Number Of Cardiovascular Risk Factors Research Articles

Characteristics and prognosis of elderly-onset antiphospholipid syndrome: An observational cohort study.

Antiphospholipid syndrome (APS) is an autoimmune disease mainly affecting young individuals. Testing for antiphospholipid antibodies is recommended for young patients who are suspected to have APS. Yet, it is hard to differentiate APS from other acquired thrombophilia disorders in elderly-onset APS patients. This study aim to investigate the characteristics and prognosis of elderly-onset APS. This is an observational cohort study. Thrombotic APS patients who underwent follow-ups between 2009 and 2022 were included. Elderly-onset APS patients (onset age ≥60years) were compared to non-elderly-onset APS patients (onset age <60years) and matched cases of elderly non-APS patients (age ≥60years with thrombosis). A total of 161 APS patients were included in this study, 45 (28.0%) were elderly-onset APS. Stroke (35.6% vs. 18.1%, p = .018) was more common at disease onset in elderly-onset APS patients. Compared to non-elderly-onset patients, elderly-onset APS patients were associated with a higher number of cardiovascular risk factors. Elderly-onset APS patients showed significantly lower positive rate (51.1% vs. 71.6%, p = .014) and ratios [1.24 (1.01-1.38) vs. 1.37 (1.16-1.77), p = .004] of lupus anticoagulant. Elderly-onset APS patients had a significantly higher 10-years cumulative all-cause mortality (p < .001) and APS-related mortality than non-elderly-onset patients (p = .002) and elderly non-APS patients (p = .040). Elderly-onset APS patients have unique disease characteristics with higher 10-years cumulative all-cause mortality and APS-related mortality. Early recognition and control of comorbidities may reduce the recurrence of thrombosis and mortality in elderly-onset APS patients.

Functional capacity evaluation in acute isquemic patients

Abstract Background An acute ischemic event may cause a functional deterioration even in previously autonomous patients. The determination of functional capacity is relevant to determine health indicators for rehabilitation nursing care, allowing at the same time to determine the patient's functional status throughout their health-disease cycle and to prescribe exercise-based rehabilitation for home-based programs. The six-minute walking test is widely used in studies involving cardiac patients, however, reference values for ischemic population after immediate clinical stabilization are not known. Also the 6MWT has a prognostic value for cardiac patients, being of utmost importance to evaluate it, after clinical stabilization in order to properly determine goals for patient´s rehabilitation process. Aim Determine the functional capacity level of ischemic patients, by gender and type of event, after clinical stabilization using the 6-minute walking test. Methods Using the 6-minute walking test, the functional capacity of ischemic inpatients was evaluated at discharge, after clinical stabilization. Patients with acute coronary syndrome with and without ST-segment elevation were included. All patients were accompanied by the rehabilitation nursing team during the in-hospital stay period and performed phase 1 cardiac rehabilitation. The 6MWT was performed based on the 2016 ATS guidelines and the expected value of the distance covered was determined based on the Enright equation. The sample was divided by gender, taking into account their widely known differences in functional capacity and also by event, namely ST elevation and Non ST-segment elevation myocardial infraction. The profile of modifiable cardiovascular risk factors (CRF) was also evaluated, being considered the following: Hypertension, Dyslipidemia, obesity, tobacco, sedentary lifestyle and stress. Results A total of 303 patients were studied (229 male), with a mean age of 62 years (men) and 62 (women). About 36% of men and 7% of women were admitted with ST elevation Myocardial Infraction, with a mean number of cardiovascular risk factors (CVRF) of 3.2 in men and 3.9 in women. The most prevalent CVRF in females is dyslipidemia and sedentary lifestyle, while in males it is dyslipidemia. The sample was divided in two groups by type of event, namely ST-elevation (group A) and NonST-elevation (group B) and in each group, data was evaluated by gender. A statistically significant difference (p&amp;lt;0.01 for males and p&amp;lt;0.02 for female) was found between the value of the 6MWT performed (441.2 meters – males; 369.5 meters - females) compared to the value estimated by the equation (559.9 males; 482.8 female gender). There is a very significant difference between the expected value and the value actually covered in the walking test. It may be pertinent to define reference values for this typology of patients, so that their functional capacity can be properly measured.

Safety of Rimegepant in Adults with Migraine and Cardiovascular Risk Factors: Analysis of a Multicenter, Long-Term, Open-Label Study.

Cardiovascular (CV) risk factors can limit treatment options for migraine. Rimegepant is an orally administered small-molecule calcitonin gene-related peptide receptor antagonist that does not induce vasoconstriction. The aim of these post hoc subgroup analyses was to assess the safety of rimegepant according to CV risk. In a multicenter, long-term, open-label, phase II/III safety study, participants with a history of 2-14 migraine attacks per month of moderate or severe pain intensity self-administered rimegepant 75 mg, orally, to treat migraine up to once daily for up to 52 weeks. Uncontrolled, unstable, or recently diagnosed CV disease was part of the exclusion criteria. Safety was assessed across subgroups according to number of CV risk factors (0, 1, or ≥ 2) and Framingham Risk Score (< 10% or ≥ 10%). Of 1800 treated participants, 28.8% had one CV risk factor and 12.1% had ≥ 2 CV risk factors; 7.0% had Framingham Risk Score ≥ 10%. Across the subgroups with 0, 1, and ≥ 2 CV risk factors and Framingham Risk Score < 10% and ≥ 10%, respectively, proportions of participants reporting adverse events (AEs; 59.6%, 61.4%, 62.2%, 59.9%, 67.5%) and serious AEs (2.7%, 2.5%, 2.3%, 2.6%, 2.4%) were consistent, and AEs leading to study drug discontinuation were low (1.9%, 3.1%, 5.5%, 2.5%, 4.8%). Rimegepant showed favorable safety and tolerability in adults with migraine and CV risk factors, including those with moderate to high CV risk. ClinicalTrials.gov NCT03266588.

Neutrophil/HDL-C, Lymphocyte/HDL-C and Monocyte/HDL-C in subjects with asymptomatic carotid atherosclerosis.

Leukocyte count is a prognostic marker for cardiovascular diseases, with key role in atherosclerosis development. Specific number of neutrophils, lymphocytes and monocytes can predict cardiovascular risk, also in asymptomatic subjects. Among the lipoprotein fractions, HDL-C is a protective factor in the cardiovascular disorders. For the above reason, we have examined the peripheral count of leukocytes, neutrophils, lymphocytes and monocytes, and the ratios between neutrophils/HDL-cholesterol, lymphocytes/HDL-cholesterol, and monocytes/HDL-cholesterol, to evaluate the possible utility of the obtained values in progression of asymptomatic carotid atherosclerosis. We performed our analysis in a cohort of 100 subjects with asymptomatic carotid atherosclerosis, of which 43 men and 57 women. The data were expressed as medians and IQR. To analyse the differences in leukocyte, neutrophil, lymphocyte, monocytes count and their ratio with HDL-cholesterol the Mann-Whitney test was employed. The peripheral count of leukocyte subtypes and the ratios, they change in relation to the number of cardiovascular risk factors and the degree of insulin resistance. In this cohort of subjects, the percentage of observed cardiovascular risk factors significantly affect some leukocyte parameters. These results, allow us to underline the importance of the leukocyte indices in the evaluation of subjects with asymptomatic vascular atherosclerosis.

OBESITY AND VITAMIN D INSUFFICIENCY IN HYPERTENSIVE PATIENTS

Objective: Our objective was to study the association between obesity and vitamin D status and to compare vitamin D levels before and after supplementation according to weight status in hypertensive patients. Design and method: A retrospective cohort study, involving 1455 patients. Student's paired-samples t-test was used to compare vitamin D levels before and after supplementation. The Pearson Correlation “r” test was used to analyze the correlation between vitamin D, anthropometric indices (body mass index (BMI) and waist circumference (WC)) and systole blood pressure (SBP). Results: A negative correlation was noted between the anthropometric indices (BMI and WC) and the vit D level. A highly significant variation was reported between the level of 25(OH) D before and after supplementation (p&lt;0.001), however, the response to vitamin D supplementation in obese patients was significantly lower than in normal weight subjects. The univariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors &gt; 5 (p = 0.07). The multivariate analysis showed a significant association between obesity and male gender (p = 0.02), SBP (p = 0.08), the cumulative number of cardiovascular risk factors &gt; 5 (p = 0.07). presence of obesity (p=0.01) and SBP more 150 mmhg (p=0.03) were predictor factors of poor response to vit D supplementation. Conclusions: Vitamin D deficiency is very common in obese subjects, specific recommendations for supplementation should be adopted according to body weight, diabetes and hypertension.

Divergent Vasodilator Mechanisms to Endothelial-Dependent Agonists with Advancing Age

Introduction: Microvascular function is maintained by a number of vasodilating factors, with nitric oxide (NO) and endothelial hyperpolarizing factors (EDHF) predominating. Advancing age is an independent risk factor in the development of cardiovascular disease, and NO-mediated vasodilation declines, or is unchanged, depending on the vascular bed examined, number of cardiovascular risk factors, or specific endothelial-dependent agonist used. Mechanisms contributing to cutaneous microvascular dysfunction with age have been attributed largely to reductions in NO signaling, but the role of EDHF-mediated dilation, particularly to acetylcholine (ACh), remains unclear. The purpose of this study was to determine the endothelial mechanisms contributing to age-induced cutaneous microvascular function and compare cutaneous microvascular function responses to those from isolated adipose arteriole preparations. We hypothesized that cutaneous microvascular vasodilation to ACh in older adults will be mediated primarily by EDHFs relative to young adults and that isolated adipose arteriole preparations will corroborate these findings. Methods: Four intradermal microdialysis fibers were placed in the skin of the ventral forearm of 9 young (3F/6M; 29±7 yrs) and 3 older adults (3F/0M; 59±11 yrs) for infusion of Ringer’s solution; L-NAME (10 mM), an NO synthase inhibitor; tetraethylammonium chloride (TEA; 50 mM), a non-specific K+ channel inhibitor; and a combination of L-NAME and TEA. Laser Doppler flowmetry and brachial mean arterial pressure were measured during infusion of ACh (10 mM and 100 mM) and in response to local heating to 39°C. Maximal vasodilation was assessed with heating to 43°C and infusion of sodium nitroprusside (28 mM). Adipose resistance arterioles for pressure myography were obtained from a gluteal biopsy or from surgical discard tissue, which were pre-constricted (ET-1), and ACh responses (10−9–10−4 M) were assessed in the presence of the above inhibitors. Cutaneous vascular conductance (CVC) and isolated arteriole responses are presented as % maximum vasodilation. Results: In response to local heating in young adults, L-NAME reduced vasodilator magnitude (Ringers 69.0±18.1% vs. L-NAME 30.3±12.1%; p&lt; 0.05) while TEA did not have any effect (69±18% vs. 49±28%; p=0.20). Combined L-NAME and TEA reduced vasodilation (69±18% vs. 19±6%; p&lt;0.05). Conversely, vasodilator magnitude to ACh was not different across the Ringers, L-NAME, or TEA sites (p=0.93-0.94), while combined inhibition of NOS and K+ channels with L-NAME and TEA, respectively, reduced vasodilator responsiveness (p&lt;0.05). In isolated resistance arterioles, there were no differences in %max dilation to ACh across inhibitor sites (p=0.19) in young adults. In older adults, neither independent nor combined inhibition of NOS or K+ channels impacted vasodilator responses to local heating, while vasodilator magnitude to ACh was most impacted by combined inhibition with L-NAME and TEA (83±14% vs. 32±15%; p&lt;0.05). Conclusion: Our data demonstrate that vasodilator plasticity in response to local heating is divergent with advancing age, relying on non-NO or K+ mechanisms relative to young adults, while NO and K+ mechanisms are suffcient to maintain ACh-mediated vasodilation. These findings further support the concept of diversity in vasodilator mechanisms within the microvasculature. NHLBI K99-HL161491 (WEH), K08-HL150340 (JJM), R01-HL160752 (JKF), R01-HL133029 (AB), and NICHD R01-HD099340 (MJD). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

7-year follow-up atherosclerotic plaque progression in patients with antiphospholipid syndrome versus diabetes mellitus and healthy controls.

Patients with antiphospholipid syndrome (APS) carry a substantial burden of cardiovascular disease and subclinical atherosclerosis. We aimed to assess a 7-year follow-up atherosclerotic plaque progression in APS patients vs diabetes mellitus (DM) and healthy controls (HC). Eighty-six patients with thrombotic APS, 86 with DM and 86 HC (all age- and sex-matched) who underwent a baseline ultrasound of carotid and femoral arteries were invited for a 7-year follow-up ultrasonography examination. We compared atherosclerosis progression among the three groups and examined determinants of plaque progression in APS patients. Sixty-four APS patients (75% females, 43.8% with primary APS), 58 patients with DM and 66 HC were included in the 7-year ultrasound re-evaluation. New plaque was detected in 51.6%, 36.2% and 25.8% of APS, DM and HC subjects, respectively. After adjusting for traditional cardiovascular risk factors (CVRFs) and baseline plaque presence, APS patients showed a 3-fold (OR = 3.07, p= 0.007) higher risk for atherosclerosis progression vs HC and 2-fold (OR = 2.25, p= 0.047) higher risk than DM patients. In multivariate analysis in the APS group, plaque progression was independently associated with systemic lupus erythematosus (SLE) co-existence (OR = 7.78, p= 0.005) and number of CVRFs (OR = 3.02, p= 0.002), after adjusting for disease-related parameters and CVRF-related medications. Sustained low-density lipoprotein target attainment reduced plaque progression risk (OR = 0.34, p= 0.021). Half of APS patients develop new atherosclerotic plaques over a 7-year follow-up, having a three-times higher risk vs HC. Concomitant SLE and number of traditional CVRFs are associated with plaque progression, supporting the need for thorough CVRF assessment and control.

Healthcare resource utilisation and safety outcomes in patients undergoing transcatheter mitral valve repair - A nationwide analysis

Abstract Background Since the publication of the EVEREST II, MITRA-FR and COAPT trials, the domain of transcatheter edge-to-edge repair (TEER) for mitral regurgitation has been rapidly progressing. However, real-world data on peri-procedural outcomes are still limited. Purpose To analyse outcomes of peri-procedural healthcare resource utilisation and in-hospital safety after TEER between 2016 and 2019 in the United States. Methods The US National Inpatient Sample was utilised to identify adult patients undergoing TEER. Primary outcomes (hospital resource utilisation) were hospital length of stay (LOS), hospital costs and adverse discharge disposition to a nursing or rehabilitation facility. Secondary outcomes (safety) were in-hospital mortality, post-procedural bleedings, vascular complications, ischemic strokes, cardiogenic shocks, cardiac arrests and pericardial tamponades. Multivariable regression models were used to analyse outcomes. Results 4,020 adult patients undergoing a TEER procedure were included. The included population was relatively frail: average age of 78.1 years (±9.7), average Charlson Comorbidity Index of 3 [IQR 1-4], average number of cardiovascular risk factors of 3 [2-4] per patient, average CHA2DS2-VASc score of 4 [3-5] and average simplified HAS-BLED score of 2 [2-3]. Distribution of the procedure was balanced between both sexes: 2,159 (53.7%) males vs. 1,861 (46.3%) females. Procedures were predominantly performed in large hospitals with 3,052 cases (75.9%), as well as in regional "hubs" at both US coastal regions with 543 cases (13.5%) in the Middle Atlantic region, 832 cases (20.7%) in the South Atlantic region, 535 cases (13.3%) in the East North Central region and 690 cases (17.2%) in the Pacific region. TEER procedure showed relatively save outcomes: 34 in-hospital deaths (0.8%), 119 (3.0%) post-procedural bleedings, 1 vascular complication requiring surgery, 24 (0.6%) ischemic strokes, 64 (1.6%) cardiogenic shocks, 20 (0.5%) cardiac arrests and 13 (0.3%) pericardial tamponades. Between 2016 and 2019, hospital LOS decreased by 22% [95% Confidence Interval (CI) 0.73-0.83], hospital costs by 6% [95% CI 0.90-0.98] and post-procedural discharge rates to a nursing or rehabilitation facility by 40% [95% CI 0.41-0.88]; each P&amp;lt;0.001 (Figure). Post-procedural bleedings and cardiac arrests were reduced by 55% [95% CI 0.27-0.76] and 87% [95% CI 0.02-0.61] during the study period, respectively. In-hospital mortality, ischemic stroke, cardiogenic shock and pericardial tamponade decreased numerically but were not statistically significant (due to low overall event rates). Of note, there was a linear increase in all adverse outcomes with increasing patient comorbidity level (P for trend &amp;lt;0.001), particularly in patients with atrial fibrillation or flutter. Conclusion TEER procedure has become a safer and more efficient procedure. Careful considerations should be taken when performing the procedure in patients with multiple comorbidities.

Global molecular calcium score: is there a link between sodium fluoride uptake and cardiovascular risk burden?

Abstract Background Sodium fluoride (18F-NaF) uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification both in atherosclerotic plaques and the aortic valve. Purpose We aimed to evaluate global cardiac microcalcification activity with 18F-NaF, as a measure of the microcalcification burden, in high cardiovascular (CV) risk patients. Additionally, as an exploratory endpoint, we evaluated the association between global cardiac microcalcification and diastolic dysfunction. Methods High CV-risk individuals without previous CV events from a single centre were prospectively scanned with 18F-NaF PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS), which was calculated by summing the product of mean standardized uptake value and volume of the region of interest on every slice within the borders of the heart. The result was then divided by the number of slices to adjust for the volume. Results We included sixty-five patients with a mean age of 64.0 ± 9.0 years and 38.5% females. There was a high rate of CV risk factors, including hypertension (95.4%), diabetes (84.6%), dyslipidemia (78.5%), obesity (58.5%), smoking (26.2%) chronic kidney disease (18.5%), and family history of premature coronary disease (9.2%). The mean 10-year risk of fatal and nonfatal cardiovascular events predicted by ASCVD risk score was 30.54 ± 18.4. Median GMCS was 221.42 [IQR 144.55-317.58]. Individuals with &amp;gt; 5 CV risk factors (46.2%) had increased overall GMCS compared to those with a lower number of CV risk factors (295.29, IQR 159.37-356.87 vs 186.16, IQR 122.57-281.78; p=0.03). Thirty-three patients underwent diastolic dysfunction evaluation by echocardiography. All patients had normal left ventricle ejection fraction, mean of 62.86 ± 3.58%. Mean E/A was 0.88 ± 0.27, mean septal e’ velocity 0.07 ± 0.02 m/s, mean lateral e’ velocity 0.08 ± 0.02 m/s, and mean average E/e’ 10.7 ± 3.3. The mean peak tricuspid regurgitation velocity was 2.14 ± 0.59 m/s and the median indexed left atrium volume was 37, IQR 29-44mL/m2. After applying the algorithm for diagnosis of diastolic dysfunction in subjects with normal ejection fraction, 21.2% had diastolic dysfunction and 36.4% had a normal diastolic function, while 42.4% were indeterminate. There was no correlation between echocardiographic variables of diastolic function and GMCS, except for indexed left atrium volume (r = 0.83, p&amp;lt;0.01). There was no association between GMCS and diastolic function categories. Conclusions In a high CV risk cohort, the global cardiac microcalcification assessed by GMCS was associated with the burden of CV risk factors. Additionally, despite a strong positive correlation between GMCS and indexed left atrium volume, we found no association between GMCS and echocardiographic variables of diastolic function.

5-lead 3D-vectorcardiography differentiates between high and low cardiovascular risk profiles in patients with suspected or know coronary heart disease

Abstract 5-lead 3D-vectorcardiography (3D-VCG), including a dorsal electrode with ensemble of artificial neural networks (ANN) offers additional information over standard 12-lead electrocardiography (ECG) in the detection of cardiac ischaemia. Artificial Intelligence (AI) and access to a massive global clinical data repository have the potential to boost the performance of VCG beyond conventional techniques. VCG offers ease-of-use at rest and is therefore a promising candidate for becoming a new screening tool for coronary artery diseases (CAD). We, thus, tested the hypothesis of 3D-VCG being able to differentiate between patients with lower and high risk of cardiovascular disease (CVD) and identify those requiring coronary interventions. In this exploratory study, we analysed patients in a national multicentre trial. Patients were recruited from general cardiologists’ praxis and radiologist centre with patients referred for further diagnosis of suspected or confirmed CVD. Based on the Perfusion (P)-Factor of the 5-lead 3D- vectorcardiography, including 731 parameters, e.g., QRS-T angle and in-house features calculated in time and frequency domains, such as beat moments a P-Index is calculated. Based on the P-Index, patients were either classified as high, medium, or low risk for CVD (medium + high defined as high CVD-risk). Confirmation of CAD was performed according to the practitioners’ discretion blinded to the P-Index. Number of risk factors (mod. PROCAM score) were compared between the high- and low-risk group using an independent t-test. The 468 patients in this sample (m:w 61:39, age: 66 [40-87] years) showed 3.6 [0 - 7] CVRF, 16% had arrhythmias or conduction disturbances (AF, PM, BBB), 24% pts. had consecutive PCI or CABG. 62% were classified as low while 38% were classified as high risk for CVD by the P-Index. Number of cardiovascular risk factors was significantly higher in the high-risk CVD-group as defined by P-Index compared to low CVD-risk (4.0 [3.0 – 5.0] vs. 3.5 [2.0 – 4.0], p &amp;lt; 0.05). P-Index differentiated between suspected CVD with or without consequent PCI or CABG (Chi2 = 4.02, p&amp;lt;0.05). The AI-based 3D-VCG is an innovative diagnostic tool that can help determine a patient's cardiovascular risk profile in resting condition for clinical and research purposes. Furthermore, the P-Index identified those with significant stenoses in need for coronary intervention and may thus be a further scalable screening method to differentiate patients with consequent interventional approach or need for risk modification. These preliminary data will have to be confirmed in a prospective, large-scale performance study to verify the diagnostic accuracy.

Abstract 15181: Sensitivity and Specificity of the Artificial Intelligence-Based 5-Lead 3D Vectorcardiography in Patients With Suspected or Confirmed Coronary Heart Disease

Introduction: Artificial Intelligence-based 5-lead 3D-vectorcardiography (5L3DVCG-AI) offers additional information over 12-lead electrocardiography (ECG) identifying coronary vascular disease (CVD) in need for coronary intervention. Hypothesis: We tested the hypothesis of 5L3DVCG-AI being able to detect patients with mild to overt signs and / or history of CVD. Methods: In this monocentric retrospective study, consecutive data of 331 patients with 5L3DVCG-AI were included. The Perfusion (P)-Factor for cardiac ischaemic pathologies, based on the P-Index including 731 parameters and in-house features calculated in time and frequency domains (e.g. beat moments), classified patients as high, medium or low risk for CVD . Diagnosis of CVD was based upon current guidelines by 2 independent blinded cardiologists and categorised as exclusion of CVD (control), mild signs or overt CVD. The P-Index was validated against clinical CVD. Cardiovascular risk factors (CVRF) were quantified with modified PROCAM score. Results: Of 331 patients (m:w 60:40%, 50.0 ± 19.8 years) of mixed ethnicity and moderate CVRF (2.1 ± 1.2), 71% were controls, 20% had mild signs of CVD and 9% overt CVD. Follow-up period was 16.2 ± 7.5 months. CVRF was significantly higher in CVD compared to controls (2.7 ± 0.5 vs. 2.0 ± 1.2, p&lt;0.05), and P-Factor correlated with number of CVRF (p&lt;0.01), with significantly higher CVRF in higher P-factor (KW p&lt;0.001). P-Factor indicated significantly more often higher risk in CVD compared to controls (0.78 ± 0.4 vs. 0.34 ± 0.48, p&lt;0.01). P-Index from 5L3DVCG-AI at rest differentiated between CVD and controls (Chi2= 6.7, p=0.01). ROC curve showed correlation between P-Index and presence of CVD (R2=0.72, p&lt;0.05). ECG at rest was not able to differentiate between CVD and controls. Conclusions: These data extend the previous findings of 5L3DVCG-AI identifying CVD with cardiac ischaemia from those without to now differentiating healthy controls from CVD and those with higher risk for CVD. 5L3DVCG-AI may thus be a further scalable screening method to identify patients at risk for CVD in need for risk modification or further diagnostic procedures. Ongoing prospective large-scale clinical trials will have to confirm these data to verify diagnostic accuracy.

Abstract 14225: Cardiovascular Structural and Functional Changes Become Apparent With Increased Waist Circumference in Childhood Obesity

Background: Higher waist circumference (WC) is associated with cardiovascular disease, however, little is known about the association between WC and cardiovascular functional change in children. The purpose of this study is to examine the relationships between numbers of cardiovascular risk factors and left ventricular (LV) geometry and function in children. Methods: Echocardiography was performed in 401 children aged 7 to 13 years. Left atrial (LA) diameter, LV end-diastolic volume, ejection fraction, mass, mass-to-volume ratio, and carotid artery intima media-thickness (IMT) were measured. Transmitral peak flow velocities during early and late diastole and mitral annular myocardial velocities during early (Em) and late diastole (Am) were measured. LA systolic force and aortic stiffness were calculated. Lipids, uric acid, fasting glucose, insulin, high sensitive CRP, and homeostasis model assessment for insulin resistance (HOMA-IR) were also assessed. Subjects were divided into 4 groups: A group, WC within normal range; B group, increased WC; C group, increased WC plus any one of the following individual factors of hypertension, dyslipidemia (low high-density lipoprotein-cholesterol and/or high triglyceride), and raised fasting glucose; D group, metabolic syndrome. Results: Compared with the A group, LA diameter, mass/volume ratio, HOMA-IR, and uric acid were greater in the B group (p&lt;0.05 for all). With increasing number of metabolic syndrome disorders (C and D groups), dyslipidemia, increased Hs-CRP, decreased Em/Am, enhanced LA systolic force, increased IMT, and aortic stiffening were observed (Table). Conclusions: Higher WC is associated with insulin resistance, hyperuricemia, and concentric LV hypertrophy. Cardiovascular structural and functional changes become apparent with increasing number of metabolic syndrome disorders. Our findings suggest that primary prevention programs should be initiated in children with increased WC.

The Impact of Cardiovascular Vulnerabilities in Non Hodgkin Lymphoma Patients Treated with Chimeric Antigen Receptor T Cell Therapy

INTRODUCTION: CAR-T therapy is an effective treatment for hematological malignancies. However, in recent years there is a growing body of literature suggesting adverse cardiovascular (CV) events among patients treated with CAR-T therapy. Whether cardiovascular risk factors serve as determinants of CV complications and CAR-T outcomes is unclear. The aim of this study is to investigate the landscape and prognostic role of CV comorbidities in patients with non-Hodgkin lymphoma (NHL) treated with autologous CD19- CAR-T. METHODS: We included patients with NHL treated with CD19-directed CAR-T across two tertiary care centers. Data collected included baseline demographics, CV risk factors, and outcomes. CV disease and risk factors included were: coronary artery disease (CAD), diabetes, hypertension (HTN), sleep apnea, smoking history, and stroke/ transient ischemic attack (TIA). CV events were defined as atrial fibrillation (AF), heart failure (HF), acute coronary syndrome (ACS), and cardiogenic shock. All CV events were adjudicated by a board certified cardiologist. RESULTS: In the cohort of 345 patients, 87% had large B cell lymphoma (LBCL), 4% follicular lymphoma, and 9% mantle cell lymphoma (MCL). Predominant CV vulnerabilities included a history of smoking (41%), HTN (32%), diabetes (12%), sleep apnea (8%), history of CAD (7%), and history of stroke/TIA (5%). Patients were categorized based on number of CV risk factors or CV disease with 37% having 0, 35% with 1, and 28% with 2 or more. A total of 41 (12%) patients experienced a CV event within the first 100 days after CAR-T infusion, with 29 (8.4%) patients developing AF, 15 (4.3%) patients with HF, 2 (0.5%) patients with ACS, and 2 (0.5%) patients with cardiogenic shock. Five patients experienced more than one cardiac event. Univariable logistic regression of CV vulnerabilities revealed that patients with a history of HTN (OR 2.23, 95% CI 1.15-4.33, p = 0.018), 1 CV risk factor (OR 2.57, 95% CI 1.05-6.91) and/or 2 or more CV risk factors (OR 3.67, 95% CI 1.51-9.88) were associated with an increased risk of CV event(s) (global p=0.012). Additional baseline characteristics increasing risk of CV events included older age (OR 1.04, 95% CI: 1.01 - 1.07, p = 0.004), Karnofsky performance scale &amp;lt; 90 (OR 2.31, 95% CI: 1.13-5.12, p = 0.021), or stage III-IV disease (OR 2.90, 95% CI 1.11-9.94, p = 0.028). The 1-year overall survival was 62%, with a trend towards worse overall survival (HR 1.59, 95% CI:1.0-2.54, p=0.053) among patients experiencing CV events (Figure 1). CONCLUSIONS: In this largest analysis to date, we found that patients with NHL treated with CAR-T therapy had a high burden of CV comorbidities that increases their risk of CV events. Given the incidence of CV events and trend towards decreased OS signifies the importance of cardiac evaluation and CV stratification prior to CAR-T therapy. Further investigation is essential to define strategies to mitigate adverse CV complications during treatment.

Cardiovascular Risk Factors and Culprit Plaque Characteristics in Women With Acute Coronary Syndromes

Outcomes after myocardial infarction in women remain poor. The number of cardiovascular risk factors in women increase with age, however the relation between risk factors and culprit plaque characteristics in this population is poorly understood. The aim of the study was to investigate the relation between risk factors and culprit plaque characteristics in women with acute coronary syndrome (ACS). A total of 382 women who presented with ACS and underwent pre-intervention optical coherence tomography imaging of the culprit lesion were included in this analysis. The culprit plaques were categorized as plaque rupture, plaque erosion or calcified plaque, and then stratified by age and risk factors. The predominant pathology of ACS was plaque erosion in young patients (<60years), which decreased with age (p <0.001). Current smokers had a high prevalence of plaque rupture (60%) and lipid plaque (79%). Women with diabetes tended to have more lipid plaque (70%) even at a young age. In women with hyperlipidemia, the prevalence of lipid plaques was modest in younger ages, but rose gradually with age (p <0.001). An increasing age trend for lipid plaque was also observed in women with hypertension (p=0.03) and current smokers (p=0.01). In conclusion, early treatment of risk factors such as diabetes in young women might be important before accelerated progression of atherosclerosis begins as age advances. Clinical trial registration: http://www.clinicaltrials.gov, NCT01110538, NCT03479723 and NCT02041650.

The Role Played by Novel Inflammatory Markers in Assessment of Peripheral Artery Disease.

Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle-brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein-cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions (p = 0.018, p = 0.016). Also, NLR (area under the curve <AUC> = 0.682, p = 0.010) and PLR (AUC = 0.692, p = 0.006) were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD.

HEART Score and Its Implementation in Emergency Medicine Departments in the West Balkan Region-A Pilot Study.

Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score's implementation in West Balkan EDs. A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2-93.4%) and specificity of 46.5% (95%CI 39.9-48.3%) for predicting MACE. This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region.

AWARE A novel web application to rapidly assess cardiovascular risk in type 2 diabetes mellitus

AimTo describe the development of the AWARE App, a novel web application for the rapid assessment of cardiovascular risk in Type 2 Diabetes Mellitus (T2DM) patients. We also tested the feasibility of using this App in clinical practice.MethodsBased on 2019 European Society of Cardiology/European Association for the Study of Diabetes criteria for cardiovascular risk stratification in T2DM, the AWARE App classifies patients into very high (VHCVR), high (HCVR) and moderate (MCVR) cardiovascular risk categories. In this retrospective clinical study, we employed the App to assess the cardiovascular risk of T2DM patients, while also collecting data about current glycaemic control and pharmacological treatment.Results2243 T2DM consecutive patients were evaluated. 72.2% of the patients were VHCVR, 8.9% were HCVR, 0.8% were MCVR while 18.2% did not fit into any of the risk categories and were classified as “moderate-to-high” (MHCVR). Compared with the other groups, patients with VHCVD were more frequently ≥ 65 years old (68.9%), with a longer disease duration (≥ 10 years [56.8%]), a history of cardiovascular disease (41.4%), organ damage (35.5%) and a higher numbers of cardiovascular risk factors. Patients with MHCVD generally had disease duration < 10 years (96%), younger age (50–60 years [55%]), no history of cardiovascular disease, no organ damage, and 1–2 cardiovascular risk factors (89%). Novel drugs such as Glucagon Like Peptyde 1 Receptor Agonists or Sodium-Glucose Linked Transporter 2 inhibitors were prescribed only to 26.3% of the patients with VHCVR and to 24.7% of those with HCVR. Glycaemic control was unsatisfactory in this patients population (HbA1c 7.5 ± 3.4% [58.7 ± 13.4 mmol/mol]).ConclusionsThe AWARE App proved to be a practical tool for cardiovascular risk stratification of T2DM patients in real-world clinical practice.

The association between electrophysiological and neuropsychological measures and cardiovascular disease in patients with Alzheimer’s Disease dementia

AbstractBackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s Disease (AD); however, it is still unclear how these measures relate to the cardiovascular profile of AD patients, and their influence on disease progression and management. Our study examined how electrophysiological and neuropsychological measures are associated with cardiovascular risk factors and the severity of small vessel disease among patients with AD dementia.MethodData were collected using a seven‐electrode COGNISION™ rig in 185 older veterans from the VA Boston Healthcare system memory disorders clinic. EEG/ERP data were recorded while participants completed a three‐tone auditory oddball task. All subjects were administered a neuropsychological battery composed of 8 subtests. Through review of medical history, we selected a subset of patients (N = 46) that met the following criteria: core clinical criteria for probable AD dementia, ≥ 65 years of age, and MMSE score between 20 and 26. We categorized these patients based on their number of cardiovascular risk factors—among hypertension, type 2 diabetes or prediabetes, hypercholesterolemia, and body mass index (BMI) ≥ 25 kg/m2 —and their small vessel disease severity (absent, mild, moderate, or severe). Spearman correlations were computed to assess the association of electrophysiological and neuropsychological measures with the number of cardiovascular risk factors and the severity of small vessel disease.ResultAlpha peak frequency was positively correlated with the number of cardiovascular risk factors (p = .011) and was inversely correlated with small vessel disease severity (p = .029). N100 standard latency was inversely correlated with small vessel disease severity (p = .018). Scores on the verbal phonemic fluency test were inversely correlated with the number of cardiovascular risk factors (p = .014), while scores on the verbal category fluency test were inversely correlated with small vessel disease severity (p = .023).ConclusionAlpha peak frequency, N100, and verbal fluency scores are associated with the number of cardiovascular risk factors and small vessel disease severity in AD patients. Overall, these electrophysiological and neuropsychological measures represent a clinical tool to help characterize the cardiovascular profile of patients with AD dementia, and its contribution to overall disease progression.

HIGH BLOOD PRESSURE IN THE NEWLY DIAGNOSED TYPE 2 DIABETES PATIENTS

Objective: Type 2 diabetes mellitus and hypertension often coexisted in type 2 diabetes patients. Hypertension is often present at the time of diagnosis of type 2 diabetes. Our study aim to evaluate the prevalence of arterial hypertension in newly diagnosed type 2 diabetics and to evaluate the comorbidities associated with hypertension at the time of diagnosis of diabetes. Design and method: Is a prospective study based on 126 newly diagnosed type 2 diabetics, 66 men, and 60 women, aged 45 to 70, hospitalized in Internal Medicine. Blood pressure is taken in consultation according to the recommendations of the ESH, based at least in two consecutive consultations. All patients underwent the assessment of the impact on the target organs, as well as a systematic evaluation for micro and macro-vascular complications. Results: At the time of diagnosis of type 2 diabetes mellitus, the prevalence of arterial hypertension is 56.2%. The patients were already followed for arterial hypertension in 24% of the cases, among them, only 11% considered for therapeutic objectives, and 3% presented with ketosis. Hypertensive diabetics are on average 61.2 years old and have metabolic syndrome in 81.1%. Women are more obese and have a significantly higher waist circumference. Men have higher blood sugar, lower HDL, higher coronary risk, and more frequently present with albuminuria. The level of blood pressure, both systolic and diastolic, rises significantly with the number of metabolic syndrome criteria, and the number of cardiovascular risk factors. We find microangiopathy in 59.1% of cases, and cardiovascular disease in 65.2% of cases. The association of microangiopathy with cardiovascular disease is significantly more frequent in hypertensive diabetics than in non-hypertensives (58% vs 31%, p = 0.005). Conclusions: High blood pressure is very prevalent in newly diagnosed diabetics. The hypertensive diabetic has a higher degree of morbidity, and presents a cardiometabolic profile with a very high cardiovascular risk compared to the non-hypertensive diabetic at the time of diagnosis of diabetes mellitus.

Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction

Although there is an established association between elevated triglyceride (eTG, ≥175 mg/dl) levels and adverse cardiovascular events, some studies have suggested that eTG levels may be linked to neutral or even improved clinical outcomes, particularly among patients with acute myocardial infarction. However, these studies had certain limitations, including small sample sizes, heterogeneous study populations, and inadequate statistical adjustments. To address these limitations, we conducted an analysis of 5347 patients with ST-segment elevation myocardial infarction (STEMI) between March 2003 and December 2020, using a prospective registry-based cohort from two large, regional STEMI centers. We used a triglyceride level of 175 mg/dl as the cutoff point for eTG levels. Of the study participants, 24.5% (n = 1312) had eTG levels. These patients were more likely to be younger, male, and have a higher number of cardiovascular risk factors compared to those with low TG levels. Despite these unfavorable cardiovascular risk profiles, patients with eTG levels had lower unadjusted risks of 1-year major adverse cardiac events (MACE) -a composite of myocardial infarction, stroke, and death- than those with low TG levels (8.8% vs. 11%, p = 0.034). However, after adjusting for certain clinical factors and lipid profile, eTG levels were not associated with a lower 1-year MACE (aHR: 1.10 (0.71–1.70), p = 0.7). In conclusion, a quarter of STEMI patients had eTG levels and these patients had comparable long-term cardiovascular outcomes compared to those with low TG levels after controlling for clinical factors and lipid profile.