bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity among countries in primary cardiovascular prevention guidelines: missed opportunities for adherence and improved outcomes
Authors: Santilli F , Blaha MJ , Li L , Li X , Na SH , Shi Z 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Bayer AG

Background
· Specialty-driven guidelines identify risk factors for cardiovascular (CV) events that may potentially be modified by lifestyle or pharmacotherapy.

Purpose
· Worldwide, the control of modifiable risk factors in people at high cardiovascular disease (CVD) risk remains poor. Our hypothesis is that differences in multiple, specialty-driven guidelines do not help, and may hinder, the accurate assessment of CV risk factors and their appropriate management in the individual patient that has multiple risk factors or comorbidities.

Methods
· We conducted a review of the most recent guidelines for CVD prevention, diabetes, hypertension, dyslipidaemia and chronic kidney disease used in Europe, Italy, the USA, China and South Korea to establish the commonalities and differences between risk factor targets, risk modifiers and treatment approaches.

Results
· The use of low dose aspirin in patients at high risk of CVD varies between regions, and between those with and without type 2 diabetes (T2D). In addition, the use of concomitant proton pump inhibitor (PPI) treatment, that may reduce the gastrointestinal bleeding risk and therefore allow more people to be included for low dose aspirin treatment consideration, is variable (see table).
· There are also differences in the definitions of risk stratification, targets for major risk factors and the use of coronary artery calcium score (CAC) to identify high-risk, asymptomatic patients.
· The LDL-C targets for patients with T2D at high CV risk vary from &lt;1.8 mmol/L (&lt;70 mg/dL)1,2,10 to &lt;2.6 mmol/L (&lt;100mg/dL);9 and those for patients with T2D at very high CV risk vary from &lt;1.4 mmol/L (&lt;55 mg/dL)1,2 to &lt;1.8 mmol/L (&lt;70 mg/dL).9
· Although CAC score is identified as a risk modifier in most guidelines, its use to guide treatment decisions in patients with ≥7.5% to &lt;20% 10-year ASCVD risk is recommended in only two guidelines.4,6

Conclusion(s)
· We suggest that physicians cannot synthesise specialty-based recommendations for a single patient with multiple comorbidities within a limited consultation time, and that this may be a major factor in the lack of progress in managing CV risk factors.
· A more unified, consistent and global approach to primary prevention of CV disease across specialties may lead to greater guideline adherence, greater patient understanding and acceptance of therapy, and improved outcomes.
Sexual dysfunction in women with increased cardiovascular risk
Authors: Vetkova M , Angelov A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Normal sexual function is considered as an essential aspect of quality of life. Distortions of the sexual activity can result in psychosocial conflicts, separation, depression and even increased morbidity and mortality. Sexual dysfunction (SD) is age related, progressive and more prevalent among women than men. An increased prevalence of SD has been reported in females with risk factors for cardiovascular (CV) disease.

Aim
To evaluate SD among women with increased CV risk compared with the general female population using Female Sexual Function Index (FSFI).

Methods
107 women with hypertension and/or diabetes mellitus (DM) and 75 healthy women were enrolled in the study. All participants completed questionnaires, evaluating their sociodemographic characteristics, health status, physical activity and sexual function (FSFI).

Results
Mean subject age was 50,4±6,62 y. in the group with increased CV risk and 47,1±6,97 y. in the control group, respectively (p&lt;0,001). There were no significant differences between the groups due to the other baseline sociodemographic characteristics – marital status, educational level, employment and income. Higher prevalence of menopause in the group with increased CV risk was found (63,6% vs 37,3%, p&lt;0,001). Dyslipidemia (52,9% vs 28,9%, p&lt;0,01), obesity (34,6% vs 8%, p&lt;0,001) and family history of premature coronary artery disease (20,6% vs 8,1%, p=0,02) were significantly more prevalent in females with increased CV risk. There was no significant difference between the groups due to the prevalence of smoking (72,9% vs 64%, NS). The majority of the study population had minimal or no everyday physical activity. No significant difference in physical activity between both groups was observed. According to FSFI, women with increased CV risk more often had SD (64% vs 33,3%, p&lt;0,001). The scores in all domains of sexual function – desire, arousal, lubrication, orgasm, satisfaction and pain, were significantly lower in women with hypertension and/or DM compared with the control group. These trends seemed more prominent in premenopause females. No significant difference in the FSFI score was found between both groups in postmenopausal women. The FSFI score was significantly lower in the subgroup of premenopausal women with increased CV risk compared with premenopausal participants in the control group (21,02±10,98 vs 28,24±5,37, p&lt;0,001).

Conclusion
Females with hypertension and/or DM more often have other CV risk factors like dyslipidemia, obesity and family history of premature coronary artery disease. They also have increased prevalence of SD, especially in premenopausal women. Screening for increased CV risk should be discussed in premenopausal women with SD.
Overall benefits of smoking cessation in patients with ASCVD are underestimated
Authors: Van Trier T , Snaterse M , Hageman SHJ , Ter Hoeve N , Sunamura M , Moll Van Charante EP , Galenkamp H , Deckers JW , Visseren FLJ , Scholte Op Reimer WJM , Peters RJG , Jorstad HT 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
New risk prediction models estimate and employ individual ‘treatment benefit’, which can be used to motivate patients with atherosclerotic cardiovascular disease (ASCVD) to quit smoking and to adhere to beneficial pharmacological interventions. However, this treatment benefit is usually calculated for a limited set of cardiovascular outcomes, i.e. years gained without myocardial infarction or stroke, while ignoring non-cardiovascular health benefits and pharmacological side- and adverse effects. Importantly, treatment effect size of medication is smaller in persistent smokers compared to non-smokers, because of the higher overall mortality of the smokers. By disregarding non-cardiovascular outcomes, the overall benefit of smoking cessation will be underestimated.

Purpose
We estimated and compared the treatment benefits – expressed as ‘gain in years without major cardiovascular events’ – of smoking cessation versus persistent smoking with targeted pharmaceutical interventions in patients with established ASCVD treated with anti-platelet agents, statins and anti-hypertensive drugs.

Methods
We pooled individual-level risk factors data from six large, recent prospective studies: RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V and HELIUS. We included patients aged ≥45 years who persisted in smoking ≥6 months after acute coronary syndrome or revascularisation. The primary outcome was SMART-REACH estimated treatment benefit expressed as gain in years without a myocardial infarction or stroke. We compared the cardiovascular treatment benefit of smoking cessation versus the use of one or more pharmaceutical treatments: bempedoic acid, colchicine and PCSK9 inhibitors.

Results
We included 989 smokers with established ASCVD (23% female), with mean age of 60 (SD 8) years at median 1.2 (IQR 1.0-2.0) years post-index event. A mean of 4.81 (95%CI 4.73-4.89) event-free years would be gained through smoking cessation. Persistent smoking with maximal pharmaceutical treatment resulted in a comparable gain of 4.83 (95% CI 4.72-4.93) event-free years.(Figure)

Conclusion
The estimated lifetime treatment benefit of smoking cessation appeared to be comparable to the use of several pharmaceutical treatments combined, even when the analysis was limited to major cardiovascular events. This substantial health benefit underscores smoking cessation to be one of the most important actions to improve the overall health of patients with established ASCVD. To accurately compare treatment options, overall benefits and harms should be considered, in addition to the patients’ preferences, in a shared decision making process.
Long-term cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients: a case-control study
Authors: Van Der Sluijs KM , Bakker EA , Schuijt TJ , Joseph J , Thijssen DHJ , Eijsvogels TMH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation (Nederlandse Hartstichting)

Background/Introduction
SARS-CoV-2 and the associated coronavirus disease 2019 (COVID-19) has substantial acute effects on cardiovascular health and physical functioning, but the long-term effects are less clear, especially in individuals that recover from COVID-19 at home, representing ~95% of all cases.

Purpose
We compared cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients versus age- and sex-matched healthy peers.

Methods
We recruited non-hospitalised adults with PCR-proven COVID-19 and age- and sex-matched controls for this case-control study. Duration of COVID-19 illness and presence of residual complaints were inquired. Cardiovascular health status and physical functioning were assessed through a series of measurements: blood pressure, blood biomarkers (NT-proBNP, high-sensitive cardiac troponin I, C-reactive protein), carotid-femoral pulse wave velocity (ARTSENS), handgrip strength, 4-metre gait speed, habitual physical activity (days per week with at least 30 minutes of moderate physical activity) and quality of life based on the 12-item short form.

Results
We included 101 ex-COVID-19 patients (median age 59.0 [54.5-65.5], 59 (58.4%) male) at a median of 5.0 [4.0-7.0] months post-infection and 101 age- and sex-matched controls (median age 58.0 [54.0-64.5], 58 (57.4%) male). Median duration of COVID-19 illness was 8.0 days [6.0-14.0] and 32.3% of the cases reported residual complaints at the time of inclusion. We found no differences between ex-COVID-19 patients and controls in blood pressure (134-81 vs. 133-81 mmHg, p=0.40 and p=0.30 for systolic and diastolic pressures respectively), concentrations of NT-proBNP (8.50 vs. 7.00 pmol/L, p=0.22), high-sensitive cardiac troponin I (4.11 vs. 3.38 ng/L, p=0.06), C-reactive protein (4.00 vs. 4.00 mg/L, p=0.93) and carotid-femoral pulse wave velocity (6.63 vs. 7.01 m/s, p=0.30). Ex-COVID-19 patients showed higher handgrip strength compared to controls (43 kg vs. 38 kg, p=0.004), but 4-metre gait speed (2.62 vs. 2.56 s, p=0.33), habitual physical activity levels (6.0 vs. 6.0 days, p=0.16) and reported quality of life (86.4% vs. 88.6%, p=0.10) were not different between groups.

Conclusion(s)
Cardiovascular health and physical functioning parameters were not different between non-hospitalised ex-COVID-19 patients and age- and sex-matched controls at five months post-infection. This suggests that individuals who recovered from COVID-19 at home do not have an increased cardiovascular risk or impaired physical functioning in the long-term.
Post-discharge light physical activity indicates recovery in acutely hospitalized older adults
Authors: Terbraak M , Kolk MS , Macneil Vroomen JL , Twisk JWT , Buurman BM , Van Der Schaaf M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Netherlands Organization for Health Research and DevelopmentThe Dutch Research Council

Introduction
Physical activity levels might be a simple overall physical marker of recovery in acutely hospitalized older adults; however, cut-off values post discharge are lacking.

Purpose
We aim to identify cut-off values for post-discharge physical activity that indicate recovery among acutely hospitalized older adults and stratified for frailty.

Methods
Prospective observational cohort study including acutely hospitalized older adults (≥70 years) during hospitalization and at home. Frailty was assessed using Fried’s criteria. Steps and intensity of physical activity were assessed using Fitbit up to one week post discharge. The primary outcome was recovery at 3-months post discharge. ROC-curve analyses were used to determine cut-off values, and logistic regression analyses to calculate odds ratios (ORs).

Results
The analytic sample included 174 participants with a mean (standard deviation) age of 79.2 (6.7) years of whom 84/174 (48%) were frail and 67 (39%) had cardiac disease. At 3-months, 109/174 participants (63%) had recovered. In all participants, determined cut-off values were 1369 steps/day (OR: 2.5, 95% confidence interval [CI]: 1.3–4.6) and 76 minutes/day of light intensity activity (OR: 3.0, 95% CI: 1.6–5.8). In frail participants, cut-off values were 1043 steps/day (OR: 3.3, 95% CI: 1.3–8.4) and 72 minutes/day of light intensity activity (OR: 4.2, 95% CI: 1.6–10.8). Determined cut-off values were not significantly associated with recovery in non-frail participants.

Conclusions
We recommend at least 1369 steps per day and 76 minutes of light activity to help older patients’ recovery from an acute hospitalization.
Association of cardiac structural abnormalities, cardiometabolic health, and development of chronotropic incompetence
Authors: Prana Jagannatha G , Dwi Adelia Yasmin AAA , Surya Pradnyana IWA , Kamardi S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Recent studies suggest chronotropic incompetence is statistically correlated with poor cardiometabolic health, systemic inflammation, and heart structural abnormalities. All may lead to exercise intolerance, impaired quality of life, and death due to cardiovascular disease (CVD). Unfortunately, there’s still a lack of data regarding which factors are associated with chronotropic incompetence.

Purpose
The purpose of this study was to identify the cardiometabolic risk factors, electrocardiographic (ECG), and echocardiographic (Echo) parameters that associated with chronotropic incompetence.

Methods
All patients who underwent cardiac treadmill stress test, ECG, and Echo in our hospital were included in this study, enrolled from 2018 until 2020. Patients were separated into two groups, patients with chronotropic incompetence and those without chronotropic incompetence. Chronotropic incompetence is defined as a maximum heart rate that can’t reach 85% age-predicted maximum heart rate. SPSS version 21 was used for data analysis. Pearson chi-square test was used to compare categorical variables based on clinical baseline characteristic, and cardiometabolic risk factors. We are using the Mann-Whitney U test to evaluate the association between ECG and Echo findings with chronotropic incompetence.

Results
Among 136 subjects of this study, the mean age was 54.7 years, 71.3% were male and 37.5% had chronotropic incompetence. Baseline characteristics and cardiometabolic factors such as T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), total cholesterol (PR 2.396; 95%CI 1.650-3;481), and LDL (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value &lt;0.05), while other factors were not significantly related. In ECG and Echo parameters, patients with chronotropic incompetence were found to had high Cornell product (1823.6±429.6vs1476.9±273.8), lower LVIDd (42.8±0.89 vs 45.2±0.72, p=0.029), lower LVIDi (24.6±0.37 vs 25.5±0.31, p=0.025), higher left ventricular mass (175.6±3.27 vs 125.1±2.63, p&lt;0.001), higher E/E’ ratio (17.3±0.29 vs 13±0.35, p&lt;0.001), and higher LAVI (47±1.98 vs 31.6±1.09, p&lt;0.001) compared with patients without chronotropic incompetence.

Conclusion(s)
There are association between chronotropic incompetence with cardiometabolic factors and structural abnormalities that indicate increased LV filling pressure. The development of chronotropic incompetence may be predicted by assessing these factors
Prevalence and impact of high BMI in CAD patients
Authors: Eid O , Eid R , Styliou T , Diakonikolaou S , Christou V , Karataraki F , Abdelrahman R , Moutiris J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
High body mass index (BMI) is a precursor to coronary artery disease (CAD) and an aggravator of the other co-existing CAD risk factors such as diabetes and hypertension. Lifestyle changes (e.g. balanced diet and exercise) in patients with high BMI are usually overlooked, although they contribute positively to prevention and improvement of CAD.

Purpose
The aim of this study is to calculate the prevalence of overweight and obesity in known CAD patients in both genders, in correlation with diabetes, hypertension, exercise and diet in CAD patients and to compare the findings to EUROASPIRE IV conducted in 2015 (1).

Methods
This study retrospectively included 362 patients (88% male; mean age 67 years) with a history of CAD (MI, PCI or CABG) from the registry of Cyprus heart survey in a hospital, in Nicosia from 2011 to 2014. Age, gender, date of myocardial infarction event, date of PCI or CABG surgery as well as CAD risk factors such as BMI, exercise, diet, hypertension and diabetes were noted on their visit to the cardiac clinic.

Results
Our study showed an overall similarity in BMI prevalence across both genders. The prevalence increased from 17.7% in patients with normal BMI (18.5-24.9) to the highest CAD prevalence of 49.2% which was seen in overweight (BMI = 25 –29.9) patients. However, there was a drop in the prevalence of obese (BMI = 30+) patients to 32.9%. This is supported by EUROASPIRE IV (1) which highlighted that CAD prevalence was higher in overweight patients (male = 83%; female = 80%) than obese patients (male = 36%; female = 44%) by nearly 2-fold. Furthermore, within the higher-than-normal BMIs, we recognized more non-diabetic CAD patients (115 overweight; 67 obese) in our study than diabetic CAD patients (62 overweight; 55 obese). On the contrary, hypertensive CAD patients (106 overweight; 80 obese) were more frequent than non-hypertensive CAD patients (71 overweight; 43 obese). Overweight patients split in nearly half when it came to exercise and diet (96 exercise, 82 do not; 90 diet, 88 do not). While in obese patients there was a higher proportion of patients not exercising or following a diet (47 exercise, 72 do not; 32 diet, 87 do not). According to EUROASPIRE IV (1), obesity contributed to higher prevalence of diabetes as patients did not lose weight.

Conclusion
Overweight and obese patients make up a large percentage of CAD patients. High BMI had a negative additive effect with hypertension but not with diabetes on the risk prevention in CAD patients which mismatches with the EUROASPIRE IV (1) findings. Despite BMI being a modifiable risk factor, not adhering to a diet or exercise was noticed in overweight and obese patients, which in return weakens their prevention of CAD.
Misleading qualification of active smokers based on carbon monoxide measurement of exhaled air
Authors: Ramotowski B , Forys WJ , Budaj A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education

Background
Carbon monoxide (CO) concentration of exhaled air is widely used in clinical trials in assessment of active smoking due to its feasibility and cost-effectiveness. The concentration of nicotine metabolite cotinine in urine is used as an objective index of smoking.

Purpose
We aimed to compare self-reported smoking and smoking cessation (SC) with results of CO and cotinine concentration.

Methods
Patients after coronary angiography (n=62) were included in SC programme with a brief counselling. The self-reported smoking and SC was verified with urine cotinine assessment (NicAlert) and CO level in exhaled air (MicroCO). The criterium of SC was non-smoking (&lt;1 cigarette ) in the last 7 days, NicAlert ≤2, MicroCO test≤6 parts per million (ppm).

Results
The mean age of patients was 61 ± 7.7 years, 49 (79%) patients were men, with median load of smoking 10 pack-years. 40 patients were assessed with both methods at baseline and follow-up visit. At baseline all the patients declaring at least 10 cigarettes daily had Nic Alert 6, but MicroCO indicated non-smoking in 25 (62,5%) patients. At follow up visit after 1 month, 35 (56,5%) patients declared SC and there was numerically higher level of misleading results of CO concentration in the whole group (p=0.077) and significantly higher in the group of patients who self-reported continuation of smoking (p=0.009)(Table 1).

Conclusion
Despite widespread and cost-effective measurement of CO the result should be carefully interpreted. It accurately indicates non-smoking patients, but the measurement in active smokers might be misleading with a significant group of patients with false negative results. To accurately assess active smokers the CO measurement should be supported with other method such as measurement of cotinine levels.
High glycemic variability attenuates diastolic function in diabetic heart failure with preserved ejection fraction
Authors: Adhikara IM , Paratte AR , Susanti VY , Anggraeni VY 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Suboptimal glycemic control characterized by high glucose variability pose inherent risks for the development of diabetic cardiomyopathy. The tangible association between type 2 diabetes mellitus (T2DM) and Heart Failure with Preserved Ejection Fraction (HFpEF) also has been widely studied. However, whether glycemic variability (GV) may independently associated with left ventricular (LV) diastolic dysfunction in T2DM patients with HFpEF remained elusive.

Purpose
To investigate association between GV and diastolic dysfunction in T2DM patients with HFpEF.

Methods
A cross-sectional study utilizing electronic medical record database from 2018 to 2021. Total of 66 patients with T2DM and HFpEF without coronary artery disease were enrolled. Baseline characteristics, clinical and laboratory variables, medication and echocardiography data were obtained. GV were calculated from standard deviation of multiple blood glucose measurement prior to echocardiography. Subjects were divided into two groups according to mean GV; high and low GV respectively. Diastolic function was analyzed applying echocardiographic parameters.

Results
LV Ejection Fraction (LVEF) was significantly lower in high GV (≥ 49.45 mg/dL) as compared to patients with low GV (65.48±9.47 vs 68.20±8.12, p=0.0408) despite similar baseline characteristics. Furthermore, high GV displayed a significant positive correlation with E/e’ (Pearson’s correlation r = 0.441; p=0.044). More importantly, univariate analysis using Fisher’s exact test revealed that High GV significantly associated with diastolic dysfunction (odds ratio: 8.16; 95% confidence interval = 1.143–95.97; p=0.0451).

Conclusion
High GV was significantly associated with lower LVEF and diastolic dysfunction. Optimal glycemic control represented by low GV may become an appealing approach to prevent HFpEF progression in T2DM patients.