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Cardiac Rehabilitation Using the Family-Centered Empowerment Model is Effective in Improving Long-term Mortality in Patients with Myocardial Infarction: A 10-year Follow-Up Randomized Clinical Trial. 使用以家庭为中心的赋权模式进行心脏康复可有效改善心肌梗死患者的长期死亡率:一项为期 10 年的随访随机临床试验。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-02 DOI: 10.1007/s40292-024-00636-2
Amir Vahedian-Azimi, Mohammad Javad Sanjari, Farshid Rahimi-Bashar, Keivan Gohari-Mogadam, Ayoub Ouahrani, Emad Mraweh Mohammed Mustafa, Ali Ait Hssain, Amirhossein Sahebkar

Introduction: Cardiac rehabilitation (CR) play a critical role in reducing the risk of future cardiovascular events and enhancing the quality of life for individuals who have survived a heart attack.

Aim: To assess the mortality rates and stability of the effects in myocardial infarction (MI) survivors after implementing a Family-Centered Empowerment Model (FCEM)-focused hybrid cardiac rehabilitation program.

Methods: This double-blind randomized controlled clinical trial, conducted at Shariati Hospital, an academic teaching hospital in Tehran, Iran (2012-2023), involved 70 MI patients and their families. Participants were randomly assigned to an FCEM intervention group or standard CR control group. The intervention commenced after the MI patient's safe discharge from the CCU and continued for the entire 10-year follow-up period. Various questionnaires were utilized to collect data on mortality rates and health-related quality of life (HRQoL).

Results: The 10-year follow-up period revealed lower mortality rates in the intervention group (5.7%, 11.4%, and 17.1% at 5, 7, and 10 years, respectively) compared to the control group (20%, 37.1%, and 48.9%). After adjusting for age, gender, and BMI, the control group had a four times higher mortality risk (HR: 4.346, 95% CI 1.671-7.307, P = 0.003). The FCEM-focused program demonstrated a significant and sustained positive impact on participants' quality of life for 48 months, with greater improvement compared to the control group.

Conclusion: This study highlights the effectiveness of FCEM-based hybrid CR programs in enhancing long-term patient outcomes and reducing mortality rates among MI survivors. Further research is needed to explore the potential benefits in larger samples and diverse populations.

Trial registration: This study (Identifier: NCT02402582) was registered in the ClinicalTrials.gov on 03/30/2015.

导言目的:评估心肌梗死(MI)幸存者在实施以家庭为中心的赋权模式(FCEM)为重点的混合心脏康复计划后的死亡率和效果稳定性:这项双盲随机对照临床试验在伊朗德黑兰的学术教学医院沙里亚蒂医院进行(2012-2023 年),共有 70 名心肌梗死患者及其家属参与。参与者被随机分配到 FCEM 干预组或标准 CR 对照组。干预在心肌梗死患者安全离开重症监护室后开始,并持续整个 10 年的随访期。采用各种问卷收集死亡率和健康相关生活质量(HRQoL)的数据:结果:10 年随访期显示,干预组的死亡率(5 年、7 年和 10 年分别为 5.7%、11.4% 和 17.1%)低于对照组(20%、37.1% 和 48.9%)。在对年龄、性别和体重指数进行调整后,对照组的死亡风险是对照组的四倍(HR:4.346,95% CI 1.671-7.307,P = 0.003)。与对照组相比,以 FCEM 为重点的项目对参与者的生活质量产生了长达 48 个月的显著且持续的积极影响,改善幅度更大:本研究强调了以 FCEM 为基础的混合 CR 项目在提高患者长期疗效和降低 MI 幸存者死亡率方面的有效性。需要进一步研究,以探索在更大样本和不同人群中的潜在益处:本研究(标识符:NCT02402582)于2015年3月30日在ClinicalTrials.gov注册。
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引用次数: 0
Nursing Counseling in Patients Recently Admitted in Cardiac Rehabilitation Unit: A Pilot Study-Brief Letter for Publication. 心脏康复科新入院患者的护理咨询:一项试点研究--供发表的简讯。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-01 DOI: 10.1007/s40292-024-00637-1
Ilaria Fucile, Filomena Attanasio, Maurizio Conte, Maddalena Tesone, Fulvio Fiorillo, Francesco Rozza, Costantino Mancusi, Nicola De Luca
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引用次数: 0
Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence. 动脉高血压患者心脏器官损伤的性别差异:评估不遵医嘱用药的作用。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.1007/s40292-024-00632-6
Arleen Aune, Annabel Ohldieck, Lene V Halvorsen, Karl Marius Brobak, Eirik Olsen, Stine Rognstad, Anne Cecilie K Larstorp, Camilla L Søraas, Anne B Rossebø, Assami Rösner, Marianne Aa Grytaas, Eva Gerdts

Introduction: Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear.

Methods: We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication.

Results: Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12-4.00] p = 0.02).

Conclusions: Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence.

Registration: URL:  https://www.

Clinicaltrials: gov ; Unique identifier: NCT03209154.

导言:女性高血压患者比男性高血压患者更容易出现左心室(LV)肥厚和左心房(LA)扩大等心脏器官损伤,但这种性别差异的机制仍不清楚:我们通过超声心动图检测了186名女性和337名男性高血压患者不遵医嘱用药与左心室肥厚和左心房增大的关系,不遵医嘱用药的定义是:尽管处方中至少有两种降压药,但日间收缩压(BP)≥135mmHg。由经验丰富的药剂师通过测量血清药物浓度来评估服药依从性。醛固酮-肾素比率(ARR)根据实际用药情况进行测量:结果:女性左心室肥厚(46% 对 33%)和 LA 肥大(79% 对 65%,P 均为 0.514)的发生率没有差异。女性的年龄比男性大,血清肾素浓度比男性低,ARR比男性高,而24小时收缩压(141 ± 9 mmHg vs. 142 ± 9 mmHg)和肥胖率(43% vs. 50%)没有差异(均为P > 0.10)。在多变量分析中,女性性别与左心室肥厚(OR 2.01[95% CI 1.30-3.10],P = 0.002)和 LA 扩大(OR 1.90[95% CI 1.17-3.10],P = 0.010)风险增加两倍独立相关,而与不遵医嘱用药没有关联。仅在男性中,较高的ARR与左心室肥厚独立相关(OR 2.12 [95% CI 1.12-4.00] p = 0.02):结论:在未得到控制的高血压患者中,女性左心室肥厚和LA增大的发生率较高,但这并不能用不依从性差异来解释:URL: https://www.Clinicaltrials: gov ; Unique identifier:NCT03209154.
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引用次数: 0
Association Between Elevated Body Mass Index and Cardiac Organ Damage in Children and Adolescents: Evidence and Mechanisms. 儿童和青少年体重指数升高与心脏器官损伤之间的关系:证据与机制
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-26 DOI: 10.1007/s40292-024-00633-5
Alessandra Annaloro, Chiara Invernizzi, Francisco Aguilar, Julio Alvarez, Cesare Cuspidi, Guido Grassi, Empar Lurbe

Introduction: Although a number of pathophysiological aspects of childhood obesity have been reported, few information are available on obesity-related cardiac organ damage.

Aim: The present study was aimed at assessing the impact of anthropometric, blood pressure (BP) and metabolic variable on cardiac structure and function in youth.

Methods: In 78 subjects aged 5-16 years attending the outpatient clinic of cardiovascular risk (Valencia, Spain) anthropometric and metabolic variables, clinic and ambulatory BP and echocardiographic parameters were assessed. Subjects were also classified according to the presence of insulin resistance.

Results: Subjects mean age (± SD) amounted to 12.03 ± 2.4 years and males to 53.8%. Ten subjects were normoweight, 11 overweight, 39 obese, and 18 severely obese. No significant difference in office and ambulatory BP was detected among different bodyweight groups. A significant direct correlation was observed between left ventricular mass index (LVMI) and obesity markers [body mass index (BMI): r = 0.38, waist circumference (WC): r = 0.46, P < 0.04 for both]. Left ventricular hypertrophy, relative wall thickness and left atrial diameter were significantly related to BMI and WC. In contrast, office and ambulatory BP were unrelated to other variables, and differences in LVMI among different BP phenotypes were not significant. When partitioning the population by insulin resistance, LVMI, adjusted for confounders, was significantly greater in the insulin-resistant group.

Conclusions: In children and adolescents characterized by different body weight patterns, weight factors "per se" and the related insulin resistance state appear to represent the main determinants of LVMI and left ventricular hypertrophy, independently on BP values and BP phenotypes.

导言:尽管有许多关于儿童肥胖症病理生理方面的报道,但很少有关于肥胖症相关心脏器官损伤的信息:本研究旨在评估人体测量、血压(BP)和代谢变量对青少年心脏结构和功能的影响:方法:在心血管风险门诊(西班牙巴伦西亚)就诊的 78 名 5-16 岁受试者中,对人体测量和代谢变量、门诊血压和非卧床血压以及超声心动图参数进行了评估。还根据是否存在胰岛素抵抗对受试者进行了分类:受试者平均年龄(± SD)为 12.03±2.4 岁,男性占 53.8%。10 名受试者体重正常,11 名超重,39 名肥胖,18 名严重肥胖。不同体重组的办公室血压和卧床血压无明显差异。左心室质量指数(LVMI)与肥胖指标之间存在明显的直接相关性[体重指数(BMI):r = 0.38,腰围(WC):r = 0.46,P 结论:左心室质量指数(LVMI)与肥胖指标之间存在明显的直接相关性:在不同体重模式的儿童和青少年中,体重因素 "本身 "和相关的胰岛素抵抗状态似乎是左心室质量指数和左心室肥厚的主要决定因素,与血压值和血压表型无关。
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引用次数: 0
Measuring Costs of Cardiovascular Disease Prevention for Patients with Familial Hypercholesterolemia in Administrative Claims Data. 从行政索赔数据中衡量家族性高胆固醇血症患者预防心血管疾病的成本。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-03 DOI: 10.1007/s40292-024-00624-6
Lauren E Passero, Megan C Roberts

Introduction: Familial hypercholesterolemia is a common genetic condition that significantly increases an individual's risk of cardiovascular events such as heart attack, stroke, and cardiac death and is a candidate for population-wide screening programs. Economic analyses of strategies to identify and treat familial hypercholesterolemia are limited by a lack of real-world cost estimates for screening services and medications for reducing cardiovascular risk in this population.

Methods: We estimated the cost of lipid panel testing in patients with hyperlipidemia and the cost of statins, ezetimibe, and PCKS9 inhibitors in patients with familial hypercholesterolemia from a commercial claims database and report costs and charges per panel and prescription by days' supply.

Results: The mean cost for a 90-day supply for statins was $183.33, 2.3 times the mean cost for a 30-day supply at $79.35. PCSK9 inhibitors generated the highest mean costs among medications used by patients with familial hypercholesterolemia.

Conclusions: Lipid testing and lipid-lowering medications for cardiovascular disease prevention generate substantial real-world costs which can be used to improve cost-effectiveness models of familial hypercholesterolemia screening and care management.

简介:家族性高胆固醇血症是一种常见的遗传疾病,会显著增加个人发生心血管事件(如心脏病发作、中风和心源性死亡)的风险,是全人群筛查计划的候选对象。由于缺乏对筛查服务和降低该人群心血管风险的药物的实际成本估算,对识别和治疗家族性高胆固醇血症的策略进行的经济学分析受到了限制:我们从商业索赔数据库中估算了高脂血症患者血脂全套检测的成本,以及家族性高胆固醇血症患者使用他汀类药物、依折麦布和 PCKS9 抑制剂的成本,并按供应天数报告了每套检测和处方的成本和费用:他汀类药物 90 天用量的平均成本为 183.33 美元,是 30 天用量平均成本 79.35 美元的 2.3 倍。在家族性高胆固醇血症患者使用的药物中,PCSK9 抑制剂产生的平均费用最高:结论:用于预防心血管疾病的血脂检测和降脂药物会产生大量实际成本,可用于改善家族性高胆固醇血症筛查和护理管理的成本效益模型。
{"title":"Measuring Costs of Cardiovascular Disease Prevention for Patients with Familial Hypercholesterolemia in Administrative Claims Data.","authors":"Lauren E Passero, Megan C Roberts","doi":"10.1007/s40292-024-00624-6","DOIUrl":"10.1007/s40292-024-00624-6","url":null,"abstract":"<p><strong>Introduction: </strong>Familial hypercholesterolemia is a common genetic condition that significantly increases an individual's risk of cardiovascular events such as heart attack, stroke, and cardiac death and is a candidate for population-wide screening programs. Economic analyses of strategies to identify and treat familial hypercholesterolemia are limited by a lack of real-world cost estimates for screening services and medications for reducing cardiovascular risk in this population.</p><p><strong>Methods: </strong>We estimated the cost of lipid panel testing in patients with hyperlipidemia and the cost of statins, ezetimibe, and PCKS9 inhibitors in patients with familial hypercholesterolemia from a commercial claims database and report costs and charges per panel and prescription by days' supply.</p><p><strong>Results: </strong>The mean cost for a 90-day supply for statins was $183.33, 2.3 times the mean cost for a 30-day supply at $79.35. PCSK9 inhibitors generated the highest mean costs among medications used by patients with familial hypercholesterolemia.</p><p><strong>Conclusions: </strong>Lipid testing and lipid-lowering medications for cardiovascular disease prevention generate substantial real-world costs which can be used to improve cost-effectiveness models of familial hypercholesterolemia screening and care management.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Implications of Estimating Glomerular Filtration Rate with Different Equations in Heart Failure Patients with Preserved Ejection Fraction. 用不同公式估算射血分数保留的心衰患者肾小球滤过率的临床意义
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-08 DOI: 10.1007/s40292-024-00631-7
Baole Zhang, Huiling Liang, Zhongping Yu, Fang-Fei Wei, Yuzhong Wu

Introduction: The prognostic values of estimated glomerular filtration rate (eGFR) calculated by different formulas have not been adequately compared in patients with heart failure with preserved ejection fraction (HFpEF).

Aim: We compared the predictive values of serum creatinine-based eGFRs calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, Modification of Diet in Renal Disease Study (MDRD) formula, and full-age-spectrum creatinine (FAS Cr) equation in 1751 HFpEF patients.

Methods: The area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were employed.

Results: eGFR values were lowest calculated with FAS Cr equation (p < 0.001). When patients were classified into 4 subgroups (eGFR ≥ 90, 89-60, 59-30, and  < 30 ml/min/1.73 m2) or only 2 subgroups (≥ 60 or  < 60 ml/min/1.73 m2), the 3 formulas correlated significantly, with the best correlation found between the MDRD and CKD-EPI formulas (kappa = 0.871 and 0.963, respectively). The 3 formulas conveyed independent prognostic information. After adjusting for potential cofounders, risk prediction for all-cause mortality was more accurate (p = 0.001) using the CKD-EPI equation than MDRD formula as assessed by AUC. Compared with MDRD formula, CKD-EPI equation exhibited superior predictive ability assessed by IDI and NRI of 0.32% (p < 0.001)/10.4% (p = 0.010) for primary endpoint and 0.37% (p = 0.010)/10.8% (p = 0.010) for HF hospitalization. The risk prediction for deterioration of renal function was more accurate (p ≤ 0.040) using the CKD-EPI equation than FAS Cr equation as assessed by AUC, IDI, and NRI.

Conclusion: The CKD-EPI formula might be the preferred creatinine-based equation in clinical risk stratification in HFpEF patients.

导言:在射血分数保留型心力衰竭(HFpEF)患者中,不同公式计算的估计肾小球滤过率(eGFR)的预后价值尚未得到充分比较。目的:在 1751 例 HFpEF 患者中,我们比较了基于血清肌酐的 eGFR 的预测值,计算方法包括慢性肾脏病流行病学协作组织(CKD-EPI)2009 方程、肾病饮食改良研究(MDRD)公式和全年龄段肌酐(FAS Cr)公式:结果:用 FAS Cr 方程计算的 eGFR 值最低(p 2),或仅计算 2 个亚组(≥ 60 或 2),3 个公式有显著相关性,其中 MDRD 公式和 CKD-EPI 公式的相关性最好(kappa = 0.871 和 0.963)。这三个公式传达了独立的预后信息。根据 AUC 评估,在调整潜在的共因子后,使用 CKD-EPI 公式预测全因死亡率的风险比使用 MDRD 公式更准确(p = 0.001)。与 MDRD 公式相比,CKD-EPI 公式在 IDI 和 NRI 的评估中显示出更高的预测能力,达 0.32%(p 结论:CKD-EPI 公式的预测能力比 MDRD 公式高:CKD-EPI公式可能是基于肌酐的高危血友病患者临床风险分层公式的首选。
{"title":"Clinical Implications of Estimating Glomerular Filtration Rate with Different Equations in Heart Failure Patients with Preserved Ejection Fraction.","authors":"Baole Zhang, Huiling Liang, Zhongping Yu, Fang-Fei Wei, Yuzhong Wu","doi":"10.1007/s40292-024-00631-7","DOIUrl":"https://doi.org/10.1007/s40292-024-00631-7","url":null,"abstract":"<p><strong>Introduction: </strong>The prognostic values of estimated glomerular filtration rate (eGFR) calculated by different formulas have not been adequately compared in patients with heart failure with preserved ejection fraction (HFpEF).</p><p><strong>Aim: </strong>We compared the predictive values of serum creatinine-based eGFRs calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation, Modification of Diet in Renal Disease Study (MDRD) formula, and full-age-spectrum creatinine (FAS Cr) equation in 1751 HFpEF patients.</p><p><strong>Methods: </strong>The area under the receiver-operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were employed.</p><p><strong>Results: </strong>eGFR values were lowest calculated with FAS Cr equation (p < 0.001). When patients were classified into 4 subgroups (eGFR ≥ 90, 89-60, 59-30, and  < 30 ml/min/1.73 m<sup>2</sup>) or only 2 subgroups (≥ 60 or  < 60 ml/min/1.73 m<sup>2</sup>), the 3 formulas correlated significantly, with the best correlation found between the MDRD and CKD-EPI formulas (kappa = 0.871 and 0.963, respectively). The 3 formulas conveyed independent prognostic information. After adjusting for potential cofounders, risk prediction for all-cause mortality was more accurate (p = 0.001) using the CKD-EPI equation than MDRD formula as assessed by AUC. Compared with MDRD formula, CKD-EPI equation exhibited superior predictive ability assessed by IDI and NRI of 0.32% (p < 0.001)/10.4% (p = 0.010) for primary endpoint and 0.37% (p = 0.010)/10.8% (p = 0.010) for HF hospitalization. The risk prediction for deterioration of renal function was more accurate (p ≤ 0.040) using the CKD-EPI equation than FAS Cr equation as assessed by AUC, IDI, and NRI.</p><p><strong>Conclusion: </strong>The CKD-EPI formula might be the preferred creatinine-based equation in clinical risk stratification in HFpEF patients.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety of Clopidogrel vs. Ticagrelor in Dual Antiplatelet Therapy Regimens for High-Bleeding Risk Acute Coronary Syndrome Patients: A Comprehensive Meta-analysis of Adverse Outcomes. 高出血风险急性冠状动脉综合征患者双重抗血小板疗法中氯吡格雷与替卡格雷的安全性:不良结果的综合 Meta 分析》。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-01 DOI: 10.1007/s40292-024-00635-3
Abdur Rehman Khalid, Farooq Ahmad, Muhammad Ahrar Bin Naeem, Smak Ahmed, Muhammad Umar, Hassan Mehmood, Muhammad Kashif, Shazib Ali

Introduction: Patients of acute coronary syndrome (ACS) at a high-bleeding risk (HBR) often require dual antiplatelet therapy (DAPT) to reduce the risk of recurrent cardiovascular events. Clopidogrel and ticagrelor are the most commonly used antiplatelet agents in DAPT regimens. However, the safety profiles of these drugs in ACS patients at HBR remain a subject of ongoing debate.

Aim: To investigate any difference between the safety of clopidogrel and ticagrelor used as a part of DAPT regimen in ACS patients at HBR.

Methods: A systematic search on PubMed, Cochrane Library, and Google Scholar was conducted to identify experimental and observational studies published up to the knowledge cutoff date in September 2023. Studies comparing the safety of clopidogrel and ticagrelor in ACS patients at HBR were included for analysis. The primary outcomes assessed were major bleeding events, stroke, and myocardial infarction (MI), while secondary outcomes included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and net adverse clinical and cerebral events (NACCE).

Results: We included a total of 8 observational studies in our meta-analysis. The pooled analysis revealed a statistically significant increase in the risk of MI (pooled RR = 1.43; 95% CI 1.12-1.83; P = 0.005) in the patients using clopidogrel. There were no statistically significant differences in major bleeding events (pooled RR = 0.94; 95% CI 0.82-1.09; P = 0.44), stroke (pooled RR = 1.36; 95% CI 0.86-2.14; P = 0.18), all-cause mortality (pooled RR = 1.17; 95% CI 0.97-1.41; P = 0.10), MACCE (pooled RR = 1.07; 95% CI 0.76-1.50; P = 0.69) and NACCE (pooled RR = 0.95; 95% CI 0.66-1.37; P = 0.78) between the two groups. Subgroup analyses based on region were performed.

Conclusion: Both drugs are generally safe for treating ACS patients with HBR at baseline, although a higher risk of MI was observed with the use of clopidogrel. Nevertheless, drug choice should factor in regional variations, patient-specific characteristics, cost, accessibility, and potential drug interactions.

简介:高出血风险(HBR)急性冠状动脉综合征(ACS)患者通常需要双重抗血小板疗法(DAPT)来降低心血管事件复发的风险。氯吡格雷和替卡格雷是 DAPT 方案中最常用的抗血小板药物。目的:研究氯吡格雷和替卡格雷作为 DAPT 方案的一部分用于 HBR ACS 患者的安全性差异:方法:在 PubMed、Cochrane Library 和 Google Scholar 上进行系统检索,以确定截至 2023 年 9 月知识截止日之前发表的实验性和观察性研究。纳入分析的研究比较了氯吡格雷和替卡格雷在HBR ACS患者中的安全性。评估的主要结果是大出血事件、中风和心肌梗死(MI),次要结果包括全因死亡率、主要不良心脑血管事件(MACCE)和净不良临床和脑事件(NACCE):我们的荟萃分析共纳入了 8 项观察性研究。汇总分析显示,使用氯吡格雷的患者发生心肌梗死的风险在统计学上有显著增加(汇总 RR = 1.43;95% CI 1.12-1.83;P = 0.005)。在大出血事件(汇总 RR = 0.94;95% CI 0.82-1.09;P = 0.44)、中风(汇总 RR = 1.36;95% CI 0.86-2.14;P = 0.18)、全因死亡率(汇总RR = 1.17;95% CI 0.97-1.41;P = 0.10)、MACCE(汇总RR = 1.07;95% CI 0.76-1.50;P = 0.69)和NACCE(汇总RR = 0.95;95% CI 0.66-1.37;P = 0.78)在两组之间的差异。根据地区进行了分组分析:尽管使用氯吡格雷会增加心肌梗死的风险,但这两种药物对于治疗基线HBR的ACS患者总体上都是安全的。不过,在选择药物时应考虑地区差异、患者特异性特征、成本、可及性和潜在的药物相互作用等因素。
{"title":"Safety of Clopidogrel vs. Ticagrelor in Dual Antiplatelet Therapy Regimens for High-Bleeding Risk Acute Coronary Syndrome Patients: A Comprehensive Meta-analysis of Adverse Outcomes.","authors":"Abdur Rehman Khalid, Farooq Ahmad, Muhammad Ahrar Bin Naeem, Smak Ahmed, Muhammad Umar, Hassan Mehmood, Muhammad Kashif, Shazib Ali","doi":"10.1007/s40292-024-00635-3","DOIUrl":"10.1007/s40292-024-00635-3","url":null,"abstract":"<p><strong>Introduction: </strong>Patients of acute coronary syndrome (ACS) at a high-bleeding risk (HBR) often require dual antiplatelet therapy (DAPT) to reduce the risk of recurrent cardiovascular events. Clopidogrel and ticagrelor are the most commonly used antiplatelet agents in DAPT regimens. However, the safety profiles of these drugs in ACS patients at HBR remain a subject of ongoing debate.</p><p><strong>Aim: </strong>To investigate any difference between the safety of clopidogrel and ticagrelor used as a part of DAPT regimen in ACS patients at HBR.</p><p><strong>Methods: </strong>A systematic search on PubMed, Cochrane Library, and Google Scholar was conducted to identify experimental and observational studies published up to the knowledge cutoff date in September 2023. Studies comparing the safety of clopidogrel and ticagrelor in ACS patients at HBR were included for analysis. The primary outcomes assessed were major bleeding events, stroke, and myocardial infarction (MI), while secondary outcomes included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and net adverse clinical and cerebral events (NACCE).</p><p><strong>Results: </strong>We included a total of 8 observational studies in our meta-analysis. The pooled analysis revealed a statistically significant increase in the risk of MI (pooled RR = 1.43; 95% CI 1.12-1.83; P = 0.005) in the patients using clopidogrel. There were no statistically significant differences in major bleeding events (pooled RR = 0.94; 95% CI 0.82-1.09; P = 0.44), stroke (pooled RR = 1.36; 95% CI 0.86-2.14; P = 0.18), all-cause mortality (pooled RR = 1.17; 95% CI 0.97-1.41; P = 0.10), MACCE (pooled RR = 1.07; 95% CI 0.76-1.50; P = 0.69) and NACCE (pooled RR = 0.95; 95% CI 0.66-1.37; P = 0.78) between the two groups. Subgroup analyses based on region were performed.</p><p><strong>Conclusion: </strong>Both drugs are generally safe for treating ACS patients with HBR at baseline, although a higher risk of MI was observed with the use of clopidogrel. Nevertheless, drug choice should factor in regional variations, patient-specific characteristics, cost, accessibility, and potential drug interactions.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prevalence and Burden of Carotid and Femoral Atherosclerosis in Subjects Without Known Cardiovascular Disease in a Large Community Hospital in South-America. 南美一家大型社区医院未发现心血管疾病的受试者颈动脉和股动脉粥样硬化的患病率和负担。
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-04 DOI: 10.1007/s40292-024-00627-3
Fernando Botto, Sebastian Obregon, Pedro Forcada, Ana Di Leva, Gabriela Fischer Sohn, Joon-Ho Bang, Martin Koretzky, Sergio Baratta, Carol Kotliar

Introduction: Clinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD).

Aim: To evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD.

Methods: We prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries.

Results: Sixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF.

Conclusions: We observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.

导言:临床指南建议通过血管超声(VUS)测量动脉(颈动脉和股动脉)斑块的负担,作为没有已知动脉粥样硬化性心血管疾病(ASCVD)的低风险或中度风险个体的风险调节因素。目的:评估30岁以上无ASCVD的受试者中按年龄和性别划分的颈动脉和股动脉斑块的患病率、亚临床动脉粥样硬化(SA)的负担及其与典型CVRF的关联:我们前瞻性地招募了 5775 名连续的心血管评估对象,并使用二维超声心动图测定了颈动脉和股动脉亚临床动脉粥样硬化的患病率和负担:结果:61%的受检者为男性,平均年龄为 51.3 岁(SD 10.6)。总体而言,颈动脉斑块发生率为 51%,股动脉斑块发生率为 39.3%,颈动脉或股动脉斑块发生率为 62.4%,颈动脉或股动脉斑块发生率均为 37.6%。随着年龄的增长,斑块的患病率和SA负担呈上升趋势,男性高于女性,且在40岁之前就开始出现,颈动脉和股动脉均是如此。根据CVRF的数量,斑块的患病率也呈上升趋势,有趣的是,我们发现在只有0或1个典型CVRF的受试者中,斑块的患病率很高:我们观察到,颈动脉或股动脉SA的发病率和负担都在增加,男性发病率更高,发病时间始于生命的第四个十年之前,并随着年龄的增长而增加。尽管与典型 CVRF 有显著关联,但仍有大量 CVRF 低的受试者被诊断出患有 SA。
{"title":"Prevalence and Burden of Carotid and Femoral Atherosclerosis in Subjects Without Known Cardiovascular Disease in a Large Community Hospital in South-America.","authors":"Fernando Botto, Sebastian Obregon, Pedro Forcada, Ana Di Leva, Gabriela Fischer Sohn, Joon-Ho Bang, Martin Koretzky, Sergio Baratta, Carol Kotliar","doi":"10.1007/s40292-024-00627-3","DOIUrl":"10.1007/s40292-024-00627-3","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD).</p><p><strong>Aim: </strong>To evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD.</p><p><strong>Methods: </strong>We prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries.</p><p><strong>Results: </strong>Sixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF.</p><p><strong>Conclusions: </strong>We observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Coenzyme Q10 Supplementation on Vascular Endothelial Function: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 补充辅酶 Q10 对血管内皮功能的影响:随机对照试验的系统回顾和元分析
IF 3 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-17 DOI: 10.1007/s40292-024-00630-8
Shahrzad Daei, Azam Ildarabadi, Sima Goodarzi, Mohsen Mohamadi-Sartang

Introduction: Coenzyme Q10 (CoQ10) has gained attention as a potential therapeutic agent for improving endothelial function. Several randomized clinical trials have investigated CoQ10 supplementation's effect on endothelial function. However, these studies have yielded conflicting results, therefore this systematic review and meta-analysis were conducted.

Aim: This systematic review and meta-analysis were conducted to assess the effects of CoQ10 supplementation on endothelial factors.

Methods: A comprehensive search was done in numerous databases until July 19th, 2023. Quantitative data synthesis was performed using a random-effects model, with weight mean difference (WMD) and 95% confidence intervals (CI). Standard methods were used for the assessment of heterogeneity, meta-regression, sensitivity analysis, and publication bias.

Results: 12 studies comprising 489 subjects were included in the meta-analysis. The results demonstrated significant increases in Flow Mediated Dilation (FMD) after CoQ10 supplementation (WMD: 1.45; 95% CI: 0.55 to 2.36; p < 0.02), but there is no increase in Vascular cell adhesion protein (VCAM), and Intercellular adhesion molecule (ICAM) following Q10 supplementation (VCAM: SMD: - 0.34; 95% CI: - 0.74 to - 0.06; p < 0.10) (ICAM: SMD: - 0.18; 95% CI: - 0.82 to 0.46; p < 0.57). The sensitivity analysis showed that the effect size was robust in FMD and VCAM. In meta-regression, changes in FMD percent were associated with the dose of supplementation (slope: 0.01; 95% CI: 0.004 to 0.03; p = 0.006).

Conclusions: CoQ10 supplementation has a positive effect on FMD in a dose-dependent manner. Our findings show that CoQ10 has an effect on FMD after 8 weeks of consumption. Additional research is warranted to establish the relationship between CoQ10 supplementation and endothelial function.

导言:辅酶 Q10(CoQ10)作为一种改善内皮功能的潜在治疗药物,已引起人们的关注。一些随机临床试验研究了补充辅酶 Q10 对内皮功能的影响。目的:本系统综述和荟萃分析旨在评估补充 CoQ10 对内皮因素的影响:方法:在2023年7月19日之前对众多数据库进行了全面检索。采用随机效应模型、加权平均差(WMD)和95%置信区间(CI)进行定量数据综合。标准方法用于评估异质性、元回归、敏感性分析和发表偏倚:荟萃分析共纳入了 12 项研究,包括 489 名受试者。结果表明,补充辅酶Q10后,血流介导的扩张(FMD)明显增加(WMD:1.45;95% CI:0.55 至 2.36;P < 0.02),但血流介导的扩张(FMD)没有增加。02),但补充 Q10 后血管细胞粘附蛋白 (VCAM) 和细胞间粘附分子 (ICAM) 没有增加(VCAM:SMD:- 0.34;95% CI:- 0.74 至 - 0.06;p < 0.10)(ICAM:SMD:- 0.18;95% CI:- 0.82 至 0.46;p < 0.57)。敏感性分析表明,FMD 和 VCAM 的效应大小是稳健的。在元回归中,FMD 百分比的变化与补充剂量有关(斜率:0.01;95% CI:0.004 至 0.03;P = 0.006):补充辅酶Q10对FMD有积极影响,且呈剂量依赖性。我们的研究结果表明,服用辅酶Q10 8周后对FMD有影响。为确定 CoQ10 补充剂与内皮功能之间的关系,还需要进行更多的研究。
{"title":"Effect of Coenzyme Q10 Supplementation on Vascular Endothelial Function: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Shahrzad Daei, Azam Ildarabadi, Sima Goodarzi, Mohsen Mohamadi-Sartang","doi":"10.1007/s40292-024-00630-8","DOIUrl":"https://doi.org/10.1007/s40292-024-00630-8","url":null,"abstract":"<p><strong>Introduction: </strong>Coenzyme Q10 (CoQ10) has gained attention as a potential therapeutic agent for improving endothelial function. Several randomized clinical trials have investigated CoQ10 supplementation's effect on endothelial function. However, these studies have yielded conflicting results, therefore this systematic review and meta-analysis were conducted.</p><p><strong>Aim: </strong>This systematic review and meta-analysis were conducted to assess the effects of CoQ10 supplementation on endothelial factors.</p><p><strong>Methods: </strong>A comprehensive search was done in numerous databases until July 19th, 2023. Quantitative data synthesis was performed using a random-effects model, with weight mean difference (WMD) and 95% confidence intervals (CI). Standard methods were used for the assessment of heterogeneity, meta-regression, sensitivity analysis, and publication bias.</p><p><strong>Results: </strong>12 studies comprising 489 subjects were included in the meta-analysis. The results demonstrated significant increases in Flow Mediated Dilation (FMD) after CoQ10 supplementation (WMD: 1.45; 95% CI: 0.55 to 2.36; p < 0.02), but there is no increase in Vascular cell adhesion protein (VCAM), and Intercellular adhesion molecule (ICAM) following Q10 supplementation (VCAM: SMD: - 0.34; 95% CI: - 0.74 to - 0.06; p < 0.10) (ICAM: SMD: - 0.18; 95% CI: - 0.82 to 0.46; p < 0.57). The sensitivity analysis showed that the effect size was robust in FMD and VCAM. In meta-regression, changes in FMD percent were associated with the dose of supplementation (slope: 0.01; 95% CI: 0.004 to 0.03; p = 0.006).</p><p><strong>Conclusions: </strong>CoQ10 supplementation has a positive effect on FMD in a dose-dependent manner. Our findings show that CoQ10 has an effect on FMD after 8 weeks of consumption. Additional research is warranted to establish the relationship between CoQ10 supplementation and endothelial function.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute Effects of Coffee Consumption on Blood Pressure and Endothelial Function in Individuals with Hypertension on Antihypertensive Drug Treatment: A Randomized Crossover Trial. 饮用咖啡对服用降压药的高血压患者血压和内皮功能的急性影响:一项随机交叉试验。
IF 3 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2024-02-03 DOI: 10.1007/s40292-024-00622-8
Fernanda Barboza de Araujo Lima de Castro, Flávia Garcia Castro, Michelle Rabello da Cunha, Sidney Pacheco, Otniel Freitas-Silva, Mario Fritsch Neves, Marcia Regina Simas Torres Klein

Introduction: Coffee is a complex brew that contains several bioactive compounds and some of them can influence blood pressure (BP) and endothelial function (EF), such as caffeine and chlorogenic acids (CGAs).

Aim: This study aimed to evaluate the acute effects of coffee on BP and EF in individuals with hypertension on drug treatment who were habitual coffee consumers.

Methods: This randomized crossover trial assigned 16 adults with hypertension to receive three test beverages one week apart: caffeinated coffee (CC; 135 mg caffeine, 61 mg CGAs), decaffeinated coffee (DC; 5 mg caffeine, 68 mg CGAs), and water. BP was continuously evaluated from 15 min before to 90 min after test beverages by digital photoplethysmography. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry evaluated EF before and at 90 min after test beverages. At the same time points, microvascular reactivity was assessed by laser speckle contrast imaging. Repeated-measures-ANOVA evaluated the effect of time, the effect of beverage, and the interaction between time and beverage (treatment effect).

Results: Although the intake of CC produced a significant increase in BP and a significant decrease in RHI, these changes were also observed after the intake of DC and were not significantly different from the modifications observed after the consumption of DC and water. Microvascular reactivity did not present significant changes after the 3 beverages.

Conclusion: CC in comparison with DC and water neither promoted an acute increase in BP nor produced an improvement or deleterious effect on EF in individuals with hypertension on drug treatment who were coffee consumers.

简介:咖啡是一种复杂的饮品,含有多种生物活性化合物,其中一些可影响血压(BP)和内皮功能(EF),如咖啡因和绿原酸(CGAs):这项随机交叉试验将 16 名成人高血压患者分配到三种测试饮料中,时间间隔为一周:含咖啡因咖啡(CC;135 毫克咖啡因,61 毫克 CGAs)、无咖啡因咖啡(DC;5 毫克咖啡因,68 毫克 CGAs)和水。从试饮前 15 分钟到试饮后 90 分钟,通过数字光电血压计连续评估血压。通过外周动脉测压仪评估反应性充血指数(RHI),在测试饮料之前和之后 90 分钟评估 EF。在同一时间点,通过激光斑点对比成像评估微血管反应性。重复测量-方差分析评估了时间的影响、饮料的影响以及时间与饮料之间的交互作用(治疗效果):结果:虽然摄入 CC 会导致血压显著升高,RHI 显著降低,但摄入 DC 后也会出现这些变化,且与摄入 DC 和水后观察到的变化无显著差异。微血管反应性在饮用这三种饮料后没有明显变化:结论:CC与DC和水相比,既不会促进血压急性升高,也不会对正在接受药物治疗的高血压患者的EF产生改善或有害影响。
{"title":"Acute Effects of Coffee Consumption on Blood Pressure and Endothelial Function in Individuals with Hypertension on Antihypertensive Drug Treatment: A Randomized Crossover Trial.","authors":"Fernanda Barboza de Araujo Lima de Castro, Flávia Garcia Castro, Michelle Rabello da Cunha, Sidney Pacheco, Otniel Freitas-Silva, Mario Fritsch Neves, Marcia Regina Simas Torres Klein","doi":"10.1007/s40292-024-00622-8","DOIUrl":"10.1007/s40292-024-00622-8","url":null,"abstract":"<p><strong>Introduction: </strong>Coffee is a complex brew that contains several bioactive compounds and some of them can influence blood pressure (BP) and endothelial function (EF), such as caffeine and chlorogenic acids (CGAs).</p><p><strong>Aim: </strong>This study aimed to evaluate the acute effects of coffee on BP and EF in individuals with hypertension on drug treatment who were habitual coffee consumers.</p><p><strong>Methods: </strong>This randomized crossover trial assigned 16 adults with hypertension to receive three test beverages one week apart: caffeinated coffee (CC; 135 mg caffeine, 61 mg CGAs), decaffeinated coffee (DC; 5 mg caffeine, 68 mg CGAs), and water. BP was continuously evaluated from 15 min before to 90 min after test beverages by digital photoplethysmography. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry evaluated EF before and at 90 min after test beverages. At the same time points, microvascular reactivity was assessed by laser speckle contrast imaging. Repeated-measures-ANOVA evaluated the effect of time, the effect of beverage, and the interaction between time and beverage (treatment effect).</p><p><strong>Results: </strong>Although the intake of CC produced a significant increase in BP and a significant decrease in RHI, these changes were also observed after the intake of DC and were not significantly different from the modifications observed after the consumption of DC and water. Microvascular reactivity did not present significant changes after the 3 beverages.</p><p><strong>Conclusion: </strong>CC in comparison with DC and water neither promoted an acute increase in BP nor produced an improvement or deleterious effect on EF in individuals with hypertension on drug treatment who were coffee consumers.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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High Blood Pressure & Cardiovascular Prevention
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