently not recommended in individuals with low/moderate cardiovascular (CV) risk but may be considered in high-risk individuals with diabetes.

Purpose
We report temporal trends in primary prevention aspirin prescription among individuals with and without diabetes and describe characteristics of incident aspirin users.

Methods
Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population ≥40 years without CVD, eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin use with and without diabetes were assessed, as were CV risk factors among incident users. Individuals in Denmark are primarily seen by general practitioners who have a gate-keeper function for secondary hospital-based care.

Results
A total of 522,680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39,803 individuals, 1.78% of the eligible population) and was lowest in 2019 (11,898 individuals, 0.49%), with similar trends for subjects with and without diabetes (Figure 1). A large proportion of incident users had no CV risk factors (diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease [a proxy for smoking]); however, this proportion decreased from 53.9% in 2000 to 30.9% in 2020 (Figure 2). The number of prevalent aspirin users peaked at 7.7% in 2008 and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% and decreased to 17.1% in 2020.

Conclusion
Prescription of aspirin for primary prevention of CVD has decreased over the last two decades in individuals both with and without diabetes. However, aspirin appears to be inappropriately prescribed in many primary prevention adults as a large proportion of incident users had no CV risk factors. Efforts to inform appropriate prescription of aspirin are needed, e.g., by improved guidance for general practitioners.Figure 1Figure 2
The risk of cardiovascular disease or death among a healthy population with mildly reduced and preserved left ventricular ejection fraction
Authors: Sintov G , Peles I , Novak L , Abayev M , Shmueli H , Kobal S L 
Published: November 2023

Abstract

Aims
We investigated the relationship between mildly reduced and preserved left ventricular ejection fraction (LVEF) and cardiovascular morbidity and all-cause mortality, in a healthy community-based cohort.

Methods and results
A total of 20,385 echocardiograms of healthy individuals with LVEF≥45%, were collected at a tertiary university medical center, between 2002-2015. Participants were divided into three groups: 209 with mildly reduced (45-50%), 1,709 with preserved (50-55%), and 18,467 with normal (&gt;55%) LVEF. Based on data from electronic medical records and multiple Cox regression analyses, we examined all-cause mortality (primary outcome) and major adverse cardiovascular events (MACE) which included: stable ischemic heart disease, acute coronary syndrome, heart failure, percutaneous coronary intervention, coronary artery bypass graft, and stroke (secondary outcome). The mean follow-up period was 7±4 years. Mean age was 33±10 years, 52.6% were females. Prevalence of death and MACE was 2.9% and 31% for mildly reduced LVEF, 1.8% and 10% for preserved LVEF, and 0.7% and 7.4% for normal LVEF, respectively. In multivariable-adjusted analyses, mildly reduced LVEF was related to increased risk of death [hazard ratio (HR) 3.58; 95% confidence interval (CI) 1.55-8.28] and MACE [HR 4.31; 95% CI 3.21- 5.79], followed by preserved LVEF ([HR 2.38; 95% CI 1.57-3.62] and [HR 1.36; 95% CI 1.14-1.61] for death and MACE, respectively), compared to normal LVEF.

Conclusion
In a healthy adult population, mildly reduced and preserved LVEF are associated with gradually higher all-cause mortality and cardiovascular morbidity, compared to normal LVEF. These results suggest that LVEF should be used as a novel parameter in cardiovascular disease prediction algorithms to reduce the prevalence of cardiovascular morbidity and mortality.
Coronary artery calcium score is a predictive tool for cardiovascular events in an asymptomatic population
Authors: Sousa F , Mendonca M I , Temtem M , Serrao M , Santos M , Sa D , Borges S , Freitas S , Henriques E , Rodrigues M , Drumond A , Sousa A C , Palma Dos Reis R 
Published: November 2023

Abstract

Background
Recent research highlights the role of the coronary artery calcium score (CAC Score) in evaluating the severity of subclinical atherosclerosis in asymptomatic individuals without apparent cardiovascular disease (CVD). However, the influence of the CAC score on the prognosis of an asymptomatic population is not consensual.

Objective
Investigate the role of the CAC score as a predictive tool for the occurrence of cardiovascular events in an asymptomatic population without known CVD.

Methods
1195 asymptomatic subjects (mean age 55.1±6.9 years, 73.8% male) selected from the prospective arm of the GENEMACOR study were followed up during 5.9±4.3 years. CAC score was performed by cardiac computed tomography and reported as Agatston units according to the Hoff Nomogram in low, moderate and high-risk categories. The bivariate analysis evaluated CV events in the three CAC score risk categories and in traditional risk factors (TRFs) individually. Multivariable Cox proportional hazard ratios (HR) with 95% conﬁdence intervals (95% CI) assessed the variables independently associated with CV events occurrence. Kaplan-Meier estimated the survival in the CAC risk categories.

Results
None of the TRFs showed significant differences in the CV events percentages. As the CAC score category increases, the percentage of CV events rises (p&lt;0.0001). After Cox regression analysis, the high CAC risk category remained a strong CV events predictor (HR=3.71; 95% CI 1.66-8.27; p=0.001), along with age and smoking (Table). At fifteen years of follow-up, 95.3%, 92.8%, and 84.3% survived in the low, moderate and high-risk categories, respectively (Long Rank test; p&lt;0.0001).

Conclusion
The presence of coronary calcifications indicated a worse prognosis in our asymptomatic population. CAC score is an excellent predictive tool for the asymptomatic subjects with coronary atherosclerosis in progression and could help initiate preventive therapy.
The concentration of small-diameter HDL particles (HDLp1) predicts the incidence of coronary calcium score in diabetic subjects without established cardiovascular disease
Authors: Carvalho L S F , Teles S B S , Bittencourt M S , Santos R D , Blaha M , Jones S , Toth P , Lotufo P , Bensenor I , Ramalho S H 
Published: November 2023

Abstract

Introduction
Type 2 diabetes (DM2) decisively influences the evolution of coronary atherosclerosis. However, this is a heterogeneous and poorly understood process. While in 50% of diabetics the chance of incident Coronary Calcium Score (CAC) in 5 years exceeds 40%, in 10% of diabetics the chance of incident CAC is less than 10%. To better understand the progression of coronary atherosclerosis measured by CAC in diabetics without cardiovascular disease, we studied the impact of the concentration of the small-diameter subfraction of HDL (HDLp1, 7 to 8nm). HDLp1 has been implicated as a central mediator of the anti-inflammatory effect of the HDL pool and could play a specific role in CAC incidence among diabetics.

Methods
From 2370 individual with two CAC evaluations and hydrogen spectroscopy/magnetic resonance (H1-NMR) plasma profile available, we found 461 diabetic individuals, non-users of statins, without previous cardiovascular disease, with CAC=0 in the first measurement and a second CAC measurement after an average period of 5 years. [HDLp1] concentration was measured by H1-NMR and divided into tertiles. The incidence of CAC was defined as an initial CAC of 0 followed by CAC&gt;0 in the second measurement. Stepwise forward logistic regressions were used to identify risk factors for CAC incidence. Discrimination analysis was performed by calculating the area under the ROC curve (AUROC).

Results
A total of 143 (31.0%) patients had incident CAC. In stepwise logistic regression, alongside factors such as age, gender, systolic blood pressure, smoking, LDL-C, C-reactive protein and HbA1c, the 3rd tertile of [HDLp1] was associated with 55.2% (95% CI 15-110%, p =0.0039) and 140% (95% CI 32-341%, p&lt;0.001) higher risk of CAC incidence compared to the 2nd tertile and 1st tertile, respectively. When compared to a model composed of 10 confounding variables (age, gender, systolic blood pressure, BMI, smoking, Lp(a), LDL-C,triglycerides, C-reactive protein and HbA1c) for predicting the incidence of CAC, the diameter of HDLp1 substantially increased the AUROC from 0.651 (95% CI 0.597-0.705) to 0.684 (95% CI 0.631–0.736), p=0.027 for the DeLong test comparing AUROCs. A restricted cubic spline demonstrated a strong association between [HDLp1] and CAC incidence.

Conclusion
The concentration of HDLp1 improves the predictive capacity for the incidence of CAC in diabetic individuals, non-users of statins, without cardiovascular disease.Spline HDLp1 concentration vs CAC incideROC for incident CAC
Lower income is associated with non-persistence to statin treatment after a first myocardial infarction
Authors: Ma K , Ohm J , Yip Lundstrom L , Yari A , Jernberg T , Svensson P 
Published: November 2023

Abstract

Introduction
Low socioeconomic status (SES), characterized by low education level and/or income, is associated with increased incidence and mortality in cardiovascular diseases (CVD) and recurrent atherosclerotic cardiovascular diseases (rASCVD) even in countries with universal healthcare. Treatment with statins is a cornerstone in the secondary prevention after myocardial infarction (MI) that reduces the risk for rASCVD and mortality. Mechanisms for how SES affects outcome post-MI are largely unknown.

Aim
The aim of this study was to investigate the association between low SES and non-persistence to statin treatment in the stable phase after a MI as a potential mediator for poorer outcome in those with low SES.

Methods
Nationwide Swedeheart registry-based cohort study on 63,900, 18–80-year-old survivors of a first MI (15,792 women) between 2006-2020 that participated in the follow-up after MI and claimed a statin-prescription (ATC-code C10AA) ≤120 days after the one-year revisit. Patients with previous history of CVD including stroke were excluded. Primary exposure was disposable income the year before MI divided into quintiles, stratified by income year and sex. Education level in three categories was investigated as a secondary exposure. The outcome was defined as time to first non-persistence to statin therapy where non-persistence was defined as a period over 180 days without expediting a new prescription. Hazard ratios (HR) with 95% CI were calculated for associations between income-quintile and non-persistence using Cox-regression adjusted for confounders (sex, age, inclusion-year, region of birth).

Results
During a median (IQR) follow-up on 7.47 years (3.7-11.2), 29,922 (46.8%) patients became non-persistent to statin treatment. An association between lower income and non-persistence was observed with a gradually increased risk for non-persistence in the lower income quintiles (table 1 and figure 1). The hazard ratio for non-persistence in the lowest compared to the highest income quintile was 1.29 (95% CI 1.24-1.34). The risk for non-persistence associated with low income remained significant after adjusting for confounders, including region of birth, where the risk for non-persistence in the lowest compared to the highest quintile was 1.17 (95% 1.13-1.22). Education was not associated with non-persistence.

Conclusions
In a nationwide post-MI population with access to universal healthcare, a strong association between income and non-persistence to statins was observed. Non-persistence to statins may be an important mediator for the increased risk for recurrent cardiovascular events after MI in patients with lower income.