Incidence Of CHD Research Articles

A Study On The Screening Of Congenital Heart Disease Using Pulse Oximetry In Asymptomatic Newborns Delivered In Tertiary Care Centre

Introduction: Congenital Heart Disease is the most common congenital abnormality in newborns and has been recognized as one of the leading causes of death in the first year of life. The global incidence of CHD is estimated at 8 per 1000 live births. Using pulse oximetry critical and many of the asymptomatic CHD can be identified in the immediate post natal period. This strategy will help in early identification and its intervention. Objective: To assess the effectiveness of pulse oximetry as a screening tool for detection of CHD in asymptomatic newborn. Methods: It was a Hospital based Cross sectional study conducted in the Department of Obstetrics and Gynaecology, in collaboration with the Department of Paediatrics, of a tertiary hospital in North Eastern State from May 2022 to April 2024. Results: The mean birth weights of the neonates were2.93±0.29 Kg and the mean gestational age was 37.74±1.56 weeks. 4% of all neonates screened with pulse oximetry showed positive result. Among them 4 (2%) neonate were diagnosed with CHD. Out of the 4 neonates diagnosed with CHD, 3 were diagnosed with VSD and 1 with PDA. Conclusion: Eight (8) i.e 4% of the neonates were screened with positive pulse oximetry and out of which four (4) were diagnosed with CHD. Proportion of neonates who were screened positive in pulse oximetry with positive echocardiographic findings were significantly higher than those who screened negative (p value <0.001). Therefore, the pulse oximetry screening for detection of CHD among asymptomatic neonates in our study showed a moderate sensitivity (75%), high specificity (97.4%) and negative predictive value (99.47%) and a reasonably low positive predictive value (37.5%), respectively

Erythrocyte Very Long-Chain Saturated Fatty Acids, Gut Microbiota-Bile Acid Axis, and Incident Coronary Artery Disease in Adults: A Prospective Cohort Study

BackgroundPrior research has highlighted inverse associations between concentrations of circulating very long-chain saturated fatty acids (VLCSFAs) and coronary artery disease (CAD). However, the intricate links involving VLCSFAs, gut microbiota, and bile acids remain underexplored. ObjectivesThis study examined the association of erythrocyte VLCSFAs with CHD incidence, focusing on the mediating role of gut microbiota and fecal bile acids. MethodsThis 10-y prospective study included 2383 participants without CHD at baseline. Erythrocyte VLCSFAs [arachidic acid (C20:0), behenic acid (C22:0), and lignoceric acid (C24:0)] were measured using gas chromatography at baseline, and 274 CHD incidents were documented in triennial follow-ups. Gut microbiota in 1744 participants and fecal bile acid metabolites in 945 participants were analyzed using 16S ribosomal ribonucleic acid sequencing and ultra-performance liquid chromatography-tandem mass spectrometry at middle-term. ResultsThe multivariable-adjusted hazard ratios (95% confidence interval) for CHD incidence in highest compared with lowest quartiles were 0.87 (0.61, 1.25) for C20:0, 0.63 (0.42, 0.96) for C22:0, 0.59 (0.41, 0.85) for C24:0, and 0.57 (0.39, 0.83) for total VLCSFAs. Participants with higher total VLCSFA concentrations exhibited increased abundances of Holdemanella, Coriobacteriales Incertae Sedis spp., Ruminococcaceae UCG-005 and UCG-010, and Lachnospiraceae ND3007 group. These 5 genera generated overlapping differential microbial scores (ODMSs) that accounted for 11.52% of the total VLCSFAs-CHD association (Pmediation = 0.018). Bile acids tauro_α_ and tauro_β_muricholic acid were inversely associated with ODMS and positively associated with incident CHD. Opposite associations were found for glycolithocholic acid and glycodeoxycholic acid. Mediation analyses indicated that glycolithocholic acid, glycodeoxycholic acid, and tauro_α_ and tauro_β_muricholic acid explained 56.40%, 35.19%, and 26.17% of the ODMS-CHD association, respectively (Pmediation = 0.002, 0.008, and 0.020). ConclusionsElevated erythrocyte VLCSFAs are inversely associated with CHD risk in the Chinese population, with gut microbiota and fecal bile acid profiles potentially mediating this association. The identified microbiota and bile acid metabolites may serve as potential intervention targets in future studies.This trial was registered at www.clinicaltrials.gov as NCT03179657.

Family History and Smoking on Coronary Heart Disease

Cases of coronary heart disease in a private hospital in Madiun City in the last year have increased by 41% due to various risk factors. So researchers are interested in examining whether the incidence of coronary heart disease is correlated with family history and smoking. This research design is quantitative with a case-control approach. The population is all CHD sufferers in the period January-November 2022. The total population is 159 subjects, with a sample of 54 case subjects and 54 control subjects. The questionnaire method was used to collect data, and then the Chi-square test was used to analyze the data. The results of this study were that there was a significant relationship between smoking and the incidence of CHD (p-value = 0,034), and there was a family history of CHD incidence (p-value = 0,012) at Hospital X Madiun City. There is a need to provide outreach regarding efforts to prevent CHD to the public in order to reduce cases of CHD.

Clinical Features and Cardiac Anomalies of Children with Down Syndrome. A Literature Report

Background: Clinical diagnosis of Down syndrome is based on the characteristic features and associated malformations. Nonetheless, there is significant individual diversity in the clinical presentation. Not every physical characteristic may be present, particularly in infants. At the same, congenital heart abnormalities (CHD) remain a major predictor of death in children with Down syndrome (DS) despite improvements in surgical therapy for these conditions. The effects of DS vary from person to person, with some people having a significant impact while others are well and capable of living unassisted as adults. So, this study is done to understand the pattern of clinical features and cardiac anomalies in various research reports.Aim: This scoping review aims to describe the frequency and distribution of clinical features and cardiac anomalies in children with Down syndrome and to consider the clinical implications of this knowledge.Methods: Medline, CINHAL, and PubMed databases were searched electronically to identify pertinent articles from 2000 to 2023. Children with Down syndrome and cardiac comorbidities aged 18 years or younger met the inclusion criteria. Articles that were not peer-reviewed or written in English were disqualified at the title or abstract level.Results: Literature revealed that the common physical and dysmorphic features found in individuals with Down syndrome include flat facial profile, epicanthal folds, upward slanting eyes, hypotonia, small ears, short neck, protruding tongue, small hands and feet, brushfield spots, sandal gap, and short stature. It's important to note that while these physical features are commonly associated with Down syndrome, not all individuals will exhibit every characteristic, and the severity can vary greatly among individuals.A high prevalence of CHD was reported in DS children from a group where consanguinity was relatively frequent. The prevalence of congenital heart disease in children with Down syndrome is the highest reported, especially when the researchers have used diagnostic ultrasound. VSD and AVSD, followed by persistent ductus arteriosus, and tetralogy of Fallot are the most common CHD in DS children. Recent research suggests that though the incidence of CHD in DS children has remained stable over time, there may be trends in some forms of CHD, with a rise in isolated, less severe kinds and a reduction in complicated, more severe ones. Individuals with Down syndrome can lead fulfilling lives with appropriate support and resources.Conclusion: All neonates with a new diagnosis or suspicion of DS must undergo comprehensive screening, which includes clinical examination, ECG, and echocardiography in the second trimester combined with fetal echocardiography when the fetal ultrasonography raises the likelihood of an abnormality. Literature proves that regardless of the existence of DS, early CHD repair is advised for newborns susceptible to biventricular surgery. For the most part, DS is not linked to an increased perioperative risk for CHD.Understanding DS heterogeneity will help professionals provide better prenatal counseling, assist parents in establishing focused early interventions to improve daily activities and the quality of life for their children, and assist policy-makers in providing and allocating resources for disability services. A sustaining commitment to scientific and clinical research studies is necessary to enhance the quality of life and survival for DS patients from infancy into adulthood.

The comprehensive study on the role of POSTN in fetal congenital heart disease and clinical applications

BackgroundCongenital heart defect (CHD) is the most common congenital abnormality, and it has long been a clinical and public health concern. Our previous findings have found Periostin (POSTN) and Pappalysin-1 (PAPPA) as potential biomarkers for fetal CHD. We aim to further elucidate POSTN's role in fetal heart development and explore the clinical applicability of POSTN and PAPPA as diagnostic marker for fetal CHD. This study is poised to establish a theoretical framework for mitigating the incidence of CHD and advance a novel approach for prenatal screening of fetal CHD.MethodsWe verified differential expression of POSTN and PAPPA in gravida serum and fetal amniotic fluid based on our previous research. We established the Postn knockout mouse by CRISPR/Cas9 to investigate whether Postn deletion leads to cardiac abnormalities in mice. Besides, we explored the mechanism of POSTN on heart development through Postn knockout mouse model and cell experiments. Finally, we established the logistic regression model and decision curve analysis to evaluate the clinical utility of POSTN and PAPPA in fetal CHD.ResultsWe observed a significant decrease in POSTN and increase in PAPPA in the CHD group. Atrial septal defects occurred in Postn−/− and Postn± C57BL/6 fetal heart, while ventricular septal defects with aortic saddle were observed in Postn± C57BL/6 fetal heart. Disruption of the extracellular matrix (ECM) in cardiomyocytes and multiple abnormalities in cellular sub-organelles were observed in Postn knockout mice. POSTN may positively regulate cell behaviors and unsettle ECM via the TGFβ-Smad2/3 signaling pathway. The combination of serum biomarkers POSTN and PAPPA with Echocardiogram can enhance the diagnostic accuracy of CHD. Furthermore, the comprehensive model including POSTN, PAPPA, and two clinical indicators (NT and age) exhibits significantly higher predictive ability than the diagnosis group without the use of serum biomarkers or clinical indicators.ConclusionsIt is the first evidence that Postn deletion leads to cardiac developmental abnormalities in fetal mice. This may involve the regulation of the TGFβ signaling pathway. Importantly, POSTN and PAPPA possess clinical utility as noninvasive prenatal promising screening indicators of CHD.

Hubungan Aktifitas Fisik, Kebiasaan Merokok dan Hipertensi terhadap Penyakit Jantung Koroner

Introduction: The incidence of CHD at the Kalabahi Hospital has increased every year. In 2019, there were 568 CHD patients, and about 60% of the total CHD patients experienced complications of Kidney Failure, so they had to be hemodialyzed and had an impact on sudden death. Objectives: This study aims to determine the relationship of physical activity, smoking habits, and hypertension to coronary heart disease at the Kalabahi Hospital Polyclinic, Alor, East Nusa Tenggara, 2022. Methode: Type of analytical research with a cross-sectional approach. The sample in this study was 52 CHD patients undergoing outpatient treatment at the Kalabahi Regional Hospital Polyclinic. The sampling technique used in this research is Total Sampling. data collection techniques using questionnaires. Data analysis used the Pearson Product Moment statistical test and Multiple Correlations to determine the relationship between Physical Activity, Smoking Habits, and Hypertension in Coronary Heart Disease. Result: Based on the results of the analysis, it was found that the relationship between physical activity and coronary heart disease had a p-value of 0.000. The relationship between smoking habits and coronary heart disease has a p-value of 0.040 and the relationship between hypertension and coronary heart disease has a p-value of 0.000. Conclusion: There is a relationship between physical activity, smoking habits, and hypertension in coronary heart disease at the Kalabahi Hospital Polyclinic, Alor, East Nusa Tenggara, 2022.

Association of Fish Oil Supplementation with Risk of Coronary Heart Disease in Individuals with Diabetes and Prediabetes: A Prospective Study in the UK Biobank.

This study aimed to explore the association between habitual intake of fish oil supplementation and the risk of developing CHD in patients with prediabetes and diabetes. Habitual use of fish oil was assessed by repeated questionnaires. Cox proportional hazard models were applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median follow-up of 11.6 years, 4304 and 3294 CHD cases were documented among 47,663 individuals with prediabetes and 22,146 patients with diabetes in the UK Biobank, respectively. After multivariable adjustment, the HRs (95% CI) of CHD were 0.91 (0.85-0.98) and 0.87 (0.80-0.95) for individuals utilizing fish oil supplementation compared with non-users among the participants with prediabetes and diabetes, respectively. Furthermore, we identified an inverse relationship between fish oil use and CHD incidence, which was significantly mediated by serum C-reactive protein (CRP) levels in individuals with prediabetes and by very-low-density lipoprotein cholesterol (VLDL-C) in patients with diabetes at baseline. The inverse associations were consistent in the analyses stratified by potential confounders. In conclusion, the consumption of fish oil supplements was linked to decreased serum CRP and VLDL-C levels and subsequent CHD risk among adults with prediabetes and diabetes. Our findings highlight the important role of the habitual intake of fish oil supplements in preventing CHD in individuals with impaired glucose metabolism.

Role of horizontal negative family history among male sibs

Introduction. Coronary heart disease is closely associated with modifiable risk factors such as hypertension, smoking, obesity, dyslipidaemia, and diabetes. At the same time, the role of family history of cardiovascular diseases (CVD) as an independent and significant risk factor for CHD is still unclear. Or may a family history of cardiovascular diseases be largely explained by a combination of traditional risk factors? Materials and methods of the study. By means of the information retrieval system of the Dimol complex, reliable group of male siblings (86 patients) with a horizontal hereditary burden of CHD (through male siblings) was formed. The study was conducted basing on the analysis of risk factors for CHD in studied patients. The obtained results were compared with published statistical data on the prevalence of risk factors for coronary heart disease among men in the Russian Federation. Results. According to our study, the prevalence of smoking habit among male siblings was 55.8%, arterial hypertension – 74.4%, abdominal obesity – 40.7%, diabetes – 20.9%, hypercholesterolemia – 58.1%. The predicted incidence of CHD according to the CAD Consortium scale was 51% (41–64). At the same time, according to the CAG and CA-MSCT findings, stenosis lesions of coronary arteries were found in 74 (86%) male siblings. Conclusions. According to our analysis, the prevalence of CHD risk factors in male siblings with exertional angina is higher than the average in the male population of the Russian Federation. Horizontal hereditary CVD burden is an independent and significant risk factor for CHD in the group of male siblings. Keywords: CHD risk factors, siblings, hereditary burden

Small dense low-density lipoprotein cholesterol compared to other lipoprotein biomarkers for predicting coronary heart disease among individuals with normal fasting glucose: The Multi-Ethnic Study of Atherosclerosis

ObjectiveThis study compared small dense low-density lipoprotein cholesterol (sdLDL-C) with apolipoprotein B (apo B), and low-density lipoprotein particles (LDL-P) in predicting CHD risk in generally healthy adults with normal fasting glucose (NFG). MethodsThis study was conducted among participants with NFG in the Multi-Ethnic Study of Atherosclerosis (MESA) prospective cohort with measurements of sdLDL-C, LDL-P, and apo B available at baseline (2000–2002) and follow-up CHD data (through 2015) (N = 3,258). Biomarkers were evaluated as quartiles, and in categories using clinically and 75th percentile-defined cut-points. Discordance/concordance of sdLDL-C relative to other biomarkers was calculated using 75th percentile cut-points and linear regression residuals. Associations between individual biomarkers, sdLDL-C discordance and CHD incidence were evaluated using Cox proportional hazards regression. ResultsThere were 241 incident CHD events in this population through 2015. Higher sdLDL-C, apo B, LDL-P were similarly associated with increased CHD in individuals with NFG. Discordance of sdLDL-C with apo B or LDL-P by 75th percentiles was not significantly associated with CHD. Residuals discordantly higher/lower sdLDL-C relative to apo B (discordant high HR=1.26, 95% CI: 0.89, 1.78; discordant low HR=0.94, 95% CI: 0.68, 1.29) and LDL-P (discordant high HR=1.25, 95% CI: 0.88, 1.75; discordant low HR=0.84, 95% CI:0.60, 1.16), compared to those with concordant measures, had non-statistically significant higher/lower risk of CHD. ConclusionsResults suggest sdLDL-C, apo B and LDL-P are generally comparable for predicting CHD events in normoglycemic individuals. Larger studies are needed to confirm findings and to investigate whether measurement of sdLDL-C may be beneficial to evaluate as an additional risk-enhancing factor.

Abstract 15208: Association Between Electrocardiographic St-t Wave Abnormalities and Stroke Risk in the Allhat Trial

Background: The presence of electrocardiographic (ECG) ST-T wave abnormalities has previously been shown to be associated with increased risk of coronary artery disease but their association with stroke incidence is unclear.Objective: We sought to investigate the relationship between ST-T wave abnormalities and stroke incidence in the ALLHAT trial. Methods: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized double-blinded clinical trial (n=33,357) conducted from 1994 through 2002, examining whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers incidence of CHD or CVD events compared to treatment with a diuretic. Major ST depression or T wave inversion on any ECG in the past 2 years were included in the study. One of the secondary outcomes included in the study was incident stroke. Hazard ratios (relative risks [RRs]) and 95% confidence intervals (CIs) were obtained using Cox proportional hazards regression model. All statistical analyses were performed using STATA 12 (Stata Corp., College Station, TX, USA). Results: Study participants were predominantly middle-aged, male, white, with prevalence of ST-T wave abnormality being 10.35% (N=3,420). Presence of ST-T wave abnormalities were not associated with a higher risk of stroke [hazard ratio 0.47 (95% CI, 0.91-1.22)] in unadjusted analyses. This relationship was not significant even after adjustment for prevalent cardiovascular disease (CABG, ASCVD) [0.51(95% CI, 0.91- 1.22)], cardiovascular risk factors (age, sex, diabetes, systolic blood pressure, diastolic blood pressure, cholesterol, BMI) [0.15 (95% CI, 0.96-1.31)] as well as randomized treatment groups in ALLHAT [0.15 (95% CI, 0.96-1.31)]. Conclusion: Presence of major ST-T wave abnormality does not predict incident stroke in the the ALLHAT trial, more observations from contemporary studies need to be elucidated.

Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials

Aims/hypothesisNordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes.MethodsWe searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle–Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence.ResultsWe included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with ‘small important’ reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose–response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] −0.26 mmol/l [95% CI −0.52, −0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and ‘small important’ or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were ‘trivial’ reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency.Conclusions/interpretationAdherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes.RegistrationClinicalTrials.gov NCT04094194.FundingDiabetes and Nutrition Study Group of the EASD Clinical Practice.Graphical abstract

Association of an evolutionary-concordance lifestyle pattern score with incident CVD among Black and White men and women.

Dietary and lifestyle evolutionary discordance is hypothesised to play a role in the aetiology of CVD, including CHD and stroke. We aimed to investigate associations of a previously reported, total (dietary plus lifestyle) evolutionary-concordance (EC) pattern score with incident CVD, CHD and stroke. We used multivariable Cox proportional hazards regression to investigate associations of the EC score with CVD, CHD and stroke incidence among USA Black and White men and women ≥45 years old in the prospective REasons for Geographic and Racial Differences in Stroke study (2003-2017). The EC score comprised seven equally weighted components: a previously reported dietary EC score (using Block 98 FFQ data) and six lifestyle characteristics (alcohol intake, physical activity, sedentary behaviour, waist circumference, smoking history and social network size). A higher score indicates a more evolutionary-concordant dietary/lifestyle pattern. Of the 15467 participants in the analytic cohort without a CVD diagnosis at baseline, 1563 were diagnosed with CVD (967 with CHD and 596 with stroke) during follow-up (median 11·0 years). Among participants in the highest relative to the lowest EC score quintile, the multivariable-adjusted hazards ratios and their 95 % CI for CVD, CHD and stroke were, respectively, 0·73 (0·62, 0·86; Ptrend < 0·001), 0·72 (0·59, 0·89; Ptrend < 0·001) and 0·76 (0·59, 0·98; Ptrend = 0·01). The results were similar by sex and race. Our findings support that a more evolutionary-concordant diet and lifestyle pattern may be associated with lower risk of CVD, CHD and stroke.

Congenital Heart Malformations in Iraq, a Review

Background: Heart malformations are among the commonest indications for admission to hospital and may causes mortality of children. There is a need to highlight this important medical issue as there is no review article on this subject in Iraq.&#x0D; Aim: This study aims to focus on this diseases in allover Iraq by reviewing the articles that have been published previously among different Iraqi academic scientific journal (IASJ) and concerned with the congenital heart diseases in various Iraqi governorates.&#x0D; Materials and Methods: Reviewing of the publications were conducted in accordance of that already described. Identification of available articles were done via applying search on IASJ (from 1997 to 2022). The keywords of ‘congenital heart disease was used in the search. Comprehensive full text articles in English were enrolled, while those published locally in periodic journals were excluded as there they were difficult to access them. Data extraction from selected publications was done in an independent manner via specialized design including the title of the study, the date of publication, area of research, topic of research, number of cases enrolled, and major results.&#x0D; Results: Most cases are diagnosed at infancy. Male predominance was recognized in Ventricular septal defect (VSD), Tetrolgy of Fallot (TOF), stenosis of Aorta, transposition of the great arteries (D), and aorta's coarctation, Female supremacy was recognized in atrio ventricular canal defect, Patent ductus arteriosus-PDA, atrial septal defects-ASD, and stenosis of pulmonary artery. The acyanotic type was more frequent than those accompanied with cyanosis as reported by many studies. A study from Basra Province has registered the highest incidence of CHD throughout analysis of data of patients with CHD which constitutes 57(40%) out of 1414 examined children. The reviewing of data from several articles in IASJ revealed a concern with correlation of CHD with other congenital disorders. Few researches were conducted on the treatment of CHD. Several works in Iraq tried to discuss the issue from other points of views as the nutritional status and feeding problems, the impact on the growth, and even the oral and dental health.&#x0D; Conclusions: According to the results of all reviewed Iraqi studies, there is a need for establishing a high standard centers with providing equipments for pediatric surgical operations .A well prepared staff is required for such type of operations. In addition, a well cooperation between the pediatricians and cardiac surgeons to achieve accurate diagnosis, managements, and follow up is needed.

422-P: Predictive Role of Triglyceride-Glucose Index on All-Cause Mortality and Incidence of Vascular Events in Type 2 Diabetes (T2D) : A 13-Year Follow-Up Observational Study

Triglyceride glucose index (TyG-i) is an alternative marker of insulin resistance and an independent predictor of CV events; yet its prognostic value in T2D remains poorly assessed.A cohort of 961 T2D was followed-up for 13.1±2.8 years. Vital status was retrieved on December 31, 2017 and data for CV events were available for 947 of them. TyG-i [ln (fasting triglycerides (mg/dL) x fasting glucose (mg/dL) / 2) ] was calculated at baseline and divided in tertiles (thresholds: 8.97 and 9.51) . Events were assessed by Kaplan-Meier (K-M) curves and HRs (95% CI) by unadjusted and adjusted Cox regressions (Cox-r) in TyG-i tertiles.At follow-up, 229 (23.8%) subjects died (18.25 x 1000 PYs) ; CV events occurred in 273 (28.8%; 25.68 x 1000 PYs) , coronary events (CHD) in 181 (19.1%; 16.20 x 1000 PYs) , hospitalization for heart failure (hHF) in 82 (8.7%; 6.79 x 1000 PYs) , cerebrovascular events (CVE) in 1 (10.7%) , peripheral vascular events (PVE) in 39 (4.1%) , ESRD in 71 subjects (7.5%; 5.87 x 1000 PYs) . On K-M, CVD (24.2%, 25.6% and 36.7%; p=0.001) and CHD (14.5%, 17.1% and 25.9%; p=0.001) increased with TyG-i. All other outcomes increased across tertiles in a not significant manner. On unadjusted Cox-r, cumulative incidence of CV events and CHD increased significantly across TyG-i tertiles (T3 vs. T1) for major CVD (HR 1.65, 95% CI 1.24-2.20, p=0.001) and CHD (1.91, 1.33-2.74, p&amp;lt;0.00for) , or marginally for PVD (1.99, 0.93-4.29, p=0.078) . After adjusting for age, diabetes duration, age at diagnosis, sex, BMI, active smoking, HbA1c, uric acid, fibrinogen, hypertension, dyslipidemia, prior CVD, CKD, retinopathy and neuropathy, HRs still increased with TyG-i for CV events (T3 vs. T1, 1.96, 95% CI 1.44-2.67, p&amp;lt;0.0001) , and CHD (T3 vs. T1, 2.03, 1.40-2.93, p&amp;lt;0.0001) . In conclusion, TyG-i was significantly and independently associated with CVD and CHD, suggesting that it may be a simple yet valid marker for risk stratification in T2D. Disclosure M.Garofolo: Employee; Eli Lilly and Company. D.Lucchesi: None. E.Gualdani: None. P.Falcetta: Speaker's Bureau; Abbott Diabetes. M.Giambalvo: None. P.Francesconi: None. S.Del prato: Advisory Panel; Applied Therapeutics, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Consultant; Menarini Group, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck &amp; Co., Inc., Sanofi, Stock/Shareholder; Novo Nordisk A/S. G.Penno: Advisory Panel; Eli Lilly and Company.

Genetic susceptibility, screen-based sedentary activities and incidence of coronary heart disease

BackgroundWhether the associations of time spent in screen-based sedentary activities with CHD vary by genetic susceptibility is currently unknown. The objective of this study was to examine the interplay of genetic susceptibility to CHD and two prevalent types of screen-based sedentary activities (television [TV] viewing and computer use) for CHD incidence.MethodsThis prospective cohort study included 373,026 individuals of European ancestry without prevalent CHD/stroke from UK Biobank data. Genetic susceptibility to CHD was assessed using weighted polygenic risk scores, calculated by summing the number of risk-increasing alleles among 300 single-nucleotide polymorphisms, multiplied by their corresponding effect estimates. TV viewing and computer use were assessed through touch-screen questionnaires. CHD incidence (n=9185) was adjudicated over a median 12.6-year follow-up.ResultsCompared with ≥4h/day of TV viewing, the hazard ratio of CHD was 0.84 (95% confidence interval [CI] 0.79–0.90) and 0.94 (0.90–0.99) for ≤1h/day and 2–3h/day of TV viewing, respectively, after adjusting for confounders including the genetic risk. CHD hazards were higher for medium and high genetic risk than for low genetic risk. Across all levels of genetic risk including high-genetic risk, ≤1h/day of TV viewing had lower CHD hazards, compared with ≥4h/day: no evidence of interaction between genetic risk and TV viewing (p value: 0.362). Estimates of the population attributable fraction (PAF) suggested that 10.9% (95% CI 6.1–15.3%) of CHD could be prevented if TV viewing time were reduced to ≤1h/day, assuming causality. The PAF values were relatively larger for medium-to-high genetic risk than for low genetic risk, although the CIs were wide and overlapping. No associations were observed for computer use.ConclusionsLess TV viewing time was associated with lower CHD risk independently of genetic risk. Clinical trials targeted at individuals with high genetic susceptibility should consider reducing TV viewing as as a behavioural target for prevention of an early onset of cardiovascular events.

PO-713-04 PROGNOSTIC EFFECTS OF ELECTROCARDIOGRAPHIC ST-T WAVE ABNORMALITIES IN THE ALLHAT (ANTIHYPERTENSIVE AND LIPID-LOWERING TREATMENT TO PREVENT HEART ATTACK TRIAL)

Major electrocardiographic (ECG) ST-T wave abnormalities are widely seen in clinical practice, but the longitudinal significance in cardiovascular risk assessment within a contemporary hypertension treatment cohort remains unknown. We sought to investigate the relationship between ST-T wave abnormalities and the primary outcome (fatal coronary heart disease or nonfatal myocardial infarction) in the ALLHAT trial. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized double-blinded clinical trial (n=33,357) conducted during 1994- 2002, examining whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers incidence of CHD or CVD events compared to treatment with a diuretic. 33,357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor were included and followed up for 4-8 years. Major ST depression or T wave inversion on any ECG in past 2 years were included in the study. The primary outcome was combined fatal CHD or nonfatal myocardial infarction. Hazard ratios (relative risks [RRs]) and 95% confidence intervals (CIs) were obtained from the Cox proportional hazards regression model. Cumulative event rates were calculated using the Kaplan-Meier method. All statistical analyses were performed using STATA 12 (Stata Corp., College Station, TX, USA). Study participants were predominantly middle-aged, male, white, with prevalence of ST-T wave abnormality being 10.35% (N=3,420). Moreover, ST-T changes were associated with a higher risk of fatal CHD or nonfatal MI [hazard ratio 1.17 (95% CI, 1.05-1.29)] in unadjusted analyses. This relationship remained statistically significant after adjustment for prevalent cardiovascular disease (stroke, CABG, ASCVD) [1.15 (95% CI, 1.04- 1.28)], cardiovascular risk factors (age, sex, diabetes, systolic blood pressure, diastolic blood pressure, cholesterol, BMI) [1.21 (95% CI, 1.09-1.34)] as well as randomized treatment groups in ALLHAT [1.21 (95% CI, 1.09-1.34)]. Presence of major ST-T wave abnormality was significantly associated with fatal CHD or nonfatal MI, underscoring the potential prognostic value of these ECG findings in overall cardiovascular risk.

Temporal trends in associations between severe mental illness and risk of cardiovascular disease: A systematic review and meta-analysis.

BackgroundSevere mental illness (SMI; schizophrenia, bipolar disorders (BDs), and other nonorganic psychoses) is associated with increased risk of cardiovascular disease (CVD) and CVD-related mortality. To date, no systematic review has investigated changes in population level CVD-related mortality over calendar time. It is unclear if this relationship has changed over time in higher-income countries with changing treatments.Methods and findingsTo address this gap, a systematic review was conducted, to assess the association between SMI and CVD including temporal change. Seven databases were searched (last: November 30, 2021) for cohort or case–control studies lasting ≥1 year, comparing frequency of CVD mortality or incidence in high-income countries between people with versus without SMI. No language restrictions were applied. Random effects meta-analyses were conducted to compute pooled hazard ratios (HRs) and rate ratios, pooled standardised mortality ratios (SMRs), pooled odds ratios (ORs), and pooled risk ratios (RRs) of CVD in those with versus without SMI. Temporal trends were explored by decade. Subgroup analyses by age, sex, setting, world region, and study quality (Newcastle–Ottawa scale (NOS) score) were conducted. The narrative synthesis included 108 studies, and the quantitative synthesis 59 mortality studies (with (≥1,841,356 cases and 29,321,409 controls) and 28 incidence studies (≥401,909 cases and 14,372,146 controls). The risk of CVD-related mortality for people with SMI was higher than controls across most comparisons, except for total CVD-related mortality for BD and cerebrovascular accident (CVA) for mixed SMI. Estimated risks were larger for schizophrenia than BD. Pooled results ranged from SMR = 1.55 (95% confidence interval (CI): 1.33 to 1.81, p < 0.001), for CVA in people with BD to HR/rate ratio = 2.40 (95% CI: 2.25 to 2.55, p < 0.001) for CVA in schizophrenia. For schizophrenia and BD, SMRs and pooled HRs/rate ratios for CHD and CVD mortality were larger in studies with outcomes occurring during the 1990s and 2000s than earlier decades (1980s: SMR = 1.14, 95% CI: 0.57 to 2.30, p = 0.71; 2000s: SMR = 2.59, 95% CI: 1.93 to 3.47, p < 0.001 for schizophrenia and CHD) and in studies including people with younger age. The incidence of CVA, CVD events, and heart failure in SMI was higher than controls. Estimated risks for schizophrenia ranged from HR/rate ratio 1.25 (95% CI: 1.04 to 1.51, p = 0.016) for total CVD events to rate ratio 3.82 (95% CI: 3.1 to 4.71, p < 0.001) for heart failure. Incidence of CHD was higher in BD versus controls. However, for schizophrenia, CHD was elevated in higher-quality studies only. The HR/rate ratios for CVA and CHD were larger in studies with outcomes occurring after the 1990s. Study limitations include the high risk of bias of some studies as they drew a comparison cohort from general population rates and the fact that it was difficult to exclude studies that had overlapping populations, although attempts were made to minimise this.ConclusionsIn this study, we found that SMI was associated with an approximate doubling in the rate ratio of CVD-related mortality, particularly since the 1990s, and in younger groups. SMI was also associated with increased incidence of CVA and CHD relative to control participants since the 1990s. More research is needed to clarify the association between SMI and CHD and ways to mitigate this risk.

“INCIDENCE AND PATTERNS OF CONGENITAL HEART DISEASES AMONG NEONATES ADMITTED IN SPECIAL NEW BORN CARE UNITS OF DISTRICT HOSPITAL NANDYAL, KURNOOL”

Objective: To nd out the pattern and incidence of congenital Heart defects among neonates in SNCU, District Hospital, Nandyal. Methods: This is a retrospectic hospital-based study conducted over a period of 12 months in the Special new born care unit of District Hospital, Nandyal from 01th January 2021 to 31st December 2021. Neonates (new born up to 28 days of age) admitted are examined in the unit irrespective of their condition comprised the study population. They were rst examined by the medical ofcer at the time of admission and subsequently by a pediatrician. Information of gender, weight, gestational age, were recorded on a predesigned Performa. After clinical examination, relevant investigations like ultrasonography, radiology, echocardiography, laboratory and genetic studies were done to conrm diagnosis if it was needed. Results: Out of 2185 total admissions, 51 (2.28%) neonates were having congenital heart defect. Of them, 23 (45.1%) were male and 28 (54.90%) females. CHD was observed in 76% full-term and 24% pre-term infants. CHD was observed in 32 infants weighing &gt;2,500 g (64% of corresponding birth weight infants); 17 weighing 1,500 to 2,500 g (34%); and 1 weighing &lt;1,500 g (2%). The incidence of CHD was higher in the full-term group. However, the incidence of complex CHD in full-term neonates was high. Conclusion: Findings from our study suggest that the recent incidence and disease pattern of CHD might have changed for both complex and simple forms of CHD in District Hospital, Nandyal.

Cut-off values for anthropometric indices in predicting morbidity and mortality in Turkey: a cohort

Abstract Background Anthropometric measurements are associated with cardiovascular outcomes and mortality and the association varies by community. This study aims to estimate the incidence of cardiovascular outcomes and all cause mortality and determines their association with the anthropometric measurements. Methods The data from Turkey Chronic Diseases and Risk Factors Survey were used for the cohort which recruited two 15 years and older adults from each family physicians' list in 2011 in Turkey using simple random sampling (n = 18,477). Family physicians collected the medical history and performed anthropometric measurements. Initially healthy participants for cardiovascular morbidity (coronary heart disease (ICD-10 codes I20.0-I25.0) and stroke (ICD-10 codes I60.0-I69.0) and all participants for all-cause and cardiovascular mortality were followed-up through electronic health records by 2017. Area under the curves (AUCs) were estimated and the adiposity risk was defined as cut-off points determined using Youden Index. The sample was stratified by age-groups (&amp;lt;65, ≥65). Poisson and Cox models were fitted for morbidity and mortality outcomes, respectively. Results Over six years of follow-up, 5.7% of 15,877 and 1.3% of 16,062 participants developed CHD and stroke respectively. In total, 664 all-cause deaths (4.0%) were observed with 155 caused by CVDs (0.9%). A body shape index (i.e. 0.658 for all-cause mortality among younger men), waist-to-height ratio (i.e. 0.743 for CHD incidence among younger women), and BMI had higher AUCs for the outcomes. Higher anthropometric measurement groups had almost always higher CHD incidence risk in all groups but lower all-cause mortality in older men. Higher body-mass index was associated with lower mortality in younger men. Conclusions This cohort study in Turkey showed that having higher anthropometric measurements is mostly associated with higher CHD incidence and mostly lower mortality among older men. This association deserves further studies. Key messages In Turkey, higher anthropometric measurements are associated with higher coronary heart disease incidence in among participants. In Turkey, higher anthropometric measurements are mostly associated with lower all-cause mortality in older age-groups.

To Determine the Frequency of Congenital Heart Disease in Infants of Diabetic Mothers

Aim: To determine the frequency of Congenital Heart Disease in infants of diabetic mother. Methodology: Cross sectional (Descriptive) study conducted in the Department of Pediatrics Special Care Baby Unit (SCBU) Khyber Teaching Hospital Peshawar from 15-04-2015 to 15-10-2015. The sample size was150 patients, using 52.5% incidence of CHD in IDM and 95% confidence interval with 8% margin of error under WHO software Results: This study was carried out on 150 patients at the Department of Pediatrics, Khyber Teaching Hospital Peshawar. CHD was detected in 79 (52.7%) patients while in 71 (47.33%) patients, CHD was not detected. Conclusion: Our study concluded moderate prevalence of Congenital Heart Disease in infants born to diabetic mothers. Keywords: Diabetes mellitus, Pregnancy, Newborn, Heart defects