-
1.
Study of cardiovascular disease prediction model based on random forest in eastern China.
Yang, L, Wu, H, Jin, X, Zheng, P, Hu, S, Xu, X, Yu, W, Yan, J
Scientific reports. 2020;(1):5245
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide and a major public health concern. CVD prediction is one of the most effective measures for CVD control. In this study, 29930 subjects with high-risk of CVD were selected from 101056 people in 2014, regular follow-up was conducted using electronic health record system. Logistic regression analysis showed that nearly 30 indicators were related to CVD, including male, old age, family income, smoking, drinking, obesity, excessive waist circumference, abnormal cholesterol, abnormal low-density lipoprotein, abnormal fasting blood glucose and else. Several methods were used to build prediction model including multivariate regression model, classification and regression tree (CART), Naïve Bayes, Bagged trees, Ada Boost and Random Forest. We used the multivariate regression model as a benchmark for performance evaluation (Area under the curve, AUC = 0.7143). The results showed that the Random Forest was superior to other methods with an AUC of 0.787 and achieved a significant improvement over the benchmark. We provided a CVD prediction model for 3-year risk assessment of CVD. It was based on a large population with high risk of CVD in eastern China using Random Forest algorithm, which would provide reference for the work of CVD prediction and treatment in China.
-
2.
Clot Lysis Time Predicts Stroke During Anticoagulant Therapy in Patients with Atrial Fibrillation.
Drabik, L, Konieczyńska, M, Undas, A
The Canadian journal of cardiology. 2020;(1):119-126
Abstract
BACKGROUND Formation of dense fibrin clots has been reported in both atrial fibrillation (AF) and ischemic stroke. We have previously demonstrated that such clot properties can predict thromboembolism and major bleeding in AF patients treated with vitamin K antagonists (VKAs). In this longitudinal cohort study, we evaluated whether impaired fibrinolysis is associated with clinical outcomes in AF. METHODS In 236 patients with AF receiving VKAs, we measured ex vivo plasma clot lysis time (CLT), a measure of global fibrinolysis along, with von Willebrand factor antigen (vWF), plasminogen activator inhibitor 1 antigen (PAI-1), and other fibrinolysis modulators. The primary outcome were ischemic cerebrovascular events. Secondary end points were death and major bleeding. RESULTS During a median follow-up time of 4.3 (interquartile range 3.7-4.8) years, annual rates of death, ischemic cerebrovascular events, and major bleeding were 1.48%, 2.96%, and 3.45%, respectively. Patients with CLT in the fourth quartile (> 115 min) had 8-fold higher stroke or transient ischemic attack (TIA) rates compared with the other patients (8.67% vs 1.1%; P < 0.0001). CLT correlated with PAI-1 and vWF (r = 0.59; P < 0.0001 for both). In the multivariate Cox regression analysis adjusted for potential confounders, the independent predictors of stroke or TIA were CLT > 115 minutes (hazard ratio [HR] 7.67, 95% confidence interval [CI] 2.78-21.17; P < 0.0001), PAI-1 (HR 1.16, 95% 1.05-1.28; P = 0.003), and CHA2DS2-VASc score ≥3 (HR 5.18, 95% 1.76-15.29; P = 0.003). CLT was not associated with death or major and minor bleeding events. CONCLUSIONS Impaired fibrinolysis may predict thromboembolic events in AF patients receiving VKA.
-
3.
Does chronic hyperglycaemia increase the risk of kidney stone disease? results from a systematic review and meta-analysis.
Geraghty, R, Abdi, A, Somani, B, Cook, P, Roderick, P
BMJ open. 2020;(1):e032094
Abstract
DESIGN Systematic review and meta-analysis of observational studies was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies reporting on diabetes mellitus (DM) or metabolic syndrome (MetS) and kidney stone disease (KSD). OBJECTIVE To examine the association between chronic hyperglycaemia, in the form of DM and impaired glucose tolerance (IGT) in the context of MetS and KSD. SETTING Population-based observational studies. Databases searched: Ovid MEDLINE without revisions (1996 to June 2018), Cochrane Library (2018), CINAHL (1990 to June 2018), ClinicalTrials.gov, Google Scholar and individual journals including the Journal of Urology, European Urology and Kidney International. PARTICIPANTS Patients with and without chronic hyperglycaemic states (DM and MetS). MAIN OUTCOME MEASURES English language articles from January 2001 to June 2018 reporting on observational studies. EXCLUSIONS No comparator group or fewer than 100 patients. Unadjusted values were used for meta-analysis, with further meta-regression presented as adjusted values. Bias was assessed using Newcastle-Ottawa scale. RESULTS 2340 articles were screened with 13 studies included for meta-analysis, 7 DM (three cohort) and 6 MetS. Five of the MetS studies provided data on IGT alone. These included: DM, n=28 329; MetS, n=31 767; IGT, n=12 770. CONTROLS DM, n=5 89 791; MetS, n=1 78 050; IGT, n=2 93 852 patients. Adjusted risk for DM cohort studies, RR=1.23 (0.94 to 1.51) (p<0.001). Adjusted ORs for: DM cross-sectional/case-control studies, OR=1.32 (1.21 to 1.43) (p<0.001); IGT, OR=1.26 (0.92 to 1.58) (p<0.0001) and MetS, OR=1.35 (1.16 to 1.54) (p<0.0001). There was no significant difference between IGT and DM (cross-sectional/case-control), nor IGT and MetS. There was a moderate risk of publication bias. Statistical heterogeneity remained significant in adjusted DM cohort values and adjusted IGT (cross-sectional/case-control), but non-signficant for adjusted DM (cross-sectional/case-control). CONCLUSION Chronic hyperglycaemia increases the risk of developing kidney stone disease. In the context of the diabetes pandemic, this will increase the burden of stone related morbidity and mortality. PROSPERO REGISTRATION NUMBER CRD42018093382.
-
4.
Insulin Resistance in Obese Children: What Can Metabolomics and Adipokine Modelling Contribute?
Rupérez, FJ, Martos-Moreno, GÁ, Chamoso-Sánchez, D, Barbas, C, Argente, J
Nutrients. 2020;(11)
Abstract
The evolution of obesity and its resulting comorbidities differs depending upon the age of the subject. The dramatic rise in childhood obesity has resulted in specific needs in defining obesity-associated entities with this disease. Indeed, even the definition of obesity differs for pediatric patients from that employed in adults. Regardless of age, one of the earliest metabolic complications observed in obesity involves perturbations in glucose metabolism that can eventually lead to type 2 diabetes. In children, the incidence of type 2 diabetes is infrequent compared to that observed in adults, even with the same degree of obesity. In contrast, insulin resistance is reported to be frequently observed in children and adolescents with obesity. As this condition can be prerequisite to further metabolic complications, identification of biological markers as predictive risk factors would be of tremendous clinical utility. Analysis of obesity-induced modifications of the adipokine profile has been one classic approach in the identification of biomarkers. Recent studies emphasize the utility of metabolomics in the analysis of metabolic characteristics in children with obesity with or without insulin resistance. These studies have been performed with targeted or untargeted approaches, employing different methodologies. This review summarizes some of the advances in this field while emphasizing the importance of the different techniques employed.
-
5.
Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment.
Singh Ospina, N, Iñiguez-Ariza, NM, Castro, MR
BMJ (Clinical research ed.). 2020;:l6670
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
-
6.
Testosterone concentrations and risk of cardiovascular events in androgen-deficient men with atherosclerotic cardiovascular disease.
Boden, WE, Miller, MG, McBride, R, Harvey, C, Snabes, MC, Schmidt, J, McGovern, ME, Fleg, JL, Desvigne-Nickens, P, Anderson, T, et al
American heart journal. 2020;:65-76
Abstract
BACKGROUND Whether androgen deficiency among men increases the risk of cardiovascular (CV) events or is merely a disease marker remains a subject of intense scientific interest. OBJECTIVES Among male subjects in the AIM-HIGH Trial with metabolic syndrome and low baseline levels of high-density lipoprotein (HDL)-cholesterol who were randomized to niacin or placebo plus simvastatin, we examined the relationship between low baseline testosterone (T) concentrations and subsequent CV outcomes during a mean 3-year follow-up. METHODS In this post hoc analysis of men with available baseline plasma T concentrations, we examined the relationship between clinical/demographic characteristics and T concentrations both as a continuous and dichotomous variable (<300 ng/dL ["low T"] vs. ≥300 ng/dL ["normal T"]) on rates of pre-specified CV outcomes, using Cox proportional hazards models. RESULTS Among 2118 male participants in whom T concentrations were measured, 643 (30%) had low T and 1475 had normal T concentrations at baseline. The low T group had higher rates of diabetes mellitus, hypertension, elevated body mass index, metabolic syndrome, higher blood glucose, hemoglobin A1c, and triglyceride levels, but lower levels of both low-density lipoprotein and HDL-cholesterol, and a lower rate of prior myocardial infarction (MI). Men with low T had a higher risk of the primary composite outcome of coronary heart disease (CHD) death, MI, stroke, hospitalization for acute coronary syndrome, or coronary or cerebral revascularization (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07, and a higher risk of the CHD death, MI, and stroke composite endpoint (11.8% vs. 8.2%; final adjusted HR 1.37, P = .04), respectively. CONCLUSIONS In this post hoc analysis, there was an association between low baseline testosterone concentrations and increased risk of subsequent CV events in androgen-deficient men with established CV disease and metabolic syndrome, particularly for the composite secondary endpoint of CHD death, MI, and stroke. CONDENSED ABSTRACT In this AIM-HIGH Trial post hoc analysis of 2118 men with metabolic syndrome and low HDL-cholesterol with available baseline plasma testosterone (T) samples, 643 males (30%) had low T (mean: 229 ng/dL) and 1475 (70%) had normal T (mean: 444 ng/dL) concentrations. The "low T" group had a 24% higher risk of the primary 5-component endpoint (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07). There was also a 31% higher risk of the secondary composite endpoint: coronary heart disease death, myocardial infarction, and stroke (11.8% vs. 8.2%, final adjusted HR 1.37, P = .04) in the low vs. normal T group, respectively.
-
7.
Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology.
Khoury, M, Kavey, RW, St Pierre, J, McCrindle, BW
The Canadian journal of cardiology. 2020;(9):1417-1428
-
-
Free full text
-
Abstract
Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease). This creates a milieu for-or increases the impact of-accelerated atherosclerosis that, in turn, increases the likelihood of premature CVD. This review highlights the importance of considering the total risk factor and risk-condition profile of pediatric patients. An algorithm is provided for stratifying patients into high-, moderate-, and at-risk categories, and practical examples are provided as to how the evaluation and management of 1 risk factor or risk condition might need to be intensified in the context of additional risk factors or risk conditions. For example, for treatment of an adolescent with familial hypercholesterolemia, the target low-density lipoprotein cholesterol level might be lowered by the concomitant presence of low high-density lipoprotein cholesterol or elevated lipoprotein(a) levels. As awareness of cardiovascular risk and atherosclerosis in pediatric patients increases, new at-risk conditions that warrant consideration are emerging. The identification and management of high-risk individuals is an important part of the overall practice of pediatric preventive cardiology.
-
8.
Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data.
Tahkola, A, Korhonen, P, Kautiainen, H, Niiranen, T, Mäntyselkä, P
BMC family practice. 2020;(1):62
Abstract
BACKGROUND In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control. METHODS In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting. RESULTS More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men). CONCLUSIONS Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
-
9.
Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus.
Jung, CH, Mok, JO
Endocrinology and metabolism (Seoul, Korea). 2020;(2):260-271
Abstract
It is well known that patients with type 2 diabetes mellitus (T2DM) are at an increased risk of morbidity and mortality from atherosclerotic cardiovascular (CV) complications. Previously, the concept that diabetes mellitus (DM) is a "coronary artery disease (CAD) risk equivalent" was widely accepted, implying that all DM patients should receive intensive management. However, considerable evidence exist for wide heterogeneity in the risk of CV events among T2DM patients and the concept of a "CAD risk equivalent" has changed. Recent guidelines recommend further CV risk stratification in T2DM patients, with treatment tailored to the risk level. Although imaging modalities for atherosclerotic cardiovascular disease (ASCVD) have been used to improve risk prediction, there is currently no evidence that imaging-oriented therapy improves clinical outcomes. Therefore, controversy remains whether we should screen for CVD in asymptomatic T2DM. The coexistence of T2DM and heart failure (HF) is common. Based on recent CV outcome trials, sodium glucose cotransporter-2 inhibitors and glucagon like peptide-1 receptor agonists are recommended who have established ASCVD, indicators of high risk, or HF because of their demonstrated benefits for CVD. These circumstances have led to an increasing emphasis on ASCVD and HF in T2DM patients. In this review, we examine the literature published within the last 5 years on the risk assessment of CVD in asymptomatic T2DM patients. In particular, we review recent guidelines regarding screening for CVD and research focusing on the role of coronary artery calcium, coronary computed tomography angiography, and carotid intima-media thickness in asymptomatic T2DM patients.
-
10.
Added sugar intake is associated with pericardial adipose tissue volume.
Yi, SY, Steffen, LM, Terry, JG, R Jacobs, D, Duprez, D, Steffen, BT, Zhou, X, Shikany, JM, Harnack, L, J Carr, J
European journal of preventive cardiology. 2020;(18):2016-2023
-
-
Free full text
-
Abstract
AIM: The purpose of this study was to determine the relationships of pericardial adipose tissue and visceral adipose tissue volume with added sugar and sugar-sweetened beverage intakes. We hypothesized that both added sugar and sugar-sweetened beverages were positively associated with pericardial adipose tissue and visceral adipose tissue volumes in black and white men and women enrolled in the prospective Coronary Artery Risk Development in Young Adults study. METHODS AND RESULTS Dietary intake was assessed by diet history at baseline, year 7 and year 20 examinations in 3070 participants aged 18-30 and generally healthy at baseline. After 25 years follow-up, participants underwent a computed tomography scan of chest and abdomen; the computed tomography scans were read, and pericardial adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue volumes were calculated. Quintiles were created for the average of baseline, year 7 and year 20 added sugar and for the average of sugar-sweetened beverages. General linear regression analysis evaluated the associations of pericardial adipose tissue and visceral adipose tissue volumes across quintiles of added sugar and across quintiles of sugar-sweetened beverage intakes adjusted for potential confounding factors. In a multivariable model, pericardial adipose tissue volume was higher across increasing quintiles of added sugar and sugar-sweetened beverage intakes (ptrend = 0.001 and ptrend < 0.001, respectively). A similar relation was observed for visceral adipose tissue (ptrend < 0.001 for both added sugar and sugar-sweetened beverages). CONCLUSIONS Long-term intakes of added sugar and sugar-sweetened beverages were associated with higher pericardial adipose tissue, visceral adipose tissue, and subcutaneous adipose tissue volumes. Because these ectopic fat depots are associated with greater risk of disease incidence, these findings support limiting intakes of added sugar and sugar-sweetened beverages.