Journal: Eur J Prev Cardiol

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<div><h4>Beyond exercise oscillatory ventilations: the prognostic impact of loop gain in heart failure.</h4><i>Cunha GJL, Maltês S, Rocha BML, Nina D, ... Mendes M, Agostoni P</i><br /><AbstractText>Exercise oscillatory ventilation (EOV) is a strong prognostic marker in patients with heart failure (HF) and left ventricular (LV) dysfunction. This phenomenon can be explained through a single quantitative measurement of ventilatory instability, the loop gain. Therefore, we aimed to evaluate whether loop gain could be a better tool than subjective EOV evaluation to identify HF patients with a higher risk of major cardiovascular complications. This was a single-center retrospective study that included patients with left ventricular ejection fraction (LVEF) ≤ 50% consecutively referred for cardiopulmonary exercise testing (CPET) from 2016-2020. Loop gain was measured through computational evaluation of the minute ventilation graph. Of the 250 patients included, the 66 that presented EOV also had higher values of loop gain, when compared to patients without EOV. Those with both EOV and higher loop gain had more severe HF, with higher NT-proBNP and VE/VCO2 slope as well as lower peak VO2 and LVEF. On multivariable analysis, loop gain was strongly correlated with the composite endpoint of cardiovascular death, urgent heart transplantation, urgent left ventricular assist device implantation or HF hospitalization, even after correcting for peak VO2, LVEF, VE/VCO2 slope and NT-proBNP. Presence of EOV was not prognostically significant in this analysis. Loop gain is an objective parameter that quantifies ventilatory instability and showed to have a strong prognostic value in a cohort of patients with HF and LVEF ≤ 50%, outperforming the classification of EOV.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 27 Jan 2023; epub ahead of print</small></div>
Cunha GJL, Maltês S, Rocha BML, Nina D, ... Mendes M, Agostoni P
Eur J Prev Cardiol: 27 Jan 2023; epub ahead of print | PMID: 36707994
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<div><h4>The Use of Evidence-Based Medical Therapy in Patients with Critical Limb-Threatening Ischemia.</h4><i>Bager LGV, Petersen JK, Havers-Borgersen E, Resch T, ... Køber L, Fosbøl EL</i><br /><b>Aim</b><br />To describe the practice patterns of evidence-based medical therapy (EBM) and overall mortality in high-risk patients with critical limb-threatening ischemia (CLTI), compared to patients with myocardial infarction (MI).<br /><b>Methods</b><br />Using Danish registries, we identified patients 40-100 years of age with a first-time hospitalization for CLTI or MI from 2008-2018 and grouped them into; CLTI, MI, and CLTI and history of MI (CLTI + MI). We examined the likelihood of filling prescriptions with EBM (i.e. antiplatelets [AP], lipid-lowering agents [LLA], angiotensin-converting enzyme inhibitor [ACEi], or angiotensin II-receptor blockers [ARB]) within 3 months after discharge among survivors. Further, we assessed the adjusted three-year mortality rates.<br /><b>Results</b><br />We included 92,845 patients: 14,941 with CLTI (54.7% male), 74,830 with MI (64.6% male) and 3,074 with CLTI + MI (65.2% male). Patients with CLTI and CLTI + MI were older and had more comorbidities than patients with MI. Compared to patients with MI, the unadjusted odds ratios of filling prescriptions were 0.15 (CI 0.14-0.15) for AP, 0.26 (CI 0.25-0.27) for LLA, and 0.71 (CI 0.69-0.74) for ARB/ACEi in patients with CLTI, and 0.22 (CI 0.20-0.24) for AP, 0.38 (CI 0.35-0.42) for LLA, and 1.17 (CI 1.08-1.27) for ARB/ACEi in patients with CLTI + MI. Adjusted analyses showed similar results. Compared to patients with MI, adjusted three-year hazard ratios for mortality were 1.69 (CI 1.64-1.74) in patients with CLTI and 1.60 (CI 1.51-1.69) in patients with CLTI + MI.<br /><b>Conclusion</b><br />Patients with CLTI were undertreated with EBM and carried a more adverse prognosis, as compared to patients with MI, despite similar guidelines.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 27 Jan 2023; epub ahead of print</small></div>
Bager LGV, Petersen JK, Havers-Borgersen E, Resch T, ... Køber L, Fosbøl EL
Eur J Prev Cardiol: 27 Jan 2023; epub ahead of print | PMID: 36708037
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<div><h4>Risk and trajectory of premature ischaemic cardiovascular disease in women with a history of pre-eclampsia: a nationwide register-based study.</h4><i>Hallum S, Basit S, Kamper-Jørgensen M, Sehested TSG, Boyd HA</i><br /><b>Aims</b><br />Pre-eclampsia increases women\'s lifetime risk of cardiovascular disease (CVD). Little is known about the trajectory of CVD after pre-eclampsia, limiting the usefulness of this knowledge for informing screening, prevention, and interventions. We investigated when the risk of CVD increases after pre-eclampsia and how the risk changes over time since pregnancy.<br /><b>Methods and results</b><br />This register-based study included 1 157 666 women with >1 pregnancy between 1978 and 2017. Cumulative incidences of acute myocardial infarction (AMI) and ischaemic stroke were estimated, as well as hazard ratios (HRs) by attained age and time since delivery. Up to 2% [95% confidence interval (CI): 1.46-2.82%] of women with pre-eclampsia in their first pregnancy had an AMI or stroke within two decades of delivery, compared with up to 1.2% (95% CI: 1.08-1.30%) of pre-eclampsia-free women; differences in cumulative incidences were evident 7 years after delivery. Ten years after delivery, women with pre-eclampsia had four- and three-fold higher rates of AMI (HR = 4.16, 95% CI: 3.16-5.49) and stroke (HR = 2.59, 95% CI 2.04-3.28) than women without pre-eclampsia; rates remained doubled >20 years later. Women with pre-eclampsia aged 30-39 years had five-fold and three-fold higher rates of AMI (HR = 4.88, 95% CI 3.55-6.71) and stroke (HR = 2.56, 95% CI 1.95-3.36) than women of similar age without pre-eclampsia.<br /><b>Conclusions</b><br />Women with a history of pre-eclampsia have high rates of AMI and stroke at early ages and within a decade after delivery. The findings suggest that pre-eclampsia history could be useful in identifying women at increased risk of CVD and that targeted interventions should be initiated soon after delivery.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 26 Jan 2023; epub ahead of print</small></div>
Hallum S, Basit S, Kamper-Jørgensen M, Sehested TSG, Boyd HA
Eur J Prev Cardiol: 26 Jan 2023; epub ahead of print | PMID: 36702629
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<div><h4>Proteomic profiling identifies novel independent relationships between inflammatory proteins and myocardial infarction.</h4><i>Valdes-Marquez E, Clarke R, Hill M, Watkins H, Hopewell JC, PROCARDIS Consortium</i><br /><b>Background</b><br />Inflammation has been implicated in the pathogenesis of coronary heart disease (CHD), but the relevance and independence of individual inflammatory proteins is uncertain.<br /><b>Objective</b><br />To examine the relationships between a spectrum of inflammatory proteins and myocardial infarction (MI).<br /><b>Methods</b><br />A panel of 92 inflammatory proteins was assessed using an OLINK multiplex immunoassay among 432 MI cases (diagnosed < 66 years) and 323 controls. Logistic regression was used to estimate associations between individual proteins and MI, after adjustment for established cardiovascular risk factors and medication use, and stepwise regression to identify proteins with independent effects. Machine learning techniques (Boruta analysis and LASSO regression) and bioinformatic resources were used to examine the concordance of results with those obtained by conventional methods and explore the underlying biological processes to inform the validity of the associations.<br /><b>Results</b><br />Among the 92 proteins studied, 62 (67%) had plasma concentrations above the lower limit of detection in at least 50% of samples. Of these, 15 individual proteins were significantly associated with MI after covariate adjustment and correction for multiple testing. Five of these 15 proteins (CDCP1, CD6, IL1-8R1, IL-6 and CXCL1) were independently associated with MI, with up to 3-fold higher risks of MI per doubling in plasma concentrations. Findings were further validated using machine learning techniques and biologically focused analyses.<br /><b>Conclusions</b><br />This study, demonstrating independent relationships between five inflammatory proteins and MI, provides important novel insights into the inflammatory hypothesis of MI and the potential utility of proteomic analyses in precision medicine.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 25 Jan 2023; epub ahead of print</small></div>
Valdes-Marquez E, Clarke R, Hill M, Watkins H, Hopewell JC, PROCARDIS Consortium
Eur J Prev Cardiol: 25 Jan 2023; epub ahead of print | PMID: 36702559
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<div><h4>Employment Status at Time of Acute Myocardial Infarction and Risk of Death and Recurrent Acute Myocardial Infarction.</h4><i>Petersen JK, Shams-Eldin AN, Fosbøl EL, Rørth R, ... Køber L, Butt JH</i><br /><b>Background</b><br />Employment is important for physical and mental health and self-esteem and provides financial independence. However, little is known on the prognostic value of employment status prior to admission with acute myocardial infarction (MI).<br /><b>Methods and results</b><br />Using Danish nationwide registries, all patients between 18 and 60 years with a first-time MI admission (2010-2018) and alive at discharge were included. Rates of all-cause mortality and recurrent MI according to workforce attachment at the time of the event was compared using multivariable Cox regression. Of the 16,060 patients included in the study, 3,520 (21.9%) patients were not part of the workforce. Patients who were not part of the workforce were older (52 versus 51 years), less often men (63% versus 77%), less likely to have higher education, more often living alone (47% versus 29%), and more often had comorbidities, including heart failure, atrial fibrillation, hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. The absolute 5-year risk of death was 3.3% and 12.8% in the workforce and non-workforce group, respectively. The corresponding rates of recurrent MI were 7.5% and 10.9%, respectively. In adjusted analyses, not being part of the workforce was associated with a significantly higher rate of all-cause mortality (HR 2.39 ([95% CI, 2.01-2.83]) and recurrent MI (1.36 [1.18-1.57]).<br /><b>Conclusion</b><br />Among patients of working age who were admitted with MI and alive at discharge, not being part of the workforce was associated with a higher long-term rate of all-cause mortality and recurrent MI.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 19 Jan 2023; epub ahead of print</small></div>
Petersen JK, Shams-Eldin AN, Fosbøl EL, Rørth R, ... Køber L, Butt JH
Eur J Prev Cardiol: 19 Jan 2023; epub ahead of print | PMID: 36653331
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<div><h4>Combining European and U.S. risk prediction models with polygenic risk scores to refine cardiovascular prevention: the CoLaus|PsyCoLaus Study.</h4><i>de La Harpe R, Thorball CW, Redin C, Fournier S, ... Fellay J, Vaucher J</i><br /><b>Background</b><br />Polygenic risk score (PRS) have potential to improve individual atherosclerotic cardiovascular disease (ASCVD) risk assessment.<br /><b>Aims</b><br />To determine whether a PRS combined with two clinical risk scores, the Systematic COronary Risk Evaluation 2 (SCORE2) and the Pooled Cohort Equation (PCE), improves prediction of ASCVD.<br /><b>Methods</b><br />Using a population-based European prospective cohort, with 6733 participants at baseline (2003-2006), the PRS presenting the best predictive accuracy was combined with SCORE2 and PCE to assess their joint performances for predicting ASCVD Discrimination, calibration, Cox proportional hazard regression and net reclassification index were assessed.<br /><b>Results</b><br />4,218 subjects (53% women; median age, 53.4 years), with 363 prevalent and incident ASCVD, were used to compare four PRSs. The metaGRS_CAD PRS presented the best predictive capacity (AUROC=0.77) and was used in the following analyses. 3,383 subjects (median follow-up of 14.4 years), with 190 first incident ASCVD, were employed to test ASCVD risk prediction. The changes in C statistic between SCORE2 and PCE models and those combining metaGRS_CAD with SCORE2 and PCE were 0.008 (95% CI, -0.00008-0.02, P =0.05), and 0.007 (95% CI, 0.005-0.01, P=0.03), respectively.Reclassification was improved for people at clinically-determined intermediate-risk for both clinical scores (NRI of 9.6% (95% CI, 0.3-18.8) and 12.0% (95%CI, 1.5-22.6) for SCORE2 and PCE, respectively).<br /><b>Conclusion</b><br />Combining a PRS with clinical risk scores significantly improved the reclassification of risk for incident ASCVD for subjects in the clinically-determined intermediate-risk category. Introducing PRSs in clinical practice may refine cardiovascular prevention for subgroups of patients in whom prevention strategies are uncertain.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 18 Jan 2023; epub ahead of print</small></div>
de La Harpe R, Thorball CW, Redin C, Fournier S, ... Fellay J, Vaucher J
Eur J Prev Cardiol: 18 Jan 2023; epub ahead of print | PMID: 36652418
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<div><h4>Leisure-time and competitive sport participation: a changing paradigm for HCM patients.</h4><i>Pelliccia A, Day S, Olivotto I</i><br /><AbstractText>HCM has long been considered the most frequent cause of death in athletes, and reason for disqualification from sport. However, our perception of the impact of sports on HCM is largely based on anecdotal evidence. In this review, we provide a reappraisal of current knowledge relative to 1) the impact of sport on LV remodeling, and 2) on the clinical outcome of HCM in athletes. 1) The limited available evidence argues against the hypothesis that intensive exercise conditioning may trigger and/or worsen the development of LV hypertrophy or cause changes in LV function in adult HCM athletes. 2) Recent observations challenge the concept of a detrimental effect of sport on HCM clinical course. The Reset-HCM study showed that 16-week moderate-intensity exercise resulted in a small, significant increase in exercise capacity and no adverse events. In a cohort of 88 low-risk HCM athletes followed for a 7-year period, survival analyses showed no difference in mortality between HCM who discontinued or pursued vigorous exercise programmes. Further reassurance was provided by the ICD Sports Safety Registry. Clinical implications: At present, patients\' attitude to sport participation is highly variable, based on social and legal backgrounds surrounding medical practice in different countries. The shared-decision-making as suggested by current US and European guidelines allows the physician to deliver a tailored and more liberal advice. Physicians should be aware of the changing paradigm relative to exercise and sport prescription for HCM and promote active lifestyle as an integral component of modern management of HCM patients.</AbstractText><br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 13 Jan 2023; epub ahead of print</small></div>
Pelliccia A, Day S, Olivotto I
Eur J Prev Cardiol: 13 Jan 2023; epub ahead of print | PMID: 36638119
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<div><h4>Early adulthood exercise capacity, but not muscle strength, associates with subclinical atherosclerosis 40 years later in Swedish men.</h4><i>Fortuin-de Smidt M, Bergman F, Grönlund C, Hult A, ... Wennberg M, Wennberg P</i><br /><b>Background</b><br />Poor exercise capacity and muscle strength in early adulthood are risk factors for cardiovascular disease (CVD). However, it is unclear how these factors relate to subclinical atherosclerosis due to a lack of longitudinal studies. This study investigated whether early adulthood exercise capacity and muscle strength associated with later adulthood subclinical atherosclerosis.<br /><b>Methods</b><br />This study included Swedish men (n = 797) that were eligible for military conscription (at ∼18-years of age) and that participated in the baseline assessment of the Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) trial between 2013 and 2016 (at 60-years of age). At conscription, isometric muscle strength (dynamometer) and maximum exercise capacity (maximal load cycle ergometer test) were measured. During later adulthood (at 60-years old), the presence of carotid plaques and intima media thickness (cIMT) were measured by high resolution ultrasound.<br /><b>Results</b><br />At follow-up, plaques were present in 62% (n = 493) of men. Exercise capacity in early adulthood associated with 19% lower odds of plaques (odds ratio (OR) 0.81, 95% confidence interval (CI) 0.68-0.96), independent of muscle strength. This association was not mediated by any single CVD risk factor. However, the total indirect effect of later, but not early, adulthood CVD risk factors was significant while the direct effect was non-significant (OR 0.85, 95%CI 0.71-1.02). Associations between muscle strength and subclinical atherosclerosis were non-significant.<br /><b>Conclusion</b><br />Higher exercise capacity during early adulthood, but not muscle strength, may protect against carotid plaque development during adulthood mediated by the combination rather than a single later adulthood CVD risk factors.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 12 Jan 2023; epub ahead of print</small></div>
Fortuin-de Smidt M, Bergman F, Grönlund C, Hult A, ... Wennberg M, Wennberg P
Eur J Prev Cardiol: 12 Jan 2023; epub ahead of print | PMID: 36631734
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<div><h4>Sex Differences in Type A Acute Aortic Dissection: A Systematic Review and Meta-Analysis.</h4><i>Carbone A, Ranieri B, Castaldo R, Franzese M, ... Czerny M, Bossone E</i><br /><b>Background</b><br />In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting.<br /><b>Aim</b><br />To explore sex differences in clinical features, management and outcomes among patients with type A AAD.<br /><b>Methods</b><br />A systematic review and meta-analysis of literature were conducted for studies (2004-2022) reporting type A AAD sex differences. Among the 1938 studies retrieved, 16 (16069 patients, 7142 women and 8927 men) fulfilled all eligibility criteria. Data were aggregated used random effects model as pooled risk ratio and mean difference.<br /><b>Results</b><br />Due to information reported by considered manuscripts, analysis were performed only among surgically treated type A AAD patients. At the time of hospital presentation type A AAD women were older than men but had lower BMI, BSA and creatinine plasma levels. Active smoking, bicuspid aortic valve and previous cardiac surgery were less common in women while diabetes mellitus was more frequent. Furthermore women experienced more frequently pericardial effusion/cardiac tamponade than men. Interestingly, in-hospital surgical mortality did not differ between sexes (RR, 1.02; 95% CI, 0.53 - 1.99; p = 0.95), whereas 5 (RR 0.94; 95% CI: 0.92 - 0.97; p < 0.001) and 10-year survival (RR 0.82; 95% CI: 0.74 - 0.92; p = 0.004) was higher among men. A descriptive analysis of in-hospital outcomes among medically treated type A AAD patients confirmed prohibitive high mortality for both sexes (men 58.6% vs women 53.8%, p = 0.59).<br /><b>Conclusions</b><br />A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies. PROSPERO registry ID: CRD42022359072.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 11 Jan 2023; epub ahead of print</small></div>
Carbone A, Ranieri B, Castaldo R, Franzese M, ... Czerny M, Bossone E
Eur J Prev Cardiol: 11 Jan 2023; epub ahead of print | PMID: 36629802
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<div><h4>Association between eating behaviour and 13-year cardiovascular damages in the initially healthy STANISLAS cohort.</h4><i>Puchkova-Sistac A, de Lauzon-Guillain B, Girerd N, Boivin JM, ... Rossignol P, Wagner S</i><br /><b>Aims</b><br />Several dimensions of eating behaviour (EB), such as restrained eating (RE), appear to be cross-sectionally associated with certain cardiovascular (CV) diseases and metabolic risk factors although little is known regarding longitudinal associations. This study aimed to assess the associations between EB and CV damage or metabolic syndrome after 13 years, in initially healthy individuals.<br /><b>Methods and results</b><br />This study included 1109 participants from the familial STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) cohort study. Emotional eating (EmE), RE, and external eating were assessed using the Dutch Eating Behaviour Questionnaire. Metabolic syndrome and CV damages such as carotid-femoral pulse-wave velocity (cfPWV), left ventricular mass, carotid intima-media thickness, and diastolic dysfunction (DD) were measured after a period of 13 years. Mixed model analysis with a family random effect and adjustment for age, sex, education, temporal gap, physical activity, metabolic factors at baseline, and the onset of CV disease during follow-up, and mediation analysis were performed in adults and adolescents separately. Among adults, EmE was associated with a 38% increased risk of DD 13 years later [odds ratio = 1.38 (1.05; 1.83)]. Stress level mediated 31.9% of this association (P = 0.01). Emotional eating was positively associated with cfPWV (β=0.02 [0.01; 0.04]). External eating was slightly associated with lower cfPWV (β=-0.03 [-0.05; -0.01]). No associations were observed between EB dimensions and metabolic syndrome. Energy intake was not found to be a mediator of any associations.<br /><b>Conclusion</b><br />Our results suggest that CV prevention should also take into account EB and include emotion regulation skills teaching.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 11 Jan 2023; epub ahead of print</small></div>
Puchkova-Sistac A, de Lauzon-Guillain B, Girerd N, Boivin JM, ... Rossignol P, Wagner S
Eur J Prev Cardiol: 11 Jan 2023; epub ahead of print | PMID: 36626936
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<div><h4>Longitudinal association of ECG abnormalities with major adverse cardiac events in people with type 2 diabetes: The Hoorn Diabetes Care System cohort.</h4><i>Harms PP, Elders PPJM, Femke R, Lissenberg-Witte BI, ... van der Heijden AA, for ESCAPE-NET</i><br /><b>Aims</b><br />To investigate the association of (changes in) ECG abnormalities with incident major adverse cardiac events (MACE) in people with type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD).<br /><b>Methods</b><br />A prospective longitudinal study of 11,993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998-2018), included cardiovascular risk factors, over 70,000 ECGs, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazzard Ratios with 95%CIs).<br /><b>Results</b><br />During a median follow-up of 6.6 (IQR, 3.1-10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3-10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 CHD, 250 HF, 126 SCA). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration (HR, 4.01 (95%CI, 2.67-6.03)), QS pattern (2.68 (0.85-8.49)), ST-segment/T-wave abnormalities (4.26 (2.67-6.80)), and tall R-wave (2.23 (1.33-3.76)). Only QS pattern (2.69 (1.20-6.03)), and ST-segment/T-wave abnormalities (2.11 (1.48-3.02)) were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups.<br /><b>Conclusion</b><br />In people with T2D without pre-existing cardiovascular disease, ECG abnormalities related to decelerated conduction, ischemia and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischemic disorders are signs of CHD.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 10 Jan 2023; epub ahead of print</small></div>
Harms PP, Elders PPJM, Femke R, Lissenberg-Witte BI, ... van der Heijden AA, for ESCAPE-NET
Eur J Prev Cardiol: 10 Jan 2023; epub ahead of print | PMID: 36625405
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<div><h4>Optimal or standard control of systolic and diastolic blood pressure across risk factor categories in patients with chronic coronary syndromes.</h4><i>Vidal-Petiot E, Elbez Y, Mesnier J, Ducrocq G, ... Fox KM, Steg PG</i><br /><b>Aims</b><br />Guidelines have lowered blood pressure (BP) targets to <130/80 mmHg. We examined the benefit of intensive control for each BP component, versus the burden of other modifiable risk factors, in patients with chronic coronary syndromes (CCS).<br /><b>Methods and results</b><br />The CLARIFY registry (ISRCTN43070564) enrolled 32 703 CCS patients, from 2009-2010, with a 5-year follow-up. Patients with either BP component below European guideline safety boundaries (120/70 mmHg) were excluded, leaving 19 167 patients (mean age 63.8 ± 10.1 years, 78% men) in the present analysis. A multivariable-adjusted Cox proportional hazards model showed a gradual increase in cardiovascular risk (cardiovascular death, myocardial infarction, or stroke) when the number of uncontrolled risk factors (active smoking, no physical activity, low-density lipoprotein cholesterol ≥100 mg/dL, and diabetes with glycated haemoglobin ≥7%) increased [adjusted hazard ratio (HR): 1.34; 95% confidence interval (CI): 1.17-1.52, 1.65 (1.40-1.94), and 2.47 (1.90-3.21) for 1, 2, and 3 or 4 uncontrolled risk factors, respectively, versus 0], without significant interaction with BP. Although uncontrolled systolic (≥140 mmHg) and diastolic (≥90 mmHg) BP were both associated with higher risk than standard BP, standard BP was associated with higher risk than optimal control for only the diastolic component (adjusted HR: 1.08; 95% CI: 0.94-1.25 for systolic BP 130-139 versus 120-129 mmHg and 1.43; 95% CI: 1.27-1.62 for diastolic BP 80-89 versus 70-79 mmHg).<br /><b>Conclusions</b><br />Our results suggest that optimal BP target in CCS may be ≤139/79 mmHg, and that optimizing the burden of other risk factors should be prioritized over further reduction of systolic BP.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 07 Jan 2023; epub ahead of print</small></div>
Vidal-Petiot E, Elbez Y, Mesnier J, Ducrocq G, ... Fox KM, Steg PG
Eur J Prev Cardiol: 07 Jan 2023; epub ahead of print | PMID: 36617264
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<div><h4>Causal associations of sleep apnea, snoring with cardiovascular diseases, and the role of body mass index: a two-sample Mendelian randomization study.</h4><i>Wang J, Campos AI, Rentería ME, Xu L</i><br /><b>Aims</b><br />Previously, observational studies have identified associations between sleep apnea (SA) and cardiovascular diseases (CVDs), whereas whether the associations are causal remain unclear.<br /><b>Methods</b><br />We used the bi-directional, two-sample Mendelian randomization (MR) study to assess the existence and direction of the causal relationship between SA or snoring and CVDs. Multivariable MR (MVMR) was used to assess the direct effect of SA on CVDs after adjusting for BMI. Single-nucleotide polymorphisms (SNPs) associated with SA and snoring were obtained from the latest genome-wide association study, which combined five cohorts with a total number of 25,008 SA cases, 172,050 snoring cases (total = 523,366).<br /><b>Results</b><br />Among the analytic sample of 523,366 individuals (25,008 SA cases and 172,050 snoring cases), and after correcting for multiple testing, inverse-variance weighted (IVW) showed SA and snoring increased the risk of hypertension (odds ratio (OR) = 1.03, 95%CI 1.02-1.05 and 1.05, 1.03-1.07), and coronary artery disease (CAD) (1.41,1.19-1.67 and 1.61,1.26-2.07) with all false-discovery rate (FDR) < 0.05, but such associations were decreased dramatically after adjusting for body mass index (BMI) using MVMR-IVW (0.06 < FDRBMI adjusted < 0.20). SA and snoring were not associated with atrial fibrillation (AF), heart failure (HF) and stroke. The presence of hypertension may increase the risk of SA (1.53, 1.04-2.25), but this association did not pass the multiple comparisons (FDR > 0.05).<br /><b>Discussion</b><br />Our results suggest SA and snoring increased the risk of hypertension and CAD, and these associations may partly be driven by BMI. Conversely, no evidence of CVDs causally influencing SA or snoring was found.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 05 Jan 2023; epub ahead of print</small></div>
Wang J, Campos AI, Rentería ME, Xu L
Eur J Prev Cardiol: 05 Jan 2023; epub ahead of print | PMID: 36611115
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<div><h4>Lifestyle trajectories and ischemic heart diseases: a prospective cohort study in UK Biobank.</h4><i>Gao Y, Chen Y, Hu M, Song J, ... Lin Y, Wu IX</i><br /><b>Aims</b><br />To evaluate the associations of baseline and long-term trajectories of lifestyle with incident ischemic heart diseases (IHD).<br /><b>Methods</b><br />29,164 participants in the UK Biobank who had at least one follow-up assessment and were free of IHD at the last follow-up assessment were included. We constructed a weighted unhealthy lifestyle score though summing five lifestyle factors (smoking, physical activity, diet, BMI, and sleep duration). Lifestyle assessed at baseline (2006-2009), the first follow-up assessment (2012-2013) and the second follow-up assessment (since 2014) were used to derive the trajectories of each individual. The joint categories were created through cross-classifying three baseline lifestyle categories (ideal, intermediate and poor) by three lifestyle trajectory categories (improve, maintain and decline).<br /><b>Results</b><br />During a median follow-up period of 4.2 years, 868 IHD events were recorded. The hazard ratio (HR) of incident IHD associated with per unit increase in unhealthy lifestyle trajectory was 1.08 (95% confidence interval (CI): 0.99-1.17). Subgroup analyses indicated such association was stronger among individuals with hypertension (HR: 1.13, 95%CI: 1.03-1.24), diabetes (HR: 1.23, 95%CI: 0.96-1.58) or hyperlipidemia (HR: 1.09, 95%CI: 0.97-1.22). Compared with participants consistently adhering to an ideal lifestyle (ideal-maintain), the HRs of incident IHD were: 1.30 (1.07-1.58) for intermediate-maintain, 1.52 (1.23-1.88) for poor-maintain, 1.25 (0.93-1.68) for intermedia-improve, 1.48 (1.17-1.88) for poor-improve, 1.46 (1.08-1.99) for intermedia-decline and 1.77 (1.21-2.59) for poor-decline.<br /><b>Conclusions</b><br />A declined lifestyle trajectory increased the risk of incident IHD, irrespective of baseline lifestyle levels. Individuals with hypertension, diabetes or hyperlipidemia were more predisposed to the influence of lifestyle change.<br /><br />© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<br /><br /><small>Eur J Prev Cardiol: 04 Jan 2023; epub ahead of print</small></div>
Gao Y, Chen Y, Hu M, Song J, ... Lin Y, Wu IX
Eur J Prev Cardiol: 04 Jan 2023; epub ahead of print | PMID: 36602532
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<div><h4>Use of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists according to the 2019 ESC guidelines and the 2019 ADA/EASD consensus report in a national population of patients with type 2 diabetes.</h4><i>Lim CE, Pasternak B, Eliasson B, Danaei G, Ueda P</i><br /><b>Aims</b><br />To assess treatment eligibility for, and received treatment with, sodium-glucose co-transporter 2 inhibitors (SGLT2) and glucagon-like peptide-1 (GLP-1) receptor agonists according to the 2019 ADA/EASD consensus report and the 2019 ESC guidelines in a nationwide sample of patients with type 2 diabetes.<br /><b>Methods and results</b><br />Both sets of guidelines included the treatment indications of heart failure, chronic kidney disease and atherosclerotic cardiovascular disease while only the 2019 ESC guidelines also recommended treatment based on high or very high cardiovascular risk. The analyses included 435 000 patients with type 2 diabetes identified from the Swedish National Diabetes Register (2020-2021). According to the 2019 ESC guidelines, 79.5% were recommended any of the two drugs (SGLT2 inhibitors: 37.2%; SGLT2 inhibitors or GLP-1 receptor agonists: 40.9%; GLP-1 receptor agonists: 1.4%). According to the 2019 ADA/EASD consensus report, 48.8% were recommended any of the two drugs (SGLT2 inhibitors: 37.2%; GLP-1 receptor agonists: 11.6%). Of those who had been recommended any of the two drugs, 33·7% had received the recommended treatment according to the 2019 ESC guidelines and 25·4% according to the 2019 ADA/EASD consensus report.<br /><b>Conclusions</b><br />In this nationwide study, the proportion of patients with type 2 diabetes who were recommended treatment with an SGLT2 inhibitor or a GLP-1 receptor agonist was approximately 80% according to the 2019 ESC guidelines and around half according to the 2019 ADA/EASD consensus report. Uptake of these recommendations in routine clinical practice was limited.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 30 Dec 2022; epub ahead of print</small></div>
Abstract
<div><h4>Glimepiride Use is Associated with Reduced Cardiovascular Mortality in Patients with Type 2 Diabetes and Chronic Heart Failure: A Prospective Cohort Study.</h4><i>He W, Yuan G, Han Y, Yan Y, ... Ni L, Wang DW</i><br /><b>Background</b><br />Glimepiride has good cardiovascular safety. However, whether glimepiride benefits clinical cardiovascular outcomes is unclear.<br /><b>Methods</b><br />A total of 21,451 inpatients with type 2 diabetes (T2D) and chronic heart failure (CHF) were analyzed, including 638 who received glimepiride treatment and 20,813 who did not. Propensity score matching yielded 509 pairs (glimepiride and non-glimepiride groups), and both groups were followed up. Kaplan-Meier and Cox regression analyses were used to compare all-cause mortality, cardiovascular mortality, hospitalizations and emergency visits for heart failure, and hospitalizations for acute myocardial infarction or stroke.<br /><b>Results</b><br />During follow-up, the all-cause mortality (adjusted hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.35-0.63; P < 0.001), cardiovascular mortality (adjusted HR, 0.34; 95% CI, 0.24-0.48; P < 0.001), and number of hospitalizations and emergency visits for heart failure (adjusted HR, 0.42; 95% CI, 0.36-0.50; P < 0.001) and hospitalizations for acute myocardial infarction or stroke (adjusted HR, 0.53; 95% CI, 0.38-0.73; P < 0.001) were significantly lower in the glimepiride group; the conclusion remained similar in all subgroups. Furthermore, high-dose glimepiride use (2-4 mg/day) was associated with lower cardiovascular mortality than low-dose (1 mg/day) (adjusted HR, 0.55; 95% CI, 0.31-0.99; P = 0.047). Glimepiride exhibited good molecular docking with soluble epoxide hydrolase (sEH) and increased the level epoxyeicosatrienoic acid (EET).<br /><b>Conclusions</b><br />Long-term continuous glimepiride use is associated with better survival, fewer hospitalizations and emergency visits for heart failure, and fewer hospitalizations for acute myocardial infarction or stroke in patients with T2D and CHF. High-dose glimepiride has greater cardiovascular protective advantages than low-dose glimepiride. The cardiovascular protective effect of glimepiride may be related to the EET level increase through sEH inhibition.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 27 Dec 2022; epub ahead of print</small></div>
He W, Yuan G, Han Y, Yan Y, ... Ni L, Wang DW
Eur J Prev Cardiol: 27 Dec 2022; epub ahead of print | PMID: 36573717
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<div><h4>Nationwide cardiovascular risk categorization: applying the European Society of Cardiology (ESC) guidelines to the Swedish National Diabetes Register.</h4><i>Eliasson B, Ekelund J, Holmberg CN, Wolden ML, Matthiessen KS, James S</i><br /><b>Aims</b><br />The 2021 European Society of Cardiology (ESC) guidelines recommend that patients with type 2 diabetes (T2D) with a very high cardiovascular disease (CVD) risk receive cardiovascular (CV)-protective glucose-lowering medication (glucagon-like peptide-1 receptor agonists or sodium-glucose co-transporter-2 inhibitors). This analysis compared previous prescribing practices with the ESC recommendations.<br /><b>Methods and results</b><br />Patients in the Swedish National Diabetes Register (NDR) with T2D, aged 18-90 years, not receiving CV-protective glucose-lowering medication in 2017 were identified, and the ESC criteria for very high CVD risk was applied. The composite outcome of major adverse CV events (MACE; defined as CV death, non-fatal stroke or non-fatal myocardial infarction) during 2017 was calculated and the number of MACE avoided with semaglutide, an example of a CV-protective glucose-lowering medication, was estimated for patients within a certain CV risk score.Of the 320,028 patients in the NDR with T2D who were not receiving CV-protective glucose-lowering medication, 129,512 patients had a very high CVD risk. Patients with a very high CVD risk had a high incidence of MACE (75.4 events/1000 person-years), which was higher in those with atherosclerotic CVD (ASCVD) with and without elevated glycated haemoglobin (>9%; 136.5 and 90.8 events/1000 person-years, respectively). If patients with a very high CVD risk, according to the ESC, and ASCVD received semaglutide, 803 MACE may have been avoided in 2017.<br /><b>Conclusions</b><br />This analysis highlights differences between previous prescribing practices in Sweden and the 2021 ESC guidelines, and offers strategies to prioritize CV-protective glucose-lowering medication for patients who would benefit most.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 26 Dec 2022; epub ahead of print</small></div>
Eliasson B, Ekelund J, Holmberg CN, Wolden ML, Matthiessen KS, James S
Eur J Prev Cardiol: 26 Dec 2022; epub ahead of print | PMID: 36567502
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<div><h4>High intensity interval training induces beneficial effects on coronary atheromatous plaques - a randomized trial.</h4><i>Vesterbekkmo EK, Aamot Aksetøy IL, Follestad T, Nilsen HO, ... Wiseth R, Madssen E</i><br /><b>Background</b><br />Coronary atheroma volume is associated with risk of coronary events in coronary artery disease (CAD). Exercise training is a cornerstone in primary and secondary prevention of CAD, but the effect of exercise on coronary atheromatous plaques is largely unknown.<br /><b>Purpose</b><br />We assessed the effect of six months supervised high intensity interval training (HIIT) on coronary plaque geometry using intravascular ultrasound in patients with stable CAD following percutaneous coronary intervention (PCI).<br /><b>Methods</b><br />Sixty patients were randomized to two sessions of weekly supervised HIIT at 85-95% of peak heart rate (n = 30) or to follow contemporary preventive guidelines (control group, n = 30). The study endpoints were change in percent atheroma volume (PAV) and total atheroma volume (TAV) normalized for segment length (TAVnorm) at six-month follow-up.<br /><b>Results</b><br />The change in average PAV for matched coronary segments from baseline to follow-up showed a significant between-group difference (-1.4, 95% CI: -2.7 to -0.1, p = 0.036). There was a significant reduction in the HIIT group (-1.2, 95% CI: -2.1 to -0.2, p = 0.017) while not in the control group (0.2, 95% CI: -0.7 to 1.1, p = 0.616). TAVnorm was reduced (-9 mm3, 95% CI: -14.7 to -3.4, p = 0.002) after HIIT, with a significant between-group difference (-12.0 mm3, 95% CI: -19.9 to -4.2, p = 0.003).<br /><b>Conclusion</b><br />In patients with established CAD, a regression of atheroma volume was observed in those undergoing six months of supervised HIIT compared with patients following contemporary preventive guidelines. Our study indicates that high intensity interval training counteracts atherosclerotic coronary disease progression and reduces atheroma volume in residual coronary atheromatous plaques following PCI.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 23 Dec 2022; epub ahead of print</small></div>
Vesterbekkmo EK, Aamot Aksetøy IL, Follestad T, Nilsen HO, ... Wiseth R, Madssen E
Eur J Prev Cardiol: 23 Dec 2022; epub ahead of print | PMID: 36562212
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<div><h4>Remnant cholesterol in patients admitted for acute coronary syndromes.</h4><i>Cordero A, Alvarez-Alvarez B, Escribano D, García-Acuña JM, ... Zuazola P, González-Juanatey JR</i><br /><b>Background</b><br />Remnant cholesterol has been identified as one of leading lipid values associated with the incidence of coronary heart disease. There is scarce evidence on its distribution and prognostic value in acute coronary syndrome (ACS) patients.<br /><b>Methods</b><br />We included all consecutive patients admitted for ACS in two different centers. Remnant cholesterol was calculated by the equation: total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol and values ≥30 were considered high.<br /><b>Results</b><br />Among the 7,479 patients, median remnant cholesterol level was 28 mg/dl (21-39) and 3,429 (45.85%) patients had levels ≥30 mg/dl. Age (r: -0.29) and body mass index (r: 0.44) were the variables more strongly correlated. At any given age, patients with overweigh or obesity had higher levels. In-hospital mortality was 3.75% (280 patients). Remnant cholesterol was not associated to higher in-hospital mortality risk (OR: 0.89; p = 0.21). After discharge (median follow-up of 57 months) an independent and linear risk of all-cause mortality and heart failure (HF) associated to cholesterol remnant levels was observed. Remnant cholesterol levels >60 mg/dl were associated to higher risk of mortality (HR: 1.49 95% CI 1.08-2.06; p = 0.016), cardiovascular mortality (HR: 1.49 95% CI 1.08-2.06; p = 0.016) and HF readmission (sHR: 1.55 95% CI 1.14-2.11; p = 0.005).<br /><b>Conclusions</b><br />Elevated remnant cholesterol is highly prevalent in patients admitted for ACS and is inversely correlated with age and positively with body mass index. Remnant cholesterol levels was not associated to higher in-hospital mortality risk but they were associated with higher long-term risk of mortality and HF.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 23 Dec 2022; epub ahead of print</small></div>
Cordero A, Alvarez-Alvarez B, Escribano D, García-Acuña JM, ... Zuazola P, González-Juanatey JR
Eur J Prev Cardiol: 23 Dec 2022; epub ahead of print | PMID: 36560864
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<div><h4>Cardiovascular risk profile after a complicated pregnancy across ethnic groups: The HELIUS study.</h4><i>Burger RJ, Gordijn SJ, Bolijn R, Reilingh A, ... Van Valkengoed IGM, Ganzevoort W</i><br /><b>Aims</b><br />Little is known about how pregnancy complications and cardiovascular disease (CVD) risk are associated, specifically among ethnic minorities. In this study we examined this association in women from six ethnic groups, and the potential value of pregnancy complications as eligibility criterion for CVD risk screening.<br /><b>Methods</b><br />We conducted a cross-sectional study combining obstetric history from the Dutch perinatal registry with data on cardiovascular risk up to 15 years after pregnancy from the multi-ethnic HELIUS study. We included 2,466 parous women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. Associations were studied across ethnicities and predictive value of pregnancy complications for CVD risk factors above traditional eligibility criteria for CVD risk screening was assessed using Poisson regression.<br /><b>Results</b><br />History of hypertensive disorders of pregnancy and preterm birth were associated with higher prevalence of chronic hypertension and chronic kidney disease across most groups (prevalence ratio 1.6-1.9). Gestational diabetes mellitus was associated with increased type 2 diabetes mellitus risk, particularly in ethnic minority groups (prevalence ratio 4.5-7.7). Associations did not significantly differ across ethnic groups. The prediction models did not improve substantially after adding pregnancy complications to traditional eligibility criteria for CVD risk screening.<br /><b>Conclusion</b><br />History of hypertensive disorders of pregnancy, preterm birth and gestational diabetes mellitus is associated with CVD risk factors in parous women, without evidence of a differential association across ethnic groups. However, addition of pregnancy complications to traditional eligibility criteria for CVD risk screening does not substantially improve the prediction of prevalent CVD risk factors.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 21 Dec 2022; epub ahead of print</small></div>
Burger RJ, Gordijn SJ, Bolijn R, Reilingh A, ... Van Valkengoed IGM, Ganzevoort W
Eur J Prev Cardiol: 21 Dec 2022; epub ahead of print | PMID: 36545905
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<div><h4>The Effect of Living Environmental Factors on Cardiovascular Diseases in Chinese Adults: Results from a Cross-sectional and Longitudinal Study.</h4><i>Yang Y, Cao L, Xia Y, Li J</i><br /><b>Aims</b><br />This study aimed to investigate the association between multiple living environmental factors and cardiovascular diseases (CVDs).<br /><b>Methods</b><br />This study was conducted on the China Health and Retirement Longitudinal Study (CHARLS), with 12,489 subjects in the cross-sectional study and 7,932 subjects in the seven-year follow-up. Living environmental factors included ambient fine particulate matter (PM2.5), indoor fuel use, tap water use, and residence type. Logistic regression and Cox proportional hazard regression models were applied to explore the association between living environmental risk factors and CVD events in a cross-sectional and a cohort analysis, respectively.<br /><b>Results</b><br />Compared with subjects in the low-risk groups, those in the middle-risk (odd ratio [OR], 95% confidence interval [CI]: 1.203, 0.943-1.534) and high-risk groups (OR, 95% CI: 1.616, 1.259-2.074) showed increased risks of CVD prevalence when considering the combined effects of their living environment. During the follow-up, similar associations were observed (hazard ratio [HR], 1.541, 95% CI [1.142-2.080] for the high-risk group; HR 1.296, 95% CI [0.968-1.736] for the middle-risk group); P for trend = 0.003).<br /><b>Conclusion</b><br />An overall poor living environmental quality is a potential risk factor for CVD. Future studies should focus more on the effects of exposure to multiple factors.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 20 Dec 2022; epub ahead of print</small></div>
Yang Y, Cao L, Xia Y, Li J
Eur J Prev Cardiol: 20 Dec 2022; epub ahead of print | PMID: 36537654
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<div><h4>Association of genetically-predicted lipid traits and lipid-modifying targets with heart failure.</h4><i>Xiao J, Ji J, Zhang N, Yang X, ... Chen L, Huang W</i><br /><b>Aims</b><br />To assess the association of genetically-predicted lipid traits and lipid-modification via licensed or investigational targets with heart failure (HF).<br /><b>Methods and results</b><br />Two-sample Mendelian randomization (MR) study was conducted using summary-level genome-wide association studies (GWASs) from UK Biobank and HERMES Consortium. Genetic variants obtained from UK Biobank GWAS data were selected as instrumental variables to predict the level of lipid traits (low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (ApoB) and apolipoprotein AI (ApoAI)) and lipid-modifying effect of eight drug targets (HMGCR, PCSK9, NPC1L1, PPARA, LPL, ANGPTL3, APOC3 and CETP). In this study, we observed that genetically-predicted LDL-C, TG, HDL-C or ApoB were significantly related to HF, which were mainly mediated by CHD. Drug target MR analyses identified PCSK9, CETP and LPL as potential targets to prevent HF. The genetic proxy of LDL-C and ApoB increase modified by PCSK9 showed similar evidence in increasing risk of HF (PLDL-C = 1.27*10-4; PApoB = 1.94*10-4); CETP played a role in HF risk via modifying all investigational lipid traits with the strongest evidence though ApoB (P = 5.87*10-6); LPL exerted effects on HF via modifying most lipid traits with the strongest evidence observed via modifying TG (P = 3.73*10-12).<br /><b>Conclusion</b><br />This two-sample MR study provided genetic evidence of the associations between lipid traits and HF risk, which were mostly mediated by CHD. Besides, drug target MR studies indicated that PCSK9 inhibition, CETP inhibition and LPL activation were effective in HF reduction.<br /><b>Funding information</b><br />Start-up Fund for high-level talents of Fujian Medical University.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 15 Dec 2022; epub ahead of print</small></div>
Xiao J, Ji J, Zhang N, Yang X, ... Chen L, Huang W
Eur J Prev Cardiol: 15 Dec 2022; epub ahead of print | PMID: 36520639
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<div><h4>Reducing gap in pre-hospital delay between women and men presenting with ST-Elevation myocardial infarction.</h4><i>Foster-Witassek F, Rickli H, Roffi M, Pedrazzini G, ... Erne P, Radovanovic D</i><br /><b>Introduction</b><br />This study aimed to analyse changes in prehospital delay over time in women and men presenting with ST-elevation myocardial infarction (STEMI) in Switzerland.<br /><b>Methods</b><br />AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 was analysed using multivariable quantile regression including the following covariates: interaction between sex and admission year, age, diabetes, pain at presentation, myocardial infarction (MI) history, heart failure history, hypertension and renal disease.<br /><b>Results</b><br />Among the 15,350 patients included (74.5% men), the median (IQR) delay between 2002 and 2019 was 150 (84; 345) minutes for men and 180 (100; 414) minutes for women. The unadjusted median prehospital delay significantly decreased over time for both sexes but the decreasing trend was stronger for women. Specifically, the unadjusted sex differences in delay decreased from 60 minutes in 2002 (p = 0.0042) to 40.5 minutes in 2019 (p = 0.165). The multivariable model revealed a significant interaction between sex and admission year (p = 0.038) indicating that the decrease in delay was stronger for women (-3.3 minutes per year) than for men (-1.6 minutes per year) even after adjustment. The adjusted difference between men and women decreased from 26.9 minutes in 2002 to -1.97 minutes for women in 2019.<br /><b>Conclusions</b><br />Over two decades, delay between symptom onset and hospital admission in STEMI decreased significantly for men and women. The decline was more pronounced in women, leading to the sex gap disappearing in the adjusted analysis for 2019.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 13 Dec 2022; epub ahead of print</small></div>
Foster-Witassek F, Rickli H, Roffi M, Pedrazzini G, ... Erne P, Radovanovic D
Eur J Prev Cardiol: 13 Dec 2022; epub ahead of print | PMID: 36511951
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<div><h4>Five-year Changes in Alcohol Intake and Risk of Atrial Fibrillation: A Danish Cohort Study.</h4><i>Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, ... Dahm CC, Jensen HK</i><br /><b>Background:</b><br/>and aims</b><br />Alcohol intake is a well-established risk factor for atrial fibrillation (AF). However, evidence on the effects of changes in alcohol intake to primary AF prevention is sparse. The aim of this study was to examine the association between five-year changes in alcohol intake and risk of incident AF.<br /><b>Methods</b><br />This study was based on the Danish cohort study Diet, Cancer, and Health. Lifestyle factors were assessed using questionnaires at a recruitment research examination and at a second examination five years later. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry.<br /><b>Results</b><br />43,758 participants without prior AF were included. Median age was 61 [25th-75th percentile 58-66] years and 54% were female. Over a median follow-up time of 15.7 years, 5,312 participants had incident AF (incidence rate 8.6/1,000 person-years). Compared to stable intake, increases in alcohol intake to ≥21 drinks/week from ≤6.9 drinks/week (HR 1.38, 95% CI 1.09-1.72) or 14-20.9 drinks/week (HR 1.27, 95% CI 1.01-1.59) at baseline were associated with higher risk of AF. In contrast, we did not observe a statistically significant association between reductions in alcohol intake and risk of AF.<br /><b>Conclusions</b><br />A five-year increase in alcohol intake was associated with greater risk of AF compared to a stable low/moderate intake.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 12 Dec 2022; epub ahead of print</small></div>
Frederiksen TC, Christiansen MK, Benjamin EJ, Overvad K, ... Dahm CC, Jensen HK
Eur J Prev Cardiol: 12 Dec 2022; epub ahead of print | PMID: 36508613
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<div><h4>Global Trends and Regional Differences in Incidence and Mortality of Cardiovascular Disease, 1990-2019: Findings from 2019 Global Burden of Disease Study.</h4><i>Li Y, Cao GY, Jing WZ, Liu J, Liu M</i><br /><b>Aims</b><br />Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide and is linked with a regional economic burden. We analyzed and compared global trends as well as regional and sociodemographic differences in CVD incidence and mortality.<br /><b>Methods and results</b><br />We obtained data to annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of CVD during 1990-2019 from the 2019 Global Burden of Disease Study. To quantify the temporal trends, we calculated changes in the incident cases and deaths as well as the estimated annual percentage changes (EAPCs) of age-standardized rates. Globally, CVD incident cases increased by 77.12% from 31.31 million in 1990 to 55.45 million in 2019; deaths rose by 53.81% from 12.07 million in 1990 to 18.56 million in 2019. The overall ASIR (EAPC, -0.56; 95% confidence interval [CI], -0.59 to -0.53) and ASMR (EAPC, -1.46; 95%CI, -1.51 to -1.40) decreased in this period. Against the global trend of ASIR falling, an increasing trend was found in Uzbekistan (EAPC, 1.24; 95%CI, 0.97-1.50), Tajikistan (EAPC, 0.49; 95%CI, 0.47-0.52), and Zimbabwe (EAPC, 0.42; 95%CI, 0.33-0.50). The number of CVD incident cases increased remarkably in low (108.3%), low-middle (114.81%) and middle (117.85%) Socio-Demographic Index regions in 1990-2019.<br /><b>Conclusion</b><br />Despite the increased number of CVD cases and deaths after adjusting for changes in population age, we observed a consistent decrease in age-standardized incidence and mortality in most countries. However, specific regions-especially low to middle SDI regions-present worrying increases in CVD cases and deaths.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 02 Dec 2022; epub ahead of print</small></div>
Li Y, Cao GY, Jing WZ, Liu J, Liu M
Eur J Prev Cardiol: 02 Dec 2022; epub ahead of print | PMID: 36458973
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<div><h4>Impact of a national screening programme on obesity and cardiovascular risk factors.</h4><i>Nakao YM, Gale CP, Miyazaki K, Kobayashi H, ... Nadarajah R, Motonishi T</i><br /><b>Background</b><br />The benefits of nationwide screening and tailored health guidance on improving obesity and cardiovascular risk factors is uncertain.<br /><b>Aim</b><br />To investigate the association of the national health screening and tailored health guidance with population health outcomes.<br /><b>Methods</b><br />A fuzzy regression discontinuity design analyzed data of men and women aged 40 to 74 years who participated in a nationwide health screening programme in Japan from Apr 1, 2008, to Mar 30, 2018 and were recorded in the Japanese National Database. Exposure was assignment to the national health guidance of counselling on healthy lifestyle and clinical follow-up for individuals found to have waist circumference ≥85 cm for men ≥90 cm for women with one or more cardiovascular risk factors during annual national health screening. The primary outcomes were changes in obesity status and cardiovascular risk factors one year after screening.<br /><b>Results</b><br />Of 3 490 112 men and 2 328 929 women, the assignment to the health guidance resulted in small reductions in obesity parameters: waist circumference; men, -0·27 cm (95% confidence interval [CI] -0·29 to -0·26); women - 0·34 (-0·41 to -0·27); body mass index, -0·07 kg/m2 (-0·075 to -0·066); -0·11 kg/m2 (-0·13 to -0·10); weight, -0·21 kg (-0·22 to -0·19); -0·28 kg (-0·32 to -0·24) that attenuated over time. Short-term improvements were also observed in blood pressure, haemoglobin A1c, fasting glucose and triglycerides across both sexes.<br /><b>Conclusion</b><br />A nationwide health screening programme was associated with only small, and transient improvements in obesity and cardiovascular risk factors.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 30 Nov 2022; epub ahead of print</small></div>
Nakao YM, Gale CP, Miyazaki K, Kobayashi H, ... Nadarajah R, Motonishi T
Eur J Prev Cardiol: 30 Nov 2022; epub ahead of print | PMID: 36447442
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<div><h4>Health Status and Cognitive Function for Risk Stratification in Chronic Coronary and Peripheral Artery Disease.</h4><i>Smolderen KG, Mena-Hurtado C, Eikelboom JW, Bosch J, ... Bhatt DL, Anand SS</i><br /><b>Background:</b><br/>and aims</b><br />It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD.<br /><b>Methods</b><br />Stable CAD and PAD patients from the international, multi-center COMPASS trial completed the visual analogue scale, (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models.<br /><b>Results</b><br />A total of 23,433 patients were in the CAD cohort and 6,899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88-0.89; PAD HR = 0.89, 95%CI 0.88-0.89) and DSST (CAD HR = 0.95, 95%CI 0.94-0.95) (PAD HR = 0.95, 95%CI 0.94-0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively.<br /><b>Conclusions</b><br />Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 29 Nov 2022; epub ahead of print</small></div>
Smolderen KG, Mena-Hurtado C, Eikelboom JW, Bosch J, ... Bhatt DL, Anand SS
Eur J Prev Cardiol: 29 Nov 2022; epub ahead of print | PMID: 36444513
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<div><h4>Persistence with long-term PCSK9 inhibitors treatment and its effectiveness in Familial Hypercholesterolemia: data from the SAFEHEART study.</h4><i>Alonso R, Arroyo-Olivares R, Muñiz-Grijalvo O, Díaz-Díaz DJL, ... Argueso R, Mata P</i><br /><b>Aims</b><br />Most heterozygous familial hypercholesterolemia (FH) patients require intensive lipid-lowering therapy (LLT) including PCSK9 inhibitors (PCSK9i) to reach current LDL-C goals. Persistence with chronic treatment is important to reduce the burden of atherosclerotic cardiovascular disease. We analysed persistence, efficacy, and impact on quality of life of PCSK9i in FH patients in clinical practice setting.<br /><b>Methods and results</b><br />Spanish Familial Hypercholesterolemia cohort study (SAFEHEART) is an open, prospective study in genetically defined FH patients in Spain. Patients ≥ 18 years of age (n = 696, 46% females) on stable LLT treated with PCSK9i were analysed. Median LDL-C at starting PCSK9i was 145 mg/dL (IQR, 123-177) [3.8 mmol/L, IQR 3.2-4.6]. After a median follow-up of 3.7 years (IQR, 2.3-4.8), 27 patients (4%) discontinued PCSK9i treatment: 5 temporarily (0.7%) and 22 permanently (3.2%). Persistence with PCSK9i was 96.1% in the whole period. Median LDL-C levels and % LDL-C reduction attained after 1 year of treatment and in the last follow-up visit were 63 mg/dL (IQR, 43-88) [1.6 mmol/L, IQR 1.1-2.23], 61 mg/dL (IQR, 44-82) [1.6 mmol/L IQR, 1.1-2.1 mmol/L], 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 and 2019 ESC/EAS LDL-C goals were attained by 77% and 48% of patients respectively at the last follow-up visit (p < 0.001). Mean QoL score increased slightly in the first year and remained stable.<br /><b>Conclusion</b><br />Long-term persistence with PCSK9i in FH patients is very high, with a good QoL. Effectiveness in LDL-C reduction and LDL-C goal achievement dramatically improved with PCSK9i in this high-risk population in clinical practice setting.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 23 Nov 2022; epub ahead of print</small></div>
Alonso R, Arroyo-Olivares R, Muñiz-Grijalvo O, Díaz-Díaz DJL, ... Argueso R, Mata P
Eur J Prev Cardiol: 23 Nov 2022; epub ahead of print | PMID: 36416136
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<div><h4>Reduction in blood pressure for people with isolated diastolic hypertension and cardiovascular outcomes.</h4><i>Suzuki Y, Kaneko H, Yano Y, Okada A, ... Yasunaga H, Komuro I</i><br /><b>Aim</b><br />Isolated diastolic hypertension (IDH) is a largely underrated risk factor for cardiovascular disease (CVD). It is currently unclear whether a reduction in blood pressure (BP) is associated with CVD events among adults with IDH. We aimed to elucidate the relationship between BP reduction and incident CVD in individuals with IDH.<br /><b>Methods</b><br />We retrospectively analyzed the data of 71,297 individuals with IDH. IDH was defined as systolic BP of < 140 mmHg and diastolic BP (DBP) of ≥90 mmHg (median age, 48 years; 83.1% men; median DBP, 92 mmHg). None of the participants took BP-lowering medications or had a history of CVD at baseline. BP was measured at baseline and 1-year follow-up, and participants were categorized into two groups based on DBP at one year (≥90 mmHg or <90 mmHg). The primary outcome was a composite endpoint that included myocardial infarction, stroke, and all-cause death.<br /><b>Results</b><br />Over a mean follow-up period of 1100 ± 859 days, 1,317 composite CVD endpoints were recorded. Participants with DBP of <90 mmHg at 1 year were at a lower risk of composite CVD events (hazard ratio [HR]:0.75, 95% confidence interval [CI]: 0.67-0.83) than those with DBP of ≥90 mmHg at 1 year. A reduction in DBP per 5 mmHg during the 1-year follow-up was associated with a lower composite CVD event risk (HR:0.92, 95% CI:0.89-0.95). The results remained consistent across a multitude of sensitivity analyses.<br /><b>Conclusions</b><br />Our analysis of a large-scale epidemiological dataset demonstrated a relationship of reduction in DBP with a reduced risk for CVD events in individuals with IDH.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print</small></div>
Suzuki Y, Kaneko H, Yano Y, Okada A, ... Yasunaga H, Komuro I
Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print | PMID: 36416186
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<div><h4>Global burden of disease attributable to high systolic blood pressure in older adults, 1990-2019: an analysis for the Global Burden of Disease Study 2019.</h4><i>Huang Y, Meng L, Liu C, Liu S, ... Sun Y, Li G</i><br /><b>Aims</b><br />High systolic blood pressure (HSBP), a significant public health challenge, has not been systematically studied in the elderly population in the context of global aging. Understanding the temporal trends of the disease burden associated with HSBP in the elderly population is essential to control and mitigate the harm caused by HSBP.<br /><b>Methods and results</b><br />We used the estimated data derived from the Global Burden of Disease (GBD) Study to analyze the disease burden of HSBP among the elderly population by region, sex, and temporal changes from 1990 to 2019. We found that the number of deaths due to HSBP increased to 7.86 (95% UI: 6.89 to 8.82) million, with an increase of 54.1%, and the number of disability-adjusted life years (DALYs) increased to 146 (95% UI: 130 to 162) million, with an increase of 52.4%. Conversely, the death and DALY rates of HSBP decreased by -27.0% and -27.8%, respectively. At the national and regional levels, Australasia and other high sociodemographic index (SDI) regions have made significant improvements in the burden of HSBP, while it remains high in other regions of the world. Additionally, the burden of HSBP in older men is greater than that in older women.<br /><b>Conclusion</b><br />Our findings indicate that the current prevention and control of HSBP in older adults is poor, with the total burden increasing significantly. There is an urgent need to implement feasible measures to resist HSBP and lessen the disparity of the global HSBP burden for older adults.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print</small></div>
Huang Y, Meng L, Liu C, Liu S, ... Sun Y, Li G
Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print | PMID: 36416196
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<div><h4>Aortic valve sclerosis and subclinical LV dysfunction in the general population with normal LV geometry.</h4><i>Yoshida Y, Nakanishi K, Daimon M, Hirose K, ... Homma S, Komuro I</i><br /><b>Aims</b><br />Aortic valve sclerosis (AVS) without hemodynamically significant obstruction is related to cardiovascular morbidity and mortality independent of left ventricular (LV) hypertrophy, although the underlying mechanisms remain unknown. This study investigated the prevalence of AVS and its association with subclinical LV systolic and diastolic dysfunction in individuals with normal LV geometry free of cardiovascular disease.<br /><b>Methods</b><br />We examined 962 participants with normal LV geometry and free from significant AV stenosis who underwent standard and speckle-tracking echocardiography. AVS was categorized into 4 groups as follows: no AVS, AV thickening, calcification on one leaflet and calcification on ≥2 leaflets.<br /><b>Results</b><br />Among the 962 participants, 767 (79.7%) individuals were classified as no AVS, 74 (7.7%) as AV thickening, 87 (9.0%) as calcification on one leaflet, and 34 (3.5%) as calcification on ≥2 leaflets. The prevalence of subclinical LV diastolic dysfunction (E/e\' ratio ≥13) and systolic dysfunction (LV global longitudinal strain (GLS) > -17.0% for men and > -18.0% for women) were greater in AVS groups than those in no AVS group. Subclinical LV diastolic impairment was evident from AV thickening and systolic dysfunction was observed at AV calcification. Multivariable logistic regression analysis demonstrated that AV thickening as well as calcification were independently associated with subclinical LV diastolic impairment (all p < 0.05), while only AV calcification on ≥2 leaflets conferred significant increased risk of impaired LVGLS.<br /><b>Conclusions</b><br />AVS was observed in approximately 20% individuals without cardiac disease and was associated with subclinical LV diastolic and systolic function even in the absence of LV morphological change.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print</small></div>
Yoshida Y, Nakanishi K, Daimon M, Hirose K, ... Homma S, Komuro I
Eur J Prev Cardiol: 22 Nov 2022; epub ahead of print | PMID: 36416216
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<div><h4>Inspiratory muscle training improves cardiopulmonary function in patients after transcatheter aortic valve replacement: a randomized clinical trial.</h4><i>Xu L, Wei J, Liu J, Feng Y, ... Chen M, Wei Q</i><br /><b>Aims</b><br />Inspiratory muscle training (IMT) can increase the strength or endurance of the diaphragm and accessory muscles of inspiration, yet there is no evidence that endorses the role of IMT in patients of transcatheter aortic valve replacement (TAVR). This study tested for the first time the effects of IMT plus usual cardiac rehabilitation (CR) on function in patients after TAVR.<br /><b>Methods</b><br />A double-blinded, randomized controlled, single-center clinical trial was undertaken. Participants who had a confirmed diagnosis of valve heart disease and were clinically stable after TAVR were recruited and received a CR program during the hospital stay.<br /><b>Results</b><br />A total of 96 patients were recruited and randomly assigned to the IMT + CR group (n = 48) or the CR group (n = 48) in a 1:1 ratio. The group difference in the primary outcome, the six-minute walk distance at the discharge of hospital, significantly favored the IMT + CR group (Mean difference -33.52, 95%CI -64.42 to -2.62, p = 0.034). The significant difference was maintained at the 1-month and 3-month follow-ups (Mean difference 41.51, 95%CI 1.82 to 81.21, p = 0.041). In addition, the mean hospital stays of subjects in the IMT + CR group was 11 days, which was significantly shorter than the 12.5 days in the CR group (p = 0.016). Sensitivity analysis using per-protocol analysis supported these findings. No adverse treatment-related events were reported.<br /><b>Conclusions</b><br />Compared with usual CR, IMT plus CR can effectively improve exercise endurance, pulmonary ventilation function and inspiratory muscle strength in patients after TAVR and shorten the length of hospital stay.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print</small></div>
Xu L, Wei J, Liu J, Feng Y, ... Chen M, Wei Q
Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print | PMID: 36378543
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<div><h4>Lipoprotein(a)-related cardiovascular and all-cause mortalities in Korean adults.</h4><i>Kim BJ, Lee MY, Choi HI, Kwon MJ, Kang JG</i><br /><b>Aims</b><br />There are inconsistent results on the association between lipoprotein(a) and mortality-related outcomes due to lack of evidence from large-scale observational studies of Asians. This study aims to evaluate the effects of lipoprotein(a) on mortality-related outcomes in the Korean population.<br /><b>Methods</b><br />This cohort study included 275430 individuals (mean age: 38 years; 50.1% men) enrolled in the Kangbuk Samsung Health Study between 2003 and 2016. The median follow-up period was 6.6 years. Cox proportional hazards analysis was used to estimate the adjusted hazard ratios (HRs) for evaluating mortality risk based on lipoprotein(a) levels and specific lipoprotein(a) categories.<br /><b>Results</b><br />The median lipoprotein(a) value was 18.5 mg/dL, and the proportion of lipoprotein(a) ≥ 50 mg/dL was 12.8%. Multivariable Cox regression analysis showed that the group with lipoprotein(a) ≥ 50 mg/dL had significantly increased risk of cardiovascular mortality (HR[95% CI]: 1.83[1.26, 2.64]) and all-cause mortality (1.20[1.03, 1.41]) than the group with lipoprotein(a) < 50 mg/dL without increased risk of cancer mortality (1.05[0.81, 1.34]). The relationship between lipoprotein(a) and cardiovascular mortality was significant regardless of low-density lipoprotein cholesterol. Specifically, lipoprotein(a) ≥100 mg/dL was associated with more than twice as increased risk of cardiovascular mortality (2.45[1.12, 5.34]) than lipoprotein(a) < 10 mg/dL. In subgroup analyses, there was an interaction in the relationships between the two lipoprotein(a) categories and cardiovascular mortality for only high-density lipoprotein cholesterol.<br /><b>Conclusions</b><br />High lipoprotein(a) concentration is an independent predictor of cardiovascular mortality in the Korean population, regardless of low-density lipoprotein cholesterol levels.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print</small></div>
Kim BJ, Lee MY, Choi HI, Kwon MJ, Kang JG
Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print | PMID: 36378545
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<div><h4>Multifactorial Effects of Outpatient Cardiac Rehabilitation in Patients with Heart Failure: A Nationwide Retrospective Cohort Study.</h4><i>Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, ... Saito Y, Imamura T</i><br /><b>Aim</b><br />Although cardiac rehabilitation (CR) is a strongly recommended therapy, no large study has assessed the effects of outpatient CR in patients with heart failure (HF) in real-world settings. Therefore, this study aimed to investigate the multifactorial effects of outpatient CR in patients with HF using a nationwide database.<br /><b>Methods and results</b><br />This nationwide retrospective cohort study was performed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Patients with acute HF who underwent inpatient CR between April 2014 and March 2020 were included. The association between outpatient CR participation and all-cause mortality, rehospitalisation for HF, use of medical resources, and medical costs was analysed using propensity score matching analysis. Of 250,528 patients, 17,884 (7.1%) underwent outpatient CR. After propensity score matching, the CR (+) group was associated with a reduction in the risk of all-cause mortality (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.60-0.68, p < 0.001) and rehospitalisation for HF compared to the CR (-) group (HR: 0.87, 95% CI: 0.82-0.92, p < 0.001). The proportion of guideline-based medication use for HF at 1 year was higher in the CR (+) group than in the CR (-) group. The total medical costs from the index hospitalisation to 1.5 years after admission were similar between the groups.<br /><b>Conclusion</b><br />Outpatient CR participation after discharge from HF was associated with reduced mortality and rehospitalisation for HF without increasing medical costs.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print</small></div>
Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, ... Saito Y, Imamura T
Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print | PMID: 36378557
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<div><h4>Serum Uric Acid Significantly Improves the Accuracy of Cardiovascular Risk Score Models.</h4><i>Moshkovits Y, Tiosano S, Kaplan A, Kalstein M, ... Maor E, Fardman A</i><br /><b>Aims</b><br />This study evaluated the impact of serum uric acid (sUA) on the accuracy of pooled cohort equations (PCE) model, Systematic Coronary Risk Evaluation score 2 (SCORE2) and SCORE2-Older Persons.<br /><b>Methods</b><br />We evaluated 19,769 asymptomatic self-referred adults aged 40-79 years free of cardiovascular disease and diabetes who were screened annually in a preventive healthcare setting. sUA levels were expressed as a continuous as well as dichotomous variable (upper sex-specific tertiles defined as high sUA). The primary endpoint was the composite of death, acute coronary syndrome or stroke, after excluding subjects diagnosed with metastatic cancer during follow up.<br /><b>Results</b><br />Mean age was 50 ± 8 years and 69% were men. During median follow up of 6 years, 1,658 (8%) subjects reached the study endpoint. PCE, SCORE2 and high sUA were independently associated with the study endpoint in a multivariable model (p < .001 for all). Continuous net reclassification improvement analysis showed a 13% improvement in the accuracy of classification when high sUA was added to either PCE or SCORE2 model (p < .001 for both). sUA remained independently associated with the study endpoint among normal-weight subjects in the SCORE2 model (HR 1.3, 95% CI 1.1-1.6) but not among overweight individuals (p for interaction = .01). Subgroup analysis resulted in a significant 16-20% improvement in the model performance among normal-weight and low-risk subjects (p < .001 for PCE; p = .026 and p < .001 for SCORE2, respectively).<br /><b>Conclusions</b><br />sUA significantly improves the classification accuracy of PCE and SCORE2 models. This effect is especially pronounced among normal-weight and low-risk subjects.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print</small></div>
Moshkovits Y, Tiosano S, Kaplan A, Kalstein M, ... Maor E, Fardman A
Eur J Prev Cardiol: 15 Nov 2022; epub ahead of print | PMID: 36378558
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<div><h4>Setting your clock: associations between timing of objective physical activity and cardiovascular disease risk in the general population.</h4><i>Albalak G, Stijntjes M, van Bodegom D, Jukema JW, ... van Heemst D, Noordam R</i><br /><b>Aims</b><br />Little is known about the impact of daily physical activity timing (here referred to as \'chronoactivity\') on cardiovascular disease (CVD) risk. We aimed to examined the associations between chronoactivity and multiple CVD outcomes in the UK Biobank.<br /><b>Methods and results</b><br />physical activity data were collected in the UK-Biobank through triaxial accelerometer over a 7-day measurement period. We used K-means clustering to create clusters of participants with similar chronoactivity irrespective of the mean daily intensity of the physical activity. Multivariable-adjusted Cox-proportional hazard models were used to estimate hazard ratios (HRs) comparing the different clusters adjusted for age and sex (model 1), and baseline cardiovascular risk factors (model 2). Additional stratified analyses were done by sex, mean activity level, and self-reported sleep chronotype. We included 86 657 individuals (58% female, mean age: 61.6 [SD: 7.8] years, mean BMI: 26.6 [4.5] kg/m2). Over a follow-up period of 6 years, 3707 incident CVD events were reported. Overall, participants with a tendency of late morning physical activity had a lower risk of incident coronary artery disease (HR: 0.84, 95%CI: 0.77, 0.92) and stroke (HR: 0.83, 95%CI: 0.70, 0.98) compared to participants with a midday pattern of physical activity. These effects were more pronounced in women (P-value for interaction = 0.001). We did not find evidence favouring effect modification by total activity level and sleep chronotype.<br /><b>Conclusion</b><br />Irrespective of total physical activity, morning physical activity was associated with lower risks of incident cardiovascular diseases, highlighting the potential importance of chronoactivity in CVD prevention.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 14 Nov 2022; epub ahead of print</small></div>
Albalak G, Stijntjes M, van Bodegom D, Jukema JW, ... van Heemst D, Noordam R
Eur J Prev Cardiol: 14 Nov 2022; epub ahead of print | PMID: 36372091
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<div><h4>Association of reproductive factors with cardiovascular disease risk in premenopausal women: nationwide population-based cohort study.</h4><i>Jeong SM, Jeon KH, Jung W, Yoo JE, ... Lee YB, Shin DW</i><br /><b>Background</b><br />Although the morbidity and mortality of cardiovascular diseases (CVD) are rising in young women, the risk factors of CVD among Korean premenopausal women have not been intensively investigated.<br /><b>Aim</b><br />To determine how age at menarche and other female reproductive factors are associated with the risk of CVD in premenopausal women.<br /><b>Methods</b><br />A total of 1,088,992 premenopausal women who participated in health screening in 2009 were included. The study outcomes were myocardial infarction (MI) and ischemic stroke. Cox proportional hazards regression analysis was conducted with adjustment of traditional CVD risk factors and reproductive factors.<br /><b>Results</b><br />Mean age was 43.8 ± 5.3 years (98.9%,  < 55 years), 3.5% were current smokers, and 1.2% were heavy drinkers. During a mean follow-up of 8.3years (9,032,685.9 person-years [PY]), there were 10,876 CVD events (1.0 per 1000PY).With later menarche, the risk of CVD increased;  ≤ 12 years (adjusted hazard ratio 1.04, 95% confidence interval 0.93-1.16), 13 years (reference), 14 years (1.06, 0.98-1.14), 15 years (1.15, 1.07-1.24), 16 years (1.23, 1.14-1.34), and ≥ 17 years (1.33, 1.24-1.44). Compared with non-users, oral contraceptives (OC) users (≥ 1 year) had an increased risk of CVD (1.11, 1.01-1.22) (P for trend = 0.007).<br /><b>Conclusions</b><br />Later menarche than the mean age at menarche (13 years old) and the use of OC (≥ 1 year) were associated with a higher risk of CVD, after adjusting for traditional cardiovascular risk factors. This study suggests that female reproductive factors could be unique risk factors for CVD in premenopausal women.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 10 Nov 2022; epub ahead of print</small></div>
Jeong SM, Jeon KH, Jung W, Yoo JE, ... Lee YB, Shin DW
Eur J Prev Cardiol: 10 Nov 2022; epub ahead of print | PMID: 36355619
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Abstract
<div><h4>U-shaped Relationship between Apolipoprotein A1 Levels and Mortality Risk in Men and Women.</h4><i>Faaborg-Andersen CC, Liu C, Subramaniyam V, Desai SR, ... Sperling LS, Quyyumi AA</i><br /><b>Background</b><br />Apolipoprotein A1 (ApoA1) is the principal protein component of high-density lipoprotein (HDL). Although low HDL cholesterol (HDL-C) levels are known to be associated with greater cardiovascular risk, recent studies have also shown heightened mortality risk at very high HDL-C levels.<br /><b>Aim</b><br />To investigate the sex-specific association between elevated ApoA1 levels and adverse outcomes, and their genetic basis.<br /><b>Methods</b><br />A prospective cohort study of United Kingdom Biobank participants without coronary artery disease at enrollment was performed. The primary exposure was serum ApoA1 levels. The primary and secondary outcome measures were cardiovascular and all-cause death, respectively.<br /><b>Results</b><br />In 402,783 participants followed for a median of 12.1 years, there was a U-shaped relationship between ApoA1 levels and both cardiovascular as well as all-cause mortality, after adjustment for traditional cardiovascular risk factors. Individuals in the highest decile of ApoA1 levels (1.91-2.50 g/L) demonstrated higher cardiovascular (HR 1.21, 95% CI 1.07-1.37, P < 0.0022) and all-cause mortality (HR 1.14, 95% CI 1.07-1.21, P < 0.0001) compared to those within the lowest risk eighth decile (1.67-1.75 g/L). The U-shaped relationship was present in both sexes, though more pronounced in men. Sensitivity analyses showed that cardiovascular mortality rates were higher in those with greater alcohol intake (P < 0.004). Adjustment for polygenic variation associated with higher ApoA1 levels did not attenuate the effect of very high ApoA1 levels on mortality. In the sub-group with very elevated HDL-C levels (>80 mg/dL in men,  > 100 mg/dL in women), there was no association between ApoA1 levels and mortality.<br /><b>Conclusion</b><br />Both very low, as well as very elevated ApoA1 levels are associated with higher cardiovascular and all-cause mortality.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 09 Nov 2022; epub ahead of print</small></div>
Faaborg-Andersen CC, Liu C, Subramaniyam V, Desai SR, ... Sperling LS, Quyyumi AA
Eur J Prev Cardiol: 09 Nov 2022; epub ahead of print | PMID: 36351048
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<div><h4>Risk of Incident Mental Disorders in Hypertrophic Cardiomyopathy: A Nationwide Propensity-Matched Study.</h4><i>Park JB, Yun JY, Kim B, Rhee TM, ... Han K, Kim HK</i><br /><b>Aims</b><br />We sought to determine the risk of mental disorders in patients with hypertrophic cardiomyopathy (HCM) compared with those without HCM.<br /><b>Methods</b><br />This is a retrospective propensity score-matched cohort study using nationwide population-based data from the Korean National Health Insurance Service. Overall, 4,046 HCM patients and 12,138 matched individuals were followed up until the first diagnosis of mental disorders or the end of the follow-up. The primary outcome was a composite of incident mood, anxiety, stress-related, or somatoform disorders. Secondary outcomes included two components of the primary outcome (i.e., mood disorders and anxiety/stress-related/somatoform disorders).<br /><b>Results</b><br />During a median follow-up period of 4.1 years, the incidence rate of the primary outcome was 54.4 and 31.5/1000 person-years among the HCM and control groups, respectively, resulting in a hazard ratio (HR) of 1.719 (95% confidence interval: 1.589-1.860). Within the first month after HCM diagnosis, the HR for the primary outcome was 3.074 (2.096-4.508). Beyond 1 month, the HRs decreased, ranging from 2.281 (1.952-2.665) during 1-12 months, to 2.087 (1.831-2.380) during 12-36 months and 1.258 (1.090-1.452) after 36 months of follow-up. Similar results were observed for the secondary outcomes. In sensitivity analysis, the risk of the specific categories of mental disorders, including single or recurrent depressive episodes and anxiety disorders was also higher in HCM patients than matched controls.<br /><b>Conclusion</b><br />HCM was significantly associated with the risk of incident mental disorders, particularly within 1 year after HCM diagnosis, underscoring the importance of screening mental health problems, including mood and anxiety disorders, in HCM patients.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 08 Nov 2022; epub ahead of print</small></div>
Park JB, Yun JY, Kim B, Rhee TM, ... Han K, Kim HK
Eur J Prev Cardiol: 08 Nov 2022; epub ahead of print | PMID: 36348515
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<div><h4>Burden of Cardiovascular Disease Attributable to Particulate Matter Pollution in the Eastern Mediterranean Region: Analysis of the 1990-2019 Global Burden of Disease.</h4><i>Motairek I, Ajluni S, Khraishah H, AlAhmad B, ... Rajagopalan S, Al-Kindi S</i><br /><b>Background</b><br />Particulate matter pollution is the most important environmental mediator of global cardiovascular morbidity and mortality. Air pollution evidence from the Eastern Mediterranean Region (EMR) is limited, owing to scarce local studies, and the omission from multinational studies. We sought to investigate trends of particulate matter (PM2.5)-related cardiovascular disease (CVD) burden in the EMR from 1990 to 2019.<br /><b>Methods</b><br />We used the 1990-2019 global burden of disease methodology to investigate total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and disability-adjusted life years (DALYs) and cause-specific CVD mortality in the EMR.<br /><b>Results</b><br />The average annual population-weighted PM2.5 exposure in EMR region was 50.3 μg/m3 (95% confidence interval [CI]:42.7 - 59.0) in 2019, which was comparable to 1990 48.1 μg/m3 (95% CI 36.5 - 65.3). This was despite an 80% reduction in household air pollution (HAP) sources since 1990. In 2019, particulate matter pollution contributed to 25.67% (95% CI 23.55% to 27.90%) of total CVD deaths and 28.10% (95% CI 25.75% to 30.37%) of DALYs in the region, most of which were due to ischemic heart disease and stroke. We estimated that 353,071 (95% CI 304,299 to 404,591) CVD deaths in EMR were attributable to particulate matter in 2019, including 264,877 (95% CI 218,472 to 314,057) and 88,194.07 (95% CI 60,149 to 119,949) CVD deaths from ambient PM2.5 pollution and HAP from solid fuels, respectively. DALY\'s in 2019 from CVD attributable to particulate matter was 28.1% when compared to 26.69% in 1990. The age-standardized death and DALY rates attributable to air pollution was 2,122 per 100 000 in EMR in 2019 and was higher in males (2,340 per 100 000) than in females (1,882 per 100 000).<br /><b>Conclusion</b><br />The EMR region experiences high PM2.5 levels with high regional heterogeneity and attributable burden of CVD due to air pollution. Despite significant reductions of overall HAP in the past 3 decades, there is continued HAP exposure in this region with rising trend in CVD mortality and DALYs attributable to ambient sources. Given the substantial contrast in disease burden, exposures, socio-economic and geo-political constraints in the EMR region, our analysis suggests substantial opportunities for PM2.5 attributable CVD burden mitigation.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 02 Nov 2022; epub ahead of print</small></div>
Motairek I, Ajluni S, Khraishah H, AlAhmad B, ... Rajagopalan S, Al-Kindi S
Eur J Prev Cardiol: 02 Nov 2022; epub ahead of print | PMID: 36321426
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<div><h4>Association between NMR metabolomic signatures of healthy lifestyle and incident coronary artery disease.</h4><i>Fu Z, Liu Q, Liang J, Weng Z, ... Xu C, Gu A</i><br /><b>Aims</b><br />To identify metabolites associated with a healthy lifestyle and explore the possible mechanisms of lifestyle in CAD.<br /><b>Methods and results</b><br />The NMR metabolomics platform was applied to perform metabolomic profiling of baseline plasma samples from a randomly selected subset of 121,733 UK Biobank participants. Cox proportional hazards models with covariate adjustments were used to investigate the associations between validated lifestyle-associated metabolites and incident CAD and to estimate the accuracy of the inclusion of metabolites to predict CAD compared with traditional prediction models. The discriminatory ability of each model was evaluated using Harrell\'s C statistic, integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI) indexes. During a median of 8.6 years of follow-up, 5,513 incident CAD cases were documented. Among the 111 lifestyle-associated metabolites, 65 were significantly associated with incident CAD after multivariate adjustment (Bonferroni P < 3.11 × 10-04). The addition of these metabolites to classic risk prediction models (Framingham Risk Score [FRS] using lipids; FRS using body mass index) improved CAD prediction accuracy as assessed by the C statistic (increasing to 0.739 [95% CI, 0.731-0.747] and 0.752 [95% CI, 0.746-0.758]), respectively; continuous NRI (0.274 [0.227-0.325] and 0.266 [0.223-0.317]) and IDI (0.003 [0.002-0.004] and 0.003 [0.002-0.004]).<br /><b>Conclusions</b><br />Healthy lifestyle-associated metabolites are associated with the incidence of CAD and may help improve the prediction of CAD risk. The use of metabolite information combined with the FRS model warrants further investigation before clinical implementation.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print</small></div>
Fu Z, Liu Q, Liang J, Weng Z, ... Xu C, Gu A
Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print | PMID: 36317303
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<div><h4>Acute Effects of Electronic Cigarettes on Vascular Endothelial Function: A Systematic Review and Meta-analysis of Randomized Controlled Trials.</h4><i>Meng XC, Guo XX, Peng ZY, Wang C, Liu R</i><br /><b>Background</b><br />The effects of e-cigarettes on endothelial function remained controversial.<br /><b>Aim</b><br />The study aimed to investigate the effects of e-cigarettes on vascular endothelial function.<br /><b>Methods</b><br />PubMed, Web of Science, Embase, and Cochrane Library were searched up to December 2021. We only included the studies in which the control group included vaping without nicotine and tobacco. Pairwise and network meta-analyses were conducted for flow-mediated dilation (FMD), pulse wave velocity (PWV), and heart rate corrected augmentation index (AIx75).<br /><b>Results</b><br />Eight studies involving 372 participants were eligible for this review. Compared with vaping without nicotine, e-cigarettes significantly increase in PWV (Mean difference = 3.09; 95% Confidential Interval: 1.51 to 4.68, p < 0.001) and AIx75 (Mean difference = 2.11; 95% Confidential Interval: 1.02 to 3.21, p < 0.001) indicators, but not affect FMD (Mean difference = 0.78; 95% Confidential Interval: -0.08 to 1.64, p = 0.075). But compared with traditional tobacco, e-cigarettes did not affect FMD (Mean difference = 0.28, 95% Confidential Interval: -0.45 to 0.59, p = 0.084). According to SUCRA, The e-cigarette ranked first for FMD (SUCRA = 97%), tobacco ranked first for PWV (SUCRA = 75%), and AIX75(SUCRA = 99%).<br /><b>Conclusions</b><br />In summary, evidence from our pooled analyses indicated that acute inhalation of e-cigarettes leads to negative changes in vascular endothelial function. E-cigarettes cannot be used as an alternative to public health strategies for tobacco control and should not be considered cardiovascular safety products. More future research should be conducted to verify our findings.<br /><br />© 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.<br /><br /><small>Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print</small></div>
Meng XC, Guo XX, Peng ZY, Wang C, Liu R
Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print | PMID: 36316290
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<div><h4>Diagnostic group differences in return to work and subsequent detachment from employment following cardiovascular disease: a nationwide cohort study.</h4><i>Jørgensen SMB, Gerds TA, Johnsen NF, Gislason G, ... Maribo T, Kristiansen M</i><br /><b>Aims</b><br />Return to work and employment maintenance following cardiovascular disease (CVD) are important rehabilitation goals for people of working-age. To identify people in particular need of vocational rehabilitation, we examined differences in return to work and subsequent detachment from employment among people with atrial fibrillation, heart failure, heart valve disease, and ischaemic heart disease.<br /><b>Methods</b><br />We conducted a nationwide cohort study and included all individuals of working age (35-65 years) who were employed when diagnosed with incident CVD in 2018. We estimated sex- and age-standardized probabilities of remaining employed at three, six, and 12 months after diagnosis, and of detachment from employment within six months after having returned to work.<br /><b>Results</b><br />Of 46,912 individuals diagnosed in 2018, 8,187 were of working-age and employed at diagnosis. The mean age was 54.7 years (SD = 6.7), and 74.0% were men. Within one year, 89.8% had returned to work, but within the subsequent six months, 23.5% of these experienced detachment from employment. At three, six, and 12 months after diagnosis the highest standardized probability of being employed was found among people with atrial fibrillation, whereas the lowest probability was found among people with heart failure (78.9% (95% CI: 77.3-80.4) vs. 62.2% (95% CI: 59.0-65.4) at 12 months). Similarly, the highest probability of detachment was found for people with heart failure (30.3% (95% CI: 26.9-33.7)).<br /><b>Conclusion</b><br />People with heart failure present the highest probability of not returning to work. There is a need for developing and documenting effects of vocational rehabilitation strategies within comprehensive cardiac rehabilitation programmes.<br /><br />© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.<br /><br /><small>Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print</small></div>
Jørgensen SMB, Gerds TA, Johnsen NF, Gislason G, ... Maribo T, Kristiansen M
Eur J Prev Cardiol: 01 Nov 2022; epub ahead of print | PMID: 36316291
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This program is still in alpha version.