European journal of preventive cardiology最新文献

Aims: This nationwide observational cohort study examined the association between hypertension status and cardiovascular disease (CVD) risk in adults aged ≥75 years without prior CVD events.

Methods: Using the Korean National Health Insurance Service (K-NHIS) database, we included individuals aged ≥75 years who underwent health check-ups in 2012-2015. Five statuses of hypertension were defined-normal, pre-hypertension, new-onset hypertension, well-controlled hypertension, and uncontrolled hypertension. The primary outcome was incident CVD (stroke or myocardial infarction). Subdistribution hazard ratios (HRs) were estimated using Fine-Gray models with death as a competing risk. Penalized splines evaluated nonlinear associations of systolic and diastolic blood pressure with outcomes.

Results: Among 869,781 participants (mean age 78.49 ± 3.48 years; 41.7% men), 120,353 (13.8%) developed CVD during a mean follow-up of 6.67 years. Compared with normal, pre-hypertension (HR 1.13; 95% CI 1.11-1.16), new-onset hypertension (HR 1.29; 95% CI 1.26-1.33), controlled hypertension (HR 1.21; 95% CI 1.18-1.23), and uncontrolled hypertension (HR 1.33; 95% CI 1.30-1.36) were all associated with higher CVD risk. Similar associative patterns were observed for stroke and myocardial infarction.

Conclusion: In this large observational cohort, elevated blood pressure (BP) categories were associated with higher risks of stroke and myocardial infarction in adults aged ≥75 years, with the highest risk in uncontrolled hypertension. Stroke risk rose progressively with increasing systolic BP, whereas myocardial infarction demonstrated a U-shaped relationship with diastolic BP. These findings highlight clinically relevant risk patterns in late life and may support future research aimed at optimizing BP assessment in older adults.

Introduction: Elevated leucocytes, particularly neutrophils, are strongly associated with poor prognosis after acute myocardial infarction (AMI). However, inflammatory indices are not included in established post-AMI risk scores. We aimed to derive a novel, inflammation-based risk score with superior performance to contemporary scores to predict in-hospital mortality after AMI.

Methods and results: This was a retrospective, multicentre, longitudinal cohort study including a derivation cohort of consecutive patients presenting with AMI between 2016 and 2023. The primary outcome was in-hospital mortality. Primary outcome risk estimates were derived by regularized machine learning techniques, incorporating leucocyte subpopulations, which we termed the INFLammation in Acute Myocardial diseases risk Estimation for Myocardial Infarction (INFLAME-MI) score. The INFLAME-MI score was validated in an external international cohort and compared to the Global Registry of Acute Coronary Events (GRACE) score. The INFLAME-MI score was derived from a cohort of 3028 AMI patients and tested in an external validation cohort of 682 AMI patients. It demonstrated strong internal discrimination (area under the curve [AUC] 0.88) and maintained excellent external predictive performance for the primary outcome, achieving a non-inferior AUC of 0.92 relative to the GRACE score (AUC 0.94, P = 0.256). Furthermore, INFLAME-MI demonstrated superior calibration and improved reclassification compared to the GRACE score (Hosmer-Lemeshow χ²₈ = 6.2 (P = 0.102) vs. χ²₈ = 22.9 (P < 0.001), respectively).

Conclusion: INFLAME-MI is a novel, rapid, and easy-to-use risk score for in-hospital mortality after AMI, derived from common inflammatory indices. In external validation, it demonstrates comparable discrimination, improved calibration, and higher net benefit at ≤7% thresholds compared with the GRACE score, particularly within key decision-making ranges. Further work is needed to establish the INFLAME-MI score through validation of these findings in diverse, prospective patient cohorts.

Aims: To describe and quantify sex differences in the screening electrocardiograms (ECG) of athletes.

Method: Five databases (MEDLINE, EMBASE, Scopus, SPORTDiscus and Web of Science) were searched from inception until October 2024. Included studies were original research articles examining athletes aged 16-40 years, who had a 12-lead screening ECG, and where analysis was stratified by sex. Risk of bias was assessed using a validated tool. A meta-analysis was performed, using a random-effects model, assessing proportions of athlete normal, borderline and abnormal ECG features (according to the 2017 International Criteria) and several ECG measurements.

Results: Eighty-five cross-sectional studies were included. The studies comprised 19,069 female athletes (mean age 20.6±2.8 years) and 57,745 male athletes (mean age 21.3±3.1 years). Female athletes were more likely to have abnormal T-wave inversion (TWI) (OR 2.3, 95% CI: 1.5-3.5), and isolated TWIV1-V3 (OR 5.6, 95% CI: 3.2-9.9) compared to males. No female athletes and two male athletes with isolated TWIV1-V3 were diagnosed with a condition associated with sudden cardiac arrest or death (both male athletes diagnosed with arrhythmogenic cardiomyopathy). Female athletes were also more likely to have an abnormal ECG per the International Criteria, though the finding was not statistically significant (OR 1.3, 95% CI: 0.7-2.4). Female athletes had a 16ms (95% CI 4-27ms) longer QTc interval than male athletes.

Conclusion: Compared to male athletes, female athletes were twice as likely to have abnormal TWI and six times as likely to have isolated TWIV1-V3, a finding which was not accompanied by diagnoses of cardiac pathology in female athletes. These data should help inform sex-specific aspects of athlete ECG screening guidelines.

Aims: Blood pressure (BP) control remains suboptimal among U.S. patients with hypertension. Single-pill combination (SPC) therapies are commonly used to improve adherence, however, their effectiveness for achieving early and sustained intensive BP control is unclear.

Methods: We performed a post-hoc analysis of SPRINT including 2,736 participants propensity matched in 1:2 ratio to compare effects of SPCs with equivalent multi-pill therapy. The estimated marginal odds of achieving target BP control were derived using generalized linear mixed models with repeated measures (LMMRM). The association between time-updated SPC use and BP change in short- (≤6 months) and long-term (>6 months) follow-up was assessed with LMMRM and SPC*time interaction term. Multivariable Cox models evaluated association of SPC use with CV events and serious adverse events (SAEs).

Results: Among SPRINT participants (N = 8623), 9.3% (N = 803) were prescribed SPC at baseline with greater use in the intensive vs. usual care group (5.79 vs. 3.90 per 100 person-months; p-diff<0.001). Among matched pairs (SPC[n = 912); multi-pill therapy[n = 1824]), SPC use was associated with 22% increased likelihood of achieving target BP by 6 months [OR(95% CI): 1.22(1.05, 1.42)]. Participants receiving SPCs (vs multi-pills) experienced more rapid BP reduction in the first 6 months (-2.0 vs. -1.2 mmHg monthly change; p-diff<0.001). Over long-term follow-up, participants using SPCs achieved significantly lower SBP at each timepoint. The risk of the primary CV composite endpoint and SAEs were not significantly different between groups.

Conclusions: SPC use resulted in greater likelihood of achieving target BP control and more rapid, sustained BP reduction without an increase in SAEs.