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Zhou J, Xu Y, Zheng Z, Zhang S, Yang J, Zhang Y, Tang B, Han H, Zhang Q, Liu F, Ding W, Qian C, Su G, Liu X, Shen Y, Shi B, Kong X, Ge Z, Zhang P, Guo X, Zhang H, Sun Y, Dong Y, Fu G, Feng L, Ge J. Effectiveness and safety of ivabradine in Chinese patients with chronic heart failure: an observational study. ESC Heart Fail 2024; 11:846-858. [PMID: 38193606 PMCID: PMC10966258 DOI: 10.1002/ehf2.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/12/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS A therapeutic strategy for chronic heart failure (HF) is to lower resting heart rate (HR). Ivabradine is a well-known HR-lowering agent, but limited prospective data exist regarding its use in Chinese patients. This study aimed to evaluate the effectiveness and safety of ivabradine in Chinese patients with chronic HF. METHODS AND RESULTS This multicentre, single-arm, prospective, observational study enrolled Chinese patients with chronic HF. The primary outcome was change from baseline in HR at 1 and 6 months, measured by pulse counting. Effectiveness was also evaluated using laboratory tests, the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score (CSS) and overall summary score (OSS), and New York Heart Association (NYHA) class. Treatment-emergent adverse events (TEAEs) were assessed. A post hoc analysis examined the effectiveness and safety of ivabradine combined with an angiotensin receptor-neprilysin inhibitor (ARNI) or beta-blocker. A total of 1003 patients were enrolled [mean age 54.4 ± 15.0 years, 773 male (77.1%), mean baseline HR 88.5 ± 11.3 b.p.m., mean blood pressure 115.7/74.4 ± 17.2/12.3 mmHg, mean left ventricular ejection fraction 30.9 ± 7.6%, NYHA Classes III and IV in 48.8% and 22.0% of patients, respectively]. HR decreased by a mean of 12.9 and 16.1 b.p.m. after 1 and 6 months, respectively (both P < 0.001). At Month 6, improvements in the KCCQ CSS and OSS of ≥5 points were observed in 72.1% and 74.1% of patients, respectively (both P < 0.001). Left ventricular ejection fraction increased by 12.1 ± 11.6 (P < 0.001), and 66.7% of patients showed improvement in NYHA class (P < 0.001). At Month 6, the overall proportion of patients in NYHA Classes III and IV was reduced to 13.5% and 2.1%, respectively. Serum brain natriuretic peptide (BNP) and N-terminal pro-BNP changed by -331.9 ng/L (-1238.6, -134.0) and -1113.8 ng/L (-2202.0, -297.2), respectively (P < 0.001). HR reductions and improvements in NYHA and KCCQ scores with ivabradine were similar with and without use of ARNIs or beta-blockers. Of 498 TEAEs in 296 patients (29.5%), 73 TEAEs in 55 patients (5.5%) were considered related to ivabradine [most frequent sinus bradycardia (n = 7) and photopsia (n = 7)]. TEAEs were reported in a similar number of patients in ARNI and beta-blocker subgroups (21.9-35.6%). CONCLUSIONS Ivabradine treatment reduced HR and improved cardiac function and health-related quality of life in Chinese patients with chronic HF. Benefits were seen irrespective of whether or not patients were also taking ARNIs or beta-blockers. Treatment was well tolerated with a similar profile to previous ivabradine studies.
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Affiliation(s)
- Jingmin Zhou
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
| | - Yamei Xu
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
| | | | | | | | | | - Baopeng Tang
- The First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | | | - Qing Zhang
- West China Hospital, Sichuan UniversityChengduChina
| | - Fan Liu
- The Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wenhui Ding
- Peking University First HospitalBeijingChina
| | | | - Guohai Su
- Jinan Central Hospital Affiliated to Shandong UniversityJinanChina
| | - Xiaohui Liu
- Beijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | | | - Bei Shi
- Affiliated Hospital of Zunyi Medical CollegeZunyiChina
| | | | - Zhiming Ge
- Qilu Hospital of Shandong University (Qingdao)QingdaoChina
| | - Ping Zhang
- Beijing Tsinghua Changgung HospitalBeijingChina
| | - Xiaomei Guo
- Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hong Zhang
- First People's Hospital of Yunnan ProvinceKunmingChina
| | - Yuemin Sun
- Tianjin Medical University General HospitalTianjinChina
| | - Yugang Dong
- The First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, Zhejiang University School of MedicineZhejiangChina
| | - Lei Feng
- Servier (Tianjin) Pharmaceutical Co., LtdBeijingChina
| | - Junbo Ge
- Department of CardiologyZhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular DiseasesShanghaiChina
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Liu D, Cui X, Xu Y, Xu L, Xie Z, Yuan S, Wang P, Wang Y, Qian S, Gong H, Nordbeck P, Yang J, Zhou J, Ge J, Sun A. Impact of heart rate changes during hospitalization on outcome in heart failure with preserved ejection fraction. ESC Heart Fail 2024. [PMID: 38514992 DOI: 10.1002/ehf2.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS The benefits of lowering heart rate (HR) in heart failure (HF) with preserved ejection fraction (HFpEF) patients are still a matter of debate. This study aimed to investigate the relationship between changes in HR during hospitalization and cardiovascular (CV) events and all-cause death in hospitalized HFpEF patients. METHODS AND RESULTS Hospitalized HF patients between January 2017 and December 2021 were consecutively enrolled in a national, multicentred, and prospective registry database, the China Cardiovascular Association Database-HF Center Registry. HF patients with a left ventricular ejection fraction of ≥50% were defined as HFpEF patients. The study analysed admission/discharge HR, change in HR during hospitalization (∆HR), and ∆HR ratio (∆HR/admission HR). The patients were categorized into three groups: no HR dropping group (ΔHR ratio > 0.0%), moderate HR dropping group (-15% < ΔHR ratio ≤ 0.0%), and excessive HR dropping group (ΔHR ratio ≤ -15%). All patients were followed up for 12 months. The primary endpoint was CV events (CV death or HF rehospitalization). The secondary endpoint was all-cause death. A total of 19 510 HFpEF patients (9750 males, mean age 71.9 ± 12.2 years) were included, with 4575 in the no HR dropping group, 8434 in the moderate HR dropping group, and 6501 in the excessive HR dropping group. Excessive HR dropping during hospitalization was significantly associated with an increased risk of CV events (17.1%) compared with the no HR dropping group (14.5%, P < 0.001) or the moderate HR dropping group (14.0%, P < 0.001), although all-cause mortality was similar among the three groups. After adjusting for multiple confounding factors, excessive HR dropping remained an independent predictor of increased CV event risk [hazard ratio 1.197, 95% confidence interval (CI) 1.078-1.328]. Subgroup analysis revealed that the prognostic impact of excessive HR dropping on increased CV event risk remained in the subgroups of older age, New York Heart Association class IV, ischaemic HF, higher left ventricular ejection fraction, absence of chronic kidney disease, and use of beta-blockers or ivabradine. Independent determinants associated with excessive HR dropping during admission included use of beta-blockers [odds ratio (OR) 1.683, 95% CI 1.558-1.819], lower discharge diastolic blood pressure (OR 0.988, 95% CI 0.985-0.991), no pacemaker (OR 0.501, 95% CI 0.416-0.603), coexisting atrial fibrillation or atrial flutter (OR 1.327, 95% CI 1.218-1.445), and use of digoxin (OR 1.340, 95% CI 1.213-1.480). CONCLUSIONS In hospitalized HFpEF patients, excessive HR dropping during hospitalization is associated with an increased risk of CV death or HF rehospitalization. These findings highlight the importance of HR monitoring and avoiding excessively slowing down HR in hospitalized HFpEF patients to reduce the risk of CV events.
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Affiliation(s)
- Dan Liu
- Department of Cardiology, Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany
- Comprehensive Heart Failure Center, Würzburg, Germany
| | - Xiaotong Cui
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Yamei Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Lei Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Zhonglei Xie
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Shuai Yuan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Peng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Yanyan Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Sanli Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Hui Gong
- Department of Cardiology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Peter Nordbeck
- Department of Cardiology, Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany
- Comprehensive Heart Failure Center, Würzburg, Germany
| | - Jiefu Yang
- Department of Cardiology, Institute of Geriatric Medicine, National Center of Gerontology, Beijing Hospital, Chinese Academy of Medical Sciences, Da Hua Road 1, Dong Dan, Beijing, 100730, China
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Aijun Sun
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
- Department of Cardiology, Jinshan Hospital of Fudan University, Shanghai, China
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Grujić-Milanović J, Rajković J, Milanović S, Jaćević V, Miloradović Z, Nežić L, Novaković R. Natural Substances vs. Approved Drugs in the Treatment of Main Cardiovascular Disorders-Is There a Breakthrough? Antioxidants (Basel) 2023; 12:2088. [PMID: 38136208 PMCID: PMC10740850 DOI: 10.3390/antiox12122088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases (CVDs) are a group of diseases with a very high rate of morbidity and mortality. The clinical presentation of CVDs can vary from asymptomatic to classic symptoms such as chest pain in patients with myocardial infarction. Current therapeutics for CVDs mainly target disease symptoms. The most common CVDs are coronary artery disease, acute myocardial infarction, atrial fibrillation, chronic heart failure, arterial hypertension, and valvular heart disease. In their treatment, conventional therapies and pharmacological therapies are used. However, the use of herbal medicines in the therapy of these diseases has also been reported in the literature, resulting in a need for critical evaluation of advances related to their use. Therefore, we carried out a narrative review of pharmacological and herbal therapeutic effects reported for these diseases. Data for this comprehensive review were obtained from electronic databases such as MedLine, PubMed, Web of Science, Scopus, and Google Scholar. Conventional therapy requires an individual approach to the patients, as when patients do not respond well, this often causes allergic effects or various other unwanted effects. Nowadays, medicinal plants as therapeutics are frequently used in different parts of the world. Preclinical/clinical pharmacology studies have confirmed that some bioactive compounds may have beneficial therapeutic effects in some common CVDs. The natural products analyzed in this review are promising phytochemicals for adjuvant and complementary drug candidates in CVDs pharmacotherapy, and some of them have already been approved by the FDA. There are insufficient clinical studies to compare the effectiveness of natural products compared to approved therapeutics for the treatment of CVDs. Further long-term studies are needed to accelerate the potential of using natural products for these diseases. Despite this undoubted beneficence on CVDs, there are no strong breakthroughs supporting the implementation of natural products in clinical practice. Nevertheless, they are promising agents in the supplementation and co-therapy of CVDs.
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Affiliation(s)
- Jelica Grujić-Milanović
- Institute for Medical Research, National Institute of the Republic of Serbia, Department of Cardiovascular Research, University of Belgrade, 11 000 Belgrade, Serbia;
| | - Jovana Rajković
- Institute for Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11 000 Belgrade, Serbia
| | - Sladjan Milanović
- Institute for Medical Research, National Institute of the Republic of Serbia, Department for Biomechanics, Biomedical Engineering and Physics of Complex Systems, University of Belgrade, 11 000 Belgrade, Serbia;
| | - Vesna Jaćević
- Department for Experimental Toxicology and Pharmacology, National Poison Control Centre, Military Medical Academy, 11 000 Belgrade, Serbia;
- Medical Faculty of the Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 500 002 Hradec Kralove, Czech Republic
| | - Zoran Miloradović
- Institute for Medical Research, National Institute of the Republic of Serbia, Department of Cardiovascular Research, University of Belgrade, 11 000 Belgrade, Serbia;
| | - Lana Nežić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Radmila Novaković
- Institute of Molecular Genetics and Genetic Engineering, Center for Genome Sequencing and Bioinformatics, University of Belgrade, 11 000 Belgrade, Serbia;
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Johri N, Matreja PS, Maurya A, Varshney S, Smritigandha. Role of β-blockers in Preventing Heart Failure and Major Adverse Cardiac Events Post Myocardial Infarction. Curr Cardiol Rev 2023; 19:e110123212591. [PMID: 36635926 PMCID: PMC10494272 DOI: 10.2174/1573403x19666230111143901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 01/14/2023] Open
Abstract
β-blockers have been widely utilized as a part of acute myocardial infarction (AMI) treatment for the past 40 years. Patients receiving β-adrenergic blockers for an extended period following myocardial infarction have a higher chance of surviving. Although many patients benefited from β-blockers, many do not, including those with myocardial infarction, left ventricle dysfunction, chronic pulmonary disease, and elderly people. In individuals with the post-acute coronary syndrome and normal left ventricular ejection fraction (LVEF), the appropriate duration of betablocker therapy is still unknown. There is also no time limit for those without angina and those who do not need β-blockers for arrhythmia or hypertension. Interestingly, β-blockers have been prescribed for more than four decades. The novel mechanism of action on cellular compartments has been found continually, which opens a new way for their potential application in cardiac failure and other cardiac events like post-myocardial infarction. Here, in this review, we studied β-blocker usage in these circumstances and the current recommendations for β-blocker use from clinical practice guidelines.
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Affiliation(s)
- Nishant Johri
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Prithpal S. Matreja
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Aditya Maurya
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Shivani Varshney
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Smritigandha
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
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Truong C, Recto C, Lafont C, Canoui-Poitrine F, Belmin JB, Lafuente-Lafuente C. Effect of Cholinesterase Inhibitors on Mortality in Patients With Dementia: A Systematic Review of Randomized and Nonrandomized Trials. Neurology 2022; 99:e2313-e2325. [PMID: 36096687 DOI: 10.1212/wnl.0000000000201161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cholinesterase inhibitors (ChEIs) have cardiovascular effects in addition to their neurologic activity and might alter mortality. We wanted to know whether treatment with ChEIs modifies mortality in patients with dementia. METHODS We searched PubMed, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and ICRTP, from their inception to November 2021, and screened bibliographies of reviews, guidelines, and included studies. We included randomized controlled trials (RCTs) and nonrandomized controlled studies at lower risk of bias comparing ChEI treatment with placebo or usual treatment, for 6 months or longer, in patients with dementia of any type. Two investigators independently assessed studies for inclusion, assessed their risk of bias, and extracted data using predefined forms. Any discordance between investigators was solved by discussion and consensus. Data on all-cause and cardiovascular mortality, measured as either crude death rates or multivariate adjusted hazard ratios (HRs), were pooled using a random-effect model. Information size achieved was assessed using trial sequential analysis (TSA). We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Twenty-four studies (12 RCTs, 12 cohorts, mean follow-up 6-120 months), cumulating 79,153 patients with Alzheimer (13 studies), Parkinson (1), vascular (1), or any type (9) dementia, fulfilled inclusion criteria. Pooled all-cause mortality in control patients was 15.1 per 100 person-years. Treatment with ChEIs was associated with lower all-cause mortality (unadjusted risk ratio [RR] 0.74, 95% CI 0.66-0.84; adjusted HR 0.77, 95% CI 0.70-0.84, moderate-quality to high-quality evidence). This result was consistent between randomized and nonrandomized studies and in several sensitivity analyses. No difference appeared between subgroups by type of dementia, age, individual drug, or dementia severity. Less data were available for cardiovascular mortality (3 RCTs, 2 cohorts, 9,182 patients, low-quality to moderate-quality evidence), which was also lower in patients treated with ChEIs (unadjusted RR 0.61, 95% CI 0.40-0.93, adjusted HR 0.47, 95% CI 0.32-0.68). In TSA analysis, the results for all-cause mortality were conclusive but not those for cardiovascular mortality. DISCUSSION There is moderate-quality to high-quality evidence of a consistent association between long-term treatment with ChEIs and a reduction in all-cause mortality in patients with dementia. These findings may influence decisions to prescribe ChEIs in those patients. TRIAL REGISTRATION INFORMATION This systematic review was registered in the PROSPERO international prospective register of systematic reviews with the number CRD42021254458 (June 11, 2021).
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Affiliation(s)
- Céline Truong
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Caryn Recto
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Charlotte Lafont
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Florence Canoui-Poitrine
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Joel Belmin Belmin
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Carmelo Lafuente-Lafuente
- From the AP-HP (C.T., C.R., J.B.B., C.L.-L.), Sorbonne Université, Hôpitaux universitaires Pitie-Salpêtrière-Charles Foix, Service de Gériatrie à orientation Cardiologique et Neurologique, Ivry-sur-Seine; Université Paris Est Créteil (UPEC) (C.L., F.C.-P., C.L.-L.), INSERM, IMRB, Clinical Epidemiology and Ageing (CEpiA) Team; and APHP (C.L., F.C.-P.), Hôpital Henri Mondor, Service de Santé Publique, Créteil, France.
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