Cardiovascular Disease In Europe Research Articles

European Lipid Guidelines and Cardiovascular Risk Estimation: Current Status and Future Challenges.

Genetic, experimental, epidemiologic, and clinical data support the causal role of elevated levels of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis and cardiovascular disease (CVD). The recommendations of the 2019 European guidelines are based on the concept of differential CV risk, which in turn defines the LDL-C goals that should be achieved. The 2019 ESC/EAS guidelines for dyslipidaemia use the Systematic COronary Risk Evaluation (SCORE) model to assess CV risk, which provides a 10-year risk of fatal CV event. The SCORE model has recently been updated to reflect current rates of cardiovascular disease in Europe. The new SCORE2 model provides estimates of the 10-year risk of fatal and non-fatal CVD events in people aged 40-69 years, thus improving the identification of individuals at higher risk of a CVD event. However, as in the SCORE age is the main determinant of risk, young people have a relatively low estimated 10-year risk of a CV event even with high levels of one or more causal risk factors. Individuals with familial hypercholesterolaemia, who have elevated LDL-C levels from birth and have a high risk of premature CVD, are one example. The concept of cumulative LDL exposure is thus becoming increasingly important. This is also supported by Mendelian randomisation studies showing that carrying genetic variants associated with lower LDL-C levels reduces CV risk. These observations have introduced the concept of "cholesterol-years", which takes into account both LDL-C levels and time of exposure. It is crucial that future European guidelines pay more attention to this point.

Impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review

BackgroundCardiovascular diseases remain the foremost global cause of death. The COVID-19 pandemic has strained health-care systems, leading to delays in essential medical services, including treatment for cardiovascular diseases. We aimed to examine the impact of the pandemic on delayed cardiovascular care in Europe. MethodsIn this systematic review, we searched PubMed, Embase, and Web of Science for peer-reviewed and published quantitative studies in English from Nov 1, 2019, to Sept 18, 2022, that addressed pandemic-induced delays in cardiovascular disease care for adult patients in Europe. Data appraisal, extraction, and quality assessment were done by two reviewers using the 14-item QualSyst tool checklist. We extracted summary patient-level data from the studies, including around 3·5 million patients. Evaluated outcomes included changes pre-March 2020 and during the COVID-19 pandemic in hospital admissions, mortality rates, medical help-seeking delays post-symptom onset, treatment initiation delays, and treatment procedure counts. The protocol is registered on PROSPERO (CRD42022354443). FindingsOf the 132 included studies (20% from the UK), all were observational retrospective, with 87% focusing on the first wave of the pandemic. Results were categorised into five disease groups: ischaemic heart diseases, cerebrovascular diseases, cardiac arrests, heart failures, and others. Hospital admissions showed significant decreases around the ranges of 12–66% for ischaemic heart diseases, 9–40% for cerebrovascular diseases, 9–66% for heart failures, 27–88% for urgent and elective cardiac procedures, and an increase between 11–56% for cardiac arrests. Mortality rates were significantly higher during the pandemic, ranging between 1–25% (vs 16–22% before the pandemic) for ischaemic heart diseases and 8–70% (vs 8–26% before the pandemic) for cerebrovascular diseases. Only one study ranked low in quality. InterpretationThe pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Policymakers and health-care systems should work together on implementing adequate resource allocation strategies and clear guidelines on how to handle care during health crises, reducing diagnosis and treatment initiation delays, and promoting a healthy lifestyle. Future studies should evaluate the long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19. FundingBelgian Science Policy Office.

The impact of the COVID-19 pandemic on delayed care of CVD in Europe: a systematic review

Abstract Aim Cardiovascular diseases are the leading cause of death worldwide and the COVID-19 pandemic has disrupted healthcare systems, causing delays in essential medical services, including cardiovascular (CV) care. This study aims to estimate the impact of the COVID-19 pandemic on delayed cardiovascular (CV) care in Europe by providing a systematic overview of the available evidence. Methods and Results PubMed, Embase, and Web of Science were searched until mid-September 2022. This review included 132 studies. Outcomes of interest were changes in hospital admission, mortality, delays in seeking medical help, delays in treatment initiation, and changes in the number of treatment procedures. Results were presented in five disease groups: Ischemic Heart Disease (IHD), cerebrovascular diseases, Cardiac Arrests (CA), Heart Failure (HF), and others. There was a significant decrease in hospital admissions for IHD, cerebrovascular diseases, and HF, and a significant increase in CA. Mortality rates were higher for IHD and cerebrovascular diseases. Urgent and elective cardiac procedures’ rates also decreased during the pandemic. Conclusions The review's limitations include its exclusive focus on European countries, which may not generalize to other regions due to differences in containment and tracing measures. The reviewed studies did not always report consistent outcomes and were primarily conducted during or just after the first wave of the pandemic, limiting our understanding of the long-term impact. Policymakers and healthcare systems should allocate adequate resources, provide clear guidelines for accessing medical care, reduce delays in seeking medical attention, and promote healthy lifestyles to prepare for future pandemics. Future reviews should consider the longer-term impact of pandemics on delayed CV care and evaluate the long-term health and health-economic impact of the COVID-19 pandemic on delayed CV care. Key messages • The pandemic has reduced hospital admissions and caused delays in seeking medical attention, while increasing mortality rates for some cardiovascular diseases in Europe. • Prepare for pandemics: allocate resources, set guidelines for care, reduce delays, promote health, and evaluate impacts on cardiovascular care.

The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.

Female specific cardiovascular risk factors

The proportion of total deaths attributable to CVD in Europe is greater for women (51%) than for men (42%). Classic manifestations of cardiovascular diseases (CVD) develop on average 7-10 years later in women than in men. The risk in women is systematically underestimated < 65 years of age, as we still consider them along the male standard. High risk women at middle-age often have (several) female-specific risk factors that are overlooked in the standard SCORE charts. These are for instance premenopausal migraine, multiple pregnancy losses, hypertensive pregnancy disorders, endometriosis, PCOS, early menopause etc. Measurement of Coronary Artery Calcium (CAC) scores with computed tomography (CT) scans is nowadays a well validated, safe and non-expensive tool to identify individuals at increased cardiovascular disease (CVD) risk at middle-age (> 40 years old). In the European and North American prevention lipid guidelines, the use of CAC is endorsed for risk clarification in patients at intermediate risk of CVD who may be good candidates for preventive therapies. The CAC score enables to identify high risk women that are overlooked in the commonly used SCORE charts. In this lecture an overview will be provided on the current knowledge of female-specific risk factors and how to use them in clinical practice.

Cardiovascular prevention: sometimes dreams can come true.

Cardiovascular disease (CVD) is a chronic condition driven by the complex interaction of different risk factors including genetics, lifestyle, environment, etc. which, differently from other pathologies, can be prevented. Treatment of CVD has been inconceivably successful but now it seems that it has reached a plateau suggesting that prevention is the way forward. However, the COVID-19 pandemic has spotted all the limits of the actual health system regarding territorial and, particularly, of preventive medicine. To this end, recently, the SCORE2 risk prediction algorithms, a contemporary model to estimate 10 years risk of CVD in Europe and the new guidelines on prevention have been released. The present review article describes a dream: how prevention of CVD should be addressed in the future. New concepts and paradigms like early genetically personalized and imaging driven risk factors, cardiac risk cartography, measurements of the exposome, estimation of costs of a delayed outcome vs. healthy lifespan, are all addressed. We highlight the importance of technologies and the concept of being engaged in a 'healthy' and not just 'sick' system as it is today. The concept of 'clearing house' with a 'care health team' instead of a 'heart team' is described. Finally, we articulate the four points necessary for the dream to come true.

ANALYSIS OF THE BURDEN OF CARDIOVASCULAR DISEASES IN UKRAINE IN 1990-2019.

The aim: To analyze the burden of cardiovascular diseases (CVD) and their modified risk factors in Ukraine to substantiate ways of prevention. Materials and methods: The burden of CVD was estimated by DALYs (Disability-Adjusted Life Years). The statistical method was used to analyze the data obtained from the statistical database of the international epidemiological study «Global Burden of Disease», updated for 2019. The analysis was carried out in the dynamics for 1990-2019 in Ukraine in comparison with European and EU countries. Results: Age-standardized DALYs per 100,000 population in Ukraine are 2.6 times higher than the average in European countries and 4 times higher than in the EU. Over the 1991-2019 the gap in DALYs increased due to a significant decrease in the burden of CVD in Europe, against the consistently high level in Ukraine. The burden of CVD in Ukraine can be reduced on 54.2% by normalizing blood pressure, on 42.1% by improving diet, on 37.3% by lowering low-density lipoprotein cholesterol, on 28.1% by lowering body mass index, and on 22.9% by quitting smoking. Conclusions: The Ukrainian strategy of reducing the burden of CVD should be intersectoral, comprehensive, combine population and individual (for high-risk groups) approaches to the control of modified CVD risk factors with modern methods of secondary and tertiary prevention of CVD, which have proven their efficiency in European countries.

Cardiovascular prevention: sometimes dreams can come true.

Cardiovascular disease (CVD) is a chronic condition driven by the complex interaction of different risk factors including genetics, lifestyle, environment, etc. which, differently from other pathologies, can be prevented. Treatment of CVD has been inconceivably successful but now it seems that it has reached a plateau suggesting that prevention is the way forward. However, the COVID-19 pandemic has spotted all the limits of the actual health system regarding territorial and, particularly, of preventive medicine. To this end, recently, the SCORE2 risk prediction algorithms, a contemporary model to estimate 10-years risk of CVD in Europe and the new guidelines on prevention have been released. The present review article describes a dream: how prevention of CVD should be addressed in the future. New concepts and paradigms like early genetically personalized and imaging driven risk factors, cardiac risk cartography, measurements of the exposome, estimation of costs of a delayed outcome vs. healthy lifespan, are all addressed. We highlight the importance of technologies and the concept of being engaged in a 'healthy' and not just 'sick' system as it is today. The concept of 'clearing house' with a 'healthcare team' instead of a 'heart team' is described. Finally, we articulate the four points necessary for the dream to come true.

The Atlas of cardiovascular disease in Europe and a focus on frailty and cardiovascular risk.

The Atlas of cardiovascular disease in Europe and a focus on frailty and cardiovascular risk.

SCORE2 Assessment in the Calculation of Cardiovascular Risk in Patients with Rheumatoid Arthritis.

Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Risk chart algorithms, such as the Systematic Coronary Risk Assessment (SCORE), often underestimate the risk of CVD in patients with RA. In this sense, the use of noninvasive tools, such as the carotid ultrasound, has made it possible to identify RA patients at high risk of CVD who had subclinical atherosclerosis disease and who had been included in the low or moderate CVD risk categories when the SCORE risk tables were applied. The 2003 SCORE calculator was recently updated to a new prediction model: SCORE2. This new algorithm improves the identification of individuals from the general population at high risk of developing CVD in Europe. Our objective was to compare the predictive capacity between the original SCORE and the new SCORE2 to identify RA patients with subclinical atherosclerosis and, consequently, high risk of CVD. 1168 non-diabetic patients with RA and age > 40 years were recruited. Subclinical atherosclerosis was searched for by carotid ultrasound. The presence of carotid plaque and the carotid intima media wall thickness (cIMT) were evaluated. SCORE and SCORE2 were also calculated. The relationships of SCORE and SCORE2 to each other and to the presence of subclinical carotid atherosclerosis were studied. The correlation between SCORE and SCORE2 was found to be high in patients with RA (Spearman’s Rho = 0.961, p < 0.001). Both SCORE (Spearman’s Rho = 0.524) and SCORE2 (Spearman’s Rho = 0.521) were similarly correlated with cIMT (p = 0.92). Likewise, both calculators showed significant and comparable discriminations for the presence of carotid plaque: SCORE AUC 0.781 (95%CI 0.755–0.807) and SCORE2 AUC 0.774 (95%CI 0.748–0.801). Using SCORE, 80% and 20% of the patients were in the low or moderate and high or very high CVD risk categories, respectively. However, when the same categories were evaluated using SCORE2, the percentages were different (58% and 42%, respectively). Consequently, the number of RA patients included in the high or very high CVD risk categories was significantly higher with SCORE2 compared to the original SCORE. (p < 0.001). In conclusion, although predictive capacity for the presence of carotid plaque is equivalent between SCORE and SCORE2, SCORE2 identifies a significantly higher proportion of patients with RA who are at high or very high risk of CVD.

Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review.

In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.

Health impact assessment of a voluntary protocol to decrease salt in bread: what can we learn?

Abstract Issue Hypertension (HT) is a major and modifiable risk factor for cardiovascular diseases (CVD), which can be caused by excessive salt intake. Portugal has one of the highest mortality rate due to CVD in Europe, mainly due to HT. Thus, reduction of salt intake from food products is one of major strategies advocated to modify blood pressure (BP) and its impact on HT. Description of the problem The Portuguese population has excessive daily salt intake mainly due to bread consumption. Thus, in 2017 a voluntary ‘Protocol' was signed between stakeholders with the goal to reduce salt content in bread by 2021. Herein, using a Health Impact Assessment (HIA) approach we aimed to estimate the potential effect in BP from the implementation of this ‘Protocol'. Thus, two national surveys were used to find average values of salt intake and BP on population, while estimates of BP reduction were calculated based upon meta-analysis data. Results It was expected that the implementation of the ‘Protocol' could reduce salt ingestion and have a higher BP effect, mostly in more vulnerable populations. In fact, results showed that individuals with low educational level, men, aged and residents in the South region of Portugal were the ones that could more benefit from the ‘Protocol' implementation. However, this study found that the effects were be very low for all groups analysed, suggesting that only slight health gains can occur. Lessons The ‘Protocol' as a voluntary agreement is not sufficient to attain the public health targets devised. Following the HIA framework, further complementary and intersectoral integrated measures, through the use of compulsory food and fiscal policies preferably extended to other highly consumed food products, were thus recommended. HIA could be used as a comprehensive tool to assess health impacts, supporting at each national context the design and implementation of effective strategies to promote salt intake reduction and effectively prevent hypertension. Key messages The systematic use of HIA to design the appropriate policy framework and to inform adequately political decision-making is crucial to promote health and prevent Non-Communicable Diseases. Voluntary agreements should be complemented by other integrated measures to improve the efficacy of policies aiming to reduce salt intake and prevent hypertension.

Epidemiology of cardiovascular disease in Europe.

This Review presents data describing the health burden of cardiovascular disease (CVD) within and across the WHO European Region. CVD remains the most common cause of death in the region. Deaths from CVD in those aged <70years, commonly referred to as premature, are a particular concern, with >60 million potential years of life lost to CVD in Europe annually. Although more women than men die from CVD, age-standardized rates of both morbidity and death are higher in men, and these differences in rates are greatest in individuals aged <70 years. Large inequalities in all measures of morbidity, treatment and mortality can be found between countries across the continent and must be a focus for improving health. Large differences also exist in the data available between countries. The development and implementation of evidence-based preventive and treatment approaches must be supported in all countries by consistent surveillance and monitoring, such that we can quantify the health burden of CVD as well as target interventions and provide impetus for action across Europe.

SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe.

The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.

Taking action: European Atherosclerosis Society targets the United Nations Sustainable Development Goals 2030 agenda to fight atherosclerotic cardiovascular disease in Europe

In 2015, the United Nations launched the Sustainable Development Goals 2030 Agenda as a universal call to action to end poverty, protect the planet, and improve the lives and prospects for all [1]. The 17 goals of this Agenda, adopted by all United Nations (UN) member states, are to be delivered within 15 years. As only 10 years remain, accelerated action is needed, with world leaders calling for a Decade of Action in 2019 to achieve these goals. According to the UN Secretary-General, urgent action is needed on three levels: 1) globally, to secure greater leadership, more resources and smarter solutions; 2) locally, to ensure smooth transition in policies, budgets, institutions and regulatory frameworks of governments, cities and local authorities; and 3) societally, to ensure an unstoppable movement of change by targeting all stakeholders.

Updated treatment thresholds in the 2019 ESC/EAS dyslipidaemia guidelines substantially expand indications for statin use for primary prevention at population level: results from the Rotterdam Study

Abstract Background In the recent update of the ESC/EAS practice guidelines for the management of dyslipidaemias, indications for statin treatment in primary prevention have been expanded to those at lower cardiovascular disease (CVD) risk and with lower LDL levels, as well as to those 65 to 75 years of age according to their level of predicted CVD risk. Purpose To compare the implications of the 2016 and 2019 ESC/EAS guidelines and determine the extent to which these updates affect treatment recommendations at population level. Methods We calculated 10-year CVD risk following the 2016 and 2019 ESC/EAS guideline recommendations and proportions of individuals qualifying for statin treatment categories per guideline. The study population included 7262 participants free of CVD, aged 45 to 75 years, from the Dutch prospective population-based Rotterdam Study. Results Mean (SD) age was 61.1 (6.9) years and 58.2% were women. Diabetes was present in 8.4% of the participants, 24.7% were smokers, mean LDL was 3.7 (0.9) mmol/L, and mean blood pressure was 137/80 (20/11) mmHg. Next to lifestyle changes, the 2016 and 2019 ESC/EAS guidelines recommend statin treatment in 13.2% (N=961) and 37.7% (N=2738) of the total population and consider statin treatment in 37.0% (N=2689) and 51.4% (N=3733), respectively. When stratified by 5-year age groups, the 2016 and 2019 ESC/EAS guidelines overall suggest a respective 29.7% (N=411) and 60.7% (N=839) of adults aged 45–55 years to be considered for statin treatment. While adults with an estimated 10-year SCORE risk of fatal CVD &amp;lt;1% and LDL &amp;lt;4.9 mmol/L were deemed to be at sufficiently low risk in the 2016 ESC/EAS guidelines and hence were suggested only lifestyle advice to modify their cardiovascular risk, in the 2019 update, 517 individuals (i.e. 37.4% of 1383 adults aged 45–55 years) were considered for statin treatment. The 2016 ESC/EAS guidelines did not provide treatment recommendations for individuals aged &amp;gt;65 years, while the 2019 ESC/EAS guidelines recommend statin treatment in 69.2% (N=1430) and considers treatment in another 27.7% (N=571) among the study population aged 65–75 years (N=2065). Conclusions Updated treatment recommendations in the 2019 ESC/EAS dyslipidaemia guideline substantially expand statin treatment to asymptomatic individuals aged 45–55 at low risk, and individuals aged 65–75 years. Whether the broadening of statin indications in asymptomatic low-risk individuals and those aged 65–75 years will lead to greater uptake of primary prevention efforts and thereby long-term lowering of the burden of CVD in Europe, remains to be investigated. Funding Acknowledgement Type of funding source: None

Pharmaco-technological researches for development of tablets composition with amlodipin and enalapril

Ukraine has one of the highest mortality rates from cardiovascular diseases in Europe, accounting for 772.1 cases among men and 440.9 among women per 100 000 population.&#x0D; Antihypertensive drugs are different in dose, active substance and mechanism of action. Monotherapy is ineffective in most cases, therefore it requires a combination of several substances from different pharmacotherapeutic groups. Enalapril and amlodipine are the most often included in treatment regimens for hypertension. Therefore it is advisable to develop combined tablets with enalapril and amlodipine.&#x0D; The aim of the work was to study the effects of excipients on the pharmaco-technological parameters of intermediates and tablets with enalapril and amlodipine.&#x0D; During the work the studied excipients were grouped into 6 factors according to their functional purpose. The experiment was based on the method of mathematical planning. The tablets were preparated by compression after wet granulation. The studies were carried out according to pharmacopoeial methods. Statistical data processing was performed by dispersion analysis.&#x0D; During the experiment it was studied the effects of 30 excipients on the pharmaco-technological properties of granules (loss on drying), tablet mass (fluidity, angle of inclination, bulk density, tapped density) and tablets (uniformity of mass, hardness, friability and disintegration). The effect of 6 qualitative factors on the main reviews (indicators) of granules, powder masses and tablets with enalapril and amlodipine was studied. It is showed by ranked rows of advantages for the influence of excipients on 10 reviews (indicators) of granules, powder masses and tablets with enalapril and amlodipine.&#x0D; As a result of the study, the effects of excipients on the pharmaco-technological parameters of intermediates and tablets with enalapril and amlodipine were studied.

Understanding the use of observational and randomized data in cardiovascular medicine.

The availability of large datasets from multiple sources [e.g. registries, biobanks, electronic health records (EHRs), claims or billing databases, implantable devices, wearable sensors, and mobile apps], coupled with advances in computing and analytic technologies, have provided new opportunities for conducting innovative health research. Equally, improved digital access to health information has facilitated the conduct of efficient randomized controlled trials (RCTs) upon which clinical management decisions can be based, for instance, by permitting the identification of eligible patients for recruitment and/or linkage for follow-up via their EHRs. Given these advances in cardiovascular data science and the complexities they behold, it is important that health professionals have clarity on the appropriate use and interpretation of observational, so-called 'real-world', and randomized data in cardiovascular medicine. The Cardiovascular Roundtable of the European Society of Cardiology (ESC) held a workshop to explore the future of RCTs and the current and emerging opportunities for gathering and exploiting complex observational datasets in cardiovascular research. The aim of this article is to provide a perspective on the appropriate use of randomized and observational data and to outline the ESC plans for supporting the collection and availability of clinical data to monitor and improve the quality of care of patients with cardiovascular disease in Europe and provide an infrastructure for undertaking pragmatic RCTs. Moreover, the ESC continues to campaign for greater engagement amongst regulators, industry, patients, and health professionals in the development and application of a more efficient regulatory framework that is able to take maximal advantage of new opportunities for improving the design and efficiency of observational studies and RCT in patients with cardiovascular disease.

Walnut Inclusion In A Palm-Based High-Fat And High-Cholesterol Diet Without Changing Total Energy Supply Stabilises Advanced Atheroma Plaque Through An Anti-Inflammatory Mechanism In Apoe-Deficient Mice

Background and Aims: The North-to-South gradient in cardiovascular disease in Europe could be partially explained by the low prevalence of lipid-rich atheroma plaques (responsible for most culprit lesions) in Southern Europe. Consumption of certain foods delays atherosclerosis progression. In a mouse model of accelerated atherosclerosis we investigated whether the inclusion of walnuts within an atherogenic diet stabilizes advanced atheroma plaque.

Why CVD in women is killer number 1

The proportion of total deaths attributable to CVD in Europe is greater for women (51%) than for men (42%). Classic manifestations of cardiovascular diseases (CVD) develop on average 7–10 years later in women than in men. The risk in women is systematically underestimated <65 years of age, as we still consider them along the male standard. Overweight, obesity, cigarette smoking, unhealthy food and lack of physical exercise have become the greatest threats to our health, already starting at young age. The various sex differences in underlying pathophysiological mechanisms involved in ischemic heart disease (IHD) often translate into other symptoms than the classical angina pectoris, which is more associated with obstructive CAD.