Lipid-Lowering Trials Are Not Representative of Patients Managed in Clinical Practice: A Systematic Review and Meta-Analysis of Exclusion Criteria.

Background Randomized clinical trials (RCTs) might not be representative of the real-world population because of unreasonable exclusion criteria. We sought to determine which groups of patients are excluded from RCTs that included lipid-lowering therapy. Methods and Results We retrieved all trials from the Cholesterol Treatment Trialists Collaboration and systematically searched for large (≥1000 participants) lipid-lowering therapy RCTs, defined as statins, ezetimibe, and PCSK9 inhibitors. We predefined groups: older adults (>70 or >75 years), women, non-Whites, chronic kidney failure, heart failure, immunosuppression, cancer, dementia, treated thyroid disease, chronic obstructive pulmonary disease, mental illness, atrial fibrillation, multimorbidity (≥2 chronic diseases), and polypharmacy. We counted the number of RCTs excluding patients of the predefined groups and meta-analyzed the prevalence of included patients to obtain pooled estimates with a random-effects model. We included 42 RCTs (298 605 patients). Eighty-one percent of trials excluded patients with severe and 76% those with moderate kidney failure. Seventy-one percent of trials excluded groups of women, 64% excluded patients with moderate to severe heart failure, 64% those with immunosuppressant conditions, 48% those with cancer, 29% those with dementia, and 29% of trials excluded older adults. The pooled prevalence for patients >70 years of age was 25% (95% CI, 0%-49%), 11% (3%-18%) for >75 years of age, and 51% (38%-63%) for multimorbidity. Conclusions The majority of lipid-lowering therapy trials excluded patients with common diseases, such as moderate-to-severe kidney disease or heart failure or with immunosuppression. Underrepresenting certain populations, including women and older adults, might lead to limited transportability of study results and uncertainty on possible side-effects and efficacy in these groups. Future trials should promote diversity in the recruitment strategies and improve equity in cardiovascular research. Registration URL: ClinicalTrials.gov; Unique Identifier: CRD42021253909

Use of leisure time in cardiovascular patients in Gorgan (South East of Caspian Sea)

The aim of this study was to compare activity patterns and leisure time between matched groups of patients with cardiovascular disease and individuals without a heart disease. The study included 100 patients recruited from those referred to cardiology department of 5th Azar General Hospital of Golestan University of Medical Sciences in Gorgan (South East of Caspian Sea) and 100 matched control subjects during the period 2007-2008. Odds ratios (OR), together with 95% confidence intervals (95% CI), were calculated using logistic regression, as estimates of relative risks. Listening to music OR = 8.800 (95% CI: 2.717-28.499, p<0.05), meditation OR = 6.111 (95% CI; 2.616-14.274, p<0.05) were independent risk factors. Subjects who performed 2 h per week and 2-4 h per week physical activity, the odds ratios were 0.038 ( 95% CI: 0.012-0.124, p<0.05) and 0.079, (95% CI: 0.024-0.260, p<0.05), respectively. Low physical activity and use of long time relaxation are associated with cardiovascular disease in these patients. Regular participation in physical activity such as walking 2 h per week and 2-4 h per week, are associated with reduced risk of cardiovascular disease. This study suggests the importance of both leisure-time physical activity and sedentary behaviors in the prevention of CVD. © 2009 Asian Network for Scientific Information

Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

No abstract available

Association between osteoarthritis and cardiovascular disease: systematic review and meta-analysis

Background: To examine for a possible relationship between osteoarthritis and cardiovascular disease (CVD). Design: A systematic review and meta-analysis Methods: Published and unpublished literature from: MEDLINE, EMBASE, CINAHL, the Cochrane Library, OpenGrey and clinical trial registers. Search to 22nd November 2014. Cohort, case-control, randomised and non-randomised controlled trial papers reporting the prevalence of CVD in osteoarthritis were included. Results: Fifteen studies with 32,278,744 individuals were eligible. Pooled prevalence for overall CVD pathology in people with osteoarthritis was 38.4% (95% Confidence interval (CI): 37.2% to 39.6%). Individuals with osteoarthritis were almost three times as likely to have heart failure (Relative Risk (RR): 2.80; 95% CI: 2.25 to 3.49) or ischaemic heart disease (RR: 1.78; 95% CI: 1.18 to 2.69) compared to matched non-osteoarthritis cohorts. No significant difference was detected between the two groups for the risk of experiencing myocardial infarction or stroke. There was a three-fold decrease in the risk of experiencing a transient ischaemic attack in the osteoarthritis cohort compared to the non-osteoarthritis group. Conclusions: Prevalence of CVD in patients with OA is significant. There was an observed increased risk of incident heart failure and ischaemic heart disease in people with OA compared to matched controls. However the relationship between OA and CVD is not straight-forward and there is a need to better understand the potential common pathways linking pathophysiological mechanisms

Recent trends and potential drivers of non-invasive cardiovascular imaging use in the United States of America and England

Background: Non-invasive Cardiovascular imaging (NICI), including cardiovascular magnetic resonance (CMR) imaging provides important information to guide the management of patients with cardiovascular conditions. Current rates of NICI use and potential policy determinants in the United States of America (US) and England remain unexplored. Methods: We compared NICI activity in the US (Medicare fee-for-service, 2011–2015) and England (National Health Service, 2012–2016). We reviewed recommendations related to CMR from Clinical Practice Guidelines, Appropriate Use Criteria (AUC), and Choosing Wisely. We then categorized recommendations according to whether CMR was the only recommended NICI technique (substitutable indications). Reimbursement policies in both settings were systematically collated and reviewed using publicly available information. Results: The 2015 rate of NICI activity in the US was 3.1 times higher than in England (31,055 vs. 9,916 per 100,000 beneficiaries). The proportion of CMR of all NICI was small in both jurisdictions, but nuclear cardiac imaging was more frequent in the US in absolute and relative terms. American and European CPGs were similar, both in terms of number of recommendations and proportions of indications where CMR was not the only recommended NICI technique (substitutable indications). Reimbursement schemes for NICI activity differed for physicians and hospitals between the two settings. Conclusions: Fee-for-service physician compensation in the US for NICI may contribute to higher NICI activity compared to England where physicians are salaried. Reimbursement arrangements for the performance of the test may contribute to the higher proportion of nuclear cardiac imaging out of the total NICI activity. Differences in CPG recommendations appear not to explain the variation in NICI activity between the US and England

Specific Characteristics of Clinical and Laboratory Changes in the Course of Arterial Hypertension Against the Background of Diabetes

Arterial hypertension (AH) is one of the leading problems in cardiology, determining the structure of cardiovascular morbidity and mortality [1,2]. Prevalence of hypertension among adults. Increasing levels of systolic (SBP) and diastolic (DBP) blood pressure (BP) are associated with a higher risk of cardiovascular events [5]

Specific Characteristics of Clinical and Laboratory Changes in the Course of Arterial Hypertension against the Background of Diabetes

Arterial hypertension (AH) is one of the leading problems in cardiology, determining the structure of cardiovascular morbidity and mortality [1,2]. Prevalence of hypertension among adults. Increasing levels of systolic (SBP) and diastolic (DBP) blood pressure (BP) are associated with a higher risk of cardiovascular events [5]

Specific Characteristics of Clinical and Laboratory Changes in the Course of Arterial Hypertension Against the Background of Diabetes

Arterial hypertension (AH) is one of the leading problems in cardiology, determining the structure of cardiovascular morbidity and mortality [1,2]. Prevalence of hypertension among adults. Increasing levels of systolic (SBP) and diastolic (DBP) blood pressure (BP) are associated with a higher risk of cardiovascular events [5]

Continuously improving the practice of cardiology

Guidelines for the management of patients with cardiovascular disease are designed to assist cardiologists and other physicans in their practice. Surveys are conducted to assess whether guidelines are followed in practice. The results of surveys on acute coronary syndromes, coronary revascularisation, secondary prevention, valvular heart disease and heart failure are presented. Comparing surveys conducted between 1995 and 2002, a gradual improvement in use ofsecondary preventive therapy is observed. Nevertheless, important deviations from established guidelines are noted, with a significant variation among different hospitals in the Netherlands and in other European countries. Measures for fiuther improvement of clinical practice indude more rapid treatment of patients with evolving myocardial infarction, more frequent use of clopidogrel and glycoprotein IIb/IIIa receptor blockers in patients with acute coronary syndromes, more frequent use of 5-blockers in patients with heart failure and more intense measures to encourage patients to stop smoking. Targets for the proportion ofpatients who might receive specific therapies are presented

Risk stratification in transposition of the great arteries

This thesis focused on multiple markers to predict clinical complications in adults with transposition of the great arteries after an atrial switch operation. These adults are at high risk of late complications including heart failure, arrhythmias, and premature mortality. In this thesis, we presented the first risk model that provides estimates of absolute risk of these major clinical events. Second, we showed that the use of novel markers, such as myocardial deformation and common genetic variants, can improve risk stratification over the use of basic clinical risk factors alone. Third, studies into the use of medication in adults with congenital heart disease showed that many patients use a multitude of cardiovascular drugs, even though the evidence that supports the use of these drugs is low. Lastly, studies into the genetic architecture of transposition of the great arteries and its late clinical complications provide insights in the molecular and pathophysiological mechanisms that are potentially involved in the occurrence of the congenital defect and its clinical course