Cardiovascular Disease In Population Research Articles

Abstract 10363: Mitochondrial DNA Copy Number is Associated with Severe Coronary Artery Disease and Risk of Subsequent Long-Term Major Adverse Cardiovascular Events

Introduction: Mitochondrial DNA copy number (mtDNA-CN) is associated with cardiovascular disease (CVD) and mortality. Here we examine, in a high-risk CVD population, the association with prevalent coronary artery disease (CAD) and subsequent major adverse events (MACE) at 1-,5- and 10-year follow-up of mtDNA-CN. Methods: Consecutive subjects (n=2267) consenting to a blood sample drawn for the Intermountain INSPIRE biorepository at the time of a coronary angiogram from July 1994 to Sept 2003 were included. The mtDNA-CN was determined by multiplexed real-time polymerase chain reaction coamplifying a stable site of mt D- Loop and a region of a single copy genomic β-2-microglobulin gene(β2M). MtDNA-CN is given as the ratio of Mt to β2M DNA. The presence of severe CAD (>70% stenosis) was analyzed using multivariate logistic regression. The subsequent MACE (including all-cause mortality and non-fatal MI) outcomes were studied using multivariate Cox proportional hazard regression. Results: The average age of subjects was 62.3 ± 13.8, 35% were female, and 50% had prior CAD. Over half (55%) had severe CAD at the angiogram. As the mtDNA-CN increased, severe CAD decreased (58% for 1 st quartile vs. 51% for 4 th quartile). After adjustment for baseline differences, subjects with mtDNA-CN in the 1 st quartile were 1.31 times more likely to have severe CAD than subjects with mtDNA-CN in the 4 th quartile (95% CI: 1.01, 1.71; p=0.04). A total of 902(39.8%) had a subsequent MACE event within 10-years (193[8.5%] in 1-year and 548[24.2%] in 5-years). There was no association between mtDNA-CN and 1-year MACE. However, mtDNA-CN was associated with 5-year (p=0.006) and 10-year (p=0.003) MACE. After adjustment, subjects with mtDNA-CN in the 1 st quartile were at 1.29 increased risk of 10-year MACE than subjects with mtDNA-CN in the 4 th quartile (95% CI: 1.07, 1.56; p=0.008). Conclusions: In a coronary angiographic population, mtDNA-CN was associated with severe CAD and the risk of subsequent long-term MACE. These findings suggest that mtDNA-CN could be used as a clinical biomarker for risk. Moreover, understanding the factors impacting mtDNA-CN may also help in the prevention of secondary CVD outcomes.

Dyslipidemia in diabetic kidney disease classified by proteinuria and renal dysfunction: A cross-sectional study from a regional diabetes cohort.

ABSTRACTAims/IntroductionDiabetic kidney disease (DKD) exacerbates dyslipidemia and increases the incidence of atherosclerotic cardiovascular disease. DKD is a concept that includes typical diabetic nephropathy and an atypical phenotype without proteinuria. We investigated dyslipidemia in different DKD phenotypes that have not been fully studied.Materials and MethodsFasting plasma was obtained from 1,073 diabetes patients enrolled in the regional diabetes cohort (ViNA cohort). Non‐proteinuric and proteinuric DKD were defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the absence or presence of urinary albumin‐to‐creatinine ratio >300 mg/g. Novel lipid risk factors, low‐density lipoprotein (LDL) triglyceride (TG) and small dense LDL cholesterol were measured using our established homologous assay.ResultsThe proportion of atherosclerotic cardiovascular disease patients was higher in non‐proteinuric DKD and even higher in proteinuric DKD than in non‐DKD. Increased estimated glomerular filtration rate grade and albuminuric stage were independently correlated with higher TG, TG‐rich lipoprotein cholesterol and apolipoprotein CIII. Therefore, proteinuric DKD had the highest of these levels. Small dense LDL cholesterol and LDL‐TG were higher in the proteinuria without renal dysfunction group in the lipid‐lowering drug‐free subset. Lipoprotein(a) was higher in DKD regardless of proteinuria.ConclusionsProteinuria was associated with an atherogenic subspecies of LDL, whereas renal dysfunction was associated with increased lipoprotein(a). Proteinuria and renal dysfunction independently exacerbated TG‐rich lipoprotein‐related dyslipidemia. This is in good agreement with the results of large‐scale clinical studies in which proteinuria and renal dysfunction synergistically increased the risk of atherosclerotic cardiovascular disease in populations with diabetes.

Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis.

Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis.

Effect of Dietary or Supplemental Vitamin C Intake on Vitamin C Levels in Patients with and without Cardiovascular Disease: A Systematic Review.

Atherosclerosis is a pro-oxidative and pro-inflammatory disease state, which is the underlying cause of most cardiovascular events, estimated to affect 5.2% of the Australian population. Diet, and specifically vitamin C, through its antioxidant properties can play a role in impeding the development and progression of atherosclerosis. This systematic review conducted comprehensive searches in Medline, Emcare, Scopus, PubMed, and Cochrane using key search terms for vitamin C, plasma vitamin C, supplementation, and cardiovascular disease (CVD). The results demonstrated that vitamin C supplementation resulted in a significant increase in vitamin C levels in populations with or without CVD, except for one study on the CVD population. It was also seen that the healthy population baseline and post-intervention vitamin C levels were high compared to the CVD population. However, further research is indicated for CVD population groups with varying baseline vitamin C levels, such as low baseline vitamin C, within a more representative elderly cohort in order to formulate and update vitamin C repletion guidelines.

Prophylactic anticoagulation in sinus rhythm for stroke prevention in cardiovascular disease: contemporary meta-analysis of large randomized trials.

Anticoagulation with non-vitamin K oral anticoagulants (NOACs) to prevent stroke is a mainstay of atrial fibrillation (AF) management. However, multiple cardiovascular diseases (CVDs) are associated with elevated ischaemic stroke risk even in sinus rhythm. In this meta-analysis, we assess efficacy and safety of prophylactic NOAC agents for stroke prevention in patients without AF. A search was conducted for randomized controlled trials (RCTs) that evaluated an NOAC and control drug (placebo or antiplatelet) in non-AF patients with mixed CVD. The primary efficacy and safety outcomes were ischaemic stroke and major bleeding, respectively. Results were stratified based on primary- and mini-NOAC doses. Thirteen RCTs were identified with a total of 89 383 patients with CVD in sinus rhythm (53 778 on NOAC, 35 605 on control drug; mean age 65.5 ± 2.7 years). Over a mean follow-up of 18.3 months, 1429 (1.6%) ischaemic strokes occurred. Use of NOAC was associated with 26% reduction in stroke [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.62-0.87; 1.1 vs. 1.8 events per 100 person-years], with numbers needed to treat of 153 patients to prevent one stroke. Major bleeding was increased with NOAC (OR 1.74, 95% CI 1.44-2.09; 2.1 vs. 1.0 events per 100 person-years). The weighted net clinical benefit (wNCB, composite of ischaemic stroke and bleeding) did not suggest a favourable effect with any NOAC dose (wNCB for primary-dose: -0.35; mini-dose: -0.06). Current evidence does not support use of NOACs for stroke prevention in non-AF CVD population as risk of major bleeding still exceeds ischaemic stroke benefit.

Social Determinants of Adherence to COVID-19 Risk Mitigation Measures Among Adults With Cardiovascular Disease.

Social determinants of health (SDOH) may limit the practice of coronavirus disease 2019 (COVID-19) risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center's COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States. CVD status was ascertained by self-reported history of receiving heart disease, heart attack, or stroke diagnosis. We built de novo, a cumulative index of SDOH burden using education, insurance, economic stability, 30-day food security, urbanicity, neighborhood quality, and integration. We described the practice of measures under the broad strategies of personal protection (mask, hand hygiene, and physical distancing), social distancing (avoiding crowds, restaurants, social activities, and high-risk contact), and work flexibility (work from home, canceling/postponing work). We reported prevalence ratios and 95% CIs for the association between SDOH burden (quartiles of cumulative indices) and practicing these measures adjusting for age, sex, race/ethnicity, comorbidity, and interview wave. Two thousand thirty-six of 25 269 (7.0%) adults, representing 8.69 million in 18 geographic areas of the United States, reported underlying CVD. Compared with the least SDOH burden, fewer individuals with the greatest SDOH burden practiced all personal protection (75.6% versus 89.0%) and social distancing measures (41.9% versus 58.9%) and had any flexible work schedule (26.2% versus 41.4%). These associations remained statistically significant after full adjustment: personal protection (prevalence ratio, 0.83 [95% CI, 0.73-0.96]; P=0.009), social distancing (prevalence ratio, 0.69 [95% CI, 0.51-0.94]; P=0.018), and work flexibility (prevalence ratio, 0.53 [95% CI, 0.36-0.79]; P=0.002). SDOH burden is associated with lower COVID-19 risk mitigation practices in the CVD population. Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines.

NLRP3 and 4 mRNA Expression in Epicardial Adipose Tissue Is Associated to Inflammosome Components Driven by Adipose Tissue Macrophages in Cardiovascular Disease Patients

Visceral obesity is characterized by low grade chronic inflammation especially driven by activated adipose tissue macrophages (ATMs) infiltration in response to danger-associated molecular patterns (DAMPs) including necrotic adipocytes and pro-inflammatory fat mediators. Among pattern recognition receptors (PPRs), nucleotide-binding and oligomerization domain (NOD)-like receptors (NLRs) gained attention as part of inflammasomes of adipose tissue which can promote insuline resistance and amplify inflammation through ATMs activation in fat tissue. Nod-like receptor protein 3 and 4 inflammasomes have been extensively studied in adipose tissue but is unclear their role in a peculiar visceral fat depot known as epicardial adipose tissue (EAT) contiguous to the myocardium and directly involved in cardiac inflammation and outcomes. In this study we evaluated NLR 3 and 4 protein (NLRP3 and 4) expression in EAT and their association to local inflammosomes and ATMs activation in overweight cardiovascular disease (CVDs) patients. We enrolled at IRCCS Policlinico San Donato 33 CVDs patients who underwent to open heart surgery and their EAT thickness, anthropometric and biochemical data were measured. Blood, plasma and EAT biopsies were collected for molecular and proteomic assays. All patients given their informed consent according to the Basic Principles of the Declaration of Helsinki and their extension. Our data shown that NLRP3 and 4 mRNA were expressed in EAT of overweight CVDs patients. NLRP4 mRNA expression increased during fat mass gain, indeed its expression correlates with EAT measurement (r=0.53, p=0.02), body mass index (0.41, p=0.01), weight (r=0.35, p=0.04) and waist (r=0.36, p=0.03). Notably both NLRP3 and 4 mRNA expression in EAT correlate with the major inflammasome genes associated to ATMs activation including ITGAX encoding for CD11c (isoform 3 r=0.38, p=0.02; isoform 4 r=-0.46, p=0.006), MRC1 encoding for CD206 (isoform 3 r=0.68, p=0.0001; isoform 4 r=-0.48, p=0.004), CCL2 encoding for MCP1(isoform 3 r=0.39, p=0.02; isoform 4 not statistically significant). Interesting the two isoforms shown a direct association to TNF-α expression in EAT (p<0.001 for both NLRPs), suggesting their implication in ATMs activation and the promotion of local inflammation in this visceral depot. In conclusion our results demonstrated that NLRP3 and 4 were expressed in EAT of overweight CVD patients and NLRP4 expression increases during fat mass increase. Moreover, both NLRPs isoforms are associated to the local activation ATMs inflammasomes which could be potentially implicated to cardiovascular outcomes in overweight CVDs population.

U.S. trends in prescription nonsteroidal anti-inflammatory drug use among patients with cardiovascular disease, 1988-2016.

Nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased risk of adverse cardiovascular events prompting labeling revisions cautioning their use among patients with cardiovascular disease (CVD). However, little is known regarding long-term trends in real-world prescribing of NSAIDs within the CVD population. We aimed to characterize the use of prescription NSAIDs among U.S. adults with CVD from 1988 to 2016. We used the National Health and Nutrition Examination Survey cross-sectional data from 1988-1994 and 19992016 to identify participants aged greater than or equal to 18years with hypertension (defined by self-report, mean blood pressure ≥140/90mm Hg, or antihypertensive medication use), or aged greater than or equal to 20years with self-reported congestive heart failure (CHF), coronary heart disease (CHD), angina, myocardial infarction (MI), or stroke. Prevalence of prescription NSAID use was analyzed in 6-year examination periods. Weighted logistic regression was performed to test time trends in prescription NSAID use. Overall, prescription NSAID use declined among all CVD populations. The highest prevalence of overall prescription NSAID use was observed during the 1999-2004 examination years, thereafter declining through the 2005-2010 and 2011-2016 examination years: in patients with hypertension (13.9% [1999-2004] to 8.5% [2011-2016]), CHF (14.6%-8.5%), CHD (16.3%-7.4%), angina (17.6%-8.5%), MI (16.1%-9.0%), and stroke (15.7%-7.9%). Decreased use of COX-2-selective inhibitors was observed during the same period; whereas, nonselective NSAID use remained relatively stable. Trends in prescription NSAID use were reflective of the general adult population. Prescription NSAID use among patients with CVD appears to have declined from 1988 to 2016, primarily due to reduced COX-2-selective inhibitor use. Nonetheless, the prevalence of prescription NSAIDs has persisted among a subset of high-risk CVD populations.

ECG abnormalities and arterial function by HIV status among high-risk populations in Rakai, Uganda

Abstract Background People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD). In Sub-Saharan Africa, where a majority of PLHIV live, population-based data on major CVD events such as stroke and myocardial infarction are difficult and expensive to collect. The use of proxy measures of future CVD events that are easier to collect, could be a feasible way to better study CVD in such settings. This study aimed to determine the acceptability of incorporating ECG and arterial function measurements into a population-based cohort study and to assess the prevalence of ECG abnormalities and arterial stiffness. Methods A pilot study was conducted within the Rakai community cohort study in Uganda on two high-risk CVD groups; one determined by age (35-49) and Framingham CVD risk scores and the other by age alone (50+). Data on ECG, arterial function, blood pressure, and HIV status were collected. The acceptability of incorporating ECG and arterial function measurements was established as an acceptance rate difference of no more than 5% to blood pressure measurements. Results A total of 118 participants were enrolled, 57 PLHIV and 61 HIV negative. Both arterial function and ECG measurements were well accepted (2% difference), but the completeness of arterial function measurements captured was suboptimal (63%). Left ventricular hypertrophy (LVH) and arterial stiffness (&amp;gt; 10 m/s) were common in both PLHIV and HIV negative participants across the two high-risk populations. Prevalence rates ranged from 30% to 53% for LVH and 25% to 58% for arterial stiffness. Conclusions The incorporation of ECG and arterial function measurements into routine activities of a population-based cohort was acceptable. LVH and arterial stiffness were common in these high-risk for CVD populations, indicating the need for future research. The use of these proxy measures might be recommended when data on CVD events cannot be collected. Key messages It is acceptable to incorporate ECG and arterial function measurements into a population-based cohort in Uganda. High prevalence rates of LVH and arterial stiffness were found in people with high risk for CVD.

Occupational Exposures and Cardiac Structure and Function: ECHO-SOL (Echocardiographic Study of Latinos).

BackgroundOur objective was to determine associations of occupational exposures with cardiac structure and function in Hispanic/Latino adults.Methods and ResultsEmployed participants were included (n=782; 52% women, mean age 52.9 years). Occupational exposures to burning wood, vehicle exhaust, solvents, pesticides, and metals at the current and longest‐held job were assessed by questionnaire. Survey multivariable linear regression analyses were used to model the relationship of each self‐reported exposure with echocardiographic measures of cardiac structure and function. Exposure to burning wood at the current job was associated with decreased left ventricular (LV) ejection fraction (−3.1%; standard error [SE], 1.0 [P=0.002]). When the analysis was restricted to exposure at the longest‐held job, occupational exposure to burning wood was associated with increased LV diastolic volume (6.7 mL; SE, 1.6 [P<0.0001]), decreased LV ejection fraction (−2.7%; SE, 0.6 [P<0.0001]), worse LV global longitudinal strain (1.0%; SE, 0.3 [P=0.0009]), and decreased right ventricular fractional area change (−0.02; SE, 0.004 [P<0.001]). Exposure to pesticides was associated with worse average global longitudinal strain (0.8%; SE, 0.2 [P<0.0001]). Exposure to metals was associated with worse global longitudinal strain in the 2‐chamber view (1.0%; SE, 0.5 [P=0.04]), increased stroke volume (3.6 mL; SE, 1.6 [P=0.03]), and increased LV mass indexed to BSA (9.2 g/m2; SE, 3.8 [P=0.01]) or height (4.4 g/m2.7; SE, 1.9 [P=0.02]).ConclusionsOccupational exposures to burning wood, vehicle exhaust, pesticides, and metals were associated with abnormal parameters of LV and right ventricular systolic function. Reducing exposures to toxic chemicals and particulates in the workplace is a potential opportunity to prevent cardiovascular disease in populations at risk.

Use of an Exposome Approach to Understand the Effects of Exposures From the Natural, Built, and Social Environments on Cardio-Vascular Disease Onset, Progression, and Outcomes.

Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments “get under the skin” to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.

Prevalence of Psychiatric Comorbidities and Behavioral Risk Factors in Cardiovascular Disease Patients

INTRODUCTION: Decades of research has revealed several links between cardiovascular diseases (CVDs) and mental illness, and has even suggested that both may actually cause one another. Emerging research is beginning to uncover high prevalence of behavioral risk factors in patients with mental illness that may lead to cardiovascular disease.&#x0D; MATERIAL AND METHODS: A descriptive cross-sectional study was designed to assess the prevalence of psychiatric comorbidities in cardiovascular disease patients and to identify the behavioral risk factors in them. A semi-structured questionnaire including Self- Reporting Questionnaire (SRQ-20) by WHO was used to screen psychiatric symptoms among 190 purposively selected samples. Data were analyzed by using descriptive and inferential statistics with SPSS version 20.0&#x0D; RESULTS: Among the 190 respondents, 150 (78.95%) were SRQ positive and table 1 shows majority (63.33%) was male. Highest proportion (60%) of the respondents was included in the age group of 40-64 years. Majority of cardiac morbidity was ischemic heart disease (55.79%). Respondents diagnosed with some kind of cardiac disease were suffering from depression (53.33%), anxiety disorder(38%) and panic disorder (8.67%). Behavioral risk factors present in respondents were smoking (90%) and alcohol abuse (90%) and more than half (65.33%) and (56%) had obesity and physical inactivity as behavioral risk factors respectively.&#x0D; CONCLUSION: Health care professionals will need to expand their use of standardized screening tools that capture psychosocial factors in the CVDs population. Thus it can help in prevention and treatment of such comorbidities.

Abstract P372: U.S. National Estimates of Prescription Nonsteroidal Anti-inflammatory Drugs Among Patients With Cardiovascular Disease

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, fever, and inflammation, but their ubiquitous use has led to concerns over increased risk of adverse cardiovascular (CV) events, particularly in patients with established CV disease (CVD). In 2005, the FDA revised labels for all NSAIDs to include a boxed warning highlighting the potential for increased CV risk. However, little is known regarding real-world prescribing of NSAIDs among patients with CVD. Our objective was to characterize the use of prescription NSAIDs among patients with CVD from 1988-2016 in the U.S. Methods: Using cross-sectional National Health and Nutrition Examination Survey (NHANES) data from 1988-1994 and 1999-2016, we included participants aged ≥18 years with hypertension (defined by self-report, mean blood pressure ≥140/90, or use of an antihypertensive medication), or aged ≥20 years with ≥1 of the following self-reported heart disease conditions: congestive heart failure (CHF), coronary heart disease (CHD), angina, myocardial infarction (MI), or stroke. Survey-weighted data were analyzed to assess prevalence and trends of prescription NSAID use within each CVD population in 6-year examination periods. Results: Overall, prescription NSAID use declined among all U.S. CVD populations over the study period. Prevalence of prescription NSAID use was highest during the 1999-2004 examination years, but thereafter, declined during the 2005-2010 examination years for those with hypertension (13.9% to 8.8%), CHF (14.6% to 8.5%), CHD (16.3% to 7.0%), angina (17.6% to 9.73%), MI (16.1% to 8.2%), and stroke (15.7% to 8.8%). Use of prescription NSAIDs since the 2005-2010 examination years has remained consistent in all CVD populations. These decreases were driven in part by reduced use of COX-2-selective NSAIDs, whereas non-selective NSAID use among all CVD populations was relatively steady from 1999 to 2016. Conclusions: Prescription NSAID use among patients with CVD appears to have declined from 1988 to 2016, primarily because of less COX-2 NSAID use following removal of 2 approved agents. Otherwise, the prevalence of prescription NSAIDs has remained somewhat stable and relatively high among these high-risk CV populations. Our results suggest additional efforts may be needed to limit the use of NSAIDs among patients with CVD, given that these agents are known to be associated with adverse CVD outcomes.

Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study.

To explore patients' understanding of the role of an advanced practice nurse (APN). The increasing prevalence of multimorbidities among people living with cardiovascular disease (CVD) has increased the complexity of their clinical care. Implementing the role of APNs in new models of care has been shown to improve outcomes in the CVD population. However, the CVD population's understanding of and experiences with the APN role have not been examined in Singapore. An exploratory descriptive qualitative design using semi-structured face-to-face individual interviews was undertaken (November 2017-March 2018). Fourteen participants were purposively sampled from an outpatient clinic in one of Singapore's national heart centres. Thematic analysis was undertaken. The COREQ guidelines were adhered to. The multi-ethnic sample included ten males and four females. Two main themes were identified: (1) APNs play a complementary role to doctors and (2) the acceptance of the APN role takes time. Each theme was supported by three subthemes to further elucidate the role and acceptance of APNs. A lack of understanding of the role of APNs is present, thereby causing the less than optimal patient acceptance of APNs. As patients with CVD experience improvements to their health through APN-led services, they may gain confidence in APNs' skills and knowledge. When introducing new roles, fully explaining these roles to the target population is pertinent as it will be facilitative to patient engagement and optimisations of care. The findings support the call for APNs to explain the value and essence of advanced practice nursing more effectively. There should be a greater emphasis on teaching APNs to introduce and explain the role of APNs through APN preparatory education and incorporating this practice in APN practice standards, especially in contexts where APN development is premature.

Abstract P540: Predictors of Resilience Among CVD Patients

Objective: A cardiovascular disease (CVD) diagnosis is a stressful event that challenges patients physically and psychologically. Tertiary prevention of CVD focuses on management of traditional risk factors, including biological factors such as hyperlipidemia, hypertension, and diabetes, and behavioral factors such as smoking, diet, and sedentary lifestyle. Recent evidence indicates nontraditional psychological and social risk factors, including depression, anxiety, hostility, low social support, social isolation, and low socioeconomic status, also influence CVD incidence and prognosis. A focus on resilience, the ability to rebound from stress or adversity, could positively impact the health of CVD patients. The objective of this systematic review was to synthesize the evidence for biological, behavioral, psychological, and social factors that influence resilience among patients with CVD. Methods: A systematic search of PubMED, PsycINFO, and CINAHL was conducted from database inception through October 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and study quality was evaluated with the National Institutes of Health Study Quality Assessment Tools. Inclusion criteria were: quantitative research studies; adult sample, age 18 or above; CVD diagnosis (e.g. acute coronary syndrome, heart failure, stroke); resilience; and published in English. Results: Of the 746 articles retrieved for review, 67 were retained for full text assessment, and 30 were eligible for study inclusion. Twenty-seven of these studies were observational, with sample sizes from 11 to &gt;237,000 participants, and settings in Europe, America, Asia, and Australia. The majority of participants were men, and only three studies reported on resilience among black participants. Psychological factors of depression, anxiety, and perceived stress were inversely associated with resilience, while quality of life and self-efficacy were positively associated with resilience. Among behavioral factors, composite measures of self-care were positively associated with resilience. Evidence for biological and social factors was minimal, but findings from a recent study suggest blacks living in lower versus higher cardiovascular-risk neighborhoods have higher levels of resilience, which was assessed with measurements of neighborhood perceptions and psychological attributes. Conclusions: This review provides evidence for factors influencing resilience in the CVD population. Research is needed to further delineate the relationship of these factors with resilience, ascertain differential effects between sexes and among minority populations, and explore interventions to enhance resilience among CVD patients. In addition, attention to the relationship of community factors with resilience in CVD is needed.

Identifying the Internalizing Disorder Clusters Among Recently Hospitalized Cardiovascular Disease Patients: A Receiver Operating Characteristics Study.

Depression and anxiety disorders are common among cardiovascular disease (CVD) populations, leading several cardiology societies to recommend routine screening to streamline psychological interventions. However, it remains poorly understood whether routine screening in CVD populations identifies the broader groups of disorders that cluster together within individuals, known as anxious-misery and fear. This study examines the screening utility of four anxiety and depression questionnaires to identify the two internalizing disorder clusters; anxious-misery and fear. Patients with a recent hospital admission for CVD (n = 85, 69.4% males) underwent a structured clinical interview with the MINI International Neuropsychiatric Interview. The participants also completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Overall Anxiety Severity Impairment Scale (OASIS), and the stress subscale of the Depression Anxiety Stress Scale (DASS). The PHQ-9 and the GAD-7 yielded appropriate screening properties to detect three different iterations of the anxious-misery cluster (sensitivity >80.95% and specificity >82.81%). The GAD-7 was the only instrument to display favorable screening properties to detect a fear cluster omitting post-traumatic stress disorder (PTSD) but including obsessive-compulsive disorder (OCD; sensitivity 81.25%, specificity 76.81%). These findings indicate that the PHQ-9 and GAD-7 could be implemented to reliably screen for anxious-misery disorders among CVD in-patients, however, the receiver operating characteristics (ROC) to detect fear disorders were contingent on the placement of PTSD and OCD within clusters. The findings are discussed in relation to routine screening guidelines in CVD populations and contemporary understandings of the internalizing disorders.

Adverse drug reactions caused by drug–drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items

Objective: Cardiovascular disease (CVD) drugs have been frequently implicated in adverse drug reaction (ADR)-related hospitalizations. Drug–drug interactions (DDIs) are common preventable cause of ADRs, but the impact of DDIs in the CVD population has not been investigated. Hence, the primary aim of the study was to identify DDIs associated with ADRs in CVD patients at hospital admission. The second aim was to develop a simple tool to identify high-risk patients for DDI-related adverse events.Methods: An observational study was conducted on the Cardiology Ward of University Clinical Hospital Center. Data were obtained from medical charts. A clinical panel identified DDIs implicated in ADRs, using LexiInteract database and Drug Interaction Probability Scale. Statistics were performed using PASW 22 (SPSS Inc.).Results: DDIs contributed to hospital admission with a total prevalence of 9.69%. DDI-related ADRs affected mainly cardiac function (heart rate or rhythm, 41.07%); bleeding and effect on blood pressure were equally distributed (17.86%). Non-cardiovascular ADRs were found in 23.21% of DDIs. After admission, 73% of the identified DDIs led to changes in prescription. Prediction ability of calculated DDI adverse event probability scores was rated as good (AUC = 0.80, p < .001).Conclusions: CVD patients are highly exposed to adverse DDIs; about one in ten patients hospitalized with CVD might have a DDI contributing to the hospitalization. Given the high prevalence of CVD, DDI-related harm might be a significant burden worldwide. Identification of patients with high DDI adverse event risk might ease the recognition of DDI-related harm and improve the use of electronic databases in clinical practice.

Vitamin D-binding protein and vitamin D receptor genotypes and 25-hydroxyvitamin D levels are associated with development of aortic and mitral valve calcification and coronary artery diseases.

To assess the association between vitamin D-Binding Protein (VDBP rs7041T>G) and vitamin D receptor (VDR rs1544410G>A) gene polymorphisms with susceptibility to cardiovascular diseases in population from west of Iran. Two hundred forty-nine individuals with cardiovascular disease (92 with aortic and Mitral Valves Calcification (AMVC) and 157 with Coronary Artery Diseases (CAD) that their diseases were confirmed by echocardiography and angiography and unrelated 182 healthy controls (gender and age-matched) were selected for this case-control study. The VDR 1544410G>A, and VDBP 7041T>G genotyping were detected by PCR-RFLP, serum vitamin D and lipid concentrations were measured by ELISA and enzyme assay, respectively. The VDR rs1544410G>A gene is a strong risk factor for CAD (OR = 1.28, p = 0.002) and the dominant genotype (T/G+G/G) of VDBP 7041 T>G SNP plays a protective role (OR = 0.67, p = 0.003) in AMVC development in studied population. In addition, lower level of vitamin D strongly increased the risk of CAD (15 ± 11.02 vs. 21.3 ± 18μg/L, p = 0.043) and AMVC (12.1 ± 13.1 vs.21.3 ± 18μg/L, p = 0.014) development in individuals carrying T/T genotype of VDBP 7041 T>G gene polymorphism. There was a strong interaction between A allele VDR rs1544410 and G allele of VDBP rs7041 genes in a protective role (OR = 0.74, p = 0.044) in AMVC patients). CAD and AMVC patients were deficient in vitamin D, i.e. their level of vitamin D was strongly lower than that in the control group. Our findings for the first time indicated that there is a strong association between vitamin D deficiency, lipid profile and the VDR rs1544410G>A and rs7T41>G VDBP genes polymorphisms. These interactions may be one of the important factors for CAD and AMVC incidence.

The Method of Assessment of the Population Risk of Cardiovascular Diseases: Rationale and Examples of Application

Epidemiological studies in cardiology often are confronted with the need of modeling the population dependence of the development of cardiovascular diseases (CVD) on a complex of influencing risk factors (RF). A method for assessment the CVD population risk is proposed, the calculation of which assumes the population group as the unit of analysis, and the prevalence of risk factors in this group as the input data. Calculation of the population risk is build taking into account predictive value of risk factors basing on their contribution to CVD prevalence. The method of calculation of population risk, examples of its application (arterial hypertension in working population, ethnic groups, ischemic heart disease in open and working population), as well as discussion of its strong and weak sides are presented in this review.

Dysfunctional EAT thickness may promote maladaptive heart remodeling in CVD patients through the ST2-IL33 system, directly related to EPAC protein expression

Dysfunctional epicardial adipose tissue (EAT) secretome can influence the heart’s stretch response. However, the molecular mechanisms are still poorly understood. The aim of this study was to clarify how dysfunctional EAT promotes maladaptive heart remodeling in cardiovascular disease (CVD) through ST2 production associated with exchange protein directly activated by cAMP (EPAC) proteins. A series of 55 CVD males were enrolled and their EAT thickness, LV mass and volumes were measured by echocardiography. Blood, plasma and EAT biopsies were collected for molecular and proteomic assays. Taking EAT thickness as a continuous variable there was a direct correlation between the ST2 cardiac stretch mediator and EAT thickness (r = 0.54, p < 0.01) and an inverse relation between the ST2 gene and IL-33 expression (r −0.50, p < 0.01). In the CVD population EPAC2 expression directly correlated with the ST2 gene (r = 0.74, p < 0.0001) causing an ST2/IL-33 system local (p < 0.001) and systemic (sST2 = 57.33 ± 3.22 and IL-33 = 0.53 ± 017 pg/mL; p < 0.0001) protein imbalance associated with maladaptive remodeling. This indicated that dysfunctional EAT is a source of both EPAC and ST2 protein and an EPAC2 isoform seems involved in ST2 production in adipose tissue. Both EPAC2 and ST2 expression were directly related to maladaptive heart remodeling indices, suggesting EAT measurements could be useful in the early assessment of CVD complications.