Heart Disease Mortality Research Articles

A LONGITUDINAL INCREASE IN SLEEP HEALTH PROBLEMS IN MIDDLE ADULTHOOD PREDICTS EARLY MORTALITY

Abstract Negative consequences of sleep health problems are common in middle-age but poorly understood. This study investigated multidimensional sleep health in middle adulthood and mortality risk. Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (T1; n=9,640, Mage=52.72) and again in 2013-2016 (T2; n=4,334). Deaths since each survey were logged. Multidimensional sleep health composite captured Regularity, Satisfaction, Alertness, Efficiency, and Duration. Cox regression adjusted for sociodemographics and known risk factors (BMI, smoking, depression/anxiety, diabetes, and hypertension) indicated that each unit higher sleep health problems at T1 was associated with 245% and 324% increase in hazard rates for all-cause (Hazard Ratio; HR=3.45, p<.001) and heart disease (HR=4.24, p<.001) mortality, respectively. Those with an increase in sleep health problems at T2 compared to T1 had a 182% increase in all-cause mortality risk (HR=2.82, p<.05), but not heart disease mortality risk. Improving sleep health may reduce early mortality risk.

A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers

IntroductionHazardous exposures from the World Trade Center (WTC) terrorist attacks have been linked to increased incidence of adverse health conditions, often associated with increased mortality. We assessed mortality in a pooled cohort of WTC rescue/recovery workers over 15 years of follow-up. Materials and methodsWe analyzed mortality through 2016 in a pooled and deduplicated cohort of WTC rescue/recovery workers from three WTC-exposed cohorts (N = 60,631): the Fire Department of the City of New York (FDNY); the WTC Health Registry (WTCHR); and the General Responder Cohort (GRC). Standardized mortality ratios (SMRs) were estimated to assess mortality vs. the US and NY state populations. Multivariable Cox proportional hazards models were used to examine associations of WTC exposures (date of first arrival, working on the WTC debris pile) with mortality risk. ResultsThere were 1912 deaths over 697,943.33 person-years of follow-up. The SMR for all-cause mortality was significantly lower-than-expected, both when using US (SMR 0.43, 95% confidence interval [CI] 0.42–0.45) and NYS (SMR 0.51, 95% CI 0.49–0.53) as reference populations. SMRs were not elevated for any of the 28 major causes of death. Arriving at the WTC site on 9/11-9/17/2001 vs. 9/18/2001-6/30/2002 was associated with 30–50% higher risk of all-cause, heart disease and smoking-related mortality in non-FDNY/non-GRC members. Conversely, arriving on 9/11/2001 vs. 9/18/2001-6/30/2002 was associated with 40% lower all-cause and smoking-related mortality risk in FDNY members. Working on vs. off the WTC pile was associated with an increased risk of all-cause mortality in non-FDNY/non-GRC members (adjusted hazard ratio [aHR] 1.25, 95% CI 1.04–1.50), and cancer-specific mortality in GRC members (aHR 1.39, 95% CI 1.05–1.84), but lower mortality risks were found in FDNY members. ConclusionsWe did not observe excess mortality among WTC rescue/recovery workers compared with general populations. However, significantly increased mortality risks among some sub-groups with high WTC exposure warrant further investigation.

Effectiveness and safety of Tiaogan formula in the treatment of coronary heart disease: A protocol for systematic review and meta-analysis

The morbidity and mortality of coronary heart disease (CHD) has remained high, which greatly increases people's economic burden. Several studies have showed that Tiaogan formula (TGF), as a kind of Chinese herbal medicine, was of benefit to relieving angina pectoris symptoms and improving the quality of life for CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of TGF to CHD. This systematic review and meta-analysis will assess the effectiveness and safety of studies of TGF in CHD patients. A systematic search for literature up to December 2022 will be conducted in following public electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database Database, and Wanfang Database. Inclusion criteria are randomized controlled trials of Tiaogan formula in the treatment of coronary heart disease. The primary outcome measures will be mortality, acute cardiovascular events, total efficacy rate, and improvement of angina symptoms. The secondary outcome measures will be electrocardiogram, levels of blood lipid, and adverse events. RevMan 5.4 software Cochrane Collaboration (London, United Kingdom) will be applied for data synthesis, sensitivity analysis, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. This study will provide a systematic review of Tiaogan formula in the treatment of CHD. This study will provide a high-quality synthesis of the effects and safety of Tiaogan formula in the treatment of CHD patients.

Consumption of whole grains and refined grains and associated risk of cardiovascular disease events and all-cause mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

BackgroundAlthough relationships between the intake of whole grains and refined grains and the incidence of cardiovascular disease (CVD) events and all-cause mortality have been investigated, the conclusions have been inconclusive. ObjectivesWe aimed to comprehensively summarize the evidence about the correlation between consuming whole grains and refined grains and risks of CVD events and all-cause mortality and to evaluate the meta-evidence quality. MethodsWe searched PubMed, Embase, and Web of Science until 15 March, 2022. Random-effects models were employed to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). We explored potential linear or nonlinear relationships using restricted cubic splines. The NutriGrade tool was employed to rate meta-evidence quality. ResultsTwenty-four articles (68 studies; 46 for whole grains and 22 for refined grains) with 1,624,407 participants were included. Per 30-g increase in daily whole grain consumption, the RRs and 95% CIs of stroke, coronary heart disease (CHD), heart failure (HF), CVD, and all-cause mortality were 0.98 (0.96, 1.00), 0.94 (0.92, 0.97), 0.97 (0.89, 1.07), 0.92 (0.88, 0.96), and 0.94 (0.92, 0.97), respectively. Whole grain consumption was linearly associated with CHD (Pnonlinearity = 0.231) and nonlinearly associated with CVD (Pnonlinearity = 0.002) and all-cause mortality (Pnonlinearity = 0.001). Except for a positive correlation between refined grain consumption and all-cause mortality in the restricted cubic spline, no significant influence of refined grain intake on stroke, CHD, HF, and CVD was detected. The meta-evidence quality for the association of whole grain consumption with stroke, CHD, HF, CVD, and all-cause mortality was moderate, moderate, low, high, and high, respectively. For refined grains, all meta-evidence was of low quality. ConclusionsConsuming whole grains, rather than refined grains, can assist in preventing CHD, CVD, and all-cause mortality. Relationships between consumption of refined grains and health outcomes should be interpreted cautiously because of the low quality of meta-evidence.

Freelisting: A Technique for Enhancing the Community Health Needs Assessment.

US health systems are required to conduct community health needs assessments (CHNAs). These assessments often rely solely on publicly reported disease prevalence data. The objective of this study was to identify a feasible qualitative method that can be implemented into CHNAs to confirm existing information and enhance them with new data and community narrative. Freelisting interviews were conducted in 2017 throughout a county in Pennsylvania. Individuals listed (1) things that improve health, (2) health problems, and (3) health barriers. Responses were grouped into like terms, Smith's salience index was calculated for each, subgroup variation was assessed. Community-reported health priorities were identified by salient terms juxtaposed with publicly reported disease prevalence data. 98 respondents throughout the county participated in freelisting interviews. Demographics resembled the population: median age 55, 46% female, 88% Caucasian, 9% uninsured. Salient terms that improve health included: "physical activity", "healthy eating", and "health services". Salient terms describing health problems included: "cardiovascular disease" and "spine and joint disease". Centers for Disease Control and Prevention (CDC)-reported chronic disease prevalence in the county included heart disease mortality (22% of deaths) and arthritis (26% of adults). Salient barriers to health included: "weight, physical activity, and dietary concerns", as well as "occupational concerns". This is in line with 2017 County Health Rankings related to obesity (reported 29%), however, while 10% were uninsured in the community, this was not a salient term. Freelisting can augment and inform CHNAs. In this single-county study, freelisting responses supported publicly available disease/mortality prevalence data and provided insight into community perceptions of health issues.

Clusters of lifestyle behaviors associated with atherosclerosis risk factors in children and adolescents with congenital heart disease: Floripa CHild Study.

Secondary cardiovascular disease is the main cause of mortality in congenital heart disease (CHD) patients. The cardiovascular risk could be widely prevented with adherence to a healthy lifestyle, however, clusters of lifestyle behaviors related to atherosclerosis risk factors in children and adolescents with CHD remain unclear. We aimed to describe the clusters of lifestyle behaviors of children and adolescents with CHD and to evaluate their association with atherosclerosis risk factors. Cross-sectional study on 227 children and adolescents with CHD (median age: 10.02 [IQR:7.08-13.02] years). Dietary intake, physical activity (PA), and sedentary behavior (SB) were evaluated. Clusters of lifestyle behaviors were determined using two-step cluster analysis. Atherosclerosis risk factors evaluated include body fat mass, central obesity, blood pressure, lipid parameters, glucose, C-reactive protein, and carotid intima-media thickness (cIMT). Multiple logistic regressions were used. The "unhealthy:high SB+low PA" cluster was associated with elevated body fat mass, central obesity, and elevated cIMT. Furthermore, the "unhealthy:low PA+unhealthy eating habits" cluster was associated with elevated body fat mass, central obesity, and elevated glucose. The unhealthier lifestyle behavior clusters were associated with atherosclerosis risk factors in children and adolescents with CHD. Multidisciplinary strategies to promote healthy behaviors are needed to prevent cardiovascular disease in later life.

An Analytical Survey on Cardiovascular Activity Among the Persons Living in a Passive Smoking Environment

Children could be particularly susceptible to the negative impacts of passive smoking on their cardiovascular health because of their underdeveloped physiological functions. Over 30% of coronary heart disease (CHD) mortality is attributable to either active smoking or exposure to passive smoke. While the specific causes of cardiovascular disease remain unknown, for a long time, people have understood that smoking has an impact that is harmful to the function of the endothelium. The purpose of this research was to report on the levels of knowledge among never-smokers about the dangers of secondhand smoke. A total of 50 participants were surveyed using a Likert scale and SPSS for this research. We used a standardized questionnaire to collect information on demographics, location, risk factors for cardiovascular disease (CVD), lifestyle, and physical activity levels among those exposed to secondhand smoke. Using the mentioned Scales and correlation analysis it was found that sleep quality is strongly positively associated with hypertension (r = 0.90 p < 0.005), and physical activity swimming is strongly positively associated with (r = 0.87, p < 0.005) is strongly positively associated. The author concluded that respondents were most knowledgeable about the risks of passive smoking to lung cancer, asthma attacks in adults and children, and preterm births in the obstetric population.

Influence of Unhealthy Food Environment on Premature Cardiovascular Disease Mortality in Brazil: An Ecologic Approach

Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population. This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest. After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]). This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.

Theory-based nursing interventions in adults with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis aimed to synthesize the outcomes of theory-based nursing interventions for coronary heart disease management. Web of Science, Scopus, Science Direct, and PubMed databases were electronically searched from January 2013 to August 2021. The Preferred Reporting Item for Systematic Reviews and Meta-analyses statement guidelines was followed for this meta-analysis. Randomized controlled trials on patients with coronary heart disease, using a theory-based nursing intervention were eligible. Methodological quality was examined by two authors using the Modified Jadad Scale. Based on the heterogeneity test, the results were analyzed using a pool of data with 95% confidence intervals, p-values, and fixed or random-effect models (PROSPERO registration number X). A total of 1030 studies were initially retrieved, and 8 randomized controlled trials were eventually included in the meta-analysis after screening. The big majority (81.3%) of participants were males, and the mean age was 54.8 (SD=8.7) years. This meta-analysis found theory-based nursing interventions had no significant effect on blood lipid profile, blood pressure, and healthy lifestyle. However, these interventions significantly reduced fasting blood glucose, and body mass index and improved the physical and psychological domains of quality of life. The evidence from this meta-analysis reveals that theory-based nursing interventions have a positive effect on fasting blood glucose, body mass index, and quality of life. However, their effects on blood lipid profile, blood pressure, and a healthy lifestyle are inconclusive. The results of this metanalysis are largely based on a few trials and were limited in terms of the number of outcomes. Conducting well-designed randomized controlled trials with adequate power is needed to make a firm conclusion on the influence of theory-based nursing interventions on patient outcomes in the CHD population. Considering the high mortality and morbidity of coronary heart disease, nurses may play a significant role in coronary heart disease management by providing interventions that are based on a certain theoretical framework. This meta-analysis provides insights into the implementation of theory-based nursing interventions in heart attack survivors or those newly diagnosed with coronary heart disease led by nurses and lasting longer than 6 months in coronary heart disease. In addition, future studies should consider enhancing the content of training programs for a healthy lifestyle within the theory-based nursing interventions and compare the effects of these interventions on acute and chronic coronary syndromes.

Projections of future coronary heart disease and stroke mortality in Japan until 2040: a Bayesian age-period-cohort analysis

We aimed to estimate the future burden of coronary heart disease (CHD) and stroke mortalities by sex and all 47 prefectures of Japan until 2040 while accounting for effects of age, period, and cohort and integrating them to be at the national level to account for regional differences among prefectures. We estimated future CHD and stroke mortality projections, developing Bayesian age-period-cohort (BAPC) models in population and the number of CHD and stroke by age, sex, and all 47 prefectures observed from 1995 to 2019; then applying these to official future population estimates until 2040. The present participants were all men and women aged over 30 years and were residents of Japan. In the BAPC models, the predicted number of national-level cardiovascular deaths from 2020 to 2040 would decrease (39,600 [95% credible interval: 32,200-47,900] to 36,200 [21,500-58,900] CHD deaths in men, and 27,400 [22,000-34,000] to 23,600 [12,700-43,800] in women; and 50,400 [41,900-60,200] to 40,800 [25,200-67,800] stroke deaths in men, and 52,200 [43,100-62,800] to 47,400 [26,800-87,200] in women). After adjusting these factors, future CHD and stroke deaths will decline until 2040at the national level and in most prefectures. This research was supported by the Intramural Research Fund of Cardiovascular Diseases of the National Cerebral and Cardiovascular Center (21-1-6, 21-6-8), JSPS KAKENHI Grant Number JP22K17821, and the Ministry of Health, Labour and Welfare Comprehensive Research on Life-Style Related (Diseases Cardiovascular Diseases and Diabetes Mellitus Program), Grant Number 22FA1015.

Meta analysis of health effects of ambient air pollution exposure in low- and middle-income countries

It is well established that exposure to ambient air pollution affects human health. A majority of literature concentrated on health effects of air pollution in high income countries. Only fewer studies analyzing health effects of air pollution in Low- and Middle-Income Countries (LMICs) are available. To bridge this gap in literature, this study investigated short term and long-term health impacts of ambient air pollutants focussed in LMICs. We evaluated Total Non-accidental mortality, Respiratory Mortality, Stroke Mortality, Cardio-vascular Mortality, Chronic Obstructive Pulmonary Disease (COPD), Ischemic Heart Disease (IHD) and Lung Cancer Mortality in LMICs particularly. Random Effects Model was utilised to derive overall risk estimate. Relative Risk (RR) estimates per 10 μg/m3 was used as input for model. Subgroup and Sensitivity Analysis by Design and Country was conducted. A total of 152 studies were included for quantitative analysis. We found positive associations between pollutants and Total Non-accidental mortality for PM10 ((RR:1.0043–1.0036), p < 0.0001), NO2 (RR:1.0222 (1.0111–1.0336), p < 0.0001), SO2 (RR:1.0107 – (1.0073–1.0140), p < 0.0001), O3 (RR: 1.0038 (1.0023–1.0053), p < 0.0001) and PM2.5 (RR: 1.0048 (1.0037–1.0059), p < 0.0001) for every 10 μg/m3 increase. We found positive association between Long-term exposure to PM10 and Total Non-accidental mortality (RR: 1.0430 (1.0278–1.0583), p < 0.0001) We also found statistically significant positive associations between pollutants and Cardiorespiratory and Cardiovascular morbidity. The positive associations persisted when analysed amongst sub-groups. However, the high heterogeneity amongst studies persisted even after performing sub-group analysis. The study has found statistically significant positive associations between short-term and long-term exposure to Ambient air pollution with various health-outcome combinations.

Analysis on impact of four major non-communicable diseases on life expectancy of local population in Ji'nan, 2015-2020

Objective: To analyze the impact of malignant neoplasms, cardiovascular diseases, respiratory diseases and diabetes (four major chronic diseases) on the increase of life expectancy of local population in Ji'nan during 2015-2020. Methods: Based on 2015-2020 cause-of-death surveillance information and population data of Ji'nan, we used abbreviated life expectancy table and Arriaga decomposition method to analyze the overall and disease specific contributions of four major chronic diseases to the increase of life expectancy, and the gender and age specific contributions of mortality rates of four major chronic diseases to the increase of life expectancy of local population from 2015 to 2020. Results: Life expectancy of the local population in Ji'nan increased by 1.59 years from 2015 to 2020. The decline in mortality rates of the four major chronic diseases contributed 1.25 years, with a contribution of 78.62%. The life expectancy in men increased by 1.66 years, with a contribution of 1.18 years from the decline in mortality rate of four major chronic diseases, and the life expectancy in women increased by 1.52 years, with a contribution of 1.35 years from the decline in mortality of four major chronic diseases. The declines in the mortality rates of malignant neoplasms, cardiovascular diseases, respiratory diseases and diabetes contributed 0.42, 0.62, 0.20, and 0.01 years to life expectancy, respectively. The decline mortality rate of gastric cancer contributed more to the increase of life expectancy compared with lung cancer. The increase in the mortality rate of hypertensive heart disease resulted in a negative contribution. Asthma and diabetes contributed very little to the increase of life expectancy. Conclusions: The increase in the life expectancy of local population in Ji'nan from 2015 to 2020 was mainly attributed to the decline in mortality of four major chronic diseases. It is necessary to pay close attention to the diseases which contributed very little or even had negative contribution to the increase of life expectancy, such as lung cancer, diabetes and hypertensive heart disease.

Rapid Drop in Coronary Heart Disease Mortality in Czech Male Population-What Was Actually behind It?

The high mortality of coronary heart disease (CHD) among Czech men-one of the highest worldwide-began to decline in 1991 soon after the abolition of government subsidies to all foodstuffs rich in animal fat. As participants in the WHO MONICA Project, we were able to analyze the CHD risk factors just before and after this major economic change. We had previously documented that the originally subsidized prices decreased animal fat consumption and consequently non-HDL cholesterol concentrations in the population. By the early 1990s, no progress had been made in the treatment of acute myocardial infarction, statins were unavailable as was not the currently more effective antihypertensive therapy. Our recent research proved a close relationship between cholesterolemia and proinflammatory macrophages in adipose tissue and accelerated macrophage polarization with increased palmitate and palmitoleate contents in cell membrane phospholipids. By contrast, the proportion of proinflammatory macrophages decreases with increasing presence of n-3 fatty acids in the cell membrane. The combination of non-HDL cholesterol drop and a decreased proportion of proinflammatory macrophages due to replacement of alimentary fat decreased CHD mortality immediately.

Abstract 9853: Trends in National Death Rates From Heart Disease in the United States, 2010–2020

Introduction: Heart disease (HD) death rates have been declining for decades. Updated trend data for 2010–2020 are needed to inform clinical and public health practice. Methods: We obtained age-standardized death rates per 100,000 population from the US Centers for Disease Control and Prevention’s WONDER database, which aggregates death certificate data from the National Vital Statistics System. Among adults aged ≥35 years, HD deaths were defined by underlying cause of death International Classification of Diseases, 10th revision codes. We calculated percent change between 2010, 2019, and 2020 death rates overall and by HD subtypes and demographic subgroups. Results: HD death rates declined during 2010-2019 and increased in 2020 across age, sex, and race and ethnicity groups. The national HD death rate declined by 9.8% from 2010 to 2019 (347.3 vs. 313.0 per 100,000) and increased by 4.1% in 2020 to 325.9 per 100,000, which approximated the 2015 rate (326.5 per 100,000). Coronary heart disease accounted for 55% of total HD deaths in 2020. Among non-Hispanic Black adults, the HD death rate declined by 10.4% during from 2010 to 2019 and increased by 11.2% in 2020, returning the 2020 HD death rate (440.7 per 100,000) to approximately the 2010 rate (442.4 per 100,000). Among adults aged 35–54 and 55–74 years, HD death rates declined from 2010 to 2019 (35–54: 5.5%, 55–74: 2.3% decline) and increased in 2020 (35–54: 12.0%, 55–74: 7.8% increase), resulting in a higher HD death rate in 2020 (35–54: 54.1, 55–74: 297.3 per 100,000) than in 2010 (35–54: 51.1, 55–74: 282.5 per 100,000). Conclusions: National declines in HD death rates had reversed by 2020 during the Coronavirus Disease-2019 pandemic. Setbacks represented approximately 5 years of lost progress among all adults and ≥10 years of lost progress among non-Hispanic Black adults and younger adults. Clinical and public health efforts may need to be modified to reverse negative trends in HD mortality.

Abstract 11777: The Prognostic Impact of Living Alone on Long-Term Cardiac Mortality in Patients With Chronic Coronary Syndrome After Percutaneous Coronary Intervention

Background: It has been reported that social frailty is associated with increased mortality in elderly patients with heart failure. However, the prognostic impact of social frailty on mortality in ischemic heart disease is unclear. Here we examined the relationship between living alone, which is one of the criteria for social frailty, and long-term mortality in patients with chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI). Methods and Results: Consecutive 830 patients with CCS who underwent PCI were enrolled. Patients were divided into two groups according to whether they lived alone or not at the time of discharge. We compared clinical characteristics between two groups and followed cardiac mortality. Patients living alone were younger (66.3 vs. 69.9 years, P = 0.002). The prevalence of comorbidities such as hypertension, diabetes, dyslipidemia, chronic kidney disease, anemia, atrial fibrillation, heart failure, stroke and peripheral artery disease were comparable between two groups. In addition, the rates of medications such as beta-blockers, renin-angiotensin-aldosterone system inhibitors, statins and anti-thrombotic agents did not differ between two groups. In the Kaplan-Meier analysis (mean follow-up period of 1703.9 days), cardiac mortality was significantly higher in the group of patients who were living alone than those who were not (P = 0.008). In the multivariable Cox proportional hazard analyses after adjusting for confounding factors, living alone was an independent predictor of cardiac mortality (hazard ratio 2.44, 95% confidence interval 1.25 - 4.74, P = 0.009). Subgroup analysis which was performed adjusting for interactions between living alone and clinically important variables revealed no interactions. Conclusion: Among CCS patients who underwent PCI, living alone was associated with long-term cardiac mortality regardless of other comorbidities and medications.

Abstract 10535: Relation of Multiple Low-Risk Lifestyle Behaviors With Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Introduction: The association of combined low-risk lifestyle behaviors (LRLBs) with cardiovascular disease (CVD) and all-cause mortality has not been systematically quantified. Objective: We undertook a systematic review and dose-response meta-analysis to assess the association of combined LRLBs with CVD and all-cause mortality. Methods: MEDLINE, EMBASE and Cochrane were searched up to December 29, 2021. Prospective cohort studies reporting the association between a minimum of 3 combined LRLBs (including healthy diet) with CVD, coronary heart disease (CHD) and stroke incidence and mortality were included. Independent reviewers extracted data and assessed study quality. Highest vs. lowest LRLB score was pooled using random effects. Heterogeneity was assessed (Cochran Q) and quantified (I 2 ). Global dose response meta-analysis (DRM) for maximum adherence was estimated using one-stage linear mixed model. The certainty of the evidence was assessed using GRADE. Results: 116 cohort comparisons (n=9,775,191) involving 382,922 cases were included. Comparing highest with lowest adherence LRLBs were associated with lower risk of CHD incidence (RR, 0.29 [95% CI, 0.21, 0.42]), stroke incidence (0.56 [0.50, 0.62]), CVD incidence (0.47 [0.37, 0.58]), CHD mortality (0.32 [0.25, 0.41]), stroke mortality (0.37 [0.30, 0.46]), CVD mortality (0.41 [0.34, 0.49]) and all-cause mortality (0.46 [0.41 to 0.52]). DRM analysis showed a linear association between LRLBs and all outcomes reaching a global DRM between 59-76% protection. LRLBs were defined with variable ranges as a healthy body weight (body mass index &lt;30kg/m 2 ), healthy diet (healthy diet score &gt;median), regular physical activity (1/week to &gt;30 minutes/day), smoking cessation (never smoked or smoking cessation), light alcohol intake (≤30g/day) and adequate sleep (5.5-9 hours). The certainty of the evidence was graded as moderate to high owing to downgrades for inconsistency and/or upgrades for a large magnitude of effect and significant dose-response gradient. Conclusions: Pooled analyses show that the combination of LRLBs was associated with a substantial lower risk of CVD outcomes and all-cause mortality. The available evidence provides a very good indication of the benefit of combined LRLBs.

Abstract 11089: Comparison of Long-Term Cardiovascular Events of Influenza Patients With versus Without Pre-Existing Cardiovascular Disease in the Infection Treated With Antiviral Agents

Introduction: The antiviral agents are highly recommended to prevent cardiovascular mortality in patients with pre-existing cardiovascular disease in the pandemic era, but the long-term cardiovascular mortality have not yet been comprehensively characterized in the influenza infection treated with antiviral agents. Hypothesis: This study aimed to compare long-term cardiovascular mortality of influenza patients with versus without pre-existing cardiovascular disease in patients with anti-viral agents. Methods: The data were extracted from the National HealthDatabase from 2001 to 2010, which covers nearly the entire population of South Korea. 865,522 influenza patients treated with anti-viral agents were selected and cardiovascular disease was classified as atrial fibrillation (AF), heart failure (HF), ischemic heart disease (IHD) and 5-year mortality were analyzed using Cox proportional hazard regression model. Results: Of these, 96,433 patients (11.1%, mean age 46) had IHD (86.4%), HF (23.1%) and AF (12.5%) in the influenza infection treated with anti-viral agents. The incidence of IHD was 0.25 per 100-person year in the pre-existing IHD, 0.25 per 100-person year in the pre-existing HF and 0.20 per 100-person year in the pre-existing AF. The incidence of myocarditis was 0.008 per 100-person year in the pre-existing IHD, 0.006 per 100-person year in the pre-existing HF and 0.01 per 100-person year in the pre-existing AF. The incidence of cardiovascular death was 0.49 per 100-person year in the pre-existing IHD, 0.47 per 100-person year in the pre-existing HF and 0.47 per 100-person year in the pre-existing AF. Conclusions: Long-term cardiovascular mortality in influenza patients with pre-existing cardiovascular disease treated with antiviral agents were not significantly different from those without pre-existing cardiovascular disease.

Abstract 14425: Improved Carcinoid Heart Disease Mortality Amid Persistent Race, Income, and Rural Disparities: Propensity Score and Machine Learning Guided Analysis of 55,910 Carcinoid Cases From 2016-2018

Introduction: It is unclear what the rates of carcinoid heart disease (CHD) diagnosis, disparities, and inpatient outcomes are. Methods: We performed the first nationally representative longitudinal analysis of the above using Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) and the 2016-2018 National Inpatient Sample (NIS), the United States’ largest all-payer inpatient dataset. The propensity score was modified for the likelihood of developing malignant carcinoid tumor (MCT). Results: From 2016-2018 among 101,521,656 hospitalizations, 55,910 (0.05%) had a malignant carcinoid tumor (MCT), of whom 4,030 (7.20%) had CHD. The rate of CHD diagnosis remained largely stable from 2016 (18,900 [0.06%]) to 2017 (19,025 [0.05%]) to 2018 (17,985 [0.05%]). Patients with versus without CHD had significantly higher unadjusted mortality in 2016 (4.05% versus 2.19%), 2017 (3.75% versus 1.95%), and 2018 (3.75% versus 1.95%). Of patients with CHD, 0.15% had acute carcinoid syndrome. Compared to the racial distribution throughout the population, the diagnosis of CHD was under-represented in Hispanics (12.83% versus 7.95%), Asians (3.13% versus 2.84%), lowest income quartile (29.47% versus 28.07%), second lowest income quartile (26.90% versus 25.41%), metros of 250,000-999,999 residents (20.79% versus 19.73%) and metros of 50,000-249,999 (9.30% versus 8.56%) (all p&lt;0.001). In ML-PS multivariable regression fully adjusting for age, sex, race, metro density, region, metastasis, and NIS calculated mortality risk by DRG, CHD initially significantly increased mortality in 2016 (OR 1.18, 95%CI 1.10-1.28; p&lt;0001) but decreased it in 2017 (OR 0.76, 95%CI 0.70-0.82; p&lt;0.001) and 2018 (OR 0.78, 95%CI 0.72-0.84; p&lt;0.001). In ML-PSr stratified by income in 2018, there was largely a step wise decrease in mortality with CHD from the lowest income quartile to highest income quartile. Conclusions: Our analysis demonstrates that racial minorities, lower income, and more rural metros have lower rates of CHD diagnosis, its associated mortality appears to be the lowest with higher income, and its mortality over time across all patients in general appears to be decreasing potentially with improved inpatient care.

Trends in Adherence to Recommended Physical Activity and Its Association with Mortality and Disease Progression among US Adults with Chronic Kidney Disease

Introduction: This study aimed to examine the trends in adherence to the Physical Activity Guidelines (PAG) for aerobic activity and sedentary time and their effects on mortality and disease progression among US adults with chronic kidney disease (CKD). Methods: We studied individuals from the National Health and Nutrition Examination Survey 2007–08 to 2017–18 with a mortality file in 2015. Multivariate regression models were used to evaluate the association between adherence to PAG and sedentary time with mortality, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio. Results: For the CKD population, adherence rate increased from 48.2% in 2007–08 to 55.0% in 2017–18, and sedentary time peaked in 2013–14 (7.5 h/day) and then decreased afterward. There was no difference in the trends across the non-CKD and CKD population. For the CKD population, adherence to the PAG was significantly associated with all-cause mortality (HR, 0.49; 95% CI: 0.38–0.63), malignant neoplasm mortality (HR, 0.30; 95% CI: 0.17–0.52), and albumin-creatinine ratio (OR, −0.27; 95% CI: −0.39 to −0.15). Sedentary time was significantly associated with all-cause mortality (HR, 1.12; 95% CI: 1.08–1.15), heart disease mortality (HR, 1.13; 95% CI: 1.08–1.19), and eGFR (OR, −0.49; 95% CI: −0.72 to −0.26). Conclusions: Favorable trends were observed in adherence to the PAG and sedentary time. Adherence to the PAG and reduction in sedentary time reduced all-cause and cause-specific mortality and prevented disease progression differently. Efforts are needed to decrease sedentary time rather than adhering to the PAG for aerobic activity alone.

Personal Activity Intelligence and Ischemic Heart Disease in a Healthy Population: China Kadoorie Biobank Study.

Personal Activity Intelligence (PAI) is a physical activity metric that translates heart rate during physical activity into a simple score, where a weekly score of 100 or greater is associated with a lower risk of cardiovascular disease and mortality. Here, we prospectively investigated the association between PAI and ischemic heart disease (IHD) mortality in a large healthy population from China. Using data from the China Kadoorie Biobank, we studied 443,792 healthy adults (60% women). The weekly PAI score of each participant was estimated based on the questionnaire data and divided into four groups (PAI scores of 0, ≤50, 51-99, or ≥100). Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fatal IHD and nonfatal myocardial infraction (MI) related to PAI were estimated using Cox proportional hazard regression analyses. There were 3050 IHD deaths and 1808 MI events during a median follow-up of 8.2 years (interquartile range, 7.3-9.1; 3.6 million person-years). After adjustments for multiple confounders, a weekly PAI score ≥ 100 was associated with a lower risk of IHD (aHR: 0.91 (95% CI: 0.83-1.00)), compared with the inactive group (0 PAI). The corresponding aHR for MI was 0.94 (95% CI: 0.83-1.05). In participants aged 60 years or older at baseline, the aHR associated with a weekly PAI score ≥ 100 was 0.84 (95% CI, 0.75-0.93) for IHD and 0.84 (95% CI, 0.73-0.98) for MI. Among healthy Chinese adults, a weekly PAI score of 100 or greater was associated with a lower risk of IHD mortality across all age groups; moreover, a high PAI score significantly lowered the risk of MI but only in those 60 years and older at baseline. The present findings extend the scientific evidence that PAI may have prognostic significance in diverse settings for IHD outcomes and suggest that the PAI metric may be useful in delineating the magnitude of weekly physical activity needed to reduce the risk of IHD mortality.