American Heart Association Guidelines Research Articles

Meta-Analysis of Lowering LDL Cholesterol and its Impact on the Cardiovascular System

Background: By lowering LDL cholesterol levels, the risk of coronary heart disease (CHD) and other serious vascular events can be significantly reduced. In order to prevent cardiovascular illnesses (CVD), mainly coronary heart disease, LDL-cholesterol (LDL-C) levels must be tightly controlled on both a primary and secondary level (CHD). Despite the fact that patients in primary prevention experience a higher absolute number of atherosclerotic cardiovascular (CV) events than those in secondary prevention of CVD, subjects in primary prevention frequently receive little attention when it comes to the clinical management of LDL-C levels. Aim: To summarise the research supporting LDL cholesterol reduction treatments for elderly people. Method: For this meta-analysis, we searched PubMed, GOOGLE SCHOLAR, SCI.HUB, MEDLINE, and Embase for publications released between January 1, 2017, and December 28, 2021. As recommended by the 2018 American Academy of Cardiology and American Heart Association guidelines, randomised controlled trials evaluating cardiovascular outcomes of an LDL cholesterol-lowering medicine with a median follow-up of at least 2 years and data on older patients (aged 75 years).The search for literature source was limited to randomized controlled trials (human being). This meta-analysis, comprised of 24 trials from the Cholesterol Therapy Trialists' Collaboration meta-analysis plus five other trials, used data from six journals. 21492 (8%) of the 244090 participants in 29 studies, were over the age of 75. Among them, 11750 (54%) came from statin trials, 6209 (28%) from ezetimibe trials, and 3533 (16%) from PCSK9 inhibitor trials. We conducted network meta-analyses for the statins and non statin treatments. Results: Of the 244090 participants in 29 studies, 21492(8%) were over 75. These included 3533 (16%) from PCSK9 inhibitor studies, 11750 (54%) from statin trials, and 6209 (28%) from ezetimibe trials. A median follow-up period of 2 to 6 years was used. Without statistically differentiating from the risk reduction in patients under the age of 75 (085 [078-092]; pinteraction=037), LDL cholesterol lowering significantly reduced the risk of major vascular events (n=3519) by 26% for 1 mmol/L reduction in LDL cholesterol (RR 074 [95% CI 061-089]; p=00019).In older patients, there was no statistically significant difference in the RRs for statin (0.82 [0.73-0.91] and non-statin (0.67 [0.47-0.95]; pinteraction=0.64) treatment. Reduced LDL cholesterol in older persons was shown to benefit all components of the composite, including coronary revascularization (080 [066-096], stroke (073 [061-087], and myocardial infarction (080 [071-090]. Practical implication: This meta analysis can be used to improve the treatment of people withlowering LDL cholesterol. Conclusion: The viability and security of diminishing LDL cholesterol in more seasoned adults are now supported by further research provided by this meta-analysis. By non-statin and statin LDL cholesterol-bringing down medication, we identified a risk reduction for major vascular events that were at least as effective as that observed in younger patients Keywords: LDL, Meta-analysis, Cardiovascular, Cholesterol,Atherosclerosis, Primary and secondary prevention.

Highlights and Perioperative Implications from the 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease

As the understanding of aortic diseases and their complications grow, increasing importance of uniformity in diagnosis and management is crucial for optimal care of this patient population. The 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease discusses these considerations in detail. The purpose of this review is to highlight essential recommendations that are of relevance to the perioperative physician who manages these patients. A few notable points include, shared decision-making with patients, creation of multidisciplinary aortic teams, lower diameter thresholds for surgery in certain situations, and increased testing for patients with heritable aortic diseases. In addition to briefly reviewing basics of aortic diseases, the authors discuss changes to guidelines that are especially relevant to perioperative care.

Your New Year’s “resolution”—check your “screen!”

Your New Year’s “resolution”—check your “screen!”

Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition.

Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.

Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015

INTRODUCTION: The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS: This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg. RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.

Management of heart failure: similarities and discrepancies between the European Society of Cardiology and the American Heart Association guidelines.

Recommendations are the fundamental elements of guidelines and are especially significant when the amount of scientific data is expanding fast, as is the scenario of heart failure (HF). Beginning with the four pillars of treatment for HF with reduced ejection fraction, the main messages of the two most recent major HF guidelines, endorsed by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA), partially overlap. There are notable differences, in part due to the timing of recent publications, like the Universal Definition of HF and the EMPEROR-Preserved trial, and in part due to differing perspectives on the natural history of HF. Specific challenges, such as risk stratification and the use of implanted cardioverter-defibrillators for primary prevention in HFrEF patients with non-ischaemic aetiology, are approached from a variety of perspectives. The ACC/AHA/HFSA recommendations place increased attention on topics that are especially pertinent to the US context, such as the cost-effectiveness of medications and the impact of health inequalities on HF care. A comparison of guideline suggestions may assist readers get a better grasp of the ESC and ACC/AHA/HFSA guidelines and apply logical ways to their own practice, wherever in the world that may be. A comparison may also contribute to the harmonization of future guidelines' recommendations by highlighting the reasons why certain areas have resulted to different recommendations while seemingly analysing the same published information.

Post-Exercise Ankle–Brachial Index Is Reduced in Healthy, Young Individuals at a Level Indicating Peripheral Artery Disease

In young patients referred for exercise-induced pain in the legs, false positive tests are a potential problem for the post-exercise ankle–brachial index (ABI) test when using the current American Heart Association guidelines for diagnosing peripheral artery disease (PAD). The present study aimed to investigate post-exercise ABI in healthy young people, and to explore whether the current diagnostic criteria for pathological ABI should be revised. Forty-eight volunteers (18–30 years) were included. Resting examinations included ABI and ultrasound of the external iliac artery. Post-exercise examinations after a treadmill load included ABI and ultrasound of the external iliac artery; after 0 min and after 3 min. A total of 60.5% of the participants had a post-exercise decrease in ABI &gt; 20%. A total of 6.5% showed a decrease in ankle systolic blood pressure &gt;30 mmHg. No significant association was observed between a change in blood flow in the external iliac artery and a reduction in ABI post-exercise. Analyses of the ultrasound recordings showed no turbulence in the external iliac artery. According to the results, a 20% decrease in ABI post-exercise seems to be a physiological condition present in young people. We support the need for a reassessment of the criteria for diagnosing PAD.

Analysis of Anxiety or Depression and Long-term Mortality Among Survivors of Out-of-Hospital Cardiac Arrest

The recent American Heart Association guidelines added a sixth link in the chain of survival highlighting recovery and emphasized the importance of psychiatric outcome and recovery for survivors of out-of-hospital cardiac arrest (OHCA). The prevalence of psychiatric disorders among this population was higher than that in the general population. To examine the prevalence of depression or anxiety and the association of these conditions with long-term mortality among individuals who survive OHCA. A longitudinal population-based cohort study was conducted to analyze long-term prognosis in patients hospitalized for OHCA between January 1, 2005, and December 31, 2015, who survived for 1 year or longer. Patients with cardiac arrest due to traumatic or nonmedical causes, such as injuries, poisoning, asphyxiation, burns, or anaphylaxis, were excluded. Data were extracted on depression or anxiety diagnoses in this population within 1 year from the database of the Korean National Health Insurance Service and analyzed April 7, 2022, and reanalyzed January 19 to 20, 2023. Follow-up data were obtained for up to 14 years, and the primary outcome was long-term cumulative mortality. Long-term mortality among patients with and without a diagnosis of depression or anxiety were evaluated. The analysis included 2373 patients; 1860 (78.4%) were male, and the median age was 53.0 (IQR, 44.0-62.0) years . A total of 397 (16.7%) patients were diagnosed with depression or anxiety, 251 (10.6%) were diagnosed with depression, and 227 (9.6%) were diagnosed with anxiety. The incidence of long-term mortality was significantly higher in the group diagnosed with depression or anxiety than in the group without depression or anxiety (141 of 397 [35.5%] vs 534 of 1976 [27.0%]; P = .001). With multivariate Cox proportional hazards regression analysis, the adjusted hazard ratio of long-term mortality for total patients with depression or anxiety was 1.41 (95% CI, 1.17-1.70); depression, 1.44 (95% CI, 1.16-1.79); and anxiety, 1.20 (95% CI, 0.94-1.53). In this study, among the patients who experienced OHCA, those diagnosed with depression or anxiety had higher long-term mortality rates than those without depression or anxiety. These findings suggest that psychological and neurologic rehabilitation intervention for survivors of OHCA may be needed to improve long-term survival.

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

Heart failure (HF) is a clinical syndrome with signs and symptoms that result from any structural or functional deterioration of ventricular filling or ejection of blood. It is the final stage of various cardiovascular diseases (e.g., coronary artery disease, hypertension, previous myocardial infarction) and remains one of the leading causes of hospitalization. It poses severe health and economic burden worldwide. Patients usually present with shortness of breath due to impaired cardiac ventricular filling and decreased cardiac output. Cardiac remodeling due to the renin-angiotensin-aldosterone system overactivation is the final pathological mechanism leading to these changes. The natriuretic peptide system is also activated to stop the remodeling. Sacubitril/valsartan, an angiotensin-receptor neprilysin inhibitor, has prompted a substantial conceptual change in HF treatment. Its primary mechanism is the inhibition of cardiac remodeling and the prevention of natriuretic peptide degradation by inhibiting the enzyme neprilysin. It is an efficacious, safe, and cost-effective therapy that improves the quality of life and survival rate in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction. It has been demonstrated to significantly reduce hospitalization rates and rehospitalization for HF when compared to enalapril. In this review, we have discussed the benefits of sacubitril/valsartan in treating patients with HFrEF, particularly in reducing hospitalizations and readmissions. We have also compiled studies to examine the drug's effect on adverse cardiac events. Finally, the cost benefits of the drug and optimal dosing strategies are also reviewed. Our review article, combined with the recommendations of the 2022 American Heart Association guidelines for heart failure, strongly suggests that sacubitril/valsartan is a cost-effective strategy that reduces hospitalizations for HFrEF patients when started early with optimal doses. There is still much uncertainty regarding the optimal usage of this drug, its use in HFrEF, and the cost benefits when used alone compared with enalapril.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

Prevalence, awareness, and treatment of isolated diastolic hypertension in the United States

BackgroundIsolated diastolic hypertension (IDH) is recognized as a risk factor for cardiovascular disease, yet its clinical epidemiology remains poorly understood due to insufficient recognition. This study aims to describe the trend in the prevalence, awareness, and treatment of IDH in the United States from 2001 to 2018. MethodsThis cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted in nine consecutive two-year cycles from 2001–2002 to 2017–2018, comprising a sample of 48,742 adults aged over 18 years. IDH was defined as a diastolic blood pressure ≥ 80 mm Hg with a systolic BP < 130 mm Hg by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. ResultsIn the nationally representative dataset, 8.9% of participants had IDH in 2017–2018, a decreased of 3.6% (95% confidence interval [CI], -2.6% to -5.0%, P<0.0002) since 2001–2002. IDH prevalence was highest among Mexican American (10.5%), individuals aged 40–59 (12.3%), increased with body mass index (BMI) (11.2% among those BMI ≥30.0 kg/m2), and tended to be higher in men (12.3%). A multiple regression analysis showed that men, white race/ethnicity, young and middle-aged people (aged 18–59), and increasing BMI were independently associated with increased risks of IDH. Among IDH patients, there was a modest increase in awareness (P<0.0002), from 22.4% (95%CI, 18.4% to 27.1%) in 2001–2002 to 35.0% (95%CI, 28.2% to 42.5%) in 2017–2018, with the largest percentage increases among non-Hispanic white and men. IDH treatment increased by 7.6% (95%CI, 3.1% to 12.1%) between 2001–2002 and 2017–2018, with the greatest increases occurring in Mexican American and men. ConclusionIDH prevalence is decreasing from 2001–2002 to 2017–2018 in the United States. Despite the significantly increased in both awareness and treatment, they remain below 50%.

Pemanfaatan Teknologi Dalam Peningkatan Kualitas Resusitasi Jantung Paru: A Literature Review

Basic life support (BLS) provides basic lifesaving measures after a heart attack and emphasizes what action must be taken. BLS focuses on cardiopulmonary resuscitation (CPR) and how it relates to saving lives after a heart attack. This method used literature review. Data was taken from scientific database on ScienceDirect, PubMed, EBSCOhost, dan Wiley Library Online . This study used criteria and keywords. Using tools and technology can guide consistency in depth, speed and recoil time American Heart Association guidelines CPR. However, this cannot be separated from the influence of several conditions, cost, user and safety factor. The assumption using tools and technology hoped that the consistency of depth, speed and recoil time can improve the quality of CPR and increase the ROSC (Return of Spontaneous Circulation) percentage as well as a good survival rate. Keywords: CPR Technology, high-quality CPR, Training CPR

Contemporary Management and Clinical Course of Acute Pulmonary Embolism: The COPE Study.

New diagnosis, risk stratification, and treatment strategies became recently available for patients with acute pulmonary embolism (PE) leading to changes in clinical practice and potentially influencing short-term patients' outcomes. The COntemporary management of PE (COPE) study is aimed at assessing the contemporary clinical management and outcomes in patients with acute symptomatic PE. Prospective, noninterventional, multicenter study. The co-primary study outcomes, in-hospital and 30-day death, were reported overall and by risk categories according to the European Society of Cardiology (ESC) and American Heart Association guidelines. Among 5,213 study patients, PE was confirmed by computed tomography in 96.3%. In-hospital, 289 patients underwent reperfusion (5.5%), 92.1% received parenteral anticoagulants; at discharge, 75.6% received direct oral anticoagulants and 6.7% vitamin K antagonists. In-hospital and 30-day mortalities were 3.4 and 4.8%, respectively. In-hospital death occurred in 20.3% high-risk patients (n = 177), in 4.0% intermediate-risk patients (n = 3,281), and in 0.5% low-risk patients (n = 1,702) according to ESC guidelines. Further stratification in intermediate-high and intermediate-low risk patients did not reach statistical significance, but intermediate-risk patients with sPESI > 0 alone had lower mortality compared to those with one or both among right ventricular dilation at echocardiography or increased troponin. Death or clinical deterioration occurred in 1.5, 5.0, and 9.4% of patients at low, intermediate-low, and intermediate-high risk for death according to ESC guidelines. For the majority of patients with PE, contemporary initial management includes risk stratification and treatment with direct oral anticoagulants. In-hospital mortality remains high in intermediate and high-risk patients calling for and informing research focused on its reduction. NCT03631810.

Effect of 2018 American College of Cardiology/American Heart Association Guideline Change on Statin Prescription for People Living with HIV

The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines were updated in 2018 to explicitly recommend statin use for primary cardiovascular disease prevention among people living with HIV (PLWH), but little is known about the effect of this guideline change. We aimed to assess the effect of the 2018 ACC/AHA guideline change on statin prescription among PLWH. We used data from an institutional HIV registry to identify PLWH aged 40–75 years, engaged in HIV care between June 2016 and May 2021, had a LDL cholesterol between 70 and 189 mg/dl, 10-year atherosclerotic cardiovascular disease (ASCVD) risk score ≥7.5%, no prior statin prescription, and no history of diabetes or ASCVD. Our outcome of interest was a new statin prescription within 12 months of eligibility. We estimated standardized risk difference (RD) with 95% confidence limits (CL) by comparing prescription probabilities before and after guideline change. Our study population comprised 251 PLWH (171 before, 80 after the guideline change), of whom 57% were aged <55 years, 82% were male, and 45% were non-Hispanic black. The standardized 12-month statin prescription risk was 43% (95% CL: 31%, 60%) after the guideline change and 19% (95% CL: 13%, 26%) before the guideline change (RD = 25%, 95% CL: 9.1%, 40%). Our results suggest that the 2018 ACC/AHA guideline change increased statin prescription among PLWH, but a sizable proportion of eligible PLWH were not prescribed statin. Future studies are needed to identify strategies to enhance implementation of statin prescription guidelines among PLWH.

Development of Low-Cost Portable Defibrillator for Sudden Cardiac Arrest Management

Defibrillation is the mainstay of treatment of cardiac arrest especially ventricular fibrillation (VF) which occurs in more than 70%. The survival in out of hospital cardiac arrest is 30–35% in the western world whereas it is low in low socioeconomic countries. At present patients/persons suffering from cardiac arrest especially outside the hospital settings has high mortality of 70% or more. As per American Heart Association guidelines, early defibrillation within minutes is the prime treatment to improve the survival. In a country like India, defibrillators are not available and it may take hours for a victim to reach appropriate centres for defibrillation causing loss of life. However, defibrillators are currently expensive, not readily available. In a vast country, it is difficult for patient to access the major hospitals, lack of beds and other facility causes delay in treatment and death of patients. Hence there is high demand for the development of an alternate defibrillator readily available everywhere. The aim of this paper is development of a low-cost portable disposable defibrillator for the management of cardiac arrest victims. The design consists of an encasing a portable battery with capacitor which stores and delivers biphasic shock of 50 J for paediatric and 150 J for adult via two paddles attached to the assembly. Up to 6 shocks can be delivered with the stored energy. The casing will have a facility to view the heart rhythm such as VF and sinus rhythm via small display. Hence the project is aimed to develop a low-cost ultraportable defibrillator that aims to provide widespread availability, early defibrillation and improve survival. The proposed diagnosing system in hardware design was tested on safety analyser and defibrillator analysers in Clinical Engineering department of Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) and the accuracy was achieved of 98.03%.

A191 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP &amp;gt;275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) &amp;gt;0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if &amp;lt;5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients &amp;lt;55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential implication of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared

Prevalence and determinants of undiagnosed hypertension in the Western region of Saudi Arabia.

Recent data regarding the prevalence and determinants of undiagnosed hypertension in Saudi Arabia are particularly lacking. This study aimed to investigate the prevalence of undiagnosed hypertension and to identify potential associates of hypertension risk among adults in the Western region of Saudi Arabia. Cross-sectional data for 489 Saudi adults were collected from public places in the cities of Madinah and Jeddah. Demographic, anthropometric (height, weight, waist circumference), and blood pressure (assessed by a digital sphygmomanometer) data were collected from all participants during face-to-face interviews. The American College of Cardiology and American Heart Association guidelines were used to evaluate blood pressure status. Sodium intake was assessed using a semi-validated food frequency questionnaire. The prevalence of undiagnosed, elevated blood pressure, stage I, or stage II hypertension was 9.82%, 39.5%, and 17.2%, respectively. The proportions of individuals with undiagnosed hypertension were higher among men and smokers (p < .001 for both). Blood pressure status was positively associated with weight, body mass index, and waist circumference among participants (p < .001 for all). Higher body mass index and waist circumference were associated with increased odds of stage I and stage II hypertension. Sodium intake was not associated with blood pressure status. A strikingly high prevalence of undiagnosed hypertension was observed among the study sample. National intervention programs are necessary to encourage regular screening and follow-up for the early detection and management of hypertension.

A34 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP &amp;gt;275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) &amp;gt;0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if &amp;lt;5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m2; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients &amp;lt;55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential deliverable of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Evaluating current guidelines for cardiopulmonary resuscitation using an integrated computational model of the cardiopulmonary system

ObjectiveWe aimed to use a high-fidelity computational model that captures key interactions between the cardiovascular and pulmonary systems to investigate whether current CPR protocols could potentially be improved. MethodsWe developed and validated the computational model against available human data. We used a global optimisation algorithm to find CPR protocol parameters that optimise the outputs associated with return of spontaneous circulation in a cohort of 10 virtual subjects. ResultsCompared with current protocols, myocardial tissue oxygen volume was more than 5 times higher, and cerebral tissue oxygen volume was nearly doubled, during optimised CPR. While the optimal maximal sternal displacement (5.5 cm) and compression ratio (51%) found using our model agreed with the current American Heart Association guidelines, the optimal chest compression rate was lower (67 compressions min−1). Similarly, the optimal ventilation strategy was more conservative than current guidelines, with an optimal minute ventilation of 1500 ml min−1 and inspired fraction of oxygen of 80%. The end compression force was the parameter with the largest impact on CO, followed by PEEP, the compression ratio and the CC rate. ConclusionsOur results indicate that current CPR protocols could potentially be improved. Excessive ventilation could be detrimental to organ oxygenation during CPR, due to the negative haemodynamic effect of increased pulmonary vascular resistance. Particular attention should be given to the chest compression force to achieve satisfactory CO. Future clinical trials aimed at developing improved CPR protocols should explicitly consider interactions between chest compression and ventilation parameters.

Abstract MP68: Adipokines as Mediators in the Association of Changes in Physical Activity With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Physical activity (PA) patterns over time influence diabetes risk through incompletely understood mechanisms. Adipokines secreted by adipose tissue have myriad endocrine effects and are affected by PA. It is unknown the extent to which adipokines mediate the association between changes in PA and diabetes. Methods: We conducted a cross-sectional study of 10,908 ARIC participants (mean age 54; 55% female; 21% Black adults) who attended Visits 1 (V1; 1987-1989) and 3 (V3; 1993-1995) of the ARIC Study. We used mediation analyses to determine the extent to which the association of changes in PA from V1 to V3 and diabetes status at V3 was explained by adipokines. Analyses were stratified by obesity status. PA was defined using American Heart Association guidelines as inactive, intermediate, and recommended (150 minutes of moderate-vigorous activity/week); the intermediate group was further divided into low and moderate (below or above the median activity level). Participants were categorized by PA at V1 and V3 - (1) stable low: inactive or low at both visits; (2) increasing: higher category at V3 than V1; (3) decreasing: lower category at V3 than V1; and (4) stable high: moderate or high at both visits. Results: Increasing PA was associated with higher adiponectin and lower leptin at V3 compared to stable low PA, while decreasing PA was associated with lower adiponectin and higher leptin compared to stable high PA (p&lt;0.01 for all comparisons). Decreasing PA was associated with 28% higher odds of diabetes compared to stable high PA (Table). Conversely, increasing PA was associated with 12% lower odds of diabetes compared to stable low PA. In mediation analyses, adjustment for leptin/adiponectin ratio explained 45% of the effect of increasing PA and 35% of the effect of decreasing PA. The directionality of associations was similar in obesity stratified analyses, but results were not statistically significant. Conclusions: The associations between changes in PA and diabetes may be mediated in part by adipokines.