Journal: Eur J Prev Cardiol

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Abstract

Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community.

Sawada N, Nakanishi K, Daimon M, Yoshida Y, ... Homma S, Komuro I
Aims
Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain.
Methods
We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS).
Results
Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were -19.1 ± 3.0% and -25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS ( = 0.46 and  = 0.15, both  < 0.01) and RVLS ( = 0.38 and  = 0.12, both  < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both  < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS ( = -0.34,  < 0.001) and RVLS ( = -0.25,  < 0.001), although it lost statistical significance following multivariable adjustment.
Conclusion
In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.



Eur J Prev Cardiol: 29 Nov 2020; 27:2006-2015
Sawada N, Nakanishi K, Daimon M, Yoshida Y, ... Homma S, Komuro I
Eur J Prev Cardiol: 29 Nov 2020; 27:2006-2015 | PMID: 31795766
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Abstract

Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project.

Wang X, Liu F, Li J, Yang X, ... Wu S, Gu D
Aims
The role of tea consumption in the primary prevention of atherosclerotic cardiovascular disease remains unclear in cohort studies. This prospective cohort study aimed to investigate the associations of tea consumption with the risk of atherosclerotic cardiovascular disease and all-cause mortality.
Methods
We included 100,902 general Chinese adults from the project of Prediction for ASCVD Risk in China (China-PAR) in 15 provinces across China since 1998. Information on tea consumption was collected through standardized questionnaires. Outcomes were identified by interviewing study participants or their proxies, and checking hospital records and/or death certificates. Cox proportional hazard regression models were used to calculate hazard ratios and their corresponding 95% confidence intervals related to tea consumption.
Results
During a median follow-up of 7.3 years, 3683 atherosclerotic cardiovascular disease events, 1477 atherosclerotic cardiovascular disease deaths, and 5479 all-cause deaths were recorded. Compared with never or non-habitual tea drinkers, the hazard ratio and 95% confidence interval among habitual tea drinkers was 0.80 (0.75-0.87), 0.78 (0.69-0.88), and 0.85 (0.79-0.90) for atherosclerotic cardiovascular disease incidence, atherosclerotic cardiovascular disease mortality, and all-cause mortality, respectively. Habitual tea drinkers had 1.41 years longer of atherosclerotic cardiovascular disease-free years and 1.26 years longer of life expectancy at the index age of 50 years. The observed inverse associations were strengthened among participants who kept the habit during the follow-up period.
Conclusion
Tea consumption was associated with reduced risks of atherosclerotic cardiovascular disease and all-cause mortality, especially among those consistent habitual tea drinkers.



Eur J Prev Cardiol: 29 Nov 2020; 27:1956-1963
Wang X, Liu F, Li J, Yang X, ... Wu S, Gu D
Eur J Prev Cardiol: 29 Nov 2020; 27:1956-1963 | PMID: 31914807
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Abstract

Coffee consumption and mortality from cardiovascular diseases and total mortality: Does the brewing method matter?

Tverdal A, Selmer R, Cohen JM, Thelle DS
Aim
The aim of this study was to investigate whether the coffee brewing method is associated with any death and cardiovascular mortality, beyond the contribution from major cardiovascular risk factors.
Methods and results
Altogether, 508,747 men and women aged 20-79 participating in Norwegian cardiovascular surveys were followed for an average of 20 years with respect to cause-specific death. The number of deaths was 46,341 for any cause, 12,621 for cardiovascular disease (CVD), 6202 for ischemic heart disease (IHD), and 2894 for stroke. The multivariate adjusted hazard ratios (HRs) for any death for men with no coffee consumption as reference were 0.85 (082-0.90) for filtered brew, 0.84 (0.79-0.89) for both brews, and 0.96 (0.91-1.01) for unfiltered brew. For women, the corresponding figures were 0.85 (0.81-0.90), 0.79 (0.73-0.85), and 0.91 (0.86-0.96) for filtered, both brews, and unfiltered brew, respectively. For CVD, the figures were 0.88 (0.81-0.96), 0.93 (0.83-1.04), and 0.97 (0.89-1.07) in men, and 0.80 (0.71-0.89), 0.72 (0.61-0.85), and 0.83 (0.74-0.93) in women. Stratification by age raised the HRs for ages ≥60 years. The HR for CVD between unfiltered brew and no coffee was 1.19 (1.00-1.41) for men and 0.98 (0.82-1.15) for women in this age group. The HRs for CVD and IHD were raised when omitting total cholesterol from the model, and most pronounced in those drinking ≥9 of unfiltered coffee, per day where they were raised by 9% for IHD mortality.
Conclusion
Unfiltered brew was associated with higher mortality than filtered brew, and filtered brew was associated with lower mortality than no coffee consumption.



Eur J Prev Cardiol: 29 Nov 2020; 27:1986-1993
Tverdal A, Selmer R, Cohen JM, Thelle DS
Eur J Prev Cardiol: 29 Nov 2020; 27:1986-1993 | PMID: 32320635
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Abstract

Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction.

Mohammadi H, Ohm J, Discacciati A, Sundstrom J, ... Jernberg T, Svensson P
Background
The association between abdominal obesity and recurrent atherosclerotic cardiovascular disease after myocardial infarction remains unknown.
Objective
The purpose of this study was to investigate the prevalence of abdominal obesity and its association with recurrent atherosclerotic cardiovascular disease in patients after a first myocardial infarction.
Design and methods
In this register-based observational cohort, 22,882 patients were identified from the national Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry at a clinical revisit 4-10 weeks after their first myocardial infarction 2005-2014. Patients were followed for recurrent atherosclerotic cardiovascular disease defined as non-fatal myocardial infarction, coronary heart disease death, non-fatal or fatal ischaemic stroke. Univariate and multivariable-adjusted Cox regression models were used to calculate hazard ratios and 95% confidence intervals in quintiles of waist circumference as well as three categories of body mass index including normal weight, overweight and obesity.
Results
The majority of patients had abdominal obesity. During a median follow-up time of 3.8 years, 1232 men (7.3%) and 469 women (7.9%) experienced a recurrent atherosclerotic cardiovascular disease event. In the univariate analysis, risk was elevated in the fifth quintile (hazard ratio 1.22, 95% confidence interval 1.07-1.39) compared with the first. In the multivariable-adjusted analysis, risk was elevated in the fourth and fifth quintiles (hazard ratio 1.21, confidence interval 1.03-1.43 and hazard ratio 1.25, confidence interval 1.04-1.50), respectively. Gender-stratified analyses showed similar associations in men, while U-shaped associations were observed in women and the body mass index analyses.
Conclusions
Abdominal obesity was common in post-myocardial infarction patients and larger waist circumference was independently associated with recurrent atherosclerotic cardiovascular disease, particularly in men. We recommend utilising waist circumference to identify patients at increased risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction.



Eur J Prev Cardiol: 29 Nov 2020; 27:1944-1952
Mohammadi H, Ohm J, Discacciati A, Sundstrom J, ... Jernberg T, Svensson P
Eur J Prev Cardiol: 29 Nov 2020; 27:1944-1952 | PMID: 31958380
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Abstract

Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

Pulipati VP, Ravi V, Pulipati P
Background
Glucagon-like peptide-1 receptor agonists (GLP1RAs) are relatively newer anti-hyperglycemic agents, which have demonstrated cardiovascular benefits in patients with type 2 diabetes mellitus.
Design
We performed a meta-analysis of randomized controlled trials to evaluate the cardiovascular outcomes of GLP1RAs compared to placebo in type 2 diabetes mellitus patients. We performed an additional subgroup analysis to evaluate the role of GLP1RAs in patients with chronic kidney disease.
Methods
MEDLINE, Cochrane and ClinicalTrials.gov databases were searched from inception to 15 July 2019. The authors extracted relevant information from articles and independently assessed the study quality.
Results
Compared to placebo, GLP1RAs demonstrated a significant reduction in all-cause mortality (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.82-0.95;  < 0.001), cardiovascular mortality (OR 0.88, 95% CI 0.81-0.96;  = 0.004), primary composite endpoint (OR 0.86, 95% CI 0.80-0.91;  < 0.001) and non-fatal stroke (OR 0.86, 95% 0.77-0.95;  = 0.004). There was no statistical difference in non-fatal myocardial infarction (OR 0.92, 95% CI 0.83-1.01;  = 0.09). In subgroup analyses of patients with estimated glomerular filtration rate less than 60 ml/min/1.73 m and less than 30 ml/min/1.73 m, there was no significant difference in the primary composite endpoint.
Conclusions
GLP1RAs demonstrated a significant reduction in all-cause mortality, cardiovascular mortality, primary composite endpoint and non-fatal stroke in patients with type 2 diabetes mellitus. There was no significant difference in the primary composite endpoint in patients with type 2 diabetes mellitus and chronic kidney disease.



Eur J Prev Cardiol: 29 Nov 2020; 27:1922-1930
Pulipati VP, Ravi V, Pulipati P
Eur J Prev Cardiol: 29 Nov 2020; 27:1922-1930 | PMID: 32089007
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Abstract

Association between insulin resistance and risk of atrial fibrillation in non-diabetics.

Lee Y, Cha SJ, Park JH, Shin JH, ... Kim CK, Park JK
Aims
Previous studies from Western countries have been unable to demonstrate a relationship between insulin resistance and new-onset atrial fibrillation. We aimed to evaluate this relationship in the nondiabetic Asian population.
Methods
Between 2001-2003, 8175 adults (mean age 51.5 years, 53% women) without both existing atrial fibrillation and diabetes and with insulin resistance measures at baseline were enrolled and were followed by biennial electrocardiograms thereafter until 2014. We constructed multivariable-adjusted Cox proportional hazard models for risk of incident atrial fibrillation.
Results
Over a median follow-up of 12.3 years, 136 participants (1.89/1000 person-years) developed atrial fibrillation. Higher homeostasis model assessment of insulin resistance (HOMA-IR) was independently associated with newly developed atrial fibrillation (hazard ratio 1.61, 95% confidence interval 1.14-2.28). Atrial fibrillation development increased at the HOMA-IR levels approximately between 1-2.5, and then plateaued afterwards ( = 0.031).
Conclusion
There is a significant relationship between insulin resistance and atrial fibrillation development independent of other known risk factors, including obesity in a nondiabetic Asian population.



Eur J Prev Cardiol: 29 Nov 2020; 27:1934-1941
Lee Y, Cha SJ, Park JH, Shin JH, ... Kim CK, Park JK
Eur J Prev Cardiol: 29 Nov 2020; 27:1934-1941 | PMID: 32122201
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Abstract

The Moderate Alcohol and Cardiovascular Health Trial (MACH15): Design and methods for a randomized trial of moderate alcohol consumption and cardiometabolic risk.

Spiegelman D, Lovato LC, Khudyakov P, Wilkens TL, ... Williamson JD, Mukamal KJ
Background
Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations.
Aim
The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older.
Methods
This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11-15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide >80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer.
Results
We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals.
Conclusions
We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines.



Eur J Prev Cardiol: 29 Nov 2020; 27:1967-1982
Spiegelman D, Lovato LC, Khudyakov P, Wilkens TL, ... Williamson JD, Mukamal KJ
Eur J Prev Cardiol: 29 Nov 2020; 27:1967-1982 | PMID: 32250171
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Abstract

Added sugar intake is associated with pericardial adipose tissue volume.

Yi SY, Steffen LM, Terry JG, R Jacobs D, ... Harnack L, J Carr J
Aim
The purpose of this study was to determine the relationships of pericardial adipose tissue and visceral adipose tissue volume with added sugar and sugar-sweetened beverage intakes. We hypothesized that both added sugar and sugar-sweetened beverages were positively associated with pericardial adipose tissue and visceral adipose tissue volumes in black and white men and women enrolled in the prospective Coronary Artery Risk Development in Young Adults study.
Methods and results
Dietary intake was assessed by diet history at baseline, year 7 and year 20 examinations in 3070 participants aged 18-30 and generally healthy at baseline. After 25 years follow-up, participants underwent a computed tomography scan of chest and abdomen; the computed tomography scans were read, and pericardial adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue volumes were calculated. Quintiles were created for the average of baseline, year 7 and year 20 added sugar and for the average of sugar-sweetened beverages. General linear regression analysis evaluated the associations of pericardial adipose tissue and visceral adipose tissue volumes across quintiles of added sugar and across quintiles of sugar-sweetened beverage intakes adjusted for potential confounding factors. In a multivariable model, pericardial adipose tissue volume was higher across increasing quintiles of added sugar and sugar-sweetened beverage intakes ( = 0.001 and  < 0.001, respectively). A similar relation was observed for visceral adipose tissue ( < 0.001 for both added sugar and sugar-sweetened beverages).
Conclusions
Long-term intakes of added sugar and sugar-sweetened beverages were associated with higher pericardial adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue volumes. Because these ectopic fat depots are associated with greater risk of disease incidence, these findings support limiting intakes of added sugar and sugar-sweetened beverages.



Eur J Prev Cardiol: 29 Nov 2020; 27:2016-2023
Yi SY, Steffen LM, Terry JG, R Jacobs D, ... Harnack L, J Carr J
Eur J Prev Cardiol: 29 Nov 2020; 27:2016-2023 | PMID: 32594762
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Abstract

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation.

Masoudkabir F, Yavari N, Pashang M, Sadeghian S, ... Mortazavi SH, Karimi A
Background
A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting.
Methods
The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers ( = 23,619), persistent postoperative opium consumers ( = 3636) and enduring postoperative opium withdrawal ( = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation.
Results
After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06-1.54;  = 0.009) and 25% (HR 1.25, 95% CI 1.13-1.40;  < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16-1.55;  < 0.0001).
Conclusions
The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.



Eur J Prev Cardiol: 29 Nov 2020; 27:1996-2003
Masoudkabir F, Yavari N, Pashang M, Sadeghian S, ... Mortazavi SH, Karimi A
Eur J Prev Cardiol: 29 Nov 2020; 27:1996-2003 | PMID: 32673508
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Abstract

Predictors of pre-rehabilitation exercise capacity in elderly European cardiac patients - The EU-CaRE study.

Marcin T, Eser P, Prescott E, Mikkelsen N, ... de Kluiver EP, Wilhelm M
Aims
Functional capacity is an important endpoint for therapies oriented to older adults with cardiovascular diseases. The literature on predictors of exercise capacity is sparse in the elderly population. In a longitudinal European study on effectiveness of cardiac rehabilitation of seven European countries in elderly (>65 years) coronary artery disease or valvular heart disease patients, predictors for baseline exercise capacity were determined, and reference ranges for elderly cardiac patients provided.
Methods
Mixed models were performed in 1282 patients (mean age 72.9 ± 5.4 years, 79% male) for peak oxygen consumption relative to weight (peak VO; ml/kg per min) with centre as random factor and patient anthropometric, demographic, social, psychological and nutritional parameters, as well as disease aetiology, procedure, comorbidities and cardiovascular risk factors as fixed factors.
Results
The most important predictors for low peak VO were coronary artery bypass grafting or valve surgery, low resting forced expiratory volume, reduced left ventricular ejection fraction, nephropathy and peripheral arterial disease. Each cumulative comorbidity or cardiovascular risk factors reduced exercise capacity by 1.7 ml/kg per min and 1.1 ml/kg per min, respectively. Males had a higher peak VO per body mass but not per lean mass. Haemoglobin was significantly linked to peak VO in both surgery and non-surgery patients.
Conclusions
Surgical procedures, cumulative comorbidities and cardiovascular risk factors were the factors with the strongest relation to reduced exercise capacity in the elderly. Expression of peak VO per lean mass rather than body mass allows a more appropriate comparison between sexes. Haemoglobin is strongly related to peak VO and should be considered in studies assessing exercise capacity, especially in studies on patients after cardiac surgery.



Eur J Prev Cardiol: 30 Oct 2020; 27:1702-1712
Marcin T, Eser P, Prescott E, Mikkelsen N, ... de Kluiver EP, Wilhelm M
Eur J Prev Cardiol: 30 Oct 2020; 27:1702-1712 | PMID: 31852300
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Abstract

High-intensity interval training is effective and superior to moderate continuous training in patients with heart failure with preserved ejection fraction: A randomized clinical trial.

Donelli da Silveira A, Beust de Lima J, da Silva Piardi D, Dos Santos Macedo D, ... Laukkanen JA, Stein R
Background
Heart failure with preserved ejection fraction (HFpEF) is a prevalent syndrome, with exercise intolerance being one of its hallmarks, contributing to worse quality of life and mortality. High-intensity interval training is an emerging training option, but its efficacy in HFpEF patients is still unknown.
Design
Single-blinded randomized clinical trial.
Methods
Single-blinded randomized clinical trial with exercise training 3 days per week for 12 weeks. HFpEF patients were randomly assigned to high-intensity interval training or moderate continuous training. At baseline and after 12 week follow-up, patients underwent clinical assessment, echocardiography and cardiopulmonary exercise testing (CPET).
Results
Mean age was 60 ± 9 years and 63% were women. Both groups ( = 19) showed improved peak oxygen consumption (VO), but high-intensity interval training patients ( = 10) had a significantly higher increase, of 22%, compared with 11% in the moderate continuous training ( = 9) individuals (3.5 (3.1 to 4.0) . 1.9 (1.2 to 2.5) mL·kg·min,  < 0.001). Ventilatory efficiency and other CPET measures, as well as quality of life score, increased equally in the two groups. Left ventricular diastolic function also improved with training, reflected by a significant reduction in E/e\' ratio by echocardiography (-2.6 (-4.3 to -1.0) . -2.2 (-3.6 to -0.9) for high-intensity interval training and moderate continuous training, respectively;  < 0.01). There were no exercise-related adverse events.
Conclusions
This randomized clinical trial provided evidence that high-intensity interval training is a potential exercise modality for HFpEF patients, being more effective than moderate continuous training in improving peak VO. However, the two strategies were equally effective in improving ventilatory efficiency and other CPET parameters, quality of life score and diastolic function after 3 months of training.



Eur J Prev Cardiol: 30 Oct 2020; 27:1733-1743
Donelli da Silveira A, Beust de Lima J, da Silva Piardi D, Dos Santos Macedo D, ... Laukkanen JA, Stein R
Eur J Prev Cardiol: 30 Oct 2020; 27:1733-1743 | PMID: 31964186
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Abstract

Heart failure is a common complication after acute myocardial infarction in patients with diabetes: A nationwide study in the SWEDEHEART registry.

Ritsinger V, Nyström T, Saleh N, Lagerqvist B, Norhammar A
Background
Several glucose lowering drugs with preventive effects on heart failure and death have entered the market, however, still used in low proportions after acute myocardial infarction. We explored the complication rates of heart failure and death after acute myocardial infarction in patients with and without diabetes.
Methods
All patients ( = 73,959) with acute myocardial infarction admitted for coronary angiography included in the SWEDEHEART registry during the years 2012-2017 were followed for heart failure (until 31 December 2017) and mortality (until 30 June 2018); mean follow-up time 1223 (SD ± 623) days.
Results
Mean age was 69 years (SD ± 12), 69% were male and 24% had diabetes. Heart failure occurred more often in diabetes (22% . 12% if no diabetes), especially if previous MI (33% vs. 23%). Patients with diabetes had increased risk of HF regardless of previous myocardial infarction (MI); with previous MI adjusted hazard ratio 2.09 (95% confidence interval 1.96-2.20) and without MI 1.52 (1.44-1.61) respectively when non-diabetes patients with first MI served as reference. In patients with no previous heart failure or MI and discharged with left ventricular ejection fraction ≥50% the risk of heart failure was particularly high in those with diabetes (1.56; 1.39-1.76) when compared with those without. Similar findings were seen for death and combined event (heart failure and death).
Conclusions
Heart failure is a common complication after acute myocardial infarction in diabetes, increasing the risk by 50-60% regardless of previous heart failure or MI. This risk is present even with normal reported left ventricular ejection fraction, indicating the existence of a large diabetes population at heart failure risk after acute myocardial infarction.



Eur J Prev Cardiol: 30 Oct 2020; 27:1890-1901
Ritsinger V, Nyström T, Saleh N, Lagerqvist B, Norhammar A
Eur J Prev Cardiol: 30 Oct 2020; 27:1890-1901 | PMID: 32019365
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Abstract

Exercise intolerance and fatigue in chronic heart failure: is there a role for group III/IV afferent feedback?

Angius L, Crisafulli A

Exercise intolerance and early fatiguability are hallmark symptoms of chronic heart failure. While the malfunction of the heart is certainly the leading cause of chronic heart failure, the patho-physiological mechanisms of exercise intolerance in these patients are more complex, multifactorial and only partially understood. Some evidence points towards a potential role of an exaggerated afferent feedback from group III/IV muscle afferents in the genesis of these symptoms. Overactivity of feedback from these muscle afferents may cause exercise intolerance with a double action: by inducing cardiovascular dysregulation, by reducing motor output and by facilitating the development of central and peripheral fatigue during exercise. Importantly, physical inactivity appears to affect the progression of the syndrome negatively, while physical training can partially counteract this condition. In the present review, the role played by group III/IV afferent feedback in cardiovascular regulation during exercise and exercise-induced muscle fatigue of healthy people and their potential role in inducing exercise intolerance in chronic heart failure patients will be summarised.



Eur J Prev Cardiol: 30 Oct 2020; 27:1862-1872
Angius L, Crisafulli A
Eur J Prev Cardiol: 30 Oct 2020; 27:1862-1872 | PMID: 32046526
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Abstract

Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II).

Salzwedel A, Jensen K, Rauch B, Doherty P, ... Schmid JP, Davos CH
Background
Despite numerous studies and meta-analyses the prognostic effect of cardiac rehabilitation is still under debate. This update of the Cardiac Rehabilitation Outcome Study (CROS II) provides a contemporary and practice focused approach including only cardiac rehabilitation interventions based on published standards and core components to evaluate cardiac rehabilitation delivery and effectiveness in improving patient prognosis.
Design
A systematic review and meta-analysis.
Methods
Randomised controlled trials and retrospective and prospective controlled cohort studies evaluating patients after acute coronary syndrome, coronary artery bypass grafting or mixed populations with coronary artery disease published until September 2018 were included.
Results
Based on CROS inclusion criteria out of 7096 abstracts six additional studies including 8671 patients were identified (two randomised controlled trials, two retrospective controlled cohort studies, two prospective controlled cohort studies). In total, 31 studies including 228,337 patients were available for this meta-analysis (three randomised controlled trials, nine prospective controlled cohort studies, 19 retrospective controlled cohort studies; 50,653 patients after acute coronary syndrome 14,583, after coronary artery bypass grafting 163,101, mixed coronary artery disease populations; follow-up periods ranging from 9 months to 14 years). Heterogeneity in design, cardiac rehabilitation delivery, biometrical assessment and potential confounders was considerable. Controlled cohort studies showed a significantly reduced total mortality (primary endpoint) after cardiac rehabilitation participation in patients after acute coronary syndrome (prospective controlled cohort studies: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20-0.69; retrospective controlled cohort studies HR 0.64, 95% CI 0.53-0.76; prospective controlled cohort studies odds ratio 0.20, 95% CI 0.08-0.48), but the single randomised controlled trial fulfilling the CROS inclusion criteria showed neutral results. Cardiac rehabilitation participation was also associated with reduced total mortality in patients after coronary artery bypass grafting (retrospective controlled cohort studies HR 0.62, 95% CI 0.54-0.70, one single randomised controlled trial without fatal events), and in mixed coronary artery disease populations (retrospective controlled cohort studies HR 0.52, 95% CI 0.36-0.77; two out of 10 controlled cohort studies with neutral results).
Conclusion
CROS II confirms the effectiveness of cardiac rehabilitation participation after acute coronary syndrome and after coronary artery bypass grafting in actual clinical practice by reducing total mortality under the conditions of current evidence-based coronary artery disease treatment. The data of CROS II, however, underscore the urgent need to define internationally accepted minimal standards for cardiac rehabilitation delivery as well as for scientific evaluation.



Eur J Prev Cardiol: 30 Oct 2020; 27:1756-1774
Salzwedel A, Jensen K, Rauch B, Doherty P, ... Schmid JP, Davos CH
Eur J Prev Cardiol: 30 Oct 2020; 27:1756-1774 | PMID: 32089005
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Abstract

Cardiac rehabilitation of elderly patients in eight rehabilitation units in western Europe: Outcome data from the EU-CaRE multi-centre observational study.

Prescott E, Eser P, Mikkelsen N, Holdgaard A, ... Van\'t Hof AW, de Kluiver EP
Aims
The European Cardiac Rehabilitation in the Elderly (EU-CaRE) HORIZON 2020 project compares the sustainable effects of cardiac rehabilitation (CR) in elderly patients.
Methods and results
A total of 1633 patients with coronary artery disease (CAD) or heart valve replacement (HVR), with or without revascularization, aged 65 or above, who participated in CR were included. Peak oxygen uptake (VO), smoking, body mass index, diet, physical activity, serum lipids, psychological distress and medication were assessed before and after CR (T0 and T1) and after 12 months (T2). Patients undergoing coronary artery bypass surgery or surgical HVR had lower VO at T0 and a greater increase to T1 and T2 (2.8 and 4.4 ml/kg/min, respectively) than CAD patients undergoing percutaneous or no revascularization (1.6 and 1.4 ml/kg/min, respectively). After multivariable adjustment, earlier CR uptake was associated with greater improvements in VO. The proportion of CAD patients with three or more uncontrolled risk factors declined from 58.4% at T0 to 40.1% at T2 ( < 0.0001). Psychological distress scores all improved and adherence to medication was overall good at all sites. There were significant differences in risk factor burden across sites, but no CR program was superior to others.
Conclusions
The outcomes of VO in CR programs across Europe seemed mainly determined by timing of uptake and were maintained or even further improved at 1-year follow-up. Despite significant improvements, 40.1% of CAD patients still had three or more risk factors not at target after 1 year. Differences across sites could not be ascribed to characteristics of the CR programs offered.



Eur J Prev Cardiol: 30 Oct 2020; 27:1716-1729
Prescott E, Eser P, Mikkelsen N, Holdgaard A, ... Van't Hof AW, de Kluiver EP
Eur J Prev Cardiol: 30 Oct 2020; 27:1716-1729 | PMID: 32102550
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Abstract

Long-term follow-up with a smartphone application improves exercise capacity post cardiac rehabilitation: A randomized controlled trial.

Lunde P, Bye A, Bergland A, Grimsmo J, Jarstad E, Nilsson BB
Background
Mobile health interventions, especially smartphone applications (apps), have been proposed as promising interventions for supporting adherence to healthy behaviour in patients post cardiac rehabilitation (CR). The overall aim of the study was to examine the effect of individualized follow-up with an app for one year on peak oxygen uptake (VO) in patients completing CR.
Design
The study was designed as a single-blinded multicentre randomized controlled trial.
Methods
The intervention group (IG) received individualized follow-up enabled with an app for one year, while the control group (CG) received usual care. The primary outcome was difference in VO. Secondary outcomes included exercise performance (time to exhaustion, peak incline (%) and peak velocity (km/h)), bodyweight, resting blood pressure, lipid profile, triglycerides, exercise habits, health-related quality of life, health status and self-perceived goal achievement.
Results
In total, 113 patients completing CR (73.4% with coronary artery disease, 16.8% after valve surgery and 9.8% with other heart diseases) were randomly allocated to the IG or CG. Intention to treat analyses showed a statistically significant difference in VO between the groups at follow-up of 2.2 ml/kg/min, 95% confidence interval 0.9-3.5 ( < 0.001). Statistically significant differences were also observed in exercise performance, exercise habits and in self-perceived goal achievement.
Conclusions
Individualized follow-up for one year with an app significantly improved VO, exercise performance and exercise habits, as well as self-perceived goal achievement, compared with a CG in patients post-CR. There were no statistically significant differences between the groups at follow-up in the other outcome measures evaluated.



Eur J Prev Cardiol: 30 Oct 2020; 27:1782-1792
Lunde P, Bye A, Bergland A, Grimsmo J, Jarstad E, Nilsson BB
Eur J Prev Cardiol: 30 Oct 2020; 27:1782-1792 | PMID: 32106713
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Abstract

Quantifying the impact of delayed delivery of cardiac rehabilitation on patients\' health.

Hinde S, Harrison A, Bojke L, Doherty P
Background
Despite its role as an effective intervention to improve the long-term health of patients with cardiovascular disease and existence of national guidelines on timeliness, many health services still fail to offer cardiac rehabilitation in a timely manner after referral. The impact of this failure on patient health and the additional burden on healthcare providers in an English setting is quantified in this article.
Methods
Two logistic regressions are conducted, using the British Heart Foundation National Audit of Cardiac Rehabilitation dataset, to estimate the impact of delayed cardiac rehabilitation initiation on the level of uptake and completion. The results of these regressions are applied to a decision model to estimate the long-term implications of these factors on patient health and National Health Service expenditure.
Results
We demonstrate that the failure of 43.6% of patients in England to start cardiac rehabilitation within the recommended timeframe results in a 15.3% reduction in uptake, and 7.4% in completion. These combine to cause an average lifetime loss of 0.08 years of life expectancy per person. Scaled up to an annual cohort this implies 10,753 patients not taking up cardiac rehabilitation due to the delay, equating to a loss of 3936 years of life expectancy. We estimate that an additional £12.3 million of National Health Service funding could be invested to alleviate the current delay.
Conclusions
The current delay in many patients starting cardiac rehabilitation is causing quantifiable and avoidable harm to their long-term health; policy and research must now look at both supply and demand solutions in tackling this issue.



Eur J Prev Cardiol: 30 Oct 2020; 27:1775-1781
Hinde S, Harrison A, Bojke L, Doherty P
Eur J Prev Cardiol: 30 Oct 2020; 27:1775-1781 | PMID: 32212842
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Abstract

Subclinical progression of systemic sclerosis-related cardiomyopathy.

Stronati G, Manfredi L, Ferrarini A, Zuliani L, ... Gabrielli A, Guerra F
Aims
Cardiac involvement in patients with systemic sclerosis (SSc) is frequent and represents a negative prognostic factor. Recent studies have described subclinical heart involvement of both the right ventricle (RV) and left ventricle (LV) via speckle-tracking-derived global longitudinal strain (GLS). It is currently unknown if SSc-related cardiomyopathy progresses through time. Our aim was to assess the progression of subclinical cardiac involvement in patients with SSc via speckle-tracking-derived GLS.
Methods
This was a prospective longitudinal study enrolling 72 consecutive patients with a diagnosis of SSc and no structural heart disease nor pulmonary hypertension. A standard echocardiographic exam and GLS calculations were performed at baseline and at follow-up.
Results
Traditional echocardiographic parameters did not differ from baseline to 20-month follow-up. LV GLS, despite being already impaired at baseline, worsened significantly during follow-up (from -19.8 ± 3.5% to -18.7 ± 3.5%,  = .034). RV GLS impairment progressed through the follow-up period (from -20.9 ± 6.1% to -18.7 ± 5.4%,  = .013). The impairment was more pronounced for the endocardial layers of both LV (from -22.5 ± 3.9% to -21.4 ± 3.9%,  = .041) and RV (-24.2 ± 6.2% to -20.6 ± 5.9%,  = .001). A 1% worsening in RV GLS was associated with an 18% increased risk of all-cause death or major cardiovascular event ( = .03) and with a 55% increased risk of pulmonary hypertension ( = .043).
Conclusion
SSC-related cardiomyopathy progresses over time and can be detected by speckle-tracking GLS. The highest progression towards reduced deformation was registered for the endocardial layers, which supports the hypothesis that microvascular dysfunction is the main determinant of heart involvement in SSc patients and starts well before overt pulmonary hypertension.



Eur J Prev Cardiol: 30 Oct 2020; 27:1876-1886
Stronati G, Manfredi L, Ferrarini A, Zuliani L, ... Gabrielli A, Guerra F
Eur J Prev Cardiol: 30 Oct 2020; 27:1876-1886 | PMID: 32306757
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Abstract

Improvements in exercise capacity of older adults during cardiac rehabilitation.

Bierbauer W, Scholz U, Bermudez T, Debeer D, ... Schmid JP, Hermann M
Aims
Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity.
Method
A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance.
Results
Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen\'s d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes.
Conclusion
As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients\' age and sex.



Eur J Prev Cardiol: 30 Oct 2020; 27:1747-1755
Bierbauer W, Scholz U, Bermudez T, Debeer D, ... Schmid JP, Hermann M
Eur J Prev Cardiol: 30 Oct 2020; 27:1747-1755 | PMID: 32321285
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Impact:

This program is still in alpha version.