Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

In a U.S. postmarketing surveillance study, only 1 in 6 IVC filters were retrieved.

UniCamillus, oggi 99,6% dei piccoli trattato nel modo sbagliato

Objectives
To assess the prevalence and severity of paruresis (‘shy bladder syndrome’) in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.

Design
We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined ‘mild’ and ‘severe’ paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a ‘mild’ and ‘severe’ paruresis diagnosis.

Setting
We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.

Results
We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18–30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of ‘mild’ paruresis was 25.8% and of ‘severe’ paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19,

Circulation, Volume 150, Issue Suppl_1, Page A4128491-A4128491, November 12, 2024. Introduction:N-3 very-long-chain polyunsaturated fatty acids (VLCPUFA; C≥24), which are found primarily in retina and a few other select tissues, are known to play critical roles in specific biological systems. Although n-3 PUFA, such as eicosapentanoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3), may confer cardiovascular benefits, they did not improve age-related macular degeneration (AMD), a leading cause of blindness worldwide, in clinical trials. The activity of ELOVL fatty acid elongase 2 (ELOVL2), an enzyme that converts EPA into tetracosapentaenoic acid (TPA, C24:5 n-3), is known to decrease in the retina with age due to promoter methylation.Hypothesis:We hypothesized that dietary VLCPUFA may delay or prevent AMD, by bypassing the ELOVL2-mediated lipid elongation step. We also hypothesize that VLCPUFA may benefit cardiometabolic health like shorter-chain n-3 PUFA through similar mechanisms.Aims:We aimed to investigate the effect of dietary VLCPUFA on retinal function and cardiometabolic risk factors in mice.Methods:We have produced a new fish oil that contains ~40% (w/w) of C24-C28-rich VLCPUFA. We fed 9-month-old ApoE -/- mice with normal or VLCPUFA fortified diet (1% or 3% (w/w)) for 8 weeks, and age-matched C57BL/6J mice were used as control. We conducted electroretinography (ERG) and cognitive ability tests at the end of feeding period. Inin vitrostudies, we performed PPAR reporter assay and investigated the anti-inflammatory effects of TPA in lipopolysaccharide-stimulated RAW264.7 cells.Results:Supplementation of VLCPUFA showed a significant and dose-dependent improvement in ERG response. Like EPA and DHA, we also observed favorable cardiometabolic changes and decreased atherosclerotic plaque area due to dietary VLCPUFA. Intriguingly, VLCPUFA supplemented aging mice exhibit better cognitive performance compared with control. Transcriptome analysis revealed that VLCPUFA-enriched fish oil favorably regulated genes involved in nuclear receptor signaling pathways, lipid metabolism and inflammation. Furthermore, purified TPA potently activates PPARs, and suppressed inflammation in macrophage cells.Conclusions:Overall, our studies revealed for the first time several potential health benefits for our new VLCPUFA-enriched fish oil in several age-related diseases and support its future development as a new dietary supplement.

Circulation, Volume 150, Issue Suppl_1, Page A4140142-A4140142, November 12, 2024. Background:Cardiovascular-kidney metabolic (CKM) syndrome is exacerbated among individuals experiencing chronic exposure to both environmental and psychosocial stressors. Both neighborhood and individual-level stressors increase chronic inflammation resulting in worsened CKM factors, such as hypertension, diabetes, and dys/hyperlipidemia. However, associations between neighborhood perceptions (NP) and lipid profiles remain understudied. Therefore, we examined associations between NP domains and lipid profiles among African-American (AA) women with ≥Stage 1 CKM syndrome (overweight/obesity) residing in resource-limited neighborhoods within the Washington, DC area.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged physical activity (PA) intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using Nuclear Magnetic Resonance (NMR) spectroscopy. Factor analysis of overall NP identified four perception sub-scores: disorder, social cohesion, violence, and safety (higher score=favorable perception). Associations between NP domains and lipoprotein particles were analyzed using multivariable regression adjusting for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:Participants (n=169) had mean age=57.16 ± 12.00 and BMI 35.99 ± 6.57. Perceptions of safety were positively associated with LDL concentrations (LDLc) and large LDL particles (L-LDLp) (β=4.70 [SD=2.41], p=0.05, β= 43.75 [17.70], p= 0.01), respectively). Perceptions about neighborhood violence were positively associated with L-LDLp (marginally) and very-low-density lipoprotein size (VLDLz) (β= 7.10 [3.96], p=0.08, β= 0.31 [0.14], p= 0.02, respectively). No associations were found between disorder and social cohesion with lipid biomarkers.Conclusions:After adjusting for BMI, ASCVD risk, and lipid-lowering therapy, there were significant associations between neighborhood perceptions of safety and violence with lipid profiles among AA women with CKM syndrome. Greater perceived safety was associated with higher LDLc and L-LDLp while more favorable perception about neighborhood violence was associated with higher L-LDLp. Future work should examine whether improving neighborhood resources and perceptions may improve CKM health among urban AA women.

Circulation, Volume 150, Issue Suppl_1, Page A4141461-A4141461, November 12, 2024. Introduction:Left atrial appendage occlusion (LAAO) is an effective method of stroke prevention in patients with atrial fibrillation (AF). However, peri-device leakage (PDL) and device related thrombus (DRT) are common limitations of LAAO. Notably, PDL is associated with an increased risk of thromboembolic events. In order to minimize DRT, the Watchman FLX Pro is coated with PVDF-HFP. We aim to minimize both DRT and PDL with our novel zonal coating application system (ZCAS). ZCAS integrates a two-part thromboresistant and endothelialization promoting coating onto LAAO devices (Figure 1). In order to determine the optimal coating for the endothelialization promoting zone of ZCAS, we validated coating candidates in an in vitro model of LAAO device endothelialization (Figure 2).Hypothesis:We hypothesized that polyethylene terephthalate (PET) mesh coated with collagen type IV, fibronectin + VEGF, or poly-L-lysine would improve endothelial cell viability and proliferation.Methods:Human umbilical vein endothelial cells (HUVEC) were cultured in DMEM/F12 supplemented with ATCC’s Endothelial Cell Growth Kit and antibiotics. For the cell viability and proliferation assay, HUVEC cells were cultured in DMEM/F12 supplemented with 2% FBS, 10 mM L-glutamine, and antibiotics. A 96 well plate with PET inserts was coated with three coating candidates. Each coating was applied in three concentrations ([1x], [10x], and [100x]) with triplicates for each concentration. The coatings included collagen type IV ([1x]: 1 ug/cm2), fibronectin ([1x]: 1 ug/cm2) + VEGF ([1x]: 10 ng/cm2), and poly-L-lysine ([1x]: 4 ug/cm2). An MTS assay was performed at 48 hours after plating to assess cell viability and proliferation.Results:MTS absorbance relative to the uncoated control (MTS absorbance coated well/MTS absorbance uncoated well) for collagen type IV at [1x], [10x], and [100x] was 0.81, 1.29, and 0.84 respectively (Table 1). Fibronectin + VEGF at [1x], [10x], and [100x] was 1.31, 1.62, and 0.96. Finally, poly-L-lysine at [1x], [10x], and [100x] was 0.69, 0.90, and 0.91 respectively.Conclusion(s):Among the coating candidates, fibronectin (1 ug/cm2) + VEGF (100 ng/cm2) had the greatest increase in cell viability and proliferation compared to the uncoated PET control. The significance of this finding lies in the potential for ZCAS to improve the endothelial seal between the LAAO device and LAA orifice, which may significantly reduce PDL post-implantation.

Circulation, Volume 150, Issue Suppl_1, Page A4143326-A4143326, November 12, 2024. Background:Digital health technologies can promote healthy lifestyle behaviors. They can help patients identify, treat, and self-care for chronic illnesses, promote healthy aging, and minimize disparities through primary prevention. However, there is limited research on the efficacy of these systems in promoting healthy eating and physical activity and improving clinical outcomes among older adults at risk for cardiovascular disease.Aims:This pilot study aimed to (1) evaluate the feasibility of the study protocol for indicators of process (e.g., recruitment, consent, retention rates, engagement), resources (e.g., participant adherence, data collection time), and program safety (e.g., number of adverse events); and (2) compare changes in eating patterns, physical activity, and clinical outcomes (weight, blood pressure, lipid profile, and hemoglobin A1C [HbA1C]) between participants randomized toGet FITvs.Get FIT+at baseline (pre-intervention) and 12 weeks (post-intervention).Methods:Fifty-four older adults (65.6 ± 5.8 years, 61% females, 61% married, 50% Asians, 6% Whites, 33% Hispanics, 11% Blacks) were randomized toGet FIT(n=24), which included one in-person behavioral counseling session on healthy eating and exercise, a participant handbook, an activity tracker (Fitbit Charge), and access to a nutrition app (MyFitnessPal) for 12 weeks, orGet Fit+(n=30), which included weekly personalized text messages to motivate and encourage participants to meet their weekly goals in addition to all the other components offered to participants inGet FIT.Results:All feasibility metrics were highly satisfactory, with consent and retention rates being 100% at 12 weeks. Both groups increased moderate to vigorous physical activity levels and decreased calorie intake over time. Participants inGet FIT+showed a 6% reduction in weight compared to less than 1% in theGet FIT group. All participants showed improvements in blood pressure levels, lipid profiles, and HbA1C, but improvements in HDL cholesterol and triglyceride levels were more prominent in theGet FIT+group.Conclusion:Our findings suggest that theGet FIT+intervention may help encourage healthy eating and physical activity among older adults while lowering their cardiometabolic risk. A large randomized clinical trial is needed to evaluate the efficacy of multicomponent digital health therapies in older adults at risk for cardiovascular disease.

Circulation, Volume 150, Issue Suppl_1, Page A4140394-A4140394, November 12, 2024. BACKGROUND:REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) was a multinational, double-blind trial that randomized 8,179 statin-treated patients with controlled low-density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 g daily or placebo. Randomization was stratified by established CV history (70.7%), or diabetes and other risk factors (29.3%).METHODS/RESULTS:We evaluated IPE in patients with CV history, further characterized as having a documented history of coronary artery disease (CAD), or not. Primary (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, nonfatal MI, nonfatal stroke) CV endpoints were evaluated. Of the 5,785 (70.7%) REDUCE-IT patients with established CV disease, 4,532 patients had a history of CAD (multi vessel CAD, prior MI, hospitalization for high-risk non-ST-segment elevation acute coronary syndrome) and 1,253 patients did not. IPE reduced primary and key secondary first and total (first plus recurrent) events in patients with and without a history of CAD. In patients with CAD, IPE demonstrated a 25% relative risk reduction in first (HR 0.75; 95% CI 0.66, 0.84;P

Circulation, Volume 150, Issue Suppl_1, Page A4139932-A4139932, November 12, 2024. Introduction:No interventions decrease the risk of developing pulmonary hypertension (PH). We hypothesize Glucagon-like peptide-1 receptor agonists (GLP-1) reduce risk of PH through salutary changes in metabolism, weight, and the pulmonary vasculature. We examined GLP-1 exposure and development of PH among pts with diabetes (DM) in a national healthcare system.Methods:Pulmonary artery systolic pressure (PASP) estimates were extracted from TTEs in the Veterans Affairs system. PH (primary outcome) was defined as PASP >35 mmHg. Individuals free of PH on or after 1/2007 (baseline) were followed through the development of PH, death, or censored on 12/2020. The primary exposure was GLP-1 prescription modeled as: 1) Baseline exposure 2) Time-updated exposure and 3) Cumulative days of exposure (among exposed). We used multivariable cox models adjusted for demographics, comorbidities, and clinical characteristics inTable 1.Results:We identified 147,619 patients with DM (63 years [IQR 59-67], 95% Male, 21% Black) with a baseline TTE free of PH. Median follow up was 4.5 years (2.3-7.3 IQR). Of these, 2,621 pts were exposed to GLP-1 at baseline and 5,699 pts after baseline. Median time on drug (among exposed) was 296 days (120-570 IQR). Characteristics of exposed vs unexposed at baseline are displayed inTable 1with Age-adjusted Kaplan Meier curve inFigure 1A. GLP-1 exposure associated with decreased risk of incident PH when modeled as baseline exposure (HR 0.76; 95% CI 0.67-0.87), time-varying exposure (HR 0.82; 95% CI 0.76-0.89), and time-varying exposure restricted to pts without baseline exposure (HR 0.85; 95% CI 0.78-0.94). Risk of PH decreased as days on GLP-1 increased (Figure 1B). At 90 days on drug, we observed decreased risk of PH (HR 0.94; 95%CI 0.92-0.96).Conclusions:GLP-1 exposure at baseline or de novo during follow up is associated with decreased incidence of PH in pts with DM. The benefit from GLP-1 starts near 90 days and increases with time on drug.

Circulation, Volume 150, Issue Suppl_1, Page A4119744-A4119744, November 12, 2024. Objective:To evaluate neuropsychological development in children with cyanotic and acyanotic congenital heart diseases (CHDs) after surgical treatment and analyze the risk factors.Methods:89 children who received follow-up in Fuwai Hospital after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into cyanotic CHDs group and acyanotic CHDs group. Neuropsychological development was assessed according to Pediatric-psychological mental test scale and statistical analysis was employed.Results:The acyanotic CHDs group achieved better distribution of development quotient than cyanotic CHDs group (p < 0.05) but worse than the normal control group (p = 0.004). The proportion in cyanotic CHDs group with developmental quotient below the moderate level was higher than that of the normal control group (p < 0.001), but there was no significant difference between the cyanotic CHDs group and acyanotic CHDs group (p = 0.055). Multivariate regression analysis indicated that for cyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower preoperative blood glucose level, lower BIS level, and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale (p < 0.05); for acyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower temperature during surgery and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale(p < 0.05).Conclusion:Distinct neuropsychological impairment could be present in children with cyanotic CHDs. Younger age at cardiac surgery, body mass, preoperative blood glucose level, BIS level during surgery, temperature during surgery and duration of tracheal intubation after surgery were perioperative factors that could influence long-time neuropsychological development in children with CHDs.

Circulation, Volume 150, Issue Suppl_1, Page A4144603-A4144603, November 12, 2024. Introduction:An early and accurate diagnosis of occlusion myocardial infarction (OMI) by an electrocardiogram (ECG) is critical for prompt catheterization lab activation (CLA) for primary percutaneous coronary intervention (PCI).Objective:To evaluate the predictive accuracy of a new mobile application, utilizing an artificial intelligence (AI) deep learning algorithm, for distinguishing cases of OMI from non-OMI among actual Emergency Department (ED) patients assessed for potential CLA.Methods: We conducted a retrospective analysis of adult patients assessed for potential CLA in the ED at Barnes Jewish Hospital, St. Louis, MO, from August 22, 2023 to April 6, 2024. Patients arriving post-cardiac arrest were excluded. The ECG obtained immediately prior to each CLA was re-analyzed using a mobile device application with the OMI ECG AI algorithm, known as the Queen of Hearts (QoH) model. Each ECG was then categorized as either OMI or non-OMI. Coronary angiograms were reviewed blinded to the ECG results.Results:Out of 102 CLAs, 57 patients were accepted for emergent coronary angiography. The QoH model predicted 54 patients (52.9%) as having an OMI. Patients predicted to have an OMI were more likely to be accepted for coronary angiography (94% vs. 17%), have primary PCI performed (85% vs. 2.1%), and have acute coronary thrombosis detected (74.1% vs. 0.0%) on coronary angiography compared to non-OMI patients. All 46 patients fulfilling STEMI ECG criteria were correctly identified as having an OMI. Two patients predicted to have OMI without STEMI ECG criteria were found to have acute coronary occlusion. Patients with OMI had higher peak high-sensitivity troponin values. Among the 55 patients predicted to have non-OMI, 41 of 45 (91.1%) were not accepted for emergent coronary angiography and 6 of 10 (60.0%) patients accepted for emergent coronary angiography did not have obstructive coronary artery disease.Conclusions:The AI-based QoH model was highly predictive of OMI confirmed at coronary angiography. Implementation of this model may help clinicians identify the risk of OMI in patients triggering a CLA, and utilization of the AI-model could have led to potential reduction of false-positive CLAs.

Circulation, Volume 150, Issue Suppl_1, Page A4147064-A4147064, November 12, 2024. Introduction:In recent years, genetic interactions with drugs have been demonstrated to alter drug metabolism. Efforts such as PharmGKB and the Clinical Pharmacogenomics Implementation Consortium (CPIC) have developed recommendations to alter the use of several commonly prescribed drugs based on patient genotype. However, most prescriptions are still given without pharmacogenomic testing.Objective:Demonstrate the real world implications of the use of pharmacogenomic testing through a retrospective study of clopidogrel prescriptions given without testing.Methods:We analyzed ~100K individuals with paired medical records and clinical grade exome sequencing data, from population health studies administered at multiple medical centers. We genotyped all individuals for CYP2C19 star alleles. We identified daily dosage of clopidogrel by processing the freetext prescription “sig” field with GPT-4. Then, we identified all instances of individuals with at least one prescription that is not in concordance with the CPIC clopidogrel use guidelines based on their CYP2C19 genotype (Bousman et al. 2023). We identified instances of thrombosis using a comprehensive codeset based on the medical records.Results:25% of individuals with a calculable daily dose of clopidogrel have a mismatch between the recommended clopidogrel dosage guideline based on their CYP2C19 genotype and their prescribed dose. 12% of these mismatched individuals are poor metabolizers (PM), who should not use clopidogrel at all. The remaining 88% are intermediate metabolizers (IM). PMs and IMs receiving clopidogrel are much more likely to experience thrombosis than other metabolizers. 25% of PMs experienced thrombosis after the initiation of clopidogrel, with 40% of these occurring in the first two months (vs normal metabolizers, binomial p-value = 0.001).Conclusions:As expected from a lack of testing and a high population frequency of pharmacogenomic variants, many patients are prescribed doses of clopidogrel that are too high given their subsequently derived pharmacogenomic information. There is at least a 38% excess of adverse events (as measured by thrombosis) in this group. At minimum, this testing could prevent 1 thrombosis event per every ~30 people prescribed clopidogrel, demonstrating tangible benefits of population-based pharmacogenomic testing.

Circulation, Volume 150, Issue Suppl_1, Page A4141367-A4141367, November 12, 2024. Background:Heart failure (HF) is a chronic condition with high morbidity and mortality rates, and is known to pose a significant burden on the healthcare system. Telemonitoring, an innovative approach using remote monitoring of patients’ health data, has emerged as a potential solution to enhance HF management and improve patient outcomes.Research Question:This systematic review investigates whether telemonitoring interventions improve heart failure outcomes compared to standard care.Aim:We aim to synthesize the current evidence on the impact of telemonitoring on all-cause mortality, cardiovascular mortality, heart failure-related hospitalization, and health-related quality of life in patients with heart failure.Methods:We conducted a thorough search of electronic databases, including PubMed, Cochrane Library, Google Scholar, and PLOS Medicine, to identify relevant randomized controlled trials (RCTs) and systematic reviews/meta-analyses (SRs/MAs) evaluating telemonitoring interventions in heart failure. Studies were selected based on pre-defined criteria. A review of the literature and risk of bias assessment was performed independently by four reviewers.Results:Out of 16,778 articles reviewed, eight were chosen for this study, comprising 3 SRs/MAs and 5 RCTs. The findings suggest that using telemonitoring interventions, such as structured telephone support, mobile health interventions, and medication support, significantly reduces deaths and hospitalizations in heart failure patients compared to standard care. Longer telemonitoring duration (≥12 months) significantly lowered hospitalization rates.Conclusions:This systematic review suggests that telemonitoring may be associated with improved heart failure outcomes, including reduced mortality and hospitalization rates. However, further research is needed to explore telemonitoring interventions’ long-term effects and cost-effectiveness in heart failure management.