OBJECTIVES:Hormonal fluctuations during menopause may contribute to an increased risk of hypertension. Evidence of a direct association is not well defined. The objective of this study was to analyze the association between premature (<40 y of age) and early menopause (40-45 y) and the onset of hypertension in the UK Biobank database. METHODS:A prospective observational cohort study was conducted in postmenopausal women in the UK Biobank database. Enrollment was between 2006 and 2010, with follow-up until the end of 2023. The outcome variable was the diagnosis of hypertension during follow-up. Lifestyle behaviors, comorbidities, and laboratory tests were collected. Survival models with Weibull distribution were fitted to the time of onset of hypertension. RESULTS:Of a total of 107,836 women with a mean follow-up of 14.5 years, 18,508 cases of hypertension were observed (17.2%). The cumulative incidence increased with earlier menopause onset: 16.6% in normal menopause, 18.8% in early menopause, and 22.6% in premature menopause (χ2 test, P<0.001). Incidence of hypertension was higher in women with surgical menopause, but there was no association in the multivariate model. The effect of premature menopause was maintained in the multivariate model, with a 12.3% higher risk of developing hypertension. CONCLUSIONS:Premature menopause had a significant effect on the development of hypertension during follow-up. Surgical menopause did not have a significant, independent effect.

INTRODUCTION:Controversy exists regarding the indication of beta-blockers (BB) in different scenarios in patients with cardiovascular disease. We sought to evaluate the effect of BB on survival and heart failure (HF) hospitalizations in a sample of pacemaker-dependent patients after AV node ablation to control ventricular rate for atrial tachyarrhythmias.METHODS:A retrospective study including consecutive patients that underwent AV node ablation was conducted in a single center between 2011 and 2019. The study's primary endpoints were the incidence of all-cause mortality, first HF hospitalization and the cumulative incidence of subsequent hospitalizations for HF. Competing risk analyses were employed.RESULTS:A total of 111 patients with a mean age of 73.9 years were included in the study. After a median follow-up of 45.5 months, 43 patients had died (38.7%) and 31 had been hospitalized for HF (27.9%). The recurrent HF hospitalization rate was 74/1000 patients/year. Patients treated with BB had a non-significant trend to higher mortality rates and a higher risk of recurrent HF hospitalizations (incidence rate ratio 2.23, 95% confidence interval 1.12-4.44; p = 0.023).CONCLUSION:After an AV node ablation, the use of BB is associated with an increased risk of HF hospitalizations in a cohort of elderly patients.

La mayoría de los pacientes con síndrome coronario crónico tienen alteraciones en el electrocardiograma y se desconoce el valor pronóstico de la hipertrofia ventricular izquierda (HVI) valorada por criterios de electrocardiograma. Registro retrospectivo de todos los pacientes con síndrome coronario crónico atendidos en una consulta monográfica. Se calculó el índice de Cornell y Sokolov-Lyon, considerándose HVI por voltaje valores > 28 (varones) o > 20 (mujeres) en el primero, y > 35 para el segundo. Durante el seguimiento se evaluó la mortalidad por causa cardiovascular, cualquier causa o eventos adversos cardiovasculares mayores (MACE) considerando reinfarto, insuficiencia cardiaca, accidente cerebrovascular o hemorragia mayor. Se incluyó a 774 pacientes y 60 (8,31%) cumplían criterios de HVI por cualquiera de los criterios. La mediana de seguimiento fue de 960 días [rango intercuartílico 538-1.586] y durante este periodo fallecieron 33 (4,6%) pacientes, 22 (3,1%) atribuibles a causa cardiovascular, y 110 (15,2%) presentaron MACE. En el análisis multivariante, ajustado por edad, sexo, diabetes, tratamiento médico y frecuencia cardiaca, los índices de HVI se asociaron linealmente con mayor riesgo de muerte por cualquier causa (HR = 1,11; IC95%, 1,07-1,16; p > 0,001), por causa cardiovascular (HR = 1,11; IC 95%, 1,06-1,17; p > 0,001) y MACE (HR = 1,04; IC 95%, 1,01-1,06; p = 0,015). También se encontró un riesgo independiente para HVI. La HVI, valorada por criterios de voltaje en el electrocardiograma, tiene un elevado valor predictivo de mortalidad y complicaciones cardiovasculares mayores en pacientes con síndrome coronario crónico. Most patients with chronic coronary syndrome altered electrocardiogram hypertension, but the prognostic value of left ventricular hypertrophy (LVH) assessed by electrocardiogram criteria is unknown. Retrosprospective registry of all patients with chronic coronary syndrome attended in a monographic clinic. We calculated the Cornell index and Sokolov-Lyon index and values > 28 (men) or > 20 (women) were considered for LVH for the first and > 35 mm in the second. During follow-up, all-cause or cardiovascular mortality or major cardiovascular events (MACE), considering reinfarction, heart failure, cerebrovascular accident, or major hemorrhage, were evaluated. A total of 774 patients were included and 60 (8.31%) fulfilled the LVH criteria by the electrocardiogram. The median follow-up was 960 days [interquartile range 538-1586] and during this period 33 (4.6%) patients died, 22 (3.1%) of the deaths were attributable to cardiovascular causes, and 110 (15,2%) patients presented a MACE. In the multivariate analysis, adjusted for age, sex, diabetes, medical treatment and heart rate, both Cornell and Sokolow-Lyon index were linearly associated with a higher risk of death from any cause (HR, 1.11; 95% CI, 1.07-1.16; P > .001), due to cardiovascular causes (HR, 1.11; 95% CI, 1.06-1.17; P > .001) and MACE (HR, 1.04; 95%CI, 1.01-1.06; P = .015). An independent risk was also observed for LVH. LVH, obtained by electrocardiogram criteria, has a high predictive value for mortality and major cardiovascular complications in patients with chronic coronary syndrome.

Introduction and objectives: Liver fibrosis is present in nonalcoholic liver disease (NAFLD) and both precede liver failure. Subclinical forms of liver fibrosis might increase the risk of cardiovascular events. The objective of this study was to describe the prognostic value of the FIB-4 index on in-hospital mortality and postdischarge outcomes in patients with acute coronary syndrome (ACS).Methods: Retrospective study including all consecutive patients admitted for ACS between 2009 and 2019. According to the FIB-4 index, patients were categorized as <1.30, 1.30-2.67 or> 2.67. Heart failure (HF) and major bleeding (MB) were assessed taking all-cause mortality as a competing event and subhazard ratios (sHR) are presented. Recurrent events were evaluated by the incidence rate ratio (IRR).Results: We included 3106 patients and 6.66% had a FIB-4 index >= 1.3. A multivariate analysis verified a higher risk of in-hospital mortality associated with the FIB-4 index (OR, 1.24; P=.016). Patients with a FIB-4 index> 2.67 had a 2-fold higher in-hospital mortality risk (OR, 2.35; P=.038). After discharge (median follow-up 1112 days), the FIB-4 index had no prognostic value for mortality. In contrast, patients with FIB-4 index >= 1.3 had a higher risk of first (sHR, 1.61; P=.04) or recurrent (IRR, 1.70; P=.001) HF readmission. Similarly, FIB-4 index >= 1.30 was associated with a higher MB risk (sHR, 1.62; P=.030).Conclusions: The assessment of liver fibrosis by the FIB-4 index identifies ACS patients not only at higher risk of in-hospital mortality but also at higher risk of HF and MB after discharge.

Background: The incidence of myocarditis after RNA-based vaccines for coronavirus has gained social and medical interest. Methods: We performed an intention-to-treat meta-analysis, following the PRISMA statement. After a systematic search, without language restriction, 9 publications were selected. Two were excluded (one was only in subjects with age 12-17 and other might had included subjects from a larger publication). We followed the PRISMA guidelines for abstracting data and assessing data quality and validity. Data was verified by 2 investigators. Results: We analyzed 17,704,413 subjects, from 7 studies, that included 627 cases of confirmed myocarditis). The incidence of myocarditis was 0.0035% (95% CI 0.0034-0.0035). Mean incidence rate was 10.69 per 100.000 persons-year. Cases reported from Israel represented 45.14% from total (283 out of the 627). Only 1 case of fatal myocarditis or death was reported. There was significant heterogeneity between results. The meta-regression analysis excluded mean age, region, number of cases or number of people included as sources of heterogeneity. No small-study effect was observed (p = 0.19). Conclusions and relevance: Myocarditis incidence after RNA vaccines is very rare (0.0035%) and has a very favorable clinical course.