High Burden Of Cardiovascular Disease Research Articles

Gaps in Guideline-Recommended Assessment and Management in Primary Health Care for Aboriginal and Torres Strait Islander Women

Aboriginal and Torres Strait Islander women experience a high and disparate burden of cardiovascular disease. Accessible and effective assessment and management in primary health care is essential to reducing inequality. This study sought to explore the extent to which the receipt of guideline-based assessment and management is influenced by gender.

Glomerular filtration function decline, mortality, and cardiovascular events: data from the Strong Heart Study.

Rapid kidney decline is associated with mortality and cardiovascular disease, even in the absence of chronic kidney disease. American Indians (AI) have particularly high burden of kidney disease, cardiovascular disease, and stroke. This study aims to examine extreme loss in glomerular function in this population in association with clinical outcomes. The Strong Heart Study, a large longitudinal cohort of adult AI participants, collected plasma creatinine at 3 examination visits between 1989-1999. Intraindividual regressions of estimated glomerular filtration rate (eGFR) provided linear estimates of change in kidney function over this time period. Surveillance with physician adjudication identified mortality and cardiovascular events between visit 3 through 2017. Mean change in eGFR was loss 6.8 mL/min over the ten year baseline (range: -66.0 to +28.9 mL/min). The top 1 percentile lost approximately 5.7 mL/min/year. Participants with extreme eGFR loss were more likely to have diabetes (95% vs 71%), hypertension (49% vs 33%), or longer smoking history, among smokers (19 pack years vs 17 pack years). CKD (eGFR<60 mL/min) was associated only with mortality, independent of slope: HR 1.1 (95% CI 1.0-1.3). However, extreme loss in eGFR (>20 mL/min over baseline period) was associated with mortality, independent of baseline eGFR: HR 3.5 (95% CI 2.7-4.4), and also independently associated with composite CVD events and CHF: HR 1.4 and 1.7 (95% CI 1.1-1.9 and 1.2-2.6), respectively. This is the first examination of decline in eGFR in association with mortality and CVD among AIs. The implications of these findings are broad: clinical evaluation may benefit from evaluating change in eGFR over time in addition to dichotomous eGFR. Also, these findings suggest there may be aspects of renal function that are not well-marked by clinical CKD, but which may have particular relevance to long-term renal and vascular health.

Outcomes of outofhospital cardiac arrest in First Nations and non-First Nations patients in Saskatoon.

One in nine (11.7%) people in Saskatchewan identify as First Nations. It is known that First Nations people have a higher burden of cardiovascular disease, but not whether outcomes of out of hospital cardiac arrest are different. We reviewed pre-hospital and inpatient records of patients with outofhospital cardiac arrest between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18years or older with outofhospital cardiac arrest of presumed cardiac origin occurring in the catchment area of Saskatoon's emergency medical services (EMS). Variables of interest included age, gender, First Nations status, EMS response times, bystander cardiopulmonary resuscitation (CPR), and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. In all, 372 patients sustained out of hospital cardiac arrest, of which 27 were status First Nations. There were no differences between First Nations and non-First Nations patients in terms of shockable rhythms (24% vs 26%; p = 0.80), ROSC (42% vs 41%; p = 0.87), survival to hospital admission (27% vs 33%; p = 0.53), and survival to hospital discharge (15% vs 12%; p = 0.54). First Nations patients with out of hospital cardiac arrest were significantly younger (mean age 46 vs. 65years; p < 0.0001) and had shorter EMS response times (median times 5.3 vs. 6.2min; p = 0.01) when compared to non-First Nations patients. In Saskatoon, First Nations patients with out of hospital cardiac arrest appear to have similar survival rates when compared with non-First Nations patients. However, First Nations patients sustaining out of hospital cardiac arrest were significantly younger than their non-First Nations counterparts. This highlights a significant public health issue.

Early Detection of Cardiovascular Disease in Patients with Chronic Kidney Disease using Data Mining Techniques

&nbsp;A constant obstacle for doctors is the high prevalence of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Increasing efforts have been made to jointly treat patients with heart and kidney disease, as shown by an increasing number of basic research and clinical investigations concerning CVD in CKD. Typical risk factors for CVD are common in CKD, such as age, blood pressure (bp), hypertension (htn), and blood sugar (sg). Standard risk factors tend to be the major contributors to CVD in patients with mild to moderate CKD. However, in patients with advanced CKD, non-traditional CKD-specific risk factors (e.g. Potassium level in blood) are more prevalent than in the general population, contributing, in addition to traditional risk factors, to the high burden of CVD in CKD. However, in patients with CKD, CVD often remains underdiagnosed and undertreated. Nevertheless, CVD still remains under control and care in patients with CKD. Researchers in this paper aims to predict the probability of CVD from CKD by using various popular data mining techniques and definitively propose a decision tree and by using Random Forest analysis to test its specificity and sensitivity to achieve concrete results with sufficient precision.

An overview of patients with urothelial bladder cancer over the past two decades: a Surveillance, Epidemiology, and End Results (SEER) study.

BackgroundTo explore the overall trends of incidence rate (IR), mortality and survival outcomes of patients with urothelial bladder cancer (UBC) over the past two decades.MethodsPatients diagnosed with UBC from 1993 to 2012 were extracted from the Surveillance, Epidemiology and End Result (SEER) 18 database. Baseline characteristics and treatment types of included patients were collected retrospectively. Moreover, the age-adjusted IRs and annual percent changes (APCs) were obtained. Afterwards, we calculated the standardized mortality ratios (SMRs) for bladder cancer (BC), cardiovascular disease (CVD) and all-cause mortality by comparing UBC cases with the general population. Finally, survival outcomes of UBC patients were analyzed and compared.ResultsA total of 220,405 UBC patients were identified, including 167,036 (75.79%) male patients and 53,369 (24.21%) female patients, with an average age of 70.84 years old. Most patients were White (89.85%), with older age (71.67%, >65 years old), lower T stage diseases (78.11%, < T2) and lower median household income (55.37%). When compared with patients diagnosed between 1993 and 2002, those diagnosed between 2003 and 2012 had older age (mean: 71.15 vs. 70.16 years old, P<0.001), higher proportion of men (76.22% vs. 74.83%, P<0.001) and lower median household income (56.69% vs. 52.50%, P<0.01). Overall, the IR of UBC increased slightly before 2003 and maintained a stable trend of about 20 per 100,000 person-years after 2003. Additionally, CVD was recognized as an important cause of death (COD) of UBC patients. UBC patients were 44.5 times more likely to die of CVD when compared with the general population. Furthermore, the 3-, 5- and 10-year overall survival (OS) and cancer-specific survival (CSS) rates were 0.709, 0.609 and 0.421, and 0.861, 0.831 and 0.789, respectively. Finally, survival outcomes between patients diagnosed in the two periods (1993–2002 vs. 2003–2012) were not significantly different.ConclusionsThe IR of UBC increased slightly before 2003 and remained stable after 2003. UBC patients had higher CVD burden than the general population. Hence, cardiovascular health should be emphasized to reduce mortality after UBC diagnosis. Lastly, survival outcomes of UBC patients in the last two decades showed no significant difference.

Abstract 14833: The Association Between Cardiovascular Disease Knowledge and Risk Factors Among African American Breast Cancer Survivors in the Deep South

Introduction: African American breast cancer survivors in the Deep South have a disproportionately high burden of cardiovascular disease (CVD) mortality. This is due, in large part, to multiple potentially modifiable CVD risk factors that are disproportionately high in this group, such as high blood pressure, obesity, and poor dietary habits. The purpose of this study was to assess the association between CVD risk factors and heart disease knowledge among African American breast cancer survivors in the Deep South. Hypothesis: We hypothesize that the key CVD risk factors (smoking, BMI, physical activity, healthy diet, total cholesterol, blood pressure, and blood sugar) will be positively associated with heart disease knowledge score. Methods: The Heart Disease Knowledge Questionnaire was used to assess the participants’ knowledge of heart disease and heart disease risk factors. Questions from My Life Check were used to assess the participants CVD risk factors. Multivariate regression analyses were performed to determine which CVD risk factors and demographic characteristics can predict the participants’ heart disease knowledge score. Results: Seventy African American breast cancer survivors living in the Deep South enrolled in the study. A research team member administered the questionnaires over the phone. The mean age of the participants was 56.76 years (± 10.36) and 42.9% had a college degree or higher level of education. Results of a multivariate regression analysis showed that the number of healthy diet score components was the only cardiovascular health metric that was statistically significantly associated with heart disease knowledge score (p = .01). Education level was the only demographic characteristic that was statistically significantly associated with heart disease knowledge score (p = .004). Conclusions: Our results indicate that women with more knowledge of heart disease and higher levels of education are more likely to have better cardiovascular health metrics. Our findings underscore the need to disseminate and implement health education interventions aimed at increasing knowledge of modifiable CVD risk factors that are targeted towards African American breast cancer survivors in the Deep South.

Abstract 12957: Delay in Qrs Interval Predicts Risk of Heart Failure and In-hospital Mortality in Patients Admitted With Atrial Fibrillation With Rapid Ventricular Response

Introduction: Atrial fibrillation is associated with increased risk of heart failure and mortality. The association of QRS duration (QRSd) with morbidity and mortality is understudied in patient with atrial fibrillation (AF) Hypothesis: We sought to investigate the association of prolonged QRSd (≥120 ms) and risk of heart failure and in-hospital death in patients admitted for AF with rapid ventricular response (RVR) Methods: A retrospective study in a community hospital using EPIC database analyzed 1637 patients from 2013-2018 with admission codes of AF with RVR. The cohort was then stratified based on QRSd ≥120ms vs &lt;120ms. A p-value of &lt;0.05 was considered significant Results: Among the 1637 patients who were admitted with AF with RVR, 233 (14%) had QRS ≥120ms. Patient’s characteristics with QRSd≥120 compared to those with QRSd&lt;120ms were mean age [75.9 (11.8) vs 70.9 (13.6), (P&lt;.0001)], history of CAD [41% vs 28%, odds ratio (OR)= 1.78, 95% confidence interval (CI): 1.3-2.3 (P&lt;.0001)], history of PVD [15% vs 7%, OR=2.38, 95% CI: 1.58-3.59 (P&lt;.0001)], history of acute MI [50% vs 33%, OR=1.99, 95% CI:1.5-2.6 (P&lt;.0001)] and CHA2DS2Vasc score [median (IQR) 5(3, 6) vs 4(3, 5) (P&lt;0.001). QRSd≥120ms was associated with higher BNP value [median (IQR) 537(305, 862) vs 371(186, 655) (P&lt;0.001)] and an increased risk of heart failure [(70% vs 55%, OR=1.93, 95% CI:1.43-2.6 (P&lt;.0001)]. Additionally, higher in-hospital mortality rate was observed in patients with QRSd≥120ms [4.3% vs 1.3%, OR=3.11, 95% CI:1.44-6.75 (P=0.006)] Conclusions: In patients who were admitted with AF with RVR, QRSd≥120ms was associated with a higher burden of cardiovascular disease, CHA2DS2Vasc score and an increased risk of heart failure resulting in worse clinical outcomes. Higher median BNP values suggest that worsening heart failure contributed to higher in-hospital mortality. Heart failure associated mortality could be alleviated with medical management or cardiac resynchronization therapy.

Gender differences in rates of percutaneous coronary intervention, cardiac surgery and valvular disease in indigenous Australians with suspected acute coronary events

Abstract Background Indigenous populations globally have a higher burden of cardiovascular disease and increased mortality after acute coronary events, partly due to inequitable access to specialised care like cardiac catheterisation. Gender differences in revascularisation rates have been well described in non-Indigenous patients. Whether this applies to Indigenous patients when cardiac catheterisation facilities are readily available is unclear. Purpose We compared the rates of percutaneous coronary intervention (PCI), cardiac surgery, 30-day and long-term all-cause mortality in Indigenous (Aboriginal and Torres Strait Islanders) patients in Far North Queensland (FNQ) – a region with a large Indigenous population and 24/7 cardiac catheterisation facilities. Method All patients who presented to the tertiary referral center for FNQ, for their first inpatient angiogram between November 2012 and October 2019 were identified. The primary study outcomes were rates of PCI or cardiac surgery and all-cause mortality measured at 30 days and long term. Secondary study outcomes were significant left ventricular dysfunction (ejection fraction &amp;lt;50%) and valvular disease (moderate to severe) in patients who had an echocardiogram. Other differences in baseline characteristics, including age, gender, body mass index, postcode and indication for angiography were accounted for using logistic and cox regression analysis. Results 1042 patients (mean age 53.7±11.6 years, 45.5% female, median follow-up 1092 days) self-identified as Indigenous. Indigenous women were older 54.8±11.4 vs 52.8±11.7 years, p=0.005 and had different angiography indications. For Indigenous women and men respectively, rates of ST elevation myocardial infarction (STEMI) were 14.6% vs 22.9%, non-STEMI 44.3% vs 46.8%, angina 32.7% vs 21.0%, cardiac arrest 2.7% vs 3.3% and other 5.7% vs 6.0%, p&amp;lt;0.001. Indigenous women had significantly lower rates of PCI or cardiac surgery, 40.5% vs 60.7%, p&amp;lt;0.001, but similar 30-day mortality, 1.5% vs 2.3% p=0.34 and long-term all-cause mortality rates 11.2% vs 10.9%, p=0.89, in unadjusted data. 685 patients (mean age 53.8±11.5 years, 45.5% female) were included in the echocardiogram subgroup. Indigenous women had significantly more valvular disease, 23.3% vs 16.3%, p=0.022 but similar rates of left ventricular dysfunction, 30.2% vs 35.8%, p=0.12. Following adjustment for other baseline characteristics female gender independently predicted lower rates of PCI or cardiac surgery, OR 0.49 (95% CI 0.38–0.64) and higher rates of valvular disease, OR 1.60 (95% CI 1.07–2.39). Rates of ventricular dysfunction, 30-day and long-term all-cause mortality were similar. Conclusions Indigenous women had significantly different indications for angiography, lower rates of PCI or cardiac surgery and higher rates of clinically significant valvular disease despite presenting in gender ratios similar to the general population in FNQ. Funding Acknowledgement Type of funding source: None

Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis.

BackgroundHigh rate of cardiovascular disease (CVD) have been reported among patients with novel coronavirus disease (COVID-19). Meanwhile there were controversies among different studies about CVD burden in COVID-19 patients. Hence, we aimed to study CVD burden among COVID-19 patients, using a systematic review and meta-analysis.MethodsWe have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar. Meta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs. We have also performed a descriptive meta-analysis on different CVDs.ResultsFifty-six studies entered into meta-analysis for ICU admission and mortality outcome and 198 papers for descriptive outcomes, including 159,698 COVID-19 patients. Results of meta-analysis indicated that acute cardiac injury, (OR: 13.29, 95% CI 7.35-24.03), hypertension (OR: 2.60, 95% CI 2.11-3.19), heart Failure (OR: 6.72, 95% CI 3.34-13.52), arrhythmia (OR: 2.75, 95% CI 1.43-5.25), coronary artery disease (OR: 3.78, 95% CI 2.42-5.90), and cardiovascular disease (OR: 2.61, 95% CI 1.89-3.62) were significantly associated with mortality. Arrhythmia (OR: 7.03, 95% CI 2.79-17.69), acute cardiac injury (OR: 15.58, 95% CI 5.15-47.12), coronary heart disease (OR: 2.61, 95% CI 1.09-6.26), cardiovascular disease (OR: 3.11, 95% CI 1.59-6.09), and hypertension (OR: 1.95, 95% CI 1.41-2.68) were also significantly associated with ICU admission in COVID-19 patients.ConclusionFindings of this study revealed a high burden of CVDs among COVID-19 patients, which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.

Comparison of clinical features and outcomes in peritoneal dialysis-associated peritonitis patients with and without diabetes: A multicenter retrospective cohort study.

BACKGROUNDThe number of end-stage renal disease patients with diabetes mellitus (DM) who are undergoing peritoneal dialysis is increasing. Peritoneal dialysis-associated peritonitis (PDAP) is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis. The profile of clinical symptoms, distribution of pathogenic organisms, and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously. Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM. We inferred that DM is associated with bad outcomes in PDAP patients.AIMTo compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODSIn this multicenter retrospective cohort study, we enrolled patients who had at least one episode of PDAP during the study period. The patients were followed for a median of 31.1 mo. They were divided into a DM group and a non-DM group. Clinical features, therapeutic outcomes, and long-term prognostic outcomes were compared between the two groups. Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression. A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTSOverall, 373 episodes occurred in the DM group (n = 214) and 692 episodes occurred in the non-DM group (n = 395). The rates of abdominal pain and fever were similar in the two groups (P > 0.05). The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli (E. coli) as compared to the non-DM group (P < 0.05). Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure, catheter removal, PDAP-related death, or relapse of PDAP (P > 0.05). Patients in the DM group were older and had a higher burden of cardiovascular disease, with lower level of serum albumin, but a higher estimated glomerular filtration rate (P < 0.05). Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality (hazard ratio = 1.531, 95% confidence interval: 1.091-2.148, P < 0.05), but did not predict the occurrence of technical failure (P > 0.05).CONCLUSIONPDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E. coli infection compared those without. Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.

Undiagnosed Hypertension and Associated Factors Among Adults in Hawela Tula Sub-City, Hawassa, Southern Ethiopia: A Community-Based Cross-Sectional Study.

BackgroundHypertension (HTN) is a major public health problem and often it is unnoticed. Undiagnosed HTN may lead to a high burden of cardiovascular diseases and complications such as stroke and heart attack. In this study, we aimed to assess the prevalence and associated factors of undiagnosed HTN.MethodsFrom February to June 2019, a community-based cross-sectional study was conducted on 383 randomly selected adults in Hawela Tulla Sub-city, Hawassa, southern Ethiopia. Data were collected by pretested questionnaires, and physical measurements of weight, height and blood pressure were collected through standardized procedures adapted from WHO STEPS survey tools. Data entry and analysis were carried out using SPSS version 23 statistical software. Descriptive analysis and logistic regression models were used to describe the results. Logistic regression analysis results were declared statistically significant if the P-value was below 0.05 and the 95% CI did not cross the null value.ResultsThe prevalence of undiagnosed HTN among the respondents was 12.3%. Only 152 (39.7%) of the study population knew the symptoms of HTN. Males (adjusted odds ratio [AOR] =2.5, 95% CI: 1.2, 5.2; P=0.016), people with a family history of HTN (AOR=2.7, 95% CI: 1.0, 7.0; P= 0.044), people who chewed khat (AOR=4.6, 95% CI: 2.0, 10.2; P<0.001), overweight or obese individuals (AOR=3.5, 95% CI: 1.7, 7.3; P=0.001) and people with diabetes mellitus (AOR=3.2, 95% CI: 1.1, 9.3; P=0.036) had a higher risk of undiagnosed HTN than their counterparts.ConclusionIdentification of people with the risk factors of undiagnosed HTN and delivering health education to reduce the risky behaviors could reduce the burden and consequences of HTN. Integrating interventions at the community level may be important.

Predictors of Olfactory Decline in Aging: A Longitudinal Population-Based Study.

BackgroundOlfactory dysfunction is common in aging and associated with dementia and mortality. However, longitudinal studies tracking change in olfactory ability are scarce. We sought to identify predictors of interindividual differences in rate of olfactory identification change in aging.MethodParticipants were 1780 individuals, without dementia at baseline and with at least 2 olfactory assessments over 12 years of follow-up (mean age = 70.5 years; 61.9% female), from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Odor identification was assessed with the Sniffin’ Sticks. We estimated the impact of demographic, health, and genetic factors on rate of olfactory change with linear mixed effect models.ResultsAdvancing age, manufacturing profession, history of cerebrovascular disease, higher cardiovascular disease burden, diabetes, slower walking speed, higher number of medications, and the APOE ε4 allele were associated with accelerated odor identification decline (ps < .014). Multi-adjusted analyses showed unique associations of age, diabetes, and ε4 to olfactory decline (ps < .017). In 1531 participants who remained free of dementia (DSM IV criteria) during follow-up, age, cardiovascular disease burden, and diabetes were associated with accelerated decline (ps < .011). Of these, age and diabetes remained statistically significant in the multi-adjusted model (ps < .001).ConclusionDemographic, vascular, and genetic factors are linked to rate of decline in odor identification in aging. Although some olfactory loss may be an inevitable part of aging, our results highlight the importance of vascular factors for the integrity of the olfactory system, even in the absence of dementia.

Cardiac Injury Patterns and Inpatient Outcomes Among Patients Admitted With COVID-19

Although certain risk factors have been associated with increased morbidity and mortality in patients admitted with Coronavirus Disease 2019 (COVID-19), the impact of cardiac injury and high-sensitivity troponin-I (hs-cTnI) concentrations are not well described. In this large retrospective longitudinal cohort study, we analyzed the cases of 1,044 consecutively admitted patients with COVID-19 from March 9 until April 15. Cardiac injury was defined by hs-cTnI concentration >99th percentile. Patient characteristics, laboratory data, and outcomes were described in patients with cardiac injury and different hs-cTnI cut-offs. The primary outcome was mortality, and the secondary outcomes were length of stay, need for intensive care unit care or mechanical ventilation, and their different composites. The final analyzed cohort included 1,020 patients. The median age was 63 years, 511 (50% patients were female, and 403 (40% were white. 390 (38%) patients had cardiac injury on presentation. These patients were older (median age 70 years), had a higher cardiovascular disease burden, in addition to higher serum concentrations of inflammatory markers. They also exhibited an increased risk for our primary and secondary outcomes, with the risk increasing with higher hs-cTnI concentrations. Peak hs-cTnI concentrations continued to be significantly associated with mortality after a multivariate regression controlling for comorbid conditions, inflammatory markers, acute kidney injury, and acute respiratory distress syndrome. Within the same multivariate regression model, presenting hs-cTnI concentrations were not significantly associated with outcomes, and undetectable hs-cTnI concentrations on presentation did not completely rule out the risk for mechanical ventilation or death. In conclusion, cardiac injury was common in patients admitted with COVID-19. The extent of cardiac injury and peak hs-cTnI concentrations were associated with worse outcomes.

Can vasohibin-1, an endothelium-derived angiogenesis inhibitor, be a marker of endothelial dysfunction in hemodialysis patients?

Endothelial dysfunction (ED) is associated with high cardiovascular disease burden in hemodialysis (HD) patients. Vasohibin-1, an endothelium-derived angiogenesis inhibitor, is essential for endothelial cell survival, therefore it may be a promising marker of ED. We aimed to investigate whether vasohibin-1 levels are associated with ED markers in HD patients. Fifty HD patients and 30 healthy controls were included in the study. As markers of ED, endothelium-dependent flow-mediated dilatation (FMD), carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) were examined. Serum vasohibin-1 levels were measured with ELISA. Serum vasohibin-1 levels were low (387.7±115.7 vs 450.1±140.1 P=.02), FMDs' were impaired (6.65±2.50 vs 10.95±2.86 P<.001), PWV (7.92±1.964 vs 6.79±0.96 P=.01) and CIMT (0.95±0.20 vs 0.60±0.11 P<.001) were increased in HD patients compared to healthy controls. In regression analysis, vasohibin-1 levels were not related with FMD, PWV, or CIMT. Hemodialysis patients have low serum vasohibin-1 levels but serum levels of vasohibin-1 did not show any significant relationship with FMD, PWV, and CIMT in HD patients. Since vasohibin-1 acts via paracrine pathways, serum levels may be insufficient to explain the relationship between vasohibin and ED. Local vasohibin-1 activity on tissue level may be more important instead of circulating levels.

Nurses\u2019 perceptions on implementing a task-shifting/sharing strategy for hypertension management in patients with HIV in Nigeria: a group concept mapping study

BackgroundPeople living with HIV (PWH) in Africa have higher burden of cardiovascular diseases (CVD) compared to the general population, probably due to increased burden of hypertension (HTN). In this study, we explored nurses’ perceptions of factors that may influence the integration of an evidence-based task-shifting/sharing strategy for hypertension control (TASSH) into routine HIV care in Lagos, Nigeria.MethodsUsing group concept mapping, we examined the perceptions of 22 nurses from HIV clinics in Lagos. Participants responded to a focused prompt on the barriers and facilitators of integrating TASSH into HIV care; next, separate focus groups generated relevant statements on these factors; and statements were then sorted and rated on their importance and feasibility of adoption to create cluster maps of related themes. The statements and cluster maps were categorized according to the Consolidated Framework for Implementation Research (CFIR) domains.ResultsAll study participants were women and with 2 to 16 years’ experience in the provision of HIV care. From the GCM activities, 81 statements were generated and grouped into 12 themes. The most salient statements reflected the need for ongoing training of HIV nurses in HTN management and challenges in adapting TASSH in HIV clinics. A synthesis of the cluster themes using CFIR showed that most clusters reflected intervention characteristics and inner setting domains. The potential challenges to implementing TASSH included limited hypertension knowledge among HIV nurses and the need for on-going supervision on implementing task-shifting/sharing.ConclusionsFindings from this study illustrate a variety of opinions regarding the integration of HTN management into HIV care in Nigeria. More importantly, it provides critical, evidence-based support in response to the call to action raised by the 2018 International AIDS Society Conference regarding the need to implement more NCD-HIV integration interventions in low-and middle-income countries through strategies, which enhance human resources. This study provides insight into factors that can facilitate stakeholder engagement in utilizing study results and prioritizing next steps for TASSH integration within HIV care in Nigeria.

The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation that, if left untreated, can cause joint destruction and physical impairments. The inflammatory process is systematic, and it is associated with increased morbidity and mortality. Over the last years, mortality presents a decreasing trend; still, there is a high burden of cardiovascular disease (CVD) in RA that seems to be related to coronary atherosclerosis. Chronic inflammation, physical inactivity, and drugs used to treat RA are some of the reasons. Thus, the management of CVD risk is essential and involves the patient's stratification using distinct parameters that include assessment of the blood lipid profile. However, 'dyslipidemia' in RA patients follows a different pattern under the impact of inflammatory processes, while therapies that target the underlying disease change the levels of specific lipid components. In this review, we explore the relationship between blood lipids and inflammation in the so-called ΄lipid paradox΄ in RA, and we present the existing knowledge over the influence of antirheumatic drugs on the lipid profile of RA patients.

P1623MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) AFTER KIDNEY TRANSPLANTATION: A POPULATION-COHORT ANALYSIS OF ENGLISH TRANSPLANT CENTRES

Abstract Background and Aims Due to a high burden of cardiovascular disease in end-stage kidney failure, candidates for kidney transplantation must undergo cardiac screening to determine their ‘cardiac fitness’ to proceed with surgery even when asymptomatic and in the absence of robust evidence. MACE rates within the first year after kidney transplantation in North American centres are reported at between 7.0% and 8.7% but data from an European cohort is lacking. Therefore, the aim of this population-cohort analysis was to determine the MACE rate within the first year after kidney transplantation for all kidney transplant recipients in England. Method We obtained data from every kidney transplant procedure performed in England between 1st April 2002 and 31st March 2018. Data was extracted from Hospital Episode Statistics using administrative ICD-10 and OPCS-4 codes, with linkage to the national death registry for mortality data (including causality). We excluded age ≤18, repeat transplant in same period, multi-organ transplant and residence outside England. MACE was defined as any hospital admissions with myocardial infarction, stroke, unstable angina, heart failure, any coronary revascularisation procedure and/or any cardiovascular-related death. Univariable and multivariable logistical regression analyses were conducted to investigate the odds for MACE after kidney transplantation. Results After exclusions, we had a cohort of 30,325 kidney transplant recipients for analysis. MACE events occurred in 781 kidney transplant recipients within the first-year post-transplantation (2.6% of all kidney transplant procedures). Of these 781 MACE events, 201 occurred during the index admission for kidney transplantation surgery (representing 25.7% of all first-year MACE events and 0.7% of all kidney transplant procedures). Predictors of long-term mortality on Cox regression include; age, non-White ethnicity, socio-economic deprivation, deceased donor, pre-existing diabetes, increased Charlson score, previous cardiac history and MACE within the first year (HR 2.59; 95% CI 2.34-2.88, p&amp;lt;0.001). Kidney transplant recipients who suffered a non-fatal MACE within the first year had 1-, 3-, 5- and 10-year patient survival of 80.5%, 70.2%, 54.5% and 38.6%, compared to 97.4%, 94.4%, 90.7% and 78.4% for kidney transplant recipients not developing MACE within the first year post-transplant (p&amp;lt;0.001). Kidney transplant recipients having MACE events during the index admission compared to subsequent admissions were differentiated by age, sex and previous cardiac history but had similar patient survival (p=0.283). Conclusion MACE events within the first year after kidney transplantation are associated with increased mortality risk in England but MACE rates are significantly lower at 2.6% than those reported in North America. This is despite similar cardiac screening strategies, which may reflect different patient demographics and kidney failure care. In the context of the increased debate concerning the utility of cardiac screening asymptomatic kidney transplant candidates, understanding baseline MACE rates can shape the design of clinical trials exploring non-inferiority of cardiac screening versus non-screening before joining the waiting list (which differs methodologically from the CARSK study). However, renal physicians and surgeons will need to determine the upper boundary of the 95% confidence interval for the hazard ratio of MACE risk in any future clinical trial.

Cardiac Rehabilitation in India: Results from the International Council of Cardiovascular Prevention and Rehabilitation's Global Audit of Cardiac Rehabilitation.

Background:Cardiac rehabilitation (CR) is recommended in clinical practice guidelines for comprehensive secondary prevention. While India has a high burden of cardiovascular diseases (CVD), availability and nature of services delivered there is unknown. In this study, we undertook secondary analysis of the Indian data from the global CR audit and survey, conducted by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR).Methods:In this cross-sectional study, an online survey was administered to CR programs, identified in India by CR champions and through snowball sampling. CR density was computed using Global Burden of Disease study ischemic heart disease (IHD) incidence estimates.Results:Twenty-three centres were identified, of which 18 (78.3%) responded, from 3 southern states. There was only one spot for every 360 IHD patients/year, with 3,304,474 more CR spaces needed each year. Most programs accepted guideline-indicated patients, and most of these patients paid out-of-pocket for services. Programs were delivered by a multidisciplinary team, including physicians, physiotherapists, among others. Programs were very comprehensive. Apart from exercise training, which was offered across all centers, some centers also offered yoga therapy. Top barriers to delivery were lack of patient referral and financial resources.Conclusions:Of all countries in ICCPR’s global audit, the greatest need for CR exists in India, particularly in the North. Programs must be financially supported by government, and healthcare providers trained to deliver it to increase capacity. Where CR did exist, it was generally delivered in accordance with guideline recommendations. Tobacco cessation interventions should be universally offered.

Determinants and clinical significance of aortic stiffness in patients with moderate or severe aortic stenosis

BackgroundPatients with degenerative aortic stenosis (AS) are often older and have systemic hypertension and atherosclerosis, which all lead to increased aortic stiffness. We aimed to assess the determinants of carotid-femoral pulse wave velocity (cf-PWV), a direct measure of aortic stiffness, and its association with revealed symptoms and clinical outcome in patients with AS. MethodsWe included 103 asymptomatic patients aged 66.6 ± 13.2 years (range 27–85 years, 69% males) with moderate (n = 50) and severe (n = 53) AS. All underwent a comprehensive echocardiography, exercise treadmill test (ETT) and assessment of aortic stiffness derived from cf-PWV by applanation tonometry. ResultsThe mean cf-PWV was 10.6 ± 3.1 m/s and resting brachial blood pressure (BP) 139 ± 20/79 ± 11 mmHg. Increased cf-PWV (≥10 m/s) was found in 44% (n = 45) patients. Patients with moderate and severe AS had a similar degree of aortic stiffness (cf-PWV 10.7 ± 3.3 vs. 10.5 ± 3.0 m/s, p = 0.698). In a univariate logistic regression analysis, higher cf-PWV was not associated with revealed symptoms (odds ratio [OR] for 1SD higher cf-PWV 1.12; 95% CI 0.62–2.04, p = 0.706). In a multivariable linear regression analysis, age, resting brachial systolic BP and diabetes were associated with higher cf-PWV independent of antihypertensive treatment and left ventricular ejection fraction. The event-free survival was significantly lower in patients with cf-PWV ≥10 m/s compared to those with cf-PWV <10 m/s (p = 0.015). ConclusionIncreased cf-PWV was common in patients with moderate or severe AS, and was associated with higher cardiovascular disease burden and impaired prognosis. cf-PWV did not correlate with the severity of AS or the frequencies of revealed symptoms by ETT.

Urinary Arsenic Species are Detectable in Urban Underserved Hispanic/Latino Populations: A Pilot Study from the Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS).

Background: Hispanics/Latinos represent >15% of the United States (US) population and experience a high burden of cardiovascular disease (CVD) and diabetes. Dietary exposure, particularly to arsenic (As), may be associated with CVD and diabetes in Hispanics/Latinos. Rural populations in the US exposed to As in drinking water have increased risk of diabetes and CVD; however, little is known about the risk among urban populations with low As in water who are mostly exposed to As through food. Methods: To explore the levels of inorganic arsenic exposure (the sum of inorganic and methylated arsenic species in urine, ∑As, corrected by a residual-based method) in persons of Hispanic/Latino origin, we conducted a pilot study quantifying urinary arsenic levels among 45 participants in the Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS). Results: The median (interquartile range) of the urinary arsenic species (µg/L) were as follows: inorganic As 0.6 (0.4, 1.0), monomethylarsonic acid 1.2 (0.7, 1.9), dimethylarsinic acid 7.2 (4.3, 15.3), and ∑As 6.0 (4.3, 10.5). Conclusions: This study adds to the existing evidence that harmful forms of arsenic are present in this group of Hispanics/Latinos.