ASCVD Score Research Articles

P1103 Thromboembolic and cardiovascular risk profiles in ulcerative colitis patients initiating advanced therapies: a single-center study

Abstract Background IBD, especially during flare periods, seems to be associated with an increased risk of thromboembolic and cardiovascular(CV) events[1]. After the results of the ORAL Surveillance study[2] enrolling patients with rheumatoid arthritis, several concerns have also been raised on the intrinsic risk of Janus kinase inhibitors (JAK-i), though the population enrolled was predominantly >50 years old and had several CV risk factors (CVRF). Accordingly, regulatory agencies recommend that JAK-i should be used only if no suitable treatment alternatives are available in patients at increased CV risk for all indications [3]. However, the real prevalence of CVRF and the risk related to JAK-i seem to be lower for patients with UC. The aim of our study is to explore the prevalence of thromboembolic and CV risks factors in a large cohort of UC patients suitable for advanced therapies. Methods We conducted a single-centre study including all consecutive adult patients with UC who initiated advanced therapies between Jun-20 and Dec-23. To assess thrombosis and CV risk, we collected all anamnestic, clinical and laboratory data from the medical records. In addition, we used an online questionnaire to collect all other information that were not available in routine clinical records. To assess CV risk, we calculated the 10-year CV risk score using the American College of Cardiology ASCVD Risk Estimator[4]. Results Out of 305 patients surveyed, we had a 100% response rate: 53.5% male, with a median age of 44 years. Overall, 39.0% were biologic-naïve, and 21.6% started a Janus kinase inhibitor (JAK-i). Baseline patients’ characteristics and variables collected are shown in Table 1 and Table 2, respectively. Cumulatively, 184 patients (60.3%) had 0-1 thromboembolic risk factors, 73 patients (23.93%) had 2 risk factors, 34 patients (11.2%) had 3 risk factors, 8 patients(2.6%) had 4, and 6 patients(1.9%) had 5 or 6 thromboembolic risk factors. Complete cholesterol data were available for 171 patients, but ASCVD score has been calculated only for 153 patients(median age 49 years) with LDL-C levels >70 mg/dL. Among them, 67.3% were classified as low risk, 6.5% as borderline risk, 20.9% as intermediate risk, and 5.2% as high risk. When CV risk was stratified by age, 66.7% of elderly patients (aged 65 years or older) were classified as intermediate risk, while 20.8% were high risk. In contrast, 79.1% of non-elderly were categorized as low risk, 12.4% at intermediate risk and 2.3% at high risk. Conclusion Our study confirms the prevalence of thrombotic and CVRF among patients affected by UC is quite low and mostly related to age. Accordingly, the concerns regarding the use of JAK-i observed in rheumatological cohorts may not be fully applicable for patients with UC.

Comparative application of MAFLD and MASLD diagnostic criteria on NAFLD patients: insights from a single-center cohort

The diagnostic criteria for Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) and Metabolic Associated Steatotic Liver Disease (MASLD) aim to refine the classification of fatty liver diseases previously grouped under Non-Alcoholic Fatty Liver Disease (NAFLD). This study evaluates the applicability of the MAFLD and MASLD frameworks in NAFLD patients, exploring their clinical utility in identifying high-risk patients. A total of 369 NAFLD patients were assessed using MAFLD and MASLD diagnostic criteria. Baseline characteristics, metabolic profiles, hepatic fibrosis, and cardiovascular risks were compared across the groups. Among NAFLD patients, 97.55% (n = 359) met MASLD criteria, and 97.01% (n = 357) fulfilled MAFLD criteria. Both frameworks MAFLD and MASLD captured overlapping populations, with MASLD encompassing slightly more cases. No significant differences were observed in metabolic risk factors, fibrosis indices (APRI, FIB-4, NAFLD fibrosis score), or cardiovascular risk (10-year ASCVD score). A small subset of lean NAFLD patients (10 cases) with distinct profiles remained uncategorized by either framework. Pure NAFLD cases (n = 10) were with mild insulin resistance (HOMA-IR: 3.07 ± 0.33) and slightly elevated LDL (102.5 ± 42.87 mg/dL), while fibrosis indices indicated low fibrosis risk. Steatosis indices supported the diagnosis of early-stage NAFLD with preserved liver function. These patients do not meet the criteria for inclusion in the MAFLD or MASLD frameworks, highlighting a gap in the current diagnostic systems. MAFLD and MASLD criteria align closely with NAFLD in capturing patients with metabolic risk with MASLD-enhanced inclusivity. Further refinement is required to address heterogeneity, particularly in lean NAFLD patients. Hypertension prevalence was comparable (17.4% in NAFLD, 18.2% in MAFLD, 17.8% in MASLD; p = 0.960), as was diabetes mellitus (36.7%, 37.8%, and 37.6%, respectively; p = 0.945). Body mass index was also similar across groups, with medians of 33.25, 33.6, and 33.4 kg/m2 (p = 0.731). Non-invasive markers of hepatic fibrosis, including APRI, FIB-4, and NAFLD fibrosis scores, did not differ significantly, with median FIB-4 scores around 1.05 (p = 0.953). Similarly, were the results of hepatic steatosis index and ASCVD score.

Nighttime systolic blood pressure a major factor of retinal vascular caliber changes in patients with newly diagnosed type 2 diabetes mellitus.

Changes in retinal vessel caliber are crucial for detecting early retinopathy, a significant cause of blindness in individuals with Diabetes Mellitus type 2 (T2DM). This study aims to evaluate the changes in retinal vessel caliber and identify factors associated with these changes in recently diagnosed T2DM patients. The study included newly diagnosed T2DM patients (within 6 months of diagnosis) who were free of antidiabetic treatment (except metformin) and matched individuals based on age and blood pressure (BP). Data collected included somatometric measurements, BP (office and 24-hour), hematological data, albuminuria (via 24-hour urine collections), ten-year atherosclerotic cardiovascular disease risk (ASCVD score), endothelial dysfunction (measured by Asymmetric Dimethylarginine, ADMA), retinal microvascular changes, assessed as central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriovenous ratio (AVR) using specialized software on non-mydriatic fundus photographs. The study involved 87 T2DM patients and 90 controls, aged 57±11 years. Key findings include no significant differences in CRAE, CRVE, and AVR between T2DM patients and controls. Age (p=0.019) and nighttime systolic BP (SBP) (p=0.002) were independent predictors of AVR. CRAE was independently associated with nighttime SBP (p=0.048). CRVE was independently associated with age (p=0.016), dipping (p=0.002), and smoking (p=0.018). In normotensive subjects, AVR was significantly lower in T2DM patients (p=0.035). The study concludes that increased nighttime SBP is a more critical factor than hyperglycemia in affecting retinal vascular caliber changes in newly diagnosed T2DM patients. This highlights the importance of managing nocturnal hypertension to prevent retinal damage in this patient population.

Obesity Is Increasing in Liver Transplant Recipients and Exacerbates Cardiovascular Risk: A Single-Centre European Study.

Recent changes in the profile of liver transplant (LT) recipients include an increasing number of patients with metabolic-associated steatotic liver disease (MASLD), which is associated with obesity and cardiovascular risk. We aimed to investigate the trend in the presence of obesity among LT recipients and its association with cardiovascular risk. Single-centre retrospective study, which included LT recipients between 2015 and 2020. Obesity and patient's demographic were assessed before LT and 12months thereafter. Cardiovascular risk factors including ASCVD score were recorded and compared between patients with and without obesity. During the study period, 358 LT were performed. The mean BMI before LT significantly increased over time during the study period (ptrend = 0.04). Pre-LT, patients with obesity were older and had a higher prevalence of MASLD, diabetes, hypertension and dyslipidaemia. Twelve months after LT, most patients gained weight, although mean BMI did not significantly increase over time (ptrend = 0.072). LT recipients with obesity 12months after LT more frequently presented with diabetes and hypertension and had higher ASCVD score than LT recipients with BMI < 30kg/m2. One-year mortality was similar between patients with or without obesity before LT (p = 0.816). In the past few years, there has been a significant increase in the prevalence of obesity in LT recipients. LT recipients with obesity present a higher cardiovascular risk as assessed by the presence of cardiovascular risk factors and the ASCVD score. Our results may be useful when designing strategies to directly target obesity and weight management in this population.

Mobile health apps for cardiovascular risk assessment: a systematic review.

mHealth apps (MHA) are emerging as promising tools for cardiovascular risk assessment, but few meet the standards required for clinical use. We aim to evaluate the quality and functionality of mHealth apps for cardiovascular risk assessment by healthcare professionals. We conducted a systematic review of MHA for cardiovascular risk assessment in the Apple Store, Play Store, and Microsoft Store until August 2023. Our eligibility criteria were based on the 2021 European Society Cardiology Guidelines on Cardiovascular Disease Prevention in Clinical Practice, the Framingham Risk Score, and the Atherosclerotic Cardiovascular Disease score. Our protocol was drafted using the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. To assess quality, we used the validated Mobile Apps Rating Scale (MARS) score, which includes 19 items across four objective scales (engagement, functionality, aesthetics, and information quality) and one additional subjective scale. For functionality evaluation, we used the IMS Institute for Healthcare Informatics functionality scale. We performed data synthesis by generating descriptive statistics. A total of 18 MHA were included in the review. The most common scores used were the Framingham score, ASCVD score, and Score 2. Only six apps achieved an overall score of 4 or greater in the MARS evaluation. The MHA with the highest MARS score was ESC CVD Risk Calculation (5 points), followed by ASCVD Risk Estimator Plus (4.9 points). In the IMS scale, four MHA had a high functionality score: ASCVD Risk Estimator Plus (5 points), ESC CVD Risk Calculation (5 points), MDCalc Medical Calculator (4 points), and Calculate by QsMD (4 points). A gap exists in the availability of high-quality MHA designed for healthcare professionals to facilitate shared decision-making in cardiovascular risk assessment. The International Prospective Register of Systematic Reviews, identifier CRD42023453807.

Assessment of Cardiovascular Risk and Factors among Post COVID-19 Patients with Type 2 Diabetes Mellitus and Dyslipidaemia

Background: The current study aims to assess the impact of structured patient education on cardiovascular complications in post-covid patients with type-2 diabetes mellitus and dyslipidaemia. Objectives: To assess the prevalence of cardiovascular risk among type-2 diabetes mellitus with dyslipidaemia in post-covid patients. to analyse the cardiovascular risk correlated with diabetes and lipid profile. to assess the impact of patient education on cardiovascular risk complications. Method: A total of 300 patients were screened and of them, 205 were enrolled in the study based on the inclusion and exclusion criteria. Patient education was given to selected patients using structured patient leaflets and oral education after baseline. They are followed up after 2 months. Cardiovascular risk was assessed by ASCVD and Framingham risk assessment score. Results: The study analysed that there was a high prevalence in males, the age group 51-70 years, non-alcoholic, and non-smokers. At the baseline, most patients were at high risk. On comparing the baseline with the review, a 49.3% difference was seen in the high-risk category. Conclusion: The study revealed that age, gender, low density lipoprotein, total cholesterol, and random blood sugar were the important cardiovascular risk factors. The implementation of pharmacist care in collaboration with physicians and nurses may reduce cardiovascular risk complications and help in better medication management.

The Acute Coronary Syndrome Risk in Medically Managed Subjects with Type 2 Diabetes Mellitus - Is the ASCVD Risk Score Failing Here?

Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS. This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson's Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS.Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows. Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent (p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001). The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS.

Increased cardiovascular risk in epilepsy.

Epilepsy is associated with increased mortality. Cardiovascular disease confers a significant portion of this increased risk. Recently there is increased interest in the burden of cardiovascular mortality in people with epilepsy. This review discusses the most common cardiovascular risk factors and their association with epilepsy including obesity, diabetes mellitus, and hyperlipidemia. Hyperlipidemia related to the use of enzyme inducing anti-seizure medications is also discussed as a topic that is of particular importance to prescribers that have patients with comorbid cardiovascular risk and epilepsy. Heart rate variability (HRV) and its association with SUDEP is discussed as well as a contributor to vascular risk. Finally, the authors discuss a potential role for neurologists who treat epilepsy to engage closer with their patient's cardiovascular risk factors using available tools such as a the ASCVD score calculator to determine the overall risk of mortality, as well as acting upon this information to guide treatment approaches integrating the information provided in this review.

Abstract 38: Prediction of Coronary Artery Disease Subtypes With Polygenic Risk Scores

Background: Coronary Artery Disease (CAD) is a complex heterogeneous disease with multiple known etiological mechanisms. Consequently, CAD could be considered to have multiple subtypes, reflecting alternative driving etiologies that may warrant distinct therapeutic approaches. Motivated by this, we developed and optimized statistical models to predict CAD subtypes informed by genetic and clinical risk factors. Methods: We developed three models, each using logistic regression: (a) clinical risk factors only, (b) clinical risk factors plus genome-wide polygenic risk scores (PRS), and (c) clinical risk factors and pathway-based PRSs. We defined 5 different CAD subtypes on the basis of the literature: (1) stable vs. unstable, (2) occlusive vs non-occlusive, (3) high vs normal LDL, (4) high vs normal Lp(a), and (5) high vs normal ASCVD score. Clinical risk factors included: ASCVD score, ApoA, ApoB, LDL, HDL, triglycerides, and C-reactive protein. We calculated 4,402 pathway PRSs obtained from six genomic pathway databases (e.g. KEGG). We optimized the models using 80% of the samples as training, and then performed model evaluation (Bonferroni-corrected P-values) in an unseen 20% of the samples as validation. Results: Among 20,935 UK Biobank participants with CAD (mean age 63 years, 58% female), addition of pathway-based PRSs improved prediction of high LDL (P=1e-19) and high Lp(a) subtypes (P=1.8e-78). Using a lasso dimension reduction approach, the pathways most associated with the high Lp(a) subtype of CAD were: Fibronectin Binding (P=6xe-260), Apolipoprotein Binding (P=6.2e-252) and Serine-Type Endopeptidase Activity (P=1.7e-203). Conclusions: We demonstrate that prediction models distinguish CAD subtypes and that a novel pathway PRS approach can increase predictive power and provide insights into the genetic underpinnings of CAD subtypes. Pathway PRSs hold promise for the targeted therapeutic management for subgroups of CAD patients.

Cardiovascular risk factors predict who should have echocardiographic evaluation in long COVID

AbstractBackgroundThe need for echocardiograms among patients with long COVID is debatable. Our aim was to evaluate the prevalence of left ventricular (LV) dysfunction and identify predictors.MethodsWe conducted a cross‐sectional study and included all consecutive patients enrolled in our post‐COVID clinic. We included patients who had an echocardiogram and had no previous known heart disease. We defined LV dysfunction as a low ejection fraction or grade II to grade III diastolic dysfunction on an echocardiogram with evidence of elevated filling pressures. We calculated the prevalence of heart disease and predictors of heart disease using logistic regression.ResultsWe included 217 post‐COVID patients enrolled in the clinic. The prevalence of LV dysfunction is 24%; 95% CI 18–30. Predictors of heart disease include older age and a previous history of hypertension and diabetes or having an intermediate or high ASCVD score. Patients with low ASCVD score did not have low ejection fraction on the screening echocardiograms.ConclusionOur study found a considerable number of patients with LV dysfunction. Older patients with cardiovascular risk factors are at risk of long COVID associated heart disease.

Does the Efficacy of Semaglutide Treatment Differ between Low-Risk and High-Risk Subgroups of Patients with Type 2 Diabetes and Obesity Based on SCORE2, SCORE2-Diabetes, and ASCVD Calculations?

Background: Diabetes is the primary contributor to cardiovascular disease risk, and when combined with obesity, it further underscores the significance of cardiovascular risk assessment. Methods: A retrospective study of 64 patients with type 2 diabetes (T2D) and obesity on once-weekly subcutaneous semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes, and ASCVD score calculations. We compare the differences between groups (ASCVD: low + borderline + intermediate versus high-risk group; SCORE2/SCORE2-OP: low + moderate versus high + very high-risk group and SCORE2-Diabetes: low + moderate versus high + very high-risk group) in terms of change from baseline in body mass index (BMI) and HbA1c and weight loss outcomes. Results: Patients in the high-risk group, according to ASCVD risk score, had statistically better results in weight loss ≥ 3%, ≥5%, and ≥10% compared to ASCVD low + borderline + intermediate and without difference regarding HbA1c. According to SCORE2/SCORE2-OP, the high + very high-risk group had statistically better HbA1c and weight loss results but only for ≥5% versus the low + moderate risk group. Based on the score SCORE2-Diabetes, the high + very high-risk group had statistically significant better results in lowering HbA1c and weight loss but only for ≥5% versus the low + moderate risk group. Conclusions: To the best of our knowledge, this study represents the initial investigation linking glycemic control and weight reduction outcomes in individuals with T2D and obesity treated with once-weekly semaglutide stratified by cardiovascular risk categories determined using the SCORE2/SCORE2-OP, SCORE2-Diabetes and ASCVD score calculations.

Utility of bioelectrical phase angle for cardiovascular risk assessment among individuals with and without diabetes mellitus.

Low values of bioimpedance-derived phase angle (PA) have been associated with various adverse outcomes. We investigated the association of PA with cardiovascular markers in individuals with and without diabetes mellitus (DM). PA was measured in 452 adults (without DM n = 153, T1DM n = 67, T2DM n = 232). Carotid intima-media thickness (IMT), renal resistive index (RRI), ankle-brachial index (ABI) and carotid-femoral Pulse Wave Velocity (cfPWV) were estimated. Furthermore, the levels of high-sensitive Troponin-T [hsTnT], N-terminal brain natriuretic peptide [NT-pro-BNP]) were measured. PA values were lower in DM independently of age, gender, and BMI (estimated marginal means 6.21, 5.83, 5.95 for controls, T1DM, T2DM p < .05), a finding which persisted after propensity score matching. PA correlated negatively with IMT (r = -0.181), RRI (r = -0.374), cfPWV (r = -0.358), hsTnT (r = -0.238) and NT-pro-BNP (r = -0.318) (all p < .001). In multivariable analysis, the associations with RRI, cfPWV, hsTnT and NT-pro-BNP remained unchanged. PA values 6.0-6.5° for males and 5.2-5.8° for females were predictive of commonly used cutoffs. The combination of ΑCC/AHA ASCVD Score with PA outperformed either factor in predicting cfPWV, RRI for males and hsTnT, BNP for both genders. PA exhibits independent correlations with various parameters pertinent to cardiovascular risk and may be useful for cardiovascular assessment.

Impact of coronary artery calcium score level in prediction of major adverse cardiovascular events

Abstract Background Elevated coronary artery calcium (CAC) is associated with an increased risk of cardiovascular (CV) and total mortality, while the coronary artery calcium score (CACS) significantly increases the sensitivity and specificity of traditional risk factors and risk scores in asymptomatic patients with intermediate risk. Purpose The aim of the study was to determine an association between the CACS and risk of major adverse CV events (MACE), as well as which value of CACS could be added in a prediction model based on traditional cardiovascular risk factors (CVRFs) in patients without established coronary artery disease (CAD) to improve risk stratification. Methods The study was performed as retrospective study, included patients of both sexes, aged over 40 years, with at least one traditional CVRF who underwent MSCT coronarography with follow up of 3 years. All patients were monitored for the presence of CVRFs, use of antihypertensive, statin and antiplatelet therapy, atherosclerotic cardiovascular disease risk score (ASCVD), 10-Year Coronary Heart Disease Risk with Coronary Artery Calcification (MESA score) and CACS. Results Of the 100 included patients, 61 (61%) were male and the mean age was 57.1±10.7 years. Most of patients (47%) had an intermediate ASCVD risk, average CACS value of 65.0 (0.0 - 383.3), mean value of CACS of 327.8±653.2, mean MESA score of 13.4±10.1 and a total of 29% MACE, with hospitalization as a most common (24%). There was an association between MACE and ASCVD score (p = 0.037), as well as CACS (p = 0.022). Logistic regression showed that the occurrence of MACE is influenced by: glucose level ([OR] (95%CI) 1.330 (1.003-1.762), (p = 0.047)), ASCVD score (([OR] (95%CI) 1.881(1.161- 3.048, (p =0.010)), MESA score (([OR] (95%CI) 1.055(1.004-1.109) (p = 0.033) and CACS (([OR] (95%CI) 1.902(1.170-3.092) (p = 0.010), where an increase in CACS by one increases the risk of MACE by almost 2 times. Conclusions The occurrence of cardiovascular outcomes is influenced by CACS, MESA score, ASCVD score, glucose level and age. Additional research is needed, with larger number of patients, to develop a predictive model based on traditional CVRFs and CACS values, in asymptomatic patients, in order to improve risk stratification.

Abstract 13411: Effect of Multilevel, Nurse-Led, Mobile Health Enhanced Intervention on Cardiovascular Disease Risk Reduction Among Patients With Uncontrolled Hypertension in Ghana: Evidence From the ADHINCRA Study

Introduction: Although cardiovascular disease (CVD) accounts for over two-thirds of premature mortality in Africa, risk assessments to guide preventive interventions for atherosclerotic CVD are rarely performed in many clinical settings. Objective: To investigate the impact of Nurse-led intervention on ASCVD risk reduction in adults with uncontrolled hypertension in Kumasi, Ghana enrolled in the ADHINCRA study. Methods: Using a cluster randomized controlled pilot trial design, four hospitals were randomized to the intervention arm and enhanced usual care (UC) arm. Two hundred and forty (240) participants were randomized to intervention (120 participants) or enhanced usual care (120 participants). We estimated the 10-year ASCVD risks for adults older than 40 years using Pooled Cohort Equations (PCE). We employed a mixed-effect linear regression model to predict the mean risk score as a function of the treatment group. ASCVD was first modeled as a continuous outcome, then categorized according to the ACC/AHA cut points: low (&lt;5%), Borderline (5%-&lt;7.5%), Intermediate (≥7.5% &lt;20%), and high-risk (≥20%). Result: The mean age (SD) was 53 ± 9.7 years; 117 men [49%]. The mean [SE] ASCVD scores for the intervention and Enhanced Usual group (EUC) arms at baseline were 14.1% (0.93) and 15.4% (1.03) respectively. At Month 12, the mean ASCVD score was 13.8% (0.77) in the intervention group and 15.2% (0.98) in the Enhanced usual group. Using the AAC/AHA risk categorization, 24% of patients in the intervention and 27% in the EUC were in the high-risk category. Relatively, ASCVD risk was 1.27% (95 CI -2.36, -0.17; P = .023) lower in the intervention group compared to the EUC arm at month 12 ( Figure 1 ). Conclusion: The Nurse-Led Multilevel Mobile Health Intervention led to a reduction in ASCVD risk, however, the reduction was not sustained after month 6, a more robust RCT is required to examine intervention sustainability in Ghana.

Cardiac and Great Vessel Toxicity with Single Fraction Stereotactic Body Radiotherapy in Early-Stage Lung Cancer

The relationship between thoracic radiotherapy and cardiovascular (CV) morbidity is an area of interest. When considering stereotactic body radiotherapy (SBRT) in the management of early-stage lung cancer, reports suggest CV dose may correlate with survival. To study this association for single fraction SBRT (SF-SBRT), we performed a retrospective review of patients treated at our institution assessing for associations between this dose schedule and CV toxicity. For the interval 2010-2022, we surveyed our IRB-approved prospective registry for SF-SBRT patients with tumors within 1 cm of the heart or any of the great vessels (GVs). Distance of the tumor to these structures was stratified as: directly contacting, within 0.5 cm, from 0.5-1 cm, or > 1 cm. Medical records were reviewed post-SBRT for CV events including: myocardial infarction (MI), heart failure (HF), structural heart damage (valvular or wall abnormalities), vascular damage (aneurysm, dilation, other abnormalities), hemoptysis, and arrhythmia which were correlated with lesion location and history. Four hundred four patients treated with SF-SBRT to 34 Gy in 1 fraction were identified. 35 patients (8.7%) had 36 lesions within 1 cm of the heart or GVs. 68.6% of patients were female and 74.3% were Caucasian. The median age was 72.5 years (range: 60-91), median Charlson comorbidity score was 6, median KPS was 80, and median ASCVD score was 21.0%. 33 patients had a smoking history with a median of 50 pack years. 12 patients (34.3%) had an arrhythmia prior to SBRT, 5 (14.2%) had prior HF, and 9 (25.7%) had prior MI or CV disease. All cases were non-small cell lung cancer or radiographic malignancy with 1 case of small cell lung cancer. Median tumor size was 1.6 cm. 91.4% of patients had stage I disease. Median follow-up was 2.26 years (0.37-4.0). Seven lesions (19.4%) were abutting the heart or GVs, 14 (38.9%) were within 0.5 cm, and 15 (41.7%) were from 0.5-1 cm. 54 events were observed with a median of 1 event per patient (0-5). The most common events were arrhythmia (15), vascular damage (9), structural damage (12), heart failure (9), and MI (6). The most commonly associated vascular structure was the aortic arch, while the most commonly involved substructures of the heart were the right atrium and left ventricle. 12 events occurred in the direct contact group, 17 in the < 0.5 cm group, and 25 in the 0.5-1 cm group. Patients with heart associated lesions accounted for 8 events, while those with vessel associated tumors accounted for 46. While cardiac events are relatively common in the medically inoperable SBRT population, they did not appear to be more common with tumors directly contacting major cardiovascular structures than for those with some separation. Most events could be attributed to medical causes other than SBRT. Further study is needed to clarify the potential role of radiation in events without direct explanation.

Statin Therapy and Tendon Rupture in High ASCVD Score Patient: A Comprehensive Case Report and Literature Review

Statin-induced tendon rupture is a rare clinical manifestation that warrants attention, especially in patients with a high 10-year

Prevalence of Non-Communicable Disease in HIV Infected patients coming to Emergency Medicine and Critical Care Department in A Tertiary Care Centre in South India

Introduction: AIDS (acquired immune deficiency syndrome), caused by the human immune deficiency virus (HIV), is a chronic, potentially life-threatening condition. Non-communicable diseases require long – term care and treatment as they are chronic conditions that result in lifelong health consequences. In our study we tried to evaluate the prevalence of Non-Communicable Diseases (NCD) among HIV patients. Methodology: This is a prospective study consisting 191 patients who were presented to the Emergency Medicine and Critical Care Department over 2 year for various HIV related acute problems. Chi-square test was used to find significance of association of qualitative variables. Atherosclerotic cardiovascular disease scale (ASCVD) and Framingham risk score were used. Results: 65.45% of patients were in the age group 40-60 yrs. From the total number of HIV patients, 64.92% (123) of patients were affected by NCDs. The prevalence rate of dyslipidemia 49(25.7%) was found to be high, followed by hypertension 48(25.1%) and diabetes 36(18.8%). There is a major association (p value &lt; 0.001) linking Framingham score and CAD and a borderline significance (p=0.093) between ASCVD score and CAD. Conclusion: The prevalence rate of non-communicable diseases among retro positive patients is high and should be screened in the same manner as done for routine patients. HIV patients presents to the Emergency room with disease related deteriorations and also with NCD associated complications. When managing in the emergency room it is always essential to think of these NCDs in HIV patients and the complication it can produce. This will help in early diagnosis, evaluate the complication in more organised manner and provide effective management. This will also provide in reducing the morbidity and mortality among such patients.

External validation of the ACC/AHA ASCVD risk score in a Colombian population cohort

No cardiovascular risk score has included Latin American patients in its development. The ACC/AHA ASCVD risk score has not been validated in Latin America; consequently, its predictive capacity in the population of the region is unknown. The aim of this study is to evaluate the discrimination capacity and calibration of the ACC/AHA ASCVD score to predict the 10-year risk of a cardiovascular event in a primary prevention cohort followed in a Colombian hospital. A retrospective cohort study was conducted in primary prevention patients belonging to an intermediate/high-risk and low-risk cohort without established atherosclerotic disease. Cardiovascular risk was calculated at inclusion. The calibration was analyzed by comparing observed and expected events in the different risk categories. A discrimination analysis was made using the area under the ROC curve and C statistic. A total of 918 patients were included—202 from the intermediate/high-risk and 716 from the low-risk cohort. The median cardiovascular risk was 3.6% (IQR 1.7–8.5%). At the 10-year follow-up, 40 events (4,4%) occurred. The area under the ROC curve was 0.782 (95% CI 0.71–0.85). The Hosmer–Lemeshow test did not show differences between expected and observed events. The ACC/AHA ASCVD score is calibrated and has good discrimination capacity in predicting 10-year risk of cardiovascular events in a Colombian population.

Impaired response of memory Treg to high density lipoproteins is associated with intermediate/high cardiovascular disease risk in persons with HIV.

Cardiovascular disease (CVD) is a leading cause of enhanced morbidity and mortality in persons with HIV (PWH) in the era of highly active antiretroviral therapy (AART). However, the underlying mechanisms are not fully understood. Regulatory T cells (Treg), notably the highly suppressive memory subset, have been shown to limit CVD. Importantly, memory Treg cell numbers remain low in many treated PWH. High density lipoproteins (HDL) also protect from CVD, and we previously found that Treg-HDL interactions reduce oxidative stress in these cells. Here, we evaluated Treg-HDL interactions in PWH and whether they were operative in those higher CVD risk. To do that, we recruited a cohort of PWH with intermediate/high CVD risk (median ASCVD risk score of 13.2%, n=15) or low/borderline risk (median ASCVD risk score of 3.6%, n=14), as well as a group of statins treated PWH with intermediate/high CVD risk (median ASCVD risk score of 12.7%, n=14). We evaluated Treg frequency, phenotype and response to HDL. PWH with Int/High CVD risk had a significantly lower number of memory Treg, but memory Treg were more activated and displayed an inflammatory phenotype, versus those with Low/BL CVD risk. In untreated patients, Treg absolute numbers were negatively correlated with ASCVD score. Although HDL decreased oxidative stress in memory Treg in all subjects, memory Treg from PWH with Int/High CVD risk were significantly less responsive to HDL than those from PWH with Low/BL CVD risk. The level of oxidative stress in memory Treg positively correlated with ASCVD scores. In contrast, plasma HDL from PWH, regardless of CVD risk, retained their anti-oxidative properties, suggesting that the defect in memory Treg response to HDL is intrinsic. Statin treatment partially ameliorated the memory Treg defect. In conclusion, the defective HDL-Treg interactions may contribute to the inflammation-induced increased CVD risk observed in many AART-treated PWH.

Comparison of Framingham Cardiovascular Risk Criteria and ASCVD Score in Iranian Obese Patients.

Calculating and predicting the risk of disease plays an important role in preventive medicine. Today, some risk scores have been designed to estimate the risk of cardiovascular diseases (CVDs) by assessing different factors. Obesity is associated with an increased risk of cardiovascular disease, so we decided to calculate the possible risk of heart disease in obese Iranian people to suggest a more accurate calculator. In this cross-sectional study, we compared the data of 289 people from Framingham Risk Score and ASCVD Risk Score calculations who had been referred to Shariati Hospital Obesity Clinic, Tehran, Iran from 2016 to 2019. In the form of sub-goals, we examined other factors such as blood pressure and hepatic aminotransferases, etc. The mean age of participants was 51.20±7.58 years, 86.2% being women. Of the whole, 19.72%, 31.83%, 21.11%, and 27.34% were categorized as overweight, Obese I, II, and III, respectively. According to the ASCVD score 80.3%, 4.8%, and 14.9%, and according to the Framingham score 95.5%, 3.5%, and 1% were classified as low-risk, intermediate-risk, and high-risk. Moreover, a fair agreement was observed between the two-risk score in the whole (Kappa=0.236; P<0.001), overweight (Kappa=0.304; P=0.028), Obese I (Kappa=0.210; P=0.048), Obese II (Kappa=0.268; P=0.015), and obese III (Kappa=0.202; P=0.023). Despite its age limit, ASCVD has a higher risk of CVDs, causing statin care (which has a protective role for cardiovascular disease) to be given to a larger population.