European journal of preventive cardiology最新文献

Aims: Both plasma levels of remnant cholesterol and low-density lipoprotein cholesterol (LDL-C) levels are independent risk factors for atherosclerotic cardiovascular disease. However, only remnant cholesterol has consistently been associated with systemic inflammation. In this study, we aimed to assess the extent to which inflammation mediates the effect of remnant and LDL cholesterol on (non)fatal major adverse cardiovascular events (MACE), comprising of coronary artery disease and ischemic stroke.

Methods and results: This prospective study included 16,445 participants without prior atherosclerotic cardiovascular disease from the EPIC-Norfolk study, with a mean age of 58.8±9.1 years, of which 9,357 (56.9%) were women. Every 1 mmol/L higher remnant cholesterol was associated with 29.5% higher high-sensitivity C-reactive protein (hsCRP) levels (95% Confidence Interval (CI): 22.1, 37.4, p<0.001), whereas LDL-C was not significantly associated with hsCRP levels in the fully adjusted model. Additionally, each 1 mmol/L higher remnant cholesterol was associated with a hazard ratio (HR) of 1.31 (95% CI: 1.14, 1.50, p<0.001) for MACE, compared to a HR of 1.21 (95% CI: 1.13, 1.31, p<0.001) for LDL-C. Mediation analysis showed that hsCRP mediated 5.9% (95% CI: 1.2, 10.6%, p<0.001) of the effect of remnant cholesterol on MACE, whereas hsCRP did not mediate the effect of LDL-C.

Conclusions: Plasma remnant cholesterol levels are independently associated with systemic inflammation and cardiovascular events. Inflammation, as measured with hsCRP, contributed minorly to the association between remnant cholesterol and MACE. This underscores the need to address both remnant cholesterol and systemic inflammation separately in the clinical management of cardiovascular disease.

Background and aims: Sleep disturbances can induce alterations in functional and electrical properties of the heart, thereby increasing susceptibility to atrial fibrillation (AF). We aimed to test the causal role of different sleep traits and their joint effects on the risk of AF.

Methods: We used an observational cohort study design along with one-sample and factorial Mendelian randomization (MR) approaches to test for individual and joint associations of sleep traits (i.e., insomnia symptoms, sleep duration and chronotype) on the risk of AF using UK Biobank and the second survey of the Trøndelag Health Study (HUNT2).

Results: One-sample MR analysis showed that genetic predisposition to insomnia symptoms (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.07, 1.21) and short (≤6 h vs. 7-8 h) sleep duration (HR 1.14; 95% CI 1.04, 1.26) increased the risk of AF in UK Biobank. However these findings (HR 0.95; 95% CI 0.81, 1.11 for insomnia symptoms and HR 1.41; 95% CI 0.57, 3.46 for short sleep duration) were not consistent in HUNT2. Factorial MR analysis showed participants with genetic predisposition to both insomnia symptoms and short sleep duration (HR 1.08; 95% CI 1.03, 1.12) had the highest risk of AF, although there was no evidence of interaction (relative excess risk due to interaction (RERI 0.03; 95% CI -0.03, 0.09). However, this finding (HR 0.96; 95% CI 0.89, 1.04) was not consistent in HUNT2. Participants with genetic predisposition to both a morning chronotype and insomnia symptoms (HR 1.08; 95% CI 1.04, 1.13) and a morning chronotype and short sleep (HR 1.06; 95% CI 1.02, 1.10) had the highest risk of AF in UK Biobank, although there was no evidence of interaction (RERI -0.01; 95% CI -0.07, 0.04 and RERI 0.06; 95% CI -0.01, 0.12, respectively).

Conclusions: Our study indicates that insomnia symptoms and short sleep duration are causal risk factors for AF. However, having two sleep traits in combination does not increase risk beyond the additive risk of each individual trait. This reinforces clinical and public health efforts to effectively manage insomnia symptoms and short sleep, in order to mitigate the risk of AF and improve overall cardiovascular health.

Background: Athlete's heart induces extreme cardiovascular remodelling, generating challenges for the differential diagnosis with early stages of cardiomyopathies. Advanced cardiac function analysis could be helpful, but data on healthy athletes and the impact of sports disciplines are lacking.

Aim: To describe myocardial deformation by cardiac magnetic resonance (CMR) in a cohort of Olympic athletes and to evaluate possible differences based on sports disciplines and sex.

Methods: A group of Olympic athletes with normal cardiovascular evaluation and a group of sedentary controls matched for age and sex underwent CMR without contrast administration. Cine-images were post-processed for volumes and function evaluation and to assess bi-ventricular myocardial deformation parameters, as left ventricular global longitudinal and circumferential strain (LV-GLS and -GCS) and right ventricular GLS, by a dedicated feature-tracking (FT) software. Athletes were divided according to ESC sports classification and sex.

Results: Three hundred Olympic athletes (13% skill, 20% power, 25% mixed, 42% endurance, 58% male) and 42 untrained controls were enrolled. No significant differences were found between LV-GLS, -GCS, and RV-GLS when comparing different sports categories, except for a slightly lower LV-GLS in the endurance group compared to the skill one (p=0.045). Athletes showed slightly lower biventricular ejection fraction (p<0.001) and LV-GCS (p<0.001) than sedentary controls, while only endurance athletes showed significant differences in LV- and RV-GLS versus the sedentary group (p=0.002 and p=0.001). Female athletes showed higher bi-ventricular GLS than males (p<0.001 for LV- and RV-GLS).

Conclusions: Our results provided for the first time CMR-FT strain values in a large cohort of Olympic athletes free of cardiovascular abnormalities, according to type of sports. Endurance athletes showed the lowest LV-GLS values being significantly different versus skill and sedentary controls. No other significant differences in myocardial deformation parameters between sports categories were found, but only based on sex.

Aims: We investigated associations between overall organic food consumption and consumption of specific organic food groups with the risk of developing atherosclerotic cardiovascular disease (ASCVD).

Methods: The study was based on a prospective cohort of middle-aged women and men from the Danish Diet, Cancer and Health study. Information about organic food consumption of vegetables, fruit, dairy products, eggs, meat, and bread and cereal products was obtained from a food frequency questionnaire. The frequency consumption of the six food groups was summarized into a total organic food score evaluated in categories (never, low, medium and high intake) and as a continuous variable. A total of 41,407 study participants were followed for a median of 16 years during which 5,365 developed ASCVD.

Results: Overall organic food consumption was associated with a 6% lower incidence rate of ASCVD per 6-point increment in the total organic food score (HR: 0.94, 95% CI: 0.89-0.99). Organic consumption of eggs was associated with lower incidence of ASCVD for both women (HR, 0.95, 95% CI 0.91-0.99) and men (HR: 0.96, 95% CI: 0.93-0.99), and organic consumption of bread and cereal products were associated with a lower incidence of ASCVD among men (HR: 0.95, 95% CI: 0.91-0.99).

Conclusions: We found that organic food consumption was associated with a lower incidence of ASCVD in a cohort of middle-aged Danish women and men.

Aim: The higher incidence of myocardial infarction during national holidays could be caused by overindulgence of food and beverages, potentially straining the heart of vulnerable individuals. Monitoring decreased thoracic impedance by cardiac implantable electronic devices (CIED) can be used for detection of fluid accumulation. We aimed to assess the relationship between cardiac metrics and national holidays in patients with CIED.

Methods: Patients with CIED-based impedance monitoring at a tertiary care hospital in Sweden were screened. Patients were included if they had data for at least one holiday (Christmas, New Year or Midsummer) between June 2015 and January 2020. Thoracic impedance, heart rate variability and activity during the holiday were compared with baseline values, defined as the average of three days preceding Christmas and Midsummer. Clinical characteristics were obtained from medical records.

Results: In total, 96 patients (82 % men, age 69±10 years, 92 % ICD, 78 % CRT, 72 % with LVEF<40%) were included, which provided data for 649 patient-holidays. During Christmas Day, New Years Day and Midsummer Day combined, impedance decreased by a mean of 1.1 Ohm [95% CI 0.7-1.6, p< 0.001], heart rate variability decreased by a mean of 8.0 ms [4.9-11.2, p >0.001] and daily activity by a mean of 40 minutes [35-45, p<0.001]. One ventricular tachycardia event requiring shock therapy was documented during the holiday.

Conclusions: A transient decrease in thoracic impedance, heart rate variability and physical activity was observed during national holidays, potentially contributing to the higher incidence of myocardial infarction during holidays.

Aims: We recently demonstrated the combined prognostic value of two simple non-invasive parameters obtained from treadmill exercise testing in patients with heart failure (HF) with reduced ejection fraction, the haemodynamic gain index (HGI) and peak rate-pressure product (RPP). However, their prognostic value is yet to be validated in patients with undifferentiated HF syndrome.

Methods: We identified consecutive HF patients undergoing treadmill exercise testing for symptom evaluation between 1/1991-2/2015. HGI was calculated from [(SBPpeak x heart ratepeak) - (SBPrest x heart raterest)]/(SBPrest x heart raterest), and peak RPP was calculated from SBPpeak x heart ratepeak. Hazard ratios per doubling of HGI and peak RPP for all-cause mortality were estimated using multivariable Cox regression models with adjustment for traditional cardiovascular risk factors and exercise testing parameters (chronotropic reserve index, estimated metabolic equivalents, abnormal heart rate recovery, and total exercise time).

Results: In our cohort of 5,940 patients with symptomatic HF diagnosis with median follow up of 7.1 years, 2,222 (37.4%) patients died. Higher both HGI and peak RPP were associated with a lower risk of mortality (adjusted hazard ratio per standard deviation increase 0.80 [0.73-0.88] and 0.85 [0.78-0.91], respectively, all p<0.001). Optimal cut-off values for HGI and peak RPP for discriminating all-cause mortality were 1.06 and 18,966, respectively.

Conclusion: Both HGI and peak RPP are predictors of mortality in patients with chronic HF and may be tools to signal need for advanced HF therapy evaluation.

Aims: Investigate sex-specific associations between total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C) and the burden of atherosclerosis assessed by coronary artery calcium (CAC) score.

Methods: A total of 10,049 participants (women: 958, men: 9,091) aged 49-75 years, without known cardiovascular disease (CVD) or current use of lipid-lowering medication, were included from the Danish Risk Score study and the Danish Cardiovascular Screening Trial cohorts. Logistic regression models and zero-inflated negative binomial regression models were used to estimate odds ratio (OR), the incidence rate ratio (IRR), and 95% confidence intervals (CI) for the association between total cholesterol, non-HDL-C, and CAC presence (CAC > 0) and extent. All analyses were adjusted for age, BMI, diabetes, smoking, hypertension, and family history of CVD.

Results: The OR for presence of CAC and total cholesterol was 1.09 (95% CI: 0.94;1.27) in women and 1.26 (95% CI: 1.19;1.33) in men. The OR for presence of CAC and non-HDL-C was 1.12 (95% CI: 0.96;1.29) in women and 1.25 (95% CI: 1.18;1.33) in men. No significant association between increased total cholesterol and extent of CAC was found, regardless of sex (women: IRR: 0.99; 95% CI: 0.83;1.19; men: IRR: 1.04; 95% CI: 0.997;1.07). Non-HDL-C was significantly associated with extent of CAC in men (IRR: 1.04; 95% CI: 1.001;1.08), but not in women (IRR: 0.93; 95% CI: 0.78;1.12).

Conclusion: Total cholesterol was associated with presence of CAC and non-HDL-C were associated with presence and extent of the CAC score in men. No association by total cholesterol or non-HDL-C were found among women.