Cardiovascular Disease In People Research Articles

138-OR: Earlier Onset of Type 2 Diabetes Increases Genetic Risk of Cardiovascular Complication

Earlier age at diagnosis of type 2 diabetes (T2D) is associated with increased risk of cardiovascular disease (CVD) . However, genetic risk factors associated with accelerated CVD in people with early onset T2D remain elusive. We aimed to investigate if the impact of polygenic risk for developing CVD differs according to age at diagnosis of T2D. Using prospective cohorts of UK Biobank (T2D, N=15,915) and Seoul National University Hospital (SNUH) T2D cohort (N=1,228) , we compared the incidence of newly developed CVD among four groups based on age at diagnosis of T2D (30-39, 40-49, 50-59, and 60-69 years of age) using time to event analysis. Polygenic risk scores (PRSs) for T2D and coronary artery disease (CAD) were calculated by PRS-CS, Bayesian regression using continuous shrinkage priors, using 1.1 million SNPs each from summary statistics of DIAGRAM and CARDIoGRAMplusC4D Consortium. In UK Biobank, people diagnosed as T2D between age 30-39 had 5.8 (95% CI 4.04-8.42) fold increased risk of CVD compared to those who developed T2D between 60-69. Higher T2D PRS was associated with earlier onset of T2D but not with risk of myocardial infarction (MI) . On the other hand, higher CAD PRS was associated with increased risk of MI but not with earlier age at diagnosis of T2D. The effect of CAD PRS on MI was largest in people diagnosed between age 30-39 and its effect size decreased as the age at diagnosis increased: HR 2.34 (1.47-3.71) for age 30-39, 1.42 (1.20-1.68) for 40-49, 1.39 (1.25-1.54) for 50-59, and 1.28 (1.11-1.48) for 60-69. Interaction analysis between age at diagnosis and CAD PRS showed additional 10% increase in risk of MI for year earlier onset of T2D (P=0.0056) . These findings were replicated in the SNUH T2D cohort, which is a hospital based cohort of East Asians. In summary, people with earlier onset T2D had higher risks for CVD, and the impact of CAD PRS for incident MI increased as age at diagnosis decreased. Genetic information in people with early onset T2D could be used to identify those with increased risk of CVD. Disclosure H.Lee: None. J.Choi: None. N.Kim: None. S.Lee: None. K.Park: None. S.Kwak: None.

The Remnant Lipoprotein Hypothesis of Diabetes-Associated Cardiovascular Disease.

Both type 1 and type 2 diabetes are associated with an increased risk of atherosclerotic cardiovascular disease (CVD). Research based on human-first or bedside-to-bench approaches has provided new insights into likely mechanisms behind this increased risk. Although both forms of diabetes are associated with hyperglycemia, it is becoming increasingly clear that altered lipoprotein metabolism also plays a critical role in predicting CVD risk in people with diabetes. This review examines recent findings indicating that increased levels of circulating remnant lipoproteins could be a missing link between diabetes and CVD. Although CVD risk associated with diabetes is clearly multifactorial in nature, these findings suggest that we should increase efforts in evaluating whether remnant lipoproteins or the proteins that govern their metabolism are biomarkers of incident CVD in people living with diabetes and whether reducing remnant lipoproteins will prevent the increased CVD risk associated with diabetes.

0154 Differences in Monocyte Activation between People with Treated HIV Infection With or Without OSA

Abstract Introduction Obstructive sleep apnea (OSA) has been associated with low grade systemic inflammation and greater cardiovascular risk, but the specific pathways mediating these effects are unclear. Monocyte activation is implicated in the development of cardiovascular disease in people with treated HIV infection. We sought to evaluate the impact of OSA on monocyte activation in people living with human immunodeficiency virus (HIV) infection. Methods Ten HIV seropositive participants with undetectable (<50 copies/mL) HIV viremia and at least one year of antiretroviral therapy underwent home sleep apnea testing to evaluate for the presence (apnea-hypopnea index -AHI4% ≥15 events/hour) or absence (AHI4% <5 events/hour) of OSA. Mononuclear cells were extracted and analyzed by flow cytometry. The composition of monocyte subsets (classical, intermediate, patrolling) was assessed using surface markers. Intracellular tumor necrosis factor alpha (TNFα), interleukin 1β (IL-1β), and interleukin 6 (IL-6) levels were measured by median fluorescence intensity (MFI, unit: au) and log-transformed. Differences in monocyte subset composition and intracellular cytokine levels between those with and without OSA were analyzed by t-test. Results Participants had a mean ± SD age of 61 ± 4.7 years, were 50% female, 80% Black race and had well-constituted CD4+ counts (mean ± SD: 934 ± 283 cells/ml). The mean AHI4% among participants with OSA (n=4) was 21.8 ± 4.4 events/hour whereas controls (n=6) had an AHI4% of 2.4 ± 2.0 events/hour (p-value = 0.001). There was no difference in the proportion of classical monocytes between groups (mean ± SD 83.8% ± 11.5% in participants with OSA vs. 84.9% ± 7.5% in controls, p=0.86). Intracellular TNFα was greater in monocytes from participants with OSA vs. controls (log-transformed MFI 3.49±0.20 au vs. 3.00±0.35 au, p=0.03). Additionally, there was a trend toward greater intracellular concentrations of IL-1β (mean log-transformed MFI 3.24±0.15 au vs. 2.95±0.48 au, p=0.22) and IL-6 (log-transformed MFI 3.28±0.16 au vs. 2.91±0.64 au, p=0.23), in participants with OSA vs. controls. Conclusion Pro-inflammatory cytokine levels are greater in monocytes obtained from people with treated HIV infection with OSA compared to those without OSA. Our findings suggest OSA may exacerbate chronic inflammation and cardiovascular risk in chronic HIV infection. Support (If Any) HL082610 and American Thoracic Society ASPIRE Fellowship

Incidence and risk factors of atrial fibrillation and atrial arrhythmias in people living with HIV: a systematic review and meta-analysis.

Cardiovascular diseases in people living with HIV (PLWH) are becoming increasingly relevant as HIV/AIDS has become more treatable with the advent of highly efficacious antiretroviral therapy. Previous studies suggested that HIV infection is an independent risk factor for atrial arrhythmia. This study aims to collectively analyze these studies to elucidate the incidence and risk factors of atrial arrhythmia in PLWH. Full-text assessments and data extraction were performed from available literature. Atrial arrhythmia was defined as atrial fibrillation or atrial flutter. Incidence rate, risk, and potential risk factors of atrial arrhythmia in PLWH were catalogued, after which random-effects models were used to estimate pooled summary statistics. PRISMA standardized meta-analysis guidelines were followed. Analysis of 94,928 PLWH had an averaged incidence rate of 6.4 cases of atrial arrhythmia per 1000 person-years. Risk of atrial arrhythmia was significantly higher in PLWH than in the general population (RR 1.35; 95% CI 1.19-1.53). Sex had no association with the risk of incidental atrial arrhythmia in PLWH (RR 1.47; 95% CI 0.95-2.28). Black race (RR 0.68; 95% CI 0.47-0.97) was associated with decreased risk, whereas lower CD4 counts (RR 1.80; 95% CI 1.18-2.77) and increased viral load (RR 1.57; 95% CI 1.19-2.09) suggested increased risk of atrial arrhythmia in PLWH. HIV infection is a risk factor of atrial arrhythmia. Providers should be aware of the increased burden of atrial arrhythmia in PLWH and continue to encourage treatment of HIV infection while managing cardiovascular risk factors and screening for arrhythmias in symptomatic patients.

MO832: Survival of Dialysis Patients With Cardiovascular Comorbidity

Abstract BACKGROUND AND AIMS Kidney disease is associated with a huge economic burden. High-income countries spend up to 2%–3% of their annual health care budget on end-stage kidney disease. Even if <0.03% of the total population receive such treatment. In 2010, 2.62 million people worldwide received dialysis, and the demand for dialysis is projected to double by 2030. The most common cause of death in patients with CKD is complications from cardiovascular disease. They are the main factor determining the decrease in the effectiveness of renal replacement therapy, especially among young and middle-aged people. Mortality from cardiovascular disease in people with end-stage CKD is 10–30 times higher than in the general population. Purpose of the work: to comparatively study the survival rates in dialysis patients, depending on the presence of cardiovascular diseases. METHOD In our study, we conducted a prospective cohort study of 210 patients (117 men and 93 women) in three different dialysis centers in Uzbekistan. The study lasted 36 months (from January 2018 to December 2020). The average age was 49.2 ± 13.8 years. The main primary diseases were glomerulonephritis (44%), diabetes mellitus (29%) and urolithiasis (7%). The duration of hemodialysis at the time of enrollment of patients in the study ranged from 6 to 172 months. Among the examined dialysis patients, 53% (n = 112) of patients (62 men and 50 women) had CVD and 47% (n = 98) of patients (52 men and 46 women) had no CVD. The main CVDs were arterial hypertension, ischemic heart disease, heart failure and various arrhythmias. Survival was determined by the Kaplan–Meier method. The [95% confidence interval (95% CI)] was determined using the Greenwood method. RESULTS After 36 months of follow-up, 43.8% (n = 92) of all patients died, 56.2% (n = 118) of patients survived (17 of them underwent kidney transplantation). When analyzing the causes of mortality, the main causes of death in dialysis patients were sudden cardiac death, acute respiratory failure, acute cerebrovascular accident, coma and acute bleeding. In dialysis patients with CVD, sudden cardiac death was 67% (n = 42) of all causes of death, while in patients without CVD, it was 57% (n = 17). The average age of the deceased (54.2 ± 1.4) was significantly higher than in patients continuing to receive HD (44.3 ± 1.1). The average duration of hemodialysis in the survivors (34.1 ± 4.7) was higher than in the deceased (27.6 ± 2.8). Upon further analysis of these patients, it was found that among the deceased patients, 70.6% (n = 65) of the patients were patients with cardiovascular diseases, and among the survivors, 54.3% (n = 64) had no cardiovascular diseases. Among those continuing to receive dialysis, there were 32.6% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within 36 months of prospective follow-up, there were 38.7% more deaths than in patients without CVD. The survival rate of patients with CVD was 0.44 (95% CI 0.33–0.51), and in patients without CVD it was 0.65 (95% CI 0.52–0.74). CONCLUSION Our scientific research has shown that >70% of dialysis patients with CKD die due to cardiovascular disease. The main place in the structure of mortality is taken by sudden cardiac death, which is the cause of death in 67% of deceased patients. Cardiovascular comorbidity adversely affects the survival of dialysis patients in Uzbekistan. In dialysis patients without cardiovascular disease in our country, the survival rate is >30% higher than in patients with CVD.

Metformin for Preventing Progression From Prediabetes to Diabetes Mellitus in People Living With Human Immunodeficiency Virus.

BackgroundDiabetes mellitus (DM) and human immunodeficiency virus (HIV) itself increase the risk for cardiovascular diseases in people living with HIV (PLHIV). Prediabetes, a condition preceding DM, is common in PLHIV receiving antiretroviral therapy (ART). Both metformin and lifestyle interventions have been established to reduce the risk of progression from prediabetes to DM in the general population. This study aimed to evaluate the efficacy of metformin for preventing DM in prediabetic PLHIV.MethodsAn open-label randomized controlled clinical trial was conducted in HIV-positive persons with prediabetes. The participants were randomized into two groups: the metformin group (received metformin) and the control group (did not receive metformin). All participants were counseled regarding diet control and lifestyle modification and followed for 12 months. The primary endpoint was the development of DM. Fasting plasma glucose (FPG), two-hour plasma glucose (2-h PG) after 75 g oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), and computer-based homeostatic model assessment index of beta-cell function (HOMA%B) and insulin resistance (HOMA-IR) were analyzed.ResultsSeventy-four participants were enrolled, 37 in each group. The mean age was 49.6 years, and 68.9% were males. At baseline, the mean CD4 cell count was 570 cells/mm3, and the mean body mass index (BMI) was 24.6 kg/m2. Baseline characteristics including age, sex, BMI, waist/hip ratio, duration of ART, ART regimen, CD4 cell count, and HIV RNA were similar between the two groups. The mean FPG, 2-h PG, HbA1c, HOMA%B, and HOMA-IR at baseline were also similar between the two groups. At 12 months, one participant in the metformin group and three in the control group developed DM (risk reduction: 5.41%; 95% confidence interval (CI): −6.92%-18.78%). When we compared changes in parameters between the two groups, there were trends toward more changes in HbA1c (DeltaHbA1c) at both six months (metformin group versus control group: -0.17% ± 0.20% versus 0.02% ± 0.58%; p = 0.074) and 12 months (metformin group versus control group: -0.05% ± 0.23% versus 0.06% ± 0.27%; p = 0.065). When we considered changes in all parameters in each group, the metformin group had significant reductions in body weight (BW) and BMI at both six and 12 months, and significant reductions in HbA1c and HOMA-IR at six months. No participant had adverse effects that led to the discontinuation of metformin. No cardiovascular event was observed during the study period.ConclusionsMetformin tends to improve HbA1c and insulin resistance and may prevent progression from prediabetes to DM in HIV-positive persons with prediabetes. A further large study with a longer study period is needed to evaluate the long-term benefit of metformin.

Serum metabolomic profiles associated with subclinical and clinical cardiovascular phenotypes in people with type 2 diabetes

BackgroundAtherosclerotic cardiovascular diseases (CVD) is the leading cause of death in diabetes, but the full range of biomarkers reflecting atherosclerotic burden and CVD risk in people with diabetes is unknown. Metabolomics may help identify novel biomarkers potentially involved in development of atherosclerosis. We investigated the serum metabolomic profile of subclinical atherosclerosis, measured using ankle brachial index (ABI), in people with type 2 diabetes, compared with the profile for symptomatic CVD in the same population.MethodsThe Edinburgh Type 2 Diabetes Study is a cohort of 1,066 individuals with type 2 diabetes. ABI was measured at baseline, years 4 and 10, with cardiovascular events assessed at baseline and during 10 years of follow-up. A panel of 228 metabolites was measured at baseline using nuclear magnetic resonance spectrometry, and their association with both ABI and prevalent CVD was explored using univariate regression models and least absolute shrinkage and selection operator (LASSO). Metabolites associated with baseline ABI were further explored for association with follow-up ABI and incident CVD.ResultsMean (standard deviation, SD) ABI at baseline was 0.97 (0.18, N = 1025), and prevalence of CVD was 35.0%. During 10-year follow-up, mean (SD) change in ABI was + 0.006 (0.178, n = 436), and 257 CVD events occurred. Lactate, glycerol, creatinine and glycoprotein acetyls levels were associated with baseline ABI in both univariate regression [βs (95% confidence interval, CI) ranged from − 0.025 (− 0.036, − 0.015) to − 0.023 (− 0.034, − 0.013), all p < 0.0002] and LASSO analysis. The associations remained nominally significant after adjustment for major vascular risk factors. In prospective analyses, lactate was nominally associated with ABI measured at years 4 and 10 after adjustment for baseline ABI. The four ABI-associated metabolites were all positively associated with prevalent CVD [odds ratios (ORs) ranged from 1.29 (1.13, 1.47) to 1.49 (1.29, 1.74), all p < 0.0002], and they were also positively associated with incident CVD [ORs (95% CI) ranged from 1.19 (1.02, 1.39) to 1.35 (1.17, 1.56), all p < 0.05].ConclusionsSerum metabolites relating to glycolysis, fluid balance and inflammation were independently associated with both a marker of subclinical atherosclerosis and with symptomatic CVD in people with type 2 diabetes. Additional investigation is warranted to determine their roles as possible etiological and/or predictive biomarkers for atherosclerotic CVD.

Aspirin to target arterial events in chronic kidney disease (ATTACK): study protocol for a multicentre, prospective, randomised, open-label, blinded endpoint, parallel group trial of low-dose aspirin vs. standard care for the primary prevention of cardiovascular disease in people with chronic kidney disease

BackgroundChronic kidney disease (CKD) is a very common long-term condition and powerful risk factor for cardiovascular disease (CVD).Low-dose aspirin is of proven benefit in the secondary prevention of myocardial infarction (MI) and stroke in people with pre-existing CVD. However, in people without CVD, the rates of MI and stroke are much lower, and the benefits of aspirin in the primary prevention of CVD are largely balanced by an increased risk of bleeding.People with CKD are at greatly increased risk of CVD and so the absolute benefits of aspirin are likely to be greater than in lower-risk groups, even if the relative benefits are the same. Post hoc evidence suggests the relative benefits may be greater in the CKD population but the risk of bleeding may also be higher. A definitive study of aspirin for primary prevention in this high-risk group, recommended by the National Institute for Health and Care Excellence (NICE) in 2014, has never been conducted. The question has global significance given the rising burden of CKD worldwide and the low cost of aspirin.MethodsATTACK is a pragmatic multicentre, prospective, randomised, open-label, blinded endpoint adjudication superiority trial of aspirin 75 mg daily vs. standard care for the primary prevention of CVD in 25,210 people aged 18 years and over with CKD recruited from UK Primary Care.Participants aged 18 years and over with CKD (GFR category G1-G4) will be identified in Primary Care and followed up using routinely collected data and annual questionnaires for an average of 5 years. The primary outcome is the time to first major vascular event (composite of non-fatal MI, non-fatal stroke and cardiovascular death [excluding confirmed intracranial haemorrhage and other fatal cardiovascular haemorrhage]). Deaths from other causes (including fatal bleeding) will be treated as competing events. The study will continue until 1827 major vascular events have occurred. The principal safety outcome is major intracranial and extracranial bleeding; this is hypothesised to be increased in those randomised to take aspirin. The key consideration is then whether and to what extent the benefits of aspirin from the expected reduction in CVD events exceed the risks of major bleeding.DiscussionThis will be the first definitive trial of aspirin for primary CVD prevention in CKD patients. The research will be of great interest to clinicians, guideline groups and policy-makers, in the UK and globally, particularly given the high and rising prevalence of CKD that is driven by population ageing and epidemics of obesity and diabetes. The low cost of aspirin means that a positive result would be of relevance to low- and middle-income countries and the impact in the developed world less diluted by any inequalities in health care access.Trial registrationISRCTN: ISRCTN40920200. EudraCT: 2018-000644-26. ClinicalTrials.gov: NCT03796156

IDF21-0383 Circulating GDF15 Predicted Mortality in Aging Chinese People with Type 2 Diabetes: Findings from Da Qing Diabetes Study

Background: Growth differentiation factor 15 (GDF15) is a member of the transforming growth factor-β (TGF-β) superfamily. In people with type 2 diabetes, GDF15 is elevated and related to diabetic complications, such as diabetic retinopathy, and diabetic nephropathy. While the association of GDF15 and major adverse cardiovascular events (MACE) is not significant after adjustment of cardiovascular risk factors. A Mendelian randomization study also reported that GDF15 was not associated with type 2 diabetes and coronary artery disease risk factors. Therefore, the relationship between GDF15 and cardiovascular diseases in people with type 2 diabetes still need more studies to confirm. Aim: This study aims to investigate the relationship between circulating GDF15 and mortality including all-cause, cardiovascular, and cancer death in Chinese aging people with type 2 diabetes using the long-term follow-up data of the Da Qing Diabetes Study. Method: A total of 510 subjects from the Da Qing Diabetes Study with type 2 diabetes were enrolled in the present study. The circulating GDF15 in 2006 or 2009 were assessed. Outcomes of all-cause, cardiovascular, and cancer mortality were followed in 2016 (mean follow-up of 7.5 years). Time-to-event survival curves for each outcome were created using the cumulative incidence method, and comparisons between the groups were performed with log-rank tests. Cox proportional hazards regression was used for the estimation of hazard ratios (HRs) and their 95% confidence intervals (CIs) for death. Results: At the end of the follow-up, 143 (28.0%) subjects died and 54.5% (78/143) were cardiovascular death. The cumulative incidence of all-cause death in the third tertile group was higher than that in the lowest level group (58.6% [95% CI 43.7 – 73.6] vs 19.6% [95% CI 12.7 – 26.5], log-rank p < 0.0001). Compared to the first tertile group of GDF15, the risk of all-cause death (HR = 3.27, 95% CI [1.90 – 5.64]), and cardiovascular death (HR = 3.11, 95% [1.45 – 6.67]) in the third tertile group increased more than two folds, even after adjustment of age, sex, smoking, SBP, LDL-c, HbA1c, duration of diabetes, and CVD history. Increased GDF15 level (per 1 SD increase) related to a higher risk of cancer death in all subjects (HR = 2.25, 95%CI [1.34 – 3.80]) and those without CVD (HR = 2.88, 95%CI [1.59 – 5.24]) after adjustment of traditional risk factors. Discussion: In the present study, an elevated level of GDF15 is related to the higher risk of all-cause, cardiovascular, and cancer death in Chinese aging people with type 2 diabetes. The results of all-cause and cardiovascular death were consistent regardless of CVD history. Expression of GDF15 was upregulated in response to many stimuli, and involved in cell stress, such as responding to ischemia in cultured cardiomyocytes. The substantial mechanism may be the protective role of GDF15 in the disease process, including insulin resistance regulation, anti-apoptosis, and anti-inflammation. These data provide more insight into the prevention of diabetic complications especially the primary and secondary prevention of cardiovascular death. The predictive power of GDF15 deserves more attention.

Comparative effectiveness of statins on non-high density lipoprotein cholesterol in people with diabetes and at risk of cardiovascular disease: systematic review and network meta-analysis

ObjectiveTo compare the efficacy of different statin treatments by intensity on levels of non-high density lipoprotein cholesterol (non-HDL-C) for the prevention of cardiovascular disease in people with diabetes.DesignSystematic review and...

Chronic obstructive pulmonary disease and atherosclerosis: common mechanisms and novel therapeutics.

Chronic obstructive pulmonary disease (COPD) and atherosclerosis are chronic irreversible diseases, that share a number of common causative factors including cigarette smoking. Atherosclerosis drastically impairs blood flow and oxygen availability to tissues, leading to life-threatening outcomes including myocardial infarction (MI) and stroke. Patients with COPD are most likely to die as a result of a cardiovascular event, with 30% of all COPD-related deaths being attributed to cardiovascular disease (CVD). Both atherosclerosis and COPD involve significant local (i.e. lung, vasculature) and systemic inflammation and oxidative stress, of which current pharmacological treatments have limited efficacy, hence the urgency for the development of novel life-saving therapeutics. Currently these diseases must be treated individually, with no therapies available that can effectively reduce the likelihood of comorbid CVD other than cessation of cigarette smoking. In this review, the important mechanisms that drive atherosclerosis and CVD in people with COPD are explained and we propose that modulation of both the oxidative stress and the inflammatory burden will provide a novel therapeutic strategy to treat both the pulmonary and systemic manifestations related to these diseases.

Personalising activity to target peak hyperglycaemia and improve cardiometabolic health in people with type 2 diabetes: protocol for a randomised controlled trial

IntroductionThe benefits of physical activity for glycaemic control in type 2 diabetes (T2D) are well-known. However, whether established glycaemic and cardiovascular benefits can be maximised by exercising at a certain...

Influence of first- and second-generation antipsychotics on anthropometric parameters of male psychiatric patients.

BackgroundThe use of antipsychotic medication, particularly second generation antipsychotics (SGAs) is a major risk factor for cardiovascular disease in people with severe mental illness (SMI). Few studies have compared body measures of people with SMI taking first generation antipsychotics (FGAs) to those taking SGAs.AimWe compare body measures between long-term male inpatients using either FGAs or SGAs.SettingThe study was conducted at Weskoppies Psychiatric Hospital, in Pretoria, Gauteng.MethodsA total of 30 patients were selected from a list of male inpatients and were included in our study. Each participant had the following anthropometric measures done and these were compared between the two groups: Waist circumference (WC), body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and hip circumference (HC). Hospital records were used to record demographic variables, diagnosis, comorbid disease and psychotropic medication for each participant.ResultsParticipants in the FGA and SGA groups had similar body measures, resulting in similar BMI, WHR and WHtR. Participants had a mean HC of 100.5 cm, 95% confidence interval (CI) (97.68, 103.22). BMI ranged from 21.87 kg/m² to 37.65 kg/m², with an overall mean of 28.5 kg/m², 95% CI (26.69, 30.22). Participants had a mean WHtR of 0.59, 95% CI (0.56, 0.61). Participants had a mean WC of 100.6 cm and 95% CI (96.26, 104.87), and the mean WHR of both groups was 1.0.ConclusionParticipants using FGAs and SGAs had similar body measures, and these indicated that this sample of male inpatients with SMI is at high risk for CVD.

Influence of first- and second-generation antipsychotics on anthropometric parameters of male psychiatric patients

Background: The use of antipsychotic medication, particularly second generation antipsychotics (SGAs) is a major risk factor for cardiovascular disease in people with severe mental illness (SMI). Few studies have compared body measures of people with SMI taking first generation antipsychotics (FGAs) to those taking SGAs. Aim: We compare body measures between long-term male inpatients using either FGAs or SGAs. Setting: The study was conducted at Weskoppies Psychiatric Hospital, in Pretoria, Gauteng. Methods: A total of 30 patients were selected from a list of male inpatients and were included in our study. Each participant had the following anthropometric measures done and these were compared between the two groups: Waist circumference (WC), body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and hip circumference (HC). Hospital records were used to record demographic variables, diagnosis, comorbid disease and psychotropic medication for each participant. Results: Participants in the FGA and SGA groups had similar body measures, resulting in similar BMI, WHR and WHtR. Participants had a mean HC of 100.5 cm, 95% confidence interval (CI) (97.68, 103.22). BMI ranged from 21.87 kg/m² to 37.65 kg/m², with an overall mean of 28.5 kg/m², 95% CI (26.69, 30.22). Participants had a mean WHtR of 0.59, 95% CI (0.56, 0.61). Participants had a mean WC of 100.6 cm and 95% CI (96.26, 104.87), and the mean WHR of both groups was 1.0. Conclusion: Participants using FGAs and SGAs had similar body measures, and these indicated that this sample of male inpatients with SMI is at high risk for CVD.

Cardiovascular diseases in people with diabetes mellitus in Spain according to the Primary Care Clinical Database (BDCAP) in 2017

Introduction and objectivesAtherosclerotic cardiovascular disease and heart failure are the leading cause of morbidity and mortality in patients with diabetes. The objective of this work is to know the prevalence of atherosclerotic cardiovascular diseases and heart failure in people diagnosed with diabetes in Spain during 2017 and compare them with those not diagnosed with diabetes according to age and sex. MethodsData for diagnoses of diabetes mellitus (DM), acute myocardial infarction (AMI), stroke, peripheral artery disease (PAD) or heart failure (HF) for 2017 were obtained from the National Health System's Primary Care Clinical Database (BDCAP). ResultsComparing people with diabetes and people without diabetes over 35 years of age, the Odds Ratio (OR) for being diagnosed with acute myocardial infarction, stroke, peripheral artery disease or heart failure is about 2 in those over 64 years of age and more than 4 in patients under that age. This OR is superior in females versus males for all diagnoses apart from peripheral artery disease. ConclusionsThis study shows the high cardiovascular comorbidity of patients with diabetes in Spain, with a greater excess of risk in patients under 65 years of age, more pronounced in women. We should offer more intensive treatment for DM2 in women.

Machine learning models for prediction of co-occurrence of diabetes and cardiovascular diseases: a retrospective cohort study

BackgroundDiabetic mellitus (DM) and cardiovascular diseases (CVD) cause significant healthcare burden globally and often co-exists. Current approaches often fail to identify many people with co-occurrence of DM and CVD, leading to delay in healthcare seeking, increased complications and morbidity. In this paper, we aimed to develop and evaluate a two-stage machine learning (ML) model to predict the co-occurrence of DM and CVD.MethodsWe used the diabetes complications screening research initiative (DiScRi) dataset containing >200 variables from >2000 participants. In the first stage, we used two ML models (logistic regression and Evimp functions) implemented in multivariate adaptive regression splines model to infer the significant common risk factors for DM and CVD and applied the correlation matrix to reduce redundancy. In the second stage, we used classification and regression algorithm to develop our model. We evaluated the prediction models using prediction accuracy, sensitivity and specificity as performance metrics.ResultsCommon risk factors for DM and CVD co-occurrence was family history of the diseases, gender, deep breathing heart rate change, lying to standing blood pressure change, HbA1c, HDL and TC\\HDL ratio. The predictive model showed that the participants with HbA1c >6.45 and TC\\HDL ratio > 5.5 were at risk of developing both diseases (97.9% probability). In contrast, participants with HbA1c >6.45 and TC\\HDL ratio ≤ 5.5 were more likely to have only DM (84.5% probability) and those with HbA1c ≤5.45 and HDL >1.45 were likely to be healthy (82.4%. probability). Further, participants with HbA1c ≤5.45 and HDL <1.45 were at risk of only CVD (100% probability). The predictive accuracy of the ML model to detect co-occurrence of DM and CVD is 94.09%, sensitivity 93.5%, and specificity 95.8%.ConclusionsOur ML model can significantly predict with high accuracy the co-occurrence of DM and CVD in people attending a screening program. This might help in early detection of patients with DM and CVD who could benefit from preventive treatment and reduce future healthcare burden.

Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

Increased burden of cardiovascular disease in people with liver disease: unequal geographical variations, risk factors and excess years of life lost

BackgroundPeople with liver disease are at increased risk of developing cardiovascular disease (CVD), however, there has yet been an investigation of incidence burden, risk, and premature mortality across a wide range of liver conditions and cardiovascular outcomes.MethodsWe employed population-wide electronic health records (EHRs; from 1998 to 2020) consisting of almost 4 million adults to assess regional variations in disease burden of five liver conditions, alcoholic liver disease (ALD), autoimmune liver disease, chronic hepatitis B infection (HBV), chronic hepatitis C infection (HCV) and NAFLD, in England. We analysed regional differences in incidence rates for 17 manifestations of CVD in people with or without liver disease. The associations between biomarkers and comorbidities and risk of CVD in patients with liver disease were estimated using Cox models. For each liver condition, we estimated excess years of life lost (YLL) attributable to CVD (i.e., difference in YLL between people with or without CVD).ResultsThe age-standardised incidence rate for any liver disease was 114.5 per 100,000 person years. The highest incidence was observed in NAFLD (85.5), followed by ALD (24.7), HCV (6.0), HBV (4.1) and autoimmune liver disease (3.7). Regionally, the North West and North East regions consistently exhibited high incidence burden. Age-specific incidence rate analyses revealed that the peak incidence for liver disease of non-viral aetiology is reached in individuals aged 50–59 years. Patients with liver disease had a two-fold higher incidence burden of CVD (2634.6 per 100,000 persons) compared to individuals without liver disease (1339.7 per 100,000 persons). When comparing across liver diseases, atrial fibrillation was the most common initial CVD presentation while hypertrophic cardiomyopathy was the least common. We noted strong positive associations between body mass index and current smoking and risk of CVD. Patients who also had diabetes, hypertension, proteinuric kidney disease, chronic kidney disease, diverticular disease and gastro-oesophageal reflex disorders had a higher risk of CVD, as do patients with low albumin, raised C-reactive protein and raised International Normalized Ratio levels. All types of CVD were associated with shorter life expectancies. When evaluating excess YLLs by age of CVD onset and by liver disease type, differences in YLLs, when comparing across CVD types, were more pronounced at younger ages.ConclusionsWe developed a public online app (https://lailab.shinyapps.io/cvd_in_liver_disease/) to showcase results interactively. We provide a blueprint that revealed previously underappreciated clinical factors related to the risk of CVD, which differed in the magnitude of effects across liver diseases. We found significant geographical variations in the burden of liver disease and CVD, highlighting the need to devise local solutions. Targeted policies and regional initiatives addressing underserved communities might help improve equity of access to CVD screening and treatment.

АНАЛИЗ ФАКТОРОВ РИСКА РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ У ЛИЦ ТРУДОСПОСОБНОГО ВОЗРАСТА

Relevance. Cardiovascular diseases, according to the World Health Organization, are one of the leading causes of mortality among the population of developed countries of the world, including the Russian Federation. The development of cardiovascular diseases is closely related to behavioral risk factors such as smoking, unhealthy diet, insufficient physical activity and a number of other factors. The planning of preventive programs at the population level and the organization of effective preventive activities of the primary health care unit requires detailed and reliable information on the prevalence of risk factors for the development of cardiovascular diseases. Currently, there is a need to raise awareness of patients about the risk factors for the development of diseases; to increase the patient's responsibility for maintaining his health; to form skills and abilities in patients to reduce the adverse effects of behavioral risk factors The purpose to analysis of risk factors for the development of cardiovascular diseases in people of working age in the practice of medical office operating of the arterial hypertension prevention. Materials and methods. Retrospective analysis of the complex of automated integrated assessment of the state of the cardiovascular system with statistical processing of the data obtained. For qualitative indicators, the statistical criterion for the significance of differences is χ2 (chi-squared). Descriptive statistics are given in the form of N(n%), that is, the number of objects with this feature and the percentage of the total number of objects in the sample. Results. Results. In the office of prevention of arterial hypertension, the average polyclinic of the GBUZ "City Polyclinic No. 91" of the city of St. Petersburg, for 5 years (2014-2018), 983 appeals of the adult population were noted. In 807 cases, there are persons aged 18 to 65 years with risk factors for the development of cardiovascular diseases. Of these, men applied 382 times, and women 425 times, which was (47.4%) and (52.5%), respectively. According to the frequency of appeals, it was noted that people over 41 years of age were more likely to apply than younger people. Analysis of the dynamics of risk factors for the development of cardiovascular diseases in people of working age revealed that hypercholysteremia, hereditary predisposition to hypertension, are most common. Conclusions. The appeal rate of persons over 41 years of age is higher than that of younger persons. The frequency of smoking, alcohol consumption, physical inactivity, overweight and obesity is increasing in 2/3 of patients. Among the studied patients of the prevention of hypertension, hypercholesterolemia was significantly more common in women, and at the age of 18 to 40 years. And, tobacosmoking, as a factor in the development of cardiovascular diseases, was significantly more common in men over the age of 50.

Biomarkers to predict cardiovascular disease in people living with HIV.

Cardiovascular diseases (CVD) is one of the leading cause of morbidity and mortality in antiretroviral treated people living with HIV (PWH) with risk score algorithms based on traditional risk factors being shown to be consistently unreliable in estimating risk in this population. This review aims to examine recent data published in last 18-24 months exploring biomarkers that may be useful in identifying PWH at risk of developing CVD. Ongoing research explores the association of inflammatory biomarkers with subclinical CVD with few studies examining their clinical utility in improving CVD risk prediction. Further mechanistic studies explore the role of monocyte/macrophages in CVD pathogenesis with some studies examining functional assays as better predictors of CVD risk. Although persistent associations with inflammatory markers and CVD are demonstrated, few biomarkers have emerged as being clinically useful. Large population studies are needed to assess their utility in improving CVD risk prediction in PWH.