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Cardiology Medical European Heart Journal - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>Adverse pregnancy outcomes (APOs) are recognized as significant female-specific risk factors for cardiovascular disease (CVD). A potential shared familial susceptibility between APOs and CVD has been proposed, but not thoroughly explored. This study employs a quasi-experimental family comparison design to investigate shared familial predisposition between APOs and CVD, by assessing risk of CVD in APO-exposed women and their APO-free sisters.<div class="boxTitle">Methods</div>Nationwide population-based cohort study encompassing primiparous women, without prior CVD, with registered singleton births in the Swedish Medical Birth Register between 1992 and 2019, grouped into: women with ≥1 APO (165 628), APO-free sisters (60 769), and unrelated APO-free comparator women (992 108). All study participants were followed longitudinally, through linkage with national health registers, from delivery until 2021, for primary endpoint major adverse cardiac events, and its individual components: ischaemic heart disease, heart failure, and cerebrovascular events.<div class="boxTitle">Results</div>Over a median follow-up of 14 years, APO-exposed women exhibited increased rates of CVDs compared with APO-free comparators. Adverse pregnancy outcome–free sisters exhibited elevated adjusted hazard ratios (aHRs) of major adverse cardiac event {aHR 1.39 [95% confidence interval (CI) 1.13–1.71]}, heart failure [aHR 1.65 (95% CI 1.14–2.39)], and cerebrovascular events [aHR 1.37 (1.04–1.72)] compared with the APO-free comparators, while no significant increase in ischaemic heart disease was observed. Within-family analysis revealed lower CVD rates in APO-free sisters compared with their APO-exposed counterparts, except for no significant difference in cerebrovascular events.<div class="boxTitle">Conclusions</div>Sisters of women with APOs face a moderately increased risk of CVD, suggesting a genetic and/or environmental influence on the association between APOs and CVDs. These findings underscore the need for evaluating the effectiveness of targeted preventive measures in women with APOs and their sisters.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>To identify the patterns of coffee drinking timing in the US population and evaluate their associations with all-cause and cause-specific mortality.<div class="boxTitle">Methods</div>This study included 40 725 adults from the National Health and Nutrition Examination Survey 1999–2018 who had complete information on dietary data and 1463 adults from the Women’s and Men’s Lifestyle Validation Study who had complete data on 7-day dietary record. Clustering analysis was used to identify patterns of coffee drinking timing.<div class="boxTitle">Results</div>In this observational study, two distinct patterns of coffee drinking timing [morning type (36% of participants) and all-day-type patterns (14% of participants)] were identified in the National Health and Nutrition Examination Survey and were validated in the Women’s and Men’s Lifestyle Validation Study. During a median (interquartile range) follow-up of 9.8 (9.1) years, a total of 4295 all-cause deaths, 1268 cardiovascular disease deaths, and 934 cancer deaths were recorded. After adjustment for caffeinated and decaffeinated coffee intake amounts, sleep hours, and other confounders, the morning-type pattern, rather than the all-day-type pattern, was significantly associated with lower risks of all-cause (hazard ratio: .84; 95% confidential interval: .74–.95) and cardiovascular disease-specific (hazard ratio: .69; 95% confidential interval: .55–.87) mortality as compared with non-coffee drinking. Coffee drinking timing significantly modified the association between coffee intake amounts and all-cause mortality (<span style="font-style:italic;">P</span>-interaction = .031); higher coffee intake amounts were significantly associated with a lower risk of all-cause mortality in participants with morning-type pattern but not in those with all-day-type pattern.<div class="boxTitle">Conclusions</div>Drinking coffee in the morning may be more strongly associated with a lower risk of mortality than drinking coffee later in the day.</span>
<span class="paragraphSection">Natural Science Foundation of China10.13039/50110000180981827806 and 621350028172202511802060Key R&D Project of Heilongjiang Province2022ZX06C07</span>
<span class="paragraphSection">National Natural Science Foundation of China10.13039/5011000018098220228662135002Natural Science Foundation of Heilongjiang Province10.13039/501100005046YQ2023H014</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>The increasing use of assisted reproductive technology (ART) has raised concerns regarding its long-term cardiovascular safety due to potential hormonal imbalances and pro-thrombotic states. This study aimed to assess the long-term cardiovascular risk associated with fertility treatments in women.<div class="boxTitle">Methods</div>Following PRISMA guidelines, a systematic review and meta-analysis was conducted in MEDLINE (via PubMed) from inception to January 2024. Randomized, cohort, or case-control studies were included if fulfilling the following criteria: the association between ART and the subsequent cardiovascular outcome was reported and adjusted for confounding factors (at least age); the presence of a control group; and minimum 1-year follow-up. Effect size (ES) estimates of the association between fertility therapy and subsequent cardiovascular disease were pooled using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with the <span style="font-style:italic;">I</span><sup>2</sup> index. This study is registered on PROSPERO (CRD42024505605).<div class="boxTitle">Results</div>Of the 7298 articles screened, 10 studies were included, encompassing 500 664 women undergoing ART and 36 395 240 controls. The analysis found no significant increase in the long-term risk of major adverse cardiovascular events [ES 1.04, 95% confidence interval (CI) 0.88–1.23, <span style="font-style:italic;">I</span><sup>2</sup> 87.61%, <span style="font-style:italic;">P</span> = .63], coronary heart disease (ES 0.88, 95% CI 0.71–1.10, <span style="font-style:italic;">I</span><sup>2</sup> 24.36%, <span style="font-style:italic;">P</span> = .26), stroke (ES 1.21, 95% CI 0.92–1.59, <span style="font-style:italic;">I</span><sup>2</sup> 70.40%, <span style="font-style:italic;">P</span> = .17), venous thromboembolism (ES 0.95, 95% CI 0.70–1.28, <span style="font-style:italic;">I</span><sup>2</sup> 49.13%, <span style="font-style:italic;">P</span> = .73), hypertension (ES 1.08, 95% CI 0.88–1.32, <span style="font-style:italic;">I</span><sup>2</sup> 94.63%, <span style="font-style:italic;">P</span> = .46), or diabetes (ES 1.03, 95% CI 0.86–1.22, <span style="font-style:italic;">I</span><sup>2</sup> 78.44%, <span style="font-style:italic;">P</span> = .77). Assisted reproductive technology was associated with a lower risk of heart failure (ES 0.75, 95% CI 0.60–0.94, <span style="font-style:italic;">I</span><sup>2</sup> 0.00%, <span style="font-style:italic;">P</span> = .01).<div class="boxTitle">Conclusions</div>Assisted reproductive technology use does not appear to be significantly associated with an increased long-term risk of cardiovascular diseases in women. While these findings suggest the cardiovascular safety of fertility treatments, further research is warranted.</span>
<span class="paragraphSection">Artificial intelligence (AI) is set to revolutionize cardiology, offering transformative advancements in diagnosis, treatment, and patient outcomes.<sup><a href="#ehae748-B1" class="reflinks">1</a></sup> However, the integration of AI into clinical practice must be approached with precision and caution to ensure that these technologies are trustworthy, evidence-based, and ultimately beneficial for patients. Recognizing this, the European Society of Cardiology (ESC) has recently established the Digital Cardiology and Artificial Intelligence (DCAI) Committee. This committee is dedicated to developing a comprehensive roadmap as illustrated in <span style="font-style:italic;">Figure 1</span> for the responsible implementation of AI in cardiology, ensuring the highest standards of patient care.</span>
<span class="paragraphSection">This is a correction to: Iacopo Olivotto, Cardiomyopathies Matter Initiative, on behalf of the, Family matters: health policies to tackle cardiomyopathies across Europe, <span style="font-style:italic;">European Heart Journal</span>, Volume 46, Issue 1, 1 January 2025, Pages 6–14, <a href="https://doi.org/10.1093/eurheartj/ehae419">https://doi.org/10.1093/eurheartj/ehae419</a></span>
<span class="paragraphSection"><strong>This commentary refers to ‘Lipid lowering for prevention of venous thromboembolism: a network meta-analysis’, by I.T. Farmakis <span style="font-style:italic;">et al.</span>, <a href="https://doi.org/10.1093/eurheartj/ehae361">https://doi.org/10.1093/eurheartj/ehae361</a> and the discussion piece ‘Why couldn’t lipid-lowering therapies of ezetimibe combined with statin further reduce the risk of venous thromboembolism?’, by L. Lv, <a href="https://doi.org/10.1093/eurheartj/ehae856">https://doi.org/10.1093/eurheartj/ehae856</a>.</strong></span>
<span class="paragraphSection"><strong>This commentary refers to ‘Lipid lowering for prevention of venous thromboembolism: a network meta-analysis’, by I.T. Farmakis <span style="font-style:italic;">et al.</span>, <a href="https://doi.org/10.1093/eurheartj/ehae361">https://doi.org/10.1093/eurheartj/ehae361</a> and the discussion piece ‘Understanding ezetimibe’s role in lipid lowering and its limited impact on venous thromboembolism risk’, by I.T. Farmakis <span style="font-style:italic;">et al</span>., <a href="https://doi.org/10.1093/eurheartj/ehae857">https://doi.org/10.1093/eurheartj/ehae857</a>.</strong></span>
<span class="paragraphSection">Bernhard Gerber of the University of Louvain (UCLouvain) takes over the role of editor-in-chief of the <span style="font-style:italic;">European Heart Journal Cardiovascular Imaging</span>, from Gerald Maurer in January 2024. Prof. Gerber is known for his expertise in non-invasive cardiovascular imaging covering all modalities and including echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging (<span style="font-style:italic;">Figure 1</span>).</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>Several studies have supported the role of innate immune system as a key factor in the sterile inflammation underlying the pathophysiology of atherosclerosis in mice. However, its involvement in humans remains unclear. This study aimed to explore the association between neutrophil count, and the intima-media thickness of common carotid arteries (IMT-CC), as well as the potential impact of long-term dietary interventions on these associations.<div class="boxTitle">Methods</div>A comprehensive analysis was conducted within the framework of the CORDIOPREV study, a long-term secondary prevention study involving dietary interventions with either a Mediterranean or a low-fat diet. The study evaluated the relationship between absolute neutrophil count and neutrophil-related ratios with IMT-CC at baseline and after 5 and 7 years of dietary intervention.<div class="boxTitle">Results</div>At baseline, patients in the highest tertile of neutrophil count had a higher IMT-CC and number of carotid plaques, when compared to lowest tertile (<span style="font-style:italic;">P</span> < .01 and <span style="font-style:italic;">P</span> < .05, respectively). Logistic regression analyses supported this association. Elevated neutrophil count, neutrophil-to-erythrocyte ratio, and neutrophil-to-HDL ratio were associated with an increased likelihood of having an IMT-CC >.9 mm {odds ratio (OR) 1.17 [95% confidence interval (CI) 1.04–1.35], OR 2.21 (95% CI 1.24–4.12), and OR 1.96 (95% CI 1.09–3.55), respectively}, after adjustment for all variables, which was corroborated by linear regression. Furthermore, a linear mixed-effect model analysis from a longitudinal analysis spanning 5 and 7 years revealed an increase in 1 unit of neutrophils/μl at these time points was associated with a mean increase of .004 (.002) mm in the IMT-CC (<span style="font-style:italic;">P</span> = .031) after adjustment for all variables. Interestingly, in patients exhibiting regression in IMT-CC after 7 years of follow-up, those following a Mediterranean diet showed a significant decrease in neutrophil count after 5 and 7 years (both with <span style="font-style:italic;">P</span> < .05), compared to baseline.<div class="boxTitle">Conclusions</div>These findings suggest that neutrophils may represent a promising target for preventing atherosclerosis. A Mediterranean diet could serve as an effective dietary strategy to reduce neutrophil levels and potentially slow the progression of atherosclerosis, offering a new neutrophil-reducing therapy concept. Further research is essential to gain deeper insights into the role of neutrophils in the pathophysiology of atherosclerotic cardiovascular disease in humans.</span>
<span class="paragraphSection"><strong>This comment refers to 'Inflammation, Cholesterol, Lipoprotein(a), and 30-Year Cardiovascular Outcomes in Women', published in</strong> <span style="font-style:italic;">The New England Journal of Medicine</span><strong>, <a href="https://doi.org/10.1056/NEJMoa2405182">https://doi.org/10.1056/NEJMoa2405182</a>.</strong></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and Aims</div>To improve upon the estimation of 10-year cardiovascular disease (CVD) event risk for individuals without prior CVD or diabetes mellitus in the Asia-Pacific region by systematic recalibration of the SCORE2 risk algorithm.<div class="boxTitle">Methods</div>The sex-specific and competing risk-adjusted SCORE2 algorithms were systematically recalibrated to reflect CVD incidence observed in four Asia-Pacific risk regions, defined according to country-level World Health Organization age- and sex-standardized CVD mortality rates. Using the same approach as applied for the original SCORE2 models, recalibration to each risk region was completed using expected CVD incidence and risk factor distributions from each region.<div class="boxTitle">Results</div>Risk region-specific CVD incidence was estimated using CVD mortality and incidence data on 8 405 574 individuals (556 421 CVD events). For external validation, data from 9 560 266 individuals without previous CVD or diabetes were analysed in 13 prospective studies from 12 countries (350 550 incident CVD events). The pooled C-index of the SCORE2 Asia-Pacific algorithms in the external validation datasets was .710 [95% confidence interval (CI) .677–.744]. Cohort-specific C-indices ranged from .605 (95% CI .597–.613) to .840 (95% CI .771–.909). Estimated CVD risk varied several-fold across Asia-Pacific risk regions. For example, the estimated 10-year CVD risk for a 50-year-old non-smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and high-density lipoprotein cholesterol of 1.3 mmol/L, ranged from 7% for men in low-risk countries to 14% for men in very-high-risk countries, and from 3% for women in low-risk countries to 13% for women in very-high-risk countries.<div class="boxTitle">Conclusions</div>The SCORE2 Asia-Pacific algorithms have been calibrated to estimate 10-year risk of CVD for apparently healthy people in Asia and Oceania, thereby enhancing the identification of individuals at higher risk of developing CVD across the Asia-Pacific region.</span>
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