Control Of Cardiovascular Risk Factors Research Articles

The Burden of Uncontrolled Cardiovascular Risk Factors in MenWithProstate Cancer: A RADICAL-PC Analysis.

Cardiovascular disease (CVD) incidence is higher in men with prostate cancer (PC) than without. We describe the rate and correlates of poor cardiovascular risk factor control among men with PC. We prospectively characterized 2,811 consecutive men (mean age 68 ± 8 years) with PC from 24 sites in Canada, Israel, Brazil, and Australia. We defined poor overall risk factor control as≥3 of the following: suboptimal low-density lipoprotein cholesterol (>2mmol/L if Framingham Risk Score [FRS]≥15 and≥3.5mmol/L if FRS<15), current smoker, physical inactivity (<600 MET min/wk), suboptimal blood pressure (BP) (≥140/90mmHg if no other risk factors, systolic BP ≥120mmHg if known CVD or FRS≥15, and≥130/80mmHg if diabetic), and waist:hip ratio>0.9. Among participants (9% with metastatic PC and 23% with pre-existing CVD), 99% had≥1 uncontrolled cardiovascular risk factor, and 51% had poor overall risk factor control. Not taking a statin (odds ratio [OR]: 2.55; 95% CI: 2.00-3.26), physical frailty (OR: 2.37; 95% CI: 1.51-3.71), need for BP drugs (OR: 2.36; 95% CI: 1.84-3.03), and age (ORper 10-year increase: 1.34; 95% CI: 1.14-1.59) were associated with poor overall risk factor control after adjustment for education, PC characteristics, androgen deprivation therapy, depression, and Eastern Cooperative Oncology Group functional status. Poor control of modifiable cardiovascular risk factors is common in men with PC, highlighting thelargegap in care and the need for improved interventions to optimize cardiovascular risk management inthispopulation.

The Role of Exercise-based Cardiac Rehabilitation in Heart Failure.

Exercise-based cardiac rehabilitation (EBCR) is a treatment modality for patients with heart failure (HF) that has withstood the test of time. It has continued to show benefits even in the current era of pharmacotherapeutics for HF. Participation in a multidisciplinary comprehensive EBCR programme reduces mortality and morbidity, has a multitude of physiological benefits, and improves cardiovascular risk factor control and quality of life. Despite this, historical barriers to enrolment and uptake remain. Strategies to overcome these, as well as alternative delivery methods of EBCR in HF patients, are emerging and include telerehabilitation, focus on special groups and emphasis on behavioural change. This review provides oversight on the modalities of exercise training in HF as well as their benefits and gives an overview of barriers to the utilisation of EBCR along with future progress in the field.

Selección de lo mejor del año 2022 en cardiología clínica y farmacoterapia cardiovascular

Cardiovascular diseases are the leading cause of death in western countries. Therapeutic advances with the development of cardiovascular drugs have led to great advances in the prognosis of patients with heart disease.The development of drugs that drastically reduce the low-density lipoprotein cholesterol, or antidiabetics that have become a main pillar in the treatment of heart failure, take us to a very attractive horizon in the management and control of cardiovascular risk factors and patients with heart disease.In this article we review a few recent cardiovascular drugs very useful for the clinical cardiologist, without neglecting the importance of therapeutic adherence.

Clinical Profile and Outcome of Acute Myocardial Infarction among Young Adults at a Tertiary Care Centre in Manipur, India: A Cohort Study

Introduction: The incidence of Acute Myocardial Infarction (AMI) is rising in young adults. Timely control of cardiovascular risk factors is important to prevent the increasing incidence of AMI in young adults. Aim: To analyse the clinical profile, risk factors, and outcomes of AMI among the young adult population in Manipur, India. Materials and Methods: A hospital-based cohort study was conducted in a tertiary care centre at Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India from January 1, 2021, to December 31, 2022, among patients aged 45 years or younger attending the medicine Outpatient Department (OPD), admitted to the Intensive Care Unit (ICU) and Intensive Coronary Care Unit (ICCU) with the first attack of AMI. Cases involving pregnancy, known cases of pericarditis, and Congenital Heart Disease (CHD) were excluded. Data were collected using a performa regarding demographic profile, clinical presentation, risk factors, and treatment outcomes. The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0 and expressed as descriptive statistics. Results: A total of 39 cases were reported with a mean age of 40.2±4.6 years, with a male-to-female ratio of 9:1. The majority of cases presented with chest pain (74.3%), followed by shortness of breath (40%), nausea (13%), and collapse (10%). 75% of cases presented with multiple clinical features. The most common risk factors in young adults were smoking (84.6%), alcohol consumption (56.4%), family history of heart disease (25.6%), hypertension (20.5%), substance abuse (20.5%), diabetes (17.9%), and dyslipidemia (25.6%). Cases showed elevated cardiac enzymes - Creatine Kinase-Myocardial Band (CK-MB) (92.3%) and Troponin I (94.9%). Electrocardiogram (ECG) changes revealed ST segment elevation MI (89.7%). Only one case resulted in death during the hospital stay. Conclusion: The incidence of AMI among young adult populations is increasing, emphasising the need to raise awareness regarding cardiovascular risk factors and lifestyle modifications. However, the cases have shown good clinical outcomes among young adults with the disease.

The feasibility and efficacy of a community-based multifactorial intervention to improve the cardiovascular risk factor control among patients with type 2 diabetes: A 2-year cluster randomized trial.

Our study is to investigate the feasibility and effectiveness of multiple cardiovascular factors intervention (MFI) in type 2 diabetes patients in China's primary care setting. We performed a cluster randomized trial to compare the proportion of patients achieved the targets between usual care group (control, 9 sites, n = 868) and MFI group (8 sites, n = 739) among patients with type 2 diabetes in primary care setting. Logistic regression model with random effects was used to estimate the association of the effect of intervention and the proportion achieved the targets. At baseline, the end of 1 year, and 2 years follow-up, the proportion of patients achieved all 3 target goals (HbA1c < 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol < 2.6 mmol/L) were 5.7%, 5.9%, 5.7% in the control group and 5.9%, 10.6%, 12.3% in the MFI group. After adjusting sex, age, diabetes duration, body mass index, HbA1c, blood pressure, and low-density lipoprotein cholesterol at baseline, there was no difference between the 2 groups (OR (95% CI): 1.27 (0.38-4.27) and 1.86 (0.79-4.38) for the first year and second year, respectively). When stratified by payment method, the patients with medical insurance or public expenses had a higher proportion achieved target goals (6.9% vs 16.4%, OR (95% CI): 2.30 (1.04-5.08)) in the second year. The controlling of cardiovascular risk factor targets remains suboptimal among patients with type 2 diabetes in primary care setting. MFI in type 2 diabetes improved cardiovascular disease risk profile, especially in the patients with medical insurance.

Challenges in the evaluation of endothelial cell dysfunction: a statement from the European Society of Hypertension Working Group on Endothelin and Endothelial Factors.

Endothelial cell function is mediated by different mechanisms in different vascular beds. Moreover, in humans, endothelial cell dysfunction triggers and accelerates the progression of cardiovascular and chronic kidney diseases. Progression of such diseases can be in part mitigated by the control of cardiovascular risk factors and drugs targeting different systems, including endothelin receptor antagonists (ERAs), renin-angiotensin aldosterone antagonists and agents affecting glucose metabolism, all of which were shown to improve endothelial cell function. In recent years, the microRNAs, which are endogenous regulators of gene expression, have been identified as transmitters of information from endothelial cells to vascular smooth muscle cells, suggesting that they can entail tools to assess the endothelial cell dysfunction in arterial hypertension and target for pharmacologic intervention. This article critically reviews current challenges and limitations of available techniques for the invasive and noninvasive assessment of endothelial cell function, and also discusses therapeutic aspects as well as directions for future research in the areas of endothelial cell biology and pathophysiology in humans.

A comprehensive review on pathogenesis, associations, clinical findings, and treatment of livedoid vasculopathy.

Livedoid vasculopathy (LV) is a thrombo-occlusive vasculopathy that involves the dermal vessels. Clinically, it is characterized by the presence of painful purpuric ulcers on the lower extremities. Histopathologically, it shows intraluminal fibrin deposition and thrombosis, segmental hyalinization, and endothelial proliferation. It is important to notice that the term "atrophie blanche" is descriptive and it includes not only patients with LV but also patients with a combination of vasculitis and vasculopathy, that is, LV and medium-sized vasculitis such as cutaneous polyarteritis nodosa (PANc). Diagnosis is based on a proper clinicopathological correlation, excluding the main differential diagnosis and considering vasculitis as a mimicker or concomitant diagnosis. Coagulation disorders must also be studied although they are not found in all LV. Its frequency is reviewed as well. Treatment of LV is challenging, and different therapies have been attempted. Among them, pain management, wound care, control of cardiovascular risk factors, and both antiplatelets and anticoagulants, mostly rivaroxaban, are the main therapies used. These different therapies as well as their degree of evidence are reviewed.

TRATAMENTO INVASIVO: BASES PARA A DECISÃO

The spectrum of clinical conditions associated with the presence of myocardial ischemia and related symptoms (angina pectoris or equivalent), regardless of the cau-sative mechanism (obstructive disease, microvascular dysfunction or coronary spasm) is called chronic coronary syndrome (CCS). Although the essence of the treatment of patients with SCC consists of changes in lifestyle and strict control of cardiovascular risk factors, in addition to antianginal therapy in maximally tolerated doses, surgical or percutaneous revascularization procedures are indicated when medical treatment fails to offer adequate symptoms control or in scenarios in which they provide a reduction in the risk of events compared to clinical therapy alone. Thus, patients with left main disease, multivessel disease (especially diabetics or those with high angiographic complexity), patients with HFrEF of ischemic etiology, and those with the last remaining patent vessel or proximal lesion of the anterior descending artery should be candidates for intervention. The choice of the intervention modality should be based on robust scientific evidence as proposed by current guidelines. In general terms, clinical parameters (patient frailty, comorbidities, and analysis of left ventricular function, for example), angiographic para-meters (anatomical complexity), and technical parameters (experience of the local team and availability of specific devices such as IVUS) are analyzed by the Heart Team in the decision-making process.

REABILITAÇÃO CARDÍACA BASEADA EM EXERCÍCIO NA ANGINA REFRATÁRIA: EXPERIÊNCIA UNICÊNTRICA

Refractory angina (RA) is a chronic clinical condition characterized by angina pectoris, which occurs as a result of myocardial ischemia, unresponsive to conventional medical treatment (i.e. control of cardiovascular risk factors and other clinical conditions, in addition to antianginal drugs), which is not eligible for coronary interventions. Patients with RA evolve with great functional limitation due to pain and consequent loss of quality of life, and their improvement is the focus of treatment. Exercise-based cardiac rehabilitation (CR) is an adjuvant therapy that effectively promotes secondary prevention in patients with coronary artery disease, but it is rarely prescribed for patients with refractory angina due to concerns about adverse events during exercise, related to triggering ischemia myocardial infarction at low thresholds. In this review, we address the experience obtained with the management of patients with RA in a reference center for the treatment of RA, especially related to exercise-based CR. Some peculiarities in the evaluation and prescription of training in patients with RA and their understanding are important to promote greater safety and efficacy of physical exercise in this population.

Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis.

Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions. In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event. A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test. A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=-0.03, 95% CI -0.05 to -0.00; P=.04 vs SMD=-0.04, 95% CI -0.07 to -0.00; P=.05). mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931.

Étude de l’impact d’un entretien pharmaceutique post-syndrome coronarien aigu à l’hôpital

Post-acute coronary syndrome pharmaceutical interviews were set up in our establishment. The objective of this study was to assess their impact on patient knowledge and their benefit at one year on medication compliance, cardiovascular risk factors (smoking, overweight, dyslipidemia) and the recurrence rate. Two groups were formed, an experimental group of patients who had benefited from pharmaceutical interviews and a control group of patients who had not benefited from them. The knowledge of the patients was measured using a quizz carried out before the interview and one month after for the experimental group, then one year after hospitalization for the two groups. A one-year follow-up of medication compliance assessed, control of cardiovascular risk factors and the rate of recurrence of acute coronary syndrome was carried out in both groups. A significant increase in knowledge (P<0.001) after the pharmaceutical interview and its maintenance over time were observed in the experimental group. One year after hospitalization, in the experimental group, the average score on the knowledge quizz (9.2/10) was significantly higher (P<0.005) than that of the control group (6.6/10); medication compliance was significantly better (P<0.05) and greater smoking cessation was observed. These encouraging results should be highlighted in order to perpetuate and develop such approaches around patient care.

Randomised clinical trial using Coronary Artery Calcium Scoring in Australian Women with Novel Cardiovascular Risk Factors (CAC-WOMEN Trial): study protocol

IntroductionCardiovascular disease (CVD) is the leading cause of death in women around the world. Aboriginal and Torres Strait Islander women (Australian Indigenous women) have a high burden of CVD, occurring...

Neuropsichiatric Manifestations of Systemic Lupus Erythematosus: Diagnosis and Treatment Approach

Abstract Neuropsychiatric involvement in systemic lupus erythematosus includes heterogeneous manifestations involving both the central and peripheral nervous system. A major issue in clinical evaluation is the attribution of neuropsychiatric symptoms to systemic lupus erithematosus. Antiphospholipid antibodies, immune complex, microangiopathy, early and accelerated arteriosclerosis are factors that have the main role in pathogenesis of neuropsychiatric manifestations of systemic lupus erithematosus. There are no neurological symptoms specific to systemic lupus erithematosus, but they can also occur very commonly in the general population. Lesions of nervous system can be focal or diffuse and may be due to systemic lupus erithematosus itself (primary lesions), but it also may be caused by other diseases or disbalances. Therapy of the neuropsychiatric manifestations depends on the nature of the pathological process (dominant inflammation or thrombosis). If it is result of an inflammatory neurotoxic process and in the presence of an increased activity of systemic lupus erithematosus, therapy includes glycocorticoids independently or in combination with immunosuppressives. Focal neuropsychiatric syndrome with antiphospholipid antibodies positivity should be treated with anticoagulant and/or antiplatelet therapy. In addition, control of classical cardiovascular risk factors, stop smoking, and treatment with hydroxychloroquine is recommended.

Study on Out-of-Hospital Management Mode of Patients with Acute Coronary Syndrome after PCI in Rural Areas

This study aims to evaluate the effectiveness and feasibility of the "Grade III Level A hospital-community hospital family" -based management model.A total of 164 rural patients who underwent percutaneous coronary intervention (PCI) were randomly divided into a control group and an intervention group according to the random number table. By comparing the two groups of patients' dependence, cardiovascular risk factors control, improvement of bad habits, and the occurrence of major adverse cardiovascular events (MACE), the management mode was evaluated. χ2 test, t test, and rank sum test were used in the analysis, and P < 0.05 was considered statistically significant.There were 74 patients in the intervention group and 90 in the control group. The completion of follow-up in the intervention group was higher than that in the control group (97.3% versus 88.9%, P < 0.05). After 3 months of intervention, the levels of fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and systolic blood pressure in the intervention group were lower than those in the control group, and the level of high-density lipoprotein was higher than those in the control group (P < 0.05). The drug dependence of the intervention group was higher than that of the control group (P < 0.05). The incidence of MACE in the intervention group was lower than that in the control group (P < 0.05).This management mode can effectively improve patient dependency, control cardiovascular risk factors, and reduce the incidence of recent MACE, which is of great significance for the long-term prognosis of patients after PCI.

Prevalence of hypertension and possible risk factors of hypertension unawareness among individuals aged 30-75 years from two Panamanian provinces: Results from population-based cross-sectional studies, 2010 and 2019.

Recent estimates of hypertension in Panama remain unknown. We aim to describe the variation in prevalence and unawareness of hypertension in two Panamanian provinces using two different cross-sectional population-based studies and to investigate risk factors associated with hypertension unawareness. Data were derived from a sub-national study conducted in the provinces of Panama and Colon (PREFREC-2010 [2,733 participants]) and from a nationally representative study (ENSPA-2019), in which we restricted our analyses to the same provinces (4,653 participants). Individuals aged 30-75 years who had (a) self-reported history of hypertension or (b) blood pressure (BP) ≥140/90mmHg or (c) a combination or both were classified as hypertensive. Participants with BP≥140/90mmHg who denied a history of hypertension were considered unaware of the condition. Multivariable logistic regression models were used to estimate the association between risk factors and unawareness, expressed as odds ratios (OR) and 95% confidence interval (CI). In 2010, the prevalence and unawareness of hypertension in men were 51.6% (95% CI: 45.7-57.5) and 32.3% (25.4-40.1), respectively, and in women 46.0% (42.1-49.9) and 16.1% (12.6-20.4), respectively. In 2019, the prevalence and unawareness of hypertension in men were 46.5% (42.1-51.0) and 52.3% (45.9-58.6), and in women 42.1% (39.6-44.7) and 33.3% (29.8-37.0). Men (2010 and 2019), age <50 years (2010 and 2019), having no/primary education (2010), and living in a non-urban region (2019) were positively associated with hypertension unawareness, whereas obesity (2010), physical inactivity (2010), family history of hypertension (2019), and BP assessment in the year before study enrollment (2010 and 2019) were inversely associated with hypertension unawareness. Benefits of a decrease in the prevalence of hypertension are being undermined by an increase in hypertension unawareness. Actions should be encouraged to strengthen the implementation of the existing healthcare program for cardiovascular risk factor control.

Time trends of cardiovascular risk management in type 1 diabetes - nationwide analyses of real-life data

BackgroundIndividuals diagnosed with and treated for type 1 diabetes (T1D) have increased risk of micro- and macrovascular disease and excess mortality. Improving cardiovascular (CV) risk factors in individuals with T1D is known to reduce diabetes- related CV complications.AimTo examine time trends in CV risk factor levels and CV-protective treatment patterns. Additionally, examine incidence rates of diabetes-related CV complications in relation to exposure CV-protective treatment.MethodsWe analysed records from 41,630 individuals with T1D, registered anytime between 1996 and 2017 in a nationwide diabetes register. We obtained CV risk factor measurements (2010–2017), CV-protective drug profiles (1996–2017) and CV complication history (1977–2017) from additional nationwide health registers.ResultsFrom 2010 to 2017 there were decreasing levels of HbA1c, LDL-C, and blood pressure. Decreasing proportion of smokers, individuals with glycaemic dysregulation (HbA1c ≥ 58 mmol/mol), dyslipidaemia (LDL-C > 2.6 mmol/l), and hypertension (≥ 140/85 mmHg). Yet, one fifth of the T1D population by January 1st, 2017 was severely dysregulated (HbA1c > 75 mmol/mol). A slight increase in levels of BMI and urinary albumin creatinine ratio and a slight decrease in estimated glomerular filtration rate (eGFR) levels was observed. By January 1st, 2017, one fourth of the T1D population had an eGFR < 60 ml/min/1.73 m2. The proportion of the T1D population redeeming lipid-lowering drugs (LLDs) increased from 5% in 2000 to 30% in 2010 followed by a plateau and then a decline. The proportion of the T1D population redeeming antihypertensive drugs (AHDs) increased from 28% in 1996 to 42% in 2010 followed by a tendency to decline. Use of LLDs was associated with lower incidence of micro- and macrovascular complications, while use of AHDs had higher incidence of CVD and CKD, when compared to non-use and discontinued use, respectively.ConclusionImprovements were seen in CV risk factor control among individuals with T1D in Denmark between 2010 and 2017. However, there is clearly a gap between current clinical guidelines and clinical practice for CV risk management in T1D. Action is needed to push further improvements in CV risk control to reduce CVD and the related excess mortality.

Cost-Effectiveness of the CNIC-Polypill Strategy Compared With Separate Monocomponents in Secondary Prevention of Cardiovascular and Cerebrovascular Disease in Portugal: The MERCURY Study

Background: Cardiovascular (CV) diseases remain a leading and costly cause of death globally. Patients with previous CV events are at high risk of recurrence. Secondary prevention therapies improve CV risk factor control and reduce disease costs. Objectives: To assess the cost-effectiveness of a CV polypill strategy (CNIC-Polypill) compared with the loose combination of monocomponents to improve the control of CV risk factors in patients with previous coronary heart disease or stroke. Methods: A Markov model cost-utility analysis was developed using 4 health states, SMART risk equation, and 3-month cycles for year 1 and annual cycles thereafter, over a lifetime horizon from the perspective of the National Health System in Portugal (base case). The NEPTUNO study, Portuguese registries, mortality tables, official reports, and the literature were consulted to define effectiveness, epidemiological costs, and utility data. Outcomes were costs (estimated in 2020 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 4% discount rate was applied. Alternative scenarios and one-way and probabilistic sensitivity analyses tested the consistency and robustness of results. Results: The CNIC-Polypill strategy in secondary prevention provides more LY and QALY, at a higher cost, than monocomponents. The incremental cost-utility ratio is €1557/QALY gained. Assuming a willingness-to-pay threshold of €30 000/QALY gained, there is a 79.7% and a 44.4% probability of the CNIC-Polypill being cost-effective and cost-saving, respectively, compared with the loose combination of monocomponents. Results remain consistent in the alternative scenarios and robust in the sensitivity analyses. Discussion: The model reflects increments in the number of years patients would live and in quality of life with the CNIC-Polypill. The clinical effectiveness of the CNIC-Polypill strategy initially demonstrated in the NEPTUNO study has been recently corroborated in the SECURE trial. The incremental cost of the CNIC-Polypill strategy emerges slightly above the comparator, but willingness-to-pay estimates and sensitivity analyses indicate that the CNIC-Polypill strategy is consistently cost-effective compared with monocomponents and remains within acceptable affordability margins. Conclusion: The CNIC-Polypill is a cost-effective secondary prevention strategy. In patients with histories of coronary heart disease or stroke, the CNIC-Polypill more effectively controls CV risk factors compared with monocomponents.

Cost-Effectiveness of the CNIC-Polypill Strategy Compared With Separate Monocomponents in Secondary Prevention of Cardiovascular and Cerebrovascular Disease in Portugal: The MERCURY Study.

Background: Cardiovascular (CV) diseases remain a leading and costly cause of death globally. Patients with previous CV events are at high risk of recurrence. Secondary prevention therapies improve CV risk factor control and reduce disease costs. Objectives: To assess the cost-effectiveness of a CV polypill strategy (CNIC-Polypill) compared with the loose combination of monocomponents to improve the control of CV risk factors in patients with previous coronary heart disease or stroke. Methods: A Markov model cost-utility analysis was developed using 4 health states, SMART risk equation, and 3-month cycles for year 1 and annual cycles thereafter, over a lifetime horizon from the perspective of the National Health System in Portugal (base case). The NEPTUNO study, Portuguese registries, mortality tables, official reports, and the literature were consulted to define effectiveness, epidemiological costs, and utility data. Outcomes were costs (estimated in 2020 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 4% discount rate was applied. Alternative scenarios and one-way and probabilistic sensitivity analyses tested the consistency and robustness of results. Results: The CNIC-Polypill strategy in secondary prevention provides more LY and QALY, at a higher cost, than monocomponents. The incremental cost-utility ratio is €1557/QALY gained. Assuming a willingness-to-pay threshold of €30 000/QALY gained, there is a 79.7% and a 44.4% probability of the CNIC-Polypill being cost-effective and cost-saving, respectively, compared with the loose combination of monocomponents. Results remain consistent in the alternative scenarios and robust in the sensitivity analyses. Discussion: The model reflects increments in the number of years patients would live and in quality of life with the CNIC-Polypill. The clinical effectiveness of the CNIC-Polypill strategy initially demonstrated in the NEPTUNO study has been recently corroborated in the SECURE trial. The incremental cost of the CNIC-Polypill strategy emerges slightly above the comparator, but willingness-to-pay estimates and sensitivity analyses indicate that the CNIC-Polypill strategy is consistently cost-effective compared with monocomponents and remains within acceptable affordability margins. Conclusion: The CNIC-Polypill is a cost-effective secondary prevention strategy. In patients with histories of coronary heart disease or stroke, the CNIC-Polypill more effectively controls CV risk factors compared with monocomponents.

Abstract 14508: Association of Multi-Ethnic Genome-Wide Blood Pressure Polygenic Risk Score With Adverse Cardiovascular Events

Background: Traditional cardiovascular (CV) risk factors and the underlying genetic risk of elevated blood pressure (BP) determine an individual’s composite risk of developing adverse CV events. We evaluated the relative contributions of the traditional CV risk factors to the development of adverse CV events in the context of varying BP polygenic risk score (PRS) profiles among multiethnic population-based cohorts (ARIC, MESA, JHS, FHS, CARDIA, and CHS cohort). Methods: Multiethnic genome-wide BP PRS was constructed among participants with WGS data through TOPMed program and were stratified into high, intermediate, and low genetic risk (&gt;80 th , 20-80 th , &lt;20 th centile). Based on the ACC/AHA Pooled Cohorts Equation (PCE), participants were stratified into low and high (10y-ASCVD risk: &lt;10% or ≥10%) CV risk factor profile groups. Cox regression was used to assess the risk of adverse CV events (incident HF, CHD, and stroke) and its components. Results: Among 21,899 American adults (mean age: 56 years; 56% women; 36% non-White race), 1 SD increase in the BP PRS computed using 1.1 million variants was associated with systolic BP (β: 4.7, 95% CI: 4.5-5.0) and HTN (OR: 1.09, 95% CI: 1.09-1.10), respectively. This association was robustly seen across racial/ethnic groups. Each SD increase in BP PRS was associated with a higher risk of the primary outcome (HR: 1.08 [1.05-1.11]) after controlling for ACC/AHA PCE risk score. Among individuals with a high BP PRS, low ASCVD risk was associated with a 69% lower hazard for the primary outcome (HR: 0.31, [0.27-0.35]) compared with those with high ASCVD risk. A similar pattern was noted in intermediate and low BP PRS groups. Comparable results were noted for all the secondary outcomes. Conclusions: In a multiethnic cohort of &gt;21,000 US adults, genome-wide BP PRS was associated with BP traits and adverse CV events. Adequate CV risk factor control may reduce this increased predisposition to adverse CV events by 69% in those with high BP PRS.

Abstract 14033: Assessment of Psychology Services Partnered With Clinical Care to Improve Cardiovascular Risk Factor Control

Introduction: Psychological distress greatly impacts cardiovascular disease, and targeted efforts to improve access to psychological services in cardiology care may aid in the reducing of cardiovascular risk factors. The objective of this preliminary study was to assess the impact and characterize the need for and use of short-term psychotherapy in cardiology by partnering a supervised postdoctoral psychology fellow with our cardiovascular prevention and women’s heart programs. Methods: A retrospective chart review was performed from January 2019 to June 2022. Participants included 36 patients engaged in preventive cardiology who attended at least one therapy session (mean age=57.6 years; 72% female; 19.4% Black, 8.3% Hispanic, 47.2% White, 24.9% other ethnicity). If available, hemoglobin A1C, LDL, weight, BMI, and blood pressure were recorded within six months pre- and post-therapy. Results: Mental health diagnoses included MDD (22.2%), GAD (47.2%) and adjustment disorder (25%). Comorbidities included HLD (69.4%), HTN (66.6%), CAD (41.6%) and DM (16.6%). 17 patients were former smokers, and one was a current smoker. More than half (52.8%) attended ≥6 psychotherapy sessions, 38.9% attended ≥6 preventive cardiology visits and 2.7% attended a nutritionist visit in the same time frame. In patients with HTN with both pre- and post-therapy measurements (n=24), 50% were above goal (130/80) pre-therapy and 20.8% post. Regarding weight (n=27), 48.2% lost weight. Among patients with LDL≥100 pre-therapy (n=9), 55.5% achieved LDL &lt;100 post-therapy. Among patients with an A1C≥5.7 pre-therapy (n=8), 12.5% lowered their A1C to &lt;5.7. Conclusions: Although further studies are needed to assess the benefit of each component of care, our preliminary study shows the demand for and potential benefit from psychological services when delivered concurrently with preventive cardiology visits. There was a high level of engagement, with over half of patients attending six or more therapy sessions. Marked improvement in blood pressure, LDL, and weight were noted. These preliminary findings raise the possibility that expanding access to psychological services in clinical cardiology care may be a model to reduce excess cardiovascular risk.