bluuebunny/crossref_metadata_2025_split huggingface dataset:
POLYGENIC RISK SCORES AND THEIR PHENOTYPIC ADJUSTMENT: NOVEL BIOMARKERS IN CARDIOVASCULAR DISEASE PREVENTION
Authors: Panagiotou Nikolaos , Bersimis Fragkiskos , Fotis Athanasios , Sagonas Alexis , Ntoumou Eleni , Salata Efi , Psychogios Apostolos , Kallistratos Manolis 
Published: June 2023

Objective:
This study aimed to develop a novel genetic tool, the Polygenic Risk Score (PRS), to non-invasively and routinely estimate predisposition to cardiovascular diseases (CVDs), comprising coronary artery disease, dilated cardiomyopathy, hypertrophic cardiomyopathy, atrial fibrillation, ischemic stroke, and heart failure. The study also aimed to improve risk estimation by incorporating chronological age, physiological characteristics, and behavioral parameters to calculate an adjusted PRS.

Design and method:
Three algorithms were designed to i) search literature databases for GWAS on CVD predisposition, ii) derive Single Nucleotide Polymorphisms (SNPs) by assessing p-values, beta coefficients, odds ratios, and linkage disequilibrium metrics, and then iii) calculate the PRS for each CVD. Manual scientific evaluation was also employed. Thus, a novel genetic panel (termed iDNA Cardio Health) was developed to assess polygenic risk for the six above mentioned CVDs, following buccal swab sampling. Finally, we employed the American Heart Association's (AHA) Life's Simple 7 (LS7) lifestyle and phenotypic characteristics scoring system to assess current cardiovascular health status and then use this information, as well as chronological age, to dynamically calculate an adjusted PRS.

Results:
After testing the iDNA Cardio Health on a Greek population sample, we were capable to examine CVD risk stratification. Additionally, we could identify individuals with high polygenic risk, who could significantly benefit from lifestyle and/or clinical modifications. Furthermore, employing the LS7 categorization, we were capable to fine-tune risk prediction based on the adjusted PRS.

Conclusions:
It is evident that current clinical tools for CVD risk estimation may underestimate the risk, while the PRS can be employed to optimally reclassify individuals with marginal intermediate risk to a high-risk category. Our novel methodology, which at its core encompasses polygenic risk, can be combined with LS7 traditional clinical risk prediction metrics and chronological age to revolutionize CVD prevention though screening, monitoring, and clinical management, thus enabling the implementation of PRS and adjusted PRS in clinical care to empower personalized medicine.
THE INFLUENCE OF AMBULATORY BLOOD PRESSURE ON THE ASSOCIATIONS OF SEX WITH CARDIOVASCULAR EVENTS AND MORTALITY IN PATIENTS UNDERGOING HEMODIALYSIS: A PROSPECTIVE COHORT STUDY
Authors: Sarafidis Pantelis , Theodorakopoulou Marieta , Iatridi Fotini , Georgiou Areti , Karagiannidis Artemios , Karkamani Eleni , Tsitouridis Alexandros , Faitatzidou Danai , Papagianni Aikaterini 
Published: June 2023

Objective:
Male patients with pre-dialysis CKD have worse ambulatory BP control than females and this is associated with higher mortality risk. Male hemodialysis patients have higher ambulatory BP levels compared to females. The aim of this study was to investigate the influence of ambulatory BP on the associations of sex with cardiovascular events and mortality in hemodialysis individuals.

Design and method:
129 male and 91 female hemodialysis patients with valid 48-hour ABPM were followed prospectively for 53.4±31.1 months. The primary endpoint was cardiovascular mortality; the secondary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary or peripheral revascularization procedure.

Results:
Cumulative-freedom from the primary endpoint was significantly lower for women (logrank-p = 0.032), while cumulative-freedom from the secondary endpoint did not differ significantly between the two groups (logrank-p = 0.644). The crude risk for cardiovascular mortality was significantly higher for women (HR = 1.613, 95% CI [1.037, 2.509]). The crude risk for the combined cardiovascular endpoint was not different between the two genders (HR = 0.918, 95% CI [0.638, 1.320]). After adjusting for other risk factors (age, diabetes, dialysis vintage, coronary disease) no significant differences in the risk for both the primary and the secondary endpoint were observed between women and men (primary: HR = 1.464 (95% CI [0.929, 2.307]), secondary: 0.866 (95% CI [0.596, 1.260])). After additional adjustment for 44-hour ambulatory BP the above relationships did not alter (primary: HR = 1.498, 95% CI [0.947, 2.368]), secondary: (HR = 0.911, 95%CI [0.625, 1.327])).

Conclusions:
In contrast to patients with pre-dialysis CKD, ambulatory BP does not appear to significantly influence the relationship between gender and adverse cardiovascular outcomes in hemodialysis patients.
RELATIONSHIP OF ARTERIAL STIFFNESS AND BASELINE CEREBRAL SMALL VESSEL DISEASE SCORE, WITH THE OCCURRENCE OF NEW LESIONS AFTER 2 YEARS OF FOLLOW-UP, INDEPENDENTLY OF BP CONTROL
Authors: Armario Pedro , Garcia-Sanzhez Sonia M , Font Maria Angels , Mengual Juan Jose , Avellaneda Carla , Montull Caterina , Castrillo Laura , Castellanos Pere , Blanch Pedro , Lleixa Merce , Martin-Baranera Montserrat , Gomez-Choco Manuel 
Published: June 2023

Objective:
Hypertension is a prominent determinant of cerebral small vessel disease (cSVD). The aim of this study was to assess in subjects with a recent lacunar stroke, the factors associated with the occurrence of new lesions of cSVD after 2 years of follow-up.

Design and method:
Patients with a recent small subcortical infarct according to STRIVE criteria were consecutively included in this prospective study. Clinical BP was measured after 5 min of rest in a sitting position using a validated semiautomatic device (OMRON Digital Automatic Blood Pressure Monitor Model HEM-907XL, Kyoto, Japan). Three measurements of BP were averaged to determine values of clinical BP at baseline and at 3, 6, 12 and 24 months of follow-up. 24h-Ambulatory blood pressure monitoring (ABPM) was performed after hospital discharge within 30 days after stroke onset and after 2-years follow-up. The aortic pulse wave velocity (aPWV), the augmentation index (AIx) and 24h brachial and central BP (24h-ABPM) were measured by means of a Mobil-O-Graph PWV (IEM, Stolberg, Germany) device. The AIx was normalized for heart rate of 75 bpm (AIX75). Brain MRI was performed using a Phillips Achieva 1.5 T MRI at admission and at 2-years follow-up.

Results:
A total of 103 patients, aged 67.04 (10.9) years, 30.4% female, were included. Follow-up MRI was acquired in 92 patients. Backwards stepwise logistic regression analysis showed that 24h-PWV (OR 1.44 CI 95% 1.01-2,06 p = 0.044) and cSVD score (OR 2.3 CI 95% 1.41-3.77, p = 0.001) were associated with the presence of new lesions. Significance for 24h-PWV was lost after introducing age in de model, and only cSVD score remained significant (OR 2.33 CI95% 1.34-3.98, p = 0.002). The presence of new lesions was not significantly different between patients with or without BP control defined by BP < 130/80 mm Hg during the 24h-ABPM.

Conclusions:
In subjects with a lacunar stroke, 24h-PWV and cSVD score were associated significantly with the presence of new lesions after 2 year of follow-up, independently of BP control
COGNITIVE COMPLAINT IN HYPERTENSIVE PATIENTS
Authors: Rivero María Noel , Más Valentina , Spósito Paola , Cuba Ximena , Llorens Mario 
Published: June 2023

Objective:
To describe the prevalence of CC in hypertensive patients and its link to an increased cardiovascular risk (CVR) profile.

Design and method:
Observational, descriptive, analytical and cross-sectional study. Inclusion criteria: hypertensive patients over 18 years old presenting Montreal Cognitive Assessment (MoCA). Exclusion criteria: motor or sensory difficulties, psychiatric disease, illiteracy.
Qualitative variables are presented as absolute and relative frequencies. Chi-square test was used for association analysis. Differences were studied through Student's t-test for independent samples. A significance level of alpha = 0.05 was set. The statistical software used was STATA v.17.0.

Results:
This study included 111 patients, with a 1:4 women:men rate and an average of 60 years old. Cognitive complaint was present in 45.9% of patients. Of all patients, 81% presented grade 3 arterial hypertension according to 2018 ESC guidelines, 31.5% having been diagnosed at least 20 years prior. 35.1% showed a non-dipper pattern and 45.9% nocturnal hypertension. Around 52.3% of patients had less than 8 years of studies and 33.3% had a MoCA score higher than 23. Dyslipidemia was present in 34.2% of patients, 72.1% were overweight/obese and 36% were smokers. 40.5% of patients had established heart disease (HD). The cognitive complaint patient group was associated with those with non-dipper pattern (p = 0.034), coronary artery disease and ischemic cardiopathy, with p-values of 0.019 and 0.045 respectively. This study observed a link between CC and transient ischemic cerebrovascular stroke (p = 0.027). Out of all patients suffering CC (51), 58.8% (30) presented unaltered MoCA, while association to an altered MoCA was significant (p = 0.039).

Conclusions:
Cognitive Complaint is related to a cardiovascular risk profile in hypertensive patients. Association with an altered MoCA in patients suffering CC highlights the risk of evolution towards Mild Cognitive Decline and dementia.
MICRONUTRIENT INTAKE AND HYPERTENSION AMONG ADOLESCENTS, NHANES 2007-2018
Authors: Baker-Smith Carissa , Kernizan Daphney , Falkner Bonita , Akins Robert 
Published: June 2023

Objective:
To examine the relationship between nutrient intake and hypertension (HTN) diagnosis in adolescents.

Design and method:
This cross-sectional study analyzed representative nutrient and sociodemographic factors from six 2-year cycles (2007 to 2008 through 2017 to 2018) of the National Health and Nutrition Examination Survey. The sample included adolescent survey participants,13 to 18 years of age. Nutrient intake estimates were derived from total dietary recall and daily supplement recall data. Systolic and diastolic HTN were defined based upon the average of 2-3 measured blood pressures. An average systolic blood pressure at or above 130mmHg was used to identify adolescents with systolic HTN, while an average diastolic blood pressure at or above 80mmHg was used to identify youth with diastolic HTN.
Using descriptive statistics, inclusive of chi-square analysis for categorical data and Wilcoxon rank sum test for continuous data, we assessed the relationship between a variety of sociodemographic variables, nutrient variables and systolic HTN (or diastolic HTN). Logistic regression was performed to determine factors associated with a greater odd of HTN. Goodness of Fit of the logistic regression model was assessed.

Results:
Among 5866 US adolescents, the sodium to potassium ratio was higher and the folate level lower among youth with systolic HTN. Other factors associated with systolic HTN included older age, male sex, and obesity. According to the logistic regression model, factors associated with a greater odd of systolic HTN included age, sex (male), and obesity. Higher folate levels were associated with a lower odd of systolic HTN. Among youth with diastolic HTN, only age and obesity were associated.

Conclusions:
Hypertension (HTN) is the most common preventable cause of cardiovascular disease (CVD) in the US and globally. It is prevalent in 2-4% of youth.1, 2 Nutrient intake and HTN in adolescents has major public health implications. Like previously published findings in adults, 3 we found that folate > 5000mcg is associated with lower blood pressure. In this study, sodium intake, potassium intake, magnesium and lycopene levels were not associated with HTN in adolescents.
FROM A SYNCOPE TO MYOCARDITIS - AN UNUSUAL MANIFESTATION OF MYOCARDITIS IN OBESE PATIENT WITH HYPERTENSION AND PARANOIDAL SCHIZOPHRENIA
Authors: Zbroch Edyta , Wawiernia Julia , Zbroch Aleksandra , Zalewska Aleksandra , Baranowska Magdalena , Sielatycki Piotr 
Published: June 2023

Objective:
The case report presents a 30-year-old obese patient with a history of paranoidal schizophrenia, sinus tachycardia and hypertension which was admitted to the Department of Internal Medicine and Hypertension after fainting the day before. In the admission the patient suffers from a chest pain, dizziness, and abdominal pain. The physical examination revealed: BP 161/104mmHg, HR 120/min, SatO2 94%, overdeveloped fatty tissue and pain in the left chest and abdominal area after a collapse. Laboratory tests showed increased inflammation and cardiac parameters as well as extremely high concentration of TCAs (Tricyclic antidepressants). The ECG and ECHO were carried out, the former showed ST elevations in ECG leads II, III, aVF, V4-V6, the latter reveled dilation of the right ventricle, left ventricular hypertrophy and lower ejection fraction, EF = 48%. Hypotensive treatment was implemented resulting lowering blood pressure. However, the patient's condition did not get better. Stabbing and burning chest pain persisted. Considering a clinical picture, contrast-MRI was performed showing LGE (late gadolinium enhancement) on the lateral-inferior part of the left ventricle wall characteristic for myocarditis (MC).
The objective of this case report is to highlight a possibility of myocarditis when there are symptoms responding to other heart diseases, atypical for MC and the role of detailed diagnostic process and holistic perspective.

Design and method:
Case report presentation of the patient admitted to the hospital due to the collapse episode the day before. Symptoms and additional test analysis and making the final diagnosis.

Results:
Initial diagnostic tests were negative or inconclusive until heart contrast-MRI was performed revealing - LGE foci in the left ventricle wall corresponding to the area of inflammatory lesion of the lateral-inferior part of the left ventricle wall.

Conclusions:
Although, myocarditis is a rare finding, more frequent in younger population, it is associated with significant complications and mortality thus early diagnosis can prevent critical condition. In presented case, the difficulty in making a final diagnosis of myocarditis was affected by predominant cardiac attack symptoms. Moreover, MC could be caused by TCA which high concentration was found in the patient's blood.
HYPERTENSION-RELATED IMPAIRMENT OF MESENTERIC ENDOTHELIAL FUNCTION CONTRIBUTES INTO GUT-LIVER AXIS VIA INTESTINAL DYSBIOSIS AND HEPATIC STEATOSIS, AND ASSOCIATES WITH GENETIC DYSRE
Authors: Dzhuryak Valentyna , Sydorchuk Larysa , Voroniuk Kseniia , Sydorchuk Ruslan , Sokolenko Alina , Repchuk Yulia , Semianiv Marianna , Yarynych Yulia , Iftoda Oksana 
Published: June 2023

Objective:
Metabolic violations, obesity and other related comorbidities are obvious in arterial hypertension. It is known that Hepatic Steatosis (HS) and Arterial hypertension (AH) has to some extend common pathogenesis realized through metabolic and immune mechanisms involving vascular and digestive system injury, and forming Gut-Liver axis, which remain mostly untouched in recent studies. We aimed on evaluating the endothelial function and mesenteric vessels remodeling depending on I/D polymorphism of angiotensin-converting enzyme (ACE) gene and A1166C polymorphism of angiotensin II type 1 receptor (AGTR1) gene in hypertensive patients with HS.

Design and method:
Study included 104 AH patients with HS (50 females, 54 males, age 53.2±8.7). Intimae-media thickness (IMT) of abdominal aorta (AO) and other flow mediated parameters of mesenteric vessels state evaluated by sonography. NO (nitrite/nitrate) plasma concentration, vascular adhesive molecule (sVCAM-1) level were defined by IEA. ACE (I/D) and AGTR1 (A1166C) genes polymorphisms assessed with PCR.

Results:
High risk of endothelial dysfunction (ED) is: D-allele of ACE gene (p<.001); C-allele of AGTR1 gene (p = .02). In DD-genotype were higher flow-mediated parameters of mesenteric vessels. IMT of AO was thicker in CC-genotype of AGTR1 gene (p = .039-.01) and independent on I/D genotypes of ACE gene. sVCAM-1 level was higher (p<.01) in D-allele of ACE gene, than in II-genotype and not depending on A1166C polymorphism of AGTR1 gene. NO plasma level doesn’t depend on ACE (I/D) and AGTR1 (A1166C) genes polymorphisms. Vascular remodeling in HS patients (AO IMT enlargement for more than 0.9 mm) is associated with dysbiosis III-IV grades’ and sVCAM-1 plasma level growth by 1,3-1,6 times (p<.05-.001). AO IMT correlates with dysbiosis severity, presence of HS and sVCAM-1 level and is independent from AH severity.

Conclusions:
Risk contingents for endothelial dysfunction and mesenteric vessels remodeling in HS patients are: by sVCAM-1 plasma level and diameter of mesenteric vessels increasing – DD-genotype carriers of ACE gene; by IMT of abdominal aorta enlargement – CC-genotype carriers of AGTR1 gene (p<0.02-0.001).
DIURETIC THERAPY – STILL NUMBER 1 REASON FOR HYPONATREMIA
Authors: Sima Diana-Stefania , Nicolae Lorena-Daiana , Weiss Emma , Munteanu Diana Mihaela , Barboi Teodora-Maria , Diaconu Camelia Cristina , Balahura Ana-Maria 
Published: June 2023

Objective:
Hyponatremia is the most common electrolyte imbalance in hospitalized patients. Up to 35% of patients develop hyponatremia during hospitalization. Hypertension is also common in hospitalized patients with prevalence rates up to 72%. We aimed to study the main causes of hyponatremia in hospitalized patients and to investigate the association between hyponatremia and hypertension in this population.

Design and method:
We included consecutive patients admitted to our hospital between March 2019 and August 2021, with the diagnosis of hyponatremia. We retrospectively analyzed the electronic health records and we collected demographic data, clinical and paraclinical data, hyponatremia etiology and associated comorbidities. We conducted comparative analysis between group without hypertension (Group 1) versus group with hypertension (Group 2).

Results:
The study population included 397 patients (mean age 71 ± 12 years old, 50,9 % women) with hyponatremia (4,9% of total admissions to our department in the specified period of time) -40,6% mild and 59,4% moderate-severe hyponatremia. The main causes of hyponatremia were diuretic use (37,7%), SARS-COV2 infection (17,1%), NYHA class IV heart failure (12,5%), SARS-COV2 infection associated with diuretic use (10,3%). 21,9% of patients had chronic treatment with psychotropic medication (antidepressants or antipsychotics), 8,6% of patients had chronic treatment with antiepileptic drugs The majority of patients in the study population had hypertension (68,3%). Patients in the hypertensive group were older (72 ± 11 vs 67 ± 15 years old, p<0,001). Mean sodium at hospital admission was lower in group 2 (125,9 vs 127,8 p = 0,01). Hyponatremic encephalopathy was more common in group 2 (15,9% vs 4,0%, p = 0,001). Diuretic use was also more prevalent in hypertensive group (56,3% vs 31,0%, p<0,001). Loop diuretic use was similar between groups (38,5%-Group 1 vs 32,5% - Group 2, p = 0,47), but thiazide-like diuretic use was more common in Group 2 (46,8% vs 20,5%, p = 0,003).

Conclusions:
The most common etiology of hyponatremia in the internal medicine department of an emergency hospital was diuretic use. Hypertension was associated with older age, lower sodium at hospital admission, hyponatremic encephalopathy and thiazide-like diuretic use in this population.
PROGNOSTIC VALUE OF ISOLATED HIGH SERUM CYSTATIN C LEVELS WITHOUT GLOMERULAR FILTRATION RATE REDUCTION
Authors: Villa Juan , Cancho Barbara , Valladares Julian , Lopez Alvaro Alvarez , Sabillon Jorge Alberto Rodriguez , Gomez Juan Lopez , Robles Nicolas Roberto 
Published: June 2023

Objective:
Cystatin C is increasingly used as a marker of renal function as a complement or alternative to serum creatinine and GFR calculated from it. However, cystatin C is also a marker of inflammation. We have assessed its efficacy as a predictor of mortality in a group of patients with elevated cystatin C and GFR > 60 ml/min.

Design and method:
We included 608 patients seen at our hospital, 65.9% of whom were male and 34.6% had diabetes mellitus. The mean age was 58.5±14.5 years and a mean GFR of 64.1±33.5 ml/min. Patients were divided into 3 groups: CONTROL (normal cystatin C and GFR > 60 ml/min, age 53.3±12.8 years, GFR 96.6±22.4 ml/min, n = 193), ELEVATED CYSTATIN (elevated cystatin C and GFR >60 ml/min, age 58.9±13, 1 years, GFR 72.2± 10.4 ml/min, n = 40 ) and CKD (chronic kidney disease, elevated cystatin C and GFR <60 ml/min, age 61.4±14.8 years, GFR 36.0±12.7 ml/min, n = 160). The relationship with overall mortality was analyzed using the survival curve by Kaplan-Meier method.

Results:
Mean cystatin C was 0.75±0.13 mg/l, versus 1.79±0.54 in the CKD group and 1.14±0.14 mg/l, p<0.001 ANOVA). In the CONTROL group survival was 93.9% at five years, compared to 78.8% in the ERC group and 82.3% in the CYSTATIN ELEVATED group (p < 0.001 Log Rank). Five-year survival before renal replacement therapy was also different for the ERC group (73%, p < 0.001 Log Rank) but not between the other two groups (CONTROL 99.0%, HIGH CYSTATIN 94.3% p = 0.08 Log Rank).

Conclusions:
The presence of elevated cystatin C in patients with GFR > 60 ml/min was a predictor of increased mortality but not of progression to end-stage renal failure. These results confirm the interest of routinely measuring cystatin C in our patients.