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Liddle syndrome is an inherited form of arterial hypertension with autosomal dominant pattern of inheritance. It is caused by activating mutation of genes coding of the epithelial sodium channel in distal nephron. Mutation leads to excessive reabsorbtion of sodium ions and volume expansion resulting in arterial hypertension. Antoher typical laboratory findings are hypokalaemia, low levels of serum aldosteron and metabolic alkalosis. Phenotypic variability makes it difficult to identify patients with Liddle syndrome, often resulting in misdiagnosis and severe complications at early age. Genetic studies should be done to confirm the diagnosis. Therapy of Liddle syndrome is based on administration of epithelial sodium channel blocker amilorid.

The document was prepared by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (1). It presents practical and simple recommendations which are, however, important for accurate blood pressure measurement. Contrary to the majority of other guidelines, it does not assess level of evidence and classes of recommendations because many aspects of blood pressure measurement are based on usual clinical practice rather than on data from high-quality studies.

Patients with metastatic renal cell carcinoma (mRCC) are often elderly and have various comorbidities, including cardiovascular diseases. Although these patients have extensive co-exposure to targeted therapy and cardiovascular drugs, the impact of this co-exposure on outcomes for patients with mRCC remains unclear. Our objective was to evaluate the association between the use of cardiovascular medication and survival of patients with mRCC. The study included 343 consecutive patients with mRCC treated with sunitinib or pazopanib in the first line. Clinical data obtained from the Renal Cell Carcinoma Information System (RENIS) clinical registry and hospital information systems were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were compared according to the use of common medications, including antihypertensives (i.e., β-blockers [BBs], angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics), acetylsalicylic acid (aspirin), statins, and proton pump inhibitors. The univariate Cox analysis evaluating the impact of the assessed comedications on patient survival revealed that only BBs were significantly associated with PFS (hazard ratio [HR] 0.533, p

The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes.Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models.The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range.This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.

Background and aims: Matrix Gla protein (MGP) is a natural inhibitor of vascular calcification critically dependent on circulating vitamin K status. Growth differentiation factor 15 (GDF-15) is a regulatory cytokine mainly of the inflammatory and angiogenesis pathways, but potentially also involved in bone mineralization. We sought to determine whether these two circulating biomarkers jointly influenced morbidity and mortality risk in patients with chronic coronary heart disease (CHD).Methods and results: 894 patients >= 6 months after myocardial infarction and/or coronary revascularization at baseline were followed in a prospective study. All-cause and cardiovascular mortality, non-fatal cardiovascular events (myocardial infarction, stroke, any revascularization), and hospitalization for heart failure (HF) were followed as outcomes. Desphospho-uncarboxylated MGP (dp-ucMGP) was used as a biomarker of vitamin K status.Both, increased concentrations of dp-ucMGP (>= 884 pmol/L) and GDF-15 (>= 1339 pg/mL) were identified as independent predictors of 5-year all-cause or cardiovascular mortality. However, their coincidence further increased mortality risk. The highest risk was observed in patients with high dp-ucMGP plus high GDF-15, not only when compared with those with "normal" concentrations of both biomarkers [HR 5.51 (95% CI 2.91-10.44), p < 0.0001 and 6.79 (95% CI 3.06 -15.08), p < 0.0001 for all-cause and cardiovascular mortality, respectively], but even when compared with patients with only one factor increased. This pattern was less convincing with non-fatal cardiovascular events or hospitalization for HF.Conclusions: The individual coincidence of low vitamin K status (high dp-ucMGP) and high GDF15 expression predicts poor survival of stable CHD patients. (C) 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Aim: We analyzed the mortality risk of myocardial infarction (MI) patients according to renal function, observed during hospitalization. Materials & methods: Patients hospitalized for MI between 2006 and 2018 were followed (n = 5659). We divided the sample into four groups by estimated glomerular filtration (eGFR) [ml/min]: normal functions (lowest eGFR during hospitalization >60); transiently moderate insufficiency (lowest eGFR >30 and ≤60, highest >60); permanently moderate insufficiency (highest eGFR >30 and ≤60); severe insufficiency (highest and lowest eGFR ≤30). Results: Permanently moderate renal insufficiency indicates increased 5-years all-cause mortality (hazard risk ratio: 2.27 [95% CIs: 1.87–2.75], p Conclusion: Even just fluctuation of eGFR toward moderate insufficiency during hospitalization represents an important prognostic indicator in MI patients.

Stiffening of large arteries, clinically manifesting as increased aortic pulse wave velocity (PWV), is an inevitable outcome of aging. Among other mechanisms, impaired glucose metabolism plays an important role, leading to the deposition of advanced glycation end products (AGEs). This process is counterbalanced by the circulating soluble receptor for AGEs (sRAGE). We investigated the association between arterial stiffness on one side and multiple circulating biomarkers and the degree of skin deposition of AGEs on the other. In a cross-sectional design, 867 participants based on a general population sample (Czech post-MONICA studies) were examined. PWV was measured by SphygmoCor device (AtCor Medical Ltd.), while skin AGEs were measured using a dedicated autofluorescence method (AGE Reader mu®). To quantify the circulating status of AGEs, carboxymethyl lysine (CML) and sRAGE concentrations were assessed by ELISA, along with conventional glucose metabolism indicators. When analyzing the whole sample using multiple linear or logistic regression models and after adjustment for potential covariates, a significant association with PWV was found for fasting glycemia, HbA1c, sRAGE, skin AGEs, and the skin AGE-to-sRAGE ratio. Among these parameters, stepwise models identified the strongest association for the skin AGEs and AGE-to-sRAGE ratio, and this was also true when diabetic subjects were excluded. In contrast, neither CML nor its ratio relative to sRAGE showed any association with arterial stiffness. In conclusion, skin AGEs along with their ratio relative to sRAGE were closely associated with arterial stiffness and is a better indicator of the current status of deposited AGEs than other relevant factors.

Leptin 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.We 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].High 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.

Background Cardiovascular disease (CVD) followed by cancer are the two leading causes of death worldwide. SCORE charts have been recommended in Europe to identify individuals at increased CVD risk. However, the SCORE ability to identify individuals at increased risk of cancer has not yet been evaluated. The aim of this study was to determine the SCORE chart calibration in a country with changing CVD epidemiology, and its discrimination ability to identify individuals at increased risk of cancer over 20-years. Methods The present analysis includes data from two cross-sectional independent surveys within the Czech post-MONICA study (randomly selected representative population samples of the Czech Republic, aged 25–64 years); 3209 individuals in 1997/98 and 3612 in 2006–2009. Results The SCORE had reasonable discrimination to predict 10-year CVD mortality, but significantly overestimated the risk across all risk categories. During the 20-year follow up, high and very high-risk categories were associated with an increased risk of cancer morbidity (in particular colorectal, other gastrointestinal, lung and malignant skin) and cancer mortality, as compared to low risk category. Conclusions The present study shows that periodical calibration testing of SCORE charts is needed in countries with changing CVD epidemiology. Furthermore, we show that in middle-aged individuals, identified by SCORE charts as being at high or very high risk for CVD, cancer morbidity and cancer mortality is increased. Rigorous cancer screening may be appropriate in this group, especially in countries with falling CVD mortality, where relative proportion of cancer mortality is increasing.

Adiponectin has several beneficial properties, namely, on the level of glucose metabolism, but paradoxically, its high concentrations were associated with increased mortality. We aimed to clarify the impact of high serum adiponectin on mortality and morbidity in patients with stable coronary artery heart disease (CAD). A total of 973 patients after myocardial infarction and/or coronary revascularization were followed in a prospective cohort study. All-cause and cardiovascular (CV) death, non-fatal cardiovascular events, and hospitalizations for heart failure (HF) were registered as outcomes. High serum adiponectin levels (≥8.58 ng/ml, i. e., above median) were independently associated with increased risk of 5-year all-cause, CV mortality or HF [with HRR 1.57 (95% CI: 1.07–2.30), 1.74 (95% CI: 1.08–2.81) or 1.94 (95% CI: 1.20–3.12), respectively] when adjusted just for conventional risk factors. However, its significance disappeared if brain natriuretic peptide (BNP) was included in a regression model. In line with this, we observed strong collinearity of adiponectin and BNP. Additionally, major adverse cardiovascular event (i. e., CV death, non-fatal myocardial infarction or stroke, coronary revascularization) incidence risk was not associated with high adiponectin. In conclusion, the observed inverse association between adiponectin concentrations and mortality risk seems to be attributable to concomitantly increased BNP, rather than high adiponectin being a causal factor.

Supplemental Digital Content is available in the text., Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP (P

Východisko: Asymptomaticke osoby se zvýseným kardiovaskularnim rizikem představuji jednu z priorit kardiovaskularni prevence, v praxi ale casto opomijenou. Nasim cilem bylo objektivizovat, jak vysokorizikove osoby dosahuji lecebných cilů v primarni peci. Metoda: Analýza zahrnovala nahodný vzorek obecne populace, vysetřený v ramci populacniho průzkumu postMONICA v letech 2016-2017. Probandi byli kategorizovani podle sveho individualniho kardiovaskularniho rizika na zakladě principů 6. spolecných evropských doporuceni a porovnana byla jejich skutecna kontrola rizikoveho profilu s teoretickými doporucenými cili kardiovaskularni prevence. Výsledky: Celkem bylo do analýzy zařazeno 898 subjektů ve věku 25-75 let (47 % mužů). Mezi nimi, 16,7 % subjektů bylo klasifikovano do kategorie "velmi vysoke riziko", 36,8 % jako "vysoke riziko", zatimco zbylých 46,5 % jako jen mirně zvýsene nebo nizke celkove individualni riziko. Z hlediska adherence k doporuceným principům, ve skupině s "velmi vysokým rizikem" abstinovalo od tabaku v jakekoliv podobě jen 58,7 %, naležitou fyzickou aktivitu (≥ 150 min alespoň mirne aktivity týdně) nahlasilo 38 %, doporucenou tělesnou konstituci (BMI 20-25 kg/m2) vykazovalo 16,7 %, naležitý krevni tlak (< 140/90 mm Hg) 39,3 % a cilove hodnoty LDL-cholesterolu (< 1,8 mmol/l) dosahlo jen 8,7 % subjektů. V kategorii "vysokeho rizika" byla adherence k těmto cilům nasledujici: 83,9 % (abstinence od tabaku), 32,7 % (fyzicka aktivita), 17 % (tělesna konstituce), 58,2 % (krevni tlak) a 30,8 % (LDL-cholesterol < 2,5 mmol/l). Přijatelnějsi byla v obou rizikových kategoriich kontrola glukozoveho metabolismu (HbA1c < 53 mmol/mol u diabetiků), tj. 75 % a 81 %, respektive. Zavěr: Celkova adherence k doporuceným principům kardiovaskularni prevence vysokorizikových osob je v primarni peci velmi daleko od sveho optima a markantni je toto zejmena u subjektů s velmi vysokým rizikem

Advanced glycation end products (AGEs) are involved in several pathophysiologic processes in vascular diseases, including progressive loss of elasticity of the vessel wall (arterial stiffness). Circulating soluble receptors for AGEs (sRAGE) act as a decoy and counterbalanced the harmful properties of AGEs as the natural protective factor. We compared the role of circulating or skin-deposed AGEs and sRAGE regarding the natural course of arterial stiffening. In a prospective cohort study, we longitudinally followed 536 general population-based subjects (subsample of Czech post-MONICA study). Aortic pulse-wave velocity (PWV) was measured twice (at baseline and after ~8 years of follow-up) using a SphygmoCor device (AtCor Medical Ltd), and the intraindividual change in PWV per year (∆PWV/year) was calculated. Concentrations of sRAGE and carboxymethyl lysine (circulating AGEs) were assessed at the follow-up visit by ELISA, while skin AGEs were measured using the autofluorescence-based device AGE Reader. Using multiple regressions, we found significant association between ∆PWV/year as a dependent variable, and both, sRAGE and skin AGEs as independent ones (each on its own model). However, the closest associations to ∆PWV/year were found for the ratio of these two factors (skin AGEs/sRAGE) [β coeff = 0.0747 (SE 0.0189), p

Kardiovaskularni onemocněni (KVO) jsou hlavni přicinou umrti v Ceske republice. Pokles umrtnosti na KVO, který je u nas pozorovan od roku 1985, může být způsoben poklesem incidence nebo letality. Letalita onemocněni souvisi předevsim s urovni lecebne pece, zatimco incidence KVO je ovlivněna rizikovým profilem obyvatelstva. Cilem teto prace bylo zjistit prevalenci zakladnich rizikových faktorů u reprezentativniho vzorku ceske populace. Metodika: Byl proveden 1% nahodný výběr vzorku populace deviti okresů Ceske republiky ve věku 25-64 let. Vysetřeni sestavalo z vyplněni standardniho dotazniku, ziskani zakladnich antropometrických udajů, opakovaneho měřeni krevniho tlaku a odběru krve. Výsledky: V obdobi 2015-2018 bylo vysetřeno celkem 2 621 osob (1 250 mužů, průměrný věk 48,3 ± 10,9 roku a 1 371 žen, průměrný věk 47,7 ± 11,0 roku; p < 0,001); respondence 44,8 %. Průměrna hodnota indexu tělesne hmotnosti (BMI) u nami vysetřene populace cinila 29,1 ± 4,8 kg/m2 u mužů a 27,15 ± 6,1 kg/m2 u žen (p < 0,001). Obezita byla zjistěna u 37,3 % mužů a 28,2 % žen. Mezi vysetřenými muži 24,8 % uvedlo, že jsou pravidelnými kuřaky, zatimco kouřeni u žen bylo zjistěno u 21,6 % (p < 0,001). Nalezli jsme vysokou prevalenci hypertenze (48,6 % u mužů a 32,4 % u žen; p < 0,001); 74,3 % hypertoniků vi o svem onemocněni, 61,5 % je medikamentozně leceno a pouze 33,9 % dosahuje cilových hodnot krevniho tlaku < 140/90 mm Hg. Průměrna hodnota celkoveho cholesterolu u nami vysetřene populace byla teměř identicka pro muže i ženy (muži 5,26 ± 1,03 mmol/l; ženy 5,28 ± 1,00 mmol/l). Hypolipidemiky bylo leceno 13,9 % mužů a 10,2 % žen (p < 0,001). Diabetes byl zjistěn u 8,2 % mužů a 4,6 % žen (p < 0,001). Prevalence vsech zakladnich rizikových faktorů výrazně narůstala s věkem u obou pohlavi (p pro trend < 0,001). Zavěr: U reprezentativniho nahodně vybraneho vzorku ceske populace středniho věku byla nalezena vysoka prevalence zakladnich rizikových faktorů kardiovaskularnich onemocněni, ktere jsou přicinou stale vysoke mortality z kardiovaskularnich přicin v Ceske republice. © 2020, CKS.

Aim: We aimed to establish the association between sclerostin (a glycoprotein involved in bone metabolism) and development of pulse wave velocity (PWV) in the general population. Methods: A prospective cohort study with a total of 522 subjects. Aortic PWV was measured twice (at baseline and after approximately 8 years of follow-up) and intraindividual change in PWV per year (ΔPWV/year) was calculated. Results: ΔPWV/year increased across the sclerostin quintiles, but generally in a strong age-dependent manner. However, a significant independent positive association between sclerostin and ΔPWV/year was observed exclusively in C allele carriers of rs5186 polymorphism for the angiotensin II receptor 1 (n = 246). Conclusion: Sclerostin concentrations were associated with an accelerated natural course of arterial stiffening, but only in interaction with renin-angiotension system.

OBJECTIVE To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th–95th percentile interval, 1.3–12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension., Graphical Abstract Graphical Abstract

Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P

Supplemental Digital Content is available in the text., The prognostic implications of isolated diastolic hypertension (IDH), as defined by 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, have not been tested using ambulatory blood pressure (BP) monitor thresholds (ie, 24-hour mean systolic BP

Aim: We explored whether matrix Gla protein (MGP, natural calcification inhibitor) and sclerostin (glycoprotein responsible for osteoblast differentiation) interact in terms of mortality risk in coronary patients. Methods: 945 patients after myocardial infarction and/or coronary revascularization were followed in a prospective study. All-cause death, fatal or nonfatal cardiovascular events and heart failure hospitalizations were registered. Results: Either high desphospho-uncarboxylated MGP (dp-ucMGP) or high sclerostin were independently associated with 5-year all-cause/cardiovascular mortality. However, we observed an additional mortality risk in the coincidence of both factors. Concomitantly high dp-ucMGP (≥884 pmol/l) plus sclerostin (≥589 ng/l) were associated with increased all-cause mortality risk compared with ‘normal’ concentration s of both factors (HRR 3.71 [95% CI: 2.07–6.62, p

Background 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. Methods 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. Results 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)]. Conclusions 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.

Uvod: Sekundarni kardiovaskularni (KV) prevence po prodělanem infarktu myokardu (IM) je nemeně důležita než lecba akutniho IM. Lepsi KV prevence může rozhodujici měrou přispět k pokracovani pozitivnich trendů KV morbidity a mortality v Ceske republice v poslednich třech desetiletich. Cil: Stanovit, jak jsou do praxe implementovana nedavna evropska doporuceni pro sekundarni prevenci ischemicke choroby srdecni (ICHS) (2012). Metodika: Konsekutivně a retrospektivně bylo vybrano 624 pacientů, mužů a žen ve věku ≤ 80 let, hospitalizovaných pro akutni koronarni syndrom a/nebo chirurgickou ci katetrizacni koronarni revaskularizaci. Byl proveden rozbor chorobopisů a nasledně byli ambulantně vysetřeni respondenti, minimalně sest měsiců, maximalně dva roky po přijeti k hospitalizaci. Výsledky: Celkem bylo vysetřeno 406 respondentů. Z nich 20 % byli aktivni kuřaci, 44,8 % bylo obeznich (BMI ≥ 30), v pasmu nadvahy a obezity (BMI ≥ 25) bylo 85,5 % respondentů, centralně obeznich (obvod pasu ≥ 102 cm u mužů, ≥ 88 cm u žen) 70,2 %, doporucovane fyzicke aktivity (30 minut 5× týdně) nedosahlo 85 %. Krevni tlak zvýsený nad hodnoty požadovane v doporucenich kardiovaskularni prevence z roku 2012 (≥ 140/90 mm Hg, u diabetiků ≥ 140/80 mm Hg) mělo 55,1 % pacientů, zvýsený LDL-cholesterol (≥ 1,8 mmol/l) 63,5 % pacientů. Diabetes (znamý a nově diagnostikovaný) vykazovalo 41,2 % respondentů, prediabetes 23,4 %. Při použiti glukozoveho tolerancniho testu to bylo 44,7 %, respektive 32,3 %. V době naseho vysetřeni bylo 88,4 % pacientů leceno antiagregancii, 81,3 % beta-blokatorem, 78,8 % inhibitory angiotenzin konvertujiciho enzymu (ACEI) nebo antagonistou receptoru ATII, 92,1 % statinem, 92,9 % prodělalo koronarni revaskularizaci. Zavěr: Větsina pacientů v sekundarni prevenci ICHS ma nezdravý životni styl - nezdravou dietu a nedostatecnou pohybovou aktivitu. Prevalence nadvahy, obezity a diabetu je velmi vysoka, prevalence obezity a centralni obezity se dale zvýsila. Farmakoterapie je v sekundarni prevenci použivana u větsiny pacientů, ale doporucených hodnot krevniho tlaku, lipidoveho a glycidoveho metabolismu je dosahovano jen u mensiny.

Řada intervencnich studii prokazala, že pacienti s ischemickou chorobou srdecni (ICHS) maji užitek z agresivnějsiho sniženi LDL cholesterolu. Cilem teto analýzy bylo posoudit, nakolik se v průběhu poslednich deseti let změnila adherence k doporucene cilove hodnotě LDL cholesterolu a davkovaci zvyklosti u statinu v sekundarni prevenci ICHS obecně. Analyzovano bylo celkem 1 349 pacientů (21,7 % žen) o průměrnem věku 64,9 roku (směrodatna odchylka [SD] ± 9,0) po akutnim koronarnim syndromu a/nebo koronarni revaskularizaci, vysetřených ve třech nezavislých kohortach (ceska data z projektu EUROASPIRE III, IV a V). Globalni kontrola hypercholesterolemie se sice v průběhu sledovaneho obdobi výrazně zlepsila, avsak stale až 52 % pacientů v roce 2017 nedosahovalo doporucene cilove hodnoty LDL (< 1,8 ,mmol/l). Stejně tak preskripce statinu v nejvyssi davce (atorvastatin 80 mg ci ekvivalent) sice signifikantně vzrostla, stale vsak cinila pouze 23 % v kohortě z roku 2017. Na zakladě individualnich hodnot LDL jsme se dale pokusili odhadnout potencial eventualni intenzifikace hypolipidemicke lecby. Maximalni možna up-titrace statinu by vedla k vzestupu adherence k doporucene hodnotě o dalsich 12 %, zatimco po přidani ezetimibu by hodnoty LDL < 1,8 mmol/l mohlo teoreticky dosahovat až 73 % pacientů. ně, jakkoliv naprosta větsina pacientů s ICHS uživa statin, adherence k doporucene cilove hodnotě LDL zůstava hrubě nedostatecna. Maximalni up-titrace statinu a zejmena castějsi uživani kombinacni hypolipidemicke lecby by mohlo situaci zlepsit.

Background Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. Methods In 4,663 young (18–49 years) and 7,185 older adults (≥50 years), brachial PP was recorded over 24 hours. Total mortality and all major cardiovascular events (MACEs) combined were coprimary endpoints. Cardiovascular death, coronary events, and stroke were secondary endpoints. Results In young adults (median follow-up, 14.1 years; mean PP, 45.1 mm Hg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1,000 person-years. The adjusted hazard ratios expressed per 10-mm Hg PP increments were less than unity (P ≤ 0.027) for MACE (0.67; 95% confidence interval [CI], 0.47–0.96) and cardiovascular death (0.33; 95% CI, 0.11–0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mm Hg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1,000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P < 0.0001). The PP-related relative risks of death, MACE, and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. Conclusions From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality., Graphical Abstract Graphical Abstract

Supplemental Digital Content is available in the text., Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of

Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Our objective has been to establish reference values for major functional and structural parameters of retinal microcirculation in a randomly selected urban population sample. A total of 398 randomly selected individuals from an urban population aged 25 to 65 years, resident in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry (SLDF), with data evaluable in 343 patients. Of this number, complete data were available for 256 individuals free from manifest cardiovascular disease, diabetes and drug treatment for hypertension and/or dyslipidemia, constituting the reference value population. Juxtapapillary retinal capillary blood flow has increased significantly with age whereas vessel and luminal diameters have decreased. No sex differences in retinal microcirculation parameters have been found. Therefore, reference values for retinal microcirculation parameters have been established by age groups. Unattended automated office systolic BP, after adjusting for age, correlated significantly with wall-to-lumen ratio (WLR) and wall thickness (WT). Moreover, after adjusting for age and mean BP, a positive relationship has been found between carotid femoral pulse wave velocity and WT, WLR and wall cross-sectional area, indicating the interaction between micro- and macro-vasculature. In conclusion, our study is the first to provide reference values of retinal microcirculation parameters in a random Caucasian population sample. Our results have shown that, at the population level, the first structural changes in retinal microcirculation are those in lumen diameters. Of note, a close relationship between BP and vascular remodeling of retinal arterioles and between aortic stiffness and WLR of retinal arterioles suggests an interaction between micro- and macro-vasculature.

Our aim was to determine the serum uric acid (SUA) levels associated with an increased risk of cardiovascular (CV) and all-cause death in the general adult population. We analyzed data obtained in two independent cross-sectional surveys performed in the Czech Republic in 2006-09 and 2015-18, involving 1% population random samples in nine districts, aged 25-64 years, stratified by age and gender. Ten-year mortality data were obtained in a cohort with examination in 2006-09. Final analyses included 3542 individuals (48.2% men) examined in 2006-09, and 2304 (47.4% men) examined in 2015-18. From a cohort examined in 2006-09, 122 men and 60 women were reported dead (33% and 27% from CV disease). In men, there was no association of baseline SUA levels with baseline SCORE category or 10-year mortality rates. In women, each 10 µmol/L increase in baseline SUA levels was associated with an increase in baseline SCORE category (P < .001). Receiver operating characteristic curve analyses in women identified the baseline SUA cutoff values discriminating: 1. between low/intermediate and high/very high SCORE categories (309 µmol/L), 2. CV mortality (325 µmol/L), and 3. all-cause mortality (298 µmol/L). After adjusting for confounders including SCORE, Cox regression analysis confirmed that the baseline SUA cutoffs of 309 µmol/L and 325 µmol/L were associated with 4-times (P = .010) and 6-times (P = .036) greater risk of CV mortality, whereas the cutoff of 298 µmol/L was associated with 87% greater risk of all-cause mortality (P = .025). In conclusion, the SUA cutoff value of 309 µmol/L identified women at high/very high SCORE category and was associated with 4-times greater risk of observed CV mortality over 10 years.