Metabolic Cardiovascular Research Articles

Longitudinal, prospective cardiovascular and metabolic risk in treatment-naive patients with chronic myeloid leukemia in chronic phase (CML-CP) starting tyrosine kinase inhibitor (TKI) therapy in a real-world setting.

7053 Background: Multiple TKIs used in the treatment (tx) of CML have been associated with the development of cardiovascular/metabolic (CV/Met) comorbidities, yet no study to date has prospectively and systematically assessed CV/Met parameters after TKI initiation. CA180-653 (NCT03045120) is a non-interventional, prospective, real-world study characterizing the effects of TKIs (dasatinib [DAS], imatinib [IM], nilotinib [NIL], and bosutinib [BOS]) on CV/Met risk factors in patients (pts) with CML-CP in routine care. Baseline CV/Met risks were previously reported (Mauro, GCOS 2019). Here, we report data from the final 2-year follow-up. Methods: Adult pts with newly diagnosed CML-CP due to start tx with DAS, IM, NIL, or BOS were enrolled; the BOS cohort was not analyzed independently due to small sample size. Pts were followed for 24 mo. Blood/urine samples, CV/Met assessments, coronary calcium scoring, echocardiography, and cytogenetic/molecular response assessments were collected at routine office visits at predetermined timepoints. The primary endpoint was change in CV/Met risk from baseline. Results: At the end of follow-up, 118 pts were enrolled; 49 received DAS, 47 IM, 16 NIL, and 6 BOS. Of these, 83 (70.3%) pts completed the study and 35 (29.7%) discontinued; the most common reason for discontinuation was withdrawal of consent (n = 19). No pts died from CML. At baseline, median age was 57 (range, 20–97) y; 59.3% of pts were male and 83.9% were White. Sixty-two (52.5%) pts had CV/Met risk factors at baseline, including hypertension (n = 45/62; 72.6%), hyperlipidemia (n = 33/62; 53.2%), diabetes (n = 19/62; 30.6%), and arrhythmia (n = 10/62; 16.1%). Over the study period, 1 (3.4%) patient receiving DAS and 2 (6.9%) receiving IM developed coronary artery calcification; 2 (9.1%) pts receiving IM developed pericardial effusion. Median left ventricular ejection fraction on 2D echocardiogram was normal for all TKIs at baseline (65.4% [range, 27–81]) and end of study (65.4% [range, 40–80]). Systolic and diastolic blood pressure increased from baseline only in pts who received NIL. Blood glucose levels increased from baseline for DAS, IM, and NIL (median: 1.9, 4.9, and 5.8 mg/dL, respectively), and low-density lipoprotein levels decreased from baseline in all 3 cohorts (median: 72.7, 52.1, and 56.3 U/L, respectively); data from the NIL group were limited by the small sample size. There was 1 death from myocardial infarction related to NIL. Conclusions: These findings suggest more than half of pts with CML-CP have CV/Met risk factors at baseline. At end of study, there was indication of CV/Met effects based on TKI selection. This highlights the importance of appropriate TKI selection based on pt comorbidity characteristics, along with close monitoring and management of CV/Met risks throughout tx. Clinical trial information: NCT03045120 .

Analysis on detection status of cardio-metabolic related risk factors in women aged 15-49 years in 15 provinces in China

Objective: To analyze the prevalence, co-prevalence of cardiovascular metabolic (CM) risk factors in women aged 15-49 years in China, and describe the influence of social economic factors on them. Methods: The project data of Nutritional Status and Health Transition of Chinese Residents in 2015 were used. The changes in epidemiological characteristics of central obesity, elevated blood pressure, FPG and TG, decreased HDL-C and co-prevalence of the risk factors in women aged 15-49 years were analyzed. According to the definition of the metabolic syndrome released by the International Diabetes Federation in 2005, five cardio-metabolic risk factors appeared as central obesity, increased triglycerides, decreased HDL-C, increased blood pressure and increased plasma glucose. Co-prevalence of risk factors was defined as detecting 2 or more risk factors in a person at the same time. Multivariate logistic regression model was used to analyze the relationship between socioeconomic factors and metabolic risk factors. Results: In 2015, in women aged 15-49 years in 15 provinces, the detection number (rates) of central obesity, elevated blood pressure, FPG and TG, decreased HDL-C, at least one CM risk factor and co-detection rate of CM risk factors were 944 (47.4%), 464 (23.3%), 123 (6.2%), 327 (16.4%), 1 025 (51.5%), 1 501 (75.4%), and 874 (43.9%), respectively. Compared with women aged 15-19 years, the women in age group of 25-, 30-, 35-, 40-, and 45-49 years were more likely to have central obesity (P<0.05), the women in age group of 30- 35-, 40-, and 45-49 years were more likely to have elevated blood pressure (P<0.05), the women aged 45-49 years were more likely to be affected by one or more CM risk factors (P<0.05), but the women in age group 25-29 years group had lower risk for elevated FPG (P<0.05). The odds of having central obesity, elevated blood pressure, FPG and TG, decreased HDL-C, at least one CM risk factor and co-prevalence of CM risk factors in women with BMI≥24.0 kg/m(2) were 14.16, 3.05, 2.46, 2.49, 2.42, 9.79 and 7.39 times higher than those in the women with BMI of 18.5-24.0 kg/m(2), respectively. The odds of having elevated FPG and TG in women aged 15-49 years in western China and the odds of having elevated blood pressure and FPG in women aged 15-49 years in eastern China were significantly higher than those in central China. No significant correlations were found between the prevalence and co-prevalence of CM risk factors and income level or urban and rural area residences in women aged 15-49 years. Conclusions: Age, BMI level and living area were the major influencing CM risk factors. The precise prevention and control measures should be taken in time for the adverse changes in CM risk factor prevalence.