High Cardiovascular Risk Group Research Articles

Association between Hearing Aid Use and Cognitive Function in Persons with Hearing Impairment Stratified by Cardiovascular Risk.

The purpose of this study was to conduct a cross-sectional analysis of the association between hearing aid use and cognitive decline in community-dwelling older adults with hearing impairment, stratified by cardiovascular risk level. This cross-sectional study covers 1857 hearing-impaired individuals selected among 10,674 community-dwelling older adults (≥65 years of age) in Japan. We investigate the association between hearing aid use and cognitive decline stratified by cardiovascular risk level, by assessing self-reported hearing impairment and hearing aid use, absolute cardiovascular risk, cognitive function, and potential confounding factors. The association between hearing impairment severity and increased cardiovascular risk, and the benefit of hearing aid use in preventing cognitive decline, were examined in a binomial logistic regression analysis, with the presence of cognitive decline as the objective variable. In the low cardiovascular risk group, hearing aid users had a lower odds ratio for decline in executive function than non-users (odds ratio = 0.61, 95% confidence interval: 0.39-0.98). However, there was no significant association between hearing aid use and cognitive decline in the high cardiovascular risk group (p > 0.05). Among older adults with hearing impairment, hearing aid use was associated with the maintenance of executive function in individuals of low cardiovascular risk.

The influence of triglyceride and low-density-lipoprotein target levels on microcirculation: Is there a difference?

Background and aimsThis study aimed to validate the role of high low-density lipoprotein cholesterol [LDL-C] and triglyceride [TG] treatment target levels on the microcirculation in a very high and high cardiovascular risk group. Methods119 patients with high or very high cardiovascular [CV] risk were included. We have registered the main co-morbidities, smoking habits, body mass index [BMI] and the lipid lowering medication. Hematocrit, whole blood viscosity [WBV] and plasma viscosity [PV], red blood cell [RBC] aggregation and deformability and fibrinogen, total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], LDL-C and TG levels were determined. ResultsThe investigation found significantly higher PV values in patients with non-target LDL-C, associated with higher fibrinogen level. Non-target TG was related to deteriorated microcirculatory parameters, as significantly higher RBC aggregation, lower RBC deformability, and higher WBV and PV. The main microcirculatory benefit in diabetes could be gained from target level of TG, in chronic coronary syndrome [CCS] patients it is more advantageous to reach both LDL-C and TG target. ConclusionThe results could highlight, that TG should play a role in failing microcirculation and cause potentially life-threatening complications, which would worsen the survival and quality of life of high or very high risk CV patients.

Differing Efficacy of Dapagliflozin Versus Empagliflozin on the Risk of Incident Atrial Fibrillation in Patients With Type 2 Diabetes: A Real-World Observation Using a Nationwide, Population-Based Cohort.

Meta-analyses of large clinical trials investigating SGLT2 (sodium-glucose cotransporter-2) inhibitors have suggested their protective effects against atrial fibrillation in patients with type 2 diabetes. However, the results were predominantly driven from trials involving dapagliflozin. We used a nationwide, population-based cohort of patients with type 2 diabetes who initiated either dapagliflozin or empagliflozin between May 2016 and December 2018. An active-comparator, new-user design was used, and the 2 groups of patients were matched using propensity scores. The primary outcome was incident nonvalvular atrial fibrillation, which was analyzed using both the main intention-to-treat and sensitivity analysis that censored patients who skipped their medications for ≥30 days. Men ≥55 years of age and women ≥60 years of age with ≥1 traditional risk factor or those with established cardiovascular disease were categorized as high cardiovascular risk group. Patients not included in the high-risk group were categorized as low risk. After 1:1 propensity-score matching, a total of 137 928 patients (mean age, 55 years; 58% men) were included and followed up for 2.2±0.6 years. The risk of incident atrial fibrillation was significantly lower in the dapagliflozin group in both the main (hazard ratio [HR], 0.885 [95% CI, 0.789-0.992]) and sensitivity analyses (HR, 0.835 [95% CI, 0.719-0.970]). Notably, this was consistent in both the low and high cardiovascular risk groups. There was no effect modification by age, sex, body mass index, duration of diabetes, or renal function. This real-world, population-based study demonstrates that patients with type 2 diabetes using dapagliflozin may have a lower risk of developing nonvalvular atrial fibrillation than those using empagliflozin.

The Association of Insomnia and Stress on Cardiovascular Risk Factors during COVID-19 Confinement in the Mexican Population

During the pandemic confinement, the WHO changed the term “social distancing” to “physical distancing”, to help people deal with the lack of social contact. As a result, there was an increase in mental health problems, including insomnia and stress, with a negative impact on cardiovascular health. The objective of this research was to identify the association between insomnia and stress and cardiovascular risk (CVR) during the pandemic in a sample of the general population in Mexico; the participants were chosen using the non-probabilistic method. The data were obtained from an online questionnaire about medical histories focused on cardiovascular risk, according to the Official Mexican Standards and Regulations for patients’ clinical records, NOM-004-SSA3-2012, along with an index for the severity of insomnia, measured with a seven-item guide, and an instrument to measure stress. The data were analyzed with descriptive statistics for several different variables: sociodemographics, stress, insomnia, and cardiovascular risk. Cardiovascular risk was compared to insomnia and stress variables, which led to statistically significant differences and correlations between the variables. Participants were divided into four groups with respect to CVR, from low to very high CVR. This research demonstrated that women were more susceptible to stress and cardiovascular risk. However, stress was a more major indicator of CVR than insomnia, but in the high and very high CVR groups, insomnia contributed along with stress; coping strategies reduced the risk in the high CVR group but did not function as expected with respect to reducing risk in the very high CVR group. These findings suggest that sleep patterns and mental health alterations present during the pandemic may persist even when the pandemic was declared as having ended and may contribute to increases in cardiovascular risk in the long-term.

The Relationship Between Echocardiographic Calcification Score and Grade of Knee Osteoarthritis.

Background and objective It has been suggested that knee osteoarthritis (KOA) is associated with the development of calcification and an increased risk of cardiovascular (CV) disease, while the contribution of KOA grade is not clearly known enough. This study aimed to investigate the relationship between the grade of KOA, the echocardiographic calcification score (echo-CCS), and CV risk assessment. Methods This cross-sectional study involved 204 patients diagnosed with KOA and classified according to the Kellgren-Lawrence staging criteria. Echo-CCS was obtained according to the presence of calcification in the aortic valve, aortic root, mitral ring, papillary muscle and ventricular septum. Framingham risk score (FRS) was used for CV risk assessment. Results Calcification was detected in 79.4% of patients. The median FRS, echo-CCS, andhigh-sensitivityC-reactive protein (hs-CRP) levels increased as the KOA grade increased (p<0.05). A one-grade increase in KOA increased the odds of echo-CCS 1-2 group by 5.15 fold (vs. no calcification group) (OR=5.15, p=0.003), while it increased the odds of echo-CCS ≥3 group by 4.61 fold (vs. echo-CCS 1-2 group) (OR=4.61, p=0.003). Median echo-CSS and hs-CRP were higher in the high CV risk group than in the moderate and low CV risk groups. Conclusion The majority of patients with KOA had intracardiac calcification.An increased KOA grade was associated with higher echo-CSS and FRS. These findings indicate that patients with higher grades of KOA may be predisposed to developing subclinical atherosclerosis.

Personalized prediction of the probability of developing arterial hypertension and coronary heart disease in miners with anthracosilicosis using an automated system

Introduction. The remaining high level of production-related cardiovascular morbidity necessitates timely preventive measures. The development of an automated forecasting technique will make it possible to implement personalized and differentiated approaches in the prevention of cardiovascular pathology in persons in contact with harmful production factors.&#x0D; Materials and methods. The object of the study were workers employed in underground coal mining: One hundred sixty eight miners with previously diagnosed anthracosilicosis and 151 miners of the control group without lung pathology (a total of 319 people). Identification of diseases of the circulatory system and risk factors was carried out using clinical, laboratory, instrumental methods. The Bayes method was used to develop a forecasting system. The forecasting software as developed in the Lazarus environment using object-oriented programming methods.&#x0D; Results. The most informative markers associated with a high probability of developing arterial hypertension and coronary heart disease in workers with anthracosilicosis have been identified. A software “Automated system for personalized prediction of the probability of developing arterial hypertension and coronary heart disease in miners with anthracosilicosis” has been developed. An automated forecasting system determines the degree of risk of diseases based on the results of the sum of prognostic coefficients.&#x0D; Limitations. The limitation of the study was related to the sample of coal mine workers examined in the clinic of the Institute, namely: age from 40 to 54 years, long-term (more than 15 years) work experience in harmful working conditions. The study did not include miners who had other occupational diseases besides anthracosilicosis.&#x0D; Conclusions. An automated system of personalized forecasting ensures the formation of high cardiovascular risk groups with minimal time costs, which allows starting primary prevention of cardiological pathology in a timely manner.

A Retrospective Study on the Adoption of Lipid Management Guidelines in Post-Myocardial Infarction Patients in a Tertiary Care Centre.

Lipid management after acute myocardial infarction (AMI) is one of the important aspects of secondary prevention in the high cardiovascular (CV) risk group, and targeted reduction of low-density lipoprotein cholesterol (LDL-C) remains the primary target for lipid therapy after myocardial infarction (MI). To conduct a retrospective study of the adequacy of lipid management in post-MI patients admitted to a tertiary care centre as compared to the 2019 European Society of Cardiology (ESC) guidelines for the management of dyslipidaemia. The study was a retrospective review of medical records of patients admitted with MI under the Ubora Heart Service, Nairobi Hospital, from January 2020 to June 2022. The study population included 79 patients, with a mean age of 59.3 (SD ±12), predominantly male (61 patients, 77.2%), and of African descent (60 patients, 75.9%). The majority of the study population presented with an ST-segment elevation myocardial infarction (STEMI) (62%), and the six most prevalent cardiovascular risk factors recorded amongst the patients were: systemic arterial hypertension in 50 (63.3%) patients; dyslipidaemia in 34 (43.0%); type II diabetes mellitus (T2DM) in 25 (31.6); history of smoking in 12 (15.2%); obesity or being overweight in 12 (15.1%); and family history of premature coronary artery disease or sudden cardiac death in four (5.1%) patients. Moreover, 88.6% of the patients had their lipid profile assessment done within 48 hours of admission, with a mean LDL-C level of 3.18 mmol/L (SD ±.18). All the patients recruited in the study were started on high-intensity statins with either 40 mg or 80 mg of atorvastatin or 20 mg or 40 mg of rosuvastatin. Thirty-nine (44%) patients recruited had repeat lipid profiles on follow-up, with a median lipid analysis time of five months (interquartile range (IQR): 2.0-10.0). Of those, only six (17.1%) achieved the LDL-C goal of <1.4 mmo/L while only 16 (45.7%) achieved a greater than 50% reduction from their baseline LDL-C level, with three (8.6%) patients having an increased LDL-C level from baseline. Overall, 14.7% of the patients studied achieved the guideline-recommended LDL-C goal of an LDL-C target of <1.4 mmo/L and a ≥ 50% reduction from baseline LDL-C. After five months of follow-up, 75 (94.9%) patients were on statin monotherapy, with 4 (5.1%) on high-intensity statin and ezetimibe combination therapy. This retrospective study highlights the need for early sensitisation and the adoption of secondary prevention strategies in acute coronary syndrome (ACS), as recommended by the 2019 ESC guidelines.

The impact of cardiac SPECT in risk stratification for women with suspected coronary artery disease in a very high cardiovascular risk country

Abstract Funding Acknowledgements Type of funding sources: None. Background Risk stratification has become increasingly important in the management of women with coronary artery disease (CAD). Population based cross-sectional study of cardiovascular risk (CVR) factors in Latvia revealed that women in age 25 -74 are in a very high CVR group: more than 60% of women have dyslipidemia, 30% have arterial hypertension (AH) and are overweight. Purpose To evaluate CVR factor profile in women with suspected CAD and performed cardiac single photon emission computed tomography (SPECT) and to prove the need of perfusion imaging for women in a very high cardiovascular risk population. Methods Cardiac SPECT for women with suspected CAD and positive or non-informative exercise test was performed in a single center from 2018 till 2022. The patients were analyzed by risk factors and perfusion test result, divided into 2 groups: normal myocardial perfusion or true myocardial perfusion defect. Results 466 patients without known CAD were analyzed. The mean age of cohort patients was 59.3±10.9 years. 28 (6.0%) patients had no CVR factors, 90 (19.3%) women had only 1, but the rest of them (348, 74.7%) had 2 or more CVR factors. Dyslipidemia was present in 358 (76.8%), AH in 282 (60.5%) and type 2 Diabetes mellitus (T2DM) in 27 (5.8%) patients. More than half of patients (n=303, 65.0%) were overweight (BMI&amp;gt;25.0 kg/m2). 65 (13.9%) women were current or ex-smokers. True myocardial perfusion defect was detected in 96 patients (20.6%). There was no statistically significant difference between CVR risk factor count and cardiac SPECT result (p=0.229), although there were patients with significant perfusion defect without any risk factor present. However, significant correlation between risk factors and detection of obstructive coronary artery disease (CAD) after positive cardiac SPECT was found (p&amp;lt;0.001). Totally in study was detected 71 patients with suspected ischemia with non-obstructive CAD (INOCA), but further investigation with intracoronary physiology measurements – coronary flow reserve (CFR), index of microvascular resistance (IMR) and acetylcholine provocation test is required to define INOCA endotype. Conclusions The cardiac SPECT is an appropriate diagnostic method for women patients with suspected CAD. Even in patients with no CVR factors, but with positive or non-informative exercise test, the CAD is present, therefore they should be referred to cardiac SPECT in a very high CVR country. In patients with significant perfusion defect and absence of obstructive CAD, the performance of intracoronary physiology measurements is required.

Cardiovascular Risk Factors Among Asian Americans: Perspectives on the Role of Acculturation in Cardiovascular Diseases Health Disparities.

The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US.

Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors

Epilepsy has been associated with cognitive impairment and potentially dementia in older individuals. However, the extent to which epilepsy may increase dementia risk, how this compares with other neurological conditions, and how modifiable cardiovascular risk factors may affect this risk remain unclear. To compare the differential risks of subsequent dementia for focal epilepsy compared with stroke and migraine as well as healthy controls, stratified by cardiovascular risk. This cross-sectional study is based on data from the UK Biobank, a population-based cohort of more than 500 000 participants aged 38 to 72 years who underwent physiological measurements and cognitive testing and provided biological samples at 1 of 22 centers across the United Kingdom. Participants were eligible for this study if they were without dementia at baseline and had clinical data pertaining to a history of focal epilepsy, stroke, or migraine. The baseline assessment was performed from 2006 to 2010, and participants were followed up until 2021. Mutually exclusive groups of participants with epilepsy, stroke, and migraine at baseline assessment and controls (who had none of these conditions). Individuals were divided into low, moderate, or high cardiovascular risk groups based on factors that included waist to hip ratio, history of hypertension, hypercholesterolemia, diabetes, and smoking pack-years. Incident all-cause dementia; measures of executive function; and brain total hippocampal, gray matter, and white matter hyperintensity volumes. Of 495 149 participants (225 481 [45.5%] men; mean [SD] age, 57.5 [8.1] years), 3864 had a diagnosis of focal epilepsy only, 6397 had a history of stroke only, and 14 518 had migraine only. Executive function was comparable between participants with epilepsy and stroke and worse than the control and migraine group. Focal epilepsy was associated with a higher risk of developing dementia (hazard ratio [HR], 4.02; 95% CI, 3.45 to 4.68; P < .001), compared with stroke (HR, 2.56; 95% CI, 2.28 to 2.87; P < .001), or migraine (HR, 1.02; 95% CI, 0.85 to 1.21; P = .94). Participants with focal epilepsy and high cardiovascular risk were more than 13 times more likely to develop dementia (HR, 13.66; 95% CI, 10.61 to 17.60; P < .001) compared with controls with low cardiovascular risk. The imaging subsample included 42 353 participants. Focal epilepsy was associated with lower hippocampal volume (mean difference, -0.17; 95% CI, -0.02 to -0.32; t = -2.18; P = .03) and lower total gray matter volume (mean difference, -0.33; 95% CI, -0.18 to -0.48; t = -4.29; P < .001) compared with controls. There was no significant difference in white matter hyperintensity volume (mean difference, 0.10; 95% CI, -0.07 to 0.26; t = 1.14; P = .26). In this study, focal epilepsy was associated with a significant risk of developing dementia, to a greater extent than stroke, which was magnified substantially in individuals with high cardiovascular risk. Further findings suggest that targeting modifiable cardiovascular risk factors may be an effective intervention to reduce dementia risk in individuals with epilepsy.

Fatness Predicts Cardiovascular Disease Risk Factor Profile Better than Fitness in Healthy Men A Discriminant Analysis Approach

Fitness is healthy and can help to reduce, but not eliminate, the negative effects of obesity. As a result,identifying variables for categorizing individuals into high-risk or low-risk groups is critical.The study’s goalwasto determine the relationship between fitness, fatness, and cardiovascular disease risk factors as well as to construct a discriminant model for categorizing individuals as high-risk or low-risk. A total of 120 in-service healthy armed forces personnel aged 25 to 49 years were randomly selected as subjects for this study and were measured for the selected fitness and fatness variables, namely cardio respiratory endurance, muscular endurance, muscular leg and back strength, flexibility, weight, waist circumference, hip circumference, waist-hip ratio, body mass index, waist to height ratio, and fat percentage. The findings revealed that fitness variables contribute little to CVD risk factors than specific fatness characteristics, which appear to play a larger role.Based on selected fitness and fatness indicators, a discriminant model was developed to classify subjects into high and low cardiovascular disease risk groups. The group centroid was found to be 0.829. The model validity was determined to be 80.6 per cent based on the classification matrix. Finally, the findings of the study suggest that age and waist circumference play an important role in distinguishing individuals with high and low CVD risk

Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort.

This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension. The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension. The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events. This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.

Correlation between coronary artery disease and coronary microvascular dysfunction symptoms and cardiac SPECT results in Latvian women patients

Abstract Introduction The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation. Women patients with intermediate or high pre-test probability for coronary artery disease – even asymptomatic or with non-informative exercise test should be referred for further focused diagnostics. Myocardial perfusion imaging with single photon emission computed tomography (SPECT) is one of the most performed non-invasive cardiac imaging tests to diagnose CAD or coronary microvascular dysfunction (CMVD). Purpose To evaluate the correlation between various CAD symptoms and cardiac SPECT results in women patients undergoing examination due to diagnosis of CAD or CMVD. Methods During the period from 2018 till 2021 we performed cardiac SPECT for women patients with intermediate or high pre-test probability or non-informative exercise test. Patients were divided into 2 groups: normal myocardial perfusion or true myocardial perfusion defect, defined as area of ischemia ≥10% of the left ventricle myocardium mass. According to the clinical symptoms patients were categorized in “asymptomatic”, “atypical symptom” and “patients with chest pain” group. The presence of CMVD and CAD in each group was determined by invasive coronary angiography or computed tomography angiography. Results In 4 years, SPECT was performed in 726 women patients. The most common presented symptoms were: chest pain (n=487, 67.1%), dyspnea (n=323, 44.5%), tachycardia and palpitations (n=117, 16.1%), fatigue (n=129, 17.8%), headache (n=28, 3.86%) and excessive sweating (n=15, 2.1%). 104 (14.3%) patients were asymptomatic, 487 (67.1%) with chest pain and 135 (18.6%) with atypical symptoms. True myocardial perfusion defect was detected in 125 patients (17.2%). The obstructive CAD was found in 32 cases (25.6%; 4.4% of all SPECTs). The CMVD was diagnosed in 68 women (54.4%; 9.4% of all SPECTs). In asymptomatic patient group obstructive CAD was diagnosed in 5 (4.8%) cases, in chest pain group – 11 (2.3%) cases and in atypical symptom group – 16 (11.9%) patients (p&amp;lt;0.001). None of asymptomatic women had CMVD. The CMVD was detected in 53 (42.4%; 7.3% of all) cases in chest pain group and in 14 (11.3%; 1.9% of all) patients in atypical symptom group (p=0.006). Conclusion Women patients with typical chest pain were more likely to have CMVD, but with atypical symptoms – CAD. Since women are in a very high cardiovascular risk group in Latvia, the cardiac SPECT is highly recommended for detection of CAD and CMVD, especially in patients with atypical symptoms. Funding Acknowledgement Type of funding sources: None.

Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[18F]F PET-CT

BackgroundFluorine-18 sodium fluoride (Na[18F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[18F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients. Methods and ResultsThirty-four high CV risk individuals without previous CV events were scanned with Na[18F]F PET-CT. Cardiac Na[18F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (rs = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (rs = 0.61), body mass index (rs = 0.66), abdominal perimeter (rs = 0.74), thoracic fat volume (rs = 0.47), and epicardial adipose tissue (rs = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[18F]F uptake. ConclusionsIn a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.

Performance of 2019 ESC risk classification and the Steno type 1 risk engine in predicting cardiovascular events in adults with type 1 diabetes: A retrospective study

AimsThe study compares the performance of the European Society of Cardiology (ESC) risk criteria and the Steno Type 1 Risk Engine (ST1RE) in the prediction of cardiovascular (CV) events. Methods456 adults with type 1 diabetes (T1D) were retrospectively studied. During 8.5 ± 5.5 years of observation, twenty-four patients (5.2%) experienced a CV event. The predictive performance of the two risk models was evaluated by classical metrics and the event-free survival analysis. ResultsThe ESC criteria show excellent sensitivity (91.7%) and suboptimal specificity (64.4 %) in predicting CV events in the very high CV risk group, but a poor performance in the high/moderate risk groups. The ST1RE algorithm shows a good predictive performance in all CV risk categories. Using ESC classification, the event-free survival analysis shows a significantly higher event rate in the very high CV risk group compared to the high/moderate risk group (p < 0.0019). Using the ST1RE algorithm, a significant difference in the event-free survival curve was found between the three CV risk categories (p < 0.0001). ConclusionsIn T1D the ESC classification has a good performance in predicting CV events only in those at very high CV risk, whereas the ST1RE algorithm has a good performance in all risk categories.

The use of menopausal hormone therapy in women at high cardiovascular risk

The review article presents the stages of the use of menopausal hormone therapy (MHT) from the standpoint of primary and secondary prevention of the risk of developing coronary heart disease (CHD) and deaths. Based on the data obtained, a number of guidelines and statement documents have been updated to reflect the need to comply with the “time hypothesis” in the appointment of MHT in order to improve the prognosis. The arguments of the possible use of MHT are shown both in the primary prevention of cardiovascular diseases in women with cardiovascular risk factors, and in patients with a history of coronary artery disease, myocardial infarctions, with the development of chronic heart failure and atrial fibrillation. In 2021, a proposal was put forward to determine the choice of MHT depending on the cardiovascular risk groups (CVR). However, such an approach to the choice of MHT excludes the personification and individualization of the possibility of using this method of treatment in the presence of certain factors of low, intermediate CVR, such as arterial hypertension, hypercholesterolemia, type 2 diabetes mellitus and others, especially with their good control. Therefore, the adoption of clinical decisions on the use of MHT in conditions of high CVR and the presence of individual clinically significant risk factors should be carried out by a multidisciplinary team, which will exclude both unmotivated prohibitions and appointments in the presence of contraindications.

Mortality rate of high cardiovascular risk patients with mild cognitive impairment

People with mild cognitive impairment (MCI) may be at higher risk of death than normal aging ones. On the other hand, patients with cardiovascular risk factors are also with higher risk of death. It may be logical to question then if the combination of MCI and cardio-vascular risk factors (in most cases arterial hypertension) can lead to higher mortality rate than expected both for high cardio-vascular risk patients and for the general population. This hypothesis is important in the light of effective early screening and prophylaxis. The general death rate of patients with very high-cardio-vascular-risk was compared in the subgroups of normal cognition and MCI. We used MMSE and MoCA (reassessment 6 months apart), Geriatric Depression scale and 4-point version of the scale for evaluating the performance in instrumental activities of daily living (4-IADL) in 249 patients. The patients also had laboratory testing, ambulatory blood pressure monitoring, ECG and echocardiography. The general mortality rate of this very high cardio-vascular risk group was assessed 8–10 years afterwards and also compared to the general national death rate published for the corresponding period from the National Social Security Institute of Bulgaria. We registered significantly higher general death rate in patients with MCI and very high cardio-vascular risk as compared to the group without MCI. The logistic regression analysis attributed approximately 14.6% of the mortality rate in this high-risk group to MCI. The major cardio-vascular risk factor was arterial hypertension—with 63.85% of the patients with home blood pressure values not in the target range at the initial cognitive screening. During the neuropsychological reevaluation 56.43% were with poor control despite the multidrug antihypertensive regimen. It is known that MCI is correlated with cardiovascular risk factors with the leading role of arterial hypertension. We found that the combination of MCI and arterial hypertension can lead to higher mortality rate than in the general aging population. This has important clinical implications for the everyday practice.

Factors associated with posoperative mortality in high perioperative risk patients. Cohort study

Introduction: Determining perioperative risk is part of the strategies implemented with the aim of reducing morbidity and mortality in the surgical population in the world. Although there is no established definition, high perioperative risk is associated with the group of patients with the highest disease burden.&#x0D; Objective: To determine postoperative mortality and its associated factors in patients with high perioperative risk.&#x0D; Methods: Analytical observational cohort study of high perioperative risk patients included in the database (n = 843) of the anesthesia program in a high complexity hospital in Colombia, between January 2011 and April 2018. Pre and postoperative variables were analyzed using uni and multivariate logistic regression per protocol. Overall and stratified mortality were estimated and factors associated with their occurrence were analyzed. Finally, survival was analyzed, the primary outcome being overall cohort mortality and stratified high cardiovascular risk mortality.&#x0D; Results: Cumulative 7-day mortality was 3.68% (95% CI 2.40-4.95%) and 30-day mortality was 10.08% (95% CI 8.05-12.12%). Perioperative mortality in the high cardiovascular risk group in the first 7 days was 3.60% (95% CI 1.13-6.07%) and 14.86% (95% CI 10.15-19.58%) at 30 days. The following preoperative variables were associated with mortality: chronic obstructive pulmonary disease, chronic kidney disease, limited functional class and abdominal aortic aneurysm. A strong association was observed between postoperative complications and a significant increase in mortality rate; the most relevant complications were cerebrovascular events and cardiogenic shock.&#x0D; Conclusions: In this group of high perioperative risk patients, and in the subgroup of high cardiovascular risk patients, overall mortality at 7 and at 30 days was estimated to be above values reported in various countries. Mortality was significantly increased by the presence of preoperative factors and postoperative complications.

CLINICAL CHARACTERISTICS OF WOMEN REFERRED TO CARDIAC SPECT: WHEN AND WHO? DATA FROM LATVIAN CARDIAC SPECT REGISTRY

Objective: Population based cross-sectional study of cardiovascular risk (CVR) factors in Latvia from year 2009 till 2019 revealed that women in age 25 -74 are in a very high CVR group: 61% of women have dyslipidemia, more than 33% have arterial hypertension (AH) and 28% are overweight. The data indicates the necessity for focused diagnostics and early detection of cardiovascular disease. The aim of study was to define the clinical profile and risk factors for women with suspected coronary artery disease (CAD) reffered to cardiac single photon emission computed tomography (SPECT) in Latvia and to find out the correlation between nuclear test result and patient clinical presentation. Design and method: Cardiac SPECT was performed in a single centre from 2018 till 2021. The women patients were analyzed by risk factors and previous diagnosis of CAD. Exercise test was performed in all cases. Patients were divided into 2 groups: normal myocardial perfusion or true myocardial perfusion defect, defined as area of ischemia more than 10% of the left ventricle myocardium mass. Results: 726 SPECT data were analyzed. The mean age of women patients was 62.6 ± 10.6 years. More than half of the patients (n = 486,66.9%) were overweight (BMI&gt; 25.0 kg/m2) and 33.3%(n = 242) were obese (BMI&gt; 30.0 kg/m2). 87 (11.9%) women were current or ex-smokers. Dyslipidemia was present in in 614 (84.6%), AH in 535 (73.7%) and type 2 Diabetes mellitus (T2DM) in 60 (8.3%) patients. 104 (14.3%) patients were asymptomatic, but with intermediate to high pre-test probability for CAD. Known CAD was present in 298 (41.0%) patients. Exercise test was found positive in 306 (42.1%) patients and the test result was not always associated with ischaemia in SPECT (p = 0.063). True myocardial perfusion defect was detected in 125 patients (17.2%). Correlation was found between significant perfusion defect in SPECT and risk factors - AH (p = 0.013) and dyslipidemia (p = 0.029). Conclusions: The registry proves the high value of imaging with cardiac SPECT for diagnostics of CAD. Women patients with intermediate or high pre-test probability – even asymptomatic or with non informative exercise test should be reffered for cardiac SPECT.

CLINICAL CHARACTERISTICS AND OUTCOME OF KOREAN HYPERTENSION COHORT

Objective: Hypertension is a chronic disease that requires long-term follow-up in many patients. The differences in ethnicity and healthcare resources affect the results of hypertension control. This study evaluated the long-term cardiovascular complications in Asian patients with hypertension compared with controls without hypertension. Design and method: This Korean Hypertension Cohort (KHC) enrolled 11,043 hypertensive patients and followed up for more than 10 years. Age and sex-matched controls without hypertension were enrolled at a 1:10 ratio. Results: The mean age was 59 years, 50.5% were male, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. Event rates in the hypertensive patients were more than twice those in the population without hypertension. Among 16 combinations of the four SBP and four DBP decile groups, all combinations with DBP &lt; 70 mmHg and most combinations with SBP &gt; 150 mmHg showed a significantly higher risk than the reference group of SBP/DBP of 130–139/80-89 mmHg. Even with normal to mildly elevated SBP (130–149 mmHg), combinations with low DBP (&lt; 70 mmHg) showed significantly higher risk than the reference group. Conclusions: This study confirmed the importance of SBP control in patients with hypertension but also raised the importance of DBP in predicting future cardiovascular events.