Indicator Of Cardiovascular Risk Research Articles

AW-AD-2: ASSOCIATION BETWEEN AMBULATORY BLOOD PRESSURE AND RISK OF HOME HYPERTENSION IN A NORMOTENSIVE POPULATION

Objective: Most of the hypertension management guidelines recommend out-of-office blood pressure (BP) measurement such as self-measured BP at home (home BP) and ambulatory BP monitoring for the accurate diagnosis and management of hypertension. Both out-of-office BP measurements are more useful than office BP as prognostic indicators of cardiovascular risk. However, no prospective study has assessed the longitudinal association between the two types of out-of-office BP measurements. Therefore, we investigated the association between ambulatory BP and the risk of home BP-based hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous study. Desigh and method: We followed up 410 participants (83.2% women; age, 53.6 years) without home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios for home hypertension (home BP ≧135/≧85 mmHg or initiation of antihypertensive treatment). In addition, the predictive ability for home hypertension incidence between the models adjusted for the covariates with 24-h, daytime, or nighttime SBP was examined using Harrell's C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The NRI considers changes in the estimated prediction probabilities that imply a change from one category to another between different models. IDI is defined as the difference between the discrimination slopes of a basic model and an extended model. Results: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The hazard ratio (95% confidence interval) for home hypertension incidence per 1-standard deviation increase in 24-h systolic BP (SBP) was 1.59 (1.33–1.90) after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistic was 0.72 (0.69–0.75) for the basic 10-year risk prediction model, which includes sex, age, BMI, current or ex-smoker status, office SBP, and baseline home SBP. By adding 24-h, daytime, or nighttime SBP to the basic model, continuous NRI and IDI significantly improved although no significant improvement in Harrell's C-statistics was observed. Conclusions: Independent of the baseline home SBP, 24-h SBP was associated with the risk of home hypertension in a normotensive population. The prediction model for home hypertension risk was improved by the addition of 24-h SBP to the basic model. It could be useful to measure ambulatory BP for the early detection of home hypertension.

New look at the power of zero coronary artery calcium (CAC) in Asian population: a systemic review and meta-analysis.

Numerous studies have validated a 5-year warranty period for heart health in Western populations with a coronary artery calcium (CAC) score of zero. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. This meta-analysis aimed to clarify the uncertainty surrounding the prevalence, warranty period, and prognostic implications of zero CAC scores in Asian populations. It also examined the impact of sex on subclinical CAC progression. While the calcium score is a crucial cardiovascular risk indicator, its interpretation in Asian populations remains unclear. The study aimed to shed light on these issues by exploring the specificities of subclinical CAC progression in the Asian context. Our systematic literature search, from the study's inception to October 2023, targeted studies on subclinical CAC progression in the Asian population with a zero CAC score. We searched the Cochrane Library, and PubMed. The search terms included "zero score", "coronary calcification", "zero CAC score", and "CAC scan". We evaluated seven published studies through a meta-analysis and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). In this meta-analysis of three observational studies addressing zero CAC prevalence (n=7,661), the pooled prevalence of zero CAC scores in the Asian population was 18.2% [95% confidence interval (CI): 12.5-25.9%]. A significant difference in follow-up warranty period was observed between the CAC zero group and subclinical CAC progression group (mean difference, 1.26 years; 95% CI: 0.94-1.58; P<0.001). Furthermore, the conversion rate of subclinical CAC progression differed significantly between males and females (risk ratio, 2.37; 95% CI: 1.98-2.84; P<0.001). Analysis of four studies revealed a notable discrepancy in the major adverse cardiovascular event (MACE) rate between the CAC (-) and CAC (+) groups (risk ratio, 4.78; 95% CI: 2.21-10.36; P<0.001). The meta-analysis of zero CAC scores in Asian populations suggested an 18.2% prevalence. A 5-year warranty period was noted, with heightened subclinical CAC progression likelihood after this duration. Additionally, sex-based differences were observed in subclinical CAC progression rates. These findings will provide clinical cardiovascular risk stratification for guiding gender-specific clinical decision-making in asymptomatic in Asian individuals.

Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients

Purposes Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. Methods The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. Results Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. Conclusions The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.

Effects of a theory‐based exercise intervention on physical activity levels and health‐related outcomes in older people with chronic diseases

The benefits of physical activity are well-documented, and the prevalence of physical inactivity is high in older patients with chronic diseases. This study aimed to investigate the impact of an aerobic exercise intervention based on the capacity, opportunity, motivation-behavior (COM-B) model on physical activity and health-related outcomes in this population. Thirty-five participants were randomly assigned to the intervention group (IG) for an exercise intervention based on the COM-B model, and 33 were assigned to the control group (CG) for usual care. Physical activity levels, daily steps and bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate, central arterial pressure, growth index, brachial-ankle pulse wave velocity, ankle-arm index were measured at baseline, during the 12-week intervention, and after the 12-week follow-up. Compared with the CG and pre-intervention, total physical activity in the IG increased significantly (P < 0.05); however, after the 12-week follow-up, total physical activity decreased. At the same time, the average daily steps of the elderly in both groups increased. Compared with the CG, at the 12-week follow-up, the bone mineral density T-value in the IG was significantly improved (P < 0.05). Compared with the pre-intervention values, during the 12-week intervention, bone mineral density T-value, body mass index, waist-hip ratio, subendocardial myocardial viability rate and central arterial pressure were significantly improved (P < 0.05); after the 12-week follow-up, brachial-ankle pulse wave velocity and ankle-arm index were significantly improved (P < 0.05). No statistically significant changes in the growth index were detected, independent of the group and time. Theory-based exercise interventions can change the physical inactivity behavior of older people with chronic diseases, effectively promoting physical activity and improves bone mineral density T-value, controls body weight, and reduces cardiovascular risk and physiological indicators related to atherosclerosis. Geriatr Gerontol Int 2023; 23: 78-84.

Beyond the Calcium Score: What Additional Information from a CT Scan Can Assist in Cardiovascular Risk Assessment?

Coronary artery disease (CAD) still represents a leading cause of mortality worldwide. Early identification of patients at the highest risk of CAD is crucial to prevent acute adverse events and reduce morbidity and mortality. The coronary artery calcium (CAC) score is a reliable cardiovascular (CV) risk index with an independent prognostic value. Guidelines recommend using it as a risk enhancer in individuals with low or moderate CV risk. However, other computed tomography (CT) measurable parameters have recently been proposed as CV risk markers. Increasing evidence demonstrates the association between epicardial fat volume and coronary atherosclerosis in chronic and acute coronary syndromes. Furthermore, other parameters obtainable from CT, such as aortic stiffness, liver fat, aortic calcium, and myocardial scarring, are under investigation. This review aims to describe all CT potential in atherosclerosis detection and cardiovascular risk assessment beyond the CAC, trying to understand how to integrate CT parameters with traditional risk factors and to improve clinicians' ability to detect CAD early, allowing appropriate therapies promptly.

In-Season Consumption of Locally Produced Tomatoes Decreases Cardiovascular Risk Indices

Tomatoes are widely consumed worldwide at any time of the year. However, depending on the variety, they have a characteristic season. We evaluated the consequences metabolic of consumption of Ekstasis tomatoes from different geographical origin and in different seasons in Fischer 344 rats. The hepatic gene expression of key enzymes in lipid metabolism was also evaluated. Animals were classified in three photoperiods (L6, L12, and L18) and in three treatments (vehicle: VH; local tomato: LT; and non-local tomato: nLT). We measured serum metabolic parameters and the gene expression of liver enzymes related to lipid metabolism (Acc1, Cpt1a, Had, Fas1, Srebp-1c, Fatp5, Cd36). LT consumption in season decreased cardiovascular risk 1 and coefficient atherogenic by 1.81 (p = 0.031) and in L6 decreased TAG and glucose (p = 0.046; p = 0.024). The L18-LT animals had decreased total cholesterol (p = 0.029) and gene expression of Srebp1-c (p = 0.022) but increased expression of Acc1 (p = 0.032). The treatments significantly affected the expression of Acc1 and Fas1 in the liver and the levels of serum TAG and glucose. A significant effect of photoperiod on serum concentration of glucose, insulin, HOMA index, and on the hepatic expression of Srep1-c, Fas1, and Acc1 was observed.

TG/HDL index to identify subjects with metabolic syndrome in the Mexican population.

The triglyceride/high-density lipoprotein (TG/HDL) index has been proposed as an indicator of cardiovascular risk. In Mexico, there is a study in young adults that relates it to insulin resistance, but no cutoff point that distinguishes subjects with metabolic syndrome has been defined. To determine the cutoff point for the TG/HDL index that identifies subjects with metabolic syndrome in the Mexican population. Metabolic syndrome was diagnosed using the criteria established in the Third Report of the Adult Treatment Panel of the National Cholesterol Education Program adapted to the Mexican population. To identify the TG/HDL index cutoff point, ROC curve analysis and the Youden index were used. 1,318 subjects aged 40.9 ± 13.0 years participated in the study; 65.6% were women and 34.4% men; 41.2% had metabolic syndrome. The TG/HDL index obtained an area under the curve of 0.85 and an optimal cutoff point value ≥ 3.46, with a sensitivity of 79.6% and specificity of 76.4%. TG/HDL index cutoff point ≥ 3.46 is suitable for identifying subjects with metabolic syndrome in the Mexican population.

Carotid and femoral bruits as cardiovascular risk indicators in a middle-aged Finnish population: A 20-year prospective study.

Effective treatment and prevention of cardiovascular (CV) diseases requires reliable methods of assessing individual CV event risk. Although standardized risk calculators like Systematic Coronary Risk Evaluation (SCORE) are sufficient in most instances, sometimes more specific clinical examination is needed to determine the most optimal intervention and its intensity. To study whether carotid and femoral bruits provide prognostic information on CV events, CV mortality and all-cause mortality beyond traditional CV risk factors. 1045 subjects (49.8% men), aged 51.3 ± 5.97 years were clinically examined in the beginning of 1990's. The subjects were followed for over 20 years and data on CV events and causes of deaths was collected. During the follow-up period, 241 (23.1%) of the subjects died and 82 (34.6%) of the deaths were of CV origin. Carotid bruits were a significant risk factor for CV deaths only if subjects with previous CV events were included. After adjusting for age, sex, systolic blood pressure, smoking, diabetes, LDL cholesterol, coronary artery disease and stroke, carotid bruits posed a hazard ratio (HR) (95% confidence interval) of 4.15 (2.39-8.52) p<0.001 for CV deaths. After excluding subjects with previous CV events (after which n = 941) neither carotid nor femoral bruits were statistically associated with CV events or all-cause mortality. Adding carotid or femoral bruits in the baseline risk model with traditional CV risk factors did not improve C-statistic, reclassification, or discrimination of the subjects. Carotid and femoral bruits do not provide clinically useful information in a pure primary prevention setting. Carotid bruits might be useful in evaluating the overall CV risk in a population where recurrent CV events may occur.

Dynamics of Lipid Profile in Antiretroviral-Naïve HIV-Infected Patients, Treated with TAF-Based Regimens: A Multicenter Observational Study.

Background: The introduction of tenofovir alafenamide (TAF) in antiretroviral therapy has deeply modified the choice of the backbone for different treatment regimens, allowing the prevention of the bone and renal toxicity that was related to the previous formulation of tenofovir disoproxil fumarate (TDF). At the same time, literature data show an onset of dyslipidemia after a switch from TDF to TAF. To better understand the possible role of TAF in dyslipidemia, antiretroviral-naïve HIV-infected patients were evaluated, comparing those treated with TAF/emtricitabine with those with abacavir/lamivudine. Methods: We enrolled 270 antiretroviral-naïve HIV-infected patients in an observational, retrospective, longitudinal, multicenter study; they started treatment from 2017 to 2019 and were followed up for at least 72 weeks. We divided patients into two groups, one treated with a TAF-based backbone in their antiretroviral regimens (TAF group) and one without TAF (NO TAF group), to evaluate possible differences in the dynamics of lipid profiles from baseline(T0) to week 24 (T24), 48 (T48) and 72 (T72). Results: No significant differences were observed at baseline between the 2 groups. In the TAF group we observed a significant development of hypercholesterolemia throughout the follow-up (p &lt; 0.0001), not evident in the NO TAF group, that instead showed a significant increase in high-density lipoprotein (HDL). There were no significant differences between the two groups regarding triglycerides, low-density lipoprotein (LDL) and cardiovascular risk index (CRI). A cholesterol-lowering treatment with statin, finally, was prescribed in 6 patients in both groups during the study. At binary logistic regression analysis, no factor was independently associated with hypercholesterolemia, except for higher age at T0. Conclusions: This real-life study shows that in HIV-naïve patients, TAF was associated with hypercholesterolemia throughout the follow-up. The clinical significance of this hypercholesterolemia will have to be clarified in further studies.

Reducing cardiovascular risk with immunomodulators: a randomised active comparator trial among patients with rheumatoid arthritis

ObjectiveRecent large-scale randomised trials demonstrate that immunomodulators reduce cardiovascular (CV) events among the general population. However, it is uncertain whether these effects apply to rheumatoid arthritis (RA) and if certain...

Predictive value of the TyG index and rheumatoid factor for cardiovascular disease risk in a rheumatoid arthritis population: data from a survey of 418 patients

ObjectiveTo investigate the correlation between the triglyceride-glucose (TyG) index and rheumatoid factor levels and the existence of cardiovascular disease in patients in the rheumatoid arthritis population and to analyze their potential value in predicting the risk of cardiovascular disease.MethodsPatients with rheumatoid arthritis treated by the Traditional Chinese Medicine Department of Rheumatism of the China-Japan Friendship Hospital from 2019–01 to 2021–12 were included in this retrospective study. Regression analysis was performed with multifactor-corrected multimodal logistic models to observe the correlation between the TyG index and rheumatoid factor and cardiovascular disease risk, construct predictive models and assess the potential predictive value of the variables on cardiovascular disease risk with receiver operating characteristic curves. The results were further corrected by sensitivity analysis and trend tests.ResultsA total of 418 patients with rheumatoid arthritis were included in the study. In the rheumatoid arthritis population, high rheumatoid factor (OR = 1.002, 95% CI = 1.001–1.002, P < 0.001), high TyG index (OR = 1.057, 95% CI = 1.008–1.109, P = 0.022), advanced age (OR = 1.080, 95% CI = 1.050–1.112, P < 0.001), and low physical activity (OR = 2.848, 95% CI = 1.195–6.785, P = 0.018) were independent risk factors for the existence of cardiovascular disease in patients. The combined coefficient calculated on the basis of the TyG index and rheumatoid factor was used to plot the receiver operating characteristic curve with an area under the curve of 0.791, which can be used to predict the potential risk of cardiovascular disease in patients with rheumatoid arthritis. Further sensitivity analysis found that the marker of focus remained associated with cardiovascular disease risk in a high-physical activity population with rheumatoid arthritis. The final trend test found a linear trend between the TyG index, rheumatoid factor levels and the risk of cardiovascular disease.ConclusionIn the rheumatoid arthritis population, the TyG index and rheumatoid factor have some potential predictive value in determining the risk of cardiovascular disease, and the predictive efficacy is better when the two tests are combined.

Abstract 12287: Adipokines and Transitions in Metabolic Risk Over Time: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Individuals with similar weights have substantial heterogeneity in metabolic risk, a key indicator of cardiovascular disease risk. Additionally, many persons progress from metabolically healthy to metabolically unhealthy status, or regress in metabolic risk, over time. The association of adipokines with transitions in metabolic risk status is unknown. Methods: Among ARIC Visit 2 (1990-92) participants without diabetes, we evaluated the associations of adipokines (adiponectin and leptin; in tertiles) with metabolic risk transitions from Visit 2 to Visit 4 (1996-98; a 6-year interval) among persons with and without obesity using logistic regression. We examined transitions from metabolically healthy (no metabolic syndrome [MetS]) to unhealthy status (MetS, with or without diabetes). Among those with MetS without diabetes at Visit 2, we examined adipokine associations with progression to MetS with diabetes and with regression to metabolically healthy status. Results: Among 7,560 participants, mean age was 57 with 56% female and 17% Black adults. Higher adiponectin levels were associated with about 75% lower risk of progression from metabolically healthy to unhealthy status in those with and without obesity, whereas higher leptin was associated with about 3-fold greater risk of progression (Table, Panel A). Among those with MetS at Visit 2, higher adiponectin was associated with lesser risk of progression to diabetes, and greater likelihood of regression to metabolically healthy status in those with and without obesity (Table, Panel B). Conversely, higher leptin was associated with greater risk of progression to diabetes in those with obesity. Conclusion: Adipokine levels are linked to transitions in metabolic risk status over time among persons with similar weight status. Adipokines may identify individuals at greatest risk of developing metabolic risk factors, who may benefit most from aggressive CVD prevention strategies.

Abstract 11824: Chronic Kidney Disease, Type 2 Diabetes and the Risk of Major Cardiovascular Events in Coronary Artery Disease versus Peripheral Artery Disease Patients

Introduction: Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM). Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD). Hypothesis: We hypothesize that cardiovasculr risk compares between PAD and CAD when analyses are stratified by the presence of CKD. Methods: We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106), CAD patients with CKD (CAD/CKD+; n=250), PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66). Results: The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p&lt;0.001), in PAD/CKD- patients (40.9%; p&lt;0.001), and in PAD/CKD+ patients (56.9%; p&lt;0.001), who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p&lt;0.001, respectively). The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063). In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p&lt;0.001), CKD (HR=1.85 [1.51- 2.26]; p&lt;0.001) and T2DM (HR=1.53 [1.29-1.83; p&lt;0.001) were mutually independent predictors of MACE. Conclusions: We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.

ODP238 RELATIONSHIP BETWEEN BODY COMPOSITION, POST PRANDIAL GLUCOSE AND INSULIN FOR EARLY PREDICTION OF TYPE 2 DIABETES AND CARDIOVASCULAR RISK.

Abstract Different studies report that visceral fat percentage, visceral adiposity index (VAI) and body mass index (BMI) are considered markers of dysfunction and adipose tissue distribution, which are considered early detection tools and indirect expression of cardio metabolic risk; however it is also reported that post prandial glucose and insulin are abnormalities that detect early type 2 diabetes and cardiovascular risk, due to their toxic effect on the vascular endothelium. The objective of the research was to evaluate the association of body composition, glucose and insulin postprandial for early prediction of diabetes and cardiovascular risk. It is a non-experimental study of cross-sectional design, in a total population of 271 adults between the ages 19 and 65 years, without diabetes, in a non-random sample calculated with 95% confidence level of patients attending outpatient clinics of private and IESS hospitals of Riobamba. Descriptive statistics were performed for all variables. With the variables related to cardio metabolic risk such as age, sex, abdominal circumference, mean arterial pressure, BMI, visceral fat and biochemical measures of HbA1c, fasting glucose, postprandial glucose and insulin, HOMA-IR index, and HDLC, triglycerides, cardio vascular risk index given by the ratio triglycerides/HDLc cholesterol over 3.5. These variables were grouped by a multivariate cluster analysis, kmeans, and two homogeneous groups were obtained, different from each other and different from the others, and then the average cardiovascular risk in each group was calculated. A 9: 1 ratio of women/men was found, for cluster 1 the average age was 49, and in cluster 2 it was 48 years, TAM: 87.5 mmHg, BMI: 27.12, PAB: 109 cm, visceral fat 12.79 and cardiovascular risk 4.78. In group 2 with predominance in cluster 2 the average values of the variables studied were significantly higher with a statistically significant p value for the differences between groups of postprandial glucose and insulin (p less than 0. 05). Conclusions postprandial glucose and insulin are early predictors of cardiovascular risk and diabetes. Key words: postprandial glucose, postprandial insulin, cardiovascular risk, body composition. Presentation: No date and time listed

Levothyroxine Therapy and Predictors of Cardiovascular Risk in Clinical Hypothyroidism: A Prospective Cohort Study

Background Hypothyroidism is associated with hypoadiponectinemia, insulin resistance, and increased cardiovascular risk. The association of adiponectin, insulin resistance, and future cardiovascular risk in clinical hypothyroidism and the effect of levothyroxine are non-conclusive because of the contradictory results. The present prospective cohort study has been conducted to evaluate the effect of levothyroxine on serum adiponectin, insulin resistance, and cardiovascular risk in patients with clinical hypothyroidism. Methods Sixty patients with clinical hypothyroidism who were prescribed levothyroxine were recruited following selection criteria and changes in Zulewski's score, glycemic parameters, homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), lipid profile, serum adiponectin, serum high-sensitivity C-reactive protein(hs-CRP), cardiovascular risk indices, and Framingham risk score were assessed 12 weeks post-levothyroxine therapy. Receiver operating characteristic (ROC) analysis was done to detect the cut-off for adiponectin levels to differentiate between responders and non-responders. Neural network models were created to predict the risk of cardiovascular morbidity. Results Post-levothyroxine therapy, there was a significant improvement in body mass index(BMI) (p = 0.025), diastolic blood pressure (p = 0.021), Zulewski's score (p< 0.001), serum insulin (p = 0.005), fasting sugar (p < 0.001), serum adiponectin (p < 0.001), thyroid profile (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), high-density lipoprotein (p = 0.007), triglycerides (p = 0.002), and subcutaneous fat (p = 0.015). Serum adiponectin showed significant improvement in hypothyroid patients compared to euthyroid individuals (mean difference: -2.21; 95% CI: -2.52 to -1.91; p < 0.001). Mean difference in insulin resistance (HOMA-IR: 0.3, p < 0.001; QUICKI: -0.002, p < 0.001) and cardiovascular risk (atherogenic index: 0.12, p = 0.04; coronary risk index: 0.14, p = 0.038; Framingham risk score: 0.65, p = 0.041) also showed improvement. Serum adiponectin and thyroid-stimulating hormone levels were directly correlated with insulin resistance and cardiovascular risk scores. Conclusion The reduced serum adiponectin level and increased cardiovascular risk in clinical hypothyroidism were improved with hormone replacement, and serum adiponectin level was found to be a good prognostic marker for the treatment response.

Reduced Heart Rate Variability as A Risk Factor for Cardiovascular Disease in Young Healthy Adults with Low and High Body Mass Indexes – A Descriptive Study

Background: Heart rate variability (HRV) is a used to assess autonomic nervous system input to the heart. Studies on the impact of HRV on underweight are limited. Aims/Objectives: To evaluate HRV in age matched young adults of different BMI category. Methodology: This cross-sectional study was done among healthy young adult volunteers between 18 and 25 years of age. Anthropometric variables were measured. ECG was recorded in lead II configuration for 5 minutes. Heart rate variability was analysed with Kubios HRV analyzer. Results: HRV indices were reduced in underweight (UW), overweight (OW) and obese group compared to normal weight (NW) BMI group. Second order polynomial regression between BMI and HF log power in both genders shows an inverted U-shaped relationship with BMI. The association between BMI, waist circumference and body fat (percentage) with HRV indices shows a significant relation to heart rate variability among which waist circumference (WC) shows a greater association with HRV indices than BMI. Comparison of HRV parameters among men and women of different BMI group shows female had greater heart rate variability compared to males across BMI Conclusions: underweight individual also have increased cardiovascular risk like obese group and abdominal obesity is better indicator of cardiovascular risk than BMI.

Impact of CPAP Therapy on New Inflammation Biomarkers.

Obstructive sleep apnea (OSA) is a common sleep disorder leading to increased risk of developing cardiovascular diseases (CVDs) by supporting a low-grade chronic inflammation as one of the pathological mechanisms. The continuous positive airway pressure (CPAP) device is used as an effective treatment for moderate and severe OSA. Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), white blood cell–mean platelet volume ratio (WMR), C-reactive protein–albumin ratio (CAR) and fibrinogen–albumin ratio (FAR) are new potential inflammatory biomarkers that are widely available and were shown to be possibly favorable screening or follow-up tools for moderate- or severe-grade OSA, as well as indirect indicators for cardiovascular risk. Our study evaluated the impact of CPAP therapy in patients with severe OSA and acceptable therapy adherence on NLR, PLR, WMR, FAR and CAR. Of 57 patients who were initially enrolled and had no exclusion criteria, 37 had a satisfactory CPAP adherence (usage of ≥4 h per night) after a minimum of 6 months of therapy. There was a statistically significant difference in NLR (2.122 ± 0.745 before therapy vs. 1.888 ± 0.735 after therapy) and FAR (86.445 ± 18.763 before therapy vs. 77.321 ± 19.133 after therapy) suggesting a positive effect of the CPAP therapy on chronic inflammatory states, thereby possibly reducing cardiovascular risk.

Residential indoor exposure to fine and ultrafine particulate air pollution in association with blood pressure and subclinical central haemodynamic markers of cardiovascular risk among healthy adults living in Perth, Western Australia

Despite that large percentages of individual daily time is spent in the home, few studies have examined the relationship between indoor particulate matter (PM) exposure in residential settings with subclinical indicators of cardiovascular risk. This cross-sectional study investigated associations between exposure to fine (PM2.5) and ultrafine (UFP) PM in domestic indoor environments, with central blood pressure (BP) and component BP measures (pulse pressure, augmented pressure [AP], augmentation index [AIx], mean arterial pressure, pulse wave velocity [PWV]) in 40 non-smoking, otherwise healthy adults (58% women) living in Perth, Western Australia. Overall, in adjusted models, an interquartile range (IQR) increase in PM2.5 was associated with a 3.2 mmHg (95% confidence interval [CI]: 0.99, 5.45) higher diastolic BP, and a 1.8 mmHg lower AP (95%CI: − 3.63, − 0.01) and 0.4 m/s PWV (95%CI: − 0.80, − 0.08), respectively. For the UFP fraction, an IQR increase was associated with a 5.2% higher AIx (95%CI: 0.51, 9.97) and a 0.6 m/s lower PWV (95%CI: − 1.00, − 0.11).When stratified by sex, higher UFP concentrations were associated with higher DBP and lower PWV among women. Among men, higher UFP concentrations were associated with lower AP. Exposure to domestic indoor fine and ultrafine PM was associated with preclinical indicators of cardiovascular risk and some of these relationships were affected by sex. These findings contribute important evidence linking low-level residential indoor PM exposure with measurable impacts on cardiovascular physiology and may inform preventative recommendations as part of risk profiles for susceptible individuals.

Effect of exercise-based cardiac rehabilitation on the ischemic threshold in patients with high-risk ischemic heart disease

Abstract Introduction Coronary artery disease is a complex condition and is not always resolved after an interventional or surgical procedure, due to the remaining obstructions in the coronary tree or the severity of the atherosclerosis, leaving anginal symptoms, ischemic threshold (IU) in the exercise, decreased cardiorespiratory fitness, and poor quality of life (QoL). Exercise-based cardiac rehabilitation programs (Ex-CRP) usually develop ischemic preconditioning mechanisms thanks to their direct anti-inflammatory, antioxidant, antithrombotic and coronary neovascularization effects, thus improving coronary reserve flow. We hypothesize that an Ex-CRP is capable of favorably impacting the UI in these patients. Therefore, the objective of this study is to evaluate the effects of an Ex-CRP on the UI in patients with high-risk ischemic heart disease. Methods Quasi-experimental study with 121 patients with ischemic threshold due to high-risk ischemic heart disease (with perfusion defects in nuclear medicine, complex coronary anatomy or partially revascularized) and presence of ischemic threshold in the exercise test. An Ex-CRP of 4–6 weeks duration was performed, consisting of supervised and monitored training concurrent with 30-minute aerobic exercise sessions at 70% of heart rate reserve, 3 times per week, supplemented with resistance exercise. and an educational understanding program for the control of risk factors and nutritional and psycho-emotional care. At the end of the program, a stress test was performed to compare the post-intervention effects and ischemic threshold was defined as the presence of angina or electrocardiographic changes of ischemia with negative ST-segment depression in 2 consecutive beats more than 80 ms from the J point. and in more than two contiguous leads. Results The 121 patients with ischemic threshold were 61±10 years old and 75% were male. On the other hand, 29.7% had a diagnosis of heart failure and an average LVEF of 53.1±12.9%. After Ex-CRP, an improvement was found in calculated VO2p (24.7±7.8 vs 34.23±7.5; p=0.000), METs at maximum effort from 7.06±2.15 to 9.78±1.14 (p&amp;lt;0.0001) and submaximal load in watts from 44±21.32 to 61±24.49; p&amp;lt;0.0001. 40.5% of the patients who were admitted with UI resolved it (absence of post-intervention ischemic diagnosis) after Ex-CRP and the remaining percentage with UI (59.5%) displaced it by 2.62 METs (p&amp;lt;0.0001). With this, the cardiovascular risk calculated by the Duke Score also decreased from −7 to −2 (p&amp;lt;0.0001), and the myocardial efficiency index improved from 8 to 6 (p&amp;lt;0.0001), strength (79±15 to 92±8%; p&amp;lt;0.0001) and QoL (65±17 vs 82±12; p&amp;lt;0.0001). Conclusions Ex-CRP had a significant effect on the resolution or displacement of the UI in patients with high-risk ischemic heart disease. In addition, it improved muscle strength, quality of life, myocardial efficiency, and reduced the cardiovascular risk index calculated by the Duke score. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL. Cúcuta, ColombiaCardioFit. CDMX, México

INCREASED EICOSAPENTAENOIC ACID TO ARACHIDONIC ACID (EPA/AA) RATIO IN BRAIN ENDOTHELIAL CELLS ASSOCIATED WITH REDUCED EXPRESSION OF NEUTROPHIL DEGRANULATION PROTEINS DURING INFLAMMATION

Endothelial cell (EC) dysfunction results in inflammation and increased atherothrombotic risk, including stroke. The omega-3 fatty acid (FA) eicosapentaenoic acid (EPA) improves arterial compliance in a manner predicted by circulating EPA/AA ratios, an indicator of cardiovascular (CV) risk. Treatment with icosapent ethyl (IPE), a formulation of highly purified EPA, reduced composite CV events, including stroke, in REDUCE-IT that correlated with on-treatment EPA levels. We measured the effects of EPA on the EPA/AA ratio and protein expression in endothelial cells from brain ECs (BECs) following cytokine challenge.