Marker Of Cardiovascular Disease Research Articles

Insulin resistance in childhood obesity: The role of dietary habits and their association with novel markers of cardiovascular disease

Background Childhood obesity presents numerous comorbidities such as insulin resistance (IR) and dyslipidemia, and could be associated with alterations in novel markers of cardiovascular (CV) risk like: (1) the activities of associated enzymes such as lipoprotein associated phospholipase A2 (Lp-PLA2) and paraoxonase 1 (PON 1), (2) reverse cholesterol transport (RCT), which comprises cellular cholesterol efflux (CCE), in addition to lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) activities, and (3) high density lipoprotein (HDL) antioxidant capacity. Moreover, IR could worsen these cardiometabolic alterations. The objective of the present study was to characterize the effect of IR on novel CV markers in a pediatric population with obesity. Methods Twenty-five obese children and adolescents with IR, and 25 without IR took part in the study. Anthropometric parameters, Tanner stage and dietary habits were registered. Glucose, insulin, non-esterified fatty acid (NEFA), lipid, and high sensitivity C reactive protein (hsCRP) levels, plus Lp-PLA2, LCAT, CETP and PON 1 activities, as well as CCE and HDL antioxidant capacity were measured. A cutoff point of 3.16 in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) determined the presence of IR. Results No differences were observed in age, sex and Tanner stage. Expectedly, the group with IR displayed higher insulin and NEFA levels (p < 0.05). They also presented increased Lp-PLA2 and decreased PON activities (p < 0.05). Importantly, these differences were associated with dietary habits (p < 0.05). Conclusion IR present in pediatric obesity associated with vascular specific inflammation and reduced PON 1 activity, in addition to alterations in glucose metabolism, thus increasing CV risk in adulthood. These proatherogenic disturbances were conditioned by dietary habits.

Relation of skinfold thickness with the serum lipids, glucose and blood pressure among Indian sedentary office workers

Background:Serum glucose, cholesterol, triglycerides and high-density lipoproteins (HDL) are established cardiovascular disease (CVD) markers, however accessibility to these markers is less in individuals from low-middle income countries. The non-invasive CVD risk marker especially skinfold measured fat percentages are less explored for its relevance with established serum biochemistry markers.Methods:A cross-sectional study was conducted in 70 sedentary office workers (aged 30–40 years) who were healthy. Peripheral fat percentages were estimated from four skinfold thickness measurements and biochemistry markers were measured and analysed using standard laboratory measurements. Blood pressure was also measured. Multivariate linear regression models were drawn to establish the association between the non-invasive and invasive CVD risk markers.Results:The skinfold measured fat percentage was negatively associated with the HDL (coefficient β = -0.15, standard error SE = 0.07, p < 0.05). No significant relation between the other biochemistry parameters with the skinfold thickness. Age and BMI were found to be mediating the above relationship.Conclusions:Skinfold thickness derived fat percentage is associated with the few of the CVD markers (especially HDL). Age and BMI are crucial mediating factors for the fat measurement. Skinfold measurements could be included as part of routine primary care screening for CVD risk, alongside invasive biochemistry parameters.

Reassessing cardiovascular risk stratification in men with erectile dysfunction.

Erectile dysfunction (ED) is an independent and strong marker of cardiovascular disease (CVD) risk. The Princeton Consensus aimed to evaluate and manage cardiovascular risk in men with ED and no known cardiovascular disease, focusing on identifying those requiring additional cardiologic work-up. It has recently been updated to the American population demographics, but European recommendations are needed. It was developed a cross-sectional investigation including erectile dysfunction patients. Data were collected from hospital registries. Two risk stratification models were employed and compared: Princeton Consensus Criteria (PC) and European Society of Cardiology (ESC) CVD Risk Criteria. The objective was to stress the importance of the changes in IV Princeton Consensus recommendations in stratifying CVD risk in men with erectile dysfunction using a model validated in European men. A total of 137 patients with ED, with a mean age of 57.1 years old, were included. According to the PC criteria, 39.7% of the patients were "Low Risk". When using ESC criteria, the proportion of "Low Risk" patients were significantly lower (12%, p < 0.05). Among "Low Risk" patients according to the PC, 52.5% and 20% were classified as High and Very high risk according to ESC criteria, respectively. One myocardial infarction was reported. The patient was classified as "Low Risk" according to the PC, but the ESC criteria categorized him as "high risk". PC is less sensitive than ESC recommendations detecting CVD. It raises concerns that Urologists could be overlooking patients with undiagnosed CVD, consequently missing out on opportunities for prevention of major cardiovascular events (MACEs) and premature deaths.

The Gut–Heart Axis: Effects of Intestinal Microbiome Modulation on Cardiovascular Disease—Ready for Therapeutic Interventions?

Recent reports demonstrate an association between distinct bacteria or bacteria-derived metabolites originating from the gut microbiome and the onset or progression of cardiovascular disease (CVD). This raises the opportunity to modulate the gut microbiome to prevent or treat CVD. To investigate whether intestinal microbiome modulation can prevent or treat CVD, this systematic literature review includes all randomized clinical trials on microbiome modulation and its effects on CVD risk published between August 2018 and August 2023. Within this review, we report the modulation of the gut microbiome by a variety of interventions and their effects on CVD, focusing on cardiovascular risk factors and risk markers of CVD. Beneficial effects were observed upon lifestyle intervention and probiotics use. The most promising diets for reducing risk factors of CVD were the Mediterranean diet, high-fiber diets, polyphenol-rich diets, and diets containing polyunsaturated fatty acids. Among drug interventions, only empagliflozin showed beneficial effects on CVD risk factors. Many dietary interventions were less conclusive because of the heterogeneity of study populations, small sample sizes, and short intervention windows or follow-up. Diet, lifestyle, probiotics, or drug interventions can modulate the gut microbiome and decrease risk markers or risk factors related to CVD. Yet, their effects on clinical endpoints remain to be determined.

Thoracic Aortic Calcification and Complex Large Aortic Arch Plaque in Patients with Chronic Coronary Syndrome.

Aortic arch plaque (AAP) morphology and complexity can serve as markers of atherosclerotic cardiovascular disease. This study investigated 1) the diagnostic value of the thoracic aortic calcification (TAC) score for detecting AAP and large complex AAP and 2) the prognostic significance of TAC in patients with chronic coronary syndrome (CCS). The predictors of AAPs with large (≥ 4 mm in thickness) and complex (ulcerated or protruded) morphologies were evaluated in 412 symptomatic patients with CCS who underwent coronary computed tomography angiography and simultaneous assessment of the aortic arch. Receiver operating curve analysis was performed to determine whether the TAC score can improve the diagnostic value of complex large AAP compared with clinical parameters. Multivariate logistic regression analyses revealed that the TAC score was an independent predictor of complex large AAP (odds ratio, 1.46; P = 0.0074). The area under the curve (AUC) for the base model comprising clinical parameters (age ≥ 70 years + current smoking status + systolic blood pressure) was 0.707 (P = 0.0177). The addition of a TAC score of ≥ 978 Agatston units (AUC, 0.744) significantly improved the AUC (AUC, 0.751, P < 0.001) for patients aged ≥ 70 years (AUC, 0.638). The multivariable Cox hazard model revealed that TAC of ≥ 432.4 (hazard ratio [HR], 4.312; P = 0.01) and large complex AAP are independently associated with the incidence of major adverse cardiovascular events (HR, 3.108; P = 0.011). This study demonstrated that TAC and AAP morphology serve as markers of major adverse cardiovascular events. The combination of advanced age, TAC score, and obstructive CAD exhibited robust diagnostic accuracy in detecting complex large AAP.

Impact of white matter hyperintensity volume on cognition among US Mexican American adults.

Higher white matter hyperintensity (WMH) volume is a marker of cardiovascular disease (CVD) risk. CVD risk factors increase risk for Alzheimer's disease and related dementias (ADRD). Mexican Americans (MA) and individuals of other Hispanic/Latino heritages have higher risk for CVD and ADRD. However, knowledge of associations between WMH volume and cognition in these groups remains limited. We conducted a cross-sectional study of associations between WMH volume and neuropsychological performance (attention/executive functioning, memory) in MA (n = 851) and non-Hispanic White (NHW; n = 747) adults in the Health and Aging Brain Study: Health Disparities. The MA group (mean age = 63.72 ± 7.90 years; 66.3% female) had higher rates of consensus diagnoses of hypertension and diabetes, whereas the NHW group (mean age = 69.18 ± 8.65 years; 55.2% female) had higher rates of diagnosed CVD (ps < .01). WMH volumes were higher among individuals with CVD risk factors/conditions (ps < .01). There were differential associations between WMH and neuropsychological performance across ethnoracial groups (ps < .001), wherein associations were steeper in the NHW group than in the MA group. Lower educational level was associated with higher WMH volume in the NHW group (p < .001), but no association was seen in the MA group (p > .05). Negative effects of pathological changes in the form of WMH on cognition may be less robust or consistent for MA adults than NHW adults. Furthermore, the impact of WMH on cognition in NHW adults may be mitigated by cognitive reserve related to educational attainment.

Investigating the Role of C-Reactive Protein/Albumin Ratio in the Preliminary Diagnosis of Patients With Unexplained Neck Lymphadenopathy.

Purpose: Lymphadenopathies in the neck are associated with several etiological factors, such as inflammation, infection, and tumors. We diagnose some of these lymphadenopathies using serologic tests, while others are diagnosed using biopsies. The C-reactive protein/albumin ratio (CAR) has recently emerged as a crucial inflammatory marker in cardiovascular diseases and various types of cancer. Our aim in this study was to investigate the role of the CAR in the preliminary diagnosis of patients with unexplained neck lymphadenopathy. Methods: Between 2013 and 2020, 223 patients presented to our clinic with neck lymphadenopathy. Among these patients, whose cause of lymphadenopathy was not identified, 74 patients (8 children, 66 adults) who underwent neck lymphadenopathy excision were included in the study. Patients were divided into 4 groups according to pathology results: (1) patients with reactive lymphoid hyperplasia; (2) patients with granulomatous disease; (3) patients with lymphoma; and (4) patients with metastatic disease. C-reactive protein (CRP), albumin, and CAR values were compared. Results: When the CAR of the patients were compared, a significant difference was found between reactive lymphoid hyperplasia and lymphomas (P = .006). CRP values were significantly higher in lymphomas than in lymphoid hyperplasia (P = .007). When the albumin values of the patients were compared, it was found that the albumin value was significantly lower in patients with metastatic disease than in those with reactive lymphoid hyperplasia (P = .032). Patients with carcinoma metastases were more common in male patients than in other groups. Conclusion: The CAR is a parameter that can be used in the preliminary diagnosis of unexplained neck lymphadenopathy. The elevation should be evaluated in favor of malignancy. It can be used as an auxiliary parameter, particularly in the diagnosis between the preliminary diagnosis of reactive lymphoid hyperplasia and lymphoma.

Abstract 4138647: Opportunistic Screening for Cardiovascular Risk Using Chest X-Rays and Deep Learning: Associations with Coronary Artery Disease in the Project Baseline Health Study and Mass General Brigham Biobank

Introduction/Background: We previously demonstrated that an open-source deep learning model (CXR-CVD Risk) can predict 10-year major adverse cardiovascular events (myocardial infarction&amp;stroke), based on a chest radiograph image (CXR). As deep learning models are black boxes, establishing the biological processes the model captures to predict risk may help build understanding and trust in the model. Research Questions/Hypothesis: To test associations between deep-learning derived CXR-CVD Risk and markers of cardiovascular disease including coronary artery calcium (CAC) and stenosis ≥50% on CT, systolic blood pressure (SBP), ankle brachial index (ABI), and prevalent myocardial infarction and stroke. Methods/Approach: We conducted external validation of CXR-CVD-Risk in two cohorts: 1) 2,097 volunteers in the Project Baseline Health Study (PBHS) and 2) 1,644 Mass General Brigham Biobank (MGBB) patients. The CXR-CVD-Risk model estimated 10-year cardiovascular event risk (probability between 0 and 1) from a CXR image. We calculated linear associations with SBP, ABI, and the logarithm of coronary artery calcium and odds ratios for prevalent hypertension, myocardial infarction, stroke, and, in the MGBB, coronary artery stenosis ≥50%. Analyses were adjusted for age, BMI, sex, smoking status, and enrolling site. Results/Data: CXR-CVD-Risk was associated with CAC in both populations (PBHS: 1.11-fold increase, 95% CI: [1.07-1.16]; MGBB: 1.03-fold increase [1.01-1.05] in CAC per 1% increase in CXR-CV-Risk). CXR-CVD-Risk was also associated with SBP (0.59 mmHg increase [0.24-0.93] in SBP per 1% increase in CXR-CV-Risk), history of hypertension, history of myocardial infarction, and stroke. There was an inverse association with ABI (0.010 decrease [0.005-0.014] in ABI) in the PBHS. In the MGBB, CXR-CVD-Risk was associated with coronary artery stenosis ≥50% (OR = 1.004 [1.002-1.007]). All estimates are after covariate adjustment. Conclusion: This deep learning CXR risk score was associated with coronary artery disease (calcium score and stenosis ≥50%), CVD risk factors, and prevalent CVD. Opportunistic screening using CXRs in the electronic record can identify patients at high risk of CVD who may benefit from prevention.

The triglyceride-glucose index as an indicator of latent atherogenicity of the plasma lipid profile in healthy men with normolipidaemia

ABSTRACT Objectives The triglyceride-glucose (TyG) index is a novel diagnostic marker for various metabolic and cardiovascular diseases. However, little is known about the association of the TyG index with plasma atherogenicity, especially with its latent forms. The aim of this study was to assess the potential of the use of the TyG index as a marker of atherogenic risk. Methods A total of 202 men with normolipidaemia, aged 20–60 years, were enrolled in this study. Fasting biochemical parameters were measured. The TyG index was calculated as ln[triglyceride(mg/dL)×glucose(mg/dL)]/2. The diagnostic ability of the TyG index for detecting atherogenic risk was tested by receiver operating characteristic (ROC) curve analysis. Results A substantial portion of normolipidaemic men had deviations from the reference values for the indices calculated using apolipoproteins. Unfavorable values for the apolipoprotein (apo) B/apoA-I ratio, low-density lipoprotein cholesterol/apoB (LDL-C/apoB) ratio, and the atherogenic index (ATH index) were observed in 32.7%, 31.7%, and 14.4% of men, respectively. The results of ROC curve analysis showed that the TyG index had good diagnostic ability for identifying unfavorable apolipoprotein indices in normolipidaemic men. Conclusions Thus, the TyG index can be a valuable additional marker for assessing latent atherogenic risk; it can provide useful information for the diagnosis and treatment of early atherosclerosis.

Sex-Specific Changes in Cardiac Function and Electrophysiology During Progression of Adenine-Induced Chronic Kidney Disease in Mice.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) often co-exist, with notable sex-dependent differences in manifestation and progression despite both sexes sharing similar risk factors. Identifying sex-specific diagnostic markers in CKD-induced CVD could elucidate why the development and progression of these diseases differ by sex. Adult, C57BL/6J male and female mice were fed a high-adenine diet for 12 weeks to induce CKD, while control mice were given a normal diet. Adenine-treated males showed more severe CKD than females. Cardiac physiology was evaluated using electrocardiogram (ECG) and echocardiogram markers. Only adenine-treated male mice showed markers of left ventricular (LV) hypertrophy. Adenine males showed markers of LV systolic and diastolic dysfunction throughout regimen duration, worsening as the disease progressed. Adenine males had prolonged QTc interval compared to adenine females and control males. We identified a new ECG marker, Speak-J duration, which increased with disease progression and appeared earlier in adenine-treated males than in females. We identified sex-dependent differences in cardiac structure, function, and electrophysiology in a CKD-induced CVD mouse model, with adenine-treated males displaying markers of LV hypertrophy, dysfunction, and electrophysiological changes. This study demonstrates the feasibility of using this model to investigate sex-dependent cardiac differences resulting from CKD.

Early Diagnosis of Subclinical Atherosclerosis in Asymptomatic Type 2 Diabetic Normotensive Menopausal Women: A Global Pulse Wave Velocity Study

AbstractArterial stiffness serves as a cardiovascular disease marker, aiding in the early identification of high-risk patients. We aimed to evaluate the prevalence of arterial stiffness, measured by global pulse wave velocity (gPWV), among diabetic normotensive menopausal women (DPMW) and its correlation with levels of glycosylated hemoglobin (HbA1c). We recruited 641 consecutive DPMW diagnosed with type 2 diabetes over 5 years. The control group (CG) consisted of 300 normotensive, normoglycemic menopausal women. Normal gPWV was defined as a velocity ≤7.1 m/s. We enrolled 641 DPMW with a mean age of 57 ± 12 years. The CG comprised 300 normotensive, normoglycemic postmenopausal women with a mean age of 56 ± 4 years. Among DPMW, 29 (4.5%) exhibited increased gPWV compared with 4 (1.3%) in the CG (p &lt; 0.01). Of the 225 (35.1%) DPMW with HbA1c &gt; 7.5%, 23 (10.2%) had increased gPWV. In contrast, among the 416 (64.9%) DPMW with HbA1c &lt; 7.5%, only 6 (1.4%) had increased gPWV (p &lt; 0.0001). Electrocardiographic (ECG) abnormalities were detected in 208 (32.4%) DPMW, with 11 (5.3%) of them exhibiting increased gPWV (p = 0.6). There was a higher prevalence of increased gPWV in asymptomatic normotensive DPMW, with a significant association between increased gPWV and elevated HbA1c levels. However, there was no correlation between increased gPWV and abnormal ECG findings, despite ECG being the sole test recommended by current guidelines for all diabetic patients. Early detection of elevated HbA1c levels and increased gPWV may identify asymptomatic DPMW at higher cardiovascular risk, highlighting the inadequacy of a simple ECG in assessing cardiovascular risk in this population.

CT-Defined Coronary Artery Calcification as a Prognostic Marker for Overall Survival in Lung Cancer: A Systematic Review and Meta-analysis

Rationale and ObjectivesCoronary artery calcification (CAC) can be quantified by computed tomography (CT). It is an important predictive and prognostic imaging marker for cardiovascular disease. The prognostic role for CAC in oncological patients is provided in preliminary studies, especially in lung cancer patients. The aim of the present study was to establish the effect of CAC score on overall survival (OS) in lung cancer patients based on the published literature Materials and MethodsLiterature databases were screened for papers analyzing the association between CAC and overall survival in lung cancer patients up to June 2024. The primary endpoint of the present systematic review was the OS. Overall, 7 studies were suitable for the analysis and were included. ResultsThe included studies comprised 2292 patients. The pooled hazard ratio for the association between CAC score and OS was HR=1.42 (95% CI=(1.19; 1.69), p<0.0001) in the univariable analysis and HR=1.56 (95% CI=(1.25; 1.94), p<0.0001) in the multivariable analysis. The pooled odds ratio for the association between CAC score and major cardiovascular events was OR=1.97 (95% CI=(1.24; 3.13)], p=0.004. ConclusionCT-defined CAC has a meaningful impact on overall survival and prediction of major cardiovascular events in lung cancer patients undergoing curative treatment. The sole presence of CAC on staging CT should be reported as an important prognostic marker in these patients.

Association between perceived discrimination and pulse wave velocity: a scoping review

Racial discrimination is a chronic stressor that may contribute to cardiovascular disease (CVD) disparities in non-Hispanic Black (NHB) adults. NHB adults experience greater perceived discrimination (PD) and CVD risk compared with non-Hispanic White adults. Although the association between PD and some subclinical CVD markers has been examined, the relationship between PD and arterial stiffness has not been established, limiting our understanding of the impact of PD on CVD.ObjectiveThe objective of this review was to summarise the literature on the relationship between PD and arterial stiffness.DesignSystematic scoping review.Data sourcesPubMed, Embase, SPORTDiscus with full text and CINALH+ with full text databases were searched from inception to 10 July 2023.Eligibility criteriaAdults (≥18 years), arterial stiffness measured as pulse wave velocity (PWV), PD assessment, and randomised control trial or observational study designs.Data extraction and synthesisOf 453 articles identified, four studies were included. Two studies were cross-sectional (United States, Brazil), one was longitudinal (United Kingdom), and another was a randomized control trial (United States).ResultsThe age of the study populations ranged from 18 years to 75 years and one study evaluated a clinical population. All studies used different PWV devices and PD assessments. Associations between PD and PWV varied by geographical region, sex, clinical status and study design.ConclusionResearch evaluating the association between PD and PWV is scarce and heterogeneous in PD and PWV assessments. There is an inconclusive association between PD and PWV.

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.

Serum Levels of Trace Elements (Magnesium, Iron, Zinc, Selenium, and Strontium) are Differentially Associated with Surrogate Markers of Cardiovascular Disease Risk in Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD), which is attributed to inflammatory processes that accelerate atherosclerosis. Therefore, the exploration of novel biomarkers association is needed. This study investigated the associations between serum trace elements (Fe, Zn, Mg, Se, and Sr) and surrogate markers of CVD in 219 RA patients and compared them with those with metabolic disorders (MetD, n = 82) and control participants (n = 64). Surrogate markers included carotid intima-media thickness (cIMT), carotid plaque presence (cPP), pulse wave velocity (PWV), distensibility (DIST), and the augmentation index (AIx). RA patients displayed heightened inflammatory markers, increased arterial stiffness and thickness, and elevated CV risk factors. Compared with those in control participants, Se levels in RA patients were lower, regardless of sex. Women and men with RA had lower Sr and Mg levels than those with MetD, respectively. Backward regression models demonstrated inverse associations of Sr and Zn with cIMT in men with RA and those with MetD, respectively. In RA patients, Sr and Zn were predictors of an increased AIx, with sex-specific associations. Increased Fe levels were associated with an increased AIx in women with MetD. Fe and Zn were predictors of increased cIMT in control participants, with sex-specific associations. Serum trace elements are independently associated with surrogate markers of CVD in patients with RA, highlighting their potential role in CV risk assessment. Prospective studies are essential for validating these associations and establishing optimal trace element levels for managing CVD risk in patients with RA.

Assessment and Predictors of Metabolic Syndrome in Patients of Xanthelasma Palpebrarum: An Observational Study.

Xanthelasma palpebrarum is considered to be a cutaneous marker for cardiovascular diseases, and there is a known association with hypertension, insulin resistance, diabetes mellitus, obesity, and stroke. Our aim was to study the association and identify the predictors of metabolic syndrome in patients with xanthelasma palpebrarum. An observational study was conducted on 55 patients in which patients of both sexes ages 20-70 years without any other skin condition were included after written informed consent. After history and examination, blood pressure and waist circumference were measured in all the subjects. Investigations were sent for fasting blood sugar levels and serum lipid profile. The 2006 IDF Definition of metabolic syndrome was used as assessment criteria. Among the 55 patients, metabolic syndrome was present in 23 patients (41.82%). There was a statistically significant (P<0.05) difference in the values of waist circumference (100% vs. 59.38%, P=0.0003), elevated blood pressure (82.61% vs. 9.38%, P<.0001), raised fasting blood sugar (47.83% vs. 18.75%, P=0.021), and raised triglyceride levels (56.52% vs. 25%, P=0.018) between patients with metabolic syndrome and those without. However, HDL cholesterol levels (34.78% vs. 50%, P=0.262) were comparable between groups. Also, a patient aged 41 years or more with even a single xanthelasma of more than one year's duration has a 76.1% chance of developing metabolic syndrome. Metabolic syndrome develops in a sizeable number of xanthelasma palpebrarum patients, and this therefore gives us an opportunity for early diagnosis and intervention to prevent the development of cardiovascular complications.

Amyloid beta, a marker of vascular aging and cardiovascular disease, is associated with accelerated progression of renal dysfunction

Abstract Background Amyloid-beta (1-40) (Αb1-40), a proinflammatory and pro-atherosclerotic peptide, is involved in Alzheimmer’s disease and vascular aging and is considered an emerging prognostic marker of atherosclerotic cardiovascular disease (ASCVD) and heart failure. Because Ab1-40 clearance is largely dependent on renal function while clinical data consistently associate this peptide with renal function, we hypothesized that Ab1-40 circulating levels would serve as a predictor of progression of renal dysfunction. Purpose To examine the potential cross-sectional and prospective bidirectional association of Ab1-40 levels with renal function in a population with a wide range of ASCVD risk. Methods In the settings of the Athens Cardiometabolic registry, data from consecutively recruited subjects with (n=137) and without clinically overt ASCVD (n=674) with available both Ab1-40 plasma levels and GFR values (total n=811) were analyzed. Αb1-40 was measured by enzyme-linked immunosorbent assay and renal function was assessed by estimation of glomerular filtration rate (GFR). Of these subjects, 182 individuals consented to be followed up and re-assessed after a minimum period of 12 months in order to examine a potential bidirectional link between changes in Ab1-40 levels and GFR. Results Patients with increased Ab1-40 levels at baseline had significantly worse renal function, reflected as lower GFR values, compared with their counterparts with lower Ab1-40 levels (GFR= 74.8 vs 93.3 vs 100.2 ml/min/1.73m2 for high, middle and low tertile of Ab1-40 levels, p&amp;lt;0.001). Elevated Ab1-40 levels were associated with chronic kidney disease (CKD) stage 2 [odds ratio (OR)=2.29, 95% confidence intervals (CI)= 1.58-3.31, p&amp;lt;0.001] and CKD stage 3 (OR=3.67, 95% CI=2.37-5.70, p&amp;lt;0.001) at baseline. Furthermore, increased Ab1-40 at baseline was prospectively associated with accelerated progression of renal dysfunction as assessed by changes in GFR values between baseline and follow-up [mean adjusted rate of decrease=-7.20 (95% CI=-1.33, -13.07) for higher vs lowest tertiles of Ab1-40 levels across a follow-up period of 12 months, p=0.017 for interaction). On the contrary, baseline GFR values were not prospectively associated with Ab1-40 levels at follow-up visits (p&amp;gt;0.05). Conclusion In a population with a wide range of ASCVD risk, high Αb1-40 levels at baseline were associated both with renal function at baseline and with accelerated rate of progression of GFR deterioration at follow-up irrespective of its baseline levels. These findings suggest a mechanistic background for the established association of Ab1-40 with renal function and warrant further research to clarify the clinical value of monitoring its circulating levels as a novel biomarker which could reflect enhanced risk for renal dysfunction.

Correlation between LDL/HDL-cholesterol ratio and long term prognosis after acute coronary syndrome and severity of coronary artery disease

Abstract Introduction Dyslipidaemia is an important correctable risk factor for coronary artery disease (CAD). Many studies have confirmed that the lower the low-density lipoprotein cholesterol (LDL-C) levels are, the lower is the CAD morbidity and mortality rates (1). However, many patients who achieved low levels of LDL-C still experience a major adverse cardiovascular event (MACE) because of the other residual risk factors. Therefore, there is a constant need for better stratification of patients who are at higher risk for novel MACE following their first acute coronary syndrome (ACS). Evidence increasingly suggests that the ratio of LDL-C/HDL-C might be a new and better marker of cardiovascular disease, as it simultaneously evaluates the levels of both LDL-C and HDL-C (2). Purpose The aim of this study was to investigate the prediction value of LDL-C/HDL-C ratio for long term prognosis after ACS as well as its correlation with CAD severity. Methods We included patients hospitalized at out centre with ACS from January 2017 to January 2024. Demographic data, data on LDL-C and HDL-C levels on admission and calculated Syntax score were used. Syntax score is a comprehensive angiographic scoring system which determines complexity by using coronary anatomy and lesion characteristics (3). Follow-up data were collected either by clinical follow-up visits or by telephone interviews. The MACE was defined as the composite of cardiovascular death, acute coronary syndrome and need for elective or urgent percutaneous or surgical revascularization. Results This registry-based study included 2471 patients with ACS, median age of 64 (interquartile range 56-73) years, 31% female. Total of 1099 patients (44%) had non-ST elevation ACS and 1372 (54%) had ST elevation myocardial infarction (STEMI). Median Syntax score was 13 (IQR 7-20.5), with 1494 (61%) patients having low Syntax score (≤16), 508 (21%) patients medium (16-22), and 448 (18%) high score (&amp;gt;22), respectively. Median follow up was 17 (3-27) months. LDL-C/HDL-C ratio correlated significantly with cardiovascular death, with weak coefficient (2.94 vs. 2.54 p&amp;lt;0.001; rho=0.102, p&amp;lt;.0001), however did not correlate with MACE (2.88 vs. 2.92, p=0.188, rho=0.06, p=0.77). This remained identical when tested for patients with STEMI and non-STE ACS. In addition, LDL-C/HDL-C ratio did not correlate with CAD severity as assessed with Syntax score (low 2.92 vs. medium 2.83 vs. high 2.86, p=0.597; rho=0.4, p=0.09). Conclusion Our data suggest that LDL-C/HDL-C ratio cannot be used as a relevant predictor of post-ACS long-term MACE or cardiovascular death, nor it can be correlated with CAD severity. Further studies are needed to establish the real value of LDL-C/HDL-C ratio as a post-ACS predictor.

High prevalence of coronary artery calcium and aortic calcification in adults with repaired coarctation of the aorta and interrupted aortic arch

Abstract Background There is a high rate of late cardiovascular mortality in patients with repaired coarctation of the aorta (CoA) and interrupted aortic arch (IAA). Coronary artery calcium (CAC) is a marker of cardiovascular disease and there is growing evidence for aortic calcification as a predictor. Recent research in the general population suggests any CAC in males &amp;lt;35 years old and females ≤45 years places them at ≥90th percentile. Aims We aimed (1) to determine the prevalence of CAC, thoracic aorta calcification (TAC), and abdominal aorta calcification (AAC) in patients with CoA or IAA repair, and (2) to compare patients to a control group of Tetralogy of Fallot (TOF) patients, a condition with no known increased risk of atherosclerotic cardiovascular disease. Methods Retrospective cohort study of adult survivors of CoA/IAA repair followed up at an adult congenital heart disease (ACHD) clinic. Patients with at least 1 chest, abdomen, or pelvis computerised tomography (CT) scan for any indication were included. The presence/absence of calcification in the coronary arteries or aorta was assessed qualitatively. Patients on antihypertensive and statin therapy were considered hypertensive and hypercholesterolaemic, respectively. Patients were compared to adult survivors of TOF repair with CT scans for any indication (controls). Results Ninety-three CoA/IAA patients (87% CoA/13% IAA, median age at latest follow-up 34 years) had a total of 169 chest and 37 abdomen/pelvis CTs; 82, 93, and 37 patients had at least 1 CT suitable for CAC, TAC, and AAC review, respectively. CAC was present in 22% (18/82), TAC in 33% (31/93), and AAC in 23% (5/22) of CoA/IAA patients. CAC was present in 12% (18/153) and TAC in 11% (18/158) of TOF patients. CoA/IAA patients were more likely to have CAC and TAC than TOF patients (p=0.04 and p&amp;lt;0.0001; respectively) and be younger at the time of diagnosis (CAC p=0.03, TAC p=0.0001) despite TOF patients being older at time of latest CT scan (p=0.0003) (Table 1). Males aged &amp;lt;35 years and females ≤45 years represented 44% (8/18) of CoA/IAA patients with CAC. CoA/IAA patients with CAC were more likely to be hypertensive and hypercholesterolaemic than those without (78% [14/18] vs 48% [31/64], p=0.03; and 28% [5/18] vs 0% [0/64], p&amp;lt;0.0001; respectively) and was similar for TAC (hypertension p=0.005, hypercholesterolaemia p=0.04) but not AAC. After a mean follow-up of 11±7 years from first ACHD clinic, of the 93 patients, 2 patients died, 5 had coronary artery disease (at least mild stenosis on invasive angiography), 3 had a stroke, and 70% (65/93) were considered hypertensive at latest follow-up. Conclusions There is a high prevalence of CAC, aortic calcification, and hypertension in young adults with repaired CoA/IAA. Coronary and thoracic aortic calcification occurs at a younger age compared to controls. Further studies are warranted to assess the impact of aggressive cardiovascular risk reduction in this high-risk group.

Lipoprotein(a) and atherosclerotic cardiovascular disease in a Brazilian tertiary hospital population

Abstract Background/Introduction Elevated levels of lipoprotein(a) [Lp(a)] are a strong risk marker of atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction (MI), ischemic stroke, and peripheral arterial disease, as well as of aortic valve calcification and stenosis. However, few studies have assessed the prevalence of high Lp(a) levels in patients followed at a tertiary hospital specialized in cardiovascular diseases (CVD). In addition, there is scant information about Lp(a) concentrations in Brazilian individuals. Purpose The aim of the study was to describe the demographic characteristics and comorbidities of patients with at least one measure of Lp(a) at a tertiary treatment center for CVD in our city – Brazil. Methods Patients treated at a heart institute had their data extracted between the years 1999 and 2021. Data were obtained through direct electronic extraction of patients' medical records. The patients were categorized according to different Lp(a) cutoff levels (&amp;gt; 50 and &amp;lt; 70, &amp;gt; 70 and &amp;lt; 90, and &amp;gt; 90 mg/dL) and by quartiles. Results Of 4,970 unique patients included in the study, the mean age at baseline was 59.9 years (SD ± 14.5), 2,634 (53%) were male, and the median Lp(a) was 23.2 mg/dL (interquartile range 8.9 - 56.8 mg/dL). In the whole cohort, 460 (9.3%) had Lp(a) &amp;gt; 50 and &amp;lt; 70, 344 (6.9%) &amp;gt; 70 and &amp;lt; 90, 612 (12.3%) &amp;gt; 90 mg/dl and 138 (2.8%) &amp;gt; 150 mg/dL. Established ASCVD was reported in 1,223 (24%) of the individuals, with a progressively higher prevalence across the Lp(a) categories above (31.2%, 33.8%, 34.2%, respectively) (table 1). Moreover, the Lp(a) median (interquartile range) in mg/dL was significantly higher in those with baseline history of ASCVD (31.4 [10.8-71.2] vs 21.2 [8.3-52]), MI (27.8 [10.6-65.9] vs 22.3 [8.5-54.7]) and stroke (24.9 [10-69.5] vs 23.1 [8.9-56.5]), all p &amp;lt; 0.05 (table 2). Lp(a) was also significantly higher among those with LDL-C ≥ 100 mg/dL relative to LDL-C &amp;lt; 100 mg/dl (25.5[9.5-63.2] vs 21.4[8.4 vs 52.2] p &amp;lt; 0.05). Conclusions In this cohort of patients followed at a tertiary center specialized in CVD, approximately a third had Lp(a) levels above 50 mg/dL, a cutoff robustly associated with ASCVD. This finding likely represents an important source of cardiovascular residual risk, particularly in those with established ASCVD, exposing the need of further therapies.