Modifiable Cardiovascular Risk Factors Research Articles

Differences in left anterior descending coronary artery disease in participants without standard modifiable cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract Background/Introduction The development of coronary artery disease (CAD) and myocardial infarction (MI) in the absence of standard modifiable cardiovascular risk factors (SMuRFs) has been highlighted as an unmet clinical need, accounting for between 10-27% of ST elevation MI and associated with higher 30-day mortality. One potential contributor to the early mortality is the higher observed rates of LAD territory culprit lesions in SMuRFless patients compared to those with at least one SMuRF. Purpose To characterise the differential proportion of LAD disease in an asymptomatic population with no prior cardiovascular disease (CVD) history, comparing individuals with CAD despite no SMuRFs to those with at least one SMuRF in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods A MESA sub-cohort with a baseline coronary artery calcium score (CACS) >0 Agatston units (AU) was prepared. SMuRF status was assigned by self-report, treatment, or biomarkers for hypertension, hypercholesterolaemia, diabetes, and smoking. Proportion of disease in the left main, LAD, circumflex, and right coronary arteries were calculated by the vessel CACS divided by the total CACS. Standard descriptive statistics were used to characterise baseline differences. Group comparisons were completed with Wilcoxon rank sum for continuous measures and Chi-square for categorical. Results A CAC positive cohort of 3,417 participants was prepared from participants with SMuRF and CT imaging data, 14.3% of whom were considered SMuRFless. Total CACS was lower in SMuRFless participants compared to those with ≥1 SMuRF (58 AU vs. 102 AU, p<0.0001). However, proportion of calcium burden in the LAD was significantly higher in SMuRFless participants with CAD (74.2% vs. 56.8%, p<0.0001). When considering clinically significant CACS strata, proportion of LAD calcium burden was not significantly different between SMuRFless vs. ≥1 SMuRF participants with a total CACS of 1-99 AU (93.7% vs. 80.0%). However, statistically significant differences in LAD calcium proportion were observed between SMuRFless vs. ≥1 SMuRF participants with a total CACS 100-400 AU (69.5% vs. 57.8%) and CACS>400AU (45.2% vs. 40.5%). This difference remained significant during multivariate modelling, including consideration of absolute CACS. Conclusion Of patients with evidence of CAD (CACS>0) in the MESA cohort, SMuRFless status was associated with a higher proportion of LAD disease compared to participants with ≥1 SMuRF. This adds to previous observations in STEMI cohorts suggesting a heightened susceptibility to atherosclerosis development in the LAD territory against a lower traditional risk burden, and highlights the need for consideration of distinct biology and clinical significance in future studies.Fig. 1Fig. 2

Influence of air pollution on NSTEMI incidence and acute coronary syndrome mortality - the 10-year community-level analysis including 80 million patient-years. EP-PARTICLES study

Abstract Introduction During the last years, air pollution has emerged as an important modifiable cardiovascular risk factor. Most research focused on heavy-polluted agglomerations and big cities, neglecting its influence on cardiovascular health in smaller cities and villages. Purpose The study aimed to assess the spatio-temporal trends and the influence of air pollution on the non-ST-elevation myocardial infarction (NSTEMI) incidence and acute coronary syndrome (ACS) mortality in an urban and rural environment. Moreover, the study aimed to investigate whether there is a connection between the influence of air pollution on hospitalization and cause-specific mortality. Methods The analysis included data on 7 main air pollutants in 709 communities in Eastern Poland in 2011-2020. Mortality data were obtained from National Health Fund and daily air pollution concentrations for each community were obtained from National Public Health Institute. Time-stratified panel data Poisson regression techniques were used. The influence of each air pollutant was analysed at a single-day lag (0-6 days) and multi-day lag (0-1, 0-6, 0-30 days) and presented as an odds ratio (OR) with a 95% confidence interval (CI) for an increase in 10 μg/m3. Results Incidence of NSTEMI was associated with exposition to benzo-a-pyrene (BaP) on all analysed lag patterns (OR 1.121, 95% CI 1.075-1.168 for lag 0, OR 1.241, 95% CI 1.169-1.317 for lag 0-30) and to particulate matter with a diameter of <10 and <2.5 μm (PM10, PM2.5), CO and NO2 on the most of analysed lag patterns (OR 1.01, 95% CI 1.005-1.015 for PM10 on lag 0, OR 1.013, 95% CI 1.007-1.02 for PM2.5 on lag 0, OR 1.017, OR 1.002, 95% CI 1.001-1.003 for CO on lag 0, 95% CI 1.007-1.028 for NO2 on lag 0). O3 and SO2 had a protective influence on NSTEMI incidence on longer lags (OR 0.984, 95% CI 0.977-0.992 for O3 on lag 0-30, OR 0.978, 95% CI 0.963-0.993 for SO2 on lag 5) Mortality due to the ACS was associated with an increase in NO2 and CO concentrations on all lag patterns (OR 1.03, 95% CI 1.02-1.04 for NO2 on lag 0, OR 1.089, 95% CI 1.068-1.11 for NO2 on lag 0-30, OR 1.003, 95% CI 1.002-1.004 for CO on lag 0, OR 1.089, 95% CI 1.068-1.11 for CO on lag 0-30). PMs concentrations had a protective effect on ACS mortality on all lag patterns (OR 0.971, 95% CI 0.966-0.976 for PM10 on lag 0, OR 0.964, 95% CI 0.958-0.971 for PM2.5 on lag 0). Conclusions An increase in most of the major air pollutants concentrations have an influence on NSTEMI incidence. Different lag patterns for air pollutants suggest various mechanisms of detrimental effect. Cause-specific mortality analysis showed the results mostly opposite to incidence analysis. It suggests that a high rate of garbage codes may prevent high-quality population analysis focusing on cause-specific mortality. The development of air quality monitoring stations and the correct use of ICD-10 diagnoses may be crucial in drawing important conclusions from environmental studies.

In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a sex-stratified analysis

Abstract Background The standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking) are known to play a major role in the pathogenesis of coronary heart disease (CHD). Despite endeavors aiming at primary and secondary prevention of these risk factors, CHD has remained a leading cause of mortality and morbidity worldwide. A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no SMuRFs, the outcomes of whom following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. Purpose The present study aimed to evaluate the association between SMuRF-less status and post-PCI outcomes among patients with ACS. Further, we sought to determine possible sex differences in the post-PCI outcomes related to the SMuRF-less status. Methods This retrospective cohort study included 7847 patients with ACS who underwent PCI. The study outcomes were all-cause mortality and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. A separate landmark analysis with the landmark (cutoff) set at 30 days after the index procedure was performed as well. Models were adjusted for age, sex, body mass index, chronic obstructive pulmonary disease, cerebrovascular accident, previous myocardial infarction, estimated glomerular filtration rate, ejection fraction, and left main disease. Results Approximately 11% of the study population had none of the SMuRFs. The SMuRF-less and SMuRF+ groups aged 63.10 ±8.91 (85.1% males) and 62.53 ± 10.91 years (74.9% males), respectively. During 12.13 [11.99-12.36] months of follow-up, the followings were respective event numbers in the SMuRF-less and SMuRF+ groups: all-cause mortality: 35 (4.1%) and 273 (3.9%); MACCE: 99 (11.6%) and 898 (12.8%). All-cause mortality (adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731), and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs (Figure 1). Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women (Figure 1). Notably, following landmark analyses, this significant association among women disappeared (adjusted-HR: 0.99, 95%CI: 0.41-2.59, P:0.991), implying that its significance stemmed, to some extent, from higher 30-day mortality (Figure 1,2). Conclusions Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of one-year mortality.

Immune checkpoint inhibitors and atherosclerotic cardiovascular events: a retrospective cohort study

Abstract Background Immune checkpoint inhibitors (ICI) are cancer therapies that have improved the prognoses of over 20 different tumour types (1). However, ICIs have been increasingly recognised to associate with major atherosclerotic cardiovascular events (MACE) in cancer survivorship (2). Purpose This study aimed to determine the incidence and predictors for MACE among cancer patients treated with ICIs. Methods We performed a single-centre retrospective analysis of consecutive ambulatory cancer patients treated with ICIs between 2018 and 2020. Demographics, baseline cardiovascular risk factors (CVRF), medication history, cancer history and ICI regimen were determined from electronic medical records. The primary endpoint of MACE, defined as a composite of acute myocardial infarction, coronary revascularization, ischaemic stroke, and acute limb ischaemia, was determined from case note review. Cox proportional multivariable modelling was performed to determine predictors for MACE using significant variables on univariate analysis (p<0.20) and variables of clinical relevance including CVRFs and use of dual ICI therapy. Time to first MACE analysis was undertaken; in those without MACE, date of death or last follow-up was used as the censoring date. Subgroup analysis was performed among patients with stage 1-3 cancer who were treated with (neo)adjuvant ICI therapy and expected to have favourable long-term prognoses. Results The study cohort included 366 patients (median age 66 years (58,73), 63% male). There were 238 patients (65%) with non-small cell lung cancer and 65 (17.8%) had prior history of atherosclerotic cardiovascular disease (ASCVD). A total of 26 patients (7.1%) experienced 27 MACE (7 myocardial infarction, 1 coronary revascularization, 13 ischaemic stroke, 6 acute limb ischaemia) over median follow up of 1.9 years (0.6,3.2). During the study, there were 226 (61.8%) cancer-related deaths; there were no cardiac deaths. On multivariable analysis, MACE was independently associated with history of ASCVD (hazard ratio [HR] 4.49, 95% CI 1.92-10.49, p<0.01) and hypertension (HR 2.57, 95% CI 1.07-6.17, p=0.04). When limited to those with stage 1-3 cancer, 16 patients (11.0%) developed MACE among a cohort of 145 patients. History of ASCVD was the only variable associated with MACE on subgroup analysis (HR 3.79, 95% 1.25-11.49, p=0.02). Conclusion Among an unselected cohort of cancer patients treated with ICIs, an increased risk of MACE was observed among patients with a history of ASCVD or hypertension. Patients undergoing ICI therapy with concomitant ASCVD or hypertension should be identified and their modifiable CVRFs aggressively treated.

Abstract 13508: Baseline Lipid Profile and Risk of Atrial Fibrillation Recurrence After Atrial Fibrillation Ablation

Introduction: Dyslipidemia is a modifiable cardiovascular risk factor. However, it is unclear if baseline lipid levels prior to atrial fibrillation (AF) ablation are associated with AF recurrence. Hypothesis: This study aimed to examine if there was an association between baseline lipid profiles and AF recurrence after AF ablation. Methods: We retrospectively studied patients who underwent AF ablation from January 2016 to September 2021 at two high-volume international centers. Patients with a lipid profile in the previous 24 months prior to AF ablation and a one-year post-ablation follow-up with electrocardiogram were included. AF recurrence was defined as having a 12-lead electrocardiographic evidence of AF or atrial tachycardia within one year after a 3-month blanking period. Logistic regression analysis was performed to examine association of lipid profiles (low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglycerides) with AF recurrence. Lipid profiles were evaluated both as continuous and categorical variables. Well-established cut-points were used for LDL, and tertiles were used for HDL, TC, and triglycerides. Results: A total of 287 patients were included in the study (mean age (SD), 63.6 (10.5), 36% female). Patients with LDL<70 mg/dL or TC < 141 mg/dL had a decreased risk of AF recurrence in unadjusted analysis. These associations remained significant after adjustment by traditional AF risk factors and statin use (odds ratios (ORs) (95% confidence interval): 0.27 (0.09 - 0.79) and 0.28 (0.09 - 0.84), respectively. TC analyzed as a continuous variable was associated with increased risk of AF recurrence (1.012 (1.002 - 1.022) per 1 mg/dL increase). (Table). Conclusions: In our international registry, patients with LDL <70 mg/dL or TC <141 mg/dL were associated with a reduced risk of AF recurrence, suggesting a beneficial effect of low LDL and TC in patients with AF undergoing catheter ablation.

A Comprehensive Review of Modifiable Cardiovascular Risk Factors and Genetic Influences in Dementia Prevention

A Comprehensive Review of Modifiable Cardiovascular Risk Factors and Genetic Influences in Dementia Prevention

Clonal Hematopoiesis Is Associated with Cardiovascular Disease Risk and Worse Survival after Autologous Hematopoietic Cell Transplantation for Lymphoma

Introduction: Autologous hematopoietic cell transplantation (HCT) is an effective treatment for patients with relapsed or refractory lymphoma, and use of HCT has contributed to a growing number of survivors. Despite these improvements in outcomes, long-term survivors of lymphoma are at high risk of developing clinically significant cardiovascular disease (CVD) which, to date, has largely been attributed to pre-HCT cardiotoxic therapeutic exposures (e.g. anthracyclines, radiation) and modifiable risk factors (e.g. hypertension, diabetes, dyslipidemia) after HCT. In the general population, clonal hematopoiesis of indeterminate potential (CHIP), which refers to clonal expansion of hematopoietic stem cells with somatic mutations, has been associated with aging-related health conditions including CVD. Accumulating data suggests CHIP is more prevalent in cancer patients compared to age-matched controls, due in part to clonal selection after genotoxic stressors. There is a paucity of information about the association between CHIP and CVD after HCT, including its interaction with modifiable risk factors and subsequent impact on survival after HCT. Methods: This was a retrospective cohort study of 861 consecutive patients who underwent autologous HCT for lymphoma between 2010 and 2016, with available pre-HCT DNA obtained from peripheral blood stem cells. We performed targeted exome sequencing of DNA (92 pre-defined gene panel with 1000x sequencing depth) to determine the presence of CHIP (variant allele frequency ≥2%). CVD outcomes of interest included de novo heart failure, coronary artery disease and stroke after HCT. Five-year cumulative incidence of CVD was calculated taking into consideration competing risk of death. Fine-Gray multivariable regression was used to evaluate the association between CHIP and CVD, adjusting for demographic, clinical and therapeutic factors. The Kaplan-Meier method was used to examine the effect of CHIP on overall survival after HCT. Results: Median age at HCT was 55.7 years (range 18.4-78.1 years); 63.3% were male; race/ethnicity: non-Hispanic White (56.9%), Hispanic (26.1%), Asian (10.8%), Black (5.1%); 78.0% had non-Hodgkin lymphoma; comorbidities at HCT: hypertension (32.1%), dyslipidemia (16.4%), diabetes (10.1%), high (≥3) HCT-comorbidity index (CI) score (46.1%). Nearly all patients (94.3%) had received anthracycline-based chemotherapy prior to HCT, and 63.3% were treated with cumulative dose ≥300mg/m 2; 6% had chest radiotherapy. Overall, 186 patients (21.7% of the cohort) had at least one CHIP variant and 57 (6.6%) had ≥2 variants. DNMT3A, PPM1D, TET2 and TP53 were the most frequently mutated genes. In total, 74 patients developed CVD within five years from HCT. The 5-year cumulative incidence of CVD was significantly higher in patients with CHIP (20.9% vs 9.1%, p<0.001), compared to those without CHIP, and there was a graded relationship between number of CHIP variants and incidence of CVD. In the adjusted (age, cancer diagnosis, HCT-CI, modifiable cardiovascular risk factors) multivariable model, CHIP was significantly and independently associated with a nearly two-fold (HR: 1.8, 95% CI=1.1-3.1; P=0.020) risk of CVD, as well as the individual outcome of heart failure (HR: 2.3, 95%CI=1.3-4.3; P=0.008). Patients who had both CHIP and hypertension had a 3-fold (HR: 3.0, 95%CI=1.4-6.5, p=0.006) risk of CVD (reference: no CHIP, no hypertension). Overall 5-year survival after HCT was significantly worse in patients with CHIP, compared to those without CHIP (47.2% vs 68.2%, p<0.001; adjusted HR: 1.9, 95%CI=1.4-2.6), attributed to the higher burden of non-relapse mortality in patients with CHIP. Conclusions: In this well-characterized and demographically diverse cohort of lymphoma patients undergoing HCT, CHIP was highly prevalent and associated with a significantly higher risk of CVD after HCT, with the highest risk among those with CHIP and hypertension. We confirmed the poor overall survival rate in patients with CHIP, independent of patient and disease-related risk factors. These findings highlight the potential role of CHIP as a novel biomarker to better define CVD risk in patients with lymphoma prior to HCT, setting the stage for better screening and implementation of interventions (e.g., aggressive management of modifiable risk factors) to reduce the risk of CVD and to ultimately improve long-term health outcomes after HCT.

The Association of Prescribed Opioids and Incident Cardiovascular Disease

Opioid prescribing remains common despite known overdose-related harms. Less is known about links to nonoverdose morbidity. We determined the association between prescribed opioid receipt with incident cardiovascular disease (CVD) using data from the Veterans Aging Cohort Study, a national prospective cohort of Veterans with/without Human Immunodeficiency Virus (HIV) receiving Veterans Health Administration care. Selected participants had no/minimal prior exposure to prescription opioids, no opioid use disorder, and no severe illness 1 year after the study start date (baseline period). We ascertained prescription opioid exposure over 3 years after the baseline period using outpatient pharmacy fill/refill data. Incident CVD ascertainment began at the end of the prescribed opioid exposure ascertainment period until the first incident CVD event, death, or September 30, 2015. We used adjusted Cox proportional hazards regression models with matching weights using propensity scores for opioid receipt to estimate CVD risk. Among 49,077 patients, 30% received opioids; the median age was 49 years, 97% were male, 49% were Black, and 47% were currently smoking. Prevalence of hypertension, diabetes, current smoking, alcohol and cocaine use disorder, and depression was higher in patients receiving opioids versus those not but were well-balanced by matching weights. Unadjusted CVD incidence rates per 1,000-person-years were higher among those receiving opioids versus those not: 17.4 (95% confidence interval [CI], 16.5–18.3) versus 14.7 (95% CI, 14.2–15.3). In adjusted analyses, those receiving opioids versus those not had an increased hazard of incident CVD (adjusted hazard ratio 1.16 [95% CI, 1.08–1.24]). Prescribed opioids were associated with increased CVD incidence, making opioids a potential modifiable CVD risk factor. PerspectiveIn a propensity score weighted analysis of Veterans Administration data, prescribed opioids compared to no opioids were associated with an increased hazard of incident CVD. Higher opioid doses compared with lower doses were associated with increased hazard of incident CVD. Opioids are a potentially modifiable CVD risk factor.

Hemodialysis Dose as a Modifiable Sex-Specific Cardiovascular Risk Factor: A Systematic Review

Hemodialysis Dose as a Modifiable Sex-Specific Cardiovascular Risk Factor: A Systematic Review

Behavioral Weight Loss Interventions for Overweight and Obese Cardiac Rehabilitation Patients: A Systematic Review.

The purpose of this systematic review was to identify evidence pertaining to the effectiveness of behavioral weight loss interventions for overweight and obese cardiac rehabilitation participants. A database search of PUBMED, CINAHL, PsycINFO, and PROSPERO yielded 10 eligible studies. Quantitative studies implementing behavioral weight loss interventions for overweight and obese adult cardiac rehabilitation participants were reviewed. Evidence supported the usefulness and effectiveness of behavioral weight loss interventions for overweight cardiac rehabilitation participants. With the limited number of studies and inclusion of quasi-experimental studies with comparative groups, it was not possible to determine the relative power of behavioral weight loss interventions across studies. In conclusion, behavioral weight loss interventions can be incorporated into cardiac rehabilitation or offered following cardiac rehabilitation to improve weight loss of overweight and obese cardiac rehabilitation participants. Findings reinforce national guidelines emphasizing the role of cardiac rehabilitation to address secondary cardiovascular disease risk factor modification, including integrating behavioral weight loss programs in cardiac rehabilitation, or referring overweight patients to weight management programs following completion of cardiac rehabilitation.

Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study

There are limited data regarding right ventricle (RV) impairment in long-term survivors of childhood acute lymphoblastic leukemia (CLS). The aim of this study was to assess RV function in these patients using echocardiographic conventional measurements and automated RV strain. Echocardiographic recordings of 90 CLS and 58 healthy siblings from the CTOXALL cohort were analyzed. For group comparisons, inverse probability weighting was used to reduce confounding. The CLS group (24.6 ± 9.7 years, 37.8% women) underwent an echocardiographic evaluation 18 (11–26) years after the diagnosis. RV systolic dysfunction was found in 16.7% of CLS individuals using RV free-wall strain (RVFWS) compared to 2.2 to 4.4% with conventional measurements. RV systolic function measurements were lower in the CLS than in the control group: TAPSE (23.3 ± 4.0 vs. 25.2 ± 3.4, p = 0.004) and RVFWS (24.9 ± 4.6 vs. 26.8 ± 4.7, p = 0.032). Modifiable cardiovascular risk factors such as obesity (p = 0.022) and smoking (p = 0.028) were independently associated with reduced RVFWS. In conclusion, RV systolic function impairment was frequent in long-term survivors of childhood leukemia, underscoring the importance of RV assessment, including RVFWS, in the cardiac surveillance of these patients.

Association between sleep duration and high blood pressure in Lithuanian adolescents

Abstract Background Sufficient sleep duration in children plays an essential role in physical, mental, and emotional development. High blood pressure (HBP) is growing public health problem in youth. The aim of this study was to evaluate the association between short sleep duration (SSD) and HBP in Lithuanian adolescents aged 11-18 years. Methods The cross-sectional study was conducted from 2019 to 2020 in Kaunas district, Lithuania. HBP was defined according to the 2017 AAP guidelines. Sleep duration was calculated from the time of going to bed to the time of waking up. SSD was defined as sleeping <8 h/day. Multivariate logistic regression was used to calculate aORs and 95% CI. Results The present analysis included 1368 subjects (723 boys and 645 girls) with a mean age of 13.96±1.76 years. Overall, the prevalence of HBP was 43.6% (51.3% for boys and 34.9% for girls). Overall, 21.7% of the subjects reported sleep duration of 7- < 8 h/day, and 11.3% - <7 h/day. In the total sample, after adjustment for sex, BMI, breakfast consumption, and parental smoking, significant associations were found between SSDs and HBP (7-<8 h/day: aOR=1.47; 95% CI, 1.12-1.95; P = 0.006, and <7 h/day: aOR=1.52; 95% CI, 1.05-2.20; P = 0.025), compared to subjects who were sleeping ≥8 h/day. In boys, after adjustment for potential confounders, SSDs were associated with higher odds of HBP (7-<8 h/day: aOR=1.94; 95% CI, 1.30-2.89; P = 0.001, and <7 h/day: aOR=2.35; 95% CI, 1.35-4.12; P = 0.003). There was no significant association between SSD and HBP among girls. Conclusions Our study showed that SSD was significantly associated with increased odds of HBP in Lithuanian adolescents, especially in boys. Public health strategies should focus more on prevention of modifiable cardiovascular disease risk factors. Key messages • Sufficient sleep duration is important for adolescents’ health and may contribute to reduce the risk of cardiovascular disease. • Future prospective studies are needed to confirm these findings.

Endocrine causes of hypertension: literature review and practical approach.

Hypertension (HTN) affects more than 30% of adults worldwide. It is the most frequent modifiable cardiovascular (CV) risk factor, and is responsible for more than 10 million death every year. Among patients with HTN, we usually distinguish secondary HTN, that is HTN due to an identified cause, and primary HTN, in which no underlying cause has been found. It is estimated that secondary hypertension represents between 5 and 15% of hypertensive patients [1]. Therefore, routine screening of patients for secondary HTN would be too costly and is not recommended. In addition to the presence of signs suggesting a specific secondary cause, screening is based on specific criteria. Identifying secondary HTN can be beneficial for patients in certain situations, because it may lead to specific treatments, and allow better control of blood pressure and sometimes even a cure. Besides, it is now known that secondary HTN are more associated with morbidity and mortality than primary HTN. The main causes of secondary HTN are endocrine and renovascular (mainly due to renal arteries abnormalities). The most frequent endocrine cause is primary aldosteronism, which diagnosis can lead to specific therapies. Pheochromocytoma and Cushing syndrome also are important causes, and can have serious complications. Other causes are less frequent and can be suspected on specific situations. In this article, we will describe the endocrine causes of HTN and discuss their treatments.

Cardiovascular risk factors in patients with ulcerative colitis

Given the current trends in increasing the life expectancy of patients with ulcerative colitis (UC), the study of the risk of atherothrombotic events in them requires study. For effective prevention of cardiovascular diseases, it is necessary to assess cardiovascular risk factors since the concept of their timely detection is the basic one when planning preventive measures. To assess the prevalence of cardiovascular risk factors in patients with UC. One hundred eighty four UC patients participated in the case-control study; 56 participants were included in the control group. The studied parameters are unmodified, behavioral, and biological factors of cardiovascular risk. The study participants were surveyed, examined, measured blood pressure, height, weight, the level of total cholesterol was studied, and the lipid spectrum was analyzed in 80 patients with UC. Parametric and nonparametric statistical methods were used. UC patients consumed fruit less often, drank tea and coffee with sugar more often, exercised less often and experienced high levels of stress. A higher incidence of arterial hypertension in UC patients was established, even though the fact of taking glucocorticosteroids was considered. No significant differences were found in the assessment of relative and total cardiovascular risk. Risk management of cardiovascular diseases in UC patients should focus on a personalized approach and timely screening of modifiable cardiovascular risk factors with their subsequent correction. The absence of significant differences in the level of relative and total cardiovascular risk indicates a limited contribution of traditional risk factors to the development of cardiovascular diseases in UC patients.

Uric Acid Levels, Number of Standard Modifiable Cardiovascular Risk Factors, and Prognosis in Patients With Coronary Artery Disease: A Large Cohort Study in Asia.

Background Serum uric acid (UA) is correlated closely with traditional cardiovascular risk factors, which might interfere with the action of UA, in patients with coronary artery disease. We performed this study to evaluate the prognostic effect of UA levels in individuals with different numbers of standard modifiable cardiovascular risk factors (SMuRFs). Methods and Results In this prospective study, we consecutively enrolled 10 486 patients with coronary artery disease. They were stratified into 3 groups according to the tertiles of UA concentrations and, within each UA tertile, further classified into 3 groups by the number of SMuRFs (0-1 versus 2-3 versus 4). The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and unplanned revascularization. Over a median follow-up of 2.4 years, 1233 (11.8%) MACCEs were recorded. Patients with high UA levels developed significantly higher risk of MACCEs than those with low UA levels. In addition, UA levels were positively associated with MACCEs as a continuous variable. More importantly, in patients with 0 to 1 SMuRF, the risks of MACCEs were significantly higher in the high-UA-level group (adjusted hazard ratio [HR], 1.469 [95% CI, 1.197-1.804]) and medium-UA-level group (adjusted HR, 1.478 [95% CI, 1.012-2.160]), compared with the low-UA-level group, whereas no significant association was found between UA levels and the risk of MACCEs in participants with 2 to 3 or 4 SMuRFs. Conclusions In patients with coronary artery disease who received evidence-based secondary prevention therapies, elevated UA levels might affect the prognosis of individuals with 0 to 1 SMuRF but not that of individuals with ≥2 SMuRFs.

FRI120 Metabolic Profile Of A Young Adult Population Assisted By A Primary Health Care Unit In A Large Urban Center

Abstract Disclosure: R.B. Boghossian: None. C.C. Lopes: None. L.L. Junqueira: None. J.O. Neno: None. B.C. Almeida: None. R. Ferrão: None. I.D. Velho Junior: None. P.C. Rezende: None. A.T. Fernandes: None. D.F. Monteiro: None. Introduction: Dyslipidemia, Glucose Intolerance (GI), Diabetes Mellitus (DM), and Metabolic Syndrome (MS) are metabolic conditions often asymptomatic and related to high cardiovascular (CV) morbidity and mortality. Nonetheless, these conditions are not commonly screened in younger adults. The LapARC cohort Study is a population-based study to assess CV risk profile in a young adult population. Objective: To evaluate the prevalence of dyslipidemia, DM, GI, and MS in a young adult population enrolled in the Family Health Strategy (FHS) in an urban center. Methods: Cross-sectional population study that enrolled individuals aged 20-50 years registered in an FHS unit. Sociodemographic, anthropometric characteristics, and CV risk factors were recorded. Office blood pressure (BP) was obtained by the average of 2 measurements obtained on two different occasions. All participants underwent laboratory evaluation (lipid and glycemic profile) and home blood pressure monitoring (HBPM). The bivariate analysis compared paciente with and without metabolic alterations. SPSS 19.0 was used in the statistical analysis. Results: We evaluated, up until this moment, 632 individuals [39.6% male gender; average age: 33.6 ± 9 years old]. The most common modifiable CV risk factors were physical inactivity (44.0%), and obesity (26.0%). The prevalence of dyslipidemia was 40%. These individuals were older, more obese and with a bigger association of hypertension and GI. Regarding the glycemic profile, 57 (9%) individuals with GI e 18 (3%) with DM. Diabetic pacientes were older, obese, with a bigger prevalence of hypertension and dyslipidemia while those with GI had just bigger prevalence of dyslipidemia compared to normoglicemic individuals. A total of 74(12%) individuals were diagnosed with MS. These were older, more obese, sedentary, with a bigger prevalence of hypertension, higher office BP and HBPM and higher levels of albuminuria. Conclusion: This young and apparently healthy population has an adverse cardiometabolic profile, indicating the importance of precocious CV risk stratification. Thus, efficient primary preventive strategies can be implemented to reduce the probability of CV disease development in the future. Presentation: Friday, June 16, 2023

Relationship between modifiable atherosclerotic cardiovascular risk factors and coronary artery bifurcation lesion

Abstract Background: Modifiable atherosclerotic cardiovascular disease risk factors are hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, and obesity; the term coronary artery bifurcation is used when a coronary artery divides into two hemodynamically important branches or when the main branch has a hemodynamic significant side branch, bifurcation lesion represent 20% or more of coronary artery stenoses undergoing angiography. Objectives: To evaluate the relationship of hypertension, diabetes, dyslipidemia, cigarette smoking, and obesity to coronary bifurcation disease. Materials and Methods: In a cross-sectional study conducted in the Iraqi Center for Heart Diseases from May 2020 to May 2021, a total of 140 adult patients (70 cases with coronary bifurcation lesions and 70 control cases with non-bifurcation lesions) with angiography-documented stenotic coronary artery disease (CAD) were defined. Case demographics and modifiable CAD risk factors were addressed. Results: In the bifurcation group, the non-bifurcation lesion was mostly an associated angiographic finding (82%). The most significantly correlated atherosclerotic risk factor with bifurcation lesion compared to non-bifurcation lesion was diabetes, followed by systemic hypertension. Dyslipidemia was the most common prevalent risk factor, equally distributed in both groups. Smoking and obesity were distributed nearly equally in both groups. Conclusion: There is a significant relationship between diabetes and hypertension with coronary bifurcation lesions compared to non-bifurcation lesions.

TCT-285 Mortality of Patients Presented With Acute ST-Segment Elevation Myocardial Infarction According to the Status of Standard Modifiable Cardiovascular Risk Factors

TCT-285 Mortality of Patients Presented With Acute ST-Segment Elevation Myocardial Infarction According to the Status of Standard Modifiable Cardiovascular Risk Factors

Dyslipidemia in Patients with Chronic Kidney Disease: An Updated Overview.

Dyslipidemia is a potentially modifiable cardiovascular risk factor. Whereas the recommendations for the treatment target of dyslipidemia in the general population are being more and more rigorous, the 2013 Kidney Disease: Improving Global Outcomes clinical practice guideline for lipid management in chronic kidney disease (CKD) presented a relatively conservative approach with respect to the indication of lipid lowering therapy and therapeutic monitoring among the patients with CKD. This may be largely attributed to the lack of high-quality evidence derived from CKD population, among whom the overall feature of dyslipidemia is considerably distinctive to that of general population. In this review article, we cover the characteristic features of dyslipidemia and impact of dyslipidemia on cardiovascular outcomes in patients with CKD. We also review the current evidence on lipid lowering therapy to modify the risk of cardiovascular events in this population. We finally discuss the association between dyslipidemia and CKD progression and the potential strategy to delay the progression of CKD in relation to lipid lowering therapy.

Acute Myocardial Infarction in Young Individuals: Demographic and Risk Factor Profile, Clinical Features, Angiographic Findings and In-Hospital Outcome.

Cardiovascular diseases (CVDs) are the leading cause of global mortality and disability. Acute myocardial infarction (AMI) in young individuals is a rare condition but can cause devastating socioeconomic and psychological consequences for both the patient and their family and an economic burden for the government. There is a paucity of data concerning the specific profile of these young patients in Bulgaria, a country with a high burden of cardiovascular morbidity and mortality. Therefore, the aim of the present study was to assess the baseline characteristics, demographic and risk factor profile, clinical features, angiographic findings and in-hospital outcomes of young patients with AMI. Additionally, these data were compared to those of the older age group. Retrospective data on 172 patients treated for AMI in "Prof. Alexandar Tschirkov", Bulgaria, from January 2018 to December 2021 were collected for the purpose of this study. Baseline characteristics, risk factor profileand clinical and angiographic features were compared in young (≤45 years) and older patients (>45 years). Males were significantly predominant in the two age groups (p < 0.01), with an obviously increasing proportion of females in the older age group. Young patients were more likely to be smokers (55.7% vs. 28.8%; p=0.001); in contrast, hypertension (70.5% vs. 91.9%; p <0.001) and obesity (16.4% vs. 31.5%; p=0.031) were more prevalent in older patients. Anterior localization of myocardial infarction (MI) wasmost common in the two age groups (47.5% vs. 41.4%), respectively. Regarding the time delay from symptom onset to first medical contact, we found that young patients tended to present earlier than their older counterparts. Young patients had a higher incidence of single vessel disease (SVD) (49.2%) and nonobstructive coronary disease (NOCD) (11.5%) than older patients. Young patients with AMI had a lower in-hospital morbidity rate than older patients, but the in-hospital mortality, although lower, was not significantly different. A high prevalence of modifiable cardiovascular risk factors (RFs), such as smoking, dyslipidemia and arterial hypertension (AH), among the young group, less evolved CADand similar high procedural success between age groups were established. Approximately 30% of young patients tend to present late in the hospital. The in-hospital mortality in the young population was lower than that in the older population but was still relatively higher than that previously reported. The reported high prevalence of modifiable RFs and late presentation of young patients with AMI highlight the need for early recognition of these RFs, better prevention, deployment of educational programs, easy access to health care and high awareness of clinicians to reduce disability and mortality from CVD.