Higher Proportion Of Hypertension Research Articles

Silent brain infarction is associated with carotid siphon calcification in ischemic stroke patients

BackgroundSilent brain infarction (SBI) had a higher prevalence in ischemic stroke patients than healthy population. Intracranial artery calcification, as the important component of atherosclerosis, is a known risk factor of ischemic stroke. Whether it is also the risk factor of SBI is uncertain. We aimed to assess the association between SBI and carotid siphon calcification (CSC) in ischemic stroke patients. MethodsWe retrospectively collected consecutive data of acute ischemic stroke patients with and without SBI by Magnetic Resonance Imaging (MRI) and calcification using non-contrast Computerized Tomography (NCCT). We used a histopathologically validated method to score the circularity, thickness, and morphology of calcification. Clinical characteristics, prevalence and pattern (intimal and medial) of CSC were compared between patients with and without SBI. The association of CSC and SBI was investigated by logistic regression analysis. ResultsTotally, 303 acute ischemic stroke patients were enrolled, of whom 260 (85.8%) had CSC. Patients with SBI were older (64.5 ± 10.4 years vs. 61.3 ± 12.1 years, P = 0.032), had a higher proportion of hypertension (77.5% vs. 65.7%, P = 0.035). Of the 260 CSC patients, there’s no significant difference except for hyperlipidemia between patients with SBI and without SBI. The prevalence of intimal pattern of CSC was higher in those with SBI (adjusted odds ratio 2.42, 95% CI 1.219–4.794). ConclusionsPatients with SBI at acute phase of ischemic stroke have more risk factors than mentioned previously. SBI associated with the intimal pattern of CSC which relate to the atherosclerosis process in symptomatic ischemic stroke patients.

Non-alcoholic fatty liver disease (NAFLD) in Filipino North American patients: Results from a multi-ethnic cohort.

Non-alcoholic fatty liver disease (NAFLD) is more prevalent in certain ethnicities due to a combination of genetic, environmental, and metabolic factors. North American Filipino populations may have lifestyle and metabolic risk factors for NAFLD; however, the prevalence of NAFLD in this group is unknown. We sought to determine whether Filipino patients are over-represented in a multi-ethnic NAFLD cohort and describe their clinical presentation, primarily compared to other ethnicities in the same geographical region and secondarily compared to Manila-based Filipino patients. A cross-sectional study was conducted with patients with NAFLD who were followed at the Hepatology Clinic at Vancouver General Hospital, Canada, from January 2015 to August 2018. Data were extracted for clinicodemographic data, ethnicity, anthropometric measures, blood work, and transient elastography (TE). External comparison data was obtained online from the Metro Vancouver census and a NAFLD study conducted in Manila, Philippines. Of 317 patients meeting inclusion criteria for the study, 224 patients had complete datasets. The mean age was 51.1 years, and 50% were female. There were 139 (62%) Caucasian and other ethnicity patients, 55 (25%) Asian patients, and 30 (13%) Filipino patients. Compared to other ethnic groups, the Filipino group had similar clinical characteristics, including NAFLD fibrosis scores and TE. Of included NAFLD patients, the proportion of Filipino patients (13.39%) was significantly greater than the proportion of Filipino residents in Metro Vancouver (5.52%, p <0.01). Our Filipino Canadians seemed to be younger, with fewer females and a lower proportion of diabetes mellitus, but a higher proportion of hypertension than the previously reported cohort from Manila. While Filipino patients have not previously been examined in multi-ethnic NAFLD studies, they may represent a high-risk population. Further research is needed to clarify the prevalence and presentation of NAFLD in Filipino Canadian patients, as this appears to be a significant health issue in this community.

Abstract 13406: Psychosocial Stress, Life Satisfaction, And Hypertension: A Mediation Analysis

Background: Disparities in hypertension control remain an important issue in public health. Evidence indicates that psychosocial factors are associated with onset and trajectory of hypertension. However, mediators of the association between psychosocial factors and hypertension are understudied. The objective of this study is to explore the mediating effect of life satisfaction on the link between psychosocial stress and hypertension. Method: This is a secondary analysis of data from the Panel Study of Income Dynamics (PSID) with the 2019 wave of 26,084 adults. Hypertension was assessed with the question: “Has a doctor or other health professional ever told you that you had high blood pressure or hypertension?” Psychosocial stress was assessed by using the K-6 Non-Specific Psychological Distress Scale developed by Dr. Ronald Kessler with 6 items. Participants were asked to rate their life satisfaction with a Likert-type question. Multiple logistic regression and mediation analysis were performed. Results: The mean age of this sample was 45 years and 27.5% were female. Results showed that participants with a higher level of psychosocial stress had a lower proportion of life satisfaction (26.3% vs. 70.7%, p&lt;0.01) and a higher proportion of hypertension (42.5% vs. 28.6%, p&lt;0.01) compared to those with a lower level of psychosocial stress. Participants who rated their life satisfied had a lower proportion of hypertension (27.4% vs. 32.9%, p&lt;0.01) compared to those who rated their life not satisfied. After controlling for covariates, regression results showed that psychosocial stress and life satisfaction were associated with hypertension independently. The indirect effect of psychosocial stress on hypertension through life satisfaction was significant (p&lt;0.01). Conclusions: Psychosocial stress was significantly associated with hypertension and this effect was partially mediated by life satisfaction. Interventions to decrease psychosocial stress that also emphasize improvements in life satisfaction may be needed to reduce the impact on hypertension.

Abstract 12159: Impact of Ischemic Heart Disease on Cardiac Resynchronization Therapy - Analysis From National Inpatient Sample

Introduction: Comparative outcomes of hospitalizations for Cardiac Resynchronization Therapy (CRT) implantation procedures with and without coexisting Ischemic Heart Diseases (IHD) have not been studied at national level databases. We attempted to assess outcomes and baseline characteristics in these hospitalizations based on the National Inpatient Sample (NIS). Hypothesis: Ischemic heart disease worsens inpatient outcomes in patients undergoing CRT implantation. Methods: We conducted a retrospective analysis of hospitalizations for CRT implantation from the National Inpatient Sample (NIS) between 2013 and 2014. ICD-9 Billing codes were used to identify the target population. The primary outcomes were inpatient mortality, and hospital length and cost of stay. Results: A total of 11057 cases were identified. IHD was listed as any diagnosis in 66% of these hospitalizations. The mean age was 72.5 and 66.9 years for CRT implantation with and without IHD, respectively. Hospitalizations without IHD were more likely to be female (44% vs. 25%; p=0.01). Patients in the CRT with IHD group had a higher comorbidity burden with a higher proportion of hypertension, chronic kidney disease, anemia, peripheral artery disease, and congestive heart failure (Table 1). Inpatient mortality was similar between both groups (OR 1.17, CI 0.75-1.81). The IHD cohort had higher rates of cardiac arrest (OR 1.30, CI 1.05-1.62), acute kidney injury (OR 1.21, CI 1.08-1.35), longer length and a higher cost of stay (Table 1). Conclusions: IHD is associated with higher costs, longer length of stay, and higher rates of cardiac arrest. However, the in-hospital mortality was not different between the two groups. Higher incidence of cardiac arrest in patients with CRT and IHD underlines the importance of ICD with CRT. The clinical implication is that the threshold of selecting a CRT-D device in patients eligible for CRT therapy should be lower in patients with IHD vis-à-vis patients without IHD.

Risk factors in young patients with myocardial infarction: what is different from the general population?

Abstract Introduction Patients that suffer from myocardial infarction (MI) at a younger age are of special medical and socioeconomic interest. Data on risk factors for MI in this patient group are however scarce. Methods In this case–control study, clinical characteristics of consecutive patients admitted to hospital with MI at age of ≤45 years were compared to a randomly selected cohort from the general population in the same geographic region in Germany. After 3:1 matching on age and gender and multivariable analyses, independent risk factors for the occurrence of MI at a younger age were analyzed. Results 522 patients with MI ≤45 years were compared to 1191 matched controls from the general population. The proportion of active smokers was more than 3-fold higher in younger MI-patients compared to the general population (82.4% vs. 24.1%, p&amp;lt;0.01), while the proportion of persons consuming alcohol at least 2 times a week was higher in the general population (19.9% vs. 36.6%, p&amp;lt;0.01). Younger patients with MI were more often obese (median body mass index 28.4 vs. 25.5 kg/m2, p&amp;lt;0.01), had a higher proportion of hypertension (25.1% vs. 0.5%, p&amp;lt;0.01) or diabetes mellitus (11.7% vs. 1.7%, p&amp;lt;0.01) and had more often a family history of the father (22.4% vs. 7.1%, p&amp;lt;0.01) or the mother (7.5% vs. 1.3%, p&amp;lt;0.01) for premature coronary artery disease. In multivariable analysis, hypertension or diabetes, active smoking, family history and body mass index ≥30 kg/m2 were strong predictors for the occurrence of MI at a younger age, while alcohol consumption was a protective factor (Figure). Conclusions This case-control study demonstrates a very strong association of active smoking, metabolic syndrome and family history with the occurrence of MI at a younger age. The contrary is found regarding alcohol consumption. These data suggest that the risk of young-onset MI goes beyond family history and underline the importance of primary prevention efforts to reduce smoking and metabolic syndrome in children, adolescents and young adults in order to reduce the burden of cardiovascular diseases. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Bremen Heart FoundationLeibniz Institute for Prevention Research and Epidemiology

Post-operative Complication Rate Comparison Between Airway Surgery and Upper Airway Stimulation Using NSQIP and ADHERE.

ObjectivePostoperative complication rates were compared between obstructive sleep apnea surgery (OSAS) and hypoglossal nerve upper airway stimulation (UAS).Study DesignCohort.SettingMulti-institutional international databases.MethodsOSAS data were collected from the NSQIP database (2014; American College of Surgeons National Surgery Quality Improvement Program). UAS data were obtained from the ADHERE registry (Adherence and Outcome of Upper Airway Stimulation for OSA International Registry; 2016–December 2019). ADHERE comorbidities and complications were categorized to match NSQIP definitions. A chi-square test was used for proportion P values.ResultsThere were 1623 UAS procedures in ADHERE and 310 in NSQIP. The UAS group was older than the OSAS group (mean ± SD, 60 ± 11 vs 42 ± 13 years) but similarly male (75% vs 77%) and overweight (body mass index, 29 ± 4 vs 29 ± 3 kg/m2). There was a higher proportion of hypertension, diabetes, and heart disease in the UAS cohort. Palatopharyngoplasty was the most common surgical procedure (71%), followed by tonsillectomy (25%). UAS operative time was longer (132 ± 47 vs 54 ± 33 minutes). Postoperative length of stay was not normally distributed, as 71% of UAS stays were <1 day as opposed to 40% of OSA stays (P < .0001). Thirty-day return to the operating room related to the procedure was 0.1% for UAS and 4.8% for OSAS (P < .0001). Surgical site infections were 0.13% for UAS and 0.9% for OSAS (P = .046).ConclusionThe UAS cohort was older and more likely to have comorbid hypertension, diabetes, and heart disease. Despite baseline differences, the postoperative complication rate was lower with UAS than with OSAS.

β-Hydroxybutyric Inhibits Vascular Calcification via Autophagy Enhancement in Models Induced by High Phosphate.

Background: Vascular calcification (VC) is a landmark of aging, while β-hydroxybutyric acid (BHB) induced by calorie restriction has been identified as a promising factor to extend the lifespan. However, the effect of BHB on VC and the potential mechanism remain unknown.Methods: A total of 160 subjects with or without metabolic abnormalities (MAs) were assigned to four groups according to different calcification severities. The association between BHB, MAs, and VC was investigated via mediation analysis. Then, with high phosphate-induced calcification models, the effect of BHB on arterial ring calcification and osteogenic phenotypic differentiation of vascular smooth muscle cells (VSMCs) was investigated. Hereafter the expressions of autophagy biomarkers, autophagy flux, and effects of autophagy inhibitors on VC were detected.Results: Severe VC was observed in the elderly, accompanied with a higher proportion of hypertension, chronic kidney disease, and lower estimated glomerular filtration rate. The serum BHB level was an independent influencing factor of VC severities. With mediation analysis, BHB was determined as a significant mediator in the effects of MAs on VC, and the indirect effect of BHB accounted for 23% of the total effect. Furthermore, BHB directly inhibited arterial ring calcification and osteogenic phenotypic differentiation in VSMCs, accompanied with autophagy enhancement in VSMCs. In accordance, the inhibition of autophagy counteracted the protective effect of BHB on VC.Conclusion: The present study demonstrated that BHB mediated the effects of MAs on VC; then, it further elucidated that BHB could inhibit arterial and VSMC calcification via autophagy enhancement.

Associations of Hepatosteatosis With Cardiovascular Disease in HIV-Positive and HIV-Negative Patients: The Liverpool HIV-Heart Project.

Hepatosteatosis (HS) has been associated with cardiovascular disorders in the general population. We sought to investigate whether HS is a marker of cardiovascular disease (CVD) risk in HIV-positive individuals, given that metabolic syndrome is implicated in the increasing CVD burden in this population. To investigate the association of HS with CVD in HIV-positive and HIV-negative individuals. We analyzed computed tomography (CT) images of 1306 subjects of whom 209 (16%) were HIV-positive and 1097 (84%) HIV-negative. CVD was quantified by the presence of coronary calcification from both dedicated cardiac CT and nondedicated thorax CT. HS was diagnosed from CT data sets in those with noncontrast dedicated cardiac CT and those with venous phase liver CT using previously validated techniques. Previous liver ultrasound was also assessed for the presence of HS. The HIV-positive group had lower mean age (P < 0.005), higher proportions of male sex (P < 0.005), and more current smokers (P < 0.005). The HIV-negative group had higher proportions of hypertension (P < 0.005), type II diabetes (P = 0.032), dyslipidemia (P < 0.005), statin use (P = 0.008), and HS (P = 0.018). The prevalence of coronary calcification was not significantly different between the groups. Logistic regression (LR) demonstrated that in the HIV-positive group, increasing age [odds ratio (OR): 1.15, P < 0.005], male sex (OR 3.37, P = 0.022), and HS (OR 3.13, P = 0.005) were independently associated with CVD. In the HIV-negative group, increasing age (OR: 1.11, P < 0.005), male sex (OR 2.97, P < 0.005), current smoking (OR 1.96, P < 0.005), and dyslipidemia (OR 1.66, P = 0.03) were independently associated with CVD. Using a machine learning random forest algorithm to assess the variables of importance, the top 3 variables of importance in the HIV-positive group were age, HS, and male sex. In the HIV-negative group, the top 3 variables were age, hypertension and male sex. The LR models predicted CVD well, with the mean area under the receiver operator curve (AUC) for the HIV-positive and HIV-negative cohorts being 0.831 [95% confidence interval (CI): 0.713 to 0.928] and 0.786 (95% CI: 0.735 to 0.836), respectively. The random forest models outperformed LR models, with a mean AUC in HIV-positive and HIV-negative populations of 0.877 (95% CI: 0.775 to 0.959) and 0.828 (95% CI: 0.780 to 0.873) respectively, with differences between both methods being statistically significant. In contrast to the general population, HS is a strong and independent predictor of CVD in HIV-positive individuals. This suggests that metabolic dysfunction may be attributable to the excess CVD risk seen with these patient groups. Assessment of HS may help accurate quantification of CVD risk in HIV-positive patients.

Hemodynamics-based analysis of factors associated with aneurysm rupture in different sides of the internal carotid artery

Objective: To explore the influence of hemodynamics, morphological and clinical characteristics on rupture risk of the dorsal and non-dorsal internal carotid artery aneurysms (ICAAs). Methods: A total of 111 patients diagnosed with aneurysm by digital subtraction angiography (DSA) or surgery, underwent cranial CT angiography (CTA) were retrospectively collected from January 2010 to December 2016 at the Department of Diagnostic Radiology, Jinling Clinical College of Xuzhou Medical University (General Hospital of Eastern Theater Command). Among them, 41 were males and 70 were females, ranging in age from 32 to 83 (56±11) years old. The patients were divided into the ruptured group (n=54) and unruptured group (n=57) based on the hemorrhagic manifestation on non-enhanced CT images or DSA or surgery of the head. Demographics and the morphological characteristics of the aneurysms were evaluated. Hemodynamic parameters, including wall share stress, wall share stress gradient, and others were obtained in overall using computational fluid dynamics simulation technique. Characteristics were compared between the ruptured and unruptured groups. Logistic regression analysis was applied to evaluate the independent risk factors for rupture, and the hemodynamic characteristics associated with dorsal and non-dorsal aneurysms were analyzed, respectively. Results: Compared with the unruptured group, patients in the ruptured group were younger ((54.2±11.4) years and (58.3±9.9) years, P=0.033), mostly female (74.1% vs 52.6%, P<0.05), with a higher proportion of hypertension (46.3% vs 22.8%, P=0.009). The ruptured internal carotid artery aneurysms (ICAAs) were more frequently located at the dorsal of an arterial arch (57.4% vs 36.8%, P<0.05), and the flow of the blood was more complex, concentrated, unstable, and with a smaller impingement zone (68.5% vs 33.3%,55.6% vs 10.5%,72.2% vs 26.3% and 79.6% vs 36.8%, respectively, all P<0.05). Logistic regression demonstrated that women, hypertension, dorsal, concentrated flow pattern, and unstable flow pattern were an independent risk factors for ICAAs rupture [OR=3.551 (1.080-11.679), 3.900 (1.172-12.976), 4.966 (1.504-16.401), 51.893 (7.913-340.296) and 50.015 (8.423-296.985), respectively, all P<0.05]. The ruptured ICAAs located at non-dorsal had more concentrated, unstable, and with smaller impingement zone (P<0.05), while those at dorsal had more complex, concentrated, and unstable flow patterns, and with smaller impingement zone (all P<0.05). Conclusion: Women, hypertension, dorsal concentration, and unstable flow pattern are independent risk factors for the rupture of ICAAs. The dorsal locations of ICAAs could have a higher risk of rupture.

MO116COMPARISON OF THE CHARACTERISTICS BETWEEN UNILATERAL AND BILATERAL RENAL STONES AND THEIR ASSOCIATION WITH KIDNEY INJURY IN CHINESE POPULATION

Abstract Background and Aims Urinary stone disease (USD) has been associated with increased risk for chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Western populations. However, the comparison of metabolic disorders between unilateral and bilateral renal stones and their association with CKD have not been fully examined. It is also unclear whether there is an increased risk for kidney tubular injury makers such as N-acetyl-ß-D-glucosaminidase (NAG) and alpha-1-microglobulin (α1-MG) in different stone formers. Method We performed a cross-sectional study of 10,281 participants in rural China in 2014. All subjects underwent a renal ultrasound to detect USD; stone formers were grouped into one or two sides of USD by ultrasound exams. CKD was defined as a decreased estimated glomerular filtration rate (eGFR, &amp;lt;60mL/min/1.73m2) and/or albuminuria (ACR≥30mg/g). Increased urine NAG and α1-MG were defined as the values of NAG and α1-MG above the 75th percentile of the sample distribution. Results The mean age of the study population was 55.4±10.0 years; 47.1% were males. Among all participants, 4.9% (n=507) had unilateral renal stone, and 0.7% had bilateral renal stones. The proportion of CKD in non-stone formers, unilateral and bilateral renal stones were 11.0%, 19.2%, and 29.7%, respectively (p for trend&amp;lt;0.001). Bilateral renal stone formers tend to have a higher proportion of hypertension and diabetes. In multivariate analyses after adjustment for multiple confounders, bilateral renal stones were significantly associated with an increased risk of decreased eGFR (OR 3.38; 95% CI 1.05-10.90), albuminuria (OR 3.01; 95% CI 1.76-5.13), CKD (OR 3.18; 95% CI 1.88-5.36), increased NAG (OR 1.95; 95% CI 1.21-3.16) and α1-MG (OR 2.54; 95% CI 1.56-4.12) compared with non-stone formers. Conclusion In the present study, bilateral renal stone formers tend to have a higher proportion of metabolic disorders and are also associated with a higher risk of CKD and kidney tubular injury. Further studies are needed to confirm the increased risk for ESRD.

Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC-EORP EUROASPIRE surveys

BackgroundGender disparities in the management of dysglycaemia, defined as either impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), in coronary artery disease (CAD) patients are a medical challenge. Recent data from two nationwide cohorts of patients suggested no gender difference as regards the risk for diabetes-related CV complications but indicated the presence of a gender disparity in risk factor management. The aim of this study was to investigate gender differences in screening for dysglycaemia, cardiovascular risk factor management and prognosis in dysglycemic CAD patients.MethodsThe study population (n = 16,259; 4077 women) included 7998 patients from the ESC-EORP EUROASPIRE IV (EAIV: 2012–2013, 79 centres in 24 countries) and 8261 patients from the ESC-EORP EUROASPIRE V (EAV: 2016–2017, 131 centres in 27 countries) cross-sectional surveys. In each centre, patients were investigated with standardised methods by centrally trained staff and those without known diabetes were offered an oral glucose tolerance test (OGTT). The first of CV death or hospitalisation for non-fatal myocardial infarction, stroke, heart failure or revascularization served as endpoint. Median follow-up time was 1.7 years. The association between gender and time to the occurrence of the endpoint was evaluated using Cox survival modelling, adjusting for age.ResultsKnown diabetes was more common among women (32.9%) than men (28.4%, p < 0.0001). OGTT (n = 8655) disclosed IGT in 17.2% of women vs. 15.1% of men (p = 0.004) and diabetes in 13.4% of women vs. 14.6% of men (p = 0.078). In both known diabetes and newly detected dysglycaemia groups, women were older, with higher proportions of hypertension, dyslipidaemia and obesity. HbA1c was higher in women with known diabetes. Recommended targets of physical activity, blood pressure and cholesterol were achieved by significantly lower proportions of women than men. Women with known diabetes had higher risk for the endpoint than men (age-adjusted HR 1.22; 95% CI 1.04–1.43).ConclusionsGuideline-recommended risk factor control is poorer in dysglycemic women than men. This may contribute to the worse prognosis in CAD women with known diabetes.

Early Chronic Kidney Disease Care Programme delays kidney function deterioration in patients with stage I–IIIa chronic kidney disease: an observational cohort study in Taiwan

ObjectivesTo investigate the effect of the Early Chronic Kidney Disease (CKD) Care Programme on CKD progression in patients with CKD stage I–IIIa.DesignObservational cohort study.SettingTaipei Medical University Research Database from three...

Abstract 17043: Predictors of Length of Stay Following Catheter Ablation of Atrial Fibrillation

Background: Catheter ablation (CA) of atrial fibrillation (AF) is a safe and effective management strategy for symptomatic AF. Traditionally, patients are observed overnight following CA, but recent data has suggested same day discharge may be feasible with low risk of complications. However, little data is available to predict length-of-stay (LOS) in AF patients undergoing CA. Methods: We conducted a single-center retrospective analysis of 200 consecutive patients undergoing CA at a tertiary care academic center from July 2017 through June 2018. Baseline demographic data, echocardiographic data, procedural characteristics and postprocedural outcomes were collected through chart review. Multivariate linear regression modeling was used to identify factors associated with increased LOS (LOS &gt; 1 day). Results: Among 200 patients, 11.5% (23) of patients had LOS &gt; 1 day (Group B) while the rest were discharged after overnight stay (Group A). The mean ages were similar in Groups A and B (64.8 years and 64.9 years respectively, p = 0.98). The mean LOS was 1.44 ± 1.83 days. Higher proportions of hypertension (p = 0.02), diabetes (p = 0.1), baseline loop diuretic use (p &lt; 0.001), EF &lt; 50% (p &lt; 0.001), increased LA diameter (p = 0.01), longer procedure time (p = 0.03), and recurrent AF following CA (p &lt; 0.001) were noted in Group B patients (Table 1). A multivariate linear regression model demonstrated that procedure time (p = 0.02) and LA diameter (p = 0.04) were positively associated with increased LOS. Conclusion: Identifying risk factors for increased LOS in patients undergoing CA of AF may guide appropriate patient selection for same day discharge. Table 1. Comparison of patients with overnight observation (Group A) and LOS &gt; 1 day (Group B) following AF ablation.

Comparative analysis of epidemiology, etiology, and outcomes between elderly and young and middle-aged acute pancreatitis patients: a retrospective, single-center study.

The aim of this study was to analyze the etiology and epidemiology of the patients with first-attack acute pancreatitis of two-age groups. This is a retrospective comparative study of 2965 patients aged 18 years and older with first-attack acute pancreatitis between 2013 and 2018 in the Affiliated Hospital of Southwest Medical University. Patients divided into the elderly group (age > or = 60 years) and the young and middle-aged group (age <60 years). The etiology tendency and clinical characteristics were analyzed. In the elderly group, the proportions of women to men was higher compared with the young and middle-aged group (1.48 vs. 0.69, P < 0.001). The primary etiology of acute pancreatitis in two groups were biliary tract diseases. The main etiology of the young and middle-aged group among men was alcohol and among women was biliary disease. Comparing with the young and middle-aged group, the elderly patients had a higher proportion of hypertension, ischemic heart disease, and cerebrovascular disease (P < 0.001). Meanwhile, the proportions of system inflammatory reaction syndrome, multiple organ dysfunction syndrome (MODS), and shock were also higher in the elderly group (P < 0.001). Mortality in the elderly group and the young and middle-aged group was 1.69 and 0.72%, respectively. Biliary tract diseases were the predominant etiological factor in two groups. The two groups had different etiological proportions according to gender, complications, comorbidities, and outcomes. Furthermore, elderly patients are more likely to with complications, comorbidities, and highly mortality rate. We should pay more attention to realize the characteristics of acute pancreatitis at different ages.

Eligibility for Low-Dose Rivaroxaban Based on the COMPASS Trial: Insights from the Veterans Affairs Healthcare System.

Low-dose rivaroxaban reduced major adverse cardiac and limb events among patients with stable atherosclerotic vascular disease (ASCVD) in the COMPASS trial. The objective of our study was to evaluate the eligibility and budgetary impact of the COMPASS trial in a real-world population. The VA administrative and clinical databases were utilized to conduct a cross-sectional study to identify patients eligible for low-dose rivaroxaban receiving care at all 141 facilities between October 1, 2014 and September 30, 2015. Proportion of patients with stable ASCVD eligible for low-dose rivaroxaban and prevalence of multiple risk enrichment criteria among eligible patients. Pharmaceutical budgetary impact using VA pharmacy pricing. Chi-squared and Student's t tests were used to compare patients eligible versus ineligible patients. From an initial cohort of 1,248,214 patients with ASCVD, 488,495 patients (39.1%) met trial eligibility criteria. Eligible patients were older (74.2 vs 64.5years) with higher proportion of hypertension (84.1% vs 82.1%) and diabetes (46.2% vs 32.9) compared with ineligible patients (p < 0.001 for all comparisons). A median of 38.7% (IQR 4.6%) of total ASCVD patients per facility were rivaroxaban eligible. Estimated annual VA pharmacy budgetary impact would range from $0.47 billion to $1.88 billion for 25% to 100% treatment penetration. Annual facility level pharmaceutical budgetary impact would be a median of $12.3 million (IQR $8.0-$16.3 million) for treatment of all eligible patients. Among eligible patients, age greater than 65years was the most common risk enrichment factor (86.9%). Prevalence of eligible patients with multiple enrichment factors varied from 34.2% (one factor) to 6.2% (four or more). Over one third of patients with stable ASCVD may qualify for low-dose rivaroxaban within the VA. Additional studies are needed to understand eligibility in other populations and a formal cost-effectiveness analysis is warranted.

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

Introduction: Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. Methods: A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. Results: Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipidemia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0–1.05], p <0.0001), male sex (OR: 2.5, 95% CI: [1.4–4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6–15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3–5.2], p = 0.009). Conclusions: IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.

A cross-sectional study on prevalence of hypertension and pre-hypertension among young adults at urban field practice area, Gandhi Medical College, Secunderabad

Background: Hypertension is also known as high or raised blood pressure. It is a condition in which the blood vessels have persistently raised pressure. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Young adults have been deemed to be at lower risk in their development of hypertension due to resultant gaps in the literature. Hence the present study was aimed to determine the prevalence of hypertension and pre-hypertension among young adults (18-35 years) residing in Urban Field Practice Area of Gandhi Medical College. Objectives of the study was to determine the prevalence of hypertension and pre-hypertension in young adults and to identify the risk factors and sociodemographic factors associated with hypertension and pre-hypertension.Methods: A sample of 233 young adults (18-35 years) was included in the community based cross sectional study by simple random sampling followed by systematic random sampling in Bholakpur. All the participants were assessed for blood pressure and BMI status. Data was analysed in MS Excel version 7.2 Software.Results: The prevalence of hypertension was 9.85% (n=23) and pre–hypertension was 23.65% (n=55). About 13.3% of the study population were smokers and 26.6% of them were alcoholics. Twenty seven percent of the study participants were obese and overweight.Conclusions: Higher proportion of hypertensives and pre-hypertensives were found in the category of males, smoking, alcohol intake and obesity than their counter ones.

The ideal implant for Mayo 2A olecranon fractures? An economic evaluation

The ideal implant for stable, noncomminuted olecranon fractures is controversial. Tension band wiring (TBW) is associated with lower cost but higher implant removal rates.On the other hand, plate fixation (PF) is purported to be biomechanically superior, with lower failure and implant removal rates, although associated with higher cost. The primary aim of this study is to look at the clinical outcomes for all Mayo 2A olecranon between PF and TBW. The secondary aim is to perform an economic evaluation of PF vs. TBW. This is a retrospective study of all surgically treated Mayo 2A olecranon fractures in a tertiary hospital from 2005-2016. Demographic data, medical history, range of motion, and complications were collected. All inpatient and outpatient costs in a 1-year period postsurgery including the index surgical procedure were collected via the hospital administrative cost database (normalized to 2014). A total of 147 cases were identified (94 TBW, 53 PF). PF was associated with higher mean age (P < .01), higher American Society of Anesthesiologists score (P< .01), and higher proportion of hypertensives (P = .04). There was no difference in the range of motion achieved at 1 year for both groups. In terms of complications, TBW was associated with more symptomatic hardware (21.6% vs. 13.7%, P= .24) and implant failures (16.5% vs. none, P < .01), whereas the plate group had a higher wound complication (5.9% vs. none, P = .02) and infection rate (9.8% vs. 3.1%, P = .09). TBW had a higher implant removal rate of 30.9% compared with 22.7% for PF (P = .36). PF had a higher cost at all time points, from the index surgery ($10,313.64 vs. $5896.36, P < .01), 1-year cost excluding index surgery ($5069.61 vs. $3850.46, P = .46), and outpatient cost ($1667.80 vs. $1613.49, P = .27). Based on our study results, we have demonstrated that TBW is the ideal implant for Mayo 2A olecranon fractures from both a clinical and economic standpoint, with comparable clinical results, potentially similar implant removal rates as PF's, and a lower cost over a 1-year period. In choosing the ideal implant, the surgeon must take into account, first, the local TBW and PF removal rate, which can vary significantly because of the patient's profile and beliefs, and second, the PF implant cost.

Clinical characteristics and the risk factors for severe events of elderly coronavirus disease 2019 patients

To investigate the clinical characteristics and risk factors for severe events of coronavirus disease 2019 (COVID-19) in elderly patients. Retrospective analysis was performed on the clinical data of all elderly COVID- 19 patients treated in Changsha Public Health Treatment Center from January 17, 2020 to March 15, 2020, which included basic diseases, symptoms, test results, and other clinical characteristics, and prognostic indicators such as severity of illness, length of hospital stay, virus shedding time and mortality rate. The differences in clinical characteristics and prognostic indicators between elderly, middle-aged, and young COVID-19 patients were also analyzed. Logistic regression model was used to conduct univariate and multivariate analysis of risk factors for developing severe events in elderly COVID-19 patients; receiver operating characteristic (ROC) curve analysis was used to evaluate the prediction efficacy. Of the 230 COVID-19 adult patients, 34 were young patients (14.8%), 136 were middle-aged patients (59.1%), and 60 were elderly (26.1%). Among the 60 elderly patients, 23 were male (38.3%) and 37 were female (61.7%), with a medium age of 66 years old. Common symptoms were fever (66.7%), cough (50.0%), and fatigue (41.7%). C reactive protein (CRP) was increased significantly. The proportion of severe cases was 31.7%, and mortality was 1.7%. The median length of hospitalization and median virus shedding time were 18.5 days and 21 days, respectively. Compared with the young and the middle-aged patients, the elderly had a higher proportion of hypertension, diabetes, and cardiovascular diseases, more common shortness of breath, higher proportions of pneumonia and severe cases (all P<0.05), and the decreased lymphocyte count and lymphocyte percentage (both P<0.05), as well as higher CRP and erythrocyte sedimentation rate (ESR) levels (both P<0.05). Compared with non-severe cases, severe elderly patients demonstrated higher CRP and aspartate aminotransferase (AST) levels (all P<0.05), the reduced lymphocyte count (P<0.05), and the prolonged length of hospitalization and virus shedding duration (both P<0.05). Univariate logistic regression analysis indicated that the lymphocytes proportion, CRP and AST levels were significantly correlated with the risk for developing severe events in elderly COVID-19 patients (all P<0.05). Multivariate logistic regression found that severe events in elderly patients with COVID-19 were significantly correlated with CRP level (OR=1.041, P=0.013). ROC curve analysis revealed that the area under the curve (AUC) for CRP to diagnose severe events in elderly COVID 19 patients was 0.851. The proportion of severe cases in elderly COVID-19 patients is higher than that in young and middle-aged patients. CRP level has a good predictive value for the possibility of severe events in elderly COVID-19 patients.

EFFECT OF AGING ON SERUM URIC ACID AND ARTERIAL HYPERTENSION PREVALENCE-DATA FROM SEPHAR III SURVEY

Objective: In the context of dramatically increase of elderly population our study aims to evaluate serum uric acid (SUA) levels and also arterial hypertension prevalence and control, in a representative group of Romanian adult population, considering the influence of age. Design and method: The study sample consists of 1920 adults included in SEPHAR III (Study for the Evaluation of Prevalence of Hypertension and cArdiovascular Risk in Romania) survey (mean age 48.63 years, 52.76% females), out of whom 447 were elderly patients (65 years of age or older). SUA levels, kidney function by estimated glomerular filtration rate (eGFR) and blood pressure measurements were performed. SUA levels between 2,40 ± 5,70 mg/dl in females and 3,40 ± 7,00 mg/dl in males respectively were considered normal. HT and HT control were defined according to the current guidelines. Results: Adult patients had a significant lower SUA levels, on average with 0.51 mg/dl, compared to elderly patients (4.89 vs. 5.40, p < 0.001) independent of eGFR levels. We also obtained significant statistical difference among the proportion of normotensive and hypertensive in the two groups with the elderly group having a higher proportion of hypertension (67.34% vs. 39.31%, p < 0.001). In terms of blood pressure control, elderly patients had a better control (86.05% vs. 73.40%, p < 0.001). Conclusions: Similarly to previous research, in our study, age represented one of the factors contributing to the increased level of serum uric acid. We also obtained an increasing prevalence of arterial hypertension with age but a better control of blood pressure values.