Comorbidities Coronary Artery Disease Research Articles

Distinct Genetic Risk Profile in Aortic Stenosis Compared With Coronary Artery Disease.

Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist. However, it is unknown which genetic and cardiovascular risk factors might be AS-specific and which could be shared between AS and CAD. To identify genetic risk loci and cardiovascular risk factors with AS-specific associations. This was a genomewide association study (GWAS) of AS adjusted for CAD with participants from the European Consortium for the Genetics of Aortic Stenosis (EGAS) (recruited 2000-2020), UK Biobank (recruited 2006-2010), Estonian Biobank (recruited 1997-2019), and FinnGen (recruited 1964-2019). EGAS participants were collected from 7 sites across Europe. All participants were of European ancestry, and information on comorbid CAD was available for all participants. Follow-up analyses with GWAS data on cardiovascular traits and tissue transcriptome data were also performed. Data were analyzed from October 2022 to July 2023. Genetic variants. Cardiovascular traits associated with AS adjusted for CAD. Replication was performed in 2 independent AS GWAS cohorts. A total of 18 792 participants with AS and 434 249 control participants were included in this GWAS adjusted for CAD. The analysis found 17 AS risk loci, including 5 loci with novel and independently replicated associations (RNF114A, AFAP1, PDGFRA, ADAMTS7, HAO1). Of all 17 associated loci, 11 were associated with risk specifically for AS and were not associated with CAD (ALPL, PALMD, PRRX1, RNF144A, MECOM, AFAP1, PDGFRA, IL6, TPCN2, NLRP6, HAO1). Concordantly, this study revealed only a moderate genetic correlation of 0.15 (SE, 0.05) between AS and CAD (P = 1.60 × 10-3). Mendelian randomization revealed that serum phosphate was an AS-specific risk factor that was absent in CAD (AS: odds ratio [OR], 1.20; 95% CI, 1.11-1.31; P = 1.27 × 10-5; CAD: OR, 0.97; 95% CI 0.94-1.00; P = .04). Mendelian randomization also found that blood pressure, body mass index, and cholesterol metabolism had substantially lesser associations with AS compared with CAD. Pathway and transcriptome enrichment analyses revealed biological processes and tissues relevant for AS development. This GWAS adjusted for CAD found a distinct genetic risk profile for AS at the single-marker and polygenic level. These findings provide new targets for future AS research.

Impact of comorbid coronary artery disease on short and medium-term outcomes after carotid artery stenting

Abstract Background Current recommendations acknowledge carotid artery disease as a clinical criteria for very high cardiovascular risk and carotid artery stenting (CAS) as one of the main therapeutic options for carotid artery stenosis. Carotid artery disease is often present in patients with coronary artery disease (CAD), presumably enhancing the cardiovascular risk of these patients. In this study, we aimed to appraise the prevalence and prognostic effects of comorbid CAD diagnosis in patients with significant carotid artery disease undergoing CAS. Methods We conducted a single-center retrospective analysis including consecutive patients that underwent CAS, between January 2007 and August 2023. Our main objective was to analyze the association of comorbid CAD in patients undergoing CAS, regarding 30-day major adverse cardiovascular events (MACE), 30-day global mortality, 1-year global mortality and major periprocedural complications. On a second perspective, we strived to identify if there was any modifiable factor that influenced worse outcomes in these populations, addressed by a Chi-Square Test. Data was collected by the medical team in our Centre, over the years of follow-up. Results A total of 380 patients were enrolled in this study, with a mean age of 72.1±8.3 years and no major differences concerning demographic characteristics. Based on the presence of previous CAD diagnosis, there was no statistical significance in 30-days MACE (p=0.442), 30-days global mortality (p=0.161), 1-year mortality (p=0.658) or periprocedural complications (p=0.062). Despite these results, there was a statistically significant difference in individuals with CAD and comorbid hypertension in 30-days CV death (p=0.002), 30-days global mortality (p=0.007) and 1-year global mortality (p=0.036). Conclusions Comorbid CAD in patients undergoing CAS due to carotid stenosis does not seem to be significantly associated with medium-term adverse events. Nevertheless, the results of this casuistry support the importance of rigorous blood pressure control in patients with significant carotid artery disease.Baseline CharacteristicsStudy outcomes

Comparative analysis of long-term outcomes in thoracoabdominal aortic aneurysm repair between Marfan syndrome patients and non–Marfan syndrome patients

BackgroundA consensus on the management of thoracoabdominal aortic aneurysm (TAAA) in patients with Marfan syndrome (MFS) has not yet been established. This study aimed to compare the long-term outcomes after open TAAA repair in patients with and without MFS. MethodsThis retrospective study examined 230 consecutive patients who underwent TAAA repair between 2012 and 2022, including of 69 MFS patients and 161 non-MFS patients. The primary endpoint was long-term mortality. The secondary endpoint was a composite of early adverse events, including early mortality, permanent stroke, permanent paraplegia, permanent renal failure, and reoperation. Univariable and multivariable logistic regression analyses were used to assess the impact of MFS on early composite adverse events, and univariable and multivariable Cox proportional hazards models were constructed to evaluate the association between MFS and overall mortality. ResultsCompared with non-MFS patients, MFS patients were younger (mean, 31.9 ± 8.5 years vs 44.8 ± 12.3 years; P < .001), had less comorbid coronary artery disease (0 vs 8.1%; P = .034), more frequently underwent Crawford extent III repair (56.5% vs 34.8%; P = .002) and applied normothermic iliac perfusion (91.3% vs 81.4%; P = .057). There was no significant difference in the rate of early composite adverse events between the MFS and non-MFS groups (23.2% vs 14.3%; P = .099), which was verified by multivariable logistic regression analyses with multiple models. Overall mortality was significantly lower in the MFS group compared to the non-MFS group (P = .026, log-rank test), with 1-, 5-, and 10-year cumulative mortality of 4.4% versus 8.7%, 8.1% versus 17.2%, and 20.9% versus 36.4%, respectively. Multivariable Cox regression analyses across different models further confirmed MFS as a significant protective factor for overall mortality (model 1: hazard ratio [HR], 0.31; 95% confidence interval [CI] 0.13-0.73; P = .007; model 2: HR, 0.32, 95% CI, 0.13-0.75; P = .009; model 3: HR, 0.38; 95% CI, 0.15-0.95; P = .039). ConclusionsDespite varying risk profiles, MFS patients undergoing open TAAA repair can achieve comparable or even superior outcomes to non-MFS patients with tailored surgical strategies, meticulous perioperative care, and close follow-up surveillance, especially in the long term.

Clinical features of coronary artery disease and 5-year survival of patients after myocardial infarction against the background of depressive disorders

Aim. To assess the features of the clinical picture of coronary artery disease (CAD) and the prognosis of patients with myocardial infarction with depressive disorder (DD).&#x0D; Materials and methods. We examined 101 patients with stable CAD who had myocardial infarction more than six months ago: 67 CAD patients with depression (Group 1) and 34 CAD patients without depression (Group 2). The clinical picture of CAD was assessed by complaints, angina self-monitoring diaries, and exercise tests. The presence and severity of DD was determined using psychometric scales: BDI (Beck Depression Scale), HADS (Hospital Anxiety and Depression Scale) and the opinion of a psychiatrist. Five-year survival information was obtained through telephone interviews with patients and their relatives.&#x0D; Results. In patients with CAD and DD in comparison with patients without DD self-monitoring diaries revealed more frequent angina attacks: 9 [6; 12] vs 6 [4; 7] per week (p=0.0001), the greater need for sublingual nitrates: 2 [0; 9] pills vs 0 [0; 4] pills (p=0.0001). DD significantly reduced exercise tolerance: 370 [250; 450] meters vs 435 [350; 500] meters using the six-minute walk test (p=0.04), according to the results of bicycle ergometry – 50 [25; 75] W vs 75 [50; 75] W (p=0.03). After 5 years of follow-up patients with comorbidities (CAD and DD) had a greater number of deaths: 13 (19.4%) vs 2 (5.9%), respectively, survived – 54 (80.6%) vs 32 (94.1%) (Gehan–Wilcoxon test, p=0.04).&#x0D; Conclusion. The comorbidity CAD and DD leads to a worsening of the clinical course of CAD and prognosis, which actualizes the need for verification of the diagnosis of DD and timely prescription of antidepressant therapy.

Prevalence and prognostic effects of comorbid coronary artery disease detected in patients undergoing carotid endarterectomy

Abstract Introduction Coronary artery disease (CAD) shares common risk factors with carotid artery stenosis and is a known perioperative risk factor for carotid endarterectomy (CEA). It is feasible to perform CEA with continuation of antiplatelet drugs, including dual antiplatelet therapy. Differing opinions exist with respect to detection of CAD prior to CEA. To support the discussions, we aimed to assess recent prevalence and prognostic effects of comorbid CAD in patients undergoing CEA without known CAD. Methods This single-center prospective cohort study included patients scheduled for elective CEA between 2013 and 2021. Of these, 108 patients without a medical history of CAD (mean age 76.6±7.3 years, 73.1% men) underwent coronary computed tomography angiography (CCTA). Coronary angiography (CAG) and subsequent fractional flow reserve (FFR) estimation were performed where necessary. CAD was defined as total or subtotal occlusion observed on CCTA, ≥75% stenosis on CAG, or lesions with FFR ≤ 0.80 in the major coronary arteries. Optimal medical therapy and/or coronary revascularization was added according to the presence, severity, and extent of CAD. The primary endpoint was MACE (the composite of all-cause mortality, myocardial infarction, or stroke) after CEA. Results The prevalence of comorbid CAD was 19.4% (21 of 108 patients). During a mean follow-up of 4.0 years, the incidence of MACE and stroke was significantly higher in patients with CAD (adjusted HR: 3.10, 95% CI: 1.43–6.71, p=0.0042 and HR: 2.76, 95% CI 1.08–7.31, p=0.041, respectively). Other than patient age, only CAD was a significant predictor of MACE. Conclusions CAD is commonly detected in patients undergoing CEA, and it predicts future MACE and stroke event.

20-LB: Impact of Optimal Medical Therapy, Insulin Sensitization, and Revascularization Strategies on Soluble Urokinase Plasminogen Activator Receptor and Its Association with Cardiovascular Outcomes—A BARI-2D Ancillary Study

Chronic inflammation is a hallmark of type 2 diabetes (T2D) and a driver of its complications. Soluble urokinase plasminogen activator receptor (suPAR) is an immune-derived signaling glycoprotein involved in the pathogenesis of diabetes-related outcomes, notably atherosclerosis and nephropathy. We aimed to determine if optimal medical therapy, insulin sensitization, and revascularization strategy impact suPAR levels and modulate its association with outcomes. We leveraged the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI-2D) trial, a study of patients with T2D and coronary artery disease (CAD) who underwent either revascularization or optimized medical therapy, and were randomized to either insulin-sensitization or insulin-provision therapy. We measured plasma suPAR levels in 2316 patients at baseline and 1-year follow-up and examined the association between suPAR and major adverse cardiovascular events (MACE). The median suPAR level at baseline was 3.02 ng/ml (IQR 2.32-3.95) and 3.15 ng/ml (2.4-4.2) at 1-year. SuPAR levels were notably higher in patients who underwent CABG (2.94 vs 2.70, p&amp;lt;0.001), but were unchanged post-PCI, insulin sensitization or insulin provisioning at 1 year. In multivariable analyses, baseline and 1-years suPAR levels were predictive of MACE, without difference in the strengths of the association between the two time points (HR of 2.18 (95%CI[1.57-3.03]) at baseline and 2.13 (95%CI[1.45-3.13]) at follow-up for the 3rd tertile compared to the first. Our findings suggest that inflammation as measured by suPAR is not reduced by revascularization or T2D treatment strategy, and likely accounts for the residual CV risk in patients with T2D. The advent of anti-suPAR therapies may offer new promise for patients with T2D and co-morbid CAD. Disclosure K. Amadi: None. G. Erne: None. F. Presswalla: None. B. Bitterman: None. M. Nelapudi: None. I. S. Pizzo: None. M. Tripathi: None. A. Tekumulla: None. N. Meyette: None. P. Blakely: None. N. Sulaiman: None. Y. Huang: None. A. Bardwell: None. J. Chen: None. C. R. Tilley: None. A. Ismail: None. S. Hayek: None. A. Vasbinder: None. R. E. Pratley: Other Relationship; Bayer Inc., Corcept Therapeutics, Dexcom, Inc., Gasherbrum Bio, Inc., Hanmi Pharm. Co., Ltd., Hengrui (USA) Ltd., Merck Sharp &amp; Dohme Corp., Novo Nordisk, Pfizer Inc., Rivus Pharmaceuticals Inc., Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. M. Banerjee: None. R. Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter &amp; Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. T. C. Catalan: None. Funding National Heart, Lung, and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center

The time-dependent impact of type 2 diabetes mellitus on incident prodromal Alzheimer's disease: a longitudinal study in 1395 participants.

To investigate the longitudinal impact of type 2 diabetes mellitus (T2DM) on the prodromal and dementia stages of Alzheimer's disease (AD), focusing on diabetes duration and other comorbidities. 1395 dementia-free individuals aged 55-90 years with a maximum 15-year follow-up data were enrolled from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of the incidence of prodromal or dementia stages of AD. Longer T2DM duration (≥5 years) (multi-adjusted HR=2.19, 95% CI=1.05-4.58), but not shorter T2DM duration (<5 years), was associated with a significantly increased risk of incident prodromal AD over a mean follow-up of 4.8 years. APOE ε4 alleles (HR=3.32, 95% CI=1.41-7.79) and comorbid coronary artery disease (CAD) (HR=3.20, 95% CI=1.29-7.95) further increased the risk of incident prodromal AD in patients with T2DM. No significant association was observed between T2DM and conversational risk of progression from prodromal AD to AD dementia. T2DM, which is characterized by a longer duration, increases the incidence risk of prodromal AD but not AD dementia. APOE ε4 allele and comorbid CAD strengthen the relationship between T2DM and prodromal AD. These findings highlight T2DM characteristics and its comorbidities as predictors for accurate prediction of AD and screening of at-risk populations.

Guideline-directed medical therapies for comorbidities among patients with atrial fibrillation: results from GARFIELD-AF.

This study aimed to identify relationships in recently diagnosed atrial fibrillation (AF) patients with respect to anticoagulation status, use of guideline-directed medical therapy (GDMT) for comorbid cardiovascular conditions (co-GDMT), and clinical outcomes. The Global Anticoagulant Registry in the FIELD (GARFIELD)-AF is a prospective, international registry of patients with recently diagnosed non-valvular AF at risk of stroke (NCT01090362). Guideline-directed medical therapy was defined according to the European Society of Cardiology guidelines. This study explored co-GDMT use in patients enrolled in GARFIELD-AF (March 2013-August 2016) with CHA2DS2-VASc ≥ 2 (excluding sex) and ≥1 of five comorbidities-coronary artery disease, diabetes mellitus, heart failure, hypertension, and peripheral vascular disease (n = 23 165). Association between co-GDMT and outcome events was evaluated with Cox proportional hazards models, with stratification by all possible combinations of the five comorbidities. Most patients (73.8%) received oral anticoagulants (OACs) as recommended; 15.0% received no recommended co-GDMT, 40.4% received some, and 44.5% received all co-GDMT. At 2 years, comprehensive co-GDMT was associated with a lower risk of all-cause mortality [hazard ratio (HR) 0.89 (0.81-0.99)] and non-cardiovascular mortality [HR 0.85 (0.73-0.99)] compared with inadequate/no GDMT, but cardiovascular mortality was not significantly reduced. Treatment with OACs was beneficial for all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use; only in patients receiving all co-GDMT was OAC associated with a lower risk of non-haemorrhagic stroke/systemic embolism. In this large prospective, international registry on AF, comprehensive co-GDMT was associated with a lower risk of mortality in patients with AF and CHA2DS2-VASc ≥ 2 (excluding sex); OAC therapy was associated with reduced all-cause mortality and non-cardiovascular mortality, irrespective of co-GDMT use. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

The Prognostic Impact of Coronary Artery Disease and Aortic Aneurysm: Insights From CT Protocol for Simultaneous Evaluation of Coronary Artery and Aorta.

There is a strong correlation between risk factors for coronary artery disease (CAD) and aortic aneurysm (AA). We aimed to investigate the prevalence and prognostic impact of CAD and AA in patients who underwent coronary aorta computed tomography (CACT) protocol, which allowed simultaneous evaluation of coronary artery and aorta. Between 2010 and 2021, 1,553 patients who underwent CACT were enrolled from a tertiary center. The presence and location of AA and the presence of CAD were identified from CT. The primary outcome was a composite of cardiovascular death, acute coronary syndrome requiring urgent revascularization, and stroke at 3 years after the index CT scan. Out of 1,553 enrolled patients, 179 (11.5%) had AA. The prevalence of CAD was significantly higher in patients with AA than those without (47.5% vs. 18.3%, P < 0.001). Among patients with AA, the prevalence of comorbid CAD was higher in those with abdominal AA than thoracic AA (57.3% vs. 37.8%, P = 0.014), respectively. In multivariable analysis, the presence of CAD was an independent predictor of primary outcome at 3 years (hazard ratio [HR], 2.58; 95% CI, 1.47-4.51; P = 0.001), while AA was not (HR, 1.00; 95% CI, 0.48-2.07; P = 0.993). In this cohort of patients undergoing simultaneous evaluation of coronary artery and aorta using CACT protocol, patients with AA had an increased risk of comorbid CAD compared to those without AA. CAD was independently associated with adverse clinical outcomes at 3 years.

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

Preexisting Coronary Artery Disease in Liver Transplant Candidates: Risk Factor or Risk Marker?

Abstract 10480: Depression and Coronary Artery Disease Share Genetic Risk Factors Enriched in Inflammation and Cardiomyopathy-Associated Pathways

Coronary artery disease (CAD) and depression are highly prevalent (7% and 8% respectively), comorbid diseases. Approximately 40% of adults who are initially diagnosed with either CAD or depression will also develop the other condition. We have observed that the polygenic risk scores for depression were significantly associated with CAD in a large hospital population even in patients without any psychiatric diagnoses and after adjusting for known CAD risk factors. This suggests that some proportion of genes that increase susceptibility to depression act pleiotropically to increase CAD risk. To identify the genes increasing risk for both CAD and depression we performed a cross-tissue S-MultiXcan analysis on the summary statistics for CAD (CARDIoGRAMplusC4D Consortium) and depression (PGC and UK Biobank). We identified 185 genes associated with both depression and CAD, representing a three-fold enrichment of shared associations ( P value &lt;1.718e-43). Next we performed a pathway enrichment analysis and observed that these genes were enriched for inflammation and cardiomyopathy-associated pathways. We then used electronic health records at Vanderbilt, to test the prevalence of cardiomyopathy in patients with comorbid depression and CAD. We found that the depression-CAD cohort had a significantly increased prevalence of cardiomyopathy diagnoses ( OR = 1.27, 95%C.I. = 1.17-1.30, P value = 3.69 e-9) compared to patients with CAD after we controlled for Type 2 Diabetes, hypertension, smoking and median BMI. We replicated these findings across two external cohorts - All of Us and Massachusetts General Hospital health records. Using a Genomic structural equation model (GSEM), we observed that inflammatory markers white blood cell (WBC) count and platelet count explained 1% and 16% of the SNP-based genetic correlation between depression and CAD, respectively in a single factor. The mediation paths models using the summary statistics data show that WBC and platelets mediate approximately 1% and 13% of comorbidity and together explain 14.4% of the total genetic correlation between depression-CAD. These results highlight cardiomyopathy and inflammation as an important biological link in the comorbid manifestation of CAD and depression.

Sex-Related Differences in Clinical Outcomes in Patients with Atrial Fibrillation and Coronary Artery Disease: A Sub-Study of the MISOAC-AF Randomized Controlled Trial.

Background: There is limited “real-world” data on the prognostic role of gender in comorbid atrial fibrillation (AF) and coronary artery disease (CAD). Methods: In this post-hoc analysis of the MISOAC-AF randomized trial (NCT: 02941978), consecutive patients with AF and CAD who were discharged from the cardiology ward between 2015 and 2018 were included. Multivariable Cox-regression analysis was performed for all-cause mortality and cardiovascular (CV) mortality. Competing-risk analysis was performed for the outcomes of stroke or systemic embolism, major bleeding, AF- or heart failure (HF)-related hospitalization, adjusted for the competing risk of all-cause death. Results: Of 1098 patients with AF, 461 patients with comorbid CAD were analyzed. Women were older and more likely to have a history of diabetes mellitus and valvular heart disease, while men were more likely to have a history of smoking or myocardial infarction. Over a median follow-up of 31 months, 143 (43.4%) men and 71 (53.7%) women died. Women were at a higher risk for all-cause mortality (adjusted hazard ration [aHR] 1.65; 95% confidence interval [CI] 1.14–2.38) and stroke or systemic embolism (aHR 3.52; 95% CI 1.46–8.49) compared to men. The risks of CV mortality, major bleeding, AF-related hospitalization, and HF-related hospitalization were similar between genders. Conclusions: In recently hospitalized patients with AF and comorbid CAD, the female gender was independently associated with increased all-cause mortality and thromboembolic events.

WITHDRAWN

SESSION TITLE: PAH with Complications SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Congenital heart disease (CHD) serves as the second most commonly associated form of primary pulmonary arterial hypertension (PAH). The prognosis of PAH related to congenital heart disease differ from other types of PAH due to factors such as defect types and sizes. The aim of the study is to compare the outcomes of PAH secondary to CHD (PAH-CHD) and PAH due to other causes. METHODS: We extracted the data from the National Inpatient Sample (NIS) database for the years 2016 to 2019 and analyzed all hospital admissions for PAH-CHD versus primary PAH due to causes other than CHD (Other PAH). We selected CHDs commonly known to be associated with primary pulmonary hypertension: atrial septal defect (ASD), ventricular septal defect (VSD), aortopulmonary window, atrioventricular septal defect, tetralogy of Fallot, patent ductus arteriosus (PDA), truncus arteriosus, double inlet left ventricle and double outlet right ventricle. We compared baseline characteristics, outcomes, and healthcare utilization between the two groups. RESULTS: Of 37,739 patients admitted with PAH, 1,355 patients had concomitant CHD and were compared with 36,384 adult PAH patients without CHD. In the PAH-CHD group, ASD was the most common associated CHD (1,195, 88%) followed by VSD (125, 9.2%) and PDA (39,2, 9%). The PAH-CHD patients were relatively younger (mean age of 53.15 vs 65.7 years), less likely to be of white race (62.36% vs 66%) and had a lower proportion of comorbid coronary artery disease (14.3% vs 28.86%), obesity (15.13% vs 22.66%), dyslipidemia (44% vs 51%), diabetes (18.08% vs 34.48%) and chronic kidney disease (19.93% vs 33.15%) [all p<0.05*]. A total of 115 (8.5%) PAH-CHD patients and 1,844 (5.07%) other PAH patients died during hospitalization. PAH-CHD patients had a higher in-hospital mortality (aOR=1.73 ;95%CI 1.08-2.76, p=0.02*). The PAH-CHD group had higher odds of having chronic respiratory failure (aOR=1.13;95%CI 1.04-1.22, p=0.003*), right ventricular failure (aOR=1.72 ;95%CI 1.12-2.6, p<0.013*), cardiogenic shock (aOR=2.1;95%CI 1.15-3.84, p=0.015*) and acute ischemic stroke (aOR=25.18;95%CI 6.78-93.46, p<0.0001*). compared to the other PAH group. PAH-CHD patients also had longer length of stay (10.6 vs 7.10 days, p=0.0009*) and higher hospitalization costs per admission ($209,507 vs $90,599, p=0.007*). CONCLUSIONS: The PAH-CHD group had higher in-hospital mortality and healthcare resource utilization than the other PAH group. PAH-CHD group were more likely to have chronic respiratory failure, right ventricular failure, cardiogenic shock and ischemic stroke. CLINICAL IMPLICATIONS: PAH-CHD seem to have higher mortality and worse PAH related in-patient complications. The difference between two groups highlights the need for further research and trials to understand the unique natural history and appropriate management of PAH-CHD patients. DISCLOSURES: No relevant relationships by Cyra-Yoonsun Kang No relevant relationships by Sandhya shri Kannayiram No relevant relationships by parnia khamooshi No relevant relationships by Viviana Reyes Pinzon No relevant relationships by Sujitha Velagapudi

AORTIC INVOLVEMENT IN TAKAYASU ARTERITIS: A NATIONAL INPATIENT SAMPLE ANALYSIS

AORTIC INVOLVEMENT IN TAKAYASU ARTERITIS: A NATIONAL INPATIENT SAMPLE ANALYSIS

Patients with comorbid coronary artery disease and hypertension: a cross-sectional study with data from the NHANES.

BackgroundHypertension (HTN) and coronary artery disease (CAD), two common cardiovascular diseases, are often comorbid and interacted. The patients with comorbid CAD and HTN have worse outcomes and prognosis, however, the prevalence remains unclear. In the cross-sectional study, we aimed to explore the prevalence and influence factors of patients with comorbid CAD and HTN in the USA.MethodsAdult patients with comorbid CAD and HTN derived from the National Health and Nutrition Examination Survey (NHANES) database in the 1999–2000 and 2017–2018 cycles were included. Demographic data, physical examination results, laboratory data, and questionnaire data were collected and compared in the two cycles. Subgroup analyses were performed between the elder (≥65 years of age) and middle-young (18–65 years of age) populations.ResultsThe age-adjusted prevalence of patients with comorbid CAD and HTN increased from 4.22% [1999–2000] to 5.40% [2017–2018] (P=0.006) and the age decreased from 71 [63–79] to 69 [61–77] years (P=0.008). The HTN control rate, the low-density lipoprotein cholesterol (LDL-C) control rate, systolic blood pressure (SBP), and the levels of blood lipids, as well as the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and statins improved in the 2017–2018 cycle as compared with the 1999–2000 (all P<0.05). On the other hand, the proportions complicated with diabetes mellitus (DM), obesity and chronic kidney disease (CKD), as well as the levels of serum glucose, glycohemoglobin and creatinine increased from the 1999–2000 to 2017–2018 (all P<0.01). Subgroup analyses revealed that the prevalence of middle-young patients with comorbid CAD and HTN increased more than their elder counterparts, while diastolic blood pressure (DBP), pulse, blood lipids and oral medication rates were inferior to the latter.ConclusionsThe recent prevalence of patients with comorbid CAD and HTN increased than 20 years ago, mainly caused by more morbid middle-young population. For another, the control of blood pressure (BP) and lipids were favorably affected by increased use of statins, ACEIs/ARBs and β-blockers in these patients. Nevertheless, there is still much room for strengthening medication utilization and intervention of risk factors in future.

Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study.

Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trialsSupplementary InformationThe online version contains supplementary material available at 10.1007/s10880-022-09876-7.

Prognostic significance of metabolomic biomarkers in patients with diabetes mellitus and coronary artery disease

BackgroundDiabetes mellitus (DM) and coronary artery disease (CAD) constitute inter-related clinical entities. Biomarker profiling emerges as a promising tool for the early diagnosis and risk stratification of either DM or CAD. However, studies assessing the predictive capacity of novel metabolomics biomarkers in coexistent CAD and DM are scarce.MethodsThis post-hoc analysis of the CorLipid trial (NCT04580173) included 316 patients with CAD and comorbid DM who underwent emergency or elective coronary angiography due to acute or chronic coronary syndrome. Cox regression analyses were performed to identify metabolomic predictors of the primary outcome, which was defined as the composite of major adverse cardiovascular or cerebrovascular events (MACCE: cardiovascular death, myocardial infarction, stroke, major bleeding), repeat unplanned revascularizations and cardiovascular hospitalizations. Linear regression analyses were also performed to detect significant predictors of CAD complexity, as assessed by the SYNTAX score.ResultsAfter a median 2-year follow up period (IQR = 0.7 years), the primary outcome occurred in 69 (21.8%) of patients. Acylcarnitine ratio C4/C18:2, apolipoprotein (apo) B, history of heart failure (HF), age > 65 years and presence of acute coronary syndrome were independent predictors of the primary outcome in diabetic patients with CAD (aHR = 1.89 [1.09, 3.29]; 1.02 [1.01, 1.04]; 1.28 [1.01, 1.41]; 1.04 [1.01, 1.05]; and 1.12 [1.05–1.21], respectively). Higher levels of ceramide ratio C24:1/C24:0, acylcarnitine ratio C4/C18:2, age > 65 and peripheral artery disease were independent predictors of higher CAD complexity (adjusted β = 7.36 [5.74, 20.47]; 3.02 [0.09 to 6.06]; 3.02 [0.09, 6.06], respectively), while higher levels of apoA1 were independent predictors of lower complexity (adjusted β= − 0.65 [− 1.31, − 0.02]).ConclusionsIn patients with comorbid DM and CAD, novel metabolomic biomarkers and metabolomics-based prediction models could be recruited to predict clinical outcomes and assess the complexity of CAD, thereby enabling the integration of personalized medicine into routine clinical practice. These associations should be interpreted taking into account the observational nature of this study, and thus, larger trials are needed to confirm its results and validate them in different and larger diabetic populations.

Clinical and economic burden of comorbid coronary artery disease in patients with acute exacerbation of chronic obstructive pulmonary disease: sex differences in a nationwide cohort study

BackgroundCoronary artery disease (CAD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). However, data related to the impact of CAD on outcomes of acute exacerbation of COPD (AECOPD) are limited and whether the relationship depends on sex remains unknown. Our aim was to determine the impact of comorbid CAD on clinical outcomes among men and women with AECOPD.MethodsWe used data from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study, which is a nationwide observational real-world study conducted between September 2017 and February 2020 at 163 centers in patients admitted with AECOPD as their primary diagnosis. Patients were stratified according to the presence or absence of CAD in men and women. The primary outcomes were the length of hospital stay and economic burden during hospitalization.ResultsAmong 3906 patients included in our study, the prevalence of CAD was 17.0%, and it was higher in women than in men (19.5% vs. 16.3%; P = 0.034). Age and other cardiovascular diseases were common factors associated with comorbid CAD in men and women, while body-mass index, cerebrovascular disease, and diabetes were determinants in men and pre-admission use of long-acting beta-adrenoceptor agonist and home oxygen therapy were protective factors in women. Only in men, patients with CAD had a longer length of hospital stay (median 10.0 vs. 9.0 days, P < 0.001), higher total cost during hospitalization (median $1502.2 vs. $1373.4, P < 0.001), and more severe COPD symptoms at day 30 compared to those without CAD. No significant difference was found in women. Comorbid CAD showed no relationship with 30-day readmission or death regardless of sex. In our real-world study, mortality/readmission risk within 30 days increased in patients with previous frequent hospitalizations and poorer pulmonary function.ConclusionsIn hospitalized AECOPD patients, comorbid CAD was significantly associated with poorer short-term outcomes in men. Clinicians should have heightened attention for men with comorbid CAD to achieve an optimal management of AECOPD patients.

Влияние вредных производственных факторов на развитие хронических неинфекционных заболеваний у рабочих в разных профессиональных категориях

The article presents data on harmful production factors for the development of the most common non-infectious diseases depending on the occupational category with a different number of them, with different leading factors and work experience in these working conditions among workers at an industrial enterprise. Materials and methods. A comprehensive study of 656 workers was carried out in 2016-2020. Their average age was 48.3 ± 14.2 years. In the study, the number of men (n = 453, 69.1%) prevailed over the number of women (n = 203, 30.9%), p &lt; 0.001. Professional categories were determined according to the International Standard Classification of Occupations ISCO-08. Each profession is assigned to a 3 professional category, taking into account the number of harmful production factors, leading factors and work experience. The comparison group consisted of management professions (engineers, section chiefs, department heads, technologists) without harmful production factors – 66 people, in which there were 30 women and 36 men, average length of service was 27.1 ± 15.4 years. Group 1 consisted of foremen, inspectors, plasterers (painters), and drivers. In this group, there are 2-3 harmful production factors (M (SD) 2.3 ± 1.3), of which the leading harmful production factors are physical overstrain, work at height, in which 185 people work, of which 71 are women and 114 men, the average length of service in these conditions is 15.9 ± 14.3 years. Group 2 consisted of crane and bulldozer operators, repairmen, operators, metering operators, fitters, molders, assemblers, electric gas welders, and finishers. In this group, 4-6 harmful production factors (M (SD) 3.2 ± 1.6) are noted, of which the leading production factors are general vibration and industrial noise, industrial dust / welding aerosol, in which 405 people work, of which 102 women and 303 men, the average length of service in these conditions is 27.7 ± 13.8 years. The average age of workers in the groups is comparable; no statistically significant difference was found (p = 0.526). There were no statistically significant differences by gender (p = 0.527). To compare more than two groups, we used one-way ANOVA with Fisher’s test (F) and Post-Hoc with Tukey’s test (aqual variances) to avoid type I errors and “multiple comparisons effect”. Since in our study there are confounder factors that can affect the study result, contingency tables and Pearson’s χ2 criterion were used to analyze the relationship between qualitative characteristics; at p &lt; 0.05, the probability of differences was 95% or more. Results and discussion. Thus, in our study, we found that general vibration, industrial noise, industrial dust and welding aerosol affect the development of arterial hypertension and chronic obstructive disease and their comorbid diseases in the professional category of workers with 11 years of experience, who are affected by several harmful industrial factors. at the same time, compared with a group without harmful production factors. These harmful production factors had a stronger effect on the development of arterial hypertension by 15% and on the development of chronic obstructive pulmonary disease by 2 times, increased systolic blood pressure and diastolic pressure than work at height and physical overstrain. Arterial hypertension is the most common factor in the development of comorbid coronary artery disease. The most frequent concomitant factors of hypertension in workers with general vibration, occupational noise, industrial dust and welding fumes were excess body weight, grade 1 obesity and smoking. The definition of occupational categories is an important socio-economic and medical determinant for patient-centered prevention of non-communicable diseases, comorbid pathology of non-communicable diseases and their risk factors in workers exposed to harmful production factors. Conclusions. The study carried out using Pearson’s criterion and regression analysis showed that the relationship with multiple occupational factors is significantly higher among workers, which allows us to conclude that general vibration, industrial noise, industrial dust / welding aerosol are additional factors for the development of arterial hypertension and chronic obstructive pulmonary disease. from workers. The obtained correlations also allow us to draw a conclusion about the influence of the combined effect of these factors, taking into account the length of service, on the likelihood of developing arterial hypertension and chronic obstructive pulmonary disease.

Abstract 12556: The Matrikine Proline-Glycine-Proline is a Novel Biomarker of Coronary Artery Disease Amongst Patients With Chronic Obstructive Pulmonary Disease

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of coronary artery disease (CAD). Proline-glycine-proline (PGP) is an extracellular matrix-derived chemokine ( matrikine ) that is increased in COPD and known to promote neutrophil chemotaxis, endothelial dysfunction, and vascular inflammation through activation of the CXC Chemokine Receptor 2 (CXCR2). Despite these observations, no study has examined PGP as a marker of CAD within COPD patients. Hypothesis: We hypothesized that circulating PGP is associated with comorbid CAD amongst COPD patients. Methods: Current and former smokers with COPD enrolled in the UAB P rospective R epository for coupling EVE nts to N ovel pa T hways in COPD (PREVENT COPD) cohort underwent phlebotomy and spirometry. Cardiovascular diagnoses were adjudicated by two physician reviewers with access to medical records. CAD was defined as a composite of prior myocardial infarction, coronary revascularization, or by physician diagnosis of CAD. Plasma PGP was measured using a solid-phase extraction method coupled with tandem mass spectrometry. Other known CXCR2 ligands (e.g. GRO alpha, IL-8) were measured by multiplex protein assay. SPSSv27 was used for logistic regression models to measure associations between plasma biomarkers and the presence of CAD. Results: The 104 participants were 60±9 years old, 50% male, and 50% Black race. CAD was prevalent in 21 (21%) of the cohort. Plasma PGP was detectable for all participants (0.05 - 15.1 ng/mL). Participants with CAD had higher PGP concentrations compared to participants without CAD (1.26 vs. 0.52 ng/mL, p=0.042). Similarly, PGP was increased among participants with prior coronary revascularization (p&lt;0.01). Associations between plasma PGP and CAD remained significant after adjustment for FEV1 % predicted and smoking status (OR 1.62, 95%CI 1.02-2.56). Concentrations of other CXCR2 ligands were low and not associated with CAD. Conclusions: Our results highlight PGP as a potentially novel biomarker of CAD among individuals with COPD. Future studies are needed to assess whether plasma PGP is predictive of CAD outcomes in COPD, as well as determine the significance of endothelial CXCR2 activation on the development of atherosclerosis.