Prevalence Of Cardiac Risk Factors Research Articles

A Step towards understanding coronary artery disease: a complication in idiopathic pulmonary fibrosis

BackgroundIdiopathic pulmonary fibrosis (IPF) is a relatively rare disease with increasing incidence trends. Cardiovascular disease is a significant complication in IPF patients due to the role of common proatherogenic immune...

Sodium-glucose co-transporter-2 inhibitors in patients treated with immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized the prognosis of cancer. Diabetes mellitus (DM) has been shown to have a negative effect on patients treated with ICIs. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality and cardiovascular (CV) outcomes.ObjectiveTo evaluate the prognostic value of SGLT2i on all-cause mortality and cardiotoxicity among patients treated with ICIs.MethodsWe performed a retrospective analysis of patients diagnosed with cancer and type 2 DM (DM2) and treated with ICIs at our center. Patients were divided into two groups according to baseline treatment with or without SGLT2i. The primary endpoint was all-cause mortality and the secondary endpoint was MACE, including myocarditis, acute coronary syndrome, heart failure, and arrhythmia.ResultsThe cohort included 119 patients, with 24 (20%) patients assigned to the SGLT2i group. Both groups exhibited a comparable prevalence of cardiac risk factors, although the SGLT2i group displayed a higher incidence of ischemic heart disease. Over a median follow-up of 28 months, 61 (51%) patients died, with a significantly lower all-cause mortality rate in the SGLT2i group (21% vs. 59%, p = 0.002). While there were no significant differences in MACE, we observed zero cases of myocarditis and atrial fibrillation in the SGLT2i, compared to 2 and 6 cases in the non-SGLT2i group.ConclusionsSGLT2i therapy was associated with a lower all-cause mortality rate in patients diagnosed with cancer and DM2 and treated with ICIs. Further studies are needed to understand the mechanism and evaluate its benefit on cardiotoxicity.Graphical

The prognostic value of beta-1 blockers in patients with non-small-cell lung carcinoma treated with pembrolizumab

BackgroundImmune checkpoint inhibitors (ICIs) such as pembrolizumab have revolutionized the treatment of metastatic non-small cell lung cancer (mNSCLC). Beta-adrenergic activation contributes to cancer initiation and progression. While non-selective beta-blocker were found to improve the efficacy of ICIs therapy, the role of beta-1 (β1)-selective -blocker (β1B) in lung cancer patients is unknown. ObjectiveTo evaluate the effect of β1B on overall survival (OS) and progression-free survival (PFS) in patients diagnosed with mNSCLC and treated with pembrolizumab. MethodsWe performed a retrospective analysis of patients diagnosed with mNSCLC and treated with first-line pembrolizumab at our center. ResultsOf 200 eligible patients, 53 (27%) were pretreated with β1B. Patients in the β1B cohort were older (73 ± 8 vs. 67 ± 10 years, p < 0.001) with a higher prevalence of cardiac risk factors and cardiovascular (CV) diseases including ischemic heart disease (32% vs. 16%, p = 0.010), heart failure (9% vs. 3%, p = 0.043) and atrial fibrillation (23% vs. 3%, p < 0.001). Compared to the non-β1B group, patient pretreated with β1B had a significant shorter median OS (12 vs. 24 months, p = 0.004) and PFS (6 vs. 8 months, p < 0.001). In a multivariate analysis, including all CV risk factors and diseases, the use of baseline β1B was a strong and independent predictor for accelerated disease progression (HR 1.92, 95%CI 1.32–2.79, p < 0.001) and shorter OS (HR 1.8, 95%, CI 1.18–2.75, p = 0.007). ConclusionsThe use of baseline β1B showed a strong and independent association for shorter OS and PFS in patients diagnosed with mNSCLC and treated with pembrolizumab.

Risk Factors for Postoperative Infections in Cardiac Surgery Patients: A Retrospective Study.

Background and objective Cardiac surgery is one of the most common surgical proceduresglobally; its incidence has been on the risedue to the faster pace ofpopulation aging thanks to technological and epidemiological advances. Patients who undergo cardiac surgeriesmayface various postoperative complications that might affect their survival, and one of these major complicationsis infection. Nosocomial pneumonia, surgical site infection (SSI), mediastinitis, bacteremia, and sepsis are common infections encountered after surgeries. In this study, we aimed to determine the common risk factors related to postoperative infections at the King Faisal Cardiac Center from January 2014 to September 2020. Materials and methods Records from 364 patients who underwent cardiac surgery and were aged above 18 yearswere assessed for postoperative infections in this retrospective cohort study. Patients who were immunosuppressed or had active systemic infections were excluded. Consent was waived by the Institutional Review Board. All procedures were performed at the King Faisal Cardiac Center, National Guard Hospital, Jeddah. Results Of the total 364 patients,105 were women and 259 were men. The mean age of the cohort was 59 years (SD = 13) and the mean BMI was 29.1 kg/m2 (SD = 5.3). The study population showed a high prevalence of cardiac risk factors and diseases: diabetes (n = 244, 67%), hypertension (n = 230, 63%), dyslipidemia (n = 144, 40%), smoking (n = 80, 22%), heart failure (n = 41, 11%), and chronic obstructive pulmonary disease (n = 6, 1.6%). The overall rate of postoperative infection was 32.7% (n = 120), and 17 (14%) of these infected patients underwent reoperations for infection. Conclusion Based on a thorough analysis of 364 patients undergoing various cardiac surgical procedures, including a multivariate analysis accounting for preoperative factors, there was a significant association between postoperative infections and hypertension, diabetes, increased preoperative activated partial thromboplastin time, and elevated HbA1c.

Older patients with early-stage triple-negative breast cancer: The Memorial Sloan Kettering Cancer Center experience.

12063 Background: Approximately 15% of cases of early-stage triple-negative breast cancer (TNBC) are diagnosed in individuals over the age of 70. Despite studies indicating that older patients derive similar benefits from polychemotherapy as younger patients, breast cancer specific mortality among older patients remains disproportionately high. Use of the comprehensive geriatric assessment (CGA) and individualized risk tools can help tailor treatment and minimize negative side effects while preserving quality of life. We performed a retrospective analysis of patients ≥ 70 years of age diagnosed with stage I-III TNBC at Memorial Sloan Kettering Cancer Center between 2015 and 2019 to describe clinical practices for managing this population. Methods: Demographics, CGA, systemic therapy data were collected from electronic medical records. A multivariable logistic regression model was used to identify factors that were independently associated with the probability of receiving chemotherapy. Results: We included 159 women, with a median age of 74.5 years (range 70-96). 67 (42%) had stage I disease, 71 (45%) had stage II, and 21 (13%) had stage III. 29 (18%) reported difficulty in Activities of Daily Living (ADL), 34 (21%) reported difficulties in Instrumental Activities of Daily Living (iADL), and 40 (26%) were identified as having a high risk for falls. 25 (17%) patients underwent CGA per physician’s choice. The prevalence of cardiac risk factors was as follows: hypertension in 80 patients (50%), diabetes in 25 (16%), obesity in 7 (4.4%), heart failure in 1 (0.6%). 147 underwent breast surgery, with 106 (67%) receiving lumpectomy and 41 (26%) mastectomy. 97 (61%) patients received chemotherapy: 35 (22%) neoadjuvant and 62 (40%) adjuvant. Anthracycline, Cyclophosphamide, Paclitaxel (AC-T) and Cyclophosphamide, Methotrexate, Fluorouracil (CMF) were the most common regimens. In multivariable logistic regression analysis, use of chemotherapy was associated with younger age (odds ratio [OR] 0.84 for one year increase in age, 95% confidence interval [CI] 0.75-0.93, p = 0.001) and higher disease stage (stage II vs. I OR 4.97, 95% CI 1.66-16.4, p = 0.006; stage III vs. I OR 22.0, 95% CI 3.3-312, p = 0.006). No significant difference was found in geriatric referrals, cardiovascular risk factors, or difficulties with ADL or iADL between those receiving or not receiving chemotherapy. Conclusions: In our single center experience, 61% of older patients with early-stage TNBC received chemotherapy, with AC-T and CMF being the most common regimens. The referral rate for CGA was low. Age &lt; 75 years and higher disease stage were significantly associated with receiving chemotherapy. Overcoming barriers to incorporating CGA and toxicity prediction into routine clinical practice is crucial for personalized treatment in this population.

Assessment of Cardiac Contribution to Exercise Intolerance in Pediatric Bilateral Lung Transplant Recipients

<h3>Purpose</h3> Exercise intolerance is common among lung transplant (LTx) recipients. However, there is limited data in pediatrics. Since the heart and lungs work in concert with each other, we aim to assess the cardiac contribution to exercise intolerance in pediatric LTx recipients by examining the prevalence of traditional cardiac risk factors (CRFs) and their performance on cardiopulmonary exercise testing (CPET). <h3>Methods</h3> All pediatric LTx recipients followed at a single center who had a resting echocardiogram (echo), were able to exercise, and had a routine CPET in the last 2 years were included. CRFs including hypertension, hyperlipidemia, diabetes mellitus (DM), body mass index (BMI), activity level, and smoking history were assessed. CPET-derived maximal oxygen consumption (VO2_max) and % predicted peak VO2 (ppVO2_max) were used to assess exercise tolerance. Left ventricular (LV) systolic and diastolic function were also assessed on resting echo. <h3>Results</h3> 11 bilateral LTx patients (7M, 4F, and median age 21 years, range 17-28 years) formed the cohort. Median time since LTx is 6 years, range 2-10 years. The majority of patients (8, 73%) had multiple CRFs: 7 (64%) had hypertension, 7 (64%) hyperlipidemia, 6 (55%) DM, 2 with BMI ≥25 kg/m², and 6 (55%) sedentary lifestyle. None had a smoking history. On resting echo, all had normal LV systolic function. 5 (45%) had LV diastolic dysfunction. On CPET, 9 (82%) had abnormal ppVO2_max ≤85%, even with maximal patient effort. None had ischemia. Surprisingly, only 2 of the 9 had a pulmonary limitation to exercise with abnormal breathing reserve (<25%) to account for abnormal ppVO2_max. 6 had a cardiac limitation to exercise attributed to inability to augment stroke volume (decreased % predicted peak O2 pulse). 1 had an abnormal respiratory exchange ratio (RER <1.10), with a normal % predicted peak O2 pulse and a chronotropic deficit (achieving 60% predicted peak heart rate). Of note, 2 patients had normal exercise tolerance with ppVO2_max >85%. <h3>Conclusion</h3> Despite maximal effort, low exercise tolerance is common among pediatric LTx recipients. The high prevalence of CRFs, diastolic dysfunction, and inability to augment stroke volume suggest a potential cardiac contribution to exercise intolerance for this cohort. Further studies are needed to define potential cardiac issues in exercise tolerance in pediatric LTx recipients.

Impact of Race on the In-Hospital Quality of Care Among Young Adults With Acute Myocardial Infarction.

BackgroundThe extent to which race influences in‐hospital quality of care for young adults (≤55 years) with acute myocardial infarction (AMI) is largely unknown. We examined racial disparities in in‐hospital quality of AMI care and their impact on 1‐year cardiac readmission.Methods and ResultsWe used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study enrolling young Black and White US adults with AMI (2008–2012). An in‐hospital quality of care score (QCS) was computed (standard AMI quality indicators divided by the total a patient is eligible for). Multivariable logistic regression was performed to identify factors associated with the lowest QCS tertile, including interactions between race and social determinants of health. Among 2846 young adults with AMI (median 48 years [interquartile range 44–52], 67.4% women, 18.8% Black race), Black individuals, especially women, exhibited a higher prevalence of cardiac risk factors and social determinants of health and were more likely to experience a non–ST‐segment–elevation myocardial infarction than White individuals. Black individuals were more likely in the lowest QCS tertile than White individuals (40.8% versus 34.7%; P=0.003). The association between Black race and low QCS (odds ratio [OR], 1.25; 95% CI, 1.02–1.54) was attenuated by adjustment for confounders. Employment was independently associated with better QCS, especially among Black participants (OR, 0.76; 95% CI, 0.62–0.92; P‐interaction=0.02). Black individuals experienced a higher rate of 1‐year cardiac readmission (29.9% versus 20.0%; P<0.0001).ConclusionsBlack individuals with AMI received lower in‐hospital quality of care and exhibited a higher rate of cardiac readmissions than White individuals. Black individuals had a lower quality of care if unemployed, highlighting the intersection of race and social determinants of health.

Women With Diabetes Are at Increased Relative Risk of Heart Failure Compared to Men: Insights From UK Biobank.

Aims: To investigate the effect of diabetes on mortality and incident heart failure (HF) according to sex, in the low risk population of UK Biobank. To evaluate potential contributing factors for any differences seen in HF end-point.Methods: The entire UK Biobank study population were included. Participants that withdrew consent or were diagnosed with diabetes after enrolment were excluded from the study. Univariate and multivariate cox regression models were used to assess endpoints of mortality and incident HF, with median follow-up periods of 9 years and 8 years respectively.Results: A total of 493,167 participants were included, hereof 22,685 with diabetes (4.6%). Two thousand four hundred fifty four died and 1,223 were diagnosed or admitted with HF during the follow up periods of 9 and 8 years respectively. Overall, the mortality and HF risk were almost doubled in those with diabetes compared to those without diabetes (hazard ratio (HR) of 1.9 for both mortality and heart failure) in the UK Biobank population. Women with diabetes (both types) experience a 22% increased risk of HF compared to men (HR of 2.2 (95% CI: 1.9–2.5) vs. 1.8 (1.7–2.0) respectively). Women with type 1 diabetes (T1DM) were associated with 88% increased risk of HF compared to men (HR 4.7 (3.6–6.2) vs. 2.5 (2.0–3.0) respectively), while the risk of HF for type 2 diabetes (T2DM) was 17% higher in women compared to men (2.0 (1.7–2.3) vs. 1.7 (1.6–1.9) respectively). The increased risk of HF in women was independent of confounding factors. The findings were similar in a model with all-cause mortality as a competing risk. This interaction between sex, diabetes and outcome of HF is much more prominent for T1DM (p = 0.0001) than T2DM (p = 0.1).Conclusion: Women with diabetes, particularly those with T1DM, experience a greater increase in risk of heart failure compared to men with diabetes, which cannot be explained by the increased prevalence of cardiac risk factors in this cohort.

Premature Myocardial Infarction: A Community Study.

ObjectiveTo evaluate the trends in incident premature myocardial infarction (MI) and prevalence of cardiac risk factors in a population-based cohort.MethodsWe studied a population-based cohort of incident premature MIs among residents (MI in men aged 18-55 years and women aged 18-65 years) in Olmsted County, Minnesota, during a 26-year period from January 1, 1987 through December 31, 2012. Recurrent MI and death after incident premature MI were enumerated through September 30, 2018.ResultsOf 3276 MI cases, 850 were premature events (37.9% [322/850] women). Age-adjusted premature MI incidence rates (2012 vs 1987) declined by 39% in men (rate ratio, 0.61; 95% CI, 0.46 to 0.81]) and 61% in women (rate ratio, 0.39; 95% CI, 0.27 to 0.57). Among men with premature MI, the prevalence of hypertension, diabetes, and hyperlipidemia increased over time, whereas in women, only the prevalence of hyperlipidemia increased. During a mean follow-up of 13.3 years, there was no temporal decline in recurrent MI in men and women. Women showed 66% decreased risk for mortality (hazard ratio, 0.34; 95% CI, 0.17 to 0.68) over time, whereas men showed no change.ConclusionThe incidence of premature MI declined over a 26-year period for both men and women. The risk factor profile of persons presenting with MI worsened over time, especially in men. Death following incident MI declined only in women. These results underscore the importance of primary prevention in young adults and of sex-specific approaches.

20-Year trend of high prevalence of zero coronary artery calcium in beach cities of Southern California: A blue zone?

BackgroundBlue zones are longevity hotspots around the world characterized by highest concentrations of healthy centenarians. Certified blue zone communities are designed by implementation of environmental and policy changes that promote healthy behaviors. ObjectiveTo examine the trends of prevalence of zero CAC, a marker of ideal cardiovascular and overall health status and burden of cardiovascular risk factors in Beach Cities/certified blue zones of Southern California and rest of California. MethodsThis is a population-based cohort study of persons aged 50 years or older in California, who underwent CAC screening between 2000 and 2019. A total of 3864 participants from Beach Cities of Southern California were identified by Zip Codes and compared with 35,537 participants from rest of California. We compared trends of prevalence of zero CAC and cardiovascular risk factors between the two groups, in 5-year intervals. ResultsAmong 39,401 participants (mean age, 58.1 years; 36% women), 13,374 (34%) had zero CAC. The prevalence of CAC ​= ​0 was significantly higher in Beach Cities compared to the rest of California (p ​< ​0.001). Across the study period, the prevalence of cardiac risk factors including obesity, smoking, diabetes and hypertension remain significantly lower in Beach Cities. (p ​< ​0.001) ConclusionsThis study, shows for the first time, that higher prevalence of zero CAC in Beach Cities of California, adds validity to excellent prognosis and longevity in these areas. The impact of policy implementation and environmental changes on lifestyle patterns, cardiovascular health and healthy ageing needs to be evaluated.

Prevalence of Cardiac Risk Factors in Patients Prescribed Azithromycin before and after the 2012 FDA Warning on the Risk of Potentially Fatal Heart Rhythms.

To measure the prevalence of cardiac risk factors among patients prescribed azithromycin before and after the United States Food and Drug Administration (FDA) issued a warning on May 17, 2012, on the risk of potentially fatal heart rhythms associated with the drug. Retrospective cohort study using administrative claims data. Truven Health Analytics MarketScan database. A total of 12,971,078 unique patients with 23,749,652 azithromycin prescriptions dispensed between January 2009 and June 2015 were included. Patients had to be continuously enrolled in a health plan for at least 365days (baseline) before the date of azithromycin dispensing (index date). Cohorts were assigned based on the index dates of the azithromycin prescriptions, either before (January 1, 2009-May 1, 2012) or after (June 1, 2012-June 30, 2015) the FDA warning was issued. A cardiac risk factor included either a cardiac condition (heart failure or dysrhythmias) or concurrent use of drugs that prolong the QT interval. The unit of analysis was each prescription of azithromycin. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of cardiac risk factors. Mean age of the patients was 40.1±21.3years old, with 60.8% females. Prior to the FDA warning, 11,596,022 (48.8%) azithromycin prescriptions were identified, and 12,153,630 (51.2%) were identified after the warning. The prevalence of a preexisting cardiac condition was 7.3% versus 7.9% (p<0.0001) before and after the FDA warning, respectively. Concurrent use of a QT-interval-prolonging drug was 23.3% versus 24.2% (p<0.0001) before and after the FDA warning, respectively. After controlling for confounders, the odds of having a cardiac risk factor after the FDA warning were significantly lower (odds ratio 0.938, 95% CI 0.936-0.940) compared with before the FDA warning. Despite the 2012 FDA warning, a nontrivial number of azithromycin prescriptions was prescribed concurrently in patients with preexisting a cardiac condition (1 of 12 azithromycin prescriptions) and in those using a QT-interval-prolonging drug (1 of 5 azithromycin prescriptions). After adjusting for confounders, the odds of cardiac risk factors being present in patients prescribed azithromycin were modestly lower after the warning; however, the prevalence remained essentially unchanged before and after the FDA warning was issued.

Prevalence of Cardiac Risk Factors and Attitude toward Self-Risk Assessment among Cardiac Care Givers.

Objective:Aim of this survey was to assess the prevalence of cardiovascular diseases (CVD) risk factors and attitude toward self-risk assessment among cardiac care physicians (who did not have CVD history), at a tertiary care cardiac center in Pakistan.Design:In this survey we included cardiac care givers who had a minimum of 1 year of working experience in a cardiac care center.Participants:Participants with self-reported history of established diagnosis of CVD were excluded. Face-to-face interviews were conducted with the help of a structured questionnaire which consisted of demographic information, data regarding established CVD risk factors, self-awareness, and attitude toward CVD risk assessment.Results:A total of 126 participants were interviewed, out of which 20.6% (26) were females and mean age was 36.1±7.6 years. The most prevalent CVD risk factor was family history of CVD (33.3%) followed by smoking (14.3%) and 23.8% had body mass index of ≥27.5 kg/m2. Around 23% of the participants did not know their cholesterol levels, similarly more than 74% were not aware of their high-density lipoproteins levels. More than 76% had never assessed their CVD risk and more than 37% don’t know or don’t have any opinion about their own CVD risk.Conclusions:The present study reveals low prevalence of conventional cardiac risk factors and marginally higher tendency of modifiable risk factors, such as smoking and obesity, among the cardiac physicians. A large proportion of these cardiac physicians have not yet assessed their CVD risk.

Prognostic value of normal and non-obstructive coronary artery disease based on CT angiography findings. A 12 month follow up study.

Introduction: The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings. Methods: This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined. Results: After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57). Conclusion: A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.

Mental health is a risk factor for poor outcomes in cardiac patients: Findings from the national DenHeart survey

ObjectiveTo explore (i) the prevalence of cardiac risk factors (obesity, smoking, excessive alcohol consumption and medication non-adherence) among cardiac patients with depression and anxiety, (ii) associations between depression and anxiety scores and cardiac risk factors and (iii) the association of depression and anxiety and cardiac risk factors with mortality, and their population attributable risk. MethodsA national cross-sectional study using patient-reported outcomes at discharge and national register data. For one year (April 15th 2013 to April 15th 2014) all patients discharged or transferred from the five Danish Heart Centres were included in the study. A total of 14,239 patients answered the HADS questionnaire, response rate 51%. ResultsMean age was 64.8 years and 69% were male. Patients with depression or anxiety (HADS-D or HADS-A score ≥ 8) had 30% and 45%, respectively, higher odds of being current smokers; 19% and 37% higher odds of being obese and 31% and 24% higher odds of excessive alcohol consumption. Depressive patients had 34% higher odds of being non-adherent to their medication. At one-year follow-up, patients with depression (HADS-D score ≥ 11) had the highest attributable risk associated with mortality followed by: smoking, ischemic heart disease, anxiety, diabetes, hypertension chronic obstructive pulmonary disease and excessive alcohol consumption. ConclusionDepression and anxiety in patients with cardiac disease is associated with cardiac risk behaviour such as smoking, obesity, excessive alcohol consumption and medication non-adherence. Depression and anxiety have an attributable risk associated with mortality that is comparable to other well-known risk factors such as smoking.

Impact of Socioeconomic Status on Risk Factors, Treatment and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention (PCI) for ST-Elevation Myocardial Infarction (STEMI)

Background: Low socioeconomic status (SES) has been shown to be associated with worse cardiovascular outcomes, potentially due to a higher prevalence of cardiac risk factors. We sought to determine whether SES impacts on reperfusion time, clinical outcomes and adherence to secondary prevention therapy in STEMI patients undergoing PCI. Method: We prospectively collected data on 5665 consecutive STEMI PCI patients between 2005 and 2015 in the multi-centre Melbourne Interventional Group registry. Patients were categorised into SES quintiles using the Index of Relative Socioeconomic Disadvantage system – a score allocated to each postcode based on factors like educational level, employment status and vehicle ownership by the Australian Bureau of Statistics using 2011 census data. Results: Lower SES patients were more likely to be obese, have diabetes, currently smoke, present to a non-PCI capable hospital and receive thrombolysis (all p≤0.01). Among primary PCI patients, door-to-balloon times were similar in all SES groups (p = NS). Drug-eluting stent use was higher in the higher SES groups (p < 0.01). Despite these differences, adjusted 30-day and 12-month mortality and MACE were similar across SES groups (p = NS). At 12 months after PCI, lower SES patients had higher rates of ongoing smoking (p < 0.01) but there were no differences in use of guideline-indicated medications across SES groups (p = NS). Conclusion: Lower SES patients have more comorbidities and are less likely to have timely access to a PCI-capable hospital resulting in more thrombolysis. Despite this, their outcomes are similar to higher SES patients, likely due to robust systems of care for STEMI in Victoria.

Screening and risk assessment for coronary artery disease in HIV infection: an unmet need.

HIV infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Increased risk of CAD in HIV-infected patients has been associated with the inflammatory sequelae of the infection as well as the greater prevalence of cardiac risk factors in HIV-positive populations and the side effects of life-prolonging antiretroviral therapies. Patients with HIV infection now have a 1.5 to 2-fold greater risk of developing CAD compared with noninfected individuals, raising the independent risk of CAD in HIV infection to levels similar to those in diabetes. Despite this increased risk, screening and other adjuvant assessment tools are lacking. In this paper we explore the current climate of CAD in the contemporary HIV-infected population and look at the tools used in the assessment and management of patients as well as the limitations of these approaches for this at-risk population group.

80. Heart failure in CVDMP daily practice: Characteristics, management and outcomes

Background The characteristics and outcomes of heart failure (HF) patients have been described by numerous studies worldwide. However very limited information is available about Saudi HF patients. Aim To determine the general characteristics, treatment, and outcomes of Saudi patients with the diagnosis of HF followed up in a Nurse-Led Cardiovascular Disease Management Program (CVDMP) in King Abdulaziz Cardiac Centre (KACC). This is a retrospective chart review study, that included all HF who are followed up in KACC/CVDMP over the time period from 2000 to 2015. Data extracted from the cardiac electronic data base (Apollo) for all patients who have at least 2 visits; enrollment (EV) and last follow up (LV). A total of 2298 patients (72% Male, mean age 58 STD 12.7 years) included in this study. Ischemic cardiomyopathy presented in 60% of patients, diabetes mellitus in 66%, dyslipidemia in 76% and 64% of patients were hypertensive. Majority of patients had both Systolic and Diastolic HF (70%), with stage C HF in EV and LV. Avarage EF improved from 32% to 38% ( P 0.0001). Over 90% of the patients were on ACE, ARBs or the combination during EV and LV. Overall mortality was 12.1%. Saudi heart failure patients are relatively younger with higher prevalence of cardiac risk factors. These patients are treated as per Guideline recommended therapy.

Preparticipation Screening of Athletic Officials: SEC Football Referees at Risk.

Although preparticipation screening for athletes is commonplace, few studies have addressed the issue for those officiating at games. To review current data on physiologic stress on sports officials, to obtain prevalence data on health parameters for football officials, and to determine the outcomes when screening criteria are applied in preseason exams. A protocol was established using health history questionnaires and physical exams with laboratory screening to assess the health of all football officials working in the Southeastern Conference (SEC) from 1997 to 2000. The main outcome measure was the prevalence of cardiac risk factors as determined by American College of Sports Medicine guidelines. Initial screening of 102 football officials revealed that 10.1% of SEC referees had elevated systolic blood pressure, 13.9% had elevated diastolic blood pressure, and 3.8% had resting tachycardia. Average body mass index (BMI) was 28.6 kg/m2, with 87.3% having a BMI that exceeded 25 (overweight). About one-third (31.6%) had a BMI greater than 30 (obese). Total fasting cholesterol exceeded 200 mg/dL in 44.2%, HDL levels were below 35 mg/dL in 34.3%, and LDL levels were above 120 mg/dL in 62.3%. Compared with age-adjusted national data, there were more overweight and more obese officials, but they had lower systolic and diastolic blood pressures and lower mean total cholesterol levels. Using the Framingham Study prediction model to estimate coronary heart disease (CHD) risk, analysis revealed that referees had a lower risk than the national 10-year CHD risk but a higher risk compared with that of the low-risk population. These data reveal a greater need for graded exercise testing. The higher rates of obesity among officials will promote further screening for CHD risk factors.

Ischaemic heart disease during pregnancy or post-partum: systematic review and case series.

The risk of manifestations of ischaemic heart disease (IHD) in fertile women is elevated during pregnancy and the post-partum period. With increasing maternal age and a higher prevalence of cardiac risk factors, the incidence of IHD during pregnancy is rising. However, information in the literature is scarce. We therefore performed a retrospective cohort study and systematically reviewed the overall (1975–2013) and contemporary (2005–2013) literature concerning IHD presenting during pregnancy or in the post-partum period. We report two cases of IHD with atypical presentation during pregnancy or post-partum. In our review, we describe 146 pregnancies, including 57 contemporary cases (2005–2013). Risk factors for IHD were present in 80 %. Of the cases of IHD, 71 % manifested in the third trimester or the post-partum period, and 95 % presented with chest pain. The main cause was coronary dissection (35 %), or thrombus/emboli (35 %) in the more contemporary group. Maternal mortality was 8 % (6 % in the contemporary group), and the main cardiac complication was ventricular tachycardia (n = 17). Premature delivery rate was 56 %, and caesarean section was performed in 57 %. Perinatal mortality was 4 %. In conclusion, IHD during pregnancy or in the post-partum period has high maternal mortality and morbidity rates. Also, premature delivery and perinatal mortality rates are high.Electronic supplementary materialThe online version of this chapter (doi:10.1007/s12471-015-0677-6) contains supplementary material, which is available to authorized users.

Role of baseline echocardiography prior to initiation of anthracycline-based chemotherapy in breast cancer patients.

BackgroundAnthracycline adjuvant therapy has taken a particular role in the treatment of early stage breast cancer with an associated decrease in rates of both relapse and death. Their success however has been limited by their myelosuppression and their well-established risk of cardiac dysfunction. Guidelines have emerged that would limit the maximum lifetime dose of anthracyclines and make a baseline assessment and periodic monitoring of cardiac function part of the routine practice, which could be cumbersome, and may condemn the patient to an unwarranted modification of his/her regimen. Our study aimed at assessing the incidence of abnormal baseline echocardiography in asymptomatic women with breast cancer prior to anthracycline therapy and establishing risk criteria associated with abnormal echocardiograms at baseline.Methods220 Patients seen at AUBMC (American University of Beirut Medical Center) who had non- metastatic breast cancer, and had an echocardiography performed before starting anthracycline chemotherapy were chosen. Data about demographic characteristics, tumor characteristics, baseline echocardiography results, and change in clinical decision was collected. Patients with suboptimal (less than 50%) ejection fraction (EF) on baseline echocardiography were analyzed for the prevalence of cardiac risk factors. Results were compared to those among the overall study group using Fisher’s Exact test. A p- value of = < 0.05 was used as reference for statistical significance.ResultsAll 220 of our patients had received a baseline echo prior to initiation of anthracycline therapy. 6.7% of these patients had already some abnormality in wall motion but only 2.7% had a suboptimal ejection fraction. 1.3% had a change in chemotherapy regimen based on ejection fraction. The patients with depressed EF had higher rates of CAD (coronary artery disease), diabetes, hypertension and dyslipidemia than the overall study group but without statistical significance.ConclusionsOur study, as well as the previous contingent studies raise the question about routine echocardiography prior to anthracycline therapy and might eventually lead to a modification of current practice guidelines.