Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.02.001
Background
In symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients, mavacamten is commercially approved to help improve left ventricular (LV) outflow tract (LVOT) gradients, symptoms, and reduce eligibility for septal reduction therapy (SRT) under the risk evaluation and mitigation strategy (REMS) program. We sought to prospectively report the initial real-world clinical experience with the use of commercially available mavacamten in a multi-hospital tertiary healthcare system.
Methods
We studied the first 150 consecutive oHCM patients (mean age 65 years, 53% women, 83% on betablockers and 61% in New York Heart Association [NYHA] class III) who were initiated on 5 mg of mavacamten with dose titrations using symptom assessment and echocardiographic measurements of LVOT gradient and LV ejection fraction (LVEF) measurements. We measured changes in NYHA class, LVEF, LVOT gradients (resting and Valsalva) at baseline, 4, 8 and 12 weeks.
Results
At 261 ± 143 days (range of 31–571 days), 69 (46%) patients had ≥1 NYHA class, and 27 (18%) additional patients had ≥2 NYHA class improvement. The mean Valsalva LVOT gradient decreased from 72 ± 43 mmHg at baseline to 29 ± 31 mmHg at 4 weeks, 29 ± 28 mmHg at 8 weeks and 30 ± 29 mmHg at 12 weeks (p < 0.001). At baseline, 100% patients had Valsalva LVOT gradients ≥30 mmHg, which reduced to 29% at 4 weeks, 28% at 8 weeks and 30% at 12 weeks. In 40 patients who reported no symptomatic improvement, the mean Valsalva LVOT gradient decreased from 73 ± 39 mmHg at baseline to 34 ± 27 mmHg at 4 weeks, 35 ± 28 mmHg at 8 weeks and 30 ± 24 mmHg at 12 weeks (P < 0.001). The mean LVEF at baseline was 66 ± 6% and changed to 64 ± 5% at 4 weeks, 63 ± 5% at 8 weeks and 62 ± 7% at 12 weeks (p < 0.0001). No patient underwent SRT, developed LVEF ≤30% or developed heart failure requiring admission. Three (2%) patients needed temporary interruption of mavacamten due to LVEF<50%.
Conclusions
In a real-world study in symptomatic oHCM patients at a multi-hospital tertiary care referral center, we demonstrate the efficacy and safety, along with the logistic feasibility of prescribing mavacamten under the REMS program.
{"title":"Real-world experience with mavacamten in obstructive hypertrophic cardiomyopathy: Observations from a tertiary care center","authors":"","doi":"10.1016/j.pcad.2024.02.001","DOIUrl":"10.1016/j.pcad.2024.02.001","url":null,"abstract":"<div><h3>Background</h3><div>In symptomatic obstructive hypertrophic cardiomyopathy<span> (oHCM) patients, mavacamten is commercially approved to help improve left ventricular (LV) outflow tract (LVOT) gradients, symptoms, and reduce eligibility for septal reduction therapy (SRT) under the risk evaluation and mitigation strategy (REMS) program. We sought to prospectively report the initial real-world clinical experience with the use of commercially available mavacamten in a multi-hospital tertiary healthcare system.</span></div></div><div><h3>Methods</h3><div><span><span>We studied the first 150 consecutive oHCM patients (mean age 65 years, 53% women, 83% on betablockers and 61% in New York Heart Association [NYHA] class III) who were initiated on 5 mg of mavacamten with dose titrations using symptom assessment and echocardiographic measurements of LVOT gradient and </span>LV ejection fraction (LVEF) measurements. We measured changes in NYHA class, </span>LVEF, LVOT gradients (resting and Valsalva) at baseline, 4, 8 and 12 weeks.</div></div><div><h3>Results</h3><div>At 261 ± 143 days (range of 31–571 days), 69 (46%) patients had ≥1 NYHA class, and 27 (18%) additional patients had ≥2 NYHA class improvement. The mean Valsalva LVOT gradient decreased from 72 ± 43 mmHg at baseline to 29 ± 31 mmHg at 4 weeks, 29 ± 28 mmHg at 8 weeks and 30 ± 29 mmHg at 12 weeks (<em>p</em> < 0.001). At baseline, 100% patients had Valsalva LVOT gradients ≥30 mmHg, which reduced to 29% at 4 weeks, 28% at 8 weeks and 30% at 12 weeks. In 40 patients who reported no symptomatic improvement, the mean Valsalva LVOT gradient decreased from 73 ± 39 mmHg at baseline to 34 ± 27 mmHg at 4 weeks, 35 ± 28 mmHg at 8 weeks and 30 ± 24 mmHg at 12 weeks (<em>P</em> < 0.001). The mean LVEF at baseline was 66 ± 6% and changed to 64 ± 5% at 4 weeks, 63 ± 5% at 8 weeks and 62 ± 7% at 12 weeks (<em>p</em> < 0.0001). No patient underwent SRT, developed LVEF ≤30% or developed heart failure requiring admission. Three (2%) patients needed temporary interruption of mavacamten due to LVEF<50%.</div></div><div><h3>Conclusions</h3><div>In a real-world study in symptomatic oHCM patients at a multi-hospital tertiary care referral center, we demonstrate the efficacy and safety, along with the logistic feasibility of prescribing mavacamten under the REMS program.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 62-68"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.07.002
Massimiliano Camilli , Péter Ferdinandy , Emanuela Salvatorelli , Pierantonio Menna , Giorgio Minotti
Many cardiovascular diseases are characterized by diastolic dysfunction, which associates with worse clinical outcomes like overall mortality and hospitalization for heart failure (HF). Diastolic dysfunction has also been suspected to represent an early manifestation of cardiotoxicity induced by cancer drugs, with most of the information deriving from patients treated with anthracyclines; however, the prognostic implications of diastolic dysfunction in the anthracycline-treated patient have remained poorly explored or neglected. Here the molecular, pathophysiologic and diagnostic aspects of anthracycline-related diastolic dysfunction are reviewed in the light of HF incidence and phenotype in cancer survivors. We describe that the trajectories of diastolic dysfunction toward HF are influenced by a constellation of patient- or treatment- related factors, such as comorbidities and exposure to other cardiotoxic drugs or treatments, but also by prospective novel opportunities to treat diastolic dysfunction. The importance of a research-oriented multidimensional approach to patient surveillance or treatment is discussed within the framework of what appears to be a distinct pathophysiologic entity that develops early during anthracycline treatment and gradually worsens over the years.
{"title":"Anthracyclines, Diastolic Dysfunction and the road to Heart Failure in Cancer survivors: An untold story","authors":"Massimiliano Camilli , Péter Ferdinandy , Emanuela Salvatorelli , Pierantonio Menna , Giorgio Minotti","doi":"10.1016/j.pcad.2024.07.002","DOIUrl":"10.1016/j.pcad.2024.07.002","url":null,"abstract":"<div><div>Many cardiovascular diseases are characterized by diastolic dysfunction, which associates with worse clinical outcomes like overall mortality and hospitalization for heart failure (HF). Diastolic dysfunction has also been suspected to represent an early manifestation of cardiotoxicity induced by cancer drugs, with most of the information deriving from patients treated with anthracyclines; however, the prognostic implications of diastolic dysfunction in the anthracycline-treated patient have remained poorly explored or neglected. Here the molecular, pathophysiologic and diagnostic aspects of anthracycline-related diastolic dysfunction are reviewed in the light of HF incidence and phenotype in cancer survivors. We describe that the trajectories of diastolic dysfunction toward HF are influenced by a constellation of patient- or treatment- related factors, such as comorbidities and exposure to other cardiotoxic drugs or treatments, but also by prospective novel opportunities to treat diastolic dysfunction. The importance of a research-oriented multidimensional approach to patient surveillance or treatment is discussed within the framework of what appears to be a distinct pathophysiologic entity that develops early during anthracycline treatment and gradually worsens over the years.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 38-47"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141725426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.09.003
Jason V. Tso, Samuel Montalvo, Jeffrey Christle, Victor Froelicher
{"title":"Can the outlier percentiles from norms increase the sensitivity of the ECG criteria for screening athletes?","authors":"Jason V. Tso, Samuel Montalvo, Jeffrey Christle, Victor Froelicher","doi":"10.1016/j.pcad.2024.09.003","DOIUrl":"10.1016/j.pcad.2024.09.003","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 93-95"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.09.005
Ming Zheng , Carl J. Lavie
Stroke is a leading cause of death and disability worldwide, with diverse comorbidities that influence its clinical outcomes. However, a comprehensive understanding of the short- and long-term patterns of stroke-related comorbidities remains limited. To address this gap, we conducted a disease-wide association study (DWAS) to systematically explore the landscape of stroke comorbidities in a population-based cohort. Using data from the FinnGen cohort, which included 337,194 participants and 27,496 ischemic stroke cases, we analyzed 1,757 medical events as potential stroke comorbidities. We employed Cox proportional hazards regression, adjusting for sex and age, to identify significant associations between stroke and these medical events. Comorbidities were classified into pre- and post-stroke categories, and their temporal patterns were analyzed over a 1- to 15-year follow-up period. Our findings revealed that stroke comorbidities span multiple disease taxonomies, with significant enrichment in the circulatory, digestive, and musculoskeletal systems. Notably, the study identified distinct pre-stroke and post-stroke comorbidities that persist or evolve over time, supporting the concept of a disease continuum. These temporal patterns suggest that stroke risk and outcomes are shaped by sequential comorbidities rather than simultaneous occurrences. This study provides the most comprehensive profile of stroke comorbidities to date, highlighting the interconnected nature of diseases. By mapping the progression of comorbidities across time and disease categories, DWAS offers valuable insights for early intervention and long-term treatment. Our findings emphasize the importance of viewing stroke as part of a broader disease continuum, offering new opportunities for prevention, diagnosis, and treatment strategies tailored to individual risk profiles.
{"title":"Landscape of stroke comorbidities: A disease-wide association study","authors":"Ming Zheng , Carl J. Lavie","doi":"10.1016/j.pcad.2024.09.005","DOIUrl":"10.1016/j.pcad.2024.09.005","url":null,"abstract":"<div><div>Stroke is a leading cause of death and disability worldwide, with diverse comorbidities that influence its clinical outcomes. However, a comprehensive understanding of the short- and long-term patterns of stroke-related comorbidities remains limited. To address this gap, we conducted a disease-wide association study (DWAS) to systematically explore the landscape of stroke comorbidities in a population-based cohort. Using data from the FinnGen cohort, which included 337,194 participants and 27,496 ischemic stroke cases, we analyzed 1,757 medical events as potential stroke comorbidities. We employed Cox proportional hazards regression, adjusting for sex and age, to identify significant associations between stroke and these medical events. Comorbidities were classified into pre- and post-stroke categories, and their temporal patterns were analyzed over a 1- to 15-year follow-up period. Our findings revealed that stroke comorbidities span multiple disease taxonomies, with significant enrichment in the circulatory, digestive, and musculoskeletal systems. Notably, the study identified distinct pre-stroke and post-stroke comorbidities that persist or evolve over time, supporting the concept of a disease continuum. These temporal patterns suggest that stroke risk and outcomes are shaped by sequential comorbidities rather than simultaneous occurrences. This study provides the most comprehensive profile of stroke comorbidities to date, highlighting the interconnected nature of diseases. By mapping the progression of comorbidities across time and disease categories, DWAS offers valuable insights for early intervention and long-term treatment. Our findings emphasize the importance of viewing stroke as part of a broader disease continuum, offering new opportunities for prevention, diagnosis, and treatment strategies tailored to individual risk profiles.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 96-99"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.06.007
Calcific coronary artery stenosis is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this State Of The Art Review, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.
{"title":"Calcified coronary lesions: Imaging, prognosis, preparation and treatment state of the art review","authors":"","doi":"10.1016/j.pcad.2024.06.007","DOIUrl":"10.1016/j.pcad.2024.06.007","url":null,"abstract":"<div><div><span>Calcific coronary artery stenosis<span><span> is a complex disease associated with adverse outcomes and suboptimal percutaneous treatment. Calcium plaque modification has emerged as a key strategy to tackle the issues that accompany calcific stenosis - namely reduced device deliverability, unpredictable lesion characteristics, and difficult dilatation. </span>Atherectomy has traditionally been the treatment modality of choice for heavily calcified coronary stenoses. Contemporary technologies have emerged to aid with planning, preparation, and treatment of calcified coronary stenosis in an attempt to improve procedural success and long-term outcomes. In this </span></span><em>State Of The Art Review</em><span>, we synthesize the body of data surrounding the diagnosis, imaging, and treatment of calcific coronary disease<span>, with a focus on i) intravascular imaging, ii) calcific lesion preparation, iii) treatment modalities including atherectomy, and iv) updated treatment algorithms for the management of calcified coronary stenosis.</span></span></div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 26-37"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/S0033-0620(24)00133-6
{"title":"List of recent issues","authors":"","doi":"10.1016/S0033-0620(24)00133-6","DOIUrl":"10.1016/S0033-0620(24)00133-6","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Page A3"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.06.004
Cardiovascular magnetic resonance (CMR) imaging is the gold standard test for myocardial tissue characterization and chamber volumetric and functional evaluation. However, manual CMR analysis can be time-consuming and is subject to intra- and inter-observer variability. Artificial intelligence (AI) is a field that permits automated task performance through the identification of high-level and complex data relationships. In this review, we review the rapidly growing role of AI in CMR, including image acquisition, sequence prescription, artifact detection, reconstruction, segmentation, and data reporting and analysis including quantification of volumes, function, myocardial infarction (MI) and scar detection, and prediction of outcomes. We conclude with a discussion of the emerging challenges to widespread adoption and solutions that will allow for successful, broader uptake of this powerful technology.
{"title":"The role of artificial intelligence in cardiovascular magnetic resonance imaging","authors":"","doi":"10.1016/j.pcad.2024.06.004","DOIUrl":"10.1016/j.pcad.2024.06.004","url":null,"abstract":"<div><div>Cardiovascular magnetic resonance (CMR) imaging is the gold standard test for myocardial tissue characterization<span> and chamber volumetric and functional evaluation. However, manual CMR analysis can be time-consuming and is subject to intra- and inter-observer variability. Artificial intelligence (AI) is a field that permits automated task performance through the identification of high-level and complex data relationships. In this review, we review the rapidly growing role of AI in CMR, including image acquisition, sequence prescription, artifact detection, reconstruction, segmentation, and data reporting and analysis including quantification of volumes, function, myocardial infarction (MI) and scar detection, and prediction of outcomes. We conclude with a discussion of the emerging challenges to widespread adoption and solutions that will allow for successful, broader uptake of this powerful technology.</span></div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 13-25"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.pcad.2024.08.004
Bożena Sosnowska , Joanna Lewek , Weronika Adach , Karina Mierczak , Agata Bielecka-Dąbrowa , Konrad Szosland , Arkadiusz Zygmunt , Jan Dąbrowski , Maciej Banach
<div><h3>Background</h3><div>The knowledge on the prevalence of elevated lipoprotein(a) (Lp(a)), patients' characteristics, and nongenetic risk factors is scarce in some regions including Poland, the largest Central and Eastern European country. Thus, we aimed to present the results from the Lp(a) registry established in Poland's 2nd largest, supra-regional hospital - the Polish Mother's Memorial Hospital Research Institute (PMMHRI).</div></div><div><h3>Methods</h3><div>The PMMHRI-Lp(a)-Registry was established in January 2022. Since that time all consecutive patients of the Departments of Cardiology, Endocrinology, and outpatient cardiology, diabetology and metabolic clinics have been included. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management of elevated Lp(a) (2024). Lp(a) was determined using Sentinel's Lp(a) Ultra, an Immunoturbidimetric quantitative test (Sentinel, Milan, Italy), and the results are presented in mg/dL.</div></div><div><h3>Results</h3><div>511 patients were included in the registry between Jan 2022 and 15th May 2024. The mean age of patients was 48.21 years. Female patients represented 53.42 % of the population. Elevated Lp(a) levels above 30 and 50 mg/dL were detected in 142 (27.79 %), and 101 (19.8 %) patients, respectively. The mean Lp(a) level was 30.45 ± 42.50 mg/dL, with no significant sex differences [mean for men: 28.80 mg/dL; women: 31.89 mg/dL]. There were also no significant differences between those with and without: coronary artery disease (CAD), dyslipidemia, stroke, heart failure, cancer, diabetes, chronic kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with a history of myocardial infarction (MI) vs those without (51.47 ± 55.16 vs 28.09 ± 37.51 mg/dL, <em>p</em> < 0.001). However, when we divided those with premature vs no premature MI, no significant difference in Lp(a) level was observed (51.43 ± 57.82 vs 51.52 ± 53.18 mg/dL, <em>p</em> = 0.95). Lipid-lowering therapy (LLT) at baseline did not significantly affect Lp(a) level, with only significant differences for the highest doses of rosuvastatin (<em>p</em> < 0.05) and in those treated with ezetimibe (as a part of the combination therapy; 44.73 ± 54.94 vs 26.84 ± 37.11 mg/dL, <em>p</em> < 0.001). For selected patients (<em>n</em> = 43; 8.42 %) with at least two Lp(a) measurements (mean time distance: 7 ± 5 months, range 1–20 months) we did not observe statistically significant visit-to-visit variability (mean difference: 3.25 mg/dL; <em>r</em> = 0.079, <em>p</em> = 0.616). While dividing the whole population into those with Lp(a) ≤30 mg/dL and > 30 mg/dL, the only hyper-Lp(a)-emia prevalence differences were seen for FH diagnosis (12.88 vs 21.43; <em>p</em> = 0.017), MI prevalence (6.52 vs 16.90 %; <em>p</em> < 0.001), thyroid disease diagnosis (18.14 vs 26.76 %; <em>p</em> = 0.033) and ezetimi
{"title":"The prevalence, patients' characteristics, and hyper-Lp(a)-emia risk factors in the Polish population. The first results from the PMMHRI-Lp(a) Registry","authors":"Bożena Sosnowska , Joanna Lewek , Weronika Adach , Karina Mierczak , Agata Bielecka-Dąbrowa , Konrad Szosland , Arkadiusz Zygmunt , Jan Dąbrowski , Maciej Banach","doi":"10.1016/j.pcad.2024.08.004","DOIUrl":"10.1016/j.pcad.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>The knowledge on the prevalence of elevated lipoprotein(a) (Lp(a)), patients' characteristics, and nongenetic risk factors is scarce in some regions including Poland, the largest Central and Eastern European country. Thus, we aimed to present the results from the Lp(a) registry established in Poland's 2nd largest, supra-regional hospital - the Polish Mother's Memorial Hospital Research Institute (PMMHRI).</div></div><div><h3>Methods</h3><div>The PMMHRI-Lp(a)-Registry was established in January 2022. Since that time all consecutive patients of the Departments of Cardiology, Endocrinology, and outpatient cardiology, diabetology and metabolic clinics have been included. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management of elevated Lp(a) (2024). Lp(a) was determined using Sentinel's Lp(a) Ultra, an Immunoturbidimetric quantitative test (Sentinel, Milan, Italy), and the results are presented in mg/dL.</div></div><div><h3>Results</h3><div>511 patients were included in the registry between Jan 2022 and 15th May 2024. The mean age of patients was 48.21 years. Female patients represented 53.42 % of the population. Elevated Lp(a) levels above 30 and 50 mg/dL were detected in 142 (27.79 %), and 101 (19.8 %) patients, respectively. The mean Lp(a) level was 30.45 ± 42.50 mg/dL, with no significant sex differences [mean for men: 28.80 mg/dL; women: 31.89 mg/dL]. There were also no significant differences between those with and without: coronary artery disease (CAD), dyslipidemia, stroke, heart failure, cancer, diabetes, chronic kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with a history of myocardial infarction (MI) vs those without (51.47 ± 55.16 vs 28.09 ± 37.51 mg/dL, <em>p</em> < 0.001). However, when we divided those with premature vs no premature MI, no significant difference in Lp(a) level was observed (51.43 ± 57.82 vs 51.52 ± 53.18 mg/dL, <em>p</em> = 0.95). Lipid-lowering therapy (LLT) at baseline did not significantly affect Lp(a) level, with only significant differences for the highest doses of rosuvastatin (<em>p</em> < 0.05) and in those treated with ezetimibe (as a part of the combination therapy; 44.73 ± 54.94 vs 26.84 ± 37.11 mg/dL, <em>p</em> < 0.001). For selected patients (<em>n</em> = 43; 8.42 %) with at least two Lp(a) measurements (mean time distance: 7 ± 5 months, range 1–20 months) we did not observe statistically significant visit-to-visit variability (mean difference: 3.25 mg/dL; <em>r</em> = 0.079, <em>p</em> = 0.616). While dividing the whole population into those with Lp(a) ≤30 mg/dL and > 30 mg/dL, the only hyper-Lp(a)-emia prevalence differences were seen for FH diagnosis (12.88 vs 21.43; <em>p</em> = 0.017), MI prevalence (6.52 vs 16.90 %; <em>p</em> < 0.001), thyroid disease diagnosis (18.14 vs 26.76 %; <em>p</em> = 0.033) and ezetimi","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"86 ","pages":"Pages 54-61"},"PeriodicalIF":5.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.pcad.2023.12.001
Purpose
The study examined effects of 9-yrs of multicomponent exercise training during the menopause interval on cardiometabolic health in hypertensive women.
Methods
Sedentary, middle-aged women (n = 25) with mild-to-moderate arterial hypertension were randomized into a soccer training (multicomponent exercise; EX; n = 12) or control group (CON; n = 13). EX took part in 1-h football training sessions, 1–3 times weekly, for a consecutive 9-years, totaling ∼800 training sessions, while CON did not take part in regular exercise training. 22 participants entered menopause during the intervention.
Results
A time×group interaction effect (P = 0.04) of 8.5 mmHg in favour of EX was observed for changes in mean arterial pressure (MAP) (EX: −4.8 [−10.7;1.1] mmHg, CON +3.7 [−2.0;9.3] mmHg). Time×group interaction effects in favour of EX were also observed for total body weight (4.6 kg, P = 0.008, EX: +0.7 [−1.7;3.0] kg, CON: +5.3 [3.0;7.6] kg, total fat percentage (5.7%-points, P = 0.02; EX (−1.9 [−4.4;0.6] %-points; P = 0.13), CON +3.8 [1.4;6.2] %-points and for total cholesterol (1.2 mmol/l, P = 0.03, EX: −0.5 [−1.0;-0.1] mmol/l, CON: +0.7 [0.2;1.1] mmol/l. EX reduced (P = 0.02) plasma low-density lipoprotein cholesterol by −0.4 [−0.8;-0.1] mmol/l, whereas an increase (P = 0.01) of 0.4 [0.1;0.8] mmol/l occurred in CON (interaction. P < 0.001). A time×group interaction (P = 0.004) existed for changes in exercise capacity in favour of EX. Fasting glucose remained unchanged in EX and increased (P < 0.001) by 0.7 [0.4;1.0] mmol/l in CON (time×group interaction P = 0.02).
Conclusion
In conclusion, long-term multicomponent exercise training fully counteracts the detrimental effects of the menopause transition on cardiometabolic health in hypertensive women.
{"title":"Long-term continuous exercise training counteracts the negative impact of the menopause transition on cardiometabolic health in hypertensive women - a 9-year RCT follow-up","authors":"","doi":"10.1016/j.pcad.2023.12.001","DOIUrl":"10.1016/j.pcad.2023.12.001","url":null,"abstract":"<div><h3>Purpose</h3><p>The study examined effects of 9-yrs of multicomponent exercise training during the menopause interval on cardiometabolic health in hypertensive women.</p></div><div><h3>Methods</h3><p>Sedentary, middle-aged women (<em>n</em> = 25) with mild-to-moderate arterial hypertension were randomized into a soccer training (multicomponent exercise; EX; <em>n</em> = 12) or control group (CON; <em>n</em> = 13). EX took part in 1-h football training sessions, 1–3 times weekly, for a consecutive 9-years, totaling ∼800 training sessions, while CON did not take part in regular exercise training. 22 participants entered menopause during the intervention.</p></div><div><h3>Results</h3><p>A time×group interaction effect (<em>P</em> = 0.04) of 8.5 mmHg in favour of EX was observed for changes in mean arterial pressure (MAP) (EX: −4.8 [−10.7;1.1] mmHg, CON +3.7 [−2.0;9.3] mmHg). Time×group interaction effects in favour of EX were also observed for total body weight (4.6 kg, <em>P</em> = 0.008, EX: +0.7 [−1.7;3.0] kg, CON: +5.3 [3.0;7.6] kg, total fat percentage (5.7%-points, <em>P</em> = 0.02; EX (−1.9 [−4.4;0.6] %-points; <em>P</em> = 0.13), CON +3.8 [1.4;6.2] %-points and for total cholesterol (1.2 mmol/l, <em>P</em> = 0.03, EX: −0.5 [−1.0;-0.1] mmol/l, CON: +0.7 [0.2;1.1] mmol/l. EX reduced (<em>P</em> = 0.02) plasma low-density lipoprotein cholesterol by −0.4 [−0.8;-0.1] mmol/l, whereas an increase (<em>P</em> = 0.01) of 0.4 [0.1;0.8] mmol/l occurred in CON (interaction. <em>P</em> < 0.001). A time×group interaction (<em>P</em> = 0.004) existed for changes in exercise capacity in favour of EX. Fasting glucose remained unchanged in EX and increased (<em>P</em> < 0.001) by 0.7 [0.4;1.0] mmol/l in CON (time×group interaction <em>P</em> = 0.02).</p></div><div><h3>Conclusion</h3><p>In conclusion, long-term multicomponent exercise training fully counteracts the detrimental effects of the menopause transition on cardiometabolic health in hypertensive women.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"85 ","pages":"Pages 54-62"},"PeriodicalIF":5.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0033062023001238/pdfft?md5=8450c2e1bcf241a5a6b56135466c3567&pid=1-s2.0-S0033062023001238-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138556943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.pcad.2024.01.021
According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of </≥80 years life expectancy (p < 0.001) and retained in the multivariate regression (p < 0.05). A better understanding of the driving forces that increase healthy living behaviors should be a primary goal in the effort to increase U.S. life expectancy: an individualized approach recognizing unique regional cultures may significantly improve adoption and maintenance of desirable health behaviors and outcomes.
根据世界卫生组织的数据，目前有 30 个国家的预期寿命≥80 岁：美国不在其中。目前的分析评估了主要生活方式行为和特征预测预期寿命≥80 岁的能力。在接受评估的 3066 个美国县中，只有 577 个（19%）的预期寿命≥80 岁。这些县的预期寿命明显较高（81 ± 3 岁 vs. 76 ± 2 岁），不运动（20.7 ± 3.9 vs. 27.0 ± 4.7%）、经常吸烟（15.9 ± 3.1 vs. 21.1 ± 3.6%）、肥胖（31.7 ± 4.7 vs. 37.3 ± 3.9%）和难以获得健康食品（7.1 ± 6.8 vs. 8.4 ± 6.6%）的人口比例也较低（所有数据均为 0.001）。二元逻辑回归显示，目前吸烟的成人百分比、肥胖百分比、不运动百分比和获得健康食品的机会有限百分比都是</≥80 岁预期寿命的重要单变量预测因素（p <0.001），并在多变量回归中得以保留（p <0.05）。更好地了解增加健康生活行为的驱动力应该是提高美国人预期寿命的首要目标：认识到独特地区文化的个性化方法可能会显著提高采用和维持理想健康行为和结果的能力。
{"title":"Predicting life expectancy in the United States: The importance of healthy living behaviors and residential geography","authors":"","doi":"10.1016/j.pcad.2024.01.021","DOIUrl":"10.1016/j.pcad.2024.01.021","url":null,"abstract":"<div><p>According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all <em>p</em><span> < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of </≥80 years life expectancy (</span><em>p</em><span> < 0.001) and retained in the multivariate regression (</span><em>p</em> < 0.05). A better understanding of the driving forces that increase healthy living behaviors should be a primary goal in the effort to increase U.S. life expectancy: an individualized approach recognizing unique regional cultures may significantly improve adoption and maintenance of desirable health behaviors and outcomes.</p></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"85 ","pages":"Pages 26-30"},"PeriodicalIF":5.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139668723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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