Higher Framingham Risk Research Articles

Perioperative myocardial damage and the incidence of type 2 myocardial infarction in patients with intermediate and high cardiovascular risk.

Perioperative myocardial infarction is a major cause of morbidity and mortality in patients undergoing surgical operations. We aimed to determine the incidence of perioperative myocardial infarction in patients with intermediate- or high-risk Framingham scores. One hundred and one patients (62 males, 39 females) over 40 years of age (mean age 72±11 years) median 73 (65-81), min- max (46-96), with Framingham risk scores of 10% or higher, and scheduled for surgical interventions in the orthopedics and urology departments of our hospital were included in the study. Patient demographics, comorbidities, blood pressures, and biochemical data were recorded. Troponin values and electrocardiographic findings were obtained during the immediate preoperative period and on postoperative day 2 and then compared. Perioperative myocardial injury and infarction were diagnosed using the third universal definition of myocardial infarction. In 44 (43%) patients, postoperative troponin values were compared with the preoperative values. In 26 (25%) patients, the changes were consistent with myocardial ischemia or damage. Alterations in troponin values with significant electrocardiogram (ECG) changes were found in 6 patients (6%). The risk of postoperative myocardial damage was high in our patients with intermediate or high-risk Framingham scores. This im-plies that close follow-up of these patients with abnormal ECG and troponin values during the pre- and postoperative period is required.

P1507Role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected angina with no previous history of coronary artery disease

Abstract Introduction Traditional risk assessment tools classify the majority of women at low risk despite cardiovascular disease remaining the leading cause of death in women. Additionally conventional stress testing techniques have poor predictive value in women, due to unique pathophysiological mechanisms causing ischaemia in women, and the lower prevalence of obstructive CAD. The study sought to evaluate the role of adjuvant carotid ultrasound (CU) in women attending for stress echocardiography (SE). Methods and results 415 women (Mean age 62±10 years, 28% Diabetes Mellitus, Mean BMI 28) attending for SE prospectively underwent CU, to assess Carotid Intima-media thickness (CIMT) and the presence of plaque. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (Carotid plaque in 41%, 15% CIMT >75th percentile). Women with CD were older (65 vs 58 years, p<0.0001), more likely to have Diabetes (41% vs 21%, p=0.0001) and hypertension (67% vs 36%, p<0.01), and had higher pretest probability of CAD (59% vs 41%, p<0.0001). 40% of women classified as low Framingham, were found to have evidence of CD. Conversely, only 40% of women classified as high Framingham risk, had CD. The positive predictive value of SE for flow-limiting CAD was 51%, but the presence of carotid plaque improved this to 71% (p<0.01). Of all clinical and test parameters, carotid plaque (p=0.001) and SE result (p=0.01) were the only independent predictors of >70% angiographic. Conclusion CU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography. Non-invasive assessment of subclinical atherosclerosis using CU offers an individualized disease-guided approach in women, where conventional scoring systems offer modest risk stratification.

Cardiovascular risk and encoding-related hippocampal connectivity in older adults

BackgroundCardiovascular conditions contribute to brain volume loss, reduced cerebrovascular health, and increased dementia risk in aging adults. Altered hippocampal connectivity has also been observed in individuals with cardiovascular conditions, yet the functional consequences of these changes remain unclear. In the present study, we collected functional magnetic resonance imaging data during memory encoding and used a psychophysiological interaction analysis to examine whether cardiovascular burden, indexed using the Framingham risk score, was associated with encoding-related hippocampal connectivity and task performance in cognitively-intact older adults between 65 and 85 years of age. Our goal was to better understand the early functional consequences of vascular and metabolic dysfunction in those at risk for cognitive decline.ResultsHigh Framingham risk scores were associated with lower total brain volumes. In addition, those with high Framingham risk scores showed an altered relationship between left hippocampal-medial prefrontal coupling and task performance compared to those with low Framingham risk scores. Specifically, we found a significant interaction of Framingham risk and learning on connectivity between the left hippocampus and primarily left midline prefrontal regions comprising the left ventral anterior cingulate cortex and medial prefrontal cortex. Those with lower Framingham risk scores showed a pattern of weaker connectivity between left hippocampal and medial prefrontal regions associated with better task performance. Those with higher Framingham risk scores showed the opposite pattern; stronger connectivity was associated with better performance.ConclusionsFindings from the current study show that amongst older adults with cardiovascular conditions, higher Framingham risk is associated with lower brain volume and altered left hippocampal-medial prefrontal coupling during task performance compared to those with lower Framingham risk scores. This may reflect a compensatory mechanism in support of memory function and suggests that older adults with elevated cardiovascular risk are vulnerable to early Alzheimer disease-like dysfunction within the episodic memory system.

Risk stratification of non-alcoholic fatty liver disease across body mass index in a community basis

The features and risk analysis of non-alcoholic fatty liver disease (NAFLD) in a community-based setting remain elusive. The predictors between obese and lean subjects need further clarification. We aimed to assess the characteristics of NAFLD during a community screening. The associated metabolic abnormalities and cardiovascular risk assessment were also analyzed. A total of 2483 subjects receiving multi-purpose health screening at 10 primary care centers were recruited. They received clinical assessment, including demographic data, laboratory examination, and abdominal sonography. The prevalence of NAFLD and metabolic syndrome were 44.5%, and 15.8%, respectively. Among those NAFLD subjects, 1212 (48.8%) subjects were obese (BMI≥ 24kg/m2). There was an increasing trend of NAFLD according to age, ranging from 25.8% of those aged <30 years to 54.4% of those aged 50-70 years (P for trend< 0.0001). High insulin resistance (IR) was the significant predictive factor for NAFLD in both obese (odds ratio [OR]=3.85, 95% confidence interval [CI]=1.87-8.36, P=0.0002) and lean subjects (OR=2.52, 95% CI=1.13-5.54, p=0.02). The prevalence of high Framingham Risk Score (≥7.5%) was 56.7% (211/372) among the male subjects, which was significantly higher than that (26%, 191/734) of the females (P<0.001). There was a significant increase of high Framingham Risk Score according to BMI, ranging from 23.1% of BMI<24kg/m2 to 45% of BMI>27kg/m2 (P for trend< 0.0001). IR is predictive of NAFLD irrespective of BMI. The cardiovascular risk may exist in lean NAFLD subjects.

EFFECT OF SEX DIFFERENCES ON INFLAMMATION IN SCHIZOPHRENIA: RELATIONSHIPS WITH SLEEP DISTURBANCES, COGNITIVE FUNCTIONING, AND CARDIOMETABOLIC RISK

Introduction Persons with schizophrenia (SZ) have life expectancies that are 15-20 years shorter than the general population, primarily due to cardiovascular-related deaths. In addition to premature mortality, persons with SZ have high rates of disability largely due to cognitive deficits. While cardiometabolic risk as well as cognition are known to be associated with poor sleep and inflammation in the general population, this has not been systematically examined in persons with SZ, although SZ is associated with inflammatory pathology and sleep disturbances that predate the use of antipsychotic medications and accumulation of poor lifestyle habits. Within the general population, women have higher inflammatory marker levels and are more likely to have sleep disturbances and cognitive decline as they age. This study examines the link between sleep, cognition and cardiometabolic risk within persons with SZ, focusing on sex differences. Methods The sample included 152 subjects with SZ (DSM-IV-TR criteria) and 141 non-psychiatric comparison (NC) subjects (age range 26 to 65 years; mean 48), with comparable sex and race distribution. We examined sleep (self-reported duration and quality), cardiometabolic risk [Framingham 10-year Risk of cardiovascular disease, high-sensitivity C-reactive protein or hs-CRP, insulin resistance using the Homeostatic Model of Assessment for Insulin Resistance or HOMA-IR], cognition [executive functioning (D-KEFS), overall cognitive functioning (TICS - modified)]; and blood-based inflammatory markers (TNF-a, IL-6, IL-10). In a subset of subjects, we also examined objective measures of sleep (total sleep time (TST), wake after sleep onset (WASO), latency, and efficiency) using wrist-worn actigraphy. The sleep-inflammation-cardiometabolic risk links were examined using Spearman's correlations and general linear models with a backward elimination approach to trim the models. Results The SZ group reported higher total sleep time and worse sleep quality, worse cardiometabolic risk, and increased levels of inflammatory markers compared to NCs. Within the SZ group, SZ men had higher Framingham Risk, lower hs-CRP and IL-6 levels, as well as better overall cognitive functioning than SZ women (Cohen's d = -0.65, 0.48, 0.38, and -0.33, respectively.) In SZ men, shorter sleep duration and poor sleep quality was associated with higher IL-6 and TNF-a levels and better executive functioning. Within the SZ group, Framingham Risk was associated with sex (as expected), age, IL-6, TNF-a, and overall cognition such that younger women with lower levels of IL-6 and TNF-a as well as better overall cognition had lower Framingham Risk (partial eta-squared = 0.19, 0.27, 0.03, 0.04, and 0.02, respectively). The levels of hs-CRP and HOMA-IR were not associated with sex. The levels of hs-CRP was associated with age, IL-6 and overall cognition (partial eta-squared = 0.02, 0.19, and 0.08, respectively). HOMA-IR was associated with age, duration of sleep, sleep quality, IL-6, and overall cognition such that younger persons with longer sleep duration, better sleep quality, lower inflammation and better cognitive functioning had less insulin resistance (partial eta-squared = 0.02, 0.02, 0.05, 0.03, and 0.08, respectively.) Objective measures of sleep disturbances (TST, WASO) were associated with HOMA-IR, executive functioning, as well as levels of hs-CRP and IL-6. Conclusions There are complexities in the associations of different inflammatory biomarkers with clinically meaningful measures of sleep, cardiometabolic health and cognition that reveal sex differences in SZ. Self-reported sleep disturbances and increased inflammation are associated in persons with SZ. Levels of inflammation and sleep disturbances, and their relationships, were sex-dependent in the SZ group, but not the NC group. Longitudinal examination of the sleep-inflammation links, their contribution to clinical outcomes, and the relationship with objective sleep measures and sex-specific factors is warranted. This research was funded by This study was supported, in part, by the National Institutes of Health (grant R01MH094151-01 to DVJ [PI]), by the National Institute of Mental Health T32 Geriatric Mental Health Program (grant MH019934 to DVJ [PI]), by the Stein Institute for Research on Aging at the University of California San Diego, and by the National Institutes of Health, Grant UL1TR001442 of CTSA funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Uromodulin in a Pathway Between Decreased Renal Urate Excretion and Albuminuria.

The mechanism explaining the inverse association between renal urate and albumin excretion remains unclear. First, we evaluated the impact of candidate variants in the main urate transporter genes (i.e., SLC2A9, SLC22A12, ABCG2) on the association between fractional excretion of uric acid (FEUA) and urinary albumin/creatinine ratio (uACR). Second, we examined uromodulin and sodium excretion as mediators of the association between FEUA and uACR. We performed cross-sectional analysis of 737 French Canadians from the CARTaGENE cohort, a random sample of the Quebec population aged 40-69 years (a total of 20,004 individuals). Individuals with available genotyping and urinary data were obtained from a sub-study including gender-matched pairs with high and low Framingham Risk Score and vascular rigidity index. We further excluded individuals with an estimated glomerular filtration rate <60 ml/min/1.73 m2, glycosuria, and use of confounding medication. A spot urine sample was analyzed. Genotyping was performed using the Illumina Omni2.5-8 BeadChips. Genetic variants were analyzed using an additive model. Final analyses included 593 individuals (45.5% of men; mean age 54.3 ± 8.6). We observed an antagonistic interaction between rs13129697 variant of the SLC2A9 gene and FEUA tertiles on uACR (P = 0.002). Using the mediation analysis, uromodulin explained 32%, fractional excretion of sodium (FENa) 44%, and uromodulin together with FENa explained 70% of the inverse relationship between FEUA and uACR. Bootstrapping process confirmed the role of both mediators. Our data suggest that the association of albuminuria with decreased renal urate excretion may be modified by the transporter SLC2A9, and mediated by uromodulin and sodium handling.

Cardiac Events after Radiation Therapy (RT) for Stage II-III Non-Small Cell Lung Cancer (NSCLC): Analysis of 748 Patients

Radiation therapy-associated cardiac toxicity in patients with NSCLC arises sooner and is of greater clinical significance than historically appreciated. Recent studies have been limited by inconsistent definitions and small size. This study reports major cardiac events after RT in a large cohort of patients with NSCLC using comprehensive, validated cardiac toxicity criteria and dose-volume data. Retrospective study of 748 patients with Stage II (9%) to III (91%) NSCLC treated with 3D-conformal (77%) or intensity-modulated (22%) RT (median dose, 64 Gy) and chemotherapy (61%), chemotherapy and surgery (33%), or RT alone (4%) between 1998–2014 at one institution. Hearts were re-contoured per cardiac atlas definitions. Patients without baseline coronary heart disease (CHD) or CHD risk equivalent were stratified by Framingham risk. Primary endpoint was major cardiac events, defined as any grade ≥3 Common Terminology Criteria for Adverse Events (CTCAE, v4.03) or Major Adverse Cardiac Events (MACE). Estimates of Kaplan-Meier overall survival (OS) and cumulative incidence of cardiac events (non-cardiac death as a competing risk) were calculated. Fine and Gray and Cox regressions were performed. Median follow up from RT was 1.9 years. Median mean heart dose was 12.3 Gy. Two-year OS stratified by low, moderate, or high Framingham risk group or known CHD was 62.7%, 56.0%, 47.0%, and 46.8%, respectively (P=.001). Median time to first major cardiac event was 10.4 months; cumulative incidence at 1, 2, and 5-years was 18.2%, 23.5%, and 32.4%, respectively. Two-year cumulative incidence of major cardiac events (conduction, 12.0%; heart failure, 5.7%; MACE, 4.8%; pericardial [all], 4.7%; pericardial [effusion, cytology benign], 1.8%; coronary/ischemic, 2.5%; valvular, 1.1%; and cardiopulmonary/other, 5.4%) was increased in patients with vs without baseline CHD (31.2% vs 18.9%; P<.0001) and those with mean heart dose >12 Gy vs ≤12 Gy (26.7% vs 19.3%; P=.009), respectively. On multivariable analysis (MVA), baseline CHD (hazard ratio [HR] 1.75, 95% CI 1.35–2.28; P<.0001) and mean heart dose (HR 1.09/5 Gy, 95% CI 1.02–1.16; P=.013) were significantly associated with major cardiac events. On MVA accounting for baseline CHD and known lung cancer prognostic factors, major cardiac events were significantly associated with decreased OS (HR 2.91, 95% CI 2.39–3.55; P<.0001), while mean heart dose was not (HR 1.04/5 Gy, 95% CI 0.99–1.09; P=.107). In this large cohort of patients with NSCLC, major cardiac events were common, occurred sooner than previously reported, and were associated with baseline CHD and heart dose. These results build upon recent reports, support efforts to minimize heart irradiation, and highlight the importance of pre-treatment cardiac risk assessment and development of risk mitigation strategies for high risk patients.

Similar neurocognitive outcomes after 48 weeks in HIV-1-infected participants randomized to continue tenofovir/emtricitabine + atazanavir/ritonavir or simplify to abacavir/lamivudine + atazanavir

Human immunodeficiency virus (HIV)-associated neurocognitive disorders can persist in many patients despite achieving viral suppression while on antiretroviral therapy (ART). Neurocognitive function over 48 weeks was evaluated using a Cogstate test battery assessing psychomotor function, attention, learning, and working memory in 293 HIV-1-infected, ART-experienced, and virologically suppressed adults. The ASSURE study randomized participants 1:2 to remain on tenofovir/emtricitabine (TDF/FTC) and ritonavir-boosted atazanavir (ATV/r) or simplify to abacavir/lamivudine + atazanavir (ABC/3TC + ATV). Neurocognitive z-scores were computed using demographically adjusted normative data and were classified as “impaired” (defined as either a z-score ≤ − 2 or having 2 or more standardized individual test z-scores ≤ − 1); while higher scores (equaling better performance) were classified as “normal”. By z-scores, 54.7% of participants had impaired neurocognition at baseline and 50.2% at week 48. There were no significant differences (p < 0.05) in the baseline-adjusted performance between treatment groups for any individual test or by z-score. Specific demographic and medical risk factors were evaluated by univariate analysis for impact on neurocognitive performance. Factors with p < 0.10 were evaluated by backwards regression analysis to identify neurocognition-correlated factors after accounting for treatment, assessment, and baseline. Four risk factors at baseline for impaired neurocognition were initially identified: lower CD4 nadir lymphocyte counts, higher Framingham risk scores, and interleukin-6 levels, and a history of psychiatric disorder not otherwise specified, however none were found to moderate the effect of treatment on neurocognition. In this aviremic, treatment-experienced population, baseline-adjusted neurocognitive function remained stable and equivalent over 48 weeks with both TDF/FTC + ATV/r-treated and in the ART-simplified ABC/3TC + ATV treatment groups.

A17631 Effectivity of Garcinia mangostana Linn extract to Reduce Blood Pressure and Inflammatory process in Hypertension Patient with High Risk Framingham Scoreʼs

Objectives: to examine the effectivity of Garcinia mangostana Linn extract consumption to reduced blood pressure and inflammatory process in hypertension patients with high risk Framingham score Methods: A randomized, Single-blind, placebo-controlled clinical trial was conducted in 66 pre-and mildly hypertensive adults which were determined based on JNC VII, age 50–70 y,Patients use combination of antihypertension drug were excluded. The patients were divided into two group. One group given 2520 mg/day Garcinia mangostana Linn extracts in 3 divided dose for 90 days and the other group given placebo. A standardized method was used to measure BP at baseline and monthly intervals. The parameters were Nitrit Oxide (NO), IL-1,IL-6,measured at baseline and after 90day's of treatment. Results: At 90 days, Garcinia mangostana Linn extracts lowered systolic BP (SBP) compared with placebo ( − 22.82 ± 11.4 vs − 10 ± 16.0 mmHg; P = 0.007). Diastolic BP was also lower, although this change did not differ from placebo ( − 8.7 ± 11.2vs − 5,4 ± 9.3 mmHg; P = 0.21). The change in heart rate was significance compared with placebo ( − 6.13 ± 9,6/minvs1,43 ± 3.04/min;P = 0.021). The change in mean arterial pressure was significance compared with placebo ( − 13,47 ± 12,01vs − 7,03 ± 9.7 mmHg;P = 0.028). Interestingly, we found that there was a significance decreasing in Nitric Oxide (NO) compared with placebo ( − 8.23 ± 14,9 uM vs4,3 ± 14.51 uM;P = 0.002). We found that The plasma IL-6 and IL-1 concentration was significantly lower compared with placebo ( − 95.86 ± 107,3 pg/ml vs37,87 ± 149,89 pg/ml;P = 0.000; − 11.26 ± 16,46 pg/ml vs9.59 ± 13.65 pg/ml; P = 0.000, respectively Conclusion: These results suggest that consumption of Garcinia mangostana Linn extract significantly reduce systolic blood pressure and inflammatory process in hypertension patients

A17065 The Effect of Garcinia mangostana Linn Extract on Castelliʼs Risk Index-1 in High Framingham Risk Score Patients

Objectives: The aim of this study was to evaluate the effect of consuming Garcinia mangostana Linn peel extract on Castelli's Risk Indexes-1 (total/high-density lipoprotein (HDL) cholesterol) in high Framingham Risk Score (FRS) patients. Methods: A randomized, single-blind, placebo-controlled clinical trial was conducted in 66 high cardiovascular disease risk adults, aged 50 to 70 which were determine using FRS. The patients were divided into two groups. One group given 2700 mg/day in 3 divided dose for 90 days and the other group given placebo. Blood sampling of HDL cholesterol and total cholesterol were performed at baseline and after 90 days of treatment. Paired T-Test was used to evaluate pre and post-intervention results between two groups in this study. Results: After 90 days, Garcinia mangostana Linn extracts increased HDL cholesterol compared with placebo (26.82 ± 10.4 vs. 15.47 ± 11.3 mg/dL; P = 0.007). Total cholesterol was reduced, compared with placebo (−8.7 ± 11.2 vs. − 5,4 ± 9.3 mg/dL; P = 0.01). In total, Garcinia mangostana Linn extracts decreased Castelli's Risk Indexes-1 compared with placebo (−3.76 ± 0.15 vs. − 1.16 ± 0.92; P = 0.025). Conclusion: The result of this study proves that Garcinia mangostana Linn extract could significantly improve CRI-1 in high FRS patients.

Factors Associated with the Risk of Developing Coronary Artery Disease in Medicated Patients with Major Depressive Disorder.

Background: The aim of this study was to identify factors associated with high Framingham Risk Score (FRS) in medicated patients with major depressive disorder (MDD). Methods: We examined 61 medicated patients with MDD (mean age 37.77 ± 7.67, 90.2% women) and 43 non-depressed controls (mean age 38.26 ± 9.20, 90.7% women). We administered the Hamilton Depression Rating Scale (HAM-D) and measured systolic blood pressure (SBP), diastolic BP (DBP), mean arterial BP (MAP), pulse wave velocity (PWV), intima-media thickness (IMT), interleukin-6 (IL-6) and triglycerides. Results: We found that medicated patients with MDD had significantly higher levels of HAM-D score (p < 0.01), SBP (p = 0.015), MAP (p = 0.037), IL−6 level (p = 0.007), as compared with controls. Medicated patients who remained moderately to severely depressed showed significantly higher SBP (p = 0.049), DBP (p = 0.009), MAP (p = 0.024), IL−6 level (p = 0.019), left PWV (p = 0.004) and average PWV (p = 0.026) than those with mild depression. Multivariate regression showed that the interaction effect between HAM-D score and triglyceride level (p = 0.018) was significantly associated with FRS in medicated patients with MDD. Conclusions: This study highlights that the interaction effect of the severity of depression and the triglyceride level, was a modifiable factor positively associated with high FRS.

Association of vitamin D status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems in patients with type 2 diabetes mellitus

Objective: The aim of the present study was to evaluate the relationship between vitamin D (25[OH]D) status and the risk of cardiovascular disease as assessed by various cardiovascular risk scoring systems such as QRISK2, BNF, ASSING, SCORE, and Framingham in patients with type 2 diabetes mellitus(T2DM).Methods: The study included 108 patients with vitamin D insufficiency (25[OH]D ≥ 10–30 ng/mL) and 100 patients with vitamin D deficiency (25[OH]D < 10 ng/mL), who were admitted to the diabetes outpatient clinics due to T2DM and who were aged 45–65 years. QRISK2, BNF, ASSING, SCORE, and Framingham were calculated and compared between the two groups.Results: HbA1c levels were significantly higher in patients with vitamin D deficiency. Patients with vitamin D deficiency had significantly higher Framingham risk score (p < .001) and significantly lower BNF score (p < .001), whereas other scores did not significantly differ between the groups. There was a moderate, statistically significant correlation between 25[OH]D levels and Framingham risk score in negative direction (r = 0.537) and a weak but statistically significant correlation between 25[OH]D levels and BNF score (r = 0.295). 25[OH]D levels were significantly higher and HbA1c levels were significantly lower in patients with Framingham cardiovascular risk score ≤10%.Conclusion: We found a close relationship with Framingham cardiovascular risk score in diabetic patients with very low serum vitamin D levels. Cardiovascular risk as assessed by the Framingham’s scale increases with decreasing 25[OH]D levels. BNF score was negatively correlated with 25[OH]D levels.

Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality.

BackgroundAmerican Heart Association/American Stroke Association expert consensus guidelines recommend consideration of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with ischemic stroke/TIA who have a high-risk Framingham Cardiac Risk Score (FCRS). Whether this guideline is being implemented in routine clinical practice, and the association of its implementation with mortality, is less clear.MethodsStudy participants were Veterans with stroke/TIA (n = 11,306) during fiscal year 2011 who presented to a VA Emergency Department or who were admitted. Patients were excluded (n = 6,915) based on prior CHD/angina/chest pain history, receipt of cardiac stress testing within 18 months prior to cerebrovascular event, death within 90 days of discharge, discharge to hospice, transfer to a non-VA acute care facility, or missing/unknown race. FCRS ≥20% was classified as high risk for CHD. ICD-9 and Common Procedural Terminology codes were used to identify receipt of any cardiac stress testing.ResultsAmong 4,391 eligible patients, 62.8% (n = 2,759) had FCRS ≥20%. Cardiac stress testing was performed infrequently and in similar proportion among high-risk (4.5% [123/2,759]) vs low/intermediate-risk (4.4% [72/1,632]) patients (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.54–1.10). Receipt of stress testing was not associated with reduced 1-year mortality (aOR 0.59, CI 0.26–1.30).ConclusionsIn this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease.

Temporal Trends in Coronary Angiography and Percutaneous Coronary Intervention: Insights From the VA Clinical Assessment, Reporting, and Tracking Program

ObjectivesThe aim of this study was to evaluate temporal trends in characteristics and outcomes among patients referred for invasive coronary procedures within a national health care system for veterans. BackgroundCoronary angiography and percutaneous coronary intervention remain instrumental diagnostic and therapeutic interventions for coronary artery disease. MethodsAll coronary angiographic studies and interventions performed in U.S. Department of Veterans Affairs cardiac catheterization laboratories for fiscal years 2009 through 2015 were identified. The demographic characteristics and management of these patients were stratified by time. Clinical outcomes including readmission (30-day) and mortality were assessed across years. ResultsFrom 2009 to 2015, 194,476 coronary angiographic examinations and 85,024 interventions were performed at Veterans Affairs facilities. The median numbers of angiographic studies (p = 0.81) and interventions (p = 0.22) remained constant over time. Patients undergoing these procedures were progressively older, with more comorbidities, as the proportion classified as having high Framingham risk significantly increased among those undergoing angiography (from 20% to 25%; p < 0.001) and intervention (from 24% to 32%; p < 0.001). Similarly, the median National Cardiovascular Data Registry CathPCI risk score increased for diagnostic (from 14 to 15; p = 0.005) and interventional (from 14 to 18; p = 0.002) procedures. Post-procedural medical management was unchanged over time, although there was increasing adoption of transradial access for diagnostic (from 6% to 36%; p < 0.001) and interventional (from 5% to 32%; p < 0.001) procedures. Complications and clinical outcomes also remained constant, with a trend toward a reduction in the adjusted hazard ratio for percutaneous coronary intervention mortality (hazard ratio: 0.983; 95% confidence interval: 0.967 to 1.000). ConclusionsVeterans undergoing invasive coronary procedures have had increasing medical complexity over time, without attendant increases in mortality among those receiving interventions. As the Department of Veterans Affairs moves toward a mix of integrated and community-based care, it will be important to account for these demographic shifts so that quality can be maintained.

Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes

ObjectiveTo examine the association between serum uric acid levels and cardiovascular disease risk among individuals without diabetes. MethodsWe investigated the association between serum uric acid levels and the risk of prevalent cardiometabolic diseases, 10-year Framingham risk for coronary heart disease, and 10-year risk for atherosclerotic cardiovascular diseases (ASCVD) among 8,252 participants aged ≥ 40 years without diabetes from Jiading district, Shanghai, China. ResultsBody mass index, waist circumference, blood glucose, glycated hemoglobin, blood pressure, and serum lipids increased progressively across the sex-specific quartiles of uric acid (all P trend < 0.05). Compared with individuals in the lowest quartile, those in the higher quartiles had a significantly higher prevalence of obesity, hypertension, and dyslipidemia (all P trend < 0.05). A fully adjusted logistic regression analysis revealed that individuals in the highest quartile had an increased risk of predicted cardiovascular disease compared with those in the lowest quartile of uric acid. The multivariate adjusted odds ratios (ORs) [95% confidence intervals (CIs)] for the highest quartiles for high Framingham risk were 3.00 (2.00–4.50) in men and 2.95 (1.08–8.43) in women. The multivariate adjusted ORs (95% CIs) for the highest quartile for high ASCVD risk were 1.93 (1.17–3.17) in men and 4.53 (2.57–7.98) in women. ConclusionSerum uric acid level is associated with an increased risk of prevalent obesity, hypertension, dyslipidemia, 10-year Framingham risk for coronary heart disease, and 10-year risk for ASCVD among Chinese adults without diabetes.

A 48-month Prospective Study of the Effects of Multifactorial Interventions on Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus in an Urban Community: The Beijing Communities Diabetes Study 12

Objective: To assess whether multifactorial interventions have long-term effects on the risk of diabetes-related macrovascular complications in patients with type 2 diabetes mellitus living in urban communities of Beijing. Design, setting and participants: A total of 2926 patients with type 2 diabetes from 15 community health centers were divided into a diabetes mellitus (DM) group (n=824), a hypertension (HTN) group (n=1267), and a cardiovascular disease (CVD) group (n=835). By applying Framingham risk scores (FRS), patients in the 3 groups were subdivided into low (FRS 20%) Framingham risk strata. After 48 months, patients were followed-up to assess the long-term effects of the multifactorial interventions. Results: At baseline, the patients’ mean neck circumference (NC) was significantly higher in the HTN and CVD groups than in the DM group (P<0.05). After 48 months of follow-up, the CVD and HTN groups both had higher blood pressures and lipid levels than the DM group (both P<0.01). Although there was no significant change in the FRS versus baseline in the low and medium Framingham risk strata, a significant reduction in FRS was noted in the high Framingham risk strata. In Cox multivariate analyses, the HTN and CVD groups had higher incidences of endpoint events than the DM group. Conclusions: This study has demonstrated for the first time a relationship between NC and CVD in diabetic patients. Multifactorial interventions for CVD risk factors over 48 months lowered the estimated 10-year risk for CVD events in diabetes. FRS score influences the incidence of CVD events in diabetic patients. Aggressive risk reduction should be focused on these individuals who had high FRS score.

Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: An ancillary study of the ASAS-COMOSPA project

ObjectivesThe objectives of this study were: (1) to compare the prevalence of cardiovascular disease and cardiovascular risk factors among different phenotypes of spondyloarthritis (SpA); (2) to assess the differences in cardiovascular disease and cardiovascular risk factors between two geographical areas, i.e. Northern Europe vs. Mediterranean region; (3) to identify potential predictive factors for high Framingham Risk Score regarding disease features in SpA and geographical area. MethodsAncillary analysis of the international, multicentric, observational, cross-sectional ASAS-COMOSPA study. Cardiovascular disease and cardiovascular risk factors were compared depending on SpA phenotype and geographical regions. Potential factors associated with higher cardiovascular risk (i.e. Framingham Risk Score) were determined by a multiple logistic regression. ResultsThe most frequent cardiovascular risk factor and cardiovascular disease were smoking (31.2%) and ischemic heart disease (3.2%), respectively. Regarding SpA phenotype, axial SpA patients showed significantly lower prevalence (P<0.05) of hypertension (19.2% vs. 33.8% vs. 26.6% for axial, peripheral and mixed phenotypes, respectively), type 2 diabetes mellitus (4.3% vs. 8.5% vs. 7.4%), dyslipidemia (13.9% vs. 28.4% vs. 15.2%) and ischemic heart disease (2.4% vs. 7.0% vs. 3.2%). Regarding geographical area, a higher frequency of hypertension (34.7% vs. 19.4%,), dyslipidemia (19.3% vs. 14.4%), obesity (29.3% vs. 20.7%) and ischemic heart disease (6.2% vs. 1.8%) was observed for Northern Europe vs. Mediterranean Region, respectively. ConclusionsOur results suggest that SpA phenotype and geographical area are associated with the prevalence of cardiovascular risk factors and the cardiovascular risk itself, observed in patients in the ASAS-COMOSPA cohort.

Associations between obesity status and cardiovascular disease risk in Chinese community population

Objective To investigate the association between obesity status, self-reported history of cardiovascular diseases(CVD) and CVD risk among community population in Chinese adults. Methods A total of 10 375 subjects aged 40 or older from Jiading Community, Shanghai Municipality were recruited to undergo questionnaire interview, anthropometric measurements and fasting blood sampling. Biochemical features were evaluated and the obesity statuses were categorized according to the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults. Subjects were assigned to three groups based on body mass index, and sex-specific analyses was performed. Estimated 10-year Framingham risk for coronary heart disease and 10-year risk for a first hard atherosclerotic cardiovascular diseases(ASCVD) event was calculated. Results Increased body mass index was associated with higher prevalence of self-reported history of CVD, 10-year Framingham risk for coronary heart disease, and 10-year risk for ASCVD. The prevalence of self-reported CVD in male participants with increasing body mass index levels(7.3%, 7.6%, and 11.2% respectively) were higher than in females(6.2%, 7.7%, and 10.6% respectively). Compared with subjects in the normal weight group, those in both overweight and obesity groups had higher 10-year Framingham risk for coronary heart disease and 10-year risk for ASCVD. Male obese participants had increased 10-year Framingham risk for coronary heart disease(OR=2.02, 95%CI 1.50-2.71) and 10-year risk for ASCVD(OR=2.57, 95%CI 1.56-4.22), respectively. Conclusion In Chinese middle-aged and elderly community population, high body mass index was independently associated with increased risk of self-reported history of CVD and 10-year risk for CVD. (Chin J Endocrinol Metab, 2017, 33: 465-472) Key words: Obesity; Cardiovascular diseases; ASCVD risk score; Framingham risk score

Modifiable cardiovascular risk factors in Rheumatoid Arthritis.

Objective:To determine the frequency of modifiable cardiovascular risk factors in Rheumatoid Arthritis patients at tertiary care hospital.Methods:During this study 246 patients of Rheumatoid Arthritis were enrolled from outpatients department of Medicine of Central Park Medical College Hospital, Lahore from July 1, 2016 to January 31, 2017. Demographic data and questions related to study were noted. After 14 hours of fasting 5ml of venous blood was drawn for Cholesterol, triglycerides, HDL and blood sugar level. Blood tests were performed on COBAS c III (ROCHE), Framingham 10 year Risk score was calculated for every individual.Results:The mean age of male population was (50.2 ±7.5) and females (48.4±7.6) and female gender was common. Seventy eight (78%) of study population has one modifiable risk factor. Most frequent risk factor found in this study was BMI>30 in 48.4% (n=119), High LDL 43.5% (n=107), moderate to high FRS score 40.2% (n=99), Hypertension 37.4% (n=92), Diabetes Mellitus was present in 22.8% (n=56), while smoking was least frequent risk factors with frequency of 15.9% (n=39). Framingham cardiovascular risk score was significantly different, males were having higher mean 10 year risk score (19.7%) and females (8.7%) with (p-<0.01). Regression analysis revealed that older patients of Rheumatoid Arthritis with disease duration of more than seven years are four times more likely to have High Framingham risk score, moderate to high LDL and diabetes mellitus with significant high Odds ratio (p-value <0.05).Conclusion:Rheumatoid Arthritis patients are having increased chances of developing cardiovascular risk factors leading to cardiovascular events with male sex, increasing age and disease duration.

PS 17-32 VARIABLES ASSOCIATED TO LACK OF LEFT VENTRICULAR HYPERTROPHY REGRESSION IN TREATED HYPERTENSIVE PATIENTS

Objective: Left ventricular hypertrophy (LVH) is an independent cardiovascular high risk predictor in hypertension (HBP) and its regression favorably affects the prognosis. The aim of this study is to determine the variables associated to lack of LVH regression in treated HBP patients (p). Design and method: Consecutive HBP p on at least 4 weeks stable treatment with LVH were included. Follow up for at least one year. Left ventricular mass index (LVMI) was measured by Devereux method at baseline and at follow up. LVH was considered > 95 g/m2 in women and > 115 g/m2 in men. Sixty demographic, anthropometric, cardiovascular risk factors, 2-D ultrasonographic, tissue Doppler, central aorta and peripheral hemodynamics, ABPM, laboratory and treatment variables were included in the algorithm. STATISTICAL ANALYSIS: Students t test, odds ratio, multivariate analysis; p < 0.05 considered statistically significant. Results: 188 treated HBP p included, follow up 588+-289 days. Sample mean age was 63.1+-13.8 years, 80 p (42.6%) were males. 144 p showed LVH regression (R) while 44 p (23.4%) persistent (P) LVH. Baseline LVMI was 113.2+-16.1 g/m2 in R LVH p and 118.5+-20.5 g/m2 in P LVH p (p=NS); follow up LVMI was 85.2+-17.6 g/m2 in R LVH p and 115.6+-14.1 g/m2 in P LVH p (p = 0.0005). 140 p (97.2%) decreased 1 SD and 48 p (33.3%) 2 SD LVMI in R LVH p while 4 p (9.1%) decreased 1 SD and 0 p (0%) 2 SD LVMI in P LVH p (p < 0.0005). Framingham score risk > 20% (OR 3.07; 95 % CI 1.55–6.06; p < 0.025), metabolic syndrome (OR 2.14; 95 % CI 1.08–4.25; p < 0.025); and high central aortic pressure (OR 2.80; 95 % CI 1.04–7.51; p < 0.005) were predictors of LVH P. Conclusions: 1) One over four treated HBP LVH p did not show regression; 2) High risk Framingham score, metabolic syndrome and central aortic pressure are LVH P predictors.