Prevalence Of Ischemic Heart Disease Research Articles

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.

The burden of ischemic heart disease and the epidemiologic transition in the Eastern Mediterranean Region: 1990-2019.

It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.

Short outcome in Patients with Non–ST-Elevation Myocardial Infarction (NSTEMI) after multi-vessel Percutaneous Intervention

Background: Non-ST elevation myocardial infarction (NSTEMI) presents a significant clinical challenge, particularly in the context of multi-vessel disease (MVD), which complicates patient management and impacts prognosis. The variability in short-term outcomes following percutaneous coronary intervention (PCI) for NSTEMI patients with MVD necessitates a deeper understanding of the associated risk factors and outcomes. Objective: To evaluate the risk factors and short-term clinical outcomes of NSTEMI patients after multi-vessel PCI, identifying predictors of major adverse cardiovascular events (MACE) and cardiac death within this population. Methods: This retrospective study was conducted at Lady Reading Hospital, Peshawar, from January 2022 to December 2022, including 100 NSTEMI patients who underwent multi-vessel PCI. The Institute Review Board approved the study, adhering to the Declaration of Helsinki. Data on demographics, clinical characteristics, and outcomes were collected. Multi-vessel disease was defined by ≥50% narrowing in the left main coronary artery or ≥70% in at least two major epicardial coronary arteries. Statistical analysis employed SPSS Version 25.0, with Kaplan–Meier and Cox regression analyses determining the impact of various predictors on short-term outcomes. Results: The mean age of participants was 65.6 ± 10.5 years, with a BMI of 22.75 ± 4.67 kg/m^2. Diabetic and ischemic heart disease prevalence was 30.4% and 26.9%, respectively. Multi-vessel disease was observed in 66.2% of patients. Short-term mortality and MACE rates were significantly influenced by factors such as age, lower BMI, renal dysfunction, and left ventricular dysfunction. The cumulative incidence of MACE within 30 days post-PCI was notably higher in patients with these risk factors. Conclusion: NSTEMI patients undergoing multi-vessel PCI face a significant risk of short-term adverse outcomes. Key predictors of increased risk include advanced age, diabetes, ischemic heart disease, and renal dysfunction. Tailored management strategies focusing on these high-risk groups are essential for improving short-term prognosis.

Abstract P3122: Rap1gap2 Fine-mapping For Causal Variants Of Prevalent Ischemic Heart Disease Among Diverse Postmenopausal Women From The Women’s Health Initiative

Background: RAP1GAP2 is a GTP-ase activating protein that regulates secretion of dense granules from platelets at sites of endothelial damage, eliciting maximal platelet aggregation, a hallmark of ischemic events. Our published sex-stratified GWAS significantly associated RAP1GAP2 (Chr 17p13.3) variants with ischemic heart disease (IHD) case status and increased mortality risk among women but not men. We hypothesize that RAP1GAP2 genetic variation may demonstrate causal effects for the increased risk of IHD case status among postmenopausal women. Purpose: To fine-map RAP1GAP2 to identify causal markers for risk of IHD case status among racially and ethnically diverse postmenopausal women. Methods: We performed secondary analysis of 8,699 postmenopausal women from the Women’s Health Initiative (Observational cohort) who have publicly available genome-wide and densely imputed genotype data via NIH/dbGap (Affymetrix Affy 6.0). IHD case status was defined as prevalence of myocardial infarction, stroke, angina, congestive heart failure, peripheral arterial disease, or atherosclerotic interventional procedures at or prior to baseline; non-IHD controls were absent of all IHD criteria. PCA and Efficient Local Ancestry Inference (ELAI) were used to infer global and SNP-wise local ancestries. For each SNP, we performed SNP-wise logistic regression modeling, calibrating for the confounding effects of local and global ancestries and controlling for major cardiac risk factors, hormone replacement and cardiac medication exposure, IHD type (obstructive, nonobstructive), eGFR, education, income, and occupation. Results: Mean age 64.08 (±7.74) for a sample of 3,125 (36%) non-Hispanic Whites, 3,841 (44%) African Americans and 1,733 (20%) Hispanic Americans. We observed 1,932 IHD cases and 6,767 non-IHD controls. Novel PCA and ELAI uncovered strong spatial global population structure, varying ancestries, and ancestry-genotype correlations across genomic regions. Fine mapping analyses are underway and results will be available at time of presentation. Conclusions: Identifying sex- and ancestry-related causal genetic factors can serve as future targets for precision prevention of IHD among postmenopausal women.

The role of IL-6, and IL-12+p40 in Ischemic heart disease patients

Background: Ischemic heart disease (IHD) is often termed coronary artery disease or coronary heart disease; because it is usually caused by atherosclerosis that occurs when fatty materials and a substance called a plaque are built up on the walls of coronary arteries. Such consequences lead to a narrowing of these arteries and then blood flow can slow down or stop, causing chest pain, shortness of breath, heart attack and other related symptoms.&#x0D; Objectives: To investigate the correlation between Ischemic heart disease and patient’s descriptive data such as gender, age, and to evaluate the role of two cytokines IL-6 and IL-12+p40 in the aetiology of IHD, as well as to observe the relationship of IL-6 , IL-12+p40 and two related diseases diabetes mellitus and hypertension in IHD patients.&#x0D; Methodology: A total of 70 (55 males and 15 females) patients with ischemic heart disease (IHD; stable angina) were included in the study. They were admitted to the Coronary Care Unit (CCU) at Ibn-Al-Betar Hospital (Baghdad) for a surgical operation during the period July 2022 - April 2023. The diagnosis was made by the consultant medical staff at the hospital. In addition to the patients, a total of 20 apparently healthy individuals (control group), with no history of cardiovascular diseases, were included in the study for the purpose of comparison with patients, they were age- and gender matched with patients. five ml of peripheral blood were obtained by venipuncture from each patient before surgical operation using 5 ml disposable syringe, the blood was drawn in a plain tube (without anti-coagulant). Serum levels of IL-6 and IL-12+p40 were quantitatively determined in patients and control subjects by means of indirect sandwich ELISA test.&#x0D; Results: Thirty patients from total IHD patients were observed to have diabetic mellitus, and the frequency in males was more than in females (73.3 vs. 26.7%), twenty two IHD patients were observed to have hypertension in percentage higher in males than in females (77.3 vs. 22.7%). The results obtained from this study about age group distributions of IHD patients with diabetic are higher in 60 and more age group in percentage (63.3%) , as well as in hypertensive patients in percentage (68.2%). Serum levels of IL-6 for total patients are (404.8 pg/ml), diabetic (480.3 pg/ml), non-diabetic (250.8 pg/ml), hypertensive (451.6 pg/ml) and non-hypertensive (322.2 pg/ml), patients showed a significant increased serum level of IL-6 as compared to controls (155.7 pg/ml). The diabetic patients also showed a significantly higher level than non-diabetic patients (480.3 vs. 250.8 pg/ml), as well as, hypertensive patients (451.6 pg/ml) versus non-hypertensive patients (322.2 pg/ml). Serum level of IL-12+p40 for total patients (410.2 pg/ml), diabetic (357.7 pg/ml), non-diabetic (458.1 pg/ml), hypertensive (270 pg/ml) and non-hypertensive (420.5 pg/ml) patients showed a significant decreased level of IL-12+p40 as compared to controls (649.3 pg/ml). In contrast, the non-diabetic patients showed a significantly higher level than diabetic patients (458.1 vs. 357.7 pg/ml), as well as, non-hypertensive patients (420.5 pg/ml) versus hypertensive patients (270.0 pg/ml).&#x0D; Conclusion: The prevalence of IHD according to age are increased in older aged patients, the male show high infected percentage than female. Chronic diseases like hypertension and diabetes mellitus were contributed to the pathogenesis of IHD, and proinflammatory cytokine cascades play crucial roles in the onset and progression of IHD.&#x0D; Recommendations: Targeting cytokines in an attempt to develop pharmacological activators of some interleukins, and inhibitors of other ones, and this may provide effective means to control atherosclerosis and associated diseases (i.e. diabetes mellitus and hypertension).&#x0D; Keywords: IL-6, IL-12+p40, IHD

The Burden of Ischemic Heart Disease Among Adults 70 Years and Older in Iran, 1990-2019

Objectives: To report the ischemic heart disease (IHD) burden and its risk factors among adults aged 70 and older in Iran in terms of sex, at both the national and provincial levels, from 1990 to 2019. Design: Systematic analysis. Outcome Measures: The modelled point prevalence of IHD, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) were reported using data obtained from the Global Burden of Disease (GBD) 2019 study, as counts and standardized rates, along with their related 95% uncertainty intervals (UIs). Results: In 2019, IHD had a point prevalence of 52886.4 per 100000 population for adults aged 70 and above in Iran, which was 7.5% higher than that in 1990, and a death rate of 1932.9, which was 22.0% lower than that in 1990. In 2019, the number of DALYs attributed to IHD was 820.4 thousand with a rate of 23630.9, which was 33.7% lower than that in 1990. Furthermore, Golestan and Tehran with rates of 32484.6 and 12752.5 had the largest and smallest DALY rates in those aged 70 and above in Iran, respectively. The highest point prevalence, death, and DALY rates for both sexes, were found in the 95+age group. In 2019, the Iran DALY rate was lower than the Middle East and North Africa region rate in all age groups in males and females, except for the 90-94 and 95+age groups in females. Nationally, systolic blood pressure (SBP) (47.8%), low-density lipoprotein (LDL) cholesterol (36.2%), and fasting plasma glucose (FPG) (35.3%) had the three highest attributable DALYs. Conclusions: Currently, the burden of IHD in Iran is considered a pressing public health issue, indicating the urgent need for effective public health interventions. Further investigations are, therefore, needed to discover causes for the high prevalence of IHD in the country and to develop better strategies for effective prevention and controlling it.