Prevalence Of Atherosclerotic Risk Factors Research Articles

Influence of Race/Ethnicity and Sex on Coronary Stent Outcomes in Diabetic Patients.

How diabetes mellitus (DM), race/ethnicity, and sex impact ischemic events following coronary artery stent procedures is unknown. Using the PLATINUM Diversity and PROMUS Element Plus Post-Approval Pooled Study (N = 4184), we examined the impact of race/ethnicity, sex, and DM on coronary stent outcomes. Primary outcome was 1-year major adverse cardiac events (MACE) (MACE composite: death, myocardial infarction [MI], and target vessel revascularization). The study sample included 1437 diabetic patients (501 White men, 470 White women, 246 minority men, 220 minority women) and 2641 patients without medically treated DM (561 minority, 1090 women). Mean age (years) ranged from 61 in minority men to 65 in White women. Diabetic patients had a higher prevalence of atherosclerotic risk factors and comorbidities. Diabetic minority women (DMW; 70% Black, 27% Hispanic) had similar atherosclerotic risk factors to other diabetics, but experienced higher 1-year MACE (14.4% vs 7.5%, P <.01) and MI (4.3% vs 1.6%, P <.01) rates compared with patients without medically treated DM. No other diabetic cohort (White men, White women, minority men) showed an increased risk of MACE vs patients without medically treated DM. The incremental risk of MACE in DMW was associated with insulin use and persisted after risk adjustment (adjusted odds ratio 1.6 vs patients without medically treated DM; 95% CI, 1.0-2.5). Independent predictors of 1-year MACE included insulin use, hyperlipidemia, renal disease, and prior MI. DMW face the highest risk of ischemic events following coronary stenting, driven, in part, by insulin use. Aggressive secondary prevention and strict glycemic control are imperative in this cohort, and further research is warranted to elucidate the biologic mechanisms underpinning these observations. NCT02240810 (http://clinicaltrials.gov/).

Moderate physical activity and healthy eating habits among older African American women with diabetes and hypertension: a qualitative study of barriers and facilitators

ABSTRACT Objective African American women have a high prevalence of atherosclerotic risk factors. Many of these atherosclerotic risk factors can be modified through increased physical activity and a healthy diet. Design We conducted a phenomenological qualitative study on perceptions of physical activity and healthy eating among 26 African American women, 55 years and older. Interviews were conducted and coded for emerging themes on barriers and facilitators of physical activity and dietary behaviors. Results Perceived barriers were pain and motivation to be active, limited definition of physical activity, time, preparation, cost of healthy meals, and daily decisions on food choice and preference. Facilitators were a routine of regular physical activity, awareness of healthy food choices, and influence of family. Conclusions Overall, participants had a general perception about the importance of physical activity and healthy eating; however, their motivation to engage in these behaviors depends on their definition, personal motivation, and food preference.

Prevalence of Atherosclerotic Risk Factors Among Children and Young Adults With Arterial Ischemic Stroke

Arterial ischemic stroke (AIS) incidence has decreased overall in recent decades yet has increased in young adults. The potential associations with atherosclerotic risk factors (ARFs) remain unknown. To assess the ages at which ARFs may be risk factors associated with AIS. A nested case-control study was conducted within Kaiser Permanente Northern California (KPNC) from January 1, 2000, through December 31, 2014. Data were analyzed from 2019 to 2022. Cases were identified using diagnostic codes and radiology reports. A total of 2 to 3 controls per case, matched on age and enrollment dates, were randomly identified and confirmed as stroke-free by medical record review. Only ARFs documented prior to stroke diagnosis (or the same date in controls) were considered to ensure the same period of observation. Comparisons were stratified by decade of life. Cases and controls were selected from the KPNC population (4.7 million children and 7.5 million young adults). Medical record review was conducted of all children (aged 29 days to 19 years) and a sample of young adults (aged 20-49 years) with International Classification of Diseases, Ninth Revision code or radiology text string search suggestive of AIS. Stroke-free controls were randomly selected. Hypertension, hyperlipidemia, diabetes, obesity, and smoking history. Odds of AIS. In all analyses, cases and controls were compared using logistic regression. A total of 141 pediatric cases (69 [48.9%] aged 29 days to 9 years; 72 [51.1%] aged 10-19 years) and 364 pediatric controls (168 [46.2%] aged 0-9 years; 196 [53.8%] aged 10-19 years) and 455 young adult cases (71 [15.6%] aged 20-29 years; 144 [31.6%] aged 30-39 years; and 240 [52.7%] aged 40-49 years) and 1018 young adult controls (121 [11.9%] aged 20-29 years; 298 [29.3%] aged 30-39 years; and 599 [58.8%] aged 40-49 years) were identified. The percent of the cases that were male or female did not differ from the percent in the control group. The odds ratio (OR) of having any ARFs on AIS was 1.87 (95% CI, 0.72-4.88) for age range 0 to 9 years; OR, 1.00 (95% CI, 0.51-1.99) for age range 10 to 19 years; OR, 2.3 (95% CI, 1.17- 4.51) for age range 20 to 29 years; OR, 3.57 (95% CI, 2.34-5.45) for age range 30 to 39 years; and OR, 4.91 (95% CI, 3.52-6.86) for age range 40 to 49 years. The risk associated with multiple ARFs was OR, 5.29 (95% CI, 0.47-59.4) for age range 0 to 9 years; OR, 2.75 (95% CI, 0.77-9.87) for age range 10 to 19 years; OR, 7.33 (95% CI, 1.92-27.9) for age range 20 to 29 years; OR, 9.86 (95% CI, 4.96-19.6) for age range 30 to 39 years; and OR, 9.35 (95% CI, 6.31-13.8) for age range 40 to 49 years. The ARF findings by both definitions were significant in all young adult groups. Atherosclerosis was the presumed etiology in 0% of cases in the age group 0 to 9 years, 1.4% in the age group 10 to 19 years, 8.5% in the age group 20 to 29 years, 21.5% in the age group 30 to 39 years, and 42.5% in the age group 40 to 49 years. Although atherosclerosis may not be a common cause of AIS in children or in early young adulthood, findings of this study suggest that ARFs associated with stroke in older adults are present in childhood and increase with age. Efforts to reduce these risk factors should begin as early as possible.

Atherosclerosis and multiple sclerosis: An overview on the prevalence of risk factors

BackgroundAtherosclerosis is the leading cause of ischemic heart disease and coronary artery disease. The process of atherosclerosis develops over a period of years and is mainly immune-mediated. Data regarding the prevalence of vascular disease and atherosclerosis among people with multiple sclerosis (pwMS) is inconsistent, therefore, we aimed to provide an overview of the prevalence of atherosclerotic risk factors in pwMS. MethodsThis is a cross-sectional study over a period of one year among pwMS visiting the Isfahan MS center. Study data have been extracted using participants’ files and a checklist that was completed by the observers. Only people with relapsing-remitting (RRMS) and secondary progressive (SPMS) forms of MS were included in the study. Participants with primary progressive (PPMS) disease are only described and have been excluded from analyses. ResultsOf the 396 pwMS (343 with RRMS and 53 with SPMS), in descending order, the reported risk factors were tobacco smoking (18.4%), dyslipidemia (10%), hypertension (8.8%), and diabetes mellitus (4.5%). In people with RRMS, 17.4% were smokers, 9.9% had dyslipidemia, 8.1% had hypertension, and 4.3% had diabetes mellitus. In SPMS patients 24.5% reported a history of smoking, 13.2% had hypertension, 9.4% had dyslipidemia, and 3.7% had diabetes mellitus. Smoking was insignificantly associated with higher expanded disability status scale (Z: 1.70, p-value = 0.090). Male sex (RR [95%CI]: 1.628 [1.172, 2.261], p-value = 0.004) and increasing age (RR [95%CI]: 1.024 [1.008, 1.040], p-value = 0.003) were associated with a higher number of risk factors. ConclusionThe highest observed atherosclerosis risk factor among pwMS was smoking. Diabetes mellitus was the least reported risk factor in our population as a whole. Overall, and in participants with RRMS, dyslipidemia and hypertension were the second and third most commonly reported risk factors, however, hypertension exceeded dyslipidemia in participants with SPMS. Male sex and increasing age were associated with a higher number of atherosclerosis risk factors.

Influence of cardiovascular drugs on the efficacy and safety of dapagliflozin in patients with type 2 diabetes mellitus in the DECLARE-TIMI 58 trial

Abstract Background In DECLARE-TIMI 58, the sodium glucose co-transporter 2 inhibitor (SGLT2i) dapagliflozin reduced the risk of the composite of cardiovascular (CV) death or hospitalization for heart failure (HHF) in a broad range of patients with type 2 diabetes mellitus (T2DM). SGLT2i are known to have diuretic and anti-hypertensive effects. However, whether concomitant CV drugs influence the efficacy and safety of dapagliflozin in these populations is less well known. Purpose We examined whether dapagliflozin consistently reduced the risk of CV outcomes and whether the safety of dapagliflozin was similar with or without the concurrent use of various CV drugs. Methods DECLARE–TIMI 58 was a randomized trial of dapagliflozin versus placebo in patients with T2DM and either atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors for CV disease followed for a median of 4.2 years. We stratified patients by the use of CV drugs at baseline commonly used for heart failure: angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARB), beta-blockers, diuretics, and mineralocorticoid receptor antagonists (MRA). Efficacy outcomes of interest were the composite of CV death/HHF and HHF alone. We used the Cox proportional-hazard model for these analyses. Results Of 17,160 patients, 13,950 (81%) used ACEi/ARB, 9,030 (53%) used beta-blockers, 6,967 (41%) used diuretics, and 762 (4%) used MRA at baseline. All were balanced by randomized treatment groups. Patients using CV drugs at baseline had a greater prevalence of atherosclerotic risk factors and established CV disease than those without. Dapagliflozin consistently reduced the risk of CV death/HHF regardless of the use of CV medications (Figure). For HHF alone, similar results were seen with no significant interactions for any of the classes. There were no significant treatment interactions by the concomitant use of any of CV drugs for adverse events including symptoms of volume depletion or acute kidney injury. Conclusions In this analysis from the DECLARE–TIMI 58 trial, dapagliflozin consistently reduced the risk of CV death/HHF and HHF alone irrespective of the concurrent use of various CV drugs without any treatment interaction for key safety events. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The DECLARE–TIMI 58 trial was supported by AstraZeneca.

Cardiovascular Outcomes and Rehospitalization Rates in Homeless Patients Admitted With Acute Myocardial Infarction

ObjectiveTo study the in-hospital outcomes and 30-day readmission data in homeless patients admitted with acute myocardial infarction (AMI). MethodsAdult patients (>18 years of age) who were admitted with AMI between January 1, 2015, and December 31, 2016, were identified in the National Readmission Database. Patients were classified into homeless or non-homeless. Baseline characteristics, rates of invasive assessment and revascularization, mortality, 30-day readmission rates, and reasons for readmission were compared between the 2 cohorts. ResultsA total of 3938 of 1,100,241 (0.4%) index hospitalizations for AMI involved homeless patients. Compared with non-homeless patients, homeless patients were younger (mean age, 57±10 years vs 68±14 years; P<.001) and had a lower prevalence of atherosclerotic risk factors (hypertension, hyperlipidemia, and diabetes) but a higher prevalence of anxiety, depression, and substance abuse. Homeless patients were less likely to undergo coronary angiography (38.1% vs 54%; P<.001), percutaneous coronary intervention (24.1% vs 38.7%; P<.001), or coronary artery bypass grafting (4.9% vs 6.7%; P<.001). Among patients who underwent percutaneous coronary intervention, bare-metal stent use was higher in homeless patients (34.6% vs 12.1%; P<.001). After propensity score matching, homeless patients had similar mortality but higher rates of acute kidney injury, discharge to an intermediate care facility or against medical advice, and longer hospitalizations. Thirty-day readmission rates were significantly higher in homeless patients (22.5% vs 10%; P<.001). Homeless patients had more readmissions for psychiatric causes (18.0% vs 2.0%; P<.001). ConclusionConsiderable differences in cardiovascular risk profile, in-hospital care, and rehospitalization rates were observed in the homeless compared with non-homeless cohort with AMI. Measures to remove the health care barriers and disparities are needed.

Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

BackgroundThe effects of Simultaneous Pancreas Kidney Transplantation (SPKT) on Peripheral Vascular Disease (PVD) warrants additional study and more target focus, since little is known about the mid- and long-term effects on the progression of PVD after transplantation.Methods101 SPKT and 26 Kidney Transplantation Alone (KTA) recipients with insulin-dependent diabetes mellitus (IDDM) were retrospectively evaluated with regard to graft and metabolic outcome. Special subgroup analysis was directed towards the development and progression of peripheral vascular complications (PVC) (amputation, ischemic ulceration, lower extremity angioplasty/ bypass surgery) after transplantation.ResultsThe 10-year patient survival was significantly higher in the SPKT group (SPKT: 82% versus KTA 40%; P < 0.001). KTA recipients had a higher prevalence of atherosclerotic risk factors, including coronary artery disease (P < 0.001), higher serum triglyceride levels (P = 0.049), higher systolic (P = 0.03) and diastolic (P = 0.02) blood pressure levels. The incidence of PVD before transplantation was comparable between both groups (P = 0.114). Risk factor adjusted multivariate analysis revealed that patients with SPKT had a significant lower amount (32%) of PVCs (32 PVCs in 21 out of 101 SPKT; P < 0.001) when compared to the KTA patients who developed a significant increase in PVCs to 69% of cases (18 PVCs in 11 out of 26 KTA; P < 0.001). In line mean values of HbA1c (P < 0.01) and serum triglycerides (P < 0.01) were significantly lower in patients with SPKT > 8 years after transplantation.ConclusionSPKT favorably slows down development and progression of PVD by maintaining a superior metabolic vascular risk profile in patients with IDDM1.

P3127Optimal revascularization strategy in non-ST-segment elevation myocardial infarction with multivessel coronary artery disease: staged vs. one-time vs. culprit-only revascularization

Abstract Background/Introduction Although optimal revascularization strategy in patients with ST-segment elevation myocardial infarction with multivessel coronary artery disease (MVD) was well established, there are few studies which investigated optimal revascularization strategy in non-ST-segment elevation myocardial infarction (NSTEM) with MVD. Purpose We investigated 2-year clinical outcomes according to strategy of revascularization in patients with NSTEMI and MVD. Methods Between November 2011 and October 2015, a total of 2474 patients with NSTEMI and MVD who underwent successful percutaneous coronary intervention were analyzed from the Korea Acute Myocardial Infarction Registry-National Institute of Health (staged 308, one-time 1043 and culprit-only 1123 patients). We did not include patients with left main disease and cardiogenic shock. Primary endpoint was major adverse cardiac events (MACE: the composite of cardiac death, myocardial infarction [MI] or target-vessel revascularization [TVR]) during 2-year follow-up (median 737 days [interquartile range 705–764]). We also analyzed the of all-cause mortality, stroke and non-TVR. Results Baseline characteristics such as age, gender, and prevalence of atherosclerotic risk factors between multivessel revascularization (MVR; staged or one-time revascularization) and CVR were similar. There was also no difference in symptom to balloon time in 2 groups. MACE occurred in 305 patients (12.3%) during 2-year follow-up. MVR could reduce incidence of MACE (10.2% vs. 14.9%; adjusted hazard ratio [HR] 1.50 for CVR, 95% confidence interval [CI] 1.20–1.88, p&lt;0.001), all-cause death (8.4% vs. 12.1%; adjusted HR 1.45 for CVR, 95% CI 1.13–1.87, p=0.003) and non-TVR (1,9% vs. 7.0%; adjusted HR 3.99 for CVR, 95% CI 2.55–6.27, p&lt;0.001). There was no difference in incidence of stroke between MVR and CVR. We also analyzed same analysis between staged and one-time revascularization. Complete revascularization was more achieved in one-time revascularization group compared to staged revascularization group (62.0% vs. 76.1%, p&lt;0.001). In multivariate Cox-regression analysis, staged revascularization was not associated with improved clinical outcomes in terms of MACE (HR 0.74, 95% CI 0.50–1.09, p=0.126), all-cause death (HR 1.07, 95% CI 0.69–1.68, p=0.759), stroke (HR 1.75, 95% CI 0.68–4.52, p=0.245) and non-TVR (HR 2.56, 95% CI 0.75–8.68, p=0.132). Analysis by propensity score matching and inverse probability of treatment weighting did not significantly affect the results. Conclusions MVR reduced 2-year adverse cardiac events in patients with NSTEMI and MVD compared to CVR. However, staged revascularization was not superior to one-time revascularization for reducing MACE among NSTEMI patients with MVD who received MVR.

Characteristics and Clinical Outcomes of Patients With Spontaneous Coronary Artery Dissection.

BackgroundThe goal of this study is to report the characteristics and long‐term clinical outcomes of patients with spontaneous coronary artery dissection (SCAD) and to identify factors associated with recurrent SCAD.Methods and ResultsThis is a retrospective cohort study that included patients who underwent coronary angiography for evaluation of acute myocardial infarction between 2006 and 2016. Among 26 598 patients hospitalized with a principal diagnosis of acute myocardial infarction, 208 (0.78%) were diagnosed with SCAD. Patients with SCAD were younger (49.0±11.6 versus 65.6±12.2 years) and more likely to be women (88.9% versus 31.6%). Atherosclerotic risk factors, such as hypertension, hyperlipidemia, obesity, and diabetes mellitus, were less prevalent. Median follow‐up was 4.7 years. Mortality was lower in patients with SCAD (1‐year mortality: 2.4% versus 8.8%; P<0.001). After using propensity score matching to control for differences in age, sex, and comorbidities, the difference in mortality was no longer present, suggesting that lower mortality in patients with SCAD is attributed primarily to their baseline characteristics. Recurrent SCAD occurred in 22 patients (10.6%). Multivariate Cox regression modeling showed concomitant fibromuscular dysplasia (hazard ratio, 5.1; 95% CI, 1.6–15.8; P=0.005) and migraine headaches (hazard ratio, 3.4; 95% CI, 1.4–8.4; P=0.008) to be associated with increased risk of recurrent SCAD.ConclusionsAmong patients with acute myocardial infarction, patients with SCAD have a lower risk of mortality, which is attributed primarily to their younger age, female sex, and low prevalence of atherosclerotic risk factors. Risk of recurrent SCAD persists years after the initial presentation. Patients with fibromuscular dysplasia and migraine are at higher risk for recurrent SCAD.

Is Prevalence of Atherosclerotic Risk Factors Increasing Among Young Adults? It Depends on How You Ask.

BackgroundIncidence of cardiovascular disease in young adults is unabated. Increased prevalence of self‐reported atherosclerotic risk factors may be driving this trend. The goal of this study was to examine whether the prevalence of atherosclerotic risk factors in young adults is increasing over time using both self‐report and standard clinical criteria.Methods and ResultsData from young adults, aged 20 to 45 years, in the National Health and Nutrition Examination Survey from 1999/2000 to 2013/2014 were analyzed. Risk factor prevalence of hypertension, diabetes mellitus, and hyperlipidemia was measured using clinical criteria and self‐report. Smoking was based on self‐report only, and obesity was based clinically on body mass index and waist to height ratio. Prevalence by survey was adjusted for age, sex, and race/ethnicity. By clinical criteria, adjusted prevalence of any 3 risk factors (hypertension, diabetes mellitus, and hyperlipidemia) declined slightly from 21.8% to 18.9% (P for trend=0.05). However, by self‐report, the adjusted prevalence of any 3 risk factors increased from 17.8% to 26.5% (P<0.01). Hypertension was unchanged by clinical criteria (P=0.32) but increased by self‐report (P<0.08). Diabetes mellitus, by clinical diagnosis and self‐report, remained unchanged (P=0.35 and P=0.29, respectively). Hyperlipidemia, by clinical criteria, declined over time (P<0.01), but increased by self‐report (P<0.01). Smoking declined (P<0.01), and obesity increased by both body mass index (P<0.01) and waist/height ratio (P<0.01).ConclusionsThe perception that young adult risk factors are increasing is consistent with increasing self‐reported risk factors. However, evidence does not suggest that clinical risk factor prevalence overall has increased in young adults.

Abstract 187: Odds of Stroke in the Young based on Preexisting Atherosclerotic Risk Factors

Background: Recent studies suggest an increasing incidence of stroke in young populations in the last 2 decades in contrast with the declining incidence in older adults. Rising prevalence of atherosclerotic risk factors (ARF) has been proposed as an explanation for this trend. The aim of this study was to determine the odds of stroke with different ARF across the young population. Methods: In a case control study nested within a cohort of children (29 days-19 years) and young adults (20-49 years) enrolled in a Northern California integrated health care system between 2000-2014, cases of ischemic stroke were identified using ICD-9 codes as well as text string searches of the radiology database, and were confirmed by chart review and adjudicated by 2 MD review. Controls matched by age and dates of enrollment were randomly selected from the cohort. Charts for all cases and controls were reviewed for evidence of ARF prior to stroke diagnosis. Results: Strokes were identified in 141 children and 449 young adults, and 354 childhood controls and 1,014 young adult controls were randomly selected. All ARF were found at very low rates in both childhood cases and controls (figure). In the 20-29 year age group, hypertension and having more than one risk factor significantly increased the odds of stroke. In the oldest 2 groups (30-39, 40-49y), all 5 ARF significantly increased the odds of stroke, as did having more then one risk factor. Conclusions: ARF are very rare in children, including in those with strokes. Hypertension begins to increase the odds of stroke in the 3 rd decade of life, but in the 4 th and 5 th decades, each risk factor’s impact on stroke risk is significant, with more then one risk factor increasing the odds of stroke 10-fold.

Abstract TP213: Associations Between Risk Factors and Stroke Mechanisms in Young Adults

Background: Atherosclerotic stroke risk factors are prevalent among young adults with stroke. However, it is not certain if these risk factors are contributors to the majority of index mechanisms of stroke in young adults. Methods: This retrospective cohort study included young adults age 18-50 with a primary stroke diagnosis (ischemic stroke, IS, transient ischemic attack, TIA, intracerebral hemorrhage, ICH, subarachnoid hemorrhage, SAH) evaluated in inpatient or outpatient settings at a tertiary care academic medical center between 1/2016-12/2017. Covariates included demographics, medical history, stroke subtype, and stroke mechanism. Comparisons were made using the Chi-square, Fisher exact, and t tests. Results: This study included 263 patients (128 women, 135 men). Atherosclerotic risk factors were common among young adults: hypertension (38%), hyperlipidemia (25%), diabetes (20%), tobacco use (47%). Women were more likely to have migraine (34% vs 16%, p=0.001), and men were more likely to be tobacco users (39% vs 54%, p=0.01). Women had more aneurysmal SAH (62% vs 23% hemorrhagic strokes, p&lt;0.001). Men had more hypertensive ICH (3% vs 23% hemorrhagic strokes, p=0.02). When comparing the frequency of atherosclerotic risk factors between young adults with stroke mechanisms commonly implicated with atherosclerosis (e.g. large artery atherosclerosis, LAA, small vessel occlusions, SVO) and unrelated stroke mechanisms, these risk factors were not more frequent in patients with LAA and SVO. Conclusion: Despite a high prevalence of atherosclerotic risk factors among young adults with stroke in this cohort, only a small proportion of young adults had stroke mechanisms pathogenically related to these risk factors. This observation should prompt further research on risk factors related to non-atherosclerotic mechanisms of stroke in young adults and modification of patient counseling about the role of atherosclerotic risk factors to their index strokes.

Quantitative analysis of carotid arterial calcification using airway CT in obstructive sleep apnea

ObjectiveTo evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT). MethodsThis study included a total of 180 consecutive OSA patients aged 45–80years underwent polysomnography and airway CT between March 2014 and October 2016. The subjects were divided into three groups based on the results of the respiratory disturbance index (RDI): mild (RDI 5–14, n=29), moderate (RDI 15–29, n=50), and severe (RDI≥30, n=101). The extent of carotid arterial calcification on each airway CT scan was quantified according to the modified Agatston scoring method. Differences among the three groups in clinical characteristics including age, gender, body mass index (BMI), comorbid disease, blood pressure, total cholesterol, and carotid arterial calcification score (CarACS) were analyzed. ResultsThe severe OSA group showed significantly stronger predominance for male and smoker, higher prevalence of diabetes, and larger BMI than those of mild and moderate OSA groups. The mean CarACS was significantly different among the three groups (mild RDI: 4.3±13.4, moderate RDI: 7.4±28.8, severe RDI: 48.6±121.6, P=0.011). Univariate linear regression showed that RDI, age, hypertension, male sex and diabetes significantly influenced on the CarACS. In a multivariate linear regression model, the CarACS was related to age, male sex, and diabetes. ConclusionsThe patients with severe OSA showed larger CarACS and a higher prevalence of atherosclerotic risk factors. The CarACS was correlated with severity of OSA, which might be more dependent on the conventional risk factors of atherosclerosis.

Assessment of the frequency of cardiovascular risk factors in patients with Takayasu's arteritis.

The prevalence of atherosclerotic risk factors and disease in Takayasu's arteritis (TAK) has not been well defined. We aimed to assess the frequency of cardiovascular (CV) risk factors and the incidence of CV events (CVEs) in patients with TAK from two ethnically different populations. Patients with TAK followed at Mayo Clinic, Rochester, MN, USA and Marmara University, Istanbul, Turkey were included in this retrospective study. Patients with TAK were compared with age-, sex- and calendar year-matched controls from the same geographical region without TAK. The 2008 Framingham 10-year general CV risk score (FRS) was used for the evaluation of CV risk at the time of TAK incidence/index date. In total, 191 patients with TAK and 191 non-TAK controls were included. Hypertension and the prevalence of lipid-lowering treatments were significantly more frequent in TAK. Prior to the incidence/index date, occurrence of CVE was significantly higher in TAK. The FRS was significantly higher in TAK compared with non-TAK at incidence/index date. The cumulative incidence of CVE was 15.4% at 10 years in TAK vs 5.8% in non-TAK; the risk of CVE was increased among patients with TAK (hazard ratio = 4.36; 95% CI: 1.25, 15.13). CV risk factors are more common in patients with TAK, particularly hypertension. The FRS is higher in patients with TAK at the time of diagnosis. The cumulative incidence of CVE was also significantly higher during follow-up in TAK. Our results suggest that patients with TAK should undergo careful assessment of CV risk factors, and an aggressive risk modification approach is warranted.

Changing Trends of Atherosclerotic Risk Factors Among Patients With Acute Myocardial Infarction and Acute Ischemic Stroke

We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primary diagnosis of AMI or AIS were included. Across 2003 to 2013, a total of 1,360,660 patients with AMI and 937,425 patients with AIS were included in the study. We noted a progressive reduction in the mean age of patients presenting with AMI and AIS (p trend <0.001 for all groups), implying that the burden of young patients with these acute syndromes is progressively increasing. In addition, there was a progressive increase in the proportion of patients who are uninsured among patients presenting with AMI and AIS. Furthermore, despite a progressively younger age at presentation, there was an observed increase in the prevalence of atherosclerotic risk factors including hypertension, hyperlipidemia, diabetes, smoking, and obesity among patients presenting with AMI or AIS during 2003 to 2013. Significant disparities were noted in the prevalence of risk factors among various demographic and geographical cohorts. Low socioeconomic status as well as uninsured patients had a significantly higher prevalence of preventable risk factors like smoking and obesity as compared to the high socioeconomic status and insured patients, respectively. In conclusion, there have been significant changes in the risk factor profile of patients presenting with AMI and AIS over the last decade.

CHANGING TRENDS OF ATHEROSCLEROTIC RISK FACTORS AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND ACUTE ISCHEMIC STROKE

We aimed to evaluate the secular trends in demographics, risk factors, and clinical characteristics of patients presenting with acute myocardial infarction (AMI) or acute ischemic stroke (AIS), using a large nationally representative data set of in-hospital admissions. We used the 2003 to 2013 Nationwide Inpatient Sample. All admissions with primary diagnosis of AMI or AIS were included. Across 2003 to 2013, a total of 1,360,660 patients with AMI and 937,425 patients with AIS were included in the study. We noted a progressive reduction in the mean age of patients presenting with AMI and AIS (p trend <0.001 for all groups), implying that the burden of young patients with these acute syndromes is progressively increasing. In addition, there was a progressive increase in the proportion of patients who are uninsured among patients presenting with AMI and AIS. Furthermore, despite a progressively younger age at presentation, there was an observed increase in the prevalence of atherosclerotic risk factors including hypertension, hyperlipidemia, diabetes, smoking, and obesity among patients presenting with AMI or AIS during 2003 to 2013. Significant disparities were noted in the prevalence of risk factors among various demographic and geographical cohorts. Low socioeconomic status as well as uninsured patients had a significantly higher prevalence of preventable risk factors like smoking and obesity as compared to the high socioeconomic status and insured patients, respectively. In conclusion, there have been significant changes in the risk factor profile of patients presenting with AMI and AIS over the last decade.

Two-Decade Trends in the Prevalence of Atherosclerotic Risk Factors, Coronary Plaque Morphology, and Outcomes in Adults Aged ≤45 Years Undergoing Percutaneous Coronary Intervention

Data are limited about the prevalence trends of risk factors, lesion morphology, and clinical outcomes of coronary artery disease in patients, aged ≤45years, undergoing percutaneous coronary intervention (PCI), between the bare-metal stent (BMS; 1994 to 2002) and drug-eluting stent (DES; 2003 to 2012) eras. From the PCI database at the Cleveland Clinic, we identified 1,640 patients aged ≤45years and without a history of coronary artery bypass grafting who underwent PCI from 1994 to 2012. There were 883 patients in the BMS era cohort with a mean follow-up period of 13.15years and 757 in the DES era cohort with a mean follow-up of 5.02years. The DES era had more obese (51.8% vs 44.7%, p <0.001) and diabetes (23.0% vs 19.5%, p= 0.09) patients. DES era patients had more B2/C lesions (74.0% vs 32.5%, p <0.001), more severe preprocedural stenosis (86.1 ± 12.9 vs 72.2 ± 21.3, p <0.001), and longer lesions (15.5 ± 9.9 vs 9.6 ± 6.8, p <0.001). No difference was observed in the 30-day mortality between the DES and BMS eras. Irrespective of era, diabetics had worse long-term mortality (19.4% vs 9.3%, p <0.001) compared with nondiabetics. Obese patients had similar long-term outcomes compared with nonobese patients. In conclusion, patients aged ≤45years, who underwent a PCI procedure in the DES era had worse risk factor profiles, including obesity, compared with patients in the BMS era. They also had more complex lesions. Procedural and long-term outcomes of these patients have not changed between the 2eras. Young diabetic patients have worse long-term outcomes compared with nondiabetics.

Heart Disease in Women: Unappreciated Challenges, GPER as a New Target.

Heart disease in women remains underappreciated, underdiagnosed and undertreated. Further, although we are starting to understand some of the social and behavioral determinants for this, the biological basis for the increased rate of rise in atherosclerosis risk in women after menopause remains very poorly understand. In this review we will outline the scope of the clinical issues related to heart disease in women, the emerging findings regarding the biological basis underlying the increased prevalence of atherosclerotic risk factors in postmenopausal women (vs. men) and the role of the G protein-coupled estrogen receptor (GPER) and its genetic regulation as a determinant of these sex-specific risks. GPER is a recently appreciated GPCR that mediates the rapid effects of estrogen and aldosterone. Recent studies have identified that GPER activation regulates both blood pressure. We have shown that regulation of GPER function via expression of a hypofunctional GPER genetic variant is an important determinant of blood pressure and risk of hypertension in women. Further, our most recent studies have identified that GPER activation is an important regulator of low density lipoprotein (LDL) receptor metabolism and that expression of the hypofunctional GPER genetic variant is an important contributor to the development of hypercholesterolemia in women. GPER appears to be an important determinant of the two major risk factors for coronary artery disease-blood pressure and LDL cholesterol. Further, the importance of this mechanism appears to be greater in women. Thus, the appreciation of the role of GPER function as a determinant of the progression of atherosclerotic disease may be important both in our understanding of cardiometabolic function but also in opening the way to greater appreciation of the sex-specific regulation of atherosclerotic risk factors.

Medical Management of Atherosclerotic Risk Factors in Vascular Surgery Patients

There is an epidemic of cardiovascular disease in the United States, which is responsible for approximately one death every 40 seconds in the United States. Whereas the overall mortality attributable to cardiovascular disease is decreasing, the overall prevalence of atherosclerotic risk factors is increasing. Optimal management of atherosclerotic risk factors can have profound effects on morbidity and mortality after vascular surgical procedures. This review covers risk factors for the development of atherosclerosis; the evaluation of patients with vascular disease; management of tobacco abuse, hypertension, hyperlipidemia, diabetes mellitus, and antiplatelet agents; and perioperative medical management concerns in vascular surgery. Tables highlight investigational biomarkers for atherosclerosis, behavioral modification recommendations to be used to improve smoking cessation, Eighth Joint National Committee guidelines for blood pressure management, definitions of high- and moderate-intensity statin therapy, and potential future areas of research. Algorithms lay out the effects of cigarette smoke, the proposed mechanism of statin pleiotropy as it pertains to the vasculature, and the proposed mechanisms of the role of hyperglycemia in atherogenesis. This review contains 3 figures, 6 tables, and 79 references.

Lower extremity autologous vein bypass for critical limb ischemia is not adversely affected by prior endovascular procedure

It has been reported that a failed endovascular intervention adversely affects results of lower extremity bypass (LEB). We reviewed rates of prior endovascular intervention (PEI) in patients undergoing LEB with autologous vein for critical limb ischemia (CLI) to determine effects on graft patency, limb salvage, and amputation-free survival. Retrospective review was conducted of consecutive autologous vein LEBs performed for CLI between 2005 and 2012 at a tertiary care academic medical center. Overall, 314 autologous vein LEBs were performed for CLI, 71% for tissue loss. TransAtlantic Inter-Society Consensus II type D or type C lesions were present in 62% and 25%, respectively. The great saphenous vein was used as a conduit in 83%, and the distal target was infrapopliteal in 60%. The 30-day mortality rate was 3.5%. Primary patency rates at 1year and 5years were 61% and 45%. Secondary patency rates at 1year and 5years were 88% and 64%, with 23% requiring an intervention to maintain patency. The 5-year limb salvage rate was 89%, and the 5-year amputation-free survival was 49%. There were 61 patients (19%) who had undergone a PEI and 253 (81%) who underwent bypass with no prior endovascular intervention (NPEI). There were 19 iliac stents, 29 femoral interventions, 13 popliteal interventions, 9 crural interventions, 9 infrainguinal thrombectomies, and 13 infrainguinal thrombolyses. PEI and NPEI patients had similar demographics and prevalence ofatherosclerotic risk factors. The 1-year primary patency rate was 62% for NPEI patients vs 59% for PEI patients (P=.759). The 1-year and 2-year secondary patency rates were 87% and 79% for NPEI patients vs 89% and 78% for PEI patients (P= .947). The 3-year limb salvage rate was 89% for NPEI patients vs 92% for PEI patients (P= .445). The 3-year amputation-free survival was 59% for NPEI patients vs 52% for PEI patients (P= .399). Median follow-up time was 323days for NPEI patients (interquartile range, 83-918) vs 463days for PEI patients (interquartile range, 145-946; P= .275). Overall operative mortality, patency rates, and limb salvage for autologous vein LEB in CLI patients continue to be excellent in the endovascular era and are not necessarily affected by a prior ipsilateral endovascular procedure. Long-term survival remains poor in CLI patients requiring LEB.