Risk Of Cardiovascular Disease In Patients Research Articles

Prevalence of very high cardiovascular disease risk in patients with type 2 diabetes mellitus: A population-based cross-sectional screening study.

The 2019 ESC/EASD guidelines categorize cardiovascular disease risk (CVD) in patients with diabetes mellitus (DM). Assessing CVD risk is necessary to identify individuals at very high risk of CVD, enabling tailored and precise intervention for this high-risk population. This study aims to evaluate the severity of a very high risk for CVD stratification among patients with type 2 DM (T2DM) across different regions in China. We conducted a cross-sectional screening study from 1 January 2020 to 30 December 2022. Disease duration, body mass index (BMI), targeted organ damage, such as atherosclerotic heart disease, proteinuria, impaired renal function, left ventricular hypertrophy, retinopathy and known CVD risk factors, were collected from diabetic patients by professionally trained physicians. The risk of CV in patients with DM was categorized into two groups: very high risk and others, according to the 2019 ESC/EASD guidelines. In total, 1 870 720 participants from 1669 hospitals in 30 provinces of China, excluding Tibet, Taiwan, Hong Kong and Macao, were enrolled from 2020 to 2022, among whom 67.50% of patients with T2DM were at very high risk for CVD. The proportions of very high-risk T2DM were higher in Northeast China (75.82%), Central China (73.65%) and Southwest China (72.66%), while the lowest prevalence of very high-risk T2DM was found in Southern China (60.15%). The multivariate binary logistic regression analyses suggested that the category of very high risk for CVD is associated with age [odds ratio (OR) = 1.04; 95% confidence interval (CI): 1.04-1.04; p < .0001], BMI (OR = 1.07; 95% CI: 1.07-1.07; p < .0001), duration of DM (OR = 1.05; 95% CI: 1.05-1.05; p < .0001), hypertension (OR = 3.75; 95% CI: 3.72-3.78; p < .0001), dyslipidaemia (OR = 5.22; 95% CI: 5.18-5.27; p < .0001) and smoking (OR = 2.92; 95% CI: 2.89-2.95; p < .0001). This study represented the largest observational study of CVD risk assessment in patients with T2DM in China. The CVD risk situation of patients with diabetes in China is critical, and comprehensive control and management of CVD risk factors, such as hypertension, BMI and dyslipidaemia, in patients with DM need to be strengthened in patients with T2DM in China.

Sex Differences in Hemodynamic and Autonomic Reactivity during Cold Pressor Test in Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is characterized by sympathetic nervous system (SNS) overactivity that contributes to increased cardiovascular risk. Hemodynamic reactivity during the cold pressor test (CPT) has been widely used to evaluate sympathetic neural control in patient populations, and increased neurocardiovascular reactivity to CPT has been shown to predict greater risk of future cardiovascular events. Prior studies have suggested that males with CKD have higher long-term cardiovascular disease risk compared to females with CKD; however, whether sex differences in neurocardiovascular responsivity during CPT exists within CKD remains unknown. Objectives: Our primary objective was to evaluate potential sex differences in hemodynamic and autonomic reactivity during CPT in patients with CKD. Hypothesis: Males with CKD have an augmented pressor and sympathetic response to sympathoexcitation induced by CPT compared with females with CKD. Methods: Patients with CKD (Stage III and IV) with stable renal function were included. Continuous beat to beat blood pressure (BP), heart rate (HR) and muscle sympathetic nerve activity (MSNA) by microneurography were measured at rest for 10 minutes and during CPT that consisted of immersion of the hand to the wrist in ice water (4–5 °C) for one minute, followed by a 5-min recovery period. Results: 25 participants with CKD were included (N= 14 male, N=11 female). There were no differences in baseline characteristics, resting hemodynamics or MSNA between male and female groups. Males with CKD had a steeper rate of increase and higher peak levels of diastolic BP (DBP, 101±3 vs 87±3; p=0.008) and mean arterial BP (MAP, 130±4 vs 112±5 mm Hg, p=0.023) during CPT compared to females with CKD, respectively. Conversely, females with CKD had a steeper rate of increase in HR during CPT compared to males. MSNA increased in both males and females during CPT; however, there was no difference in MSNA reactivity during CPT between groups. Conclusions: Males with CKD had greater BP reactivity during CPT compared to females with CKD, while females with CKD had greater HR reactivity during CPT compared to males. There was no difference in sympathetic reactivity between groups. Augmented BP reactivity during CPT in males with CKD may contribute to sex differences in cardiovascular disease risk in patients with CKD. Supported by NIH Grants R33AT010457 and R01HL135183. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

CT-based whole lung radiomics nomogram: a tool for identifying the risk of cardiovascular disease in patients with chronic obstructive pulmonary disease.

To evaluate the value of CT-based whole lung radiomics nomogram for identifying the risk of cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD). A total of 974 patients with COPD were divided into a training cohort (n = 402), an internal validation cohort (n = 172), and an external validation cohort (n = 400) from three hospitals. Clinical data and CT findings were analyzed. Radiomics features of whole lung were extracted from the non-contrast chest CT images. A radiomics signature was constructed with algorithms. Combined with the radiomics score and independent clinical factors, multivariate logistic regression analysis was used to establish a radiomics nomogram. ROC curve was used to analyze the prediction performance of the model. Age, weight, and GOLD were the independent clinical factors. A total of 1218 features were extracted and reduced to 15 features to build the radiomics signature. In the training cohort, the combined model (area under the curve [AUC], 0.731) showed better discrimination capability (p < 0.001) than the clinical factors model (AUC, 0.605). In the internal validation cohort, the combined model (AUC, 0.727) performed better (p = 0.032) than the clinical factors model (AUC, 0.629). In the external validation cohort, the combined model (AUC, 0.725) performed better (p < 0.001) than the clinical factors model (AUC, 0.690). Decision curve analysis demonstrated the radiomics nomogram outperformed the clinical factors model. The CT-based whole lung radiomics nomogram has the potential to identify the risk of CVD in patients with COPD. This study helps to identify cardiovascular disease risk in patients with chronic obstructive pulmonary disease on chest CT scans. •To investigate the value of CT-based whole lung radiomics features in identifying the risk of cardiovascular disease in chronic obstructive pulmonary disease patients. •The radiomics nomogram showed better performance than the clinical factors model to identify the risk of cardiovascular disease in patients with chronic obstructive pulmonary disease. •The radiomics nomogram demonstrated excellent performance in the training, internal validation, and external validation cohort (AUC, 0.731; AUC, 0.727; AUC, 0.725).

Cardiovascular Risk in Patients With Glomerular Disease: A Narrative Review of the Epidemiology, Mechanisms, Management, and Patient Priorities.

Cardiovascular (CV) disease is a major cause of morbidity and mortality for patients with glomerular disease. Despite the fact that mechanisms underpinning CV disease risk in this population are likely distinct from other forms of kidney disease, treatment and preventive strategies tend to be extrapolated from studies of patients with undifferentiated chronic kidney disease (CKD). There is an unmet need to delineate the pathophysiology of CV disease in patients with glomerular disease, establish unique risk factors, and identify novel therapeutic targets for disease prevention. The aims of this narrative review are to summarize the existing knowledge regarding the epidemiology, molecular mechanisms, and management of CV disease in patients with common glomerular disease, highlight the patient perspective, and propose specific areas for future study. The literature for this narrative review was accessed using common research search engines, including PubMed, PubMed Central, Medline, and Google Scholar. Information for the patient perspective section was collected through iterative discussions with a patient partner. We reviewed the epidemiology, molecular mechanisms of disease, management approaches, and the patient perspective in relation to CV disease in patients with glomerulopathies. Throughout, we have highlighted the current knowledge and have discussed future research approaches, both clinical and translational, while integrating the patient perspective. Patients with glomerular disease have significant CV disease risk driven by multifactorial, molecular mechanisms originating from their glomerular disease but complicated by existing comorbidities, kidney disease, and medication side effects. The current approach to risk stratification and treatment relies heavily on existing data from CKD patients, but this may not always be appropriate given the unique pathophysiology and mechanisms associated with CV disease risk in patients with glomerular disease. We highlight the need for ongoing glomerular disease-focused studies aimed to better delineate CV disease risk, while integrating the patient perspective. This is a narrative review and does not represent a comprehensive and systematic review of the literature.

Cardiovascular disease risk in patients with inflammatory arthritis nowadays still substantially elevated

ObjectivesThis study aims to assess current cardiovascular disease risk and prevalence of risk factors in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (SpA).Methods2050 consecutive patients with...

Machine Learning for Risk Prediction of Cardiovascular Disease: Current Advances and Future Prospects

One of the main causes of death worldwide is cardiovascular disease (CVD). Effective treatment of this global concern depends on early detection, as well as management. Currently, people with established heart issues are treated by physicians and other medical experts, with detection at later stages of CVD. However, the burden of cardiovascular disease treatment can be significantly reduced if it was possible to accurately estimate a patient's CVD risk at the initial stages. Machine learning techniques have emerged as a viable method for improving CVD risk prediction, which enables treatments to be more effectively tailored to each individual patient's needs. An in-depth analysis of current research on machine learning applications for CVD risk prediction is provided in this publication. The paper discusses the benefits of applying machine learning techniques, various prediction algorithms, performance assessment, and current research limits. Our findings suggest that machine learning methods are useful for predicting CVD risk and have the potential to improve clinical judgment, which may help to lessen the burden of cardiovascular disease in the future. This research also helps to shape the medical field by providing insights on treating similar deadly diseases using AI and machine learning models.&#x0D;

Global research hotspots and trends in exercise interventions for rheumatoid arthritis over the past two decades: A bibliometric and visualization study.

Rheumatoid arthritis (RA) is a prolonged multifactorial autoimmune disease of unknown etiology. With the global population aging, the incidence of RA is increasing, highlighting the need for more effective treatments. Exercise interventions have been recognized as safe and effective for managing pain, improving function, and reducing fatigue in RA patients. However, the existing literature in this field lacks a thorough, organized, and clear line of analysis. In this study, we conducted a comprehensive analysis of the 20-year literature on exercise interventions for RA, aiming to identify hotspots and cutting-edge trends. Our objective is to provide subsequent researchers with valuable ideas and references. Using Cite Space, VOS viewer, and R-bibliometrix software for visualization and analysis, we compiled the main dataset from the web of science database, consisting of 1790 articles on exercise interventions in RA published between 2000 and 2023. Among these articles, the United States contributed the highest number of papers (433), while Karolinska Institutet ranked first institutionally with 90 papers. The study focused on the keyword's quality of life, cardiovascular disease, aerobic exercise, social support, psychology, and multidisciplinary care. The research highlighted the importance of clinical efficacy studies that investigate different types of exercise modalities (cardiorespiratory aerobic, resistance, aquatic, and neurological) either alone or in combination, to improve pain and function and reduce cardiovascular disease risk in patients with RA. Additionally, sedentary behavior, fatigue, and multidisciplinary care were identified as potential areas for further research. Overall, this study provides a scientific perspective on exercise interventions for RA and offers valuable insights for academics, funding organizations, and policymakers.

Discordant association of nonalcoholic fatty liver disease with lipoprotein(a) and markers of atherogenic dyslipidemia

Nonalcoholic fatty liver disease (NAFLD) is associated with atherogenic dyslipidemia and an increased risk of cardiovascular events. Previous studies have suggested an inverse relationship between NAFLD severity and lipoprotein(a) [Lp(a)] level, but contemporary data from the U.S. are lacking. Lp(a), lipid profile, apolipoproteins, and nuclear magnetic resonance-based lipoprotein particle concentrations were measured in 151 patients with biopsy-proven NAFLD. Levels were compared between those with nonalcoholic fatty liver (NAFL) on histology and non-alcoholic steatohepatitis (NASH). Median age was 55 [48, 62] years, 67% of patients were women, 83% were White, 43% had NAFL, and 57% had NASH. Triglyceride level was higher and high-density lipoprotein-cholesterol (HDL-C) was lower among those with NASH as compared with NAFL. Circulating apolipoprotein-B (ApoB) and low-density lipoprotein particle concentration (LDL-P) were 9% and 17% higher in the NASH group as compared with NAFL, respectively. Contrastingly, Lp(a) concentration was 50% lower in NASH relative to NAFL group. Hepatocyte ballooning, lobular inflammation, and fibrosis on histology were inversely associated with Lp(a) concentration. NAFLD severity has a discordant association with Lp(a) and other markers of atherogenic dyslipidemia. This relationship may have implications for prognosticating cardiovascular disease risk in patients with NAFLD.

Evaluation of Arterial Stiffness in Depression Patients.

It has been known that there is a significant correlation between depression and cardiovascular diseases. However, the reasons behind this correlation that could affect mortality and morbidity were not fully identified. The present study aimed to analyze arterial stiffness diagnosed with ultrasonography, which could be associated with cardiovascular disease risks in depression patients, and to compare the findings with those of healthy controls. The study was conducted with 35 depression patients and 35 healthy individuals. Routine complete blood and biochemistry tests were requested for all patients, and their weight and height, waist circumference, and diastolic and systolic arterial blood pressure were measured. Femoral and carotid artery intima-media thickness and other arterial stiffness parameters were determined with Doppler ultrasonography. It was determined that the systolic pressure (P = .028) was higher in the patient group (P = .028). Also, the carotid elastic modulus (P = .048) was significantly higher in the patient group. A negative and significant correlation was determined between femoral compliance and chlorpromazine equivalent dose (P = .021, r = -0.389). It was determined that the systolic blood pressure and carotid elastic modulus arterial stiffness parameters were significantly higher in depression patients. Measurable arterial stiffness parameters should be investigated in depression patients as cardiovascular risk markers. Furthermore, the determination of the effects of psychotropic drugs employed in arterial stiffness treatment could play an important role in the determination of cardiovascular disease risk in these patients.

Classification of Cardiovascular Disease Risk for Patients with Obstructive Sleep Apnea

Abstract Cardiovascular disease (CVD) is a disorder that affects the heart function and blood vessels, such as coronary heart disease, arrhythmias, heart attack, rheumatic heart disease, stroke, etc. The risks associated with CVD are physical inactivity, improper diet, and smoking and liquor drinking. Some behavioral risk factors include increased blood sugar and blood pressure levels, obesity, stress, and genetic factors. Obstructive sleep apnea (OSA) is a disorder related to sleep respiration that affects blood oxygen concentration and air entering the lungs. It will probably lead to overweight, heart disease, diabetes, stroke, and hypertension. Several kinds of research are being carried out, and they demonstrate the relationship between patients with CVD and those with OSA. The present study uses polysomnography data from the Sleep Heart Health Study and CVD-related physiological data obtained from the National Sleep Research Resource. The data set is preprocessed, and principal component analysis reduction is applied and fed to the ResNet-101 classifier for classifying patients with OSA into three types of coronary heart disease (CHD) is a disorder in which the coronary arteries were blocked and CVD risk groups. After training the proposed network with 80 % of records, accuracy was obtained as 94.87 % for “no risk” and “risk,” with a 95.89 % level of CVD risk among patients with OSA apart from its capability to detect the severity of OSA.

Bariatric Surgery and Cardiovascular Disease Risk in Patients with Pulmonary Hypertension: A Propensity Score Matched Analysis of US National Inpatient Sample.

Previous research has suggested the ameliorating effect of bariatric surgery (BaS) on patients with pulmonary hypertension (PH), but there is a lack of data on the effect of bariatric surgery on the odds of cardiovascular diseases in PH patients. The current study aims to evaluate the association of BaS and coronary artery diseases (CAD), heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), cardiac valve diseases, cardiac rhythm disorders, acute pulmonary embolism, and in-hospital mortality in patients with PH. The national inpatient sample (NIS) data from 2016 to 2019 were analyzed by using ICD-10 codes. A propensity score matching in a 3:1 ratio was performed to match the BaS and non-BaS groups. A total of 3605 patients with a history of BaS and 501419 patients without a history of BaS were included. After propensity matching, BaS was independently associated with a lower CAD hospital admission and a lower rate of in-hospital mortality. On the contrary, BaS was associated with a higher prevalence of atrial fibrillation (AF) and acute pulmonary embolism in patients with PH. HFpEF, HFrEF, other cardiac rhythm disorders, complete heart block, cardiac valve diseases, and ischemic stroke were not significantly different between the two groups in patients with PH. BaS is independently associated with a reduced rate of in-hospital mortality and CAD hospital admission in patients with PH. However, the risk of atrial fibrillation and acute pulmonary embolism was higher in these patients.

Management of cardiovascular disease risk in patients with rheumatoid arthritis

Patients with rheumatoid arthritis along with a risk of developing cardiovascular disease are complex cases for nurses to manage. Louise Murphy details the challenges associated Rheumatoid Arthritis (RA) is a chronic destructive autoimmune disease, characterised by symmetric synovitis. The aetiology of rheumatoid arthritis is complex and largely unknown. Comorbidities such as cardiovascular disease (CVD) are frequently observed in patients with rheumatoid arthritis due to a combination of disease and genetic factors. Cardiovascular disease is one of the leading causes of death in people with rheumatoid arthritis ( Aletaha and Smolen 2018 ) with a 45-60% increased mortality rate due to cardiovascular related events compared to the general population. General practice nurses are in a unique position to be able to provide guidance, advice and support to patients with rheumatoid arthritis who need to make lifestyle changes to reduce CVD risk. General practice nurses can also screen for traditional CVD risk factors and undertake cardiovascular disease risk assessment safely and effectively to identify those patients with rheumatoid arthritis who are at risk of developing cardiovascular disease in the future.

Mitigating Cardiovascular Disease Risk in Patients With Type 2 Diabetes and Chronic Kidney Disease—An Unmet Need With Promising Solutions

Mitigating Cardiovascular Disease Risk in Patients With Type 2 Diabetes and Chronic Kidney Disease—An Unmet Need With Promising Solutions

Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus–a multicenter study in China

BackgroundVisceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.MethodsPatients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m2 ≤ BMI < 24 kg/m2; overweight when 24 kg/m2 ≤ BMI < 28 kg/m2; and obesity when BMI ≥ 28 kg/m2. Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm2. Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.ResultsIn patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm2. Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).ConclusionsT2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.

Elevated Cardiovascular Disease Risk in Patients with Restless Legs Syndrome.

There are studies in the literature that link restless legs syndrome with increasing cardiovascular disease risk. The reason for this was that increased sympathomimetic activation in restless legs syndrome causes tachycardia, hypertension, and autonomic instability. We intended to assess the cardiovascular disease risk in patients with restless legs syndrome using electrocardiogram parameters. The present investigation compared the demographic characteristics, electrocardiogram variables, and lab results of 40 patients diagnosed with restless legs syndrome with 43 healthy controls. Restless legs syndrome patients had a higher frontal QRS-T angle than healthy control patients. Restless legs syndrome patients had lower hemoglobin, neutrophil, lymphocyte, basophil, albumin, and high-density lipoprotein cholesterol levels. There was a significant increase in eosinophil, platelet, C-reactive protein, total cholesterol, low-density lipoprotein cholesterol, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio values in patients with restless legs syndrome. The frontal QRS-T angle is highly correlated with the neutrophil-to-lymphocyte ratio (P = .001). Similarly, monocyte-to-lymphocyte ratio and C-reactive protein-to-albumin ratio values were significantly correlated with frontal QRS-T (P = .011 and P = .24). The fact that frontal QRS-T angle and neutrophil-to-lymphocyte ratio were correlated in the restless legs syndrome group in our study suggests that the inflammatory process may have increased the risk of cardiovascular disease in restless legs syndrome patients. Our findings show that the frontal QRS-T angle is high in restless legs syndrome patients. We conclude that C-reactive protein-to-albumin ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio are higher in the restless legs syndrome patient group and are related to cardiovascular disease risk.

Calprotectin and CRP as biomarkers of cardiovascular disease risk in patients with chronic kidney disease: a follow-up study at 5 and 10 years

Chronic kidney disease (CKD) and low-grade inflammation are associated with increased risk of cardiovascular disease (CVD). Calprotectin, a protein mainly secreted by activated neutrophils during inflammatory conditions, has been linked to CVD risk in general populations. The aim of this study was to evaluate the association of calprotectin with CVD risk in CKD patients, relative to C-reactive protein (CRP). One hundred and fifty-three patients with moderate CKD were prospectively followed up at 5 and 10 years. We used Cox regression modelling with stepwise adjustments for other relevant covariates (age, sex, cystatin C, previous CVD, systolic blood pressure, HDL cholesterol and HbA1c) to assess the association of baseline calprotectin and CRP with the risk of fatal or non-fatal CVD events. Twenty-nine and 44 patients experienced a CVD event during median follow-up of 4.8 and 10.9 years, respectively. Higher calprotectin was associated with increased CVD risk at both time points, which remained statistically significant after multivariable adjustments, including adjustment for CRP. For CRP, the associations did not remain statistically significant after final multivariable adjustments. In conclusion, we have shown that in patients with CKD, calprotectin was independently associated with the risk of future CVD events, suggesting that calprotectin may provide prognostic information of CVD risk.

Comparison of Frontal QRS-T Angle in Patients with Panic Disorder and Healthy Control Group: A Preliminary Study.

Autonomic instability is blamed for panic disorder pathophysiology. It has been suggested that this may raise the risk of cardiovascular disease. A new proposal for ventricular depolarization and repolarization impairment is the frontal QRS-T angle. In this cross-sectional study, 61 patients with panic disorder and 73 healthy controls were included. The severity of panic disorder was evaluated using the Severity Measure for Panic Disorder-Adult. Electrocardiography, echocardiography, hemogram, and biochemistry data were recorded. Patients with panic disorder had a greater frontal QRS-T angle than healthy controls. In panic disorder patients, the values for hemoglobin, eosinophil count, and high-density lipoprotein cholesterol were all significantly lower than healthy controls. In comparison to healthy controls, panic disorder patients had significantly higher values for total cholesterol, fasting triglycerides, low-density lipoprotein cholesterol, platelet-to-lymphocyte ratio, and monocyte-to-high-density lipoprotein cholesterol ratio. Significant correlations were found between frontal QRS-T and Severity Measure for Panic Disorder-Adult, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The frontal QRS-T value is positively and significantly predicted by the neutrophil-to-lymphocyte ratio value according to the linear regression analysis for the frontal QRS-T angle [F(6.54) = 8.375, P < .001, adjusted R 2: 0.424]. The current study found that the frontal QRS-T angle increased with the severity of the disease in patients with panic disorder. Frontal QRS-T angle may help to estimate cardiovascular disease risk in patients with panic disorder. This relationship may be necessary in terms of cardiovascular events and inflammatory conditions.

Coronary artery calcium, hepatic steatosis, and atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus: Results from the Dallas heart study

IntroductionCardiovascular disease (CVD) risk amongst those with type 2 diabetes (T2D) is heterogenous. The role of imaging-based cardiometabolic biomarkers (e.g., coronary artery calcium [CAC] score, and hepatic triglyceride content [HTC]) in CVD risk stratification in T2D is unclear. To better understand this, we sought to evaluate the individual and joint associations between CAC and hepatic steatosis (HS) with clinical atherosclerotic CVD (ASCVD) in Dallas Heart Study (DHS) participants with and without T2D. MethodsWe examined participants in the DHS, a multi-ethnic cohort study, without self-reported ASCVD. CAC scoring was performed via computed tomography with the mean of two consecutive scores used. HTC was measured using magnetic resonance spectroscopy, and HS was defined as HTC >5.5% The primary outcome was incident ASCVD, defined as coronary heart disease (CHD; myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery), ischemic stroke, transient ischemic attack, or CVD death. Cox regression analyses, and interaction testing was performed to evaluate the individual and joint associations between CAC and HS with ASCVD. The association between HS and coronary heart disease was validated in the UK Biobank (UKB). ResultsA total of 1252 DHS participants were included with mean age 44.8 ± 9.3 years, mean body mass index 28.7 ± 5.9 kg/m2, 55% female, and 59% black with an overall prevalence of T2D of 9.7%. CAC scores were significantly higher (p < 0.01) and HS was significantly more prevalent in those with T2D (p < 0.01). Over a median of 12.3 years, 8.3% of participants experienced ASCVD events. The ASCVD event rate was significantly higher in participants with T2D (20.5% vs 7.0%, p < 0.01). Continuous CAC was associated with ASCVD events in the overall cohort regardless of T2D status with a significant interaction present between CAC and T2D status on ASCVD, Pinteraction = 0.02. HTC was not associated with ASCVD risk in participants without T2D but was inversely associated with risk in participants with T2D (HR 0.91, 95% CI 0.83–0.99 per 1% increase in HTC, p = 0.02), Pinteraction = 0.02. Amongst 37,266 UKB participants, 4.5% had T2D. CHD events occurred in 2.2% of participants, with 10.2% of events occurring amongst those with T2D. An inverse relationship between HTC and CHD was also found amongst those with T2D in UKB with a significant interaction between T2D status and HTC on CHD (HR per 1% increase in HTC 0.95, 95% CI 0.91–0.99, p = 0.01, Pinteraction = 0.02). ConclusionsIn the DHS, we found that CAC was associated with ASCVD risk independent of T2D status. We did not observe an association between HTC and ASCVD in participants without T2D, but there was an inverse association between HTC and ASCVD in those with T2D that was replicated in the UKB cohort. Further investigation is warranted to understand the possible protective association of HS in participants with T2D.

Cardiovascular disease risk in patients with type 2 diabetes and hypertension.

Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan Correspondence to Tomoyuki Kawada, MD, PhD, Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan. Tel: +81 3 3822 2131; fax: +81 3 5685 3065; e-mail: [email protected]

Retinal perfusion density can predict cardiovascular disease risk in patients with retinal vein occlusion.

To correlate microvascular changes and assess the relationship between microvascular changes and cardiovascular disease (CVD) risk in patients with retinal vein occlusion (RVO). Patients over 40 years of age with unilateral RVO were included in this prospective study. Those known to have cardiovascular disease were excluded. A detailed medical history was taken and physical exam was done to measure the height, weight, body mass index (BMI), and systolic blood pressure (SBP). A comprehensive eye check-up was followed by optical coherence tomography angiography (OCTA). Microvascular indices such as vessel density (VD) and perfusion density (PD) were noted. A statistical model was developed for prediction of CVD risk and was integrated with the World Health Organization (WHO)'s risk prediction charts. This study included 42 patients with RVO and 22 controls with an age range of 42-82 years. There were 40 males (62.5%) and 24 females (37.5%). Along with age, SBP, and gender, perfusion density was found to have significant impact on CVD risk (P = 0.030). Reduction in PD was associated with increase in CVD risk. PD had a greater influence on CVD in <50 years age than in >70 years group. Using linear regression, a model with accuracy of 72.1% was developed for CVD risk prediction and was converted into color coded charts similar to WHO risk prediction charts. These findings suggest a significant correlation between microvascular parameters and CVD risk in RVO patients. Based on these parameters, an easy-to-use and color-coded risk prediction chart was developed.