CV Comorbidities Research Articles

Web discussions on cardiovascular diseases: assessing the impact of COVID-19 pandemic. An Italian prospective analysis

Funding AcknowledgementsType of funding sources: Private company. Main funding source(s): Non-conditioning grant from Sanofi Italia.Background.Awareness and risk knowledge are the first steps along the complex journey leading to effective primordial, primary and secondary cardiovascular disease (CVD) prevention. Interactions among people significantly influence awareness and personal beliefs and favour behavioral changes. Given the increased use of Internet to search information and share experiences on health, Web and social media represent innovative health-information-gathering sources, facilitating interactions and information exchanges able to influence health-related behaviour.Purpose.This study is based on a longitudinal Web listening analysis approach, aimed at analyzing and comparing Web discussions collected before the COVID-19 pandemic (February 2018–February 2020) with those occurred during the first pandemic wave in Italy (March–July 2020).Methods.A preliminary analysis of the data indexed by prominent search engines (i.e., Google) was performed, followed by a systematic process of data collection. Automated data identification was analyzed using data mining techniques, machine learning and Natural Language Processing (NLP) algorithms. This analysis was integrated by a qualitative analysis.Results.In Italy, over the entire study timeframe, Web conversations associated to health topics were primarily focused on vaccines and tumors, and discussions on CVDs (about 235,000 conversations) were only at the 5th place. The main topics of the conversations concerned symptoms (25%), treatments (18%), causes of disease (14%), quality of life (13%). Conversations on prevention were marginal (only 5%). During the pandemic timeframe discussion topics were focused on the growing COVID-19 risk for people with CV comorbidities, the risk linked to CVD therapies and the difficulties and delays in accessing hospitals. Over 80% of patients were not satisfied about their caring experience and such dissatisfaction grew stronger during the pandemic. In this period, anxiety, frustration, fear and depression were the mainly mentioned feelings. A good relationship with physicians (empathy, understanding) was mentioned by patients as a key factor of a positive caring experience.Conclusions.The limited attention to CVDs and their prevention registered through the conversations on the Web is not consistent with the epidemiological relevance of such diseases in terms of health risks and mortality. Given the crucial role of Web interactions in influencing beliefs and health-related behaviours, this study highlights the urgency to promote novel prevention strategies and to engage people leveraging digital channels and social media. The COVID-19 pandemic worsened the quality of relationship and contact with physicians. Such evidence underlines further the need to develop novel models of patient management - even remotely (digital tools, telemedicine), to encourage citizen/patient involvement and empowerment.

Non-cardiovascular comorbidities in heart failure patients and their impact on prognosis.

With the aging of the population and improvement of life expectancy of patients with heart disease, there is an increase in non-cardiovascular (CV) comorbidities affecting chronic heart failure (HF) patients. The increased prevalence of different CV and non-CV comorbidities is a rising problem in the management of patients with HF, mostly because these comorbidities may lead to poor prognosis, increase of hospitalizations and mortality rate. Recently, important data from multicenter randomized studies point to diabetes mellitus or iron deficiency as new pharmacological targets, and this highlights the need of broad expertise for the 21st-century cardiologist. The management of HF should take into account non-CV comorbidities. In this review, we discuss novel aspects of non-CV comorbidities in HF patients and emphasize the impact on prognosis.

Impact of Beta-blockers Use on Ventricular Arrhythmias and ICD Shocks in Patients on Long-Term Inotropic Therapy

Purpose Continuous infusion of inotropes is increasingly used in patients with end-stage heart failure who are being discharged from the hospital. However, Dobutamine and Milrinone are both known to be arrhythmogenic agents. Because Milrinone does not act through the beta-adrenergic system, it may allow for the cautious addition of beta-blockers (BB). We therefore sought to compare the impact of BB use is these patients on ventricular arrhythmias. Methods We retrospectively reviewed all patients who were discharged from our Institution on inotropes (used as a bridge to durable LVAD or transplant, as a bridge to recovery, or as a palliative measure). The cohort was stratified into 2 groups based on whether BB were added to the medical regimen. We compared the incidence of ventricular arrhythmias and ICD device therapy (defined as shock or anti-tachycardia pacing) between the 2 groups. Results Between 2010 and 2017, 349 patients were discharged on inotropes. Mean age was 61+14 years, 74% were men and 64% were African American. Most patients (330) were treated with Milrinone. BB were used in 195 (56%) of patients, whereas 154 (44%) did not receive these meds. There were no significant differences between the 2 groups in baseline socio-demographics, etiology of cardiomyopathy, CV comorbidities, or invasive hemodynamics. Patients on BB were more likely to receive an LVAD/transplant (49% vs. 41%) or be weaned off inotropes (12% vs. 4%), and less likely to transition to hospice care/death (37% vs 53%). Patients on BB were more likely to receive ACEI/ARB than those who were not on BB (67% vs. 47%, p Conclusion In heart failure patients who are discharged on inotropes, the use of BB appears to be associated with a lower incidence of sustained ventricular arrhythmias, ICD shocks or anti-tachycardia pacing. Prospective studies are warranted to confirm these findings.

Blood Pressure Target Achievement Under Monotheraphy: A Real-Life Appraisal

IntroductionDespite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension.AimTo investigate BP control under monotherapy in the setting of real-life.MethodsWe extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant’Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18–65 years; (b) < 140/80 mmHg in those aged > 65 years.ResultsFrom an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m2) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18–65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies.ConclusionsOur data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.Electronic supplementary materialThe online version of this article (10.1007/s40292-020-00420-y) contains supplementary material, which is available to authorized users.

P0824QUALITY OF LIFE (QOL) DURING THE COURSE OF CKD: A LONGITUDINAL STUDY

Abstract Background and Aims Measuring QoL in CKD patients is fundamental to estimate the human cost of chronic diseases and to assess the effect of treatments. Non-medical factors play an important role in CKD progression and QoL. However, there is very limited information on the evolution of QoL over time in CKD patients and it remains unclear whether traditional and CKD specific risk factors are implicated QoL in CKD patients over CKD progression. Method We studied a cohort of 582 stage 2-5 CKD patients (age: 61±12 years; M: 60%, diabetics: 33%) and measured QoL by the short form of the Rand corporation questionnaire (SF36), an instrument which measures eight domains of QoL (physical functioning, role physical health, energy fatigue, pain, role emotional problem, emotional well-being, social function, and general health] and two summary scores, (the physical component score and the mental component score) which are calculated by a well validated algorithm (Taft C et al, 2001, Quality of life research). In all patients the SF36 was administered at enrolment and after one (489 patients), two (n=434) and three (n=287) years. The evolution of SF36 dimensions over-time and the predictors of SF36 changes were analyzed by the Linear Mixed Model (LMM). Results At baseline the median value of the Physical Component Score (PCS) was 43.7 (Interquartile range: 34.0-50.3) and the Mental Component Score (MCS) was 46.3 (37-52.9) and on average did not change over the 3 years follow up [median PCS at the 3rd year: . 46.3 (35.7-52.0), median MCS at the 3rd year 43 (33.6-50.6)]. On average the GFR at baseline was 36±13 ml/min/1.73 m2 and declined to 34±17 ml/min/1.73m2 at the 3rd year. On detailed longitudinal analysis by the LMM the PCS associated with the evolution of the GFR over time (beta=0.10; 95% CI from 0.06 to 0.13; P&amp;lt;0.001). Adjustment for time (0,1,2,3 years), age and gender did not materially modify such an association (beta=0.09; 95%CI from 0.06 to 0.13, p&amp;lt;0.001) while further adjustment for traditional (Systolic BP, diabetes, smoking, cholesterol), BMI, CV comorbidities and CKD specific (hemoglobin, albumin, calcium, phosphate) risk factors attenuated but did not cancel out the PCS-GFR link (beta=0.05, 95%CI 0.006 to 0.093, P=0.03). This finding suggests that the PCS-GFR link is either largely confounded or mediated by these risk factors but that the same risk factors do not explain in full the same link . The MCS – GFR association was weaker (beta=0.05, 95%CI from 0.008 to 0.09; P=0.02) than the PCS-GFR relationship, became non significant after simple adjustment for time, age and gender (beta=0.04 ; 95%CI -0.003 to 0.08; P=0.07) and was nullified after full adjustment (beta=-0.01; 95%CI -0.07 to 0.04; P=0.59) for the same risk factors. Conclusion The PCS and the MCS remain stable over the course of CKD but appear associated with the evolution of the GFR over time. Traditional and CKD specific risk factors substantially confound and/ or mediate these associations.

P0831HIGH SERUM ALKALINE PHOSPHATASE PREDICTS THE RISK OF CKD PROGRESSION: EFFECT NODIFICATION BY THE GFR

Abstract Background and Aims In the post-hoc analyses of the SUSTAIN and ASSURE trials (Kidney Blood Press Res. 2018;43:449-457), Apabetalone, an epigenetic modulator which lowers serum alkaline phosphatase (AlkPhos), stabilized the GFR in patients with cardiovascular disease and a GFR &amp;lt;60/ml/min/1.73m2. Analyzing the relationship between AlkPhos and renal outcomes in patients with established CKD is useful to preliminarily explore the biological hypothesis that AlkPhos is implicated in CKD progression. Method We investigated the relationship between AlkPhos and the risk for a combined renal end-point (30% GFR loss or dialysis/renal transplantation) in a cohort of 609 stage 3-5 CKD patients with an average GFR of 34.8±12.1ml/min/1.73 m2. Results Median AlkPhos levels were 91 IU/L (Interquartile range 71-117 IU/L) and in the vast majority of patients had values below 147 IU/L (the upper limit of the normal range). Over a median follow up of 3 years, two-hundred patients had the combined renal end-point. In an unadjusted analysis 1 ln increase in AlkPhos entailed a 49% risk excess for the renal end-point (HR: 1.49, 95% CI 1.11-2.01, P=0.008). Adjusting for traditional (age, gender, smoking, diabetes, total cholesterol, BMI, systolic BP, CV comorbidities) and CKD specific risk factors (hemoglobin, albumin, phosphate, and hs-CRP) did not modify the strength of this association (HR:1.48, 95% CI 1.08-2.02, P=0.016). Furthermore, In a fully adjusted analysis testing the GFR as an effect modifier of the AlkPhos - combined renal end point relationship showed a strong GFR- AlkPhos interaction (Figure). Indeed the risk for the combined renal end-point was gradually more pronounced at progressively more severe degrees of renal dysfunction, the HR being 0.94 (CI95% 0.60-1.47) at a GFR of 40 ml/min/m2 and 2.71 (CI95% 1.49-4.93) at 10 ml/min/1.73m2. Conclusion In patients with stage 3-5 CKD alkaline phosphatase within the normal range is associated with the risk for progression to ESRD and the GFR is an effect modifier of this relationship. Findings in this study are compatible with the hypothesis that within the normal range of this biomarker, the risk for CKD progression by alkaline phosphatase is amplified by the severity of CKD. These data are in keeping with post-hoc analyses of the SUSTAIN and ASSURE trials and provide circumstantial support to the hypothesis that interventions lowering serum alkaline phosphatase may mitigate CKD progression.

Respiratory Failure Treated by ECLS in Previously Unscreened Patients - Is Lung Transplantation Feasible?

ECLS is increasingly used to bridge deteriorating candidates to LTx. Most centers would only bridge patients previously approved for Tx and on the waiting list. Our center has accepted to transplant patients supported with ECLS device previously unknown to the transplant team. Unscreened patients on ECLS for respiratory failure were included in this retrospective single-center analysis. Criteria to accept patients for Tx were: preserved kidney and liver function, acceptable muscular reserve, no systemic disorders, no significant CV comorbidities. This group was compared to deteriorating patients on the waiting list and bridged to their Tx. Ninety-six patients were bridged by ECLS to primary LTx between 2005 and 2018. This included 37 (38%) unscreened patients with a median age was 30 years (13-65). The main diagnosis was CF (14, 38%) followed by fibrosis (11, 30%) and ARDS (6, 16%). Median ECLS bridging time was was similar in both groups (5 vs 7 days). Thirty (81%) patients listed during ECLS were intubated prior to implantation of ECLS device. Seven of them (19%) could be weaned from invasive ventilation and could be bridged awake to Tx compared to 17 (32%) patients in the control group. Among the 37 unscreened patients, 13 (35%) were on VA ECMO, 13 (35%) on VV double site ECMO and 7 (19%) on a combination of modalities. 32/37 patients (90%) reached Tx. At 72 hours PGD grade 3 was observed in 2 recipients in the group evaluated during ECLS period compared to 1 recipient in the other group. No differences were found in terms of length of mechanical ventilation after Tx among the two groups: 2 days (1-15) vs 4 days (1-37). One and 5-year survival rate per intention to treat were: 57% vs 64 % and 45% vs 50% (p=0.414), respectively. Long-term results of Tx for previously unscreened patients on ECLS are comparable to ECLS bridged patients already on the waiting list. Our data provide evidence that this group of patients should not be excluded from a life-saving transplantation.

Abstract P320: Temporal Trends In Prevalence &amp; Prognostic Implications Of Cardiac And Non-cardiac Comorbidities Among Patients With Acute Decompensated Heart Failure: Aric Study Community Surveillance

Introduction: Patients with HF have multiple co-existing CV and non-CV comorbidities. The temporal trends in the burden of co-morbidities and associated risk of mortality among patients with acute decompensated HF (ADHF) is not well-established. Methods: HF related hospitalizations were captured in the ARIC surveillance cohort study across 4 US communities 2005 to 2014 using ICD-9 codes. HF hospitalizations were adjudicated using validated algorithm to identify ADHF with reduced ejection fraction (HFrEF, ejection fraction &lt;50%) and preserved ejection fraction (HFpEF). Data on prevalence of CV and non-CV co-morbidities were obtained from medical record review. Mortality outcomes were ascertained for up to 1-year post-admission, by linking hospital records with death files. Results: Of the 22,805 hospitalizations sampled between 2005-2004, 8914 were classified as ADHF corresponding to 41,146 weighted hospitalizations for ADHF (53% HFrEF, 47% HFpEF). The burden of CV co-morbidities remained stable while that of and that of non-CV comorbidities increased significantly over time among patients with HFpEF and HFrEF. The overall burden of CV co-morbidities was not significantly associated with risk of mortality among patients with HFrEF and HFpEF. In contrast, greater burden of non-CV comorbidities was significantly associated with higher risk of in-hospital, 28-day, and 1-year mortality for both HFpEF and HFrEF. Among patients with HFrEF, the risk of mortality associated with higher burden of non-CV comorbidities did not change over time. In contrast, for HFpEF, there was a significant temporal decline in the non-CV burden associated risk of in-hospital mortality and an increase in the risk of 1-year mortality over time. Conclusion: The burden of non-CV co-morbidities among patients with ADHF has increased over time. Higher burden of non-CV comorbidities was associated with higher risk of mortality, with stable temporal associations in HFrEF and an increasing risk over time for 1-year mortality for HFpEF.

A13918 Prevalence, Treatment and Awareness Of Hypertension

Objectives: Hypertension is well known as a major health issue worldwide, posing substantial cardiovascular risks upon those affected. The factors associated with awareness and treatment of hypertension must be addressed to guide further interventions. Methods: We started a nationwide survey in association with local pharmacies in Taiwan in 2017. Each participant was inquired of their body habitus, comorbidities, medication and habits of blood pressure (BP) measurement. We then recorded their blood pressure on site for 3 times. Hypertension was defined as mean blood pressure ≥ 140/90 mmHg or currently taking anti-hypertensive medication. Results: A total of 55,837 participants were recruited in this survey. The average age was 56.9 ± 16.0 years old. There was equal gender distribution. The prevalence of hypertension was 37.3% after age standardization. (67.1% of age above 60) 14.1% of all hypertensives were untreated. There was an overall 68.3% treat-to-target rate. (58.8% overall control rate) 56.7% of all hypertensives measured their BP less than once every week. Prevalence of hypertension was associated with older age (age ≥ 60 years old), male, overweight (BMI ≥ 27 kg/m2), CV comorbidities and smoking. Untreated hypertension was related to younger age (age < 60 years old), male, central obesity (male abdominal girth ≥ 90 cm, female ≥ 80 cm), smoking and those without CV comorbidities. Conclusion: Prevalence of hypertension in Taiwan in 2017 was similar to previous observations. Treatment and control rates were high, which may be related to the vicinity of medical resources. BP measurement was rather unsatisfactory, especially in those with younger age, central obesity and without prior CV morbidities. The widespread adoption of blood pressure measurements may help to further eliminate the burden of hypertension.

0451 OVERLAP SYNDROME OF COPD AND OSA: METABOLIC RISK FACTORS AND SYSTEMIC INFLAMMATION

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common and their co-occurrence, known as the overlap syndrome, is estimated in at least 1% of the general population. However, further knowledge is needed to fully characterize the overlap syndrome. We retrospectively studied 256 persons with stable COPD characterized in 2 previous physical activity studies. Body-mass index (BMI) was calculated from height and weight measured in the clinic. Participants were asked specifically if they had a diagnosis of OSA, hypertension (HTN), congestive heart failure (CHF), coronary artery disease (CAD), or diabetes mellitus (DM). CRP and IL-6 were determined using a high-sensitivity immunoturbidimetric assay with a sensitivity of 0.03 mg/L and 0.094 pg/mL, respectively. We compared characteristics between those with COPD-OSA (N=61) and those with COPD only (N=195) using unpaired T test, Wilcoxon rank sum test, or Chi square test, as appropriate. To assess the independent relationship between overlap syndrome and levels of CRP and IL-6, we used linear regression models (PROC GLM, SAS 9.4), adjusting for age, BMI, %predicted FEV1, pack-years, and history of CAD. There was no difference between those with COPD-OSA and those with COPD only with respect to age (cohort mean 71 ± 8 years) and %predicted FEV1 (cohort mean 58 ± 21 %predicted). BMI and the prevalence of HTN and DM were significantly higher in the COPD-OSA group compared to the COPD only group. Persons with COPD-OSA were more likely to report CV disease including CAD and CHF, compared to those with COPD only. Both CRP (P=0.02) and IL-6 levels (P=0.02) were significantly higher in persons with COPD-OSA compared to persons with COPD only, after controlling for age, BMI, %predicted FEV1, pack-years, and history of CAD. Compared to COPD only, those with COPD-OSA had a 1.64 mg/L [95%CI: 1.09 to 2.48] increase in CRP and a 1.39 ng/mL [95%CI:1.06 to 1.81] increase in IL-6. Persons with COPD-OSA have a significantly higher prevalence of metabolic risk factors including higher BMI, HTN, and DM, higher levels of inflammatory biomarkers, and are more likely to have CV comorbidities than persons with COPD only.

PS 06-16 PREVALENCE AND CLINICAL FEATURES OF PREDIABETES IN PATIENTS WITH HYPERTENSION

Objective: Although prediabetes and hypertension are major components of metabolic syndrome, there is no reported data on the prevalence of prediabetes (FBS 100–125 mg/dL or HbA1c 5.7–6,4%) in hypertensive patients. We evaluated the prevalence and characteristics of prediabetes among hypertensive patients treated at primary clinics in Korea. Design and Method: Anthropometric and hemodynamic data and a variety of laboratory tests using serum and urine were obtained for 3109 patients who participated in the Wonder study which is a nation-wide, multi-centered, cross-sectional study. Risk factors and comorbidities according to diabetes status tertiles (normal, prediabetes and diabetes) were identified using multilevel logistic regression models. Results: The overall prevalence of normal, prediabetes and diabetes in patients with hypertension was 21.8%, 48.7and 29.5%, respectively. Smoking is significantly less in prediabetes and diabetic patients compared to normal glucose hypertensive subject. However, risk factors (high waist circumference and serum triglycerides, and low serum high-density lipoprotein), and subclinical organ damages such as LVH and microalbuminuria, and coronary artery disease, CKD and peripheral arterial disease were significantly increased as increasing diabetes status tertiles. Conclusions: The prevalence of prediabetic state in hypertension patients was 48.7%. Epidemiological factors of the prediabetes in hypertension patients showed higher CV risk factors and CV comorbidities, Almost half adults in Korean hypertensive patients was found to have prediabetes. We should have action to prevent prediabetes to be diabetes through better detection, awareness, prevention and treatment.

PP02

Objective: The aim of this study was to investigate gender inequality in age groups of hypertensive (HTN) patients admitted for severe HTN urgencies that were not controlled in the emergency department (ED). Design and method: Starting from all hypertensive patients admitted to the Internal Medicine Clinic between December 2012 and December 2015 (5762 pts) we studied those admitted for severe HTN urgencies that did not respond to treatment in the ED and thus necessitated further observation/intervention to obtain blood pressure (BP) control. Patients with HTN emergencies – stroke, acute coronary syndromes (ACS), pulmonary edema, acute renal failure/acutely decompensated chronic renal disease (CRD), were excluded. This population was further evaluated for CV risk factors and comorbidities focusing on gender differences and age. Results: See figure.Conclusions: Females admitted with severe refractory HTN urgencies had a significantly higher CV burden – they were more frequently obese, diabetic, dyslipidemic and already had a more complex CV history. However, when comparing age groups, females were significantly more affected after 45 years of age, while the situation is reversed in the younger age group.

OP.4D.08] DISORDERED SLEEP BREATHING (SDB) IS THE MAJOR DETERMINANT OF NON-DIPPING AND NOCTURNAL HYPERTENSION IN KIDNEY TRANSPLANT PATIENTS

Objective: In renal transplant patients, the prevalence of nocturnal hypertension by far exceeds that of hypertension as assessed by clinic, daytime, and average 24-hour ABPM and night-time systolic BP (SBP) and the night-day ratio but no other BP metrics are independently associated with IMT in this population (Transplantation 2015 Dec 17). BP during nighttime may provide information for the assessment of CV risk attributable to BP burden in renal transplant patients but the determinants of this phenomenon are still undefined in these patients. Design and method: We recorded 24h-ABPM and performed polysomnography in 215 clinically stable transplant patients. Major classical CV risk factors and CKD-specific risk factors (including phosphate, eGFR, proteinuria and C Reactive Protein) were measured alongside. Our primary goal was to identify the functional correlates of average BP during night-time and of the night/day ratio, a parameter quantifying the BP dipping phenomenon. Results: The Apnea-Hypopnea Index (AHI) exceeded 5 episodes/h in 56 patients and 15 episodes/h in 19. Thus, 17% of patients had mild-to-moderate SDB and 9% severe SDB. In unadjusted analyses, AHI was directly related with night-time SBP (r = 0.19, P = 0.005) and the night/day SBP ratio (r = 0.18, P = 0.01). AHI also associated with average 24h-SBP and DBP (both r = 0.14, P = 0.04). Furthermore, age, gender, BMI, diabetes, phosphate, C-Reactive Protein, and background CV comorbidities were all associated with AHI. In multiple regression analyses adjusting for these parameters as well as for average day-time SBP, Hb, and proteinuria, AHI remained related with average night-time SBP (beta = 0.10, P = 0.02) and with the night/day SBP ratio (beta = 0.17, P = 0.02). In these models, the AHI ranked as the strongest correlate of nigh-time SBP burden. These results did not change also forcing into the model immunosuppressive treatment. Conclusions: In stable transplant patients, sleep disordered breathing is the most powerful functional correlate of nocturnal BP. These relationships are independent of age and comorbidities, eGFR and proteinuria and likely represents irreversible effects of long-term past exposure to kidney failure on the central nervous system.

Strategies for reducing the risk of cardiovascular disease in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by multimorbidities in affected patients. Even though the majority of these comorbidities are also related to advanced age and cigarette smoke, also COPD itself has significant impact on insurgence, or worsening of these conditions. As a consequence, COPD is regarded as a complex disease with pulmonary and extra-pulmonary involvement. According to current guidelines for the management of COPD patients, the comprehensive treatment of this condition should target respiratory symptoms as well as comorbidities. Cardiovascular disease is one of the most frequent comorbidities in COPD patients and there are several strategies for reducing the risk of cardiovascular disease in COPD patients. These include smoking cessation, pharmacologic prevention of cardiovascular disease, and the treatment of COPD. Beta-blockers for the prevention of cardiovascular disease have been traditionally limited in COPD patients, albeit current evidence supporting their efficacy and safety in these patients. With regard to COPD medications, corticosteroids are generally not recommended, except for exacerbations, while long-acting beta2-agonists have demonstrated an acceptable profile of cardiovascular safety. Long-acting anticholinergic bronchodilators, in particular tiotropium in the mist inhaler formulation, have been associated with an increased risk of major cardiovascular events and mortality. Data on this issue remain, however, controversial. Glycopyrronium, a recently introduced anticholinergic, demonstrated. a rapid and sustained relief of respiratory symptoms with a favorable safety profile and no increase in cardiovascular risk, in monotherapy and in combination with a long-acting beta2-agonist in a comprehensive trial program indicating a valid option for COPD patients with CV comorbidities.

Early Graft Loss, Cardiovascular Risk Factor Control and African-American Disparities in Kidney Transplantation.

There is continued and significant debate regarding the salient etiologies associated with racial disparities in kidney transplant (KTX) recipients. Methods: This was a longitudinal cohort study of all adult KTX recipients, comparing African-American (AA) and non-AA recipients that had early graft loss (<5 yrs) to those with graft longevity (surviving graft with at least 5 yrs of follow-up). Results: 524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). In the entire cohort, early graft loss was significantly associated with disability income (adjusted odds-ratio [AOR] 2.2, 95% CI: 1.1-4.5), kidney donor risk index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control; AAs with a mean systolic BP <150 mmHg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while LDL <100 mg/dL (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dL (AOR 0.4, 0.2-1.0) and HgbA1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients. The figure below demonstrates through ROC curve analysis that CV risk factors and control are predictive for graft loss in AA recipients (C-statistic 0.69, p<0.001), but not in non-AA patients (C-statistic 0.57, p=0.211).Figure: No Caption available.Conclusions: These results demonstrate that AA recipients have unique risk factors for early graft loss, suggesting that controlling CV comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.

SAT0541 Gout Patients Treated with Conventional Urate-Lowering Therapy: Association between Disease Control and Health-Related Quality of Life

BackgroundGout patients have impaired quality of life compared with the general population [1]. Gout is a chronic, progressive disease and many patients treated with conventional urate-lowering therapy (ULT) are inadequately...

SAT0540 Gout Patients Treated with Conventional Urate-Lowering Therapy: Association between Disease Control and Work Productivity

BackgroundInadequate control of hyperuricaemia in gout patients can lead to loss of work productivity, activity limitations [1] and higher gout-related treatment costs [2]. Some patients treated with conventional urate-lowering therapy...

SAT0400 Prevalence of Comorbidities in Patients with Psoriatic Arthritis and their Impact on Cardiovascular Risk and Quality of Life

BackgroundMultiple studies suggest that patients with Psoriatic Arthritis (PsA) are at increased risk of cardiovascular diseases than the general population. This risk seems to be strongly associated with subclinical atherosclerosis...

AB0572 Additional risk for cardiovascular comorbidities in patients with psoriatic arthropathy

BackgroundCardiovascular(CV) comorbidities are an important issue of inflammatory arthritis (1.2), given that mortality increases with the severity form of the disease(3). CV risk factors and metabolic factors were present more...

The Management of Gastroprotection in Patients Receiving Antiplatelet Agents – Focus on Clopidogrel and PPI

Abstract: Clopidogrel as an adjunct to aspirin has improved outcomes after acute coronary syndromes and coronary stent implantation. Patients with CV co-morbidities, receiving antiplatelet agents because of their usefulness in primary or secondary cardiovascular prevention, present a significantly increased GI risk; therefore in those patients gastroprotective agents are useful to reduce this risk. Laboratory studies suggested a reduced antiplatelet effect when proton pump inhibitors (PPIs) are co-administered; those data were corroborated from large retrospective studies. Strong evidence from RCTs and systematic review evaluating the clinical interaction between PPI and clopidogrel failed to demonstrate difference in cardiovascular outcomes, confirming a significant reduction in gastrointestinal bleeding in PPI users. To date, the available evidences do not support the warning that PPI prescription could worsen clinical outcome of patients receiving clopidogrel.