Incidence Of Acute Cardiovascular Events Research Articles

Long-term incidence of acute cardiovascular events in transgender people - a large cohort study with national registry data

Long-term incidence of acute cardiovascular events in transgender people - a large cohort study with national registry data

Accelerated arterial thrombus formation in Hutchinson Gilford Progeria Syndrome

Abstract Introduction Arterial thrombosis is an age-associated cause of myocardial infarction and stroke, which are the leading causes of mortality and morbidity worldwide. Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder that is caused by a point mutation in the lamin A gene. It is characterized by progressive premature aging, in which caused a decreased life expectancy. Two most frequent causes of death of children with HGPS are myocardial infarction and ischemic stroke – cardiovascular events that are tightly linked to arterial thrombosis. Despite this fact, the effect of the specific lamin A gene mutation on arterial thrombus formation remains unknown. Methods Transgenic heterozygous LmnaG609G knock-in (HGPS) mice and the corresponding wild-type (WT) littermate controls underwent photochemically-induced carotid artery endothelial injury to trigger thrombosis. Coagulation and fibrinolytic factors were measured in these animals. Ex-vivo platelet activation assay was also performed. Results HGPS mice displayed accelerated thrombus formation as underlined by shortened time to occlusion compared to WT littermates (Figure 1A-B). The level of tissue factor and von Willebrand factors are comparable between groups. No significant differences were found on factors involved in the fibrinolytic system, which was confirmed by the comparable level of D-dimers in both groups. A higher level of thrombin-antithrombin complex was observed, accompanied by lower level of antithrombin. Interestingly, HGPS animals displayed enhanced platelet activation markers expression upon ADP, collagen, and thrombin stimulation compared to WT group, demonstrating a higher platelet reactivity in progeria animals (Figure 1C). Conclusions Our study demonstrated an increased arterial thrombotic response in HGPS mice as compared to WT littermates which is, at least in part, mediated by higher platelet reactivity. This novel observation may provide a mechanistic explanation for the increased incidence of acute cardiovascular events observed in children with HGPS and warrant further clinical investigations also in consideration of available antiplatelet therapies.

Arterial thrombosis in Hutchinson-Gilford Progeria Syndrome

Abstract Introduction Arterial thrombosis is the most common age-associated event underlying major adverse cardiovascular (CV) events. The interplay between the vascular endothelium, platelets, and the coagulation cascade leads to thrombus formation, which results in the cessation of blood supply to the downstream tissues. Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic condition with striking features of premature aging. It is caused by defects in the nuclear A-type lamin gene, leading to intracellular accumulation of progerin. This genetic disorder is characterized by shortened lifespan, primarily due to an increased incidence of myocardial infarction and ischemic stroke. Declined vascular function and compliance have been reported in HGPS patients. Nevertheless, the effect of the specific A-type lamin gene mutation on coagulation and thrombus formation has not been investigated previously. Methods 28- to 30-week-old male and female transgenic heterozygous LmnaG609G knock-in (HGPS) mice and corresponding wild-type (WT) littermate controls were exposed to photochemically-induced carotid artery endothelial injury to trigger arterial thrombosis. Vascular and circulating levels of tissue factor (TF), plasminogen activator inhibitor (PAI)-1, and von Willebrand factor (vWF) were measured using enzyme-linked immunosorbent assay (ELISA). TF activity assay was also performed on carotid artery homogenates of WT and HGPS animals. Results HGPS mice displayed accelerated thrombus formation compared to the WT animals as underlined by a shortened time to occlusion. Although this finding suggests an increased activation of the extrinsic coagulation cascade, no significant differences were found in TF expression and activity in carotid artery lysates. Circulating and vascular expression of the fibrinolytic factor PAI-1 was also found to be similar between WT and HGPS animals. Furthermore, no significant difference in plasma vWF between the two groups was observed. Conclusions Our results show an increased arterial thrombotic response in HGPS mice as compared to WT littermates. This novel observation could provide a mechanistic explanation for the increased incidence of acute cardiovascular events observed in HGPS patients. Further studies will be conducted to investigate the molecular mechanism underlying the observed effects, in particular, on the potential involvement of platelets. Funding Acknowledgement Type of funding sources: None.

The impact of UEFA Euro 2020 football championship on Takotsubo Syndrome: Results of a multicenter national registry.

ObjectivesThe UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE).Methods and resultsCardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6–495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74–1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87–1.11; P = 0.80)] or TTS [IRR 1.66(0.80–3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period.ConclusionsThe data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.

Cost Effectiveness of the First-in-Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting.

The aim of this study was to model the potential long-term disease progression and pharmacoeconomic value of sacubitril/valsartan for the treatment of essential hypertension from a Chinese healthcare system perspective. A Markov cohort model with five health states was constructed to simulate the incidence of acute cardiovascular events and cost per quality-adjusted life-year (QALY) gained with sacubitril/valsartan compared with allisartan isoproxil and valsartan over a lifetime horizon with an annual cycle. Multivariable risk regression models derived from China-PAR data accompanied by hazard ratios were used to transform the dual mechanism of sacubitril/valsartan to lower blood pressure and left ventricular mass index into long-term fatal and non-fatal cardiovascular risks. Efficacy data were calculated using a network meta-analysis integrated by the results of clinical trials. Healthcare costs were determined from a real-world study and published literature, supplemented by expert opinion. Utilities were derived from literature. Both costs and health outcomes were discounted at 5.0% annually, and prices corresponded to 2021. Model validation, deterministic and probabilistic sensitivity analyses were conducted to test the robustness of results. For simulated patients with hypertension, sacubitril/valsartan reduced the rates of myocardial infarction by 6.67% and 6.39%, stroke by 9.38% and 8.98%, and heart failure hospitalization by 9.92% and 9.62% relative to allisartan isoproxil and valsartan, respectively. It was also associated with gains in life expectancy among hypertensive individuals of 0.362-0.382 years. Eventually, lifetime costs per patient were CN¥59,272 (US$9187) for sacubitril/valsartan, CN¥54,783 (US$8492) for allisartan isoproxil, and CN¥56,714 (US$8791) for valsartan; total QALYs were 11.38, 11.24, and 11.25, respectively. The incremental cost-effectiveness ratio was CN¥31,805/QALY (US$4930/QALY) compared with allisartan isoproxil, and CN¥19,247/QALY (US$2983/QALY) compared with valsartan, both of which are below the one time per-capita GDP of CN¥80,976/QALY (US$12,551/QALY) in China. Similar results were obtained in various extensive sensitivity analysis scenarios. This was the first study to evaluate the cost effectiveness of sacubitril/valsartan in the treatment of hypertension. Sacubitril/valsartan compares favorably with allisartan isoproxil and valsartan in the Chinese setting, which is mainly due to its higher efficacy resulting in fewer cardiovascular events and ultimately less related mortality over time. The results could inform deliberations regarding reimbursement and access to this treatment in China and may provide reference for facilitating more reasonable and efficient allocation of limited resources in such low- and middle-income countries.

Incidence of ischemic stroke in patients with periodic limb movements in sleep: one-year follow-up

Objective. To assess the influence of periodic limb movements in sleep on the incidence of acute cardiovascular events. Design and methods. Fifty-six participants aged 60–75 years were included in the study. Eligibility criteria included no history of acute cardiovascular events and the presence of 1 or more risk factors for cardiovascular diseases. Nocturnal actigraphy and cardiorespiratory monitoring were performed. Patients with apnea/hypopnea index &gt; 5/h were excluded (n = 6). Based on periodic limb movements index (PLMI) two groups were formed: main (PLMI ≥ 15/h, n = 26) and controls (PLMI &lt; 15/h, n = 24). The groups were prospectively observed during 1 year. The endpoints of the study were cases of acute cardiovascular events. Results. Despite the similar prevalence of common risk factors for cardiovascular diseases in two groups, the patients with PLMI ≥ 15/h have a higher incidence of ischemic stroke within 1 year (odds ratio 1,07). Conclusions. Elevated PLMI might be regarded as a potential predictor for higher risk for ischemic stroke. Nevertheless, further investigations in the field are needed.

Acute Lower Respiratory Tract Infection Increased the Risk of Cardiovascular Events and All-Cause Mortality in Elderly Patients With Stable Coronary Artery Disease.

Objective: To investigate the predictors of acute cardiovascular events within 90 days after an acute lower respiratory tract infection (ALRTI) in elderly patients with stable coronary artery disease (sCAD).Methods: Observational analyses were conducted in a prospective cohort of the elderly with sCAD, during 90 days after they were hospitalized for ALRTI. Multiple logistic regression analysis was performed to identify predictors for acute cardiovascular events and all-cause mortality.Results: The present study comprised 426 patients with sCAD (median age: 88 years; IQR: 84–91; range: 72–102). Among these patients, 257 suffering from ALRTI were enrolled in the infection group. Meanwhile, 169 patients who did not suffer from ALRTI were regarded as the non-infection group. Compared with the non-infection group, patients in the infection group had a higher incidence of acute cardiovascular events (31.9 vs. 13.6%, p < 0.001) and all-cause mortality (13.2 vs. 1.8%, p < 0.001) during the 90-day follow-up. In addition, in the infection group, the incidence of cardiovascular events was also higher than those in the non-infection group during the 7-day and 30-day follow-up (10.9 vs. 2.4%, p = 0.001; 20.6 vs. 6.5%, p < 0.001). The same difference in the incidence of all-cause mortality during 7 and 30 days (1.2 vs. 0%, p = 0.028; 3.9 vs. 0.6%, p = 0.021) was observed between the two groups. Furthermore, multiple regression analysis found that ALRTI was independently associated with increased risk of cardiovascular events and all-cause mortality in elderly patients with sCAD.Conclusion: In elderly patients with sCAD, ALRTI was an independent predictor for both cardiovascular events and all-cause mortality.

Acute cardiovascular events in type 2 diabetics treated with SGLT2i. Results of a real life registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction and objectives Sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have proven to reduce risk of cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). The aim of this study is to analyse the adverse CV events of acute presentation in a diabetic population with poor control in which treatment with SGLT2i tries to improve it independently of the presence of previous established CV disease. Material and methods Retrospective observational study included 544 patients with inadequately controlled TDM2 from 2 hospitals and 10 primary care centres of reference for the 78,000 population. They received a SGLT2i (Empagliflozin, Dapagliflozin or Canagliflozin) as add-on therapy to other glucose-lowering medications between February 2018 and February 2019. Evolution was monitored until February 2020. We analysed the population"s baseline characteristics and the incidence of acute cardiovascular events during follow-up (stroke, peripheral arterial ischemia, ACS, adverse events and death). Results 544 patients were included, 342 men (63%), with a mean age of 65.94 ± 10.26 years (52.2% &amp;gt; 65 yo). The mean follow-up was 22.62 ± 6.3 months from the start of SGLT2i. Initial HbA1c was 7.95 ± 1.29%, mean BMI 31.39 ± 5.49 kg/m2, preserved renal function with mean GFR of 83.62 ± 0.53 ml/min/1.73 m2 and the duration of diabetes was 12.48 ± 7.75 years. At baseline, 32.5% (N = 177) were on insulin. Prior to the prescription of SGLT2i 11.6% (N = 63) were diagnosed of heart failure and 4.2% (N = 23) had suffered decompensation (during/on/in) the previous year. 23.7% (N = 127) had had previous adverse cardiovascular event: 98 patients injured 1 organ (22 stroke, 57 ischemic heart disease and 19 peripheral arterial ischemia), 24 injured 2 organs and 5 injured 3. A greater proportion of patients (409/544) received Empagliflozin (75.2%) followed by 98 Dapagliflozin (18%) and 37 Canagliflozin (6.8%). Just 16% (N = 87) of the patients discontinued treatment, due to genital infections in 3.1% (N = 17) and 3 drops in GF to &amp;lt; 30 as main causes. Serious complications were rare (2 acidosis, 3 sepsis). No amputations or severe hypoglycaemia were reported. During the follow-up there were 12 deaths (2.2%) because of oncological pathology except for 2 cases of terminal heart failure. The incidence of acute cardiovascular events was low (N = 19, 3.5%) and they were non-fatal, but unlike the basal affectation in which coronary disease predominated, during the follow-up the new events were 7 strokes (1.3%) and 7 episodes of peripheral arterial ischemia (1.3%), 4 cases of ACS and 1 case of stroke + ACS. 10 patients had had previous events and in 9 cases it was de novo. Conclusions In our diabetic population, the use of SGLT2i is associated with few acute cardiovascular events in the first 1-3 years of follow-up, with good tolerance and low percentages of discontinuation of treatment due to adverse events.

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications.

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50–64 years; C: 65–79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50–64 years, 65–79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.

Predictors of acute cardiovascular events following acute exacerbation period for patients with COPD: a nested case\u2013control study

BackgroundIt has been noted that there is an increase in the incidence of acute cardiovascular events (CVEs) in patients with chronic obstructive pulmonary disease (COPD) during an acute exacerbation (AE), thereby causing increased inpatient mortality. Thus, we have tried to identify predictors of acute CVEs in patients with AECOPD via a nested case–control study.MethodsA total of 496 cases hospitalized for AECOPD were included in this study, and followed-up for up to 6 months after discharge. Acute CVEs in the AE period were defined as a new or worsening acute coronary syndrome (ACS), arrhythmia, or left ventricular disfunction (LVD). Predictors of CVEs were selected from several variables, including baseline characteristics and treatments in the stable period as well as symptoms, laboratory tests, complications and treatments in the AE period.ResultsThirty cases (6.05%) had acute CVEs, namely 2 had ACS, 13 had LVD and 19 experienced some form of arrhythmia. Four deaths were observed in the CVE group, with significantly increased death risk compared with the non-CVE group (P = 0.001, OR = 5.81). Moreover, patients who had CVEs were more prone to have re-exacerbation within 3 months. Multivariate analysis showed that previous LVD history (P = 0.004, OR = 5.06), 20% increase in heart rate (HR) (P = 0.003, OR = 10.19), electrolyte disturbance (P = 0.01, OR = 4.24) and diuretics (P = 0.002, OR = 6.37) were independent predictors of CVEs. In addition, usage of theophylline, fluoroquinolone and inhaled beta agonists in the AE period were not statistically associated with acute CVEs.ConclusionsOur preliminary study indicates that patients hospitalized for AECOPD with previous LVD history or increased HR need close observation and diuretics should be cautiously used with regular electrolyte monitoring. These findings need to be confirmed in a large cohort.

Mortality of Cardiovascular Events in Patients With COPD and Preceding Hospitalization for Acute Exacerbation

Acute exacerbation (AE) of COPD may be accompanied by the deterioration of cardiovascular comorbidities, as evidenced by the increased incidence of acute cardiovascular events. The goal of this study was to determine whether preceding AE might be associated with mortality of cardiovascular events. Using a health insurance research database in Taiwan, patients with COPD were identified who experienced first-time acute myocardial infarction (AMI; n= 26,442), ischemic stroke (n= 54,959), and intracranial hemorrhage (ICH; n= 14,893) over a 13-year period. In each cohort, 4,356, 6,655, and 1,727 patients, respectively, had been hospitalized for AE within the previous year prior to the index cardiovascular events, and patients with COPD but without hospitalization for AEs constituted the control subjects. ORs of 90-day mortality and hazard ratios (HRs) of overall mortality during follow-up in relation to hospitalization for an AE and the frequency of hospitalization for AEs (ie, 1 and≥ 2 hospitalizations for AEs) were estimated with adjustment for potential confounders. Hospitalization for an AE was independently associated with 90-day mortality of AMI (OR, 1.33; 95%CI, 1.24-1.43), ischemic stroke (OR, 1.46; 95%CI, 1.36-1.56), and ICH (OR, 1.19; 95%CI, 1.06-1.32). Hospitalization for an AE was associated with overall mortality of AMI (HR, 1.23; 95%CI, 1.19-1.27), ischemic stroke (HR, 1.29; 95%CI, 1.26-1.33), and ICH (HR, 1.19; 95%CI, 1.13-1.26). In addition, compared with control subjects, patients with more frequent hospitalizations for AEs exhibited significant trends at higher risk of 90-day and overall mortality of AMI, ischemic stroke, and ICH. Finally, these results were consistent with propensity score matching-based estimates. Preceding hospitalization for AEs is associated with 90-day and overall mortality of cardiovascular events in COPD.

CARDIAC COMPLICATIONS OF DIABETICS IN SEPSIS

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Although much is known about long-term sequelae of diabetics, little has been said about their course in sepsis. Previous research has failed to show an increased incidence of acute cardiovascular dysfunction (Esper et al, 2008). In general cardiovascular complications and infections are leading causes of morbidity and mortality amongst diabetics (Tancredi et al 2015, Bhansali et al, 2003). We propose that increased incidence of acute cardiovascular events will also be found in the setting of sepsis requiring hospitalization in a medical intensive care unit (MICU) and that previous studies may have missed the comprehensive spectrum of cardiac events they may experience. METHODS: A retrospective review of the electronic medical record was done among patients admitted to the MICU between 2011 and 2015. ICD codes billed during admission were used to measure principal admission diagnoses and acute cardiovascular events during admission. In hospital mortality was also collected. Only patients with a chief admission diagnosis that was an infectious disease were included (N= 1720) and this was used as a proxy for sepsis. The primary endpoint measured was relative risk of new onset cardiovascular events in diabetics versus non-diabetics among patients admitted to the MICU for sepsis. The secondary endpoint was relative risk of mortality during admission. This was quantified using two different Chi-Square Tests for Independence. We proposed that diabetics with sepsis were more likely than non-diabetics with sepsis to have cardiac events or to die during hospitalization. RESULTS: A between group analysis was done for septic diabetics versus septic non-diabetics using a Pearson Chi Square test comparing overall acute cardiac events and mortality. Patients with diabetes and sepsis were more likely to have a cardiac event during admission (65.2% vs 54.7%, p<0.0001) compared with septic patients without diabetes. Moreover, septic diabetes were more likely to die during admission than septic patients without diabetes (13.1% vs 9.1%, p =.01). CONCLUSIONS: In sepsis in the critical care setting, diabetes serves as an independent predictor of cardiac events and death during admission. CLINICAL IMPLICATIONS: Our study highlights the importance of close monitoring of diabetics for cardiac events when critically ill and for having a low threshold to evaluate cardiac complaints. These findings build upon our previous findings with our diabetic cohort of increased incidence of pulmonary embolus, arrhythmias, acute coronary syndromes and heart failure exacerbations while in the MICU. We suggest increased vigilance for diagnosing pulmonary emboli and acute coronary syndromes in this population when critically ill. Diabetics should have a lower threshold for prophylactic anticoagulation, need continued use of telemetry and should receive aspirin and statins if there is no contraindication to these medicines. DISCLOSURES: No relevant relationships by Robert Balk, source=Web Response No relevant relationships by Sarah Peterson, source=Web Response No relevant relationships by Rachel Wilson, source=Web Response No relevant relationships by Rebecca Wilson, source=Web Response

Cardiovascular Events after the Sewol Ferry Disaster, South Korea.

Major incidents affecting large numbers of people may increase the rate of acute cardiovascular events, even among those who are not directly involved in the incident. It is hypothesized that the MV Sewol ferry disaster (South Korea) would increase the incidence of cardiovascular events nation-wide. Data on all adult patients (&gt;18 years) who were diagnosed with acute cardiovascular events, including acute myocardial infarction (MI), angina, and cardiac arrhythmias, were extracted from the National Emergency Department Information System (NEDIS) from March 15 through June 17, during the years 2011-2014 (four weeks before to eight weeks after the event date). Poisson regression models were used to calculate the incidence rate ratios (IRRs) comparing the weekly changes in the occurrences of cardiovascular events from the week of the Sewol event (April 16-22, 2014) to eight weeks after the disaster (June 11-17, 2014), using the one-month period before Sewol as a reference period (March 15-April 15), adjusting for calendar years (years 2011-2014) and environmental factors. During the study periods, cardiovascular events were identified in 73,823 patients. Compared to the reference period, the week of the Sewol disaster and the three weeks after the disaster showed a significant increase in the number of acute cardiovascular events, IRRs of 1.09 (95% CI, 1.03-1.15) and 1.08 (95% CI, 1.02-1.15), respectively (P &lt;.01 for both). In particular, there was 21% increase in incidence of arrhythmia (IRR = 1.21; 95% CI, 1.02-1.44; P = .03) during the week of the Sewol disaster compared with the reference period. This study showed a significant increase in the incidence of acute cardiovascular events during the week of, and the three weeks after, the Sewol ferry disaster in 2014. These additional cardiac emergencies may be triggered by emotional stressors related to the event, highlighting the public health importance of indirect exposure to a tragic catastrophe.Kong SY, Song KJ, Shin SD, Ro YS. Cardiovascular events after the Sewol ferry disaster, South Korea. Prehosp Disaster Med. 2019;34(2):142-148.

1953. Comparative Effectiveness of High- vs. Standard-Dose Influenza Vaccine on Hospitalization for Acute Myocardial Infarction in Nursing-Home Residents: A Post-hoc Analysis From a Large Cluster-Randomized Trial

BackgroundThere is growing evidence supporting the role of influenza vaccine in decreasing the risk of cardiovascular (CV) events, including acute myocardial infarction. The development of vaccines targeting older adults, such as high-dose (HD) and adjuvanted formulations, offers the promise of enhanced CV protection in this high-risk group. We evaluated whether a HD trivalent vaccine was associated with a reduced incidence of acute CV events (ACE) among nursing home (NH) residents, compared with a standard-dose trivalent vaccine (SD).MethodsThis is a secondary analysis of data from a single-blind, pragmatic, cluster-randomized comparative effectiveness trial. We recruited and randomized Medicare-certified NHs located within 50 miles of a CDC influenza reporting city to facility-wide standard of care for the residents to either HD or SD as the vaccine offered for the 2013–2014 influenza season. Long-stay residents 65 and older in a fee-for-service Medicare plan were eligible for the study. Study staff were masked to NH allocations and raw data access to minimize bias. Outcome data of interest were obtained from the Centers for Medicare and Medicaid Services (CMS). The primary outcome was hospitalization for an acute cardiovascular event (ACE), defined as acute myocardial infarction, atrial fibrillation or heart failure between November 2013 and May 2014. Hazard ratios were estimated from cox-proportional hazard models with facility random effects to account for clustering. We conducted stratified analyses by gender and baseline cardiovascular disease. All models were adjusted for individual and facility level baseline characteristics.ResultsA total of 823 facilities with 38,672 eligible residents were randomized into balanced groups. Facility and resident characteristics were comparable. The incidence of hospitalization for ACE was significantly lower in HD than SD facilities (10.1% vs. 11.0%; adjusted HR 0.92; 95% CI 0.85–0.95; P-value 0.015). Figure 1 shows adjusted HR for each outcome; selected subgroups are presented in Figure 2. ConclusionHigh-dose flu vaccine reduces the risk of hospitalization for ACE in long-term care residents by 8% relative to standard-dose vaccine. Registration NCT01815268. Funding sanofi pasteur.Disclosures E. Saade, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. N. Joyce, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. J. Ogarek, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. H. E. Davidson, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. D. Canaday, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. A. Yasin, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. T. Shireman, Sanofi-Pasteur: Grant Investigator, Grant recipient. V. Mor, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support. S. Gravenstein, sanofi pasteur: Collaborator, Research support. Seqirus: Collaborator, Research support.

Risk for cardiovascular disease in patients with nontuberculous mycobacteria treated with macrolide.

Macrolide antibiotics are the most important pharmacological agents for the treatment of nontuberculous mycobacterial disease. We investigated the incidence of acute cardiovascular events in patients taking macrolides for nontuberculous mycobacterial disease and determined the difference in risk between clarithromycin and azithromycin. A population-based retrospective cohort study was conducted in South Korea using the Health Insurance Review and Assessment Service database. Patients ≥40 years treated with macrolide for nontuberculous mycobacteria (NTM) between 2011 and 2015 were examined. The primary outcome was hospitalization or emergency department visit for cardiovascular disease along with acute myocardial infarction, cerebrovascular disease, and cardiac arrhythmia. The standardized incidence ratio (SIR) for cardiovascular disease was calculated by comparing the patients with the general population in the year 2013. Cox proportional hazard model was used to compare the risk between clarithromycin and azithromycin. In total, 16,525 patients with nontuberculous mycobacterial disease treated with macrolide were included; 13,870 received clarithromycin and 2,655 received azithromycin. The cardiovascular incidence was significantly higher in patients with nontuberculous mycobacterial disease than in the age- and sex-stratified general population [SIR, 1.44; 95% confidence interval (CI), 1.27-1.61]. The risk was not significantly different between patients treated with clarithromycin and azithromycin (adjusted hazard ratio, 0.90; 95% CI, 0.65-1.24). The incidence of cardiovascular disease was significantly higher in patients treated with macrolide for nontuberculous mycobacterial disease than in the general population. This risk was not different between patients treated with clarithromycin and azithromycin.

Association between long-term blood pressure change and the incidence of cardiovascular diseases: a population-based cohort study

Objective: To explore the association between long-term changes in blood pressure (BP) levels and the incidence of cardiovascular diseases (CVD). Methods: A total of 5 752 participants, who participated baseline examination in 1992-1993 and re-examination in 2007, were followed up till December 31, 2013 according to the study protocol of the Chinese Multi-provincial Cohort Study. Participants were stratified by baseline BP and re-examination BP and cross-combined into 9 subgroups. The 20-year incidence of acute cardiovascular events, acute coronary heart disease (CHD) and acute stroke events were analyzed and association between disease incidence and 15-year changes in BP were determined using the competing risk regression model. Results: (1) There were 523 CVD events (170 CHD, 373 stroke) during the 20 years follow up. The number of participants with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) of <130/80 mmHg (1 mmHg=0.133 kPa), 130-139/80-89 mmHg, and hypertension were 2 892 (50.3%), 1 328 (23.1%) and 1 532 (26.6%), respectively. (2) Among participants with baseline SBP of 130-139 mmHg or DBP of 80-89 mmHg, 870 (65.5%) progressed to hypertension and 279 (21.0%) maintained at the same stratum over a 15-year follow up period. (3) After adjustment for age, sex, body mass index, smoking status, diabetes, total cholesterol, and high-density lipoprotein cholesterol at baseline, participants maintained SBP/DBP at 130-139/80-89 mmHg had a higher risk of developing acute cardiovascular events, CHD and stroke with the hazard ratios (HR) and 95% confidence interval (95%CI) of 2.04 (1.16, 3.57), 3.29 (1.30, 8.35) and 1.63 (0.80, 3.33), compared with those who maintained their SBP < 130 mmHg and DBP <80 mmHg. Participants whose BP increased from 130-139/80-89 mmHg to hypertension over the follow up period had 2.81-fold (1.84, 4.29), 3.17-fold (1.43, 7.03) and 2.71-fold (1.65, 4.44) higher risk for the incidence of acute cardiovascular events, CHD, and stroke, respectively, compared with participants who maintained their SBP <130 mmHg and DBP <80 mmHg. Conclusions: Participants with SBP/DBP of 130-139/80-89 mmHg have a high long-term risk for progression to hypertension. Sustained exposure to SBP/DBP of 130-139/80-89 mmHg or higher increases the risk of CVD incidence, and our results highlight the importance of early prevention for participants with this BP stratum.

Baseline aortic pulse wave velocity is associated with central and peripheral pressor responses during the cold pressor test in healthy subjects.

Cold environmental temperatures increase sympathetic nerve activity and blood pressure, and increase the risk of acute cardiovascular events in aged individuals. The acute risk of cardiovascular events increases with aortic pulse wave velocity as well as elevated central and peripheral pulse pressures. The aim of this study was to examine the independent influence of aortic pulse wave velocity upon central and peripheral pressor responses to sympathetic activation via the cold pressor test (CPT). Twenty‐two healthy subjects (age: 18–73 years) completed a CPT with the left hand immersed in 2–4°C water for 3 min. During the CPT, central (from: 36 ± 7 to: 51 ± 12 mmHg) and peripheral pulse pressure increased (from: 54 ± 7 to: 66 ± 11; both P < 0.05). In all subjects the increase in central pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r 2 = 0.221, P = 0.027) but not age (P > 0.05). In a subset of subjects with higher arterial stiffness, the increase in peripheral pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r 2 = 0.415, P = 0.032) but not age (P > 0.05). These data indicate that central and peripheral pulse pressure responses during sympathetic activation are positively and independently associated with aortic pulse wave velocity through a wide age range. Decreasing aortic pulse wave velocity in aged individuals with elevated arterial stiffness may help reduce the incidence of acute cardiovascular events upon exposure to cold environmental temperatures.

Disease Activity and Increased Risk of Cardiovascular Death among Patients with Psoriatic Arthritis.

Recent studies indicate increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA), but results are inconsistent. This prompted our investigation of the mortality rate, cause of death, and incidence of acute CV events in patients from northern Sweden with PsA. Patients with established PsA (464) were included. To calculate standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for CV events, data were extracted from the National Causes of Death Register and the National Inpatient Care Register in Sweden, and compared with the general population. The study period was 1995-2011. To study the effect of inflammatory activity, a composite disease activity index (DAI) was used. The SMR (95% CI) for overall mortality and diseases of the circulatory system (International Classification of Diseases, 10th edition; I00-I99) was 1.22 (0.89-1.63) and 1.64 (1.02-2.52), respectively. In regression analysis, DAI was significantly associated with death (OR 1.99, 95% CI 1.41-2.80) when adjusted for age and sex (p < 0.001), and remained significant after stratifying patients into the 2 major causes of death: diseases of the circulatory system and malignant neoplasms. Peripheral and axial disease was associated with death (OR 4.02, 95% CI 1.84-8.84, p < 0.001) compared with peripheral disease only. The SIR (95% CI) for a CV event (myocardial infarction or stroke) was 0.597 (0.40-0.86); this association was only significant in men. Patients with PsA had a small but significant increase in SMR for death due to diseases of the circulatory system compared with the general population. Among patients, death was associated with DAI, as well as axial involvement in combination with peripheral disease, indicating more aggressive disease phenotypes.

Role of the Sympathetic Nervous System in Stress-Mediated Cardiovascular Disease.

A high incidence of acute cardiovascular events and sudden cardiac death following unexpected acute emotional stress or a natural catastrophic disaster has been well-documented over the past decades. Chronic psychosocial factors have been shown to be directly linked to the development of hypertension, cardiovascular disease and stroke. Activation of various neurogenic pathways is an important mediator of acute and chronic stress-induced hypertension and heart disease. Heightened sympathetic activation has been shown to be a critical contributor linking psychogenic effects on cardiovascular regulation to serious and often fatal CV outcomes. Accordingly, several therapeutic approaches that attenuate autonomic imbalance via modulation of increased sympathetic outflow by either non-pharmacological or interventional means have been shown to alleviate clinical symptoms. Likewise stress reduction per se achieved with transcendental medicine has been linked to improved patient outcomes. Therapies that oppose adrenergic activity and/or have the potential to attenuate negative emotions are likely to reduce cardiovascular risk and its adverse consequences attributable to chronic mental stress.

Abstract 16028: Sustained Increase in the Incidence of Acute Cardiovascular Events After the 2011 Northeast Japan Tsunami: A Population Based Study

BACKGROUD: No population based studies to date have reported the long-term effects on the incidence of acute myocardial infarction (AMI) and acute decompensated heart failure (DHF) after a devastating tsunami. METHODS: A population based AMI and DHF registration study was conducted in the Iwate prefecture 2 years before and 2 years after the 2011 Japan earthquake and tsunami. Clinical records were reviewed at all hospitals within the district and at nearby teaching hospitals. AMI including sudden cardiac death and DHF were then registered according to the MONICA criteria, and the Framingham definition, respectively. RESULTS: During the 4 year survey period, a total of 1,223 AMI cases (mean age = 74.5) and 1,416 DHF cases (mean age = 80.1) were identified. The standardized incidence ratio (SIR) and 95% CI for AMI and DHF during the disaster year of 2011 and the post disaster year of 2012 were determined respectively from the number of observed cases relative to the number of expected cases calculated by age adjusted incidence rates for two pre disaster years (2009-2010). When the SIR of AMI and DHF were compared between the control area and the tsunami stricken area (Figure), ratios for both AMI and DHF were significantly higher in the tsunami stricken area in the disaster year of 2011(AMI; 1.24, 95% CI 1.08 - 1.42: DHF; 1.58, 95% CI 1.43 - 1.74), and this increase was sustained even in the post disaster year of 2012 (AMI; 1.24, 95% CI 1.08 - 1.43: DHF; 1.28, 95% CI 1.15 - 1.43). However, in the control area with no significant tsunami damage, no such increase was apparent during the disaster year or the post disaster year. CONCLUSION: After the devastating tsunami, the incidence of AMI and DHF increased significantly and this increase was sustained for more than a year. This suggests that sudden drastic changes in daily life due to devastating natural disasters increase the incidence of acute cardiovascular events in a sustained manner