bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social, behavioral, and metabolic risk factors for racial disparities in cardiovascular disease mortality in US adults
Authors: He J , Bundy J D , Geng S , Tian L , He H , Mills K T , Chen J I N G 
Published: November 2023

Abstract

Background
Cardiovascular disease (CVD) mortality is persistently higher in the Black population than in other race and ethnicity groups in the US.

Purpose
To determine whether social, behavioral, and metabolic risk factors mediate racial disparities in CVD mortality and to assess the contribution of these risk factors to CVD mortality in the US general population.

Methods
A nationally representative sample of 50,808 individuals aged ≥20 years from National Health and Nutrition Examination Surveys (NHANES) 1999-2018 were included in the analysis. Data on social, behavioral, and metabolic factors were collected in each NHANES survey using standard methods. CVD deaths were ascertained from linkage to the National Death Index with follow-up through 2019.

Results
Over an average of 9.4 years of follow-up, 2,598 CVD deaths were confirmed. In a multivariable Cox regression model stratified by NHANES cycle and adjusted for age, sex, race, and social, behavioral, and metabolic risk factors simultaneously, individuals who were unemployed, had a lower family income, did not own a home, were not married nor living with a partner, were current smokers, reported no leisure-time physical activity, slept &lt;6 or &gt;8 hours/day, had obesity, hypertension, or diabetes, or had an albumin-to-creatinine ratio ≥30 mg/g or estimated-glomerular filtration rate &lt;60 ml/min/1.73 m2 were at significantly higher risk for CVD mortality. After adjusting for these risk factors, hazard ratios (95% CI) of CVD mortality for Black individuals compared to White individuals decreased from 1.54 (1.34-1.77) to 0.86 (0.75-1.00). Social risk factors explained 72.9% Black-White differences in CVD mortality in a multivariable mediation analysis. The population attributable fractions (95% CI) for the top five risk factors for CVD mortality were 12.5% (5.6-19.3%) for hypertension, 10.6% (6.9-14.3%) for albuminuria, 9.4% (5.3-13.6) for physical inactivity, 9.1% (4.6-13.7%) for family income-to-poverty ratio &lt;300%, and 7.2% (4.5-9.9%) for estimated-glomerular filtration rate &lt;60 ml/min/1.73 m2 in the US general population.

Conclusion
Social, behavioral, and metabolic risk factors fully explained the Black-White difference in CVD mortality. Hypertension, albuminuria, physical inactivity, low family income, and reduced kidney function are leading risk factors for CVD mortality in the US population.
Kidney function and future risk of atherosclerotic cardiovascular disease: a study from, approximately half million adults
Authors: Rana J , Liu J , Moffet H , Gulati M , Virani S , Karter A , Sidney S 
Published: November 2023

Abstract

Background
Data are lacking regarding contribution of kidney function towards atherosclerotic cardiovascular diseases (ASCVD) in young to middle aged adults.

Purpose
To evaluate the impact of kidney function on future risk of ASCVD in a large, young contemporary population without prior ASCVD.

Methods
This observational cohort study included young to middle aged adults (ages 30-55 years) without established ASCVD (as of January 1, 2006) who were members of an integrated healthcare delivery system in Northern California. Adjusted multivariate models (age, sex, race, diabetes, hypertension, HDL-C, LDL-C, total cholesterol, smoking, albuminuria) were specified to estimate risk ratios (RRs) for incident ASCVD events by kidney function (eGFR mL/min/1.732). Incident ASCVD events were defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through December 31, 2020.

Results
A total of 426,735 individuals met the selection criteria. Mean age was 45.4 (±7.0) years. Fifty-five percent were women, and the median follow-up was 12.7 (IQR=11) years. In fully adjusted models, risk of future ASCVD, compared to patients with eGFR ≥ 60 was 1.7 (95% CI 1.5-1.9) for eGFR 30-59 RR and RR of 2.2 (95% CI 1.8- 2.7) for eGFR &lt; 30. The kidney function-ASCVD associations were similar by sex for eGFR 30-59, but risks were accentuated among women with eGFR&lt;30 (figure).

Conclusions
There was increased risk of future ASCVD with worsening kidney function. This risk was more pronounced among women. Using eGFR as part of risk assessment can inform targeting early interventions to prevent both kidney disease and subsequent ASCVD, especially in the era where effective pharmacotherapy such as SGLT2-Inhibitors have demonstrated renal and cardioprotective effects in high-risk populations.
Genetic risk, modifiable risk factors, and atrial fibrillation in the Danish diet, cancer, and health cohort
Authors: Frederiksen T C , Christiansen M K , Benjamin E J , Overvad K , Olsen A , Grarup N , Andersen M K , Hansen T , Jensen H K , Dahm C C 
Published: November 2023

Abstract

Background
The etiology of AF is multifactorial. Genetic susceptibility and lifestyle contribute to atrial fibrillation (AF) risk.(1,2) However, the relationship between combined genetic predisposition and lifestyle risk factors on AF risk is unclear.

Purpose
We aimed to assess a possible interaction between modifiable risk factors and genetics on AF risk.

Methods
We included AF cases and a randomly drawn subcohort of 4,040 participants from the Danish Diet, Cancer, and Health study. Modifiable risk factors were assessed including smoking, body mass index, physical activity, diet, alcohol consumption, total cholesterol, and blood pressure. Based on cumulation of risk factors, a risk factor profile was determined for all participants and categorized as poor, intermediate, and ideal. Based on DNA sequence polymorphisms, we calculated a genetic risk score for AF, and categorized participants as having a low (quintile 1), intermediate (quintile 2-4) or high (quintile 5) genetic risk. Diagnoses of AF and/or atrial flutter were obtained from the Danish National Patient Register. We used weighted Cox proportional hazards regression to assess hazard ratios of AF.

Results
3,094 AF cases occurred during a median follow-up of 12.9 years. Median age at baseline in the subcohort was 55 years (25th-75th percentile 52-60) and 2,092 (55%) were women. Participants at intermediate and high genetic risk had higher rates of AF compared with those at low genetic risk. Likewise, intermediate, and poor risk factor profiles were associated with higher rates of AF compared with those having ideal risk factor profiles. Weighted cumulative incidence proportions and hazard ratios of AF according to genetic risk and modifiable risk factors are shown in Figure 1. Within each category of genetic risk, incidence rates per 1,000 person-years were gradually higher with worse modifiable risk factor profiles. (Figure 2). For participants with high genetic risk, the incidence rates of AF per 1,000 person years were 5.0 (95% CI 3.4-7.3) for ideal, 6.6 (95% CI 5.4-8.1) for intermediate, and 10.4 (95% CI 9.2-11.8) for poor risk factor profiles. On an additive scale, there was a statistically significant interaction between genetic risk and modifiable risk factors (relative excess risk due to interaction=0.86 (95% 0.68-1.03, p&lt;0.001).

Conclusions
A genetic risk score and modifiable risk factors were each associated with AF risk. The rates of AF increased gradually with cumulation of modifiable risk factors within each category of the genetic risk score, and we found an additive interaction between genetic risk and the modifiable risk factor profile. This underlines the importance of risk factor modification in primary AF prevention.Figure 1Figure 2
Incidence of depression in type 2 diabetes patients with and without cardiovascular disease
Authors: Zareini B , Soerensen K K S , Blanche P B , Falkentoft A C F , Fosboel E F , Koeber L K , Torp-Pedersen C T P 
Published: November 2023

Abstract

Background
Information on how subtypes of incident cardiovascular disease (CVD) affect the rate of depression in patients with type 2 diabetes (T2D) can help identity high-risk patients.

Purpose
To compare the incidence of depression among patients with T2D with incident CVD relative to patients with T2D free of CVD but similar duration of T2D.

Methods
Patients diagnosed with incident T2D without CVD or psychiatric disease were identified from the Danish registries between 2000 and 2018. CVD was defined as the first diagnosis of acute myocardial infarction (AMI), heart failure (HF), stroke, or peripheral artery disease (PAD). The patients were followed 90 days after first T2D diagnosis until first occurrence of depression, emigration, death, one year after CVD development, or end of the study (December 31, 2019). We used time-dependent Poisson regression to estimate the incidence rate ratios (IRR) of depression following different types of CVD compared with patients without CVD. The model included age, sex, comorbidities, calendar year, T2D duration, educational level, and living situation as covariates.

Results
Among 175,916 incident T2D patients (median age 61 (IQR:51;70), 59% males) followed for 1,306,228 person-years (py), 34,825 experienced depression. The crude incidence rate of depression per 1000 py (95% confidence interval) in patients without CVD was 25.8 (16.8;37.9). Compared with T2D patients without CVD, adjusted IRR of depression following AMI, stroke, PAD, and HF was: 2.4 (1.8;3.1) 5.7 (5.3;6.2), 2.5 (2.2;2.9), 2.3 (2.1;2.6), respectively.

Conclusions
All CVDs was associated with increased rate of depression, but highest rate was seen in T2D patients with stroke.
Physical exercise as a treatment for persisting symptoms post covid infection
Authors: Kogel A , Machatschek M , Scharschmidt R , Wollny C , Lordick F , Ghanem M , Laufs U , Fikenzer S 
Published: November 2023

Abstract

Background and purpose
Subsequent to the health problems of the acute phase of SARS-CoV-2 infection, the long-term consequences of SARS-CoV-2 infection are affecting large numbers of patients worldwide. To date, no evidence-based treatment is available for the increasing number of patients with persisting symptoms post COVID 19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option post COVID.

Methods
We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post COVID. Based on these findings a prospective randomized controlled study with open-label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post COVID infection were screened. Patients with cardiovascular findings were excluded. 44 patients consented and were randomized to four weeks of supervised personalized strength endurance training for 4 weeks or usual care (Fig.1). The mean age was 42.7±13.4 years, and 61% were females.

Results
The individualized combined training was very well tolerated by the participants and the exercise compliance (quality of training) was high at 96.7 ± 2.0 %. There were no adverse events related to the training. Spirometric analysis showed a significantly higher increase in VO2peak (exercise: 10.0±12.7% vs. control: 0.1±8.9%, p&lt;0.01) and oxygen-pulse (exercise: 9.8±10.8% vs. control: 0.0±13.9%, p&lt;0.05) indicating the training effects of the intervention (Fig.2). Parameters of the Multidimensional Fatigue inventory-20 (MFI-20), the McGill Quality of Life Questionnaire (MQOL), and the Post-COVID-19 Functional Status (PCFS) were significantly improved after 4 weeks in both groups. The improvements in fatigue and quality of life were not statistically different between the training and usual care groups.

Conclusion
An individualized exercise program is a safe and well-tolerated treatment option in patients with persisting symptoms post-Covid. These patients significantly improve in physical performance after 4 weeks compared to patients without exercise intervention. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of allocation to the training group.Fig. 1:Flow diagram of the inclusion process in the PCTS studyFig. 2:Changes in relative oxygen uptake, oxygen pulse, and MFI-20 of the exercise and the control group between T0: baseline visit and T1: after exercise intervention or after the corresponding period in the control group. The red line represents the mean.*: p&lt;0.05; **: p&lt;0.01 ***: p&lt;0.001, ****: p&lt;0.0001, #: p&lt;0.05 percentual change between groups.
The role of preparticipation screening in detecting silent coronary artery disease in master athletes: a way to prevent exercise-related adverse cardiovascular events
Authors: Scarfo' G , Rizza A , Fusi J , Besola L , Colli A , Franzoni F 
Published: November 2023

Abstract

Introduction
Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre-existing lesions. However, long-term exercise is frequently associated with adverse cardiovascular events in 35-year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death.

Purpose
The aim of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes.

Methods
Between 2018 and 2019, 420 35-year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular risk factors or previous cardiovascular diseases. After a physical examination, all subjects were submitted to spirometry and ECG stress test.

Results
The ECG stress test demonstrated signs of myocardial ischemia (ST depression &gt; 1 mm) in 41 subjects; 3 athletes showed a frequency-dependent left bundle-branch block; 24 subjects had exercise-induced premature ventricular complexes during the ECG stress test. These subjects underwent further evaluations (Tc-99 myocardial perfusion SPECT and coronary angio-CT) to detect the presence of perfusion defects or coronary abnormalities: 26 athletes had an important coronary atherosclerosis with significant stenosis in one or more vessels and later subjected to Percutaneous transluminal coronary angioplasty (PTCA) or to coronary artery bypass grafting (CABG). 5 athletes presented a coronary myocardial bridge and 1 subject was demonstrated to have an anomalous origin of the left coronary.

Conclusions
Preparticipation screening in 35-year-older athletes was able to detect the presence of obstructive coronary artery disease (CAD) in the 38% of suspected cases and anomalous origin or intramural coronary course in 8,8% of cases that showed electric abnormalities during the stress test. Despite recent conflicting opinions about the scientific value of the preparticipation screening in young athletes, the present study demonstrated that it was fundamental to early detect silent conditions that could predispose master athletes to adverse cardiovascular events.
Effect of exercise training on cardiorespiratory fitness, quality of life and objectively measured physical activity in patients undergoing anthracycline-based chemotherapy: the Caprice RCT
Authors: Stuetz L , Schneider C , Dierks A , Campbell K , Wilhelm M , Eser P 
Published: November 2023

Abstract

Introduction
Exercise training based cardio-oncologic rehabilitation programmes (ET) were shown to counteract the loss in cardiorespiratory fitness and quality of life (QoL) and reduce cancer fatigue during anthracycline-based chemotherapies (AC). It is unknown whether these changes are due to greater volumes of physical activity (PA) induced by ET and whether ET is associated with greater objectively measured daily PA compared to guideline-based recommendation of PA.

Method
Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres in Switzerland and randomly assigned to three months centre-based ET during (EXduringAC) or after (EXpostAC) AC. All patients were counselled on guideline directed PA and PA was measured with an activity tracker. Primary endpoints were peak VO2, fatigue and QoL after AC (AC-end) and at 3 months follow-up. PA and steps were compared between days with and without centre-based training session.

Results
Data of 51 patients were available. Neither Intention-to-Treat (ITT) nor Per-Protocol (PP) analyses revealed between group differences with regard to peak VO2, fatigue, and QoL at neither AC-end nor follow-up (Figure 1). There was also no between group difference with regard to PA and steps, however, compared to EXpostAC, in EXduringAC the steep decline in PA and steps in AC cycles 3 and 4 was prevented (PP analysis, Figure 2). PA on days with centre-based training sessions was 28 (95% confidence interval 24-32) min higher and patients performed 4382 (3995-4768) steps more compared to days without centre-based training sessions.

Conclusion
ET performed during or after AC had no additional effect on changes in peak VO2, fatigue, or QoL assessed at AC-end or follow-up compared to using an activity tracker alone, possibly due to the lack of additional PA completed by patients during ET. This is the first study that objectively measured the effect of ET on PA and daily step count during and following AC. While days with centre-based ET had significantly more PA and steps, this surplus was likely to be compensated on days without centre-based ET.Figure 1Figure 2
Typical and atypical chest pain: an equivocal and dangerous definition
Authors: Cosmi D , Tarquini B , Mariottoni B , Bennati M , Morganti M , Cosmi F 
Published: November 2023

Abstract

Background
The traditional classification of stable chest pain into typical, atypical and non anginal1 is equivocal and can lead to doctor's decisions and patient's perception that do not correspond to the real importance of the clinical picture.

Methods
In the last 15 years, 3,588 outpatients, aged &gt;35 years (mean 64±9, female 55%) were evaluated for stable chest pain reported for more than 48 hours. We excluded 290 patients with a history of myocardial infarction or angina pectoris, heart failure, valve diseases or any other major cardiovascular event, or ECG signs of recent ischemia. In the other 3,298 cases we applied the traditional classification of chest pain. All patients were evaluated for the presence of HEART score risk factors² (smoking, obesity, family history of cardiovascular events, hypertension, diabetes, hypercholesterolemia) as well as age. All patients with typical or atypical angina and those with non-anginal pain according to the physician's judgment were evaluated with one or more functional cardiovascular tests (exertion test, nuclear stress tests, stress echo).A follow-up was performed at 6 months and 1 year, for the detection of major cardiovascular events (cardiovascular death, non-fatal heart attack, revascularization, stroke) and non-cardiovascular mortality.

Results
Table 1 shows the results of chest pain classification and positive functional test. Table 2 shows major events at one year of follow-up stratified according to the initial assessment of chest pain. Table 3 stratifies the events according to the extent of the risk factors and age. It is evident that a positive functional test is also present in 10% of patients with atypical pain and in 4% of those with non-anginal pain. Patients with typical pain undergo revascularization more frequently (39%). The peculiarity of our study is that the prognosis and rate of events do not differ in terms of clinical and ischemic burden among the 3 groups at 1 year of follow-up, except when patients are stratified by risk burden and for age (Table 4). About 1% of patients had a clinical event regardless of the type of pain and the presence of ischemia and 87% of the events involved patients with ≥ 3 risk factors or heavy smokers. Nine percent of all heavy smokers aged &lt;65 years had a major event and are the highest risk group with a peak of 12.5% in those with atypical pain.

Conclusions
The traditional classification of stable chest pain should be abandoned, as it does not correlate with actual disease burden and prognosis, that appears to be linked to the burden of cardiovascular risk and above all to smoking in patients &lt; 65 years of age, rather than to the clinical and ischemic burden. It will be necessary to evaluate whether the anatomical burden for the search of high-risk coronary lesions improves the prognosis with added value with respect to the treatment of risk factors³.Picture 1Picture 2
Non-HDL cholesterol and residual risk of myocardial infarction and death in statin-treated patients with and without diabetes
Authors: Hansen M K , Mortensen M B , Olesen K K W , Thrane P , Maeng M 
Published: November 2023

Abstract

Background
Patients with coronary artery disease continue to be at risk of myocardial infarction despite lipid-lowering treatment with statins. However, it is uncertain whether non-high-density lipoprotein (non-HDL) cholesterol identifies increased residual risk in patients with and without diabetes.

Purpose
To test the hypothesis that non-HDL cholesterol identifies residual risk of myocardial infarction and death in statin-treated patients with and without diabetes.

Methods
Contemporary cohort study of consecutive patients undergoing coronary angiography (CAG) for evaluation of coronary artery disease between 2011 and 2020. Analyses were performed in the semi-national Western Denmark Heart Registry. Non-HDL cholesterol was calculated within one year after CAG as total cholesterol minus HDL cholesterol and divided into four groups according to percentile level (&lt;25th, 25th-74th, 75th-94th, and ≥95th percentile). Outcomes were diagnosis of myocardial infarction and all-cause death occurring between one year after CAG and end of follow-up (July 31, 2022). Risk according to non-HDL-C percentile group was estimated as adjusted hazard ratio (95% confidence interval).

Results
A total of 105,804 patients underwent CAG. We included 54,037 statin-treated patients with median duration of follow-up 4.6 years. Among 11,400 patients with diabetes, we observed 587 myocardial infarctions and 2,654 patients died. In 42,637 patients without diabetes, we observed 1,548 myocardial infarctions and 5,842 patients died. The risk of myocardial infarction was similarly increased in patients with and without diabetes. Compared to non-HDL cholesterol &lt;25th percentile, the adjusted hazard ratios were in patients with diabetes 1.2 (95% CI: 0.9-1.5) for 25th-74th percentile, 1.3 (95% CI: 0.9-1.9) for 75th-94th percentile, and 2.2 (95% CI: 1.3-4.0) for ≥95th percentile, and in patients without diabetes 1.0 (95% CI: 0.9-1.2), 1.3 (95% CI: 1.0-1.6), and 2.0 (95% CI: 1.4-3.0). Non-HDL cholesterol was associated with increased risk of death in patients without diabetes with adjusted hazard ratios of 1.0 (95% CI: 0.9-1.1), 1.3 (95% CI: 1.2-1.5), and 2.1 (95% CI: 1.6-2.6), however this association was attenuated in patients with diabetes (0.9 (95% CI: 0.8-1.0), 1.0 (95% CI: 0.9-1.2), and 1.2 (95% CI: 0.9-1.7)). Results were similar when stratifying on presence of obstructive coronary artery disease in both patients with and without diabetes.

Conclusion
In statin-treated patients with and without diabetes, non-HDL cholesterol identified residual risk of myocardial infarction. Further, elevated non-HDL cholesterol was associated with increased risk of all-cause death in patients without diabetes.Figure 1.Figure 2.