European Guidelines Research Articles

Prediction of individual lifetime cardiovascular risk and potential treatment benefit: development and recalibration of the LIFE-CVD2 model to four European risk regions.

The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals. The updated LIFE-CVD (i.e. LIFE-CVD2) models were derived using individual participant data from 44 cohorts in 13 countries (687 135 individuals without established CVD, 30 939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1 657 707 individuals (61 311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95% confidence interval 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (Clinical Practice Research Datalink) and the Netherlands (Extramural LUMC Academic Network). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example, a 50-year-old smoking woman with a systolic blood pressure (SBP) of 140 mmHg was estimated to gain 0.9 years in the low-risk region vs. 1.6 years in the very high-risk region from lifelong 10 mmHg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low-risk region to 4.8 years in the very high-risk region. By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines.

The lipid profile of the young patient with ischemic heart disease. Do these patients meet the goals?

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena Introduction Ischemic heart disease is becoming increasingly common in young individuals, with dyslipidemia being an important risk factor for developing acute coronary syndrome (ACS). Recently, new analytical parameters of the lipid profile have been described, which are associated with a higher cardiovascular risk. Purpose The aim of the study was to analyse characteristics, lipid profile and, whether LDL goals are achieved in young patients with ACS admitted to our Coronary Care Unit (CCU). Methods Retrospective cohort of all patients with ACS minor than 45 years admitted to a CCU between January 2010 and February 2023. The LDL goals were established according to the European clinical practice guidelines (<70 mg/dL or <55 mg/dL after 2019). Results A total of 287 patients were included, with 82.6% being male and an average age of 41 years. 77% were smokers and 9% were ex-smokers. The prevalence of classic cardiovascular risk factors at admission was as follows: dyslipidemia 105 (37%), overweight 74 (26%), obesity 70 (25%), hypertension 87 (30%), and diabetes 29 (10%). Lipid profile’s results are showed in picture 1. Smoking, gender, as well as obesity or overweight were not significantly associated with a worse lipid profile. Significant differences were also not found based on the extent of coronary involvement (analyzing the number of affected vessels or the presence of coronary occlusion) or the reason for admission (NSTEMI vs. STEMI). As for secondary prevention, 70% of patients completed the cardiac rehabilitation program. The percentage of patients who achieved the LDL goal was 62.4% at 6 months (with an average of 61 mg/dL) and 52.4% at one year (with an average of 72 mg/dL). The majority of patients (74%) who did not meet the goals at 6 months still did not achieve them at one year. A higher initial LDL-C level was associated with a lower likelihood of achieving the goals at 6 months and one year, although it did not reach statistical significance at one year (p = 0.05 and 0.08, respectively). No other predictors of success were found, although participation in a Cardiac Rehabilitation Program was associated with a non-significant trend towards goal attainment, likely due to the small sample size (45% vs. 65%, p = 0.09). Conclusion Young patients with ACS have a good short-term and long-term prognosis, which is why secondary prevention becomes particularly important. However, a significant percentage of patients still do not achieve the recommended LDL-C goals, leaving room for improvement in reducing morbidity and mortality in this population. Larger patient series are needed to gain a better understanding of this population.Table 1.Lipid profile'sLDL and Lipoprotein (a) at admission

TAVI in younger patients: is it a reliable option?

Abstract Funding Acknowledgements None. Background/Introduction Severe aortic stenosis is the most common valve disease requiring intervention. It has very poor prognosis, and early intervention is recommended. Either surgical or percutaneous transcatheter intervention is possible. According to European guidelines, surgical aortic valve replacement (SAVR) is usually indicated for patients younger than 75 years old. However, some patients are refused surgery, and transcatheter aortic valve implantation (TAVI) might be an option of treatment for these patients, however medium-long term results are still uncertain. Purpose This study intends to evaluate the efficacy and safety of TAVI in younger patients with severe symptomatic aortic stenosis. Methods Retrospective cohort of 224 patients were submitted to TAVI in the last 3 years, of which 21 patients were younger than 75 years old. The primary endpoints are mortality, major adverse cardiovascular events (MACE) and rehospitalization (related to the procedure, valve, or heart failure). Efficacy and safety were evaluated during a follow-up of at least 6 months, compared with the traditional group. Results A total of 224 patients underwent TAVI during the last 3 years at our center. Of these, 21 patients (9%) were younger than 75 years. The mean age was 72,1±3 [62-75] years old and 33% were female (n=7). 95% (n=20) of the TAVI procedures were due to degenerative severe aortic stenosis and 5% (n=1) due to degenerative aortic surgical valve prothesis. The mean euroscore risk value was 6,2±1,3%, and 18 patients were refused for surgery (86%) and 3 patients refused surgery (14%). All procedures were performed by transfemoral access, with 2 peripheral access complications (9,5%), 1 hemorrhagic (4%), solved with covered stent, and 1 closure device occlusion solved with wire crossing and balloon inflation (4%). It was necessary to implant 3 temporary pacemakers, however, only 2 patients required a definitive pacemaker implantation (9,5%). There were no cases intraprocedural death, MACE or aortic severe complications. There was a statistically significant reduction of risk of peripheral complications and pacemaker implantation on younger patients comparing with older patients (p=0,04 and p=0,05 respectively). Mean follow-up time was 14±8,3 months [6-39 months]. During follow-up there were no deaths, MACE or episodes of rehospitalization due to heart failure recorded. Regarding echocardiographic evaluation, there were no cases of significant valve degeneration, with mean aortic gradient of 13±4,1mmHg, no significant leakage or other echocardiographic findings. In younger patients, TAVI appears to be also valid therapeutic option, with less risk of peripheral access complication or need of permanent pacemaker implantation. During the follow-up there was no cases of prothesis degeneration, proving to be a reliable option for the medium to long term.

Advanced airway management in the prehospital setting during traumatic out-of-hospital cardiac arrest following traffic collision in Japan, 2013-2019

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Okinaka Memorial Institute for Medical Research; Toranomon Hospital. Background The European guideline on management of major bleeding and coagulopathy following trauma (sixth edition) recommend that endotracheal intubation or alternative airway management be performed without delay to facilitate adequate ventilation and oxygenation during trauma resuscitation. However, controversy remains as to whether advanced airway management should be provided for out-of-hospital cardiac arrest (OHCA) in the prehospital setting. Purpose This study aimed to examine the association of prehospital advanced airway management with outcomes after traumatic OHCA. Methods This observational study analyzed the Japanese government-led nationwide population-based registry data of OHCA patients. Patients with traumatic OHCA following traffic collision who received advanced life support in the prehospital setting from 2013 to 2019 were included. Propensity score matching was used to examine the association of advanced airway management with outcomes after traumatic OHCA following traffic collision. The primary outcome was one-month survival. Results A total of 5,617 patients (mean [SD] age, 60.1 [21.6] years; 68.6% male) were included. 3,822 (68.0%) received advanced airway management, and 1,795 (32.0%) did not. After adjusting for potential confounders using propensity score matching, advanced airway management was associated with decreased chance of one-month survival (23/1452 [1.6%] vs 43/1452 [3.0%]; RR, 0.53; 95%CI, 0.32-0.88; P=0.0128). Similar association was observed for prehospital return of spontaneous circulation (88/1452 [6.1%] vs 139/1452 [9.6%]; RR, 0.63; 95%CI, 0.49-0.82; P=0.0004). Conclusion Among patients with traumatic OHCA following traffic collision, advanced airway management was associated with decreased chance of one-month survival and prehospital return of spontaneous circulation.

European guidelines for the treatment of arterial hypertension 2023: new trends

The treatment strategy for arterial hypertension is aimed at controlling blood pressure levels, as well as preventing serious cardiovascular complications and affecting the prognosis of the disease. Therefore, pharmacotherapy of arterial hypertension is given great importance as a guide to the treatment of patients in real practice. The new 2023 European Society Guidelines for the diagnosis and treatment of hypertension were developed after a thorough analysis of studies in the field of arterial hypertension, and were not limited to RCTs only, but also included realistic studies (observational, cohort, administrative databases). The 2023 Guidelines support the proven value of five major classes of antihypertensive drugs: thiazide/thiazide-like diuretics, ACEIs, ARBs, calcium antagonists, and β-blockers. New data from meta-analyses support the greater clinical relevance of RAS blockers, calcium channel blockers, and thiazide/thiazide-like diuretics in preventing hypertension-related outcomes, leading to their preferred use in the pharmacotherapy of arterial hypertension, including various combinations of drugs. A new trend in the pharmacotherapy of arterial hypertension has been the inclusion of β-blockers among the main antihypertensive drugs, including their preferred use for a number of clinical conditions. New classes of drugs, such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, are cited as having BP-lowering effects and with strong evidence of reduced cardiovascular and renal outcomes in patients with type 2 diabetes and, in the case of SGLT2 inhibitors, in non-diabetic patients. The 2023 Guidelines significantly updated information on available combination strategies for the treatment of arterial hypertension, and added data on the effectiveness of fixed combinations, including quadropills and polypills.

European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events.

A study was designed to investigate whether the coronary artery disease polygenic risk score (CAD-PRS) may guide lipid-lowering treatment initiation as well as deferral in primary prevention beyond established clinical risk scores. Participants were 311 799 individuals from the UK Biobank free of atherosclerotic cardiovascular disease, diabetes, chronic kidney disease, and lipid-lowering treatment at baseline. Participants were categorized as statin indicated, statin indication unclear, or statin not indicated as defined by the European and US guidelines on statin use. For a median of 11.9 (11.2-12.6) years, 8196 major coronary events developed. CAD-PRS added to European-Systematic Coronary Risk Evaluation 2 (European-SCORE2) and US-Pooled Cohort Equation (US-PCE) identified 18% and 12% of statin-indication-unclear individuals whose risk of major coronary events were the same as or higher than the average risk of statin-indicated individuals and 16% and 12% of statin-indicated individuals whose major coronary event risks were the same as or lower than the average risk of statin-indication-unclear individuals. For major coronary and atherosclerotic cardiovascular disease events, CAD-PRS improved C-statistics greater among statin-indicated or statin-indication-unclear than statin-not-indicated individuals. For atherosclerotic cardiovascular disease events, CAD-PRS added to the European evaluation and US equation resulted in a net reclassification improvement of 13.6% (95% CI, 11.8-15.5) and 14.7% (95% CI, 13.1-16.3) among statin-indicated, 10.8% (95% CI, 9.6-12.0) and 15.3% (95% CI, 13.2-17.5) among statin-indication-unclear, and 0.9% (95% CI, 0.6-1.3) and 3.6% (95% CI, 3.0-4.2) among statin-not-indicated individuals. CAD-PRS may guide statin initiation as well as deferral among statin-indication-unclear or statin-indicated individuals as defined by the European and US guidelines. CAD-PRS had little clinical utility among statin-not-indicated individuals.

The Effects of Waste Ceramic Powders and Waste Glass Powders on the Rheological and Mechanical Properties of Self-Compacting Concrete

Two key axes dominated this experimental research. The first was developing self-compacting concrete from ceramic waste powder (CWP) and glass waste powder (GWP), which met and followed the recommended European specification and guidelines for self-compacting concrete (EFNARC) standards. The second axis indicated the self-compacting concrete's rheological and mechanical performance. Sixteen different mixtures were produced using supplementary cementitious materials (SCMs) to replace cement partially. The replacement levels of SCMs were 5%, 10%, and 15% (by weight of cement), divided into three series: Series A (containing ceramic waste powder), Series B (containing glass waste powder), and Series C (containing combinations of ceramic waste powder and glass waste powder). The SCC rheological properties for all mixtures with different levels of SCMs replacement in the mixture gradually decreased as the substitution ratios increased. The reduction in flowability for substitution, ranging from 5% to 35%, was approximately 0% to 12%, respectively. However, the reduction was insignificant; the fresh properties remained within the limits specified by EFNARC. Regarding the mechanical properties, at an early age, the strength of mixtures decreased with increasing alternative ratios. However, after 90 days, the strength increased by about 11% and 9% of the compressive and flexural strengths, respectively, over the control mix, indicating that SCMs improve the concrete strength over time and are suitable to contribute to an eco-friendly concrete industry without compromising strength.

Understanding transcatheter edge-to-edge repair "knobology": Advanced catheter steering for different scenarios of transseptal puncture.

Following the introduction in the latest European and American guidelines, transcatheter edge-to-edge repair has become a valid alternative to surgery for ineligible patients. Among the available technologies, MitraClip (Abbott) was the first to be introduced for the percutaneous treatment of mitral regurgitation with the edge-to-edge technique. Although its safety and effectiveness has been widely demonstrated, the optimal procedural results are highly dependent from operators' experience. In this manuscript, we provide a full guide of advanced steering maneuvers of MitraClip in different scenarios of transseptal puncture.

HYPERTENSION MANAGEMENT IN GEORGIA: BRIDGING GAPS IN CARDIOVASCULAR RISK ASSESSMENT AND BLOOD PRESSURE CONTROL (SNAPSHOT STUDY)

Objective: To assess management of hypertensive patients in Georgia, including cardiovascular (CV) risk and blood pressure (BP) control. Design and method: SNAPSHOT is a cross-sectional observational multicenter epidemiological study that included 607 hypertensive patients in Georgia. The assessment of CV risk and BP control performed by investigators was compared to evaluations based on recommendations from European guidelines (SCORE 2&OP). Results: Patients were recruited by 31 investigators, of which 74.2% were cardiologists, 12.9% endocrinologists, 9.7% neurologists, and 3.2% general practitioners. The analysis included 606 patients with a mean (standard deviation [SD]) age of 63.0 (11.6). Half patients were female (51.7%). Most patients were overweight or obese (81.8%) and non-smokers (68.8%). They had no (11.5%), one (36.6%), 2 (37.5%), 3 (14.2%), or 4 (0.2%) risk factors for hypertension. Most patients (68.4%) had additional comorbidities, mainly dyslipidemia (46.6%), coronary artery disease (35.0%) and diabetes mellitus (24.3%). Hypertension was treated in 93.9% of patients, with the most common treatments consisting of angiotensin-converting enzyme inhibitors (63.0%), diuretics (59.0%), and/or beta blockers (55.5%). The co-administration of these treatments, along with other BP-lowering medications, occurred in 37.3% (combination of 2) and 36.8% (combination of 3) of patients. Moreover, 63.9% of patients used a single-pill combination. Mean (SD) systolic and diastolic BP were 141.2 (20.8) mmHg and 84.7 (11.6) mmHg, respectively. BP was considered controlled according to the investigator in 72.0% of patients, while it was actually controlled according to guidelines in 19.1% of patients. CV risk was assessed by the investigator as low, moderate, high, or very high in respectively 21.0%, 30.9%, 27.1%, and 21.0% of patients. According to guidelines, CV risk was mainly categorized as high (15.2%) or very high (84.6%). Therefore, there was an agreement between the 2 risk assessments in only 33.3% of cases, while the investigators underestimated the risk for 64.6% of patients. Conclusions: This study brought attention to significant disparities in hypertension and CV risk assessment compared to guideline recommendations. This emphasized the importance of adhering to established guidelines for medical assessments to enhance the effectiveness of hypertension management in Georgia.

European Guidelines for Postgraduate Education in Orthodontics and their impact on the world

With the help of educators from all over Europe, the European Guidelines for Postgraduate Education in Orthodontics were created, and its influence spread far and wide.These recommendations, which promote evidence-based treatment and integrate the most recent developments in orthodontic research and technology, have enabled orthodontic instructors and postgraduate students globally to stay up to date with the quickly changing field of orthodontics.The World Federation of Orthodontists (WFO) Guidelines for Postgraduate Orthodontic Education, which were released in 2009 and later revised in 2023, were also influenced by the European Guidelines. The use of these guidelines by postgraduate program directors around the world and by related educational, scientific, and administrative institutions will allow them to adapt their curricula to worldwide standard and to strive for excellence in themselves and our speciality.

Preoperative evaluation of adult patients before elective, non-cardiothoracic surgery : A joint recommendation of the German Society for Anesthesiology and Intensive Care Medicine, the German Society for Surgery and the German Society for Internal Medicine

The 70recommendations summarize the current status of preoperative risk evaluation of adult patients prior to elective non-cardiothoracic surgery. Based on the joint publications of the German scientific societies for anesthesiology and intensive care medicine (DGAI), surgery (DGCH), and internal medicine (DGIM), which were first published in 2010 and updated in 2017, as well as the European guideline on preoperative cardiac risk evaluation published in 2022, acomprehensive re-evaluation of the recommendation takes place, taking into account new findings, the current literature, and current guidelines of international professional societies. The revised multidisciplinary recommendation is intended to facilitate astructured and common approach to the preoperative evaluation of patients. The aim is to ensure individualized preparation for the patient prior to surgery and thus to increase patient safety. Taking into account intervention- and patient-specific factors, which are indispensable in the preoperative risk evaluation, the perioperative risk for the patient should be minimized and safety increased. The recommendations for action are summarized under "General Principles(A)," "Advanced Diagnostics(B)," and the "Preoperative Management of Continuous Medication(C)." For the first time, arating of the individual measures with regard to their clinical relevance has been given in the present recommendation. Ajoint and transparent agreement is intended to ensure ahigh level of patient orientation while avoiding unnecessary preliminary examinations, to shorten preoperative examination procedures, and ultimately to save costs. The joint recommendation of DGAI, DGCH and DGIM reflects the current state of knowledge as well as the opinion of experts. The recommendation does not replace the individualized decision between patient and physician about the best preoperative strategy and treatment.

European guidelines on phlebotomy in emergency medicine

European guidelines on phlebotomy in emergency medicine

NOCTURNAL HYPERTENSION: THE VEILED DARK SIDE OF HYPERTENSION MANAGEMENT IN A REAL WORLD

Objective: Nocturnal hypertension (NH) is highly prevalent among Chinese and Asian populations, while it is usually undetected and uncontrolled in real world clinical practice. This study is aimed to explore the status of nocturnal blood pressure (BP) control in subjects undergone 24h ambulatory blood pressure monitoring (ABPM) in China. Design and method: A nationwide 24h ABPM database was analyzed. NH was defined as average nighttime BP >=120/70 mmHg according to the recent Chinese and European hypertension guidelines. Results: A total of 210782 Chinese adult subjects undergone 24h ABPM between 2020-2022 with suspected and established hypertension were include in this preliminary analysis. Half of the participants was male, the mean age was 59.5(+/-15.3) years. The average nocturnal BP was 127.8/76.0 (+/- 20.0/ 12.9) mmHg. Overall, nocturnal BP was under controlled (<120/70 mmHg) among 23% of the participants, 20% in male, 26% in female, much less than the 45% of daytime BP control and 35% of 24h average BP control in the total subjects. Nighttime systolic BP <120 mmHg was found in 37% of the participants, while nighttime diastolic BP<70 mmHg was seen in 32% of the participants. Conclusions: NH was uncontrolled in about 3/4 of Chinese adults undergone 24h ABPM, indicating an urgent need for NH detecting and managing in practice.

AN UPDATED REPORT FROM THE HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY

Objective: Ambulatory blood pressure monitoring (ABPM) is recommended by current European guidelines for the early diagnosis of hypertension and to monitor the efficacy of antihypertensive treatments. The Hungarian Society of Hypertension has initiated a 5-year, nationwide program in 2021 to promote the routine use of ABPM and to improve the motivation of doctors and patients. This is an updated report on the Hungarian ABPM Registry. Design and method: This is an ongoing, multicenter, open-label, observational study. Adult (age >18 years) patients with known hypertension(HT), or with suspected/newly diagnosed hypertension(nHT) can be involved in the study. ABPM monitoring is performed by GPs, internists, and cardiologists using validated Meditech ABPM-06 monitors. Current report analyzed ABPM data between 21.02.2021-16.11.2023, that were collected into an electronic case report. Overall, 40621 ABPMs were performed, due to protocol deviation 1901 patients were excluded from the analysis. Results: 26315 patients were HTs(68.3%), 12193 patients were nHTs(31.5%). In the HT group 95.5%, in the nHT group 21.5% were treated. 63.6% of all patients were hypertensives according to the 24-hour average blood pressure(BP) values. Mean 24-hour systolic and diastolic BP was 133.84±14.5 mmHg and 79.2±10.3 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between HT and nHT patients (133.75±13.96mmHg vs. 133.86±14.72mmHg, respectively, p=NS). Obesity(BMI >30 kg/m2) increased the risk of hypertension(OR=1.82[1.73;1.92]for 24-hour average). Coffee consumption(more than 3/day)(OR=1.22[1.16;1.29]for 24-hour average), snoring(OR=1.39[1.33;1.46]for 24-hour average)and smoking(OR=1.10[1.03;1.18]for 24-hour average)all increased the risk of hypertension, primarily affecting more the daytime BP values(OR=1.24[1.18;1.31]for daytime in coffee consumption, OR=1.13[1.07;1.19]for nighttime in coffee consumption; OR=1.42[1.36;1.49]for daytime in snoring, OR=1.31[1.25;1.38]for nighttime in snoring; OR=1.09[1.01;1.16]for daytime in smoking, OR=1.01[0.94;1.08]for nighttime in smoking (NS)). Lack of regular sport(less than 3x30 minutes weekly)increased the risk of hypertension(OR=1.11[1.05;1.18]for 24-hour average), primarily affecting more the nighttime values(OR=1.19[1.12;1.26]for nighttime, OR= 1.02[0.96;1.07]for daytime(NS)). Conclusions: Hypertension is highly prevalent in both HT and nHT patients, irrespectively of gender or treatment. Obesity, lack of regular sport, coffee consumption, snoring and smoking are all significant risk factors in developing hypertension, latter ones affecting more the daytime BP values, whereas lack of regular sport affects more the nighttime BP values.

Topical and Systemic Retinoids in the Management of Hidradenitis Suppurativa: A Comprehensive Literature Review.

Hidradenitis suppurativa (HS) is a debilitating chronic skin disorder characterized by painful inflammatory nodules, abscesses and sinus tracts involving intertriginous areas and has an adverse impact on patient quality of life. Over the past decade, the therapeutic options of HS have increased significantly to comprise multiple modalities, including topical medication, systemic therapies (mainly antibiotics, retinoids, and biologics), surgical approaches, and lifestyle modifications. Biologics alone or in combination with surgery remain the treatment of choice for moderate to severe disease. However, non-biologic therapies (including retinoids) may be used as monotherapy for mild disease and in combination with biologics and surgical treatment in moderate to severe disease. Retinoids, specifically isotretinoin, acitretin, and alitretinoin, are historically used in the management of HS, supported by anecdotal evidence and with variable treatment response. Although the current American and European guidelines offer different recommendations on the use of retinoids in HS, retinoids remain a valuable ally in HS management. This review provides a comprehensive analysis of the current scientific literature on retinoid therapy (topical and systemic) in HS, highlighting disparities in mechanisms of action, efficacy, and safety to clarify their role in HS treatment.

THE INVESTIGATION OF TRANSFERABILITY OF DEFINITIONS OF CARDIOMETABOLIC AND VASCULAR AGING PHENOTYPES ACROSS MULTIPLE COHORTS

Objective: According to the European guidelines for the prevention of cardiovascular diseases (CVD) (2021), Russia was identified as a country with a very high CV risk. We aimed to investigate the applicability of the standardized definitions of vascular aging phenotypes (VP) in Russian population and align them with the existing reference datasets. Design and method: In 2012-2013 1,600 residents of St. Petersburg (age 21-67) were randomly examined as a part of the multicenter epidemiological study. Anthropometry, blood pressure measurement, blood biochemistry analysis were taken. Subjects completed questionnaires describing their lifestyle, current health condition and medication usage. 618 patients (42% men) from initial cohort with a mean age of 48 [37;55] years were randomly subsampled for carotid-femoral pulse wave velocity assessment (Sphygmocor). The VP were defined using the ‘Reference Values for Arterial Stiffness’ Collaboration database which included 16,867 measurements from eight European countries populations15 to 97 years. According to the criteria, patients with overt CVD, diabetes mellitus and the use of antihypertensive, lipid-lowering therapy were excluded from the analysis of VP. Results: The Russian cohort had significantly higher prevalence of CVD (11,4% compared to 6,9% in the Nreference population, p=5.65x10-5), intake of antihypertensives (28,1% compared to 14,3% in the reference, p<1x10-16) and lipid-lowering therapy (6,1% compared to 4,1%, p=0.025, Figure 1A). Additionally, our cohort had significantly higher prevalence of optimal BP (40,2% vs 28%, p=4.6x10-7) and lower prevalence of first-degree (p=0.048) and second degree (p=0.00084) hypertension (Figure 1B). Comparison of the prevalence of VP between the European and Russian cohorts showed a significant decrease of the early vascular aging (EVA) phenotype with age in the Russian population (p=0.011). The prevalence of the supernormal vascular aging phenotype (SUPERNOVA) in the group of 60-69 years old was higher in the Russian population (p=0.0035) Conclusions: A higher prevalence of CVD was demonstrated in the study cohort despite lower hypertension burden and higher CV drugs intake compared to the European cohort. Multidirectional trajectories of EVA and SUPERNOVA VP with age were detected in Russian population, potentially indicating the presence of the clearing selection pressure at the older age (Agreement No 075-15-2022-301).

TIME IN TARGET RANGE OF SYSTOLIC BLOOD PRESSURE AND EGFR SLOPE IN PATIENTS WITH TYPE 2 DIABETES

Objective: Time in target range (TTR) of systolic blood pressure, a novel measure to assess the effect of blood pressure control, is attracting attention in recent European guidelines. However, few studies have explored the renoprotective value of systolic TTR in patients with type 2 diabetes (T2D). Design and method: We used the database of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial, and 4409 eligible participants were enrolled in the present study. The systolic target range for the standard and intensive therapy was defined as 120 to 140 mm Hg and 110 to 130 mm Hg, respectively. Results: After adjustment for covariates, systolic TTR was significantly and positively associated with 2 indices of eGFR slope (P <= 0.0016), regardless of additional adjustment for systolic blood pressure average and variability. The association of systolic TTR and eGFR slope was significantly stronger in CKD patients than those without CKD (P for interaction <=0.044). When TTR was treated as a categorical variable, participants with the highest systolic TTR in the CKD group had a significantly positive association with eGFR slope (P <= 0.00046). Similar results were obtained in the further subgroup analysis. Conclusions: Among patients with diabetes, systolic TTR showed a significant and positive association with eGFR slope, with a stronger association observed in those with CKD. TTR reflects both blood pressure level and stability across blood pressure management, emphasizing the importance of maintaining stable blood pressure control for renoprotection in T2D patients, particularly in those with CKD.

Retrospective cohort study on the bilateral occurrence of invasive lobular breast cancer

ObjectiveInvasive lobular carcinoma (ILC) is the second most common histological subtype of invasive breast cancer, following the no special type (NST) invasive carcinoma. It has historically been assumed that ILC occurs bilaterally in 20–29 % of cases, which has influenced the inclusion of MRI in the standard workup of ILC according to European guidelines. However, challenging this long-held belief regarding the bilateral occurrence of ILC opens up the possibility of revising the guidelines and using MRI only for more specific indications. This study aims to evaluate whether the previously reported high percentage of bilaterality still holds true and to question the added value of MRI in the standard workup of ILC. Study designA retrospective cohort study was conducted following approval from the institutional review board (EC 21/18/249) at Antwerp University Hospital (UZA). The cohort comprised female patients of all ages who had been diagnosed with either ILC or NST invasive carcinoma and had sought consultation at the UZA breast clinic. A comprehensive database was established to collect information on patient characteristics, imaging, and pathology. ResultsA total of 271 patients with ILC were included in the study, with incidence dates ranging from 01/01/2007 to 01/01/2023. Among these patients, a synchronous bilateral ILC lesion was observed in 1.85 % (5/271) of cases. This proportion is significantly lower than the reported percentage of patients with a bilateral lesion in the literature population, which stands at 4.95 %. The reference group consisted of 809 patients with NST invasive carcinoma, with incidence dates ranging from 01/01/2017 to 01/01/2023. In the control group, a synchronous bilateral NST lesion was observed in 3.96 % (32/809) of cases. There is no significant difference in the bilaterality rates between the group of ILC patients and the group of NST patients. Furthermore, MRI did not detect any histopathologically confirmed contralateral ILC lesion that had not already been detected by mammography or ultrasound. ConclusionsThe study results indicate a lower occurrence of bilateral ILC than previously assumed. Additionally, the incidence of synchronous bilateral lesions in ILC patients is not higher compared to patients with NST invasive carcinoma. Performing an MRI does not provide additional value in detecting bilateral carcinomas in ILC. Consequently, it is recommended that the current European guidelines be reassessed, and the indications for undergoing an MRI should be adjusted accordingly.

Chemical Composition and Elements Concentration of Fillet, Spine and Bones of Common Carp (Cyprinus carpio) in Relation to Nutrient Requirements for Minerals.

The aim of the study was to compare the content of major components, selected elements and heavy metals in the fillet, spine and bones of a carp (Cyprinus carpio). Moreover, the extent to which a prepared portion of carp tissue (100 g of fillet and 10 g of carp spine or bones) met the requirements for analyzed elements in adults (women and men) and children was calculated. The proximate composition (total protein, total lipid, ash, moisture) and mineral content of the fish samples were determined. The nutrient composition presented fluctuations among the different tissues. Moisture was the main constituent in the fillet and in the spine with 77.8% and 56.0%, respectively, whereas in bones, the main ingredient was ash (36.2%). All carp tissues were good sources of protein, with 16.5%, 21.0% and 17.0% in spine, bones and fillet, respectively. The most abundant main elements were the potassium in the fillet (4005 mg kg-1) and calcium in the bones (116,463 mg kg-1). The most abundant trace elements were iron in fillet and zinc in bones and spine. Carp meat can be considered a safe foodstuff in terms of concentrations of Hg, Pb and Cd, as the levels of these contaminants were less than FAO and European Commission maximum guidelines.

Understanding the psychological impact of identifying carrier status on young adults: A qualitative study exploring peer reactions.

The benefits and harms of identifying carriers in childhood have long been debated with European Guidelines advising against this practice. Yet over a thousand carriers are identified via newborn bloodspot screening per year in the United Kingdom alone. One of the concerns about identification is the impact it has on an individual's identity. This, in part, will be determined by how parents and peers view carriers, particularly during young adulthood. To address the paucity of research looking at how carriers are perceived by peers, this study sought to explore the views of young adults, who themselves are not carriers, toward carriers. As the narratives around COVID-19 increased, the salience of the term "carrier", the impact of such narratives on perceptions, was also explored. Twenty-five 18-25 year olds participated in a diary-interview study in the United Kingdom during 2021 to explore their perceptions of carriers via hypothetical scenarios. Data were analyzed using thematic analysis. Interviewees believed carriers would experience stigma-including societal and self-stigma. This was because people used existing illness beliefs to make sense of carrier status about which they had low levels of understanding. Interviewees believed carriers would experience challenges in familial and romantic relationships due to others' judgments. They also believed parents of carriers would experience a burden around making reproductive decisions, with clear views on what society would view as acceptable choices. Importantly interviewees felt knowledge of ones' own carrier status conferred complex communication challenges within relationships. These findings suggest an urgent need for more research and support for young adults entering a key stage in life for identity formation who have knowledge of their carrier status. The results suggest that support targeted toward the carrier regarding navigating complex communication and targeted more broadly to avoid stigma based on misunderstanding should be researched and developed.