European journal of preventive cardiology最新文献

Aims: Electronic health records (EHR) can be used to target atrial fibrillation (AF) screening. We evaluated the performance of risk prediction models scalable across nationwide EHRs.

Methods: Retrospective cohort study individuals aged ≥30 years without diagnosed AF in the Clalit Health Services (Israel) EHR dataset between January 1 2019 and June 30, 2019. The primary outcome was a diagnosis of AF or atrial flutter (AFl) within 6 months. The FIND-AF, CHA2DS2-VASc and C2HEST scores were evaluated, with prediction performance assessed overall and by sex. The optimum threshold to apply in prospective screening was determined with a lift analysis.

Results: Of 2,166,795 individuals in the cohort 4,275 developed AF within 6 months. Prediction performance was strongest for FIND-AF (AUROC 0.871, 95% CI 0.864-0.877; calibration slope 0.73, 95% CI 0.67-0.79) compared with CHA2DS2-VASc (AUROC 0.838, 95% CI 0.831-0.845; calibration slope 0.63, 95% CI 0.60-0.67) and C2HEST scores (AUROC 0.834, 95% CI 0.823-0.844; calibration slope 0.62, 95% CI 0.58-0.65), including in women (FIND-AF AUROC 0.883, 95% CI 0.876-0.889; CHA2DS2-VASc AUROC 0.865, 95% CI 0.858-0.872; C2HEST AUROC 0.853, 95% CI 0.846-0.861) and men (FIND-AF AUROC 0.857, 95% CI 0.850-0.864; CHA2DS2-VASc AUROC 0.835, 95% CI 0.828-0.843; C2HEST AUROC 0.814, 95% CI, 0.806-0.822). Lift analysis suggested that screening the top 15% of FIND-AF risk compared to screening by age would identify 72% compared to 63% of AF diagnoses.

Conclusion: The FIND-AF machine learning algorithm was scalable in routine EHR data with good discrimination for incident AF. Prospective evaluation is now required to evaluate risk-guided AF screening.

Aims: Although weekend warrior physical activity is linked to lower mortality in the general population, whether it confers similar benefits among individuals with cardiovascular disease (CVD) remains unknown. This study aimed to investigate the association between a weekend warrior activity pattern and mortality in patients with CVD.

Methods and results: We performed a sub-cohort analysis of 8,128 UK Biobank participants with CVD. Physical activity patterns were defined by weekly moderate-to-vigorous physical activity (MVPA) volume and distribution: weekend warrior (≥150 min/week MVPA, with ≥50% accumulated on 1-2 days), regularly active (≥150 min/week MVPA spread over >2 days), and inactive (<150 min/week MVPA). Outcomes were all-cause, CVD-specific, and cancer-specific mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for mortality across activity patterns. Of the participants, 3,004 (44.09%) were weekend warriors, 1,540 (18.95%) were regularly active, and 3,584 (36.96%) were inactive. Over a median follow-up of 7.85 years, 881 deaths occurred. Compared with the inactive pattern, both weekend warrior (HR, 0.61; 95% CI: 0.52-0.71) and regularly active (HR, 0.68; 95% CI: 0.56-0.82) patterns were associated with lower risks of all-cause mortality among participants with CVD. Similar associations were observed for CVD- and cancer-specific mortality.

Conclusions: Among individuals with CVD, the weekend warrior pattern was associated with a lower risk of mortality, with survival benefits comparable to those observed for the regularly active pattern. This pattern may serve as a practical alternative for patients who have difficulty maintaining regular activity across the week.

Aims: The association between socioeconomic deprivation and atrial fibrillation (AF) remains debated, with limited evidence on its interaction with genetic predisposition. We aimed to evaluate the combined effect of socioeconomic deprivation and genetic risk on incident AF.

Methods: Participants without prior AF from the UK Biobank were included. Socioeconomic deprivation was defined as the top 5% of the Index of Multiple Deprivation (IMD). Genetic risk was assessed using a polygenic risk score (PRS) for AF. The primary outcome was incident AF. Findings were replicated in an independent South Korean cohort.

Results: Among 425,423 participants (mean age 56.5±8.1 years; 45.2% male), 21,264 were in the deprived group. The deprived group was younger and had more comorbidities. AF incidence was higher in the deprived vs. non-deprived group (incidence rate 5.8 vs. 4.7/1,000 person-years; adjusted hazard ratio (aHR) 1.16 [95% CI 1.09-1.24], P<0.001). Most IMD components (except housing and living environment) were linked to increased AF risk (aHR ranging from 1.13 to 1.19). Deprivation had a stronger effect in those with low genetic risk (lowest PRS tertile: aHR 1.36 [1.19-1.56]) compared to those with high genetic risk (highest PRS tertile: aHR 1.11 [1.01-1.22]; interaction P=0.0013). Results were consistent in the Korean cohort (n=7,898).

Conclusion: Socioeconomically deprived individuals have a significantly higher risk of AF, with this risk further influenced by genetic predisposition. Targeted public health policies and personalized AF screening for high-risk groups may help lessen the burden of AF and improve cardiovascular health.

Cuffless blood pressure (BP) monitoring devices represent a promising innovation in hypertension management. This scientific statement provides a comprehensive update on these emerging technologies, their specific validation requirements, their potential clinical applications, and their present and future challenges. These devices generate considerable interest by enabling noninvasive BP measurement without arterial occlusion, thereby eliminating the discomfort associated with traditional cuff-based monitoring, particularly during sleep. The technologies on which these devices are based comprise a heterogeneous group, primarily utilizing pulse wave propagation time or waveform analysis through contact or noncontact sensors. They can be categorized as continuous or intermittent, automated or manual, calibration-free or requiring cuff/demographic calibration, and wearable or stationary. This technological diversity necessitates validation protocols distinct from those used for conventional cuff-based monitors, with specific requirements for each device category. Potential clinical applications include widespread out-of-office BP monitoring, unbiased assessment of circadian BP patterns and BP variability, improved detection of nocturnal hypertension, enhanced treatment adherence and long-term BP control, and continuous monitoring in hospital settings. Additionally, their lower cost compared with conventional technologies could enhance the early detection of hypertension in resource-limited settings. However, due to insufficient accuracy validation, this scientific statement does not still recommend their use in clinical decisions, in line with international guidelines not recommending their use in hypertension management. Key challenges ahead include developing standardized validation protocols, establishing normative BP data, manage the resulting burden on clinicians in handling huge volumes of data, exploring additional hemodynamic parameters, and advancing sensor technology, mathematical models, and algorithms.

Objectives: This systematic review aims to evaluate the effects of smoking cessation or switching to exclusive electronic cigarette (EC) use on vascular function in adult smokers, using prospective evidence from clinical studies.

Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science and Embase on Oct 13, 2025. Eligible studies included randomized controlled trials (RCTs), quasi-experimental designs, and prospective cohort studies reporting quantitative or narrative data on vascular outcomes (i.e., pulse wave velocity (PWV), augmentation index (AIx), and flow-mediated dilation (FMD)), after smoking cessation or switching to ECs. Risk of bias was assessed using the Joanna Briggs Institute tools. Results were synthesized qualitatively. Certainty of the evidence was determined using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation).

Results: Twenty-three studies involving a total of 11,702 participants were included: 14 cohort studies, 5 quasi-experimental and 4 RCTs. Overall, smoking cessation was consistently associated with improvements in PWV, AIx, and FMD, with some effects observable within one month and sustained up to 24 months. The overall certainty of evidence was very low, except for a moderate level of certainty derived from RCTs investigating FMD. Improvements were seen across different cessation methods, including pharmacotherapy and ECs. RCTs on ECs reported significant improvements in FMD irrespective of nicotine content, suggesting that combustion rather than nicotine may be the primary driver of vascular impairment. Sensitivity analyses excluding lower-quality RCTs confirmed the primary findings.

Conclusions: Smoking cessation appears to improve vascular function, as reflected by early favorable changes in endothelial and arterial stiffness markers; however, the overall certainty varies from moderate to very low, according to the outcome. These findings are consistent with the biological plausibility of cardiovascular benefit from sustained smoking abstinence.