793 results found
Brandts J, Bray S, Villa G, et al., 2023, Optimal implementation of the 2019 ESC/EAS dyslipidaemia guidelines in patients with and without atherosclerotic cardiovascular disease across Europe: a simulation based on the DA VINCI study., Lancet Reg Health Eur, Vol: 31
BACKGROUND: The impact of the stepwise implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) treatment algorithm on low-density lipoprotein cholesterol (LDL-C) goal attainment was simulated in patients from the DA VINCI study. METHODS: Monte Carlo simulation was used to evaluate treatment optimisation scenarios, based on a patient's risk category: statin intensification (step 1), addition of ezetimibe (step 2), and addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (step 3). Residual cardiovascular risk and predicted relative and absolute risk reduction (RRR and ARR) in cardiovascular events were assessed. FINDINGS: In DA VINCI, 2482 patients did not achieve their 2019 ESC/EAS LDL-C goals and were included in the simulation. In patients without atherosclerotic cardiovascular disease (ASCVD) (n = 962), 27.0% (n = 259) and 57.0% (n = 548) are likely to achieve their LDL-C goals at step 1 and step 2, respectively. Of those at very high risk without ASCVD (n = 74), 88.1% (n = 65) are likely to achieve their LDL-C goals at step 3. In patients with ASCVD (n = 1520), 12.0% (n = 183), 42.1% (n = 641) and 93.2% (n = 1416) are likely to achieve their LDL-C goals at steps 1, 2 and 3, respectively. In patients with and without ASCVD, treatment optimisation may result in mean simulated RRR of 24.0% and 17.7%, respectively, and ARR of 8.1% and 2.6%, respectively. INTERPRETATION: Most patients at high cardiovascular risk are unlikely to achieve LDL-C goals through statin optimisation and ezetimibe, and will require a PCSK9 inhibitor, leading to greater reduction in cardiovascular risk. FUNDING: Amgen.
McGuire DK, Busui RP, Deanfield J, et al., 2023, Effects of oral semaglutide on cardiovascular outcomes in individuals with type 2 diabetes and established atherosclerotic cardiovascular disease and/or chronic kidney disease: Design and baseline characteristics of SOUL, a randomized trial., Diabetes Obes Metab, Vol: 25, Pages: 1932-1941
AIM: To describe the design of the SOUL trial (Semaglutide cardiOvascular oUtcomes triaL) and the baseline clinical data of its participants. MATERIALS AND METHODS: In SOUL, the effects of oral semaglutide, the first oral glucagon-like peptide-1 receptor agonist, on the risk of cardiovascular (CV) events in individuals with type 2 diabetes and established atherosclerotic CV disease (ASCVD) and/or chronic kidney disease (CKD) will be assessed. SOUL is a randomized, double-blind, parallel-group, placebo-controlled CV outcomes trial comparing oral semaglutide (14 mg once daily) with placebo, both in addition to standard of care, in individuals aged ≥50 years with type 2 diabetes and evidence of ASCVD (coronary artery disease [CAD], cerebrovascular disease, symptomatic peripheral arterial disease [PAD]) and/or CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 ). The primary outcome is time from randomization to first occurrence of a major adverse CV event (MACE; a composite of CV death, nonfatal myocardial infarction or nonfatal stroke). This event-driven trial will continue until 1225 first adjudication-confirmed MACEs have occurred. Enrolment has been completed. RESULTS: Overall, 9650 participants were enrolled between June 17, 2019 and March 24, 2021 (men 71.1%, White ethnicity 68.9%, mean age 66.1 years, diabetes duration 15.4 years, body mass index 31.1 kg/m2 , glycated haemoglobin 63.5 mmol/mol [8.0%]). The most frequently used antihyperglycaemic medications at baseline were metformin (75.7%), insulin and insulin analogues (50.5%), sulphonylureas (29.1%), sodium-glucose cotransporter-2 inhibitors (26.7%) and dipeptidyl peptidase-4 inhibitors (23.0%). At randomization, 70.7% of participants had CAD, 42.3% had CKD, 21.1% had cerebrovascular disease and 15.7% had symptomatic PAD (categories not mutually exclusive). Prevalent heart failure was reported in 23.0% of participants. CONCLUSION:
Beaney T, Wang W, Schlaich MP, et al., 2023, Global blood pressure screening during the COVID-19 pandemic: results from the May Measurement Month 2021 campaign, Journal of Hypertension, Vol: 41, Pages: 1446-1455, ISSN: 0263-6352
BACKGROUND: Raised blood pressure (BP) remains the biggest risk factor contributing to the global burden of disease and mortality, despite the COVID-19 pandemic. May Measurement Month (MMM), an annual global screening campaign aims to highlight the importance of BP measurement by evaluating global awareness, treatment and control rates among adults with hypertension. In 2021, we assessed the global burden of these rates during the COVID-19 pandemic. METHODS: Screening sites were set up in 54 countries between May and November 2021 and screenees were recruited by convenience sampling. Three sitting BPs were measured, and a questionnaire completed including demographic, lifestyle and clinical data. Hypertension was defined as a systolic BP at least 140 mmHg and/or a diastolic BP at least 90 mmHg (using the mean of the second and third readings) or taking antihypertensive medication. Multiple imputation was used to impute the average BP when readings were missing. RESULTS: Of the 642 057 screenees, 225 882 (35.2%) were classified as hypertensive, of whom 56.8% were aware, and 50.3% were on antihypertensive medication. Of those on treatment, 53.9% had controlled BP (<140/90 mmHg). Awareness, treatment and control rates were lower than those reported in MMM campaigns before the COVID-19 pandemic. Minimal changes were apparent among those testing positive for, or being vaccinated against COVID-19. Of those on antihypertensive medication, 94.7% reported no change in their treatment because of the COVID-19 pandemic. CONCLUSION: The high yield of untreated or inadequately treated hypertension in MMM 2021 confirms the need for systematic BP screening where it does not currently exist.
Graham SE, Clarke SL, Wu K-HH, et al., 2023, Author Correction: The power of genetic diversity in genome-wide association studies of lipids., Nature, Vol: 618, Pages: E19-E20
Carnagarin R, Nolde JM, Yang J, et al., 2023, Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns, JOURNAL OF HYPERTENSION, Vol: 41, Pages: 632-637, ISSN: 0263-6352
Kanagaratnam P, McCready J, Tayebjee M, et al., 2023, Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial, EP Europace, Vol: 25, Pages: 863-872, ISSN: 1099-5129
Aims:There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF.Methods and results:We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097–0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639–2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test).Conclusion:The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met.Trial registrationClinical Trials Registration: NCT02459574.
Wang N, Harris K, Woodward M, et al., 2023, Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management., Hypertension, Vol: 80, Pages: 608-617
BACKGROUND: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response. METHODS: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes). RESULTS: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1). CONCLUSIONS: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control. RE
Kanoni S, Graham SE, Wang Y, et al., 2022, Implicating genes, pleiotropy, and sexual dimorphism at blood lipid loci through multi-ancestry meta-analysis., Genome Biol, Vol: 23
BACKGROUND: Genetic variants within nearly 1000 loci are known to contribute to modulation of blood lipid levels. However, the biological pathways underlying these associations are frequently unknown, limiting understanding of these findings and hindering downstream translational efforts such as drug target discovery. RESULTS: To expand our understanding of the underlying biological pathways and mechanisms controlling blood lipid levels, we leverage a large multi-ancestry meta-analysis (N = 1,654,960) of blood lipids to prioritize putative causal genes for 2286 lipid associations using six gene prediction approaches. Using phenome-wide association (PheWAS) scans, we identify relationships of genetically predicted lipid levels to other diseases and conditions. We confirm known pleiotropic associations with cardiovascular phenotypes and determine novel associations, notably with cholelithiasis risk. We perform sex-stratified GWAS meta-analysis of lipid levels and show that 3-5% of autosomal lipid-associated loci demonstrate sex-biased effects. Finally, we report 21 novel lipid loci identified on the X chromosome. Many of the sex-biased autosomal and X chromosome lipid loci show pleiotropic associations with sex hormones, emphasizing the role of hormone regulation in lipid metabolism. CONCLUSIONS: Taken together, our findings provide insights into the biological mechanisms through which associated variants lead to altered lipid levels and potentially cardiovascular disease risk.
Ojji DB, Cornelius V, Partington G, et al., 2022, Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial, HYPERTENSION, Vol: 79, Pages: 2593-2600, ISSN: 0194-911X
Mackenzie IS, Rogers A, Poulter NR, et al., 2022, Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial, LANCET, Vol: 400, Pages: 1417-1425, ISSN: 0140-6736
Schutte AE, Jafar TH, Poulter NR, et al., 2022, Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension, CARDIOVASCULAR RESEARCH, ISSN: 0008-6363
Mishchenko LA, Kolesnik T, Khomazyuk TA, et al., 2022, May Measurement Month 2017-2019: an analysis of blood pressure screening results from Ukraine( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F41-F44, ISSN: 1520-765X
Houehanou C, Sonou A, Adjagba P, et al., 2022, May Measurement Month 2018: an analysis of blood pressure screening results from Benin( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F9-F11, ISSN: 1520-765X
Poulter NR, Borghi C, Damasceno A, et al., 2022, May Measurement Month: results of 12 national blood pressure screening programmes between 2017 and 2019, EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F1-F5, ISSN: 1520-765X
Kowlessur S, Ori B, Heecharan J, et al., 2022, May Measurement Month 2017: an analysis of blood pressure screening results from Mauritius( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F25-F27, ISSN: 1520-765X
Miglinas M, Sevcenko V, Racaite A, et al., 2022, May Measurement Month 2017-2019: an analysis of blood pressure screening results from Lithuania( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F22-F24, ISSN: 1520-765X
Memon FS, Wang W, Beaney T, et al., 2022, May Measurement Month 2018: an analysis of blood pressure screening results from Pakistan( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F31-F33, ISSN: 1520-765X
Toure A, Ismael OY, Souley K, et al., 2022, May Measurement Month 2017-19: an analysis of blood pressure screening results from Niger( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F28-F30, ISSN: 1520-765X
Ortellado J, Paniagua M, Wang W, et al., 2022, May Measurement Month 2017-19: an analysis of blood pressure screening results from Paraguay( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F34-F37, ISSN: 1520-765X
Mirrakhimov E, Zakirov U, Abilova S, et al., 2022, May Measurement Month 2019: analysis of blood pressure screening in Bishkek, Kyrgyzstan( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F19-F21, ISSN: 1520-765X
Quintana FSW, Casasola MAV, Lopez ACO, et al., 2022, May Measurement Month 2017-2019: an analysis of blood pressure screening results from Guatemala( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F16-F18, ISSN: 1520-765X
Glantschnig T, Koppelstaetter C, Zweiker D, et al., 2022, May Measurement Month 2018-2019: an analysis of blood pressure screening results from Austria( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F6-F8, ISSN: 1520-765X
Valdez-Tiburcio O, Gonzalez-Medina A, Valdez-Valoy L, et al., 2022, May Measurement Month 2017-2019: an analysis of blood pressure screening results from Dominican Republic( ), EUROPEAN HEART JOURNAL SUPPLEMENTS, Vol: 24, Pages: F12-F15, ISSN: 1520-765X
Stergiou G, Brunstrom M, MacDonald T, et al., 2022, Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension, JOURNAL OF HYPERTENSION, Vol: 40, Pages: 1847-1858, ISSN: 0263-6352
Wang N, Harris K, Hamet P, et al., 2022, Cumulative Systolic Blood Pressure Load and Cardiovascular Risk in Patients With Diabetes, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 80, Pages: 1147-1155, ISSN: 0735-1097
Gnanenthiran SR, Borghi C, Burger D, et al., 2022, Renin-Angiotensin System Inhibitors in Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials Led by the International Society of Hypertension, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 11
Ramdas S, Judd J, Graham SE, et al., 2022, A multi-layer functional genomic analysis to understand noncoding genetic variation in lipids, AMERICAN JOURNAL OF HUMAN GENETICS, Vol: 109, Pages: 1366-1387, ISSN: 0002-9297
Lin Q, Ye T, Ye P, et al., 2022, Hypertension in stroke survivors and associations with national premature stroke mortality: data on 2.5 million participants from multinational screening campaigns., The Lancet Global Health, Vol: 10, Pages: e1141-e1149, ISSN: 2214-109X
BackgroundBlood pressure (BP) control plays a pivotal role in reducing stroke incidence and recurrence. May Measurement Month (MMM) is the largest global BP screening campaign, initiated in 2017 by the International Society of Hypertension (ISH). We aim to compare MMM participants with and without a previous stroke and to investigate associations between national-level estimates of BP management from MMM and premature stroke mortality.MethodsOver 2.5 million volunteers (≥18 years) were screened in May 2017 and 2018 from 92 countries. Three seated BPs and demographic, lifestyle, and cardiovascular disease data were collected. Associations between risk factors and stroke history were analysed using mixed-effects logistic regression. Linear regression was used to investigate associations between national-level estimates of BP management and premature stroke mortality based on Global Burden of Diseases (GBD) data. FindingsOf 2 222 399 (88·4%) participants with recorded data on a history of stroke, 62 639 (2·8%) reported a previous stroke. Those with a stroke history had higher rates of hypertension and treated and controlled hypertension than those without. One third of those with a stroke history had untreated or treated but uncontrolled BP (≥140/90 mmHg). Strong positive associations were found between national premature stroke mortality and increasing mean systolic BP levels and proportion of participants with raised BP and strong negative associations with the proportions of hypertensives on treatment and with controlled BP. InterpretationBP control remains suboptimal worldwide amongst those with a previous stroke. National estimates of BP management reflect national premature stroke mortality sufficiently well to provide a prompt for policymakers to promote BP screening and management.
Juraschek SP, Wang D, McEvoy JW, et al., 2022, Effects of glucose and blood pressure reduction on subclinical cardiac damage: Results from ADVANCE, International Journal of Cardiology, Vol: 358, Pages: 103-109, ISSN: 0167-5273
OBJECTIVE: Observational data suggest a potential for subclinical cardiac damage from intensive blood glucose or blood pressure (BP) control, particularly in adults with very low blood glucose and BP levels. However, this has not been tested in a randomized trial. METHODS: The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Research Controlled Evaluation (ADVANCE) study was a factorial, randomized trial designed to test the effects of intensive blood glucose (hemoglobin A1c ≤6.5% versus usual care) and intensive BP (combination of perindopril-indapamide versus placebo) control on vascular events in adults with diabetes. Using mixed effects tobit models, we determined the effect of the randomized interventions on change in subclinical cardiac injury (high sensitivity cardiac troponin T [hs-cTnT]) and strain (N-terminal b-type pro natriuretic peptide [NT-proBNP]), 1 year after randomization. RESULTS: Among the 682 participants, mean age was 66.1 (SD, 6.5) years; 40% were women. Mean baseline hemoglobin A1c was 7.4% (SD, 1.5) and systolic/diastolic BP was 147 (SD,21)/81 (SD,11) mmHg. After 1 year, intensive versus standard glucose control did not significantly change hs-cTnT (1.5%; 95%CI:-4.9,8.2) or NT-proBNP (-10.3%; 95%CI: -20.2%,0.9%). Intensive versus standard BP control also did not affect hs-cTnT (-2.9%; 95%CI: -8.9,3.6), but did significantly lower NT-proBNP by 21.6% (95%CI:-30.2%,-11.9%). Changes in systolic BP at 1 year (versus baseline) were strongly associated with NT-proBNP (P = 0.004), but not hs-cTnT (P = 0.95). CONCLUSIONS: In adults with diabetes, intensive BP control reduced NT-proBNP without increasing hs-cTnT, supporting the benefits and safety of intensive BP control in adults with diabetes. This trial is registered at clinicaltrials.gov, number: NCT00145925.
Nolde JM, Beaney T, Carnagarin R, et al., 2022, Global impact of different blood pressure thresholds in 4 021 690 participants of the May Measurement Month initiative, Hypertension, Vol: 79, Pages: 1497-1505, ISSN: 0194-911X
BACKGROUND: Influential guidelines currently define hypertension at different thresholds of blood pressure (BP). The global May Measurement Month initiative provides a unique opportunity to estimate the potential consequences of universal lowering of BP thresholds on the prevalence of hypertension based on a large, real-world, patient-level data set. METHODS: The average of the second and third of 3 attended BP readings after 5 minutes of rest from 4 021 690 standardized, opportunistic BP screenings in various settings of the 2017 to 2019 May Measurement Month initiatives from 104 countries were analyzed to assess the demographic and phenotypic impact of 3 defined BP thresholds. RESULTS: The age- and sex-standardized median of the relative increase in rate of hypertension with a change of thresholds from ≥140/≥90 to ≥130/≥80 mm Hg was 72.3% (interquartile range, 59.3%-91.3%) among the participating countries. With a change from ≥140/≥90 to ≥120/≥70 mm Hg, the median range was 162.6% (interquartile range, 132.8%-202.6%). The increase in rate of hypertension was most pronounced in low-income (95.3% and 203.9%) and least pronounced in high-income countries (71.6% and 167.1%). CONCLUSIONS: The impact of a universal application of lower BP thresholds for the definition of hypertension would have an enormous impact on the prevalence of hypertension globally with large disparities between countries and substantial heterogeneity of demographic and phenotypic patterns, which should be confirmed in dedicated population studies. While focusing on lower BP targets may constitute an opportunity for early intervention, the potential socioeconomic consequences may pose unsurmountable obstacles for most health care systems worldwide.
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