Multiple Cardiovascular Risk Factors Research Articles

Association Between Cardiovascular Risk Factors and the Severity of Coronavirus Disease 2019: Nationwide Epidemiological Study in Korea.

Background: Acute respiratory viral infections can result in cardiovascular involvement, with such patients having a significantly higher mortality rate than those without cardiovascular involvement. Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, it is important to determine whether cardiovascular risk factors are associated with the severity of COVID-19.Methods: These nationwide data were provided by the Korea Disease Control and Prevention Agency. We defined a patient as having a “critical illness” if they required more than invasive mechanical ventilation and “fatal illness” if they died.Results: Among the total 5,307 patients, 2,136 (40.8%) were male. The critical illness rate was 5.1% (males: 6.7, females: 4.0%) and the fatality rate was 4.54%. The multivariable analysis showed that age ≥60 years, male sex, diabetes mellitus, hypertension, heart failure, chronic kidney disease, cancer, and dementia were independent risk factors for critical illness. The risk scoring model showed the significance of multiple risk factors. Patients with four risk factors; old age (≥60 years), male sex, hypertension, and diabetes mellitus had a more than a 100 times higher risk for severe COVID-19 than those without these risk factors (OR; 95% confidence interval, 104; 45.6–240.6 for critical, 136.2; 52.3–3547.9 for fatal illness).Conclusions: This study demonstrated that cardiovascular risk factors are also significant risk factors for severe COVID-19. In particular, patients who have multiple cardiovascular risk factors are more likely to progress to severe COVID-19. Therefore, early and appropriate treatment of these patients is crucial.

Central Systolic Blood Pressure Is Associated With Early Vascular Damage in Children and Adolescents With Type 1 Diabetes.

Objective of the study: This study aimed to test the effect of multiple cardiovascular risk factors on subclinical indices of atherosclerosis in children and adolescents with type 1 diabetes (T1D).Methods: Carotid intima-media thickness (cIMT), carotid distensibility coefficient (cDC), and carotid–femoral pulse wave velocity (PWV) were measured in children and adolescents with T1D, in a follow-up at the outpatient clinics of Verona. Blood pressure (BP; both central and peripheral), metabolic and other cardiovascular risk factors were evaluated in multivariate linear regressions to assess the association with the measured indices of subclinical vascular damage.Results: One hundred and twenty-six children and adolescents were included. cIMT was above the 95th percentile for age and height in 60.8% of the population, whereas 26% of the sample had cDC impairment (less than the 5th percentile) and 4.8% had an elevated PWV. Independent determinants of cIMT according to the regression models were only gender type of glucose monitoring and central systolic BP (cSBP). PWV was associated with age, sex, heart rate, and cSBP; cDC with age and both cSBP and, alternatively, peripheral BP (pBP). Neither pBP nor any of the tested metabolic parameters, including glycated hemoglobin, was associated with PWV and cIMT.Conclusions: A high proportion of early vascular damage, especially an increased cIMT, is present in children and adolescents with T1D in whom cSBP seems to be a common determinant. In children and adolescents with T1DM, a special focus should be on hemodynamic risk factors beyond metabolic ones.

Cardiovascular diseases and risk factors in kidney transplant candidates

Objectives: Cardiovascular diseases and risk factors are associated with adverse cardiac events following kidney transplant. Therefore, pre-transplant evaluation of cardiovascular diseases and risk factors is important for determining the cardiac risk. The objective of this study is to determine the prevalence of cardiovascular diseases and risk factors in kidney transplant candidates. Methods: This is a single-center and observational study which includes 174 end-stage renal disease patients (male: 55.2% and mean age: 49 ± 13 years) who underwent kidney transplant. Preoperative clinical characteristics, cardiovascular diseases and risk factors of the patients were examined retrospectively. Results: The study population had multiple cardiovascular risk factors such as hypertension (66.7%), diabetes (28.2%), dyslipidemia (29.9%) and smoking (30.5%) in the evaluation conducted prior to kidney transplant. The most common cardiovascular diseases were detected as congestive heart failure (10.9%) and coronary artery disease (8.6%). The rate of the patients who underwent myocardial revascularization (percutaneous coronary intervention or coronary artery bypass grafting) before kidney transplant was 6.9%. The patients’ mean left ventricular mass index was 114 ± 32 g/m2, and 55.5% of the study population had left ventricular hypertrophy. Conclusions: In our study, the prevalence of cardiovascular diseases and risk factors in the patients who underwent kidney transplant was found to be high.

Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography

ObjectivesThe objective of the study was to assess the relationship between the coexistence of cardiovascular risk factors (CVRFs) and the incidence and severity of obstructive sleep apnoea (OSA). MethodsThe study involved 88 people, aged 53.76 ± 12.59 years. A questionnaire, basic anthropometric measurements, blood pressure, standard laboratory tests (total cholesterol, triglycerides and glucose) and polysomnography were performed. Each patient was assessed for the presence of CVRFs: i.e. obesity, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, type 2 diabetes and smoking. OSA was diagnosed based on the apnoea and hypopnea index (AHI) in polysomnography. ResultsIt was documented that the mean AHI values were significantly higher in obese patients than in non-obese patients, in patients with arterial hypertension than in patients without hypertension, in patients with hypercholesterolaemia than in patients without hypercholesterolaemia and in patients declaring smoking than in non-smoking patients. The correlation analysis revealed a significant positive linear relationship between the number of CVRFs and the AHI value in polysomnography (r = 0.40, p < 0.05). Based on the regression analysis, it was documented that obesity, arterial hypertension and smoking are independent predictors of higher AHI values. ConclusionsIn the study group of patients with multiple cardiovascular risk factors, there is a directly proportional relationship between the number of cardiovascular risk factors and the AHI index in polysomnography.

Omega-3 fatty acids for the prevention of atherosclerotic cardiovascular disease.

Marine-derived omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are a type of polyunsaturated fatty acids with many purported beneficial health effects including the prevention of atherosclerotic cardiovascular disease (ASCVD) events. Omega-3 fatty acid intake may be supplemented via dietary sources, as well as prescription or non-prescription products. Omega-3 fatty acids have been shown to reduce serum triglycerides, but there remains ongoing debate regarding the effect of omega-3 fatty acids on major adverse cardiovascular events in patients with established, or at risk of, ASCVD. Recent evidence from randomized, placebo-controlled trials has demonstrated that low-dose (1g daily or less) omega-3 fatty acids (DHA and EPA) do not reduce cardiovascular events or death in patients with or without established ASCVD. Contrarily, the REDUCE-IT trial demonstrated that a purified form of EPA ethyl esters (icosapent ethyl) at 4g daily reduced cardiovascular events and death in patients with ASCVD (or diabetes and multiple cardiovascular risk factors) and elevated triglycerides on background statin therapy. However, 4g daily of omega-3 carboxylic acids (DHA and EPA) did not show a cardiovascular benefit in the STRENGTH trial, which enrolled a similar population. The explanation for this observed discrepancy remains a source of contention and discourse. For now, icosapent ethyl has the most compelling evidence to support a cardiovascular benefit and should be considered in select patients who meet the REDUCE-IT criteria. Furthermore, alternative versions of omega-3 fatty acids should not be considered equivalent to icosapent ethyl. Patients taking an omega-3 fatty acid supplement should be monitored for potential adverse effects, including gastrointestinal disorders or bleeding, in addition to a possible increased risk of atrial fibrillation.

Text messages for primary prevention of cardiovascular disease: The TextMe2 randomized clinical trial

Primary prevention guidelines emphasize the importance of lifestyle modification, but many at high-risk have suboptimal cardiovascular risk factor (CVRF) control. Text message support may improve control, but the evidence is sparse. Our objective was to determine the impact of text messages on multiple CVRFs in a moderate-high risk primary prevention cohort. This study was a single-blind randomized clinical trial comparing semi-personalized text message-based support to standard care. A random sample of adults with 10-year absolute cardiovascular risk score ≥10% and without coronary heart disease, referred from February 2019 to January 2020, were recruited from an outpatient cardiology clinic in a large tertiary hospital in Sydney, Australia. Patients were randomized 1:1 to intervention or control. Intervention participants received 4 texts per week over 6 months, and standard care, with content covering: diet, physical activity, smoking, general cardiovascular health, and medication adherence. Controls received standard care only. Content was semipersonalized (smoking status, vegetarian or not-vegetarian, physical ability, taking medications or not) and delivered randomly using automated software. The primary outcome was the difference in the proportion of patients who have ≥3 uncontrolled CVRFs (out of: low-density lipoprotein cholesterol >2.0 mmol/L, blood pressure >140/90 mm Hg, body mass index ≥25 kg/m2, physical inactivity, current smoker) at 6 months adjusted for baseline. Secondary outcomes included differences in biomedical and behavioral CVRFs. Among 295 eligible participants, 246 (mean age, 58.6 ± 10.7 years; 39.4% female) were randomized to intervention (n=124) or control (n=122). At 6 months, there was no significant difference in the proportion of patients with ≥3 uncontrolled CVRFs (adjusted relative risk [RR] 0.98; 95% confidence interval [CI] 0.75-1.29; P=.88). Intervention participants were less likely to be physically inactive (adjusted RR 0.72; 95% CI 0.57-0.92; P=.01), but there were no significant changes in other single CVRFs. More intervention participants reduced the number of uncontrolled CVRFs at 6-months from baseline than controls (86% vs 75%; RR 1.15; 95% CI 1.00-1.32; P=.04). In moderate-high cardiovascular risk primary prevention, text message-based support did not significantly reduce the proportion of patients with ≥3 uncontrolled CVRFs. However, the program did motivate behavior change and significantly improved cardiovascular risk factor control overall. Larger multicenter studies are needed.

Exercise blood pressure and cardiovascular disease risk: a systematic review and meta-analysis of cross-sectional studies.

A hypertensive response to exercise (HRE) is associated with cardiovascular disease and high blood pressure (BP). A poor cardiovascular risk factor profile may underlie these associations, although this has not been systematically elucidated. Via systematic review and meta-analysis, we aimed to assess the relationship between exercise BP and cardiovascular risk factors, and determine if cardiovascular risk is higher in those with an HRE vs. no-HRE across different study populations (including those with/without high BP at rest). Three online databases were searched for cross-sectional studies reporting data on exercise BP, an HRE and cardiovascular risk factors (including arterial structure, lipid, metabolic, inflammatory and kidney function markers). Random-effects meta-analyses and meta-regression were used to calculate pooled correlations between exercise BP and each risk factor and pooled mean differences between those with/without an HRE. Thirty-eight studies (38 295 participants, aged 50 ± 3years; 78% male) were included. Exercise SBP was associated with arterial, lipid and kidney function risk markers (P < 0.05). Those with an HRE had greater aortic stiffness (+0.80 ± 0.35 m/s), total (+0.14 ± 0.03 mmol/l) and low-density lipoprotein (+0.12 ± 0.03 mmol/l) cholesterol, triglycerides (+0.24 ± 0.04 mmol/l), glucose (+0.15 ± 0.05 mmol/l), white blood cell count (+0.49 ± 0.16 mmol/l) and albumin-to-creatinine ratio (standardized mean difference: +0.97 ± 0.34), and lower flow-mediated dilation (-4.13 ± 1.02%) and high-density lipoprotein cholesterol (-0.04 ± 0.01 mmol/l) vs. those with no-HRE (P < 0.05 all). Results were broadly similar across study populations. Exercise SBP is associated with multiple cardiovascular risk factors, which appear worse in those with an HRE vs. no-HRE. As results were similar across population groups, an HRE should be considered an important indicator of cardiovascular risk.

Factores de riesgo cardiovascular y evolución de pacientes con COVID-19 atendidos en un Hospital Nacional de Referencia de Lima, P

Introduction: Coronavirus disease 2019 (COVID-19) fatal outcomes have been associated with multiple cardiovascular risk factors. In new epidemic areas, such as Latin America, there is a lack of studies about this. Objectives: To evaluate demographic data, signs and symptoms during emergency arrival, prevalence of cardiovascular risk factors, laboratory and ECG findings and their influence in mortality, in a retrospective cohort of patients in a national reference hospital of Lima, Peru. Methods: Review the clinical records of the patients attended at Hospital Rebagliati Hospital during March 6th and April 30th, 2020, using rRT-PCR was used for the detection of the RNA of SARS-CoV-2 following the protocol Charité, Berlin, Germany, from nasopharyngeal swabs at the National Institute of Health. Bivariate analysis and multivariate analysis using logistic regression was done. Values of p &lt; 0.05 were considered significant for all analyses. Results: One hundred six hospitalized patients were evaluated. The mean age of patients was 61.58 years (SD 16.81). Cardiovascular risk factors among them were hypertension (46.2%), diabetes (28.3%), and obesity (28.3%), among others. Fifty-six patients died (52.8%). Mortality associated factors at the multivariate analysis were arterial hypertension (OR=1.343, 95% 1.089-1.667), myocardial injury (OR=1.303, 95% 1.031-1.642), and mechanical ventilation (OR 1.262, 95% 1.034-1.665), as associated factors. Conclusion: Cardiovascular risk factors and cardiovascular signs or symptoms are common during emergency arrival in patients with COVID-19. Arterial hypertension, myocardial injury and mechanical ventilation were associated with mortality in multivariate analysis, as observed in other regions of the world.

Stroke Prevention by Anticoagulants in Daily Practice Depending on Atrial Fibrillation Pattern and Clinical Risk Factors.

The objective of the study was to assess the effectiveness of individual direct oral anticoagulants versus vitamin K antagonists for primary prevention of stroke (ischemic and hemorrhagic) in routine clinical practice in patients with various clinical risk factors depending on their atrial fibrillation (AF) patterns. A nested case-referent study was conducted using data from 2 national registries of patients with stroke and AF. Stroke cases with previous history of AF were matched to up to 2 randomly selected referent patients with AF and no stroke. The association of individual anticoagulant use with ischemic or hemorrhagic stroke was studied in patients with or without permanent AF using multivariable conditional logistic models, controlled for clinically significant risk factors and multiple other cardiovascular risk factors. In total, 2586 stroke cases with previous AF and 4810 nonstroke referent patients with AF were retained for the study. Direct oral anticoagulant users had lower odds of stroke of any type than vitamin K antagonist users: the adjusted-matched OR for ischemic stroke were 0.70 (95% CI, 0.50–0.98) for dabigatran, 0.68 (95% CI, 0.53–0.86) for rivaroxaban, and 0.73 (95% CI, 0.52–1.02) for apixaban while for hemorrhagic stroke they were 0.31 (95% CI, 0.14–0.68), 0.64 (95% CI, 0.39–1.06), and 0.70 (95% CI, 0.33–1.49), respectively. The effects of individual direct oral anticoagulants relative to vitamin K antagonists were similar in permanent AF and nonpermanent AF patients. Similar results were observed for each direct oral anticoagulant in real life as those observed in the pivotal clinical trials. The pattern of AF did not affect the outcome.

GLP-1 receptor agonists: evolution and advancement in the treatment of type 2 diabetes mellitus

Type 2 diabetes mellitus is a progressive disease, associated with multiple cardiovascular risk factors (obesity, hypertension, dyslipidemia) and with the development of micro- and macro-vascular complications. Several anti-diabetic drugs commonly used, such as sulfonylureas, thiazolidinediones and insulin induce weight gain and have modest or negative effects on cardiovascular risk factors and cardiovascular events. In this context, the GLP-1 receptor agonists (GLP-1 RA) instead have an important action on glycemic control and β-cell dysfunction, show favorable effects on body weight, hypertension and lipid profile, have a reduced risk of hypoglycemia and more recently have demonstrated clear benefits on major cardiovascular events, cardiovascular mortality and renal damage. In these years it has been an evolution on the role of the GLP-1 RA in the new paradigm of type 2 diabetes. For this reason the GLP-1 RA find place at any moment of the cardiovascular and renal continuum, from the initial one for controlling blood glucose and the different risk factors to the most advanced when cardiovascular damage is already present. The GLP-1 RA therefore represent a key elements in the management of patients with type 2 diabetes at any time in the natural history of the disease both for glycemic control and for the prevention of CV and renal events. KEY WORDS GLP-1 receptor agonists; type 2 diabetes; cardiovascular risk factors; cardiovascular disease; cardiovascular outcome trials.

EFFECTS OF EXERCISE ON GLUCOSE AND LIPID METABOLISM IN ELDERLY PATIENTS

ABSTRACT Introduction: Metabolic syndrome is a condition in which multiple cardiovascular metabolic risk factors gather in the body. Objective: To explore the effects of exercise prescription on glucose and lipid metabolism in elderly patients with metabolic syndrome. Methods: A total of 85 elderly people were selected from a pension community. The influencing factors of physical activity were analyzed by the Pearson correlation analysis method, Mann-Whitneyu test and Kruskal-Wallish test. Finally, we quantitatively analyzed the influence and path of each factor on the physical activity of the elderly. Results: Among the 85 elderly people in nursing homes, 2 cases (1.1%) had a high level of physical activity, 70 cases (38.9%) had a medium level of physical activity, and 51 cases (60.0%) had a low level of physical activity. Conclusions: The improvement of glucose and lipid metabolism and healthy body fitness with the prescription of exercises of high oxygen + low resistance and that of exercises of high resistance + low oxygen is better than that with the prescription of exercises of full oxygen and full resistance. The improvement of sleep quality with the prescription of exercise with high oxygen and low resistance was better than that of exercise with complete oxygen, complete resistance and high resistance and low oxygen. Level of evidence II; Therapeutic studies - investigation of treatment results.

Efficacy of IVRS-based mHealth intervention in reducing cardiovascular risk in metabolic syndrome: A cluster randomized trial

AimsEfficacy of mobile-phone based intervention for reducing cardiovascular risk in metabolic syndrome (MetSyn). MethodsWe screened adults 20–60 years in 10 villages in India for MetSyn using stratified cluster sampling. Lifestyle and biochemical risk factors were assessed. International Harmonized Criteria were used for diagnosis. Villages were randomized with 5 each in control and intervention groups. Interactive voice response system (IVRS) in Hindi was developed. In intervention clusters two messages for promotion of healthy lifestyle and medical treatment were broadcast daily over 12-months and risk factors reassessed. Results1012/1200(84%) persons were screened and MetSyn diagnosed in 286(28.3%). Villages were divided into 5 control(n = 136) and 5 intervention(n = 147) clusters. Baseline characteristics in both clusters were similar. Acceptability of intervention was >60% in 80% participants. At 12 months, significantly greater participants in intervention vs control clusters had healthier lifestyle (healthy diet 28.8vs14.7%, physical activity 25.9vs13.1%, tobacco 13.7vs32.5%), anthropometry (waist circumference 85.7 ± 6.3vs88.6 ± 14.0 cm, body mass index 21.9 ± 2.8vs23.1 ± 2.9 kg/m2), systolic BP 123.6 ± 7.7vs128.6 ± 14.1 mmHg, fasting glucose 95.6 ± 19.4vs109.4 ± 43.7 mg/dl, cholesterol 175.5 ± 36.5vs186.4 ± 43.3 mg/dl, and triglycerides 147.6 ± 48.3vs159.5 ± 60.7 mg/dl (p < 0.01). Prevalence of metabolic syndrome declined in intervention group by 22.3%vs3.9%, p < 0.001). ConclusionAn interactive voice response system based technology significantly reduced multiple cardiovascular risk factors and prevalence of metabolic syndrome.

Kidney outcomes using a sustained ≥40% decline in eGFR: A meta‐analysis of SGLT2 inhibitor trials

BackgroundA recent meta‐analysis of sodium–glucose cotransporter 2 (SGLT2) inhibitor outcome trials reported that SGLT2 inhibitors were associated with reduction in the risk of adverse composite kidney outcomes, with moderate heterogeneity across the trials; however, the endpoints were defined differently across the trials.HypothesisThe apparent heterogeneity of the meta‐analysis of kidney composite outcomes of SGLT2 inhibitor trials will be substantially reduced by using a consistent assessment of sustained ≥40% decline in eGFR/chronic kidney dialysis/transplantation/renal death across trials.MethodsWe performed a meta‐analysis of kidney composite outcomes from the four SGLT2 cardiovascular outcome trial programs conducted in general type 2 diabetes mellitus populations, which included, as a surrogate of progression to kidney failure, a sustained ≥40% decline in eGFR along with kidney replacement therapy and kidney death. The trials assessed were VERTIS CV (NCT01986881), CANVAS Program (NCT01032629 and NCT01989754), DECLARE‐TIMI 58 (NCT01730534), and EMPA‐REG OUTCOME (NCT01131676).ResultsData from the trials comprised 42 516 individual participants; overall, 998 composite kidney events occurred. SGLT2 inhibition was associated with a significant reduction in the kidney composite endpoint (HR 0.58 [95% CI 0.51–0.65]) and with a highly consistent effect across the trials (Q statistic p = .64; I 2 = 0.0%).ConclusionsOur meta‐analysis highlights the value of using similarly defined endpoints across trials and supports the finding of consistent protection against kidney disease progression with SGLT2 inhibitors as a class in patients with type 2 diabetes mellitus who either have established atherosclerotic cardiovascular disease or are at high cardiovascular risk with multiple cardiovascular risk factors.

Invited Perspective: Metal Mixtures and Child Health: The Complex Interplay of Essential and Toxic Elements.

Invited Perspective: Metal Mixtures and Child Health: The Complex Interplay of Essential and Toxic Elements.

Disparities in cardiovascular risk factors by race/ethnicity among adult survivors of childhood cancer: A report from the Childhood Cancer Survivorship Study (CCSS).

10017 Background: Racial, ethnic, and socioeconomic disparities are documented in outcomes for childhood cancer survivors. Understanding whether childhood cancer modifies established disparities in cardiovascular risk factors (CVRFs) in the general population would inform strategies to reduce health inequities among survivors. Methods: The CCSS is a retrospectively constructed cohort with prospective follow-up consisting of 25,579 five year survivors of childhood cancer diagnosed between 1970 and 1999. We estimated the incidence of self-reported Common Terminology Criteria for Adverse Events (CTCAE) grade &gt;2 CVRFs (hypertension, diabetes, dyslipidemia, and obesity) and multiple (&gt;2) CVRFs among survivors. Multivariable Poisson regression estimated the rate ratios (RR) of CVRFs by race/ethnicity, adjusted for key treatment exposures and sociodemographics. Results: Within the CCSS cohort, there were 20,416 non-Hispanic White (NHW), 1625 non-Hispanic Black (NHB), and 2043 Hispanic survivors with the cumulative incidence estimates of each CVRF at age 40 displayed in Table. Survivors who self-reported “Other” or mixed race were excluded for this analysis (n=1495). NHB survivors were more likely to report hypertension (unadjusted RR 1.3; 95% Confidence Interval [CI] 1.0-1.6), diabetes (RR 1.6; 95% CI 1.0-2.4), obesity (RR 1.6; 95% CI 1.4-1.9), and multiple CVRF (RR 1.3; 95% CI 1.2-1.5), whereas Hispanic survivors were more likely to report diabetes (RR 1.7; 95% CI 1.2-2.4), obesity (RR 1.4; 95% CI 1.2-1.5), and multiple CVRFs (RR 1.1; 95% CI 1.0-1.3) compared with NHW survivors. These observed disparities in risks of CVRFs remained nearly unchanged even after adjustment for sociodemographic factors (age, sex, household income, education, marital status, employment, and insurance) and treatment exposures (Yes/No for anthracyclines, alkylators, and chest radiation). Conclusions: NHB and Hispanic adult survivors demonstrate a higher burden of CVRF compared with NHW survivors, particularly diabetes and obesity. The associated morbidity of these conditions and established increase they incur in risk of more severe cardiovascular disease emphasizes the need for interventions to mitigate CVRFs to promote health equity among these survivors.[Table: see text]

Atherosclerotic Burden and Remodeling Patterns of the Popliteal Artery as Detected in the Magnetic Resonance Imaging Osteoarthritis Initiative Data Set.

BackgroundAn artificial intelligence vessel segmentation tool, Fully Automated and Robust Analysis Technique for Popliteal Artery Evaluation (FRAPPE), was used to analyze a large databank of popliteal arteries imaged through the OAI (Osteoarthritis Initiative) to study the impact of atherosclerosis risk factors on vessel dimensions and characterize remodeling patterns.Methods and ResultsMagnetic resonance images from 4668 subjects contributing 9189 popliteal arteries were analyzed using FRAPPE. Age ranged from 45 to 79 years (median, 61), and 58% were women. Mean lumen diameter, mean outer wall diameter, and mean wall thickness (MWT) were measured per artery. Their median values were 5.8 mm (interquartile range, 5.2–6.5 mm), 7.3 mm (interquartile range, 6.7–8.1 mm), and 0.78 mm (interquartile range, 0.73–0.84 mm) respectively. MWT was associated with multiple cardiovascular risk factors, with age (4.2% increase in MWT per 10‐year increase in age; 95% CI, 3.9%–4.5%) and sex (8.6% higher MWT in men than women; 95% CI, 7.7%–9.3%) being predominant. On average, lumen and outer wall diameters increased with increasing MWT until the thickness was 0.92 mm for men and 0.84 mm for women. After this point, lumen diameter decreased steadily, more rapidly in men than women (−7.9% versus −6.1% per 25% increase in MWT; P<0.001), with little change in outer wall diameter.ConclusionsFRAPPE has enabled the analysis of the large OAI knee magnetic resonance imaging data set, successfully showing that popliteal atherosclerosis is predominantly associated with age and sex. The average vessel remodeling pattern consisted of an early phase of compensatory enlargement, followed by a negative remodeling, which is more pronounced in men.

Usefulness of cardiometabolic index for the estimation of diabetes risk among general population in rural China: a community-based study

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiometabolic index (CMI) defines adiposity based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR). This newly proposed metric has been used to detect multiple cardiovascular risk factors, but data relative to diabetes in the general population are lacking. This study aims to validate CMI’s utility of discriminating diabetes and compares it with other indexes among general Chinese population. Methods Analyses were based on a cross-sectional study of 11,478 participants that underwent assessment of metabolic and anthropometric parameters in rural areas of northeastern China in 2013. CMI was calculated by TG/HDL-C × WHtR. Multivariate logistic regressions were performed to clarify CMI’s association with diabetes, ROC analyses were engaged to investigate CMI’s discriminating ability for diabetes. Results The prevalence of diabetes was 9.93% in males while 10.76% in females, and increased with CMI’s increment. After full adjustment, each SD increment of CMI had odds ratios (ORs) for diabetes of 1.471 (1.367–1.584) and 1.422 (1.315–1.539) in females and males, respectively. Compared with bottom categories of CMI, the top quartiles had ORs of 3.736 (2.783–5.015) in females and 3.697 (2.757–4.958) in males. The ROC results showed an excellent discriminating power of CMI (AUC: 0.702 for females, 0.664 for males). Conclusions An increasing CMI was correlated with higher odds of diabetes, supporting CMI as a useful and economic measure to screen and quantify diabetes in general Chinese population. Monitoring and promoting achievement of dyslipidemia and abdominal obesity based on CMI may improve subclinical and cardiovascular outcomes. Abstract Figure.

Malignant Arrhythmia in Acute Conus Artery Occlusion

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

Malignant Arrhythmia in Acute Conus Artery Occlusion

We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.

Monotherapy in patients with pulmonary arterial hypertension at four German PH centres

BackgroundAlthough combination therapy is the gold standard for patients with pulmonary arterial hypertension (PAH), some of these patients are still being treated with monotherapy.MethodsWe conducted a retrospective analysis at four German PH centres to describe the prevalence and characteristics of patients receiving monotherapy.ResultsWe identified 131 incident PAH patients, with a mean age of 64 ± 13.8 years and a varying prevalence of comorbidities, cardiovascular risk factors and targeted therapy. As in other studies, the extent of prescribed PAH therapy varied with age and coexisting diseases, and younger, so-called “typical” PAH patients were more commonly treated early with combination therapy (48% at 4–8 months). In contrast, patients with multiple comorbidities or cardiovascular risk factors were more often treated with monotherapy (69% at 4–8 months). Survival at 12 months was not significantly associated with the number of PAH drugs used (single, dual, triple therapy) and was not different between “atypical” and “typical” PAH patients (89% vs. 85%).ConclusionAlthough “atypical” PAH patients with comorbidities or a more advanced age are less aggressively treated with respect to combination therapy, the outcome of monotherapy in these patients appears to be comparable to that of dual or triple therapy in “typical” PAH patients.