Journal: Eur J Prev Cardiol

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Abstract

The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank.

Chieng D, Canovas R, Segan L, Sugumar H, ... Kalman JM, Kistler PM
Aims
Epidemiological studies report the beneficial effects of habitual coffee consumption on incident arrhythmia, cardiovascular disease (CVD), and mortality. However, the impact of different coffee preparations on cardiovascular outcomes and survival is largely unknown. The aim of this study was to evaluate associations between coffee subtypes on incident outcomes, utilizing the UK Biobank.
Methods and results
Coffee subtypes were defined as decaffeinated, ground, and instant, then divided into 0, <1, 1, 2-3, 4-5, and >5 cups/day, and compared with non-drinkers. Cardiovascular disease included coronary heart disease, cardiac failure, and ischaemic stroke. Cox regression modelling with hazard ratios (HRs) assessed associations with incident arrhythmia, CVD, and mortality. Outcomes were determined through ICD codes and death records. A total of 449 563 participants (median 58 years, 55.3% females) were followed over 12.5 ± 0.7 years. Ground and instant coffee consumption was associated with a significant reduction in arrhythmia at 1-5 cups/day but not for decaffeinated coffee. The lowest risk was 4-5 cups/day for ground coffee [HR 0.83, confidence interval (CI) 0.76-0.91, P < 0.0001] and 2-3 cups/day for instant coffee (HR 0.88, CI 0.85-0.92, P < 0.0001). All coffee subtypes were associated with a reduction in incident CVD (the lowest risk was 2-3 cups/day for decaffeinated, P = 0.0093; ground, P < 0.0001; and instant coffee, P < 0.0001) vs. non-drinkers. All-cause mortality was significantly reduced for all coffee subtypes, with the greatest risk reduction seen with 2-3 cups/day for decaffeinated (HR 0.86, CI 0.81-0.91, P < 0.0001); ground (HR 0.73, CI 0.69-0.78, P < 0.0001); and instant coffee (HR 0.89, CI 0.86-0.93, P < 0.0001).
Conclusion
Decaffeinated, ground, and instant coffee, particularly at 2-3 cups/day, were associated with significant reductions in incident CVD and mortality. Ground and instant but not decaffeinated coffee was associated with reduced arrhythmia.

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

Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print
Chieng D, Canovas R, Segan L, Sugumar H, ... Kalman JM, Kistler PM
Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print | PMID: 36162818
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Abstract

REPRODUCIBILITY OF VENTRICULAR ARRHYTHMIAS AT EXERCISE TESTING FOR PREDICTION OF NON-ISCHEMIC LEFT VENTRICULAR SCAR IN ATHLETES.

Brunetti G, Graziano F, Cavigli L, Cipriani A, ... Corrado D, Zorzi A
Introduction
The non-ischemic left ventricular scar (NILVS) is an emerging substrate of ventricular arrhythmias (VA) in the athlete. We tested the diagnostic value of VA reproducibility at repeated exercise testing (ET).
Methods
We included consecutive athletes who underwent CMR for evaluation of VA and two consecutive ET off-therapy within 12 months. Those with positive family history for premature sudden death/cardiomyopathy, syncope/pre-syncope, ECG or echocardiography abnormalities or low-risk VA (exercise-suppressed infundibular or fascicular VA) were excluded. The NILVS was defined as subepicardial/midmyocardial stria of late gadolinium enhancement involving >5% of the LV mass. Reproducibility was defined as the occurrence of VA with the same pattern and behaviour during repeated ET.
Results
Of 325 athletes who underwent CMR for evaluation of VA, 75 were included, and 30 showed NILVS involving 3 [2-4] LV segments. At first ET, athletes with NILVS showed a higher prevalence of exercise-induced VA (93% versus 53%, p<0.001), while other VA characteristics did not differ between groups. At repeated ET, reproducibility was observed in 97% of athletes versus 13% without NILVS (p<0.001). Reproducibility yielded a positive predictive value of 83% and negative predictive value of 98%. The remaining 87% of athletes with normal CMR either did not show any VA at repeated ET (59%) or showed arrhythmias with different patterns, mostly infundibular.
Conclusions
VA reproducibility at repeated ET predicted an underlying NILVS in athletes with VA and otherwise normal clinical workup. This finding may improve risk stratification and appropriate CMR referral of athletes with apparently idiopathic VA.

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

Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print
Brunetti G, Graziano F, Cavigli L, Cipriani A, ... Corrado D, Zorzi A
Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print | PMID: 36166397
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Abstract

Discordance of Apolipoprotein B with Low-Density Lipoprotein Cholesterol or Non-High Density Lipoprotein cholesterol and Coronary Atherosclerosis.

Su X, Cai X, Pan Y, Sun J, ... Wei T, He Y
Background
High level of apolipoprotein B (Apo B) is associated with incident subclinical atherosclerosis.
Aim
The present study evaluated the associations between discordant Apo B with low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) and coronary atherosclerotic burden.
Methods
This study enrolled 3,043 participants aged 50-75 years from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study that was conducted in the community in Lishui City, China. Discordant Apo B with LDL-C and non-HDL-C were defined by residuals and medians. Coronary atherosclerotic burden was evaluated by segment involvement score (SIS) and segment stenosis score (SSS) which were determined by computed tomography angiography (CTA). We performed discordance analyses examining associations of discordant Apo B with LDL-C or non-HDL-C with the coronary atherosclerotic burden.
Results
The mean age of participants was 61.2 ± 6.7 years, 53.6% were female. Participants with discordant high Apo B relative to non-HDL-C were at higher odds of plaques (OR: 1.30; 95% CI: 1.08-1.57), SIS [cOR (common odds ratio), 1.35; 95% CI, 1.14-1.60], and SSS (cOR, 1.40; 95% CI, 1.18-1.67) compared with concordant group. However discordantly low Apo B with non-HDL-C was associated with decreased odds of the coronary atherosclerotic plaques and its burden. Similar results were shown for discordant analyses for Apo B with LDL-C.
Conclusions
Discordantly high Apo B with LDL-C and non-HDL-C were associated with an increased odds of the coronary atherosclerotic plaques and its burden. These findings highlighted the importance of Apo B for primary prevention of coronary atherosclerosis.

© The Author(s) 2022. 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.

Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print
Su X, Cai X, Pan Y, Sun J, ... Wei T, He Y
Eur J Prev Cardiol: 27 Sep 2022; epub ahead of print | PMID: 36166398
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Abstract

Projected Impact of Treatment Intensification with Satin, Ezetimibe, and Statin plus Ezetimibe Fixed-Dose Combination on MACE Across Six Countries.

Farnier M, Santos RD, Cosin-Sales J, Ezhov MV, ... Khan I, Catapano AL
Aims
The 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) dyslipidaemia guidelines recommend achievement of low-density-lipoprotein cholesterol (LDL-C) goals based on an individual\'s risk. We aimed to evaluate the impact of guideline adoption with statin, ezetimibe, and statin plus ezetimibe fixed-dose combination (FDC) on LDL-C goal achievement and incidence of major adverse cardiovascular events (MACE) across six countries.
Methods
A simulation model with a 5-year horizon (2020-2024) was developed based on Institute for Health Metrics and Evaluation Global Burden of Disease Study database with a business-as-usual (BAU) scenario representing status-quo, intervention scenario-1 representing treatment with statin and ezetimibe as separate agents, and intervention scenario-2 representing treatment with statin or statin plus ezetimibe FDC. MACE was defined as the composite of myocardial infarction, ischaemic stroke, and cardiovascular death.
Results
The mean population LDL-C was reduced from 4.25 mmol/L in the BAU scenario, to 3.65 mmol/L and 3.59 mmol/L in intervention scenarios-1 and -2, respectively. Compared to BAU, intervention scenarios-1 and -2 resulted in relative reduction of MACE by 5.4% and 6.4% representing approximately 3.7 and 4.4 million MACE averted, respectively, across six countries over 5-years. The absolute benefit in terms of MACE averted was highest for China, while France had highest relative reduction in MACE with both intervention scenarios compared to BAU.
Conclusion
The 2019 ESC/EAS guideline-based treatment intensification with strategies based on statin, ezetimibe, and statin plus ezetimibe FDC is estimated to result in a substantial population-level benefit in terms of MACE averted compared to BAU.

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

Eur J Prev Cardiol: 22 Sep 2022; epub ahead of print
Farnier M, Santos RD, Cosin-Sales J, Ezhov MV, ... Khan I, Catapano AL
Eur J Prev Cardiol: 22 Sep 2022; epub ahead of print | PMID: 36134461
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Abstract

The association between dairy intake and risk of cardiovascular disease and mortality in patients with stable angina pectoris.

Van Parys A, Sæle J, Puaschitz NG, Anfinsen ÅM, ... Nygård OK, Lysne V
Introduction
The association of dairy products with cardiovascular disease and mortality risk remains heavily debated. We aimed to investigate the association between intake of total dairy and dairy products and the risk of acute myocardial infarction (AMI), stroke, and cardiovascular and all-cause mortality.
Methods
We included 1929 patients (80% men, mean age 62 years) with stable angina pectoris from the Western Norway B-vitamin Intervention Trial. Dietary data were obtained via a 169-item food frequency questionnaire. Risk associations were estimated using Cox proportional hazard regression models adjusted for relevant covariates. Non-linear associations were explored visually.
Results
The mean (± SD) dairy intake in the study population was 169 ± 108 g/1000 kcal. Median follow-up times were 5.2, 7.8 and 14.1 years for stroke, AMI, and mortality, respectively. Higher intake of total dairy and milk were positively associated with stroke risk (HR [95%CI]: 1.14 [1.02, 1.27] and 1.13 [1.02, 1.27], cardiovascular mortality (1.06 [1.00, 1.12] and 1.07 [1.01, 1.13]) and all-cause mortality (1.07 [1.03, 1.11] and 1.06 [1.03, 1.10]) per 50 g/1000 kcal. Higher cheese intake was inversely associated with AMI risk (0.92 [0.83, 1.02]) per 10 g/1000 kcal. Butter was associated with increased AMI risk (1.10 [0.97, 1.24]), and all-cause mortality (1.10 [1.00, 1.20] per 5 g/1000 kcal.
Conclusion
Higher dairy and milk consumption were associated with increased risk of mortality and stroke. Cheese was associated with decreased, and butter with increased, risk of AMI. Dairy is a heterogenous food group with divergent health effects and dairy products should therefore be investigated individually.

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

Eur J Prev Cardiol: 22 Sep 2022; epub ahead of print
Van Parys A, Sæle J, Puaschitz NG, Anfinsen ÅM, ... Nygård OK, Lysne V
Eur J Prev Cardiol: 22 Sep 2022; epub ahead of print | PMID: 36134600
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Abstract

How to evaluate resting ECG and imaging in children practising sport: critical review and proposal of an algorithm for ECG interpretation.

Ragazzoni GL, Cavigli L, Cavarretta E, Maffei S, ... Pieles G, D\'Ascenzi F
The athlete\'s heart is a well-known phenomenon in adults practicing competitive sports. Unfortunately, to date, most of the studies on training-induced cardiac remodelling have been conducted in adults and the current recommendations refer mainly to adult individuals. However, an appropriate interpretation of resting ECG and imaging in children practising sports is crucial, given the possibility of early detect life-threatening conditions and managing therapy and eligibility to sports competitions in the rapidly growing paediatric athlete population. While several articles have been published on this topic in adult athletes, a practical guide for the clinical evaluation of pediatric athletes is still missing. In this critical review, we provided a comprehensive description of the current evidence on training-induced remodeling in pediatric athletes with a practical approach for clinicians on how to interpret the resting 12-lead ECG and cardiac imaging in pediatric athlete. Indeed, given that training may mimic potential cardiovascular disorders, clinicians evaluating children practicing sports should pay attention to the risk of missing a diagnosis of a life-threatening condition. However, this risk should be balanced with the risk of overdiagnosis and unwarranted disqualification from sports practice, when interpreting an ECG as pathological while, on the contrary, it may represent a physiological expression of athlete\'s heart. Accordingly, we proposed an algorithm for the evaluation of normal, borderline, and abnormal ECG findings that can be useful for the readers for their daily clinical practice.

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

Eur J Prev Cardiol: 21 Sep 2022; epub ahead of print
Ragazzoni GL, Cavigli L, Cavarretta E, Maffei S, ... Pieles G, D'Ascenzi F
Eur J Prev Cardiol: 21 Sep 2022; epub ahead of print | PMID: 36130334
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Abstract

Cholesterol not particle concentration mediates the atherogenic risk conferred by apolipoprotein B particles - A Mendelian randomization analysis.

Helgadottir A, Thorleifsson G, Snaebjarnarson A, Stefansdottir L, ... Stefansson K, Holm H
Background:
and aims
The causal contribution of apolipoprotein B (apoB) particles to coronary artery disease (CAD) is established. We examined whether this atherogenic contribution is better reflected by non-high density lipoprotein cholesterol (non-HDL-C) or apoB particle concentration.
Method and results
We performed Mendelian randomization (MR) analysis using 235 variants as genetic instruments; testing the relationship between their effects on the exposures, non-HDL-C and apoB, and on the outcome CAD using weighted regression. Variant effect estimates on the exposures came from the UK Biobank (N = 376,336) and on the outcome from a meta-analysis of five CAD data-sets (187,451 cases and 793,315 controls). Subsequently, we carried out sensitivity and replication analyses.In univariate MR analysis both exposures associated with CAD (βnon-HDL-C = 0.40, P = 2.8 × 10-48 and βapoB = 0.38, P = 1.3 × 10-44). Adding effects on non-HDL-C into a model that already included those on apoB significantly improved the genetically predicted CAD effects (P = 3.9 × 10-5), while adding apoB into the model including non-HDL-C did not (P = 0.69). Thirty-five percent (82/235) of the variants used as genetic instruments had discordant effects on the exposures, associating with non-HDL-C/apoB ratio at P < 2.1 × 10-4 (0.05/235). Fifty-one variants associated at genome-wide significance.
Conclusion
Many sequence variants have discordant effects on non-HDL-C and apoB. These variants allowed us to show that the causal mechanism underlying the relationship between apolipoprotein B particles and CAD is more associated with non-HDL-C than apoB particle concentration.

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

Eur J Prev Cardiol: 20 Sep 2022; epub ahead of print
Helgadottir A, Thorleifsson G, Snaebjarnarson A, Stefansdottir L, ... Stefansson K, Holm H
Eur J Prev Cardiol: 20 Sep 2022; epub ahead of print | PMID: 36125206
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Abstract

Randomized trial of cardiovascular prevention in Norway combining an in-hospital lifestyle course with primary care follow-up: The Hjerteløftet Study.

Bergum H, Sandven I, Abdelnoor M, Anderssen SA, ... Dufseth L, Klemsdal TO
Background
Cardiovascular risk factor control is suboptimal in Europe, including Norway. The present study examined the efficacy of a multimodal primary prevention intervention program based on the existing Norwegian health care system.
Methods
In this open-label randomized controlled trial, adult patients with elevated cardiovascular risk were randomly assigned to an intervention program including a hospital-based lifestyle course and primary care follow-up or to a control group. The participants were recruited between 2011 and 2015. Primary outcome was change in validated cardiovascular risk scores (NORRISK, NORRISK 2, Framingham, PROCAM) between baseline and follow-up. Secondary outcomes included major cardiovascular risk factors.
Results
After 36 months the NORRISK score was significantly improved in patients assigned to the intervention group (IG) compared to patients assigned to the control group (CG); absolute difference in mean delta score in the IG (n = 305) compared to mean delta score in the CG (n = 296): -0,92, 95% CI: -1,48 to -0,36, p = 0,001. The results for NORRISK 2, Framingham and PROCAM showed similar significant effects. The secondary endpoints including total cholesterol and blood pressure were only minimally, and non-significantly, reduced in the IG, but the proportion of smokers (p = 0,0028) and with metabolic syndrome (p < 0,0001) were significantly reduced. A limited number of cardiovascular events were observed, IG (n = 9), CG (n = 16).
Conclusions
In subjects with elevated cardiovascular risk, a newly developed prevention program, combining a hospital-based lifestyle course and primary care follow-up, significantly reduced cardiovascular risk scores after 36 months. This benefit appeared achievable primarily through improvements in metabolic syndrome characteristics and smoking habits.

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

Eur J Prev Cardiol: 17 Sep 2022; epub ahead of print
Bergum H, Sandven I, Abdelnoor M, Anderssen SA, ... Dufseth L, Klemsdal TO
Eur J Prev Cardiol: 17 Sep 2022; epub ahead of print | PMID: 36124709
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Abstract

Prenatal Exposure to the Chinese Famine of 1959-1962 and Risk of Cardiovascular Diseases in Adulthood: Findings from the China PEACE Million Persons Project.

Chen C, Nie Z, Wang J, Ou Y, ... Li J, Feng Y
Aims
Much remains unknown about the role of prenatal exposure to environmental stressors in the development of cardiovascular diseases (CVD). The current study aimed to investigate whether exposure to famine early in life was associated with a higher risk of CVD in adulthood.
Methods and results
Among 71667 men and women participated in the Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project in southern China, specific years of birth were used to define two cohorts: the exposed group (born during the famine of 1959-1962) and the non-exposed group (born before the famine [1949-1958] or after the famine [1963-1972]). Multivariable-adjusted generalized linear models were used to examine the associations of famine exposure with the risk of developing CVD, as well as with the 10-year CVD risk defined by well-established risk scores. Compared with the non-famine group, early-life exposure to the Chinese famine was significantly associated with increased risks of total CVD (odds ratio, OR = 1.28, 95% CI: 1.16-1.41), coronary heart disease (OR: 1.23 [1.07-1.41]), acute myocardial infarction (OR: 1.32 [1.01-1.70]), heart failure (OR: 2.01 [1.53-2.60]), and stroke (OR: 1.28 [1.12-1.45]) in adulthood. In those without established CVD, early-life exposure to the famine was associated with higher levels of total cholesterol, systolic blood pressure, waist circumference, risk of diabetes, and therefore 10-year CVD risk.
Conclusion
Early-life exposure to the Chinese famine is associated with an elevated CVD risk later in life, independent of known risk factors.

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

Eur J Prev Cardiol: 14 Sep 2022; epub ahead of print
Chen C, Nie Z, Wang J, Ou Y, ... Li J, Feng Y
Eur J Prev Cardiol: 14 Sep 2022; epub ahead of print | PMID: 36101510
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Abstract

How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology (EAPC).

Pedretti RFE, Hansen D, Ambrosetti M, Back M, ... Wilhelm M, Abreu A
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology (EAPC) clinical consensus document a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.

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

Eur J Prev Cardiol: 13 Sep 2022; epub ahead of print
Pedretti RFE, Hansen D, Ambrosetti M, Back M, ... Wilhelm M, Abreu A
Eur J Prev Cardiol: 13 Sep 2022; epub ahead of print | PMID: 36098041
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Abstract

Frequent vegetable consumption is inversely associated with Hypertension among indigenous Africans.

Akpa OM, Okekunle AP, Asowata OJ, Chikowore T, ... Ramsay M, Owolabi M
Background
The relationship between vegetable consumption and hypertension occurrence remains poorly characterized in sub-Saharan Africa.
Aim
This study assessed the association of vegetable consumption with odds of hypertension among indigenous Africans.
Methods
We harmonized data on prior vegetable consumption and hypertension occurrence (defined as one of the following conditions; systolic blood pressure ≥140 or diastolic blood pressure ≥90mmHg or previous diagnosis or use of antihypertensive medications) from 16,445 participants across five African countries (Nigeria, South Africa, Kenya, Ghana and Burkina Faso) from the SIREN and AWI-Gen studies. Vegetable consumption (in servings/week) was classified as \'low\' (<6). \'moderate\' (6-11), \'sufficient\' (12-29) and \'high\' (≥30). Odds ratios (OR) and 95% confidence interval (CI) of hypertension were estimated by categories of vegetable consumption (using \'low\' consumption as reference), adjusting for sex, age in years, family history of cardiovascular diseases, education, smoking, alcohol use, physical inactivity, body mass index, diabetes mellitus and dyslipidaemia using logistic regressions at P < 0.05.
Results
The mean age of participants was 53·0 (+/-10·7) years, and 7,552 (45·9%) were males, while 7,070 (42·9%) had hypertension. Also, 6,672(40·6%) participants had \'low\' vegetable consumption, and 1,758(10·7%) had \'high\' vegetable consumption. Multivariable-adjusted OR for hypertension by distribution of vegetable consumption (using \'low\' consumption as reference), were 1·03 (95% CI: 0·95, 1·12) for \'moderate\' consumption; 0·80 (0·73, 0·88) for \'sufficient\' and 0·81 (0·72, 0·92) for \'high\' consumption, P-for-trend <0·0001.
Conclusion
Indigenous Africans who consumed at least twelve servings of vegetables per week were less likely to be found hypertensive, particularly among males and young adults.

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

Eur J Prev Cardiol: 13 Sep 2022; epub ahead of print
Akpa OM, Okekunle AP, Asowata OJ, Chikowore T, ... Ramsay M, Owolabi M
Eur J Prev Cardiol: 13 Sep 2022; epub ahead of print | PMID: 36098047
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Abstract

Dose-dependent relationship of blood pressure and glycemic status with risk of aortic dissection and aneurysm.

Suzuki Y, Kaneko H, Yano Y, Okada A, ... Yasunaga H, Komuro I
Aim
Data on the dose-dependent association of blood pressure (BP) and fasting plasma glucose (FPG) level with the risk of aortic dissection (AD) and aortic aneurysm (AA) are limited.
Methods
This observational cohort study included 3,358,293 individuals registered in a health check-up and claims database in Japan (median age, 43 [36-51] years; 57.2% men). Individuals using BP- or glucose-lowering medications or those with a history of cardiovascular disease were excluded.
Results
In a mean follow-up period of 1,199 ± 950 days, 1,095 and 2,177 cases of AD and AA, respectively, were recorded. Compared with normal/elevated BP, HRs of stage 1 and stage 2 hypertension were 1.89 (95% CI:1.60-2.22) and 5.87 (95% CI:5.03-6.84) for AD and 1.37 (95% CI:1.23-1.52) and 2.17 (95% CI:1.95-2.42) for AA, respectively. Compared with normal FPG, HRs of prediabetes and diabetes were 0.82 (95% CI:0.71-0.94) and 0.48 (95% CI:0.33-0.71) for AD and 0.94 (95% CI:0.85-1.03) and 0.61 (95% CI:0.47-0.79) for AA, respectively. The cubic spline demonstrated that the risk of AD and AA increased with increasing BP but decreased with increasing FPG level. Contour plots using generalized additive models showed that higher SBP and lower FPG level were associated with an elevated risk of AD and AA.
Conclusions
Our analysis showed a dose-dependent increase in the risk of AD or AA with BP and a similar decrease associated with FPG, and also suggested a potential interaction between hypertension and hyperglycemia in the development of AD and AA.

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Eur J Prev Cardiol: 09 Sep 2022; epub ahead of print
Suzuki Y, Kaneko H, Yano Y, Okada A, ... Yasunaga H, Komuro I
Eur J Prev Cardiol: 09 Sep 2022; epub ahead of print | PMID: 36082610
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Abstract

New Perspectives for Hypertension Management: Progress in Methodological and Technological Developments.

Parati G, Goncalves A, Soergel D, Bruno RM, ... Santalucia P, Kahan T
Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programs should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimise the use of current BP control strategies including lifestyle-modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control, and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol-reduction programs, encourage physical activity, and target obesity control.

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Eur J Prev Cardiol: 08 Sep 2022; epub ahead of print
Parati G, Goncalves A, Soergel D, Bruno RM, ... Santalucia P, Kahan T
Eur J Prev Cardiol: 08 Sep 2022; epub ahead of print | PMID: 36073370
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Abstract

Indications and utility of cardiac genetic testing in athletes.

Castelletti S, Gray B, Basso C, Behr ER, ... Wilde A, Papadakis M
Sports Cardiology practice commonly involves the evaluation of athletes for genetically determined cardiac conditions that may predispose to malignant arrhythmias, heart failure, and sudden cardiac death. High-level exercise can lead to electrical and structural cardiac remodelling which mimics inherited cardiac conditions (ICCs). Differentiation between \'athlete\'s heart\' and pathology can be challenging and often requires the whole armamentarium of available investigations. Genetic studies over the last 30 years have identified many of the genetic variants that underpin ICCs and technological advances have transformed genetic testing to a more readily available and affordable clinical tool which may aid diagnosis, management, and prognosis. The role of genetic testing in the evaluation and management of athletes with suspected cardiac conditions is often unclear beyond the context of specialist cardio-genetics centres. This document is aimed at physicians, nurses, and allied health professionals involved in the athlete\'s care. With the expanding role and availability of genetic testing in mind, this document was created to address the needs of the broader sports cardiology community, most of whom work outside specialized cardio-genetics centres, when faced with the evaluation and management of athletes with suspected ICC. The first part of the document provides an overview of basic terminology and principles and offers guidance on the appropriate use of genetic testing in the assessment of such athletes. It outlines key considerations when contemplating genetic testing, highlighting the potential benefits and pitfalls, and offers a roadmap to genetic testing. The second part of the document presents common clinical scenarios in Sports Cardiology practice, outlining the diagnostic, prognostic, and therapeutic implications of genetic testing, including impact on exercise recommendations. The scope of this document does not extend to a comprehensive description of the genetic basis, investigation, or management of ICCs.

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

Eur J Prev Cardiol: 07 Sep 2022; 29:1582-1591
Castelletti S, Gray B, Basso C, Behr ER, ... Wilde A, Papadakis M
Eur J Prev Cardiol: 07 Sep 2022; 29:1582-1591 | PMID: 36070487
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Abstract

Sex and age as predictors of HRQOL change in phase-II cardiac rehabilitation.

Jellestada L, Auschraa B, Zuccarella-Hackla C, Principa M, ... Eulera S, Hermannb M
Aims
Cardiac rehabilitation (CR) not only improves cardiovascular outcomes, but also health-related quality of life (HRQOL). Unfortunately, CR is still underutilized, especially among women and older patients. Aim of this study was to highlight age- and sex-specific effects of inpatient CR on HRQOL.
Methods
From 2012 to 2018, 18,459 patients were prospectively assessed in six Swiss CR clinics. Of these, we retrospectively analyzed a final sample of 8\'286 patients with a mean (SD) age of 67.8 (11.3) in men and 72.2 (11.3) in women. HRQOL was measured at CR entry and discharge. In multivariable analyses, sex- and age- specific changes in HRQOL throughout CR were estimated, adjusting for baseline HRQOL and clinical characteristics.
Results
Participants of both sexes improved significantly (p <.001) in all domains of HRQOL during CR. Women reported significantly lower social (p < .001) and emotional (p < .001) HRQOL than men at CR entry. Female sex predicted greater improvement in social (F 19.63, p < .001), emotional (F = 27.814, p < .001) and physical HRQOL (F = 20.473, p < .001). In a subgroup of n= 2\'632 elderly patients (> 75 years) female sex predicted greater changes in emotional (F = 15.738, p < .001) and physical (F = 6.295, p = .012), but not in social HRQOL.
Conclusions
Women report poorer HRQOL at CR entry compared to men, but in turn particularly benefit from CR in this regard. Our results indicate that sex- and age-specific needs of patients should be considered.

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

Eur J Prev Cardiol: 06 Sep 2022; epub ahead of print
Jellestada L, Auschraa B, Zuccarella-Hackla C, Principa M, ... Eulera S, Hermannb M
Eur J Prev Cardiol: 06 Sep 2022; epub ahead of print | PMID: 36065084
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Abstract

Saturated fat: villain and bogeyman in the development of cardiovascular disease?

Valk R, Hammill J, Grip J
Background
Cardiovascular disease (CVD) is the leading global cause of death. For decades, the conventional wisdom has been that the consumption of saturated fat (SFA) undermines cardiovascular health, clogs the arteries, increases risk of CVD and leads to heart attacks. It is timely to investigate whether this claim holds up to scientific scrutiny.
Objectives
The purpose of this paper is to review and discuss recent scientific evidence on the association between dietary SFA and CVD.
Methods
PubMed, Google scholar and Scopus were searched for articles published between 2010 and 2021 on the association between SFA consumption and CVD risk and outcomes. A review was conducted examining observational studies and prospective epidemiologic cohort studies, RCTs, systematic reviews and meta analyses of observational studies and prospective epidemiologic cohort studies and long-term RCTs.
Results
Collectively, neither observational studies, prospective epidemiologic cohort studies, RCTs, systematic reviews and meta analyses have conclusively established a significant association between SFA in the diet and subsequent cardiovascular risk and CAD, MI or mortality nor a benefit of reducing dietary SFAs on CVD rick, events and mortality. Beneficial effects of replacement of SFA by polyunsaturated or monounsaturated fat or carbohydrates remain elusive.
Conclusions
Findings from the studies reviewed in this paper indicate that the consumption of SFA is not significantly associated with CVD risk, events or mortality. Based on the scientific evidence, there is no scientific ground to demonize SFA as a cause of CVD. SFA naturally occurring in nutrient-dense foods can be safely included in the diet.

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

Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print
Valk R, Hammill J, Grip J
Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print | PMID: 36059207
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Abstract

Cardiac screening prior to return to play after SARS-CoV-2 infection: focus on the child and adolescent athlete: A Clinical Consensus Statement of the Task Force for Childhood Health of the European Association of Preventive Cardiology.

D\'Ascenzi F, Castelletti S, Adami PE, Cavarretta E, ... Niebauer J, Halle M
Cardiac sequelae after COVID-19 have been described in athletes, prompting the need to establish a return-to-play (RTP) protocol to guarantee a safe return to sports practice. Sports participation is strongly associated with multiple short- and long-term health benefits in children and adolescents and plays a crucial role in counteracting the psychological and physical effects of the current pandemic. Therefore, RTP protocols should be balanced to promote safe sports practice, particularly after an asymptomatic SARS-CoV-2 infection that represents the common manifestation in children. The present consensus document aims to summarize the current evidence on the cardiac sequelae of COVID-19 in children and young athletes, providing key messages for conducting the RTP protocol in paediatric athletes to promote a safe sports practice during the COVID-19 era.

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

Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print
D'Ascenzi F, Castelletti S, Adami PE, Cavarretta E, ... Niebauer J, Halle M
Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print | PMID: 36059208
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Abstract

PAEDIATRIC FAMILIAL HYPERCHOLESTEROLAEMIA SCREENING IN EUROPE - PUBLIC POLICY BACKGROUND AND RECOMMENDATIONS.

Gidding SS, Wiegman A, Groselj U, Freiberger T, ... Pinto FJ, Geanta M
Familial hypercholesterolaemia (FH) is under-recognized and under-treated in Europe leading to significantly higher risk for premature heart disease in those affected. As treatment beginning early in life is highly effective in preventing heart disease and cost-effective in these patients, screening for FH is crucial. It has therefore now been recognized by the European Commission Public Health Best Practice Portal as an effective strategy. Model programmes exist in Europe to identify young individuals with FH, which are based on cascade screening of first-degree relatives of affected individuals, universal screening for high cholesterol, opportunistic screening of high-risk individuals, or a combination of the above approaches. Recommendations presented herein to improve identification of FH emphasize that every country should have an FH screening programme. These programmes should be adapted from existing strategies to best fit the individual country\'s healthcare system, governments should provide financial support for these programmes and related care, and further research to optimize care and implementations should be conducted.

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

Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print
Gidding SS, Wiegman A, Groselj U, Freiberger T, ... Pinto FJ, Geanta M
Eur J Prev Cardiol: 05 Sep 2022; epub ahead of print | PMID: 36059237
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Abstract

Association of Life\'s Simple 7 with incident cardiovascular disease in 52,956 patients with cancer.

Kaneko H, Suzuki Y, Ueno K, Okada A, ... Yasunaga H, Komuro I
Aims
Cancer survivors have a greater risk of cardiovascular disease (CVD). Although Life\'s Simple 7 is used for CVD risk stratification in a general population, its utility in cancer survivors remains unknown. We aimed to clarify the association of Life\'s Simple 7 with incident CVD among cancer survivors. Furthermore, we analyzed the relationship between the change in Life\'s Simple 7 and the subsequent CVD risk.
Methods
This retrospective observational study was conducted using the JMDC Claims Database, and we analyzed 53,974 patients with a prior history of breast, colorectal, or stomach cancer, which is a common cancer site in the Japanese population. The median age was 54 years, and 37.8% were men. We modified the original definition of Life\'s Simple 7 and identified the following (modified) ideal Life\'s Simple 7 cardiovascular health metrics: nonsmoking, body mass index < 25 kg/m2, physical activity at goal, optimal dietary habits, untreated fasting plasma glucose < 100 mg/dL, untreated blood pressure < 120/80 mmHg, and untreated total cholesterol < 200 mg/dL. The primary endpoint was composite CVD outcome, including myocardial infarction, angina pectoris, stroke, and heart failure.
Results
Over a mean follow-up period of 975 ± 794 days, 3,150 composite CVD outcomes were recorded. The risk of CVD events increased with a greater number of non-ideal Life\'s Simple 7. The hazard ratio per 1-point increase in non-ideal Life\'s Simple 7 was 1.15 (95% CI:1.12-1.18). Furthermore, a 1-point increase in non-ideal Life\'s Simple 7 over one year was associated with subsequent CVD risk (Hazard ratio 1.12, 95% CI:1.06-1.19).
Conclusions
Life\'s Simple 7 could be applicable for CVD risk stratification even among cancer survivors. Optimizing Life\'s Simple 7 may prevent the development of CVD in cancer survivors.

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

Eur J Prev Cardiol: 03 Sep 2022; epub ahead of print
Kaneko H, Suzuki Y, Ueno K, Okada A, ... Yasunaga H, Komuro I
Eur J Prev Cardiol: 03 Sep 2022; epub ahead of print | PMID: 36056806
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Abstract

Reduction in blood pressure for elevated blood pressure/stage 1 hypertension according to the ACC/AHA guideline and cardiovascular outcomes.

Kaneko H, Yano Y, Suzuki Y, Okada A, ... Yasunaga H, Komuro I
Aims
Few studies have examined the relationship of blood pressure (BP) change in adults with elevated BP or stage 1 hypertension according to the ACC/AHA guideline with cardiovascular outcomes. We sought to identify the effect of BP change among individuals with elevated BP or stage 1 hypertension on incident heart failure (HF) and other cardiovascular diseases (CVDs).
Methods and results
We conducted a retrospective cohort study including 616,483 individuals (median age 46 years, 73.7% men) with elevated BP or stage 1 hypertension based on the ACC/AHA BP guideline. Participants were categorized using BP classification at one-year as normal BP (n = 173,558), elevated BP/stage 1 hypertension (n = 367,454), or stage 2 hypertension (n = 75,471). The primary outcome was HF, and the secondary outcomes included (separately) myocardial infarction (MI), angina pectoris (AP), and stroke. Over a mean follow-up of 1,097 ± 908 days, 10,544 HFs, 1,317 MIs, 11,070 APs, and 5,198 strokes were recorded. Compared with elevated BP/stage 1 hypertension at one-year, normal BP at one-year was associated with a lower risk of developing HF (HR:0.89, 95% CI:0.85-0.94), whereas stage 2 hypertension at one-year was associated with an elevated risk of developing HF (HR:1.43, 95% CI:1.36-1.51). This association was also present in other cardiovascular outcomes including MI, AP, and stroke. The relationship was consistent in all subgroups stratified by age, sex, baseline BP category, and overweight/obesity.
Conclusion
A one-year decline in BP was associated with the lower risk of HF, MI, AP, and stroke, suggesting the importance of lowering BP in individuals with elevated BP or stage 1 hypertension according to the ACC/AHA guideline to prevent the risk of developing CVD.

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

Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print
Kaneko H, Yano Y, Suzuki Y, Okada A, ... Yasunaga H, Komuro I
Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print | PMID: 36047246
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Abstract

Effect of LDL receptor mutation type on incident major adverse cardiovascular events in familial hypercholesterolemia.

Paquette M, Carrié A, Bernard S, Cariou B, ... Béliard S, Baass A
Aims
Patients with familial hypercholesterolemia (FH) are at increased risk of cardiovascular disease (CVD) due to extremely high circulating LDL-C concentrations. Our objective was to study the effect of the type of LDL receptor (LDLR) mutation on the incidence of major adverse cardiovascular events (MACE).
Methods
This was a multinational prospective cohort study, which included patients with heterozygous FH aged 18-65 years, without a prior history of CVD, and carrying a pathogenic or likely pathogenic variant in the LDLR gene.
Results
A total of 2131 patients (20 535 person-years of follow-up) were included in the study, including 1234 subjects carrying a defective mutation in the LDLR and 897 subjects carrying a null mutation. During the follow-up, a first MACE occurred in 79 cases (6%) in the defective group and in 111 cases (12%) in the null group. The mean baseline LDL-C concentration was 17% higher in the null group than in the defective group (7.90 vs 6.73 mmol/L, p < 0.0001). In a Cox regression model corrected for traditional cardiovascular risk factors, the presence of a null mutation was associated with a hazard ratio of 2.09 (1.44-3.05), p = 0.0001.
Conclusion
Carriers of a null mutation have an independent ∼two-fold increased risk of incident MACE compared to patients carrying a defective mutation. This study highlights the importance of genetic screening in FH in order to improve patient care.

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

Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print
Paquette M, Carrié A, Bernard S, Cariou B, ... Béliard S, Baass A
Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print | PMID: 36047048
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Abstract

Habitual fish oil supplementation and the risk of incident atrial fibrillation: Findings from a large prospective longitudinal cohort study.

Zhang J, Cai A, Chen G, Wang X, ... Lip GYH, Lin H
Background
Mixed effects of fish oil supplementation on the risks of atrial fibrillation (AF) were observed in several large-scale randomized controlled trials. Whether this relationship would be modified by genetic AF risk, baseline cardiovascular disease (CVD) status and background oily fish consumption is unknown.
Methods
We included 468665 participants without AF at baseline from the UK Biobank cohort. The association between fish oil supplementation and the AF risk was assessed in the study cohort and in several subgroups, including genetic AF predisposition, baseline CVD status and background oily fish consumption.
Results
During a median follow-up of 11.1 years, fish oil users had a higher rate of incident AF (6.2% vs 5.2%, adjusted hazard ratio [HR] of 1.10 and 95% confidence interval [CI] 1.07, 1.13). Compared to non-users, fish oil users had a higher rate of incident AF in the low (3.7% vs 3.0%, P = 0.02), intermediate (5.8% vs 4.8%, P < 0.0001) and high (9.8% vs 8.1%, P < 0.0001) genetic AF risk groups. In participants without CVD at baseline, fish oil users had a higher rate of incident AF (5.3% vs 4.1%, P < 0.0001), which was not observed in participants with CVD at baseline (11.6% vs 11.1%, P = 0.56), with significant interaction (P-interaction < 0.0001). The association between fish oil supplementation and the AF risk was not modified by background oily fish consumption (P-interaction = 0.62).
Conclusion
Habitual fish oil supplementation was associated with the risk of incident AF, regardless of genetic AF predisposition and background oily fish consumption. This association was observed only in individuals without CVD at baseline.

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Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print
Zhang J, Cai A, Chen G, Wang X, ... Lip GYH, Lin H
Eur J Prev Cardiol: 01 Sep 2022; epub ahead of print | PMID: 36047058
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Abstract

Incidental Coronary Calcium in Cancer Patients Treated with Anthracycline and/or Trastuzumab.

Hooks M, Sandhu G, Maganti T, Chen KHA, ... Shenoy C, Nijjar PS
Background
Cancer patients are at increased risk of cardiovascular disease (CVD) after treatment with potentially cardiotoxic treatments. Many cancer patients undergo non-gated chest CT (NCCT) for cancer staging prior to treatment.
Aims
We aimed to assess whether coronary artery calcification (CAC) on NCCT predicts CVD risk in cancer patients.
Methods
603 patients (mean age: 61.3 years, 30.8% male) with either breast cancer, lymphoma or sarcoma were identified retrospectively. Primary endpoint was a MACE composite including non-fatal myocardial infarction (MI), new heart failure (HF) diagnosis, HF hospitalization and cardiac death, with Fine-Gray analysis for non-cardiac death as competing risk. Secondary endpoints included a coronary composite and a HF composite.
Results
CAC was present in 194 (32.2%) and clinically reported in 85 (43.8%) patients. At a median follow-up of 5.3 years, 256 (42.5%) patients died of non-cardiac causes. CAC presence or extent was not an independent predictor of MACE (SHR 1.28; 0.73-2.27). CAC extent was a significant predictor of the coronary composite outcome (SHR per 2-fold increase 1.14; 1.01-1.28), but not of the HF composite outcome (SHR per 2-fold increase 1.04; 0.95-1.14).
Conclusion
CAC detected incidentally on NCCT scans in cancer patients is prevalent and often not reported. CAC presence or extent did not independently predict MACE. CAC extent was independently associated with increased risk of CAD events but not HF events.

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Eur J Prev Cardiol: 26 Aug 2022; epub ahead of print
Hooks M, Sandhu G, Maganti T, Chen KHA, ... Shenoy C, Nijjar PS
Eur J Prev Cardiol: 26 Aug 2022; epub ahead of print | PMID: 36017793
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Abstract

Obesity and cardiovascular disease: mechanistic insights and management strategies. A joint position paper by the World Heart Federation and World Obesity Federation.

Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, ... Pinto FJ, Wilding JP
The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life and >2.8 million deaths each year. Obesity is relapsing, progressive and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognising resource and support variances between countries).

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

Eur J Prev Cardiol: 25 Aug 2022; epub ahead of print
Lopez-Jimenez F, Almahmeed W, Bays H, Cuevas A, ... Pinto FJ, Wilding JP
Eur J Prev Cardiol: 25 Aug 2022; epub ahead of print | PMID: 36007112
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Abstract

Chronic kidney disease as cardiovascular risk factor in routine clinical practice: a position statement by the Council of the European Renal Association.

Ortiz A, Wanner C, Gansevoort R, ERA Council
The ESC 2021 guideline on Cardiovascular Disease (CVD) Prevention in Clinical Practice has major implications for both cardiovascular (CV) risk screening and kidney health of interest to primary care physicians, cardiologists, nephrologists and other professionals involved in CVD prevention. The proposed CVD prevention strategies require as first step the categorization of individuals into those with established atherosclerotic CVD, diabetes, familiar hypercholesterolemia or chronic kidney disease (CKD), i.e. conditions that are already associated with a moderate to very high CVD risk. This places CKD, defined as decreased kidney function or increased albuminuria as a starting step for CVD risk assessment. Thus, for adequate CVD risk assessment, patients with diabetes, familiar hypercholesterolemia or CKD should be identified by an initial laboratory assessment that requires not only serum to assess glucose, cholesterol and creatinine to estimate the glomerular filtration rate, but also urine to assess albuminuria. The addition of albuminuria as an entry-level step in CVD risk assessment should change clinical practice as it differs from the current healthcare situation in which albuminuria is only assessed in persons already considered to be at high risk of CVD. A diagnosis of moderate of severe CKD requires a specific set of interventions to prevent CVD. Further research should address the optimal method for CV risk assessment that includes CKD assessment in the general population, i.e. whether this should remain opportunistic screening or whether systematic screening .

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

Eur J Prev Cardiol: 23 Aug 2022; epub ahead of print
Ortiz A, Wanner C, Gansevoort R, ERA Council
Eur J Prev Cardiol: 23 Aug 2022; epub ahead of print | PMID: 35997796
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Abstract

Epigenetics in the primary and secondary prevention of cardiovascular disease: influence of exercise and nutrition.

Gevaert AB, Wood N, Boen JRA, Davos CH, ... Simonenko M, Scott Bowen T
Increasing evidence links changes in epigenetic systems, such as DNA methylation, histone modification and non-coding RNA expression, to the occurrence of cardiovascular disease (CVD). These epigenetic modifications can change genetic function under influence of exogenous stimuli, and can be transferred to next generations, providing a potential mechanism for inheritance of behavioral intervention effects. The benefits of exercise and nutritional interventions in the primary and secondary prevention of CVD are well established, but the mechanisms are not completely understood. In this review, we describe the acute and chronic epigenetic effects of physical activity and dietary changes. We propose exercise and nutrition as potential triggers of epigenetic signals, promoting the reshaping of transcriptional programs with effects on CVD phenotypes. Finally, we highlight recent developments in epigenetic therapeutics with implications for primary and secondary CVD prevention.

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

Eur J Prev Cardiol: 22 Aug 2022; epub ahead of print
Gevaert AB, Wood N, Boen JRA, Davos CH, ... Simonenko M, Scott Bowen T
Eur J Prev Cardiol: 22 Aug 2022; epub ahead of print | PMID: 35989414
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Abstract

Coronary microvascular dysfunction is an independent predictor of developing cancer in patients with non-obstructive coronary artery disease (NOCAD).

Rajai N, Ahmad A, Toya T, Sara JD, ... Lerman LO, Lerman A
Background
Cardiovascular disease and cancer share common pathogenesis and risk factors. Coronary microvascular dysfunction (CMD), reflecting impaired coronary microvascular dilation in response to stress, is related to a higher risk of major cardiovascular events; however, its association with cancer has not been explored.
Methods
A retrospective study on 1042 patients with non-obstructive coronary artery diseases was performed. Data regarding demographic, clinical history, diagnostic coronary reactivity test, and cancer occurrence was collected. CMD was defined as coronary flow reserve (CFR, the ratio of hyperemic blood flow to resting blood flow) ≤2.5.
Results
Thirty-four percent had CMD (67.4% female and the average age was 52.4 ± 12.2 years). Of 917 patients with no history of cancer, 15.5% developed cancer during follow-up (median of 9 (4,16) years). Kaplan-Meier analysis showed CMD patients had lower cancer-free survival compared to those without CMD (log-rank p = 0.005). Cox proportional hazard analyses showed that after adjusting for age, sex, hypertension, diabetes, smoking, and glomerular filtration rate, CMD is independently associated with cancer (HR, 1.4, 95%CI, 1.09-2.04, p = 0.04). The rate of MACE was significantly higher in CMD compared to those non-CMD patients in patients who had a previous history of cancer (OR, 2.5, 95%CI, 1-6.2, p = 0.04) and patients with no history of cancer (OR, 1.4, 95%CI, 1.01-1.9, p = 0.044).
Conclusion
CMD is associated with cancer incidence in patients presenting with non-obstructive coronary artery diseases. This study emphasizes the following-up in patients with CMD to evaluate the risk of MACE as well as potential malignant diseases.

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

Eur J Prev Cardiol: 22 Aug 2022; epub ahead of print
Rajai N, Ahmad A, Toya T, Sara JD, ... Lerman LO, Lerman A
Eur J Prev Cardiol: 22 Aug 2022; epub ahead of print | PMID: 35989450
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Abstract

Including Measures of Chronic Kidney Disease to Improve Cardiovascular Risk Prediction by SCORE2 and SCORE2-OP.

Matsushita K, Kaptoge S, Hageman SH, Sang Y, ... Coresh J, Chronic Kidney Disease Prognosis Consortium
Aims
The 2021 ESC guideline on cardiovascular disease (CVD) prevention categorizes moderate and severe chronic kidney disease (CKD) as high and very-high CVD risk status regardless of other factors like age and does not include estimated glomerular filtration rate (eGFR) and albuminuria in its algorithms, SCORE2 and SCORE2-OP, to predict CVD risk. We developed and validated an \"Add-on\" to incorporate CKD measures into these algorithms, using a validated approach.
Methods
In 3,054,840 participants from 34 datasets, we developed three Add-ons (eGFR only, eGFR + urinary albumin-to-creatinine ratio [ACR] [the primary Add-on], and eGFR + dipstick proteinuria) for SCORE2 and SCORE2-OP. We validated c-statistics and net reclassification improvement (NRI), accounting for competing risk of non-CVD death, in 5,997,719 participants from 34 different datasets.
Results
In the target population of SCORE2 and SCORE2-OP without diabetes, the CKD Add-on (eGFR only) and CKD Add-on (eGFR + ACR) improved c-statistic by 0.006 (95%CI 0.004-0.008) and 0.016 (0.010-0.023), respectively, for SCORE2 and 0.012 (0.009-0.015) and 0.024 (0.014-0.035), respectively, for SCORE2-OP. Similar results were seen when we included individuals with diabetes and tested the CKD Add-on (eGFR + dipstick). In 57,485 European participants with CKD, SCORE2 or SCORE2-OP with a CKD Add-on showed a significant NRI (e.g., 0.100 [0.062-0.138] for SCORE2) compared to the qualitative approach in the ESC guideline.
Conclusion
Our Add-ons with CKD measures improved CVD risk prediction beyond SCORE2 and SCORE2-OP. This approach will help clinicians and patients with CKD refine risk prediction and further personalize preventive therapies for CVD.

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

Eur J Prev Cardiol: 16 Aug 2022; epub ahead of print
Matsushita K, Kaptoge S, Hageman SH, Sang Y, ... Coresh J, Chronic Kidney Disease Prognosis Consortium
Eur J Prev Cardiol: 16 Aug 2022; epub ahead of print | PMID: 35972749
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Abstract

Uptake of prescription smoking cessation pharmacotherapies after hospitalisation for major cardiovascular disease.

Robijn AL, Woodward M, Pearson SA, Hsu B, ... Jorm L, Havard A
Aims
We determined the prevalence of prescription smoking cessation pharmacotherapy (SCP) use after hospitalisation for major cardiovascular disease among people who smoke and whether this varies by sex.
Methods
We conducted a population-based cohort study including all people hospitalised in New South Wales, Australia, between July 2013-December 2018 (2017 for private hospitals) with a major cardiovascular disease diagnosis. For patients who also had a diagnosis of current tobacco use, we used linked pharmaceutical dispensing records to identify prescription SCP dispensings within 90 days post-discharge. We determined the proportion who were dispensed an SCP within 90 days, overall and by type of SCP. We used logistic regression to estimate the odds of females being dispensed an SCP relative to males.
Results
Of the 150,758 patients hospitalised for a major cardiovascular disease, 20,162 (13.4%) had a current tobacco use diagnosis, 31% of whom were female. Of these, 11.3% (12.4% of females, 10.9% of males) received prescription SCP within 90 days post-discharge; 3.0% (were dispensed varenicline, and 8.3% were dispensed nicotine replacement therapy patches. Females were more likely than males to be dispensed a prescription SCP (OR 1.16, 95%CI 1.06-1.27); however, this was not maintained after adjusting for potential confounders (aOR 1.04, 95%CI 0.94-1.15).
Conclusion
Very few females and males who smoke use prescription SCPs after hospitalisation for a MCD. Use of varenicline, the SCP with the highest efficacy, was particularly low. This represents a missed opportunity to increase smoking cessation in this high-risk population, thereby reducing their risk of recurrent cardiovascular events.

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

Eur J Prev Cardiol: 11 Aug 2022; epub ahead of print
Robijn AL, Woodward M, Pearson SA, Hsu B, ... Jorm L, Havard A
Eur J Prev Cardiol: 11 Aug 2022; epub ahead of print | PMID: 35950363
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Abstract

Non-pharmacological factors for hypertension management: a systematic review of international guidelines.

Maniero C, Lopuszko A, Papalois KB, Gupta A, Kapil V, Khanji MY
Background
Lifestyle modifications are cornerstone of hypertension prevention and treatment. We aimed to systematically review hypertension guidelines on their recommendations on non-pharmacological factors including lifestyle interventions, to highlight strength of evidence, similarities, and differences.
Methods
The systematic review was registered with the international Prospective Register of Systematic Reviews (CRD42021288815). Publications in MEDLINE and EMBASE over 10 years since January 2010 to June 2020 were identified. We also included the search from websites of organizations responsible for guidelines development.
Study selection
Two reviewers screened the titles and abstracts to identify relevant guidelines.
Data extraction
Two reviewers independently assessed rigor of guideline development using the AGREEII instrument, and one reviewer extracted recommendations.
Results
Of the identified guidelines, 10 showed good rigor of development (AGREE Score ≥ 60%) and were included in the systematic review. The guidelines were consistent in most recommendations (reduced salt intake, weight, dietary patterns, increased physical activity and smoking cessation, and limiting alcohol intake). Some areas of disagreement were identified, regarding recommendations on novel psychological and environmental factors such as stress or air pollution, alcohol intake thresholds, meat, coffee and tea consumption and refined sugars.
Conclusions
Current guidelines agree on the importance of lifestyle in the treatment and prevention of hypertension. Consensus on smoking cessation, limited salt intake, increased physical activity support their integration in management of hypertensive patients and in public health measurements in general population as preventative measurements. Further research into the role of environmental and psychological factors may help clarify future recommendations.

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

Eur J Prev Cardiol: 10 Aug 2022; epub ahead of print
Maniero C, Lopuszko A, Papalois KB, Gupta A, Kapil V, Khanji MY
Eur J Prev Cardiol: 10 Aug 2022; epub ahead of print | PMID: 35947982
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Abstract

Management and treatment of cardiotoxicity due to anticancer drugs: 10 questions and answers.

Chianca M, Fabiani I, Del Franco A, Grigoratos C, ... Cardinale DM, Emdin M
Since the introduction of anthracyclines into clinical practice in the 1960s, chemotherapy have always been associated to cardiotoxicity. Patients on cardiotoxic drugs can develop a wide range of cardiovascular diseases, including left ventricular (LV) systolic dysfunction and heart failure (HF), arrhythmias, hypertension, and coronary artery disease (CAD). The rising number of cancer patients, population aging, and the frequent overlap of cardiovascular and oncological diseases have highlighted the importance of close collaboration between cardiologists and oncologists. As a result, in 1995, cardiologists at the IEO (European Institute of Oncology) coined the term cardioncology, a new discipline focused on the dynamics of cardiovascular disease in cancer patients. Given the complex scenario characterized by a constant dialogue between the oncological condition and cardiovascular comorbidity, it is essential for the clinician to get the knowledge to properly fulfill the needs of the oncological patient under cardiotoxic treatment. Through the answer to 10 questions, we aim to describe the complex issue of cardiotoxicity by addressing the main critical points and current evidence related to the assessment, management, treatment and surveillance of cancer patients under chemotherapy.

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Eur J Prev Cardiol: 08 Aug 2022; epub ahead of print
Chianca M, Fabiani I, Del Franco A, Grigoratos C, ... Cardinale DM, Emdin M
Eur J Prev Cardiol: 08 Aug 2022; epub ahead of print | PMID: 35938306
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Abstract

Menopause modulates the circulating metabolome: evidence from a prospective cohort study.

Karppinen JE, Törmäkangas T, Kujala UM, Sipilä S, ... Kovanen V, Laakkonen EK
Aims
We studied the changes in the circulating metabolome and their relation to the menopausal hormonal shift in 17β-oestradiol and follicle-stimulating hormone levels among women transitioning from perimenopause to early postmenopause.
Methods and results
We analysed longitudinal data from 218 Finnish women, 35 of whom started menopausal hormone therapy during the study. The menopausal transition was monitored with menstrual diaries and serum hormone measurements. The median follow-up was 14 months (interquartile range: 8-20). Serum metabolites were quantified with targeted nuclear magnetic resonance metabolomics. The model results were adjusted for age, follow-up duration, education, lifestyle, and multiple comparisons. Menopause was associated with 85 metabolite measures. The concentration of apoB (0.17 standard deviation [SD], 99.5% confidence interval [CI] 0.03-0.31), very-low-density lipoprotein triglycerides (0.25 SD, CI 0.05-0.45) and particles (0.21 SD, CI 0.05-0.36), low-density lipoprotein (LDL) cholesterol (0.17 SD, CI 0.01-0.34) and particles (0.17 SD, CI 0.03-0.31), high-density lipoprotein (HDL) triglycerides (0.24 SD, CI 0.02-0.46), glycerol (0.32 SD, CI 0.07-0.58) and leucine increased (0.25 SD, CI 0.02-0.49). Citrate (-0.36 SD, CI -0.57 to -0.14) and 3-hydroxybutyrate concentrations decreased (-0.46 SD, CI -0.75 to -0.17). Most metabolite changes were associated with the menopausal hormonal shift. This explained 11% and 9% of the LDL cholesterol and particle concentration increase, respectively. Menopausal hormone therapy was associated with increased medium-to-large HDL particle count and decreased small-to-medium LDL particle and glycine concentration.
Conclusions
Menopause is associated with proatherogenic circulating metabolome alterations. Female sex hormones levels are connected to the alterations, highlighting their impact on women\'s cardiovascular health.

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

Eur J Prev Cardiol: 05 Aug 2022; 29:1448-1459
Karppinen JE, Törmäkangas T, Kujala UM, Sipilä S, ... Kovanen V, Laakkonen EK
Eur J Prev Cardiol: 05 Aug 2022; 29:1448-1459 | PMID: 35930503
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Abstract

Cardiac remodelling in the highest city in the world: Effects of altitude and chronic mountain sickness.

Doutreleau S, Ulliel-Roche M, Hancco I, Bailly S, ... Parati G, Verges S
Aims
A unique Andean population lives in the highest city of the world (La Rinconada, 5,100  m, Peru) and frequently develops a maladaptive syndrome, termed chronic mountain sickness (CMS). Both extreme altitude and CMS are a challenge for the cardiovascular system. This study aims to evaluate cardiac remodelling and pulmonary circulation at rest and during exercise in healthy and CMS highlanders.
Methods
Highlanders living permanently at 3,800  m (n = 23) and 5,100  m (n = 55) with (n = 38) or without CMS (n = 17) were compared to 18 healthy lowlanders. Rest and exercise echocardiography were performed to describe cardiac remodelling, pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). Total blood volume (BV) and haemoglobin mass were determined in all people.
Results
With the increase in altitude of residency, the right heart dilated with an impairment in right ventricle systolic function, while the left heart exhibited a progressive concentric remodelling with grade I diastolic dysfunction but without systolic dysfunction. Those modifications were greater in moderate-severe CMS patients. Mean PAP was higher both at rest and during exercise in healthy highlanders at 5,100  m. The moderate-severe CMS subjects had a higher PVR at rest and a larger increase in PAP during exercise. The right heart remodelling was correlated with PAP, total BV and SpO2.
Conclusions
Healthy dwellers at 5,100  m, exhibit both right heart dilatation and left ventricle concentric remodelling with diastolic dysfunction. Those modifications are even more pronounced in moderate-severe CMS subjects and could represent the limit of the heart\'s adaptability before progression to heart failure.

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Eur J Prev Cardiol: 05 Aug 2022; epub ahead of print
Doutreleau S, Ulliel-Roche M, Hancco I, Bailly S, ... Parati G, Verges S
Eur J Prev Cardiol: 05 Aug 2022; epub ahead of print | PMID: 35929776
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Abstract

Temporal trends in atherosclerotic cardiovascular disease risk among U.S. adults. Analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2018.

Chobufo MD, Singla A, Rahman EU, Michos ED, Whelton PK, Balla S
Background
Atherosclerotic cardiovascular diseases are a significant cause of disability and mortality. Study of trends in cardiovascular risk at a population level helps understand the overall cardiovascular health and the impact of primary prevention efforts.
Aim
To assess trends in the estimated 10-year atherosclerotic cardiovascular disease(ASCVD) risk among U.S. adults from 1999-2000 to 2017-2018 with no established cardiovascular disease(CVD).
Methods
Serial cross-sectional analysis of National Health and Nutrition Examination Survey(NHANES) data from 1999-2000 to 2017-2018(10 cycles), including 24022 US adults aged 40-79 years with no reported atherosclerotic cardiovascular disease(ASCVD). ASCVD risk was assessed using the pooled cohort equations (PCE).
Results
There was a significant temporal decline in the mean 10-year ASCVD risk from 13.5% (95%CI, 12.5-14.4) in 1999-2000 to 11.1% (10.5-11.7) in 2011-2012 (ptrend <  0.001) and to 12.0% (11.3-12.7) in 2017-2018 (overall ptrend = 0.001), with the mean ASCVD risk score remaining stable from 2013-2014 through 2017-2018 (ptrend =  0.056). A declining trend in ASCVD risk was noted in females, non-Hispanic Blacks and those with income < 3 times the poverty threshold with ptrend of <0.001, 0.002, and 0.007, respectively. Mean total cholesterol and prevalence of smokers showed a downward trend (ptrend <0.001 for both) whereas type 2 diabetes and mean BMI showed an upward trend (ptrend <0.001 for both).
Conclusion
The 20-year trend of ASCVD risk among NHANES participants 40-79 years, as assessed by the use of PCE, showed a non-linear downward trend from 1999-2000 to 2017-2018. The initial and significant decline in estimated ASCVD risk from 1999-2000 to 2011-2012 subsequently stabilized, with no significant change from 2013-2014 to 2017-2018. Mean BMI and prevalence of diabetes mellitus increased while mean serum cholesterol levels and prevalence of smoking declined during the study period. Our findings support invigoration of efforts aimed at prevention of CVD, including primordial prevention of CVD risk factors.

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Eur J Prev Cardiol: 03 Aug 2022; epub ahead of print
Chobufo MD, Singla A, Rahman EU, Michos ED, Whelton PK, Balla S
Eur J Prev Cardiol: 03 Aug 2022; epub ahead of print | PMID: 35919951
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Abstract

Performance of Current Risk Stratification Models for Predicting Mortality in Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, ... Van Spall HGC, Shahzeb Khan M
Background
There are several risk scores designed to predict mortality in patients with heart failure (HF).
Aim
To assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF.
Methods
MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analyzed using C-statistics, and pooled using generic inverse-variance random-effects model.
Results
Nineteen studies (n = 494,156 patients; AHF:24,762; chronic HF mid-term mortality:62,000; chronic HF long-term mortality:452,097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality (C-statistic:0.76, [0.68-0.83]), chronic HF mid-term mortality (1 year; C-statistic:0.74, [0.68-0.79]) and chronic HF long-term mortality (≥2 years; C-statistic:0.71, [0.69-0.73]). MEESSI-AHF (C-statistic:0.81, [0.80-0.83]) and MARKER-HF (C-statistic:0.85, [0.80-0.89]) had excellent discrimination for AHF and chronic HF mid-term mortality respectively, whereas MECKI had good discrimination (C-statistic:0.78, [0.73-0.83]) for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow p > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance.
Conclusions
Majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.

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Eur J Prev Cardiol: 03 Aug 2022; epub ahead of print
Siddiqi TJ, Ahmed A, Greene SJ, Shahid I, ... Van Spall HGC, Shahzeb Khan M
Eur J Prev Cardiol: 03 Aug 2022; epub ahead of print | PMID: 35919956
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Abstract

Alcohol consumption and subclinical and clinical coronary heart disease: A Mendelian randomization analysis.

Hisamatsu T, Miura K, Tabara Y, Sawayama Y, ... Ueshima H, SESSA and ACCESS Research Groups
Aims
The potential effect of alcohol consumption on coronary heart disease (CHD) remains unclear. We used the variant rs671 in the aldehyde dehydrogenase 2 gene (ALDH2) as an instrument to investigate the causal role of alcohol intake in subclinical and clinical CHD.
Methods
We conducted two Mendelian randomization studies: a cross-sectional study of coronary artery calcification (CAC) on computed tomography of 1029 healthy men (mean age, 63.8 years) and a case-control study of 421 men with CHD (acute coronary syndrome [ACS] or stable angina pectoris) who underwent coronary revascularization and 842 age-matched male controls.
Results
In the CAC study, medians (25%tiles, 75%tiles) of alcohol consumption by ALDH2-rs671 *2 homozygotes (n = 86 [8.4%]), *1*2 heterozygotes (n = 397 [38.5%]), and *1 homozygotes (n = 546 [53.1%]) were 0.0 (0.0, 0.0), 28.0 (0.0, 129.0), and 224.0 (84.0, 350.0) g/week, respectively. In age-adjusted Poisson regression with robust error variance, compared with *2 homozygotes, relative risks for prevalent CAC score >0, ≥100, and ≥300 in *1 homozygotes were 1.29 (95% confidence interval, 1.06-1.57), 1.76 (1.05-2.96), and 1.81 (0.80-4.09), respectively. In age-adjusted ordinal logistic regression for CAC distributions, we observed higher odds among *1 homozygotes (odds ratio, 2.19 [1.39-3.46]) and even among *1*2 heterozygotes (1.77 [1.11-2.82]) compared with *2 homozygotes. In the case-control study, conditional logistic regression revealed lower prevalence of *1 homozygotes among men with CHD (odds ratio, 0.54 [0.35-0.82]), especially ACS (0.46 [0.27-0.77]), than controls.
Conclusion
Our findings indicate a positive association of alcohol consumption with CAC burden but an inverse association with clinical CHD, especially ACS.

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Eur J Prev Cardiol: 30 Jul 2022; epub ahead of print
Hisamatsu T, Miura K, Tabara Y, Sawayama Y, ... Ueshima H, SESSA and ACCESS Research Groups
Eur J Prev Cardiol: 30 Jul 2022; epub ahead of print | PMID: 35907253
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Abstract

Pulmonary hypertension during exercise underlies unexplained exertional dyspnea in patients with type 2 diabetes.

Gojevic T, Van Ryckeghem L, Jogani S, Frederix I, ... Hansen D, Verwerft J
Aim
To compare the cardiac function and pulmonary vascular function during exercise between dyspneic and non-dyspneic patients with type 2 diabetes mellitus (T2DM).
Methods
47 T2DM patients with unexplained dyspnea and 50 asymptomatic T2DM patients underwent exercise echocardiography combined with ergospirometry. Left ventricular (LV) function (stroke volume, cardiac output, LV ejection fraction, systolic annular velocity (s\')), estimated LV filling pressures (E/e\'), mean pulmonary arterial pressures (mPAP) and mPAP/COslope were assessed at rest, low- and high-intensity exercise with colloid contrast.
Results
Groups had similar patient characteristics, glycemic control, stroke volume, cardiac output, LV ejection fraction and E/e\' (p > 0.05). The dyspneic group had significantly lower systolic LV reserve at peak exercise (s\') (p = 0.021) with a significant interaction effect (p < 0.001). The dyspneic group also had significantly higher mPAP and mPAP/CO at rest and exercise (p < 0.001) with significant interaction for mPAP (p < 0.009) and insignificant for mPAP/CO (p = 0.385). There was no significant difference in mPAP/COslope between groups (p = 0.706). However, about 61% of dyspneic vs. 30% of non-dyspneic group had mPAP/COslope > 3 (p = 0.009). The mPAP/COslope negatively predicted V̇O2peak in dyspneic group (β= -1.86, 95% CI -2.75, -0.98; multivariate model R²:0.54).
Conclusion
Pulmonary hypertension and less LV systolic reserve detected by exercise echocardiography with colloid contrast underlie unexplained exertional dyspnea and reduced exercise capacity in T2DM.

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Eur J Prev Cardiol: 26 Jul 2022; epub ahead of print
Gojevic T, Van Ryckeghem L, Jogani S, Frederix I, ... Hansen D, Verwerft J
Eur J Prev Cardiol: 26 Jul 2022; epub ahead of print | PMID: 35881689
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Abstract

Cardiovascular events in patients with chronic myeloid leukaemia treated with tyrosine kinase inhibitors in Taiwan: a nationwide population-based study.

Yang YC, Huang RY, Tsai HJ, Li PC, Yang YH, Hsieh KP
Aims
New-generation breakpoint cluster region-Abelson tyrosine kinase inhibitors (TKIs) have a higher incidence of cardiovascular events than imatinib in patients with chronic myeloid leukaemia (CML). However, this knowledge is insufficiently proven. Hence, this study aimed to explore the association between cardiovascular events and TKIs in patients with CML.
Methods and results
This retrospective population-based cohort study enrolled first-time users of imatinib, dasatinib, and nilotinib between 1 January 2007 and 31 December 2016. Arterial thromboembolic events (ATEs) were the primary outcome, while other cardiovascular-related events were the secondary outcomes. The event rates were estimated using Kaplan-Meier estimates, and the hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression. Additionally, the competing risk was adjusted using the Fine and Gray competing risk model. We included 1207 patients. Nilotinib had a significantly higher ATE risk (subdistribution HR = 4.92, 95% CI = 1.68-14.36) than imatinib. Conversely, no difference was found for other cardiovascular-related events. Risks of ATE and other cardiovascular-related events were similar between dasatinib and imatinib and between nilotinib and dasatinib. The risk of ATE hospitalization consistently increased throughout the main analyses and sensitivity analyses.
Conclusion
Nilotinib-treated patients had a significantly higher risk of developing ATE than imatinib-treated patients. However, the risks of ATE and other cardiovascular-related events were not significantly different between dasatinib and imatinib.

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

Eur J Prev Cardiol: 20 Jul 2022; 29:1312-1321
Yang YC, Huang RY, Tsai HJ, Li PC, Yang YH, Hsieh KP
Eur J Prev Cardiol: 20 Jul 2022; 29:1312-1321 | PMID: 34179961
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Abstract

Cardioprotective effects of Influenza Vaccination among Patients with Established Cardiovascular Disease or at High Cardiovascular Risk: A Systematic Review and Meta-analysis.

Jaiswal V, Ang SP, Yaqoob S, Ishak A, ... Jaiswal A, Biswas M
Background
The clinical impact of the influenza vaccination on cardiovascular outcomes in people with established cardiovascular disease (CVD) is still debated.
Aim
The aim of this meta-analysis was to estimate the effect of influenza vaccination on cardiovascular and cerebrovascular outcomes among patients with established CVD.
Methods
We systematically searched all electronic databases from inception until 15 April 2022. Primary clinical outcomes were all-cause mortality (ACM), and major adverse clinical events (MACE). Secondary endpoints were heart failure, myocardial infarction, CV mortality, and stroke.
Results
Eighteen articles (five randomized trials and thirteen observational studies), with a total of 22,532,165 patients were included in the analysis. There were 217,072 participants included in the high cardiovascular risk or established CVD population (vaccinated n = 111,073 and unvaccinated n = 105,999). The mean age of the patients was 68 years old, without any difference between groups (69 vs 71) years. At mean follow-up of 1.5 years, vaccinated group was associated with lower risk for all-cause mortality [HR, 0.71(95%CI, 0.63-0.80), p < 0.001], MACE [HR, 0.83(95%CI:0.72-0.96), p = 0.01], CV mortality [HR, 0.78(95%CI:0.68-0.90), p < 0.001] and myocardial infarction [HR, 0.82(95%CI:0.74-0.92), p < 0.001] compared to unvaccinated group. While incidence of stroke [HR, 1.03 (95%CI, 0.92-1.06), p = 0.61] and heart failure [HR, 0.74 (95%CI, 0.51-1.08), p = 0.12] did not differ between the two groups.
Conclusion
Influenza vaccination reduced major adverse clinical events, all-cause mortality, CV mortality and myocardial infarction. These highlighted the importance of influenza vaccination in established CVD or high cardiovascular risk.

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

Eur J Prev Cardiol: 20 Jul 2022; epub ahead of print
Jaiswal V, Ang SP, Yaqoob S, Ishak A, ... Jaiswal A, Biswas M
Eur J Prev Cardiol: 20 Jul 2022; epub ahead of print | PMID: 35857821
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Abstract

Lipid cutoffs for increased cardiovascular disease risk in nondiabetic young people.

Kim MK, Han K, Kim HS, Yoon KH, Lee SH
Aims
The relevance of blood lipid abnormalities to cardiovascular disease (CVD) risk in young populations is unclear. Here, we aimed to identify the cutoff levels of lipid parameters for increased risk of CVD among nondiabetic young adults aged 20-39 years.
Methods
Using data from a nationally representative Korean National Health Insurance System database, we followed up 6,204,153 subjects who underwent health examinations between 2009 and 2012 until the end of 2018. The primary outcome was incident CVD, defined as a composite of myocardial infarction and stroke. We assessed the associations between pre-specified lipid levels and CVD risk. Subgroup analysis of the number of cardiovascular risk factors (obesity, hypertension, and current smoking) was also conducted.
Results
During a median follow-up of 7.7 years, there were 14,569 (0.23%) cases of myocardial infarction, 9,459 (0.15%) cases of stroke, and 23,680 (0.38%) cases of composite CVD. Using total cholesterol (TC) level of <140 mg/dL, triglyceride (TG) level of <60 mg/dL, LDL-cholesterol level of <100 mg/dL, and non-HDL-cholesterol level of <130 mg/dL as reference groups, a significantly higher risk of CVD was observed in subjects with a TC level of ≥200 mg/dL, TG level of ≥60 mg/dL, LDL-cholesterol level of ≥130 mg/dL, or non-HDL-cholesterol level of ≥140 mg/dL. The cutoff levels of TC that had statistical significance for increased risk of CVD were 240, 220, and 200 mg/dL in subjects with 0, 1, or 2-3 risk factors, respectively.
Conclusions
Even modest increases in lipid levels were associated with increased risk of CVD in this nondiabetic young population. Our data provide potential criteria for stratifying CVD risk based on real-world evidence.

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

Eur J Prev Cardiol: 11 Jul 2022; epub ahead of print
Kim MK, Han K, Kim HS, Yoon KH, Lee SH
Eur J Prev Cardiol: 11 Jul 2022; epub ahead of print | PMID: 35816409
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Abstract

Associations of Genetic Susceptibility and Healthy Lifestyle with Incidence of Coronary Heart Disease and Stroke in Individuals with Hypertension.

Wang M, Brage S, Sharp SJ, Luo S, Au Yeung SL, Kim Y
Background
This study explored the associations of genetic susceptibility and adherence to a healthy lifestyle with incident coronary heart disease (CHD) and stroke in individuals with hypertension.
Method
This study included 258,531 European descendants with hypertension at baseline from UK Biobank. Genetic risk of CHD and stroke was estimated using polygenic risk scores derived from 300 and 87 single-nucleotide polymorphisms, respectively. Lifestyle scores were calculated based on 4 lifestyle components (no obesity, no current smoking, regular physical activity and healthy diet). Cox regression with age as the underlying timescale was fit for incident CHD (n = 7,470) and stroke (n = 5,015), separately.
Result
A favourable lifestyle (3-4 lifestyle components) was associated with 37% and 30% lower hazards of CHD (95% confidence interval, 32%-42%) and stroke (23%-37%), compared with an unfavourable lifestyle (0-1 lifestyle component), at all levels of genetic risk. Evidence of interaction between genetic susceptibility and lifestyle adherence was found for stroke (P = 0.036): no evidence of interaction for CHD (P = 0.524). A favourable lifestyle at high genetic risk had lower 12-year absolute risk of CHD and stroke, compared with an unfavourable lifestyle at low-to-intermediate genetic (exception: an unfavourable lifestyle at low CHD genetic risk).
Conclusion
Adhering to a healthy lifestyle is associated with lower CHD and stroke risk regardless of genetic risk among individuals with hypertension. Risk of CHD and stroke for those at high genetic risk but adhering to a healthy lifestyle was generally lower than for those at low-to-intermediate genetic risk but adhering to an unhealthy lifestyle.

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Eur J Prev Cardiol: 05 Jul 2022; epub ahead of print
Wang M, Brage S, Sharp SJ, Luo S, Au Yeung SL, Kim Y
Eur J Prev Cardiol: 05 Jul 2022; epub ahead of print | PMID: 35788660
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Abstract

Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy.

Karalexi MA, Frisell T, Cnattingius S, Holmberg D, ... Skalkidou A, Papadopoulos FC
Aims
We compared the incidence of cardiovascular disease (CVD) in transgender participants with a diagnosis of gender dysphoria (GD) with and without gender-affirming hormone therapy (GAHT) to the incidence observed in the general population.
Methods and results
The population-based cohort included all individuals >10 years in Sweden linked to Swedish nationwide healthcare Registers (2006-2016). Two comparator groups without GD/GAHT were matched (1:10) on age, county of residence, and on male and female birth-assigned sex, respectively. Cox proportional models provided hazard ratios (HR) and 95% confidence intervals (CI) for CVD outcomes. Among 1779 transgender individuals (48% birth-assigned males [AMAB], 52% birth-assigned females [AFAB]) 18 developed CVD, most of which were conduction disorders. The incidence of CVD for AFAB individuals with GD was 3.7 per 1000 person-years (95%CI: 1.4-10.0). AMAB individuals with GD had an incidence of CVD event of 7.1 per 1000 person-years (95%CI: 4.2-12.0). The risk of CVD event was 2.4 times higher in AMAB individuals (HR: 2.4, 95%CI: 1.3-4.2) compared to cisgender women, and 1.7 higher compared to cisgender men (HR: 1.7, 95%CI: 1.0-2.9). Analysis limited to transgender individuals without GAHT yielded similar results to those with GAHT treatment.
Conclusion
The incidence of CVD among GD/GAHT individuals was low, although increased compared to matched individuals without GD and similar to the incidence among GD/no GAHT individuals, thus not lending support for a causal relationship between treatment and CVD outcomes. Larger studies with longer follow-up are needed to verify these findings, as well as possible effect modification by comorbidity.

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

Eur J Prev Cardiol: 02 Jul 2022; epub ahead of print
Karalexi MA, Frisell T, Cnattingius S, Holmberg D, ... Skalkidou A, Papadopoulos FC
Eur J Prev Cardiol: 02 Jul 2022; epub ahead of print | PMID: 35778824
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Abstract

Lifestyle and metabolic risk factors in patients with early-onset myocardial infarction: A case-control study.

Wienbergen H, Boakye D, Günther K, Schmucker J, ... Hambrecht R, Ahrens W
Aims
Family history is a known risk factor for early-onset myocardial infarction (EOMI). However, the role of modifiable lifestyle and metabolic factors in EOMI risk is unclear and may differ from that of older adults.
Methods
This case-control study included MI patients aged ≤45 years from the Bremen STEMI Registry and matched controls randomly selected from the general population (German National Cohort) at the same geographical region. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the individual and combined associations of lifestyle and metabolic factors with EOMI risk, overall and according to family history for premature MI.
Results
A total of 522 cases and 1,191 controls were included. Hypertension, current smoking, elevated waist-to-hip ratio and diabetes mellitus were strongly associated with the occurrence of EOMI. By contrast, higher frequency of alcohol consumption was associated with decreased EOMI risk. In a combined analysis of the risk factors hypertension, current smoking, BMI ≥25.0 kg/sqm and diabetes mellitus, participants having one (OR = 5.4, 95%CI = 2.9-10.1) and two or more risk factors (OR = 42.3, 95%CI = 22.3-80.4) had substantially higher odds of EOMI compared to those with none of these risk factors, regardless of their family history.
Conclusion
This study demonstrates a strong association of smoking and metabolic risk factors with the occurrence of EOMI. The data suggest that the risk of EOMI goes beyond family history and underline the importance of primary prevention efforts to reduce smoking and metabolic syndrome in young persons.

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Eur J Prev Cardiol: 01 Jul 2022; epub ahead of print
Wienbergen H, Boakye D, Günther K, Schmucker J, ... Hambrecht R, Ahrens W
Eur J Prev Cardiol: 01 Jul 2022; epub ahead of print | PMID: 35776839
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This program is still in alpha version.