High Risk Of Cardiovascular Complications Research Articles

Perioperative myocardial injury and infarction after noncardiac surgery: a review of pathophysiology, diagnosis, and management.

Perioperative myocardial injury is a relatively common complication after noncardiac surgery associated with significant morbidity and mortality. It is frequently driven by physiologic factors such as hypotension, tachycardia, and anemia. Diagnosis of perioperative myocardial injury after noncardiac surgery is based on elevated cardiac troponin levels, greater than the 99th percentile of the assay's upper reference limit within 30 days of surgery. Perioperative myocardial injury is further classified into non-ischemic and ischemic based on the underlying pathophysiology. Ischemic injury, also called myocardial injury after non-cardiac surgery (MINS), is further classified into perioperative myocardial infarction or myocardial injury without infarction. Classifying perioperative myocardial injury further is particularly important for clinical management and prognosis. MINS-with or without infarction-is independently and strongly associated with short- and long-term mortality. Compared to nonoperative myocardial infarction, perioperative myocardial infarction carries an increased risk of adverse outcomes including all-cause mortality. Preventative measures include a thorough preoperative risk assessment, risk factor optimization, and avoidance of intraoperative mismatch of myocardial oxygen supply and demand. Surveillance of patients at higher risk of cardiovascular complications is warranted and can lead to early recognition, closer monitoring, and appropriate management. This review will provide a framework for understanding perioperative myocardial injury and highlight the contemporary literature addressing its diagnosis and management.

Resistant arterial hypertension: modern view of the problem

In clinical practice, uncontrolled arterial hypertension remains a difficult but solvable task, given the available arsenal of antihypertensive drugs. However, resistant arterial hypertension is diagnosed in 10%–15% of these cases. A significantly higher risk of cardiovascular complications indicates the extreme importance of the successful treatment of this pathology. Resistant hypertension is defined as above-goal high blood pressure in a patient despite concurrent use of three antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a renin–angiotensin blocker (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. All antihypertensive drugs should be administered at maximum or maximally tolerated doses. Resistant hypertension also includes cases in which blood pressure targets are achieved with ≥4 antihypertensive medications. The diagnosis of resistant hypertension requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office blood pressure above goal but out-of-office blood pressure at or below the target). Once antihypertensive medication adherence is confirmed and out-of-office blood pressure recordings exclude a white-coat effect, the evaluation includes the identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. The management of resistant hypertension includes the maximization of lifestyle interventions, correction of sleep disorders, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower blood pressure if blood pressure remains high.

The Exploring of Growth Differentiation Factor-15 and H63D Gene Polymorphisms in β-thalassemia Major: Implications for Cardiovascular Risk and Iron Overload

BACKGROUND: β-thalassemia major (βTM) is a genetic disorder characterized by a deficiency in hemoglobin production, ineffective erythropoiesis, chronic hemolysis, lifelong blood transfusions, iron overload, and increased risk of cardiac complications. OBJECTIVE: The study aimed to evaluate the growth differentiation factor-15 (GDF-15) concentration in βTM patients and its correlation with cardiac complications. H63D refers to a specific mutation in the HFE gene, which is associated with hereditary hemochromatosis (HH), a genetic disorder characterized by excessive accumulation of iron in the body. This mutation involves a change of histidine (H) to aspartic acid (D) at position 63 in the HFE protein. This mutation is often only written abbreviated as (H63D). MATERIALS AND METHODS: This case–control study was done on 120 subjects. A total of 60 patient samples were randomly collected from the Genetic Hematology Center at the Babylon Hospital, with an age range of 10–26 years. In addition, 60 samples were collected from healthy children in the same age range as the control group; patients and controls were subdivided into (10–18) and (18–26) year groups. GDF-15 was measured by enzyme-linked immunosorbent assay, and the genotyping of mutation was done by amplification refractory mutation system-polymerase chain reaction technique. RESULTS: The study revealed a significant increase in ferritin (FER) and GDF-15 levels in the patients compared to controls (P < 0.001). GDF-15 showed a direct correlation with age (r = 0.244, P = 0.02) and FER (r = 0.215, P = 0.04). There was a significant difference in H63D mutations between controls and patients (P = 0.044), with a higher proportion of the C-G (heterozygous for the mutant allele) genotype observed in βTM patients (31.67%). Additionally, a notable effect of the H63D mutation on serum ferritin (higher) levels within the βTM group was observed. CONCLUSION: Elevations of the GDF-15 in βTM patients indicate a high risk of cardiovascular complications in patients with βTM. The H63D mutation of the hemostatic iron regulator (HFE) gene is frequently found in βTM. Although a significant effect of the mutation was obtained on serum FER levels, it did not act as a risk factor in βTM patients. However, the frequent presence of the H63D mutation in patients indicated a possible association between single-nucleotide polymorphism and the iron regulation pathway.

Primary Care Utilization and Cardiovascular Screening in Adult Survivors of Childhood Cancer

Cardiovascular disease is the leading noncancer cause of premature death among survivors of childhood cancer. Adult survivors of childhood cancer are largely managed by primary care practitioners (PCPs), and health care utilization patterns related to cardiovascular screening are not well described. To examine screening and health care utilization among survivors of childhood cancer at high risk for cardiovascular complications. This multicenter cross-sectional study included participants enrolled in a randomized clinical trial from 2017 to 2021. Abstracted documentation of participants' cancer history, cardiotoxic treatment exposures, and survivorship care plans were obtained from participants' PCPs spanning 2 years preceding trial enrollment. Participants were members of the Childhood Cancer Survivor Study cohort at elevated risk for ischemic heart disease or heart failure, enrolled in a randomized trial focused on improving cardiovascular risk factor control. Data were analyzed from November 2022 to July 2023. Outcomes of interest were numbers of PCP and specialist visits, cardiovascular risk factors (hypertension, dyslipidemia, and diabetes), risk factor screening, and cardiac testing. Multivariable logistic regression assessed characteristics associated with up-to-date cardiac testing at enrollment. Of 347 enrolled participants, 293 (84.4%) had evaluable medical records (median [range] age, 39.9 [21.5-65.0] years; 149 [50.9%] male) and were included in analyses. At baseline, 238 participants (81.2%) had a documented PCP encounter; 241 participants (82.3%) had undergone blood pressure screening, 179 participants (61.1%) had undergone lipid testing, and 193 participants (65.9%) had undergone diabetes screening. A total of 63 participants (21.5%) had echocardiography completed or planned. Only 198 participants (67.6%) had records referencing a cancer history. PCP documentation of prior cardiotoxic exposures was low compared with known exposures, including radiation therapy (103 participants [35.2%] vs 203 participants [69.3%]; P < .001) and anthracycline chemotherapy (27 participants [9.2%] vs 222 participants [75.8%]; P = .008). Few records referenced a need for cancer-related late effects surveillance (95 records [32.4%]). Independent factors associated with cardiac screening included documentation of increased cardiovascular disease risk (odds ratio [OR], 11.94; 95% CI, 3.37-42.31), a late-effects surveillance plan (OR, 3.92; 95% CI, 1.69-9.11), and existing cardiovascular risk factors (OR per each additional factor, 2.09; 95% CI, 1.32-3.31). This cross-sectional study of adult survivors of childhood cancer at increased risk of cardiovascular disease found low adherence to recommended cardiac testing and documentation of risk for these individuals. Improving accuracy of reporting of survivors' exposures and risks within the medical record may improve screening.

Left Ventricular Global Longitudinal Strain (LV GLS) assessed by Echocardiography predicts myocardial fibrosis and iron overload in transfusion dependent beta-thalassemia patients

Abstract Background Cardiac involvement represents the leading cause of death in transfusion dependent beta-thalassemia (TDT) patients. It is mainly related to cardiac iron overload and myocardial fibrosis, causing progressive damage and a deterioration of systolic and diastolic function. Moreover, myocardial fibrosis may not be directly related with the degree of cardiac iron deposition and it is associated with a higher risk of cardiovascular complications. To date, Cardiac Magnetic Resonance (CMR) is the gold standard for the evaluation of iron overload with T2* sequences and for the detection of myocardial fibrosis with late gadolinium enhancement (LGE). However, CMR is not always feasible. Left Ventricular Global Longitudinal Strain (LV GLS) with Speckle Tracking Echocardiography (STE) is a non-invasive imaging tool, which may play a key role in the early recognition of subclinical myocardial damage and dysfunction (figure 1). Purpose The aim of this study was the evaluation of the role of LV GLS with STE in the characterization of myocardial involvement in a population of TDT patients. Methods An observational, cross-sectional, monocentric study was conducted enrolling 44 patients with TDT from the outpatient clinic of hematology located in our teritary hospital from January 2022 to December 2022. Each patient underwent a thorough clinical evaluation, laboratory testing, transthoracic echocardiogram (TTE) with LV GLS-STE by a trained cardiologist and contrast enhanced CMR with T2* technique and LGE sequences. A T2* value &amp;lt; 20 msec was set to define the presence of iron overload. Results The mean age of patients was 39± 9 years with a slight prevalence of female sex (53% vs 47% respectively). Atherosclerotic cardiovascular risk factors were rarely present, the most common was arterial hypertension in about 12% of patients. The TTE pointed out a left ventricular ejection fraction within the normal range (mean value of 59 ± 5%). As regards LV GLS, the mean value was -21.1 ± 3.0%. Cardiac iron overload was observed in 18% of patients, while about 15% of patients had cardiac fibrosis. A clinical and statistically significant difference was observed between LV GLS values in patients with cardiac iron overload as compared to patients without (-18.2 ± 2.1% vs -20.6 ± 3.1%; p value=0.043). A clinical and statistically significant difference was documented, also, between LV GLS values in patient with cardiac fibrosis as compared to patient without LGE (-16.4 ± 1.7% vs -20.6 ± 2.8%; p value=0.002). As regards cardiac fibrosis, a LV GLS cut-off value of -18,3% was found by the analysis of ROC curve with an AUC of 0.931 (95% CI: 0.846-1.000) (figure 2). Conclusions In a small population of TDT patients we observed that LV GLS with STE may be a promising tool able to help clinicians in the early identification of cardiac iron overload and fibrosis, providing useful information for diagnostic workup and therapeutic approach.

New criteria to identify patients at higher risk for cardiovascular complications after percutaneous coronary intervention

Abstract A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age &amp;gt;80 years (3 points), dialysis (6 points), left ventricular ejection fraction &amp;lt;30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non−ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.Derivation of risk scoreAll-cause death rate at 1 year

Characterizing risk factors for the development of cardiovascular events in CAR-T Patients

Abstract Introduction Chimeric antigen receptor (CAR) T-cell therapy, which involves ex-vivo engineering of autologous T-cells against cancer cells, has transformed the management of B and plasma cell malignancies, leading to further efforts in identifying new targets and indications. As the use of CAR T therapy expands, understanding its effects on the cardiovascular (CV) system becomes increasingly relevant. The systemic inflammatory response elicited by CAR T therapy can result in cytokine release syndrome (CRS) with manifestations including sinus tachycardia, hypotension, arrhythmias, and in severe cases, left ventricular dysfunction and cardiogenic shock. Risk factors for CAR T related CV events are not well-described. We evaluated risk factors for a primary composite endpoint of adverse CV events in a real-world cohort of patients with B and plasma cell malignancies receiving standard of care (SOC) CAR T therapy. Methods Medical records from all consecutive patients treated with SOC CAR T cell therapy at a U.S. health system from March 2018 to December 2021 were retrospectively reviewed under an IRB approved protocol. Our outcome was a single composite endpoint of clinically significant CV events including arrhythmia, acute coronary syndrome, stroke, CV death, ejection fraction decrease under 52.5%, heart failure exacerbation, and acute pericardial disease. All events resulted in an inpatient cardiology consult, upgrade to an ICU, or outpatient cardiology appointment. A multivariable Fine-Gray model was used to model CV risk and account for the competing risk of non-CV death. Results 123 patients were evaluated with a median follow-up of 16 months. 32 (26.0%) patients experienced the composite endpoint, with 1 CV death and 18 subsequent non-CV deaths, primarily from progressive disease (PD). Of the 91 patients that did not experience an adverse CV event, 35 (28.5%) died of non-CV causes, most commonly PD. In bivariate analysis, history of Coronary Artery Disease, Atrial Fibrillation (AF), Mantle Cell lymphoma, Tyrosine Kinase Inhibitor (TKI) exposure, Eastern Cooperative Oncology Group (ECOG) score ≥ 1, and CRS grade ≥ 2 were associated with the composite outcome (Table 1). A multivariable Fine-Gray regression model developed with stepwise selection showed a history of AF, ECOG score ≥ 1, Hispanic ethnicity, or CRS grade ≥ 2 were simultaneously associated with the composite outcome (Figure 1). Conclusions Risk factors associated with adverse CV events in CAR T include a history of AF, ECOG score ≥1, CRS grade ≥ 2, and Hispanic ethnicity. These findings are limited by sample size and number of events. These predictors, if validated in larger cohorts, have the potential to identify patients at high risk for CV complications who may benefit from multidisciplinary care pre- and post-CAR T infusion. Enhanced collaboration between oncologists and cardiologists to optimize CV function for this high-risk cohort may lead to improved outcomes.

Prognostic Significance of Carotid and Lower Extremity Artery Stenosis in Patients With High and Very High Cardiovascular Risk.

Aim To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods The study included men and women aged 40-67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56-2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02-6.23; p=0.044).Conclusion In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02-6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.

Myocardial injury due to covid-19 expressed through biomarkers and echocardiographic parameters: an integrative review of the literature

The high risk of cardiovascular complications during and after infection with SARS-CoV-2, a virus that causes COVID-19, is well documented in the world literature. Through cardiac changes, the role of echocardiography and biomarkers of myocardial injury is exalted as useful tools that can affect the morbidity and mortality of these patients. For a better understanding of the subject, an integrative review was performed from bibliographic data arranged in indexed databases. The objective of this study was to answer the following question: What is the role of biomarkers, conventional echocardiography and the Speckle Tracking analysis by the occurrence of myocardial injury caused by the SARS-CoV-2 virus? We concluded with the analysis of 10 studies eligible for the review that there is an intimate relationship between troponin and brainnatriureticpeptide with echocardiographic findings of myocardial injury by COVID-19. Moreover, these biomarkers were easy and widely available for screening patients eligible for echocardiography. Therefore, more studies are necessary to assess the validity and consolidation of this simple screening method that can predict cardiovascular complications in advance, often fatal.

Update on Immunotherapy Cardiotoxicity: Checkpoint Inhibitors, CAR T, and Beyond.

Immunotherapy is an innovative approach to cancer treatment that involves using the body's immune system to fight cancer. The landscape of immunotherapy is constantly evolving, as new therapies are developed and refined. Some of the most promising approaches in immunotherapy include immune checkpoint inhibitors (ICIs): these drugs target proteins on the surface of T-cells that inhibit their ability to attack cancer cells. By blocking these proteins, checkpoint inhibitors allow T-cells to recognize and destroy cancer cells more effectively. CAR T-cell therapy: this therapy involves genetically modifying a patient's own T-cells to recognize and attack cancer cells. CAR T-cell therapy exhibits favorable response in many patients with refractory hematological cancers with growing clinical trials in solid tumors. Immune system modulators: these drugs enhance the immune system's ability to fight cancer by stimulating the production of immune cells or inhibiting the activity of immune-suppressing cells. While immunotherapy has shown great promise in the treatment of cancer, it can also pose significant cardiac side effects. Some immunotherapy drugs like ICIs can cause myocarditis, which can lead to chest pain, shortness of breath, and heart failure. Other cardiac side effects of ICIs include arrhythmias, pericarditis, vasculitis, and accelerated atherosclerosis. It is important for patients receiving immunotherapy to be monitored closely for these side effects, as prompt treatment can help prevent serious complications. Patients should also report any symptoms to their healthcare providers right away, so that appropriate action can be taken. CAR T-cell therapy can also illicit an exaggerated immune response creating cytokine release syndrome (CRS) that may precipitate cardiovascular events: arrhythmias, myocardial infarction, and heart failure. Overall, while immune modulating therapy is a promising and expanding approach to cancer treatment, it is important to weigh the potential benefits against the risks and side effects, especially in patients with high risk for cardiovascular complications.

Effect of thrombocytosis on cardiovascular risk in rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis have a high level of comorbidity, and their most common and socially significant conditions are cardiovascular diseases, which represent a major cause of mortality. Currently, there are no data on the differences in cardiovascular risk scales in patients with rheumatoid arthritis depending on the presence or absence of thrombocytosis.&#x0D; AIM: To assess and compare cardiovascular risk according to conventional scales in patients with thrombocytosis and normal thrombocytes.&#x0D; MATERIALS AND METHODS: The study involved 85 patients diagnosed with rheumatoid arthritis: 40 with thrombocytosis [including 25 (62,5%) women] and 45 with normal thrombocytes [including 29 (64,4%) women]. The following scales were used to assess risk of cardiovascular complications: Systematic COronary Risk Evaluation with adjustment factor 1.5 (mSCORE), Reynolds Risk Score (RRS), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network / SIGN to Assign Preventative Treatment (ASSIGN).&#x0D; RESULTS: The obtained findings have demontrated that according to the mSCORE and RRS scales the patients of both groups had almost identical parameters; however, according to the ASSIGN and QRISK3 high risk of cardiovascular complications has been detected nearly twice as frequently in the patients with rheumatoid arthritis and thrombocytosis in comparison with those with normal level of thrombocytes. It is also worth noting that more frequent determination of high risk of cardiovascular complications by the QRISK3 was statistically significant.&#x0D; CONCLUSIONS: The QRISK3 calculation has shown significantly higher prevalence of high-risk cardiovascular complications among the patients with platelet counts 450 ∙ 109/l compared with those with platelet levels within the reference values. Thus, the QRISK3 scale can be considered as more informative for estimating risk of cardiovascular complications in rheumatoid arthritis.

A reduction of left ventricular global longitudinal strain (LV GLS) assessed with speckle tracking echocardiography (STE) predicts myocardial fibrosis in transfusion dependent beta-thalassemia

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac involvement is common and the leading cause of death in transfusion dependent beta-thalassemia (TDT) patients. It is mainly related with cardiac iron overload and myocardial fibrosis, leading to a progressive cardiac damage which evolves towards a severe deterioration of systo-diastolic cardiac function. Moreover, myocardial fibrosis may not be directly related with the degree of cardiac iron deposition and it is associated with a high risk of cardiovascular complications. To date, Cardiac Magnetic Resonance (CMR) is the gold standard for the evaluation of iron overload with T2* sequences and for the detection of myocardial fibrosis with late gadolinium enhancement (LGE). However, CMR is not always feasible. Left Ventricular Global Longitudinal Strain (LV GLS) with Speckle Tracking Echocardiography (STE) is a non-invasive imaging tool, which may play a key role in the early recognition of subclinical myocardial damage and dysfunction (figure 1). This may help clinicians in guiding the diagnostic algorithm and the therapeutic approach. Purpose The aim of this study was the evaluation of the role of LV GLS with STE in the characterization of myocardial involvement in a population of TDT patients. Methods An observational, cross-sectional, monocentric study was conducted by the enrollment of 38 patients with TDT from the outpatient clinic of hematology of our hospital. Each patient underwent a thorough clinical evaluation including laboratory testing, transthoracic echocardiogram (TTE) with LV GLS-STE and contrast enhanced CMR with T2* technique and LGE sequences. A T2* value &amp;lt; 20 msec was set to define the presence of iron overload. Results The mean age of patients was 38 ± 10 years with a slight prevalence of female sex (53% vs 47% respectively). Cardiovascular risk factors were rarely present, the most common was arterial hypertension in about 12% of patients. The TTE pointed out a left ventricular ejection fraction within the normal range (mean value of 59 ± 5%). As regards LV GLS, the mean value was −19,8 ± 2,9%. Cardiac iron overload was observed in 18% of patients, while about 15% of patients had cardiac fibrosis. A mild clinical but not statistically significant difference was observed between LV GLS values in patients with cardiac iron overload as compared to patients without (−18,3 ± 2,3% vs −20,1 ± 3,0%; p value=0,147). A statistically significant difference was documented between LV GLS values in patient with cardiac fibrosis as compared to patient without LGE (−16.4 ± 1.7% vs −19,8 ± 2,4%; p value=0,004). A LV GLS cut-off value of −18,3% was found by the analysis of ROC curve with an AUC of 0,904 (95% CI: 0,798–1,000) (figure 2). Conclusions In a small population of TDT patients we observed that LV GLS with STE may be a promising tool in the early identification of cardiac damage to provide useful informations for diagnostic and therapeutic approach.

Effect of Nitrendipine and Amlodipine on Cognitive Functions of Patients with Arterial Hypertension

Background: Arterial hypertension (AH) is one of the main factors causing a high risk of cardiovascular complications and mortality. The existence of a relationship between high blood pressure (BP) and the risk of developing central nervous system pathology, primarily stroke, and cognitive impairment, has been shown. The purpose of this study was a comparative assessment of the effect of 12-month antihypertensive therapy (AHT) with the inclusion of nitrendipine (NIT) or amlodipine (AML) on cognitive functions (CF) in hypertensive patients. Methods and Results: The study included 111 patients of both genders aged 30-75 years with AH Grades 1-3 (ESC/ESH, 2018). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring, neuropsychological tests (Mini-Cog test, Montreal Cognitive Assessment (MoCA) test, Hospital Anxiety and Depression Scale (HADS), and self-assessment questionnaire for memory, attention, thinking, ability to cope with one's affairs, and ability to make decisions). After the screening stage, all patients were discontinued from previous therapy and assigned to the 2 regimes of AHT. Group 1 included 58 AH patients who received NIT as monotherapy or as part of combination AHT; Group 2 included 53 patients who received AML as monotherapy or as part of combination AHT. Correlation analysis between the parameters of DBPP and the MoCA test revealed a weak but statistically significant negative correlation between the total MoCA score and the average 24-h SBP (rs=-0.33, P=0.015). In addition, there was a weak but statistically significant negative correlation between the total MoCA score and the daytime SBP variability and daytime DBP variability (rs=-0.40 and rs=-0.35, respectively, P=0.000 in both cases). A weak but statistically significant negative correlation was found between the total Mini-Cog score and PWV and PPc (rs=-0.24, P=0.01 and rs=-0.27, P=0.007, respectively). Analysis of the office BP indicators showed high antihypertensive efficacy of 12-month therapy in both groups, regardless of the therapy regimens. A comparative analysis of the effect of AHT with the inclusion of NIT or AML on CF in AH patients showed the advantages of combined AHT with the inclusion of NIT. Amlodipine treatment did not significantly affect any test score. Thus, in Group 1, after 12 months of therapy, there was an increase in the total Mini-Cog score from 3.8±1.08 points to 4.55±0.75 points (P&lt;0.001), while in Group 2, there was a non-significant decrease in this score from 4.26±0.98 points to 3.92±0.95 points (P&gt;0.05). There was also an increase in the total MoCA score in Group 1 from 23.3±2.8 points to 25.08±2.6 points (P&lt;0.001), while in Group 2, there was a non-significant decrease in this score from 24.06±2.73 points to 23.07±2.7 points (P&gt;0.05). It should be noted that only in Group 1 did we find a significant improvement in CF, such as abstraction, delayed recall, memory, and attention, as well as a significant improvement in work-coping and decision-making. In Group 1, the HADS Depression score decreased from 4.6±3.7 points to 3.32±2.95 points (P&lt;0.05), HADS Anxiety score decreased from 7.01±5.37 points to 4.95±3.75 points (P&lt;0.02). At the same time, in Group 2, in contrast, the HADS Depression score and the HADS Anxiety score did not significantly change. Conclusion: A weak but statistically significant negative correlation was found between the total MoCA score and the daytime SBP/DBP variability in AH patients. A weak but statistically significant negative correlation was found between the total Mini-Cog score and pulse wave velocity and central pulse pressure. A pronounced antihypertensive efficacy of 12-month combination therapy was noted, with the inclusion of both NIT and AML. The NIT-based treatment contributed to a significant increase in the total Mini-Cog score and the total MoCA score and a substantial improvement in CF. Abstraction, delayed recall, memory, attention, work-coping, and decision-making significantly improved, compared to AML-based treatment. The presented data allow a differentiated approach to tactics for treating AH patients with severe cognitive impairment.

The Correlation Between Aldosterone and Leukocyte-Related Inflammation: A Comparison Between Patients with Primary Aldosteronism and Essential Hypertension.

Hypertension patients with primary aldosteronism (PA) have a higher risk of cardiovascular complications than blood pressure-matched essential hypertension (EH) patients. The cause may be closely related to inflammation. We explored the correlations between leukocyte-related inflammation parameters and plasma aldosterone concentration (PAC) in PA patients and clinical characteristics-matched EH patients. A total of 346 PA and 346 sex, age and 24-h blood pressure-matched EH patients at the 2nd Affiliated Hospital of Nanchang University from January 2020 to June 2021 were enrolled in this study. The differences and correlations of aldosterone and leukocyte parameters between the two groups were analyzed. Compared with EH patients, the lymphocyte count was significantly lower (P = 0.004), the neutrophil-lymphocyte ratio (NLR) (P = 0.023) and the monocyte-lymphocyte ratio (MLR) (P = 0.037) were significantly higher in PA patients. Linear regression analysis and multivariate regression analysis identified that lymphocyte count, NLR and MLR were significantly and independently correlated with PAC in PA patients, and the correlations were stronger with increasing levels of aldosterone. However, in EH patients, only NLR maintained an independent correlation with PAC. Leukocyte-related inflammation parameters, including lymphocyte count, NLR, and MLR, were significantly and independently correlated with PAC in PA patients. The correlations were stronger with increasing levels of aldosterone. However, the above correlations were not always present in patients with EH matched for clinical characteristics.

New Hypertension After Pregnancy in Patients With Heart Disease.

Background After pregnancy, patients with preexisting heart disease are at high risk for cardiovascular complications. The primary objective was to compare the incidence of new hypertension after pregnancy in patients with and without heart disease. Methods and Results This was a retrospective matched-cohort study comparing the incidence of new hypertension after pregnancy in 832 patients who are pregnant with congenital or acquired heart disease to a comparison group of 1664 patients who are pregnant without heart disease; matching was by demographics and baseline risk for hypertension at the time of the index pregnancy. We also examined whether new hypertension was associated with subsequent death or cardiovascular events. The 20-year cumulative incidence of hypertension was 24% in patients with heart disease, compared with 14% in patients without heart disease (hazard ratio [HR], 1.81 [95% CI, 1.44-2.27]). The median follow-up time at hypertension diagnosis in the heart disease group was 8.1 years (interquartile range, 4.2-11.9 years). The elevated rate of new hypertension was observed not only in patients with ischemic heart disease, but also in those with left-sided valve disease, cardiomyopathy, and congenital heart disease. Pregnancy risk prediction methods can further stratify risk of new hypertension. New hypertension was associated with an increased rate of subsequent death or cardiovascular events (HR, 1.54 [95% CI, 1.05-2.25]). Conclusions Patients with heart disease are at higher risk for developing hypertension in the decades after pregnancy when compared with those without heart disease. New hypertension in this young cohort is associated with adverse cardiovascular events highlighting the importance of systematic and lifelong surveillance.

Inpatient epidemiology, healthcare utilization, and association with comorbidities of Turner syndrome: A National Inpatient Sample study.

We aimed to investigate the prevalence, resource utilization, and comorbidities of patients with Turner syndrome (TS) hospitalized in the United States. We identified patients within the Nationwide Inpatient Sample database from the year 2017 to 2019. A propensity-matched cohort of non-TS patients from the same database was constructed to serve as comparators. There were 9845 TS patients, corresponding to inpatient prevalence of 10.4 per 100,000 admissions. The most common admission diagnosis was sepsis (27.9%). TS patients had higher inpatient mortality (adjusted odds ratio 2.16, 95% confidence interval 1.57-2.96) and morbidity, including shock, ICU admission, acute kidney injury, systemic inflammatory response syndrome, acute respiratory distress syndrome, and multi-organ failure. Increased risk of comorbidities, such as stroke, myocardial infarction, autoimmune diseases, and non-variceal gastrointestinal bleeding, was observed. TS patients had longer length of stay (LOS; 5.1 days vs. 4.5 days, p < 0.01) and displayed a mean additional $5382 (p < 0.01) in total hospital costs and a mean additional $20,083 (p < 0.01) in total hospitalization charges. In conclusion, hospitalization of patients with TS was associated with a significantly higher inpatient morbidity, mortality, expenditures, and longer LOS compared to non-TS patients. Patients with TS had a higher risk of cardiovascular complications, autoimmune diseases, and gastrointestinal bleeding.

Низкая приверженность терапии и пути ее преодоления на примере антиагрегантной терапии

The article is focused on the issues of poor patient adherence to medication treatments, including antiplatelet drugs, its reasons, and solutions for overcoming compliance barriers. As of today, treatment adherence remains low leading to a higher risk of cardiovascular complications. Poor adherence to acetylsalicylic acid (ASA) treatment is mainly linked to a relatively frequent development of gastrointestinal side effects. The solutions for overcoming this problem include the use of lowest effective doses and the development of different acetylsalicylic acid (ASA) formulations: enteric coated and buffered. The efficacy and safety of these formulations are compared in the article. Buffered formulation (e.g. ASA + magnesium hydroxide) is similar to plain ASA as regards its antiplatelet activity and the prevalence of "aspirin- resistance", while its intake is associated with a lower risk of enteropathy and gastropathy as compared to plain and even enteric coated ASA. This is particularly important for patients with obesity and diabetes mellitus, as these conditions are associated with an affected rate of absorption from the small intestine. Based on the study findings a conclusion is made that buffered ASA should be the preferred formulation for use. The literature review is illustrated by a clinical case. KEYWORDS: chronic ischemic heart diseases, secondary prevention, adherence to therapy, acetylsalicylic acid, antiaggregant therapy, acetylsalicylic acid buffered and enteric coated formulations, aspirin-resistance. FOR CITATION: Ageev F.T., Smirnova M.D., Fofanova T.V. Poor patient adherence to medication treatments and solutions for overcoming compliance barriers as illustrated by antiplatelet therapy. Russian Medical Inquiry. 2023;7(1):56–61 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-1-56-61.

PS-P16-5: ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) RISK STRATIFICATION OF HYPERTENSIVE ADULTS AT A TERTIARY HOSPITAL

Background: Most hypertensive patients have cardiometabolic risk factors, which raises the likelihood of developing atherosclerotic cardiovascular events. As a result, international professional societies have recommended the use of ASCVD risk assessment in the diagnosis and treatment of hypertension. However implementation of this recommendation remains a challenge in local practice. Objective: To determine the atherosclerotic cardiovascular risk stratification of adult patients with hypertension using a Cardiovascular Specialty Organization's Risk Factor Counting method at a tertiary hospital Outpatient Department Methodology: The research study employed a descriptive, cross-sectional study design of 122 hypertensive adults between November 2020 to October 2021. Data gathered were a clinicodemographic profile, family history, smoking status, body mass index, and diagnostic tests including 12 lead electrocardiogram, urinalysis, lipid profile, and fasting blood sugar or Hba1c. Statistical analysis was done using the SPSS version 26. Results: The majority of the 122 enrolled patients were aged 51 to 60 (37.7%) and 61 to 70 years old (23.0%) Results revealed that the majority of hypertensive adults in a tertiary hospital were high risk at 79.51% and 20.49% were low to intermediate risk. There was a significant difference in the risk classification distribution of patients based on their age, diabetes, dyslipidemia, BMI, and microalbuminuria or proteinuria. Diabetic and dyslipidemic patients were 35.6 and 5.52 times more likely, to be ASCVD high risk respectively. Obese I and Obese II were 6.96 and 5.24 times more likely to be at a high risk of ASCVD as well. Conclusions: In conclusion, the majority of hypertensive adults were at high risk for cardiovascular complications. Among the risk factors studied, diabetes, dyslipidemia, and body mass index, when compared to other risk variables, were significantly associated with high ASCVD risk.

Features of the metabolism of polyunsaturated fatty acids in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a widespread disease with a high risk of cardiovascular complications, disability and mortality. The progression of T2DM is closely related to lipid metabolism disorders, caused both by insufficient intake of polyunsaturated fatty acids (PUFAs), and by a violation of their endogenous metabolism. Desaturase enzymes, FADS1/2, are involved in the regulation of PUFA metabolism. Violation of the functioning of FADS1/2 and their genes leads to a change in the biosynthesis of PUFAs and the fatty acid composition of cell membranes. The purpose of this research was to summarize the data of modern literature on the metabolism of PUFAs and the effect of FADS genetic variants on the fatty acid composition of cell membranes in T2DM. Material and methods. The search and analysis of publications was carried out using the PubMed, MEDLINE, Web of Science databases, mainly for the last 10 years, using the search keywords: polyunsaturated fatty acids, fatty acid desaturases, desaturase genes, type 2 diabetes mellitus. Results. In the pathogenesis of T2DM and its complications, many factors play a role, including impaired PUFA metabolism. A large evidence base has been accumulated on the effect of PUFAs on cardiometabolic risk factors in T2DM. The effect of desaturase activity on the fatty acid composition of cells was identified as the most important link in the metabolism of PUFAs. Focusing on the modulation of desaturase activity and studying the polymorphism of fatty acid desaturase genes may be a useful therapeutic option in the treatment of patients with T2DM and its complications. Conclusion. A promising direction of scientific research in the treatment and prevention of T2DM and its complications is the study of genetic mechanisms associated with the metabolism of PUFAs and their metabolites.

Семейная гиперхолестеринемия в педиатрической практике

Familial hypercholesterolemia (FH) is a hereditary disease characterized by elevated levels of low-density lipoproteins, early onset and progressive course of atherosclerosis (usually at a young age), and high risk of cardiovascular complications. Detection of mutations in family members enables the diagnosis of FH. However, approximately 20% of FH patients are tested negative for the FH-associated mutations. This results in a delayed diagnosis and late therapy initiation, especially in children. Therefore, raising awareness about FH both among healthcare professionals and in the society is very important. Key words: children, lipid-lowering therapy, familial hypercholesterolemia, screening, registry