Fatal CVD Research Articles

A sex-related analysis on the influence of lipoprotein(a) on primary cardiovascular disease prevention and its interplay with traditional lipid markers: results from a 20-year cohort study

Abstract Introduction Elevated lipoprotein(a) [Lp(a)] levels is an established risk factor mediating cardiovascular disease. Purpose The relationship between Lp(a) and the first fatal/non-fatal CVD incident over a 20-year period in males and females without CVD was assessed. Methods A longitudinal prospective study was conducted during 2002–2022. In 2002, a total of 3,042 CVD-free adults (1,514 males and 1,528 females) were enrolled. A follow-up was carried out after 20 years, in 2022, which included 2,169 participants. Out of these, 1,988 had comprehensive data for the occurrence of CVD. The recommended threshold of 50mg/dL was used to define abnormal Lp(a) status (≥50mg/dL). Results During the 2002-2022 period, 718 (i.e. 36%) of participants had a fatal or non-fatal CVD event. Twenty-year CVD-event rate was 35.8% and 40.0% in participants with normal and abnormal Lp(a) levels, respectively. For every mg/dL increase in Lp(a), the odds of having a CVD event within 20 years increases by approximately 0.36% (Hazard ratio (HR) = 1.0036, 95% confidence interval (CI) 1.001,1.007, p=0.048). When stratified by sex the relationship remained significant only in females (HR= 1.006, 95% confidence interval (CI) 1.001,1.011, p=0.023). In the multivariate analysis, significance was lost after adjusting for low- and high-density lipoprotein (LDL-C, HDL-C) and triglycerides (HR= 1.0017, 95% confidence interval (CI) 0.998,1.005, p=0.348). Conclusion Elevated Lp(a) levels are linked to higher CVD risk, particularly in females. Despite growing efforts to clarify Lp(a) as a risk-predicting marker in CVD, clinical guidelines still require definitive evidence, particularly from a sex-focused perspective.

Racial Disparities in Incident and Recurrent Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis.

Most prior studies of cardiovascular (CVD) events have focused on incident events. We analyzed differences by race/ethnicity in incident and recurrent CVD events in the Multi-Ethnic Study of Atherosclerosis from baseline in 2000-2002 through 2019 using joint and multivariable adjusted Cox proportional hazards modeling. Among 6,814 men and women aged 45-85 years without known CVD at enrollment, during median follow up of 17.7 years, 1206 incident and 695 recurrent CVD events were observed; 891 individuals with a non-fatal incident event were at risk for recurrent events. Rates of combined incident and recurrent CVD events among Black, White, Chinese, and Hispanic participants were 16.8, 18.6, 13.3, and 19.3 per 1000 person-years, respectively. First recurrent CVD event rates in Black, White, Chinese, and Hispanic participants were 87.7, 68.7, 78.1, and 80.7 per 1000 person-years, respectively. Revascularization rates were lower in Black versus White participants (3.8 vs 6.4 per 1000 person-years, p<0.0001). Adjusted hazard for CVD mortality was higher for Black vs. White participants (hazard ratio 1.85; 95% CI: 1.03, 3.29). In this multi-ethnic cohort, Black participants had a lower or similar rate of incident and recurrent CVD events, lower rate of revascularization, and higher rate of fatal CVD compared to White participants.

Cardiovascular risk assessment using SCORE2 in a population with hypertension – The reality at a primary health care unit

Introduction and objectivesCardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal, thus it is important to identify individuals at risk. Patients with hypertension have an increased risk of adverse cardiovascular (CV) events. The role of LDL cholesterol (LDL-C) in atherosclerotic CVD is well-established. SCORE2, a new CV risk calculation tool, is used to predict the 10-year risk of fatal or non-fatal CVD. The aim of this study was to understand the impact of SCORE2 on CV risk assessment in a population with hypertension from a moderate risk country, compared to the previously used SCORE. MethodsThis observational cross-sectional study analyzed a population census of 3146 patients diagnosed with hypertension without complications (K86). After applying inclusion and exclusion criteria, 654 patients were included. Data from medical records were collected to calculate and compare SCORE and SCORE2 categories and LDL-C targets. ResultsPatients were classified into SCORE categories: 188 (28.75%) low, 448 (68.5%) moderate, 17 (2.6%) high and 1 (0.15%) very high risk. Using SCORE2, individuals in the SCORE low risk category were reclassified, requiring new targets: 149 individuals (80%) as low to moderate and 39 (20%) as high risk. These differences became more evident when considering SCORE moderate and high-risk categories, where 358 patients (77%) received a higher CV risk categorization, and therefore a lower LDL-C target. There was a significant increase in individuals failing to meet the target when using SCORE2, compared to SCORE (p<0.001). ConclusionThese findings support the importance of CV risk assessment using SCORE2 algorithm in patients with hypertension.

Prediction of individual lifetime cardiovascular risk and potential treatment benefit: development and recalibration of the LIFE-CVD2 model to four European risk regions.

The 2021 European Society of Cardiology prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding initiation of prevention. We aimed to update and systematically recalibrate the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model to four European risk regions for the estimation of lifetime CVD risk for apparently healthy individuals. The updated LIFE-CVD (i.e. LIFE-CVD2) models were derived using individual participant data from 44 cohorts in 13 countries (687 135 individuals without established CVD, 30 939 CVD events in median 10.7 years of follow-up). LIFE-CVD2 uses sex-specific functions to estimate the lifetime risk of fatal and non-fatal CVD events with adjustment for the competing risk of non-CVD death and is systematically recalibrated to four distinct European risk regions. The updated models showed good discrimination in external validation among 1 657 707 individuals (61 311 CVD events) from eight additional European cohorts in seven countries, with a pooled C-index of 0.795 (95% confidence interval 0.767-0.822). Predicted and observed CVD event risks were well calibrated in population-wide electronic health records data in the UK (Clinical Practice Research Datalink) and the Netherlands (Extramural LUMC Academic Network). When using LIFE-CVD2 to estimate potential gain in CVD-free life expectancy from preventive therapy, projections varied by risk region reflecting important regional differences in absolute lifetime risk. For example, a 50-year-old smoking woman with a systolic blood pressure (SBP) of 140 mmHg was estimated to gain 0.9 years in the low-risk region vs. 1.6 years in the very high-risk region from lifelong 10 mmHg SBP reduction. The benefit of smoking cessation for this individual ranged from 3.6 years in the low-risk region to 4.8 years in the very high-risk region. By taking into account geographical differences in CVD incidence using contemporary representative data sources, the recalibrated LIFE-CVD2 model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making for cardiovascular prevention as recommended by 2021 European guidelines.

Dietary atherogenicity and thrombogenicity indexes predicting cardiovascular mortality: 50-year follow-up of the Seven Countries Study

Background and aimTo study the relationships of an Atherogenicity Index (ATI) and a Thrombogenicity Index (THI), with 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE) and cerebrovascular disease or stroke (STR), in 16 international cohorts of middle-aged men. Methods and resultsFoods from a dietary survey in subsamples of men in each cohort of the Seven Countries Study (SCS) were chemically analyzed for several types of fatty acids that were converted into ATI and THI identifying each of 16 cohorts. Ecological correlations of the ATI and THI were calculated with the three fatal CVD conditions and with all-cause mortality at 25 and 50 years. Correlation coefficients (Rs) were positive and highly significant between ATI and THI versus CHD mortality, with levels ranging from 0.79 to 0.97, depending on the duration of follow-up and the choice of 10 or of 16 cohorts. This was not the case for HDUE and STR mortality for which Rs were variable and not significant. A strong direct association was also found with all-causes deaths at 25 and 50-years. ATI and THI were also directly related with dietary saturated fat and cholesterol levels and inversely with the Mediterranean Adequacy Index (a score identifying the Mediterranean diet). ConclusionThese findings indicate that CHD has a different relationship with dietary lipids intake than HDUE and STR. This suggests that HDUE and STR have different underlying pathways or are different diseases.

Abstract 08: Blood Pressure Percentile Charts Better Identify High Risk Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Current guidelines set a static threshold for diagnosis of hypertension based on absolute blood pressure (BP) levels for all ages. However, BP generally increases with age and relative levels tend to track within individuals from young adulthood on. We aimed to determine whether BP percentiles , compared to the current AHA/ACC clinical thresholds for hypertension, are better able to identify young adults at higher risk for future CVD events. Methods: Among 5,115 CARDIA participants (ppts; mean age 25 yrs; 54% female; 51% Black), we used baseline BP level and over 35 years of follow-up for fatal and non-fatal CVD events. We calculated normative BP percentiles for adults aged 18 and older using NHANES by estimating underlying BP among treated individuals combined with observed BP for untreated individuals (Figure). Using these BP Percentile Charts, we calculated the baseline BP percentile for each ppt. Adjusted survival analyses examined the association between BP percentile (in deciles) and incident CVD events over 30 years. C statistics for models using BP percentiles vs those using current guideline-recommended thresholds were compared to determine relative accuracy. Results: At baseline, mean S/DBP was 112/70 mmHg and &lt;1% were on antihypertensive medications. Adjusted HRs for BP percentile decile demonstrated a dose-response effect with increasing risk associated with higher deciles of SBP. Compared to the 5 th decile young adults with SBPs in the highest decile 90-100% (SBP ≥127 for men and ≥120 for women) had a HR of 1.76 (95% CI 1.10-2.83). C statistics for models using BP percentiles were higher than for models using guideline-recommended thresholds (0.724 vs 0.713). No significant association was seen with DBP deciles. Conclusion: BP percentiles are better able to predict future CVD risk in young adults as compared to current age-invariant thresholds. These methods may help to risk stratify young adults and more accurately identify higher risk individuals for early prevention efforts.

Abstract 14410: Hemoglobin A1c and Major Adverse Cardiovascular Events in the VA Million Veteran Program: Evidence-Based Recommendation for Life’s Essential Eight Improvement

Background: The American Heart Association (AHA) recently proposed the Life’s Essential 8 (LE8) score as an enhanced measurement tool for cardiovascular health. For the blood glucose metric in LE8, persons with diabetes mellitus (DM) and a hemoglobin A1c (HbA1c) &lt;7% receive higher points (40 out of 100) and successively fewer with increasing HbA1c. However, some studies have found that having a HbA1c &lt;6% in DM patients was associated with a higher risk of mortality, especially cardiovascular (CVD) death. Aim: We sought to categorize DM with HbA1c &lt;7% into two groups (&lt;6% vs . 6-6.9%) and compare their associations with risk for a major adverse cardiovascular event (MACE) to better inform DM HbA1c cut points and LE8 scoring. Methods: Prospective cohort study of 213,760 Veterans enrolled in the VA Million Veteran Program (MVP) (2011-2021) who had a HbA1c measurement and were free of 5 point-MACE (fatal CVD, non-fatal myocardial infarction [MI], non-fatal stroke, non-fatal heart failure and non-fatal atrial fibrillation [Afib]) at baseline. Results: During a mean follow-up of 4.9 years, we identified 38,151 instances of MACE, including 9,665 MI, 2,837 stroke, 5,523 fatal CVD, 16,543 heart failure, and 18,114 Afib. Compared to diabetic patients with HbA1c of 6-6.9%, diabetic patients with a very low HbA1c level (&lt;6%) had significantly higher risk of MACE [Hazard Ratio (HR): 1.15; 95%CI: 1.09-1.21], which was comparable to diabetic patients with HbA1c of 7-7.9% [HR: 1.14 (95%CI: 1.09-1.18)]. Similar results were observed for the associations between HbA1c and risk for stroke, heart failure, Afib and fatal CVD (Figure 1). Conclusions: Our results confirm previous findings that a very low HbA1c level among diabetic patients was associated with a higher risk for MACE. Based on our findings, we suggest further categorization of diabetic patients with HbA1c below 7% (i.e., &lt;6% and 6-6.9%) and subsequent adjustment in LE8 scoring (i.e., from 40 to 30 points) for HbA1c.

Abstract 14359: Life’s Essential 8 and Cardiovascular Health of Veterans: The Million Veteran Program

Background and Hypothesis: The American Heart Association (AHA) recently proposed the Life’s Essential 8 (LE8) score as an enhanced measurement tool for cardiovascular health. No studies to date have estimated its association with the risk for atherosclerotic cardiovascular disease (ASCVD) incidence and prognosis. Methods: A prospective cohort study of 384,518 Veterans enrolled in the VA Million Veteran Program (MVP) (2011-2021). LE8 score was developed using AHA guidelines. Primary outcome was total ASCVD. Secondary outcome was hard ASCVD which included non-fatal myocardial infarction, non-fatal stroke, and fatal CVD. Results: Based on 1.16 million person-years of follow-up among Veterans with no ASCVD at baseline, 46,295 Veterans had ASCVD events during follow-up. LE8 score was associated with ASCVD and its subtypes in a linear dose-response manner (Figure 1A). The overall population-attributable fractions for all non-ideal LE8 scores was 59% (95%CI: 51%-66%) for ASCVD, where non-ideal blood pressure was most influential (Figure 1B). Based on 0.6 million person-years of follow-up among patients with ASCVD at baseline, the hazard ratio for incident or recurrent hard ASCVD was 0.52 (95%CI: 0.48-0.56) comparing veterans with ≥650 to those with LE8 score &lt;350, with a dose-response linear association pattern. Conclusions: Based on 1.76 million person years of follow-up among Veterans, a high LE8 score was associated with a significantly lower ASCVD risk and a lower likelihood of developing adverse cardiovascular events regardless of ASCVD status at baseline. Theoretically, an ideal LE8 could potentially prevent almost 59% of ASCVD in this study. Our results support the importance of AHA’s promotion of LE8.

Abstract 17076: The Relationship Between Impaired Microvascular Function, Cardiovascular Risk Profile and Subclinical Atherosclerotic Burden in a Swedish Middle-Aged Cohort

Introduction: Microvascular function is associated with cardiovascular risk factors and deteriorates in individuals with cardiovascular disease. Hypothesis: The aim of this study was to investigate the relationship between microvascular function, cardiovascular risk profile and subclinical atherosclerotic burden. Methods: The study enrolled 3809 randomly selected individuals, 50-65 years old, participating in the population-based observational cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS). Microvascular function was measured in forearm skin using an arterial occlusion and release protocol determining the peak blood oxygen saturation, OxyP. Cardiovascular risk was calculated using the updated Systematic Coronary Risk Evaluation (SCORE2; 10-year risk of fatal and non-fatal CVD events). OxyP was compared with Coronary artery calcification score (CACS) and plaques in the carotid arteries. Results: Individuals with OxyP values in the lowest quartile (Q1; impaired microvascular function), had a mean SCORE2 of 5.8% compared to 3.8% in those with the highest values of OxyP (Q4), a relative risk increase of 53%. In the low-risk SCORE2 level (&lt;5% risk), 19.0% of the individuals have impaired microvascular function as compared to 48.1% in the high-risk SCORE2 level (&gt;10% risk). OxyP was lower in individuals with coronary artery calcification (CACS&gt;0) and those with both carotid plaque and CACS&gt;0, as compared to individuals without subclinical atherosclerotic burden (CACS=0 and no carotid plaque; 87.5 ±5.6 % and 86.9 ±6.0 % vs 88.6 ± 5.8 %, p &lt; 0.01). Conclusion: In a population without cardiovascular disease or diabetes mellitus, impaired microvascular function is associated with higher SCORE2 risk and CACS&gt;0. Hence, assessment of microvascular function may be a useful tool for accurate cardiovascular risk prediction, in addition to imaging assessment of atherosclerosis in the coronary and carotid arteries.

Tryptophan metabolites and incident cardiovascular disease: The EPIC-Norfolk prospective population study

Background and aimsCardiovascular disease (CVD) remains the largest cause of death globally due to various risk factors. One novel potential contributor to CVD might be the metabolism of the essential amino acid tryptophan (Trp), which through many pathways can produce immunomodulatory metabolites such as kynurenine, indole-3-propionate and serotonin. We aim to identify the metabolites with the strongest association with cardiovascular disease, utilizing a substantial and diverse cohort of individuals. In our pursuit of this aim, our primary focus is to validate and reinforce the findings from previous cross-sectional studies. MethodsWe used the community-based EPIC-Norfolk cohort (46.3 % men, age 59.8 ± 9.0) with a median follow-up of 22.1 (17.6–23.3) years to study associations between the relative levels of Trp metabolites measured with untargeted metabolomics and incident development of CVD. Serum from n = 11,972 apparently healthy subjects was analysed, of which 6982 individuals had developed CVD at the end of follow-up. Cox proportional hazard models were used to study associations, adjusted for sex, age, conventional cardiovascular risk factors and CRP. All metabolites were Ln-normalised prior to analysis. ResultsHigher levels of Trp were inversely associated with mortality (HR 0.73; CI 0.64–0.83) and fatal CVD (HR 0.76; CI 0.59–0.99). Higher levels of kynurenine (HR 1.33; CI 1.19–1.49) and the [Kynurenine]/[Tryptophan]-ratio (HR 1.24; CI 1.14–1.35) were associated with a higher incident development of CVD. Serotonin was not associated with overall CVD, but we did find associations for myocardial infarction and stroke. Adjustment for CRP did not yield any discernible differences in effect size. ConclusionsTryptophan levels were inversely correlated with CVD, while several of its major metabolites (especially kynurenine and serotonin) were positively correlated. These findings indicate that mechanistic studies are required to understand the role of Trp metabolism in CVD with the goal to identify new therapeutic targets.

Leisure time and occupational physical activity, overall and cardiovascular mortality: a 24-year follow-up in the OPERA study

Background In earlier studies, the health benefits of physical activity have only been related to leisure time physical activity (LTPA). High occupational physical activity (OPA) might even be harmful. The current physical activity recommendations do not separate the OPA and LTPA. We investigated the effect of LTPA and OPA on cardiovascular morbidity and mortality during long-term follow-up. We also examined how heavy work affects the benefits of leisure time exercise. Material and methods The study was part of the OPERA study and the baseline examinations were conducted between the years 1991 and 1993. The Follow-up of events continued until the end of the year 2020. Study subjects (n = 1044) were divided into four groups according to their LTPA (“no exercise”, “irregular”, “regular” and “heavy regular”) and into three groups according to their OPA (“no activity”, “mild” and “heavy”). The amount of exercise was self-reported and the exercise status was defined at the beginning of the study. Study subjects were followed up for their overall mortality (26 years), fatal and non-fatal CVD events (24 and 20 years) and heart failure (20 years). The survival analysis was performed using Kaplan–Meier curves and Cox-proportional hazard models. Results “Heavy” OPA group subjects belonging to the “irregular” (less than 1–2 times 30 min exercise per week) LTPA group experienced the lowest overall mortality compared to other LTPA groups. Also, overall mortality was increased in the “mild” (p = 0.002) and CVD mortality in the” heavy” (p = 0.005) OPA group compared to “no activity”. The incidence of heart failure was increased in the “no exercise” LTPA compared to the “heavy regular” (p = 0.015) group. Conclusions Study subjects who were in physically demanding occupations (heavy OPA) seemed to benefit from less LTPA than WHO currently recommends. Thus we suggest targeting different LTPA recommendations to different OPA groups.

Estimation of 10-year risk of fatal and non-fatal cardiovascular disease in a portuguese population

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the most common noncommunicable disease and actually the leading cause of death globally. Hence, it is important to identify individuals who may benefit from CVD preventive strategies. The European Society of Cardiology (ESC) has recently updated the European Systematic Coronary Risk Evaluation (SCORE) to SCORE2 and SCORE2-OP risk prediction algorithms. Those tools were recalibrated to four groups of countries (low, moderate, high and very high CVD risk) based on national CVD mortality rates published by the WHO, with Portugal being now considered a moderate risk country. Purpose To evaluate the application of SCORE2 and SCORE2-OP in a Portuguese population sample. Methods We conducted a cross-sectional study, including individuals aged 40-90 years, without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia. The sample was recruited at a local cardiovascular screening event in Portugal that took place in May 2022. The 10-year fatal and non-fatal CVD risk was calculated using SCORE2 (for individuals aged &amp;lt; 70 years) and SCORE2-OP (for individuals aged ≥ 70 years) tools. Based on CVD risk category, patients were stratified into 3 categories: low to moderate, high and very high risk according to new SCORE algorithms. Primary outcome was the assessment of 10-year risk of fatal and non-fatal CVD with SCORE2 e SCORE2-OP in a local Portuguese population. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable linear regression was used to analyze 10-year CVD risk. Results This cohort included 431 individuals. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of individuals were women. Regarding baseline characteristics of the included individuals, 48.1% had hypertension, 38.3% had dyslipidemia, 25.5% were obese and 6.6% were smokers. Based on the SCORE2 model 92 (26.1%) individuals were classified into low to moderate risk, 162 (46.0%) into high risk and 98 (27.8%) into very high-risk category. SCORE2 median was 3.43 % (Q1-Q3: 5.5-8.0 p&amp;lt; 0.01) and SCORE2-OP median was 12.70 % (Q1-Q3: 9.7-12.7). Active smoking was the only independent predictor of 10-years CVD risk both in SCORE2 (RR 3.28, 95% CI: 1.93-4.66, p=0.001) and SCORE2-OP (RR 6.31, 95% CI: 2.67-9.52, p&amp;lt;0.001). Conclusions Most individuals in this sample were stratified into high or very high risk of developing 10-year fatal and non-fatal cardiovascular events. This data is in accordance with the updated risk category of Portugal based on World Health Organization cardiovascular mortality rates. These results not only validate the application of SCORE to the Portuguese setting, but also reinforce how this easily applicable tool can help to identify patients who will benefit from CVD preventive strategies.

Is there a role for conicity index in 10-year risk cardiovascular disease prediction?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the leading cause of death globally and one of the most frequent causes of disability. Therefore, the complete and correct evaluation of cardiovascular risk factors is essential to timely prevent CVD. Once central obesity is related with the amount of visceral adipose tissue - an independent predictor of CVD risk - its assessment may play an important role in 10-year CVD prediction. The conicity index (C-Index) assesses central adiposity but there is limited data regarding its role in 10-year CVD risk prediction. Purpose To evaluate the role of C-Index in predicting 10-year risk of fatal and non-fatal CVD according to SCORE2 and SCORE2-OP models in a moderate-risk country population. Methods We conducted a cross-sectional study in a Portuguese population sample. Individuals aged 40-90 years without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia were included in the study through a local cardiovascular (CV) screening event in Portugal, during May 2022. The C-Index was calculated for each individual according to the Valdez’s formula. For CVD risk assessment, we used the cut-offs values proposed by Pitanga et al. 1.18 for women and 1.25 for men. The population was divided into two groups according to the C-Index (risk high versus low). The 10-year risk of fatal and non-fatal CVD was calculated using SCORE2 and SCORE2-OP models. Results A total of 431 individuals were enrolled in this study. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of were women. A total of 48.1% had hypertension, 38.3% dyslipidemia, 25.5% obesity and 6.6% were active smokers. Overall, 387 (90.2%) individuals were found to have elevated C-Index (SCORE2/2-OP mean± DP: 14.99± 7.56 versus 09.81± 3.37), of which 259 were female. In the univariate analysis, there was a correlation between C-Index and estimation of the Risk Cardiovascular Disease according to SCORE2/2-OP but was not statistically significant (Exp (beta) 95 % (CI):2.52 (-2.06-7.10, p=0.28)). However, in the multivariable linear regression analyzes the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p&amp;lt;0.001)) was independent predictive factor related to the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP. Conclusions In the present study most of the patients were categorized into high-risk category. Conicity index was not significantly correlated with estimation of the Risk of Cardiovascular Disease according to SCORE2 and SCORE2-OP models, but the variable waist circumference (Exp (beta) 95 % (CI)18.47 (4.69 – 32.24, p&amp;lt;0.001)) was an independent predictive factor related. More studies are needed to assess the role of C-Index in CVD risk prediction.

Factors influencing systemic coronary risk estimation 2 (SCORE 2)

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): statutory measures. Purpose The aim of the study was to identify factors correlating with estimated an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in apparently healthy people aged 40-69 years with risk factors that are untreated or have been stable for several years and independent predictors of high and very high CVD risk. Methods 148 patients from high-risk country without established ASCVD, diabetes mellitus, CKD, Familial Hypercholesterolemia were included in the study. The clinical examination, laboratory results, chest x-ray, echocardiography using Vivid E95 - GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), spiroergometry using The MetaSoft® Studio application were performed. The subjects were divided into a low-risk group with low-to-moderate CVD risk in SCORE2 (70 pts) and a high risk group with high and very high CVD risk (78pts). Results Pts from high risk group had significantly more frequently s arrythmia (23 vs 2%; p&amp;lt;0,001) and obesity (45 vs 10%; p&amp;lt;0.001), they more often use too much amounts of alcohol (8 versus 0%; p=0.02) compared to low risk group. High risk pts had also significantly higher BMI (29 vs 24 kg; p&amp;lt;o.001), fat (27 vs 19 kg; p&amp;lt;0,001) and TBW (41 vs 38kg; p=0.03); higher LAVI (35 vs 27 ml/m2; p&amp;lt;0.001), left ventricular mass index (86 vs 73 g/m2; p&amp;lt;0,001); E/E’ (7,5 vs 6 cm/s; p=0,0002) but lower V02AT (13 vs 15 ml/min/kg; p=0,01), V02/kg (20 vs 22 ml/min/kg; p=0.008) compared to counterparts. High risk pts presented also higher values of hs of TnT (6,8 vs 3,2 pg/ml; p&amp;lt;0,001 ) and NTproBNP (100 vs 5 pg/ml; p&amp;lt;0,001) and lower level of eGFR (82 vs 98 ml/min/1,73m2). In a multiple logistic regression model the following variables were independently associated with high and very high CVD risk: : E/E’&amp;gt;6,75 cm/s (OR 3.9 95% CI: 1.5-10.3; p=0.004) and hs TnT &amp;gt;4.8 pg/ml (OR6.02, 95% CI: 2.3-15.8; p=0.0002) SCORE 2 (%) correlated positively with metabolic age (R Spearman= 0,79; p&amp;lt;0.0001), hs TnT (R=0.6;p&amp;lt;0.001), NT-proBNP (R=0,5;p&amp;lt;0.001) and negatively with eGFR (R=-0,5; p&amp;lt;0/001), VO2max (ml/min/kg) (R=-0,3; p=0.0008) -Figure 1. Conclusions Higher left ventricular filling pressure assessed by E/E’ and higher hsTnT level are independent predictors of high and very high risk in SCORE 2. The increasing 10-year cardiovascular disease risk correlates with higher metabolic age, higher level of NT-proBNP and hsTnT and lower level of eGFR.

Differences in 10-year cardiovascular risk estimation using SCORE and SCORE2 risk prediction tools: a moderate risk country population analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) risk assessment plays a central role in nowadays clinical practice given its burden in morbidity and mortality worldwide. In the 2021 European Society of Cardiology Guidelines on cardiovascular disease prevention a new CVD risk prediction algorithm was presented, the SCORE2. This tool overcomes some of old SCORE limitations by predicting 10-year fatal and non-fatal CVD risk in individuals without previous CVD or diabetes aged 40-65 years and by including contemporary data from epidemiological data of 13 European countries. Differences on 10-year cardiovascular risk category prediction between SCORE and SCORE2 is still scarce. Purpose We aimed to compare differences in 10-year cardiovascular disease risk prediction in a Portuguese population using SCORE and SCORE2. Methods We conducted a cross-sectional study in a Portuguese population sample. Individuals aged 40-65 years old without known Atherosclerotic Cardiovascular Disease, Diabetes, Chronic Kidney Disease or Familial Hypercholesterolemia were included. The 10-year CVD risk was calculated using SCORE and SCORE2. Based on CVD risk category, patients were stratified into 4 categories - low, moderate, high and very high risk – according to SCORE and in 3 categories - low to moderate, high and very high risk - according to SCORE2 model. Primary outcome was 10-year CVD risk prediction difference between above mentioned models. According to the data distribution, appropriate statistical tests were conducted. Results 117 individuals were included in the study cohort, 79 (67.5%) of which were women. In our study, the 10-year risk prediction of fatal and non-fatal cardiovascular events was significantly different between SCORE and SCORE2. When assessing 10-year risk of CVD through SCORE model, 97.1% (n= 100) of the individuals were classified into low and moderate risk categories. On the other hand, when evaluating CVD risk with SCORE2 only 66% (n=62) of the participants were classified into those risk categories, meaning that 30.9% (n=29) of patients were in high and very high-risk categories with SCORE2 (vs. 2.9% with SCORE). Correlation between SCORE and SCORE2 was verified (R=0.572; p&amp;lt; 0.0001). Regarding cardiovascular risk factors, active smoking was the only independent predictor for 10-year CVD risk in SCORE2 (RR: 3.28, 95% CI: 1.93-4.66, p=0.001). There were no independent predictors for CVD risk in SCORE. Conclusions Ten-year cardiovascular risk assessment may be underestimated by SCORE model. In the present study, through SCORE CVD risk classification most of patients were classified into lower risk categories than those obtained through updated SCORE2. SCORE2 is a more up-to-date and more calibrated CVD risk assessment tool than old SCORE, so SCORE2 may contribute to a better reclassification of patients and hereafter allow intensification of CVD protection measures.

LIFE EVENTS AND CARDIOVASCULAR DISEASE EVENTS: THE STUDY OF WOMEN'S HEALTH ACROSS THE NATION

Abstract Cardiovascular disease (CVD) is the number one cause of death for women, and major life events across midlife may contribute to CVD risk. The present study aimed to test whether greater exposure to major life events across nearly two decades of longitudinal follow-up would be associated with higher risk of clinical cardiovascular disease events. 3,222 middle-aged women from the multi-ethnic Study of Women’s Health Across the Nation reported and provided up to 15 years of major life events, non-fatal incident CVD events, traditional biobehavioral and sociodemographic factors, and death certificates. Cox proportional hazards models were used to test the association between average annual life events and incident fatal and nonfatal CVD events. Each additional major life event was associated with a 1.16-fold (95% CI: 1.08-1.23) increase in CVD events. CVD risk will be discussed considering evidence of racial/ethnic disparities in exposure to major life events.

Cause of death and excess mortality in patients with lower-risk myelodysplastic syndromes (MDS): A report from the European MDS registry.

Information on causes of death (CoDs) and the impact of myelodysplastic syndromes (MDS) on survival in patients with lower-risk MDS (LR-MDS) is limited. A better understanding of the relationship between disease characteristics, clinical interventions and CoDs may improve outcomes of patients with LR-MDS. We prospectively collected data on patients with LR-MDS in the European MDS registry from 2008 to 2019. Clinical, laboratory and CoDs data were obtained. To examine MDS-specific survival, relative survival (RS) was estimated using national life tables. Of 2396 evaluated subjects, 900 died (median overall survival [OS]: 4.7 years; median follow-up: 3.5 years). The most common CoDs were acute myeloid leukaemia/MDS (20.1%), infection (17.8%) and cardiovascular disease (CVD; 9.8%). Patients with isolated del(5q) and with red cell transfusion needed during the disease course, had a higher risk of fatal CVD. The 5-year OS was 47.3% and the 5-year RS was 59.6%, indicating that most patients died due to their underlying MDS. Older patients (aged >80 years) and the lowest-risk patients were more likely to die from competing causes. This study shows that MDS and its related complications play crucial role in the outcome of patients with LR-MDS.

Comparison between the European SCORE and the updated SCORE2 for cardiovascular outcomes

Abstract Introduction The European Systematic Coronary Risk Evaluation (SCORE) has predicted a 10-year risk of CVD since 1986. It included only fatal CVD outcomes, underestimating the total CVD burden, especially for younger people. To counteract this issue, a new score was created (SCORE2) to estimate 10-year fatal and non-fatal CVD risk in Europeans without previous CVD or diabetes aged 40–69 years. Purpose Establish a comparison between SCORE and SCORE2 in terms of CV outcomes in a moderate-risk population. Methods A population of 1,178 individuals without CVD (mean age 53.3±6.9 years; 73.9 male) was stratified into three risk categories for SCORE and SCORE2: low, moderate and high-risk. Using t-test and Chi-square, we compared the two scores in terms of means and risk categories. Kaplan-Meier estimator evaluated MACE occurrence for each category of the two scores during an extended follow-up (mean of 5.2±3.4 years). MACE discriminative capacity of SCORE and SCORE2 was evaluated through C-index methodology. Results The means of the two scores were significantly different (p&amp;lt;0.0001): 2.1±2.4 for SCORE and 6.0±3.3 for SCORE2. 51% of the individuals with high-risk SCORE2 presented the lowest value of SCORE (0–5%). Kaplan-Meier curves showed that the highest category had a worst survival for each score. SCORE2 showed a better discriminative capacity for MACE (C-index 0.678) relatively to SCORE (C-index 0.591), with statistical significance (p&amp;lt;0.0001). Conclusion SCORE2 enhanced the identification of individuals at higher risk of developing CVD and better discriminated MACE occurrence relatively to SCORE. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM

Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people

Study objectiveThe aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. MethodsThis study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010–2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used. ResultsFour PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95%CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained. ConclusionOur study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.

Application of the 2019 ESC/EAS guidelines for the management of dyslipidaemia to the French population: Impact of lowering intervention thresholds on prevalence and treatment of hypercholesterolemia

The 2019 recommendations for the management of dyslipidaemia by the ESC/EAS modified slightly criteria for CV risk level and lowered significantly the intervention thresholds (lifestyle and/or drugs intervention). To evaluate, at a population level, the impact of the 2019 lowering intervention thresholds on prevalence and treatment of LDL hypercholesterolemia in France. Data from Esteban, a cross sectional study conducted on a representative sample of the French population between 2014 and 2016 were used. Data were collected with questionnaires and a clinical exam. An individual evaluation of cardiovascular risk using calculated SCORE for 10 year risk of fatal CVD and criteria defined in the 2019 ESC/EAS recommendations. People were considered having LDL hypercholesterolemia if their LDL level were higher than the threshold specified in the 2019 recommendations: 0.55 mg/dl for very high risk and secondary prevention; 0.7 for high risk; 1.0 for moderate risk and 1.16 for low risk. An estimate of the prevalence of hypercholesterolemia, based on those new 2019 recommendations with expanded definition of hypercholesterolemia due to lowered thresholds, yields a prevalence rate of 72.1% in France. Results by risk group shown that the prevalence was 57.3% in the low risk group, 89.7% in the moderate risk group and was ≥ 90% in the high, very high and secondary prevention group. Expanded definition of disease by lowering thresholds in 2019 recommendations led to 3/4 of the French population needing a lifestyle and/or drugs interventions. These elements raise the question of a hierarchical organisation of prevention strategies, particularly in low-risk groups or in younger populations. These results highlight the impact, in terms of quantifying the burden of the 2019 ESC/EAS recommendations, but also the impact on care, with 3 of 4 patients needed to be treated using health-diet and/or medication measures.