Pubblicazioni recenti - cardiovascular events
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Translating scientific recommendations into reality: a feasibility study using group-based high-intensity functional exercise training in adolescents with cerebral palsy.
Disabil Rehabil2023 Dec;():1-10. doi: 10.1080/09638288.2023.2290204.
Minghetti Alice, Widmer Michèle, Viehweger Elke, Roth Ralf, Gysin Ramon, Keller Martin,
Abstract
PURPOSE:
To examine the feasibility and effects of a functional high-intensity exercise intervention performed in a group-setting on functionality, cardiovascular health and physical performance in adolescents with cerebral palsy (CP).
METHODS:
Ten adolescents with a diagnosis of CP (2 females; 16.6?±?3.4?years; GMFCS: I-II) participated in a 12-week training intervention, containing progressive resistance training using free weights and high-intensity workouts twice a week. The six-minute walking test, arterial stiffness and physical performance (strength and power tests) were measured before and after the intervention.
RESULTS:
No adverse events were reported. We measured small increases in the six-minute walking test (??=?28.8?m, 95% CI [-1.78;52.7]; ?=?0.34 [-0.04;0.72]) and a small reduction in arterial stiffness (? = -4.65% [-10.90;1.25]; ?=?-0.46 [-1.36;0.21]). All measures of physical performance increased (0.24??????0.88).
CONCLUSION:
Functional training with free weights in high-functioning adolescents with CP is safe and effective in increasing parameters of physical performance and cardiovascular health. Positively influenced indicators of everyday independence (i.e. strength parameters) showed a transfer into movements of daily life. Concerns about adverse events through high-intensity training in adolescents with CP appear unjustified when training is performed progressively, following basic training principles.
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Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort.
BMC Public Health2023 Dec;23(1):2402. doi: 10.1186/s12889-023-17332-w.
Ghavami Mojgan, Abdshah Alireza, Esteghamati Sadaf, Hafezi-Nejad Nima, Nakhjavani Manouchehr, Esteghamati Alireza,
Abstract
INTRODUCTION:
Recent studies have introduced elevated lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease (CHD). This study investigated whether the addition of Lp(a) as a novel biomarker to the Framingham Risk Score (FRS) model improves CHD risk prediction.
METHODS:
The study included 1101 Iranian subjects (443 non-diabetic and 658 diabetic patients) who were followed for 10 years (2003-2013). Lp(a) levels and CHD events were recorded for each participant.
RESULTS:
The Net Reclassification Index (NRI) after adding Lp(a) to the FRS model was 19.57% and the discrimination slope was improved (0.160 vs. 0.173). The Akaike Information Criterion (AIC), a measure of model complexity, decreased significantly after adding Lp(a) to the FRS model (691.9 vs. 685.4, P value: 0.007).
CONCLUSIONS:
The study concluded that adding Lp(a) to the FRS model improves CHD risk prediction in an Iranian population without making the model too complex. This could help clinicians to better identify individuals who are at risk of developing CHD and to implement appropriate preventive measures.
© 2023. The Author(s).
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The Association of Incidental Radiation Dose to the Heart Base with Overall Survival and Cardiac Events after Curative-intent Radiotherapy for Non-small Cell Lung Cancer: Results from the NI-HEART Study.
Clin Oncol (R Coll Radiol)2023 Nov;():. doi: S0936-6555(23)00444-2.
Walls G M, O'Connor J, Harbinson M, Duane F, McCann C, McKavanagh P, Johnston D I, Giacometti V, McAleese J, Hounsell A R, Cole A J, Butterworth K T, McGarry C K, Hanna G G, Jain S,
Abstract
AIMS:
Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer radiotherapy. The dose to the heart base has been associated with poor survival in multiple institutional and clinical trial datasets using unsupervised, voxel-based analysis. Validation has not been undertaken in a cohort with individual patient delineations of the cardiac base or for the endpoint of cardiac events. The purpose of this study was to assess the association of heart base radiation dose with overall survival and the risk of cardiac events with individual heart base contours.
MATERIALS AND METHODS:
Patients treated between 2015 and 2020 were reviewed for baseline patient, tumour and cardiac details and both cancer and cardiac outcomes as part of the NI-HEART study. Three cardiologists verified cardiac events including atrial fibrillation, heart failure and acute coronary syndrome. Cardiac substructure delineations were completed using a validated deep learning-based autosegmentation tool and a composite cardiac base structure was generated. Cox and Fine-Gray regressions were undertaken for the risk of death and cardiac events.
RESULTS:
Of 478 eligible patients, most received 55 Gy/20 fractions (96%) without chemotherapy (58%), planned with intensity-modulated radiotherapy (71%). Pre-existing cardiovascular morbidity was common (78% two or more risk factors, 46% one or more established disease). The median follow-up was 21.1 months. Dichotomised at the median, a higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (20.2 months versus 28.3 months; hazard ratio 1.40, 95% confidence interval 1.14-1.75, P = 0.0017) and statistical significance was retained in multivariate analyses. Furthermore, heart base Dmax was associated with pooled cardiac events in a multivariate analysis (hazard ratio 1.75, 95% confidence interval 1.03-2.97, P = 0.04).
CONCLUSIONS:
Heart base Dmax was associated with the rate of death and cardiac events after adjusting for patient, tumour and cardiovascular factors in the NI-HEART study. This validates the findings from previous unsupervised analytical approaches. The heart base could be considered as a potential sub-organ at risk towards reducing radiation cardiotoxicity.
Copyright © 2023. Published by Elsevier Ltd.
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Atherosclerotic Cardiovascular Events in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Retrospective Cohort Study.
Heart Lung Circ2023 Dec;():. doi: S1443-9506(23)04375-5.
Tan Sean, Spear Ella, Sane Nikhita, Chan Jasmine, Nelson Adam J, Alamgeer Muhammad, Nerlekar Nitesh, Segelov Eva, Nicholls Stephen J,
Abstract
BACKGROUND:
Immune checkpoint inhibitors (ICIs) are effective therapies for numerous cancers, but have been associated with atherosclerotic cardiovascular disease (ASCVD). This study aimed to identify predictors for ASCVD events among cancer patients treated with ICIs and the cardiovascular risk factor (CVRF) control of those who developed ASCVD.
METHOD:
A single-centre retrospective study of 366 cancer patients who received ICIs from 2018 to 2020 was performed. Demographic, baseline CVRF, cancer history, and ICI regimen data were obtained from medical records. The primary end point of ASCVD events was defined as myocardial infarction, coronary revascularisation, ischaemic stroke, or acute limb ischaemia. Cox proportional multivariable modelling and competing risks analysis were performed to assess ASCVD predictors. Descriptive analysis was performed to describe CVRF management among those who developed ASCVD events.
RESULTS:
Over a median follow-up of 3.4 years (2.8-4.3), 26 patients (7.1%) experienced 27 ASCVD events (seven myocardial infarction, one coronary revascularisation, 13 ischaemic stroke, and six acute limb ischaemia events). There were 226 (61.8%) cancer-related deaths and no cardiac deaths. History of ASCVD before ICI initiation was independently associated with ASCVD events on traditional Cox modelling (hazard ratio [HR] 4.00; 95% confidence interval [CI] 1.79-8.91; p
CONCLUSIONS:
History of ASCVD was associated with subsequent ASCVD events among patients treated with ICIs, which could occur even after active treatment was stopped. Identification and aggressive management of modifiable CVRFs should be considered throughout cancer survivorship in patients who received ICI treatment.
Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.
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Space-time clusters of cardiovascular mortality and the role of heatwaves and cold spells in the city of São Paulo, Brazil.
Spat Spatiotemporal Epidemiol2023 Nov;47():100620. doi: 10.1016/j.sste.2023.100620.
Moraes Sara Lopes de, Almendra Ricardo, Barrozo Ligia Vizeu,
Abstract
The effects extreme air temperature events are related with an increase in cardiovascular mortality among vulnerable groups worldwide. Therefore, we identify spatiotemporal mortality clusters associated with diseases of the cardiovascular system among people ? 65 years in São Paulo, from 2006 to 2015, and investigate whether high-risk mortality clusters occurred during or following extreme air temperature events. To detect the clusters, we used daily mortality data and a retrospective space-time scan analysis with a discrete Poisson model. Extreme air temperature events were defined by daily mean temperatures, below the 10th percentile for cold spells and above the 90th percentile for heatwaves, with two or more consecutive days. We found statistically significant high-risk mortality clusters located in the peripheral areas. The spatiotemporal clusters of risk areas for cardiovascular and ischemic heart disease occurred during or following cold spell events, whereas those for stroke and ischemic stroke events were related to heatwaves.
Copyright © 2023. Published by Elsevier Ltd.
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Prognostic value of stress hyperglycemia ratio in patients with acute myocardial infarction: a systematic review with Bayesian and frequentist meta-analysis.
Trends Cardiovasc Med2023 Nov;():. doi: S1050-1738(23)00107-X.
Karakasis Paschalis, Stalikas Nikolaos, Patoulias Dimitrios, Pamporis Konstantinos, Karagiannidis Efstratios, Sagris Marios, Stachteas Panagiotis, Bougioukas Konstantinos I, Anastasiou Vasileios, Daios Stylianos, Apostolidou-Kiouti Fani, Giannakoulas George, Vassilikos Vassilios, Fragakis Nikolaos, Giannopoulos George,
Abstract
The present systematic review and meta-analysis aimed to investigate the prognostic value of stress hyperglycemia ratio (SHR) in patients with acute myocardial infarction (AMI). A total of 26 cohort studies, involving 87974 patients, were analyzed. The frequentist meta-analysis showed that AMI patients with SHR in the upper quantile had a significantly higher hazard of major adverse cardiovascular and cerebrovascular events (MACCE, HR?=?1.7; 95% CI= [1.42, 2.03]; P
Copyright © 2023. Published by Elsevier Inc.
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The contribution of mitochondria to age-related skeletal muscle wasting: A sex-specific perspective.
Life Sci2023 Nov;():122324. doi: 10.1016/j.lfs.2023.122324.
Nuccio Alessandro, Nogueira-Ferreira Rita, Moreira-Pais Alexandra, Attanzio Alessandro, Duarte José Alberto, Luparello Claudio, Ferreira Rita,
Abstract
As people age, their skeletal muscle (SkM) experiences a decline in mitochondrial functionality and density, which leads to decreased energy production and increased generation of reactive oxygen species. This cascade of events, in turn, might determine the loss of SkM mass, strength and quality. Even though the mitochondrial processes dysregulated by aging, such as oxidative phosphorylation, mitophagy, antioxidant defenses and mtDNA transcription, are the same in both sexes, mitochondria age differently in the SkM of men and women. Indeed, the onset and magnitude of the impairment of these processes seem to be influenced by sex-specific factors. Sexual hormones play a pivotal role in the regulation of SkM mass through both genomic and non-genomic mechanisms. However, the precise mechanisms by which these hormones regulate mitochondrial plasticity in SkM are not fully understood. Although the presence of estrogen receptors in mitochondria is recognized, it remains unclear whether androgen receptors affect mitochondrial function. This comprehensive review critically dissects the current knowledge on the interplay of sex in the aging of SkM, focusing on the role of sex hormones and the corresponding signaling pathways in shaping mitochondrial plasticity. Improved knowledge on the sex dimorphism of mitochondrial aging may lead to sex-tailored interventions that target mitochondrial health, which could be effective in slowing or preventing age-related muscle loss.
Copyright © 2023. Published by Elsevier Inc.
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Cardiovascular Risk in Patients with Haematological Malignancies: A Systematic Review and Meta-Analysis of 1,960,144 cases.
Am J Cardiol2023 Nov;():. doi: S0002-9149(23)01331-0.
Yong Jung Hahn, Mai Aaron Shengting, Mateti? Andrija, Elbadawi Ayman, Elgendy Islam Y, Lopez-Fernandez Teresa, Mamas Mamas A,
Abstract
Patients with haematological malignancies (HM) are at risk of future cardiovascular (CV) events. We therefore conducted a systematic review and meta-analysis to quantify their risk of future CV events. We searched Medline and Embase databases from inception till 31 January 2023 for relevant articles using a combination of keywords and medical subject headings. Studies examining CV outcomes in patients with HM versus controls without HM were included. Outcomes of interest included acute myocardial infarction (AMI), heart failure (HF), and stroke. The outcomes were expressed as hazard ratios (HR) and their 95% confidence intervals (95% CI). This study is registered with PROSPERO at CRD42022307814. Fifteen studies involving 1,960,144 cases (178,602 patients with HM and 1,781,212 controls) were included in the quantitative analysis. Ten studies examined the risk of AMI, 5 examined HF, and 11 examined stroke. When compared with the control group, the HRs for HM for AMI, HF, and stroke were 1.65 (95% CI 1.29-2.09, p
Copyright © 2023. Published by Elsevier Inc.
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Ambient dust pollution with all-cause, cardiovascular and respiratory mortality: A systematic review and meta-analysis.
Sci Total Environ2023 Nov;():168945. doi: 10.1016/j.scitotenv.2023.168945.
Pouri Nasrin, Karimi Behrooz, Kolivand Ali, Mirhoseini Seyed Hamed,
Abstract
A severe health crisis has been well-documented regarding dust particle exposure. We aimed to present the risk of all-cause, cardiovascular, and respiratory mortality due to particulate matter (PM) exposure during non-dust and dust storm events by performing a meta-analysis. A systematic review of the literature was conducted by an online search of the databases (Google Scholar, Web of Science, Scopus, and PubMed) with no restrictions according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. We performed a random-effects model to compute the pooled rate ratio (RR) of mortality with 95?% confidence intervals (CI). The Office of Health Assessment and Translation (OHAT) risk of bias rating tool was prepared to assess the quality of the individual study. The registration number in PROSPERO was CRD42023423212. We found a 16?% (95?% CI: 0.7?%, 24?%) increase in all-cause, 25?% (95?% CI: 14?%, 37?%) increase in cardiovascular, and 18?% (95?% CI: 13?%, 22?%) increase in respiratory mortality per 10??g/m increment in dust exposure. Furthermore, the RRs per 10??g/m increment in PM were 1.046 (95?% CI: 1.019, 1.072)¸ 1.085 (95?% CI: 1.045, 1.0124), and 1.089 (95?% CI: 0.939, 1.24) for all-cause, cardiovascular, and respiratory mortality, respectively. PM during dust days significantly increased the all-cause (1.013, 95?% CI: 1.007, 1.018) cardiovascular mortality risk (1.014, 95?% CI: 1.009, 1.02). We also found significant evidence for all-cause, cardiovascular, and respiratory mortality among females and the elderly age group due to dust particle (PM and PM) exposure. Our results provided significant evidence about high concentrations of PM and PM during dust storm events related to mortality risk.
Copyright © 2023. Published by Elsevier B.V.
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Age disparities in glucose-lowering treatment for Danish people with type 2 diabetes: a cross-sectional study between 2019 and 2020.
Lancet Healthy Longev2023 Dec;4(12):e685-e692. doi: 10.1016/S2666-7568(23)00210-6.
Johansson Karl Sebastian, Bülow Cille, Jimenez-Solem Espen, Petersen Tonny Studsgaard, Christensen Mikkel Bring,
Abstract
BACKGROUND:
The pharmacotherapeutic guidelines for type 2 diabetes have changed considerably during the past decades. SGLT2 inhibitors and GLP-1 receptor agonists have emerged as first-line agents by preventing cardiovascular events within a few years of treatment. In contrast, sulphonylureas and insulin have been deprioritised due to less beneficial effects and the risk of hypoglycaemia-particularly in older people who are frail. We hypothesised that medications with a high risk of hypoglycaemia were used more often in older people compared with younger people.
METHODS:
In a nationwide cohort of people with type 2 diabetes in Denmark from 2019 to 2020, we described the use of specific glucose-lowering medications in relation to age and glycated haemoglobin A (HbA) by descriptive statistics and regression models adjusted for sex, socioeconomic factors, renal function, and several comorbidities.
FINDINGS:
Among 290?890 people with type 2 diabetes, glucose-lowering medication usage peaked at age 70 years. Increasing age was associated with relatively less use of metformin, GLP-1 receptor agonists, and SGLT2 inhibitors and more use of basal insulin, DDP-4 inhibitors, and sulphonylureas. When comparing 80-year-olds with 60-year-olds at similar HbA levels of 6·5% (48 mmol/mol), 80-year-olds used 8% (95% CI 7-10%) fewer glucose-lowering medications, were 55% less likely to receive GLP-1 receptor agonists or SGLT2 inhibitors (relative ratio 0·45, 95% CI 0·42-0·48), and 65% more likely to receive sulphonylureas (1·65, 1·54-1·76). Among 23?032 individuals aged 80 years or older with HbA levels of less than 6·5% (
INTERPRETATION:
In Danish people with type 2 diabetes, the likelihood of using glucose-lowering medications with a high risk of hypoglycaemia (eg, sulphonylureas and basal insulin) increased with age, whereas the likelihood of using GLP-1 receptor agonists and SGLT2 inhibitors decreased. Some people aged 80 years or older with an HbA level of less than 6·5% (48 mmol/mol) were potentially overtreated with sulphonylureas or insulin. These findings emphasise the importance of frequently re-evaluating glucose-lowering treatments.
FUNDING:
None.
TRANSLATION:
For the Danish translation of the abstract see Supplementary Materials section.
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
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First-in-human trial of a self-expandable, temporary dilation system for intracranial atherosclerotic disease in patients presenting with acute ischemic stroke.
J Neurointerv Surg2023 Nov;():. doi: jnis-2023-020983.
Ohta Tsuyoshi, Takeuchi Masataka, Yamagami Hiroshi, Tsuto Kazuma, Yamamoto Shiro, Asai Katsunori, Ishii Akira, Imamura Hirotoshi, Yoshimura Shinichi, Fukumitsu Ryu, Sakai Chiaki, Sakai Nobuyuki, Tateshima Satoshi,
Abstract
BACKGROUND:
Intracranial atherosclerotic disease (ICAD) significantly contributes to ischemic stroke, especially among Asian populations. Large vessel occlusion (LVO) due to underlying ICAD accounts for 15-35% of acute ischemic stroke cases requiring endovascular therapy. However, the successful recanalization rate of ICAD-related LVO remains lower. The TG dilator is a self-expandable device, temporarily dilating ICAD-related blocked blood vessels.
OBJECTIVE:
To demonstrate TG dilator safety and efficacy for ICAD-related acute ischemic stroke.
METHODS:
This was a single-arm, open-label, non-randomized, prospective, multicenter, and investigator-initiated trial that involved patients undergoing TG dilator application for acute ischemic stroke caused by ICAD-related LVO or severe stenosis.
RESULTS:
We enrolled 10 patients in this trial between November 2022 and April 2023. The median (IQR) age was 68 (59.3-75.3) years. Before using the dilator, seven patients received stent retriever treatment. All 10 patients were prescribed a loading dose of aspirin with prasugrel. The median application time was 10 (10-12) min. At the end of the procedure, we achieved significant recanalization immediately in all patients. The stenosis/occlusion decreased from 100% (100-100) to 68% (56.3-75.3). No patient experienced recurrent ischemic stroke or reocclusion within 90 days. We achieved a modified Rankin scale score of 0-2 in 8 patients by day 90. We detected no cases of intracranial hemorrhage, equipment failure, distal embolism, vasospasm, dissection, or perforation requiring intervention.
CONCLUSIONS:
Acute revascularization using the TG dilator on patients with ICAD-related LVO or severe stenosis did not cause any significant adverse event, and consistently improved blood flow at 90 days.
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Predictive value of protein-bound uremic toxins for heart failure in patients with chronic kidney disease.
ESC Heart Fail2023 Dec;():. doi: 10.1002/ehf2.14566.
Zwaenepoel Bert, De Backer Tine, Glorieux Griet, Verbeke Francis,
Abstract
AIMS:
This retrospective cohort study aimed to be the first to evaluate the association between plasma protein-bound uremic toxins (PBUTs) concentrations, echocardiographic parameters of heart failure (HF), and incident HF events in patients with chronic kidney disease (CKD) not on dialysis.
METHODS AND RESULTS:
Retrospective, single-centre, cohort study at the Ghent University Hospital, Belgium. Adults with CKD stages G1-G5, not on dialysis, could be included. Exclusion criteria were ongoing pregnancy, age
CONCLUSIONS:
Elevated free concentrations of IxS, pCG, and pCS were independently associated with an increased risk of HF events in non-dialysed CKD patients. Further research is necessary to confirm these findings and investigate the potential impact of PBUT-lowering interventions on HF events in this patient group.
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Coronary microvascular function in male physicians with burnout and job stress: an observational study.
BMC Med2023 Dec;21(1):477. doi: 477.
von Känel Roland, Princip Mary, Holzgang Sarah A, Garefa Chrysoula, Rossi Alexia, Benz Dominik C, Giannopoulos Andreas A, Kaufmann Philipp A, Buechel Ronny R, Zuccarella-Hackl Claudia, Pazhenkottil Aju P,
Abstract
BACKGROUND:
As a professional group, physicians are at increased risk of burnout and job stress, both of which are associated with an increased risk of coronary heart disease that is at least as high as that of other professionals. This study aimed to examine the association of burnout and job stress with coronary microvascular function, a predictor of major adverse cardiovascular events.
METHODS:
Thirty male physicians with clinical burnout and 30 controls without burnout were included. Burnout was assessed with the Maslach Burnout Inventory and job stress with the effort-reward imbalance and overcommitment questionnaire. All participants underwent myocardial perfusion positron emission tomography to quantify endothelium-dependent (cold pressor test) and endothelium-independent (adenosine challenge) coronary microvascular function. Burnout and job stress were regressed on coronary flow reserve (primary outcome) and two additional measures of coronary microvascular function in the same model while adjusting for age and body mass index.
RESULTS:
Burnout and job stress were significantly and independently associated with endothelium-dependent microvascular function. Burnout was positively associated with coronary flow reserve, myocardial blood flow response, and hyperemic myocardial blood flow (r partial?=?0.28 to 0.35; p-value?=?0.008 to 0.035). Effort-reward ratio (r partial?=??-?0.32 to?-?0.38; p-value?=?0.004 to 0.015) and overcommitment (r partial?=??-?0.30 to?-?0.37; p-value?=?0.005 to 0.022) showed inverse associations with these measures.
CONCLUSIONS:
In male physicians, burnout and high job stress showed opposite associations with coronary microvascular endothelial function. Longitudinal studies are needed to show potential clinical implications and temporal relationships between work-related variables and coronary microvascular function. Future studies should include burnout and job stress for a more nuanced understanding of their potential role in cardiovascular health.
© 2023. The Author(s).
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Adipose tissue specific insulin resistance and prognosis of nondiabetic patients with ischemic stroke.
Diabetol Metab Syndr2023 Dec;15(1):246. doi: 246.
Zhou Qi, Yan Hongyi, Jin Aoming, Meng Xia, Lin Jinxi, Li Hao, Wang Yongjun, Pan Yuesong,
Abstract
BACKGROUND:
Insulin resistance is linked to atherosclerotic cardiovascular diseases and stroke, whereas less is known about adipose tissue specific insulin resistance and outcomes after ischemic stroke. This study aimed to estimate the association between adipose tissue specific insulin resistance and prognosis of nondiabetic patients with ischemic stroke.
METHODS:
Patients with ischemic stroke without a history of diabetes mellitus in the Third China National Stroke Registry were included. Adipose tissue specific insulin resistance index (Adipo-IR) was calculated by fasting serum insulin and free fatty acids and categorized into 5 groups according to the quintiles. Outcomes included stroke recurrence (ischemic or hemorrhagic), combined vascular events, all-cause death, and poor outcome (modified Rankin Scale, 3-6) at 12 months after stroke onset. We assessed the association between Adipo-IR and risk of prognosis by multivariable Cox/logistic regression models adjusted for potential covariates.
RESULTS:
Among 2,222 patients, 69.0% were men with a mean age of 62.5 years. At 12 months, 185 (8.3%) patients had recurrent stroke, 193 (8.7%) had combined vascular events, 58 (2.6%) died, and 250 (11.5%) had a poor outcome. Compared with patients with the lowest quintile, patients with the second, third, fourth, fifth quintiles of the Adipo-IR were associated with an increased risk of stroke recurrence (hazard ratio [HR], 1.77; 95% CI, 1.04-3.03; P = 0.04; HR, 2.19; 95% CI, 1.30-3.68; P = 0.003; HR, 1.84; 95% CI, 1.06-3.21; P = 0.03; HR, 2.11; 95% CI, 1.20-3.71; P = 0.01, respectively) and marginally associated with an increased risk of combined vascular events ( HR, 1.60; 95%CI, 0.97-2.64; P = 0.07; HR, 1.91; 95% CI, 1.17-3.13; P = 0.01; HR, 1.62; 95% CI, 0.96-2.75; P = 0.07; HR, 1.80; 95% CI, 1.05-3.09; P = 0.03, respectively) at 12 months after adjustment for potential covariates. Adipo-IR was not associated with mortality and poor outcome at 12 months.
CONCLUSIONS:
These findings suggest that adipose tissue specific insulin resistance is independently associated with recurrent stroke and combined vascular events after acute ischemic stroke in nondiabetic patients.
© 2023. The Author(s).
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Methodology and results of cost-effectiveness of LDL-C lowering with evolocumab in patients with acute myocardial infarction in China.
Cost Eff Resour Alloc2023 Dec;21(1):93. doi: 93.
Wan Yuansheng, Liu Jinyu, Zhan Xiaolian, Zhang Yu, You Ruxu,
Abstract
BACKGROUND:
According to the Chinese guidelines for lipid management (2023), evolocumab in combination with statins was recommended as secondary prevention of cardiovascular disease. However, because of the variation in the price of evolocumab and its different methods of confirming clinical efficacy, it was necessary to explore its economics and the impact of different methods of confirming efficacy on its economic studies.
OBJECTIVE:
The purpose of this paper was to assess the cost-effectiveness of evolocumab with statins versus statins alone for patients with acute myocardial infarction(AMI) in China and to investigate the impact of different clinical effectiveness modeling approaches on economic outcomes.
METHODS:
A Markov cohort state-transition model was used to estimate the incremental cost-effectiveness ratio (ICER) based on Chinese observational data on cardiovascular event rates, efficacy from the Asian subgroup of the FOURIER trial, cost and utility from the Chinese Yearbook of Health Statistics, health insurance data, and published studies conducted in China. This study conducted subgroup analyses for different populations and dosing regimens; sensitivity analyses for parameters such as cost, utility, and cardiovascular event rates; and scenario analyses on hospital hierarchy, time horizon, starting age, and price for statins.
RESULTS:
ICERs ranged from 27423 to 214777 Chinese yuan(CNY) per QALY gained, all below the willingness-to-pay threshold of CNY 257094. Only when the time horizon became small, the ICERs were greater than the willingness-to-pay. The probabilities that adding evolocumab to statins was cost-effective ranged from 76 to 98%. When the time horizon became small, i.e. evolocumab was discontinued before the age of 75 (after conversion), the corresponding ICERs were almost always greater than the willingness-to-pay. ICERs for modelling approaches based on clinical endpoints were 1.34 to 1.95 times higher than ICERs for modelling approaches based on reduced LDL-C levels.
CONCLUSIONS:
From the Chinese healthcare and private payer perspectives, adding evolocumab to statin therapy in AMI patients is more likely to be a cost-effective treatment option at the current list price of CNY 283.8. However, evolocumab may not be cost-effective if used for shorter periods of time. The results based on different clinical effectiveness modeling approaches were significantly different.
© 2023. The Author(s).
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Effectiveness and safety of injectable PCSK9 inhibitors in dyslipidaemias' treatment and cardiovascular disease prevention: An overview of 86 systematic reviews and a network metaanalysis.
Clin Investig Arterioscler2023 Nov;():. doi: S0214-9168(23)00100-6.
Pamporis Konstantinos, Karakasis Paschalis, Simantiris Spyridon, Sagris Marios, Bougioukas Konstantinos I, Fragakis Nikolaos, Tousoulis Dimitrios,
Abstract
OBJECTIVE:
Multiple systematic reviews (SR) have been performed on the effects of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), often providing conflicting findings. This overview and network meta-analysis (NMA) aimed to summarize SR findings on the efficacy and safety of PCSK9i and provide an updated NMA.
MATERIALS AND METHODS:
MEDLINE (Pubmed), Scopus, Cochrane, Epistemonikos and Google Scholar were searched from inception to September 21, 2023 for SRs of randomized controlled trials (RCTs) and from January 1, 2020 to September 21, 2023 for additional RCTs. Double-independent study selection, data extraction and quality assessment were performed. Qualitative analysis was performed for SRs and a frequentist random-effects model NMA was performed for RCTs.
RESULTS:
Totally, 86 SRs and 76 RCTs were included. Alirocumab (77/86 [90%]) and evolocumab (73/86 [85%]) were mostly analyzed. Associations from SRs (35/42 [83%]) and the updated NMA indicated PCSK9i benefit on major adverse cardiovascular events (MACEs). Reductions were also noted for cerebrovascular events (47/66 [71%]), coronary revascularization (29/33 [88%]) and myocardial infarction (41/63 [65%]). Alirocumab was associated with reductions on all-cause mortality (RR=0.82, 95%CI [0.72,0.94]). Data on any CV event reduction were conflicting (7/16 [44%]). Inclisiran appeared effective only on MACEs (RR=0.76, 95%CI [0.61,0.94]). No reductions in heart failure were observed (0/16). No increases were identified between PCSK9i and any (0/35) or serious adverse events (0/52). However, PCSK9i were associated with injection-site reactions (20/28 [71%]).
CONCLUSION:
PCSK9i appeared to be effective in CV outcomes and their clinical application was generally safe.
Copyright © 2023 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.
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Symptoms and signs in patients with heart failure: association with 3-month hospitalisation and mortality.
Heart2023 Dec;():. doi: heartjnl-2023-323295.
Ali Mohammad Rizwan, Lam Carolyn S P, Strömberg Anna, Hand Simon P P, Booth Sarah, Zaccardi Francesco, Squire Iain, McCann Gerry P, Khunti Kamlesh, Lawson Claire Alexandra,
Abstract
OBJECTIVES:
To determine the association between symptoms and signs reported in primary care consultations following a new diagnosis of heart failure (HF), and 3-month hospitalisation and mortality.
DESIGN:
Nested case-control study with density-based sampling.
SETTING:
Clinical Practice Research Datalink, linked to hospitalisation and mortality (1998-2020).
PARTICIPANTS:
Database cohort of 86 882 patients with a new HF diagnosis. In two separate analyses for (1) first hospitalisation and (2) death, we compared the 3-month history of symptoms and signs in cases (patients with HF with the event), with their respective controls (patients with HF without the respective event, matched on diagnosis date (±1 month) and follow-up time). Controls could be included more than once and later become a case.
MAIN OUTCOME MEASURES:
All-cause, HF and non-cardiovascular disease (non-CVD) hospitalisation and mortality.
RESULTS:
During a median follow-up of 3.22 years (IQR: 0.59-8.18), 56 677 (65%) experienced first hospitalisation and 48 146 (55%) died. These cases were matched to 356 714 and 316 810 HF controls, respectively. For HF hospitalisation, the strongest adjusted associations were for symptoms and signs of fluid overload: pulmonary oedema (adjusted OR 3.08; 95% CI 2.52, 3.64), shortness of breath (2.94; 2.77, 3.11) and peripheral oedema (2.16; 2.00, 2.32). Generic symptoms also showed significant associations: depression (1.50; 1.18, 1.82), anxiety (1.35; 1.06, 1.64) and pain (1.19; 1.10, 1.28). Non-CVD hospitalisation had the strongest associations with chest pain (2.93; 2.77, 3.09), fatigue (1.87; 1.73, 2.01), general pain (1.87; 1.81, 1.93) and depression (1.59; 1.44, 1.74).
CONCLUSIONS:
In the primary care HF population, routinely recorded cardiac and non-specific symptoms showed differential risk associations with hospitalisation and mortality.
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
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Incremental value of machine learning for risk prediction in tetralogy of Fallot.
Heart2023 Dec;():. doi: heartjnl-2023-323296.
Ishikita Ayako, McIntosh Chris, Roche S Lucy, Barron David J, Oechslin Erwin, Benson Lee, Nair Krishnakumar, Lee Myunghyun M, Gritti Michael N, Hanneman Kate, Karur Gauri Rani, Wald Rachel M,
Abstract
OBJECTIVE:
Machine learning (ML) can facilitate prediction of major adverse cardiovascular events (MACEs) in repaired tetralogy of Fallot (rTOF). We sought to determine the incremental value of ML above expert clinical judgement for risk prediction in rTOF.
METHODS:
Adult congenital heart disease (ACHD) clinicians (?10 years of experience) participated (one cardiac surgeon and four cardiologists (two paediatric and two adult cardiology trained) with expertise in heart failure (HF), electrophysiology, imaging and intervention). Clinicians identified 10 high-yield variables for 5-year MACE prediction (defined as a composite of mortality, resuscitated sudden death, sustained ventricular tachycardia and HF). Risk for MACE (low, moderate or high) was assigned by clinicians blinded to outcome for adults with rTOF identified from an institutional database (n=25 patient reviews conducted by five independent observers). A validated ML model identified 10 variables for risk prediction in the same population.
RESULTS:
Prediction by ML was similar to the aggregate score of all experts (area under the curve (AUC) 0.85 (95% CI 0.58 to 0.96) vs 0.92 (0.72 to 0.98), p=0.315). Experts with ?20 years of experience had superior discriminative capacity compared with
CONCLUSIONS:
Robust prediction of 5-year MACE in rTOF was achieved using either ML or a multidisciplinary team of ACHD experts. Risk prediction of some clinicians was enhanced by incorporation of ML suggesting that there may be incremental value for ML in select circumstances.
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
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Ablation versus antiarrhythmic drugs as first-line therapy for treatment-naive atrial fibrillation: Systematic Review and Meta-Analysis.
Am J Cardiol2023 Nov;():. doi: S0002-9149(23)01350-4.
Ullah Waqas, Johnson Drew, Nair Abhinav S, Dikdan Sean, Frankel Eitan, Humayun Wajahat, Pavri Behzad, Frisch Daniel,
Abstract
BACKGROUND:
Evidence on the relative safety and efficacy of atrial fibrillation catheter ablation and antiarrhythmic drugs (AAD) as first-line therapy for patients with treatment-naive atrial fibrillation (AF) remains disputed.
METHOD:
Digital databases were queried to identify relevant randomized controlled trials (RCTs). Incidence of recurrent AF, major adverse cardiovascular events (MACE), and its components (all-cause death, non-fatal stroke, and bleeding) were compared using the DerSimonian and Laird method under the random-effects model to calculate pooled unadjusted risk ratio (RR) with 95% confidence intervals (CI).
RESULTS:
A total of 6 RCTs consisting of 1,120 patients (574 ablation, 549 AAD) were included in the final analysis. Over a median follow-up of 1 year, the risk of any AF recurrence (RR 0.54, 95% CI 0.39-0.75) was significantly lower in patients receiving ablation compared with AAD. However, there was similar risk of MACE (RR 2.65, 95% CI 0.61-11.46), trial-defined composite endpoint of adverse events (RR 0.71, 95% CI 0.28-1.80), stroke (RR 2.42, 95% CI 0.22-26.51), all-cause mortality (RR 1.98, 95% CI 0.28-13.90), and procedure/medication failure (RR 2.65, 95% CI 0.61-11.46) with both therapies.
CONCLUSION:
In patients presenting with treatment-naive AF, ablation as a first-line therapy lowers the risk of AF recurrence with no associated increase in major adverse events, stroke, and mortality compared with AADs.
Copyright © 2023. Published by Elsevier Inc.
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Usefulness of PREDICT Case Type Risk Category in the CRISP Registry.
Am J Cardiol2023 Nov;():. doi: S0002-9149(23)01344-9.
Kobayashi Daisuke, Amin Elena K, Morgan Gareth J, Reddy Surendranath R Veeram, Fleming Gregory A, Forbes Thomas J, Nykanen David G,
Abstract
Procedural risk in Congenital Cardiac Catheterization (PREDICT) was recently reported as the contemporary procedure-type risk metric by the C3PO (Congenital Cardiac Catheterization Project on Outcomes) registry. The usefulness of this metric has not been evaluated elsewhere. CRISP registry of CCISC (Congenital Cardiovascular Interventional Study Consortium) dataset was analyzed. The study period was 14 years (2009 - 2022). The primary outcome was significant adverse event (SAE). Cases were assigned to the 6 PREDICT risk categories. Univariate and multivariable logistic regression models were used to evaluate the association between PREDICT and the primary outcome. The model discriminative performance was evaluated by the c-statistic. In a total of 64,419 enrolled cases, PREDICT case types were assigned in 59,822 cases (93%). The frequency for PREDICT category was 0=7,494 (12.5%), 1=16,932 (28.3%), 2=17,023 (28.5%), 3=9,885 (16.5%), 4=4,403 (7.4%), and 5=4,085 (6.8%). SAE was observed in 2,474 cases (4.1%). The SAE rates for category were 0=1.0%, 1=2.3%, 2=4.0%, 3=6.2%, 4=8.2%, and 5=9.0%. In a multivariable model, PREDICT case type risk category (odds ratios for category: 0=0.49, 1=1.00, 2=1.40, 3=2.06, 4=2.79, and 5=3.15; p
Copyright © 2023. Published by Elsevier Inc.
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