Cardiovascular Disease Complications Research Articles

Metabolic risk factor targets in relation to clinical characteristics and comorbidities among individuals with type 2 diabetes treated in primary care - The countrywide cross-sectional AUSTRO-PROFIT study.

This study assessed the achievement rates of metabolic risk factor targets and their association with clinical characteristics and comorbidities among individuals with type 2 diabetes (T2D) treated in the primary care in Austria. A countrywide cross-sectional study, the AUSTRO-PROFIT, was conducted in Austria from 2021 to 2023 on 635 individuals with T2D. Metabolic risk factor targets were defined as the percentage of people achieving low-density lipoprotein cholesterol (LDL-C) <70 mg/dL (or < 55 mg/dL if cardiovascular or microvascular disease was present), glycated haemoglobin (HbA1c) <7% (53 mmol/mol) and blood pressure < 140/90 mmHg. The mean age of the participants was 65.7 ± 11.2 years; the median duration of T2D was 8 (4-14) years; and 58.7% of the participants were male. The percentages of participants achieving LDL-C, HbA1c, blood pressure and all targets were 44%, 53%, 57% and 13%, respectively. Older age, longer T2D duration, cardiovascular disease and microvascular complications were associated with suboptimal achievement of metabolic risk factor targets. The AUSTRO-PROFIT study revealed notable variations in metabolic targets achievement with respect to clinical characteristics and comorbidities. These findings underscore the importance of establishing national diabetes registries and implementing multifactorial targeted and individualized interventions to further improve the quality of T2D care in primary care settings in Austria.

SINGLE-CENTER EXPERIENCE OF HEART TRANSPLANTATION AT THE HEART CENTER OF ASTANA

Background. Chronic heart failure is a major global health issue. As a complication of most cardiovascular diseases, it affects 4% of the population. Heart transplantation is the gold standard in the treatment of patients with end-stage heart failure. Objective of the study was to evaluate early and long-term outcomes of heart transplants performed at the Heart Center University Medical Center (Heart Center) over a 10-year period. Materials and methods. Cross-sectional study was conducted from 2012 to 2022, 86 orthotopic heart transplants were performed at the Heart Center. The analysis of the obtained results was conducted retrospectively. Results. From August 2012 to December 2022, 114 patients were on the waiting list for heart transplantation. Of these, 86 (75.4%) patients underwent transplantation; 10 (8.7%) patients were excluded. Among the 86 patients, 49 (56.9%) had previously undergone cardiac surgery. Of these, 42 (48.8%) had a left ventricular assist device implanted earlier, 3 (3.4%) had a fully artificial heart, and 2 (2.5%) were on temporary mechanical support (central veno-arterial Extracorporeal membrane oxygenation). Hospital mortality was 8 (9.3%) recipients. In 2.7% of cases, the cause of death was an acute cerebrovascular accident on the second day post-surgery. Postoperative renal dysfunction was noted in 28 (32.5%) patients. An analysis of all performed heart transplantation cases showed a 30-day survival rate of 94%, a 1-year survival rate of 84.3%, and a 5-year survival rate of 64.7%. Conclusion. In the hospital period and the first 6 months after heart transplantation, infectious-septic complications were predominant, whereas in later periods, rejection reactions were more common.

Febuxostat leads to better cardiovascular outcomes compared to allopurinol in patients with advanced chronic kidney disease: A Population-based Cohort Study

ObjectiveHyperuricemia is a risk factor for cardiovascular disease complications in patients with chronic kidney disease. The impact of febuxostat on cardiovascular disease in advanced chronic kidney disease remains unclear. This study aimed to explore the cardiovascular benefits of xanthine oxidase inhibitors, particularly febuxostat and allopurinol, in patients with advanced chronic kidney disease. MethodsA retrospective population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database (NHIRD) (2006–2017). The TriNetX dataset served as an external validation dataset. The study involved 13,187 patients with advanced chronic kidney disease treated with febuxostat or allopurinol. After propensity score matching, a balanced cohort of 976 patients (488 in each arm) was created. Hazard ratios (HRs) were calculated for all-cause mortality and hospitalizations, utilizing the competing risk regression model. ResultsFebuxostat was associated with lower all-cause mortality (HR, 0.79; 95% confidence interval [CI], 0.64–0.98) and fewer hospitalizations (HR, 0.53; 95% CI, 0.44–0.63) than allopurinol. After adjustments, febuxostat also reduced hospitalizations for heart failure (HR, 0.59; 95% CI, 0.43–0.80) and infection (HR, 0.65; 95% CI, 0.52–0.82). This cardiovascular benefit of febuxostat was consistently observed in the TriNetX dataset. Moreover, subgroup analysis revealed that febuxostat was better in reducing death and heart failure events than allopurinol across most of the subgroups. ConclusionsFebuxostat may confer cardioprotective effects in patients with advanced chronic kidney disease compared with allopurinol, thereby potentially useful in reducing cardiovascular risks in this high-risk population.

Myeloproliferative Neoplasms and Cardiovascular Disease: A Review.

Myeloproliferative neoplasms (MPN) are a heterogenous group of disorders of clonal hematopoiesis characterized by constitutive activation of the JAK/STAT signaling pathway leading to proliferation of blood cells. Cardiovascular disease (CVD) contributes significantly to the morbidity and mortality of patients with MPN. Particularly well-known CVD complications of MPNs are arterial and venous thrombotic events. However, MPNs are also associated with other forms of CVD including atrial fibrillation, heart failure, and pulmonary hypertension. Recent studies have characterized outcomes of patients with MPN and CVD, including acute myocardial infarction (AMI), heart failure, atrial fibrillation, and pulmonary hypertension. Additionally, optimal cardiovascular disease prevention strategies in patients with MPN are not yet clear. Further investigation is warranted to improve CVD outcomes in patients with MPN. Clinicians should be aware of cardiovascular complications of MPN, including thrombotic as well as non-thrombotic complications (heart failure, arrhythmias, pulmonary hypertension).

Individual cereals intake is associated with progression of diabetes and diabetic chronic complications

Background and aimsThe relationship between cereals intake and diabetes is unclear. We aimed to explore associations between individual cereals intake and risks of incident and progression of diabetes. MethodsWe included 502,490 participants from UK Biobank at baseline. A single touchscreen food frequency questionnaire was used to estimate the intake of individual cereals (bran, biscuit, oat, muesli, and other cereals). Main outcomes included incident diabetes and diabetic complications of cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetic retinopathy (DR). Polygenic risk score (PRS) of glycosylated hemoglobin (HbA1c) was calculated for mediating effects analysis. ResultsAmong participants without diabetes, when compared to subjects who never had cereals, hazard ratios (95%CI) of developing diabetes in those who had ≥ 6 bowls/week were 0.72 (0.67 to 0.78) for bran, 0.86 (0.81 to 0.92) for biscuit, 0.75(0.66 to 0.84) for oat, and 0.57(0.53,0.61) for muesli. Among people with diabetes without CVD, a higher intake of aforementioned four individual cereals was associated with a 13%-32% lower risk of developing CVD. Among people with diabetes without CKD, a higher intake of aforementioned four individual cereals was associated with a 9%-28% lower risk of developing CKD. We observed a significant mediating effect of the PRS of HbA1c for the association between aforementioned four individual cereals and developing diabetes. ConclusionA higher consumption of cereals was significantly associated with lower risks of diabetes and diabetic complications. Polygenic of HbA1c mediates the effect of cereals on incident diabetes.

Multi-parametric thrombus profiling microfluidics detects intensified biomechanical thrombogenesis associated with hypertension and aging.

Arterial thrombosis, which represents a critical complication of cardiovascular diseases, is a leading cause of death and disability worldwide with no effective bioassay for clinical prediction. As a symbolic feature of arterial thrombosis, severe stenosis in the blood vessel creates a high-shear, high-gradient flow environment that effectively facilitates platelet aggregation towards vessel occlusion even with platelet amplification loops inhibited. However, no approach is currently available to comprehensively characterize the size, composition and platelet activation status of thrombi forming under this biorheological condition. Here, we present a thrombus profiling assay that monitors the multi-dimensional attributes of thrombi forming in conditions mimicking the physiological scenario of arterial thrombosis. Using this platform, we demonstrate that different receptor-ligand interactions contribute distinctively to the composition and activation status of the thrombus. Our investigation into hypertensive and older individuals reveals intensified biomechanical thrombogenesis and multi-dimensional thrombus profile abnormalities, demonstrating a direct contribution of mechanobiology to arterial thrombosis and endorsing the diagnostic potential of the assay. Furthermore, we identify the hyperactivity of GPIbα-integrin αIIbβ3 mechanosensing axis as a molecular mechanism that contributes to hypertension-associated arterial thrombosis. By studying the interactions between anti-thrombotic inhibitors and hypertension, and the inter-individual variability in personal thrombus profiles, our work reveals a critical need for personalized anti-thrombotic drug selection that accommodates each patient's pathological profile.

Platelets at the intersection of inflammation and coagulation in the APC-mediated response to myocardial ischemia/reperfusion injury.

Thromboinflammation is a complex pathology associated with inflammation and coagulation. In cases of cardiovascular disease, in particular ischemia-reperfusion injury, thromboinflammation is a common complication. Increased understanding of thromboinflammation depends on an improved concept of the mechanisms of cells and proteins at the axis of coagulation and inflammation. Among these elements are activated protein C and platelets. This review summarizes the complex interactions of activated protein C and platelets regulating thromboinflammation in cardiovascular disease. By unraveling the pathways of platelets and APC in the inflammatory and coagulation cascades, this review summarizes the role of these vital mediators in the development and perpetuation of heart disease and the thromboinflammation-driven complications of cardiovascular disease. Furthermore, this review emphasizes the significance of the counteracting effects of platelets and APC and their combined role in disease states.

The role of depth of general anesthesia in serum CGRP and SP level in diabetes patients.

Diabetes, which is associated with cardiovascular disease and related microvascular complications, affects life expectancy and decrease quality of life. A trial reports that the risk of patients with diabetes having cardiovascular disease is 2-4 times compared with that in patients without diabetes. This study aims to investigate the relationship between depth of general anesthesia in patients with diabetes mellitus. This clinical study totally includes 40 patients with diabetes mellitus, and these patients are divided into following two groups: diabetes mellitus deep anesthesia group and diabetes mellitus light anesthesia group, and then these patients receive general anesthesia combined with laparoscopic surgery. Preoperative patient general data and intraoperative patient general data are collected and analyzed. Calcitonin gene-related peptide (CGRP) and substance P (SP) level are determined by Enzyme-linked immunosorbent assay (ELISA). This study included a total of 40 patients. There were no significant differences in demographic and preoperative patient general data between the two groups. Measurements were taken for operative time, anesthesia time, recovery time after drug withdrawal, dwell time in the recovery room, intraoperative fluid volume, intraoperative blood loss, and intraoperative urine output between the two groups. Significant differences were observed in the recovery time after drug withdrawal between the two groups. CGRP and SP level in diabetes mellitus deep anesthesia group are evidently more than those in diabetes mellitus light anesthesia group. CGRP and SP level are involved in the diabetes mellitus and up-regulated CGRP and SP can prevent the development of diabetes mellitus. Our study extends the existing literature by addressing a gap in knowledge regarding the impact of anesthesia depth on neuropeptide levels in diabetes mellitus patients. By delineating this relationship, we aim to contribute to the advancement of perioperative care practices and ultimately improve outcomes for individuals with diabetes undergoing surgical procedures. Our study's findings provide valuable insights into the complex interactions between anesthesia, neuropeptides, and diabetes mellitus, offering the potential for personalized perioperative care, enhanced pain management, and improved surgical outcomes. These implications highlight the clinical relevance of our research and its potential to inform future advancements in perioperative care for diabetic patients undergoing surgery.

Harm Reduction in Tobaccoism : What Does the Scientific Evidence Say?

Smoking is considered a chronic disease caused by chemical dependence of nicotine. This is highly addicting, it in the brain system it influences our emotions, increases the feeling of pleasure/humor and reduces the anxiety. In a planet with about 8 billion people, around 1,36 billion are smokers. Cigarette smoking is the leading cause of preventable death in the world, around 8 million people die every year. A global public health problem, and those who smoke are vulnerable to 50 tobacco-related diseases, several kinds of cancer, lung diseases, cardiovascular disease, erectile dysfunction, female infertility and pregnancy complications. In 2020, according to data from the World Health Organization, 22,3% of the world population consumed tobacco, 36,7% of men and 7,8%of women. In Brazil, due to policies implemented to smoking control, we had a significant drop in the of period (1989 to 2019) from 34,8% of smokers to 12,6% and in 2021, the total percentage of smokers age 18 or over was 9.1%. All forms of tobacco consumption are harmful to health and there is no safe level. Cigarette smoke 4.720 different toxic substances such as nicotine, irritants, tar and carbon monoxide. In the last 15 years, new heated tobacco devices have arrived on the market with promises of less harm to health. In 78 countries this products are available, including Japan, The United States, Canada, Portugal, Australia, Italy and The United Kingdom. As they do not cause tobacco combustion, they created significantly lower levels of toxic substances, which is the strongest arguments made by defenders of those products. A systematic review of the literature in 2018 on heated tobacco products identified 31 studies randomly and blind over those devices, 11 independent and 20 funded by the products manufacturers, needing further long-term research. Another systematic review (relevant studies from 2015 to February 2021), both “in vitro” as alive has shown that the benefits of heated tobacco are controversial and more research is needed to the short-and-long term health effects. Another large concern is that availability of these smokeless products may encourage cigarette consumption, especially among young people and often with the combined use of traditional cigarettes and heated tobacco products.

Blood Viscosity Changes in Diabetes Mellitus: A 20-Year Bibliometric Review and Future Directions.

Changes in hematological parameters due to diabetes are reflected in changes in whole blood viscosity (WBV). Understanding the impact of diabetes and its cardiovascular disease (CVD) complications can provide substantiation of how laboratory tests for WBV are useful to monitor the progression and treatment.The review examines research work done in the past 20 years to provide a framework for the present agenda. This was a narrative review that followed the standard Scale for the Assessment of Narrative Review Articles (SANRA) approach. It includes both conceptual and empirical reviews. WBV was appraised in the context of bibliographic research on diabetes and other related factors such as metabolic syndrome (MetS) and oxidative stress. The association of abnormal erythrocytes as well as the relationship between WBV and MetS is established. Changes in diabetes that contribute to the development of diabetic cardiovascular complications occur through the pathway of WBV physiology. However, longitudinal analysis is very limited. There is a dearth of longitudinal study data on WBV in diabetes management. This lack of data justifies a need for further studies, especially prospective and retrospective analysis, to investigate the prevalence of diabetes mellitus about the prevalence of cardiovascular complications indices, especially estimated WBV (eWBV) between periods and within cohorts.

Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes

BackgroundThe global prevalence of diabetes is similar in men and women; however, there is conflicting evidence regarding sex differences in diabetes-related complications. The aim of this study was to investigate...

Association of retinal age gap with chronic kidney disease and subsequent cardiovascular disease sequelae: a cross-sectional and longitudinal study from the UK Biobank.

Chronic kidney disease (CKD) increases the risk of cardiovascular disease (CVD) and is more prevalent in older adults. Retinal age gap, a biomarker of aging based on fundus images, has been previously developed and validated. This study aimed to investigate the association of retinal age gap with CKD and subsequent CVD complications. A deep learning model was trained to predict the retinal age using 19200 fundus images of 11052 participants without any medical history at baseline. Retinal age gap, calculated as retinal age predicted minus chronological age, was calculated for the remaining 35906 participants. Logistic regression models and Cox proportional hazards regression models were used for the association analysis. A total of 35906 participants (56.75±8.04 years, 55.68% female) were included in this study. In the cross-sectional analysis, each 1-year increase in retinal age gap was associated with a 2% increase in the risk of CKD prevalence [odds ratio 1.02, 95% confidence interval (CI) 1.01-1.04, P=.012]. A longitudinal analysis of 35039 participants demonstrated that 2.87% of them developed CKD in follow-up, and each 1-year increase in retinal age gap was associated with a 3% increase in the risk of CKD incidence (hazard ratio 1.03, 95% CI 1.01-1.05, P=.004). In addition, a total of 111 CKD patients (15.81%) developed CVD in follow-up, and each 1-year increase in retinal age gap was associated with a 10% increase in the risk of incident CVD (hazard ratio 1.10, 95% CI 1.03-1.17, P=.005). We found that retinal age gap was independently associated with the prevalence and incidence of CKD, and also associated with CVD complications in CKD patients. This supports the use of this novel biomarker in identifying individuals at high risk of CKD and CKD patients with increased risk of CVD.

Prognostic Implications of Diabetic Ketoacidosis on Long-term Mortality and Diabetes-related Complications

ObjectivesDiabetic ketoacidosis (DKA) occurring after diabetes diagnosis is often associated with risk factors for other diabetes-related complications. In this study we aimed to determine the prognostic implications of DKA on all-cause mortality and complications in type 1 diabetes (T1D). MethodsPreviously collected data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were obtained through the the National Institute of Diabetes and Digestive and Kidney Diseases Central Repository. Using Cox proportional hazards models with time-dependent covariates, we examined age- and sex-adjusted, glycated hemoglobin–adjusted, and fully adjusted associations of DKA with all-cause mortality, cardiovascular disease, microvascular, and acute complications over 34 years. ResultsOf the 1,441 study participants, 297 had 488 DKA events. Prior DKA was associated with a higher risk of age- and sex-adjusted all-cause mortality (hazard ratio [HR] 8.28, 95% confidence interval [CI] 3.74 to 18.32, p<0.001), major adverse cardiovascular events (MACEs) (HR 2.05, 95% CI 1.34 to 3.13, p<0.001), and all advanced microvascular and acute complications compared with no prior DKA. Most associations except retinopathy were significant even after adjustment for covariates. In our fully adjusted analysis, prior DKA was associated with a significantly higher risk of subsequent all-cause mortality (HR 9.13, 95% CI 3.87 to 21.50, p<0.001), MACEs (HR 1.66, 95% CI 1.07 to 2.59, p=0.03), advanced kidney disease (HR 2.10, 95% CI 1.00 to 4.22, p=0.049), advanced neuropathy (HR 1.49, 95% CI 1.05 to 2.13, p=0.03), severe hypoglycemia (HR 1.53, 95% CI 1.28 to 1.81, p<0.001), and recurrent DKA (HR 3.24, 95% CI 2.41 to 4.36, p<0.001) compared with person-time without DKA. ConclusionsDKA is a prognostic marker for diabetes complications, including excess all-cause mortality. Intensified clinical interventions, such as cardiovascular prevention strategies, may be warranted after diagnosis of DKA.

Depression, Perfectionism, and Hypertension in the Elderly: A Path Analysis Examining Worry, Ambiguity Tolerance, and Problem-Solving

Introduction: Hypertension is a prevalent condition among the elderly, significantly contributing to the burden of cardiovascular disease and related complications. This study examined how depression and perfectionism influence hypertension in older adults. It also explored how worry, tolerance for ambiguity, and problem-solving skills might influence this relationship. Methods: Researchers recruited 192 participants with hypertension from a health center in Khoy city, Urmia, Iran. Participants completed questionnaires that assessed depression, perfectionism, worry, ambiguity tolerance, and problem-solving skills. Statistical methods were used to analyze the data and identify relationships between these factors and hypertension. Results: Depression, perfectionism, worry, and ambiguity tolerance were all significantly associated with hypertension. Interestingly, problem-solving skills were not linked to blood pressure. Further analysis revealed that worry played a reinforcing role in the link between depression/perfectionism and hypertension, while ambiguity tolerance had a protective effect. In other words, higher worry levels strengthened the association between depression/perfectionism and high blood pressure, while greater tolerance for ambiguity lessened this association. Conclusion: These findings suggest that emotional factors like worry and intolerance for ambiguity can significantly impact blood pressure in older adults. Therefore, managing these emotions alongside depression and perfectionistic tendencies may be crucial for controlling hypertension.

Clinical and Metabolic Particularities of a Roma Population with Diabetes-Considering Ethnic Disparities in Approaching Healthcare Management.

The Roma population is Europe's largest ethnic minority, yet data on the prevalence of non-communicable diseases remain scarce in medical literature. This study aimed to compare the clinical and metabolic particularities of a Roma population with diabetes with a group of non-Roma. We conducted an observational, transversal study and evaluated 808 adult patients with diabetes mellitus, from a tertiary diabetes care hospital. The prevalence of metabolic syndrome was high among both groups, 94.3% in the Roma patients and 89.1% in the non-Roma. A slightly higher mean value of the triglyceride-glucose (TyG) index was observed among the Roma group (10.07 ± 0.71 versus 9.71 ± 0.82). Among the non-Roma, variables that were significantly associated with the TyG index were glycated hemoglobin (HbA1c), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-c), and low-density lipoprotein-cholesterol (LDL-c), while among the Roma, HbA1c and HDL-c were correlated with this index. There were no differences concerning myocardial infarction; however, the number of patients with a history of stroke was 2.1 times higher in the Roma group compared to the non-Roma group. The prevalence of cardiovascular risk factors, cardiovascular disease, and microvascular complications among the study's Roma population are quite significant, underscoring the importance of ethnic disparities in approaching healthcare management strategies.

Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease

Heart failure (HF) constitutes a major determinant of outcome in chronic kidney disease (CKD) patients. The main pattern of HF in CKD patients is preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD) is a frequent pathophysiological mechanism and specific preclinical manifestation of HFpEF. Therefore, exploring and intervention of the factors associated with risk for LVDD is of great importance in reducing the morbidity and mortality of cardiovascular disease (CVD) complications in CKD patients. We designed this retrospective cross-sectional study to collect clinical and echocardiographic data from 339 nondialysis CKD patients without obvious symptoms of HF to analyze the proportion of asymptomatic left ventricular diastolic dysfunction (ALVDD) and its related factors associated with risk by multivariate logistic regression analysis. Among the 339 nondialysis CKD patients, 92.04% had ALVDD. With the progression of CKD stage, the proportion of ALVDD gradually increased. The multivariate logistic regression analysis revealed that increased age (OR 1.237; 95% confidence interval (CI) 1.108–1.381, per year), diabetic nephropathy (DN) and hypertensive nephropathy (HTN) (OR 25.000; 95% CI 1.355–48.645, DN and HTN vs chronic interstitial nephritis), progression of CKD stage (OR 2.785; 95% CI 1.228–6.315, per stage), increased mean arterial pressure (OR 1.154; 95% CI 1.051–1.268, per mmHg), increased urinary protein (OR 2.825; 95% CI 1.484–5.405, per g/24 h), and low blood calcium (OR 0.072; 95% CI 0.006–0.859, per mmol/L) were factors associated with risk for ALVDD in nondialysis CKD patients after adjusting for other confounding factors. Therefore, dynamic monitoring of these factors associated with risk, timely diagnosis and treatment of ALVDD can delay the progression to symptomatic HF, which is of great importance for reducing CVD mortality, and improving the prognosis and quality of life in CKD patients.

Wearable self-powered ballistic signal detectors with ferroelectric composites arrays for cardiovascular and diabetic complication

Abstract Background Flexible and wearable electronic devices with lightweight are needed to monitor and guide treatment in patients with cardiovascular disease and diabetic complication. We aimed to develop self-powered wearable bio-signal sensing arrays for cardiovascular and diabetic complication diagnosis and continuous monitoring. Methods Ferroelectric composites were designed to have piezoelectric property and high flexibility. Detection of arterial pulse as ballistogram (BCG) was simultaneously compared with electrocardiogram (ECG) in 20 controls. Heart rate and components of ECG was compared with those of BCG. Then, 9 ferroelectric BCG sensors as a square type array with self-power generation were fabricated to attachable thin film. Pressure distribution with BCG sensor array attached to socks were compared between 20 controls and 20 patients with diabetic neuropathy or vasculopathy during standing and ambulation for gait pressure distribution. Pressure distribution pattern was compared to neuropathy and vasculopathy parameters. Results Heart rate between BCG and ECG was significantly correlated (interclass correlation coefficient, ICC 0.99, 95% CI 0.98-0.99, p&amp;lt;0.001). QRS and T wave in ECG were correlated to second and third wave in BCG. Radial artery augmentation index by blood pressure monitoring was significantly correlated to BCG pressure (ICC 0.76, 95% CI 0.38-0.90, p=0.002). Analysis of foot pressure distribution demonstrated the highest pressure point at the anterolateral plantar area below a little tow. However, pressure gradient between anterolateral and anteromedial plantar area in diabetic patients was greater than that in controls (42.3±10.2 mV vs. 31.2±8.5 mV, p=0.024). Pressure gradient in diabetic patients was correlated to ankle-brachial index (ICC 0.62, 95% CI 0.32-0.90, p=0.036), but not to neuropathy parameters. Conclusion Wearable BCG sensor could accurately detect heart rate, blood pressure index and significantly correlated to ABI. Pressure distribution pattern and gradient analysis in diabetic patients by wearable BCG sensor arrays might predict diabetic complications. Gait remedial training guided by wearable BCG sensor arrays might aid to prevent diabetic complications.

#1411 Intrarenal hemodynamics in patients with coronary heart disease in the post-COVID-19 period

Abstract Background and Aims Coronary heart disease (CHD) and obesity are common pathologies in patients who have had COVID-19. Endothelial dysfunction (ED) markers determination has been important in such patients due to the high risk of cardiovascular diseases progression and complications development. THE AIM Assessment of endothelial dysfunction severity in patients with CHD and obesity in the post-COVID-19 period to improve the management of these patients. Method 49 patients were examined, who had COVID-19 a year ago. The first group (n=24) included patients with coronary artery disease in the post-COVID period. The second group (n=25) included patients with CHD and obesity who had COVID-19. We evaluated data from an ultrasound examination of the kidneys with duplex scanning of the renal arteries (resistance index (RI), pulsation index (PI)). We also studied the medical history, performed an objective examination, the results of a biochemical blood test, albuminuria levels. Results We demonstrated higher RI and PI of interlobar, segmental arteries in persons of the second group. An increase in RI and PI of segmental arteries accompanied by an increase in uric acid (p=0.001). The average level of microalbuminuria in the first group was 15.71 ± 4.51 μg/l, in the second group it was 24.38 ± 5.38 μg/l (p=0.110). Increasing glucose levels accompanied by an elevation of C-reactive protein levels. Obese patients had significantly higher levels of total cholesterol, triglycerides, low density lipoproteins than patients in the first group. Conclusion We observed changes in lipid metabolism, a higher incidence of diabetes mellitus in females, and changes in intrarenal hemodynamic parameters associated with uric acid levels in patients with coronary heart disease and obesity in the post-COVID-19 period.

Analysis Of Direct Medical Costs On Type 2 Diabetes Mellitus Outpatient With Cardiovascular Disease

T2DM is a chronic disease characterized by high blood glucose levels due to insulin resistance or insufficient insulin production. Aim of this study was to analyze the direct medical costs of outpatient T2DM management with cardiovascular disease complications. 58 T2DM patients at the Universitas Sumatera Utara Hospital, in Sumatera Utara, Indonesia were recruited in this study in April-May 2023. This study analyze based on payer prespective named as Badan Penyelenggara Jaminan Sosial (BPJS). This quantitative research was carried out by collecting data retrospectively. Result of this study show that phycian service IDR 8,715,000, drug acquisition cost IDR 13,081,242, laboratory examination IDR 2,531,000, medical execution IDR 410,000, and administration IDR 1,425,000. Conclusion of this study, that drug acquisition cost was the highest cost IDR 13,081,242.

Cardiovascular Disease and Inpatient Complications in Turner Syndrome: A Propensity Score Analysis.

Turner syndrome is a genetic disorder that occurs in female individuals and is characterized by the absence of 1 of the X chromosomes. This study examined the risk of cardiovascular disease and inpatient clinical outcomes in patients with Turner syndrome. Data were extracted from the Nationwide Inpatient Sample 2016 database. Propensity score analysis was used to match women with Turner syndrome and women without Turner syndrome admitted to a hospital in the same year to evaluate the risk of cardiovascular disease and inpatient clinical outcomes in patients with Turner syndrome. After 1:1 matching, 710 women with Turner syndrome and 710 women without Turner syndrome were included in the final analysis. Compared with women without Turner syndrome, women with Turner syndrome were more likely to have a bicuspid aortic valve (9.4% vs 0.01%; P < .01), coarctation of the aorta (5.8% vs 0.3%; P < .01), atrial septal defect (6.1% vs 0.8%; P < .01), and patent ductus arteriosus (4.6% vs 0.6%; P < .01). Patients with Turner syndrome were more likely to have an aortic aneurysm (odds ratio [OR], 2.46 [95% CI, 1.02-5.98]; P = .046), ischemic heart disease (OR, 1.66 [95% CI, 1.10-2.5]; P = .02), heart failure (OR, 3.15 [95% CI, 1.99-4.99]; P < .01), and atrial fibrillation or flutter (OR, 2.48 [95% CI, 1.42-4.34]; P < .01). Patients with Turner syndrome were more likely to have pulmonary arterial hypertension (OR, 2.12 [95% CI, 1.08-4.14]; P = .03) and acute kidney injury (OR, 1.60 [95% CI, 1.06-2.42]; P = .03) and to require mechanical ventilation (OR, 1.66 [95% CI, 1.04-2.68]; P = .04). Turner syndrome is associated with an increased rate of cardiovascular disease and inpatient complications. These findings suggest that patients with Turner syndrome should be screened and monitored closely for cardiovascular disease and inpatient complications.