Burden Of Cardiovascular Disease Risk Factors Research Articles

Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

Abstract MP06: Cardiovascular Disease in Community-Dwelling US Adults Involved With the Criminal Justice System: A Simulation Analysis

Introduction: Approximately 4.4 million US adults live in the community while on probation or parole. They have disproportionately elevated cardiovascular risk factors, morbidity and mortality, along with limited access to healthcare. However, the long-term burden of cardiovascular disease (CVD) in this population is uncertain. We developed a simulation model to quantify cardiovascular risk and adverse events in community-dwelling US adults involved with the criminal justice system, leveraging all known sources of data on this under-studied, high-risk population. Methods: We adapted the CVD Policy Model, a validated state-transition simulation model of CVD in all US adults, using input data specific to 25-54 year-old individuals on probation or parole in 2018. Population size was defined using estimates from the Bureau of Justice Statistics. CVD risk factor burden was approximated by re-weighting data from the National Health and Nutrition Examination Survey years 2005 to 2018 to match demographic, socioeconomic, and health variables among individuals reporting past-year probation or parole in the National Survey on Drug Use and Health. CVD incidence and mortality rates were calibrated to outcomes in cohort studies and vital statistics data. Outcomes were myocardial infarction (MI), stroke, and death over a 10-year horizon (2018-2027) and were compared with projections for an age- and gender-matched cohort of adults in the general US population. We also examined projected reductions in CVD outcomes over 10 years that could be expected if risk factor distributions in the probation/parole population were similar to distributions observed for the general US population. Results: The simulated cohort consisted of 2.9 million adults 25-54 years of age on probation or parole in 2018; 71% were men, 30% were living below the poverty line, and 57% had no regular access to healthcare. An estimated 61% were current smokers, 29% had BP ≥130/80 mmHg, and 8% had diabetes. The study cohort was projected to experience between 36,400 and 69,600 incident MIs and between 22,400 and 37,500 incident strokes over 10 years. This would be 1.4-2.6 times the CVD incidence in age- and gender-matched adults in the general US population. Lowering rates of active smoking in those on probation or parole to rates observed for the general US population (i.e., from 61% to 21%) would reduce MI and stroke events by 16,400 to 29,100 over 10 years, a 27% reduction from current projections. Discussion: We developed and calibrated a computer simulation model to quantify the burden of CVD in community-dwelling US adults followed by the US justice system. We project that adults on probation or parole have higher CVD risk than the general US population. Future work will leverage this platform to estimate the impact of clinical, community, and policy interventions to reduce CVD burden in this vulnerable population.

Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis.

Effective therapies for reducing cardiovascular disease (CVD) risk in people with elevated lipoprotein(a) are lacking, especially for primary prevention. Because of the potential association of lipoprotein(a) with thrombosis, we evaluated the relationship between aspirin use and CVD events in people with elevated lipoprotein(a). We used data from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of baseline cardiovascular disease. Due to potential confounding by indication, we matched aspirin users to nonusers using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) stratified by baseline lipoprotein(a) level (threshold of 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. After propensity matching, the study cohort included 2183 participants, including 1234 (57%) with baseline aspirin use and 423 (19%) with lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had a higher burden of CVD risk factors, more frequent aspirin use (61.7% versus 55.3%, P=0.02), and higher rate of incident CHD events (13.7% versus 8.9%, P<0.01). Aspirin was associated with a significant reduction in CHD events among those with elevated lipoprotein(a) (hazard ratio, 0.54 [95% CI, 0.32-0.94]; P=0.03). Those with lipoprotein(a) >50 mg/dL and aspirin use had similar CHD risk as those with lipoprotein(a) ≤50 mg/dL regardless of aspirin use. Aspirin use was associated with a significantly lower risk for CHD events in participants with lipoprotein(a) >50 mg/dL without baseline CVD. The results of this observational propensity-matched study require confirmation in studies with randomization of aspirin use.

Associations of built environment characteristic using NEWS questionnaires with major cardiovascular diseases and all-cause mortality

Abstract Background The WHO of 2016 reports that cardiovascular diseases (CVDs) represent the leading cause of death in most countries and China has one of the highest prevalence of CVDs[1-2]. In order to reduce the burden of CVD risk factors, environmental interventions have become increasingly recognized as necessary approaches to health promotion and diseases prevention[3]. Pervious evidence mainly from the western countries, examined the effects of built environment on health (i.e. physical activity, mental health, self-reported health scale and CVD risk factors) , while the potential impact on CVDs has not been fully explored[4]. Thus, the aim of this study is to evaluate the longitudinal relationships between perceived built environment attributes using neighborhood environment walkability scale (NEWS) questionnaire and the CVDs in Chinese adults, to explore the different between urban and rural areas, and to provide a logical foundation for both research and policy making. Methods PURE-China is a prospective cohort study, recruiting participants aged 35–70 years from 115 urban and rural communities in 12 provinces of China between 2005 and 2009[5]. Baseline including NEWS information was collected using standardized questionnaires. Participants without any NEWS data and with baseline CVDs were excluded. The primary outcome is the composite of major CVD events and all-cause mortality. The main exposure variables including land use mix-diversity, land use-access, streets connectivity, infrastructure for walking and cycling, aesthetics, safety from traffic, safety from crime, and community satisfaction. Cox frailty model with random intercepts to account for cluster were used to assess the association between total built environment score/ subscales score and the time to occurrence of events. Based and fully-adjusted model were estimated and presented as HR and 95%CI. Interactions and stratified subgroup analysis were also tested. Results A total of 32,534 PURE participants were included with averaged 51 years old and 59.9% females. During a median follow-up period of 11.7 years (IQR 9.4 – 12.2), we documented 3298 (10.2%) new CVD events and 1639 (5.1%) all cause deaths. Table 1 summarizes based models and adjusted models results. For composite outcomes, higher level of land use access (HR, 1.06; 95%CI, 1.01-1.11), aesthetics (HR, 1.07; 95%CI, 1.02-1.12), safety from crime (HR, 1.06; 95%CI, 1.01-1.10), community satisfaction (HR, 1.04; 95%CI, 1.00-1.09), combined BE metrics (HR, 1.05; 95%CI, 1.01-1.10) were associated with a lower risk of composite outcome in adjusted model. For major CVD events more statistically significant differences were observed. Conclusions and Relevance High level of specific BE characteristics were associated with lower risk of all-cause mortality and CVD in China. Our findings may guide policy makers on how to implement BE measures to easing the burden of CVDs and premature deaths.Table 1

Cardiovascular disease screening in homeless individuals-a feasibility study

Abstract Background The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals, yet population-level CVD screening largely excludes homeless individuals. Purpose (i)To investigate feasibility of dedicated mobile CVD screening for homeless individuals; and (ii)To estimate prevalence of risk factors and burden of CVD Methods With patients, health professionals and researchers, we co-developed and implemented a 15-minute CVD assessment for homeless individuals as an add-on service to the Find&amp;Treat service (a peer-led, multi-disciplinary outreach team across London) during scheduled, routine visits to homeless hostels. We included a questionnaire (demographic, past medical history and symptom data) as well as clinical assessment (blood pressure, ABPI, cholesterol, HDL, HDL ratio, glucose, HbA1c and mobile ECG to detect atrial fibrillation, AF). Results Among 656 individuals screened in 75 routine visits between May 2019 and January 2023, we recruited 524 (79.9%) individuals. Mean age was 47 (SD 13.1) years (range 18-87). Male gender (79%) and white ethnicity (55%) were more common. Current or previous smoking (79%), previous CVD (stroke, myocardial infarction, or peripheral arterial disease) (15%) and family history of heart attack in a 1st degree relative&amp;lt;60 years (27%) were common. Although only 2% reported previously diagnosed hypercholesterolaemia, 24% of screened individuals had total cholesterol&amp;gt;5.0 mmol/L. Prevalence of AF was high, particularly among those aged 18-30 (7/57, 12.3%). Asian and British Asian individuals had highest prevalence of raised HbA1C levels (&amp;gt;6%) (8/33, 24.2%), compared to black and black British (22/120, 18.3%) and white (15/283, 5.3%) individuals. Among individuals aged 25 – 84 with no previous CVD, one third had a 10-year QRISK score of ≥10% (120/362, 33.1%), consistent across different ethnic groups: white (75/233, 32.2%), black (24/77, 31.2%) and Asian (6/17, 35.3%). Conclusions A simple, pragmatic CVD assessment for homeless individuals was feasible and acceptable, and identified gaps in diagnosis and prevention. There is a high burden of CVD risk factors and CVD amongst homeless individuals, which could be addressed by integration of CVD screening into existing inclusion health outreach frameworks.

Abstract 14413: Contemporary Prevalence, Comorbidity Burden, and Treatment of Overweight and Obesity: Insights From the Multicenter Mass General Brigham Healthcare System

Background: Real-world evidence is critical to identify treatment gaps and inform healthcare service design, but contemporary anti-obesity medication (AOM) use patterns are sparsely reported. Aims: To describe the prevalence of obesity/overweight, evidence-based obesity-related conditions (ORCs), and AOM use among eligible patients, with a focus on cardiovascular disease (CVD). Methods: In this cross-sectional analysis of the multicenter Mass General Brigham healthcare system spanning 2018-2022, we identified all adult patients eligible for AOM (BMI 27-29.9 kg/m 2 with ≥1 ORC or BMI ≥30 kg/m 2 ). The prevalence of ORCs was ascertained using administrative codes and available EHR data. Prescription of FDA-approved AOM by BMI category, number of ORCs, number of key CVD risk factors, and the presence of prior MACE were also evaluated. Results: Of 2,922,522 individuals who met inclusion criteria, 998,234 (34%) were eligible for AOM (mean age, 49 years; 53% female). Of these, 30%, 41%, 18%, and 11% had a BMI (kg/m 2 ) of 27-29.9, 30-34.9, 35-39.9, and ≥40, respectively. Prior metabolic/bariatric surgery was seen in 2.3%. Musculoskeletal disorders (54%), dyslipidemia/hyperlipidemia (35%), and hypertension (32%) were the most common ORCs, with ≥2 ORCs observed in 58%. Prescription of any FDA-approved AOM was observed in only 1.2% of all eligible patients. Liraglutide 3.0 mg (58% of all AOM) was the most prescribed AOM. AOM prescriptions increased modestly with higher BMI, ORC burden, and number of CVD risk factors ( Figure ). Among those with prior MACE (11%), 1.5% (1.0% if without T2DM) were prescribed FDA-approved AOM. Conclusions: Although more than 1 in 3 contemporary patients in a large healthcare system are eligible by guidelines and FDA labeling, AOM prescription remains exceedingly low, even among high-risk persons with severe obesity and established CVD. Novel care delivery pathways are needed to accelerate closure of these considerable implementation gaps.

Socio-economic distribution of modifiable risk factors for cardiovascular diseases: An analysis of the national longitudinal ageing study in India

The association of socioeconomic status (SES) with modifiable risk factors for cardiovascular diseases (CVDs) is unclear in developing nations. We studied SES variations in major risk factors and their percentage distribution for adults aged 45 years or above in India. Using individual records of 59,672 individuals aged 45 years or above from the Longitudinal Ageing Study in India Wave 1 (cross-sectional study design), 2017–18, we chart age-and-sex-adjusted prevalence of clinical risk factors such as measured high blood pressure, hypertension, overweight, obesity, central adiposity and self-reported high blood glucose; and lifestyle risk factors such as excessive use of alcohol, current use of smoking and smokeless tobacco and physical inactivity across SES variables of education, quintiles of mean per capita expenditure and social caste. Multivariable analysis was used to explore the SES gradient of risk factors. The sample used in the study is predominantly rural (69.9%), illiterate (50.7%), has more females (54.2%), and belongs to other backward classes (45.6%). Prevalence of high blood pressure, overweight, obesity, central adiposity, high blood glucose, and physical inactivity increased; and excessive alcohol consumption and current use of smoking/smokeless tobacco decreased with income, education, and social caste. However, no significant income gradient was noted for lifestyle risk factors except the use of smokeless tobacco. The income gradient was largest for central adiposity (waist-circumference) with a difference of 23.4 percentage points as it increased from 38.7% among the poorest to 62.1% among the richest. The major burden of CVDs risk factors among older adults aged 45+ years falls among high SES.

Trend of risk factors for cardiovascular diseases among young and middle-aged indians: Insights from a nationally representative survey

BackgroundIndia, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states. MethodsThe present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same. ResultsA declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019–21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey. ConclusionThe present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.

0455 Association of high-risk obstructive sleep apnea with endothelial dysfunction in a large population-based sample in MiHeart Study

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with endothelial dysfunction and cardiovascular disease (CVD). There are limited data evaluating the association with endothelial dysfunction measured by reactive hyperemia index (RHI) in an asymptomatic population free of CVD. We hypothesized that there would be a significant association between high risk of OSA and endothelial dysfunction in the Miami Heart (MiHeart) study, a population-based cohort of relatively young individuals free of known cardiovascular disease (CVD). Methods Cross-sectional data from 2097 participants (mean age: 53 years, 50% female) enrolled in the MiHeart study and underwent flow-mediated dilation using the EndoPat 2000 system was analyzed for this study. OSA was determined by Berlin questionnaire (high vs. low risk); logistic regression was utilized to examine the association between high OSA risk (reference low-risk OSA) and RHI (cut off &amp;lt; 1.67 vs. ≥1.67) in unadjusted models, and after accounting for age, sex, race/ethnicity (model 2), and BMI, diabetes, hypertension, high cholesterol, and smoking (model 3). Results 704 (34%) participants were categorized as high OSA risk, according to the Berlin questionnaire. These participants were more likely to be male, Hispanic and had a higher CVD risk factor burden when compared to low OSA risk. In addition, those with high OSA risk had higher prevalence of endothelial dysfunction (17.5% vs. 13.9%) than the low OSA risk (p &amp;lt; 0.05) group. High risk of OSA was associated with a higher risk of endothelial dysfunction in the unadjusted model (OR=1.32, 95% CI 1.03, 1.68). When adjusted for age, sex, and race/ethnicity, this association was slightly attenuated (OR 1.26, 95% CI 0.97, 1.62). Upon adjusting for CVD risk factors (model 3), the association between high-risk OSA and endothelial dysfunction was further attenuated and was not statistically significant (OR=1.18, 95% CI 0.87, 1.59). There was a strong, independent association between presence of diabetes and endothelial dysfunction (OR= 2.01, 95% CI 1.35, 2.94). Conclusion Younger individuals with high risk for OSA have elevated odds of endothelial dysfunction, and this relationship is likely mediated by demographics and cardiometabolic risk factors such as diabetes. Support (if any) The Miami Heart Study is funded by Baptist Health South Florida.

Regional Disparities of Cardiovascular Risk Factors and Major Cardiovascular Events in Non-electively Hospitalized Young Adults.

Cardiovascular diseases contribute to considerable morbidity and mortality in the USA. We sought to establish regional disparities across the nation contributing to cardiovascular disease (CVD) among non-elective young adult hospitalizations. The National Inpatient Sample (2019) was utilized to identify the incidence of non-elective hospitalizations among young adults (18-44 yrs) and analyze the burden of CVD risk factors and outcomes (MACCE; all-cause mortality, AMI, cardiac arrest and stroke) in different US regions. A total of 5,833,930 (median age 32 [26-37] years) non-elective admissions were recorded; plurality from the south (39.6%). Most admissions were white (51.4%) and female (65.5%) amid all regions. The burden of CVD risk factors was significantly higher in the South followed by the Mid-west regions. The South had the highest and the Northeast had the lowest rates of MACE (2.9% vs 2.3%) and stroke (1.0% vs 0.8%). The risk of AMI was high for the south and Midwest regions (1.1%). All-cause mortality was highest in South and West regions (0.7%). Multivariate adjusted odds for these cardiovascular events were higher in the West (aOR 1.22; 95%CI 1.12-1.33) followed by South (aOR 1.16; 95%CI 1.07-1.26) regions. This population-based study assessing non-elective admissions in the young revealed a higher burden of CVD risk factors and rate of MACCE in the South compared to other areas of the USA. Regional policies should be tailored to the local CVD risk burden.

Understanding the barriers and facilitators that influence access to quality cardiovascular care for rural Indigenous peoples: protocol for a scoping review

IntroductionMāori (the Indigenous peoples of New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD healthcare. Rural Māori...

Two decade trends in cardiovascular disease outcomes and cardiovascular risk factors among US veterans living with HIV

Coomprhensive data on temporal trends in cardiovascular disease (CVD) risk factors and outcomes in people living with HIV are limited. Using retrospective data on 50,284 US Veterans living with HIV (VLWH) who received care in the VA from 2001 to 2019, we calculated the prevalence and incidence estimates of CVD risk factors and outcomes, as well as the average annual percent changes (AAPC) in the estimates. The mean age of the Veterans increased from 47.8 (9.1) years to 58.0 (12.4) years during the study period. The population remained predominantly (>95%) male and majority Black (∼50%). The prevalence of the CVD outcomes increased progressively over the study period: coronary artery disease (3.9%–18.7%), peripheral artery disease (2.3%, 10.3%), ischemic cerebrovascular disease (1.1%–9.9%), and heart failure (2.4%–10.5%). There was a progressive increase in risk factor burden, except for smoking which declined after 2015. The AAPC in prevalence was statistically significant for the CVD outcomes and risk factors. When adjusted for age, the predicted prevalence of CVD risk factors and outcomes showed comparable (but attenuated) trends. There was generally a comparable (but attenuated) trend in incidence of CVD outcomes, procedures, and risk factors over the study period. The use of statins increased from 10.6% (2001) to 40.8% (2019). Antiretroviral therapy usage increased from 77.7% (2001) to 85.0% (2019). In conclusion, in a retrospective analysis of large-scale VA data we found the burden and incidence of several CVD risk factors and outcomes have increased among VLWH over the past 20 years.

Left ventricular mass index and risk of cognitive decline in a general elderly population: Tanushimaru cohort study

Background and Aims : Elevated cardiovascular disease risk factor burden is a recognized contributor to poorer cognitive function. Recent cohort study suggested that higher N-terminal pro-B-type natriuretic peptide levels predicted incident dementia. However, there is little study of the longitudinal association between left ventricular (LV) structure and future cognitive decline. Therfore, we hypothesied that LV structure is associated with cognitive decline.

Social Engagement and All-Cause Mortality: A Focus on Participants of the Minority Aging Research Study

Social engagement is known to improve health; less is known about whether social activities at the core of African American life decrease mortality risk in this minoritized population. This study investigated whether and which aspects of social engagement predict mortality risk in older African Americans. Data from 768 African Americans (aged ∼73 years; nondemented at baseline) participating in the Minority Aging Research Study, a longitudinal community-based, cohort study of aging, was collected between 2004 and 2020 and analyzed in 2020. Participants self-reported late-life social activity, social network size, life space, and purpose in life at baseline and completed approximately 6.5 years of annual follow-up (range=15.70). Cox models included time from baseline to death or censoring and an indicator for death versus censored with age, sex, education, cardiovascular disease risk factor burden, depressive symptomatology, and motor gait performance as covariates. As of March 2020, 25% of participants died (n=192; age at death ∼83 years). In fully adjusted Cox models, mortality risk decreased by 34% (hazard ratio=0.66; 95% CI=0.48, 0.91; p=0.012) for those with higher compared with that for those with lower social activity generally, with community/volunteer-, group-, and socially-related activities specifically driving these results. Engaging in late-life social activity, especially group- and socially-based activities, was most consistently and robustly associated with reduced mortality risk in African Americans regardless of health. These results lay the foundation for considering community-based approaches to increase and/or maintain social participation in older African Americans as a potential means by which to increase longevity in this population.

The Burden of Cardiovascular Disease Attributable to Modifiable Risk Factors and Cost-effectiveness Analysis of IraPEN Program in the General Population of Iran.

Background: Cardiovascular diseases (CVDs) contribute to over 30% of deaths worldwide and more than 40% in Iran in 2019. Establishing a cost-effective program to control cardiovascular diseases is essential for any country. This study aimed to estimate the cost-effectiveness of the primary prevention program (IraPEN) for cardiovascular diseases in Iran. Methods: This methodological cost-effectiveness study was performed to estimate the cost-effectiveness of the IraPEN program by modifying cardiovascular disease risk factors in the IraPEN program. We calculated the economic burden of CVDs risk factors from 2016 to 2018 in 4 pilot cities in Iran. We observed 160,833 individuals for 2 years to measure the economic burden of cardiovascular diseases. To estimate the variation of the 1-year risk of cardiovascular illnesses, and according to the study's goal of estimating the 1-year risk of cardiovascular disease, only 36,631 people remained in the study who compiled the program's instruction for 1 year. Propensity scores were used to consider the effect of those excluded from the study. The 10-year risk of CVDs was estimated by the laboratory tests and information registered in the population’s electronic records. To evaluate the effect of the IraPEN program in reducing the risk factors for cardiovascular diseases, major CVD risk factors were studied by the World Health Organization formula (whocvdrisk) and cardiovascular diseases risk scoring. We used the 10-year risk for CVDs to conduct a cost-effectiveness analysis in terms of cost per disability-adjusted life-year (DALY) saved. Results: According to estimates of the 1-year relative risk reduction in cardiovascular disease, the results showed that relative risk reductions for men and women were 0.74 and 0.65, respectively. Hence, about 174,088 annual acute CVDs events reduction would be expected; this decrease is predicted for men (93,034) more than women (81,054) for the total population of Iran. The total cost of treatment for people with cardiovascular diseases was 165 USD for coronary heart disease or stroke per individual. All risk factors were further reduced in women than men, except for smoking. DALYs averted was 1057.66 for samples who were in the study for a year (36631 samples). The total cost per averted DALY was 47.16. Conclusion: Estimating the costs associated with disease prevention programs is more important in developing countries. The most cost-effective strategies have been preventive therapies that target high-risk individuals. PEN risk reduction programs for primary prevention such as Ira-pen are highly cost-effective and efficient in low- and middle-income countries.

Race and Sex Differences in Mortality in Individuals with Chronic Obstructive Pulmonary Disease.

Rationale: Despite differences in chronic obstructive pulmonary disease (COPD) comorbidities, race- and sex-based differences in all-cause mortality and cause-specific mortality are not well described. Objectives: To examine mortality differences in COPD by race-sex and underlying mechanisms. Methods: Medicare claims were used to identify COPD among REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort participants. Mortality rates were calculated using adjudicated causes of death. Hazard ratios (HRs) for mortality comparing race-sex groups were modeled with Cox proportional hazards regression. Results: In the 2,148-member COPD subcohort, 49% were women, and 34% were Black individuals; 1,326 deaths occurred over a median 7.5 years (interquartile range, 3.9-10.5 yr) follow-up. All-cause mortality per 1,000 person-years comparing Black versus White men was 101.1 (95% confidence interval [CI], 88.3-115.8) versus 93.9 (95% CI, 86.3-102.3; P = 0.99); comparing Black versus White women, all-cause mortality per 1,000 person-years was 74.2 (95% CI, 65.0-84.8) versus 70.6 (95% CI, 63.5-78.5; P = 0.99). Cardiovascular disease (CVD) was the leading cause-specific mortality among all race-sex groups. HR for CVD and chronic lung disease mortality were nonsignificant comparing Black versus White men. HR for CVD death was higher in Black compared with White women (HR, 1.44; 95% CI, 1.06-1.95), whereas chronic lung disease death was lower (HR, 0.44; 95% CI, 0.25-0.77). These differences were attributable to higher CVD risk factor burden among Black women. Conclusions: In the REGARDS COPD cohort, there were no race-sex differences in all-cause mortality. CVD was the most common cause of death for all race-sex groups with COPD. Black women with COPD had a higher risk of CVD-related mortality than White women. CVD comorbidity management, especially among Black individuals, may improve mortality outcomes.

0704 Association of high-risk obstructive sleep apnea with inflammatory markers in asymptomatic young and middle-aged adults in Miami Heart (MiHeart) Study at Baptist Health South Florida

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with elevated inflammatory markers in those with cardiovascular disease (CVD). In contrast, there are limited data to support this association in asymptomatic individuals. The Miami Heart Study measured high sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6) and TNF- Alpha in a cohort of asymptomatic individuals from the general population. We hypothesized that there will be significant association of high OSA risk with inflammatory markers in Miami Heart Study cohort free of CVD. Methods We analyzed data for 2359 clinical CVD-free participants from the Miami Heart Study, age 40-65 years (May 2015-Sept 2018). High OSA risk included those with an OSA diagnosis and/or those with high risk using the Berlin questionnaire. Poisson regression analyses were utilized to examine the associations between high OSA risk (reference: low risk) and hs-CRP, IL-6 and TNF alpha levels (continuous), in univariate and multivariate models (adjusting for age, sex, race/ethnicity [model 2], and BMI, diabetes, hypertension, high cholesterol and smoking [model 3]). Results 800 (34%) participants were categorized as high OSA risk. Those with high OSA risk tended to be Hispanic, male, and with a higher CVD risk factor burden, especially obesity (64% vs 17%, p &amp;lt; 0.005) when compared to those with low OSA risk. Patients with high OSA risk had higher median values of hs-CRP (2.1 vs 1.0), IL-6 (2.0 vs 1.4), and TNF-alpha (1.2 vs 1.1) when compared to those with low OSA risk (all p &amp;lt; 0.001). When adjusting for age, sex, and race/ethnicity, the mean difference between patients with high and low OSA risk in hs-CRP was 1.86 (95% CI 1.69, 2.02), and 0.85 (95% CI 0.71, 0.99) in IL6. When further adjusting for CVD risk factors, these differences were attenuated, but statistically significant (hs-CRP [0.32, 95% CI 0.16, 0.48]; IL6 [0.37, 95% CI 0.21, 0.53]). In adjusted analyses, TNF-alpha was not statistically different between OSA risk populations. Conclusion Individuals at high risk for OSA had significant higher levels of hs-CRP and IL6, signaling to potential role of OSA in mediating the increased inflammatory markers in asymptomatic CVD risk free individuals. Support (If Any) Baptist Health South Florida

Trends in 10-Year Predicted Risk of Cardiovascular Disease Associated With Food Insecurity, 2007-2016.

IntroductionConsumption of a healthy diet improves cardiovascular (CV) risk factors and reduces the development of cardiovascular disease (CVD). Food insecure (FIS) adults often consume an unhealthy diet, which can promote obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and hyperlipidemia (HLD). The Supplemental Nutrition Assistance Program (SNAP) is designed to combat food insecurity by increasing access to healthy foods. However, there is a paucity of data on the association of SNAP participation among FIS adults and these CVD risk factors.MethodsThe National Health and Nutrition Examination Survey (NHANES) is a publicly available, ongoing survey administered by the Centers for Disease Control and Prevention and the National Center for Health Statistics. We analyzed five survey cycles (2007–2016) of adult participants who responded to the CVD risk profile questionnaire data. We estimated the burden of select CVD risk factors among the FIS population and the association with participation in SNAP.ResultsAmong 10,449 adult participants of the survey, 3,485 (33.3%) identified themselves as FIS. Food insecurity was more common among those who were younger, female, Hispanic, and Black. Among the FIS, SNAP recipients, when compared to non-SNAP recipients, had a lower prevalence of HLD (36.3 vs. 40.1% p = 0.02), whereas rates of T2DM, HTN, and obesity were similar. Over the 10-year survey period, FIS SNAP recipients demonstrated a reduction in the prevalence of HTN (p < 0.001) and HLD (p < 0.001) which was not evident among those not receiving SNAP. However, obesity decreased only among those not receiving SNAP. The prevalence of T2DM did not change over the study period in either group.ConclusionOver a 10-year period, FIS adults who received SNAP demonstrated a reduction in the prevalence of HTN and HLD, which was not seen among those not receiving SNAP. However, the prevalence of obesity and T2DM did not decline among SNAP recipients, suggesting that additional approaches are required to impact these important CVD risk factors.

Association between arthritis and cardiovascular risk factors in community-based adults: an opportunity to target cardiovascular risk

BackgroundUndertreated risk factors are major contributors to the burden of cardiovascular disease (CVD). Those with arthritis have an increased prevalence of CVD risk factors. CVD risk factors are often asymptomatic, which may be a barrier their treatment. Arthritis causes pain and immobility, and is a common reason for individuals to seek healthcare. Our aims were to (1) examine the relationship between arthritis and CVD risk factors in Australian adults, and (2) calculate the proportion of CVD risk factors that could be reduced if individuals with arthritis were targeted.MethodsThis cross-sectional study uses data from the 2017–18 Australian National Health Survey which included 13,776 participants, categorised into young (18–39 years), middle aged (40–64 years) and older (≥ 65 years) adults. Hypertension, height and weight were measured. Arthritis, dyslipidemia and diabetes were self-reported. The associations between arthritis and CVD risk factors were examined using logistic regression, and the population attributable fraction (PAF) of arthritis for each CVD risk factor was calculated.ResultsArthritis was reported by 4.0% of young adults, 28.8% of middle-aged adults and 54.5% of older adults. Those with arthritis were at increased odds of obesity (2.07 fold in young, 1.75 fold in middle-aged and 1.89 fold in older adults), increased odds of diabetes (5.70 fold in young, 1.64 fold in middle-aged and 1.37 fold in older adults), increased odds of hypertension (2.72 fold in young, 1.78 fold in middle-aged and 1.48 fold in older adults) and an increased odds of dyslipidaemia (4.64 fold in young, 2.14 fold in middle-aged and 1.22 fold in older adults) compared to those without arthritis. This elevated chance remained significant even after adjusting for obesity, with the exception of diabetes in the older population. This elevated chance remained significant even after adjusting for obesity, with the exception of diabetes in the older population. The PAF of the presence of arthritis for having at least one CVD risk factor was 30.7% in middle-aged adults and 70.4% in older adults.ConclusionAustralian adults of all ages with arthritis are at increased odds of having CVD risk factors. For young and middle-aged adults, this increased odds remains significant even when adjusted for obesity. Presentation to healthcare practitioners with arthritis is an opportunity to screen for asymptomatic CVD risk factors with the potential of improving outcomes for both diseases. By adopting an approach of managing arthritis and CVD risk factors in parallel, rather than in silos, we could reduce the burden of CVD risk factors by 20–30%.

Abstract 61: Major Adverse Cardiovascular And Cerebrovascular Events Among Homeless Cancer Survivors: A Decade-apart Nationwide Hospitalizations Analysis

Background: Homelessness being one of the independent risks for cardiovascular disease (CVD), we explored the burden of CVD risk factors and major adverse cardiac and cerebrovascular events (MACCE) and in-hospital outcomes among homeless cancer survivors in the USA two-decade apart. Methods: We compared the baseline demographic, comorbidities, and inpatient MACCE outcomes (all-cause mortality, cardiac arrest including arrhythmia, and stroke) between 2007 and 2017 using homeless cancer survivors' hospitalizations from National Inpatient Sample datasets. Results: A total of 14973 (median age 59 years, 53.4% male) admissions among homeless cancer survivors were studied (4778 in 2007 &amp; 10195 in 2017, Table 1). Cohort 2017 had younger (median age 57 vs. 71 years), male (59.5% vs. 40.5%), Hispanic (8.0% vs. 5%), non-elective (93.8% vs. 87.4%) and low household income (24.7% vs. 20.8%) (p&lt;0.001) admissions, and had a significantly higher burden of traditional cardiovascular risk factors like smoking, hypertension, hyperlipidemia, diabetes with chronic complications, congestive cardiac failure, alcohol abuse, drug abuse and depression compared to 2007 cohort. Univariate incidence of composite MACCE (16.2 vs 19.5%) and all-cause mortality (0.9 vs 1.3%) were significantly lower in 2017 compared to 2007. Multivariate analysis after socio-demographics, admitting hospital-related characteristics and comorbidities did not reveal worsening for MACCE-related hospitalizations (aOR 1.16, 95 CI 0.83-1.62, p=0.381). Conclusion: Homeless cancer survivors tend to be younger in 2017 than in 2007, with higher prevalence of cardiovascular risk factors and hospitalizations related to MACCE. However, they also tend to have improved in-hospital outcomes. Propagating aggressive screening in such survivors may further prevent MACCE-related hospitalizations.