Cardiovascular Comorbidities In Patients Research Articles

Structure of Cardiovascular Comorbidity in Patients with Non-Alcoholic Fatty Liver Disease

Structure of Cardiovascular Comorbidity in Patients with Non-Alcoholic Fatty Liver Disease

A cross-sectional study of psoriasis hospitalizations in patients with cardiovascular comorbidities in patients under 60.

There is limited data assessing length of stay, cost of care, and differences in demographic data in hospitalized psoriasis patients with and without cardiovascular disease. Our study compares hospitalized psoriatic patients with and without comorbid cardiovascular disease for differences in length of stay and cost of care, as well as to assess differences in patient demographics. A cross-sectional study of hospital encounters of patients under the age of 60 with psoriasis in the National Inpatient Sample from 2016 to 2020 was performed using univariate analyses and a multivariable logistic regression model. A total of 2,485 psoriasis hospitalizations were included. 2,145 (86.3%) had psoriasis without cardiovascular disease and 340 (13.7%) had psoriasis with cardiovascular disease. Linear regression models identified significantly longer lengths of stay (Beta: 1.6; SE: 0.721; P = 0.030) and higher cost of care (Beta: 4,946; SE: 1,920; P = 0.011) in psoriasis patients with cardiovascular comorbidities.

#2201 Assessment of long-term cardiovascular comorbidities in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis

Abstract Background and Aims ANCA associated vasculitis (AAV) is closely correlated to elevated cardiovascular disease (CVD) rates, positioning it a one of the leading causes of death among these patients. The impact of AAV on the risk of CVD has not been described in large prospective cohorts with a long-term follow up. The aim of our study was to evaluate the occurrence of cardiovascular events, encompassing major adverse cardiovascular events (MACE), to delineate associated risk factors, and to draw comparisons with other cohorts of patients diagnosed with CKD. Method We included 848 patients with a diagnosis of AAV who participated in 7 EUVAS RCTs (NORAM, CYCAZAREM, CYCLOPS, MEPEX, IMPROVE, RITUXVAS, and MYCYC), recruited from 74 centers in 17 European countries. The three-point MACE outcome was defined as acute myocardial infarction (AMI), stroke, or death from cardiovascular event. We used multivariate logistic regression analysis to assess the risk factors of MACE. Patients from our cohort were compared to the patients from the Chronic Renal Insufficiency Cohort (CRIC), which is a multicenter, prospective observational cohort study of participants with CKD. Results During the median follow up of 8 years (range 0-24.5, IQR: 2.9-13.6), 100 (11.8%) patients developed diabetes, 98 (13.4%) coronary heart disease (CHD), 90 (12.1%) hypertension, 70 (9.6%) deep vein thrombosis (DVT), 43 patients (5.9%) had a stroke and 28 (3.8%) an AMI. The number of MACE during FU was 144 (17%). MACE was more frequent among patients older than 65 years (n = 62 (43.1%); p-value: 0.013). CVD was the primary cause of death in 43 patients (14%). During the first 5 years after randomization, there was a significant increase in the number of cardiovascular events compared to the period 6 years- end of follow up (CHD: n = 55 vs n = 23, p ≤ 0.001; DVT: n = 55 vs n = 29; p < 0.001; stroke: n = 35 vs n = 24, p-value < 0.001). The prognostic factors for MACE in our cohort were hemodialysis dependency during RCT, age, male sex, previous history of CHD and stroke, and occurrence of diabetes during follow up. Within the subset of patients who underwent kidney biopsy, those in the crescentic class (n = 16) followed by the mixed class (n = 15) exhibited a significant higher incidence of MACE (p = 0.02). When compared to the cohort of patients with CKD from the CRIC study, the risk for CHD was higher (13.4% (95% CI: 11.16-16.11) vs 5.4% (95% CI 4.5-6.5); respectively; RR: 2.49 (95% CI 1.91-3.24); p-value<0.01). Additionally, there was a higher risk for stroke (5.6% (95% CI 4.2-7.4) vs 2.8% (95% CI 2.2- 3.7); RR 1.97 (95% CI: 1.33- 2.91) p-value: 0.0006). Conclusion Patients with AAV had an increased risk of stroke and CHD compared to patients with CKD from other etiologies. During the first years after diagnosis, there is an increased risk for CVD occurrence. The prognostic factors for MACE in our cohort were hemodialysis dependency, age, male sex, previous story of CHD and stroke, and diabetes during follow up. Patients with AAV should be considered at high cardiovascular risk; therefore, the therapeutic approach should include the management of traditional cardiovascular risk factors and lifestyle modification. Efforts should be made to meet strict therapeutic targets and to implement early CVD detection programs.

Prevalence of Cardiovascular Comorbidities in Patients with Rheumatoid Arthritis.

Background and Objectives: The risk of developing cardiovascular diseases (CVD) in patients suffering from rheumatoid arthritis (RA) is two times higher compared to the general population. The objective of this retrospective study was to determine which cardiovascular complications can appear in men vs. women with rheumatoid arthritis. Early diagnosis and initiation of therapeutic measures to reduce the progression rate of rheumatoid arthritis, while also maintaining an active lifestyle, are the most important problems in young patients. Materials and Methods: We included a number of 200 patients, divided into two groups according to gender (124 women and 76 men) with rheumatoid arthritis, presenting various stages of disease concomitant with cardiovascular complications. We assessed traditional and non-traditional risk factors, as well as electrocardiographic and echocardiographic findings in both groups. Results: All patients presented an atherogenic coefficient over two, indicating a significant risk of atherogenesis. Men had elevated levels of total cholesterol compared with women (≥200 mg/dL; 77.6%-men vs. 25.8%-women, p < 0.001). The participants presented cardiac arrhythmias, especially in the active stage of RA. Women had an increased risk of atrial fibrillation by 2.308 times compared to men (p = 0.020). One of the most important complications found in young women was pulmonary arterial hypertension (p = 0.007). Conclusions: In daily clinical practice, the screening of RA is carried out in sufficiently. This disease is often undiagnosed, and the risk factors remain unassessed. As a result, RA patients continue to present an increased risk of developing CVD.

Frequency and features of cardiovascular diseases in spondyloarthritis

BACKGROUND: Group of spondyloarthritis include not only damage of musculoskeletal system, oftenly it’s combination with a variety of comorbid pathologies, primarily involving the cardiovascular system, is characteristic. Given the high importance of early detection, assessment and further prediction of the risks of cardiovascular diseases in this cohort of patients, a competent interpretation of the risks of aggravating cardiovascular diseases and their prevention is one of the priority tasks not only for rheumatologists, but also for specialists in related fields.&#x0D; AIM: To study the structure of comorbid pathology and assess the frequency of cardiovascular diseases in patients with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis, to conduct a comparative analysis of the incidence of cardiovascular comorbidities in different groups of spondyloarthritis.&#x0D; MATERIALS AND METHODS: The study included 153 patients with a verified diagnosis of spondyloarthritis. Patients were divided into 3 groups depending on the nature of the lesion of the musculoskeletal system: ankylosing spondylitis meeting the modified New York criteria for ankylosing spondylitis (1984) (n = 53), psoriatic arthritis meeting the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 40) and psoriatic spondylitis simultaneously meeting the modified New York criteria for ankylosing spondylitis and the CASPAR criteria for psoriatic arthritis (n = 60). All patients taken with monoclonal antibodies (inhibitors TNF-alpha).&#x0D; RESULTS: When studying cardiovascular comorbidity in patients with spondyloarthritis in three groups, arterial hypertension was most common in the ankylosing spondylitis group — 37.7%, in psoriatic arthritis — 62.5%, in the psoriatic spondyloarthritis group — 51.7%, conduction disturbance in ankylosing spondylitis — 28, 3%, in psoriatic arthritis — 17.5%, in the psoriatic spondyloarthritis group — 18.3%, dyslipidemia is significantly more common in the psoriatic arthritis and psoriatic spondyloarthritis groups — 47.5% and 51.7%, respectively, compared with the ankylosing spondylitis group — 18.9%. Along with cardiovascular diseases, endocrine disorders were detected with a high frequency of occurrence: overweight was more common in patients of the psoriatic arthritis and psoriatic spondyloarthritis groups — 35.0 and 38.3%, respectively, significant differences in the incidence of type 2 diabetes mellitus in the three groups has not been identified.&#x0D; CONCLUSIONS: It is necessary to carry out medical examination in order to identify comorbidities in patients with various forms of spondyloarthritis, in order to determine further tactics of management and correction, depending not only on the activity of the disease, but also taking into account comorbidities.

The Impact of Cardiovascular Vulnerabilities in Non Hodgkin Lymphoma Patients Treated with Chimeric Antigen Receptor T Cell Therapy

INTRODUCTION: CAR-T therapy is an effective treatment for hematological malignancies. However, in recent years there is a growing body of literature suggesting adverse cardiovascular (CV) events among patients treated with CAR-T therapy. Whether cardiovascular risk factors serve as determinants of CV complications and CAR-T outcomes is unclear. The aim of this study is to investigate the landscape and prognostic role of CV comorbidities in patients with non-Hodgkin lymphoma (NHL) treated with autologous CD19- CAR-T. METHODS: We included patients with NHL treated with CD19-directed CAR-T across two tertiary care centers. Data collected included baseline demographics, CV risk factors, and outcomes. CV disease and risk factors included were: coronary artery disease (CAD), diabetes, hypertension (HTN), sleep apnea, smoking history, and stroke/ transient ischemic attack (TIA). CV events were defined as atrial fibrillation (AF), heart failure (HF), acute coronary syndrome (ACS), and cardiogenic shock. All CV events were adjudicated by a board certified cardiologist. RESULTS: In the cohort of 345 patients, 87% had large B cell lymphoma (LBCL), 4% follicular lymphoma, and 9% mantle cell lymphoma (MCL). Predominant CV vulnerabilities included a history of smoking (41%), HTN (32%), diabetes (12%), sleep apnea (8%), history of CAD (7%), and history of stroke/TIA (5%). Patients were categorized based on number of CV risk factors or CV disease with 37% having 0, 35% with 1, and 28% with 2 or more. A total of 41 (12%) patients experienced a CV event within the first 100 days after CAR-T infusion, with 29 (8.4%) patients developing AF, 15 (4.3%) patients with HF, 2 (0.5%) patients with ACS, and 2 (0.5%) patients with cardiogenic shock. Five patients experienced more than one cardiac event. Univariable logistic regression of CV vulnerabilities revealed that patients with a history of HTN (OR 2.23, 95% CI 1.15-4.33, p = 0.018), 1 CV risk factor (OR 2.57, 95% CI 1.05-6.91) and/or 2 or more CV risk factors (OR 3.67, 95% CI 1.51-9.88) were associated with an increased risk of CV event(s) (global p=0.012). Additional baseline characteristics increasing risk of CV events included older age (OR 1.04, 95% CI: 1.01 - 1.07, p = 0.004), Karnofsky performance scale &amp;lt; 90 (OR 2.31, 95% CI: 1.13-5.12, p = 0.021), or stage III-IV disease (OR 2.90, 95% CI 1.11-9.94, p = 0.028). The 1-year overall survival was 62%, with a trend towards worse overall survival (HR 1.59, 95% CI:1.0-2.54, p=0.053) among patients experiencing CV events (Figure 1). CONCLUSIONS: In this largest analysis to date, we found that patients with NHL treated with CAR-T therapy had a high burden of CV comorbidities that increases their risk of CV events. Given the incidence of CV events and trend towards decreased OS signifies the importance of cardiac evaluation and CV stratification prior to CAR-T therapy. Further investigation is essential to define strategies to mitigate adverse CV complications during treatment.

#4072 HEART OF STONE: THE IMPACT OF CARDIOVASCULAR RISK ON NEPHROLITHIASIS: AN OBSERVATIONAL STUDY

Abstract Background and Aims The incidence of nephrolithiasis has risen in recent years, largely due to changes in diet and lifestyle. An association between nephrolithiasis and risk of cardiovascular disease has been described, including atherosclerosis. The underlying mechanisms linking the two conditions are not well understood, making it important to study the role of exercise and nutritional habits. This study aims to examine the incidence of cardiovascular comorbidities in patients with nephrolithiasis, considering demographic information and the timeline of disease diagnosis and follow-up. Conditions such as dyslipidemia, myocardial infarction, stroke, and metabolic syndrome are of particular interest in this population. Method We retrospectively analysed consecutive patients that were referred to our tertiary medical center nephrolithiasis clinic between 2021 and 2023. The demographic information collected included gender, age at first nephrolithiasis diagnosis, current age, and family history. The cardiovascular conditions analysed included metabolic syndrome, hypertension, diabetes, gout, smoking, stroke, and dyslipidemia. Additionally, renal function (GFR-EPI) was also taken into account. Appropriate tests for continuous and categorical variables were applied, recurring to SPSS v21.0. Results A total of 84 patients were included in the study. Of these, 51.2% (n=43) were women with a median age of 52 years (IQR: 13-83) and a median age of first nephrolithiasis diagnosis of 34 years (IQR: 9-75). The analysed comorbidities showed a high incidence of hypertension (n=35, 41.7%), obesity (n=33, 40.7%), dyslipidemia (n=50, 61%), and metabolic syndrome (n=20, 23.8%). Family history was identified in 37.3% (n=31) of patients, with a significant difference for men, where 64.5% (n=20) had a positive family history (p-value 0.033). The results showed a relationship between increased body mass index and younger age of first nephrolithiasis diagnosis (p-value 0.012) and lower renal function at diagnosis (p-value 0.005). Conclusion The diagnosis of nephrolithiasis requires a change in the patient's diet and lifestyle, not only because of the risk of recurrence, but also because these patients are at a higher risk of developing serious cardiovascular events. This study highlights the high incidence of these comorbidities and underscores the importance of both the patient and the nephrologist being diligent in addressing these issues to achieve better kidney and overall health outcomes.

Long-term prognostic impact of cardiovascular comorbidities in patients with prostate cancer receiving androgen deprivation therapy: A population-based competing risk analysis.

Our study investigated how adverse cardiovascular outcomes are impacted by cardiovascular comorbidities in patients with prostate cancer treated by androgen deprivation therapy (ADT). Using prospective, population-based data, all Hong Kong patients with prostate cancer who received ADT during 1 January 1993 to 3 March 2021 were identified and followed up for the endpoint of cardiovascular hospitalization/mortality until 31 September 2021, whichever earlier. Multivariable competing risk regression was used to compare the endpoint's cumulative incidence between different combinations of major cardiovascular comorbidities (heart failure [HF], myocardial infarction [MI], stroke and/or arrhythmia), with noncardiovascular death as competing event. Altogether, 13 537 patients were included (median age 75.9 [interquartile range 70.0-81.5] years old; median follow-up 3.3 [1.5-6.7] years). Compared to those with none of prior HF/MI/stroke/arrhythmia, the incidence of the endpoint was not different in those with only stroke (subhazard ratio [SHR] 1.06 [95% confidence interval (CI): 0.92-1.23], P = .391), but was higher in those with only HF (SHR 1.67 [1.37-2.02], P < .001), arrhythmia (SHR 1.63 [1.35-1.98], P < .001) or MI (SHR 1.43 [1.14-1.79], P = .002). Those with ≥2 of HF/MI/stroke/arrhythmia had the highest incidence of the endpoint (SHR 1.94 [1.62-2.33], P < .001), among whom different major cardiovascular comorbidities had similar prognostic impacts, with the number of comorbidities present being significantly prognostic instead. In conclusion, in patients with prostate cancer receiving ADT, the sole presence of HF, MI or arrhythmia, but not stroke, may be associated with elevated cardiovascular risks. In those with ≥2 of HF/MI/stroke/arrhythmia, the number of major cardiovascular comorbidities may be prognostically more important than the type of comorbidities.

Cardiovascular disease in asthma patients: From mechanisms to therapeutic implications.

Cardiovascular disease (CVD) is often associated with asthma, and asthma patients have an increased risk of CVD mortality. Our understanding of the bidirectional risk of CVD and asthma has been based on several observational studies. However, specific pathogenetic mechanisms underlying the development of cardiovascular comorbidities in patients with asthma have not yet been fully determined. Such cardiovascular complications in patients with asthma have been attributed to airway and systemic inflammation present in both asthma and CVD. Indeed, there is evidence that mast cells, eosinophils, inflammatory cytokines, and immunoglobulin E increase in both lungs of patients with asthma and in injured heart and vessels of CVD patients. These findings suggest that allergic asthma and CVD may share pathogenic pathways. Understanding these pathways is critical to the choice of pharmacological interventions. Currently, the most appropriate therapeutic approach lies in using the best available evidence to optimize the management of both asthma and CVD. Therapy should be optimized to take advantage of the favorable benefits that each medication may have on both organs while minimizing the likelihood of adverse effects on the lungs and heart. It is noteworthy that inhaled β2-agonists provide benefits in patients with acute decompensated heart failure. Furthermore, inhaled corticosteroids may reduce the risk of atherosclerosis. On the other hand, asthma is not an absolute contraindication to using cardio-selective β1-blockers, but these medications should be prescribed with caution, especially if they are necessary to prevent acute cardiovascular events, and alternative treatment options are unavailable. In addition, when aspirin intake causes the onset of hypersensitivity, P2Y12 inhibitors (e.g., clopidogrel, prasugrel, and ticagrelor) are effective and safe treatment alternatives.

Chinese expert consensus on the management of cardiovascular comorbidities in patients with chronic obstructive pulmonary disease

Patients with chronic obstructive pulmonary disease(COPD) often have co-existent systemic diseases(comorbidities), among which cardiovascular diseases (CVD) are the most common. The interactions between COPD and CVD are manifested in shared risk factors, disease severity, common symptoms, risks for exacerbations and disease progression, as well as therapeutic interventions. However, there is a knowledge gap in the management of COPD comorbidities. This expert consensus aims to increase the awareness, and to promote early diagnosis and proper management of cardiovascular comorbidities of COPD in medical professionals in China. The experts recommend that differential diagnosis should be performed for exertional dyspnea, a common symptom of COPD and cardiovascular diseases especially heart failure. Screening for cardiovascular diseases is needed in patients with COPD, and should be managed accordingly. COPD and comorbid CVD should be treated according to usual guidelines. Patients with COPD tolerate well to most of the medications for CVD. Selective β1-blockers for cardiovascular diseases are not contraindicated in COPD, but should be initiated from lower doses, and symptoms of airflow limitation be monitored. Likewise, β2-agonists and antimuscarinic drugs for COPD are generally safe for patients with comorbid CVD. Optimization of COPD management can improve heart function and cardiovascular outcomes.

Significance of cardiovascular comorbidity in patients with chronic myelomonocytic leukemia.

In aretrospective study, we analyzed the prevalence of common cardiovascular comorbidities in 310patients with chronic myelomonocytic leukemia (CMML), their potential prognostic impact, and potential correlations with laboratory and molecular features. 115 (36%) patients had adocumented cardiovascular comorbidity. In these patients, coronary heart disease 41/115 (36%), atrial fibrillation 34/115 (29%), and hypertension 75/115 (64%) were documented. None of these conditions had asignificant impact on survival. Unexpectedly, patients with cardiovascular comorbidity had alower number of circulating blasts and alower prevalence of EZH2 mutations. Moreover, time to transformation was significantly longer in these patients. Cardiovascular comorbidity does not seem to have amajor impact on prognosis in CMML patients. The unexpected lower transformation rate in these patients needs to be further investigated.

Should cardiovascular comorbidities be a contraindication for pulmonary metastasectomy?

Limited information is available about the impact of cardiovascular comorbidities (CVC) on the postoperative course of patients undergoing pulmonary metastasectomy (PM). In this study, we aim to compare the postoperative morbidity, mortality, and the long-term survival of patients with and without CVC undergoing PM. A retrospective monocentric study was conducted including 760 patients who underwent PM in curative intention. Patients were divided into two groups depending on the presence of CVC. The data from 164 patients with CVC (21.6%) and 596 patients without CVC (78.4%) were investigated. In both groups, zero in-hospital-mortality and limited 30-day mortality was detected. Postoperative complications occurred more often in patients with CVC (N=47, 28.7% vs. N=122, 20.5%, P=0.02). However, most of them were minor (N=37, 22.6% vs. N=93, 15.6%, P=0.03). The presence of multiple CVC (N=18 patients, 40% vs. N=28, 23.9%, P=0.04) and reduced left ventricular function (N=5, 62.5% vs. N=42, 27.1%, P=0.03) were identified as risk factors for postoperative morbidity. Patients with CVC showed reduced overall survival (5-year survival rate: 75.8% vs. 68%, P=0.03). In the multivariate analysis lobectomy [hazard ratio (HR) 0.3, 95% confidence interval (CI): 0.1-0.8, P=0.02] and general vascular comorbidities (HR 2.1, 95% CI: 1.1-3.9, P=0.01) were identified as independent negative prognostic factors. Resection of pulmonary metastases can be performed safely in selected patients with stable CVC. The presence of CVC in patients undergoing PM is associated with reduced overall survival compared to patients without CVC in the long term follow up. However, a prolonged 5-year survival rate of 68% could be achieved.

Cardiovascular comorbidities in patients with a severe form of psoriasis: A case-controlled study assessing clinical, biochemical, and radiological parameters

Background: Psoriasis is a common, chronic, inflammatory, and proliferative disorder of the skin, and is associated with elevated lipid levels and exaggerated inflammatory status, which may lead to cardiovascular morbidities and mortalities. Aims: The aim was to estimate the cardiovascular risk profile among psoriatic patients when compared to controls. Settings and Design: This was a case-controlled study performed at a tertiary-care hospital. Methods and Material: One hundred patients with severe psoriasis were evaluated for clinical, biochemical, electrocardiographic, and radiological signs of cardiovascular comorbidities and were compared with one hundred age- and sex-matched controls. Statistical Analysis: IBM Corp. Released 2015. IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp. Results: Males predominated (1.27:1), with the most common age group being 31 to 40 years old. Smoking and alcohol consumption were common among the psoriatic patients (odds ratio = 4.14 and 2.38, respectively). The mean PASI score among the cases was 26.19 ± 10.8, with an extreme effect on their quality of life. The psoriatic patients presented with independent cardiovascular risk factors, including systolic hypertension (148.67 ± 10.91 mm of Hg), elevated fasting blood sugars (129.46 ± 35.64 mg/dL), hypercholesterolemia (152.34 ± 44.56 mg/dL), and hypertriglyceridemia (186.29 ± 29.45 mg/dL), with metabolic syndrome among 41% of the cases. On the electrocardiogram, the P wave was elevated (22%) and the QTc interval was prolonged (20%) among the cases. On high-resolution ultrasonography, the intima–media of the carotid arteries were thickened (0.944 ± 0.132 mm), indicating subclinical atherosclerosis in the psoriatic patients. Conclusions: Early detection and periodic screening for cardiovascular risk factors among psoriatic patients and aggressive therapeutic management are recommended to reduce the disease burden and improve their quality of life.

THU058 - Comorbidity severity scores and cardiovascular comorbidities in patients with non-alcoholic steatohepatitis (NASH), with and without cirrhosis, in a real-world setting

THU058 - Comorbidity severity scores and cardiovascular comorbidities in patients with non-alcoholic steatohepatitis (NASH), with and without cirrhosis, in a real-world setting

PREVALENCE OF CARDIOVASCULAR COMORBIDITIES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN SUBURBAN AREAS OF SOUTH-WEST INDIA

Objective: Chronic obstructive pulmonary disease (COPD) is the vital cause of morbidity and mortality in Western world, though it has become an increasing cause of mortality in India also in the past decade. Another concern is that COPD patients use medications that stimulate the cardiovascular system, including anticholinergic agents and sympathomimetic medications to study the prevalence of cardiovascular comorbidities in patients with COPD. Methods: It was a prospective observational study, which was conducted on inpatient subjects diagnosed to have COPD based on GOLD guidelines 2020, for a period of 1 year in tertiary care hospital. Results: The most of the patients were in 60–80 year age group (70%) and majority was males (87%). All the males (n=87) were smokers (62 ex-smokers and 25 present smokers) while all females (n=13) were non-smokers. The mean BMI for patients with CVD was 25.85±4.19 kg/m2 while for patients without CVD, mean BMI was 27.46±3.98 kg/m2. About 63.2% of the males (n=87) had some cardiovascular comorbidity as compared to 38.5% of females (n=13). The prevalence of cardiovascular comorbidities in subjects with COPD was 60% in the present study. This was significantly higher in patients with COPD as compared to the reported prevalence value in the general population of comparable age group. The prevalence of associated cardiovascular abnormality in COPD patients with increased PCV (Packed cell volume), leukocytosis, and neutrophilia are 56.3%, 65%, and 60%, respectively. The most common cardiovascular comorbidity in subjects with COPD was ischemic heart disease (21%), followed by heart failure (20%), stroke (5%), arrhythmias (3%), and LVH (3%).

Cardiovascular Risk in Patients with COPD: Cardiovascular Comorbidities in Patients with COPD Increase CAT and mMRC Dyspnea Scores

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a number of different comorbidities. Cardiovascular diseases (CVD) are the most frequent comorbidities in COPD. The economic burden associated with cardiovascular comorbidity (CVC) in this population of patients is considerable. The COPD patients are related to the increased systemic inflammation, reduced capacity for physical activity, and airflow obstruction. AIM: The aim of our investigation was to evaluate the dyspnea as a disabling symptom in COPD patients with cardiovascular comorbidity (CVC) especially heart failure. The main aim of this study is to evaluate its intensity in patients with COPD in stages II according to GOLD. METHODS: The investigation was conducted from December 2019 to January 2020, on pulmonology and allergology clinic and cardiology clinic of medical faculty in Skopje. We investigated 65 outpatients with COPD, 44 with different type of CVD, Group I, and 21 without CVD, Group II. All patients were with partial chronic respiratory failure (In type 1 respiratory failure hypoxemic). Patients, according GOLD initiative, were in COPD stadium II, 70% &lt; forced expiratory volume in 1 s (FEV1)&gt;50%. Heart condition was diagnosed on the basis of clinical examination, electrocardiography, and echocardiography of the heart. Included patients with CVD were with ejection fraction (EF) &lt;65%. Dyspnea was measured with modified MRC (mMRC) dyspnea scale. RESULTS: The forced vital capacity and forced expiratory volume in 1 s were statically significantly higher in Group II with CVD. Dyspnea measured with Modified Medical Research Council (MRC) dyspnea scale showed statistically significantly higher values in Group I COPD patients with CVC (2.9 ± 1.4) versus Group II without CVC (1.7 ± 1.4), (p &lt; 0.05). The perception of the higher dyspnea in Group I was associated with increased COPD assessment test-scores, in Group I: Group I (19.8 ± 9.1) versus Group II: (9.8 ± 9.1), (p &lt; 0.001). The number of exacerbations and what is more important the number of severe exacerbation leading to hospitalizations was statistically higher in patients of Group I with CVC than in Group II without CVC (3.0 ± 1.1 vs. 1.0 ± 2.1), (p &lt; 0.001) and the number of hospitalizations (1.0 ± 1.1 vs. 0.3 ± 2.1) (p &lt; 0.001). CONCLUSION: We can conclude that patients with COPD who have CVC have an increased risk of high symptoms, which mean poor quality of life and increased morbidity.

Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis.

PsA is characterized by a high prevalence of cardiovascular (CV) comorbidities. Recognizing these comorbidities is critical due to their influence on the quality of life and the choice of therapy. Imaging techniques also play an important role in the evaluation of the CV risk in psoriatic disease, improving the prediction of CV events when combined with clinical scores as a predictive tool. Meta-analyses point to a significant reduction in the incidence of CV events associated with the suppression of inflammatory activity when using systemic therapies. Consequently, the mortality rate in PsA patients has fallen in the last 40 years and is now similar to that of the general population, including cardiovascular causes. Obesity is an especially relevant CV comorbidity in patients with psoriatic disease, most of whom are overweight/obese. Body mass index (BMI) is a risk factor for PsA and a causal relationship with psoriasis has been demonstrated by Mendelian randomized studies. The study of fat distribution shows that patients with psoriasis are characterized by visceral fat accumulation, which correlates with CV risk measurements. These findings suggest that approaches to the prevention and treatment of psoriatic disease might come from targeting adiposity levels, in addition to the immune pathways. Weight loss treatment with low energy diets in patients with PsA has been associated with significant improvements in disease activity. Novel strategies using a multimorbidity approach, focused more on patients outcomes, are necessary to better address comorbidities, improve clinical outcomes and the quality of life of patients with psoriatic disease.

Evaluation of cardiovascular comorbidity in cancer patients and analysis of potential risk factors for cardiovascular complications of checkpoint inhibitor therapy

Aim. To analyze the spectrum of cancer types and baseline cardiovascular comorbidity in patients receiving checkpoint inhibitor therapy.Material and methods. We performed retrospective analysis of case records of 112 cancer patients (55 men and 57 women) who received checkpoint inhibitor therapy in St. Petersburg hospitals. We analyzed primary tumor localizations, received immunotherapy and the initial comorbid conditions in patients.Results. The mean age of patients at the time of anticancer therapy initiation was 59,7±12,1 years for men, 57,7±14,1 years for women (p=0,249). The most common indications for immunotherapy were the following localizations: melanoma (34,8%), lungs (21,4%) and urinary system (12,5%). Among women who received checkpoint inhibitors, the lung and gynecologic cancer had the same prevalence (17,5%). The vast majority of patients (85,7%) received antiPD-1 agents, while the anti-CTLA4+anti-PD-1 combination was received by only 8,6% of patients, anti-PD-L1 monotherapy — 5,7%. Before anticancer therapy initiation, 69,6% of patients had prior CVD and/or risk factors. There were following most common comorbid conditions: hypertension — 58,9%, coronary artery disease — 36,6%, heart failure — 24,1%. At the same time, men in comparison with women were more likely to have prior stroke (12,7% vs 1,75%, respectively, p=0,024). There were no other significant sex differences between the incidence of cardiovascular diseases.Conclusion. Based on current publications describing potential risk factors for cardiovascular complications of cancer immunotherapy with checkpoint inhibitors, among the patients included in this study, 87,5% of patients can be attributed to the high-risk group.

Cardiovascular comorbidities in acromegaly

Introduction and purpose: Acromegaly is a rare disease which occurs with the frequency of 0.2-1.1 cases per 100 000 patients per year. The main cause is the excess level of growth hormone (GH) which stimulates the liver to the insulin-like growth factor type 1 (IGF-1) secretion. IGF-1 leads to the tissues overgrowth. In addition, acromegalic patients suffer from many comorbidities, such as: cardiovascular, endocrinological, neoplastic and musculoskeletal complications. The main aim of this review is the update of the latest information concerning cardiovascular comorbidities in patients with acromegaly.State of knowledge: Studies revealed that 80% of acromegalic patients will develop cardiovascular comorbidities. Complications such as: hypertension, cardiomyopathy, arrhythmia, heart valve disease, atherosclerosis and coronary heart disease as well as myocardial infarction were the most widely described. They are responsible for 44% of deaths in the first decade of the acromegaly and 23% in the second one.Conclusions: Because of the delayed diagnosis of acromegaly in most patients, most comorbidities are discovered in advanced stages leading to the decrease in patients’ life span. Adequate knowledge about potential complications is necessary to increase patients’ quality of lives.

Role of Hypertension on the Severity of COVID-19: A Review.

:The novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a global pandemic. The substantial morbidity and mortality associated with the infection has prompted us to understand potential risk factors that can predict patient outcomes. Hypertension has been identified as the most prevalent cardiovascular comorbidity in patients infected with COVID-19 that demonstrably increases the risk of hospitalization and death. Initial studies implied that renin–angiotensin–aldosterone system inhibitors might increase the risk of viral infection and aggravate disease severity, thereby causing panic given the high global prevalence of hypertension. Nonetheless, subsequent evidence supported the administration of antihypertensive drugs and noted that they do not increase the severity of COVID-19 infection in patients with hypertension, rather may have a beneficial effect. To date, the precise mechanism by which hypertension predisposes to unfavorable outcomes in patients infected with COVID-19 remains unknown. In this mini review, we elaborate on the pathology of SARS-CoV-2 infection coexisting with hypertension and summarize potential mechanisms, focusing on the dual roles of angiotensin-converting enzyme 2 and the disorders of renin–angiotensin–aldosterone system in COVID-19 and hypertension. The effects of proinflammatory factors released because of immune response and gastrointestinal dysfunction in COVID-19 are also discussed.