Prevalence Of Cardiovascular Disease Research Articles

The association between weight loss medications and cardiovascular complications.

Obesity and its cardiovascular complications are major causes of morbidity and mortality. Little is known in real-world settings about the effect of newly approved antiobesity medications (AOMs) on cardiovascular complications among patients with obesity. This retrospective cohort study examined the association between newly approved AOM use and cardiovascular events among Medicare patients with obesity using data from 2020 to 2022. Patient age, gender, comorbidity scores, socioeconomic status, and baseline cardiovascular comorbidities were compared descriptively. Subgroup analysis compared variables by medication type. Relative risk and absolute risk of cardiovascular disease (CVD) events were estimated using Cox and Aalen regression models. The analysis included 5926 patients treated with semaglutide and tirzepatide, including Ozempic (5404 patients), Wegovy (375 patients), or Mounjaro (147 patients). Hypertension, type 2 diabetes, and hyperlipidemia were the most common comorbidities. For patients with AOMs, less incidence of heart failure (4.89% vs. 6.13%, p < 0.0001), atrial fibrillation (3.83% vs. 5.17%, p < 0.0001), arrhythmia (3.59% vs. 4.14%, p < 0.0153), and peripheral vascular disease (3.44% vs. 2.94%, p < 0.0395) was found versus patients without AOMs. Patients receiving AOMs showed an 8% risk reduction in any CVD. Protective effect on CVD was apparent over the first 375 days. Results suggest that utilization of AOMs effectively alleviates the high prevalence of CVD.

Sex Differences in Cardiovascular Disease-Related Hospitalization and Mortality in Japan - Analysis of Health Records From a Nationwide Claim-Based Database, the Japanese Registry of All Cardiac and Vascular Disease (JROAD).

The prevalence of cardiovascular disease (CVD) is rising in Japan with its aging population, but there is a lack of epidemiological data on sex differences in CVD, including acute coronary syndrome (ACS), acute heart failure (AHF), and acute aortic disease.Methods and Results: This retrospective study analyzed data from 1,349,017 patients (January 2012-December 2020) using the Japanese Registry Of All Cardiac and Vascular Diseases database. ACS patients were youngest on average (70.5±12.9 years) and had the lowest female proportion (28.9%). AHF patients had the oldest mean age (79.7±12.0 years) and the highest proportion of females (48.0%). Acute aortic disease had the highest in-hospital mortality (26.1%), followed by AHF (11.5%) and ACS (8.9%). Sex-based mortality differences were notable in acute aortic disease, with higher male mortality in Stanford Type A acute aortic dissection (AAD) with surgery (males: 14.2% vs. females: 10.4%, P<0.001) and similar rates in Type B AAD (males: 6.2% vs. females: 7.9%, P=0.52). Aging was a universal risk factor for in-hospital mortality. Female sex was a risk factor for ACS and acute aortic disease but not for AHF or Types A and B AAD. Sex-based disparities in the CVD-related hospitalization and mortality within the Japanese national population have been highlighted for the first time, indicating the importance of sex-specific strategies in the management and understanding of these conditions.

The association between levels of brain-derived neurotrophic factor and comorbid depression in patients with cardiovascular disease: The Framingham Heart Study.

The current study aims to investigate the association of serum brain-derived neurotrophic factor (BDNF) levels with symptoms of depression in adults with and without prevalent cardiovascular disease (CVD), an often burdensome comorbidity. This cross-sectional study included participants from FHS (Framingham Heart Study) who had available serum BDNF levels. Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression Scale (CES-D) with a score ≥16 indicating mild to moderate and ≥21 severe depression. Participants taking antidepressant medications were excluded from the study. Altogether 3716 FHS participants were included in the final analysis (mean age, 64.3 ± 11.5 years; 55% women). After adjusting for potential confounders, greater BDNF levels were associated with reduced severe depression risk (odds ratio [OR], 0.78 [95% CI, 0.64-0.96]; P = 0.016). Among participants with CVD, greater BDNF levels were related to lower risk of depressive symptoms (CES-D ≥ 16 OR, 0.63 [95% CI, 0.45-0.89], P = 0.008; CES-D ≥ 21 OR, 0.49 [95% CI, 0.31-0.76], P = 0.002). The inverse relationship between BDNF and depressive symptom risk was present in women with CVD (CES-D ≥ 16 OR, 0.63 [95% CI, 0.40-0.99], P = 0.047; CES-D ≥ 21 OR, 0.38 [95% CI, 0.21-0.70], P = 0.002) but not in men. Lower serum BDNF levels are associated with a higher risk of depressive symptoms in CVD, particularly among women. These findings implicate BDNF in the complex biological mechanisms that underlie prior associations observed between CVD and depression. To reduce the burden of depression in the large proportion of midlife and older adults with CVD, a better understanding of how BDNF may modify these pathways is merited.

Neighborhood Social Vulnerability and Premature Cardiovascular Disease in Haiti

Higher social vulnerability is associated with premature cardiovascular disease (CVD) and mortality but is understudied in low-income countries that have both the highest magnitude of social vulnerability and a growing CVD epidemic. To evaluate the association between social vulnerability and hypertension, CVD, and CVD subtypes in Haiti as a model for similar low-income countries. This population-based cohort study used enrollment data from adults participating in the Haiti Cardiovascular Disease Cohort Study. Recruitment occurred via multistage random sampling throughout slum and urban neighborhoods in Port-au-Prince, Haiti, from March 2019 to August 2021. Data were analyzed from May 2022 to December 2023. A modified Haitian Social Vulnerability Index (SVI-H) was created following the US Centers for Disease Control and Prevention Social Vulnerability Index method. Twelve variables across the domains of socioeconomic status, household characteristics, and social and community context were included. The SVI-H was calculated for each study neighborhood block and then stratified into SVI-H quartiles (quartile 1 was the least vulnerable; quartile 4, the most vulnerable). Prevalent hypertension and total CVD, defined as heart failure (HF), stroke, transient ischemic attack (TIA), angina, or myocardial infarction (MI). Age-adjusted Poisson regression analysis yielded prevalence ratios (PRs) comparing the prevalence of hypertension, total CVD, and CVD subtypes across SVI-H quartiles. Among 2925 adults (1704 [58.3%] female; mean [SD] age, 41.9 [15.9] years), the prevalence of hypertension was 32.8% (95% CI, 31.1%-34.5%) and the prevalence of CVD was 14.7% (95% CI, 13.5%-16.0%). Hypertension prevalence ranged from 26.2% (95% CI, 23.1%-29.3%) to 38.4% (95% CI, 34.8%-42.0%) between quartiles 1 and 4, while CVD prevalence ranged from 11.1% (95% CI, 8.8%-13.3%) to 19.7% (95% CI, 16.8%-22.6%). SVI-H quartile 4 vs 1 was associated with a greater prevalence of hypertension (PR, 1.17; 95% CI, 1.02-1.34) and CVD (PR, 1.48; 95% CI, 1.16-1.89). Among CVD subtypes, SVI-H was significantly associated with HF (PR, 1.64; 95% CI, 1.23-2.18) but not with combined stroke and TIA or combined angina and MI. In urban Haiti, individuals living in neighborhoods with the highest social vulnerability had greater prevalence of hypertension and HF. Understanding CVD disparities in low-income countries is essential for targeting prevention and treatment interventions toward populations at highest risk globally.

ECG autoencoder based on low-rank attention

The prevalence of cardiovascular disease (CVD) has surged in recent years, making it the foremost cause of mortality among humans. The Electrocardiogram (ECG), being one of the pivotal diagnostic tools for cardiovascular diseases, is increasingly gaining prominence in the field of machine learning. However, prevailing neural network models frequently disregard the spatial dimension features inherent in ECG signals. In this paper, we propose an ECG autoencoder network architecture incorporating low-rank attention (LRA-autoencoder). It is designed to capture potential spatial features of ECG signals by interpreting the signals from a spatial perspective and extracting correlations between different signal points. Additionally, the low-rank attention block (LRA-block) obtains spatial features of electrocardiogram signals through singular value decomposition, and then assigns these spatial features as weights to the electrocardiogram signals, thereby enhancing the differentiation of features among different categories. Finally, we utilize the ResNet-18 network classifier to assess the performance of the LRA-autoencoder on both the MIT-BIH Arrhythmia and PhysioNet Challenge 2017 datasets. The experimental results reveal that the proposed method demonstrates superior classification performance. The mean accuracy on the MIT-BIH Arrhythmia dataset is as high as 0.997, and the mean accuracy and F1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$F_1$$\\end{document}-score on the PhysioNet Challenge 2017 dataset are 0.850 and 0.843.

Forecasting the Burden of Cardiovascular Disease and Stroke in the United States Through 2050-Prevalence of Risk Factors and Disease: A Presidential Advisory From the American Heart Association.

Cardiovascular disease and stroke are common and costly, and their prevalence is rising. Forecasts on the prevalence of risk factors and clinical events are crucial. Using the 2015 to March 2020 National Health and Nutrition Examination Survey and 2015 to 2019 Medical Expenditure Panel Survey, we estimated trends in prevalence for cardiovascular risk factors based on adverse levels of Life's Essential 8 and clinical cardiovascular disease and stroke. We projected through 2050, overall and by age and race and ethnicity, accounting for changes in disease prevalence and demographics. We estimate that among adults, prevalence of hypertension will increase from 51.2% in 2020 to 61.0% in 2050. Diabetes (16.3% to 26.8%) and obesity (43.1% to 60.6%) will increase, whereas hypercholesterolemia will decline (45.8% to 24.0%). The prevalences of poor diet, inadequate physical activity, and smoking are estimated to improve over time, whereas inadequate sleep will worsen. Prevalences of coronary disease (7.8% to 9.2%), heart failure (2.7% to 3.8%), stroke (3.9% to 6.4%), atrial fibrillation (1.7% to 2.4%), and total cardiovascular disease (11.3% to 15.0%) will rise. Clinical CVD will affect 45 million adults, and CVD including hypertension will affect more than 184 million adults by 2050 (>61%). Similar trends are projected in children. Most adverse trends are projected to be worse among people identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic. The prevalence of many cardiovascular risk factors and most established diseases will increase over the next 30 years. Clinical and public health interventions are needed to effectively manage, stem, and even reverse these adverse trends.

Assessing the Risk of Normal Weight Obesity in Korean Women across Generations: A Study on Body Composition and Physical Fitness.

Normal weight obesity (NWO) refers to a condition in which the body mass index falls within the normal range, but the percent of body fat is excessive. Although there are reports of a high prevalence of cardiovascular and metabolic diseases in NWO, analyses regarding physical fitness have been lacking. Therefore, the purpose of this study was to analyze the age-related prevalence of NWO and to examine physical fitness across generations. Our study utilized a dataset comprising 119,835 participants for analysis. The prevalence of NWO across ages was examined using cross-tabulation analysis. For body composition and physical fitness, medians and group differences were assessed by generation through Kruskal-Wallis and Bonferroni post hoc tests. Additionally, univariate logistic regression was adopted to analyze the odds ratio. The prevalence of NWO in Korean women was 18.3%. The fat-free mass of the NWO group was consistently lower than that of both the group with normal body mass indexes (Normal) and obese body mass indexes (Obesity) across all generations. Additionally, the waist circumference and blood pressure were greater in the now group than in the Normal group. When considering maximal strength, muscle endurance, power, balance, and coordination, the NWO group exhibited lower levels compared to the Normal group. The NWO group showed lower muscle mass than both the Normal and Obesity groups, resulting in significantly reduced physical fitness compared to that of the Normal group, similar to the Obesity group. This condition may increase not only the risk of posing a potentially more serious health concern than obesity but also the risk of falls in elderly people. Therefore, based on this study, it is crucial to not only define obesity using BMI criteria but also to diagnose NWO. Public health policies and preventive measures must be implemented accordingly.

Predicting the Future Prevalence of Cardiovascular Disease: The Good, the Bad, the Known, and the Unknown.

Predicting the Future Prevalence of Cardiovascular Disease: The Good, the Bad, the Known, and the Unknown.

Prevalence of Cardiovascular Risk Factors in Rural Kenya-2023: Vihiga II.

The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) risk factors among adults in Vihiga County, Western Kenya. A cross-sectional population-based study was completed. Participants (n = 575) were selected at the household level using a systematic random sample, and sociodemographic, anthropometrical, clinical, and biochemical data were collected. The sample consisted of 71.8% women and 28.2% men. The prevalence of high blood pressure (BP) was 56.4%. A greater proportion of women (62.8%) had low levels of high-density lipoprotein (HDL) compared with men (44.7%) (odds ratio [OR], 2.99; 95% CI, 1.59-5.64). High triglyceride levels were more prevalent in men (16.4%) compared with women (15.4%) (OR, 0.37; 95% CI, 0.19-0.71). Based on average waist to hip ratio, abdominal obesity was significantly higher in women (55.4%) compared with men (27.6%) (OR, 2.62; 95% CI, 1.52-4.49). Low levels of physical inactivity were prevalent in women (36.3%) at significantly higher proportions compared with men (22.7%) (OR, 1.73; 95% CI, 1.02-2.92). Women used tobacco at significantly lower proportions (0.5%) compared with men (27.2%) (OR, 0.01; 95% CI, 0.00-0.06). A higher proportion of women (47.9%) rated their general health as poor compared with men (37.1%), a statistically significant difference (OR, 2.0; 95% CI, 1.23-3.28). The prevalence of CVD risk factors, such as hypertension, obesity, dyslipidemia, low physical activity, and tobacco use indicates the urgent need for comprehensive health promotion programs to improve public health in rural areas of Kenya.

Evaluation of Socio-demographic Factors and Comorbidities in Adult Hemophilia Patients

Purpose: The association between socio-demographic factors and hemophilia status and the prevalence of comorbidities were evaluated. Material and Methods: Patients with hemophilia A (n=111) and B (n=24) who were filled a questionnaire form about their sociodemographic factors were included in our study. Factor and inhibitor levels, comorbidities, factor replacement therapies, hemophilic arthropathy, viral status and annual bleeding episodes were recorded. Results: Median age was 39 years in 135 hemophilia patients and 63.1 % of all the patients had severe hemophilia which was significantly higher among hemophilia A patients (p=0.002). Most of the patients (74.8%) were treated with prophylactic factor replacement therapy. Inhibitor status was positive in 8.9% of all patients. Unemployment rate was found 33.3%. Annual bleeding episodes were higher in patients who had a job. Most of the patients (60 %) were graduated from at least high school. The prevalence of cardiovascular disease, hypertension, diabetes mellitus and obesity were 6.7%; 17.8%, 13.3%, 11.9% respectively. Although there is no association between the obesity and annual bleeding episodes, right ankle was the most affected joint in overweight/obese patients. Conclusion: Age-related comorbidities and the relation of hemophilia status and social life are needed to be more investigated.

Exploring the role of air pollution on the development of atherosclerosis disorder in human endothelial cells

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): QU - NSPP Introduction Atherosclerosis, the main cause of cardiovascular and cerebrovascular diseases, is a global health threat. Rising cardiovascular disease prevalence, unexplained by traditional risk factors, prompts exploration of the impact of occupational exposure to environmental toxins as a risk factor. benzo[a]pyrene (BaP) is a polyaromatic compound that mediate its toxicity through activation of the Aryl hydrocarbon receptor (AhR). The molecular mechanisms of involvement of environmental toxins and the role of AhR/CYP1A pathway in atherosclerosis development remain not fully investigated. Purpose The current study explores the AhR pathway activation in endothelial cells upon exposure to environmental toxins in order to elucidate the molecular mechanisms of atherosclerotic cardiovascular diseases and plaque formation through investigating pro-inflammatory (CYP1A1, CYP1B1, TNF-a) and pro-apoptotic markers (BCL-2, Caspase-3). Methods EA. hy926 cell line underwent treatment with increasing concentrations of BaP (0-20 microM), as well as 10nm of TCDD, to confirm the results. DSMO was used as a control. Total RNA and protein were isolated to investigate mRNA expression and protein expression of AhR, CYP1A1, CYP1B1, as well as caspase-3, Bcl-2, and TNF-α using RT-PCR and Western Blot analysis. Statistical analysis was done using one-way ANOVA. Results The results showed that BaP induce significant dose-dependent upregulation of AhR and target genes (CYP1A1, CYP1B1). At 20uM, expression of AhR (3-fold), CYP1A1 (2.5-fold) and CYP1B1 (2-fold) was significantly high as compared to their respective controls and low doses. As for apoptotic markers, Bcl-2 was significantly downregulated at the highest concentrations 10uM and 20uM (0.7- and 0.6-fold, respectively). Caspase-3 showed no significant change but exhibited upregulation across all doses. TCDD 10nM significantly upregulated AhR (2.0-fold), CYP1A1 (1.5-fold), CYP1B1 (1.7-fold). Bcl-2 downregulated (0.6-fold), TNF-α significantly upregulated (1.8-fold) at 10nM. Caspase-3 increased 2-folds but was not statistically significant. Conclusion This study illustrated that AhR inducers, such as BaP, can accelerate the pathological progress of atherosclerosis by evoking oxidative stress and inflammation response molecules in human endothelial cells, demonstrated by the reduced expression of anti-apoptotic markers and the increased expression of inflammatory markers.

Excessive sucrose consumption reduces synaptic density and increases cannabinoid receptors in Göttingen minipigs

Diets high in sucrose and fat are becoming more prevalent the world over, accompanied by a raised prevalence of cardiovascular diseases, cancers, diabetes, obesity, and metabolic syndrome. Clinical studies link unhealthy diets with the development of mental health disorders, particularly depression. Here, we investigate the effects of 12 days of sucrose consumption administered as 2 L of 25% sucrose solution daily for 12 days in Göttingen minipigs on the function of brain receptors involved in reward and motivation, regulating feeding, and pre- and post-synaptic mechanisms. Through quantitative autoradiography of cryostat sections containing limbic brain regions, we investigated the effects of sucrose restricted to a 1-h period each morning, on the specific binding of [3H]raclopride on dopamine D2/3 receptors, [3H]UCB-J at synaptic vesicle glycoprotein 2A (SV2A), [3H]MPEPγ at metabotropic glutamate receptor subtype 5 (mGluR5) and [3H]SR141716A at the cannabinoid receptor 1 (CB1). Compared to control diet animals, the sucrose group showed significantly lower [3H]UCB-J and [3H]MPEPγ binding in the prefrontal cortex. The sucrose-consuming minipigs showed higher hippocampal CB1 binding, but unaltered dopamine D2/3 binding compared to the control group. We found that the sucrose diet reduced the synaptic density marker while increasing CB1 binding in limbic brain structures, which may subserve maladaptive changes in appetite regulation and feeding. Further studies of the effects of diets and lifestyle habits on brain neuroreceptor and synaptic density markers are warranted.

NT-proBNP in severe aortic valve stenosis: necessity for higher cut-off values regarding congestive heart failure detection in atrial fibrillation

Abstract Background NT-proBNP is an established biomarker for the determination of fluid overload. Patients suffering from atrial fibrillation seem to have higher serum levels of NT-proBNP than patients in sinus rhythm, independent from fluid overload. However, there is no established alternative cut-off for patients with atrial fibrillation, especially in patients with severe aortic valve stenosis. Aim The aim of the current study was to evaluate the levels of serum NT-proBNP for patients with atrial fibrillation (AF) and sinus rhythm (SR) for the determination of fluid overload in patients with severe aortic valve stenosis. Methods 167 Patient suffering from severe aortic valve stenosis undergoing evaluation for TAVR at our hospital were included in this study. Upon recruitment blood samples from every patient were collected and an ECG was documented for each patient. Serum NT-proBNP was measured and volume overload was objectivated by calculation of plasma volume status (PVS), an already published method to estimate fluid overload or depletion by using a formula including weight and haematocrit. Results 37 patients (22.2%) suffered from AF upon recruitment. 47 patients (28.1%) showed fluid overload, indicated by increased PVS (PVS &amp;gt; 0, SR n=37, AF n=10). 94 patients (56.3%) were male and mean age was 80 years. Patients with and without AF showed no significant difference in age, sex or prevalence of cardiovascular diseases, except for gradients across the aortic valve (SR 47mmHg vs. AF 38mmHg; p&amp;lt;0.05) and left ventricular ejection fractions (SR 57% vs. AF 55%; p&amp;lt;0.05). Patients suffering from atrial fibrillation showed significantly higher serum levels of NT-proBNP (4843 ng/L vs. 1226 ng/L, p&amp;lt;0.001). ROC-analyses in patients with SR and severe aortic valve stenosis, showed satisfying results for NT-proBNP (AUC 0.72; sensitivity 0.81; specificity 0.58) to detect fluid overload. Comparable results were evident in patients with AF (AUC 0.77; sensitivity 0.70; specificity 0.78), but cut-off-values in patients suffering from atrial fibrillation were more than six times as much as in patients with sinus rhythm (6575 ng/L vs. 1053 ng/L). Conclusion NT-proBNP proved itself as a sufficient marker to determine volume overload in patients with severe aortic valve stenosis. Cut-offs for accurate determination of fluid overload deviate greatly in patients with sinus rhythm and atrial fibrillation, therefore different cut-offs might be required.

Behavioral counseling for cardiovascular disease prevention in 36 low-income and middle-income countries

BackgroundGiven the substantial prevalence of cardiovascular disease (CVD) in low-income and middle-income countries (LMICs), evaluation of behavioral counseling for prevention of CVD is important. MethodsWe pooled nationally representative cross-sectional surveys from 36 LMICs between 2013 and 2020. The population was divided into three groups according to CVD risk: the potential risk group, the risk group and the CVD group. We estimated the prevalence of six types of behavioral counseling among the three groups separately: smoking, salt reduction, fruit and vegetable intake, dietary fat reduction, physical activity and body weight. ResultsThere were 16,057 (25.4%) in the potential risk group, 43,113 (49.9%) in the risk group, and 7796 (8.6%) in the CVD group. The prevalence of receiving at least four types of counseling in the three groups was 15.6% (95% CI 13.9 to 17.5), 14.9% (95% CI 14.0 to 15.9), and 19.8% (95% CI 17.7 to 22.2), respectively. The lowest prevalence was for tobacco use counseling: 24.5% (95% CI 22.5 to 26.4), 23.2% (95% CI 22.1 to 24.3), and 32.1% (95% CI 29.5 to 34.8), respectively. The prevalence of counseling was higher in upper-middle-income countries than in lower-middle-income countries. Women, older people, those with more education, and those living in urban areas were more likely to receive counseling. ConclusionThe prevalence of behavioral counseling for CVD is low in LMICs, especially among potentially at-risk populations and in low-income countries. These findings highlight the current urgent need to improve CVD prevention and management systems to enhance behavioral counseling and intervention.

#2246 Cardiovascular changes and outcomes across the early CKD spectrum: a UK Biobank cardiovascular MRI substudy

Abstract Background and Aims Chronic kidney disease (CKD) patients are at a significant risk of accelerated cardiovascular (CV) disease (CVD), which increases as glomerular filtration rate (GFR) declines. The prevalence of CVD in early CKD is high but there is lack of data on early myocardial changes in this group of patients. We investigated the associations of early CKD with alterations in cardiac structure and function and adverse CV outcomes using cardiovascular magnetic resonance (CMR) imaging. Method We used measures of CMR analysis from participants in the UK Biobank CMR imaging substudy to extract information on morphology and function of the four heart chambers. Early CKD was defined as an estimated GFR with cystatin (eGFRcys) between 60 and 90 ml/min. Patients with left ventricular ejection fraction &amp;lt;50%, history of CVD, eGFRcys &amp;lt; 60 ml/min, uACR &amp;gt; 3 mg/mmol, and those on renal replacement therapy were excluded. The association between early CKD and CMR parameters was analysed in 5 linear regression models: unadjusted, age adjusted, sociodemographic adjusted, sociodemographic and lifestyle adjusted, and a fully adjusted model also including clinical characteristics. Cox regression analyses were used to determine association between mildly decreased eGFR and adverse CV outcomes (myocardial infarction, stroke, CV death, and a composite CV outcome). Results A total of 33 124 individuals [17 825 (53.8%) women, age 64 (11) years] who received CMR imaging between 2014 and 2019 and fulfilled the inclusion criteria were identified: 19,919 with no CKD and 13,205 with early CKD. Participants with early CKD were more likely to be older, males and smokers. In the fully adjusted model, early CKD was associated with structural changes in the left ventricle (LV) [mass −1.04 g (−1.75 to −0.33), end-diastolic volume −2.69 mL (−4.01 to −1.38), end-systolic volume −0.95 mL (−1.30 to −0.60)], right ventricle (RV) [end-diastolic volume −3.24 mL (−4.67 to −1.82), end-systolic volume −1.73 mL (−2.55 to −0.91)], right atrium (maximum volume −2.81 mL (−4.09 to −1.53), minimal volume −1.46 mL (−2.30 to −0.62)]. Early CKD was also associated with a change in LV global circumference strain [-0.16 (−0.31 to −0.01)] but it was not associated with changes in the left atrium parameters or functional parameters [LV ejection fraction 0.21 (−0.05 to 0.48), RV ejection fraction 0.21 (−0.07 to 0.49)]. These changes were not associated with adverse CV outcomes on multivariable analyses (HR for MI 1.35, 95% CI 0.94-1.94; HR for stroke 0.98, 95% CI 0.63-1.50). Conclusion In a low-risk general population (without known CVD and with preserved LV ejection fraction) mildly reduced kidney function, as measured with eGFRcys, was associated with smaller LV and RV volumes, larger LV mass, and impaired LV global circumference strain. This early cardiac remodelling was not associated with adverse CV outcomes, but the event rate was very small during follow up. These findings suggest that cardiomyopathy associated with early CKD is not a regional condition of the left ventricle but affects the heart globally.

#1920 The impact of kidney function on cardiac diastolic dysfunction trajectories: insights from a longitudinal study

Abstract Background and Aims Although the association between kidney dysfunction and cardiac diastolic dysfunction has been investigated in cross-sectional studies, we currently lack a complete understanding of how the diastolic dysfunction changes over time in individuals with different kidney functions. Exploring the diastolic dysfunction trajectories is crucial as it can provide valuable insights into how kidney function influences cardiac health and which patients are at the highest cardiovascular risk. E/e’ is an echocardiography measure that estimates left ventricular filling pressure and diastolic dysfunction. This study evaluates how kidney function impacts changes in E/e′ over time. Method We identified patients from the Utrecht Patient Oriented Database (UPOD) who visited the outpatient clinic of Utrecht University Medical Center between January 2012 and April 2022. Patients who had received at least three echocardiography reports with a minimum of 12 months between them and had recorded serum creatinine measurements in their electronic health records were included. The estimated glomerular filtration rate (eGFR [mL/min/1.73 m2]) was calculated using the CKD-EPI 2021 creatinine formula without ethnicity and categorized as follows: eGFR ≥ 90, eGFR ≥ 60 - &amp;lt;90, eGFR &amp;lt; 60. Linear mixed-effect models were utilized to determine the impact of kidney function on changes in E/e′ over time. Results A total of 436 patients were included of whom 34.7% were women. The total number of echocardiography examination was 1308. Overall, the median eGFR for all patients was 78.2 mL/min/1.73 m2 [IQR: 61.9, 90.7]. Among them, 26.6%, 51.4%, and 22.0%, had an eGFR ≥ 90, eGFR ≥ 60 - &amp;lt; 90, and eGFR &amp;lt; 60, respectively. Patients with an eGFR &amp;lt; 60 had a higher prevalence of hypertension (64.6%) and cardiovascular disease (84.4%) compared to those with an eGFR ≥ 90, where the prevalence of hypertension and cardiovascular disease was 49.1% and 67.2%, respectively. Additionally, patients with an eGFR &amp;lt; 60 had the lowest mean ejection fraction of 44.9% ± 18.5% and the highest median E/e′ of 12.84 [10.10, 16.16]. The linear mixed model analysis showed that the estimated change in E/e′ per year depended on the level of kidney function. For patients with eGFR ≥ 60 - &amp;lt;90, E/e′ did not significantly change per year (p-value: 0.927). However, for patients with eGFR &amp;lt; 60, a statistically significant (p = 0.014) increase in the E/e′ of 0.45 (0.09, 0.81) was observed per year. Hypertension, diabetes mellitus, and cardiovascular disease were found to affect the change in E/e′, with estimates of 0.95 (0.41, 1.49), 1.82 (0.82, 2.89), and 1.25 (0.54, 1.97), respectively. Conclusion The trajectory of changes in E/e′ over time was significantly affected by varying levels of kidney function. Patients with impaired kidney function (eGFR &amp;lt; 60) have a higher E/e’ compared to those with normal kidney function (eGFR ≥ 90) and presented a significant increase of E/e’ per year.

#2752 Decline of residual renal function in peritoneal patients: in search of the lost kidney?

Abstract Background and Aims The latest (2020) recommendations of the International Society of Peritoneal Dialysis have proposed a new paradigm of adequacy. In this context, preserving residual renal function (RRF) is considered one of the most important therapeutic targets to reduce cardiovascular risk and mortality. Incremental peritoneal dialysis can contribute to preserving RRF. The goal of this study is to evaluate factors which are associated with a decline in RRF in APD patients. Method We conducted a retrospective study of incidental peritoneal dialysis patients between 2020 and 2022. We started considering 62 patients who underwent APD. 23 were excluded due to lack of data, follow-up of less than 1 year, need for haemodialysis sessions before or during follow-up, interfering surgery (bariatric surgery and nephrectomy) and treatment using the CAPD technique. We analyzed data from 39 APD patients (see Table 1) and classified them into two groups based on their RRF decline using the cut-off of 1 ml/min/year (calculated as the mean of urea and creatinine clearance). They were distinguished into slow progressors and fast progressors and we identified any differences in clinical and dialysis parameters at baseline and 12-month follow-up. We calculated dialytic, renal and total Kt/V in both groups and looked for possible predictors of faster RRF loss. For statistical analysis, we used ANOVA for continuous variables, Kruskal-Wallis for non-continuous variables and Fisher for qualitative variables. Finally, predictive data were extracted using logistic regression. Results We found 22 slow progressors and 17 fast progressors. A significant difference was found in the prevalence of cardiovascular disease (18.2% vs 47.1%, p 0.028), residual renal function (5.71 ml/min vs 6.85 ml/min, p 0,03) and dialysing solution volumes (13.2 L vs 14.1 L, p 0.05) between the two groups, with higher values in the fast progressors. In this group, more male patients were also observed (p 0.11), treated with 2 or more antihypertensive drugs (p 0.30) and exposed to higher weekly dialysate glucose (p 0.23) and daily ultrafiltration rates (p 0.23). At the 12-month follow-up, the mean decline in renal function was -1, 56 ml/min in the entire sample, -3.03 ml/min in the fast progressors group and -0.43 ml/min in the slow progressors group; the change in daily Uf inversely correlated with the change in RRF (p 0.025; r -0.35, Fig. 1). There was a mean reduction in ultrafiltrate volume (-22.7 ml vs +123.5 ml, p 0.028) and in the amount of glucose in the dialysing solutions (-138.6 g vs +100.5 g, p 0.007) compared to baseline values in patients who preserved RRF. In contrast, the difference between the two groups in the number of patients who started PD with&amp;lt;5 sessions per week is borderline (p 0.099). Weekly dialysis Kt/V is higher in fast-progressor patients (1 vs 0.88; p 0.205) with a total weekly Kt/V in both cases above the recommended target of 1.7. On multivariate regression analysis, baseline renal function and the presence of heart disease correlate with a more rapid decline in RRF (p 0.047; p 0.021 respectively). Conclusion With the limitations of low sample size and short follow-up time, we observed that ultrafiltration and peritoneal exposure to dialysate glucose may play a role in RRF loss, but more research is needed to confirm this. We found that patients with heart disease and higher baseline RRF were more likely to experience a faster decline in RRF. Overall findings suggest that maintaining RRF is crucial in APD patients, and incremental dialysis can help preserve it. We recommend further studies with longer follow-up times to better understand the relationship between RRF and APD.

#2775 ERCOS multicenter Spanish study: clinical profile of patients with chronic kidney disease G3a-G5D and osteoporosis

Abstract Background and Aims Fracture risk evaluation has recently been integrated into the 2017 KDIGO CKD-MBD (Chronic Kidney Disease- Mineral and Bone Disorder) guideline and its 2021 Spanish endorsement. It is now suggested to test bone mineral density (BMD) to assess fracture risk “if results will impact treatment decisions”. In fact, multiple new prospective studies have now documented that lower BMD predicts incident fractures in patients with CKD G3a–G5D. However, we scarcely know current real clinical practice in this population. Thus, the aim of the ERCOS (“Enfermedad Renal Crónica OSteoporosis”) study was to describe the clinical profile of patients with CKD who had been diagnosed of osteoporosis in outpatient Nephrology and Rheumatology clinics in Spain. Method ERCOS is a descriptive, observational, and multicenter Spanish study. Patients were recruited by consecutive sampling from 15 different Spanish hospitals. Osteoporosis characteristics (history of fragility fracture, BMD and other fracture risk factors), associated comorbidities, biochemical parameters and treatment were analyzed. Results A total of 163 patients (median age 77 years old) were included. Most were women (71.2%) and 98.3% of them were postmenopausal. Hypertension was the most frequent comorbidity (87.1%) and “attributed” cause of CKD (43.2%). Diabetes mellitus and cardiovascular disease were present in 35.6% and 29.4% of patients, respectively. Median estimated glomerular filtration rate was 36 ml/min/1.73 m2 [creatinine 1.48 mg/dl (95% CI 1,2-2)]. 38% of patients were G5D CKD patients (95.2% undergoing hemodialysis). 37.7% of patients had had a fragility fracture after the diagnosis of CKD (vertebral 52.5%, hip 24.6%, wrist 21.3%, humerus 16.4%, among others). Importantly, despite the diagnosis of osteoporosis, only 60.1% of the patients received specific treatment (mainly bisphosphonates or denosumab). Moreover, antiosteoporotic treatment was much more frequently prescribed by rheumatologists (46.9%), internal medicine physicians (23.5%), and only 13.3% was prescribed by nephrologists. 19.4% of patients suffered from fragility fractures even after initiating specific treatment. Conclusion Most patients with moderate and severe CKD with osteoporosis were old postmenopausal women with a high prevalence of diabetes or cardiovascular disease. Although about 40% had even suffered a fragility fracture, there is a high treatment gap, especially relevant among nephrologists. A call to action and to avoid existing therapeutic nihilism seems necessary, expanding the knowledge of the new more proactive guidelines and homogenizing the care and therapeutic approach in these patients.

#2219 Glycemic control and adverse outcomes in patients with diabetes and CKD stage 4-5: a nationwide cohort study

Abstract Background and Aims Although poor glycemic control is strongly associated with adverse clinical outcomes, few studies have evaluated their risk across the full glycemic spectrum in patients with moderate to advanced chronic kidney disease (CKD). Guidelines for HbA1c targets are mainly derived from extrapolation of trials conducted in people with normal or mildly reduced kidney function. In non-dialysis CKD individualized targets are recommended, often aiming for less strict glycemic control, due to lack of evidence for the efficacy of lower HbA1c, and potentially greater harm. In this study, we analyzed long-term outcomes across the full spectrum of HbA1c in CKD stage 4-5. Method Using data from the Swedish Renal Registry, we included patients with diabetes and CKD stages 4-5. Adjusted cause-specific Cox models were used to analyze associations between the one-year baseline mean HbA1c level (&amp;lt;43, 43-52 [reference], 53-64, 65-74, 75-89, ≥90 mmol/mol) and the occurrence of major adverse cardiovascular events (MACE, a composite of cardiovascular death, hospitalization for myocardial infarction or stroke), kidney replacement therapy (KRT), all-cause mortality, and hospitalization/death due to hypoglycemia. Results We included 2571 patients (71 years, 64% men, eGFR 20 mL/min per 1.73m², HbA1c 59.7 mmol/mol [7.6%], 75% insulin users). At baseline, patients with a higher HbA1c level were younger, had a higher prevalence of cardiovascular disease and were more likely prescribed insulin. Kidney function and malnutrition-inflammation markers were, however, not different between groups. Over a median follow-up of 4.9 [4.6;5.2] years, 939 (37%) KRT, 1078 (42%) MACE, and 1523 (59%) deaths occurred. Increasing HbA1c was gradually associated with the risk of MACE (adjusted HR from 0.76 [95% CI: 0.60-0.96] for HbA1c &amp;lt;43 mmol/mol to 1.39 [1.01-1.92] for HbA1c ≥ 90 mmol/mol) (Fig.). In contrast, a J-shaped relationship was observed for the risk of all-cause mortality. Compared to the reference group (43-52 mmol/mol; 5-year absolute risk 52% [48-56]), a HbA1c &amp;lt;43 mmol/mol was not associated with a higher mortality (adjusted HR 1.03 [0.86-1.23], 5-year absolute risk 57% [51-63]), while any HbA1c above 75 mmol/mol was associated with a higher risk of death. The risks of KRT and severe hypoglycemia were not different across HbA1c levels. Conclusion In CKD stage 4-5, HbA1c above the general recommendation for non-CKD patients (43-52 mmol/mol) is associated with a higher risk of MACE and all-cause mortality, but not KRT, without increased risk of severe hypoglycemia. This suggests that targeting a lower HbA1c, together with other cardio-reno-metabolic prevention strategies, might contribute to improve health outcomes in this very high-risk population.

#1804 Long-term outcomes of CKD patients with lupus nephritis: a nationwide cohort study

Abstract Background and Aims Health trajectories of patients with lupus nephritis (LN) are poorly understood in the setting of moderate and advanced chronic kidney disease (CKD). Furthermore, data on comparison of outcomes of LN to other forms of CKD are scarce. Therefore, the aim of this study was to compare long-term outcomes between LN and CKD from other etiologies. Method Using data from the Swedish Renal Registry (2006-2021), we compared clinical outcomes between patients with moderate and advanced CKD related to LN (LN-CKD), and patients with CKD due to primary glomerular diseases (PGD-CKD, i.e. IgA nephropathy, focal segmental glomerulosclerosis, membranous nephropathy), and due to other common CKD etiologies with high cardiovascular risk (Other-CKD, mostly diabetes and nephrosclerosis). Cox proportional hazard models were used to estimate the adjusted hazard ratios of mortality, major cardiovascular events (MACE), heart failure (HF), kidney replacement therapy (KRT) and acute kidney injury (AKI). Models were adjusted for age, sex, comorbidities, clinical and biological data including kidney function, medications and healthcare utilization. Results At baseline, patients with LN-CKD (N = 317, 61 years, 76% women, median eGFR 30 mL/min per 1.73 m²) and PGD-CKD (N = 2296, 57 years, 30% women, eGFR 29 mL/min per 1.73 m²), were younger and had lower prevalence of cardiovascular disease than patients with Other-CKD (N = 34778, 75 years, 36% women, eGFR 25 mL/min per 1.73 m²). Over a median follow-up of 6.2 [3.3; 9.8] years, 19029 deaths (51%), 15768 (42%) MACE and 8390 (22%) KRT events occurred. The unadjusted 5-year absolute risks of death and MACE were high both in patients with LN-CKD (27% and 25%) and Other-CKD (50% and 44%), but lower in those with PGD-CKD (16% and 14%), whereas the 5-year absolute KRT risk was higher in patients with PGD-CKD (PGD-CKD: 37%, LN-CKD: 23%, Other-CKD: 23%). In multivariable analyses and as compared to PGD-CKD, patients with LN-CKD had a higher risk of death (adjusted HR: 1.63 [95% CI: 1.32-2.02]), MACE (1.65 [1.31-2.08]), HF (1.68 [1.31-2.14]) and AKI (1.45 [1.02-2.05]) and showed a lower risk of KRT (HR: 0.81 [0.64-1.02]), although the 95% CI slightly overlapped (Figure, panel A). In contrast, the risks of adverse events were similar between patients with LN-CKD and those with Other-CKD (Figure, panel B). Conclusion While LN-CKD had a lower risk of KRT than PGD-CKD, they exhibited a higher risk of death, MACE, KRT, HF and AKI, reaching the risk magnitude of patients with high cardiovascular burden (Other-CKD). Our findings may inform decisions for care planning in patients with advanced CKD and LN.