European journal of preventive cardiology最新文献

Aims: Among statin-treated participants with elevated triglycerides and known cardiovascular disease or with diabetes and other risk factors, icosapent ethyl reduced the risk of cardiovascular events in the REDUCE-IT study. In this post hoc analysis of REDUCE-IT, we quantified the effects of icosapent ethyl on total hospitalizations and days lost to hospitalization and death.

Methods: Randomization to treatment with 2 g twice daily of icosapent ethyl or matching placebo was performed among 8179 participants receiving statin therapy with established cardiovascular disease or age ≥50 years with diabetes and ≥1 additional risk factor, fasting triglyceride 1.69-5.63 mmol/L, and low-density lipoprotein cholesterol 1.06-2.59 mmol/L. Total hospitalizations were analyzed with a competing risks marginal model for total events. The likelihood of no days lost to hospitalization and death and the rate of days lost among those who were hospitalized or died during the study were analyzed with a zero-inflated Poisson regression model.

Results: During a median 5.0 years of follow-up, icosapent ethyl treatment was associated with fewer total hospitalizations (HR (95% CI) = 0.91 (0.84, 0.98), P=0.017). Participants randomized to icosapent ethyl were more likely to survive until the end of the study without hospitalization (OR (95% CI) = 1.12 (1.02, 1.22), p=0.016) and had fewer days lost among those who were hospitalized or died (RR (95% CI) = 0.93 (0.93, 0.94), p<0.001).

Conclusion: Icosapent ethyl was associated with fewer total hospitalizations and fewer days lost due to hospitalization and death, providing additional insights on the effects of icosapent ethyl on patient-centered measures of total disease burden.

Objectives: Giant cell arteritis (GCA) is a chronic large-vessel vasculitis affecting older adults, associated with significant cardiovascular (CV) complications. Understanding CV risk drivers among GCA, including classical CV risk factors and inflammation, is essential for improved patient management. We (i) assessed the association between GCA and risks of cardiovascular events, including aortic events, major adverse cardiovascular events (MACE), peripheral artery disease (PAD) events, and visceral artery events (ii) assessed the impact of traditional CV risk factors and GCA disease activity on these outcomes.

Methods: Using the French National Health Data System (SNDS), we included 23,193 patients aged ≥50 years diagnosed with incident GCA from 2012-2022. Patients were matched with a general population cohort (92,772 individuals) and a hospitalized cohort (92,772 individuals) using propensity score matching based on CV comorbidities. Primary outcomes were first incidence of aortic events, MACE, PAD events, and visceral artery events.

Results: Patients with GCA faced an increased risk of all CV outcomes compared with the general population cohort: aortic events (HR: 5.33; 95%CI, 4.50-6.32), MACE (HR: 2.15; 95% CI, 2.04-2.26), PAD events (HR: 2.72; 95%CI, 2.47-2.99), and visceral artery events (HR: 3.04; 95%CI, 2.33-3.97).When compared with the hospitalized cohort, GCA patients had increased risk of all outcomes except for MACE risk which did not significantly differ (HR: 1.01; 95%CI, 0.96-1.06). GCA disease activity was associated with increased MACE (HR: 1.98; 95%CI, 1.63-2.42).

Conclusions: GCA significantly increases risks of vascular complications, highlighting the importance of cardiovascular risk management and inflammation control strategies.

Introduction: Lp(a) is an independent risk factor for a variety of cardiovascular (CV) outcomes. However, it remains unclear whether its prognostic value differs between individuals with varying baseline traditional CV risk. This study aims to evaluate the association between Lp(a) levels and all-cause & CV mortality, stratified by baseline CV risk.

Methods: Using data from NHANES III (1988-1994) with mortality follow-up through 2019, we analysed a nationally representative cohort of U.S. adults. Baseline CV risk was stratified into low, borderline-intermediate, and high groups using the PREVENT equations. Associations between Lp(a) levels and outcomes were assessed using multivariable Cox and Fine-Gray competing risk models.

Results: A total of 55,050,155 survey-weighted records (4,707 unweighted) were analysed. The mean age was 48 (±13) years, with 51% female. Over a mean follow-up of 22.4 years (±7.07), there were 17,301,805 all-cause and 4,965,456 CV deaths. Elevated Lp(a) (>50 mg/dL) was present in 15% overall, more commonly in the high-risk group (15% vs 11% in low-risk). In the high-risk group, Lp(a) >75 mg/dL was associated with higher all-cause (HR: 1.25; 95% CI: 1.02-1.53) and CV mortality (sHR: 1.21; 95% CI: 1.09-1.36). Lp(a) 50-75 mg/dL showed a borderline association with all-cause mortality (HR: 1.16; 95% CI: 1.00-1.34) but not CV mortality (sHR: 1.06; 95% CI: 0.98-1.15). No significant associations were observed in lower-risk groups.

Conclusions: Elevated Lp(a) levels (> 75 mg/dL) are associated with increased all-cause and CV mortality among individuals with high baseline traditional CV risk, as defined by the AHA's PREVENT score, independent of traditional risk factors. Our findings highlight the value of Lp(a) particularly among those with elevated baseline risk, where its prognostic utility appears greatest.

The rising prevalence of obesity poses an increasing burden on individuals, health care systems, and society. Obesity is the main risk factor for several cardiovascular diseases (CVD). Physical activity (PA) may help to reduce the risk for CVD across the lifespan independent of obesity. The obesogenic and built environment can influence obesity and PA. The primary objective of this scientific statement is to underscore the role of obesity as a risk factor for CVD and to explore how PA can be leveraged to mitigate CVD risk. A novel aspect is the examination of how environmental factors influence the feasibility and implementation of current PA guidelines. Rather than focusing exclusively on a specific age group, this scientific statement investigates how environmental determinants may affect the implementation of increasing PA throughout the lifespan by focusing on three age groups: children and adolescents (<18 years), adults (18-64 years), and older adults (≥65 years). Furthermore, this scientific statement analyses the association of the built environment on PA behaviour by conducting a scoping literature review to identify age-specific evidence regarding the relation of the built environment on PA across the lifespan. This review highlights potentially effective strategies to reduce CVD risk within the context of the built environment and provides practical implications for healthcare professionals and policymakers to increase PA behaviour on an individual and societal level. Altogether, the present work raises awareness of the broader challenges posed by obesity and advocates for PA as a key strategy to improve public health outcomes.

Cardiovascular disease causes almost four million deaths in Europe, costing the EU €282billion/annum. Future mortality rate improvements will be gained through improving secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Wide gaps exist between ASCVD prevention/treatment guidelines and their implementation across Europe. We aim to estimate lifetime benefits available via optimised secondary prevention in patients with ASCVD in Denmark, France, Germany, Italy, Poland, Spain and the UK. A literature review identified ASCVD risk factor prevalence in ASCVD populations in seven countries. The simulation used an analytical framework and the SMART-REACH survival model to derive event probabilities over 1-year, associated with being 'at-risk' and 'risk free'. The effect of modifying four risk-factors in the SMART-REACH model - hypertension, hypercholesterolaemia, diabetes and tobacco smoking - was examined. The impact of improving treatment coverage and smoking cessation from (estimated) 43% to 70% (i.e. 70% of patients reach treatment targets/cease smoking) was analysed. Over 94,359 cardiovascular-event-free life years could be gained/year across seven countries by improving secondary ASCVD prevention: 25,333 years in Germany, 21,144 in Italy, 14,584 in France, 13,324 in the UK, 9,393 in Spain, 9,369 in Poland and 1,212 in Denmark. This is a step in better quantifying the impact of improved secondary ASCVD prevention, giving an indication of the potential of EU and national Cardiovascular Health Plans in cardiovascular survival gains. Countries should incentivise proactive identification of patients at risk and ensure subsequent, timely treatment according to guidelines. Future work should utilise updated data and modelling integrating additional cardiometabolic risk factors.