Key Risk Factors For Cardiovascular Disease Research Articles

Cardiovascular Disease Prediction from Retinal Images using Machine Learning

The structure and function of the microvascular are significantly influenced by the key cardiovascular disease risk factors of hypertension and heart attacks. Images taken with a fundus camera can be used to spot irregularities in the blood vessels of retina that indicate the extent injury on blood vessels by hypertension and heart attacks. Using machine learning and AI techniques, detecting the preclinical signs that fall below the threshold of an observer. The proposed methodology aimed to investigate the effects of hypertension and heart attacks on morphological characteristics of retinal blood vessels. With a diagnosis of hypertension and heart attack, data scientists collect retinal images. Interference data is removed— information about structures other than that retinal vasculature using the vessel segmentation method, leaving only morphological details about the blood vessel of retina. Keywords— Heart Disease, Retinal Image, Microvasculature, Hypertension

Cardiovascular disease risk management during COVID-19: in-person vs virtual visits.

Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. Thisstudy assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits. Retrospective interrupted time-seriesanalysis. Data came from an electronic health record shared by 52 community clinics for index (March 1, 2019, toFebruary 29, 2020) and follow-up (July 1, 2020, to February 28, 2022) periods. Analyses compared follow-up period changes in slope and level of population monthly means of 10-year reversible CVD risk score, blood pressure (BP), andhemoglobin A1c (HbA1c) among patients whose completed follow-up period visits were primarily in person vs primarily VC. Propensity score weighting minimizedconfounding. There were 10,028 in-person and 6593 VC patients in CVD risk analyses, 9874 in-person and 5390 VC patients in BP analyses, and 8221 in-person and 4937 VC patients in HbA1c analyses. The VC group was more commonly younger, female, White, and urban. Mean reversible CVD risk, mean systolic BP, and percentage of BP measurements that were 140/90 mm Hg or higher increased significantly from index to follow-up periods in both groups. Rate of change between these periods was the same for all outcomes in both groups, regardless of care modality. Among community clinic patients with CVD risk, receiving a majority of care in person vs a majority of care via VC was not significantly associated with longitudinal trends in reversible CVD risk score or key CVD risk factors.

Abstract 14413: Contemporary Prevalence, Comorbidity Burden, and Treatment of Overweight and Obesity: Insights From the Multicenter Mass General Brigham Healthcare System

Background: Real-world evidence is critical to identify treatment gaps and inform healthcare service design, but contemporary anti-obesity medication (AOM) use patterns are sparsely reported. Aims: To describe the prevalence of obesity/overweight, evidence-based obesity-related conditions (ORCs), and AOM use among eligible patients, with a focus on cardiovascular disease (CVD). Methods: In this cross-sectional analysis of the multicenter Mass General Brigham healthcare system spanning 2018-2022, we identified all adult patients eligible for AOM (BMI 27-29.9 kg/m 2 with ≥1 ORC or BMI ≥30 kg/m 2 ). The prevalence of ORCs was ascertained using administrative codes and available EHR data. Prescription of FDA-approved AOM by BMI category, number of ORCs, number of key CVD risk factors, and the presence of prior MACE were also evaluated. Results: Of 2,922,522 individuals who met inclusion criteria, 998,234 (34%) were eligible for AOM (mean age, 49 years; 53% female). Of these, 30%, 41%, 18%, and 11% had a BMI (kg/m 2 ) of 27-29.9, 30-34.9, 35-39.9, and ≥40, respectively. Prior metabolic/bariatric surgery was seen in 2.3%. Musculoskeletal disorders (54%), dyslipidemia/hyperlipidemia (35%), and hypertension (32%) were the most common ORCs, with ≥2 ORCs observed in 58%. Prescription of any FDA-approved AOM was observed in only 1.2% of all eligible patients. Liraglutide 3.0 mg (58% of all AOM) was the most prescribed AOM. AOM prescriptions increased modestly with higher BMI, ORC burden, and number of CVD risk factors ( Figure ). Among those with prior MACE (11%), 1.5% (1.0% if without T2DM) were prescribed FDA-approved AOM. Conclusions: Although more than 1 in 3 contemporary patients in a large healthcare system are eligible by guidelines and FDA labeling, AOM prescription remains exceedingly low, even among high-risk persons with severe obesity and established CVD. Novel care delivery pathways are needed to accelerate closure of these considerable implementation gaps.

The association between adolescent depression and dyslipidemia

BackgroundChildren and adolescents with major depressive disorder (MDD) are at increased risk for premature cardiovascular disease (CVD). Whether adolescents with MDD manifest evidence of dyslipidemia, a key risk factor for CVD, is unknown. MethodsYouth recruited through an ambulatory psychiatry clinic and the community, were categorized following diagnostic interview as MDD or as healthy controls [HC]. CVD risk factors including high density lipoprotein (HDL), low density lipoprotein (LDL), and triglyceride concentrations were collected. Depression severity was measured using the Center for Epidemiological Studies Depression Scale for Children. The associations of diagnostic group as well as depressive symptom severity with lipid concentrations were examined using multiple regression analyses. Models were adjusted for age, sex, and standardized Body Mass Index. ResultsParticipants (n = 243) were 68 % female with a mean age of 15.04 ± 1.81 years. MDD and HC participants had comparable levels of dyslipidemia (MDD: 48 %, HC: 46 %, p > .7) and hypertriglyceridemia (MDD: 34 %, HC: 30 %, p > .7). Among depressed adolescents, greater depressive symptoms were associated with higher total cholesterol concentrations in unadjusted models only. Greater depressive symptoms were associated with higher HDL concentrations and a lower triglyceride-to-HDL ratio, after adjusting for covariates. LimitationsCross-sectional design. ConclusionsAdolescents with clinically significant depressive symptoms manifested similar levels of dyslipidemia as healthy youth. Future studies examining the prospective trajectories of depressive symptoms and lipid concentrations are needed to determine the point at which dyslipidemia emerges in the course of MDD, and the mechanism of the association that imparts increased CVD risk for depressed youth.

Abstract P141: Six-Month Follow-Up of Menopausia, Salud, Corazón (Menopause, Health, Heart): A Multi-Component Intervention to Reduce Cardiovascular Disease Risk in Midlife Latinas

Background: Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Latina White women, potentially due to multiple sociocultural and environmental factors. The purpose of this study is to evaluate the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. Here we report data at a 6-month follow-up. Methods: This is a randomized two-group, repeated measures experimental study. Forty-nine perimenopausal Latinas (age 40-60 years) were randomized to a 6-month multi-component intervention or wait-list control. The intervention consists of 12-weekly culturally tailored Spanish language-based sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. Between May 2021 and June 2022, thirty-five participants (18 intervention and 17 control) completed a 6-month follow-up. Primary outcomes at this study visit included weight, body mass index, waist circumference, and blood pressure. Secondary outcomes included health behaviors and psychological factors (nutrition, physical activity, sleep, self-efficacy, perceived stress). We assessed the initial efficacy of the intervention at 6 months using general linear models for continuous outcomes and logistic regression for categorical outcomes. Models adjusted for outcome measures at baseline and baseline group differences (health insurance, vasomotor symptoms). Models were two-sided at a level of significance of p≤0.1. Results: At baseline, the mean age was 47.8 ± 4.4 years, 37% had less than high school education, 97% were born outside of the United States, and 51% reported it was somewhat/very difficult to pay for basics. Women in the intervention group were more likely to have health insurance (61% vs 24%, p=0.06) and less likely to report any vasomotor symptoms (44% vs 77%, p=0.09). At 6 months (post-intervention), compared to the waitlist control group, the intervention group had lower perceived stress (ß[SE]= -2.15 [1.05], p=0.05) and systolic blood pressure (ß[SE]= -2.72 [1.61], p=0.1) even after adjusting for baseline measures and group differences. There were no other significant differences post-intervention. Conclusions: This pilot study found that a culturally tailored Spanish language intervention consisting of nutrition education, physical activity, and stress management may be effective in reducing stress and blood pressure in perimenopausal Latinas —key risk factors for CVD.

Abstract 10976: Midlife Caregivers: At Risk for Cardiovascular Disease?

Introduction: Caregivers remain an invisible population that may be at increased risk for cardiovascular disease (CVD) secondary to the additional stress of caregiving. Some groups of caregivers demonstrate as much as an 82% increased risk of CVD compared with non-caregivers. Purpose/Hypothesis: The purpose of this study was to describe characteristics of midlife caregivers from a large, publicly available dataset and to identify CVD risk factors among a subset of these caregivers. Methods: This was a secondary analysis of data from the Midlife in the United States (MIDUS) study. The sample was limited to participants who reported caring for someone else. Data were collected using sociodemographic questionnaires and survey instruments. Key CVD risk factors examined were for a subset of caregivers with complete data for these variables: blood pressure (BP), cholesterol levels, body mass index (BMI), perceived stress (Cohen’s perceived stress scale [PSS]), depression (Centers for Epidemiological Studies Depression Inventory [CESD]), and anxiety (Spielberger Trait Anxiety Inventory). Results: In the overall sample of 417 midlife caregivers, the mean age was 52±13 years, 62.1% were female, 62.1% were married, and 18% graduated from a 4-year institution. The most common care recipient was the mother of the caregiver (24.2%), 52.3% lived with their care recipient, and the average number of care hours per week was 25.13 ± 27.23. Care given included help bathing, dressing, and toileting (55.4%), shopping, cooking, laundry, and housework (88.7%), and help with transportation in and out of the home (65.2%). Data regarding CVD risk factors were available for a subset of 66 caregivers. Of those, 71.2% were either overweight or obese, mean systolic BP was 128±20, mean diastolic BP was 78±11, 57.6% had high density lipoprotein cholesterol <60, low density lipoprotein >100 (48.5%), 31.8% had total cholesterol >200, and 13% had triglycerides >150. The average score on the PSS was moderate at 22.5±6.5. Mean depressive symptom score was 8.7±7 and mean anxiety was high at 34.9±9. Conclusions: Caregivers at midlife are a unique subgroup, often caring for parents, and show unfavorable levels of CVD risk factors such as low HDL, high LDL, and high perceived stress and anxiety.

High-density lipoprotein cholesterol efflux capacity in patients with obstructive sleep apnea and its relation with disease severity

BackgroundObstructive sleep apnea (OSA) is linked to an accelerated risk of cardiovascular disease (CVD). Some key CVD risk factors are present in patients suffering from OSA such as hypertension, inflammation, oxidative stress, and dyslipidemia. High-density lipoprotein (HDL) cholesterol efflux capacity (CEC) is proposed as a reliable biomarker of HDL function and the present study aimed to quantify this biomarker in patients with OSA.MethodsATP binding cassette subfamily A member 1 (ABCA1), non-ABCA1, and total CEC were determined in 69 polysomnographic-confirmed OSA patients and 23 controls. Moreover, paraoxonase (PON) activities, high-sensitivity C-reactive protein (hsCRP), apolipoprotein B (apo B), and apolipoprotein A-I (apo A-I) circulating levels were quantified in the studied population.Results: All CEC measures were reduced in the OSA group compared to the control group. Strikingly, ABCA1 CEC was diminished in severe OSA in comparison with mild OSA. Furthermore, PON activities and apo A-I showed lower levels, while hsCRP and apo B were elevated in OSA patients compared to controls. Moreover, ABCA1 CEC showed an inverse association with hsCRP and a positive association with apo A-I, while non-ABCA1 CEC presented an association with HDL-C.ConclusionThese results suggest the presence of an impaired HDL function in OSA. In particular, ABCA1 CEC was associated with disease severity and inflammation which could be a factor increasing the risk of CVD.

Gender Factor Effects on Compliance of Statin Therapy in Hyperlipidemia Patients

Background: The biggest cause of death worldwide is cardiovascular disease (CVD), which accounts for 31% of all fatalities that are officially reported each year. Hyperlipidemia is thought to be a key risk factor for CVD. Due to the lack of symptoms associated with hyperlipidemia, many patients do not feel the need to take medication. Undoubtedly, treating and managing the hypercholesterolemia and other diseases with no symptoms has been difficult for both patients and medical professionals. Methodology: Study was conducted in co-operation of department of Cardiology & Medicine PMC Hospital Nawabshah. 100 patients were registered having hyperlipidemia, included through convenience sampling technique. Two groups were made age from 31-50 years and other age from 51 to 70 years. Drug compliance was measured by using Morisky scale and detailed history by using the pre-formed proforma. Results: Result showed there was compliance of statin therapy in both genders PDC was more than 80%, but in comparison of both groups statin therapy compliance was statistically non-significant p value-0.726. Conclusion: The majority of the participants in this study who had hyperlipidemia adhered to their statin medication. The factors determining compliance revealed good adherence in the high-risk population, especially in people over 50 years old. Keywords: Gender, compliance. Statin therapy. Hyperlipidemia.

Prevalence of cardiovascular risk factors by HIV status in a population-based cohort in South Central Uganda: a cross-sectional survey.

IntroductionCardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population‐based data are available from sub‐Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10‐year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South‐Central Uganda.MethodsA cross‐sectional study was conducted in 37 communities of the population‐based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV‐negative participants aged 35–49 years were included. Prevalence estimates and 10‐year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio‐demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia.ResultsOverweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high‐density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten‐year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV‐adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35–3.96) and high triglycerides (OR = 2.08, CI 1.25–3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55–4.18) and low HDL (OR = 1.36, CI 1.09–1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35–0.52).ConclusionsIn this population‐based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten‐year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.

Training Culturally Congruent Health Coaches to be Socially-Embedded Support on Physical Activity among Older Asian Americans: Phase One Report

There is a reported heterogeneity in burden with cardiovascular disease (CVD) among Asian Americans subgroups. Physical inactivity is an identified key risk factor for CVD, across age and race/ethnic backgrounds. The latest data showed that 42% of Asian Americans are physically inactive. Health coaching is a rapidly emerging primary or supplemental intervention to address issues related to preventable chronic illness, including physical inactivity. Hence, the purpose of this paper is to describe Phase One of this project - training of culturally congruent Health Coaches as socially embedded social support to promote physical activity to their older Asian communities. A 3-day training curriculum was developed based on the four pillars of Health Coaching and the Transtheoretical Model of Change. Fifteen Asian Americans Health Coaches were trained using this curriculum. Fifteen health coaches completed the 3-day training. Phase Two of this project is ongoing and results may provide information on the long-term effects of health coaching among older Asian Americans.

Structure and Function of Mitochondria-Associated Endoplasmic Reticulum Membranes (MAMs) and Their Role in Cardiovascular Diseases.

Abnormal function of suborganelles such as mitochondria and endoplasmic reticulum often leads to abnormal function of cardiomyocytes or vascular endothelial cells and cardiovascular disease (CVD). Mitochondria-associated membrane (MAM) is involved in several important cellular functions. Increasing evidence shows that MAM is involved in the pathogenesis of CVD. MAM mediates multiple cellular processes, including calcium homeostasis regulation, lipid metabolism, unfolded protein response, ROS, mitochondrial dynamics, autophagy, apoptosis, and inflammation, which are key risk factors for CVD. In this review, we discuss the structure of MAM and MAM-associated proteins, their role in CVD progression, and the potential use of MAM as the therapeutic targets for CVD treatment.

Conquering hypertension in Vietnam\u2014solutions at grassroots level: study protocol of a cluster randomized controlled trial

BackgroundVietnam has been experiencing an epidemiologic transition to that of a lower-middle income country with an increasing prevalence of non-communicable diseases. The key risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam, particularly hypertension (HTN). Inasmuch, the burden of CVD will continue to increase in the Vietnamese population unless effective prevention and control measures are put in place. The objectives of the proposed project are to evaluate the implementation and effectiveness of two multi-faceted community and clinic-based strategies on the control of elevated blood pressure (BP) among adults in Vietnam via a cluster randomized trial design.MethodsSixteen communities will be randomized to either an intervention (8 communities) or a comparison group (8 communities). Eligible and consenting adult study participants with HTN (n = 680) will be assigned to intervention/comparison status based on the community in which they reside. Both comparison and intervention groups will receive a multi-level intervention modeled after the Vietnam National Hypertension Program including education and practice change modules for health care providers, accessible reading materials for patients, and a multi-media community awareness program.In addition, the intervention group only will receive three carefully selected enhancements integrated into routine clinical care: (1) expanded community health worker services, (2) home BP self-monitoring, and (3) a “storytelling intervention,” which consists of interactive, literacy-appropriate, and culturally sensitive multi-media storytelling modules for motivating behavior change through the power of patients speaking in their own voices. The storytelling intervention will be delivered by DVDs with serial installments at baseline and at 3, 6, and 9 months after trial enrollment. Changes in BP will be assessed in both groups at several follow-up time points. Implementation outcomes will be assessed as well.DiscussionResults from this full-scale trial will provide health policymakers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam.Trial registrationClinicalTrials.gov NCT03590691. Registered on July 17, 2018. Protocol version: 6. Date: August 15, 2019.

Abstract 14833: The Association Between Cardiovascular Disease Knowledge and Risk Factors Among African American Breast Cancer Survivors in the Deep South

Introduction: African American breast cancer survivors in the Deep South have a disproportionately high burden of cardiovascular disease (CVD) mortality. This is due, in large part, to multiple potentially modifiable CVD risk factors that are disproportionately high in this group, such as high blood pressure, obesity, and poor dietary habits. The purpose of this study was to assess the association between CVD risk factors and heart disease knowledge among African American breast cancer survivors in the Deep South. Hypothesis: We hypothesize that the key CVD risk factors (smoking, BMI, physical activity, healthy diet, total cholesterol, blood pressure, and blood sugar) will be positively associated with heart disease knowledge score. Methods: The Heart Disease Knowledge Questionnaire was used to assess the participants’ knowledge of heart disease and heart disease risk factors. Questions from My Life Check were used to assess the participants CVD risk factors. Multivariate regression analyses were performed to determine which CVD risk factors and demographic characteristics can predict the participants’ heart disease knowledge score. Results: Seventy African American breast cancer survivors living in the Deep South enrolled in the study. A research team member administered the questionnaires over the phone. The mean age of the participants was 56.76 years (± 10.36) and 42.9% had a college degree or higher level of education. Results of a multivariate regression analysis showed that the number of healthy diet score components was the only cardiovascular health metric that was statistically significantly associated with heart disease knowledge score (p = .01). Education level was the only demographic characteristic that was statistically significantly associated with heart disease knowledge score (p = .004). Conclusions: Our results indicate that women with more knowledge of heart disease and higher levels of education are more likely to have better cardiovascular health metrics. Our findings underscore the need to disseminate and implement health education interventions aimed at increasing knowledge of modifiable CVD risk factors that are targeted towards African American breast cancer survivors in the Deep South.

Abstract 16555: The Relationship of Preeclampsia and Maternal Region of Birth and Duration of Residence in Non-US Born Black Women

Introduction: Preeclampsia is a risk factor for cardiovascular disease (CVD) and disproportionately effects black women. Few studies have explored the prevalence of CVD risk factors and preeclampsia risk in non-US-born black women. We investigated the differential risk of preeclampsia by maternal birth country and duration of stay in US-born vs non-US-born black women residing in US. Methods: We analyzed data from 2967 black women (US-born and non-US-born) in the Boston Birth Cohort (1998 - 2016). Maternal sociodemographic characteristics and key CVD risk factors (hypertension, obesity, diabetes, smoking) were characterized in the two groups. We performed multivariate logistic regression to investigate the prevalence of preeclampsia by maternal birth country and the duration of stay in the US (&lt;10 years and ≥ 10 years) after controlling for explanatory variables. In all analyses, US-born black women were used as the reference group. Results: Of the study group, 40.5% were non-US-born (42% Caribbean, 36% from Sub-Saharan Africa and 21% from other regions). US-born black women were younger and had higher baseline prevalence of obesity (BMI≥ 30Kg/m2), multiparity, pregestational diabetes, smoking, maternal stress, lower educational level, and single marital status. As compared to US-born black women, non-US-born women had a 26% lower risk of preeclampsia. When further categorized by their duration of residence in the US, the prevalence of preeclampsia in non-US-born women with duration of stay &lt;10 years was 8.5%, compared to 9.3% in those with duration of stay beyond 10 years (Figure). Conclusions: As compared to US-born blacks, the prevalence of CVD risk factors and preeclampsia is lower in non-US-born blacks. The "healthy immigrant effect” which typically results in health advantages for foreign born women, tends to wane with increasing duration of US residence (≥ 10 years). Further research on the impact of CVD risk factors on preeclampsia is needed.

Abstract MP16: Reallocating Sedentary Behavior With Sleep or Physical Activity is Associated With Favorable Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis: MESA

Introduction: Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). However, many studies have investigated these relationships in isolation even though a change in any one given behavior will affect the time spent in the others. It is unknown how reallocating time in sedentary behavior with sleep or physical activity effects overall CVH in a diverse cohort of men and women at risk of cardiovascular disease (CVD). Hypothesis: Reallocating 30 minutes of sedentary time with sleep, light (LIPA), or moderate to vigorous physical activity (MVPA) is associated with more favorable overall CVH due to improvements in risk factors for CVD. Methods: Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis (MESA) Sleep Ancillary Study. Eligible participants (n= 1718) wore Actiwatch accelerometers for 24 hours a day, and had at least 3 days of valid accelerometry. Time spent in sleep, sedentary behavior, LIPA, and MVPA was determined based on an established algorithm. The American Heart Association’s life simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. All components were ascertained from MESA exam 5. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 minutes of sedentary time for an equivalent amount of sleep, LIPA, or MVPA. Results: The mean age of participants was 68.3, 54.0% were female and 38.6% were white. The mean CVH score was 5.9 (95%CI: 5.8-6.0). On average, participants spent 499.3 minutes/day in sedentary time, 415.3 minutes/day in LIPA, 26.0 minutes/day in MVPA, and 388.2 minutes/day sleeping. Reallocating 30 minutes of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β(SE): 0.077(0.023), 0.039(0.017), and 0.485(0.065) respectively]. Reallocating 30 minutes of sedentary time to sleep was associated with lower BMI. Reallocating 30 minutes of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Reallocating 30 minutes of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI. Conclusions: Our study demonstrates that sleep, LIPA, and MVPA are all positively associated with more favorable overall CVH and several key CVD risk factors. These findings underscore the importance of lifestyle modifications in improving CVH.

PCV98 PCSK9 INHIBITORS: AN ANALYSIS OF CURRENT UPTAKE AND POTENTIAL OPPORTUNITIES IN ENGLAND

Cardiovascular disease (CVD) affects approximately 6 million people in England and costs the NHS an estimated £7 billion a year. A key risk factor for CVD is hypercholesterolaemia. PCSK9 inhibitors, such as alirocumab and evolocumab, are a treatment option for patients who, despite taking the maximum tolerated dose of statins, still have cholesterol higher than recommended levels. This study compares actual prescription of PCSK9 inhibitors with expected use and considers opportunities for improved access to these drugs. An analysis of the initial uptake estimates from the NICE resource impact report for alirocumab and evolocumab and actual daily dose (ADD) prescribing data from the NICE innovation scorecard for the same drugs in 2018. The study included a review of the NICE technology appraisal guidance (TAG) for alirocumab (TA393) and evolocumab (TA394), and publications from 2016–2019 relating to uptake of, and guidance and initiatives associated with, PCSK9 inhibitors in England. On publication of the TAG for alirocumab and evolocumab in 2016, NICE estimated that there would be 11,542 people receiving PCSK9 inhibitors by 2018. However, analysis of data from the NICE innovation scorecard for 2018 shows that 755,806 ADDs of alirocumab and evolocumab were actually prescribed. This is equivalent to approximately 2,069 people receiving treatment and indicates that uptake of PCSK9 inhibitors was 82% lower than expected in 2018. While there is considerable potential for PCSK9 inhibitors to alleviate some of the burden of CVD, prescription of these drugs is considerably lower than expected. Despite price reduction, the cost of PCSK9 inhibitors may remain the main barrier to access to these drugs. Further barriers could include a lack of clear guidance for clinicians, patient identification and, until recently, limited clinical trial data regarding CVD outcomes. New initiatives, such as the Accelerated Access Collaborative, may ultimately lead to improved access to PCSK9 inhibitors.

Abstract P300: Cluster Analysis of Discrepancies Between Self-Reported and Investigator-Assessed Biomeasures of Cardiovascular Disease Risk

Introduction: Hypertension and obesity are major cardiovascular disease (CVD) risk factors that affect huge numbers of Americans. Although hypertension and obesity are largely preventable and manageable, national statistics evidence that these CVD risks are not effectively managed. Patterns of personal under-estimates of individual risk, i.e., discrepancies between one’s perceived health (self-reported biomeasures) relative to actual health (investigator-assessed biomeasures) may contribute to delays in seeking care that could result in CVD risk detection and management. Hypothesis: We hypothesized that personal patterns of awareness reflecting a higher degree of self-reported underestimation of biomeasures of CVD risk would reveal personal profiles of greater CVD risk. Methods: Adults, aged 18 and over were recruited at a large community event. Self-reported systolic and diastolic blood pressure (SBP, DBP; mmHg), weight (lb.) were collected before objective investigator-obtained assessments of SBP, DBP, and weight. K-means (non-hierarchical) cluster analysis was used to divide data into clusters. The z-score of mean differences between self-reported and measured SBP, DBP, and weight were included in the cluster analysis. ANOVA was used to examine differences in variables among clusters. Results: A total of 61 subjects were eligible and included in the cluster analysis. The mean age of the sample was 55.2 yrs (range 21 to 73; SD: 12.9) and mostly female (63.9%). Mean SBP, DBP, and weight were 133.8, 77.6, and 176.8, respectively. Three clusters from k-means cluster analysis were identified. Cluster 1 (n=22) had moderate discrepancies, with mean differences in SBP, DBP, weight of 14.0, 3.2, -0.5, respectively. Cluster 2 (n=17) had low discrepancies, with mean differences in SBP, DBP, weight: 3.0, -2.6, 7.1, respectively. Cluster 3 (n=22) showed high discrepancies, with mean differences in SBP, DBP, weight of 27.2, 10.5, 4.5, respectively. There were significant mean differences between Cluster 2 (low discrepancies) and Cluster 3 (high discrepancies) in investigator-obtained SBP and DBP (p&lt;0.01, p&lt;0.05, respectively). Conclusions: A wide range of accuracy in personal awareness of biomeasures of risk was uncovered with patterns of discrepancy ranging from low to high; those having a pattern of greatest inaccuracy had significantly higher SBP and DBP (key risk factors for CVD) than those with least inaccuracy. These data highlight the importance of regular objective screening of biomeasures and suggests that relying on personal awareness or self-report of biomeasures is ineffective. The greater discrepancy between self-perceived and investigator-assessed numbers was associated with greater blood pressure-related CVD risks underscoring the potential benefit of arming individuals with information to “know their numbers.”

Perceptions of Heart-Healthy Behaviors among African American Adults: A Mixed Methods Study.

African Americans have a disproportionately higher risk of chronic conditions such as cardiovascular disease (CVD), type 2 diabetes, and hypertension than other ethnic or racial groups. Data regarding CVD-related perceptions and beliefs among African Americans are limited, particularly in the Southwest US. Assessment of current views regarding health and health behaviors is needed to tailor interventions to meet the unique needs of specific populations. We sought to examine knowledge, attitudes, and perceptions of African Americans living in Arizona toward CVD and etiological factors associated with health behaviors and chronic disease development to inform state health agency program development. Transcripts from 14 focus groups (n = 103) were analyzed using Grounded Theory for perceived disease risk, knowledge of CVD risk factors, nutrition, preventative behaviors, and barriers and motivators to behavior change. Participants identified CVD, stroke, and diabetes as leading health concerns among African-Americans but were less certain about the physiological consequences of these diseases. Diet, stress, low physical activity, family history, hypertension, and stroke were described as key CVD risk factors, but overweight and obesity were mentioned rarely. Participants described low socio-economic status and limited access to healthy foods as contributors to disease risk. Focus group members were open to modifying health behaviors if changes incorporated their input and were culturally acceptable. Respondents were 41% male and 59% female with a mean age of 46 years. This study provides insight into CVD and associated disease-related perceptions, knowledge, and attitudes among African Americans in the Southwest and recommendations for interventions to reduce CVD risk.

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988-2014.

BackgroundNo study has quantified trends in the prevalence of cardiovascular disease risk factors and cardiovascular health metrics among obese people in the United States in recent years.Methods and ResultsWe examined the secular changes in cardiovascular health metrics and key cardiovascular disease risk factors among obese adults (aged ≥20 years) in the United States. We included 18 626 obese adults (body mass index ≥30) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999–2014. Among those obese adults, there were decreases in mean systolic blood pressure, diastolic blood pressure, and total cholesterol levels and increases in mean high‐density lipoprotein cholesterol levels and mean hemoglobin A1c levels. Prevalence of blood pressure health and lipid health remained stable during the period 1988–2014, whereas prevalence of blood glucose health decreased significantly during this period. Prevalence of freedom from cardiovascular disease risk factors remained stable at ≈15% among the adult obese population during the period 1988–2014, whereas prevalence of presence of all 3 risk factors increased from 16.4% to 22.4% during this period, commensurate with a decline in those with 1 to 2 risk factors (from 69.6% to 62.4%).ConclusionsDuring the past 3 decades, blood pressure health and blood lipid health remained stable or improved, whereas blood glucose health deteriorated among adult obese population. This resulted in an overall decrease in cardiovascular health status among obese adults and greater risk of type 2 diabetes mellitus. The data argue for interventions targeted to those obese persons who are metabolically unhealthy to stem rising rates of diabetes mellitus.

Culturally adaptive storytelling method to improve hypertension control in Vietnam - “We talk about our hypertension”: study protocol for a feasibility cluster-randomized controlled trial

BackgroundVietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. At present, the major risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam; inasmuch, the burden of CVD will continue to increase in this country unless effective prevention and control measures are put in place. A national survey in 2008 found that the prevalence of hypertension (HTN) was approximately 25 % among Vietnamese adults and it increased with advancing age. Therefore, novel, large-scale, and sustainable interventions for public health education to promote engagement in the process of detecting and treating HTN in Vietnam are urgently needed.MethodsA feasibility randomized trial will be conducted in Hung Yen province, Vietnam to evaluate the feasibility and acceptability of a novel community-based intervention using the “storytelling” method to enhance the control of HTN in adults residing in four rural communities. The intervention will center on stories about living with HTN, with patients speaking in their own words. The stories will be obtained from particularly eloquent patients, or “video stars,” identified during Story Development Groups. The study will involve two phases: (i) developing a HTN intervention using the storytelling method, which is designed to empower patients to facilitate changes in their lifestyle practices, and (ii) conducting a feasibility cluster-randomized trial to investigate the feasibility, acceptability, and potential efficacy of the intervention compared with usual care in HTN control among rural residents. The trial will be conducted at four communes, and within each commune, 25 individuals 50 years or older with HTN will be enrolled in the trial resulting in a total sample size of 100 patients.DiscussionThis feasibility trial will provide the necessary groundwork for a subsequent large-scale, fully powered, cluster-randomized controlled trial to test the efficacy of our novel community-based intervention. Results from the full-scale trial will provide health policy makers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam and other developing countries.Trial registrationClinicalTrials.gov. Registration number: https://clinicaltrials.gov/ct2/show/NCT02483780(registration date June 22, 2015).