Individual Risk Factors Research Articles

Association of Risk Factors of Acute Myocardial Infarction and Heart Blockage Among non-diabetic Patients in a Tertiary Care Hospital – An Observational Study

Introduction: Cardiovascular diseases (CVDs) are a leading cause of death in the world. In 2015, an estimated 442.7 million prevalent cases of CVD were present worldwide. Cardiovascular diseases account for more than 17 million deaths globally each year. Previous studies identified diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity and sedentary lifestyle as risk factors. Aim of the study: The aim of this study was to determine the risk factors for acute myocardial infarction associated with heart blockage among non-diabetic patients. Methods: This was an observational study conducted in the Department of Cardiology of Jashore Medical College Sadar Hospital, Jashore, Bangladesh during the period from April, 2021 to March, 2022. In this study, we included 120 non-diabetic patients who were diagnosed with myocardial infarction. Result: Mean age was 53.03±11.3 years & most of our patients were male. Among all patients, majority (65%) patients had >60% blockage, followed by 30(25%) patients had 40%-60% artery blockage, and <40% blockage was found in 10% patients. Hypertension, dyslipidemia & dyslipidemia with hypertension, age ≥60 years, family history of CHD, smoking, diabetes & obesity were individual risk factors of CHD among non-diabetic patients. The most common risk factors for heart blockage were age >45 years, high blood pressure, high LDL, unhealthy diet, and stressful life. Conclusion: In our study, we found hypertension, history of CHD, dyslipidemia, dyslipidemia with hypertension, stress, age ≥60 years, and obesity were individual risk factors for CHD. These elements work as crucial risk factors for myocardial infarction in non-diabetic patients. Risk factors like age >45 years, high blood pressure, high LDL, unhealthy diet, and stressful life were responsible for the highest heart blockage in myocardial infarction patients. J Inv Clin Cardiol 2023; 5(2): 38-44

Trajectories of physical activity among participants of six-month mobile app-based disease management program for cardiovascular risk: a group-based trajectory modelling approach

Abstract Background Mobile app-based health promotion is an emerging preventive intervention for cardiovascular disease that allows for the frequent and longitudinal monitoring of physical activity (PA). Previous studies exploring PA trajectories categorized participants in a limited number of follow-up assessments and did not consider dynamic nature with changes that occur over the intervention period. Purpose This study explored the trajectories of PA during mobile app-based disease management programs in adults with cardiovascular risk using group-based trajectory modelling (GBTM). Methods Participants who completed a six-month disease management program using a mobile app were enrolled. The program promoted behavioural changes for the management of cardiovascular risk factors in individuals with one or more of hypertension, diabetes, or dyslipidaemia. Daily step count was measured using a wrist-worn activity tracker (Fitbit devices). Each participant was encouraged to wear a tracker for the monitoring of exercise and physical activity. To analyse relatively physically inactive participants, we included those with baseline step count <8,000 steps/day. GBTM was conducted to identify distinct patterns of longitudinal step count changes of baseline, 3-22 weeks, and 24 weeks. Participants with PA measurements <4 time points were excluded. The baseline characteristics and indicators related to mobile app usage during the first two weeks were compared among the trajectory groups. Results A total of 1,760 participants were included in the analysis (age: median 55 years; 83.8% men; body mass index (BMI): median 27.0 kg/m²; baseline step count: median 6,118 steps/day). GBTM identified four step count trajectory groups: rapid increase (T1, rapid increase in the first three months; 5%), gradual increase (T2, gradual increase in the first three months; 24%), moderate activity (T3, maintained at around 7,000 steps/day; 45%), and physically inactive (T4, around 4,500 steps/day throughout the program; 26%) (Figure 1). The trajectory groups that showed increasing PA patterns were older (T1: median 57 years; T2: 55 years; T3: 55 years; T4: 54 years; p=0.040) with a lower baseline BMI (T1: median 26.6 kg/m²; T2: 26.4 kg/m²; T3: 27.0 kg/m²; T4: 27.7 kg/m²; p<0.001) and were predominantly men (T1: 89.5%; T2: 87.4%; T3: 82.8%; T4: 81.1%; p=0.028). PA increasing patterns were associated with a longer time of mobile app use (T1: median 8.5 min/day; T2: 5.5 min/day; T3: 5.5 min/day; T4: 4.9 min/day; p=0.012) and more login times (T1: median of daily average 3.9/day; T2: 3.0/day; T3: 3.1/day; T4: 2.9/day; p=0.003) during the first two weeks of the program. Conclusions GBTM showed that 30% of participants in the mobile app-based intervention showed significant PA improvement during the first 12 weeks. Results of this study suggest that the response to PA intervention may be associated with lifestyle prior to the program and willingness to use the mobile app.Figure 1.Step count trajectories

Complex versus non-complex, should we adjust the antiplatelet strategy to the type of percutaneous coronary intervention? Results from a real world PCI population

Abstract Background/introduction Personalized dual antiplatelet treatment (DAPT) using risk stratification is key to minimize bleeding- and ischemic events after percutaneous coronary intervention (PCI). Known ischemic risk factors include complex procedures which are integrated in the recommendation for extended DAPT in patients with additional ischemic risk factors. Purpose We aimed to provide insight whether a complex PCI (CPCI) should be regarded as an individual risk factor, regardless of other risk factors, to adjust the antiplatelet strategy. Also, we determined the effect of DAPT duration and choice of P2Y12 inhibitor on outcomes. Methods We included patients from the South East (Zuid Oost) Netherlands Heart Registry (ZON-HR) and excluded patients using oral anticoagulants. This PCI registry prospectively collects baseline-, procedural- and follow-up data including medication use and the intended DAPT duration. Patients were stratified to non-CPCI or CPCI comprising of bifurcation lesions with two stents, venagraft PCI, chronic total occlusion (CTO) or ≥ 60mm stent. Analyses were conducted using Cox regression analysis. Multivariate analysis was performed to adjust for risk factors and baseline differences. Results We included 3691 patients (842 CPCI). Table 1 demonstrates the baseline characteristics and DAPT strategy. CPCI was more often required in patients with a high ischemic risk profile based on the extensiveness of atherosclerosis and comorbidities. Non-CPCI patients more often underwent PCI for acute coronary syndrome. Outcomes are presented in table 2. Compared to non-CPCI, CPCI increased the risk of major adverse cardiac and cerebral events (MACCE) in the second half of the year as opposed to bleeding events, which more often occurred in the first months after CPCI, driven by access site bleedings (73% in CPCI versus 56% in non-CPCI, p=0.01). All-cause mortality was higher during the overall follow-up period after a CPCI compared to non-CPCI. These findings remain significant when corrected for additional risk factors in both groups. In patients with CPCI, treatment with ticagrelor or prasugrel strongly reduced MACCE between 6-12 months when compared to clopidogrel (multivariate HR: 0.28, 95% CI: 0.08-0.98), but did not influence bleeding events or all-cause mortality. No effect of extended DAPT was observed. Conclusions A CPCI is an important ischemic risk factor that could be used for risk stratification to guide antiplatelet strategy. Treatment with ticagrelor or prasugrel strongly diminished the risk of MACCE without increasing the bleeding risk in patients with a CPCI. As the risk of MACCE increases between 6-12 months after PCI while the risk of bleeding events diminishes in this period, extended DAPT from 6 to 12 months could also be considered to provide extended protection.Table 1.Table 2

Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort

Abstract Background Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland. Methods A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated. Results 2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population). Conclusions This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies. Key messages • The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors. • The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.

Supplemental Material for Preadolescent Individual, Familial, and Social Risk Factors Associated With Longitudinal Patterns of Adolescent Alcohol, Cannabis, and Other Illicit Drug Use in a Population-Representative Cohort

Supplemental Material for Preadolescent Individual, Familial, and Social Risk Factors Associated With Longitudinal Patterns of Adolescent Alcohol, Cannabis, and Other Illicit Drug Use in a Population-Representative Cohort

Effectiveness of contemporary risk stratification in patients with hypertrophic cardiomyopathy: a pilot study

Abstract Introduction Risk stratification and primary prevention of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) is a challenging discipline. When using current stratification systems, there is always a compromise between sensitivity and specificity. Objective In our pilot study, we sought to determine the incidence of SCD and the effectiveness of stratification systems, i.e., the ESC HCM Risk-SCD score and the system of individual major risk factors (RF) according to ACC/AHA in patients followed in an expert center. Methods Patients with HCM were risk-stratified and followed for 10 ± 8 years at the referral HCM center. Results Five hundred and five patients were stratified, and 71 (14%) were implanted with a cardioverter-defibrillator (ICD) based on risk stratification. ICD patients were stratified at age 39 ± 17 years, of which 26 (35%) were women, maximal left ventricular wall thickness (MLWT) was 23 ± 7 mm, and left atrial dimension (LA) 46 ± 7 mm. During follow-up, 12 (17%) patients had ≥ 1 appropriate ICD therapy at age 46 ± 19 years. Patients with ≥ 1 appropriate ICD therapy had an average 5-year ESC score of 1.8 ± 0.4% and an average ACC/AHA major RF of 1.4 ± 0.8, MLWT 25 ± 6 mm, LA 47 ± 7 mm. None of the ICD patients died of SCD. Five (7%) patients suffered from ICD complications, including 4 (6%) inappropriate shock, and one patient experienced infective endocarditis requiring system extraction. During follow-up, 118 (23%) patients died, of which 28 (6%) from HCM-related causes, 12 (2%) from stroke, 11 (2%) from advanced heart failure, one perioperatively (myectomy) and 4 (1%) patients died suddenly (SCD). The mean age of SCD patients at the time of stratification was 59 ± 14 years; all were male, MLWT 18 ± 5 mm, LA 49 ± 2 mm, mean ESC score 2.0 ± 0.9%, and three (75%) had no RF present according to ACC/AHA. The ESC HCM Risk-SCD score was markedly less sensitive (sensitivity 56%; 95% CI 21-86) but more specific (specificity 98%; 95% CI 96-99) than the ACC/AHA approach (sensitivity 77%; 95% CI 46-95; and specificity 71%; 95% CI 67-75) (Figure). Conclusion With current risk stratification, albeit imperfect, SCD is rare in HCM patients managed at an expert center.

Individual level risk factors associated with episodes of heat as recorded within primary care records: a time-stratified case-cross over study

Abstract Background A key recommended action outlined in Heat-Health Action Plans is to identify individuals at risk and deploy targeted interventions, however this is not routinely undertaken. A major contributing factor is a lack of understanding of individual-level risk factors to support an evidence-based approach to targeted prevention. Aim To use electronic health data to identify individual level characteristics associated with increased risk of mortality during heatwaves in England. Methods A time-stratified case-crossover analysis was undertaken of individual-level clinical and socio-environmental (SE) risk factors. Conditional logistic regression was used to characterise associations between temperature and the risk of death on hot days, with analysis stratified by potential risk modifying factors. Results Heat mortality risk was modified by a large range of chronic conditions, with cardio-respiratory, mental health and cognitive function conditions, diabetes and Parkinson’s, all increasing risk. Prescribed medications also increased odds of death during heatwaves. Heat mortality risk was modified by a range of SE determinants of health investigated, with ORs increasing with age; OR differences by sex, ethnicity and living arrangement; an increasing trend in ORs by alcohol intake and body mass index, excluding the obese-3 group. Results suggest the least deprived have the lowest OR and the most deprived have the highest. Conclusions This study has important implications for patient medication management during heat events, incorporating heat-risk considerations into other health policies. The results also provide important evidence on the role of disadvantage in driving the inequitable distribution of climate impacts, and the need for better socio-economic data sets linked to health records. The findings highlight the importance of incorporating an assessment of individual SE circumstances when prioritising patients at highest risk during heat events.

The Influence of GLP1 on Body Weight and Glycemic Management in Patients with Diabetes—A Scientometric Investigation and Visualization Study

Diabetes medications can affect weight and cardiovascular health. Some medications can aid in weight management, while others may lead to weight gain. Patients must be monitored and receive appropriate care to manage weight and prevent cardiovascular complications. Despite advancements in diabetes treatments that can influence weight and cardiovascular outcomes, ongoing research is necessary in this intricate field. Long-term effects, individual variations, and combination therapies are still subjects of uncertainty and ongoing investigation. The major objective of the research is to evaluate the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on body weight in diabetic patients through a scientometric assessment. Methodology: Research data were gathered from the Web of Science Core Collection (WoSCC) database by searching for the keywords “Body Weight”, dulaglutide, and semaglutide, identifying 60 relevant articles in the field. While there are advantages in managing diseases in which the cardiovascular system is implicated, there are also clinical considerations for personalized medicine and shared decision-making. The scientometric analysis of the articles revealed important insights into how dulaglutide and semaglutide impact weight management and their potential benefits for managing cardiovascular diseases in individuals with diabetes. Conclusions: Semaglutide shows superior outcomes compared to other commercially available GLP-1RAs, particularly in improving blood sugar control, lowering body weight, and addressing other cardio-metabolic risk factors in individuals with type 2 diabetes (T2DM). The findings suggest that GLP-1 RAs have the potential to provide cardiovascular protection by influencing various physiological factors such as blood pressure, pulse rate, glycated hemoglobin (HbA1c) levels, and the urinary albumin-to-creatinine ratio (RAC). The development and validation of the 4GI model provides a sophisticated tool for evaluating the complex interactions involved in diabetes treatments, offering insights into the mechanisms of action of various medications.

Predictive factors for lymph node metastasis in papillary thyroid cancer patients undergoing neck dissection: insights from a large cohort study

BackgroundThis study aimed to investigate the risk factors and metastatic patterns in papillary thyroid cancer (PTC) patients undergoing lymph node dissection, offering guidance for clinical practice.MethodsA total of 924 PTC patients who underwent thyroidectomy with central neck dissection (CND) or lateral neck dissection (LND) between January 2021 and November 2022 were included in the analysis. The study investigated the relationships between clinicopathological characteristics, lymph node metastasis, and various risk factor.ResultsAmong the 924 PTC patients, the cervical lymph node metastasis rate was 59.1% (546 patients). Of these patients, 381 had central neck metastasis (CNM, 41.2%), while the remaining 165 patients had lateral neck metastasis (LNM, 17.9%). Factors associated with increased risk of CNM and LNM included larger tumor diameter, presence of multiple tumors, and capsular invasion (p<0.05). Male sex, age <55 years, larger tumor diameter (>0.85 cm), multiple tumors, capsular invasion, and absence of Hashimoto’s disease were identified as independent risk factors for CNM (p<0.05), with an AUC value of 0.722. CNM, maximum diameter >1.15 cm, and multiple tumors were independent risk factors for LNM (p<0.05), with an AUC of 0.699.ConclusionThese findings suggest that tailored neck dissection based on individual risk factors is crucial, particularly in cases of suspected LNM with larger tumors, CNM, multiple tumors, and capsular invasion.

Genetic Risk Scores for the Clinical Rheumatologist.

The advent of genome-wide sequencing and large-scale genetic epidemiological studies has led to numerous opportunities for the application of genetics in clinical medicine. Leveraging this information toward the formation of clinically useful tools has been an ongoing research goal in this area. A genetic risk score (GRS) is a measure that attempts to estimate the cumulative contribution of established genetic risk factors toward an outcome of interest, taking into account the cumulative risk that each of these individual genetic risk factors conveys. The purpose of this perspective is to provide a systematic framework to evaluate a GRS for clinical application. Since the initial polygenic risk score methodology in 2007, there has been increasing GRS application across the medical literature. In rheumatology, this has included application to rheumatoid arthritis, gout, spondyloarthritis, lupus, and inflammatory arthritis. GRSs are particularly relevant to rheumatology, where common diseases have many complex genetic factors contributing to risk. Despite this, there is no widely accepted method for the critical application of a GRS, which can be a particular challenge for the clinical rheumatologist seeking to clinically apply GRSs. This review provides a framework by which the clinician may systematically evaluate a GRS. As genotyping becomes more accessible and cost-effective, it will become increasingly important to recognize the clinical applicability of GRSs and identify those of the highest utility for patient care. This framework for the evaluation of a GRS will also help ensure reliability among GRS research in rheumatology, thereby helping to advance the field.

Evaluating suicide prevention gatekeeper training designed to identify and support people from asylum-seeking and refugee backgrounds

BackgroundSuicide-related behaviours and individual risk factors for suicide differ between ethnicities and demonstrate additional variation based on voluntary and forced migration. People forcibly displaced by violence and conflict, such as those seeking asylum and refugees, are likely to face stressors that can increase suicide risk. Research into evidenced-based suicide prevention strategies among people from asylum-seeking and refugee backgrounds is scarce. However, early, contextually-appropriate, identification and intervention may be a promising way to facilitate support for people in these groups. This research proposes that a contextually-responsive gatekeeper training is an appropriate strategy to increase the identification and support for people from asylum-seeking and refugee backgrounds.MethodsThe present article relates to the statistical findings of a larger mixed-method study used to validate and refine a contextually-responsive gatekeeper training program. The qualitative results of this research will be published separately. The outcome measures – knowledge about suicide in multicultural contexts, attitudes towards suicide and prevention, and self-efficacy to intervene were measured quantitatively, adopting a similar pre- and post-training procedure used in previous training evaluations. Using Generalised Estimating Equations, statistical comparisons were made between three identical self-report surveys completed by participants across three consecutive time points – pre-training, immediately post-training, and three months following training completion – known in this investigation as time-point zero (T0), time-point one (T1), and time-point two (T2). Lastly, during the T2 follow-up, additional open-ended questions were included to understand which areas of training they feel prepared them effectively and how the program could have better prepared them to intervene.ResultsA total of 28 participants took part in the study. Quantitative analysis indicated the program’s capacity to exert a significant favourable and lasting influence on knowledge about suicide and self-efficacy to intervene. In addition, follow-up measurements suggest that the content delivered to participants transferred effectively into real-world suicide prevention behaviours.ConclusionsFindings suggest that tailored suicide prevention training can have a significant influence on knowledge about suicide in multicultural contexts, self-efficacy to intervene in a crisis, and that course content translates effectively into real-world suicide prevention behaviour. Modifying training practices, based on feedback from contextually-experienced attendees, appears to be a pivotal factor in promoting the support of people from asylum-seeking and refugee backgrounds.

Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Managing Crohn’s Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis

Background and Aims: Postoperative recurrence in Crohn’s disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn’s disease. Methods: A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn’s disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. Results: Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn’s disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. Conclusions: Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn’s disease.

Cardiovascular Risk Scores and Migraine Status

A previous cohort study in the US found that women with higher cardiovascular risk were more likely to have a history of migraine but less likely to have active migraine. Extrapolating these results to men and European individuals is crucial to understanding the complex association between migraine activity status and vascular health in other populations. To evaluate the association pattern between a cardiovascular risk score, the most recent European version of the Systematic Coronary Risk Evaluation 2 (SCORE2) risk estimation system, and migraine activity status in Dutch men and women. The prospective population-based Lifelines cohort consists of community-dwelling adults residing in the northern part of the Netherlands. Individuals with a terminal illness, incapacitated individuals, including those with a severe mental illness, or who were unable to visit their general practitioner or complete the questionnaires were excluded from participation within Lifelines. Participants whose data on the cardiovascular risk scores and migraine status were complete were included in the analysis. Data on baseline characteristics were collected between November 1, 2006, to December 31, 2014. Cross-sectional and follow-up analyses were conducted within the prospective cohort. Questionnaires were sent approximately every 1.5 to 2.5 years, and the last self-reported migraine assessment took place between October 1, 2019, and January 31, 2021. Data were analyzed from March 1, 2022, to August 16, 2024. The SCORE2 is a sex-specific European cardiovascular risk score that includes age, cholesterol levels, smoking status, diabetes, and systolic blood pressure. The primary outcome was the association pattern between cardiovascular risk scores and migraine activity status. SCORE2 risk scores were measured once at baseline; groups of the SCORE2 (<1.0%, 1.0% to <2.5%, 2.5% to <5.0%, 5.0% to <7.5%, 7.5% to <10.0%, and ≥10.0%) were created based on the sum of points of individual risk factors. Migraine activity status was assessed using self-reported questionnaires and classified as (1) prevalent (ie, migraine at baseline), (2) incident (ie, no migraine at baseline but migraine in ≥1 follow-up), and (3) none. To evaluate the influence of age, we conducted stratified analyses of the SCORE2 by age categories (<40, 40-49, and ≥50 years). The total study population consisted of 140 915 individuals at baseline with a mean (SD) age of 44.4 (12.7) years, of whom 58.5% were women. In total, 25 915 individuals (18.4% of the total population) had prevalent migraine and 2224 (1.9% of the 115 000 without prevalent migraine) had incident migraine. The odds of having prevalent and incident migraine, compared with individuals with a SCORE2 category of less than 1.0%, varied and decreased with increasing SCORE2 categories, with odds ratios (ORs) for prevalent migraine ranging from 0.93 (95% CI, 0.90-0.96) for a SCORE2 category of 1.0% to less than 2.5% to 0.43 (95% CI, 0.39-0.48) for a SCORE2 category of at least 10.0% and, for incident migraine, from 0.63 (95% CI, 0.57-0.69) for a SCORE2 category of 1.0% to less than 2.5% to 0.17 (95% CI, 0.10-0.27) for a SCORE2 category of at least 10.0%. A similar pattern was observed in both sexes but more profound in women. In women, ORs for prevalent migraine ranged from 1.21 (95% CI, 1.16-1.25) to 0.70 (95% CI, 0.58-0.83) (vs 1.19 [95% CI, 1.09-1.29] to 0.84 [95% CI, 0.72-0.99] in men) and, for incident migraine, 0.72 (95% CI, 0.64-0.80) to 0.20 (95% CI, 0.07-0.43) (vs 1.18 [95% CI, 0.92-1.52] to 0.44 [95% CI, 0.22-0.78] in men). Models with incident migraine as the outcome showed lower ORs across the ascending cardiovascular risk score categories. Age stratification suggested that the association between cardiovascular risk scores and migraine activity status were unlikely to be strongly influenced by age. In this cohort study of community-dwelling Dutch adults, the odds of having prevalent or incident migraine decreased with increasing cardiovascular risk score categories. These results support the hypothesis that a relatively healthy cardiovascular system increases the probability of having active or developing migraine in the future, especially among women. Sex differences might play a pathophysiological role in the association between migraine activity and vascular health.

Comparative Efficacy of Classic Versus Horizontal Incision Techniques in Skin-Reducing Mastectomy: A Single Center Retrospective Analysis.

Background: The reconstruction of large breasts carries a heightened risk profile. While skin-reducing mastectomy (SRM) techniques facilitate the correction of breast ptosis, they are frequently associated with a high incidence of vascular complications. This study compares two SRM techniques-the horizontal incision and the classic inverted T incision-by examining their clinical and surgical outcomes. Methods: We retrospectively analyzed data from 24 patients (30 breasts) who underwent SRM with immediate prosthetic reconstruction between 2019 and 2023 at the European Institute of Oncology in Milan, Italy. Our comparison focused on breast aesthetic outcome, reconstruction quality, complication rates (early and late), and patient satisfaction, utilizing the BREAST-Q questionnaire to gauge the latter. Results: Among the 24 patients included in the study, 16 (20 breasts) were treated with the inverted T technique, and 8 (10 breasts) with the horizontal incision approach. A higher overall complication rate was observed with the inverted T technique compared to the horizontal method, with early complications outnumbering late ones. The most common issues were recurrent seroma and skin necrosis leading to implant exposure. Notably, there were no cases of implant infection. Although the horizontal incision technique achieved slightly higher patient satisfaction scores, the difference was not statistically significant. Discussion: The inverted T and horizontal incision techniques each have unique benefits and drawbacks. Our findings indicate enhanced patient satisfaction and reduced complication rates with the horizontal incision technique. The selection of the technique should be customized based on the patient's individual risk factors, tissue quality, and preferences.

Gestational Diabetes : A Cross-Section of Factors and Complications in Mothers and Newborns in Southern Morocco

By way of introduction, the prevalence of gestational diabetes varies between 1% and 14%, in Morocco, a single study conducted in Dakhla in southern Morocco in 2019, estimates that the prevalence of GD is 7.7% in accordance with the recommendations of the American Diabetes Association, hence the need to explore the epidemiological profile in southern Morocco.  Methodology:- A cross-sectional descriptive analytical correlational epidemiological survey of 202 pregnant women during the period 2021-2022, conducted at the Dakhla regional hospital centre, which attempts to describe the individual, biological and gynecological-obstetric risk factors in pregnant women with gestational diabetes. As well as maternal and neonatal complications. The study also analyses the effect of hospital performance on the management of parturients.  Results:- The prevalence of GD is high in the age group [35,41] and over 42 years, mainly among illiterate. Several risk factors have been identified for GD : age, high preconceptional BMI, low level of education, polycystic syndrome, history of urinary infection, positive vaginal swab for Streptococcus B, and complications for mothers and newborns revolving around Dystocic delivery, macrosomia and hypoglycaemia in newborns. There is also retinopathy in premature babies due to candida albicans and early bacterial infection due to GSB in full- term newborns.

Innovative Biomedical Interventions for Cardiovascular Risk Reduction and Health Promotion: A Review Study

Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide, with increasing prevalence in both developed and developing regions. The complexity of CVD necessitates innovative approaches that combine biomedical research with clinical practice for effective prevention, diagnosis, and treatment. This chapter explores cutting-edge biomedical interventions to reduce cardiovascular risk and promote heart health. It focuses on recent advancements in biomarker identification, gene therapy, nanotechnology, and regenerative medicine, offering new strategies for early detection and targeted treatment of cardiovascular conditions. Additionally, the chapter highlights the role of precision medicine and personalized healthcare approaches in managing individual risk factors, including hypertension, dyslipidemia, and diabetes, while addressing lifestyle influences like nutrition and physical activity. Public health initiatives are also discussed, examining how biomedical research has contributed to the development of population-level interventions, such as community-based screening programs and digital health tools for monitoring cardiovascular health. By integrating biomedical innovation with preventive healthcare strategies, this chapter provides a comprehensive overview of the future directions in cardiovascular risk reduction, underscoring the importance of a multi-disciplinary approach for enhancing patient outcomes and promoting long-term cardiovascular wellness.

The interrelation of cardiometabolic risk factors and metabolic dysfunction-associated steatotic liver disease subtypes

Introduction. Metabolic dysfunction-associated steatotic liver disease is one of the leading causes of cirrhosis, liver cancer and extrahepatic complications. The number and various combinations of cardiometabolic risk factors, as well as the severity of liver steatosis, can affect the aggressiveness and prognosis of the disease. The article presents the results of own studies aimed at determining the prognostic significance of risk factors (individual and in different combinations) and steatometry.Objective. To determine the influence of individual cardiometabolic factors, their number and various combinations on the aggressiveness and prognosis of metabolic dysfunction-associated steatotic liver disease; to assess the prognostic value of steatometry for the disease.Material and methods. The examination results (steatometry, blood biochemistry tests, abdominal ultrasound) of patients diagnosed with metabolic dysfunction-associated steatotic liver disease were retrospectively analyzed. Statistical analysis: Student's t-test, Pearson's χ2-test, odds ratio, relative risk, Fisher's φ-test, ROC-analysis.Results. 146 patients were included. Cohort characteristics: average age 49.3 years, 84 men (57.5%). Aggressive forms (steatohepatitis, advanced steatosis) were associated with arterial hypertension, carbohydrate metabolism disorders (the most significant is insulin resistance), dyslipidemia, hyperuricemia. The severity of liver steatosis was less in patients who received therapy for lipid metabolism disorders comparing with those who didn’t. The presence of three or more cardiometabolic risk factors in a patient increased the risk of steatohepatitis and advanced steatosis. The combination of arterial hypertension and hyperuricemia significantly increased the risk of steatohepatitis. Advanced hepatic steatosis (≥310 dB/m2 by steatometry) was reliably associated with steatohepatitis.Conclusion. Individual risk factors, their number and combinations, contribute differently to the development of aggressive forms of the disease. Hyperuricemia should be considered as an additional cardiometabolic risk factor. Steatometry is capable of identifying advanced hepatic steatosis, being a risk factor for the development of steatohepatitis, which allows us to recommend it for the early diagnosis of metabolic dysfunction-associated steatotic liver disease.

The Presentation, Clinical Diagnosis, Risk Factors, and Management of Rapidly Progressive Hip Osteoarthritis: A Narrative Literature Review.

Rapidly progressive hip osteoarthritis (RPOH) is a rare and severe form of osteoarthritis (OA), marked by the rapid degeneration and destruction of the femoral head, often within months. Despite its unclear etiology, several factors such as subchondral fractures and immune responses have been proposed as possible contributors. This narrative review aims to synthesize current knowledge on the pathogenesis, risk factors, clinical presentation, imaging features, and grading systems of RPOH. Predominantly affecting elderly females, RPOH presents distinctive challenges in both diagnosis and management due to its abrupt onset and severity. Known risk factors include advanced age, female gender, obesity, intra-articular corticosteroids use, and long-term hemodialysis. Clinically, RPOH is characterized by severe pain during active weight-bearing movements, despite patients presenting a normal range of motion during passive examination in the early stages. While several classification systems exist, there is no universal standard, complicating differential diagnosis and clinical approaches. This review emphasizes the necessity for early diagnostic methods utilizing specific biomarkers, rapid differential diagnosis, and targeted, personalized interventions based on individual risk factors.

Do Personalized Nutrition Interventions Improve Dietary Intake and Risk Factors in Adults With Elevated Cardiovascular Disease Risk Factors? A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Dietary modifications can improve cardiovascular disease (CVD) risk factors. Personalized nutrition (PN) refers to individualized nutrition care based on genetic, phenotypic, medical, behavioral, and/or lifestyle characteristics. PN may be beneficial in improving CVD risk factors, including diet. However, this has not been reviewed previously. The aim was to evaluate the effectiveness of PN interventions on CVD risk factors and diet in adults at elevated CVD risk. Six databases were searched for randomized controlled trials published between 2000 and 2023 that tested the impact of PN interventions on CVD risk factors in people at elevated risk. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria checklist. Data synthesis of eligible articles included participant characteristics, intervention details, and change in primary CVD risk factor outcomes, including blood pressure (BP), plasma lipids, and CVD risk score, and secondary risk factors, including anthropometric outcomes and diet quality. Random-effects meta-analyses were conducted to explore weighted mean differences (WMDs) in change or final mean values for studies with comparable data (studies with dietary counseling interventions) for outcomes including BP, blood lipids, and anthropometric measurements. Of 7676 identified articles, 16 articles representing 15 studies met the inclusion criteria. Studies included between 40 and 563 participants and reported outcomes for CVD risk factors, including hyperlipidemia (n = 5), elevated BP (n = 3), overweight/obesity (n = 1), and multiple risk factors (n = 6). Risk of bias was low. Results suggested potential benefit of PN on systolic BP (WMD: -1.91; 95% CI: -3.51, -0.31 mmHg) and diastolic BP (WMD: -1.49; 95% CI: -2.39, -0.58 mmHg) and dietary intake in individuals at high CVD risk. Results were inconsistent for plasma lipid and anthropometric outcomes. Results were promising for PN interventions that used dietary counseling on CVD risk factors in at-risk individuals. However, further evidence for other personalization methods is required, including improving methodological quality and longer study duration in future PN interventions. OpenScience Framework (https://doi.org/10.17605/OSF.IO/SHVWP).