Cardiovascular Mortality In Adults Research Articles

Abdominal Compared With Coronary Artery Calcification and Incident Cardiovascular Events and Mortality in Black Adults.

Black adults show heightened cardiovascular risk compared with other groups despite comparable or lower coronary artery calcium (CAC) scores, indicating potential cardiovascular risk underestimation by CAC. Abdominal aortic calcification (AAC), preceding CAC, may predict cardiovascular events better in Black adults who are prone to early atherosclerotic cardiovascular disease and excess events at low CAC scores. We included 2551 participants from the JHS (Jackson Heart Study) visit 2 examination (2005-2008) without cardiovascular disease, followed through 2016. Cox regression estimated hazard ratios for incident cardiovascular events defined as a composite of myocardial infarction, stroke, heart failure, and all-cause mortality. The predictive value of CAC and AAC, when added to the American College of Cardiology/American Heart Association cardiovascular risk algorithm (pool cohort equation), was assessed. Mean age was 57±10 years; 66% were women. Over a follow-up period of 12.6 years, 287 (11.3%) cardiovascular events and 360 (14.1%) mortality cases were observed. Adjusting for demographic and clinical variables, each 2-fold increase in CAC and AAC was associated with cardiovascular events (CAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]; AAC: hazard ratio, 1.10 [95% CI, 1.06-1.13]) and all-cause mortality CAC: hazard ratio, 1.04 [95% CI, 1.01-1.08]; AAC: hazard ratio, 1.05 [95% CI, 1.01-1.08]). The incremental value of CAC (0.17 [95% CI, 0.08-0.23]) and AAC (0.15 [95% CI, 0.07-0.29]) to the pool cohort equation by net reclassification index was comparable. Notably, 45% of participants with 0 CAC showed some degree of AAC. Each 2-fold increase in AAC was associated with an increased risk of cardiovascular events (hazard ratio, 1.07 [95% CI, 1.01-1.19]) but not all-cause mortality among participants with 0 CAC. AAC is comparable to CAC in predicting cardiovascular events and all-cause mortality among Black adults, potentially valuable when CAC is absent.

Abstract 4131486: Cardiovascular Mortality in Children and Young Adults: Trends and Demographic Differences in the United States, 1999 to 2021

Background: Cardiovascular disease (CVD) mortality in the U.S. younger population is on the rise. However, limited data is available on CVD-related mortality trends in this population. Aim: This study aimed to assess the temporal trends and demographic differences in CVD-related mortality among the U.S. youth. Methods: The CDC WONDER dataset was analyzed from 1999-2021 for CVD-related mortality in children and young adults (age <25 years). Socio-demographic data including gender, race/ethnicity, urbanization status and census region was acquired. Age adjusted mortality rates (AAMR) per 100,000 persons and annual percent changes (APCs) with 95% confidence interval (CIs) were calculated. Results: Between 1999-2021, a total 54,283 CVD-related deaths occurred among the youth in the U.S. The overall AAMR declined from 1999-2008 (APC, -1.15 [-3.4 to 0.53]), followed by sharp decrease from 2008-2012 (APC, -3.28 [-4.68 to 0.86]). The AAMR continued to decrease steadily from 2012 to 2019 (APC: -1.20, [-3.76 to -0.06]), followed by a sharp increase in from 2019 to 2021, (APC, 3.03 [-0.66 to 5.12]). Males consistently had higher AAMRs than females from 1999 (AAMR males: 2.99 vs females: 2.3) to 2021 (AAMR males: 2.39 vs females: 1.74). Non-Hispanic (NH) Black or African Americans had the highest AAMR in 2020 (3.68), followed by NH Whites (1.71), Hispanic or Latinos (1.59), and Asian and Pacific Islanders (1.2). AAMRs also showed significant variations across different regions (overall AAMR West 1.81; Northeast 1.93; Midwest 2.3; South 2.69). Metropolitan areas (2.23) consistently had lower mortality rates than nonmetropolitan areas (2.59). Conclusion: Our analysis revealed that CVD-related mortality in the youth declined from 1999-2019, followed by an increase in 2020 to 2021. Highest mortality rates were seen in males, Black or African Americans, Western region of the U.S, and nonmetropolitan areas. Tailored interventions are necessitated to decrease the burden of CVD-related mortality in these demographics among children and young adults in the United States.

Association Between Systemic Inflammation Markers and Cardiovascular Mortality in Adults with Metabolic Dysfunction-Associated Steatotic Liver Disease

Background and AimIdentifying metabolic dysfunction-associated steatotic liver disease (MASLD) patients at increased risk of cardiovascular mortality remains an unmet clinical need. We investigated the ability of four systemic inflammation markers to identify cardiovascular mortality risk in MASLD patients. Methods and ResultsThis cohort study included 4,787 MASLD patients from the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2018. The weighted Cox proportional hazards model was used to assess the relationship between four systemic indicators of inflammation and cardiovascular mortality. During a median (IQR) follow-up of 7.0 (3.8-10.3) years, 567 all-cause mortality and 174 cardiovascular mortality were recorded. Compared to the first quartile of systemic inflammation levels, the HRs of cardiovascular mortality in the fourth quartile were 3.22 (95% CI 1.83-5.66) for SII, 2.74 (95% CI 1.32-5.69) for SIRI, 3.69 (95% CI 1.87-7.28) for NLR, and 1.83 (95% CI 1.05-3.20) for PLR. For predicting 10-year cardiovascular mortality, SIRI (AUC=0.70) and NLR (AUC=0.69) were superior to SII (AUC=0.60) and PLR (AUC=0.52). Stratification of MASLD patients based on the optimal cutoff values revealed an HR of 2.67 (95% CI 1.65-4.32) for cardiovascular mortality with SIRI > 1.23, and an HR of 2.39 (95% CI 1.51-3.79) with NLR > 2.18. Combining systemic inflammation markers with the Fibrosis-4 Score can provide more accurate prognostic information for MASLD patients. ConclusionsSIRI and NLR outperformed SII and PLR in predicting the risk of cardiovascular mortality, proving to be useful tools for risk stratification in MASLD patients.

Serum Uric Acid and the Risk of Cardiovascular and All-Cause Mortality in Community-Dwelling Older Adults

Serum Uric Acid and the Risk of Cardiovascular and All-Cause Mortality in Community-Dwelling Older Adults

Associations of urinary phytoestrogens with all-cause and cardiovascular mortality in adults: a population-based cohort study.

The overall understanding of the correlations between mortality risk and phytoestrogens in general population remains limited. We examined the association between urinary phytoestrogen levels and all-cause and cardiovascular mortality based on the National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazard regression models were employed to calculate adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). Nonlinear relationships were assessed using multivariable-adjusted restricted cubic splines (RCS). In the fully adjusted model, the highest quartiles of urinary genistein levels were correlated with significantly elevated all-cause (HR = 1.36, 95%CI: 1.16-1.59) and cardiovascular (HR = 1.58, 95%CI: 1.20-2.09) mortality. Urinary enterolactone levels in the third quartile were associated with reduced all-cause (HR = 0.77, 95%CI: 0.65-0.90) and cardiovascular (HR = 0.74, 95%CI: 0.55-0.99) mortality. In the highest quartiles of urinary daidzein levels, the cardiovascular mortality was significantly increased (HR = 1.44, 95%CI: 1.09-1.90). RCS showed an non-linear relationship between urinary daidzein levels and all-cause mortality (P = 0.04). In the context of a nationally representative sample, genistein exhibited associations with elevated all-cause and cardiovascular mortality, whereas enterolactone showed an association with reduced mortality. The dose-response relationship between urinary daidzein levels and all-cause mortality as well as sex-specific disparities in the impact of phytoestrogen levels should be considered.

Abstract P408: Association of Social Risk Factors with Cardiovascular-Kidney-Metabolic Syndrome at Baseline in Youth with Hypertension Disorders: A SUPERHERO Analysis

Poor cardiovascular-kidney-metabolic (CKM) health is associated with an increased risk for cardiovascular disease events and cardiovascular mortality in adults. There is a disproportionate burden of CKM syndrome among adults with social risk factors, and the presence of social risk factors can contribute to health and healthcare disparities in patients with CKM syndrome. Nothing is known about the association of social risk factors with CKM syndrome in youth with hypertension disorders. We conducted a cross-sectional analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data obtained using standardized and validated biomedical informatics scripts. Inclusion criteria were youth <19 years old who received care from subspecialists for hypertension disorders from 1/1/2026–12/31/2023 defined by ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The outcome was CKM syndrome defined by ICD-10 codes and included no risk, stage 1 and stage 2 CKM syndrome; for this analysis we excluded those who were unclassified ( n =630, 7%). Exposure was presence of at least one social risk factor defined by ICD-10 codes and included food access, transportation, housing, income, education, employment, family, and crime. We used directed acyclic graph-informed bivariate generalized linear models; no biasing paths were present so no additional covariates were included. Of 8,726 participants, the mean age was 12.8 years ( SD 4.5) and 62% were male. CKM syndrome stage 1 prevalence was 20% and CKM stage 2 was 65%. Seventy-four (0.8%) youth had at least one social risk factor. Presence of social risk factors was not associated with CKM syndrome (OR 0.9, 95% CL 0.6 to 1.5). Among youth referred for hypertension disorders, we found that those with social risk factors were not more likely to have CKM syndrome. Given the low prevalence of social risk factors by ICD-10 codes only in this early SUPERHERO phase, there is a critical need for a transdisciplinary approach to more comprehensively screen for and identify social risk factors. Further investigation into this important topic may inform risk stratification based on presence of social risk factors and targeted interventions to improve CKM health. Future SUPERHERO analysis will investigate the impact of interventions addressing social risk factors on CKM health outcomes.

Cardiovascular Disease Patterns, Mortality, and Hospitalization Trends in Adults Over 18: Insights From the Behavioral Risk Factor Surveillance System Database.

Background Cardiovascular diseases (CVDs), including coronary artery disease, heart attacks, strokes, and hypertension, are the leading cause of global morbidity and mortality. Despite advancements in diagnostic techniques, treatment protocols, and public health initiatives, the prevalence of CVD continues to rise. Hence, understanding trends of predisposing factors for CVD and current treatment modalities such as medication use and frequency of hospitalization is essential for developing effective interventions and improving public health strategies. This study leverages Behavioral Risk Factor Surveillance System (BRFSS) data to analyze these trends among adults older than 18 years. Methods Data were sourced from the BRFSSdatabase, analyzing CVD patterns from 2019 to 2021. The study included adults with high cholesterol or blood pressure, coronary heart disease, stroke, and heart failure. Data analysis utilized age-adjusted prevalence, mortality, and hospitalization rates. Results The analysis of the BRFSS data revealed several key trends in CVD patterns from 2019 to 2021. There was a statistically significant increase (p<0.05) in the age-adjusted prevalence of adults taking medication for high cholesterol, rising from 28.9% to 31%, and for controlling high blood pressure, increasing from 57.7% to 60.4%. From 2019 to 2021, coronary heart disease mortality increased from 360,900 to 382,820, while stroke deaths rose from 150,005 to 162,890. Trends show rising mortality for both conditions despite missing data for some years. Mortality rates for coronary heart disease and stroke also rose and were statistically significant (p<0.05), with coronary heart disease mortality increasing from 88 to 92.8 cases per 100,000, and stroke mortality from 37 to 41.1 cases per 100,000.Hospitalization rates for heart failure among Medicare beneficiaries aged 65 and older initially decreased in 2020, likely due to the COVID-19 pandemic impacting hospital admissions, but rose again in 2021 as healthcare-seeking behaviors normalized.Significant gender and racial disparities were observed, with higher mortality rates among males (127.4 per 100,000) and Black, non-Hispanic individuals (110.5 per 100,000). Conclusions This study highlights the increasing medication use for cholesterol and blood pressure among adults older than 18 years, yet mortality rates for coronary heart disease and stroke persist. Significant gender and racial disparities in medication use and mortality rates were observed. These findings underscore the need for targeted public health intervention towards improving medication adherence and addressing social determinants of health, to reduce CVD burden and enhance health equity across diverse populations.

Association between Triglyceride-Glucose Index and risk of all-cause and cardiovascular mortality in adults with prior cardiovascular disease: a cohort study using data from the US National Health and Nutrition Examination Survey, 2007–2018

ObjectiveThe association between the Triglyceride-Glucose (TyG) Index and mortality rates in patients with cardiovascular disease (CVD) remains unclear. This study investigates the association between the TyG index and the incidence...

457-P: Association of System Inflammation Index with Risk of Cardiovascular Mortality among Individuals with Type 2 Diabetes

Introduction &amp; Objective: This study aimed to examine the associations of system inflammation index, including system inflammation response index (SIRI) and system immune-inflammation index (SII), with cardiovascular mortality in adults with type 2 diabetes (T2D). Methods: This analysis included 2,954 individuals from the National Health and Nutrition Examination Survey (NHANES) 1999-2010. Cardiovascular mortality was ascertained by linkage to National Death Index (NDI) records through 31 December 2019. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During an average of 12.4 years of follow-up, 248 cardiovascular disease (CVD) deaths occurred. After multivariate adjustment, per one-unit increment in SIRI was significantly associated with a 16% higher risk of cardiovascular mortality (P &amp;lt;0.0001) in a dose-response manner (P non-linear = 0.26). However, the association between SII and CVD deaths exhibits a J-shaped relationship (P non-linear = 0.03) and When extreme level of SII was compared, the multivariate-adjusted HR was 1.81 (95% CI 1.11, 2.95) for CVD deaths (P trend = 0.017). Conclusion: Higher SIRI and very high SII were linearly associated with elevated risk of cardiovascular mortality among individuals with T2D. Disclosure H. Li: None. W. Guo: None. Y. Li: None. T. Zeng: None. W. Kong: None. Funding National Natural Science Foundation of China (Grant No. 81974107); Bethune-Merck Diabetes Research Foundation (Grant No. G-X-2019-056);

Associations of dietary flavonoid intake with the risk of all-cause and cardiovascular mortality in adults

Background and AimsFlavonoids are widely distributed polyphenolic compounds in the diet that possess various health-promoting effects. This study aimed to investigate the association between dietary flavonoid intake and all-cause and cardiovascular mortality in adults. Methods and ResultsThe data on the six main subclasses of flavonoids, including isoflavones, anthocyanidins, flavan-3-ols, flavanones, flavones, and flavonols, were obtained from the 2007-2010 National Health and Nutrition Examination Survey (NHANES) dataset of adults. The participants were followed up until December 30, 2019. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for dietary flavonoid intake and mortality. The study included a total of 8,758 adults (mean age 44.00 years; 47.40% men). A median follow-up of 10.7 years yielded 1,113 all-cause deaths and 261 cardiovascular deaths were recorded. In comparison to category 1, category 4 of flavan-3-ols, flavonols, and total flavonoids were associated with lower risks of all-cause mortality, with multivariable-adjusted HRs of 0.71 (95% CI: 0.55–0.92, Ptrend=0.021), 0.58 (95% CI: 0.45–0.74, Ptrend<0.001), and 0.63 (95% CI: 0.50–0.80, Ptrend=0.010), respectively. Similarly, higher intake of category 4 flavonoids was associated with a reduced risk of cardiovascular mortality, with HRs of 0.68 (95% CI: 0.29–0.89, Ptrend=0.035) for flavones, 0.41 (95% CI: 0.22–0.78, Ptrend=0.001) for flavonols, and 0.54 (95% CI: 0.36–0.80, Ptrend=0.021) for total flavonoids. ConclusionDietary flavonoid intake is associated with all-cause and cardiovascular mortality. Increasing dietary flavonoid intake may reduce the risk of death in adults.

Associations of serum carotenoids with all-cause and cardiovascular mortality in adults with MAFLD

Background and aimsThe associations between serum carotenoids and mortality are contradictory in various metabolic-associated diseases. This study aimed to examine the associations of five major serum carotenoids with mortality among adults with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods and resultsThis analysis included 3040 individuals with MAFLD from the Third National Health and Nutrition Examination Survey (NHANES III). All-cause and cardiovascular mortality were ascertained by linkage to the National Death Index through December 31, 2019. Cox proportional hazards regression models were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and restricted cubic spline (RCS) analyses were performed to assess the linearity of the associations.During a follow-up period of 826,547 person-years, 1325 all-cause and 429 cardiovascular deaths occurred. For all-cause mortality, compared with those in the lowest quartiles, the multivariable-adjusted HRs (95% CIs) in the highest quartiles were 0.63 (0.49–0.81) for α-carotene; 0.65 (0.52–0.80) for β-carotene; 0.64 (0.51–0.81) for β-cryptoxanthin; 0.73 (0.56–0.95) for lycopene; and 0.69 (0.52–0.91) for lutein/zeaxanthin. For cardiovascular mortality, the multivariable-adjusted HRs (95% CIs) in the highest quartiles were 0.51 (0.33–0.78) for α-carotene; 0.54 (0.35–0.82) for β-carotene; 0.52 (0.34–0.80) for β-cryptoxanthin; 0.63 (0.44–0.90) for lycopene; and 0.62 (0.39–0.99) for lutein/zeaxanthin. Besides, serum α-carotene, β-cryptoxanthin, and lycopene exhibited linear correlations with all-cause mortality in MAFLD adults, and four serum carotenoids, except β-carotene, were linearly correlated with cardiovascular mortality. ConclusionsLower serum α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin concentrations were associated with higher risk of all-cause and cardiovascular mortality in US adults with MAFLD.

Abstract 1057: Association Between Remnant Cholesterol And All-cause Mortality And Cardiovascular Mortality In Young And Middle-aged American Adults: A Retrospective Cohort Study

Background: The association of remnant cholesterol with all-cause mortality and cardiovascular mortality in young, middle-aged American adults remains unclear. The purpose of the study is to explore this relationship. Methods: This retrospective cohort study included 16428 patients aged from 18 to 65 years old from the National Health and Nutrition Examination Survey (1999–2018) with follow-up mortality outcomes records linked to the National Death Index (NDI) until December 31, 2019. Participants were divided into four groups based on the RC quartile: a Q1 group (≤0.359 mmol/L), a Q2 group (0.359–0.517 mmol/L), a Q3 group (0.518–0.768 mmol/L), and a Q4 group (≥0.768 mmol/L). Multivariable Cox proportional hazards models were used to estimate the risk of mortality. Results: During a 123-month follow-up, a total of 931 (5.02%) all-cause deaths and 239 (1.22%) CVD-related deaths were recorded. After adjusting for multiple potential confounding factors and comparing them with the Q1 RC group of the participants, the adjusted hazard ratios for all-cause mortality for the Q2–Q4 groups were 0.98 (0.69, 1.38), 1.02 (0.74, 1.39), and 1.45 (1.09, 1.92) ( P for trend = 0.001), and those for cardiovascular mortality were 1.41 (0.68, 2.94), 1.77 (0.86, 3.62), and 2.98 (1.38, 6.43), respectively ( P for trend =0.001). The restricted cubic splines revealed a non-linear association between the baseline RC and cardiovascular mortality. Interestingly, an interaction effect was found between gender and RC in all-cause mortality. Conclusion: RC was associated with an increased risk of all-cause mortality and cardiovascular mortality in young and middle-aged American populations.

Physical fitness in adolescent patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is the most frequent monogenic auto-inflammatory disease worldwide responsible for episodes of fever, serositis and musculoskeletal symptoms. Inflammatory attacks are responsible for sedentary behavior and FMF patients may be at increased cardiovascular risk. Cardiorespiratory Fitness (CRF) and physical capacities during adolescence are associated with cardiovascular mortality in adulthood. In this study, we aimed to describe the physical fitness of FMF adolescents. A monocentric retrospective study at the Versailles Hospital between January 2020 and June 2023. All FMF patients over 14-year-old who had completed a routine physical test were included. Clinical and physical data including results of the 6-minute walking test, timed unipedal stance test, Ruffier-Dickson index, 30-seconds chair-stand test and sit-and-reach test were extracted from medical records. Results were compared with previously published normative reference values and criterion-referenced standards for healthy subjects. Eighteen FMF patients (12 girls, 6 boys) were included. The median age was 16 years old [14-18]. Clinical history included joint symptoms (n = 11), chest pleuritis (n = 8), and leg pain (n = 11). Estimated VO2max was below the recommended thresholds in 13 patients, which predicts cardiovascular risk. Cardiovascular adaptation was poor in 11 patients. Low VO2max was associated with CRP > 5mg/l on test day and history of joint symptoms. FMF patients displayed altered physical capacities compared to normative values of healthy subjects. History of musculoskeletal pain, systemic inflammation and sedentary behavior may participate in impaired physical abilities and promote cardiovascular diseases in adulthood. Specific exercise programs could benefit patients for disease control and cardiovascular risk reduction.

Effect of calorie labelling in the out-of-home food sector on adult obesity prevalence, cardiovascular mortality, and social inequalities in England: a modelling study

England implemented a menu calorie labelling policy in large, out-of-home food businesses in 2022. We aimed to model the likely policy impact on population-level obesity and cardiovascular disease mortality, as well as the socioeconomic equity of estimated effects, in the adult population in England. For this modelling analysis, we built a comparative assessment model using two scenarios: the current implementation scenario refers to actual deployment only in large (≥250 employees), out-of-home food businesses, whereas the full implementation scenario refers to deployment in every out-of-home food business. We compared each scenario with a counterfactual: the scenario in which no intervention is implemented (ie, baseline). For both scenarios, we modelled the impact of the policy through assumed changes in energy intake due to either consumer response or product reformulation by retailers. We used data from the Office for National Statistics and the National Diet and Nutrition Survey 2009-19, and modelled the effect over 20 years (ie, 2022-41) to capture the long-term impact of the policy and provided mid-period results after 10 years. We used the Monte Carlo approach (2500 iterations) to estimate the uncertainty of model parameters. For each scenario, the model generated the change in obesity prevalence and the total number of deaths prevented or postponed. The current implementation scenario was estimated to reduce obesity prevalence by 0·31 percentage points (absolute; 95% uncertainty interval [UI] 0·10-0·35), which would prevent or postpone 730 cardiovascular disease deaths (UI 430-1300) of the 830 000 deaths (UI 600 000-1 200 000) expected over 20 years. However, the health benefits would be increased if calorie labelling was implemented in all out-of-home food businesses (2·65 percentage points reduction in obesity prevalence [UI 1·97-3·24] and 9200 cardiovascular disease deaths prevented or postponed [UI 5500-16 000]). Results were similar in the most and the least deprived socioeconomic groups. This study offers the first modelled estimation of the impact of the menu calorie labelling regulation on the adult population in England, although we did not include a cost-effectiveness analysis. Calorie labelling might result in a reduction in obesity prevalence and cardiovascular disease mortality without widening health inequalities. However, our results emphasise the need for the government to be more ambitious by applying this policy to all out-of-home food businesses to maximise impact. European Research Council.

Clonal Hematopoiesis Risk Score and All-Cause and Cardiovascular Mortality in Older Adults.

Clonal hematopoiesis (CH) with acquired pathogenic variants in myeloid leukemia driver genes is common in older adults but of unknown prognostic value. To investigate the prevalence of CH and the utility of the CH risk score (CHRS) in estimating all-cause and disease-specific mortality in older adults with CH. This population-based prospective cohort study involved community-dwelling older adults (aged 67-90 years) without hematologic malignant neoplasms (HMs) who were participants in the Atherosclerosis Risk in Communities Visit 5 at 4 US centers: Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland. Samples were collected from 2011 to 2013, sequencing was performed in 2022, and data analysis was completed in 2023. The exposure was a diagnosis of CH. CHRS scores (calculated using 8 demographic, complete blood cell count, and molecular factors) were used to categorize individuals with CH into low-risk (CHRS ≤9.5), intermediate-risk (CHRS >9.5 to <12.5), and high-risk (CHRS ≥12.5) groups. The primary outcome was all-cause mortality, and secondary outcomes were HM mortality, cardiovascular disease mortality, and death from other causes. Among 3871 participants without a history of HM (mean [SD] age, 75.7 [5.2] years; 2264 [58.5%] female individuals; 895 [23.1%] Black individuals; 2976 White individuals [76.9%]), 938 (24.2%) had CH. According to the CHRS, 562 (59.9%) were low risk, 318 (33.9%) were intermediate risk, and 58 (6.2%) were high risk. During a median (IQR) follow-up of 7.13 (5.63-7.78) years, 570 participants without CH (19.4%) and 254 participants with CH (27.1%) died. Mortality by CHRS risk group was 128 deaths (22.8%) for low risk, 93 (29.2%) for intermediate risk, and 33 (56.9%) for high risk. By use of multivariable competing risk regression, subdistribution hazard ratios (sHRs) for all-cause mortality were 1.08 (95% CI, 0.89-1.31; P = .42) for low-risk CH, 1.12 (95% CI, 0.89-1.41; P = .31) for intermediate-risk CH, and 2.52 (95% CI, 1.72-3.70; P < .001) for high-risk CH compared with no CH. Among individuals in the high-risk CH group, the sHR of death from HM (6 deaths [10.3%]) was 25.58 (95% CI, 7.55-86.71; P < .001) and that of cardiovascular death (12 deaths [20.7%]) was 2.91 (95% CI, 1.55-5.47; P < .001). In this cohort study, the CHRS was associated with all-cause, HM-related, and cardiovascular disease mortality in older adults with CH and may be useful in shared decision-making to guide clinical management and identify appropriate candidates for clinical trials.

Blood transfusion is correlated with elevated adult all-cause mortality and cardiovascular mortality in the United States: NHANES 1999 to 2018 population-based matched propensity score study

Background and aimsThe association of blood transfusion with an increase in medium- and short-term mortality in specific populations has been confirmed. However, the correlation between blood transfusion and long-term mortality in the general population remains unclear. This cohort study evaluated the correlation between blood transfusion and overall and cause-specific mortality in the general American adult population. MethodsThe authors utilized 10 sets of 2-year cycle data (1999–2018) from the National Health and Nutrition Examination Survey on the outcomes of adults who did and did not receive blood transfusions. Propensity score-matching (1:1) was performed based on age, sex, race, education level, marital status, poverty-income ratio, arteriosclerotic cardiovascular disease, cancer, anemia, hypertension, and diabetes status. After controlling for demographic characteristics and clinical risk factors, Cox regression analysis was performed to evaluate the correlation between blood transfusion and all-cause and cause-specific mortality. ResultsThe study included 48,004 adult participants. The risk of all-cause mortality increased by 101 % with blood transfusion, and the risk of cardiovascular mortality increased by 165 %. After propensity score-matching, 6,116 pairs of cases were retained, and the risk of all-cause mortality increased by 84 % with blood transfusion, and the risk of cardiovascular mortality increased by 137 %. The sensitivity analysis results were robust. ConclusionsIn the general American population, blood transfusion significantly impacts long-term all-cause and cardiovascular mortality and may be an unacknowledged risk factor for death. Thus, the effective management of blood transfusion in the general population may be beneficial.

Associations between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus: A prospective cohort study from NHANES 2007–2018

AimsTo investigate the dose-response association between physical activity and all-cause and cardiovascular mortality in adults with type 2 diabetes mellitus and the effects of replacing sedentary behavior with physical activity. Methods4808 adults with type 2 diabetes mellitus were included in NHANES 2007–2018. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals. Isotemporal substitution analyses were further to determine the possible benefit of replacing sedentary time. ResultsDuring a median follow-up of 6.58 years, 902 deaths occurred, including 290 deaths from cardiovascular disease. Compared with the inactive group, the low-active and high-active groups were associated with declined risks of all-cause mortality [HRs (95% CIs) 0.64 (0.50, 0.83); 0.60 (0.50, 0.73), respectively] and cardiovascular mortality [0.50 (0.29, 0.88); 0.54 (0.39, 0.76)), respectively]. Dose-response analysis showed a significant U-shaped curve between physical activity and all-cause and cardiovascular mortality. Replacing 30 min/day of sedentary time with physical activity was substantially linked to a reduced risk of 8–32% mortality. ConclusionA high level of PA of 40.52 and 31.66 MET-h/week was respectively related to the lowest risk of all-cause and cardiovascular mortality. Replacing sedentary time with physical activity could benefit the type 2 diabetes mellitus population.

Methylmalonic acid, vitamin B12, and mortality risk in patients with preexisting coronary heart disease: a prospective cohort study

BackgroundThe inconsistent relationship between Vitamin B12 (B12), methylmalonic acid (MMA, marker of B12 deficiency) and mortality was poorly understood, especially in patients with coronary heart disease (CHD). This study aims to investigate the association of serum MMA, and B12-related biomarkers (serum level, dietary intake, supplement use, and sensibility to B12) with all-cause and cardiovascular mortality in adults with CHD.MethodsThe data of this study were from a subcohort within the US National Health and Nutrition Examination Survey (NHANES). We included adults with preexisting CHD with serum MMA and B12, and dietary B12 intake measurements at recruitment. All participants were followed up until 31 December 2019. Weighted Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% CI of mortality risk.ResultsOverall, 1755 individuals (weighted mean [SE] age, 65.2 [0.5] years; 1047 men [weighted 58.5%]) with CHD were included, with geometric mean levels of serum MMA 182.4 nmol/L, serum B12 494.5 pg/ml, and dietary B12 intake 4.42 mg/day, and percentage of B12 supplements use 39.1%. During a median follow-up of 7.92 years, 980 patients died. Serum B12 concentration, dietary B12 intake and supplements use were not significantly associated with mortality risk (each p ≥ 0.388). In contrast, individuals in the top tertile of MMA had multivariable-adjusted HRs (95% CIs) of 1.70 (1.31–2.20) for all-cause mortality, and 2.00 (1.39–2.89) for cardiovascular mortality (both p trend < 0.001) compared to those in the bottom tertile of MMA. MMA-related mortality risk was particularly higher among participants with sufficient serum B12 (p < 0.001). CHD patients with increased levels of both MMA and B12 had a doubled mortality risk compared to those with lower MMA and B12 (p < 0.001).ConclusionMMA accumulation but not serum or dietary vitamin B12 was associated with increased cardiovascular mortality risk among patients with CHD. This paradox may be related to decreased response to vitamin B12.

Cardiovascular Risk Markers in Adults With Adrenal Incidentaloma and Mild Autonomous Cortisol Secretion.

Many adrenal adenomas exhibit mild autonomous cortisol secretion (MACS). Although MACS is associated with increased cardiovascular mortality, the underlying mechanisms are not fully defined. To investigate mechanisms that may link MACS and cardiovascular mortality in adults with adrenal adenoma. Cross-sectional study. Twenty adults with adrenal adenoma and MACS and 20 controls with nonfunctioning adrenal adenoma. Reactive hyperemia index (RHI) was measured by peripheral artery tonometry and 24-hour ambulatory blood pressure monitoring (24h AMBP) was performed. Indices of insulin secretion and sensitivity were estimated by measuring glucose and insulin fasting and following a mixed meal. The primary outcome was the difference in RHI between participants with MACS vs nonfunctioning adrenal adenoma. The average cortisol after 1-mg dexamethasone and urinary free cortisol were higher in patients with MACS. There was no significant difference in fasting RHI (2.0 [interquartile range (IQR) 1.6-2.4] vs 2.0 [IQR 1.7-2.2, P = .72), but postprandial RHI was higher in patients with MACS (2.2 [1.8-2.7] vs 1.8 [1.5-2.2], P = .04). 24-hour ambulatory blood pressure monitoring and Matsuda index were not significantly different in the groups. Fasting glucose and glucose area under the curve after the mixed meal were higher and insulinogenic index was lower in participants with MACS. Adults with adrenal adenoma and MACS do not have fasting endothelial dysfunction and postprandial endothelial function may be better. These patients have fasting and postprandial hyperglycemia with lower insulin secretion, which may underlie the association between MACS and increased cardiovascular mortality.

Abstract 12832: Risk of Extreme Wet Climate Conditions and Racial/Ethnic-Specific Cardiovascular Mortality in Southwest United States

Introduction: Coastal regions are highly vulnerable to extreme climate conditions, which are known to have effects on adult cardiovascular disease mortality (CVDM). Racial/ethnic (R/E) minority populations (ie Non-Hispanic (NH) Black) are known to have a greater incidence of CVDM compared to their NH White counterparts. Consequently, there is a need to document associations between climate extremes and R/E-specific CVDM. Hypothesis: Extreme wet conditions associated with CVDM should vary by R/E, where strongest increased risk is expected for minority populations. Methods: Population-based study using sex, age (45-84 years), and R/E-specific (NH White, Black, Asian, &amp; Hispanic/Latino) CVD deaths [ICD-10 (I00-99)] from CDC for Southwest US (California, Arizona, New Mexico) from Jan 1999 to Dec 2020. Climate exposure categories (mild, moderate, extreme dry/wet) were based on Palmer Drought Severity Index (PDSI), which integrates temperature and precipitation. With population estimates, CVDM rates were associated with PSDI categories using negative binomial regression upon adjusting for diabetes, smoking prevalence, sex, trend, month, state, unemployment rate, and air pollution (PM 2.5 ). Results: From 1999-2020, 1,307,418 (67.6% NH White, 16.1% Hispanic, 7.4% NH Asian, 8.9% NH Black) CVD deaths were recorded. CVDM was associated with a significant increased risk during extreme wet events (compared to extreme drought) only among NH Asian (adjusted rate ratio [RR] 1.08; 95% CI 1.06-1.09) and NH White (RR 1.02; 95% CI 1.01-1.025) in Southwest US (Figure). Insignificant interactions were observed between extreme wet and PM2.5 on CVDM by R/E. Conclusions: Extreme wet climate conditions were associated with an increased risk of CVDM among NH Asian and White adults. Both climate extreme events and R/E should be considered as predisposing risk factors for CVDM. Further studies are needed to assess such CVDM risk factors for other susceptible areas in the US.