European journal of preventive cardiology最新文献

Aims: Atrial fibrillation and flutter (AF) are common in patients with Type 2 diabetes and are associated with worse outcomes.

Methods and results: Harmony Outcomes was a multi-centre, event-driven, double-blind, placebo-controlled trial comparing the effects of albiglutide, a glucagon-like peptide-1 receptor agonist, with placebo on a composite of major adverse cardiac events (MACEs; non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death) in 9463 patients aged >40 years with Type 2 diabetes and established cardiovascular disease. Herein, the cardiovascular effects of albiglutide in patients with and without AF, as well as the effects on AF events during follow-up, were analysed. Patients with a history of AF (8.9%) exhibited a higher event rate for the primary composite MACE endpoint during 1.6 years of follow-up {12.7 vs. 6.3 events/100 person-years, adjusted hazard ratio [aHR] 1.41 [95% confidence interval (CI) 1.14-1.74], P = 0.001}. Treatment with albiglutide reduced the occurrence of the primary endpoint irrespective of history of AF at baseline (history of AF: aHR 0.83 [0.58-1.19], no history of AF: aHR 0.77 [0.66-0.90]; Pinteraction = 0.71). During follow-up, 239 patients (2.5%) experienced an AF event. Overall, albiglutide was associated with numerically fewer AF events [108 vs. 131; hazard ratio 0.82 (0.63-1.06), P = 0.12], irrespective of baseline history of AF (Pinteraction = 0.92).

Conclusion: In patients with Type 2 diabetes, treatment with albiglutide, compared with placebo, reduced the risk of cardiovascular events irrespective of history of AF. Further, albiglutide treatment did not increase AF adverse events but was associated with a trend to a lower rate of AF events during follow-up without reaching statistical significance.

Aims: Myocardial infarction (MI) and stroke significantly affect health, quality of life, and socioeconomic stability. We investigated the association of MI and stroke with the risk of suicide.

Methods: This nationwide population-based cohort study used Korean National Health Insurance Service data on all patients diagnosed with atherosclerotic cardiovascular disease (ASCVD), defined as a composite of MI or stroke, between January 1, 2004, and December 31, 2008. For each patient, five age- and sex-matched controls were selected. All participants were followed up from diagnosis (or the corresponding entry date for controls) until suicide, other causes of death, or December 31, 2021, whichever occurred first.

Results: This study included 37,912 individuals with ASCVD and 189,560 matched controls. During a median follow-up of 11.3 years, 1,250 suicides occurred. The incidence rate of suicide per 1,000 person-years were 0.737 and 0.497 among individuals with and without ASCVD, respectively. Multivariable analysis showed a significantly higher risk of suicide for individuals with ASCVD (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.24-1.65), with HRs of 1.42 (95% CI, 1.14-1.78) for MI and 1.47 (95% CI, 1.23-1.76) for stroke. The risk of suicide increased further in individuals with both MI and stroke (HR, 1.85; 95% CI, 1.07-3.21). The association between ASCVD and increased suicide risk was consistent across age, sex, and a history of depressive disorder.

Conclusions: Individuals with ASCVD have increased risks of suicide. Our findings suggest the importance of screening and preventing suicidal ideation in individuals with ASCVD to improve prognosis.

Aim: Effective control of cardiovascular risk factors reduces mortality among patients with type 2 diabetes (T2D), but most evidence is based on baseline measurements. This study investigated the associations between changes and cumulative control of cardiovascular risk factors over the follow-up period and mortality.

Methods: We analyzed 138,193 participants with T2D aged 35-75 years from the ChinaHEART project. Risk factor control included no current smoking, healthy diet, physical activity, and normal levels of blood pressure, cholesterol, glucose, and BMI. Cumulative control was assessed using time-weighted average (TWA), and Cox models estimated hazard ratios (HRs). Changes in control were evaluated by comparing the number of risk factors controlled at baseline and the second follow-up.

Results: Over a median follow-up period of 5.6 years, 9,698 deaths occurred (4,475 from CVD). Compared with participants with 0-2 risk factors controlled, those with 3 and 6-7 factors controlled had lower risks of all-cause mortality [HRs: 0.77 (95% CI: 0.73-0.81) and 0.43 (0.38-0.48), respectively]. Improved control was associated with reduced mortality [HR: 0.86 (0.77-0.96)] compared to stable low control, whereas degraded control increased mortality risk by 23% compared to stable high control. Participants in the highest quartile of TWA risk factor control had 47% lower mortality [HR: 0.53 (0.47-0.60)] than those in the lowest quartile. Similar associations were observed for CVD mortality.

Conclusions: Sustained and cumulative cardiovascular risk factor control substantially lowers mortality among patients with T2D, underscoring the critical importance of continuous risk factor management.

Aims: Haptoglobin (HP) 2-2 phenotype has been suggested as a risk factor for cardiovascular disease (CVD) and to modulate fenofibrate benefit on CVD risk in Type 2 diabetes. However, little is known as to whether HP levels modulate CVD risk and fenofibrate response.

Methods and results: Haptoglobin phenotype and levels were determined in 8047 Fenofibrate Intervention and Event Lowering in Diabetes trial participants at baseline and randomization (after a 16 week run-in period, including a 6 week fenofibrate therapy) and their association with new on-trial total CVD events over 5 years was assessed. Higher baseline HP levels were associated with total CVD events in the placebo group {n = 4030, hazard ratio [95% confidence interval (CI)] = 1.30 [1.02-1.66] for HP level Tertile 3 vs. Tertile 1, P = 0.035}. This was driven by participants with HP 1-1 phenotype (P for interaction = 0.011). Participants with the lowest baseline HP level tertile and HP 1-1 phenotype tended to have the lowest CVD risk, whereas CVD risk was similar in other participants, regardless of HP phenotype and levels. Fenofibrate benefit on total CVD events did not differ significantly by HP phenotypes, baseline HP level tertiles, or tertiles of change in HP levels by fenofibrate during active run-in.

Conclusion: Higher baseline HP levels were associated with a higher CVD risk, especially in participants with HP 1-1 phenotype. A lower CVD risk is found only in Type 2 diabetes participants with both the HP 1-1 phenotype and low baseline HP levels. Fenofibrate benefits on CVD risk reduction did not differ by HP levels or phenotype.

Lay summary: We evaluated the relationship of different forms or phenotypes of the blood protein, haptoglobin, and its circulating levels with the risk of developing CVD and fenofibrate benefit in patients with Type 2 diabetes, and showed that both HP phenotype and levels are important to assess CVD risk in patients with Type 2 diabetes, although fenofibrate did not modulate CVD risk via HP phenotype or level.Higher baseline HP levels were associated with higher CVD risk, especially in participants with HP 1-1 phenotype.Fenofibrate benefit on CVD did not differ by HP phenotype and baseline or change in HP levels.

Background: Fine particulate matter (PM2.5) is a well-recognized environmental pollutant increasingly implicated in the pathogenesis of cardiovascular disease (CVD). Whilst numerous studies have established its deleterious effects, incongruencies in the magnitude, dose-response gradients, and modifying factors across systematic reviews (SRs) and MAs (MAs) have limited translational clarity.

Methods: Per the PRISMA guidelines, we conducted an umbrella review of SRs and MAs examining the association between PM2.5 exposure and cardiovascular morbidity, mortality, or intermediate biomarkers in human populations. Searches were performed across PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar up to June 2025. The methodological quality of included reviews was appraised using AMSTAR 2 and ROBIS.

Results: Thirty-eight SRs and MAs met eligibility criteria, encompassing data from diverse geographic regions and demographic settings. Cumulative evidence demonstrates a robust association between both short- and long-term PM2.5 exposure and elevated cardiovascular risk, including myocardial infarction (RR: 1.02, 95% CI: 1.01-1.03), stroke (RR: 1.011, 95% CI: 1.010-1.012), heart failure (RR: 1.018, 95% CI: 1.011-1.025), arrhythmia (RR: 1.015, 95% CI: 1.006-1.024), and other cardiovascular mortality. Several reviews identified dose-dependent relationships, with increased risk observable even at PM2.5 concentrations below current WHO standards (5 µg/m³ annual mean; 15 µg/m³ 24-hour mean), U.S. national air quality standards (12 µg/m³ annual mean; 35 µg/m³ 24-hour mean), and Indian national air quality standards (40 µg/m³ annual mean; 60 µg/m³ 24-hour mean) have also been associated with increased cardiovascular risk. Subgroup analyses highlighted increased susceptibility among older adults, individuals with pre-existing CVD, and populations in low- and middle-income countries. Whilst most reviews were rated as moderate-to-high quality, methodological heterogeneity in exposure assessment and under-representation of data from South Asia and sub-Saharan Africa remain key limitations.

Conclusions: This umbrella review consolidates high-level evidence linking PM2.5 exposure to a broad spectrum of adverse cardiovascular outcomes. The findings underscore the urgent need to tighten global air quality regulations, prioritize vulnerable populations, and advance mechanistic and regional research to inform tailored policy interventions.

Aims: What proportion of patients with an acute myocardial infarction (MI) or stroke get a new diagnosis of diabetes (NDD) at the time of hospitalization is unclear.

Methods and results: We systematically searched MEDLINE and Embase from database inception to 30 January 2025, to select English-language observational studies that included adult patients with MI or stroke and reported the number of patients with NDD. The denominator was patients without known diabetes. Study quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analyses were used to calculate the pooled proportion of NDD in patients with MI or stroke. Heterogeneity was explored in subgroup analyses, and any change over time was evaluated using meta-regression. 82 studies that included 9440 patients with NDD were identified. Included studies were of good methodological quality: 17 (22%) tested all eligible patients for diabetes, and 19 (23%) used registry-based samples. 16.0% [95% confidence interval (CI), 14.3-17.7, n = 52] patients with MI had NDD, and 15.3% (95% CI 12.5-18.0, n = 30) patients with stroke had NDD, albeit with high heterogeneity. The pooled proportion was higher when oral glucose tolerance test was used to diagnose diabetes. The proportion of NDD did not change over the last 30 years (0.1% per year decline; 95% CI -0.3% to 0.1%).

Conclusion: Among patients admitted with MI or stroke, one in six gets a new diagnosis of diabetes. Improving diabetes screening could help identify people before having a diabetes-related cardiovascular event.

Aims: There is an overabundance of cardiovascular disease (CVD) risk-prediction models applicable to patients with Type 2 diabetes (T2D), but most of them still require external validation. Our aim was to assess the performance of 18 CVD risk scores in a Spanish cohort of patients with T2D.

Methods and results: The CARdiovascular Risk in patients with DIAbetes in Navarra (CARDIANA) cohort, which includes 20 793 individuals with T2D and no history of CVD, was used to externally validate 13 models developed in patients with T2D [Action in Diabetes and Vascular Disease (ADVANCE), Atherosclerosis Risk in Communities, Basque Country Prospective Complications and Mortality Study risk engine, Cardiovascular Healthy Study, Diabetes Cohort Study, DIAL2, DIAL2-extended, Fremantle, Kaasenbrood, Swedish National Diabetes Register (NDR), PREDICT1-diabetes, SCORE2-diabetes, and Wan] and 5 models developed in the general population (ASCVD, PREVENT-basic, PREVENT-full, QRISK2, and SCORE2). Harrell's C-statistic and calibration plots were used as measures of discrimination and calibration, respectively. There were 991 incident CVD events within 5 years of follow-up, resulting in a cumulative incidence of 5.0% (95% confidence interval 4.7-5.3). Discrimination ability was moderate for all the models, with SCORE2-diabetes, NDR, PREDICT1-diabetes, PREVENT-full, Wan, ADVANCE, and both DIAL2 models showing the highest C-index values. All models showed good calibration, although most of them required recalibration, with the exception of ADVANCE-, DIAL2-, and SCORE2-related models.

Conclusion: In our context, models derived for or adapted to diabetes patients, as well as models derived in the general population but incorporating diabetes-related metabolic measures (such as Hb1Ac) as predictors, demonstrated better performance than the others. DIAL2, DIAL2-extended, SCORE2-diabetes, and ADVANCE showed optimal calibration even without recalibration, which implies greater applicability, especially for SCORE2-diabetes and ADVANCE because of their simplicity.