non-CVD Group Research Articles

Inflammatory index is a promising biomarker for maintenance hemodialysis patients with cardiovascular disease.

Maintenance hemodialysis (MHD) patients are at a higher risk of cardiovascular disease (CVD), a common complication and leading cause of death. Persistent micro-inflammation is a unique feature of MHD. Given the established role of inflammation in the pathogenesis of atherosclerosis, this study aims to explore whether novel inflammatory markers (inflammation index) can serve as independent risk factors for CVD in MHD patients. A cross-sectional survey was conducted on patients from three dialysis centers, categorized into a CVD and non-CVD group based on medical history, laboratory tests, and physical examination. Fasting blood samples were collected from all participants for indicator testing. The analysis of 209 patients revealed that 104 had concurrent CVD. Patients in the CVD group were significantly older and exhibited higher anxiety and depression scores. Forward stepwise multivariate logistic regression results identified the inflammation index neutrophil-to-lymphocyte ratio (NLR) (OR = 1.27, 95% CI 1.082-1.491, P < 0.05) and systemic immune-inflammation index (SII) (OR = 1.001, 95% CI 1.0001-1.002, P < 0.05) as independent risk factors for CVD in MHD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that SII, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and NLR all possess predictive diagnostic values for CVD events in this patient population. Hemodialysis centers can utilize simple and cost-effective inflammatory markers to proactively identify patients at risk of CVD. Future research into how inflammation contributes to CVD in MHD is required.

Dietary inflammation influences the prevalence of cardiovascular diseases in prediabetes and diabetes patients: findings from the National Health and Nutrition Examination Survey (NHANES 2001–2018)

Prediabetes is an early phase before diabetes. Diabetes and dietary inflammation are two crucial factors that are strongly associated with cardiovascular diseases (CVDs). Dietary interventions slowed the progression of diabetes and CVD. However, the associations between CVDs and dietary inflammation in different stages of pathoglycaemia have not been investigated. To explore the effect of a proinflammatory diet on CVD incidence at different stages of diabetes, NHANES (2001–2018) data were collected and analysed. A total of 3137 CVD patients with a comparable non-CVD group (n = 3137) were enrolled after propensity score matching (PSM) analysis. These patients were subsequently categorized into three subgroups: those with diabetes (n = 3043), those with prediabetes (n = 1099) and those with normoglycemia (n = 2132). The DII (Dietary inflammatory index) is a risk factor for CVD, both in overall individuals and in each subgroup of population-based information. In diabetic individuals, the odds ratios (ORs) (95% CIs) of CVD incidence for the DII were 1.10 (1.05, 1.15) and 1.08 (1.03, 1.13) according to the crude and adjusted models, respectively. For individuals with prediabetes, the ORs (95% CIs) of CVD risk for DII were 1.05 (0.97, 1.14) and 1.11 (1.01, 1.22) according to the crude and adjusted models, respectively. After adjusting for population-based information and hypertension status, the DII appeared to have the highest OR for individuals with prediabetes, and no significant association was found between the DII score and CVD risk in the normoglycemia group. Moreover, the OR of CVD for DII in the uncontrolled diabetes group was 1.06 (0.98, 1.16)*. These results suggest that the DII is more closely associated with the risk of CVDs in prediabetic and diabetic populations, and we should pay more attention to diet control before a person develops diabetes to prevent CVD progression.

E012 Burden and risk factors for cardiovascular involvement in connective tissue disease

Abstract Background/Aims Connective tissue diseases (CTD) are associated with several cardiovascular manifestations. Cardiovascular diseases (CVD) are significant cause of morbidity and premature death. The pathogenesis of CVD in CTD patients is incompletely understood and likely multifactorial. Traditional risk factors for atherosclerosis are common among patients with CTD as well as metabolic syndrome. Furthermore, diabetes, dyslipidaemia, hypertension, and obesity may all be exacerbated by connective tissue disease itself or treatment with glucocorticoids. The aim of this study was to assess the burden of CVD and the risk factors for the development of cardiovascular disease in patients with CTD. Methods This was a retrospective study from a single centre. We reviewed clinical records of CTD patients as determined by treating rheumatologist. This CTD cohort included patients with systemic lupus erythematosus (SLE), myositis, systemic sclerosis, Sjogren’s syndrome, mixed and undifferentiated connective tissue diseases. Data on demographic, clinical, laboratory parameters, cardiac investigations, treatment and outcome were collected from electronic patient records. CVD and traditional risk factors were defined using standard criteria. Results A total of 298 patients with CTD were included in the analysis. Mean age of the cohort was 61±17.7 years and majority were females (n = 240, 80.5%). Of the 298 patients, 64 had CVD (21.5%). Most common CVD was ischaemic heart disease (17 patients) followed by hypertension (12), arrhythmia (9), pulmonary arterial hypertension (7), valvular diseases (5), pericardial disease (3), cardiomyopathy (3), myocarditis (2), thromboembolism (3), aortic dissection (2) and coronary spasm (1). Patient with CTD who had CVD were older (72.5±12.2 years) compared to CTD patients who did not develop CVD (non-CVD group, 57.7±17.6 years). The duration of CTD was shorter in patients with CVD (88.9±41.7 months), compared to 106±84.3 months in non-CVD group. The risk factors such as smoking, diabetes and dyslipidaemia was higher in the CVD group. Comparing CVD vs non-CVD patients respectively, systolic BP (147.1±23.0 vs 133.6±18.3mmHg), diastolic BP (83.2 ± 16.3 vs 78.2 ± 11.2mmHg) and serum uric acid (321.8±97.4 vs 292±83.9mg/dL) values were higher and statistically significant (p &amp;lt; 0.05) in CVD group. Patients with CVD had longer exposure to steroids (50%) compared to non-CVD patients (31.6%). They required high dose steroids (9.4% vs 5.6% in non-CVD patients). Current and previous DMARD use was also higher in patients who had CVD (51.6% vs 44.9%). Conclusion This study has demonstrated high burden of cardiovascular disease in CTD patients. Traditional risk factors were more prevalent in the CVD group. DMARD’s and steroid use was also higher in the CVD group. Screening for cardiovascular diseases and disease control in CTD patients is paramount for better outcomes. Further analysis will be carried out for risk factors and relevant outcomes. Disclosure K.K. Garg: None. S. Sampath: None. A. Erinjogunola: None. B. Ting: None. H. Noori: None. G.M. Koduri: None.

Sex-specific differences in intestinal microbiota associated with cardiovascular diseases

BackgroundCardiovascular diseases (CVD), including coronary heart disease (CHD), display a higher prevalence in men than women. This study aims to evaluate the variations in the intestinal microbiota between men and women afflicted with CHD and delineate these against a non-CVD control group for each sex.MethodsOur research was conducted in the framework of the CORDIOPREV study, a clinical trial which involved 837 men and 165 women with CHD. We contrasted our findings with a reference group of 375 individuals (270 men, 105 women) without CVD. The intestinal microbiota was examined through 16S metagenomics on the Illumina MiSeq platform and the data processed with Quiime2 software.ResultsOur results showed a sex-specific variation (beta diversity) in the intestinal microbiota, while alpha-biodiversity remained consistent across both sexes. Linear discriminant analysis effect size (LEfSe) analysis revealed sex-centric alterations in the intestinal microbiota linked to CVD. Moreover, using random forest (RF) methodology, we identified seven bacterial taxa—g_UBA1819 (Ruminococcaceae), g_Bilophila, g_Subdoligranulum, g_Phascolarctobacterium, f_Barnesiellaceae, g_Ruminococcus, and an unknown genus from the Ruminococcaceae family (Ruminococcaceae incertae sedis)—as key discriminators between men and women diagnosed with CHD. The same taxa also emerged as critical discriminators between CHD-afflicted and non-CVD individuals, when analyzed separately by sex.ConclusionOur findings suggest a sex-specific dysbiosis in the intestinal microbiota linked to CHD, potentially contributing to the sex disparity observed in CVD incidence.Trial registration Clinical Trials.gov.Identifier NCT00924937.Graphical

Blood C-peptide concentration as a proxy marker of cardiovascular disease: An observational cross-sectional study.

Cardiovascular diseases (CVDs) are among the leading causes of disability and early death in sub-Saharan Africa. Most of the current blood tests for CVD diagnosis involve performing about three test profiles; often at additional cost to patients. C-peptide, a cleavage product of proinsulin, is a promising marker that has the potential to serve as a proxy marker for diagnosing CVDs in resource-poor settings. The study was an observational cross-sectional one and involved 127 consenting persons diagnosed with CVD and 127 individuals without CVD. The socio-demographic and clinical characteristics of participants were obtained. Blood levels of C-peptide, fasting plasma glucose (FPG), total creatinine kinase (CK), creatine kinase myocardial bound (CKMB), lactate dehydrogenase (LDH), propeptide of brain natriuretic peptide (PBNP), Troponin T, lipids, and biomarkers of kidney and liver function were analyzed using ELISA and an automated analyzer. Insulin resistance was computed using the modified homeostatic model assessment (HOMA-IR). The CVD Group had significantly higher levels of C-peptide, CK, CKMB, troponin T, PBNP, FPG, HOMA-IR, and several selected kidney, liver, and lipid parameters compared to the non-CVD Group (p < 0.05 for all). Troponin T recorded a positive correlation (r = 0.34, p < 0.001) with C-peptide among the CVD Group. The sensitivity and specificity of C-peptide in identifying CVD were 96.1% and 91.3% respectively (area under the curve = 0.938, p < 0.001). C-peptide levels were higher in the CVD Group and appeared to be a valuable (high sensitivity and specificity) biomarker in detecting CVD.

Plasma branched-chain amino acid concentrations in individuals without cardiovascular diseases versus patients diagnosed with hypertension and coronary artery disease

Aim. Branched-chain amino acids (BCAAs) have been postulated as potential indicators of cardiovascular risk. The objective of this study was to explore the relationship between plasma BCAAs and different stages of cardiovascular disorders.Material and methods. In our cross-sectional study, plasma BCAAs (valine, leucine and isoleucine) in individuals without cardiovascular diseases (CVDs) (nonCVD group, total n=27, with n=16 healthy, but with metabolic disorders) were compared to patients diagnosed with CVDs [CVD group, total n=109, being n=61 hypertension (n=31 with signs of beginning of myocardial remodeling) and n=48 patients with coronary artery disease (CAD)].Results. The plasma concentration of BCAAs was significantly higher in the group of patients with cardiovascular disease compared with the healthy group (p&lt;0.05 for all amino acids tested): valine concentration was 238.7 [219.6; 267.0] μM in the non-CVD group and 261.2 [233.8; 298.7] μM in the CVD group; leucine concentration was 134.8 [122.4; 153.2] μM and 146.8 [129.0; 166.6] μM, respectively; and isoleucine 72.7 [65.3; 84.4] μM and 81.7 [68.0; 96.2] μM, respectively. Leucine and isoleucine concentration levels were minimal in the healthy participant subgroup and maximal in the IBS patient subgroup. No statistically significant differences in BCAAs concentrations were found in the subgroups without CAD. Significant increases in concentrations were observed in the subgroups of patients with CAD as follows: valine concentration was 256.3 [219.0; 297.9] μM in hypertension group and 261.7 [236.5; 307.5] μM in CAD group; leucine concentration was 141.8 [123.5; 166.6] μM and 154.1 [134.7; 172.7] μM, respectively, and isoleucine 72.8 [65.7; 94.0] μM and 85.7 [74.9; 101.7] μM, respectively. BCAAs profiles in all participants with metabolic disorders had “good” diagnostic accuracy with area under the receiver operating characteristics curve being 0.72, 0.70 and 0.70 for valine, leucine and isoleucine, respectively.Conclusion. BCAAs concentrations are elevated with higher severity of the cardiovascular disorder and exhibit potential as early independent indicators of coronary artery disease.

The clinical value of carotid plaque score in patients with metabolic syndrome and cardiovascular diseases

ObjectiveTo investigate the relationship between carotid plaque load score (CPS) and metabolic syndrome (MS) and cardiovascular diseases (CVD), in order to provide theoretical basis for the precaution and control of MS and CVD. MethodsA total of 1962 patients were incorporated into the study and divided into MS group and non-MS group, CVD group and non-CVD group. CPS and CIMT were obtained by carotid artery ultrasound, and the data of each group were statistically analyzed. ResultsAge, BMI, basal metabolic rate, body fat rate, gender, and the incidence of central obesity, hypertension, diabetes and dyslipidemia are statistical different between MS group and non-MS group (P < 0.05). CIMT between CVD group and non-CVD group are statistical different (1.040 ± 0.239 VS 0.972 ± 0.297, P < 0.001).CPS was statistically significant between MS group and non-MS group(2.254 ± 2.728 VS 1.548 ± 2.219, P = 0.003) and between CVD group and non-CVD group (2.322 ± 2.760 VS 1.688 ± 2.347, P = 0.004). ConclusionPatients in MS group and CVD group have higher carotid plaque burden than those in non-MS group and non-CVD group. The higher the CPS was, the higher the incidence of MS and CVD was, and the distribution of CPS in MS and CVD population was consistent.

Association of Vitamin D with Cardiovascular Disease

Objective: To investigate the relationship between vitamin D level in serum and cardiovascular diseases. Study Design: Prospective study. Place and duration: Study was conducted in Choudhary Parvez Ellahi institute of cardiology in one year duration from 1st February 2020 to 1st February 2021. Methodology: One hundred and fifty patients presented with cardiac illness at emergency department were enrolled in study. Serum vitamin D hydroxyl level was divided into three categories deficiency, insufficiency and deficiency. SPSS version 23 was used for fata analysis. P value ≤0.5 was taken as significant. Results: Serum 25(OH) D levels in both the groups were shown in table. III. In the non-CVD Group, 48% of patients were deficient. 56% of patients were insufficient and n=30 (40%) patients were sufficient serum level. While, in CVD Group, n=44 (58.6%) patients were deficient. 37.3% of patients were insufficient, and 61.3% patients were sufficient serum level. The differences were statistically significant. Conclusion: Serum 25-hydroxy vitamin D at lower values associated with increased cardiovascular diseases. Further studies are needed to recommend vitamin D supplements to reduce the risk of cardiovascular diseases.

Interaction between rheumatoid arthritis and mediterranean diet on the risk of cardiovascular disease for the middle aged and elderly from National Health and Nutrition Examination Survey (NHANES)

BackgroundCardiovascular diseases (CVD) occurrence were associated with rheumatoid arthritis (RA) and Mediterranean diet (MD), but few studies have been conducted to explore the combined effect. This study was to outline the relationship of coexistence of RA and MD on the risk of CVD based on the National Health and Nutrition Examination Survey (NHANES) database.MethodsThe data of this cross-sectional study was from the NHANES 2005–2010. The definition of CVD and RA was based on the self-reported questions, respectively; and the alternate MD Index assessed all participants’ adherence to the MD. Weighted multivariate logistic regression was adopted to explore the relationship of RA, MD on the risk of CVD, and coexistence effect of RA and MD. The additive interaction was evaluated by the relative excess risk due to interaction (RERI), attributable proportion (AP) and the synergy index (SI). The multiplicative interaction was evaluated by odds ratio (OR) and 95% confidence interval (CI) of product-term.ResultsA total of 3,352 participants from NHANES database who were divided into CVD group (n = 385) and non-CVD group (n = 2,967). The result indicated that RA (Model 1: OR = 3.98, 95%CI: 2.76–5.73; Model 2: OR = 2.65, 95%CI: 1.69–4.16) and low adherence to the MD (Model 1: OR = 1.82, 95%CI: 1.13–2.93; Model 2: OR = 1.67, 95%CI:1.01–2.77) was associated with an increased risk of CVD, respectively. Additionally, we observed the additive (RERI = 4.76, 95% CI: 0.52-9.00; AP = 0.74, 95% CI: 0.54–0.95; SI = 8.21, 95% CI: 1.48–45.51) and multiplicative (OR = 3.63, 95% CI: 1.44–9.15) interaction of RA and low adherence to the MD on the risk of CVD.ConclusionRA and MD were associated with CVD occurrence, respectively, and there may be an interaction between RA and MD for the development of CVD.

Can peripheral biomarkers reflect the psychological condition in geriatric populations? The influence of cardiovascular comorbidities.

Although previous studies indicated the association between peripheral biomarkers and psychological conditions, a higher prevalence of cardiovascular diseases (CVD) among geriatric populations may hinder the applicability of the biomarkers. The objective of this study was to assess the adequacy of the application of biomarkers to evaluate psychological conditions among geriatric populations. We collected information on the demographics and history of CVD in all participants. All participants completed the Brief Symptom Rating Scale (BSRS-5) and the Chinese Happiness Inventory (CHI), which are the measurement of negative and positive psychological conditions, respectively. Four indicators of the peripheral biomarkers, including the standard deviation of normal to normal RR intervals (SDNN), finger temperature, skin conductance, and electromyogram were collected for each participant during a 5-min resting state. Multiple linear regression models were conducted to evaluate the association between the biomarkers and the psychological measurements (BSRS-5, CHI) with and without the inclusion of the participants with CVD. A total of 233 participants without CVD (non-CVD group) and 283 participants with CVD (CVD group) were included. The CVD group was older and with higher body mass index compared to the non-CVD group. In the multiple linear regression model with all participants, only BSRS-5 scores had a positive association with electromyogram. After the exclusion of the CVD group, the association between the BSRS-5 scores and electromyogram was more relevant, while CHI scores became positively associated with SDNN. A single measurement of the peripheral biomarker may be insufficient to depict psychological conditions among geriatric populations.

Relationship Between Cardiovascular Events and Serum Lipid and Plasma Fatty Acid Profile in Maintenance Hemodialysis Patients With Diabetic Mellitus.

Cardiovascular disease (CVD) is a frequent complication in hemodialysis (HD) patients, especially when the underlying disease is diabetes mellitus (DM). In this study, we investigated cardiovascular events and lipid and fatty acid profile in maintenance HD patients with diabetic kidney disease (DKD). The subjects were 123 patients undergoing HD at Oyokyo Kidney Research Institute Hirosaki Hospital, who were considered to have DKD as the underlying cause of dialysis induction. Among these patients, the lipid and fatty acid profile were examined in two groups, CVD group (n=53) and non-CVD group (n=70), according to the presence or absence of a history of cardiovascular events (coronary artery disease, stroke, arteriosclerosis obliterans, valvular disease, and aortic disease). For serum lipid profile, the levels of total-cholesterol (T-C), triglycerides (TG), high density lipoprotein-cholesterol (HDL-C), and low density lipoprotein-cholesterol (LDL-C) were measured, and for fatty acid balance, 24 fractions of fatty acid composition in plasma total lipids were measured. These markers were compared between the CVD and non-CVD groups. The levels of T-C and TG were significantly lower in the CVD group compared with the non-CVD group (147.7±36.9 mg/dl vs. 159.2±35.6 mg/dl, p<0.05, 120.2±65.7 mg/dl vs. 143.8±124.4 mg/dl, p<0.05). In the plasma fatty acid composition, alpha-linolenic acid (ALA) and docosapentaenoic acid (DPA) were significantly lower in the CVD group compared with the non-CVD group (0.74±0.26 wt% vs. 0.84±0.31 wt%, p<0.05; 0.61±0.21 wt% vs. 0.70±0.30 wt%, p<0.05). Abnormal fatty acid balance, especially low levels of ALA and DPA, rather than serum lipids, are more likely the factors associated with cardiovascular events in maintenance HD patients with underlying DKD.

Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis

Introduction: The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD. Methods: This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk. Results: During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26–2.55; HR = 2.48 in women, 95% confidence interval 1.66–3.71; reference: high LTI/low FTI group). Conclusions: Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

Analysis of cardiovascular disease factors on SARS-CoV-2 infection severity

BackgroundAt present, COVID-19 is a global pandemic and is seriously harmful to humans. In this retrospective study, the aim was to investigate the interaction between CVD and COVID-19. MethodsA total of 180 patients diagnosed with COVID-19 in Yichang Central People's Hospital from 29 January to 17 March 2020 were initially included. The medical history, clinical manifestations at the time of admission, laboratory test results, hospitalization time and complications were recorded. According to the medical history, the patients were assigned to the nonsevere group with non-CVD (n=90), the nonsevere group with CVD (n=22), the severe group with non-CVD (n=40) and the severe group with CVD (n=28). ResultsIn the severe group, compared with non-CVD patients, CVD patients had a significantly higher incidence of fever (P<0.05). However, compared with the nonsevere group, the severe group had significantly higher proportions of patients with hypertension, type 2 diabetes mellitus, CHD and HF (all P<0.05). Among the patients with nonsevere COVID-19, the WBC count and the levels of IL-6, CRP, D-dimer, NT-proBNP, and FBG were significantly higher and the Hb level was significantly lower in the CVD patients than in the non-CVD patients (all P<0.05). However, among the patients with severe COVID-19, only the level of NT-proBNP was significantly higher in CVD patients than in non-CVD patients (P<0.05). In addition, the WBC count and the levels of IL-6, CRP, D-dimer, CKMB, ALT, AST, SCR, NT-proBNP, and FBG were significantly higher and the Hb level was significantly lower in the severe group than in the nonsevere group (all P<0.05). However, among the patients with severe COVID-19, the incidences of acute myocardial injury, acute kidney injury, arrhythmia, and sudden death were significantly higher in the CVD group than in the non-CVD group (all P<0.05). The same results were found in the comparison of the nonsevere group with the severe group. Among the patients with nonsevere COVID-19, those without CVD had a mean hospitalization duration of 25.25 (SD 7.61) days, while those with CVD had a mean hospitalization duration of 28.77 (SD 6.11) days; the difference was significant (P<0.05). The same results were found in the comparison of the severe group. ConclusionsCVD affects the severity of COVID-19. COVID-19 also increases the risk of severe CVD.

Knowledge, Attitude, and Practice Toward Cardiovascular Diseases in the Lebanese Population.

Background & Objective:Cardiovascular diseases (CVD) are the leading cause of death globally. Assessing CVD knowledge, attitude, and practice (KAP) is necessary to spread awareness about CVD in Lebanon, their corresponding risk factors, and behaviors in which individuals can avoid or minimize the possibility of developing a CVD.Subjects & Methods:This was a case-control analytical study that targeted 921 CVD and non-CVD subjects. A questionnaire form was used to collect data related to patients’ demographics, socioeconomic status, habits, medical and family history, KAP towards CVD, and source of information. Data was analyzed using SPSS v.25.Results:Data from 921 participants were distributed over the CVD group (52.6% males aged 58.3 ± 13.7 years [n = 460]) and the non-CVD group (47.7% males aged 36.3 ± 15.4 years [n = 461]). CVD patients were significantly older than non-CVD subjects (p < 0.001). All three KAP scores of both groups were of poor to fair levels. Both CVD knowledge and attitude mean scores in CVD patients (26.6 ± 5.2 over 40 [66.50%] and 63.3 ± 10.2 over 85 [74.47%], respectively) were significantly higher than the ones of non-CVD subjects (23.5 ± 7.9 over 40 [58.75%] and 61.4 ± 12.4 over 85 [72.74%], respectively, p < 0.001). However, the CVD mean practice score was significantly lower in CVD patients (6.0 ± 1.7 over 9 [66.67%]) than the one of non-CVD subjects (6.3 ± 2.2 over 9 [70.00%] p < 0.001). Mostly, educational level (p < 0.001), governorate (p < 0.01), and smoking (p < 0.001) were predictors of KAP CVD in both groups.Conclusion:With an overall limited knowledge, attitude, and practice toward CVDs, the Lebanese population (with CVD or non-CVD) needs targeted national campaigns about CVD according to the identified predictors of CVD KAP to prevent and to alleviate the complications due to CVDs.

Association of Coffee, Tea, and Caffeine Consumption With All-Cause Risk and Specific Mortality for Cardiovascular Disease Patients.

AimThe aim of the study was to examine the relationship between coffee, tea, caffeine consumption and risk of all-cause death and cardiovascular disease (CVD) death in CVD population.MethodsThis cohort study included 626 CVD participants aged ≥18 years old who derived from the National Health and Nutrition Examination Surveys (NHANES) database 2003–2006. The end time of follow-up was 2015, and with a median follow-up time of 113.5 (63, 133) months. CVD death was defined as a death caused by congestive heart failure (CHF), coronary heart disease (CHD), angina pectoris, heart attack or stroke. Cox model and competitive-risk model were used to explore the relationship of coffee, tea, caffeine, decaffeinated coffee/tea on the risk of the all-cause death and CVD death for CVD population, respectively. Additionally, we explored the effect of urinary caffeine and caffeine metabolites on all-cause death.ResultsAll patients were divided into survival group (n = 304), non-CVD death group (n = 223), and CVD death group (n = 99). The incidence of all-cause death and CVD death was ~51.44 and 15.81% in the study. After adjusting age, body mass index (BMI), cancer, estimated glomerular filtration rate (eGFR), energy, the history of CVD medications, carbohydrate and family income to poverty ratio (PIR), the results suggested coffee, caffeine, iced tea and hot tea consumption (≥4 cups per day) were associated with an increased risk of the all-cause death in CVD patients; while hot tea (1–3 cups per day), decaffeinated coffee/iced tea/hot tea could reduce the risk of the all-cause death. Likewise, coffee, caffeine, iced tea (≥4 cups per day), hot tea, decaffeinated iced tea/ hot tea (Always) could enhance the risk of the CVD death in CVD population. We also found that 1-methylxanthine showed a significant positive association on the risk of all-cause death in CVD population.ConclusionOur study indicated that higher consumption of coffee, tea and caffeine could increase the risk of all-cause and CVD death for CVD patients.

Serum Tenascin-C and Alarin Levels Are Associated with Cardiovascular Diseases in Type 2 Diabetes Mellitus.

Background Tenascin-C (TNC), an extracellular matrix glycoprotein, is elevated in inflammatory and cardiovascular pathologies, whereas alarin, a novel orexigenic peptide, participates in insulin resistance and glycometabolism. The roles of these molecules in individuals with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), clinical conditions associating with metabolic disorders, and chronic inflammation, remain controversial. Our study aimed at determining the potential role of TNC and alarin in CVD adult patients with T2DM. Methods This was a cross-sectional study. Basic and clinical information for 250 patients with T2DM were analyzed. Based on their cardiovascular disease status, participants were assigned into the CVD and non-CVD groups. Serum TNC and alarin levels were assessed by enzyme-linked immunosorbent assay (ELISA). Results Serum TNC and alarin concentrations in the CVD group were significantly higher than those of the non-CVD group. Moreover, serum TNC levels were positively correlated with age, waist circumference, and waist-hip ratio; however, they were negatively correlated with TC, LDL-C, and eGFR levels. Alarin levels were positively correlated with BMI, waist circumference, and hip circumference. In logistic regression models, TNC and alarin were also established to be independent determinants for CVD in T2DM patients and their increases were associated with CVD severity. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) values for TNC and alarin were 0.68 and 0.67, respectively. TNC and alarin were good predictors of CVD occurrence. When the cutoff value for TNC was 134.05 pg/mL, its sensitivity was 69.47% while its specificity was 61.29%. When the cutoff value for alarin was 142.69 pg/mL, sensitivity and specificity were 38.95% and 90.97%, respectively. Conclusion Elevated TNC and alarin levels are independently associated with the occurrence and severity of CVD in T2DM individuals. Therefore, these two biomarkers are potential diagnostic and prognostic indicators for CVD in diabetics.

The Linkage Between Bone Densitometry and Cardiovascular Disease.

Dual-energy X-ray absorptiometry (DXA) has been traditionally used to assess body composition covering bone, fat and muscle content. Cardiovascular disease (CVD) has deleterious effects on bone health and fat composition. Therefore, early detection of bone health, fat and muscle composition would help to anticipate a proper diagnosis and treatment plan for CVD patients. In this study, we leveraged machine learning (ML)-based models to predict CVD using DXA, demonstrating that it can be considered an innovative approach for early detection of CVD. We leveraged state-of-the-art ML models to classify the CVD group from non-CVD group. The proposed logistic regression-based model achieved nearly 80% accuracy. Overall, the bone mineral density, fat content, muscle mass and bone surface area measurements were elevated in the CVD group compared to non-CVD group. Ablation study revealed a more successful discriminatory power of fat content and bone mineral density than muscle mass and bone areas. To the best of our knowledge, this work is the first ML model to reveal the association between DXA measurements and CVD in the Qatari population. We believe this study will open new avenues of introducing DXA in creating the diagnosis and treatment plan of cardiovascular diseases.

Correlation between the Variability of Glycosylated Hemoglobin and Cardiovascular Risk in New-Onset T2DM Patients.

Objective To investigate the relationship between glycosylated hemoglobin variant index and cardiovascular disease in patients with type 2 diabetes. Methods A total of 120 patients with type 2 diabetes who were admitted to the Department of Endocrinology in Chun'an Branch of Zhejiang Provincial People's Hospital from January 2014 to January 2017 were enrolled. The clinical data, fasting blood glucose, and glycosylated hemoglobin levels of the patients were collected, and HGI was obtained by calculating the FPG level into the formula. Follow-up for three years was performed to observe the cardiovascular disease (including coronary heart disease and ischemic stroke) in patients. The occurrence of CVD was analyzed in patients with different levels of HGI. Multivariate logistics regression analysis was used to analyze the risk factors of CVD in patients with T2DM. Results After three years of follow-up, 8 cases of 120 patients were lost to follow-up. In the end, 24 cases of CVD occurred in 112 patients, with an incidence rate of 21.43%. Comparing the clinical data of CVD patients and non-CVD patients, it was found that the proportion of age, FPG, HbA1c, HGI, and insulin control in the CVD group was higher than that of the non-CVD group, and the difference was statistically significant (P < 0.05). After grouping according to different HGI levels, it was found that with the increase of HGI level, the proportion of HbA1c, FPG, TC, CVD, and insulin use showed an upward trend (P < 0.05). Multivariate logistic regression analysis showed that high HGI level (OR = 4.660), older age (OR = 4.815), and higher FPG level (OR = 1.717) are independent risk factors that affect T2DM patients with cardiovascular disease (P < 0.05). Conclusion High HGI is independently associated with CVD events in patients with type 2 diabetes. HGI testing is helpful for clinical assessment of personalized assessment and prediction of cardiovascular risk in patients with diabetes.

Investigation on the Prediction of Cardiovascular Events Based on Multi-Scale Time Irreversibility Analysis

Investigation of the risk factors associated with cardiovascular disease (CVD) plays an important part in the prevention and treatment of CVD. This study investigated whether alteration in the multi-scale time irreversibility of sleeping heart rate variability (HRV) was a risk factor for cardiovascular events. The D-value, based on analysis of multi-scale increments in HRV series, was used as the measurement of time irreversibility. Eighty-four subjects from an open-access database (i.e., the Sleep Heart Health Study) were included in this study. None of them had any CVD history at baseline; 42 subjects had cardiovascular events within 1 year after baseline polysomnography and were classed as the CVD group, and the other 42 subjects in the non-CVD group were age matched with those in the CVD group and had no cardiovascular events during the 15-year follow-up period. We compared D-values of sleeping HRV between the CVD and non-CVD groups and found that the D-values of the CVD group were significantly lower than those of the non-CVD group on all 10 scales, even after adjusting for gender and body mass index. Moreover, we investigated the performance of a machine learning model to classify CVD and non-CVD subjects. The model, which was fed with a feature space based on the D-values on 10 scales and trained by a random forest algorithm, achieved an accuracy of 80.8% and a positive prediction rate of 86.7%. These results suggest that the decreased time irreversibility of sleeping HRV is an independent predictor of cardiovascular events that could be used to assist the intelligent prediction of cardiovascular events.

Abstract 9094: Intensive Lifestyle Medicine for Primary &amp; Secondary Prevention for Cardiovascular Risk Reduction in Patients With Diabetes

Introduction: Cardiovascular disease (CVD) carries significant morbidity and mortality, especially for patients with diabetes. Intensive Cardiac rehabilitation (ICR) has proven benefits for patients with CVD through a high fiber low fat diet, peer support, exercise and stress reduction; which may help in diabetes management. However, outcomes of ICR in patients with diabetes with and without CVD are unknown. Hypothesis: ICR can improve outcomes in diabetic patients with or without CVD. Methods: We conducted a retrospective cohort study of 4793 diabetic patients who were offered ICR at 46 CR centers across USA from January 2016 to December 2020. Five ICR centers in Hawaii had patients enrolled with diabetes without any CVD as Hawaii is the only state in US which has approved ICR for diabetic patients without CVD for primary prevention. ICR sessions are 4-hours long, twice weekly for 9-weeks of lifestyle modification aiming at high fiber low fat diet, peer support, exercise and stress reduction. Diabetic patients were divided into two groups: CVD group (known CVD) - 3723 patients (78%) and Non-CVD group (without CVD) - 1070 patients (22%). Primary endpoints were change in HbA1C, LDL and BP. Secondary outcomes were change in BMI, triglycerides, cholesterol, HDL, dietary fat intake, dietary fiber intake, depression scores (CESD) and exercise minutes per week. We used t tests to compare variables pre and post ICR. Results: The mean age of patients was 66.5 ± 0.2 years, 43% were females and 44% were white. ICR completion rate &amp; number of ICR sessions was higher in Non-CVD group (Non-CVD: 60.11 ± 27.16 vs. CVD: 55.67 ± 33.15, p&lt;0.01). Primary (HBA1c, BP, LDL) and secondary outcomes improved in both groups Pre and Post ICR as shown in table. Conclusions: Significant improvement in diabetes &amp; ICR outcomes were achieved for both groups after completing ICR. Although long term outcomes are unknown, diabetic patients should continue to participate in ICR for further risk reduction.