European Society of Cardiology: Cardiovascular Disease Statistics 2019

Physical activity levels and associated biopsychosocial characteristics among attendees to exercise-based cardiac rehabilitation

Aim. Exercise-based cardiac rehabilitation (exCR) reduces morbidity and mortality after acute coronary syndrome (ACS). Little is known about physical activity (PA) levels at exCR program completion and associated demographic, medical, and psychosocial factors. Methods. Cross-sectional data from the ongoing Keep-Up-Going study were used, including 100 participants with recent ACS and ≥80% attendance to 3 months supervised exCR program. Physical activity was assessed by an accelerometer and self-reported psychosocial characteristics were collected at the end of the exCR. Associations between achieving the PA target (>150 min of moderate-to-vigorous-intensity PA/week) and biopsychosocial characteristics were assessed using univariable logistic regression analyses. Results. Mean age was 67 years and 24% were women. Participants achieving the PA target (76%) were more likely to have higher levels of social support, higher outcome expectations for PA, and higher intrinsic regulation (motivation, p < .05 for all). Those not achieving the PA target (24%) had a higher proportion of sedentary time, fewer steps/day, and were more likely to be older, retired, and have reduced left ventricular ejection fraction (LVEF) (p < .05 for all). Conclusions. Although exCR participation provides exercise routines, one-fourth of individuals did not reach the guideline-directed PA targets after an ACS. In addition to higher age and reduced LVEF, lower levels of social support, outcome expectations, and motivation were associated with low levels of PA. Exploring these factors could be of importance to support individuals' behavior change toward increased PA during the exCR period.

Associations of Physical Fitness During Childhood with Arterial Structure and Stiffness in Adolescence: An 8-Year Follow-up Study

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of morbidity and premature mortality globally. While the relationship between indicators of physical fitness and arterial structure and stiffness are reasonably well-studied in adults, these associations in children and adolescents remain less understood. The aim of this study was to investigate longitudinal associations of cardiorespiratory fitness, muscular fitness and motor fitness with arterial structure and stiffness from childhood to adolescence.

RESULTS

Higher mean value of VO2peak/LM from childhood to adolescence was associated with higher carotid intima-media thickness (cIMT) at 8-year follow-up (β = 0.184, 95% confidence interval [CI] = 0.019 to 0.350). Better performance in sit-up test at baseline was associated with lower cardio-ankle vascular index (CAVI) (β = - 0.219, 95% CI = - 0.387 to - 0.051) at 8-year follow-up, and higher mean sit-up performance from baseline to 8-year follow-up was associated with lower carotid-femoral pulse-wave velocity (cfPWV) (β = - 0.178, 95% CI = - 0.353 to - 0.003) and CAVI (β = - 0.190, 95% CI = - 0.365 to - 0.016) at 8-year follow-up. Also cross-sectionally, better sit-up performance at 8-year follow-up was associated with lower cfPWV (β = - 0.232, 95% CI = - 0.411 to - 0.054) and CAVI (β = - 0.185, 95% CI = - 0.365 to - 0.005) and higher carotid artery distensibility (β = 0.165, 95% CI = 0.004 to 0.327) at 8-year follow-up. Most of the associations were explained by body fat percentage (BF%).

CONCLUSIONS

Physical fitness had a weak if any association with indicators of arterial structure and arterial stiffness in adolescence. BF% largely explained the associations of higher VO2peak/LM with higher cIMT and better sit-up performance with lower arterial stiffness in adolescents. Therefore, preventing adiposity rather than improving CRF should be addressed in public health strategies to prevent CVDs in general paediatric populations.

KEY POINTS

Better sit-up performance was associated with lower arterial stiffness, but the association was largely explained by body fat percentage. Lower body muscular strength, handgrip strength, or motor fitness was not associated with arterial stiffness or carotid artery intima-media thickness. Measures other than cardiorespiratory fitness, muscular fitness, or motor fitness, such as adiposity, should be used to screen children and adolescents at increased risk of cardiovascular diseases.

Cardiac imaging for the detection of ischemia: current status and future perspectives

INTRODUCTION

Coronary artery disease is the main cause of mortality worldwide mandating early detection, appropriate treatment, and follow-up. Noninvasive cardiac imaging techniques allow detection of obstructive coronary heart disease by direct visualization of the arteries or myocardial blood flow reduction. These techniques have made remarkable progress since their introduction, achieving high diagnostic precision. This review aims at evaluating these noninvasive cardiac imaging techniques, rendering a thorough overview of diagnostic decision-making for detection of ischemia.

AREAS COVERED

We discuss the latest advances in the field such as computed tomography angiography, single-photon emission tomography, positron emission tomography, and cardiac magnetic resonance; their main advantages and disadvantages, their most appropriate use and prospects. For the review, we analyzed the literature from 2009 to 2024 on noninvasive cardiac imaging in the diagnosis of coronary artery disease. The review included the 78 publications considered most relevant, including landmark trials, review articles and guidelines.

EXPERT OPINION

The progress in cardiac imaging is anticipated to overcome various limitations such as high costs, radiation exposure, artifacts, and differences in interpretation among observers. It is expected to lead to more automated scanning processes, and with the assistance of artificial intelligence-driven post-processing software, higher accuracy and reproducibility may be attained.

Neutrophil percentage-to-albumin ratio and the risk of all-cause and cardiovascular mortality: a 20-year follow-up cohort study of 36,428 US adults

BACKGROUND

The neutrophil percentage-to-albumin ratio (NPAR) has been identified as a prognostic indicator of mortality in various diseases; however, its association with all-cause and cardiovascular mortality in the general population remains insufficiently studied.

METHODS

This retrospective cohort study analyzed data from 36,428 individuals who participated in the National Health and Nutrition Examination Survey between 1999 and 2018. Participants were divided into tertiles based on NPAR levels, with follow-up data collected through December 31, 2019. Weighted multivariable Cox regression models were employed to assess the associations between NPAR and both all-cause and cardiovascular mortality. Kaplan-Meier survival analyses were used to compare survival rates across NPAR tertiles. Additionally, restricted cubic spline analyses and subgroup and sensitivity analyses were conducted to further investigate these associations.

RESULTS

During the follow-up period of up to 20 years, 4,716 deaths occurred among the 36,428 participants, including 1,260 deaths attributed to cardiovascular disease. At baseline, the mean NPAR was 13.66 (SD 2.42), the average age was 45.75 years (SD 16.20), and 50.33% of participants were female. Multivariable analyses showed that individuals in the highest NPAR tertile had a significantly increased risk of both all-cause mortality (HR, 95% CI: 1.45, 1.33-1.57) and cardiovascular mortality (HR, 95% CI: 1.69, 1.39-2.06). Kaplan-Meier survival curves demonstrated significant differences in both all-cause and cardiovascular mortality across NPAR groups. A nonlinear association was observed between NPAR and the risk of both all-cause and cardiovascular mortality. Sensitivity analyses confirmed the robustness of these associations. Additionally, a significant interaction between NPAR and hypertension was identified in relation to all-cause mortality (relative excess risk due to interaction, 95% CI: 0.20, 0.07-0.34; multiplicative interaction, P = 0.04).

CONCLUSIONS

An elevated baseline NPAR is independently associated with an increased risk of all-cause and cardiovascular mortality.

Association of epicardial fat volume with the severity of coronary artery disease: a preliminary study on risk prediction of obstructive coronary heart disease

BACKGROUND

We aimed to explore the correlation between epicardial fat volume (EFV) and the severity of coronary atherosclerotic artery disease (CAD), evaluate the predictive value of EFV for obstructive CAD, and provide prediction for the selection of clinical treatment schemes for CAD.

METHODS

A total of 203 patients undergoing chest computed tomography (CT) and Coronary Artery Angiography (CAG) were included in this retrospective study. The severity of coronary stenosis and SYNTAX score were evaluated by CAG images. There were 141 patients in obstructive CAD group which was defined as coronary stenosis severity ≥ 70% and 62 patients in non obstructive CAD group.

RESULTS

Multivariate logistic regression analysis showed that after adjusting for confounding factors, EFV (OR, 1.008; 95% CI, 1.000-1.016; p = 0.039) was an independent risk factor for obstructive CAD. Spearman correlation analysis showed a significant positive correlation between EFV and SYNTAX score, as well as the number of coronary lesions (r = 0.157, p = 0.026; r = 0.231, p = 0.002). The EFV of males was significantly higher than that of females (p < 0.001). EFV was significantly positively correlated with intrathoracic fat volume (IFV) (p < 0.001).

CONCLUSIONS

EFV maybe an independent risk factor for obstructive CAD. Quantitative measurement of EFV by QCT can predict the severity of CAD. EFV was significantly correlated with IFV, but not with BMI.

CLINICAL TRIAL NUMBER

Not applicable.

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Non-malignant gynaecological disease and risk of cardiovascular or cerebrovascular disease: a systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is the leading cause of death globally. Non-malignant gynaecological diseases (NMGD) significantly affect patient health and well-being and may be associated with cardiovascular or cerebrovascular disease (C/CVD).

METHODS

Seven databases were searched for relevant studies up to 21 April 2024. Observational studies reporting risk estimates and 95% CIs for the association between NMGD and C/CVD were included. Data were extracted by two independent reviewers. Random effects models were used to calculate summary relative risk (SRR) with 95% CI. Composite C/CVD outcome was defined as a combination of ischaemic heart disease, cerebrovascular disease, heart failure, and peripheral vascular disease. The ROBINS-I tool defined study quality and risk of bias.

RESULTS

We screened 6639 studies, of which 59 were eligible for full-text review and 28 were included in our analysis, comprising a total of 3 271 242 individuals. The majority (53.5%) of the studies were scored as having a 'serious'/'critical' risk of bias. Overall, individuals with an NMGD had a significantly greater risk of composite C/CVD with low heterogeneity among contributing studies (SRR 1.28, 95% CI 1.20 to 1.37; n=16 studies, I2=65.3%), ischaemic heart disease (SRR 1.41, 95% CI 1.31 to 1.51; n=21 studies, I2=73.7%), and cerebrovascular disease (SRR 1.33, 95% CI 1.18 to 1.51; n=16 studies, I2=91.5%). In NMGD-specific analyses, the risk of C/CVD and its components was greater among those with a history of endometriosis or polycystic ovary syndrome.

CONCLUSIONS

We found an overall association between NMGD and C/CVD across all studies. However, estimates from individual studies varied substantially.

Cardiometabolic risk factors in women: what's sauce for the goose is not sauce for the gander

PURPOSE OF REVIEW

The aim of this review was to discuss cardiometabolic risk factors that affect women.

RECENT FINDINGS

Recent calls to action to address cardiometabolic risk factors specific to women relate to increasing evidence of sex-specific differences in patient-related, drug-related, and socio-demographic factors leading to sub-optimal care of women.

SUMMARY

Certain aspects of common modifiable cardiovascular risk factors (e.g. smoking, hypertension, dyslipidaemia and diabetes) affect female individuals more adversely. Additionally, there are risk factors or enhancers that particularly affect cardiometabolic health in women [e.g. premature menopause, polycystic ovarian syndrome (PCOS), familial partial lipodystrophy, socio-cultural factors]. Understanding these risk factors may provide insight on how to improve cardiometabolic outcomes in women.

Home-Based Physiotherapy Programme Reduces Hospital Stay and Costs in Cardiac Surgery. A Retrospective Cohort Study

BACKGROUND AND PURPOSE

Cardiac surgery enhances cardiovascular disease (CVD) patient survival rates, and the fast-track protocol can reduce complications, hospital length of stay (HLOS) and associated costs. However, there is no evidence on the effectiveness of unsupervised physiotherapy programmes in reducing HLOS and postoperative pulmonary complications in patients undergoing fast-track surgery. The study aimed to determine if a pre-surgical respiratory programme reduces intensive care unit length of stay (ICULOS) and HLOS patients undergoing fast-track surgery, and its effects on post-operative complications and healthcare costs.

METHODS

This was a retrospective observational cohort study. The patients were divided into two groups: those who followed the exercise programme (pre-hab group) and those who did not (no pre-hab group). The study analysed the mean of ICULOS and HLOS for each group, recorded post-operative complications, and calculated healthcare costs using the Spanish Ministry of Health cost tables.

RESULTS

A total of 418 patients participated in the study with a mean age of 70.44 (10.87) years. The study found significant differences in HLOS (p = 0.001) and ICULOS (p = 0.003) between groups. Pre-hab HLOS was 232.8 (221.3) hours in the hospital, whereas no pre-hab LOS increased to 315.1 (277.9) hours. Pre-hab ICULOS was 82.0 (129.8) hours when No pre-hab ICULOS accounted 120.2 (190.3) hours. This reduction in hospital admissions resulted in savings of €356,107.16 in average healthcare costs for the pre-hab group. Mortality risk (p = 0.034) was also reduced in the pre-hab group (17.7% vs. 26.65% in the no pre-hab group).

DISCUSSION

An unsupervised home-based respiratory programme reduces hospital and ICU stay, healthcare costs, post-surgical pulmonary complications, and mortality risk. The clinical application of an unsupervised home-based pre-habilitation programme, focussing on ventilatory exercises and costal expansion techniques, has proven effective in enhancing patient recovery post-cardiac surgery, offering significant healthcare cost savings, and reducing the burden on hospital resources.

Major abnormalities of the electrocardiogram and cardiovascular risk in a medium and high-risk Mediterranean population

INTRODUCTION

Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events.

OBJECTIVE

To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO).

METHOD

1.752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel's C Indices, Nam d'Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated.

RESULTS

At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51-58.03, pvalor<.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38-4.21, pvalor=.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76-18.72, pvalor=.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36-7.71, pvalor<.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed.

CONCLUSIONS

MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.

Assessment of Cardiovascular Risk in the PURE Poland Cohort Study Using the Systematic Coronary Risk Evaluation (SCORE) Scale and Galectin-3 Concentrations: A Cross-Sectional Study

The SCORE (Systematic Coronary Risk Evaluation) scale is useful for cardiovascular disease (CVD) risk stratification. However, there is a new biomarker, namely, galectin-3 (gal-3), that offers additional predictive value. This cross-sectional study assessed the relationship between serum gal-3 concentrations and CVD risk based on the SCORE scale in a Polish cohort from the PURE study. A total of 259 participants with complete cholesterol, blood pressure (BP), and smoking data were included. Individuals with myocardial infarction, stroke, diabetes, or renal failure were excluded. Gal-3 concentrations were measured using ELISA, and statistical analyses examined associations with SCORE categories. The median gal-3 concentration was 221.32(161.64-360.00) ng/mL. Higher gal-3 concentrations were found in older individuals, smokers, and those with elevated BP(p < 0.05). Positive correlations were observed with SCORE values (r = 0.39) and systolic BP (r = 0.64). Participants with SCORE ≥5% had significantly higher gal-3 concentrations. ROC analysis showed moderate diagnostic value for SCORE ≥ 10% (sensitivity 0.618 and specificity 0.810). Higher SCORE and diastolic BP are independent risk factors for increased galectin-3 concentrations, explaining 79.5% of the variance in the studied group. Serum gal-3 is significantly associated with CVD risk estimated by SCORE, supporting its potential role in risk stratification.

Kinesiophobia in patients with coronary heart disease: a Rodgers' evolutionary concept analysis

Introduction

Research on kinesiophobia in coronary heart disease is increasing, but existing studies primarily adopt concepts from the chronic pain domain, neglecting the specific characteristics of coronary heart disease patients. This gap limits effective identification and management.

Objective

This study aims to clarify the concept of kinesiophobia in coronary heart disease using Rodgers' evolutionary concept analysis.

Methodology

Rodgers' evolutionary concept analysis method was applied to review the literature. A comprehensive search was conducted in PubMed, Web of Science, PsycINFO, CINAHL, Cochrane Library, Embase, Scopus, ProQuest, OVID, CNKI, Wanfang Data, CBM, and VIP Database (up to June 30, 2024). Inclusion criteria: Studies on coronary heart disease patients, addressing the concept's attributes, antecedents, and consequences, published in English or Chinese. Exclusion criteria: Unavailable full text, gray literature, non-peer-reviewed texts, and study protocols.

Results

A total of 31 articles were included. The attributes of kinesiophobia in coronary heart disease patients were identified as self-symptomatic distress, complex emotional responses, subjective avoidance behavior with personality tendencies, and misperceptions with negative reactions. Antecedents included sociodemographic, disease-related, and psychological factors. Consequences encompassed reduced participation in cardiac rehabilitation, decreased functional capacity, increased major adverse cardiac events, and lower quality of life.

Conclusion

In this study, we found that kinesiophobia in patients with coronary heart disease is a subjective avoidance behavior that includes both "fear of pain or weakness" and "fear of cardiac events" based on personality tendencies, driven by complex emotional responses and misperceptions based on their own symptomatic disturbances, and presents an excessive and irrational fear of movement. This analysis highlights the need for early identification and multidisciplinary interventions tailored to this population. It also provides a foundation for developing more specific and objective assessment tools.

Clinical Significance of Extracellular Volume of Myocardium (ECV) Assessed by Computed Tomography: A Systematic Review and Meta-Analysis

Background/Objectives: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. Methods: A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using Cochrane Handbook formulas. Statistical analyses employed random-effects models (R version 4.4.2). Results: The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23-1.96; I2 = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. Conclusions: CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.

SET7 lysine methyltransferase mediates the up-regulation of NADPH oxidase expression, oxidative stress, and NLRP3 inflammasome priming in atherosclerosis

BACKGROUND

Dysregulation of histone methylation-based epigenetic mechanisms leads to either transient or long-lasting transcriptomic alterations in vascular and immune cells with important consequences on atherosclerotic plaque development and stability. We hypothesized that the epigenetic enzyme SET7 lysine methyltransferase contributes to the up-regulation of NADPH oxidase (Nox) and NLRP3 inflammasome expression in atherosclerosis.

METHODS

To test this hypothesis, we examined human non-atherosclerotic and atherosclerotic tissue samples, apolipoprotein E-deficient (ApoE-/-) mice, and human macrophages (Mac) employing real-time PCR, Western blot, immunofluorescence microscopy, and histological techniques. Male ApoE-/- mice with established atherosclerosis were randomized to receive concomitant with the high-fat diet, 5 mg/kg (R)-PFI-2, a selective SET7 pharmacological inhibitor, or its vehicle, every other day for 4 weeks.

RESULTS

The results revealed that SET7 mRNA and protein, and H3K4me1 levels were significantly elevated in human carotid atherosclerotic lesions, aorta of atherosclerotic mice, and in cultured pro-inflammatory Mac. In the atherosclerotic mice, pharmacological blockade of SET7 catalytic activity with the specific inhibitor, significantly reduced atherosclerotic plaque development, decreased the aortic up-regulation of mRNA and protein levels of Nox catalytic subunits, mitigated the formation of NT-/4HNE-protein adducts, attenuated NLRP3 gene and protein expression, and reduced pro-caspase-1 and pro-IL18 cleavage. In polarized pro-inflammatory human M1-Mac, SET7-oriented pharmacological intervention reduced the transcriptional up-regulation of Nox catalytic subunits, NLRP3, caspase-1, IL1β, and IL18, and the secretion IL1β and TNFα. Transient overexpression of SET7 in human endothelial cells enhanced mRNA levels of Nox1, Nox2, Nox4, Nox5, and p22phox.

CONCLUSION

The novel results show that SET7 regulates important mechanisms leading to enhanced formation of reactive oxygen species and pro-inflammatory cytokines release in atherosclerosis. The data recommend SET7 as a promising target for pharmacological interventions and as supportive therapeutic strategy in atherosclerotic cardiovascular diseases.

The impact of specialist cardiology inpatient care on the long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI): A nationwide cohort study

BACKGROUND

Specialist cardiac care has been shown to reduce inpatient mortality following non-ST segment myocardial infarction (NSTEMI), but whether this benefit extends beyond index admission is unclear.

METHODS

Using the linked Myocardial Ischaemia National Audit Project (MINAP) registry, and Office for National Statistics mortality recording, we included 425,205 NSTEMI patients admitted to UK hospitals, between January 2005 and March 2019 that survived to discharge. 217,964 (52 %) were admitted to a specialty cardiac ward. Multivariable Cox-regression models were applied to imputed data to estimate Hazard Ratios for mortality over our study period.

RESULTS

Patients admitted to specialty cardiology wards were younger (70 years vs. 75), less often female (32 % vs. 40 %) but more often received statins (86 % vs. 84 %) or beta-blockers (83 % vs. 77 %) (all P < 0.001). One-year (aHR:0.84, 95 % CI 0.83-0.86), and ten-year mortality (aHR: 0.88, 95 % CI 0.87-0.89) were lower in patients admitted to specialty cardiac wards, compared to admitted elsewhere (all P < 0.001). There was significant geographic variation in the proportion admitted to speciality cardiac wards (London 59 % vs. East of England 43 %), with over 1700 deaths potentially avoided if the MINAP target of 80 % was reached.

CONCLUSION

Patients admitted to a cardiac ward had significantly lower mortality compared to alternate wards persisting up to ten-years. There is wide regional variation in the proportion of patients who received specialist cardiology care during their admission and an opportunity exists for lives saved if the proportion of NSTEMI patients admitted to a cardiac ward were to reach the MINAP target of 80 %.

Analysis of the patient-sharing network in hypertension management: a retrospective study in China

OBJECTIVE

To explore the robustness of the patient-sharing network and validate the association between strength and persistence of physicians' relationships in China.

DESIGN, SETTING AND PARTICIPANTS

We conducted a patient-sharing network analysis to describe the persistence of patient-sharing relationships and logistic regression to analyse factors associating with the persistence of patient-sharing relationships in the Yinzhou Health Information System from 1 January 2010 to 31 December 2018; all outpatient records that had a hypertension diagnosis were included in this study.

OUTCOME MEASURES

The persistence ratio was defined as the proportion of the patient-sharing relationships in a given year that continued to exist in the following year, the 1-, 2- and 3-year persistence to test the robustness of the findings.

RESULTS

This study included 3916 physicians from 42 public healthcare facilities in Yinzhou. The 1-year persistence ratio fluctuated around 80%, and the 3-year persistence ratio was around 60% over the study period. The strength of the relationship, tie characteristics and physician specialty were important factors associating with the persistence of the relationships. The persistence of the relationships increased significantly as the strength of the relationships increased (for relationships with strength ∈ [3, 5), OR=3.987, 95% CI 3.896 to 4.08; for relationships with strength ∈ [5, 7), OR=6.379, 95% CI 6.147 to 6.626; and for relationships with strength ∈ [7, 9), OR=8.373, 95% CI 7.941 to 8.829). Physicians from the same healthcare institution were more likely to form ties that persisted for at least 1 year compared with physicians from different institutions (OR=1.510, 95% CI 1.480 to 1.540).

CONCLUSIONS

Our study showed that physicians frequently formed relationships with other physicians through sharing patients in Yinzhou, China, and these relationships had similar rates of persistence to studies conducted in developed countries, which indicated that findings of social network analyses conducted in developed countries still hold value in developing countries.

Relationship Between Perceived Social Support and Physical Frailty Among Older Patients with Coronary Artery Disease: A Dual Mediation Model

Background: Physical frailty is common among older patients with coronary artery disease (CAD) and is influenced by perceived social support, health literacy, and a sedentary lifestyle. This study examined the dual mediating roles of health literacy and a sedentary lifestyle in the relationship between perceived social support and physical frailty in older patients with CAD. Methods: This cross-sectional study included data collected from 182 older patients with CAD at a general hospital in Korea between June 2022 and January 2023. Participants completed self-reported questionnaires measuring the main variables and demographic information. Clinical data were obtained from electronic medical records. Results: The mediation hypothesis was tested using a dual mediation model with the PROCESS macro (Model 6) and 95% bias-corrected bootstrap confidence intervals. Perceived social support indirectly influenced physical frailty through three pathways: health literacy alone, sedentary lifestyle alone, and a sequential process in which health literacy influenced sedentary lifestyle and ultimately physical frailty. Conclusions: This study identified a strong mediating effect of health literacy and a sedentary lifestyle on the relationship between perceived social support and physical frailty. A built environment of perceived social support among older patients with CAD improves health literacy, modifies sedentary lifestyles, and helps prevent physical frailty. Thus, healthcare professionals should evaluate the perceived social support, health literacy, and sedentary lifestyle of older patients when developing physical frailty prevention programs.

Sex Differences in the Participation in Secondary Prevention Stroke Studies

BACKGROUND

Women show higher age-standardized mortality rates for ischemic stroke. Nevertheless, women are underrepresented in secondary stroke prevention trials. Our analysis investigated contributors to reduced study participation among women in a comprehensive stroke center in Austria.

METHODS

The population-based Tyrolean Stroke Pathway database was used to describe sex distribution in patients with ischemic stroke in the region and at the study site. Screening logs from 3 secondary stroke prevention studies at the Medical University of Innsbruck were analyzed containing information on age, self-reported sex, and causes for nonparticipation. Binary and multinomial logistic regression were performed to calculate odds ratios (ORs) and 95% CIs.

RESULTS

Women constituted 45.6% of all patients with ischemic stroke in the federal region and 43.1% at the study site. Of 4511 patients screened, 68.1% were included in at least 1 stroke trial, 39.5% of whom were female. Screened women were older than screened men, median age (interquartile range) of 76 (66-83) versus 72 (61-80) years. Women showed higher odds than men of receiving comfort terminal care (OR, 1.53 [95% CI, 1.14-2.05]), being unable to provide informed consent (OR, 1.95 [95% CI, 1.54-2.47]) due to aphasia (OR, 2.79 [95% CI, 1.91-4.06]) or cognitive impairment (OR, 1.96 [95% CI, 1.30-2.95]), and being ineligible for study participation based on inclusion and exclusion criteria (OR, 1.28 [95% CI, 1.04-1.58]). When adjusting for age, women were not more likely than men to refuse study participation (OR, 1.09 [95% CI, 0.84-1.43]).

CONCLUSIONS

Female sex was associated with higher odds of exclusion from studies due to comorbidities and more severe neurological deficits. However, in our analysis women were not more likely to refuse study participation.

Artificial intelligence in cardiovascular magnetic resonance imaging

Artificial intelligence is rapidly evolving and its possibilities are endless. Its primary applications in cardiac magnetic resonance imaging have focused on: image acquisition (in terms of acceleration and quality improvement); segmentation (in terms of saving time and reproducibility); tissue characterisation (including radiomic techniques and the non-contrast assessment of myocardial fibrosis); automatic diagnosis; and prognostic stratification. The aim of this article is to attempt to provide an overview of the current situation as preparation for the significant changes currently underway or imminent in the very near future.

Assessment of the biosafety profile of Galium verum in vitro on myoblasts and in ovo on chorioallantoic membrane

BACKGROUND

Cardiovascular diseases are the first cause of death in the world. Ischemic heart disease is the main cause of heart failure. New approaches are continuously sought to identify better therapeutic success. Thereby, current research has been drawn to identifying and completing the therapeutic profile of natural sources. Galium species are representatives exhibiting diuretic and antibacterial potential in living organisms and can treat burns, wounds, and skin diseases. Moreover, it was also observed that these plants manifest cardioprotective effects as well as having antihemolytic, antioxidant, antibacterial, anti-inflammatory, immunomodulatory, and antiproliferative potential. In ischemic heart disease, Galium verum (G. verum) extract manifested preservative properties in terms of contractility, systolic and diastolic function maintenance, and reduced damage to the heart after ischemia. In addition, G. verum extract upregulated the activity of antioxidant enzymes alleviating the production of pro-oxidants.

AIM

To test the ethanolic extract of G. verum on the H9C2(2-1) cell line by evaluating the in vitro biosafety profile and in ovo irritative potential.

METHODS

Cells were tested in vitro for viability (using the MTT test), cellular morphology, cell number, confluence, nuclear morphology (by immunofluorescence staining of cell nuclei and F-actin assay) and in ovo by the hen’s egg chorioallantoic membrane (CAM) test and CAM anti-irritant methods to study the irritation potential on the CAM.

RESULTS

The extract demonstrated a dose-dependent stimulatory activity. The viability increased to 170% for the dose of 55 µg/mL and decreased to 135% at 200 µg/mL. The results of cell number, confluence, and morphological analysis did not present significant changes compared with control untreated cells. The immunofluorescence assay showed insignificant apoptotic potential, and the hen’s egg CAM test revealed that the extract was in the weak to moderately irritating category with an irritation score of 5.3. When applying the sample to the CAM, only slight coagulation was observed (128 s). The anti-irritant test revealed the protective potential of the extract in the vascular plexus.

CONCLUSION

The ethanolic extract of G. verum manifests a stimulating effect on cardiomyocytes, enhancing cell viability, and maintaining a normal elongated shape, cell number, and confluence, without significant signs of apoptosis and with a weak irritative effect in ovo. In addition, the extract demonstrated a protective effect against hemorrhage, lysis, and coagulation of blood vessels induced by sodium dodecyl sulfate on the CAM.

Reduced Heating Wireless Energy Transmission System for Powering Implanted Circulatory Assist Devices: Benchtop and In-Vivo Studies

This study aimed to develop a novel Transdermal Energy Transmission System (TETS) device that addresses the driveline complications faced by patients with advanced heart failure (HF). Our TETS device utilizes a two-channel configuration with a very-low duty cycle and a pulsed RF power transmission technique, along with elliptically shaped flexible coil inductive coupling elements. We integrated a battery charging controller module into the TETS, enabling it to recharge an implanted Lithium-Ion (Li-Ion) battery that powers low-power-rated Circulatory Assist Devices, or left ventricular assist devices (LVADs). Benchtop measurements demonstrated that the TETS delivered energy from the implanted coils to the battery charging module, at a charging rate of up to 2900 J/h, presented an average temperature increase (ΔT) of 3 °C. We conducted in vivo measurements using four porcine models followed by histopathological analysis of the skin tissue in the implanted coils areas. The thermal profile analysis from the in vivo measurements and the calculated charging rates from the current and voltage waveforms, in porcine models, indicated that the charging rate and temperature varied for each model. The maximum energy charging rate observed was 2200 J/h, with an average ΔT of 3 °C. The exposed skin tissue histopathological analysis results showed no evidence of tissue thermal damage in the in vivo measurements. These results demonstrate the feasibility of our developed TETS device for wireless driving implanted low-power-rated LVADs and Li-Ion charging.

Determinants of Longitudinal Changes in Exercise Blood Pressure in a Population of Young Athletes: The Role of BMI

AIM

Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes.

METHODS

A longitudinal retrospective study was conducted on adolescent athletes who underwent at least two sport-related pre-participation screening visits, including exercise testing with a standardized incremental ramp protocol on treadmill. Blood pressure was assessed at rest (SBPrest), at the 3rd minute of exercise (SBP3min), and at peak exercise (SBPpeak). Predictors of blood pressure response (i.e., respective changes vs. baseline (Δ)) were determined by multivariate regression models after adjustment for age, sex, follow-up duration, related baseline SBP values, characteristics of sport, and ΔBMI.

RESULTS

A total of 351 young athletes (mean age at baseline 13 ± 2 years, 54% boys, average follow-up duration 3.4 ± 2.2 years) were enrolled. BMI increased by 1.5 ± 1.8 kg/m2 (p < 0.001) during follow-up. At baseline, mean SBPrest was 103 ± 14 mmHg, mean SBP3min 124 ± 18 mmHg, and mean SBPpeak 154 ± 23 mmHg. A significant between-visit increase in SBPrest (ΔSBPrest 7.0 ± 17.4 mmHg; p < 0.001), ΔSBP3min (4.8 ± 11 mmHg, p < 0.001), and ΔSBPpeak (11.7 ± 24 mmHg, p < 0.001) was observed. ΔSBP3min was significantly predicted by male sex (p < 0.01), baseline BMI (p < 0.01), ΔBMI (p < 0.01), and number of practiced sports (p < 0.05), whereas ΔSBPpeak was positively predicted by male gender (p < 0.01), baseline BMI (p < 0.05), and ΔBMI (p < 0.01) and negatively by baseline resting heart rate (p < 0.01). In a logistic regression model, ΔBMI was the only independent determinant of passing from a lower to an upper quartile of SBP3min (p < 0.001), while ΔBMI and male sex were independent determinants of moving to a higher quartile of SBPpeak (p < 0.001).

CONCLUSIONS

Increase in BMI during development and male sex are independent determinants of the increase in exercise blood pressure, both at light and maximal intensity, in a population of adolescent athletes.

Leveraging Mobile Health and Wearable Technologies for the Prevention and Management of Atherosclerotic Cardiovascular Disease

PURPOSE OF REVIEW

This review aims to assess the role of mobile health (mHealth) interventions and wearable technologies in the prevention and management of atherosclerotic cardiovascular disease (ASCVD). We sought to explore the benefits, challenges, and equity implications of these digital health modalities, with a focus on improving patient outcomes and reducing ASCVD risk.

RECENT FINDINGS

Recent studies have shown that mHealth interventions and wearable devices effectively promote healthy behaviors, offer real-time physiological monitoring, and aid in the early prevention of ASCVD by targeting key risk factors such as metabolic syndrome and sedentary lifestyles. These technologies hold great potential for improving patient engagement and enabling timely interventions. However, challenges such as technological constraints, high costs, and gaps in digital literacy significantly hinder their broader adoption, particularly among disadvantaged populations. In summary, our findings highlight the critical need for accessible, affordable, and inclusive digital health solutions to prevent and manage ASCVD, promoting more equitable healthcare delivery. To maximize these benefits, future research should focus on harnessing artificial intelligence and digital markers to improve early event prediction and develop personalized preventive strategies.

A Matlab Toolbox for cardiac electrophysiology simulations on patient-specific geometries

In this paper, we present CardioMat, a Matlab toolbox for cardiac electrophysiology simulation based on patient-specific anatomies. The strength of CardioMat is the easy and fast construction of electrophysiology cardiac digital twins from segmented anatomical images in a general-purpose software such as Matlab. CardioMat implements a quasi-automatic pipeline that guides the user toward the construction of anatomically detailed cardiac electrophysiology models. Importantly, the CardioMat framework includes the generation of physiologically plausible fiber orientation and Purkinje networks. The main novelty of our framework is its ability to handle voxel-based geometries as produced by segmentation procedures directly, without the need for an unstructured mesh. Indeed, the CardioMat monodomain solver uses a smoothed boundary approach and runs completely on GPU for fast simulations. We employed CardioMat in different application scenarios to show its potentialities and provide preliminary assessment of the feasibility, diagnostic performance, and accuracy of the toolbox. In particular, we showed that CardioMat simulations derived from post-infarction patients hold high sensitivity, specificity, predictive value, and accuracy for localization of deceleration zones in sinus rhythm.

Identification of potential biomarkers associated with cuproptosis and immune microenvironment analysis in acute myocardial infarction: A diagnostic accuracy study

Acute myocardial infarction (AMI), a critical cardiovascular condition, is often associated with serious health risks. Recent studies suggest a link between copper-induced apoptosis and immune cell infiltration. Specifically, abnormal accumulation of copper ions can lead to intracellular oxidative stress and apoptosis, while also affecting immune cell function and infiltration. Nevertheless, studies exploring this relationship in the context of AMI are notably scarce, underscoring the necessity of identifying biomarkers associated with cuproptosis in AMI. Consensus clustering analysis was employed to classify distinct subtypes of AMI in the GSE66360 dataset. Concurrently, differential expression analysis was performed to identify differentially expressed genes (DEGs) across subtypes and between AMI and control samples. We employed Venn diagrams to validate the selection of cuproptosis-related DEGs in patients with AMI. A protein-protein interaction network was constructed to pinpoint potential candidate genes. Receiver operating characteristic curves were generated to identify promising biomarkers. The immune infiltration milieu was analyzed using CIBERSORT algorithms. Finally, the expression levels of identified cuproptosis-related biomarkers were validated at the transcriptional level. We classified AMI into 2 distinct cuproptosis-related subtypes, leading to the identification of 157 cuproptosis-related DEGs. Further analysis refined this list to 10 potential candidate genes. Among these, 5 emerged as significant biomarkers for AMI: granzyme A (GZMA), GTPase immunity-associated proteins (GIMPAs) GIMAP7, GIMAP5, GIMAP6, and TRAF3 interacting protein 3 (TRAF3IP3). A comprehensive examination of immune infiltration in AMI samples revealed significant differences in the levels of 11 types of immune cells, with GZMA displaying the highest correlation with activated mast cells and CD8 + T cells. We observed markedly lower expression levels of GZMA, GIMAP6, and TRAF3IP3 in the AMI group compared to controls. This study identified 5 cuproptosis-related biomarkers (GZMA, GIMAP7, GIMAP5, GIMAP6, and TRAF3IP3) associated with AMI, laying a theoretical foundation for the treatment of AMI.

Residual Traditional Risk in Non-Traditional Atherosclerotic Diseases

Individuals with chronic inflammatory and immune disorders are at an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Despite extensive literature exploring the relationship between "non-traditional" atherosclerotic conditions and CV risk, many aspects remain unresolved, including the underlying mechanisms promoting the "non-traditional CV risk", the development of an innovative and comprehensive CV risk assessment tool, and recommendations for tailored interventions. This review aims to evaluate the available evidence on key "non-traditional" CV risk-enhancer conditions, with a focus on assessing and managing CV risk factors. We conducted a comprehensive review of 412 original articles, narrative and systematic reviews, and meta-analyses addressing the CV risk associated with "non-traditional" atherosclerotic conditions. The analysis examined the underlying mechanisms of these relationships and identified strategies for assessing and mitigating elevated risk. A major challenge highlighted is the difficulty in quantifying the contribution of individual risk factors and disease-specific elements to CV risk. While evidence supports the cardiovascular benefits of statins beyond lipid lowering, such as pleiotropic and endothelial effects, current guidelines lack specific recommendations for the use of statins or other therapies targeting non-traditional CV risk factors. Additionally, the absence of validated cardiovascular risk scores that incorporate non-traditional risk factors hinders accurate CV risk evaluation and management. The growing prevalence of "non-traditional CV risk-enhancer conditions" underscores the need for improved awareness of CV risk assessment and management. A thorough understanding of all contributing factors, including disease-specific elements, is crucial for accurate prediction of cardiovascular disease (CVD) risk. This represents an essential foundation for informed decision-making in primary and secondary prevention. We advocate for future research to focus on developing innovative, disease-specific CV risk assessment tools that incorporate non-traditional risk factors, recognizing this as a promising avenue for translational and clinical outcome research.

Evaluation of Pericoronary Fat Attenuation Index to Better Identify Culprit Lesions in Acute Coronary Syndrome According to Stenosis Severity

OBJECTIVE

To investigate the incremental value of pericoronary fat attenuation index (FAI) in routine coronary artery computed tomography angiography (CCTA) to identify culprit lesions in acute coronary syndrome (ACS).

METHODS

We reviewed the CCTA data from 80 ACS patients and 40 individuals with stable coronary atherosclerosis. ACS patient plaques were categorized into culprit and nonculprit groups. The plaque-specific pericoronary FAI was assessed using the Perivascular Fat Analysis Tool. We applied a default prespecified window of -190 to -30 Hounsfield units (HU) and a broader prespecified window of -190 to 20 HU. FAI values within these prespecified windows and the types and severity of plaque stenosis were compared across the 3 groups. Additionally, we investigated high-risk characteristics of plaques in the ACS group and their correlation with FAI. The effectiveness and worthiness of FAI in identifying culprit lesions were analyzed based on the receiver operating characteristic curve.

RESULTS

The FAI values under the 2 prespecified windows were higher in the culprit group than in the nonculprit and control groups (all P < 0.001). The culprit group showed the most mixed plaques and the most severe stenosis (all P < 0.001). In the ACS group, the FAI value was significantly lower around calcified lesions (-85.00 ± 9.97 HU) than around noncalcified (-78.00 ± 11.52 HU) and mixed plaques (-78.00 ± 9.24 HU) (both P < 0.001). The culprit group had more high-risk plaques, and high-risk plaques had higher FAI values than those without high-risk characteristics (-70.00 ± 7.67 HU vs -82.00 ± 10.16 HU, P < 0.001). The efficacy of FAI under the default prespecified window in identifying culprit lesions was higher compared than that under the broader prespecified window (area under the curve = 0.799 vs 0.761, P = 0.042), and the diagnostic cutoff values were -77 versus -58 HU. The FAI under the default prespecified window exhibited an incremental value for identifying culprit lesions, as compared with stenosis severity (area under the curve = 0.970 vs 0.939, P < 0.001).

CONCLUSION

The culprit lesions have higher FAI than the nonculprit lesions and the controls. FAI is a worthy parameter for identifying culprit lesions in routine CCTA according to stenosis severity, and the default prespecified window is a better option.

Multi-criteria Bayesian optimization of Empirical Mode Decomposition and hybrid filters fusion for enhanced ECG signal denoising and classification: Cardiac arrhythmia and myocardial infarction cases

This paper introduces a new advanced model for denoising and classification of ECG signals, focusing on the use of a hybrid filter and Bayesian optimization. The hybrid filter synergistically combines enhanced empirical mode decomposition (EEMD), Chebyshev Type II filters, Butterworth, Daubechies Wavelet, and Savitzky-Golay filters, leveraging their respective advantages for effective noise reduction while preserving the essential features of the ECG signal. We employ a multi-criteria Bayesian optimization process, using cross-correlation and mean squared error (MSE) as key metrics, to refine the filter parameters to further improve the signal quality. Additionally, we deploy a residual and parallel deep learning architecture adapted for the precise classification of cardiac conditions, such as arrhythmia and myocardial infarction. The results show a significant improvement in classification accuracy, from 96.63%-97.86% to 97.24%-98.62% after filtering, and reaching 98.03%-99.61% after optimization for arrhythmia. For myocardial infarction, accuracy increases from 96.29%-97.42% to 97.34%-98.44% after filtering, and from 98.13%-99.07% after optimization. This holistic and multi-criteria approach enhances the reliability of medical diagnostics and represents a significant advancement in the processing of biomedical signals.

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease

BACKGROUND

Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited.

OBJECTIVES

This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD.

METHODS

This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records.

RESULTS

The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = -0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables.

CONCLUSIONS

Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Cost-Effectiveness of Three Different New-Generation Drug-Eluting Stents in the Randomised BIO-RESORT Trial at 3 Years

BACKGROUND AND OBJECTIVE

Evidence on health economic outcomes for percutaneous coronary intervention (PCI) comparing different contemporary drug-eluting stents (DES) with each other is scarce, as most previous randomised DES trials did not assess such aspects. This prespecified health economic evaluation of the Comparison of Biodegradable Polymer and Durable Polymer Drug-Eluting Stents in an All Comers Population (BIO-RESORT) trial aimed to compare at 3-year follow-up both health effects and costs of PCI with one of three new-generation drug-eluting stents (DES) in patients with obstructive coronary artery disease.

METHODS

The randomised BIO-RESORT trial assessed in 3514 patients the ultrathin-strut biodegradable polymer Orsiro sirolimus-eluting stent (SES) and very-thin-strut Synergy everolimus-eluting (EES) stent versus the thin-strut durable polymer Resolute Integrity zotarolimus-eluting stent (ZES). In the current analysis, we used the perspective of a health insurer in the Netherlands. The main endpoints were quality-adjusted life years (QALYs), and costs for each treatment strategy. Bootstrapping with 5000 resamples was performed to capture the uncertainty of results.

RESULTS

Mean QALYs for each stent group were 2.566 for the SES, 2.551 for the EES, and 2.550 for the ZES. Mean costs per strategy were €14,670 for the SES, €14,946 for the EES, and €15,069 for the ZES. The SES had the highest probability of being cost-effective for every willingness-to-pay threshold up to €100,000 per QALY. Furthermore, in 79% of modelling scenarios, the SES was more effective and cheaper than ZES.

CONCLUSION

At 3-year follow-up, PCI with the SES had the highest probability of being cost-effective due to greater effectiveness and lower costs compared with the ZES and EES. These findings suggest that, due to the overall high volume of coronary stenting in clinical practice, use of this SES could result in substantial cost savings, complemented by slight additional health benefits.

Circular RNA regulatory role in pathological cardiac remodelling

Cardiac remodelling involves structural, cellular and molecular alterations in the heart after injury, resulting in progressive loss of heart function and ultimately leading to heart failure. Circular RNAs (circRNAs) are a recently rediscovered class of non-coding RNAs that play regulatory roles in the pathogenesis of cardiovascular diseases, including heart failure. Thus, a more comprehensive understanding of the role of circRNAs in the processes governing cardiac remodelling may set the ground for the development of circRNA-based diagnostic and therapeutic strategies. In this review, the current knowledge about circRNA origin, conservation, characteristics and function is summarized. Bioinformatics and wet-lab methods used in circRNA research are discussed. The regulatory function of circRNAs in cardiac remodelling mechanisms such as cell death, cardiomyocyte hypertrophy, inflammation, fibrosis and metabolism is highlighted. Finally, key challenges and opportunities in circRNA research are discussed, and orientations for future work to address the pharmacological potential of circRNAs in heart failure are proposed. LINKED ARTICLES: This article is part of a themed issue Non-coding RNA Therapeutics. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v182.2/issuetoc.

Probiotics: A Potential Strategy for Preventing and Managing Cardiovascular Disease

Probiotics are gaining recognition as a viable strategy for mitigating cardiovascular risk factors. Specifically, recent studies highlight their potential benefits in managing cholesterol levels, blood pressure, and inflammation, which are critical components in the prevention of cardiovascular diseases (CVD). This comprehensive review aims to elucidate the impact of probiotic consumption on major cardiovascular risk factors, including individuals with hypertension, type II diabetes mellitus, metabolic syndrome, hypercholesterolemia, and in secondary prevention in coronary artery disease. Scientific evidence based on human studies suggests that probiotic consumption is associated with positive effects on anthropometric measures, inflammation markers, blood pressure, glucose metabolism markers, lipid profiles, and endothelial function. However, these findings should be interpreted pragmatically and acknowledge the significant variability in results. This variability may be attributed to factors such as probiotic composition (single strain or multiple strains), the characteristics of the delivery matrix (food, capsules, and sachets), the duration of the intervention, the dosage regimen, and baseline health profiles of the participants. Incorporating probiotics as part of a comprehensive and healthy lifestyle approach can be considered a feasible strategy for both the prevention and management of CVD. However, further research is needed on factors influencing the effect of probiotics, such as: (i) optimal probiotic strain(s), (ii) appropriate dosage, (iii) duration of treatment, (iv) optimal delivery vehicle, and (v) sex-specific differences.

Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology

AIMS

Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.

METHODS AND RESULTS

Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.

CONCLUSION

NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.

2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study

BACKGROUND

The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD occurrence precedes diabetes diagnosis.

OBJECTIVES

The aim of this study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.

METHODS

This combined case-control and cohort study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Conditional logistic regression was used to compute ORs for CVD prevalence in the 30-year period before T2DM diagnosis. Cox proportional hazards regression models were used to compute HRs for 5-year CVD incidence after T2DM diagnosis.

RESULTS

The study included 127,092 individuals with T2DM and 381,023 matched comparisons. In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD. CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, with ORs ranging from 2.18 (95% CI: 1.91-2.48) in the earliest period (25-30 years before diagnosis) to 2.96 (95% CI: 2.85-3.08) in the latest period (<5 years before diagnosis). After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons (HR: 2.20; 95% CI: 2.12-2.27).

CONCLUSIONS

Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM.

Causes of death and trends in mortality from the year 2000 to 2017 in patients with acute myocardial infarction

OBJECTIVE

To investigate the most common causes of death and trends in cause-specific long-term mortality in patients hospitalized for acute myocardial infarction (AMI).

METHODS

This analysis was based on 10,718 patients, aged 25-74 years, recorded by the population-based Myocardial Infarction Registry Augsburg between 2000 and 2017. All hospitalized cases of AMI occurring in the study region during this period were included. If a patient died during follow-up (median: 6.6 years, IQR: 2.8-11.2) the death certificate was obtained and coded using the ICD-10 to determine the main cause of death. Cause-specific mortality was calculated for three 6-year periods. Multivariable adjusted Cox regression models stratified by time interval were calculated.

RESULTS

The most common cause of death was cardiovascular disease (CVD), more precisely ischemic-heart disease (IHD), followed by cancer. The proportions of CVD deaths and IHD deaths were stable over time. An increasing trend was observed in cancer mortality in post-AMI patients. In male patients, the hazard ratio for cancer mortality was 44.4% higher in 2012-2017 compared to 2000-2005, in female patients, it was more than twice as high in 2006-2012 compared to 2000-2005.

CONCLUSION

This study revealed consistent CVD and IHD long-term mortality and increasing trends in long-term cancer mortality in patients post-AMI. Thus, post-AMI patients should emphasize tertiary prevention of CVD by minimizing risk factors. Furthermore, patients should regularly undergo cancer screening programs. The reasons for the unfavorable development in terms of increasing cancer mortality should be investigated in further studies.

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP)

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

The role of Nutri-Score and NutrInform Battery in guiding the food choices of consumers with specific nutritional needs: A controlled study

BACKGROUND AND AIMS

There is a significant knowledge gap regarding the effectiveness of front-of-pack labeling (FoPL) systems in helping food choices that meet specific nutritional requirements. This study sought to compare the effectiveness of the Nutri-Score (NS) and NutrInform Battery (NIB) labels in assisting consumers to select food products with low sodium or low saturated fat.

METHODS AND RESULTS

Utilizing a controlled experimental design, a sample of 1512 participants (aged 18-70, 50.8% females) was exposed to scenarios through computer-assisted web interviewing, where they selected food products suitable for people with suboptimal blood pressure or plasma cholesterol levels, labeled with either NS, NIB, or no label (blind). The NIB proved significantly more efficacious than NS in guiding participants towards making selections in better agreement with nutritional needs, for blood pressure or cholesterol control. Furthermore, the NIB was generally viewed more favorably, with participants rating it as more trustworthy, informative, and useful for the required task. Notably, younger participants, those with higher nutritional knowledge, and those less inclined towards intuitive or spontaneous decision-making demonstrated a greater propensity for making health-congruent food choices when using the NIB.

CONCLUSION

The findings suggest that the informative FoPL system, NIB, may offer greater advantages in addressing specific dietary requirements. This underscores the important role of FoPL systems in promoting public health and meeting diverse and specific consumer needs. Further research is needed to confirm these results in broader contexts and for additional health conditions.

Progress in the Clinical Application of Artificial Intelligence for Left Ventricle Analysis in Cardiac Magnetic Resonance

Cardiac magnetic resonance (CMR) imaging enables a one-stop assessment of heart structure and function. Artificial intelligence (AI) can simplify and automate work flows and improve image post-processing speed and diagnostic accuracy; thus, it greatly affects many aspects of CMR. This review highlights the application of AI for left heart analysis in CMR, including quality control, image segmentation, and global and regional functional assessment. Most recent research has focused on segmentation of the left ventricular myocardium and blood pool. Although many algorithms have shown a level comparable to that of human experts, some problems, such as poor performance of basal and apical segmentation and false identification of myocardial structure, remain. Segmentation of myocardial fibrosis is another research hotspot, and most patient cohorts of such studies have hypertrophic cardiomyopathy. Whether the above methods are applicable to other patient groups requires further study. The use of automated CMR interpretation for the diagnosis and prognosis assessment of cardiovascular diseases demonstrates great clinical potential. However, prospective large-scale clinical trials are needed to investigate the real-word application of AI technology in clinical practice.

Epidemiology of aortic and peripheral arterial diseases in France

BACKGROUND

Peripheral arterial diseases (PADs) account for much of the morbidity and hospitalizations experienced by patients with cardiovascular disease. Epidemiological data on these diseases are lacking in France.

AIMS

To describe the epidemiology of aortic diseases (aneurysm and dissection) and PADs in France in 2022.

METHODS

This study was carried out using the National Health Data System. Patients hospitalized with these diseases in 2022 and patients who died from these diseases in 2021 were selected. The prevalence of aortic diseases and PADs among people alive on 1 January 2023 was estimated from previous hospitalizations and registered long-term disease. Mortality and secondary treatment were examined in the year following hospitalization.

RESULTS

In 2022, there were 68,702 patients hospitalized in France for a lower extremity artery disease (LEAD), 9083 for abdominal aortic aneurysm and 9027 for dissection or aneurysm of a medium-sized artery (standardized rates: 112.6, 15.0 and 15.5 per 100,000, respectively). The standardized prevalences of these diseases were 1.23%, 0.17% and 0.22% of adults, respectively. Regional and social disparities in the age-standardized rates of hospitalized patients were observed. One-year mortality ranged from approximately 11% for patients hospitalized for thoracic aortic aneurysm or medium-sized artery dissection/aneurysm to 27.0% for aortic dissection. The proportions of patients hospitalized due to LEAD who were being treated with antiplatelet or lipid-lowering drugs 1 year after the index hospitalization were 86.6% and 75.9%, respectively.

CONCLUSION

The burden of aortic diseases and PADs is considerable in France and mortality remains high for ruptured aortic aneurysm and aortic dissection.

Lifestyle interventions for cardiometabolic health

Unhealthy lifestyle behaviors such as poor diets and physical inactivity account for most of the cardiometabolic disease (CMD) burden, including type 2 diabetes and cardiovascular diseases. Much of this burden is mediated by the effects of unhealthy lifestyle behaviors on overweight and obesity, and disproportionally impacts certain population groups-including those from disadvantaged socioeconomic backgrounds. Combined lifestyle interventions (CLIs), which target multiple behaviors, have the potential to prevent CMD, but their implementation, reach and effectiveness in routine practice are often limited. Considering the increasing availability of effective but expensive pharmaceutical options for weight loss, we review the short-term and long-term benefits and cost-effectiveness of CLIs on overweight, obesity and associated CMDs, in controlled studies and in routine care. Against the backdrop of changing living environments, we discuss the effective components of CLIs and the many challenges associated with implementing them. Finally, we outline future directions for research and implications for policy and practice to improve lifestyle behaviors and cardiometabolic health at the population level.

Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention

BACKGROUND

Chronic ischemic heart disease (IHD) is one of the leading causes of morbidity and mortality. Physical activity (PA) is an effective secondary preventive strategy in IHD management. The German treatment guideline recommends that general practitioners (GPs) deliver PA advice to patients. This recommendation seems inadequately implemented, often due to GP's insufficient specific training. International guidelines recommend training GPs in how to deliver such advice effectively and efficiently. Evidence is lacking on whether such training can enhance the frequency and quality of PA advice in routine care. The OptiCor project aims to develop and evaluate a GP training in the delivery of very brief PA advice to optimise the treatment of patients with IHD in general practice.

METHODS

OptiCor comprises three study phases according to the Medical Research Council recommendations for developing and evaluating complex interventions. Phase 1 (needs analysis): A nationwide representative household survey will be conducted to collect data on the receipt of GP-delivered PA advice in people with IHD. Qualitative interviews and group discussions with GPs and people with IHD will help to explore, e.g., attitudes, experiences with, and barriers and facilitators of PA advice implementation or reception, respectively. Findings will inform the training development. Phase 2 (pilot): A pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training on proportions of GP-delivered PA advice during routine care of IHD patients will be piloted. Phase 3 (evaluation): A full pragmatic cRCT will be conducted with patient-reported proportions of GP-delivered PA advice as primary endpoint. Collection of health economic and process-related data will facilitate a potential future broad implementation and health economic evaluation of the training.

DISCUSSION

If the developed training successfully improves proportions and quality of GP delivered PA advice to patients with IHD, it could serve as a low-threshold and sustainable strategy for implementing PA recommendations in the secondary prevention of IHD in routine GP practice.

TRIAL REGISTRATION

Work package (WP) 1, WP5, and WP6 have been prospectively registered at German Clinical Trials Register (WP1: DRKS00031304, 19/06/2023; WP5: DRKS00034641, 10/07/2024; WP6: DRKS00034642; 10/07/2024).

Causal associations of Sjögren's syndrome with cardiovascular disease: A two-sample Mendelian randomization study

Study objectives

Observational and cohort studies have associated Sjögren's syndrome (SS) with various types of cardiovascular disease (CVD), yet causal relationships have not been established. We employed Mendelian randomization (MR) to investigate potential causal links between SS and CVD in the general population.

Methods

We conducted a two-sample MR analysis using data from four distinct sources for 11 genome-wide significant single nucleotide polymorphisms (SNPs) associated with SS and data for 13 types of CVD sourced from FinnGen, IEU OpenGWAS, and GWAS catalog. The inverse variance weighted method was selected as the primary analytical approach, complemented by various sensitivity analyses.

Results

MR analyses provide evidence of a significantly increased risk of ischemic stroke associated with genetically predicted SS (odds ratio [OR], 1.0237; 95 % CI, 1.0096 to 1.0379; p = 0.0009), as well as suggestive evidence of a potential causal relationship between SS and an increased risk of chronic heart failure (OR, 1.0302; 95 % CI, 1.0020 to 1.0592; p = 0.0355). Sensitivity analyses reinforced these associations, demonstrating robustness and consistency across multiple statistical methods. The secondary analysis, conducted after outlier correction using MR-PRESSO and RadialMR methods, reaffirmed these associations and also indicated a suggestive causal link between SS and non-rheumatic valvular heart disease (OR, 1.0251; 95 % CI, 1.0021 to 1.0486; p = 0.0323).

Conclusions

This study demonstrates that genetically predicted SS is a potential causative risk factor for ischemic stroke, chronic heart failure, and non-rheumatic valvular heart disease on a large-scale population. However, further research incorporating ancestral diversity is required to confirm a causal relationship between SS and CVD.

Novel protocol for the transcriptomic analysis of endothelial extracellular vesicles in atherosclerosis

INTRODUCTION

Despite the key role of the endothelium in atherosclerosis, there are no direct techniques for its analysis. The study of extracellular vesicles of endothelial origin (EEVs), might lead to the identification of molecular signatures and early biomarkers of atherosclerosis. The aim of this work was to set up the methods for EEVs separation and transcriptomic analysis.

METHODS

We adapted an antibody-magnetic-bead based immunocapture protocol for plasma EEVs separation from control (G1), subclinical atherosclerosis (G2) and peripheral artery disease subjects (PAD) (G3), and modified an ultra-low input RNASeq method (n=5/group). By bioinformatics analysis we compared the transcriptome of plasma EEVs with that of human aortic endothelial cells (TeloHAECs), and then, searched for differentially expressed genes (DEG) among EEVs of G1, G2 and G3. From those DEG, UCP2 was selected for further validation in plasma EVs (qPCR), and in vitro, in stimulated TeloHAECs (IL-1β, TNFα, oxLDL and hypoxia).

RESULTS

The RNASeq analysis of plasma EEVs rendered 1667 genes enriched in transcripts expressed by TeloHAECs (NES: 1.93, p adjust=1.4e-73). One hundred seventy DEGs were identified between G2 vs G1, and 180 between G3 vs G1, of which 17 were similarly expressed in G2 and G3 vs control, including UCP2. IL-1β and TNFα (10ng/mL, p<0.05), hypoxia (1% O2, p=0.05) and oxLDL (100μg/mL, p=0.055) reduced UCP2 expression in TeloHAECs.

CONCLUSIONS

We set up a protocol for EEVs separation and sequencing that might be useful for the identification of early markers of endothelial dysfunction in atherosclerosis.

Quantifying myocardial perfusion during MR-guided interventions without exogenous contrast agents: intra-arterial spin labeling

PURPOSE

To test intra-arterial spin labeling (iASL) using active guiding catheters for myocardial perfusion measurements during magnetic resonance (MR)-guided interventions in a pig study.

METHODS

In this work, a single-loop radiofrequency (RF) coil at the tip of a 6F active coronary catheter was used as a transmit coil for local spin labeling. The transmit magnetic RF field (B1) of the coil and the labeling efficiency were determined, and iASL was tested in two pigs after the catheter was engaged in the aortic root, the ostium of the left coronary artery (LCA) under MR-guidance. The iASL effect was assessed by the signal difference between spin-labeling On and control (spin-labeling OFF) images, and in a cross-correlation between ON/Off states of spin-labeling a binary labeling paradigm. In addition, quantitative myocardial perfusion was calculated from the iASL experiments.

RESULTS

The maximum B1 in the vicinity of the catheter coil was 2.1 µT. A strong local labeling effect with a labeling efficiency of 0.45 was achieved with iASL both in vitro and in vivo. In both pigs, the proximal myocardial segments supplied by the LCA showed significant labelling effect up to distances of 60 mm from the aortic root with a relative signal difference of (3.14 ± 2.89)% in the first and (3.50 ± 1.25)% in the second animal. The mean correlation coefficients were R = 0.63 ± 0.22 and 0.42 ± 0.16, respectively. The corresponding computed myocardial perfusion values in this region of the myocardium were similar to those obtained with contrast perfusion methods ((1.2 ± 1.1) mL/min/g and (0.8 ± 0.6) mL/min/g).

CONCLUSION

The proposed iASL method demonstrates the feasibility of selective myocardial perfusion measurements during MR-guided coronary interventions, which with further technical improvements may provide an alternative to exogenous contrast-based perfusion. Due to the invasive nature of the iASL method, it can potentially be used in concert with MRI-guided coronary angioplasty.

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study

BACKGROUND

Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands.

METHODS

In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries.

RESULTS

In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality.

CONCLUSIONS

In this observational longitudinal study, changes in exposure to a healthier food environment over 14 years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

Assessment of safety profile of ivabradine in real-world scenario using FDA adverse event reporting system database

BACKGROUND

Ivabradine is primarily indicated for patients with sinus rhythm and a heart rate ≥ 75 beats/min, who have NYHA class II-IV chronic heart failure with systolic dysfunction. There is currently a lack of large-scale, real-world studies concerning its drug adverse reactions.

RESEARCH DESIGN & METHODS

This research assesses the side effects of ivabradine by analyzing reports of adverse events (AEs) from the FDA's Adverse Event Reporting System (FAERS) database. To evaluate the importance of these AEs, four sequential analytic strategies were utilized.

RESULTS

In total, 2,701 ivabradine-related AE reports were identified in the FAERS database. We identified 26 ivabradine-induced AEs, each with more than 20 reports, including some significant AEs not mentioned on the product label. The timing of AEs was also analyzed, with the majority of AEs occurring within the first month of ivabradine use. Gender-specific analysis indicates that female have a higher risk of AEs, such as off-label use, tachycardia, drug effectiveness for unapproved indications, and rash compared to male.

CONCLUSION

This study provides important information for maximizing the usage of ivabradine, increasing its efficacy, and reducing any possible negative effects. The actual clinical use of the medication will be greatly aided by this knowledge.

Improvement of non-adherence and reduction of BP values in patients with difficult-to-treat hypertension: the ATHAN clinical trial

Hypertension treatment and blood pressure (BP) control reduce cardiovascular disease burden. However, prevalence of controlled BP is overall insufficient and lack of adherence to treatment is a suggested major contributor. This prospective, randomized clinical trial was designed to evaluate whether a specific 3-month (m) action plan to improve therapeutic adherence results in a decrease in BP. Patients with ambulatory 24 h-BP ≥ 130/80 mmHg despite receiving ≥2 antihypertensive drugs and with therapeutic non-compliance confirmed by antihypertensive drugs analyzed in urine were randomized (1:1) to receive a specific 3 m program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified and knowledge of non-adherence was only notified to patients randomized to the intervention group. Before randomization and at 3 m all patients underwent urinary screening for antihypertensive drugs and 24 h-ambulatory-BP monitoring. Forty-five patients (36% women, mean age: 58 ± 13 yr) were randomized. At 3 m, mean (95% CI) BP differences (INT vs. C) were 12.2 mmHg (4.3-20.8), adjusted-p = 0.032 and 8.7 mmHg (2.5-14.8), adjusted-p = 0.018 for 24 h-systolic and 24 h-diastolic BP, respectively. Differences (INT vs. C) for office SBP and DBP were 18.4 mmHg (6.8-30.1), adjusted-p = 0.005 and 15.7 mmHg (7.2-24.2), adjusted-p < 0.001. Non-detected antihypertensive drugs were median [IQR]: 40% [25-100] and 0% [0-20] at baseline and 3 m, respectively, in the INT group, and 33.3% [25-63.7] and 33.3% [23.8-57.9], in the C group (p < 0.001 for the 3-month between-group comparison). A combined action plan of notifying knowledge of non-adherence plus a 3-month specific nursing intervention to improve therapeutic adherence results in BP reduction in patients with inadequate therapeutic compliance.

Cardiac Molecular Analysis Reveals Aging-Associated Metabolic Alterations Promoting Glycosaminoglycans Accumulation via Hexosamine Biosynthetic Pathway

Age is a prominent risk factor for cardiometabolic disease, often leading to heart structural and functional changes. However, precise molecular mechanisms underlying cardiac remodeling and dysfunction exclusively resulting from physiological aging remain elusive. Previous research demonstrated age-related functional alterations in baboons, analogous to humans. The goal of this study is to identify early cardiac molecular alterations preceding functional adaptations, shedding light on the regulation of age-associated changes. Unbiased transcriptomics of left ventricle samples are performed from female baboons aged 7.5-22.1 years (human equivalent ≈30-88 years). Weighted-gene correlation network and pathway enrichment analyses are performed, with histological validation. Modules of transcripts negatively correlated with age implicated declined metabolism-oxidative phosphorylation, tricarboxylic acid cycle, glycolysis, and fatty-acid β-oxidation. Transcripts positively correlated with age suggested a metabolic shift toward glucose-dependent anabolic pathways, including hexosamine biosynthetic pathway (HBP). This shift is associated with increased glycosaminoglycan synthesis, modification, precursor synthesis via HBP, and extracellular matrix accumulation, verified histologically. Upregulated extracellular matrix-induced signaling coincided with glycosaminoglycan accumulation, followed by cardiac hypertrophy-related pathways. Overall, these findings revealed a transcriptional shift in metabolism favoring glycosaminoglycan accumulation through HBP before cardiac hypertrophy. Unveiling this metabolic shift provides potential targets for age-related cardiac diseases, offering novel insights into early age-related mechanisms.

Association of Diagonal Earlobe Crease with Risk of Atrial Fibrillation in Stable Patients with Coronary Artery Disease

Background: Diagonal earlobe crease (DELC) is a proposed visible predictor of coronary artery disease (CAD). However, studies on the association between atrial fibrillation (AF) and DELC are lacking. This study evaluated the association between DELC and the incidence of AF in patients with CAD. Methods: A total of 669 participants aged <65 years (mean, 53.8 ± 7.5 years) diagnosed with CAD and without AF were evaluated for the presence of DELC. The study outcome was the incidence of AF based on the presence of DELC. The study period was planned for 60 months with a minimum follow-up period of 12 months. Results: Herein, the incidence of DELC was 10.8%. During the follow-up period (44.6 ± 14.9 months), the incidences of AF development were 16.4% and 8.4% in DELC and non-DELC groups, respectively. Kaplan-Meier analysis revealed that the occurrence of AF was significantly higher in the DELC group than in the non-DELC group (log-rank test, p = 0.02). Compared with patients without DELC, patients with DELC had a high risk of AF development (adjusted hazard ratio = 1.88, 95% confidence interval = 1.01-3.53). Conclusions: DELC is associated with an increased risk of AF in patients with CAD. These findings may aid in the detection of AF in patients with CAD.