Address Cardiovascular Disease Risk Research Articles

P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY

Background and objective: Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia. Methods: Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development. Results: The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP. Conclusions: The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.

Precision Nutrition for Management of Cardiovascular Disease Risk during Menopause.

Women can spend up to 40% of their lives in the postmenopausal state. As women begin to transition into menopause, known as perimenopause, changes in hormonal concentrations and body composition dramatically increase overall cardiometabolic risk. Dietary patterns and interventions can be utilized to prevent and treat cardiovascular disease (CVD) and some dietary patterns over others may be more beneficial due to their specific effects on the health aspects of menopause. In this narrative review, we summarize key cardiovascular alterations that occur during the menopause transition and explore current dietary recommendations to address CVD risk as well as explore the new frontier of precision nutrition and the implications for nutrition prescription during menopause. Popular dietary interventions for CVD such as the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet (MED) have limited data in women following menopause. However, both diets improve CVD risk biomarkers of total cholesterol and low-density lipoprotein cholesterol as well as lower oxidative stress and inflammation and improve endothelial function. As the menopause transition increases the risk for developing metabolic syndrome, insulin insensitivity, and dyslipidemia, the DASH diet and MED may be impactful dietary strategies for mediating CVD risk in menopausal women. However, these are "one-size-fits-all" approaches that neglect individual characteristics such as genetic predisposition and environmental factors. Precision nutrition considers individual factors for nutrition prescription, spanning from evaluating food intake preferences and behaviors to deep phenotyping. Data from a large-scale investigation of the menopause transition suggests nutritional strategies that address postprandial glycemic responses, and the gut microbiome may attenuate some of the unfavorable effects of menopause on CVD risk factors. Considering menopause, women are a clinical population that would greatly benefit from precision nutrition. Future research should explore the use of machine learning and artificial intelligence in a precision nutrition framework to modify the DASH diet and MED to address adverse effects that occur during the menopause transition are vital for supporting women's health as they age.

Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research.

Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.

A Comprehensive Literature Review on Managing Systemic Lupus Erythematosus: Addressing Cardiovascular Disease Risk in Females and Its Autoimmune Disease Associations.

This review aimed toevaluate the mechanism of premature cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) patients, particularly in the female population, and emphasize the need for early management interventions; explore the association between SLE and two autoimmune diseases, myasthenia gravis (MG) and antiphospholipid antibody syndrome (APS), and their management strategies; and evaluate the effectiveness of pharmacological and non-pharmacological interventions in managing SLE, focusing on premenopausal females, females of childbearing age, and pregnant patients. We conducted a comprehensive literature review to achieve these objectives using various databases, including PubMed, Google Scholar, and Cochrane. The collected data were analyzed and synthesized to provide an evidence-based overview of SLE, its management strategies as an independent disease, and some disease associations.The treatment should be focused on remission, preventing organ damage, and improving the overall quality of life (QOL). Extensive emphasis should also be focused on diagnosing SLE and concurrent underlying secondary diseases timely and managing them appropriately.

NAFLD: An Emerging Causal Factor for Cardiovascular Disease.

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide that poses a significant threat to human health. Cardiovascular disease (CVD) is the leading cause of mortality in NAFLD patients. NAFLD and CVD share risk factors such as obesity, insulin resistance, and type 2 diabetes. However, whether NAFLD is a causal risk factor for CVD remains a matter of debate. This review summarizes the evidence from prospective clinical and Mendelian randomization studies that underscore the potential causal relationship between NAFLD and CVD. The mechanisms of NAFLD contributing to the development of CVD and the necessity of addressing CVD risk while managing NAFLD in clinical practice are also discussed.

HealthyRHearts - reducing cholesterol in rural adults via telehealth-based medical nutrition therapy: protocol for a cluster randomised controlled trial

BackgroundFew randomised controlled trials specifically focus on prevention in rural populations. Cardiovascular disease (CVD) contributes to approximately one quarter of deaths in Australia. Nutrition is a key component affecting many risk factors associated with CVD, including hypercholesterolaemia. However, access to medical nutrition therapy (MNT) is limited for people living in rural areas, potentially exacerbating inequities related to health outcomes. Telehealth services present an opportunity to improve MNT access and address healthcare disparities for rural populations. The present study aims to evaluate feasibility, acceptability, and cost-effectiveness of a telehealth MNT CVD intervention program in lowering CVD risk over 12-months in regional and rural primary health care settings.Methods/designA cluster randomised controlled trial set in rural and regional general practices in NSW, Australia, and their consenting patients (n = 300 participants). Practices will be randomised to either control (usual care from their General Practitioner (GP) + low level individualised dietetic feedback) or intervention groups (usual care from their GP + low level individualised dietetic feedback + telehealth MNT intervention). Telehealth consultations will be delivered by an Accredited Practising Dietitian (APD), with each intervention participant scheduled to receive five consultations over a 6-month period. System-generated generic personalised nutrition feedback reports are provided based on completion of the Australian Eating Survey – Heart version (AES-Heart), a food frequency questionnaire. Eligible participants must be assessed by their GP as at moderate (≥ 10%) to high (> 15%) risk of a CVD event within the next five years using the CVD Check calculator and reside in a regional or rural area within the Hunter New England Central Coast Primary Health Network (HNECC PHN) to be eligible for inclusion. Outcome measures are assessed at baseline, 3, 6 and 12 months. The primary outcome is reduction in total serum cholesterol. Evaluation of the intervention feasibility, acceptability and cost-effective will incorporate quantitative, economic and qualitative methodologies.DiscussionResearch outcomes will provide knowledge on effectiveness of MNT provision in reducing serum cholesterol, and feasibility, acceptability, and cost-effectiveness of delivering MNT via telehealth to address CVD risk in rural regions. Results will inform translation to health policy and practice for improving access to clinical care in rural Australia.Trial registrationThis trial is registered at anzctr.org.au under the acronym HealthyRHearts (Healthy Rural Hearts), registration number ACTRN12621001495819.

Systematic review and meta-analysis of church-based interventions to improve cardiovascular disease risk factors

BackgroundChurch-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective. MethodsSystematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted. ResultsA total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13). ConclusionsChurch-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.

Endometrial cancer survivors' perceptions of their cardiovascular disease risk (results from WF-1804CD AH-HA)

ObjectiveDespite considerable burden of cardiovascular disease (CVD), data on endometrial cancer survivors' CVD perceptions are lacking. We assessed survivors' perspectives on addressing CVD risk during oncology care. MethodsThis cross-sectional analysis utilized data from an ongoing trial of an EHR heart health tool (R01CA226078 & UG1CA189824) conducted through the NCI Community Oncology Research Program (NCORP, WF-1804CD). Endometrial cancer survivors post-potentially curative treatment were recruited from community practices and completed a pre-visit baseline survey, including American Heart Association Simple 7 CVD factors. Likert-type questions assessed confidence in understanding CVD risk, CVD risk perception, and desired discussion during oncology care. Medical record abstraction ascertained data on CVD and cancer characteristics.Results: Survivors (N = 55, median age = 62; 62% 0–2 years post-diagnosis) were predominately white, non-Hispanic (87%). Most agreed/strongly agreed heart disease poses a risk to their health (87%) and oncology providers should talk to patients about heart health (76%). Few survivors reported smoking (12%) but many had poor/intermediate values for blood pressure (95%), body mass index (93%), fasting glucose/A1c (60%), diet (60%), exercise (47%) and total cholesterol (53%). 16% had not seen a PCP in the last year; these survivors were more likely to report financial hardship (22% vs 0%; p = 0.02). Most reported readiness to take steps to maintain or improve heart health (84%). ConclusionsDiscussions of CVD risk during routine oncology care are likely to be well received by endometrial cancer survivors. Strategies are needed to implement CVD risk assessment guidelines and to enhance communication and referrals with primary care.Clinical Trials #: NCT03935282

Genetic liability to age at first sex and birth in relation to cardiovascular diseases: a Mendelian randomization study

BackgroundGrowing evidence suggests that various reproductive factors, including early menarche, early menopause, and age at first birth, may increase the risk of developing cardiovascular disease (CVD) later in life. However, the associations between reproductive factors and CVDs are inconsistent and controversial. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential links between age at first sex (AFS) and age at first birth (AFB) and several CVDs.MethodsWe obtained summary statistics for exposure from the largest genome-wide association studies of AFS and AFB. To serve as instrumental variables, we selected 259 SNPs associated with AFS and 81 SNPs associated with AFB at the genome-wide significance level. We employed a random-effects inverse-variance weighted method to pool estimates, and conducted multivariable MR analysis to determine the direct association between AFS and AFB with CVDs, while accounting for the effects of confounders.ResultsThe genetic liability to later AFS was associated with decreased risks of heart failure (odd ratio [OR] 0.700; 95% confidence interval [CI] 0.639–0.767; p = 2.23 × 10−14), coronary artery disease (OR 0.728; 95% CI 0.657–0.808; p = 1.82 × 10−9), myocardial infarction (OR 0.731; 95% CI 0.657–0.813; p = 8.33 × 10−9), stroke (OR 0.747; 95% CI 0.684–0.816; p = 6.89 × 10−11), and atrial fibrillation (OR 0.871; 95% CI 0.806–0.941; p = 4.48 × 10−4). The genetic liability to later AFB was also associated with decreased risks of CVDs, including myocardial infarction (OR 0.895; 95% CI 0.852–0.940; p = 8.66 × 10−6), coronary heart disease (OR 0.901; 95% CI 0.860–0.943; p = 9.02 × 10−6), heart failure (OR 0.925; 95% CI 0.891–0.961; p = 5.32 × 10−5), and atrial fibrillation (OR 0.944; 95% CI 0.911–0.978; p = 0.001). However, no association was found between AFB and stroke. The associations remained independent from the effects of AFS and AFB on potential confounders, including smoking, alcohol intake, body mass index, and depression. Mediation analysis suggested that education attainment partly mediates the link from AFS and AFB to CVD outcomes.ConclusionOur results observed a causal relationship between later AFS, AFB and lower CVDs risk; it emphasizes the importance of providing sex education since early sex and birth may have undesirable effects. Cardiovascular risk stratification that considers reproductive factors may help address CVD risk.

Abstract P400: Effectiveness and Acceptability of Dietary Telehealth Interventions Targeting Cardiovascular Disease Risk Factors: A Systematic Review and Meta-Analysis

Introduction: Dietary telehealth interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic. Objective: To examine (1) effectiveness of dietary telehealth interventions in improving diet-related CVD risk factors and (2) their acceptability among CVD patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that examined the effect of dietary telehealth interventions on CVD risk factors (Table 1) among adult CVD patients. Two investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms, and included English language RCTs published before July 2022. Pooled data for each CVD outcome were assessed using a random effects model, and mean difference (MD), standardized MD (SMD), or risk ratio (RR) were calculated using R software. Results: A total of 15 RCTs with 3,751 participants were included in the analysis. Participants had a mean age (SD) of 60.9 (3.6) years, 23.3% were women. Most RCTs were conducted in the US (33.3%) and in urban areas (93.3%). Interventions involved either phone calls, apps, texts, or websites, and follow-up durations ranged from 4 to 56 weeks. Of the 15 studies, 4 were of high quality, 10 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD: -3.01 [95% CI: -4.75 to -1.28]) and low-density lipoprotein cholesterol (SMD: -0.11 [95% CI: -0.19 to -0.03]) to significantly favor dietary telehealth interventions compared to usual care among CVD patients. There was no significant difference between the acceptability of dietary telehealth interventions and usual care. Significant I 2 indicated moderate to considerable heterogeneity. Conclusions: Dietary telehealth interventions show promise in addressing CVD risk factors.

Drivers of cardiovascular disease risk factors in slums in Kampala, Uganda: a qualitative study

ABSTRACT Background Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease. Objective This study explored the drivers of CVD risk factors in slums in Kampala, Uganda. Methods This qualitative study employed focus group discussions (FGDs) to collect data among slum residents. A total of 10 FGDs separate for gender and age group were held in community public places. Discussions were audio-recorded, transcribed, and transcripts analysed thematically with the aid of Atlas ti 7.0. Study themes and sub-themes are presented supported by participant quotations. Results Five themes highlighted the drivers of CVD risk factors in slum communities. (1) Poverty: a critical underlying factor which impacted access and choice of food, work, and housing. (2) Poverty-induced stress: a key intermediate factor that led to precarious living with smoking and alcohol use as coping measures. (3) The social environment which included socialisation through drinking and smoking, and family and peers modelling behaviours. (4) The physical environment such as the high availability of affordable alcohol and access to amenities for physical activity and healthy foods. (5) Knowledge and information about CVD risk factors which included understanding of a healthy diet and the dangers of smoking and alcohol consumption. Conclusion To address CVD risk in slums, broad-ranging multisectoral interventions are required, including economic empowerment of the slum population, stress reduction and coping interventions, and alcohol legislation. Also, there is a need for community CVD sensitisation and screening as well as increasing access to physical activity amenities and healthy foods within slums.

A Systematic Review to Identify Targets of Mindfulness-Based Interventions for Cardiovascular Risk to Enhance Engagement with Racial/Ethnic Minorities

Cardiovascular disease (CVD) is a persistent public health challenge and racial/ethnic minority populations experience disparities in CVD risk factors. Mindfulness-based interventions (MBIs) have been examined as a strategy to address CVD risk factors, though their potential for implementation with racial and ethnic minorities remains unclear. This review examines primary intervention studies testing the impact of MBI on CVD risk, with a focus on critical appraisal of implementation characteristics (i.e., intervention design, delivery, uptake, and contextual factors) relevant to the engagement of racial/ethnic minority populations. A systematic review identified 30 studies published through January 2022 for inclusion. Included studies were randomized controlled trials testing meditation or mindfulness-based interventions against any control to measure change or improvement in cardiovascular health measures or risk behaviors in adults living in the US or territories. The Oxford Implementation Index was utilized to identify and extract relevant implementation data, and critical analysis of each study’s implementation process was conducted. All identified studies were published between 2011 and 2021 and represent early or pilot stages of research. As such, limitations and barriers in implementation strategies for racial/ethnic minority populations were identified. This review outlines several potential targets for future research to enhance engagement with racial/ethnic minorities. Trial Registration. PROSPERO CRD42019141454.

Perceptions of community members on contextual factors driving cardiovascular disease behavioural risk in Ghana: a qualitative study

BackgroundThere is clear evidence that lifestyle interventions are effective towards reducing cardiovascular risk. However, implementing these interventions in real-world setting has been suboptimal, especially in sub-Saharan Africa, thus creating ‘evidence to practice gap.’ We explore perceptions of community members on contextual factors driving cardiovascular disease (CVD) behavioural risk (alcohol consumption, smoking, physical (in)activity and fruits and vegetables consumption) in Ghana.MethodsThis was a cross-sectional study. Thirty (30) focus group discussions (FGDs) were carried out in five communities in Ghana (Ga Mashie, Tafo, Gyegyeano, Chanshegu and Agorve) between October and November 2017, and these were analysed using a thematic approach.ResultsFive main factors were raised by participants as contextual factors driving alcohol consumption and smoking and these include economic (poverty, unemployment, loss of jobs), psycho-social (worries, hardships, anxieties), medical (pain suppression, illness management), sexual (sexual performance boost), and socio-cultural (curse invocation, quest for supernatural powers) factors. Personal/social factors (time constraints, personal dislike, lack of knowledge of the benefits of exercise), economic factors (poverty, economic hardship), and negative health effects (getting tired easily, medical conditions) were cited as reasons why community members did not engage in physical activity. Consumption of fruits and vegetables in the five communities were determined by availability, cost, personal (dis)like, lack of knowledge about benefits, and cultural taboo. Participants’ narratives revealed that the symbolic functions of some of these behavioural risk factors and the built environment were important determining factors that have sustained these behaviours in these communities over the years.ConclusionsThis study showed that successful implementation of CVD interventions in Ghana needs to address the perceptions of community members on factors driving CVD behavioural risk factors. Future policies and interventions should be developed based on these contextual factors taking into consideration the age, sex and ethnic variations especially with interventions seeking to address CVD risk factors at the primary health care level. These findings should urge local policy makers and health managers to incorporate the roles of these contextual factors in new programs targeting cardiovascular health. Closing the ‘evidence to practice’ gap as far as CVD interventions are concerned may be impossible without this.

Effects of almond on cardiometabolic outcomes in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.

An enhanced risk for cardiovascular disease (CVD) still exists even when T2DM patients have tight control on blood sugar. Thus, identification of treatment approaches that address CVD risk factors may be useful for patients beyond the blood sugar management. Although emerging evidence suggests that nuts consumption have beneficial effects on cardiometabolic health, the effects of almond intake in patients with type 2 diabetes are still controversial. Therefore, our objective was to investigate the effect of almond on cardiometabolic outcomes in patients with T2DM through a systematic review and meta-analysis of available randomized controlled trials (RCTs). A systematic search was conducted in PubMed, Web of Science, Scopus, Embase, and Google Scholar to identify relevant RCTs up to March 2021. There was no language and time limitation. Weighted mean difference (WMD) was pooled using a random effects model. Heterogeneity, sensitivity analysis, and publication bias were reported using standard methods. Nine RCTs were included in the final analysis. Almond intake resulted in significant reduction in low-density lipoprotein cholesterol (LDL-C) (WMD: -5.28 mg/dL; 95% CI, -9.92, -0.64; p=.026) compared with the control group. This lowering effect of LDL-C was robust in subgroups with almond consumption >50 g/day, and baseline LDL-C level <130 mg/dL. However, the effect of almond on total cholesterol, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, insulin, hemoglobin A1c, body mass index, weight, body fat, systolic and diastolic blood pressure, and CRP was not significant compared with the control group. In summary, the current meta-analysis indicated that almond consumption decreased LDL-C, and had no favorable effect on other cardiometabolic outcomes in patients with T2DM. However, further high-quality studies are needed to firmly establish the clinical efficacy of the almond.

Relation of Menopause With Cardiovascular Risk Factors in South Asian American Women (from the MASALA Study)

The menopausal transition is a time of accelerating risk of cardiovascular disease (CVD), and promoting cardiovascular health during midlife is an important period of time to prevent CVD in women. The association of menopause with cardiovascular risk factors or subclinical atherosclerosis has not previously been evaluated in South Asian American women, a population with a disproportionately higher CVD burden compared with other race/ethnic groups. The objective of this study was to evaluate the association of menopause with CVD risk factors and subclinical cardiometabolic disease markers. We studied women aged 40 to 84 years from the Mediators of Atherosclerosis in South Asians Living in America study. The association of self-reported menopausal status with multiple demographic and clinical variables was assessed with linear and logistic regression adjusted for age and cardiovascular health behaviors. In a secondary ("age-restricted") analysis, postmenopausal participants outside the age range of premenopausal participants were excluded. In the age-restricted sample, menopause was associated with a higher adjusted odds of hypertension (odds ratio=1.19, 95% confidence interval [CI] 1.02 to 1.41), and higher systolic blood pressure (β=6.34, 95% CI 0.82 to 11.87), and significantly higher subcutaneous fat area (β=42.8, 95% CI 5.8 to 91.4). No significant associations between menopause and ectopic fat deposition, coronary artery calcium, or carotid intima-media thickness were observed. In South Asian American women in the Mediators of Atherosclerosis in South Asians Living in America study, menopause was associated with cardiovascular risk factors and higher subcutaneous fat deposition. Menopausal status is an important factor to examine and address CVD risk factors.

Geographic Disparities in Cardiovascular Death Among Patients with Myelodysplastic Syndromes

Introduction:Acquired somatic mutations in hematopoietic stem cells lead to myelodysplastic syndromes (MDS) and are also associated with accelerated atherosclerosis. In subjects without MDS, these mutations constitute a potent cardiovascular risk factor: clonal hematopoiesis (CH). In a previous analysis, we demonstrated that an MDS diagnosis was an independent risk factor for cardiovascular disease (CVD) compared to propensity matched non-cancer controls. CVD is the most common non-cancer cause of death in MDS, and rural residence has been independently associated with many CVD risk factors. However, there are no studies examining the association of geographic disparities and cardiovascular death in patients with MDS.Methods:We identified adult patients diagnosed with MDS between 2001 and 2016 using the Surveillance, Epidemiology, and End Results (SEER) database. MDS risk was classified as low, intermediate or high, using International Classification of Diseases for Oncology 3 rd Edition (ICDO-3) codes. Rural and urban populations were categorized using the US Department of Agriculture's Rural-Urban Continuum Codes (RUCC). Primary cause of death reported to State Registries (SEER COD recode) was used to estimate cause-specific survival, calculated from date of MDS diagnosis to date of CVD-related death. Cases with missing data on any key variable were excluded from analysis. SEER*Stat version 8.3.9 was used to calculate incidence rates. Chi-square and t-test were used to compare categorical and continuous variables, respectively. Survival analyses employed the Kaplan-Meier method and log-rank tests. Multivariable Cox-proportional hazards repression estimated the association of rural residence with CVD death adjusting for age, sex, race, ethnicity, MDS risk, and geographic location. SAS version 9.4 was used for statistical analysis.Results:We included 52,750 patients with MDS, 56.8% were male and 84.8% were white. Low, intermediate and high histologic risk were seen in 18.7%, 64.4% and 16.9% respectively. Most patients were from urban areas (88%), however the estimated incidence rate for MDS was 6.7 per 100,000 per population at risk in both urban and rural populations. The rural MDS population was younger (median age 75 vs 77 years, p<0.004) and had a higher proportion of whites (90.5% vs 84%, p<0.001), but no difference in MDS risk distribution was noted by rurality (Table 1). Unadjusted analyses revealed a trend towards lower overall survival in the rural MDS population (24 vs 25 months, p=0.051). After adjusting for age, sex, race, ethnicity, MDS risk and area of residence, rural subjects with MDS had a 12% increased hazard (HR 1.12, 95%CI 1.03 - 1.22) for CVD-related death compared to urban subjects (Figure 1). Further, the adjusted HR for CVD-related death was 1.23 (CI95% 1.01 - 1.50) for those who lived in the most rural areas (RUCC codes 8 and 9, less than 2,500 urban population). Among young MDS patients (age<65), those residing in rural areas had a higher proportion of CVD-related death (6% vs 4.7%, p=0.031) and significantly shorter CVD-specific survival compared to urban patients (Figure 2). MDS histologic risk was also a significant factor in the multivariable model (Table 2). Compared to low risk MDS, patients with intermediate and high risk had adjusted HR for CVD-related death of 1.17 (95%CI 1.11 - 1.24) and 1.2 (95%CI 1.09 - 1.32), respectively. Other factors significantly associated with increased hazard for CVD-related death in the adjusted model were advancing age and male sex.Discussion:In a large population-based study, we found that rural area of residence is significantly associated with a higher burden of CVD-related death in subjects with MDS, after adjusting for demographic risk factors and MDS risk classification. Although aging is an important issue in rural areas, the geographical disparities in CVD-related death among MDS patients are not explained by age alone and the difference was notable in young MDS patients. These findings should prompt hematologists caring for patients with MDS from rural areas to rigorously evaluate and address CVD risk factors. As novel treatments improve cancer-specific survival in MDS, marginalized populations with different CVD risk profiles may be disproportionally affected by the cardiovascular risk from CH, which should be considered when developing MDS surveillance programs. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Anthracycline treatment, cardiovascular risk factors and the cumulative incidence of cardiovascular disease in a cohort of newly diagnosed lymphoma patients from the modern treatment era.

The development of cardiovascular disease (CVD) in long-term survivors of lymphoma is of increasing importance. Here, we characterize the cumulative incidence and risk factors for CVD in lymphoma patients diagnosed in the current treatment era. From 2002-2015, newly diagnosed lymphoma patients (>18 years) were enrollment into a prospective cohort study that captured incident CVD, consisting of congestive heart failure (CHF), acute coronary syndrome (ACS), valvular heart disease (VHD), and arrhythmia. The cumulative incidence of CVD was calculated with death modeled as a competing risk. We estimated the association of treatment with anthracyclines or radiotherapy and traditional CVD risk factors with incidence of CVD using hazard ratios (HR) and 95% confidence intervals (CI) estimated from Cox regression. After excluding prevalent CVD at lymphoma diagnosis, the study consisted of 3063 patients with a median age of 59 years (range 18-95). The cumulative incidence of CVD at 10-years was 10.7% (95% CI, 9.5%-12.1%). In multivariable analysis, increasing age (HR=1.05 per year, p< 0.001), male sex (HR=1.36, p= 0.02), current smoker (HR=2.10, p< 0.001), BMI > 30 kg/m2 (HR=1.45, p= 0.01), and any anthracycline treatment (HR=1.57, p< 0.001) were all significantly associated with risk of CVD. Anthracyclines were associated with increased risk of CHF (HR=2.71, p< 0.001) and arrhythmia (HR=1.61, p< 0.01), but not VHD (HR=0.84, p= 0.58) or ACS (HR=1.32, p= 0.24) after adjustment for CVD risk factors. Even in the modern treatment era, CVD remains common in lymphoma survivors and preventive efforts are required that address both treatment and CVD risk factors.

MHealth Technology and CVD Risk Reduction.

To review existing mHealth-based interventions and examine their efficacy in reducing cardiovascular disease (CVD) risk factors. A total of 50 articles are included in this review. The majority of the mHealth interventions targeted a specific CVD risk factor, while 4 addressed 2 or more CVD risk factors. Of the 9 mHealth-supported weight loss intervention trials, 4 resulted in significant weight loss. Four out of 7 RCTs targeting improvement in physical activity reported significant improvement, while 4 of the 8 mHealth-supported smoking cessation intervention trials resulted in smoking abstinence. Of the 10 mHealth-based diabetes intervention trials, 5 reported significant reductions in HbA1c; however, only 3 out of the 9 antihypertension interventions resulted in significant reductions in blood pressure. There is a growing body of literature focused on mHealth interventions that address CVD risk factors. Despite the immense potential of mHealth interventions, evidence of their efficacy in mitigating cardiovascular risk is heterogeneous.

Cardiovascular disease: the gender divide

Cardiovascular disease is often thought of as a condition that mainly affects men. Beverley Bostock analyses the role practice nurses can play in recognising and managing cardiovascular disease in womenAlthough cardiovascular disease (CVD) is recognised to be a condition that affects men more than women overall, this risks underplaying the significant challenges relating to the diagnosis and management of CVD in women. Women are adversely affected compared to men in terms of diagnosis, acute management and implementation of secondary prevention, and the evidence base for treating women is lacking, due to the low numbers of women included in trials. Hormonal fluctuations throughout a woman's lifetime can also affect CVD risk. GPNs are ideally placed to consider the challenges of recognising and addressing CVD risk in women and to support them with engaging in reducing their lifetime risk.

Cardiovascular disease: the gender divide

Although cardiovascular disease (CVD) is recognised to be a condition that affects men more than women overall, this risks underplaying the significant challenges relating to the diagnosis and management of CVD in women. Women are adversely affected compared to men in terms of diagnosis, acute management and implementation of secondary prevention, and the evidence base for treating women is lacking, due to the low numbers of women included in trials. Hormonal fluctuations throughout a woman's lifetime can also affect CVD risk. GPNs are ideally placed to consider the challenges of recognising and addressing CVD risk in women and to support them with engaging in reducing their lifetime risk.