Global Cardiovascular Research Articles

THE GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS LIRAGLUTIDE AND SEMAGLUTIDE IMPROVE CARDIOVASCULAR AND RENAL OUTCOMES ACROSS BASELINE BLOOD PRESSURE CATEGORIES: ANALYSIS OF LEADER AND SUSTAIN 6

High blood pressure (BP) is prevalent in patients with type 2 diabetes (T2D). This post hoc analysis evaluated major adverse cardiovascular (CV) events (MACE) and renal events in patients from LEADER and SUSTAIN 6 (CV outcome trials) with T2D and high CV risk who received liraglutide or semaglutide (vs placebo) according to BP categories: normal ( < 120/80 mmHg), elevated (systolic 120-129 mmHg and diastolic < 80 mmHg), stage 1 hypertension (systolic 130-139 mmHg or diastolic 80-89 mmHg), and stage 2 hypertension (systolic 140 mmHg or diastolic 90 mmHg). LEADER and SUSTAIN 6 were global randomized CV outcome trials of liraglutide and semaglutide, vs placebo, in 9340 and 3297 patients, respectively, with T2D and high CV risk. Primary outcome was MACE (CV death, non-fatal myocardial infarction, or non-fatal stroke), with secondary outcomes including nephropathy. We evaluated the cardiorenal effect of liraglutide and semaglutide on the primary and secondary renal endpoints by baseline BP categories using Cox proportional hazards, with treatment and risk group as factors, adjusted for baseline characteristics related to cardiorenal risk. In LEADER, 15%, 14%, 30%, and 41% of patients had normal BP, elevated BP, stage 1 or stage 2 hypertension, respectively; proportions for SUSTAIN 6 were 13%, 13%, 31%, and 43%, respectively. Within each BP category, baseline demographics were generally well balanced across trial groups. The effects of liraglutide and semaglutide on MACE and secondary nephropathy endpoints across BP categories are shown in the Figure. Liraglutide and semaglutide demonstrated consistent improvements in CV and renal outcomes across most baseline BP categories.

P635The addition of yoga to aerobic exercise programs reduces global cardiovascular risk

Abstract Introduction Regular physical activity may modulate the inflammatory process and be cardio-protective. Yoga is a form of exercise that may have cardiovascular benefits. The effects of yoga on global cardiovascular risk have not been adequately described. The purpose of this study is to determine whether the addition of yoga to a regular exercise regimen reduces global cardiovascular risk. Methods Sixty consecutive individuals with essential hypertension were recruited in a lifestyle intervention program. All individuals with known hypertensive end organ damage, known cardiovascular diseases, as well as those taking medications/supplements that affected blood pressure, blood sugar, cholesterol or vascular inflammation were excluded. Participants were randomized to either a yoga group or similar duration stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercises thrice weekly. Blood pressure, cholesterol levels and hs-CRP were measured, and Reynold's Global Cardiovascular Risk Score was calculated at baseline and at the end of the 3-month intervention program. Results At screening, there were no statistically significant differences between the groups in any measured parameters or the 10-year risk of a cardiovascular event as measured by the Reynolds Risk Score. (8.2 vs. 9.0%; yoga vs. control group) After the 3-month intervention period, there was a statistically significantly greater decrease in the Reynold's Risk Score in the yoga vs. the control group. (7.0 vs. 8.4%, p=0.003, relative reduction 13.2 vs. 6.5%, p&lt;0.0001) Baseline and 3 Month Outcomes Conclusions In patients with essential hypertension on no medications and with no known end organ damage, the practice of yoga incorporated into a 3-month exercise intervention program was associated with significant greater improvement in the Reynold's Risk of a 10-year cardiovascular event, when compared to the control stretching group. If these results are validated in more diverse populations over a longer duration of follow up, yoga may represent an important addition to traditional cardiovascular disease prevention programs.

Microalbuminuria and cardiorenal risk: old and new evidence in different populations.

Since the association of microalbuminuria (MAU) with cardiovascular (CV) risk was described, a huge number of reports have emerged. MAU is a specific integrated marker of CV risk and targets organ damage in patients with hypertension, chronic kidney disease (CKD), and diabetes and its recognition is important for identifying patients at a high or very high global CV risk. The gold standard for diagnosis is albumin measured in 24-hour urine collection (normal values of less than 30 mg/day, MAU of 30 to 300 mg/day, macroalbuminuria of more than 300 mg/day) or, more practically, the determination of urinary albumin-to-creatinine ratio in a urine morning sample (30 to 300 mg/g). MAU screening is mandatory in individuals at risk of developing or presenting elevated global CV risk. Evidence has shown that intensive treatment could turn MAU into normoalbuminuria. Intensive treatment with the administration of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, in combination with other anti-hypertensive drugs and drugs covering other aspects of CV risk, such as mineralocorticoid receptor antagonists, new anti-diabetic drugs, and statins, can diminish the risk accompanying albuminuria in hypertensive patients with or without CKD and diabetes.

Grenada Heart Project–Community Health ActioN to EncouraGe healthy BEhaviors (GHP-CHANGE): A randomized control peer group–based lifestyle intervention

The incidence of cardiovascular (CV) risk factors is increasing globally, with a disproportionate burden in the low and low-middle income countries (L/LMICs). Peer support, as a low-cost lifestyle intervention, has succeeded in managing chronic illness. For global CV risk reduction, limited data exists in LMICs. The GHP-CHANGE was designed as a community-based randomized trial to test the effectiveness of peer support strategy for CV risk reduction in the island of Grenada, a LMIC. We recruited 402 adults from the Grenada Heart Project (GHP) Cohort Study of 2827 subjects with at least two CV risk factors. Subjects were randomized in a 1:1 fashion to a peer-group based intervention group (n = 206) or a self-management control group (n = 196) for 12 months. The primary outcome was the change from baseline in a composite score related to Blood pressure, Exercise, Weight, Alimentation and Tobacco (FBS, Fuster-BEWAT Score), ranging from 0 to 15 (ideal health = 15). Linear mixed-effects models were used to test for intervention effects. Participants mean age was 51.4 years (SD 14.5) years, two-thirds were female, and baseline mean FBS was 8.9 (SD 2.6) and 8.5 (SD 2.6) in the intervention and control group, respectively (P = .152). At post intervention, the mean FBS was higher in the intervention group compared to the control group [9.1 (SD 2.7) vs 8.5 (SD 2.6), P = .028]. When balancing baseline health profile, the between-group difference (intervention vs. control) in the change of FBS was 0.31 points (95% CI: -0.12 to 0.75; P = .154). The GHP-CHANGE trial showed that a peer-support lifestyle intervention program was feasible; however, it did not demonstrate a significant improvement in the FBS as compared to the control group. Further studies should assess the effects of low-cost lifestyle interventions in LMICs.

Improving Global Cardiovascular Health

Improving Global Cardiovascular Health

HIGH PREVALENCE OF SUBJECTS WITH HIGH CARDIOVASCULAR RISK IN COMMUNITY PHARMACIES – NEGATIVE TREND IN 2018

Objective: Our aim is to analyze characteristics and global cardiovascular (CV) risk in a sample of subjects who visited pharmacies in Zagreb County on World Hypertension Day 2017 and 2018. This is part of an ongoing collaboration of pharmacist from Zagreb County and Croatian Society of Hypertension. Design and method: Blood pressure (BP) and total serum cholesterol (TC) (Roche Accutrend Plus; not always fasting) were measured by local pharmacists. In 2017, 906 subjects (369 M, 546 F, mean age 53.7, range 21–74) and in 2018, 901 subjects (327 M 574F) who visited pharmacies for various reasons and agreed to participate, were enrolled. BP was measured twice after rest of 5 minutes in a seated position using Omron M6 device and appropriate cuff. Subjects were divided into 2 subgroups depending on smoking habits. There is a risk of sampling bias as only those who agreed to participate were included. Demographic and anthropometric data; cardiovascular risk factors; data on salt intake and opinion about the usefulness of smart-phone applications in hypertension were collected. Results: In 2017 and 2018 BP > 140/90 mmHg was found in 34.7% and 39.7 % (M vs. F; p < 0.0001,), TC > 5 mmol/l in 29.1% and 55.2% (M vs. F; p < 0.0001), and there were 34.9% and 28.4% smokers (M vs. F; p > 0.05), respectively. Heart Score >5% was determined in 20.5% and 17%, >10 % in 6.3% and 6.3%, respectively. Conclusions: In this study, we confirmed our previous findings that subjects with high BP, TC and high global CV risk are regularly visited pharmacies. Unfortunately, there is no positive trend as we failed to find differences between 2017 and 2018. It is of utmost importance to include pharmacists as collaborators in everyday work where they can help with education about healthy lifestyle and adherence, while during public health actions they could identify subjects with high global CV risk who should be transferred to physicians.

Estimated Global, Regional, and National Cardiovascular Disease Burdens Related to Fruit and Vegetable Consumption: An Analysis from the Global Dietary Database (FS01-01-19)

ObjectivesInadequate fruit and vegetable intake contributes to cardiovascular diseases (CVD), and the impacts of fruits and vegetables on CVD risk worldwide has not been well established by country, age, and sex. Our objective was to derive comprehensive and accurate estimates of the burdens of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available. MethodsNational intakes of fruit and vegetables (including legumes) were estimated using a Bayesian hierarchical model using individual-level intake data from nationally and sub-nationally representative diet surveys and country-level availability data (266 surveys representing 1,630,069 individuals from 113 of 187 countries─82% of the world’s population). The effects of fruits and vegetables on coronary heart disease (CHD) and stroke mortality, collectively referred to as CVD mortality, were derived from the most recent meta-analyses of prospective cohorts. Disease specific mortality data were obtained from the Global Burden of Diseases study. A comparative risk assessment framework was used to estimate the proportional attributable fraction (PAF) and number of disease-specific deaths. ResultsIn 2010, suboptimal intakes of fruit were estimated to result in 521,395 (95% uncertainty interval [UI] 498,254-542,808) CHD deaths (PAF: 7.5%; 7.2–7.8%) and 1,255,978 (1187,716–1325,879) stroke deaths (PAF: 21.7%; 20.5–22.9%) globally per year. Suboptimal intakes of vegetables were estimated to result in 809,425 (783,362–836,687) CHD deaths (PAF: 11.6%; 11.3–12.0%) and 210,849 (196,297–226,577) stroke deaths (PAF: 3.6%; 3.4–3.9%). The proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in males and younger adults. Among the 20 most populous countries, China (541,564; 482,709–608,314; PAF: 20.3%) had the largest absolute CVD deaths from suboptimal fruit intake and India (199,364; 176,961–222,688; PAF: 11.6%) from vegetables. Results for the global burden of fruits and vegetables on CVD in 1990 and 2015 will be presented at the meeting. ConclusionsSuboptimal fruit and vegetable intake each contribute to significant CVD mortality, demonstrating a pressing need for public health and policy priorities to increase intake. Funding SourcesGates Foundation. Supporting Tables, Images and/or Graphs▪▪▪▪▪

Estimated Global, Regional, and National Cardiovascular Disease Burdens Related to Fruit and Vegetable Consumption: An Analysis from the Global Dietary Database (FS01-01-19)

ObjectivesInadequate fruit and vegetable intake contributes to cardiovascular diseases (CVD), and the impacts of fruits and vegetables on CVD risk worldwide has not been well established by country, age, and sex. Our objective was to derive comprehensive and accurate estimates of the burdens of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available. MethodsNational intakes of fruit and vegetables (including legumes) were estimated using a Bayesian hierarchical model using individual-level intake data from nationally and sub-nationally representative diet surveys and country-level availability data (266 surveys representing 1630,069 individuals from 113 of 187 countries─ 82% of the world’s population). The effects of fruits and vegetables on coronary heart disease (CHD) and stroke mortality, collectively referred to as CVD mortality, were derived from the most recent meta-analyses of prospective cohorts. Disease specific mortality data were obtained from the Global Burden of Diseases study. A comparative risk assessment framework was used to estimate the proportional attributable fraction (PAF) and number of disease-specific deaths. ResultsIn 2010, suboptimal intakes of fruit were estimated to result in 521,395 (95% uncertainty interval [UI] 498,254–542,808) CHD deaths (PAF: 7.5%; 7.2–7.8%) and 1255,978 (1187,716–1325,879) stroke deaths (PAF: 21.7%; 20.5–22.9%) globally per year. Suboptimal intakes of vegetables were estimated to result in 809,425 (783,362–836,687) CHD deaths (PAF: 11.6%; 11.3–12.0%) and 210,849 (196,297–226,577) stroke deaths (PAF: 3.6%; 3.4–3.9%). The proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in males and younger adults. Among the 20 most populous countries, China (541,564; 482,709–608,314; PAF: 20.3%) had the largest absolute CVD deaths from suboptimal fruit intake and India (199,364; 176,961–222,688; PAF: 11.6%) from vegetables. Results for the global burden of fruits and vegetables on CVD in 1990 and 2015 will be presented at the meeting. ConclusionsSuboptimal fruit and vegetable intake each contribute to significant CVD mortality, demonstrating a pressing need for public health and policy priorities to increase intake. Funding SourcesGates Foundation. Supporting Tables, Images and/or Graphs▪▪▪▪▪

The Interplay of the Global Atherosclerotic Cardiovascular Disease Risk Scoring and Cardiorespiratory Fitness for the Prediction of All-Cause Mortality and Myocardial Infarction: The Henry Ford ExercIse Testing Project (The FIT Project)

Cardiorespiratory fitness (CRF) is inversely associated with atherosclerotic cardiovascular disease (ASCVD) risk. It is unclear whether the prognostic value of CRF differs by baseline estimated ASCVD risk. We studied a retrospective cohort of patients without known heart failure or myocardial infarction (MI) who underwent treadmill stress testing. CRF was measured by metabolic equivalents of task (METs) and ASCVD risk was calculated using the Pooled Cohorts Equations. Multivariable-adjusted Cox regressions analyses examined the association between METs and incident all-cause mortality and MI outcomes stratified by baseline ASCVD risk. The C-index evaluated risk discrimination while net reclassification improvement evaluated reclassification with CRF added to the ASCVD risk score. Our study population consisted of 57,999 patients of mean age 53 (13) years, 49% women, 64% white, 29% black. Over a median follow-up 11 years (interquartile range 8 to 14 years) there were 6,670 (11%) deaths, while there were 1,757 (3.0%) MIs over a median follow-up of 6 years (interquartile range 3 to 8 years). Among patients with ASCVD risk ≥20%, those with METs ≥12 had a 77% lower risk of all-cause mortality (Hazard ratio 0.23 95% confidence interval = 0.20, 0.27) and 67% lower risk of MI (Hazard ratio 0.33 95% confidence interval = 0.24, 0.46) compared to METs <6. Similar results were obtained for those with ASCVD risk <5%. Addition of METs to ASCVD risk score improved the C-statistic from 0.778 to 0.798 for all-cause mortality and 0.726 to 0.733 for MI (both p <0.001). Addition of METs to ASCVD risk score significantly reclassified risk of all-cause mortality (p <0.001) but not MI (p = 0.052). In conclusion, CRF is inversely associated with risk of all-cause mortality and MI at all levels of ASCVD risk, and provides incremental risk discrimination and reclassification beyond the ASCVD risk score.

Global Cardiovascular Disease and Stroke Prevention: A Call to Action for Nursing.

Global Cardiovascular Disease and Stroke Prevention: A Call to Action for Nursing.

Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondary prevention: Analysis of a large real practice database in Italy

Background and aimsTarget and intensity of low-density lipoprotein cholesterol (LDL-C) lowering therapy should be tailored according to the individual global cardiovascular (CV) risk. We aimed at retrospectively evaluating real-life LDL-C goal attainment and predictive factors for predefined LDL-C therapeutic goals both in primary and secondary prevention. MethodsWe collected data from a large cohort of outpatients aged 40–65 years, followed by general practitioners, cardiologists and diabetologists in Italy. All data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including LDL-C. Study population was stratified according to the presence or absence of previous CV events, including coronary artery disease (CAD), peripheral artery disease (PAD) or stroke/TIA. CV risk profile characterization was based on the European SCORE. Predefined therapeutic goals were set according to the European guidelines on dyslipidaemia: LDL-C levels <70 mg/dl for very high CV risk patients in primary prevention and for those in secondary prevention; <100 mg/dl LDL-C levels for high CV risk patients in primary prevention. Logistic regression analysis with clinical covariates was used to identify predictive factors for achieving these goals; lipid lowering therapy entered in the analysis as continuous (model 1) or categorical variable (model 2). ResultsWe included 4,142 outpatients (43,7% female, age 58.0 ± 5.2 years, BMI 28.5 ± 5.0 kg/m2) among whom 2,964 (71.6%) in primary and 1,178 (28.4%) in secondary prevention. In primary prevention, none of the patients at very high CV risk had LDL-C <70 mg/dl and 8.9% of patients at high CV risk showed LDL-C <100 mg/dl. Only 5.8% of patients in secondary prevention had LDL-C levels <70 mg/dl, specifically 6.5% of patients with CAD, 2.6% of patients with PAD and 4.7% of patients with CVD (p < 0.001). Beyond diabetes and lipid lowering therapy, high risk SCORE estimation resulted a strong and independent predictor for the lack of achieving all predefined therapeutic targets, including LDL-C <100 mg/dl [OR: 0.806 (0.751–0.865)); p < 0.001], and LDL-C <70 mg/dl [OR: 0.712 (0-576-0.880); p = 0.002], in primary prevention. ConclusionsDespite high or very high SCORE risk and use of lipid lowering therapies, we observed poor achievement of LDL-C targets in this large cohort of outpatients followed in a setting of real practice in Italy.

4-Pyridoxic Acid/Pyridoxine Ratio in Patients with Type 2 Diabetes is Related to Global Cardiovascular Risk Scores.

Background: Vascular diseases are multifactorial and several risk factors may have synergetic effect on the global vascular risk. Among patients with diabetes, we investigated whether vitamin B6 species differ according to global cardiovascular risk. Methods: The present observational study included 122 patients with type 2 diabetes (mean (SD) age = 69.9 (9.1) years; 50% men). Concentrations of vitamin B6 vitamers were measured. Classical blood biomarkers and risk factors were used to compute a multivariate risk score. Results: Plasma concentrations of 4-pyridoxic acid were higher in patients with high risk versus those with low risk scores (48.2 (63.7) vs. 31.9 (15.0) nmol/L; p = 0.031). Plasma pyridoxine was significantly lowered in patients at high risk (2.8 (28.4) vs. 38.1 (127.8) nmol/L; p = 0.003). PAr index (4-pyridoxic acid/pyridoxal + pyridoxal 5′-phosphate) (1.05 (0.07) vs. 0.84 (0.06); p = 0.017) and the ratio of 4-pyridoxic acid/pyridoxine (7.0 (4.8) vs. 3.9 (3.2); p < 0.001) were higher in patients at high risk. After adjustment for cystatin C and C-reactive protein, only pyridoxine and 4-pyridoxic acid/pyridoxine ratio remained significantly different according to vascular risk scores. 4-Pyridoxic acid/pyridoxine ratio was the best marker to discriminate between patients according to their risk scores—area under the curve (AUC) (95% confidence intervals (CI)) = 0.72 (0.62–0.81). 4-Pyridoxic acid/pyridoxine ratio was directly related to plasma levels of soluble vascular cell adhesion molecule 1. Conclusion: Vitamin B6 metabolism was shifted in patients with multiple vascular risk factors. The catabolism to 4-pyridoxic acid was enhanced, whereas the catabolism to pyridoxine was lowered. High 4-Pyridoxic acid/pyridoxine ratio is independently associated with global cardiovascular risk.

Cardiovascular Risk Factors and Risk Measurement in Patients with Psoriatic Arthritis in a University Hospital

Abstract Background: Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes. Objectives: To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis. Methods: Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher’s exact test were used to compare frequencies, as well as correlation measurements. Results: 45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol. Conclusions: There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.

Global Cardiovascular Risk of the HIV Positive Patients Receiving Antiretroviral Therapy in Brazzaville

A cross-sectional, descriptive and analytical study was conducted from January to August 2015 at the Brazzaville Ambulatory Treatment Center and at the National Blood Transfusion Center. The objective was to contribute to improving the care of people living with HIV under antiretroviral therapy by assessing their global cardiovascular risk (CVR). The variables studied focused on the epidemiological, clinical and biological aspects. The global CVR was assessed by the Framingham and WHO/ISH scores. There were 135 HIV-positive subjects, including 64 treated patients and 71 untreated HIV+ subjects. The subjects were divided into 83 men (61.5%) and 52 women (38.5%), with an average age of 42.6 ± 2.9 old years. The subjects were single people (62.2%), of a secondary educational level (63.7%), and civil servants (32.6%). The main risk factors found were dyslipidaemia (60%), obesity (36%), smoking (12.6%), hypertension (5.9%), diabetes (0.7%). The metabolic syndrome was found in seven cases (11.3%). The global CVR according to the score of Framingham, initially moderated at 17.2%, and mean at 1.5% within treated patients, was mean at 9.4% and high at 1.6% of the subjects respectively at the sixth month of treatment (p < 0.03). For the score of the WHO/ISH, the risk was high at 2% and very high at 3% within treated patients initially. This risk was increased to 3.1% for the high and very high risk respectively at sixth month of treatment (p < 0.04). In Congo, the HIV population involves a high global CVR under antiretroviral therapy. Preventive actions are highly recommended.

Do Biomarkers Improve Short-term Risk Prediction of Global Cardiovascular Events in Older Adults? Insights from the Atherosclerosis Risk in Communities Study*

Do Biomarkers Improve Short-term Risk Prediction of Global Cardiovascular Events in Older Adults? Insights from the Atherosclerosis Risk in Communities Study*

Evolution of natriuretic peptide biomarkers in heart failure: Implications for clinical care and clinical trials

Natriuretic peptides (NPs) are recommended by international guidelines to exclude non-heart failure causes of acute dyspnea and to assess prognosis. NPs are commonly used as an entry criterion for clinical trials, to minimize enrollment of misdiagnosed patients, or to ensure enrollment of a sufficiently at-risk population. NP values used to select trial populations to date have been inconsistent across studies. Future trials should consider using standardized thresholds for NP levels, with protocol-specified adaptations appropriate for the specific study and patient population to account for factors that can influence the NP level. NPs have been used as an endpoint for proof-of-concept or phase 2 clinical trials, although it is important to remember that positive results in early phase studies may be unstable due to small numbers and the play of chance, and they are not always reproducible in phase 3 trials. Likewise, failure to reduce NP in phase 2 may not necessarily indicate that a drug will be ineffective on clinical outcomes in phase 3. NP guided therapy has been intensively studied, but the clinical outcome benefits of this approach remain uncertain. Neprilysin inhibitors have stimulated further exploration of the NP system and how it influences, and is potentially influenced by, heart failure therapies. This paper discusses the utility of NPs in the current clinical research and practice environment and addresses areas in need of further research from the perspectives of academic clinical trialists, clinicians, biostatisticians, regulators, and pharmaceutical industry scientists who participated in the 13th Global Cardiovascular Clinical Trialists Forum.

Phase angle measured by electrical bioimpedance and global cardiovascular risk in older adults.

Population aging is a worldwide phenomenon associated with physiological and metabolic changes that contribute to the increased prevalence of risk factors for cardiovascular disease. The phase angle (PA) is a variable calculated by bioelectrical impedance analysis, interpreted as a direct measure of cell stability. The objective of the present study was to investigate the correlation of PA with the anthropometric measures, metabolic profile and the cardiovascular risk estimated by the Global Cardiovascular Risk Score in the elderly population. A cross-sectional study was carried out with 402 patients aged >60 years (70.4 ± 6.9 years, 74% female) treated in primary care. Patients were evaluated by blood pressure, anthropometric measurements and body composition. The score of the risk and the stratification of the cardiovascular risk were calculated using the criteria from the Framingham Heart Study. Age, systolic blood pressure, neck circumference and fat-free mass correlated with PA in female patients. In men, age and systolic blood pressure were the variables that correlated with the PA in the bivariate analysis. In the multiple linear regression, for the female group the risk score presented an independent variation with PA (P = 0.051) and age (P < 0.0001). The same correlation was observed for the male group both for PA (P = 0.042) and age (P < 0.0001). The present data show an independent association of PA with overall cardiovascular risk in the elderly population. Geriatr Gerontol Int 2018; 18: 732-737.

Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography

The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography. A total of 269 patients with LBBB (mean age, 69.5±10.9years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters. During a median of 27.5months (interquartile range, 12.8-43.9months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS>-12.2%, global circumferential strain > -11.8%, and twist<6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P=.015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS. Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.

OP.3C.01] COMPARISON BETWEEN EUROPEAN SYSTEMATIC CORONARY RISK EVALUATION AND ITALIAN CUORE ALGORITHMS IN ADULT OUTPATIENTS FOLLOWED BY GENERAL PRACTITIONERS AND SPECIALISED CENTRES

Objective: Global cardiovascular (CV) risk stratification based on either European Systematic Coronary Risk Evaluation (SCORE) or Italian CUORE algorithms should be performed in all adult outpatients by both general practitioners (GPs) and specialised physicians (SPs). Design and method: To compare individual CV risk profile by using either European SCORE and Italian CUORE algorithms in adult outpatients followed by GPs and SPs in Italy. All available data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including blood pressure (BP), serum cholesterol, triglycerides and glucose levels. CV risk profile characterization was based on both SCORE and CUORE algorithms. Study population was stratified according to referring physicians (GPs, cardiologists, diabetologists, other SPs). Results: We analysed data from an overall population sample of 10,404 adult outpatients (age 60.76.5 years, BMI 28.34.9 kg/m2, BP 136.714.4/82.18.2 mmHg, total cholesterol 212.240.7 mg/dl, HDL cholesterol 50.812.3 mg/dl), among whom 7,767 (74.7%) were followed by GPs, 1,239 (11.9%) by cardiologists, 1,006 (9.7%) by diabetologists and 392 (3.8%) by other SPs. Systolic/diastolic BP, total/LDL cholesterol and triglycerides levels were higher and HDL cholesterol was lower in patients followed by GPs and cardiologists compared to other groups. Conversely, BMI and fasting glucose levels were higher in patients followed by diabetologists than in other groups. All major CV risk factors and comorbidities were more frequently reported and controlled in patients followed by cardiologists than in the other groups, with the only exception of diabetes. Both European SCORE (4.74.5) and Italian CUORE (13.711.5) were significantly higher in outpatients followed by cardiologists than in those followed by GPs (4.03.6 and 11.59.7) and diabetologists (3.73.5 and 10.39.2) or other SPs (3.32.8 and 9.47.4; P < 0.001 for all comparisons). Conclusions: Despite proper use of drugs and better pharmacological control of major risk factors, both European SCORE and Italian CUORE algorithms reported higher CV risk profile in patients followed by cardiologists than in patients followed by diabetologists, GPs, and other SPs.

Adding markers of organ damage to risk score models improves cardiovascular risk assessment: Prospective analysis of a large cohort of adult outpatients

IntroductionGlobal cardiovascular (CV) risk stratification is recommended in all outpatients. Risk score charts, however, do not include markers of organ damage (OD). AimTo evaluate the potential added value of including different markers of subclinical OD to US Framingham, European SCORE and Italian Cuore risk score calculators. MethodsWe prospectively evaluated adult outpatients, who underwent blood pressure (BP) assessment and global CV risk stratification. The following OD markers were considered: 1) cardiac OD: electrocardiographic) or echocardiographic left ventricular (LV) hypertrophy; 2) vascular OD: carotid atherosclerotic plaque; 3) renal OD: reduced estimated glomerular filtration rate or creatinine clearance. Different risk score calculators were applied for comparisons. ResultsWe included an overall population sample of 1979 outpatients (44.0% female, age 57.2±13.0years, BMI 26,6±4,4kg/m2, clinic systolic/diastolic BP 145.4±18.3/85.8±10.7mmHg), among whom 117 (5.9%) presented cardiac, 161 (8.1%) vascular, and 117 (5.9%) renal OD. US Framingham, European SCORE and Italian Cuore risk scores were all significantly raised in patients with than in those without OD. A trend toward increase for US Framingham CVD death, European ESC and Italian Cuore scores was observed according to degree of all markers of OD. Among these, reduced ClCr and eGFR showed high sensitivity and specificity to identify high risk individuals. ConclusionsPresence of cardiac, vascular or renal OD is associated with higher risk scores, independently by the types of calculators, age and gender classes. OD detection should be included in CV risk stratification in order to improve diagnostic, prognostic and therapeutic processes.