History Of Coronary Artery Disease Research Articles

GlycA Levels Independently Predict Coronary Artery Calcium Incidence and Progression in the ELSA-Brasil Cohort (Brazilian Longitudinal Study of Adult Health)

Atherosclerosis is an inflammatory disease. Coronary artery calcium (CAC) is a marker of atherosclerotic disease events and mortality risk. Elevated GlycA, an emerging marker of inflammation, is associated with a higher risk for coronary artery disease (CAD). However, there is conflicting evidence on whether GlycA predicts subclinical CAD progression. We hypothesized that GlycA can predict subclinical CAC incidence/progression in healthy individuals. We included 2,690 ELSA-Brasil cohort participants without cardiovascular/chronic inflammatory disease not receiving statin therapy who had GlycA levels measured and two interval CAC assessments between 2010 through 2018. Multivariable logistic and linear regression models were computed to evaluate GlycA as a predictor of CAC incidence and progression. CAC incidence required a baseline CAC of 0. CAC progression required a baseline CAC > 0. The mean age of participants was 48.6 ± 7.7 years, 56.7% were female, 54.6% and 16.1% (429/2690) were White and Black, respectively. The mean CAC interscan period was 5.1 ± 0.9 years, the mean GlycA level was 414.7 ± 65 μmol/L, and the incidence of CAC was 13.1% (280/2,129). GlycA level odds ratio (OR) for CAC incidence was 1.002 [95% confidence interval (CI) 1.0005-1.005, p=0.016] adjusted for demographics, lifestyle, a family history of early CAD (≤60 years), lipids, and comorbidities. The GlycA (≤p25 vs ≥p75) OR for CAC progression (Berry definition) was 1.77 (95% CI 1.07-2.96, p=0.03) in a similar multivariable-adjusted model. Higher GlycA levels were associated with CAC incidence and progression in a healthy Brazilian cohort.

Outcomes of Patients with Normal LDL-Cholesterol at Admission for Acute Coronary Syndromes: Lower Is Not Always Better.

There are few prospective data on the prognostic value of normal admission low-density lipoprotein cholesterol (LDL-C) in statin-naïve patients with acute coronary syndromes (ACS) who are treated with a preemptive invasive strategy. We aimed to analyze the proportion of patients with normal LDL-C at admission for ACS in our practice, and their characteristics and clinical outcomes in comparison to patients with high admission LDL-C. Two institutions' prospective registries of patients with confirmed ACS from Jan 2017 to Jan 2023 were used to identify 1579 statin-naïve patients with no history of prior coronary artery disease (CAD), and with available LDL-C admission results, relevant clinical and procedural data, and short- and long-term follow-up data. Normal LDL-C at admission was defined as lower than 2.6 mmol/L. All demographic, clinical, procedural, and follow-up data were compared between patients with normal LDL-C and patients with a high LDL-C level (≥2.6 mmol/L) at admission. There were 242 (15%) patients with normal LDL-C at admission. In comparison to patients with high LDL-cholesterol at admission, they were significantly older (median 67 vs. 62 years) with worse renal function, had significantly more cases of diabetes mellitus (DM) (26% vs. 17%), peripheral artery disease (PAD) (14% vs. 9%), chronic obstructive pulmonary disease (COPD) (8% vs. 2%), and psychological disorders requiring medical attention (19% vs. 10%). There were no significant differences in clinical type of ACS. Complexity of CAD estimated by coronary angiography was similar between the two groups (median Syntax score 12 for both groups). There were no significant differences in rates of complete revascularization (67% vs. 72%). Patients with normal LDL-C had significantly lower left ventricular ejection fraction (LVEF) at discharge (median LVEF 52% vs. 55%). Patients with normal LDL-C at admission had both significantly higher in-hospital mortality (5% vs. 2%, RR 2.07, 95% CI 1.08-3.96) and overall mortality during a median follow-up of 43 months (27% vs. 14%, RR 1.86, 95% CI 1.45-2.37). After adjusting for age, renal function, presence of diabetes mellitus, PAD, COPD, psychological disorders, BMI, and LVEF at discharge in a multivariate Cox regression analysis, normal LDL-C at admission remained significantly and independently associated with higher long-term mortality during follow-up (RR 1.48, 95% CI 1.05-2.09). A spontaneously normal LDL-C level at admission for ACS in statin-naïve patients was not rare and it was an independent risk factor for both substantially higher in-hospital mortality and mortality during long-term follow-up. Patients with normal LDL-C and otherwise high total cardiovascular risk scores should be detected early and treated with optimal medical therapy. However, additional research is needed to reveal all the missing pieces in their survival puzzle after ACS-beyond coronary anatomy, PCI optimization, numerical LDL-C levels, and statin therapy.

Characteristics, predictors and outcomes of new-onset QT prolongation in sepsis: a multicenter retrospective study

BackgroundSepsis-induced myocardial injury is a serious complication of sepsis. QT prolongation is a proarrhythmic state which reflects myocardial injury in a group of heterogeneous disorders. However, the study on the clinical value of QT prolongation in sepsis is limited.MethodsWe aimed to investigate the clinical characteristics and predictors of new-onset QT prolongation in sepsis and its impact on the outcome in a multicenter retrospective cohort study. Electrocardiographic and clinical data were collected from patients with sepsis from the wards and intensive care units of four centers after exclusion of QT-influencing medications and electrolyte abnormalities. Clinical outcomes were compared between patients with and without QT prolongation (QTc > 450 ms). Multivariate analysis was performed to ascertain whether QT prolongation was an independent predictor for 30-day mortality. The factors predicting QT prolongation in sepsis were also analyzed.ResultsNew-onset QT prolongation occurred in 235/1024 (22.9%) patients. The majority demonstrated similar pattern as type 1 long QT syndrome. Patients with QT prolongation had a higher 30-day in-hospital mortality (P < 0.001), which was also associated with increased tachyarrhythmias including paroxysmal atrial fibrillation or tachycardia (P < 0.001) and ventricular arrhythmia (P < 0.001) during hospitalization. QT prolongation independently predicted 30-day mortality (P = 0.044) after multivariate analysis. History of coronary artery disease (P = 0.001), septic shock (P = 0.008), acute respiratory (P < 0.001), heart (P = 0.021) and renal dysfunction (P = 0.013) were independent predictors of QT prolongation in sepsis.ConclusionsNew-onset QT prolongation in sepsis was associated with increased mortality as well as atrial and ventricular arrhythmias, which was predicted by disease severity and organ dysfunction.Graphical abstract

CACS, CCTA and mCAD-LT score in the pre-transplant assessment of coronary artery disease and the prediction of post-transplant cardiovascular events.

The optimal cardiovascular assessment of liver transplant (LT) candidates is unclear. We aimed to evaluate the performance of CT-based coronary tests (coronary artery calcium score [CACS] and coronary CT angiography [CCTA]) and a modification of the CAD-LT score (mCAD-LT, excluding family history of CAD) to diagnose significant coronary artery disease (CAD) before LT and predict the incidence of post-LT cardiovascular events (CVE). We retrospectively analysed a single-centre cohort of LT candidates who underwent non-invasive tests; invasive coronary angiography (ICA) was performed depending on the results of non-invasive tests. mCAD-LT was calculated in all patients. Six-hundred-and-thirty-four LT candidates were assessed and 351 of them underwent LT. CACS, CCTA and ICA were performed in 245, 123 and 120 LT candidates, respectively. Significant CAD was found in 30% of patients undergoing ICA. The AUROCs of mCAD-LT (.722) and CCTA (.654) were significantly higher than that of CACS (.502) to predict the presence of significant CAD. Specificity of the tests ranged between 31% for CCTA and 53% for CACS. Among patients who underwent LT, CACS ≥ 400 and mCAD-LT were independently associated with the incidence of CVE; in patients who underwent CCTA before LT, significant CAD at CCTA also predicted post-LT CVE. In this cohort, mCAD-LT score and CT-based tests detect the presence of significant CAD in LT candidates, although they tend to overestimate it. Both mCAD-LT score and CT-based tests classify LT recipients according to their risk of post-LT CVE and can be used to improve post-LT risk mitigation.

Adapting transformer-based language models for heart disease detection and risk factors extraction

Efficiently treating cardiac patients before the onset of a heart attack relies on the precise prediction of heart disease. Identifying and detecting the risk factors for heart disease such as diabetes mellitus, Coronary Artery Disease (CAD), hyperlipidemia, hypertension, smoking, familial CAD history, obesity, and medications is critical for developing effective preventative and management measures. Although Electronic Health Records (EHRs) have emerged as valuable resources for identifying these risk factors, their unstructured format poses challenges for cardiologists in retrieving relevant information. This research proposed employing transfer learning techniques to automatically extract heart disease risk factors from EHRs. Leveraging transfer learning, a deep learning technique has demonstrated a significant performance in various clinical natural language processing (NLP) applications, particularly in heart disease risk prediction. This study explored the application of transformer-based language models, specifically utilizing pre-trained architectures like BERT (Bidirectional Encoder Representations from Transformers), RoBERTa, BioClinicalBERT, XLNet, and BioBERT for heart disease detection and extraction of related risk factors from clinical notes, using the i2b2 dataset. These transformer models are pre-trained on an extensive corpus of medical literature and clinical records to gain a deep understanding of contextualized language representations. Adapted models are then fine-tuned using annotated datasets specific to heart disease, such as the i2b2 dataset, enabling them to learn patterns and relationships within the domain. These models have demonstrated superior performance in extracting semantic information from EHRs, automating high-performance heart disease risk factor identification, and performing downstream NLP tasks within the clinical domain. This study proposed fine-tuned five widely used transformer-based models, namely BERT, RoBERTa, BioClinicalBERT, XLNet, and BioBERT, using the 2014 i2b2 clinical NLP challenge dataset. The fine-tuned models surpass conventional approaches in predicting the presence of heart disease risk factors with impressive accuracy. The RoBERTa model has achieved the highest performance, with micro F1-scores of 94.27%, while the BERT, BioClinicalBERT, XLNet, and BioBERT models have provided competitive performances with micro F1-scores of 93.73%, 94.03%, 93.97%, and 93.99%, respectively. Finally, a simple ensemble of the five transformer-based models has been proposed, which outperformed the most existing methods in heart disease risk fan, achieving a micro F1-Score of 94.26%. This study demonstrated the efficacy of transfer learning using transformer-based models in enhancing risk prediction and facilitating early intervention for heart disease prevention.

Distal Upper Extremity Arterial Calcification as a Predictor for Subclinical Coronary Artery Disease by Coronary Artery Calcium Scoring.

Several studies have linked calcification of the thoracic and lower extremity arterial trunks to an increased risk of developing coronary artery disease (CAD). Calcifications of the radial and/or ulnar artery are regularly identified in hand/wrist x-rays; however, the clinical relevance of these findings as related to identifying subclinical CAD is not well understood. Associations between CAD and upper extremity calcifications have been reported, but the timeline is unclear. The purpose of this study was to evaluate the association between upper extremity arterial calcifications on hand radiographs with CAD by coronary artery calcification (CAC) scoring in patients with no known history of CAD. This is a pilot single-center, prospective, matched cohort study. We included patients with no known history of CAD, related symptoms, or major risk factors. We recruited five patients with calcifications (cal+) and five patients matched by age, race, sex, and medical history but without calcifications (cal-). CAC scores were determined from computed tomography scanning, and lipid profile was evaluated. In the cal+ group, the mean CAC total score was 244.1; in the control (cal-) group, it was 85.2. The mean total cholesterol levels were 220.8 mg per dL and 167 mg per dL in the cal+ and cal- groups, respectively. Two cal+ patients with CAC scores of 937 and 669 died shortly after being enrolled in our study. Preliminary findings suggest that calcifications in the radial or ulnar artery in otherwise asymptomatic patients with no history of CAD may be an independent sign of CAD.

Ultra-high-resolution CT vs. invasive angiography for detecting hemodynamically significant coronary artery disease: Rationale and methods of the CORE-PRECISION multicenter study

BackgroundDirect coronary arterial evaluation via computed tomography (CT) angiography is the most accurate noninvasive test for the diagnosis of coronary artery disease (CAD). However, diagnostic accuracy is limited in the setting of severe coronary calcification or stents. Ultra-high-resolution CT (UHR-CT) may overcome this limitation, but no rigorous study has tested this hypothesis. MethodsThe CORE-PRECISION is an international, multicenter, prospective diagnostic accuracy study testing the non-inferiority of UHR-CT compared to invasive coronary angiography (ICA) for identifying patients with hemodynamically significant CAD. The study will enroll 150 patients with history of CAD, defined as prior documentation of lumen obstruction, stenting, or a calcium score ≥400, who will undergo UHR-CT before clinically prompted ICA. Assessment of hemodynamically significant CAD by UHR-CT and ICA will follow clinical standards. The reference standard will be the quantitative flow ratio (QFR) with <0.8 defined as abnormal. All data will be analyzed in independent core laboratories. ResultsThe primary outcome will be the comparative diagnostic accuracy of UHR-CT vs. ICA for detecting hemodynamically significant CAD on a patient level. Secondary analyses will focus on vessel level diagnostic accuracy, quantitative stenosis analysis, automated contour detection, in-depth plaque analysis, and others. ConclusionCORE-PRECISION aims to investigate if UHR-CT is non-inferior to ICA for detecting hemodynamically significant CAD in high-risk patients, including those with severe coronary calcification or stents. We anticipate this study to provide valuable insights into the utility of UHR-CT in this challenging population and for its potential to establish a new standard for CAD assessment.

Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese.

We attempted to clarify whether the multiple criteria for metabolic syndrome (MetS) can sufficiently predict cardiovascular disease, whether waist circumference (WC) should be required, and whether sex-specific thresholds for each component are necessary. Only a few large-scale studies among East Asians have addressed the ability of MetS to predict cardiovascular disease. We analyzed the data of 330,051 men and 235,028 women aged 18-74 years with no history of coronary artery disease (CAD) or cerebrovascular disease (CVD) from a nationwide Japanese claims database accumulated during 2008-2016. The association of each MetS component with CAD or CVD (CAD/CVD), MetS associated with CAD/CVD according to various criteria, and utility of modified criteria with more specific optimal values for each component were examined using multivariate Cox regression and receiver operating characteristic (ROC) analysis. During the study, 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD. For each current MetS criteria, there was a 1.3- to 2.9-fold increased risk of CAD/CVD. Optimal thresholds for predicting CAD/CVD were WCs of 83 and 77 cm, triglycerides levels of 130 and 90 mg/dl, high-density lipoprotein cholesterol levels of 50 and 65 mg/dl, blood pressures of 130/80 and 120/80 mmHg, and fasting plasma glucose levels of 100 and 90 mg/dl for men and women, respectively. The existing MetS criteria and modified criteria were not significantly different in predicting CAD/CVD, but using the modified criteria markedly increased the prevalence of MetS and percentage of people with MetS developing CAD/CVD. Although various criteria for MetS similarly predicted CAD/CVD, the new criteria greatly reduced the number of high-risk individuals, especially women, overlooked by the current criteria.

April 2024 Critical Care Case of the Month: A 53-year-old Man Presenting with Fatal Acute Intracranial Hemorrhage and Cryptogenic Disseminated Intravascular Coagulopathy

No abstract available. Manuscript truncated after 150 words. History of Present Illness: A 53-year-old man was admitted for acute onset of left hemiparesis, left facial droop and dysarthria witnessed by his wife (a nurse) while they were watching TV that evening. She reported the patient had no previous history of coronary artery disease or cerebral vascular disease, prior to an admission occurring three weeks earlier. The patient presented at that time with acute, severe left-sided chest pain that began while he was doing some heavy yardwork. While being evaluated in the emergency department (ED), he developed left-sided facial numbness, hemiparesis and dysarthria. A CT scan of the brain was normal. Neurological symptoms resolved before lytic therapy could be administered. Troponins and EKG were normal. A D-dimer was &gt;20 mg/L, but a CTA of the chest showed no pulmonary embolism and was otherwise unrevealing. The chest pain resolved without specific therapy. Subsequent CTA of the head and neck and …

Evaluating Total Atherosclerosis Burden of Baroreceptor-Resident Arteries after Ischemic Cerebrovascular Disease for Identifying Patients with Heavy Coronary Atherosclerosis Burden.

The carotid sinuses and aortic arch are baroreceptor-resident arteries (BRAs) and atherosclerosis-susceptible sites of brain-supplying arteries, which would impair baroreflex-mediated blood pressure (BP) regulation and prompt coronary atherosclerosis. We sought to determine the relationship between total atherosclerosis burden (TAB) of BRAs and coronary atherosclerosis burden (AB) in patients with ischemic cerebrovascular disease (ICVD) and explore the potential contribution of BP profiles to this relationship. In this cross-sectional analysis of patients with ICVD who simultaneously undertook computed tomography angiography and 24-hour ambulatory BP monitoring, TAB of BRAs was scored based on the atherosclerotic vessel circumference ratio of the carotid sinuses and aortic arch, while the ABs of the intracranial, cervical, aortic, and coronary arteries were scored based on stenosis severity and plaque complexity as routine. Among the 230 patients analyzed, coronary AB was significantly correlated with TAB of BRAs, independently of, and more tightly than the ABs of the intracranial, cervical, and aortic arteries, and the stenosis- and complexity-based AB of BRA-located arteries (bilateral common and extracranial internal carotid arteries and aortic arch). Both coronary AB and TAB of BRAs were negatively associated with the night-to-day BP dipping ratios, which was quite different from the relationship between intracranial AB and 24-hour BP characteristics. These findings were also true for patients with ICVD without a history of coronary artery disease. Evaluating TAB of BRAs might provide a new link between atherosclerosis of brain- and heart-supplying arteries, connected partially by BP circadian rhythm. It might facilitate identifying patients with ICVD with heavy coronary AB and comprehensively managing vascular risk.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

Impact of TIMI Risk Stratification on In-Hospital Mortality in Non-ST Elevation Acute Coronary Syndrome: Perspectives from a Coronary Intervention Facility

Background: Acute coronary syndrome (ACS) encompasses a range of conditions, including non-ST segment elevation myocardial infarction (NSTEMI), which is associated with substantial morbidity and mortality. Risk stratification is essential for guiding management strategies to improve patient outcomes. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a validated tool for predicting mortality in NSTEMI patients, yet its applicability in South Asian populations requires further investigation. Objective: This study aimed to evaluate the association of the TIMI risk score with in-hospital mortality among NSTEMI patients in a tertiary care cardiac center and to assess the relevance of the TIMI score as a prognostic tool in a South Asian context. Methods: A cross-sectional study was conducted with 126 patients presenting with NSTEMI at the National Institute of Cardiovascular Disease, Karachi. Data were collected from June 2012 to June 2013 after the institutional review board's approval. Inclusion criteria were adults aged 18 to 85 with a TIMI score ≥5, while exclusion criteria were refusal to consent and a history of cardiac surgery. Demographics, clinical characteristics, and in-hospital outcomes were analyzed using SPSS version 25, employing Chi-square and Fisher's exact tests for categorical data, with a significance level set at p≤0.05. Results: The study found that 52 (41.3%) patients had diabetes mellitus, and 78 (61.9%) suffered from hypertension. A positive family history of coronary artery disease was observed in 29 (23.0%) patients. Among participants, 42 (33.3%) were smokers. The in-hospital mortality rate was 14.3%. No significant differences were noted in mortality regarding demographic and clinical variables. Conclusion: Elevated TIMI scores in NSTEMI patients are associated with significant in-hospital mortality. The findings underscore the importance of the TIMI risk score as a predictor of short-term outcomes in a South Asian population. The study highlights the need for further validation of the TIMI score in diverse populations and the optimization of risk stratification tools.

The Value of Admission Glycated Hemoglobin and Associated Factors in Non-Diabetic Patients with Heart Failure in Aden

Introduction: Heart failure (HF) is a multifactorial disorder characterized by impaired cardiac function, systemic inflammation and neurohormonal activation. It is a major cause of morbidity and mortality worldwide and has significant impacts on the quality of life, cost and longevity. This study was conducted to investigate the value of admission glycated hemoglobin (HbA1c) and associated factors among non-diabetic patients with heart failure. Methods: This is a descriptive prospective-hospital based study included 42 non-diabetic patients with HF on first occasion for admission at three major Aden hospitals for the period (January1st–December 31st, 2021). After thorough clinical history and examination, patients were investigated for random blood sugar, lipid profile, Pro Brain Natriuretic Peptide (Pro-BNP), HbA1c and followed till hospital discharge. Results: HF in non-diabetic patients predominates in males (81.0%) with a mean age of 56.0 ±11.5 years. The main associated factors were arterial hypertension (47.6%), coronary artery disease (9.5%), Khat chewing (57.1%), smoking (31.0%), obesity (28.6%), and family history of HF (21.4%). patients presented with New York Heart Association (NYHA) class III (47.6%) and low ejection fraction of ≤40.0% (76.2%). The median Pro-BNP was 2166.0 pg/mL, the mean admission HbA1c was 5.8% and the case fatality rate was 4.8%. The mean body mass index (BMI) was increasing with increasing level of admission HbA1c. HbA1c of 6.0-6.4% was associated with mortality cases and had significant positive association with BMI and significant negative association with total cholesterol. Conclusion: The admission HbA1c of 6.0-6.4% was associated with HF hospitalization and mortality in non-diabetic patients. This association is independent of age, gender, hypertension, hypercholesterolemia, glycemia, and clinical outcome suggesting direct effects of BMI on the development of high HbA1c level in non-diabetic patients with HF.

Triglyceride glucose index is associated with functional coronary artery stenosis in hypertensive patients.

The triglyceride glucose (TyG) index is an effective method for determining insulin resistance (IR). Limited research has explored the connection between the TyG index and functionally significant stenosis in hypertensive patients. Furthermore, the connections between the TyG index, fat attenuation index (FAI) and atherosclerotic plaque characteristics are also worth exploring. The study screened 1622 hypertensive participants without coronary artery disease history who underwent coronary computed tomography angiography. The TyG index was calculated as ln (fasting glucose [mg/dL] * fasting TG [mg/dL]/2). Adverse plaque characteristics (HRPCs), high-risk plaques (HRPs), FAI, and CT-derived fractional flow reserve (FFRCT) were analyzed and measured for all patients. Functionally significant stenosis causing ischemia is defined as FFRCT ≤ 0.80. Two patient groups were created based on the FFRCT: the FFRCT < 0.80 group and the FFRCT > 0.80 group. In hypertensive patients, the association between the TyG index and FFRCT was examined applying a logistic regression model. The TyG index was higher for people with FFRCT ≤ 0.80 contrast to those with FFRCT > 0.80. After controlling for additional confounding factors, the logistic regression model revealed a clear connection between the TyG index and FFRCT ≤ 0.80 (OR = 1.718, 95% CI 1.097-2.690, p = 0.018). The restricted cubic spline analysis displayed a nonlinear connection between the TyG index and FFRCT ≤ 0.80 (p for nonlinear = 0.001). The TyG index increased the fraction of individuals with HRPs and HRPCs, FAI raised, and FFRCT decreased (p < 0.05). The multivariate linear regression analysis illustrated a powerfulcorrelation between high TyG index levels and FAI, FFRCT, positive remodeling (PR), and low-attenuation plaque (LAPs) (standardized regression coefficients: 0.029 [p = 0.007], -0.051 [p < 0.001], 0.029 [p = 0.027], and 0.026 [p = 0.046], separately). In hypertensive patients, the TyG index showed an excellent association with a risk of FFRCT ≤ 0.80. Additionally, the TyG index was also linked to FAI, FFRCT, PR, and LAPs.

Footsteps to Wellness: A Systematic Review and Meta-Analysis of Walking Pace and Coronary Artery Disease Event.

Coronary artery disease (CAD) poses a global health challenge, necessitating effective preventive strategies. Despite the pivotal role of physical activity in cardiovascular health, many fall short of recommended guidelines for daily physical activity. Simple and accessible, walking presents an opportunity, with increased pace emerging as a potential strategy for reducing the risk of cardiovascular diseases. Thus, we aimed to elucidate the potential association between walking pace and the risk of CAD events in adults without a prior history of CAD through a systematic review. We searched PubMed, Scopus, Web of Science, and ScienceDirect without publication date restrictions to identify prospective cohorts that analyzed walking pace and adult CAD events. The literature search conducted from April 02, 2023, to August 21, 2023, identified a total of four studies (six cohorts) for meta-analysis using random-effects models. The Newcastle-Ottawa Scale was used to assess study quality, and data extraction involved two independent reviewers. The analysis calculated overall relative risks (RRs) and 95% confidence intervals (CIs) for those with the quickest walking paces compared to those with the slowest walking paces. A funnel plot analysis for publication bias and subgroup analysis were also conducted. Results from the meta-analysis involving 160,519 participants and 3,351 CAD events demonstrated a 46% decreased risk for those walking at the quickest pace (pooled RR = 0.54, 95% CI = 0.45-0.66). No significant heterogeneity was observed. In conclusion, walking pace emerges as a significant risk factor for CAD events in adults without a prior history of CAD. It serves as a potential screening tool to identify individuals at higher risk. Promoting a faster walking pace as a daily activity may effectively mitigate the burden of CAD.

COVID-19 Chest Manifestation on CT Scan and Associated Risk Factors for Developing Pulmonary Fibrosis.

This retrospective study describes the imaging findings on chest computed tomography (CT) scans of coronavirus disease 2019 (COVID-19) patients as well as the prevalence of pulmonary fibrosis and the potential risk factors for the disease. One of the major COVID-19 centers in the western province of Saudi Arabia,the King Abdullah Medical Complex in Jeddah, was the site of this study. All adult COVID-19 patients who got a CT chest scan between January 2020 and April 2022 were included in the trial. The imaging findings and pulmonary severity scores (PSS) were obtained from the patients' CT chest. Patients were divided into two groups according to the evidence of fibrotic-like lung changes; clinical and radiological data between the two groups were subsequently compared. Data from the patients' electronic records was collected. The average patient age was 56.4 years, and most (73.5%) patients were men. Two-thirds of the patients had comorbidities (69.1%). CT scans revealed that diffuse lung infiltration is reported in 61% of cases, followed by lower lobes in 19.9%. Ground glass opacity (94.1%), consolidation (76.5%), septal thickening, and/or reticulation (24.4%) were the main chest findings during the initial CT scan. Fibrotic-like lung changes were developed in 9.6% of patients. Patients known to have a positive history of hypertension (p-value = 0.031) and coronary artery disease (CAD) (p-value = 0.011) were found to be significantly more likely to develop lung fibrosis. The patients' pneumonia severity score was significantly higher among the lung fibrotic patients (p-value = 0.026). Also, patients who were diagnosed with pulmonary fibrosis stayed longer in the hospital (p-value 0.001). Sex and age did not correlate significantly with risk of lung fibrosis. Pulmonary fibrosis was observed in 9.6% of COVID-19 patients. A close follow-up of patients with severe pneumonia, prolonged hospitalization, and pre-existing CAD and hypertension was necessary, as pulmonary fibrosis was more likely to occur as a result of these factors. There is a need for a thorough, long-term investigation with a large sample size.

Abstract P195: Metabolites Mediate the Association of the MIND Diet With Hypertension and Chronic Kidney Disease

The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND), is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. The Mediterranean and DASH diets are associated with decreased risk of cardiometabolic disease; however, less is known regarding the association of the MIND diet with cardiometabolic disease. The objectives of this analysis were (1) to determine if the MIND diet is associated with prevalent hypertension and chronic kidney disease (CKD) and (2) to identify metabolites associated with the MIND diet and if these metabolites mediate the association of the MIND diet with hypertension and CKD. In the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort, we examined the association of the MIND diet with prevalent hypertension and CKD. Fully adjusted models included age, sex, race, calories, alcohol, smoking, education, exercise, income, region, BMI, lipidemia, history of coronary artery disease, and diabetes. In the REGARDS stroke case-cohort sub-study, 357 metabolites were measured in baseline plasma. Weighted linear regression models were used to test the association between MIND diet score and metabolites adjusting for age, sex, race, calories, alcohol, and smoking. Weighted logistic regression models were used to test the association between MIND-metabolites and hypertension and CKD adjusting for age, race, sex, BMI, alcohol, and smoking. Mediation analysis was conducted to examine metabolites mediating the association between MIND diet and hypertension and CKD. Sensitivity analyses were conducted in the cohort random controls. A higher MIND diet score was associated with lower odds of hypertension (odds ratio [OR] 0.97, 95% CI 0.96-0.99; p=0.01) and CKD (OR 0.88, 95% CI 0.86-0.91; p&lt;0.0001). Fifty-one metabolites were associated with the MIND diet (MIND-metabolites). Three MIND-metabolites were associated with greater odds of hypertension; however, these associations were attenuated in the fully adjusted models. Twelve MIND-metabolites were associated with greater odds of CKD. Mediation analyses indicated dimethylguanidino valeric acid (DMGV), guanosine, and C7 carnitine to mediate the association between MIND diet and hypertension. DMGV, guanosine, gluconic acid, S-Adenosyl-L-homocysteine, C7 carnitine, and 5 triacylglycerols mediated the association between MIND diet and CKD. Higher adherence to the MIND diet is associated with a lower likelihood of hypertension and CKD. MIND diet-related metabolites were found to be associated with hypertension and CKD and may provide insight to metabolic pathways linking diet and disease.

Pulmonary edema in a young male with severe uncontrolled cardiovascular risk factors and pan-vascular atherosclerosis: a case report.

Cardiovascular risk factors are the cause of atherosclerotic disease, which can involve all the elastic and muscolo-elastic arteries. The etiopathogenesis of atherosclerosis is multifactorial since genetics, lifestyle, and comorbidities can be simultaneously involved. Clinical manifestations can be heterogeneous and include myocardial infarction, stroke, aortic aneurysms, renal artery stenosis, renal insufficiency, peripheral artery disease, etc. Currently, 70% of clinical events cannot be prevented with available drug therapy, statins included, and at least 10% of coronary events occur in apparently healthy individuals in the absence of major traditional risk factors. The case of a young male with a history of coronary artery disease and multiple atherosclerotic risk factors not properly treated who was admitted to the emergency department for pulmonary edema and high blood pressure is presented. During the diagnostic workup, a dramatic atherosclerotic involvement of all arterial trees emerged. Moreover, the patient presented with thrombosis of the right subclavian artery, which was treated with a heparin infusion and later complicated by cerebral hemorrhage with residual hemiplegia.

Percutaneous Coronary Intervention Associated with a Higher Risk of Hypoxemia and COVID-19 Severity.

The primary goal of the present study was to measure the implications of hypoxemia in COVID-19 patients with a history of coronary artery disease (CAD). A systematic search of the literature published from November 1, 2019 to May 1, 2021, was conducted on PubMed/MEDLINE, Embase, and Web of Science databases. Afterwards, an observational study was designed based on the electronic health records of COVID-19 patients hospitalized in a tertiary referral hospital during the same period. A total of 179 COVID-19 cases were divided into two groups: cases with a history of CAD and percutaneous coronary intervention (CAD/PCI+, n = 89) and controls (n = 90). Clinical data were extracted from the electronic database of the hospital and statistically analyzed. After the application of inclusion/exclusion criteria, only three studies were deemed eligible, one of which was concerned with the impact of CAD on the all-cause mortality of COVID-19. Results from our observational study indicated that the cases were older (median age: 74 vs. 45) and more likely to develop hypoxemia (25.8% vs. 8.8%) than the controls. CAD/PCI+ was correlated with a more severe COVID-19 (11% vs. 1%). Age was a moderately significant independent predictor of increased COVID-19 severity, while hypoxemia was not. Considering the negative impact of hypoxemia on the prognosis of COVID-19 and its higher prevalence among COVID-19 patients with underlying CAD, further research is warranted to unravel the negative effects of COVID-19 on the mechanisms of gas exchange and delivery in patients with pre-existing CAD.

Incidence and Predictors of Acute Coronary Syndrome in Patients on Maintenance Hemodialysis: A Prospective Cohort Study.

Cardiovascular diseases are the leading cause of death among patients on hemodialysis, with approximately 40% of the cardiovascular deaths linked to acute coronary syndrome. We aimed to investigate the incidence and risk factors of acute coronary syndrome in patients undergoing hemodialysis. Patients undergoing hemodialysis were prospectively enrolled from January 2018. Data regarding hospitalization due to acute coronary syndrome were collected at 3-month intervals through December 31, 2021. Cox regression model was used to estimate the association between baseline factors and incident acute coronary syndrome during follow-up. Patients' mean age was 66 years, 48% were men, and 16% had a history of coronary artery disease at enrolment. Over a median follow-up of 1,187 days, 85 patients were hospitalized due to acute coronary syndrome. Left main or triple vessel disease was identified in 67 patients. Risk factors associated with incident acute coronary syndrome included aging, male sex, smoking, low diastolic blood pressure, and baseline comorbidities, in addition to dialysis factors including low urea clearance, central venous catheter use, and history of dialysis access dysfunction. After multivariate analysis, age, diabetes, hyperlipidemia, smoking, and frequent interventions for vascular access remained significant risk factors. A high acute coronary syndrome incidence was observed in our cohort, with traditional risk factors playing a consistent role with that in the general population. A history of frequent dialysis access dysfunction was also associated with incident acute coronary syndrome.