Prevalence Of Ischemic Heart Disease Research Articles

Adu, K.K. and Adjei, E. (2018). The phenomenon of data loss and cyber security issues in Ghana. Foresight, 20(2), 150–61. Ahmed, M.T.U., Bhuiya, N.I. and Rahman, M.M. (2017). A secure enterprise architecture focused on security and technology-transformation (SEAST), The 12th International Conference for Internet Technology and Secured Transactions, (ICITST-2017), Cambridge, UK, 11–4/12/2017. Alanazi, S.T., Anbar, M., Ebad, S.A., Karuppayah, S.

Few epidemiological studies have discussed the gender-specific prevalence of ischemic heart disease (IHD). We aimed to investigate the gender-specific prevalence of IHD among Saudi patients visiting the emergency department and if it is affected by diabetes mellitus and/or hypertension. Three hundred patients were recruited from Prince Sultan Cardiac Center in Al Ahsa, KSA. Hypertension was identified as systolic pressure equal to or more than 140 mmHg and/or diastolic pressure equal to or more than 90 mmHg or by the patient currently being on antihypertensive medication, and coronary artery disease (CAD) was diagnosed by electrocardiogram, cardiac markers, cardiac exercise testing or coronary angiography. Hypertension was found in 80% of males and 72% of females. A significantly higher rate of diabetes was noted in females (62%) compared to males (48%) (p<0.012). Co-existing diabetes and hypertension was found in 70% of females as compared to 38% of males. The occurrence of IHD in males was significantly higher than that in females (p<0.001). However, the incidence of myocardial infarction was greater in females (52%) compared to males (38%) (p<0.035). Co-existing hypertension and diabetes may affect the gender prevalence of myocardial infarction among emergency department patients, with more infarctions being noted among females. This finding helps to guide the treatment strategy for both genders.

Ischemic heart disease among the population of working age in Kyiv region: statistical analysis of the modern epidemiological situation

Annotation. Ischemic heart disease (IHD) is one of the main causes of high mortality, disability and a decrease in the quality of life of the working-age population (WAP) in Ukraine. Aim of the work: to determine the modern features of mortality, disability, prevalence and incidence of ischemic heart disease in the working-age population of the Kyiv region. The analysis of the epidemiology of IHD in the Kyiv region was carried out in dynamics for 2010–2019 and compared to Ukraine. The statistical data of the State Statistics Committee of Ukraine, the Center for Medical Statistics of the Ministry of Health of Ukraine, and the Kyiv Regional Center for Medical Statistics on mortality, disability, prevalence and incidence of IHD in the working-age population of the Kyiv region were analyzed with the medical-statistical method. It has been established that IHD is a significant cause of the loss of labor potential in the Kyiv region. IHD accounts for every fourth (25.0%) death in the working age, and the regional level of working-age population mortality from IHD is the highest in Ukraine. In the Kyiv region working-age population dies from ischemic heart disease 1.5–1.7 times, and from myocardial infarction – 1.7–1.9 times more often than the average in Ukraine. Regional levels of incidence IHD among working-age population exceed similar indicators in Ukraine by 1.2 times, the incidence of myocardial infarction – 1.5 times, the prevalence of ischemic heart disease – 1.7 times. Identified unfavorable dynamic trends in mortality and prevalence of IHD among the working-age population of the Kyiv region. The mortality rate from IHD among working-age population increased in the Kyiv region in 2019 compared to 2010, by 7.9%. The prevalence of IHD increased during 2010–2018 by 14.4%, and the primary incidence of myocardial infarction – by 14.9%. The unfavorable epidemiological situation with IHD among working-age population in the Kyiv region necessitates improving the system for the prevention and the organization of medical care for patients with IHD in this region.

Both incidence and prevalence of ischaemic heart disease are declining in parallel: a national data-linkage study in New Zealand (ANZACS-QI 52).

To examine trends in ischaemic heart disease (IHD) incidence and prevalence in New Zealand from 2005 to 2016, using comprehensive linked national hospitalization and mortality data as proxy measures of all significant events. Incident and prevalent cases of IHD in people aged ≥25 years were identified using individual patient-linkage of routinely collected ICD-10-coded hospitalization and mortality data. Incidence rates and prevalence proportions were calculated by sex and age group and then age-standardized to the 2016 New Zealand population. Ischaemic heart disease incidence and prevalence declined in men and women in all age groups. The average annual rate of decline in age-standardized IHD incidence was 3.3% for women and 2.7% for men, and the rate of decline in age-standardized IHD prevalence was 3.2% for women and 2.2% for men. Despite a 17% increase in the New Zealand population aged 25 years and over during the study period, the total number of people living with IHD also decreased, particularly in those aged 65 years and older. In contrast to observations from other countries, where IHD incidence but not IHD prevalence has been falling, declining IHD incidence in New Zealand in recent decades is now mirrored by declining IHD prevalence.

Relationship between endothelial function and vascular stiffness on lower limit of cerebral autoregulation in patients undergoing cardiovascular surgery.

Hemodynamic management based on cerebral autoregulation range is a possible strategy for preserving major organ perfusion during cardiovascular surgery. The purpose of this study was to evaluate the relation of vascular properties with lower limit of cerebral autoregulation (LLA). LLA was monitored in 66 patients undergoing cardiovascular surgery using near-infrared spectroscopy. To determine the clinical importance of LLA monitoring, association of blood pressure excursions below LLA and acute kidney injury (AKI) was evaluated. Flow-mediated dilation (FMD) and pulse wave velocity (PWV) were measured for the evaluation of endothelial function and aortic stiffness. Variables associated with LLA were evaluated. Excluding patients on hemodialysis, there were 15 patients (25.9%) who developed AKI. Blood pressure excursions below LLA were higher in patients who developed AKI (4.55mmHg×hr vs. 1.23mmHg×hr, P=.017). In the univariate analysis, prevalence of ischemic heart disease (No IHD: 53±13.0mmHg vs. IHD: 60.0±13.6mmHg, P=.056) and FMD (r=-0.42, 95% CI -0.61 to -0.19, P<.001) were associated with LLA before cardiopulmonary bypass (CPB). During CPB, calcium channel blocker (No Ca blocker: 42±10.6mmHg vs. Ca blocker: 49±14.3mmHg, P=.033), diabetes (no DM: 44±13.2mmHg vs. DM: 55±10.0mmHg, P=.024), FMD (r=-0.32, 95% CI -0.55 to -0.05, P=.021), and PWV (r=0.28, 95% CI 0.012 to 0.513, P=.041) were associated with LLA. Multivariate analysis showed that FMD was correlated with LLA before CPB (r=-2.19, 95% CI -3.621 to -0.755, P=.003), while PWV was correlated with LLA during CPB (r=0.01, 95% CI 0.001-0.019, P = .023). Endothelial function and aortic stiffness may be important factors in determining LLA at different phases in cardiovascular surgery.

Ethnic variability in mortality from ischaemic heart disease/cardiomegaly in Malaysia.

The prevalence of ischaemic heart disease with associated cardiomegaly and other chronic diseases such as diabetes mellitus has increased in Malaysia in recent years. As the contribution to mortality from ischaemic heart disease/cardiomegaly in different ethnic populations is unclear, a three year (January 2013-December 2015) retrospective study of autopsy cases was undertaken at the Department of Forensic Pathology, University Malaya Medical Centre. There were 80 cases with lethal ischaemic heart diseases/cardiomegaly. The age range was 30-69 years (mean 50.19 years) with a male to female ratio of 39:01. The most vulnerable age was 50-59 years accounting for 38.75% of cases. Malays accounted for 15% of cases, Indians for 32.5% and Chinese for 36.25%. Although in 35 cases (43.75%) there was a history suggestive of ischaemic heart disease, the remaining 45 cases (56.25%) were apparently healthy until the terminal collapse. It appears that Indian males in the 50-59 year age range are most at risk for lethal cardiac events in this population, most often with no preceding symptoms or signs. The study demonstrates the value of studying subpopulations for disease risk rather than relying on accrued general population data.

Abstract 14943: Comparison of Heart Failure Patients Newly Prescribed Sacubitril/valsartan With Those Newly Prescribed Aceis/arbs; A Cohort Study Using Us Optum Electronic Health Record Data

Background: The clinical development program of sacubitril/valsartan (sac/val) for heart failure with reduced ejection fraction (HFrEF) only included a very limited number of patients being naive to prior angiotensin converting enzyme inhibitors (ACEis) or angiotensin II receptor antagonists (ARBs). Recent studies support the use of sac/val in hospitalised HF patients without prior ACEis/ARBs. This study aims to compare HF patients newly prescribed either sac/val or ACEis/ARBs. Methods: Retrospective non-interventional cohort study describing two mutually exclusive adult patient cohorts diagnosed with HFrEF either initiating sac/val or ACEis/ARBs. All patients were naive to both sac/val and ACEis/ARBs for 12 months prior to the first prescription. All patients had a left ventricular ejection fraction (LVEF) ≤40%. Patients were identified any time between 1 st July 2015 and 31 st Dec 2018 in the Optum® de-identified EHR dataset from providers across the continuum of care. Results: 2,414 patients were initiated on sac/val, 36,563 on ACEis/ARBs. Mean age was 66.1 (SD 12.9) and 67.2 years (SD 13.7) for sac/val and ACEis/ARBs users, respectively. Sac/val patients were more likely to be male: 70.8% vs 67.2% (p&lt;0.0001) and had a lower mean LVEF: 26.9% vs 29.3% (p&lt;0.0001). Patients newly initiated on sac/val had similar proportion of ischemic heart disease (67.9% vs 68.2%, p=0.72), and more often valvular heart disease (48.6% vs 44.3%, p&lt;0.0001), and use of cardio resynchronization therapy device (40.9% vs 24.0%, p&lt;0.0001). Conclusions: This real-world study indicates that sac/val tends to be newly prescribed to younger, male HFrEF patients with lower LVEF and a higher proportion of cardio resynchronization therapy devices compared with patients newly initiated on ACEis/ARBs. The prevalence of ischemic heart disease is similar between the groups.

Abstract 14282: Association Between Hospitalization Costs and Left Ventricular Ejection Fraction in Patients With Heart Failure in the Advanced Aging Society

Introduction: The economic burden associated with heart failure (HF) is expected to increase in the world due to aging. Left ventricular ejection fraction (LVEF) is a basic clinical index that indicates the severity of HF, and guideline-directed medical therapies are recommended stratified by LVEF. However, there is paucity of information between LVEF and hospitalization costs. Hypothesis: Therefore, we evaluated the association between the hospitalization costs and LVEF in elder HF patients in Japan, which is at forefront of aging. Methods: We studied 346 consecutive patients who admitted to Miyazaki prefectural Nobeoka Hospital due to HF between January 2015 and March 2018. Results: Median hospitalization costs were comparable between the HF reduced EF (HFrEF; LVEF&lt;40%: n=129) and HF preserved EF (HFpEF; LVEF≥40%: n=217) ($7128 vs $6580, P =0.373), LVEF was not correlated with hospitalization costs ( P =0.051) (Figure A). Meanwhile, in the subgroup aged over 75 years, median hospitalization costs were significantly higher in HFrEF than in HFpEF ($7249 vs $6471, P =0.031). The HFrEF group also had higher level of brain natriuretic peptide (1011 vs 479 pg/ml, P &lt;0.001), higher prevalence of ischemic heart disease (40% vs 27%, P =0.004), and higher rate of percutaneous coronary intervention (10% vs 2%, P =0.008) than HFpEF group. In addition, LVEF was significantly correlated with hospitalization costs ( P =0.005) (Figure B), and remained as a significant independent predictor of hospitalization costs in multivariate liner regression analysis (β=—0.173, P =0.014). Conclusions: LVEF was not significantly correlated with hospitalization costs in the entire cohort, but was an independent negative factor for hospitalization costs in the subgroup of aged over 75. This might provide helpful evidence for future novel healthcare strategies that target HF inpatient cost reductions.

Increased risk of ischemic heart disease in patients with bipolar disorder: A population-based study

ObjectiveThis study investigated the national prevalence and incidence of ischemic heart disease and associated factors among Taiwanese patients with bipolar disorder. MethodsWe used a random sample of 766,427 subjects who were ≥18 years old from the National Health Research Institute database in 2005. Subjects with at least one primary diagnosis of bipolar disorder or ischemic heart disease were identified. We compared the prevalence and incidence of ischemic heart disease in bipolar patients and the general population in 2005 and the same cohort from 2006 to 2010. These associated factors with respect to ischemic heart disease among patients with bipolar disorder were also analyzed. ResultsThe prevalence of ischemic heart disease in patients with bipolar disorder was 1.69 times higher than in the general population (7.85% vs 4.67%; odds ratio 1.69; 95% confidence interval, 1.41–2.03) in 2005. The average annual incidence of ischemic heart disease in patients with bipolar disorder was also 1.60 times higher than in the general population (2.02% vs 1.24; risk ratio 1.60; 95% confidence interval, 1.36–1.90) from 2006 to 2010. The higher prevalence of ischemic heart disease among bipolar patients was associated with increased age, diabetes, hypertension, and antidepressant use. ConclusionsPatients with bipolar disorder had a significantly higher prevalence and incidence of ischemic heart disease than the general population in both sexes, especially at younger ages. Among patients with bipolar disorder, older age, and hyperlipidemia were risk factors of ischemic heart disease.

Association of Echocardiographic Left Ventricular End-Systolic Volume and Volume-Derived Ejection Fraction With Outcome in Asymptomatic Chronic Aortic Regurgitation

Volumetric measurements by transthoracic echocardiogram may better reflect left ventricular (LV) remodeling than conventional linear LV dimensions. However, the association of LV volumes with mortality in patients with chronic hemodynamically significant aortic regurgitation (AR) is unknown. To assess whether LV volumes and volume-derived LV ejection fraction (Vol-LVEF) are determinants of mortality in AR. This cohort study included consecutive asymptomatic patients with chronic moderately severe to severe AR from a tertiary referral center (January 2004 through April 2019). Clinical and echocardiographic data were analyzed retrospectively. Aortic regurgitation severity was graded by comprehensive integrated approach. De novo disk-summation method was used to derive LV volumes and Vol-LVEF. Associations between all-cause mortality under medical surveillance and the following LV indexes: linear LV end-systolic dimension index (LVESDi), linear LVEF, LV end-systolic volume index (LVESVi), and Vol-LVEF. Of 492 asymptomatic patients (mean [SD] age, 60 [17] years; 425 men [86%]), ischemic heart disease prevalence was low (41 [9%]), and 453 (92.1%) had preserved linear LVEF (≥50%) with mean (SD) LVESVi of 41 (15) mL/m2. At a median (interquartile range) of 5.4 (2.5-10.1) years, 66 patients (13.4%) died under medical surveillance; overall survival was not different than the age- and sex-matched general population (P = .55). Separate multivariate models, adjusted for age, sex, Charlson Comorbidity Index, and AR severity, demonstrated that in addition to linear LVEF and LVESDi, LVESVi and Vol-LVEF were independently associated with mortality under surveillance (all P < .046) with similar C statistics (range, 0.83-0.84). Spline curves showed that continuous risks of death started to rise for both linear LVEF and Vol-LVEF less than 60%, LVESVi more than 40 to 45 mL/m2, and LVESDi above 21 to 22 mm/m2. As dichotomized variables, patients with LVESVi more than 45 mL/m2 exhibited increased relative death risk (hazard ratio, 1.93; 95% CI, 1.10-3.38; P = .02) while LVESDi more than 20 mm/m2 did not (P = .32). LVESVi more than 45 mL/m2 showed a decreased survival trend compared with expected population survival. In this large asymptomatic cohort of patients with hemodynamically significant AR, LVESVi and Vol-LVEF worked equally as well as LVESDi and linear LVEF in risk discriminating patients with excess mortality. A LVESVi threshold of 45 mL/m2 or greater was significantly associated with an increased mortality risk.

Differences in lipid treatment patterns in women versus men in a large cohort of patients with atherosclerotic cardiovascular disease in Ontario, Canada

Abstract Background/Introduction The prevalence of ischaemic heart disease is lower in women vs men in Canada. Studies have shown that women are more likely to be underdiagnosed and less likely to receive guideline-recommended treatments than men. Women receiving lipid-lowering therapies (LLTs) are also less likely to attain treatment goals vs men. Purpose We analysed use of LLTs and attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in a recent longitudinal cohort of patients with ASCVD with public drug coverage in Ontario to describe differences observed between female and male patients. Methods Patients ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1 year follow up period for LDL-C goal attainment (&amp;lt;2.0 mmol/L or 50% reduction from index LDL-C as per Canadian Cardiovascular Society Guidelines) and analysed by LLT category. Results 143,302 patients with ASCVD ≥65 years on LLTs were identified of which 41% were female. A higher proportion of female vs male patients were prescribed low (3% vs 2%) and medium intensity statins (51% vs 44%) compared with high intensity statins (43% vs 52%). A higher proportion of women failed to attain LDL-C goal compared to men (33% vs 24%) (Figure). When analysed by low, moderate or high intensity statin, 65%, 35%, and 27% of female patients and 49%, 25% and 19% of male patients failed to attain LDL-C goal at follow up. Conclusions In this retrospective study, women with a diagnosis of ASCVD were more frequently treated with low/moderate intensity statins whereas men were more frequently treated with high intensity statins. Approximately 2 of 3 women and 3 of 4 men receiving statin treatment attained LDL-C goal during the 1-year follow up period. Overall, there appear to be treatment differences between female and male patients with ASCVD, with males receiving higher intensity statin therapy and attaining LDL-C goal more frequently. Further research is needed to determine why these discrepancies exist. This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Canada Inc

Prevalence, Clinical Characteristics, and Risk Among Patients with Ischemic Heart Disease in the Young Jordanian Population.

PurposeThis study aims to evaluate the prevalence of ischemic heart disease (IHD) among the young population in Jordan. We examined the risk factors that might be involved in disease incidence. Clinical characteristics, patients’ living standards, and various other risk factors were considered to conduct the study.MethodsA retrospective study was conducted at King Abdullah University Hospital. Data were collected from patients who visited this hospital between January 2013 and December 2017. Only young Jordanian adults of age <50 years were included in this study. The data of 358 patients were purposively collected and analyzed (as per the determined inclusion criteria), where information related to their baseline characteristics, clinical characteristics, and related biochemical assays was reviewed.ResultsThis study showed a high prevalence of IHD among young males in Jordan. It also revealed that increased age, smoking, hypertension, unfavorable lipid profile, and obesity were the major possible risk factors for the occurrence of disease. These patients were initially diagnosed with either unstable angina or acute myocardial infarction. Initial WBCs count, particularly monocytes differential, was high in about one-third of patients, besides cardiac biomarkers.ConclusionThe high incidence of IHD was noticed among young individuals. We suggest that more efforts should be instigated for reducing the high prevalence of IHD by adopting a healthy lifestyle, preventive attitude, and nutritious food intake.

Independent relevance of left ventricular hypertrophy for risk of ischaemic heart disease in 25,000 Chinese adults

Abstract Background The prevalence of left ventricular hypertrophy (LVH) is strongly related with established cardiovascular disease (CVD) risk factors and, hence, there has been some uncertainty about its independent relevance for ischaemic heart disease (IHD) after taking account of such risk factors. Purpose To examine the associations of LVH with prevalent and incident cases of IHD after adjustment for established risk factors for CVD in a population-based study of Chinese adults. Methods The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey in 2004–2008. A random sample of 24,786 participants had a 12-lead electrocardiogram (ECG) recorded at the second resurvey in 2013–2014. Electronic records of ECG tracings were used to estimate LVH using 5 different criteria (Sokolov, Cornell, Romhilt-Estes, Gubner and Mortara). IHD cases were recorded by linkage to electronic records of hospitalisation, death and disease registries. Cox regression was used to estimate the associations of LVH with prevalent (n=1325) and incident (n=900) cases of IHD after adjustment for age, sex, region, prior vascular disease, smoking, alcohol, SBP, diabetes, lipids and body mass index (BMI). Results The overall prevalence of LVH in the population varied depending on the criteria used for detection (Mortara [10%], Sokolov [14%], Cornell [6%], Romhilt-Estes [4%] and Gubner [1%]). The prevalence of LVH (using Sokolov) increased with age and was higher in men than women (20% vs 10%) and linearly with levels of SBP, but also by ∼10-fold between the 10 regions in China. Irrespective of which criteria were used for detection (Table), LVH was strongly associated with both prevalent and incident cases of IHD after adjustment for age, sex, region and established CVD risk factors. Any one measure of LVH was associated with an adjusted OR (95% CI) of 1.30 (1.10, 1.53) for prevalent IHD and 1.40 (1.20, 1.64) for incident IHD, respectively. Conclusions Overall, 1 in 10 Chinese adults had LVH, and LVH was associated with 30% higher risk of prevalent IHD and 40% higher risk of IHD independent of established CVD risk factors. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): UK Wellcome Trust

Importance of familial predisposition to heart failure to the risk of anthracycline related cardiotoxicity: a nationwide study

Abstract Background/Introduction Anthracycline-based chemotherapy has improved the prognosis in cancer and hematological malignancies but is associated with the development of heart failure (HF). Besides well-known cardiac risk factors and cumulative dose of anthracycline, recent research has suggested that genetic variations associated with cardiomyopathies may increase the risk of HF associated with anthracycline. However, the importance of familial predisposition for the risk of developing anthracycline associated cardiotoxicity is unknown. Purpose To evaluate the risk of anthracycline related HF in patients with vs. without a first-degree relative with HF. Methods In the nationwide Danish registries, patients treated with anthracycline from 2004–2016 were identified. Primary outcome was a subsequent diagnosis of HF. Follow-up was 10 years or December 31, 2017. Familial relations were identified in the Danish Family Registry, which hold all persons born since 1942. Exposure was a first-degree biological relative (parent or sibling) with a diagnosis of HF. Risk of HF was evaluated in a cumulative incidence function with death as competing event and in a Fine and Grey model adjusted for age, sex, prevalent ischemic heart disease, atrial fibrillation, hypertension and chronic obstructive pulmonary disease. Results A total of 11.651 patients (mean age 48.0 (SD±8.6), 12.2% male gender) were evaluated after exclusion of 46 with pre-anthracycline HF. Mean follow-up was 4.4 years (SD±2.9). In the group with a first-degree relative with HF (n=1.608) 35 patients (2.2%) was diagnosed with HF vs. 133 (1.3%) in the group without a first-degree relative with HF (n=10.043) corresponding to incidence rates per 1000 patient years of 5.2 (95% CI: 3.8–7.3) vs. 3.0 (95% CI: 2.5–3.5). The cumulative incidence of HF was higher in the first-degree relative HF group (Figure 1a), yielding an adjusted hazard ratio of 1.53 (95% CI: 1.05–2.24, p=0.03) for HF associated with anthracycline. All-cause mortality showed a trend towards higher risk in the later 5 years of follow-up in the first-degree relative HF group with a 10-year risk of 32.4% (95% CI: 28.4–36.5) vs. 26.1% (95% CI: 24.9–27.4) but no significant difference in the Kaplan-Meier estimate (p=0.08) (Figure 1b). Conclusion In this nationwide register-based study having a first-degree relative with HF was associated with a small but increased risk of anthracycline related HF, yielding attention towards the family predisposition, when estimating the risk of cancer therapy related cardiotoxicity. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Odense University Hospital

Ischemic heart disease is more prevalent in low-income-countries and more often undertreated: data from report-hf

Abstract Background The pathogenic role of ischemic heart disease (IHD) in heart failure is well known. However, little is known about the global differences in the prognostic significance and treatment patterns of IHD in acute heart failure (AHF). Methods We prospectively enrolled 18,553 patients with AHF from 44 countries and 365 centers in the REPORT-HF registry. Patients with a history of coronary artery disease, an ischemic etiology of the AHF event or coronary revascularization were classified as IHD. Differences in clinical characteristics, treatment and outcome were analyzed. Results Compared to 9,344 (50%) patients without IHD, the 9,189 (50%) patients with IHD were older, more often had a left ventricular ejection fraction [LVEF] &amp;lt;40%, (HFrEF) and decompensated chronic HF (DCHF) and had a greater comorbidity burden. Despite patients from lower-income countries having a higher prevalence of IHD (55% vs. 45% in high-income countries), only 27% of patients with IHD from low-income countries were treated with medicines commonly prescribed for HF (Figure A) compared to 16% of patients with IHD from high income countries. After correction for clinical confounders and medication use, patients with IHD had a shorter “door-to-nitrates and -diuretics time” and worse 1-year mortality (hazard ratio: 1.18, 95% CI: 1.09, 1.27, Figure B) irrespective of geographic region (Pinteraction &amp;gt;0.1). We found a significant interaction for prognosis (Pinteraction &amp;lt;0.001) between IHD and HF diagnosis (DCHF vs. new-onset HF) as well as HF subtype (HFrEF vs. HF with preserved ejection fraction) respectively, such that IHD conveyed worse outcomes in patients with new-onset HF and HFrEF respectively in all world regions. Conclusion In this large global contemporary cohort of patients with AHF, IHD was more common in patients from low income countries, conveyed worse 1-year mortality, particularly in patients with new onset HF and patients with HFrEF. Despite worse outcomes, patients in regions with the greatest burden of IHD were more often undertreated. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy

BackgroundAmong the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available.MethodsA retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27–June 11, 2020). Clinical characteristics and the times from symptoms’ onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex.ResultsOf the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39–2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29–2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13–1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55–0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25–0.63), yet both sexes had a high level of multimorbidity. The times from symptoms’ onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45–5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13–1.90).ConclusionsMen and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

Cardiovascular morbidity of adult population in Kyiv region

Annotation. The population of the Kyiv region are losing the largest number of life potential years in Ukraine due to cardiovascular diseases (CVD), which determines the special medico-social significance of CVD in this region. The aim of the work is to determine the modern features of the incidence and prevalence of CVD among the adult population of the Kyiv region. The analysis of the incidence and prevalence of CVD among the adult population of the Kyiv region was carried out in dynamics for 2010–2019 and compared with Ukraine on the basis of statistical data from the Center for Medical Statistics of the Ministry of Health of Ukraine and the Kyiv Regional Center of Medical Statistics using statistical methods of dynamic and territorial analysis. It has been determined that in the Kyiv region more than a million residents suffer from CVD. In 2019 the incidence rate of CVD was 446.2, and the prevalence of CVD was 7114.8 per 10 thousand of the adult population. The epidemic of CVD in the Kyiv region is much more spread than in Ukraine. Myocardial infarctions in the region are diagnosed 1.2 times, and strokes 1.5 times more often than in the country, and the prevalence of ischemic heart disease is 1.5 times higher than in Ukraine. The tendency to increasing the prevalence (by 8.5%) and incidence (by 5.7%) of CVD in the Kyiv region during 2010–2017 and the absence of the possibility of further objective monitoring of the CVD morbidity due to the cancellation of the state registration system of morbidity were determined. Unfavorable dynamic trends in CVD morbidity in Kyiv region and a significant excess of regional indicators of averages in Ukraine indicate the need to improve the system of prevention and medical care for patients with CVD in Kyiv region, on which our further research will be focused.

Metabolic predictors for mortality among patients treated with long-term clozapine – A longitudinal study

Clozapine is the only antipsychotic compound indicated for refractory-schizophrenia. However, it is associated with emergent metabolic dysregulation and cardiovascular risk which may lead to mortality. In this study we aimed to explore predictors for mortality in a large cohort of schizophrenia patients treated with long-term clozapine, using the electronic medical records of the largest health care provider in Israel. Among 27,929 patients diagnosed with schizophrenia, 1817 were prescribed clozapine during the years 2012-2014. We compared patients who survived (n=1705) and patients who died (n=112) during the 3-year follow-up period. Socio-demographic background, cardiovascular morbidity, medication prescriptions and health-care utilization were compared between groups. Cox proportional hazard models were used to assess the association of variables with survival. Chronic hypertension was found to be the only metabolic factor associated with significant hazard ratio (HR) for mortality (HR: 1.55 95% CI: 1.03-2.34). Moreover, those who died had more prevalent ischemic heart disease (14% vs 3%, p<0.005) as well as more frequent hospitalizations (0.01±0.02 vs 0.11±0.18 average per month, p<0.005), for longer periods (2.22±9.87 vs 20.38±33.76 days per month, p<0.005). Among those who died, less patients received prescriptions of statins for hyperlipidemia (13.7% vs. 52.9% in survivors, p<0.005) and hypoglycemics for diabetes mellitus (16.3% vs. 67.1% in survivors, p<0.005). Inadequate treatment of metabolic syndrome, under chronic clozapine treatment, was found to be an independent predictor for mortality. Adequate rigorous regimen for diagnosis and treatment of metabolic risk factors, especially hyperlipidemia and diabetes mellitus, might lower complications rate and prolong life expectancy among this population.

Association between asthma and cardiovascular disease

Epidemiological studies on the association between asthma and cardiovascular disease have reported conflicting results. This cross-sectional study evaluated the association between asthma and ischaemic heart disease (IHD)/stroke in Korean adults. Data from the Korean Genome and Epidemiology Study-Health Examinees were used. Among 173209 participants, 3162 asthmatic and 159408 control participants were selected. Histories of asthma, IHD and stroke were obtained. Participants were categorized according to their current status of asthma management: 'well-controlled', 'being treated', and 'not being treated'. Crude and adjusted (age, gender, body mass index, income, smoking, alcohol consumption, hypertension, diabetes, dyslipidaemia and nutritional intake) odds ratios (ORs) for IHD and stroke in asthmatic patients were analysed using a multiple logistic regression model. Participants with asthma reported a significantly higher prevalence of IHD (6.0% vs 3.0%) and stroke (2.3% vs 1.4%) than those without asthma (P<.001). Asthmatic participants had a higher OR (1.46, 95% confidence interval [CI]=1.251-1.71, P<.001) for IHD than those without asthma. The association between asthma and IHD was significant only in patients aged ≥53years (men: adjusted OR=1.31, 95% CI=1.01-1.70, P=.046; women: adjusted OR=1.64, 95% CI=1.32-2.03, P<.001) according to age and sex and in the 'not being treated' asthma group (adjusted OR=1.47, 95% CI=1.14-1.91, P=.003) according to the asthma management status. Stroke was not significantly associated with asthma (adjusted OR=1.17, 95% CI=0.92-1.48, P=.203) in the adjusted model and all subgroup analyses. Asthma was associated with IHD, mainly in older patients and untreated asthma patients, but not with stroke.

Echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population.

Global longitudinal strain (GLS) is a strong predictor of adverse cardiovascular outcome in men. However, studies have indicated that GLS may not predict cardiovascular outcomes as effectively in women. The aim of this study was to identify echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population. A total of 1245 women from the general population free of heart failure (HF) and atrial fibrillation had an echocardiographic examination performed including tissue Doppler imaging. In this subset, 747 women had images eligible for strain analysis. Endpoint was a composite of acute myocardial infarction, HF, and cardiovascular death. During follow-up (median 12.5 years), 162 women (13.0%) reached the composite outcome. These women had higher left ventricular (LV) mass index (LVMI), more LV hypertrophy, lower E/A, higher E/e', larger LV dimensions, and longer deceleration time. LVMI and e' remained as significant predictors of the composite outcome [LVMI: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, P = 0.004, per 5 g/m2 increase] (e': HR 1.53, 95% CI 1.07-2.20, P = 0.020, per 1 cm/s decrease) after adjusting for age, hypertension, systolic blood pressure, diabetes mellitus, total cholesterol, smoking status, prevalent ischaemic heart disease, LV ejection fraction, E/e', E, E/A, interventricular septum thickness in diastole, left ventricular posterior wall in diastole, a', body surface area, and pro-brain natriuretic peptide. GLS was not an independent predictor of outcome after multivariable adjustment. The degree of LV hypertrophy assessed as LVMI and diastolic dysfunction evaluated by e' are associated with adverse cardiovascular outcome in women from the general population.

Both Small and Large Infrarenal Aortic Size is Associated with an Increased Prevalence of Ischaemic Heart Disease

Past studies have suggested a potential "J shaped" relationship between infrarenal aortic diameter and both cardiovascular disease (CVD) prevalence and all cause mortality. However, screening programmes have focused primarily on large (aneurysmal) aortas. In addition, aortic diameter is rarely adjusted for body size, which is particularly important for women. This study aimed to investigate specifically the relationship between body size adjusted infrarenal aortic diameter and baseline prevalence of CVD. A retrospective analysis was performed on a total of 4882 elderly (>50 years) participants (mean age 69.4±8.9 years) for whom duplex ultrasound to assess infrarenal abdominal aortic diameters had been performed. History of CVDs, including ischaemic heart disease (IHD), and associated risk factors were collected at the time of assessment. A derivation cohort of 1668 participants was used to select cut offs at the lower and upper 12.5% tails of the aortic size distributions (aortic size index of <0.84 and >1.2, respectively), which was then tested in a separate cohort. A significantly elevated prevalence of CVD, and specifically IHD, was observed in participants with both small and large aortas. These associations remained significant following adjustment for age, sex, diabetes, hypertension, dyslipidaemia, obesity (body mass index), and smoking. The largest and smallest infrarenal aortic sizes were both associated with prevalence of IHD. In addition to identifying those with aneurysmal disease, it is hypothesised that screening programmes examining infrarenal aortic size may also have the potential to improve global CVD risk prediction by identifying those with small aortas.