European journal of preventive cardiology最新文献

Objective: The normalized creatinine-to-cystatin C ratio (NCCR) is a novel composite biomarker that approximates relative skeletal muscle mass and diabetes risk. However, the association between NCCR and atherosclerotic cardiovascular disease (ASCVD) remains unclear. In this study, we obtained data from the UK Biobank with the aim to assess the association between the NCCR and ASCVD risk.

Methods: This study included 267167 participants from the UK Biobank enrolled between 2006 and 2010. Baseline NCCR was determined using the following formula: creatinine [mg/dL]/cystatin C [mg/L] × 10/body weight [kg]. The primary study outcome was the all-cause ASCVD incidence. Multivariable Cox proportional hazards regression was used to estimate the relationship between NCCR and ASCVD. Kaplan-Meier curves, restricted cubic spline (RCS), subgroup, and sensitivity analyses was conducted to enhance the robustness of our results.

Results: During a 15 years follow-up in average, 27026 participants developed ASCVD. NCCR showed a significant negative association with ASCVD (hazard ratio [HR] = 0.91, 95% CI: 0.89 - 0.92). Further sex-specific analysis revealed significant negative non-linear associations between NCCR and ASCVD in males, whereas a stronger linear association in females. Moreover, stratified and interaction analyses of the subgroups and several sensitivity analyses confirmed the stability of our core results.

Conclusions: A high NCCR was independently associated with a reduced risk of ASCVD, particularly in females. Therefore, NCCR, which can be easily calculated from standard blood biochemistry, may potentially improve ASCVD risk assessment without the requirement of additional laboratory testing.

Aims: The role of low-density lipoprotein cholesterol (LDL-C) in atherosclerotic cardiovascular disease in individuals aged >75 remains controversial. This study aimed to assess whether LDL-C levels are associated with coronary plaque burden and future myocardial infarctions (MI) in individuals across different ages, with focus on those aged 76-92.

Methods: This contemporary cohort study included symptomatic statin-naïve individuals who underwent coronary computed tomography angiography (CCTA) from 2008-2021, from the Western Denmark Heart Registry. Outcomes included 1) adjusted risk ratio (aRR) for CAC >90th percentile, 2) aRR for post-CCTA revascularization within 90 days of CCTA, indicating advanced atherosclerotic disease, and 3) adjusted hazard ratio (aHR) for MI.

Results: The study included 37,910 individuals, of whom 1,562 were aged 76-92. A total of 433 individuals experienced MI during a median follow-up time of 5.1 years. Higher LDL-C levels were associated with higher risk of CAC >90th percentile, post-CCTA revascularization, and MI across all age groups. In individuals aged 76-92, the aRRs per 1 mmol/L higher LDL-C for CAC >90th percentile and for post-CCTA revascularization were 1.19 (95% CI: 1.00-1.40) and 1.41 (1.22-1.64); corresponding values at age 61-75 years were 1.07 (1.01-1.14) and 1.32 (1.23-1.41), respectively. At age 76-92 and 61-75 years, the aHRs for MI were 1.57 (1.06-2.32) and 1.22 (1.03-1.44) per 1 mmol/L higher LDL-C.

Conclusion: In statin-naïve symptomatic individuals aged 76-92, higher LDL-C was associated with CAC >90th percentile, post-CCTA revascularization, and increased risk of MI. These findings suggest that elevated LDL-C is a driver of coronary artery disease throughout life.

Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of disease starting with liver steatosis and progressing to fibrosis. We evaluated whether non-invasive tests of steatosis and fibrosis are associated with cardiovascular outcomes, and whether bempedoic acid treatment reduced cardiovascular risk.

Methods: A post-hoc exploratory analysis of CLEAR Outcomes (n=13,970, median follow-up 40·6 months) was carried out using non-invasive tests to estimate liver steatosis and fibrosis: Framingham Steatosis Index (FSI), Fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS). The endpoint was a 4-component major adverse cardiovascular event. Time-to-event was analyzed using Cox proportional hazards models.

Results: The mean (±SD) age was 66 ±9 years and BMI 30 ±5 kg/m2. Adjusted for other risk factors, liver steatosis was associated with an increased incidence of MACE4 in the placebo group, with hazard ratio (HRFSI) 1·13 (95%CI 1·08-1·18) for 1 unit of FSI increase. Similarly, liver fibrosis was associated with increased risk of MACE4, HRFIB4 1·21 (95%CI 1·09-1·34) and HRNFS 1·16 (95%CI 1·10-1·23) for 1 unit of increase in score. In patients at risk for liver steatosis, the HR for MACE4 associated with 1-unit of FSI increase was lower in the bempedoic acid group: HRFSI_BA 1·04 (95%CI 0·99-1·09) vs. HRFSI_PBO 1·14 (95%CI 1·09-1·18). Treatment effect was not related to the degree of fibrosis.

Conclusion: Liver steatosis and fibrosis assessed with non-invasive tests are associated with an increased risk of MACE4. Bempedoic acid reduced MACE4 risk, with an additional benefit in patients with elevated steatosis scores.

Aims: While physical exercise is widely recognized as a lifestyle treatment for managing blood pressure, direct comparisons between exercise modalities performed at different weekly exercise doses remain limited. In the meantime, post-menopausal women are at increased risk of hypertension due to the compounded negative effects of aging and dramatic hormone changes during the menopausal transition. Therefore, this study aims to comprehensively evaluate the dose-response effects of exercise modalities on blood pressure in post-menopausal women.

Methods and results: A systematic search for randomized controlled trials was conducted across seven databases, encompassing data from inception to December 2024. Dose-response network meta-analyses were conducted to compare the effects of exercise modalities performed at various weekly exercise doses on blood pressure. The primary outcome was the within-group change of systolic (SBP) and diastolic (DBP) blood pressure. Results were reported as mean difference (MD) and 95% credible intervals (CrI), expressed in mmHg. Certainty of evidence was evaluated using Confidence in Network Meta-Analysis (CINeMA) tool. A total of 79 studies, involving 3,628 post-menopausal women, were included in this analysis. Dose-response network meta-analysis identified that multi-component exercises performed at the dose of 900 metabolic equivalent of tasks-min/week (METs-min/week) provided the most consistent benefits in lowering both SBP (MD=-11.94 mmHg; 95% CrI [-16.72, -7.16]) and DBP (MD=-8.60 mmHg; 95% CrI [-11.55, -5.60]).

Conclusion: This review represents the most comprehensive integration of evidence to date on the comparative dose-response effectiveness of exercise modalities on reducing blood pressure in post-menopausal women, with multi-component exercise at 900 METs-min/week offering the most consistent and beneficial effects.