Major Cardiovascular Disease Research Articles

Narrowing Cardiovascular Disease Health Disparities by Advancing the Role of Pharmacists Through a Multisector Consortium.

Demand for scaling and sustaining clinical services to improve health outcomes while minimizing costs is rising, particularly for patients dealing with major cardiovascular disease and stroke risk factors such as hypertension. Consequently, there is growing national and local interest in engaging pharmacists as part of the solution through the implementation of comprehensive medication management. To capitalize on this momentum, a team from the University of Southern California led the establishment of the California Right Meds Collaborative (CRMC) in 2019. CRMC aims to reduce the burden of uncontrolled chronic disease by advancing the role of pharmacists as team members in the health care system. This case study describes CRMC's structure and approach to developing value-based payment models and advancing the competency of pharmacists through training, continuous quality improvement, and technical assistance. In addition, this case study provides an overview of a CRMC pilot project wherein a local health plan tested a value-based payment model to deliver comprehensive medication management. The pilot underwent many iterative changes throughout its duration but ultimately was considered a success and adopted as part of standard practice. Lessons learned from this effort can help others leverage the availability of pharmacists to assist vulnerable populations in their communities.

Evaluation of Regional Wall Motion Abnormalities with Echocardiography in the Emergency Department

Abstract Introduction Acute coronary syndrome (ACS) is a major cardiovascular disease, particularly in cases where standard electrocardiogram findings are equivocal. Focused cardiac ultrasound (FOCUS) has become increasingly accepted as a tool in emergency medicine. The primary objective of this study was to evaluate the accuracy, sensitivity, and specificity of FOCUS in detecting regional wall motion abnormalities (RWMA) compared with standard echocardiography (ECHO). Materials and Methods This prospective observational study included 91 patients who presented to the emergency department between June 1, 2023, and November 30, 2023. Senior emergency physicians performed FOCUS examinations, which were performed by an emergency assistant or specialist who works in the emergency department, has at least 2 years of experience in ultrasonography (USG), and has basic USG and advanced USG certificates. The examinations assessed the presence of RWMA in each patient's left ventricle. Results All 91 patients were included in the study for comparison with formal ECHO. The mean age was 58, and 32% of patients were female. Compared with the criterion standard of formal ECHO, the sensitivity of FOCUS performed by emergency physicians for detecting RWMA was 85% (95% confidence interval [CI], 73–92), the specificity was 53% (95% CI, 36–69), and the overall accuracy was 74% (95% CI, 64–82). Conclusion Our study demonstrates the potential utility of FOCUS performed by emergency physicians in detecting RWMA in patients with high suspicion of ACS.

A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease.

Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption. Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in MAGI-1 are also linked to chronic inflammatory disorders such as spontaneous glomerulosclerosis, celiac disease,ulcerative colitis, and Crohn's disease. Increased MAGI-1 expression has been observed in colonic epithelial samples from Crohn's disease and ulcerative colitis patients. MAGI-1 also plays a role in regulating EC activation and atherogenesis in mice and is essential for Influenza A virus (IAV) infection, endoplasmic reticulum stress-induced EC apoptosis, and thrombin-induced EC permeability. Despite being understudied in human disease; evidence suggests that MAGI-1 may play a role in linking CVD and MDD. Therefore, further investigation of MAG-1 could be warranted to elucidate its potential involvement in these conditions.

Remission to normal blood pressure in older adults with hypertension who did not receive antihypertensive medication: analysis of data from two longitudinal cohorts

How often hypertensive patients could achieve remission to normal blood pressure (BP) (i.e., <140/90mmHg) in the absence of antihypertensive drugs, which is important for the management of hypertension, remains largely unknown. This observational study aimed to investigate the change of BP in older adults with hypertension who did not take antihypertensive drugs and preliminarily examine whether the remission from hypertension to normal BP observed in this setting was associated with lower risk of cardiovascular disease (CVD). 2760 participants aged 33-99 years (median 60 years, interquartile 54-68 years) from the Health and Retirement Study (wave 2006 to wave 2018) and the English Longitudinal Study of Ageing (wave 1998 to wave 2016), who had no major CVD, were hypertensive, and were not on antihypertensive drugs at the time of baseline BP measurement, and had at least one follow-up BP measurement before which no antihypertensive drugs were taken, were included for analysis. The main outcome was the proportion of patients who achieved remission of hypertension at the last wave of measurement. During a median follow-up of six years, 52% of the participants showed a reduction of ≥6mmHg in systolic BP and 60% a reduction of ≥3mmHg in diastolic BP. 1171 participants (42%, 95% CI: 41-44%) achieved remission at the last measurement, and by that time 67%, 43%, and 29% of them had maintained the normotensive state for around 4, 8, and 12 years, respectively. Various supplementary analyses that aimed to examine the impact of chance and bias yielded similar results. Preliminary analyses showed that being non-smokers at baseline, achieving a normal body mass index during follow-up, and quitting alcohol drinking during follow-up, among others, were associated with the remission of hypertension. Compared with the participants who remained hypertensive, those who achieved remission had a lower CVD risk (adjusted hazard ratio 0.66, 95% CI: 0.47-0.92). In many of this study population, hypertension could be reversed without the intervention of drug treatment in the first few years after diagnosis. This finding may have implications for more individualized management of hypertension. Further studies to identify the factors or algorithms predictive of such hypertension remission are warranted. The Chinese University of Hong Kong (7106452; 7105959),Shenzhen Science and Technology Program (KQTD20190929172835662), Strategic Priority Research Program of Chinese Academy of Sciences (XDB 38040200), National Institute on Aging(R01AG017644; NIA U01AG009740).

Interventions for primary prevention of cardiovascular disease: umbrella review of systematic reviews.

Cardiovascular diseases are the leading cause of death globally. The aim of this overview of systematic reviews was to compare the effectiveness of different pharmacological and non-pharmacological interventions for the primary prevention of cardiovascular disease. A structured search of the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE and the Database of Abstracts of Reviews of Effects archive was conducted to find systematic reviews that reported the effect of various pharmacological and non-pharmacological interventions for the primary prevention of cardiovascular disease from inception to March 2021. References of included studies were also checked. The included systematic reviews' methodological quality was assessed using the Assessment of Multiple Systematic Reviews 2 instrument (range, 0-16). The outcomes of each included review's meta-analysis were extracted and described narratively. This study analysed 95 systematic reviews, including 41 on non-pharmacological interventions and 54 on pharmacological interventions for cardiovascular health. The majority of the reviews focused on lipid-lowering interventions (n = 25) and antiplatelet medications (n = 21), followed by nutritional supplements, dietary interventions, physical activity, health promotion and other interventions. Only 1 of the 10 reviews addressing cardiovascular mortality showed a potential benefit, while the others found no effect. Antiplatelets were found to have a beneficial effect on all-cause mortality in 2 out of 12 meta-analyses and on major cardiovascular disease events in 8 out of 17 reviews. Lipid-lowering interventions showed beneficial effects on cardiovascular disease mortality, all-cause mortality and major cardiovascular disease events in varying numbers of the reviews. Glucose-lowering medications demonstrated significant benefits for major cardiovascular events, coronary heart disease events and mortality. However, the combination of dietary interventions, physical activities, nutritional supplements and polypills showed little or no significant benefit for major cardiovascular outcomes or mortality. More research is needed to determine whether the effect of treatment varies depending on population characteristics. The findings of this review should be interpreted with caution because the majority of studies of non-pharmacological interventions compare primary prevention with usual care, which may include recommended pharmacological treatment in higher-risk patients (e.g. statins and/or antihypertensive medications, etc.). In addition, randomised controlled trial evidence may be better suited to the study of pharmacological interventions than dietary and lifestyle interventions. This umbrella review captured the variability in different interventions on randomised controlled trial evidence on interventions for primary prevention of cardiovascular disease and identified areas that may benefit from further research. Specifically, this review focused on randomised controlled trial evidence on interventions for primary prevention of cardiovascular disease. Researchers may use these findings as a resource to direct new intervention studies and network meta-analyses to compare the efficacy of various interventions based on these findings. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme as award number 17/148/05.

In vivo and In silico Analysis of Antihypertensive Activities of Ficus religiosa Fruit Extract

Hypertension is one of the major cardiovascular diseases leading to serious health consequences including cardiovascular events such as stroke and even death. These may also include significant damages to the body’s most organs like heart, kidneys and brain. This deadly disease requires proper treatment drugs with lower cost and fewer adverse effects. In this study, Ficus religiosa fruit has been selected as a candidate plant and its fruit extract was used to perform different pharmacological tests in hypertensive rat model. It was observed that the extract decreased the heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) moderately in comparison to deoxycorticosterone acetate (DOCA) in ethanol‑induced hypertensive rats. These effects were similar to that of atenolol, a standard antihypertensive drug. While testing liver function, it was seen that SGOT and SGPT levels were reduced significantly. The creatinine value was decreased to 0.43±0.2 U/L from 2.9±1.3 U/L (induced by DOCA) and 2.6±1.6 U/L (induced by ethanol). While observing cardiovascular parameters, the fruit extract given at dose of 400 mg/kg, lowered total Cholesterol (TC) to 97 mg/dl from 176 mg/dl, low-density lipoprotein (LDL) to 40 mg/dl from 75 mg/dl and Triglycerides (TG) to 61 mg/dl from 118 mg/dl. The increased values were induced by DOCA. In the same test, the high-density lipoprotein (HDL) was increased to 80 mg/dl from 44 mg/dl. These changes were comparable to those of the standard drug Atenolol. F. religiosa fruit contains different chemical constituents such as isofucosterol, leucopelargonidin, quercetin and beta sitosterol as reported earlier. Molecular docking studies with some of these constituents showed good binding affinity with the targeted protein (receptor) as compared to the standard drugs. Additionally, all the compounds have satisfied Lipinski’s rules and other pharmacokinetic parameters. Moreover, they showed no adverse effects in aquatic and non-aquatic environments. We, thus, conclude that F. religiosa fruit extract could be taken for the discovery of a safe alternative for managing hypertension. Dhaka Univ. J. Pharm. Sci. 23(1): 23-36, 2024 (June)

Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars)

BackgroundWe aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting.MethodsThe PolyPars Study is a two-arm...

Knowledge of cardiovascular diseases and associated risk factors in the general adult population of Jeddah, Saudi Arabia: A cross-sectional study examining gender disparities.

To assess knowledge about cardiovascular diseases (CVD) among the general population, we emphasized gender-related disparities and other lifestyle and health-related factors. This cross-sectional study was conducted among 395 individuals from the general population of Jeddah, Saudi Arabia. An online questionnaire was administered to assess knowledge of CVD types, symptoms, and risk factors. The majority of participants identified coronary heart disease (73.7%) as having CVD, with no sex effect. Males had higher knowledge regarding cerebrovascular disease (44% vs 31.5%) and congenital heart diseases (60% vs 51.9%) as being part of CVD, while they had lower knowledge of peripheral arterial disease (44% vs 50.7%) than females, respectively (P < .05). Males exhibited better knowledge of heart attack and stroke symptoms than females. Knowledge was optimal for major CVD risk factors, such as smoking (90.6%) and high low-density lipoprotein cholesterol levels (85.1%); however, gaps were observed in recognizing diabetes (56.2%) and stress (69.4%) as factors for CVD. The mean overall knowledge score was 16.33 ± 5.72 25, with no difference between sexes (P = .239). Predictors of good CVD knowledge included university-level education, daily healthy food consumption, and perceived life as highly stressful; nonetheless, sex showed no significant effect. While the general population displayed a suboptimal understanding of CVD, notable sex disparities were observed, highlighting the need for tailored public health interventions. Emphasizing cognitive and behavioral aspects can foster better prevention and management strategies, given the evident gender disparities.

The Burden of Cardiovascular Disease Attributable to Hypertension in Nigeria: A Modelling Study Using Summary-Level Data.

Globally, cardiovascular disease (CVD) remains the leading cause of mortality and disability, with hypertension being the single most important modifiable risk factor. Hypertension is responsible for about 18% of global deaths from CVD, of which African regions are disproportionately affected, especially sub-Saharan Africa. This study assessed the burden of major CVD subtypes attributable to hypertension in Nigeria. The population attributable fractions (PAF) for myocardial infarction, all strokes, ischaemic stroke and intracerebral haemorrhagic stroke attributable to hypertension in Nigeria were calculated using published results from the INTERHEART and INTERSTROKE studies and prevalence estimates of hypertension in Nigeria. PAF estimates were obtained for age, sex, and geopolitical zones. Overall, hypertension contributed to 13.2% of all myocardial infarctions and 24.6% of all strokes, including 21.6% of all ischaemic strokes and 33.1% of all intracerebral haemorrhagic strokes. Among men aged ≤55 years, the PAF for myocardial infarction ranged from 11.7% (North-West) to 14.6% (South-East), while in older men, it spanned 9.2% (North-West) to 11.9% (South-East). Among women aged ≤65 years, PAF varied from 18.6% (South-South) to 20.8% (South-East and North-Central), and among women aged >65 years, it ranged from 10.4% (South-South) to 12.7% (South-East). Hypertension is a key contributor to the burden of CVD in Nigeria. Understanding the burden of hypertension in the Nigerian population overall and key subgroups is crucial to developing and implementing contextualised health policies to reduce the burden of CVD. Public health interventions and policies centred on hypertension will play a critical role in potentially alleviating the burden of cardiovascular diseases (CVD) in Nigeria.

Distinct biological signature and modifiable risk factors underlie the comorbidity between major depressive disorder and cardiovascular disease

Major depressive disorder (MDD) and cardiovascular disease (CVD) are often comorbid, resulting in excess morbidity and mortality. Here we show that CVDs share most of their genetic risk factors with MDD. Multivariate genome-wide association analysis of shared genetic liability between MDD and atherosclerotic CVD revealed seven loci and distinct patterns of tissue and brain cell-type enrichments, suggesting the involvement of the thalamus. Part of the genetic overlap was explained by shared inflammatory, metabolic and psychosocial or lifestyle risk factors. Our data indicated causal effects of genetic liability to MDD on CVD risk, but not from most CVDs to MDD, and showed that the causal effects were partly explained by metabolic and psychosocial or lifestyle factors. The distinct signature of MDD–atherosclerotic CVD comorbidity suggests an immunometabolic subtype of MDD that is more strongly associated with CVD than overall MDD. In summary, we identified biological mechanisms underlying MDD–CVD comorbidity and modifiable risk factors for prevention of CVD in individuals with MDD.

Comparison of physical activity levels between men and women with major cardiovascular diseases

Comparison of physical activity levels between men and women with major cardiovascular diseases

What interventions are effective in reducing development of hypertension and other cardiovascular complications in women who have had hypertensive disorders of pregnancy? A systematic review.

Hypertensive disorders of pregnancy (HDP) affect approximately 10-15% of pregnancies and pre-eclampsia affects 3-5% of pregnancies. Women with previous pre-eclampsia or HDP are at increased risk of hypertension (2 to 5 times) and major cardiovascular disease (1.5 to 3 times). There is little guidance on how to reduce this risk. To establish if there are interventions in women with previous HDP or pre-eclampsia that reduce the risk of developing adverse cardiovascular outcomes. A protocol was submitted to PROSPERO; inclusion and exclusion criteria were determined and a search strategy implemented. Primary outcomes were: development of hypertension or change in blood pressure and development of other cardiovascular complications. Records and full texts were screened independently by two reviewers. The Cochrane Risk of Bias tool was used for quality assessment. 3593 articles were screened. Nine articles were included. There were seven randomised-controlled trials and two quasi-experimental studies. One study trialled antihypertensive use, two studies looked at blood pressure monitoring and six studies focused on lifestyle interventions. Three trials reported significant reductions in diastolic blood pressure in the experimental group. No studies looked at the optimal time of intervention or the impact of interventions on the development of other long-term cardiovascular complications. Five studies reported participant feedback. The majority of studies were of low quality. Further research needs to explore potential interventions and optimal timing of interventions to reduce cardiovascular risk. Women also need to be consulted about their preferences for discussions about cardiovascular risk and potential interventions.

Economic burden of tobacco use in Pakistan

BackgroundThe lack of reliable tobacco healthcare and economic cost estimates leaves the tobacco industry undertaxed and thriving in Pakistan and makes the country as one of the top tobacco-consuming nations....

Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults : Real-World Evidence From a Target Trial Emulation Study.

There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials. To investigate the benefits and risks of using statins for primary prevention in old (aged 75 to 84 years) and very old (aged ≥85 years) adults. Sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy. Territory-wide public electronic medical records in Hong Kong. Persons aged 75 years or older who met indications for statin initiation from January 2008 to December 2015 were included. Participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD), were excluded from the analysis. Among 69 981 eligible persons aged 75 to 84 years and 14 555 persons aged 85 years or older, 41 884 and 9457 had history of CHD equivalents (for example, diabetes) in the respective age groups. Initiation of statin therapy. Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction). Of 42 680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), 9676 and 1600 of them developed CVDs in each age group, respectively. Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]). No significantly increased risks for myopathies and liver dysfunction were found in both age groups. Unmeasured confounders, such as lifestyle factors of diet and physical activity, may exist. Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older. Health Bureau, the Government of Hong Kong Special Administrative Region, China, and National Natural Science Foundation of China.

Deep cardiac phenotyping by cardiovascular magnetic resonance reveals subclinical focal and diffuse myocardial injury in patients with psoriasis (PSOR-COR study).

Psoriasis vulgaris (PV) is a chronic inflammatory disorder frequently associated with cardiovascular disease (CVD). This study aims to provide a prospective tissue characterization in patients with PV without major CVD using cardiovascular magnetic resonance (CMR). Patients with PV underwent laboratory assessment, a 12-lead and 24-h ECG, and a CMR exam at a 1.5-T scanner. Scan protocol included assessment of left (LV) and right (RV) ventricular function and strain analysis, native and post-contrast T1 mapping, T2 mapping and late gadolinium enhancement (LGE). In total, 60 PV patients (median(IQR) age in years: 50.0 (36.0-60.8); 34 men (56.7%)) were recruited and compared to 40 healthy volunteers (age in years: 49.5 (37.3-57.8); 21 men (53.0%)). No differences were found regarding LV and RV function (p = 0.78 and p = 0.75). Global radial and circumferential strains were lower in patients (p < 0.001 and p < 0.001, respectively). PV had higher global T1 times (1001 (982-1026) ms vs. 991 (968-1005) ms; p = 0.01) and lower global T2 times (48 (47-49) ms vs. 50 (48-51) ms; p < 0.001); however, all values were within local reference ranges. Focal non-ischemic fibrosis was observed in 17 (28.3%) PV patients. Deep cardiac phenotyping by CMR revealed subclinical myocardial injury in patients with PV without major CVD, despite preserved LV and RV function. Diffuse and focal fibrosis might be the first detectable signs of adverse tissue remodeling leading to reduced circumferential and radial myocardial deformation. In the background of local and systemic immunomodulatory therapy, no signs of myocardial inflammation were detected. The exact impact of immunomodulatory therapies on the myocardium needs to be addressed in future studies. ISRCTN71534700.

A combined observational and Mendelian randomization investigation reveals NMR-measured analytes to be risk factors of major cardiovascular diseases

Dyslipidaemias is the leading risk factor of several major cardiovascular diseases (CVDs), but there is still a lack of sufficient evidence supporting a causal role of lipoprotein subspecies in CVDs. In this study, we comprehensively investigated several lipoproteins and their subspecies, as well as other metabolites, in relation to coronary heart disease (CHD), heart failure (HF) and ischemic stroke (IS) longitudinally and by Mendelian randomization (MR) leveraging NMR-measured metabolomic data from 118,012 UK Biobank participants. We found that 123, 110 and 36 analytes were longitudinally associated with myocardial infarction, HF and IS (FDR < 0.05), respectively, and 25 of those were associated with all three outcomes. MR analysis suggested that genetically predicted levels of 70, 58 and 7 analytes were associated with CHD, HF and IS (FDR < 0.05), respectively. Two analytes, ApoB/ApoA1 and M-HDL-C were associated with all three CVD outcomes in the MR analyses, and the results for M-HDL-C were concordant in both observational and MR analyses. Our results implied that the apoB/apoA1 ratio and cholesterol in medium size HDL were particularly of importance to understand the shared pathophysiology of CHD, HF and IS and thus should be further investigated for the prevention of all three CVDs.

European and US Guideline-Based Statin Eligibility, Genetically Predicted Coronary Artery Disease, and the Risk of Major Coronary Events.

A study was designed to investigate whether the coronary artery disease polygenic risk score (CAD-PRS) may guide lipid-lowering treatment initiation as well as deferral in primary prevention beyond established clinical risk scores. Participants were 311 799 individuals from the UK Biobank free of atherosclerotic cardiovascular disease, diabetes, chronic kidney disease, and lipid-lowering treatment at baseline. Participants were categorized as statin indicated, statin indication unclear, or statin not indicated as defined by the European and US guidelines on statin use. For a median of 11.9 (11.2-12.6) years, 8196 major coronary events developed. CAD-PRS added to European-Systematic Coronary Risk Evaluation 2 (European-SCORE2) and US-Pooled Cohort Equation (US-PCE) identified 18% and 12% of statin-indication-unclear individuals whose risk of major coronary events were the same as or higher than the average risk of statin-indicated individuals and 16% and 12% of statin-indicated individuals whose major coronary event risks were the same as or lower than the average risk of statin-indication-unclear individuals. For major coronary and atherosclerotic cardiovascular disease events, CAD-PRS improved C-statistics greater among statin-indicated or statin-indication-unclear than statin-not-indicated individuals. For atherosclerotic cardiovascular disease events, CAD-PRS added to the European evaluation and US equation resulted in a net reclassification improvement of 13.6% (95% CI, 11.8-15.5) and 14.7% (95% CI, 13.1-16.3) among statin-indicated, 10.8% (95% CI, 9.6-12.0) and 15.3% (95% CI, 13.2-17.5) among statin-indication-unclear, and 0.9% (95% CI, 0.6-1.3) and 3.6% (95% CI, 3.0-4.2) among statin-not-indicated individuals. CAD-PRS may guide statin initiation as well as deferral among statin-indication-unclear or statin-indicated individuals as defined by the European and US guidelines. CAD-PRS had little clinical utility among statin-not-indicated individuals.

Associations of Relative Intensity of Physical Activity with Incident Cardiovascular Events and All-Cause Mortality.

The relative intensity of a physical activity (PA) can be estimated as the percent of one's maximal effort required. We compared associations of relative and absolute intensity PA with incident major cardiovascular disease (CVD) and all-cause mortality in 5,633 women from the Objective Physical Activity and Cardiovascular Health Study (mean age 78.5±6.7). Absolute intensity was measured by accelerometry. Relative intensity was estimated by dividing accelerometer-estimated metabolic equivalents (METs) by maximal MET capacity. Both were aggregated into mean daily hours of light intensity PA (LPA) and moderate-to-vigorous PA (MVPA). Cox proportional hazards models estimated hazard ratios (HRs) for one-hour higher amounts of PA on outcomes. During follow-up (median=7.4 years), there were 748 incident CVD events and 1,312 deaths. Greater LPA and MVPA, on either scale, was associated with reduced risk of both outcomes. HRs for a one-hour increment of absolute LPA were 0.88 (95% CI:0.83-0.93) and 0.88 (95% CI:0.84-0.92) for incident CVD and mortality, respectively. HRs for a one-hour increment of absolute MPVA were 0.73 (95% CI:0.61-0.87) and 0.55 (95% CI:0.48-0.64) for the same outcomes. HRs for a one-hour increment of relative LPA were 0.70 (95% CI:0.59-0.84) and 0.78 (95% CI:0.68-0.89) for incident CVD and mortality, respectively. HRs for a one-hour increment of relative MPVA were 0.89 (95% CI:0.83-0.96) and 0.82 (95% CI:0.77-0.87) for the same outcomes. On the relative scale, LPA was more strongly, inversely associated with both outcomes than relative MVPA. Absolute MVPA was more strongly inversely associated with the outcomes than relative MVPA. Findings support the continued shift in the PA intensity paradigm towards recommendation of more movement, regardless of intensity. Relative LPA--a modifiable, more easily achieved behavioral target, particularly among ambulatory older adults--was associated with reduced risk of incident major CVD and death.

EFFECT OF ANTIHYPERTENSIVE DEPRESCRIBING ON SERIOUS ADVERSE EVENTS, MORTALITY, AND CARDIOVASCULAR DISEASE: LONG-TERM FOLLOW-UP OF THE OPTIMISE RANDOMISED CONTROLLED TRIAL

Objective: Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and frailty. The OPTIMISE trial showed that this can be achieved without affecting blood pressure control at 3-month follow-up. This longer-term follow-up study aimed to examine the impact on serious adverse events (SAEs), mortality and cardiovascular disease (CVD) outcomes after at least 3 years. Design and method: Participants aged 80 years or older, with systolic blood pressure &lt;150 mmHg, and receiving at least 2 antihypertensive medications were randomised (1:1) to a strategy of antihypertensive medication reduction (removal of one antihypertensive) or usual care. Participants were followed-up via their primary and secondary care electronic health records, at least 3 years after randomisation. The primary outcome was SAEs, defined as hospitalisation or death from any cause. Secondary outcomes included mortality, stroke, myocardial infarction and major CVD events. Analyses were undertaken using Cox proportional hazards modelling. Results: Among 569 randomised participants (intervention=282; control=287) with a mean age 85 years (276 [48.5%] women), 564 (99.1%) were followed-up for a median of 3.9 years. Medication reduction was sustained in 109 participants (52.7% of those alive in the intervention group) at 3 years. Participants in the intervention group were prescribed fewer antihypertensives than the control group (mean difference -0.35, 95%CI -0.52 to -0.18). Overall, 202 (72.1%) patients in the intervention group and 218 (76.8%) patients in the control group experienced SAEs during follow-up (adjusted HR 0.93, 95%CI 0.76-1.12). There was no evidence of a difference in mortality (aHR 0.81, 95%CI 0.58-1.13), stroke (aHR 0.91, 95%CI 0.40-2.06), myocardial infarction (aHR 0.86, 95%CI 0.42-1.77) or CVD events (aHR 1.00, 95%CI 0.68-1.46). Conclusions: Medication reduction was sustained in half of those attempting it, with no evidence of harm from SAEs, mortality or CVD after almost four years. These findings suggest that deprescribing antihypertensive medication is safe in older patients living in the community with controlled blood pressure.

P081 Out-patient management of gout in secondary care: Results from the North West regional audit

Abstract Background/Aims Recommendations for gout management have significantly evolved as outlined by the latest National Institute for Health and Care Excellence (NICE), European League Against Rheumatism (EULAR), British Society for Rheumatology (BSR) and the Medicines and Healthcare products Regulatory Agency (MHRA) guidelines, with increased emphasis being placed on optimising cardiovascular risk. This regional audit aimed to assess concordance with these guidelines within rheumatology outpatient settings in the North West region of England. Methods New or follow-up patients with gout, presenting to a rheumatology outpatient setting within the Greater Manchester and Lancashire area over a five-week period between 1/3/23 and 7/4/23 were included. We collated data on demographics, co-morbidity assessment including cardiovascular risk, prescribing of febuxostat in major cardiovascular disease, diuretic use and advice, setting of treat-to-target levels, use of cardiovascular risk prediction tools and subsequent follow up arrangements. For new patients, collected data also included referral reason, and prescription recommendations for first-line urate-lowering therapy (ULT) and co-prescriptions for flare prophylaxis. Results Ninety-two patients (mean age 60 years, 80% male) were included from 13 rheumatology departments. Twenty-three patients were new referrals. Sixty-seven patients (73%) had ≥ 1 relevant comorbidity; hypertension being the most common (55%). Twenty (22%) patients were on diuretics. Twelve (55%) of these patients had a diagnosis of hypertension without heart failure; none received recommendations to reduce or stop diuretics. In line with current guidelines, no patient with major cardiovascular disease was treated with febuxostat. Treat-to-target levels were agreed in 49 (57%) applicable patients. Cardiovascular prediction tools were only calculated or known in three (3%) patients. However, clinic data collected would have allowed a risk assessment calculation in 13 (14%) patients. Sixteen (17%) patients audited had no planned follow-up. Compared to NICE guidelines, 18 (78%) new patients reviewed in clinic were referred appropriately to rheumatology services. Twenty-two (96%) new patients referred were eligible to start ULT, of which 15 (75%) were started on a NICE/ EULAR recommended first-line ULT treatment (14 patients on allopurinol including 11 patients with no major cardiovascular disease, one patient on febuxostat). Eleven (79%) patients started on allopurinol were initiated on a low dose (50-100mg), as recommended by NICE and the BSR. Ten (67%) patients of those initiated on ULT were also prescribed prophylactic colchicine. Two additional patients were prescribed NSAIDs with PPI cover and one patient was prescribed oral steroids without PPI cover. Conclusion Most new patients were referred and prescribed first-line ULT treatment appropriately, often with colchicine prophylaxis. Uptake of febuxostat as first-line therapy was limited. Cardiovascular risk assessment was rarely done; further work exploring barriers to undertaking these assessments in rheumatology clinics is likely to improve both patient care and guideline compliance. Disclosure L. Gould: Other; L.G. has received conference fees from Eli Lilly. A. Richards: None. L. Gray: Other; L.G. has received travel and conference fees from Eli Lilly. M. Badarulla: Other; M.B. has received conference fees from Eli Lilly. L. Mercer: Other; L.M. has received conference fees from Nordic Pharma and UCB. R. Farid: None. R. Heaton: Consultancies; R.H. has received consultancy fees from Galapagos. Honoraria; R.H. has received speaker honorarium from Abbvie and Nordic. Other; R.H. has received conference fees from UCB. M. Al-Attar: None. M. Whitehead: None. S. Kamath: None. L. Teh: None. A. Odekunle: None. C.A. Sharp: None. A. Babiker: None. S. Hopping: None. A. Oldroyd: None. K. Lazarewicz: None. C. Saleh: None. S. Horton: None. D. Roy: Honoraria; D.R. has an honorary University of Manchester research assistant contract. A. Opeseyitan: None. D. Das: None. S. Varughese: None. D. Yidana: None. S. Wig: None. J. Bluett: Grants/research support; J.B. has received a research grant award from Pfizer. Other; J.B. has received travel/conference fees from UCB, Fresenius Kabi, Pfizer and Eli Lilly.