Epidemiologic studies consistently report a U-shaped curve relationship between the amount of alcohol consumption and cardiovascular disease, with consumption of ≥ three alcoholic drinks being ...associated with an increased risk. However, the cardioprotective effect of light and moderate alcohol consumption has been recently questioned. In the absence of a randomized trial confirming the cardioprotective effect of light or moderate alcohol consumption, an alternative method to prove the causality is Mendelian randomization using a genetic variant serving as a proxy for alcohol consumption. A Mendelian randomization analysis by Holmes et al. suggests that a reduction in alcohol intake is beneficial for cardiovascular health also in light to moderate drinkers. In a recent analysis of 83 prospective studies, alcohol consumption was roughly linearly associated with a higher risk of stroke, coronary heart disease excluding myocardial infarction, heart failure and risk of death from aortic aneurysm dissection. By contrast, increased alcohol consumption was associated with a lower risk of myocardial infarction. "Low-risk" alcohol consumption recommended by the National Institute of Public Health, Czech Republic, should not exceed 16 g of 100% ethanol/day for women and 24 g/day for men; at least two days a week should be alcohol free, and the dose of ethanol during binge drinking should not exceed 40 g. In practice, this means one standard drink daily for five days at most and two standard drinks at most when binge drinking. These amounts should be considered the highest acceptable limits, but alcohol consumption in general should be discouraged.
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IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
Hypertensive disorders in pregnancy (HDP), remain the leading cause of adverse maternal, fetal, and neonatal outcomes. Epidemiological factors, comorbidities, assisted reproduction techniques, ...placental disorders, and genetic predisposition determine the burden of the disease. The pathophysiological substrate and the clinical presentation of HDP are multifarious. The latter and the lack of well designed clinical trials in the field explain the absence of consensus on disease management among relevant international societies. Thus, the usual clinical management of HDP is largely empirical. The current position statement of the Working Group 'Hypertension in Women' of the European Society of Hypertension (ESH) aims to employ the current evidence for the management of HDP, discuss the recommendations made in the 2023 ESH guidelines for the management of hypertension, and shed light on controversial issues in the field to stimulate future research.
X-chromosomal genetic variants are understudied but can yield valuable insights into sexually dimorphic human traits and diseases. We performed a sex-stratified cross-ancestry X-chromosome-wide ...association meta-analysis of seven kidney-related traits (n = 908,697), identifying 23 loci genome-wide significantly associated with two of the traits: 7 for uric acid and 16 for estimated glomerular filtration rate (eGFR), including four novel eGFR loci containing the functionally plausible prioritized genes ACSL4, CLDN2, TSPAN6 and the female-specific DRP2. Further, we identified five novel sex-interactions, comprising male-specific effects at FAM9B and AR/EDA2R, and three sex-differential findings with larger genetic effect sizes in males at DCAF12L1 and MST4 and larger effect sizes in females at HPRT1. All prioritized genes in loci showing significant sex-interactions were located next to androgen response elements (ARE). Five ARE genes showed sex-differential expressions. This study contributes new insights into sex-dimorphisms of kidney traits along with new prioritized gene targets for further molecular research.
Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for ...cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information.
We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA).
The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico.
We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries.
US National Institutes of Health, UK Medical Research Council, Wellcome Trust.
Secondary prevention of atherosclerotic vascular diseases represents a cascade of procedures to reduce the risk of future fatal and non-fatal cardiovascular events. We sought to determine whether the ...expression of selected microRNAs influenced mortality of stable chronic cardiovascular patients.
The plasma concentrations of five selected microRNAs (miR-1, miR-19, miR-126, miR-133 and miR-223) were quantified in 826 patients (mean age 65.2 years) with stable vascular disease (6–36 months after acute coronary syndrome, coronary revascularization or first-ever ischemic stroke). All-cause and cardiovascular mortality rates were followed during our prospective study.
Low expression (bottom quartile) of all five miRNAs was associated with a significant increase in five-year all-cause death, even when adjusted for conventional risk factors, treatment, raised troponin I and brain natriuretic protein levels hazard risk ratios (HRRs) were as follows: miR-1, 1.65 (95% CI: 1.16–2.35); miR-19a, 2.27 (95% CI: 1.59–3.23); miR-126, 1.64 (95% CI: 1.15–2.33); miR-133a, 1.46 (95% CI: 1.01–2.12) and miR-223, 2.05 (95% CI: 1.45–2.91). Nearly similar results were found if using five-year cardiovascular mortality as the outcome. However, if entering all five miRNAs (along with other covariates) into a single regression model, only low miR-19a remained a significant mortality predictor; and only in patients with coronary artery disease 3.00 (95% CI: 1.77–5.08), but not in post-stroke patients 1.63 (95% CI: 0.94–2.86).
In stable chronic coronary artery disease patients, low miR-19a expression was associated with a substantial increase in mortality risk independently of other conventional cardiovascular risk factors.
•Circulating miRNA's estimation may improve risk prediction in coronary patients.•Low miR-19a expression indicated about 4× higher cardiovascular mortality risk.•This phenomenon reflects probably impaired reparation potential of cardiomyocytes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
OBJECTIVES:There is an ongoing controversy about the magnitude of the difference between unattended automated office blood pressure (AOBP) and conventional office blood pressure (BP). The aim of our ...study was to compare unattended AOBP with both auscultatory BP and oscillometric attended AOBP in an epidemiological setting.
METHODS:In 2588 participants of the Czech post-MoNItoring of CArdiovascular Disease study (a randomly selected 1% representative population sample aged 25–64 years, mean age 48 ± 11 years, 47.5% males), BP was measured using an AOBP device unattended, auscultatory mercury sphygmomanometer and an oscillometric attended AOBP device.
RESULTS:On average, auscultatory BP was 10.6/5.6 mmHg higher than unattended AOBP. Similarly, oscillometric attended AOBP was 9.9/3.4 mmHg higher than unattended AOBP, while the mean difference between attended oscillometric AOBP and auscultatory BP was 0.8/2.1 mmHg. Unattended systolic AOBP of 127 mmHg corresponded to SBP of 140 mmHg measured by a conventional sphygmomanometer. The prevalence of hypertension varied depending on the measurement technique and ranged from 31.5 to 40.1%. Reasonable agreement in hypertension diagnosis was observed with unattended AOBP cut-off at least 130/85 mmHg when compared with both auscultatory (McNemar P = 0.07, kappa 0.819) and attended oscillometric AOBP (McNemar P = 0.46, kappa 0.852) thresholds of at least 140/90 mmHg.
CONCLUSION:Unattended automated office SBP is on average 10 mmHg lower than the office auscultatory or attended AOBP values. In epidemiological settings, a threshold of unattended AOBP at least 130/85 mmHg should make comparison of hypertension prevalence possible with studies using auscultatory techniques and cut-off values of 140/90 mmHg.
OBJECTIVE:Manual office blood pressure (BP) is still recommended for diagnosing hypertension. However, its predictive value is decreased by errors in measurement technique and the white-coat effect. ...The errors can be eliminated by automated office BP (AOBP) measurement taking multiple readings with the participant resting quietly alone. Therefore, use of AOBP in clinical practice requires a threshold value for hypertension diagnosis. The aim of the present study was to determine an AOBP threshold corresponding to the 140/90 mmHg manual office BP using data from a large random population sample.
METHODS:In 2145 participants (mean age 47.3 ± 11.3 years) randomly selected from a Brno population aged 25–64 years, BP was measured using manual mercury and automated office sphygmomanometers.
RESULTS:Manual SBP (mean difference 6.39 ± 9.76 mmHg) and DBP (mean difference 2.50 ± 6.54 mmHg) were higher than the automated BP. According to polynomial regression, automated systole of 131.06 (95% confidence interval 130.43–131.70) and diastole of 85.43 (95% confidence interval 85.03–85.82) corresponded to the manual BP of 140/90 mmHg. Using this cut-off, the white-coat hypertension was present in 24% of participants with elevated manual BP, whereas 10% had masked hypertension and 11% masked uncontrolled hypertension. In individuals with masked uncontrolled hypertension, only AOBP was associated with the urinary albumin–creatinine ratio, whereas there was no association with manual BP.
CONCLUSION:AOBP of 131/85 mmHg corresponds to the manual BP of 140/90 mmHg. This value may be used as a threshold for diagnosing hypertension using AOBP. However, outcome-driven studies are required to confirm this threshold.
Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may ...represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals.
A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73).
There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals.
Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.
While determinants of aortic pulse wave velocity (aPWV) are well known, much less is known about factors affecting lower-extremity pulse wave velocity (lePWV). Unlike aPWV, increased lePWV does not ...predict cardiovascular risk, but limits lower-extremity blood flow and is associated with increased left ventricular mass. The aim of this study was to compare the effect of cardiovascular risk factors on aPWV and lePWV. A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, mean age 54±13.5 years, 47% men) were examined. Pulse wave velocity was measured using the SphygmoCor device. Aging had a large effect on aPWV, but only a small effect on lePWV. After adjustment for covariates, we observed that hypertension, diabetes, chronic kidney disease and dyslipidemia were positively and significantly associated with aPWV. However, only hypertension had a significant effect on lePWV. Increased ankle systolic blood pressure was associated with increased aPWV independently of brachial blood pressure. Ankle systolic blood pressure was more closely related to aPWV than lePWV. Subjects with an ankle-brachial index <1.0 had higher aPWV and lower lePWV compared with individuals with a normal ankle-brachial index. Lower-extremity arterial stiffness is affected by age and cardiovascular risk factors to a lesser extent than aortic stiffness. Increased ankle systolic blood pressure is linked not only to increased lower-extremity arterial stiffness, but also increased aortic stiffness. In subjects with a low ankle-brachial index, lower-extremity arterial stiffness is spuriously decreased.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ