European journal of preventive cardiology最新文献

Aims: Hepcidin regulates plasma and tissue iron levels. We studied the association of hepcidin levels with the risk of incident heart failure (HF) and cardiac dysfunction in older adults.

Methods: We included adults from the ongoing, longitudinal Atherosclerosis Risk in Communities (ARIC) study who were free from prevalent anemia and HF at Visit 5 (2011-2013) and had available hepcidin and covariate data. Associations of plasma hepcidin levels with overall adjudicated incident HF, HF with reduced and HF with preserved ejection fraction (HFrEF and HFpEF) were assessed using multivariable Cox proportional hazards regression models. Cross-sectional associations of hepcidin with echocardiographic measures of cardiac structure and function were estimated using multivariable linear regression models.

Results: The mean age was 75±5 years old and 56% were women. In fully adjusted models, lower hepcidin levels were associated with a higher risk of overall incident HF (HR [95% CI] per 50% lower hepcidin: 1.15 [1.05-1.26]; P=0.003) and HFpEF (HR [95% CI]: 1.25 [1.10-1.42]; P=0.001). Plasma hepcidin level was not significantly associated with the risk of incident HFrEF (HR [95% CI]: 1.08 [0.94-1.24]; P=0.30). Lower hepcidin levels were associated with higher E wave (P=0.046), higher E/e' ratio (P=0.002), higher left atrial volume index (P=0.005) and higher pulmonary artery systolic pressure (P=0.02).

Conclusion: In community-dwelling older adults without anemia, lower plasma hepcidin levels associate with a higher risk of incident HF (particularly HFpEF) and diastolic dysfunction. The findings imply the importance of monitoring iron metabolism dysregulation, even in absence of anemia, in late life.

Introduction: Premature advanced subclinical coronary atherosclerosis among young adults is an under-recognized and unique disease phenotype that has not been well characterized.

Methods: We used data from 44,047 participants with no prior CVD history (59.8% male) from the Coronary Artery Calcium (CAC) Consortium. We defined advanced disease as CAC ≥90th percentile for age, sex, and race, and compared risk factor profile of persons with advanced disease to those without CAC and those with CAC <90th percentile. Using multivariable-adjusted Cox proportional hazard and competing risks regression, we assessed the association of premature advanced disease with all-cause, cardiovascular, and CHD mortality.

Results: Of 44,047 participants, 18,561 (42.2%) had CAC. Among those with CAC, 6,680 (36.0%) had CAC ≥90th percentile. Notably, 76.4% of those with CAC ≥90th percentile had multivessel CAC compared to 40.6% of those with CAC <90th percentile. After a mean follow-up of 12.5±3.6 years, the incidence per 1,000 person-years of all-cause (2.93 vs 1.85 vs 1.11), cardiovascular (1.11 vs 0.39 vs 0.21), and CHD mortality (0.65 vs 0.19 vs 0.08) was highest in the advanced disease group compared to CAC <90th percentile and the no CAC group. Persons with CAC ≥90th percentile had a higher multivariable-adjusted risk of all-cause (HR:2.17[1.83-2.57]), cardiovascular (SHR:3.89[2.78-5.44]), and CHD mortality (SHR:5.45[3.38-8.78]), compared to those without CAC. In the subgroup analysis, there was no difference in mortality between men and women with advanced CAC.

Conclusions: Premature advanced atherosclerosis is a distinct clinical phenotype that strongly predicts all-cause and cause-specific mortality. Among persons with CAC at young age, those with scores ≥ 90th percentile have the highest risk of early death and should be identified in future guidelines as a focus for aggressive clinical prevention.

Aim: Primary prevention of cardiovascular disease (CVD) relies on effective risk stratification to guide interventions. Current models, primarily developed using regression analysis, can lead to inaccurate estimates when applied to external populations. This study evaluates the utility of cluster analysis as an alternative method for developing CVD risk stratification models, comparing its performance with established CVD risk prediction models.

Methods: Using data from 3,416 individuals (mean age of 66 years and no prior CVD) followed for an average of 5.2 years for incidence of CVD, we developed a risk stratification model using cluster analysis based on established CVD risk factors. We compared our model to the Systematic Coronary Risk Evaluation (SCORE2), the Pooled Cohort Equations (PCE) and the Predicting Risk of Cardiovascular Disease Events (PREVENT) models. We used Poisson and Cox regression to compare CVD risk between risk categories in each model. Predictive accuracy of the models was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and C-statistic.

Results: During the study, 161 CVD events were detected. The high-risk cluster had a sensitivity of 59.0%, a PPV of 7.5% a specificity of 64.2% and NPV of 96.9% to predict CVD. Compared to the high-risk groups of the SCORE2, PCE and PREVENT, the high-risk cluster had a high sensitivity and NPV, but a low specificity and PPV. No statistically significant differences were found in C-statistic between models.

Conclusions: Cluster analysis performed comparably to existing models and identified a larger high-risk group that included more individuals who developed CVD, though with more false positives. Further studies in larger, diverse cohorts are needed to validate the clinical utility of cluster analysis in CVD risk stratification.

Aim: Air pollution remains the single largest environmental health risk factor, while atrial fibrillation (AF) is the most prevalent arrhythmia globally. The study aimed to investigate the relationship between short-term exposure to air pollution and acute AF admissions.

Methods: Individual data on AF hospitalization in the years 2011-2020 were collected from the National Health Fund in Poland (ICD-10: I48.XX). To obtain high-resolution data on air pollution we applied a modelling method using the GEM-AQ model. Associations between air pollution exposure and acute AF admissions were estimated using generalized additive models with Poisson regression.

Results: Over the analysed period, we recorded 252,566 acute admissions due to AF. Each 10 µg/m3 increment of PM2.5 and NO2 concentration, 1 µg/m3 of SO2 and 10 ng/m3 of benzo(a)pyrene (BaP) concentration on the day of exposure resulted in 1.13% (0.70%-1.55%), 1.65% (1.05%-2.26%), 0.11% (0.01%-0.21%), and 0.3% (0.04%-0.55%) increases in acute AF admissions, respectively. The estimates are larger for women and older people. Stronger associations between PM2.5 and BaP concentrations and AF admissions in poorly urbanized areas were noted. Areas with high gross domestic product levels were more affected by the increase in NO2 concentrations, resulting in a 0.2% (1.001-1.003) increase in AF admissions. Exposure-response functions show steeper slopes of the pollutant-outcome associations in the lower ranges of exposures, far below World Health Organization (WHO) air quality guideline norms. For the zero-emission scenario, we estimate avoidable AF admissions - 5,873 for PM2.5 (95% CI 3,679 to 8,047) and 3,295 for NO2 (2,108-4,477).

Conclusions: Air pollution acts as a triggering factor and can be associated with acute AF hospitalisations. PM2.5 and NO2 have an impact on AF even at concentrations levels below WHO air quality guideline norms.

Due to the aging population, focusing on healthy aging has become a global priority. Cardiovascular diseases (CVDs) and frailty, characterized by increased vulnerability to adverse stress and health events, interact synergistically in advanced age. In older adults, hip fractures are a frequent dramatic "life-transition" event. Conditions such as arrhythmias, orthostatic hypotension, heart failure, peripheral artery disease and adverse drug reactions may facilitate falls and thus bone fractures in older adults. Cardiovascular complications or the worsening of previous CVDs may increase the degree of frailty and disability following this surgery. The close relationship between older age, CVDs, frailty and orthopaedic surgery leads to the need to focus on the various phases of interventions in a multidisciplinary approach. This document aims to provide practical support to prevent cardiovascular complications in older and frail patients undergoing hip procedures by suggesting specific assessments and interventions. In particular, in pre-operative care the focus should be on the assessment and management of concomitant CVD and frailty, while immediate peri- and post-operative care should highlight specific concerns for anesthesia, prevention and management of thrombotic complications, specific nursing needs, including the prevention of infections and delirium, and the establishment of an integrated rehabilitation program focusing on CVDs and the risk of new falls, with a positive role for care-givers. Furthermore, by optimizing the "hip surgery pathway" the objective is to help avoid the deterioration of health and loss of independence that often result from this surgery through the correct management of cardiovascular patients in this peculiar context.