R. Providencia, Hussam Ali, A. Creta, Sérgio Barra, P. Kanagaratnam, Richard J Schilling, M. Farkowski, R. Cappato
Catheter ablation is the most effective rhythm-control option in patients with atrial fibrillation (AF) and is currently considered and option mainly for improving symptoms. We aimed to assess the impact of catheter ablation on hard clinical outcomes. We performed a systematic review of randomized controlled trials comparing catheter ablation vs. optimized medical treatment. We searched MEDLINE, EMBASE and CENTRAL on January 8th, 2024, for trials published ≤10 years. We pooled data risk ratio (RR) & mean differences (MD), with 95% confidence interval (CI), and calculated the Number Needed to Treat (NNT). Sub-group and sensitivity analyses were performed for presence/absence of heart failure (HF), paroxysmal/persistent AF, early ablation, higher/lower quality, and published ≤5 vs >5 years. Twenty-two randomized controlled trials were identified, including 6,400 patients followed for 6 to 52 months. All primary endpoints were significantly reduced by catheter ablation vs. medical management: all-cause hospitalization (RR=0.57, 95%CI 0.39-0.85, P=0.006), AF relapse (RR=0.48, 95%CI 0.39-0.58, P<0.00001), all-cause mortality (RR=0.69, 95%CI 0.56-0.86, P=0.0007, NNT=44.7) driven trials with HF patients. A benefit was also demonstrated for all secondary endpoints: cardiovascular mortality (RR=0.55, 95%CI 0.34-0.87), cardiovascular (RR=0.83, 95%CI 0.71-0.96) and HF hospitalizations (RR=0.71, 95%CI 0.56-0.89), AF burden (MD=20.6%, 95%CI 5.6-35.5), LVEF recovery (MD=5.7%, 95%CI 3.5-7.9) and quality of life (MLHFQ, AFEQT & SF-36 scales). Catheter ablation significantly reduced hospitalizations, AF burden and relapse, and improved quality of life. An impact on hard clinical outcomes, with an important mortality reduction and improvement in LVEF, was seen for patients with AF and HF.
{"title":"Catheter ablation for atrial fibrillation and impact on clinical outcomes","authors":"R. Providencia, Hussam Ali, A. Creta, Sérgio Barra, P. Kanagaratnam, Richard J Schilling, M. Farkowski, R. Cappato","doi":"10.1093/ehjopen/oeae058","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae058","url":null,"abstract":"\u0000 \u0000 \u0000 Catheter ablation is the most effective rhythm-control option in patients with atrial fibrillation (AF) and is currently considered and option mainly for improving symptoms. We aimed to assess the impact of catheter ablation on hard clinical outcomes.\u0000 \u0000 \u0000 \u0000 We performed a systematic review of randomized controlled trials comparing catheter ablation vs. optimized medical treatment. We searched MEDLINE, EMBASE and CENTRAL on January 8th, 2024, for trials published ≤10 years. We pooled data risk ratio (RR) & mean differences (MD), with 95% confidence interval (CI), and calculated the Number Needed to Treat (NNT). Sub-group and sensitivity analyses were performed for presence/absence of heart failure (HF), paroxysmal/persistent AF, early ablation, higher/lower quality, and published ≤5 vs >5 years.\u0000 \u0000 \u0000 \u0000 Twenty-two randomized controlled trials were identified, including 6,400 patients followed for 6 to 52 months. All primary endpoints were significantly reduced by catheter ablation vs. medical management: all-cause hospitalization (RR=0.57, 95%CI 0.39-0.85, P=0.006), AF relapse (RR=0.48, 95%CI 0.39-0.58, P<0.00001), all-cause mortality (RR=0.69, 95%CI 0.56-0.86, P=0.0007, NNT=44.7) driven trials with HF patients. A benefit was also demonstrated for all secondary endpoints: cardiovascular mortality (RR=0.55, 95%CI 0.34-0.87), cardiovascular (RR=0.83, 95%CI 0.71-0.96) and HF hospitalizations (RR=0.71, 95%CI 0.56-0.89), AF burden (MD=20.6%, 95%CI 5.6-35.5), LVEF recovery (MD=5.7%, 95%CI 3.5-7.9) and quality of life (MLHFQ, AFEQT & SF-36 scales).\u0000 \u0000 \u0000 \u0000 Catheter ablation significantly reduced hospitalizations, AF burden and relapse, and improved quality of life. An impact on hard clinical outcomes, with an important mortality reduction and improvement in LVEF, was seen for patients with AF and HF.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"51 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644566","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}
I. Landi, L. Guerritore, A. Iannaccone, A. Ricotti, P. Rola, M. Garrone
In acute decompensated heart failure (HF), systemic venous congestion contributes to patients’ symptoms and hospital admissions. The purpose of our study is to determine if venous congestion, examined using the Venous Excess Ultrasound (VExUS) score, predicts heart failure-related hospitalisation and mortality in patients admitted to the Emergency Department (ED) with acute decompensated heart failure. 50 patients admitted for acute HF in ED underwent ultrasound assessment according to the VExUS score within the first 24 hours and 72 hours. All patients were followed-up with a telephone call at 30 and 60 days after the hospital discharge. On admission, 56% had a VEXUS score 3. After 72 hours, 32% had no more signs of congestion at the Doppler VEXUS examination (VCI < 2 cm, VEXUS score 0), a similar percentage still exhibited a VEXUS score 3 despite therapy. 80% of patients were hospitalised after the admission to the ED, whilst six (15%) died in-hospital, all exhibited a first assessment VExUS 3 score. No patient with a VExUS score below 3 died during the study. During short-term follow-up, 18 patients were re-admitted to ED for acute decompensated HF. 94% of the re-admitted patients had a VExUS score 3 at the Doppler assessment at the first ED admission. Severe venous congestion, defined as a VExUS score of 3 at the initial assessment of patients with acute decompensated HF predicts in-patient mortality, HF-related death, and early readmission.
{"title":"Assessment of Venous Congestion with Venous Excess Ultrasound (VExUS) score in the Prognosis of Acute Heart Failure in the Emergency Department: a Prospective Study","authors":"I. Landi, L. Guerritore, A. Iannaccone, A. Ricotti, P. Rola, M. Garrone","doi":"10.1093/ehjopen/oeae050","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae050","url":null,"abstract":"\u0000 \u0000 \u0000 In acute decompensated heart failure (HF), systemic venous congestion contributes to patients’ symptoms and hospital admissions. The purpose of our study is to determine if venous congestion, examined using the Venous Excess Ultrasound (VExUS) score, predicts heart failure-related hospitalisation and mortality in patients admitted to the Emergency Department (ED) with acute decompensated heart failure.\u0000 \u0000 \u0000 \u0000 50 patients admitted for acute HF in ED underwent ultrasound assessment according to the VExUS score within the first 24 hours and 72 hours. All patients were followed-up with a telephone call at 30 and 60 days after the hospital discharge.\u0000 \u0000 \u0000 \u0000 On admission, 56% had a VEXUS score 3. After 72 hours, 32% had no more signs of congestion at the Doppler VEXUS examination (VCI < 2 cm, VEXUS score 0), a similar percentage still exhibited a VEXUS score 3 despite therapy. 80% of patients were hospitalised after the admission to the ED, whilst six (15%) died in-hospital, all exhibited a first assessment VExUS 3 score. No patient with a VExUS score below 3 died during the study. During short-term follow-up, 18 patients were re-admitted to ED for acute decompensated HF. 94% of the re-admitted patients had a VExUS score 3 at the Doppler assessment at the first ED admission.\u0000 \u0000 \u0000 \u0000 Severe venous congestion, defined as a VExUS score of 3 at the initial assessment of patients with acute decompensated HF predicts in-patient mortality, HF-related death, and early readmission.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"29 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662289","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}
{"title":"Extensive Lipid Lowering, Thickness of the Fibrous Caps, and the Plaque Stability","authors":"Shinya Goto, Shinichi Goto","doi":"10.1093/ehjopen/oeae056","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae056","url":null,"abstract":"","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"8 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141681260","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}
J. Lewek, A. Bielecka-Dabrowa, Peter P. Toth, Maciej Banach
Over several decades the approach to treating dyslipidemias during pregnancy remains essentially unchanged. The lack of advancement in this field is mostly related to the fact that we lack clinical trials of pregnant patients both with available as well as new therapies. While there are numerous novel therapies developed for nonpregnant patients, there are still many limitations in dyslipidemia treatment during pregnancy. Besides pharmacotherapy and careful clinical assessment, the initiation of behavioral modifications as well as pre-conception management are very important. Among the various lipid-lowering medications, bile acid sequestrants are the only ones officially approved for treating dyslipidemia in pregnancy. Ezetimibe and fenofibrate can be considered if their benefits outweigh potential risks. Statins are still considered contraindicated, primarily due to animal studies and human case reports. However, recent systematic reviews and meta-analyses as well as data on familial hypercholesterolemia (FH) in pregnant patients have indicated that their use may not be harmful and could even be beneficial in certain selected cases. This is especially relevant for pregnant patients at very high cardiovascular risk, such as those who have already experienced an acute cardiovascular event or have homozygous or severe forms of heterozygous FH. In these cases, the decision to continue therapy during pregnancy should weigh the potential risks of discontinuation. Bempedoic acid, olezarsen, evinacumab, evolocumab and alirocumab, and inclisiran, are options to consider just before and after pregnancy is completed. In conclusion, decisions regarding lipid-lowering therapy for pregnant patients should be personalized. Despite the challenges in designing and conducting studies in pregnant women, there is a strong need to establish the safety and efficacy of dyslipidemia treatment during pregnancy.
{"title":"Dyslipidemia management in pregnant patients: a 2024 update","authors":"J. Lewek, A. Bielecka-Dabrowa, Peter P. Toth, Maciej Banach","doi":"10.1093/ehjopen/oeae032","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae032","url":null,"abstract":"\u0000 Over several decades the approach to treating dyslipidemias during pregnancy remains essentially unchanged. The lack of advancement in this field is mostly related to the fact that we lack clinical trials of pregnant patients both with available as well as new therapies. While there are numerous novel therapies developed for nonpregnant patients, there are still many limitations in dyslipidemia treatment during pregnancy.\u0000 Besides pharmacotherapy and careful clinical assessment, the initiation of behavioral modifications as well as pre-conception management are very important. Among the various lipid-lowering medications, bile acid sequestrants are the only ones officially approved for treating dyslipidemia in pregnancy. Ezetimibe and fenofibrate can be considered if their benefits outweigh potential risks. Statins are still considered contraindicated, primarily due to animal studies and human case reports. However, recent systematic reviews and meta-analyses as well as data on familial hypercholesterolemia (FH) in pregnant patients have indicated that their use may not be harmful and could even be beneficial in certain selected cases. This is especially relevant for pregnant patients at very high cardiovascular risk, such as those who have already experienced an acute cardiovascular event or have homozygous or severe forms of heterozygous FH. In these cases, the decision to continue therapy during pregnancy should weigh the potential risks of discontinuation. Bempedoic acid, olezarsen, evinacumab, evolocumab and alirocumab, and inclisiran, are options to consider just before and after pregnancy is completed.\u0000 In conclusion, decisions regarding lipid-lowering therapy for pregnant patients should be personalized. Despite the challenges in designing and conducting studies in pregnant women, there is a strong need to establish the safety and efficacy of dyslipidemia treatment during pregnancy.","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652877","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}
C. Witt, R. Mols, István Bakos, E. Horváth-Puhó, Bo Christensen, B. Løgstrup, Jens Cosedis Nielsen, H. Eiskjær
We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional health care utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000-2017. Data on chronic conditions, use of health care services and demographics were obtained from Danish national administrative and health registries. Health care utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using negative binomial regression model. The association between of SEP, multimorbidity and prognostic outcomes were analyzed using Cox proportional hazards regression. We followed 2.007 patients (median age of 70), 79% were males, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level) for 5.2 (IQR; 2.2-7.3) years. In adjusted regression models, higher number of chronic conditions were associated with increased health care utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had higher number of chronic conditions, but SEP had limited influence on health care utilization. Patients living alone and those with low educational level had a trend towards higher risk of all-cause mortality (adjusted hazard ratio: 1.17, 95% confidence interval [CI] 1.03-1.33 and 1.09, 95% CI 0.96-1.24). Multimorbidity increased the use of cross-sectional health care services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend toward higher risk of mortality after CRT implantation.
{"title":"Influence of multimorbidity and socioeconomic position on long-term health care utilization and prognosis in patients after cardiac resynchronization therapy implantation","authors":"C. Witt, R. Mols, István Bakos, E. Horváth-Puhó, Bo Christensen, B. Løgstrup, Jens Cosedis Nielsen, H. Eiskjær","doi":"10.1093/ehjopen/oeae029","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae029","url":null,"abstract":"\u0000 \u0000 \u0000 We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional health care utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation.\u0000 \u0000 \u0000 \u0000 We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000-2017. Data on chronic conditions, use of health care services and demographics were obtained from Danish national administrative and health registries. Health care utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using negative binomial regression model. The association between of SEP, multimorbidity and prognostic outcomes were analyzed using Cox proportional hazards regression.\u0000 We followed 2.007 patients (median age of 70), 79% were males, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level) for 5.2 (IQR; 2.2-7.3) years. In adjusted regression models, higher number of chronic conditions were associated with increased health care utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had higher number of chronic conditions, but SEP had limited influence on health care utilization. Patients living alone and those with low educational level had a trend towards higher risk of all-cause mortality (adjusted hazard ratio: 1.17, 95% confidence interval [CI] 1.03-1.33 and 1.09, 95% CI 0.96-1.24).\u0000 \u0000 \u0000 \u0000 Multimorbidity increased the use of cross-sectional health care services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend toward higher risk of mortality after CRT implantation.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687075","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}
F. Ricci, A. Larsson, T. Ruge, Kristian Galanti, V. Hamrefors, R. Sutton, Brian Olshansky, Arthur Fedorowski, M. Johansson
The pathophysiology of orthostatic hypotension (OH), a common clinical condition, associated with adverse outcomes, is incompletely understood. We examined the relationship between OH and circulating endostatin, an endogenous angiogenesis inhibitor with antitumor effects proposed to be involved in blood pressure (BP) regulation. We compared endostatin levels in 146 patients with OH and 150 controls. A commercial chemiluminescence sandwich immunoassay was used to measure circulating levels of endostatin. Linear and multivariate logistic regressions were conducted to test the association between endostatin and OH. Endostatin levels were significantly higher in OH patients (59,024 ± 2513 pg/mL) versus controls (44,090 ± 1978 pg/mL, p<0.001). A positive linear correlation existed between endostatin and the magnitude of systolic BP decline upon standing (p<0.001). Using multivariate analysis, endostatin was associated with OH (adjusted odds ratio per 10% increase of endostatin in the whole study population = 1.264, 95%CI 1.141-1.402), regardless of age, sex, prevalent cancer, and cardiovascular disease, as well as traditional cardiovascular risk factors. Circulating endostatin is elevated in patients with orthostatic hypotension and may serve as a potential clinical marker of increased cardiovascular risk in patients with orthostatic hypotension. Our findings call for external validation. Further research is warranted to clarify the underlying pathophysiological mechanisms.
{"title":"Orthostatic hypotension is Associated with Higher Levels of Circulating Endostatin","authors":"F. Ricci, A. Larsson, T. Ruge, Kristian Galanti, V. Hamrefors, R. Sutton, Brian Olshansky, Arthur Fedorowski, M. Johansson","doi":"10.1093/ehjopen/oeae030","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae030","url":null,"abstract":"\u0000 \u0000 \u0000 The pathophysiology of orthostatic hypotension (OH), a common clinical condition, associated with adverse outcomes, is incompletely understood. We examined the relationship between OH and circulating endostatin, an endogenous angiogenesis inhibitor with antitumor effects proposed to be involved in blood pressure (BP) regulation.\u0000 \u0000 \u0000 \u0000 We compared endostatin levels in 146 patients with OH and 150 controls. A commercial chemiluminescence sandwich immunoassay was used to measure circulating levels of endostatin. Linear and multivariate logistic regressions were conducted to test the association between endostatin and OH.\u0000 \u0000 \u0000 \u0000 Endostatin levels were significantly higher in OH patients (59,024 ± 2513 pg/mL) versus controls (44,090 ± 1978 pg/mL, p<0.001). A positive linear correlation existed between endostatin and the magnitude of systolic BP decline upon standing (p<0.001). Using multivariate analysis, endostatin was associated with OH (adjusted odds ratio per 10% increase of endostatin in the whole study population = 1.264, 95%CI 1.141-1.402), regardless of age, sex, prevalent cancer, and cardiovascular disease, as well as traditional cardiovascular risk factors.\u0000 \u0000 \u0000 \u0000 Circulating endostatin is elevated in patients with orthostatic hypotension and may serve as a potential clinical marker of increased cardiovascular risk in patients with orthostatic hypotension. Our findings call for external validation. Further research is warranted to clarify the underlying pathophysiological mechanisms.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717623","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}
Regina Dalmau, A. Cordero, Luís Masana, Emilio Ruiz, Antoni Sicras-mainar, J.R. Gonzalez-Juanatey
The retrospective NEPTUNO study evaluated the effectiveness of the CNIC-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD). Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACE) after two years. After matching, 1,080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared to Monocomponents, Equipotent drugs, and Other therapies cohorts (16.1% vs 24%, 24.4%, and 24.3%, respectively; P<0.001). The hazard ratios (HR) for recurrent MACE were higher in Monocomponents (HR=1.12; P=0.042), Equipotent drugs (HR=1.14; P=0.031), and Other therapies cohorts (HR=1.17; P=0.016) compared to the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in low-density lipoprotein cholesterol (-56.1% vs -43.6%, -33.3%, and -33.2% in the Monocomponents, Equipotent drugs, and Other therapies, respectively; P<0.001) and systolic blood pressure (-13.7% vs -11.5%, -10.6%, and -9.1% in the CNIC-polypill, Monocomponents, Equipotent drugs, and Other therapies, respectively; P<0.001) compared to other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2,317–€2,407 cost savings per event prevented. In IHD, the CNIC-Polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost-saving compared to other therapeutic options.
回顾性 NEPTUNO 研究评估了 CNIC 多联疗法（包括乙酰水杨酸、雷米普利和阿托伐他汀）与其他治疗方法在心血管疾病二级预防中的有效性。在这项子研究中，重点是缺血性心脏病（IHD）患者亚组。 接受四种策略治疗的患者：CNIC-多聚酶抑制剂、其单成分散剂、等效药物和其他疗法。主要终点是两年后复发主要心血管不良事件（MACE）的发生率。经过匹配后，每个队列共纳入了 1080 名患者。与单克隆抗体、等效药物和其他疗法队列相比，CNIC-多聚酶抑制剂队列的复发性MACE发生率明显较低（分别为16.1% vs 24%、24.4%和24.3%；P<0.001）。与 CNIC 聚能丸相比，单组分（HR=1.12；P=0.042）、等效药物（HR=1.14；P=0.031）和其他疗法（HR=1.17；P=0.016）组别中复发性 MACE 的危险比（HR）更高，需要治疗 12 例患者才能预防 MACE。CNIC-多聚酶抑制剂对低密度脂蛋白胆固醇的降低幅度更大（单组分、等效药物和其他疗法分别为-56.1% vs -43.6%、-33.3%和-33.2%；P<0.001）和收缩压（CNIC-多丸、单一成分、等效药物和其他疗法分别为-13.7% vs -11.5%、-10.6%和-9.1%；P<0.001）。与其他治疗方案相比，CNIC-多聚酶抑制剂干预的成本更低，效果更好，每预防一起事件可节省成本2317-2407欧元。 与其他治疗方案相比，CNIC-多聚酶抑制剂是心肌缺血二级预防治疗指南推荐的典范，可带来更好的疗效并节约成本。
{"title":"The CNIC-Polypill (acetylsalicylic acid, atorvastatin, and ramipril), an effective and cost-saving secondary prevention strategy compared with other therapeutic options in patients with ischemic heart disease","authors":"Regina Dalmau, A. Cordero, Luís Masana, Emilio Ruiz, Antoni Sicras-mainar, J.R. Gonzalez-Juanatey","doi":"10.1093/ehjopen/oeae027","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae027","url":null,"abstract":"\u0000 \u0000 \u0000 The retrospective NEPTUNO study evaluated the effectiveness of the CNIC-polypill (including acetylsalicylic acid, ramipril, and atorvastatin) vs other therapeutic approaches in secondary prevention for cardiovascular (CV) disease. In this substudy, the focus was on the subgroup of patients with ischaemic heart disease (IHD).\u0000 \u0000 \u0000 \u0000 Patients on four strategies: CNIC-polypill, its monocomponents as loose medications, equipotent medications, and other therapies. The primary endpoint was the incidence of recurrent major adverse CV events (MACE) after two years. After matching, 1,080 patients were included in each cohort. The CNIC-polypill cohort had a significantly lower incidence of recurrent MACE compared to Monocomponents, Equipotent drugs, and Other therapies cohorts (16.1% vs 24%, 24.4%, and 24.3%, respectively; P<0.001). The hazard ratios (HR) for recurrent MACE were higher in Monocomponents (HR=1.12; P=0.042), Equipotent drugs (HR=1.14; P=0.031), and Other therapies cohorts (HR=1.17; P=0.016) compared to the CNIC-polypill, with a number needed to treat of 12 patients to prevent a MACE. The CNIC-polypill demonstrated a greater reduction in low-density lipoprotein cholesterol (-56.1% vs -43.6%, -33.3%, and -33.2% in the Monocomponents, Equipotent drugs, and Other therapies, respectively; P<0.001) and systolic blood pressure (-13.7% vs -11.5%, -10.6%, and -9.1% in the CNIC-polypill, Monocomponents, Equipotent drugs, and Other therapies, respectively; P<0.001) compared to other cohorts. The CNIC-polypill intervention was less costly and more effective than any other therapeutic option, with €2,317–€2,407 cost savings per event prevented.\u0000 \u0000 \u0000 \u0000 In IHD, the CNIC-Polypill exemplifies a guideline-recommended secondary prevention treatment linked to better outcomes and cost-saving compared to other therapeutic options.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"49 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755151","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}
Omar Abdel-Razek, R. Jung, P. Di Santo, R. Mathew, B. Hibbert
{"title":"Impact of hypoxic hepatitis in cardiogenic shock: A substudy of the DOREMI trial","authors":"Omar Abdel-Razek, R. Jung, P. Di Santo, R. Mathew, B. Hibbert","doi":"10.1093/ehjopen/oeae024","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae024","url":null,"abstract":"","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":" 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140211413","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}
I. Turnbull, C. F. Camm, J. Halsey, H. Du, D. Bennett, Yiping Chen, Canqing Yu, D. Sun, Xiaohong Liu, Liming Li, Zhengming Chen, R. Clarke, Junshi Chen, Zhengming Chen (PI), R. Clarke, R. Collins, Liming Li (PI), Chen Wang, Jun Lv, R. Peto, R. Walters, D. Avery, D. Bennett, Ruth Boxall, Ka Hung Chan, Yiping Chen, Zhengming Chen, J. Clarke, R. Clarke, H. Du, A. Mohamed, H. Fry, S. Gilbert, P. Im, A. Iona, M. Kakkoura, C. Kartsonaki, H. Lam, Kuang Lin, James Liu, M. Mazidi, I. Millwood, S. Morris, Qunhua Nie, A. Pozarickij, Paul Ryder, S. Said, D. Schmidt, Becky Stevens, I. Turnbull, Baihan Wang, Lin Wang, N. Wright, Ling Yang, Xiaoming Yang, Pang Yao, Xiao Han, C. Hou, Q. Xia, Chao Liu, Pei Pei, Dianjanyi Sun, Canqing Yu, N. Chen, Duo Liu, Zhenzhu Tang, Ningyu Chen, Qilian Jiang, J. Lan, Mingqiang Li, Yun Liu, Fanwen Meng, Jinhuai Meng, Rong Pan, Yulu Qin, Ping Wang, Sisi Wang, L. Wei, Liyuan Zhou, C. Dong, Pengfei Ge, X. Ren, Zhongxiao Li, Enke Mao, Tao Wang, Hui Zhang, Xi Zhang, Jinyan Chen, Ximin Hu, Xi
The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors, but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other ECG abnormalities in the China Kadoorie Biobank. A random sample of 25,239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-2014. Participants were followed-up for 5 years for incident stroke, ischaemic heart disease (IHD), heart failure (HF) and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area. Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, ≥ 5, respectively). AF was associated with 2-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71–2.69) and stroke (1.88; 1.44–2.47), and a 4-fold higher HR for HF (3.79; 2.21–6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD and CHA₂DS₂-VASc scores ≥2 (36.7% vs 36.2% vs 37.7%, respectively), but was 2-fold greater than for ischaemia (19.4%), LVH (18.0%) or normal ECG (14.1%), respectively. The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.
{"title":"Correlates and consequences of atrial fibrillation in a prospective study of 25,000 participants in the China Kadoorie Biobank","authors":"I. Turnbull, C. F. Camm, J. Halsey, H. Du, D. Bennett, Yiping Chen, Canqing Yu, D. Sun, Xiaohong Liu, Liming Li, Zhengming Chen, R. Clarke, Junshi Chen, Zhengming Chen (PI), R. Clarke, R. Collins, Liming Li (PI), Chen Wang, Jun Lv, R. Peto, R. Walters, D. Avery, D. Bennett, Ruth Boxall, Ka Hung Chan, Yiping Chen, Zhengming Chen, J. Clarke, R. Clarke, H. Du, A. Mohamed, H. Fry, S. Gilbert, P. Im, A. Iona, M. Kakkoura, C. Kartsonaki, H. Lam, Kuang Lin, James Liu, M. Mazidi, I. Millwood, S. Morris, Qunhua Nie, A. Pozarickij, Paul Ryder, S. Said, D. Schmidt, Becky Stevens, I. Turnbull, Baihan Wang, Lin Wang, N. Wright, Ling Yang, Xiaoming Yang, Pang Yao, Xiao Han, C. Hou, Q. Xia, Chao Liu, Pei Pei, Dianjanyi Sun, Canqing Yu, N. Chen, Duo Liu, Zhenzhu Tang, Ningyu Chen, Qilian Jiang, J. Lan, Mingqiang Li, Yun Liu, Fanwen Meng, Jinhuai Meng, Rong Pan, Yulu Qin, Ping Wang, Sisi Wang, L. Wei, Liyuan Zhou, C. Dong, Pengfei Ge, X. Ren, Zhongxiao Li, Enke Mao, Tao Wang, Hui Zhang, Xi Zhang, Jinyan Chen, Ximin Hu, Xi","doi":"10.1093/ehjopen/oeae021","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae021","url":null,"abstract":"\u0000 \u0000 \u0000 The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors, but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other ECG abnormalities in the China Kadoorie Biobank.\u0000 \u0000 \u0000 \u0000 A random sample of 25,239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-2014. Participants were followed-up for 5 years for incident stroke, ischaemic heart disease (IHD), heart failure (HF) and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area.\u0000 \u0000 \u0000 \u0000 Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, ≥ 5, respectively). AF was associated with 2-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71–2.69) and stroke (1.88; 1.44–2.47), and a 4-fold higher HR for HF (3.79; 2.21–6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD and CHA₂DS₂-VASc scores ≥2 (36.7% vs 36.2% vs 37.7%, respectively), but was 2-fold greater than for ischaemia (19.4%), LVH (18.0%) or normal ECG (14.1%), respectively.\u0000 \u0000 \u0000 \u0000 The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"2 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140229807","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}
R. Kirwan, M. Mazidi, Tom Butler, F. P. de Heredia, Gregory Y H Lip, Ian G Davies
Reduced muscle mass and strength is frequently associated with both alterations in blood lipids and poorer cardiometabolic outcomes in epidemiological studies; however, a causal association cannot be determined from such observations. Two-sample Mendelian randomization (MR) was applied to assess the association of genetically determined appendicular lean mass (ALM) and handgrip strength (HGS) with serum lipid particle diameter. MR was implemented using summary-level data from the largest genome-wide association studies (GWAS) on ALM (n = 450,243), HGS (n = 223,315) and lipoprotein (LDL, VLDL and HDL) particle diameters (n = 115,078). Inverse variance weighted method (IVW) was used to calc ulate the causal estimates. Weighted median (WM)-based method, and MR-Egger, leave-one-out method were applied as sensitivity analysis. Greater ALM had a statistically significant positive effect on HDL particle diameter (MR-Egger: β=0.055, SE = 0.031, p = 0.081; IVW: β=0.068, SE = 0.014, p < 0.001), and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β= −0.114, SE = 0.039, p = 0.003; IVW: β= −0.081, SE = 0.017, p < 0.001). Similarly, greater HGS had a statistically significant positive effect on HDL particle diameter (MR-Egger: β=0.433, SE = 0.184, p = 0.019; IVW: β=0.121, SE = 0.052, p = 0.021), and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β=−0.416, SE = 0.163, p = 0.011; IVW: β=−0.122, SE = 0.046, p = 0.009). There was no statistically significant effect of either ALM or HGS on LDL particle diameter. There were potentially causal associations between both increasing ALM and HGS, and increasing HDL particle size and decreasing VLDL particle size. These causal associations may offer possibilities for interventions aimed at improving CVD risk profile.
{"title":"The association of appendicular lean mass and grip strength with LDL, VLDL and HDL particle diameter: a Mendelian randomization study of the UK Biobank cohort","authors":"R. Kirwan, M. Mazidi, Tom Butler, F. P. de Heredia, Gregory Y H Lip, Ian G Davies","doi":"10.1093/ehjopen/oeae019","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae019","url":null,"abstract":"\u0000 \u0000 \u0000 Reduced muscle mass and strength is frequently associated with both alterations in blood lipids and poorer cardiometabolic outcomes in epidemiological studies; however, a causal association cannot be determined from such observations. Two-sample Mendelian randomization (MR) was applied to assess the association of genetically determined appendicular lean mass (ALM) and handgrip strength (HGS) with serum lipid particle diameter.\u0000 \u0000 \u0000 \u0000 MR was implemented using summary-level data from the largest genome-wide association studies (GWAS) on ALM (n = 450,243), HGS (n = 223,315) and lipoprotein (LDL, VLDL and HDL) particle diameters (n = 115,078). Inverse variance weighted method (IVW) was used to calc ulate the causal estimates. Weighted median (WM)-based method, and MR-Egger, leave-one-out method were applied as sensitivity analysis.\u0000 \u0000 \u0000 \u0000 Greater ALM had a statistically significant positive effect on HDL particle diameter (MR-Egger: β=0.055, SE = 0.031, p = 0.081; IVW: β=0.068, SE = 0.014, p < 0.001), and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β= −0.114, SE = 0.039, p = 0.003; IVW: β= −0.081, SE = 0.017, p < 0.001). Similarly, greater HGS had a statistically significant positive effect on HDL particle diameter (MR-Egger: β=0.433, SE = 0.184, p = 0.019; IVW: β=0.121, SE = 0.052, p = 0.021), and a statistically significant negative effect on VLDL particle diameter (MR-Egger: β=−0.416, SE = 0.163, p = 0.011; IVW: β=−0.122, SE = 0.046, p = 0.009). There was no statistically significant effect of either ALM or HGS on LDL particle diameter.\u0000 \u0000 \u0000 \u0000 There were potentially causal associations between both increasing ALM and HGS, and increasing HDL particle size and decreasing VLDL particle size. These causal associations may offer possibilities for interventions aimed at improving CVD risk profile.\u0000","PeriodicalId":505595,"journal":{"name":"European Heart Journal Open","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140244248","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}
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