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Cardiovascular Risk Profile in Master Paralympic Athletes, a High-Risk Undertreated Population: A Cross-Sectional Longitudinal Study. 残奥大师级运动员--未得到充分治疗的高危人群--的心血管风险概况:一项横断面纵向研究。
IF 3 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-05-01 Epub Date: 2024-05-07 DOI: 10.1007/s40292-024-00648-y
Giuseppe Di Gioia, Francesca Vespasiano, Federica Mango, Viviana Maestrini, Sara Monosilio, Maria Rosaria Squeo, Erika Lemme, Marco Bernardi, Antonio Pelliccia

Introduction: Recently, European Society of Cardiology (ESC) validated a prediction model to estimate 10-year fatal and non-fatal cardiovascular disease risk (CVDR) in individuals (aged 40-60 years) without previous cardiovascular disease or diabetes (ESC-SCORE2) and to provide indications for treatment. At present, data describing the CVDR in Paralympic athletes (PAs) are scarce and inconsistent. Therefore, we sought to assess the prevalence of risk factors in PAs to estimate their CVDR through SCORE2.

Methods: We enrolled 99 PAs aged ≥ 40 y.o., who participated at 2012-2022 Paralympic Games, competing in 22 different sport disciplines classified according to sport type (power, skills, endurance and mixed) and disabilities: spinal cord injuries (SCI) and non-SCI. CVDR factors, anthropometric measurements and blood samples were collected.

Results: Among the 99 PAs (78% males, mean age 45.7 ± 4.7 y.o.), 52.5% had SCI; 54% were dyslipidemic and 23% were smokers. According to ESC-SCORE2, 29% had high and 1% very-high CVDR. Women (compared to men) and endurance (compared to other sport) exhibited better CV profile. SCI showed no differences when compared with non-SCI for CVDR, excepted for a lower HDL and lower exercise performance. None of the dyslipidemic athlete was on pharmacologically treatment, despite the altered lipid profile had already been detected at younger age.

Conclusion: PAs are a selected population, presenting a high CV risk profile, with 30% showing either high or very-high CVDR according to ESC-SCORE2. Dyslipidemia was the most common risk factor, underestimated and undertreated, emphasizing the need for specific preventive strategies in this special setting of athletes.

导言:最近,欧洲心脏病学会(ESC)验证了一个预测模型(ESC-SCORE2),用于估算既往无心血管疾病或糖尿病患者(40-60 岁)的 10 年致命性和非致命性心血管疾病风险(CVDR),并提供治疗指征。目前,描述残奥运动员(PA)心血管疾病风险的数据很少,而且不一致。因此,我们试图通过 SCORE2 评估残奥运动员的危险因素发生率,以估算他们的心血管疾病发生率:我们招募了 99 名年龄≥ 40 岁的残疾人运动员,他们参加了 2012-2022 年残奥会,按照运动类型(力量型、技巧型、耐力型和混合型)和残疾程度(脊髓损伤(SCI)和非脊髓损伤)参加了 22 个不同运动项目的比赛。研究人员收集了心血管疾病危险因素、人体测量数据和血液样本:在 99 名运动障碍患者中(78% 为男性,平均年龄为 45.7 ± 4.7 岁),52.5% 患有 SCI;54% 患有血脂异常,23% 为吸烟者。根据ESC-SCORE2,29%患有高心血管疾病风险,1%患有极高心血管疾病风险。女性(与男性相比)和耐力(与其他运动相比)表现出更好的心血管疾病状况。与非 SCI 运动员相比,SCI 运动员除了高密度脂蛋白较低和运动表现较差外,在心血管疾病风险方面没有任何差异。血脂异常的运动员均未接受药物治疗,尽管他们在年轻时就已发现血脂变化:结论:根据ESC-SCORE2标准,30%的运动员具有高或极高的心血管疾病风险。血脂异常是最常见的风险因素,但却被低估和治疗不足,这强调了在运动员这一特殊群体中采取特殊预防策略的必要性。
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引用次数: 0
Safety and Efficacy of Anti-Hypertensive Medications in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis. 射血分数保留型心力衰竭患者服用抗高血压药物的安全性和有效性:系统回顾与元分析》。
IF 3 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-05-01 Epub Date: 2024-05-13 DOI: 10.1007/s40292-024-00646-0
Mohammed Al-Sadawi, Michael Tao, Simrat Dhaliwal, Mark Goldschmit, Edlira Tam, Noel Mann

Introduction: Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether treatment of hypertension in HFpEF patients is associated with improved cardiovascular outcomes.

Aim: The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF.

Methods: We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension.

Results: A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77-1.35; p = 0.9, OR 0.88, 95% CI 0.73-1.06; p = 0.19, OR 0.99, 95% CI 0.87-1.12; p = 0.83, OR 0.90, 95% CI 0.79-1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07-3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83-0.98; p = 0.02).

Conclusions: While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.

简介高血压(HTN)是射血分数保留型心力衰竭(HFpEF)的常见并发症。目的:本荟萃分析旨在评估抗高血压药物治疗与 HFpEF 患者心血管预后的关系:我们在数据库中搜索了有关高血压药物治疗与 HFpEF 患者心血管预后和安全终点相关性的研究报告。检索的数据库包括 OVID Medline、Web of Science 和 Embase。主要终点是全因死亡率。次要终点包括心血管(CV)死亡率、心衰(HF)恶化、CV住院、复合主要不良心血管事件(MACE)、高钾血症、肾功能恶化和低血压:共有 12 项研究的 14062 名 HFpEF 参与者(7010 人接受药物治疗,7052 人接受安慰剂治疗)符合纳入标准。与安慰剂治疗相比,使用抗高血压药物与降低全因死亡率、冠心病死亡率或冠心病住院率无关(OR 1.02,95% CI 0.77-1.35;P = 0.9,OR 0.88,95% CI 0.73-1.06;P = 0.19,OR 0.99,95% CI 0.87-1.12;P = 0.83,OR 0.90,95% CI 0.79-1.03;P = 0.11)。抗高血压药物与继发急性心肌梗死(AMI)的风险降低无关(OR 0.53,95% CI 0.07-3.73;P = 0.5)。使用抗高血压药物与MACE风险显著降低有关(OR 0.90,95% CI 0.83-0.98;P = 0.02):虽然抗高血压药物治疗与降低全因死亡风险无关,但无论是否患有高血压,使用抗高血压药物可能与降低高房颤患者不良心血管结局的风险有关。需要进行更多高质量的研究来澄清这种关联,并确定特定药物类别的效果。
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引用次数: 0
Acknowledgement to Referees. 鸣谢裁判员。
IF 3 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-04 DOI: 10.1007/s40292-024-00628-2
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引用次数: 0
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 PERIPHERAL VASCULAR DISEASE 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
Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. 诊断射血分数保留型心力衰竭的新策略:全面文献综述
IF 3 Q2 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-03-01 Epub Date: 2024-03-15 DOI: 10.1007/s40292-024-00629-1
Costantino Mancusi, Christian Basile, Carmen Spaccarotella, Giuseppe Gargiulo, Ilaria Fucile, Stefania Paolillo, Paola Gargiulo, Ciro Santoro, Lina Manzi, Federica Marzano, Pasquale Ambrosino, Nicola De Luca, Giovanni Esposito

Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.

射血分数保留型心力衰竭(HF)是一种全球流行的疾病,约占心力衰竭患者的 50%。随着全球人口的老龄化,预计其发病率和流行率还会进一步上升。遗憾的是,直到最近,还没有有效的药物能降低与高房颤相关的高死亡率和住院率,这使其成为心血管医学中一个尚未满足的重大需求。虽然 HFpEF 通常被定义为射血分数正常但左心室充盈压升高的 HF,但对每一个疑似 HFpEF 患者进行有创血液动力学评估既不可行也不实际。因此,人们提出了一些临床标准和诊断工具来帮助诊断 HFpEF。总体而言,这些标准和工具旨在帮助医护人员根据体征、症状、生物标志物和非侵入性成像结果,识别和评估可能患有 HFpEF 的患者。通过采用这些非侵入性诊断方法,临床医生可以为疑似 HFpEF 患者做出关于最佳药物治疗和康复策略的明智决定。本文献综述旨在概述目前可用于诊断和监测这种致残性疾病的所有方法。
{"title":"Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review.","authors":"Costantino Mancusi, Christian Basile, Carmen Spaccarotella, Giuseppe Gargiulo, Ilaria Fucile, Stefania Paolillo, Paola Gargiulo, Ciro Santoro, Lina Manzi, Federica Marzano, Pasquale Ambrosino, Nicola De Luca, Giovanni Esposito","doi":"10.1007/s40292-024-00629-1","DOIUrl":"10.1007/s40292-024-00629-1","url":null,"abstract":"<p><p>Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"127-140"},"PeriodicalIF":3.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11043114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140136636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 PERIPHERAL VASCULAR DISEASE 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
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 PERIPHERAL VASCULAR DISEASE 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
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 PERIPHERAL VASCULAR DISEASE 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 PERIPHERAL VASCULAR DISEASE 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。
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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 PERIPHERAL VASCULAR DISEASE 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。
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High Blood Pressure & Cardiovascular Prevention
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