Publications

Abstract Background The National Health Service in England “Long Term Plan” aims to prevent 150,000 strokes and myocardial infarctions over the next 10 years. To achieve this, resources are being allocated to improve early detection of conditions strongly associated with cardiovascular disease. This includes working towards people routinely knowing their “ABC” risk factors (“A”: atrial fibrillation (AF), “B': hypertension and “C”: high cholesterol) (1). Purpose The aims of this study were to: 1) determine the proportion of participants with “A”, “B”, and “C” criteria; and 2) to identify risk factors for patients fulfilling any of these criteria. Methods LIPIDOGRAM2015 was a nationwide cross-sectional survey for adults in Poland. Adults were recruited in 2015 and 2016 by 438 family physicians. For the ABC criteria, “A” was defined as AF identified in the medical records of the participant, “B” was defined as either systolic blood pressure greater than 140mmHg or diastolic blood pressure greater than 90mmHg or both, and “C” was defined as total cholesterol greater than 200mg/dL (5.17mmol/L). The scaled and centred dataset underwent principal component analysis using singular value decomposition to achieve dimensionality reduction. K-means clustering was used to stratify patients with Hartigan's rule being used to identify optimal K number (2–4). The p-value for statistical significance used in this study was p<0.01 unless otherwise specified. Results 13,724 patients were included in the study. 71.0% (n=9,747) of participants fulfilled the criteria for one or more of the “A”, “B” or “C” components (Fig. 1). 26 variables were used in this analysis with Principal Component Analysis showing 7 principal components explaining over 50% of the variance with 20 components explaining over 90%. K-means clustering was also performed, finding 39 separate clusters. Correlations and statistical significance tests showed a high degree of variability between variables. Participants with AF were older (mean (SD) 67.7 (9.5) vs 55.7 (13.7), p<0.0001), with higher prevalence of concomitant coronary heart disease (CHD) (OR 6.73, 95% CL 5.75, 7.87) and ischaemic stroke (OR 13.45, 95% CL 7.66, 23.6). Participants with hypertension were older (mean (SD) 60.1 (SD 12.4) vs 53.8 (14.0), p<0.0001), with a higher BMI (mean (SD) 29.9 (5.1) vs 27.5 (4.8), p<0.0001) and resting heart rate (mean (SD) 75.7 (10.7) vs 72.7 (8.9), p<0.0001), more likely to be male (OR 1.42, 95% CL 1.32, 1.53) and have diabetes (OR 1.61, 95% CL 1.46, 1.78). Participants with high cholesterol showed an inverse correlation with prevalence of both concomitant diabetes (OR 0.85, 95% CL 0.77, 0.94) and CHD (OR 0.85, 95% CL 0.76, 0.94) (Fig. 2). Conclusion Simple demographic and clinical variables could be used to guide targeted screening to increase population awareness of “ABC” status, allowing for a greater proportion of the population to be appropriately managed with cardiovascular prevention strategies. Funding Acknowledgement Type of funding sources: None. “ABC” Venn diagramCorrelogram and significance plot

In this population-based epidemiological cohort, the risk of developing AF was increased in women affected by frailty at baseline but not in men.

Plasminogen activator inhibitor type 1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) were also determined.Ischemic stroke, major bleeding, and mortality were recorded during a median follow-up of 53 months while on anticoagulation.Results: Plasma ] nM/mg protein) at baseline showed association with age (r = 0.36, p < 0.0001) and CHA2DS2-VASc ( p = 0.003) but not with type of AF.Plasma PC was correlated with CLT (r = 0.34, p < 0.0001), and weakly with Ks (r = -0.15,p = 0.024), but not with fibrinogen, PAI-1 or TAFI levels.Of note, AF patients with left ventricular ejection fraction <40% (n = 57, 23.5%) had 22.7% higher ( p = 0.005) PC levels and CLT prolonged by 10% ( p = 0.044).Ischemic cerebrovascular events were observed in 20 patients (1.9%/year) who had at baseline 36.4% higher PC, 6% reduced Ks, and 15% longer CLT (all p < 0.05), also after adjustment for age.PC did not differ in patients who experienced major bleeding or death compared with the remainder.Conclusion(s): Our findings suggest that protein carbonylation contributes to the formation of more compact fibrin clots and impaired fibrinolysis in AF, probably due to posttranslational modifications of fibrinogen.We are the first to show that enhanced protein carbonylation in AF patients increases the risk of ischemic cerebrovascular events during anticoagulation, which highlights the role of oxidative stress in thrombotic manifestations of AF.

In conclusion, in patients hospitalized with STEMI, COVID-19 infection was associated with increased mortality, LOS, and cost but during the pandemic year of 2020 there was a small trend for increased mortality for patients with a diagnosis of STEMI.

The effect of invasive treatment in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with associated frailty remains undefined. This retrospective cohort study aimed to compare the outcomes of invasive treatment with conservative management in this specific patient population. We used the Tianjin Health and Medical Big Data Superplatform, with data from 82 hospitals in Tianjin, China, from January 2010 to March 2024. Patients with NSTEMI were included and divided into a non-frailty group (Hospital Frailty Risk Score [HFRS] < 5) and a frailty group (HFRS ≥ 5). Propensity score matching (PSM) was employed to balance the covariates, and invasive treatment was compared with conservative management. The primary endpoint was major adverse cardiac events (MACE), defined as the composite endpoint of all-cause mortality and recurrent myocardial infarction (MI) within 3 years. There were 73,823 NSTEMI patients (median age 66; 32.6% female) included in the analysis: 26,522 patients were in the frailty group, and 47,301 patients were in the non-frailty group. Among NSTEMI patients with frailty, 14,414 patients (54.3%) underwent invasive treatment. Following PSM yielding 6,040 well-matched pairs, frail patients undergoing invasive treatment had a lower risk of recurrent MI (subdistribution hazard ratio [sHR], 0.681; 95% confidence interval [CI] 0.614-0.754; P < 0.001), all-cause mortality (adjusted hazard ratio [aHR], 0.447; 95% CI 0.410-0.488; P < 0.001) and MACE (aHR, 0.516; 95% CI 0.481-0.553; P < 0.001), compared to conservative management. Similar results for invasive treatment compared to conservative management were observed in NSTEMI patients without frailty. Regardless of whether patients had associated frailty or not, invasive treatment was related to a decreased risk of recurrent MI and all-cause mortality in NSTEMI patients, when compared to conservative management.

Ethics approval was granted by the Central Medical Ethic Committee of Chinese PLA General Hospital (approval no S2014-065-01). The (inter)national research presentations, peer-reviewed publications and media coverage of the research will be sued for dissemination of the results.