Predictor Of Cardiovascular Mortality Research Articles

203Pulmonary transit time is a better predictor of cardiovascular mortality and HF hospitalization in HF-rEF patients than left and right ventricular ejection fraction or feature tracking GLS

203Pulmonary transit time is a better predictor of cardiovascular mortality and HF hospitalization in HF-rEF patients than left and right ventricular ejection fraction or feature tracking GLS

Coronary calcification as a predictor of cardiovascular mortality in advanced chronic kidney disease: a prospective long-term follow-up study

BackgroundPatients with advanced chronic kidney disease (CKD) exhibit higher prevalence of coronary artery calcification (CaC) than general population. CaC has been proposed as a risk factor for mortality in end-stage CKD, but most studies in the field are based on short-term follow-up.MethodsWe conducted a cohort, 10-year prospective longitudinal study of consecutive cases referred to the renal unit. A non-enhanced multislice coronary computed tomography was performed at baseline. CaC was assessed by Agatston method. Patients were stratified according to their CaC score: severe calcification group (CaCs< 400 HU) and mild-moderate calcification group (CaCs≥400 HU). The overall and cardiovascular (CV) mortality, CV events, and factors potentially associated with CaC development were recorded.Results137 patients with advanced CKD were enrolled and provided consent. Overall mortality rate was 58%; 40% due to CV events. The rate of overall mortality in the severe calcification group was 75%, and 30% in the low calcification group, whereas the rate of CV mortality was 35% vs. 6%, respectively (p < 0.001). The severe calcification group was older, had higher prevalence of type 2 diabetes mellitus, former cardiologic events, and lower albumin serum levels than the mild-moderate calcification group. In a multivariate Cox model, severe CaC was a significant predictor of CV mortality (HR 5.01; 95%CI 1.28 to 19.6, p = 0.02).ConclusionsAmong advanced CKD, there was a significantly increase of CV mortality in patients with severe CaCs during a 10-year follow-up period. CaCs could be a useful prognostic tool to predict CV mortality risk in CKD patients.

High sensitivity C-reactive protein, a predictor of cardiovascular mortality and morbidity, and psoriasis: a case control study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis, a chronic inflammatory disease, is associated with systemic comorbidities. The blood levels of various inflammatory markers are increased in psoriasis. One of them is high sensitivity C-reactive protein (hs-CRP). The serum level of hs-CRP is increased in many inflammatory diseases like psoriasis, cardio vascular diseases, infections, arthritis and others. The objectives of the study were to determine serum level of hs-CRP in psoriasis in relation to its PASI score, which is a subjective method to determine severity of the disease, whereas hs-CRP is an objective and more reliable method. And to have a better idea of systemic inflammatory process caused by psoriasis, serum level of hs-CRP was evaluated in psoriasis patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A case control study was conducted including 38 patients of chronic plaque psoriasis from dermatology outpatient department of Maharaja Agrasen Medical College (MAMC), Agroha, India, and 38 healthy controls.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The serum level of hs-CRP was significantly raised in psoriasis patients (p&amp;lt;0.001). The mean hs-CRP level in psoriasis patients was 6.824±8.562 mg/l whereas it was 1.072±0.929 mg/l in controls. Two observations were noticed, one, the increase in hs-CRP level correlated with PASI score and second, it was much higher in psoriatic patients as compared to controls.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The much higher hs-CRP levels in psoriasis as compared to controls and its correlation with severity of psoriasis has led us to propose that this much high hs-CRP is a biomarker of systemic inflammatory process of psoriasis as well as inflamed cutaneous lesions.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

MON-105 Sedentary Behavior and Light Physical Activity were Related with Percent Body fat in Elderly Type 2 Diabetes

Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accident. Percent body fat is a predictor of cardiovascular mortality. We investigated whether physical activity level or physical inactivity expressed as SB was related with percent body fat in type 2 diabetes. In this cross sectional study, we measured the duration of SB, light(LPA), moderate to vigorous physical activity(MVPA), total energy expenditure(TEE) and step counts using wireless activity tracker (fitbit HR®:FB) for 7 days in free-living condition, and also percent body fat (%BF) using body composition analyzer (Inbody®) from 120 smart phone user with T2D. The subjects were divided into exercise (Exe, n=68) and non-exercise group(nonExe, n=52) based on self-reports of whether or not the recommended exercises(30min/day, 3 days/week for 3 months) had been performed. Each variable was tested for normal distribution. Transformed SB (SBt) was by reflect and square root for normal distribution. Transformed LPA(LPAt) and transformed MVPA(MVPAt) was by logarithm. Participants were as follows: female, 59.2%; age, 59.3±8.4 years; BMI, 25.5±3.4kg·m2; A1c; 7.6±1.2%, %BF; 30.4±7.1%. They spent SB for 15.7±3.7h/day, LPA for 4.4±1.7 h/day, MVPA for 0.9±0.8h/day. The %BF was related with SBt(β=-0.262, P<0.001) and LPAt(β=-0.297, P<0.001), but not with MVPAt after adjusted for age, and gender, and HbA1c. There was no significant difference in SB, LPA and MPA between self-reported exercise and non-exercise groups, but VPA was statistically significantly higher in the exercise group (P <0.001) and MVA in the MPA plus VPA group was also significantly higher (P = 0.003). A multiple linear regression was calculated to predict body fat percentage based on their age, gender, HbA1c, SB, and LPA. Participants’ predicted percent body fat was equal to 89.494-0.105(age)-13.047(gender)-0.507(HbA1C)-7.655(LPAt) (F(4, 64) = 62.929, p < 0.0001), with an R2 of 0.785,where gender is coded as 1=Male, 2=Female, from multiple linear regression In conclusion, decreased body fat in elderly diabetic patients might be associated with reduced inactivity and increased light physical activity, but not with moderate or vigorous physical activity. It would be better to use the activity tracker to avoid sedentary behavior and make more light movements.

Relationship Among Fatty Liver, Specific and Multiple‐Site Atherosclerosis, and 10‐Year Framingham Score

Despite a well-documented increase in the prevalence of subclinical atherosclerosis in patients with steatosis, the relationship among steatosis and atherosclerosis, specific atherosclerotic sites, multiple-site atherosclerosis, and cardiovascular risk prediction is incompletely understood. We studied the relationship among steatosis, atherosclerosis site, multiple-site atherosclerosis, coronary artery calcification (CAC), and 10-year Framingham Risk Score (FRS) in 2,554 patients with one or more cardiovascular risk factors (CVRF), free of cardiovascular events and other chronic liver diseases, and drinking less than 50 g alcohol/day. All patients underwent arterial ultrasound (carotid [CP] and femoral [FP] plaques defined as intima-media thickness (IMT) > 1.5 mm), coronary computed tomography scan (severe CAC if ≥ 100), 10-year FRS calculation, and steatosis detection by the fatty liver index (FLI, present if score ≥ 60). Patients with steatosis (36% of total) had higher prevalence of CP (50% versus 45%, P = 0.004) and higher CAC (181 ± 423 versus 114 ± 284, P < 0.001) but similar prevalence of FP (53% versus 50%, P = 0.099) than patients without steatosis. Steatosis was associated with carotid IMT and CAC, but not with FP, independent of age, diabetes, hypertension, and tobacco use (P < 0.001). Fifty-three percent of patients had at least 2-site atherosclerosis and steatosis was associated with at least 2-site atherosclerosis independent of age and CVRF (odds ratio = 1.21, 95% confidence interval 1.01-1.45, P = 0.035). Sixty-four percent of patients with steatosis had a FRS score of 10% or more. FLI was associated with FRS beyond the CVRF or the number of atherosclerosis sites (P < 0.001). Adding FLI to CVRF predicted an FRS greater than or equal to 10% better than CVRF alone (area under the receiver operating characteristic curve = 0.848 versus 0.768, P < 0.001). Conclusion: Steatosis is associated with carotid and coronary, but not femoral atherosclerosis, and with cardiovascular mortality risk. The multiple-site involvement and quantitative tonic relationship could reinforce the prediction of cardiovascular mortality or events over classical CVRF or imaging-based detection of atherosclerosis.

Abstract P038: Liver Enzyme Levels Are Associated With Metabolic Syndrome and Predict All-Cause and Cardiovascular Mortality in a High-Risk Population: The Strong Heart Family Study

Introduction: Non-alcoholic fatty liver disease has been associated with an increased risk of cardiovascular disease (CVD). Levels of the circulating hepatic enzymes aspartate amino transferase (AST) and alanine amino transferase (ALT) are used as non-invasive biomarkers of liver fat and fibrosis. A number of studies have investigated the potential for these biomarkers of liver function, as well as their ratio AST/ALT, to predict CVD risk, with equivocal results. We hypothesized that these measurements might be important biomarkers of CVD in American Indians (AI) who experience high rates of both liver disease and type 2 diabetes-related CVD. Methods: The Strong Heart Family Study (SHFS) is a population-based family study of heart disease and its risk factors in AI. Participants (n=2760) were recruited from 12 tribes located within 3 geographical regions in Arizona, North/South Dakota, and Oklahoma. Circulating biomarkers and metabolic measures were assessed during a clinic visit in 2001-2003. Participants were followed for morbidity and mortality events until the end of 2016. Median follow-up time was 14.5 years. Results: In this study, 59.8% were female, mean (± standard deviation) age was 40.8 ±17.2 years, mean BMI was 31.3 ± 7.5 kg/m 2 , 19% had type 2 diabetes (T2D), 32.6% were hypertensive, and 36.1% were current smokers. In univariate analyses, higher ALT and AST levels (IU/L) were associated with all components of the metabolic syndrome (MS), i.e., increased waist circumference, triglycerides, blood pressure, fasting glucose, and decreased HDL-C; all p&lt;0.01. Among diabetes-free participants, those with MS (n=790, as defined by NCEP ATP III criteria) had higher ALT (37.0 ± 0.6 IU/L vs. 29.4 ± 0.6 IU/L, p&lt;0.01) and AST (28.5 ± 0.5 IU/L vs. 24.5 ± 0.5 IU/L, p&lt;0.01) than those who were free of MS (n=1419). In a Cox proportional-hazards model, ALT, AST and the AST/ALT ratio were significantly associated with all-cause mortality (n= 439 deaths), when controlling for age, sex, smoking status, hypertension and T2D. Hazards ratios (95% confidence interval) associated with ALT, AST, and ALT/AST ratio were 1.02 (1.01, 1.03), 1.03 (1.02, 1.04), and 1.2 (1.1, 1.3) respectively. In a separate model, AST and AST/ALT ratio were significantly associated with CVD mortality (n=120), and respective hazard ratios were 1.03 (1.01, 1.05) and 1.2 (1.01, 1.43). Parallel trends for associations between these liver biomarkers and incident CVD events (n=272) were not statistically significant though the hazard ratio related to AST/ALT ratio was 1.12 (0.97, 1.3). Conclusions: In American Indians of the SHFS, liver function biomarkers are significantly associated with metabolic syndrome and its components, and predict all-cause and cardiovascular mortality, suggesting that common mechanisms impact MS-related CVD risk factors and liver disease biomarker levels in this high-risk population.

Successful primary percutaneous coronary intervention determines the very long-term prognosis in ST-segment elevation myocardial infarction even in survivors of the acute phase. The ANIN Myocardial Infarction Registry.

IntroductionSuccessful primary percutaneous coronary intervention (pPCI) saves lives in the acute phase of ST-elevation myocardial infarction (STEMI) and improves the mid-term prognosis. Whether that benefit remains significant in very long-term follow-up and is associated with total ischaemic time (TIT), especially in survivors of the acute phase of STEMI, is unknown.AimWe sought to investigate the impact of initial and final thrombolysis in myocardial infarction (TIMI) flow on long-term survival in a homogeneous, unselected group of patients with STEMI undergoing pPCI at a high-volume centre.Material and methodsAll consecutive STEMI patients treated with pPCI in our tertiary centre were enrolled in the ANIN Myocardial Infarction Registry.ResultsAmong 1064 patients 871 (82%) had an occluded infarct artery (IRA) at baseline, while pPCI was successful in 885 (83%) patients. At 9 years all-cause and cardiovascular (CV) mortality were 28% (294 patients) and 19% (196 patients), respectively. Failure of pPCI was an independent predictor of long-term all-cause and CV mortality (OR = 1.5, 95% CI: 1.1–2.0, p = 0.03 and OR = 1.8, 95% CI: 1.3–2.7, p = 0.001, respectively). In survivors of the acute phase, occluded IRA at baseline was an independent predictor of all-cause mortality (OR = 1.5, 95% CI: 1.0–2.3, p = 0.04), while pPCI failure predicted CV mortality (OR = 1.8, 95% CI: 1.2–2.8, p = 0.005). Mortality rate increased with TIT even in patients with pPCI success.ConclusionsAngiographic results of pPCI determine the very long-term survival of STEMI patients, even in survivors of the acute phase of STEMI. Shortening of TIT is crucial.

Mortality risk stratification in patients with asymptomatic carotid stenosis

AIMS: The aim of this analysis was to (a) determine the long-term 5-year all-cause and cardiovascular (CV) mortality in patients with asymptomatic internal carotid artery stenosis (ACS), (b) identify risk factors that could be used in mortality risk stratification, and (c) develop a model for predicting a patient's risk of CV death within 5 years. METHODS: This was a multicenter natural history study involving 1121 patients with ACS undergoing medical intervention alone. Proportional-hazards models were used to calculate all-cause and CV mortality using clinical and plaque texture features. RESULTS: Totally 1121 patients with 50%–99% ICA stenosis (European Carotid Surgery Trial criteria) from the Asymptomatic Carotid Stenosis and Risk of Stroke study were included in this analysis for mortality. Mean follow-up was 48 months (range, 6–96 months). There were 213 (19%) deaths during follow-up. Average annual all-cause mortality was 4.6%. About 68.1% of all deaths were due to CV causes. Independent predictors of all-cause mortality were age, male gender, carotid stenosis >80% (NASCET criteria), diabetes, cardiac failure, left ventricular hypertrophy (LVH) on electrocardiogram (ECG), smoking, absence of antiplatelet therapy, and history of vertebrobasilar symptoms. It was also shown that age, male gender, diabetes, fibrinogen >3.6 g/L, carotid stenosis >80% (NASCET criteria), cardiac failure, absence of antiplatelet therapy, and LVH on ECG were independent risk factors for CV mortality. Receiver operating characteristic curves for the above models were 0.709 (95% confidence interval [CI], 0.659–0.754) and 0.701 (95% CI, 0.656–0.746), respectively. The CV mortality prediction model could identify several subgroups of asymptomatic patients with different risk. The highest 90%–100% predicted 5-year CV mortality carried 25 times the risk of the low-risk subgroup in which the 5-year predicted CV mortality was 4%. CONCLUSION: Mortality risk can be taken into consideration in clinical practice, in order to identify patients with ACS who are unlikely to benefit from carotid endarterectomy. The majority of patients with ACS have a very high risk of myocardial infarction and should not be denied aggressive risk factor modification or a full cardiac investigation according to the current guidelines.

Long-term results of surgical treatment of secondary severe mitral regurgitation in patients with end-stage heart failure: Advantage of prosthesis insertion

Surgical treatment of secondary mitral regurgitation (SMR) is controversial. To analyse outcome after undersizing annuloplasty (UA) and mitral valve replacement (MVR). Consecutive patients operated on for severe SMR, with left ventricular ejection fraction (LVEF)<40% and refractory CHF, were included. Endpoints were in-hospital mortality, mid-term cardiovascular (CV) mortality, evolution of LV variables and recurrence of mitral regurgitation (MR). 59 patients were included (mean age 65±10 years, preoperative LVEF 36±6%; effective regurgitant orifice [ERO] 41±17 mm2), 41 with ischaemic disease: 12 underwent UA and 47 underwent MVR; only eight had concomitant coronary revascularization. In-hospital mortality was 3.3% (8.3% in UA group; 2.1% in MVR group). Eight-year CV mortality was 39±13% (40±18% in UA group; 27±10% in MVR group). Older age (hazard ratio 1.14, 95% confidence interval 1.07 to 1.22; P<0.001) and LV end-systolic diameter (hazard ratio 1.18, 95% confidence interval 1.09 to 1.27; P<0.001) independently predicted CV mortality. LVEF did not change between the preoperative and follow-up transthoracic echocardiograms in the MVR group (36±6% vs. 35±10%; P=0.6) or the UA group (36±5% vs. 31±12%; P=0.09). Conversely, LV end-diastolic diameter decreased significantly in the MVR group (64±8m to 59±9mm; P=0.002), but not in the UA group (61±7m to 64±10mm; P=0.2). Recurrence of significant MR occurred in 81% of patients in the UA group (mean postoperative ERO 19±6 mm2) versus none in the MVR group. Surgical treatment of SMR can be performed with acceptable operative risk and mid-term survival in severe heart failure, even if there is no indication for revascularization. MVR is associated with significant reverse remodelling, and UA with prohibitive risk of MR recurrence.

Prediction of cardiovascular mortality and morbidity in the malmö diet-cancer cohort for the identification of healthy vascular ageing, using markers of vascular status

BackgroundThis study aims to translate two arterial measurements, aortic Pulse Wave Velocity (aPWV) and carotid Intima-Media Thickness (cIMT), into a combined Vascular Ageing Index (VAI), to evaluate the predictive power of VAI and utilize it to identify a sub-group with Healthy Vascular Ageing (HVA).MethodsIn all, 2718 subjects were included from the CV arm of the Malmö Diet Cancer study (median age 72 years, 62.2% females). Median follow-up for CV events (N = 269) was 6.5 years. VAI was created by a function that combined aPWV and cIMT. Cox regressions for aPWV, cIMT and VAI, adjusted for conventional CV risk factors, were carried out. aPWV and cIMT were mutually adjusted for while VAI was analyzed separately. Model improvements for a model of conventional CV risk factors were assessed using Harrell’s c-statistic and continuous Net Reclassification Index (NRI).ResultsCox regression Results: (fully adjusted model): 1 SD of log-(aPWV), HR: 1.22 (95% CI: 1.03–1.42, P = 0.010), 1 SD of log (cIMT), HR: 1.29 (95% CI: 1.13–1.47, P < 0.001), 1 SD of log-VAI, HR: 1.43 (95% CI: 1.22–1.68, P < 0.001) (Figure 1). C-statistics: 0.715 (conventional risk factor model), 0.721 (+aPWV), 0.734 (+aPWV and cIMT) and 0.732 (+VAI). NRI showed a significant (P < 0.001) improvement for classification of event-free subjects when adding aPWV and cIMT or VAI.ConclusionVAI added marginally to prediction of CV events. However, the classification of subjects who remained free from CV events was significantly improved.

Circulating proteins as predictors of cardiovascular mortality in end-stage renal disease

IntroductionProteomic profiling of end-stage renal disease (ESRD) patients could lead to improved risk prediction and novel insights into cardiovascular disease mechanisms. Plasma levels of 92 cardiovascular disease-associated proteins were assessed by proximity extension assay (Proseek Multiplex CVD-1, Olink Bioscience, Uppsala, Sweden) in a discovery cohort of dialysis patients, the Mapping of Inflammatory Markers in Chronic Kidney disease cohort [MIMICK; n = 183, 55% women, mean age 63 years, 46 cardiovascular deaths during follow-up (mean 43 months)]. Significant results were replicated in the incident and prevalent hemodialysis arm of the Salford Kidney Study [SKS dialysis study, n = 186, 73% women, mean age 62 years, 45 cardiovascular deaths during follow-up (mean 12 months)], and in the CKD5-LD-RTxcohort with assessments of coronary artery calcium (CAC)-score by cardiac computed tomography (n = 89, 37% women, mean age 46 years).ResultsIn age and sex-adjusted Cox regression in MIMICK, 11 plasma proteins were nominally associated with cardiovascular mortality (in order of significance: Kidney injury molecule-1 (KIM-1), Matrix metalloproteinase-7, Tumour necrosis factor receptor 2, Interleukin-6, Matrix metalloproteinase-1, Brain-natriuretic peptide, ST2 protein, Hepatocyte growth factor, TNF-related apoptosis inducing ligand receptor-2, Spondin-1, and Fibroblast growth factor 25). Only plasma KIM-1 was associated with cardiovascular mortality after correction for multiple testing, but also after adjustment for dialysis vintage, cardiovascular risk factors and inflammation (hazard ratio) per standard deviation (SD) increase 1.84, 95% CI 1.26–2.69, p = 0.002. Addition of KIM-1, or nine of the most informative proteins to an established risk-score (modified AROii CVM-score) improved discrimination of cardiovascular mortality risk from C = 0.777 to C = 0.799 and C = 0.823, respectively. In the SKS dialysis study, KIM-1 predicted cardiovascular mortality in age and sex adjusted models (hazard ratio per SD increase 1.45, 95% CI 1.03–2.05, p = 0.034) and higher KIM-1 was associated with higher CACscores in the CKD5-LD-RTx-cohort.ConclusionsOur proteomics approach identified plasma KIM-1 as a risk marker for cardiovascular mortality and coronary artery calcification in three independent ESRD-cohorts. The improved risk prediction for cardiovascular mortality by plasma proteomics merit further studies.

Choice reaction time and grip strength as predictors of cardiovascular mortality in middle-aged and elderly Japanese: from the Radiation Effects Research Foundation Adult Health study.

Cognitive function and physical function are important predictors of mortality. To investigate whether or not reaction time (RT) as a cognitive function and grip strength (GS) as a physical function were associated, alone or in combination, with mortality from heart disease or stroke. The subjects included 4901 Adult Health Study participants in Hiroshima who had undergone RT and GS measurements, were 35-74 years old at baseline (1970-1972) and were followed until the end of 2007. After adjustment for other potential risk factors, RT was positively and GS was negatively associated with mortality from both heart disease and stroke. These associations were persistent in the model when adjusting simultaneously for RT, GS and other factors, but hazard ratios were attenuated. When we evaluated the associations by baseline age and gender, we found the greater hazard ratios for RT in the younger cohort, but no clear modification by age for GS. The interaction between RT and GS was statistically significant (P = 0.012) for stroke mortality. In the stratified analyses divided using the age-specific median value of RT or GS, the estimated hazard ratio of stroke mortality for RT was significant in participants with weak or strong GS but greater in the former, and for GS, it was only significant in participants with slow RT. RT and GS, alone and in combination, predicted heart disease and stroke mortalities. Interventions for both cognitive function and physical function may be beneficial for the prevention of cardiovascular disease mortality.

A new look at weather-related health impacts through functional regression

A major challenge of climate change adaptation is to assess the effect of changing weather on human health. In spite of an increasing literature on the weather-related health subject, many aspect of the relationship are not known, limiting the predictive power of epidemiologic models. The present paper proposes new models to improve the performances of the currently used ones. The proposed models are based on functional data analysis (FDA), a statistical framework dealing with continuous curves instead of scalar time series. The models are applied to the temperature-related cardiovascular mortality issue in Montreal. By making use of the whole information available, the proposed models improve the prediction of cardiovascular mortality according to temperature. In addition, results shed new lights on the relationship by quantifying physiological adaptation effects. These results, not found with classical model, illustrate the potential of FDA approaches.

A9728 Comparison of awake home blood pressure using evening measurements to measurement done before bedtime in Malaysian hypertensive patients

Objectives: Studies have reported that home blood pressure (HBP) is a better predictor of cardiovascular mortality and morbidity than office blood pressure (BP). Guidelines recommend averaging the morning and evening HBP measurements to derive the mean awake BP. However recommendation in guidelines regarding the timing of evening HBP measurements is not consistent. Furthermore it is not convenient for most patients to measure the evening HBP before dinner. Hence this study aimed to compare the mean awake HBP when done in the morning and evening to HBP done in the morning and before going to bed. Methods: This is a cross-sectional study of 306 hypertensive patients in a primary care setting in Malaysia. A convenience sampling method was used to recruit patients. Patients were educated according to the standard guidelines on how to measure HBP using a validated oscillometric BP device. Two consecutive BP measurements were taken three times a day (morning, evening before dinner and at bedtime) for seven days. After excluding the measurements of the first day, the remaining measurements were used to derive the mean awake BP. Paired t-test was used for analysis. Results: The mean age of the population was 67 ± 10 years, 46.6% were males. The mean morning HBP was 129.5 mm ± 15 mmHg; mean evening BP taken before dinner was 126.9 ± 14.3 mmHg and bedtime 125.7 ± 15.9mmHg. The mean awake BP using morning and evening was 128.0 mmHg compared with 127.5 mmHg based on morning and bedtime readings, a difference of 0.5 mmHg (p = 0.13). Conclusion: There is no difference in awake HBP whether it is measured in the evening or before bedtime. For convenience of the patients, it would appear to be acceptable the HBP to be done before bed instead of the recommended time of evening before dinner.

A16440 Peripheral Arterial Stiffness is an Independent Risk Predictor of Cardiovascular Mortality

A16440 Peripheral Arterial Stiffness is an Independent Risk Predictor of Cardiovascular Mortality

Galectin-3 Interacts with Vascular Cell Adhesion Molecule-1 to Increase Cardiovascular Mortality in Hemodialysis Patients.

Background: Interactions and joint effects of galectin-3 and vascular cell adhesion molecule 1 (VCAM-1) on risks of all-cause and cardiovascular (CV) mortality remain unclear in patients with maintenance hemodialysis (MHD). Methods: Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed between higher and lower concentration groups of serum galectin-3 and VCAM-1. The modification effect between serum galectin-3 and VCAM-1 on mortality risk was investigated using an interaction product term. Results: During follow-up, galectin-3 and VCAM-1 were associated with incremental risks of all-cause mortality (aHR: 1.038 (95% confidence interval (CI): 1.001–1.077) and 1.002 (95% CI: 1.001–1.003), respectively). Nonetheless, VCAM-1 but not galectin-3 predicted CV mortality (aHR: 1.043 (95% CI: 0.993–1.096) and 1.002 (95% CI: 1.001–1.003), respectively). In the interaction analysis, patients with combined higher galectin-3 (>29.5 ng/mL) and VCAM-1 (>1546.9 ng/mL) were at the greatest risk of all-cause and CV mortality (aHR: 4.6 (95% CI: 1.6–13.4), and 4.2 (95% CI: 1.3–14.4), respectively). The interactions between galectin-3 and VCAM-1 with respect to all-cause and CV mortality were statistically significant (p < 0.01 and < 0.05, respectively). Conclusion: Galectin-3 and VCAM-1 could serve as a promising dual biomarker for prognostic assessment, considering their joint effects on pathogenesis of leukocyte trafficking and atherothrombosis.

Homoarginine/ADMA ratio and homoarginine/SDMA ratio as independent predictors of cardiovascular mortality and cardiovascular events in lower extremity arterial disease

Endothelial dysfunction plays a key role in development of atherosclerosis and lower extremity arterial disease (LEAD). Homoarginine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are sensitive markers for endothelial dysfunction and independent risk factors for cardiovascular death. However, homoarginine may influence the proatherogenic effects of ADMA and SDMA suggesting homoarginine/ADMA ratio or homoarginine/SDMA ratio as further predictors for cardiovascular mortality. Therefore, we investigated the predictive value of homoarginine/ADMA ratio and homoarginine/SDMA ratio related to cardiovascular mortality and cardiovascular events in claudicant patients with LEAD. 151 patients with intermittent claudication were included in a prospective observational study (observation time 7.7 ± 2.5 years) with cardiovascular mortality as main outcome parameter and the occurrence of cardiovascular events as secondary outcome parameter. Homoarginine, ADMA and SDMA were measured by high-performance liquid chromatography at baseline. Low homoarginine/ADMA ratio and homoarginine/SDMA ratio were independently associated with higher cardiovascular mortality (HR 2.803 [95% CI 1.178–6.674], p = 0.020; HR 2.782 [95% CI 1.061–7.290], p = 0.037, respectively) and higher incidence of cardiovascular events (HR 1.938 [95% CI 1.015–3.700], p = 0.045; HR 2.397 [95% CI 1.243–4.623], p = 0.009, respectively). We observed that homoarginine/ADMA ratio and homoarginine/SDMA ratio are independent predictors for long-term cardiovascular mortality and events in claudicant patients with LEAD.

P3715Impact of stress myocardial blood flow as an important prognostic predictor for cardiovascular mortality in hemodialysis patients

P3715Impact of stress myocardial blood flow as an important prognostic predictor for cardiovascular mortality in hemodialysis patients

The Social Economic Factors and Models of Forecasting Mortality Because of Cardiovascular Diseases

The purpose of the study is modeling and analysis of effect of social economic characteristics of regions on population mortality of cardiovascular diseases. The official data of the Federal service of state statistics of the Russian Federation were used concerning social economic indices and mortality of cardiovascular diseases in the regions of Russia in 2012. The selection of social economic indices included percentage of males in population structure, percentage of individuals of retirement age, percentage of urban population, percentage of individuals with income lower that living wage, percentage of the unemployed individuals, Gini coefficient, percentage of individuals with university education, atmosphere air pollution with emissions of permanent sources, average per capita consumption of vodka and liqueurs, criminality, percentage of regional budget for social cultural expenses, percentage of workers involved in unhealthy labor conditions from total number of population of region. The selection of indices of mortality of cardiovascular diseases included class of diseases of blood circulation system in general, ischemic heart disease and class of cerebrovascular diseases. The mortality was evaluated in overall by population and separately on able-bodied age. The modeling of dependence of mortality from social economic indices was implemented using regression analysis. The calculated ?-coefficients and coefficients of determination were applied to determine approximate input of each predictor into alteration of levels of mortality. The statistically significant mathematical models of dependence of mortality on number of social economic indices were derived. The values explain on 40-75% spreading of regional indices of mortality. The percentage of input of age factor into regional differences of mortality reaches 13-35% in various classes of cardiovascular mortality. Besides, in able-bodied age the average per capita consumption of hard alcoholic beverages (vodka and liqueurs) can be considered as a stable predictor of cardiovascular mortality with corresponding input of 5-7% in the regional differences. The other social economic indices demonstrate a statistically significant relationship only in certain indices of mortality that permits to surmise about only supposed cause-and-effect relationships.

Metformin Regresses Left Ventricular Hypertrophy in Normotensive Patients with Coronary Artery Disease without Type 2 Diabetes Mellitus—The MET-REMODEL Trial

Background: Left ventricular hypertrophy (LVH) is highly prevalent in patients with coronary artery disease (CAD) and is an independent predictor of cardiovascular mortality. Metformin has been shown to regress LV mass (LVM) in animal models of LVH. We hypothesize that metformin may regress LVH in nondiabetic and normotensive CAD patients with prediabetes and/or insulin resistance. Methods: In this randomized double-blind placebo controlled trial, 68 patients with prediabetes (HbA1c ?39 mmol/mol and less than 48 mmol/mol) and/or insulin resistance (fasting insulin resistance index ? 2.7) were assigned to receive either metformin (2g daily dose) or placebo for 12 months. An intention-to-treat (ITT) and per-protocol analysis was designed to determine the effect of metformin on the following study endpoints: Primary endpoint was change in left ventricular mass indexed to height1.7 (LVMI), assessed by magnetic resonance imaging; other endpoints were changes in LVM, changes in body weight, office blood pressure (BP) and biomarkers. Results: In the ITT analysis (n=61), metformin treatment significantly reduced: LVMI (metformin -2.7 ± 2.3 g/m1.7 vs. placebo -1.4 ± 2.7 g/m1.7; P=0.05), body weight (lowered by 3.6 kgs, p=0.002), office systolic BP (metformin -4.8 ± 15.6 mmHg vs. placebo 4.6 ± 15.7 mmHg; P=0.02) and reduced concentration of thiobarbituric acid reactive substances (TBARs), a biomarker for oxidative stress (p=0.04). In the on-per protocol analysis (n=56), metformin resulted in a greater reduction of LVMI (metformin -3.1 ± 1.9 g/m1.7 vs. placebo -1.2 ± 2.7 g/m1.7; P=0.005), and greater weight reduction of 4.2kgs (p=0.001). Conclusions: Metformin treatment significantly reduced LVMI, office SBP, body weight and oxidative stress. These results reveal a novel mechanism for the cardioprotective effect of metformin and raise the possibility of using metformin in nondiabetic patients with CAD. Disclosure M. Mohan: None. S. Al-Talabany: None. A.M. McKinnie: None. I. Mordi: None. J.S. Singh: None. S.J. Gandy: None. A. Choy: None. J.G. Houston: None. J. George: None. A.D. Struthers: Research Support; Self; AstraZeneca. Advisory Panel; Self; AstraZeneca. C.C. Lang: None.