bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restarting statins in a specialist lipid clinic setting
Authors: Malone R , Kennedy C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Board.

Background
Statin therapy remains a gold standard in the primary and secondary prevention of cardiovascular disease (CVD).[1] Poor statin compliance and discontinuation due to statin intolerance (SI) remains a pervasive clinical issue.[1] Research has demonstrated that the prevalence of SI is overestimated with most SI symptoms being nocebo.[2-3] Our practice involves a patient centred intervention to restart statins with four components: 1) careful exclusion of differential diagnoses 2) an in-person discussion regarding SI based on contemporary evidence 3) an incremental introduction of statins starting at the lowest dose 4) virtual follow up to ensure implementation of the therapeutic plan. The aim of this study was to assess the effectiveness of this intervention in terms of statin reintroduction and subsequent cholesterol levels.

Methods
An ethically approved retrospective chart review was performed of consecutive adult patients attending a specialist lipid clinic over a six-month period in 2021. Patient data recorded included demographics, clinical characteristics, treatment received and biochemical profiles. Statistical analysis was performed using the Student T-test.

Results
This study included 370 patients. SI prevalence was 25% with 10% referred explicitly for SI. Patients with SI were predominantly female (71%). Statin-associated muscle symptoms were the most common SI (62%). Statin therapy was restarted in 48% of patients [Rosuvastatin: (62%), Simvastatin: (16%), Atorvastatin: (13%), Pravastatin: (9%)]. Restarting a statin demonstrated significantly improved mean reductions in both total cholesterol (TC) (P = 0.007) and low-density lipoprotein C (LDL-C) (P&lt; 0.001) levels versus management with or without alternative lipid-lowering agents [primarily ezetimibe (30%)]. Statin restart: (TC mean reduction: 3.17 ± 2.27 mmol/L, LDL-C mean reduction: 2.93 ± 1.77 mmol/L). Management with or without alternative lipid-lowering agents: [TC mean reduction: 1.61 ± 1.46 mmol/L, LDL-C: 1.35 ± 0.93 mmol/L].

Conclusion
This study highlights the prevalence of SI among patients attending a lipid clinic. Statins were successfully restarted in half of presenting cases and conferred significant improvement in both TC and LDL-C levels compared to management with or without alternative lipid-lowering agents. Interventions for SI are warranted given the high prevalence of nocebo effect and the undoubted benefits of statin treatment. Ideally such interventions should be replicated in a primary care setting.
Sport-related acute myocardial: occurrence of intraluminal thrombus could be associated with sport intensity
Authors: Kouame I , Chague F , Lhuillier I , Yao H , Bichat F , Maza M , Saint Jalmes M , Braghini N , Porot G , Zeller M , Cottin Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Agence régionale de santé Société Française de Cardiologie.

Background
Contemporary data addressing coronary artery disease (CAD) characteristics of sport-related acute myocardial infarction (SR-AMI) are scarce and underlying mechanisms are poorly understood, in particular according to metabolic intensity.

Purpose
To identify coronary angiographic feature of patients with SR-AMI according to sport intensity.

Methods
From the RICO database, a large regional acute MI survey, all consecutive patients hospitalized in our University Hospital from 2010 to 2021 who underwent coronary angiography for SR-AMI were retrospectively analysed. SR-AMI was defined as MI occurring during sport activity or within the first hour of recovery. Patients were adjudicated according to Ainsworth classification, with a 7 METs (Metabolic Equivalents) cut-off.

Results
Among the 173 patients included, most were male (n=156(91%)). Median (IQR) age was 60 y (51-67), and had ST segment elevation MI (STEMI) (n= 112 (64%)). The main SR-AMI occurred while cycling (41%), jogging (23%), hiking (9%) or playing soccer (9%). Patients commonly experienced out -of-hospital sudden cardiac arrest (OHSCA) (17%). Atherothrombotic risk factors were dyslipidaemia (34%), current smoking (32%) or hypertension (31%) and history of coronary artery disease (10%). Most (n=156(91%)) had significant lesions, mainly treated by percutaneous coronary intervention (n=131(77%)) or coronary artery bypass grafting (n=11(6%)). In-hospital death occurred in 12 patients (7%), of whom 11 experienced OHSCA- and one was admitted with a cardiogenic shock during the Covid-19 pandemics lockdown. Main clinical and angiographic characteristics are summarized in table 1. Patients in the METs group ≥ 7 were younger, had lower diabetes rates, higher ST-segment elevation MI and had higher rate of intra-luminal thrombus.

Conclusion
In our large retrospective study, SR-AMI occurring during an elevated intensity exercise had specific angiographic features. Further studies are needed to explore underlying mechanisms of MI according to exercise intensity.
High sweet foods and low life satisfaction can act as risk factors for acute coronary syndrome through synergistic interaction
Authors: So J , Chung K , Seo J , Kim B , Chun H , Han S , Chung I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea.

Background
Dietary and psychological factors contribute to development of coronary artery disease (CAD). However, contributing components of these lifestyle factors may vary depending on ethnic and cultural background, and secondary prevention programs dealing with these factors in specific population are not well established.

Aims
We aimed to analyze dietary and psychological characteristics and independent risk factors in Korean patients with acute coronary syndrome (ACS).

Methods
Ninety-two patients with ACS (29 acute myocardial infarction, 63 unstable angina) and 69 controls were subject to analysis of lifestyle factors focused on dietary and psychological status. Dietary intake was assessed by a food frequency questionnaire (FFQ) using the KoGES software and Can-Pro 4.0. Psychological depression and perceived stress were measured with the Patient Health Questionnaire 9 (PHQ-9) and the Korean version of Perceived Stress Scale (K-PSS), respectively. In additions, eight domains of life satisfaction was assessed with the Domain Satisfaction Questionnaire (DSQ).

Results
ACS group had more men (79% vs 61%) and was older (53 yr vs. 49 yr), less physically active, and higher waist circumference and BMI than controls. Dietary analyses showed that ACS group had more intakes of sweets and fish/seafood in both men and women compared to controls. Psychological analyses showed that ACS group had higher depressive symptom (5.4 vs. 4.2, p&lt;0.05) and less total DSQ scores (average satisfaction scores across the 8 life domains: 4.2 vs. 4.7, p&lt;0.001) along with the lower DSQ scores of all 8 individual domains (love relationship, leisure, standard of living, job, health, family life, sex life, and self). There was a modest but significant linear inverse correlation between daily sweet intakes and total DSQ score (r = -0.23, p=0.01). Sweets (OR: 4.57, 95% CI: 1.94-11.40) and total DSQ scores (OR: 0.34, 95% CI: 0.14-0.81) were identified, by multivariate logistic regression analysis, as independent risk factors that synergistically as well as individually contribute to development of ACS.

Conclusions
High sweet food intake and low life satisfaction can act as independent risk factors for ACS through interactive mechanism. These data also highlight the importance of the role of positive psychological factor in cardiovascular health.
Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia
Authors: Frojd L A F , Munkhaugen J M , Papageorgiou C P , Sverre E S , Moum T M , Dammen T D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Drammen hospital, Vestre Viken trust.

Background
Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and associated with impaired prognosis. Therefore, knowledge about correlates of HRQoL may be of clinical importance. However, there is limited knowledge about how a comprehensive set of psychosocial factors, including type D personality, depression, anxiety, and insomnia influence HRQoL in CHD outpatients.

Purpose
To determine the relative associations of clinical and psychosocial factors with mental and physical HRQoL in a sample of Norwegian CHD outpatients.

Methods
This cross-sectional study included 1017 patients 2-36 (mean 16) months after hospitalisation for a coronary heart disease event (80% myocardial infarction). Data on HRQoL, psychosocial factors, coronary risk factors, comorbidity, and demographics were collected from self-report questionnaires, clinical examination with blood samples and hospital medical records. HRQoL was assessed using the Short Form 12 (SF12), which is a 12-item questionnaire comprising two subscales: Mental Component Scale (MCS) and Physical Component Scale (PCS). Type D personality, depression and anxiety, and insomnia were measured using the type D Scale 14 (DS14), Hospital Anxiety and Depression Scale (HADS), and the Bergen Insomnia Scale (BIS), respectively. Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS, respectively.

Results
Mean age was 61 (SD 10) years, 20% were females, 18% had type D personality, 20% depression, 14% anxiety and 45% insomnia. Mean scores for SF12 subscales were 47.1 (6.0) for MCS and 38.5 (4.8) for PCS. Type D personality, symptoms of depression, and insomnia, but not anxiety, were negatively associated with MCS, but not PCS in multi-adjusted analyses. (Table). Chronic kidney disease was associated with reduced MCS, whereas chronic obstructive pulmonary disease and low physical activity were all negatively associated with PCS. Younger age was associated with poor MCS, whereas older age was associated with poor PCS.

Conclusions
This study found that HRQoL was low among Norwegian CHD outpatients. Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest correlates of the mental component of HRQoL. However, these variables were not significantly associated with the physical subscale of the SF12. Assessing and managing type D personality, depression, and insomnia among these group of CHD outpatients may improve HRQoL.
Including coronary artery calcium scores to guide treatment in a specialist lipid clinic setting
Authors: Mays H , Malone R , Nasa A , Salama S , Hennessy M , O'connor P , Kennedy C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Multi-Ethnic Study of Atherosclerosis demonstrated that coronary artery calcium (CAC) scoring has proven to be an effective tool at guiding lipid lowering therapy in patients with dyslipidaemia who are at risk of atherosclerotic cardiovascular disease (ASCVD) in the setting of a cohort study. The 2019 joint ESC/EAS dyslipidaemia guidelines identify a number of risk modifiers to stratify ASCVD risk from low to very-high including Lipoprotein (a) [Lp(a)] and the identification of familial hypercholesterolaemia (FH) mutations.

Purpose
1) To determine whether CAC scoring can improve the risk assessment of ASCVD in a lipid clinic setting and therefore act as a more effective guide for clinicians when implementing lipid lowering therapy. 2) To compare CAC scores in patients grouped by Lp(a) levels and FH mutations.

Methods
A retrospective cohort analysis of patients attending a specialist lipid clinic from July to December 2021 in a tertiary referral centre. Data was collected in July/August 2022. Patients were divided into two groups, those with a CAC score of 0 and greater than 0. Data collected included patient risk factors and modifiers as described in the 2019 joint ESC/EAS dyslipidaemia guidelines, serum Lp(a) levels and FH mutation status. Statistical analysis with SPSS software applied the Mann-Whitney and Chi Squared test.

Results
49.4% patients (n=41) had a CAC score of greater than 0. Of the patients classified as very-high risk, 91.3% (n=21) had a CAC score of greater than 0. For those classified as high risk, 26.5% (n=9) had a CAC score greater than 0. The mean Lp(a) plasma level was 124nmol/L for a CAC score of 0, compared to 249nmol/L for a CAC score of greater than 0 (U=562,p=0.02). 23 patients had FH mutations, of which 47.8% (n=11) had CAC scores of greater than 0 (χ2 = 2.15, p= 0.340).

Conclusion
This initial analysis describes CAC scores in patients attending a specialist lipid clinic classified by ASCVD risk and risk modifiers. It suggests CAC scores have a role, either additional or confirmatory, in ASCVD risk assessment. Further analysis is required to include additional risk modifiers, expand the cohort and preform a more granular stratification of the group by CAC score.
Benefits of 4-tiered classification of exercise-induced left ventricular hypertrophy in adolescent athletes
Authors: Szabo D , Eklics K , Szokodi I , Cziraki A , Toth M , Sarszegi Z S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation and Technology Ministry Hungary - National Research, Development and Innovation Office (Innovációs és Technológiai Minisztérium - Nemzeti Kutatási, Fejlesztési és Innovációs Hivatal Hungary.

Introduction
Exercise-induced left ventricular hypertrophy (LVH) is widely investigated in adolescent athletes characterized by 2-tiered classification (2TC). Though, the differentiation of normal adaptive changes from pathological LVH can be challenging. 4-tiered classification (4TC) may discriminate better different forms of exercise-induced LVH providing three-dimensional information of the left ventricle (LV).

Purpose, methods
The main objective of our study was to distinguish alterations between 2TC and 4TC examining 121 adolescent athletes with echocardiography. Moreover, these results were also compared to the matched LV parameters of 114 adult athletes.

Results
Examining the 4TC allocation representing parameters (LV mass, LV mass/BSA, LV end-diastolic volume/BSA, concentricity) of the adolescent and adult athletes we identified significant differences (p&lt; 0,05) between the different LVH groups and normal geometry, suggesting that the applied classification provides proper group distinguishing power. There were no significant differences between the cumulative training times of the different LVH groups (p &gt;0,05). Furthermore, the BSA corrected LV parameters did not show any correlation with training time. Totally 25 athletes (22%) were reclassified in 4TC into completely different groups, highlighted the 6 athletes (5%) reclassified from normal geometry to concentric LVH and the 11 adolescent (9%) reclassified from normal to eccentric LVH. The reclassifications rate showed similar pattern in adult athletes.

Conclusion
Based on all these data we assume that training time has no significant impact on the classification. Cardiac remodeling develops already in young age, and further training time has less impact on the adaptive changes. We prefer to apply 4TC in the routine echocardiographic examination of endurance athletes to specify a more sensitive and distinct screening method.
Aortic root and left ventricular diameters ratio: a new tool to differentiate the athlete's heart from pathological aortic dilatation
Authors: Ragazzoni G L , Cavigli L , Quer L , Cangiano N , Santoro A , Mandoli G E , Pastore M C , Focardi M , Cameli M , Valente S , D'ascenzi F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Training-induced cardiac remodelling is usually accompanied by a harmonic and symmetric adaptation of cardiac chambers. Mild aortic enlargement may be a consequence of intense training, although even the definition of aortic dilatation, particularly in athletes and tall athletes, is sometimes challenging. It is therefore essential to early identify competitive athletes with aortic dilatation to manage this condition appropriately.

Purpose
This study aimed to test a new parameter for the definition of aortic dilatation in competitive athletes, assessing the balancing cardiac remodelling in athletes through the ratio between the aortic diameter and left ventricular (LV) diameter.

Methods
Competitive athletes were compared with sedentary subjects and with patients with known aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26±7 years), 410 sedentary (74.1% males, mean age 29±11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56±7 years).

Results
Patients with aortic dilatation had both an absolute (39.2±2.4 mm) and indexed (19.4±2.2 mm/m2) aortic diameter larger than athletes (30.6±3.2 mm; 16.1±1.5 mm/m2) and sedentary subjects ( 30.5±3.1 mm; 16.5±1.6 mm/m2), with no statistically significant differences between athletes and sedentary subjects. The ratio between the aortic diameter and LV end-diastolic diameter was lower in athletes (0.59 ± 0.06), compared to sedentary subjects (0.65 ± 0.05) and to patients with aortic dilatation (0.81 ± 0.06). The latter had a significantly higher value than the remaining groups (p &lt;0.05). The analysis of the ROC curves highlighted that the cut-off of the ratio between the aortic root diameter and LV diastolic diameter was 0.71, with a 96% sensitivity and 99% specificity of detecting a pathological aortic dilatation.

Conclusions
This study tested a new echocardiographic parameter for the definition of an aortic dilatation in competitive athletes. The ratio between aortic diameter and LV end-diastolic diameter, with a cut off of 0.71, demonstrated a good sensitivity and specificity to differentiate between physiological and pathological remodelling of the aorta.
Proteomics and recurrence of atrial fibrillation: a pilot study nested in the PREDIMAR trial
Authors: Razquin C , Fernandez-Irigoyen J , Barrio-Lopez M T , Ramos P , Macias R , Ibanez-Criado A , Santamaria E , Goni L , Castellanos E , Ibanez-Criado J L , Tercedor L , Garcia-Bolao I , Martinez-Gonzalez M A , Almendral J , Ruiz-Canela M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III (ISCIII): Fondo de Investigación Sanitaria y Fondo Europeo de Desarrollo Regional and Proteored Regional Government of Navarra.

Introduction
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. Although catheter ablation is the most efficacious therapy to decrease AF recurrences, relapses occur in 30% of patients in the first year after ablation. Novel biomarkers of recurrence are needed for a better prediction and management of AF.

Purpose
In this pilot study we aimed to analyze the baseline proteome of subjects included in a case-control study nested within the PREDIMAR, a secondary prevention trial, to find differential proteins associated with AF recurrence.

Methods
We selected 18 cases defined as AF recurrence and 18 controls without AF recurrence matched by age. After QC process, baseline serum proteomics data (354 proteins) from 16 cases and 17 controls were obtained.

Results
Ten proteins were differentially represented in cases vs controls. keratin type I cytoskeletal 17 (K17) (FC=2.14; p=0.017) and endoplasmic bifunctional protein (GDH/6PGL) (FC=1.65; p=0.032). Eight proteins were underregulated among cases vs controls: c4b-binding protein alpha chain (C4bpA) (FC=0.64; p=0.006), coagulation factor XI (FXI) (FC=0.83; p=0.011), chloride intracellular channel protein 1 (CLIC1) (FC=0.62; p=0.017), haptoglobin (FC=0.37; p=0.021), immunoglobulin heavy constant alpha 2 (Ig alpha-2 chain C region) (FC=0.49; p=0.022), c4b-binding protein beta chain (C4bpB) (FC=0.73; p=0.028), N-acetylglucosamine-1-phosphotransferase subunit gamma (GlcNAc-1-phosphotransferase subunit gamma) (FC=0.61; p=0.033) and platelet glycoprotein Ib alpha chain (GP-Ib alpha) (FC=0.84; p=0.038).
In multivariate logistic models, we found that even after the adjustment for age, sex, BMI, T2D and hypertension the direct association between K17 and the inverse association between C4bpA, F11, CLIC1, IGHA2, GNPTG and GP1BA with AF recurrence maintained the statistical significance.
F11, C4bpA, C4bpB and CLIC1 have been previously associated with first arrhythmia or AF.
This pilot study suggests that the circulating proteome may serve as a predictor of AF recurrence after catheter ablation.