Lowering Drug Use Research Articles

Medical Foods for the management of Chronic Illness and their Regulations in India, US and European Union

As many chronic illnesses are incurable and require repeated treatments, this problem contributes to long-term drug use. But when it comes to managing and treating chronic illnesses, medical foods can provide an alternative to natural medications. Medical foods are foods that have been particularly prepared to meet the unique dietary needs of people with specific illnesses. When it comes to therapeutic applications such as deglutition, dyspepsia, or eating disorders, they are crucial in providing patients with nutritional support. In addition, they significantly improve patients' quality of life by lowering drug use, averting problems that could result from an excessive reliance on pharmaceuticals, and saving treatment costs. Depending on the illness, medical foods' nutritional content can be adjusted and customized. They are exempt from laws pertaining to drugs since they are not drugs. Every medical food is created especially for the chronic condition in question. As a result, the purpose of this review is to clarify the use of medical foods for conditions such as Parkinson's, Alzheimer's, anxiety and sleep disorders, pain syndrome, cancer, congenital metabolic disorders, and diabetes mellitus, and to suggest their use as a dietary supplement for these long-term illnesses.

Incidence of erectile dysfunction treatment after radical prostatectomy by Statin use in Finnish Nationwide Cohort Study

Background Erectile dysfunction (ED) is common after radical prostatectomy (RP) due to cavernous nerve damage. Risk of ED is also affected by vascular function. Statins prevent vascular events but their association with post-prostatectomy ED is unclear. We explored the likelihood of starting ED treatment after RP by statin use at the population level. Methods The study cohort included 14,295 prostate cancer (PCa) patients with no ED treatment prior to diagnosis of PCa treated with RP in Finland during 1995–2013. Information on use of cholesterol-lowering drugs and ED medication during 1995–2014 and penile prosthesis implantation during 1996–2014 were gathered from national registries. Risk of ED treatment initiation after RP was analyzed by pre-diagnostic and post-diagnostic statin and non-statin cholesterol lowering (NSCL) drug use with Cox regression model. Results Pre-diagnostic statin use or NSCL drug use overall had no association with risk of ED treatment initiation after RP. Post-diagnostic statin use was associated with a slightly increased risk of initiation of any ED treatment (HR = 1.07; 95% CI = 1.01–1.14). Patients with the longest duration of post-diagnostic statin use had a significantly decreased risk of PDE5 inhibitor initiation compared to non-users (HR = 0.43; 95% CI = 0.20–0.94). Among patients with no cardiovascular comorbidities, pre-diagnostic statin users had a significantly increased risk of initiation of injectable ED drugs (HR = 1.27; 95% CI = 1.04–1.55), however, no association with risk of any other ED treatment was observed. Conclusion Statin users have a slightly increased risk of ED treatment initiation after RP, which probably reflects the effect of the underlying vascular insufficiency.

Abstract 9614: Association Between Myocardial Contraction Fraction and Heart Failure Subtypes in the Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction: Myocardial contraction fraction (MCF) is a non-ejection fraction volumetric measure of myocardial shortening which has been associated with incident heart failure (HF) including in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. However, less is known regarding MCF’s prediction of HF subtypes. Methods: This analysis included men and women aged 45-84 free of clinical cardiovascular disease who underwent cardiac magnetic resonance imaging (cMRI) during the baseline MESA examination and who had data regarding incident adjudicated definite or probable HF events. MCF was calculated using cMRI measurements and defined as the ratio of stroke volume to myocardial volume. HF subtypes were divided into HF with ejection fraction (EF) < 50% (HF EF < 50%, including HF with reduced EF (EF ≤ 40%) and HF with mildly reduced EF (EF 41-49%) and HF with preserved EF (HFpEF, EF ≥ 50%). Cox proportional hazards regression was used to examine the association between MCF and incident HF subtype per decile increase in MCF. Event time was defined as time of first defined HF subtype, and censoring occurred at death or end of follow-up. After an incident HF event, participants were not at risk for another HF subtype. Covariates adjusted for were age, gender, race-ethnicity, education, body-mass index, tobacco and alcohol use, systolic blood pressure (BP), diabetes, physical activity, total cholesterol, and BP and lipid lowering drug use. Results: Among 4,983 participants (mean age 61, 52% female, 61% non-White) over a maximum of 18 years follow-up, there were 275 incident HF events (142 HF EF < 50%, 113 HFpEF, 20 unknown EF). MCF differed across HF status (p<0.001) . Participants without incident HF had a higher mean MCF (0.65) compared to HFpEF (0.62), HF EF < 50% (0.53), and unknown EF (0.52). The adjusted risk of any HF was reduced (HR 0.86, 95% CI 0.82, 0.91) per decile increase of MCF. MCF was strongly associated with incident HF EF < 50% (adjusted HR 0.80, CI 0.74, 0.86) but was not associated with HFpEF (adjusted HR 0.98, CI 0.91, 1.05). Conclusions: In a multi-ethnic cohort, increasing MCF is associated with a decreased risk of incident HF EF<50%. MCF is not significantly associated with incident HFpEF, suggesting different etiologic pathways for these two HF subtypes.

Profile of glucose lowering drug use in outpatients with type 2 diabetes mellitus

The use of glucose lowering agents with favorable weight profile is a growing practice in Diabetology. To characterize medication combinations in patients with type 2 Diabetes (T2D) and their effect on metabolic control. Review of medical records of 249 outpatients with T2D with a median age of 66 years, cared for at a medical network. Clinical characteristics, glycated hemoglobin (HbA1c), details of Diabetes treatment (types of drugs or insulin), renal function, lipids and B12 vitamin levels were registered. The median disease duration was 16 years. The most recent HbA1c was 7.4%. No patient was using sulfonylureas, 45 were using Dipeptidyl peptidase 4 inhibitors, 113 were using Sodium-glucose Cotransporter-2 (SGLT2i) Inhibitors, 21 used Glucagon-like Peptide-1 Receptor Agonists (GLP1ra), 158 used basal insulin and 61 on basal plus bolus insulin. The use of SGLT2i or GLP1ra was associated with a metabolic control similar to those patients not using them, while patients on rapid insulin had a significantly worse metabolic control and a tendency to greater body mass index. The use of basal insulin and rapid insulin was significantly associated with more hypoglycemia events. The use of SGLT2i and GLP1ra in patients with T2D is associated with better metabolic control than rapid insulin with less risk of hypoglycemia. The use of these therapies should be prioritized in the future.

934-P: Real-World Evidence of Glucose Lowering Drug Use, Glycemic Outcomes, and Severe Hypoglycemia in Hong Kong: Eighteen-Year Trends in 0.9 Million Adults with Diabetes

Introduction: Improvements in glycemic outcomes have stalled since 20in some international surveys. We examined the latest trends in drug use and glycemic outcomes following recent introduction of newer classes of glucose lowering drugs (GLDs) in a territory-wide analysis. Methods: Using data from the Hong Kong Diabetes Surveillance Database, we estimated age-specific trends in the proportion of patients reaching different glycemic targets, and rates of severe hypoglycemia (SH) in 963,612 patients between 2002-2019. We assessed patterns of GLDs use by age, sex, presence of atherosclerotic cardiovascular disease (ASCVD) and estimated glomerular filtration rate (eGFR) . Results: HbA1c improved most markedly between 2007-2014 but plateaued since 2014, with 53.1% patients achieving HbA1c <7% in 2019. The 20-44 age group had the highest proportion with HbA1c ≥9% (22.1% in 2002 and 16.8% in 2019) compared with the ≥75 age-group (14.9% in 2002 and 5.5% in 2019) . SH rates declined between 2002-20 and further in 2010-2014. Between 2002-2019, metformin use increased steadily from 41.1% to 58.7%, sulfonylurea use decreased from 52.2% to 31.1% while insulin use remained static. Use of dipeptidyl-peptidase 4 inhibitors (DPP4i) experienced rapid growth between 2007-20equally in all age groups, with a slower rise between 2011-2019. DPP4i remains the most widely prescribed newer oral GLDs (14.3%) compared with sodium glucose co-transporter 2 inhibitors (SGLT2is) (4.2%) and glucagon like peptide-1 receptor agonists (GLP1-RAs) (0.6%) in 2019. Compared with over 75s, higher proportions of the 20-44 age-group were treated with SGLT2is (6.4% versus 1.7%) and GLP-1RAs (1.5% versus 0.1%) and thiazolidinediones (8.1% versus 3.4%) in 2019, irrespective of ASCVD status. Conclusions: Following rapid improvement in 2007-2014, glycemic control and SH rates had plateaued despite the increasing use of SGLT2is and GLP-1RA in Hong Kong. Disclosure A.Yang: None. J.C.Chan: Board Member; Asia Diabetes Foundation, Consultant; Bayer AG, Boehringer Ingelheim International GmbH, Celltrion, Merck Sharp & Dohme Corp., Roche Diabetes Care, Viatris Inc., Research Support; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Hua Medicine, Servier Laboratories, Stock/Shareholder; GemVCare Ltd. E.Chow: Research Support; Hua Medicine, Medtronic, Powder Pharmaceuticals Inc., Speaker's Bureau; Novartis AG, Sanofi. H.Wu: None. E.S.H.Lau: None. X.Zhang: None. M.Shi: None. B.Fan: None. A.P.Kong: Advisory Panel; Abbott, Kyowa Kirin Co., Ltd., Other Relationship; AstraZeneca, Novo Nordisk, Research Support; Boehringer Ingelheim, Speaker's Bureau; AstraZeneca, Bayer, Eli Lilly and Company, Sanofi, Stock/Shareholder; Aptorum Group Limited. A.Luk: None. R.C.Ma: Other Relationship; Bayer AG, Boehringer Ingelheim International GmbH, Research Support; AstraZeneca, Bayer AG, Novo Nordisk A/S, Pfizer Inc., Tricida, Inc.

IDF21-0632 Real world evidence on sulphonylureas use in Asian patients with type 2 diabetes – The JADE register

Background: Of 463 million people with diabetes worldwide, over 50% reside in Asia. Sulphonylureas (SUs) such as gliclazide are essential medications listed by the World Health Organization with clinical use for over 60 years. Aim: We explored clinical profiles and patterns of oral glucose lowering drug (OGLD) use in Asian patients with type 2 diabetes (T2D), with a focus on SUs including gliclazide. Method: Patients with T2D aged ≥18 years from 11 countries/regions (China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Taiwan, Thailand, Vietnam, and Singapore) with structured assessment and prospectively enrolled in the Joint Asia Diabetes Evaluation (JADE) Register between November 2007 and December 2019 were included. Patients with type 1 diabetes or treated with insulin/injectable glucagon-like peptide-1 receptor agonists were excluded. Results: Amongst 62,512 patients (mean ± SD age: 57.3 ± 11.8 years; 46.4% women), 54,783 (87.6%) were treated with OGLD at enrolment. Most patients received one (37.5%) or two (44.2%) OGLDs. Metformin was used by 84.1% of treated patients, followed by SUs (59.4%) and DPP-4 inhibitors (23.0%). SUs were used alone (9.0%) or in combination (50.4%), mainly with metformin (30.6%) and metformin plus DPP-4 inhibitors (9.2%). Amongst SU users, gliclazide (47.0%) was most commonly prescribed, followed by glimepiride (40.3%) and glibenclamide (8.4%). Amongst SU users, gliclazide users were more likely than gliclazide non-users to achieve HbA1c < 7% (OR 1.09, 95% CI 1.02–1.17) with lower risk of self-reported hypoglycaemia (OR 0.81, 95% CI 0.72–0.92), when adjusting for sociodemographic factors, cardiometabolic risk factors, medication use, country/region and year of registration.Tabled 1Treated with any OGLD (N=54,783)Treated with any SUs (N=32,558)Treated with gliclazide (N=15,312)Age(years)mean ± SD57.5±11.658.0±11.559.7±11.5Menn (%)29,473 (53.8%)17,349 (53.3%)7,900 (51.6%)BMI(kg/m2)mean ± SD26.2±4.526.1±4.425.8±4.3BMI≥25 kg/m2n (%)29,921 (56.8%)17,668 (56.1%)7,728 (52.1%)Diabetes duration (years)mean ± SD5 (2-10)6 (3-12)7 (3-12)≤1 year (%)n (%)11,902 (21.9%)4,965 (15.4%)2,421 (16.0%)eGFR (mL/min/1.73m2)mean ± SD81.9±22.180.2±22.579.7±22.1<60 mL/min/1.73m2n (%)7,529 (16.5%)5,155 (18.8%)2,684 (19.8%)Hypertensionn (%)46,587 (85.6%)28,147 (87.0%)13,042 (85.6%)Dyslipidaemian (%)41,447 (83.1%)24,647 (82.7%)11,731 (81.8%)Diabetes complicationsn (%) Chronic kidney disease7,592 (13.9%)5,189 (15.9%)2,707 (17.7%) Diabetic retinopathy5,890 (11.8%)3,952 (13.4%)2,385 (17.1%) Peripheral sensory neuropathy5,263 (9.7%)3,555 (11.0%)1,214 (8.0%) Coronary heart disease4,845 (8.8%)2,988 (9.2%)1,575 (10.3%)Class of OGLDn (%) Metformin46,080 (84.1%)25,888 (79.5%)11,981 (78.2%) Sulphonylureas32,558 (59.4%)-- DPP-4 inhibitors12,591 (23.0%)7,189 (22.1%)2,631 (17.2%) Thiazolidinedione4,776 (8.7%)2,884 (8.9%)733 (4.8%) Alpha-glucosidase inhibitors3,509 (6.4%)2,217 (6.8%)684 (4.5%) Glinides748 (1.4%)72 (0.2%)25 (0.2%) SGLT2 inhibitors284 (0.5%)153 (0.5%)104 (0.7%) Open table in a new tab Discussion: This large register-based study provides unique insights into clinical characteristics and patterns of OGLD use in Asian patients with T2D confirming the popular use of SUs, often combined with metformin. Affordability, good glycaemic control and safety profiles support the use of SUs including gliclazide as a first line OGLD in patients with T2D.

Cholesterol lowering drug use and breast cancer survival: the Multiethnic Cohort Study

PurposePrior studies conducted primarily in white populations have suggested that pre-diagnostic cholesterol lowering drugs (CLDs) improved survival among women with breast cancer (BC). However, this association had not been well characterized in diverse racial/ethnic populations. We investigated whether pre-diagnostic CLD use is associated with all-cause and BC-specific mortality among female BC cases of the Multiethnic Cohort (MEC).MethodsCLD use was ascertained through questionnaires administered in 2003–2008. A total of 1448 incident BC cases were identified by linkage to SEER cancer registries in Hawaii and California from 2003 to 2014. Multivariable Cox regression was conducted to estimate hazard ratios (HR) and 95% confidence intervals (CI) of the associations of pre-diagnostic CLD use with all-cause and BC-specific mortality, adjusting for tumor characteristics, first course of treatment, health behaviors, co-morbidities, and demographics. Subgroup analyses by stage and hormone receptor status were conducted for all-cause mortality.ResultsThere were 224 all-cause and 87 BC-specific deaths among the 1448 BC cases during a median follow-up of 4.5 years after diagnosis. Women with BC who ever used CLDs had a 27% lower hazard of all-cause mortality (HR 0.73, 95% CI 0.54–0.98) and 17% lower hazard of BC-specific mortality (HR 0.83, 95% CI 0.49–1.39) compared to never users. CLD use reduced mortality among women with advanced-stage tumors and hormone receptor-positive breast tumors (HR 0.54 95% CI 0.33–0.90; HR 0.69, 95% CI 0.48–0.99, respectively).ConclusionThese findings demonstrate an improved survival associated with CLD use prior to diagnosis in a multiethnic population of women with BC.

Increasing glycaemia is associated with a significant decline in HDL cholesterol in women with prediabetes in two national populations

Internationally, studies have shown associations between lipids and glycemia; however, whether the link varies by gender and population has been rarely examined. We investigated relationships between glycemia and HDL- and Non-HDL-cholesterol and their modification by gender. We undertook a cross-sectional analysis from the National Health Examination Survey for Thailand (NHES-Thailand) and the Health Survey for England (HS-England) in adults aged 18–75 year. Glycaemia was assessed by FPG in Thailand and by HbA1c in the UK. In population- and gender-stratified analyses, the relationships between glycemia and lipids were explored. A total of 15,145 Thai and 3484 UK adults with blood measurement were included. The prevalences of prediabetes were: in NHES-Thailand, 16% (SE = 0.004), based on FPG (5.6 to < 7.0 mmol/L) and in HS-England, 19% (0.007) based on HbA1c (39 to < 48 mmol/mol). Increasingly abnormal glucose homeostasis was associated with increasing age, adiposity, SBP, proportion of antihypertensive and lipid-lowering agent use and with decreasing HDL-cholesterol. Independent of age, adiposity, smoking, alcohol, physical activity, and lipid and BP lowering drug use, increasing glycemia was associated with decreasing HDL-cholesterol specifically in women with prediabetes (NHES-Thailand, beta-coefficient − 0.07 (95% CI − 0.15, − 0.001) p = 0.04 and HS-England, − 0.03 (− 0.04, − 0.006) p = 0.01). In both populations, among those with prediabetes, increasing glycaemia is associated with an adverse, significant decline in HDL cholesterol, specifically in women. These adverse effects are apparent in widely-differing international populations.

Urinary nucleic acid oxidation product levels show differential associations with pharmacological treatment in patients with type 2 diabetes

The relationship between RNA and DNA oxidation and pharmacological treatment has not been systematically investigated in patients with type 2 diabetes (T2D). We aimed to investigate the association between pharmacological treatments and levels of urinary markers of nucleic acid oxidation in T2D patients. Vejle Diabetes Biobank cohort data was nested into nationwide registry data. Multiple logistic regression was used to associate drug usage with risk of high (above median) RNA and DNA oxidation. Data from 2664 T2D patients (64% male, age range: 25–75) were included. Questionnaire-validated lipid lowering drug use was associated with low RNA oxidation (Odds ratio, OR 0.71, 95% CI: [0.59–0.87]). Insulin and non-specific antidiabetic drugs were associated with low DNA oxidation (insulin: OR 0.60, 95% CI [0.49–0.73]). Oral antidiabetics were associated with high DNA oxidation and RNA oxidation (OR 1.30, 95% CI [1.10–1.53] and OR 1.26, 95% CI [1.07–1.29]). Our findings indicate that diabetes-related drugs are associated with RNA and DNA oxidation and further studies are required to determine causality in T2D patients.

Type 2 diabetes treatment and progression of chronic kidney disease in Italian family practice

Progressive chronic kidney disease represents a dreadful complication of type 2 diabetes mellitus (T2DM). We tested the pattern of use and the renal effects of old glucose-lowering drugs in T2DM patients cared for by Italian general practitioners (GPs). Data of 2606 T2DM patients were extracted from the databases of GPs, who do not have access to the most recent glucose-lowering drugs in Italy. The rate of kidney function decline was calculated by CKD-EPIcr, based on two consecutive creatinine values. Metformin was used in 55% of cases, either alone or with sulfonylureas/repaglinide, across the whole spectrum of CKD (from 66% in stage G1 to only 8% in G4). Sulfonylurea use peaked at 21-22% in stage G2-G3a, whereas repaglinide use significantly increased from 8% in G1 to 22% in G4. The median rate of CKD decline was - 1.64mL/min/1.73m2 per year; it was higher in G1 (- 3.22 per year) and progressively lower with CKD severity. 826 cases (31.7%) were classified as fast progressors (eGFR decline more negative than - 5mL/min/1.73m2 per year). The risk of fast progressing CKD was associated with increasing BMI, albuminuria, and sulfonylurea use, alone (OR, 1.47; 95% confidence interval, 1.16-1.85), or in association with metformin (OR, 1.40; 95% CI 1.04-1.88). No associations were demonstrated for metformin, cardiovascular and lipid lowering drug use. In the setting of Italian family practice, sulfonylurea use is associated with progressive CKD in patients with T2DM. Metformin, at doses progressively reduced according to CKD stages, as recommended by guidelines, is not associated with fast progression.

Impaired Heart Rate Response to Exercise in Diabetes and Its Long-term Significance

ObjectiveTo investigate the effect of diabetes mellitus on exercise heart rate and the role of impaired heart rate in excess mortality in diabetes. Patients and MethodsPatients without cardiovascular disease who underwent exercise testing from September 1, 1993, through December 31, 2010, were included. Mortality was determined from Mayo Clinic records and the Minnesota Death Index. Multivariate linear regression was used to compare heart rate responses in patients with vs without diabetes. Cox regression was used to determine the effect of abnormal heart rate recovery and abnormal chronotropic index on survival. ResultsA total of 21,396 patients (65.4% men) with a mean ± SD age of 51±11 years, including 1200 patients with diabetes (5.4%), were included. Patients with diabetes had a higher resting heart rate (81±14 vs 77±13 beats/min), lower peak heart rate (154±20 vs 165±19 beats/min), heart rate reserve (73±19 vs 88±19 beats/min), chronotropic index (0.86±0.22 vs 0.99±0.20), and heart rate recovery (15±8 vs 19±9 beats/min) vs patients without diabetes. There were 1362 deaths (6.4%) during a mean ± SD follow-up of 11.9±4.9 years. Adjusting for age, sex, and heart rate–lowering drug use, a chronotropic index less than 0.8 contributed significantly to risk in patients with diabetes (hazard ratio [HR], 2.21; 95% CI, 1.62-3.00; P<.001) and patients without diabetes (HR, 1.94; 95% CI, 1.71-2.20; P<.001), as did abnormal heart rate recovery (patients with diabetes: HR, 2.21; 95% CI, 1.60-5.05; P<.001; patients without diabetes: HR, 1.75; 95% CI, 1.55-1.97). ConclusionsPatients with diabetes exhibit abnormal heart rate responses to exercise, which are independently predictive of reduced long-term survival in patients with diabetes as in patients without diabetes.

Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study

Objective To determine the association between use of lipid lowering drugs (statin or fibrate) in older people with no known history of vascular events and long term risk of coronary...

Abstract 19263: Vasodilator Use and Wave Intensity Patterns in Hypertension

Background: Blood pressure is the result of interactions between the heart and the arteries. Although the effects of vasoactive blood pressure-lowering drugs on arteries has been widely investigated, their in vivo effects on ventricular-arterial interactions are not well understood. Hypothesis: We aimed to assess the relationship between antihypertensive drug use and ventricular arterial interactions assessed via wave intensity analysis (WIA), which quantifies the energy contained in waves generated by the heart and/or reflected from the periphery (figure). Methods: We studied 152 subjects with treated hypertension. We measured central pressure using carotid arterial tonometry. Ascending aortic flow was quantified with through-plane phase-contrast MRI. We performed WIA and assessed the relationship between specific classes of blood pressure lowering drug use and WIA patterns. Results: In models that adjusted for age, gender, body size, race, presence of diabetes and glomerular filtration rate, angiotensin receptor blocker (ARB) use was associated with a greater likelihood of a mid-systolic expansion (i.e., suction) wave (Hazard Ratio=31.1; P=0.005), whereas beta-blocker use was associated with a lower likelihood of such wave (HR=0.16; P=0.02). ARB use was also independently associated with a lower energy in the late systolic forward suction wave (Beta=-0.18; standardized beta=-0.24; P=0.007). This association persisted after adjustment for the forward compression wave (beta=-0.13; standardized beta=-0.16; P=0.008). No associations between WIA patterns and calcium channel blocker use, diuretic use, ACE inhibitor use or long-anting nitrate use were found. Conclusions: Wave intensity analysis is a useful tool to assess the effects of vasodilators on ventricular-arterial interactions. ARB use is selectively associated with systolic suction waves (from blood inertia), which may in turn unload the heart in mid and late systole.

Analysis of resting heart rate and clinical characteristics in outpatients with stable coronary artery disease in Turkey: PULSE study

An association between resting heart rate (RHR) and cardiovascular morbidity and mortality has been shown in patients with coronary artery disease (CAD). We aimed to evaluate the RHR and its relationship with clinical variables in outpatients with stable CAD at secondary and tertiary care centers in Turkey. Adults with stable CAD in sinus rhythm were included in this non-interventional, national, cross-sectional, multicenter study. Data were collected at a single study visit from 83 centers. The mean ± standard deviation age of all patients (n = 2,919) was 61 ± 10 years and 73% were males. The mean (SD) RHR was 73 ± 12 bpm, and 62% of patients had RHR of ≥ 70 bpm. Females more frequently had RHR ≥ 70 bpm compared with males (67% vs. 60%; p = 0.002). RHR was significantly higher in patients with angina than in those without (76 ± 13 vs. 73 ± 11 bpm, p < 0.001). Left ventricular ejection fraction and heart rate lower-ing drug use were significantly lower in patients with a RHR ≥ 70 bpm (p < 0.05). The RHR of outpatients with stable CAD was not within the level recommended by the guidelines.

The association between childhood trauma and lipid levels in an adult low-income, minority population

BackgroundThe objective of this study is to investigate the association between childhood trauma and lipid profiles in adults from a highly traumatized population at-risk for cardiovascular disease. MethodWe recruited 452 participants, primarily African-American and of low socioeconomic status, from general medical clinics in a large urban hospital. We performed direct comparisons, univariate analysis of variance and regression analyses together and separated by sex, examining the associations of child abuse, body mass index, lipid lowering drug use, blood pressure, age, and substance use to HDL levels and HDL/LDL ratios. ResultsA history of moderate to severe levels of childhood trauma and abuse was associated with a significant decrease in HDL levels (P≤.01) and HDL/LDL ratios (P≤.001) relative to males with low levels of abuse. This relationship held when the status of lipid-lowering drugs was considered. When controlling for age, substance abuse, tobacco use, and adult trauma, the effects of childhood trauma remained significant. We found a significant child abuse by sex interaction on HDL/LDL ratios [F(1,369)=13.0, P≤.0005] consistent with a differential effect of trauma on dyslipidemia in male but not female subjects. ConclusionsOur data suggest that childhood trauma exposure, obtained with self-report measures, may contribute to increased risk of cardiovascular disease by way of stress-mediated alterations of lipid concentration and composition in male, but not female, subjects.

PP04 Persisting Gender Differences and Attenuating Age Differences in Cardiovascular Drug use for Prevention and Treatment of Coronary Heart Disease

BackgroundEvidence on recent time trends in age-gender differences in cardiovascular drug use is scarce. We studied time trends in age-gender-specific cardiovascular drug use for primary prevention, in-hospital treatment and secondary...

Abstract 19136: Incidence of Diabetes Mellitus in Patients with Congenital Heart Disease

Introduction: Today 0.8-1 % of all children are born with congenital heart defects (CHD) and most live into adulthood, with estimations and registry data indicating that 90-95% of all CHD now reach adulthood. CHD may increase the risk of infections and subsequently higher risk of diabetes type 1. Diabetes type 2 (T2D) increases and CHD could lead to a more sedentary lifestyle with a higher risk of developing T2D. Rhe relation between CHD and diabetes has previously not been investigated. Hypotheses: We estimated the risk of developing diabetes in a large cohort of patients with CHD as found in the nationwide diabetes registry in Sweden, NDR Methods: the National Diabetes Registry, NDR has an estimated coverage above 70% for Sweden. We identified patients with CHD in the NDR and compared to two controls groups, control group 1 never hospitalized paired patients with T1D or T2D and a second control group randomly selected paired patients with diabetes T1D or T2D and previous hospitalization for any reason. Both control groups were adjusted by age and gender. The analyzed characteristics were age, gender, type of diabetes, diabetes duration, systolic blood pressure, BMI, waist measurement, HbA1c, smoking, microalbuminuria, antihypertensive, lipid lowering drug use and type of hypoglycaemic treatment. Results: We found 1860 patients in the NDR with CHD as additional diagnosis. With a presumed prevalence of between 0.3 and 0.4% of the adult population, diabetes was found in 6.2 to 8.2% of all adults with CHD, for an odds-ratio of 1.35 (1.3-1.4, p&lt;0.001) for diabetes of any kind to occur in patients with CHD as compared to adults without CHD. CHD and diabetes with the Swedish population at age 18-100 years CHD Total pop OR P Total no 25.000 (est) 7.562.648 With diabetes 1860 425.375 with diabetes 7.4% 5.6% 1.35 (1.3-1.4) &lt;0.0001 Conclusion. Based on estimated prevalence of adults with congenital heart disease in Sweden, the prevalence of diabetes seems to be higher in the CHD population than in the population without CHD, given an OR of 1.35.

Erectile Dysfunction Is Not Independently Associated with Cardiovascular Death: Data from the Vitamins and Lifestyle (VITAL) Study

Erectile dysfunction (ED) is a significant problem among aging men. ED is independently associated with cardiovascular (CV) events (angina, myocardial infarction, and stroke). We sought to determine if ED was associated with CV death. Risk of CV death in men with ED. Exactly 31,296 men in Washington aged 50-76 completed a questionnaire in 2000-2002 on supplements, diet, exercise, personal health, and ED. ED was determined by one question: "Have you experienced impotence in the last year?" We excluded patients with a history of coronary artery disease or stroke. Participants linked yearly through 2008 to the Washington State Death Certificate System. CV death was defined by death certificates listing CV-related deaths (International Classification of Diseases 10th Revision [ICD-10] codes: I00-I15, I20-I52, and I60-I99). We performed multivariate Cox proportional hazard regression adjusting for age, marital status, race, education, self-rating of health, body mass index (BMI), antihypertensive/lipid-lowering drug use, diabetes, family history of CV disease, smoking, and exercise. About 7,762 men had ED and there were 486 CV deaths over 7.8-year average follow-up. The typical man who suffered CV death was older, single, reporting poor health, taking antihypertensives, higher BMI, a smoker, a diabetic, and had a family history of CV disease. When adjusting for age, marital status, and education only, men with ED had a 23% increased risk of CV death (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.01, 1.49). With further adjustment for known risk factors for CV disease (diabetes, treatment for hypertension or hyperlipidemia, family history of myocardial infarction/stroke, BMI, and exercise), ED no longer predicted CV death (HR 0.93, 95% CI 0.76, 1.15). In this community-based cohort, ED was not independently associated with an elevated risk of CV death. These data do not contradict prior data associating ED and CV events but rather suggest that ED may be a manifestation of other known risk factors for CV disease.

The plasma leptin/adiponectin ratio predicts first cardiovascular event in men: A prospective nested case–control study

ObjectiveThe plasma leptin/adiponectin (L/A) ratio has been proposed as a preferential marker of atherosclerosis susceptibility compared to leptin and adiponectin alone. We determined the extent to which the L/A ratio predicts incident cardiovascular disease (CVD) taking account of clinical risk factors, microalbuminuria, the total cholesterol/HDL cholesterol (TC/HDL-C ratio), triglycerides, high sensitive C-reactive protein (hs-CRP) and insulin sensitivity (homeostasis model assessment (HOMAir)). MethodsA community-based prospective nested case–control study was carried out in 103 non-diabetic men who developed a first cardiovascular event (cases) and 106 male control subjects (no clinically manifest CVD and no lipid lowering drug use at baseline; median follow-up of 3.0 and 10.5years, respectively). Plasma leptin, adiponectin, the leptin/adipnectin (L/A) ratio, as well as hs-CRP, HOMAir and the TC/HDL-C ratio were determined at baseline. ResultsPlasma leptin levels and the L/A ratio were higher in cases vs. controls (p=0.002 for both), but the difference in adiponectin was not significant (p=0.10). Age-adjusted incident CVD was associated with plasma leptin, adiponectin and the L/A ratio (p=0.045 to p=0.001). The relationships of incident CVD with plasma leptin (p=0.19) and adiponectin (p=0.073) lost statistical significance after additional adjustment for smoking, waist circumference, hypertension, microalbuminuria, the TC/HDL-C ratio, hs-CRP and HOMAir. In this fully adjusted analysis, the L/A ratio remained predictive of incident CVD (hazard ratio: 1.40 (95% CI 1.05–1.87), p=0.024). ConclusionThis study suggests that the L/A ratio may be a preferential marker of a first cardiovascular event in men compared to plasma leptin and adiponectin levels alone.

Abstract P120: Prevalence of Ventricular Premature Beats Decreases With Serum Magnesium in Adults with Type 2 Diabetes

Introduction: Ventricular premature beats (VPB) predict cardiovascular mortality among several adult populations. Controlled dietary magnesium (Mg) depletion studies demonstrated that diminished Mg intake and status induced VPB and other arrhythmias. Thus, we hypothesized that the prevalence of VPB is closely associated with serum Mg concentrations in a general adult population at high cardiovascular risk. Methods: Anthropometric, demographic and lifestyle characteristics were assessed in 750 Cree adults, &gt;18yrs, who participated in an age-stratified, cross-sectional health survey in Quebec, Canada. Holter electrocardiograms recorded heart rate variability and cardiac arrhythmias for two consecutive hours. Multivariate logistic regression was used to evaluate potential associations between serum Mg and VPB. Results: VPB prevalence in adults with hypomagnesaemia (serum Mg ≤ 0.70mmol/L) was over twice that of adults without hypomagnesaemia (50% vs. 21%, p =0.015); results were not materially altered when adults with cardiovascular disease history were excluded. All hypomagnesaemic adults with VPB had type 2 diabetes. Prevalence of VPB declined across the serum Mg concentration gradient in adults with type 2 diabetes only ( p &lt;0.001). In multivariate logistic regressions adjusted for age, sex, community, body mass index, smoking, physical activity, alcohol consumption, kidney disease, antihypertensive and cholesterol lowering drug use, and blood docosahexaenoic acid concentrations, the odds of VPB among diabetics with serum Mg &gt; 0.70 mmol/L was 0.24 (95%CI: 0.06-0.98; p =0.046). Conclusions: Prevalence of VPB significantly declined across the serum Mg concentration gradient in adults with type 2 diabetes, indicating that future interventions to increase levels of serum Mg among adults with type 2 diabetes may confer protection against cardiac arrhythmia.