Journal: Eur J Prev Cardiol

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Abstract

Serum Urate and Heart Failure: A Bidirectional Mendelian Randomisation Study.

Yang F, Hu T, Cui H
Aims
Observational studies indicate that serum urate level is associated with heart failure. However, whether this association is causal remains controversial, due to confounding factors and reverse causality. We aim to evaluate the causal relationship of genetically predicted serum urate level with heart failure (HF).
Methods
A bidirectional Mendelian randomisation (MR) study was performed. Instrumental variables were obtained from the largest genome-wide association studies of serum urate (457,690 individuals) to date. We obtained summary statistics of HF from HERMES consortium (47,309 cases; 930,014 controls), the FinnGen study (13,087 cases; 195,091 controls), and the UK Biobank study (1,088 cases; 360,106 controls). Inverse-variance weighted method was applied to obtain MR estimates and other statistical methods were conducted in the sensitivity analyses. The reverse MR analysis was performed to evaluate the effect of HF on serum urate levels.
Results
Genetically determined serum urate level was associated with HF (odds ratio (OR), 1.07; 95% CI, 1.03-1.10; p=8.6×10-5). The main results kept robust in the most sensitivity analyses. The association pattern remained for the heart failure in FinnGen (OR, 1.10; 95%CI, 1.03-1.19; p=0.008) and the combined results of three data sources (OR, 1.08; 95%CI, 1.04-1.13; p<0.001). No consistent evidence was found for the causal effect of HF on serum urate levels.
Conclusions
We provide consistent evidence for the causal effect of genetically predicted serum urate level on HF, but not the reverse effect of HF. Urate-lowering therapy may be of cardiovascular benefit in the prevention of HF.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 17 May 2022; epub ahead of print
Yang F, Hu T, Cui H
Eur J Prev Cardiol: 17 May 2022; epub ahead of print | PMID: 35578763
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Abstract

Age-dependent associations of body mass index with myocardial infarction, heart failure, and mortality in over 9 million Koreans.

Lee HJ, Kim HK, Han KD, Lee KN, ... Lee SP, Kim YJ
Background
While obesity is a well-known cardiovascular risk factor, little is known whether age has a modifying effect.
Aim
To determine the age-dependent associations of BMI with cardiovascular outcomes.
Methods
A population-based cohort of 9,278,433 Koreans without prior cardiovascular disease were followed up for the incidence of myocardial infarction (MI), heart failure (HF), and all-cause death. The effect of BMI with optimal normal weight (18.5-22.9 kg/m2) as reference was analyzed according to age groups [young (20-39 years), middle-aged (40-64 years), and elderly (≥65 years)] and age decades.
Results
During 8.2 years, MI, HF, and all-cause death occurred in 65,607 (0.71%), 131,903 (1.42%), and 306,065 (3.30%), respectively. Associations between BMI and all outcomes were significantly modified by age (p-for-interaction < 0.001). There was a proportional increase in incident MI according to BMI in young subjects; this relationship became U-shaped in middle-aged subjects, and inversely proportional/plateauing in elderly subjects. A U-shaped relationship between BMI and incident HF was observed, but the impact of obesity was stronger in young subjects while the impact of underweight was stronger in middle-aged and elderly subjects. Meanwhile, lower BMI was associated with higher all-cause mortality in all ages, although this association was attenuated at young age, and pre-obesity was associated with the greatest survival benefit. These associations were independent of sex, smoking, physical activity, and comorbidities.
Conclusions
The impact of BMI on cardiovascular risk differs according to age. Weight loss may be recommended for younger overweight subjects, while being mildly overweight may be beneficial at old age.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 17 May 2022; epub ahead of print
Lee HJ, Kim HK, Han KD, Lee KN, ... Lee SP, Kim YJ
Eur J Prev Cardiol: 17 May 2022; epub ahead of print | PMID: 35580584
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Abstract

Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients.

Georgiopoulos G, Mavraganis G, Delialis D, Georgiou S, ... Stellos K, Stamatelopoulos K
Background
The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established.
Aims
We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.
Methods
We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.
Results
MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p < 0.05 for NRI, IDI, and Delta Harrell\'s C index). MaxWT < 0.9 mm predicted very low probability of cardiovascular events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.
Conclusion
Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability for events.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 17 May 2022; epub ahead of print
Georgiopoulos G, Mavraganis G, Delialis D, Georgiou S, ... Stellos K, Stamatelopoulos K
Eur J Prev Cardiol: 17 May 2022; epub ahead of print | PMID: 35580589
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Abstract

Prognostic impact of type 1 and type 2 diabetes mellitus in atrial fibrillation and the effect of severe hypoglycaemia: A nationwide cohort study.

Karayiannides S, Norhammar A, Landstedt-Hallin L, Friberg L, Pia L
Aims
To compare prognosis between individuals without diabetes, type 1 and type 2 diabetes in a nationwide atrial fibrillation cohort in Sweden and study the significance of severe hypoglycaemia.
Methods
Using data from all-inclusive national registers, 309,611 patients with non-valvular atrial fibrillation were enrolled during 2013-2014. Of these, 2,221 had type 1 and 58,073 had type 2 diabetes. Patients were followed for all-cause mortality until March 27, 2017, and for myocardial infarction, ischaemic stroke and first-ever diagnosis of heart failure or dementia until December 31, 2015. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox and competing risk regression.
Results
Using individuals without diabetes as reference (HR = 1), the adjusted HRs in type 1 versus type 2 diabetes were for mortality 1.87 (CI 1.73-2.02) vs. 1.51 (CI 1.47-1.55), heart failure 1.59 (CI 1.42-1.78) vs. 1.41 (CI 1.34-1.48), myocardial infarction 2.49 (CI 2.17-2.85) vs. 1.70 (CI 1.59-1.81), ischaemic stroke 1.59 (CI 1.35-1.87) vs. 1.31 (CI 1.22-1.40) and dementia 1.46 (CI 1.15-1.85) vs. 1.28 (CI 1.18-1.40). Among individuals with type 2 diabetes, those with previous severe hypoglycaemia had increased risk of mortality (HR 1.26; CI 1.17-1.36) and dementia (HR 1.37; CI 1.08-1.73) compared with those without previous severe hypoglycaemia.
Conclusion
Presence of diabetes-regardless of type- in atrial fibrillation is associated with an increased risk of premature death, cardiovascular events and dementia. This increase is more pronounced in type 1 than in type 2 diabetes. A history of severe hypoglycaemia is associated with a worsened prognosis in type 2 diabetes.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Eur J Prev Cardiol: 17 May 2022; epub ahead of print
Karayiannides S, Norhammar A, Landstedt-Hallin L, Friberg L, Pia L
Eur J Prev Cardiol: 17 May 2022; epub ahead of print | PMID: 35580601
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Abstract

OLD AND NEW EQUATIONS FOR MAXIMAL HEART RATE PREDICTION IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION ON BETA-BLOCKERS TREATMENT. RESULTS FROM THE MECKI SCORE DATASET.

Magr D, Piepoli M, Gallo G, Corr U, ... Agostoni P, MECKI score Research Group (see appendix)
Background
Predicting maximal heart rate (MHR) in heart failure and reduced ejection fraction (HFrEF) still remains a major concern. In such a context, the Keteyian equation is the only one derived in a HFrEF cohort on optimized β-blockers treatment. Therefore, using the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) dataset, we looked for a possible MHR equation, for an external validation of Keteyien formula and, contextually, for accuracy of the historical MHR formulas and their relationship with the HR measured at the anaerobic threshold (AT).
Methods and results
Data from 3,487 HFrEF outpatients on optimized β-blockers treatment from the MECKI dataset were analyzed. Besides excluding all possible confounders, the new equation was derived by using HR data coming from maximal cardiopulmonary exercise test (CPET).The simplified derived equation was [109 - (0.5*age) + (0.5*HR rest) + (0.2*LVEF) - (5 if haemoglobin < 11 g/dL)]. The R2 and the SEE were 0.24 and 17.5 beats·min-1 with a MAPE = 11.9%. The Keteyian equation had a slightly higher mean absolute percentage error (MAPE = 12.3%). Conversely the Fox and Tanaka equations showed extremely higher MAPE values. The range 75-80% of MHR according to the new and the Keteyian equations was the most accurate in identifying the HR at the AT (MAPEs 11.3% to 11.6%).
Conclusions
The derived equation to estimate the MHR in HFrEF patients, by accounting also for the systolic dysfunction degree and anemia, improved slightly the Keteyian formula. Both formulas might be helpful in identifying the true maximal effort during an exercise test and the intensity domain during a rehabilitation program.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 17 May 2022; epub ahead of print
Magr D, Piepoli M, Gallo G, Corr U, ... Agostoni P, MECKI score Research Group (see appendix)
Eur J Prev Cardiol: 17 May 2022; epub ahead of print | PMID: 35578814
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Abstract

The influence of exercise and postural changes on ventricular repolarization in the long QT syndrome: a systematic scoping review.

Harvey A, Curnier D, Dodin P, Abadir S, Jacquemet V, Caru M
Current exercise recommendations make it difficult for long QT syndrome (LQTS) patients to adopt a physically active and/or athletic lifestyle. The purpose of this review is to summarize the current evidence, identify knowledge gaps, and discuss research perspectives in the field of exercise and LQTS. The first aim is to document the influence of exercise training, exercise stress, and postural change interventions on ventricular repolarization in LQTS patients, while the second aim is to describe electrophysiological measurements used to study the above. Studies examining the effects of exercise on congenital or acquired LQTS in human subjects of all ages were included. Systematic searches were performed on 1 October 2021, through PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and ISI Web of Science, and limited to articles written in English or French. A total of 1986 LQTS patients and 2560 controls were included in the 49 studies. Studies were mainly case-control studies (n = 41) and examined exercise stress and/or postural change interventions (n = 48). One study used a 3-month exercise training program. Results suggest that LQTS patients have subtype-specific repolarization responses to sympathetic stress. Measurement methods and quality were found to be very heterogeneous, which makes inter-study comparisons difficult. In the absence of randomized controlled trials, the current recommendations may have long-term risks for LQTS patients who are discouraged from performing physical activity, rendering its associated health benefits out of range. Future research should focus on discovering the most appropriate levels of exercise training that promote ventricular repolarization normalization in LQTS.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur J Prev Cardiol: 10 May 2022; epub ahead of print
Harvey A, Curnier D, Dodin P, Abadir S, Jacquemet V, Caru M
Eur J Prev Cardiol: 10 May 2022; epub ahead of print | PMID: 35537006
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Abstract

Burden of cardiovascular risk factors and disease in five Asian groups in Catalonia: a disaggregated, population-based analysis of 121 000 first-generation Asian immigrants.

Satish P, Vela E, Bilal U, Cleries M, ... Mauri J, Cainzos-Achirica M
Aims
To evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese.
Methods and results
Retrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals (\'locals\'). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD.
Conclusions
In Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

Eur J Prev Cardiol: 06 May 2022; 29:916-924
Satish P, Vela E, Bilal U, Cleries M, ... Mauri J, Cainzos-Achirica M
Eur J Prev Cardiol: 06 May 2022; 29:916-924 | PMID: 33969397
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Abstract

Sex-specific anthropometric and blood pressure trajectories and risk of incident atrial fibrillation: the Rotterdam Study.

Lu Z, Tilly MJ, Geurts S, Aribas E, ... van Rosmalen J, Kavousi M
Aims
To investigate sex-specific longitudinal trajectories of various obesity-related measures and blood pressure at population level and further assess the impact of these trajectories on new-onset atrial fibrillation (AF).
Methods
Participants with ≥2 repeated assessments for various risk factors from the population-based Rotterdam Study were included. Latent class linear mixed models were fitted to identify the potential classes. Cox proportional hazards models were used to assess the association between risk factors\' trajectories and risk of new-onset AF, with the most favourable trajectory as reference.
Results
Among 7,367 participants (mean baseline age: 73 years, 58.8% women), after a median follow-up time of 8.9 years (interquartile range: 5.3-10.4), 769 (11.4%) participants developed new-onset AF. After adjustments for cardiovascular risk factors, persistent-increasing body mass index (BMI) trajectory carried higher risk for AF [hazard ratio, 95% confidence interval: (1.39; 1.05-1.85) in men, (1.60; 1.19-2.15) in women], compared with the lower-and-stable BMI trajectory. Trajectories of elevated-and-stable waist circumference (WC) in women (1.53; 1.09-2.15) and elevated-and-stable hip circumference (HC) in men (1.83; 1.11-3.03) were associated with incident AF. For systolic blood pressure (SBP), the initially hypertensive trajectory carried the largest risk for AF among women (1.79; 1.21-2.65) and men (1.82; 1.13-2.95). Diastolic blood pressure (DBP) trajectories were significantly associated with AF risk among women, but not men.
Conclusions
Longitudinal trajectories of weight, BMI, WC, HC and SBP were associated with new-onset AF in both men and women. DBP trajectories were additionally associated with AF in women. Our results highlight the importance of assessing long-term exposure to risk factors for AF prevention among men and women.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Eur J Prev Cardiol: 05 May 2022; epub ahead of print
Lu Z, Tilly MJ, Geurts S, Aribas E, ... van Rosmalen J, Kavousi M
Eur J Prev Cardiol: 05 May 2022; epub ahead of print | PMID: 35512674
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Abstract

Sex-Specific Added Value of Cardiac Biomarkers for 10-Year Cardiovascular Risk Prediction.

Zhu F, Arshi B, Leening MJG, Aribas E, ... Ikram MK, Kavousi M
Background
Sex-specific risk predictive performance of N-terminal pro B-type natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin T (hs-cTnT) and creatine kinase myocardial band (CK-MB), for individual and composite cardiovascular outcomes remains unclear.
Objectives
To evaluate the sex-specific predictive value of NT-proBNP, hs-cTnT and CK-MB for 10-year risk prediction of coronary heart disease (CHD), stroke, heart failure (HF) and composite outcomes.
Methods
5430 individuals (mean age 68.6 years, 59.9% women) from the Rotterdam Study, with biomarker measurements between 1997-2001, were included. Participants were followed until 2015. We fitted \'basic\' models using traditional cardiovascular risk factors. Improvements in c-statistics and net reclassification improvement (NRI) for events and non-events were calculated.
Results
During a median follow-up of 14 years, 747 (13.8%), 563 (10.4%), and 664 (12.2%) participants were diagnosed with CHD, stroke, and HF respectively. NT-proBNP improved the discriminative performance of the \'basic\' model for all endpoints (c-statistic improvements ranging from 0.007 to 0.050) and provided significant event-net reclassification improvement (NRI) for HF (14.3% in women; 10.7% in men) and for stroke in men (9.3%). The addition of hs-cTnT increased c-statistic for CHD in women by 0.029 (95%CI, 0.011-0.047) and for HF in men by 0.034 (95%CI, 0.014-0.053), and provided significant event-NRI for CHD (10.3%) and HF (7.8%) in women, and for stroke (8.4%) in men. The added predictive value of CK-MB was limited.
Conclusion
NT-proBNP and hs-cTnT provided added predictive value for various cardiovascular outcomes above traditional risk factors. Sex differences were observed in the predictive performance of these biomarkers.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Eur J Prev Cardiol: 05 May 2022; epub ahead of print
Zhu F, Arshi B, Leening MJG, Aribas E, ... Ikram MK, Kavousi M
Eur J Prev Cardiol: 05 May 2022; epub ahead of print | PMID: 35512434
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Abstract

Medications for blood pressure, blood glucose, lipids, and anti-thrombotic medications: relationship with cardiovascular disease and death in adults from 21 high-, middle-, and low-income countries with an elevated body mass index.

Leong DP, Rangarajan S, Rosengren A, Oguz A, ... Yusuf R, Yusuf S
Aims
Elevated body mass index (BMI) is an important cause of cardiovascular disease (CVD). The population-level impact of pharmacologic strategies to mitigate the risk of CVD conferred by the metabolic consequences of an elevated BMI is not well described.
Methods and results
We conducted an analysis of 145 986 participants (mean age 50 years, 58% women) from 21 high-, middle-, and low-income countries in the Prospective Urban and Rural Epidemiology study who had no history of cancer, ischaemic heart disease, heart failure, or stroke. We evaluated whether the hazards of CVD (myocardial infarction, stroke, heart failure, or cardiovascular death) differed among those taking a cardiovascular medication (n = 29 174; including blood pressure-lowering, blood glucose-lowering, cholesterol-lowering, or anti-thrombotic medications) vs. those not taking a cardiovascular medication (n = 116 812) during 10.2 years of follow-up. Cox proportional hazard models with the community as a shared frailty were constructed by adjusting age, sex, education, geographic region, physical activity, tobacco, and alcohol use. We observed 7928 (5.4%) CVD events and 9863 (6.8%) deaths. Cardiovascular medication use was associated with different hazards of CVD (interaction P < 0.0001) and death (interaction P = 0.0020) as compared with no cardiovascular medication use. Among those not taking a cardiovascular medication, as compared with those with BMI 20 to <25 kg/m2, the hazard ratio (HR) [95% confidence interval (95% CI)] for CVD were, respectively, 1.14 (1.06-1.23); 1.45 (1.30-1.61); and 1.53 (1.28-1.82) among those with BMI 25 to <30 kg/m2; 30 to <35 kg/m2; and ≥35 kg/m2. However, among those taking a cardiovascular medication, the HR (95% CI) for CVD were, respectively, 0.79 (0.72-0.87); 0.90 (0.79-1.01); and 1.14 (0.98-1.33). Among those not taking a cardiovascular medication, the respective HR (95% CI) for death were 0.93 (0.87-1.00); 1.03 (0.93-1.15); and 1.44 (1.24-1.67) among those with BMI 25 to <30 kg/m2; 30 to <35 kg/m2; and ≥35 kg/m2. However, among those taking a cardiovascular medication, the respective HR (95% CI) for death were 0.77 (0.69-0.84); 0.88 (0.78-0.99); and 1.12 (0.96-1.30). Blood pressure-lowering medications accounted for the largest population attributable benefit of cardiovascular medications.
Conclusion
To the extent that CVD risk among those with an elevated BMI is related to hypertension, diabetes, and an elevated thrombotic milieu, targeting these pathways pharmacologically may represent an important complementary means of reducing the CVD burden caused by an elevated BMI.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 04 May 2022; epub ahead of print
Leong DP, Rangarajan S, Rosengren A, Oguz A, ... Yusuf R, Yusuf S
Eur J Prev Cardiol: 04 May 2022; epub ahead of print | PMID: 35512128
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Abstract

Triglyceride-glucose index in the development of heart failure and left ventricular dysfunction: analysis of the ARIC study.

Huang R, Lin Y, Ye X, Zhong X, ... Zhuang X, Liao X
Aims
We aimed to investigate whether the triglyceride-glucose (TyG) index, an easy-calculated and reliable surrogate of insulin resistance, was associated with the development of heart failure (HF) and left ventricular (LV) dysfunction.
Methods and results
A total of 12 374 participants (mean age: 54.1 ± 5.7 years, male: 44.7%) free of history of HF and coronary heart disease at baseline from the Atherosclerosis Risk in Communities study were included. The TyG index was calculated as ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. The long-term TyG index was calculated as the updated cumulative average TyG index using all available TyG index from baseline to the events of HF or the end of follow-up. We evaluated the associations of both the baseline and the long-term TyG index with incident HF using Cox regression analysis. We also analysed the effect of the TyG index on LV structure and function among 4889 participants with echocardiographic data using multivariable linear regression analysis. There were 1958 incident HF cases over a median follow-up of 22.5 years. After adjusting for potential confounders, 1-SD (0.60) increase in the baseline TyG index was associated with a 15% higher risk of HF development [hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.10-1.21]. Compared with participants in the lowest quartile of the baseline TyG index, those in the highest quartile had a greater risk of incident HF [HR (95% CI): 1.25 (1.08-1.45)]. In terms of LV structure and function, a greater baseline TyG index was associated with adverse LV remodelling and LV dysfunction. Similar results were found for the long-term TyG index.
Conclusion
In a community-based cohort, we found that a greater TyG index was significantly associated with a higher risk of incident HF and impaired LV structure and function.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 04 May 2022; epub ahead of print
Huang R, Lin Y, Ye X, Zhong X, ... Zhuang X, Liao X
Eur J Prev Cardiol: 04 May 2022; epub ahead of print | PMID: 35512245
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Abstract

Factors associated with excess female mortality in obstructive hypertrophic cardiomyopathy.

Javidgonbadi D, Schaufelberger M, Östman-Smith I
Background
Several studies have reported excess female mortality in patients with hypertrophic cardiomyopathy, but the cause is unknown.
Aims
To compare risk-factors for disease-related death in both sexes in a geographical cohort of patients with obstructive hypertrophic cardiomyopathy (oHCM).
Methods and results
Data-bases in all ten hospitals within West Götaland Region yielded 250 oHCM-patients (123 females, 127 males). Mean follow-up was 18.1 y. Risk-factors for disease-related death were evaluated by Cox-hazard regression and Kaplan-Meier survival-curves, with sex-comparisons of distribution of risk-factors and therapy in total and age-matched (n = 166) groups. At diagnosis females were older, median 62 y vs. 51 y, (P < 0.001), but not different in outflow-gradients and median NYHA-class. However, septal hypertrophy was more advanced: 10.6 [IQR = 3.2] vs. 9.6 [2.5] mm/m2 BSA; P = 0.002. Females had higher disease-related mortality than males (P = <0.001), with annual mortality 2.9% vs. 1.5% in age-matched groups (P = 0.010 log-rank). For each risk-category identified (NYHA-class ≥ III, outflow-gradient ≥50 mmHg), a higher proportion of females died (P = 0.0004; P = 0.001). Calcium-blocker therapy was a risk-factor (P = 0.005) and was used more frequently in females (P = 0.034). A beta-blocker dose above cohort-median reduced risk for disease-related death in both males (HR = 0.32; P = 0.0040) and in females (HR = 0.49; P = 0.020). Excess female deaths occurred in chronic heart-failure (P = 0.001) and acute myocardial infarctions (P = 0.015). Fewer females received beta-blocker therapy after diagnosis (64% vs. 78%, P = 0.018), in a smaller dose (P = 0.007), and less frequently combined with disopyramide (7% vs. 16%, P = 0.048).
Conclusion
Addressing sex-disparities in the timing of diagnosis and pharmacological therapy has the potential to improve the care of females with oHCM.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur J Prev Cardiol: 04 May 2022; epub ahead of print
Javidgonbadi D, Schaufelberger M, Östman-Smith I
Eur J Prev Cardiol: 04 May 2022; epub ahead of print | PMID: 35512246
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Abstract

High cholesterol absorption is associated with increased cardiovascular risk in haemodialysis patients: insights from the AURORA study.

Silbernagel G, Duarte K, Sadiku S, Fauler G, ... Scharnagl H, Zannad F
Aims
Statin treatment did not reduce the risk of cardiovascular events in haemodialysis patients in the 4D and AURORA trials. Post hoc analyses in the 4D study suggested that high cholesterol absorption was associated with increased cardiovascular risk and that atorvastatin would reduce cardiovascular risk in haemodialysis patients with low cholesterol absorption but not in those with high cholesterol absorption.
Methods and results
AURORA is a randomized, double-blind, placebo-controlled, multi-centre trial in haemodialysis patients. The participants were randomly assigned to receive either rosuvastatin, 10 mg daily, or a matching placebo. There was a follow-up for cardiovascular death with a median duration of 3.9 years. The cholestanol and lathosterol to cholesterol ratios were used to estimate cholesterol absorption and synthesis, respectively. Measurement of non-cholesterol sterols was available in 2332 participants of the 2733 patients included in the primary analysis of the AURORA study. A total of 598 participants died from cardiovascular diseases. The 3rd vs. the 1st tertile of the cholestanol-to-cholesterol ratio was significantly associated with increased risk of cardiovascular death [hazard ratio, HR (95% confidence interval, CI) = 1.36 (1.11-1.65)] in univariate (P = 0.002) and multivariate models (P = 0.034). In contrast, the 3rd vs. the 1st tertile of the lathosterol-to-cholesterol ratio was significantly associated with decreased risk of cardiovascular death [HR (95% CI) = 0.81 (0.67-0.99)] in univariate (P = 0.041) and multivariate (P = 0.019) models. There was no significant interaction between the cholestanol and lathosterol to cholesterol tertiles and treatment group in predicting cardiovascular death.
Conclusion
The present data from the AURORA study confirm that high cholesterol absorption is associated with increased cardiovascular risk in haemodialysis patients. Assessment of the individual cholesterol absorption rate to guide initiation of statin treatment is not supported by the findings in the AURORA study.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Eur J Prev Cardiol: 04 May 2022; epub ahead of print
Silbernagel G, Duarte K, Sadiku S, Fauler G, ... Scharnagl H, Zannad F
Eur J Prev Cardiol: 04 May 2022; epub ahead of print | PMID: 35512252
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Impact:
Abstract

Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study.

Fortuin-de Smidt MC, Sewe MO, Lassale C, Weiderpass E, ... Butterworth AS, Wennberg P
Aims
This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors.
Methods and results
EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%).
Conclusions
In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.

© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Eur J Prev Cardiol: 11 Apr 2022; epub ahead of print
Fortuin-de Smidt MC, Sewe MO, Lassale C, Weiderpass E, ... Butterworth AS, Wennberg P
Eur J Prev Cardiol: 11 Apr 2022; epub ahead of print | PMID: 35403197
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Impact:
Abstract

Utility of the CHA2DS2-VASc score for predicting ischaemic stroke in patients with or without atrial fibrillation: a systematic review and meta-analysis.

Siddiqi TJ, Usman MS, Shahid I, Ahmed J, ... Rihal CS, Alkhouli M
Aims
Anticoagulants are the mainstay treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), and the CHA2DS2-VASc score is widely used to guide anticoagulation therapy in this cohort. However, utility of CHA2DS2-VASc in NVAF patients is debated, primarily because it is a vascular scoring system, which does not incorporate atrial fibrillation related parameters. Therefore, we conducted a meta-analysis to estimate the discrimination ability of CHA2DS2-VASc in predicting ischaemic stroke overall, and in subgroups of patients with or without NVAF.
Methods and results
PubMed and Embase databases were searched till June 2020 for published articles that assessed the discrimination ability of CHA2DS2-VASc, as measured by C-statistics, during mid-term (2-5 years) and long-term (>5 years) follow-up. Summary estimates were reported as random effects C-statistics with 95% confidence intervals (CIs). Seventeen articles were included in the analysis. Nine studies (n = 453 747 patients) reported the discrimination ability of CHA2DS2-VASc in NVAF patients, and 10 studies (n = 138 262 patients) in patients without NVAF. During mid-term follow-up, CHA2DS2-VASc predicted stroke with modest discrimination in the overall cohort [0.67 (0.65-0.69)], with similar discrimination ability in patients with NVAF [0.65 (0.63-0.68)] and in those without NVAF [0.69 (0.68-0.71)] (P-interaction = 0.08). Similarly, at long-term follow-up, CHA2DS2-VASc had modest discrimination [0.66 (0.63-0.69)], which was consistent among patients with NVAF [0.63 (0.54-0.71)] and those without NVAF [0.67 (0.64-0.70)] (P-interaction = 0.39).
Conclusion
This meta-analysis suggests that the discrimination power of the CHA2DS2-VASc score in predicting ischaemic stroke is modest, and is similar in the presence or absence of NVAF. More accurate stroke prediction models are thus needed for the NVAF population.

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Eur J Prev Cardiol: 30 Mar 2022; 29:625-631
Siddiqi TJ, Usman MS, Shahid I, Ahmed J, ... Rihal CS, Alkhouli M
Eur J Prev Cardiol: 30 Mar 2022; 29:625-631 | PMID: 33693717
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Impact:
Abstract

Residual cardiovascular risk reduction guided by lifetime benefit estimation in patients with symptomatic atherosclerotic disease: effectiveness and cost-effectiveness.

Hageman SHJ, Dorresteijn JAN, Bots ML, Asselbergs FW, ... Visseren FLJ, Westerink J
Aims
To determine the (cost)-effectiveness of blood pressure lowering, lipid-lowering, and antithrombotic therapy guided by predicted lifetime benefit compared to risk factor levels in patients with symptomatic atherosclerotic disease.
Methods and results
For all patients with symptomatic atherosclerotic disease in the UCC-SMART cohort (1996-2018; n = 7697) two treatment strategies were compared. The lifetime benefit-guided strategy was based on individual estimation of gain in cardiovascular disease (CVD)-free life with the SMART-REACH model. In the risk factor-based strategy, all patients were treated the following: low-density lipoprotein cholesterol (LDL-c) < 1.8 mmol/L, systolic blood pressure <140 mmHg, and antithrombotic medication. Outcomes were evaluated for the total cohort using a microsimulation model. Effectiveness was evaluated as total gain in CVD-free life and events avoided, cost-effectiveness as incremental cost-effectivity ratio (ICER). In comparison to baseline treatment, treatment according to lifetime benefit would lead to an increase of 24 243 CVD-free life years [95% confidence interval (CI) 19 980-29 909] and would avoid 940 (95% CI 742-1140) events in the next 10 years. For risk-factor based treatment, this would be an increase of 18 564 CVD-free life years (95% CI 14 225-20 456) and decrease of 857 (95% CI 661-1057) events. The ICER of lifetime benefit-based treatment with a treatment threshold of ≥1 year additional CVD-free life per therapy was €15 092/QALY gained and of risk factor-based treatment €9933/QALY gained. In a direct comparison, lifetime benefit-based treatment compared to risk factor-based treatment results in 1871 additional QALYs for the price of €36 538/QALY gained.
Conclusion
Residual risk reduction guided by lifetime benefit estimation results in more CVD-free life years and more CVD events avoided compared to the conventional risk factor-based strategy. Lifetime benefit-based treatment is an effective and potentially cost-effective strategy for reducing residual CVD risk in patients with clinical manifest vascular disease.

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Eur J Prev Cardiol: 30 Mar 2022; 29:635-644
Hageman SHJ, Dorresteijn JAN, Bots ML, Asselbergs FW, ... Visseren FLJ, Westerink J
Eur J Prev Cardiol: 30 Mar 2022; 29:635-644 | PMID: 34009323
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Impact:
Abstract

The role of the electrocardiographic phenotype in risk stratification for sudden cardiac death in childhood hypertrophic cardiomyopathy.

Norrish G, Topriceanu C, Qu C, Field E, ... Omar RZ, Kaski JP
Aims
The 12-lead electrocardiogram (ECG) is routinely performed in children with hypertrophic cardiomyopathy (HCM). An ECG risk score has been suggested as a useful tool for risk stratification, but this has not been independently validated. This aim of this study was to describe the ECG phenotype of childhood HCM in a large, international, multi-centre cohort and investigate its role in risk prediction for arrhythmic events.
Methods and results
Data from 356 childhood HCM patients with a mean age of 10.1 years (±4.5) were collected from a retrospective, multi-centre international cohort. Three hundred and forty-seven (97.5%) patients had ECG abnormalities at baseline, most commonly repolarization abnormalities (n = 277, 77.8%); left ventricular hypertrophy (n = 240, 67.7%); abnormal QRS axis (n = 126, 35.4%); or QT prolongation (n = 131, 36.8%). Over a median follow-up of 3.9 years (interquartile range 2.0-7.7), 25 (7%) had an arrhythmic event, with an overall annual event rate of 1.38 (95% CI 0.93-2.04). No ECG variables were associated with 5-year arrhythmic event on univariable or multivariable analysis. The ECG risk score threshold of >5 had modest discriminatory ability [C-index 0.60 (95% CI 0.484-0.715)], with corresponding negative and positive predictive values of 96.7% and 6.7.
Conclusion
In a large, international, multi-centre cohort of childhood HCM, ECG abnormalities were common and varied. No ECG characteristic, either in isolation or combined in the previously described ECG risk score, was associated with 5-year sudden cardiac death risk. This suggests that the role of baseline ECG phenotype in improving risk stratification in childhood HCM is limited.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur J Prev Cardiol: 30 Mar 2022; 29:645-653
Norrish G, Topriceanu C, Qu C, Field E, ... Omar RZ, Kaski JP
Eur J Prev Cardiol: 30 Mar 2022; 29:645-653 | PMID: 33772274
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Impact:
Abstract

The role of exercise in the prevention of cancer therapy-related cardiac dysfunction in breast cancer patients undergoing chemotherapy: systematic review.

Murray J, Bennett H, Bezak E, Perry R
Aims
Breast cancer (BC) patients undergoing chemotherapy are at risk of developing cancer therapy-related cardiac dysfunction (CTRCD). Exercise has been proposed to prevent CTRCD; however, its effectiveness remains unclear. The aim of this systematic review was to establish the effect of exercise on global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF) in BC patients undergoing chemotherapy, to determine if exercise can prevent the development of CTRCD.
Methods and results
Four databases (Medline, Scopus, eMbase, SPORTDiscus) were searched. Studies were eligible for inclusion if they measured GLS or LVEF prior to and following an exercise intervention of any length in BC patients undergoing chemotherapy and were published in English from 2000 onwards. Risk of bias was evaluated using the QUADAS-2 tool. Of the 398 studies screened, eight were eligible. Changes were similar in exercising (EX) and non-exercising (CON) groups for GLS (EX: pre: -19.6 ± 0.4, post: -20.1 ± 1.0, CON: pre: -20.0 ± 0.4, post: -20.1 ± 1) and LVEF (EX: pre: 58.5 ± 4.1%, post: 58.6 ± 2%, CON: pre: 56.6 ± 4.2%, post: 55.6 ± 4.6%). Exercise maintained or improved peak oxygen uptake (VO2peak) during chemotherapy, while declines were observed in non-exercising groups. The included studies were limited by methodological deficiencies.
Conclusion
The ability of exercise to prevent CTRCD is unclear. However, exercise positively impacts cardiorespiratory fitness in BC patients undergoing chemotherapy. Future research must address the methodological limitations of current research to understand the true effect of exercise in the prevention of CTRCD.

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Eur J Prev Cardiol: 25 Mar 2022; 29:463-472
Murray J, Bennett H, Bezak E, Perry R
Eur J Prev Cardiol: 25 Mar 2022; 29:463-472 | PMID: 33693524
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Impact:
Abstract

Dose-response effects of physical activity on all-cause mortality and major cardiorenal outcomes in chronic kidney disease.

Kuo CP, Tsai MT, Lee KH, Lin YP, ... Tseng WC, Tarng DC
Aims
Physical activity has a protective effect against mortality and cardiovascular events in chronic kidney disease (CKD) patients. Nonetheless, how different levels of physical activity affect the health benefits in CKD remains unclear. This study aimed to investigate the dose-response effects of physical activity on mortality and major cardiorenal events in CKD.
Methods and results
We evaluated a longitudinal cohort of 4508 Taiwanese CKD patients between 2004 and 2017. Physical activity was assessed by the NHANES questionnaire and quantified in metabolic equivalent-hours per week (MET-hour/week). Patients were categorized into highly active (≥7.5 MET-h/week), low-active (0.1 to <7.5 MET-h/week), or inactive (0 MET-h/week) groups. Cox regression and restricted cubic spline models were utilized to explore the association between physical activity and the risks of study outcomes, including all-cause mortality, end-stage renal disease (ESRD), and major adverse cardiovascular events (MACE, a composite of cardiovascular death, myocardial infarction, ischaemic stroke, and hospitalized heart failure). During a median follow-up of 686 days, 739 death, 1059 ESRD, and 521 MACE events occurred. Highly active group had the lowest chance of all study outcomes, followed by low-active and inactive groups (P < 0.001). Multivariable Cox regression showed that only highly active group was independently associated with lower risks for all-cause mortality [hazard ratio (HR) 0.62; 95% confidence interval (CI) 0.53-0.74], ESRD (HR 0.83, 95% CI 0.72-0.96), and MACE (HR 0.63, 95% CI 0.51-0.76) compared to the inactive group. The risks of MACE did not further decrease once physical activity surpassed 15 MET-h/week, indicating a U-shaped association. The results were consistent in the subgroup and sensitivity analyses.
Conclusion
Physical activity of 7.5 to <15 MET-h/week is associated with lower risks of adverse cardiorenal outcomes and should be integrated into the care of CKD.

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Eur J Prev Cardiol: 25 Mar 2022; 29:452-461
Kuo CP, Tsai MT, Lee KH, Lin YP, ... Tseng WC, Tarng DC
Eur J Prev Cardiol: 25 Mar 2022; 29:452-461 | PMID: 33704426
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Impact:
Abstract

Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys.

De Bacquer D, Astin F, Kotseva K, Pogosova N, ... Jennings C, EUROASPIRE IV and V surveys of the European Observational Research Programme of the European Society of Cardiology
Aims 
Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient\'s perspective.
Methods and results 
In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour.
Conclusion 
Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.

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Eur J Prev Cardiol: 11 Mar 2022; 29:383-395
De Bacquer D, Astin F, Kotseva K, Pogosova N, ... Jennings C, EUROASPIRE IV and V surveys of the European Observational Research Programme of the European Society of Cardiology
Eur J Prev Cardiol: 11 Mar 2022; 29:383-395 | PMID: 34293121
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Impact:
Abstract

Time trends in ischaemic heart disease incidence and mortality over three decades (1990-2019) in 20 Western European countries: systematic analysis of the Global Burden of Disease Study 2019.

Vancheri F, Tate AR, Henein M, Backlund L, ... Palmieri L, Strender LE
Aims
To investigate and compare changes in the rates of ischaemic heart disease (IHD) incidence and mortality between 1990 and 2019 in 20 high-income Western European countries with similar public health systems and low cardiovascular risk.
Methods and results
The 2020 updated version of the Global Burden of Disease database was searched. Variability and differences in IHD incidence and mortality rates (per 100 000) between countries over time, were calculated. A piecewise linear (join point) regression model was used to identify the slopes of these trends and the points in time at which significant changes in the trends occur. Ischaemic heart disease incidence and mortality rates varied widely between countries but decreased for all between 1990 and 2019. The relative change was greater for mortality than for incidence. Ischaemic heart disease incidence rates declined by approximately 36% between 1990 and 2019, while mortality declined by approximately 60%. Breakpoint analysis showed that the largest decreases in incidence and mortality occurred between 1990 and 2009 (-32%, -52%, respectively), with a much slower decrease after that (-5.9%, -17.6%, respectively), and even a slight increase for some countries in recent years. The decline in both incidence and mortality was lower in the Mediterranean European countries compared to the Nordic and Central European regions.
Conclusions
In the Western European countries studied, the decline in age-standardized IHD incidence over three decades was slower than the decline in age-standardized IHD mortality. Decreasing trends of both IHD incidence and mortality has substantially slowed, and for some countries flattened, in more recent years.

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Eur J Prev Cardiol: 10 Mar 2022; 29:396-403
Vancheri F, Tate AR, Henein M, Backlund L, ... Palmieri L, Strender LE
Eur J Prev Cardiol: 10 Mar 2022; 29:396-403 | PMID: 34487157
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Impact:
Abstract

Drug-resistant hypertension in primary aldosteronism patients undergoing adrenal vein sampling: the AVIS-2-RH study.

Rossi GP, Rossitto G, Amar L, Azizi M, ... Seccia TM, Lenzini L
Aims
We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres.
Methods and results
The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 1*10-4) with a higher rate of RH in men than in women (23% vs. 15% P < 1*10-4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all.
Conclusions
(i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.

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Eur J Prev Cardiol: 10 Mar 2022; 29:e85-e93
Rossi GP, Rossitto G, Amar L, Azizi M, ... Seccia TM, Lenzini L
Eur J Prev Cardiol: 10 Mar 2022; 29:e85-e93 | PMID: 33742213
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Impact:
Abstract

Combined assessment of stress cardiovascular magnetic resonance and angiography to predict the effect of revascularization in chronic coronary syndrome patients.

Gavara J, Perez N, Marcos-Garces V, Monmeneu JV, ... Chorro FJ, Bodi V
Aims
The role of revascularization in chronic coronary syndrome (CCS) and the value of ischaemia vs. anatomy to guide decision-making are in constant debate. We explored the potential of a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance (CMR) and presence of multivessel disease by angiography to predict the effect of revascularization on all-cause mortality in CCS.
Methods and results
The study group comprised 1066 CCS patients submitted to vasodilator stress CMR pre-cardiac catheterization (mean age 66 ± 11 years, 69% male). Stress CMR-derived ischaemic burden (extensive if >5 ischaemic segments) and presence of multivessel disease in angiography (two- or three-vessel or left main stem disease) were computed. The influence of revascularization on all-cause mortality was explored and adjusted hazard ratios (HRs) with the corresponding 95% confidence intervals were obtained. During a median 7.51-year follow-up, 557 (52%) CMR-related revascularizations and 308 (29%) deaths were documented. Revascularization exerted a neutral effect on all-cause mortality in the whole study group [HR 0.94 (0.74-1.19), P = 0.6], in patients without multivessel disease [n = 598, 56%, HR 1.12 (0.77-1.62), P = 0.6], and in those with multivessel disease without extensive ischaemic burden [n = 181, 17%, HR 1.66 (0.91-3.04), P = 0.1]. However, compared to non-revascularized patients, revascularization significantly reduced all-cause mortality in patients with simultaneous multivessel disease and extensive ischaemic burden (n = 287, 27%): 3.77 vs. 7.37 deaths per 100 person-years, HR 0.60 (0.40-0.90), P = 0.01.
Conclusions
In patients with CCS submitted to catheterization, evidence of simultaneous extensive CMR-related ischaemic burden and multivessel disease identifies the subset in whom revascularization can reduce all-cause mortality.

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Eur J Prev Cardiol: 10 Mar 2022; 29:407-416
Gavara J, Perez N, Marcos-Garces V, Monmeneu JV, ... Chorro FJ, Bodi V
Eur J Prev Cardiol: 10 Mar 2022; 29:407-416 | PMID: 34686874
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Impact:
Abstract

Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Mass General Brigham YOUNG-MI Registry.

Weber B, Biery DW, Singh A, Divakaran S, ... Di Carli MF, Blankstein R
Aims
Autoimmune systemic inflammatory diseases (SIDs) are associated with an increased risk of cardiovascular (CV) disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of SID among adults who experience an MI at a young age. We sought to determine the prevalence and prognostic implications of SID among adults who experienced an MI at a young age.
Methods and results
The YOUNG-MI registry is a retrospective cohort study from two large academic centres, which includes patients who experienced a first MI at 50 years of age or younger. SID was ascertained through physician review of the electronic medical record (EMR). Incidence of death was ascertained through the EMR and national databases. The cohort consisted of 2097 individuals, with 53 (2.5%) possessing a diagnosis of SID. Patients with SID were more likely to be female (36% vs. 19%, P = 0.004) and have hypertension (62% vs. 46%, P = 0.025). Over a median follow-up of 11.2 years, patients with SID experienced an higher risk of all-cause mortality compared with either the full cohort of non-SID patients [hazard ratio (HR) = 1.95, 95% confidence interval (CI) (1.07-3.57), P = 0.030], or a matched cohort based on age, gender, and CV risk factors [HR = 2.68, 95% CI (1.18-6.07), P = 0.018].
Conclusions
Among patients who experienced a first MI at a young age, 2.5% had evidence of SID, and these individuals had higher rates of long-term all-cause mortality. Our findings suggest that the presence of SID is associated with worse long-term survival after premature MI.

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Eur J Prev Cardiol: 10 Mar 2022; 29:352-359
Weber B, Biery DW, Singh A, Divakaran S, ... Di Carli MF, Blankstein R
Eur J Prev Cardiol: 10 Mar 2022; 29:352-359 | PMID: 33784740
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Impact:
Abstract

Global, regional, and national quality of care of ischaemic heart disease from 1990 to 2017: a systematic analysis for the Global Burden of Disease Study 2017.

Aminorroaya A, Yoosefi M, Rezaei N, Shabani M, ... Larijani B, Farzadfar F
Aims
By 2030, we seek to reduce premature deaths from non-communicable diseases, including ischaemic heart disease (IHD), by one-third to reach the sustainable development goal (SDG) target 3.4. We aimed to investigate the quality of care of IHD across countries, genders, age groups, and time using the Global Burden of Diseases Study (GBD) 2017 estimates.
Methods and results
We did a principal component analysis on IHD mortality to incidence ratio, disability-adjusted life-years (DALYs) to prevalence ratio, and years of life lost to years lived with disability ratio using the results of the GBD 2017. The first principal component was scaled from 0 to 100 and designated as the quality of care index (QCI). We evaluated gender inequity by the gender disparity ratio (GDR), defined as female to male QCI. From 1990 to 2017, the QCI and GDR increased from 71.2 to 76.4 and from 1.04 to 1.08, respectively, worldwide. In the study period, countries of Western Europe, Scandinavia, and Australasia had the highest QCIs and a GDR of 1 to 1.2; however, African and South Asian countries had the lowest QCIs and a GDR of 0.8 to 1. Moreover, the young population experienced more significant improvements in the QCI compared to the elderly in 2017.
Conclusion
From 1990 to 2017, the QCI of IHD has improved; nonetheless, there are remarkable disparities between countries, genders, and age groups that should be addressed. These findings may guide policymakers in monitoring and modifying our path to achieve SDGs.

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Eur J Prev Cardiol: 10 Mar 2022; 29:371-379
Aminorroaya A, Yoosefi M, Rezaei N, Shabani M, ... Larijani B, Farzadfar F
Eur J Prev Cardiol: 10 Mar 2022; 29:371-379 | PMID: 34041535
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Impact:
Abstract

Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015-16.

Hopstock LA, Morseth B, Cook S, Eggen AE, ... Nilsen A, Njølstad I
Aims
To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway.
Methods and results
In the population-based Tromsø Study 2015-16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (<140/90 mmHg, <130/80 mmHg if diabetes), LDL cholesterol (<1.8 mmol/L), HbA1c (<7.0% if diabetes), overweight (body mass index (BMI) <25 kg/m2, waist circumference women <80 cm, men <94 cm), smoking (non-smoking), physical activity (self-reported >sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat <10E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers.
Conclusion 
Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care and treatment after MI and stroke is needed.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur J Prev Cardiol: 10 Mar 2022; 29:362-370
Hopstock LA, Morseth B, Cook S, Eggen AE, ... Nilsen A, Njølstad I
Eur J Prev Cardiol: 10 Mar 2022; 29:362-370 | PMID: 33778888
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Abstract

Cardiopulmonary assessment prior to returning to high-hazard occupations post symptomatic COVID-19 infection: A position statement of the Aviation and Occupational Cardiology Task Force of the European Association of Preventive Cardiology.

Rienks R, Holdsworth D, Davos CH, Halle M, ... Guettler N, Nicol E
This article provides an overview of the recommendations of the Aviation and Occupational Cardiology Task Force of the European Association of Preventive Cardiology on returning individuals to work in high hazard occupations (such as flying, diving and workplaces that are remote from healthcare facilities) following symptomatic COVID-19 infection. This process requires exclusion of significant underlying cardiopulmonary disease and this consensus statement (from experts across the field) outlines the appropriate screening and investigative processes that should be undertaken. The recommended response is based on simple screening in primary healthcare to determine those at risk, followed by first line investigations, including an exercise capacity assessment, to identify the small proportion of individuals who may have circulatory, pulmonary, or mixed disease. These individuals can then receive more advanced, targeted investigations. This statement provides a pragmatic, evidence-based approach for those (in all occupations) to assess employee health and capacity prior to a return to work following severe disease, or while continuing to experience significant post-COVID-19 symptoms (so called \"long-COVID\" or Post-COVID-19 syndrome).

© Crown copyright 2022.

Eur J Prev Cardiol: 09 Mar 2022; epub ahead of print
Rienks R, Holdsworth D, Davos CH, Halle M, ... Guettler N, Nicol E
Eur J Prev Cardiol: 09 Mar 2022; epub ahead of print | PMID: 35266533
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Abstract

Less revascularization in young women but impaired long-term outcomes in young men after myocardial infarction.

Kerola AM, Palomäki A, Rautava P, Kytö V
Background
Female sex has previously been associated with poorer outcomes after myocardial infarction (MI), although evidence is scarce among young patients.
Aim
We studied sex differences in cardiovascular outcomes after MI in young patients <55 years old.
Methods
Consecutive young (18-54 years) all-comer patients with out-of-hospital MI admitted to 20 Finnish hospitals (n = 8934, 17.3% women) in 2004-2014 were studied by synergizing national registries. Differences between sexes were balanced by inverse probability weighting. The median follow-up period was 9.1 years (max 14.8 years).
Results
Young women with MI had more comorbidities at baseline, were revascularized less frequently, and received fewer evidence-based secondary prevention medications (P2Y12 inhibitors, renin-angiotensin signaling pathway inhibitors, statins, and lower statin dosages) after MI than young men. Long-term mortality or the occurrence of major adverse cardiovascular events (MACE; recurrent MI, stroke, or cardiovascular death) did not differ between the sexes in the unadjusted analysis. However, after baseline and treatment-difference adjustment, men had poorer outcomes after MI. Adjusted long-term mortality was 21.3% in men vs. 17.2% in women (HR 1.29; 95% CI 1.10-1.53; p=0.002). Cumulative MACE rate was 33.9% in men vs. 27.9% in women during follow-up (HR 1.23; 95% CI 1.09-1.39; p=0.001). Recurrent MI and cardiovascular death occurrences were more frequent among men. Stroke occurrence did not differ between sexes.
Conclusions
Young women were found to receive less active treatment after MI than young men. Nevertheless, male sex was associated with poorer long-term cardiovascular outcomes after MI in young patients after baseline feature adjustment.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.

Eur J Prev Cardiol: 06 Mar 2022; epub ahead of print
Kerola AM, Palomäki A, Rautava P, Kytö V
Eur J Prev Cardiol: 06 Mar 2022; epub ahead of print | PMID: 35253860
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Abstract

Body weight and physical fitness in women with ischemic heart disease: Does physical fitness contribute to our understanding of the obesity paradox in women?

Quesada O, Lauzon M, Buttle R, Wei J, ... Pepine CJ, Bairey Merz CN
Aims
Body mass index (BMI)-defined obesity is paradoxically associated with lower all-cause mortality in patients with known cardiovascular disease (CVD). This study aims to determine the role of physical fitness in the obesity paradox in women with ischemic heart disease (IHD).
Methods and results
Women undergoing invasive coronary angiography with signs/symptoms of IHD in the Women\'s Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1997-2001) were analyzed. This study investigated the longer-term risk of major adverse cardiovascular events (MACE) and all-cause mortality associated with BMI and physical fitness measured by Duke Activity Status Index (DASI). Overweight was defined as BMl ≥25 to 30 kg/m2, obese as BMI ≥30 kg/m2, unfit as DASI scores <25, equivalent to ≤ 7 metabolic equivalents [METs]. Among 899 women, 18.6% were normal BMI-fit, 11.4% overweight-fit, 10.4% obese-fit, 15.3% normal BMI-unfit, 23.8% overweight-unfit, 30.4% obese-unfit. In adjusted models compared to normal BMI-fit, normal BMI-unfit women had higher MACE risk (HR 1.65, 95%CI 1.17-2.32, p = 0.004); whereas obese-fit and overweight-fit women had lower risk of mortality (HR 0.60, 95%CI 0.40-0.89, p = 0.012 and HR 0.62, 95% CI 0.41-0.92, p = 0.018, respectively).
Conclusion
To address the paradox of body weight and outcomes in women, we report for the first time that among women with signs/symptoms of IHD overweight-fit and obese-fit were at lower risk of long-term all-cause mortality; whereas normal BMI-unfit were at higher risk of MACE. Physical fitness may contribute to the obesity paradox in women, warranting future studies to better understand associations between body weight, body composition, and physical fitness to improve cardiovascular outcomes in women.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

Eur J Prev Cardiol: 03 Mar 2022; epub ahead of print
Quesada O, Lauzon M, Buttle R, Wei J, ... Pepine CJ, Bairey Merz CN
Eur J Prev Cardiol: 03 Mar 2022; epub ahead of print | PMID: 35244151
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Abstract

Global Burden of Rheumatic Heart Disease and its Association with Socioeconomic Development Status, 1990-2019.

Lv M, Jiang S, Liao D, Lin Z, Chen H, Zhang J
Aims
Rheumatic heart disease (RHD) remains an important health issue, yet global attention to RHD is diminishing. The aim of this study was to investigate the global burden of RHD and its relationship with socioeconomic development status.
Methods and results
Data were obtained from Global Burden of Disease (GBD) 2019 database. Incidence, prevalence, disability-adjusted life years (DALYs), and deaths numbers and rates for RHD were extracted and stratified by sex, level of socio-demographic index (SDI), country, and territory. In addition, the burden of RHD was compared across age groups. From 1990-2019, the age-standardized incidence and prevalence rates of RHD increased by 14.4% (11.2%-17.0%) and 13.8% (11.0%-16.0%), respectively. Incidence and prevalence rates showed an increasing trend in low SDI and low-middle SDI locations, while high-middle SDI and high SDI locations showed a decreasing trend. The age-standardized DALYs and deaths rates of RHD decreased by 53.1% (46.4-60.0) and 56.9% (49.8%-64.7%), and this downward trend more prominent in high-middle SDI and middle SDI locations. In addition, the age of incidence and prevalence rate were concentrated between 5-24 years and 15-49 years, predominantly in poor regions, and RHD appeared to be more common in women than in men.
Conclusion
The burden of RHD is negatively correlated with socioeconomic development status. In particular, the burden of RHD among children, adolescents, and women of childbearing age in poorer regions requires more attention. Policymakers should use the 2019 GBD data to guide cost-effective interventions and resource allocation for RHD.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.

Eur J Prev Cardiol: 01 Mar 2022; epub ahead of print
Lv M, Jiang S, Liao D, Lin Z, Chen H, Zhang J
Eur J Prev Cardiol: 01 Mar 2022; epub ahead of print | PMID: 35234886
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This program is still in alpha version.