Abstract Background Vitamin K is the essential co-factor for activation of matrix Gla-protein (MGP), the natural inhibitor of tissue calcification. Biologically inactive, desphospho-uncarboxylated ...MGP (dp-ucMGP) is a marker of vascular vitamin K status and is described to predict mortality in patients with heart failure and aortic stenosis. We hypothesized that increased dp-ucMGP might be associated with mortality risk in clinically stable patients with chronic vascular disease. Materials and methods We examined 799 patients (mean age 65.1 ± 9.3 years) who suffered from myocardial infarction, coronary revascularization or first ischemic stroke (pooled Czech samples of EUROASPIRE III and EUROASPIRE-stroke surveys), and followed them in a prospective cohort study. To estimate the 5-year all-cause and cardiovascular mortality we ascertained vital status and declared cause of death. Circulating dp-ucMGP and desphospho–carboxylated MGP (dp-cMGP) were measured by ELISA methods (IDS and VitaK). Results During a median follow-up of 2050 days (5.6 years) 159 patients died. In the fully adjusted multivariate Cox proportional hazard model, the patients in the highest quartile of dp-ucMGP (≥977 pmol/L) had higher risk of all-cause and cardiovascular 5-year mortality HRR 1.89 (95% CI, 1.32–2.72) and 1.88 (95% CI, 1.22–2.90), respectively. Corresponding HRR for dp-cMGP were 1.76 (95% CI, 1.18–2.61) and 1.79 (95% CI, 1.12–2.57). Conclusions In patients with overt vascular disease, circulating dp-ucMGP and dp-cMGP were independently associated with the risk of all-cause and cardiovascular mortality. Since published results are conflicting regarding the dp-cMGP, we propose only circulating dp-ucMGP as a potential biomarker for assessment of additive cardiovascular risk.
The purpose: To evaluate longitudinal trends in the prevalence of hyperuricaemia and chronic kidney disease (CKD) in Czech adults with and without arterial hypertension (HT).
Materials and methods: ...Two independent cross-sectional surveys were performed in 2006-2009 and 2015-2018, each screening involving 1% population random sample of the general population of nine districts of the Czech Republic aged 25-64 years, stratified by age and gender. Hyperuricaemia was defined as serum uric acid ≥ 420 μmol/l in men, and ≥ 360 μmol/l in women. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m
2
and/or albumin/creatinine ratio ≥ 3 mg/mmol.
Results: Final analyses included 3504 individuals examined in 2006-2009, and 2309 in 2015-2018. The overall prevalence of hyperuricaemia increased from 16.4% to 25.2% in men (p < 0.001), and from 7.6% to 10.9% in women (p < 0.001), whereas the overall prevalence of CKD declined from 6.8% to 3.6% in men (p = 0.001), and from 7.6% to 4.8% in women (p < 0.001). There was no interaction between HT and hyperuricaemia in either gender; the increase in hyperuricaemia prevalence was observed both in hypertensive and normotensive adults and was accompanied by the increased prevalence of abdominal obesity. Contrarily, there was an interaction between HT and CKD in both men (p < 0.001) and women (p = 0.011); the CKD prevalence declined only in hypertensive individuals, specifically in those using antihypertensive medication and was accompanied by the increased use of renin-angiotensin-aldosterone system (RAS) inhibitors and calcium channel blockers (CCBs).
Conclusions: Over the period of 10 years, the overall prevalence of hyperuricaemia increased, while the prevalence of CKD decreased. An increase in the prevalence of hyperuricaemia was observed both in hypertensive and normotensive individuals and was accompanied by an increase in the prevalence of abdominal obesity. A decline in the prevalence of CKD was only observed in hypertensive individuals and was accompanied by the increased use of RAS inhibitors and CCBs.
The purpose of this study was to ascertain way in which conventional risk factors, readiness to modify behaviour and to comply with recommended medication, and the effect of this medication were ...associated with education in patients with established coronary heart disease (CHD).
The EUROASPIRE IV (EUROpean Action on Secondary Prevention by Intervention to Reduce Events) study was a cross-sectional survey undertaken in 24 European countries to ascertain how recommendations on secondary CHD prevention are being followed in clinical practice. Consecutive patients, men and women ≤80 years of age who had been hospitalized for an acute coronary syndrome or revascularization procedure, were identified retrospectively. Data were collected through an interview with examinations at least six months and no later than three years after hospitalization.
A total of 7937 patients (1934 (24.37%) women) were evaluated. Patients with primary education were older, with a larger proportion of women. Control of risk factors, as defined by Joint European Societies 4 and 5 guidelines, was significantly better with higher education for current smoking (p = 0.001), overweight and obesity (p = 0.047 and p = 0.029, respectively), low physical activity (p < 0.001) and low high-density lipoprotein (HDL)-cholesterol (p = 0.011) in men, and for obesity (p = 0.005), high blood pressure (p < 0.005 and p < 0.001), low physical activity (p = 0.001), diabetes (p < 0.001) and low HDL-cholesterol (p = 0.023) in women. Patients with primary and secondary education were more often treated with diuretics and antidiabetic drugs. Better control of hypertension was achieved in patients with higher education.
Particular risk communication and control are needed in secondary CHD prevention for patients with lower educational status.
BACKGROUND AND AIMSLeptin is an adipocyte-derived peptide involved in energy homeostasis and body weight regulation. The position of leptin in cardiovascular pathophysiology remains controversial. ...Some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as a neutral or even protective factor. We have explored whether high leptin affects the mortality and morbidity risk in patients with stable coronary heart disease. METHODS AND RESULTSWe followed 975 patients ≥6 months after myocardial infarction or coronary revascularization in a prospective study. All-cause or cardiovascular death, non-fatal cardiovascular events (recurrent myocardial infarction, stroke, or any revascularization), and hospitalizations for heart failure (HF) we used as outcomes. High serum leptin concentrations (≥18.9 ng/mL, i.e., 4th quartile) were associated with worse survival, as well as with a higher incidence of fatal vascular events or hospitalizations for HF. Even after full adjustment for potential covariates, high leptin remained to be associated with a significantly increased 5-years risk of all-cause death Hazard risk ratio (HRR) 2.10 (95%CIs:1.29-3.42), p < 0.003, CV death HRR 2.65 (95%CIs:1.48-4.74), p < 0.001, and HF hospitalization HRR 1.95 (95% CIs:1.11-3.44), p < 0.020. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced HRR 1.27 (95%CIs:0.76-2.13), p = 0.359. CONCLUSIONSHigh leptin concentration entails an increased risk of mortality, apparently driven by fatal CV events and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.
Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to ...mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD.
To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries.
Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years.
Countries' per capita income levels and world region; individuals' socioeconomic demographics.
Self-reported use of aspirin for secondary prevention of CVD.
The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% 95% CI, 7.6%-8.6%). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries.
Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.
Aortic stiffness is strongly related to age and mean arterial pressure (MAP). In the present analysis, we investigated whether antihypertensive treatment modulates the association of the aortic pulse ...wave velocity (PWV) with age and with MAP in the general population. In the Czech post-MONICA cross-sectional study, we measured the PWV in 735 subjects (mean age 61.2±7.8 years, 54.1% women, 44.3% on antihypertensive medication). We used a linear regression model to assess the effect of treatment on the PWV. The independent covariates in our analysis included sex, age, MAP, heart rate, body mass index, plasma glucose, low-density lipoprotein cholesterol, smoking and observer. The patients receiving treatment were older (64.1±6.7 vs. 58.9±7.8 years), had higher systolic blood pressure (135.9±16.2 vs. 130.1±16.5 mm Hg) and had higher pulse wave velocity (9.1±2.2 vs. 8.2±2.1 m s(-1); P for all <0.0001) than untreated subjects. After adjustment for MAP, the use of treatment modified the association between age and the PWV (regression equations, treated patients 9.68-0.009 × age vs. untreated subjects 6.98+0.020 × age, difference of regression slopes, F=11.2; P=0.0009). In analyses adjusted for age, treatment was associated with a smaller increase of the PWV with MAP (treated patients 9.63-0.006 × MAP vs. untreated subjects 7.18+0.010 × MAP, F=10.70; P=0.0001). These results were driven primarily by subjects whose blood pressure was below 140/90 mm Hg. In the cross-sectional analysis from a random sample of the general population, antihypertensive treatment was associated with a less steep increase in the PWV with age and the mean arterial pressure. Further longitudinal studies are needed to confirm this finding.
It has been suggested that accumulation of advanced glycation end products (AGEs) is involved in several pathophysiological processes in the vessel wall. We hypothesized that low levels of the ...soluble receptor for AGEs (sRAGE) might be associated with increased arterial stiffness, a manifestation of vascular ageing in the general population. Using a cross-sectional design, we analyzed 1077 subjects from the Czech post-MONICA study. The aortic pulse wave velocity (aPWV) was measured using a Sphygmocor device. sRAGE concentrations were assessed in frozen samples using enzyme-linked immunosorbent assay methods (R&D Systems). aPWV significantly (P<0.0001) increased across the sRAGE quartiles. An aPWV of 1 m s(-1) was associated with a 37% increase in the risk of low sRAGE (<918 pg ml(-1), bottom quartile; P-value=0.018). In a categorized manner, subjects in the bottom sRAGE quartile had an odds ratio of an increased aPWV (⩾9.3 m s(-1)), adjusted for all potential confounders of 2.05 (95% confidence interval: 1.26-3.32; P=0.004), but this was only the case for non-diabetic hypertensive patients. In contrast, a low sRAGE was rejected as an independent predictor of an increased aPWV in normotensive or diabetic subjects using similar regression models. In conclusion, low circulating sRAGE was independently associated with increased arterial stiffness in a general population-based sample, but this was only observed in hypertensive non-diabetic patients.
Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades.
The purpose of this study was to determine what proportion of this CHD mortality ...decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments.
The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies.
Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively.
More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.
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