Cardiovascular Disease Group Research Articles

Inflammatory index is a promising biomarker for maintenance hemodialysis patients with cardiovascular disease.

Maintenance hemodialysis (MHD) patients are at a higher risk of cardiovascular disease (CVD), a common complication and leading cause of death. Persistent micro-inflammation is a unique feature of MHD. Given the established role of inflammation in the pathogenesis of atherosclerosis, this study aims to explore whether novel inflammatory markers (inflammation index) can serve as independent risk factors for CVD in MHD patients. A cross-sectional survey was conducted on patients from three dialysis centers, categorized into a CVD and non-CVD group based on medical history, laboratory tests, and physical examination. Fasting blood samples were collected from all participants for indicator testing. The analysis of 209 patients revealed that 104 had concurrent CVD. Patients in the CVD group were significantly older and exhibited higher anxiety and depression scores. Forward stepwise multivariate logistic regression results identified the inflammation index neutrophil-to-lymphocyte ratio (NLR) (OR = 1.27, 95% CI 1.082-1.491, P < 0.05) and systemic immune-inflammation index (SII) (OR = 1.001, 95% CI 1.0001-1.002, P < 0.05) as independent risk factors for CVD in MHD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that SII, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and NLR all possess predictive diagnostic values for CVD events in this patient population. Hemodialysis centers can utilize simple and cost-effective inflammatory markers to proactively identify patients at risk of CVD. Future research into how inflammation contributes to CVD in MHD is required.

Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists and cancer mortality. A real-world registry

Abstract Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra) reduce cardiovascular events through different mechanisms, nevertheless, their association with cancer remains unclear. Purpose We aim to compare the combined treatment (SGLT2i and GLP1ra) with monotherapy regarding hospitalization or/and death for cancer in a general population and a subgroup of patients with cardiovascular disease (CVD). Methods Retrospective observational study of patients who were prescribed SGLT2i, GLP1ra, or both drugs. Multinomial propensity score was performed in all the population and in a subgroup of patients with CVD (atrial fibrillation [AF], heart failure [HF], coronary artery disease [CAD], peripheral arterial disease [PAD], or cerebrovascular accident [CVA]). The following variables were included to adjust the three groups: Sex, Age, Obesity, diabetes mellitus (DM), high blood pressure (HBP), dyslipidemia (DLP), CAD, HF, AF, and CVA. The three primary outcomes were (i) hospitalization for any cancer, (ii) death for any cancer, and (iii) the combined event in the included population and the subgroup of patients with CVD. The multivariate Cox regression analysis determined the hazard rate (HR) of age, sex, risk factors, and treatment for each outcome. Results We included 14709 patients (11366 with SGLT2i, 1016 with GLP1ra, and 2327 with both treatments) from the treatment initiation. The subgroup with CVD included 4957 (33.7%) patients (Fig 1). After 33 months of median follow-up, the incidence of cancer events was similar between patients with and without CVD (3.4% or 3.7%, respectively). Sex (male) and age were the main risk factors for the 3 outcomes in both groups. Combined treatment and its duration had a protector role for cancer mortality regarding monotherapy with SGLT2i or GLP1ra in all population (HR [95%CI]) 0.2216 [0.106-0.459]; p&amp;lt;0.001 or 0.1928 [0.071-0.519]; p=0.001, respectively) (Fig 2a) and in the subgroup of patients with CVD (HR [95%CI]) 0.279 [0.078-0.994]; p&amp;lt;0.049 or 0.129 [0.024-0.668]; p=0.014, respectively) (Fig 2b), but these results were not found for the outcome of hospitalization for cancer. The combined therapy concerning SGLT2i and duration of treatment showed a protective role against the combined event (HR [95%CI]) 0.709 [0.521-0.967]; p=0.029) and (HR [95%CI]) 0.991 [0.983-0.999]; p=0.032) in the general population but not in the group of CVD. A higher survival rate for any cancer mortality was observed in those patients with the combined therapy respect to monotherapy (SGLT2i or GLP1ra) in the general population (Fig 2c) and the subgroup of patients with CVD (Fig 2d). Conclusions Initiation of combined therapy vs. monotherapy was associated with a lower rate of cancer mortality in the general population and patients with CVD. Future clinical trials and mechanistic studies will clarify the possible role of these drugs on carcinogenesis.Figure 1Figure 2

Can Cardiovascular Risk Be Simply Estimated in Nonalcoholic Fatty Liver Disease Patients?

Backgrounds and Aims: In the pathogenesis of nonalcoholic fatty liver disease (NAFLD), inflammation plays a pivotal role. The presence of inflammatory cells is closely linked with epicardial adipose tissue (EAT). A recently identified prognostic indicator for cardiovascular disease (CVD) is the ratio of monocyte count to HDL-cholesterol (MHR). Our primary aim was to investigate the relationship between EAT and markers of inflammation in individuals with NAFLD, and to evaluate its predictability using straightforward diagnostic measures. Material-Method: This retrospective study included two hundred eighteen patients who underwent thoracic computed tomography angiography between 2014 and 2021. The patients were divided into the NAFLD group (HU48 IU) according to the liver attenuation ratio. 136 patients in the NAFLD group and 82 in the non-NAFLD group. Results: The body mass index (BMI), triglyceride levels, notably the EAT volume and MHR in the NAFLD group, exhibited higher values than non-NAFLD group. Among participants in the NAFLD group, a positive correlation was observed between EAT volume and factors such as age, MHR, c-reactive protein, BMI, urea, glucose, and alanine aminotransferase. Through linear regression analysis, it was determined that MHR stood as the sole independent predictor of EAT volume in patients with NAFLD. Conclusion: EAT volume, a risk marker for CVD, can be predicted in NAFLD patients by MHR without radiological methods. Thus, easier and earlier detection of NAFLD patients in the high-risk group for CVD will be possible.

DCNeT: A disease comorbidity network-based temporal deep learning framework to predict cardiovascular risk in patients with mental disorders

Patients with mental disorders (MDs) are at higher subsequent risk of developing cardiovascular diseases (CVDs) than the general population. Early identification of cardiovascular risk in patients with MDs is beneficial for timely intervention and reducing disease burden. Recently, deep learning approaches have been increasingly applied in CVDs risk prediction. However, these methods have three major issues: 1) mostly relying on multiple types of clinical data, 2) not sufficiently mining and utilizing comorbidity patterns hidden in complex correlations among various diseases, and 3) not fully leveraging the time information, including the irregular intervals. To address these issues, we propose a disease comorbidity network-based temporal deep learning framework (DCNeT) to predict the subsequent CVDs risk for patients with MDs based on routinely collected administrative health data. Firstly, to identify the comorbidity patterns of MDs, we construct a disease comorbidity network (DCN) for MDs and apply graph embedding method to generate disease embeddings for each disease in the DCN. Then, a code attention mechanism is proposed to obtain the weight of each disease which is embedded into dense vectors based on the structure of DCN. We present a view attention mechanism to compute the attention weights of different types of features including disease embeddings, basic features, and disease indicators for generating the final representations of patients’ hospitalizations. Furthermore, to fully utilize the information on the irregular time intervals between hospitalizations, a time encoding module is designed, and the time-aware LSTM is adopted to model the irregular time intervals and capture the temporal patterns of patients’ hospitalizations. The experimental results show that DCNeT outperforms the state-of-the-art methods, with the area under the receiver operating characteristic curve of 0.7658, 0.8143, 0.8110, and 0.7839 on four datasets, respectively. The ablation experiments further demonstrate that each module of DCNeT, including the code attention, view attention, and time encoding module, contributes to its superior performance, with average improvements of 1.20 %, 1.65 %, and 1.13 % in accuracy, respectively. Our DCNeT could be utilized as an efficient framework for identifying high-risk groups of CVDs among patients with MDs that may benefit from screening and preventive strategies.

Behavioral counseling for cardiovascular disease prevention in 36 low-income and middle-income countries

BackgroundGiven the substantial prevalence of cardiovascular disease (CVD) in low-income and middle-income countries (LMICs), evaluation of behavioral counseling for prevention of CVD is important. MethodsWe pooled nationally representative cross-sectional surveys from 36 LMICs between 2013 and 2020. The population was divided into three groups according to CVD risk: the potential risk group, the risk group and the CVD group. We estimated the prevalence of six types of behavioral counseling among the three groups separately: smoking, salt reduction, fruit and vegetable intake, dietary fat reduction, physical activity and body weight. ResultsThere were 16,057 (25.4%) in the potential risk group, 43,113 (49.9%) in the risk group, and 7796 (8.6%) in the CVD group. The prevalence of receiving at least four types of counseling in the three groups was 15.6% (95% CI 13.9 to 17.5), 14.9% (95% CI 14.0 to 15.9), and 19.8% (95% CI 17.7 to 22.2), respectively. The lowest prevalence was for tobacco use counseling: 24.5% (95% CI 22.5 to 26.4), 23.2% (95% CI 22.1 to 24.3), and 32.1% (95% CI 29.5 to 34.8), respectively. The prevalence of counseling was higher in upper-middle-income countries than in lower-middle-income countries. Women, older people, those with more education, and those living in urban areas were more likely to receive counseling. ConclusionThe prevalence of behavioral counseling for CVD is low in LMICs, especially among potentially at-risk populations and in low-income countries. These findings highlight the current urgent need to improve CVD prevention and management systems to enhance behavioral counseling and intervention.

E012 Burden and risk factors for cardiovascular involvement in connective tissue disease

Abstract Background/Aims Connective tissue diseases (CTD) are associated with several cardiovascular manifestations. Cardiovascular diseases (CVD) are significant cause of morbidity and premature death. The pathogenesis of CVD in CTD patients is incompletely understood and likely multifactorial. Traditional risk factors for atherosclerosis are common among patients with CTD as well as metabolic syndrome. Furthermore, diabetes, dyslipidaemia, hypertension, and obesity may all be exacerbated by connective tissue disease itself or treatment with glucocorticoids. The aim of this study was to assess the burden of CVD and the risk factors for the development of cardiovascular disease in patients with CTD. Methods This was a retrospective study from a single centre. We reviewed clinical records of CTD patients as determined by treating rheumatologist. This CTD cohort included patients with systemic lupus erythematosus (SLE), myositis, systemic sclerosis, Sjogren’s syndrome, mixed and undifferentiated connective tissue diseases. Data on demographic, clinical, laboratory parameters, cardiac investigations, treatment and outcome were collected from electronic patient records. CVD and traditional risk factors were defined using standard criteria. Results A total of 298 patients with CTD were included in the analysis. Mean age of the cohort was 61±17.7 years and majority were females (n = 240, 80.5%). Of the 298 patients, 64 had CVD (21.5%). Most common CVD was ischaemic heart disease (17 patients) followed by hypertension (12), arrhythmia (9), pulmonary arterial hypertension (7), valvular diseases (5), pericardial disease (3), cardiomyopathy (3), myocarditis (2), thromboembolism (3), aortic dissection (2) and coronary spasm (1). Patient with CTD who had CVD were older (72.5±12.2 years) compared to CTD patients who did not develop CVD (non-CVD group, 57.7±17.6 years). The duration of CTD was shorter in patients with CVD (88.9±41.7 months), compared to 106±84.3 months in non-CVD group. The risk factors such as smoking, diabetes and dyslipidaemia was higher in the CVD group. Comparing CVD vs non-CVD patients respectively, systolic BP (147.1±23.0 vs 133.6±18.3mmHg), diastolic BP (83.2 ± 16.3 vs 78.2 ± 11.2mmHg) and serum uric acid (321.8±97.4 vs 292±83.9mg/dL) values were higher and statistically significant (p &amp;lt; 0.05) in CVD group. Patients with CVD had longer exposure to steroids (50%) compared to non-CVD patients (31.6%). They required high dose steroids (9.4% vs 5.6% in non-CVD patients). Current and previous DMARD use was also higher in patients who had CVD (51.6% vs 44.9%). Conclusion This study has demonstrated high burden of cardiovascular disease in CTD patients. Traditional risk factors were more prevalent in the CVD group. DMARD’s and steroid use was also higher in the CVD group. Screening for cardiovascular diseases and disease control in CTD patients is paramount for better outcomes. Further analysis will be carried out for risk factors and relevant outcomes. Disclosure K.K. Garg: None. S. Sampath: None. A. Erinjogunola: None. B. Ting: None. H. Noori: None. G.M. Koduri: None.

Assessment of the Relationship Between Liver Enzymes and Cardiovascular Disease: A Study in Bangladeshi Adults.

Elevated liver enzyme levels are suggested to be associated with an increased risk of cardiovascular disease (CVD). However, few studies have explored the relationship between liver enzymes and myocardial infarction (MI). This study aimed to evaluate the potential association of elevated liver enzymes with MI within a population group in Bangladesh. In this cross-sectional study, 348 participants were enrolled, 189 with MI in the CVD group and 159 in the control group. Serum levels of liver enzymes (AST, ALT and GGT) and other biochemical parameters were measured using standard methods. Multivariate logistic regression models were applied to determine the associations between elevated liver enzymes and CVD. In the CVD group, 51.6%, 30.9% and 67.7% of individuals had elevated serum AST, ALT and GGT levels, respectively. On the contrary, the control group had 17.0%, 15.1% and 35.2% of individuals with high serum AST, ALT and GGT levels, respectively. Overall, 71.8% of the subjects in the CVD group and 44.7% of the subjects in the control group had at least one or more elevated liver enzymes (p < 0.001). The mean level of all three liver enzymes was significantly higher in the CVD group than in the control group (p < 0.001). In both the CVD and control groups, males had higher levels of liver enzymes than females. In the regression models, the serum levels of AST, ALT and GGT showed a positive and independent association with the prevalence of CVD (p < 0.001). However, GGT showed the strongest association among the three enzymes. This study shows a high prevalence of liver enzyme abnormalities in individuals with CVD. Serum levels of AST, ALT and GGT were independently associated with the prevalence of CVD. This suggests that measuring liver enzyme levels could be a useful marker in predicting CVD at an early stage.

Soluble ST2 and its relation to inflammatory, vascular atherosclerotic, and calcification markers in patients with atrial fibrillation or heart failure at moderate-to-high cardiovascular risk

Background: Cardiovascular diseases (CVDs) are the major cause of death globally. Among them, heart failure (HF) and atrial fibrillation (AF) result in poor prognosis and quality of life. Standard methods for assessing AF and HF, through history and physical examination, have limited sensitivity and specificity, which lead to delayed diagnosis and high risk of mortality. The identification of biomarkers able to detect the early stages of disease and/or their progression is of great importance for improving the clinical outcome. As AF and HF often coexist, it would be of great importance to find a biomarker with diagnostic utility in predicting HF in AF patients. Soluble suppression of tumorigenesis-2 (sST2) is a part of the cardioprotective IL-33/ST2 signaling pathway and may serve as a candidate biomarker for HF and AF. We aimed to evaluate sST2 serum levels in patients with AF and HF with preserved ejection fraction (HFpEF) and to explore potential relationships with traditional CVD risk factors and with novel biomarkers for vascular calcification such as undercarboxylated matrix Gla-protein (ucMGP). Materials and Methods: This study included 99 patients stratified into three groups: HFpEF (n=19), paroxysmal or persistent AF in sinus rhythm (n=33), and control group without CVD but at moderate-to-high CVD risk (n=47). Hemodynamic and anthropometric measures, coronary artery calcification (CAC), routine laboratory parameters, circulating ucMGP, and sST2 were measured. Results: sST2 levels were highly elevated in HFpEF patients. Significant positive correlation was found between sST2 and CAC-score (r=0.237, p=0.039), negative relations with serum lipids in AF patients, and positive association with serum C-reactive protein (r=0.609, p=0.018) in HFpEF patients. Soluble ST2 positively correlates with ucMGP in the entire studied population (r=0.252, p=0.006) and in the combined CVD group (AF+HFpEF) (r=0.254, p=0.036). Conclusions: sST2 levels emerge as a novel biomarker in CVD and may have prognostic importance for HF prediction in AF patients.

Temporary relationship between sleep duration and depression and its impact on future risk of cardiovascular disease

BackgroundAlthough sleep duration and depression were correlated, their temporal sequence and how the sequence influence on future risk of cardiovascular disease (CVD) remained undetermined. This study aimed to explore the temporal relationship between sleep duration and depression, and its association with future CVD risk. MethodsWe included 10,629 middle-aged and elderly participants with repeated measurements of sleep duration and depressive symptoms (measured by Center for Epidemiological Studies-Depression scale [CESD]) at the first two visits from the China Health and Retirement Longitudinal Study. Cross-lagged analysis and mediation analysis were used to examine the temporal relationship between sleep duration and depression and its impact on future risk of CVD. ResultsThe adjusted cross-lagged path coefficient from baseline sleep duration to follow-up CES-D (β1 = −0.191; 95 % confidence interval [CI], −0.239 to −0.142) was significantly greatly than that from baseline CES-D to follow-up sleep duration (β2 = −0.031; 95 % CI, −0.031 to −0.024) (Pdifference < 0.0001). Similarly, the path coefficient from baseline sleep duration to annual changes in CES-D was significantly greater than that from baseline CES-D to annual changes in sleep duration (β1 = −0.093 versus β2 = −0.015, Pdifference < 0.0001). The path coefficient from baseline sleep duration to follow-up CES-D in CVD group was significantly greater than that in those without CVD (Pdifference of β1 = 0.0378). Furthermore, 27.93 % of the total association of sleep duration with CVD was mediated by depression symptoms. ConclusionsThe findings provide evidence that decrease in sleep duration probably precedes the increased in depressive symptoms, and depression partially mediated the pathway from sleep duration to incident CVD.

Bidirectional associations between mental disorders, antidepressants and cardiovascular disease

BackgroundMental disorders have a high comorbidity with cardiovascular disease (CVD), but the causality between them has not been fully appreciated.ObjectiveThis study aimed to systematically explore the bidirectional causality between the...

Prevalence of cardiovascular diseases and traditional cardiovascular risk factors in patients with rheumatoid arthritis: a real-life evidence from BioSTAR nationwide registry.

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030-20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567-13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA.

Anthropometrics and Plasma Atherogenic Index in Saudi Women Madinah KSA.

to determine the lipid profile levels and association with anthropometric measurements and atherogenic index of plasma values in females from Taibah University. A cross-sectional study was conducted from January 2019 to January 2020 at the female section of Taibah University, located in Madinah, Saudi Arabia. The study sample consisted of 240 females ranging from 19 to 50 years. Measurements related to anthropometry such as height, weight, waist, and hip circumference, were calculated. Body Mass Index, Lipid profiles, and Atherogenic Index of Plasma were also measured. Almost 73.4% of the participants were obese and overweight, with a mean BMI of 28.79±5.7 kg/m2. Overweight and obese women were observed to have high total cholesterol and triglyceride levels (P≤0.05). Out of 244 participants, 120 (49.2%) and 44 (18%) were at intermediate and high risk of cardiovascular disease (CVD), respectively, as determined by the atherogenic index of plasma AIP. Intermediate and high-risk CVD groups had higher lipid profile levels and high waist-to-hip ratio compared to those in females at low risk (P≤0.05). AIP was positively and significantly associated with total cholesterol and triglyceride but negatively correlated with HDL concentration. Furthermore, the BMI had significantly positive correlation with triglyceride and waist to hip ratio (P≤0.05). The majority of the participants were overweight and obese, with high levels of triglycerides and total cholesterol and high waist to hip ratio, placing them at intermediate or high risk of CVD based on AIP values. Additional CVD risk screenings, targeted specifically at overweight and obese women, are needed.

Prospective cohort study of the association of cardiovascular disease with triglyceride glucose index and triglyceride glucose-related indicators

Objective: To investigate the association of cardiovascular diseases (CVD) with triglyceride glucose index (TyG) and TyG-related indicators in Uyghur populations of The Xinjiang Production and Construction Corps. Methods: Based on the cohort of the Uygur population of The Xinjiang Production and Construction Corps, 11 833 study subjects were included. The Kaplan-Meier method was used to estimate the cumulative incidence of CVD in each quartile of TyG and TyG-related indicators. Cox proportional hazards regression model was used to evaluate the relationship between TyG and CVD, TyG-related indicators and CVD. Framingham CVD risk score model (Framingham model) was used to evaluate whether the addition of TyG and TyG-related indicators could improve the predictive ability of the model. The potential mediating role of the TyG in the association between obesity and CVD was examined through mediation effect analysis. Results: The average age of the subjects was (37.00±13.67) years-old, and 51.0% were male. The median follow-up time was 5.67 years, with 1 288 CVD events. The cumulative incidence of CVD increased with the increase of TyG and TyG-related indicators quartiles, and compared with the Q1 group, the risk of CVD in the Q4 group of TyG, TyG-BMI, and TyG-WHtR increased by 20% (HR=1.20, 95%CI: 1.01-1.42), 77% (HR=1.77, 95%CI: 1.46-2.16) and 68% (HR=1.68, 95%CI: 1.36-2.09), respectively. After adding TyG, TyG-BMI, and TyG-WHtR to the Framingham model, respectively, the model's area under the curve, net reclassification improvement, and integrated discrimination improvement were improved. In the association between BMI, WHtR, and CVD, the proportion of mediating effects mediated by the TyG index was 10.55% and 11.50%. Conclusions: Elevated levels of TyG and TyG-related indicators were strongly associated with the risk of CVD in the Uyghur population of The Xinjiang Production and Construction Corps, with TyG-BMI being the most closely correlated with CVD. Early monitoring of TyG-BMI helps identify high-risk groups of CVD.

Combined effect of falling difficulty and cardiovascular diseases on the risk of all-cause and cardiovascular mortality in older adults: an analysis of the National Health and Nutrition Examination Survey.

Older adults with cardiovascular diseases (CVD) are prone to falls. This study aimed to analyze the combined effect of falling difficulty and CVD on the risk of all-cause- and CVD mortality in older adults. In this retrospective cohort study, people aged ≥60 years with information on falling difficulty and CVD from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were selected. Multivariable Cox proportional hazards regression model was used to assess the associations of falling difficulty and CVD with all-cause- and CVD mortality. A total of 1409 participants were included, of whom 868 (58.1%) participants died, and 237 (15.0%) died of CVD. The mean age of participants was 72.1 (0.3) years and 825 (64.7%) were female. Older adults with falling difficulty or CVD were associated with an increased risk of all-cause- and CVD mortality. Older adults in the no falling difficulty & CVD group [hazard ratio (HR) = 1.45, 95% confidence interval (CI) 1.19-1.78], the falling difficulty & no CVD group (HR = 1.45, 95%CI 1.12-1.89), and the falling difficulty & CVD group (HR = 2.13, 95%CI 1.77-2.56) were related to a higher risk of all-cause mortality compared to those in the no falling difficulty & no CVD group. The combined effect of falling difficulty and CVD was positively correlated with the risk of all-cause mortality (HR = 1.26, 95%CI: 1.18-1.34; P-trend <0.001) and CVD mortality (HR = 1.36, 95%CI: 1.18-1.56; P-trend <0.001). The combined effect of falling difficulty and CVD was positively associated with the risk of all-cause- and CVD mortality in older adults.

Patterns and Outcomes of Obesity Using Body Mass Index in Patients Hospitalized with Acute Cardiovascular Disorders: A Retrospective Analysis of 7284 Patients in a Middle Eastern Country

Background: We aimed to study the presentation and in-hospital outcomes of obese patients hospitalized for cardiovascular diseases (CVDs) in a Middle Eastern country. Methods: This retrospective study included patients admitted to the Heart Hospital between 2015 and 2020. Patients were divided according to their body mass index (BMI): Group I (BMI 18.5–24.9), Group II (BMI 25–29.9), and Group III (BMI ≥ 30), by applying one-way ANOVAs and chi-square tests. The obese group (BMI ≥ 30) was graded and compared (Grade I (BMI 30–34.9), Grade II (BMI 35–39.9), and Grade III (BMI ≥ 40)). Results: There were 7284 patients admitted with CVDs (Group I (29%), Group II (37%), and Group III (34%)). The mean age was higher in Group III than Groups I and II (p &lt; 0.001). Male sex was predominant in all groups except for morbid obesity (Grade III), in which females predominated. Diabetes mellitus (DM), hypertension, and dyslipidemia were more common in Group III. Chest pain was more common in Group II, while shortness of breath was more evident in Group III (p &lt; 0.001). Group II had more ST-elevation myocardial infarction (STEMI), followed by Group I (p &lt; 0.001). Atrial fibrillation (AF) was observed more frequently in Group III (p &lt; 0.001). Congestive heart failure (CHF) was common in Group III (19%) (p &lt; 0.001). In the subanalysis, (Grade I (62%), Grade II (22.5%), and Grade III (15.5%)), Grade I had more STEMI, whereas AF and CHF were higher in Grade III (p &lt; 0.001). Percutaneous Coronary Intervention was performed less frequently in Grade III (p &lt; 0.001). In-hospital mortality was higher in Grade III (17.1%), followed by Grades II (11.2%) and I (9.3%) (p &lt; 0.001). Conclusions: In this study, one third of the hospitalized CVS patients were obese. AF and CHF with preserved EF were the most common cardiovascular presentations in obese patients. In patients with CVDs, obesity was associated with higher rates of comorbidities and in-hospital mortality. However, obesity measured by BMI alone was not an independent predictor of mortality in obese cardiac patients.

Medical and social problems of management of risk factors of cardiovascular diseases leading to morbidity, disability and mortality

Despite the success of recent decades in reducing mortality from diseases of the circulatory system (CVD), cardiovascular disease (CVD) remains the most common non-communicable pathology in all countries of the world. CVDs have high rates of morbidity, disability, and mortality. The most common of these are arterial hypertension and coronary heart disease. CVD occurs against the background of the presence of risk factors (RF). The ability to timely detect risk factors and manage their level underlies the prevention of CVD. Monitoring the level of risk factors at the individual level and assessing their prevalence at the group level is not feasible without the use of specialized software. Registration and monitoring of patients in the program allows you to create a data archive for use by medical professionals and the patient himself. In the literature there is information about the prevention and medical examination of the population with cardiovascular diseases. However, to date, the medical and social problems of FR management in CVD have not been sufficiently described. In this regard, the effectiveness of measures carried out within the framework of prevention and medical examination decreases.The fight against diseases of the CVD group has not only social, but also economic significance. High rates of temporary disability and disability of patients lead to serious losses at the state level. This determines the need for further improvement of mechanisms for the prevention and treatment of CVD.

Abstract 151: Age‐Related Increases in Carotid Artery Calcification: Insights from NaF PET/CT Imaging

Introduction Atherosclerosis, the hardening and narrowing of the arteries, occurs due to the buildup of plaque on the inner walls of the arteries which can result in reduced blood flow to the organs and tissues. Risk factors such as smoking, chronic kidney disease, and aging can contribute to plaque formation. The gradual loss of elasticity in arterial walls and the presence of other risk factors, such as high blood pressure and diabetes, contribute to the increased risk of cardiovascular disease (CVD) observed in aging populations. Early detection through sensitive and specific imaging methods is important for the detection and treatment of CVD. 18F‐Sodium Fluoride positron emission tomography/computerized tomography (NaF‐PET/CT) can be utilized to detect and quantify molecular calcification and therefore early atherosclerosis in patients with CVD. Research has shown a positive correlation between NaF uptake in the common carotid arteries/thoracic aorta and cardiovascular/thromboembolic risk. This study aims to assess the effect of aging on NaF uptake in the left common carotid artery (LCC) in subjects with known cardiovascular risk factors. Methods In total, 36 subjects (mean age 55.4 ± 12.3 years, 50% males) with known cardiovascular risk factors underwent FDG‐PET/CT. Participants were recruited from a group of patients with chest pain syndromes who were referred for coronary CT angiography. Individuals who were not taking any blood pressure medications and who had a greater than 1% increased risk of fatal CVD, estimated by the systematic coronary risk evaluation tool, were eligible for inclusion into the at‐risk for CVD group. NaF PET/CT was performed 90 min after the intravenous injection of 2.2 MBq of NaF/kg. NaF uptake in the LCC was quantitatively assessed by measuring the blood‐pool‐corrected maximum standardized uptake value (SUVmean) on each axial slice. Pearson’s R was calculated and evaluated for significance in all variables. The threshold for significance was set at P &lt; 0.05. Results A significant association between age in patients with cardiovascular risk factors and NaF uptake in the LCC artery was found. Age positively correlated with NaF uptake (r=0.472, p= 0.004) across all 36 patients. Conclusion Our results demonstrate that NaF uptake increases in the LCC with age in subjects with known cardiovascular risk factors. The strong association between age and calcification of the carotid arteries within a population of individuals with unfavorable cardiovascular and thromboembolic risk profiles demonstrates the potential of NaF PET/CT. NaF PET/CT may allow physicians to evaluate effectiveness of treatment and determine a patient's risk for CVD. However, additional trials are needed to further evaluate the associations found in this study and determine relevance in a clinical setting.

Impact of periodontitis on circulating cell-free DNA levels as a measure of cardiovascular disease

ObjectivesThe present study aims to assess the serum circulating cell-free (cfDNA) concentrations in patients with periodontitis and cardiovascular disease (CVD) and to evaluate the impact of periodontitis on circulating cfDNA levels and the confounding factors that might mediated the possible relationship.Materials and methodsHealthy controls (n=30) and patients with CVD (n=31), periodontitis (n=31), and periodontitis + CVD (n=30) were enrolled in the present study. All subjects underwent regular periodontal examination and blood sampling and cfDNA evaluation. The analysis of the plasma cfDNA concentrations was performed using a dsDNA Assay Kit.ResultsIn comparison with healthy controls and CVD patients, periodontitis and periodontitis+CVD exhibited significantly higher expression of circulating cfDNA (p<0.05). There was a positive correlation among plasma cfDNA and clinical attachment loss (CAL) (p=0.019), high sensitivity C-reactive protein (hs-CRP) (p=0.027), and periodontal inflamed surface area (PISA) (p=0.003). Furthermore, the multivariate regression analysis evidenced that PISA (p<0.001), hs-CRP (p=0.014), and full-mouth bleeding score (FMBS) (p=0.004) were significant predictors of circulating cfDNA concentrations.ConclusionsThe results of the study highlighted that the periodontitis and periodontitis + CVD group showed higher circulating cfDNA expression in comparison with healthy controls and CVD patients. Moreover, the extent of periodontitis was correlated with the increased cfDNA levels and represented a significant predictor of the increased circulating cfDNA concentrations.Clinical relevanceUnbalanced circulating cfDNA concentrations have been indicated to represent a possible risk of CVD and endothelial dysfunction. Periodontitis and periodontitis + CVD patients showed higher circulating cfDNA expression; moreover, the extent of periodontitis significantly predicted higher circulating cfDNA concentrations, suggesting the potential increased risk of developing CVD in periodontitis patients.

Association of Magnesium Depletion Score With Cardiovascular Disease and Its Association With Longitudinal Mortality in Patients With Cardiovascular Disease.

Background Dietary magnesium and serum magnesium play an important part in cardiovascular disease (CVD). However, the association between magnesium depletion score (MDS) and CVD development and prognosis remains unclear. This analysis examines the cross-sectional relationship between MDS and CVD, and the longitudinal association between MDS and all-cause and CVD mortality in individuals with CVD. Methods and Results In all, 42 711 individuals were selected from the National Health and Nutrition Examination Survey, including 5015 subjects with CVD. The association between MDS and total and individual CVDs was examined using the survey-weighted multiple logistic regression analysis. Among 5011 patients with CVD, 2285 and 927 participants were recorded with all-cause and CVD deaths, respectively. We applied survey-weighted Cox proportional hazards regression analyses to investigate the impact of MDS on the mortality of individuals with CVD. The CVD group had higher MDS levels than the non-CVD groups. After controlling all confounding factors, individuals with MDS of 2 and ≥3 had higher odds of total CVD and specific CVD than those with MDS of 0. Besides, each 1-unit increase in MDS was strongly related to the risk of total CVD and specific CVD. The relationship between MDS and total CVD was stable and significant in all subgroups. The fully adjusted Cox regression model indicated that high MDS, irrespective of MDS as a categorical or continuous variable, was significantly associated with an elevated risk of all-cause and CVD deaths. Conclusions MDS is a vital risk factor for the prevalence and mortality of individuals with CVD.

The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.

Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.