10-year Cardiovascular Research Articles

Triglyceride Glucose Index Is Associated With Arterial Stiffness and 10-Year Cardiovascular Disease Risk in a Chinese Population.

Background: Insulin resistance (IR) is a significant risk factor for cardiovascular disease (CVD). In this study, the association of the triglyceride glucose (TyG) index, a simple surrogate marker of IR, with arterial stiffness and 10-year CVD risk was evaluated.Methods: A total of 13,706 participants were enrolled. Anthropometric and cardiovascular risk factors were determined in all participants, while serum insulin levels were only measured in 955 participants. Arterial stiffness was measured through brachial-ankle pulse wave velocity (baPWV), and 10-year CVD risk was evaluated using the Framingham risk score.Results: All participants were classified into four groups according to the quartile of the TyG index. BaPWV and the percentage of participants in the 10-year CVD risk categories significantly increased with increasing quartiles of the TyG index. Logistic regression analysis showed that the TyG index was independently associated with a high baPWV and 10-year CVD risk after adjusting for traditional CVD risk factors. The area under the receiver operating characteristics curve (AUROC) of the TyG index for predicting a high baPWV was 0.708 (95%CI 0.693–0.722, P < 0.001) in women, higher than that in men. However, the association of the homeostatic model assessment of IR (HOMA-IR) with a high baPWV and the 10-year CVD risk was absent when adjusting for multiple risk factors in 955 participants.Conclusions: The TyG index is independently associated with arterial stiffness and 10-year CVD risk.

Myocardial perfusion PET imaging to evaluate coronary microvascular dysfunction in men with prostate cancer receiving androgen deprivation therapy.

211 Background: Strategies to inform cardiovascular (CV) risk are needed for prostate cancer patients initiating androgen deprivation therapy (ADT). Reduced myocardial blood flow reserve (MBFR) and coronary microvascular dysfunction (CMD) represent functional counterparts of traditional CV risk factors, including hyperlipidemia, insulin-resistance, and the metabolic syndrome. Myocardial perfusion PET stress imaging quantifies MBFR and detects CMD. However, the potential utility of these measures to indicate adverse CV changes in prostate cancer patients receiving ADT is poorly understood. Methods: In this prospective study (NCT03535987), eligible prostate cancer patients were planned for at least 6 months of ADT and curative-intent radiation therapy. All patients had a Framingham 10-year general CV risk score of at least 10% and no prior ADT exposure. Myocardial perfusion PET stress imaging was performed within 3 weeks of ADT initiation and again following 6 months of ADT exposure. MBFR was calculated as the ratio of MBF during stress / MBF during rest, and CMD was defined per established criteria as reduced MBFR (ratio &lt; 2.0) in patients without coronary artery disease. Study outcomes included the change in MBFR following 6 months of ADT exposure and the incidence of reduced MBFR and CMD. McNemar’s test and Wilcoxon signed rank test were used for comparison of paired data. Results: Fifteen patients completed baseline myocardial perfusion PET imaging, of whom 13 completed follow-up imaging at 6 months. At baseline, the median (IQR) Framingham CV risk score was 30.4% (19.6, 35.5). One patient (7.7%) had reduced MBFR at baseline, and 5 additional patients (46.2%) developed newly reduced MBFR (ratio &lt; 2.0) within 6 months of ADT initiation (p = 0.025). While no patients had CMD at baseline, 3 patients (30%) developed incident CMD (p = 0.083). MBFR declined in 69% of patients [median decline -0.32 (IQR -0.51, -0.22)] over 6 months ADT exposure. Conclusions: Myocardial perfusion PET imaging demonstrated a high incidence of reduced MBFR and CMD within 6 months of ADT initiation. These findings support further investigation of myocardial PET imaging, a widely-available clinical tool, as a potential research and clinical strategy to inform CV risk assessment in prostate cancer patients receiving ADT. Clinical trial information: NCT03535987.

Association of cardiovascular and fracture risks in women without clinical manifestations of atherosclerosis

Aim . To study the associations of cardiovascular (CVR) and fracture risks using electronic versions of the SCORE (Systematic Coronary Risk Evaluation) and FRAX (Fracture Risk Assessment Tool) scores in women without clinical manifestations of atherosclerosis. Material and methods. This cross-sectional study included 200 female outpatients aged 45-69. All patients signed informed consent. The 10-year CVR was assessed using the high-risk SCORE charts. The 10-year risk of major osteoporotic fractures (MOF) and hip fractures was assessed using the Russian FRAX model. Bone mineral density (BMD) of the bones of the spine, femoral neck and proximal femur was measured using dual-energy X-ray absorptiometry. Statistical analysis was carried out using the Statistica.12.0, SPSS Statistics 26.0 and Excel 2016 software packages. Results. L ow CVR (SCORЕ &lt;1%) was detected in 72 (36%) women, moderate (SCORЕ ≥1% and &lt;5%) – in 124 (62%), and high (SCORЕ ≥ 5% and &lt;10%) – in 4 (2%). Depending on the CVR degree, the patients were divided into 2 groups: group I – patients with SCORE &lt;1 (low risk); group II – SCORE ≥1 (increased risk). Since bone mass is not the only but the main risk factor for fractures, the association between BMD and CVR was assessed. The SCORE ≥1 was identified in 128 women, of whom osteoporosis was diagnosed in 33 (26%), osteopenia – in 43 (34%) patients. The combination of increased CVR and absolute risk (AR) of major MOF was noted in 7 (5,5%) people. An inverse correlation was noted between CVR and BMD of the proximal femur and femoral neck. A positive correlation was also demonstrated between CVR (SCORE) and AR of MOFI and femoral neck fractures (FRAX). Multivariate regression (adjusted for age, body mass index, hypercholesterolemia) confirmed the reliability of a negative relationship between CVR and BMD of the lumbar vertebra. Conclusion. The data obtained confirm the hypothesis of multifaceted relationships of cardiovascular diseases caused by atherosclerosis with osteoporosis, manifested both at the clinical and preclinical levels, and at the level of risk formation, which makes it possible to recommend the cross-use of CVR and fracture AR scores for early primary prevention. This strategy will contribute to the early detection of combined pathology and timely preventive measures.

Cost-Effectiveness of Initiating Pharmacological Treatment in Stage One Hypertension Based on 10-Year Cardiovascular Disease Risk: A Markov Modeling Study.

Antihypertensive drug treatment is cost-effective for adults at high risk of developing cardiovascular disease (CVD). However, the cost-effectiveness in people with stage 1 hypertension (140-159 mm Hg systolic blood pressure) at lower CVD risk remains unclear. The objective was to establish the 10-year CVD risk threshold where initiating antihypertensive drug treatment for primary prevention in adults, with stage 1 hypertension, becomes cost-effective. A lifetime horizon Markov model compared antihypertensive drug versus no treatment, using a UK National Health Service perspective. Analyses were conducted for groups ranging between 5% and 20% 10-year CVD risk. Health states included no CVD event, CVD and non-CVD death, and 6 nonfatal CVD morbidities. Interventions were compared using cost-per-quality-adjusted life-years. The base-case age was 60, with analyses repeated between ages 40 and 75. The model was run separately for men and women, and threshold CVD risk assessed against the minimum plausible risk for each group. Treatment was cost-effective at 10% CVD risk for both sexes (incremental cost-effectiveness ratio £10 017/quality-adjusted life-year [$14 542] men, £8635/QALY [$12 536] women) in the base-case. The result was robust in probabilistic and deterministic sensitivity analyses but was sensitive to treatment effects. Treatment was cost-effective for men regardless of age and women aged >60. Initiating treatment in stage 1 hypertension for people aged 60 is cost-effective regardless of 10-year CVD risk. For other age groups, it is also cost-effective to treat regardless of risk, except in younger women.

Diastolic Function and Clinical Outcomes After Transcatheter Aortic Valve Replacement: PARTNER 2 SAPIEN 3 Registry

BackgroundFew studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis. ObjectivesThe authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). MethodsBaseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups. ResultsAmong the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in ≥1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01). ConclusionsIn the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 [PII S3HR/NR7]; NCT03222141)

Abstract 12725: Smokers Are Aware of Their Health Risk

Background: Health checkup results, even if 12-lead ECG and chest X-ray are included, usually do not reflect risk of smoking and it may lead smokers to continue smoking. Therefore, to show specific risk amount of smoking, 10-year cardiovascular (CV) risks were calculated with and without smoking at the same level of other risk factors and the information was sent to the smokers. Smoking cessation rate was compared between smokers with and without the information. Methods: In subjects who had the annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 2018, the brochure which included the 2 values of 10-year CV risks calculated by the Framingham risk score (2008) based on the results of the health checkup was sent to male smokers aged 40 between 74 with no history of CV disease and the 10-year CV risk between 10% and 40%. Male smokers with the same condition were extracted from subjects who had the annual health checkup in 2017 as the control subjects. Smoking cessation was evaluated at the health checkup next year. Results: The brochure was sent to 499 smokers in 2018 and 344 of those received the health checkup in 2019. The 10-year CV risk of smokers was 1.80±0.05 times higher than that of non-smokers at the same level of other risk factors. As the control subjects, 568 smokers were extracted from 2017 checkup and 407 of those received the health checkup in 2018. Clinical characteristics of the 2018 checkup (n=344) and the 2017 checkup (n=407) groups were similar in terms of age, clinical risk factors, duration of smoking and number of cigarettes smoked per day. Smoking cessation rate of the 2018 checkup group next year was 7.0% while that of the 2017 checkup group was 7.1%. By the logistic regression analysis adjusted for age, duration of smoking and number of cigarettes smoked per day, smoking cessation rate of the 2018 checkup group was not higher than that of the 2017 checkup group (odds ratio=0.97, 95% confidence interval=0.55 to 1.71, p=0.9131). Conclusions: Showing specific amount of risk by smoking was not helpful for smoking cessation. Most smokers seem to be aware of the risk. To promote smoking cessation, interventions such as increased price of cigarette and/or limitation of smoking area may be more practical than emphasizing health hazards of smoking.

Abstract 14505: Risk Reclassification by Circulating Immune Markers in Ambulatory Us Adults Without Prevalent Cardiovascular Diseases: Insights From National Health and Nutrition Examination Survey

Introduction: Inflammation is associated with worse cardiovascular (CV) prognosis. We evaluated the impact of adding elevated monocyte lymphocyte ratio (MLR) to 10-year atherosclerotic CV disease (ASCVD) risk score. Hypothesis: Adding elevated MLR improves risk classification by 10-year ASCVD risk score. Methods: We used data from 6 cycles of NHANES (1999-2010) to identify ambulatory US adults aged ≥ 18 years without prevalent cardiovascular disease and total leukocyte count in normal range (4,000-11,000 cells/μL). Elevated MLR (≥0.3) was defined using optimal cutoff to predict CV mortality by Youden index. CV mortality was derived from linked National Center for Health Statistics data. We compared the change in reclassification of the 10-year ASCVD risk score at a pre-specified cutoff of 5% (low risk) and reported the net reclassification index (NRI). We further compared predictive value of the circulating immune with risk factors in ASCVD risk score using time-to-event and logistic models. Results: Among 21,599 eligible participants with median age 47 years (IQR, 34, 63; 49.2% women and 49.5% non-Hispanic White), there were 627 CV deaths with annual incidence rate of 0.3% over median follow-up of 9.6 years (IQR 6.8, 13.1). Median ASCVD risk score was 5% (IQR 1.6, 16.7). Adding elevated MLR to categorical 10-year ASCVD risk score correctly up classified 3.2% participants with CV mortality and incorrectly up classified 0.4% participants with no CV mortality. There was significant improvement in risk classification (NRI 2.7±1.4%, p=0.044, Panel A). Adding elevated CRP (≥0.3 mg/dL) did not change risk class (NRI -0.2±0.0%, p=827, Panel B). Among ASCVD components, MLR had higher predictive value than race, smoking, high-density lipoprotein, and total cholesterol in both time-to-event and logistic models. Conclusions: Elevated MLR significantly improves CV risk reclassification in ambulatory adults without prevalent CV disease and is better than CRP.

Abstract 16350: Predicted versus Observed 10-year Cardiovascular Event Rates in a Rural Population-Based Health Program: The Heart of New Ulm Project

Introduction: Assessment of 10-year ASCVD risk via the Pooled Cohorts Equation (PCE) is a standard component of the clinician-patient risk discussion to aid treatment decisions for the primary prevention of ASCVD. However, calibration of the PCE to modern populations remains a concern. Methods: We studied a sample of individuals participating in the Heart of New Ulm (HONU) Project, a population-based health program aimed at reducing ASCVD risk in a rural, agricultural community of New Ulm, Minnesota. HONU collected baseline survey data on 5,221 individuals in 2009. For this analysis, we included participants who were aged 40-79 years, free of ASCVD at baseline and had adequate data to calculate 10-year ASCVD risk. New Ulm is served by a single healthcare system, allowing surveillance via electronic health records (EHR). EHR data and state death records were used to determine rates of non-fatal myocardial infarction and stroke, and ASCVD death from 2010-2019. ASCVD event rates were compared to estimated 10-year risks calculated using the PCE, and stratified by sex and clinically relevant risk categories. Results: The sample (n=2,819, mean age 56.1 ± 9.9 years, 59.6% female) had a low prevalence of tobacco use (8.1% current smokers), diabetes (6.5%) and higher prevalence of hypertension (44.4%) and hyperlipidemia (56.6%). The median estimated 10-year ASCVD risk for the entire sample was 5.7% (interquartile range 2.3 -13.5%) with an observed 10-year ASCVD event rate of 3.4%. ASCVD rates were lower than predicted across all risk categories in both men and women, especially in those with a 10-year risk ≥7.5% (Table). Conclusion: In a rural sample exposed to ASCVD risk reduction efforts, observed rates of ASCVD were substantially lower compared to estimated ASCVD risk. The uncertainty of current risk models and the potential for significantly lower than predicted ASCVD event rates in certain populations should be included in the clinician-patient risk discussion.

Abstract 15663: Prediction of 5-year Cardiovascular and All-cause Mortality After Myocardial Infarction in United States Veterans

Objective: This is a large prospective study aimed to develop risk prediction models of CVD and all-cause mortality in patients who survived MI. Methods: Using 2002-2012 national electronic health record data from the Veterans Health Administration, sex-specific risk prediction models for CVD and all-cause death were developed from the 5-year follow-up data of 100,601 first MI survivors aged &gt;30 years. Model performance was evaluated using a 5-fold cross-validation approach. Results: We followed 98,657 male and 1,944 female MI survivors up to 5 years (407,199 person-years). There were 31,622 deaths (men 31,147, women 475) and 12,901 CVD deaths (men 12,752, women 149) observed during follow up. Among men, greater age, current smoking, diabetes, atrial fibrillation, heart failure, peripheral artery disease, geographic region, and lower BMI (&lt;20kg/m 2 ) were associated with increased risk of subsequent CVD and all-cause-mortality, while statin treatment, hypertension medication, beta-blocker, eGFR level, and high BMI (≥25 kg/m 2 ) were significantly associated with reduced risk of CVD and all-cause-mortality. Similar associations were generally observed among women. We observed U-shaped relations between total cholesterol and outcomes, and HDL cholesterol and outcomes. The prediction models demonstrated good discrimination and calibration. The estimated Harrell’s C-statistics of the final models versus the cross-validation estimates were similar, ranging from 0.75 to 0.81. The predicted risk of death was well-calibrated compared to observed risk. Conclusions: We developed and validated risk prediction models of 5-year risk for CVD and all-cause death for patients following MI. Traditional risk factors, co-morbidity, lack of blood pressure or lipid treatment, and geographic region were all associated with greater risk of CVD and all-cause mortality.

Effects of Handgrip Strength on 10-Year Cardiovascular Risk among the Korean Middle-Aged Population: The Korea National Health and Nutrition Examination Survey 2014.

Handgrip strength is a simple, inexpensive health status indicator and can be used to assess mortality rate and cardiovascular disease (CVD) risk. This study used data from the Sixth Korea National Health and Nutrition Examination Survey (2014) to determine the effective use of handgrip strength to predict CVD risk. We analyzed data from 2427 adults aged from 40 to 64 years without CVD at baseline. Relative handgrip strength was calculated as the sum of the maximal absolute handgrip strength of both hands divided by body mass index, and the 10-year risk of CVD was calculated using the Framingham risk score. We performed logistic regression analysis to assess the association between handgrip strength and 10-year CVD risk. Results showed that CVD risk increased with age (95% CI: 1.19–1.33, p < 0.001). Men were 38.05 times more likely to develop CVD than women (95% CI: 15.80–91.58, p < 0.001). Every increase by 1 in handgrip strength reduced the 10-year CVD risk by 1.76 times (95% CI: 1.58–3.71, p < 0.001), and when waist-to-height ratio was <0.50, the CVD risk decreased by 3.3 times (95% CI: 0.16–0.56, p < 0.001). Developing specific modifications and improving lifestyle habits that could lead to increased handgrip strength and reduced obesity, which could prevent CVD, is recommended.

Premature acute coronary syndrome

Abstract Introduction The prevalence of acute coronary syndrome (ACS) at an early age is rising, resulting in higher morbidity and mortality rates. Purpose To characterize patients admitted with premature ACS, comparing with those with non-premature ACS. Methods A retrospective study encompassing patients of a National Registry of ACS was performed. We compared two groups: one composed of men &amp;lt;55 and women &amp;lt;65 years-old; and other with men ≥55 and women ≥65 years-old at the ACS admission. Clinical characteristics, in-hospital evolution and 1-year clinical outcomes were analysed. Primary endpoint was the composite of in-hospital mortality, stroke and re-myocardial infarction (MI). Secondary endpoints were re-MI, stroke, in-hospital and 1-year mortality, 1-year cardiovascular (CV) and non-CV readmissions. Results A total of 26523 patients were enrolled and 6637 (25%) had premature ACS, with a mean age of 49±7 years-old. It was found a larger prevalence of smoking habits, obesity and dyslipidemia, but not diabetes. ST-segment elevation MI (STEMI) was the main admission diagnosis (51,2% vs 40,3%), with more frequent activations of the STEMI network (17,1% vs 12,8%) and a consequently shorter time from symptom onset to admission (483 vs 584 min). Coronary angiogram was largely performed in younger patients (91,4% vs 82,1%), mainly revealing one-vessel disease (49,3% vs 34,3%). They had lower Killip-Kimbal (KK) class (6% vs 18,1% with KK class &amp;gt;1) and mostly preserved left ventricular ejection fraction (LVEF) (67,3% vs 58,6%). Major bleeding (0,9% vs 1,7%), sustained ventricular tachycardia (1,1% vs 1,5%) and mechanical complications (0,2% vs 0,7%) were uncommon. Composite endpoint was more frequent in non-premature ACS patients (6,2% vs 1,9%). Non-premature age, KK class &amp;gt;1, multivessel disease and depressed LVEF were independent predictors of primary endpoint (each with p&amp;lt;0,001). Younger patients had inferior rates of in-hospital mortality (1% vs 4,7%), re-MI (0,5% vs 1%) and stroke (0,4% vs 0,7%). One-year mortality (1,7% vs 9,1%), and 1-year CV (9,7% vs 15,5%) and non-CV readmissions (3,7% vs 8,2%) were also lower. All comparative data presented have a statistically significant p-value (p&amp;lt;0,012). Conclusions Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, primary prevention is essential to correct modifiable CV risk factors and reduce coronary events in these patients. Funding Acknowledgement Type of funding source: None

Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex.

ResumoFundamento:A circunferência do pescoço (CP) é uma medida indireta do tecido adiposo subcutâneo da parte superior do corpo, apontada como um preditor independente de doenças cardiometabólicas.Objetivos:Verificar a associação entre a CP e o risco cardiovascular em 10 anos (risco de doença cardiovascular [DCV] em 10 anos) em homens e mulheres separadamente.Métodos:Análise seccional com inclusão de 13.920 participantes da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). A associação entre a CP (utilizada como variável contínua e agregada em quartis) e o risco de DCV em 10 anos, estimado pelo Framingham Global Risk Score (FGRS), foi investigada por meio de modelos lineares generalizados após ajustes por características sociodemográficas, comportamentos em saúde, índice de massa corporal e circunferência da cintura. O nível de significância estatístico adotado foi de 5%.Resultados:A média da CP foi de 39,5 cm (desvio-padrão [DP] de ± 3,6) nos homens e 34,0 cm (DP de ±2,9) nas mulheres. Após ajustes, o aumento de 1 cm na CP foi associado ao incremento de 3% (IC 95%: 1,02 a 1,03) e 5% (IC 95%: 1,04 a 1,06) na média aritmética do risco de DCV em homens e mulheres, respectivamente. No último quartil da CP, homens e mulheres apresentaram um incremento de 18% (IC 95%: 1,13 a 1,24) e 35% (IC 95%: 1,28 a 1,43), respectivamente, na média aritmética do risco de DCV após ajustes.Conclusões:Verificamos associação positiva e independente entre a CP e o risco de DCV em 10 anos. Resultados sugerem que a CP pode contribuir para a predição de risco cardiovascular além daquele observado pelas medidas antropométricas clássicas.

An invasive strategy is associated with improved short- and long-term outcomes in acute myocardial infarction independently of frailty status and GRACE score: a nationwide analysis of 12144 episodes

Abstract Introduction Frailty is common among patients presenting with acute myocardial infarction (MI), who have conflicting risks regarding benefits and harms of invasive procedures. Purpose To assess the clinical management and prognostic impact of invasive procedures in frail MI patients in a real-world scenario. Methods We analysed 5422 episodes of ST-elevation MI (STEMI) and 6692 of Non-ST-elevation MI (NSTEMI) recorded from 2010–2019 in a nationwide registry. A validated deficit-accumulation model was used to create a frailty index (FI), comprising 22 features [BMI &amp;gt;25kg/m2, myocardial infarction, angina, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), valvular disease, bleeding, pacemaker/implantable cardioverter defibrillator, chronic kidney disease (creatinine &amp;gt;2.0mg/dL), dialysis/renal transplant, stroke/transient ischaemic attack, diabetes, hypertension, dyslipidaemia, smoking, peripheral vascular disease, dementia, chronic lung disease, malignancy, polymedication (&amp;gt;3 cardiovascular drugs), admission haemoglobin &amp;lt;10g/dL; not including age]. Episodes with missing data on any FI parameter were not included. Frailty was initially defined as FI&amp;gt;0.25 (i.e. ≥6 features). Results Overall, 511 (9.4%) STEMI and 1763 (26.4%) NSTEMI patients were considered frail. Angiography, PCI and CABG were less frequently performed in frail patients (p&amp;lt;0.001). Delayed angiography (&amp;gt;72h) was more common among NSTEMI frail patients (p&amp;lt;0.001), and radial access was less commonly used overall (p&amp;lt;0.001). Guideline-recommended in-hospital medical therapy, including aspirin (NSTEMI), dual-antiplatelet therapy (STEMI/NSTEMI), heparin/heparin-related agents (NSTEMI), beta-blockers (STEMI) and ACEIs/ARBs (STEMI), was less commonly used in frail patients; discharge medical therapy exhibited similar patterns. Frail patients had longer hospital stay and increased in-hospital all-cause and cardiovascular (CV) mortality, as well as 1-year all-cause and CV hospitalization and all-cause mortality (p&amp;lt;0.001). Using receiver-operator-characteristics curve analysis, FI cutoffs of 0.11 (STEMI) and 0.20 (NSTEMI) yielded the best accuracy to predict 1-year all-cause mortality (area under the curve: 0.629 and 0.702 respectively, p&amp;lt;0.001) – these cutoffs were subsequently used to define frailty. Although frailty attenuated in-hospital risk reductions from angiography (STEMI/NSTEMI) and PCI (NSTEMI only) (Wald test p&amp;lt;0.05), their 1-year prognostic benefit remained unaffected (Wald test p&amp;gt;0.05). Angiography and PCI were associated with improved in-hospital and 1-year outcomes, independently of frailty status or GRACE score (p&amp;lt;0.001). Conclusion Frail MI patients are less commonly offered standard therapy; however, angiography and PCI were associated with short- and long-term prognostic benefits regardless of frailty status or GRACE score. Increased adherence to current recommendations might improve post-MI outcomes in frail patients. Invasive strategy and 1-year outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): Portuguese Society of Cardiology

Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality?

Abstract Background Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Purpose Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients. Methods A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P. A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year. Results A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001). In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047). Conclusion In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality. Funding Acknowledgement Type of funding source: None

Temporal trends in cause-specific readmissions and their risk factors in heart failure patients in Sweden

Abstract Background It remains unclear whether readmissions of patients with heart failure (HF) have decreased over time in an era of improved therapy and management of HF. This study aimed to determine the temporal short- and long-term trends of cause-specific rehospitalization and their risk factors in a Swedish context. Methods HF patients in the Swedish Heart Failure Registry (SwedeHF) were investigated. Maximum follow-up time was 1 year. Outcomes included the first occurrence of all-cause, cardiovascular (CV) and HF rehospitalizations. Cox proportional hazards models were performed to determine the impact of increasing years on risk for rehospitalization and its known risk factors. Results Totally, 25,644 index-hospitalized HF patients SwedeHF from 2004 to 2011 were enrolled in the study. For 8 years, the incidence risk of 1-year all-cause rehospitalization remained unchanged, whereas the incidence risk of CV (P=0.038) or HF (P=0.0038) rehospitalization decreased. After adjustment for age and sex, a 3% decrease per every second year was observed for 1-year CV and HF rehospitalizations (P&amp;lt;0.05). However, time to the first occurring all-cause, CV and HF rehospitalization did not change significantly from 2004–2011 (P-values 0.13–0.87). When two study periods (2004–2005 vs. 2010–2011) were compared, the risk factor profile for rehospitalization was found to change. Conclusions Throughout the 8-year study period, CV- and HF-related rehospitalizations decreased, whereas all-cause rehospitalization remained unchanged, indicating a parallel increase in non-CV rehospitalization in the HF patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish Society of Cardiology and the Swedish Heart-Lung Foundation.

Post-infectious myocardial infarction: does percutaneous coronary intervention improves outcomes?

Abstract Introduction and objectives Acute infections are frequent triggers for myocardial infarction (MI), and associated with poor prognosis. However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis remains unknown. We aimed to evaluate the prognostic impact of PCI at the acute phase of post-infectious MI in patients with significant coronary stenosis. Methods Observational study in 4573 consecutive MI patients of the RICO Survey in coronary units, of whom 476 patients (10%) had a concurrent diagnosis of acute infection at admission. Among them, 321 patients with a significant stenosis (&amp;gt;50%) at coronary angiography were analysed. After propensity score matching based on clinical and angiography data, in-hospital and one-year outcomes were compared between patients with and without PCI. Results Among the 321 patients (mean age 74y), most (n=195 (61%)) underwent PCI. Acute atherothrombotic event (type 1 MI) and STEMI were much more frequent in the PCI group (53 vs 19%, p&amp;lt;0.001, and 51% vs 32%, p=0.001, respectively). As expected, Troponin Ic peak was almost 3 times higher in the PCI group (17 [4–72] vs 6 [1–20] ng/mL, p&amp;lt;0.001). Coronary lesions were less severe in the PCI group (3-vessels disease: 36% vs 52%, p&amp;lt;0.004; SYNTAX score: 11 [6–19] vs 19 [11–28], p&amp;lt;0.001). At one year follow up, recurrence rate (5% for both groups, p=0.8), and cardiovascular (CV) mortality (15% vs 13%, p=0.6) were similar for both groups. After propensity score matching, in-hospital (OR = 1.45 (0.43–4.85), p=0.5) and 1-year CV mortality: OR = 1.73 (0.66–4.54), p=0.3) were similar in patients with and without PCI. Conclusion In this first observational work investigating treatment strategy in post-infectious MI, PCI might not improve short and long-term prognosis. These findings do not support the use of systematic invasive procedures after post-infectious MI. Interventional studies are urgently needed to confirm these findings. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Agence Régionale de Santé Bourgogne Franche Comté, CHU Dijon Bourgogne

Determinants of Metabolic Syndrome and 5-Year Cardiovascular Risk Estimates among HIV-Positive Individuals from an Indian Tertiary Care Hospital.

Longer survival due to use of antiretroviral therapy (ART) has made human immunodeficiency virus- (HIV-) infected individuals prone to chronic diseases such as diabetes, hypertension, and cardiovascular diseases (CVD). Metabolic syndrome (MS), a constellation of risk factors which increase chances of the cardiovascular disease and diabetes, can increase the morbidity and mortality among this population. Hence, the present study was conducted with the objectives of estimating the prevalence and determinants of MS among ART naïve and ART-treated patients and assess their 5-year CVD risk using the reduced version of Data Collection on Adverse Effects of Anti-HIV Drugs (D : A : D) risk prediction model (D : A : D(R)). This hospital-based cross-sectional study included 182 adults aged ≥ 18 years. MS was defined using the National Cholesterol Education Program-Adult Treatment Panel-3 (NCEP ATP-3) criteria. Univariate and multivariate logistic regressions were done to identify the factors associated with MS. Prevalence of MS was 40.1% (95% confidence interval (CI) = 33.0%–47.2%). About 24.7% of the participants had at least a single criterion for MS. Age >45 years (adjusted odds ratio (AOR) = 2.3; 95% CI = 1.1–4.9, p < 0.018) and body mass index (BMI) > 23 kg/m2 (AOR = 6.4; 95% CI = 3.1–13.1, p < 0.001) were positively associated with MS, whereas daily consumption of high sugar items was inversely associated (AOR = 0.2; 95% CI = 0.1–0.5, p < 0.001). More than 50% of the participants were found to have moderate or high 5-year CVD risk. Observed prevalence of MS among HIV patients was higher than other studies done in India. Considering a sizeable number of participants to be having moderate to high CVD risk, culturally appropriate lifestyle interventions need to be planned.

A Cross-Sectional Examination of 10-Year Atherosclerotic Cardiovascular Disease Risk Among US Firefighters by Age and Weight Status.

Objective:Examine atherosclerotic cardiovascular disease (ASCVD) risk scores by age and weight status in career firefighters.Methods:Medical examinations for firefighters more than or equal to 40 years (n = 644) were examined. ASCVD 10-year risk scores were calculated from sex- and race-specific equations and were reported by three age (40 to 44.9, 45 to 49.9, more than or equal to 50 years) and weight (normal, overweight, obese) categories.Results:Mean risk scores were 1.8%, 3.5%, and 6.2% for firefighters 40 to 44.9, 45 to 49.9, and more than or equal to 50 years, respectively. The association of weight status with increased ASCVD risk was higher (P < 0.01) among older firefighters, where risk was 0.8% (95% confidence interval [CI]: 0.6 to 1.1) and 2.3% (95% CI: 2.0 to 2.6) among normal versus obese 40 to 44.9 year olds, and 4.1% (95% CI: 3.1 to 5.3) and 7.8% (95% CI: 6.7 to 8.9) among normal versus obese more than or equal to 50 year olds.Conclusions:While firefighters cannot avoid aging, physicians should counsel firefighters with weight-maintenance or weight-loss advice to prevent and manage elevated ASCVD risk.

Improvement of the 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Following Bariatric Surgery.

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.

Abstract 243: Long-term Effects of ACC/AHA Cholesterol Control on Cardiac Function

Background: The impact of long term strict cholesterol control on reservoir function and outcome in heart failure is unclear. Methods: We retrospectively analyzed 2939 patients (31.9% female, mean age 65.1±11.8 years) whom strict application of ACC/AHA cholesterol management with an average length of 9.4 years of follow-up. We also evaluated the ventricular ejection fraction, mass, and Global sore (Framingham-CVD), as well as 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Results: Overall, 64.3% of patients were identified as strictly cholesterol control (case group). As compared to age-gender-race matched control group, patients in cases group have higher LV mass (152.9±34.4g vs. 143.6±34.4 g, p=0.0005) as well as an LV mass index (90.5±18.1 vs. 85 ±17 g/m2 vs. g/m2, P=0.0002) and Framingham Global CVD Risk score (18.9±17.7 vs. 8.6±17.3, P&lt;0.001), but not for LVEF (68.5%±7.5% vs. 69.1%±6.6%, p=0.263). The average percentage decrease in LVEF in patients with mild coronary artery calcification (CAC score&lt;100) in cases is 6.2%, and when CAC score&gt;400, the LVEF decreased up to 15.3% regardless of the cholesterol control status. Major coronary arteries with severe calcification are associated with increasing the risk of abnormal ejection fraction (LVEF&lt;50%) 4.84 times after adjusting for traditional CAD risk factors. Long-term ACC/AHA cholesterol control can not prevent the ASCVD risk score increase (Table 1). Conclusions: The strict long-term application of ACC/AHA cholesterol control can effectively LV mass change. However, this strategy does not adequately prevent LV systolic function attenuation. The 10-Year ASCVD risk score is one of the robust indicators of cardiac function for long-term lipid control outcomes. Abbreviations: LAD: left anterior descending, LCX: circumflex coronary arteries, RCA: right coronary artery. CTA: coronary computed tomography angiogram. LVEF:Left Ventricular Ejection Fraction