Common Cardiovascular Research Articles

CML-330: Incidence of Cardiovascular (CV)-Related Hospitalizations and Associated Costs Among US Patients with Chronic-Phase Chronic Myeloid Leukemia (CP-CML) Treated with First-Line (1L) Tyrosine Kinase Inhibitors (TKI) in SIMPLICITY: An Observational Study

Context Evidence suggests that common CV risk factors (obesity, diabetes status, age, etc.), combined with TKI therapy, may contribute to CV events in patients with CP-CML. Furthermore, CV events occurring in patients with CP-CML are often associated with significant morbidity, mortality, and healthcare resource utilization. Objective To assess the incidence of CV-related hospitalizations, subsequent length of stay (LOS), and associated costs among patients with CP-CML in a real-world setting. Design Retrospective observational study. Setting SIMPLICITY is an ongoing observational study of patients with CP-CML in Europe and the U.S. who are treated with 1L TKIs. Patients from the U.S. cohort were included in this analysis. Interventions Dasatinib (DAS), imatinib (IM), nilotinib (NIL). Main outcome measures Incidence of CV-related hospitalizations and LO, adjusted per 1000 patient-years (PY) of follow-up. Mean total hospitalization costs for each CV event were analyzed; these results will be described in the poster. Results In all, 808 patients received 1L TKI therapy: IM (n=243), DAS (n=301), or NIL (n=264). Median follow-up was approximately 4 years (48.7–51.3 months). Age, treatment center type, duration of therapy, and baseline fatigue differed significantly among the groups (P Conclusions In this real-world study of CP-CML patients, assessment of CV-related hospitalizations and LOS showed that most hospitalizations occurred within 18 months of 1L TKI initiation. The incidence of CV-related hospitalizations and LOS were descriptively lowest among patients receiving dasatinib. CV-risk profile and comorbidities should be taken into account prior to 1L TKI therapy initiation. Funding BMS.

Coronary and aortic calcification are associated with cardiovascular events on immune checkpoint inhibitor therapy

BackgroundAlthough the incidence of immune checkpoint inhibitor (ICI)-related cardiovascular (CV) toxicity is low, the overall burden of CV events after ICI is unknown. Risk factors for CV events after ICI have yet to be identified. ObjectivesWe sought to evaluate the association between vascular calcification on routine baseline computed tomography (CT) imaging and CV events following ICI. MethodThis was a single-center, retrospective cohort study of 76 patients referred to Cardio-Oncology with prior ICI treatment. Coronary and aortic calcification on non-gated chest and abdominal CT imaging were qualitatively assessed. The association of baseline clinical parameters and vascular calcification with symptomatic heart failure (HF), acute coronary syndrome, myocarditis, symptomatic arrhythmia, or pericardial effusion after ICI was evaluated. ResultsOver 11 months of follow-up, there were 80 CV events that occurred in 49 patients. Worse coronary and aortic calcification on pre-treatment CT imaging was seen in patients with a CV event (p = .018 and p = .014, respectively). There were no differences in traditional CV risk factors between those with and without a CV event. Eighteen patients (37%) were restarted on ICI therapy after a non- myocarditis or symptomatic systolic HF CV event without recurrent events or mortality over 13 months of follow-up. ConclusionsSymptomatic HF was the most common CV event seen after ICI therapy. Worse coronary and aortic calcification on baseline CT imaging was associated with CV events following ICI. With careful clinical evaluation, selected patients may be re-treated with ICI following a non- myocarditis or symptomatic systolic HF CV event.

Cardiorenal Disease is the Most Common First CV Manifestation in Type 2 Diabetes

Introduction: Recent cardiovascular (CV) and renal outcome trials have shown significant cardiorenal benefits of SGLT-2i in T2D patients without CV diseases (CVD). This investigation assessed sequential development of cardiorenal disease and the risk associated with heart failure (HF) and chronic kidney disease (CKD). Methods: T2D patients without prior CVD/CKD were identified from a US insurance claims database encompassing commercial, Medicare and Medicaid patients. First record of the following diagnoses was identified: stroke, myocardial infarction (MI), peripheral artery disease (PAD), cardiorenal disease (HF or CKD). Cox regression models evaluated risk for incident CKD, adjusted for age and sex in T2D groups with HF (HF + T2D) compared with T2D only group. Similarly, risk for incident HF was evaluated for patients with CKD (CKD + T2D) compared to T2D only group. Results: 1.12M patients (41% female, mean age 51.7y) were identified and followed for 1.6 years or 1.85 million patient-years. Of 128,393 (11.44%) who developed a CVD event, 62% had incident cardiorenal disease (CKD 42%, HF 20%), followed by PAD (25%), stroke (10%), and MI (6.5%). HF was associated with an increased risk of CKD (HR 2.41 [CI 95% 2.25 -2.48]) compared with T2D only group, and CKD was associated with an increased risk of HF (HR 2.53 [CI 95% 2.46 – 2.61]), compared with T2D only group. Conclusions: In T2D patients without prior CVD/CKD, cardiorenal disease was the most common manifestation and was associated with significantly increased risk for each other. This finding should be considered when choosing optimal preventive strategies.

Strengths and Opportunities of Network Medicine in Cardiovascular Diseases

Network medicine can advance current medical practice by arising as response to the limitations of a reductionist approach focusing on cardiovascular (CV) diseases as a direct consequence of a single defect. This molecular-bioinformatic approach integrates heterogeneous "omics" data and artificial intelligence to identify a chain of perturbations involving key components of multiple molecular networks that are closely related in the human interactome. The clinical view of the network-based approach is greatly supported by the general law of molecular interconnection governing all biological complex systems. Recent advances in bioinformatics have culminated in numerous quantitative platforms able to identify CV disease modules underlying perturbations of the interactome. This might provide novel insights in CV disease mechanisms as well as putative biomarkers and drug targets. We describe the network-based principles and discuss their application to classifying and treating common CV diseases. We compare the strengths and weaknesses of molecular networks in comparison with the classical current reductionist approach, and remark on the necessity for a two-way approach connecting network medicine with large clinical trials to concretely translate novel insights from bench to bedside.

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.

Efficacy of fixed dose of triple combination of perindopril-indapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study

Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide.
 Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4–8 mg daily), indapamide (1.25–2.5 mg daily) and amlodopine (5–10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry.
 Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p<0.05 and at 6 months: 85% versus 53%, p<0.05). The adherence to triple fixed-dose combination was also higher in comparison with one to non-fixed combination (at 3 months: 82% versus 64%, p<0.05 and at 6 months: 87% versus 61%, p<0.05). It has been established that low-dose of perindopril/indapamide/amlodopine (4mg/1.25/10mg and 8mg/2.5/5mg) were used frequently in fixed-dose combination cohort of patients than in non-fixed combination (15% versus 0%, P<0.05, and 33% versus 19%, p<0.05, respectively). At the same time, maximum doses of these agents (8mg/2.5mg/10mg) were required for achieving target BP levels in a significantly lower proportion of patients receiving fixed-dose combination as compared to patients receiving non-fixed combination (52% versus 81%, p<0.05). Additionally, the triple fixed-dose combination has proved to be better in restoring ambulatory blood pressure monitoring profile than non-fixed combination.
 Conclusion: Achievement of target blood pressure levels in patients with uncontrolled arterial hypertension and abdominal obesity was possible at lower doses of perindopril, indapamide, and amlodipine when used as a fixed-dose combination rather than non-fixed (free) combination.

Cardiovascular (CV)-Related Hospitalizations and Associated Costs Among US Patients in Simplicity: An Observational Study of Patients with Chronic-Phase Chronic Myeloid Leukemia (CP-CML) in Routine Clinical Practice

Cardiovascular (CV)-Related Hospitalizations and Associated Costs Among US Patients in Simplicity: An Observational Study of Patients with Chronic-Phase Chronic Myeloid Leukemia (CP-CML) in Routine Clinical Practice

P3526Heart Failure hospitalization and mortality in non-valvular Atrial Fibrillation: The ENGAGE-AF TIMI 48 Trial

Abstract Introduction Atrial Fibrillation (AF) is associated with increased risk of cardiovascular (CV) morbidity and mortality. Heart Failure (HF) represents the most common CV complication, more common than thromboembolic events. Purpose We aimed to determine clinical factors associated with HF hospitalization and mortality in a contemporary cohort of patients with AF without previous history of HF. Methods The Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 (ENGAGE-AF TIMI 48) study tested the oral factor Xa inhibitor edoxaban in comparison with warfarin for the prevention of stroke or systemic embolism, in 21,105 patients with AF. We assessed the composite endpoint of HF hospitalization, death due to HF or sudden cardiac death in 8981 patients without a history of HF. Cox proportional hazard models were used to evaluate the significant clinical predictors associated with the endpoint of interest. Results Over a median follow-up of 2.8 years, 589 patients (6.5%) experienced the composite endpoint. Older patients, cardiovascular risk factors (hypertension, diabetes, heart valve disease), history of stroke and coronary artery disease, impaired renal function (ClCr ≤50 ml/min), heart rate at baseline and diuretic use were associated with increased risk of the composite endpoint (model c-statistic 0.66) (Figure 1). Outcomes were not affected by randomization to edoxaban or warfarin. In patients with available cardiac-derived biomarkers, elevated levels of both NT-proBNP and Troponin I were significantly associated with the endpoint after adjustment for the clinical predictors (Figure 1). The addition of the biomarkers to clinical predictors enhanced risk estimation (c-statistics 0.69, NRI 0.40, IDI 0.01, all p<0.001 for NT-proBNP and c-statistics 0.70, NRI 0.43, IDI 0.03, all p<0.001 for Troponin I). Figure 1 Conclusions HF hospitalization and mortality are important complications in AF patients without a history of HF. The addition of cardiac biomarkers to clinical characteristics enhances risk estimation. These findings may improve risk stratification.

Abstract P2061: Cardiovascular Risk Profile of a Young Adult Population Assisted by a Family Healthcare Unit in Rio De Janeiro With High Risk for Obstructive Sleep Apnea Screened By Stop-Bang Questionnaire and Epworth Sleepiness Scale

Objective: To establish the relationship between cardiovascular (CV) risk profile and detected risk of Obstructive Sleep Apnea (OSA) in two questionnaires - STOP-BANG (SB) and Epworth Sleepiness Scale (ESS), in a young population of adults registered in a Family Health Unit (USF) located in Rio de Janeiro, Brazil - LapARC cohort study. Methods: This cross-sectional population study enrolled adults between 20-50 years old, registered in a primary healthcare unit in Rio de Janeiro. A database is being developed including sociodemographic and anthropometric data, and CV risk factors. Office blood pressure (OBP) and Home Blood Pressure Monitoring (HBPM) (7-day protocol) were obtained with Omron-705CP. Furthermore, OSA was investigated by SB and ESS. Patients with a high risk for OSA in either of these two questionnaires were subsequently assigned for polysomnography (PSG). Results: A total of 391 subjects were evaluated [40% males, 38 ± 8 years], where 96 (25%) were identified as high risk for OSA by the SB questionnaire and 143 (37%) by ESS. The most common CV risk factor was physical inactivity (45%), followed by dyslipidemia (34%) and obesity (24%). By OBP, the prevalence of hypertension was 24% while by HBPM was 18%, with a low concordance between them (kappa=0.385). Subjects with a high risk by SB are older, with a higher prevalence of obesity (50% vs 16%), hypertension (29% vs 9%), and higher office BP and HBPM. On the other hand, individuals with high-risk by ESS were more obese (34% vs 19%), with increased waist circumference (48% vs 32%), higher prevalence of dyslipidemia (43% vs 41%) and metabolic syndrome (13% vs 7%). However, there was no difference in BP levels. Among the subjects assigned to PSG, 46% had a diagnosis of OSA (AHI ≥ 5/hour) and 23% of moderate/severe OSA (AHI>15/hour). The best predictor of OSA was SB, positive in 100% of subjects with moderate/severe OSA, while ESS was positive in only 20% of them. Conclusion: This young and apparently healthy population presented a high prevalence and risk for OSA. The SB had a higher association with higher BP levels, while ESS was associated with a worse metabolic profile. Therefore, SB questionnaire seems to be the best predictor for moderate/severe OSA in this population.

Is self-reported insomnia a risk factor for subclinical carotid atherosclerosis?

Background. Insomnia is considered an additional cardiovascular (CV) risk factor (RF). However, the data on its association with vascular damage is controversial. We analyzed the relation between self-reported insomnia and carotid atherosclerosis in the population-based sample. Material and methods. We selected 985 (males — 38%; mean age 45.2 ± 11.6 years) participants of the St Petersburg population-based sample (the ESSE-RF study) who did not have previously known CV events. All subjects underwent a structured interview (lifestyle, medical history). Insomnia was diagnosed when complaints occurred ≥ 3 times/week (the questions: “How often did you have difficulties in falling asleep for > 30 min after going to bed in the last month?”, “How often did you have difficulties in falling asleep after midnight awakening in the last month?”). Subclinical atherosclerosis was assessed by carotid intima-media thickness (IMT): normal ≤ 0.9 mm, increased IMT 0.9–13 mm, IMT > 13 mm indicated an atherosclerotic plaque. Results. In total, 209 subjects reported at least one insomnia complaint; 79 participants (8%) reported both sleeponset and sleep-maintenance problems. IMT thickening was found in 142 subjects (14.4%). IMT values were higher in those with frequent nocturnal awakenings vs. non-insomniacs (0.75 ± 0.18 vs. 0.71 ± 0.17 mm, p = 0.006). They also showed greater prevalence of thickened IMT (χ 2 = 4.6, p = 0.026). Mean IMT weakly correlated with insomnia complaints (ρ = 0.10, p = 0.002), but the association was no longer significant after adjustment for age, BP and total cholesterol level. Conclusion. We demonstrated an association between insomnia complaints and subclinical carotid atherosclerosis, although we assume it to be weak compared to the common CV RF.

Effects of sodium glucose cotransporter type 2 inhibitors on heart failure.

Heart failure (HF) is emerging as one of the most common cardiovascular (CV) events in patients with type 2 diabetes (T2D), and the one associated with the worst prognosis. T2D and insulin resistance are strong predictors of incident HF, especially HF with preserved ejection fraction (HFpEF). Recent data suggest that even when all traditional risk factors for ASCVD are well controlled, patients with T2D continue to have a substantially greater risk of developing HF-indicating that traditional risk factor control is insufficient from a HF prevention standpoint, and highlighting the need for novel, more effective strategies for both prevention and treatment of heart failure in patients with T2D. Until recently, medications developed for glucose-lowering had, at best, neutral effect on heart failure outcomes in patients with T2D, while several classes of T2D medications had little data in regards to HF risk, and others actually increased the risk of HF hospitalization. Sodium glucose cotransporter type 2 inhibitors (SGLT-2i) have a novel and unique mechanism of action. By inhibiting sodium and glucose reabsorption in the proximal tubule, SGLT-2i result in a number of downstream effects, including glucosuria, weight loss, osmotic diuresis and natriuresis, which should theoretically be beneficial in HF. Three CVOTs of various SGLT-2i (EMPA-REG OUTCOME, CANVAS and DECLARE-TIMI 58) enrolled markedly different patient populations in terms of ASCVD risk, but have demonstrated robust and consistent benefits in reduction of hospitalization for HF. In a meta-analysis of the three outcomes trials, SGLT-2i significantly reduced the risk of cardiovascular death or hospitalization for HF by 23% and hospitalization for HF by 31%. Although the declines in HF hospitalization with SGLT-2is are impressive, only a small proportion of patients with established HF were enrolled in these trials, and these benefits, therefore, represent primarily a HF prevention signal. Whether this prevention of HF benefit will translate to better outcomes for those patients with established HF (with or without diabetes), and whether it will extend across the spectrum of HF phenotypes (HFrEF and HFpEF) is yet to be determined, and is being actively investigated in several large ongoing trials.

A combined care model using early access to specialists off-hours to reduce cardiac admissions.

Despite the implementation of diagnostic and treatment algorithms for many common cardiovascular (CV) complaints, identifying low- and intermediate-risk cardiac patients presenting to the emergency department (ED) who could be managed without hospital admission remains difficult. We hypothesized that the presence of an attending cardiologist in the ED after normal working hours would decrease the proportion of these patients admitted to the hospital. We conducted a retrospective study of patients seen in the ED with cardiac diagnoses identified by ICD-9 codes during the time period when the cardiologist was available (6p.m.-midnight) compared with patients seen at other times of the day in the 12months before and after the consultation program was implemented. The primary outcome was disposition at the time of discharge from the ED. Logistic regression was used to model the primary outcome. A difference-in-differences approach was used as the primary statistical test .Following the start of the consultation program, the odds of discharge home from the ED with or without observation increased (OR 1.69, 95% CI [1.45-1.96]). There was a significant interaction between pre-/post-intervention status and time of day in the odds of discharge home from the ED (P = 0.04) suggesting an association between the consultation program and disposition patterns that is independent of concurrent programs aimed to reduce utilization. An ED-based cardiology consultation program may reduce the need for inpatient stays by identifying low- to intermediate-risk patients safe for discharge from the ED with or without a period of active management/observation.

Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India

AimsThe prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. MethodsA total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. ResultsOf total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). ConclusionFH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.

Abstract 16717: Cardiovascular Risk Profile of a Young Adult Population Assisted on a Primary Family Health Care Unit Located in Rio De Janeiro - A Pilot Project of LapARC Cohort Study

Methods: This cross-sectional population study enrolled young adults between 20-50 years old, registered in a primary family healthcare unit located in the center of Rio de Janeiro, Brazil. The pilot study has already evaluated 23% of the local population. A database is being developed at the entrance of each participant into the cohort including sociodemographic characteristics, anthropometric measurements, and traditional cardiovascular (CV) risk factors. Furthermore, Office Blood Pressure (BP) was measured in 2 different occasions and the mean value was registered. Also, all subjects were submitted to a standard protocol, including a thorough clinical examination, a laboratory evaluation (lipid and glycemic profile and renal function) and electrocardiogram (EKG). Results: A total of 411 subjects were evaluated [162 (40%) males, mean age: 38 ± 8 years]. The most common CV risk factor was physical inactivity (45%), followed by obesity (25%) and dyslipidemia (19%). The prevalence of hypertension was 23%. Hypertensives were more frequently male, with a high prevalence of obesity and diabetes, and increased Sokolow’s index in the EKG. Moreover, a total of 23 (5%) subjects were diagnosed with impaired glucose tolerance and 18 (4%) with Diabetes Mellitus (DM), considering those with a previous diagnosis and the ones with serum glucose higher than 126mg/dL. The diabetic patients were older, with a higher prevalence of obesity, hypertension and dyslipidemia. A total of 147 (32%) presented dyslipidemia and only 15 (3%) are undergoing pharmacological intervention. The prevalence of metabolic syndrome was 21%. In relation to renal function, there are only 2 patients with Chronic Kidney Disease (CKD) stage 3 and no patients presented moderately increased albuminuria. Median UAER was 4.01 [IQL 2.75-5.92] and there is no difference between genders. Additionally, only 29% of participants did not present CV risk factors while 31% presented 2 to 5 CV risk factors. Conclusions: This young and apparently healthy population presented a high prevalence of modifiable (obesity and physical inactivity) and controllable (hypertension and dyslipidemia) CV risk factors, pointing to the importance of early CV risk stratification. Thus, effective prevention measures can be planned and implemented to decrease the probability of this population to develop a CV disease in the future.

Interleukin 6 trans-signalling and risk of future cardiovascular events.

The pro-inflammatory response to interleukin 6 (IL6) trans-signalling in atherosclerosis is driven by the IL6 and soluble IL6 receptor (sIL6R) binary complex. The binary IL6:sIL6R complex is inactivated by sgp130 through the formation of the ternary IL6:sIL6R:sgp130 complex. The aim of this study was to investigate if IL6 trans-signalling, estimated by a ratio between the binary and ternary complexes, associates with the risk of future cardiovascular events (CVE) in a Swedish cohort of 60-year-old men and women (n = 4232). Binary and ternary complex levels expressed in nanomol/Litre were derived from serum concentrations of IL6, sIL6R, and sgp130. Cox regression models were used to assess the risk of CVE (myocardial infarction, angina pectoris, and ischaemic stroke, n = 525), expressed as hazard ratio (HR) with 95% confidence interval (CI), associated with increasing circulating levels of the three molecules and with the binary/ternary complex ratio. Estimates were adjusted for the common cardiovascular (CV) risk factors. To assess the level of IL6-trans-signalling, we estimated the binary/ternary complex ratio and then analysed the association with CVE risk. A ratio higher than the median, representing a relative excess of the active binary complex was associated with increased CVE risk (adjusted HR 1.44, 95% CI 1.21-1.72). The ratio between the functional moieties of IL6 trans-signalling, IL6:sIL6R, and IL6:sIL6R:sgp130, was associated with CVE risk indicating that it could be a promising marker of CV risk and possibly be used in selecting patients for anti-inflammatory therapy.

Cardiovascular risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-Eastern Nigeria: Implications for primary care geriatric cardiovascular health advocacy

Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. Aim: This study was aimed at determining the frequencies of nonconstitutional CV risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-eastern Nigeria. Setting and Design: This was a cross-sectional study carried out on a sampled of 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria, between May 2012 and October 2012. Subjects and Methods: Geriatric Nigerians aged 60 years and above were screened for nonconstitutional risk factors of CV disease. The data collected included sociodemographic variables, metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher administered the questionnaire. Results: The top five most common CV risk factors were as follows: physical inactivity (67.1%), inadequate fruits consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcohol beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that risk factors of CV disease exist among geriatric Nigerians in primary care with five most frequent being physical inactivity, inadequate fruits consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary health care in the study area.

The predictive utility of the plant phylogeny in identifying sources of cardiovascular drugs

Context: Cardiovascular disease (CVD) is the number one cause of death globally, responsible for over 17 million (31%) deaths in the world. Novel pharmacological interventions may be needed given the high prevalence of CVD.Objective: In this study, we aimed to find potential new sources of cardiovascular (CV) drugs from phylogenetic and pharmacological analyses of plant species that have experimental and traditional CV applications in the literature.Materials and methods: We reconstructed the molecular phylogeny of these plant species and mapped their pharmacological mechanisms of action on the phylogeny.Results: Out of 139 plant species in 71 plant families, seven plant families with 45 species emerged as phylogenetically important exhibiting common CV mechanisms of action within the family, as would be expected given their common ancestry: Apiaceae, Brassicaceae, Fabaceae, Lamiaceae, Malvaceae, Rosaceae and Zingiberaceae. Apiaceae and Brassicaceae promoted diuresis and hypotension; Fabaceae and Lamiaceae had anticoagulant/thrombolytic effects; Apiaceae and Zingiberaceae were calcium channel blockers. Moreover, Apiaceae, Lamiaceae, Malvaceae, Rosaceae and Zingiberaceae species were found to possess anti-atherosclerotic properties.Discussion and conclusions: The phylogeny identified certain plant families with disproportionately more species, highlighting their importance as sources of natural products for CV drug discovery. Though there were some species that did not show the same mechanism within the family, the phylogeny predicts that these species may contain undiscovered phytochemistry, and potentially, the same bioactivity. Evolutionary pharmacology, as applied here, may guide and expedite our efforts in discovering sources of new CV drugs.

Cardiovascular risk factors among geriatric Nigerians in a primary care clinic of a tertiary hospital in Southeastern Nigeria

Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. This study was aimed at determining the frequencies of CV risk factors among geriatric Nigerians in a primary care clinic of a tertiary hospital in Southeastern Nigeria. Patients and Methods: This was a cross-sectional study carried out on 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Geriatric Nigerians aged 60 years and above were screened for risk factors of CV disease. The data collected included sociodemographic variables and metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher-administered questionnaire. Results: The top five most common CV risk factors were physical inactivity (67.1%), inadequate fruit consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcoholic beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that the risk factors of CV disease exist among geriatric Nigerians in primary care, with five most frequent being physical inactivity, inadequate fruit consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary care in the study area.

Causes of Death in a Contemporary Cohort of Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Insights From the TECOS Trial.

We evaluated the specific causes of death and their associated risk factors in a contemporary cohort of patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular (CV) safety trial adding sitagliptin versus placebo to usual care in patients with type 2 diabetes and ASCVD (median follow-up 3 years). An independent committee blinded to treatment assignment adjudicated each cause of death. Cox proportional hazards models were used to identify risk factors associated with each outcome. A total of 1,084 deaths were adjudicated as the following: 530 CV (1.2/100 patient-years [PY], 49% of deaths), 338 non-CV (0.77/100 PY, 31% of deaths), and 216 unknown (0.49/100 PY, 20% of deaths). The most common CV death was sudden death (n = 145, 27% of CV death) followed by acute myocardial infarction (MI)/stroke (n = 113 [MI n = 48, stroke n = 65], 21% of CV death) and heart failure (HF) (n = 63, 12% of CV death). The most common non-CV death was malignancy (n = 154, 46% of non-CV death). The risk of specific CV death subcategories was lower among patients with no baseline history of HF, including sudden death (hazard ratio [HR] 0.4; P = 0.0036), MI/stroke death (HR 0.47; P = 0.049), and HF death (HR 0.29; P = 0.0057). In this analysis of a contemporary cohort of patients with diabetes and ASCVD, sudden death was the most common subcategory of CV death. HF prevention may represent an avenue to reduce the risk of specific CV death subcategories.

Cardiovascular risk factors, anxiety symptoms and inflammation markers: Evidence of association from a cross-sectional study

IntroductionAnxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism.AimsTo investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample.MethodsCross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.ResultsFifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04).ConclusionsFurther evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.