Daily Cardiology Research Analysis

BACKGROUND: There is a scarcity of prospective data on the impact of available vaccinations against respiratory viruses on hard clinical endpoints in patients with heart failure (HF). AIMS: We investigated whether, in the population of high-risk HF patients, simultaneous vaccination against influenza and respiratory syncytial virus (RSV) improves outcomes during the subsequent infection season. METHODS: We conducted a prospective, randomized, single-centre, open-label study in which patients with high-risk HF were randomized 1:1 to simultaneous influenza and RSV vaccination or standard of care (SOC). The primary composite endpoint comprised all-cause death, HF hospitalization (HFH) or clinical signs/symptoms of infection within a 6 month follow-up period (regular structured telephone interview). Secondary endpoints were components of the composite primary endpoint. RESULTS: Two hundred twenty patients were randomized. During the follow-up period, the primary endpoint occurred in 59% of patients in the vaccination group versus 75% in the SOC group [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.48-0.92, P = 0.01]. Regarding the secondary endpoint analyses, during 6 month follow-up, 3% in the vaccination group died compared with 5% of patients in the SOC arm (HR 0.50, 95% CI 0.12 1.99, P = 0.32), and 18% versus 16% of study participants were hospitalized for HF in the two study arms, respectively (HR 0.86, 95% CI 0.45-1.62, P = 0.64). Infection occurred in 53% of vaccinated patients compared with 68% in SOC (HR 0.68, 95% CI 0.48-0.96, P = 0.03). CONCLUSIONS: In the population of high-risk HF, simultaneous vaccination against influenza and RSV reduced the incidence of the primary outcome. The effect was driven by a significant reduction in infections.

AIMS: Major adverse cardiovascular events (MACE) related to cardiovascular disease are a major cause of death in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the impact of MASLD on incident MACE and overall mortality in the general population in Germany. METHODS AND RESULTS: A total of 14 575 patients were included for the analysis. Elevated liver enzymes were present in 21.7% and MASLD, defined with a positive fatty liver index (FLI) in the absence of relevant alcohol use, was detected in 37% of participants. MACE were defined as a three-item composite endpoint of acute myocardial infarction (AMI), stroke and cardiovascular mortality (3-point MACE) and extended MACE (eMACE) including MACE criteria, incident atrial fibrillation and pulmonary embolism. In the group with a positive FLI (≥60) a higher rate of male sex and a higher age as well as a higher prevalence of metabolic and cardiovascular risk factors compared to the group with a negative FLI (<30) were present. At 5 years of follow-up, 475 patients (3.7%) developed 3-point MACE and 577 (4.9%) developed eMACE. In the subgroup with MASLD, the incidence of eMACE was higher (7.1% vs. 3.7%; p < 0.0001). Using Cox regression analysis with a stepwise adjustment strategy, we were able to show an independent prediction of MACE and eMACE by hepatic steatosis under consideration of various confounders. The presence of MASLD was associated with an increased risk of developing MACE by 62.3% (p < 0.0001) and eMACE by 44.0% (p < 0.0001). Importantly, MASLD was associated with an increased risk for all-cause mortality (hazard ratio 1.55; p < 0.0001). CONCLUSIONS: Metabolic dysfunction-associated steatotic liver disease is an independent risk factor for MACE and is associated with a significantly increased risk of all-cause mortality. In the management of patients with cardiovascular risk, identification of MASLD can potentially refine their disease trajectory.

BACKGROUND: The association of constipation with incident cardiovascular disease (CVD) has been suggested; however, there are few studies including general population and assessing whether constipation can improve the predictive performance for future CVD. OBJECTIVES: This study aims to quantify the association of constipation with the risk and attribution of developing CVD using a nationwide epidemiological database in Japan. METHODS: In 1,516,763 individuals without prior CVD from the DeSC database between April 2014 and November 2022, constipation was defined by International Classification of Diseases-10th revision code before the initial health checkup. We assessed the association of constipation with incident CVDs including myocardial infarction (MI), angina pectoris, stroke, heart failure (HF), atrial fibrillation (AF), and a composite of them using multivariable Cox models. RESULTS: Constipation was observed in 186,448 individuals (12.3%), showing a significant association with composite and each CVD, particularly with HF (HR: 1.30; 95% CI: 1.29-1.32 and HR: 1.32; 95% CI: 1.29-1.34, respectively). Followed by hypertension, constipation was the second highest population attributable fractions for the composite CVD, stroke, HF, and AF. Adding constipation to the established risk factors showed a modest but significant improvement in the prediction for the CVDs (net reclassification improvement for composite CVD: 0.122; 95% CI: 0.116-0.127; P < 0.001). CONCLUSIONS: In individuals without prior CVD, constipation was associated with incident CVDs including myocardial infarction, angina pectoris, stroke, HF, and AF. Constipation may be promising for the prediction of future CVD other than established risk factors, suggesting the importance of constipation not just as a quality-of-life issue but as a potential cardiovascular risk in the general population.