Increase In Cardiovascular Events Research Articles

Cardiovascular Outcomes of Romosozumab Treatment – Real World Data Analysis

Abstract Romosuzumab is a potent treatment for osteoporosis, with significant effects on bone density and fracture prevention. This study evaluated the cardiovascular safety of romosozumab in a real-world cohort of postmenopausal women at high fracture-risk. We retrospectively evaluated postmenopausal women who initiated treatment with romosuzumab between January 1, 2020, and June 30, 2023. We examined the occurrence of a Major Adverse Cardiovascular-Event (MACE) during and after treatment. After applying inclusion and exclusion criteria, 847 women were followed for a median of 729 days (interquartile range [IQR]: 445-1060). The incidence rate of MACE was 24.0 (95%CI 17.7-32.5) per 1000 person-years during the study period. The change in the rate of MACE from 0-90 days and 90-365 days post-treatment initiation was 0.04 and 0.06 events per 1000 days, respectively. The difference in the rate between these intervals was not statistically significant (P=.09). After 1 year of treatment, the slope of MACE increased to 0.10, differing significantly from the preceding 12 months on treatment (P<.001). The incidence of MACE was higher in those with a background of previous cardiovascular disease or diabetes at all timepoints, as expected. The consistency in event rates during treatment suggests that romosozumab is not associated with an increase in MACE in postmenopausal women. This finding challenges reports suggesting an increase in cardiovascular events within the first year of romosuzumab treatment.

Comparison between coronary calcium score and segment involvement score when used in clinical routine

Abstract Data from a nationwide registry on coronary computer tomography angiography. Background The Coronary Artery Calcium Score (CACS) and segment involvement score (SIS) are crucial factors in assessing the severity of coronary artery disease (CAD) and determining the likelihood of future cardiovascular events. However, there are few large multicenter studies comparing the predictive value of CACS and SIS when used in the clinical routine. Objectives To compare CACS and SIS ability to predict cardiovascular outcomes when used in the clinical routine. Methods This retrospective cohort study included patients who underwent Coronary Computed Tomography Angiography (CCTA) for CAD evaluation between 2006-2022 in 29 different centers in Sweden. CACS was calculated using the Agatston method, and SIS was determined based on the number of coronary segments exhibiting plaque. For SIS, patients were categorized into SIS=0, SIS=1, SIS=2, SIS=3, SIS³4, for CACS patients were categorized into CACS=0, CACS=1-9, CACS=10-99, CACS=100-299, CACS³300. Patients were followed regarding the primary outcome of death or myocardial infarction. Multivariable Cox proportional hazards models were used for adjusting for potential confounders. Results A total of 23034 patients underwent CCTA and were followed for up to ten years. Median age (IQR) was 58 (49–67) years, 50% were women, 9% had diabetes mellitus, 42% had hypertension, 25% had hyperlipidemia, 5% had previously known CAD. There were 955 patients (4.1%) with myocardial infarction (MI) and 409 patients (2.2%) died during follow up. There was an increase in cardiovascular events with increasing SIS. When comparing SIS and presence of obstructive stenosis, SIS was a better predictor of outcome (Figure 1). There was also an increase cardiovascular events with increasing CACS (Figure 2). When adjusted for age, sex, risk factors, previous cardiovascular disease and intervention, both SIS and CACS were independently associated with outcome. When SIS and CACS were compared in a receiver operating characteristic curve, CACS had significantly larger AUC than SIS, (0.70[0.67-0.73] vs 0.62[0.60-0.63]). Conclusion Our findings show that both CACS and SIS are important and independent predictors of cardiovascular outcomes thereby offering a valuable tool for personalized risk stratification and management in clinical settings. When used in the clinical routine, CACS appears to be more strongly associated with outcome than SIS.Figure1 Survival SISFigure 2 Survival CACS

Synergistic effects of glucose tolerance and BMI on cardiovascular events and all-cause mortality in a healthy population: CA.ME.LI.A study 7 years follow-up.

The CA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) epidemiological study was conducted in Abbiategrasso (Milan, Italy) to identify risk factors for metabolic and cardiovascular disease in an apparently healthy population of northern Italy. The population (n = 2,545, 1,251 men, 1,254 women) was stratified according to body mass index [normal body weight (NBW): <25 kg/m2; overweight-obese (OWO): ≥25 kg/m2] and according to fasting blood glucose [normal fasting glucose: <100 mg/dL; impaired fasting glucose (IFG): 100-125 mg/dL; diabetes mellitus (DM): ≥126 mg/dL]. The incidence of cardiovascular (CV) events and overall mortality were studied by the Kaplan-Meier method using the log rank test. Univariate analysis was conducted with time-dependent Cox models. During the 7-yr follow-up period, 80 deaths and 149 CV events occurred. IFG [hazard ratio (HR): 2.81; confidence interval (CI): 1.37-5.77; P = 0.005], DM (HR: 4.88; CI: 1.47-16; P = 0.010), or OWO (HR: 2.78; CI:1.68-4.59; P < 0.001) all produced significant increases in CV events and deaths. In the combination IFG/OWO (HR: 5.51; CI: 3.34-9.08; P < 0.001), there was an apparent additive effect of the two conditions, whereas in the combination DM/OWO (HR: 12.71; CI: 7.48-22; P < 0.001), there was an apparent multiplicative effect on the risk for CV events and deaths. In males, the DM/NBW group had a higher incidence of cardiovascular events and deaths than the IFG/OWO group. In contrast, in females, the IFG/OWO group had a higher incidence of cardiovascular events and deaths than the DM/NBW group. In women, there was a greater incidence of CV events in the IFG/OWO group (HR: 6.23; CI: 2.88-13; P < 0.001) than in men in the same group (HR: 4.27; CI: 2.15-8.47; P < 0.001). Consistent with these data, also all-cause mortality was progressively increased by IFG/DM and OWO, with an apparently exponential effect in the combination DM/OWO (HR: 11.78; CI: 6.11-23; P < 0.001). IFG/DM and OWO, alone or in combination, had major effects in increasing mortality for all causes and CV events. The relative contributions of hyperglycemia and overweight/obesity on cardiovascular events and deaths were apparently, to a certain extent, sex dependent. Females were more affected by overweight/obesity either alone or combined with IFG, as compared with males.NEW & NOTEWORTHY For the first time, the combined effects of glucose tolerance and BMI have been investigated in an apparently healthy large population sample of a city in the north of Italy. We found that there are synergistic effects of glucose levels with BMI to increase not only cardiovascular events and deaths but also cancer-related deaths and all-cause mortality.

Clinical case of indacaterol / glycopyrronium bromide prescription in a patient with severe copd and concomitant pathology

Combinations of inhaled glucocorticosteroids (IHGC) and long-acting bronchodilator inhalers (LABA inhalers) have been widely used to treat chronic obstructive pulmonary disease (COPD) over the past two decades. Prescription of these drugs was based on large studies showing that this therapeutic regimen was more effective compared to placebo and monotherapy. The article presents a clinical case report of a patient with severe course of COPD and coronary heart disease (CHD). Up-to-date concepts of using dual bronchodilator therapy when switching from combinations of inhaled glucocorticosteroids and long-acting bronchodilator inhalers (IHGC/LABA) is discussed. A patient with COPD and coronary artery disease, atrial fibrillation while using IHGC/LABA had progressive respiratory failure, frequent exacerbations, and acute symptomatology. As there is evidence that the use of IHGC/LABA has a number of limitations in the combined course of COPD and cardiovascular diseases, first of all in coronary artery disease and arrhythmias, it was recommended to replace therapy with a combination of dual bronchodilators – a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA). The therapy resulted in stabilization of the condition, reduction of clinical symptoms, and absence of cardiovascular complications. It has been concluded that the dual bronchodilator therapy with a combination of glycopyrronium bromide and indacaterol is prioritized in COPD, including COPD combined with cardiovascular pathology; no increase in cardiovascular events in patients with COPD combined with coronary artery disease is observed; Breezhaler inhaler is user-friendly for the patients and has advantages over other delivery devices.

LOW-RENIN VERSUS NON-LOW RENIN HYPERTENSION: A COMPARISON OF CONTROL IN A SPECIALIST CLINIC

Objective: A significant proportion of hypertensive individuals display a low-renin profile and are commonly referred as subjects with low-renin-hypertension (LRH) phenotype. LRH is associated with a significant increase in cardiovascular events but it is debated whether it is more difficult to treat than non-low-renin hypertension (NLRH). Here, we investigated the prevalence of LRH and blood pressure (BP) control at 3 and 12 months in specialist centre in the UK. Design and method: Consecutive hypertensive subjects not on treatment with beta-blockers and centrally acting drugs were recruited from the hypertension outpatient service at Guy's and St. Thomas’ Hospital, London. Anthropometric variables, biochemistry assessment and BP measurement were evaluated in a baseline visit following which subjects were classified as LRH if renin concentration was &lt; 5mU/L. Clinical data at 3 and 12 months were then used to assess BP control. Results: 205 patients ((mean±SD) age 44±13 years, 61% male) of whom 92% on pharmacological treatment were recruited. Prevalence of LRH was 28% and the two groups (LRH/NLRH) were similar in age, gender, body mass index, prevalence of diabetes and dyslipidaemia. Subjects with LRH (n=59) had higher systolic BP values compared to NLRH (156±23 mmHg vs 147±20 mmHg, P=0.013) whilst the difference was non-significant for diastolic BP (94±14 mmHg vs 91±14 mmHg, P=0.175). Decrease in systolic BP values were greater in LRH compared to NLRH at 3 months and 12 months (10.8±2.9 mmHg vs 5.1±1.6 mmHg and 13.1±3.4 mmHg and 6.3 ±1.7 mmHg respectively, both P&lt; 0.05). with BP values at 12 months similar between the two groups (144±20/88±11 mmHg vs 141±16/89±12 mmHg for LRH and NLRH respectively, P=0.375, Figure 1). Treatment at 12 months differed in the two groups, with LRH patients more likely to be prescribed diuretics (39% vs 25%) and less likely to be prescribed ACE-i/ARB (39.0% v 61.4%), both P&lt;0.05. Conclusions: LRH phenotype is common among patients evaluated in a specialist centre for hypertension. Despite higher BP values at the time of the encounter, LRH patients achieve similar levels of BP control compared to NLRH at 3 and 12 months during the follow up.

Cardiovascular Risk Management In Patients With Rheumatoid Arthritis: A Systematic Review.

Rheumatoid arthritis (RA) is an autoimmune chronic inflammatory joint disease associated with pain, swelling, and morning stiffness. It not only affects the joints but also exhibits many extra-articular manifestations. It is recognized as an independent risk factor for cardiovascular (CV) abnormalities. The possibility of cardiovascular disease (CVD) risk in patients with RA is about twofold higher compared to non-RA individuals. Therefore, early risk assessment and management of risk factors are crucial to reduce the CV morbidity and mortality associated with RA. This systematic literature review summarizes the data available on the management of CVD risk factors in RA. A total of 61 articles from the most reputable journals published between 2013 and 2023 were reviewed, of which seven papers were selected for in-depth analysis. We tried to eliminate bias using various bias-eliminating tools. This analysis considers the proposed solution for CV risk prevention and management in RA patients. Optimal control of disease activity and persistent monitoring of other factors responsible for increased CV events in RA patients is the ultimate management of CV abnormalities. This study summarizes the recommendations for the management of CV risk factors in patients with RA.

Association of a genetic variant in angiopoietin-like 3 with serum HDL-C and risk of cardiovascular disease: A study of the MASHAD cohort over 6 years.

Loss-of-function (LOF) variants of the angiopoietin-like 3 (ANGPTL3) gene are reported to be associated with serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) concentrations and thereby affect the risk of cardiovascular disease (CVD). In the present study, we examined the association of rs10789117 in the ANGPTL 3 gene locus and the risk of CVD in the group of people who were part of the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort. One thousand and two healthy individuals enrolled in this study of whom 849 subjects were healthy and 153 subjects developed CVD outcomes after 6 years of follow-up. After a 12-h overnight fasting, 20 mL of blood samples were collected for the measurement of fasting blood glucose and lipid profile. DNA was extracted, and the Tetra-ARMS PCR (amplification refractory mutation system) was used for genotyping of rs10789117 in the ANGPTL3 gene. The genotype frequencies of the variant of rs10789117 in the ANGPTL3 gene were estimated using χ2 tests. Eventually, the statistical analysis was done by SPSS version 20. Individuals with AC/CC genotypes (rs10789117) were found to have to greater risk of CVD events compared to AA genotype (OR = 1.43, 95%CI = 1.01-2.02, p = 0.041). There was a 1.3-fold increase in cardiovascular events in individuals carrying the C allele of rs10789117 variant compared to non-carriers (OR = 1.32, 95%CI = 1.06-1.72, p value = 0.038). There were significant differences between different genotypes for serum triglyceride levels within the control group, but this difference was not significant in the group with CVD. Moreover, there was a significant association between CC genotype and CVD risk in the individuals with a normal serum HDL-C. We have found that a rs10789117 C>A in ANGPTL3 gene polymorphism was associated with incident CVD events, and this may be of value as a risk stratification biomarker in CVD in the Iranian population.

Differences in coronary angiographic findings and outcomes between men and postmenopausal women with stable chest pain.

Despite the significant increase in cardiovascular events in women after menopause, studies comparing postmenopausal women and men are scarce. We analyzed data from a nationwide, multicenter, prospective registry and enrolled 2412 patients with stable chest pain who underwent elective coronary angiography. Binary coronary artery disease (b-CAD) was defined as the ≥50% stenosis of epicardial coronary arteries, including the left main coronary artery. Compared with the men, postmenopausal women were older (66.6 ± 8.5 vs. 59.5 ± 11.4 years) and had higher high-density lipoprotein cholesterol levels (49.0 ± 12.8 vs. 43.6 ± 11.6 mg/dl, P < 0.01). The prevalence of diabetes did not differ significantly ( P = 0.40), and smoking was more common in men than in postmenopausal women ( P ≤ 0.01). At enrollment, b-CAD and revascularization were more common in men than in postmenopausal women (50.3% vs. 41.0% and 14.4% vs. 9.7%, respectively; both P < 0.01). However, multivariate analyses revealed that revascularization [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.49-1.08] was not significantly related to sex and a similar result was found in age propensity-matched population (OR: 0.80; 95% CI: 0.52-1.24). During the follow-up period, the secondary composite cardiovascular outcomes were lower in postmenopausal women than in men (OR: 0.55; 95% CI: 0.31-0.98), also consistent with the result using the age propensity-mated population (OR: 0.33; 95% CI: 0.13-0.85). Postmenopausal women experienced coronary revascularization comparable to those in men at enrollment, despite the average age of postmenopausal women was 7 years older than that of men.Postmenopausal women exhibit better clinical outcomes than those of men if optimal treatment is provided.

Cardiovascular Safety of Amphetamine/Dextroamphetamine versus Methylphenidate in Older Adults

Background: Recent epidemiological data has shown a sharp increase in stimulant use among older adults, which is notable as older adults may be especially vulnerable to their cardiovascular effects. Results of recent studies have shown an increase in cardiovascular events among older adults using stimulants; however, little data exists comparing cardiovascular safety of these agents head-to-head. Objective: To determine if the incidence of serious cardiovascular events, including myocardial infarction (MI), stroke/transient ischemic attack (TIA), or arrhythmia, are different in patients taking amphetamine/dextroamphetamine compared with patients taking methylphenidate. Methods: Retrospective chart review of veterans 50 years and older at the Veterans Affairs North Texas Health Care System (VANTHCS) who were first prescribed a stimulant between 2015 and 2021. The primary outcome was the difference in composite cardiovascular events between amphetamine/dextroamphetamine and methylphenidate. Secondary outcomes were the composite cardiovascular endpoints compared individually (MI, stroke/TIA, or arrhythmia). Hazard ratios were calculated based off of a time-to-event analysis displayed using a Kaplan-Meier curve for primary and secondary outcomes. Results: 466 veterans were screened for inclusion, 30 were excluded, and 436 were included. There was no difference found in composite cardiovascular events between the 241 veterans in the amphetamine/dextroamphetamine group and the 195 veterans in the methylphenidate group with 12 (5%) vs 8 (4.1%) events respectively (P = .6635). There was also no difference in time-to-event analysis (P = .4966). Conclusion: In elderly veterans, there was no difference found in incidence of major cardiovascular events with the use of amphetamine/dextroamphetamine compared with methylphenidate.

Abstract 13817: Very Short-Term Blood Pressure Variability by Pulse Transit Time-Based Measurements During Sleep Predicts Future Cardiovascular Events in Patients With Ischemic Heart Disease

Background: Blood pressure (BP) variability (BPV) is recognized as an independent factor associated with cardiovascular (CV) events. However, monitoring very short-term BPV, which occurs within seconds or minutes remains challenging, and its prognostic impact has yet to be established. In a previous study, we reported that pulse transit time (PTT) enabled monitoring beat-to-beat BP, which is useful for evaluating very short-term BPV during sleep. Aims: This study aimed to clarify the prognostic relevance of PTT-based very short-term BPV during sleep. Methods and Results: We conducted a prospective study involving 206 consecutive hospitalized patients (mean 67.6 years old, 78.1% male) with ischemic heart disease. PTT-driven BP was continuously recorded during the night. To assess very short-term BPV, we defined the PTT index as the average number of acute transient rises in systolic BP (≥12 mmHg) within 30 s/h, and the standard deviation (SD) of PTT-BP was calculated. We followed up with patients for a median of 759 days and observed 49 CV events, including cardiac death, worsening heart failure, acute coronary syndrome, and ischemic stroke. Kaplan-Meier analysis revealed that patients with higher PTT index, as well as higher SD of mean and diastolic PTT-BP were associated with increased CV events ( Figure ). In a multivariate Cox proportional hazards analysis, after adjusting for confounding variables, PTT index, as well as SD of mean and diastolic PTT-BP were independently associated with increased risks of adverse events (hazard ratio, 1.019, 1.245, and 1.244; P = 0.02, 0.04, and 0.09, respectively). Conclusions: PTT-index and SD of mean and diastolic BP during the night, which represent measures of very short-term BPV, predicted the future risk of CV events in patients with ischemic heart disease through the PTT-driven approach and may serve as a target to reduce the residual risk in such patients.

OR26-05 Long-term Mortality And Cardiometabolic Effects Of Treatment For Hyperthyroidism: EGRET Study

Abstract Disclosure: B. Torlinska: None. J.M. Hazlehurst: None. K. Nirantharakumar: None. G. Thomas: None. P. Julia: None. K.R. Abrams: None. K. Boelaert: None. Objectives: Hyperthyroidism has been linked to long-term cardiovascular and metabolic morbidity and increased mortality. Current evidence indicates differential cardio-metabolic effects from antithyroid drugs (ATD) and definitive treatment options (radioiodine or thyroidectomy). We aimed to assess differences in mortality and cardiometabolic outcomes depending on treatment modality to better inform patient-clinician decision-making. Methods: We identified 55,318 patients with newly diagnosed hyperthyroidism, treated with ATD, radioiodine or thyroidectomy from a UK population-based electronic health record database (&amp;gt;2,000 contributing primary care practices, &amp;gt;16M patients). Health records were linked with Office for National Statistics (ONS) mortality data, (Hospital Episode Statistics) HES, and Health Survey for England for background BMI comparison. All-cause mortality, major cardiovascular events (MACE: cardiovascular death, heart failure or stroke) and post-treatment obesity diagnosis were studied. A “target trial” approach was used to allow to elucidate causal effects from observational data; average treatment effects (ATE) were estimated. Confounding was controlled for using inverse-probability weights (IPW) with regression adjustment. Mortality was assessed as time-to-event; other outcomes were modelled as binary (funded by NIHR RfPB, NIHR200772). Results: Patients treated with ATD comprised 77.6% of the cohort; 14.6% were treated with radioiodine, and 7.8% with thyroidectomy. The average follow-up was 12.1 years (SD 5.2). Estimated mean survival was 12.0 years with ATD treatment. Definitive treatment increased survival: radioiodine by 1.7y. (95%CI: 1.2-2.2; P&amp;lt;0.0001) and thyroidectomy by 1.1y. (0.1-2.0; P=0.03). The estimated risk of MACE if the population were treated with ATD was 10.2% (9.9-10.5), which significantly increased by an additional 1.3% (0.5-2.1; P=0.001) with radioiodine but not with thyroidectomy (0.1% [-1.1, 1.3], P=0.08). Compared with background population, thyroidectomy was associated with an increased likelihood of obesity in both men (OR=1.57 [1.29-1.91], P&amp;lt;0.0001), and women (1.27 [1.16-1.39], P&amp;lt;0.0001), while radioiodine increased obesity risk in women (1.13 [1.06-1.20], P=0.0002) but not in men (1.04 [0.93-1.16], P=0.5). Conclusion: EGRET is the first large study using population-based linked community and hospital data to evaluate long-term consequences of treatment modalities for hyperthyroidism. We confirmed a decreased mortality in patients undergoing definitive treatment whereas a slightly increased risk of obesity was found in patients treated with radioiodine and surgery. Compared to medical treatment, a small increase in cardiovascular events was noted with radioiodine. Presentation: Saturday, June 17, 2023

Doble reparación tricuspídea mediante técnica de De Vega y anillo. Revisión de nuestra experiencia

Introduction/objectivesTricuspid regurgitation is the main indication for tricuspid valve repair. Undertreatment or late approach lead to a worse prognosis with an increase in cardiovascular events and mortality. A perfect annuloplasty technique that provides excellent results without complications does not exist. In this article we analyze the results obtained after combining two of the main tricuspid repair techniques with the aim of counteracting their deficiencies and improving long-term results. MethodsA seven-year retrospective study of all the tricuspid repair procedures performed in our center, comparing the results of the different techniques applied. Results153 patients with ages between 52 and 79 years were studied, with a mean age of 62.8 years. 10.5% underwent mixed technique of De Vega annuloplasty+Carpentier ring. When performing the mixed technique, no recurrence of tricuspid regurgitation was evidenced in any case during follow-up. ConclusionsThe results suggest that the De Vega annuloplasty prior to the implantation of the Carpentier prosthetic ring allows a rapid repair, with the possibility of adjustments in case of unsatisfactory repair results without compromising ischemia and facilitates the choice of the correct prosthesis size.

MWF RAT AS A NOVEL ANIMAL MODEL OF CARDIORENAL SYNDROME TYPE IV

Objective: Cardiorenal syndrome type 4 (CRS type 4) is characterized by primary chronic kidney disease (CKD) leading to cardiac dysfunction and an increase in cardiovascular events. There is an unmet need for suitable animal models of CRS to further define the pathogenesis and progression of CRS to test new therapeutic strategies. We aim to determine if CKD in aged Munich Wistar Frömter (MWF) rat may translate to cardiovascular alterations of CRS. Design and method: Profibrotic markers and angiotensin receptor (ATR) expression was measured by RT-q-PCR in kidney, aorta and heart from 22 and 45-week-old (aged) male MWF rats (n = 7-10/group). Results: Aged MWF showed higher renal expression of tubular damage markers (Kim-1 and Ngal) and profibrotic factors (Col1A1, Col3A1, TGF-beta) together with lower levels of AT2R. Thoracic aorta also exhibited increased expression of profibrotic CTGF-1 and Col1-A1, as well as a lower AT2R expression. Both age groups were hypertensive with similar systolic and diastolic blood pressure levels. However, aged MWF had an increased PWV and heart weight, together with increased intrinsic arterial stiffness and an outward hypertrophic remodeling in mesenteric arteries. In 45-week-old MWF, levels of cardiac CTGF-1, AT1R and AT2R were higher, whereas TGF-beta expression was lower. No differences were observed for Col1A1 or Col3A1. Conclusions: The presence of renal and vascular fibrosis, hypertension, arterial stiffness and cardiac hypertrophy, together with inflammation, vascular remodeling and early profibrotic cardiac environment, potentially counterregulated by AT2R make aged-MWF rat an useful model for CRS study.

THE PREDICTION OF CARDIOVASCULAR EVENTS BY PHENOTYPE OF CENTRAL AND PERIPHERAL BLOOD PRESSURE IN SUBJECTS WITHOUT HYPERTENSION

Objective: Hypertension (HBP) is a common disease with aging, but the rate of recognition or poor control is still high. Until now, most guidelines related to HBP consisted of only peripheral blood pressure (BP) measurement. However, according to many studies, it is known that central BP (CBP) has a clearer relationship than peripheral BP, which can more clearly express an individual's BP status with the prediction of cardiovascular (CV) events. Therefore, we aimed to evaluate the effect of CBP on the prediction of CV events and to investigate the prediction of CV events by phenotype of central and peripheral BP in subjects without hypertension. Design and method: A total of 2910 patients were enrolled from June 2011 to December 2016, and were followed up through October 2022. CBP was measured using radial tonometry. The primary endpoints were composite outcome. Results: The median follow-up period for enrolled patients was 7.5 years. Out of a total of 722 patients (mean age of 52.5 ± 13.7 years) without HBP, 21 patients (2.9%) had events of primary end points during the follow up period. Systolic BP averaged 126 mmHg (±15 mmHg) in the event-free group and 136 mmHg (±15 mmHg) in the CV event group, while CBP measured 115 mmHg (±16 mmHg) in the event-free group and 126 mmHg (±16 mmHg) in the CV event group. In Cox proportional hazards model, CBP and systolic BP, every 10 mmHg increase, showed an increase in risk of 30% and 40% respectively. Isolated central systolic hypertension and both central and peripheral systolic hypertension showed 4.9 % and 6% of the CV event rate, respectively (p = 0.897). Conclusions: Irrespective of the brachial BP status, isolated central hypertension increased CV events. Therefore, to prevent CV events is an essential control not peripheral BP but also CBP.

Treating chronic kidney disease to reduce cardiovascular risk.

Chronic kidney disease (CKD) is a complex syndrome and a relevant problem of public health due to its large incidence and prevalence and to the high costs for its management. The hallmark of CKD, the progressive reduction in the glomerular filtration rate (eGFR), is strongly associated with an increase in cardiovascular events, such as fatal and non-fatal heart attack, stroke and heart failure, and mortality. Therefore, clinicians should pay any effort for preventing or slowing down the decline of renal function in order to reduce not only the occurrence of critical renal events (the need for dialysis or renal transplantation, among the most dreadful) but also the incidence of cardiovascular events. Accordingly, an early diagnosis and a targeted treatment in patients with kidney disease are crucial to reduce the evolution towards more advanced stages of the disease and the occurrence of complications. For a long time, the therapeutic approach to the majority of CKD patients was based on the strict control of risk factors, such as the diabetic disease and hypertension, together with the use of renin-angiotensin-aldosterone system inhibitors, particularly in the presence of albuminuria. Over time, this strategy proved to be only partially effective, since most CKD patients showed a progressive worsening of renal function. Gliflozins and incretins are novel anti-diabetic drugs that have been demonstrated to slow down the slope of eGFR reduction in patients with CKD, irrespective of diabetic status. Concurrently, these drugs showed to significantly impact cardiovascular prognosis reducing the incidence of clinical events. For their ability to act on a wide spectrum of disease, gliflozins and incretins are also called 'cardio-nephro-metabolic' drugs.

Prevalence and Safety of Prescribing PPIs with Clopidogrel in Palestine.

Proton pump inhibitors (PPIs) are commonly prescribed medications that are thought to increase the risk of cardiovascular events because they reduce the effectiveness of clopidogrel via shared hepatic pathways. This study examined the prevalence of concomitant prescribing of clopidogrel/PPI among patients diagnosed with acute coronary syndrome and the adverse cardiovascular event associated with this interaction. A retrospective cohort study was conducted by retrieving patient data from the Nat Health Insurance claims processor database in Palestine. Adults diagnosed with Acute Coronary Syndrome (ACS) from 2019 through 2021 who were prescribed clopidogrel or clopidogrel in combination with a PPI were included in the study. Endpoints were adverse cardiac events, including readmission for revascularization during the first year of treatment. The study included 443 patients; the prevalence of prescribing concomitant clopidogrel with a PPI was 74.7%, whereas 49.2% were prescribed interacting PPI (omeprazole, esomeprazole, and lansoprazole). 59 (13.3%) of participants experienced a cardiovascular event within 1 year of starting therapy, including 27 (12.4%) patients who had a cardiovascular event while taking an interacting PPI. No significant association was found between PPI administration and increased CV event risk in patients receiving concomitant clopidogrel and PPIs therapy (p = 0.579). In this study, we observed a high prevalence of prescribing a PPI in combination with clopidogrel, regardless of the FDA recommendations. No significant increase in cardiovascular events was observed in patients receiving concomitant clopidogrel and PPI therapy.

PS-C27-6: HIGH BRACHIAL-ANKLE PULSE WAVE VELOCITY IS ASSOCIATED WITH THE RENAL OUTCOME IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERTENSION

Background: Increase in arterial stiffness is associated with increase in cardiovascular events and mortality. Although studies have shown an association between arterial stiffness and chronic kidney disease (CKD), the association between CKD progression and arterial stiffness has not been clearly defined. The aim of this study is to investigate the association between brachial-ankle pulse wave velocity and chronic kidney disease progression in CKD patients with hypertension. Methods: A total of 717 CKD (stage 3 to 5) patients with hypertension were enrolled from the prospective observational cohort of CMERC-HI (Cardiovascular and Metabolic Disease Etiology Research Center-High Risk). Patients were classified into tertile based on brachial-ankle PWV: low, intermediate, high. Primary outcome was progression of CKD, which was composite of at least 50% decrease in estimated glomerular filtration rate (eGFR) from baseline or end stage kidney disease requiring dialysis. Results: The mean age of study subjects was 60.7 ± 11.8 years and 404 (56.3%) were male. During a median follow-up of 42.5 months, CKD progression occurred in 213 (29.7%). There were statistically significant differences in age (54.0 ± 12.1, 61.0 ± 11.1, 67.1 ± 8.2 in low, intermediate, high group, respectively, P &lt; 0.001) among brachial-ankle PWV tertile groups. In multivariate Cox analysis, brachial-ankle PWV above the median value was related to increased risk of CKD progression (HR, 2.29; 95% CI, 1.33–3.94, P = 0.003) compared to subjects with brachial-ankle PWV below the median. In addition, when the study population was divided into tertiles, the intermediate and high brachial-ankle PWV group were associated with progressively increased risk of CKD progression (HR, 2.03; 95% CI, 1.09–3.77, P = 0.03, HR, 2.51: 95% CI, 1.27–4.96, P = 0.008) compared to low brachial-ankle PWV group after adjusting for confounding factors. The Kaplan-Meier analysis also showed statistically significant association between brachial-ankle PWV and CKD progression. In contrast, there was no statistically significant association between CKD progression and femoral-ankle PWV, an index for peripheral arterial stiffness, which suggests that increase in central arterial stiffness is associated with CKD progression. Conclusions: High brachial-ankle pulse wave velocity may be an independent predictor of CKD progression in CKD patients with hypertension.

Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction?

Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.

43 CARDIAC TROPONINS AND COVID-19: WHAT DO WE KNOW ABOUT HETEROPHILIC ANTIBODIES?

Abstract Background During the Coronavirus disease-19 (COVID-19) pandemic, a significant increase in cardiovascular events and death for acute Myocardial Infarction (AMI) has been widely described. In turn, cardiac troponins represent the main serum diagnostic biomarkers of AMI. However, several mechanisms of troponins elevation other than AMI could be identified such as the analytic interference due to the Heterophilic Antibodies (HA), which represents a less explored and underestimated cause. Methods The research of the following keywords “Heterophilic” or “Heterophile Antibodies” associated with “Troponin”, “Troponin I”, “Troponin T” or “High-sensitive Troponin” have identified 73 works in the most popular bibliographic databases such as PubMed, Scopus, and Web of Science, in which the first was published in 1998. In our systematic review, the inclusion criteria have considered all the works in which clinical information about the patients are described. The results have included 55 papers for an overall population of 128 cases that have presented HA's interference in troponins’ assay. In the great part of the works, HA's capture test has been performed to diagnose this interference. The association between HA and COVID-19 has also been explored with the identification of three works in scientific literature. In addition, we reported a clinical case of a young patient with persistent high serum ultra-sensitive Troponin levels due to HA, during the COVID-19 pandemic. Results The results have indicated the most at-risk population in patients with a history of multiple hospitalizations and with poor cardiovascular risk factors, who usually complained of atypical chest pain combined with persistent elevation of cardiac troponins without high CK-MB values. Instead, only a few data could be isolated in the literature about HA's interference on troponins essay in COVID-19 patients. However, has been widely ascertained how increased serum levels of cardiac troponins have been identified in most of the SARS-COV-2 swabs positive populations, and several cardiac and extracardiac mechanisms may explain this condition. Conclusions The description of the most common clinical features of patients with HA's interference could help clinicians to early recognize this phenomenon, reducing the number of instrumental examinations and the hospitalization period of these patients. Therefore, the analytical mistake due to HA could be always considered in AMI differential diagnosis, and the use of HA's capture test in the at-risk population may determine an early diagnosis. Finally, the HA's phenomenon could increase during the COVID-19 period, considering how infections and vaccinations may stimulate heterophile's activity.

Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Patients With Diabetes Undergoing Percutaneous Coronary Intervention

BackgroundDiabetes was reported to be associated with an impaired response to clopidogrel. ObjectivesThe aim of this study was to evaluate the safety and efficacy of clopidogrel monotherapy after very short dual antiplatelet therapy (DAPT) in patients with diabetes undergoing percutaneous coronary intervention (PCI). MethodsA subgroup analysis was conducted on the basis of diabetes in the STOPDAPT-2 (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2) Total Cohort (N = 5,997) (STOPDAPT-2, n = 3,009; STOPDAPT-2 ACS [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2 for the Patients With ACS], n = 2,988), which randomly compared 1-month DAPT followed by clopidogrel monotherapy with 12-month DAPT with aspirin and clopidogrel after cobalt-chromium everolimus-eluting stent implantation. The primary endpoint was a composite of cardiovascular (cardiovascular death, myocardial infarction, definite stent thrombosis, or stroke) or bleeding (TIMI [Thrombolysis In Myocardial Infarction] major or minor) endpoints at 1 year. ResultsThere were 2,030 patients with diabetes (33.8%) and 3967 patients without diabetes (66.2%). Regardless of diabetes, the risk of 1-month DAPT relative to 12-month DAPT was not significant for the primary endpoint (diabetes, 3.58% vs 4.12% [HR: 0.87; 95% CI: 0.56-1.37; P = 0.55]; nondiabetes, 2.46% vs 2.49% [HR: 0.99; 95% CI: 0.67-1.48; P = 0.97]; Pinteraction = 0.67) and for the cardiovascular endpoint (diabetes, 3.28% vs 3.05% [HR: 1.10; 95% CI: 0.67-1.81; P = 0.70]; nondiabetes, 1.95% vs 1.43% [HR: 1.38; 95% CI: 0.85-2.25; P = 0.20]; Pinteraction = 0.52), while it was lower for the bleeding endpoint (diabetes, 0.30% vs 1.50% [HR: 0.20; 95% CI: 0.06-0.68; P = 0.01]; nondiabetes, 0.61% vs 1.21% [HR: 0.51; 95% CI: 0.25-1.01; P = 0.054]; Pinteraction = 0.19). ConclusionsClopidogrel monotherapy after 1-month DAPT compared with 12-month DAPT reduced major bleeding events without an increase in cardiovascular events regardless of diabetes, although the findings should be considered as hypothesis generating, especially in patients with acute coronary syndrome, because of the inconclusive result in the STOPDAPT-2 ACS trial. (Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2 [STOPDAPT-2], NCT02619760; Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus-Eluting Cobalt-Chromium Stent–2 for the Patients With ACS [STOPDAPT-2 ACS], NCT03462498)