Cardiovascular Risk Assessment Research Articles

Abstract 13464: Considering Race and Ethnicity in Cardiovascular Risk Assessment

Background: Cardiovascular disease (CVD) remains one of the leading causes of mortality in American adults, with disparities among racial and ethnic groups due to differential healthcare access and systemic racism. To better characterize the validity and generalizability of the AHA/ACC’s 2019 guidelines for primary prevention of CVD and 2018 special report on the use of the risk assessment tool for ASCVD, we examined the racial and ethnic composition of the study populations used in the underlying cited works. Methods: We reviewed all the references cited in the guidelines for our primary outcome, inclusion of race and ethnicity information. In addition, data were collected on study design, location (international, US, or both), reported sex/gender of participants, and total participants. We further assessed discussion of race and ethnicity within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (>5 sentences). Finally, we pooled the racial distributions for all study populations and compared it to national rates in the US population of 76% White, 14% Black, 6 % Asian, 19% Hispanic. Results: Of the 58 cited articles, 12 (20.6%) reported racial and/or ethnic backgrounds of participants. Of those 12 articles, 7 (12% of total) included cursory discussions of race and ethnicity, while the remaining 5 included no such discussion. Only 3 (5%) reported both race and sex distributions, none of which allowed calculation of race by sex. The pooled racial averages were 20% Black, 1% Asian and 9% other, with 11% identifying ethnicity as Hispanic. Conclusion: The majority of the guideline source data provides no information regarding the racial and ethnic backgrounds of study participants. Studies that do address race and ethnicity show an overrepresentation of white individuals compared to the general US population and provide no data specifically addressing the risk to people who are neither white nor male. This leads to potential underestimation of risks and imprecise risk calculations for non-white populations due to small sample sizes in the original studies. It is crucial to include diverse participant groups in studies at population rates to ensure precise risk calculations, improve CVD prevention, and reduce mortality rates.

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

IntroductionCentral aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). MethodsIn a prospective, longitudinal cohort study aortic and office systolic BPs were registered in patients undergoing elective coronary angiography. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2. Multivariable Cox models were used for the association with incident myocardial infarction (MI), stroke, and death. ResultsAortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6,605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1,367 strokes (CKD: 353), 1,858 MIs (CKD: 446) and 7,551 deaths (CKD: 2,515) occurred. CKD increased the risk of stroke, MI and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mmHg: 1.08 (1.05–1.12) and 1.06 (1.03–1.09), respectively) and with MI in CKD patients (adjusted hazard ratios: 1.08 (1.03–1.13) and 1.08 (1.04–1.12), respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. ConclusionRegardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Abstract 11548: An Examination of Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults in the All of Us Research Program

Introduction: Although cardiovascular health (CVH) disparities have been documented among sexual minority (e.g., gay/lesbian, bisexual) adults, research has been limited by a focus on sexual identity differences in individual, rather than composite, measures of CVH. Composite measures of CVH provide more comprehensive assessments of future cardiovascular disease risk. Methods: We analyzed data from the All of Us Research Program to examine sexual identity differences in CVH using the American Heart Association’s Life's Essential 8 measure of ideal CVH. Participants received a score from 0-100 for each CVH metric. We calculated an unweighted average to determine cumulative ideal CVH (range 0-100). Higher scores indicated a more favorable CVH profile. We used sex-stratified multiple linear regression models to estimate differences in individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. All models were adjusted for age, race, ethnicity, household income, education, and insurance status Results: The sample included 6,597 participants with a mean age of 63.3 years (±13.89) of which 57% were female and 79% were Non-Hispanic White. Lesbian women (B = -7.43, 95% CI = -13.20, -1.65), gay men (B = -6.39, 95% CI = -10.17, -2.61), and bisexual men (B = -7.41, 95% CI = -14.71, -0.10) had less favorable nicotine exposure scores than their heterosexual counterparts of the same sex. Gay (B = -9.65, 95% CI = -16.60, -2.71) and bisexual men (B = -14.12, 95% CI = -27.53, -0.72) had less favorable physical activity scores than heterosexual men. Bisexual men also had lower cumulative ideal CVH scores than heterosexual men (B = -5.22, 95% CI = -9.16, -1.29). In contrast, gay men had more favorable body mass index scores (B = 6.23, 95% CI = 2.24, 10.22) than heterosexual men. Conclusions: This is the first study to examine ideal CVH in sexual minority adults in the All of Us Research Program. Findings have important implications for the development of interventions to promote optimal CVH among middle-aged and older sexual minority adults. Interventions to reduce nicotine exposure are needed for lesbian women and sexual minority men. Efforts to improve the CVH of sexual minority men should also focus on increasing physical activity.

Abstract 13915: Comparison of Proteomic CV Risk to Established ASCVD 10-year Risk Decision Points

Introduction: The ASCVD pooled cohort equation (PCE) is well-established for CV risk assessment. Decision points for determining treatment plans are low, intermediate and high risk over 10 years, however this approach over and underestimates risk in certain subgroups. The validated CV Risk SomaSignal® Test (SST) provides 4-year risk probability of MACE allowing for timely assessment of risk, but the shorter timescale makes comparison to 10-year PCE risk less intuitive. Hypothesis: Using a previously described metacohort (n=5,575) of patients with increased CV risk, we hypothesized that PCE would stratify patients differently than the CV Risk SST, and that CV Risk score scaled to 10 years would yield an improved net reclassification index (NRI). Methods: CV Risk SST and PCE scores were calculated on metacohort plasma samples. CV risk score was scaled to 10 years by parameterizing the model for a 10-year score, and then calculating a quadratic equation for the conversion. CV risk score was stratified by four established risk bins, whereas the PCE was stratified similarly using &lt;7.5%, 7.5%-15%, 15%-20%, and &gt; 20% risks based on literature and practice-derived cutoffs. Event rates were compared between scores, and NRI was calculated. Results: We observed total NRI of 11.4% for the 10-year CV Risk SST vs. PCE, with up-classification (positive NRI=83.7%) mitigating down-classification (negative NRI=-0.723). Event rates for the high-risk group in the CV Risk test were higher than the PCE, and lower in the low-risk group (p &lt; 0.05). Conclusions: The CV Risk SST stratifies patients by identifying low- and high-risk groups using thresholds that are more discriminatory than low-risk and high-risk thresholds in the PCE. For comparison, the CV risk SST can be scaled to 10-year risk, with CV risk SST having a positive NRI for identifying MACE. This reclassification can allow targeted therapies in patients at greater risk and use of non-pharmacological therapies in the low-risk patients.

Abstract 12714: Superior Longitudinal Aortic Strain and Ventriculoarterial Coupling in Older Women is Independent of Body Size, Blood Pressure, and Moderately Correlated With Framingham 10-year Risk

Background: Traditional risk factors are less helpful in predicting cardiovascular (CV) risk in women (1, 2). We used a novel cardiac MRI (CMR) method to determine sex differences in aortic global longitudinal strain (AoGLS), pulse wave velocity (AAPWV), and ventriculoarterial coupling (VAC) and correlated to Framingham Risk Scores (FRS). Methods: Community adults without CV disease underwent CMR. AoGLS was the maximal absolute Lagrangian strain tracking the phasic distance between brachiocephalic artery origin and aortic annulus. VAC was calculated as AAPWV divided by LVGLS. Sex-specific simplified FRS 10-year risk (TYR) and Heart/Vascular Age (HVA) were derived from pooled cohort equations (3). Results: These n=202 subjects (46% female) were similar in age (69.7 vs. 70.7, p=0.433). Women had better AAPWV (8.4m/s vs. 9.1m/s, p=0.020), AoGLS (6.2% vs. 5.2%, p=0.030), LVGLS (-21.9% vs. -20.1%, p=0.021), RVGLS (-32.8% vs. -29.9%, p=0.020), VAC (-0.39m/s·% vs. -0.47m/s·%, p=0.006), and smaller cardiac volumes (Table A). Female sex was associated with better AoGLS (β=0.838, p=0.030; R 2 =0.103) and VAC (β=-0.93, p=0.006; R 2 =0.113) independent of smoking, DBP, and BSA. Age only weakly correlated with AoGLS (β=-0.128 p&lt;0.001; R 2 =0.277). AoGLS correlated moderately with FRS in women (TYR r=-0.400 p=&lt;0.001; HVA r=-0.621 p&lt;0.001) and weakly in men (TYR r=-0.354 p=&lt;0.001; HVA r=-0.365 p=&lt;0.001). VAC was associated with adverse TYR (β=-6.915, p=0.017; R 2 =0.145) and HVA (β=-14.948, p=0.001; R 2 =0.084); VAC correlated moderately with FRS in women (TYR r=-0.233 p=0.024; HVA r=-0.364 p&lt;0.001) but not in men (TYR r=-0.175 p=0.068; HVA r=-0.183 p=0.056). Conclusion: Novel CMR-derived aortic strain identified sex differences in aortic age correlating with 10-year CV risk. Women had better aorto-ventricular strain and coupling independent of DBP and BSA. Chronological age was not useful in estimating aortic age. Advanced aortic imaging may augment CV risk assessment in women.

Assessing awareness of long-term health risks among women with a history of preeclampsia: a cross-sectional study.

Pregnancy complications, such as hypertensive disorders, present a substantial global public health challenge, with significant long-term implications for maternal and offspring health. This cross-sectional study aims to determine the level of awareness regarding long-term health risks among women who experienced preeclampsia during pregnancy in Cyprus and Greece. The study participants included adult women with a history of preeclampsia, while women with normal pregnancies were used as the comparison group. Data collection took place between June 2021 and February 2022, utilizing an online, self-administered questionnaire. The study included 355 women, with 139 (39.2%) in the preeclampsia group and 216 (60.8%) in the comparison group. Findings revealed that more than half of the women with prior preeclampsia (55.4%) were not aware of hypertensive disorders that can occur during pregnancy before their diagnosis, and a similar percentage (45.2%) had not received information about the long-term health risks following their diagnosis. Remarkably, only 3 participants (4.7%) with a history of preeclampsia were aware of the risk of developing cardiovascular diseases. There were no statistically significant differences between the preeclampsia and the comparison group regarding their concerns about long-term health risks, frequency of health checks, perceptions of factors influencing cardiovascular disease development, and doctor communication about different health topics, except from hypertension or high blood pressure. The study underscores the low level of awareness of long-term health risks among women with prior preeclampsia in Cyprus and Greece. This emphasizes the importance of implementing public health programs aimed at promoting cardiovascular risk assessment and effective management, both for clinicians and women with have experienced preeclampsia.

Abstract 13363: Echocardiographic Coronary Flow Velocity Parameters in Assessing Sub-Clinical Atherosclerosis in Inflammatory Bowel Disease Patients: A Meta-Analysis

Introduction: Chronic inflammatory diseases are linked to atherosclerosis and cardiovascular events. However, there are conflicting results in the literature regarding differences in echocardiographic Coronary Flow velocity parameters, which serve as markers of subclinical atherosclerosis, between inflammatory bowel disease (IBD) patients and healthy controls. Hypothesis: We aim to assess the Coronary Flow Velocity Reserve (CFVR), baseline Diastolic Peak Flow Velocity (DPFV), and hyperemic DPFV in IBD patients. Methods: We conducted a systematic search of databases, from January 1, 2014, to June 1, 2023, to gather relevant studies. The pooled mean differences in various parameters between IBD patients and controls were calculated using the standard mean difference with 95% confidence interval (CI), and random effect model was used when heterogeneity (I 2 ) crossed 50%. Results: 4 studies with 342 participants were included. The mean age of the IBD group was 39.25 years and of the control group was 41.25 years. Male comprised 51.46% of the study participants. IBD patients had a significantly lower CFVR (SMD; -1.12 95%CI; [-1.62, -0.61], p-value&lt;0.01) and hyperemic DPFV (SMD; -0.68, 95%CI [-1.09, -0.27], p-value&lt;0.01) than healthy controls. Whereas, Healthy controls had a lower baseline DPFV (SMD; 0.69 95%CI; [0.35, 1.04], p-value&lt;0.01) than the IBD group. Conclusions: IBD was associated with Coronary Microvascular Disease assessed as impaired CFVR and hyperemic DPFV. This suggests reduced myocardial perfusion in IBD patients and the need for regular cardiovascular risk assessment and targeted interventions to mitigate the increased risk of cardiovascular events.

Erythrocyte membrane fluidity: A novel biomarker of residual cardiovascular risk in type 2 diabetes.

Improving the composition of circulating fatty acids (FA) leads to a reduction in cardiovascular diseases (CVD) in high-risk individuals. The membrane fluidity of red blood cells (RBC), which reflects circulating FA status, may be a valid biomarker of cardiovascular (CV) risk in type 2 diabetes (T2D). Red blood cell membrane fluidity, quantified as general polarization (GP), was assessed in 234 subjects with T2D, 86 with prior major CVD. Based on GP distribution, a cut-off of .445 was used to divide the study cohort into two groups: the first with higher GP, called GEL, and the second, defined as lower GP (LGP). Lipidomic analysis was performed to evaluate FA composition of RBC membranes. Although with comparable CV risk factors, the LGP group had a greater percentage of patients with major CVD than the GEL group (40% vs 24%, respectively, p < .05). Moreover, in a logistic regression analysis, a lower GP value was independently associated with the presence of macrovascular complications. Lipidomic analysis showed a clear shift of LGP membranes towards a pro-inflammatory condition due to higher content of arachidonic acid and increased omega 6/omega 3 index. Increased membrane fluidity is associated with a higher CV risk in subjects with T2D. If confirmed in prospective studies, membrane fluidity could be a new biomarker for residual CV risk assessment in T2D.

Advancements in Cardiovascular Risk Assessment: Integrating New Tools and Guidelines in Internal Medicine Practice

Advancements in Cardiovascular Risk Assessment: Integrating New Tools and Guidelines in Internal Medicine Practice

Impact of Hematopoietic Cell Transplantation on Cardiovascular Risk Factors and Insulin Sensitivity

The use of hematopoietic cell transplantation (HCT) for treating malignant conditions in children has increased over the past five decades, leading to a growing population of long-term survivors.This population of childhood HCT survivors faces increased risks of adverse medical effects due to cancer treatments, including adverse cardiovascular disease (CVD) risk factors such as metabolic syndrome, insulin resistance. but the impact of exposure to HCT preparative conditioning regimen has not been clearly delineated. These risk factors, including obesity, dyslipidemia, hypertension, and insulin resistance (IR), are significant contributors to premature cardiovascular disease and represent a leading cause of non-relapse deaths in childhood cancer and HCT survivors. This study aimed to assess the early development of CVD risk factors and their relationship to insulin resistance in a large population of pediatric and young adult HCT survivors of childhood hematologic malignancies. The study compared their cardiovascular risk profiles, insulin resistance (measured by euglycemic hyperinsulinemic clamp studies), and body composition (determined by dual X-ray absorptiometry - DXA) with a cohort of sibling controls. We enrolled 151 HCT recipients (26.36 ±0.90 years at study enrollment; time since HCT of 2.6-31.5 years) and 92 sibling controls to complete at cardiovascular risk assessment including insulin sensitivity by hyperinsulinemic euglycemic clamp, anthropometry, body composition by dual X-ray absorptiometry, blood pressure, and serum biomarkers. We used linear models to test for mean differences in all continuous outcomes between survivors and siblings, accounting for intra-family correlations with generalized estimating equations. Recipients of HCT were found to have lower insulin sensitivity and more likely to have adverse CVD risk factors in comparison to their healthy siblings. Significantly higher percent fat mass and visceral adipose tissue, and significantly lower lean body mass were noted in HCT recipients than sibling controls despite having a similar body mass index between the two groups. Total body irradiation in the conditioning regimen was one of the strongest factors associated with lower insulin sensitivity, dyslipidemia and abnormal body composition leading to sarcopenic obesity. This study reveals that pediatric and young adult HCT survivors are more insulin resistant and have a higher prevalence of adverse cardiovascular risk factors compared to sibling controls. The presence of cardiovascular risk factors at a relatively young age raises concerns about an escalating trajectory of cardiovascular disease in this population. Therefore, regular monitoring of HCT survivors for cardiometabolic risk factors and early intervention will be crucial for preventing cardiovascular-related complications in the future. The findings underscore the importance of survivorship care for pediatric and young adult HCT survivors, with a focus on managing cardiovascular risk factors and promoting a healthy lifestyle to mitigate long-term adverse effects. Early identification and targeted interventions can significantly improve the long-term health outcomes of this vulnerable population, reducing the burden of cardiovascular disease and related complications.

Biochemical Study For Evaluation of some Clinical Parameters as Predictors of Myocardial Infarction in Patients With Type 2 Diabetes Mellitus Undergoing Elective Percutaneous Coronary Intervention

When blood flow to the heart muscle is impeded, fat and cholesterol build up on the inner wall of the heart, causing coronary heart disease (CHD), myocardial infarction (MI), and sudden cardiac death are just a few of the diseases that can occur in CAD as a result of atherosclerosis. A catheter is used during Percutaneous Coronary Intervention (PCI), also known as angioplasty, a non-surgical procedure to squeeze a balloon or stent into a narrowing area to restore blood flow to the myocardium. Therefore, it is treated with medication to widen or open up the veins in the heart muscle that contain plaque accumulation that results in stenosis in order to avoid the coronary artery blockage from occurring again. The key CVD risk factor is lipid profile and some biochemicals parameters, and each kind these parameters are associated with an increase in the incidence of MI. Anabolic processes, energy metabolism, and blood sugar levels are all controlled by the hormone insulin. Glycosylated hemoglobin (HbA1c) is frequently used to measure the average blood glucose levels of a person based on the age. The resulting values also help to diagnose diabetes mellitus by determining the blood sugar level. Elevated aminotransferase levels indicating liver function, have attracted great concern as potential novel markers of cardiovascular risk assessment. Although blood urea nitrogen (BUN), creatinine (Cr), and electrolytes is not the mainstay of diagnosis in MI patients, they may have a role in providing a more detailed view of the complications and mortality rates.

Cardiovascular Disease Risk Profiling among First-Degree Relatives of Premature Coronary Artery Disease Patients

Background and Aims: First-degree relatives of patients with premature coronary artery disease are at heightened risk of cardiovascular events due to the synergy of genetic and environmental factors. The aim of this study was to assess the cardiovascular disease (CVD) risk factors and to estimate cardiovascular risk in first-degree relatives of patients with premature CAD. Methods: The study was conducted among first-degree relatives of patients with coronary artery disease in a tertiary care hospital in Kathmandu. A total of 144 first-degree relatives aged 18 years or older participated in this study. Age and gender matched subjects with no clinical evidence of CAD and no history of premature CAD in frst degree relatives were recruited as controls. The cardiovascular risk of study participants was assessed using the American Heart Association (AHA) Cardiovascular Risk Assessment Tool. Result: The study age group was between 18 to 59 years. The mean age of the subjects was 35.54 ± 10.57 years and 63.19% of subjects were men. A statistically significant number of first-degree relatives of premature CAD were found to be hypertensive and had metabolic syndrome. CVD risk factors like physical inactivity, smoking, diabetes, and dyslipidemia were found in 46.5%, 47.22%, 13.2%, and 52.01%, of the study participants, respectively. Conclusion: The study highlights the widespread presence of risk factors and underlying medical conditions among young study participants both with and without a family history of premature CAD. Appropriate direction based on opportunistic screening programs and risk stratifcation should be initiated which can play an important role in the primary prevention of early CAD.

Albuminuria as a marker of atherosclerosis burden and a possible predictor of adverse events in patients with polyvascular disease

The role of albuminuria as a marker of the atherosclerosis burden and a predictor of prognosis in patients with polyvascular disease (PD) has been little studied. To evaluate the prevalence, association with atherosclerosis burden, and prognostic value of albuminuria in relation to cardiovascular and bleeding complications in patients with PD. The data was obtained from the prospective registry REGATA-1 (NCT04347200). Seventy four patients (75.7% males, median age 67 [61-69] years) with PD (CAD and peripheral arterial disease) were enrolled. All patients received aspirin and rivaroxaban 2.5 mg. The albumin-creatinine ratio in a single morning urine sample, estimated glomerular filtration rate (eGFR), and von Willebrand factor levels were determined. Mild albuminuria (10-29 mg/g) was detected in 45.9% of patients, moderate and severe (≥30 mg/g) - in 29.7%; eGFR<60 ml/min - in 21.7%, chronic kidney disease (CKD) according to the full KDIGO criteria (eGFR and/or albuminuria ≥30 mg/g) - twice as often (39.2%). The frequency of nephroprotective therapy prescription was insufficient. The level of albuminuria did not correlate with von Willebrand factor (endothelial dysfunction marker), but was associated with affecting of 4-5 vascular beds (ROC AUC 0.775; p=0.011). During the follow-up (12 [8-18] months) 3 patients developed MACE, 11 - BARC 2-3 bleedings. Neither albuminuria nor eGFR were predictors of MACE, bleeding, or net clinical benefit. CKD (KDIGO) was also not associated with bleedings. CKD (KDIGO) was independent predictor of MACE (in significant multiple regression model beta - coefficient for CKD was 0.097; p=0.042), however, the small number of end points allows us to speak only of a hypothesis-generating trend. The implementation of CKD (KDIGO) has increased the predictive value of the REACH score. Albuminuria is highly prevalent in patients with PD. It is a marker of atherosclerosis burden. CKD, diagnosed taking into account the level of albuminuria, can be used in a comprehensive assessment of cardiovascular risk in this category of patients.

Abstract 149: Metabolic Neuroimaging in the Assessment of Cardiovascular Risk: A Regional FDG‐PET Analysis

Introduction Emerging evidence suggests a robust association between cardiovascular disease (CVD) and cognitive decline, accentuating the necessity for early detection and intervention. 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) has proven efficacious in identifying metabolic neurological changes at a molecular level, even before conventional imaging methods can detect structural changes. This study analyzed regional glucose metabolism in individuals with known CVD risk factors. The detection of such metabolic changes could assist in determining the necessity and timing of vascular interventions, such as carotid endarterectomy (CEA) or carotid artery angioplasty with stenting (CAS), contributing to improved patient outcomes and reduced postoperative complications. Methods We compared 79 healthy controls (mean age 44.5 ± 13.8 years, 53.2% males) and 40 individuals (mean age 55.9 ± 11.9 years, 50% males) at increased risk for cardiovascular disease (CVD) as assessed by the systematic coronary risk evaluation tool. All subjects were grouped into two age‐matched cohorts: younger (&lt;45 years) and older (≥45 years). All subjects underwent whole‐body FDG‐PET/CT imaging. The quantitative regional analysis of PET images was performed using MIMneuro version 7.1.5 (MIM Software, Inc., Cleveland, Ohio). 70 neurological structures were analyzed in each subject. An independent samples t‐test was used to assess the differences in z‐scores between controls and at‐risk subjects. The threshold for significance was set at P &lt; 0.05. Results Within the younger cohort, the cingulate gyrus (p=0.0206) and the anterior cingulate gyrus (p=0.0348) demonstrated significant hypometabolism in patients with known cardiac risk factors when compared to healthy controls. Within the older cohort, the supplementary motor area demonstrated significant hypometabolism (p=0.0145), while both the pons (p=0.0169) and pontine tegmentum (p=0.0063) had significant hypermetabolism in patients with known cardiac risk factors when compared to healthy controls. Conclusion Our analysis revealed an inverse relationship between increased cardiovascular disease risk and metabolic activity, particularly in three brain regions: the cingulate gyrus, the anterior cingulate gyrus, and the supplementary motor area. The findings substantiate the vulnerability of the cingulate gyrus to the impacts of small vessel disease. Hypoperfusion, a potential consequence of atherosclerotic plaque accumulation in the perfusing artery, engenders a pernicious cycle of hypoxia, oxidative stress, mitochondrial dysfunction, and inflammation, which exacerbates neuronal cell death. The cingulate gyrus, vascularized by the pericallosal arteries (branches of the anterior cerebral artery from the internal carotid arteries), and the pontine tegmentum, supplied by branches of the basilar artery, are pivotal in this context. Calcification within these arteries could potentially instigate decreased perfusion, thereby contributing to the observed hypometabolism. Examining microstructural and functional changes in the neurovascular system in response to cardiovascular disease risk factors provides key insights. These findings could inform targeted interventions, streamline perioperative strategies, and aid in decision‐making regarding the timing of vascular interventions. Future studies investigating the association among arterial calcification, regional hypometabolism, and cognitive decline may provide a deeper understanding of the complex interplay between cardiovascular health and cognitive function, supporting the improvement of intervention strategies and refinement surgical techniques.

Cardiometabolic Risk, Peripheral Arterial Disease and Cardiovascular Events in Polycystic Ovary Syndrome: Time to Implement Systematic Screening and Update the Management.

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. It presents with gynaecologic, metabolic, and psychologic manifestations. The dominant drivers of pathophysiology are hyperandrogenism and insulin resistance. Both conditions are related to cardiometabolic risk factors, such as obesity, hypertension, dyslipidaemia, hyperglycaemia, type 2 and gestational diabetes, nonalcoholic fatty liver disease and obstructive sleep apnoea. Women with PCOS of reproductive age consistently demonstrated an elevated risk of subclinical atherosclerosis, as indicated by different measurement methods, while findings for menopausal age groups exhibited mixed results. Translation of subclinical atherosclerosis into the increased incidence of peripheral arterial disease and major cardiovascular (CV) events is less clear. Although several expert groups have advised screening, the CV risk assessment and prevention of CV events are frequently underdiagnosed and overlooked aspects of the management of PCOS. A combination of lifestyle management and pharmacotherapy, including the promising new era of anti-obesity medicine, can lead to improvements in cardiometabolic health.

Cardiovascular risk assessment in patients with antiphospholipid syndrome: a cross-sectional performance analysis of nine clinical risk prediction tools

ObjectivesThis study aimed to assess the performance of cardiovascular risk (CVR) prediction models reported by European Alliance of Associations for Rheumatology and European Society of Cardiology recommendations to identify high-atherosclerotic...

Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness

BackgroundPreeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. ObjectiveTo analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. MethodsSixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student’s t-test or the Mann–Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman’s correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. ResultsWomen with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5–34.3) vs. 19.0% (14–29) and 24.0 (14.0–30.0) vs. 20.0% (12.3–26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8−10.7) vs. 8.8m/s (8.3−9.6) and 10.0 (8.8−10.6) vs. 8.8m/s (8.3−9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. ConclusionsWomen who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE.

SIOG2023-4-P-322 - Baseline Cardiovascular risk assessment and stratification in patients with hematologic neoplasm

SIOG2023-4-P-322 - Baseline Cardiovascular risk assessment and stratification in patients with hematologic neoplasm

Оценка кардиоваскулярного риска у пациентов с сахарным диабетом 2-го типа на инсулинотерапии

В статье представлены результаты собственных исследований по стратификации кардиоваскулярного риска у пациентов с сахарным диабетом 2-го типа, получающих инсулинотерапию. Проведен одномоментный ретроспективный анализ данных медицинской документации 100 пациентов – жителей г. Минска, которые состояли на учете по поводу СД 2-го типа в УЗ «Минский городской клинический эндокринологический центр». Сравнительный анализ частоты встречаемости групп очень высокого риска КВР у пациентов с СД 2-го типа и группы контроля позволил выявить значимо более высокие показатели в основной группе – 90%, чем в группе сравнения – 65% (χ2=17,9; р&lt;0,01). Во всех группах был выявлен уровень HbA1c более 7%, что значительно повышает риск развития кардиоваскулярной патологии. Также в группах с более значимым кардиоваскулярным риском выявлялись более высокие значения гликированного гемоглобина (Н=11,18, p&lt;0,01). У пациентов, имеющих очень высокий риск развития кардиоваскулярной патологии, в основной группе и группе сравнения было выявлено превышение более чем в 2 раза уровня ХС-ЛПНП над целевым значением (&lt;1,4 ммоль/л) для лиц с очень высоким КВР (p&lt;0,01). Анализ полученных данных показал, что в странах с очень высоким риском развития сердечно-сосудистой патологии, в том числе в Республике Беларусь, частота встречаемости макрососудистых осложнений (ИБС и ХСН) значительно выше, чем в странах с низким/умеренным КВР (р&lt;0,01). This article presents the results of own studies on cardiovascular risk stratification in patients with type 2 diabetes mellitus receiving insulin therapy. A one-time retrospective analysis of medical records of 100 patients from Minsk, who were registered for type 2 diabetes at the Minsk City Clinical Endocrinological Center, was carried out. A comparative analysis of the frequency of occurrence of groups of very high risk of CVR in patients with type 2 diabetes and the control group revealed significantly higher rates in the main group – 90% than in the comparison group – 65% (χ2=17.9; p&lt;0.01). In all groups, an HbA1c level of more than 7% was detected, which significantly increases the risk of developing cardiovascular pathology. Also, in groups with a more significant cardiovascular risk, higher values of glycated hemoglobin were detected (H=11.18, p&lt;0.01). In patients with a very high risk of developing cardiovascular pathology, in the main group and the comparison group, an excess of LDL-C levels over the target value (&lt;1.4 mmol/l) was revealed by more than 2 times for individuals with a very high CVR (p&lt;0. 01). Analysis of the data obtained showed that in countries with a very high risk of developing cardiovascular pathology, including the Republic of Belarus, the incidence of macrovascular complications (CHD and CHF) is significantly higher than in countries with low-moderate CVR (p&lt;0.01).

Cardiovascular Risk Assessment and Control in Outpatients Evaluated by 24-hour Ambulatory Blood Pressure and Different LDL-C Equations.

Office blood pressure (OBP) and low-density lipoprotein cholesterol (LDL-C) calculated by the Friedewald formula (F) are the cornerstones of the cardiovascular risk (CVR) assessment and management based on the SCORE2/SCORE2-OP model proposed by the 2021 ESC Guidelines on Cardiovascular Disease Prevention. We compared the CVR stratification estimated by the old SCORE and the SCORE2/SCORE2-OP using OBP and ambulatory blood pressure measurement(ABPM), and we evaluated the prevalence of LDL-C control, after calculating it using three validated equations, in outpatients referred for arterial hypertension. A cross-sectional study on 1539 consecutive patients with valid ABPM. LDL-C was calculated using the Friedewald formula (F), its modification by Martin (M), and the Sampson (S) equation. SCORE and SCORE2/SCORE2-OP were estimated using OBP, mean daytime (+ 5 mmHg adjustment), and mean24-hour systolic blood pressure (+ 10 mmHg adjustment). Individual CVR by 2021 ESC Guidelines (and SCORE2/SCORE2-OP) was compared to the 2019 ESC/EAS Guidelines (and SCORE). Differences in the prevalence of LDL-C control according to the three methods to calculate LDL-C were also analysed. Mean age was60 ± 12 years,with male prevalence (54%). Mean LDL-C values were 118 ± 38 mg/dL (F), 119 ± 37 mg/dL (M), and 120 ± 38 mg/dL (S), respectively. Within the same population, SCORE and SCORE2/SCORE2-OP significantly varied, but no differences emerged aftercomparing the average SCORE2/SCORE2-OP calculated with OBP (6% IQR 3-10), mean24-hour systolic BP (7% IQR 4-11), and meandaytime systolic BP (7% IQR 4-11). SCORE2/SCORE2-OP and 2021 ESC Guidelines reclassified the CVR independently of the method usedfor BP measurement. The low-moderate risk group decreased by 32%, whereas the high and veryhighrisk groups increased by 18% and 12%, respectively. We found a significant reduction in reaching the LDL-C goals regardless of the equation used to calculate it, except for those > 65 years, in whom results were confirmed only by using the M. SCORE2/SCORE2-OP and 2021 ESC Guidelines recommendations led to a non-negligible CVR reclassification and subsequent lack of LDL-C goal, regardless of estimating SCORE2 using OBP or ABPM. Calculating the LDL-C with the M may be the best choice in specific settings.