Pre-existing Cardiovascular Risk Factors Research Articles

Cardiovascular events in patients receiving immuno-oncology agents, in phase I clinical trials: CAVIO study.

e24009 Background: Among immunoncology agents (IO), immune checkpoint inhibitors are the most used, demonstrating survival benefit across multiple cancer types. Adverse events are often reported with IO; cardiotoxicity is rare, but potentially fatal. CAVIO study evaluated the occurrence of cardiovascular events (CVE) in patients receiving IO in phase I clinical trials (ph1CT). Methods: We retrospectively reviewed clinical and cardiological data of patients consecutively enrolled, from Jan2016 to Dec2021, in ph1CT with IO alone or in combination. Any type and grade of CVE occurred on treatment, related or not to IO, was evaluated. Fisher’s exact tests were used to compare variables. Cox regression and Kaplan Meier methods were used for multivariable analyses and estimating overall survival (OS). Hazard ratio (HR) and 95% confident interval (CI) were calculated. Results: 211 patients were included; median age was 57 years. The most frequent site of primary tumor was breast (25%). 43 of 211 patients experienced ≥1 CVE of any grade (G) during the treatment, of which < 1% G3 and none ³G4. The most frequent ones were hypertension (n = 20, 9%) and thrombosis (n = 15, 7%), only one myocarditis (2%). Table 1 shows the significant differences observed between patients experiencing CVE or not. The occurrence of CVE was not associated with pre-existing cardiovascular risk factors nor with number of prior therapy lines. The median progression free survival (mPFS) and mOS were 2 and 9 months respectively, regardless the CVE occurrence. Patients using anticoagulant at the end of ph1CT showed worse PFS and OS (1.8 and 5.4m) than those who did not (2.5 and 11.1m), similarly was for PS ECOG 1 vs 0. The result was consistent at the multivariate model adjusted for the primary site of tumor, PS ECOG, previous lines of treatment and age, in which PS ECOG 1 and the use of anticoagulant remained statistically significant associated with negative OS (for PSECOG: HR:1.84, 95% CI 1.31-2.57, p < 0.001; for anticoagulant use: HR: 1.72, 95%CI:1.20-2.47, p:0.003). Conclusions: The occurrence of CVE did not change the outcomes of patients treated with IO in ph1RC. Severe CVE were rare, hypertension being the most frequent. Further data are needed on the correlation of anticoagulant use, IO and patients prognosis. [Table: see text]

Left Ventricular Trabeculations at Cardiac MRI: Reference Ranges and Association with Cardiovascular Risk Factors in UK Biobank.

Background The extent of left ventricular (LV) trabeculation and its relationship with cardiovascular (CV) risk factors is unclear. Purpose To apply automated segmentation to UK Biobank cardiac MRI scans to (a) assess the association between individual characteristics and CV risk factors and trabeculated LV mass (LVM) and (b) establish normal reference ranges in a selected group of healthy UK Biobank participants. Materials and Methods In this cross-sectional secondary analysis, prospectively collected data from the UK Biobank (2006 to 2010) were retrospectively analyzed. Automated segmentation of trabeculations was performed using a deep learning algorithm. After excluding individuals with known CV diseases, White adults without CV risk factors (reference group) and those with preexisting CV risk factors (hypertension, hyperlipidemia, diabetes mellitus, or smoking) (exposed group) were compared. Multivariable regression models, adjusted for potential confounders (age, sex, and height), were fitted to evaluate the associations between individual characteristics and CV risk factors and trabeculated LVM. Results Of 43 038 participants (mean age, 64 years ± 8 [SD]; 22 360 women), 28 672 individuals (mean age, 66 years ± 7; 14 918 men) were included in the exposed group, and 7384 individuals (mean age, 60 years ± 7; 4729 women) were included in the reference group. Higher body mass index (BMI) (β = 0.66 [95% CI: 0.63, 0.68]; P < .001), hypertension (β = 0.42 [95% CI: 0.36, 0.48]; P < .001), and higher physical activity level (β = 0.15 [95% CI: 0.12, 0.17]; P < .001) were associated with higher trabeculated LVM. In the reference group, the median trabeculated LVM was 6.3 g (IQR, 4.7-8.5 g) for men and 4.6 g (IQR, 3.4-6.0 g) for women. Median trabeculated LVM decreased with age for men from 6.5 g (IQR, 4.8-8.7 g) at age 45-50 years to 5.9 g (IQR, 4.3-7.8 g) at age 71-80 years (P = .03). Conclusion Higher trabeculated LVM was observed with hypertension, higher BMI, and higher physical activity level. Age- and sex-specific reference ranges of trabeculated LVM in a healthy middle-aged White population were established. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kawel-Boehm in this issue.

Aromatase Inhibitors and Plasma Lipid Changes in Postmenopausal Women with Breast Cancer: A Systematic Review and Meta-Analysis.

Background: Women are typically diagnosed with estrogen receptor-positive breast cancer around the postmenopausal period when declining estrogen levels initiate changes in lipid profiles. Aromatase inhibitors (AI) are used to prevent the progression of cancer; however, a further reduction in estrogen levels may have detrimental effects on lipid levels, which was our working hypothesis. Methods: Our meta-analysis was conducted on the lipid profiles of postmenopausal breast cancer patients at baseline and at different treatment time points. Results: We identified 15 studies, including 1708 patients. Studies using anastrozole (ANA), exemestane (EXE), letrozole (LET), and tamoxifen (TMX) were involved. Subgroup analyses revealed that 3- and 12-month administrations of LET and EXE lead to negative changes in lipid profiles that tend to alter the lipid profile undesirably, unlike ANA and TMX. Conclusions: Our results suggest that, despite statistically significant results, EXE and LET may not be sufficient to cause severe dyslipidemia in patients without cardiovascular comorbidities according to the AHA/ACC Guideline on the Management of Blood Cholesterol. However, the results may raise the question of monitoring the effects of AIs in patients, especially those with pre-existing cardiovascular risk factors such as dyslipidemia.

Long-term cardiovascular assessment of women who had a pregnancy complicated by a hypertensive disorder.

Women with hypertensive disorders of pregnancy (HDP) are at increased risk of developing hypertension and cardiovascular disease later in life. However, from studies so far, it is difficult to define whether this association reflects preexisting maternal cardiovascular risk or merely reflect a potentially causal relationship between HDP and later cardiovascular risk. We performed detailed cardiovascular assessment in women at mid-gestation, prior to development of a HDP and at 2 years post-partum aiming to identify cardiovascular changes prior to development of HDP and to assess persistent cardiovascular alterations long after the HDP event. This was a prospective observational study in which we performed detailed cardiovascular assessment at mid-gestation and at median of 2.3 years (interquartile range 2.1 to 2.4 years) post-partum. We examined 112 women who developed a HDP and 451 women whose pregnancy was not complicated by hypertension. We used conventional and more advanced echocardiographic techniques, i.e. speckle tracking, to accurately determine left ventricular systolic and diastolic function. We used M-mode measurements to determine left ventricular remodeling and estimate left ventricular mass. Maternal vascular status was assessed using ophthalmic artery Doppler and by calculating peak systolic velocity (PSV) ratio, as a marker of peripheral vascular resistance. At mid-gestation, women who subsequently developed HDP had increased ophthalmic artery PSV ratio. These women also had mild cardiac functional and morphological alterations which were mostly accounted for by maternal cardiovascular risk factors. At 2 years post-partum, women who experienced HDP, compared to those who did not, had cardiovascular abnormalities with reduction in left ventricular systolic and diastolic function which remained after multivariable analysis. Longitudinal analysis demonstrated that the evolution of cardiovascular changes in the HDP and non-HDP groups was similar. Mild cardiac functional and morphological alterations precede the development of HDP and such changes persist for at least 2 years postpartum. The cardiac changes are likely to be the consequence of preexisting maternal cardiovascular risk factors rather than an adverse consequence of HDP. This article is protected by copyright. All rights reserved.

Upadacitinib for the treatment of moderate-to-severe Crohn's disease.

Despite an increasing number of therapies for Crohn's disease (CD), half of patients do not respond to initial treatment or lose response over time, highlighting the need for novel therapies. Inhibition of Janus kinases (JAKs) hasemerged as an important therapeutic target for CD. Upadacitinib is an orally administered selective JAK1 inhibitor, which is effective for the induction and maintenance of remission in moderately-to-severely active CD, including in patients with prior failure of biological therapy. Nonselective JAK inhibition has been associated with thromboembolic disease, cardiovascular eventsand malignancy in patients older than 50years with rheumatoid arthritis and pre-existing cardiovascular risk factors, which should be considered upon prescription. Upadacitinib is the first and currently only oral advanced therapy for CD.

COVID-19 outcomes in patients with pre-existing cardiovascular disease and risk factors: perspectives from a hospital in Ireland

Background/Aims COVID-19 has led to substantial changes in the provision of emergency healthcare services. International data suggest that COVID-19 is associated with increased morbidity and mortality in patients with pre-existing cardiovascular disease and cardiovascular risk factors. This study aimed to explore the association between pre-existing cardiovascular disease and/or cardiovascular risk factors and COVID-19 disease severity and outcomes in an Irish hospital. Methods This retrospective study obtained data from a bioresource database of patients with confirmed COVID-19 infection (n=649) in a large hospital in Dublin. Data were collected on patients' demographic characteristics, cardiovascular diseases, cardiovascular disease risk factors and medications taken for cardiovascular conditions. The World Health Organization progression scale was used to assess the severity of COVID-19 infection in each patient. Cross-tabulation analysis was used to analyse associations between variables, with a P value of ≤0.05 indicating significance. Results Mortality rates were six times greater in patients with cardiovascular disease compared to those without cardiovascular disease (18.6% vs 3.1%). A higher percentage of patients with one or more cardiovascular risk factors had moderate (53.4%) or severe (19.1%) COVID-19 and higher mortality rates (10.7%) than those without cardiovascular risk factors. Of the patients who died from COVID-19 (n=40), 60.0% (n=24) had one or more cardiovascular diseases, while 80.0% (n=32) had one or more cardiovascular risk factors. Conclusions Existing cardiovascular disease and cardiovascular risk factors increase the risk of more severe disease and worse clinical outcomes in patients with COVID-19. Many cardiovascular risk factors are modifiable, so it is important to consider preventative education strategies designed to reduce modifiable risk factors to improve outcomes for patients with COVID-19.

Association of Left Ventricular Myocardium Dose Exposure with Heart Failure in Lung Cancer Radiotherapy

The volume of left anterior descending (LAD) coronary artery dose receiving 15 Gy (LAD V15 Gy) has been associated with major adverse cardiac events (MACE; a composite endpoint of unstable angina, heart failure hospitalization/urgent visit, myocardial infarction, coronary revascularization, and cardiac death) and mortality in patients with locally advanced non-small cell lung cancer (LA-NSCLC) following radiotherapy (RT). With growing evidence supporting specific cardiac substructure dose exposure with distinct pathophysiologic cardiac endpoints, our objective was to assess whether RT dose to the left ventricular myocardium (LVM) was associated with the specific cardiac endpoints of heart failure (HF) vs. overall MACE. Retrospective analysis of 701 patients with LA-NSCLC treated with RT between 2003 and 2014. LAD was segmented manually, while LVM (excluding blood pool) was segmented using an open-source deep learning-based automated algorithm (TotalSegmentator; Wasserthal et al, 2022) and dosimetric parameters (mean, max, and VX Gy in 5 Gy increments) collected. HF was defined as any grade ≥3 Common Terminology Criteria for Adverse Event (CTCAE) HF or cardiomyopathy. Receiver operating curve and cut-point analyses estimating HF were performed. Fine and Gray and Cox regressions, adjusting for preexisting cardiovascular (CV) risk factors and other prognostic factors, were calculated. Of 701 patients, the median age was 65 years (interquartile range [IQR], 57-73), 51% were men. At a median follow up of 20 months (IQR, 8-45) following RT, there were 64 HF events. The median time to HF was 20 months (IQR, 9-43), with a 2-year cumulative incidence of 5.2%. The optimal cut-point for the LVM dose variable with the highest C-index predicting HF was LVM V10 Gy ≥10% (.58). By LVM V10 Gy cut point ≥10% vs <10%, the 2-year HF cumulative incidence was 7.2% vs 4.0% (p = .005). Adjusting for baseline CV risk, there was an increased risk of HF with LVM V10 Gy ≥10% (vs. <10%) (subdistribution hazard ratio [SHR] 2.81; 95% confidence interval [CI], 1.02-7.70; p = .045), but not LAD V15 Gy ≥10% (p>.3). Conversely, adjusting for baseline CV risk, there was an increased risk of MACE with LAD V15 Gy ≥10% (SHR = 19.70; 95% CI = 2.57-151.35; p = 0.004), but not LVM V10 Gy ≥10% (p>0.3). On all-cause mortality analysis, adjusting for CV and other prognostic factors, LAD V15 Gy ≥10% (HR = 1.4; 95% CI = 1.02-1.80; p = 0.036), but not LVM ≥10% (p>0.5), remained significantly associated with mortality. Left ventricular myocardium V10 ≥10%, is associated with the specific endpoint of HF, but not overall MACE, while LAD V15 ≥10% remained strongly associated with MACE and all-cause mortality, but not HF. These findings underscore the need to study the interaction between RT dose to specific substructures (i.e., myocardium) and pathophysiologically relevant cardiac endpoints (i.e., HF).

Association between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in hospitalised patients with COVID-19.

Pre-existing cardiovascular disease and cardiovascular risk factors are common in patients with COVID-19 and there remain concerns for poorer in-hospital outcomes in this cohort. We aimed to analyse the relationship between pre-existing cardiovascular disease, mortality and cardiovascular outcomes in patients hospitalised with COVID-19 in a prospective, multicentre observational study. This prospective, multicentre observational study included consecutive patients of age ≥18 in their index hospitalisation with laboratory-proven COVID-19 in Australia. Patients with suspected but not laboratory-proven COVID-19 and patients with no available past medical history were excluded. The primary exposure was pre-existing cardiovascular disease, defined as a composite of coronary artery disease, heart failure or cardiomyopathy, atrial fibrillation or flutter, severe valvular disease, peripheral arterial disease and stroke or transient ischaemic attack. The primary outcome was in-hospital mortality. Secondary outcomes were clinical cardiovascular complications (new onset atrial fibrillation or flutter, high-grade atrioventricular block, sustained ventricular tachycardia, new heart failure or cardiomyopathy, pericarditis, myocarditis or myopericarditis, pulmonary embolism and cardiac arrest) and myocardial injury. 1,567 patients (mean age 60.7 (±20.5) years and 837 (53.4%) male) were included. Overall, 398 (25.4%) patients had pre-existing cardiovascular disease, 176 patients (11.2%) died, 75 (5.7%) had clinical cardiovascular complications and 345 (37.8%) had myocardial injury. Patients with pre-existing cardiovascular disease had significantly increased in-hospital mortality (aOR: 1.76 95% CI: 1.21-2.55, p = 0.003) and myocardial injury (aOR: 3.27, 95% CI: 2.23-4.79, p < 0.001). There was no significant association between pre-existing cardiovascular disease and in-hospital clinical cardiovascular complications (aOR: 1.10, 95% CI: 0.58-2.09, p = 0.766). On mediation analysis, the indirect effect and Sobel test were significant (p < 0.001), indicating that the relationship between pre-existing cardiovascular disease and in-hospital mortality was partially mediated by myocardial injury. Apart from age, other cardiovascular risk factors such as diabetes, hypercholesterolemia and hypertension had no significant impact on mortality, clinical cardiovascular complications or myocardial injury. Pre-existing cardiovascular disease is associated with significantly higher mortality in patients hospitalised with COVID-19. This relationship may be partly explained by increased risk of myocardial injury among patients with pre-existing cardiovascular disease which in turn is a marker associated with higher mortality.

RISCO DE MORTE SÚBITA CARDÍACA E EFEITOS ADVERSOS CARDIOVASCULARES ASSOCIADOS AO USO DE ANTIDEPRESSIVOS

Introduction: Treatment of depression / depressive disorder requires effective therapeutic agents, well tolerated and with a low rate of complications and adverse events. However, some antidepressants(AD)have been associated with an increased risk of sudden cardiac death (SCD) and general and cardiovascular adverse events, important in daily clinical practice. Objective: Raise possible adverse cardiovascular events and risk of SCD associated with AD use in adult patients. Additionally, investigate general adverse effects, action mechanisms and main risk drug interactions with AD and guidelines for monitoring / optimized clinical management of patients. Methodology: integrative review aiming, from scientific literature, to collect information regarding the objectives of this review in the main databases: PubMed; Lilacs; Google Scholar; Brazilian´s Health Ministry. Selection criteria were: meta-analysis articles, systematic review, review, guidelines, consensus and observational studies (cohort studies, case-control or cross-sectional studies) and randomized control studies, published between 2010 and April 2023. Results: 173 publications were selected allowing verify which patients had high risk for developing adverse cardiovascular events associated with the use of AD: elderly; preexisting cardiovascular risk factors; patients with comorbidities (mainly acute and/or chronic coronary artery disease, heart failure and renal failure); CYP450 poor/slow metabolizers; previous history of ventricular arrhythmias or syncope; carriers of channelopathies; family history of long QT syndrome, sudden death, diabetes mellitus and arterial hypertension; polypharmacy; AD use in high doses; electrolyte abnormalities (eg: hypokalemia, hypomagnesaemia, etc.). Studies demonstrated that selective serotonin reuptake inhibitors had a relative risk of SCD of 2.39 (95%CI 1.20-4.80) while tricyclic ADs risk ranging from 1.69 (95%CI 1.14-2.50) at 4.37 (95%CI 1.23-15.60). We summarized the risk information in tables and charts with recommendations from main studies and guidelines regarding the clinical management, monitoring and management of adverse events. Conclusion: Although the use of ADs has recognized general and cardiovascular adverse effects, their risks shouldn´t deprive patients of appropriate therapy for psychiatric disorders, including those with cardiovascular diseases. The available literature data allow adopting screening of patients who need the use of DA, monitoring treatment and adopting effective preventive measures to reduce the risk of possible complications.

The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease.

Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences. The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women. A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P=.02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years. In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.

Association between cardiovascular risk and coronavirus disease 2019: findings from 2021 National Health Interview Survey

PurposeTo examine the association between pre-existing cardiovascular disorders and the risk of coronavirus disease 2019 (COVID-19) among community-dwelling adults in the United States. MethodsWe analyzed data from the 2021 National Health Interview Survey, encompassing 28,848 nationally representative participants aged ≥18. We examined the association by two age groups, younger adults (aged 18-59) and older adults (aged ≥60). Weighted analyses were conducted to consider the complex sampling design used in the National Health Interview Survey. ResultsThe results show that 13.9% of younger and 8.2% of older adults were infected with coronavirus, corresponding to a nationwide estimate of 23,701,358 COVID-19 cases in younger adults and 6310,206 in older adults in 2021. Pre-existing cardiovascular risk factors (overweight, obesity, hypertension, and diabetes) in both age groups and pre-existing cardiovascular diseases (angina, heart attack, and coronary heart disease) in older adults were significantly associated with COVID-19 infection. Significant dose-response relationships existed between increased pre-existing cardiovascular risk factors and COVID-19 infection, with the strongest association in non-Hispanic Black, followed by Hispanic ethnicities and non-Hispanic White. ConclusionsPre-existing cardiovascular disorders are significantly associated with the risk of COVID-19 infection. The magnitudes of this risk association are more substantial among minority populations.

Abstract P396: A Culturally Tailored Mobile Health Lifestyle Intervention Improves Cardiovascular Health Among African Americans With Preexisting Risk Factors

Background: African-American (AA) adults have a higher prevalence of cardiovascular (CV) risk factors, leading to higher CV disease mortality than White adults. Prior findings of our mobile health (mHealth) lifestyle intervention (FAITH! App) demonstrated efficacy in promoting ideal cardiovascular health (CVH) in AAs. Hypothesis: We hypothesized that the intervention group with preexisting CV risk factors would have a greater increase in LS7 scores than the control group with the same risk factors following use of the FAITH! App. Methods: A cluster randomized controlled trial was conducted among AAs from 16 churches in Minnesota. The intervention included culturally relevant, LS7-focused education modules, diet/physical activity self-monitoring and a group sharing board. A subgroup of participants with ≥1 diagnosis of overweight/obesity, hyperlipidemia, hypertension (HTN) or diabetes was examined. The primary outcome was change in LS7 score—a measure of CVH ranging from poor to ideal (range 0-14 points)—at 6 months post-intervention. Results: Forty-nine participants (75.5% female) were included in the intervention (n=20; mean age [SD]: 58.8 [9.5]) or control (n=29, mean age [SD]: 52.5 [10.7]) groups (Table 1). There was no significant difference in the CV risk factor prevalence between the two groups. There was a greater increase in LS7 score in the intervention vs. control group across all CV risk factors, with significant differences among those with overweight/obesity (1.77, p&lt;.0001) and with 2+ or 3+ CV risk factors (1.00, p=.03; 1.09, p=.04). Compared to the control group, the increase in the percentage of participants with ideal LS7 scores in the intervention group was higher among those with overweight/obesity, HTN, diabetes and 3+ CV risk factors. Conclusions: Our culturally tailored mHealth lifestyle intervention was associated with notable increases in LS7 scores among AAs with preexisting CV risk factors, suggesting its efficacy in improving CVH among this population.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis.

Tofacitinib was the first Janus kinase inhibitor to be approved for the treatment of rheumatoid arthritis (RA), and there is a large body of data to inform the efficacy and safety of this drug for patients at different places in their treatment journeys and with diverse demographics and characteristics. Here, we summarize tofacitinib clinical efficacy and safety data from some clinical trials, post hoc analyses, and real-world studies, which provide evidence of the efficacy of tofacitinib in treating patients with RA at various stages of their treatment journeys, and with differentiating baseline characteristics, such as age, gender, race, and body mass index. In addition, we review the safety data available from different patient subpopulations in the tofacitinib clinical development program, real-world data, and findings from the ORAL Surveillance post-marketing safety study that included patients aged ⩾50 years with pre-existing cardiovascular risk factors. The available efficacy and safety data in these subpopulations can enable better discussions between clinicians and patients to guide informed decision-making and individualized patient care.

Association of Rituximab With Risk of Long-term Cardiovascular and Metabolic Outcomes in Patients With Pemphigus

The association of different therapeutic approaches with long-term cardiovascular and metabolic outcomes in patients with pemphigus remains to be precisely evaluated. To assess the risk of long-term cardiovascular and metabolic outcomes and all-cause mortality in patients with pemphigus managed by rituximab compared with those receiving treatment with first-line corticosteroid-sparing agents (azathioprine and mycophenolate mofetil [MMF]). A global population-based retrospective cohort study compared 961 patients with pemphigus that was managed with rituximab with those treated with azathioprine or MMF (n = 961) regarding the risk of several cardiovascular and metabolic outcomes. Propensity score matching was performed to optimize comparability. Patients were enrolled from the Global Collaborative Network of TriNetX platform. Risk of myocardial infarction, stroke, peripheral vascular disease, pulmonary embolism, hypertension, hyperlipidemia, type 2 diabetes, obesity, osteoporosis, and avascular bone necrosis. Of 1602 participants, 855 (53.4%) were women and 747 (46.6%) were men; the mean (SD) age was 54.8 (16.6) years for those treated with rituximab and 54.4 (18.2) years for those treated with azathioprine or MMF. Compared with those treated by azathioprine/MMF, patients treated with rituximab experienced a lower risk of myocardial infarction (relative risk [RR], 0.45; 95% CI, 0.24-0.86; P = .01), stroke (RR, 0.42; 95% CI, 0.26-0.69; P < .001), peripheral vascular disease (RR, 0.47; 95% CI, 0.28-0.79; P = .003), hypertension (RR, 0.48; 95% CI, 0.38-0.63; P < .001), hyperlipidemia (RR, 0.45; 95% CI, 0.32-0.64; P < .001), type 2 diabetes (RR, 0.63; 95% CI, 0.51-0.77; P < .001), obesity (RR, 0.49; 95% CI, 0.34-0.72; P < .001), and osteoporosis (RR, 0.46; 95% CI, 0.30-0.71; P < .001). The all-cause mortality was comparable between patients in both groups (hazard ratio, 0.94; 95% CI, 0.62-1.43; log-rank P = .77). The results of this cohort study suggest that rituximab was associated with protection against long-term cardiovascular and metabolic outcomes compared with conventional immunosuppressants. This agent might be particularly preferred in individuals with preexisting cardiovascular and metabolic risk factors.

Abstract 12171: Cardiovascular Events in Chimeric Antigen Receptor T-Cell Therapy Recipients With Pre-Existing Cardiac Dysfunction

Introduction: Cytokine release syndrome (CRS) and associated cardiovascular (CV) events are common following infusion of chimeric antigen receptor T cell therapy (CAR-T). There are no data characterizing whether CAR-T recipients with a pre-existing cardiac dysfunction (LVEF &lt;53%) are at increased risk for CV events following CAR-T. Hypothesis: We hypothesized that cardiac dysfunction would be associated with a higher rate of CV events following CAR-T infusion. CV events were defined as a composite of cardiogenic shock, clinical heart failure, myocardial infarction, or arrhythmia. Methods: Patients in a multi-center registry of adult CAR-T recipients with a known baseline LVEF were included (n=241). Covariates included standard baseline CV and cancer parameters. Results: In total, 22 (9%) CAR-T patients had a pre-existing cardiac dysfunction. Those with and without [219 (91%)] baseline cardiac dysfunction were similar in age, gender, pre-existing CV risk factors, and ECOG performance status. LVEF among patients with cardiac dysfunction ranged from 25%-52%. There was no difference in prior anthracycline use, cancer type or burden, but cardiac dysfunction patients had higher rates of prior radiation (36% vs 16%, p=0.02). Cardiac dysfunction patients received less investigational CAR-T (9% vs 31%, p=0.03), more tisagenlecleucel (36% vs 18%, p=0.04), and had similar rates of axicabtagene ciloleucel and lisocabtagene maraleucel. There was no difference in mean CRS grade, rate of ≥2 grade CRS, or in tocilizumab or steroids use between those with and without cardiac dysfunction. During a median follow-up of 294 (IQR 123-661) days, 60 (25%) patients experienced CV events with more events in patients with cardiac dysfunction (63% vs 21%, p&lt;0.001). In a Cox model adjusted for covariates identified in univariate analyses, baseline cardiac dysfunction was independently associated with an increased CV events risk (adjusted HR: 4.9, 95% CI 2.54–9.61, p&lt;0.001) Conclusions: CAR-T recipients with pre-existing cardiac dysfunction experience more CV events despite similar rates of CRS.

AML-382 Cardiovascular Disease and Diabetes Mellitus Impact Outcomes of Patients With Acute Myeloid Leukemia

Incidence of both cardiovascular disease (CVD) and acute myeloid leukemia (AML) increases with age, and patients with AML more frequently have preexisting diabetes mellitus (DM), congestive heart failure, and myocardial infarction than non-cancer patients. We examined the influence of preexisting CVD and cardiovascular risk factors on the clinical outcomes of patients with AML. A total of 291 adult patients with AML with available smoking history treated at the University of Maryland Greenebaum Comprehensive Cancer Center 2014-2020 were reviewed retrospectively. Comorbidities identified through chart review were analyzed individually. Fisher's exact and t-tests were used to compare on-study characteristics and the outcomes of patients with and without CVD. Response rate (CR, CRi), overall survival (OS), and cumulative incidence of relapse were evaluated. OS was estimated by the Kaplan-Meier method. The multivariable logistic regression model was used to estimate the probability of achieving the best response. One-third of patients (34%) had preexisting CVD at AML diagnosis. Patients with CVD were more likely to have worse performance status and secondary AML (both P=0.03) and receive hypomethylating agent (HMA)-based induction therapy (72% vs. 38%, P<0.001). With a median follow-up of 40 months, CVD was associated with a lower probability of achieving CR or CRi (0.45 vs. 0.71, P<0.001). Having DM was independently associated with a worse response to treatment accounting for other on-study characteristics (OR=0.24, 95% CI: 0.08-0.80, P=0.01). Accounting for age, performance status, presence of complex karyotype, or secondary disease and treatment, CVD patients had worse OS than non-CVD patients (HR=1.5, 95% CI: 1.1-2.2, P=0.002), with 1- and 3-year OS of 44% versus 67% and 25% versus 40%, respectively (HR=1.9, 95% CI: 1.4-3.5, P<0.001), but no difference in cumulative incidence of relapse. Smoking did not impact OS (P=0.7). Sixty-two patients (21%) received allogeneic stem cell transplants, including 27% with preexisting CVD, and these patients had a worse OS (HR=2, 95% CI: 1-3.9). AML patients with CVD and those with DM have worse treatment outcomes and survival. Further clinical studies are required to understand the impact of CVD on the outcomes of AML patients.

Clinical experience of a cardio-oncology consultation at a tertiary university hospital in Portugal: An observational study

IntroductionHeart disease and cancer are the two leading causes of morbidity and mortality worldwide. Advances in cancer screening and management have led to longer survival and better quality of life. Despite this progress, many cancer patients experience cardiovascular complications during and after cancer treatment. This study describes the experience of a cardio-oncology program at tertiary academic hospital. MethodsIn this retrospective observational study, cancer patients referred to the CHULN cardio-oncology consultation (COC) between January 2016 and December of 2019 were included. Data collected included: patient demographics, cancer type, reason for referral, cardiovascular risk factors, cardiac and oncologic treatments and clinical outcomes. ResultsA total of 520 patients (mean age: 65 ± 14 years; 65% women) were referred to the COC. The main reasons for referral were suspected heart failure (26%), pre-high risk chemotherapy assessment (20%) and decreased LVEF (15%). Pre-existing cardiovascular risk factors were common (79%) and 309 (59%) were taking cardiac medications. The most common type of malignancy was breast cancer (216, 41%) followed by gastrointestinal (139, 27%). More than half received anthracycline-based regimens (303, 58%). Most patients (401; 77%) successfully completed cancer therapy. At the time of last data collection, the majority of patients were alive (430, 83%). Cardiac-related mortality was observed in 16%. ConclusionsThe close collaboration between cardiology and oncology teams and timely cardiac monitoring was the key to the majority of patients to completing their prescribed cancer therapy.

Electrocardiographic Abnormalities in Hospitalized Patients with COVID-19 and the Associations with Clinical Outcome

The cardiovascular (CV) system can often be affected during SARS-CoV-2 infection and several acute manifestations, such as myocardial infarction, pericarditis, myocarditis and arrhythmias have been described. We provide a retrospective overview of electrocardiographic (ECG) features and their relationship with clinical outcomes in a cohort of patients admitted to our COVID-19 Unit between November 2020 and May 2021. Resting standard 12-lead ECGs were performed in all patients at admission and in those recovering from SARS-CoV-2 infection also at discharge. Clinical and serological records alongside ECG measurements were retrospectively evaluated and statistical analysis was performed to identify relationships between variables. A total of 123 patients (44% females) with a mean age of 73.9 years were enrolled. Ninety-five (77%) patients recovered from SARS-CoV-2 infection and were discharged while 28 (23%) died in hospital. Almost 90% of patients displayed at least one CV risk factor and 41 (33%) patients had at least one previous CV event. We observed that heart rate, corrected QT interval dispersion (QTcd) and inverted T waves are independently associated with in-hospital death and inverted T waves show the strongest association. This association remained significant even after correcting for the number of CV risk factors at baseline and for the type of CV risk factor at baseline. Our study demonstrated that some ECG abnormalities at admission are independently associated with in-hospital death regardless of pre-existing CV risk factors. These findings may be of particular relevance in clinical settings with limited access to advanced techniques, such as cardiac magnetic resonance and could help improve the outcomes of patients with cardiac involvement related to SARS-CoV-2 infection.

Cardiovascular risk factors, radiation therapy, and myocardial infarction among lymphoma survivors

Background Mediastinal radiation is associated with increased risk of myocardial infarction (MI) among non-Hodgkin lymphoma (NHL) survivors. Objective To evaluate how preexisting cardiovascular risk factors (CVRFs) modify the association of mediastinal radiation and MI among a national population of NHL survivors with a range of CVRFs. Material and methods Using Danish registries, we identified adults diagnosed with lymphoma 2000–2010. We assessed MI from one year after diagnosis through 2016. We ascertained CVRFs (hypertension, dyslipidemia, and diabetes), vascular disease, and intrinsic heart disease prevalent at lymphoma diagnosis. We used multivariable Cox regression to test the interaction between preexisting CVRFs and receipt of mediastinal radiation on subsequent MI. Results Among 3151 NHL survivors (median age 63, median follow-up 6.5 years), 96 were diagnosed with MI. Before lymphoma, 32% of survivors had ≥1 CVRF. 8.5% of survivors received mediastinal radiation. In multivariable analysis, we found that mediastinal radiation (HR = 1.96; 95% CI = 1.09–3.52), and presence of ≥1 CVRF (HR = 2.71; 95% CI = 1.77–4.15) were associated with an increased risk of MI. Although there was no interaction on the relative scale (p = 0.14), we saw a clinically relevant absolute increase in risk for patients with CVRF from 10-year of MI of 10.5% without radiation to 29.5% for those undergoing radiation. Conclusion Patients with CVRFs have an importantly higher risk of subsequent MI if they have mediastinal radiation. Routine evaluation of CVRFs and optimal treatment of preexisting cardiovascular disease should continue after receiving cancer therapy. In patients with CVRFs, mediastinal radiation should only be given if oncologic benefit clearly outweighs cardiovascular harm.