European Journal Of Preventive Cardiology Research Articles

EHealth for maintenance cardiovascular rehabilitation - current status and future challenges.

Journal Article Accepted manuscript eHealth for maintenance cardiovascular rehabilitation – current status and future challenges Get access Ewa Piotrowicz, MD, PhD, FESC Ewa Piotrowicz, MD, PhD, FESC Telecardiology Center, National Institute of Cardiology, Warsaw, Poland Corresponding Author Email: epiotrowicz@ikard.pl https://orcid.org/0000-0002-7302-237X Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwad195, https://doi.org/10.1093/eurjpc/zwad195 Published: 14 June 2023 Article history Received: 05 June 2023 Accepted: 07 June 2023 Published: 14 June 2023

Atrial fibrillation is the most prevalent cardiac condition in master athletes.

Journal Article Accepted manuscript Atrial fibrillation is the most prevalent cardiac condition in master athletes Get access Eivind Sørensen, Eivind Sørensen Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, Gjettum, Norway Corresponding author: Eivind Sørensen, Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, Gjettum, Norway. E-mail: Eivind.Sorensen@vestreviken.no https://orcid.org/0000-0002-4801-6146 Search for other works by this author on: Oxford Academic Google Scholar Trygve Berge, Trygve Berge Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, Gjettum, Norway https://orcid.org/0000-0002-7681-8621 Search for other works by this author on: Oxford Academic Google Scholar Marius Myrstad Marius Myrstad Department of Medical Research, Bærum Hospital Vestre Viken Hospital Trust, Gjettum, Norway https://orcid.org/0000-0002-9682-5255 Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwad188, https://doi.org/10.1093/eurjpc/zwad188 Published: 02 June 2023 Article history Received: 31 May 2023 Accepted: 01 June 2023 Published: 02 June 2023

Cardiovascular risk markers in patients with spinal cord injury: the Austrian wheelchair dancer study

Journal Article Accepted manuscript Cardiovascular Risk Markers in Patients with Spinal Cord Injury: The Austrian Wheelchair Dancer Study Get access Barbara Mayr, Barbara Mayr Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Lindhofstraße 20, 5020 Salzburg, Austria https://orcid.org/0000-0002-2835-3938 Search for other works by this author on: Oxford Academic Google Scholar Michelle Felber, Michelle Felber Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Lindhofstraße 20, 5020 Salzburg, Austria Search for other works by this author on: Oxford Academic Google Scholar Vanessa Frey, Vanessa Frey Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria. Member of the European Reference Network EpiCARE https://orcid.org/0000-0002-5337-1273 Search for other works by this author on: Oxford Academic Google Scholar Nora Renz, Nora Renz Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria. Member of the European Reference Network EpiCARE https://orcid.org/0000-0001-8011-6684 Search for other works by this author on: Oxford Academic Google Scholar Kerstin Schwenker, Kerstin Schwenker Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria. Member of the European Reference Network EpiCAREKarl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, AustriaNeuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, AustriaSpinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Austria https://orcid.org/0000-0002-0316-6108 Search for other works by this author on: Oxford Academic Google Scholar Eugen Trinka, Eugen Trinka Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria. Member of the European Reference Network EpiCAREKarl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, AustriaNeuroscience Institute, Christian Doppler University Hospital, Center for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, AustriaSpinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Austria https://orcid.org/0000-0002-5950-2692 Search for other works by this author on: Oxford Academic Google Scholar Josef Niebauer Josef Niebauer Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Lindhofstraße 20, 5020 Salzburg, Austria Corresponding author: Prof. Josef Niebauer, MD, PhD, MBA, University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Lindhofstraße 20, 5020 Salzburg, Austria. ph.:+43(0)5 7255-23200, fax: +43(0)5 7255-23299. E-mail: j.niebauer@salk.at https://orcid.org/0000-0002-2811-9041 Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwad128, https://doi.org/10.1093/eurjpc/zwad128 Published: 24 April 2023 Article history Received: 06 March 2023 Revision received: 18 April 2023 Accepted: 20 April 2023 Published: 24 April 2023

Choline Supplementation Improves Cognitive Performance in Frail Hypertensive Patients: Novel Insights on Endothelial Function from the INTERVENTIONIST Study.

Journal Article Accepted manuscript Choline Supplementation Improves Cognitive Performance in Frail Hypertensive Patients: Novel Insights on Endothelial Function from the INTERVENTIONIST Study Get access Pasquale Mone, MD, Pasquale Mone, MD Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Albert Einstein College of Medicine, Montefiore University Hospital, New York, NY, USAASL Avellino Search for other works by this author on: Oxford Academic Google Scholar Urna Kansakar, PhD, Urna Kansakar, PhD Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Albert Einstein College of Medicine, Montefiore University Hospital, New York, NY, USA Search for other works by this author on: Oxford Academic Google Scholar Angela Lucariello, PhD, Angela Lucariello, PhD Parthenope University, Naples Search for other works by this author on: Oxford Academic Google Scholar Anna Marro, MD, Anna Marro, MD ASL Avellino Search for other works by this author on: Oxford Academic Google Scholar Antonella Pansini, MD, Antonella Pansini, MD ASL Avellino Search for other works by this author on: Oxford Academic Google Scholar Fahimeh Varzideh, PhD, Fahimeh Varzideh, PhD Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Albert Einstein College of Medicine, Montefiore University Hospital, New York, NY, USA Search for other works by this author on: Oxford Academic Google Scholar Giovanna Nittolo, MD, Giovanna Nittolo, MD ASL Avellino Search for other works by this author on: Oxford Academic Google Scholar Lino De Angelis, MD, Lino De Angelis, MD ASL Avellino Search for other works by this author on: Oxford Academic Google Scholar Valentina Trimarco, PhD, Valentina Trimarco, PhD University of Naples “Federico II”, Naples, Italy Search for other works by this author on: Oxford Academic Google Scholar Giuseppe Martinelli, MD, Giuseppe Martinelli, MD Parthenope University, Naples Search for other works by this author on: Oxford Academic Google Scholar ... Show more Antonio De Luca, MD, PhD, Antonio De Luca, MD, PhD Parthenope University, Naples Search for other works by this author on: Oxford Academic Google Scholar Gaetano Santulli, MD, PhD Gaetano Santulli, MD, PhD Department of Medicine, Division of Cardiology, Einstein Institute for Aging Research, Albert Einstein College of Medicine, Montefiore University Hospital, New York, NY, USAUniversity of Naples “Federico II”, Naples, ItalyDepartment of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York, NY, USA Address Correspondence to: Gaetano Santulli, MD, PhD: gaetano.santulli@einsteinmed.edu, Albert Einstein College of Medicine, 1300 Morris Park Avenue, 10461 New York, NY, USA. https://orcid.org/0000-0001-7231-375X Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwad120, https://doi.org/10.1093/eurjpc/zwad120 Published: 18 April 2023 Article history Received: 15 January 2023 Revision received: 13 March 2023 Accepted: 17 April 2023 Published: 18 April 2023

Putting saturated fat in context-replacement and total intake matter.

The manuscript ‘Saturated Fat: Villain and Bogeyman in the Development of Cardiovascular Disease?’ was recently published in European Journal of Preventive Cardiology.1 Given the extraordinary importance of nutrition on health, we would like to contextualize this review and help avoid unnecessary public confusion. We agree with the authors that complexities exist in nutritional research. With regard to this specific review, it is important to consider what macronutrient may have replaced saturated fatty acids (SFA) in cited studies. Specifically, was SFA replaced with polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs), or healthful carbohydrates such as whole grains? Or was SFA replaced with refined grains, sugar, or harmful trans unsaturated fats? Many of the SFA studies and reviews cited by the authors did not account for replacement or were in the context of replacement with refined carbohydrates or trans fat. When replacement is accounted for, the adverse effects of SFA on cardiovascular outcomes are much more consistent. The authors actually report several meta-analyses of observational studies and clinical trials showing that replacing SFA with PUFA is associated with reduced risk of cardiovascular disease, even though they conclude these beneficial effects ‘remain elusive’. This was also demonstrated in a 2015 study of over 120 000 individuals showing that replacement of SFA with PUFA as well as MUFA or whole-grain carbohydrates was associated with improved cardiovascular outcomes, while replacement with refined carbohydrates or smaller amounts of trans fat was associated with no difference.2 Though this particular study accounted for replacement macronutrients and met all inclusion criteria for the authors’ review, it was not cited. The authors also failed to mention that several older studies supposedly vindicating SFA, such as the Sydney Diet Heart Study from decades ago, included PUFA from vegetable oil products high in harmful trans fat. Fortunately, vegetable oils with artificial trans fat are now banned in most industrialized countries.

Letter to the Editor.

Journal Article Accepted manuscript Letter to the Editor Get access Giovanni Mario Pes, Giovanni Mario Pes Department of Medicine, Surgery and Pharmacy, University of Sassari, ITALY Search for other works by this author on: Oxford Academic Google Scholar Maria Pina Dore Maria Pina Dore Department of Medicine, Surgery and Pharmacy, University of Sassari, ITALY Corresponding Author: email mpdore@uniss.it https://orcid.org/0000-0001-7305-3531 Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwac276, https://doi.org/10.1093/eurjpc/zwac276 Published: 17 November 2022 Article history Received: 05 November 2022 Revision received: 14 November 2022 Accepted: 15 November 2022 Published: 17 November 2022

A Bibliometric Analysis of High-Intensity Interval Training in Cardiac Rehabilitation.

As global quality of life has improved, the risk factors for cardiovascular diseases have gradually increased in prevalence. People have consequently sought to improve their health through physical exercise. High-intensity interval training (HIIT) is a cardiac rehabilitation (CR) tool that has been of great interest for several years. However, its feasibility and safety remain controversial. This study aimed to explore hot research topics and new directions regarding the role of HIIT in CR and to describe the dynamic development of the field. We used the Web of Science Core Collection database to develop visualizations using CiteSpace software (v.6.1.R2). The number of articles published, institutional collaboration networks, author partnerships, and keyword co-occurrence and clustering were used to analyze the impact of HIIT on CR. Our results showed that Norway, Canada, and the United States were the most prominent contributors to this field. Articles by Nigam, A and Juneau, M had the highest number of citations. The Norwegian University of Science and Technology had performed the most in-depth research in this area. The European Journal of Preventive Cardiology had published the most articles. The United States had the highest number of publishing journals. Relevant issues focused on coronary artery disease, exercise capacity, heart failure, cardiorespiratory fitness, and physical activity. HIIT in heart transplantation may be at the forefront of research in this field and future studies should focus on this topic. HIIT-based CR can therefore improve the exercise capacity and quality of life of cardiovascular patients and improve patient compliance in a safe manner.

A short history of the European Association of Preventive Cardiology (EAPC).

The history of the EAPC is closely related to the history of the European Society of Cardiology (ESC). The ESC decided at the turn of the century to overcome the splitting into 27 topic related Working Groups with great differences in size and activities and to create a new organizational concept based on Associations, each having an official ESC scientific journal and an annual ESC connected congress. The European Association for Cardiovascular Prevention and Rehabilitation was built on the fundaments of epidemiology and prevention, exercise physiology, cardiac rehabilitation and sports cardiology. The official journal of the Association was launched in 2003 and the first EuroPRevent Congress was held in Athens in 2006. During the following years, the different interests of the founding working groups came closer together, which resulted in a name change of the Association into "European Association of Preventive Cardiology" and of the journal into "European Journal of Preventive Cardiology". The name change marked the migration of Preventive Cardiology to centre stage in the ESC. This document summarizes how and from where the EAPC started and where it stands now.

Do journals and corporate sponsors back certain views in topics where disagreement prevails?

The article focuses on scientific disagreement about the use of statin-related drugs in the prevention of cardiovascular events. The study forms part of an exploration of the broader principle of research polarization, foremost in medicine. The hypothesis is that statin-positive and statin-critical researchers publish in different committed central journals, and that they are financially supported by different dedicated corporate sources. Methodologically we use Web of Science (WoS) analytic tools to perform publication analysis of a time series covering 1998–2018 in three seven-year windows. For each window data is captured based on sets of known statin-positive and statin-critical articles and researchers, and their primary and secondary co-authors. Standard deviation is used as a focused normalization and visual instrument together with Spearman’s correlation coefficient in order to compare frequency distributions of statin-positive and critical journal and sponsor articles. Z-test p-values are used to assess the probability of error concerning the distributions.Findings at general topical level showed that a few journals consistently and significantly occupied top positions, 2 of which, American Journal of Cardiology and Circulation, published articles from both positions. Besides, Journal of the American College of Cardiology served as a major publisher of statin-positive research from 2005, as did European Heart Journal from 2012, replacing American Journal of Cardiology at the top. From 2012 Atherosclerosis and European Journal of Preventive Cardiology served as top-publishers of statin-critical articles. Two central US funding agencies, US Department of Health Human Services and National Institutes of Health (NIH), operated at general topical level across the time series, but the agencies played only a minor role in the divergent research positions. From 2005 statin-positive as well as statin-critical research was mainly sponsored by multinational pharmaceutical companies, predominantly Merck, AstraZeneca and Pfizer. In conclusion, the initial hypothesis about dedicated journals and sponsors was entirely substantiated at the general topical level and at the journal level of research disagreement, but not at sponsor level. Distinct dedicated journals were extracted separately from the 2 divergent statin positions. Since the WoS coverage of sponsor data 1998–2004 was sporadic sponsor data are analyzed from 2005. Only from 2012 the WoS sponsor coverage of the topic is consistently at 60%.

Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators.

This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.

How research on depression could now fundamentally change preventive cardiology.

How research on depression could now fundamentally change preventive cardiology Maximilian Andreas Storz Maximilian Andreas Storz Maximilian Andreas Storz, Peter-Goessler-Strasse 14, 72076 Tuebingen, Germany. Email: storzm815@gmail.com Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, 2047487320915804, https://doi.org/10.1177/2047487320915804 Published: 31 March 2020

The difference in referencing in Web of Science, Scopus, and Google Scholar.

AimsHow often a medical article is cited is important for many people because it is used to calculate different variables such as the h‐index and the journal impact factor. The aim of this analysis was to assess how the citation count varies between Web of Science (WoS), Scopus, and Google Scholar in the current literature.MethodsWe included the top 50 cited articles of four journals ESC Heart Failure; Journal of cachexia, sarcopenia and muscle; European Journal of Preventive Cardiology; and European Journal of Heart Failure in our analysis that were published between 1 January 2016 and 10 October 2019. We recorded the number of citations of these articles according to WoS, Scopus, and Google Scholar on 10 October 2019.ResultsThe top 50 articles in ESC Heart Failure were on average cited 12 (WoS), 13 (Scopus), and 17 times (Google Scholar); in Journal of cachexia, sarcopenia and muscle 37 (WoS), 43 (Scopus), and 60 times (Google Scholar); in European Journal of Preventive Cardiology 41 (WoS), 56 (Scopus), and 67 times (Google Scholar); and in European Journal of Heart Failure 76 (WoS), 108 (Scopus), and 230 times (Google Scholar). On average, the top 50 articles in all four journals were cited 41 (WoS), 52 (Scopus, 26% higher citations count than WoS, range 8–42% in the different journals), and 93 times (Google Scholar, 116% higher citation count than WoS, range 42–203%).ConclusionScopus and Google Scholar on average have a higher citation count than WoS, whereas the difference is much larger between Google Scholar and WoS.

ESC Heart Failure receives its first impact factor

ESC Heart Failure (ESC-HF) is an open access journal of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) that published its first issue in 2014, with the help of Wiley Publishing. The journal focuses on basic, clinical, and epidemiological heart failure research. Prof. Stefan D. Anker is Editor-in-Chief and Deputy Editors are Prof. Zoltán Papp (Basic Science) and Prof. Stephan von Haehling (Clinical). In the first year, ESC-HF published two issues, which further increased over time to currently six issues per year (2 in 2014, 4 in 2015/2016/2017, 6 in 2018, 6 expected in 2019). Of course, the number of articles published each year also increased during those years (16 in 2014, 39 in 2015, 38 in 2016, 92 in 2017, 147 in 2018, and 135 in the first 4 issues in 2019). In 2019 we expect to publish about 200 articles in ESC-HF, which is 12 times more than in the beginning year of the journal. We would therefore like to thank all publishing authors that have put their trust into our journal and decided to submit their work to ESC-HF for review. We would also like to thank all reviewers, statisticians, and associate editors, as well as the editorial board. Special thanks go to our editorial office – Monika Diek, Anja Janssen, and Corinna Denecke – without them it would not be possible to publish ESC-HF. Like every year, during summer Thomson Scientific published the new journal impact factors. In Europe and the USA, it is perceived as the most important measure for each journal. Not many people know how this impact factor is calculated: the number of citations of a journal X from the last 2 years are counted for the relevant year and then divided by the number of all original and review articles that were also published in the last 2 years. The formula for calculating the impact factor of journal X in 2018 is shown in Figure 1. This year, ESC-HF received its first impact factor of 3.407, which we think is a great accomplishment, reflecting the hard work everyone involved has put into the journal. If one looks at the best cited papers of the last 3 years, one can see continued interest into the published papers (Tables 1-3 1-75 according to Web of Science76). Of these articles, already 15 have been cited ≥10 times. Many of them are original articles, but also editorials, short communications and reviews are of great interest for the scientific community. In order to estimate how the impact factor of ESC-HF might develop, we compared it to the European Journal of Heart Failure (EJHF, 2018 impact factor 12.129) and European Journal of Preventive Cardiology (EJPC, 2018 impact factor 5.640). Both journals also belong to the ESC Journal Family and have continuously increased their impact factor over the last years (Figure 2). We expect that ESC-HF will equally increase its impact factor over the next years. Looking at the most cited articles of EJHF in the past 3 years, one can see that there is a very broad mix of papers that are of increased relevance to the scientific community: ESC guidelines, HFA practice guidelines, HFA position papers, trial designs, original, and review articles (Tables 4-6).77-151 In EJPC, the most cited articles in the past 3 years were predominatly original and review articles (Tables 7-9).152-226 In total, ESC-HF has published 467 articles so far, EJHF 3717 articles and EJPC 2726 articles. To further look into the best papers ever published in the three different journals, we compared the top 10 ever published papers of all three journals (Tables 10-12).1-3, 26, 27, 77-79, 152, 153, 227-246 The average number of citations of the top 10 cited papes in ESC-HF is 36.1, in EJHF 214.6, and in EJPC 167.7. The best paper so far in ESC-HF received 143 citations,226 in EJHF 624,75 and in EJPC 342.79 Therefore, one can see that all three journals are on a great path that will lead to further success. Conflict of interest: none declared. A full list of references is available at onlinelibrary.wiley.com/doi/10.1002/ejhf.1665.

European Journal of Preventive Cardiology.

European Journal of Preventive Cardiology.

Descriptive bibliometric analysis of global publications in lifestyle-based preventive cardiology.

Lifestyle-based preventive cardiology aims to combat the global burden of cardiovascular disease. There have been rapid advances in lifestyle and behavioural interventions aimed at preventing cardiovascular disease in individuals at high risk and in the general population. This study is the first bibliometric analysis of publications in the field of lifestyle-based preventive cardiology. Journal articles relating to lifestyle-based preventive cardiology published from 1996 to 2017 were retrieved from the Scopus database. The publications were limited to those in the English language. The data were indexed using bibliometric methodology and exported to Microsoft Excel for analysis. VOS viewer software was used to conduct co-occurrence and collaboration analysis between authors, institutions and countries. A total of 3300 publications were identified. The annual growth rate of publications increased globally during the study period. The USA made the highest contribution to global publications (1402) and total citation counts (68,540). Harvard Medical School was the most prolific institution and David Wood was the most prolific author in the field. The European Journal of Preventive Cardiology published the largest number of articles in this field. Obesity was the most common theme. The current growth trends predict a large increase in the number of global publications on lifestyle-based preventive cardiology. Further research could focus on smoking cessation, which at present is under-represented in lifestyle-based preventive cardiology output.

Fitness and strength in young adulthood and protection from future heart failure

We are in the midst of a heart failure (HF) pandemic with wide-ranging implications for aging populations, physicians, and healthcare delivery systems (1). The major epidemiologic determinants for HF have been traditionally viewed as hypertension, coronary artery disease, valvular disease, and more recently obesity, diabetes, and kidney disease (2,3). Among those with HF, approximately half have HF with reduced ejection fraction (HFrEF) and the other half with preserved ejection fraction (HFpEF). In this issue of the European Journal of Preventive Cardiology , Lindgren and co-workers report on a ray of hope in HF epidemiology (4). They describe a protective relationship between cardiopulmonary fitness as well as muscle strength and the development of HF at a relatively young age in all categories in which it can be accounted for using automated sources of data. This report is a major advance in the cardiopulmonary fitness literature, which has had a global interest in “survival of the fittest” which was a way of explaining the relationship between fitness and mortality (5). In brief, cardiopulmonary fitness has been associated with reduced mortality not only because of improved risk factors, and modest reductions in atherosclerotic events such as myocardial infarction, but because it markedly improves the survival of potentially fatal events such as critical illness.

Corrigendum.

Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation by Magri etal., European Journal of Preventive Cardiology 2015 22: 1046-1055, DOI: 10.1177/2047487314551546.

Five Tips for Writing Qualitative Research in High-Impact Journals

The recent ‘‘#BMJnoQual’’ debate around the British Medical Journal’s (BMJ) approach to publishing qualitative research studies raised unprecedented debate and concern among qualitative research communities internationally. The debate arose from a BMJ rejection letter, which stated that the journal did not prioritize publishing qualitative work because it receives ‘‘limited downloads’’ and thus this was not then a priority. When this rejection letter was shared on Twitter, a flurry of concerned responses followed (Bekker, 2015). A subsequent letter to the BMJ from over 75 concerned internationally known researchers, including Clark, called on the journal to recognize the value of qualitative research and publish it more, not less, regularly (Greenhalgh et al., 2016). This letter has now been viewed 32,000 times. The BMJ, in their own responses, both to this letter (BMJ Editors, 2016) and on social media (Bekker, 2015), initially indicated there would be no change. However, they subsequently modified their stance to indicate they will be formally calling for more qualitative methods and increasing their expertise in review (Loder, 2016). This is a welcome change. We entreat those seeking to widen access and increase awareness of their qualitative research to be even more determined to meet the challenge of making their work relevant and useful to readers of highimpact mainstream journals. We write as two cardiac researchers who have brought qualitative research to readers of mainstream journals in various forms: primary studies, large reviews, and editorials calling for qualitative work. This work has been published in journals in general medicine (BMJ, Lancet, International Journal of Clinical Practice), cardiology (Heart, Journal of the American College of Cardiology, American Heart Journal, European Journal of Heart Failure, European Journal of Preventive Cardiology, International Journal of Cardiology), rehabilitation (Clinical Rehabilitation), and nursing (Journal of Advanced Nursing, Nursing Outlook, International Journal of Nursing Studies). Although we have had rejections aplenty and periods of doubt and frustration, nevertheless it’s vital that the large readerships of higher impact mainstream journals less familiar with qualitative research read and use our research. We offer five considerations to help those writing qualitative research for mainstream journals to maximize their chances of publication success.

Tooth brushing for a longer and healthier life.

Patients with coronary artery disease (CAD) who have no teeth have nearly double the risk of death compared with CAD patients with all of their teeth, according to research performed at the Uppsala Clinical Research Center, Uppsala, Sweden, and published in the European Journal of Preventive Cardiology in December 2015 [1]. The study of 15,456 patients from 39 countries found that levels of tooth loss were linearly associated with increasing rates of death and stroke. In recent decades, periodontal disease has emerged as a potential risk factor for CAD. Already in 1993, De Stefano et al. showed that dental disease was associated with an increased risk of CAD [2]. Similar to CAD, periodontal disease is a widespread disease with chronic inflammatory properties, influenced by numerous risk factors, of which lifestyle, poor oral health habits, age, smoking, diabetes and socioeconomic status are the most significant ones [3–10]. In patients with type 1 diabetes, periodontal disease is an independent predictor of long-term progression of calcium deposits in the coronary arteries [11]. Recently, genetic evidence for plasminogen as a shared genetic risk factor of CAD and periodontitis was shown [12]. Periodontal disease is the main cause of tooth loss and is related to poor dental hygiene, being one of the strongest risk factors for the occurrence of periodontal disease. The study by Vedin et al. [1] is the first study to prospectively assess the relationship between tooth loss and outcomes in patients with CAD. The results are derived from a substudy of the STABILITY trial [13, 14], which evaluated the effects of the lipoprotein-associated phospholipase A2 (Lp-PLA2) inhibitor darapladib versus placebo in patients with CAD. At the start of the study all patients completed a questionnaire about lifestyle factors, psychosocial factors, and their number of teeth in five different categories: (26–32 i.e. considered to have all teeth, 20–25, 15–19, 1–14 teeth and no teeth). Patients were followed for an average of 3.7 years. Associations between tooth loss and outcomes were calculated after adjusting for cardiovascular risk factors and socioeconomic status. The primary outcome was major cardiovascular events being a composite of cardiovascular death, myocardial infarction and stroke. Patients who lost their teeth were older, smokers, female, less active and more likely to have diabetes, high blood pressure, more body fat and a lower level of education. During follow-up there were 1543 major cardiovascular events, 705 cardiovascular deaths, 1120 deaths from any cause and 301 strokes. After adjusting for cardiovascular risk factors and socioeconomic status, every increase in category of tooth loss was associated with a 6 % increased risk of major cardiovascular events, 17 % increased risk of cardiovascular death, 16 % increased risk of all-cause death and 14 % increased risk of stroke. After adjusting for risk factors and socioeconomic status, the group with no teeth had a 27 % increased risk of major cardiovascular events, 85 % increased risk of cardiovascular death, 81 % increased risk of all-cause death and 67 % increased risk of stroke compared with those with all of their teeth. The authors commented that the risk increase was linear with the highest risk in those with no remaining teeth. For example, the risks of cardiovascular death and all-cause death were almost double to those in patients with all teeth remaining. Coronary heart disease and periodontal disease share many risk factors such as smoking, unhealthy lifestyle and diabetes but after adjusting for these factors an apparently independent relationship between the two conditions was found. Many patients in the study had lost teeth: around 16 % of patients had no teeth and about 40 % were missing half of their teeth. Several mechanisms by which periodontal disease may impact CAD and cerebral strokes have been proposed, including detrimental effects on endothelial function, atherosclerosis progression and plaque stability [15, 16]. Systemic inflammation generated by periodontal disease has been suggested as a possible causative pathway based on observations of increased levels of inflammatory markers in patients with periodontal disease [17]. The inflammation from periodontal disease is thought to trigger the atherosclerotic process and may explain the associations observed in the present study. However, the associations between periodontal disease and CAD included several cardiovascular outcomes and were independent of multiple risk factors. Therefore, the possibility of residual confounding or influence by unmeasured causal factors cannot be excluded. During the study period 746 patients experienced a myocardial infarction. There was a numerically increased risk of myocardial infarctions for every increase in tooth loss. However, this finding was not significant after adjustment for risk factors and socioeconomic status. The occurrence of this phenomenon was not fully clear to the authors as they found strong associations with other cardiovascular outcomes including stroke. To summarise, in this large global cohort of patients with CAD, self-reported tooth loss predicted adverse cardiovascular outcomes and all-cause death independent of cardiovascular risk factors and socioeconomic status [1]. Every increased level of tooth loss was associated with a 6 % increased risk of major cardiovascular events, and an approximately 15 % higher risk of cardiovascular death, death from any cause and stroke. Overall, CAD patients with no teeth had nearly twice the risk of death to those patients with all of their teeth. The relationship between tooth loss and outcomes in CAD patients has not previously been evaluated in a prospective study. However, it is too premature to conclude that periodontal disease directly causes adverse events in CAD patients. According to the authors, tooth loss remains an easy and inexpensive way to identify patients at higher risk who need more intense dental instructions as poor dental hygiene remains one of the strongest risk factors for periodontal disease. As a result, one should intensively hang onto tooth brushing and flossing in order to live longer and healthier!

Depression Might Double Coronary Risk, Not Stroke

Depression significantly increased the risk of coronary heart disease in a large, long-term study. Data from the prospective cohort Whitehall II study showed that the presence of depressive symptoms on one or two occasions, identified by the 30-item General Health Questionnaire (GHQ-30), was associated with a 12% increase in CHD risk (hazard ratio, 1.12). However, if depressive symptoms were recorded at three or four assessment points, the risk of CHD risk doubled (HR, 2.06). In contrast, significant positive associations between depression and the development of stroke seen in the first 5 years of follow-up in the study (HR, 1.6) were not sustained in the long term (HR, 0.94 at 5-10 years' follow-up). A baseline survey and subsequent clinical examinations resulted in 10,308 men and women recruited from 1985 to 1988. Clinical examinations were undertaken every 5 years, with postal surveys in between, and included the GHQ-30. National databases were used to identify cases of fatal and nonfatal cardiovascular events and stroke. The mean age of participants at the first GHQ-30 measurement was 44 years, and was 61 years by the fourth assessment. The study was published in the European Journal of Preventive Cardiology (Eur. J. Prev. Cardiol. 2014;21[3]:340–46). It is not clear why depressive symptoms might be causally linked to CHD but not stroke. “European prevention guidelines refer to depression as a coronary risk factor,” noted lead author Eric Brunner, PhD, of University College London in a press release. “In our study, repeated episodes of depressive symptoms accounted for 10% of all CHD events in the study population.” “Whether or not the association is causal, supporting individuals to recover from chronic or repeated episodes of depression has merit, particularly if the individual is then better able to reduce any vascular risk – for example, by quitting smoking.” Paul Thompson, MD, a ­professor of medicine at the University of Connecticut, commented that this large study suggests, for the first time, that some vascular abnormality contributes to depression and not necessarily that depression is directly related to stroke. In contrast, the findings support what many have thought for years, that depression is a risk factor for heart disease. The investigators and Dr. Thompson said they had no conflict of interest to disclose.