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Supplemental Digital Content is available in the text., Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP (P

WOS: 000468732700018, PubMed ID: 31054483, Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient., ESC - EORP; AmgenAmgen; Eli LillyEli Lilly; PfizerPfizer; SanofiSanofi-Aventis; Ferrer; Novo NordiskNovo Nordisk, The EUROASPIRE V survey was carried out under the auspices of the ESC - EORP. Since the start of EORP, the following companies have supported the programme: Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript.

Accumulation of advanced glycation end-products (AGE) has been suggested to be involved in several pathophysiological processes in the vessel wall. Soluble isoform of receptor for AGE (sRAGE) acts as a decoy for capturing circulating AGE, thus preventing them from binding to the cell-surface receptor (RAGE) and protecting against the RAGE-AGE axis-elicited processes. We hypothesized that low sRAGE levels might be associated with increased arterial stiffness. In a cross-sectional design, we analyzed 1077 subjects, aged 25 to 64 years, from the Czech population-based study ("Post-MONICA"). Aortic pulse wave velocity (aPWV) measured by the Sphygmocor device, was used to assess aortic stiffness. sRAGE concentrations were assessed in frozen samples by ELISA methods (R&D Systems). Aortic PWV significantly (p

Lipoprotein associated phospholipase A2 (Lp PLA2) represent new cardiovascular risk factor and potential treatment target. We aimed to analyze the epidemiological situation of this factor in Czech population.The study population consisted from 1 962 subjects, a random samples of general population (postMONICA study), and from patients with manifest coronary or cerebrovascular disease (Czech samples of EUROASPIRE III survey). Lp PLA2 activity was estimated using commercial kits by diaDexus Inc. in frozen samples. Increased activity (by definition, i.e.195 nmol/ min/ ml) was observed in 21.1 % of sample, no apparent difference between subject with and without manifest vascular disease was found. Males showed higher Lp PLA2 activity, than females (179.6 vs 146, resp., p0.0001), while no substantial increase with age was observed. Taking Lp PLA2 activity195 as dependent variable, following independent variables entered the multiple logistic regression: male gender [with odds ratio 4.26 (3.26- 5.58)], low HDL cholesterol (i.e.1.0 mmol/ l in males or1.2 mmol/ l in females) [3.49 (2.62- 4.64)], LDLcholesterol2.5 mmol/ l [6.95 (4.79- 10.07)] and lipid lowering treatment [0.59 (0.44- 0.79)]. In subject without manifest vascular disease, 6.3 % of them showed co incidence of markedly increased Lp PLA2 activity with high conventional risk (SCORE10 %). Expanding this group by intermediate risk subjects (ie. with Lp PLA2 activity 152- 194 and/ or SCORE 5- 9.9 %) leads to increase of this prevalence to 28.9 % of primary prevention subjects.Increased Lp PLA2 activity is in Czech population highly prevalent and with exception of lipid parameters, generally independent from conventional cardiovascular risk. However, up to 29 % of subject in primary prevention amalgamate increased Lp PLA2 activity with high conventional cardiovascular risk.

Ankle brachial index (ABI) is a diagnostic tool for peripheral arterial disease (PAD) and a cardiovascular risk stratification tool. Despite this evidence and guidelines recommending its use in everyday practice, ABI is not widely used. Automatic ABI measurement may lower the barrier to incorporate ABI measurement into everyday practice. The aim of this study was to validate a novel automatic oscillometric ABI device (BOSO ABI) against a gold standard-Doppler device in an epidemiological setting.In 839 patients from the Czech post-MONICA study (a randomly selected representative population sample aged over 25 years), mean age 54.3±13.8 years (47% of men), ABI measurement was performed using the BOSO ABI device and a handheld Doppler device in a random fashion. The two techniques were carried out by different investigators each blinded to the findings of the other. Analyses were conducted as proposed by Bland and Altman.The mean ABI difference between the two methods was 0.1±0.11, with 95% limits of agreement ranging from -0.11 to 0.30. The difference between Doppler and oscillometric ABI increased significantly with increasing mean ABI (r=0.29; P0.001). When considering Doppler the gold standard, automated oscillometric measurement had a 76.9% sensitivity, 97.9% specificity, and 37% positive and 99.6% negative predictive values in diagnosing ABI0.9.The BOSO ABI device cannot be used interchangeably for standard Doppler ABI measurement in diagnosing PAD. However, its high negative predictive value allows using it as a screening tool for PAD.

Systolic blood pressure and heart rate measured at rest and during a standardized exercise test were analyzed in the cohort of middle-aged male employees followed-up an average of 17 years in the Paris Prospective Study I. The population sample selected for the analysis included 4,907 men who completed at least 5 minutes of bicycle ergometry, who had no heart disease at entry, and whose resting blood pressure was less than or equal to 180/105 mm Hg. Exercise-induced increase in systolic blood pressure was positively correlated with resting systolic blood pressure (r = 0.104, p less than 0.0001), whereas the correlation of exercise-induced heart rate increase with resting heart rate was negative (r = -0.169, p less than 0.001). Using Cox regression analysis with the inclusion of resting systolic blood pressure and heart rate; exercise-induced elevations of systolic blood pressure and heart rate; and controlling for age, smoking, total cholesterol, body mass index, electrical left ventricular hypertrophy, and sports activities, cardiovascular mortality was found to be associated with the systolic blood pressure increase (p less than 0.05), whereas no association with resting systolic blood pressure was found. Total mortality was predicted by resting systolic blood pressure and its elevation (p less than 0.01 for both) and by resting heart rate (p less than 0.0001). The heart rate increase did not contribute to death prediction. In conclusion, the magnitude of the exercise-induced increase of systolic blood pressure, but not of heart rate, may represent a risk factor for death from cardiovascular as well as noncardiovascular causes, independently of resting blood pressure and heart rate.

Ivabradine reduces heart rate by inhibiting the If channels mediated current, while sinus rhythm is sustained. The aim of the BEAUTIFUL study was to assess whether the administration of ivabradine to patients with stable ischemic heart disease and ejection fractionor = 40% will result in reduction of cardiovascular morbidity and mortality. This was a double blind randomized study including 10,917 patients. Half of the patients were administered placebo and half were treated with ivabradine additional to the treatment normally used in the secondary prevention ofischemic heart disease; the starting dose was 5 mg twice a day and could be increased to 7.5 mg twice a day. The combined primary endpoint was cardiovascular-event related death, hospitalization for acute myocardial infarction and hospitalization for heart failure. The follow up was 19 months. Ivabradine decreased heart rate by 6 beats/min. The majority of patients took beta-blockers (87%) and combination with ivabradine was well tolerated. Ivabradine did not significantly affect the combined primary endpoint. Significant reduction by 36% (p = 0.001) in myocardial infarction and by 30% (p = 0.016) in coronary revascularization was observed in the pre-defined subgroup of patients with heart rateor = 70/min. Adverse events rate was the same in the active and the control groups. It is possible to conclude that ivabradine did not improve cardiovascular prognosis in all patients with stable ischemic heart disease and decreased ejection fraction but was beneficial as an additional add-on treatment to the current medication, including beta-blockers, in patients whose heart rate wasor = 70/min.

The antiplatelet effect of aspirin is mostly explained by the irreversible cyclooxygenase-1 inhibition resulting in the suppression of thromboxane A2 synthesis. The benefit of aspirin was proved in various cardiovascular diseases. However, the inter- and intraindividual variability of its antiplatelet effect is well known. Aspirin resistance can be understood from the clinical point of view--as a failure of the protective effect of aspirin from thrombotic complication or can be defined from the laboratory aspect--as an inability to cause in vitro detectable platelet function inhibition. The cause of this phenomenon has not been completely explained yet and more mechanisms have been proposed, incomplete suppression of thromboxane A2 generation being one of them. Laboratory diagnostics of aspirin resistance is based on the demonstration of the insufficient inhibition of platelet aggregation or the incomplete suppression of thromboxane A2 synthesis (assay for its metabolite, 11-dehydrothromboxane B2 in urine). The results of some trials raise the possibility that aspirin resistance could be a new independent predictor of cardiovascular events.

The associations of blood pressure (BP), body mass index (BMI) and iliac-to-thigh circumference index (CI) with total, cardiovascular and cancer mortality were investigated in 7312 middle-aged men, initially free of coronary heart disease, known cancer and not treated for hypertension, who have been followed for 15 to 20 years in the Paris prospective study I. Using Cox survival regression analysis, total mortality (1208 deaths) was found to be highest in relatively lean men (BMI24.4 kg/m2) with elevated blood pressure (mean BPor = 96 mmHg) and central pattern of body mass distribution (CI1.82). Cancer causes accounted for a large proportion of the increased mortality risk. In parallel, mortality from cardiovascular diseases increased independently with blood pressure and iliac-to-thigh circumference index, but increased with body mass index only in men with low blood pressure (mean BP96 mmHg). Taking into account serum cholesterol and cigarette smoking levels as covariates and excluding deaths occurring 5 to 10 years after the examination only slightly attenuated the intensity of this pattern of association.

The authors analyze the influence of various factors on the work absenteeism in an industrial population. The work absenteeism changes significantly with age. Short, frequent incapacities, in particular on account of respiratory diseases, are typical for young age (approximately under 25 years). Least numbers of sickness days per year were recorded in workers in the fourth decade of life. Absenteeism on account of cardiovascular disease rises with age. The total work absenteeism is higher in manual workers, as compared with administrative workers and higher in women than in men. The differences depend also on the mean monthly income--the lowest rate of work absenteeism was recorded in people with a gross income above 4,500 Kcs. The influence of these factors in such that it is not possible to detect a relationship between work incapacity and biological factors, e.g. blood pressure, body weight, lipidogram, blood sugar level and others. It is beyond doubt, however, that the morbidity and mortality rate from non-infectious diseases depend on these factors. The causes of work incapacity are complex and are mostly influenced by circumstances beyond the health services.

The authors analyzed the incidence of cerebrovascular diseases (dg. 430-438) in an industrial population in 1982-1986. The morbidity from cerebrovascular diseases associated with temporary or permanent work incapacity had during the investigation period a slightly rising trend which was more marked in manual male workers above 50 years of age. Strokes are the cause for granting invalidity pensions in cca 4%. In general cardiovascular and cerebrovascular diseases account for cca 21% of invalidity pensions. In the register of cerebrovascular attacks the incidence of strokes was roughly double in men as compared with women; it was on average 30 patients per year per 36,000 employees, i.e. cca 0.8%. Cerebrovascular attacks are in cca 70% associated with hypertension and the basis of almost three quarters of strokes is cerebral ischaemia. The trend of cerebrovascular diseases is unfavourable and depends above all on the control of hypertension in the population.