Cumulative Incidence Of Cardiovascular Disease Research Articles

Disparities in tobacco smoking and risk of cardiovascular disease in people with low socioeconomic status or serious psychological distress: A simulation analysis

High tobacco smoking prevalence in people with low SES or serious psychological distress (SPD) in the U.S. may increase cardiovascular disease (CVD) risk among these marginalized subpopulations. We estimate how smoking disparities contribute to CVD disparities. Using the Simulation of Tobacco and Nicotine Outcomes and Policy model, a validated microsimulation model of tobacco use and clinical outcomes, we used 2004-2019 data from the National Health Interview Survey to first compare 20-year cumulative CVD incidence for 40-year-olds by sex, smoking status, and marginalized subpopulation membership. Second, we simulated the marginalized subpopulations with representative age, sex, and smoking status distributions to estimate 20-year cumulative CVD incidence under status quo and counterfactual scenarios. In the counterfactual scenario, smoking prevalence and trends in the low SES and SPD subpopulations match those in the higher SES and non-SPD subpopulations, respectively. The model-projected impact of smoking on 20-year cumulative CVD incidence is considerably larger than the impact of low SES or SPD; for example, among 40-year-old males, cumulative CVD incidence is 28.3% for low SES people who currently smoke, 13.0% for low SES people who never smoke, and 26.2% for higher SES people who currently smoke. In the second analysis, in the status quo scenario, model-projected 20-year cumulative CVD incidence is 19.3% for low SES and 22.1% for SPD; in the counterfactual scenario, it is 18.1% for low SES and 19.6% for SPD. Interventions focused on reducing smoking disparities could substantially reduce CVD in marginalized subpopulations.

Using machine learning methods to investigate the impact of age on the causes of death in patients with early intrahepatic cholangiocarcinoma who underwent surgery.

The impact of age on the causes of death (CODs) in patients with early-stage intrahepatic cholangiocarcinoma (ICC) who had undergone surgery was analyzed in this study. A total of 1555 patients (885 in the older group and 670 in the younger group) were included in this study. Before and after applying inverse probability of treatment weighting (IPTW), the different CODs in the 2 groups were further investigated. Additionally, 7 different machine learning models were used as predictive tools to identify key variables, aiming to evaluate the therapeutic outcome in early ICC patients undergoing surgery. Before (5.92 vs. 4.08years, P < 0.001) and after (6.00 vs. 4.08years, P < 0.001) IPTW, the younger group consistently showed longer overall survival (OS) compared with the older group. Before IPTW, there were no significant differences in cholangiocarcinoma-related deaths (CRDs, P = 0.7) and secondary malignant neoplasms (SMNs, P = 0.78) between the 2 groups. However, the younger group had a lower cumulative incidence of cardiovascular disease (CVD, P = 0.006) and other causes (P < 0.001) compared with the older group. After IPTW, there were no differences between the 2 groups in CRDs (P = 0.2), SMNs (P = 0.7), and CVD (P = 0.1). However, the younger group had a lower cumulative incidence of other CODs compared with the older group (P < 0.001). The random forest (RF) model showed the highest C-index of 0.703. Time-dependent variable importance bar plots showed that age was the most important factor affecting the 2-, 4-, and 6-year survival, followed by stage and size. Our study confirmed that younger patients have longer OS compared with older patients. Further analysis of the CODs indicated that older patients are more likely to die from CVDs. The RF model demonstrated the best predictive performance and identified age as the most important factor affecting OS in early ICC patients undergoing surgery.

Life’s Essential 8 and Incident Cardiovascular Disease in U.S. Women With Breast Cancer

BackgroundRelationships between lifestyle risk factors and cardiovascular disease (CVD) risk in women with breast cancer (BC) are underexplored. ObjectivesTo evaluate the incidence of CVD in relation to the Life’s Essential 8 (LE8) score among women with BC. MethodsData from the Women’s Health Initiative were utilized. The primary exposure was the LE8 score assessed prior to BC diagnosis. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). The primary endpoint was a composite of incident CVD events, which included coronary heart disease, defined as myocardial infarction along with coronary revascularization, CVD death, and stroke. We calculated the cumulative incidence of CVD and estimated hazard ratios. ResultsAmong 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% CI: 0.46-0.69) for moderate CVH and 0.34 (95% CI: 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD. ConclusionsHigher LE8 scores were associated with a lower risk of incident CVD among women with BC in the United States.

Transition between cardiometabolic conditions and body weight among women: which paths increase the risk of diabetes and cardiovascular diseases?

Previous studies investigated the association of body weight and hypertension with risk of incident cardiometabolic multimorbidity. Our aim was to estimate the risk of diabetes and cardiovascular disease later in life for subjects with different progression patterns of overweight, obesity, and hypertension in mid-life. This was a prospective cohort study in which data from 12,784 participants in the Australian Longitudinal Study on Women’s Health were used. Multistate model was used to study the progression pattern of overweight, obesity, hypertension, diabetes, and cardiovascular disease over the life course. The cumulative incidence of diabetes and cardiovascular disease up to the age of 73 was estimated for women with different patterns of other conditions. The six most common paths and corresponding cumulative incidences for diabetes were overweight 5.1%, obesity 11.5%, hypertension 6.9%, progression from overweight to obesity 8.2%, overweight and hypertension 12.1%, and obesity and hypertension 36.8%. For women with diabetes and other conditions, the cumulative incidence of cardiovascular disease (heart disease or stroke) as the next immediate condition was 22.4%. The corresponding figure for women who only had a report of diabetes but did not have high body weight or hypertension was 8.3%. The higher risk of transition from healthy state to a cardiometabolic condition was associated with low education, income stress, smoking, not drinking alcohol (compared to low drinkers), physical inactivity, and high perceived stress. Women with obesity and hypertension in middle-age had a substantially higher risk of developing diabetes and cardiovascular disease than women without these potentially preventable conditions.

ASSOCIATIONS OF THE CARDIOMETABOLIC INDEX WITH THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS WITH HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA: RESULTS OF A LONGITUDINAL COHORT STUDY

Objective: We aimed to explore the relationship between the cardiometabolic index (CMI) and cardiovascular disease (CVD) and its subtypes (coronary artery disease and stroke) in patients with hypertension and obstructive sleep apnea (OSA). Design and method: We conducted a retrospective cohort study enrolling 2067 participants from the Urumqi Research on Sleep Apnea and Hypertension study. The CMI was calculated as triglyceride to high-density lipoprotein cholesterol ratio × waist-to-height ratio. Participants were divided into three groups (T1, T2, and T3) according to the tertile of CMI. The Kaplan-Meier method helped to calculate the cumulative incidence of CVD in different groups. We assessed the association of CMI with the risk of CVD and CVD subtypes by estimating hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox models. Results: During a median follow-up of 6.83 years (interquartile range: 5.92-8.00 years), 326 incident CVD were identified, including 121 incident stroke and 205 incident coronary heart disease (CHD). Overall, after adjusting for confounding variables, CMI was positively associated with the risk of new-onset CVD (per SD increment, adjusted HR: 1.31; 95% CI: 1.20, 1.43), new-onset CHD (per SD increment, adjusted HR: 1.33; 95% CI: 1.20, 1.48), and new-onset stroke (per SD increment, adjusted HR: 1.27; 95% CI: 1.10, 1.47). Similar results were obtained in various subgroup and sensitivity analyses. Adding CMI to the baseline risk model for CVD improved the C-index (P &lt; 0.001), continuous net reclassification improvement (P &lt; 0.001), and integrated discrimination index (P &lt; 0.001). Similar results were observed for CHD and stroke. Conclusions: There was a positive association between CMI levels and the risk of new-onset CVD in patients with hypertension and OSA. This finding suggests that CMI may help identify people at high risk of developing CVD.

Association between cardiac conduction block and cardiovascular disease and all-cause mortality: The kailuan study

BackgroundAlthough bundle branch block and atrioventricular block are recognized to be association with cardiovascular disease (CVD) and mortality, the relationship between cardiac conduction block (CCB) and both CVD and all-cause mortality has yet to be explored. AimsTo explore the relationship between CCB and CVD and all-cause mortality. Methods and resultsWe included 145,805 subjects (mean age 49.7 years, 81.2% males) from the kailuan study. CCB was diagnosed through a 12‑lead electrocardiograph (ECG). Mortality and CVD events were ascertained through multiple sources, including a municipal social insurance institution, hospital records, death certificates, and regular active follow-ups. After a mean follow-up of 12.5 years, 18,301 cases developed all-cause mortality. After excluding 4443 subjects with CVD presence at baseline, 13,208 cases of CVD occurred among the 141,362 study subjects during follow-up. Compared with non-CCB group, the cumulative incidence of CVD and all-cause mortality for CCB group was 18.38% VS 12.14% and 33.45% VS 14.18%, respectively. The multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) with CCB group were 1.25(1.17–1.34) for CVD, and 1.31(1.25–1.38) for all-cause mortality. Additionally, there were generally stronger associations for CCB with all-cause mortality and CVD in younger participants compared with their older counterparts (Ps-interaction <0.001). ConclusionCCB can increase the risk of CVD and all-cause mortality in the general population. Our findings highlight the importance of strategies for preventing CCB to reduce the risk of CVD and mortality.

Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents

Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding. To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD. This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022. Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence. The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017. A total of 1 138 833 men (mean [SD] age, 18.3 [0.8] years), of whom 463 995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48 606 experienced a CVD outcome (18 598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile) was 7.2% (95% CI, 5.9%-8.6%) for BMI and 1.8% (95% CI, 1.0%-2.5%) for cardiorespiratory fitness. Similarly, in the sibling analysis, hypothetically shifting everyone in the worst deciles of BMI to the middle decile would prevent 14.9% of CVD at age 60 years, whereas the corresponding number for cardiorespiratory fitness was 5.3%. In this Swedish national cohort study, cardiovascular risk factors in late adolescence, especially a high BMI, were important targets for CVD prevention, independently of unobserved genetic and environmental factors shared by full siblings. However, the role of adolescent cardiorespiratory fitness in CVD may have been overstated by conventional observational studies.

Population prevalence of ECG abnormalities and risk of incident CVD outcomes: 5-year follow-up of 25,000 Chinese adults

Abstract Background and purpose Little is known about the utility of automated reporting of electrocardiograms (ECGs) for prediction of cardiovascular disease (CVD) types in low- and middle-income countries. We compared derived ECG phenotypes and a clinical risk score for prediction of incident major CVD types in a population study of Chinese adults. Methods CVD risk factors were collected and 12-lead ECGs performed with automated interpretation using Mortara’s VERITAS™ algorithm on 25,239 adults in the China Kadoorie Biobank resurvey in 2013-2014. Incident CVD outcomes were recorded prospectively over a median follow-up of 5 years. We examined the prevalence and prognosis of broad ECG phenotypes developed from automated outputs: (i) atrial fibrillation/flutter (AFib); (ii) ischaemia (possible/probable or definite); (iii) left ventricular hypertrophy (LVH); and (iv) normal ECG. Participants were stratified by modified CHA2DS2-VA score (&amp;lt;3 vs ≥3) and by age at resurvey. Kaplan-Meier curves were plotted to display cumulative CVD event rates during follow-up for ECG phenotypes. Results The mean (SD) age at resurvey was 59.5 (10.2) years, 62% were women and 57% were from rural areas. Overall, 44.3% had a normal ECG and 1.2% had AFib (0.4%, 0.9%, and 3.9% at ages &amp;lt;55, 55-69, and 70+). A total of 28.1% had ischaemia, and 13.6% had LVH (Table). The prevalence of all pathological ECG phenotypes increased with age and prior CVD. AFib was more common in individuals with CHA2DS2-VA ≥3 vs &amp;lt;3 (3.6% vs 0.8%). CHA2DS2-VA ≥3 was associated with higher HRs (95% CI) for stroke (1.91; 1.67-2.19), ischaemic heart disease (IHD) (1.79; 1.52-2.11), and heart failure (HF) (1.80; 1.23-2.62), respectively. Compared to CHA2DS2-VA ≥3, HRs for the AFib phenotype were greater for IHD (2.62; 1.97-3.50) and HF (3.79; 2.21-6.49) and similar for stroke (1.88; 1.44-2.77). LVH was most strongly associated with HF (1.83; 1.31-2.55) and positive associations with each CVD type were greater for definite vs probable/possible ischaemic phenotypes. After adjustment for age, 5-year cumulative incidence rates of CVD were 36.8% in individuals with AFib, 19.4% in those with ischaemia (all), 18.0% in those with LVH, and 14.1% in those with normal ECGs. Individuals with CHA2DS2-VA ≥3 had a 3-fold greater cumulative incidence of CVD than those with scores &amp;lt;3 (40.9% vs 13.9%). Conclusions All pathological ECG phenotypes were associated with higher risks of CVD outcomes, but AFib was most strongly predictive and comparable to moderate-high CHA2DS2-VA scores. However, absolute risks of subsequent CVD events were similar in those with ischaemia, LVH and a normal ECG. When combined with clinical risk scores, automated ECG interpretation is a useful adjunct in low-resource settings for CVD risk prediction in population studies and in clinical practice.

Clonal Hematopoiesis Is Associated with Cardiovascular Disease Risk and Worse Survival after Autologous Hematopoietic Cell Transplantation for Lymphoma

Introduction: Autologous hematopoietic cell transplantation (HCT) is an effective treatment for patients with relapsed or refractory lymphoma, and use of HCT has contributed to a growing number of survivors. Despite these improvements in outcomes, long-term survivors of lymphoma are at high risk of developing clinically significant cardiovascular disease (CVD) which, to date, has largely been attributed to pre-HCT cardiotoxic therapeutic exposures (e.g. anthracyclines, radiation) and modifiable risk factors (e.g. hypertension, diabetes, dyslipidemia) after HCT. In the general population, clonal hematopoiesis of indeterminate potential (CHIP), which refers to clonal expansion of hematopoietic stem cells with somatic mutations, has been associated with aging-related health conditions including CVD. Accumulating data suggests CHIP is more prevalent in cancer patients compared to age-matched controls, due in part to clonal selection after genotoxic stressors. There is a paucity of information about the association between CHIP and CVD after HCT, including its interaction with modifiable risk factors and subsequent impact on survival after HCT. Methods: This was a retrospective cohort study of 861 consecutive patients who underwent autologous HCT for lymphoma between 2010 and 2016, with available pre-HCT DNA obtained from peripheral blood stem cells. We performed targeted exome sequencing of DNA (92 pre-defined gene panel with 1000x sequencing depth) to determine the presence of CHIP (variant allele frequency ≥2%). CVD outcomes of interest included de novo heart failure, coronary artery disease and stroke after HCT. Five-year cumulative incidence of CVD was calculated taking into consideration competing risk of death. Fine-Gray multivariable regression was used to evaluate the association between CHIP and CVD, adjusting for demographic, clinical and therapeutic factors. The Kaplan-Meier method was used to examine the effect of CHIP on overall survival after HCT. Results: Median age at HCT was 55.7 years (range 18.4-78.1 years); 63.3% were male; race/ethnicity: non-Hispanic White (56.9%), Hispanic (26.1%), Asian (10.8%), Black (5.1%); 78.0% had non-Hodgkin lymphoma; comorbidities at HCT: hypertension (32.1%), dyslipidemia (16.4%), diabetes (10.1%), high (≥3) HCT-comorbidity index (CI) score (46.1%). Nearly all patients (94.3%) had received anthracycline-based chemotherapy prior to HCT, and 63.3% were treated with cumulative dose ≥300mg/m 2; 6% had chest radiotherapy. Overall, 186 patients (21.7% of the cohort) had at least one CHIP variant and 57 (6.6%) had ≥2 variants. DNMT3A, PPM1D, TET2 and TP53 were the most frequently mutated genes. In total, 74 patients developed CVD within five years from HCT. The 5-year cumulative incidence of CVD was significantly higher in patients with CHIP (20.9% vs 9.1%, p&amp;lt;0.001), compared to those without CHIP, and there was a graded relationship between number of CHIP variants and incidence of CVD. In the adjusted (age, cancer diagnosis, HCT-CI, modifiable cardiovascular risk factors) multivariable model, CHIP was significantly and independently associated with a nearly two-fold (HR: 1.8, 95% CI=1.1-3.1; P=0.020) risk of CVD, as well as the individual outcome of heart failure (HR: 2.3, 95%CI=1.3-4.3; P=0.008). Patients who had both CHIP and hypertension had a 3-fold (HR: 3.0, 95%CI=1.4-6.5, p=0.006) risk of CVD (reference: no CHIP, no hypertension). Overall 5-year survival after HCT was significantly worse in patients with CHIP, compared to those without CHIP (47.2% vs 68.2%, p&amp;lt;0.001; adjusted HR: 1.9, 95%CI=1.4-2.6), attributed to the higher burden of non-relapse mortality in patients with CHIP. Conclusions: In this well-characterized and demographically diverse cohort of lymphoma patients undergoing HCT, CHIP was highly prevalent and associated with a significantly higher risk of CVD after HCT, with the highest risk among those with CHIP and hypertension. We confirmed the poor overall survival rate in patients with CHIP, independent of patient and disease-related risk factors. These findings highlight the potential role of CHIP as a novel biomarker to better define CVD risk in patients with lymphoma prior to HCT, setting the stage for better screening and implementation of interventions (e.g., aggressive management of modifiable risk factors) to reduce the risk of CVD and to ultimately improve long-term health outcomes after HCT.

Abstract P108: Post-Diagnosis Body Weight Change and Cardiovascular Outcomes in Cancer Survivors

Background: The development of cancer and its treatment often entail changes in body weight. This study aimed to investigate the association of post-diagnosis body weight change with cardiovascular disease (CVD) risk in cancer survivors. Methods: From the Korean National Health Insurance database, we identified 112,565 3-year cancer survivors who had been diagnosed with cancer at age ≥20 years from 2006 through 2013 and had normal body weight (body mass index [BMI] 18.5-22.9 kg/m2) before a cancer diagnosis. In categorical analysis, participants were classified into 4 groups according to their post-diagnosis BMI: 1) obesity (BMI ≥25 kg/m2); 2) overweight (BMI 23-24.9 kg/m2); 3) normal weight (BMI 18.5-22.9 kg/m2); and 4) underweight (BMI &lt;18.5 kg/m2). In continuous analysis, post-diagnosis change in BMI was assessed by subtracting pre-diagnosis BMI from post-diagnosis BMI. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or cardiovascular death. We examined the association of post-diagnosis BMI change with CVD risk using cause-specific Cox model. Results: Over a median follow-up of 5.5 years, 3,797 new CVD events occurred. The cumulative incidence of CVD according to post-diagnosis BMI was the highest in the obesity group, followed by underweight, overweight, and normal weight groups (Figure A). The findings remained broadly consistent after multivariable adjustment; being obese post-diagnosis was associated with a higher CVD risk than maintaining normal weight (HR 1.28, 95% CI 1.05-1.58). However, being underweight post-diagnosis was no more associated with the risk of CVD (HR 0.99, 95% CI 0.86-1.14) (Figure B). Similar findings were observed in a continuous analysis (Figure C). Conclusions: Weight gain after a cancer diagnosis was associated with a higher CVD risk, whereas the association was null for post-diagnosis weight loss. CVD prevention programs for cancer survivors should consider incorporating strategies for preventing weight gain.

Gallbladder disease is associated with the risk of cardiovascular disease among Uyghurs in Xinjiang: a prospective cohort study

BackgroundGallbladder disease (GBD) can increase the risk of cardiovascular disease (CVD). However, GBD has rarely been reported in the less developed, rural areas of Xinjiang. This study aimed to determine the prevalence of GBD and incidence of CVD in a prospective cohort study in rural Xinjiang. Moreover, the study aimed to explore the association between GBD and CVD within this cohort.MethodsThe study cohort included 11,444 Uyghur adults in Xinjiang, 3rd division, from the 51st Mission. Study groups were classified according to whether GBD was present or absent at baseline. The occurrence of CVD was the end event. Demographic, anthropometric, and biochemical data were recorded, and the incidence of CVD in the GBD and non-GBD groups analysed. Cox proportional hazards regression models were used to assess the association between GBD and CVD and factors associated with their incidence. Several subgroup analyses were performed to assess CVD incidence in different subgroups. The interaction between GBD and cardiometabolic risk factors, and subsequent risk of developing CVD, was evaluated.ResultsPrevalence of GBD in the study cohort was 10.29%. After a median follow-up of 4.92 years, the cumulative incidence of CVD in the study cohort was 10.49%, 8.43% in males and 12.65% in females. CVD incidence was higher in the GBD group (34.04% vs. 7.78%, HR = 4.96, 95% CI: 4.40–5.59). After multivariate adjustment, the risk of CVD remained higher in the GBD group (HR = 2.89, 95% CI: 2.54–3.29). Subgroup analyses showed male sex, smoking, alcohol consumption, lack of exercise, and abnormal renal function were all associated with increased risk of CVD. Moreover, the risk of CVD was markedly higher in GBD combined with cardiometabolic risk factors (hypertension, T2DM, dyslipidaemia, overweight, and abdominal obesity), than in cardiometabolic risk factors alone and this was higher in the GBD group than in the non-GBD group regardless of whether cardiometabolic risk factors were combined.ConclusionGBD is an important independent risk factor for CVD development. Awareness of these associations will raise concerns among clinicians about the risk of cardiovascular disease in patients with GBD.

Association between triglyceride-glucose index and risk of cardiovascular disease among postmenopausal women

ObjectiveWe aimed to examine the association of triglyceride-glucose index (TyG) with risk for cardiovascular disease (CVD) among postmenopausal women.MethodsA total of 7741 participants met the inclusion criteria, and were included in the analysis. The TyG index was calculated as ln (triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2). The participants were classified into four groups by the quartiles of TyG index, and the Q1 group was used as the reference group. The cumulative incidence of CVD for the groups were compared using the Kaplan–Meier curves. The association between the TyG index and risk of CVD among postmenopausal women was assessed by the Cox proportional hazards models (hazard ratio [HR], 95% confidence intervals [CI]).ResultsDuring a median follow-up of 12 years, a total of 383 (4.95%) participants developed incident CVD. After adjusting for potential confounding factors, a high baseline TyG index (Q4 group) was associated with higher future risk of CVD, the HR (95% CI) of CVD risk was 1.70 (1.21–2.38) in Q4 group compared with the Q1 group. Subgroup analyses showed the Q4 group was significantly associated with the risk of CVD, regardless of age at menopause (younger than 50 years; 50 years and older) and obesity status.ConclusionsHigher TyG index at baseline as a marker of insulin resistance (IR), is associated with higher risk of future CVD among postmenopausal women. The TyG index may serve as a simple and easy marker for early identification of high-risk individuals in the postmenopausal women.

Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients.

Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis. A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk. In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older (p 0.006) and had a higher 5-year cumulative incidence of CVD (p 0.013) than HPV-positive patients. Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.

Association between Seafood Intake and Cardiovascular Disease in South Korean Adults: A Community-Based Prospective Cohort Study.

Cardiovascular disease (CVD) is the most common non-communicable diseases causing 18.6 million deaths worldwide. Several studies have revealed that seafood consumption has a protective effect against CVD. This study investigated the correlation between CVD and seafood intake based on a 10-year follow-up of the Korean Genome and Epidemiology Study (KoGES). The study population, which included 6565 adults age, 55.65 (±8.68), was divided into seafood intake-based tertiles. CVD included myocardial infarction, coronary artery disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease. At baseline, participants with low seafood intake also had low eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes. Prospectively, hazard ratios (HRs) with 95% confidence intervals (CIs) for CVD were analyzed using Cox proportional hazards regression models. Seafood intake exhibited a significantly inverse relationship with the cumulative CVD incidence over 10 years regardless of sex (women: log-rank test p &lt; 0.001 and men: log-rank test p &lt; 0.0401). The longitudinal association of low seafood intake with the CVD risk was significantly stronger in female participants after adjusting for confounding variables (HR (95% confidence interval (CI)) = 0.718 (0.519-0.993) p-trend = 0.043). These results suggested that seafood consumption potentially ameliorates CVD risk in middle-aged adults.

Cardiovascular, bone, and metabolic health in men with castrate-resistant prostate cancer treated with androgen deprivation: a matched cohort study

Background Descriptive data on late effects associated with castrate-resistant prostate cancer (CRPC) are sparse. We aimed to define the timing and incidence of cardiovascular disease (CVD), fractures, and diabetes in a patient population with CRPC. Methods In the population-based STHLM0 cohort 1464 men with CRPC were identified and matched with three men free from prostate cancer (PC) in the Stockholm region of Sweden. Kaplan–Meier estimates of net survival were used to describe time to CVD, fracture, and diabetes. Cox regression was used to compare incidence rates (IRRs) for the respective late effects. Cumulative incidence analyses of late effects in the presence of the competing risk of death were performed to estimate absolute risks. Results The Kaplan Meier estimates demonstrated a higher net probability for CVD, fracture, and diabetes among men diagnosed with CRPC compared to the matched comparators. The IRRs were 1.94 (95% CI: 1.79–2.12) for CVD, 2.08 (95% CI: 1.70–2.53) for fracture, and 2.00 (95% CI: 1.31–3.05) for diabetes, respectively, comparing men diagnosed with CRPC to men free from PC. The cumulative incidence of CVD at 12 months of follow-up was higher in men diagnosed with CRPC compared to healthy controls regardless of age with a difference in cumulative incidence being 0.20 for men aged <65 and 0.11 for men aged >84. Conclusions In this cohort, the incidence of CVD was significantly higher among men with CRPC compared to healthy controls. Despite having this end-stage disease this finding proves that clinicians must recognize this late effect in men diagnosed with CRPC to improve preventive actions. These men did not have a higher absolute risk of fractures and diabetes after accounting for deaths due to any cause compared to healthy controls.

Incident Cardiovascular Diseases Among Survivors of High-Risk Stage II-III Colorectal Cancer: A Cluster-Wide Cohort Study.

The incidence and survival of colorectal cancer (CRC) are increasing. There is an increasing number of long-term survivors, many of whom are elderly and have comorbidities. We conducted a population-based study in Hong Kong to assess the long-term cardiovascular disease (CVD) incidence associated with adjuvant fluoropyrimidine-based chemotherapy among CRC survivors. Using the population-based electronic medical database of Hong Kong, we identified adults who were diagnosed with high-risk stage II-III CRC and treated with radical surgery followed by adjuvant fluoropyrimidine-based chemotherapy between 2010 and 2019. We evaluated the cause-specific cumulative incidence of CVD (including ischemic heart disease, heart failure, cardiomyopathy, and stroke) using the flexible parametric competing risk modeling framework. The control group without a history of CVD was selected from among a noncancer random sample from primary care clinics in the same geographic area. We analyzed 1,037 treated patients with CRC and 5,078 noncancer controls. The adjusted cause-specific hazard ratio (HR) for CVD in the cancer cohort compared with the control group was 2.11 (95% CI, 1.39-3.20). The 1-, 5-, and 10-year cause-specific cumulative incidences were 2.0%, 4.5%, and 5.4% in the cancer cohort versus 1.2%, 3.0%, and 3.8% in the control group, respectively. Age at cancer diagnosis (HR per 5-year increase, 1.16; 95% CI, 1.08-1.24), male sex (HR, 1.40; 95% CI, 1.06-1.86), comorbidity (HR, 1.88; 95% CI, 1.36-2.61 for 1 comorbidity vs none, and HR, 6.61; 95% CI, 4.55-9.60 for ≥2 comorbidities vs none), diabetes (HR, 1.38; 95% CI, 1.04-1.84), hypertension (HR, 3.27; 95% CI, 2.39-4.50), and dyslipidemia/hyperlipidemia (HR, 2.53; 95% CI, 1.68-3.81) were associated with incident CVD. Exposure to adjuvant fluoropyrimidine-based chemotherapy was associated with an increased risk of CVD among survivors of high-risk stage II-III CRC. Cardiovascular risk monitoring of this group throughout cancer survivorship is advisable.

Associations of the Cardiometabolic Index with the Risk of Cardiovascular Disease in Patients with Hypertension and Obstructive Sleep Apnea: Results of a Longitudinal Cohort Study.

Purpose We aimed to explore the relationship between the cardiometabolic index (CMI) and cardiovascular disease (CVD) and its subtypes (coronary artery disease and stroke) in patients with hypertension and obstructive sleep apnea (OSA). Methods We conducted a retrospective cohort study enrolling 2067 participants from the Urumqi Research on Sleep Apnea and Hypertension study. The CMI was calculated as triglyceride to high‐density lipoprotein cholesterol ratio × waist‐to‐height ratio. Participants were divided into three groups (T1, T2, and T3) according to the tertile of CMI. The Kaplan-Meier method helped to calculate the cumulative incidence of CVD in different groups. We assessed the association of CMI with the risk of CVD and CVD subtypes by estimating hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox models. Results During a median follow-up of 6.83 years (interquartile range: 5.92-8.00 years), 326 incident CVD were identified, including 121 incident stroke and 205 incident coronary heart disease (CHD). Overall, after adjusting for confounding variables, CMI was positively associated with the risk of new-onset CVD (per SD increment, adjusted HR: 1.31; 95% CI: 1.20, 1.43), new-onset CHD (per SD increment, adjusted HR: 1.33; 95% CI: 1.20, 1.48), and new-onset stroke (per SD increment, adjusted HR: 1.27; 95% CI: 1.10, 1.47). Similar results were obtained in various subgroup and sensitivity analyses. Adding CMI to the baseline risk model for CVD improved the C-index (P < 0.001), continuous net reclassification improvement (P < 0.001), and integrated discrimination index (P < 0.001). Similar results were observed for CHD and stroke. Conclusion There was a positive association between CMI levels and the risk of new-onset CVD in patients with hypertension and OSA. This finding suggests that CMI may help identify people at high risk of developing CVD.

Association of Permanent Vascular Access Dysfunction with Subsequent Risk of Cardiovascular Disease: A Population-Based Cohort Study.

A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis VA dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of death in patients receiving chronic hemodialysis. Information about CVD associated with hemodialysis VA dysfunction is unclear. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients. This nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from 23 million beneficiaries and data was collected from 2000 to 2013. Patients with end-stage renal disease who had received permanent VA construction and hemodialysis and were aged at least 20 years old from 2000 to 2007 were included in the study population. The primary outcome was CVD, as defined by ICD-9-CM codes 410–414 and 430–437. A total of 197 individuals with permanent VA dysfunction were selected as the test group, and 100 individuals with non-permanent VA dysfunction were selected as the control group. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14–8.20). A Kaplan–Meier analysis revealed that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group. Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD.

Abstract P090: Utility Of High-sensitivity Cardiac Troponin T For Short-term Cardiovascular Risk Monitoring In The General Population

Background: Cardiac troponins are the cornerstone for the detection of heart attacks. Beyond the acute setting, there is growing evidence that high-sensitivity cardiac troponin T (hs-cTnT) is associated with long-term cardiovascular disease (CVD) risk. The implications of minute elevations in hs-cTnT on short-term CVD risk in the general population has not been investigated. Methods: We included 12,632 adults (43% men, 25% black, mean age: 57 years) in the Atherosclerosis Risk in Communities (ARIC) study who had at least one measurement of hs-cTnT (Roche) across visits 2 (1990-1992), 3 (1996-1998), and 4 (2011-2013) without diagnosed CVD, defined as coronary heart disease, heart failure, or stroke. We used bootstrapping to generate confidence intervals for the cumulative incidence of CVD and generalized estimating equation log-binomial models to quantify the short-term relative rates of incident CVD. Results: Overall, 3.8% (n=479) had elevated hs-cTnT ≥ 14ng/L at their earliest visit; of whom 65% (n=311) had intermediate or lower predicted 10-year risk by the Pooled Cohort Equation. The cumulative 1-year incidence of CVD among those with hs-cTnT ≥ 14ng/L was 5.7% (95% CI: 4.0%, 7.4%) compared to 1.0% (0.9%, 1.1%) among those with hs-cTnT &lt; 6 ng/L and 1.7% (1.3%, 2.2%) among those with hs-cTnT between 6 to 14 ng/L. Among those with hs-cTnT ≥ 14ng/L, the cumulative incidence of CVD at 2 years was 9.6% (7.3%, 11.8%) and at 3-years was 12.7% (10.0%, 15/3%) (Figure 1A). After accounting for traditional CVD risk factors, hs-cTnT ≥ 14ng/L was associated with 2.9 (2.0, 4.1) times higher incidence of CVD at 1-year compared to 1.9 (1.5, 2.4) times incidence at 3-years (Figure 1B). Conclusions: Middle-aged adults in the general population without CVD who had an elevated hs-cTnT experienced a 5.7% 1-year risk of CVD compared to 1% among those with low hs-cTnT. The relative risk associated with elevations in hs-cTnT was most pronounced within the first year, supporting its use for short-term risk monitoring as part of annual preventive visits.

Abstract EP68: Can A Single Model For General Population Predict Cardiovascular Events In Cancer Survivors?

Introduction: No specific guideline exists for the primary prevention of cardiovascular disease (CVD) in cancer survivors. We hypothesized that CVD risk and its association with risk factors are comparable between cancer survivors and the general population, such that they may share currently available risk scores (e.g., Pooled Cohort Equation; PCE) for initial risk discussion. Methods: We studied 59 445 cancer survivors (≥5 years from diagnosis) and 59 445 age/sex-matched non-cancer controls aged 40-79 years (51.6% female) and free of CVD among participants of 2009 Korean National Health Insurance health screening. We calculated 10-year cumulative incidence of CVD events (composite of myocardial infarction, stroke, or cardiovascular death) and hazard ratios for traditional CVD risk factors in cancer survivors vs. non-cancer controls. We then evaluated discrimination and calibration of a previously-derived, general Korean population-based CVD risk model (having similar predictors as the PCE) applied to cancer survivors. Results: During a median follow-up of 10.3 years, 6,809 CVD events occurred. Multivariable-adjusted 10-year cumulative CVD incidence was 2.8% (2.7-3.0) among cancer survivors and 3.0% (2.0-3.2) among non-cancer controls (Figure A). Associations of traditional risk factors with CVD events were similar between cancer survivors and controls (Figure B). Results were consistent when stratified by sex and age. A CVD risk model, previously derived from the general Korean population similarly as the PCE, showed good discrimination (C-index, 0.747) and calibration (Figure C) when applied to cancer survivors. By cancer subtype, some cancers were associated with higher or lower CVD risk than controls (Figure D). Conclusions: CVD risk and associations with predictors were similar between cancer survivors and non-cancer individuals. Pre-existing models for general population may perform well in overall cancer survivors, although subtype-specific recalibration may be desirable for some cancers.