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Aims To identify robust circulating predictors for incident atrial fibrillation (AF) using classical regressions and machine learning (ML) techniques within a broad spectrum of candidate variables. Methods and results In pooled European community cohorts (n = 42 280 individuals), 14 routinely available biomarkers mirroring distinct pathophysiological pathways including lipids, inflammation, renal, and myocardium-specific markers (N-terminal pro B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI]) were examined in relation to incident AF using Cox regressions and distinct ML methods. Of 42 280 individuals (21 843 women [51.7%]; median [interquartile range, IQR] age, 52.2 [42.7, 62.0] years), 1496 (3.5%) developed AF during a median follow-up time of 5.7 years. In multivariable-adjusted Cox-regression analysis, NT-proBNP was the strongest circulating predictor of incident AF [hazard ratio (HR) per standard deviation (SD), 1.93 (95% CI, 1.82–2.04); P < 0.001]. Further, hsTnI [HR per SD, 1.18 (95% CI, 1.13–1.22); P < 0.001], cystatin C [HR per SD, 1.16 (95% CI, 1.10–1.23); P < 0.001], and C-reactive protein [HR per SD, 1.08 (95% CI, 1.02–1.14); P = 0.012] correlated positively with incident AF. Applying various ML techniques, a high inter-method consistency of selected candidate variables was observed. NT-proBNP was identified as the blood-based marker with the highest predictive value for incident AF. Relevant clinical predictors were age, the use of antihypertensive medication, and body mass index. Conclusion Using different variable selection procedures including ML methods, NT-proBNP consistently remained the strongest blood-based predictor of incident AF and ranked before classical cardiovascular risk factors. The clinical benefit of these findings for identifying at-risk individuals for targeted AF screening needs to be elucidated and tested prospectively. [ABSTRACT FROM AUTHOR]

Aims To evaluate the association of ultra-processed food (UPF) intake and mortality among individuals with history of cardiovascular disease (CVD) and analyse some biological pathways possibly relating UPF intake to death. Methods and results Longitudinal analysis on 1171 men and women (mean age: 67 ± 10 years) with history of CVD, recruited in the Moli-sani Study (2005–10, Italy) and followed for 10.6 years (median). Food intake was assessed using a food frequency questionnaire. UPF was defined using the NOVA classification according to degree of processing and categorized as quartiles of the ratio (%) between UPF (g/day) and total food consumed (g/day). The mediating effects of 18 inflammatory, metabolic, cardiovascular, and renal biomarkers were evaluated using a logistic regression model within a counterfactual framework. In multivariable-adjusted Cox analyses, higher intake of UPF (Q4, ≥11.3% of total food), as opposed to the lowest (Q1, UPF <4.7%), was associated with higher hazards of all-cause (hazard ratio [HR]: 1.38; 95% confidence interval (CI): 1.00–1.91) and CVD mortality (HR: 1.65; 95% CI: 1.07–2.55). A linear dose–response relationship of 1% increment in UPF intake with all-cause and CVD mortality was also observed. Altered levels of cystatin C explained 18.3% and 16.6% of the relation between UPF (1% increment in the diet) with all-cause and CVD mortality, respectively. Conclusion A diet rich in UPF is associated with increased hazards of all-cause and CVD mortality among individuals with prior cardiovascular events, possibly through an altered renal function. Elevated UPF intake represents a major public health concern in secondary CVD prevention. [ABSTRACT FROM AUTHOR]

We investigated the association of cumulative socioeconomic disadvantage (CSD) and socioeconomic status (SES) trajectories across the life course with the risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) and tested some biological mechanisms to explain such associations. Longitudinal analysis was conducted of 21,756 people without HF or AF who were recruited for the Moli-sani Study (2005–2010; Italy) and followed up for 8.2 years. CSD was computed using childhood SES, education, and adulthood SES indicators, and the same were used to define overall trajectories. A high level of disadvantage across the life course (CSD ≥ 8) was associated with increased risk of HF (hazard ratio (HR) = 2.58, 95% confidence interval (CI): 1.78, 3.74) or AF (HR = 1.57, 95% CI: 1.05, 2.33), as compared with lower CSD. All explanatory factors accounted for 18.5% and 24% of the excess of HF and AF risks, respectively, associated with CSD. For people with low childhood SES, advancements in education lowered their risk of HF (HR = 0.70, 95% CI: 0.48, 1.02) or AF (HR = 0.50, 95% CI: 0.28, 0.89), whereas achievements of adulthood SES were unlikely to contribute to disease reduction. In conclusion, a life-course–disadvantaged SES is an important predictor of first hospitalization for HF and AF; known risk factors partially explained the SES–disease gradient. Being in an upwardly mobile group is likely to mitigate the effect of poor childhood circumstances, especially through educational advancement. [ABSTRACT FROM AUTHOR]

Aims  There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts. Methods and results  In a community-based pooled cohort, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day. N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one drink (12 g) per day was 1.16, 95% CI 1.11–1.22, P < 0.001. Associations were similar across types of alcohol. In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF. Conclusions  In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention. [ABSTRACT FROM AUTHOR]

Background To evaluate the adherence to Mediterranean diet (MD) and its major socioeconomic and psychosocial determinants in a large sample of the Italian population, covering three main geographical areas of the Country (Southern, Central and Northern). Methods Data were obtained from the Italian Nutrition & Health Survey (INHES), including a total of 7, 430 participants (age >20) recruited from all over Italy (2010–13). Dietary information was collected by the European Food Propensity Questionnaire. Adherence to MD was assessed by using the MedDietScore based on 11 food groups. Associations were tested by multivariable logistic regression analysis (Odds ratio [OR] with 95% CI). Results Adherence to MD was higher in Southern Italy as compared with the Northern (OR = 1.34; 95% CI 1.18–1.53), and was closely associated with adult age (OR= 2.40; 1.61–3.58 for those aged > 75 years as compared with 20–34 years) and higher educational level (OR = 1.77; 1.40–2.24 for post-secondary education as opposed to lowest educational attainment). Subjects reporting adverse life events and those with family-related stress were less likely to show an optimal adherence to MD (OR = 0.55; 0.46–0.67 and OR = 0.44; 0.28–0.69, for highest vs. lowest tertile, respectively) as compared with adequate controls. A number of eating behaviours were also inversely associated with MD, such as consuming higher amount of alcohol in the weekend than in week days. Conclusions Adherence to MD is strongly determined by age, geographical area and educational level. Psychosocial factors and several eating behaviours are also closely associated. [ABSTRACT FROM AUTHOR]

Background There is lack of evidence about the likely impact of the economic crisis on dietary habits in Western societies. We aimed to assess dietary modifications that possibly occurred during the recession and to investigate major socioeconomic factors associated with such modifications. Methods Cross-sectional analysis on 1829 subjects from the general population recruited in the larger INHES study (n = 9319) a telephone-based survey on nutrition and health conducted in Italy from 2010 to 2013. Association of socioeconomic (education, household income, occupation) with self-reported impact of the economic crisis on dietary habits was tested by multivariable logistic regression analysis. Results Low-educated subjects (OR = 2.30; 95% CI: 1.39–3.80), those with poor income (OR = 5.71; 95% CI: 3.68–8.85), and unemployed (OR = 3.93; 95% CI: 1.62–9.56) had higher odds of reporting undesirable dietary changes due to recession. Adherence to the Mediterranean diet was lower in subjects reporting a negative impact of the crisis on diet as compared to those declaring no effect, whereas the quality of grocery items was higher in the latter. Conclusions Undesirable dietary changes due to the economic crisis were mainly reported by lower socioeconomic groups. Subjects perceiving a negative impact of the recession on their diet also showed a lower adherence to Mediterranean diet and reduced quality of grocery products. [ABSTRACT FROM AUTHOR]

: BackgroundTransforming growth factor-β1 (TGF-β1) has been demonstrated to be overexpressed in hypertension. Leptin, an adipocyte product, has been shown to play a role in obesity-related hypertension and in vitro studies demonstrated a biologic interaction between leptin and TGF-β1. Thus, we evaluate a possible in vivo association between TGF-β1, body mass index (BMI), and leptin circulating levels in hypertensive subjects.: MethodsBlood samples for fasting leptin and TGF-β1, were evaluated in 29 overweight, 46 obese, and 29 nonobese hypertensive patients before and after a 12-week calorie-restricted diet. Monocyte cultures were used for in vitro experiments.: ResultsTransforming growth factor-β1 was significantly elevated in hypertensive obese patients (n = 46) as compared with TGF-β1 levels of hypertensive patients with normal BMI (n = 29) (8. 9 ± 3 ng/mL v 4.4 ± 2; P < .001). The circulating levels of TGF-β1 were associated with BMI and leptin levels in an univariate analysis (r = 0.59, P < .0001; r = 0.62, P < .0001, respectively) and these associations were still present after stepwise multivariate analysis. Weight loss of 10% produced a parallel decrease in TGF-β1 (from 8.9 ± 3 ng/mL to 5.3 ± 2.8 ng/mL; P < .01) and leptin levels (from 30 ± 24 ng/mL to 17 ± 14; P < .05). In vitro experiments showed that leptin is able to induce a dose-dependent increase in TGF-β1 production and mRNA expression in human monocyte cultures.: ConclusionsOur data indicate that TGF-β1 levels are positively associated with BMI and leptin levels in hypertensive patients and suggest that adipose tissue may be an important determinant of TGF-β1 levels possibly by a leptin-dependent pathway. [Copyright &y& Elsevier]