Consumer-Led Screening for Atrial Fibrillation:A Report From the mAFA-II Trial Long-Term Extension Cohort

BACKGROUND: There are limited data on mobile health detection of prevalent atrial fibrillation (AF) and its related risk factors over time. OBJECTIVES: This study aimed to report the trends on prevalent AF detection over time and risk factors, with a consumer-led photoplethysmography screening approach. METHODS: 3,499,461 subjects aged over 18 years, who use smart devices (Huawei Technologies Co.) were enrolled between October 26, 2018, and December 1, 2021. RESULTS: Among 2,852,217 subjects for AF screening, 12,244 subjects (0.43%; 83.2% male, mean age 57 ± 15 years) detected AF episodes. When compared with 2018, the risk (adjusted HRs, 95% CI) for monitored prevalent AF increased significantly for subjects when monitoring started in 2020 (adjusted HR: 1.34; 95% CI: 1.27-1.40; P 93% confirmation of detected AF episodes even for the low-risk general population, highlighting the increased risk for detecting prevalent AF and the need for modification of OSA that increase AF susceptibility. (Mobile Health [mHealth] Technology for Improved Screening, Patient Involvement and Optimizing Integrated Care in Atrial Fibrillation [mAFA (mAF-App) II study]; ChiCTR-OOC-17014138

Relationship Between Lipoprotein(a), Renal Function Indicators, and Chronic Kidney Disease: Evidence From a Large Prospective Cohort Study

BACKGROUND: Chronic kidney disease (CKD) poses a significant global public health challenge. While lipoprotein(a) (Lp[a]) has been established as a significant factor in cardiovascular disease, its connection to CKD risk remains a topic of debate. Existing evidence indicates diverse risks of kidney disease among individuals with various renal function indicators, even when within the normal range. OBJECTIVE: This study aims to investigate the joint associations between different renal function indicators and Lp(a) regarding the risks of incident CKD in the general population. METHODS: The analysis involved a cohort of 329,415 participants without prior CKD who were enrolled in the UK Biobank between 2006 and 2010. The participants, with an average age of 56 (SD 8.1) years, included 154,298/329,415 (46.84%) males. At baseline, Lp(a) levels were measured using an immunoturbidimetric assay and classified into 2 groups: low (&lt;75 nmol/L) and high (≥75 nmol/L). To assess participants' baseline renal function, we used the baseline urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The relationship between Lp(a), renal function indicators, and the risk of CKD was evaluated using multivariable Cox regression models. These models were adjusted for various factors, including sociodemographic variables, lifestyle factors, comorbidities, and laboratory measures. RESULTS: A total of 6003 incident CKD events were documented over a median follow-up period of 12.5 years. The association between elevated Lp(a) levels and CKD risk did not achieve statistical significance among all participants, with a hazard ratio (HR) of 1.05 and a 95% CI ranging from 0.98 to 1.13 (P=.16). However, a notable interaction was identified between Lp(a) and UACR in relation to CKD risk (P for interaction=.04), whereas no significant interaction was observed between Lp(a) and eGFR (P for interaction=.96). When compared with the reference group with low Lp(a) and low-normal UACR (&lt;10 mg/g), the group with high Lp(a) and low-normal UACR exhibited a nonsignificant association with CKD risk (HR 0.98, 95% CI 0.90-1.08; P=.74). By contrast, both the low Lp(a) and high-normal UACR (≥10 mg/g) group (HR 1.16, 95% CI 1.08-1.24; P&lt;.001) and the high Lp(a) and high-normal UACR group (HR 1.32, 95% CI 1.19-1.46; P&lt;.001) demonstrated significant associations with increased CKD risks. In individuals with high-normal UACR, elevated Lp(a) was linked to a significant increase in CKD risk, with an HR of 1.14 and a 95% CI ranging from 1.03 to 1.26 (P=.01). Subgroup analyses and sensitivity analyses consistently produced results that were largely in line with the main findings. CONCLUSIONS: The analysis revealed a significant interaction between Lp(a) and UACR in relation to CKD risk. This implies that Lp(a) may act as a risk factor for CKD even when considering UACR. Our findings have the potential to provide valuable insights into the assessment and prevention of CKD, emphasizing the combined impact of Lp(a) and UACR from a public health perspective within the general population. This could contribute to enhancing public awareness regarding the management of Lp(a) for the prevention of CKD.</p

Photoplethysmography-Based Machine Learning Approaches for Atrial Fibrillation Prediction:A Report From the Huawei Heart Study

BACKGROUND: Current wearable devices enable the detection of atrial fibrillation (AF), but a machine learning (ML)–based approach may facilitate accurate prediction of AF onset. OBJECTIVES: The present study aimed to develop, optimize, and validate an ML-based model for real-time prediction of AF onset in a population at high risk of incident AF. METHODS: A primary ML-based prediction model of AF onset (M1) was developed on the basis of the Huawei Heart Study, a general-population AF screening study using photoplethysmography (PPG)–based smart devices. After optimization in 554 individuals with 469,267 PPG data sets, the optimized ML-based model (M2) was further prospectively validated in 50 individuals with paroxysmal AF at high risk of AF onset, and compared with 72-hour Holter electrocardiographic (ECG) monitoring, a criterion standard, from September 1, 2019, to November 5, 2019. RESULTS: Among 50 patients with paroxysmal AF (mean age 67 ± 12 years, 40% women), there were 2,808 AF events from a total of 14,847,356 ECGs over 72 hours and 6,860 PPGs (45.83 ± 13.9 per subject per day). The best performance of M1 for AF onset prediction was achieved 4 hours before AF onset (area under the receiver operating characteristic curve: 0.94; 95% confidence interval: 0.93-0.94). M2 sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (at 0 to 4 hours before AF onset) were 81.9%, 96.6%, 96.4%, 83.1%, and 88.9%, respectively, compared with 72-hour Holter ECG. CONCLUSIONS: The PPG- based ML model demonstrated good ability for AF prediction in advance. (Mobile Health [mHealth] technology for improved screening, patient involvement and optimizing integrated care in atrial fibrillation; ChiCTR-OOC-17014138

Circulating Vitamin D Concentrations and Risk of Atrial Fibrillation:A Mendelian Randomization Study Using Non-deficient Range Summary Statistics

Vitamin D deficiency is a common disorder and has been linked with atrial fibrillation (AF) in several observational studies, although the causal relationships remain unclear. We conducted a Mendelian randomization (MR) analysis to determine the causal association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and AF. The analyses were performed using summary statistics obtained for single-nucleotide polymorphisms (SNPs) identified from large genome-wide association meta-analyses conducted on serum 25(OH)D ( = 79,366) and AF ( = 1,030,836). Six SNPs related to serum 25(OH)D were used as instrumental variables. The association between 25(OH)D and AF was estimated using both the fixed-effect and random-effects inverse variance weighted (IVW) method. The MR analyses found no evidence to support a causal association between circulating 25(OH)D level and risk of AF using random-effects IVW (odds ratio per unit increase in log 25(OH)D = 1.003, 95% CI, 0.841-1.196; = 0.976) or fixed-effect IVW method (OR = 1.003, 95% CI, 0.876-1.148; = 0.968). Sensitivity analyses yielded similar results. No heterogeneity and directional pleiotropy were detected. Using summary statistics, this MR study suggests that genetically predicted circulating vitamin D concentrations, especially for a non-deficient range, were not causally associated with AF in the general population. Future studies using non-linear design and focusing on the vitamin D deficiency population are needed to further evaluate the causal effect of vitamin D concentrations on AF

Activity evaluation of cocoa pod borer sex pheromone in cacao fields

The previously identified female sex pheromone of cocoa pod borer, Conopomorpha cramerella, was re-evaluated for its attractive activity in different field conditions. It was found that lures containing 100-μg of synthetic sex pheromone blend, (E,Z,Z)- and (E,E,Z)-4,6,10-hexadecatrienyl acetates, and the corresponding alcohols in a ratio of 40:60:4:6 in a polyethylene vial attracted male C. cramerella moths in Sabah and peninsular Malaysia and in Sumatra and Sulawesi, Indonesia, suggesting that the same pheromone strain existed in a wide stretch of the Indo-Malayan archipelago. Of the three kinds of trap designs tested, the Delta traps were more effective than Pherocon V scale traps. Male captures were not significantly different among traps baited with 100-, 300-, or 1,000-μg doses of sex pheromone. A release rate study of pheromone formulation conducted in the laboratory showed that volatile active ingredients were desorbed from polyethylene vials following first-order kinetics, which indicates a satisfactory "half-life time" of a 100-μg loading is ≈6 wk under laboratory conditions. A satisfactory attractiveness of the lure with a 100-μg loading was ≈1-2 mo in the fields

Oral Anticoagulants for Nonvalvular Atrial Fibrillation in Patients with High Risk of Gastrointestinal Bleeding

IMPORTANCE: Many patients with nonvalvular atrial fibrillation (NVAF) are at a high risk of gastrointestinal (GI) bleeding due to conditions including older age; stage III to V chronic kidney disease (CKD); HAS-BLED (hypertension, kidney or liver disease, stroke history, prior bleeding, unstable international normalized ratio, age >65, drug or alcohol use) score of 3 or greater; corticosteroid, antiplatelet or nonsteroidal anti-inflammatory drug (NSAID) use; or GI conditions. OBJECTIVE: To compare the risk of stroke and/or systemic embolism (SE) and major bleeding (MB) among patients with NVAF and high risk of GI bleeding who received non–vitamin K antagonist oral anticoagulants (NOACs) vs those who received warfarin. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with NVAF who were 75 years and older; had stage III to V CKD; had an HAS-BLED score of 3 or greater; used corticosteroids, antiplatelets, or NSAIDs; or had GI conditions. Data were collected from the Centers for Medicare & Medicaid Services and 4 commercial insurance databases between January 1, 2012, and September 30, 2015. Data analysis was conducted from January 2012 to September 2015. EXPOSURES: New prescription for apixaban, dabigatran, rivaroxaban, or warfarin between January 1, 2013, and September 30, 2015 (identification period). MAIN OUTCOMES AND MEASURES: Six propensity score–matched cohorts were created to compare between study drugs. For the primary objective, Cox models were used to estimate stroke and/or SE and MB hazard ratios (HRs). RESULTS: A total of 381 054 patients (187 489 [49.2%] women) with NVAF and at least 1 high-risk GI bleeding factor were identified (HAS-BLED score ≥3: 284 527 [74.7%]; aged ≥75 years: 252 835 [66.4%]; corticosteroid, antiplatelet, or NSAID therapy: 107 675 [28.3%]; prior GI bleeding conditions: 74 818 [19.6%]; and stage III-V CKD: 56 892 [14.9%]). All NOACs were associated with a lower risk of stroke and/or SE vs warfarin (apixaban: HR, 0.60; 95% CI, 0.52-0.68; dabigatran: HR, 0.75; 95% CI, 0.64-0.88; rivaroxaban: HR, 0.79; 95% CI, 0.73-0.86). Compared with warfarin, apixaban and dabigatran were associated with a lower risk of MB (apixaban: HR, 0.59; 95% CI, 0.56-0.63; dabigatran: HR, 0.78; 95% CI, 0.70-0.86), while rivaroxaban was associated with a higher risk (HR, 1.11; 95% CI, 1.05-1.16). CONCLUSIONS AND RELEVANCE: In this study of patients with NVAF and high risk of GI bleed, NOACs were associated with lower rates of stroke and/or SE, but NOACs had varying risks of MB compared with warfarin. These results may help inform treatment options in this patient population

Prevalence, incidence and mortality of hypertrophic cardiomyopathy based on a population cohort of 21.9 million in China

There are limited studies on the prevalence and incidence of clinically diagnosed hypertrophic myocardiopathy (HCM) and its mortality in the Chinese population, and the projected population burden of HCM over the next decades. We collected data on HCM and its mortality from the Beijing Municipal Health Commission Information Center (BMHCIC) database and estimated the prevalence and incidence based on the whole Beijing population. Calculation of population trends was performed using annual percentage change (APC) and average annual percentage change (AAPC). Finally, future HCM incidence was built by modelling projection of HCM to the next decades using Poisson regression analysis and Gray Model 1,1(GM [1,1]). The prevalence of HCM was 0.0069% (95%CI, 0.0065–0.0072%; N = 1343) in 2010, rising to 0.076% (95% CI, 0.074–0.077%; N = 16,616) in 2019, and the incidence of HCM was 6.85 per 100 000 person-year in 2010, rising to 11.76 per 100 000 person-year in 2019. Males had higher prevalence and incidence of HCM than females. The APPC for the rising incidence of HCM was 5.8% and the expected numbers will double increase in 2029 by assuming the same increase trend as the last decades. HCM had increased annual incidence of HF (APPC: 8.4, 4.4–12.6, p  0.05) during the studied period. Males had lower mortality (2.70% vs. 4.20%, p < 0.001) than females. The calculated HCM prevalence was much lower compared to prior screening studies from 2004, although the predicted HCM incidence would double over the next decades. HCM was associated with a stable risk of mortality during the studied period