Common Cardiovascular Risk Factors Research Articles

Right ventricular infarction: epidemiological, clinical, and angiographic characteristics and the outcomes through the experience of a Moroccan cardiology department

Background: Acute myocardial infarction (MI) is a major cause of cardiovascular mortality, which is the leading cause of death in the world. Our objective in this study was to evaluate the epidemiological, clinical, and angiographic features of right ventricular infarction (RVI), as well as its complications and its therapeutic approaches. Patients and methods: It is a single-centered retrospective descriptive study conducted over a period of 2 years from November 2018 to October 2020. The authors included 82 patients with RVI hospitalized in the cardiovascular ICU during the initial phase of acute coronary syndrome with persistent ST segment elevation. Patients who were diagnosed with RVI at electrocardiogram and echocardiography were recruited. Results: The authors included 500 patients hospitalized for STEMI, 82 had MI extended to the RV, reflecting a rate of 16.4%. The mean age in our study was 64±12.3 years. Dyslipidemia, diabetes mellitus, and hypertension were the most common cardiovascular risk factors among these patients. RVI co-existed with inferior MI in 62.2 of cases and in 37.8% of anterior MI, while isolated RVI was seen in only one patient. Transthoracic echocardiography showed right ventricular (RV) systolic dysfunction in 24.39% of cases, while RV dilatation was seen in only 10.9% of patients. Therapeutic approach was based essentially on revascularization with thrombolysis and coronary angiography +/- PCI. The percentage of mortality was 2.4%. Conclusion: RVI is relatively rare and is mostly related to an extension of an inferior MI. Early diagnosis, prompt treatment, and appropriate are the keys to improve prognosis, and reduce complications.

Arterial Stiffness and Heart Failure With Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) is prevalent and associated with a poor prognosis, imposing a significant burden on society. Arterial stiffness is increasingly recognized as a crucial factor in the pathophysiology of HFpEF, affecting diagnosis, management, and prognosis. As a hallmark of vascular aging, arterial stiffness contributes to increased afterload on the left ventricle (LV), leading to diastolic dysfunction, a key feature of HFpEF. Elevated arterial stiffness is linked with common cardiovascular risk factors in HFpEF, such as hypertension, diabetes and obesity, exacerbating the progression of disease. Studies have demonstrated that patients with HFpEF exhibit significantly higher levels of arterial stiffness compared to those without HFpEF, highlighting the value of arterial stiffness measurements as both diagnostic and prognostic tools. Moreover, interventions aimed at reducing arterial stiffness, whether through pharmacological therapies or lifestyle modifications, have shown potential in improving LV diastolic function and patient outcomes. Despite these advancements, the precise mechanisms by which arterial stiffness contributes to HFpEF are still not fully understood, necessitating the need for further research.

Echocardiographic evaluation of mitral inflow e wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction

Abstract AIMS AND OBJECTIVES: To study the clinical characteristics and to assess the usefulness of echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in patients admitted with ST-elevation myocardial infarction (STEMI) with or without revascularization therapy to predict in-hospital mortality. BACKGROUND: Myocardial infarction is a high-risk condition, especially when filling pressure is raised, and earlier reports have suggested that E/e’ is associated with poor outcome. However, whether E/e’ predicts risk better than left ventricular ejection fraction (LVEF), which is the current standard of practice, is not known. MATERIALS AND METHODS AND RESULTS: The echocardiographic evaluation of mitral inflow E wave velocity-to-tissue Doppler e’ wave velocity ratio (E/e’) as a prognostic indicator in ST-elevation myocardial infarction” was carried out on 100 patients admitted in the Department of Cardiology of Fortis Escorts Heart Institute, Okhla, New Delhi, from November 2019 to March 2021. The mean age of the patients with ST-elevation myocardial infarction was 59.8 ± 11.3 years. In patients who had E/e’ >15, male predominance and higher age (mean 63.7 ± 7.7 years) were found. Out of common cardiovascular risk factors, smoking and diabetes mellitus were found to be statistically significant. 67.7% of patients were belonged to the Killip Class II or more. In patients who had E/e’ >15, 29 (93.5%) patients had LVEF ≤45%. Twenty-seven (87.1%) patients had deceleration time (DT) ≤140 ms. Moderate or severe mitral regurgitation (MR) was found in 19.4% of patients, while the mean values of LVEDD and LVESD were 50.4 ± 2.15 mm and 39.7 ± 3.3 mm, respectively. The mean velocity of E and A was 0.87 ± 0.12 m/s and 0.75 ± 0.11 m/s, respectively. The mean E/A ratio was 1.1 ± 0.22. The mean velocity of e’ was 5.02 ± 0.45 cm/s and E/e’ ratio was 17.48 ± 1.57. The association of various clinical features showed that male gender, higher age, smoking, and diabetes mellitus, cardiogenic shock, and Killip Class II or greater were significant factors associated with E/e’ >15. Echocardiographic findings showed that LVEF ≤45%, higher LVEDD and LVESD, higher peak E velocity, DT ≤140 ms, lower mitral annulus e’ velocity, higher E/e’ ratio, and moderate or severe MR were significantly associated with E/e’ >15. CONCLUSION: The current study concluded that Doppler echocardiographic estimation of E/e’ ratio can be used as a marker of elevated left ventricular filling pressure and hence can be used as a prognostic marker in risk stratification of patients admitted in coronary care units. The E/e’ ratio is an independent and powerful predictor of the in-hospital mortality.

Advanced glycation end products measured by skin autofluorescence and subclinical cardiovascular disease: the Rotterdam Study

BackgroundAdvanced glycation end products (AGEs) have been linked to cardiovascular disease (CVD), especially coronary heart disease (CHD), but their role in CVD pathogenesis remains unclear. Therefore, we investigated cross-sectional associations of skin AGEs with subclinical atherosclerosis, arterial stiffness, and hypertension after confirming their relation with CHD.MethodsIn the population-based Rotterdam Study, skin AGEs were measured as skin autofluorescence (SAF). Prevalent MI was obtained from digital medical records. Carotid plaques, carotid intima-media thickness (IMT), coronary artery calcification (CAC), pulse wave velocity (PWV), and hypertension were assessed. Associations of SAF with endophenotypes were investigated in logistic and linear regression models adjusting for common cardiovascular risk factors. Effect modification by sex, diabetes mellitus, and chronic kidney disease (CKD) was tested.Results3001 participants were included (mean age 73 (SD 9) years, 57% women). One unit higher SAF was associated with the presence of carotid plaques (OR 1.2 (0.92, 1.57)), a higher max IMT (0.08 SD (0.01, 0.15)), higher CAC (OR 2.2 (1.39, 3.48)), and PWV (0.09 SD (0.01, 0.16)), but not with hypertension (OR 0.99 (0.81, 1.21)). The associations with endophenotypes were more pronounced in men and participants with diabetes or CKD with significant interactions.ConclusionsPreviously documented associations between SAF and CVD, also found in our study, may be explained by the endophenotypes atherosclerosis and arterial stiffness, especially in men and individuals with diabetes or CKD, but not by hypertension. Longitudinal studies are needed to replicate these findings and to test if SAF is an independent risk factor or biomarker of CVD.Trial registration: The Rotterdam Study has been entered into the Netherlands National Trial Register (NTR; www.trialregister.nl) and the WHO International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/network/primary/en/) under shared catalogue number NTR6831.

Abstract 11686: Aortic Stenosis is Independently Associated With Smoking, Diabetes Mellitus, Hypertension, Hyperlipidemia, Renal Disease, COPD, and Caucasian Ethnicity in Addition to Advanced Age, Rheumatic Fever, and Bicuspid Aortic Valve

Hypothesis: Aortic valve stenosis is known to be associated with age, rheumatic fever, and bicuspid aortic valve but its association with other cardiovascular risk factors is less known. The purpose of this study was to investigate any association between aortic stenosis and other common cardiovascular risk factors. Method: The large Nationwide Inpatient Sample database was utilized to study these associations using uni- and multivariate analyses. Data was extracted from the first available database that used ICD-10 codes specifically coding aortic stenosis alone, which occurred in the year 2016. Results: In the database of patients over age of 40, a significant association was identified between aortic stenosis and smoking (OR: 1.12, CI 1.1 - 1.15, P < 0.001), diabetes mellitus (OR: 1.19, CI 1.17 - 1.21, P < 0.001), hypertension (OR: 1.36, CI 1.33 - 1.39, P < 0.001), hyperlipidemia (OR: 1.47, CI 1.44 - 1.49, P < 0.001), renal disease (OR: 1.46, CI 1.43 - 1.48, P < 0.001), chronic obstructive lung disease (COPD) (OR: 1.16, CI 1.14 - 1.18, P < 0.001), obesity (OR: 1.35, CI 1.32 - 1.39, P < 0.001), and Caucasian race (OR: 1.47, CI 1.42 - 1.52, P < 0.001), in addition to known factors such as age, rheumatic disease and bicuspid aortic valve. Conclusion: Based on this large database study, we found a new association of aortic valve stenosis with race and many cardiovascular risk factors such as smoking, renal disease, COPD, Caucasian race, and obesity. The role of these new risk factors in the pathogenesis of aortic stenosis warrants further investigation.

Abstract 12097: Genetics of Cardiac Troponin

Introduction: In the absence of coronary artery disease, observational studies suggest that myocardial injury may occurs because of drugs/toxins, infection, inflammatory disease, and malignancy, alongside commonly associated conditions such as heart failure, kidney disease, and hypertension, among others. The causes and optimal treatment for myocardial injury without ischemic heart disease remains an unmet need in cardiovascular medicine. We aimed to leverage genome-wide association studies (GWAS) to identify previously unreported risk loci for circulating troponin levels in the absence of ischemia, and Mendelian randomization (MR) to highlight causes of myocardial injury and identify potential targets for intervention. Methods: We performed a GWAS meta-analysis of circulating cardiac troponin I (cTnI) and T (cTnT) among up to 46,267 healthy ambulatory individuals using METAL. Using publicly-available GWAS of ~40 common cardiovascular risk factors such as lipids, blood pressure, and kidney function available from the IEU Open GWAS Project, we used Mendelian randomization (MR) to identify their potential causal association with circulating troponin. We primarily employed inverse-variance weighted MR; weighted median and weighted mode methods were applied as sensitivity analyses. Results: Our meta-analysis revealed three risk loci each for cTnI and cTnT, including a previously unreported signal on chromosome 3 (rs1706435) for cTnT. After accounting for multiple testing by controlling the false discovery rate (q < 0.05), MR identified 8 and 10 cardiovascular risk factors associated with elevated cTnI and cTnT, respectively. These factors included blood pressure, creatinine, classes of obesity, and waist circumference. Conclusions: This analysis identified a new risk locus for circulating troponin in the absence of ischemia. Our MR results provide human genetic evidence to support obesity and hypertension as important contributors to elevated circulating troponin, highlighting their potential role in myocardial injury.

Exploring PCSK9 Genetic Impact on Lipoprotein(a) via Dual Approaches: Association and Mendelian Randomization.

Previous investigations have suggested an association between the PCSK9 common polymorphism E670G and Lipoprotein(a) (Lp(a)) levels, as well as a link between plasma PCSK9 levels and Lp(a) concentrations. However, the causal relationship between plasma PCSK9 and Lp(a) levels remains uncertain. In this study, we explored the association between PCSK9 E670G polymorphism and Lp(a) levels in 614 healthy Taiwanese individuals. Employing a two-sample Mendelian randomization (MR) analysis using openly accessible PCSK9 and Lp(a) summary statistics from the genome-wide association studies (GWAS) and UK Biobank, we aimed to determine if a causal link exists between plasma PCSK9 levels and Lp(a) concentrations. Our findings reveal that the E670G G allele is independently associated with a decreased likelihood of developing elevated Lp(a) levels. This association persists even after adjusting for common cardiovascular risk factors and irrespective of lipid profile variations. The MR analysis, utilizing six PCSK9 GWAS-associated variants as instrumental variables to predict plasma PCSK9 levels, provides compelling evidence of a causal relationship between plasma PCSK9 levels and Lp(a) concentration. In conclusion, our study not only replicates the association between the PCSK9 E670G polymorphism and Lp(a) levels but also confirms a causative relationship between PCSK9 levels and Lp(a) concentrations through MR analysis.

Nt-Probnp in Patients with Acute Myocardial Infarction Without Heart Failure

Abstract NT-proBNP is marker of acute heart failure. Recent investigation implicate its role in different cardiac and non-cardiac diseases and different mechanism of release in patients with STEMI and NSTEMI. Our study included 66 patients with diagnosis of acute myocardial infarction, hospitalized in Clinical Centre Kragujevac. We evaluated standard biochemical analysis including NTproBNP, electrocardiography, transthoracic echocardiography and coronary angiography. The most common cardiovascular risk factors were emotional stress (93,94%), and physical inactivity( 81,82%). NT-proBNP values were higher in patients with AMI vs health volunteers (943 vs. 162,5 pg/ml, p = 0,0001), NSTEMI vs STEMI patients (1427 pg/ml vs. 592 pg/m, p = 0,005), patients with culprit lesion on left vs right coronary artery (1421 vs. 548, p =0.02), and anterior vs inferior location AMI (1714vs. 625, p =0.022). We found positive correlation NT-proBNP values with CRP, urea, creatinine, and negative correlation with triglicerides, hemoglobin, left ventricular ejection fraction. Higher values of NT-proBNP values are recorded in patients with AMI, NSTEMI, anterior location AMI and with culprit lesion on left coronary artery.

Correlation of systolic and diastolic blood pressure with echocardiographic phenotypes of cardiac structure and function from three German population-based studies

Arterial hypertension is considered a risk factor for the development of heart failure. Here we investigate cross-sectional associations of systolic and diastolic blood pressure with subtle functional and morphological changes of left ventricular echocardiographic parameters representing early dysfunction in three representative German population-based studies. We assessed 26,719 individuals without symptomatic heart failure from the Hamburg City Health Study (HCHS, n = 7396, derivation cohort), the Gutenberg Health Study (GHS, 14,715, validation cohort) and the Study of Health in Pomerania (SHIP, 4608, validation cohort). Multivariable linear regression analyses with systolic and diastolic blood pressure as continuous exposure variables were adjusted for common cardiovascular risk factors and antihypertensive medication. Both systolic and diastolic blood pressure were consistently associated with measures of left ventricular hypertrophy (β per standard deviation (SD) for LV mass (g) and systolic blood pressure: 5.09 (p < 0.001); diastolic blood pressure: 2.29 (p < 0.001) in HCHS). Systolic blood pressure correlated with declining diastolic function (β per SD for E/e′: 0.29, p < 0.001 in HCHS) and diastolic blood pressure with declining systolic function (β per SD for LVEF, in %: − 0.15; p = 0.041 in HCHS) in all cohorts. Pending further validation, our results from three independent German population samples suggest differential effects of systolic versus diastolic blood pressure on left ventricular structure and function.

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review.

Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer's Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.

Behavioral Sleep Interventions and Cardiovascular Risk Factors: Systematic Review and Meta-analysis of Randomized Controlled Trials.

Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking. Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on ( a ) blood pressure in participants with hypertension/prehypertension, ( b ) glycemic control in participants with DM/pre-DM, ( c ) anthropometrics in participants who were overweight/obese, and ( d ) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change. Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A 1c % (-0.84; 95% confidence interval [CI], -1.34 to -0.34), but not a significant reduction in systolic blood pressure (-0.18; 95% CI, -0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A 1c % (-0.71; 95% CI, -1.01 to -0.42) and weight (-0.78; 95% CI, -1.11 to -0.45), but not systolic blood pressure (-0.72; 95% CI, -1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis. Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.

Associations Between Coronary Artery Calcification and Left Ventricular Global Longitudinal Strain and Diastolic Parameters: the ELSA-Brasil Study

Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro=0.07, p=0.105) but did so with E/e' (ro=0.19, p <0.001), septal e' (ro=0.28, p <0.001), and lateral e' (ro=0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.

Causal association between basal metabolic rate and risk of cardiovascular diseases: a univariable and multivariable Mendelian randomization study

Basal metabolic rate (BMR) is associated with cardiovascular health; however, the causal relationship between BMR and the risk of cardiovascular diseases (CVDs) remains unclear. This study aimed to investigate the potential causal relationship of BMR on common CVDs including aortic aneurysm (AA), atrial fibrillation and flutter (AFF), calcific aortic valvular stenosis (CAVS), heart failure (HF), and myocardial infarction (MI) by Mendelian randomization (MR). The univariable MR analysis using inverse variance weighted (IVW) model as the primary analysis method revealed that genetically predicted higher BMR causally increased the risk of AA [IVW odds ratio (OR) = 1.34, 95% confidence interval CI 1.09–1.65, p = 0.00527], AFF (IVW OR = 1.87, 95% CI 1.65–2.12, p = 1.697 × E-22), and HF (IVW OR = 1.35, 95% CI 1.20–1.51, p = 2.364 × E-07), while causally decreasing the risk of MI (IVW OR = 0.83, 95% CI 0.73–0.93, p = 0.00255). In the multivariable MR analysis, which controlled for common cardiovascular risk factors, direct effects of BMR on an increased risk of AA and AFF, as well as a decreased risk of MI, but an attenuated causal effect on HF, were observed. In conclusion, the current MR study provides evidence for a causal relationship between BMR and the risk of AA, AFF, HF, and MI.

Diagnosis and management of chagasic cardiomyopathy patients in several institutions in Argentina

IntroductionAccording to estimates by the World Health Organization, the infection and disease caused by the protozoan parasite Trypanosoma cruzi affects almost 6 million people, and more than 1 million suffer chagasic cardiomyopathy (Ch-CMP). It is estimated that 376,000 of these individuals live in Argentina. This study describes the characteristics and medical management of individuals with Ch-CMP in Argentina.MethodsThis is a descriptive, retrospective, cross-sectional study on the diagnosis and clinical and therapeutic evaluation of patients with Ch-MCP using historical records collected from different medical institutions in the country between 1 January 2018 and 30 June 2021.ResultsDuring this period, 652 patients (mean age 61.2 years ± 12.9) were included, with women accounting for 60.3% of the sample. The diagnosis of cardiac insufficiency was 36.0% and 64.4% had arrhythmias. The most common cardiovascular risk factors detected were arterial hypertension (69.5%), smoking (56.6%), and diabetes (20.9%). Less than half of the subjects (45.4%) had been studied by electrocardiogram (ECG), chest X-ray, and echocardiogram. ECG studies showed conduction disorders (38.8%), left ventricular hypertrophy (28.1%), ventricular extrasystoles (22.0%), complete right bundle branch block (8.6%), and atrioventricular block (2.6%). According to the Kuschnir classification, 21.4% of the study subjects were in Grade 3.ConclusionsThe patients included in the study had a similar clinical presentation and history of the disease to those published in other studies. When evaluating the medical practices, we found that patients were inadequately studied. Although it is difficult to estimate the fraction of the total number of patients represented by the present study, the study allowed us to establish that the care received by patients was not adequate.

A machine learning based approach to identify carotid subclinical atherosclerosis endotypes.

To define endotypes of carotid subclinical atherosclerosis. We integrated demographic, clinical, and molecular data (n = 124) with ultrasonographic carotid measurements from study participants in the IMPROVE cohort (n = 3340). We applied a neural network algorithm and hierarchical clustering to identify carotid atherosclerosis endotypes. A measure of carotid subclinical atherosclerosis, the c-IMTmean-max, was used to extract atherosclerosis-related features and SHapley Additive exPlanations (SHAP) to reveal endotypes. The association of endotypes with carotid ultrasonographic measurements at baseline, after 30 months, and with the 3-year atherosclerotic cardiovascular disease (ASCVD) risk was estimated by linear (β, SE) and Cox [hazard ratio (HR), 95% confidence interval (CI)] regression models. Crude estimates were adjusted by common cardiovascular risk factors, and baseline ultrasonographic measures. Improvement in ASCVD risk prediction was evaluated by C-statistic and by net reclassification improvement with reference to SCORE2, c-IMTmean-max, and presence of carotid plaques. An ensemble stacking model was used to predict endotypes in an independent validation cohort, the PIVUS (n = 1061). We identified four endotypes able to differentiate carotid atherosclerosis risk profiles from mild (endotype 1) to severe (endotype 4). SHAP identified endotype-shared variables (age, biological sex, and systolic blood pressure) and endotype-specific biomarkers. In the IMPROVE, as compared to endotype 1, endotype 4 associated with the thickest c-IMT at baseline (β, SE) 0.36 (0.014), the highest number of plaques 1.65 (0.075), the fastest c-IMT progression 0.06 (0.013), and the highest ASCVD risk (HR, 95% CI) (1.95, 1.18-3.23). Baseline and progression measures of carotid subclinical atherosclerosis and ASCVD risk were associated with the predicted endotypes in the PIVUS. Endotypes consistently improved measures of ASCVD risk discrimination and reclassification in both study populations. We report four replicable subclinical carotid atherosclerosis-endotypes associated with progression of atherosclerosis and ASCVD risk in two independent populations. Our approach based on endotypes can be applied for precision medicine in ASCVD prevention.

Cardiorespiratory fitness and cardiovascular risk among in-patients with depression compared to healthy controls.

Compared to the general population, individuals with depression have an increased risk for cardiovascular diseases. Nevertheless, little is known so far whether cardiorespiratory fitness (CRF) moderates this relationship. Therefore, we examined whether common physiological cardiovascular risk factors differ between patients with depression and healthy (non-depressed) controls, whether patients and controls differ in CRF, and whether higher CRF is associated with a lower cardiovascular risk in both patients and healthy controls. Additionally, we examined whether within the patient sample, cardiovascular risk factors differ between patients with mild, moderate and severe depression, and whether the relationship between symptom severity and cardiovascular risk is moderated by patients' CRF levels. Data from a multi-centric, two-arm randomized controlled trial (RCT) was analyzed, including 210 patients (F32, single episode: n = 72, F33, recurrent major depression: n = 135, F31-II, bipolar type II: n = 3) and 125 healthy controls. Waist circumference, body mass index, body fat, blood pressure, cholesterol levels, triglycerides, and blood glucose were considered as cardiovascular risk markers. CRF was assessed with a submaximal ergometer test. Differences between groups were examined via χ2-tests and (multivariate) analyses of covariance. Compared to healthy controls, patients with depression had a higher cardiovascular risk as evident from about half of the examined indicators. In the total sample, participants with good CRF had more favourable scores across nearly all risk markers than counterparts with poor CRF. For most variables, no interaction occurred between group and fitness, indicating that in patients and controls, similar differences existed between participants with poor and good CRF. Few differences in risk markers were found between patients with mild, moderate and severe depression, and no interaction occurred between depression severity and CRF. Patients with depression and healthy controls differ in several cardiovascular risk markers, putting patients at increased risk for CVDs. In contrast, people with good CRF show more favourable cardiovascular risk scores, a relationship which was observed in both healthy controls and patients with depression. Physical health of psychiatric patients should receive the clinical attention that it deserves. Lifestyle interventions targeting healthy diet and/or physical activity are recommended as a physically active and healthy lifestyle contributes equally to patients' mental well-being and cardiovascular health.

Cardiac troponin T, NT-proBNP and GDF-15 associate with future focal myocardial scar types, but not diffuse fibrosis assessed by cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust, Vestre Viken Hospital Trust, South-Eastern Norway Regional Health Authority, Roche Diagnostics provided reagents for hs-cTnT analyses Background In cardiovascular risk prediction, there is growing evidence that imaging and circulating cardiac biomarkers provide incremental prognostic value compared to single biomarkers or traditional risk factors. In patients with suspected or established cardiovascular disease (CVD), cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) associate with focal and diffuse fibrosis assessed by cardiac magnetic resonance (CMR) imaging. There is limited data on the associations between established and emerging circulating cardiac biomarkers with subsequent myocardial fibrosis in subjects without CVD recruited from the general population. Purpose Assess the associations between biomarkers of cardiac injury (cTnT), stress (NT-proBNP) and fibrosis and inflammation (growth differentiation factor-15, GDF-15), and subsequent focal and diffuse myocardial fibrosis assessed by CMR imaging. Methods We recruited 200 study participants born in 1950 from the general population. All participants were without known coronary artery disease or renal dysfunction. cTnT, NT-proBNP, and GDF-15 were measured in samples collected at baseline in 2012–2015, and CMR was performed 4–7 years later. Presence and type (ischemic/non-ischemic) of focal myocardial fibrosis were assessed by late gadolinium enhancement (LGE) imaging. Diffuse fibrosis was assessed by the extracellular volume (ECV) in the midventricular septum. Logistic regression analysis was used to examine relationships between log transformed concentrations of cardiac biomarkers and CMR parameters. Results The median age was 63.9 (63.4–64.5) and 52% were male (Table 1). cTnT was associated with presence of any LGE scar adjusted for common cardiovascular risk factors (OR 1.85, 95% CI 1.25–2.72), but this association was attenuated when left ventricular mass was added to the model (Table 2). NT-proBNP (OR 1.66, 95% CI 1.10–2.72) and GDF-15 (OR 4.45, 95% CI 1.29–15.27) were associated with presence of any LGE scar in the fully adjusted models (Table 2). cTnT (OR 1.90, 95% CI 1.06–3.39) and NT-proBNP (OR 2.72, 95% CI 1.29–5.76) were associated with ischemic scars. Only GDF-15 (OR 4.52, 95% CI 1.09–18.72) associated with non-ischemic scars in adjusted models. None of the biomarkers were significantly associated with ECV. Conclusion(s) In a general population cohort, biomarkers of myocardial injury and stress associate with ischemic type scars, but not diffuse fibrosis. GDF-15, an emerging circulating biomarker of fibrosis and inflammation, associates with non-ischemic type scars.

Optimization of fuzzy systems for risk factors in the prevention of cardiovascular diseases

Obesity and overweight are the most common cardiovascular risk factors in people who have suffered myocardial infarction. They are also considered a threat to health worldwide. People with obesity have twice the risk of suffering heart failure than people with a normal body mass index. In this paper, fuzzy logic models which are optimized are proposed to detect risk factors for heart disease according to age and body mass index.

Association Between Plasma Levels of ANGPTL3, 4, 8 and the Most Common Additional Cardiovascular Risk Factors in Patients with Hypertension.

ANGPTL3, 4 and 8 have been reported to be involved in the regulation of lipid and glucose metabolism. The aim of this study was to investigate the expression of ANGPTL3, 4, 8 in hypertensive patients with or without overweight/obesity, T2D, and hyperlipidemia, and the possible association between their expression and the status of the aforementioned comorbidities. Plasma levels of ANGPTL3, 4, and 8 in 87 hospitalized patients with hypertension were measured using ELISA kits. Associations between circulating ANGPTLs levels and the most common additional cardiovascular risk factors were assessed using multivariate linear regression analyses. Pearson's correlation analysis was used to examine the association between ANGPTLs and clinical parameters. In the context of hypertension, (1) although not statistically significant, circulating ANGPTL3 levels were higher in the overweight/obese group than in the normal weight group; (2) circulating levels of ANGPTL3 and ANGPTL8 were significantly lower in patients with T2D than in non-diabetic patients; (3) circulating ANGPTL3 levels were significantly higher in the hyperlipidemic group than in the non-hyperlipidemic group. ANGPTL3 was associated with T2D and hyperlipidemia status, whereas ANGPTL8 was independently associated with T2D status. In addition, circulating ANGPTL3 levels were positively correlated with TC, TG, LDL-C, HCY, and ANGPTL8, and circulating ANGPTL4 levels were positively correlated with UACR and BNP. Changes in circulating ANGPTL3 and ANGPTL8 levels have been observed in hypertensive patients with the most common additional cardiovascular risk factors, suggesting a role in the common comorbidities of hypertension and cardiovascular disease. Hypertensive patients with overweight/obesity or hyperlipidemia may benefit from therapies targeting ANGPTL3.

Transcatheter aortic valve implantation improves endothelial and autonomic function

Abstract Funding Acknowledgements Type of funding sources: None. Background Degenerative aortic stenosis is the leading native valve pathology in developed countries. Its degeneration process is affected by aging, common cardiovascular risk factors and an atherosclerotic-like process preceded by endothelial and autonomic dysfunction. With the increasing integration of transcatheter aortic valve implantation (TAVI) in the treatment of aortic stenosis in the elderly, research is being intensively oriented into its beneficial effect on the cardiovascular system. Measurements of vascular function with flow mediated dilatation (FMD) and autonomic cardiac function using heart rate variability parameters represent a validated method for treatment evaluation at different time-points. Purpose The purpose of our study was to assess whether haemodynamic and structural changes after TAVI will have a positive impact on endothelial and autonomic cardiac function on early and late follow-up. Methods 50 patients with severe aortic stenosis destinated to TAVI were prospectively included. Data was collected at baseline (24 hours before the procedure), on early follow-up (48 hours after the procedure) and on late follow-up (6 months after the procedure). While different heart rate variability parameters were obtained using a high-resolution electrocardiogram, FMD was assessed using a standardized ultrasound-based process with induced forearm hyperaemia. Results 43 patients completed the study (mean age 81 (75-85); 60% women). FMD measurements significantly changed from baseline to early follow-up (2.8 ± 1.5 % to 4.7 ± 2.7 %, p &amp;lt; 0.001). Improvement was persistent on late follow up (4.8 ± 2.7 %, p = 0.936). Moreover, heart rate variability parameters remained unchanged on early follow-up and improved 6 months after. Late follow-up statistical significance was reached by HF, a frequency-domain parameter (5231 ± 1783 to 6507 ± 1789 ms2; p = 0.029) and two Poincare diagram parameters: RR ecc (682 to 906 ms2; p &amp;lt; 0.001) and SDRR (9.6 to 23.9 ms; p = 0.001). Significant predictors of FMD change were as following: baseline maximal aortic valve velocity (R = 0.415; p = 0.011), mean aortic gradient (R = 0.373; p = 0.018), indexed stroke volume (R = 0.503; p = 0.006) and NT-proBNP (R = 0.491; p = 0.001). Conclusions Both endothelial and autonomic function improved after TAVI. While FMD seems to change early due to acute haemodynamic changes attributed to aortic valve stenosis resolution, autonomic cardiac functions remain stable and ameliorate late after procedure, likely reflecting left ventricular reverse remodelling.