Low Cardiovascular Risk Profile Research Articles

P143 High throughput multiplex assay identifies clinically meaningful clusters in systemic sclerosis patients with low cardiovascular risk and no history of heart disease

Abstract Background/Aims People with systemic sclerosis (SSc) often show subclinical evidence of primary heart involvement (pHI), which when clinically evident, is a prognostic factor of poor outcome. We aimed to profile serum proteins in patients with SSc and no history of pHI and identify clinically meaningful clusters to aid early identification and stratification for pHI. Methods Serum from 78 patients from CONVAS (‘CONnective Tissue Disease and VASculitis Cohort’) and ELCASA (‘ELectrophysiology and CArdiac imaging in SclerodermA’) cohorts [no history of pHI, pulmonary hypertension, diabetes or > 2 traditional cardiovascular (CV) risk factors] was used to measure 355 proteins across inflammation, cardiometabolic and cardiovascular II/III Olink panels. Unsupervised hierarchical clustering using scaled normalised protein expression (NPX) was used to define clusters. Demographic and clinical characteristics were compared between clusters and significant differences reported using Kruskal-Wallis rank sum test for continuous or Pearson’s chi-squared test for categorical variables, at the 5% significance threshold. Results Clinical characteristics of the patient cohorts have been previously published (also summarised in table 1,column 2). Unsupervised hierarchical clustering revealed three patient clusters - C1 [27/78 (35%)], C2 [33/78 (42%)] and C3 [18/78 (23%)] with intermediate, low and high protein expression respectively. C2 patients were younger (median age 51 years) compared to C1 (61 years) and C3 (58 years) (p < 0.001). High expression cluster C3 had a significantly higher proportion of males [7/18 (39%)](p = 0.009), shorter disease duration [median 1.15 years, IQR (0.66 to 7.23)], higher modified Rodnan skin scores (MRSS) [median 5.50, IQR (3.25 to 11)] (p = 0.002) and current disease modifying anti-rheumatic drugs (DMARD) use [16/18 (89%)](p = 0.005). NTproBNP and CRP were elevated in C1 and C3, and high-sensitivity troponin I (hsTnI) was highest in C3[median 6.15 IQR (5.08 to 89.58)](p = 0.002); n = 3 within C1 showed especially high NTproBNP (median 227.50pg/ml) and CRP (median 13mg/dl). No differences in antibody profiles were noted across the three clusters (table 1). Conclusion Differences in serum protein expression identifies clinically meaningful clusters of SSc patients with elevated acute phase and serum cardiac markers despite low CV risk profile. Future work should assess their utility as prognostic biomarkers of SSc-pHI. Disclosure R. Shukla: None. R. Dumitru: Grants/research support; ACORN charity and Charitable Foundation Fellowship, Leeds Teaching Hospital. B. Erhayiem: None. G. Fent: None. F. Del Galdo: Consultancies; Abbvie, AstraZeneca, Boehringer-Ingelheim, Capella, Chemomab, GSK, Janssen, Mitsubishi-Tanabe. S. Plein: Other; funded by a British Heart Foundation Personal Chair. D. Plant: None. M.H. Buch: Consultancies; AbbVie, Arxx Therapeutics, Boehringer Ingelheim, Galapagos, Gilead, and Pfizer (all paid to host institution).

Pulmonary Arterial Hypertension in the Elderly: Peculiar Features and Challenges for a Proper Phenotyping Approach.

(1) Introduction. Although pulmonary arterial hypertension (PAH) usually affects young people with a low cardiovascular risk profile, progressive epidemiologic changes have been providing a codified phenotype of elderly subjects with PAH and increased risk predictors for left heart disease. We therefore conducted a systematic review to describe the current knowledge and characteristics of elderly individuals with PAH and further insights concerning their prognostic outcomes and therapeutic response. (2) Methods. A search was conducted in PubMed, Embase, and Cochrane Library for publications evaluating the epidemiology, diagnostic work-up, and treatment of PAH in elderly subjects. (3) Among the 74 publications initially retrieved, 16 full-text articles were selected for the present systematic review. Compared to their younger counterparts, elderly individuals with PAH showed greater clinical deterioration, reduced exercise capacity, and worse prognostic outcomes, as well as less response to PAH-targeted therapy and higher rates of PAH drug discontinuation. (4) Conclusions. Demographic changes over time contributed to define a peculiar PAH phenotype in elderly patients, with an increased burden of cardiovascular comorbidities and distinctive features compared to young patients. Further investigations are needed in order to better clarify the nosologic criteria, and management in this subset population.

Heart failure outcomes in low-risk patients with atrial fibrillation: a case-control study of 680523 Swedish individuals.

Knowledge of long-term outcomes in patients with atrial fibrillation (AF) remains limited. We sought to evaluate the risk of new-onset heart failure (HF) in patients with AF and a low cardiovascular risk profile. Data from the Swedish National Patient Register were used to identify all patients with a first-time diagnosis of AF without underlying cardiovascular disease at baseline between 1987 and 2018. Each patient was compared with two controls without AF from the National Total Population Register. In total, 227811 patients and 452712 controls were included. During a mean follow-up of 9.1 (standard deviation 7.0) years, the hazard ratio (HR) for new-onset HF was 3.55 [95% confidence interval (CI) 3.51-3.60] in patients compared with controls. Women with AF (18-34years) had HR for HF onset 24.6 (95% CI 7.59-80.0) and men HR 9.86 (95% CI 6.81-14.27). The highest risk was within 1year in patients 18-34years, HR 103.9 (95% CI 46.3-233.1). The incidence rate within 1year increased from 6.2 (95% CI 4.5-8.6) per 1000 person-years in young patients (18-34years) to 142.8 (95% CI 139.4-146.3) per 1000 person-years among older patients (>80years). Patients studied had a three-fold higher risk of developing HF compared with controls. Young patients, particularly women, carry up to 100-fold increased risk to develop HF within 1year after AF. Further studies in patients with AF and low cardiovascular risk profile are needed to prevent serious complications such as HF.

Sex-Specific Dietary Patterns and Social Behaviour in Low-Risk Individuals.

Dietary and social behaviour are non-medical factors that influence health outcomes. Non-communicable diseases are related to dietary patterns. To date, little is known about how social behaviour is associated with health-related dietary patterns, and, in particular, we lack information about the role of sex within this possible relation. Our cross-sectional study investigated associations between dietary patterns and social behaviour including personality traits (self-control, risk taking), political preferences (conservative, liberal, ecological, social) and altruism (willingness to donate, club membership, time discounting) in men and women. We performed sex-specific correlation analyses to investigate relationships between dietary patterns based on self-reported protocols from the Mediterranean Diet Adherence Screener (MEDAS) and the validated Healthy Eating Index (HEI) from the EPIC Study and a self-reported social behaviour questionnaire. In linear regression models, we analysed associations between dietary and social behaviour patterns. Sex differences were measured by interaction analysis for each social behaviour item. The study sample consisted of N = 102 low-risk individuals. The median age of the study participants was 62.4 (25th/75th percentile 53.6, 69.1) years, and 26.5% were women. Analyses showed that a lower HEI score was correlated with a higher BMI in both women and men. MEDAS and HEI showed a positive correlation with each other in men. In men, a higher MEDAS showed a positive correlation when they estimated their ability as high, with the same for self-control and preference for ecological politics and MEDAS. A weak negative correlation has been shown between men with a preference for conservative politics and MEDAS. HEI showed a positive significant correlation with age in men. Male participants without club membership scored significantly higher in the HEI compared to non-members. A negative correlation was shown for time discounting in men. Linear regression models showed positive associations between preferences for ecological-oriented politics and nutrition for both HEI and MEDAS. No sex interactions were observed. We faced a few limitations, such as a small sample size, particularly for women, and a limited age spectrum in a European cohort. However, assuming that individuals with a preference for ecological-oriented politics act ecologically responsibly, our findings indicate that ecological behaviour in low-risk individuals might determine, at least in part, a healthy diet. Furthermore, we observed dietary patterns such as higher alcohol consumption in men or higher intake of butter, margarine and cream in women that indicate that women and men may have different needs for nutritional improvement. Thus, further investigations are needed to better understand how social behaviour affects nutrition, which could help to improve health. Our findings have the potential to inform researchers and practitioners who investigate the nature of the relationship between social behaviour and dietary patterns to implement strategies to create first-stage changes in health behaviour for individuals with a low cardiovascular risk profile.

Predicting Significant Coronary Obstruction in a Population with Suspected Coronary Disease and Absence of Coronary Calcium: CORE-64 / CORE320 Studies.

Coronary artery calcium (CAC) scanning can be performed using non-contrast computed tomography to predict cardiovascular events, but has less value for risk stratification in symptomatic patients. To identify and validate predictors of significant coronary obstruction (SCO) in symptomatic patients without coronary artery calcification. A total of 4,258 participants were screened from the CORE64 and CORE320 studies that enrolled patients referred for invasive angiography, and from the Quanta Registry that included patients referred for coronary computed tomography angiography (CTA). Logistic regression models evaluated associations between cardiovascular risk factors, CAC, and SCO. An algorithm to assess the risk of SCO was proposed for patients without CAC. Significance level of 5% was used in the analyses. Of the 509 participants of the CORE study, 117 (23%) had zero coronary calcium score; 13 (11%) patients without CAC had SCO. Zero calcium score was related to younger age, female gender, lower body mass index, no diabetes, and no dyslipidemia. Being a current smoker increased ~3.5 fold the probability of SCO and other CV risk factors were not significantly associated. Considering the clinical findings, an algorithm to further stratify zero calcium score patients was proposed and had a limited performance in the validation cohort (AUC 58; 95%CI 43, 72). A lower cardiovascular risk profile is associated with zero calcium score in a setting of high-risk patients. Smoking is the strongest predictor of SCO in patients without CAC.

Editor's Choice – Association Between Peri-OPerative Aspirin ResisTance and CardioVascular Outcome (POPART-CVO): a Prospective Non-Interventional Cohort Study

New onset aspirin resistance during surgery, known as peri-operative aspirin resistance, is observed in up to 30% of vascular surgery patients and is associated with post-operative myocardial damage; questioning aspirin effectiveness towards peri-operative cardiovascular events. The objective of this study was to prospectively evaluate whether peri-operative aspirin resistance in vascular surgery is associated with an adverse cardiovascular outcome. Based on a sample size calculation, 194 adult elective vascular or endovascular surgery patients receiving aspirin were analysed in this prospective, single centred, non-interventional cohort study. Platelet function was measured before surgery, one hour after incision, four hours post-operatively, and on the morning of the first and second post-operative days using the Multiplate analyser. The primary outcome was myocardial injury after non-cardiac surgery (MINS). Secondary outcomes included major bleeding, admission to intensive care unit, length of hospital stay, and major adverse cardiac and cerebrovascular events. Subgroup analyses were performed for patients with different cardiovascular risk and for patients who underwent endovascular surgery. Peri-operative aspirin resistance was observed in 27.8% of patients but was not associated with MINS (27.8% vs. 32.1%, aspirin resistance vs. no aspirin resistance, OR 0.812, 95% CI 0.406 - 1.624, p= .56) or with any of the secondary endpoints (all p > .050). In nine of the 10 subgroup analyses, aspirin resistance was not associated with a difference in MINS rate. However, in patients with a low cardiovascular risk profile (RCRI 0-2), MINS occurred more frequently in patients without aspirin resistance (p= .049). This study confirmed previous reports demonstrating that peri-operative aspirin resistance is common in patients undergoing vascular or endovascular surgery. However, in patients who continue aspirin throughout the peri-operative period, aspirin resistance is a phenomenon, which does not appear to be related to MINS. Measuring peri-operative platelet function using the Multiplate analyser with the intention to identify and potentially prevent or treat peri-operative aspirin resistance seems to be dispensable.

Nailfold Video Capillaroscopy in Pregnant Women With and Without Cardiovascular Risk Factors.

ObjectiveTo evaluate microvasculature in pregnant women with and without cardiovascular risk factors.DesignCross-sectional, observational study.PopulationWomen were recruited at the outpatient clinic for high risk prenatal care. Out of a total of 345 women assessed at first and/or second and/or third trimester, 169 women without and 176 with cardiovascular risk factors were included.MethodsNailfold video capillaroscopy (NVC) measurements were performed at magnification of 200x at all fingers except thumbs. Images were stored for offline measurement of capillary density (CDe) and capillary diameters (CDi). Maternal anthropometrics, obstetric, and medical history were used for categorization in low and high cardiovascular risk. Comparison between groups and trimesters, with respect to pregnancy outcome, was performed using linear mixed model analysis.ResultsWomen with a high risk cardiovascular profile show higher CDe, regardless of pregnancy outcome. CDi drops during pregnancy, with lowest CDi in third trimester in patients with preeclampsia. Capillary bed (CB), as a composite of CDe and CDi, is stable during pregnancy in women with low risk cardiovascular profile. In women with high risk cardiovascular profile, CB drops from the first to the second trimester, regardless of pregnancy outcome. Only in women with pre-eclampsia, the CB is lower in the third trimester as compared to the first trimester.There is an inverse association between CDe and mean arterial pressure (MAP) in women with high cardiovascular risk and pre-eclampsia.ConclusionMicrocirculation is altered during the course of pregnancy and microcirculatory behavior is different in patients with low and high cardiovascular risk profile, as well as in patients with preeclampsia.

152 Effects of nutraceuticals on the control of the lipid-glycaemic structure and on endothelial protection, in patients with low cardiovascular risk profile

Abstract Aims Nutraceuticals are dietary supplements that contain a concentrated form of a presumed bioactive substance originally derived from a food. There is a relationship between the consumption of monacolin K from red yeast rice and maintenance of normal blood low density lipoprotein cholesterol (LDL-C) concentrations recognized by the European Agency on Food Safety. The present study evaluates the effects of a therapeutical association of nutraceuticals (a combination of containing fermented red rice, named Monacolin K and Coenzyme Q10) on lipo-glycaemic profile and on the vascular function evaluated as endothelial function and arterial stiffness (using the non-invasive methods of EndoPAT and SphygmoCOR). Methods The present is a single-centre prospective study enrolling 30 patients with low cardiovascular risk profile (SCORE risk, cardiovascular disease risk <10% at 10 years). Patients were consecutive enrolled from March 2019 to February 2020 (recruitment period). The average follow-up was 14 weeks, from intaking monacolin K 10 mg + Coenzyme Q10 10 mg. The scheduled evaluations of the enrolled population were: before the beginning of the therapy and after a period of 14 weeks. Results After 14 weeks of treatment we demonstrated a statistically significant reduction in total cholesterol (P 0.015) and LDL (P 0.003). An important effect on the inflammatory profile was highlighted, resulting in a decrease in Hs-CRP at 12-weeks (P 0.052), associated with a progressive reduction of arterial stiffness (P 0.063) and an improvement in endothelial function (P 0.048). Conclusions Data obtained suggest that formulations with natural nutraceuticals, especially fermented red rice, have a protective cardiovascular effect, not also through reduction of plasma lipids but in endothelial function and arterial stiffness improvement.

Prevalence and Causes of Myocardial Infarction with Non-Obstructive Coronary Arteries in a Contemporary Cohort of Patients with Suspected Myocardial Infarction.

Background: A significant proportion of patients presenting with acute myocardial infarction (MI) has no coronary obstruction at coronary angiography and no other obvious non-coronary pathophysiology causing MI. These patients are classified as MI with non-obstructive coronary arteries (MINOCA). Data on incidence and predictors of MINOCA are still limited. Methods: This study enrolled patients presenting symptoms suggestive of MI and undergoing a comprehensive cardiac work-up including an early invasive strategy. Patients with non-obstructive coronary arteries and without other obvious reasons for MI were scheduled for further work-up including magnetic resonance or intraluminal imaging. MINOCA was diagnosed according to the current European Society of Cardiology guidelines. Results: From the 1532 patients enrolled, 730 had available coronary imaging and 546 were diagnosed with MI. No significant coronary obstructions were found in 117 patients with MI. After the exclusion of 6 patients with acute myocarditis or takotsubo-syndrome as well as 88 with type II MI, 23 patients were diagnosed with MINOCA (4% of all MIs). Among these 23 patients, the most common etiology of MINOCA was thromboembolic events followed by coronary spasm. Female sex, the absence of hypercholesterolemia, and a normal left-ventricular ejection fraction were independently predictive for MINOCA compared to patients with other causes of MI. Conclusion: More than 20% of patients presenting with acute MI showed no significant coronary obstruction. About 4% of these patients were diagnosed with MINOCA. Female sex, a lower cardiovascular risk profile, and normal left-ventricular function were predictive for MINOCA.

Heart failure in low risk patients with atrial fibrillation, nationwide registry case-control study based on 227811 patients

Abstract Background Heart failure (HF) is common in patients with atrial fibrillation (AF), and also associated with worse outcome. Consequently, it is commonly included in risk prediction models for AF, used in daily clinical praxis. However, knowledge about the association between solely AF and incidental HF is limited. Aim This study aims to evaluate the short and long-term risks for onset of HF in patients with AF and low cardiovascular risk profile. Methods All patients with first recorded hospitalization for AF in the Swedish National Patient Register, were included from the 1St January 1987 to 31st December 2018. Each patient with AF was matched by age, sex and county with two controls from the Swedish Total Population Register. Patients <18 years, or with concomitant hypertension, diabetes mellitus, coronary and periphery artery disease, previous stroke or transitory ischemic attack, cardiomyopathy, pulmonary arterial hypertension, congenital heart disease, valvular heart disease and renal failure prior or at baseline were excluded. Results In total 227 811 patients and 452 712 controls met the inclusion and exclusion criteria and were included in the study. The incidence rate for incidental HF per 1000 person-year within one year after AF diagnosis was 6.2 (95% CI: 4.5–8.6) among patient 18–34, increased with increasing age and was 142.8 (95% CI: 139.4–146.3) among those >80 years. Within five years the incidence rate decreased in all age categories and was 2.4 (95% CI: 1.8–3.0) among the youngest and 94.0 (95% CI: 92.4–95.6) in the oldest age group. When compared to matched controls from the general population patients with AF had a hazard ratio (HR) and CI 95% to develop HF within one year at 103.9 (46.3–233.1), 34.9 (26.5–45.9), 17.5 (15.5–19.8), 10.3 (9.6–11.1) and 6.1 (5.8–6.4) among patients aged 18–34, 35–49, 50–59, 60–69, 70–79 and >80 years, respectively. Conclusion Despite low cardiovascular risk profile AF still carries high risk for developing incidental HF in particular during the first observation year with increasing tendency along with increasing age. Younger patients with AF and without other cardiovascular comorbidities had more than 100 times higher relative risk to develop HF within one year when compared to matched controls. Funding Acknowledgement Type of funding sources: None.

This Month in Adult Urology

This Month in Adult Urology

Metabolic profiling links cardiovascular risk and vascular end organ damage

Background and aimsAn untargeted metabolomics approach allows for a better understanding and identification of new candidate metabolites involved in the etiology of vascular disease. We aimed to investigate the associations of cardiovascular (CV) risk factors with the metabolic fingerprint and macro- and microvascular health in an untargeted metabolomic approach in predefined CV risk groups of aged individuals. MethodsThe metabolic fingerprint and the macro- and microvascular health from 155 well-characterized aged (50–80 years) individuals, based on the EXAMIN AGE study, were analysed. Nuclear magnetic resonance spectroscopy was used to analyse the metabolic fingerprint. Carotid-femoral pulse wave velocity and retinal vessel diameters were assessed to quantify macro- and microvascular health. ResultsThe metabolic fingerprint became more heterogeneous with an increasing number of risk factors. There was strong evidence for higher levels of glutamine [estimate (95% CI): −14.54 (−17.81 to −11.27), p < 0.001], glycine [−5.84 (−7.88 to −3.79), p < 0.001], histidine [−0.73 (−0.96 to −0.50), p < 0.001], and acetate [−1.68 (−2.91 to −0.46), p = 0.007] to be associated with a lower CV risk profile. Tryptophan, however, was positively associated with higher CV risk [0.31 (0.06–0.56), p = 0.015]. The combination of a priori defined CV risk factors explained up to 45.4% of the metabolic variation. The metabolic fingerprint explained 20% of macro- and 23% of microvascular variation. ConclusionsMetabolic profiling has the potential to improve CV risk stratification by identifying new underlying metabolic pathways associated with atherosclerotic disease development, from cardiovascular risk to metabolites, to vascular end organ damage.

Cardiovascular risk profiles and 20-year mortality in older people: gender differences in the Pro.V.A. study

The age- and gender-related cardio-metabolic changes may limit the applicability of guidelines for the prevention of cardiovascular diseases (CVD) in older people. We investigated the association of cardiovascular risk profile with 20-year all-cause and CVD-mortality in older adults, focusing on age- and gender-specific differences. This prospective study involved 2895 community-dwelling individuals aged ≥65 years who participated in the Pro.V.A study. The sum of achieved target levels (smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes) recommended by the European Society of Cardiology 2016 guidelines was assessed in each participant. From this sum, cardiovascular risk profile was categorised as very high (0–2), high (3), medium (4), low (5), and very low (6–7 target levels achieved). All-cause and CV mortality data over 20 years were obtained from health registers. At Cox regression, lower cardiovascular risk profile was associated with reduced 20-year all-cause mortality in both genders, with stronger results for women (HR = 0.42 [95%CI:0.25–0.69] and HR = 0.61 [95%CI:0.42–0.89] for very low vs. very high cardiovascular risk profile in women and men, respectively). This trend was more marked for CVD mortality. Lower cardiovascular risk profile was associated with reduced all-cause and CVD mortality only in men < 75 years, while the associations persisted in the oldest old women. A lower cardiovascular risk profile, as defined by current guidelines, may reduce all-cause and CVD mortality in older people, with stronger and longer benefits in women. These findings suggest that personalised and life-course approaches considering gender and age differences may improve the delivery of preventive actions in older people.

Gender differences and health inequality: Evolution of cardiovascular risk in workers

The aim was to find out if there are any such differences due to gender in a cohort of workers followed for ten years, comparing their lifestyles and following the evolution of the main cardiovascular risk factors (CVRF) and their impact on cardiovascular risk. An observational longitudinal study of 698 civil servants workers (186 women and 512 men) of a local government office from Córdoba (Spain), was conducted over the period 2003–2014. We compared the initial and final prevalence of physical activity, smoking, obesity, hypertension, metabolic syndrome and diabetes. Cardiovascular risk was also assessed using the REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) equations. There was a greater rise in the prevalence of hypertension and hypercholesterolemia in the cohort in women than in men (94.2% vs. 38% and 92% vs 21.1%), while the reduction in smoking also differed by gender (26.4% vs. 36.5%). It could be that since women present a lower cardiovascular risk profile, they are treated less or less effort is made to keep the risk factors low, resulting in a worse evolution of smoking, hypercholesterolemia and hypertension in women.

Reciprocal communication of pericoronary adipose tissue and coronary atherogenesis

ObjectivePericoronary adipose tissue (PCAT) has been linked to underlying coronary artery disease (CAD) and proposed to modulate adjacent atherosclerotic plaque formation over pro-inflammatory pathways. In vitro and ex vivo studies support the bilateral communication of adipose tissue and vessel wall. We quantified PCAT and its dynamics in a low coronary risk cohort with a semi-automated software in serial coronary computed tomography angiography (CTA). MethodsWe retrospectively included patients from a tertiary care hospital who underwent serial coronary CTA with a low cardiovascular risk profile. All examinations were evaluated in a standardized approach: epicardial adipose tissue (EAT) volume and attenuation was quantified in total, in the atrioventricular (RCA, LCX) or interventricular (LAD) sulcus and within a 5 mm radius for each coronary artery (PCAT). Coronary plaques were quantified using a semi-automated software and compared for progression, stability or regression. ResultsOf 120 patients (27% females), 59.2% showed atherosclerotic plaques. After 36 months mean follow-up, 22 (18.3%) showed plaque regression, 39 (32.5%) were stable and 49 (40.8%) were progressive. Total EAT volume decreased by -15.6 ± 37.2 mm³ in the regressive group, increased by 2.7 ± 30.6 mm³ in the stable group and by 24.3 ± 37.1 mm³ in the progressive group (p = 0.003).Per-vessel analysis showed a significant decrease of PCAT attenuation in patients with CAD regression (−3.8 ± 7.6HU) compared to the stable (1.2 ± 9.1HU) and progressive group (3.5 ± 8.2HU, p < 0.0001). Mean sulcus EAT attenuation did not show a significant change (p = 0.135). ConclusionEpicardial adipose tissue volume is mutually changing with the progression or regression of coronary artery disease. Perivascular but not epicardial attenuation levels correlate to adjacent plaque and support a direct bilateral influence.

Clinical Profiles and Factors Associated with a Low Sodium Intake in the Population: An Analysis of the Swiss Survey on Salt.

As a part of the salt controversy, it has been suggested that people with a low sodium intake have an increased risk of cardiovascular events. However, there is no clear explanation for this increased risk. We examined the socio-demographic, clinical profile, and behavioral factors associated with a low sodium intake in the Swiss subjects who participated in the Swiss Survey on Salt. Only 13.3% of the Swiss population eat less than 5 g of salt daily and among them 78.2% are women. Subjects with a low sodium intake eat and drink less as reflected by lower intakes of proteins, potassium, and calcium and a smaller urine volume. In addition, a low blood pressure, a normal body mass index, a low prevalence of obesity, a low serum uric acid, and less alcohol and cigarette consumption characterized this group, suggesting a rather low cardiovascular risk profile. Being single and doing most of the cooking at home are associated with a low intake of sodium, as well as a less frequent consumption of meat and fish when eating less than 5 g salt per day. However, the awareness of the effects of salt on health and cardiovascular risk, health concerns, and physical activity are similar in subjects eating more or less salt. In conclusion, we could not evidence clinical or behavioral factors that could significantly increase the risk of developing cardiovascular events in low salt eaters.

Reciprocal communication of perivascular epicardial adipose tissue and coronary atherogenesis

Abstract Purpose Perivascular epicardial adipose tissue (PEAT) has been linked to underlying coronary artery disease (CAD) and proposed to modulate adjacent atherosclerotic plaque formation. In vitro and ex vivo studies support bilateral influence of adipose tissue and vessel wall. Therefore, we quantified PEAT volume and composition and its dynamics in a low coronary risk patient cohort with a semi-automate software in serial CT exams. Methods and materials We retrospectively included 120 patients (27% females) from a tertiary care hospital who underwent serial cardiac CT angiographies with a low cardiovascular risk profile. All coronary CTs were evaluated in a standardized approach: epicardial adipose tissue (EAT) volume and attenuation was quantified in total, in the atrioventricular (RCA, LCX) or interventricular (LAD) sulcus and in a 5mm radius for each coronary artery (PEAT). Coronary plaques were quantified using a semi-automated software and compared to progression, stability of regression between the two scans. The measurements were compared on a per-patient and per-vessel basis between plaque-naïve and diseased vessels. Results Of 120 patients (32% female), 59.2%) had atherosclerotic plaque formation. After 36 months mean follow-up, 22 (18.3%) showed a CAD regression plaques, 39 (32.5%) had stable coronary arteries and 49 (40.8%) progressive CAD. Total EAT volume decreased by −15.6±37.2 mm3 in the regressive group, increased by 2.7±30.6mm3 in the stable group and by 24.3±37.1mm3 in the progressive CAD group (p=0.003). Per-vessel analysis showed a significant decrease of perivascular EAT attenuation in patients with CAD regression (−3.8±7.6 HU) compared to CAD stable (1.2±9.1 HU) and CAD progressive patients (3.5±8.2 HU, p&amp;lt;0.0001). Mean sulcus EAT attenuation did not show a significant change at follow-up (p=0.135) Conclusion Epicardial adipose tissue volume is mutually changing with the progression or regression of coronary artery disease. Perivascular but not epicardial attenuation levels correlated to adjacent plaque and support a direct bilateral influence. Change per-vessel-basis (n=360) Funding Acknowledgement Type of funding source: None

Biomarkers' ability to predict cardiac toxicity in oncological patients undergoing to antineoplastic treatment: 5-year follow-up

Abstract Background It is known that anticancer treatment can cause adverse cardiovascular (CV) events, influencing patients' survival and quality of life regardless of their cancer prognosis; today there are no defined protocols for the early identification of cardiotoxicity (CTX). Purpose To evaluate the ability of biomarkers, cardiac TnI and NT-proBNP, to predict CTX induced by antineoplastic therapy. Methods We have enrolled women with non-metastatic breast cancer who had to start a treatment with Anthracycline (ANT), in the patients (pts) with HER2+ cancer, Trastuzumab (TRZ) could also be introduced. The presence of a known heart disease, a previous mediastinal irradiation and a previous treatment with ANT, were the main exclusion criteria. All pts underwent complete cardiological evaluation (ECG, Echo) before the beginning of the therapy (T0), after each ANT cycle and every 3 months up to 1 year of follow-up after the end of therapy with ANT. During each visit, a venous sampling was performed for the determination of biomarkers. We collected the data of the routine cardiological visits carried out by the pts in the following 5 years. Results 179pts finished the follow-up,7pts (21%) were hypertensive, 9pts (5%) diabetic, 32pts (18%) dyslipidemics. 53pts (30%) (“TnI+ group”) showed a significant increase in TnI (&amp;gt;0.04ng/mL) or less than this cut-off but persistently &amp;gt;0.015ng/mL in at least 2 measurements; comparing the LVEF of the two groups detected at 1 year follow-up it was observed a significant difference: 60±6.5% in the “TnI+ group” and 63±4.1% in the “TnI− group” (p=0.005); a tendency to significance was observed from the comparison between LVEF measured at baseline compared to that of 1-year follow-up in the “TnI+ group” (62±4.2% vs 60±6.5%, p=0.06); furthermore 7 patients of the “TnI+ group” developed LV systolic dysfunction (according to the definition of the CREC) early in the first year of follow-up (vs 1 pts of the “TnI− group”, p=0.001), with recovery after the introduction of specific cardiology therapy. 76/179 pts (43%) showed NT-proBNP values ≥125 ng/L in at least two consecutive determinations (“NT-proBNP+ group”), in this group 25% of the pts had more than 3 CV risk factors, compared to 11% in the “NT-proBNP− group” (p=0.011), 3/8 pts that showed LV systolic dysfunction were included in the “NT-proBNP+ group”. Conclusion(s) In a homogeneous group of patients with a low CV risk profile, anticancer treatment with low doses of ANT and with TRZ can induce significant changes in plasma TnI levels that can be correlated with early alterations in LV systolic function, but not with major CV events after 5 years. Significant increases in NT-proBNP have also been reported, but there has been no significant correlation with the progressive development of LV dysfunction and HF. The combination of individual clinical risk factors and biomarkers, especially TnI, in a predictive model could allow early identification of CTX. Funding Acknowledgement Type of funding source: None

Habitual physical activity is not associated with lower cardiovascular risk profile or higher aerobic fitness

Introduction: Physical inactivity is considered as one of the factors to increase the risk of developing cardiovascular diseases (CVDs) and decrease aerobic fitness mainly in middle-age. Increased habitual physical activity (HPA) is one of the strategies recommended to reduce physical inactivity. However, it is not known whether middle-age individuals who exclusively perform greater amount of HPA have greater aerobic fitness and / or a lower risk of CVDs. Objective: Verify the association between HPA with the risk of CVDs and aerobic fitness in individuals who only perform HPA. Method: We selected 89 male volunteers, age: 47.4 ± 5.06 years, who did not practice systemized physical training. Our measurements were: HPA by the International Physical Activity Questionnaire and Baecke questionnaires, the aerobic fitness by direct assessment of maximal oxygen consumption (VO2 máx) and the risk of developing cardiovascular disease by the score calculation of General Cardiovascular Risk Profile from Framingham Study. Results: There was no correlation of the HPA level with cardiovascular risk factors, general cardiovascular disease risk and VO2 máx. Moreover, no difference was found between the categorical groups of the IPAQ questionnaire and between the groups, “clusters”, calculated from the Baecke questionnaire scores for the variables of cardiovascular risk, general cardiovascular disease risk and VO2 máx. Conclusion: This study have found that the HPA level of middle-aged men is not associated with lower cardiovascular risk profile or higher aerobic fitness, suggesting that only increase HPA may not be enough to promote beneficial adaptations in aerobic fitness and improve risk profile for CVDs. These results may be related to low volume and intensity of HPA, which reinforces the importance of performing physical training with control of these variables for health promotion.

VENO ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA ECMO) IN PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION

Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction in patients with low cardiovascular risk profile. Hemodynamic instability is believed to occur less often. Veno arterial extracorporeal membrane oxygenation (VA ECMO) is a life saving mechanical circulatory support