European journal of preventive cardiology最新文献

Aims: Cigarette smoking cessation reduces cardiovascular risk via various mechanisms. Thereby, the role of blood pressure remains unclear, with studies reporting both decreased and increase blood pressure values after cessation, potentially influenced by weight change. We previously showed that the glucagon like peptide-1 analogue dulaglutide mitigates weight gain after smoking cessation. This secondary analysis investigates the effect of smoking cessation on blood pressure changes in dulaglutide- vs. placebo-treated individuals. We hypothesized a beneficial effect of smoking cessation on blood pressure, particularly in dulaglutide-treated participants.

Methods and results: This is a predefined secondary analysis of a randomized, double-blind, placebo-controlled trial. Participants (n = 255) underwent a 12-week smoking cessation programme including standard of care (behavioural counselling and varenicline) with weekly injections of dulaglutide 1.5 mg or placebo, followed by a follow-up of 52 weeks. The primary outcome was change in systolic blood pressure after 52 weeks in abstinent vs. smoking individuals. Further outcomes included blood pressure and body weight changes at Week 12 and 52 according to smoking status and treatment arms. A path analysis was performed to estimate direct and indirect effect of different variables on systolic blood pressure changes. Two hundred and eighteen out of 255 participants with complete blood pressure readings were included in the analyses. Across the entire study population, systolic blood pressure was stable over the period of 52 weeks after smoking cessation despite a weight gain of +3 kg (0, 5.4) at Week 52. Blood pressure reductions were seen in the subgroups of participants with minimal weight gain ≤3 kg [-4.6 mmHg (-9, 3)] and in individuals with hypertensive blood pressure values at baseline [-16 mmHg (-22, 2)]. Dulaglutide treatment reduced body weight and blood pressure initially, followed by a weight rebound and a blood pressure increase of +7.5 mmHg (-1, 15) at Week 52. The path analysis identified weight as an important factor influencing blood pressure during smoking cessation.

Conclusion: Our analysis suggests that smoking cessation may have a beneficial effect on blood pressure- especially in hypertensive individuals-, counteracting the expected blood pressure increase caused by post-cessation weight gain. However, it also underlines the importance of weight control after smoking cessation as a crucial factor in smoking cessation.

Registration: ClinicalTrials.gov: NCT03204396.

Aim: The aim was to examine the relationship between exposure to environmental metallic and metalloid pollutants and cardiovascular disease (CVD) and all-cause mortality by integrating the information currently available from systematic reviews and meta-analyses.

Method: PubMed, Embase, and Web of Science for systematic reviews and meta-analyses were thoroughly searched up to October 9, 2024. Systematic reviews and meta-analyses of various kinds that evaluated the relationship between exposure to ambient metallic and metalloid pollutants and CVD and all-cause mortality were included. The methodological quality and the evidence quality were assessed using AMSTAR2 and GRADE, respectively.

Results: We identified 25 meta-analyses and 81 health outcomes-76 unique outcomes from observational studies and 5 unique outcomes from RCTs-from 8,841 independent publications. Exposure to non-essential metallic and metalloid pollutants, including arsenic, lead, and cadmium as well as essential metallic and metalloid contaminants like copper, has been associated with an elevated risk of CVD events and CVD mortality, according to moderate-quality evidence. According to low-quality evidence, exposure to arsenic, lead, and cadmium increases the risk of CHD, while exposure to lead, cadmium, and copper is strongly associated with an increased risk of stroke and all-cause mortality. Further, zinc and selenium may be protective factors for CVD and all-cause mortality.

Conclusion: Despite variations in evidence gradients, environmental metallic and metalloid contaminants like arsenic, lead, cadmium, mercury, and copper are linked to CVD events and mortality, whereas zinc and selenium may offer protection.

Metabolic dysfunction-associated steatotic liver disease (MASLD) can be interpreted as the hepatic expression of metabolic syndrome, which is estimated to affect 30% of the adult population. Obesity, dyslipidaemia, arterial hypertension, and T2DM are considered significant risk factors of MASLD. The relationship is two-way with MASLD found in up to 75% of patients with T2DM. Importantly, MASLD is associated with increased risk of cardiovascular diseases (CVD) such as arrhythmia, atherosclerotic heart disease, heart failure, and CVD-associated mortality. In addition, MASLD patients present with a high prevalence of major adverse cardiac events, which calls for systematic surveillance of CVD in MASLD. This review focuses on the pathophysiology behind development of CVD in MASLD, the types of cardiovascular complications, morbidity and survival, and suggestions for evaluation of patients with MASLD.

Background: Cardiovascular disease is a common comorbidity in chronic obstructive pulmonary disease (COPD). Yet cardiovascular disease and risk is under diagnosed in COPD and is often undertreated, increasing the risk of cardiopulmonary events.

Methods: We formed a Global Working Group of experts in COPD and cardiovascular disease to produce a consensus statement detailing the identification and management of cardiopulmonary risk in patients with COPD. We conducted virtual meetings supplemented by remote working and communication. The Chairs (CPG, MB) proposed a draft consensus statement, which was further developed by the Global Working Group. The selection of the final consensus statement and key points were obtained using the modified Delphi method.

Results: The consensus statement is, 'Given the high burden of fatal and non-fatal major cardiovascular and respiratory events in patients with COPD it is important that cardiopulmonary risk is assessed and managed'. Patients with cardiovascular risk factors or disease who have regular cough or expectoration, recurrent "chest infections", a significant smoking history, or dyspnoea should complete spirometry to confirm the presence of COPD. Prevalent and incident cardiovascular disease and risk in patients with COPD, including heart failure, dyslipidaemia, hypertension, ischaemic heart disease and atrial fibrillation, should be managed according to clinical guidelines. In addition, COPD exacerbation risk in patients with COPD should be addressed to reduce cardiopulmonary risk. Enhanced integration with specialists in cardiology, pulmonology and primary care is recommended.

Conclusions: The identification and management of cardiopulmonary risk in patients with COPD is an unmet public health need that can be addressed through shared understanding and multidisciplinary working to improve cardiopulmonary outcomes.

Aim: As the global population ages, cardiovascular diseases, particularly heart failure (HF), have become leading causes of mortality and disability among elderly patients. Diabetes and hypertension are major risk factors for cardiovascular diseases, making this group especially vulnerable to heart failure. Current clinical tools for predicting HF risk are often complex, requiring extensive clinical parameters and laboratory tests, which limit their practical application. Therefore, a need exists for a predictive model that is both simple and effective in assessing heart failure risk in elderly patients with diabetes and hypertension.

Methods and results: This study utilized data from the National Health and Nutrition Examination Survey (NHANES), spanning seven cycles from 2003 to 2016, including 71,058 subjects. The study focused on elderly patients (aged 65 and above) diagnosed with both diabetes and hypertension, ultimately including 1,445 participants. We examined seven novel composite indices: A Body Shape Index (ABSI), Atherogenic Index of Plasma (AIP), BARD score, Body Fat Percentage (BFP), Body Roundness Index (BRI), Fatty Liver Index (FLI), and Prognostic Nutritional Index (PNI). These indices were selected for their simplicity and ease of calculation from routine clinical assessments. The primary outcome was heart failure status, and data preprocessing included imputation for missing values using random forest algorithms. Various machine learning models were applied, including Random Forest, Logistic Regression, XGBoost, and others, with model performance assessed through metrics like accuracy, precision, recall, F1 score, and ROC AUC. The best-performing model was further analyzed using SHAP (SHapley Additive exPlanations) values to determine feature importance. The study found that the XGBoost model demonstrated superior performance across all evaluation metrics, with an AUC value of 0.96. Significant predictors of heart failure included BRI and PNI, which had the highest SHAP values, indicating their substantial influence on model predictions. The study also highlighted the robust predictive capabilities of AIP, particularly in assessing cardiovascular events in elderly patients.

Conclusion: The study demonstrates that novel composite indices like ABSI, AIP, BARD score, Body Fat Percentage, BRI, FLI, and PNI have significant potential in predicting heart failure risk among elderly diabetic and hypertensive patients. These indices offer clinicians new tools for cardiovascular risk assessment that are simpler and potentially more effective in clinical practice. Future research should focus on validating these findings in different populations and exploring their longitudinal predictive power.

Aims: Sarcopenia is an emerging risk factor for cardiovascular disease (CVD). However, previous studies did not take into consideration the cardiovascular impact of the changes in sarcopenia status. We investigated the relationship between changes in sarcopenia status and incident CVD.

Methods: Participants from two prospective cohorts: the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were included. Changes in sarcopenia status were assessed by sarcopenia status at the initial two surveys. CVD was ascertained by self-reported physician-diagnosed heart disease or stroke.

Results: A total of 6,608 and 4,316 adults from CHARLS (mean age: 59.2 years, female: 53.6%) and HRS (mean age: 63.2 years, female: 60.2%) were analyzed, with a median follow-up of 5.0 years and 7.5 years, respectively. Meta-analysis showed a significant relationship between sarcopenia and CVD risk. Bidirectional MR analysis supported the robustness and causality, and no reverse association was found between CVD and sarcopenia. Compared with stable no sarcopenia participants, multivariable-adjusted incidence rate ratio (IRR) and 95% confidence interval (95% CI) for incident CVD in those who progressed from no sarcopenia to possible sarcopenia/sarcopenia were 1.29 (1.02-1.64) and 1.39 (1.11-1.74) in both cohorts. In contrast, sarcopenia participants who recovered to no sarcopenia/possible sarcopenia had lower incidence of CVD (CHARLS, IRR 0.61, 95% CI 0.43-0.87; HRS, IRR 0.20, 95% CI 0.11-0.39) than stable sarcopenia participants did.

Conclusions: The progression of sarcopenia status increases the risk of CVD, while the recovery of sarcopenia status reduces the risk of incident CVD.