Prevalence Of Ischemic Heart Disease Research Articles

The Prevalence and Epidemiological Features of Ischaemic Heart Disease in Sri Lanka

Background: There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs. Objectives: To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES. Methods: We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies. Conclusions: We estimated prevalence of History+ of 3.9% (95% CI 3.3%–4.4%) and Angina+ of 3.0% (95% CI 2.4%–3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.

Combining Loop and Thiazide DiureticsAcross the Left Ventricular Ejection Fraction Spectrum: The CLOROTIC Trial.

The addition of hydrochlorothiazide (HCTZ) to furosemide in the CLOROTIC (Combining Loop with Thiazide Diuretics for Decompensated HeartFailure) trial improved the diuretic response in patients with acute heart failure (AHF). This work aimed to evaluate if these results differ across the spectrum of left ventricular ejection fraction (LVEF). This post hoc analysis of the randomized, double-blind, placebo-controlled CLOROTIC trial enrolled 230patients with AHF to receive either HCTZ or a placebo in addition to an intravenous furosemide regimen. The influence of LVEF on primary and secondary outcomes was evaluated. The median LVEF was 55%: 166 (72%) patients had LVEF >40%, and 64 (28%) had LVEF≤40%. Patients with a lower LVEF were younger, more likely to be male, had a higher prevalence of ischemic heart disease, and had higher natriuretic peptide levels. The addition of HCTZ to furosemide was associated with the greatest weight loss at 72of 96 hours, better metrics of diuretic response, and greater 24-hour diuresis compared with placebo, with no significant differences according to the LVEF category (using 2 LVEF cutoff points: 40% and 50%) or LVEF as a continuous variable (all P values were insignificant). There were no significant differences observed with the addition of HCTZ in terms of mortality, rehospitalizations, or safety endpoints (impaired renal function, hyponatremia, and hypokalemia) among the 2 LVEF groups (all P values were insignificant). Adding HCTZ to intravenous furosemide seems to be effective strategy for improving diuretic response in AHF without treatment effect modification according to baseline LVEF. (Combining Loop with Thiazide Diuretics for Decompensated HeartFailure [CLOROTIC], NCT01647932; Randomized, double blinded, multicenter study, to asses Safety and Efficacy of the Combination of Loop With Thiazide-type Diuretics vs Loop diuretics with placebo in Patients With Decompensated, EudraCT Number 2013-001852-36).

Statin therapy impact on Long-Term outcomes in acute heart Failure: Retrospective analysis of hospitalized patients

BackgroundStatin therapy is well-established for treating hyperlipidemia and ischemic heart disease (IHD), but its role in Acute Decompensated Heart Failure (ADHF) remains less clear. Despite varying clinical guidelines, the actual utilization and impact of statin therapy initiation in patients with ADHF with an independent indication for statin therapy have not been thoroughly explored. MethodsWe conducted a retrospective observational study on 5978 patients admitted with ADHF between January 1st, 2007, and December 31st, 2017. Patients were grouped based on their statin therapy status at admission and discharge. We performed multivariable analyses to identify independent predictors of short-term, intermediate-term, and long-term mortality. A sensitivity analysis was also conducted on patients with an independent indication for statin therapy but who were not on statins at admission. ResultsOf the total patient cohort, 73.9% had an indication for statin therapy. However, only 38.2% were treated with statins at admission, and 56.1% were discharged with a statin prescription. Patients discharged with statins were younger, predominantly male, and had a higher prevalence of IHD and other comorbidities. Statin therapy at discharge was an independent negative predictor of 5-year all-cause mortality (hazard ratio 0.80, 95% confidence interval 0.76–0.85). The sensitivity analysis confirmed these findings, demonstrating higher mortality rates in patients not initiated on statins during admission. ConclusionsThe study highlights significant underutilization of statin therapy among patients admitted with ADHF, even when there’s an independent indication for such treatment. Importantly, initiation of statin therapy during hospital admission was independently associated with improved long-term survival.

Targeting the PANoptosis signaling pathway for myocardial protection: therapeutic potential of Xian Ling Gu Bao capsule.

Introduction: Myocardial infarction (MI), the most prevalent ischemic heart disease, constitutes a primary cause of global cardiovascular disease with incidence and mortality. The pathogenesis of MI is exceedingly intricate, with PANoptosis playing a pivotal role in its pathological process. Xian Ling Gu Bao capsule (XLGB) contains various active components, including flavonoids, terpenes, and phenylpropanoids, and exhibits a wide range of pharmacological activities. However, it remains unclear whether XLGB can protect the myocardium from damage after MI. This study aimed to investigate the impact of XLGB on isoprenaline (ISO)-induced MI in mice and its potential mechanisms. Methods: This study assessed the protective effects of XLGB against ISO-induced MI through techniques such as echocardiography, HE staining, Masson staining, and enzyme-linked immunosorbent assay (ELISA). Furthermore, the potential mechanisms of XLGB's protective effects on MI were explored using bioinformatics, molecular docking, and molecular dynamics simulations. These mechanisms were further validated through immunofluorescence staining and Western blotting. Results: The results demonstrated that various doses of XLGB exhibited a significant reduction in myocardial injury induced by myocardial infarction. Intriguingly, higher dosages of XLGB displayed superior therapeutic efficacy compared to the positive control metoprolol. This protective effect is primarily achieved through the inhibition of oxidative stress and the inflammatory processes. Furthermore, we have elucidated that XLGB protected the myocardium from MI-induced damage by suppressing PANoptosis, with a critical role played by the NLRP3/Caspase3/RIP1 signaling pathway. Of particular note, the primary compounds of XLGB were found to directly interact with NLRP3/Caspase3/RIP1, a discovery further validated through molecular docking and molecular dynamics simulations. This suggests that NLRP3/Caspase3/RIP1 may be a therapeutic target for XLGB-induced myocardial protection. Conclusion: In summary, our findings reveal a novel property of XLGB: reverses myocardial damage following MI by inhibiting the NLRP3/Caspase3/RIP1-mediated PANoptosis pathway.

Burden of Ischemic Heart Diseases among US States from 1990-2019.

Ischemic Heart Disease (IHD) is a leading cause of global mortality, including in the United States. Understanding the burden of IHD in the United States is crucial for informed decision-making and targeted interventions aimed at reducing morbidity and mortality associated with this leading cause of death. This study aimed to understand the burden of IHD, identify gender disparities and risk factors, explore the relationship between socioeconomic growth and IHD, and analyze risk factor distribution across the states of the United States. This study utilized data from the Global Burden of Diseases Study 2019, which provided comprehensive information on IHD from 1990 to 2019. Data related to IHD from these years were extracted using a query tool from the Institute for Health Metrics and Evaluation (IHME) website. The study assessed the relationship between IHD and socioeconomic development using the Socio-demographic Index (SDI) and measured the overall impact of IHD using Disability-adjusted Life Years (DALYs), considering premature death and disability. Additionally, the study analyzed the burden of IHD attributed to six main risk factors. Data analysis involved comparing prevalence, mortality, SDI, DALYs, attributable burden, and risk estimation among the states. Between 1990 and 2019, there was an improvement in socioeconomic development in all states. Age-standardized rates of disease burden for IHD decreased by 50% [ASDR 3278.3 to 1629.4 (95% UI: 1539.9-1712.3) per 100,000] with the most significant decline observed in Minnesota. Males had higher burden rates than females in all states, and the southeast region had the highest mortality rates. The prevalence of IHD showed a declining trend, with approximately 8.9 million cases (95% UI: 8.0 million to 9.8 million) in 2019, representing a 37.1% decrease in the Age-standardized Prevalence Rate (ASPR) from 1990. Metabolic risks were the leading contributors to the disease burden, accounting for 50% of cases, with Mississippi having the highest attributable risk. Arkansas had the highest attributable risk for high cholesterol and smoking. Conversely, Minnesota had the lowest burden of IHD among all the states. This study highlights variations in the burden of IHD across US states and emphasizes the need for tailored prevention programs to address specific risk factors and gender differences. Understanding the trend in IHD may inform policymakers and healthcare professionals in effectively allocating resources to reduce the burden of IHD and improve national health outcomes.

Temporal trends in the prevalence and death of ischemic heart disease in women of childbearing age from 1990 to 2019: a multilevel analysis based on the Global Burden of Disease Study 2019.

Our objective is to describe the current prevalence and death of ischemic heart disease (IHD) in women of childbearing age (WCBA) at the global, regional, and national levels and to analyze its temporal trends from 1990 to 2019. WCBA was defined as women aged 15-49 years. Estimates and 95% Uncertainty Intervals (UI) of IHD prevalence and death numbers for seven age groups were extracted from the 2019 Global Burden of Disease Study. The age-standardized prevalence and death rate (ASPR and ASDR) of IHD in WCBA was estimated using the direct age-standardization method. Joinpoint regression analysis was used to calculate average annual percent change (AAPC) to represent the temporal trends from 1990 to 2019. Between 1990 and 2019, the global ASPR of IHD experienced a 3.21% increase, culminating in 367.21 (95% UI, 295.74-430.16) cases per 100,000 individuals. Conversely, the ASDR decreased to 11.11 (95% UI, 10.10-12.30) per 100,000 individuals. In 2019, among the five sociodemographic index (SDI) regions, the highest ASPR was observed in the high-middle SDI region, whereas the highest ASDR was found in the low-middle SDI region. Regionally, the Caribbean reported the highest ASPR (563.11 per 100,000 individuals; 95% UI, 493.13-643.03), and Oceania reported the highest ASDR (20.20 per 100,000 individuals; 95% UI, 13.01-31.03). At the national level, Trinidad and Tobago exhibited the highest ASPR (730.15 per 100,000 individuals; 95% UI, 633.96-840.13), and the Solomon Islands had the highest ASDR (77.77 per 100,000 individuals; 95% UI, 47.80-121.19). Importantly, over the past three decades, the global ASPR has seen a significant increase [AAPC = 0.11%, 95% Confidence Interval (CI): 0.09-0.13; P < 0.001], while the ASDR has demonstrated a significant decreasing trend (AAPC = -0.86%, 95% CI: -1.11 to -0.61; P < 0.001). Air pollution, tobacco use, high systolic blood pressure, elevated body mass index, dietary risks, and high LDL cholesterol have been identified as the leading six risk factors for IHD-related deaths among WCBA in 2019. Despite the significant decline in the global ASDR for IHD among WCBA over the last thirty years, the ASPR continues to escalate. We need to remain vigilant about the increased burden of IHD in WCBA. It calls for aggressive prevention strategies, rigorous control of risk factors, and the enhancement of healthcare coverage to mitigate the disease burden of IHD among WCBA in forthcoming years.

Morbidity and Mortality Trends of Ischemic Heart Disease and Medical Interventions in Mediterranean Countries—Pre-COVID Analysis: Croatia, Slovenia, France, Italy, and Spain

Ischemic heart disease (IHD) morbidity and mortality indices, along with medical intervention rates, were analyzed among Mediterranean countries, Croatia, Slovenia, Spain, Italy, and France, in the pre-COVID period. Standardized IHD incidence and prevalence rates from 1990 and mortality rates from 1985 were obtained from the Global Burden of Disease Study 2017 and Health for All databases. Coronary artery bypass graft (CABG) and transluminal coronary angioplasty (TCA) rates in the 2011–2019 period were obtained from Eurostat. Trends were estimated with Joinpoint regression analysis. IHD mortality rates range from 13.6 to 74.3 for females and from 37.8 to 126.03 for males. IHD mortality rates in Croatia were 5.6-fold higher among females and 3.3-fold higher among males compared to France. All countries decreased standardized IHD prevalence and incidence rates, although the magnitude varied. The high-to-low ratio, Croatia vs. Spain, was 3.5-fold for CABG and 3.2-fold for TCA. Slovenia, as opposed to Croatia, reduced the gap for all medical indicators except for relatively high prevalence rates. Despite a significant rise in medical interventions in Croatia, ineffective clinical and public health initiatives have led to only modest declines in IHD mortality rates over the past decade.

Retrospective Evaluation of Risk Factors for Ischemic Heart Disease in Patients with Dermatitis Herpetiformis

Background and Purpose: Some have proposed that the cardiovascular risk among individuals with DH differs from that of the general population. This study aimed to analyze cardiovascular risk factors in DH patients and compare them to a matched control group without DH or celiac disease.&#x0D; &#x0D; Methods: This was a retrospective hospital-based study involving patients diagnosed with DH, both clinically and histopathologically, along with age- and sex-matched control subjects without the disease. The presence of ischemic heart disease, and the risk factors including laboratory values, treatment and comorbidity histories were evaluated comparatively. (SPSS version 28.0). &#x0D; &#x0D; Results: Thirty-five patients with DH and 49 controls were included. No significant difference was found between the DH patients and controls regarding the prevalence of ischemic heart disease (22.9% vs. 14.3%, p:0.312). Diabetes mellitus was significantly higher and HDL cholesterol levels were significantly lower in the DH group (respectively, p: 0.044 and p: 0.018). Celiac autoantibodies, the laboratory values, or treatments did not show any significant correlation with heart disease in DH.&#x0D; &#x0D; Conclusion: This study revealed that HDL cholesterol were significantly lower in DH patients compared to general population. More research is needed to optimize the cardiovascular health of DH patients.

Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019

IntroductionDespite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. MethodsThis study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. ResultsIHD accounted for approximately 2.55 million (95 % UI 2.29–2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84–675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85–89 years age-group, in 2019. ConclusionThe age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

Epidemiology and outcomes of emergency department visits in systemic lupus erythematosus: Insights from the nationwide emergency department sample (NEDS).

Systemic lupus erythematosus (SLE) patients are prone to frequent emergency department (ED) visits. This study explores the epidemiology and outcomes of ED visits by patients with SLE utilizing the Nationwide Emergency Department Sample (NEDS). Using NEDS (2019), SLE ED visits identified using ICD-10 codes (M32. xx) were compared with non-SLE ED visits in terms of demographic and clinical features and primary diagnoses associated with the ED visits. Factors associated with inpatient admission were analyzed using logistic regression. Variations in ED visits by age and race were assessed. We identified 414,139 (0.35%) ED visits for adults ≥ 18years with SLE. ED visits with SLE comprised more women, Black patients, ages 31-50years, Medicare as the primary payer, and had higher comorbidity burden. A greater proportion of Black and Hispanic SLE patients who visited the ED were in the youngest age category of 18-30years (around 20%) compared to White patients (less than 10%). Non-White patients had higher Medicaid utilization (27%-32% vs 19% in White patients). Comorbidity patterns varied based on race, with more White patients having higher rates of hyperlipidemia and ischemic heart disease (IHD) and more Black patients having chronic kidney disease (CKD), hypertension, and heart failure. Categorizing by race, SLE/connective tissue disease (CTD) and infection were the most prevalent primary ED diagnosis in non-White and White patients, respectively. Age ≥ 65years, male sex, and comorbidities were linked to a higher risk of admission. Black race (OR 0.86, p = .01) and lowest income quartile (OR 0.78, p = .003) had lower odds of inpatient admission. Infection and SLE/CTD were among the top diagnoses associated with ED visits and inpatient admission. Despite comprising a significant proportion of SLE ED visits, Black patients had lower odds of admission. While the higher prevalence of older age groups, hyperlipidemia, and IHD among White patients may partly explain the disparate results, and further study is needed to understand the role of other factors including reliance on the ED for routine care compared among Black patients, differences in insurance coverage, and potential socioeconomic biases among healthcare providers.

Systematic review and meta-analysis of increased ischemic heart disease vulnerability in schizophrenia patients

Abstract Background Ischemic heart disease (IHD) is the leading cause of death in Europe and worldwide and past studies have shown its unusually high prevalence in schizophrenia patients. We conducted the first review to synthesise the prevalence of ischemic heart disease (IHD) in schizophrenia patients of the developed world in a quantitative review using the PRISMA standards (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Purpose The aim of this systematic review and meta-analysis is to assess the current state of research on the prevalence of ischemic heart disease in schizophrenia patients in the developed world. Methods Studies included were primary research in the form of population-based cohort studies for both males and females. Articles that were not in English, not peer-reviewed, were unspecific in cardiac conditions and mental illnesses, or of an unsuitable data type were excluded. The searches were conducted in PubMed and Embase (Ovid) on 12th of October 2022, and last updated on January 4th, 2023. Data were extracted and analysed in R for meta-analysis, with possible biases investigated. The protocol and review were carried out in accordance with the PRISMA guidelines and are accessible online at Open Science Framework. Results Five population-based longitudinal cohort studies were included from various regions of the developed world, four of which were meta-analysed. In all studies, schizophrenia patients had a higher risk of IHD than controls, which was supported by the meta-analysis indicating that schizophrenics are 1.66 times more likely to develop IHD (HR = 1.66; 95%CI: 1.30-2.12; p&amp;lt;0.01). However, the analyses displayed significant heterogeneity (I2 = 82%). Furthermore, all studies demonstrated a particularly concerning vulnerability for IHD among female and younger schizophrenia patients. Conclusions This review demonstrated a significant increase in the risk of IHD among schizophrenia patients, particularly in younger age groups and females. Although the small number of studies with diverse patient characteristics (inpatient or both inpatient and outpatient) in each study limited the precision of the overall hazard ratio, the meta-analysis confirmed the negative trend presented in the review process. The especially broad coverage of the sample population in the publications has suggested that this risk has persisted throughout the socio-economic and medical advancements in the developed world since the Second World War.

Left ventricular early diastolic strain rate and cardiovascular outcome in patients with left ventricular non-compaction phenotype

Abstract Introduction Speckle-tracking echocardiography is an increasingly important tool for assessing left ventricular non-compaction phenotype (LVNC). This study aims to analyse left ventricular early diastolic strain rate (eSR) in LVNC and explore its association with CV outcome during long-term follow-up. Methods Fifty-nine patients meeting prespecified criteria were included from our prospective LVNC cohort. eSR was determined using TomTec ImageArena (Figure A). A combined endpoint (cardiovascular events) was defined including atrial flutter/fibrillation, sustained ventricular arrhythmias, aborted cardiac arrest, and cardiovascular mortality. Results Baseline characteristics were comparable between patients reaching the endpoint (16 [27%]) and those without (43 [73%]) except for a higher prevalence of ischemic heart disease in the former (event group: 13%; no-event group: 2%; P=0.019). In the event group, there was a non-significant tendency for a lower LVEF (38 [26–56]% vs 51 [43–56]%; P=0.091) and LVGLS (-12.3 [-16.3 to -9.7]% vs -15.2 [-17.7 to -12.8]%; P=0.111). In contrast, eSR was significantly lower in the event group (0.45 [0.30–0.65]s-1 vs 0.70 [0.39–0.93]s-1; P=0.018; Figure B). Patients with an eSR ≤ 0.70 s-1 (ROC AUC 70%; P=0.005) exhibited a lower event-free probability in Kaplan-Meier survival analysis (P=0.001; Figure C). Inclusion of eSR improved the fitness (ꭓ2) of a multivariable logistic regression model for clinical characteristics (age, gender, and NC:C ratio; Figure D), while LVEF and LVGLS did not (Table). This improvement in ꭓ2 by eSR was significant (ANOVA P=0.033), while that by LVEF or LVGLS was not (P=0.302 and 0.152, respectively). Conclusions eSR was lower in LVNC patients with events, differentiated those with events from those without, and was associated with a higher risk of events during long-term follow-up. Outcome association of eSR was independent of age, gender, and NC:C ratio and improved their event prediction. eSR has potential value for functional characterization and outcome prediction in LVNC.

Atrial fibrillation in patients with hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is associated with complications such as heart failure, atrial fibrillation (AF) and sudden cardiac death. The treatment of AF in HCM patients can be challenging since AF often aggravates symptoms and increases the risk of stroke. Little is known on which factors contribute to the development of AF in these patients. Purpose To determine the incidence of AF in Danish HCM patients and identify risk factors that increase risk of AF. Methods Using Danish national registers all patients without previous AF, aged 16 or older diagnosed with HCM between the 1st of January 2005, and the 31st of December 2018 were included in the analysis. The association between HCM and incident AF was investigated using multivariable Cox proportional-hazard analysis. Cumulative incidence of AF was calculated using the Aalen-Johansen estimator, taking death as a competing risk into account. Results A total of 3,200 HCM patients without prevalent AF were included, median age was 66 years (IQR 55-77) and 48% were female. During the study period, 477 (15%) patients were diagnosed with incident AF. The risk of developing AF was equal between genders and average time from HCM diagnosis to debut of AF was 1260 days. Risk of AF development was increased for patients with prevalent ischemic heart disease (HR 1.33, CI [1.08 – 1. 63]) and hypertension (HR 1.34, CI [1.11 – 1. 63]) as well as for patients classifies as obstructive HCM at diagnosis (HR 1.27, CI [1.06 – 1. 53]). Following AF diagnosis, prescription with oral anticoagulants and antiarrhythmic medication increased markedly. Conclusion AF is a common complication in HCM. Patients with obstructive HCM, hypertension and ischemic heart disease were at increased risk of developing AF.Figure 1:CI of AF by genderFigure 2:HR for AF developement

Abstract 16126: Sex Differences in the Relationship Between Left Ventricular Global Longitudinal Strain and Abnormal Myocardial Flow Reserve in a Patient Population With Sleep Disordered Breathing

Introduction: Obstructive sleep apnea (OSA), a form of sleep disordered breathing (SDB), is associated with abnormal myocardial flow reserve (MFR), a precursor to heart failure with preserved ejection fraction (HFPEF). Sex differences have been reported in the prevalence of abnormal MFR and OSA. However, it is unknown if there are sex differences in the relationship between left ventricular (LV) global longitudinal strain (GLS) and abnormal MFR in a patient population with SDB. Methods: We compared LV GLS among patients in our institution who had sleep testing for obstructive sleep apnea (OSA), cardiac PET stress test and an echocardiogram between 2015 and 2019. We reprocessed the echocardiograms using a vendor neutral software to obtain the two-dimensional LV GLS. Results: Among the 148 participants, 59% were female. Compared with females, males had lower BMIs, a higher prevalence of prior myocardial infarction or revascularization, and a greater severity of nocturnal airway obstruction and hypoxia. Males also had a greater proportion with abnormal LV GLS (≥ -17). See Table. The prevalence of abnormal MFR (&lt; 2.0) was higher among participants with abnormal LV GLS ( P = 0.031). This association was persistent among males but was lost among females (see Figure ). In age and sex adjusted logistic regression persons with abnormal LV GLS had 2X the odds of abnormal MFR (OR 2.3; 95% CI: 1.02 - 5.03). Among males, this association was significant (OR 4.8; 95%CI:1.5 - 13.7). No association observed among females. Formal interaction analyses did not meet statistical significance ( P int = 0.106). Conclusions: In this patient population with SDB, there was a significant association between LV GLS and abnormal MFR. The sex differences in the relationship may be due to differences in the severity of OSA and prevalence of ischemic heart disease. Future studies should clarify these relationships and elucidate the drivers of the sex disparities observed in these findings.

Abstract 15977: Utilizing Admission Bloodwork to Risk Stratify for Acute Kidney Injury in Hospitalized Patients With NSTEMI or Unstable Angina Undergoing Invasive Coronary Angiography± PCI

Introduction: AKI after invasive coronary angiography (CAG) or PCI is common with an estimated incidence of 7-9%. This complication incurs approximately a $9,500 higher cost of stay, with proportional length of stay increases with absolute elevations in serum creatinine (sCr). While the majority of adverse events occur within 30 days of procedure, there is evidence of increased mortality, stroke, and MACE at 1 year and 5 years following index AKI. This study aimed to identify risk factors for AKI in hospitalized NSTEMI and unstable angina undergoing CAG ± PCI. Methods: Patients who were admitted for NSTEMI or UA who underwent CAG from 2011-2022 in Northeast Ohio Cleveland Clinic hospitals were identified from the EMR. Admission and serial blood work results in addition to demographics, past medical history, and hospital course were compiled and analyzed via multivariable logistic regression using R statistical software. KIDAGO definitions of AKI were utilized to define presence of AKI. All patients declared ESRD prior to admission were excluded from analysis. Results: 4,174 cases were included in the analysis with mean age 66.5 years, 63% male, and 81% Caucasian. 7% developed AKI and there was no difference in the proportion of race, gender, or prevalence of ischemic heart disease between those who developed AKI and those who did not. Patients who developed AKI were older (70.9 vs. 66.1 years, p&lt;0.001), and were more likely to have a history of CHF (22.2 vs 10.1%, p&lt;0.0001), CKD (26.3 vs. 9.5%, p&lt;0.001), CVA (22.5 vs 15.3%, p=0.001), and hypertension (66.6 vs 59.4%, p=0.016). Multivariable logistic regression was performed on admission blood work in the presence of known risk factors for AKI, Table 1. Conclusions: In patients admitted with NSTEMI or UA who undergo CAG ± PCI, admission blood work helps identify patients at risk for AKI even in the presence of traditional risk factors such as IABP, age, and history of CKD.

Abstract 17368: Burden of Cardiovascular Diseases in Haiti: Implications for Low-Income Countries

Introduction: Although 80% of global cardiovascular disease (CVD) burden occurs in low- and middle-income countries, data from Black populations in these settings are scarce. We estimated the baseline prevalence of CVD using data from the population-based Haiti Cardiovascular Disease Cohort. Methods: Among urban Haitian adults ≥18 years, we collected data on demographics, health behaviors, psychosocial measures, anthropometrics and clinical exams including imaging and laboratory data at enrollment from 2019-2021. Prevalent cases of CVD were adjudicated using approaches guided by US and international cohorts. Multivariable Poisson regressions assessed relationships between risk factors and prevalent CVD. Results: Among 3,003 participants, median age was 40 years, 58.1% were female, and 70.2% reported income of &lt;$1/day. The most common risk factors were elevated blood pressure (30.4% hypertension, 23.0% prehypertension) and obesity (17.2%). Age-adjusted prevalence of CVD was 14.7% (95%CI 13.3%, 16.5%). Heart failure was the predominant disease with an adjusted prevalence of 11.9% (95%CI 10.5%, 13.5%), followed by stroke (2.4% [95%CI 1.9%, 3.3%]), angina (2.1% [95%CI 1.6%, 2.9%]), MI (1.0% [95%CI 0.6%, 1.8%]), and TIA (0.4% [95%CI 0.2%, 1.0%]). Of all heart failure, 80% had preserved ejection fraction, with a median age of 57 years. Heart failure was associated in a dose-response relationship with hypertension, and with obesity, diabetes, chronic kidney disease, depression, and stress. Conclusions: The burden of CVD in urban Haiti is primarily early-onset heart failure, with low prevalence of ischemic heart disease, challenging current global assumptions. These findings highlightunderscore the urgent need for local population-based epidemiologic data on cardiovascular disease and risk factors to inform health policy, planning and promotion.

Significance of fatty liver index to detect prevalent ischemic heart disease: evidence from national health and nutrition examination survey 1999-2016.

Non-alcoholic fatty liver disease (NAFLD) contributes to the development of ischemic heart disease via multiple mechanisms. Fatty liver index (FLI) has been proposed as an accurate, convenient, and economic surrogate of the severity of NAFLD. Our present study aims to assess the association between FLI and the prevalent IHD and to evaluate the potential value of FLI to refine the detection of prevalent IHD in the general population. Our work recruited 32,938 subjects from the National Health and Nutrition Examination Survey 1999-2016. IHD was diagnosed according to the subjects' self-report. FLI was determined based on triglycerides, BMI, γ-glutamyltransferase, and waist circumference. 2,370 (7.20%) subjects were diagnosed with IHD. After adjustment of age, sex, race, current smoking, current drinking, PIR, BMI, WC, TC, TG, GGT, Scr, FPG, SBP, anti-hypertensive therapy, anti-diabetic therapy, and lipid-lowering therapy, one standard deviation increase of FLI resulted in a 27.0% increment of the risk of prevalent IHD. In the quartile analysis, we observed a 1.684 times risk of prevalent IHD when comparing the fourth quartile with the first quartile, and there was a trend towards higher risk across the quartiles. The smooth curve fitting displayed a linear relationship between FLI and the presence of IHD without any threshold or saturation effect. Subgroup analysis revealed a robust association in conventional cardiovascular subpopulations, and the association could be more prominent in female subjects and diabetes patients. ROC analysis demonstrated an incremental value of FLI for detecting prevalent IHD after introducing it to conventional cardiovascular risk factors (AUC: 0.823 vs. 0.859, P for comparison <0.001). Also, results from reclassification analysis implicated that more IHD patients could be correctly identified by introducing FLI into conventional cardiovascular risk factors (continuous net reclassification index: 0.633, P < 0.001; integrated discrimination index: 0.034, P < 0.001). The current analysis revealed a positive and linear relationship between FLI and the prevalent IHD. Furthermore, our findings suggest the incremental value of FLI to refine the detection of prevalent IHD in the general population.

Study of comorbidities in chronic obstructive pulmonary disease patients at tertiary health care centre in south Gujarat just in the era of Covid-19 pandemic − a cross-sectional study

Background: Chronic obstructive pulmonary disease (COPD) can coexist with other diseases that may significantly impact the disease course. In this study, our aim is to study the prevalence of various extrapulmonary comorbid conditions associated with COPD. Method: This is a cross-sectional study, including all COPD patients presenting to Outpatient Department (OPD) and Inpatient Department (IPD) of Respiratory Medicine Department after meeting the inclusion and exclusion criteria. A COPD patient was defined as a smoker or having exposure to noxious gases, with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) &lt;0.7 and comorbidities were defined based on objective laboratory findings and questionnaires. Comorbidities were identified from patient self-reports and disease-specific lab analysis and medication. Results: Among the 200 patients of COPD, hypertension was found to be the most common comorbidity with a prevalence of 44% followed by diabetes mellitus with a prevalence of 28% and then dyslipidaemia 26.5%. The prevalence of ischemic heart disease (8.5%), depression (16.5%), anemia (16%), osteoarthritis (13%), and chronic kidney disease (9.5%) were other comorbidities among the patients. Smoking is the major culprit with an 80.5% prevalence among the patients. Conclusions: Hypertension was the most common comorbidity in our study population. An increasing number of people in any aging population will suffer from multi-morbidity, defined as the presence of two or more chronic conditions, and COPD is present in the majority of multi-morbid patients. Whether or not COPD and comorbid diseases are related, management of the COPD patient must include the identification and treatment of its comorbidities.

Low-intensity pulsed ultrasound of different intensities differently affects myocardial ischemia/reperfusion injury by modulating cardiac oxidative stress and inflammatory reaction.

The prevalence of ischemic heart disease has reached pandemic levels worldwide. Early revascularization is currently the most effective therapy for ischemic heart diseases but paradoxically induces myocardial ischemia/reperfusion (MI/R) injury. Cardiac inflammatory reaction and oxidative stress are primarily involved in the pathology of MI/R injury. Low-intensity pulsed ultrasound (LIPUS) has been demonstrated to reduce cell injury by protecting against inflammatory reaction and oxidative stress in many diseases, including cardiovascular diseases, but rarely on MI/R injury. This study was designed to clarify whether LIPUS alleviates MI/R injury by alleviating inflammatory reaction and oxidative stress. Simultaneously, we have also tried to confirm which intensity of the LIPUS might be more suitable to ameliorate the MI/R injury, as well as to clarify the signaling mechanisms. MI/R and simulated ischemia/reperfusion (SI/R) were respectively induced in Sprague Dawley rats and human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs). LIPUS treatment, biochemical measurements, cell death assay, estimation of cardiac oxidative stress and inflammatory reaction, and protein detections by western blotting were performed according to the protocol. In our study, both in vivo and in vitro, LIPUS of 0.1 W/cm2 (LIPUS0.1) and 0.5 W/cm2 (LIPUS0.5) make no significant difference in the cardiomyocytes under normoxic condition. Under the hypoxic condition, MI/R injury, inflammatory reaction, and oxidative stress were partially ameliorated by LIPUS0.5 but were significantly aggravated by LIPUS of 2.5 W/cm2 (LIPUS2.5) both in vivo and in vitro. The activation of the apoptosis signal-regulating kinase 1 (ASK1)/c-Jun N-terminal kinase (JNK) pathway in cardiomyocytes with MI/R injury was partly rectified LIPUS0.5 both in vivo and in vitro. Our study firstly demonstrated that LIPUS of different intensities differently affects MI/R injury by regulating cardiac inflammatory reaction and oxidative stress. Modulations on the ASK1/JNK pathway are the signaling mechanism by which LIPUS0.5 exerts cardioprotective effects. LIPUS0.5 is promising for clinical translation in protecting against MI/R injury. This will be great welfare for patients suffering from MI/R injury.