European journal of preventive cardiology最新文献

Aims: This study aimed to explore relationships between visit-to-visit lipid variability, coronary artery calcification (CAC), inflammation, and long-term mortality, which may be prognostically relevant.

Methods: This prospective cohort study included participants from the Multi-Ethnic Study of Atherosclerosis with available plasma low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides from all three initial exams who underwent computed tomography CAC quantification at the third (index) exam. Visit-to-visit variability (coefficient of variation) was calculated from all three initial exams. Outcomes included the index Agatston score, cardiovascular mortality, all-cause mortality, and high-sensitivity C-reactive protein (hsCRP).

Results: Altogether, 1515 participants were analysed. Higher HDL-C variability was associated with higher index Agatston score (quartile 4 [Q4; vs Q1] adjusted marginal effects 0.25 [0.02-0.48]), but not LDL-C, TC, and triglycerides variability. Over a 15.1-year median follow-up, higher HDL-C (Q4 vs Q1: adjusted sub-hazard ratio 2.68 [1.61-4.48]) and TC (Q4 vs Q1: adjusted sub-hazard ratio 2.13 [1.17-3.89]) variability, but not LDL-C and triglycerides variability, were associated with higher risk of cardiovascular mortality, which remained significant after adjusting for the index Agatston score. Additionally, higher HDL-C variability was associated with higher risk of all-cause mortality (Q4 vs Q1: adjusted hazard ratio 1.46 [1.00-2.11]), but LDL-C, TC, and triglycerides variability were not. HDL-C (Q4 vs Q1: adjusted β: 0.132 [0.034-0.230]) and TC (Q4 vs Q1: adjusted β: 0.210 [0.064-0.357]) variability, but not LDL-C and triglycerides variability, may be correlated with hsCRP.

Conclusions: Elevated HDL-C variability was associated with greater CAC burden and long-term risks of cardiovascular and all-cause mortality. These mortality-related associations were probably not completely explainable by atherosclerosis.

Aims: To evaluate the effect of Life's Essential 8 (LE8), a comprehensive cardiovascular health (CVH) metric from the American Heart Association, on the risk of cardiac conduction disorders (CCD).

Methods and results: We conducted a prospective cohort study of 112,160 adults from the UK Biobank, free of cardiovascular disease at baseline, to examine the association between LE8 scores and the risk of CCD. LE8 scores were categorized into low (0-49), moderate (50-79), and high (80-100) CVH groups. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CCD incidence during a median follow-up of 11.6 years. A total of 2,760 CCD cases were identified. After adjustment for confounders, the high CVH group exhibited a significantly lower risk of CCD compared to the low CVH group (HR: 0.48, 95% CI: 0.40-0.56). Further analyses showed reduced risks for both severe conduction block (HR: 0.63, 95% CI: 0.52-0.78) and left bundle branch or fascicular block (HR: 0.35, 95% CI: 0.25-0.49) in the high CVH group. Restricted cubic spline regression revealed an L-shaped association between LE8 score and CCD risk. Among individual LE8 metrics, WQS analysis revealed that BMI and sleep health were the major contributors to reduced CCD risk.

Conclusions: Higher LE8 scores were associated with a lower risk of CCD, including severe conduction block requiring pacemaker implantation and left bundle branch or fascicular block. Comprehensive strategies targeting optimal CVH, especially BMI and sleep health, may be beneficial for preventing CCD.

Aims: Risk estimation of different types of cardiovascular events (CVE) following a hospitalisation for exacerbated chronic obstructive pulmonary disease (exCOPD) is warranted to consider prevention.

Methods: A case-crossover study was conducted using the French exhaustive hospital discharge database (2013-2019). Case-patients had a diagnosis of COPD, hospitalised for a CVE in France in 2018-2019 (admission date was index date) with no other CVE in ≤12 months, and had ≥1 hospitalisation for exCOPD ≤24 weeks before index CVE. The key exposure was hospitalisation for exCOPD (overall and according to levels of care intensity) ≤1-4 weeks versus 9-24 weeks preceding the CVE. Conditional logistic regression models estimated odds ratios (OR) for the association between hospitalisation for exCOPD and different types of CVE.

Results: Among 9,840 case-patients, the most frequent CVE was decompensated heart failure (5,888 case-patients, 59.8%). The CVE risk was greater ≤4 weeks after a hospitalisation for any exCOPD (OR, 3.03; 95% confidence interval [CI], 2.90-3.16) and 7 times greater if mechanical ventilation was necessary (OR, 6.99; 95% CI, 6.09-8.03). The risk of NSTEMI (OR, 5.33; 95% CI, 4.47-6.34) was the highest among CVE. The risk was also significantly increased (p<0.05) for many other CVE: STEMI (OR, 4.24), resuscitated cardiac arrest (OR, 4.33), pulmonary embolism (OR, 4.02), atrial fibrillation/flutter (OR, 3.03), ischaemic stroke (OR, 1.93) and limb events (1.34). Ten percent of CVE were fatal.

Conclusion: Following hospitalisation for exCOPD, the risk of cardiovascular complications is increased. These patients require close and sustained monitoring to mitigate CVE risk.

Aims: Cardiac rehabilitation (CR) after percutaneous coronary intervention (PCI) for acute (ACS) or chronic (CCS) coronary syndrome is underutilised worldwide. The determinants of underuse are not fully understood. Using real-world data, this study explored the effect of socio-geographical factors on CR participation.

Methods: Patients from the Aquitaine region (France) who underwent PCI between 2017 and 2019 were selected from a regional PCI register. Their 1-year CR participation was tracked using the French hospital database. Associations between CR participation and socio-geographical factors, (social deprivation, general practitioner accessibility, and distance to the nearest CR centre) were assessed through logistic regression mixed models at 1 and 3 months in ACS, and at 3 and 6 months in CCS.

Results: Among the 19,002 patients, 5,073 (26.7%) participated in CR (ACS: 4,071, 33.0%; CCS: 1,002, 15.0%). A CR centre distance >25 km reduced participation at 3 months in ACS patients (OR = 0.83, 95% CI: 0.70-0.99, p = 0,023), but not at 1 month after PCI. CCS patients from most advantaged areas were more likely to participate in CR at 3 (OR = 0.62, 95% CI: 0.44-0.88, p = 0.002) and 6 months (OR = 0.59, 95% CI: 0.42-0.82, p < 0.001). General practitioner accessibility did not affect participation.

Conclusion: Post-PCI CR participation was low. Proximity to CR centres promoted participation for ACS patients, while CR usage correlated with higher socio-economic status for CCS patients. These findings highlight socio-geographical inequalities in CR access, providing a basis for targeted interventions, such as telerehabilitation or expanded coverage.

Background and aims: To assess independent impacts of air and noise pollution, and residential green exposure on non-invasively derived coronary obstruction and myocardial ischemia.

Methods: Consecutive patients screened by coronary computed tomography angiography (CCTA) for stable chest pain between 01/01/2019 and 31/12/2020 were included in a registry. Exposure associations between residential PM2.5 (particulate matter <2.5 micrometres), NO2 (nitric dioxide), major road distance, airport distance and normalized difference vegetation index (NDVI), and obstructive coronary artery disease (OCAD, stenosis ≥50%) and abnormal fractional flow reserve (FFRCT<80%) measurement were assessed by propensity score-adjusted logistic regression. Subgroup analysis was performed according to Framingham low (<10%) and high (>20%) 10-year coronary heart disease risk categories.

Results: 2620 patients were enrolled, including 420(16%) FFRCT analyses. OCAD was reported in 518(20%) patients and abnormal FFRCT in 276(11%). People with OCAD lived closer to the airport (10.841 [7.869-19.022]km vs. 12.297 [8.691-22.843]km, p<0.001). People living closer to the airport had more cardiovascular and socio-economic risk factors. Distance to airport decreased OCAD risk (OR 0.983, 95%CI 0.974-0.992, per 1km) in univariable analysis. After propensity score (PS) adjustment, environmental stressors were not significantly associated with OCAD, regardless of risk categories. Only distance to major road decreased abnormal FFRCT risk (OR 0.634, 95%CI: 0.421-0.926, per 1km) in high-risk patients after PS adjustment.

Conclusions: We found no clear environmental associations with CT-derived coronary obstruction or ischemia. However, airport proximity was linked to OCAD risk via cardiovascular and socio-economic factors, while major road proximity was independently associated with myocardial ischemia in high-CV-risk patients, warranting further investigation.

Aims: The benefits of exercise in patients with heart failure are well documented. However, to date, the association between exercise habits and prognosis is yet to be evaluated. In this study, we investigated the association between pre-hospital exercise habits and post-discharge prognosis in older adult patients with heart failure.

Methods: This post-hoc analysis utilised data from the FRAGILE-HF study, which included 1,262 patients aged ≥ 65 years who required hospitalisation for heart failure decompensation. Exercise habits before hospitalisation were assessed through a three-question physical activity assessment tool. The primary outcome was all-cause mortality.

Results: Of the 1,262 patients, 587 (46.5%) reported no regular exercise habits before hospitalisation. No significant differences were observed in the histories of heart failure hospitalisations or other comorbidities. However, patients in the exercise habit group consistently exhibited better physical function, such as greater grip strength, gait speed, and short physical performance battery scores, than those in the non-exercise habit group. In addition to physical function, patients with exercise habits exhibited significantly lower all-cause mortality than those without exercise habits (log-rank test, p=0.019). The adjusted Cox regression models suggested that pre-hospital exercise was associated with a lower mortality risk (hazard ratio, 0.75; 95% confidence interval, 0.58-0.98; p=0.035).

Conclusion: Exercise habits before hospitalisation were significantly associated with better strength and physical function and lower post-discharge all-cause mortality in older adult patients with heart failure. These findings highlight the importance of assessing exercise habits for risk stratification among this population.

Background: Cardiometabolic conditions including hypertension, diabetes, hyperlipidaemia and obesity are significant risk factors for cardiovascular diseases. Myocardial fibrosis (MF) is a complication and final common pathway of these conditions, potentially leading to heart failure, arrhythmias and sudden death. Existing reviews explored pathophysiological changes and treatment of MF, but the global prevalence of MF among individuals with cardiometabolic conditions remain limited.

Objectives: To evaluate the global prevalence of MF in individuals with cardiometabolic conditions and explore factors influencing its rate.

Methods: CINAHL, Cochrane Library, Embase, PubMed, ProQuest Theses and Dissertations, Scopus, and Web of Science were systematically reviewed until January 2024. Studies included individuals with hypertension, type 2 diabetes mellitus, hyperlipidaemia, and obesity, with MF prevalence assessed via biopsy or Late Gadolinium Enhancement-Cardiac Magnetic Resonance (LGE-CMR). Meta-analysis was conducted using jamovi and factors associated with MF were synthesised narratively. This review is registered on PROSPERO, CRD42024544632.

Results: The meta-analysis included 52 articles involving 5,921 individuals. 32.7% of individuals with cardiometabolic conditions developed MF, with hypertension demonstrating the highest prevalence [35.2%(95%CI:25.5-45.0)]. Biopsy-based studies reported a higher prevalence [75.6%(95%CI:53.6-97.6)] compared to LGE-CMR studies [26.8%(95%CI:20.6-33.0)]. Key factors associated with MF included increased LV mass/LV hypertrophy, reduced LV function, and myocardial stiffness.

Conclusions: This first global review estimates that one-third of individuals with cardiometabolic conditions develop MF, with the rate expected to rise. Standardized CMR measures cut-offs are needed to address prevalence inconsistencies. Future research should explore MF prevalence using diverse samples, combined CMR measures, considering socio-demographic and clinical factors for more accurate estimates.