bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical activity during adolescence and early adulthood and adult cardiometabolic risk profile: a longitudinal study
Authors: Soendergaard S M , Lynggaard V , Winding T N , Kempel M K 
Published: October 2022

Abstract

Introduction
Physical activity (PA) is important in the prevention of cardiometabolic diseases. However, little is known of the effect of maintaining PA during adolescence and cardiometabolic risk in early adulthood.

Purpose
This 14-year longitudinal prospective cohort study investigated the association of maintaining PA since adolescence and subsequent cardiometabolic risk factors in early adulthood and to what extend adiposity affects this.

Methods
Data were drawn from an ongoing cohort and consisted of 262 participants with longitudinal information on PA and cardiometabolic risk factors in adulthood. The cardiometabolic risk factors were collected by blood samples, anthropometric measures, and blood pressure in a health examination at the age of 28 years (table 1). Subsequently, the risk factors were clustered in four domains (“Inflammation”, “Lipids”, “Glucose metabolism” and “Blood pressure”) and calculated into z-scores. Further, a composite z-score of all domains was calculated. PA was obtained by questionnaires at age 15, 18, 21 and 28. The participants were categorized into “inactive maintainers”, “fluctuaters” and “active maintainers” and linear regression was used to examine the association between PA groups and the cardiometabolic domains in a crude and two adjusted models 1 and 2.

Results
Increasing z-scores from “active maintainers” to “fluctuaters” to “inactive maintainers” were seen in all domains except in “blood pressure” when adjusted for sex, smoking, parental and own education, and parental cardiovascular medical history, and significantly different when comparing “active maintainers” to “inactive maintainers” (table 2, model 1). In the composite z-score outcome including all domains, a significantly adverse z-score was found for “inactive maintainers” z=0.63, p=0.001 when adjusted for the variables in model 1 (table 2). When also adjusted for body fat percentage (model 2), the z-score became insignificant z=0.19, p=0.198 (table 2).

Conclusion
Maintaining PA from adolescence to early adulthood is associated with a significant lower cardiometabolic risk profile compared to inactive maintainers. However, some of the adverse risk profile is explained by being overweight or obese. Given the increasing prevalence of CVD and diabetes these results highlight the importance of maintaining PA at all stages of life.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Karen Elise Jensen Foundation and The Steno Partner Collaboration between Goedstrup Hospital and Steno Diabetes Center Aarhus.
Fibroblast growth factor 21 is independently associated with long term mortality in metabolic syndrome
Authors: Phrommintikul A , Osataphan N , Sa-Nguanmoo P , Wongcharoen W , Chattipakorn N , Chattipakorn S 
Published: October 2022

Abstract

Background
Metabolic syndrome (MetS), a cluster of interrelated cardiovascular risk factors, is associated with increased risk of cardiovascular and non-cardiovascular disease. Fibroblast growth factor 21 (FGF21) plays an important role in metabolic regulation and has been shown to be elevated in MetS. However, role of FGF21 in pathogenesis of cardiovascular disease is still controversial.

Objective
We aimed to identify the association between plasma FGF21 level and long-term mortality in MetS patients.

Methods
Patients with MetS were enrolled in this study during 2015–2017. Blood samples for FGF21 were collected after 12-hour fasting and plasma FGF21 levels were determined using a human FGF21 enzyme-linked immunosorbent assay (ELISA) at the first time of the enrollment. Clinical parameters, and all-cause mortality were recorded. Cox-proportional hazard regression was used for the analysis of association between plasma FGF21 level and all-cause mortality.

Results
A total of 202 Mets patients (male 44.6%) with mean age of 64.3±8.3 years and BMI of 27.3±5.4 kg/m2 were enrolled. After a median follow up of 80 months, 32 (15.8%) patients died. Multivariable Cox proportional hazard regression showed that FGF21 level was independently associated with all-cause mortality after adjustment for age, established cardiovascular disease, estimated glomerular filtration rate and left ventricular ejection fraction. Patients with FGF21 level above median (240 pg/ml) had higher risk of all-cause death compared to patients with FGF21 ≤240 pg/ml (hazard ratio [HR], 3.66; 95% confidence interval [CI], 1.24–10.82; p=0.019) (Figure 1).

Conclusion
FGF21 level is independently associated with long term mortality in metabolic syndrome.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Thailand research fund
Lp(a) is not associated with arterial stiffness: a Mendelian randomization study
Authors: Simistiras A , Delialis D , Georgiopoulos G , Bampatsias D , Maneta E , Dimoula A , Petropoulos I , Neofytou O , Oikonomou E , Kontogiannis C , Ioannou S , Miliotou A , Kanakakis I , Evangelou E , Stamatelopoulos K 
Published: October 2022

Abstract

Background
Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness.

Aim
To investigate the potential causal association of Lp(a) levels with PWV.

Methods
We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings.

Results
Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV.

Conclusions
Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease.

Funding Acknowledgement
Type of funding sources: None.
Time series clustering of left atrial strain curves for risk stratification in the general population
Authors: Ntalianis E , Sabovcik F , Cauwenberghs N , Daels Y , Kuznetsova T 
Published: October 2022

Abstract

Objective
Currently, only the peak reservoir left atrial (LA) strain has been in use while a huge amount of useful information during different phases of cardiac cycle has been ignored. In this study, therefore, we tested the hypothesis that an unsupervised time series analysis utilizing the whole LA deformation curves will identify distinct clusters associated to risk factors and improve cardiovascular (CV) risk prediction over the traditionally used covariables in the general population.

Design and method
We prospectively studied 929 community-dwelling individuals (mean age, 51.6 years; 52.9% women), in whom we acquired clinical and echocardiographic data including LA strain traces at baseline and collected cardiac events on average 7.2 years later. We employed two unsupervised time series techniques such as Self-Organizing map and Variational Autoencoder (VAE) with Convolutional Neural Network as building block to cluster spatiotemporal patterns of LA strain curves. Clinical characteristics and cardiac outcome were used to evaluate the validity of the clusters (k).

Results
According to the quantization error value for every k, the optimal number of clusters was 5 for applied methods. Figure 1 (left panel) illustrates the centroids of the clusters using the proposed VAE network. The first three clusters had differences in sex distribution and heart rate, but had similar low CV risk profiles. On the other hand, cluster 5 had the worst CV risk factors combination, and higher prevalence of left ventricular remodelling and diastolic dysfunction (ie, lowest e' velocity and highest E/e') compared to other clusters. We also observed an increase in the risk for incidence of adverse events between cluster 5 and other clusters (Figure 1, right panel). After adjustment for traditional risk factors, cluster 5 had the highest risk of cardiac events as compared to cluster 1, 2 and 3 (HR: 1.36; 95% CI: 1.10–1.69); P=0.0046).

Conclusion
Unsupervised Machine/Deep Learning algorithms employed on time series LA strain curves identifies clinically meaningful clusters of LA deformation, and provides incremental prognostic information over traditional risk stratification.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): KU Leuven
Radial artery calcification in predicting coronary calcification and atherosclerosis burden
Authors: Achim A , Kakonyi K , Nagy F , Jambrik Z , Varga A , Nemes A , Sk Chan J , Toth G , Ruzsa Z 
Published: October 2022

Abstract

Background
Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds, however studies examining the relationship between coronary and radial artery calcification are lacking.
The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease.

Methods and results
This is a single-center, retrospective cross-sectional study based on doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC-group) and 99 without (NRC-group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (&gt;100 Agatson units) or intracoronary imaging (IVUS, OCT). A significant correlation was observed between radial calcification and coronary calcification variables (67.3%, vs 32.7% – p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC-group (60% vs 44%, p=0.02). RC therefore predicts the extent and severity of coronary artery disease.

Conclusion
RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

Funding Acknowledgement
Type of funding sources: None.
Prognostic implications of cardiac 82-rubidium positron emission tomography in angina patients with no perfusion defects
Authors: Rauf M , Hansen K , Galatius S , Wiinberg N , Brinth L , Hojstrup S , Talleruphus U , Prescott E 
Published: October 2022

Abstract

Background
Myocardial perfusion imaging with 82-Rubidium positron emission tomography (82Rb-PET) is increasingly used in the assessment of stable coronary artery disease (CAD). Among other variables, it provides quantitative measures of myocardial blood flow (MBF) which has shown the prognostic significance of coronary microvascular dysfunction (CMD), also in patients without perfusion defects. However, other 82Rb-PET variables may also be of prognostic significance in these patients.

Purpose
The purpose of this study was to evaluate the prognostic value of 82Rb-PET in patients with symptoms suggestive of CAD but no perfusion defects.

Methods
A study was conducted with 3726 consecutive patients who underwent 82Rb-PET on the suspicion of stable CAD between January 2018 and August 2020. After exclusion of patients with regional perfusion defects, we examined the association of 82Rb-PET derived parameters with a composite endpoint: all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure or ischemic stroke in 2175 patients. CMD was defined as myocardial blood flow reserve (MBFR) &lt;2. Analyses were further stratified to assess differences across gender.

Results
Resting and stress MBF were higher in women, while MBFR was lower and CMD more prevalent (30.5% among women versus 25.3% among men, p=0.008). Over a median follow-up of 1.7 years (IQR 1.1–2.5 years) a total of 148 events were observed. In unadjusted analyses, MBF during stress, MBFR, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve and Ca-score were associated with adverse outcomes in both genders (Figure 1). A joint multivariable Cox model, for both genders, adjusted for patient characteristics, cardiovascular risk factors and 82Rb-PET variables showed reduced MBFR &lt;2 (HR 1.75, 95% CI 1.24–2.48), resting LVEF (HR 1.38 per 10% decrease, 95% CI 1.24–1.54) and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07–1.31) to be significant predictors of outcomes (Figure 2). Results were consistent in subgroups defined by gender, previous history of ischemic heart disease (IHD), reduced LVEF and atrial fibrillation.

Conclusion
MBFR, LVEF and LVEF-reserve derived from 82Rb-PET are predictors of adverse outcome and provide prognostic information in patients with no perfusion defects. This may aid in identifying patients at risk and provide opportunity of prevention.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Bispebjerg Frederiksberg Hospital, Copenhagen
Inflammation and risk of recurrent cardiovascular events according to prior vascular disease location
Authors: Burger P M , Ridker P , Dorresteijn J , Koudstaal S , Mosterd A , Pradhan A , Visseren F 
Published: October 2022

Abstract

Background
In recent years, anti-inflammatory drugs have been shown to reduce the risk of recurrent cardiovascular disease (CVD) events in patients with coronary artery disease (CAD), but have not yet been tested in patients with other vascular disease locations. Whether the relation between inflammation and recurrent CVD is modified by prior vascular disease location is unknown.

Purpose
This study aimed to establish the relation between low-grade inflammation and recurrent CVD according to prior vascular disease location.

Methods
Inflammation was measured by plasma concentrations of high-sensitivity C-reactive protein (CRP). Patients from the UCC-SMART cohort with CAD (n=4,517), cerebrovascular disease (CeVD; n=2,154), peripheral artery disease (PAD, n=1,154), or abdominal aortic aneurysm (AAA, n=424), and CRP ≤10 mg/L were included in the main analysis (combined n=8,249). Patients with CRP &gt;10 mg/L (n=756) were analysed separately. The primary outcome was a composite of myocardial infarction, ischemic stroke, or cardiovascular death. Secondary outcomes included the primary outcome components, major adverse limb events (MALE), and all-cause mortality. The relation between CRP and outcomes was assessed using Cox proportional hazard models stratified by prior vascular disease location, and adjusted for potential confounders.

Results
During a median follow-up of 9.5 years (interquartile range 5.1–13.9) 1,877 CVD events, 887 MALE events, and 2,341 deaths were observed. In the total population, CRP was related to recurrent CVD (hazard ratio [HR] per 1 mg/L 1.08; 95% confidence interval [CI] 1.05–1.10), and all secondary outcomes except for ischemic stroke (HR 1.03; 95% CI 0.99–1.08). Compared to the first quintile of CRP, HRs for recurrent CVD were 1.66 (95% CI 1.41–1.96) for the last quintile ≤10 mg/L, and 1.97 (95% CI 1.64–2.36) for the subgroup with CRP &gt;10 mg/L. CRP was related to recurrent CVD in patients with CAD (HR per 1 mg/L 1.08; 95% CI 1.04–1.11), as well as CeVD (HR 1.05; 95% CI 1.01–1.10), PAD (HR 1.08; 95% CI 1.03–1.13), and AAA (HR 1.08; 95% CI 1.01–1.15; p for interaction 0.815). The relation between CRP and all-cause mortality was stronger for patients with CAD (HR 1.13; 95% CI 1.09–1.16) compared to other locations (HRs 1.06–1.08; p=0.002).

Conclusion
Inflammation is an independent risk factor of recurrent CVD and mortality, irrespective of prior vascular disease location. Trials of anti-inflammatory drugs in patients with CeVD, PAD, and AAA are warranted.

Funding Acknowledgement
Type of funding sources: None.
Antiplatelet therapy and risk of adverse cardiovascular events in peripheral artery disease
Authors: Kamil S , Sehested T S G , Blanche P , Houlind K , Lassen J F , Gislason G , Dominguez H 
Published: October 2022

Abstract

Background
Antiplatelet therapy has been shown to reduce adverse cardiovascular (CV) events in patients with PAD, but despite the well-established medication benefit, large-scale epidemiological data evaluating antiplatelet agent of choice with low bleeding risk and high antithrombotic effect is sparse.

Purpose
We explored Danish healthcare registers to examine guideline-recommended antiplatelet therapy and associated risk of adverse CV outcomes in patients with PAD.

Methods
All patients with a first-time diagnosis of PAD between January 1, 1997 and December 31, 2016 were identified. Patients alive six months after diagnosis were divided into four treatment groups: aspirin, clopidogrel, dual therapy (DAPT), and no antiplatelet therapy. Logistic regression models were used to estimate 1-year risk of myocardial infarction (MI), stroke, CV death, all-cause mortality, and gastrointestinal (GI) bleeding.

Results
We identified a total of 85,771 PAD patients [median age 70.6 (IQR 63–77 years), 52% male]. The results suggest that compared to no antiplatelet therapy, use of clopidogrel alone significantly decreased 1-year risk of incident MI, stroke, CV death and all-cause mortality with odds ratios 0.56 (CI 0.46–0.68), 0.69 (CI 0.59–0.81), 0.72 (CI 0.56–0.94), and 0.79 (CI 0.65–0.97) respectively. Likewise, aspirin monotherapy was associated with only a marginal reduction in 1-year risk of stroke by 11% and all-cause mortality by 7%. Odds ratios for GI bleeding were estimated to be 1.18 (CI 1.04–1.34), 1.34 (CI 0.94–1.91), and 1.54 (CI 1.05–2.26) for aspirin, clopidogrel, and DAPT groups, respectively.

Conclusion
In this nationwide study, clopidogrel is associated with significantly reduced risk of MI, stroke, CV death and all-cause mortality with low risk of bleeding and appears to support clopidogrel as antiplatelet agent of choice for CV risk reduction in patients with PAD.

Funding Acknowledgement
Type of funding sources: None.
Identification of factors associated with smoking cessation in patients with coronary artery diseases. Findings from a large nationwide cohort of smoking cessation services
Authors: Allagbe I , Marianne Z , Thomas D , Limosin F , Chague F , Le Faou A L 
Published: October 2022

Abstract

In patients with coronary artery diseases (CAD) (i.e. prior myocardial infarction (MI) or angina), smoking cessation (SC) is a major prevention goal. From a large French national database of SC services, we aimed to describe social, medical and smoking characteristics, as well as predictive factors of SC in men and women with CAD.

Methods
We conducted a retrospective study of smokers with CAD who visited a SC service and were included in the nationwide database of SC services (CDTnet). Endpoint was the abstinence rate, defined as SC maintained for at least 28 consecutive days, confirmed by an exhaled carbon monoxide &lt;10 ppm.

Results
Among the 4,532 smokers with CAD (myocardial infarction and angina), 21% (948) were women. The mean age was 55 years in both sexes. Two-thirds had consulted after a hospital contact and nearly half (45%) smoked more than 20 cigarettes per day. Compared to men, women presented more often with anxio-depression symptoms (57% vs 41%) and respiratory diseases (38% vs 28%), were less educated (65% vs 73% had at least one degree), suffered less often from other cardiovascular diseases such as stroke or peripheral arterial disease (16% vs 21%) and much lower rate of alcohol misuse (9% vs 25%). Finally, 82% of smokers received Nicotine Replacement Therapy (NRT) at the first consultation. The abstinence rate achieved was similar in women and men (54%). Factors positively associated with SC in women were: having more than one previous quit attempt, having a level of education ≥ first secondary school diploma) (OR=1.42; CI95% [1.04–1.95]) and using an electronic cigarette at the first consultation (OR=2.74; CI95% [1.22–6.58]). In men, these factors were: being employed (OR=1.25; CI95% [1.08–1.45]), declaring high confidence in quitting (OR=1.24; CI95% [1.07–1.44]) and using NRT (OR=1.41; CI95% [1.13–1.74]). Psychiatric or respiratory diseases were negatively associated with SC in both men and women. In men, the factors negatively associated with SC were: smoking at home, having diabetes, using cannabis and presenting with high nicotine dependence. Among women, living with a smoker hampered SC.

Conclusion
Our findings on a large nationwide cohort from SC services showed that in smokers with prior MI or angina, it is important to take into account comorbidities, particularly psychiatric and respiratory disorders, in order to improve smoking cessation rates.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019