Prevalence Of Atherosclerotic Cardiovascular Disease Research Articles

Examining the relationship between Life’s Essential 8 and atherosclerotic cardiovascular disease among Adults in the United States: Insights from the National Health and Nutrition Examination Surveys (2017-2020)

The American Heart Association recently updated the assessment of cardiovascular health (CVH) with the Life’s Essential 8 (LE8) score. Our cross-sectional analytical study utilized data from 5042 adults in the United States (US) from the 2017 to 2020 NHANES surveys to examine the relationship between CVH assessed by LE8 metrics and the prevalence of atherosclerotic cardiovascular disease (ASCVD). Multivariate linear regressions were utilized to explore the relationship between CVH metrics and ASCVD, while linear probability models were used to predict ASCVD prevalence based on achieved LE8 scores. Controlling for relevant covariates revealed an inverse association between LE8 metrics and ASCVD prevalence. Improvements in LE8 were linked to a 29% reduction in ASCVD prevalence, with transitions to higher LE8 quartiles predicting a 4.8% reduction in ASCVD prevalence. Subgroup analysis indicated significant effects of age, education, and gender on ASCVD prevalence, with younger age, college education, and the female gender being associated with lower prevalence (P < 0.05). Higher LE8 scores correlated with decreased ASCVD prevalence, while factors such as younger age, college education, and the female gender were also associated with lower ASCVD prevalence. Conversely, transitioning from married to divorced/widowed/separated status was linked to increased ASCVD prevalence (P < 0.01).

Trends and Disparities in Treatment and Control of Atherosclerotic Cardiovascular Disease in US Adults, 1999 to 2018.

Although cardiovascular mortality continued declining from 2000 to 2019, the rate of this decrease decelerated. We aimed to assess the trends and disparities in risk factor control and treatment among US adults with atherosclerotic cardiovascular disease to find potential causes of the deceleration. A total of 55 ,021 participants, aged ≥20 years, from the 1999 to 2018 National Health and Nutrition Examination Survey were included, of which 5717 were with atherosclerotic cardiovascular disease. Risk factor control was defined as hemoglobin A1c <7%, blood pressure <140/90 mm Hg, and non-high-density lipoprotein cholesterol <100 mg/dL. The prevalence of atherosclerotic cardiovascular disease oscillated between 7.3% and 8.9% from 1999 to 2018. A significant increasing trend was observed in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension within the population with atherosclerotic cardiovascular disease (Ptrend≤0.001). Non-high-density lipoprotein cholesterol <100 mg/dL increased from 7.1% in 1999 to 2002 to 15.7% in 2003 to 2006, before plateauing. Blood pressure control (<140/90 mm Hg) increased until 2011 to 2014, but declined to 70.1% in 2015 to 2018 (Ptrend<0.001, Pjoinpoint=0.14). Similarly, the proportion of participants achieving hemoglobin A1c control began to decrease after 2006 (Pjoinpoint=0.05, Ptrend=0.001). The percentage of participants achieving all 3 targets increased significantly from 4.5% to 18.6% across 1999 to 2018 (Ptrend=0.02), but the increasing trend decelerated after 2005 to 2006 (Pjoinpoint<0.001). Striking disparities in risk factor control and medication use persisted between sexes, and between different racial and ethnic populations. Worsened control of glycemia, blood pressure, obesity, and alcohol consumption, leveled lipid control, and persistent socioeconomic disparities may be contributing factors to the observed deceleration in decreasing cardiovascular mortality trends.

Cardiovascular risk assessment of newborns in Nigeria using the atherogenic index of plasma and its associations with gestational age and birth weight: a cross-sectional hospital-based study

Background: The prevalence of atherosclerotic cardiovascular disease is rising, and its onset from childhood is widely studied. Prematurity and low birth weight were associated with higher atherogenic risk when assessed using some lipid ratios. However, the atherogenic index of plasma (AIP), a sensitive marker for atherosclerosis is understudied in newborns. Utilizing AIP, this study aimed to determine atherogenic risk prevalence among newborns and its association with gestational age and birth weight. Methods: Newborns were consecutively recruited, and their lipid profiles were determined. The AIP was calculated as the logarithm to base 10 (log10) of the ratio of molar concentrations of triglyceride to high-density lipoprotein cholesterol. The atherogenic risk was operationalized using AIP: high, &gt;0.24; medium, 0.1–0.24; and low/no risk, &lt;0.1. The relationship between AIP values, gestational age, and birth weight was analyzed using Pearson correlation. Results: The mean AIP of the 167 newborns studied was –0.35±0.34, which is within the global reference range. Three (1.8%), 10 (6.0%), and 154 (92.2%) newborns were in the high, medium, and low/no atherogenic risk categories, respectively. Hence, 13 newborns (7.8%) had medium to high atherogenic risk. AIP had a moderate significantly positive relationship only with gestational age (r=0.35, P&lt;0.001). Conclusions: The study found an atherogenic risk prevalence of 7.8% using AIP in newborns which, contrary to previous studies that used other ratios, has no significant association with birth weight, correlating positively with gestational age, though is lowest in late preterms. Follow-up studies will elucidate these findings.

Abstract P344: Epidemiology and Burden of Patients Living With Overweight/Obesity and Established Atherosclerotic Cardiovascular Disease

Introduction: Obesity is a serious chronic, progressive metabolic disorder associated with increased morbidity and mortality. Compared with individuals of healthy weight, those living with overweight/obesity are at higher risk for atherosclerotic cardiovascular disease (ASCVD). Given the established relationship between obesity and ASCVD, individuals living with overweight/obesity and ASCVD may gain additional benefits by directly treating obesity. Hypothesis: We assessed the hypothesis that comorbidity burden is higher in adults living with overweight/obesity and ASCVD than in those without ASCVD. Methods: This was a retrospective real-world study using Optum Market Clarity, a linked electronic medical record and administrative health care claims data set. Adults living with overweight and ≥1 weight-related comorbidity or obesity were included. The point prevalence of ASCVD was described for the overall study period (1/1/2017 to 6/30/2021). Stratified prevalence analyses were conducted by age group (ie, ≤45 years, 45-64 years, and ≥65 years). Comorbidity burden was assessed as percentage of patients with weight-related comorbidities. Results: The study encompassed 4,773,152 patients eligible for prescription weight management treatment; 245,824 (5.3%) had been diagnosed with ASCVD. Over the study period of 2017-2021, with a median (Q1-Q3) follow-up time of 43.7 (29.0-57.2) months, peripheral arterial disease was the most prevalent (2.5%) ASCVD condition among these patients, followed by ischemic heart disease (2.2%) and ischemic or hemorrhagic stroke (1.3%). Yearly prevalence of peripheral arterial disease, ischemic heart disease, and ischemic or hemorrhagic stroke within the study period ranged from 2.3%-3.8%, 2.0%-3.2%, and 1.2%-1.8%, respectively. These patients, compared with those without ASCVD, had a mean age of 63.8 vs 49.4 years and mean BMI of 33.4 vs 34.7 kg/m 2 , and 52.7% vs 40.8% were male (all P &lt;.001). The prevalence of ASCVD increased with age: patients aged ≥65 years had an overall prevalence of 14.1%, with yearly prevalence ranging from 13.3%-18.8%, compared with 5.5% in patients aged 45 to 64 years, with yearly prevalence ranging from 5.2%-7.8%. Overall, patients with ASCVD had a higher comorbidity burden than patients without ASCVD, including type 2 diabetes (49.7% vs 17.6%), prediabetes (15.5% vs 9.0%), dyslipidemia (75.6% vs 30.4%), obstructive sleep apnea (22.3% vs 10.2%), and chronic kidney disease (21.1% vs 3.7%; all P &lt;.001). Conclusions: ASCVD is prevalent among people living with overweight/obesity, to a greater extent in older and male individuals. People living with ASCVD and overweight/obesity bear a substantially higher comorbidity burden compared with those without ASCVD. Further evidence is needed to support pharmacotherapy-based chronic weight management to lower the cardiovascular disease burden in this population.

Physical signs and atherosclerotic cardiovascular disease in familial hypercholesterolemia: the HELLAS-FH Registry.

Three physical signs, namely tendon xanthomas, corneal arcus and xanthelasma, have been associated with heterozygous familial hypercholesterolemia (heFH). The prevalence and clinical significance of these signs are not well established among contemporary heFH individuals. This study explored the frequency as well as the association of these physical signs with prevalent atherosclerotic cardiovascular disease (ASCVD) in heFH individuals. Data from the Hellenic Familial Hypercholesterolemia Registry were applied for this analysis. The diagnosis of heFH was based on the Dutch Lipid Clinic Network Score. Multivariate logistic regression analysis was conducted to examine the association of heFH-related physical signs with prevalent ASCVD. Adult patients ( n = 2156, mean age 50 ± 15 years, 47.7% women) were included in this analysis. Among them, 14.5% had at least one heFH-related physical sign present. The prevalence of corneal arcus before the age of 45 years was 6.6%, tendon xanthomas 5.3%, and xanthelasmas 5.8%. Among physical signs, only the presence of corneal arcus before the age of 45 years was independently associated with the presence of premature coronary artery disease (CAD). No association of any physical sign with total CAD, stroke or peripheral artery disease was found. Patients with physical signs were more likely to receive higher intensity statin therapy and dual lipid-lowering therapy, but only a minority reached optimal lipid targets. The prevalence of physical signs is relatively low in contemporary heFH patients. The presence of corneal arcus before the age of 45 years is independently associated with premature CAD.

Epidemiology of multimorbidity associated with atherosclerotic cardiovascular disease in the United States, 1999–2018

BackgroundThe multimorbidity of Atherosclerotic cardiovascular disease (ASCVD) and many other chronic conditions is becoming common. This study aimed to assess multimorbidity distribution in ASCVD among adults in the United States from 1999 to 2018.MethodsThis cross-sectional survey from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 using stratified multistage probability design. Among the 53,083 survey respondents during the study period, 5,729 US adults aged ≥ 20 years with ASCVD. Joinpoint regression was used to assess the statistical significance of prevalence trends in the prevalence of ASCVD stratified by multimorbidity. The Apriori association rule mining algorithm was used to identify common multimorbidity association patterns in ASCVD patients.ResultsOverall, 5,729 of 53,083 individuals had ASCVD, and the prevalence showed a slow declining trend (biannual percentage change = -0.81%, p = 0.035, average 7.71%). The prevalence of ASCVD significantly decreased in populations without dyslipidemia, diabetes mellitus (DM), hypertension, asthma, chronic obstructive pulmonary disease (COPD), and arthritis (all groups, p < 0.05). Additionally, 65.6% of ASCVD patients had at least four of the 12 selected chronic conditions, with four and five being the most common numbers of conditions (17.9% and 17.7%, respectively). The five most common chronic conditions were (in order) dyslipidemia, hypertension, arthritis, chronic kidney disease, and DM. The coexistence of hypertension and dyslipidemia had the highest support in association rules (support = 0.63), while the coexistence of dyslipidemia, hypertension, metabolic syndrome, and DM had the highest lift (lift = 1.82).ConclusionsDuring the 20-year survey period, there was a significant decrease in the overall prevalence of ASCVD. However, this reduction was primarily observed in individuals without dyslipidemia, DM, hypertension, asthma, COPD, and arthritis. Among populations with any of the evaluated chronic conditions, the prevalence of ASCVD remained unchanged. Most of ASCVD patients had four or more concurrent chronic conditions.

Familial Hypercholesterolemia in the Elderly: An Analysis of Clinical Profile and Atherosclerotic Cardiovascular Disease Burden from the Hellas-FH Registry.

Familial hypercholesterolemia (FH) carries a high risk of atherosclerotic cardiovascular disease (ASCVD). As the population ages, the age-related influence on clinical characteristics and outcomes becomes increasingly pertinent. This cross-sectional analysis from the HELLAS-FH registry aims to explore potential differences in clinical characteristics, treatment, ASCVD, and goal achievement between those younger and older than 65 years with FH. A total of 2273 adults with heterozygous FH (51.4% males) were studied. Elderly FH patients (n = 349) had a higher prevalence of ASCVD risk factors, such as hypertension (52.1% vs. 20.9%, p < 0.05) and type 2 diabetes (16.9% vs. 6.0%, p < 0.05), compared to younger patients (n = 1924). They also had a higher prevalence of established ASCVD (38.4% vs. 23.1%, p < 0.001), particularly CAD (33.0% vs. 20.2%, p < 0.001), even after adjusting for major ASCVD risk factors. Elderly patients were more frequently and intensively receiving lipid-lowering treatment than younger ones. Although post-treatment LDL-C levels were lower in elderly than younger patients (125 vs. 146 mg/dL, p < 0.05), both groups had similar attainment of the LDL-C target (3.7% vs. 3.0%). Elderly FH patients have a higher prevalence of ASCVD, particularly CAD. Despite more aggressive treatment, the achievement of LDL-C targets remains very poor. These results emphasize the importance of early FH diagnosis and treatment in reducing ASCVD.

The mixed effect of Endocrine-Disrupting chemicals on biological age Acceleration: Unveiling the mechanism and potential intervention target

IntroductionAlthough previous studies investigated the potential adverse effects of endocrine-disrupting chemicals (EDCs) on biological age acceleration and aging-related diseases, the mixed effect of multiple types of EDCs on biological age acceleration, including its potential underlying mechanism, remains unclear. MethodsData from the National Health and Nutrition Examination Survey (NHANES) were used to analyze biological age measures, including Klemera-Doubal method biological age (KDM-BA), phenotypic age, and homeostatic dysregulation (HD). Weight quantile sum (WQS) regression was performed to screen biological age-related EDCs (BA-EDCs) and assess the mixed effect of BA-EDCs on biological age acceleration and aging-related disease. Targets of BA-EDCs were obtained from three databases, while heart aging-related genes were obtained from the Aging Anno database. Protein–protein interaction (PPI) network and MCODE algorithm were applied to identify potential interactions between BA-EDC targets and heart aging-related genes. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed to identify related pathways. ResultsThis cross-sectional study included 1,439 participants. A decile increase in BA-EDCs co-exposure was associated with 0.31 years and 0.17 years of KDM-BA and phenotypic age acceleration, respectively. The mixed effect of BA-EDCs was associated with an increased prevalence of atherosclerotic cardiovascular disease (ASCVD). Vitamins C and E demonstrated a significant interaction effect on the association between BA-EDCs and KDM-BA acceleration. PPI network and functional enrichment analysis indicated that the AGE-RAGE signaling pathway in diabetic complications was significantly enriched. ConclusionOur results showed that the co-exposure effect of BA-EDCs was associated with biological age acceleration and ASCVD, with the AGE-RAGE signaling pathway being the underlying mechanism. Vitamins C and E may also be an actionable target for preventing EDC-induced biological aging.

Effectiveness of Lipid-lowering Therapy for the Secondary Prevention and Achievement of Therapeutic Goals in Atherosclerotic Cardiovascular Diseases in Accordance with the American College of Cardiology/American Heart Association 2018 Guidelines on the Management of Blood Cholesterol

Introduction: According to the India Report 2020, Kerala had the highest prevalence of atherosclerotic cardiovascular diseases (ASCVDs). Dyslipidemia is a modifiable risk factor that can prevent secondary events. American College of Cardiology/American Heart Association 2018 Guidelines for the management of blood cholesterol for secondary prevention of clinical ASCVD recommend high-intensity statins and moderate-intensity statin combination therapy for achieving target low-density lipoprotein-cholesterol (LDL-C). We conducted a study to evaluate the achievement of therapeutic goals in accordance with the guidelines in a tertiary care hospital in Kerala. Materials and Methods: Three hundred and twenty adult patients prescribed with high-intensity statin monotherapy (atorvastatin 40 mg, rosuvastatin 20 mg, and rosuvastatin 40 mg) or moderate-intensity statin combination therapy (atorvastatin 10 mg and fenofibrate 145 mg) for the secondary prevention of ASCVD event were included. Data were collected from the medical records and patient interviews. Achievement of the therapeutic goal of LDL-C ≤70 mg/dL in accordance with guidelines was evaluated and compared; the mean percentage change in LDL-C was at the baseline and after 3 months. Patients were counselled on lifestyle modifications and educated about hypolipidemic agents. Since we are aiming for secondary prevention, the patients were given appropriate counselling concerning their disease and medications they are on. Dietary lifestyle modifications were also taught. Results: One hundred and thirty-eight patients achieved the therapeutic goal, with atorvastatin 40 mg (89.37%) being the most prescribed drug, followed by rosuvastatin 20 mg (5.62%) while rosuvastatin 40 mg had a higher efficacy with mean LDL reduction 65.71 ± 15.93 at 3 months follow-up. Comparing the adherence scores before and after patient counseling, the P value was found to be &lt; 0.001, indicating it is significant. Conclusion: Lifestyle modifications and lipid-lowering therapy are crucial to tackle dyslipidemia. Poor achievement of therapeutic goals implies the need for adopting measures to improve adherence and health-related outcomes for patients with ASCVD.

Optimal Screening for Predicting and Preventing the Risk of Heart Failure Among Adults With Diabetes Without Atherosclerotic Cardiovascular Disease: A Pooled Cohort Analysis.

The optimal approach to identify individuals with diabetes who are at a high risk for developing heart failure (HF) to inform implementation of preventive therapies is unknown, especially in those without atherosclerotic cardiovascular disease (ASCVD). Adults with diabetes and no HF at baseline from 7 community-based cohorts were included. Participants without ASCVD who were at high risk for developing HF were identified using 1-step screening strategies: risk score (WATCH-DM [Weight, Age, Hypertension, Creatinine, HDL-C, Diabetes Control, QRS Duration, MI, and CABG] ≥12), NT-proBNP (N-terminal pro-B-type natriuretic peptide ≥125 pg/mL), hs-cTn (high-sensitivity cardiac troponin T ≥14 ng/L; hs-cTnI ≥31 ng/L), and echocardiography-based diabetic cardiomyopathy (echo-DbCM; left atrial enlargement, left ventricular hypertrophy, or diastolic dysfunction). High-risk participants were also identified using 2-step screening strategies with a second test to identify residual risk among those deemed low risk by the first test: WATCH-DM/NT-proBNP, NT-proBNP/hs-cTn, NT-proBNP/echo-DbCM. Across screening strategies, the proportion of HF events identified, 5-year number needed to treat and number needed to screen to prevent 1 HF event with an SGLT2i (sodium-glucose cotransporter 2 inhibitor) among high-risk participants, and cost of screening were estimated. The initial study cohort included 6293 participants (48.2% women), of whom 77.7% without prevalent ASCVD were evaluated with different HF screening strategies. At 5-year follow-up, 6.2% of participants without ASCVD developed incident HF. The 5-year number needed to treat to prevent 1 HF event with an SGLT2i among participants without ASCVD was 43 (95% CI, 29-72). In the cohort without ASCVD, high-risk participants identified using 1-step screening strategies had a low 5-year number needed to treat (22 for NT-proBNP to 37 for echo-DbCM). However, a substantial proportion of HF events occurred among participants identified as low risk using 1-step screening approaches (29% for echo-DbCM to 47% for hs-cTn). Two-step screening strategies captured most HF events (75-89%) in the high-risk subgroup with a comparable 5-year number needed to treat as the 1-step screening approaches (30-32). The 5-year number needed to screen to prevent 1 HF event was similar across 2-step screening strategies (45-61). However, the number of tests and associated costs were lowest for WATCH-DM/NT-proBNP ($1061) compared with other 2-step screening strategies (NT-proBNP/hs-cTn: $2894; NT-proBNP/echo-DbCM: $16 358). Selective NT-proBNP testing based on the WATCH-DM score efficiently identified a high-risk primary prevention population with diabetes expected to derive marked absolute benefits from SGLT2i to prevent HF.

Remnant cholesterol in atherosclerotic cardiovascular disease: a systematic review and meta-analysis

Abstract Background Accumulating evidence suggests a substantial contribution of remnant cholesterol (RC) to residual risk for the development or relapse of atherosclerotic cardiovascular disease (ASCVD). Purpose We aimed to evaluate the association of RC levels with ASCVD risk by different risk categories and method of RC assessment. We also assessed available evidence on the effect of lipid-lowering therapies (LLTs) on RC levels. Data sources: English-language searches of Medline, Pubmed and Embase (inception to 31 January 2023); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews. Study selection: Studies reporting on the risk of the composite endpoint [all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE)] by RC levels. Moreover, we searched for studies reporting differences in RC levels after administration of LLT(s). Data extraction: Dual extraction and quality assessment of individual studies. Data synthesis: Among n=29 studies with 257,387 participants, we found a pooled linear (pooled HR:1.27 per 1-SD increase,95% CI:1.12-1.43,P&amp;lt;0.001,I2=95%,n=15 studies) and non-linear association (pooled HR:1.59 per quartile increase,95% CI:1.35-1.85,P&amp;lt;0.001,I2=87.9%,n=15 studies) of RC levels and the risk of MACE both in patients with and without established ASCVD. Interestingly, the risk of MACE was higher in studies with directly measured vs. calculated RC levels. In a limited number of studies and participants, LLTs reduced RC levels. Limitation: Publication bias and heterogeneity regarding the number of participants per study, follow-up duration, ASCVD prevalence, measurement of RC levels and endpoints. Conclusion RC levels are associated with ASCVD risk both in primary and secondary prevention. Directly measured RC levels are associated with ASCVD risk more evidently. Available LLTs tend to decrease RC levels, although the clinical relevance of RC decrease merits further investigation.

South Asian adults with ASCVD exhibit a reduction in circulating vascular regenerative cell content compared to White European adults: a sub-analysis of the ORIGINS-RCE CardioLink-13 study

Abstract Background Compared to people of other races and ethnicities, South Asian (SA) adults are disproportionately affected by a higher burden of type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). We previously found that compared to individuals of White European (WE) descent with T2D, SA individuals with T2D exhibited profoundly less vascular regenerative (VR) cell content. Given that VR cells critically regulate vessel homeostasis, we postulated that the "vascular regenerative cell exhaustion" phenomenon we had observed may also contribute to the prevalence of ASCVD in SA populations. Purpose The ORIGINS-RCE CardioLink-13 study compared the frequencies of VR cells and cell types in individuals of SA and WE ethnicities with either 1) T2D and cardiovascular-risk factors or 2) documented ASCVD. This sub-analysis was conducted to determine if there are differences in the frequency of circulating VR cells and cell types in SA and WE individuals with ASCVD. Methods Among the 120 self-identified SA and WE adult participants (≥40 years of age), 23 SA and 41 WE individuals had ASCVD. Peripheral blood samples were processed for pro-inflammatory vs. pro-vascular progenitor cell enumeration as well as measurement of reactive oxygen species (ROS) production using a unique high aldehyde dehydrogenase (ALDHhi) activity-based flow cytometry assay in combination with side scatter properties (SSC) and lineage specific cell surface markers to identify progenitor cell populations. Results Compared to samples from the WE participants, the SA adults had a lower frequency of ALDHhiSSClowCD133+ (59% vs. 48%, P&amp;lt;0.001) cells and ALDHhiSSClowCD34+CD133+ (56% vs. 45%, P&amp;lt;0.001) progenitor cells with previously established pro-angiogenic properties. We also observed that SA participants had a decreased frequency of ALDHhiSSClowCD34+CD133+CD45- (0.0019% vs. 0.0005%, P&amp;lt;0.05) cells which may represent a rare population of circulating endothelial progenitor cells with vasculogenic functions. SA participants also exhibited a shift in monocyte polarization from a reparative phenotype towards a pro-inflammatory state, as demonstrated by a decrease in ALDHhiSSCmidCD14+CD163+ (86% vs. 78%, P&amp;lt;0.01) monocytes and an increase in ALDHhiSSCmidCD86+CD163- (8.2% vs. 13%, P&amp;lt;0.01) cells. There were no significant differences in the frequency of circulating granulocytes (ALDHhiSSChi cells) suggesting comparable inflammatory granulocyte burden between SA and WE adults, with no meaningful difference in intracellular ROS production in ALDHhi progenitor cell subsets, as previously observed in participants with T2D. Conclusions South Asian adults with ASCVD demonstrate a loss of vascular regenerative cells suggesting a compromised ability to repair damaged vessels which may contribute to their elevated cardiovascular risk.

Abstract 15850: Low Rates of Achievement of Low-Density Lipoprotein Cholesterol Levels &lt;55 mg/dL Among Patients With Atherosclerotic Cardiovascular Disease in the United States: Findings From the Cardiovascular Multicenter Observational Investigation of Lipid Care in the United States-2 Registry

Introduction: Guidelines are increasingly recommending a goal LDL-C &lt;55 mg/dL in persons with atherosclerotic cardiovascular disease (ASCVD). The proportion and characteristics of US adults with ASCVD with an LDL-C &lt;55 mg/dL remains unclear. Aims: To evaluate lipid management in ASCVD patients and factors associated with achieving an LDL-C &lt;55mg/dL. Methods: Using electronic health record data from 8 US health systems, we evaluated LDL-C levels and treatment patterns in persons with prevalent ASCVD seen as outpatients between 1/1/2021-12/31/2021 with an LDL-C level within the prior year. Multivariable logistic regression modeling with generalized estimating equations was used to evaluate factors associated with an LDL-C &lt;55 mg/dL. Results: Among 178,240 eligible ASCVD patients, 43.5% (77,472) had an LDL- C &lt;70 mg/dL and 22.0% (39,270) had an LDL-C &lt;55 mg/dL. Older age was associated with higher odds of LDL-C &lt;55 mg/dL (OR 1.10 per 10 years, 95% CI 1.07-1.13), while female sex (OR 0.71, 95% CI 0.68-0.64) Black race (OR 0.77, 95% CI 0.70-0.86), and non-coronary artery disease forms of ASCVD including peripheral artery disease (PAD, OR 0.61, 95% CI 0.58-0.64) and cerebrovascular disease (CeVD, OR 0.72, 95% CI 0.66-0.79) were associated with lower odds of LDL-C &lt;55 mg/dL in multivariable modeling. Overall, while 75.0% were on a statin, only 36.9% were on a high-intensity statin, 5.7% were on ezetimibe, and 1.7% were on a PCSK9i. Combination therapy was rare: only 4.2% were on a statin+ezetimibe, 0.5% on statin+PCSK9i, and 0.3% on all three. Conclusions: Less than a quarter of US patients with ASCVD achieve an LDL &lt;55 mg/dL. Achieving this goal is even less common among younger adults, women, Black persons, and those with PAD and CeVD. Current therapeutic regimens often fail to use high-intensity statins, and markedly underutilize combinations of statins with ezetimibe and/or PCSK9 inhibitors.

Abstract 17498: Association Between 5-Year Change in Cardiovascular Risk and Atherosclerotic Cardiovascular Disease Incidence: A Multicohort Study

Introduction: Early measurement of atherosclerotic cardiovascular disease (ASCVD) risk factors contains valuable information about an individual's risk history. Hypothesis: Individuals with different historical cardiovascular risk statuses have varied risks of future ASCVD incidence. Methods: We analyzed pooled data from 7 community-based prospective cohort studies with up to 20-year follow-ups ( panel A ). White or Black participants aged 40-75 years without prevalent ASCVD were included. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (&lt;20%) or high risk (≥20%). Changes in CVD risk over a 5-year interval were considered. The main outcome is incident ASCVD. Results: Among 11026 participants (mean [SD] age,60.0 [8.1] years). 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up of 9.9 years, 2560 (23.2%) ASCVD events occurred. Compared to individuals with consistently high risk, participants with non-high to high risk (HR 0.67; 95%CI 0.59-0.77), high to non-high risk (HR 0.57; 95%CI 0.41-0.80), and consistently non-high risk (HR 0.33; 95%CI 0.29-0.37) had a lower risk of incident ASCVD. Compared to individuals with consistently non-high risk, participants with high to non-high risk (HR 1.74; 95%CI 1.26-2.41), non-high to high risk (HR 2.04; 95%CI 1.84-2.27), and consistently high risk (HR 3.03; 95%CI 2.69-3.42) had an increased risk of incident ASCVD ( panel B ). Conclusions: Changes in the CVD risk status over time inform dissimilar ASCVD risk than a single risk assessment. Dynamic risk evaluation might enable more accurate cardiovascular risk stratification and decision on preventive interventions should take historical risk status into account.

Genome-Wide Association Study of Cardiovascular Resilience Identifies Protective Variation in the CETP Gene.

Background The risk of atherosclerotic cardiovascular disease (ASCVD) increases sharply with age. Some older individuals, however, remain unaffected despite high predicted risk. These individuals may carry cardioprotective genetic variants that contribute to resilience. Our aim was to assess whether asymptomatic older individuals without prevalent ASCVD carry cardioprotective genetic variants that contribute to ASCVD resilience. Methods and Results We performed a genome-wide association study using a 10-year predicted ASCVD risk score as a quantitative trait, calculated only in asymptomatic older individuals aged ≥70 years without prevalent ASCVD. Our discovery genome-wide association study of N=12 031 ASCVD event-free individuals from the ASPREE (Aspirin in Reducing Events in the Elderly) trial identified 2 independent variants, rs9939224 (P<5×10-8) and rs56156922 (P<10-6), in the CETP (cholesteryl ester transfer protein) gene. The CETP gene is a regulator of plasma high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a) levels, and it is a therapeutic drug target. The associations were replicated in the UK Biobank (subpopulation of N=13 888 individuals aged ≥69 years without prevalent ASCVD). Carriers of the identified CETP variants (versus noncarriers) had higher plasma high-density lipoprotein cholesterol levels, lower plasma low-density lipoprotein cholesterol levels, and reduced risk of incident ASCVD events during follow-up. Expression quantitative trait loci analysis predicted the identified CETP variants reduce CETP gene expression across various tissues. Previously reported associations between genetic CETP inhibition and increased risk of age-related macular degeneration were not observed among the 3917 ASPREE trial participants with retinal imaging and genetic data available. Conclusions Common genetic variants in the CETP gene region are associated with cardiovascular resilience during aging. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.

Rapid and specific detection of LDL based on light addressable potentiometric sensor decorated with reduced graphene oxide-polyaniline-hemin nanocomposites

Atherosclerotic Cardiovascular Disease (ASCVD) is one of the major fatal diseases for humans and the fatality rate is increasing rapidly. Low density lipoprotein (LDL) is a serum key marker in the diagnosis of ASCVD because LDL level is associated with the prevalence of ASCVD. Herein, a light addressable potentiometric sensor (LAPS) was constructed for rapid detection of LDL using reduced graphene oxide-polyaniline-hemin nanocomposites (RGO-PANI-HNCs) and low density lipoprotein aptamer (LDLapt) as sensitive membrane of LAPS. Under the effect of bias voltage, the specific binding between LDL and LDLapt, and forming the LDL-LDLapt complex will cause the voltage change on the sensitive membrane surface of the LAPS system, which will cause the change of original current–voltage (I-V) balance in the circuit, resulting in the shift of I-V curve. The correlation between the potential shift of LAPS and LDL concentration was linear from 1.0 to 100.0 μg/mL under optimal conditions. The sensitivity is 4.7671 mV/μg/mL, and the detection limit is 0.79 μg/mL. Also, the LDL biosensor showed satisfactory specificity, selectivity, reproducibility, and showed a good precision in real human serum samples, which provides a simple and effective way for the early diagnosis of ASCVD.

Association between 5-year change in cardiovascular risk and the incidence of atherosclerotic cardiovascular diseases: a multi-cohort study

BackgroundThe influence of the historical cardiovascular risk status on future risk of atherosclerotic cardiovascular disease (ASCVD) is poorly understood. We aimed to investigate the association between 5-year changes in cardiovascular risk and ASCVD incidence.MethodsWe analyzed pooled data from seven community-based prospective cohort studies with up to 20 years of follow-up data. The study populations included White or Black participants aged 40–75 years without prevalent ASCVD. Cardiovascular risk was assessed using the pooled cohort equation and was categorized into non-high (< 20%) or high risk (≥ 20%). Changes in cardiovascular disease (CVD) risk over a 5-year interval were recorded. The main outcome was incident ASCVD.ResultsAmong 11,026 participants (mean [SD] age, 60.0 [8.1] years), 4272 (38.7%) were female and 3127 (28.4%) were Black. During a median follow-up period of 9.9 years, 2560 (23.2%) ASCVD events occurred. In comparison with individuals showing a consistently high CVD risk, participants whose CVD risk changed from non-high to high (hazard ratio [HR], 0.67; 95% confidence interval [CI] 0.59–0.77) or high to non-high (HR, 0.57; 95% CI 0.41–0.80) and those with a consistently non-high risk (HR, 0.33; 95% CI 0.29–0.37) had a lower risk of incident ASCVD. In comparison with individuals showing a consistently non-high CVD risk, participants whose CVD risk changed from high to non-high (HR, 1.74; 95% CI 1.26–2.41) or from non-high to high risk (HR, 2.04; 95% CI 1.84–2.27) and those with a consistently high risk (HR 3.03; 95% CI 2.69–3.42) also showed an increased risk of incident ASCVD.ConclusionsIndividuals with the same current CVD risk status but different historical CVD risks exhibited varying risks of future ASCVD incidents. Dynamic risk evaluation may enable more accurate cardiovascular risk stratification, and decision-making regarding preventive interventions should take the historical risk status into account.Graphical

Overweight/obesity and prevalent atherosclerotic cardiovascular disease in patients with heterozygous familial hypercholesterolemia: An analysis from HELLAS-FH registry

Overweight/obesity and prevalent atherosclerotic cardiovascular disease in patients with heterozygous familial hypercholesterolemia: An analysis from HELLAS-FH registry

The effect of telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach) on health care cost and utilization: results of a randomized controlled trial.

Peripheral artery disease (PAD) is the third most prevalent atherosclerotic cardiovascular disease. In 2016, costs per patient associated with PAD exceeded even the health-economic burden of coronary heart disease. Although affecting over 200 million people worldwide, a clear consensus on the most beneficial components to be included in home-based exercise programs for patients with peripheral artery disease is lacking. The aim of the study was to examine the health care use and costs caused by the 12-month patient-centered 'Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease' (TeGeCoach) program in a randomized controlled trial. This is a two-arm, parallel-group, open-label, pragmatic, randomized, controlled clinical trial (TeGeCoach) at three German statutory health insurance funds with follow-up assessments after 12 and 24-months. Study outcomes were medication use (daily defined doses), days in hospital, sick pay days and health care costs, from the health insurers' perspective. Claims data from the participating health insurers were used for analyses. The main analytic approach was an intention-to-treat (ITT) analysis. Other approaches (modified ITT, per protocol, and as treated) were executed additionally as sensitivity analysis. Random-effects regression models were calculated to determine difference-in-difference (DD) estimators for the first- and the second year of follow-up. Additionally, existing differences at baseline between both groups were treated with entropy balancing to check for the stability of the calculated estimators. One thousand six hundred eighty-five patients (Intervention group (IG) = 806; Control group (CG) = 879) were finally included in ITT analyses. The analyses showed non-significant effects of the intervention on savings (first year: -352€; second year: -215€). Sensitivity analyses confirmed primary results and showed even larger savings. Based on health insurance claims data, a significant reduction due to the home-based TeGeCoach program could not be found for health care use and costs in patients with PAD. Nevertheless, in all sensitivity analysis a tendency became apparent for a non-significant cost reducing effect. NCT03496948 (www. gov), initial release on 23 March 2018.

21-LB: Prevalence of Atherosclerotic Cardiovascular Diseases in Women with Type 2 Diabetes across the Middle East and Africa—Primary Gender Analysis of the PACT-MEA Study

Objectives: Contemporary data on cardiovascular (CV) burden in women with type 2 diabetes (T2D) is lacking, particularly in the Middle East and Africa where the incidence and prevalence of T2D is one of the highest globally. We report prevalence of ASCVD/ASCVD risk stratified by gender to identify opportunities for improving T2D care. Methods: PACT-MEA (PACT-MEA; NCT05317845) is a cross-sectional, observational study of adults (≥18 years) with T2D from 55 clinics in Bahrain, Egypt, Jordan, Kuwait, Qatar, South Africa, and United Arab Emirates. Medical history, demographics, clinical information, and laboratory values were collected from medical charts of patients at a clinic visit in 2022. We report the prevalence (95% CI) of established atherosclerotic cardiovascular disease (eASCVD) and ASCVD risk, the latter defined by the 2021 European Society of Cardiology (ESC) Guidelines on CV Disease Prevention in Clinical Practice (risk categories: moderate, high, very high [including eASCVD]). Prevalence estimates were weighted according to the size of the diabetes population in each country. Results: Of the 3,726 patients enrolled, 47% were female, with a median age of 59.0; 35% were &amp;lt;55 years old. Across the seven PACT-MEA countries, prevalence of eASCVD was 16.0% (95% CI: 13.4-18.6) among females and 26.6% (23.7-29.5) among males. Per ESC guidelines, 0.6% (0.0-1.2) of females were at moderate risk for ASCVD, 72.5% (69.0-75.9) were at high risk, and 26.9% (23.5-30.3) were at very high risk. Among males, 0.7% (0.0-1.5), 65.9% (62.4-69.4), and 33.4% (29.9-36.8) were at moderate, high, and very high ASCVD risk, respectively. Conclusions: We found 1 in 6 women with T2D in the Middle East and Africa have eASCVD and nearly all are at high/very high ASCVD risk. This highlights the need for better screening and timely management of T2D in women and men to minimize CV risk, as well as the importance of gender inclusiveness in clinical studies. Disclosure F. Alawadi: Research Support; Novo Nordisk. E. Mashaki ceyhan: None. H. M. Sabbour: Research Support; Novo Nordisk. S. Salek: None. G. Yadav: Employee; Novo Nordisk. S. Verma: Advisory Panel; Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novartis, Novo Nordisk, Novo Nordisk Canada Inc., Consultant; AstraZeneca, Other Relationship; Amarin Corporation, AstraZeneca, Bayer Inc., Boehringer Ingelheim and Eli Lilly Alliance, Boehringer Ingelheim International GmbH, Canadian Medical and Surgical Knowledge Translation Research Group, EOCI Pharmacomm, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novartis Canada, Novo Nordisk, Novo Nordisk Canada Inc., Pfizer Inc., PhaseBio Pharmaceuticals, Inc., S &amp; L Solutions Event Management Inc, Sanofi, Sun Pharmaceutical Industries Ltd., Toronto Knowledge Translation Working Group, Research Support; Amarin Corporation, Amgen Canada, AstraZeneca, Bayer Inc., Boehringer Ingelheim International GmbH, HLS Therapeutics Inc., Novartis, Novo Nordisk, Pfizer Inc., PhaseBio Pharmaceuticals, Inc. S. H. Assaad-khalil: Board Member; AstraZeneca, Merck &amp; Co., Inc., Servier Laboratories, Sanofi, Consultant; AstraZeneca, Servier Laboratories, Sanofi, Merck &amp; Co., Inc., Research Support; Novo Nordisk, Eva Pharma. W. Almahmeed: None. N. Alamuddin: Consultant; Novo Nordisk, Speaker's Bureau; Novo Nordisk. H. Alkandari: None. J. A. Haddad: None. L. N. Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. L. Lombard: None. R. A. Malik: None.