Prevalence Of Cardiovascular Events Research Articles

Does Chronotype Influence Diurnal Changes in Cardiovascular Disease Risk Factors? A Preliminary Analysis

Introduction: Humans experience diurnal fluctuations in the prevalence of cardiovascular events which is likely an output of endogenous circadian influence. Relatedly, vascular endothelial cell function, measured by conduit artery responsiveness to hyperemia during a flow-mediated dilation test, is supposed to follow a diurnal rhythm that is moderated by an individual’s chronotype. We therefore sought to examine the extent to which diurnal changes in other cardiovascular risk factors, such as blood pressure, cardiac chronotropy, and circulating blood leukocytes, were related to chronotype in humans. A moderating influence of chronotype on diurnal changes in the aforementioned parameters was hypothesized given prior research associating a preference for evening wakefulness with an adverse cardiometabolic phenotype. Methods: All data are presented as mean ± standard deviation. This abstract includes secondary data from a preliminary sample of 16 young (19 ± 2 years), healthy males and females. Participants completed a Munich Chronotype Questionnaire (MCQ) to quantify diurnal preference for morning or evening activity. The corrected mid-sleep time on free days (MSFSC) was calculated from the MCQ and interpreted to represent an index for morning or evening chronotype. Participants attended data collection sessions in the morning (09:16 ± 01:27 hh:mm) and again in the evening (16:19 ± 00:31 hh:mm) under resting conditions for the quantification of blood pressure and enumeration of circulating leukocytes from venous blood. Results: The sample included in this analysis had a slight preference for evening wakefulness (MSFSC = 04:58 ± 01:17 hh:mm). A significant and robust diurnal variation was found among circulating venous leukocytes (P < 0.001) which measured higher in the afternoon (2.06×106 ± 3.67×105 cells/mL blood) than morning (1.61×106 ± 4.68×105 cells/mL blood). The diurnal variation in circulating venous leukocytes was independent (β = -9.87×104; R2 = 0.19; P = 0.186) of individual chronotype, as were individual diurnal changes of all other hemodynamic parameters included in this analysis (all P > 0.05). More participants will be recruited to satisfy statistical power for primary outcomes. Discussion: These preliminary results from healthy, young adults indicate that individual disposition towards morning or evening wakefulness may not exert a profound influence over diurnal changes in several cardiovascular disease risk factors under resting conditions. Funding Sources: The study was funded by the Natural Sciences and Engineering Research Council of Canada (DG: 20011033) held by Dr. MJM). JMC and MIB were supported by Ontario Graduate Scholarships. JCS was supported by the Natural Sciences and Engineering Research Council of Canada Graduate Scholarships – Master’s. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter?

Adrenaline-producing tumors are mostly characterized by a sudden release of catecholamines with episodic symptoms. Noradrenergic ones are usually less symptomatic and characterized by a continuous overproduction of catecholamines that are released into the bloodstream. Their effects on the cardiovascular system can thus be different. The aim of this study was to determine the prevalence of cardiovascular complications by catecholamine phenotype. We retrospectively analyzed data on the prevalence of cardiovascular events in 341 consecutive patients with pheochromocytoma and paraganglioma treated from 1995 to 2023. Biochemical catecholamine phenotype was determined based on plasma or urinary catecholamines and metanephrines. According to the phenotype, 153 patients had noradrenergic pheochromocytoma and paraganglioma and 188 had adrenergic pheochromocytoma and paraganglioma. In the whole sample, the incidence of serious cardiovascular complications was 28% (95 patients), with no difference between the phenotypes or sexes. The noradrenergic phenotype had significantly more atherosclerotic complications (composite end point of type 1 myocardial infarction and symptomatic peripheral artery disease; odds ratio, 3.58 [95% CI, 1.59-8.83]; P=0.003), while the adrenergic phenotype more often had type 2 myocardial infarction and takotsubo-like cardiomyopathy (OR, 0.24 [95% CI, 0.09-0.57]; P=0.002). These changes remained even after adjustment for conventional risk factors of atherosclerosis. We found a 28% incidence of cardiovascular complications in a consecutive group of patients with pheochromocytoma and paraganglioma. Patients presenting with a noradrenergic phenotype have a higher incidence of atherosclerotic complications, while the adrenergic phenotype is associated with a higher incidence of acute myocardial damage due to takotsubo-like cardiomyopathy.

Cardiovascular aging in patients with chronic kidney disease: pathogenesis and potential therapeutics

Patients with chronic kidney dysfunction have an elevated risk for various cardiovascular diseases. Even in the early stages of chronic kidney disease (CKD) the prevalence of cardiovascular events and mortalities is extremely high if compared with age-matched general population. With worsening of kidney function this risk is growing intensely. There are many traditional and non-traditional risk factors that can lead to cardiovascular disease in CKD. Cardiovascular rather than kidney failure, per se, is the main cause of mortality in CKD. The increase of calcification promoters and the decrease of inhibitors leads to the development of vascular calcification in the early stages of CKD. In this regard, CKD mimics cardiovascular system aging with a premature onset and an accelerated progression.Various non-pharmacological and pharmacological interventions have been studied to retard premature cardiovascular aging in CKD. In this review article, we are summarizing the pathogenesis, risk factors, and possible management strategies of cardiovascular disease in CKD.

Effect of pioglitazone on proteinuria and cardiovascular events in patients with diabetic nephropathy

Introduction: Slowing the progression of diabetes to DN has established a great deal of interest in recent years. Objectives: Considering the enormous costs of managing patients with diabetes and the lack of similar studies on the Iranian population, the present study aimed at investigating the effect of pioglitazone on the progression of DN and the prevalence of cardiovascular events. Patients and Methods: The present prospective study was undertaken on 55 patients with type 2 diabetes who were divided into two groups. The group 1 patients received 30 mg of pioglitazone daily in addition to other blood sugar-controlling drugs. Patients in the group 2 recieved other anti-diabetic medications. During a six-month follow-up period, proteinuria and the occurrence of cardiovascular events were assessed. Results: The 24-hour urinary proteinuria decreased within the group 1 and these intragroup differences were significant (P<0.001) during six months of follow-up compared to month two. There was no significant difference in the ratio of cardiovascular events in the group 1 compared to the group 2. Conclusion: Adding 30 mg of pioglitazone to other blood sugar-lowering medications could lower proteinuria in individuals with type 2 diabetes; however, it had no impact on the risk of cardiovascular events.

Association of Cardiovascular Disease in Patients with Mycosis Fungoides and Sézary Syndrome Compared with that in a Matched Control Cohort

Mycosis fungoides/Sézary syndrome (MF/SS) produces a low-grade chronic inflammatory state that may be associated with an increased risk of cardiovascular (CV) events, as seen in other chronic, systemic dermatologic diseases. To assess this association, a retrospective, cross-sectional study was designed in which 421 patients with a biopsy-proven diagnosis of MF/SS were compared with a control cohort of 4,210 age-, gender-, and race-matched patients randomly selected from the National Health and Nutritional Evaluation Survey database. The MF/SS cohort had a 14% prevalence of CV events, which was not statistically different from the control population's prevalence of 13%. In the MF/SS cohort, a multivariable logistic regression model showed that older patients (OR= 1.05 for each year of age, 95% confidence interval= 1.02-1.07) and those diagnosed with hypertension (OR= 3.40, 95% confidence interval= 1.71-6.75) had a higher risk of a CV event (P < 0.001). Risk factors such as gender, race, smoking, diabetes, and obesity were not significantly associated with CV events. Findings suggest that in the MF/SS population, advancing age and hypertension are risk factors for CV events, requiring clinical recognition and management. In addition, further research is needed to understand the complex interplay of how chronic inflammation in MF/SS impacts the immune development of CV disease.

Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort

ObjectivesDistinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks.DesignA cross-sectional and retrospective observational study.SettingA population-based French cohort (CONSTANCES).Participants130 197 adults enrolled between 2012...

1787-PUB: An Increased Risk of Metabolic Syndrome in Type 2 Diabetes Mellitus Patients Is Suggested by a High TG/HDL Ratio—A Retrospective Study

Background: The prevalence of cardiovascular events and the risk of mortality are higher among patients with Metabolic syndrome (MetS), and the risk factors include central obesity, increased blood pressure, increased fasting blood glucose (FBG) levels and abnormal blood lipids. Early diagnosis of MetS and timely intervention can prevent unnecessary complications related to its progression and help reduce the risk of Cardiovascular disorders (CVD). Purpose: The purpose of this EHR-based real-world study was to identify the relationship between Triglyceride/High-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic syndrome. Methods: Participants in the trial must have had type 2 diabetes mellitus for at least six months and must be presenting for routine treatment in one of 14 centres around the nation. Data on medical history, diabetes complications, medications, and laboratory values were gathered using an EMR (MEDEVA) integrated research proforma, and the study period was for six months (March-August 2022). Clinical and statistical professionals at MEDEVA combined anonymized data and conducted analyses using Python 3.6 (pandas, scikit-learn, SciPy for exploratory data analysis, and Matplotlib for exploratory visualisation), SPSS version 26 (statistical analysis). Results: Of the 372 patients with Type 2 Diabetes Mellitus, 278 had Metabolic Syndrome (MetS), and 94 did not have MetS. The TG/HDL ratio was significantly higher for the group with MetS (5.1) than the group without MetS (2.7). As a next step, to avoid potential confounding, the sample was adjusted for BMI and age, i.e., covariate matching was done. The TG/HDL ratio continued to be higher for the group with MetS (5.4) than the group without MetS (2.7). Conclusion: We discovered a strong link between metabolic syndrome and the TG/HDL-C ratio. A high TG/HDL ratio indicates an increased risk of developing metabolic syndrome. Disclosure A.K.Saxena: None. S.S.Dariya: None. A.Patil: None. S.K.Patra: None. D.Kumar: None. R.Regulla: None. M.Gupta: None. M.Lakshmanan: None. R.Sheohare: None. B.Patni: None. M.Aslam: None. A.Maheshwari: None. N.K.Singh: None. V.S.Hiremath: None.

Review of 20-year results of ASCOT Legacy

The article presents the results of a 20-year follow-up of patients in the ASCOT Legacy study, indicating that antihypertensive and lipid-lowering therapy reduces mortality in patients with hypertension and high cardiovascular risk in the long term. In the group of patients treated with amlodipine compared with the β-blocker atenolol, there was a decrease in mean systolic and diastolic blood pressure (BP), as well as a long-term improve in the form of a decrease in the prevalence of cardiovascular events and mortality due to stroke. An important feature of therapy based on amlodipine was the reduction in BP variability. The article reflects the results of major studies that determine the possibility and effectiveness of early prescription of combined antihypertensive and lipid-lowering therapy.

Clinical course of patients with adrenal incidentalomas and cortisol autonomy: a German retrospective single center cohort study.

Adrenal incidentalomas with cortisol autonomy are associated with increased cardiovascular morbidity and mortality. Specific data on the clinical and biochemical course of affected patients are lacking. Retrospective study from a tertiary referral centre in Germany. After exclusion of overt hormone excess, malignancy and glucocorticoid medication, patients with adrenal incidentalomas were stratified according to serum cortisol after 1 mg dexamethasone: autonomous cortisol secretion (ACS), >5.0; possible ACS (PACS), 1.9-5.0; non-functioning adenomas (NFA), ≤1.8 µg/dl. A total of 260 patients were enrolled (147 women (56.5%), median follow-up 8.8 (2.0-20.8) years). At initial diagnosis, median age was 59.5 (20-82) years, and median tumour size was 27 (10-116) mm. Bilateral tumours were more prevalent in ACS (30.0%) and PACS (21.9%) than in NFA (8.1%). Over time, 40/124 (32.3%) patients had a shift of their hormonal secretion pattern (NFA to PACS/ACS, n=15/53; PACS to ACS, n=6/47; ACS to PACS, n=11/24; PACS to NFA, n=8/47). However, none of the patients developed overt Cushing's syndrome. Sixty-one patients underwent adrenalectomy (NFA, 17.9%; PACS, 24.0%; ACS, 39.0%). When non-operated patients with NFA were compared to PACS and ACS at last follow-up, arterial hypertension (65.3% vs. 81.9% and 92.0%; p<0.05), diabetes (23.8% vs. 35.6% and 40.0%; p<0.01), and thromboembolic events (PACS: HR 3.43, 95%-CI 0.89-13.29; ACS: HR 5.96, 95%-CI 1.33-26.63; p<0.05) were significantly less frequent, along with a trend towards a higher rate of cardiovascular events in case of cortisol autonomy (PACS: HR 2.23, 95%-CI 0.94-5.32; ACS: HR 2.60, 95%-CI 0.87-7.79; p=0.1). Twenty-five (12.6%) of the non-operated patients died, with higher overall mortality in PACS (HR 2.6, 95%-CI 1.0-4.7; p=0.083) and ACS (HR 4.7, 95%-CI 1.6-13.3; p<0.005) compared to NFA. In operated patients, prevalence of arterial hypertension decreased significantly (77.0% at diagnosis to 61.7% at last follow-up; p<0.05). The prevalence of cardiovascular events and mortality did not differ significantly between operated and non-operated patients, whereas thromboembolic events were significantly less frequent in the surgical treatment group. Our study confirms relevant cardiovascular morbidity in patients with adrenal incidentalomas (especially those with cortisol autonomy). These patients should therefore be monitored carefully, including adequate treatment of typical cardiovascular risk factors. Adrenalectomy was associated with a significantly decreased prevalence of hypertension. However, more than 30% of patients required reclassification according to repeated dexamethasone suppression tests. Thus, cortisol autonomy should ideally be confirmed before making any relevant treatment decision (e.g. adrenalectomy).

Cardiologist Evaluation and Approval Was the Primary Predictor of Kidney Transplant Candidacy and Transplantation Among Patients With Reduced Left Ventricular Ejection Fraction.

We evaluated 109 consecutive adults with LVEF ≤40% at the time of initial kidney transplant evaluation between 2013 and 2018. Posttransplant cardiovascular outcomes were defined as nonfatal myocardial infarction (MI), admission for HF, cardiovascular death, and all-cause mortality. A cardiologist participated in kidney transplant evaluation for 87% of patients and was present at 49% of transplant selection conferences. Twenty-four patients (22%) were denied by a cardiologist for kidney transplant' and 59 (54%) were denied by the selection committee, of whom 43 were because of cardiovascular risk. Forty-two (38%) patients were approved for kidney transplant. On univariate analysis, the variables associated with denial for kidney transplant included cardiologist denial, higher cardiac troponin T, prior coronary intervention, cardiovascular event, positive stress study, lower ejection fraction, and lower VO2 max (all P < 0.05). Cardiologist denial was the most significant predictor of denial for kidney transplant in different multivariate models. At a median follow-up of 15 mo, 5 (5%) suffered nonfatal MI, 13 (12%) were hospitalized for HF exacerbation, and 17 (16%) died. Only 22 patients, 52% of those approved, underwent kidney transplant. After kidney transplant, there was 1 death, 1 nonfatal MI, and 3 hospitalizations for HF. Median LVEF improved from 38% before listing to 55% posttransplant. Cardiologist denial was the primary predictor of rejection for kidney transplant. Despite careful selection, prevalence of cardiovascular events and mortality after kidney transplant was 23%. There is need for a structured multidisciplinary approach for patients with impaired LVEF.

Maternal Inheritance of Familial Hypercholesterolemia Gene Mutation Predisposes to Coronary Atherosclerosis as Assessed by Calcium Score in Adulthood.

Animal studies have demonstrated that fetal exposure to high maternal cholesterol levels during pregnancy predisposes to aortic atheroma in the offspring. In humans, little is known about the consequences of this exposure on the development of atherosclerotic cardiovascular disease later in life. We wanted to assess whether maternal/paternal inheritance of familial hypercholesterolemia (FH) gene mutation could be associated with subclinical coronary atherosclerosis. We retrospectively included 1350 patients, followed in the French registry of FH, with a documented genetic diagnosis. We selected 556 age- and sex-matched pair of patients based on the sex of the parents who transmitted the FH gene mutation, free of coronary cardiovascular event, and with a subclinical coronary atherosclerosis evaluation assessed using coronary artery calcium (CAC) score. We performed univariate and multivariate analysis to assess the individual effect of parental inheritance of the FH gene mutation on the CAC score. In the whole population, patients with maternal inheritance of FH gene mutation (n=639) less frequently had a family history of premature cardiovascular events (27.7% versus 45%, P<0.0001) and were 2 years older (46.9±16.8 versus 44.7±15.9 years old, P=0.02) than those with paternal inheritance (n=711). There was no difference in the prevalence of cardiovascular events between the two groups. In the matched subgroup, maternal inheritance was significantly associated with an increase in CAC score value by 86% (95% CI, 23%-170%; P=0.003), a 1.81-fold risk of having a CAC score ≥100 Agatston units (95% CI, 1.06-3.11; P=0.03), and a 2.72-fold risk of having a CAC score ≥400 Agatston units (95% CI, 1.39-5.51; P=0.004) when compared with paternal inheritance in multivariate analysis. Maternal inheritance of FH gene mutation was associated with more severe subclinical coronary atherosclerosis assessed by CAC score and may be considered as a potential cardiovascular risk factor.

Adherence to therapy and the risk of cardiovascular events in patients with heart failure: data from the outpatient registry

Aim. To determine the adherence to drug therapy and the prevalence of cardiovascular events (CVEs) in patients with heart failure (HF) after a 1-year follow-up in a specialized cardiology unit of a research center.Material and methods. CVEs were analyzed within the prospective observational study COMPLIANCE (Assessment of adherenСe tO Medical theraРy and its infLuence on long-term outcomes In pAtieNts with Chronic hEart failure in the outpatient registry). The study included 72 patients with HF, verified according to clinical guidelines. Patients were divided into 2 groups: adherent and non-adherent to treatment. Overall adherence to therapy and adherence to specific drugs were assessed using the original National Society for Evidence-Based PharmacotherapyAdherence Scale. The study included 2 visits: inclusion in the study and a visit after 1-year follow-up. After a 1-year follow-up, a comparative analysis of the two groups was performed to achieve the primary composite endpoint: death, acute cerebrovascular accident, myocardial infarction, decompensated HF with and without hospitalization.Results. A Kaplan-Meier analysis of 1-year survival showed that the mean time to onset of primary composite endpoint was 10,2 (95% confidence interval: 9,5-10,8) months. A significant relationship was found between the occurrence of composite endpoint and adherence to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (p=0,001), which was not confirmed for beta-blockers and mineralocorticoid receptor antagonists (p=0,338 and p=0,335, respectively). The risk of composite endpoint was 3,6 times higher in non-adherent patients than in adherent patients (hazard ratio, 3,6; 95% confidence interval, 1,5-8,5 (p=0,003)).Conclusion. A significant relationship was found between nonadherence to treatment and the incidence of CVEs, the risk of which increases by 3,6 times in non-adherent patients compared with adherent patients with HF.

Patterns of Lipid Lowering Therapy Use Among Older Adults in a Managed Care Advantage Plan in the United States

Background: The prevalence of cardiovascular events is increasing. There are many new lipids lowering therapies available in recent years. Increased evidence through literature and guidelines suggests that the use of lipid lowering therapy (LLT) benefits patients who are at risk for cardiovascular events. Objective: The objective of this study was to describe the current LLT use as well as patterns of treatment modification among adults ≥ 65 years. Methods: A retrospective analysis of administrative claims data between January 2016 and May 2018 was conducted. Patients with a LLT refill and continuous enrollment during 1-year prior and 1-year follow-up were identified. The treatment episodes captured were interruption of therapy, intensity changes, dose changes, treatment augmentation, switching, and discontinuation. An analysis of treatment patterns among patients ≥75 years was also performed. Results: The study included 14,360 patients with a LLT of which 99% of patients were on statins as monotherapy or combination. Overall non-statin therapy use either as monotherapy or combination was 2.1%. There were significant differences among new initiators and existing users of therapy. Among prevalent users 57.4% had no changes in the follow-up period, 13.6% interrupted therapy, and 6.6% discontinued. Among new users, 47.9% patients had interrupted therapy, 25% had no changes, and 21.9% discontinued therapy. Conclusion: Most patients were on monotherapy and statins with low non-statin use. The new users among them were more likely to discontinue and interrupt therapy, highlighting the limitations and issues that older patients face that need to increase adherence.

Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus.

Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease, including coronary heart disease, heart failure, arrhythmia, and sudden cardiac death. Therefore, developing effective methods to control risk factors and improve prognosis is the primary focus during the diagnosis and treatment of CKD. For example, the SPRINT study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. A co-crystal complex of sacubitril, which is a neprilysin inhibitor, and valsartan, which is an angiotensin receptor blockade, has the potential to be widely used against CKD. Sacubitril inhibits neprilysin, which further reduces the degradation of natriuretic peptides and enhances the beneficial effects of the natriuretic peptide system. In contrast, valsartan alone can block the angiotensin II-1 (AT1) receptor and therefore inhibit the renin–angiotensin–aldosterone system. These two components can act synergistically to relax blood vessels, prevent and reverse cardiovascular remodeling, and promote natriuresis. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, we propose clinical recommendations based on an expert consensus to guide ARNI-based therapeutics and reduce the occurrence of cardiovascular events in patients with CKD.

IMPACT OF THE CARDIOVASCULAR POLYPILL (TRINOMIA) ON CHRONIC KIDNEY DISEASE. PROSPECTIVE REAL-LIFE DATA

Objective: Cardiovascular diseases are the leading cause of mortality and morbidity worldwide. Moreover, chronic kidney disease (CKD) patients exhibit significantly higher incidence and prevalence of cardiovascular events. In this population, used to a high burden of pills, the importance of a polypill-based treatment strategy increases to simplify treatment and ensure adherence. The cardiovascular polypill composition includes a lipid-lowering drug, antihypertensive agent, and antiplatelet therapy and is marketed in Spain since 2015 with the name of Trinomia. This report aims to obtain real-life data to evaluate ifTrinomia improves the standard of care. Design and method: Prospective, single-center, observational study of a cohort of CKD patients under the standard of care starting any combination of Trinomia in secondary prevention. Patient demographics, clinical history, blood pressure, and analysis of blood lipids, albumin-to-creatinineratio, and estimated glomerular filtration rate were measured at baseline and 6 and 12 months after starting treatment Results: A total of 49 patients (35 males) were included, with a mean age of 78,83 years (range 51–95). 91,83% had hypertension, 63,26% with type 2 diabetes and 2,04% with type 1 diabetes. Regarding the cause of secondary prevention, 75,4% had cardiovascular disease, 16,4% had a stroke, and 8.16% had both. All laboratory results are displayed in table 1. Conclusions: Although most of the variables studied, probably because it was a small group of patients with adequate baseline control, did not reach statistical significance, some results are worth noting. eGFR is 3 points higher at one year, with a reduction in UACR, which does not reach statistical significance but translates into a lower hyperfiltration without worsening renal function or an increase in serum potassium. In addition, there was a 5-point decrease in systolic blood pressure and a 3-point in diastolic (n.s.), and a better lipid profile is achieved, with a 10-point reduction in LDL and a 24-point reduction in triglycerides.

Comparison of Cardiovascular Risk and Events among Spanish Patients with and without Ocular Pseudoexfoliation.

The purpose of this study was to calculate and compare individual cardiovascular risk (CVR) and the development of cardiovascular events and mortality in patients with and without ocular pseudoexfoliation (PEX). A cohort study was carried out to compare two groups of patients who underwent cataract surgery: patients with (n = 99) and without PEX (n = 239). The CVR factors were recorded for all the subjects, and CVR was calculated for each individual using ERICE risk assessment charts. After a six-year follow-up, the cardiovascular events and mortality rates were compared between the two groups. The mean CVR was 36.41% in the PEX group and 33.72% in the non-PEX group (p = 0.13). High blood pressure was detected in significantly more PEX patients (71.4%) than non-PEX patients (58.6%, p = 0.035), yet no differences were found in the other CVR factors. The prevalence of cardiovascular events in the PEX and non-PEX patients was 17.1% and 12.5%, respectively (p = 0.26), with 5% of patients in the PEX group and 5% in the non-PEX group suffering an acute coronary event (p = 0.9). Moreover, 12% of the PEX patients and 7.5% of the non-PEX patients experienced a stroke (p = 0.17), and the six-year mortality rate was 29.3% in the PEX group and 25.9% in the non-PEX group (p = 0.52). PEX was associated with high blood pressure in our cohort of patients, although cardiovascular risk was not shown to be higher in this group. In addition, patients with PEX did not experience more cardiovascular events or have a higher mortality rate than patients without PEX during the period studied.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Diet as adjunctive therapy for sleep apnea risk: not only how much but also what to eat.

Development and Validation of a Discrete Event Simulation Model to Evaluate the Cardiovascular Impact of Population Policies for Obesity

IntroductionOur aim was to describe the development and validation of an obesity model representing the cardiovascular risks associated with different body mass index (BMI) categories, through simulation, designed to evaluate the epidemiological and economic impact of population policies for obesity.MethodsA discrete event simulation model was built in R considering the risk of cardiovascular events (heart failure, stroke, coronary heart disease, and diabetes) associated with BMI categories in the Spanish population. The main parameters included in the model were estimated from Spanish hospital discharge records and the Spanish Health Survey and allowed both first-order and second-order (probabilistic sensitivity analysis) uncertainty to be programmed into the model. The simulation yielded the incidence and prevalence of cardiovascular events as validation outputs. To illustrate the capacity of the model, we estimated the reduction in cardiovascular events and cost-utility (incremental cost/incremental quality-adjusted life-years [QALYs]) of a hypothetical intervention that fully eliminated the cardiovascular risks associated with obesity and overweight.ResultsThe Validation Status of Health-Economic decision models (AdViSHE) tool was applied. Internal validation plots showed adequate goodness of fit for the Spanish population. External validation was achieved by comparing the simulated and real incidence by age group for stroke, acute myocardial infarction, and heart failure. The intervention reduced the population hazard ratios of stroke, acute myocardial infarction, and heart failure to 0.81, 0.74, and 0.78, respectively, and added 0.74 QALYs to the whole population.ConclusionsThis obesity simulation model evidenced good properties for estimating the long-term epidemiological and economic impact of policies to tackle obesity in Spain. The conceptual model could be implemented for other counties using country-specific input data.

Abstract MP46: The Associations Between Adverse Pregnancy Outcomes And Cardiovascular Delivery Complications: The National Inpatient Sample

Background: Women with adverse pregnancy outcomes (APOs) are at increased risk of long-term cardiovascular (CV) disease, but less is known about the spectrum of acute CV outcomes in women with various APOs. We evaluated the risk of CV events at delivery in women with gestational diabetes (GDM), gestational hypertension and preeclampsia/eclampsia (PEC), overall and by race/ethnicity, in a US sample. Methods: We used the 2016-2017 National Inpatient Sample survey data from the Agency for Healthcare Research and Quality (AHRQ). ICD10-CM diagnosis codes were used to identify women with a delivery hospitalization and to identify CV outcomes. We examined demographics and prevalence of CV events at delivery by the 3 APOs. Logistic regression was used to determine risk of various adverse CV events at delivery by APO, adjusted for age, income and hospital location. To generate national estimates, sampling weights provided by AHRQ were used. Results: Among 3,776,531 deliveries in 2016-2017, GDM was the most common APO (n=552,975; 7.3%). GDM occurred more frequently in Hispanics and Asians/Pacific Islanders (23% and 11%, respectively), while PEC occurred more frequently in Blacks (20%). While there was greater occurrence of CV events with all 3 APOs, after adjustment, only PEC was significantly associated with increased odds of adverse CV events [peripartum cardiomyopathy: OR 3.87 (95% CI 3.30-4.55), congestive heart failure: OR 4.04 (3.52-4.63), acute ischemic heart disease: OR 3.67 (2.65-5.08) and arrhythmias: OR 1.39 (1.22-1.59)]. Risk was elevated for Whites, Blacks, Hispanics and Asians/Pacific Islanders, although there was heterogeneity of the magnitude of risk by race/ethnicity ( Table ). Discussion: Women with APOs, especially PEC, are more likely to experience acute CV complications at hospital delivery than women without APOs. While Black women are more likely to develop PEC, women of all race/ethnicities with PEC are at risk of CV complications.

Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options.

Patients with chronic kidney disease (CKD) exhibit an elevated cardiovascular risk manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Although the incidence and prevalence of cardiovascular events is already significantly higher in patients with early CKD stages (CKD stages 1–3) compared with the general population, patients with advanced CKD stages (CKD stages 4–5) exhibit a markedly elevated risk. Cardiovascular rather than end-stage kidney disease (CKD stage 5) is the leading cause of death in this high-risk population. CKD causes a systemic, chronic proinflammatory state contributing to vascular and myocardial remodeling processes resulting in atherosclerotic lesions, vascular calcification, and vascular senescence as well as myocardial fibrosis and calcification of cardiac valves. In this respect, CKD mimics an accelerated aging of the cardiovascular system. This overview article summarizes the current understanding and clinical consequences of cardiovascular disease in CKD.