Influenza Vaccination for the Prevention of Cardiovascular Disease in the Americas: Consensus document of the Inter-American Society of Cardiology and the Word Heart Federation

Background Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America. Objective The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease. Methods A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of statements. The modified RAND/UCLA methodology was used. This document was supported by a grant from the WHF. Results An extensive literature search was divided into seven questions, and a total of 23 conclusions and 29 recommendations were achieved. There was no disagreement among experts in the conclusions or recommendations. Conclusions There is a strong correlation between influenza and cardiovascular events. Influenza vaccination is not only safe and a proven strategy to reduce cardiovascular events, but it is also cost saving. We found several barriers for its global implementation and potential strategies to overcome them

Populations of planets in multiple star systems

Astronomers have discovered that both planets and binaries are abundant throughout the Galaxy. In combination, we know of over 100 planets in binary and higher-order multi-star systems, in both circumbinary and circumstellar configurations. In this chapter we review these findings and some of their implications for the formation of both stars and planets. Most of the planets found have been circumstellar, where there is seemingly a ruinous influence of the second star if sufficiently close (<50 AU). Hosts of hot Jupiters have been a particularly popular target for binary star studies, showing an enhanced rate of stellar multiplicity for moderately wide binaries (>100 AU). This was thought to be a sign of Kozai-Lidov migration, however recent studies have shown this mechanism to be too inefficient to account for the majority of hot Jupiters. A couple of dozen circumbinary planets have been proposed around both main sequence and evolved binaries. Around main sequence binaries there are preliminary indications that the frequency of gas giants is as high as those around single stars. There is however a conspicuous absence of circumbinary planets around the tightest main sequence binaries with periods of just a few days, suggesting a unique, more disruptive formation history of such close stellar pairs.Comment: Invited review chapter, accepted for publication in "Handbook of Exoplanets", ed. H. Deeg & J. A. Belmont

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Hybrid Processing

Human societies have converted biomass into energy and products for millennia using both biochemical and thermochemical processes. Familiar examples of biochemical processing includes fermentation of sugar- or starch-rich crops and milk into sauerkraut, beer, wine, yogurt, and cheese. Familiar examples of thermochemical processing include baking and cooking of food and burning wood for heat and power

Polygenic Risk Modelling for Prediction of Epithelial Ovarian Cancer Risk

Funder: Funding details are provided in the Supplementary MaterialAbstractPolygenic risk scores (PRS) for epithelial ovarian cancer (EOC) have the potential to improve risk stratification. Joint estimation of Single Nucleotide Polymorphism (SNP) effects in models could improve predictive performance over standard approaches of PRS construction. Here, we implemented computationally-efficient, penalized, logistic regression models (lasso, elastic net, stepwise) to individual level genotype data and a Bayesian framework with continuous shrinkage, “select and shrink for summary statistics” (S4), to summary level data for epithelial non-mucinous ovarian cancer risk prediction. We developed the models in a dataset consisting of 23,564 non-mucinous EOC cases and 40,138 controls participating in the Ovarian Cancer Association Consortium (OCAC) and validated the best models in three populations of different ancestries: prospective data from 198,101 women of European ancestry; 7,669 women of East Asian ancestry; 1,072 women of African ancestry, and in 18,915 BRCA1 and 12,337 BRCA2 pathogenic variant carriers of European ancestry. In the external validation data, the model with the strongest association for non-mucinous EOC risk derived from the OCAC model development data was the S4 model (27,240 SNPs) with odds ratios (OR) of 1.38(95%CI:1.28–1.48,AUC:0.588) per unit standard deviation, in women of European ancestry; 1.14(95%CI:1.08–1.19,AUC:0.538) in women of East Asian ancestry; 1.38(95%CI:1.21-1.58,AUC:0.593) in women of African ancestry; hazard ratios of 1.37(95%CI:1.30–1.44,AUC:0.592) in BRCA1 pathogenic variant carriers and 1.51(95%CI:1.36-1.67,AUC:0.624) in BRCA2 pathogenic variant carriers. Incorporation of the S4 PRS in risk prediction models for ovarian cancer may have clinical utility in ovarian cancer prevention programs.</jats:p

Częstość występowania i czynniki predykcyjne miażdżycy w wielu obszarach tętniczych u pacjentów z chorobą wieńcową

Background: Cardiovascular diseases are the number one killer in the developed countries, accounting for approximately half of all deaths, with the leading causes being myocardial infarction and ischaemic stroke. In line with the ageing population, the prevalence of coronary artery disease (CAD), lower extremity peripheral arterial disease (PAD), supra-aortic arterial disease (SAD) and renal stenosis (RAS) is increasing. Polyvascular atherosclerosis (PVA) coexisting in several territories has an adverse effect on cardiovascular morbidity and mortality. Aim: To determine prevalence, coexistence and predictors of significant PAD, SAD and RAS in patients with suspected CAD. Methods: Based on angiography, the frequency of coexisting CAD, SAD, PAD and RAS (stenosis ł 50%) was determined in 687 (487 male) consecutive patients, aged 63.5 &#177; 9.1 years, referred for coronary angiography. Results: Significant CAD was found in 545 (79.3%) patients (1-vessel in 164; 2-vessel in 157; 3-vessel in 224). SAD, RAS and PAD were found in 136 (19.8%), 55 (8%), and 103 (15%) patients, respectively. Of the 545 patients with confirmed CAD, 346 (63.5%) had stenoses limited to coronary arteries. 2-, 3- and 4-level PVA was found in 130 (23.8%), 61 (11.2%) and 8 (1.5%) patients, respectively. Of the 142 patients without CAD, 127 (89.4%) had no significant stenoses elsewhere, 12 (8.5%) had 1 extracoronary territory and 3 (2.1%) had 2-territory involvement. Backward stepwise binary logistic regression analysis showed the following independent predictors of at least 2-level PVA: 2- and 3-vessel CAD (p 1.3 mg/dl; and 1.9-fold, 2.4-fold and 2-fold in patients with hyperlipidaemia, smokers and women, respectively. Conclusions: Significant atherosclerosis in extracoronary arterial territories is present in 36% of patients with documented CAD. With advancing PVA, accumulation of atherosclerosis risk factors, previous atherothrombotic events and more severe CAD is observed.Wstęp: W dobie starzejących się społeczeństw częstość choroby wieńcowej (CAD), miażdżycy zarostowej tętnic kończyn dolnych (PAD), występowania zwężeń tętnic odchodzących od łuku aorty, tj. tętnic szyjnych, kręgowych i podobojczykowych (SAD), jak również zwężeń tętnic nerkowych (RAS) znacznie wzrasta. Wielopoziomowa miażdżyca (PVA), tj. obecność zwężeń miażdżycowych ł 50% w 2 lub więcej obszarach tętniczych, związana jest z częstszym występowaniem zdarzeń sercowo-naczyniowych, w tym zgonów. Cel: Ocena częstości występowania SAD, PAD i RAS u chorych z CAD oraz wyodrębnienie czynników predykcyjnych PVA. Metody: Badaniem objęto 687 (487 mężczyzn) kolejnych chorych, w średnim wieku 63,5 &#177; 9,1 roku, u których wykazano angiograficznie obecność przynajmniej jednego zwężenia ł 50% zlokalizowanego w tętnicach wieńcowych, dogłowowych, nerkowych lub kończyn dolnych. Wyniki: Zwężenia ł 50% w tętnicach wieńcowych stwierdzono u 545 (79,3%) chorych (1-naczyniowa CAD u 164, 2-naczyniowa CAD u 157, 3-naczyniowa CAD u 224 chorych). Obecność SAD, RAS i PAD ł 50% stwierdzono u odpowiednio 136 (19,8%), 55 (8%) oraz 103 (15%) chorych. Spośród 545 chorych z potwierdzoną CAD, u 346 (63,5%) zwężenia występowały tylko w tętnicach wieńcowych, natomiast 2-, 3-, 4-obszarową PVA wykazano u odpowiednio 130 (23,8%), 61 (11,2%) oraz 8 (1,5%) chorych. Spośród 142 chorych bez istotnych zwężeń w tętnicach wieńcowych, u 127 (89,4%) nie wykazano zwężeń ł 50% w żadnym z pozostałych obszarów tętniczych, natomiast u 12 (8,5%) chorych stwierdzono zwężenia w jednym obszarze pozawieńcowym, a u 3 (2,1%) w dwóch obszarach. Zidentyfikowano następujące niezależne czynniki predykcyjne ł 2-poziomowej PVA: chromanie przestankowe (ryzyko względne &#8211; RW = 15,7; p < 0,001), wielonaczyniowa CAD (RW = 2,1; p = 0,001), stężenie kreatyniny ł 1,3 mg/dl (RW = 2,8; p = 0,007), hiperlipidemia (RW = 1,9; p = 0,067), palenie tytoniu (RW = 2,4; p < 0,001) oraz płeć żeńska (RW = 2; p = 0,003). Wnioski: Istotne zwężenia w tętniczych obszarach pozawieńcowych występują u 36% chorych z udokumentowaną, istotną chorobą wieńcową. Wraz z rosnącym zaawansowaniem miażdżycy obserwuje się większą częstość i kumulację licznych czynników ryzyka miażdżycy, a także wielonaczyniową chorobę wieńcową

Position statement on use of pharmacological combinations in a single pill for treatment of hypertension by Argentine Federation of Cardiology (FAC) and Argentine Society of Hypertension (SAHA)

The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.Fil: Renna, Nicolas Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: Piskorz, Daniel. Sanatorio Británico; ArgentinaFil: Stisman, Diego. Instituto de Cardiología de Tucumán; ArgentinaFil: Martinez, Diego. Universidad Nacional de Córdoba; ArgentinaFil: Lescano, Ludmila. Hospital San Bernardo; ArgentinaFil: Vissani, Sergio. Centro de Neurología y Rehabilitación; ArgentinaFil: Espeche, Walter. Hospital San Martin; ArgentinaFil: Marquez, Diego. Hospital San Bernardo; ArgentinaFil: Parodi, Roberto Leandro. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Naninni, Diego. Instituto Especialidades de la Salud Rosario; ArgentinaFil: Baroni, Marcos. Instituto Modelo de Cardiología; ArgentinaFil: Llanos, Daniel. Centro de Diagnóstico y Tratamiento; Argentina. Clínica Chapelco y Centro Médico Roca; ArgentinaFil: Martinez, Rocio. Hospital Italiano; ArgentinaFil: Barochinner, Jessica. Hospital Italiano; ArgentinaFil: Staffieri, Gustavo. Grupo Oroño; ArgentinaFil: Lanas, Fernando. Universidad de La Frontera; ChileFil: Velásquez, Mónica. Universidad de La Frontera; ChileFil: Marin, Marcos. Hospital Italiano; ArgentinaFil: Williams, Bryan. University College London; Estados UnidosFil: Ennis, Irene Lucia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigaciones Cardiovasculares "Dr. Horacio Eugenio Cingolani". Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Investigaciones Cardiovasculares "Dr. Horacio Eugenio Cingolani"; Argentin