bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical application of the new cardiovascular risk prediction algorithms SCORE2 and SCORE2-OP in patients with dyslipidemia
Authors: Barkas F , Sakkou SF , Styla C , Anastasiou G , Koutsogianni AD , Liamis G , Liberopoulos E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
European Society of Cardiology (ESC) has recently launched the SCORE2 and SCORE2-OP cardiovascular risk prediction algorithms.

Purpose
Cardiovascular risk assessment of patients with dyslipidemia according to SCORE2 and SCORE2-OP in comparison with the HELLENIC SCORE.

Methods
A retrospective observational study involving 1334 dyslipidemic patients followed-up for ≥3 years at our outpatient lipid clinic in our university general hospital. After excluding patients with established cardiovascular disease, diabetes mellitus, familial hypercholesterolemia, chronic renal disease, and those receiving hypolipidemic treatment, patients were categorized according to HELLENIC SCORE and SCORE2 / SCORE2-OP into the following cardiovascular risk groups: low-moderate, high and very high.

Results
A total of 532 patients were included in the present analysis (40% male, 17% smokers, mean age 55 [48-62] years, 8.6%&gt; 70 years). Subjects’ mean cholesterol levels were 257 (228-291) mg/dL, triglycerides 136 (99-196) mg/dL, high-density lipoprotein cholesterol 52 (45-62) mg/dL, and low-density lipoprotein cholesterol 173 (149-200) mg/dL. According to SCORE calculation, 428 patients (80%) were classified into low-moderate, 87 (17%) high and 17 (3%) very high cardiovascular risk group. According to SCORE2 and SCORE2-OP algorithms, the proportion of those considered as high (n=230, 43%) and very high cardiovascular risk (n=89, 17%) increased (Figure).

Conclusions
The proportion of patients classified into high and very cardiovascular risk groups is anticipated to increase by implementing the new SCORE2 and SCORE2-OP.
Lifetime versus 10-year risk of recurrent events in patients with cardiovascular disease: impact of age
Authors: Van Trier T , Snaterse M , Hageman SHJ , 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
Most risk models for patients with established atherosclerotic cardiovascular disease (ASCVD) calculate short-term risk of recurrent events and death, typically for a duration of 10 years. However, lifetime risk estimates may better support the healthcare professional in selecting patients for intensified preventive treatment (1). Also, a cross-sectional study suggested that communicating lifetime risk to ASCVD patients enhances risk perception and willingness for therapy (2). In the new ESC prevention guideline, however, 10-year risk estimates remain standard for ASCVD patients but the additional use of lifetime risk is recommended for communication in the shared decision-making process (3).

Purpose
We therefore aimed to compare estimates of 10-year with lifetime risk of recurrent ASCVD events or death, stratified by age.

Methods
We pooled individual-level data on risk factors from six large, recent prospective studies (RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V and HELIUS). We included Dutch patients aged ≥45 years with a follow-up of ≥6 months after acute coronary syndrome or revascularisation. The SMART-REACH models were used to estimate the difference between 10-year and lifetime risk of recurrent myocardial infarction, stroke, or cardiovascular death, stratified by age (&lt;55, 55-65, 65-75, ≥75 years).

Results
In 3,230 ASCVD patients (24% women), mean age 61±8 years, at median follow-up 1.1 (IQR 1.0-1.8) years after index event, SMART-REACH 10-year risk was 23±11% versus lifetime 56±11%. (Figure 1) We found a considerable difference between 10-year and lifetime risk in patients aged 45-55 years (18±8% vs. 61±10%). Discrepancies decreased with increasing age, with similar estimates in the highest (75-85) age group. (Figure 2).

Conclusion
Lifetime risk of a limited set of cardiovascular outcomes rather than 10-year risk may provide a more complete estimate of future ASCVD disease burden, as especially in younger patients 10-year risk is usually low, even in the presence of risk factors.
Atrial fibrillation and 13-year risk of CVD mortality in Russian population cohort
Authors: Shapkina M , Ryabikov A , Mazdorova E , Titarenko A , Avdeeva E , Scherbakova L , Pikhart H , Bobak M , Malyutina S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The study was supported by RFBR #20-313-90015, RAS # АААА-А17-117112850280-2

Introduction
Given the worldwide increase in life expectancy, ageing-related conditions are becoming increasingly important. Atrial fibrillation (AF) is the most common arrhythmia and a serious predictor of the progression of heart failure and thromboembolic events (largely, stroke). Thus, the study of AF impact on cardiovascular (CVD) mortality is of particular relevance.

Objectives
We aimed to analyze the impact of AF on the 13-year risk of CVD mortality in the Russian population sample of elderly age.

Methods
A random population sample (n=9360, age 45-69 years) was examined at baseline in 2003-2005 in the Russian arm of the HAPIEE project. The cohort was re-examined twice and was followed up for end points up to end of 2017 (12.7 years on the average). Fatal end-points were ascertained by local mortality register; the current study focused on CVD deaths. Baseline AF was defined by rest ECG with evaluation by the Minnesota code (MC 8-3-1, 8-3-2; 6-8 with "fibrillation" for atrium). Those with prevalent CVD at baseline and with inadequate ECGs were excluded from analysis; Cox-regression age- and multivariable-adjusted models were estimated.

Results
In total, data on 8565 persons aged 45-69 years at baseline were analyzed. Among those, 145 (1.6%) subjects had AF at baseline and of those 100 subjects had no existing CVD. During the 13-year follow-up, there were 431 cases of CVD death (10.9%) in the cohort, among them 63% (n=272) were fatal coronary heart disease (CHD) and 23% (n=101) were fatal stroke (2.5%). In age-adjusted models, men with baseline AF had increased risk of CVD death (HR=5.76; 95%CI 3.88-8.55), fatal stroke (HR=6.26; 95%CI 2.96-13.22), and fatal CHD (HR=5.86; 95%CI 3.58-9.59). After adjusting for other risk factors, the increased risk remained for all CVD outcomes: 4.49 (95%CI 2.84-7.09) for CVD death, 3.62 (95%CI 1.46-8.96) for fatal stroke, and 4.95 (95%CI 2.81-8.70) for fatal CHD. In women, the age-adjusted HR for CVD death in women with baseline AF was 3.92 (95%CI 1.60-9.62) but in fully-adjusted models the HR was attenuated (HR=2.22; 95%CI 0.87-5.70). The numbers of deaths from CHD and stroke in women were too small for meaningful analyses.

Conclusion
In this urban population-based cohort of subjects free from CVD at baseline, 11% of participants died from CVD death during 13 years follow-up. Men and women with baseline AF had approximately 4-fold increase in CVD mortality risk. The estimated CVD excess mortality risk associated with AF in this Russian cohort is consistent with findings from Western European and North American populations.
Systemic inflammatory indices derived from complete blood count in assessment of future cardiovascular risk in preeclampsia
Authors: Pereira Da Silva Oliveira A , Andreea Rechitean AR , Ana Carolina Santos MSC , Andreia Matos MSC , Ana Portelinha PHD , Maria Jose Areias MD , Manuel Bicho MDPHD , Irene Rebelo PHD , Maria Clara Bicho MDPHD 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): FCT, Portugal
Systemic inflammatory parameters derived from complete blood count (CBC) might present a good potential and a cheap method in assessment the risk for the development of cardiovascular related diseases.
The aim of this research is to retrospectively evaluate the interplay of CBC derived indexes with other inflammatory parameters in women with arterial hypertension after a history of preeclampsia.
Clinical and laboratory data were collected and analysed in 170 previously pregnant women (n=170) with a mean age of 35 years (s= 5.477 years) and the average BMI value equal to 26.4 kg/m2 (s= 4.57 kg/m2), and the follow-up period was 10 years after pregnancy.
The majority of women who currently present hypertension (52.9%), were diagnosed previously with preeclampsia (97.8%, p=0.000). Compared to the non preeclamptic population, theese women present differences in BMI (p=0.002), waist circumference (p=0.000), hip circumference (p=0.045, M. Whitney), waist /hip ratio (p=0.001), granulocyte (p=0.037), Granulocyte X platelet/lymphocyte ratio (p=0.034), neutrophil/lymphocyte ratio (p=0.034, M. Whitney), ApoB (p=0.023) and NOX concentration (p= 0.033).
Prior preeclamptic women were associated with a higher risk of developing hypertension. Anthropometric data suggests that BMI, waist circumference, hip/waist ratio and CBC derived inflammatory indeces are parameters that can aid in prognosis of future hypertension in women.
Cardiac telerrehabilitation: a safe and effective alternative in patients with coronary artery disease
Authors: Calvo-Lopez M , Arranz R , Marin J , Gruosso D , Falces-Salvador C , Roque M , Andrea R , Vidal B , Sitges M , Sanz-De La Garza M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Ferrer Internaciona Groupl, S.A

Background
Center-based cardiac rehabilitation programs (CRP) have shown to reduce morbidity and mortality after an ischemic cardiac event, but their vastly underutilized. Home-based CRP seems to improve patient’s adherence, but there is still scarce evidence, especially in elderly patients and women.

Purpose
To develop a holistic home-based CRP for ischemic heart disease patients and evaluate its safety and impact on functional capacity, adherence to a heart-healthy lifestyle and quality of life.

Methods
The 8-week home-based CRP will include 60 patients (50% women) with no age limit who have suffered an acute myocardial infarction in the previous 3 months, with LVEF ≥40% and a tablet/mobile device. The CRP (Picture 1) includes 3 weekly exercise sessions combining tailored aerobic and strength training and 1 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment.

Results
Between January and October 2021, 56 patients were included: 2 were rejected for presenting ventricular arrhythmias in the initial stress test and 4 due to technological barrier; 14 patients are currently performing the CRP. The preliminary results from the 36 patients who have completed the CRP show a significant increase in functional capacity, muscle strength, weekly training volume, adherence to Mediterranean diet, emotional state (anxiety) and quality of life (Picture 2). There have been no complications and patient’s adherence has been excellent for both exercise (85%) and educational (80%) sessions.

Conclusion
A holistic telematic CRP dedicated to patients after an ischemic cardiac event, including patients of both gender and of no age-limit, seems to be a feasible, safe and effective in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with the Mediterranean diet and emotional state.
Gender differences in hemostatic potential in coronary artery disease
Authors: Hojker M , Kosuta D , Bozic Mijovski M , Jug B , Novakovic M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Clinical presentation and contribution of different risk factors in coronary artery disease (CAD) vary between genders. Women are known to be generally older, have more comorbidities and are more likely to present with atypical symptoms. Previous research suggests there are important gender differences in the pathophysiology of CAD. One of the important mechanisms for atherothrombotic events seems to be increased coagulation, for which differences in presentation between genders is not yet fully documented.

Purpose
Our aim was to investigate a possible correlation between gender and coagulation appraised by overall hemostatic, coagulation and fibrinolytic potentials (OHP, OCP and OFP) in patients with CAD.

Methods
Consecutive patients after a recent acute myocardial infarction (within 90 days from inclusion) had fasting blood samples withdrawn. OHP, OCP and OFP were determined using thrombin and recombinant tissue-type plasminogen activator by absorbance measurements at 405 nm in 1-minute intervals for 40 minutes. Areas under the curve were constructed for OCP and OHP with the obtained measurements, OFP was calculated as the difference between the two areas: OFP = [(OHP – OCP) / OCP] x 100 (%). Baseline data and cardiovascular risk factors profiles were collected.
Proportions were compared using χ2 test, means were compared using t-test, medians were compared using Mann-Whitney U test, linear regression models were constructed for the multivariate analysis.

Results
We included 117 patients (mean age 56 ± 10 years), 23 (20%) were women. Arterial hypertension was present in 86 (73.5%), diabetes mellitus in 10 (8.5%), dyslipidemia in 75 (64.1%), family history in 46 (39.3%) patients, 54 (46.2%) were active smokers (within 2 years). There were no significant differences in mean age and risk factors presence between genders. Median OCP and median OHP were significantly higher in women (25.1 (interquartile range [IQR] 5.8) vs 21.8 (IQR 5.7), p=0.035; and 9.5 (IQR 4.3) vs 7.8 (IQR 3.1), p=0.032, respectively) while median OFP were similar.
Female gender retained its significant predictive value after multivariate adjustment for age and traditional risk factors for OCP (R2 0.25; ANOVA for regression p&lt;0.001; Beta 2.96 [0.61-5.31], p=0.014) and OHP (R2 0.24; ANOVA for regression p&lt;0.001; Beta 2.04 [0.76-3.32], p=0.002).

Conclusion
In patients after acute myocardial infarction women seem to have a higher procoagulant state, as determined by OCP and OHP. Our findings suggest different pathophysiology of CAD in women, further research is needed to fully understand and address gender differences in CAD.
Anticoagulation use in the setting of atrial fibrillation in a typical outpatient cardiology population
Authors: Mustafa M , Sanmugathas N , Mcintosh K , Angaran P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The risk of cerebrovascular events has been greatly reduced with the guideline recommendation of anticoagulation in the presence of atrial fibrillation (AF). Based on current epidemiological evidence, over ⅓ of patients with known AF who are eligible for anticoagulation, do not receive them. The elderly population are especially susceptible to this disparity. The CHA2DS2-VASC score is currently being used to assess for need for anticoagulation in patients with AF. More recently, the HAS-BLED score has been developed to assess for bleeding risk. Weighing the bleeding risk using HAS-BLED score with stroke risk using CHA2DS2-VASC score, we assessed if a segment of the Canadian population with AF were appropriately anti-coagulated.

Purpose
Assess the concordance of one outpatient cardiology practice with anticoagulation guidelines for atrial fibrillation.

Materials & Methods
Patients were randomly selected from a single centre outpatient Cardiology practice between January and May 2021. The patients were selected by 1 researcher. The patients selected must have been diagnosed with atrial fibrillation by ECG and Holter analysis. The HAS-BLED and CHA2DS2-VASC scores were calculated for each individual.

Results
101 patients were selected for this study. 66 were male and 35 were female with ages ranging from 33 to 91 years old. Patients with a CHA2DS2-VASC score greater than 1, were anti-coagulated with direct oral anticoagulation (DOAC) unless they were in severe renal failure (creatinine clearance &lt;30ml/min) in which case Warfarin was used. In the age group of 65 and under, 12 patients had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. In the age group 65 and over, 72 had a CHA2DS2-VASC score greater than 1. Of the 72 individuals, 71 were appropriately anti-coagulated. In the age group 80 and over, 29 individuals had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. For the individuals on anticoagulants, the HAS-BLED score was less than or equal to the CHA2DS2-VASC score. Only one of the patients in the study with a CHA2DS2-VASC score greater than 1, was not anti-coagulated. There were no reported major bleeding risks in the patients reviewed.

Conclusion
In a sample of the typical Canadian population, based on risk factor assessments using both the CHA2DS2-VASC and HAS-BLED scores, 99% of patients were appropriately anti-coagulated in the presence of AF. This shows a significant increase in appropriate management of AF patients compared to the current national and global averages. There were no major bleeding events reported in any of the patients receiving full anticoagulation. This supports the recommendation that the benefit of anticoagulation in stroke reduction from thromboembolism outweighs the risk of major bleeding events.
Diabetes mellitus in coronary artery disease
Authors: Diakonikolaou S , Styliou T , Christou V , Eid O , Eid R , Karataraki F , Abdelrahman R , Moutiris J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Morbidity and mortality are increased in patients with myocardial infarction that also have co-existing diabetes mellitus (DM) making it an important risk factor for coronary artery disease (CAD). Overall, diabetes mellitus worsens the prognosis in CAD patients.

Purpose
This paper was done from a study, that enabled us to measure the prevalence of diabetes mellitus in patients with coronary artery disease, in relevance to other CAD risk factors (age, gender, systolic blood pressure, LDL-C and smoking). These results would give us the ability to compare it with the outcomes of the EUROSPIRE IV study published in 2015 (1).

Methods
Retrospective observational study of consecutive patients from the Registry of Cyprus Heart Survey, examined in the Cardiology Clinic of Nicosia General Hospital, between the years 2011-14. The total number of patients was 371 (11.5% females and 88.4% males). These patients had a history of myocardial infarction and underwent either a PCI or a CABG.

Results
From the total amount of patients, 36.9% had history of diabetes mellitus. The percentage adjusted to gender shows that 44% of females and 35.6% of males included in the study had diabetes. The mean age of people that had diabetes and coronary artery disease was 68.65 (CI: 67.18, 70.12). The prevalence of diabetics with hypertension and coronary artery disease was 75.91% while the average systolic blood pressure (SBP) was 138 mmHg (CI: 135.33, 140.67). The systolic blood pressure was ≥140 mmHg in half of the diabetic individuals. Smoking was also assessed as a risk factor in patients with diabetes and CAD. The prevalence of ex-smokers was 28.46%, of smokers 18.24% and of non-smokers 53.28%. Finally, values of low density lipoprotein cholesterol (LDL-C) were measured in 90.5% of diabetic patients, 88.7% of them had an LDL-C ≥1.8 mmol/L (≥70mg/dL) and 53.22% had an LDL-C ≥2.5 mmol/L (≥100mg/dL). The average LDL-C value was 109.19 mg/dL.

Conclusions
The outcome of the study revealed that a substantial number of patients with CAD suffer from diabetes. Therefore, diabetes was verified as a major risk factor in patients with CAD and the development of acute coronary syndrome. Regarding those patients, other risk factors proved to have a negative impact on their cardiovascular health. Moreover, the risk factors in patients with DM and CAD of this study were compared with the well known study, EUROASPIRE IV (1). The prevalence of diabetes in the present study was 36.9%, compared to 26.8% in EUROASPIRE IV, indicating a higher prevalence in our study. We concluded that marked reduction in the events of myocardial infarction can be seen if we reduce the prevalence of uncontrolled diabetes mellitus occurrences with medication or better control of the risk factors of CAD early in the diagnosis to reduce complications.
Role of serum n-6 polyunsaturated fatty acids in the development of acute coronary syndromes
Authors: Inoue N , Morikawa S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aims
n-3 polyunsaturated fatty acids (PUFAs) have an inhibitory effect against the development of coronary artery disease (CAD). However, whether n-6 PUFAs, dihomo-gamma-linolenic acid (DGLA), and arachidonic acid (AA) play a role in the development of CAD remains unclear. This study investigated the association between PUFAs and the risk of developing acute coronary syndrome (ACS) using the lipid and PUFAs data of patients who received percutaneous coronary intervention (PCI) for either non-emergent conditions (staged group) or ACS (ACS group).

Methods
We retrospectively evaluated 433 patients who underwent PCI between 2014 and 2021. The patients were divided into the ACS group (n = 18) and the staged group (n = 132). The lipid and PUFAs values of each patient between the two groups were compared. Moreover, to investigate the correlation between n-6 PUFAs levels and ACS, the effects of confounding factors such as use of strong statins and low-density cholesterol (LDL-C) levels were adjusted.

Results
The ACS group had higher n-6 PUFAs levels than the staged group (DGLA: 36.8 ug/mL vs. 29.6 ug/mL; AA: 203.3 ug/mL vs. 145.8 ug/mL). Furthermore, the analysis of covariance adjusted for LDL-C levels showed a significant difference between the two groups in terms of DGLA and AA levels.

Conclusions
The n-3 PUFAs levels did not significantly differ between the staged and ACS groups. Moreover, the ACS group had higher DGLA and AA levels and lower n-3 PUFAs/AA ratios than the staged group. Therefore, excess n-6 PUFAs may be a risk factor for ACS.