Background Cardiovascular Risk Research Articles

P0468 Prevalence of traditional cardiovascular risk factors in Crohn’s disease

Abstract Background Cardiovascular risk in inflammatory bowl disease (IBD) has only recently been described, whereas the increased risk of venous thromboembolic events in IBD was identified long before. An excess risk of ischaemic heart disease and stroke of around 20% has already been demonstrated. Are traditional cardiovascular risk factors the best way of assessing this excess risk? Our aim is to determine the frequency of traditional risk factors in Crohn’s disease Methods This was a prospective observational study involving 118 patients with CD. All patients were thoroughly interviewed, and screened for arterial hypertension by self-measurement validated by the European Society of Cardiology (ESC), fasting blood glucose, glycated haemoglobin and lipid profiles, the rest of the factors were gathered through questioning. The data collected was entered and analysed using EPIINFOV and SPSS statistical software. Results There were 70 men (59.3%) and 48 women (40.7%) with a sex ratio of 1.46. The mean age was 36. 49 +/- 11.62 with a median of 34 years and extremes of 19 and 67 years, There were only five subjects whose age represented a risk factor - two men and three women In our population, the family history of cardiovascular disease was 10.2%, smoking as a cardiovascular risk factor was present in 28% of patients, arterial hypertension was present in only 10.2% of patients, with a non-significant female predominance with a p = 0.06, In our series there were only two type 2 diabetic patients on metformin, Only 11.9% of our subjects were sedentary. In our female population, 16.7% were postmenopausal for more than ten years, 57.6% of our patients had dyslipidaemia (according to ESC 2017), the cardiovascular risk was low in the majority of our patients at 88.1% according to the Framingham score. The prevalence of traditional risk factors in our population is low. This result is consistent with those in the literature, which may be due to the specific features of Crohn’s disease, such as weight loss or hypovolaemia during flare-ups, but also to the fact that our population is young? Conclusion The low frequency of traditional cardiovascular risk factors does not explain the increased risk of developing cardiovascular disease found in Crohn’s disease. The study of non-traditional risk factors is imperative and could explain this paradox.

Effect of an 18-month meditation training on cardiovascular risk in older adults: a secondary analysis of the Age-Well randomized controlled trial

BackgroundCardiovascular risk factors represent an important health issue in older adults. Previous findings suggest that meditation training could have a positive impact on these risk factors. The objective of this study was to investigate the effects of an 18-month meditation-based intervention on cardiovascular health.MethodsAge-Well was a randomized, controlled superiority trial with blinded end point assessment, including community-dwelling cognitively unimpaired adults 65 years and older enrolled between November 24, 2016, and March 5, 2018, in France. One hundred and thirty-four participants were included in this secondary analysis. Participants were randomly affected to an intervention group that received an 18-month meditation-based program or to comparison groups (active control group i.e. non-native language training or passive control group i.e. no intervention). The main outcome was change in the Framingham Risk Score (FRS); other outcomes were changes in cardiovascular and metabolic risk factors.ResultsThere was no difference in FRS change after 18 months between trial arms (p = .38). When assessing individual cardiovascular or metabolic risk factors, meditation training was associated with a greater reduction in diastolic blood pressure than the comparison group in participants with intermediate to high cardiovascular risk (FRS > 10%) at baseline (p = .03).ConclusionAn 18-month meditation training was not effective to increase overall cardiovascular health in older adults, but improved diastolic blood pressure in a subgroup analysis including at-risk participants. These results suggest a potential benefit of a long-term meditation intervention in older adults at-risk of cardiovascular diseases, and highlights the need for future research in more targeted populations.Trial registrationClinicalTrials.gov Identifier: NCT02977819.

Non-modifiable and Modifiable Risk Factors in Vascular Ageing Extremes: The African-PREDICT Study

BackgroundCardiovascular risk factors accelerate vascular ageing beyond chronological age, hence early vascular ageing (EVA). Carotid to femoral pulse wave velocity (cfPWV) is a measure of vascular ageing and is used to identify EVA and supernormal vascular ageing (SUPERNOVA). Vascular ageing is not completely understood in African populations. Therefore, we aimed to phenotype young South African adults stratified by cfPWV extremes in terms of non-modifiable and modifiable risk factors. This study included 1133 young adults (mean age: 24.5 years). We measured cfPWV using applanation tonometry. Body composition measures, self-reported 24-h dietary intake, smoking and alcohol consumption were included. Fasting blood samples were analysed for biochemical risk factors. Three groups based on cfPWV percentiles were compared and included SUPERNOVA (≤ 10th percentile), average vascular ageing (AVA, between 10 to 90th percentile) and EVA (≥ 90th percentile).ResultsChronological age, male sex, smoking, alcohol use, and blood pressure were incrementally higher across PWV groups (all p trend ≤ 0.007). Black ethnicity was higher (p = 0.038) in the SUPERNOVA group. In exploratory factor analysis, a factor pattern including mean arterial pressure and fasting glucose showed beneficial odds (OR 0.62, p = 0.002) for SUPERNOVA and higher likelihood (OR 2.10, p < 0.001) for EVA. Another factor pattern of socio-economic status and total dietary fat showed lower odds (OR 0.64, p = 0.003) for EVA.ConclusionPoor lifestyle behavioural risk factors seem detrimental in the EVA group conferring a possible higher risk of future CVD.

Improving cardiovascular risk stratification with ECG-predicted risk factors in primary prevention

Abstract Background Cardiovascular risk- and screening scores guide clinical practice. Built upon simple risk factors, they could benefit from information on actual, subclinical cardiac changes. The ECG provides proxies for various cardiac states, which can be detected using machine learning. We systematically assess the added value of ECG-based cardiovascular risk factor estimates for six outcomes in two population-based cohorts: Study of Health in Pomerania (SHIP-Start) and UK Biobank (UKB). Methods We employed convolutional neural networks to analyze ECGs from the Hamburg City Health Study (HCHS) for the assessment of multiple risk factors, including age, weight, diabetes, atrial fibrillation (AF) and heart failure. Cox models were fitted on UKB and SHIP to predict 5 and 15 year time-to-event. Endpoints were death, cardiovascular death, AF, stroke, heart failure and myocardial infarction. Covariates were sex, age, body mass index, diabetes, hypertension and smoking (Cox-RF), ECG-predicted risk factors (Cox-AI), and a combination (Cox-RF/AI). Stratified Monte Carlo cross-validation was used as validation and groups of C-indices were compared using Mann-Whitney U tests. Results The study included 9103 HCHS participants (mean age 62.0±8.4 years, 51% women), 3546 SHIP participants (age 49.7±16.4, 51% women), and 32828 UKB participants (age 64±7.6 years, 52% women). Cox-AI performed comparable or better than Cox-RF for AF (SHIP: 0.88 vs. 0.84, UKB: 0.71 vs. 0.72) and heart failure (SHIP: 0.8 vs. 0.79, UKB: 0.76 vs. 0.75), but was less strong for the other outcomes. The combination of information on cardiovascular risk factors and ECG information (Cox-RF/AI) significantly improved the predictive ability compared to risk factors alone (Cox-RF) for AF (SHIP: 0.89 vs. 0.84, UKB: 0.76 vs. 0.72), cardiovascular death (SHIP: 0.90 vs. 0.89, UKB: 0.75 vs. 0.74) and heart failure (SHIP: 0.81 vs. 0.79, UKB: 0.80 vs. 0.75). Discussion ECG-based risk factors complement risk stratification by incorporating nuanced information on cardiac function and structure, improving risk prediction and thus possibly clinical decision making and patient outcomes.

Gap between estimated cardiovascular risk and individual risk perception: a survey from a cardiovascular prevention center.

Abstract Background Cardiovascular risk scores represent a great achievement of preventive cardiology, since they allow to stratify individual risk. The recently updated European Society of Cardiology Scores offer an accurate cardiovascular risk estimation. However, a gap between perceived and calculated risk may strongly interfere in healthy lifestyle changes as well as in cardioprotective drugs adherence. Purpose: The aim of the present study was to evaluate and quantify the above-mentioned gap. Methods A cohort of subjects referred to our Cardiovascular Prevention Center were included in the present study. Cardiologists assessed each tradional and emerging risk factor in terms of presence or absence, severity, distance from target, and the cardiovascular risk was calculated using appropriate ESC scores. Each subject filled out a questionnaire in which they were asked to declare their perceived cardiovascular risk and to report, among all the traditional and emerging cardiovascular risk factors, which ones they believed to have greater impact on their individual risk. Results 366 consecutive subject were included, 70% in primary prevention and 30% with atherosclerotic cardiovascular disease, mean age was 65 years, male gender was prevalent (57%), arterial hypertension (AHT) was found in 78,7% (43,4% uncontrolled), dyslipidaemia in 91,5% (87,5% not at target), diabetes in 18,6%, smokers were 12,9% and 24,4% had obesity. Among emerging risk factors, sedentary lifestyle was found in 63%, while 18% reported regular aerobic physical activity, mediterranean diet adherence was found in 26% and moderate-to-severe perceived anxiety in 23%, depression in 17% and stress in 66%. 6,6% had low risk cardiovascular risk, 16,1% intermediate, 38,0% high and 39,3% very high. A concordance between estimated and perceived risk was found in 18,9% while a discordance in 81,1%; 93,3% underestimate their risk, while 6,7% only overestimate it (figure 1A). A significant higher rate of discordance was found with the progressive increase of the risk (p&amp;lt;0.0001). Different perceived cardiovascular risk among each estimated classes of risk was shown in figure 1B and figure 2; of note only 11% of high risk and 8% of very high risk were concordant in their risk perception. In particular, elderly (p&amp;lt;0.001), male (p&amp;lt;0.001), subjects with AHT (p=0.001) and dyslipidaemia (p=0.02) showed higher rate of underestimation while younger (p&amp;lt;0.001), female (p&amp;lt;0.001) as well as anxiety (p=0.047) and depressed (p=0.010) had higher rate of overestimation. Conclusions A high rate of subject underestimate its cardiovascular risk; the higher the risk, the higher the gap between perceived and estimated risk. This risk gap represents a "risk within the risk". for these reasons it is necessary to increase all efforts towards a more effective health education in the field of cardiovascular prevention in order to reinforce patients awareness and physician-patient alliance.Figure 1Figure 2

Does the absence of breast arterial calcification (BAC 0) rule out severe coronary artery disease? A computed tomography angiography study

BackgroundCardiovascular risk (CV)-stratification in females is challenging, and current models miss a high proportion at-risk. Breast arterial calcifications (BAC) are independent prognosticators, but their interaction with the coronary artery disease profile by computed tomography (CT) is controverse, and the role of BAC 0 unclear. Objectiveto investigate the interaction of BAC with coronary CT outcomes (CAC score, coronary stenosis severity and high-risk plaque (HRP). MethodsConsecutive patients referred to mammography (MG) and coronary CTA for clinical indications within 1 year were included. Three different age groups were compared (<55 years;55-65 years;>65 years). Results443 patients were included. There were significant age differences for the prevalence of BAC 0 (p<0.001), BAC 0/CAC>300 AU (p=0.0023) and obstructive disease (>50% stenosis)(p=0.0048) but not for high-risk-plaque (HRP)(p=0.4905). High CAC (>300 AU) was present in only 0.82% of females with BAC 0 in less than 55 year, but significantly more often in those above 65 years (p=0.0004;OR=16.58:95% CI: 2.829-361.7) and 55 years with 12.1% and 8.4%. Obstructive coronary disease (>50% stenosis) in BAC 0 was present in 18.2%; with age-dependent differences (10.7% vs 14.7% vs 29.9%) (p=0.0003). The correlation between BAC, CAC and CADRADS was weak (r=0.246 and r=0.243, p<0.001). There was no association of BAC with HRP. ConclusionBAC 0 rules out severe CAC >300AU in females <55 years only, but not in those above 55 years- with adherent implications for primary prevention. However, BAC 0 does not to rule out obstructive disease and high-risk plaques in symptomatic patients among all age groups.

Risk of Stroke and Myocardial Infarction Among Initiators of Triptans

Triptans are contraindicated in patients with ischemic heart disease or previous myocardial infarction, and caution is advised when prescribing these drugs to patients with vascular risk factors. However, controlled observational studies have either shown no association or an apparent lower risk, possibly owing to a channeling of triptans to individuals at low risk of cardiovascular outcomes, and it remains unclear whether avoiding triptan treatment for these patients is meaningful. To establish whether an association between triptans and ischemic events could be demonstrated using a self-controlled design because this type of design is robust to the previously mentioned type of confounding. All people in nationwide Danish registries who were initiating triptans and all the ischemic events that they experienced were identified. A case-crossover design was used to estimate odds ratios (OR) for associations between first-ever triptan use and ischemic outcomes, comparing triptan exposure in the 2-week period up to the event with four 2-week reference periods. Data were obtained for the period January 1995 to August 2022. Included from the population of Denmark were individuals redeeming a prescription for any triptan and experiencing at least 1 of 3 predefined ischemic outcomes. No one was excluded. Initiation of any triptan. Acute myocardial infarction, ischemic stroke, or nonspecified stroke. Identified were a total of 429 612 individuals (median [IQR] age, 38 [28-48] years; 325 687 female [75.8%]) who redeemed a first prescription for a triptan in the study period. Of these patients, 11 (0.003%) had a myocardial infarction with the first triptan prescription in either a focal or referent window (odds ratio [OR], 3.3; 95% CI, 1.0-10.9), 18 (0.004%) had ischemic stroke (OR, 3.2; 95% CI, 1.3-8.1), and 35 (0.008%) had ischemic/nonspecified stroke (OR, 3.0; 95% CI, 1.5-5.9). Case patients had a median age of approximately 60 years and had a high-risk cardiovascular profile. Results of this case-crossover study suggest that triptan initiation was associated with higher risk of ischemic stroke and myocardial infarction. For the individual patient with low background cardiovascular risk, the risk of an ischemic event after triptan initiation was very low.

Cardiovascular risk burden, dementia risk and brain structural imaging markers: a study from UK Biobank

BackgroundCardiovascular risk burden is associated with dementia risk and neurodegeneration-related brain structure, while the role of genetics and incident cardiovascular disease (CVD) remains unclear.AimsTo examine the association of overall cardiovascular...

Age, sex, antihypertensive drugs and the Mediterranean diet on hypertension-related biomarkers: Impact on carotid structure and blood lipids in an Argentinian cross-sectional study

BackgroundCardiovascular risk is modifiable by changes in lifestyle and pharmacological management, with hypertension being a common pathology worldwide. Its treatment must address multiple metabolic targets. Based on the hypothesis that certain antihypertensive medications, such as the commonly used enalapril and losartan, and dietary habits improve hypertension-related changes in carotid structure and cardiometabolic variables, this work aimed to associate these drugs, as well as the Mediterranean diet adherence and non-modifiable biological factors, with changes in carotid intima-media thickness [cIMT] and blood lipids. MethodsSociodemographic, clinical, biochemical and lifestyle data were collected in a cross-sectional study of 313 subjects under survey due to cardiovascular risk factors, aged 34–83 years (Cordoba, Argentina). Generalised structural equation models were used for analysis. ResultsA higher cIMT with age and male sex was confirmed. Women had lower triacylglycerols and saturated fatty acids in serum but higher circulating levels of LDL-C, HDL-C and total cholesterol than men. Also, a higher adherence to the Mediterranean diet was associated with lower triacylglycerols, but higher levels of HDL-C cholesterol and ω-3 polyunsaturated fatty acids (ω-3 PUFAs) in serum. A greater adherence to the Mediterranean diet did not affect cIMT. Enalapril was associated with increased serum ω-3 PUFAs levels, but it did not affect other lipid fractions. Moreover, enalapril may control cIMT, whereas losartan may not. ConclusionsOur data demonstrate that the Mediterranean diet and enalapril are associated with a cardioprotective circulating lipid profile in hypertension. Concerning this, enalapril potentially promotes serum ω-3 PUFAs levels beyond its classical antihypertensive effect, which encourages future clinical studies to confirm it.

Impaired retinal micro-vascular function in patients with atrial fibrillation

BackgroundCardiovascular (CV) risk factors and CV diseases, in particular heart failure, are strongly associated with impaired microvascular retinal endothelial function. Whether atrial fibrillation (AF) contributes to vascular dysfunction is not clear. Therefore, the aim of this study was to investigate the impact of AF on retinal microvascular function. MethodsIn this study, vascular function was measured non-invasively with flicker-light induced vasodilatation of retinal arterioles (FIDart%). Patients with a history of AF and risk factors for heart failure (HF) or heart failure (n = 69; age 67.9 ± 9.2 years, 71% male, 35% HFrEF, 56% paroxysmal, 25% persistent, 19% permanent AF), as well as age, sex and ejection fraction matched patients with absent history of AF (n = 66; age 63.4 ± 10.6 years, 67% male, 47% HFrEF) were included. Patients with AF were further divided into those with paroxysmal AF (in sinus rhythm – AFSR: n = 38, age 71.4 ± 9.2, 73% male), and those with AF at the time of the study visit. ResultsRetinal microvascular function was impaired in patients with AF compared to patients without AF (FIDart% 1.1% [0.3–2.8] vs. 2.7% [1.3–5.1], p < 0.001). Patients currently in AF have poorer retinal microvascular function (FIDart% 0.8% [0.1–1.9) compared to patients with a history of AF but currently in SR at the time of retinal function measurement (1.5% [0.6–4.9] p = 0.017). In patients with AF, impaired retinal vascular function was independently associated with larger left atrial volume (mean 49.8 ± 18.4), even after correction for confounding factors in different models (SCR = -0. 251 to −0.256, p = 0.035–0.01). ConclusionsAF in patients with heart failure is associated with impaired vascular function, even if currently in sinus rhythm. The association of retinal microvascular dysfunction with left atrial volume, a surrogate for elevated cardiac filling pressures, may further highlight the important interplay between the vasculature and elevated filling pressures in the development of AF.

Identification of novel biomarkers for the prediction of subclinical coronary artery atherosclerosis in patients with rheumatoid arthritis: an exploratory analysis

BackgroundCardiovascular (CV) risk estimation calculators for the general population underperform in patients with rheumatoid arthritis (RA). The purpose of this study was to identify relevant protein biomarkers that could be added to traditional CV risk calculators to improve the capacity of coronary artery calcification (CAC) prediction in individuals with RA. In a second step, we quantify the improvement of this prediction of CAC when these circulating biomarkers are added to standard risk scores.MethodsA panel of 141 serum and plasma proteins, which represent a broad base of both CV and RA biology, were evaluated and prioritized as candidate biomarkers. Of these, 39 proteins were selected and measured by commercial ELISA or quantitative mass spectroscopy in 561 individuals with RA in whom a measure of CAC and frozen sera were available. The patients were randomly split 50:50 into a training/validation cohort. Discrimination (using area under the receiver operator characteristic curves) and re-classification (through net reclassification improvement and integrated discrimination improvement calculation) analyses were performed first in the training cohort and replicated in the validation cohort, to estimate the increase in prediction accuracy for CAC using the ACA/AHA (American College of Cardiology and the American Heart Association) score with, compared to without, addition of these circulating biomarkers.ResultsThe model containing ACC/AHA score plus cytokines (osteopontin, cartilage glycoprotein-39, cystatin C, and chemokine (C–C motif) ligand 18) and plus quantitative mass spectroscopy biomarkers (serpin D1, paraoxonase, and clusterin) had a statistically significant positive net reclassifications index and integrated discrimination improvement for the prediction of CAC, using ACC/AHA score without any biomarkers as the reference category. These results were confirmed in the validation cohort.ConclusionIn this exploratory analysis, the addition of several circulating CV and RA biomarkers to a standard CV risk calculator yielded significant improvements in discrimination and reclassification for the presence of CAC in individuals with RA.

Ten-year risk assessment for cardiovascular diseases using ASCVD risk estimator plus: outcomes from hypertension and diabetes patients

BackgroundCardiovascular risk prediction models encompass numerous CVD risk factors. Available prediction models were developed from non-Asian cohorts hence we decided to evaluate the performance of the ASCVD risk estimator model and the associated 10-year CVD predisposing factors in Punjab.MethodsWe carried out a cross-sectional study among patients having hypertension and diabetes mellitus in a tertiary hospital in Punjab, India. 201 participants without ASCVD who were ≥ 40 years old and had been admitted to the medical ward were assessed. a pre-validated questionnaire was used to collect data on the socio-demographics and behavioral patterns. Lipid profile and blood pressure measurements were collected as per standard protocols. The respondents’ CVD risk was assessed using ASCVD Risk Estimator Plus. Data were analyzed using IBM SPSS version 26; bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of 10-year risk for CVD at a 5% level of significance.Measurements.We examined the stratification of the predicted outcomes and evaluated the associations between individual risk factors and the predicted cardiovascular events. Our study categorized the results of these outcomes into 4 categories: low category (1–5%), borderline category (6–9%) intermediate category (10–20%), and high category (21–95%).ResultsOut of the 201 participants that enrolled in our study, the majority 76 (37.8%) were in the intermediate category, 56 (27.9%) were in the high category, 41 (20.4%) were in the borderline category, 28 (13.9%) were in the low category. The median ASCVD percentage was 14.20%. Respondents who were alcoholics, smokers, and drug abusers (OR = 5.8, 95% CI 0.397–83.584) were associated with the highest likelihood of developing CVDs. Furthermore, males had a significantly higher mean predicted CVD outcome % (M = 23.18%) compared to females (M = 14.91%).ConclusionAccording to our prediction study, it was discovered that 145 (72.1%) participants were not likely to have had an ASCVD in the next 10 years. However, middle-aged males should be more cautious with their lifestyle habits, particularly in dealing with risk factors that can expose them to CVDs.

External validation and update of the J-ACCESS model in an Italian cohort of patients undergoing stress myocardial perfusion imaging

BackgroundCardiovascular risk models are based on traditional risk factors and investigations such as imaging tests. External validation is important to determine reproducibility and generalizability of a prediction model. We performed an external validation of t the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) model, developed from a cohort of patients undergoing stress myocardial perfusion imaging. MethodsWe included 3623 patients with suspected or known coronary artery disease undergoing stress single-photon emission computer tomography (SPECT) myocardial perfusion imaging at our academic center between January 2001 and December 2019. ResultsIn our study population, the J-ACCESS model underestimated the risk of major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and severe heart failure requiring hospitalization) within three-year follow-up. The recalibrations and updated of the model slightly improved the initial performance: C-statistics increased from 0.664 to 0.666 and Brier score decreased from 0.075 to 0.073. Hosmer–Lemeshow test indicated a logistic regression fit only for the calibration slope (P = .45) and updated model (P = .22). In the update model, the intercept, diabetes, and severity of myocardial perfusion defects categorized coefficients were comparable with J-ACCESS. ConclusionThe external validation of the J-ACCESS model as well as recalibration models have a limited value for predicting of three-year major adverse cardiac events in our patients. The performance in predicting risk of the updated model resulted superimposable to the calibration slope model.

Influence of background cardiovascular risk factors on VEGF inhibitor-related adverse vascular events in patients with non-small cell lung cancer: a retrospective study.

Vascular endothelial growth factor (VEGF) inhibitors are widely used in chemotherapy for non-small lung cancer (NSCLC). The purpose of the current study was to examine the impact of background cardiovascular risk factors on VEGF inhibitor-related adverse vascular events (VEGF-related AVEs) in patients with NSCLC who also had comorbidities. We conducted a retrospective study of 118 NSCLC patients treated with bevacizumab or ramucirumab from April 2010 to December 2022. We compared baseline cardiovascular risk factors with VEGF-related AVEs. VEGF-related AVEs and discontinuation due to VEGF-related AVEs were reported in 54 patients and 21 patients, respectively. VEGF-related AVEs were significantly more common with male sex, smoking history, history of hypertension, dyslipidemia, diabetes mellitus, or cardiovascular disease. Discontinuation due to VEGF-related AVEs was significantly more common in patients with history of hypertension or chronic kidney disease. VEGF-related AVEs were significantly more common in patients with ≥ 3 cardiovascular risk factors than patients with < 3. Discontinuation due to VEGF-related AVEs was significantly more common in patients with ≥ 4 cardiovascular risk factors than patients with < 4. Multivariate analysis demonstrated that male sex, hypertension, and ≥ 6 cycles of VEGF inhibitors were each associated with VEGF-related AVEs and hypertension was associated with discontinuation due to VEGF-related AVEs. Our study demonstrated that history of hypertension was independently associated with increased risk of both VEGF-related AVEs and discontinuation due to VEGF-related AVEs. In conclusion, we need to be aware of VEGF-related AVEs when using VEGF inhibitors for patients with ≥ 3 cardiovascular risk factors.

Awareness Among Primary Care Physicians in Canada of Guideline Recommendations for Lowering LDL-Cholesterol in High-Risk Patients

BackgroundCardiovascular (CV) risk management for high-risk patients is often provided by primary care physicians (PCPs). We surveyed Canadian PCPs regarding their awareness and implementation of the 2021 Canadian Cardiovascular Society (CCS) lipid guideline recommendations for patients following an acute coronary syndrome (ACS) and those with diabetes but without CV disease. MethodsA committee of PCPs and specialists with lipid expertise, including some 2021 CCS lipid guideline coauthors, designed a survey to probe PCP awareness and practice patterns regarding CV risk management. From a national database, a total of 250 PCPs completed the survey between January and April 2022. ResultsAlmost all PCPs (97.2%) concurred that a post-ACS patient should be seen by their PCP within 4 weeks of hospital discharge (81.2% said within 2 weeks). Almost half (44.4%) responded that discharge summaries provided inadequate information, and 41.6% felt that lipid management post-ACS was the responsibility primarily of specialists. A total of 58.4% articulated that they face challenges when seeing a post-ACS patient, related to inadequate discharge information, complexities of polypharmacy and duration of therapies, and managing statin intolerance. A total of 63.2% and 43.6% correctly identified low-density lipoprotein cholesterol (LDL-C) intensification thresholds of 1.8 mmol/L in post-ACS patients, and 2.0 mmol/L in diabetes patients, respectively, and 81.2% incorrectly thought that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were indicated for patients with diabetes but without CV disease. ConclusionsOne year following publication of the 2021 CCS lipid guidelines, our survey reveals knowledge gaps among responding PCPs regarding intensification thresholds and treatment options for patients post-ACS, or those with diabetes. Innovative and effective knowledge-translation programs to address these gaps are desirable.

Background cardiovascular risk factors in patients of metastatic prostate cancer on androgen deprivation therapy: A retrospective observational study from a tertiary care hospital of Eastern India

Background: Androgen deprivation therapy (ADT) is indispensable part of treatment for metastatic prostate cancer (MPC) patients. There is documented association between ADT and adverse cardiovascular (CV) events, with variability between the different modes. However, there is dearth of evidence on the background CV risk factors of these group of patients at diagnosis. Aims and Objectives: We envisaged this retrospective observational study in the department of oncology to document the background CV risk factors of MPC patients at diagnosis, to help us better select the available ADTs based on their CV risks. Materials and Methods: Over a period of 2 years, all patients registered for treatment with a diagnosis of MPC, indicated for ADT, and available detailed history and background cardiological evaluation at presentation, were included in the study. As indirect indicators of CV risks, history of smoking, presence and treatment of dyslipidemia, and type 2 diabetes mellitus (T2DM), were documented. As direct indicators of CV risks, presence and treatment of hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF), ECG, and echocardiography changes suggesting cardiac morbidity were documented and the data were analyzed using descriptive statistical methods. Results: Indirect indicators: dyslipidemia, habit of smoking, and T2DM were found in 74%, 29.3%, and 13.3% patients, respectively. Direct indicators: Presence of hypertension, IHD, CCF, abnormalities in ECG, and echocardiography were found in 38.7%, 10.6%, 4%, 28%, and 34.6% patients, respectively. ST-T changes on ECG, low EF, and IHD on echocardiography were seen in 28.5%, 23%, and 26.9%, respectively. Conclusions: MPC patients have a substantial pre-existing CV risk at diagnosis. Our findings warrant a meticulous screening of all MPC patients for CV risk factors, to help in judicious selection of their ADT.

Cardiovascular Risk Factors are Linked to Venous Thromboebolism: A systematic review and meta-analysis of case-control studies

Background Cardiovascular risk factors are associated with venous thromboembolism (VTE) has received increased attention in the past few years. At present, it is not clear whether the each cardiovascular risk factor is risk factor for venous thromboembolism. Features of cardiovascular risk factor have shown to be been individually associated with VTE. However, whether each of the factors additively increases the risk of VTE is uncertain. We performed a meta-analysis to assess the association between some major cardiovascular risk components and VTE. Methods Online Pub Med and Embase database were searched for case-control studies evaluating cardiovascular risk factors and incident Venous Thromboembolism in adults. Independent observers extracted data regarding annualized VTE incidence from studies meeting predetermined criteria, (Blood pressure: ≥ 140/90 mmHg. Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L in male, ≤ 1.0 mmol/L in female, waist circumference ≥90cm for men, ≥80cm for women or body mass index &gt; 30 kg/m2. Data were analyzed weighted, random-effects meta-analysis. Results Thirty two case-control studies with a total of 30929 patients met the inclusion criteria. Odds ratios or weighted means and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of X2 and I2 statistics. Compared with controls, the OR for VTE was 2.24 for obesity (95% CI, 1.83 to 2.75), 1.56 for hypertension (95% CI, 1.26 to 1.92) and 1.55 for diabetes mellitus (95% CI, 1.25 to 1.92). Weighted mean high-density lipoprotein cholesterol (HDL) levels were significantly lower in VTE patients with cardiovascular risk factor compared to controls with inverse correlation with risk of VTE, whereas no difference was observed for total cholesterol levels. Conclusion Cardiovascular risk factors are significantly associated with higher risk of VTE, which may imply that it may contribute to the multi factorial pathogenesis of VTE. Nevertheless, this report could not determine whether the combination of all three components is associated with a higher risk than each of the components in isolation.

Cardiovascular Risk Factors and Risk of Alzheimer Disease and Mortality: A Latent Class Approach.

Background Cardiovascular risk factors co-occur with one another, and little is known about the extent of their clustering and risk of Alzheimer disease (AD). We identify groups of cardiovascular risk factors in cognitively normal individuals and investigate between-group differences in incident AD and death. Methods and Results Cognitively normal individuals were recruited from the National Alzheimer's Coordinator Center. A latent class analysis was conducted with hypertension, hypercholesterolemia, heart condition, stroke, smoking history, diabetes, and high body mass index. Between-group differences in the incidence of AD, mortality, and mortality-adjusted AD were investigated. This study included 12 412 cognitively normal individuals (average follow-up, 65 months). Three groups were identified: (1) low probabilities of cardiovascular risk factors (reference; N=5398 [43%]), (2) hypertension and hypercholesterolemia (vascular-dominant; N=5721 [46%]), and (3) hypertension, hypercholesterolemia, diabetes, and high body mass index (vascular-metabolic; N=1293 [10%]). Both vascular groups were significantly older, had more men, were slightly less educated, and were slightly more cognitively impaired than the reference group (all P<0.05). However, only the vascular-metabolic group had a significantly younger age of death compared with the reference group (84.3 versus 88.7 years, P<0.001). Only the vascular-dominant group had a greater incidence of AD (odds ratio [OR], 1.30; P<0.001) compared with the reference group. Mortality was greater in the vascular-dominant (OR, 3.26; P<0.001) and vascular-metabolic groups (OR, 1.84; P=0.02). Mortality-adjusted AD was greater in the vascular-dominant (OR, 1.54; P=0.02) and vascular-metabolic groups (OR, 1.46; P=0.04). Conclusions Three distinct cardiovascular risk factor groups were identified in cognitively normal elderly individuals. Only the vascular-dominant group was associated with a greater incidence of AD. Selective mortality may contribute to the attenuated association between the vascular-metabolic group and incident AD.

Cardiovascular risk and emotion regulation contribute to depression symptomatology in middle-aged and older autistic adults

BackgroundCardiovascular risk factors (CVRF) and executive function difficulties increase during later-life and are associated with depression symptoms among non-autistic older people. These associations, however, have not yet been explored among middle-aged and older autistic people. MethodsUsing data collected via Simons Foundation Powering Autism Research (SPARK), Research Match, we examined the frequency of CVRF, and associations between CVRF, executive function and depression symptoms in 387 middle-aged and older autistic people (aged 40–83 years). ResultsAutistic adults reported high rates of CVRF (two, 28.9%; three or more, 23.2%). Rates of high cholesterol and obesity were greater among middle-aged and older autistic adults compared to the general population. CVRF, age, and emotion regulation (but not inhibitory control), were significantly associated with depression symptoms in middle-aged and older autistic adults. ConclusionsCVRF occur at high rates in middle-aged and older autistic adults, and it is important that healthcare providers monitor risk factors in order to implement preventative strategies. CVRF are associated with depressive symptoms among middle-aged and older autistic adults, but may not be as important as difficulties with emotion regulation.

Body-weight variability and risk of cardiovascular outcomes in patients with type 1 diabetes: a retrospective observational analysis of data from the DCCT/EDIC population

BackgroundCardiovascular risk and body-weight management are both emerging challenges of type 1 diabetes care. We evaluated the association between intraindividual variability of body-weight and risk of cardiovascular events in people with type 1 diabetes.MethodsWe analyzed 1,398 participants from the DCCT/EDIC studies. Five indices of intraindividual variability of body-weight were calculated for each participant taking into account body-weight measures obtained during the DCCT follow-up (average 6 ± 2 years). The Average Successive Variability (ASV) index, the main variable of interest, was defined as the average absolute difference between successive body-weight measures. The primary outcome was a composite of major adverse cardiovascular events (MACE: nonfatal myocardial infarction or stroke, or cardiovascular death) occurring during the subsequent EDIC follow-up (20 ± 3 years). All-cause death was a secondary outcome. Risk of outcomes were assessed by Cox proportional hazards regression analyses, adjusted for traditional cardiovascular risks factors, including BMI.ResultsThe cumulative incidence of MACE and all-cause death during follow-up were 5.6% (n = 79) and 6.8% (n = 95), respectively. The adjusted Hazard Ratio (HR) for MACE by every increase of 1 standard deviation (SD) of ASV was 1.34 (95% CI, 1.06–1.66), p = 0.01. For all-cause death, the adjusted HR for 1 SD increase of ASV was 1.25 (1.03–1.50), p = 0.03. Similar results were observed when considering the other indices of intraindividual variability of body-weight.ConclusionsHigh body-weight variability (body-weight cycling) is associated with increased risk of MACE and all-cause death in people with type 1 diabetes, independently of the BMI and traditional cardiovascular risk factors.