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We investigated the association between self-rated poor physical health (srPPH), a validated proxy measure of health-related quality of life, and age-adjusted cardiovascular mortality (AACVM) rates across overall U.S. counties and within various demographics. Nationwide county-level analysis. We analyzed county-level data spanning 2010–2019 from the Behavioral Risk Factors Surveillance System (BRFSS) and the Centers for Disease Control and Prevention (CDC). This analysis included data from 2892 counties with complete records on srPPH and AACVM. srPPH was defined as the age-adjusted average number of days respondents reported being in poor physical health over the past 30 days. To estimate the average srPPH per resident in each county, the CDC utilized validated statistical models applied to BRFSS data. To assess the association between srPPH and AACVM, we employed Poisson Generalized Linear Mixed Models, generating incident rate ratios (IRRs). Out of the 307,045,647 residents living in 2892 U S. counties in 2010, 8,157,571 (2.7 %) cardiovascular deaths were recorded during the study period. Counties where residents reported the greatest number of physically unhealthy days—indicative of higher srPPH—experienced the highest AACVM rates, despite significant decreases in overall AACVM rates from 2010 to 2019. Moreover, srPPH was independently associated with higher AACVM rates (IRR: 1.018; 95 % CI: 1.011 to 1.025) across most demographic groups, except Hispanics. This association was particularly strong among middle-aged (45–64 years old) women and elderly (≥65 years old) non-Hispanic Black individuals. srPPH may serve as a valuable community health marker that can help identify populations at risk for cardiovascular mortality, independent of other social determinants of health. When used in combination with objective measures of cardiovascular health, this metric can enhance targeted screening and intervention efforts in high-risk populations. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) are a major threat to public health globally. A large proportion of people with dyslipidaemia have poorly controlled lipid levels, emphasizing the need for alternative lipid-lowering treatments that are both effective and safe. Xuezhikang, a red yeast rice (RYR) extract, containing 13 kinds of monacolins and other bioactive components, emerges as one such promising option. Its discovery was built on a long history of RYR use as a functional food supplement and traditional Chinese medicine. Several randomized, controlled clinical trials have substantiated its lipid-lowering effects and its potential to protect against CVDs. Safety concerns with statins did not arise during decades of experience with Xuezhikang treatment in clinical practice. The approval of Xuezhikang in multiple regions of Asia marked a conceptual shift in CVD management, moving from single agents to polypills and from synthetic medicines to natural extracts. This review comprehensively addresses important topics related to this medicinal natural extract, including the ancient utilization of RYR, the development of Xuezhikang, its mechanisms of action, pleiotropic effects, clinical studies, challenges, and future perspectives to enhance our understanding regarding the role of Xuezhikang, a representative, domestic lipid-lowering drug of RYR, in prevention and treatment of CVD. This review article summarizes the potential of Xuezhikang as a safe and effective alternative for cardiovascular disease prevention and treatment, providing a wide spectrum of benefits. [Display omitted] [ABSTRACT FROM AUTHOR]

• Previous therapy with colchicine was rarely an exclusion criterion in trials assessing it for cardiovascular prevention. • Only a few studies about colchicine excluded patients with autoimmune or inflammatory diseases. • Subgroup analysis of patients with chronic inflammatory diseases should be performed in future trials assessing colchicine for cardiovascular prevention. To review randomised controlled trials (RCT) investigating colchicine (COL) for cardiovascular (CV) prevention in patients at high to very high CV risk aiming to extract data that could be useful in rheumatology practice. A systematic search of multiple databases according to the PICO framework was performed from inception to April 3, 2023. Three researchers independently screened abstracts/titles and reviewed full texts reviewed. Data extraction was performed using a pilot‐tested data extraction form. A total of 14,096 references were retrieved by the search and 30 articles, describing 28 RCTs, were included in the review (Total number of patients 16,795, of which 8,463 randomised to COL; dose 0.5–2 mg/day, treatment duration 1day-29 months). Only one of the 28 RCTs provided clear information on whether patients with rheumatic diseases (more specifically gout) were enrolled in the study cohorts and previous use of COL was an exclusion criterion only in 14 (50 %) RCTs. Previous therapy with glucocorticoids and/or non-steroidal anti-inflammatory drugs and/or immune suppressive therapies was an exclusion criterion only in 9 (32 %) RCTs. Our results highlight the need to redefine the eligibility criteria as well as the reporting of results in future RCTs in order to minimise bias or previous exposure to COL and also obtain data that could be useful in rheumatology practice. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) treatment with anthracyclines and/or anti-human epidermal growth factor receptor-2 (HER2) antibodies is associated with an increased risk of cardiovascular disease complications, including cancer therapy-related cardiac dysfunction (CTRCD). While Cardio-Oncology Rehabilitation (CORe) programs including exercise have emerged to minimize these risks, its role in preventing CTRCD is unclear. We investigated the effectiveness of an exercise-based CORe program in preventing CTRCD [left ventricular ejection fraction (LVEF) drop ≥10% to a value <53% or a decrease >15% in global longitudinal strain (GLS)]. Secondary outcomes examined changes in cardiac biomarkers, physical performance including peak oxygen consumption, psychometric and lifestyle outcomes. Safety, adherence, and patient satisfaction were also assessed. This is a randomized controlled trial including 122 early-stage BC women receiving anthracyclines and/or anti-HER2 antibodies, randomized to CORe (n = 60) or usual care with exercise recommendation (n = 62). Comprehensive assessments were performed at baseline and after cardiotoxic treatment completion. The average duration of the intervention was 5.8 months. No cases of CTRCD were identified during the study. LVEF decreased in both groups, but was significantly attenuated in the CORe group [−1.5% (−2.9, −0.1); p = 0.006], with no changes detected in GLS or cardiac biomarkers. The CORe intervention led to significant body mass index (BMI) reduction (p = 0.037), especially in obese patients [3.1 kg/m2 (1.3, 4.8)]. Physical performance and quality-of-life remained stable, while physical activity level increased in both groups. No adverse events were detected. This study suggests that CORe programs are safe and may help attenuate LVEF decline in BC women receiving cardiotoxic therapy and reduce BMI in obese patients. An exercise-based cardio-oncology rehabilitation program: the ONCORE randomized trial. Caption: The ONCORE randomized controlled trial (n = 122) evaluated the effectiveness of an exercise-based CORe program in the prevention of cardiac disfunction. Participation in the CORe group significantly mitigated the LVEF decline (p = 0.006) and reduced BMI (p = 0.037) mainly in obese patients. BMI, body mass index; CORe, cardio-oncology rehabilitation; CR, cardiac rehabilitation; CO, cardio-oncology; LVEF, left ventricular ejection fraction; OR, oncology rehabilitation. [Display omitted] [ABSTRACT FROM AUTHOR]

• The approval of colchicine revolutionised the therapeutic algorithm for cardiovascular prevention bringing to the forefront the long-term direct targeting of inflammation. • Anti-inflammatory treatment with colchicine is a therapeutic tool to be added on top of the most advantageous standard of care in patients still at high risk of recurrent cardiovascular events. • The low cost of colchicine and the reassuring data on long-term safety strenghten the rationale to use this drug for cardiovascular prevention. [ABSTRACT FROM AUTHOR]

• A multi-phase process was undertaken to develop Cardiac College for Women. • This is a co-designed education curriculum for CVD secondary prevention in women. • It can be delivered based on women's preferences for modalities and content. • It is hoped these resources will support women to reduce their risk of CV sequelae. Despite their differential risk factor burden, context and often different forms of heart disease, cardiac rehabilitation (CR) programs generally do not provide women with needed secondary prevention information specific to them. to co-design evidence-informed, theory-based comprehensive women-focused education, building from Health e-University's Cardiac College for CR. A multi-disciplinary, multi-stakeholder steering committee (N = 18) oversaw the four-phase development of the women-focused curriculum. Phase 1 involved a literature review on women's CR information needs and preferences, phase 2 a CR program needs assessment, phase 3 content development (including determining content and mode, assigning experts to create the content, plain language review and translation), and phase 4 will comprise evaluation and implementation. In phase 2, a focus group was conducted with Canadian CR providers; it was analyzed using Braun and Clarke's iterative approach. Nineteen providers participated in the focus group, with four themes emerging: current status of education, challenges to delivering women-focused education, delivery modes and topical resources. Results were consistent with those from our related global survey, supporting saturation of themes. Co-designed educational materials included 19 videos. These were organized across 5 webpages in English and French, specific to tests and treatments, exercise, diet, psychosocial well-being, and self-management. Twelve corresponding session slide decks with notes for clinicians were created, to support program delivery in CR flexibly. While further evaluation is underway, these open-access CR education resources will be disseminated for implementation, to support women in reducing their risk of cardiovascular sequelae. [ABSTRACT FROM AUTHOR]

Excess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached. In Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008–12 and 2018–19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt. Two recent studies conducted by the Italian Society of Human Nutrition "Young Working Group" have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO. Italy has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers. • Average salt intake in Italy is still almost twice the WHO recommended level. • Cereal-based products are the major source of non-discretionary salt intake in Italy. • The sodium content of cereal-based products is in almost all cases well above the benchmarks proposed by WHO. • There is an urgent need to proceed to food reformulation by defining sodium targets for the foods most relevant to high salt intake. [ABSTRACT FROM AUTHOR]

CAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast. The accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC ​= ​0, 1–99, 100–399, and ≥400, respectively. From 2016 to 2021, 934 patients (mean age 60 ​± ​12 ​y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b ​= ​0.76, p ​< ​0.0001). Among those with no visual CAC, 76% had CAC ​= ​0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist. Visual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to "de-risk" patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions. [ABSTRACT FROM AUTHOR]

The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting. 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001). FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention. • Detection of extra-coronary subclinical atherosclerosis (scATS) improves stratification of CV risk. • Synergistic power of scATS with Framingham risk score (FHRS) as a combined score is unknown. • Atherosclerosis burden score (ABS) is the ultrasonography number of carotid and femoral arteries plaques. • The combined score FHRAB improved the CV predictive ability of the FHRS. • FHRABS offers a simple-to-use, radiation-free score to promote personalized CV prevention. [ABSTRACT FROM AUTHOR]

To contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly causing an increase in unhealthy habits. We investigated changes in cardiovascular (CV) risk assessed by the SCORE-2 in a healthy population of healthcare workers during the COVID-19 pandemic; an analysis by subgroups was also conducted (sportspeople vs sedentary subjects). We compared medical examination and blood tests in a population of 264 workers aged over 40, performed yearly before (T0) and during the pandemic (T1, T2). We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile at T0 (2.35%) to a mean high-risk profile at T2 (2.80%). Furthermore, in sedentary subjects was observed a greater and early increase in SCORE-2 compared to sportspeople. Since 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines. • The spread of COVID-19 forced billions of people to remain at home, leading to radical changes in daily life behaviors. • Moreover, healthcare workers experienced additional stress due to the increased risk of contagion. • We found a significant increase in cardiovascular risk profile during the pandemic in healthy healthcare workers. • The increase in systolic blood pressure was independent predictor of the reported increasing in cardiovascular risk. [ABSTRACT FROM AUTHOR]

• 74 million adults in India had diabetes in 2021 (1 in 12), more than half undiagnosed. • Diabetes in India is associated with earlier age of onset compared to Western groups. • More than 90% of Indian patients with diabetes are estimated to have dyslipidemia. • Indian patients with diabetes have an aggressive course of atherosclerosis. • Aggressive treatment of diabetic dyslipidemia is needed to prevent ASCVD events. In 2021 an estimated 74 million individuals had diabetes in India, almost all type 2 diabetes. More than half of patients with diabetes are estimated to be undiagnosed and more 90% have dyslipidemia that is associated with accelerated development of atherosclerotic cardiovascular disease (ASCVD). Patients of Indian descent with diabetes have multiple features that distinguish them from patients with diabetes in Western populations. These include characteristics such as earlier age of onset, higher frequency of features of the metabolic syndrome, more prevalent risk factors for ASCVD, and more aggressive course of ASCVD complications. In light of the unique features of diabetes and diabetic dyslipidemia in individuals of Indian descent, the Lipid Association of India developed this expert consensus statement to provide guidance for management of diabetic dyslipidemia in this very high risk population. The recommendations contained herein are the outgrowth of a series of 165 webinars conducted by the Lipid Association of India across the country from May 2020 to July 2021, involving 155 experts in endocrinology and cardiology and an additional 2880 physicians. [ABSTRACT FROM AUTHOR]

Previous studies imply a profound residual mortality risk following successful abdominal aorta aneurysm (AAA) repair. This excess mortality is generally attributed to increased cardiovascular risk. The aim of this study was (1) to quantify the excess residual mortality for patients with AAA, (2) to evaluate the cross sectional level of cardiovascular risk management, and (3) to estimate the potential of optimised cardiovascular risk management to reduce the excess mortality in these patients. Excess mortality was estimated through a systematic review and meta-analysis, and through data from the Swedish National Health Registry. Cardiovascular risk profiles were individually assessed during eligibility screening of patients with AAA for two multicentre pharmaceutical AAA stabilisation trials. The potential of full implementation of cardiovascular risk management was estimated through the validated Second Manifestations of ARTerial disease (SMART) risk scores algorithm. The meta-analysis showed a similarly impaired survival for patients who received early repair (small AAA) or regular repair (≥ 55 mm), and a further impaired survival for patients under surveillance for a small AAA. Excess mortality was further quantified using Swedish population data. The data revealed a more than quadrupled and doubled five year mortality rate for women and men who had their AAA repaired, respectively. Evaluation of the level of risk management of 358 patients under surveillance in 16 Dutch hospitals showed that the majority of patients with AAA did not meet therapeutic targets set for risk management in high risk populations, and indicated a more pronounced prevention gap in women. Application of the SMART risk score algorithm predicted that optimal implementation of risk management guidelines would reduce the 10 year risk of major adverse cardiovascular events from 43% to 14%. Independent of the rupture risk, AAA is associated with a worryingly compromised life expectancy with a particularly poor prognosis for women. Optimal implementation of cardiovascular risk prevention guidelines is predicted to profoundly reduce cardiovascular risk. [ABSTRACT FROM AUTHOR]

Coronary CT-Scan permits non-invasive visualization of all stages of coronary artery atherosclerosis allowing early therapeutic interventions, lifestyle changes and accurate follow-up all of which result in an improved prognosis. We discuss the possibility of a systematic coronary CT-scan in the global population at certain ages such as fifty or sixty years-old (or both). May this strategy decrease the onset of myocardial infarction or ischemic chronic heart failure thus improving quality (and quantity) of life? May it also reduce the medical costs for the individual and the society? Is it technically possible to deploy such a strategy? What would be the obstacles for its set up and what solutions might be proposed? [ABSTRACT FROM AUTHOR]

Nutrition can play a key role in cardiovascular disease risk reduction, and its risk factors modification. This paper aims to present, compare, and summarize the main dietary concepts for preventing the main cardiovascular disease risk factors – obesity, hypertension, and dyslipidemia. The dietary models and macronutrient intakes were compared between main cardiovascular risk factors prevention recommendations. Dietary recommendations related to selected cardiovascular risk factors share the points, that can be suggested as crucial for overall cardiovascular risk factors reduction. Recommendations suggest limiting saturated fatty acids intake to <10% of total caloric intake in obesity, and <7 % in hypercholesterolemia, along with an increased intake of mono- and polyunsaturated fatty acids. In addition, daily dietary fiber intake should reach a level of 25-40 g. The vegetables and fruits should be consumed at a daily minimum level of 200g (or 4-5 portions) each. Salt intake should not exceed 5g/day. Alcohol should be generally avoided, and moderate intake levels (sex-specific) should not be exceeded. It is also worth noting, that proteins are essential for tissue formation and regeneration. Carbohydrates are the main source of energy, but it is necessary to choose products with a low glycemic index. Dietary antioxidants help combat free radicals and prevent cell damage. [ABSTRACT FROM AUTHOR]

Pregnancy represents a stress test for every woman's cardiovascular (CV) system, and a pre-existing maternal unfavorable cardio-metabolic phenotype can uncover both adverse pregnancy outcomes and the subsequent development of cardiovascular disease (CVD) risk factors during and after pregnancy. Moreover, the maternal cardiac and extracardiac environment can affect offspring's cardiovascular health through a complex mechanism called developmental programming, in which fetal growth can be influenced by maternal conditions. This interaction continues later in life, as adverse developmental programming, along with lifestyle risk factors and genetic predisposition, can exacerbate and accelerate the development of CV risk factors and CVD in childhood and adolescence. The aim of this narrative review is to summarize the latest evidences regarding maternal-fetal dyad and its role on primordial, primary and secondary CV prevention. [Display omitted] The bidirectional relationship between cardiovascular prevention and maternal-fetal dyad. Life's Essential 8, along with mental health and socio-economic factors are crucial players in pre-gestational CV health (left-sided picture). An inadeguate maternal cardio-metabolic health represents a trigger for the development of pregnancy-related complications, which, in turn, further worsen maternal cardio-metabolic health. Maternal cardio-metabolic environment and pregnancy-related complications negatively affect fetal developmental programming (center). These conditions are strongly associated with increased risk of short- and long-term CV event and cardio-metabolic issues, both for the mother and her offspring (right-sided picture). [ABSTRACT FROM AUTHOR]

Background: Chronic hypertension (CHT) is the main risk factor for cardiovascular diseases in women with a history of hypertensive disorders of pregnancy (HDP).Objectives: This study sought to assess the effectiveness of peripartum screening in predicting CHT after HDP.Methods: In this longitudinal prospective study, women with HDP underwent peripartum transthoracic echocardiography and were evaluated for CHT (blood pressure ≥140/90 mm Hg or on antihypertensive medication) at least 3 months postpartum. Univariable and multivariable analyses assessed the association between clinical and transthoracic echocardiography data and a postpartum diagnosis of CHT.Results: At a median postpartum follow-up of 124 days (IQR: 103-145 days), 70 (33.2%) of 211 women remained hypertensive. Compared with normotensive women, women with CHT were older (35.5 ± 5.0 years vs 32.9 ± 5.6 years; P = 0.001), were more likely to be Afro-Caribbean (27.1% vs 7.8%; P < 0.0001), had higher body mass index (33.4 ± 5.9 kg/m2 vs 31.2 ± 5.4 kg/m2; P = 0.006), and had higher mean arterial pressure (106.5 ± 8.4 mm Hg vs 103.3 ± 7.0 mm Hg; P = 0.004). Moreover, they showed significantly higher left ventricular mass index (84.0 ± 17.9 g/m2 vs 76.3 ± 14.8 g/m2; P = 0.001), higher relative wall thickness (0.46 ± 0.10 vs 0.40 ± 0.10; P < 0.0001), and lower global longitudinal strain (-15.6% ± 2.7% vs -16.6% ± 2.2%; P = 0.006) than normotensive women. A prediction model combining clinical (maternal age and first trimester mean arterial pressure) and echocardiographic features (left ventricular mass index >75 g/m2, relative wall thickness >0.42, and E/e' ratio >7) showed excellent accuracy in identifying women with persistent hypertension after HDP (area under the curve: 0.85; 95% CI: 0.79-0.90).Conclusions: This peripartum screening approach might be used to identify women at risk of CHT who would benefit from intensive blood pressure monitoring and pharmacological strategies from the early postpartum period to prevent cardiovascular disease. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death worldwide. Although many pharmacological agents exist, drug compliance and therapeutic goal achievement continue to be suboptimal. This meta-analysis aims to study the effectiveness of polypills in controlling blood pressure, dyslipidemia and in reducing future cardiovascular events. We conducted a systematic search of electronic databases using pre-specified terms. Randomized clinical trials (RCT) comparing polypills (statin, antihypertensive agents, with or without aspirin) with the standard of care were included. Outcomes of interest were changes in [systolic blood pressure (SBP), diastolic blood pressure (DBP)] mmHg, [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C)] mg/dl, cardiovascular (CVD) mortality, and major adverse cardiovascular events (MACE). A total of 18 RCTs with 26,483 participants were included. The population had 55% males, with a mean age of 61.8 ± 7 years, and a mean BMI of 26.7 ± 4.2 kg/m2. The mean follow-up was 15.0 ± 20 months. Compared with standard of care, polypill use was associated with a significant reduction of SBP (Mean Difference [MD] -6.39; [95%CI -9.21, −3.56] p < 0.001), DBP (MD -4.19, [95%CI -5.48, −2.89; p < 0.001], TC (MD -24.95, [95%CI -33.86, −16.04]; p < 0.001), and LDL-C (MD -27.92, [95%CI -35.39, −20.44]; p < 0.001). Polypill use was also associated with a significant reduction of CVD mortality (RR = 0.78; 95% CI (0.61, 0.99); P = 0.04) and MACE [RR = 0.76;95% CI (0.64, 0.91); P = 0.002]. This meta-analysis showed that compared to standard of care, polypill use was associated with a significant reduction of SBP, DBP, TC, LDL-C, and a significant reduction in fatal and non-fatal cardiovascular events. • Cardiovascular disease remains the leading cause of morbidity and mortality. • Hypertension and dyslipidemia control leads to optimal cardiovascular outcomes. • Taking multiple pills a day represent a burden and a challenge to most patients. • Polypills might represent a promising strategy to optimize control and adherence. • Our study examined the effect of polypills on cardiovascular outcomes and adherence. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between aspirin use during first pregnancy and later maternal cardiovascular risk.Study Design: In this secondary analysis of a prospective cohort, we included participants who carried their first pregnancy to 20 + weeks, had data regarding aspirin use, and attended a study visit 2-7 years following delivery. The exposure was aspirin use during the first pregnancy. We calculated aspirin use propensity scores from logistic regression models including baseline variables associated with aspirin use in pregnancy and cardiovascular risk. Outcomes of interest were incident cardiovascular-related diagnoses 2-7 years following delivery. Robust Poisson regression calculated the risk of outcomes by aspirin exposure, adjusting for the aspirin use propensity score.Main Outcome Measures: The primary outcome was a composite of incident cardiovascular diagnoses at the time of the study visit: cardiovascular events, chronic hypertension, metabolic syndrome, prediabetes or type 2 diabetes, dyslipidemia, and chronic kidney disease.Results: Of 4,480 women included, 84 (1.9%) reported taking aspirin during their first pregnancy. 52.6% of participants in the aspirin-exposed group and 43.0% in the unexposed group had the primary outcome. After adjusting for the aspirin use propensity scores, aspirin use during the first pregnancy was not associated with any of the outcomes.Conclusion: We did not detect an association between aspirin use during the first pregnancy and cardiovascular-related diagnoses 2-7 years later. Our study was only powered to detect a large difference in relative risk, so we cannot rule out a smaller difference that may be clinically meaningful. [ABSTRACT FROM AUTHOR]

Current prediction models for mainland Europe do not include ethnicity, despite ethnic disparities in cardiovascular disease (CVD) risk. SCORE2 performance was evaluated across the largest ethnic groups in the Netherlands and ethnic backgrounds were added to the model. 11,614 participants, aged between 40 and 70 years without CVD, from the population-based multi-ethnic HELIUS study were included. Fine and Gray models were used to calculate sub-distribution hazard ratios (SHR) for South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin groups, representing their CVD risk relative to the Dutch group, on top of individual SCORE2 risk predictions. Model performance was evaluated by discrimination, calibration and net reclassification index (NRI). Overall, 274 fatal and non-fatal CVD events, and 146 non-cardiovascular deaths were observed during a median of 7.8 years follow-up (IQR 6.8–8.8). SHRs for CVD events were 1.86 (95 % CI 1.31–2.65) for the South-Asian Surinamese, 1.09 (95 % CI 0.76–1.56) for the African-Surinamese, 1.48 (95 % CI 0.94–2.31) for the Ghanaian, 1.63 (95 % CI 1.09–2.44) for the Turkish, and 0.67 (95 % CI 0.39–1.18) for the Moroccan origin groups. Adding ethnicity to SCORE2 yielded comparable calibration and discrimination [0.764 (95 % CI 0.735–0.792) vs. 0.769 (95 % CI 0.740–0.797)]. The NRI for adding ethnicity to SCORE2 was 0.24 (95 % CI 0.18–0.31) for events and − 0.12 (95 % CI -0.13–0.12) for non-events. Adding ethnicity to the SCORE2 risk prediction model in a middle-aged, multi-ethnic Dutch population did not improve overall discrimination but improved risk classification, potentially helping to address CVD disparities through timely treatment. [Display omitted] • Adding ethnicity improved risk categorisation in a multi-ethnic Dutch population. • This highlights the importance of including ethnicity in risk prediction models. • This may reduce cardiovascular risk disparities in ethnic minority populations. [ABSTRACT FROM AUTHOR]

The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real- world patients is understudied. To identify predictors of low adherence and discontinuation to statin therapy within 6 months after STEMI and to estimate their impact on cardiovascular outcomes at one year follow-up. We evaluated real-world adherence to statin therapy by comparing the number of bought tablets to the expected ones at 1 year follow-up through pharmacy registries. A total of 6043 STEMI patients admitted from 2012 to 2017 were enrolled in the FAST STEMI registry and followed up for 4,7 ± 1,6 years; 304 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events, and ischemic stroke. The compliance cut-off chosen was 80% as mainly reported in literature. From a total of 5744 patients, 418 (7,2%) patients interrupted statin therapy within 6 months after STEMI, whereas 3337 (58,1%) presented >80% adherence to statin therapy. Statin optimal adherence (>80%) resulted as protective factor towards both cardiovascular (0.1% vs 4.6%; AdjHR 0.025, 95%CI 0.008–0.079, p < 0.001) and all-cause mortality (0.3% vs 13.4%; Adj HR 0.032, 95%CI 0.018–0.059, p < 0.001) at 1 year follow-up. Further, a significant reduction of ischemic stroke incidence (1% vs 2.5%, p = 0.001) was seen in the optimal adherent group. Statin discontinuation within 6 months after STEMI showed an increase of both cardiovascular (5% vs 1.7%; AdjHR 2.23; 95%CI 1.37–3.65; p = 0,001) and all-cause mortality (14.8% vs 5.1%, AdjHR 2.32; 95%CI 1.73–3.11; p 〈0,001) at 1 year follow-up. After multivariate analysis age over 75 years old, known ischemic cardiopathy and female gender resulted as predictors of therapy discontinuation. Age over 75 years old, chronic kidney disease, previous atrial fibrillation, vasculopathy, known ischemic cardiopathy were found to be predictors of low statin adherence. n our real-world registry low statin adherence and discontinuation therapy within 6 months after STEMI were independently associated to an increase of cardiovascular and all-cause mortality at 1 year follow-up. Low statin adherence led to higher rates of ischemic stroke. • Impact of statin adherence and discontinuation after myocardial infarction is understudied. Scarce data are available on the role of adherence to statin therapy in very high risk populations. • The aim of the present study was to evaluate the impact of statin adherence and discontinuation within 6 months in a large real world registry of Italian STEMI patients on cardiovascular outcomes at 1 year after discharge. • Adherence was assessed through real-world data from pharmaceutical registries. • Low statin adherence and discontinuation within 6 months after STEMI were independently associated to an increase of cardiovascular and all-cause mortality at 1 year follow-up. • Age over 75 years old, chronic kidney disease, previous atrial fibrillation, vasculopathy, known ischemic cardiopathy resulted as predictors of low statin adherence. Age over 75 years old, known ischemic cardiopathy and female gender were predictive of statin discontinuation. [ABSTRACT FROM AUTHOR]

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the European Society of Cardiology Heart Failure Association (HFA) together with the International Cardio-Oncology Society (ICOS) proposed charts for baseline CV risk assessment of cancer patients scheduled to receive anthracyclines and anti-human epidermal growth factor receptor-2 (HER2) agents. We investigated HFA/ICOS risk stratification, prescriptions of cardioactive drugs, and occurrence of CV events in a multicentric breast cancer (BC) cohort from 3 Italian Outpatient Cardio-Oncology Clinics. 373 BC patients who underwent a baseline Cardio-Oncologic evaluation were included, of whom 202 scheduled to receive anthracyclines and 171 anti-HER2. Mean age was 60 ± 12 years and 49% of BC patients had ≥2 CV risk factors. In the anthracyclines group, 51% were at low-risk, 43% at medium-risk and 6% at high-risk; while in the anti-HER2 group, 27% patients were at low-risk, 58% at medium-risk and 15% at high-risk. In both groups, a medium-to-high risk was associated with use of cardioactive therapies (p < 0.0001). There were no LVD events in anthracycline recipients, and 16 LVD among anti-HER2 patients. A medium-to-high risk was not associated with LVD occurrence (p = 0.17). Patients with medium-to-high HFA/ICOS risk were more likely to receive cardioactive therapies, possibly explaining the lack of association of risk categories with LVD occurrence. • Anthracyclines and anti-HER2 agents are backbone treatments for many cases of BC, but may be burdened by the risk of LVD. • Cardiotoxicity is more common in patients with a worse CV risk profile. • In this real-world cohort, BC women frequently had inadequately controlled CV risk factors. • HFA/ICOS risk was associated with prescription of cardioactive therapies, mostly to achieve a better control of CV profile. [ABSTRACT FROM AUTHOR]

Background and Aims: The Mediterranean Diet (MD) represents a key player in cardiovascular disease prevention. Therefore, we aimed to assess the relationship between adherence to the MD and inflammatory, lipid and glycemic profile in patients affected by polyvascular atherosclerotic disease (PAD). We also investigated the incidence of long-term major adverse cardiovascular events (MACEs) according to MD adherence.Methods and Results: We enrolled 107 patients with PAD, defined as the simultaneous involvement of at least two vascular districts. Adherence to the MD was estimated through a 9-item simplified form of the Mediterranean Diet Score. Improved fasting glycemic and LDL-cholesterol levels were reported in the high-adherence group compared with the low-adherence group (p < 0.001 and p = 0.0049, respectively). Both C-reactive protein and platelet-to-lymphocyte ratio were significantly lower in high-adherence patients than those with poor adherence to the MD (p = 0.0045 and p = 0.008, respectively). During follow-up (mean 34 ± 11 months), fatal events happened exclusively in the low-adherence group (58%), with an event-free survival of 37% compared with 87% in the moderate-adherence group and 70% in the high-adherence group (log-rank p-value < 0.001). Low adherence to the MD was associated with a higher incidence of MACEs in the Cox regression model adjusted for atherosclerotic risk factors (HR 12.23, 95% CI 4.00-37.39).Conclusions: High adherence to Mediterranean dietary pattern seems to be associated with improving inflammatory and metabolic status in patients suffering from PAD, potentially translating into better long-term cardiovascular outcomes. These findings provide evidence regarding the relevance of MD as a secondary preventive tool in this high-risk population. [ABSTRACT FROM AUTHOR]

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Cardiac CT-Scan and cardiac magnetic resonance imaging (MRI) are two booming cardiac imaging modalities especially in chest pain screening for CT-Scan and in surveillance of patients with known coronary artery disease for MRI. Artificial Intelligence is already of great help in radiologic diagnosis and its use should widen in the next few years. Teleradiology allows remote interpretation of all radiology exams and should develop in cardiac imaging. Expert radiology diagnosis centers should develop gathering cardiologists and radiologists with great experience in the field of cardiac imaging interpretation. Peripheral acquisition radiology centers would be disseminated all across the country without a need for a local expert and would send their images to the expert center for interpretation. The expert center would be the middle of this spider web, sending back the report and the selected images to the peripheral center, allowing optimal care for all patients nationwide. Artificial Intelligence would be a major asset of these expert centers, improving through the years. This operating mode would allow the onset of systematic screening for coronary artery disease in the global population and the surveillance of known coronary artery disease treated patients. [ABSTRACT FROM AUTHOR]

Seasonal influenza immunisation reduces cardiovascular events in high-risk patients, but 50% do not receive routine immunisation. The perceptions and current role of cardiologists in recommending and prescribing influenza immunisation has not been well described. We used an exploratory sequential mixed methods design. Semi-structured interviews of 10 cardiologists were performed to identify themes for quantitative evaluation. 63 cardiologists undertook quantitative evaluation in an online survey. The interviews and surveys addressed (a) attitudes and behaviours regarding influenza immunisation and (b) preventative care in cardiology. One quarter (25.4%, n = 16) of cardiologists recommended influenza immunisation to all patients. Less than half (49.2%, n = 31) recommended influenza immunisation to secondary prevention patients. Almost 1/3 of respondents (31.7%, n = 20) were uncertain or unaware of the guidelines regarding influenza immunisation and patients with cardiac disease. Most cardiologists believed that general practitioners were responsible for ensuring patients received influenza immunisation (76.2%, n = 48). Despite reducing cardiovascular events in high-risk patients, influenza immunisation is not widely recommended by cardiologists. Further clinician education is needed to address the knowledge gaps which prevent recommendation and uptake of this guideline directed treatment. • Patients with ischaemic heart disease and heart failure derive a cardiovascular benefit from influenza immunisation. • However, as many as 1 in 2 are not immunized. • Cardiologists are well placed to promote influenza immunisation, however only one quarter recommend it to all patients. • Influenza immunisation is deprioritized compared with other aspects of preventive cardiovascular care. • Further education of cardiologists is needed to improve awareness of this guideline recommended treatment. [ABSTRACT FROM AUTHOR]

• The ketogenic diet presents the potential for rapid short-term body mass, triglycerides level, Hb1Ac, and blood pressure reduction. • The ketogenic diet's efficacy for weight loss and metabolic changes is not significant in long-term observations. • The ketogenic diet is not better for long-term effects compared to other dietary patterns. • The low-carb pattern seems more beneficial than very low-carbohydrate in terms of cardiovascular mortality. • Other safety concerns should be taken into consideration when conducting future research. The ketogenic diet is based on extreme carbohydrate intake reduction and replacing the remaining with fat and has become a popular dietary pattern used for weight loss. The relationship between the ketogenic diet and cardiovascular risk is a controversial topic. This publication aimed to present evidence on the ketogenic diet and cardiovascular risk factors and mortality. The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure. Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations. In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet. Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research. [ABSTRACT FROM AUTHOR]

• 10-year risk assessment not adequate for younger subjects • LDL-C not the appropriate marker in the statin/ezetimibe/PCSK9 trials • ApoB superior to LDL-C and non-HDL-C • Clinical reasoning aids clinical care. All the major lipid prevention guidelines agree that the 10-year risk of a cardiovascular event should be the primary method to select individuals for statin prevention of a cardiovascular event. They also all rely on LDL cholesterol (LDL-C) as the primary metric to monitor lipid lowering therapy. These two principles form the major instruments on which primary prevention of cardiovascular disease is based worldwide. Their application is based on decades of prospective observational studies and large numbers of randomized clinical trials. Their development and application are milestones in medical progress. But are there limits, which were unseen and unintended, that need to be identified and overcome so that cardiovascular prevention can improve? Based on new insights and old knowledge, this Viewpoint will apply Clinical Reasoning, the process by which we integrate all the relevant knowledge, including the knowledge we have gained from physiology, pathology, epidemiology, metabolism, experimental models of disease, and our clinical experience as well as the results of randomized clinical trials to the analysis of a single case to answer these questions. Moreover, this Viewpoint will challenge the universal practice of relating the clinical outcomes of the major successful lipid lowering trials to the decrease in LDL-C and argue that cardiovascular prevention should move from the Risk model to the Causal Benefit model. This Viewpoint will be framed around a single case because, as caregivers, we make decisions case by case and because, as caregivers, the individual is the true object of our concern. [ABSTRACT FROM AUTHOR]

This dietary guidance, informed by best contemporary evidence, aims to assist medical practitioners and allied health professionals in advising patients for the primary and secondary prevention of cardiovascular disease (CVD). While differing in some details from other current guidelines, the core messages accord with those published in 2019 by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Atherosclerosis Society; the National Lipid Association in 2014 and the NH&MRC Australian Dietary Guidelines in 2013. These were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II) and the levels of evidence and classes of a recommendation developed using the GRADE system. Recommendations with high levels of evidence include increased consumption of plant based foods comprising mainly complex, fibre enriched carbohydrates (wholegrains, fruits and vegetables) while limiting intake of refined starches; partial replacement of saturated fats with monounsaturated or polyunsaturated fats and oils; reduced salt intake; achievement and maintenance of healthy weight; and low-to-moderate consumption of alcohol. Additional guidance but with moderate levels of evidence includes increased consumption of fish (and fish oils where indicated); reduction in sugar-sweetened beverages and added sugars; avoidance of butter and cream especially in those at increased CVD risk but encouragement of yoghurt; allow moderate consumption of lean meat but limit intake of processed meats; and limit cholesterol-rich foods such as eggs and crustaceans for those at increased CVD risk. Guidance has been formulated qualitatively on food categories of commonly eaten foods while avoiding prescriptive quantitative measures that are less readily translatable. This approach accords with current guidelines such as the American College of Cardiology/American Heart Association 2019 guidelines and is understandable and readily implemented. [ABSTRACT FROM AUTHOR]

High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA. A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0–1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (≥3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features. 528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p = 0.004 and 2.02, p = 0.012 for LAP and RI > 1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p = 0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p = 0.003 and 1.04, p = 0.002 for LAP-Vol, respectively). Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis. [ABSTRACT FROM AUTHOR]

Le scanner coronaire est indiqué dans le bilan de douleurs thoraciques chez tous les patients avec une préférence pour ceux ayant un risque faible à intermédiaire de coronaropathie. Les études récentes ont complété cette indication en démontrant sa fiabilité dans le bilan de douleurs thoraciques chez les patients à haut risque de coronaropathie, notamment dans le syndrome coronaire aigu (SCA) sans élévation du segment ST. Il apparaît également intéressant et prometteur pour le dépistage cardiovasculaire en prévention primaire chez un patient porteur de facteurs de risque cardiovasculaire, permettant ainsi d'ajuster la stratégie préventive et notamment le traitement par statine, ainsi que pour le suivi du coronarien stenté ou ponté. Le score calcique a démontré être un marqueur prédictif du risque de mortalité, cardiovasculaire et totale, indépendant des autres facteurs de risque connus et son usage est recommandé dans la stratification du risque cardiovasculaire. Cependant, son interprétation reste délicate de même que le changement dans la prise en charge que le résultat implique pour le patient. Un score calcique supérieur à zéro marque la présence d'une athérosclérose coronaire et doit faire discuter un traitement hypolipémiant. Dans le cadre du bilan pré-TAVI, le scanner cardiaque est devenu le gold standard pour la mesure de l'anneau aortique et le choix de la prothèse à implanter, ainsi que pour toutes les mesures réglementaires avant la procédure. Enfin, le bilan pré-ablation de fibrillation auriculaire comprend désormais un scanner cardiaque permettant d'éliminer un thrombus de l'oreillette gauche ou de l'auricule gauche, de rechercher un retour veineux pulmonaire anormal et de fournir un support 3-D pour la navigation lors de la procédure rythmologique interventionnelle d'ablation. Cardiac CT-scan is recommended for sorting patients presenting with stable or acute chest pain with low to intermediate risk of coronary artery disease (CAD). Recent studies have shown its reliability for diagnosing CAD in high-risk patients, notably those with acute coronary syndrome (ACS) without ST-elevation. Coronary CT-scan also represents a great opportunity for the screening of atherosclerosis in patients at risk and allows a better prevention of coronary artery disease by introduction of preventive treatments in patients with abnormal coronary CT-scan, especially statins. It is useful for the follow-up of patients who underwent a coronary arteries revascularization with either stents or bypasses. Coronary arteries calcium scoring appears to be an independent predictive factor of cardiovascular and total mortality and its use is recommended for stratifying the cardiovascular risk. However, its interpretation remains unobvious and the patient management is poorly improved by the results. Anyway, if the score is above zero, atherosclerosis is present and therefore a lipid lowering treatment should be discussed. Cardiac CT-scan has become the Gold Standard exam before an aortic valve replacement, for the measurement of the aortic root notably, allowing the best prothesis selection. Before atrial fibrillation ablation procedure by pulmonary vein isolation, the cardiac CT-scan allows a 3-D visualization of the two atria, especially the left atrium, and rules out any suspicion of cardiac thrombus. It allows the research of an anomalous pulmonary venous connection. The 3-D support will also enable the operator to navigate in the heart during the ablation procedure. [ABSTRACT FROM AUTHOR]

Background and Aim: Along with the increasing evidence of the cardioprotective effects of the Mediterranean Diet (MD), the scientific interest and advocacy of dietary variety as a potentially healthy eating habit gradually faded, until its complete oblivion in the latest European cardiovascular prevention guidelines. Our study aims to investigate whether dietary variety adds to the "Mediterranean-ness" of the diet in protecting against coronary heart disease (CHD).Methods and Results: In this case-control Italian study, data on eating habits were collected from 178 patients with CHD and 155 healthy controls, primarily males, frequency matched for age and gender, using the Food Frequency Questionnaire (FFQ) of the European Prospective Investigation into Cancer and Nutrition. Adherence to MD was estimated from FFQ by the Mediterranean Diet Score (MDS), an index developed by Trichopoulou (2003) ranging from 0 to 9, with higher scores indicating a stricter adherence. Overall dietary variety was computed from FFQ as a count of single food items consumed at least once a month. Associations between MDS or overall dietary variety and coronary status were evaluated by logistic regression models adjusted for BMI, physical activity, smoking, education, and caloric intake; the Odds Ratio (OR) for CHD for each 1.5-point increase in MDS was 0.76 [IC 95% 0.59; 0.98], whereas the OR for CHD for each 15-item increase in dietary variety was 0.62 [IC 95% 0.46; 0.84]. Remarkably, adherence to MD and overall dietary variety were independently associated with a significantly reduced chance of CHD.Conclusion: Dietary Mediterranean-ness and overall dietary variety exhibit additive cardioprotective effects. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is common in patients with end-stage renal disease (ESRD) on hemodialysis (HD). However, antithrombotic therapy to prevent CVD increases the risk of bleeding. We aimed to investigate the prevalence of CVD and the practice patterns of antithrombotic agents in patients with ESRD on HD. In a cross-sectional population based cohort of chronic HD patients (n = 626) from Vienna, Austria, the medical histories of patients and use of antithrombotic treatment were recorded, and the distribution of antithrombotic therapies for primary (n = 260, 41.5%) or secondary (n = 366, 58.5%) prevention of CVD was analyzed. Single antiplatelet therapy (SAPT) was used in 234 patients (37.4%), dual antiplatelet (DAPT) in 50 (8.0%), combination of anticoagulation and antiplatelet in 59 (9.4%), anticoagulation monotherapy in 78 (12.5%), and no antithrombotics in 205 patients (32.7%). The prevalence of CVD was 58.5%. In primary CVD prevention, 23.5% (n = 61) of patients were treated with SAPT. For secondary prevention, SAPT was used in 173 (47.3%), DAPT in 49 (13.4%), and dual antithrombotic therapies in 50 patients (13.7%), while 55 (15.0%) patients received no antithrombotics. Age (odds ratio [OR] per 1 year increase 0.96, 95%CI 0.94–0.99, p = 0.004) and hereditary nephropathy (OR 4.13, 95%CI 1.08–15.78, p = 0.038) were independently associated with the absence of antithrombotic therapy in secondary CVD prevention. The majority of patients did not receive antithrombotic therapy for primary prevention. Only 15% did not receive antithrombotic agents in the secondary prevention setting. The net-clinical benefit of antithrombotic therapy in ESRD needs to be determined. Image 1 • Patients on hemodialysis are a neglected population regarding cardiovascular disease (CVD) prevention. • In this cross-sectional population-based cohort, 23.5% of patients received antiplatelet agents in primary CVD prevention. • In secondary CVD prevention, 15.0% of patients received no antithrombotics. • Patients receiving no antithrombotics were more likely to be younger and to have hereditary nephropathy. [ABSTRACT FROM AUTHOR]

We aimed to examine cardiovascular risk factors and health behaviors in patients with acute coronary syndromes (ACS) according to potential extension of eligibility criteria for protein convertase subtilisin/kexin-9 inhibitors (PCSK9i) to all patients with low-density lipoprotein cholesterol (LDL-c) equal or above 1.8 mmol/l. In this prospective cross-sectional study, patients with ACS between 2009 and 2016 and with available LDL-c at one year were considered. We defined three mutually exclusive groups of patients according to eligibility for PCSK9i: "not eligible", "currently eligible", and "newly eligible". We explored the control of cardiovascular risk factors and health behaviors. Out of 3025 patients who had an ACS one year ago, 1071 (35.4%) were not eligible for PCSK9i, 415 (13.7%) were currently eligible, and 1539 (50.9%) were newly eligible. The proportion of patients with uncontrolled hypertension in the not eligible group was lower than in the group currently eligible (27.6% vs 33.6%, p = 0.02), but similar to the group newly eligible (27.6% vs 28.2%, p = 0.73). The proportion of smokers in the not eligible group was lower than in the group currently eligible (21.2% vs 28.0%, p = 0.02), but similar to the group newly eligible (21.2% vs 22.5%, p = 0.51). More than half of patients with ACS would be additionally eligible for PCSK9i if prescription is extended from current guidelines to all patients with LDL-c equal or above 1.8 mmol/l. Patients currently eligible for PCSK9i one year after an ACS had a worst control of cardiovascular risk factors than patients potentially newly eligible. • More than half of acute coronary syndrome patients were newly eligible for PCSK9i. • Newly and not eligible patients: similar control of cardiovascular risk factors. • Patients newly eligible had a better health profile than those currently eligible. [ABSTRACT FROM AUTHOR]

Despite progress in the treatment of acute myocardial infarction (AMI), long-term prognosis in MI survivors remains a challenge. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Our aim was to assess the relation between participation in MC-AMI and major adverse cardiovascular and cerebrovascular events (MACCE) in 12-month follow-up. In this single-center, retrospective analysis we compared 719 patients participating in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching, two groups of 529 subjects each were compared. MC-AMI was related with MACCE reduction by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%), higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p ≪ 0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p ≪ 0.05) and ICD implantation (2.8% vs. 0.6%, p ≪ 0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI to be inversely associated with the occurrence of MACCE (HR = 0.500, 95% Cl 0.349–0.718, p ≪ 0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. MC-AMI is the first program of comprehensive care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE. • MC-AMI is a care model including revascularization, rehabilitation and prevention of SCD after MI. • Managed Care in Acute Myocardial Infarction reduces MACCE by 40% in 12-month follow-up. • Strict and complex approach after MI warrants better results within the same healthcare resources. [ABSTRACT FROM AUTHOR]

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Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, highlighting the limitations of current primary and secondary prevention frameworks. In this review, we detail how the polygenic risk score for CAD can improve our current preventive and treatment frameworks across three clinical applications that span the life course: (i) identification and treatment of people at increased risk early in the life course prior to the onset of clinical risk factors, (ii) improving the precision around risk estimation in middle age, and (ii) guiding treatment decisions and enabling more efficient clinical trials even after the onset of CAD. We end by summarizing the efforts needed as we head towards more widespread use of polygenic risk score for CAD in clinical practice. [Display omitted] • CAD PRS can identify people at high risk of CAD early in the life course prior to the onset of risk factors. • In middle age and in the presence of conventional risk factors, CAD PRS can improve precision in risk prediction. • PRS can predict recurrent events even after the onset of clinical CAD and holds a promise to serve as an enriching biomarker. • Early implementation studies of CAD PRS validate the proposed clinical utility and suggest no harm, but larger scale implementation efforts are underway. [ABSTRACT FROM AUTHOR]

The 2018 AHA/ACC cholesterol guideline builds on the 2013 ACC/AHA cholesterol guideline statin recommendations to provide more detailed recommendations for the use of nonstatin therapy risk stratification for primary prevention statin use. New information has become available after the development of the 2018 AHA/ACC cholesterol guideline that can further inform clinical practice. Proprotein convertase subtilisin kexin type-9 (PCSK9) monoclonal antibodies are now a reasonable or even good value following over 60% reductions in their acquisition price, and the identification of high risk patient groups most likely to benefit from further low-density lipoprotein cholesterol (LDL-C) lowering. Meta-analyses and clinical trial data now show that patients with LDL-C ≥ 100 mg/dl are more likely to experience progressively greater reductions in the risk of cardiovascular and total mortality and coronary heart disease events for progressively higher LDL-C levels. Icosapent ethyl, a highly concentrated form of modified EPA has been shown to reduce cardiovascular events in high risk patients with moderate hypertriglyceridemia on statin therapy. Comparisons with other statin guidelines revealed that statin initiation for those with ≥7.5% 10-year atherosclerotic cardiovascular disease (ASCVD) risk is the most effective strategy for reducing the most ASCVD events for the proportion of the population treated. Data from younger populations finally became available for coronary artery calcium (CAC) scoring (mean age of 51 years) which confirmed the value of CAC > 0 for identifying individuals at increased ASCVD risk most likely to benefit from statin initiation. This analysis also found that statins could keep CAC = 0 in those with risk factors. Epidemiologic pooling studies now clearly show that LDL-C and non-high-density lipoprotein cholesterol levels in young adulthood confer excess risk for ASCVD later in life. Accumulating data support earlier risk factor intervention trials as the next research priority. [ABSTRACT FROM AUTHOR]

A universal approach to health literacy employs clear communication and emphasizes patient action in support of understanding cardiovascular risks and making healthy lifestyle changes. The aim of this project was to evaluate the impact of a health literacy module on enhancing students' written patient education material using standardized readability assessment tools. A professional elective course employed team-based learning and a community health fair activity. The course was enhanced with four hours of health literacy content. Pharmacy student learners were assigned a cardiovascular condition and designed an informational pamphlet. Two faculty members evaluated the student pamphlets in the pre-health literacy module (n = 15) and post-module (n = 23) groups using the Flesch grade level, Flesch reading ease score, and 15 health literacy criteria identified from previous literature. There was a modest integration of health literacy concepts based on the Flesch grade level and the mean total health literacy criteria achieved. Student learners improved in areas of readability, message content, numeracy/statistics, and patient actionability concepts. Simplifying technical jargon remains to be a barrier. The results will be used to improve our health literacy pamphlet rubric and classroom instruction. The health literacy module was valuable in fostering understanding and application of health literacy concepts, and preparing student learners for providing patient-centered communication. [ABSTRACT FROM AUTHOR]

Abstract Background As adult congenital heart disease (ACHD) patients are aging, a high prevalence of cardiovascular risk factors is encountered similar to the general population. Currently, data regarding the primary and secondary prevention of acquired cardiovascular disease in ACHD is lacking. Methods The German National Register of Congenital Heart Defects was systematically screened for ACHD patients with established cardiovascular risk factors or documented acquired cardiovascular conditions. Data were analyzed with regard to the according medical treatment. Results Overall, 539 patients were included (mean age 38.4 ± 17.7 years, 49.2% female). Diabetes was present in 57 pts. (10.6%), arterial hypertension in 113 pts. (21.0%), hyperlipidaemia in 81 pts. (15.0%) and obesity in 271 pts. (50.2%). 31 pts. (5.8%) were smokers. Coronary artery disease was established in 16 pts. (3.0%), peripheral vascular disease in 9 pts. (1.7%), and cerebrovascular accidents in 141 pts. (26.2%). Out of the patients with coronary artery disease only 81.3% received antithrombotic treatment. Only 18.8% were prescribed a statin. Of the pts. with peripheral arterial disease, 44.4% received an antiplatelet drug, and only 22.2% were on a statin. Patients with arterial hypertension received antihypertensive drugs in 66.4%. Conclusions Primary and secondary prevention of acquired cardiovascular disease in ACHD is underutilized. This highlights the importance of educating primary physicians as well as ACHD physicians about the need of primary and secondary prevention for acquired cardiovascular disease. Highlights • As ACHD pts. are aging, a high prevalence of cardiovascular risk factors is encountered similar to the general population • Primary and secondary prevention of acquired cardiovascular disease in ACHD is underutilized. • Educating primary physicians/ACHD physicians about the need of prevention for acquired cardiovascular disease is important [ABSTRACT FROM AUTHOR]

2 Diabetic patients and cardiovascular risk Type 2 diabetes mellitus (DM) confers a significantly high risk of unfavourable CV outcomes as reaffirmed in the recent ESC guidelines defining CV risk categories [2],[3]. Keywords: Glucose-lowering drugs; Cardiovascular outcome trials; Diabetes mellitus type 2; Therapeutical targets; Cardiovascular risk; Cardiovascular prevention EN Glucose-lowering drugs Cardiovascular outcome trials Diabetes mellitus type 2 Therapeutical targets Cardiovascular risk Cardiovascular prevention 205 207 3 03/06/21 20210415 NES 210415 1 Introduction In January 2020, the European Heart Journal published a focus issue on diabetes [1], accompanying the release of the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular (CV) diseases (the third set of Guidelines produced by the ESC in collaboration with EASD) [2]. The therapeutical evolution has made available options with demonstrated strong and previously unforeseeable CV benefits, in patients with DM and established CV disease or at high/very-high CV risk. [Extracted from the article]

Background: An abnormal frontal QRS-T angle (fQRSTa) is associated with increased risk of death in primary and secondary cardiovascular prevention. The aim of this study was to evaluate the fQRSTa prognostic role in patients undergoing myocardial revascularization and/or cardiac valve surgery.Methods: We enrolled and prospectively followed for 48 ± 26 months 939 subjects with available QRS and T axis data; mean age was 68 ± 12 years, 449 patients (48%) underwent myocardial revascularization, 333 (35%) cardiac valve surgery, 94 (10%) valve plus bypass graft surgery and 63 (7%) cardiac surgery for other cardiovascular (CV) diseases. The ECG variables were collected at the end of the cardiac rehabilitation program and fQRSTa was considered normal if <60°, abnormal if >120°, borderline otherwise. Endpoints were overall and CV mortality.Results: The fQRSTa was normal in 333 patients (36%), borderline in 285 (30%) and abnormal in 321 (34%). Overall (p = 0.012) and cardiovascular (p = 0.007) mortality were significantly higher in patients with abnormal fQRSTa even after adjusting separately for gender, PR-, QTc- intervals, presence of right or left bundle branch block and left atrial volume index. The predictive value was confirmed in patients with stable coronary artery disease (SCAD), not in patients with acute coronary syndrome or valve disease. SCAD patients with abnormal both fQRSTa and QRS axis had higher risk of overall (hazard ratio = 2.9, p < 0.0001) and CV (hazard ratio = 4.4, p < 0.0001) mortality compared with SCAD patients with normal fQRSTa, even after multivariate adjustment for age, gender, ECG intervals, left-ventricle ejection fraction and mass index.Conclusions: In SCAD patients undergoing myocardial revascularization, abnormal fQRSTa is independent predictor of overall and CV mortality. [ABSTRACT FROM AUTHOR]

Background Hypercholesterolemia treatment guidelines emphasize an adequate whole grains (WG) intake, alone or complementary to pharmacological treatment. We conducted this study to compare the prevalence of adequate WG intake and levels of blood lipids according to the statin/WG intake status. Methods This cross-sectional analysis of a community-based study included 12,754 men and women, age 45–64. Statin use over past 30 days was recorded by trained nurses. Food intake over past 12 months was assessed by a validated food-frequency questionnaire. Adequate WG intake was defined as ≥ 3 oz-equivalents/day, representing ≥ 3 WG servings/day. Results The prevalence of an adequate WG intake was marginally superior in statin users (26.79%) than non-users (21.51%). This superiority was attenuated after multiple covariates adjustment (PR 1.12, 95%CI 1.02–1.22). Statin users with an adequate WG intake had lower multivariable-adjusted mean blood total cholesterol (185.14 mg/dL vs. 190.14 mg/dL) and LDL cholesterol (103.30 mg/dL vs. 108.19 mg/dL) than those with an inadequate WG intake. Statin users with an adequate WG intake had lower odds (OR, 95% CI) of having TC ≥ 240 mg/dL (OR 0.67, 95% CI 0.46–0.98) and lower odds of having LDL ≥ 100 mg/dL (OR 0.72, 95% CI 0.58–0.89), compared to statin users with inadequate WG intake. A subgroup analysis restricted to those with prevalent CVD yielded similar results. Conclusions In this community based sample of middle-aged adults, only one in four statin users had adequate whole grain intake. Statin users with adequate WG intake had statistically and clinically significant lower levels of blood total- and LDL-cholesterol. [ABSTRACT FROM AUTHOR]

Background The American Heart Association's ideal cardiovascular health (ICH) define criteria for seven metrics, four classified as lifestyle factors (diet, physical activity, smoking and body-mass index) and four classified as health factors (smoking, blood pressure, fasting plasma glucose and total cholesterol). We aimed to analyze ICH scores at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment and the associations with sociodemographic characteristics (age, sex, race, educational level, and family income). Methods We analyzed 13,356 ELSA-Brasil participants without cardiovascular disease using quasi-Poisson regression models to study the association between the ICH score and sociodemographic characteristics. Results Mean ICH scores were 2.5 ± 1.3. Only 1047 (7.8%) participants had 5 or more ICH metrics. In adjusted models, age 65–74 years was associated with lower ICH scores (− 35.4%; 95% confidence interval [CI]: − 37.6% to − 33.1%) compared to age 35–44 years. Women had higher ICH scores compared to men (+ 13.8%; 95%CI: + 11.8% to + 15.7%), mainly due to differences in the health factor ICH metrics. Participants of Black race had lower ICH scores compared to those of White race (− 9.4%; 95%CI: − 11.8% to − 7.0%). Individuals with less than high school education had lower ICH scores than college-educated individuals (− 17.2%; 95%CI: − 20.0% to − 14.2%). Low (< 1245 USD) family income was also associated with lower ICH scores compared to those with high (≥ 3320 USD) family income (− 4.4%, 95%CI: − 7.2% to − 1.6%). Conclusions We found a low proportion of individuals with 5 or more ICH metrics. Age, sex, race, educational level and income were associated with ICH scores. [ABSTRACT FROM AUTHOR]

Control of blood pressure (BP) in hypertension is recognized as a key measure in the management of cardiovascular (CV) risk and is a cornerstone of preventive strategies. It is not defined, however, whether an initiation of the antihypertensive treatment in the early stages of hypertension (such as prehypertension or high-normal BP), may bring benefits for the long-term prevention of CV events. In addition, it has not been thoroughly addressed the issue whether achievement of a prompt BP reduction in hypertensive patients may contribute to reduce CV damage and events. The aim of this article is to critically examine data from studies exploring these important questions. Our conclusion is that the available evidence, though not very extensive, supports the prevailing benefits associated with early BP control. We also discuss the therapeutic strategies to achieve early control of BP. Finally, we believe that this aspect deserves to be more thoroughly addressed in upcoming international guidelines. [ABSTRACT FROM AUTHOR]

Background Extensive evidence exists about the prognostic role of systolic blood pressure (SBP) reduction ≤ 140 mm Hg. Recently, the SPRINT trial successfully tested the strategy of lowering SBP < 120 mm Hg in patients with arterial hypertension (AH). Aim To assess whether the SPRINT results are reproducible in a real world community population. Methods Cross-sectional, population-based study analyzing data of 24,537 Caucasian people with AH from the Trieste Observatory of CV disease, 2010 to 2015. We selected and divided 2306 subjects with AH according to the SPRINT trial criteria; similarly, SPRINT clinical outcomes were considered. Results Study patients median age was 75 ± 8 years, two third male, one third had ischemic heart disease. They were older, with lower body mass index, higher SBP and Framingham CV risk score than the SPRINT patients. Three-hundred-sixty-eight patients (16%) had SBP < 120 mm Hg. During 48 [36–60] months of follow-up, 751 patients (32%) experienced a major adverse cardiac event (MACE). The SBP < 120 mm Hg group had higher incidence of MACE, CV deaths and all-cause death than SBP ≥ 120 mm Hg group (37% vs 31%; 10% vs 4%; 19% vs 10%, all p < 0.05). The condition of SBP < 120 mm Hg was an independent predictor of MACE in multivariate Cox analysis together with older age, male gender, higher Charlson score. Conclusions In our experience, the SBP < 120 mm Hg condition is associated with worse clinical outcomes, suggesting the SPRINT results are not reproducible tout court in Caucasian community populations. These differences should be taken as a warning against aggressive reducing of SBP < 120 mm Hg. [ABSTRACT FROM AUTHOR]

Background Fixed dose combinations of cardiovascular therapy (‘polypills’) have now been launched in several dozen countries. There is considerable clinical interest in the effects of switching to polypill-based care from typical current treatment regimens, especially if polypills contain components at sub-maximal dosage. Methods The SPACE Collaboration includes three trials of polypill based care vs usual care in patients with established CVD or at high calculated risk. Individual patient data for 3140 trial participants were combined. Patients were categorized according to the potency of the statin and the number of BP lowering medications they were taking at baseline. Effects on adherence to anti-platelet medication, systolic blood pressure (SBP) and LDL cholesterol stratified by baseline potency of medication were determined using fixed effects models. Results Randomisation to the polypill group was associated with improved SBP at 12 months, but this improvement varied according to baseline BP regimen: − 3.3, − 5.9, − 2.5 and + 1 mm Hg for patients taking 0, 1, 2 and 3 + BP lowering medications at baseline. For changes in LDL cholesterol at 12 months, significant improvements in LDL cholesterol were seen for those taking no statin (− 0.21 mmol/L; 95% CI: − 0.34 to − 0.07), less potent statin (− 0.16 mmol/L; 95% CI: − 0.29 to − 0.04) and equipotent statins (− 0.14 mmol/L; 95% CI − 0.26 to − 0.02) at baseline. Conclusion The adherence benefits of polypills tend to offset the loss of potency from use of individual components with lower dose potency, and to facilitate improvements in multiple risk factors. [ABSTRACT FROM AUTHOR]

Background and Aims: The clustering of high levels of LDL cholesterol (LDL-C) and other risk factors represents a predisposing condition for atherosclerotic disease development. Cardiovascular prevention is based on effective control of these conditions. In adult subjects with mild hypercholesterolemia we compared in the real life the effects of a new combination of nutraceuticals on lipid and glucose metabolism and blood pressure with those of an established nutraceutical combination.Method and Results: This multicenter, controlled, randomized, single-blind trial was designed to compare the effect of Armolipid Plus® versus that of LopiGLIK® on lipid and glucose levels and blood pressure (BP) in subjects with mild hypercholesterolemia not on statin therapy. Primary outcome was the proportion of subjects achieving therapeutic targets of LDL-C (<130 mg/dl); secondary outcomes were the effects on HDL-C, glycated haemoglobin and insulin levels. Data from an overall sample of 359 adult individuals (age 55.2 ± 11.1 years, women 57.7%, LDL-C 157.3 ± 22.6 mg/dl, HDL-C 50.7 ± 13.0 mg/dl) are reported. 72% of subjects treated with LopiGLIK® and 43% treated with Armolipid Plus® achieved the primary endpoint (p < 0.0001). Both treatments reduced plasma levels of total and LDL-C and triglycerides (p < 0.001 for all comparisons). The treatments also reduced systolic and diastolic blood pressure, plasma levels of glycated haemoglobin, insulin and HOMA index. The changes induced by LopiGLIK® in all these metabolic parameters were greater than those obtained with Armolipid Plus®.Conclusions: The present analysis shows that LopiGLIK® may represent a more effective tool for clinical management of CV risk factors in subjects with mild hypercholesterolemia. [ABSTRACT FROM AUTHOR]