European journal of preventive cardiology最新文献

Aims: Hypertrophic cardiomyopathy (HCM) is associated with a significant risk of arrhythmia and heart failure (HF), yet treatment options for patients with HCM have remained limited. We aimed to investigate the relationship between sodium-glucose cotransporter-2 inhibitor (SGLT2i) use and clinical outcomes among patients with concurrent HCM and diabetes in real-world settings.

Methods and results: Using the Korean National Health Insurance Service database, we identified patients with a confirmed diagnosis of HCM and prescriptions for antidiabetic drugs from 2018 to 2022. After propensity matching, we compared 2063 patients who received SGLT2i with 2063 patients who did not for clinical outcomes. The primary outcome was a composite of all-cause death and HF hospitalization. Secondary outcomes included individual outcomes of all-cause death, HF hospitalization, sudden cardiac death, and ischaemic stroke. During a median follow-up period of 3.1 years, patients with HCM on SGLT2i had a significantly lower risk of the primary outcome [hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.67-0.86]. Specifically, SGLT2i use was associated with reduced all-cause mortality (HR 0.56, 95% CI 0.46-0.68) and fewer HF hospitalizations (HR 0.82, 95% CI 0.72-0.94). Additionally, SGLT2i use was linked to a decreased risk of sudden cardiac death (HR 0.50, 95% CI 0.33-0.77) and ischaemic stroke (HR 0.74, 95% CI 0.62-0.88). Subgroup analyses by age, sex, and atrial fibrillation did not reveal any significant interactions.

Conclusion: The use of SGLT2i was associated with a decreased risk of adverse clinical outcomes among patients with HCM with concurrent diabetes on antidiabetic drugs.

Lay summary: This population-based cohort study examined the association between sodium-glucose cotransporter-2 inhibitors (SGLT2is) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) and diabetes. Patients with HCM and diabetes who used SGLT2i had a significantly lower risk of all-cause death and heart failure hospitalization compared with those who did not use SGLT2i.These associations were consistent across various subgroups, including sex, age, atrial fibrillation, and income levels.

Aims: Whether polycystic ovary syndrome (PCOS) is an independent risk factor for long-term cardiovascular disease (CVD) is unclear, and the risk of CVD in easily overlooked young nonobese PCOS patients is unknown. This study aimed to investigate the associations of PCOS with CVD and identify the management priorities.

Methods and results: 3864 participants (645 with PCOS) from UK Biobank were recruited from 2006-2010. The cumulative incidences of the CVD were calculated and compared between patients with and without PCOS via the log rank test. Cox proportional risk regression models were used to assess the relationships of PCOS with CVD and the impact of PCOS treatments on CVD risk. Polygenic risk scores and linkage disequilibrium score regression were used to assess the genetic-level associations. Then proteomics subgroup cohort was conducted to explore the significant biomarker involved in the PCOS-CVD associations. Compared with participants without PCOS, participants with PCOS had greater risks of CVD (hazard ratio (HR)=1.77, 95% confidence interval (CI)=1.19-2.65), coronary artery disease (HR=2.27, 95% CI=1.35-3.81) and myocardial infarction (HR=2.08, 95% CI=1.11-3.90) independent of genetic risk, especially for young nonobese PCOS patients (Pfor interaction <0.05). Current commonly used treatments did not affect CVD incidence. Proteomics cohort revealed that discoidin, CUB and LCCL domain-containing protein 2 (DCBLD2) may be specific CVD biomarker for patients with PCOS.

Conclusion: Patients with PCOS had an increased risk of CVD, and young nonobese PCOS patients should be prioritized for CVD risk management. These findings support the necessity of clinical surveillance and suggest DCBLD2 as a possible CVD biomarker in females with PCOS.

In recent years, major advances in our understanding of risk factors implicated in the development of cardiovascular disease (CVD), in available tools for early detection of CVD, and in effective interventions to prevent subclinical or clinically manifest disease, have led to an increasing appreciation of prevention as a major pillar of cardiovascular (CV) medicine. Preventive Cardiology has evolved into a dynamic sub-speciality focused on the promotion of CV health through all stages of life, and on the management of individuals at risk of developing CVD or experiencing recurrent CV events, through interdisciplinary care in different settings. As the level of knowledge, specialized skills, experience, and committed attitudes related to CV prevention has exceeded core cardiology training, the European Association of Preventive Cardiology (EAPC) has placed major emphasis on continuous education and training of physicians and allied professionals involved in CV prevention, with the aim of setting standards for practice and improving quality of care. The EAPC recognizes the need for a comprehensive educational offer across different levels of training (from core cardiology to sub-speciality to expert training) as well as the need for interdisciplinary approaches that will promote synergies among allied professionals involved in CV prevention. This statement by the EAPC aims to highlight current gaps and unmet needs and to describe the framework to help standardize, structure, and deliver comprehensive, up-to-date, interactive, and high-quality education using a combination of traditional and novel educational tools. The document aims to form the basis for ongoing refinements of the EAPC educational offer, with the ultimate goal of ensuring that new evidence in the field will translate to better CV practice and improved outcomes for our patients.

Aims: The ability to be physically active is pivotal to the quality of life in elderly patients. This study aims to describe the association between exercise capacity and health-related quality of life (HRQoL), anxiety, and depression following an exercise-based cardiac rehabilitation (CR) programme in elderly cardiac patients.

Methods and results: Patients aged ≥65 years with acute and chronic coronary syndrome or heart valve surgery were consecutively included from eight CR centres in seven European countries. Exercise capacity [VO2peak(mL/kg/min)] was assessed with a cardiopulmonary exercise test (97%) or a 6-min walk test. Outcome variables included HRQoL [36-item Short-Form Health Survey physical and mental component scores (PCS and MCS)], anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9). Mixed models were used to address the association between baseline and the development in VO2peak, and outcome variables stratified on sex, and adjusted for baseline values, age, and CR centre. A total of 1633 patients were included (T0), 1523 (93%) completed end-of-CR assessment (T1), and 1457 (89%) were available for 1-year follow-up (T2). Women had higher percentage of predicted VO2peak but poorer scores in HRQoL, anxiety, and depression at all time points. All scores improved in both sexes at follow-up. We found significant associations between VO2peak at baseline as well as development in VO2peak and all outcome variables at T1 and T2 in men (all P < 0.001). In women, VO2peak was only associated with PCSs (P < 0.001).

Conclusion: Improvements in exercise capacity were strongly associated with improvements in HRQoL and mental health, however, with stronger associations in men. The results highlight the importance of physical fitness for HRQol and mental health. The findings from this study might be useful to better target individual CR programmes.