Burden Of Cardiovascular Risk Factors Research Articles

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

Neighborhood Walkability Is Associated With Lower Burden of Cardiovascular Risk Factors Among Cancer Patients

The burden of cardiovascular disease and related risk factors in Greece: the ATTICA epidemiological study (2002–2022)

ObjectiveThe aim of this study was to present the burden of cardiovascular disease (CVD) and its related risk factors based on a 20-year observation period (2002–2022). MethodsIn 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD, cancer, or any other chronic infections were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants (1988 had complete data for CVD). Lifetime risk for CVDs and disability-adjusted-life-years (DALYs) lost were also calculated. ResultsThe 20-year CVD incidence was 3600 cases/10,000 individuals (man-to-woman ratio 5:4). At the index age of 40 years, the lifetime risk for developing CVD was 68% for men and 63% for women; as the participants were getting older, the lifetime risk declined by approximately 19% and 13% for men and women, respectively, but remained at high levels, reaching 55% for both sexes. Participants between 45 and 55 years exhibited the highest CVD burden concerning aggregated DALYs. The burden was greater in men than in women, at ages below 35 years; beyond this age threshold, this trend shifted, and women exhibited a higher CVD burden. ConclusionThe burden of CVD in Greece has shown increasing trends over the past 20 years as a result of the accumulative growth of the prevalence of modifiable CVD risk factors. The disability-adjusted life-years lost are the most observed ever before, urging for efficient public health strategies and measures.

Greenspaces And Cardiovascular Health.

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.

Racial-Ethnic disparities in stroke prevalence among patients with heart failure

Racial-ethnic disparities exist in the prevalence and outcomes of heart failure (HF) and are presumed to be related to differences in cardiovascular risk factor burden and control. There is little data on stroke disparities among patients with HF or the factors responsible. We hypothesized disparities in stroke prevalence exist among patients with HF in a manner not fully explained by burden of cardiovascular disease. We analyzed data from the National Health and Nutrition Examination Survey (1999–2014). Cardiovascular profiles were compared by race/ethnicity. Using survey-weighted models, effect modification of the relationship between HF and stroke by race/ethnicity was examined adjusting for cardiovascular profiles. Of 40,437 participants, 2.5 % had HF. The HF cohort had a greater proportion of White and Black participants (77 % vs 74 % and 15 % vs 12 %, respectively) and fewer participants of Hispanic ethnicity (8 % vs 14 %). Stroke was 8 times more prevalent in HF (19.6 % vs 2.3 %, <0.001). Among individuals with HF, race-ethnic differences were identified in the prevalence and mean values of vascular risk factors but were largely driven by higher rates in Black participants. There was significant interaction between HF and race/ethnicity; HF increased the odds of stroke over 7-fold in participants of Hispanic ethnicity (aOR: 7.84; 95 % CI: 4.11–15.0) but to a lesser extent in Black and White participants (Black aOR: 2.49; 95 % CI: 1.72–3.60; White aOR: 3.36; 95 % CI: 2.57–4.40). People of Hispanic ethnicity with HF have a disproportionately higher risk of stroke in a manner not fully explained by differences in vascular risk profiles.

Effect of liraglutide on thigh muscle fat and muscle composition in adults with overweight or obesity: Results from a randomized clinical trial.

Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. This is a pre-specified secondary analysis of a randomized, double-blind, placebo-controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30kg/m2 or ≥27kg/m2 and metabolic syndrome. Participants were randomly assigned to a once-daily subcutaneous injection of liraglutide (target dose 3.0mg) or matching placebo for 40weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40-week follow-up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least-square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. Among the 128 participants with follow-up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow-up of 36weeks was -2.87% among participants randomized to liraglutide (n=73) and 0.05% in the placebo group (absolute change: -0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was -0.24% (95% CI, -0.41 to -0.06, P-value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow-up with liraglutide, but there was no change with placebo. In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once-daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.

Application of the Academic Research Consortium High Bleeding Risk criteria in patients treated with coronary bioresorbable polymer everolimus-eluting stents: Insights from the POEM trial

BackgroundPrevious studies have investigated a 1 to 6-month short dual antiplatelet therapy (S-DAPT) after percutaneous coronary intervention (PCI) with modern drug eluting-stents to reduce bleeding events. ObjectivesTo investigate cardiovascular outcomes in patients at high bleeding risk (HBR) according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria after PCI with the Synergy bioresorbable-polymer everolimus-eluting stents (EES). MethodsWe applied ARC-HBR criteria in the population of the prospective, single-arm, multicenter POEM (Performance of Bioresorbable Polymer-Coated Everolimus-Eluting Synergy Stent in Patients at HBR Undergoing Percutaneous Coronary Revascularization Followed by 1-Month Dual Antiplatelet Therapy) trial. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite or probable stent thrombosis at 12 months. ResultsThe original POEM cohort included 356 patients (80.4 %) fulfilling ARC-HBR criteria. Oral anticoagulant (OAC) usage and age ≥75 years were the most frequent major and minor ARC-HBR criteria, respectively. The ARC-HBR group was mainly represented by men (71.1 %), with 74.4 ± 9.3 years and a high burden of cardiovascular risk factors. DAPT was prescribed in 79.3 %, and single antiplatelet (SAPT) with OAC in 18.7 %. 12-month follow-up was completed in 96.2 %. The primary endpoint occurred in 5.2 % (95 % CI 3.29–8.10) of patients, whereas bleeding Academic Research Consortium type 3–5 occurred in 2.7 % (95 % CI, 1.39 %–5.05 %). ConclusionPrevious results of the POEM trial showed positive outcomes regarding ischemic and bleeding events with an S-DAPT regimen after Synergy EES. These results are also confirmed in sub-group analysis when ARC-HBR criteria are applied.

Management and outcome in foreign-born vs native-born patients with myocardial infarction in Sweden.

Previous studies on disparities in healthcare and outcome have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcome in myocardial infarction (MI) patients, by country of birth. In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART registry were included and compared by geographic region of birth. The primary outcome was one-year major adverse cardiovascular events (MACE) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12 years), the individual components of MACE, 30-day mortality, management, and risk factors. Logistic regression, Cox proportional hazard models and propensity score matching (PSM), accounting for baseline differences, were used. Foreign-born patients were younger, often male, and had a higher cardiovascular (CV) risk factor burden, including smoking, diabetes, and hypertension. In PSM analyses, Asia-born patients had higher likelihood of revascularisation (OR 1.16, 95% CI 1.04-1.30), statins and betablocker prescription at discharge and a 34% lower risk of 30-day mortality. Furthermore, no statistically significant differences were found in the primary outcomes except for Asia-born patients having lower risk of one-year MACE (HR 0.85, 95% CI 0.73-0.98), driven by lower mortality (HR 0.72, 95% CI 0.57-0.91). The results persisted over long-term follow-up. This study shows that in a system with universal healthcare coverage in which acute and secondary preventive treatments do not differ by country of birth, foreign-born patients, despite higher CV risk factor burden, will do at least as well as native-born patients.

Crosstalk of human coronary perivascular adipose-derived stem cells with vascular cells: role of tissue factor.

The coronary perivascular adipose tissue (cPVAT) has been associated to the burden of cardiovascular risk factors and to the underlying vessel atherosclerotic plaque severity. Although the "outside to inside" hypothesis of PVAT-derived-adipokine regulation of vessel function is currently accepted, whether the resident mesenchymal stem cells (ASCs) in PVAT have a regulatory role on the underlying vascular arterial smooth muscle cells (VSMCs) is not known. Here, we investigated the interactions between resident PVAT-ASCs and VSMCs. ASCs were obtained from PVAT overlying the left anterior descending (LAD) coronary artery of hearts removed at heart transplant operations. PVAT was obtained both from patients with non-ischemic and ischemic heart disease as the cause of heart transplant. ASCs were isolated from PVAT, phenotypically characterized by flow cytometry, functionally tested for proliferation, and differentiation. Crosstalk between ASCs and VSMCs was investigated by co-culture studies. ASCs were detected in the adventitia of the LAD-PVAT showing differentiation capacity and angiogenic potential. ASCs obtained from PVAT of non-ischemic and ischemic hearts showed different tissue factor (TF) expression levels, different VSMCs recruitment capacity through the axis ERK1/2-ETS1 signaling and different angiogenic potential. Induced upregulation of TF in ASCs isolated from ischemic PVAT rescued their angiogenic capacity in subcutaneously implanted plugs in mice, whereas silencing TF in ASCs decreased the proangiogenic capacity of non-ischemic ASCs. The results indicate for the first time a novel mechanism of regulation of VSMCs by PVAT-ASCs in angiogenesis, mediated by TF expression in ASCs. Regulation of TF in ASCs may become a therapeutic intervention to increase cardiac protection.

Cardiovascular Health, Lifestyle Factors, and Social Determinants in Asian Subpopulations in the United States

Asian Americans are often aggregated in national public health surveillance efforts, which may conceal important differences in the health status of subgroups that are included in this highly diverse population. Little is known about how cardiovascular health varies across Asian subpopulations and the extent to which lifestyle and social risk factors contribute to any observed differences. This national study used data from the National Health Interview Survey to evaluate the burden of cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and cardiovascular diseases (heart attack, coronary heart disease, angina, stroke) across Asian groups (Chinese, Asian Indian, Filipino, Other Asian), and determine whether differences are related to lifestyle factors and/or social determinants of health. The weighted study population included 13,592,178 Asian adults. Filipino adults were more likely to have hypertension than Chinese adults (29.4% vs 15.4%; adjusted odds ratio [OR] 2.40, 95% confidence interval [1.91 to 3.02]), as were Asian Indians (15.7%; OR 1.59 [1.25 to 2.02]). These patterns were similar for hyperlipidemia and diabetes mellitus. For cardiovascular diseases, Filipino adults were significantly more likely to have coronary heart disease (4.2% vs 1.9%; OR 2.19 [1.32 to 3.56]), heart attack (2.6% vs 0.9%; OR 2.79 [1.44 to 5.41]), angina (1.8% vs 0.9%; OR 2.15 [1.06 to 4.32]), and stroke (2.1% vs 0.8%; OR 2.54 [1.42 to 4.55]) compared with Chinese adults, whereas there were no differences compared with Asian Indian adults. Adjustments for lifestyle factors and social determinants completely attenuated differences in coronary heart disease, heart attack, and angina among subpopulations. In conclusion, these findings demonstrate that cardiovascular risk factors and diseases vary significantly across Asian subpopulations, with Filipino adults experiencing the highest burden and Chinese adults the lowest, and that differences in cardiovascular disease are largely attenuated after adjustment for lifestyle and social determinants.

Relationship between Health Status and Lifestyle Factors in Patients with Cardiovascular Diseases

Background: The need to study behavioral patterns associated with lifestyle modification is evidenced not only by the high global mortality rate from cardiovascular diseases, but also by the growing burden of cardiovascular risk factors. Our objective was to assess the dynamics of risk factors in people with different health status and the role of healthy lifestyle recommendations in lifestyle changes. Materials and methods: The first stage of the study was conducted in 2016 and included 1,600 respondents while the second was in 2019 involving 991 respondents, which were then divided into three groups by their health status: apparently healthy, those who developed an atherosclerotic cardiovascular disease (CVD) during the observation period, and those already sick (initial CVD cases). The participants were examined and surveyed for the main cardiovascular risk factors, such as blood pressure, cholesterol, including its atherogenic lipoprotein, smoking, body mass index, and past illnesses. Lifestyle modification following the receipt of healthy lifestyle recommendations was assessed by survey. Results: The most pronounced dynamics of risk factors was revealed among those who developed a CVD in the course of observation: cholesterol decreased from 5.7 to 5.2 mmol/L, p = 0.005, its atherogenic lipoprotein – from 4.3 to 3.4 mmol/L, p &lt; 0.001, systolic blood pressure – from 144 to 128 mmHg, p &lt; 0.001, and the body mass index – from 30.8 to 30.7 kg/m2, p = 0.255. Most patients from this group (59.3 %) received healthy lifestyle recommendations and the proportions of those who followed them and modified their lifestyle were higher than in other groups (39.0 % and 54.7 %, respectively; p &lt; 0.001). In the group of apparently healthy individuals, lifestyle recommendations were given to 27.4 % members; yet, this group was noted for a high prevalence of lifestyle self-modification (23.8 %). Among those who already suffered from a CVD at the beginning, the proportion of patients who received healthy lifestyle recommendations was 1.5 times lower (38.3 %) compared to the group of patients who developed the disease, p &lt; 0.001. Conclusion: Those who developed a disease during observation received recommendations for a healthy lifestyle more often and modified it, but the number of such recommendations decreased with disease duration. The decision to modify the lifestyle was more often made by those who were given lifestyle recommendations, while self-modification was less frequent.

Cardiorespiratory Fitness in Middle-aged Men and Women through the Queens College Step Test: A Cross-sectional Study

Introduction: Increased Body Mass Index (BMI) is associated with a decreased level of maximium oxygen uptake (VO2 max), which indirectly affects Cardiorespiratory Fitness (CRF) in young adults. Therefore, it is important to assess CRF in the middleaged population, despite a high burden of cardiovascular risk factors in this age group. CRF refers to the circulatory system’s ability to supply oxygen to functioning muscles during continuous physical exercise. Maximum oxygen uptake (VO2 max) is the best measure of CRF and serves as the gold standard for quantifying an individual’s aerobic capacity. Aim: To evaluate CRF in middle-aged men and women. Materials and Methods: The present cross-sectional study conducted in the Department of Physiotheraphy, NITTE Institute of Physiotheraphy included a total of 134 subjects aged between 45 and 65 years, who were selected from Justice KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. The male and female groups consisted of 67 subjects each. The study was conducted over a period of 12 months, from March 2022 to March 2023. All subjects were included based on specific inclusion criteria. VO2 max was estimated by following the Queens College Step Test (QCST) method. The Pearson's correlation coefficient was used to examine the relationship between age, height, weight, BMI, waist-to-hip ratio, heart rate, and VO2 max. A p-value &lt;0.05 was considered statistically significant. Results: The mean value of VO2 max was assessed and compared between middle-aged males (65.8±3.5 mL/kg/min) and females (46.6±1.7 mL/kg/min). It was discovered that VO2 max was significantly higher in middle-aged males than in middle-aged females (p&lt;0.001), as indicated by heart rate changes from pretest to post-test. The mean value of BMI was compared between males (24.4±3.2) kg/m2 and females (24.4±4.9) kg/m2 , and the difference was found to be statistically non significant (p-value=0.916). Similarly, the mean value of waist-to-hip ratio was compared between males (0.9±0.1) and females (0.9±0.1), and the difference was also statistically non significant (p-value=0.637). Conclusion: Middle-aged males exhibit substantially higher VO2 max compared to middle-aged females (p&lt;0.001). Consequently, middle-aged females demonstrate a considerable decrease in aerobic capacity, as indicated by VO2 max, and decreased cardiovascular fitness, which serve as predictors of cardiovascular disease risk factors.

Global burden of adolescent and young adult cardiovascular diseases and risk factors: Results from Global Burden of Disease Study 2019

&lt;p&gt;Comprehensive research on the global burden of CVDs among adolescents and young adults (15-44 years) is lacking. We analyzed the results from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study 2019, and the incidence, mortality, and disability-adjusted life-years (DALYs) of 13 CVD types in adolescents and young adults were calculated. We also assessed 19 risk factors associated with CVD-related DALYs across 204 countries and territories from 1990-2019. In 2019, there were 5.7 million CVD incidents and 45.4 million DALYs and 761,458 deaths due to CVDs in adolescents and young adults, globally. CVDs remained the first leading cause of death worldwide among 21 causes of death and the fifth leading cause of death and disability combined in 2019. From 1990-2019, the absolute number of CVD incidents and CVD-related deaths and DALYs increased by 45.5%, 21.6%, and 18.0%, respectively. The highest age-standardized DALY, incidence, and mortality rates from CVDs were observed in the low- and low-middle-sociodemographic index (SDI) regions. Ischemic heart disease, stroke, and rheumatic heart disease were the top three CVDs with the highest age-standardized DALYs. The five leading specific risk factors contributing to CVD-related DALYs were high systolic blood pressure, high low-density lipoprotein (LDL) cholesterol, high body mass index (BMI), ambient particulate matter pollution (PM2.5), and smoking. The burden of CVDs in adolescents and young adults increased substantially from 1990-2019. Effective and targeted strategies for the prevention and management of CVDs in this population are needed to reduce the overall CVD burden.&lt;/p&gt;

Sexual function scores are associated with arterial stiffness in postmenopausal women.

Female sexual dysfunction (FSD) has been suggested to be correlated with the burden of cardiovascular risk factors. We aimed to evaluate the possible association between functional indices of vascular function and FSD scores in apparently healthy postmenopausal women. This cross-sectional study included 116 postmenopausal women who underwent assessment of endothelial function with measurement of flow-mediated dilation (FMD) of the branchial artery and arterial stiffness estimation with measurement of the carotid-femoral pulse wave velocity (PWV). We used the Greene Climacteric Scale to evaluate vasomotor symptomatology, the Female Sexual Function Index (FSFI) to evaluate FSD and the Beck Depression Inventory to evaluate mood disorder. Low sexual function was defined as an FSFI score <26.55. These included FSFI and low sexual function scores as well as measures of PWV and FMD. Sexual function scores were associated with measures of blood pressure (normal vs low sexual function; systolic blood pressure: 120.2 ± 15.0 mm Hg vs 113.4 ± 14.6 mm Hg; analysis of covariance P = .026; diastolic blood pressure: 75.9 ± 10.5 mm Hg vs 70.3 ± 9.9 mm Hg; analysis of covariance P = .012; both adjusted for age, body mass index, current smoking, and PWV). Systolic blood pressure, but not diastolic blood pressure, was associated with FSFI (B = 0.249, P = .041) and PWV (B = 0.392, P < .001). PWV measures were associated with FSFI (B = -0.291, P = .047) and pulse pressure (B = 0.355, P = .017). FMD measures were also associated with FSFI (B = 0.427, P = .033). All models were adjusted for age, body mass index, current smoking, insulin resistance, vasomotor symptomatology, and Beck Depression Inventory. Our findings demonstrate that lower scores of sexual function are associated with deteriorated vascular function mainly manifested as arterial stiffening, further contributing to systolic blood pressure changes. The strength of this study is the carefully selected healthy sample of postmenopausal women, with simultaneous assessment of climacteric symptomatology and mood disorders. The limitations include the small sample size, the cross-sectional design, and the recruitment of consecutive outpatients of a university menopause clinic. Longitudinal studies and interventions to improve FSD should further assess the clinical relevance of these findings.

Relationship between Framingham Risk Score and Cognitive Performance among Rural Indian Participants of SANSCOG study

AbstractBackgroundThe burden of Cardiovascular risk factors is increasing in India and the rural population is more susceptible due to rapidly changing lifestyle. There cardiovascular risk factors are known to occur in clusters and are implicated in poor cognitive performance. The Framingham risk score (FRS) is a simplified and common tool for the assessment of risk of developing Cardiovascular events over 10 years using six risk factors, such as, age, gender, total cholesterol (TC), high density lipoprotein cholesterol (HDL), smoking habits, and systolic blood pressure. Srinivaspura Aging, Neuro Senescence and COGnition (SANSCOG) is a longitudinal, prospective cohort study in healthy aging individuals in a town located near Bangalore, India, where participants are recruited from the community.MethodOur objective was to examine to effect of FRS on cognitive performance measured by COGNITO among SANSCOG cohort participants. We performed separate multiple linear regression analysis to examine to effect of FRS on various COGNITO domains after adjusting for years of education and Geriatric Depression Scale (GDS) scores.ResultIn a sample of 3929 individuals, 2022 (51.5%) were women. The median (IQR) age of the sample was 58 (50,65), the median (IQR) years of education was 4 (0,9) and the median (IQR) GDS was 2 (1,6). Multiple linear regression analysis was used to see the association of FRS with various cognitive tests after adjusting for years of education and GDS revealed that individuals with higher FRS performed poorly in all cognitive domains as shown in Table 1. When we examined this in men and women separately the results remained the same.ConclusionWe have demonstrated that higher FRS affects cognitive performance among rural elderly Indian individuals of both genders. It is imperative to design and implement strategies for risk‐reduction such as early identification and management of risk factors, a healthy lifestyle, balanced diet and regular physical exercise.

Cardiovascular Health of Middle-Aged U.S. Adults by Income Level, 1999 to March 2020 : A Serial Cross-Sectional Study.

Although cardiovascular mortality has increased among middle-aged U.S. adults since 2011, how the burden of cardiovascular risk factors has changed for this population by income level over the past 2 decades is unknown. To evaluate trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher-income middle-aged adults and how social determinants contribute to recent associations between income and cardiovascular health. Serial cross-sectional study. NHANES (National Health and Nutrition Examination Survey), 1999 to March 2020. Middle-aged adults (aged 40 to 64 years). Age-standardized prevalence of hypertension, diabetes, hyperlipidemia, obesity, and cigarette use; treatment rates for hypertension, diabetes, and hyperlipidemia; and rates of blood pressure, glycemic, and cholesterol control. The study population included 20 761 middle-aged adults. The prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults had an increase in hypertension over the study period (37.2% [95% CI, 33.5% to 40.9%] to 44.7% [CI, 39.8% to 49.5%]) but no changes in diabetes or obesity. In contrast, higher-income adults did not have a change in hypertension but had increases in diabetes (7.8% [CI, 5.0% to 10.6%] to 14.9% [CI, 12.4% to 17.3%]) and obesity (33.0% [CI, 26.7% to 39.4%] to 44.0% [CI, 40.2% to 47.7%]). Cigarette use was high and stagnant among low-income adults (33.2% [CI, 28.4% to 38.0%] to 33.9% [CI, 29.6% to 38.3%]) but decreased among their higher-income counterparts (18.6% [CI, 13.5% to 23.7%] to 11.5% [CI, 8.7% to 14.3%]). Treatment and control rates for hypertension were unchanged in both groups (>80%), whereas diabetes treatment rates improved only among the higher-income group (58.4% [CI, 44.4% to 72.5%] to 77.4% [CI, 67.6% to 87.1%]). Income-based disparities in hypertension, diabetes, and cigarette use persisted in more recent years even after adjustment for insurance coverage, health care access, and food insecurity. Sample size limitations could preclude detection of small changes in treatment and control rates. Over 2 decades in the United States, hypertension increased in low-income middle-aged adults, whereas diabetes and obesity increased in their higher-income counterparts. Income-based disparities in hypertension, diabetes, and smoking persisted even after adjustment for other social determinants of health. National Institutes of Health.

Anti-MDA-LDL antibody levels indicate protection from coronary CT-derived valve calcification in the SCOT-HEART Trial

Abstract Introduction Coronary CT-derived valve calcification is becoming increasingly important in the multi-modality assessment of valvular disease, especially in aortic and mitral stenosis, where trans-catheter structural heart interventions may be indicated. Separately, natural antibodies targeted against malondialdehyde-modified LDL (MDA-LDL), an important subset of all oxidised low-density lipoproteins, are related to less coronary atherosclerosis and freedom from cardiovascular events. Purpose To investigate possible relationships between coronary CT-derived valve calcification and anti-MDA-LDL antibodies. Methods In a substudy of the multicentre randomised controlled SCOT-HEART trial (Scottish COmputed Tomography of the HEART), we investigated the association between manually assessed presence or absence of mitral and aortic valve calcification and IgM/ IgG anti-MDA-LDL antibodies. Serological biomarkers were measured using laboratory-developed enzyme-linked immunosorbent assays and assessed in tertiles versus imaging parameters, with adjustment for the ASSIGN cardiovascular risk score. Results In 830 patients (53% male, 57.6±9.8 years) with a heavy burden of cardiovascular risk factors (36% hypertension, 12% diabetes mellitus and 55% history of current or ex-smoking), the highest tertile of IgM anti-MDA-LDL related to a lower incidence of aortic valve calcification (odds ratio [95% confidence interval], 0.59 [0.36 – 0.96], p=0.04, p=0.07 for trend across tertiles) and mitral valve calcification (0.26 [0.07–0.72], p=0.02, p=0.05 for trend). There was also a trend for the highest tertile of IgG anti-MDA-LDL antibodies relating to a lower incidence of aortic valve calcification (0.36 [0.10–0.99], p=0.05, p=0.25 for trend), but not for mitral valve calcification. Conclusions Anti-MDA-LDL antibody levels were associated with a lower incidence of aortic and mitral valve calcification. Assessment of these novel biomarkers, which are known to relate to freedom from cardiovascular events, may be useful in screening patients prior to coronary CT for planning suitability for trans-catheter structural heart interventions.

Chest pain in patients with cancer: prevalence of myocardial infarction and diagnostic performance of high-sensitivity cardiac troponin T/I

Abstract Background Among patients with active or past cancer presenting with acute chest discomfort to the emergency department (ED), multiple uncertainties remain regarding the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools. Purpose We aimed to evaluate 1) the prevalence of AMI among consecutive patients with a history of cancer presenting with acute chest pain to the ED; 2) time to discharge from the ED and hospitalization rate; 3) the diagnostic accuracy of 34 predefined chest pain characteristics (CPCs) and ECG signatures; 4) the diagnostic accuracy of hs-cTnT and hs-cTnI concentrations; and 5) the performance of the European Society of Cardiology (ESC) 0/1h-hs-cTnT/I algorithms. Methods Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study. Cancer status was prospectively assessed. Final diagnosis was centrally adjudicated by two independent cardiologists, applying the 4th universal definition of AMI. Findings were externally validated in an independent, multicenter cohort. Results Among 8267 patients, 711 (8.6%) had cancer. Cancer patients had a higher burden of cardiovascular risk factors and preexisting cardiac disease, and more often a final diagnosis of AMI (184 [26%] patients with cancer vs 1562 [21%, P&amp;lt;0.001] without cancer). This difference was largely due to a significantly higher proportion of NSTEMIs in cancer patients (23% vs 17%; p&amp;lt;0.001). Total length of stay in the ED was significantly longer in patients with cancer versus those without (5.2h versus 4.3h, p&amp;lt;0.001). The hospitalization rate was higher in cancer patients (49.8%) than in non-cancer patients (34.3%, P&amp;lt;0.001), driven by non-AMI diagnoses (36.3% vs 21.3%, P&amp;lt;0.001). All-cause mortality at 5-years was 34.4% in patients with cancer versus 8.9% in patients without cancer (P&amp;lt;0.001). In cancer patients, high-sensitivity cardiac troponin (hs-cTn) T, but not hs-cTnI, concentrations had lower diagnostic accuracy for NSTEMI versus those without cancer (hs-cTnT area under the receiver-operating characteristics curve 0.89 [95%CI 0.86-0.92] vs 0.94 [95%CI 0.93-0.94], p&amp;lt;0.001). In cancer patients, the ESC 0/1h-hs-cTnT/I-algorithms maintained a very high safety but had lower efficacy with significantly more patients remaining in the observe zone (with hs-cTnT: 39.0% vs 20.0%, P&amp;lt;0.001). Similar findings were obtained in the external validation cohort. Conclusions Patients with current or past cancer have a substantially higher prevalence of AMI as the cause of acute chest pain. Time to discharge from the ED and the rate of hospitalization are increased, mainly due to non-AMI causes. The diagnostic performance of hs-cTnT/I and the efficacy of the ESC 0/1-h-hs-cTnT/I-algorithms is reduced.

Sex differences in 82Rubidium PET-derived myocardial flow reserve and implications for long-term cardiac outcomes

Abstract Introduction Coronary small vessel disease (CMD), defined by reduced myocardial flow reserve (MFR) in the absence of obstructive coronary artery disease, holds prognostic information on major cardiac events (MACE). We aimed to investigate if the prognostic value of MFR is independent of sex. Method A multicenter registry-based study of 7169 consecutive patients referred to clinically 82Rubidium PET myocardial perfusion imaging. We excluded patients with abnormal perfusion (defects &amp;gt;5% at rest or stress), previous revascularization, cardiomyopathy, or a diagnosis of heart failure. Global MFR≤2 was considered reduced. Patients were followed in registries for major adverse cardiac events (MACE) comprising all-cause mortality and admission for myocardial infarction, stroke, heart failure or unstable angina pectoris. Results A total of 2591 patients were included, 51% women, median age 69 [IQR 60-75] years. Women were older and men had a higher burden of cardiovascular risk factors. Overall, 31% had MFR≤2 (34% women vs 28% men, p&amp;lt;0.001). Mean MFR was lower in women compared with men (2.30 (SD 0.66) vs 2.44 (0.70), respectively) with higher myocardial blood flow both at rest and during stress among women (both p&amp;lt;0.001, Figure 1). In a linear regression model, sex remained associated with MFR after adjustments for age (p&amp;lt;0.001). At 3-year follow-up, MACE was less frequent in women than men (7.0% vs 9.4%, p=0.03). MFR≤2 was associated with MACE with an age-adjusted hazard ratio (HR) of 1.83 (95% CI: 1.20-2.77, p&amp;lt;0.01) in women and 1.75 (1.21-2.54, p&amp;lt;0.01) in men (p for interaction 0.82). The association remained significant after adjustments for left ventricular ejection fraction and charlson comorbidity index with a HR of 1.58 (1.07-2.31, p&amp;lt;0.05) in men and a HR of 1.68 (1.09-2.58, p&amp;lt;0.05) in women (p for interaction 0.69). On a continuous scale, MFR per every 0.1 unit decrease remained significantly associated to MACE (Figure 2). Conclusions Among patients suspected of obstructive CAD, CMD is more prevalent among women than men. The increased hazard of adverse outcomes with CMD did not differ by sex. This study provides new insight into the phenotype and prognosis of patients with CMD.Figure 1:Baseline distribution of MFRFigure 2:HR for MACE

Aortic stenosis progression among patients with bicuspid aortic valve

Abstract Background Bicuspid aortic valve (BAV) is associated with an increased risk of aortic stenosis (AS). The role of AS progression rate, its determinants, and prognostic implications need to be better understood in patients with BAV-AS. Aim This study aims to compare AS progression rate between patients with BAV and tricuspid aortic valve (TAV), its determinants, and its impact on clinical outcomes. Methods We retrospectively included patients who had undergone &amp;gt; 1 transthoracic echocardiogram (TTE) documenting AS and preserved left ventricular ejection fraction (LVEF). Moderate to severe aortic valve regurgitation and aortic prosthetic valves were excluded. Patients with suspected BAV in TTE and a confirmatory CT scan were identified. A greedy matching was used to match patients with BAV and patients with TAV on age and sex in a ratio 1:1. Aortic peak velocity (APV) was modeled as a function of time using a mixed-effects nonlinear model to capture possible biphasic progression. A core model parameter reflecting AS rate of progression was calculated and compared between patients with BAV-AS and TAV-AS. Multivariate linear regression was used to explore possible predictors of AS progression. All-cause death was compared between patients with BAV and TAV. Results We matched 80 patient-pairs from within our study cohort by age and sex (age 54 ± 11 years, 40 % female). Follow-up time was higher for patients with tricuspid aortic valves (TAV) (5.9±2.6 years vs. 4.6±2.8 years, p&amp;lt;0.01). Patients with TAV-AS had a higher prevalence of cardiovascular risk factors (arterial hypertension [81 % vs. 41 %, p&amp;lt;0.001], diabetes mellitus [39% vs. 8%, p&amp;lt;0.001], and dyslipidemia [71 % vs. 26 %, p&amp;lt;0.001]). Baseline APV was similar between patients with TAV-AS and BAV-AS (2.9±0.9 m/s vs. 2.7±1.0 m/s, p=0.05), but AS progression rate was higher among patients with TAV-AS (logistic growth rate: 0.11±0.04/year vs. 0.02±0.04/year, p&amp;lt;0.001). No interaction was seen between aortic valve morphology and comorbidities with respect to AS progression rate. TAV-AS was associated with increased rate of all-cause death (p=0.02) but failed to remain a significant predictor of mortality after multivariate adjustment for baseline comorbidities and AS rate of progression. Conclusion In our matched cohort, the BAV-AS progression rate was lower than TAV-AS. BAV-AS was associated with lower mortality despite similar baseline AS severity, possibly reflecting a slower AS progression and a decreased burden of cardiovascular risk factors in this population.

Global molecular calcium score: is there a link between sodium fluoride uptake and cardiovascular risk burden?

Abstract Background Sodium fluoride (18F-NaF) uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification both in atherosclerotic plaques and the aortic valve. Purpose We aimed to evaluate global cardiac microcalcification activity with 18F-NaF, as a measure of the microcalcification burden, in high cardiovascular (CV) risk patients. Additionally, as an exploratory endpoint, we evaluated the association between global cardiac microcalcification and diastolic dysfunction. Methods High CV-risk individuals without previous CV events from a single centre were prospectively scanned with 18F-NaF PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS), which was calculated by summing the product of mean standardized uptake value and volume of the region of interest on every slice within the borders of the heart. The result was then divided by the number of slices to adjust for the volume. Results We included sixty-five patients with a mean age of 64.0 ± 9.0 years and 38.5% females. There was a high rate of CV risk factors, including hypertension (95.4%), diabetes (84.6%), dyslipidemia (78.5%), obesity (58.5%), smoking (26.2%) chronic kidney disease (18.5%), and family history of premature coronary disease (9.2%). The mean 10-year risk of fatal and nonfatal cardiovascular events predicted by ASCVD risk score was 30.54 ± 18.4. Median GMCS was 221.42 [IQR 144.55-317.58]. Individuals with &amp;gt; 5 CV risk factors (46.2%) had increased overall GMCS compared to those with a lower number of CV risk factors (295.29, IQR 159.37-356.87 vs 186.16, IQR 122.57-281.78; p=0.03). Thirty-three patients underwent diastolic dysfunction evaluation by echocardiography. All patients had normal left ventricle ejection fraction, mean of 62.86 ± 3.58%. Mean E/A was 0.88 ± 0.27, mean septal e’ velocity 0.07 ± 0.02 m/s, mean lateral e’ velocity 0.08 ± 0.02 m/s, and mean average E/e’ 10.7 ± 3.3. The mean peak tricuspid regurgitation velocity was 2.14 ± 0.59 m/s and the median indexed left atrium volume was 37, IQR 29-44mL/m2. After applying the algorithm for diagnosis of diastolic dysfunction in subjects with normal ejection fraction, 21.2% had diastolic dysfunction and 36.4% had a normal diastolic function, while 42.4% were indeterminate. There was no correlation between echocardiographic variables of diastolic function and GMCS, except for indexed left atrium volume (r = 0.83, p&amp;lt;0.01). There was no association between GMCS and diastolic function categories. Conclusions In a high CV risk cohort, the global cardiac microcalcification assessed by GMCS was associated with the burden of CV risk factors. Additionally, despite a strong positive correlation between GMCS and indexed left atrium volume, we found no association between GMCS and echocardiographic variables of diastolic function.