Advanced Cardiovascular Disease Research Articles

Prevalence and Predictors of Sarcopenia, Protein-Energy Wasting, and Sarcopenic Obesity in Patients with Chronic Kidney Disease

Background Sarcopenia, sarcopenic obesity, and protein-energy wasting (PEW) are common in patients with chronic kidney disease (CKD) and are associated with adverse outcomes. This study is aimed at determining their prevalence and predictors. Materials and Methods This cross-sectional study included 442 adult CKD patients. Sarcopenia was defined using a modified Asian Working Group for Sarcopenia criteria, sarcopenic obesity as the coexistence of sarcopenia and obesity, and PEW according to the International Society of Renal Nutrition and Metabolism criteria. Results Sarcopenia prevalence was 29.9% (132 patients), with 9.5% being severe, 12.7% moderate, and 7.7% mild. Sarcopenic obesity affected 13.3% (59 patients) and PEW was noted in 27.3% (121 patients). Among sarcopenic patients, 59% met PEW criteria. Multivariate analysis identified increasing age, male sex, higher body mass index BMI, lower estimated glomerular filtration rate (eGFR), and cardiovascular disease as independent predictors of sarcopenia. Higher BMI, lower eGFR, and cardiovascular disease predicted sarcopenic obesity. For PEW, significant predictors included age, lower BMI, decreased eGFR, advanced CKD stage, cardiovascular disease, and sarcopenia. Conclusion Sarcopenia, sarcopenic obesity, and PEW are highly prevalent in CKD patients, with substantial overlap. Advanced age, lower kidney function, and cardiovascular disease are significant predictors across all three conditions. These findings highlight the need for comprehensive nutritional assessment and targeted interventions in CKD patients.

Assessment of Relation between Periodontal Disease and Macular Degeneration

ABSTRACT Background and Aim: Periodontal disease may result in chronic inflammation and bacteremia in some people. The study aimed to evaluate the connection between periodontal disease and macular degeneration. Materials and Methods: The specialist dental surgeon conducted the dental examination using a community periodontal index probe. An ophthalmologist performed the eye examination. Age-related macular degeneration (AMD) was identified through specific criteria such as the existence of particular types of drusen and pigmentary abnormalities. Results: Two hundred participants were part of the study. According to the data, factors such as advanced age, limited education, low income, hypertension, cardiovascular disease (CVD), and hepatitis B surface antigen (HBsAg) presence were strongly linked to AMD in all participants. Conclusion: Multiple studies have indicated a connection between periodontitis in the mouth and macular degeneration in individuals under 60 years of age.

(202) Comparative Study of the Efficacy of Avanafil and Atorvastatin Daily Dose in Management of Vasculogenic Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) is defined as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations”. ED is not only a medical problem but affects the marital relations and patient's self-esteem and causes the quality of life to decrease. which in turn causes the patient to go into depression or develop anxiety. In the past, erectile dysfunction was considered, in most cases, to be a purely psychogenic disorder, but current evidence suggests that more than 80% of cases have an organic aetiology. Causes of organic erectile dysfunction can now be broadly divided into nonendocrine and endocrine. Of the nonendocrine aetiologies, vasculogenic (affecting blood supply) is the most common and can involve arterial inflow disorders and abnormalities of venous outflow (corporeal veno-occlusion). Avanafil is a second-generation phosphodiesterase type 5 inhibitor approved for erectile dysfunction by the FDA on 2012 and by EMA in 2013. With a high selectivity for phosphodiesterase type 5 isoform AND faster onset of action compared with other PDE5 inhibitors, it offers more tolerability and less adverse events. Atorvastatin is 3-hydroxy-methylglutaryl (HMG)-CoA reductase inhibitor act on the rate-limiting step in cholesterol biosynthesis (the conversion of HMG-CoA to mevalonate) and are effective in treating dyslipidemia. statins reverse endothelial dysfunction by decreasing the action of oxidized low-density lipoprotein (LDL) on endothelial cells, resulting in an increase of NO activity. Objective is to evaluate and compare the efficacy of avanafil and atorvastatin daily dose in management of patients with vasculogenic erectile dysfunction. Methods A 60 adult heterosexual males complaining of vasculogenic erectile dysfunction proven by penile duplex were collected from outpatient andrology clinics of Al-Azhar University Hospitals. The patients were divided into two treatment groups: (Group A): 30 patients received daily dose of 100 mg avanafil. (Group B): 30 patients received daily dose of 40 mg atorvastatin, The main outcome measures and the difference in penile duplex ultrasound results and IIEF-EF scores between the two groups are evaluated and compared at the end of the study, Age of patients between 20 and 50 years, established diagnoses of Vasculogenic erectile dysfunction, Normal lipid profile, Normal Total and Free testosterone levels and No contraindications to the study medications were included criteria. However patients who failed to fulfill any of the inclusion criteria, psychogenic or neurogenic erectile dysfunction, dyslipidemia Patients with Renal or Hepatic insufficiency and Patients with advanced cardiovascular diseases such as heart failure and coronary artery disease on antianginal drugs especially nitrates were excluded. Results Our study revealed statistically significant improvement in Penile Doppler ultrasonography parameters (PSV, EDV& RI) and IIEF-EF scores in avanafil group compared to atorvastatin group. Conclusions avanafil 100 mg daily dose leads to significant improvement in men with vasculogenic erectile, while atorvastatin 40 mg caused no significant differences, neither positively nor adversely. In summary, avanafil at dose of 100 mg can be a therapeutic appropriate choice in cases of vasculogenic ED. Disclosure No.

Lian-Mei-Yin formula alleviates diet-induced hepatic steatosis by suppressing Yap1/FOXM1 pathway-dependent lipid synthesis.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, with a global prevalence of 25%. Patients with NAFLD are more likely to suffer from advanced liver disease, cardiovascular disease, or type II diabetes. However, unfortunately, there is still a shortage of FDA-approved therapeutic agents for NAFLD. Lian-Mei-Yin (LMY) is a traditional Chinese medicine formula used for decades to treat liver disorders. It has recently been applied to type II diabetes which is closely related to insulin resistance. Given that NAFLD is another disease involved in insulin resistance, we hypothesize that LMY might be a promising formula for NAFLD therapy. Herein, we verify that the LMY formula effectively reduces hepatic steatosis in diet-induced zebrafish and NAFLD model mice in a time- and dose-dependent manner. Mechanistically, LMY suppresses Yap1-mediated Foxm1 activation, which is crucial for the occurrence and development of NAFLD. Consequently, lipogenesis is ameliorated by LMY administration. In summary, the LMY formula alleviates diet-induced NAFLD in zebrafish and mice by inhibiting Yap1/Foxm1 signaling-mediated NAFLD pathology.

Steatotic liver disease predicts cardiovascular disease and advanced liver fibrosis: A community-dwelling cohort study with 20-year follow-up

BackgroundSteatotic liver disease (SLD) has emerged as new nomenclature to increase awareness and reflect the pathophysiology of the disease better. We investigated the risk of advanced fibrosis and cardiovascular disease (CVD) in SLD using data derived from a Korean prospective cohort. MethodsWe defined SLD using the fatty liver index (FLI) and identified advanced fibrosis with the age-adjusted Fibrosis-4 Index. SLD was further subcategorized into metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD). FindingsThe Ansung–Ansan cohort of the Korean Genome and Epidemiology study, following 9497 participants from 2002 to 2020, included 3642 (38.3%) with MASLD, 424 (4.5%) with MetALD, and 207 (2.1%) with ALD. During the median follow-up of 17.5 years, CVD risk was higher in those with MASLD (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.12–1.45; P < 0.001), MetALD (HR, 1.88; 95% CI, 1.33–2.65; P < 0.001), and ALD (HR, 1.95; 95% CI, 1.01–3.77; P < 0.001) than in those without SLD, after adjusting for conventional risk factors. Notably, CVD risk was higher in the MetALD than in the MASLD group (P = 0.027). In the MASLD group, the number of cardiometabolic risk factors (CMRFs) correlated positively with CVD risk (HR, 1.34; 95% CI, 1.24–1.45; P < 0.001 for trend). Among the CMRFs, hypertension (HR, 1.94; 95% CI, 1.63–2.31; P < 0.001) was the predominant contributor to CVD. The MASLD (HR, 1.39; 95% CI, 1.25–1.55; P < 0.001), MetALD (HR, 1.75; 95% CI, 1.38–2.23; P < 0.001), and ALD (HR, 2.00; 95% CI, 1.30–3.07; P = 0.002) groups had a higher risk of advanced fibrosis than did the non-SLD group (P < 0.001 for trend). InterpretationOur study provides new insight into hepatic and cardiovascular outcomes related to SLD subtypes. The risk of CVD increased in the order of no SLD, MASLD, and MetALD. The SLD subcategories, considering CMRFs and alcohol intake, outperformed traditional fatty liver categorizations in predicting CVD risk. The proposed SLD terminology could impact clinical practice, warranting further exploration of the heterogeneity of clinical outcomes among SLD subtypes.

Early rehabilitation challenges of surgical patients with COVID-19 infection - a single-arm study

Background/Aim. A very limited amount of data regarding the rehabilitation outcome of surgical patients with COVID-19 is available in the current literature. The aim of this study was to point out the characteristics of early rehabilitation of these patients and determine the predictors of rehabilitation outcomes. Methods. The study was designed as a prospective clinical trial. It included patients who had surgical treatment from April 1, 2022, to March 31, 2023, at the University Clinical Center of Vojvodina, Serbia and either had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preoperatively or developed coronavirus disease 2019 (COVID-19) within 72 hrs after surgery. The rehabilitation program was planned for each patient according to the type of surgical treatment, age, clinical presentation and severity of the COVID-19, length of immobilization, and comorbidities. Rehabilitation treatment (RT) started with a minimum of one 30-minute daily session, up to three 30-minute sessions daily. Patients were assessed at the beginning of RT and discharge. Outcomes were assessed with the Modified Borg Scale (MBS) for dyspnoea, Barthel index (BI) for activities of daily living, Six-Minute Walk Test (6MWT) for exercise tolerance, and Timed up and Go (TUG) test for balance and lower limb mobility. Results. A total of 81 patients were included in the study. RT was successful for 42 patients (24 female and 18 male) with an average age of 62.10 ? 20.07 years. These patients exhibited significant functional improvement, which was measured by all tests that assessed rehabilitation outcome at discharge: BI (p &lt; 0.001), MBS (p &lt; 0.001), 6MWT (p &lt; 0.001), and TUG test (p &lt; 0.001). The remaining 31 patients had unsuccessful RT. The binary logistic regression analysis has shown that age (p = 0.009), cardiovascular disease (p = 0.017), and malignancy (p = 0.022) were significant predictors of rehabilitation outcome. Conclusion. Results of the present study implicate that individually tailored RT during the acute phase of COVID-19 in surgical patients is very challenging. Advanced age, cardiovascular disease, and malignancy are predictors of unfavorable outcomes, and careful consideration is needed when planning the treatment for these patients.

Prosedur Percutaneous Trans Luminal Angioplasty (PTA) Pada Pasien Dengan Kasus Aneurisma Artery Popliteal (AAP)

Popliteal Artery Aneurysm (AAP) is a pathological dilation of the popliteal artery, and although often asymptomatic, can lead to serious complications such as rupture, thrombosis, or embolism. Aneurysms if ruptured can result in internal bleeding such as, stroke, and can sometimes be fatal. This research method is a literature review study, where literature exploration is carried out in various databases with keywords such as Percutaneous Transluminal Angioplasty (PTA)", Popliteal Artery Aneurysm (AAP) cases. Percutaneous transluminal angioplasty (PTA) in popliteal artery aneurysm (AAP) involves patient preparation, tools, procedure, post-operative care, and outcome evaluation. Patient preparation includes education, renal function evaluation, medication adjustment. Equipment preparation includes catheterization table, fluoroscopy system, various types of catheters, appropriate contrast agent. The PTA process includes insertion of the catheter into the femoral artery, evaluation and delineation of the popliteal artery, and completion of the procedure. PTA examination in AAP requires careful preparation and coordinated medical team collaboration to achieve optimal results. Percutaneous transluminal angioplasty (PTA) has proven to be effective as a primary therapeutic option to treat popliteal artery aneurysms (AAP) and prevent popliteal artery stenosis. Risk factors such as advanced age, male gender, and cardiovascular disease were considered in the literature analysis. Although PTA successfully improves the diameter of the popliteal artery as a minimally invasive method, it is important to recognize that the success of the procedure and the decision to use stents have a significant impact on the final outcome.

Incidence of Thromboembolism in COVID-19 Patients in Intensive Care Units: A Retrospective Cohort Analysis.

Coronavirus disease 2019 (COVID-19) infection was declared a pandemic, causing high mortality and morbidity worldwide.It predisposes patients to both arterial and venous thromboembolism, which causes high mortality, and is one of the most serious complications of the disease. The aim of this retrospective study was to determine the frequency of thromboembolic events in patients diagnosed with COVID-19 in the intensive care unit (ICU) and to identify the factors causing thromboembolism. The digital records of patients admitted to the adult ICU of Derince Training and Research Hospital, Kocaeli, Turkey, with a diagnosis of COVID-19 between March 13, 2020, and December 31, 2021, were retrospectively reviewed. Data of 484 patients, 248 (51.2%) female and 236 (48.8%) male, aged between 18-98 years were analyzed. The overall, arterial and venous incidence of thromboembolism was 14.8%, 11.3%, and 3.5%, respectively. There was no significant association between COVID-19 variants and the development of thromboembolism. The effect of various patient variables on the development of thromboembolism was evaluated, including cardiovascular disease (p<0.001), age (p=0.003), use of acetylsalicylic acid (ASA) (p<0.001), antiplatelet therapy (p<0. 001), acute physiology and chronic health evaluation (APACHE) II score (p=0.003), D-dimer (p=0.015), fibrinogen (p=0.032), ferritin (p=0.015), prothrombin time (PT) (p=0.015), international normalized ratio (INR) (p=0.012), troponin (p=0.012) values at the ICU admission were found statistically significant. The cut-off values were 2.565 (μg/mL) for D-dimer, 435.51 (mg) for fibrinogen, 633.55 (ml/ng) for ferritin, 1.155 for INR, and 0.085 (ng/mL) for troponin. Although low-molecular-weight heparin(LMWH) is the first choice, it may be appropriate to add ASA and other antiplatelet agents to reduce the risk of thromboembolism in patients with high thromboembolic risk including advanced age, cardiovascular disease, and elevated levels ofD-dimer, troponin, ferritin, and fibrinogen.

COVID-19 incidence and outcomes among patients with kidney replacement therapy.

We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6-0.9) and 0.3 (95% CI, 0.2-0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality.

Systemic and local vascular inflammation and arterial reactive oxygen species generation in patients with advanced cardiovascular diseases.

Systemic inflammation may cause endothelial activation, mediate local inflammation, and accelerate progression of atherosclerosis. We examined whether the levels of circulating inflammatory cytokines reflect local vascular inflammation and oxidative stress in two types of human arteries. Human internal mammary artery (IMA) was obtained in 69 patients undergoing coronary artery bypass graft (CABG) surgery and left anterior descending (LAD) artery was obtained in 17 patients undergoing heart transplantation (HTx). Plasma levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) were measured using ELISA, high-sensitivity C-reactive protein (hs-CRP) was measured using Luminex, and mRNA expression of proinflammatory cytokines in the vascular tissues was assessed. Furthermore, formation of superoxide anion was measured in segments of IMA using 5 uM lucigenin-dependent chemiluminescence. Vascular reactivity was measured using tissue organ bath system. TNF-α, IL-6 and IL-1β mRNAs were expressed in all studied IMA and LAD segments. Plasma levels of inflammatory cytokines did not correlate with vascular cytokine mRNA expression neither in IMA nor in LAD. Plasma TNF-α and IL-6 correlated with hs-CRP level in CABG group. Hs-CRP also correlated with TNF-α in HTx group. Neither vascular TNF-α, IL-6 and IL-1β mRNA expression, nor systemic levels of either TNF-α, IL-6 and IL-1β were correlated with superoxide generation in IMAs. Interestingly, circulating IL-1β negatively correlated with maximal relaxation of the internal mammary artery (r = -0.37, p = 0.004). At the same time the mRNA expression of studied inflammatory cytokines were positively associated with each other in both IMA and LAD. The positive correlations were observed between circulating levels of IL-6 and TNF-α in CABG cohort and IL-6 and IL-1β in HTx cohort. This study shows that peripheral inflammatory cytokine measurements may not reflect local vascular inflammation or oxidative stress in patients with advanced cardiovascular disease (CVD). Circulating pro-inflammatory cytokines generally correlated positively with each other, similarly their mRNA correlated in the arterial wall, however, these levels were not correlated between the studied compartments.

Factors Associated with Mortality in COVID-19 Patients with Comorbidities Who Were Hospitalized in the Different CT-EPI in the Labe Region, Guinea 2020-2022

Coronavirus infectious disease (COVID-19) shows remarkable symptomatic heterogeneity. To date, only a few demographic and clinical factors, such as advanced age, diabetes, and cardiovascular disease, have been associated with poor outcomes and increased risk of mortality from COVID-19. In the Labe region, the lethality of COVID-19 disease remains high in people with comorbidities. In our study, comorbidities were frequently associated with COVID-19 infection and were dominated by hypertension and diabetes. This recognition may help direct efforts toward prevention and management. The objective of the study was to describe the factors associated with mortality in COVID-19 patients with comorbidities hospitalized in the Labe region (Epidemiological Treatment Centers -CT Epi- and home). <i>Methods: </i>The study was carried out in the CT-Epi of COVID-19. It focused on the analysis of 1443 records of patients hospitalized in the CT-Epi of the Labe Region. It was a transversal and analytical study conducted in July 2022. Factors associated with mortality in patients with comorbidities were identified through patient records and content analysis. <i>Results: </i>A total of 1443 patients with COVID-19 hospitalized in the Labe region participated in our study, including 244 with comorbidities and 1199 patients with COVID-19 without comorbidities. Among these patients in our study, 823 were men and 620 were women, i.e., a M/F sex ratio of 1.33. The average age was 45 years (Min= 7 years; Max= 99 years). Bivariate analysis showed that there was a statistically significant association between comorbidities and the occurrence of death in patients with COVID-19. There is a positive association between this risk factor, which is comorbidity, and the occurrence of death. Therefore, we say that comorbidities are risk factors that are responsible for the occurrence of death in patients with COVID-19 in the Labe region. <i>Conclusion</i>: In our study, advanced age, hypertension, diabetes, HIV, and chronic lung disease were the main risk factors for hospitalization or death due to COVID-19 in the Labe region. Further research is needed to identify risk factors associated with severe forms and mortality of COVID-19 to optimize management of patients with comorbidities. This study places particular emphasis on the priority targets (people over 60 and people with co-morbidities) of accelerated vaccination campaigns against COVID-19.

Female Recruitment Into Cardiovascular Disease Trials

Female Recruitment Into Cardiovascular Disease Trials

Metabolic-Associated Fatty Liver Disease (MAFLD) is associated with immune activation, increased epicardial fat volume, and steatohepatitis among people with HIV in a Thai cohort.

A change in terminology from fatty liver disease to metabolic-associated fatty liver disease (MAFLD), along with modified diagnostic criteria, was proposed in 2020, and data regarding MAFLD burden in people living with HIV are limited. We investigated associations between MAFLD and immune activation, cardiovascular disease (CVD) risks including epicardial fat volume, and steatohepatitis in an Asian cohort. We evaluated CVD risk (epicardial fat tissue, coronary artery calcium [CAC] score, and 10-year atherosclerotic CVD [ASCVD] score) in people living with HIV aged >50 years. Individuals with excessive alcohol consumption and viral hepatitis infections were excluded. MAFLD diagnosis was based on 2020 International Consensus criteria. Non-alcoholic steatohepatitis (NASH) with significant activity and liver fibrosis was defined as FibroScan-aspartate aminotransferase (FAST) score ≥0.67 and >0.35. Multivariate logistic regression models were used to investigate factors associated with MAFLD and NASH with significant activity and liver fibrosis. The median age was 54 years (interquartile range [IQR] 52-60) and current CD4 count was 613 (IQR 467-804) cells/mm3 . A total of 37% were female, and most (98%) people living with HIV were virally suppressed. The prevalence of MAFLD and non-alcoholic fatty liver disease was 35% and 38%, respectively. In multivariate analyses, higher body mass index, albumin, epicardial fat volume, and liver stiffness were significantly associated with MAFLD. A higher CD4/CD8 ratio was associated with a lower risk of MAFLD. People with HIV with MAFLD had higher odds of having NASH with significant activity and liver fibrosis (adjusted odds ratio 3.3; 95% confidence interval 1.6-6.6), and similar associations were also observed among different MAFLD categories. The complex relationship between MAFLD and immune activation, steatohepatitis, and epicardial fat tissue suggests an increased risk of advanced liver disease and CVDs beyond the traditional risk factors in people living with HIV with fatty liver disease.

Trimethylamine-N-oxide paradoxically depresses contractile function while activating mitochondrial respiration in mouse hearts.

Trimethylamine-N-oxide (TMAO) is an end-product of gut-microbiome metabolism linked to cardiovascular disease (CVD). However, precise cardiovascular influences of the TMAO concentrations reported in early or severe disease remain to be detailed. We investigated acute effects of TMAO on cardiac contractile, coronary and mitochondrial function. Male C57Bl/6 mouse hearts were Langendorff perfused to assess concentration-dependent effects of TMAO (1-300 µM) on left ventricular (LV) function, coronary flow and select protein expression. Effects of 10 and 100 µM TMAO on LV mitochondrial function were examined via respirometry. TMAO at 10-300 µM concentration-dependently depressed LV contractile function, with coronary flow paralleling changes in isovolumic pressure development. Direct coronary effects were evident at >30 µM TMAO in hearts performing minimal isovolumic work, though this response was reduced by >65%. In contrast, exposure to 10 or 100 µM TMAO increased mitochondrial complex I, II and maximal respiratory fluxes while appearing to reduce outer membrane integrity. Expression of phospho-AMPKα and total GSK-3β declined. Acute exposure to TMAO levels reported in advanced CVD significantly inhibits cardiac contractility and induces modest coronary constriction while paradoxically over-activating mitochondrial respiration.

Oxidative Stress and Cardiovascular Risk Factors: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Introduction-Oxidative stress is linked to cardiovascular diseases (CVD) and is suggested to vary by sex. However, few population-level studies have explored these associations and the majority comprise populations with advanced CVD. We assessed urinary isoprostane concentrations, a standard measure of oxidative stress, in a relatively young and healthy cohort, hypothesizing that higher oxidative stress is associated with an adverse cardiometabolic profile and female sex. Methods-Oxidative stress was measured in 475 women and 266 men, aged 48-55 years, from the Coronary Artery Risk Development in Young Adults (CARDIA) study using urinary 8-isoprostane (IsoP) and 2,3-dinor-8-isoprostane (IsoP-M). Multivariable-adjusted regression was used to evaluate cross-sectional associations. As secondary analysis, previously measured plasma F2-isoprostanes (plasma IsoP) from another CARDIA subset was similarly analyzed. Results-Mean (SD) ages for men and women were 52.1(2.3) and 52.2(2.2) years, respectively (p = 0.46), and 39% of the participants self-identified as Black (vs. White). Before adjustments, female sex was associated with higher median urinary IsoP (880 vs. 704 ng/g creatinine in men; p < 0.01) and IsoP m (1675 vs. 1284 ng/g creatinine in men; p < 0.01). Higher body mass index (BMI), high-density cholesterol (HDL-C), and triglycerides, current smoking, and less physical activity were associated with higher oxidative stress. Diabetes was not associated with urinary IsoP but was associated with lower IsoP m and plasma IsoP. Higher serum creatinine showed diverging associations with higher plasma and lower urinary isoprostane concentrations. Conclusions-Different isoprostane entities exhibit varying association patterns with CVD risk factors, and therefore are complementary, rather than interchangeable, in assessment of oxidative stress. Still, consistently higher isoprostanes among women, smokers, less active persons, and those with higher BMI and plasma triglycerides could reflect higher oxidative stress among these groups. While urinary isoprostanes are indexed to urinary creatinine due to variations in concentration, caution should be exercised when comparing groups with differing serum creatinine.

Oxygen Therapy and Associated Risk Factors for Home Isolated COVID-19 Patients: A Review

During the second wave of the viral pandemic, hospitals were overcrowded by the escalation of Coronavirus Disease-2019 (COVID19) cases. To effectively address the drastic escalation of the COVID-19 pandemic, innovative solutions are warranted. The rising demand for critical-care services burdens hospitals; hence, to alleviate the burden on the healthcare system, asymptomatic patients or those with mild symptoms can be treated at home through continuous monitoring and care. Affected patients are at risk of hypoxia, which urgently requires oxygen therapy. Depending on the extent of oxygen demand, patients can boost their oxygen levels by making use of a nasal cannula, face mask, oxygen cylinder, and/or oxygen concentrator. Several risk factors are associated with the augmented probability of COVID-19 progression to severe status due to increased oxygen requirement, and they include advanced age, obesity, glucose intolerance, hypertension, and cardiovascular disease. A close monitoring of oxygen saturation (SpO2 ) along with other clinical investigations like complete and differential blood counts, serum electrolytes, random blood sugar, liver function tests, coagulation profile (Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR)), renal function test, C-reactive protein (CRP), D-dimer and ferritin level are mandatory for patients receiving home-based oxygen therapy. An awareness of safety considerations such as perfectly fitting, proper sized mask, availability of ventilation, knowledge of caregiver about danger signs and good functioning of fire alarm system at home are of prime importance before setting up oxygenation devices at home, and this further mandates a comprehensive evaluation of home-based management and treatment of mildly symptomatic patients with COVID-19.

Atherosclerosis: risk assessment and the role of aiming for optimal glycaemic control in young patients with type 1 diabetes.

Compared with healthy children, peers with type 1 diabetes mellitus (DM1) have an increased risk of developing advanced atherosclerosis and cardiovascular disease (CVD). Glycaemic control is the most important modifiable risk factor for CVD in DM1. Currently, monitoring of glycaemic control relies on glycosylated haemoglobin levels (HbA1c), self-monitoring of blood glucose (SMBG), and the use of continuous glucose monitoring (CGM) systems. The flow-mediated dilatation (FMD), pulse wave velocity (PWV), ankle-brachial index (ABI), and carotid intima-media thickness (cIMT) may be used to assess the risk of CVD, by estimating the process of atherosclerosis in peripheral vessels. Aim of the study: To summarize the current literature on the correlation of metabolic control in young people with DM1, assessed by key metrics from CGM reports, and the development of atherosclerosis and the incidence of CVD. Conclusions: Chronic hyperglycaemia is an independent risk factor for vascular changes. The effect of glycaemic control - assessed on the basis of parameters obtained from CGM reports - on the risk of CVD in DM1 has been analysed in few studies, especially in the paediatric population.

Abstract C077: Understanding the epidemiology of NAFLD in Asian Americans: A literature review and survey development

Abstract Background: Non-alcoholic fatty liver disease (NAFLD) affects about 25% of the general population in the US. Although epidemiology of NAFLD is well studied in the US, the scientific understanding of how this disease affect Asian Americans is very limited. Given that NAFLD is strongly increases the risks of liver cancer, a condition that disproportionally affect Asian Americans, it is critical that we better understand the burden of NAFLD in this population and identify protective/risk factors. The goals of this study are to (1) review the existing body of literature on the epidemiology of NAFLD in Asian Americans and (2) develop a survey based to better understand the burden of the disease. Methods: In this study we conducted a review of previous studies on NAFLD in Asian Americans and in Asia/Pacific regions. We focused on three aspects: (1) the prevalence and incidence rates of NALFD in the target populations; (2) the risk factors and protective factors of NAFLD; (3) the knowledge of and attitude towards NAFLD and its prevention, diagnosis, and treatment. We also identified limitations in previous studies with regards to study design and methodology. Findings: We have found that so far there has been there is paucity of data for NAFLD burdens in Asian Americans. The few existing studies estimated the prevalence of NAFLD to be between 18% to 43% in Asian Americans, with higher rates in men than women. Comparative studies have inconsistent findings on the prevalence of NAFLD between Asian and non-Asian American populations, likely due to differences in target population and sampling methods. However, one consistent finding so far was that Asian Americans with NAFLD have lower BMI and waist circumference, and aminotransferases and triglycerides, and similar risk factors for advanced fibrosis and atherosclerotic cardiovascular disease, than non-Asian Americans with NAFLD. Though limited, these studies suggested that Asian Americans are potentially at high risks for NAFLD and liver cancer, but the specific mechanisms remained unclear. Survey Development: Recognizing the gaps in previous literature, we designed a survey to better understand the burden of NAFLD in Asian Americans and provide foundation for behavioral and clinical interventions. We developed a survey to examine the knowledge, attitude, and behaviors related to NAFLD prevention, diagnosis, and treatment among Asian Americans. Conclusion: Despite inconsistent findings on how prevalence rates compare between Asian Americans and non-Hispanic white, increased evidence points to an elevated risks for advanced NAFLD and worsen outcomes in Asian Americans. We will discuss the implications for the prevention in Asian Americans, as well as linkage to care for early diagnosis and treatment for Asian Americans with NAFLD. We will also discuss the participant recruitment and data collection process of conducting the survey. Citation Format: Lin Zhu, Dasam Jeong, Yassah N. Lavelah, Yin Tan, Grace X. Ma. Understanding the epidemiology of NAFLD in Asian Americans: A literature review and survey development [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C077.

The potential of tailoring the gut microbiome to prevent and treat cardiometabolic disease.

Despite milestones in preventive measures and treatment, cardiovascular disease (CVD) remains associated with a high burden of morbidity and mortality. The protracted nature of the development and progression of CVD motivates the identification of early and complementary targets that might explain and alleviate any residual risk in treated patients. The gut microbiota has emerged as a sentinel between our inner milieu and outer environment and relays a modified risk associated with these factors to the host. Accordingly, numerous mechanistic studies in animal models support a causal role of the gut microbiome in CVD via specific microbial or shared microbiota-host metabolites and have identified converging mammalian targets for these signals. Similarly, large-scale cohort studies have repeatedly reported perturbations of the gut microbial community in CVD, supporting the translational potential of targeting this ecological niche, but the move from bench to bedside has not been smooth. In this Review, we provide an overview of the current evidence on the interconnectedness of the gut microbiome and CVD against the noisy backdrop of highly prevalent confounders in advanced CVD, such as increased metabolic burden and polypharmacy. We further aim to conceptualize the molecular mechanisms at the centre of these associations and identify actionable gut microbiome-based targets, while contextualizing the current knowledge within the clinical scenario and emphasizing the limitations of the field that need to be overcome.

Cardiac risk stratification of the liver transplant candidate: A comprehensive review.

Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.