Framingham Risk Factors Research Articles

Supplementation of Antioxidants in Chronic Kidney Disease: Clinical Necessity or Wishful Thinking? A Bench to Bedside Translational Research.

Chronic Kidney Disease (CKD) patients are at increased risk for atherosclerosis, cardiovascular disease (CVD) and progression to end stage kidney disease (ESKD). This heavy CVD risk cannot be solely at-tributed to traditional Framingham risk factors. Oxidative stress (OS), defined as the disruption of balance between prooxidants and antioxidants in favor of the former, has emerged as a novel risk factor for CVD and CKD progression. Specifically, lipid peroxidation has been identified as a trigger for endothelial dys-function, the first step towards atherogenesis and protein oxidation has been associated with CKD progres-sion. The oxidation of proteins and lipids starts early in CKD, increases gradually with disease progression and is further exacerbated in ESKD, due to dialysis related factors. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease and progression of CKD, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from ex-perimental and clinical studies that test antioxidants for their possible beneficial effects against CVD and CKD progression such as vitamins E and C, statins, omega-3 fatty acids, trace elements, polyphenols and N-acetylcysteine. </p>.

Shifting perspectives in coronary involvement of polyarteritis nodosa: case of 3-vessel occlusion treated with 4-vessel CABG and review of literature

BackgroundPolyarteritis Nodosa (PAN) is a systemic vasculitis (SV) historically thought to spare the coronary arteries. Coronary angiography and contemporary imaging reveal coronary stenosis and dilation, which are associated with significant morbidity and mortality. Coronary arteries in PAN are burdened with accelerated atherosclerosis from generalized inflammation adding to an inherent arteritic process. Traditional atherosclerotic risk factors fail to approximate risk. Few reports document coronary pathology and optimal therapy has been guarded.MethodsDatabase publication query of English literature from 1990–2022.ResultsSeverity of coronary involvement eludes laboratory monitoring, but coronary disease associates with several clinical symptoms. Framingham risk factors inadequately approximate disease burden. Separating atherosclerosis from arteritis requires advanced angiographic methods. Therapy includes anticoagulation, immunosuppression and revascularization. PCI has been the mainstay, though stenting is confounded by vagarious alteration in luminal diameter and reports of neointimization soon after placement.ConclusionsWhen graft selection avoids the vascular territory of SV’s, CABG offers definitive therapy. We have contributed report of a novel CABG configuration in addition to reviewing, updating and discussing the literature. Accumulating evidence suggests discrete clinical symptoms warrant suspicion for coronary involvement.

Impaired metabolism predicts coronary artery calcification in women with systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) exhibit a high risk for cardiovascular diseases (CVD) which is not fully explained by the classical Framingham risk factors. SLE is characterized by major metabolic alterations which can contribute to the elevated prevalence of CVD. A comprehensive analysis of the circulating metabolome and lipidome was conducted in a large cohort of 211 women with SLE who underwent a multi-detector computed tomography scan for quantification of coronary artery calcium (CAC), a robust predictor of coronary heart disease (CHD). Beyond traditional risk factors, including age and hypertension, disease activity and duration were independent risk factors for developing CAC in women with SLE. The presence of coronary calcium was associated with major alterations of circulating lipidome dominated by an elevated abundance of ceramides with very long chain fatty acids. Alterations in multiple metabolic pathways, including purine, arginine and proline metabolism, and microbiota-derived metabolites, were also associated with CAC in women with SLE. Logistic regression with bootstrapping of lipidomic and metabolomic variables were used to develop prognostic scores. Strikingly, combining metabolic and lipidomic variables with clinical and biological parameters markedly improved the prediction (area under the curve: 0.887, p<0.001) of the presence of coronary calcium in women with SLE. The present study uncovers the contribution of disturbed metabolism to the presence of coronary artery calcium and the associated risk of CHD in SLE. Identification of novel lipid and metabolite biomarkers may help stratifying patients for reducing CVD morbidity and mortality in SLE. INSERM and Sorbonne Université.

The Controversies of Coronary Artery Disease in End-Stage Kidney Disease Patients: A Narrative Review.

Cardiovascular disease (CVD) accounts for more than 50% of deaths among patients with end-stage kidney disease (ESKD). Approximately 40-50% of ESKD patients have clinically significant coronary artery disease (CAD) due to atherosclerosis which accounts for a significant proportion of CVD risk. However, other CVD pathologies including myocardial fibrosis, vascular calcification and arterial stiffening play important contributory roles. The pathophysiology of CAD in ESKD is distinct from the general population. ESKD patients is typically have diffuse multi-vessel involvement with increased calcification that involves both intimal and medial layers of the arterial wall. There is a complex interplay between an increased burden of traditional Framingham risk factors and exposure to non-traditional risk factors including chronic inflammation and dialysis per se. Established treatments for CAD risk factors including cholesterol lowering with statin therapy have attenuated effects and ESKD patients also have worse outcomes after revascularisation. Recent trials such as the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) have established that direct modulation of inflammation improves CVD outcomes in the general population, which may prove to be a potential attractive therapeutic target in ESKD patients. Multiple retrospective observational studies comparing mortality outcomes between haemodialysis (HD) and peritoneal dialysis (PD) patients have been inconclusive. Randomised trials on this issue of clinical equipoise are clearly warranted but are unlikely to be feasible. Screening for stable CAD in asymptomatic ESKD patients remains a clinical dilemma which is unique to chronic dialysis patients being assessed for kidney transplantation. This has become particularly relevant in light of the recent ISCHEMIA-CKD trial which demonstrated no difference between optimal medical therapy and revascularisation upon CVD outcomes or mortality. The optimal strategy for screening is currently being investigated in the ongoing large international multi-centre CARSK trial. Here we discuss the pathophysiology, risk modification, treatment, screening and future directions of CAD in ESKD.

#4346 SERUM NONSKELETAL ALKALINE PHOSPHATASE AS A MARKER OF METABOLIC ENDOTOXINEMIA AND PREDICTOR OF ADVERSE OUTCOME IN PATIENTS WITH CKD

Abstract Background and Aims Elevated alkaline phosphatase (ALP) levels are widely recognized as a marker of poor outcomes in chronic kidney disease (CKD). This association remains poorly understood, with arguments pointing to the skeletal and non-skeletal isozyme fractions as being decisive factors. The liver and intestinal isoenzymes of ALP are able to dephosphorylate and thus inactivate a number of substrates which have been implicated in the promotion of inflammation, including the bacterial endotoxin lipopolysaccharide (LPS). Present study aimed to test the hypothesis whether association of total ALP with all-cause mortality is mainly driven by non-skeletal ALP and its link with metabolic endotoxemia and inflammation. Method Laboratory parameters of mineral and bone disease, inflammation (C-reactive protein, CRP), and metabolic endotoxemia (Lipopolysaccharide binding protein, LBP) were assessed in 431 CKD patients enrolled in the Leuven Mild-to-Moderate CKD Study between Nov 2005 and Sept 2006. Non-skeletal ALP levels were estimated as residuals of the linear regression of log transformed total and bone-specific ALP. Spearman correlation, multivariate regression, and Cox proportional hazard analyses were performed to investigate the associations between skeletal and non-skeletal ALP, LBP, CRP and mortality. Data were censored at start of renal replacement therapy. Results Median age was 63 years, 54% were men, 19% had diabetes, 31% had established cardiovascular disease. At baseline, non-skeletal ALP was associated with inflammatory parameters (CRP: rho = 0.33, P&amp;lt;0.001) and with metabolic endotoxemia (LBP: rho = 0.32, P&amp;lt;0.001). Non-skeletal ALP was a significant predictor of elevated CRP (&amp;gt;3 mg/dL) in multivariate models (odds ratio (OR) per standard deviation (SD) increase 1.97; 95% CI 1.21-3.21; P = 0.006). This association was attenuated by further adjustment for LBP (OR 1.40; 95% CI 0.69-2.80; P = 0.3). During a median follow-up of 8.0 (interquartile range, 2.6-14.7) years 131 patients died. High non-skeletal ALP associated with increased risk of all-cause mortality, even after adjusting for demographics, Framingham risk factors and comorbidities (Hazard ratio (HR) per SD increase 1.28; 95% CI 1.05 – 1.56; P = 0.016). This association was attenuated by further adjustment for LBP (HR 1.22; 95% CI 1.00-1.50; P = 0.051). High bone-specific ALP was not associated with increased risk of all-cause mortality. Conclusion In patients with CKD not yet on dialysis, increased non-skeletal ALP (as opposed to skeletal ALP) is associated with inflammation and increased risk of all-cause mortality. These associations are at least partly driven by metabolic endotoxemia.

PREDICTION OF ATHEROSCLEROSIS DEVELOPMENT AND MODIFICATION OF ITS RISK FACTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: Early-onset atherosclerosis with cardiovascular (CV) sequelae is the major cause of death in systemic lupus erythematosus (SLE); that cannot be explained only by traditional Framingham risk factors as SLE-related factors may also have an impact. The present study aimed to analyze the determinants of atherosclerosis development and risk factors modification by statin therapy in SLE patients. Design and method: This prospective randomized study included 100 SLE patients aged 40.9±1.4 years (90 females, 10 males) and 32 age-, sex-matched healthy controls. Brachial artery flow-mediated dilation (FMD), ultrasound of extracranial and peripheral arteries, and cardiac calcium scoring were used for the identification of atherosclerosis. 52 SLE patients with dyslipidemia were randomized to receive simvastatin 40 mg/day (n = 27) or placebo (n = 25). Lipid panel, FMD, and inflammatory markers were assessed at baseline and after 6 months. Results: The mean duration of SLE was 9.9±0.88 years. The disease activity index (SLEDAI) and SLE damage score (SLICC) were 11.8±0.6 and 1.85±0.13 points, respectively. In 66% of SLE patients, atherosclerosis was present in at least one vascular area which was 3.5 times more frequently compared with controls. Atherosclerosis of carotid arteries was detected in 41% of SLE patients, lower limb arteries, and coronary arteries in 58% and 39% of patients, respectively. FMD was significantly decreased in SLE patients compared to controls (7.95±0.49% vs 11.6±0.3%, p&lt;0.001). In multiple linear regression, age (p&lt;0.001), nephritis (p = 0.001), polyarthritis (p = 0.019), and Raynaud's syndrome (p = 0.045) were associated with low FMD. In binary logistic regression, independent determinants of the atherosclerosis development in SLE were age (p&lt;0.001), body mass index (BMI) (p = 0.001), anti-dsDNA (p = 0.023), FMD (p = 0.017) and malar rash (p = 0.02). After simvastatin treatment, the level of LDL-Cholesterol reduced by 42%, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 decreased by 34.7%, 51.1%, and 47.7% respectively, while FMD increased by 26.0% (p&lt;0.05); in the placebo group, there were no significant changes. Conclusions: The independent determinants of atherosclerosis in SLE patients were both traditional CV risk factors (age, BMI) and SLE-specific factors (anti-dsDNA, malar rash, FMD). In SLE patients with dyslipidemia, simvastatin may have not only lipid-lowering but also potentially anti-inflammatory benefits.

Optimized feature fusion-based modified cascaded kernel extreme learning machine for heart disease prediction in E-healthcare

In recent years, medical technological innovators have focused on diverse clinical therapies to find innovative ways to overcome clinical challenges. But still, there emerge certain drawbacks like high computational cost, increased error, less training ability, the requirement of high storage space and degraded accuracy. To conquer these drawbacks, the proposed research article presents an innovative cascaded extreme learning machine for effective heart disease (HD) prediction. Missing data filtering and normalization methods are carried out for data pre-processing. From the pre-processed data, the features are extracted using the Framingham risk factor extraction module, whereas the extracted features are fused to generate a feature vector. The most significant features are selected using Rhino Satin Herd optimization algorithm. Using a linear weight assignment approach, the feature weighting process is undertaken by allocating higher weights to significant features and less weight to unwanted features. Finally, classification is performed through the Cascaded kernel soft plus extreme learning machine with a stacked autoencoder model. The performance is analyzed using PYTHON to evaluate the superiority of the proposed model. The proposed model obtained an overall accuracy of 90%, precision of 94%, recall of 91.3% and F1 measure of 92.6% in the Cleveland-Hungarian dataset, which is comparatively superior to the existing methods. An accuracy of 92.6% is attained for predicting HD in terms of the heart patient dataset. The proposed model attains better performance because of effective accuracy outcome, reduced overfitting issues, fewer error rates, better convergence and training ability.

Lower extremity symptoms and ankle-brachial index screening as predictors of cardiovascular outcomes in Black adults.

The prevalence of peripheral artery disease (PAD) and leg symptoms are higher in Black than White adults. We studied the effects of self-reported lower extremity symptoms and ankle-brachial indices (ABI) groups on outcomes. Black participants in the Jackson Heart Study with baseline ABI and PAD symptom assessments (exertional leg pain by the San Diego Claudication questionnaire) were included. Abnormal ABI was < 0.90 or > 1.40. Participants were divided into (1) normal ABI, asymptomatic, (2) normal ABI, symptomatic, (3) abnormal ABI, asymptomatic, and (4) abnormal ABI, symptomatic to examine their associations with MACE (stroke, myocardial infarction, fatal coronary heart disease) and all-cause mortality, using Kaplan-Meier survival curves and stepwise Cox proportional hazard models adjusting for Framingham risk factors. Of 4586 participants, mean age was 54.6 ± 12.6 years, with 63% women. Compared with participants with normal ABI who were asymptomatic, participants with abnormal ABI and leg symptoms had highest risk of MACE (adjusted HR 2.28; 95% CI 1.62, 3.22) and mortality (aHR 1.82; 95% CI 1.32, 2.56). Participants with abnormal ABI without leg symptoms had higher risk for MACE (aHR 1.49; 95% CI 1.06, 2.11) and mortality (aHR 1.44; 95% CI 1.12, 1.99). Participants with normal ABI and no leg symptoms did not have higher risks. Among Black adults, the highest risk for adverse outcomes were in symptomatic participants with abnormal ABIs, followed by asymptomatic participants with abnormal ABIs. These findings underscore the need for further studies to screen for PAD and develop preventative approaches in Black adults with asymptomatic disease.

Algorithmic fairness in computational medicine.

SummaryMachine learning models are increasingly adopted for facilitating clinical decision-making. However, recent research has shown that machine learning techniques may result in potential biases when making decisions for people in different subgroups, which can lead to detrimental effects on the health and well-being of specific demographic groups such as vulnerable ethnic minorities. This problem, termed algorithmic bias, has been extensively studied in theoretical machine learning recently. However, the impact of algorithmic bias on medicine and methods to mitigate this bias remain topics of active discussion. This paper presents a comprehensive review of algorithmic fairness in the context of computational medicine, which aims at improving medicine with computational approaches. Specifically, we overview the different types of algorithmic bias, fairness quantification metrics, and bias mitigation methods, and summarize popular software libraries and tools for bias evaluation and mitigation, with the goal of providing reference and insights to researchers and practitioners in computational medicine.

Evaluation of Intima-Media Thickness and Arterial Stiffness as Early Ultrasound Biomarkers of Carotid Artery Atherosclerosis.

Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke. It begins early in life and progresses silently over the years. Identification of individuals with subclinical atherosclerosis is needed to initiate early aggressive vascular prevention. Although carotid plaque appears to be a powerful predictor of cardiovascular risk, carotid intima-media thickness (CIMT) and arterial stiffness can be detected at the initial phases and, therefore, they are considered important new biomarkers of carotid atherosclerosis. There is a well-documented association between CIMT and cerebrovascular events. CIMT provides a reliable marker in young people, in whom plaque formation or calcification is not established. However, the usefulness of CIMT measurement in the improvement of risk cardiovascular models is still controversial. Carotid stiffness is also significantly associated with ischemic stroke. Carotid stiffness adds value to the existing risk prediction based on Framingham risk factors, particularly individuals at intermediate cardiovascular risk. Carotid ultrasound is used to assess carotid atherosclerosis. During the last decade, automated techniques for sophisticated analysis of vascular mechanics have evolved, such as speckle tracking, and new methods based on deep learning have been proposed with promising outcomes. Additional research is needed to investigate the imaging-based cardiovascular risk prediction of CIMT and stiffness.

Correlation Pattern of oxLDL, cortisol, hsCRP, and Adiponectin Levels in Atherosclerosis Risk Population-Based on Framingham Risk Score

Background: The central pathology of cardiovascular disease (CVD) is atherosclerosis. Therefore, it is necessary to examine proteins involved in the and CVD disease mechanism to predict the occurrence of cardiovascular disease due to atherosclerosis. Purpose: This study analysed the correlation pattern of hsCRP, oxLDL, cortisol, and adiponectin levels in atherosclerotic risk population based on the Framingham Risk Score (FRS) to determine the risk of atherosclerosis. Methods Participants were selected using the purposive sampling method,158 participants classes were fired into three risk groups according to FRS. Blood samples were collected, a hsCRP, oxLDL, cortisol, and adiponectin levels were measured using Enzyme-linked Immunosorbent Assay (ELISA). Results and Discussion: Using the inner model test result, four significant direct relationships are formed, indicated by p-value< 0.000. It was FRS to oxLDL, cortisol adiponectin, cortisol to oxLDL, and oxLDL to adiponectin. Based on the indirect effect analysis, it is known that the indirect effect of FRS on Adiponectin through the increase in hs-CRP levels (0.211), FRS on Adiponectin increases in OxLDL levels is significant (-0.224). The coefficient of the effect of the FRS on Adiponectin levels through an increase in OxLDL levels is negative, and also FRS on Adiponectin. The indirect effect of FRS on Adiponectin is that the indirect effect and is not significant (4.083) through the increase in cortisol levels. Conclusion: All variables used in this study are correlated with each other. FRS with hsCRP and adiponectin form a relationship that directly affects each other. Meanwhile, FRS affect adiponectin through OxLDL and cortisol. Key words: Adiponectin, Atherosclerosis, Cardiovascular disease, Framingham Risk Factor, hsCRP.

Iliac Artery Calcification Burden is Associated With Adverse Cardiovascular Outcomes and Mortality After Infrainguinal Revascularization for Chronic Limb-threatening Ischemia

Coronary artery calcification has been shown to increase cardiovascular risk beyond that predicted by traditional Framingham risk factors. The purpose of this study was to determine whether the burden of iliac artery calcification is associated with adverse cardiovascular events and mortality following infrainguinal interventions for chronic limb-threatening ischemia (CLTI).

FC 082DIET QUALITY, PROTEIN-BOUND URAEMIC TOXINS AND GASTROINTESTINAL MICROBIOME IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Individuals with chronic kidney disease (CKD) have significantly increased risk of cardiovascular mortality which is only partially explained by Framingham risk factors. There is a growing body of evidence linking the gut-derived uraemic toxins indoxyl sulphate (IS) and p-cresyl sulphate (PCS) with accelerated kidney disease progression and cardiovascular burden in CKD. Whilst the effect of specific nutrients on uraemic toxin generation has been explored, few studies have characterised the impact of diet quality on the gastrointestinal microbiome in the CKD population. This study aims to explore the associations between dietary quality, protein-bound uraemic toxins and gastrointestinal microbiome in adults with CKD. Method This was a baseline cross-sectional study of adults with stage 3 to 4 CKD who were enrolled in a randomised controlled trial of prebiotic and probiotic supplementation. Habitual dietary intake was measured using a 7-day diet history method by a specialist Dietitian. Diet quality was assessed using food group analysis; protein intake, fibre intake, dietary protein:fibre ratio and adherence to plant-based diet index (PDI) (overall PDI, healthy PDI, unhealthy PDI). Serum uraemic toxins (free and total; IS and PCS) were determined by ultra-performance liquid chromatography. Metagenomic sequencing was used to determine gastrointestinal microbiota richness, diversity, composition and functional capacity. Results There were 68 CKD patients [66% male, median age 70 (IQR 58-75) years] with a mean estimated glomerular filtration rate of 34 ± 11 mL/min/1.73m2. Greater adherence to a hPDI was associated with lower levels of free PCS [-0.021 µmol/L (95% CI -0.042 to -0.001)], while a higher intake of dietary fibre intake was associated with lower levels of free IS [-0.022 µmol/L (95% CI -0.043 to -0.001)]. Compositionally, the gastrointestinal microbiota of this cohort was dominated by members of the phyla Firmicutes and Bacteroidetes. Supervised analysis at the species level demonstrated that 21% of variance in gastrointestinal microbial composition could be attributed to protein:fibre ratio (F=1.27, p=0.04). Further, a higher protein:fibre ratio was associated with an increased relative abundance of unclassified members of order Oscillospirales. Subdoligranulum formicile was correlated with dietary intake of vegetables and wholegrains while an unclassified Prevotella species was correlated with food items considered discretionary including sweet drinks, sweet desserts, animal fats and potatoes. Conclusion The study suggests that habitual diets that are higher in fibre and plant-based foods may positively influence uraemic toxin levels and gut microbiota diversity and composition in adults with CKD. These findings provide rationale for well-designed dietary intervention studies targeting the production of uraemic toxins and exploring the impact on gut microbiome in the CKD population.

The contemporary significance of Framingham risk factors.

The contemporary significance of Framingham risk factors.

Association and Prediction of Subclinical Atherosclerosis by Nonalcoholic Fatty Liver Disease in Asymptomatic Patients.

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing in the general population. This study evaluated the association between NAFLD and significant coronary stenosis in asymptomatic adults and evaluated sex-based differences. Methods We performed a retrospective cross-sectional study in participants without previous cardiovascular diseases who visited the Seoul National University Hospital Health Promotion Center for a health checkup between January 1, 2010, and December 31, 2015. NAFLD was diagnosed on sonography, while coronary artery stenosis (CAS) was assessed on coronary computed tomography angiography (CCTA). Results We obtained 3,693 participants who met the inclusion criteria, and 3,449 of them had no significant stenosis. Among the participants with significant stenosis, the prevalence of NAFLD was 59.4% (145 patients). The prevalence of NAFLD was 47.26% in male participants, which was higher than that in female participants. The association between NAFLD and significant CAS persisted after adjusting for age, body mass index, glycated hemoglobin, and Framingham risk factors. The correlation between NAFLD and significant coronary stenosis appeared to be stronger in women than in men, but the absolute risk was higher in men than in women. Conclusion NAFLD was strongly associated with CAS. We should be alert about an increased cardiovascular risk in patients with NAFLD and more intensively provide primary prevention by performing tests to detect subclinical atherosclerosis.

Coronary Artery Disease in Patients with HIV Infection: An Update.

Premature cardiovascular disease among the HIV-infected population is of great concern among clinicians. The increased life expectancy of HIV-infected individuals is mainly due to the early detection of infection and the advent of antiretroviral therapy. Once known as a deadly disease, HIV infection has transitioned into a chronic condition. Cardiovascular disease in this population is thought to progress early due to traditional and non-traditional risk factors. Early detection of subclinical atherosclerosis has become a center of focus in research as our complete understanding of this process it not yet well known. Advancements in cardiac computed tomography angiography has enabled the exploration of coronary artery disease by further evaluation of coronary stenosis and plaque analysis. An increase in cardiovascular event rates in this population is currently thought to be linked to antiretroviral therapy, Framingham risk factors, and HIV. We sought to present an updated comprehensive review of the available literature on HIV related to atherosclerosis and cardiovascular risk.

Cardio-ankle vascular index as an arterial stiffness marker improves on cardiovascular events by adding to framingham risk score

Abstract Background The cardio-ankle vascular index (CAVI) is a non-invasive measurement that evaluates arterial stiffness using the analysis of oscillometric waveform during cuff-Inflation. Several studies reported that CAVI is associated with cardiovascular risk factors, while the clinical prognostic value of CAVI as a surrogate marker of atherosclerosis has not been fully elucidated. Meanwhile, the Framingham risk score (FRS) is an established marker of cardiovascular outcomes. Purpose To investigate whether adding CAVI to Framingham risk score improves the prediction of cardiovascular events. Methods This prospective observational study included consecutive 422 patients with cardiovascular risk factors but without known coronary artery disease (69±8 years, 63% men). CAVI was measured by the oscillometric method with VaSera vascular screening system. Patients with atrial fibrillation, left ventricular ejection fraction &amp;lt;50%, both ABI&amp;lt;0.9, severe valvular diseases, or hemodialysis were excluded. Primacy outcomes were cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure and revascularization. Results During a median follow-up of 3.1 years, cardiovascular events occurred in 12.8% (3.3%, 15.7%, and 19.1% in the low, intermediate and high-risk group of stratification by FRS, respectively). The ROC curve analysis for discriminating cardiovascular events showed that the AUC of CAVI added to Framingham risk score was the highest compared to Framingham risk score and CAVI alone (CAVI added to Framingham risk score: AUC 66.9, 95% CI 59.6–74.2, Framingham risk score alone: AUC 61.5, 95% CI 53.8–69.1, CAVI alone: AUC 62.3, 95% CI 54.1–70.6). The logistic regression analysis demonstrated that CAVI and Framingham risk score were independent predictors of cardiovascular events (CAVI: OR 1.381, 95% CI 1.164–1.597, p=0.004, Framingham risk score: OR 1.135, 95% CI 1.044–1.225, p=0.007). Next, when logistic regression analysis was performed simultaneously on Framingham risk factor and CAVI, CAVI was an independent predictor of cardiovascular events (OR 1.347, 95% CI 1.124–1.569, p=0.009). Furthermore, in the likelihood ratio test, CAVI added to Framingham risk score significantly improved the cardiovascular event prediction ability than Framingham risk factor alone. Next, when patients with intermediate risk (n=217) were divided into two groups based on CAVI of 9.0, the Kaplan-Meier estimate showed that events occurred more frequently in higher CAVI group (9.3% and 29.1%, log-rank, P=0.009) and the C-statistic was 0.662. Multiple Cox analysis showed that, in the intermediate risk group, CAVI was an independent predictor of primary outcomes (HR 1.387 per 1 index, 95% CI 1.081–1.779, p=0.010). Conclusion The measurement of CAVI could be a useful predictor for cardiovascular events. In addition, the combination of CAVI and Framingham risk score could improve the predictability compared to the Framingham risk score alone. Funding Acknowledgement Type of funding source: None

CT Simulation is Useful for Quantifying Pre-Treatment Coronary Artery Calcification in Breast Cancer Patients

Women diagnosed with breast cancer often receive oncologic treatments like chemotherapy and radiation that increase their risk of having a significant cardiac event. If high-cardiovascular-risk women can be identified before treatment, measures could be taken to reduce cardiac toxicity resulting in a large impact on cardiac- and all-cause mortality. In addition to traditional Framingham risk factors, coronary artery calcium (CAC) score gives important prognostic information for risk of cardiac event. While a cardiac-cycle gated CT scan is the standard imaging modality for CAC quantification, non-gated scans have shown good concordance with gated scans and other CV risk factors. Herein, we undertake a survey of breast cancer patients to determine the distribution of cardiovascular risk using CAC score, and quantify the reproducibility of CAC score calculated using CT simulation scans for breast cancer patients. The 100 most recent patients carrying a diagnosis of breast cancer and having CT simulation scans (one primary and a subsequent scan for boost plan) within 2 weeks and 2 months apart were included. Patients’ CT simulation scans were screened for CAC in a treatment planning system. CT window was set between 100-120 Hounsfield units. For patients’ whose CT simulation scans were negative for calcium during screening, a CAC score of 0 was recorded. For any patient with CAC in any of his/her scans, were exported as DICOM files and imported into InTuition for manual CAC score calculation using the Agatston method. Briefly, the density (in Hounsfield units) of a lesion in a coronary artery is converted to a score. That score is then weighted by the area of the lesion in square millimeters. CAC score risk stratification was performed using previously defined Agatston score ranges, and concordance assessed between scans for each patient. There were 47 left breast, 48 right breast, and 5 bilateral breast cancer cases. 73% of patients had a CAC score of zero on both scans. The agreement of the absolute CAC score between CT sim scans of the same individual was high (Rˆ2 = 0.98). The CAC risk group concordance was 90%. Calculating a CAC from a CT simulation scan is feasible and has good replicability on multiple scans. Future directions for this research include improved treatment decision-making by leveraging this radiographic data to personalize treatments with more conformal therapies to avoid heart dose for women at higher baseline risk of CVD.

Coronary artery disease (CAD) risk factor analysis in an age-stratified hospital population with systemic lupus erythematosus (SLE)

ObjectivesPatients with systemic lupus erythematosus (SLE) are at higher risk for coronary artery disease (CAD) particularly at a younger age. We sought to determine the effect of risk factors on the prevalence of CAD in age stratified hospitalized patients with SLE. MethodsThe National Inpatient Sample (NIS) was queried for hospitalized patients with SLE during the years 2010–2015, and a control group without SLE. The study sample was stratified by age, 18–35 years, 36–55 years, and adults >55 years. The effect of SLE and traditional Framingham risk factors on the prevalence of CAD were assessed. Dominance analysis allowed for ranking of CAD risk factors in each age group. ResultsA total 167,466 patients were matched to an equal number of controls. 88.8% were women, 48.5% Caucasian and 29% African-American. In lupus patients 18–35 years prevalent risk factors included hyperlipidemia, hypertension, hypercoagulability and CKD. Diabetes and depression ranked least important. In middle and older patients, traditional risk factors were dominant. In adults >55 years the prevalence of CAD appears higher in Caucasians whereas in young patients 18–35 years, African Americans are dominant. ConclusionCAD in the young adult patient with SLE is represented predominately by an African-American population and it is dominated by a hypercoagulable state and a less significant role for diabetes. In the lupus cohort over 55 years, which is predominantly Caucasian, SLE specific factors are less significant.

P099: Extending the trimodal distribution of death; trauma patients die at increased rates after discharge. Linking trauma registry data to vital statistics and hospital datasets identifies opportunities to save life

Introduction: The New Brunswick Trauma Registry is a database of injury admissions from eight hospitals throughout the province. Data tracks individuals in-hospital. By linking this information with vital statistics, we are able to observe outcomes post-discharge and can model health outcomes for participants. We want to know how outcomes for trauma patients compare with the general population post discharge. Methods: Using data from 2014-15, we followed over 2100 trauma registry observations for one year and tracked mortality rate per 1,000 people by age-group. We also compared the outcomes of this group to all Discharge Abstract Database (DAD) entries in the province (circa. 7500 total). We tracked mortality in-hospital, at six months, and one year after discharge. We truncated age into groups aged 40-64, 65-84, and 85 or older. Results: In-hospital mortality among those in the trauma registry is approximately 20 per 1,000 people for those age 40-64, 50 per 1,000 people for those aged 65-84, and 150 per 1,000 people aged 85 or older. For the oldest age group this is in line with the expected population mortality rate, for the younger two groups these estimates are approximately 2-4 times higher than expected mortality. The mortality at six-month follow-up for both of the younger groups remains higher than expected. At one-year follow-up, the mortality for the 65-84 age group returns to the expected population baseline, but is higher for those age 40-64. Causes of death for those who die in hospital are injury for nearly 50% of observations. After discharge, neoplasms and heart disease are the most common causes of death. Trends from the DAD are similar, with lower mortality overall. Of note, cardiac causes of death account for nearly as many deaths in the 6 months after the injury in the 40 -64 age group as the injury itself. Conclusion: Mortality rates remain high upon discharge for up to a year later for some age groups. Causes of death are not injury-related. Some evidence suggests that the injury could have been related to the eventual cause of death (e.g., dementia), but questions remain about the possibility for trauma-mitigating care increasing the risk of mortality from comorbidities. For example, cardiac death, which is largely preventable, is a significant cause of death in the 40-64 age group after discharge. Including an assessment of Framingham risk factors as part of the patients rehabilitation prescription may reduce mortality.