Family History Of Myocardial Infarction Research Articles

The effect of Trimetazidine on the left ventricular global longitudinal strain assessed by cardiac magnetic resonance in stable angina patients with previous myocardial infarction and left ventricular

Abstract Introduction Trimetazidine (TMZ) is an anti-ischemic metabolic agent that is indicated in adults as add-on therapy for the symptomatic treatment of patients with stable angina pectoris (SA). Global left ventricular (LV) systolic function is an important predictor of outcomes in patients after myocardial infarction (MI). Cardiac magnetic resonance (CMR) imaging has now evolved into a major tool for the evaluation of patients with LV dysfunction, providing precise measurements of ejection fraction (EF) and viability assessment but also now allowing assessment of global longitudinal strain (GLS) from standard cine CMR images. We hypothesized that the use of TMZ 80 mg as an anti-ischemic agent in patients with SA, history of MI, reduced EF and in the presence of viable myocardium may produce an early modification of GLS. Methods TRIM-AZ - was a non-interventional, prospective Azerbaijan study to analyze the capacity of short-term therapy with TMZ 80 mg on LV GLS evaluated by CMR in patients with previous MI. Patients with a confirmed diagnosis of heart failure (HF) with impaired LV systolic function and SA in the presence of viable myocardium were included. The treatment of all patients was optimized according to the latest ESC guidelines before entry in the study. Patients were randomized into two groups, one received TMZ 80 mg on top of guidelines directed medical therapies, and the other was the control group. A CMR as well as a transthoracic echography were performed for all patients at the inclusion visit and 8 weeks later. Results 52 patients were included in the study, 30 patients in the TMZ group and 22 in the control group,. At baseline, the mean age was 62±7 years , 63% were smokers, 60% hypertensive, 60% diabetics, 48% had a family history of MI, 12% had typical symptoms of SA while 88% had atypical form (e.g. like shortness of breath). All patients received baseline therapy with ARNI/ACE-i, SGLT2 inhibitors, beta-blockers, MRA, ASA, and statin. 8 weeks after the initiation of TMZ, there were no significant changes in LVEF assessed both by Echo and CMR (29,8%±3,2% vs 30,1%±3,5% by echo in TMZ group; 31,3%±2,7% vs 31,6%±2,7% by echo in the control group; 25,9%±3,1% vs 26,9±4,1% by CMR in TMZ group; 26,9%±2,1% vs 30,1%±2,3% by CMR in the control group), however GLS was significantly improved in TMZ group (-9,9%±1,1% to -12,7%±1,2%, p=0,00), but not in control group (-9,3%±1,3% vs -10,3%±1,4% p=0,3). No adverse event related to TMZ use was reported during the study. Conclusion These findings suggest that the use of trimetazidine in patients with stable angina , previous MI and heart failure in the presence of viable myocardium could improve the left ventricular global longitudinal strain assessed by CMR.

Public Awareness of Early Symptoms of Acute Myocardial Infarction in Arar, Saudi Arabia

Background: A significant factor in patient delays is a lack of understanding of MI symptoms. Denial, fear, and an undue reliance on self-management could be the causes of more delays. This study aimed to assess the level of public awareness concerning the early symptoms of acute myocardial infarction (MI) and the appropriate actions to be taken when these symptoms manifest in the population of Arar, Saudi Arabia. Methods: A cross-sectional design employing a quantitative approach was used. Data were collected through an online self-administered questionnaire distributed to 390 participants using convenience sampling. The collected data were analyzed using descriptive and inferential statistics. Results: The study revealed mixed awareness levels among participants. While 63.6% correctly recognized chest pain as a symptom of MI, only 61.8% identified radiating pain to the shoulder, arm, back, neck, and jaw as an alarming symptom. Additionally, 74.9% recognized shortness of breath, and 64.6% identified fatigue as potential MI symptoms. Other symptoms, such as cold sweats (57.2%) and nausea (40.3%), were less well-known. Among the recognized risk factors, smoking (86.7%), diabetes (64.1%), and hypertension (79%) were relatively well-acknowledged, while obesity (84.4%) and sedentary lifestyles (86.9%) were recognized to a lesser extent. Age, education, income, city of residence, personal or family history of MI, history of MI among acquaintances, and exposure to AMI information in media and books significantly influenced awareness scores (p < 0.05). Conclusion: The study underscores the importance of tailored public health interventions to enhance MI awareness, especially among younger individuals, those with higher education, and those with lower incomes. It highlights the need for addressing lesser-known risk factors, such as obesity and sedentary lifestyles, to comprehensively prevent MI.

GI Amyloid: More Than a Heavy Heart

Amyloid transthyretin (ATTR) amyloidosis is caused by the accumulation of insoluble transthyretin (TTR) amyloid fibrils. These proteins can build up in various organ systems such as the musculoskeletal, gastrointestinal, and ocular system. However, there is usually a predilection for the heart and nervous system [1]. ATTR comprises approximately 16% of GI amyloid cases, with the small bowel being the most common area of involvement [2]. Symptoms typically include abdominal pain, nausea and vomiting, unintentional weight loss, diarrhea, and constipation. Given the rarity of the disease, we present a case of biopsy proven ATTR GI amyloidosis to raise awareness and, consequently, aid in early recognition. Our patient is a 48-year-old female with a medical history of substance use disorder who had multiple evaluations for complaints of chest discomfort and gastrointestinal symptoms including nausea, vomiting and diarrhea. Initial evaluation included an echocardiography which found severe left ventricular hypertrophy. Given her significant family history of myocardial infarction, a left cardiac catheterization was completed, however, this revealed normal coronary vasculature. Subsequently, the patient started medical therapy for heart failure with preserved ventricular function pending further testing. Despite medical management, the patient developed worsening symptoms of heart failure warranting repeat echocardiography which showed a significant reduction in ejection fraction. In addition to the patient's worsening cardiac symptoms, she continued to have refractory gastrointestinal symptoms and developed new epigastric pain. Therefore, the patient underwent upper endoscopy with discovery of abnormal peristalsis. After which, a gastric emptying study was done, resulting in a diagnosis of gastroparesis. With the constellation of findings i.e., the pattern of ventricular hypertrophy, lack of hypertensive and coronary artery disease, as well as gastroparesis without a known etiology, there was suspicion for systemic infiltrative disease, which led to further investigation. Gastric, small, and large bowel biopsies confirmed amyloid deposits. The patient also underwent a Tc99m-PYP scan which revealed evidence of cardiac amyloidosis; monoclonal protein analysis test was negative, and a cardiac biopsy showed a profile consistent with amyloid transthyretin type. The patient remained on pharmacologic therapy for gastroparesis and has been referred to cardiac transplantation services for further management.Our case highlights that amyloidosis, including GI amyloidosis, has the potential to go unrecognized due to non-specific signs and symptoms. Clinicians should therefore always have a high index of suspicion as GI involvement in systemic amyloidosis, regardless of protein subtype, is common. This high index of suspicion will allow for the appropriate pathologic examination to be pursued, and ultimately the appropriate management.

Family history of myocardial infarction with non-obstructive coronary arteries (MINOCA)

Abstract Introduction Genetic factors play an important role in the development of myocardial infarction (MI), and a positive family history is a risk factor for MI. The significance of family history among patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) is not known, and previous studies of family history in MI have not made a distinction between MINOCA and MI due to coronary artery disease (MI-CAD) based on angiographic findings. Purpose To investigate family history of MI with and without obstructive coronary arteries in patients with a working diagnosis of MINOCA. Methods A nationwide register-based case-control study of 15 462 MINOCA cases and 38 220 controls without MI with a non-obstructive coronary angiography due to chest pain, together with 204 424 MI-CAD cases, defined as MI with obstructive coronary arteries with a degree of stenosis >50%, between the years 1995-2020. Data from the Swedish coronary angiography and angioplasty register with information about angiographic findings was merged with information on first-degree relatives from the Swedish multi-generation register. Odds ratio (OR) was calculated with a 95% confidence interval (CI), to analyze the probability of MINOCA patients having first-degree relatives with 1) MINOCA, 2) MI-CAD, and 3) MI-CAD patients having first-degree relatives with MI-CAD. Logistic regression models adjusted for age, sex, hypertension, diabetes, hyperlipidemia and smoking status. Results A total of 161 MINOCA patients (1%) had ≥1 first-degree relative with MINOCA and the probability of having a positive family history of MINOCA did not differ compared to controls, with age and sex adjusted OR 1.08 (95% CI 0.89-1.31) and when adjusting for all covariates 1.08 (95% CI 0.87-1.34). Conversely, 1436 MINOCA patients (9%) had ≥1 first-degree relative with MI-CAD and the probability of having a positive family history of MI-CAD was higher compared to controls with age and sex adjusted OR 1.12 (95% CI 1.05-1.20) and when adjusting for all covariates OR 1.16 (95% CI 1.04-1.20). The sensitivity analysis showed that 24 972 MI-CAD (9%) patients had a positive family history of MI-CAD compared to controls, OR adjusted for age and sex 1.68 (95% CI 1.61-1.75), and OR adjusted for all covariates 1.68 (95% CI 1.60-1.75). Conclusions In this first study that examines family history of MINOCA, including data from over 250 000 coronary angiograms, a positive family history of MI-CAD was more common among patients with a working diagnosis of MINOCA compared to controls without MI and with non-obstructive coronary arteries. A family history of MINOCA was uncommon and was not associated with MINOCA. These results indicate that genetic factors and shared environmental factors within a family leading to CAD are important also for MINOCA, thus MI-CAD and MINOCA share underlying mechanisms.

Abstract 16988: Conventional and Regionally Distinctive Risk Factors for First-Onset Myocardial Infarction in Bangladesh. The Bangladesh Risk of Acute Vascular Events (BRAVE) Study

Background: South Asians may be particularly susceptible to premature myocardial infarction (MI) owing both to classic cardiovascular risk factors and distinctive practices more common in South Asian populations. Hypothesis: Identifying modifiable risk factors for MI in South Asian populations should inform prevention strategies. Goal: To study conventional risk factors and several distinctive South Asian characteristics and practices in relation to the likelihood of first-ever MI in Bangladesh. Methods: In a case-control study involving 8,133 first MI cases and 8,122 controls, we calculated odds ratios (ORs) for MI (adjusted, when appropriate, for age, sex, smoking status, history of diabetes, history of hypertension, family history of MI, and LDL-cholesterol) and assessed their potential public health impact using population attributable fractions (PAFs). Results: The mean (SD) age of first MI was 53 (11) years. Adjusted ORs (95% CIs) were 2.75 (2.53-2.99) for cigarette smoking, 2.33 (2.08-2.60) for parental history of MI, 2.26 (2.07-2.48) for history of hypertension, 1.79 (1.61-1.98) for history of diabetes, and 1.61 (1.55-1.67) per 1-SD higher LDL-cholesterol. The highest PAFs (95% CIs) were for current cigarette smoking (48.9% [46.1%-51.6%]), higher LDL-cholesterol (32.4% [30.2%-34.4%]) and history of hypertension (14.7% [13.2%-16.1%]). As for regionally distinctive practices, ORs were 4.05 (3.15-5.21) with biri smoking, 2.04 (1.48-2.81) with chewing tobacco, and 1.26 (1.05-1.51) with parental history of first cousin marriage. Conclusion: In a large case-control study, we confirmed the relevance of several conventional risk factors to risk of first-onset MI in the Bangladesh population. We also identified significant associations with MI of practices distinctive to South Asian populations, including indigenous modes of tobacco consumption and parental first-cousin marriage, apparently independent of conventional risk factors. These findings should help identify opportunities for cardiovascular disease prevention in South Asia that embrace both conventional and regionally distinctive risk factors.

Myocardial Infarction in Young Athletes.

Myocardial infarction (MI) in young athletes is very rare but can have serious consequences, including sudden cardiac death (SCD), an increased proarrhythmic burden in future life, and/or heart failure. We present two cases of young athletes with MI. They did not have previous symptoms, traditional risk factors, or a family history of MI. One case involves a 37-year-old male amateur athlete who experienced two MI following intense physical exertion, likely due to the erosion of an insignificant atherosclerotic plaque caused by a sudden increase in blood pressure during exercise. The second case describes a 36-year-old male semi-professional runner who collapsed at the finish line of a half-marathon and was diagnosed with hypertrophic cardiomyopathy. The heart's oxygen demand-supply mismatch during intensive exercise led to MI. Following the case presentation, we discuss the most common causes of MI in young athletes and their mechanisms, including spontaneous coronary artery dissection, chest trauma, abnormalities of the coronary arteries, coronary artery spasm, plaque erosion, hypercoagulability, left ventricular hypertrophy, and anabolic steroids use.

Heart rate variability: reference values and role for clinical profile and mortality in individuals with heart failure

AimsTo establish reference values and clinically relevant determinants for measures of heart rate variability (HRV) and to assess their relevance for clinical outcome prediction in individuals with heart failure.MethodsData from the MyoVasc study (NCT04064450; N = 3289), a prospective cohort on chronic heart failure with a highly standardized, 5 h examination, and Holter ECG recording were investigated. HRV markers were selected using a systematic literature screen and a data-driven approach. Reference values were determined from a healthy subsample. Clinical determinants of HRV were investigated via multivariable linear regression analyses, while their relationship with mortality was investigated by multivariable Cox regression analyses.ResultsHolter ECG recordings were available for analysis in 1001 study participants (mean age 64.5 ± 10.5 years; female sex 35.4%). While the most frequently reported HRV markers in literature were from time and frequency domains, the data-driven approach revealed predominantly non-linear HRV measures. Age, sex, dyslipidemia, family history of myocardial infarction or stroke, peripheral artery disease, and heart failure were strongly related to HRV in multivariable models. In a follow-up period of 6.5 years, acceleration capacity [HRperSD 1.53 (95% CI 1.21/1.93), p = 0.0004], deceleration capacity [HRperSD: 0.70 (95% CI 0.55/0.88), p = 0.002], and time lag [HRperSD 1.22 (95% CI 1.03/1.44), p = 0.018] were the strongest predictors of all-cause mortality in individuals with heart failure independently of cardiovascular risk factors, comorbidities, and medication.ConclusionHRV markers are associated with the cardiovascular clinical profile and are strong and independent predictors of survival in heart failure. This underscores clinical relevance and interventional potential for individuals with heart failure.ClinicalTrials.gov identifierNCT04064450.

The Prevalence of Microalbuminuria in Patients with Hypertension and Acute Ischemic Stroke

Objective: The purpose of this study was to ascertain the prevalence of microalbuminuria in hypertensive individuals who had recently suffered from an acute ischemic stroke. Study Design: Cross-sectional study Place and Duration: Department of Physiology, Sheikh Zayed Medical College, Rahim Yar Khan in the duration from July, 2022 to December, 2022. Methods: This study comprised 148 hypertension individuals of either sex who had suffered an ischemic stroke. Participants' full demographic information, including age, sex, BMI, and comorbidities, was recorded after obtaining informed written consent. Microalbuminuria was detected in a urine sample collected over the course of 24 hours using the Pyrogallol Red assay. Microalbuminuria was defined as a daily urinary albumin content of 30-300 mg. Association of Microalbuminuria was determined among all cases. SPSS 22.0 was used to analyze all data. Results: Among 148 cases, 87 (58.8%) were males and 61 (41.2%) were females. Patients mean age was 57.6±14.82 years and had mean BMI 25.9±7.48 kg/m2. Mean duration of HTN was 3.19±5.28 years. History of ischemic stroke was found in 14 (9.5%) cases, and family history of myocardial infarction found in 23 (15.5%) cases. Comorbidities were DM, CAD, Congestive heart failure, Atrial fibrillation and peripheral artery disease. We found Microalbuminuria in 68 (45.9%) cases. In 68 cases of microalbuminuria 38 cases had age >50 years, 19 cases were aged between 36-50 years and 11 cases were aged between 18-35 years. Conclusion: The high prevalence of microalbuminuria in hypertension patients with acute ischemic stroke led us to the conclusion that this marker can be used to reliably identify hypertensive individuals at high risk for ischemic stroke at a low cost. Keywords: Hypertension, Albuminuria, Ischemic stroke, Diabetes mellitus

Maternal age at birth of last child and cardiovascular disease mortality later in life among a national cohort of postmenopausal women from the United States.

Abstract Maternal age at last birth of child is increasing in the United States, and it has been reported to influence future chronic diseases. In this study of nationally-representative sample of postmenopausal women, there was no conclusive association between maternal age at last birth of child and cardiovascular disease mortality later in life. Objective Maternal age at last birth (ALB) of child is increasing in the United States, and it has been reported to influence future chronic diseases. However, the relationship of ALB and cardiovascular disease (CVD) events later in life has not been widely studied. We evaluated the association of ALB with CVD mortality. Methods Data were from 7,971 parous postmenopausal women older than 45 years who participated in the US National Health and Nutritional Examination Survey from 1999 to 2018 and had mortality follow-up data through to December 31, 2019. ALB was self-reported, whereas CVD mortality was assessed using International Classification of Diseases codes. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). Results The mean age of participants was 63 ± 9.8 years, with 9.5% being non-Hispanic Black, 9.7% being Hispanic women, and 21% reporting ALB ≥35 years. During a median follow-up of 8.1 years, 443 participants died from CVD. In age-adjusted models, CVD mortality was elevated for women with ALB of <25 years (HR, 1.68; 95% CI, 1.23-2.29) and ALB of ≥35 years (HR, 1.37; 95% CI, 1.00-1.88). However, after additional adjustment for race and ethnicity, foreign born, education, marital status, poverty income ratio, parity, smoking status, age at menarche, oral contraceptive pills use and family history of myocardial infarction, these estimates were attenuated resulting in no association between ALB and CVD mortality. Conclusions In this study of nationally representative sample of postmenopausal women, there was no conclusive association between maternal ALB and CVD mortality later in life.

Nocturia in men and associated comorbidities: a southeast Michigan study

Nocturia is a highly prevalent condition associated with poor quality of life and increased adverse health outcomes. Our study investigates the prevalent condition of nocturia and its profound impact on individuals’ quality of life and adverse health outcomes. We explore the correlation between nocturia and various comorbidities in a southeast Michigan population by analyzing data from 1023 participants who completed self-administered questionnaires during the 2021 Michigan Institute of Urology’s Men’s Health Event; 892 participants responded to the nocturia questionnaire. Categorizing participants based on the severity of nocturia into three groups—no nocturia, nocturia once per night, and multiple nocturia episodes per night—we employed Pearson’s Chi-square test to examine the relationship between nocturia severity and the presence of comorbidities. Our findings demonstrate significant associations between increasing episodes of nocturnal voids and the prevalence of hypertension, non-insulin-dependent diabetes and anxiety. Additionally, arthritis and colorectal polyps exhibit notable links with multiple nocturia episodes, while participants with a family history of hypertension show decreased prevalence as nocturnal voids increase, and a family history of myocardial infarction is notably associated with nocturia, particularly in the nocturia once per night group. Our research highlights the widespread impact of nocturia and its strong associations with diverse comorbidities, underscoring the importance of further investigation to comprehend the underlying mechanisms and enhance patient outcomes.

Analyzing And Detecting Risk Factors For The Diagnosis Of Angina Pectoris With Machine Learning

Aim: To classify angina pectoris (AP) in women by applying the Bagged CART approach, which is one of the machine learning (ML) methods, to the open-access AP dataset. Another aim is to reveal the risk factors associated with AP in women through modeling. Materials and Methods: In the current study, modeling was done with the Bagged CART technique utilizing an open-access data set containing the factors associated with AP. Model results were assessed with accuracy (ACC), sensitivity (Sen), balanced accuracy (BACC), positive predictive value (PPV), specificity (Spe), negative predictive value (NPV), and F1-score performance criteria. In addition, a 5-fold cross-validation approach was applied in the modeling phase. Finally, variable importance was derived with modeling. Results: ACC, BACC, Sen, Spe, PPV, NPV, and F1-score from Bagged CART modeling were 98.5%, 98.5%, 99.0%, 98.0%, 98.0%, 99.0%, and 98.5%, respectively. Depending on the variable importance values calculated for the input variables investigated in the current study, age, family history of myocardial infarction: yes, the average number of cigarettes smoked per day smoking status: current, family history of angina: yes, hypertensive condition: moderate, smoking status: ex, hypertensive condition: mild, family history of stroke: yes, whether the woman has diabetes: yes were obtained as the most important variables associated with AP. Conclusion: With the ML model used, the AP dataset was classified successfully, and the associated risk factors were revealed. ML models can be used as clinical decision support systems for early diagnosis and treatment.

Serial analysis of coronary artery disease progression by artificial intelligence assisted coronary computed tomography angiography: early clinical experience

BackgroundStudies have shown that quantitative evaluation of coronary artery plaque on Coronary Computed Tomography Angiography (CCTA) can identify patients at risk of cardiac events. Recent demonstration of artificial intelligence (AI) assisted CCTA shows that it allows for evaluation of CAD and plaque characteristics. Based on publications to date, we are the first group to perform AI augmented CCTA serial analysis of changes in coronary plaque characteristics over 13 years. We evaluated whether AI assisted CCTA can accurately assess changes in coronary plaque progression, which has potential clinical prognostic value in CAD management.Case presentation51-year-old male with hypertension, hyperlipidemia and family history of myocardial infarction, underwent CCTA exams for anginal symptom evaluation and CAD assessment. 5 CCTAs were performed between 2008 and 2021. Quantitative atherosclerosis plaque characterization (APC) using an AI platform (Cleerly), was performed to assess CAD burden. Total plaque volume (TPV) change-over-time demonstrated decreasing low-density non-calcified plaque (LD-NCP) with increasing overall NCP and calcified-plaque (CP). Examination of individual segments revealed a proximal-LAD lesion with decreasing NCP over-time and increasing CP. In contrast, although the D2/D1/ramus lesions showed increasing stenosis, CP, and total plaque, there were no significant differences in NCP over-time, with stable NCP and increased CP. Remarkably, we also consistently visualized small plaques, which typically readers may interpret as false positives due to artifacts. But in this case, they reappeared each study in the same locations, generally progressing in size and demonstrating expected plaque transformation over-time.ConclusionsWe performed the first AI augmented CCTA based serial analysis of changes in coronary plaque characteristics over 13 years. We were able to consistently assess progression of plaque volumes, stenosis, and APCs with this novel methodology. We found a significant increase in TPV composed of decreasing LD-NCP, and increasing NCP and CP, with variations in the evolution of APCs between vessels. Although the significance of evolving APCs needs to be investigated, this case demonstrates AI-based CCTA analysis can serve as valuable clinical tool to accurately define unique CAD characteristics over time. Prospective trails are needed to assess whether quantification of APCs provides prognostic capabilities to improve clinical care.

Abstract 10043: Plasma Metabolite Dimethylguanidino Valeric Acid and Risk of Incident Coronary Heart Disease Among Women

Introduction: Circulating dimethylguanidino valeric acid (DMGV) has been related to visceral adiposity and unhealthy obesogenic lifestyle factors, and recently emerged as an early marker of cardiovascular disease. Hypothesis: We tested whether circulating DMGV was associated with the risk of coronary heart disease (CHD) among women. We also investigated obesogenic diet/lifestyle factors and biomarkers associated with higher DMGV levels. Methods: This prospective nested case-control study included 1518 women (759 incident cases of fatal CHD and nonfatal myocardial infarction and 759 controls) from the Nurses’ Health Study (NHS). Incident cases of CHD were identified over 10-14 years of follow-up time. Obesogenic lifestyle factors (such as physical inactivity and dietary intakes), adiposity, and cardiometabolic abnormalities (hypertension, dyslipidemia, and diabetes) were assessed in the NHS and the Women's Lifestyle Validation Study (WLVS; n=723). Results: In the NHS, higher plasma DMGV levels were related to greater risk of CHD (P for linear relation=0.007) after controlling for demographic factors, family history of myocardial infarction, and postmenopausal hormone. Compared with women in the lowest quartile of DMGV levels, those in the highest quartile had a relative risk (RR) of 1.70 (95% CI: 1.25, 2.31) for CHD. The RR in the highest quartile was attenuated after controlling for obesogenic factors and adiposity. Obesogenic diet/lifestyle factors, adiposity, altered adipokine levels, and cardiometabolic abnormalities were significant factors related to higher plasma DMGV levels in the NHS and WLVS. Conclusions: Circulating DMGV may be a significant metabolite related to obesogenic diet quality, lifestyles, and cardiometabolic abnormalities among women. High DMGV levels were associated with an increased risk of incident CHD among women.

PMON154 Cardiovascular Complications in Acromegaly-A National Inpatient Sample Analysis

Abstract Introduction Cardiovascular complications are the frequent cause of death in Acromegaly. Most of the prior studies on the epidemiology of cardiovascular complications in Acromegaly had a small sample size due to the rarity of Acromegaly. We wanted to investigate the prevalence of cardiovascular risk factors and cardiovascular diseases in patients with Acromegaly in a large sample size using the NIS (National inpatient sample) Methods We utilized the National inpatient sample (NIS) 2016, 2017, and 2018 for our analysis. All patients with Acromegaly were included. The frequency of different cardiovascular risk factors and cardiovascular diseases was estimated. Results A total of weighted 5654 weighted hospitalizations (95% CI 5220-6089) with Acromegaly were included. Out of these, 15% had heart failure, 20% had cardiac arrhythmias, 7% had valvular diseases, 3% had pulmonary circulation disorders, 6.9% had peripheral vascular diseases. 42.1% had hypertension with no complications, 13.9% had hypertension with complications, 2% had paralysis, 17.7% had Diabetes mellitus without complications, 15.2% had Diabetes mellitus with complications, 20.9% had obesity, 33% had dyslipidemia, 11.6% had nicotine dependence, and 4.7% had a family history of myocardial infarction. The mean elixhauser comorbidity score was 2.9. A total of 33% of patients had pituitary surgery at the time of hospitalization. Discussion Cardiovascular risk factors and cardiovascular diseases remain a significant issue in acromegaly patients. Hypertension was the most common cardiovascular risk factor, and cardiac arrhythmias were the most common cardiovascular disease. Acromegaly patients have a higher risk for mortality than the general population due to cardiovascular complications. This is directly correlated with increased IGF-1 levels which can be eliminated with surgery. However, 80-90% of patients do not cure despite surgery. Hence, aggressive control of the cardiovascular risk factors and strict biochemical control is necessary to reduce cardiovascular mortality in acromegaly patients. Acromegaly patients should be regularly screened for cardiovascular risk factors, and they should receive guideline-directed management of these conditions. Potential limitations of our study include the retrospective nature, lack of documentation of pituitary resection, and the exact treatment received in the outpatient for Acromegaly in NIS. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

OR02-4 Prediabetes is a Risk Factor for Myocardial Infarction-A National Inpatient Sample Study

Abstract Introduction Prediabetes is defined as Hba1c 5.7% - 6.4%, with an intermediate metabolic state and includes impaired glucose tolerance and impaired fasting glucose due to insulin resistance. While Type 2 Diabetes Mellitus is a well-established risk factor for cardiovascular disease, the possible link between Prediabetes and risk of Myocardial infarction (MI) has become a focus of interest in recent years. We wanted to evaluate if Prediabetes is independently associated with increased risk for MI. Methods We included adult patients admitted to teaching hospitals with a primary or secondary diagnosis of "acute myocardial infarction" from the National inpatient sample of 2016, 2017, and 2018. We created three separate multivariate logistic regression models with outcomes as MI, Percutaneous intervention (PCI), and CABG (Coronary artery bypass grafting). Results A total of 1,794,149 (95% CI 1,753,742-1,834,556) weighted hospitalizations with MI were included. Out of the 1.79 million patients with MI, 1% had Prediabetes. Prediabetes was greatly associated with increased odds for MI (OR 1.41, 95% CI 1.35-1.47, P=0.000). After adjusting for age, sex, race, family history of MI, dyslipidemia, hypertension, Diabetes, nicotine dependence, and obesity, Prediabetes was significantly associated with increased odds of MI (OR 1.25, 95% CI 1.20-1.31, P=0.000), increased odds of PCI (OR 1.45, 95% CI 1.37-1.53, P=0.000) and increased odds of CABG (OR 1.95, 95% CI 1.77-2.16, P=0.000). Discussion Our study shows that Prediabetes may be an independent risk factor for MI despite adjusting for the well-established risk factors. Coronary interventions such as PCI and CABG were highly associated with Prediabetes, suggesting macrovascular CAD. This growing evidence indicates the need to identify patients with Prediabetes and aggressively manage their cardiovascular risk factors to prevent MI. Although Prediabetes is commonly missed during coding and adds a limitation to this study, we would highlight that the association of Prediabetes with Myocardial Infarction, PCI, and CABG is a significant addition to the literature. Our study serves as a wake-up call for clinicians and patients to shift the focus to preventing Prediabetes and not just Diabetes. Our findings reinforce the importance of early recognition by screening and early intervention of Prediabetes by lifestyle changes and/or medications to decrease the risk of cardiovascular events. Presentation: Saturday, June 11, 2022 12:15 p.m. - 12:30 p.m.

Hypercholesterolemia diagnosis, treatment patterns and target achievement in patients with acute coronary syndromes in Germany.

Patients who experience an acute coronary syndrome (ACS) are at high risk of further cardiovascular events. Long-term treatment of cardiovascular risk factors, such as hyperlipidemia, is critical to prevent progression of coronary heart disease. However, many patients do not reach recommended target levels for low-density lipoprotein (LDL) cholesterol, despite receiving lipid-lowering therapy. To obtain an insight into the current treatment situation for very high-risk patients after an initial ACS in Germany. The multicenter HYDRA-ACS registry study was initiated to document the clinical characteristics of very high-risk patients with ACS and hyperlipidemia in clinical practice. In addition, lipid profiles, lipid-lowering therapy, and lipid target achievement during treatment were documented over 1 year. 353 patients who were documented had a mean age of 57.3years, mean body mass index was 28.6kg/m2, and 73.4% were male; 52.4% had a family history of myocardial infarction (MI) and 32.6% a family history of coronary heart disease (CHD). Patients' medical histories commonly included CHD (32.9%), percutaneous coronary intervention (PCI; 25.5%), and previous ACS (23.0%). Common comorbidities included hypertension (68.6%), diabetes (17.3%), heart failure (16.7%), and stable angina pectoris (15.9%). The proportion of patients receiving lipid-lowering therapy increased from 65.7% at baseline to 100% at the 12-month follow-up (p < 0.0001). Substantial increases in use were seen for statins (85.0% vs. 36.5%, p = 0.0002) and cholesterol resorption inhibitors (32.9% vs. 8.6%, p = 0.0003). Use of combination therapy increased. The proportion of patients undertaking physical exercise increased (p < 0.0001), as did consumption of fruit and vegetables (p = 0.0222) and fish (p = 0.0162), while alcohol consumption decreased (p = 0.0019). Median LDL cholesterol level decreased significantly from baseline (87 vs. 166mg/dL, p < 0.0001), and the proportion of patients with a level < 70mg/dL increased (50.0% vs. 5.7%, p < 0.0001). Median HDL cholesterol increased (47 vs. 45mg/dL, p = 0.0235) and median triglyceride level decreased (119 vs. 148mg/dL, p = 0.0080). The proportion of patients receiving antihypertensive drugs and platelet aggregation inhibitors increased. The most frequent cardiovascular events during the 12-month follow-up were PCI (25.9%) and cardiac catheterization without PCI (12.9%); MI occurred in 2.4% of patients; no deaths were reported. This study provides a contemporary picture of the treatment of hyperlipidemia after ACS in patients in Germany. Despite treatment with lipid-lowering therapy, many patients did not achieve recommended lipid targets by 12months after an ACS event.

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania.

Introduction:HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa.Objectives:To compare the prevalence of ischemic ECG findings among Tanzanians with and without HIV and to identify correlates of ischemic ECG changes among Tanzanians with HIV.Methods:Consecutive adults presenting for routine HIV care at a Tanzanian clinic were enrolled. Age- and sex-matched HIV-uninfected controls were enrolled from a nearby general clinic. All participants completed a standardized health questionnaire and underwent 12-lead resting ECG testing, which was adjudicated by independent physicians. Prior MI was defined as pathologic Q-waves in contiguous leads, and myocardial ischemia was defined as ST-segment depression or T-wave inversion in contiguous leads. Pearson’s chi-squared test was used to compare the prevalence of ECG findings among those with and without HIV and multivariate logistic regression was performed to identify correlates of prior MI among all participants.Results:Of 497 participants with HIV and 497 without HIV, 272 (27.8%) were males and mean (sd) age was 45.2(12.0) years. ECG findings suggestive of prior MI (11.1% vs 2.4%, OR 4.97, 95% CI: 2.71–9.89, p < 0.001), and myocardial ischemia (18.7% vs 12.1% OR 1.67, 95% CI: 1.18–2.39, p = 0.004) were significantly more common among participants with HIV. On multivariate analysis, ECG findings suggestive of prior MI among all participants were associated with HIV infection (OR 4.73, 95% CI: 2.51–9.63, p = 0.030) and self-reported family history of MI or stroke (OR 1.96, 95% CI: 1.08–3.46, p = 0.023).Conclusions:There may be a large burden of ischemic heart disease among adults with HIV in Tanzania, and ECG findings suggestive of coronary artery disease are significantly more common among Tanzanians with HIV than those without HIV.

Pre-infarction Angina: Time Interval to Onset of Myocardial Infarction and Comorbidity Predictors.

AimsAs part of efforts to identify candidates for patient education aimed at decreasing mortality from acute myocardial infarction, we investigated the prevalence of pre-infarction angina and its predictors among comorbidities in patients who were hospitalized with acute myocardial infarction (MI).MethodsWe conducted a prospective multicenter observational registry of MI patients from 1998 to 2014 (N = 12,093). The present study investigated the prevalence of pre-infarction angina and its predictors among comorbidities with a logistic regression model. Pre-infarction angina was defined as chest pain/oppression observed within 1 month before the onset of MI but which lasted <30 min.ResultsAfter excluding 976 (8.1%) patients with missing data on pre-infarction angina, 11,117 patients [66.4 ± 12.0 years, 9,096 (75.2%) male] were analyzed. Of these, 5,428 patients (48.8%) experienced pre-infarction angina before the onset of MI, while 5,689 (51.2%) experienced sudden onset of acute MI. Most patients experienced the first episode of angina >6 h before the onset of MI, while 15% did so ≤6 h before. Patients with hypertension, diabetes, dyslipidemia, or a family history of MI had a higher probability of pre-infarction angina than those without. Elderly patients and those with a history of cerebrovascular disease were less likely to experience pre-infarction angina.ConclusionsAlmost half of MI patients in our registry experienced pre-infarction angina before MI onset. Patients with hypertension, diabetes, dyslipidemia, or a family history of MI had a higher probability of experiencing pre-infarction angina than those without.

Preconception leisure-time physical activity and family history of stroke and myocardial infarction associate with preterm delivery: findings from a Norwegian cohort

BackgroundPreterm birth poses short and long-term health consequences for mothers and offspring including cardiovascular disease sequelae. However, studies evaluating preexisting family history of cardiovascular disease and risk factors, such as physical activity, as they relate prospectively to risk of delivering preterm are lacking.ObjectivesTo evaluate whether preconception past-year weekly leisure-time physical activity or a family history of stroke or of myocardical infarction prior to age 60 years in first degree relatives associated, prospectively, with preterm delivery.DesignCohort study. Baseline data from Cohort Norway (1994–2003) health surveys were linked to the Medical Birth Registry of Norway for identification of all subsequent births (1994–2012). Logistic regression models provided odds ratios (OR) and 95% confidence intervals (CI) for preterm delivery (< 37 weeks gestation); multinomial logistic regression provided OR for early preterm (< 34 weeks) and late preterm (34 through to end of 36 weeks gestation) relative to term deliveries.ResultsMean (SD) length of time from baseline health survey participation to delivery was 5.6 (3.5) years. A family history of stroke associated with a 62% greater risk for late preterm deliveries (OR 1.62; CI 1.07–2.47), while a family history of myocardial infarction associated with a 66% greater risk of early preterm deliveries (OR 1.66; CI 1.11–2.49). Sensitivity analyses, removing pregnancies complicated by hypertensive disorders of pregnancy, diabetes mellitus, and stillbirth deliveries, gave similar results. Preconception vigorous physical activity of three or more hours relative to less than 1 h per week associated with increased risk of early preterm delivery (OR 1.52; 95% CI 1.01–2.30), but not late or total preterm deliveries. Light physical activity of three or more hours per week relative to less activity prior to pregnancy was not associated with early, late, or total preterm deliveries.ConclusionsResults suggest that family history of cardiovascular disease may help identify women at risk for preterm delivery. Further, research is needed regarding preconception and very early pregnancy vigorous physical activity and associated risks.

Ten-Year Cardiovascular Disease Risk Trajectories by Obstetric History: A Longitudinal Study in the Norwegian HUNT Study.

BackgroundWomen with a history of obstetric complications are at increased risk of cardiovascular disease, but whether they should be specifically targeted for cardiovascular disease (CVD) risk screening is unknown.Methods and ResultsWe used linked data from the Norwegian HUNT (Trøndelag Health) Study and the Medical Birth Registry of Norway to create a population‐based, prospective cohort of parous women. Using an established CVD risk prediction model (A Norwegian risk model for cardiovascular disease), we predicted 10‐year risk of CVD (nonfatal myocardial infarction, fatal coronary heart disease, and nonfatal or fatal stroke) based on established risk factors (age, systolic blood pressure, total and high‐density lipoprotein cholesterol, smoking, antihypertensive use, and family history of myocardial infarction). Predicted 10‐year CVD risk scores in women aged between 40 and 60 years were consistently higher in those with a history of obstetric complications. For example, when aged 40 years, women with a history of preeclampsia had a 0.06 percentage point higher mean risk score than women with all normotensive deliveries, and when aged 60 years this difference was 0.86. However, the differences in the proportion of women crossing established clinical thresholds for counseling and treatment in women with and without a complication were modest.ConclusionsFindings do not support targeting parous women with a history of pregnancy complications for CVD screening. However, pregnancy complications identify women who would benefit from primordial and primary prevention efforts such as encouraging and supporting behavioral changes to reduce CVD risk in later life.