Adverse Cardiovascular Disease Outcomes Research Articles

Cardiovascular events risk in office-masked nocturnal hypertension defined by home blood pressure monitoring: the J-HOP nocturnal blood pressure study

Abstract Background Elevated nocturnal home blood pressure (BP) has been reported to be associated with increased risk for cardiovascular disease (CVD). Masked hypertension defined by home BP monitoring is also a strong risk factor for adverse CVD outcomes. However, no study has investigated the association between office-masked nocturnal hypertension defined by home BP monitoring and CVD events risk. Purpose This study aimed to examine the association between office-masked nocturnal hypertension defined by home BP monitoring and CVD events risk in a clinical practice-based population. Methods This was a prospective observational study including Japanese participants with CVD or high risk of CVD. Three office BPs were taken on two different occasions. Nocturnal home BP was measured three times per night for two weeks. The association between office-masked nocturnal hypertension and incident total CVD events (including fatal and non-fatal stroke and coronary heart disease) was examined using Cox regression. Results 2,545 participants were followed for the mean of 7.1 years (18,116 person-years), during which 152 (6.0%) CVD events occurred. Mean age (standard deviation) was 63.3 (10.3) years; 49.0% were male; 82.6% took antihypertensive medications. The proportions of participants with normotension (office BP <140/90 mmHg and nocturnal home BP <120/70 mmHg), white-coat hypertension (office BP ≥140/90 mmHg and nocturnal home BP <120/70 mmHg), office-masked nocturnal hypertension (office BP <140/90 mmHg and nocturnal home BP ≥120/70 mmHg), and sustained hypertension (office BP ≥140/90 mmHg and nocturnal home BP ≥120/70 mmHg) were 25.3%, 14.4%, 23.2%, and 37.1%, respectively. The office-masked nocturnal hypertensive group and sustained hypertensive group had higher incidence rates of total CVD events compared with the normotensive group. Relative to normotension, those with both office-masked nocturnal hypertension (adjusted hazard ratio [aHR] 1.72, 95% confidence interval [CI] 1.01–2.92) and sustained hypertension (aHR 1.75, 95%CI 1.03–2.96) had similarly increased CVD risk, even after adjustment for daytime home BP values. Conclusions Screening for office-masked nocturnal hypertension with home BP monitoring identifies a potentially important group of patients with increased risk for incident CVD events for whom additional preventative measures may be appropriate.

The Use of the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Predicting Transcatheter Aortic Valve Implantation Mortality

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are simple biomarkers that reflect systemic inflammation and are associated with adverse cardiovascular disease outcomes. The utility of NLR and PLR for risk prediction following transcatheter aortic valve implantation (TAVI) is not clear. We retrospectively analysed a prospectively maintained database of patients who underwent TAVI at a tertiary hospital from 2009 to 2022. Baseline demographics, NLR, PLR and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores were obtained. The 30-day and 1-year survival rates were analysed using a logistic regression model while overall survival was analysed using the Kaplan-Meier method. Predictors of survival were calculated using a Cox-hazards regression model and presented as odds ratio (OR) with 95% confidence interval (CI). Overall, 367 patients were included in this study (mean age 84 years, 51% male). Median follow-up was 19 months (interquartile range 8.8-40 months) with a median survival of 7.2 years (interquartile range 3.5-10.3 years). NLR was associated with 30-day mortality (OR 1.75; 95% CI 1.25-2.68; p<0.01). PLRs marginally predicted 1-year mortality (OR 1.01; 95% CI 1.00-1.02). However, only the STS-PROM score significantly predicted overall survival (hazard ratio 1.07; 95% CI 1.02-1.12; p=0.03) after adjustment for NLR and PLR. NLR is associated with 30-day mortality following TAVI. PLR was not a clinically significant predictor of mortality after TAVI. Only the STS-PROM score remained a significant predictor of overall survival.

Recent advancement in regulatory requirements on hypertension in India as Per CDSCOIN comparison with Australia

Hypertension is a significant health issue in India and Australia, and it is associated with a considerable reduction in adverse cardiovascular disease outcomes. To decrease the prevalence of hypertension by 25% by 2025 and expedite access to treatment services, The India Hypertension Control Initiative (IHCI) was established. To enhance hypertension management in public sector clinics, the IHCI project was introduced in 2018-2019 in 26 districts in five Indian states: Punjab, Madhya Pradesh, Kerala, Maharashtra, and Telangana. Both India and Australia, face significant public health issues related to hypertension, with 28.1% of adults suffering from the condition. With 28.1% of adults in both India and Australia suffering from hypertension, the two countries face serious public health challenges. India has made great strides toward controlling hypertension and improving regulatory policies. The prevalence in both countries varied significantly between urban and rural areas as well as between specific demographic groups. Men’s awareness, treatment, and control in rural areas were substantially lower than women’s. All of the national studies reported that the prevalence is lower in urban areas when compared to rural areas in Australia, but contrastingly prevalence is higher in urban areas when compared to rural areas. In rural areas, treatment and awareness are especially crucial. With a greater percentage of people suffering from hypertension, it is a serious problem in both countries. This paper examines and compares the regulatory requirements concerning hypertension in the two countries.

Social Determinants of Cardiovascular Health in Asian Americans: A Scientific Statement From the American Heart Association.

To achieve cardiovascular health (CVH) equity in the United States, an understanding of the social and structural factors that contribute to differences and disparities in health is necessary. The Asian American population is the fastest-growing racial group in the United States but remains persistently underrepresented in health research. There is heterogeneity in how individual Asian American ethnic groups experience CVH and cardiovascular disease outcomes, with certain ethnic groups experiencing a higher burden of adverse social conditions, disproportionately high burden of suboptimal CVH, or excess adverse cardiovascular disease outcomes. In this scientific statement, upstream structural and social determinants that influence CVH in the Asian American population are highlighted, with particular emphasis on the role of social determinants of health across disaggregated Asian American ethnic groups. Key social determinants that operate in Asian American communities include socioeconomic position, immigration and nativity, social and physical environments, food and nutrition access, and health system-level factors. The role of underlying structural factors such as health, social, and economic policies and structural racism is also discussed in the context of CVH in Asian Americans. To improve individual-, community-, and population-level CVH and to reduce CVH disparities in Asian American ethnic subgroups, multilevel interventions that address adverse structural and social determinants are critical to achieve CVH equity for the Asian American population. Critical research gaps for the Asian American population are given, along with recommendations for strategic approaches to investigate social determinants of health and intervene to reduce health disparities in these communities.

Depression and Adverse Cardiovascular Disease Outcomes: Cause or Consequence?

Depression and Adverse Cardiovascular Disease Outcomes: Cause or Consequence?

AMYLOID-BETA 40 ADVERSELY INFLUENCES LARGE ARTERY STIFFNESS AND CUTANEOUS MICROVASCULAR FUNCTION IN OLDER ADULTS WITH DIVERSE CARDIOVASCULAR RISK

Objective: Amyloid-beta (Aβ) peptides are considered to play a prominent role in Alzheimer's disease, but emerging experimental and clinical observations link Aβ40 with adverse extracerebral vascular manifestations and cardiovascular disease events. However, it is unclear if Aβ40 adversely influences both large artery stiffness and cutaneous microvascular function in humans. We sought to determine whether Aβ40 was associated with large artery stiffness and cutaneous microvascular function in older adults with diverse cardiovascular risk. Design and method: This cross-sectional study analysed data from 610 older adults (65.7±8.7 yrs, 242F). Large artery stiffness was assessed by carotid-femoral pulse wave velocity (CFPWV) using a SphygmoCor device, and cutaneous microvascular function was assessed by measuring acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) responses following iontophoresis. Plasma Aβ40 concentration was measured using a human Aβ40 assay kit (Simoa Human A β40). Results: One standard deviation increase in Aβ40 was significantly associated with 0.74 (0.52, 0.96) m/s greater CFPWV in an age- and sex-adjusted model (Model-1, p&lt;0.001), which remained significant after further adjustments for conventional cardiovascular disease risk factors [Model-2, 0.46 (0.26, 0.66) m/s, p&lt;0.001]. Additionally, one standard deviation increase in Aβ40 was significantly associated with lower cutaneous acetylcholine [-27.3 (-38.9, -15.7) au] and sodium nitroprusside [-27.0 (-38.1, -15.9) au] responses in Model-1 (both p&lt;0.001). Further adjustments for conventional cardiovascular disease risk factors did not modify the inverse association [Model-2, acetylcholine response, -20.7 (-32.5, -8.8) au: sodium nitroprusside response, -21.1 (-32.3, -9.9) au: both p&lt;0.001]. Subgroup analyses found an indication of interaction effect whereby female sex influenced more on the association between Aβ40 and CFPWV, and type 2 diabetes influenced more on the association between Aβ40 and cutaneous acetylcholine responses (both p&lt;0.05). Conclusions: Aβ40 was associated with increased large artery stiffness and decreased cutaneous microvascular function in older adults with diverse cardiovascular risk. These findings suggest a potential mechanistic link between Aβ40 deposition in the systemic circulation and previously observed adverse cardiovascular disease outcomes.

Risk of Adverse Cardiovascular Outcomes in Postmenopausal Women with Inflammatory Bowel Disease

BackgroundIndividuals with inflammatory bowel disease (IBD) who lack traditional cardiovascular disease (CVD) risk factors, such as young females, are observed to experience adverse CVD outcomes. Whether women with IBD have increased CVD risk after the menopause transition is unclear.MethodsWe conducted a survival analysis of Women’s Health Initiative (WHI) participants and excluded those with missing IBD diagnosis, model covariate data, follow-up data, or a baseline history of the following CVD outcomes: coronary heart disease (CHD), ischemic stroke, venous thromboembolism (VTE), peripheral arterial disease (PAD). Risk of outcomes between IBD and non-IBD women was performed using Cox proportional hazard models, stratified by WHI trial and follow-up. Models were adjusted for age, socio-demographics, comorbidities (e.g., hypertension, diabetes, hypercholesterolemia, etc.), family history, and lifestyle factors (e.g., smoking, alcohol, physical activity, body mass index, etc.).ResultsOf 134,022 WHI participants meeting inclusion criteria, 1367 (1.0%) reported IBD at baseline. Mean baseline age was 63.4 years. After adjusting for age and other confounders, no significant difference was observed between IBD and non-IBD women for the risk of CHD (HR 0.96, 95% CI 0.73–1.24), VTE (HR 1.11, 95% CI 0.81–1.52) or PAD (HR 0.64, 95% CI 0.28–1.42). After adjusting for age, risk of ischemic stroke was significantly higher (HR 1.41, 95% CI 1.06–1.88) in IBD than non-IBD women. With further adjustment, the excess risk of ischemic stroke among IBD women was attenuated and no longer statistically significant (HR 1.31, 95% CI 0.98–1.76).ConclusionsAmong postmenopausal women with IBD, risk of ischemic stroke may be higher than in non-IBD women.

Implications of Cardiopulmonary Risk for the Management of COPD: A Narrative Review.

Chronic obstructive pulmonary disease (COPD) constitutes a major global health burden and is the third leading cause of death worldwide. A high proportion of patients with COPD have cardiovascular disease, but there is also evidence that COPD is a risk factor for adverse outcomes in cardiovascular disease. Patients with COPD frequently die of respiratory and cardiovascular causes, yet the identification and management of cardiopulmonary risk remain suboptimal owing to limited awareness and clinical intervention. Acute exacerbations punctuate the progression of COPD in many patients, reducing lung function and increasing the risk of subsequent exacerbations and cardiovascular events that may lead to early death. This narrative review defines and summarises the principles of COPD-associated cardiopulmonary risk, and examines respiratory interventions currently available to modify this risk, as well as providing expert opinion on future approaches to addressing cardiopulmonary risk.

Abstract P115: Urban Greenspace and All-Cause, Cardiovascular Disease-Specific, and Breast Cancer-Specific Mortality Among Older Women With Breast Cancer in the United States: Regional Variations Within the Surveillance, Epidemiology, and End Results and Medicare Linked Database

Background: Cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality in the US. Cancer survivors are at increased risk for adverse CVD outcomes due to multiple factors, including cardiotoxicity. Research suggests that greenspace contributes to better health outcomes, including CVD and breast cancer (BC). Objective: To explore relationships between urban greenspace and all-cause (ACM), CVD-specific (CVDSM), and BC-specific (BCSM) mortality and explore regional differences among older women diagnosed with BC in the US SEER-Medicare database. Methods: The 2011 national landcover database was linked to the 2010 census tracts and the 2010-2017 SEER-Medicare BC cohort. Women were included if they were 66+ years at diagnosis, had invasive BC, enrolled in Medicare Part A and Part B for 12 months before diagnosis, and had a census tract match for greenspace. Independent variable ‘greenspace’ was census tract percent tree canopy quartiles. Outcomes were all-cause, CVD, and BC-specific survival. Censoring was determined by the end of the study date, 12/31/2018. Covariates included age and comorbidity at BC diagnosis, race/ethnicity, dual enrollment in both Medicare and Medicaid eligibility, neighborhood social vulnerability, and tumor stage. Results: Regional variations in association between greenspace and BC survival were observed (Table 1). Greenspace is protective for ACM and BCSM in California, Washington, New Jersey, and Michigan, while no significant associations were observed in Georgia or Louisiana. For CVDSM, greenspace is protective in CA, while no significant differences were observed in Washington, Louisiana, and Michigan. An inverse relationship is observed for CVDSM in Georgia and New Jersey. Discussion: Our findings warrant more studies to investigate why greenspace is protective in some areas (i.e., CA, NJ, MI) or hazardous in other areas (i.e., GA). There is a need to identify critical factors and pathways contributing to these greenspace-survival differences.

Association of neutrophil-to-lymphocyte ratio and risk of cardiovascular and all-cause mortality in hypertension patients

Background and objectiveHypertension affects over a billion people worldwide and is often associated with poor prognoses. The neutrophil-to-lymphocyte ratio (NLR) has become a significant marker, showing a connection to adverse outcomes in cardiovascular diseases (CVDs). The objective of this study is to examine the relationship between the NLR and outcomes in patients with hypertension. MethodsThe study included hypertensive individuals who were surveyed in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. Mortality status was determined using the data from National Death Index (NDI). To investigate the dose-response relationship, restricted cubic spline (RCS) models were used. This study employed adjusted cox proportional hazards regression models to compute hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) for all-cause and cardiovascular mortality. The predictive accuracy of the NLR for survival outcomes was assessed utilizing time-dependent receiver operating characteristic (ROC) curve analysis. ResultsA total of 13,724 participants were included in the final analysis, including 7073 males and 6651 females. The cohort was stratified into higher (>2.0) and lower (≤2.0) NLR groups according to the median value. Over a median follow-up of 64 months, there were 1619 all-cause deaths and 522 cardiovascular deaths among participants. The RCS analysis indicated a non-linear relationship between NLR and the risk of mortality. The adjusted model showed that the group with a higher NLR had a significantly higher risk of all-cause (HR 1.47, 95% CI 1.22–1.77) and cardiovascular mortality (HR 2.08, 95% CI 1.52–2.86). ROC analysis showed that the area under the curves (AUCs) of 0.692, 0.662, 0.644, and 0.625 for predicting all-cause mortality, and 0.712, 0.692, 0.687, and 0.660 for cardiovascular mortality at 1, 3, 5, and 10 years. ConclusionElevated NLR is associated with increased risk of cardiovascular and all-cause mortality, and NLR may independently predict outcomes in individuals with hypertension.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research. Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460. Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities. Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

Improving the Detection and Management of Kidney Health in Primary Care.

Chronic kidney disease (CKD) is a major cause of morbidity and mortality, contributing to approximately 20 000 deaths in 2021 in Australia. Importantly, progression of CKD can be substantially reduced if it is detected and treated early. Here we present the perspectives of a general practitioner (primary care physician), a nephrologist and a patient advocate on how the diagnosis and management of CKD in primary care could be improved. Early detection and treatment of CKD are impeded by limited patient awareness and knowledge, communication challenges between patients and doctors, and psychosocial issues, with these factors also interacting with, and exacerbating, each other. We make the following recommendations to help improve outcomes in patients with CKD: (1) identifying people at increased risk of CKD and ensuring they have a complete kidney health check (including estimated glomerular filtration rate, urine albumin-creatinine ratio and a blood pressure check) every 1-2 years; (2) using simple, nonconfrontational language and supportive resources to communicate with patients about kidney health; (3) implementing early treatment to slow the progression of CKD and avoid adverse cardiovascular disease outcomes; and (4) asking patient-orientated questions to support shared decision-making and empower patients to be active partners in their healthcare. We acknowledge that limited time is a major barrier to implementing these recommendations in primary care. Utilizing the expertise of the whole practice team, and adopting supportive technology to introduce efficiencies, are likely to be of benefit. By adopting these recommendations, we believe general practitioners have the opportunity to drive improved outcomes and quality of life for people living with CKD in Australia.

Real-World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes-Results From a Large Registry Cohort in Asia.

Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D. We used data on 83 721 patients with T2D from a multi-institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person-years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients. In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out.

Mid-Regional Proadrenomedullin in COVID-19—May It Act as a Predictor of Prolonged Cardiovascular Complications?

The rising prevalence of cardiovascular disease (CVD) and the impact of the SARS-CoV-2 pandemic have both led to increased mortality rates, affecting public health and the global economy. Therefore, it is essential to find accessible, non-invasive prognostic markers capable of identifying patients at high risk. One encouraging avenue of exploration is the potential of mid-regional proadrenomedullin (MR-proADM) as a biomarker in various health conditions, especially in the context of CVD and COVID-19. MR-proADM presents the ability to predict mortality, heart failure, and adverse outcomes in CVD, offering promise for improved risk assessment and treatment strategies. On the other hand, an elevated MR-proADM level is associated with disease severity and cytokine storms in patients with COVID-19, making it a predictive indicator for intensive care unit admissions and mortality rates. Moreover, MR-proADM may have relevance in long COVID, aiding in the risk assessment, triage, and monitoring of individuals at increased risk of developing prolonged cardiac issues. Our review explores the potential of MR-proADM as a predictor of enduring cardiovascular complications following COVID-19 infection.

Abstract 18447: Comparative Seasonal Variation in Outcomes Among Patients Hospitalized for Heart Failure in Cold- and Warm-Climate States

Background: Despite emerging evidence that extreme heat and air pollution exposure are linked to adverse cardiovascular disease outcomes, paradoxical seasonal trends in heart failure hospitalizations and deaths have been observed, with peaks occurring in winter months. This study aimed to explore how seasonal variations in heart failure admissions differ among individuals hospitalized in cold-climate and warm-climate states. Methods: Population-level, state-wide data were used to explore outcomes among all individuals hospitalized for heart failure in Texas (1999-2016) and New York (1994-2007). Seasonal variation was assessed using time of discharge (January-March, April-June, July-September, October-December). Multivariable logistic and linear regression were used to explore the relationship between time of discharge and the primary outcomes of interest: mortality and length of stay (LOS). Analyses were adjusted for age, sex, race, ethnicity, and comorbidities (hypertension, hyperlipidemia, diabetes, CAD, arrhythmias, anemia, COPD, tobacco use). Results: Among individuals hospitalized for heart failure in both Texas and New York, mortality and LOS were significantly increased during winter months compared to spring, summer, and early fall (Table). While similar seasonal trends were observed across states, the observed effect sizes were smaller in the Texas population. Conclusions: Among patients hospitalized for heart failure in Texas and New York, there is an increase in mortality and LOS during winter months. However, the differences in effect sizes after controlling for traditional risk factors suggests that other variables (i.e., temperature fluctuations) may affect these seasonal trends and warrants further exploration.

Recent advancement in regulatory requirements on hypertension in India as per CDSCO in comparison with south Africa

Hypertension is a significant health issue in India and KwaZulu-Natal, South Africa, and it is associated with a considerable reduction in adverse cardiovascular disease outcomes. The India Hypertension Control Initiative (IHCI) was launched to accelerate access to treatment services and reduce hypertension prevalence by 25% by 2025. The IHCI project was designed to improve hypertension control in public sector clinics, and it was launched in the 2018–2019 in 26 districts across five states of India: Punjab, Madhya Pradesh, Kerala, Maharashtra, and Telangana. Both India and KwaZulu-Natal, South Africa, face significant public health issues related to hypertension, with 29.8% of adults suffering from the condition. India has made significant progress in addressing hypertension and refining regulatory measures. The overall occurrence of hypertension in India is 29.8%. There was a vital difference in the prevalence between urban and rural areas and among certain demographic groups in both countries. In rural areas, awareness, treatment, and control were significantly lower among men compared to women. Hypertension prevalence was higher in urban than rural areas in all studies that covered both types of area in the country. Awareness and treatment are especially important in the rural areas. It appears that hypertension is a significant issue in both countries, with higher prevalence rates in urban areas and among certain demographic groups. In this paper, we review and focus on the comparison on regulatory requirements on hypertension in both the countries.

Vascular Age Assessed From an Uncalibrated, Noninvasive Pressure Waveform by Using a Deep Learning Approach: The AI-VascularAge Model.

Aortic stiffness, assessed as carotid-femoral pulse wave velocity, provides a measure of vascular age and risk for adverse cardiovascular disease outcomes, but it is difficult to measure. The shape of arterial pressure waveforms conveys information regarding aortic stiffness; however, the best methods to extract and interpret waveform features remain controversial. We trained a convolutional neural network with fixed-scale (time and amplitude) brachial, radial, and carotid tonometry waveforms as input and negative inverse carotid-femoral pulse wave velocity as label. Models were trained with data from 2 community-based Icelandic samples (N=10 452 participants with 31 126 waveforms) and validated in the community-based Framingham Heart Study (N=7208 participants, 21 624 waveforms). Linear regression rescaled predicted negative inverse carotid-femoral pulse wave velocity to equivalent artificial intelligence vascular age (AI-VA). The AI-VascularAge model predicted negative inverse carotid-femoral pulse wave velocity with R2=0.64 in a randomly reserved Icelandic test group (n=5061, 16%) and R2=0.60 in the Framingham Heart Study. In the Framingham Heart Study (up to 18 years of follow-up; 479 cardiovascular disease, 200 coronary heart disease, and 213 heart failure events), brachial AI-VA was associated with incident cardiovascular disease adjusted for age and sex (model 1; hazard ratio, 1.79 [95% CI, 1.50-2.40] per SD; P<0.0001) or adjusted for age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, prevalent diabetes, hypertension treatment, and current smoking (model 2; hazard ratio, 1.50 [95% CI, 1.24-1.82] per SD; P<0.0001). Similar hazard ratios were demonstrated for incident coronary heart disease and heart failure events and for AI-VA values estimated from carotid or radial waveforms. Our results demonstrate that convolutional neural network-derived AI-VA is a powerful indicator of vascular health and cardiovascular disease risk in a broad community-based sample.

Comparison of Atherosclerotic Cardiovascular Risk Factors and Cardiometabolic Profiles Between Current and Never Users of Marijuana.

The relationship between marijuana use and cardiovascular health remains uncertain, with several observational studies suggesting a potential association with increased adverse atherosclerotic cardiovascular disease (ASCVD) outcomes. This study examined the relationship between marijuana use, ASCVD risk factors, and cardiometabolic risk profiles. US adults (18-59 years) without cardiovascular disease were identified from the National Health And Nutrition Examination Survey (2005-2018) based on self-reported marijuana use. Current users (used within the past month) and never users were compared with assess the burden and control of traditional ASCVD risk factors and biomarkers, using inverse probability of treatment weighting to adjust for sociodemographic and lifestyle factors, including tobacco use. Of the 13 965 participants identified (mean age, 37.5; 51.2% female; 13% non-Hispanic Black), 26.6% were current users. Current users were predominantly male, low-income, and more likely to be concurrent tobacco users. Inverse probability of treatment weighting analysis showed no significant differences in the burden and control of hypertension (19.3% versus 18.8%, P=0.76; 79.8% versus 77.8%, P=0.75), dyslipidemia (24.0% versus 19.9%, P=0.13; 82% versus 75%, P=0.95), diabetes (4.8% versus 6.4%, P=0.19; 52.9% versus 50.6%, P=0.84), obesity (35.8% versus 41.3%, P=0.13), and physical activity levels (71.9% versus 69.3%, P=0.37) between current and never users. Likewise, mean 10-year ASCVD risk scores (2.8% versus 3.0%, P=0.49), 30-year Framingham risk scores (22.7% versus 24.2%, P=0.25), and cardiometabolic profiles including high-sensitivity C-reactive protein (3.5 mg/L versus 3.7 mg/L, P=0.65), neutrophil-lymphocyte ratio (2.1 versus 2.1, P=0.89), low-density lipoprotein (114.3 mg/dL versus 112.2 mg/dL, P=0.53), total cholesterol (191.2 mg/dL versus 181.7 mg/dL, P=0.58), and hemoglobin A1C (5.4% versus 5.5%, P=0.25) were similar between current and never users. This cross-sectional study found no association between self-reported marijuana use and increased burden of traditional ASCVD risk factors, estimated long-term ASCVD risk, or cardiometabolic profiles. Further studies are needed to explore potential pathways between adverse cardiovascular disease outcomes and marijuana use.

Prevalence of anemia and associated factors among adult hypertensive patients in Referral Hospitals, Amhara Regional State

Anemia is a risk factor for adverse cardiovascular disease outcomes in hypertensive patients. Chronic anemia increases preload, reduces afterload, and leads to increased cardiac output in hypertension patients. In the long term, this may result in maladaptive left ventricular hypertrophy, which in turn is a well-recognized risk factor for cardiovascular disease outcomes and all-cause mortality in hypertension. Low hemoglobin and hematocrit levels might be strongly indicate hypertensive end-organ damage, specifically kidney failure. Therefore, this study determined the prevalence of anemia and associated factors among hypertensive patients in Referral Hospitals, Amhara Regional State, Ethiopia, in 2020. An institution-based cross-sectional study was conducted in Amhara Regional Referral Hospitals from February 20 to April 30, 2020. Random and systemic sampling techniques were used to select 428 study participants. Data were entered and coded in to Epi data version 3.0 and then exported into STATA 14 for analysis. In bivariable logistic regression, variables with a p-value of < 0.25 were included in multivariable logistic regression. Using a 95% confidence interval, variables having a p-value ≤ 0.05 in multivariable logistic regression were declared as statistically significant variables. In this study, a total of 428 study participants were involved with 99.5% response rate. The prevalence of anemia among hypertensive patients was 17.6%, with a 95% CI (14.3–21.5%). Estimated glomerular filtration rate (eGFR) < 90 ml/min (AOR = 2.77, 95% CI 1.56- 4.92)], duration of hypertension (HTN) ≥ 5 years (AOR = 2.37, 95% CI 1.36–4.15), uncontrolled blood pressure (AOR = 1.91, 95% CI 1.08–3.35), and higher pulse pressure (AOR = 1.05 (95% CI 1.02–1.08) were significantly associated with anemia. Nearly one out of five hypertensive patients had anemia. Impaired estimated glomerular filtration rate, duration of HTN, blood pressure status, and pulse pressure were the independent predictors of anemia among hypertensive patients. Screening hemoglobin level at a regular interval is recommended for the hypertensive patients to take an appropriate intervention.

Protein Glycosylation Influences Soluble Urokinase Plasminogen Activator Receptor (suPAR) Measurements

Elevated plasma levels of the biomarker soluble urokinase plasminogen activator receptor (suPAR) are prognostic of adverse outcomes in cardiovascular disease (CVD). This novel inflammatory protein has five known N-linked glycosylation sites, but the contribution of glycosylation to disease progression is unknown. This study aimed to assess the impact of glycosylation on suPAR measurements. Bio-banked plasma samples from healthy volunteers and patients with CVD were treated with deglycosylation enzymes. suPAR was measured for all treated and untreated samples using the Virogates suPARnostic ELISA. Percentage change in suPAR concentrations following treatment were compared using paired t-test, and differences between patient cohorts were examined using the Mann-Whitney test. In healthy subjects, suPAR concentrations increased after pre-treatment with deglycosylation enzymes (median 1.8 vs 2.4 ng/mL; p<0.001; n=15). In patients diagnosed with myocardial infarction (MI), a percentage increase in suPAR concentrations was also obtained after deglycosylation treatment, and this increment was higher than acute chest pain patients without MI (58% vs 44%; p=0.02; n=15). In patients with acute decompensated heart failure, a higher percentage change in suPAR concentrations was also observed following deglycosylation, compared with that of healthy subjects (38% vs 30%; p=0.04; n=33). suPAR immunoreactivity increased for the ViroGates ELISA after removal of protein glycosylation, as demonstrated by higher concentrations observed after treatment. This suggests that the current clinical assay for suPAR is influenced by its N-linked glycosylation. As glycosylation alterations are associated with CVD, further investigations are required to assess this implication with respect to the prognostic accuracy of suPAR in cardiovascular disease progression.