Journal: Eur J Prev Cardiol

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<div><h4>Improving 10-year cardiovascular risk prediction in apparently healthy people: flexible addition of risk modifiers on top of SCORE2.</h4><i>Hageman SH, Petitjean C, Pennells L, Kaptoge S, ... Visseren FL, Dorresteijn JA</i><br /><b>Background</b><br />In clinical practice, factors associated with cardiovascular disease (CVD) like albuminuria, education level, or coronary artery calcium are often known, but not incorporated in cardiovascular risk prediction models. The aims of the current study were to evaluate a methodology for the flexible addition of risk modifying characteristics on top of SCORE2 and to quantify the added value of several clinically relevant risk modifying characteristics.<br /><b>Methods and results</b><br />Individuals without previous CVD or DM were included from the UK Biobank, ARIC, MESA, EPIC-NL and HNR studies (n=409,757) in whom 16,166 CVD events and 19,149 non-cardiovascular deaths were observed over exactly 10.0 years of follow-up. The effect of each possible risk modifying characteristic was derived using competing risk-adjusted Fine and Gray models. The risk modifying characteristics were applied to individual predictions with a flexible method using the population prevalence and the subdistribution hazard ratio (SHR) of the relevant. Risk modifying characteristics that increased discrimination most were CAC percentile with 0.0198 (95%CI 0.0115; 0.0281) and hs-Troponin-T with 0.0100 (95%CI 0.0063; 0.0137). External validation was performed in the CPRD cohort (UK, n = 518,015, 12,675 CVD events). Adjustment of SCORE2 predicted risks with both single and multiple risk modifiers did not negatively affect calibration and led to a modest increase in discrimination (0.740 (95%CI 0.736-0.745) versus unimproved SCORE2 risk C-index 0.737 [95%CI 0.732-0.741]).<br /><b>Conclusions</b><br />The current paper presents a method on how to integrate possible risk modifying characteristics that are not included in existing CVD risk models for the prediction of CVD event risk in apparently healthy people. This flexible methodology improves the accuracy of predicted risks and increases applicability of prediction models for individuals with additional risk known modifiers.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 02 Jun 2023; epub ahead of print</small></div>
Hageman SH, Petitjean C, Pennells L, Kaptoge S, ... Visseren FL, Dorresteijn JA
Eur J Prev Cardiol: 02 Jun 2023; epub ahead of print | PMID: 37264679
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<div><h4>Lifestyle patterns, genetic susceptibility, and risk of valvular heart disease: a prospective cohort study based on the UK Biobank.</h4><i>Jia C, Zeng Y, Huang X, Yang H, ... Chen W, Yang X</i><br /><b>Aims</b><br />Genetic and lifestyle factors are both major contributors to valvular heart disease (VHD). However, it is still uncertain whether genetic susceptibility alters the association between lifestyle and VHD. We aimed to investigate the association between lifestyle and VHD in different genetic risk backgrounds.<br /><b>Methods and results</b><br />A prospective cohort study was carried out on 499 341 participants without VHD at baseline. The assessment of lifestyle included smoking, alcohol consumption, diet, activity, and sleep. Genetic susceptibility was separately measured by polygenic risk scores (PRSs) and family history of cardiovascular disease (CVD). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) between lifestyle and VHD, as well as aortic stenosis (AS). During a median follow-up of 10.8 years, 12 983 incident VHD cases were diagnosed (incidence rate 2.46 per 1000 person-years), including 3527 AS cases (incidence rate 0.66 per 1000 person-years). The risk of VHD and AS decreased with healthier lifestyles (P value for trend <0.001). Compared to individuals with a unhealthy lifestyle, the HRs of VHD in intermediate and healthy lifestyle groups were 0.81 (0.76-0.86) and 0.81 (0.76-0.87). The negative association between healthy lifestyle and VHD events was independent of genetic risk (P for interaction between healthy lifestyle scores and PRSs/family history of CVD was 0.723/0.763). Similar findings were obtained in analyses of AS, and a stronger negative association was found.<br /><b>Conclusion</b><br />Our study reveals that adherence to a healthy lifestyle is significantly associated with a reduced risk of VHD especially AS, irrespective of genetic susceptibility.<br /><b>Summary</b><br />Based on a cohort of around 490 000 participants, the study investigated the association between lifestyle and VHD under different stratifications of genetic risk. The study found that a healthy lifestyle was associated with a lower risk of VHD, particularly AS, independent of genetic risk. Our findings suggest that advance interventions for lifestyle may be an effective way to reduce the global burden of VHD.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 01 Jun 2023; epub ahead of print</small></div>
Jia C, Zeng Y, Huang X, Yang H, ... Chen W, Yang X
Eur J Prev Cardiol: 01 Jun 2023; epub ahead of print | PMID: 37259902
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<div><h4>Screening for anxiety and depression in clinical practice: Translating scores from WHO-5/ASS-2/MDI-2 to HADS.</h4><i>Johnsen NF, Jensen SN, Christensen KB, Pedersen SS, ... Zwisler AD, Gislason GH</i><br /><b>Aim</b><br />The aim of this study was to evaluate if a combination of World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2) and Major Depression Inventory-2 (MDI-2) can replace the Hospital Anxiety and Depression Scale (HADS) as screening tool for anxiety and depression in cardiac patients across diagnoses, and whether it is feasible to generate crosswalks (translation tables) for use in clinical practice.<br /><b>Methods</b><br />We used data from the Danish \'Life with a heart disease\' survey, in which 10,000 patients with a hospital contact and discharge diagnosis of ischemic heart disease (IHD), heart failure (HF), heart valve disease (HVD) or atrial fibrillation (AF) in 2018 were invited. Potential participants received an electronic questionnaire including 51 questions on health, well-being, and evaluation of the health care system. Crosswalks between WHO-5/ASS-2 and HADS-A, and between WHO-5/MDI-2 and HADS-D were generated and tested using item response theory (IRT).<br /><b>Results</b><br />A total of 4346 patients responded to HADS, WHO-5, ASS-2, and MDI-2. Model fit of the bi-factor IRT models illustrated appropriateness of a bi-factor structure and thus of essential uni-dimensionality (RMSEA(p value) range 0.000-0.053(0.0099-0.7529) for anxiety, and 0.033-0.061(0.0168-0.2233) for depression). A combination of WHO-5 and ASS-2 measured the same trait as HADS-A, and a combination of WHO-5 and MDI-2 measured the same trait as HADS-D. Consequently, crosswalks (translation tables) were generated.<br /><b>Conclusions</b><br />Our study shows that it is feasible to use crosswalks between HADS-A and WHO-5/ASS-2, and HADS-D and WHO-5/MDI-2 for screening cardiac patients across diagnoses for anxiety and depression in clinical practice.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 26 May 2023; epub ahead of print</small></div>
Johnsen NF, Jensen SN, Christensen KB, Pedersen SS, ... Zwisler AD, Gislason GH
Eur J Prev Cardiol: 26 May 2023; epub ahead of print | PMID: 37235731
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<div><h4>Relation of Life\'s Essential 8 to the Genetic Predisposition for Cardiovascular Outcomes and All-cause Mortality: Results from a National Prospective Cohort.</h4><i>Zhang J, Chen G, Habudele Z, Wang X, ... Lip GYH, Lin H</i><br /><b>Aims</b><br />To evaluate the independent, mediating, interactive, and associated effects of Life\'s Essential 8 (LE8) and genetic predisposition on the risk of cardiovascular outcomes and all-cause mortality.<br /><b>Methods</b><br />We retrieved a total of 254,783 individuals from the UK Biobank. LE8 was determined by 8 metrics (nicotine exposure, physical activity, diet, sleep, body mass index, blood pressure, blood glucose, and blood lipids), and was characterized as low, moderate, and high cardiovascular health (CVH). Genetic predisposition was estimated using the polygenic risk score (PRS). Cox regressions were performed to evaluate the associations between LE8, PRS and outcomes.<br /><b>Results</b><br />During a median follow-up of 12.53 years, all-cause mortality occurred in 10,257 of 197,473 participants, cardiovascular mortality in 2,074 of 215,675, and incident CVD in 71,774 of 215,675. Individuals with moderate or high CVH experienced a lower risk (HRs 0.33 to 0.81) of adverse health outcomes compared with their counterparts with low CVH. A substantial proportion (16.1∼69.8%) of health outcomes could be attributable to moderate or high LE8, and up to 51.2% of the associations between PRS and adverse outcomes were mediated by LE8. In high PRS group, individuals with high CVH had lower CVD mortality (HR: 0.26, 95% CI: 0.18, 0.39), compared to those with low CVH.<br /><b>Conclusion</b><br />Ideal CVH was associated with lower risks of cardiovascular outcomes and all-cause mortality, with a more pronounced association observed in individuals with high PRS for CVD. Improving CVH according to LE8 guidelines should be encouraged, especially for those with PRS that indicate high CVD risk.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 25 May 2023; epub ahead of print</small></div>
Zhang J, Chen G, Habudele Z, Wang X, ... Lip GYH, Lin H
Eur J Prev Cardiol: 25 May 2023; epub ahead of print | PMID: 37228091
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<div><h4>An estimation of the consequences of reinforcing the 2016 and 2019 ESC/EAS guidelines on current lipid-lowering treatment in patients with type 2 diabetes in tertiary care - a SwissDiab study.</h4><i>Singeisen H, Renström F, Laimer M, Lehmann R, Bilz S, Brändle M</i><br /><b>Background</b><br />In 2019, the ESC/EAS updated the 2016 guidelines for the management of dyslipidaemias recommending more stringent LDL-cholesterol (LDL-C) targets in diabetes mellitus type 2 (DM2). Based on a real-world patient population, this study aimed to determine the feasibility and cost of attaining guideline-recommended LDL-C targets, and assess cardiovascular benefit.<br /><b>Methods</b><br />The Swiss Diabetes Registry is a multicentre longitudinal observational study of outpatients in tertiary diabetes care. Patients with DM2 and a visit 01.01.2018-31.08.2019 that failed the 2016 LDL-C target were identified. The theoretical intensification of current lipid-lowering medication needed to reach the 2016 and 2019 LDL-C target was determined and the cost thereof extrapolated. The expected number of MACE prevented by treatment intensification was estimated.<br /><b>Results</b><br />294 patients (74.8%) failed the 2016 LDL-C target. The percentage of patients that theoretically achieved the 2016 and 2019 target with the indicated treatment modifications were: high-intensity statin, 21.4% and 13.3%; ezetimibe, 46.6% and 27.9%; PCSK9 inhibitor (PCSK9i), 30.6% and 53.7%; ezetimibe and PCSK9i, 1.0% and 3.1%, whereas one (0.3%) and five patients (1.7%) failed to reach target, respectively. Achieving the 2016 versus 2019 target would reduce the estimated 4-year MACE from 24.9 to 18.6 versus 17.4 events, at an additional annual cost of medication of 2,140 CHF versus 3,681 CHF per patient, respectively.<br /><b>Conclusions</b><br />For 68% of the patients, intensifying statin treatment and/or adding ezetimibe would be sufficient to reach the 2016 target, whereas 57% would require cost-intensive PCSK9i therapy to reach the 2019 target, with limited additional medium-term cardiovascular benefit.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 25 May 2023; epub ahead of print</small></div>
Singeisen H, Renström F, Laimer M, Lehmann R, Bilz S, Brändle M
Eur J Prev Cardiol: 25 May 2023; epub ahead of print | PMID: 37226890
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<div><h4>Body Weight Time in Target Range and Cardiovascular Outcomes in Adults with Overweight/Obesity and Type 2 Diabetes.</h4><i>Liu M, Xu X, Chen X, Guo Y, ... Zhuang X, Liao X</i><br /><b>Aims</b><br />Prescription of weight loss to individuals is often characterized by weight fluctuations. However, current body weight management metrics may have difficulty characterizing the changes in body weight over time. We aims to characterize the long-term changes using body weight time in target range (TTR) and test its independent association with cardiovascular outcomes.<br /><b>Methods</b><br />We included 4,468 adults from the Look AHEAD (Action for Health in Diabetes) trial. Body weight TTR was defined as the percentage of time during which body weight was within the Look AHEAD weight loss goal range. The associations of body weight TTR with cardiovascular outcomes were analyzed using multivariable Cox modeling and restricted cubic spline function.<br /><b>Results</b><br />Among the participants (mean age 58.9 years, 58.5% women, 66.5% White), there were 721 incident primary outcomes (cumulative incidence: 17.5%, 95% confidence interval [CI]: 16.3%-18.8%) during a median of 9.5 years of follow-up. Each 1-SD (standard deviation) increase in body weight TTR was significantly associated with a decreased risk of the primary outcome (hazard ratio [HR]: 0.84, 95% CI: 0.75-0.94) after adjusting for mean and variability of body weight and traditional cardiovascular risk factors. Further analyses using restricted cubic spline indicated the inverse association between body weight TTR and primary outcome in a dose-dependent manner. Similar associations remained significant among the participants with a lower baseline or mean body weight.<br /><b>Conclusion</b><br />In adults with overweight/obesity and type 2 diabetes, higher body weight TTR was independently associated with lower risks of cardiovascular adverse events in a dose-response manner.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 22 May 2023; epub ahead of print</small></div>
Liu M, Xu X, Chen X, Guo Y, ... Zhuang X, Liao X
Eur J Prev Cardiol: 22 May 2023; epub ahead of print | PMID: 37216922
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<div><h4>Obesity in HFpEF with and without diabetes - Risk factor or innocent bystander?</h4><i>Prausmüller S, Weidenhammer A, Heitzinger G, Spinka G, ... Bartko PE, Pavo N</i><br /><b>Background</b><br />Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear.<br /><b>Objectives</b><br />This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM.<br /><b>Methods</b><br />This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM and survival was assessed.<br /><b>Results</b><br />6,744 individuals with HFpEF were included, of which 1,702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4kg/m2 vs. 27.1kg/m2, p<0.001), higher NT-proBNP values (864mg/dl vs. 724mg/dl, p<0.001) and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared to those without T2DM, with a mortality rate of 39.2% and 26.7% respectively (p<0.001). In the overall cohort, using the BMI category 22.5 to 24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5kg/m2 (HR: 1.27 [CI 1.09-1.48], p=0.003) and decreased in BMI categories ≥25kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM.<br /><b>Conclusions</b><br />Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 21 May 2023; epub ahead of print</small></div>
Prausmüller S, Weidenhammer A, Heitzinger G, Spinka G, ... Bartko PE, Pavo N
Eur J Prev Cardiol: 21 May 2023; epub ahead of print | PMID: 37210596
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<div><h4>Orthostatic hypertension and major adverse events: A systematic review and meta-analysis.</h4><i>Pasdar Z, De Paola L, Carter B, Pana TA, Potter JF, Myint PK</i><br /><b>Introduction</b><br />The role of orthostatic hypertension (OHT) in cardiovascular disease (CVD) and mortality is unclear. We aimed to determine if this association exists through a systematic review and meta-analysis.<br /><b>Methods</b><br />Study inclusion criteria included: (i) any observational/interventional studies of participants aged ≥18 years (ii) which assessed the relationship between OHT and (iii) at least one outcome measure - all-cause mortality (primary outcome), coronary heart disease, heart failure, stroke/cerebrovascular disease, or neurocognitive decline. MEDLINE, EMBASE, Cochrane, clinicaltrials.gov and PubMed were independently searched by two reviewers (inception-19th April 2022). Critical appraisals were conducted using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed using a generic inverse variance method, and narrative synthesis, or pooled results were presented as an odds or hazards ratio (HR/OR), with 95% confidence interval.<br /><b>Results</b><br />Twenty studies (n = 61669; 47.3% women) were eligible, of which thirteen were included in the meta-analysis (n = 55456; 47.3% women). Median (IQR) follow-up for prospective studies was 7.85 (4.12, 10.83) years. Eleven studies were of good quality, eight fair and one poor. Relative to orthostatic normotension (ONT), systolic OHT (SOHT) was associated with a significant 21% greater risk of all-cause mortality (HR:1.21,1.05-1.40), 39% increased risk of CVD mortality based on 2 studies (HR:1.39, 1.05-1.84) and near doubled odds of stroke/cerebrovascular disease (OR:1.94, 1.52-2.48). Lack of association with other outcomes may be due to weak evidence or low statistical power.<br /><b>Conclusions</b><br />Patients with SOHT may have higher mortality risk relative to those with ONT and increased odds of stroke/cerebrovascular disease. Whether interventions can reduce OHT and improve outcomes should be explored.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 18 May 2023; epub ahead of print</small></div>
Pasdar Z, De Paola L, Carter B, Pana TA, Potter JF, Myint PK
Eur J Prev Cardiol: 18 May 2023; epub ahead of print | PMID: 37202364
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<div><h4>Causal relationships between the gut microbiome, blood lipids, and heart failure: a Mendelian randomization analysis.</h4><i>Dai H, Hou T, Wang Q, Hou Y, ... Bi Y, Xu M</i><br /><b>Background</b><br />Studies have linked gut microbiome and heart failure (HF). However, their causal relationships and potential mediating factors have not been well defined.<br /><b>Aims</b><br />To investigate the causal relationships between the gut microbiome and HF and the mediating effect of potential blood lipids by using genetics.<br /><b>Method</b><br />We performed a bidirectional and mediation Mendelian randomization (MR) study using summary statistics from the genome-wide association studies of gut microbial taxa (Dutch Microbiome Project, n = 7,738), blood lipids (UK Biobank, n = 115,078), and a meta-analysis of HF (115,150 cases and 1,550,331 controls). We applied the inverse-variance weighted estimation method as the primary method, with several other estimators as complementary methods. The multivariable MR approach based on Bayesian model averaging (MR-BMA) was used to prioritize the most likely causal lipids.<br /><b>Results</b><br />Six microbial taxa are suggestively associated with HF causally. The most significant taxon was the species Bacteroides dorei (odds ratio = 1.059, 95% confidence interval [CI] = 1.022 - 1.097, P value = 0.0017). The MR-BMA analysis showed that apolipoprotein B (ApoB) was the most likely causal lipid for HF (the marginal inclusion probability = 0.717, P value = 0.005). The mediation MR analysis showed that ApoB mediated the causal effects of species Bacteroides dorei on HF (proportion mediated = 10.1%, 95% CI = 0.2% - 21.6%, P value = 0.031).<br /><b>Conclusion</b><br />The study suggested a causal relationship between specific gut microbial taxa and HF and that ApoB might mediate this relationship as the primary lipid determinant of HF.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 17 May 2023; epub ahead of print</small></div>
Dai H, Hou T, Wang Q, Hou Y, ... Bi Y, Xu M
Eur J Prev Cardiol: 17 May 2023; epub ahead of print | PMID: 37195998
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<div><h4>Insulin Resistance Drives Cognitive Impairment in Hypertensive Prediabetic Frail Elders: The CENTENNIAL Study.</h4><i>Mone P, De Gennaro S, Moriello D, Frullone S, ... Marro A, Santulli G</i><br /><b>Aims</b><br />Prediabetes is a condition that confers an increased cardiovascular risk. Frailty is a condition very common in hypertensive patients and insulin resistance has been linked to frailty in older adults with diabetes. Our aim was to evaluate the association between insulin resistance and cognitive impairment in hypertensive and prediabetic and frail older adults.<br /><b>Methods</b><br />We studied consecutive prediabetic and hypertensive elders with frailty presenting at the Avellino local health authority of the Italian Ministry of Health from March 2021 to March 2022. All of them fulfilled the following inclusion criteria: A previous diagnosis of hypertension with no clinical or laboratory evidence of secondary causes; a confirmed diagnosis of prediabetes; age >65 years; Montreal Cognitive Assessment (MoCA) Score <26; frailty.<br /><b>Results</b><br />We enrolled 178 frail patients, of which 141 successfully completed the study. We observed a strong inverse correlation (r: -0.807; p < 0.001) between MoCA Score and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). The results were confirmed by a linear regression analysis using MoCA Score as dependent variable, after adjusting for several potential confounders.<br /><b>Conclusion</b><br />Taken together, our data highlight for the first time the association between insulin resistance and global cognitive function in frail elders with hypertension and prediabetes.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 17 May 2023; epub ahead of print</small></div>
Mone P, De Gennaro S, Moriello D, Frullone S, ... Marro A, Santulli G
Eur J Prev Cardiol: 17 May 2023; epub ahead of print | PMID: 37196030
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<div><h4>Sweetened beverages and incident heart failure.</h4><i>Zhang Z, Zhang K, Sun Y, Yu B, ... Xia F, Wang N</i><br /><b>Aims</b><br />Recent studies have demonstrated the associations of the consumption of different beverages with cardiometabolic diseases, whereas no studies have investigated such associations in heart failure (HF). Thus, this study aimed to explore the associations of the consumption of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and pure fruit/vegetable juices (PJs) with the risk of incident HF.<br /><b>Methods</b><br />This prospective cohort study included 209,829 participants in the UK Biobank who completed at least one 24-h diet questionnaire and who were free of baseline HF. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).<br /><b>Results</b><br />During a median follow-up of 9.9 years, 4,328 incident HF cases were recorded. Compared to corresponding nonconsumers, individuals who consumed >2 L/week SSBs or ASBs had an increased risk of HF (HR: 1.22, 95% CI: 1.08-1.38 and HR: 1.30, 95% CI: 1.16-1.47, respectively) in the multivariate adjusted model. An inverse association was observed between the consumption of >0-1 L/week PJs and the risk of HF (HR: 0.90, 95% CI: 0.83-0.98). Additionally, a significant interaction was observed between PJ consumption and sleep duration on HF risk (P for interaction =0.030).<br /><b>Conclusions</b><br />Increased consumption of SSBs or ASBs may be an independent risk factor for HF, whereas moderate intake of PJs may have a protective effect on HF.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 13 May 2023; epub ahead of print</small></div>
Zhang Z, Zhang K, Sun Y, Yu B, ... Xia F, Wang N
Eur J Prev Cardiol: 13 May 2023; epub ahead of print | PMID: 37178176
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<div><h4>Comprehensive Characterization of Non-Cardiac Comorbidities in Acute Heart Failure- an analysis of ESC-HFA EORP Heart Failure Long-Term Registry.</h4><i>Chioncel O, Benson L, Crespo-Leiro MG, Anker SD, ... Maggioni AP, Lund LH</i><br /><b>Purpose</b><br />To evaluate the prevalence and associations of non-cardiac comorbidities (NCC) with in-hospital and post-discharge outcomes in acute heart failure (AHF) across the ejection fraction (EF) spectrum.<br /><b>Methods</b><br />9326 AHF patients from ESC-HFA-EORP-HF-Long-Term-Registry had complete information for the following 12 NCCs: anemia, chronic obstructive pulmonary disease (COPD), diabetes, depression, hepatic dysfunction, renal dysfunction, malignancy, Parkinson disease, peripheral vascular disease (PVD), rheumatoid arthritis, sleep apnoea, stroke/TIA(transient ischemic attack). Patients were classified by number of NCCs (0, 1, 2, 3, and ≥4).<br /><b>Results</b><br />Of AHF patients, 20.5% had no NCC, 28.5% had 1 NCC, 23.1% had 2 NCC, 15.4% had 3 NCC and 12.5% had ≥4 NCC. In-hospital and post-discharge mortality increased with number of NCCs from 3.0% and 18.5% for 1 NCC to 12.5% and 36% for ≥4 NCCs.Anemia, COPD, PVD, sleep apnoea, rheumatoid arthritis, stroke/TIA, Parkinson and depression were more prevalent in HFpEF. The hazard ratio (95% confidence interval) for post-discharge death for each NCC was for anemia 1.6 (1.4-1.8), diabetes 1.2 (1.1-1.4), kidney dysfunction 1.7 (1.5-1.9), COPD 1.4 (1.2-1.5), PVD 1.2 (1.1-1.4), stroke/TIA 1.3 (1.1-1.5), depression 1.2 (1.0-1.5), haepatic dysfunction 2.1 (1.8-2.5), malignancy 1.5 (1.2-1.8), sleep apnoea 1.2 (0.9-1.7), rheumatoid arthritis 1.5 (1.1-2.1) and Parkinson 1.4 (0.9-2.1). Anemia, kidney dysfunction, COPD and diabetes were associated with post-discharge mortality in all EF categories, PVD, stroke/TIA and depression only in HFrEF and sleep apnoea and malignancy only in HFpEF.<br /><b>Conclusion</b><br />Multiple NCCs conferred poor in-hospital and post-discharge outcomes. EF categories had different prevalence and risk profile associated with individual NCCs.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 13 May 2023; epub ahead of print</small></div>
Chioncel O, Benson L, Crespo-Leiro MG, Anker SD, ... Maggioni AP, Lund LH
Eur J Prev Cardiol: 13 May 2023; epub ahead of print | PMID: 37172316
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<div><h4>Achieved Systolic Blood Pressure and Cardiovascular Outcomes in 60-80-Year-Old Patients: The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) Trial.</h4><i>Deng Y, Bai J, Yang X, Liu W, ... Zhang W, Cai J</i><br /><b>Aims</b><br />Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, data is missing on patients who had target-achieved (TA). This study aims to show the cardiovascular effect of maintaining SBP at intensive levels.<br /><b>Methods</b><br />The Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) trial was a multicentre, randomized, controlled trial which enrolled 8511 young-older (60-80 years) hypertensive patients without prior stroke to compared the cardiovascular prognosis of the intensive treatment (SBP target, 110 to <130 mmHg) versus the standard treatment (130 to <150 mmHg). This secondary analysis assessed data in patients who achieved a mean SBP within target values. The association of mean achieved SBP and cardiovascular events was examined using a cubic spline function.<br /><b>Results</b><br />In total, 3053 patients (72.0%) in the intensive-treatment group and 3427 (80.3%) in the standard-treatment group had SBP target achieved, with mean follow-up SBP values of 124.2 mmHg and 137.4 mmHg, respectively. Throughout the median 3.38-year follow-up, the cardiovascular risk was significantly lower in the TA intensive-treatment group than in the TA standard-treatment group (adjusted hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.46-0.80; P < 0.001). In the intensive-treatment group, patients failing to achieve SBP targets presented higher cardiovascular risk than those TA patients (HR 2.04, 95%CI 1.44-2.88; P < 0.001). A J-shaped relationship was observed between mean achieved SBP and risk of cardiovascular events, with the lowest risk at an SBP of 126.9 mmHg.<br /><b>Conclusions</b><br />Maintaining SBP at <130 mmHg offers additional cardiovascular benefits among young-older patients with hypertension.<br /><b>Trial registration</b><br />clinicaltrials.gov. Identifier: NCT03015311.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 12 May 2023; epub ahead of print</small></div>
Deng Y, Bai J, Yang X, Liu W, ... Zhang W, Cai J
Eur J Prev Cardiol: 12 May 2023; epub ahead of print | PMID: 37172116
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<div><h4>Combining serum metabolomic profiles with traditional risk factors improves 10-year cardiovascular risk prediction in people with type 2 diabetes.</h4><i>Huang Z, Klaric L, Krasauskaite J, Khalid W, ... Wilson JF, Price JF</i><br /><b>Aims</b><br />To identify a group of metabolites associated with incident CVD in people with type 2 diabetes and assess its predictive performance over-and-above a current CVD risk score (QRISK3).<br /><b>Methods</b><br />A panel of 228 serum metabolites was measured at baseline in 1,066 individuals with type 2 diabetes (Edinburgh Type 2 Diabetes Study) who were then followed up for CVD over the subsequent 10 years. We applied 100 repeats of Cox LASSO (least absolute shrinkage and selection operator) to select metabolites with frequency >90% as components for a metabolites-based risk score (MRS). The predictive performance of the MRS was assessed in relation to a reference model which was based on QRISK3 plus prevalent CVD and statin use at baseline.<br /><b>Results</b><br />Of 1,021 available individuals, 255 (25.0%) developed CVD (median follow-up: 10.6 years). Twelve metabolites relating to fluid balance, ketone bodies, amino acids, fatty acids, glycolysis and lipoproteins were selected to construct the MRS which showed positive association with 10-year cardiovascular risk following adjustment for traditional risk factors [HR 2.67 (95%CI 1.96, 3.64)]. C-statistic was 0.709 (95%CI 0.679, 0.739) for the reference model alone, increasing slightly to 0.728 (95%CI 0.700, 0.757) following addition of the MRS. Compared with the reference model, the net reclassification index and integrated discrimination index for the reference model plus the MRS was 0.362 (95%CI 0.179, 0.506) and 0.041 (95%CI 0.020, 0.071), respectively.<br /><b>Conclusions</b><br />Metabolomics data might improve predictive performance of current CVD risk scores based on traditional risk factors in people with type 2 diabetes. External validation is warranted to assess the generalizability of improved CVD risk prediction using the MRS.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 12 May 2023; epub ahead of print</small></div>
Huang Z, Klaric L, Krasauskaite J, Khalid W, ... Wilson JF, Price JF
Eur J Prev Cardiol: 12 May 2023; epub ahead of print | PMID: 37172216
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<div><h4>The Underutilization of Preventive Cardiovascular Measures in Patients with Cancer. An Analysis of the Behavioural Risk Factor Surveillance System, 2011-2022.</h4><i>Sayed A, Munir M, Addison D, Abushouk AI, ... Moustafa K, Virani SS</i><br /><b>Aims</b><br />To characterize the influence of a cancer diagnosis on the use of preventive cardiovascular measures in patients with and without cardiovascular disease (CVD).<br /><b>Methods</b><br />Data from the Behavioural Risk Factor Surveillance System Survey (spanning 2011 to 2022) were used. Multivariable logistic regression models adjusted for potential confounders were applied to calculate average marginal effects (AME), the average difference in the probability of using a given therapy between patients with and without cancer. Outcomes of interest included the use of pharmacological therapies, physical activity, smoking cessation, and post-CVD rehabilitation.<br /><b>Results</b><br />Among 5,012,721 respondents, 579,114 reported a history of CVD (coronary disease or stroke), and 842,221 reported a diagnosis of cancer. The association between cancer and the use of pharmacological therapies varied between those with versus without CVD (p-value for interaction: <0.001). Among patients with CVD, a cancer diagnosis was associated with a lower use of blood pressure-lowering medications (AME: -1.46% [95% CI: -2.19 to -0.73%]), lipid-lowering medications (AME: -2.34% [95% CI: -4.03 to -0.66%]), and aspirin (AME: -6.05% [95% CI: -8.88 to -3.23%]). Among patients without CVD, there were no statistically significant differences between patients with and without cancer regarding pharmacological therapies. Additionally, cancer was associated with a significantly lower likelihood of engaging in physical activity in the overall cohort, and in using post-CVD rehabilitation regimens, particularly post-stroke rehabilitation.<br /><b>Conclusions</b><br />Preventive pharmacological agents are underutilized in those with cancer and concomitant CVD, and physical activity is underutilized in patients with cancer in those with or without CVD.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 09 May 2023; epub ahead of print</small></div>
Sayed A, Munir M, Addison D, Abushouk AI, ... Moustafa K, Virani SS
Eur J Prev Cardiol: 09 May 2023; epub ahead of print | PMID: 37158488
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<div><h4>Carotid ultrasound and Systematic Coronary Risk Assessment 2 (SCORE2) in the prediction of cardiovascular events.</h4><i>Bao X, Xu B, Lind L, Engström G</i><br /><b>Aims</b><br />Subclinical carotid atherosclerosis adds predictive value to traditional risk factors for cardiovascular diseases (CVDs). Systematic Coronary Risk Assessment 2 (SCORE2), an algorithm composed of traditional risk factors, is state-of-the-art to estimate the 10-year risk of first-onset CVDs. We aim to investigate whether and how subclinical carotid atherosclerosis affects the performance of SCORE2.<br /><b>Methods</b><br />Carotid plaque presence and intima media thickness (IMT) were measured with ultrasound. SCORE2 was calculated in 4,588 non-diabetic participants aged 46-68 years. The incremental value for predicting CVD events of adding carotid plaque or IMT to SCORE2 was evaluated using C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The predicted 10-year CVD risk by SCORE2 and the observed event rate were compared between participants with and without carotid plaque.<br /><b>Results</b><br />Adding plaque or IMT to SCORE2 significantly improved performance for predicting CVDs. The improvement in C-statistics, IDI and NRI of adding plaque to SCORE2 for events occurring during the first 10 years were 2.20, 0.70 and 46.1%, respectively (all p < 0.0001). SCORE2 over-predicted the 10-year CVD risk in those without carotid plaque (3.93% observed versus 5.89% predicted, p < 0.0001) while under-predicted the risk in those with carotid plaque (9.69% observed versus 8.12% predicted, p = 0.043).<br /><b>Conclusion</b><br />Carotid ultrasound adds predictive performance to SCORE2 for assessment of CVD risk. Using SCORE2 without considering carotid atherosclerosis could under- or over-estimate the risk.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 09 May 2023; epub ahead of print</small></div>
Bao X, Xu B, Lind L, Engström G
Eur J Prev Cardiol: 09 May 2023; epub ahead of print | PMID: 37159540
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<div><h4>Creatinine-Based EKFC Equation is Superior to the CKD-EPI Equation for Mortality Risk Stratification in General Non-black Population.</h4><i>Lu X, Gao R, Liao S</i><br /><b>Aims</b><br />A recent study demonstrated that the new modified estimated glomerular filtration rate (eGFR) equation proposed by the European Kidney Function Consortium (EKFC) was more accurate and precise than the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. This study aimed to compare the prognostic values of these two creatinine-based equations with regard to all-cause and cardiovascular mortality in general non-black population.<br /><b>Methods and results</b><br />A population-based cohort study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018, and 38983 non-black individuals aged 20 years or older without a history of dialysis were enrolled. Among 38983 participants, 6103 deaths occurred after a median follow-up duration of 112 months, of which 1558 deaths were due to cardiovascular causes. There were U-shaped relations between the eGFR values and the risk of all-cause and cardiovascular mortality. The areas under the curves (AUCs) for the EKFC were significantly higher than those for the CKD-EPI equation for all-cause and cardiovascular mortality. The integrated discrimination improvement (IDI) for the EKFC equation compared with the CKD-EPI equation was 2.40% and 1.26% for 10-year all-cause and cardiovascular mortality; the net reclassification improvement (NRI) for the EKFC equation compared with the CKD-EPI equation was 8.67% and 11.13% for 10-year all-cause mortality and cardiovascular mortality.<br /><b>Conclusions</b><br />Creatinine-based EKFC equation outperformed the CKD-EPI equation for the prediction of long-term all-cause and cardiovascular mortality in the general non-black population.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 09 May 2023; epub ahead of print</small></div>
Lu X, Gao R, Liao S
Eur J Prev Cardiol: 09 May 2023; epub ahead of print | PMID: 37158036
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<div><h4>eHealth for maintenance cardiovascular rehabilitation: a systematic review and meta-analysis.</h4><i>Heimer M, Schmitz S, Teschler M, Schäfer H, ... Mooren FC, Schmitz B</i><br /><b>Aims</b><br />To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioral change techniques (BCTs).<br /><b>Methods</b><br />A systematic review was conducted (PubMed, CINAHL, MEDLINE, Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). BCTs were defined based on the described intervention and coded according to the BCT handbook.<br /><b>Results</b><br />Fourteen eligible studies (1,497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02--0.70; p = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05-0.52; p = 0.02) compared to usual care. QoL was higher with eHealth compared to care as usual (SMD = 0.17; 95%CI 0.02-0.32; p = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared to care as usual (SMD = -0.20; 95%CI -0.40-0,00; p = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behavior and/or goal setting, as well as feedback on behavior were most frequently included.<br /><b>Conclusion</b><br />eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD, while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. PROSPERO, CRD42020203578.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 08 May 2023; epub ahead of print</small></div>
Heimer M, Schmitz S, Teschler M, Schäfer H, ... Mooren FC, Schmitz B
Eur J Prev Cardiol: 08 May 2023; epub ahead of print | PMID: 37154363
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<div><h4>Sleep duration and its association with adiposity markers in adolescence: a cross-sectional and longitudinal study.</h4><i>Martínez-Gómez J, Fernández-Alvira JM, de Cos-Gandoy A, Bodega P, ... Fuster V, Fernández-Jiménez R</i><br /><b>Background</b><br />Large studies linking adolescents\' objectively measured sleep duration and adiposity markers are lacking.<br /><b>Aim</b><br />To characterize sleep duration and its cross-sectional and longitudinal associations with adiposity markers in adolescence.<br /><b>Methods</b><br />Seven-day accelerometry was performed in a cohort of adolescents enrolled in the SI! Program for Secondary Schools trial in Spain at approximately age 12 (1216 adolescents, 49.6% girls), 14 (1026 adolescents, 51.3% girls), and 16 (872 adolescents, 51.7% girls) years. Participants were classified as very short sleepers (VSS; <7 h), short sleepers (SS; 7 to <8 h), or recommended-time sleepers (RTS; 8 to 10 h). Adjusted associations between sleep duration and adiposity markers were analyzed using generalized linear and Poisson models.<br /><b>Results</b><br />At ∼12 years, 33.7% of adolescents met sleep recommendations, and this percentage decreased with advancing age (22.6% at ∼14 and 18.7% at ∼16 years). Compared with RTS, overweight/obesity prevalence ratios (PR) at ∼12, 14, and 16 years among SS were 1.19 (95%CI 1.09-1.30), 1.41 (95%CI 1.34-1.48), and 0.99 (95%CI 0.77-1.26) and among VSS were 1.30 (95%CI 1.28-1.32), 1.93 (95%CI 1.41-2.64), and 1.32 (95%CI 1.26-1.37). Compared with adolescents who always met sleep recommendations, the prevalence of overweight/obesity was ∼5 times higher in those never meeting recommendations or meeting them only once. Similar trends were observed for waist-to-height ratio (p=0.010) and fat-mass index (p=0.024).<br /><b>Conclusion</b><br />Most adolescents did not meet sleep recommendations. Shorter sleep duration was independently associated with unfavorable adiposity markers, and such adverse impact was cumulative. Health promotion programs should emphasize the importance of good sleep habits.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 04 May 2023; epub ahead of print</small></div>
Martínez-Gómez J, Fernández-Alvira JM, de Cos-Gandoy A, Bodega P, ... Fuster V, Fernández-Jiménez R
Eur J Prev Cardiol: 04 May 2023; epub ahead of print | PMID: 37140006
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<div><h4>Association of healthy dietary patterns and cardiorespiratory fitness in the community.</h4><i>Mi MY, Gajjar P, Walker ME, Miller P, ... Lewis GD, Nayor M</i><br /><b>Aims</b><br />To evaluate the associations of dietary indices and quantitative cardiorespiratory fitness (CRF) measures in a large, community-based sample harnessing metabolomic profiling to interrogate shared biology.<br /><b>Methods and results</b><br />Framingham Heart Study (FHS) participants underwent maximum effort cardiopulmonary exercise tests for CRF quantification (via peak VO2) and completed semi-quantitative food frequency questionnaires. Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI) and Mediterranean-style Diet Score (MDS), and fasting blood concentrations of 201 metabolites were quantified. In 2380 FHS participants (54 ± 9 years, 54% female, body mass index 28 ± 5 kg/m2), 1 SD higher AHEI and MDS were associated with 5.2% (1.2 mL/kg/min, 95% CI 4.3-6.0%, P < 0.0001) and 4.5% (1.0 mL/kg/min, 95% CI 3.6-5.3%, P < 0.0001) greater peak VO2 in linear models adjusted for age, sex, total daily energy intake, cardiovascular risk factors, and physical activity. In participants with metabolite profiling (N = 1154), 24 metabolites were concordantly associated with both dietary indices and peak VO2 in multivariable-adjusted linear models (FDR < 5%). Metabolites that were associated with lower CRF and poorer dietary quality included C6 and C7 carnitines, C16:0 ceramide, and dimethylguanidino valeric acid, and metabolites that were positively associated with higher CRF and favourable dietary quality included C38:7 phosphatidylcholine plasmalogen and C38:7 and C40:7 phosphatidylethanolamine plasmalogens.<br /><b>Conclusion</b><br />Higher diet quality is associated with greater CRF cross-sectionally in a middle-aged community-dwelling sample, and metabolites highlight potential shared favourable effects on cardiometabolic health.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print</small></div>
Mi MY, Gajjar P, Walker ME, Miller P, ... Lewis GD, Nayor M
Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print | PMID: 37164358
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<div><h4>Increased cardiovascular events in young patients with mental disorders: a nationwide cohort study.</h4><i>Park CS, Choi EK, Han KD, Ahn HJ, ... Oh S, Lip GYH</i><br /><b>Aims</b><br />It remains unclear whether young patients with mental disorders have a higher risk of cardiovascular diseases than does the general population. Using a nationwide database, we investigated the prognostic association between the risks of myocardial infarction (MI), ischaemic stroke (IS), and mental disorders in young patients.<br /><b>Methods and results</b><br />Young patients aged between 20 and 39 years old who underwent nationwide health examinations between 2009 and 2012 were screened. A total of 6 557 727 individuals were identified and subsequently classified according to mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients were then followed up for MI and IS until December 2018. Patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts. During the follow-up period (median, 7.6 years; interquartile range, 6.5-8.3), 16 133 cases of MI and 10 509 cases of IS occurred. Patients with mental disorders had higher risks of MI (log-rank P = 0.033 in eating disorder and log-rank P < 0.001 in all other mental disorders). Patients with mental disorders had higher risks of IS except post-traumatic stress disorder (log-rank P = 0.119) and eating disorder (log-rank P = 0.828). After adjusting for covariates, the overall diagnosis and each mental disorder were independently associated with increased cardiovascular endpoints.<br /><b>Conclusion</b><br />Mental disorders in young patients may have deleterious effects which increase the incidence of MI and IS. Prevention efforts are needed to prevent MI and IS in young patients with mental disorders.<br /><b>Lay summary</b><br />Although young patients with mental disorders did not show worse baseline characteristics in this nationwide study, mental disorders in young patients have deleterious effects on the incidence of both myocardial infarction (MI) and ischaemic stroke (IS) events, across depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorders, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print</small></div>
Park CS, Choi EK, Han KD, Ahn HJ, ... Oh S, Lip GYH
Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print | PMID: 37156491
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<div><h4>Cardiovascular Disease Burden Attributable to Non-Optimal Temperature: Analysis of the 1990-2019 Global Burden of Disease.</h4><i>Al-Kindi S, Motairek I, Khraishah H, Rajagopalan S</i><br /><b>Background</b><br />Extreme temperatures are increasingly experienced as a result of climate change. Both high and low temperatures, impacted by climate change, have been linked with cardiovascular disease (CVD). Global estimates on non-optimal temperature-related CVD are not known.<br /><b>Objectives</b><br />The authors investigated global trends of temperature-related CVD burden over the last 3 decades.<br /><b>Methods</b><br />The authors utilized the 1990-2019 global burden of disease methodology to investigate non-optimal temperature, low temperature-, and high temperature-related CVD deaths and disability-adjusted life years (DALYs) globally. Non-optimal temperatures were defined as above (high temperature) or below (low temperature) the location-specific theoretical minimum-risk exposure level, or the temperature associated with the lowest mortality rates. Analyses were later stratified by sociodemographic index (SDI) and world regions.<br /><b>Results</b><br />In 2019, non-optimal temperature contributed to 1,194,196 (95% uncertainty interval [UI]: 963,816 to 1,425,090) CVD deaths and 21,799,370 (95% UI: 17,395,761 to 25,947,499) DALYs. low temperature contributed to 1,104,200 (95% UI: 897,783 to 1,326,965) CVD deaths and 19,768,986 (95% UI: 16,039,594 to 23,925,945) DALYs. High temperature contributed to 93,095 (95% UI: 10,827 to 158,386) CVD deaths and 2,098,989 (95% UI: 146,158 to 3,625,564) DALYs. Between 1990 and 2019, CVD deaths related to non-optimal temperature increased by 45% (95% UI: 32% to 63%), low temperature by 36% (95% UI: 25% to 48%), and high temperature by 600% (95% UI: -1879% to 2027%). Non-optimal temperature and high temperature-related CVD deaths increased more in countries with low income than countries with high income.<br /><b>Conclusion</b><br />Non-optimal temperatures are significantly associated with global CVD deaths and DALYs, underscoring the significant impact of temperature on public health.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print</small></div>
Al-Kindi S, Motairek I, Khraishah H, Rajagopalan S
Eur J Prev Cardiol: 28 Apr 2023; epub ahead of print | PMID: 37115593
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<div><h4>Higher Risk of Adverse Cardiovascular Outcomes in Females with Type 2 Diabetes Mellitus: An Umbrella Review of Systematic Reviews.</h4><i>Yaow CYL, Chong B, Chin YH, Kueh MTW, ... Dimitriadis GK, Chew NWS</i><br /><b>Background</b><br />Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have excess mortality risk compared to their male counterparts. An important next step to address the high global burden of T2DM and cardiovascular disease (CVD) is an umbrella review to summarize data on sex differences in cardiovascular outcomes for patients with T2DM and assess the strength of the evidence observed.<br /><b>Methods</b><br />Medline and Embase were searched from inception till 7th August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesized with a narrative synthesis, with tabular presentation of findings and forest plots for reviews that performed a meta-analysis.<br /><b>Results</b><br />27 review articles evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had higher risk of developing coronary heart disease (CHD; RRR: 1.52, 95%CI: 1.32-1.76, p < 0.001), acute coronary syndrome (ACS; RRR: 1.38, 95%CI: 1.25-1.52, p < 0.001), heart failure (RRR: 1.09, 95%CI: 1.05-1.13, p < 0.001) than males. Females had a higher risk of all-cause mortality (RRR: 1.13, 95%CI: 1.07-1.19, p < 0.001), cardiac mortality (RRR: 1.49, 95%CI: 1.11-2.00, p = 0.009) and CHD mortality (RRR: 1.44, 95%CI: 1.20-1.73, p < 0.001) as compared to males.<br /><b>Conclusions</b><br />This umbrella review demonstrates that females with T2DM have a higher risk of cardiovascular outcomes than male counterparts. Future research should address the basis of this heterogeneity and epidemiological factors for better quality of evidence, and identify actionable interventions that will narrow these sex disparities.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 26 Apr 2023; epub ahead of print</small></div>
Yaow CYL, Chong B, Chin YH, Kueh MTW, ... Dimitriadis GK, Chew NWS
Eur J Prev Cardiol: 26 Apr 2023; epub ahead of print | PMID: 37185913
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<div><h4>Mitigation of aircraft noise-induced vascular dysfunction and oxidative stress by exercise, fasting, and pharmacological α1AMPK activation: molecular proof of a protective key role of endothelial α1AMPK against environmental noise exposure.</h4><i>Kvandová M, Rajlic S, Stamm P, Schmal I, ... Jansen T, Münzel T</i><br /><b>Aims</b><br />Environmental stressors such as traffic noise represent a global threat, accounting for 1.6 million healthy life years lost annually in Western Europe. Therefore, the noise-associated health side effects must be effectively prevented or mitigated. Non-pharmacological interventions such as physical activity or a balanced healthy diet are effective due to the activation of the adenosine monophosphate-activated protein kinase (α1AMPK). Here, we investigated for the first time in a murine model of aircraft noise-induced vascular dysfunction the potential protective role of α1AMPK activated via exercise, intermittent fasting, and pharmacological treatment.<br /><b>Methods and results</b><br />Wild-type (B6.Cg-Tg(Cdh5-cre)7Mlia/J) mice were exposed to aircraft noise [maximum sound pressure level of 85 dB(A), average sound pressure level of 72 dB(A)] for the last 4 days. The α1AMPK was stimulated by different protocols, including 5-aminoimidazole-4-carboxamide riboside application, voluntary exercise, and intermittent fasting. Four days of aircraft noise exposure produced significant endothelial dysfunction in wild-type mice aorta, mesenteric arteries, and retinal arterioles. This was associated with increased vascular oxidative stress and asymmetric dimethylarginine formation. The α1AMPK activation with all three approaches prevented endothelial dysfunction and vascular oxidative stress development, which was supported by RNA sequencing data. Endothelium-specific α1AMPK knockout markedly aggravated noise-induced vascular damage and caused a loss of mitigation effects by exercise or intermittent fasting.<br /><b>Conclusion</b><br />Our results demonstrate that endothelial-specific α1AMPK activation by pharmacological stimulation, exercise, and intermittent fasting effectively mitigates noise-induced cardiovascular damage. Future population-based studies need to clinically prove the concept of exercise/fasting-mediated mitigation of transportation noise-associated disease.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 26 Apr 2023; epub ahead of print</small></div>
Abstract
<div><h4>The Association of Intensive Blood Pressure Treatment and Non-Fatal Cardiovascular or Serious Adverse Events in Older Adults with Mortality: Mediation Analysis in SPRINT.</h4><i>Krishnaswami A, Rich MW, Kwak MJ, Goyal P, ... Kado DM, Odden MC</i><br /><b>Background:</b><br/>and aims</b><br />Randomized clinical trials of hypertension treatment intensity evaluate effects on incident major adverse cardiovascular events (MACE) and serious adverse events (SAE). Occurrences after a non-fatal index event have not been rigorously evaluated. The current aim was to evaluate the association of intensive (<120 mmHg) to standard (<140 mmHg) blood pressure treatment to mortality mediated through a non-fatal MACE or non-fatal SAE in 9,361 Systolic Blood Pressure Intervention trial participants.<br /><b>Methods</b><br />Logistic regression and causal mediation modeling to obtain direct and mediated effects of intensive BP treatment. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cardiovascular (CVM) and non-CV mortality (non-CVM).<br /><b>Results</b><br />The direct effect of intensive treatment was a lowering of ACM [OR 0.75, 0.60-0.94]. The MACE-mediated effect substantially attenuated [OR 0.96, 0.92-0.99] ACM; while the SAE-mediated effect was associated with increased [OR 1.03, 1.01-1.05] ACM. Similar patterns were noted for intensive BP treatment on CVM and non-CVM. We also noted the SAE incidence was 3.9-fold higher than MACE incidence (13.7% vs 3.5%), and there was a total of 365 (3.9%) ACM with non-CVM 2.6-fold higher than CVM [2.81% (263/9,361) vs 1.09% (102/9,361)]. The SAE to MACE and non-CVM to CVM preponderance was across all age-groups with the ≥ 80-year age group having the highest differences.<br /><b>Conclusion</b><br />The current analytic techniques demonstrated that intensive BP treatment was associated with an attenuated mortality benefit when MACE-mediated and possibly harmful when SAE-mediated. Current cardiovascular trial reporting of treatment effects does not allow expansion of the lens to focus on important occurrences after the index event.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 25 Apr 2023; epub ahead of print</small></div>
Krishnaswami A, Rich MW, Kwak MJ, Goyal P, ... Kado DM, Odden MC
Eur J Prev Cardiol: 25 Apr 2023; epub ahead of print | PMID: 37185634
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<div><h4>Prognostic Benefit of Early Diagnosis with Exercise Stress Testing in Heart Failure with Preserved Ejection Fraction.</h4><i>Saito Y, Obokata M, Harada T, Kagami K, ... Okumura Y, Ishii H</i><br /><b>Background</b><br />Delayed diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) can lead to poor clinical outcomes. Exercise stress testing, especially exercise stress echocardiography, plays a primary role in the early detection of HFpEF among dyspneic patients, but its prognostic significance is unknown, as is whether initiation of guideline-directed therapy could improve clinical outcomes in such early-stage HFpEF.<br /><b>Methods</b><br />Ergometry exercise stress echocardiography was performed in 368 patients with exertional dyspnea. HFpEF was diagnosed by a total score of HFA-PEFF algorithm Step 2 (resting assessments) and Step 3 (exercise testing) ≥ 5 or elevated pulmonary capillary wedge pressure at rest or during exercise. The primary endpoint comprised all-cause mortality and worsening HF events.<br /><b>Results</b><br />HFpEF was diagnosed in 182 patients, while 186 had non-cardiac dyspnea (controls). Patients diagnosed with HFpEF had a seven-fold increased risk of composite events than that of controls (hazard ratio [HR] 7.52; 95% confidential interval [CI], 2.24-25.2; P = 0.001). Patients with an HFA-PEFF Step 2 < 5 points but had an HFA-PEFF ≥ 5 after exercise stress testing (Steps 2-3) had a higher risk of composite events than controls. Guideline-recommended therapies were initiated in 90 patients diagnosed with HFpEF after index exercise testing. Patients with early treatment experienced lower rates of composite outcomes than those without (HR 0.33; 95% CI, 0.12-0.91; P = 0.03).<br /><b>Conclusions</b><br />Identification of HFpEF by exercise stress testing may allow risk stratification in dyspneic patients. Furthermore, initiation of guideline-directed therapy may be associated with improved clinical outcomes in patients with early-stage HFpEF.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 24 Apr 2023; epub ahead of print</small></div>
Saito Y, Obokata M, Harada T, Kagami K, ... Okumura Y, Ishii H
Eur J Prev Cardiol: 24 Apr 2023; epub ahead of print | PMID: 37094815
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<div><h4>Dietary intake and cardiovascular outcomes in patients with chronic vascular disease: insights from the COMPASS trial cohort.</h4><i>Wan D, Dehghan M, de Souza RJ, Ramasundarahettige C, ... Yusuf S, Anand SS</i><br /><b>Aims</b><br />Patients with coronary artery disease (CAD) and patients with peripheral artery disease (PAD) are at risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There are limited data regarding dietary patterns and the risk of recurrent MACE and MALE in CAD and PAD patients. We aimed to identify dietary patterns associated with MACE and MALE in patients with CAD and/or PAD.<br /><b>Methods and results</b><br />We analysed data collected from patients enrolled into the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, in which diet was assessed by a short food frequency questionnaire (FFQ) at baseline. Two dietary pattern scores, the modified Alternate Healthy Eating Index (mAHEI) and Mediterranean Diet Score (mMDS), were calculated. We tested the association between mAHEI and mMDS and the incidence of MACE and/or MALE. The mean mAHEI score was 23.0 ± 7.7 (out of 70) overall and was similar comparing CAD and PAD patients. The incidence of MACE or MALE was 6.3% in the lowest diet quality quartile (as assessed by mAHEI) compared with 4.2% in the highest quartile over 30 months. In the fully adjusted model, the hazard ratio of a low diet quality (Quartile 1) compared with the highest (Quartile 4) for MACE or MALE was 1.27 (95% CI: 1.08-1.49; P = 0.004, Q1 vs. Q4). This excess hazard was primarily driven by higher MACE in both the CAD and PAD cohorts.<br /><b>Conclusions</b><br />Poor diet quality as assessed by the mAHEI is independently associated with a higher risk of recurrent MACE and MALE in patients with chronic CAD and/or PAD.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 20 Apr 2023; epub ahead of print</small></div>
Wan D, Dehghan M, de Souza RJ, Ramasundarahettige C, ... Yusuf S, Anand SS
Eur J Prev Cardiol: 20 Apr 2023; epub ahead of print | PMID: 37080912
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<div><h4>Biomarker-based prediction of fatal and non-fatal cardiovascular outcomes in individuals with diabetes mellitus.</h4><i>Haller PM, Goßling A, Magnussen C, Brenner H, ... Westermann D, BiomarCaRE Consortium</i><br /><b>Aims</b><br />The role of biomarkers in predicting cardiovascular outcomes in high-risk individuals is not well established. We aimed to investigate benefits of adding biomarkers to cardiovascular risk assessment in individuals with and without diabetes.<br /><b>Methods</b><br />We used individual-level data of 95,292 individuals of the European population harmonized in the BiomarCaRE consortium and investigated the prognostic ability of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP). Cox-regression models were used to determine adjusted hazard ratios (adj-HR) of diabetes and log-transformed biomarkers for fatal and non-fatal cardiovascular events. Models were compared using the likelihood ratio test. Stratification by specific biomarker cut-offs was performed for crude time-to-event analysis using Kaplan-Meier-plots.<br /><b>Results</b><br />Overall, 6,090 (6.4%) individuals had diabetes at baseline, median follow-up was 9.9 years. Adjusting for classical risk factors and biomarkers, diabetes (HR 2.11 [95% CI 1.92, 2.32]), and all biomarkers (HR per interquartile range hs-cTnI 1.08 [95% CI 1.04, 1.12]; NT-proBNP 1.44 [95% CI 1.37, 1.53]; hs-CRP 1.27 [95% CI 1.21, 1.33]) were independently associated with cardiovascular events. Specific cut-offs for each biomarker identified a high-risk group of individuals with diabetes losing a median of 15.5 years of life compared to diabetics without elevated biomarkers. Addition of biomarkers to the Cox-model significantly improved the prediction of outcomes (likelihood ratio test for nested models p < 0.001), accompanied by an increase in the c-index (increase to 0.81).<br /><b>Conclusion</b><br />Biomarkers improve cardiovascular risk prediction in individuals with and without diabetes and facilitate the identification of individuals with diabetes at highest risk for cardiovascular events.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 20 Apr 2023; epub ahead of print</small></div>
Haller PM, Goßling A, Magnussen C, Brenner H, ... Westermann D, BiomarCaRE Consortium
Eur J Prev Cardiol: 20 Apr 2023; epub ahead of print | PMID: 37079290
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<div><h4>Cardiovascular risk profiles in patients with Inflammatory Bowel Disease differ from matched controls from the general population.</h4><i>Sleutjes JAM, van der Woude CJ, Verploegh PJP, Aribas E, ... Roeters van Lennep JE, de Vries AC</i><br /><b>Aims</b><br />Inflammatory bowel disease (IBD) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). We compared CVD risk factors and 10-years risk in IBD patients to the general population.<br /><b>Methods</b><br />In this cross-sectional study consecutive IBD patients ≥45 years were included. History of ASCVD and CVD risk factors (smoking, hypertension, overweight, hypercholesterolemia, diabetes, metabolic syndrome) were assessed. The SCORE2 algorithm was used to estimate 10-year CVD risk. One to four age-sex matched controls were derived from the prospective population-based Rotterdam Study cohort.<br /><b>Results</b><br />235 IBD patients were included (56% women, median age 59 years (IQR 51-66)) and matched to 829 controls (56% women, median age 61 years (IQR 56-67)). IBD patients experienced ASCVD events more often compared to matched controls (OR 2.01, 95%CI 1.23-3.27), specifically heart failure (OR 2.02, 95%CI 1.02-4.01) and coronary heart disease (OR 2.01, 95%CI 1.7-3.13). IBD patients showed lower odds of overweight (OR 0.48, 95%CI 0.35-0.66) and hypercholesterolemia (OR 0.45, 95%CI 0.31-0.65), and higher odds of hypertension (OR 1.67, 95%CI 1.19-2.32), higher waist circumference (+4 cm, p = .006) and triglyceride levels (+0.6 mmol/L, p < .001) as compared to controls. Mean 10-year CVD risk was 4.0% (SD ±2.6) in 135 IBD patients vs 6.0% (SD ±1.6) in 506 controls.<br /><b>Conclusion</b><br />The increased CVD risk in IBD is discrepant with the 10-year CVD risk estimate. SCORE2 may underestimate CVD risk in IBD patients due to differing CVD risk profiles compared to the general population, including lower prevalence of hypercholesterolemia and overweight, and higher prevalence of hypertension, abdominal obesity and hypertriglyceridemia.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 19 Apr 2023; epub ahead of print</small></div>
Sleutjes JAM, van der Woude CJ, Verploegh PJP, Aribas E, ... Roeters van Lennep JE, de Vries AC
Eur J Prev Cardiol: 19 Apr 2023; epub ahead of print | PMID: 37075221
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<div><h4>Nurse-led care after ablation of atrial fibrillation: a Randomised Controlled Trial.</h4><i>Vanharen Y, Abugattas de Torres JP, Adriaenssens B, Convens C, ... Van Bogaert P, De Greef Y</i><br /><b>Background:</b><br/>and aims</b><br />The added value of advanced practitioner nurse (APN) care after ablation of atrial fibrillation (AF) is unknown. The present study investigates the impact of APN-led care on AF recurrence, patient knowledge, lifestyle, and patient satisfaction.<br /><b>Methods</b><br />65 patients undergoing AF ablation were prospectively randomised to usual care (N=33) or intervention (N=32) group. In addition to usual care, the intervention consisted of an educational session, three consultations spread over six months and telephone accessibility coordinated by the APN. Primary outcome was the AF recurrence rate at 6-month follow-up. Secondary outcomes were lifestyle factors (alcohol intake, exercise, BMI, smoking), patient satisfaction and AF knowledge measured at 1 and 6 months between groups and within each group.<br /><b>Results</b><br />Study demographics at 1 month were similar, except AF knowledge was higher in the intervention group (8.6 versus 7, p=0.001).At 6 months, AF recurrence was significantly lower in the intervention group (13.5% vs 39.4%, p=0.014). Between groups, patient satisfaction and AF knowledge were significantly higher in the intervention group, respectively 9.4 vs. 8.7 (p<0.001) and 8.6 vs 7.0 out of 10 (p<0.001). Within the intervention group, alcohol intake decreased from 3.9 to 2.6 units per week (p=0.031) and physical activity increased from 224.4±210.7 to 283.8±169.3 (p=0.048). No changes occurred within the usual care group. Assignment to the intervention group was the only protective factor for AF recurrence (Exp(B) 0.299, p=0.04) in multivariable-adjusted analysis.<br /><b>Conclusion</b><br />Adding APN-led care after ablation of atrial fibrillation improves short-term clinical outcome, patient satisfaction and physical activity and decreases alcohol intake.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 17 Apr 2023; epub ahead of print</small></div>
Vanharen Y, Abugattas de Torres JP, Adriaenssens B, Convens C, ... Van Bogaert P, De Greef Y
Eur J Prev Cardiol: 17 Apr 2023; epub ahead of print | PMID: 37067048
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<div><h4>Association of prolactin with all-cause and cardiovascular mortality among patients with type 2 diabetes: a real-world study.</h4><i>Shen Y, Yang Q, Hu T, Wang Y, ... Wang C, Bao Y</i><br /><b>Background</b><br />The association between prolactin and mortality has been less studied, and findings were inconsistent among different populations. We aimed to investigate the association between serum prolactin (PRL) and mortality among patients with type 2 diabetes.<br /><b>Methods</b><br />We performed a retrospective cohort study of 10,907 patients with at least two prolactin measurements within two years since their first inpatient diagnosis of type 2 diabetes. Baseline and mean values of serum PRL were used as exposures. A multivariable-adjusted Cox proportional hazards model was used to estimate the association between PRL and mortality.<br /><b>Results</b><br />During a mean follow-up of 5.34 years, 863 patients died, of whom 274 were due to cardiovascular events. Multivariable-adjusted hazard ratios (aHRs) based on different levels of baseline PRL (<100, 100-199, 200-299, and ≥300 mIU/L) were 1.00, 1.10 (95% confidence interval (CI), 0.90-1.36), 1.35 (95% CI 1.11-1.67), and 1.49 (95% CI 1.18-1.84) for all-cause mortality, and 1.00, 1.24 (95% CI 0.86-1.81), 1.71 (95% CI 1.14-2.62), and 2.42 (95% CI 1.55-3.78) for cardiovascular mortality, respectively. Positive associations were also found when we used the mean values of PRL as the exposure. These associations were consistent among patients of different baseline characteristics. Further sensitivity analyses excluding patients with subclinical or clinical hypothyroidism at baseline and who died within the first six months since baseline demonstrated similar results.<br /><b>Conclusions</b><br />A positive association between baseline PRL and mortality was observed among patients with type 2 diabetes. PRL may be considered a potential biomarker of mortality among patients with type 2 diabetes.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 12 Apr 2023; epub ahead of print</small></div>
Shen Y, Yang Q, Hu T, Wang Y, ... Wang C, Bao Y
Eur J Prev Cardiol: 12 Apr 2023; epub ahead of print | PMID: 37042353
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<div><h4>Metabolic syndrome is associated with similar long-term prognosis in non-obese and obese patients. An analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 cohort studies.</h4><i>Osadnik K, Osadnik T, Gierlotka M, Windak A, ... Jóźwiak J, LIPIDOGRAM Investigators </i><br /><b>Aims</b><br />We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality.<br /><b>Methods</b><br />The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS and obese patients with MetS. Differences in all-cause mortality was analyzed using Kaplan-Meier and Cox regression analyses.<br /><b>Results</b><br />45,615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14,202 (31%) by NCEP/ATP III criteria, and 17,216 (37.7%) by JIS criteria. Follow-up was available for 44,620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese (hazard ratio, HR: 1.88 [95% CI, 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively) and non-obese individuals (HR: 2.11 [95% CI 1.85-2.40] and 1.7 [95% CI, 1.56-1.85] according to NCEP/ATP III and JIS criteria respectively). Obese patients without MetS had a higher mortality risk than non-obese patients without MetS (HR: 1.16 [95% CI 1.10-1.23] and HR: 1.22 [95%CI 1.15-1.30], respectively in subgroups with NCEP/ATP III and JIS criteria applied).<br /><b>Conclusions</b><br />MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 11 Apr 2023; epub ahead of print</small></div>
Osadnik K, Osadnik T, Gierlotka M, Windak A, ... Jóźwiak J, LIPIDOGRAM Investigators
Eur J Prev Cardiol: 11 Apr 2023; epub ahead of print | PMID: 37039119
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<div><h4>Efficacy and safety of low levels of low-density lipoprotein cholesterol: trans-ancestry linear and non-linear Mendelian randomization analyses.</h4><i>Liu H, Li J, Liu F, Huang K, ... Lu X, Gu D</i><br /><b>Aims</b><br />LDL cholesterol (LDL-C) is a well-established risk factor for coronary artery disease (CAD). However, the optimal LDL-C level with regard to efficacy and safety remains unclear. We aimed to investigate the causal relationships between LDL-C and efficacy and safety outcomes.<br /><b>Methods</b><br />We analyzed 353,232 British from the UK Biobank and 41,271 Chinese from the China-PAR project. Linear and non-linear Mendelian randomization (MR) analyses were performed to evaluate the causal relation between genetically proxied LDL-C and CAD, all-cause mortality, and safety outcomes (including hemorrhagic stroke, diabetes mellitus, overall cancer, non-cardiovascular death, and dementia).<br /><b>Results</b><br />No significant non-linear associations were observed for CAD, all-cause mortality, and safety outcomes (Cochran Q P > 0.25 in British and Chinese) with LDL-C levels above the minimum values of 50 mg/dL and 20 mg/dL in British and Chinese, respectively. Linear MR analyses demonstrated a positive association of LDL-C with CAD (British: odds ratio [OR] per unit mmol/L increase, 1.75, P = 7.57 × 10-52; Chinese: OR, 2.06, P = 9.10 × 10-3). Furthermore, stratified analyses restricted to individuals with LDL-C levels less than the guidelines-recommended 70 mg/dL demonstrated lower LDL-C levels were associated with a higher risk of adverse events, including hemorrhagic stroke (British: OR, 0.72, P = 0.03) and dementia (British: OR, 0.75, P = 0.03).<br /><b>Conclusion</b><br />In British and Chinese populations, we confirmed a linear dose-response relationship of LDL-C with CAD and found potential safety concerns at low LDL-C levels, providing recommendations for monitoring adverse events in people with low LDL-C in the prevention of cardiovascular disease.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 11 Apr 2023; epub ahead of print</small></div>
Liu H, Li J, Liu F, Huang K, ... Lu X, Gu D
Eur J Prev Cardiol: 11 Apr 2023; epub ahead of print | PMID: 37040432
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<div><h4>Visceral adiposity index and the risk of heart failure, late-life cardiac structure and function in ARIC Study.</h4><i>Xu C, Guo Y, Zhang S, Lai Y, ... Zhuang X, Cai Z</i><br /><b>Background</b><br />It is well established that obesity is associated with the risk of heart failure (HF). However, the data about relationship between visceral fat and the risk of HF are limited.<br /><b>Aim</b><br />We aim to evaluate the association between visceral obesity assessed by visceral adiposity index (VAI) and incident HF and left ventricular (LV) structure and function in Atherosclerosis Risk in Communities (ARIC) Study.<br /><b>Methods</b><br />We included 12,161 participants (aged 54.1 ± 5.8years) free of history of HF and coronary heart disease at baseline (1987-1989) in ARIC Study. We used multivariable Cox hazard regression models to assess the association between the VAI and incident HF. We further explored the effects of the VAI on LV geometry and function among 4,817 participants with echocardiographic data using multivariable linear regression analysis and multinomial logistic regression.<br /><b>Results</b><br />During a median follow-up of 22.5 years, a total of 1,904 (15.7%) participants developed HF. After adjustment for traditional HF risk factors, one unit increase in the baseline VAI was associated with an 8% higher risk of incident HF [hazard ratio (HR): 1.08, 95% confidence interval (CI):1.06-1.11]. Results were similar when participants were categorized by VAI tertiles. Compared with participants in the lowest tertile of VAI, those in the second tertile and third tertile had a greater risk of incident HF [HR (95%CI) :1.19 (1.05-1.34), 1.42 (1.26-1.61), respectively]. For the analyses of the HF subtypes, the higher VAI was only associated with the risk of HF with preserved ejection fraction, not with HF with reduced ejection fraction. In addition, the greater VAI was associated with worse LV diastolic function and abnormal LV geometry including concentric remodeling, concentric hypertrophy and eccentric Hypertrophy.<br /><b>Conclusion</b><br />This study shows that higher VAI was independently associated with the increased risk of incident HF and abnormal LV geometry and LV diastolic dysfunction.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print</small></div>
Xu C, Guo Y, Zhang S, Lai Y, ... Zhuang X, Cai Z
Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print | PMID: 37036032
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<div><h4>Intensive Blood Pressure Lowering and the Risk of New-onset Diabetes in Patients with Hypertension: A Post-hoc Analysis of the STEP Randomized Trial.</h4><i>Yang R, Zhu Y, Xu M, Tao Y, Cong W, Cai J</i><br /><b>Aims</b><br />The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial reported the cardiovascular benefit of intensive systolic blood pressure (SBP) control in patients with hypertension. The association between intensive SBP lowering and the risk of new-onset diabetes is unclear. This study aimed to evaluate the effect of intensive SBP lowering on the incidence of new-onset diabetes.<br /><b>Methods</b><br />Participants in STEP who had baseline fasting serum glucose (FSG) concentrations <7.0 mmol/l and no history of diabetes or hypoglycaemic medication use were included. The primary outcome was new-onset diabetes defined as the time to first occurrence of FSG concentrations ≥7.0 mmol/l. The secondary outcome was new-onset impaired fasting glucose (FSG: 5.6-6.9 mmol/l) in participants with normoglycemia. A competing risk proportional hazards regression model was used for analysis.<br /><b>Results</b><br />The cohort comprised 5,601 participants (mean age: 66.1 years) with a mean baseline SBP of 145.9 mmHg. Over a median follow-up of 3.42 years, 273 (9.6%) patients in the intensive SBP group (target, 110 to <130 mmHg) and 262 (9.5%) in the standard SBP group (target, 130 to <150 mmHg) developed diabetes (adjusted hazard ratio, 1.01; 95% confidence interval, 0.86-1.20). The adjusted hazard ratio for the secondary outcome was 1.04 (95% confidence interval, 0.91-1.18). The mean highest FSG concentration during the follow-up was 5.82 and 5.84 mmol/l in the intensive and standard groups, respectively.<br /><b>Conclusion</b><br />Intensive SBP lowering is not associated with an altered risk of new-onset diabetes or impaired fasting glucose in hypertensive patients.<br /><b>Registration</b><br />STEP ClinicalTrials.gov, number: NCT03015311.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print</small></div>
Yang R, Zhu Y, Xu M, Tao Y, Cong W, Cai J
Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print | PMID: 37036035
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<div><h4>Predictive Performance of Established Cardiovascular Risk Scores in the Prediabetic Population: External Validation using the UK Biobank Dataset.</h4><i>Li M, Lin Y, Zhong X, Huang R, ... Liao X, Zhuang X</i><br /><b>Background:</b><br/>and aims</b><br />Prediabetes is a highly heterogenous metabolic state with increased risk of cardiovascular disease (CVD). Current guidelines raised the necessity of CVD risk scoring for prediabetes without clear recommendations. Thus, this study aimed to systematically assess the performance of 11 models, including five general population-based and six diabetes-specific CVD risk scores, in prediabetes.<br /><b>Methods and results</b><br />A cohort of individuals aged 40-69 years with prediabetes (HbA1c ≥ 5.7 and <6.5%) and without baseline CVD or known diabetes was identified from the UK Biobank, which was used to validate 11 prediction models for estimating 10-year or 5-year risk of CVD. Model discrimination and calibration were evaluated by Harrell\'s C-statistic and calibration plots, respectively. We further performed decision curve analyses to assess the clinical usefulness.Overall, 56,831 prediabetic individuals were included, of which 4,303 incident CVD events occurred within a median follow-up of 8.9 years. All the 11 risk scores assessed had modest C-statistics for discrimination ranging from 0.647 to 0.680 in prediabetes. Scores developed in the general population did not outperform those diabetes-specific models (C-statistics 0.647-0.675 vs. 0.647-0.680), while the PREDICT-1° Diabetes equation developed for type 2 diabetes performed best [0.680 (95% confidence interval 0.672-0.689)]. The calibration plots suggested overall poor calibration except that the PREDICT-1° Diabetes equation calibrated well after recalibration. The decision curves generally indicated moderate clinical usefulness of each model, especially worse within high threshold probabilities.<br /><b>Conclusion</b><br />Neither risk stratification schemes for the general population nor those specific for type 2 diabetes performed well in the prediabetic population. The PREDICT-1° Diabetes equation could be a substitute in the absence of better alternatives, rather than the general population-based scores. More precise and targeted risk assessment tools for this population remain to be established.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print</small></div>
Li M, Lin Y, Zhong X, Huang R, ... Liao X, Zhuang X
Eur J Prev Cardiol: 10 Apr 2023; epub ahead of print | PMID: 37036042
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<div><h4>Genetic and Clinical Factors Underlying a Self-Reported Family History of Heart Disease.</h4><i>Jowell A, Bhattacharya R, Marnell C, Wong M, ... Honigberg MC, Natarajan P</i><br /><b>Aim</b><br />To estimate how much information conveyed by self reported family history of heart disease (FHHD) is already explained by clinical and genetic risk factors.<br /><b>Methods</b><br />Cross-sectional analysis of UK Biobank participants without preexisting coronary artery disease using a multivariable model with self-reported FHHD as the outcome. Clinical (diabetes, hypertension, smoking, apolipoprotein B-to-apolipoprotein AI ratio, waist-to-hip ratio, high sensitivity C-reactive protein, lipoprotein(a), triglycerides) and genetic risk factors (polygenic risk score for coronary artery disease [PRSCAD], heterozygous familial hypercholesterolemia [HeFH]) were exposures. Models were adjusted for age, sex, and cholesterol-lowering medication use. Multiple logistic regression models were fitted to associate FHHD with risk factors, with continuous variables treated as quintiles. Population attributable risks (PAR) were subsequently calculated from the resultant odds ratios.<br /><b>Results</b><br />Among 166,714 individuals, 72,052 (43.2%) participants reported a FHHD. In a multivariable model, genetic risk factors PRSCAD (OR 1.30, CI 1.27-1.33), and HeFH (OR 1.31, 1.11-1.54) were most strongly associated with FHHD. Clinical risk factors followed: hypertension (OR 1.18, CI 1.15-1.21), Lp(a) (OR 1.17, CI 1.14-1.20), apolipoprotein B-to-apolipoprotein AI ratio, (OR 1.13, 95% CI 1.10-1.16) and triglycerides (OR 1.07, CI 1.04-1.10). For the PAR analyses: 21.9% (CI 18.19-25.63) of the risk of reporting a FHHD is attributed to clinical factors, 22.2% (CI% 20.44-23.88) is attributed to genetic factors, and 36.0% (CI 33.31-38.68) is attributed to genetic and clinical factors combined.<br /><b>Conclusions</b><br />A combined model of clinical and genetic risk factors explains only 36% of the likelihood of FHHD, implying additional value in the family history.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 03 Apr 2023; epub ahead of print</small></div>
Jowell A, Bhattacharya R, Marnell C, Wong M, ... Honigberg MC, Natarajan P
Eur J Prev Cardiol: 03 Apr 2023; epub ahead of print | PMID: 37011137
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<div><h4>Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry.</h4><i>Liang YY, Feng H, Chen Y, Jin X, ... Geng Q, Zhang J</i><br /><b>Aims</b><br />To investigate the joint association of accelerometer-measured physical activity (PA) and sleep duration with mortality risk.<br /><b>Methods and results</b><br />A 7-day accelerometer recording was performed on 92 221 participants (age 62.4 ± 7.8 years; 56.4% women) from the UK Biobank between February 2013 and December 2015. We divided sleep duration into three groups (short, normal, and long), total volume of PA into three levels according to tertiles (high, intermediate, low), and moderate-to-vigorous PA (MVPA) into two groups based on the World Health Organization guidelines. The mortality outcomes were prospectively collected through the death registry. Over a median follow-up of 7.0 years, 3080 adults died, of which 1074 died from cardiovascular disease (CVD) and 1871 from cancer. The associations of PA and sleep duration with mortality risk were all in a curvilinear dose-response pattern (Pnonlinearity <0.001). PA and sleep duration had additive and multiplicative interactions on mortality risk (Pinteraction <0.05). Compared with the participants with guideline-recommended MVPA and normal sleep duration, those without recommended MVPA but having short or long sleep duration were at a higher risk for all-cause mortality [short sleep: hazard ratio (HR) = 1.88; 95% confidence interval (CI), 1.61-2.20; long sleep: HR = 1.69; 95% CI, 1.49-1.90]. A higher volume of PA or recommended MVPA attenuated the detrimental effects of short or long sleep duration on all-cause and CVD mortality risks.<br /><b>Conclusion</b><br />MVPA meeting recommendations or a higher volume of PA at any intensity potentially diminished the adverse effects on all-cause and cause-specific mortality associated with short and long sleep duration.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 29 Mar 2023; epub ahead of print</small></div>
Liang YY, Feng H, Chen Y, Jin X, ... Geng Q, Zhang J
Eur J Prev Cardiol: 29 Mar 2023; epub ahead of print | PMID: 36990109
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<div><h4>The prognostic effect of prediabetes defined by different criteria in patients with stable coronary artery disease: a prospective cohort study in Asia.</h4><i>Cui K, Yin D, Song W, Wang H, ... Fu R, Dou K</i><br /><b>Aims</b><br />To evaluate the prognostic impact of prediabetes identified by different glycemic thresholds (according to ADA or WHO/IEC criteria) and diagnostic tests (fasting plasma glucose [FPG] or hemoglobin A1c [HbA1c]) in patients with stable coronary artery disease (CAD).<br /><b>Methods</b><br />In this prospective cohort study, we consecutively enrolled 4,088 stable CAD nondiabetic patients with a median follow-up period of 3.2 years. Prediabetes was defined according to ADA criteria as FPG 5.6∼6.9 mmol/L and/or HbA1c 5.7∼6.4%, and WHO/IEC criteria as FPG 6.1∼6.9mmol/L and/or HbA1c 6.0∼6.4%. The primary endpoint was major adverse cardiovascular event (MACE), including all-cause death, myocardial infarction or stroke.<br /><b>Results</b><br />The prevalence of prediabetes defined according to ADA criteria (67%) was double that of WHO/IEC criteria (34%). Compared with patients with normoglycemia, those with WHO/IEC-defined prediabetes were significantly associated with higher risk of MACE (adjusted HR 1.50, 95%CI 1.10-2.06), mainly driven by the higher incidence of events in individuals with HbA1c-defined prediabetes. However, this difference was not found in patients with ADA-defined prediabetes and normoglycemia (adjusted HR 1.17, 95%CI 0.81-1.68). Although FPG was not associated with cardiovascular events, HbA1c improved the risk prediction for MACE in a model of traditional risk factors. Furthermore, the optimal cutoff value of HbA1c for predicting MACE was 5.85%, which was close to the threshold recommended by IEC.<br /><b>Conclusion</b><br />This study supports the use of WHO/IEC criteria for the identification of prediabetes in stable CAD patients. HbA1c, rather than FPG, should be considered as a useful marker for risk stratification in this population.<br /><b>Trial registration</b><br />not applicable.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 29 Mar 2023; epub ahead of print</small></div>
Cui K, Yin D, Song W, Wang H, ... Fu R, Dou K
Eur J Prev Cardiol: 29 Mar 2023; epub ahead of print | PMID: 36987575
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<div><h4>Advanced heart failure in ACHD: The Role of renal dysfunction in management and outcomes.</h4><i>Krishnathasan K, Dimopoulos K, Duncan N, Ricci P, ... Li W, Constantine A</i><br /><b>Background</b><br />Previous studies in adult congenital heart disease \"CHD\" have demonstrated a link between renal dysfunction and mortality. However, the prognostic significance of renal dysfunction in CHD and decompensated heart failure \"HF\" remains unclear. We sought to assess the association of renal dysfunction and outcomes in adults with CHD presenting to our center with acute HF between 2010-2021.<br /><b>Design & methods</b><br />This retrospective analysis focused on the association between renal dysfunction, pre-existing and on admission, and outcomes during and after the index hospitalization. Chronic kidney disease \"CKD\" was defined as eGFR<60 mL/min/1.73m2. Cox regression analysis was used to identify predictors of death post-discharge.<br /><b>Results</b><br />In total, 176 HF admissions were included (mean age 47.7±14.5 years, 43.2% female). One-half of patients had CHD of great complexity, 22.2% had a systemic right ventricle, and 18.8% Eisenmenger syndrome. CKD was present in one-quarter of patients. The median length of intravenous diuretic therapy was 7[4-12] days, with a maximum dose of 120[80-160] mg furosemide equivalents/day, and 15.3% required inotropic support. In-hospital mortality was 4.5%. The 1- and 5-year survival free of transplant or ventricular assist device \"VAD\" post-discharge were 75.4% (95%CI: 69.2-82.3%) and 43.3% (95%CI: 36-52%), respectively. On multivariable Cox analysis, CKD was the strongest predictor of mortality or transplantation/VAD. Greatly complex CHD and inpatient requirement of inotropes also remained predictive of an adverse outcome.<br /><b>Conclusions</b><br />Adult CHD patients admitted with acute HF are a high-risk cohort. CKD is common and triples the risk of death/transplantation/VAD. Expert multidisciplinary approach is essential for optimizing outcomes.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 28 Mar 2023; epub ahead of print</small></div>
Krishnathasan K, Dimopoulos K, Duncan N, Ricci P, ... Li W, Constantine A
Eur J Prev Cardiol: 28 Mar 2023; epub ahead of print | PMID: 36974357
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<div><h4>Ethnic Differences in Blood Pressure Levels over Time - The HELIUS Study.</h4><i>Vriend EMC, Wever BE, Bouwmeester TA, Agyemang C, ... Collard D, van den Born BH</i><br /><b>Background:</b><br/>and aims</b><br />Hypertension is an important global health burden with major differences in prevalence among ethnic minorities compared to host populations. Longitudinal research on ethnic differences in blood pressure (BP) levels provides the opportunity to assess the efficacy of strategies aimed at mitigating gaps in hypertension control. In this study we assessed the change in BP levels over time in a multi-ethnic population-based cohort in Amsterdam, the Netherlands.<br /><b>Methods</b><br />We used baseline and follow-up data from HELIUS to assess differences in BP over time between participants of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish descent. Baseline data were collected between 2011-2015, follow-up data between 2019-2021. Main outcome was ethnic differences in systolic BP over time determined by linear mixed models adjusted for age, sex, and use of antihypertensive medication.<br /><b>Results</b><br />We included 22,109 participants at baseline, from which 10,170 participants had complete follow-up data. Mean follow-up time was 6.3 (1.1) years. Compared to the Dutch population, mean systolic BP increased significantly more from baseline to follow-up in Ghanaians (1.78 mmHg, 95%CI 0.77-2.79), Moroccans (2.06 mmHg, 95%CI 1.23-2.90), and the Turkish population (1.30 mmHg, 95%CI 0.38-2.22). SBP differences were in part explained by differences in BMI. No differences in systolic BP trajectory were present between the Dutch and Surinamese population.<br /><b>Conclusion</b><br />Our findings indicate a further increase of ethnic differences in systolic BP among Ghanaian, Moroccan, and Turkish populations compared to the Dutch reference population that are in part attributable to differences in BMI.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 27 Mar 2023; epub ahead of print</small></div>
Vriend EMC, Wever BE, Bouwmeester TA, Agyemang C, ... Collard D, van den Born BH
Eur J Prev Cardiol: 27 Mar 2023; epub ahead of print | PMID: 36971109
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<div><h4>Association of Long-term Time in Target Range for Systolic Blood Pressure with Cardiovascular Risk in the Elderly: A Chinese Veterans Cohort Study.</h4><i>Lin Z, Xiao Z, Chen W, Xu W, ... Chen Y, Bin J</i><br /><b>Aims</b><br />Short-term blood pressure (BP) time in target range (TTR) independently predicts cardiovascular (CV) outcomes in adults. However, there are limited data regarding long-term TTR for BP among elderly participants. We aimed to determine whether future CV risk varies for those who can maintain a long-term systolic BP target range by assessing TTR in elderly individuals with hypertension.<br /><b>Methods</b><br />The Chinese veteran cohort study included 943 elderly participants with hypertension aged over 75 years. The primary outcome was the first occurrence of CV events during annual visits. TTR was estimated over 15 years of follow-up using linear interpolation. The target range was defined as 120 to 140 mmHg according to guidelines. The association between systolic BP TTR and CV outcomes was estimated using multivariable Cox proportional hazards models.<br /><b>Results</b><br />During the 15-year follow-up, the probability of CV events gradually decreased with increasing TTR for systolic BP. After multivariable adjustment for traditional CV risk factors and mean BP, comparing the highest versus lowest quartiles of TTR for systolic BP, the hazard ratios (95% CIs) were 0.424 (0.289-0.624) for the primary outcome. For each 1-SD increase in TTR, the risk of the primary outcome decreased by 25.4% (HR: 0.746; 95% CI: 0.666-0.834). Consistent findings were observed in sensitivity analyses.<br /><b>Conclusions</b><br />Greater long-term TTR for systolic BP was associated with a decreased risk of CV events in elderly individuals independent of mean BP, suggesting that systolic BP TTR might serve as a modifiable risk factor for future CV health in elderly patients with hypertension.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print</small></div>
Lin Z, Xiao Z, Chen W, Xu W, ... Chen Y, Bin J
Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print | PMID: 36947144
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<div><h4>Masters Athlete Screening Study (MASS): incidence of cardiovascular disease and major adverse cardiac events and efficacy of screening over five years.</h4><i>Morrison BN, Isserow S, Taunton J, Oxborough D, ... Warburton DER, McKinney J</i><br /><b>Background</b><br />The efficacy of cardiovascular screening in Masters athletes (MAs) (≥ 35y), and whether screening decreases their risk of major adverse cardiac events (MACE) is unknown.<br /><b>Purpose</b><br />To evaluate the effectiveness of yearly cardiovascular screening, and the incidence of cardiovascular disease (CVD) and MACE over five years.<br /><b>Methods</b><br />MAs (≥35 y) without previous history of CVD underwent yearly cardiovascular screening. Participants with an abnormal screen underwent further evaluations.<br /><b>Results</b><br />In the initial year, 798 MAs (62.7% male, 55 ± 10y) were screened; 11.4% (n = 91) were diagnosed with CVD. Coronary artery disease (CAD) was the most common diagnosis (n = 64; 53%). During follow-up, there were an additional 89 CVD diagnoses with an incidence rate of 3.58/100, 4.14/100, 3.74/100, 1.19/100, for years one to four, respectively. The most common diagnoses during follow-up were arrhythmias (n = 33; 37%). Increasing age (OR = 1.047, 95% confidence interval (CI): 1.003-1.094; p = 0.0379), Framingham Risk Score (FRS) (OR = 1.092, 95%CI: 1.031-1.158; p = 0.003), and LDL cholesterol (OR = 1.709, 95%CI: 1.223-2.401; p = 0.002) were predictive of CAD, whereas moderate intensity activity (min/wk) (OR = 0.997, 95%CI: 0.996-0.999; p = 0.002) was protective. Ten MACE (2.8/1,000 athlete-years) occurred. All of these MAs were male, and 90% had ≥10% FRS. All underwent further evaluations with only two identified to have obstructive CAD.<br /><b>Conclusion</b><br />MACE occurred despite yearly screening. All MAs who had an event had an abnormal screen; however, cardiac functional tests failed to detect underlying CAD in most cases. It may be appropriate to offer computed computed coronary tomography angiography in MAs with ≥10% FRS to overcome the limitations of functional testing, and to assist with lifestyle and treatment modifications.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print</small></div>
Morrison BN, Isserow S, Taunton J, Oxborough D, ... Warburton DER, McKinney J
Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print | PMID: 36947149
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<div><h4>Temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in European adults with and without diabetes.</h4><i>Kristensen AMD, Pareek M, Kragholm KH, Torp-Pedersen C, McEvoy JW, Prescott EB</i><br /><b>Background:</b><br/>and aims</b><br />Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial and guideline recommendations have changed throughout the last decades. We report temporal trends in primary prevention aspirin use among persons with and without diabetes and describe characteristics of incident aspirin users.<br /><b>Methods</b><br />Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population of subjects ≥40 years without CVD eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin users with and without diabetes were assessed, as were CVD risk factors among incident users.<br /><b>Results</b><br />A total of 522,680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39,803 individuals, 1.78% of the eligible population) and was lowest in 2019 (11,898 individuals, 0.49%), with similar trends for subjects with and without diabetes. The percentage of incident users with no CVD risk factors (diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease [a proxy for smoking]) decreased from 53.9% in 2000 to 30.9% in 2020. The temporal trends in prevalent aspirin users followed a unimodal curve, peaked at 7.7% in 2008 and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% decreasing to 17.1% in 2020.<br /><b>Conclusion</b><br />Aspirin therapy for primary prevention of CVD has decreased over the last two decades. However, the drug remained used in individuals with and without diabetes and a large proportion of individuals started on aspirin therapy had no CVD risk factors.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print</small></div>
Kristensen AMD, Pareek M, Kragholm KH, Torp-Pedersen C, McEvoy JW, Prescott EB
Eur J Prev Cardiol: 22 Mar 2023; epub ahead of print | PMID: 36947152
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<div><h4>Prediction of Coronary Artery Disease Using Urinary Proteomics.</h4><i>Wei D, Melgarejo JD, Van Aelst L, Vanassche T, ... Peter K, Zhang ZY</i><br /><b>Aims</b><br />Coronary artery disease (CAD) is multifactorial, caused by complex pathophysiology, and contributes to a high burden of mortality worldwide. Urinary proteomic analyses may help to identify predictive biomarkers and provide insights into the pathogenesis of CAD.<br /><b>Methods</b><br />Urinary proteome was analysed in 965 participants using capillary electrophoresis coupled with mass spectrometry. A proteomic classifier was developed in a discovery cohort with 36 individuals with CAD and 36 matched controls using the support vector machine. The classifier was tested in a validation cohort with 115 individuals who progressed to CAD and 778 controls and compared with two previously developed CAD-associated classifiers, CAD238 and ACSP75. The Framingham and SCORE2 risk score were available in 737 participants. Bioinformatics analysis was performed based on the CAD-associated peptides.<br /><b>Results</b><br />The novel proteomic classifier was comprised of 160 urinary peptides, mainly related to collagen turnover, lipid metabolism, and inflammation. In the validation cohort, the classifier provided an AUC of 0.82 (95% CI: 0.78-0.87) for the CAD prediction in 8 years, superior to CAD238 (AUC: 0.71, 95% CI: 0.66-0.77) and ACSP75 (AUC: 0.53, 95% CI: 0.47-0.60). On top of CAD238 and ACSP75, the addition of the novel classifier improved the AUC to 0.84 (95% CI: 0.80-0.89). In a multivariable Cox model, a 1-SD increment in the novel classifier was associated with CAD (HR: 1.54, 95% CI: 1.26-1.89, P < 0.0001) higher risk of CAD. The new classifier further improved the risk reclassification of CAD on top of the Framingham or SCORE2 risk score (net reclassification index: 0.61, 95% CI: 0.25-0.95, P = 0.001; 0.64, 95% CI: 0.28-0.98, P = 0.001, correspondingly).<br /><b>Conclusions</b><br />A novel urinary proteomic classifier related to collagen metabolism, lipids, and inflammation showed potential for the risk prediction of CAD. Urinary proteome provides an alternative approach to personalized prevention.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 21 Mar 2023; epub ahead of print</small></div>
Wei D, Melgarejo JD, Van Aelst L, Vanassche T, ... Peter K, Zhang ZY
Eur J Prev Cardiol: 21 Mar 2023; epub ahead of print | PMID: 36943304
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<div><h4>The impact of modifiable risk factors in the association between socioeconomic status and sudden cardiac death in a prospective cohort study: equal access to healthcare, unequal outcome.</h4><i>Warming PE, Ågesen FN, Lynge TH, Garcia R, ... Jabbari R, Tfelt-Hansen J</i><br /><b>Aims</b><br />Low socioeconomic status is associated with all-cause mortality and cardiac risk factors. Furthermore, sudden cardiac death (SCD) is among the leading causes of death in the general population, and identification of high-risk subgroups is needed. The aim of this study was to investigate the association between income and education level and incidence of SCD, and to calculate the impact of modifiable mediating risk factors.<br /><b>Methods</b><br />Participants in the Copenhagen City Heart Study were followed from 1993-2016. SCD was identified using high quality death certificates, autopsy reports, discharge summaries, and national registry data. Hazard ratios were calculated using Cox proportional hazards regression and adjusted cumulative incidences were predicted using cause-specific Cox models. Mediation analyses were performed using a marginal structural model approach.<br /><b>Results</b><br />During 24 years of follow-up, 10,006 participated, whereof 5,514 died during the study period with 822 SCDs. Compared to long education, persons with elementary school level education had an SCD incidence rate ratio (IRR) of 2.48 (CI-95% 1.86-3.31), and low income was likewise associated with an SCD IRR of 2.34 (CI-95% 1.85-2.96) compared to high income. In the association between education and SCD, the combined mediating effect of smoking, physical activity, and BMI accounted for about 20% of the risk differences.<br /><b>Conclusion</b><br />We observed an inverse association between both income and education and the risk of SCD, which was only in part explained by common cardiac risk factors, implying that further research into competing causes of SCD is needed and stresses the importance of targeted preventive measures.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 21 Mar 2023; epub ahead of print</small></div>
Warming PE, Ågesen FN, Lynge TH, Garcia R, ... Jabbari R, Tfelt-Hansen J
Eur J Prev Cardiol: 21 Mar 2023; epub ahead of print | PMID: 36943322
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<div><h4>Sport and Exercise in Genotype positive (+) Phenotype negative (-) Individuals. Current Dilemmas and Future Perspectives.</h4><i>Paldino A, Rossi M, Dal Ferro M, Tavcar I, ... Sinagra G, Finocchiaro G</i><br /><AbstractText>Genotype positive - phenotype negative (GEN + PHEN-) individuals harbor a pathogenic or likely pathogenic variant without exhibiting a phenotypic manifestation of the disease. In the last few years, the widespread use of genetic testing in probands and relatives has increasingly led to the identification of these individuals, with emerging dilemmas regarding their clinical management. A genetic variant may exhibit a variable expressivity even in the same family and spontaneous conversion to overt phenotype is largely unpredictable. Little is known about the possible influence of environmental factors, such intense or moderate exercise with open questions regarding their possible role in promoting or worsening the phenotypic expression. Current guidelines for sports participation in this setting acknowledge the weak burden of evidence and the many uncertainties. The recommendations to engage in intensive exercise and competitive sports is usually contingent on annual clinical surveillance, except for pathogenic variants in specific genes, such as LMNA or PKP2. In certain conditions, such as arrhythmogenic cardiomyopathy, guidelines do not differentiate between GEN + PHEN- individuals and patients with overt disease and recommend avoiding participation in high-intensity recreational exercise and competitive sports. It should be emphasized that international guidelines, traditionally restrictive in terms of sports participation and focused on disqualification, embraced recently a more liberal attitude promoting a shared decision-making approach in absence of clinical markers of increased risk. In this review, we will discuss the current state of knowledge on GEN + PHEN- individuals and the dilemmas surrounding the impact of exercise and prognosis, focusing on cardiomyopathies and channelopathies, which are the predominant causes of sudden cardiac death in the young and in young athletes.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print</small></div>
Paldino A, Rossi M, Dal Ferro M, Tavcar I, ... Sinagra G, Finocchiaro G
Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print | PMID: 36929832
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<div><h4>20-year trends in the prevalence of modifiable cardiovascular risk factors in young acute coronary syndrome patients hospitalised in Switzerland.</h4><i>Mahendiran T, Hoepli A, Foster-Witassek F, Rickli H, ... Radovanovic D, Fournier S</i><br /><b>Aim</b><br />Modifiable cardiovascular risk factors (RFs) play a key role in the development of coronary artery disease. We evaluated 20-year trends in RF prevalence among young adults hospitalised with acute coronary syndromes (ACS) in Switzerland.<br /><b>Methods and results</b><br />Data were analysed from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry from 2000 to 2019. Young patients were defined as those aged <50 years. Among 58\'028 ACS admissions, 7\'073 (14.1%) were young (median 45.6 years, IQR 42.0-48.0), of which 91.6% had at least one modifiable RF, and 59.0% had at least two RFs. Smoking was the most prevalent RF (71.4%), followed by dyslipidaemia (57.3%), hypertension (35.9%), obesity (21.7%) and diabetes (10.1%). Compared with older patients, young patients were more likely to be obese (21.7% vs 17.4%, p < 0.001) and active smokers (71.4% vs 33.9%, p < 0.001). Among young patients, between 2000 and 2019 there was a significant increase in the prevalence of hypertension from 29.0% to 51.3% and obesity from 21.2% to 27.1% (both ptrend < 0.001), but a significant decrease in active smoking from 72.5% to 62.5% (ptrend = 0.02). There were no significant changes in the prevalence of diabetes (ptrend = 0.32) or dyslipidaemia (ptrend = 0.067).<br /><b>Conclusion</b><br />Young ACS patients in Switzerland exhibit a high prevalence of RFs, and are more likely than older patients to be obese and smokers. Between 2000 and 2019, RF prevalence either increased or remained stable, except for smoking which decreased but still affected ∼2/3 of young patients in 2019. Public health initiatives targeting RFs in young adults in Switzerland are warranted.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print</small></div>
Mahendiran T, Hoepli A, Foster-Witassek F, Rickli H, ... Radovanovic D, Fournier S
Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print | PMID: 36929213
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<div><h4>Trends in Cardiovascular Risk Factors Control Among US Adults by Glycemic Statuses, 2007-2018.</h4><i>Yuan S, Song C, He J, Zhang R, ... Song W, Dou K</i><br /><b>Aims</b><br />Understanding the national trends in cardiovascular risk factors control of individuals with prediabetes and diabetes is critical for diabetes prevention and management. Our study aims to estimate how cardiovascular risk factors changed in US adults with different glycemic statuses between 2007-2008 and 2017-2018.<br /><b>Methods</b><br />This was a serial cross-sectional study based on the National Health and Nutrition Examination Surveys (between 2007-2008 and 2017-2018 cycle). Non-pregnant American participants aged 20 years or older were included. Cardiovascular risk factors including weight, blood pressure, plasma cholesterol, and smoking by glycemic statuses were estimated.<br /><b>Results</b><br />A total of 33,040 American adults were included. From 2007-2008 to 2017-2018, the age-adjusted proportions of individuals who reached weight control (body mass index < 30 kg/m2) of both normoglycemia group and prediabetes group had a significant decrease over the study period, while the trend in participants with diabetes was not significant (mean difference: -5.34%, 95% confidence interval: -15.28%, 4.59%; P for trend = 0.298). The age-adjusted means of total cholesterol of all three groups decreased during the study decade (P for trend < 0.010), with participants with diabetes maintaining the lowest level. Individuals with high total cholesterol were more likely to receive statin therapy in the diabetes group. Notably, prediabetes participants had the highest level of total cholesterol and low-density lipoprotein cholesterol and were less likely to achieve lipid control with statin therapy. Sensitivity analysis with the second definition of prediabetes and diabetes resulted in a consistent trend.<br /><b>Conclusions</b><br />In this nationally representative cross-sectional study, we systematically estimated the cardiovascular risk factors control in American adults and found poor weight control in the normoglycemia and prediabetes group. Despite the significant decrease trend of plasma total cholesterol in all groups, the high cholesterol level in the prediabetes group deserves special concern.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print</small></div>
Yuan S, Song C, He J, Zhang R, ... Song W, Dou K
Eur J Prev Cardiol: 17 Mar 2023; epub ahead of print | PMID: 36929777
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<div><h4>Decreased free fatty acid levels associated with adverse clinical outcomes in coronary artery disease patients with type 2 diabetes: Findings from the PRACTICE study.</h4><i>Pan Y, Wu TT, Mao XF, Hou XG, ... Zheng YY, Xie X</i><br /><b>Background:</b><br/>and aims</b><br />Increased free fatty acid (FFA) levels are known to be strongly associated with mortality in coronary artery disease (CAD) patients and the development of type 2 diabetes (T2DM). However, few studies have been large enough to accurately examine the relationship between FFA levels and mortality in CAD patients with T2DM.<br /><b>Methods</b><br />From December 2016 to October 2021, 10 395 CAD patients enrolled in PRACTICE, a prospective cohort study in China, were divided into four groups according to baseline FFA concentration. We investigated mortality, including all-cause mortality (ACM) and cardiac mortality (CM), as the primary endpoint. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse cardiovascular events (MACEs). The median follow-up time was 24 months.<br /><b>Results</b><br />In the total cohort, there were 222 ACMs, 164 CMs, 718 MACEs and 803 MACCEs were recorded. After controlling for baseline variables, the association between FFA levels and the risk of mortality presented a nonlinear U-shaped curve, with the lowest risk at 310 µmol/L. We also identified a nonlinear U-shaped relationship for ischemic events (MACE or MACCE) with the lowest risk at 500 µmol/L. Subgroup analysis showed that a U-shaped relationship between FFA and mortality or ischemic events was observed only in individuals with T2DM but not in nondiabetic CAD patients.<br /><b>Conclusions</b><br />A nonlinear U-shaped association was identified between baseline FFA levels and mortality or ischemic events in CAD patients with T2DM.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 13 Mar 2023; epub ahead of print</small></div>
Pan Y, Wu TT, Mao XF, Hou XG, ... Zheng YY, Xie X
Eur J Prev Cardiol: 13 Mar 2023; epub ahead of print | PMID: 36912007
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<div><h4>Risk factors variability and cardiovascular risk among patients with diabetes: a nationwide observational study.</h4><i>Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, ... Eliasson B, Nicolucci A</i><br /><b>Background</b><br />Cardiovascular risk factors control is fluctuating, tends to change over time, and is potentially impacted by multifactorial interactions. Currently, the existence of risk factors, rather than their variability or interplay with one another, is used to define the population at risk. The association between variability of risk factors and cardiovascular morbidity and mortality risk among patients with T2DM remains debatable.<br /><b>Methods</b><br />Using registry-derived data, we identified 29,471 people with T2D, without CVD at baseline, and with at least five measurements of risk factors. Variability for each variable was expressed as quartiles of the standard deviation during three years (exposure). The incidence of myocardial infarction, stroke, and all-cause mortality was assessed during 4.80 (2.40-6.70) years following the exposure phase. The association between measures of variability and the risk of developing the outcome was investigated through multivariable Cox proportional-hazards regression analysis with stepwise variable selection. Then, the recursive partitioning and amalgamation (RECPAM) algorithm was used to explore the interaction among the variability of risk factors associated with the outcome.<br /><b>Results</b><br />An association between the variability of HbA1c, body weight, systolic blood pressure, and total cholesterol with the outcome considered was found. Among the 6 classes of risk identified by RECPAM, patients with a high variability of both body weight and blood pressure had the highest risk (Class 6, HR = 1.81; 95% CI 1.61-2.05) compared with patients with low variability of both body weight and total cholesterol (Class 1, reference), despite a progressive reduction in the mean level of risk factors during successive visits. Individuals with high weight variability but low-moderate systolic blood pressure variability (Class 5, HR = 1.57; 95% CI 1.28-1.68), patients with moderate/high weight variability associated with high/very high HbA1c variability (Class 4, HR = 1.33; 95%CI 1.20-1.49), subjects with moderate/high weight variability and with low/moderate HbA1c variability (Class 3, HR = 1.12; 95%CI 1.00-1.25), as well as those with low weight variability associated with high/very high total cholesterol variability (Class 2, HR = 1.14; 95%CI 1.00-1.30) also showed a significant increase in the risk of event.<br /><b>Conclusions</b><br />Combined high variability of two risk factors, particularly body weight and blood pressure, is associated with cardiovascular risk among patients with T2DM. These findings highlight the importance of continuous balancing of multiple risk factors.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 10 Mar 2023; epub ahead of print</small></div>
Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, ... Eliasson B, Nicolucci A
Eur J Prev Cardiol: 10 Mar 2023; epub ahead of print | PMID: 36897149
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<div><h4>Determining cardiovascular risk in patients with unattributed chest pain in UK primary care: an electronic health record study.</h4><i>Jordan KP, Rathod-Mistry T, van der Windt DA, Bailey J, ... Kyriacou T, Mamas MA</i><br /><b>Background</b><br />Most adults presenting in primary care with chest pain symptoms will not receive a diagnosis (\"unattributed\" chest pain) but are at increased risk of cardiovascular events.<br /><b>Aim</b><br />To assess within patients with unattributed chest pain, risk factors for cardiovascular events and whether those at greatest risk of cardiovascular disease can be ascertained by an existing general population risk prediction model or by development of a new model.<br /><b>Methods</b><br />The study used UK primary care electronic health records from the Clinical Practice Research Datalink (CPRD) linked to admitted hospitalisations. Study population was patients aged 18 plus with recorded unattributed chest pain 2002-2018. Cardiovascular risk prediction models were developed with external validation and comparison of performance to QRISK3, a general population risk prediction model.<br /><b>Results</b><br />There were 374,917 patients with unattributed chest pain in the development dataset. Strongest risk factors for cardiovascular disease included diabetes, atrial fibrillation, and hypertension. Risk was increased in males, patients of Asian ethnicity, those in more deprived areas, obese patients, and smokers. The final developed model had good predictive performance (external validation c-statistic 0.81, calibration slope 1.02). A model using a subset of key risk factors for cardiovascular disease gave nearly identical performance. QRISK3 underestimated cardiovascular risk.<br /><b>Conclusion</b><br />Patients presenting with unattributed chest pain are at increased risk of cardiovascular events. It is feasible to accurately estimate individual risk using routinely recorded information in the primary care record, focusing on a small number of risk factors. Patients at highest risk could be targeted for preventative measures.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 10 Mar 2023; epub ahead of print</small></div>
Jordan KP, Rathod-Mistry T, van der Windt DA, Bailey J, ... Kyriacou T, Mamas MA
Eur J Prev Cardiol: 10 Mar 2023; epub ahead of print | PMID: 36895179
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<div><h4>Prospective relationship between occupational physical activity and risk of ischemic heart disease - are men and women differently affected?</h4><i>Allesøe K, Aadahl M, Jacobsen RK, Kårhus LL, Mortensen OS, Korshøj M</i><br /><b>Background</b><br />High occupational physical activity (OPA) seems to increase risk of CVD among men. However, findings are mixed, and it is not known if women are differently affected.<br /><b>Aims</b><br />To investigate the relationship between OPA and risk for ischemic heart disease (IHD), and whether it differs across sex.<br /><b>Methods</b><br />A prospective cohort study based on 1,399 women and 1,706 men, aged 30-61 years, participating in the Danish Monica 1 study in 1982-84, actively employed, without prior IHD and answering an OPA question. Information on incidence of IHD, before and during the 34-years follow-up, was retrieved by individual linkage to the Danish National Patient Registry. Cox proportional hazards models were used to investigate the association between OPA and IHD.<br /><b>Results</b><br />Compared to women with sedentary work, women in all other OPA categories had lower hazard ratio (HR) for IHD. Among men, the risk of IHD was 22% higher among those with light OPA, and 42% and 46% higher among those with moderate OPA with some lifting or strenuous work with heavy lifting, respectively, compared to men with sedentary OPA. Compared to women with sedentary work, HR for IHD was higher among men in all OPA categories. There was statistically significant interaction between OPA and sex.<br /><b>Conclusion</b><br />Demanding or strenuous OPA seems to be a risk factor for IHD among men, whereas a higher level of OPA seems to protect from IHD among women. This emphasizes the importance of taking sex-differences into account in studies of health effects of OPA.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 08 Mar 2023; epub ahead of print</small></div>
Allesøe K, Aadahl M, Jacobsen RK, Kårhus LL, Mortensen OS, Korshøj M
Eur J Prev Cardiol: 08 Mar 2023; epub ahead of print | PMID: 36883915
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This program is still in alpha version.