bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial hypercholesterolemia in community-based KHDC Nepal program-baseline data
Authors: Sharma S K , Adhikari S , Shah N , Aebischer Perone S , Lab B , Heller O , Chappuis F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): HUG and Republic and Canton of Geneva – Service de solidarité internationaleBP Koirala Institute of Health Sciences
Familial hypercholesterolemia (FH) is either underdiagnosed or diagnosed after primary coronary events. Although homozygous variant of FH is considered rare, heterozygous FH is estimated to occur in about 1 in 200 to 300 individuals. There is no study pertaining to prevalence of FH in Nepal which could be a factor influencing cardiovascular morbidity and mortality.
We present a baseline data of FH in an ongoing in participants of community-based cardiovascular and kidney diseases preventive (KHDC Nepal) program in Mechinagar municipality in Eastern Nepal.
KHDC is a program to collaborate among health post, primary health center or equivalent, and local government along with community representatives created to educate, screen, and intervene for selective NCDs. This program is in alignment with the World Health Organization’s Package of Essential Noncommunicable (WHO PEN) disease interventions for primary health care in low-resource settings. General health status and lifestyle habits, physical examination, and blood pressure were assessed. Blood tests done included fasting lipid profile, serum creatinine, FBS, and HbA1c. A mechanism was developed to follow-up screened positive persons in the primary health centers. Referrals were made to the tertiary care center as needed.
We analyzed initial 7289 participants, 20 years or above, who were enrolled in KHDC program in the year 2020. We assessed for FH using Dutch Lipid Clinic Network(DLCN), Simon Broome and AHA criteria. Participants were categorized as definite, probable, possible, or no FH based on the scores of DLCN criteria; as definite and probable based on Simon Broome criteria and as clinically diagnosed FH based on AHA criteria.
The median age of the patient was 54 years, the majority being females (62.7%). A total of 70(0.96%) of the participants had elevated LDL-C levels of more than 190mg/dl detected during the screening and had no secondary cause for hyperlipidemia. According to DLCN criteria, 65(0.89%) participants were grouped under possible FH, 5(0.06%) were grouped under probable FH while none of them could be delineated as definite FH. According to Simon Broome criteria, 14(0.2%) participants were grouped under probable and none of them could be delineated as definite. According to AHA criteria, 10 (0.13%) participants were categorized as clinically diagnosed FH. DNA analysis was not available in our setup. Clinically manifested atherosclerotic disease was recorded in 5 participants. None of the participants were aware of the FH.
This community-based program of the adult population help create baseline data of FH in Nepal. Larger study with genetic analysis is likely to reveal true prevalence of FH in Nepal.
The most important safety risk of fish oil from the latest meta-analysis?
Authors: Yan J , Liu M , Yang D , Zhang Y , An F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This project was supported by the National Natural Science Foundation of China (No. 81670325 and No. 81370325).

Background
Fish oil supplements are popular worldwide, and many people believe that fish oil supplements are beneficial to their health. However, there is still controversy about whether Omega-3 fatty acids can reduce the cardiovascular risk of users. In recent years, the publication of several large randomized controlled trials has pointed out the direction for us to use fish oil supplements.

Purpose
We conducted a meta-analysis of recently released large randomized controlled trials to evaluate the clinical value of fish oil supplements.

Methods
Five latest large randomized controlled trials on Omega-3 fatty acids were included, including the ASCEND study, VITAL study, REDUCE-IT study, STRENGTH study and OMEMI Study. We analyzed the effects of fish oil supplements on the incidence of major cardiovascular events, myocardial infarction, stroke, atrial fibrillation, death from cardiovascular cause and death from all-cause.

Results
Fish oil supplements can significantly reduce the risk of myocardial infarction in users (RR 0.85, 95%CI 0.72- 0.99; P = 0.04), however, significantly increase the risk of atrial fibrillation (RR 1.32 95%CI 1.11-1.58; P=0.002). The use of fish oil supplements had no effect on the incidence of major cardiovascular events (RR 0.93, 95%CI 0.84-1.04; p=0.23) and stroke (RR 0.99, 95%CI 0.84-1.17; P = 0.93). Similarly, there was no effect on death from cardiovascular cause (RR 0.91, 95%CI 0.79-1.05; P = 0.20) and death from all-cause (RR 0.99, 95%CI 0.92-1.07; P = 0.79).

Conclusion
The results of this meta-analysis showed that fish oil supplements can reduce the incidence of myocardial infarction, but significantly increase the risk of atrial fibrillation. We should reconsider the role of fish oil supplements in preventing cardiovascular disease. We also need some large randomized controlled trials to verify the risk of atrial fibrillation caused by the use of fish oil supplements.
Tailor-made cardiac rehabilitation for patients with obesity: results of the OPTICARE-XL randomized controlled trial
Authors: Ter Hoeve N , Den Uijl I , Sunamura M , Stam HJ , Boersma H , Lenzen MJ , Brouwers RWM , Tenbult-Van Limpt NCCW , Kemps HMC , Van Den Berg-Emons HJG 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Organisation for Health Research and Development (ZonMW) and Capri Cardiac Rehabilitation

Background
More than a third of the patients referred to cardiac rehabilitation (CR) suffers from obesity, and this number is growing. However, in patients with obesity, standard CR is not effective in achieving the recommended physical activity levels and results achieved in weight loss and health related quality of life (HRQOL) are unsatisfactory.

Purpose
To describe the effectiveness of a new state of the art CR program designed for patients with obesity, OPTICARE XL, on weight, physical activity and HRQOL.

Methods
A total of 201 patients that were referred to CR after a diagnosis of coronary artery disease (CAD) or atrial fibrillation (AF) and a BMI≥30 were randomized to standard CR (n=99) or OPTICARE XL CR (n=102). Standard CR consists of a 6 till 12 week aerobic exercise program, supplemented with cardiovascular lifestyle education. OPTICARE XL CR is a one-year intervention including aerobic and strength exercise, behavioral coaching on diet and physical activity and an after-care program. Weight was measured with a calibrated weight scale, physical activity (steps/day) was measured with an Actigraph GT3X+, and HRQOL with the MacNew questionnaire. Data was analyzed by means of linear mixed-effect models.

Results
Included patients had a mean age of 59 years, were predominantly male (73%) and the majority was referred to CR after a CAD (66% CAD, 34% AF). Patients in the OPTICARE XL group showed on average greater weight loss three months after the start of CR (mean change -3.6 kg vs -1.8 kg, respectively, p=0.002). Six months post CR, changes in body weight were equal between groups (-2.5 kg in both groups, p=0.959). No significant between-group differences were seen in improvements in physical activity both three months after the start of CR (+880 steps/day for OPTICARE XL vs +481 steps/day for standard CR, p=0.169) and six months post CR (+331 steps/ day vs +283 steps/day, p=0.919). With regard to HRQOL score, also no significant between groups differences in improvements were seen both three months after the start of CR (+0.6 for OPTICARE XL vs +0.5 for standard CR, p=0.169) and six months post CR (+0.5 for both groups, p=0.907).

Conclusion
OPTICARE XL had added value on the short-term, but this did not sustain on the long-term. We suggest to re-evaluate the OPTICARE XL program to expand short-term effects.
Leveraging cluster analysis of weather and pollution features to predict acute cardiac or cerebrovascular events
Authors: Testa A , Anticoli S , Pezzella FR , Mangiardi M , Di Giosa A , Marchegiani G , Frati G , Sciarretta S , Peruzzi M , Cavarretta E , Gaspardone A , Mariano E , Versaci B , Versaci F , Biondi-Zoccai G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Despite mounting evidence, the impact of the interplay between weather and pollution features on the risk of acute cardiac and cerebrovascular events has not been entirely appraised.

Purpose
We aimed to perform a comprehensive cluster analysis of weather and pollution features in a large metropolitan area, and their association with acute cardiac and cerebrovascular events.

Methods
Anonymized data on acute myocardial infarction (AMI) and acute cerebrovascular events were obtained from 3 tertiary care center from a single large metropolitan area. Weather and pollution data were obtained averaging measurements from several city measurement stations managed by the competent regional agency for enviromental protection, and from the Metereologic Center of Italian Military Aviation. Unsupervised machine learning was performed with hierarchical clustering to identify specific days with distinct weather and pollution features. Clusters were then compared for rate of acute cardiac and cerebrovascular events with Poisson models.

Results
As expected, significant pairwise correlations were found between weather and pollution features. Building upon these correlations, hierarchical clustering, from a total of 1169 days, generated 4 separate clusters: mostly winter days with low temperatures and high ozone concentrations (cluster 1, n=60, 5.1%), days with moderately high temperatures and low pollutants concentrations (cluster 2, n=419, 35.8%), mostly summer and spring days with high temperatures and high ozone concentrations (cluster 3, n=673, 57.6%), and mostly winter days with low temperatures and low ozone concentrations (cluster 4, n=17, 1.5%). Overall cluster-wise comparisons showed significant overall differences in adverse cardiac and cerebrovascular events (p&lt;0.001), as well as in cerebrovascular events (p&lt;0.001) and strokes (p=0.001). Between-cluster comparisons showed that Cluster 1 was associated with an increased risk of any event, cerebrovascular events, and strokes in comparison to Cluster 2, Cluster 3 and Cluster 4 (all p&lt;0.05), as well as AMI in comparison to Cluster 3 (p=0.047). In addition, Cluster 2 was associated with a higher risk of strokes in comparison to Cluster 4 (p=0.030). Analysis adjusting for season confirmed the increased risk of any event, cerebrovascular events and strokes for Cluster 1 and Cluster 2.

Conclusions
Unsupervised machine learning can be leveraged to identify specific days with a unique clustering of adverse weather and pollution features which are associated with an increases risk of acute cardiovascular events, especially cerebrovascular events. These findings may improve collective and individual risk prediction and prevention.
Independent and additional value of cardiopulmonary exercise test to the new york heart association classification in heart failure
Authors: Moraes Alves De Souza I , Donelli Da Silveira A , Stein R , Santos Pereira Ramos JV , Sadigursky Ribeiro R , Meira Pazelli A , Borges De Oliveira Q , Sahade Darze E , Fonteles Ritt LE 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Cardiopulmonary Exercise Test (CPET) is the gold standard test for functional assessment in Heart Failure (HF), but it has not been adequately evaluated on top of the New York Heart Association (NYHA) class.

Purpose
We aimed to assess the independent and additional value of CPET to NYHA class in patients with HF and ejection fraction (EF) &lt;50%. Our secondary purpose is to assess the performance of CPET variables in patients with better (NYHA I or II) and worse (NYHA III or IV) functional class.

Methods
Patients with HF and reduced or mid range ejection fraction (EF) who underwent CPET were followed for the occurrence of the primary end point of death, heart transplantation and left ventricular assist device (LVAD) implant. Cox regression analysis and ROC curve analysis were used to determine independent predictors for the primary outcome and the additional CPET value, respectively. Kaplan–Meier failure curves were created to illustrate time to primary end point. A value of p &lt;0.05 was considered statistically significant.

Results
613 patients were followed for a mean of 30 ± 22 months. Mean age was 56 ± 12 years, 64% were male, mean EF was 30 ± 8%. NYHA as follows: NYHA I 32%, NYHA II 41%, NYHA III 24% and NYHA IV 2.8%. The rate of primary outcomes was 13%. Death occurred in 8.7%, heart transplantation in 4.4% and there were no cases of LVAD´s implantation. Independent predictors of the primary outcome were: EF (HR 0.946; 95% CI 0.918-0.976; p&lt;0.001), NYHA (HR 2.1; 95% CI 1.55-2.73; p&lt;0.001). When peak VO2 was added to the model, it was maintained as an independent predictor (HR 0.90; 95% CI 0.85-0.96; p 0.001), as was the percentage of predicted peak VO2 (HR 0.03; 95% CI 0.007-0.147; p&lt;0.001), VE/VCO2 slope (HR 1.02; 95% CI 1.01-1.04; p 0.011) and CPET score (HR 1.16; 95% CI 1.06-1.27; p&lt;0.001). ROC curve of the predictor model with only NYHA and ROC curves of the models adding the other CPET variables are shown in Figure 1. There was no significant difference between the curves of the model containing only NYHA and the models with the CPET parameters or the CPET score (Table 1). VO2 peak and VE/VCO2 slope were able to discern survival in functional classes I and II (log rank p &lt; 0.001), but were not clearly in classes III and IV (log rank p = 0.113 and p = 0.124 respectively). CPET score was able to discern survival in both groups, in those with the best and worst functional class (log rank p &lt; 0.05).

Conclusion
CPET variables were independent predictors of prognosis in HF, even when controlled by NYHA class. Although they have independent value, their additional value was modest and not statistically significant.
Cardiopulmonary exercise testing in post-COVID-19 patients: Where does exercise intolerance come from?
Authors: Milani M , Milani JGPO , Cipriano GFB , Cahalin LP , Stein R , Cipriano Junior G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Background
Post-COVID-19 persistent symptoms and exercise intolerance are poorly understood. Cardiopulmonary exercise testing (CPET) assessment is important to address the sources of the underlying symptoms and limitations.

Purpose
To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects via CPET.

Methods
This cohort study assessed subjects with different SARS-CoV-2 illness severities. The propensity score matching method was used to select the control group. Patients with available CPET prior to SARS-CoV-2 infection were compared before and after COVID-19.

Results
288 subjects (144 post-COVID-19 and 144 matched-controls) were assessed. The median age was 43.0 years, and 57% were male, with different illness severity (60.4% mild, 20.8% moderate, 18.8% severe). Residual symptoms were reported in 41% of the sample. CPET was performed 14.4±9.4 weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (91.7%), pulmonary (6.3%), and cardiovascular (2.1%) systems. Lower median percent-predicted peak oxygen consumption was observed in the severe subgroup (72.2%) compared to both mild (98.5%) and control subgroups (91.6%). Peak oxygen consumption (peakVO2), VO2 at the ventilatory thresholds (VO2 at VT), and heart rate differed among illnesses, severities, and controls. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar (Figure 1). Additional subgroup analysis of 42 subjects with prior CPET revealed changes only on peak treadmill speed in the mild subgroup and additional reductions on peakVO2 and VO2 at VT in the moderate/severe subgroup (Figure 2), while ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse remained unchanged.

Conclusions
Peripheral muscle fatigue was the most common etiology of exercise limitation in post-COVID-19 patients regardless of the SARS-CoV-2 illness severity. Our data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components.
Assessment of cardiorespiratory fitness and physiological responses with different ergometers in people with bipolar disorder: data from the FINEXT-BD study
Authors: Gorostegi-Anduaga I , Etxaniz-Oses J , Maldonado-Martin S , Garcia-Corres E , Gonzalez-Pinto A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III

Background
Bipolar disorder (BD) is a mental illness in which manic and depressive episodes are combined. People with BD are associated with an unhealthy lifestyle. Assessment of cardiorespiratory fitness (CRF) indicates the overall health of the person and is essential for the design of the exercise intensity ranges in an individualized way. The assessment of CRF can be performed with different ergometers (treadmill, T vs. cycloergometer, C) and the results may differ.

Purpose
To analyze and compare the CRF and physiological responses of two peak, progressive and ramped protocols on different ergometers (T and C) in people with BD.

Methods
Physiological variables (peak blood pressure, test duration, ventilatory threshold, peak heart rate, peak oxygen uptake [VO2peak], peak metabolic equivalent) assessed by cardiopulmonary exercise tests (T and C) were measured in participants (n=28, 67.8% women, 45.9±12.5 yr old) with BD.

Results
Differences were found in peak systolic blood pressure (T=148±29.5 vs. C=184±32.7 mmHg, P&lt;0.001, Cohen's d=1.14), peak diastolic blood pressure (T=79±10.7 vs. v=88±17.1 mmHg, P&lt;0.01, Cohen's d=0.72) and test duration (C=9.4±3.6 vs. T=11.3±4.9 min, P&lt;0.01, Cohen's d=0.43) with higher values in C (24.5%, 12.4% and 19.6%, respectively). No other statistically significant (P&gt;0.05) between ergometers-differences were found in the rest of studied variables, including VO2peak as the gold standard of CRF assessment (T=23.8±7.6 vs. C=24.6±7.7 mL·kg-1·min-1).

Conclusions
The no differences between ergometers (T vs. C) when assessing CRF and physiological responses in people with BD indicate that both modes of assessment could be used interchangeably. The increased blood pressure response in C compared to T could be due to unfamiliarity with the ergometer and the physiological factors that determine blood pressure.
Feasibility and preliminary effects of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR): A pilot randomised controlled trial
Authors: Chong M S , Sit JWH , Choi KC , Suhaimi A , Chair SY 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
As COVID-19 pandemic continues, using technologies within cardiac rehabilitation facilitates access to care and reduces the frequency of direct contact with vulnerable cardiac patients. We aimed to assess the feasibility of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) and preliminarily evaluate its effects on patients with coronary heart disease (CHD).

Methods
Between February 2021 to May 2021, a total of 28 patients with CHD were recruited and randomised to receive a 12-week TecHCR programme (n = 14) or a 12-week conventional, centre-based programme (n = 14). The TecHCR group received three center-based, supervised exercise training sessions. Participants were instructed to wear a fitness tracker watch for exercise self-monitoring at home environment, and the exercise data were shared through a web-based application for remote monitoring by the intervener. Participants received six audio-visual educational videos via a messaging application and a weekly video/telephone call follow-up. Self- Efficacy for Exercise (ESE), Health Promoting Lifestyle Profile II (HPLP II), Hospital Anxiety and Depression Scale (HADS), exercise capacity and cardiovascular health outcomes were assessed at baseline and at 12th week on completion of the programme. Generalised estimating equations analysis was conducted to compare the outcomes between groups.

Results
Out of 28 participants (56.46±12.98 years old; 1 female), 67.9% had percutaneous coronary intervention and 28.6% had coronary bypass grafting surgery. Among 14 participants in the TecHCR group, three dropped out due to: 1) fear to attend face-to-face supervised exercise training during high daily COVID-19 cases; 2) infected with COVID-19 and 3) found a job in overseas. Eleven participants in the TecHCR group attended all video/telephone call sessions, nine participants completed 3 supervised exercise training sessions and nine participants adhered to the weekly exercise recommendations. No treatment-related adverse events were reported. TecHCR was non-inferior to conventional, centre-based program on exercise self-efficacy, exercise capacity and cardiovascular health outcomes. TecHCR group showed significantly greater improvement in health-promoting behavior when compared with the control group (p =0.013) at post-intervention.

Conclusion
This pilot study demonstrated the feasibility in recruitment and implementation of TecHCR as an alternative delivery mode and could enhance health-promoting behavior among patients with CHD.

Implications
The TecHCR program provides accessible interventions to patients without frequent visits to the outpatient centre. A full-scale randomised controlled trial is needed to confirm the effectiveness of TecHCR.