Cardiovascular Disease In Patients Research Articles

RUNX1 Isoforms Regulate RUNX1 and Target-Genes Differentially in Platelets-Megakaryocytes: Association with Clinical Cardiovascular Events.

Hematopoietic transcription factor RUNX1 is expressed from proximal P2 and distal P1 promoter to yield isoforms RUNX1 B and C, respectively. The roles of these isoforms in RUNX1 autoregulation and downstream-gene regulation in megakaryocytes and platelets are unknown. To understand the regulation of RUNX1 and its target genes by RUNX1 isoforms. We performed studies on RUNX1 isoforms in megakaryocytic HEL cells and HeLa cells (lack endogenous RUNX1), in platelets from 85 healthy volunteers administered aspirin or ticagrelor, and on the association of RUNX1 target genes with acute events in 587 patients with cardiovascular disease (CVD). In chromatin immunoprecipitation and luciferase promoter assays, RUNX1 isoforms B and C bound and regulated P1 and P2 promoters. In HeLa cells RUNX1B decreased and RUNX1C increased P1 and P2 activities, respectively. In HEL cells, RUNX1B overexpression decreased RUNX1C and RUNX1A expression; RUNX1C increased RUNX1B and RUNX1A. RUNX1B and RUNX1C regulated target genes (MYL9, F13A1, PCTP, PDE5A and others) differentially in HEL cells. In platelets RUNX1B transcripts (by RNAseq) correlated negatively with RUNX1C and RUNX1A; RUNX1C correlated positively with RUNX1A. RUNX1B correlated positively with F13A1, PCTP, PDE5A, RAB1B, and others, and negatively with MYL9. In our previous studies, RUNX1C transcripts in whole blood were protective against acute events in CVD patients. We found that higher expression of RUNX1 targets F13A1 and RAB31 associated with acute events. RUNX1 isoforms B and C autoregulate RUNX1 and regulate downstream genes in a differential manner and this associates with acute events in CVD.

Usefulness of the cardiopulmonary exercise test up to the anaerobic threshold for pati-ents aged ≥ 80 years with cardiovascular disease on cardiac rehabilitation.

A cardiopulmonary exercise test provides information regarding appropriate exercise intensity, but there have been few reports on its use in patients over 80 years of age. Retrospective observational study. A total of 511 cardiovascular disease patients who performed a cardiopulmonary exercise test from February 2011 to January 2020 were investigated. Patients were stratified according to age: < 70 years, 70-79 years, and ≥ 80 years, and the results of the cardiopulmonary exercise test up to anaerobic threshold were compared. Patients in the < 70 age bracket showed higher oxygen consumption, carbon dioxide output, and ventilatory volume and lower ventilation equivalents per oxygen consumption and carbon dioxide output in all time periods. However, there were no significant differences in these parameters or the work rate (70-79 years of age: 41.4 ± 11.7 watts, vs ≥ 80 years: 42.2 ± 10.9 watts, p = 0.95) or oxygen consumption per body weight at anaerobic threshold (12.2 ± 0.2 ml/min/kg, vs 12.1 ± 0.4 ml/min/kg, p = 0.97) between the 70-79 year age bracket and the ≥ 80 year age bracket. Even for cardiovascular disease patients age ≥ 80 years, a cardiopulmonary exercise test up to anaerobic threshold can supply useful information for guiding cardiac rehabilitation.

Sedentary behaviour may cause differences in physical outcomes and activities of daily living in older cardiovascular disease patients participating in phase I cardiac rehabilitation

This study aimed to investigate the rate of sedentary behaviour and differences in physical outcomes and activities of daily living (ADL) based on sedentary behaviour time of hospitalized older cardiovascular disease patients undergoing phase I cardiac rehabilitation. Older cardiovascular disease patients were enrolled from October 2020 to September 2023 and were divided into the high sedentary behaviour group (≥ 480 min/day) and low sedentary behaviour group (< 480 min/day). Patients’ clinical characteristics, usual gait speed, and Five Times Sit to Stand Test time were compared as indices of physical outcomes. Motor, cognitive, and total Functional Independence Measure (FIM) scores were used as indices of ADL and compared between groups using analysis of covariance. Final analysis included 402 patients (mean age: 76.7 years, female: 35.3%). The high sedentary behaviour group included 48.5% of the study patients. After adjustment for baseline characteristics, gait speed (0.80 ± 0.27 vs. 0.96 ± 0.23 m/s, p < 0.001) was lower and FTSST time (11.31 ± 4.19 vs. 9.39 ± 3.11 s, p < 0.001) was higher in the high sedentary behaviour group versus low sedentary behaviour group. Motor (85.82 ± 8.82 vs. 88.09 ± 5.04 points, p < 0.001), cognitive (33.32 ± 2.93 vs. 34.04 ± 2.24 points, p < 0.001), and total FIM scores (119.13 ± 10.66 vs. 122.02 ± 6.30 points, p < 0.001) were significantly lower in the high sedentary behaviour group versus low sedentary behaviour group after adjustment. In older cardiovascular disease patients in phase I cardiac rehabilitation, sedentary behaviour time might influence physical outcomes and ADL at discharge. It is thus important to consider the amount of sedentary behaviour time spent by these patients during daily life while hospitalized.

1280-P: Higher Triglyceride–Glucose Index Is Associated with a Higher Risk of Cardiovascular Disease in Patients with Type 1 Diabetes

1280-P: Higher Triglyceride–Glucose Index Is Associated with a Higher Risk of Cardiovascular Disease in Patients with Type 1 Diabetes

450-P: Pulse Pressure as a Predictor of Cardiovascular Events in Cardiovascular Disease Patients with Differing Glycemic State

450-P: Pulse Pressure as a Predictor of Cardiovascular Events in Cardiovascular Disease Patients with Differing Glycemic State

Outpatient Consultation of Diabetes and Cardiovascular Diseases Patients in Abuja Public Hospitals Based on Selected Indicators

AIM. Diabetes and cardiovascular diseases are among the reasons for most outpatient consultations. The study aimed to evaluate the reported experiences of patients being managed for diabetes and cardiovascular diseases in the outpatient clinics of Abuja public hospitals. METHOD. A prospective cross-sectional study of 787 systematically sampled patients receiving care in five public hospitals in Abuja was conducted. A structured questionnaire was used to collect data on the number of yearly consultations, problems encountered in accessing trained health personnel, time spent on hospital appointments, major treatment challenges, and ways to improve their experience on hospital visits. Consultation experience was defined as good or poor. Patients who consulted at least four times in a year, reported no problems in accessing trained health personnel, and had no treatment challenges were regarded as having a good consultation experience. Frequency, percentage, mean, and standard deviation were used to summarize the data. Logistic regression was used to predict and classify the binary outcomes. A p-value ≤ 0.05 was considered significant. RESULTS. More of the patients (66.2%) had up to four consultations in a year. Long waiting time (56.1%) was the common problem encountered when accessing trained medical personnel. The major treatment challenge was hospital waiting time (49.4%). The mean time spent in the hospital on appointment days was 5.04±1.80. Approximately 40% of the patients suggested proper scheduling of hospital appointments as the major way to improve treatment experiences. Poor consultation was recorded by 96.6% of the patients. Logistic regression showed that a higher educational level (OR = 0.031, 95% CI [0.008-0.119], _P=_0.001) was associated with reporting poor management. CONCLUSION. The average number of yearly consultations was below the minimum standard, and patients spent long hours on consultation days before meeting with healthcare personnel. Most patients were dissatisfied with the services received and rated them poor.

Evaluation of a Cardiovascular Disease/Diabetes Mellitus Expansion Program for Community Health Workers Employed by Rhode Island Community Health Teams.

The integration of certified community health workers (CCHWs) with specialty chronic disease training into clinical care teams has demonstrated improvements in chronic disease quality of care, management, and outcomes. Rhode Island Department of Health's Diabetes, Heart Disease, and Stroke Program expanded the roles of CCHWs employed by Community Health Teams for chronic disease with a focus on cardiovascular disease (CVD) and diabetes mellitus (DM) from 2020 to 2023. Rhode Island Department of Health's Diabetes, Heart Disease, and Stroke Program sought to determine whether patient health behaviors and clinical outcomes improved with specialty trained CCHW support. Community Health Teams identified high-risk or rising-risk patients with hypertension, high cholesterol, and/or diabetes. During an infrastructure phase, patients were assigned a CCHW who had not received CVD/DM specialty training. During a performance phase, a separate cohort of patients was assigned a CVD/DM specialty-trained CCHW. In each phase, patients were seen by the CCHWs at least twice and completed baseline and follow-up health assessments. The trained CCHWs utilized the baseline assessment to offer health coaching specific to the patient's chronic disease-related needs. Improvements in blood pressure readings and cholesterol were observed at an individual level for CVD patients. However, a significant difference was not observed for hypertension or high cholesterol when comparing phases. Individual-level results indicated improved HbA1c values for DM patients; however, the differences in clinical values were not significant. Although there were no significant differences for clinical values between the phases, the proportion of patients who reported confidence in managing their condition(s) increased from baseline to follow-up for both phases. It cannot be concluded that specialty-trained CCHWs have significant impact on patient behaviors and clinical outcomes. However, overall CCHW intervention did result in improved self-efficacy in patients to manage their chronic conditions. Further evaluation is needed to understand what factors led to improved patient confidence levels.

Apolipoprotein E Gene Variation in Pakistani Subjects with Type 2 Diabetes with and without Cardiovascular Complications.

Background: Apolipoprotein E (APOE) gene polymorphism has been implicated in the pathogenesis of various metabolic disorders, including type 2 diabetes mellitus (T2DM). Type 2 diabetes mellitus (T2DM) is a major public health concern worldwide, including in Pakistan. Cardiovascular problems linked with T2DM have a significant impact on individuals and society. The goal of this study is to investigate the relationship between Apolipoprotein E (ApoE) genotypes, dyslipidemia, and cardiovascular complications such as ischemic heart disease (IHD) and stroke. Methods: This study was carried out on 260 subjects divided into controls and diabetics. The diabetics were further divided into four subgroups such as D1: diabetics without cardiovascular issues, D2: diabetics with heart disease, D3: diabetics with stroke, and D4: diabetics with both heart disease and stroke. Anthropometric parameters (age, BMI) and risk factors (smoking, diabetes duration, hypertension) were assessed in all groups. Serum levels of TC, TG, LDL, HDL, VLDL, creatinine, BSF, and HbA1c were also measured. Apolipoprotein E gene polymorphism was determined using PCR-RFLP. Results: Hypertension, BMI, and dyslipidemia are defined as elevated levels of total cholesterol, triglycerides, LDL, and VLDL, and decreased levels of HDL. Uncontrolled hyperglycemia (elevated fasting blood sugar and glycated hemoglobin) in T2DM was linked to vascular complications such as IHD and stroke. Hypertension was prevalent in 79.3% of the population. Stage 2 hypertension was more prevalent in all age groups. It was also noted that common genotypes in the Pakistani population are 3/3, 4/4, 2/3, and 3/4. The frequency of genotypes 3/4 and 2/3 is highest in diabetics with stroke. Genotype 3/3 is present frequently in diabetics with IHD/stroke and patients with both these complications. However, genotype 4/4 is most frequently found in diabetics with IHD. Conclusions: It is concluded that BMI, hypertension, hyperglycemia, atherosclerosis, and dyslipidemia are linked with cardiovascular complications of type 2 diabetes. Apolipoprotein E gene polymorphism is associated with cardiovascular disease in patients with diabetes by affecting the lipid profile.

Evaluation of N-terminal pro-atrial natriuretic peptide and Soluble ST2 as Predictors for Cardiovascular Diseases in Patients with Type 2 Diabetes in Al-Basra, Iraq

Evaluation of N-terminal pro-atrial natriuretic peptide and Soluble ST2 as Predictors for Cardiovascular Diseases in Patients with Type 2 Diabetes in Al-Basra, Iraq

The Cumulative and Single Effect of 12 Aldehydes Concentrations on Cardiovascular Diseases: An Analysis Based on Bayesian Kernel Machine Regression and Weighted Logistic Regression.

This study investigates the individual and cumulative effects of 12 aldehydes concentrations on cardiovascular disease (CVD). A total of 1529 individuals from the 2013-2014 National Health and Nutrition Examination Survey were enrolled. We assessed serum concentrations of 12 aldehydes, including benzaldehyde, butyraldehyde, crotonaldehyde, decanaldehyde, heptanaldehyde, hexanaldehyde, isopentanaldehyde, nonanaldehyde, octanaldehyde, o-tolualdehyde, pentanaldehyde, and propanaldehyde. CVD patients were identified based on self-reported disease history from questionnaires. The Bayesian kernel machine regression was used to evaluate the cumulative effect of 12 aldehyde concentrations on CVD. Both weighted and unweighted logistic regression were used to assess the association of serum aldehyde concentrations with CVD, presenting effect sizes as odds ratio (OR) with 95% confidence interval (CI). Additionally, a restricted cubic spline analysis was also conducted to explore the relationship between benzaldehyde and CVD. Among the participants, 111 (7.3%) were identified as having CVD. Isopentanaldehyde concentrations were notably higher in CVD patients compared to those without CVD. Bayesian kernel machine regression indicated no cumulative effect of aldehydes on CVD. Unweighted logistic regression revealed a positive association between benzaldehyde and CVD when adjusting for age and sex (OR = 1.12, 95% CI = 1.03-1.21). This association persisted after adjusting for age, sex, race, education, hypertension, diabetes, alcohol consumption, and smoking, with an OR of 1.12 (95% CI = 1.02-1.22). The restricted cubic spline showed a linear association between benzaldehyde and CVD. In the weighted logistic model, the association between benzaldehyde and CVD remains significant (OR = 1.17, 95% CI = 1.06-1.29). However, no significant association was found between other aldehydes and CVD. Our study reveals the potential contributing role of benzaldehyde to CVD. Future studies should further validate these findings in diverse populations and elucidate the underlying biological mechanisms.

Establishment and validation of prediction model for atherosclerotic cardiovascular disease in patients with hyperuricemia.

To construct a risk prediction model for atherosclerotic cardiovascular disease (ASCVD) in patients with hyperuricemia. Data in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) (2007-2010). Participants from Huashan Hospital were included as an external validation. Logistic regression analysis was used to explore the relevant factors of ASCVD in patients with hyperuricemia. The discriminability of the model was evaluated using the area under the curve (AUC) statistic of the receiver operating characteristic curve. Hosmer-Lemeshow test, correction curve and decision curve analysis (DCA) were used to evaluate the model. A total of 389 patients collected from the NHANES were included in the final analysis. Logistic regression analysis showed that age, creatinine (Cr), glucose (Glu), serum uric acid (SUA), and history of gout were predictive factors for ASCVD in hyperuricemia (HUA) patients. These predictive factors were used to construct a nomogram. And 157 patients from NHANES were in the internal validation group and 136 patients from Huashan Hospital were in the external validation group. The AUC values of the three groups were 0.943, 0.735, and 0.664. The p values of the Hosmer-Lemeshow test were .568, .600, and .763. The calibration curve showed consistency between the nomogram and the actual observed values. The DCA curve indicated that the model has good clinical practicality. This study constructed the ASCVD risk prediction model for HUA patients, which is beneficial for medical staff to detect high-risk populations of ASCVD in the early stage.

Blood pressure assessment, treatment and control for primary prevention of cardiovascular disease in patients with and without depression

Blood pressure assessment, treatment and control for primary prevention of cardiovascular disease in patients with and without depression

Perception and use of relaxation techniques in cardiovascular disease patients two years after cardiac rehabilitation

Perception and use of relaxation techniques in cardiovascular disease patients two years after cardiac rehabilitation

Left ventricular filling pressure correlates with exercise capacity during exercise stress test in cardiovascular disease patients

Left ventricular filling pressure correlates with exercise capacity during exercise stress test in cardiovascular disease patients

The Nutritional and Biochemical Indicators of Cardiovascular and Chronic Kidney Diseases Patients Compared to a Normal Group

The Nutritional and Biochemical Indicators of Cardiovascular and Chronic Kidney Diseases Patients Compared to a Normal Group

Construction of clinical nursing pathway for falls risk management in elderly cardiovascular disease patients.

Construction of clinical nursing pathway for falls risk management in elderly cardiovascular disease patients.

Genetic Causality between Type 1 Diabetes and Arrhythmia Identified by a Two-sample Mendelian Randomization Study

BackgroundClinical studies have shown that cardiovascular diseases in patients with type 1 diabetes (T1D) are often atypical or asymptomatic. The link between T1D and arrhythmia remains unclear. To infer causality between T1D and arrhythmia at the genetic level, we conducted a Mendelian randomization study through the genetic tools of T1D. MethodsIn this study, we used genetic variables and summary statistics from genome-wide association studies of T1D and arrhythmia. Single nucleotide polymorphisms were selected based on the assumptions of instrumental variables. The inverse variance-weighted method was used as the primary analysis to summarize the causal effects between exposure and outcome. The weighted median and weighted mode methods were used as secondary methods. We tested for horizontal pleiotropy using the MR-Egger method and detected heterogeneity using the Q-test. A leave-one-out sensitivity analysis was performed. Scatter plots, forest plots, and funnel plots were used to visualize the results of the MR analysis. ResultsIn this study, we selected 28 T1D-related SNPs as instrumental variables. The IVW [odds ratio (OR) = 0.98, 95 % confidence interval (CI) = 0.97−1.00, P = 0.008], weighted median (OR = 0.98, 95 % CI = 0.96 − 0.99, P = 0.009), and weighted mode (OR = 0.98, 95 % CI = 0.96−0.99, P = 0.018) analysis methods suggested a causal effect of T1D on arrhythmia. The MR-Egger method indicated no horizontal pleiotropy (P = 0.649), and the Q-test showed no heterogeneity (IVW, P = 0.653). ConclusionsOur MR analysis revealed a causal association between T1D and the development of arrhythmia, indicating that patients with T1D had a higher risk of arrhythmia.

The Effect of Hyperlipidemia on Cardiovascular Diseases: A Risk Factor in Cardiovascular Diseases at FMH Hospital Lahore

Background: Cardiovascular diseases (CVDs) represent a major global health concern, causing approximately 17.9 million deaths annually, accounting for 32% of all global deaths. Among these fatalities, 85% are attributed to heart attacks and strokes. Hyperlipidemia, a common metabolic disorder, significantly contributes to the risk of CVDs by causing disturbances in lipid metabolism, including elevated levels of low-density lipoprotein cholesterol (LDL-C), increased triglycerides, elevated total cholesterol (TC), and decreased levels of high-density lipoprotein cholesterol (HDL-C). Objective: To determine the impact of hyperlipidemia on cardiovascular diseases, focusing on its role as a prominent risk factor. Methods: This retrospective study was conducted at the Department of Pathology, Fatima Memorial Hospital, Lahore, from June 2023 to December 2023, following approval from the Institutional Review Board (IRB). Data were collected using a non-probability convenient sampling technique. The sample size was calculated based on a 95% confidence level, an estimated prevalence of hyperlipidemia in CVD patients of 4.5%, and a desired margin of error, resulting in a sample size of 65-70 patients. Inclusion criteria included CVD patients diagnosed with hyperlipidemia, while patients with hyperlipidemia but no CVD were excluded. Data were collected from medical records using a self-designed Performa. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp.). Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation (SD). Bar charts were used for categorical data and histograms for continuous data. A p-value of less than 0.05 was considered statistically significant. Chi-square analysis was used to identify correlations between lipid levels and CVD status. Results: Out of the 65 subjects, 45 (69.2%) had no CVD, while 20 (30.8%) were diagnosed with CVD. Total cholesterol levels were &lt;200 mg/dL in 36 patients (55.4%), 200-240 mg/dL in 15 patients (23.1%), and &gt;240 mg/dL in 14 patients (21.5%). LDL levels were &lt;100 mg/dL in 21 patients (32.3%), 130-189 mg/dL in 38 patients (58.5%), and &gt;190 mg/dL in 6 patients (9.2%). HDL levels were &lt;39 mg/dL in 36 patients (55.4%) and &gt;40 mg/dL in 29 patients (44.6%). Triglyceride levels were &lt;150 mg/dL in 15 patients (23.1%), 150-199 mg/dL in 30 patients (46.2%), and 200-499 mg/dL in 20 patients (30.8%). Chi-square analysis revealed a significant association between triglyceride levels and CVD status (p &lt; 0.001) and significant results for LDL and HDL levels (p &lt; 0.005). Conclusion: This study highlights the profound impact of hyperlipidemia on cardiovascular health, emphasizing its role as a significant risk factor for CVDs. The strong association between elevated lipid levels and increased risk of cardiovascular events underscores the need for effective lipid management strategies to reduce the burden of cardiovascular diseases and improve patient outcomes.

Dietary habits and compliance with dietary guidelines in patients with established cardiovascular disease.

Unhealthy dietary habits are an important risk factor for cardiovascular disease (CVD) and adopting a healthy diet is a central recommendation in CVD prevention. This study assessed the dietary habits of patients with established CVD, their compliance to dietary guidelines, and the relationship between guideline-compliance and recurrent cardiovascular event risk. 2656 patients with established CVD from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART) prospective cohort study, were included between 1996 and 2022. Data on dietary intake was retrospectively collected for all participants in December 2022 using a 160-item food frequency questionnaire. Compliance with dietary guidelines was quantified using an amended version of the Dutch Healthy Diet 2015 (DHD-15) index (range: 0-135). Cox proportional hazard models were used to quantify the relationship with cardiovascular events (stroke and myocardial infarction). Among 2656 CVD patients (77% male, mean age 59 ± 9 years), median energy intake was 1922 [IQR: 1536-2351] kcal/day. The median DHD-15 index was 81.7 [IQR 71.2-92.0], with high compliance scores for recommendations on legumes and fish, and low scores for recommendations on whole grains, red meat, processed meat, and dairy. A higher DHD-15 score was associated with lower stroke risk (HR 0.78, 95% CI 0.66-0.92 per 10-point increase) but not with myocardial infarction. Compliance with dietary guidelines was suboptimal in patients with established CVD. High compliance was associated with a clinically significant reduction in stroke risk in patients with established CVD, emphasizing the importance of dietary counseling.

HEART + score: integrating carotid ultrasound to chest pain assessment in the emergency department.

The HEART score is a clinical decision tool that stratifies patients into categories of low, moderate, and high-risk of major adverse cardiac events in the emergency department (ED) but cannot identify underlying cardiovascular disease in patients without prior history. The presence of atherosclerosis can easily be detected at the bedside using carotid ultrasound. Plaque quantification is well established, and plaque composition can be assessed using ultrasound grayscale pixel distribution analysis. This study aimed to determine whether carotid plaque burden and/or composition correlated with risk of events and could improve the sensitivity of the HEART score in risk stratifying ED patients with chest pain. The HEART score was calculated based on history, electrocardiogram, age, risk factors, and initial troponin in patients presenting to the ED with chest pain (n = 321). Focused carotid ultrasound was performed, and maximum plaque height and total plaque area were used to determine plaque burden (quantity). Plaque composition (% blood, fat, muscle, fibrous, calcium-like tissue) was assessed by pixel distribution analysis. Carotid plaque height and area increased with HEART score (p < 0.0001). Carotid plaque % fibrous and % calcium also increased with HEART score. The HEART score had a higher area under the curve (AUC = 0.84) in predicting 30-day events compared to the plaque variables alone (AUCs < 0.70). Integrating plaque quantity into the HEART score slightly increased test sensitivity (62-69%) for 30-day events and reclassified 11 moderate-risk participants to high-risk (score 7-10). Plaque burden with advanced composition features (fibrous and calcium) was associated with increased HEART score. Integrating plaque assessment into the HEART score identified subclinical atherosclerosis in moderate-risk patients.