bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validating available Donor-recipient risk assessment tools in a German Heart Transplant cohort
Authors: Oehler D , Boettger C , Sigetti D , Voss F , Haurand J M , Ballazs C , Hoeckmann M , Kalampokas N , Aubin H , Scheiber D , Horn P , Polzin A , Kelm M , Lichtenberg A , Boeken U 
Published: November 2023

Abstract

Objective
Several Risk assessment tools have been developed to help predict mortality after heart transplantation. While validated within their regional transplant cohorts, it remains unclear whether they can also be applied to other cohorts. We therefore aimed to test and compare the predictive value of an US-Score validated in the UNOS Database by Joyce et al., a French Score by Jasseron et al., and the BO-Score within the Eurotransplant area developed by Schramm et al.

Methods
We applied the three scores to our cohort using published model coefficients and variables (see Figure 1 for distribution). The initial BO-Score as well as the French Score were hereby modified to produce positive integer values within our cohort (mod. French Score = [initial French Score + 2.24]x10, mod. BO Score = [initial BO initial score+10]x3). C-statistics using ROC-analysis (Figure 2) were used to compare the three scores regarding their ability to discriminate between 30-day, 1 year and 5-year survivors and non-survivors within our heart transplant cohort.

Results
The French Score performed best predicting the 1 survival with an AUC of 0.69 [95% CI: 0.59-0.79, p&lt;0.0001], followed by the BO-Score with 0.66 (95% CI: 0.56-0.77, p=0.003) and the US-Score with an AUC of 0.67, CI 0.57-0.76, p=0.02). Regarding 30-day-Survival, only the French Score with an AUC of 0.64 [95% CI: 0.52-0.76, p=0.006] as well as the BO-Score with 0.71 (95% CI: 0.60-0.81, p=0.008) could predict mortality sufficiently, while the US-Score could not discriminate statistically significant between survivors and non-survivors (AUC 0.64, CI 0.52-0.76, p=0.06). All scores performed worst predicting 5-year survival, with only the BO-Score being statistically significant (AUC 0.61, 95% CI: 0.56-0.77, p=0.003).

Conclusion
In our heart transplant cohort, the available donor recipient risk assessment tools performed best predicting 1 year survival, with worse and heterogenous results for 30 day or 5 year survival. Further developments will have to incorporate risk factors not yet taken into account in order to make even more reliable predictions, especially for the Eurotransplant area.Figure 1 and 2
Male patients with first diagnosed and never treated essential hypertension accompanied by organ damage are at high risk for non-alcoholic fatty liver disease indicated by Hepatic steatosis index
Authors: Triantafyllidi H , Vlachos S , Benas D , Fambri A , Birmpa D , Schoinas A , Thymis I , Kostelli G , Mexi A , Katsaros D , Ikonomidis I 
Published: November 2023

Abstract

Background
Non-alcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome as well as to arterial hypertension and overall cardiovascular (CV) disease. We aimed to investigate if those first diagnosed and never treated patients with essential hypertension at high risk for NAFLD, measured by the Hepatic Steatosis Index (HSI), already have an impaired CV risk profile estimated by increased blood pressure burden and accompanied by the presence of hypertension-mediated organ damage (HMOD).

Methods
We studied 300 non-diabetic, first diagnosed and never-treated young hypertensive patients [mean age=51+11 years, 60% males, 32% smokers]. Ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) and endothelial dysfunction (PBR5-25)] were estimated in each patient before treatment initiation. HIS was calculated as 8 times (ALT/AST ratio) +BMI (+2, if female; +2, if diabetes mellitus). Increased HIS levels predispose for augmented risk for NAFLD.

Results
The whole hypertensive population was divided regarding HSI median value=39.5 in two groups, Group A (higher risk for NAFLD group, n=150, age=50+10, 59% males, 33% smokers) and Group B (lower risk for NAFLD group, n=150, age=51+11, 60% males, 31% smokers). Group A patients had increased BMI (32+5 vs. 27+3, p&lt;0.001), systolic night-time ABPM (127+15 vs. 124+11, p=0.05), office systolic (152+19 vs. 145+17 mmHg, p=0.004) and diastolic BP (94+11 vs. 90+11 mmHg, p=0.002), central systolic BP (146+20 vs. 137+15, p=0.006), Chol (216+39 vs. 206+35, p=0.02), LDL (138+35 vs.130=33 mg/dl, p=0.04) and Trigl (139+75 vs. 112+63, p=0.001), E/Ea (7+2 vs. 6+2, p=0.01) and LVMI (83+18 vs. 79+17, p=0.03) compared to Group B. All other studied demographic, laboratory, ABPM and HMOD parameters (PWV, MAU, CFR and cIMT) were similar between groups. HSI was related to BMI (p&lt;0.001) and office BP, both systolic (p=0.001) and diastolic (p=0.008) in total population as well as to LVMI (r=0.17, p=0.02) in males. Finally, in multiple regression analysis, we found that HSI was independently associated with LVMI (beta=0.14, p=0.05) only in male hypertensives.

Conclusions
Patients first diagnosed arterial hypertension and augmented CV risk (smoking, obesity, hyperlipidemia, BP burden and HMOD) are also at high risk for NAFLD. As successful antihypertensive treatment may lead to HMOD regression, probably there is still time for those patients to be treated for hypertension disease and hyperlipidemia and quit smoking, in order to reduce future CV risk.LVMI and HSI in male hypertensives
MyD88 in myeloid cells promotes angiotensin II-induced vascular inflammation and is associated with all-cause mortality and incident heart failure in humans with arterial hypertension
Authors: Finger S , Wild S , Schulz A , Wild J , Molitor M , Mueller C , Zeller T , Daiber A , Muenzel T , Radsak M , Fleming I , Andrade-Navarro M , Wild P , Wenzel P 
Published: November 2023

Abstract

Background
Angiotensin II (AngII) causes hypertension and promotes vascular accumulation of inflammatory cells. We aimed to determine how myeloid factor of differentiation 88 (MyD88) contributes to vascular dysfunction and arterial hypertension in mice and humans.

Methods
Male C57BL/6 as well as MyD88-/-, LysMCre/wtMyD88LSL/LSL, LysMCre/wt, TLR2-/-, TLR4-/-, TLR7-/- and TLR9-/- were investigated in the AngII-model of hypertension (1 mg/kg/d for 7days). Biodata analyses were performed in the Gutenberg-Health Study (GHS), a population based cohort. In addition, we performed computational analyses of known hypertension-related genes from genome-wide association studies (GWAS) to investigate whether they preferentially interact with MyD88 in the human protein network.

Results
MyD88 deficiency attenuated AngII-induced blood pressure increase and endothelial dysfunction in conductance and resistance vessels. Vascular mRNA expression levels of vcam-1, nos2, nox2 were decreased in AngII-infused MyD88-/- mice compared to C57BL/6 controls. Flow cytometric analyses revealed that AngII-induced aortic accumulation of CD11b+Ly6Chi inflammatory monocytes was significantly dampened in MyD88-/- mice. AngII increased mRNA expression of cd62L, cd68 and ccl2, which was blocked in MyD88-/- mice, indicating a role of MyD88 for myeloid cell activation and differentiation. Additionally, aortic interferon-g+ NK cells and mRNA levels of interleukin-12 and interleukin-1b were reduced in AngII-treated MyD88-/- mice. Bone marrow transfer experiments demonstrated a vasoprotective effect of MyD88 deficiency in bone marrow-derived cells, and selective expression of MyD88 in LysMCre/wtMyD88LSL/LSL mice restored AngII-induced pathology, revealing that myelomonocytic cells drives vascular dysfunction in a MyD88-dependent manner. Furthermore, data from 1,274 individuals in the GHS indicated, that MyD88 mRNA expression was associated with all cause mortality and incident chronic heart failure after a median follow-up of 11.6 years. Computational analysis of the human protein interaction network demonstrated that MyD88 is significantly connected to proteins encoded by genetic loci associated with blood pressure traits in multiple GWAS.

Conclusion
We provide evidence, that MyD88 expressed by myelomonocytic cells promotes AngII-induced vascular dysfunction and arterial hypertension. MyD88 might be used as an inflammatory diagnostic marker for the risk of death in hypertensive patients.
Central Blood Pressure predicts the future cardiovascular risk better than peripheral Blood Pressure: the northern shanghai study
Authors: Yu S , Zhao S , Tang J , Zhang Y , Xu Y 
Published: November 2023

Abstract

Background
Controversy exists in the comparison between central and peripheral blood pressure (BP) in predicting the future cardiovascular risk.

Aim
To examine whether central BP predicts cardiovascular events and mortality better than brachial BP in a large cohort of elderly Chinese.

Method
A total of 3048 participants enrolled in the Northern Shanghai Study, a prospective cohort study focusing on the cardiovascular risk of community-dwelling elderly Chinese living in the north of Shanghai, China between 2014 and 2019, were included. Central BP was estimated tonometrically from the redial pulse waveform. The vital status and cardiovascular events of all participants were confirmed by reviewing the regional morality record system in October 2022. Cox proportional hazards models were conducted to evaluated the predictive value of central and peripheral systolic BP (SBP) and pulse pressure (PP).

Results
During the median follow-up of 5.6 years, the primary composite cardiovascular endpoint was occurred in 315 participants (10.3%). When central and peripheral SBP were analyzed separately, both central and peripheral SBP significantly associated with the primary composite endpoint (Peripheral: HR 1.047, 95% CI 1.016 to 1.079; Central: HR 1.051, 95%CI 1.020 to 1.091; Per 5 mm Hg), after adjusting age, sex, BMI, current smoking, lipid, cerebrocardiovascular disease, diabetes, antihypertensive treatment, statin treatment, hypoglycemic treatment and estimated glomerular filtration rate. When central and peripheral SBP were included in the same stepwise Cox regression, only central SBP stayed in the final model (HR 1.054, 95%CI 1.024 to 1.085, per 5 mm Hg), after adjustment for covariates. Similar trends were observed on the comparison between central and peripheral PP.

Conclusions
Central BP predicts the future cardiovascular risk better than peripheral BP in the elderly Chinese.
J-shaped association between serum uric acid levels and chronic kidney disease: a cross-sectional study using large health examination data
Authors: Kawasoe S , Kubozono T , Salim A A , Ojima S , Kawabata T , Ikeda Y , Miyahara H , Kokushige K , Ohishi M 
Published: November 2023

Abstract

Introduction
Hyperuricemia has been recognized as a risk for cardiovascular disease based on the results of many observational studies. On the other hand, a J-shaped association has been reported in which people with very low serum uric acid levels also have increased cardiovascular risk. Although renal dysfunction is closely associated with cardiovascular disease, there are no reports on whether serum uric acid levels and renal function show a J-shaped association. Hypouricemia, defined as a serum uric acid level of 2.0 mg/dL or less, is relatively common among Japanese, but the absence of symptoms and low prevalence (0.2% in men and 0.4% in women) have made epidemiological studies difficult. Therefore, we used the large-sized data from Japanese population that underwent health examinations and evaluated the association between serum uric acid levels and chronic kidney disease.

Methods
Data from 227,672 individuals (104,854 men and 122,818 women) who underwent health examinations between 2001 and 2018 were included. All analyses were performed separately for men and women because of sex differences in serum uric acid levels. Participants were classified according to serum uric acid (SUA) quartiles, with hypouricemia SUA below 2.0 mg/dL being classified as a separate category, resulting in five groups (men: ≤2.0, 2.1-5.1, 5.2-5.9, 6.0-6.8, ≥6.9 mg/dL; women: ≤2.0, 2.1-3.7, 3.8-4.4, 4.5-5.1, ≥5.2 mg/dL) to describe the characteristics. We defined chronic kidney disease (CKD) as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 and examined the association between SUA category and CKD by univariable and multivariable logistic regression analysis, which included age, BMI, alcohol intake, presence of hypertension, dyslipidemia, and diabetes as covariates.

Results
The characteristics of the population were as follows. Men: age 56 ± 15 years, SUA 5.9 ± 1.3 mg/dL, eGFR 80 ± 17 mL/min/1.73 m2, CKD 9.4%; women: age 57 ± 15 years, SUA 4.5 ± 1.1 mg/dL, eGFR 81 ± 18 mL/min/1.73m2, CKD 9.4%. The results of univariable and multivariable analyses of the association between SUA categories and CKD by gender are shown in Table. Compared to the reference group (men, SUA 2.1-5.1 mg/dL; women, SUA 2.1-3.7 mg/dL), CKD risk was increased not only in the higher uric acid groups but also in the hypouricemia group with SUA 2.0 mg/dL or less.

Conclusion
For both men and women, serum uric acid levels and CKD prevalence showed a J-shaped association. Uric acid is itself an important antioxidant in vivo, and its absence may have induced a worsening of renal function due to increased oxidative stress.
Combined pharmacotherapy in atrial fibrillation patients and their risk of stroke, dementia, and cardiovascular deaths
Authors: Ding M , Wennberg A , Modig K 
Published: November 2023

Abstract

Background
Even though there have been many advances in oral anticoagulation (OAC) for stroke prevention among atrial fibrillation (AF) patients, the incidence of adverse outcomes in these patients remain high. Optimal management of underlying cardiovascular (CV) conditions have been proposed to provide additional benefit to the prognosis of AF, including major CV and cognitive outcomes. However, concrete epidemiological evidence is still lacking.

Purposes
To investigate the effect of combinations of CV pharmacotherapies on the risk of stroke, dementia, and CV deaths among AF patients.

Methods
Using the Swedish Total Population Register and National Patient Register, we identified all individuals born between 1907-1950, who have been living in Sweden since 1987 and were diagnosed with first-ever AF between January 1st 2006-December 31st 2010. Persons with a history of stroke and dementia at the time of AF diagnoses were excluded. Included AF patients were followed for stroke, dementia, and cardiovascular deaths until December 31st, 2020. Use of CV drugs (i.e., OAC, antihypertensives, antiplatelets, and lipid-lowering drugs (LLD)) was defined as prescription within 1 year since AF diagnosis, ascertained via the Prescribed Drug Register.

Results
A total of 135896 AF patients were followed for a mean follow-up of 6.8 years (SD 4.8), and 17259 (12.7%) incident stroke, 18092 (13.3%) dementia, and 75514 (55.6%) CV deaths were observed. OAC were prescribed to 41.53% of the AF patients within 1 year since AF diagnosis, and antihypertensives to 80.6%, LLD to 30.8%, and antiplatelets to 45.4%. only 2.8% of the AF patients were using OAC only, and 38.7% were using both OAC and antihypertensives. 10.9% were using both OAC and antiplatelets, and 16.8% both OAC and LLD. After propensity score matching, combination of OAC and antihypertensives was statistically significantly associated with a lower risk of stroke (multi-adjusted hazard ratio [HR]=0.80, 95% confidence interval [CI]: 0.93-0.88) and CV deaths (0.84, 0.80-0.88), although insignificant for dementia (0.93, 0.85-1.02), compared to using only OAC. OAC combined with antiplatelets, and OAC with LLD, were however associated with an increased risk of stroke and dementia (HR ranging from 1.08-1.23), but a decreased risk of CV deaths (HR=0.96, 95% CI: 0.93-0.98; HR=0.82, 95% CI: 0.80-0.85), compared to using only OAC. Using neither drug in the combinations was associated with the highest risk for all three outcomes.

Conclusions
This observational study indicates that older AF patients may benefit from combined therapy of OAC and antihypertensives in terms of stroke, CV deaths, and dementia. Further evidence from clinical trials is needed to confirm this finding.
DAHNA-An integrated innovative mobile application for the screening and personalised management of the atherosclerotic cardiovascular disease risk
Authors: Tatu-Chitoiu G , Damian S , Dragoi P , Weiss E , Tatu-Chitoiu D 
Published: November 2023

Abstract

Background
DAHNA (Diet According to the Healthy Heart Nutritional Approach) is an integrated and innovative mobile app that allows for: 1. Screening of atherosclerotic cardiovascular disease (ASCVD) risk; 2. A personalized healthy diet (macro- and micronutrients) based on cardiometabolic screening; 3. Long-term management of major risk factors; 4. Highly incentivizing rewards within the app.

Objective
To present the functionalities, mode of operation, and initial results of DAHNA through public implementation.

Methods
DAHNA can be downloaded on mobile phones (iOS and Android). Firstly, the app assesses the user's ASCVD risk score based on their country of residence using a "one-size-fits-all" risk calculator that combines the 2021 European Society of Cardiology (ESC) SCORE2/SCORE2-OP scores and the American Heart Association (AHA) Framingham score. For Europe, the calculation is based on the four SCORE2/SCORE2-OP tables for the four risk regions. DAHNA is not limited to healthy individuals and allows the user to indicate if they have diabetes, chronic kidney disease, or ASCVD. Secondly, based on the individual ASCVD risk score, DAHNA offers the following features: 1. Personalized healthy menus (Mediterranean diet) based on the only macro- and micronutrients proven to reduce individual ASCVD risk and in the recommended daily dose, with an automatically generated ingredient list and quantities; the user can choose to purchase the ingredients personally or order the list from suppliers; 2. Periodic follow-up of ASCVD risk outcomes; 3. Display of healthy life minutes gained by the user; 4. Notifications, reminders, rewards within the app, personalized weight loss plans, PDF reports to share with healthcare teams, and nutritional education; 5. A recommendation for a medical examination for those with high or very high risk; 6. Short movies to introduce physical activity and up-to-date medical information; 7. All data is collected in a central database.

Results
Between August 10th, 2022 and February 12th, 2023, 19,780 users downloaded DAHNA (mean age 48 +/- 10 years, 58% females, 11.13% with diabetes, 15.16% smokers, 16.4% with hypertension; 14% had low-to-moderate risk, 40% had high risk, and 46% had very high risk). A 100% correspondence was confirmed between the results of the DAHNA calculator and the ESC tables.

Conclusion
1. DAHNA self-screening showed that 86% of users belong to the high or very high ASCVD risk group, which is consistent with statistical data showing Romania among the countries with a very high ASCVD risk. 2. This app is the first to assign a personalized healthy diet based on specific micronutrients to control ASCVD risk, provide medical recommendations for a healthy lifestyle, and allow for real-time management of major risk factors and ASCVD risk in large populations. These data should be important for adjusting health policies.
Effect of exercise in incident atrial fibrillation among diabetes mellitus with different diabetes duration
Authors: Choi J , Lee S R , Choi E K , Lee K Y , Ahn H J , Kwon S I , Han K D , Oh S I 
Published: November 2023

Abstract

Background/Introduction
In previous studies, level of exercise and AF risk seems to have nonlinear relationship. Vigorous physical activities have been considered as a risk factor of atrial fibrillation (AF). However, other studies have shown regular exercise to be associated with reduced incidence, symptoms, recurrence, and burden of AF. Conversely, a sedentary lifestyle is an important risk factor for the development of AF. Currently, the effect of exercise amount on the risk of AF among patients with diabetes mellitus (DM) according to diabetes duration has not been examined.

Purpose
This study aimed to evaluate the effect of exercise amount on incident AF among patients with DM using a nationwide population cohort.

Methods
The subjects with type 2 DM who underwent the Korean National Health Insurance Service health examination during 2015 and 2016 were identified. The study population was divided into four groups according to DM duration (new onset, less than 5 years, 5 to 10 years, and more than 10 years). Also, they were categorized into four groups according to the amount of exercise (0, &lt;500, 500 to 1000, 1000-1500, and ≥1500 METs-Min per week). The study outcome was incident AF.

Results
A total of 2,392,486 subjects with a mean follow-up duration of 3.9 ± 0.9 years were enrolled (mean age 59.3 ± 12.0, female 39.8%). The mean DM duration was 5.3 ± 5.1 years, and the mean exercise amount was 643.0 ± 638.0 METs-min/week. 704,732 subjects were new-onset DM, 649,811 subjects had less than 5 years of DM duration, 464,870 subjects had DM duration between 5 to 10 years, and 573,073 subjects had more than 10 years of DM. As the DM duration became longer, age, the prevalence of comorbidities (hypertension, chronic kidney disease, chronic heart failure, prior myocardial infarction, prior stroke, and prior peripheral artery disease), the prevalence of more than three oral anti-diabetes medications, and insulin usage increased sequentially (all p&lt;0.0001). In each DM duration group, the exercise amount of AF risk showed slightly different relationship. The new-onset DM group and DM duration 5 to 10 years groups showed the most reduced AF risk in exercise amounts 1000 -1500 METs-Min/week (adjusted hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.82-0.96 p=0.0016 and adjusted HR 0.83, 95% CI 0.77-0.89, p=0.0098, respectively). The DM duration less than 5 years and more than 10 years groups both showed the lowest risk in exercise ≥1500 METs-Min/week (adjusted HR 0.91, 95% CI 0.85-0.97; adjusted HR 0.85, 95% CI 0.81-0.90, both p&lt;0.001).

Conclusions
Regular exercise of more than ≥1500 METs-Min/week did not increase the risk of AF risk in DM patients. It was associated with reduced AF risk in all DM patients except new-onset DM. Further study is needed to assess the biophysiological change regarding DM duration that could affect the AF risk.