Comparative Effectiveness of Sleeve Gastrectomy and One-Anastomosis Gastric Bypass on Cardiovascular Disease Risk: Insights from a Prospective Cohort Study.

Introduction: The American Heart Association (AHA) pooled cohort equations provide sex and race specific estimates of 10-year atherosclerotic cardiovascular disease (ASCVD) risk based on traditional risk factors, but not physical activity (PA) or fitness. The effect of exercise training on estimated ASCVD risk has not been previously evaluated, which is clinically relevant to individuals with type 2 diabetes (T2D) who have increased risk of ASCVD. The purpose of the present study is to determine the effect of aerobic (AER), resistance (RES) or combination (COMB) exercise training on 10-year ASCVD risk in individuals with T2D. Methods: The present study is an ancillary analysis of the Health Benefits of Aerobic and Resistance Training Study (HART-D). Adults with T2D (n=148) were randomized to 9 months of AER, RES, COMB exercise training or a control group (CON); 10-year ASCVD risk was calculated using the AHA pooled cohort equations based on each participants’ demographic (age, sex, race) and clinical data (high density lipoprotein, total cholesterol, systolic blood pressure/history of hypertension) and known T2D status at baseline and follow-up. Change in ASCVD risk was evaluated with an analysis of covariance with adjustment for baseline ASCVD risk. Results: Participants in the present analysis had a mean (SD) 10-year ASCVD risk of 12.2% (9.4). Baseline ASCVD risk was associated with body fat (r=-0.22, p< 0.001) and duration of T2D (r=0.18, p=0.03), but not with peak VO 2 , hemoglobin A 1C , or other cardiometabolic variables (p>0.05). No significant change in ASCVD risk was observed in the AERO (-0.36%, CI: -1.44 to 0.71), RES (-0.43%, CI: -1.49 to 0.63) and the COMB groups (-0.54%, CI: -1.57 to 0.49) compared to the CON (0.02%, CI: -1.26 to 1.31) group. However, in exercisers only, the change in diastolic blood pressure was associated with change in ASCVD (r=0.34, p<0.001), but not change in hemoglobin A 1C , peak VO 2 , body fat mass, or other cardiometabolic risk factors (p>0.05). Conclusions: The present study suggests that 9 months of exercise training did not reduce ASCVD risk predicted by the pooled cohort equations. Since exercise training is recommended by the AHA to reduce ASCVD risk especially in adults with T2D, future studies should evaluate if adding a variable that represents physical activity and/or fitness provides additional discrimination in the prediction of ASCVD.

PurposeAs a powerful indicator of arterial stiffening, the brachial-ankle pulse wave velocity (baPWV) has been extensively validated for predicting cardiovascular events. However, whether and how the brachial-ankle pulse wave velocity (baPWV) is correlated with the 10-year atherosclerotic cardiovascular disease (ASCVD) risk is unclear. This study aimed to investigate the association between baPWV and 10-year ASCVD risk in Chinese population.MethodsA total of 1768 subjects were enrolled from Shanghai, China. They were divided into two groups according to the Pooled Cohorts Equations model made by ACC/AHA as follows: low ASCVD risk (n = 992, 10-year ASCVD risk <7.5%) and high ASCVD risk (n = 776, 10-year ASCVD risk ≥7.5%). The baseline characteristics were obtained via the use of a questionnaire. Measurement of baPWV, laboratory tests, and echocardiography were conducted by trained physicians. The relationship between baPWV and 10-year ASCVD risk was evaluated using multiple logistic regression model and generalized additive model.ResultsThe mean age of the subjects was 58.89±8.60 years, 32.69% of which were male. Non-linear relationship analysis revealed threshold effects between baPWV and 10-year ASCVD risk in which a baPWV of approximately 16 m/s might be the threshold effect of 10-year ASCVD risk. After multivariable adjustment, logistic-regression analysis demonstrated that ankle-brachial index (ABI) (OR 5.28, 95% CI 1.20–12.23) and baPWV (OR 9.09, 95% CI 6.84–12.07) were independently correlated with 10-year ASCVD risk. The AUC for baPWV for predicting 10-year ASCVD risk was 0.80 (95% CI 0.78–0.82).ConclusionIncreased baPWV as an indicator of arterial stiffness correlates strongly with 10-year ASCVD risk in general middle-aged and elderly populations. The association between baPWV and 10-year ASCVD risk is not purely linear but non-linear. Subjects with baPWV above 16 m/s are more likely to encounter a higher 10-year ASCVD risk.

The Million Hearts Cardiovascular Disease Risk Reduction Model provides financial incentives for practices to lower 10-year atherosclerotic cardiovascular disease (ASCVD) risk for high-risk (ASCVD ≥30%) Medicare patients. To estimate average practice-level ASCVD risk reduction, we applied optimal trial outcomes to a real-world population with high ASCVD risk. This study uses observational registry data from the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence Registry from January 2013 to June 2016. We modeled ASCVD risk reductions using historical clinical trial data (reducing cholesterol by 26.5%, reducing systolic blood pressure by 10.9%, reducing smoking rates by 21.8%) the average reduction in ASCVD risk associated with individual and combined risk factor modifications, and then percentage of practices achieving the various incentive thresholds for the Million Hearts Model. The final study population included 135 166 patients, with 16 248 (12.0%) with 10-year ASCVD risk of ≥30%, but without existing ASCVD. The mean 10-year ASCVD risk was 41.9% (±1 SD of 11.6). Using risk factor reductions from clinical trials, lowering cholesterol, blood pressure, and smoking rates reduced 10-year ASCVD risk by 3.3% (±3.1), 6.3% (±1.1) and 0.5% (±1.3), respectively. Combining all 3 reductions resulted in a 9.7% (±3.6) reduction, with 67 (27.0%) of practices achieving a patient-level average 10-year ASCVD risk reduction of ≥10%, 181 (73.0%) achieving a 2 to 10% reduction, and no practice achieving <2% reduction. In cardiology practices, about 1 out of 8 patients have a 10-year ASCVD risk ≥30% and qualify as high risk in the Million Hearts Model. If practices target the three main modifiable risk factors and achieve reductions similar to clinical trial results, ASCVD risk could be substantially lowered and all practices could receive incentive payments. These findings support the potential benefit of the Million Hearts Model and provide guidance to participating practices.

The 2017 American College of Cardiology/American Heart Association blood pressure guideline recommends initiation of antihypertensive medication for adults with stage 1 hypertension (systolic blood pressure, 130-139 mm Hg, or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10% estimated by the pooled cohort equations (PCEs). In 2023, the American Heart Association published the predicting risk of cardiovascular disease events (PREVENT) equations to estimate ASCVD and total cardiovascular disease risk. We analyzed US National Health and Nutrition Examination Survey data from 2013 to 2020 for 1703 adults aged 30 to 79 years without self-reported cardiovascular disease with stage 1 hypertension. We estimated 10-year ASCVD risk by the PCEs and 10-year ASCVD and total cardiovascular disease risk by the base PREVENT equations. Analyses were weighted to represent noninstitutionalized US adults with stage 1 hypertension. Mean 10-year ASCVD risk was 5.4% (95% CI, 5.0%-5.9%) and 2.9% (95% CI, 2.7%-3.1%) using the PCEs and PREVENT equations, respectively. The proportion with 10-year ASCVD risk of 10% to <15% and ≥15% was 8.1% and 7.8% estimated by the PCEs, respectively, and 3.0% and 0.3% estimated by the PREVENT equations, respectively. No participants had a 10-year ASCVD risk ≥10% on the PREVENT equations and <10% on the PCEs, while 12.5% had a 10-year ASCVD risk ≥10% on the PCEs and <10% on the PREVENT equations. The mean 10-year total cardiovascular disease risk estimated by the PREVENT equations was lower than the mean 10-year ASCVD risk on the PCEs. Among US adults with stage 1 hypertension, the 10-year predicted ASCVD risk estimated by the PREVENT equations was approximately half the risk estimated by the PCEs.

Association between estimated glomerular filtration rate and 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai, China

Background: Atherosclerotic cardiovascular disease (ASCVD) and breast cancer are two of the most diagnosed chronic diseases among women in the U.S. Although prevention of ASCVD with statins is widely practiced, breast cancer chemoprevention with selective estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs) is underutilized in the primary care setting, despite significant evidence in randomized controlled trials demonstrating its clinical benefits. We compared the risk of ASCVD and breast cancer among predominantly Hispanic women undergoing screening mammography, as well as uptake of statins and SERMs/AIs for ASCVD and breast cancer risk reduction, respectively, among high-risk women. Methods: We conducted a retrospective cohort study among 1,655 English or Spanish-speaking women, age 40-79 years, with no prior history of breast cancer, who underwent screening mammography from 2014 to 2016 at Columbia University Irving Medical Center in New York City. Participants completed a survey collecting data on sociodemographic and breast cancer risk factors and had available data in the electronic health record (EHR) for calculating ASCVD risk, including systolic blood pressure, total and HDL cholesterol, history of diabetes, treatment for hypertension, and current smoking status. The main outcomes included 5-year and lifetime invasive breast cancer risk according to the Gail model, and 10-year and lifetime ASCVD risk score according to the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) ASCVD risk calculator. High-risk was defined as a 5-year invasive breast cancer risk 1.67% and 10-year ASCVD risk 7.5%. Secondary outcomes included uptake of chemoprevention with SERMs or AIs and statins among women at high-risk for breast cancer and ASCVD, respectively, based upon medication lists in the EHR. We compared mean lifetime risk of breast cancer vs ASCVD for the entire cohort using a paired t-test, and the proportion of high-risk women taking statins vs chemoprevention using McNemar’s test. Results: Among 1,655 evaluable women, mean age was 58 years (SD=10.1 years), with 76% Hispanic, 6% non-Hispanic White, 3% non-Hispanic Black, 2% Asian, and 13% other. About half (48%) of women met high-risk criteria for ASCVD compared to 15% who met high-risk criteria for breast cancer. Among all women, mean lifetime ASCVD risk was higher than mean lifetime breast cancer risk (10.71% vs. 5.46%, p&amp;lt; 0.001). Among women at high risk for ASCVD or breast cancer, respectively, statin uptake was higher compared to SERM/AI uptake for breast cancer chemoprevention (84% vs. 7%, p&amp;lt; 0.001). Overall, fewer Hispanic compared to non-Hispanic women met high-risk criteria for ASCVD (47% vs. 51%, respectively) and breast cancer (9% vs. 34%, respectively). Conclusions: In a population of predominantly Hispanic women undergoing screening mammography, we found that more women met high-risk criteria for ASCVD compared to breast cancer. Among women at high risk for ASCVD, statin uptake was about 12-fold higher compared to uptake of breast cancer chemoprevention among women at high risk for breast cancer. Given significant underutilization of breast cancer chemoprevention, placing this in the context of prevention of other chronic diseases, such as statins for ASCVD, may enhance uptake of SERMs or AIs in the primary care setting. Citation Format: Luisa Nilan, Mary M. McDermid, Jacquelyn N. Amenta, Julia E. McGuinness, Katherine D. Crew, Rita Kukafka. Comparison of Breast Cancer vs Cardiovascular Disease Risk and Uptake of Chemoprevention vs Statins in a Cohort of Predominantly Hispanic Women Undergoing Screening Mammography [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-23.

Introduction: Cardiovascular disease (CVD) is the leading cause of approximately one-third deaths worldwide. Absolute lipid parameters are inadequate in predicting CVD risk and several lipid indices have been introduced namely “Atherogenic index of plasma” (AIP) and “Atherogenic coefficient” (AC). CVD risk of a patient for the upcoming 10 years can be calculated using atherosclerotic cardiovascular disease (ASCVD) risk calculator. Though, this method currently accepts as the gold standard, certain drawbacks have been reported. Therefore, the aim of this study was to investigate the correlation of AIP and AC with CVD risk estimation for the upcoming 10 years calculated by ASCVD risk calculator. Methods: Hundred and fifty-three patients were recruited for the study. Socio-demographic data were collected through interviewer-based questionnaire. Total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides values were obtained from the lipid profile test results of the study participants. AIP and AC were calculated using formulas while 10-year ASCVD risk was calculated by ASCVD risk calculator. Results: There was no significant correlation between AIP and 10-year ASCVD risk (p&gt;0.05) and AC and 10-year ASCVD risk (p&gt;0.05), but a significant correlation was observed between AIP and AC (Pearson’s correlation r=0.425, p&lt;0.05). Conclusions: CVD risk of patients should be assessed routinely especially as it is overlooked in most patients presenting normal lipid profile variables, hence the actual risk remains silent unless it is properly investigated using laboratory investigations

Annals for Educators - 17 November 2020.

Background: Patients with early-stage breast cancer are more likely to die from cardiovascular disease (CVD) than breast cancer. Aromatase inhibitors (AI) are used as adjuvant therapy in postmenopausal women with hormone receptor-positive breast cancer to improve survival rates, however, AI use has numerous adverse effects including increasing the risk of CVD due to negative effects on blood pressure and cholesterol levels. The American College of Cardiology/American Heart Association 2019 guidelines recommend that all patients at intermediate or high risk for CVD based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk score be on a statin. We aimed to evaluate CVD risk and statin use among racially/ethnically diverse women with breast cancer on adjuvant AI therapy. Methods: We evaluated postmenopausal women with stage I-III breast cancer treated with AIs between 2007 and 2018 at Columbia University Irving Medical Center in New York, NY. Ten-year ASCVD risk score was calculated at breast cancer diagnosis from age (20-79 years), gender (female only), race (white/black/other), serum total cholesterol (130-320 mg/dL) and HDL cholesterol (20-100 mg/dL), systolic blood pressure (90-200 mm Hg), hypertension treatment (yes/no), diabetes (yes/no), and smoking status (current/former/never). Individuals were categorized based upon their 10-year ASCVD risk as low (&amp;lt;5%), borderline (5-7.5%), intermediate (7.5-20%), or high risk (&amp;gt;20%). We used descriptive statistics and multivariable logistic regression to determine predictors of statin use among patients with intermediate or high risk ASCVD risk scores. Results: Of 363 evaluable patients, median age at diagnosis was 64 years (range, 50-80) and 35.8% were non-Hispanic white, 32.5% Hispanic, 23.4% non-Hispanic black, and 8.3% other races. Overall, the proportion of women with low risk ASCVD risk was 25.6%, borderline risk was 8.0%, intermediate risk was 37.7%, and high risk was 28.7%. Mean 10-year ASCVD risk scores were 13.7% for black women, 11.5% Hispanics, and 11.0% for white women and other races (p=0.082). The percentage of patients on statins was 50% in the intermediate risk category and 77% in the high risk category. Among those with intermediate or high ASCVD risk scores (N=240), statin use was associated with higher ASCVD risk, higher total cholesterol and systolic blood pressure, and a diagnosis of hypercholesterolemia. Conclusions: Among women with early-stage breast cancer starting adjuvant AI therapy, there is a high prevalence with intermediate and high ASCVD risk. Given the effects of AI therapy on CVD risk factors, these patients should be screened for ASCVD risk and started on statin therapy when indicated. Citation Format: Monica F Chen, Morgan Manger, Katherine D Crew. Cardiovascular disease risk and statin use among women with breast cancer treated with adjuvant aromatase inhibitor therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-07.

Several studies have shown improvement in cardiometabolic risk factors, as well as in the related mortality following bariatric surgery. However, few studies have assessed changes in the estimated cardiovascular risk. The aim of the present study was to investigate the effect of bariatric surgery on the estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk. We performed a retrospective analysis from a prospectively maintained database of patients who underwent a primary bariatric procedure from 2004 to 2018. The 10-year ASCVD risk was estimated before and after 1year of surgery using the ASCVD Risk Estimator Plus of the American College of Cardiology. Changes in the ASCVD risk were evaluated. There were 58 (51.3%) women and 55 (48.7%) men with a mean age of 49.9years. Before surgery, 64 patients had arterial hypertension, 57 T2DM, and 49 were smokers. Baseline mean estimated 10-year ASCVD risk was 8.50 ± 7.92%. Fifty-one (45.1%), 10 (8.8%), 41 (36.3%), and 11 (9.7%) patients were classified as low, borderline, intermediate, and high risk, respectively. One year after surgery, 92.9% of the patients showed a reduction of the estimated 10-year ASCVD risk. Mean values were significantly lower (5.31 ± 5.95%) when compared to basal ones (p < 0.0001). According to the risk classification, 71 (62.8%), 13 (11.5%), 26 (23%), and 3 (2.7%) were cataloged as low, borderline, intermediate, and high risk, respectively. Surgically induced weight loss leads to a significant improvement in the estimated 10-year ASCVD risk, 1year after surgery.

Estimated versus observed 10-year atherosclerotic cardiovascular event rates in a rural population-based health initiative: The Heart of New Ulm Project

BackgroundWhether Triglyceride-glucose (TyG) index is associated with 10-year risk of a first hard atherosclerotic cardiovascular disease (ASCVD) event in the United States remains unclear.MethodsIn this cross-sectional study, the participants, ranged from 40 to 79 years old, were from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. TyG index was the independent variable and 10-year risk of a first hard ASCVD was the dependent variable. The other variables, such as age, gender, race, body mass index (BMI), hypertension treatment states, smoking states and low-density lipoprotein cholesterol (LDL-C) et al. were considered as the potential confounding factors. Multivariate linear regression models and smooth curve fittings were used to evaluate the association between TyG index and 10-year risk of a first hard ASCVD event.ResultsA total of 2,142 participants were included in the analysis. The results showed that TyG index was associated with an increased 10-year risk of a first hard ASCVD event [β = 2.208, 95% (1.716, 2.700), P < 0.00001]. The association had statistical significance in both men [β = 3.862 95% CI (3.274, 4.450), P < 0.00001] and women [β = 1.067, 95% CI (0.286, 1.849), P = 0.00756)] according to subgroup analysis. Smooth curve fittings revealed that TyG index was linearly associated with 10-year risk of ASCVD in both male and female.ConclusionTriglyceride-glucose index was associated with an increased 10-year risk of a first hard ASCVD event in the United States, suggesting it is necessary to monitor and control an appropriate range of TyG index.

Association of 10-Year Atherosclerotic Cardiovascular Disease Risk Score with Carotid Atherosclerosis in Middle-Aged Abdominal Obesity Patients with Type 2 Diabetes Mellitus

Background: Identification of target organ damage and/or risk-enhancing factors help treatment decisions in hypertensive and hyperlipidaemic patients who reside in borderline to an intermediate risk category based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimates. Aim: In the present study, we aimed to investigate the comparative efficacy of certain hypertension-mediated organ damage markers (HMOD) for the prediction of 10-year ASCVD risk ≥10%, in patients with primary hypertension without established CVD. Methods: One-hundred thirty-seven asymptomatic hypertensive patients ≥40 years of age were enrolled in the present study. Ten-year ASCVD risks were estimated by Pooled Cohort Equations. The following HMOD markers; pulse pressure (PP), left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI) and estimated glomerular filtration rate (eGFR) were evaluated with respect to efficacy for predicting ≥10% ASCVD risk with ROC analysis. Results: CAVI gave the greatest Area Under Curve (AUC = 0.736, p < .000), and followed by CIMT (AUC = 0.727, p < .000), LVMI (AUC = O.630, p = .01), and PP (AUC = 0.623, p = .02). ABI and eGFR were not found to be predictive. CAVI correlated best with estimated 10-year ASCVD risk (r = 0.460, p < .000). A CAVI value ≥8 was found 71% sensitive and 72% specific for predicting ≥10% risk in 10-year ASCVD risk scale. CAVI gave the best graded response to increments in 10-year ASCVD risk categories. Conclusion: We suggest that CAVI is the best surrogate for 10-year ASCVD risk, among several HMOD markers.

Introduction and Objective: This study aimed to examine changes in the 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk in patients treated with once-weekly subcutaneous semaglutide 2.4 mg in the real-world. Methods: Adult patients with overweight or obesity were identified from a large US claims and EMR database. Propensity score weighting was used to balance the characteristics between those who initiated semaglutide 2.4 mg from June 2021 to June 2023 and were treated for at least 12 months and those who did not initiate semaglutide 2.4 mg. The 10-year ASCVD risk score was calculated in those with assessment at baseline and 12 months using the AHA/ACC algorithm. Results: A total of 161 semaglutide 2.4 mg users and 43,578 non-users were included. After balancing, baseline characteristics were similar between the two cohorts. Semaglutide 2.4 mg users were 48.0 ± 9.6 yr, 75% women, while non-users were aged 48.7 ± 11.4 yr, 73% women. Among patients with BMI measurements at baseline and 12 months, the BMI of semaglutide 2.4 mg users (n=86) reduced from 38.6 kg/m2 at baseline to 33.1 kg/m2 at 12 months (a relative change of -14.2%), while the BMI for non-users (n=22,785) remained stable from 37.6 kg/m2 to 37.2 kg/m2. At 12 months, the proportion of patients in the intermediate-high-risk category (7.5% or above) of the ASCVD risk score decreased from 14.9% to 9.3% (an absolute change of -5.6% and a relative change of -37.5%) for the semaglutide 2.4 mg users, and increased from 17.7% to 18.7% (an absolute change of +1.0% and a relative change of +5.6%) for non-users. Conclusion: In adults with overweight or obesity, semaglutide 2.4 mg led to a reduction in ASCVD risk at one year based on AHA/ACC criteria, while in non-users, the risk slightly increased in the same time frame. This highlights the potential role of semaglutide 2.4 mg on ASCVD prevention in addition to clinically meaningful weight reduction in the real-world. Disclosure A. Ruseva: None. M.E. Bassan: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. E.X. Du: Other Relationship; Novo Nordisk. A. Fabricatore: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk A/S. B.O. Hartaigh: Employee; Novo Nordisk A/S. A. Manceur: Other Relationship; Novo Nordisk. W. Michalak: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk A/S. R. Ramasubramanian: Other Relationship; Novo Nordisk. J. Song: Other Relationship; Novo Nordisk. Z. Zhao: Employee; Novo Nordisk. F. Lopez-Jimenez: Other Relationship; Anumana, Ultrasight, Anumana, Novo Nordisk.