Common Cardiovascular Research Articles

Plasma cytokines are associated with major adverse cardiovascular events in follow-up of patients undergoing carotid endarterectomy

Abstract Background Patients with carotid artery disease undergoing carotid endarterectomy (CEA) have a high risk of experiencing Major Adverse Cardiovascular Events (MACE) after surgery. The occurrence of MACE in CEA-treated patients is not predicted by common cardiovascular (CV) risk factors. Purpose We aimed to identify the association between plasma and plaque inflammatory cytokines and the incidence of MACE in the follow-up after CEA. We hypothesized that MACE is related to a higher level of circulating inflammatory cytokines at the time of surgery. Methods We prospectively enrolled patients with carotid artery disease undergoing CEA. Plasma and carotid plaques were collected during the surgery. Inflammatory cytokines (MCP-1/CCL2, IL-8/CXCL8, IFN-gamma, IL-10, IL-1beta/IL-1F2, IL-6, PDGF-AA, PDGF-AB/BB, TNF-alpha, VEGF) were measured in plasma and tissue homogenates using a customized 10-plex Luminex assay. Baseline demographics and clinical data for all the patients were extracted from electronic health records. MACE after CEA was defined as a composite measure of nonfatal cardiac events such as myocardial infarction with or without revascularization, cerebrovascular events (ischemic stroke, TIA, and amaurosis fugax), and all-cause mortality. Results Of 107 patients who underwent CEA with a median age of 73 (67-78) years, 57 (53.2%) experienced MACE during a median follow-up of 5.2 [2.2-9.3] years: 23 (40.3%) cardiac events, 9 (15.7%) CVA, and 25 (43.8%) all-cause mortality. Plaque cytokines levels did not differ between the groups with and without MACE in the follow-up after CEA. Instead, plasma cytokines were associated with MACE in the follow-up after CEA, as summarized in Figure 1. In the logistic regression analysis, plasma levels of MCP-1/CCL2, IFN-gamma, and TNF-alpha were independent predictors of MACE in follow-up post-CEA in univariate and multivariable models adjusted for CV risk factors such as age, BMI, systolic and diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, and glucose level: MCP1/CCL2 (HR 1.009 [1.002-1.015]; p=0.007), IFN-gamma (HR 1.368 [1.014-1.845]; p=0.040), and TNF-alpha (HR 1.121 [1.022-1.228]; p=0.015) (Table 1). Conclusions Plasma levels of CCL2, IFN-gamma, and TNF-alpha are associated with the high incidence of MACE in the follow-up after CEA, indicating that these are potential biomarkers of MACE in this patient population and potential therapeutic targets in patients' progression of systemic atherosclerosis.Plasma cytokines and MACE after CEACytokines logistic regression analysis

Mortality risk in patients with carotid artery disease undergoing carotid endarterectomy compared to the general population

Abstract Background Patients with carotid artery disease undergoing carotid endarterectomy (CEA) appear to be at high risk of all-cause mortality during their follow-up. However, the possible predictors of this adverse outcome are not elucidated yet. Purpose We aimed to test cardiovascular (CV) risk factors as possible predictors of all-cause mortality in patients undergoing CEA and to determine whether there is a difference between the mortality rate of our study cohort and the general population. We hypothesize that CEA-treated patients have a higher mortality rate during follow-up after surgery than the general population, which is not related to the presence of CV risk factors. Methods We prospectively enrolled and followed up patients undergoing CEA. Univariate and multivariable Cox regression were performed to test whether common CV risk factors (demographics, laboratory values, comorbidities, and events before CEA) were predictive of all-cause mortality. We then compared the standardized mortality ratio (SMR) of our population and the age-sex-matched Minnesota (MN) general population at 5,10, and 21 years of follow-up after CEA. Results A total of 710 patients were followed for a median of 7.1 [2.9-11.9] years after CEA. Mortality occurred in 198 (27.0%) patients during the follow-up. The median time to event was 11.0 [10.0-12.0] years. Age was the only predictor of all-cause mortality in CEA-treated patients in multivariable models adjusted for known CV risk factors (Model 1: HR 1.03 [95%CI 1.01-1.06]; p=0.004; Model 2: HR 1.02 [95%CI 1.00-1.04]; p=0.023) (Table 1). However, the CEA-treated group had a higher mortality rate than would have been expected in the MN population (log-rank p<0.001) (Fig.1A). Compared to the MN population, at 5 years of follow-up only patients <60 years old had a higher SMR (4.53 [1.95-8.92]; p=0.001), whereas, at 10 years and 21 years of follow-up, our study population had a higher mortality rate at any age (Fig.1B). Conclusions The elevated mortality risk post-CEA in our cohort cannot be solely attributed to chronological aging. The underlying process of atherosclerosis likely contributes to all-cause mortality, and plaque characteristics may offer additional insight into the risk stratification of this patient group.All cause mortality predictors after CEAStudy population vs. MN population SMR

Cardiovascular outcomes in Parkinson’s disease patients from a retrospective cohort study

Parkinson’s disease (PD) reports high rates of morbidity and mortality, but the risk of adverse cardiovascular outcomes in patients with PD has not been fully elucidated. This bi-center retrospective cohort study using the electronic health records (EHR) database of two tertiary hospitals screened a total of 327,292 subjects who visited the outpatient clinic, and 1194 patients with PD were propensity score-matched with a control population. The primary outcome was the occurrence of major adverse cardiovascular events (MACE). Key secondary outcomes included all-cause death, cardiovascular (CV) death, stroke, myocardial infarction (MI), heart failure hospitalization and 30-day CV death. After PS matching, MACE occurrence was not significantly different between PD and non-PD groups (18.2% vs. 17.5%, log-rank p = 0.98). Key secondary outcomes were also similar between the two groups. In patients with PD, MACE rate, and also CV risk score, were higher in patients with more severe PD (according to Hoehn and Yahr scale and unified Parkinson’s disease rating scale), and after multivariable analysis, PD severity was not an independent predictor of MACE. Patients with PD are at an increased risk of adverse cardiovascular outcomes, but the contribution from other common CV risk factors cannot be ignored. The management of prevalent CV risk factors is therefore important in mitigating adverse outcomes among patients with PD.

Development and validation of machine learning algorithms based on electrocardiograms for cardiovascular diagnoses at the population level

Artificial intelligence-enabled electrocardiogram (ECG) algorithms are gaining prominence for the early detection of cardiovascular (CV) conditions, including those not traditionally associated with conventional ECG measures or expert interpretation. This study develops and validates such models for simultaneous prediction of 15 different common CV diagnoses at the population level. We conducted a retrospective study that included 1,605,268 ECGs of 244,077 adult patients presenting to 84 emergency departments or hospitals, who underwent at least one 12-lead ECG from February 2007 to April 2020 in Alberta, Canada, and considered 15 CV diagnoses, as identified by International Classification of Diseases, 10th revision (ICD-10) codes: atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), cardiac arrest (CA), atrioventricular block (AVB), unstable angina (UA), ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), pulmonary embolism (PE), hypertrophic cardiomyopathy (HCM), aortic stenosis (AS), mitral valve prolapse (MVP), mitral valve stenosis (MS), pulmonary hypertension (PHTN), and heart failure (HF). We employed ResNet-based deep learning (DL) using ECG tracings and extreme gradient boosting (XGB) using ECG measurements. When evaluated on the first ECGs per episode of 97,631 holdout patients, the DL models had an area under the receiver operating characteristic curve (AUROC) of <80% for 3 CV conditions (PTE, SVT, UA), 80–90% for 8 CV conditions (CA, NSTEMI, VT, MVP, PHTN, AS, AF, HF) and an AUROC > 90% for 4 diagnoses (AVB, HCM, MS, STEMI). DL models outperformed XGB models with about 5% higher AUROC on average. Overall, ECG-based prediction models demonstrated good-to-excellent prediction performance in diagnosing common CV conditions.

The role of exercise training on cardiovascular risk factors and heart disease in patients with chronic kidney disease G3-G5 and G5D: a Clinical Consensus Statement of the European Association of Preventive Cardiology of the ESC and the European Association of Rehabilitation in Chronic Kidney Disease.

Cardiovascular (CV) morbidity and mortality is high in patients with chronic kidney disease (CKD). Most patients reveal a high prevalence of CV risk factors such as diabetes or arterial hypertension and many have manifest cardiovascular disease (CVD), such as coronary artery disease and chronic heart failure with an increased risk of clinical events including sudden cardiac death. Diabetes mellitus and hypertension contribute to the development of CKD and the prevalence of CKD is in the range of 20-65% in diabetic and 30-50% in hypertensive patients. Therefore, prevention and optimal treatment of CV risk factors and comorbidities are key strategies to reduce CV risk and improve survival in CKD. Beyond common CV risk factors, patients with CKD are often physically inactive and have low physical function leading to subsequent frailty with muscle fatigue and weakness, sarcopenia and increased risk of falling. Consequently, the economic health burden of CKD is high, requiring feasible strategies to counteract this vicious cycle. Regular physical activity and exercise training (ET) have been shown to be effective in improving risk factors, reducing CVD and reducing frailty and falls. Nonetheless, combining ET and a healthy lifestyle with pharmacological treatment is not frequently applied in clinical practice. For that reason, this Clinical Consensus Statement reviews the current literature and provides evidence-based data regarding the role of ET in reducing CV and overall burden in patients with CKD. The aim is to increase awareness among cardiologists, nephrologists, and healthcare professionals of the potential of exercise therapy in order to encourage implementation of ET in clinical practice, eventually reducing CV risk and disease, as well as reducing frailty in patients with CKD G3-G5D.

An Overview on the Mechanisms of Myocardial Damage in Hypertension and the Diagnostic Contribution of Cardiospecific Troponins T and I

Hypertension (HT) is one of the most common cardiovascular (CV) pathologies and a key risk factor for the development of CV disease and its complications. There are two main etiopathogenetic types of HT: primary and secondary. As a result of HT, damage to many organs (heart, blood vessels, retina, etc.) can occur. These organs are considered the main target organs in HT and assessment of their condition plays an important role for optimal management of patients with HT. Increased levels of cardiospecific troponins T and I, localized in the main type of myocardial cells (cardiomyocytes), may indicate myocardial damage. At the same time, the degree of myocardial damage may correlate with the degree of increase in cardiospecific troponins T and I. In recent studies, cardiospecific troponins T and I have established themselves as early and highly specific criteria for myocardial damage not only in myocardial infarction, but also in many other cardiac ( e.g., arrhythmias, endocarditis, myocarditis, takotsubo syndrome, or cardiomyopathy) and extra-cardiac ( e.g., renal failure, sepsis, or diabetes mellitus) conditions. Many authors suggest using cardiospecific troponins T and I as prognostic markers for the above pathologies. Thus, the determination of cardiospecific troponins T and I can provide additional diagnostic advantages in the management of patients with pathological conditions that damage the myocardium. The purpose of this article is to systematize information about the pathogenetic mechanisms of myocardial damage in HT and to consider the diagnostic contribution of cardiospecific troponins T and I for the management of patients with HT.

Abstract 17605: Multidisciplinary Team Approach in the Management of Pregnant Women With Complex Congenital Heart Disease: A Case Series

Introduction: Women with congenital heart disease (CHD) now live well into adulthood and consider pregnancy. A multidisciplinary team approach is crucial to the management of complex pregnant cardio-obstetrics patients. Here, we present a case series of three patients where careful team-based care resulted in successful delivery and without significant postpartum complications. Case series: Baseline patient characteristics and delivery details are summarized in Table 1. Patient 1, with history of repaired bicuspid aortic valve (AV) and subsequent severe bioprosthetic aortic stenosis, presented with incalcitrant supraventricular tachycardia leading to an urgent c-section. Patient 2, with history of complete Shone complex, underwent emergent c-section in the cardiac OR with extracorporeal membrane oxygenation on standby after developing rapid atrial tachycardia. Patient 3 fortunately did not suffer difficulties during her pre-planned c-section. She had a history of partial AV canal defect and subaortic membrane causing severe left ventricular outflow tract obstruction. Despite the differences between their hospitalizations and pregnancy course, utilizing a multidisciplinary approach led to no long-term postpartum complications and delivery of healthy neonates for all three patients. Discussion: Cardiovascular (CV) disease is the leading cause of maternal mortality accounting for greater than 25% of deaths. CHD is the most common CV condition encountered in pregnant women. Consistent with the Presidential Advisory from the AHA and ACOG, development of a cardio-obstetrics team is vital to managing complex maternal CV disease and minimizing CV morbidity and mortality. Conclusion: Integrating the expertise and collaboration among a multidisciplinary cardio-obstetrics team from preconception through the postpartum period allows for individualized care necessary to optimize maternal and fetal outcomes for women with complex CHD.

Influence of the Type of Disability and Sporting Discipline on Lipid Profile in a Cohort of Italian Paralympic Athletes

Dyslipidemia is the most frequent cardiovascular (CV) risk factor in able-bodied athletes and is frequently undertreated, resulting in an underestimated risk of atherosclerosis-related diseases. Data on lipid profile in Paralympic athletes are lacking. Our study aimed to identify the prevalence of dyslipidemia and the influence of disability type and sporting discipline in Paralympic athletes. We evaluated 289 athletes who participated in the Paralympic Games from London 2012 to Beijing 2022. All athletes underwent clinical/physical evaluation, blood tests, and body composition analysis. They were divided into different groups based on sports disciplines and disability type (spinal cord injuries [SCIs] and non-SCIs [NSCIs]). Among the Paralympic athletes, 34.6% had a low-density lipoprotein (LDL) level ≥115mg/100ml. They were older (38.1 ± 9.2 vs 30.6 ± 9.6, p=0.001) and had a higher CV risk. Athletes with SCI showed similar total cholesterol and triglycerides, higher LDL (110.9 ± 35.2 vs 102.7 ± 30.6mg/100ml, p=0.03) and lower high-density lipoprotein (HDL) (53.6 ± 13.6 vs 60.5 ± 15.4mg/100ml, p=0.001) than those with NSCI. Endurance athletes had lower LDL, the highest HDL, and the lowest triglycerides and LDL/HDL ratio compared with other sports disciplines. A mean follow-up of 61.5 ± 30.5months was available in 47% athletes, and 72.7% of the athletes with dyslipidemia continued to present altered LDL values at follow-up. In conclusion, dyslipidemia is the most common CV risk factor in the Paralympics, affecting 35% of athletes, with only mild lipid changes over a medium-term time. The type of disability and sporting discipline has an impact on lipids, improving HDL and reducing LDL, with a better profile observed in NSCI and endurance athletes.

FRI120 Metabolic Profile Of A Young Adult Population Assisted By A Primary Health Care Unit In A Large Urban Center

Abstract Disclosure: R.B. Boghossian: None. C.C. Lopes: None. L.L. Junqueira: None. J.O. Neno: None. B.C. Almeida: None. R. Ferrão: None. I.D. Velho Junior: None. P.C. Rezende: None. A.T. Fernandes: None. D.F. Monteiro: None. Introduction: Dyslipidemia, Glucose Intolerance (GI), Diabetes Mellitus (DM), and Metabolic Syndrome (MS) are metabolic conditions often asymptomatic and related to high cardiovascular (CV) morbidity and mortality. Nonetheless, these conditions are not commonly screened in younger adults. The LapARC cohort Study is a population-based study to assess CV risk profile in a young adult population. Objective: To evaluate the prevalence of dyslipidemia, DM, GI, and MS in a young adult population enrolled in the Family Health Strategy (FHS) in an urban center. Methods: Cross-sectional population study that enrolled individuals aged 20-50 years registered in an FHS unit. Sociodemographic, anthropometric characteristics, and CV risk factors were recorded. Office blood pressure (BP) was obtained by the average of 2 measurements obtained on two different occasions. All participants underwent laboratory evaluation (lipid and glycemic profile) and home blood pressure monitoring (HBPM). The bivariate analysis compared paciente with and without metabolic alterations. SPSS 19.0 was used in the statistical analysis. Results: We evaluated, up until this moment, 632 individuals [39.6% male gender; average age: 33.6 ± 9 years old]. The most common modifiable CV risk factors were physical inactivity (44.0%), and obesity (26.0%). The prevalence of dyslipidemia was 40%. These individuals were older, more obese and with a bigger association of hypertension and GI. Regarding the glycemic profile, 57 (9%) individuals with GI e 18 (3%) with DM. Diabetic pacientes were older, obese, with a bigger prevalence of hypertension and dyslipidemia while those with GI had just bigger prevalence of dyslipidemia compared to normoglicemic individuals. A total of 74(12%) individuals were diagnosed with MS. These were older, more obese, sedentary, with a bigger prevalence of hypertension, higher office BP and HBPM and higher levels of albuminuria. Conclusion: This young and apparently healthy population has an adverse cardiometabolic profile, indicating the importance of precocious CV risk stratification. Thus, efficient primary preventive strategies can be implemented to reduce the probability of CV disease development in the future. Presentation: Friday, June 16, 2023

Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure

BackgroundOlder adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden.MethodsWe used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003–2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003–2017. We determined FRIDs –cardiovascular (CV) and non-cardiovascular (non-CV) medications – at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors.ResultsAmong 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14).ConclusionsFRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.

#3807 HEART FAILURE IN ASCEND-ND AND ASCEND-D

Abstract Background and Aims Heart failure (HF) is a common cardiovascular (CV) complication in chronic kidney disease (CKD) [1]. Two CV outcome trials (ASCEND-ND [NCT02876835][2] and ASCEND-D [NCT02879305][3]) have provided the principal assessment of CV risk with daprodustat in CKD: both studies showed noninferiority of daprodustat to erythropoiesis-stimulating agent (ESA). Here, we examined the risk of HF in daprodustat-treated patients in the ASCEND-ND and ASCEND-D trials. Method The Phase 3, open-label, randomised, event-driven ASCEND trials investigated oral, once-daily daprodustat vs injectable ESA in patients with anaemia of CKD not on (ASCEND-ND) or on (ASCEND-D) dialysis. Time-to-first adjudicated major adverse CV event (MACE) was the primary CV endpoint. Time-to-first MACE or hospitalisation for heart failure (HHF) was a key secondary endpoint; the composite of time-to-first adjudicated MACE + HHF was assessed as a principal secondary endpoint, and time-to-first HHF alone as an additional secondary endpoint. To better understand HF-specific outcomes, post-hoc analyses accounting for competing risk of death were conducted via the composite endpoint of all-cause mortality (ACM) + HHF – more typically employed to evaluate HF-specific outcomes and to assess “hospitalisation-free survival”. Post-hoc subgroup analyses of patients identified as having a baseline HF history were also conducted. Results Overall, 3872 and 2964 patients were randomised in ASCEND-ND and ASCEND-D, respectively. All key prespecified and post-hoc CV endpoints in ASCEND-ND and ASCEND-D are shown in the Table, and the composite endpoint of ACM + HHF is shown in the Figure. In summary, for components of MACE for daprodustat vs ESA, respectively, ACM events were similar between treatment arms in both studies: ASCEND ND: 11.6% vs 12.2%; ASCEND-D: 14.8% vs 14.6%. For HHF alone in both studies, event rates for daprodustat vs ESA, respectively, were: 7.2% vs 5.9% (hazard ratio [HR] 95% confidence interval [CI] = 1.22 [0.95, 1.56]) in ASCEND ND; and 7.5% vs 6.8% (HR [95% CI] = 1.10 [0.84, 1.45]) in ASCEND-D. In post-hoc analyses using the composite endpoint of ACM + HHF in ASCEND-ND, the event rate for daprodustat was 20.3% (n = 393/1937), and the event rate for ESA was 19.0% (n = 368/1935) (HR [95% CI] = 1.09 [0.94, 1.26]). More HHF events were observed in patients with a history of HF (daprodustat: 20.4% [n = 54/265]; ESA: 13.4% [n = 34/254]). In ASCEND-D, ACM + HHF events were similar for daprodustat (24.4% [n = 363/1487]) and ESA (24.8% [n = 366/1477]; HR [95% CI] = 0.98 [0.85, 1.14]). In this composite endpoint in patients with a history of HF in ASCEND-D, there were also more HHF events in those treated with daprodustat (18% [n = 47/267]) vs ESA (13% [n = 32/254]), but there were fewer deaths with daprodustat (21% [n = 56/267]) than ESA (28% [n = 71/254]). For subgroup analyses of daprodustat vs ESA, the proportion of patients with a history of HF at baseline was greater in ASCEND-D (18.0% vs 17.2%) than ASCEND-ND (13.7% vs 13.1%). Incidence of MACE + HHF was similar between treatment arms in both studies. Conclusion Our findings showed that there was a higher HHF risk in daprodustat-treated patients who had a history of HF compared to ESA-treated patients. While HF risk was similar between treatments in patients on dialysis (ASCEND-D) when combining ACM + HHF in a post-hoc analysis, the risk remained numerically higher for daprodustat vs ESA in patients not on dialysis (ASCEND-ND). The underlying mechanism responsible for these observations and differences is not known, although patients with advanced CKD and comorbid HF who are not on dialysis are recognised to be at underlying risk of HF decompensation.

30-Day Cardiovascular Readmissions Following Discharge With COVID-19: A US Nationwide Readmission Database Analysis From the Pandemic Year 2020

BackgroundCOVID-19 is known to be associated with a myriad of cardiovascular (CV) complications during acute illness, but the rates of readmissions for CV complications after COVID-19 infection are less well established. MethodsThe US Nationwide Readmission Database was utilized to identify COVID-19 admissions that occurred in the period from April 1st to November 30th, 2020, using International Classification of Diseases, 10th edition, Clinical Modification administrative claims. ResultsA total of 521,351 admissions for COVID-19 were identified. The all-cause 30-day readmission rate was 11.6% (n = 60,262). The incidence of CV-related readmissions was 5.1% (n = 26,725), accounting for 44.3% of all-cause 30-day readmissions. Both CV-related and non-CV-related readmissions occurred at a median of 7 days. Patients readmitted with CV causes had a higher comorbidity burden, with a median Charlson comorbidity score of 6. The most common CV cause of readmission was acute heart failure (8.5%), followed by acute myocardial infarction (5.2%). Venous thromboembolism and stroke during 30-day readmission occurred at rates of 4.6% and 3.6%, respectively. Stress cardiomyopathy and acute myocarditis were less frequent, with incidences of 0.1% and 0.2%, respectively. CV-related readmissions were associated with higher mortality, compared with non-CV-related readmissions (16.5% vs 7.5%, P < 0.01). Each 30-day CV-related readmission was associated with greater cost of care than each non-CV-related readmission ($13,803 vs $10,310, P < 0.01). ConclusionsAmong survivors of index COVID-19 admission, 44.7% of all 30-day readmissions were attributed to CV causes. Acute heart failure remains the most common cause of readmission after COVID-19, followed closely by acute myocardial infarction. CV causes of readmissions remain a significant source of mortality, morbidity, and resource utilization.

Abstract P472: Matching Young Adult Strokes in a Claims Database to the Clinical Get With the Guidelines-Stroke Registry

Background: Due to its lower incidence, strokes in young adults, studies have difficulty answering why there are more women than men less than 35 with incident strokes. The goal of this study is to link claims and registry data to create a new longitudinal and clinical cohort of strokes in young adults. Methods: Colorado mandates reporting of commercial and public insurance (Medicaid and Medicare) claims to the All Payer Claims Database (APCD). We identified all first-time stroke admissions using ICD-9 /10 codes between 2012 to 2018 in young adults (18-55). Get with the Guidelines (GWTG) Stroke registry has stroke cases from 41 hospitals in Colorado since 2010. Matching was based on exact birthdate, sex and +/- 1day in admission/discharge dates. Confirmation of match was based on comparing the admitting hospital between the two databases. Cardiovascular(CV) and non-CV risk factors occurring from enrollment until 1 day prior to stroke date in the APCD were included. Student’s T-test, and Z-tests were used to test differences between men and women. Results: We identified 3032 stroke cases in the APCD. Of these, 1455 (48.0%) matched to an admission in the GWTG-Stroke registry. Of these, 1303 (89.6%) also matched based on the admitting hospital (Table). The final cohort contained 51% women, 11.3% &lt;35, 35.2% between 35-45, and 63.5% between 45-55. The most common CV risk factors were hypertension, hyperlipidemia, and tobacco use in men, and hypertension, tobacco use, and obesity in women. The most common non-CV risk factors were migraines, renal failure, thrombophilia in men and migraines, malignancy, and thrombophilia in women. The prevalence of cardiovascular risk factors was higher in men, while the prevalence of non-cardiovascular risk factors was higher in women. There was no difference in the severity of strokes between men and women. Conclusions: Clinical registries such as GWTG-Stroke can be used to supplement longitudinal administrative cohorts of young adults with stroke to get richer data on stroke etiology and severity.

Lipoprotein(a): Cardiovascular Disease, Aortic Stenosis and New Therapeutic Option

Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.

Abstract 12905: Prevalence of Cardiovascular Disease in Mid-Life Among Women Who Have Had a Child With Congenital Heart Disease

Background: Women whose offspring have congenital heart disease (CHD) have higher risk of cardiovascular (CV) disease and mortality later in life. The mechanism is not well-understood and may be related to angiogenic imbalance, genetic predisposition, or stress-related pathways. We aimed to describe the prevalence of CV disease and traditional and sex-specific risk factors among women with a child with CHD at 18-23 years after delivery. Methods: We conducted an online survey among mothers whose infants had undergone cardiac surgery before six months of age and enrolled in a prospective observational study at the Children’s Hospital of Philadelphia. Maternal surveys investigated sociodemographic characteristics and self-reported health behaviors and medical history. We described the prevalence of baseline characteristics. Results: 531 women were contacted and 220 (41%) completed the survey and are included in this analysis. Child and maternal characteristics are presented in Table. Mean maternal age was 52 years, 86% were White, and 68% completed college. Regarding sex-specific risk factors, 10% had preeclampsia and 32% had history of preterm delivery. The most common traditional CV risk factors were high cholesterol (32%) and hypertension (27%). Overall, 4.6% of women reported a history of atherosclerotic cardiovascular disease (ASCVD) and 15% reported any cardiac disease, as defined by arrhythmia, structural heart disease, or ASCVD. Of the 6 women with prior myocardial infarction (2.7%), mean age at onset was 44 years. Complexity of the child’s CHD was significantly associated with prevalence of ASCVD but not other types of CV disease (p=0.008) Conclusion: Having a child with CHD is a potentially important sex-specific CV risk factor that is not well-studied. Understanding how this maternal characteristic interacts with other traditional and sex-specific risk factors is critical to understanding mechanistic pathways leading to CV disease in these women.

Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology-part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias.

Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to cancer itself or cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. The management of acute coronary syndromes and acute pericardial diseases in cancer patients was covered in part 1 of a clinical consensus document. This second part focusses on acute heart failure, acute myocardial diseases, venous thromboembolic diseases and acute arrhythmias.

Detection and characteristics of hypertension patients admitted in 37 cardiology departments from 17 Sub-Saharan African countries

Abstract Background High blood pressure (BP) is a major risk factor for several common cardiovascular (CV) disease such as stroke, heart failure or chronic kidney disease. The Sub-Saharan Africa (SSA) should face the highest rate of hypertension worldwide with an overall prevalence estimation of 46%. Due to scarce resources and inadequate healthcare provision, SSA have scarce hard data on treatment and control of high BP. Purpose To assess the detection and characteristics of hypertension patients admitted in hospitalizations 17 SSA countries Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. Hypertension and severity of hypertension were defined according to 2018 ESC/ESH guidelines and BP was measured twice using standardized method. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)) Results The study involved 4360 patients. Hypertension was measured on 1906 (43.7%) patients at admission. Proportion of patients with high BP in hospital increased from 42.2% in 2016 to 52.2% in 2021 (p&amp;lt;0.05) and differed significantly across countries from 77.6% in Niger to 100% in Chad. Among hypertensive patients, men represented 59.6% of patients and mean of age was 59±15.1 years. Overall, 61.4% of patients were from low income countries. The mains causes of admission among hypertensive patients were heart failure (37.8%) and stroke (18.9%). Average of systolic BP was 159±29.3 mmHg and average of diastolic BP was 96.7±16mmHg. Overall, 760 (40.3%), 525 (27.8%) and 602 (31.9%) had grade 1, grade 2 and grade 3 hypertension respectively. History of CV disease was observed in 51.5% of patients. Thus, 70.4% of patients had at least one CV risk factor other than hypertension. Angiotensin converting enzyme inhibitors and diuretics was prescribed in 56.9% and 55.8% of patients respectively. The average amount of antihypertensive drugs prescribed in hospital was 2.09±1.18. Overall, 237 (12.4%), 295 (15.5%), 640 (33.6%) and 734 (38.5%) received respectively no drug, monotherapy, two-drug strategies and three and more drug strategies. Conclusion In patients admitted in cardiology departments, hypertension is a huge burden in SSA. Funding Acknowledgement Type of funding sources: None.

Cardiovascular Complications in COVID-19 and Its Vaccines

The COVID-19 pandemic due to SARS-CoV-2 has proven to be a tremendous challenge to the medical community. The greatest challenge since the turn of the century. The authors summarized the main cardiovascular (CV) complications and mechanisms of COVID-19 and its vaccines. COVID-19 has lung tropism, but it has been reported to affect the CV system as well. The presence of comorbidities such as hypertension, CV disease, diabetes, and chronic obstructive pulmonary disease increased the risk of developing serious complications and in turn mortality significantly. The common CV complications include cardiac arrhythmia, myocardial infarction, myocarditis, and cardiac failure, which occurred in around 20% of all COVID-19 patients. The present difficulty in the diagnosis of CV complications were that COVID-19 symptoms often mimic CV events. Furthermore, the rapid diagnosis and management of serious CV events are sometimes overlooked due to COVID-19. Access to medical treatments were sometimes restricted due to the limited healthcare resources during the pandemic. The advent of various covid vaccines have reduced the number of these complications. However, CV events following mRNA vaccines or adenoviral vector vaccines are recognized as well as myocarditis and vaccine-induced immune thrombotic thrombocytopenia. With increasing experience in managing covid patients with CV complications, physicians are becoming better equipped in preventing, detecting, and treating these complications. Keywords: COVID-19; Cardiovascular complication; Myocardial infarction; Myocarditis; COVID-19 vaccine

High Prevalence of Additional Cardiovascular Risk Factors in Eastern-Indian Young Adults with Type 2 Diabetes Mellitus.

Background and Aims:The American Diabetes Association recommends statin therapy for young type 2 diabetes mellitus (T2DM) adults only if one additional cardiovascular (CV) risk factor coexists. The data regarding CV risk factors in young Indian T2DM adults is limited. Hence, we assessed the prevalence of CV risk factors in young adults with T2DM from eastern India.Methods:In this cross-sectional study, diabetic medical health check records of eastern-Indian T2DM patients performed between March 2018 and March 2019 were retrospectively reviewed and the relevant data of T2DM patients (n = 3564) including CV risk factors [serum LDL-cholesterol of ≥100 mg/dL, hypertension (>140/90 mmHg), smoking, chronic kidney disease (eGFR of <60 ml/min), microalbumin to creatinine ratio of ≥30 mg/mg, and obesity/overweight (body mass index ≥23 kg/m2)] were analysed.Results:There were 3280 T2DM patients from eastern India and 679 (20.7%) were ≤40 years of age. Overweight/obesity (74.3%) and serum LDL-cholesterol of ≥100 mg/dL (69.2%) were the two most common additional CV risk factors. At least one additional CV risk factor was present in 576 (95.36%) patients, whereas at least two additional CV risk factors were present in 409 (67.7%) patients. At least one non-obesity/overweight CV risk factor was present in 472 (78.1%) patients.Conclusions:The study demonstrates a high prevalence of additional CV risk factors in young eastern-Indian adults with T2DM. Hence, there is a need for an intensive approach to managing the CV risk factors in young Indian adults with T2DM.

Effects of Metformin in Heart Failure: From Pathophysiological Rationale to Clinical Evidence.

Type 2 diabetes mellitus (T2DM) is a worldwide major health burden and heart failure (HF) is the most common cardiovascular (CV) complication in affected patients. Therefore, identifying the best pharmacological approach for glycemic control, which is also useful to prevent and ameliorate the prognosis of HF, represents a crucial issue. Currently, the choice is between the new drugs sodium/glucose co-transporter 2 inhibitors that have consistently shown in large CV outcome trials (CVOTs) to reduce the risk of HF-related outcomes in T2DM, and metformin, an old medicament that might end up relegated to the background while exerting interesting protective effects on multiple organs among which include heart failure. When compared with other antihyperglycemic medications, metformin has been demonstrated to be safe and to lower morbidity and mortality for HF, even if these results are difficult to interpret as they emerged mainly from observational studies. Meta-analyses of randomized controlled clinical trials have not produced positive results on the risk or clinical course of HF and sadly, large CV outcome trials are lacking. The point of force of metformin with respect to new diabetic drugs is the amount of data from experimental investigations that, for more than twenty years, still continues to provide mechanistic explanations of the several favorable actions in heart failure such as, the improvement of the myocardial energy metabolic status by modulation of glucose and lipid metabolism, the attenuation of oxidative stress and inflammation, and the inhibition of myocardial cell apoptosis, leading to reduced cardiac remodeling and preserved left ventricular function. In the hope that specific large-scale trials will be carried out to definitively establish the metformin benefit in terms of HF failure outcomes, we reviewed the literature in this field, summarizing the available evidence from experimental and clinical studies reporting on effects in heart metabolism, function, and structure, and the prominent pathophysiological mechanisms involved.