Atherosclerotic Cardiovascular Disease Score Research Articles

Prediction of Cardiovascular Events by Pulse Waveform Parameters: Analysis of CARTaGENE.

BackgroundWaveform parameters provide approximate data about aortic wave reflection. However, their association with cardiovascular events remains controversial and their role in cardiovascular prediction is unknown.Methods and ResultsWe analyzed participants aged between 40 and 69 from the population‐based CARTaGENE cohort. Baseline pulse wave analysis (central pulse pressure, augmentation index) and wave separation analysis (forward pressure, backward pressure, reflection magnitude) parameters were derived from radial artery tonometry. Associations between each parameter and major adverse atherosclerotic events (MACE; cardiovascular death, stroke, myocardial infarction) were obtained using adjusted Cox models. The incremental predictive value of each parameter compared with the 10‐year atherosclerotic cardiovascular disease score alone was assessed using hazard ratios, c‐index differences, continuous net reclassification indexes, and integrated discrimination indexes. From 17 561 eligible patients, 2315 patients had a MACE during a median follow‐up of 10.1 years. Central pulse pressure, forward pressure, and backward pressure, but not augmentation index and reflection magnitude, were significantly associated with MACE after full adjustment. All parameters except forward pressure statistically improved MACE prediction compared with the atherosclerotic cardiovascular disease score alone. The greatest prediction improvement was seen with augmentation index and reflection magnitude but remained small in magnitude. These 2 parameters enhanced predictive performance more strongly in patients with low baseline atherosclerotic cardiovascular disease scores. Up to 5.7% of individuals were reclassified into a different risk stratum by adding waveform parameters to atherosclerotic cardiovascular disease scores.ConclusionsSome waveform parameters are independently associated with MACEs in a population‐based cohort. Augmentation index and reflection magnitude slightly improve risk prediction, especially in patients at low cardiovascular risk.

The association between low-density and non-high-density lipoprotein cholesterol with incident cardiovascular disease among low-risk Iranians during 2 decades follow-up

IntroductionTo examine the associations between low-density and non-high-density lipoprotein cholesterol (LDL-C and non-HDL-C, respectively) with incident cardiovascular disease (CVD) in low-risk subjects. Materials and methodsFrom a total of 2467 non-diabetic aged 40–70 years, free of CVD with LDL-C range 1.81 ≤ LDL-C < 4.91 mmol/L with 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 7.5 %, the associations of LDL-C and non-HDL-C with incident CVD were assessed using multivariable Cox proportional hazard regression analyses adjusted for age, sex, body mass index, waist circumference, HDL-C, triglycerides, chronic kidney disease, current smoking, hypertension, and family history of CVD. ResultsDuring a median follow-up of 18 years, 559 CVD events occurred. Compared to the LDL-C < 2.59 mmol/L as reference, the categories of 2.59 ≤ LDL-C < 3.36, 3.36 ≤ LDL-C < 4.14, and ≥ 4.14 mmol/L were associated with hazard ratios (95 % confidence intervals) of 1.39(0.89–2.18), 1.72(1.11–2.68), and 2.19(1.36–3.51) for incident CVD (P for trend <0.0001), respectively. Compared to the non-HDL-C < 3.36 as reference, the categories of 3.36 ≤ non-HDL-C < 4.14, 4.14 ≤ non-HDL-C < 4.91, and ≥ 4.91 mmol/L were associated with 1.48(0.96–2.30), 1.37(0.89–2.16), and 2.15(1.36–3.39) higher risk for incident CVD (P for trend = 0.001), respectively. Among those with ASCVD score <5 % (n = 2070), even the 2.59 ≤ LDL-C < 3.36 mmol/L increased the risk for CVD [1.73(1.01–2.97)]. Results for non-HDL-C categories remained unchanged compared to those with ASCVD risk < 7.5%. ConclusionsAmong Iranian individuals with ASCVD risk as little as < 5 %, LDL-C ≥ 2.59 mmol/L and non-HDL-C ≥ 3.36 mmol/L, independent of traditional risk factors, were associated with a significantly higher risk of incident CVD, individuals that might potentially benefit from pharmacological therapy.

Cardiovascular Risk Factors and Physical Fitness Among Subjects with Asymptomatic Colonic Diverticulosis.

The association between diverticular disease and atherosclerotic cardiovascular disease (ASCVD) has been demonstrated previously, mainly in symptomatic subjects. To evaluate 10years cardiovascular risk, exercise performance and association to ASCVD among subjects with asymptomatic diverticulosis. A retrospective cross-sectional cohort of self-referred participants in a medical screening program, who underwent a screening colonoscopy. Demographics, clinical and laboratory variables, ASCVD score, and metabolic equivalents (METs) during treadmill stress test were compared between subjects with and without diverticulosis as diagnosed on screening colonoscopy. 4586 participants underwent screening colonoscopy; 799 (17.4%) had diverticulosis. Among 50-69 yo participants, diverticulosis subjects had a higher ASCVD score compared to non-diverticulosis subjects. Exercise performance was comparable between the groups, across all age groups. Using logistic regression analysis, advanced age group (50-59 yo Adjusted odds ratio (AOR) [95% confidence interval (CI)] 2.57 (1.52-4.34), p < 0.001; 60-69 yo, AOR 2.87 (2.09-3.95), p < 0.001; ≥ 70 yo AOR 4.81 (3.23-7.15), p < 0.001; compared to < 50 yo age group), smoking [AOR 1.27 (1.05-1.55), p = 0.016], HTN [AOR 1.27 (1.03-1.56), p = 0.022], obesity [AOR 1.36 (1.06-1.74), p = 0.014] and male sex [AOR 1.29 (1.02-1.64), p=0.036] were associated with diverticular detection during screening colonoscopy. Among males, achieving METs score ≥ 10 was inversely associated with diverticular detection during screening colonoscopy [AOR 0.64 (0.43-0.95), p = 0.027]. Tenyears probability for ASCVD estimated by the ASCVD score is higher among subjects with asymptomatic diverticulosis compared to subjects without diverticulosis. Improved exercise performance is demonstrated for the first time to correlate with decreased probability for diverticular disease in screening colonoscopy.

ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN SYSTOLIC LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS

Objective: Hypertension is diagnosed and managed using brachial blood pressures; accurate measurement can be impeded by several temporary or permanent factors, including fractures, presence of vascular access devices, limb deformities and altered muscle tone after stroke. Leg (ankle) blood pressure measurement is a practical alternative, but limited data exist to guide clinicians’ interpretation of leg blood pressure values for hypertension diagnosis and treatment. Design and method: Individual participant data meta-analyses were undertaken, using data from 14 studies within the international inter-arm blood pressure difference individual participant data (INTERPRESS-IPD) Collaboration, to 1) determine the relationship between arm and leg systolic blood pressure, 2) develop and validate a multivariable model predicting arm from leg systolic blood pressure, and 3) investigate the prognostic association between leg systolic blood pressure and cardiovascular disease and mortality. Results: Arm and leg systolic blood pressure data existed for 33,710 individuals (mean age: 58 years, mean arm systolic/diastolic blood pressure at baseline: 138/80 mmHg, 45% female). Mean leg systolic blood pressure was 12.0 (95% CI, 8.8 to 15.2) mmHg higher than arm systolic blood pressure. The multivariable model derived to predict highest arm from highest leg systolic blood pressure demonstrated excellent performance (area under receiver operating characteristic curves, sensitivity and specificity remained above 0.89, 0.80 and 0.81, respectively, across blood pressure thresholds from 160 to 130 mmHg). Lowest leg systolic blood pressure was a predictor of all-cause mortality and cardiovascular events over a 10-year period. Cardiovascular risk scores were similar for observed arm systolic blood pressure and the highest arm systolic blood pressure predicted from lowest leg systolic blood pressure [Atherosclerotic Cardiovascular Disease Score: 16.73% (12.65) vs 17.17% (12.61), Framingham Score: 19.33% (15.05) vs 19.91% (15.06)]. Conclusions: These results provide a robust evidence-based method for describing the arm-leg systolic blood pressure relationship and estimating individual brachial systolic blood pressure and cardiovascular risk from leg blood pressure measurements using individual participant data. A freely available and easy-to-use web-based calculator has been created to support patients and clinicians in estimating equivalent arm blood pressure when only leg blood pressure measurements and patient characteristics are available.

Abstract 16: Addressing Gaps In Cholesterol Management In Primary Cardiovascular Prevention In A Resident Run Internal Medicine Clinic: A Mixed Method Approach

Background: Provider and system level barriers can delay timely initiation of statin therapy in primary atherosclerotic cardiovascular disease (ASCVD) prevention. A simple, pragmatic and scalable quality improvement (QI) approach is needed to address these gaps. Methods: We describe methods and preliminary results of a QI initiative in a resident run internal medicine clinic in Cayuga Medical Center (total 19 residents, 5 attendings, ~200 patients seen/month with 10% no shows). First, we assessed rates of lipids tested and statin use in 40-75 years old patients without ASCVD. Second, we performed a focus group discussion (FGD) among residents, attendings and clinic leadership to understand barriers for statin use. Third, we outlined key actionable items informed by FGD. Finally, we will assess the impact of the intervention. Findings: We report baseline data in 325 consecutive patients (Table). Mean age was 55.2 years (50.2% women), 50.6% did not have lipids checked and only 17.5% were on statin therapy in the preceding 3 years. Three major themes from FGD were: lack of automated ASCVD score reporting in electronic medical record (EMR), insufficient clinic time and follow up visits. Subsequently, we adopted automated ASCVD risk reporting in EMR and telemedicine follow up to address identified gaps and associated downstream impact, which is currently ongoing. Conclusion: Using mixed-method approach, we describe an implementation strategy to address gaps in cholesterol management in primary prevention patients in a resident run clinic. If effective, this strategy can be a model for other clinics.

Abstract 424: An Automated Estimated Atherosclerotic Cardiovascular Disease Risk Score

Background: Calculating Atherosclerotic Cardiovascular Disease (ASCVD) risk is a key step in CVD prevention, but that standard approach requires risk factor data and use of a computer. Objective: To develop a simplified ASCVD risk score automatically calculated by the clinical laboratory from a standard lipid panel. Methods: Using data from 6,027 participants (excluding those with diabetes or on lipid lowering drugs) from the National Health and Nutrition Examination Survey (NHANES), we developed regression equations to generate an eASCVD risk score that provides estimates similar to standard ASCVD score in 4 race/sex groups: Non-Hispanic Whites men (NHWM) or women (NHWW) and Black men (BM) or women (BW), using TC, HDL-C, TG, and age. The new eASCVD score was externally validated in the Atherosclerosis Risk In Communities (ARIC) (N=14,742) study and compared to the standard ASCVD risk score for its association with clinical ASCVD events (N=14,742). Results: The eASCVD risk score had a sensitivity of 69% and a specificity of 97.5% for identifying statin-eligible patients with at least intermediate risk by the standard risk score at a cutpoint of 7.5%/10-year. By using the sum of the presence of non-lipid risk factors (SBP&gt;130 mmHg, blood pressure medications and smoking) to adjust the threshold of the eASCVD risk score, its overall sensitivity increased to 94%, with a specificity of 92%. For each race/gender group, the eASCVD risk score performed similarly, but the positive predictive value (PPV) for men was better (88.6% for NHWM and 88.7% for BM) than for women (79% for NHWM and 78.7% for BW). Finally, eASCVD risk score showed 90% agreement with the standard risk score in predicting CVD events in the ARIC study. Conclusions: The eASCVD risk score can be automatically calculated by the clinical laboratory from a standard lipid panel. It identifies the majority of statin-eligible patients and can be used as a decision aid for statin therapy.

Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization.

OBJECTIVES:Sepsis survivors face increased risk for cardiovascular complications; however, the contribution of intrasepsis events to cardiovascular risk profiles is unclear.SETTING:Kaiser Permanente Northern California (KPNC) and Intermountain Healthcare (IH) integrated healthcare delivery systems.SUBJECTS:Sepsis survivors (2011–2017 [KPNC] and 2018–2020 [IH]) greater than or equal to 40 years old without prior cardiovascular disease.DESIGN:Data across KPNC and IH were harmonized and grouped into presepsis (demographics, atherosclerotic cardiovascular disease scores, comorbidities) or intrasepsis factors (e.g., laboratory values, vital signs, organ support, infection source) with random split for training/internal validation datasets (75%/25%) within KPNC and IH. Models were bidirectionally, externally validated between healthcare systems.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Changes to predictive accuracy (C-statistic) of cause-specific proportional hazards models predicting 1-year cardiovascular outcomes (atherosclerotic cardiovascular disease, heart failure, and atrial fibrillation events) were compared between models that did and did not contain intrasepsis factors. Among 39,590 KPNC and 16,388 IH sepsis survivors, 3,503 (8.8%) at Kaiser Permanente (KP) and 600 (3.7%) at IH experienced a cardiovascular event within 1-year after hospital discharge, including 996 (2.5%) at KP and 192 (1.2%) IH with an atherosclerotic event first, 564 (1.4%) at KP and 117 (0.7%) IH with a heart failure event, 2,310 (5.8%) at KP and 371 (2.3%) with an atrial fibrillation event. Death within 1 year after sepsis occurred for 7,948 (20%) KP and 2,085 (12.7%) IH patients. Combined models with presepsis and intrasepsis factors had better discrimination for cardiovascular events (KPNC C-statistic 0.783 [95% CI, 0.766–0.799]; IH 0.763 [0.726–0.801]) as compared with presepsis cardiovascular risk alone (KPNC: 0.666 [0.648–0.683], IH 0.660 [0.619–0.702]) during internal validation. External validation of models across healthcare systems showed similar performance (KPNC model within IH data C-statistic: 0.734 [0.725–0.744]; IH model within KPNC data: 0.787 [0.768–0.805]).CONCLUSIONS:Across two large healthcare systems, intrasepsis factors improved postsepsis cardiovascular risk prediction as compared with presepsis cardiovascular risk profiles. Further exploration of sepsis factors that contribute to postsepsis cardiovascular events is warranted for improved mechanistic and predictive models.

Inter-arm blood pressure difference and cardiovascular risk estimation in primary care: a pilot study.

Systolic inter-arm differences (IAD) in blood pressure (BP) contribute independently to cardiovascular risk estimates. This can be used to refine predicted risk and guide personalised interventions. To model the effect of accounting for IAD in cardiovascular risk estimation in a primary care population free of pre-existing cardiovascular disease. A cross-sectional analysis of people aged 40-75 years attending NHS Health Checks in one general practice in England. Simultaneous bilateral BP measurements were made during health checks. QRISK2, atherosclerotic cardiovascular disease (ASCVD), and Framingham cardiovascular risk scores were calculated before and after adjustment for IAD using previously published hazard ratios. Reclassification across guideline-recommended intervention thresholds was analysed. Data for 334 participants were analysed. Mean (standard deviation) QRISK2, ASCVD, and Framingham scores were 8.0 (6.9), 6.9 (6.5), and 10.7 (8.1), respectively, rising to 8.9 (7.7), 7.1 (6.7), and 11.2 (8.5) after adjustment for IAD. Thirteen (3.9%) participants were reclassified from below to above the 10% QRISK2 threshold, three (0.9%) for the ASCVD 10% threshold, and nine (2.7%) for the Framingham 15% threshold. Knowledge of IAD can be used to refine cardiovascular risk estimates in primary care. By accounting for IAD, recommendations of interventions for primary prevention of cardiovascular disease can be personalised and treatment offered to those at greater than average risk. When assessing elevated clinic BP readings, both arms should be measured to allow fuller estimation of cardiovascular risk.

Cardiovascular Risk for Patients With and Without Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder.

BackgroundTo compare estimated 10‐year and 30‐year cardiovascular risk in primary care patients with and without serious mental illness (SMI; bipolar disorder, schizophrenia, or schizoaffective disorder).Methods and ResultsAll patients aged 18 to 75 years with a primary care visit in January 2016 to September 2018 were included and were grouped into those with and without SMI using diagnosis codes. Ten‐year cardiovascular risk was estimated using atherosclerotic cardiovascular disease scores for patients aged 40 to 75 years without cardiovascular disease; 30‐year cardiovascular risk was estimated using Framingham risk scores for patients aged 18 to 59 years without cardiovascular disease. Demographic, vital sign, medication, diagnosis, and health insurance data were collected from the electronic health record by a clinical decision support system. Descriptive statistics examined unadjusted differences, while general linear models examined differences for continuous variables and logistic regression models for categorical variables. Models were then adjusted for age, sex, race, ethnicity, and insurance type. A total of 11 333 patients with SMI and 579 924 patients without SMI were included. After covariate adjustment, 10‐year cardiovascular risk was significantly higher in patients with SMI (mean, 9.44%; 95% CI, 9.29%–9.60%) compared with patients without SMI (mean, 7.99%; 95% CI, 7.97–8.02). Similarly, 30‐year cardiovascular risk was significantly higher in those with SMI (25% of patients with SMI in the highest‐risk group compared with 11% of patients without SMI; P<0.001). The individual cardiovascular risk factors contributing most to increased risk for those with SMI were elevated body mass index and smoking. Among SMI subtypes, patients with bipolar disorder had the highest 10‐year cardiovascular risk, while patients with schizoaffective disorder had the highest 30‐year cardiovascular risk.ConclusionsThe significantly increased cardiovascular risk associated with SMI is evident even in young adults. This suggests the importance of addressing uncontrolled major cardiovascular risk factors in those with SMI at as early an age as possible.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02451670.

Abstract P036: Pooled Cohort Equation As A Predictor Of Incident Hypertension Among Hispanics/latinos: The Hispanic Community Health Study/study Of Latinos (HCHS/SOL)

Introduction: Hypertension risk assessment is the first step towards primary prevention of hypertension. The pooled cohort equation (PCE) provides an atherosclerotic cardiovascular disease (ASCVD) risk score. We sought to examine whether incident hypertension varied across categories of ASCVD risk as defined by the PCE Methods: Data from the HCHS/SOL baseline and visit 2 exam were used. Hypertension (baseline and incident) was defined as SBP &gt;140 mm Hg and DBP &gt;90 mm Hg. We included participants 40-74 years of age free of hypertension and ASCVD at baseline (n=3,692). Participants were classified into one of four ASCVD risk categories based on the PCE: low (&lt;5%), borderline (5-7.5%), intermediate (7.5-to 10%) and high (&gt;10%). Survey logistic regression models were used to determine the risk of hypertension overall, by age group and Hispanic/Latino background (Dominican, Central American, Cuban, Mexican, Puerto-Rican, South American) accounting for HCHS/SOL complex survey design. Results:: Overall, at baseline, the mean age was 51.2 ±0.23 years, 56% female, SBP: 119.7±0.26 and DBP: 72.6±0.20, ASCVD risk scores: low (65%); borderline (14.7%), intermediate (7.5%), and high (13.5%); 29.8% developed hypertension over 5.9 (range 4.1 – 9.6) years of follow-up. Intermediate (OR=2.2, CI: 1.5-3.2) and high (OR=2.5, CI: 1.9-3.5) baseline ASCVD risk categories were associated with increased odds of incident hypertension at follow-up compared to the low risk category. Age group and Hispanic/Latino background modified the relationship between increased baseline ASCVD score and incident hypertension, with strongest associations among those aged 50-59 years old (OR=2.3, CI: 1.7, 3.2) and Hispanics/Latinos of Dominican descent (OR=4.1, CI: 2.0, 8.4). Conclusions: Higher ASCVD risk was associated with an increased incidence of hypertension that varied by age and Hispanic/Latino background. The PCE ASCVD risk score can help guide public health measures to prevent hypertension.

Phytosterol Therapy Effectively Reduces LDL-C in Middle-Aged, Borderline Risk South Asians

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> Piper Biosciences. <h3>Background/Synopsis</h3> The effectiveness of a plant sterol gummy supplement was studied in a South-Asian (SA) patient population with low to moderate cardiovascular disease (CVD) risk as defined by an Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score of < 7.5%, and a low density lipoprotein (LDL)-C level of 120-189 mg/dl. Statin therapy is often not recommended to patients with ASCVD score < 7.5% even in the presence of risk accelerators such as SA ethnicity, to which the 2018 National Lipid Association (NLA) guidelines call attention. <h3>Objective/Purpose</h3> Phytosterols are known to lower LDL-C and are included in NLA and other global guidelines. This study aimed to establish their impact on LDL-C levels in 'borderline' risk SAs. <h3>Methods</h3> 50 SAs were recruited during the COVID 19 pandemic, mainly from a preventive cardiology clinic dedicated to reducing SA heart disease risk. Eligible subjects had a 10-year CV risk score (ASCVD) <7.5% and LDL-C level of 120-193mg/dl at study enrollment. Subjects intolerant of or refusing statins were also recruited. The study was administered with a fully decentralized design, leveraging mailed supplements, televisits, remote lab collection, and SMS-based communications. Upon completing baseline labs and surveys, subjects were provided a 90-day supply of 1400mg phytosterol gummy supplements in individual packets (Piper Biosciences, Los Altos, CA) to be ingested twice daily. Subjects were instructed to continue current lifestyle habits and report major dietary pattern deviations. The primary endpoint was LDL-C reduction at 3 months. Pre- and post-study surveys were administered to assess diet and lifestyle. <h3>Results</h3> 33 of the 50 subjects successfully completed the protocol. A significant overall reduction in LDL-C of 5.8% was observed (p=0.03) (Table 1, Figure 1). Subgroup A (n=27) completed the protocol with no significant dietary variation, demonstrating a significant LDL-C reduction of 6.5% (p=0.002), as well as a total cholesterol (TC) reduction of 4.4% (p=0.01). There was no significant change in other metrics, including BMI, fasting glucose, or HbA1C. Patients who completed the protocol but reported worsening dietary habits (Subgroup B, n=6) showed an average increase in LDL-C of 6% (p=0.2) and in TC of 8% (p=0.002). Survey responses indicate that 94% of subjects would be interested in long-term supplementation if recommended by physician and 80% would prefer taking it proactively to manage cholesterol levels. <h3>Conclusions</h3> Plant sterols are an effective and sustainable means to lower LDL-C in middle-aged SAs, whose CV risk is often underestimated. To our knowledge this study represents the first demonstration of phytosterol effectiveness in the highest coronary disease risk population globally.

Elevated Plasma von Willebrand Factor Levels Are Associated With Subsequent Ischemic Stroke in Persons With Treated HIV Infection.

BackgroundWe assessed whether key biomarkers of endothelial activation and hemostasis/thrombosis were elevated in individuals receiving effective antiretroviral therapy (ART) in the year before ischemic stroke.MethodsWe conducted a case–control study nested in the CFAR Network of Integrated Clinical Systems cohort, comparing 42 adjudicated cases with ischemic stroke with 83 controls matched for ART regimen. Angiopoietin-1, angiopoietin-2, C-reactive protein, interleukin-6, plasminogen activation inhibitor–1, P-selectin, serum amyloid–A, soluble CD14, ICAM-1, VCAM-1, apolipoprotein A1, ADAMTS13, and von Willebrand factor (VWF) were measured in stored plasma collected before the stroke event. We used conditional logistic regression to identify associations with ischemic stroke, with and without adjustment for Atherosclerotic Cardiovascular Disease (ASCVD) and Veterans Aging Cohort Study (VACS) scores.ResultsAfter adjustment for age and sex, higher plasma viral load and higher angiopoeitin-2, soluble CD14, and VWF were associated with increased odds of ischemic stroke; higher nadir CD4 count was associated with decreased odds of ischemic stroke. VWF remained associated with subsequent ischemic stroke after adjustment for ASCVD score (adjusted odds, 1.74; 95% CI, 1.01–2.98 per log2 increment). In a separate model adjusting for VACS score, only VWF (adjusted odds, 1.80; 95% CI, 1.04–3.12 per log2 increment) was associated with subsequent ischemic stroke. In a sensitivity analysis excluding participants with viral load ≥400 copies/mL, associations between VWF and ischemic stroke were attenuated, with risk estimates ranging from 1.59 to 1.64 per log2 increment.ConclusionsEndothelial activation and related release and attachment of VWF may play an important role in ischemic stroke among persons with treated HIV infection.

Serum Biomarkers are Associated With Atherosclerotic Cardiovascular Disease Among Patients With Nonalcoholic Fatty Liver Disease Undergoing Elective Angiography

Cardiovascular disease is the most common cause of death among patients with nonalcoholic fatty liver disease (NAFLD). We assessed select cardiac biomarker associations for existing or future coronary artery disease (CAD) risk in patients with NAFLD. Patients with/without NAFLD undergoing elective cardiac angiography were prospectively enrolled. Severe CAD was defined as presence of at least 1 proximal artery >70% stenosis; risk of severe CAD as either existing severe CAD or atherosclerotic cardiovascular disease score ≥20; NAFLD was defined as hepatic fat in the absence of other liver diseases. Cardiac biomarkers (high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin I [hs-cTnI]) were measured using Atellica Solution assays (Siemens Healthineers). A total of 619 patients were enrolled (mean age, 63 ± 10 years; 80% male; 31% type 2 diabetes; 65% NAFLD); 42% had severe CAD, and 57% had risk of severe CAD. NAFLD prevalence was similar between patients with and without severe CAD (68% vs 62%; P > .05). Patients with NAFLD with severe CAD (44%) or with risk of severe CAD (58%) had higher levels of hs-cTnI than NAFLD controls (both P < .001). Presence of severe CAD or risk of severe CAD in all patients was associated with older age, male, aspects of metabolic syndrome, and elevated hs-cTnI: odds ratio 2.0 (95% confidence interval [CI],1.4-2.9) and 1.8 (95% CI, 1.1-3.0), respectively; 2.3 (95% CI, 1.4-3.8) and 2.2 (95% CI, 1.2-4.2), respectively, in patients with NAFLD (all P < .02). CAD is common in patients with NAFLD. High hs-cTnI was associated with an increased risk of CAD. Pending validation, hs-cTnI may be a useful marker for CAD risk prediction in patients with NAFLD.

Coronary Calcium Scanning and Cardiovascular Risk Assessment Among Firefighters

Sudden cardiac death is the main cause of death among firefighters. The goal of this study is to identify firefighters at risk for cardiovascular disease using coronary artery calcium screening. Asymptomatic firefighters aged ≥40 years without known cardiovascular disease or diabetes (N=487) were recruited from fire departments in 3 Maryland counties from 2016 to 2018, with data analysis from 2018 to 2019. The cardiovascular disease prevention program included an evaluation of blood pressure, cholesterol, BMI, fasting glucose, medications, and a coronary calcium scan. A subset (n=100) was evaluated in more detail, including family history, metabolic syndrome, diet, exercise, smoking, and atherosclerotic cardiovascular disease risk score. Results indicated that 191 (39%) firefighters had a coronary artery calcium score >0, of which 91% were above the average for age, sex, and ethnicity. On univariable logistic regression, older age, male sex, hypertension, BMI, and glucose were significantly (p<0.05) associated with a higher likelihood of having any coronary artery calcium. Multiple logistic regression found that older age; male sex; taking lipid-lowering or antihypertensive medications; and higher low-density lipoprotein cholesterol, BMI, and fasting blood glucose were significantly associated with a higher likelihood of having coronary artery calcium. Of those with coronary artery calcium, 141 (74%) were not on lipid-lowering medication. In addition, 47 (94%) of those on lipid-lowering medication had a low-density lipoprotein cholesterol >70 mg/dL. In the detailed subset, 30 (30%) had coronary artery calcium. Among these, 28 (93%) had an atherosclerotic cardiovascular disease risk score <7.5%. Thus, if atherosclerotic cardiovascular disease scores alone were used to assess risk in this subset, an opportunity would have been missed to identify and treat firefighters who may have benefited from more aggressive treatment. A coronary artery calcium scan may identify the firefighters at increased risk for cardiovascular disease. A comprehensive cardiovascular disease prevention program implemented early in a firefighter's career may help reduce cardiovascular disease risk and thus death and disability in this high-risk population.

Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study.

Microvascular dysfunction is the key element in the pathogenesis of systemic sclerosis (SSc), whereas the contribution of large and medium size vessel abnormalities is yet to be established. The aim of the present study is to assess the association between micro- and macrovascular function by utilizing a broad spectrum of assessments of vascular performance. We included consecutive, consenting SSc patients who underwent nailfold video capillaroscopy (NVC) for microcirculation evaluation. Peripheral and central systolic and diastolic blood pressure, carotid intima-media thickness (cIMT), aortic augmentation index (AIx) corrected for a heart rate of 75 beats per minute (AIx-75), and carotid-femoral pulse wave velocity (PWV) were also performed to assess macrovascular function. Cardiovascular risk disease (CVD) algorithms were also calculated and included in the analysis. A total of 81 patients (6 males) were studied with mean age 55.44 ± 13.40years. Reduced capillary density was inversely correlated with arterial stiffness (Alx-75) and augmentation pressure (r = - 0.262, p = 0.018, and r = - 0.249, p = 0.025 respectively). Alx was significantly lower in the early compared to late pattern (28.24 ± 11.75 vs 35.63 ± 10.47, p = 0.036). A significant trend was found among NVC patterns with Alx-75 values being higher with the progression of microangiopathy towards the "late" group (26.36 ± 10.90 vs 30.81 ± 11.59 vs 35.21 ± 7.90, p = 0.027 for trend). Similarly, Framingham risk score and Atherosclerotic Cardiovascular Disease score were progressively higher across the worsening NVC patterns (4.10 ± 4.13 vs 2.99 ± 2.72 vs 6.36 ± 5.65, p = 0.023, and 6.99 ± 7.18 vs 5.63 ± 4.41 vs 12.09 ± 9.90, p = 0.019, respectively, for trends). Finally, QRISK3 (10-year cardiovascular disease risk) and ASCVD (Atherosclerotic Cardiovascular Disease) scores were inversely correlated with the number of capillaries (r = - 0.231, p = 0.048, and r = - 0.260, p = 0.038 respectively). These data suggest that CVD risk scores and macrovascular parameters are strongly correlated with microvasculopathy in patients with SSc. Key Points • Microangiopathy is the hallmark of SSc, but the relationship between subclinical atherosclerosis and small vessel disease remains unknown. • Arterial stiffening and CVD risk scores are positively associated with the degree of progression of peripheral microvasculopathy assessed with NVC. • The results of the study suggest an association between NVC abnormalities and higher CVD risk in SSc patients.

Cardiovascular Risk Is Elevated in Lean Subjects with Nonalcoholic Fatty Liver Disease.

Background/AimsNonalcoholic fatty liver disease (NAFLD) and obesity are independently associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD), the leading cause of mortality in patients with NAFLD. Many NAFLD patients are lean, but their ASCVD risk compared to obese subjects with NAFLD is unclear.MethodsData from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys database were analyzed (n=4,786). NAFLD was defined as a comprehensive NAFLD score ≥40 or a liver fat score ≥–0.640. ASCVD risk was evaluated using the American College of Cardiology/American Heart Association guidelines.ResultsThe frequency of subjects without NAFLD, with obese NAFLD, and with lean NAFLD was 62.4% (n=2,987), 26.6% (n=1,274), and 11.0% (n=525), respectively. Subjects with lean NAFLD had a significantly higher ASCVD score and prevalence of a high ASCVD risk (mean 15.6±14.0, 51.6%) than those with obese NAFLD and without NAFLD (mean 11.2±11.4, 39.8%; mean 7.9±10.9, 25.5%; all p<0.001). Subjects with lean NAFLD and significant liver fibrosis showed a significantly higher odds ratio for a high risk for ASCVD than those with obese NAFLD with or without significant liver fibrosis (odds ratio, 2.60 vs 1.93; p=0.023).ConclusionsSubjects with lean NAFLD had a significantly higher ASCVD score and prevalence of high risk for ASCVD than those with obese NAFLD. Similarly, lean subjects with significant liver fibrosis had a higher probability of ASCVD than obese subjects in the subpopulation with NAFLD.

Prediction of Cardiovascular Risk among Healthcare Professionals using Atherosclerotic Cardiovascular Disease Risk Score in a Tertiary Care Hospital in Aurangabad, India

Background: The current scenario of long working hours, sedentary lifestyle, and occupational stress has led to an increased prevalence of noncommunicable risk factors among the medical fraternity. Hence, determining the risk of developing atherosclerotic cardiovascular disease (ASCVD) has become highly essential to curb the predisposing factors leading to it. Objectives: The objectives of the study are to cluster the cardiovascular risk factors among healthcare professionals and to estimate the ASCVD Risk Score among healthcare professionals of a teaching hospital in Aurangabad. Methods: A population of 200 subjects were considered for the study. Cardiovascular risk factors such as age, race, gender, diabetes mellitus, antihypertensive medications, dyslipidemia, alcohol consumption, smoking, family history of hypertension, physical activity, waist circumference (central obesity), obesity, and stress/mental status were studied. Assessing each of its prevalence to predict the risk of cardiovascular disease using ASCVD Risk Score formed the crux of the study. Results: On assessing the risk factors in all subjects, it was found that type 2 diabetes mellitus (34.6%), dyslipidemia (32%), and hypertension (22.09%) were predominantly seen among majority of the healthcare professionals. The average lifetime ASCVD Score among healthcare professionals was 57.8%. It was observed that as age advances, the risk of developing an ASCVD also increased. Conclusion: Utilizing a simple tool such as the ASCVD Risk Score Calculator can not only predict the risk of ASCVD but can also help initiate preventive strategies and prolong the life of a medico!

Interplay between non-alcoholic fatty liver disease and cardiovascular risk in an asymptomatic general population.

Non-alcoholic fatty liver (NAFLD) is a major cause of liver disease worldwide leading also to a higher risk of cardiovascular events. We aimed to evaluate the impact of fatty liver and fibrosis on cardiovascular risk in a general population. Five hundred and forty-two subjects included in the community-based ABCD (Alimentazione, Benessere Cardiovascolare e Diabete) study were recruited. Steatosis (controlled attenuation parameter>288dB/m) and severe fibrosis (low risk, liver stiffness measurement [LSM]<7.9KPa with M probe and <5.7KPa with XL probe; intermediate risk, LSM 7.9-9.5KPa with M probe and 5.7-9.2KPa with XL probe; high risk, LSM≥9.6KPa with M probe and ≥9.3KPa with XL probe) were assessed with FibroScan. Cardiovascular risk was evaluated by the atherosclerotic cardiovascular disease (ASCVD) risk estimator and defined low if <5%, borderline if 5-7.4%, intermediate if 7.5-19.9% and high if ≥20%. Intima-media thickness (IMT) was measured with ultrasound. Prevalence of steatosis and of severe fibrosis in this cohort was 31.7% and 4.8%, respectively. ASCVD score was evaluated in patients with and without steatosis and according to the risk of severe fibrosis. By ordinal regression analysis, both steatosis (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.13-2.33, P=0.009) and severity of fibrosis (OR 1.67, 95% CI 1.18-2.36, P=0.003) were independent risk factors for a higher ASCVD risk after adjusting for obesity. Subjects with NAFLD, when compared with those without, did not differ for IMT (0.75 vs 0.72mm; P=0.11) and IMT≥1mm (15.6% vs 12.1%; P=0.24). Higher prevalence of IMT≥1mm was found in patients at high or intermediate risk of severe fibrosis (24% and 28.6%, respectively) compared with those at low risk (12.1%) (P=0.03); this association was maintained after adjusting for confounders (OR 2.70, 95% CI 1.01-2.86, P=0.04). In the setting of a general adult population, the presence of NAFLD and severe fibrosis are associated with to a higher cardiovascular risk profile, pointing towards the need for specific preventive measures.

An Association Rule Mining Analysis of Lifestyle Behavioral Risk Factors in Cancer Survivors with High Cardiovascular Disease Risk.

We aimed to assess which lifestyle risk behaviors have the greatest influence on the risk of cardiovascular disease in cancer survivors and which of these behaviors are most prominently clustered in cancer survivors, using logistic regression and association rule mining (ARM). We analyzed a consecutive series of 897 cancer survivors from the Korean National Health and Nutritional Exam Survey (2012–2016). Cardiovascular disease risks were assessed using the atherosclerotic cardiovascular disease score (ASCVDs). We classified participants as being in a low-risk group if their calculated ASCVDs was less than 10% and as being in a high-risk group if their score was 10% or higher. We used association rule mining to analyze patterns of lifestyle risk behaviors by ASCVDs risk group, based upon public health recommendations described in the Alameda 7 health behaviors (current smoking, heavy drinking, physical inactivity, obesity, breakfast skipping, frequent snacking, and suboptimal sleep duration). Forty-two percent of cancer survivors had a high ASCVD. Current smoking (common odds ratio, 11.19; 95% confidence interval, 3.66–34.20, p < 0.001) and obesity (common odds ratio, 2.67; 95% confidence interval, 1.40–5.08, p < 0.001) were significant predictors of high ASCVD in cancer survivors within a multivariate model. In ARM analysis, current smoking and obesity were identified as important lifestyle risk behaviors in cancer survivors. In addition, various lifestyle risk behaviors co-occurred with smoking in male cancer survivors.

Cardiovascular Risk Based on ASCVD and KDIGO Categories in Chinese Adults: A Nationwide, Population-Based, Prospective Cohort Study.

The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline used eGFR and urinary albumin-creatinine ratio (ACR) to categorize risks for CKD prognosis. The utility of KDIGO's stratification of major CVD risks and predictive ability beyond traditional CVD risk prediction scores are unknown. To evaluate CVD risks on the basis of ACR and eGFR (individually, together, and in combination using the KDIGO risk categories) and with the atherosclerotic cardiovascular disease (ASCVD) score, we studied 115,366 participants in the China Cardiometabolic Disease and Cancer Cohort study. Participants (aged ≥40 years and without a history of cardiovascular disease) were examined prospectively for major CVD events, including nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death. During 415,111 person-years of follow-up, 2866 major CVD events occurred. Incidence rates and multivariable-adjusted hazard ratios of CVD events increased significantly across the KDIGO risk categories in ASCVD risk strata (all P values for log-rank test and most P values for trend in Cox regression analysis <0.01). Increases in c statistic for CVD risk prediction were 0.01 (0.01 to 0.02) in the overall study population and 0.03 (0.01 to 0.04) in participants with diabetes, after adding eGFR and log(ACR) to a model including the ASCVD risk score. In addition, adding eGFR and log(ACR) to a model with the ASCVD score resulted in significantly improved reclassification of CVD risks (net reclassification improvements, 4.78%; 95% confidence interval, 3.03% to 6.41%). Urinary ACR and eGFR (individually, together, and in combination using KDIGO risk categories) may be important nontraditional risk factors in stratifying and predicting major CVD events in the Chinese population.