Cardiovascular and Cerebrovascular Events Linked to Abuse and Misuse of Sympathomimetic Nasal Decongestants: A Narrative Review of Clinical Evidence.

Are We There Yet? Pediatric Screening for Inflammatory Biomarkers and Low Cardiorespiratory Fitness to Identify Youth at Increased Risk of Cardiovascular Disease

In theoperative and peri-operative period, these events in-clude life-threatening arrhythmias at the time of donorliver reperfusion, myocardial ischemia or myocardialinfarction (MI) or congestive heart failure. In long termOLTx survivors, CV events include unstable angina, MIor death. Therefore, assessing short and long term CVrisk is an important aspect of the ESLD pretransplantevaluation.Currently, there is no widely accepted algorithm toidentify patients that are at high risk of perioperativetransplant CV events from the hemodynamic stress ofsurgery. Contrary to data in the vascular surgery pop-ulation

Arterial wall hypertrophy occurs with age in humans and is a strong predictor of cardiovascular disease risk. The responsible mechanism is unknown, but data from studies in experimental animals suggest that elevated sympathetic-adrenergic tone may be involved. To test this hypothesis in humans we studied 11 young (29 +/- 1 yr; means +/- SE) and 13 older (63 +/- 1) healthy normotensive men under supine resting conditions. Muscle sympathetic nerve activity (MSNA) burst frequency (peroneal microneurography) was 70% higher in the older men (39 +/- 1 vs. 23 +/- 2 bursts/min; P < 0.001). Femoral artery intima media thickness (IMT; B-mode ultrasound) and the femoral IMT-to-lumen diameter ratio (IMT/lumen) were approximately 75% greater in the older men (both P < 0.001). Femoral IMT (r = 0. 82) and the femoral IMT/lumen (r = 0.85) were strongly and positively related to MSNA (both P < 0.001). The significant age group differences in femoral IMT and the IMT/lumen were abolished when the influence of MSNA was removed. In contrast, the relationship between MSNA and femoral wall thickness remained significant after removing the influence of age. We conclude that 1) primary aging is associated with femoral artery hypertrophy in humans and 2) this is strongly related to elevations in sympathetic nerve activity to the vasculature. These results support the hypothesis that tonic elevations in sympathetic nerve activity may be an important mechanism in the arterial remodeling that occurs with human aging.

Usefulness of Ventricular Premature Complexes to Predict Coronary Heart Disease Events and Mortality (from the Atherosclerosis Risk In Communities Cohort)

Inappropriate use of aspirin for primary prevention

Osteoarthritis (OA) is a degenerative arthritis affecting over 30 million Americans most of whom are over 65 years or older. Its clinical management is complicated by several disease- and treatment-specific factors. These include the co-occurrence of cardiovascular and gastrointestinal disorders (CV-GID), the inappropriate use of non-steroidal anti-inflammatory drugs (NSAID) to manage pain, and the risk of certain age-related chronic conditions like Alzheimer’s disease and related dementia (ADRD). Moreover, older adults with OA are at a higher risk of CV-GID, inappropriate NSAID use, and ADRD. Additionally, these factors can also affect one another in both a positive and a negative way. For example, the long-term use of NSAID has been shown to increase the risk for cardiovascular and gastrointestinal disorders. On the other hand, their use has been shown to decrease the risk of ADRD in some studies. NSAID use is disproportionately higher among older adults, so the benefits or risks associated with such use should be taken into account while making treatment decisions. However, there is a gap in our understanding of the clinical and demographic factors that increase the risk of co-occurring CV-GID, inappropriate NSAID use, and ADRD in older adults with OA. This dissertation pursued three related aims to fill this knowledge gap: 1) identify the leading predictors of CV-GID; 2) identify the leading predictors of inappropriate NSAID use; and 3) examine whether duration of NSAID use is a leading predictor of ADRD and how other factors affect this relationship using a combination of machine learning techniques. All three aims used a retrospective, longitudinal, cohort study design using de-identified commercial health insurance insurance claims data from Optum De-identified Clinformatics Data Mart for years 2015 through 2017. OA was identified from these data using a combination of International Classification of Disease – 9th Revision and 10th Revision (ICD-9 and ICD-10) codes. Using a random forest classifier, we identified age, cardiac arrhythmia, and the duration of opioid use to be the top three leading predictors of CV-GID in our study cohort. In the second aim, we found that around 13% of older adults with OA were prescribe NSAIDs not in accordance with their CV and GI risk profile (i.e. inappropriate NSAID use). Using an eXtreme Gradient Boosting classifier and Shapley Additive eXplanations, we found durations of non-selective and selective NSAID use to be the top two predictors of inappropriate NSAID use. Older adults with low CV and high GI or

Overweight and obesity are growing global health problems. The prevalence of hypertension and diabetes mellitus, frequently coexisting with obesity is increasing drastically, with all three (obesity, hypertension and diabetes) being strong risk factors for cardiovascular morbidity and mortality. In order to optimally reduce the risk for cardiovascular events in patients with obesity-related hypertension, optimal blood pressure control along with comprehensive lifestyle modification is required. Obesity and hypertension are characterized by elevated sympathetic activity as well as insulin resistance and the reninangiotensin- aldosterone system (RAAS) for the onset and development. Importantly, these characteristics, themselves, are one of the cardiovascular risks. Therefore, pharmacological treatments should be selected from favourable effects on elevated sympathetic nervous system activity, insulin resistance and stimulated RAAS. Current data suggests that angiotensin- converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) with or without a diuretic are recommended, because of their cardio- and renal-protective effects and favourable effects on insulin resistance and elevated sympathetic nervous activity. Most patients with obesity-related hypertension, however, are very resistant to control hypertension and frequently require two or more types of medications to achieve blood pressure goals. Several epidemiological (i.e. V-Heft III, ACCOMPLISH study, PRAISE study, PRAISE-2 study) and clinical studies have shown that calcium channel blockers (CCBs) are favourable for cardiac risk with neutral or ameliorative effects on insulin resistance and elevated sympathetic nervous activity. Keywords: Calcium channel blockers, hypertension, obesity, metabolic syndrome, ACCOMPLISH study, obesity-related hypertension, reninangiotensin-aldosterone system, insulin resistance and stimulated, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ameliorative effects, dyslipidaemia, hyperglyaemia, beta-adrenoceptor antagonists, dihydropyridine, homeostatic model assessments of insulin resistance, lipolysis, Microalbuminuria, Cushing7apos;s syndrome, Pheochromocytoma, homeostasis, hypertriglyceridaemia, fibrinolysis, hyperinsulinamia, Hyperleptinaemia, thermogenesis, ancillary factor, thiazide, ricacidemia, achycardia, nicardipine, nisoldipine, manidipine, nilvadipine, benidipine, efonidipine, L-type calcium channel, T-type calcium channels, diltiazem, verapamil, euglycaemic hyperinsulinaemic clamp, placebo, PRAISE-2, congestive heart failure, cardiomyopathy, Nifedipine, proteinuria, renin-angiotensin, ameliorative effect

Objective: Cardiovascular (CV) risk stratification in patients with arterial hypertension is essential for tailoring adequate antihypertensive treatment. Only few data is available on CV risk stratification in primary care patients with arterial hypertension. The aim of this subanalysis from the Swiss Hypertension Cohort Study (HccH) was to evaluate the compliance of general practitioners with the ESH/ESC guidelines on CV risk stratification in arterial hypertension as well as potential gaps in the risk stratification process. Design and method: HccH is an ongoing prospective observational study which has been initiated in 2005 by the Institute for Primary Care of the University of Basel, Switzerland. Data collection is conducted by general practitioners in Switzerland. Eligible patients are adult men and women (age > = 18 years) with arterial hypertension. Inclusion criteria are antihypertensive treatment respectively a mean through sitting office blood pressure (OBPM) > = 140/90mmHg. Patient characteristics, OBPM, ambulatory blood pressure (ABPM), CV risk factors, asymptomatic target organ damage (OD), diabetes mellitus (DM), chronic kidney disease (CKD) and symptomatic CV and renal disease are recorded on an annual basis and CV risk analyzed according to the 2013 ESH/ESC Guidelines. Results: Baseline data from 1005 patients included into HccH are given in the following table:BMI: Body Mass Index; CHD: Coronary Heart Disease; CHF: Congestive Heart Failure; CKD: Chronic Kidney Disease; GFR: Glomerular Filtration Rate; PAD: Peripheral Artery Disease; TIA: Transitory Ischemic Attack; Smoking Status: Y: active smoker, N: never smoked, Ex: former smoker. Data given as mean ± SD or absolute numbers (% of recorded data) where applicable. Conclusions: Decisions about treatment and optimal therapy in hypertensive patients should be based on an individual overall CV risk. Therefore a complete performance of risk stratification is very important. Our preliminary analysis from HccH demonstrates that CV risk factors from medical history and clinical data, with the exception of ABPM, appear to be comprehensively recorded in primary care. Substantial gaps were revealed with regards to the assessment of asymptomatic OD, particularly microalbuminuria and left ventricular hypertrophy, indicating that overall CV risk may be significantly underestimated in primary care patients with arterial hypertension.

Smoking, blood pressure and cardiovascular risk.

The role of cardiovascular CT in occupational health assessment for coronary heart disease: An expert consensus document from the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the American College of Cardiology (ACC) and the American College of Radiology (ACR)

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant contributor to morbidity and mortality, linked to adverse cardiovascular outcomes. While extensive research highlights the cardiovascular burden in non-lean MASLD, lean MASLD remains comparatively understudied. To address this gap, our study evaluates cardiovascular outcomes in lean MASLD compared with non-lean MASLD. This is a retrospective cohort study of patients with MASLD identified in the multi-institutional database, TriNetX. Lean MASLD was defined as a body mass index <25 kg/m 2 . Leveraging 1:1 propensity score matching, we balanced baseline characteristics, including age, sex, comorbidities, laboratory values, and medication use. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular events, cerebrovascular outcomes, new-onset heart failure, and all-cause mortality over 1-, 3-, 5-, and 7-year follow-up. After matching, there were 67,519 patients in both groups. At 7-year follow-up, lean patients with MASLD demonstrated significantly higher rates of new onset heart failure compared with non-lean patients with MASLD (HR: 1.23, 95% CI: 1.16-1.31, P < 0.0001), composite cardiovascular events (HR: 1.21, 95% CI: 1.13-1.30, P < 0.0001), cerebrovascular events (HR: 1.33, 95% CI: 1.24-1.43, P < 0.0001), and all-cause mortality (HR: 1.48, 95% CI: 1.38-1.59, P < 0.0001). These increased risks were noted at 1-, 3-, and 5-year follow-up. Patients with lean MASLD are at significantly higher risks of cardiovascular events and all-cause mortality compared with non-lean patients with MASLD. Further research is needed to clarify the underlying pathophysiology and develop tailored interventions to improve outcomes for this growing population.

The interaction between APOE ɛ4 and vascular risk factors on cognitive function is stronger in women than in men. These effects may be mediated by the amount of tau pathology in the brain. Therefore, we examined whether APOE ɛ4 and sex modify cross-sectional associations between cardiovascular risk and tau deposition in cognitively normal older adults from the Alzheimer’s Disease Neuroimaging Initiative. We calculated the Framingham Heart Study cardiovascular disease risk score for 141 participants (74 women, 47 APOE ɛ4 carriers) with complete medical history data, processed tau-PET data and a Clinical Dementia Rating global score of 0.0 at the time of the tau-PET scan, implying no significant cognitive or functional impairment. We used linear regression models to examine the effects of sex, APOE ɛ4, cardiovascular risk and their interactions on tau deposition in the entorhinal cortex, inferior temporal cortex and a composite meta-region of interest of temporal lobe areas. We found a significant three-way interaction among sex, APOE ɛ4 status and cardiovascular disease risk on tau deposition in the entorhinal cortex (β = 0.04; 95% CI, 0.01–0.07; P = 0.008), inferior temporal cortex (β = 0.02; 95% CI, 0.0–0.05; P = 0.029) and meta-region (β = 0.02; 95% CI, 0.0–0.04; P = 0.042). After stratifying by APOE ɛ4 status to examine interactions between sex and cardiovascular disease risk on tau in APOE ɛ4 carriers and non-carriers, we found a significant two-way interaction between sex and cardiovascular disease risk on tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02–0.08; P = 0.001), inferior temporal cortex (β = 0.03; 95% CI, 0.01–0.05; P =0.009) and meta-region (β = 0.02; 95% CI, 0.01–0.04; P = 0.008) only among APOE ɛ4 carriers. In analyses stratified by sex, higher cardiovascular risk scores were associated with higher levels of tau in the entorhinal cortex (β = 0.05; 95% CI, 0.02–0.08; P = 0.002), inferior temporal cortex (β = 0.02; 95% CI, 0.0–0.05; P = 0.023) and meta-region (β = 0.02; 95% CI, 0.01–0.04; P = 0.013) in female APOE ɛ4 carriers but not in male carriers. Our findings suggest that cognitively normal older women carrying at least one APOE ɛ4 allele, may be particularly vulnerable to the effects of cardiovascular disease risk on early tau deposition.

Transfusion Dependent Thalassemia (TDT) is a hereditary hematologic disorder requiring chronic transfusions, leading to iron overload and frequent endocrinological complications, notably hypogonadism, defined as secondary or hypogonatropic, potentially impacting quality of life and cardiovascular (CV) risk. This study aimed to evaluate the pattern of hypogonadism in TDT and its impact on CV risk compared to non-hypogonadal subjects with TDT and hypogonadal subjects without TDT. A cross-sectional observational study assessed 22 TDT patients with hypogonadism (H-TDT) and 31 TDT without a diagnosis of hypogonadism (NH-TDT) aged 18 years or older. A control group of adult non-thalassemic hypogonadotropic hypogonadism patients (HH-C) was included for comparison. Data on medical history, clinical signs/symptoms of hypogonadism, lifestyle factors, blood pressure, and hormone levels were collected. CV risk was assessed using Framingham and Progetto Cuore scores, as well as echocardiographic parameters. H-TDT patients had significantly higher FSH and LH levels than HH-C (p < 0.001). Significant differences in CV and total cholesterol levels were found between TDT patients with and without hypogonadism (p = 0.046, p = 0.004, respectively). CV risk was similar between H-TDT patients and the HH-C. The nature of hypogonadism in TDT is essentially mixed, definitively transcending a purely hypogonadotropic profile. Furthermore, while the CV risk is higher in subjects with H-TDT compared to NH-TDT, it remains extraordinarily low and not pathological according to two validated scores in the general population. This suggests a need to identify more suitable tools for the CV risk in TDT patients.

Aspirin is recommended in patients with atherosclerotic cardiovascular disease for secondary prevention. In patients without atherosclerotic cardiovascular disease and not at high 10-year risk, there is no evidence aspirin reduces adverse cardiovascular events and it could increase bleeding. The 2019 American College of Cardiology/American Heart Association Guidelines on Primary Prevention of Cardiovascular Disease state that aspirin may be considered for primary prevention (class IIb) in patients 40 to 70 years that are at higher risk of atherosclerotic cardiovascular disease and that routine use of aspirin should be avoided (class III:Harm) for patients >70 years. We examined the frequency of patients on aspirin for primary prevention that would have been considered unindicated or potentially harmful per the recent guideline where aspirin discontinuation may be beneficial. To assess the potential impact, within the National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence Registry, we assessed 855 366 patients from 400 practices with encounters between January 1, 2018 and March 31, 2019, that were receiving aspirin for primary prevention. We defined inappropriate use as the use of aspirin in patients <40 or >70 years and use without a recommended indication as use of aspirin in patients 40 to 70 years with low, borderline, or intermediate 10-year atherosclerotic cardiovascular disease risk. Frequency of inappropriate use and use without a recommended indication were calculated and practice-level variation was evaluated using the median rate ratio. Inappropriate use occurred in 27.6% (193 674/701 975) and use without a recommended indication in 26.0% (31 810/122 507) with significant practice-level variation in inappropriate use (predicted median practice-level rate 33.5%, interquartile range, 24.1% to 40.8%; median rate ratio, 1.71 [95% CI, 1.67-1.76]). Immediately before the 2019 American College of Cardiology/American Heart Association Guidelines on Primary Prevention of Cardiovascular Disease, over one-fourth of patients in this national registry were receiving aspirin for primary prevention inappropriately or without a recommended indication with significant practice-level variation. These findings help to determine the potential impact of guideline recommendations on contemporary use of aspirin for primary prevention.

Aim To detect serum level of cholesterylester transfer protein (CETP) (the enzyme involved in reverse cholesterol transport) in patients with rheumatoid arthritis (RA) and to evaluate its relation to various clinical parameters of the disease, lipid profile, and carotid intima-media thickness (CIMT) as a marker of atherosclerosis and cardiovascular disease risk. Patients and methods This study involved a total of 80 participants, comprising 50 patients with RA and 30 age-matched and sex-matched healthy controls. Detailed medical history and thorough clinical examination (general and musculoskeletal) as well as laboratory investigations including lipid profile were performed for all patients with RA. Serum level of CETP was assessed by enzyme-linked immunosorbent assay technique. Carotid ultrasound scan was performed for all patients with RA to detect CIMT. Results Serum level of CETP was significantly lower in patients with RA than controls (4.11 ± 2.77 ng/ml in patients with RA and 5.30 ± 2.73 ng/ml in controls, P = 0.003). Regarding lipid profile values, high-density lipoprotein was lower in patients with RA relative to controls (63.02 ± 12.8 vs. 69.8 ± 6.7 mg/dl, P = 0.012), whereas total cholesterol (218.9 ± 39.5 vs. 206.9 ± 31.8 mg/dl, P = 0.073), triglycerides (144.2 ± 16.2 vs. 136.1 ± 16.6 mg/dl, P = 0.059), and low-density lipoprotein (118.5 ± 27.5 vs. 112.6 ± 38.5 mg/dl, P = 0.56) showed no significant differences between both groups. No correlation was found between serum level of CETP and the characteristics of patients with RA including demographic data, disease activity markers (28-joint disease activity score, erythrocyte sedimentation rate, and C-reactive protein), serological markers (rheumatoid factor and anti-cyclic citrullinated peptide antibodies titer), as well as lipid profile parameters. On the contrary, serum level of CETP was significantly negatively correlated with CIMT (r=−0.321, P = 0.023). Conclusion Finally, we concluded that CETP was found to be low in patients with RA when compared with controls and is inversely related to CIMT, suggesting its possible role in cardiovascular mortality risk in this disease.