Διερεύνηση του προγνωστικού αποτελέσματος της ρύθμισης των επιπέδων αρτηριακής πίεσης και LDL-χοληστερόλης σε υπερτασικούς ασθενείς. Μία προοπτική μελέτη.

Εισαγωγή. Η υψηλή αρτηριακή πίεση (ΑΠ) και η δυσλιπιδαιμία είναι γνωστοί παράγοντες καρδιαγγειακού κινδύνου. Η μείωση της ΑΠ και της LDL-χοληστερόλης (LDL-C) και η στόχευση σε επίπεδα κατώτερα των ενδεδειγμένων οδηγιών προλαμβάνει τα καρδιαγγειακά επεισόδια και βελτιώνει την πρόγνωση. Σκοπός της παρούσας εργασίας ήταν η διερεύνηση της επίδρασης της συνδυασμένης επίτευξης των θεραπευτικών στόχων αρτηριακής πίεσης και LDL-C ως προς το θάνατο και την πρώτη εμφάνιση καρδιαγγειακών επεισοδίων σε υπερτασικούς ασθενείς. Μεθοδολογία. Μεταξύ των 2.380 υπερτασικών ασθενών χωρίς εγκατεστημένη καρδιαγγειακή νόσο στους οποίους χορηγήθηκε αντιυπερτασική θεραπεία κατά την έναρξη, αξιολογήθηκε η πορεία ελέγχου της ΑΠ και της LDL-C σε 1.034 ασθενείς με 6 συμπληρωμένες μετρήσεις ΑΠ και 3 συμπληρωμένες μετρήσεις LDL-C. Ο έλεγχος της ΑΠ ορίστηκε ως ΑΠ <140/90mmHg στις μισές ή περισσότερες μετρήσεις. Οι στόχοι LDL-C ορίστηκαν με βάση το επίπεδο καρδιαγγειακού κινδύνου. Ο έλεγχος των λιπιδίων ορίστηκε ως επιτευχθείς στόχος LDL-C σε 2 ή 3 επισκέψεις. Το HeartScore χρησιμοποιήθηκε για την εκτίμηση του καρδιαγγειακού κινδύνου κατά την έναρξη. Αποτελέσματα: Η μέση παρακολούθηση των ασθενών ήταν 141 μήνες και καταγράφηκαν 32 θάνατοι (2.8%). Παρά την κατάλληλη αντιυπερτασική θεραπεία, 376 ασθενείς (32.8%) δεν πέτυχαν τον έλεγχο της ΑΠ σε μισές ή περισσότερες επισκέψεις παρακολούθησης. Αντίστοιχα, 538 ασθενείς (52.0%) δεν πέτυχαν τους στόχους LDL-C σε τουλάχιστον μία επίσκεψη. Οι ασθενείς με μη αποτελεσματικό έλεγχο της ΑΠ είχαν σχεδόν 2 φορές πιο αυξημένο κίνδυνο ολικής θνησιμότητας και πρώτης εμφάνισης καρδιαγγειακών επεισοδίων σε σύγκριση με άτομα με αποτελεσματικό έλεγχο της ΑΠ (adjusted HR = 1.96, 95% CI: 0.98-3.93 και HR = 1.15, 95% CI: 0.84-1.58, αντίστοιχα). Οι ασθενείς που δεν πέτυχαν τους στόχους θεραπείας τόσο για την ΑΠ όσο και για την LDL παρουσίασαν σημαντικά αυξημένο κίνδυνο ολικής θνησιμότητας και πρώτης εμφάνισης καρδιαγγειακού επεισοδίου (adjusted HR=2.28, 95% CI: 0.87 - 6.02 και HR = 3.25, 95% CI: 0.77 - 4.08). Συμπεράσματα: Ο μη αποτελεσματικός έλεγχος της ΑΠ σχετίζεται με την ολική θνησιμότητα και τα καρδιαγγειακά επεισόδια στην υπέρταση. Ο κίνδυνος αυτός ήταν μεγαλύτερος με την ταυτόχρονη παρουσία τιμών LDL-C πάνω από τους στόχους θεραπείας, υπογραμμίζοντας έτσι την ανάγκη για συνδυασμένη επίτευξη ελέγχου ΑΠ και LDL-C.Background: Hypertension and dyslipidemia are well-known risk factors for cardiovascular disease (CVD). In such patients, lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) and targeting to values below pre-specified cut-offs prevents cardiovascular events (CV) and improves prognosis. However, the impact of both BP and LDL-C control as compared to control of only one and/or none of these two risk factors is not well-studied. In the current study, we aimed to investigate the combined effect of BP and LDL-C control in the prevention of death and the first occurrence of cardiovascular events in hypertensive patients. Methods: Among 2,380 treated patients with hypertension and no overt CVD at baseline, we assessed the trajectory of BP and LDL-C control in 1,034 subjects with 6 completed BP and 3 completed LDL-C measurements. BP control was defined as BP <140/90mmHg in half or more visits. The level of cardiovascular risk determined the LDL-C goals for each patient. Lipid control was defined as achieved LDL-C targets in 2 or 3 visits. The HeartScore was used to estimate the cardiovascular risk at baseline. Results: Across a median follow up of 141 months, 32 deaths (2.8%) were recorded. Despite appropriate anti-hypertensive treatment, 376 patients (32.8%) did not achieve conventional BP control in half or more of follow-up visits. Respectively, 538 patients (52.0%) did not meet the LDL-C goals in at least one assessment. Patients with suboptimal BP control had almost 2-fold increased risk for all-cause mortality and first occurrence of CV events (adjusted HR=1.96, 95% CI: 0.98-3.93 and HR=1.15, 95% CI: 0.84-1.58, respectively) as compared to subjects with effective BP control. Patients who did not reach treatment goals for both BP and LDL showed substantially increased risk for all-cause mortality and first occurrence of a CV event (adjusted HR=2.28, 95% CI: 0.87 - 6.02 and HR=3.25, 95% CI: 0.77 - 4.08). Conclusions: Suboptimal BP control was related to all-cause mortality and CVD occurrence in our cohort of hypertensive patients. The risk was even higher in the concurrent presence of LDL-C values above treatment targets, thus, highlighting the need for combined achievement of BP and LDL-C control

Novel near-infrared spectroscopy-intravascular ultrasound-based deep-learning methodology for accurate coronary computed tomography plaque quantification and characterization

AIMS: Coronary computed tomography angiography (CCTA) is inferior to intravascular imaging in detecting plaque morphology and quantifying plaque burden. We aim to, for the first time, train a deep-learning (DL) methodology for accurate plaque quantification and characterization in CCTA using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS). METHODS AND RESULTS: Seventy patients were prospectively recruited who underwent CCTA and NIRS-IVUS imaging. Corresponding cross sections were matched using an in-house developed software, and the estimations of NIRS-IVUS for the lumen, vessel wall borders, and plaque composition were used to train a convolutional neural network in 138 vessels. The performance was evaluated in 48 vessels and compared against the estimations of NIRS-IVUS and the conventional CCTA expert analysis. Sixty-four patients (186 vessels, 22 012 matched cross sections) were included. Deep-learning methodology provided estimations that were closer to NIRS-IVUS compared with the conventional approach for the total atheroma volume (ΔDL-NIRS-IVUS: -37.8 ± 89.0 vs. ΔConv-NIRS-IVUS: 243.3 ± 183.7 mm3, variance ratio: 4.262, P < 0.001) and percentage atheroma volume (-3.34 ± 5.77 vs. 17.20 ± 7.20%, variance ratio: 1.578, P < 0.001). The DL methodology detected lesions more accurately than the conventional approach (Area under the curve (AUC): 0.77 vs. 0.67, P < 0.001) and quantified minimum lumen area (ΔDL-NIRS-IVUS: -0.35 ± 1.81 vs. ΔConv-NIRS-IVUS: 1.37 ± 2.32 mm2, variance ratio: 1.634, P < 0.001), maximum plaque burden (4.33 ± 11.83% vs. 5.77 ± 16.58%, variance ratio: 2.071, P = 0.004), and calcific burden (-51.2 ± 115.1 vs. -54.3 ± 144.4, variance ratio: 2.308, P < 0.001) more accurately than conventional approach. The DL methodology was able to segment a vessel on CCTA in 0.3 s. CONCLUSIONS: The DL methodology developed for CCTA analysis from co-registered NIRS-IVUS and CCTA data enables rapid and accurate assessment of lesion morphology and is superior to expert analysts (Clinicaltrials.gov: NCT03556644)

Associations of Maternal Educational Level, Proximity to Green Space During Pregnancy, and Gestational Diabetes With Body Mass Index From Infancy to Early Adulthood:A Proof-of-Concept Federated Analysis in 18 Birth Cohorts

International sharing of cohort data for research is important and challenging. We explored the feasibility of multicohort federated analyses by examining associations between 3 pregnancy exposures (maternal education, exposure to green vegetation, and gestational diabetes) and offspring body mass index (BMI) from infancy to age 17 years. We used data from 18 cohorts (n = 206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13, and 14-17 years. Associations were estimated using linear regression via 1-stage individual participant data meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z score comparing low with high education, at age 2-3 years = 0.03 (95% confidence interval (CI): 0.00, 0.05), at 4-7 years = 0.16 (95% CI: 0.14, 0.17), and at 8-13 years = 0.24 (95% CI: 0.22, 0.26)). Gestational diabetes was positively associated with BMI from age 8 years (BMI z score difference = 0.18, 95% CI: 0.12, 0.25) but not at younger ages; however, associations attenuated towards the null when restricted to cohorts that measured gestational diabetes via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age 1 year but not at older ages. Opportunities of cross-cohort federated analyses are discussed.</p

Associations of Maternal Educational Level, Proximity to Green Space During Pregnancy, and Gestational Diabetes With Body Mass Index From Infancy to Early Adulthood:A Proof-of-Concept Federated Analysis in 18 Birth Cohorts

International sharing of cohort data for research is important and challenging. We explored the feasibility of multicohort federated analyses by examining associations between 3 pregnancy exposures (maternal education, exposure to green vegetation, and gestational diabetes) and offspring body mass index (BMI) from infancy to age 17 years. We used data from 18 cohorts (n = 206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13, and 14-17 years. Associations were estimated using linear regression via 1-stage individual participant data meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z score comparing low with high education, at age 2-3 years = 0.03 (95% confidence interval (CI): 0.00, 0.05), at 4-7 years = 0.16 (95% CI: 0.14, 0.17), and at 8-13 years = 0.24 (95% CI: 0.22, 0.26)). Gestational diabetes was positively associated with BMI from age 8 years (BMI z score difference = 0.18, 95% CI: 0.12, 0.25) but not at younger ages; however, associations attenuated towards the null when restricted to cohorts that measured gestational diabetes via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age 1 year but not at older ages. Opportunities of cross-cohort federated analyses are discussed.</p

The Mediterranean Diet Benefit on Cardiovascular Hemodynamics and Erectile Function in Chronic Heart Failure Male Patients by Decoding Central and Peripheral Vessel Rheology

Background: Mediterranean diet was evaluated on erectile performance and cardiovascular hemodynamics, in chronic heart failure patients. Methods: 150 male stable heart failure patients were enrolled in the study (62 &plusmn; 10 years, New York Heart Association (NYHA) classes I&ndash;II, ejection fraction &le;40%). A detailed echocardiographic evaluation including estimation of the global longitudinal strain of the left ventricle and the systolic tissue doppler velocity of the tricuspid annulus was performed. Erectile dysfunction severity was assessed by the Sexual Health Inventory for Men-5 (SHIM-5) score. Adherence to the Mediterranean diet was evaluated by the MedDietScore. Results: The SHIM-5 score was positively correlated with the MedDietScore (p = 0.006) and augmentation index (p = 0.031) and inversely correlated with age (p = 0.002). MedDietScore was negatively associated with intima-media-thickness (p &lt; 0.001) and serum prolactin levels (p = 0.05). Multi-adjusted analysis revealed that the inverse relation of SHIM-5 and prolactin levels remained significant only among patients with low adherence to the Mediterranean diet (p = 0.012). Conclusion: Consumption of Mediterranean diet benefits cardiovascular hemodynamics, while suppressing serum prolactin levels. Such physiology may enhance erectile ability independently of the of the left ventricle ejection fraction

Associations of Maternal Educational Level, Proximity to Greenspace During Pregnancy, and Gestational Diabetes With Body Mass Index From Infancy to Early Adulthood:A Proof-of-Concept Federated Analysis in 18 Birth Cohorts

International sharing of cohort data for research is important and challenging. We explored the feasibility of multicohort federated analyses by examining associations between 3 pregnancy exposures (maternal education, exposure to green vegetation, and gestational diabetes) and offspring body mass index (BMI) from infancy to age 17 years. We used data from 18 cohorts (n = 206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13, and 14-17 years. Associations were estimated using linear regression via 1-stage individual participant data meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z score comparing low with high education, at age 2-3 years = 0.03 (95% confidence interval (CI): 0.00, 0.05), at 4-7 years = 0.16 (95% CI: 0.14, 0.17), and at 8-13 years = 0.24 (95% CI: 0.22, 0.26)). Gestational diabetes was positively associated with BMI from age 8 years (BMI z score difference = 0.18, 95% CI: 0.12, 0.25) but not at younger ages; however, associations attenuated towards the null when restricted to cohorts that measured gestational diabetes via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age 1 year but not at older ages. Opportunities of cross-cohort federated analyses are discussed.</p

Associations of maternal education, area deprivation, proximity to greenspace during pregnancy and gestational diabetes with Body Mass Index from early childhood to early adulthood: A proof-of-concept federated analysis in seventeen birth cohorts

Background: International sharing of cohort data for research is important and challenging. The LifeCycle project aimed to harmonise data across birth cohorts and develop methods for efficient federated analyses of early life stressors on offspring outcomes. Aim: To explore feasibility of federated analyses of associations between four different types of pregnancy exposures (maternal education, area deprivation, proximity to green space and gestational diabetes) with offspring BMI from infancy to 17 years. Methods: We used harmonised exposure and outcome data from 17 cohorts (n=200,650 mother-child pairs) from the EU Child Cohort Network. For each child, we derived BMI at five age periods: (i) 0-1 years, (ii) 2-3, (iii) 4-7, (iv) 8-13 and (v) 14-17 years. Associations were estimated using linear regression via one-stage individual participant data meta-analysis using the federated analysis platform DataSHIELD. Results: Associations between lower maternal education and higher child BMI emerged from age 4 years and increased with age (difference in BMI z-score comparing low with high education age 0-1 years = 0.02 [95% CI 0.00, 0.03], 2-3 years = 0.01 [CI -0.02, 0.04], 4-7 years = 0.14 [CI 0.13, 0.16], 8-13 years = 0.22 [CI 0.20, 0.24], 14-17 years = 0.20 [CI 0.16, 0.23]). A similar pattern was found for area deprivation. Gestational diabetes was positively associated with BMI from 8 years (8-13 years = 0.17 [CI 0.10, 0.24], 14-17 years = 0.012 [CI -0.13, 0.38]) but not at younger ages. The normalised difference vegetation index measure of maternal proximity to green space was weakly associated with higher BMI in the first year of life but not at older ages. Conclusions: Associations between maternal education, area-based socioeconomic position and GDM with BMI increased with age. Maternal proximity to green space was not associated with offspring BMI, other than a weak association in infancy. Opportunities and challenges of cross-cohort federated analyses are discussed

Associations of maternal educational level, proximity to greenspace during pregnancy, and gestational diabetes with body mass index from infancy to early adulthood: a proof-of-concept federated analysis in 18 birth cohorts

International sharing of cohort data for research is important and challenging. We explored the feasibility of multi-cohort federated analyses by examining associations between three pregnancy exposures (maternal education, exposure to green vegetation and gestational diabetes) with offspring BMI from infancy to 17 years. We used data from 18 cohorts (n=206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13 and 14-17 years. Associations were estimated using linear regression via one-stage IPD meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z-score comparing low with high education age 2-3 years = 0.03 [95% CI 0.00, 0.05], 4-7 years = 0.16 [95% CI 0.14, 0.17], 8-13 years = 0.24 [95% CI 0.22, 0.26]). Gestational diabetes was positively associated with BMI from 8 years (BMI z-score difference = 0.18 [CI 0.12, 0.25]) but not at younger ages; however associations attenuated towards the null when restricted to cohorts which measured GDM via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age one but not at older ages. Opportunities of cross-cohort federated analyses are discussed.</p