Control Of Cardiovascular Risk Factors Research Articles

Effect of incremental exercise training interventions in a Cardiac Rehabilitation Program following myocardial infarction

Abstract Background Exercise-based cardiac rehabilitation is recommended after myocardial infarction (MI) to improve prognosis, quality of life and control of cardiovascular risk factors. However, the specific impact of different exercise training interventions remains incompletely understood. Purpose To study the health outcomes of three incremental exercise training interventions during a Cardiac Rehabilitation Program (CRP) following MI. Methods We implemented a post-MI Phase 2 CRP in 2022. After initial exercise testing, a 3-month, individualized aerobic and strength ambulatory training program was provided by Cardiologists and Physical Medicine and Rehabilitation physicians (Group 1, n=58). Additionally, a subset of patients received one session of supervised teaching of aerobic and strength training by physiotherapists (Group 2, n=19), and another subset received 8-20 sessions of in-hospital supervised training (Group 3, n=13). Exercise testing was repeated at the end of Phase 2 and peak oxygen consumption (peak VO2) was measured. We analysed quality of life (SF-36), depression (PHQ2), anxiety (GAD2), adherence to Mediterranean diet (PREDIMED) and pharmacological treatment (Morisky-Green), and weekly physical activity (IPAQ). Health outcomes were compared at the beginning and after Phase 2 CRP. Results The cohort comprised 90 patients who completed Phase 2 CRP (mean age 61.2±10.8 years, 84.4% male and 47.8% smokers). Reductions in systolic blood pressure (-10.3±13.8mmHg), LDL cholesterol (-60.7±35.4mg/dL), weight (-2.8±6.6kg, -3±7.8%) and body mass index (-1±2.2) were attained (p<0.05). Smoking abstinence was accomplished in 88.4% of smokers and most patients achieved an LDL<55mg/dL (81.1%). Improvements in quality of life (SF-36 +10.4±19.4 points, p<0.001) and anxiety and depression symptoms (PHQ2 -0.5±1.6 points and GAD2 -0.6±1.6 points, p<0.01) were noted. An increase in peak VO2 (+5.12±5.44ml/kg/min, +23.5±27.4% from baseline, p<0.001) and predicted functional capacity (+13.4±23.8%, p<0.001) was achieved. Patients increased their reported weekly physical activity by 2520.3±2935.4 METS/week (+132% from baseline, p<0.001) and most of them were adherent to Mediterranean diet (91.1%) and pharmacological treatment (95.6%). Patients achieved similar health outcomes regardless of their exercise training group, except for patients in Group 3, who experienced a more pronounced improvement in peak VO2 (+8.1±6.4ml/kg/min, +37.8±34.7% from baseline; p<0.05) and a trend towards higher increase in predicted functional capacity (+21.7±19.2%, p<0.25) and greater weight loss (-5.5±9.4kg, -5.9±9.6%; p<0.2). Conclusions Supervised in-hospital training during a Phase 2 CRP provides superior physical fitness improvements and more pronounced weight loss in MI patients. However, a Phase 2 CRP based on ambulatory training provides similar benefits regarding other health outcomes, such as control of cardiovascular risk factors and quality of life amelioration.Exercise training interventions in a CRP

Impact of Phase III cardiac telerehabilitation on cardiorrespiratory fitness, safety and adherence in patients with ischemic heart disease

Abstract Background and Purpose Cardiac rehabilitation program (CRP) is an interdisciplinary intervention aimed to improve exercise tolerance, promote the reintegration of patients with heart disease into their normal lives, and reduce the rate of long-term complications and mortality. Of the three phases, Phase II is responsible for achieving sufficient and safe gains to guarantee adaptation, but it is in Phase III where the long-term beneficial effects and self-management will be achieved. Nevertheless, only 30% - 60% of patients report continuing regular exercise during this stage, adherence rates are heterogeneous, and the diversity of results sustained over time is wide. Therefore, cardiac telerehabilitation (CTR) emerged as an affordable tool to achieve closer and safer surveillance at Phase III. The aim of the study is to evaluate the impact of CTR on exercise tolerance, safety and phase III adherence in patients with ischemic heart disease (IHD) Methods Quasi-experimental study that follows Phase II, in which patients with IHD were assigned to virtual sessions at 1st, 3rd, 6th and 12th months, In each session, they were questioned about adherence to training, exercise tolerance, symptoms, outcomes and control of cardiovascular risk factors (CVRF). The percentage of moderate in relation to vigorous physical activity was also evaluated. After one year they underwent a cardiopulmonary exercise test to analyze comparisons in cardiorespiratory fitness (CRFit) and control of CRF between the end of Phase II and the annual follow-up of Phase III. Results At one year of Phase III follow-up, a significant gain in VO2p and maintenance of the other variables associated with fitness such as oxygen pulse (OP2) and VE/VCO2 slope were evident, with a reduction in weight and diastolic blood pressure. There was a significant gain in CRF measured by VO2p and METs-load in those patients who maintained adherence to CTR Phase III (p=0.0001, see figure), with more improvement in those with attendance>50% (2 or more virtual sessions; p=0.008 and p=0.004 , respectively). A directly proportional correlation was observed between the percentage of attendance and the percentage of vigorous physical activity (p<0.01, Pearson r=0.46, CI 0.16-0.68). A positive and significant correlation was observed between the percentage of attendance at CTR Phase III and the number of METs-load (p<0.05, Pearson r=0.36, CI 0.05-0.61), as well as positive and significant correlation with the amount of VO2p (p<0.01, Pearson r=0.50, CI 0.21-0.70) at the end of Phase III. No cardiovascular adverse events were reported. Conclusion CTR strategy in Phase III is safe, effective and has high adherence rates among patients in our population, achieving control of CVRF, maintaining levels of METs-load and obtaining even greater increases in VO2p at one year of follow-up compared to those obtained at the end of Phase II.

HIV and cardiovascular risk: should we use other targets for cholesterol control? Brazilian data compared to major studies

Abstract In daily clinical practice, cardiologists are confronted with patients with HIV/AIDS and this population needs special attention due to their higher cardiovascular risk. Studies show an increase in cardiovascular disease (CVD) among people with HIV/AIDS and one of the main causes of death in this group. HIV is associated with dyslipidaemia and endothelial damage, which have been proposed as a cause of the increased risk of events, and HIV replication is a determining factor in endothelial dysfunction. With antiretroviral therapy (ART) there has been a reduction in morbidity and mortality from HIV/AIDS, however, several studies have shown an increase risk factors for CVD in this population, both in individuals on ART and those not on it. Two high-impact studies related to cardiovascular risk in the HIV population are Start and Smart. Studies are important for understanding this occurrence and its relationship with the presence of the virus and the use of antiretroviral therapy in this population. In view of the higher cardiovascular risk of these patients and the question of whether they deserve a different cholesterol target from other populations. Methods A retrospective, observational study was carried out on a sample of HIV patients from the Brazilian STD/AIDS Reference Centre (CRT), selected by lottery using their registration number, from 1 January 2011 to February 2023, aged over 18. 148 medical records were assessed and the following were collected population characteristics. Discussion: the CRT data were compared with the Start and Smart studies. The Reprieve study showed benefits earlier than expected with patients receiving a statin. An interim analysis revealed a 35 per cent reduction in serious adverse cardiovascular events in the statin group, leading to the placebo group stopping earlier. The viral load varied between the studies, with CRT having an average of 500,000 copies/ml, Start 12,759 copies/ml and Smart less than 400 copies/ml. Studies have associated HIV infection and higher viral loads with impaired endothelial function and vasodilation. Despite the data in the literature, all the patients with heart disease had undetected viral loads and CD4+ cell counts above 500 cells/mm³. Those with a high viral load in the study were not the ones with CVD. Conclusions In CRT, the percentage of primary events attributable to serious conditions unrelated to AIDS was 1.3 per cent. Analysing biomarkers could elucidate the effects of antiretroviral therapy on arterial disease. Another fact that probably justifies the low occurrence of cardiovascular and cerebral events in CRT is the multidisciplinary care given to patients, providing intensive primary and secondary prevention through counselling and follow-up. We suggest better control of cardiovascular risk factors with multi-professional intervention and more aggressive targets for the control of comorbidities.Characteristics and Cardiovascular risk

Advancing care in type 2 diabetes and atherosclerosis: assessing pharmacist-led strategies in England's primary care - a retrospective observational study

Abstract Background Type 2 diabetes (T2D) mellitus is a complex multi-system disorder with a tendency to develop complications. ‘Persistence to therapy’ plans affect almost 50% of all people with T2D, leading to suboptimal glycaemic and cardiovascular (CVD) risk factor control. The interplay between T2D and established atherosclerotic cardiovascular disease (ASCVD) underscores the need for a comprehensive, multidisciplinary approach to care that addresses both glycaemic control and CVD risk factors. Purpose This study retrospectively analysed pharmacist-led interventions in patients living with T2D and established ASCVD in general practices in a large UK city. Methods A retrospective pre-post observational study was conducted using electronic health record data from men and women diagnosed with T2D and ASCVD. Participants attended an independent prescribing pharmacist-led clinic within 21 general practices. The practices operated linked and comprehensive electronic health records systems, facilitating access to high-quality longitudinal data that align with study objectives. Results A total of 380 patients received pharmacist-led interventions. Comparisons of pre-intervention and post-intervention data revealed a significant decrease in HbA1c levels (73.7 ± 10.7 mmol/mol vs 67.2 ± 8.5 mmol/mol, p < 0.01), systolic blood pressure (132 ± 10.2 mmHg vs 125.9 ± 9.9 mmHg, p < 0.01), and diastolic blood pressure (76.8 ± 5.9 mmHg vs 72.4 ± 5.0 mmHg, p < 0.001). Additionally, total cholesterol levels significantly reduced from 4.4 ± 0.7 mmol/L to 3.9 ± 0.7 mmol/L (p < 0.001). The proportion of patients achieving the triple target of HbA1c (≤58 mmol/mol), BP (≤140/80 mmHg), and total cholesterol (≤5 mmol/L) increased significantly from 2.4% before the intervention to 23.4% afterward (p < 0.001). The initiation of the sodium-glucose co-transporter 2 inhibitors (SGLT2i) therapies was the most common prescribing intervention (67%). Conclusions Pharmacist-led interventions in a general practice setting significantly improved several critical diabetes and CVD risk related outcomes. These findings underscore the potential benefits of integrating pharmacist-led care models into the management of T2D, particularly for patients with concurrent ASCVD and adopting an individualised, evidence-based approach to prescribing interventions.

Impact of provision of abdominal aortic calcification results on fruit and vegetable intake: 12-week randomized phase 2 controlled trial

Provision of non-invasive vascular imaging results to individuals has been shown to improve cardiovascular disease risk factor control: its impact on diet remains uncertain. In this two-arm, single-blind, parallel, 12-week randomized controlled trial, 240 participants, 57.5% females aged 60–80 y had abdominal aortic calcification and clinical assessments performed at a hospital clinic. Participants were randomized 1:1 to receive (intervention n = 121) or not (control n = 119) their calcification results. Both groups received educational resources on cardiovascular disease risk control and were unblinded to the intervention. Outcome measures were performed at baseline and 12 weeks. The primary outcomes of the study were changes in fruit and vegetable intake measures over 12 weeks assessed using plasma carotenoid concentrations (biomarkers of FV intake) and a food frequency questionnaire. Secondary outcomes included 12-week changes in other aspects of the diet, physical activity, body weight, blood pressure, heart rate, lipid profile, glucose concentrations, estimated cardiovascular disease risk score, and medication use. Between-group differences were tested using linear mixed-effects regression. There were no between-group differences in the primary outcomes at 12 weeks: plasma carotenoids (mean difference +0.03 µg/mL [95%CI −0.06, 0.13]) and fruit and vegetable intakes (+18 g/d [−37, 72]). However, the provision of calcification results led to between-group differences in serum total (−0.22 mmol/L [−0.41, −0.04]) and non-HDL (−0.19 mmol/L [−0.35, −0.03]) cholesterol, and estimated cardiovascular disease risk score (−0.24% [−0.47, −0.02]). No between-group differences were seen for other secondary outcomes. In this work, providing vascular imaging results did not improve diet but did improve some cardiovascular disease risk factors (Australian and New Zealand Clinical Trials Registry ACTRN12618001087246).

Progressive T1 high-intensity plaques in carotid stenosis: Comparative MRI analyses in asymptomatic and symptomatic phases of low-grade stenosis

Background and PurposeCarotid artery stenosis, particularly the progression from asymptomatic to symptomatic lesions, is a key factor in cerebrovascular events. This study identifies predictors of symptom development in low-grade carotid stenosis (<50%), focusing on intraplaque hemorrhage (IPH) and dynamic plaque changes. Materials and MethodsWe conducted a retrospective study analyzing 30 cases of symptomatic low-grade carotid stenosis, using carotid MRI before and after symptom onset. Key measures included relative plaque signal intensity (rSI) and high-intensity plaque (HI plaque) volume. Stepwise regression analysis examined the influence of these factors on Symptomatic rSI, Symptomatic plaque volume, and NIHSS scores. ResultsSignificant increases were observed in rSI (1.32 ± 0.32 to 1.69 ± 0.25, p < 0.001) and HI plaque volume (296.4 ± 362.7 mm³ to 717.5 ± 554.9 mm³, p < 0.001) from asymptomatic to symptomatic phases. Past smoking (p = 0.008) and statin use (p = 0.04) were associated with higher Symptomatic rSI, while poor risk factor control (p = 0.03) was negatively associated. Female sex (p = 0.007) and current smoking (p = 0.009) were linked to smaller Symptomatic plaque volumes, while ischemic heart disease (p = 0.0002) and poor risk factor control (p = 0.002) predicted larger plaque volumes. Larger plaques were correlated with higher NIHSS scores (p = 0.002). ConclusionsIPH and plaque volume are key markers of progression in low-grade carotid stenosis. Poor control of cardiovascular risk factors and a history of ischemic heart disease contribute to plaque burden and stroke severity. Continuous monitoring and strict risk management are essential in reducing stroke severity in these patients.

Diagnóstico de la diabetes mellitus tipo 2. Situación epidemiológica, características de los pacientes, factores de riesgo y pronóstico

Type 2 diabetes mellitus (DM2) is one of the most prevalent chronic diseases. It accounts for approximately 90% of diabetes cases worldwide. This disease is characterized by insulin resistance and the progressive dysfunction of pancreatic beta cells, resulting in chronic hyperglycemia. In recent decades, the prevalence of DM2 has increased considerably due to changes in lifestyles, population aging, and urbanization. The complications associated with DM2, such as retinopathy, nephropathy, neuropathy, cardiovascular diseases, and lower extremity amputations, are a significant burden in terms of both healthcare and the economy. Intensive control of blood glucose and cardiovascular risk factors is crucial for preventing these complications. Early detection and effective interventions, such as lifestyle changes and pharmacological treatments, are essential in order to reduce the incidence of DM2 and its comorbidities.

Breast cancer and cardiovascular health.

Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer.

Polypills in the Management of Cardiovascular Risk-A Perspective.

Cardiovascular disease and cardiovascular risk factors are global healthcare problems, given their high prevalence and the recognized low rates of adequate control despite the abundant body of evidence on different therapeutic options. The World Heart Federation has scrutinized the reasons for poor control of cardiovascular risk factors. Among these reasons, patients' poor adherence to treatment regimens as well as limited rates of evidence-based therapy prescription from healthcare providers play a substantial role in the challenge of cardiovascular risk management. Polypills are fixed-dose combinations including two or more active drugs, from different pharmacological classes, combined in a single dosage form. Polypills were designed to simplify the clinical management of pharmacotherapy and increase adherence to treatment. From this perspective, we discuss the current literature on the use of polypills in the primary and secondary prevention of cardiovascular disease as well as future challenges and the potentials of this treatment strategy.

Ten Recommendations for Accelerating Hypertension and Diabetes Control to Reduce Stroke, Heart, and Renal Disease with the Aim to Save Lives in Cameroon Through Partnerships and Collaborations.

Hypertension and diabetes are currently the most common, treatable, and controllable cardiovascular and metabolic risk factors for stroke, heart, and renal diseases in Cameroon. Hypertension affects 30% of adults aged≥20years with 90% as uncontrolled cases, while type 2 diabetes affects 6% of the same population, with 70% remaining underdiagnosed. Despite publication of the first Roadmap on raised blood pressure by the World Heart Federation in 2015, the Pan African Society of Cardiology Roadmap in 2017, andthe technical package for cardiovascular disease management in primary health care (WHO-HEARTS) in 2020, very little progress has been made in improving the diagnosis, treatment, and control of cardiovascular risk factors and diseases in Cameroon. The Cameroon Cardiac Society and a dozen Cameroon non-communicable diseases societies, national organizations from the community and the civil society, along with researchers and members of academia and the health sector, came together under the patronage of representatives of the government to propose new strategies to improve hypertension and diabetes control and save lives in Cameroon. Two simple and practical algorithms for the management of hypertension and diabetes were developed. The ten recommendations tailored to be efficiently implemented in our country were summarized under the acronym 'A SMART VIEW' (Awareness, Screening, Manufacture, Activity, Research, Task-shifting, HIV/AIDS, Insurance, Education, and WHO-HEARTS). It is our hope that all stakeholders will further collaborate to remove barriers and enhance facilitators to deploy the proposed actions and reduce the burden of uncontrolled hypertension and untreated diabetes in Cameroon.

Position paper on retinal arterial occlusion. SEMI-SERV

The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.

Abstract P363: Prevelance of Hypertension in Kidney Transplant Recepients as Determined by Ambulatory BP Monitoring (ABPM)

Background: Cardiovascular disease remains the most common cause of death among kidney transplant recipients, with hypertension being one of the most prevalent risk factors. Understanding the current prevalence of hypertension in this population is critical to help shape post-transplant care policies and guidelines and ensure proper management of CVD risk. Methods: We included all kidney transplant recipients who received their transplant between 2019 and 2023 at our center and who completed 24-hour ABPM at 12 months post-transplant. We reported data in mean (SD) unless noted otherwise. BP was categorized per AHA guidelines. This study was deemed exempt by the IRB. Results: A total of 940 patients were included in this study. Detailed results are seen in Figure 1 and Table 1. Notable to mention that 60% of the patients had blood pressure &gt; 130/80 mmHg at 12 months post kidney transplant, with the majority being stage 1. Patients with more severe hypertension tended to be older, had lower eGFR, and had more comorbidities. They also had lower diastolic blood pressure than stage 1 HTN patients, consistent with older age. Night-time BP was significantly higher among stage 2 HTN patients. Conclusion: Hypertension remains a prevalent condition post-kidney transplant despite the majority of patients having satisfactory kidney allograft function. Ongoing BP monitoring and assessment of out-of-office BP post-kidney transplantation is critical to ensure control of this important cardiovascular risk factor. 24-hour ABPM has several advantages in this group, including accurate measurement of out-of-office BP and detection of nocturnal hypertension, an independent risk factor for cardiovascular events. Additional studies are needed to describe the hypertension subphenotypes (e.g., sustained vs. masked) and to identify predictors of severe uncontrolled hypertension in this patient population.

Predicting factors of blood pressure normalization in hypertensive patients after short-term follow-up.

Normalization of blood pressure in hypertensive patients is a major challenge for practitioners. Knowledge of the factors associated with normalization of blood pressure could help optimize management of these hypertensive patients. In this study, we analysed the factors predictive of this in a population of hypertensive patients followed as outpatients in a specialised department. Retrospective and analytic study (January 2021-May 2022) of adult hypertensive patients over 40 years old who had been receiving antihypertensive treatment as outpatients in the Cardiology Department of the Bouake Teaching Hospital for at least 6 months. We studied the epidemiological and clinical parameters as well as the factors involved in the normalization of blood pressure in this population. Statistical analysis was performed using SPPS version 26 software (SPSS Inc., Chicago, IL, USA). We collected 194 patients records (57.7% women). The mean age was 59.13 years [extremes: 40-89 years]. One hundred and nine (56.2%) patients had a low socioeconomic status and 151 (77.83%) had at least 2 cardiovascular risk factors. The mean systolic blood pressure on admission was 171.12 ± 22.38 mmHg [extremes: 140-259 mmHg] and the mean diastolic blood pressure was 97.98 ± 17.83 mmHg [extremes: 60-168 mmHg]. First-line treatment consisted of dual anti-hypertensive therapy (n = 133; 68.55%) and fixed combination (n = 152; 78.35%). Only 25.25% (n = 49) of patients achieved normalization of blood pressure with therapeutic adherence estimated at 37.62% (n = 73). In multivariate analysis adjusted for anti-hypertensive treatment adherence, age (OR = 1.03; 95% CI = 1.002-1.059; p = 0.039), absence of alcoholism (OR = 9.48; 95% CI = 2.13-42.11; p = 0.003), number of cardiovascular risk factors <2 (OR = 1.52; 95% CI = 1.06-2.16; p = 0.021), normalization of uricemia (OR = 1.05; 95% CI = 1.00-1.11; p = 0.039) and natraemia (OR = 1.01; 95% CI = 1.00-1.03; p = 0.021), dual therapy (OR = 0.40; 95% CI = 0.18-0.90; p = 0.027), change in treatment for optimization (OR = 4.22; 95% CI = 1.71-10.37; p = 0.002), intellectual education (OR = 10.40; 95% CI = 4.31-25.10; p < 0.001) and health insurance (OR = 0.09; 95% CI = 0.04-0.21; p < 0.001) were the main factors predicting normalization of blood pressure. Control of cardiovascular risk factors and compliance with treatment are the main factors in normalizing blood pressure.

Joint effects of physical frailty and traditional cardiovascular risk factor control on cardiovascular disease in patients with diabetes

ObjectivesPhysical frailty has been found to increase the risk of multiple adverse outcomes including cardiovascular disease (CVD) in diabetic patients, but whether this could be modified by traditional risk factor control remains unknown. We aimed to explore the joint and interaction effects of frailty and traditional risk factor control on the risk of CVD. DesignA population-based cohort study. Setting and participantsWe included 15,753 participants with type 2 diabetes at baseline from UK Biobank. MeasurementsPhysical frailty was assessed by Fried criteria’s frailty phenotype. The degree of risk factor control was determined by the numbers of the following factors controlled within the target range, including glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, smoking, and kidney condition. Incident CVD included coronary heart disease, stroke, or heart failure. Cox proportional hazard models were used to assess the individual and joint effects of frailty and risk factor control on the risk of CVD. ResultsAfter a median follow-up of 13.5 years, 1129 incident CVD events were observed. Compared with non-frailty, both prefrailty and frailty were significantly associated with increased risk of CVD (HR 1.22, 95% CI [1.13, 1.31] for pre-frailty and 1.70 [1.53, 1.90] for frailty). For the joint effects, participants with frailty and a low degree of risk factor control (control of 0−1 risk factors) had the highest risk of CVD (2.92 [2.04, 4.17]) compared to those with non-frailty and optimal risk factor control (control of 4−5 risk factors). Moreover, a significant additive interaction between frailty and risk factor control was observed, with around 3.8% of CVD risk attributed to the interactive effects. ConclusionsBoth prefrailty and frailty were associated with a higher risk of CVD in participants with type 2 diabetes. Moreover, physical frailty could interact with the degree of risk factor control in an additive manner to increase the CVD risk.

Sleep disturbances in type 1 diabetes and mitigating cardiovascular risk.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in persons with type 1 diabetes (T1D). Despite control of known cardiovascular (CV) risk factors and better glycemic management, persons with T1D still face heightened CVD risk, suggesting additional contributing factors. Sleep has recently been recognized as a CV risk factor, however; the role of sleep in CVD specifically in T1D population has only started to emerge. Extensive evidence suggests that persons with T1D often encounter sleep disturbances. This review aims to comprehensively explore the relationship between sleep disturbances and CVD in T1D, and proposed possible mediators including glycemic control which has been studied more extensively, and less studied factors such as blood pressure, lipid metabolism, and weight management. Stress and self-care behaviors likely also play a role in the relationship between sleep disturbances and CVD. The evidence regarding sleep interventions in the context of T1D in mitigating these CV risk factors has recently been shown in early, small-scale studies. Sleep assessments should be a part of standard of care in persons with T1D. Further research should focus on understanding the impact and mechanistic pathways of sleep disturbances on CV risk, and developing T1D specific sleep interventions to reduce CVD burden in this population.

Association Between Patient Sex and Familial Hypercholesterolemia and Long-Term Cardiovascular Risk Factor Management 5 Years After Acute Coronary Syndrome.

Long-term control of cardiovascular risk factors after acute coronary syndrome (ACS) is the cornerstone for preventing recurrence. We investigated the extent of cardiovascular risk factor management in males and females with and without familial hypercholesterolemia (FH) 5 years after ACS. We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations. A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; P=0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; P<0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; P<0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; P=0.001). Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.

Five-year trend in secondary prevention medication prescription and risk factor control among patients with diabetes mellitus and cardiovascular diseases in Perak health clinics.

Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events, particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics. Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control. Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of ≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities. SPM prescription has increased over time, but the achievement of treatment targets, particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases.

Adherence to optimal medical therapy and control of cardiovascular risk factors in patients after ST elevation myocardial infarction in Mexico.

In developing countries, there is a notable scarcity of real-world data on adherence to optimal medical therapy (OMT) and its correlation with major cardiovascular adverse events (MACEs) after ST-elevation myocardial infarction (STEMI). Our study focuses on addressing this gap by evaluating adherence to OMT, examining its influence on the risk of MACEs after STEMI, and assessing subsequent cardiovascular risk factor control in Mexico. We conducted a prospective observational study of post-STEMI patients after hospital discharge. Adherence to treatment was assessed over a median of 683 days (interquartile range: 478-833) using the Simplified Medication Adherence Questionnaire (SMAQ). Patients were followed up for 4.5 years to monitor MACEs (cardiovascular death, cardiogenic shock, recurrent myocardial infarction, and heart failure). We included 349 patients with a mean age of 58.08 years (±10.9), predominantly male (89.9%). Hypertension (42.4%), smoking (34.3%), type 2 diabetes mellitus (31.2%), obesity (22.92%), and dyslipidemia (21.4%) were highly prevalent. Adherence to OMT per SMAQ was 44.7%. The baseline clinical characteristics of adherent and non-adherent patients did not significantly differ. OMT prescription rates were as follows: acetylsalicylic acid, 91.1%; P2Y12 inhibitors, 76.5%; and high-intensity statins, 86.6%. While non-adherent patients had a numerically higher rate of MACEs (73 vs. 49 first events), there was no statistically significant difference (hazard ratio 1.30, 95% confidence interval 0.90-1.88). In this real-world study of patients after STEMI, we observed low adherence to OMT, a low proportion of global cardiovascular risk factor control, and a numerically higher incidence of recurrent major adverse cardiovascular events in non-adherent patients. Strategies to improve adherence to OMT and risk factor control are needed.

Long term worsening of arterial stiffness from monitoring of QKD interval predicts the occurrence of cardiovascular events.

Arterial stiffness is an independent predictor of cardiovascular events in different populations. Destiffening appears to be possible through the control of the main cardiovascular risk factors, with however important individual variations. There are so far too few data available on the prognostic importance of changes in arterial stiffness. We tested the consequences of changes in arterial stiffness assessed with the QKD method on the incidence of cardiovascular events in a cohort of hypertensive patients. The change of QKD100-60 was calculated as the difference between baseline and last follow-up value. Patients were classified as group 0 with stable or increased QKD100-60 and group 1 with decreased QKD100-60 (increased arterial stiffness). The prognostic of these two groups was analysed with a Cox model including age, baseline QKD100-60, 24 h SBP (baseline and change), delay between first and last recording, sex, diabetes, smoking, and hypercholesterolemia. We included 555 essential hypertensive patients with 24 h ambulatory measurement of BP and QKD at baseline and follow-up. The follow-up period was 12.28 ± 7.38 years with an average time between baseline and last recording of 8.86 ± 6.48 years. 94 cardiovascular events occurred. The group with increased arterial stiffness shows the double risk of occurrence of cardiovascular event than the group with stable or reduced arterial stiffness independently of other factors including changes in 24 h SBP.

Impact of Isolated Type 2 Endoleak on Subsequent Cardiovascular Events and Mortality

Assess subsequent cardiovascular events and all-cause mortality in patients with intact abdominal aortic aneurysm (AAA) treated by endovascular aneurysm repair (EVAR) according to the existence of isolated endoleak type 2 (EL2) at 1year after EVAR implantation. This retrospective, single-center study included patients treated with EVAR between 2010 and 2017 in the vascular surgery department of the University Hospital of Lyon with an infrarenal AAA > 50mm. The baseline clinical characteristics collected just before EVAR were retrieved from electronic patient records of our institution. AAA characteristics, procedure, and the 1-year postoperative computed tomography angiography (CTA) were reported. Study end points, major adverse cardiovascular events (MACE), major adverse lower-extremity events (MALE), and all-cause mortality were recorded during follow-up. Patients were divided into 2 groups according to the presence of isolated EL2 (EL2 +) or absence (EL2 -) of any endoleak on CTA at 1year. MACE, MALE, and all-cause mortality were compared between both groups. During the study period, 589 patients were treated by endovascular surgery and 207 were included. According to the CTA results at 1year, 60 patients (29%) were included in the EL2+group and 147 patients (71%) in the EL2 - group. A total of 109 patients (53%) experienced a MACE or MALE; significantly fewer patients in the EL2+than in the EL2 - group did so (P=0.009). There were 47 patients (23%) who experienced at least 1 MALE, and the frequency was significantly lower in the EL2+group (P=0.017). Patients with AAA treated by EVAR who did not develop EL2 at 1year were at higher risk of MALE during follow-up. This might be explained by more frequent symptomatic lower extremity peripheral arterial disease at baseline in this group. These patients therefore require a closer follow-up and strict control of cardiovascular risk factors to prevent cardiovascular morbi-mortality.