Prevalent CVD Research Articles

Detecting cardiovascular diseases using unsupervised machine learning clustering based on electronic medical records

BackgroundElectronic medical records (EMR)-trained machine learning models have the potential in CVD risk prediction by integrating a range of medical data from patients, facilitate timely diagnosis and classification of CVDs. We tested the hypothesis that unsupervised ML approach utilizing EMR could be used to develop a new model for detecting prevalent CVD in clinical settings.MethodsWe included 155,894 patients (aged ≥ 18 years) discharged between January 2014 and July 2022, from Xuhui Hospital, Shanghai, China, including 64,916 CVD cases and 90,979 non-CVD cases. K-means clustering was used to generate the clustering models with k = 2, 4, and 8 as predetermined number of clusters k = 2, 4, and 8. Bayesian theorem was used to estimate the models’ predictive accuracy.ResultsThe overall predictive accuracy of the 2-, 4-, and 8-classification clustering models in the training set was 0.856, 0.8634, and 0.8506, respectively. Similarly, the predictive accuracy of the 2-, 4-, and 8-classification clustering models in the testing set was 0.8598, 0.8659, and 0.8525, respectively. After reducing from 19 dimensions to 2 dimensions by principal component analysis, significant separation was observed for CVD cases and non-CVD cases in both training and testing sets.ConclusionOur findings indicate that the utilization of EMR data can support the development of a robust model for CVD detection through an unsupervised ML approach. Further investigation using longitudinal design is needed to refine the model for its applications in clinical settings.

Morbidity and Mortality Risk Among People With Human Immunodeficiency Virus and Central or Visceral Adiposity: A Targeted Literature Review.

Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH). Comprehensive targeted literature searches were conducted in Medline/Embase (27 June 2022), identifying peer-reviewed articles and conference abstracts reporting on cohorts of PWH. Screening was guided by PECOS (Population, Exposure, Comparator, Outcomes, Study design) criteria. From the included studies, outcomes of interest including mortality and morbidity risk by VAT area and WC were extracted, overall, and by sex, race/ethnicity, and duration of HIV. Relationships between outcome and exposure variables were summarized. Thirty-five studies were included (sample size range: 31-1748 PWH). Twenty-five studies characterized the relationship between increased WC and negative health outcomes-cardiovascular disease (CVD), arteriosclerosis, hypertension, diabetes, hepatic fat and fibrosis, and cognitive impairment-among PWH. Fifteen studies reported on increased VAT and negative health outcomes: all-cause mortality, CVD, atherosclerosis, hepatic fat, and fibrosis. Importantly, there was a 2.1-times higher odds of 5-year all-cause mortality among PWH with the highest amount of VAT in the only study identified reporting on mortality. Among the studies characterizing the relationship between morbidity and VAT, for example, 1 found that, for each 10-cm2 increase in VAT, the risk of prevalent CVD increased by 1.05 (95% CI: 1.0-1.1) times. WC may be a useful and cost-effective surrogate for visceral adiposity, which is an important marker of morbidity and mortality among PWH.

Abstract 4128250: Healthier Lifestyle is Associated with Better Arterial Health in People without Prevalent Cardiovascular Disease

Background: Higher arterial stiffness contributes to atherogenesis and arterial calcification, resulting in cardiovascular morbidity and mortality. Research Question: The relations of lifestyle, measured by the AHA Life’s Essential 8 (LE8), with arterial health (AH) and CVD outcomes are incompletely understood. Aims: To examine the association of LE8 with AH and extent to which carotid-femoral pulse wave velocity (PWV) mediates the association of LE8 with outcomes in a sample free of CVD. Methods: In 3 Framingham Heart Study cohorts, we studied the relations of LE8 (total score and components) with AH, assessed by arterial stiffness (PWV, by tonometry) and coronary calcification score (CAC, by computed tomography) using multivariable-adjusted linear regression (p<0.01 considered significant after Bonferroni correction). We evaluated the extent to which PWV mediates the association of LE8 with outcomes using Cox proportional hazards regression models (p<0.05 considered significant). Results: We studied 5222 participants, aged 50±15 years, 56% women. Characteristics of the sample are presented in Table . Higher LE8 score (better cardiovascular health) was associated with more favorable AH measures (PWV inverse transformed, standardized; CAC log(CAC+1); all β±SE, x10 -3 ): β PWV =-14.4±0.7, β CAC= -51.9±7.8, both p<0.01). Of the LE8 components, BMI (β PWV =-1.53±0.31), BP (β PWV =-9.74±0.36), fasting glucose (β PWV =2.03±0.45), lipids (β PWV =-1.54±0.31, β CAC =-16.14±3.30) and smoking (β CAC =-17.9±2.8) were the greater contributors to AH (all p<0.01). PWV mediated modest degrees of the associations between LE8 and CHD, HF, CVD, and CVD mortality [ Figure ]. Conclusions: In people without prevalent CVD, healthier lifestyle was associated with better AH. Arterial stiffness mediates the association between lifestyle measures and CHD, HF, CVD, and CVD-mortality. Our results support studying lifestyle interventions to improve arterial health and their benefits for CVD outcomes.

Abstract 4138647: Opportunistic Screening for Cardiovascular Risk Using Chest X-Rays and Deep Learning: Associations with Coronary Artery Disease in the Project Baseline Health Study and Mass General Brigham Biobank

Introduction/Background: We previously demonstrated that an open-source deep learning model (CXR-CVD Risk) can predict 10-year major adverse cardiovascular events (myocardial infarction&stroke), based on a chest radiograph image (CXR). As deep learning models are black boxes, establishing the biological processes the model captures to predict risk may help build understanding and trust in the model. Research Questions/Hypothesis: To test associations between deep-learning derived CXR-CVD Risk and markers of cardiovascular disease including coronary artery calcium (CAC) and stenosis ≥50% on CT, systolic blood pressure (SBP), ankle brachial index (ABI), and prevalent myocardial infarction and stroke. Methods/Approach: We conducted external validation of CXR-CVD-Risk in two cohorts: 1) 2,097 volunteers in the Project Baseline Health Study (PBHS) and 2) 1,644 Mass General Brigham Biobank (MGBB) patients. The CXR-CVD-Risk model estimated 10-year cardiovascular event risk (probability between 0 and 1) from a CXR image. We calculated linear associations with SBP, ABI, and the logarithm of coronary artery calcium and odds ratios for prevalent hypertension, myocardial infarction, stroke, and, in the MGBB, coronary artery stenosis ≥50%. Analyses were adjusted for age, BMI, sex, smoking status, and enrolling site. Results/Data: CXR-CVD-Risk was associated with CAC in both populations (PBHS: 1.11-fold increase, 95% CI: [1.07-1.16]; MGBB: 1.03-fold increase [1.01-1.05] in CAC per 1% increase in CXR-CV-Risk). CXR-CVD-Risk was also associated with SBP (0.59 mmHg increase [0.24-0.93] in SBP per 1% increase in CXR-CV-Risk), history of hypertension, history of myocardial infarction, and stroke. There was an inverse association with ABI (0.010 decrease [0.005-0.014] in ABI) in the PBHS. In the MGBB, CXR-CVD-Risk was associated with coronary artery stenosis ≥50% (OR = 1.004 [1.002-1.007]). All estimates are after covariate adjustment. Conclusion: This deep learning CXR risk score was associated with coronary artery disease (calcium score and stenosis ≥50%), CVD risk factors, and prevalent CVD. Opportunistic screening using CXRs in the electronic record can identify patients at high risk of CVD who may benefit from prevention.

Abstract 4133257: Circulating Ketone Bodies, Lipoprotein(a) and Incident Cardiovascular Outcomes and Mortality: Insights from The UK Biobank

Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Recent epidemiological studies have revealed an association between ketone bodies (KB) and adverse cardiovascular outcomes, offering a unique insight into metabolic health and its impact on mortality risk. Elevated levels of both Lp(a) and KB may synergistically amplify pathological processes, including endothelial dysfunction, inflammation, and oxidative stress, through their involvement in shared pathophysiological pathways, thereby exacerbating disease progression beyond the impact of each biomarker individually. Methods: Utilizing data from the UK Biobank, KB were measured by nuclear magnetic resonance spectroscopy and serum Lp(a) concentrations were measured using an immunoturbidimetric assay. Four groups were created as follows: Group 1: Lp(a)<125 nmol/L and Total KB<75 th percentile (<94 μmol/L); Group 2: Lp(a)≥125 nmol/L and Total KB<75 th percentile; Group 3: Lp(a)<125 nmol/L and Total KB≥75 th percentile; and Group 4: Lp(a)≥125 nmol/L and Total KB≥75th percentile. Multivariable-adjusted Cox proportional hazard models were used to examine the association of Lp(a) and total KB with incident cardiovascular outcomes and mortality. Results: A total of 72,704 UK Biobank participants (mean age 56 y, SD=8, 55% women) without prevalent CVD or HF with a median follow up of 13.4 years were included. In the fully adjusted model, compared with those in the reference group (Group 1), participants in Group 2, Group 3, and Group 4 demonstrated a 14%, 17%, and 38%, increased risk of incident ASCVD events, respectively (p<0.01 for all). However, those with Lp(a) ≥ 125 nmol/L and total KB < 75th percentile demonstrated no increased risk of HF, all-cause mortality, stroke, or CVD mortality. Participants with elevated levels of both Lp(a) and KB had significantly increased risk of all outcomes (Table). There was no evidence for a statistically significant interaction between Lp(a) and KB on any outcome. Conclusion: Consistent with prior literature, Lp(a) was associated with atherosclerotic outcomes. However, elevated KB was associated with all outcomes, irrespective of Lp(a) levels.

Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis.

This study examined the association of estimated heel bone mineral density (eBMD, derived from quantitative ultrasound) with: (1) prevalent and incident cardiovascular diseases (CVDs: ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), non-ischemic cardiomyopathy (NICM), arrhythmia), (2) mortality (all-cause, CVD, IHD), and (3) cardiovascular magnetic resonance (CMR) measures of left ventricular and atrial structure and function and aortic distensibility, in the UK Biobank. Clinical outcomes were ascertained using health record linkage over 12.3yr of prospective follow-up. Two-sample Mendelian randomization (MR) was conducted to assess causal associations between BMD and CMR metrics using genetic instrumental variables identified from published genome-wide association studies. The analysis included 485 257 participants (55% women, mean age 56.5±8.1yr). Higher heel eBMD was associated with lower odds of all prevalent CVDs considered. The greatest magnitude of effect was seen in association with HF and NICM, where 1-SD increase in eBMD was associated with 15% lower odds of HF and 16% lower odds of NICM. Association between eBMD and incident IHD and MI was non-significant; the strongest relationship was with incident HF (SHR: 0.90 [95% CI, 0.89-0.92]). Higher eBMD was associated with a decreased risk in all-cause, CVD, and IHD mortality, in the fully adjusted model. Higher eBMD was associated with greater aortic distensibility; associations with other CMR metrics were null. Higher heel eBMD is linked to reduced risk of a range of prevalent and incident CVD and mortality outcomes. Although observational analyses suggest associations between higher eBMD and greater aortic compliance, MR analysis did not support a causal relationship between genetically predicted BMD and CMR phenotypes. These findings support the notion that bone-cardiovascular associations reflect shared risk factors/mechanisms rather than direct causal pathways.

Relationship of device measured physical activity type and posture with cardiometabolic health markers: pooled dose–response associations from the Prospective Physical Activity, Sitting and Sleep Consortium

Aims/hypothesisThe aim of this study was to examine the dose–response associations of device-measured physical activity types and postures (sitting and standing time) with cardiometabolic health.MethodsWe conducted an individual participant harmonised meta-analysis of 12,095 adults (mean ± SD age 54.5±9.6 years; female participants 54.8%) from six cohorts with thigh-worn accelerometry data from the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. Associations of daily walking, stair climbing, running, standing and sitting time with a composite cardiometabolic health score (based on standardised z scores) and individual cardiometabolic markers (BMI, waist circumference, triglycerides, HDL-cholesterol, HbA1c and total cholesterol) were examined cross-sectionally using generalised linear modelling and cubic splines.ResultsWe observed more favourable composite cardiometabolic health (i.e. z score <0) with approximately 64 min/day walking (z score [95% CI] −0.14 [−0.25, −0.02]) and 5 min/day stair climbing (−0.14 [−0.24, −0.03]). We observed an equivalent magnitude of association at 2.6 h/day standing. Any amount of running was associated with better composite cardiometabolic health. We did not observe an upper limit to the magnitude of the dose–response associations for any activity type or standing. There was an inverse dose–response association between sitting time and composite cardiometabolic health that became markedly less favourable when daily durations exceeded 12.1 h/day. Associations for sitting time were no longer significant after excluding participants with prevalent CVD or medication use. The dose–response pattern was generally consistent between activity and posture types and individual cardiometabolic health markers.Conclusions/interpretationIn this first activity type-specific analysis of device-based physical activity, ~64 min/day of walking and ~5.0 min/day of stair climbing were associated with a favourable cardiometabolic risk profile. The deleterious associations of sitting time were fully attenuated after exclusion of participants with prevalent CVD and medication use. Our findings on cardiometabolic health and durations of different activities of daily living and posture may guide future interventions involving lifestyle modification.Graphical

Omega-3 Blood Levels and Stroke Risk: A Pooled and Harmonized Analysis of 183 291 Participants From 29 Prospective Studies.

The effect of marine omega-3 PUFAs on risk of stroke remains unclear. We investigated the associations between circulating and tissue omega-3 PUFA levels and incident stroke (total, ischemic, and hemorrhagic) in 29 international prospective cohorts. Each site conducted a de novo individual-level analysis using a prespecified analytical protocol with defined exposures, covariates, analytical methods, and outcomes; the harmonized data from the studies were then centrally pooled. Multivariable-adjusted HRs and 95% CIs across omega-3 PUFA quintiles were computed for each stroke outcome. Among 183 291 study participants, there were 10 561 total strokes, 8220 ischemic strokes, and 1142 hemorrhagic strokes recorded over a median of 14.3 years follow-up. For eicosapentaenoic acid, comparing quintile 5 (Q5, highest) with quintile 1 (Q1, lowest), total stroke incidence was 17% lower (HR, 0.83 [CI, 0.76-0.91]; P<0.0001), and ischemic stroke was 18% lower (HR, 0.82 [CI, 0.74-0.91]; P<0.0001). For docosahexaenoic acid, comparing Q5 with Q1, there was a 12% lower incidence of total stroke (HR, 0.88 [CI, 0.81-0.96]; P=0.0001) and a 14% lower incidence of ischemic stroke (HR, 0.86 [CI, 0.78-0.95]; P=0.0001). Neither eicosapentaenoic acid nor docosahexaenoic acid was associated with a risk for hemorrhagic stroke. These associations were not modified by either baseline history of AF or prevalent CVD. Higher omega-3 PUFA levels are associated with lower risks of total and ischemic stroke but have no association with hemorrhagic stroke.

Abstract 18587: Factors Associated With Changes in High Sensitivity Troponin and NT-proBNP in Response to Intensive Blood Pressure Lowering in SPRINT

Background We have recently shown that intensive SBP lowering was associated with a modest increase in hscTnT and a decrease in NT-proBNP. In the present study, we sought to compare the independent determinants of changes in biomarkers in intensive vs. standard SBP lowering in SPRINT. Methods: Hs-cTnT and NT- proBNP were measured at baseline, 1-year, and 2-year from stored specimens. Biomarker changes were analyzed according to categories (≥50% increase, ≥50% decrease, and &lt;50% change). The impact of intensive SBP lowering on changes in biomarkers levels was assessed using multivariable-adjusted multinomial logistic regression models in standard and intensive SBP lowering separately. Results: Of 9,361 SPRINT participants, we measured cTnT and NT-proBNP in 8,828 (baseline), 7,887 (year 1), and 7,463 (year 2) free of CVD events. Among individuals with detectable hscTnT at baseline (≥6 ng/L), a 50% increase in hscTnT was observed in 4.5% (year 1) and 6.7% (year 2). Among individuals with baseline NT-proBNP ≥125 pg/mL, a 50% increase in NT-proBNP was observed in 16.7% (year 1) and 21.1% (year 2). Overall, a similar pattern of associations was observed with both biomarkers across treatment groups (see Figure). Several exceptions were noted. Prevalent CVD was associated with an increase in both NT-proBNP and hscTnT in the standard SBP lowering arm but not in the intensive SBP lowering arm. Higher baseline hscTnT was associated with an increase in hscTnT only in the standard arm. Furthermore, we observed biomarker-specific differences. For example, white race, female sex, and blood pressure were consistently associated with an increase in NT-proBNP. In contrast, declining renal function and male sex were associated with increasing hscTnT. Conclusion Factors associated with changes in biomarkers varied by treatment assignment and between biomarkers. These findings highlight the role of noncardiac factors on biomarker changes in the context of intensive SBP lowering.

Association of marine PUFAs intakes with cardiovascular disease, all-cause mortality, and cardiovascular mortality in American adult male patients with dyslipidemia: the U.S. National Health and Nutrition Examination Survey, 2001 to 2016

BackgroundThe relationship between marine polyunsaturated fatty acid (PUFA) intake and cardiovascular disease and mortality in dyslipidemic patients is unclear. Men with dyslipidemia have a higher risk of cardiovascular disease than women, and PUFA supplementation may be more beneficial in men.ObjectiveThe purpose of this study was to assess the relationship between different types of marine polyunsaturated fatty acids intakes and cardiovascular disease, all-cause mortality, and cardiovascular mortality in adult U.S. males with dyslipidemia.MethodsThe study ultimately included 11,848 adult men with dyslipidemia who were screened from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2016. This was linked to the 2019 National Death Index (NDI) records to establish a prospective cohort. In the study, a logistic regression model was established to assess the relationship between PUFA intake and prevalent CVD, and a Cox proportional hazards regression model was established to assess the relationship between PUFA intake and death.ResultsIn the fully adjusted models, compared with participants in the lowest tertile, participants with the highest DPA intake were associated with a lower risk of CVD (CVD: OR = 0.71, 95%CI: 0.55, 0.91; angina: OR = 0.54, 95%CI: 0.38, 0.79; stroke: OR = 0.62, 95%CI: 0.43, 0.89), but not with three subtypes of congestive heart failure, coronary heart disease, and myocardial infarction. And the highest tertile level of DPA intake can reduce all-cause mortality (HR = 0.77, 95%CI: 0.64, 0.91) and CVD mortality (HR = 0.68, 95%CI: 0.52, 0.90).ConclusionsCardiovascular disease risk, all-cause mortality, and CVD mortality were inversely associated with dietary DPA intake but not EPA and DHA intakes in U.S. male participants with dyslipidemia.

Cumulative social disadvantage and cardiovascular disease burden and mortality.

To investigate the association between cumulative social disadvantage and cardiovascular burden and mortality in a large cohort of the general population. Cross-sectional (n = 15 010, aged 35 to 74 years, baseline investigation period 2007 to 2012) and longitudinal data (5- and 10-year follow-ups from 2012 to 2022) from the Gutenberg Health Study were used to investigate the association between individual socioeconomic status (SES, measured via a validated questionnaire) and cardiovascular disease (CVD, composite of atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and/or venous thromboembolism) risk and mortality. Subjects with prevalent CVD had a lower SES sum score, as well as lower education, occupation, and household net-income scores (all P < 0.0001). Logistic regression analysis showed that a low SES (vs. high, defined by validated cut-offs) was associated with 19% higher odds of prevalent CVD [odds ratio (OR) 1.19, 95% CI 1.01; 1.40] in the fully adjusted model. At 5-year follow-up, low SES was associated with both increased cardiovascular [hazard ratio (HR) 5.36, 2.24; 12.82] and all-cause mortality (HR 2.23, 1.51; 3.31). At 10-year follow-up, low SES was associated with a 68% higher risk of incident CVD (OR 1.68, 1.12; 2.47) as well as 86% higher all-cause mortality (HR 1.86, 1.55; 2.24). In general, the education and occupation scores were stronger related to risk of CVD and death than the household net-income score. Low SES was estimated to account for 451.45 disability-adjusted life years per 1000 people (years lived with disability 373.41/1000 and years of life lost 78.03/1000) and an incidence rate of 11 CVD cases and 3.47 CVD deaths per 1000 people per year. The population attributable fraction for CVD incidence after 5 years was 4% due to low SES. Despite universal healthcare access, cumulative social disadvantage remains associated with higher risk of CVD and mortality. Dimensions of education and occupation, but not household net income, are associated with outcomes of interest.

Combining serum metabolomic profiles with traditional risk factors improves 10-year cardiovascular risk prediction in people with type 2 diabetes.

To identify a group of metabolites associated with incident cardiovascular disease (CVD) in people with type 2 diabetes and assess its predictive performance over-and-above a current CVD risk score (QRISK3). A panel of 228 serum metabolites was measured at baseline in 1066 individuals with type 2 diabetes (Edinburgh Type 2 Diabetes Study) who were then followed up for CVD over the subsequent 10 years. We applied 100 repeats of Cox least absolute shrinkage and selection operator to select metabolites with frequency >90% as components for a metabolites-based risk score (MRS). The predictive performance of the MRS was assessed in relation to a reference model that was based on QRISK3 plus prevalent CVD and statin use at baseline. Of 1021 available individuals, 255 (25.0%) developed CVD (median follow-up: 10.6 years). Twelve metabolites relating to fluid balance, ketone bodies, amino acids, fatty acids, glycolysis, and lipoproteins were selected to construct the MRS that showed positive association with 10-year cardiovascular risk following adjustment for traditional risk factors [hazard ratio (HR) 2.67; 95% confidence interval (CI) 1.96, 3.64]. The c-statistic was 0.709 (95%CI 0.679, 0.739) for the reference model alone, increasing slightly to 0.728 (95%CI 0.700, 0.757) following addition of the MRS. Compared with the reference model, the net reclassification index and integrated discrimination index for the reference model plus the MRS were 0.362 (95%CI 0.179, 0.506) and 0.041 (95%CI 0.020, 0.071), respectively. Metabolomics data might improve predictive performance of current CVD risk scores based on traditional risk factors in people with type 2 diabetes. External validation is warranted to assess the generalizability of improved CVD risk prediction using the MRS.

Abstract P362: Racial Disparities in Cardiovascular Disease Mortality: Mediation by Socioeconomic Factors and Statin Use (The ELSA-Brasil Study)

Background: Statins are an effective strategy to reduce CVD risk, however, treatment goals are not achieved especially among Blacks and “Pardos” in Brazil. Hypothesis: Socioeconomic differences and lack of statin treatment for primary CVD prevention can explain part of the elevated mortality risk of Blacks and “Pardos”. Methods: Data from the ELSA-Brasil cohort (15,105 civil servants, from 6 state capital cities), excluding Asians, Indigenous, those with prevalent CVD and missing information about race or statin use. Race was self-reported as Black, “Pardo” or White. Brazilian guidelines at baseline (2008) were used to define those eligible for statin treatment. Cox survival analysis determined the risk of CVD mortality for Black and “Pardo” compared to White (adjusted by age, sex, hypertension, diabetes, LDL-c, BMI and smoking). We used inverse odds ratio weighting technique to calculate mediation for socioeconomic factors (SEF) (education, income, and having health insurance) and statin use when indicated to determine the natural direct and indirect effects of race on CVD mortality. We estimated the percent mediation as the percent change between β coefficients with and without weights applied. Results: Among the 13,396 individuals, the mean age was 52±9 years, 55.2% were women, 54.2% were White, and 10.2% were taking statins. Adjusted Black and “Pardo”/White CVD mortality HR was 1.91 (CI 95% = 1.30-2.81, p&lt;0,001). The direct effect of race on CVD mortality when considering the weight of SEF was 1.37 (CI 95% = 0.86-2.19) and considering the weight of statin use was 2.01 (CI 95% =1.36-2.98). SEF explained 51.5% (CI 95% = 17.0-60.2) and not using statins when indicated explained 7.8% (CI 95% = 4.2-23.3) of the racial inequality observed in CVD mortality risk (Table 1). Conclusions: The higher Black and “Pardo”/White CVD mortality risk is primarily explained by racial differences in SEF. Not using statins when there is indication for treatment increases in about 8% the CVD mortality risk for Blacks and “Pardos” compared to Whites.

Abstract P421: Eggs as Part of a Healthy Eating Pattern Are Not Adversely Associated With Dyslipidemia in the Framingham Offspring Study

Background: For decades, dietary guidelines have recommended restricting egg consumption out of concern about the high content of dietary cholesterol and potential effects on LDL cholesterol levels and, in turn, cardiovascular risk. However, the evidence supporting these recommendations has been increasingly questioned. Objective: To examine the association of egg consumption with plasma lipid levels and risk of dyslipidemia in adults in the Framingham Offspring Study, and to determine whether these effects are modified by other dietary factors. Methods: We included 1,852 adults aged 30-64 years with available 3-day food records, and without prevalent CVD or use of lipid-lowering or glucose-lowering medications. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of elevated fasting LDL-C and triglycerides after adjusting for confounding. Analysis of covariance models were used to estimate sex-specific mean plasma levels of total cholesterol, LDL, the ratio of LDL:HDL, and triglycerides associated with categories of egg intake. Confounding factors retained in the final models included age, BMI, and other dietary factors. Stratified analyses were used to evaluate effect modification by several dietary factors. Findings: Over approximately 6 years of follow-up, 372 adults developed new-onset elevated LDL and 306 adults developed new-onset elevated triglycerides levels. Overall, those with higher egg consumption (vs. lower) had very similar intakes of other healthy foods at baseline (e.g., whole grains, fruits, vegetables, dairy, and fish). Men and women consuming ≥5 eggs per week (vs. &lt;0.5) had no increased risk of elevated LDL (HR=0.85, 95% CI: 0.59-1.22) or triglycerides (HR=1.25, 95% CI: 0.83-1.86). In fact, men with higher egg intakes (≥5 vs. &lt;0.5 per week) had a total cholesterol level that was 8.6 mg/dL lower, an LDL level that was 5.9 mg/dL lower, and a log-transformed triglyceride level that was 0.13 units lower (p&lt;0.05 for all differences) after 4 years of follow-up. Further, participants with higher egg consumption in combination with higher fiber intake had lower levels of all lipids (p&lt;0.05 for total cholesterol, LDL, and LDL:HDL for the category of higher egg &amp; higher fiber vs. lower egg &amp; lower fiber). Moreover, consumption of &gt;5 eggs/week (vs. &lt;0.5) combined with either higher intakes of total fish or fiber was also associated with statistically significant reductions in LDL levels. Conclusions: This study suggests that higher egg intakes had no adverse effects on serum lipids in healthy adults and may be beneficial as part of a healthy eating pattern.

Cardiovascular risk indicators among depressed persons: A special case?

BackgroundTraditional cardiovascular risk indicators only partially explain cardiovascular risks in depressed persons. Depressed persons may exhibit a profile of cardiovascular risk indicators that goes beyond traditional cardiovascular risk indicators, such as symptom severity, insomnia, loneliness and neuroticism, yet research on the added value of these depression-related characteristics in predicting cardiovascular risks of depressed persons is scarce. MethodsData from N = 1028 depressed Dutch adults without prevalent CVD were derived from two longitudinal depression cohort studies. The outcome was medication-confirmed self-reported CVD. Fifteen depression-related clinical and psychological characteristics were included and tested against traditional cardiovascular risk indicators. Data were analysed using Cox regression models. Incremental values of these characteristics were calculated using c-statistics. ResultsAfter a median follow-up of 65.3 months, 12.7% of the participants developed CVD. Only anxiety and depressive symptom severity were associated with incident CVD beyond traditional cardiovascular risk indicators. The c-statistic of the model with traditional cardiovascular risk indicators was 85.47%. This increased with 0.56 or 0.33 percentage points after inclusion of anxiety or depression severity, respectively. LimitationsOther relevant depression-related characteristics were not available in the datasets used. ConclusionAnxiety and depressive symptom severity were indicative of an increased cardiovascular risk. Including these as additional risk indicators barely improved the ability to assess cardiovascular risks in depressed persons. Although traditional cardiovascular risk indicators performed well in depressed persons, existing risk prediction algorithms need to be validated in depressed persons.

A Prospective Observational Study on Medication Use Management and Prevalence of Cardiovascular Disease with Comorbidities in a Tertiary Care Hospital

Background and Aim Medication use management involves a set of regulations and analytical techniques for defining comprehending and assessing medicine prescription distribution and consumption and also evaluating measures to improve the efficacy of these processes. The present study aimed to assess the medication use pattern prevalence and comorbidity conditions associated with cardiovascular diseases CVD.Methods A prospective observational study was conducted for a duration of six months in the inpatient medicine department of Chigateri District hospital Davangere Tertiary care teaching hospital. Two hundred four case reports of patients with CVD were reviewed and details such as demographics specified drugs prescribed Health Related Quality of Life HRQOL were recorded.Result Two hundred four patients were enrolled out of which 57.35 were males and 42.65 were females. Most of the patients were in the age range of 58-67 years. The most prevalent CVD treated was hypertension HTN 28.23 and the most common comorbidity associated was HTN 32.17. Social habits like smoking 13.75 and HTN 16.92 were found to be the most frequent associated risk factors in CVD patients. The most commonly prescribed class of drugs was antiplatelet 28.41 the common prescribed drug was Furosemide 13.39 and Fixed Dose Combination FDC was Ecosprin gold Atorvastatin Clopidogrel Aspirin 35.29. Most of the prescriptions showed polypharmacy 84.31. While assessing the HRQOL physical component summary PCS 56.94 and mental component summary MCS 54.24 were in a modest range.Conclusion The most prevalent type of CVD was HTN. HTN and DM were the prevalent comorbid conditions among the study population. In the study polypharmacy was noted which may have an impact on rationality. Statins and antiplatelet use was appropriate however excessive use of Furosemide must be controlled. Proper prescription writing increases patient treatment compliance which promotes reason.

Abstract 10145: Cardiovascular Disease Risk and Outcomes Among Veterans by Sexual Orientation

Introduction: Lesbian, gay, and bisexual (LGB) adults have CVD risk and outcome inequities compared to heterosexual peers. With upwards of 7 million sexual minority adults aged &gt;50 by 2030, assessing and addressing their cardiovascular health is critical for clinicians and public health practitioners. However, few electronic health record (EHR) cohorts have been used to study this association. Methods and Results: In this analysis, we used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender EHR cohort, excluding transgender individuals to avoid conflating sexual orientation with gender identity. The baseline date was the first primary care appointment on or after October 1, 2009. Sexual orientation of 1,108,990 veterans was identified via a natural language processing tool with 88.2% sensitivity, 91.5% specificity, and 85.9% PPV; 185,788 veterans were classified as LGB. Prevalent CVD (history of AMI, ischemic stroke, or revascularization in the year preceding the baseline date) was present among 19,887 veterans (4,684 LGB). We calculated sample statistics stratified by sex and sexual minority status; results are displayed in the Table . We used logistic regression analyses to assess the association between sexual minority status and prevalent CVD. Adjusting for age, sex, race, and Hispanic ethnicity, LGB veterans had 1.12 [1.16, 1.24] times the odds of prevalent CVD compared to non-sexual minority veterans. Upon additional adjustment for BMI, diabetes, hypertension, lipids, substance use, anxiety, and depression, this association remained significant (OR [95% CI]: 1.08 [1.04, 1.12]). Conclusion: This is one of the first studies to examine cardiovascular health within a veteran population stratified by sexual orientation. Addressing the cardiovascular health of marginalized populations requires further exploring the mechanisms by which stress results in CVD risk and outcomes and the inequitable distribution of both.

Tackling cardiovascular prevention after coronary disease settled: the challenges of guideline implementation

Funding AcknowledgementsType of funding sources: None.PurposeCardiovascular disease (CVD) as it is known, is a multifactorial disease that needs to be addressed exactly in that way. Knowledge deficit regarding symptoms and unadjusted lifestyles are still the most relevant nursing diagnoses identified as main causes for readmissions in patients with CVD (1). Recent guidelines evidenced that after a CVD event, patients should attend to their lifestyle choices and health behaviors, in order to avoid future events, as this works in a cardioprotective way (2). Having programs structured in a way that makes it possible to involve both population and person-centered strategies all teamed up, could be a way of involving patients in their own care, tackling several recommendations at the same time. Our aim is to describe the implementation of a cardiovascular disease prevention program with a multidisciplinary approach and identify the most prevalent CVD risk factors during the first trimester of its implementation.MethodsIn order to improve patient outcomes post-discharge, the program was outlined as follows: firstly. a Multidisciplinary Appointment was structured, with a Cardiologist and a Nurse, where also family is invited, to assess risk factors, therapeutic adherence and quality of life. According to the patient's needs and preferences they can be assigned to the Cardiac Rehabilitation Lab, to the Education Group Sessions on CVD risk factors where a Nutritionist, Psychiatrist and Physiatrist also participate according to the sessions' topic. For more personalized approach it also comprises: Therapeutic Groups and Mental Health Appointment; Nutrition Appointment; and Nursing Counseling at Outpatient clinics for family and person-centered approach. To assess the program at its third month baseline the focus group method was used for patients and professionals perspectives.ResultsThe program was implemented from October to December 2021. During that time 24 patients were admitted. Nursing Counseling was needed for almost all patients for different reasons. Out of those, 50% were assigned to the group sessions, 33.33% were assigned to the Cardiac Rehab, 12.5% were oriented to the Nutrition consults and 20,83% to the Mental Health consults. Even though we offered therapeutic groups as an option for some patients, none of them were willing to go. Regarding the modifiable risk factors, 70% of patients had 3 or more risk factors, showing that we do have a high risk population to tackle. Putting it into perspective, the most prevalent risk factors were dyslipidemia (70.83%), tobacco use (70.83%), obesity (54.17%) and hypertension (50%).ConclusionsManaging a multidisciplinary program can be demanding, and there were several challenges to this program’s implementation such as: short-staffing, structural issues, covid-19 prevention issues, digital systems, agendas, etc.). But focusing on patients' needs and preferences, helped us to do our utmost to make this program happen.

Prevalence of cardiovascular disease risk factors in urban and rural areas of Hyderabad, Sindh, Pakistan

Background: CVDs are a major public health concern in Pakistan. The major CVD risk factors are age, gender, obesity, hypertension, hyperglycemia and hyperlipidemia. However, prevalence and risk factors associated with population of urban and rural Hyderabad are unexplored. This study was set up to study CVD among population of Hyderabad. Methodology: This cross-sectional study was carried out on 304 participants living in the urban and rural areas of Hyderabad, Pakistan. Out of 304, 161 were men and 143 were women with age range from 30 to 70 years. Data was collected through interview based questionnaire. Weight and height were measured for calculation of BMI. Systolic Blood pressure (SBP) and Diastolic Blood Pressure (DBP) was measured using sphygmomanometer. Biochemical analysis was carried out for the assessment of Fasting Blood Sugar (FBS), Triglycerides (TG), Total Cholesterol (TC) and Low density Lipoproteins (LDL) using standard kit methods. Ethical consent obtained before collection of data. SPSS version 22 was used for statistical analysis. Results: Hyperlipidemia was highly prevalent CVD risk factor particularly increased LDL 61.2%, followed by hypertension 46.8%, Obesity 14.8% and hyperglycemia 8.8%. Except hyperlipidemia, which was higher in women 63.6%, men had higher prevalence of obesity 17.4%, hypertension 48.4% and hyperglycemia 9.3%. Participants from urban area had higher prevalence of hypertension 47.3%, hyperglycemia 9.7% and hyperlipidemia 62.4%. However, Obesity was slightly higher 16.6% in rural population. Conclusion: This study indicates Men had higher prevalence of CVD risk factors, and according to geographic location, urbanized population based higher prevalence of CVD risk factors.

Atrial fibrillation and 13-year risk of CVD mortality in Russian population cohort

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The study was supported by RFBR #20-313-90015, RAS # АААА-А17-117112850280-2 Introduction Given the worldwide increase in life expectancy, ageing-related conditions are becoming increasingly important. Atrial fibrillation (AF) is the most common arrhythmia and a serious predictor of the progression of heart failure and thromboembolic events (largely, stroke). Thus, the study of AF impact on cardiovascular (CVD) mortality is of particular relevance. Objectives We aimed to analyze the impact of AF on the 13-year risk of CVD mortality in the Russian population sample of elderly age. Methods A random population sample (n=9360, age 45-69 years) was examined at baseline in 2003-2005 in the Russian arm of the HAPIEE project. The cohort was re-examined twice and was followed up for end points up to end of 2017 (12.7 years on the average). Fatal end-points were ascertained by local mortality register; the current study focused on CVD deaths. Baseline AF was defined by rest ECG with evaluation by the Minnesota code (MC 8-3-1, 8-3-2; 6-8 with "fibrillation" for atrium). Those with prevalent CVD at baseline and with inadequate ECGs were excluded from analysis; Cox-regression age- and multivariable-adjusted models were estimated. Results In total, data on 8565 persons aged 45-69 years at baseline were analyzed. Among those, 145 (1.6%) subjects had AF at baseline and of those 100 subjects had no existing CVD. During the 13-year follow-up, there were 431 cases of CVD death (10.9%) in the cohort, among them 63% (n=272) were fatal coronary heart disease (CHD) and 23% (n=101) were fatal stroke (2.5%). In age-adjusted models, men with baseline AF had increased risk of CVD death (HR=5.76; 95%CI 3.88-8.55), fatal stroke (HR=6.26; 95%CI 2.96-13.22), and fatal CHD (HR=5.86; 95%CI 3.58-9.59). After adjusting for other risk factors, the increased risk remained for all CVD outcomes: 4.49 (95%CI 2.84-7.09) for CVD death, 3.62 (95%CI 1.46-8.96) for fatal stroke, and 4.95 (95%CI 2.81-8.70) for fatal CHD. In women, the age-adjusted HR for CVD death in women with baseline AF was 3.92 (95%CI 1.60-9.62) but in fully-adjusted models the HR was attenuated (HR=2.22; 95%CI 0.87-5.70). The numbers of deaths from CHD and stroke in women were too small for meaningful analyses. Conclusion In this urban population-based cohort of subjects free from CVD at baseline, 11% of participants died from CVD death during 13 years follow-up. Men and women with baseline AF had approximately 4-fold increase in CVD mortality risk. The estimated CVD excess mortality risk associated with AF in this Russian cohort is consistent with findings from Western European and North American populations.