Damiano Magrì, Massimo Piepoli, Giovanna Gallo, Emiliano Fiori, Michele Correale, Andrea Attanasio, Matteo Beltrami, Attilio Lauretti, Alberto Palazzuoli, Piergiuseppe Agostoni
The HF syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization and down-regulation of cardiac β1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. CI, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the β-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response, is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.
心房颤动综合征的特点是交感神经亢进导致的自律神经失衡,交感神经亢进导致心肌需氧量增加、氧化应激、外周血管收缩、后负荷不匹配以及心脏β1受体的逐渐脱敏和下调。这些变化,再加上其他一些结构和外周变化,导致了促时性失调(CI),如心率(HR)不能随活动或需求而持续增加。无论采用哪种方法和临界值来定义 CI,CI 都与运动能力下降和预后恶化有关。此外,不同的药物类别可能会干扰生理性运动诱导的心率反应,从而产生一些混淆。尤其是β受体阻滞剂,虽然会降低峰值心率,但已知会改善预后和左心室肌力储备,因此至少在射血分数减低和轻度减低的房颤患者中应避免停用β受体阻滞剂。同样,速率适应性起搏也是一种仍有争议的策略,用于平衡运动引起的心率反应减弱。本综述除了概述可能的 CI 定义外,还讨论了 CI 的临床影响以及潜在的药物和非药物治疗策略。
{"title":"Chronotropic Incompetence across Heart Failure Categories.","authors":"Damiano Magrì, Massimo Piepoli, Giovanna Gallo, Emiliano Fiori, Michele Correale, Andrea Attanasio, Matteo Beltrami, Attilio Lauretti, Alberto Palazzuoli, Piergiuseppe Agostoni","doi":"10.1093/eurjpc/zwae348","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae348","url":null,"abstract":"<p><p>The HF syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization and down-regulation of cardiac β1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. CI, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the β-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response, is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolas Johner, Mattia Branca, David Carballo, Stéphanie Baggio, David Nanchen, Elena Tessitore, Lorenz Räber, Thomas Felix Lüscher, Christian M Matter, Stephan Windecker, Nicolas Rodondi, François Mach, Baris Gencer
Aims: The benefit of long-term beta-blocker therapy after acute coronary syndromes (ACS) without heart failure in the reperfusion era is uncertain. Two recent randomized trials found conflicting results. The present study assessed the safety of beta-blocker discontinuation within 12 months following ACS with LVEF ≥40%.
Methods: In a multicentre prospective real-world cohort (N=3,762) of patients hospitalized for ACS, patients with LVEF ≥40% and beta-blockers at discharge were included. Patients who continued beta-blockers at one year were compared with those who discontinued beta-blockers within 12 months post-ACS using target trial emulation and inverse probability weighting over an additional four-year follow-up. The primary endpoint was major adverse cardiovascular events (MACE), a composite of four-year cardiovascular death, myocardial infarction, stroke, transient ischemic attack, unplanned coronary revascularization, or unstable angina hospitalization.
Results: Of 2,077 patients, 1,758 (85%) continued beta-blockers and 319 (15%) had discontinued beta-blockers at one year. The risk of primary endpoint was similar in both groups (14.1% versus 14.3% with beta-blocker discontinuation versus continuation; adjusted hazard ratio [aHR]=0.98; 95% confidence interval, 0.72-1.34, P=0.91). Subgroup analysis suggested a higher risk of primary endpoint with beta-blocker discontinuation after STEMI (aHR=1.46 [0.99-2.16]) compared to NSTEMI (aHR=0.70 [0.40-1.22], Pinteraction=0.033), whereas there was no interaction with LVEF (Pinteraction=0.68).
Conclusions: Beta-blocker discontinuation within 12 months following ACS with LVEF ≥40% was not associated with an increased risk of MACE compared to long-term beta-blocker therapy. Subgroup analysis suggested potential risk in STEMI patients. Discontinuing beta-blockers 12 months after ACS appears safe in patients with LVEF ≥40%, particularly after NSTEMI.
{"title":"Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort.","authors":"Nicolas Johner, Mattia Branca, David Carballo, Stéphanie Baggio, David Nanchen, Elena Tessitore, Lorenz Räber, Thomas Felix Lüscher, Christian M Matter, Stephan Windecker, Nicolas Rodondi, François Mach, Baris Gencer","doi":"10.1093/eurjpc/zwae346","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae346","url":null,"abstract":"<p><strong>Aims: </strong>The benefit of long-term beta-blocker therapy after acute coronary syndromes (ACS) without heart failure in the reperfusion era is uncertain. Two recent randomized trials found conflicting results. The present study assessed the safety of beta-blocker discontinuation within 12 months following ACS with LVEF ≥40%.</p><p><strong>Methods: </strong>In a multicentre prospective real-world cohort (N=3,762) of patients hospitalized for ACS, patients with LVEF ≥40% and beta-blockers at discharge were included. Patients who continued beta-blockers at one year were compared with those who discontinued beta-blockers within 12 months post-ACS using target trial emulation and inverse probability weighting over an additional four-year follow-up. The primary endpoint was major adverse cardiovascular events (MACE), a composite of four-year cardiovascular death, myocardial infarction, stroke, transient ischemic attack, unplanned coronary revascularization, or unstable angina hospitalization.</p><p><strong>Results: </strong>Of 2,077 patients, 1,758 (85%) continued beta-blockers and 319 (15%) had discontinued beta-blockers at one year. The risk of primary endpoint was similar in both groups (14.1% versus 14.3% with beta-blocker discontinuation versus continuation; adjusted hazard ratio [aHR]=0.98; 95% confidence interval, 0.72-1.34, P=0.91). Subgroup analysis suggested a higher risk of primary endpoint with beta-blocker discontinuation after STEMI (aHR=1.46 [0.99-2.16]) compared to NSTEMI (aHR=0.70 [0.40-1.22], Pinteraction=0.033), whereas there was no interaction with LVEF (Pinteraction=0.68).</p><p><strong>Conclusions: </strong>Beta-blocker discontinuation within 12 months following ACS with LVEF ≥40% was not associated with an increased risk of MACE compared to long-term beta-blocker therapy. Subgroup analysis suggested potential risk in STEMI patients. Discontinuing beta-blockers 12 months after ACS appears safe in patients with LVEF ≥40%, particularly after NSTEMI.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephan Mueller, Marina Kabelac, Isabel Fegers-Wustrow, Ephraim B Winzer, Andreas B Gevaert, Paul Beckers, Bernhard Haller, Frank Edelmann, Jeffrey W Christle, Mark J Haykowsky, Vandana Sachdev, Dalane W Kitzman, Axel Linke, Volker Adams, Ulrik Wisloff, Burkert Pieske, Emeline van Craenenbroeck, Martin Halle
Aims: Exercise training (ET) is an effective therapy in heart failure with preserved ejection fraction (HFpEF), but the influence of different ET characteristics is unclear. We aimed to evaluate the associations between ET frequency, duration, intensity [% heart rate reserve (%HRR)] and estimated energy expenditure (EEE) with the change in peak oxygen consumption (V̇O2) over 3 months of moderate continuous training (MCT, 5×/week) or high-intensity interval training (HIIT, 3×/week) in HFpEF.
Methods and results: ET duration and heart rate (HR) were recorded with a smartphone application. EEE was calculated using the HR data during ET and the individual HR-V̇O2 relationships during cardiopulmonary exercise testing. Differences between groups and associations between ET characteristics and peak V̇O2 change were assessed with linear regression analyses. Peak V̇O2 improved by 9.2 ± 13.2% after MCT and 8.7 ± 15.9% after HIIT (P = 0.67). The average EEE of 1 HIIT session was equivalent to ∼1.42 MCT sessions and when adjusted for EEE, the mean difference between MCT and HIIT was -0.1% (P = 0.98). For both MCT and HIIT, peak V̇O2 change was positively associated with ET frequency (MCT: R2 = 0.103; HIIT: R2 = 0.149) and duration/week (MCT: R2 = 0.120; HIIT: R2 = 0.125; all P < 0.05). Average %HRR was negatively associated with peak V̇O2 change in MCT (R2 = 0.101; P = 0.034), whereas no significant association was found in HIIT (P = 0.234). Multiple regression analyses explained ∼1/3 of the variance in peak V̇O2 change.
Conclusion: In HFpEF, isocaloric HIIT and MCT seem to be equally effective over 3 months. Within each mode, increasing ET frequency or duration/week may be more effective to improve peak V̇O2 than increasing ET intensity.
{"title":"Comparison of exercise training modalities and change in peak oxygen consumption in heart failure with preserved ejection fraction: a secondary analysis of the OptimEx-Clin trial.","authors":"Stephan Mueller, Marina Kabelac, Isabel Fegers-Wustrow, Ephraim B Winzer, Andreas B Gevaert, Paul Beckers, Bernhard Haller, Frank Edelmann, Jeffrey W Christle, Mark J Haykowsky, Vandana Sachdev, Dalane W Kitzman, Axel Linke, Volker Adams, Ulrik Wisloff, Burkert Pieske, Emeline van Craenenbroeck, Martin Halle","doi":"10.1093/eurjpc/zwae332","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae332","url":null,"abstract":"<p><strong>Aims: </strong>Exercise training (ET) is an effective therapy in heart failure with preserved ejection fraction (HFpEF), but the influence of different ET characteristics is unclear. We aimed to evaluate the associations between ET frequency, duration, intensity [% heart rate reserve (%HRR)] and estimated energy expenditure (EEE) with the change in peak oxygen consumption (V̇O2) over 3 months of moderate continuous training (MCT, 5×/week) or high-intensity interval training (HIIT, 3×/week) in HFpEF.</p><p><strong>Methods and results: </strong>ET duration and heart rate (HR) were recorded with a smartphone application. EEE was calculated using the HR data during ET and the individual HR-V̇O2 relationships during cardiopulmonary exercise testing. Differences between groups and associations between ET characteristics and peak V̇O2 change were assessed with linear regression analyses. Peak V̇O2 improved by 9.2 ± 13.2% after MCT and 8.7 ± 15.9% after HIIT (P = 0.67). The average EEE of 1 HIIT session was equivalent to ∼1.42 MCT sessions and when adjusted for EEE, the mean difference between MCT and HIIT was -0.1% (P = 0.98). For both MCT and HIIT, peak V̇O2 change was positively associated with ET frequency (MCT: R2 = 0.103; HIIT: R2 = 0.149) and duration/week (MCT: R2 = 0.120; HIIT: R2 = 0.125; all P < 0.05). Average %HRR was negatively associated with peak V̇O2 change in MCT (R2 = 0.101; P = 0.034), whereas no significant association was found in HIIT (P = 0.234). Multiple regression analyses explained ∼1/3 of the variance in peak V̇O2 change.</p><p><strong>Conclusion: </strong>In HFpEF, isocaloric HIIT and MCT seem to be equally effective over 3 months. Within each mode, increasing ET frequency or duration/week may be more effective to improve peak V̇O2 than increasing ET intensity.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anan Abu Rmilah, Alkurashi Adham, Haq Ikram-Ul, Hossam Alzu'bi, Anevakar Nandan, Hayan Jouni, Satomi Hirashi, Dawn Owen, Anita Deswal, Steven H Lin, Jun-Ichi Abe, Tzu Cheng Chao, Jacinta Browne, Tim Leiner, Nadia Laack, Joerg Herrmann
Aims: Radiation therapy (RT) is an integral component of cancer therapy but associated with adverse events. Our goal was to establish risk prediction models for major adverse cardiovascular and cerebrovascular events (MACCE) after chest RT.
Methods and results: A retrospective study of lung/breast cancer patients who had chest RT with planning CT at Mayo Clinic between 01/2010 and 01/2014. Predictive models were developed based on weighted independent predictors using a derivation (406 lung and 711 breast cancer) and validation cohort (179 lung and 234 breast cancer). Patient characteristics, pre-RT CT for coronary artery calcification (CAC), and post-RT MACCE data were reviewed. Post-RT MACCE occurred in 6.1 and 5.6% in the derivation and validation cohort over a mean follow-up of 42 ± 13 months. Post-therapy model (C2AD2) included CAC (two points), MACCE history (two points), age ≥74 (three points), DM (two points), and mean heart radiation dose ≥ 850 mGy (two points), and pre-therapy model (C2AD) included post-therapy model parameters minus mean heart radiation dose. Both models stratified patients into three risk groups: low (0-2), intermediate (3-5), and high (≥6). Post-RT MACCE across these groups were 2.7, 8.9, and 19.8% in the derivation, and 3.9, 6.6, and 16.4% in the validation cohort for post-therapy model (C2AD2) and 2.8, 9.2, and 20.4% in the derivation and 3.7, 9.2, and 13.2% in the validation cohort for pre-therapy model. Both models showed statistically significant graded survival outcome.
Conclusion: Post-therapy (C2AD2) and pre-therapy (C2AD) models are simple, easy to use and effective tools to stratify breast and lung cancer patients undergoing chest radiation for post-RT MACCE.
{"title":"Novel risk score for predicting acute cardiovascular and cerebrovascular events after chest radiotherapy in patients with breast or lung cancer.","authors":"Anan Abu Rmilah, Alkurashi Adham, Haq Ikram-Ul, Hossam Alzu'bi, Anevakar Nandan, Hayan Jouni, Satomi Hirashi, Dawn Owen, Anita Deswal, Steven H Lin, Jun-Ichi Abe, Tzu Cheng Chao, Jacinta Browne, Tim Leiner, Nadia Laack, Joerg Herrmann","doi":"10.1093/eurjpc/zwae323","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae323","url":null,"abstract":"<p><strong>Aims: </strong>Radiation therapy (RT) is an integral component of cancer therapy but associated with adverse events. Our goal was to establish risk prediction models for major adverse cardiovascular and cerebrovascular events (MACCE) after chest RT.</p><p><strong>Methods and results: </strong>A retrospective study of lung/breast cancer patients who had chest RT with planning CT at Mayo Clinic between 01/2010 and 01/2014. Predictive models were developed based on weighted independent predictors using a derivation (406 lung and 711 breast cancer) and validation cohort (179 lung and 234 breast cancer). Patient characteristics, pre-RT CT for coronary artery calcification (CAC), and post-RT MACCE data were reviewed. Post-RT MACCE occurred in 6.1 and 5.6% in the derivation and validation cohort over a mean follow-up of 42 ± 13 months. Post-therapy model (C2AD2) included CAC (two points), MACCE history (two points), age ≥74 (three points), DM (two points), and mean heart radiation dose ≥ 850 mGy (two points), and pre-therapy model (C2AD) included post-therapy model parameters minus mean heart radiation dose. Both models stratified patients into three risk groups: low (0-2), intermediate (3-5), and high (≥6). Post-RT MACCE across these groups were 2.7, 8.9, and 19.8% in the derivation, and 3.9, 6.6, and 16.4% in the validation cohort for post-therapy model (C2AD2) and 2.8, 9.2, and 20.4% in the derivation and 3.7, 9.2, and 13.2% in the validation cohort for pre-therapy model. Both models showed statistically significant graded survival outcome.</p><p><strong>Conclusion: </strong>Post-therapy (C2AD2) and pre-therapy (C2AD) models are simple, easy to use and effective tools to stratify breast and lung cancer patients undergoing chest radiation for post-RT MACCE.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamal Awad, Ahmed K Mahmoud, Mohammed Tiseer Abbas, Said Alsidawi, Chadi Ayoub, Reza Arsanjani, Juan M Farina
Aims: Lipoprotein(a) [Lp(a)] levels are known to be mainly genetically determined. However, only scarce data are available on the intra-individual variability of Lp(a) levels across time.
Methods: We included adult patients (≥18 years old) who had baseline and follow-up Lp(a) measurements (between 1997 and 2024) with a minimum of one year apart. Patients were categorized into three groups as follows: normal (<30 mg/dL), borderline (30 to 50 mg/dL) and high Lp(a) (≥50 mg/dL). Multivariable logistic regression was conducted to assess the predictors of the intra-individual changes in Lp(a) ≥10 mg/dL.
Results: A total of 11,669 individuals (median age: 54 years, 60% males) were included in our analysis, with median time between measurements of 4.5 years (IQR: 2.2, 10.6). The median Lp(a) was 16 mg/dL (IQR: 7, 52) at baseline, compared with 15 mg/dL (IQR: 7, 52) at follow-up. At follow-up, 96.4% of individuals with normal Lp(a) and 89.9% with high Lp(a) remained in their categories, while 51.2% with borderline Lp(a) changed their category. Of the included population, 24.9% had an intra-individual Lp(a) change ≥10 mg/dL. Female sex (p <0.001), history of ASCVD (p=0.003), statin therapy (p=0.003) and elevated low-density lipoprotein cholesterol (LDL-C) levels ≥100 mg/dL (p <0.001) were significantly associated with higher odds of intra-individual Lp(a) changes ≥10 mg/dL.
Conclusions: Lipoprotein(a) levels were generally stable over time; however, patients with borderline levels may require more than one Lp(a) measurement, especially if they are females, have a history of ASCVD, have elevated LDL-C levels or are on statins therapy.
{"title":"Intra-individual Variability in Lipoprotein(a) Levels: Findings from a Large Academic Health System Population.","authors":"Kamal Awad, Ahmed K Mahmoud, Mohammed Tiseer Abbas, Said Alsidawi, Chadi Ayoub, Reza Arsanjani, Juan M Farina","doi":"10.1093/eurjpc/zwae341","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae341","url":null,"abstract":"<p><strong>Aims: </strong>Lipoprotein(a) [Lp(a)] levels are known to be mainly genetically determined. However, only scarce data are available on the intra-individual variability of Lp(a) levels across time.</p><p><strong>Methods: </strong>We included adult patients (≥18 years old) who had baseline and follow-up Lp(a) measurements (between 1997 and 2024) with a minimum of one year apart. Patients were categorized into three groups as follows: normal (<30 mg/dL), borderline (30 to 50 mg/dL) and high Lp(a) (≥50 mg/dL). Multivariable logistic regression was conducted to assess the predictors of the intra-individual changes in Lp(a) ≥10 mg/dL.</p><p><strong>Results: </strong>A total of 11,669 individuals (median age: 54 years, 60% males) were included in our analysis, with median time between measurements of 4.5 years (IQR: 2.2, 10.6). The median Lp(a) was 16 mg/dL (IQR: 7, 52) at baseline, compared with 15 mg/dL (IQR: 7, 52) at follow-up. At follow-up, 96.4% of individuals with normal Lp(a) and 89.9% with high Lp(a) remained in their categories, while 51.2% with borderline Lp(a) changed their category. Of the included population, 24.9% had an intra-individual Lp(a) change ≥10 mg/dL. Female sex (p <0.001), history of ASCVD (p=0.003), statin therapy (p=0.003) and elevated low-density lipoprotein cholesterol (LDL-C) levels ≥100 mg/dL (p <0.001) were significantly associated with higher odds of intra-individual Lp(a) changes ≥10 mg/dL.</p><p><strong>Conclusions: </strong>Lipoprotein(a) levels were generally stable over time; however, patients with borderline levels may require more than one Lp(a) measurement, especially if they are females, have a history of ASCVD, have elevated LDL-C levels or are on statins therapy.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Small Bouts, Big Impact: The Role of Incidental Physical Activity in Cardiovascular Prevention.","authors":"Kyuwan Lee, Mi-Hyang Jung","doi":"10.1093/eurjpc/zwae338","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae338","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Can Coronary Artery Calcium Predict the Risk of Major Cardiovascular Events from Radiotherapy?","authors":"Wee Loon Ng, Choon Ta Ng, Terrance Chua","doi":"10.1093/eurjpc/zwae325","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae325","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lipid management in patients with atherosclerotic cardiovascular disease: it is time to apply the guidelines!","authors":"Marie Hauguel-Moreau, Maryam Kavousi","doi":"10.1093/eurjpc/zwae335","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae335","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emilie Marie Juelstorp Pedersen, Harman Yonis, Gertrud Baunbæk Egelund, Nicolai Lohse, Christian Torp-Pedersen, Birgitte Lindegaard, Andreas Vestergaard Jensen
Aims: Infections have been associated with acute myocardial infarction (AMI), but differences in risk between infection types and age groups are unclear. This study aims to investigate whether infections are associated with subsequent AMI and whether the risk differs across infection sites and age groups.
Methods: Nationwide registers were used to include 702596 adults hospitalized between 1987-2018 with either; pneumonia (n=344319), urinary tract infection (UTI) (n=270101), soft tissue/bone infection (n=66718), central nervous system infection (CNS) (n=17025), or endocarditis (n=4433). Patients were sex- and age-matched with two unexposed controls. Outcome was first-time AMI within ten years. A time-dependent cox proportional hazards model with cut-offs at 30 and 90 days was used for calculating adjusted hazard ratios (HR).
Results: Pneumonia, UTI, and soft tissue/bone infection were associated with increased relative rates of AMI compared to matched, unexposed controls. Highest relative rates were found within the first 0-30 days post-exposure; Pneumonia: HR 3.39 (95% CI 3.15-3.65), UTI: HR 2.44 (95% CI 2.21-2.70), Soft tissue/bone infection: HR 1.84 (95% CI 1.45-2.33). Relative rates decreased over time but remained significantly elevated throughout the follow-up period and was increased in all age groups. No association was found for CNS infection and for endocarditis only at 31-90 days, HR 2.28 (95% CI 1.20-4.33).
Conclusion: Acute infections are associated with increased relative rates of AMI across different infection sites and age groups with higher relative rates found for pneumonia. This indicates that some infections may act as a trigger for AMI with a site and/or pathogen specific risk.
目的:感染与急性心肌梗死(AMI)有关,但感染类型和年龄组之间的风险差异尚不清楚。本研究旨在调查感染是否与随后发生的急性心肌梗死有关,以及不同感染部位和年龄组的风险是否存在差异:该研究使用全国性登记册,纳入了 1987-2018 年间因肺炎(n=344319)、尿路感染(UTI)(n=270101)、软组织/骨感染(n=66718)、中枢神经系统感染(CNS)(n=17025)或心内膜炎(n=4433)住院的 702596 名成人。患者的性别和年龄与两名未受感染的对照组相匹配。结果为十年内首次发生急性心肌梗死。计算调整后的危险比(HR)时,采用了以30天和90天为分界点的时间依赖性Cox比例危险模型:结果:与匹配的未暴露对照组相比,肺炎、UTI 和软组织/骨骼感染与急性心肌梗死的相对发生率增加有关。肺炎:HR 3.39 (95% CI 3.15-3.65),UTI:HR 2.44 (95% CI 2.21-2.70),软组织/骨骼感染:HR 1.84 (95% CI 3.15-3.65):HR 1.84 (95% CI 1.45-2.33)。随着时间的推移,相对比率有所下降,但在整个随访期间仍显著升高,并且在所有年龄组中都有所上升。中枢神经系统感染和心内膜炎在31-90天内没有相关性,HR为2.28(95% CI为1.20-4.33):结论:在不同感染部位和年龄组中,急性感染与急性心肌梗死的相对发生率增加有关,其中肺炎的相对发生率更高。这表明,某些感染可能是诱发急性心肌梗死的导火索,其风险与感染部位和/或病原体有关。
{"title":"Severe infections as risk factors for acute myocardial infarction: a nationwide, Danish cohort study from 1987-2018.","authors":"Emilie Marie Juelstorp Pedersen, Harman Yonis, Gertrud Baunbæk Egelund, Nicolai Lohse, Christian Torp-Pedersen, Birgitte Lindegaard, Andreas Vestergaard Jensen","doi":"10.1093/eurjpc/zwae344","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae344","url":null,"abstract":"<p><strong>Aims: </strong>Infections have been associated with acute myocardial infarction (AMI), but differences in risk between infection types and age groups are unclear. This study aims to investigate whether infections are associated with subsequent AMI and whether the risk differs across infection sites and age groups.</p><p><strong>Methods: </strong>Nationwide registers were used to include 702596 adults hospitalized between 1987-2018 with either; pneumonia (n=344319), urinary tract infection (UTI) (n=270101), soft tissue/bone infection (n=66718), central nervous system infection (CNS) (n=17025), or endocarditis (n=4433). Patients were sex- and age-matched with two unexposed controls. Outcome was first-time AMI within ten years. A time-dependent cox proportional hazards model with cut-offs at 30 and 90 days was used for calculating adjusted hazard ratios (HR).</p><p><strong>Results: </strong>Pneumonia, UTI, and soft tissue/bone infection were associated with increased relative rates of AMI compared to matched, unexposed controls. Highest relative rates were found within the first 0-30 days post-exposure; Pneumonia: HR 3.39 (95% CI 3.15-3.65), UTI: HR 2.44 (95% CI 2.21-2.70), Soft tissue/bone infection: HR 1.84 (95% CI 1.45-2.33). Relative rates decreased over time but remained significantly elevated throughout the follow-up period and was increased in all age groups. No association was found for CNS infection and for endocarditis only at 31-90 days, HR 2.28 (95% CI 1.20-4.33).</p><p><strong>Conclusion: </strong>Acute infections are associated with increased relative rates of AMI across different infection sites and age groups with higher relative rates found for pneumonia. This indicates that some infections may act as a trigger for AMI with a site and/or pathogen specific risk.</p>","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Feeding the Future: The Intersection of the Planetary Health Diet and Cardiovascular Disease.","authors":"Siobhan Hickling","doi":"10.1093/eurjpc/zwae342","DOIUrl":"https://doi.org/10.1093/eurjpc/zwae342","url":null,"abstract":"","PeriodicalId":12051,"journal":{"name":"European journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":8.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}