European journal of preventive cardiology最新文献

Background: Participation in cardiac rehabilitation (CR) by ethnic minorities is poor, despite evidence supporting its effectiveness. This study evaluated CR participation and completion by South Asian compared to White European service users, and assessed factors associated with non-completion in both groups.

Method: The National Audit of Cardiac Rehabilitation (NACR) data (January 2014 to February 2023) was used to identify South Asian and White European service users referred for CR following myocardial infarction, percutaneous coronary intervention and coronary artery bypass graft. Logistic regression and backwards selection were used to examine differences in participation and completion between groups and identify associated factors.

Findings: From 421,281 service users eligible for CR (383,833 White European, 37,448 South Asian, 115,812 women, median age 67 years), 222,928 participated (53%), of which 171,297 (77%) completed. After adjustment for age, sex, index of multiple deprivation (IMD) and co-morbidities, South Asian service users were 12% more likely to participate in CR than White Europeans (aOR 1.12, 95% CI 1.09 to 1.15), but 22% less likely to complete (aOR 0.78, 95% CI 0.75 to 0.82). In both groups, strongest associations with non-completion were higher deprivation, diabetes and being single. In White European and South Asian men, stroke and depression were also key factors. Non-completion was also associated with respiratory conditions in White Europeans and with rheumatism and family cardiovascular history in South Asian men.

Interpretation: South Asians are more likely to participate but less likely to complete CR than White Europeans. Programmes tailored to individual needs are required to reduce disparities in care.

Background: Peripheral artery disease (PAD) is a prevalent and debilitating complication of diabetes and obesity, yet it remains underrecognized and undertreated. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, have shown cardiovascular benefits, but their impact on peripheral vascular outcomes remains unclear.

Objective: We conducted a systematic review and meta-analysis to evaluate the effect of semaglutide on limb events (LEs) in individuals with type 2 diabetes and/or overweight or obesity.

Methods: Following PRISMA guidelines, 19 randomized controlled trials encompassing 51,557 participants were included. Major limb events, prespecified and reported as safety outcomes in the original trials, were defined a priori as the primary outcome of this meta-analysis, comprising revascularizations, amputations, and PAD progression. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Semaglutide significantly reduced the risk of LEs compared to control interventions (OR 0.70; 95% CI 0.60-0.82; p < 0.0001), with no heterogeneity across studies (I² = 0%). Benefits were consistent across patient subgroups, in patients with diabetes (OR 0.70; 95% CI: 0.57-0.87; p = 0.001) or obesity (OR 0.71; 95% CI: 0.56-0.89; p = 0.003); oral formulation (0.71; 95% CI: 0.53-0.94; p = 0.02) or subcutaneous (0.68; 95% CI: 0.49-0.95; p = 0.02 and 0.71; 95% CI: 0.57-0.89; p = 0.003, for 1.0 mg and 2.4 mg, respectively); and regardless of background SGLT2 inhibitor use. Meta-regression showed no significant effect modification by age, BMI, HbA1c, follow-up duration, or SGLT2i use.

Conclusions: This meta-analysis suggest that semaglutide is associated with a significant reduction in major limb events across diverse populations and treatment settings, supporting a potential protective effect on limb-related vascular safety.

Background: Guidelines recommend using the SMART2 model, estimating the risk of recurrent cardiovascular (CV) events, to support treatment decisions in patients with established atherosclerotic CV disease (ASCVD). They further outline that adding biomarkers, comorbidities, anthropometric, and social factors may improve these predictions.

Aims: To investigate the added predictive value of guideline-outlined factors including biomarkers, comorbidities, anthropometric, and social factors on top of the SMART2 model using an approach enabling their use as add-on predictors.

Methods: Patients aged 40-80 with ASCVD were included from 11 cohorts (n=179,382 with 25,789 recurrent CV events). Additional factors included biomarkers (troponin I, NT-proBNP, albuminuria), comorbidities (heart failure, atrial fibrillation, coronary multivessel disease), anthropometric measurements (body-mass index, waist and hip circumference), social (employment, education), and other factors (former smoking, parental CV history). Cross-cohort availability of these factors ranged from 2 cohorts for albuminuria to all cohorts for BMI. These factors were assessed as add-on predictors to the SMART2 model using Fine-Gray models with SMART2 coefficients as offset with recurrent CV events as primary outcome (non-fatal myocardial infarction or stroke, or CV death). Added predictive value was assessed through cohort cross validation by change (Δ) in C--statistic, calibration, and net benefit through decision curve analysis.

Results: Sub distribution hazard ratios for additional factors ranged from 0.77 [95% confidence interval 0.75-0.80] for employment status to 1.69 [1.63-1.76] for heart failure history. ΔC-statistic was largest for NT-proBNP (0.0127 [0.0060-0.0193]) and troponin I (0.0100 [0.0020-0.0181]), with statistically significant but smaller ΔC-statistics for employment, heart failure, and atrial fibrillation. Calibration was adequate before and after integration of additional factors. Decision curve analysis demonstrated added net benefit beyond SMART2 for NT-proBNP, heart failure history, atrial fibrillation, albuminuria, current employment, coronary multivessel disease, and education level across clinically relevant thresholds up to 40% predicted risk.

Conclusions: The flexible add-on of guideline-outlined factors on top of SMART2 enables more personalised and improved estimation of recurrent CV event risk in patients with established ASCVD.