Cardiovascular Risk Prevention Research Articles

App-based intervention for cardiovascular and diabetes risk awareness and prevention

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Centre for Primary Health Care and Equity, University of New South WalesAustralian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Background Cardiovascular disease and type 2 diabetes mellitus are highly prevalent worldwide. They have similar risk factors, and people with diabetes have a two- to threefold increased risk of myocardial infarction and stroke. Many of the risk factors are lifestyle related. Hence, behaviour change interventions have the potential to decrease the risk for cardiovascular disease and type 2 diabetes mellitus. Purpose We aimed to develop and evaluate an app-based intervention for the primary prevention of cardiovascular disease and type 2 diabetes mellitus. Methods We developed our app using the methodology by Tombor and colleagues for the development of digital behaviour change interventions. We used the Behaviour Change Wheel and embedded 12 behaviour change techniques. The three core modules of the app consisted of i) risk scores for 5-year cardiovascular disease and type 2 diabetes mellitus; ii) goal setting and tracking functions for smoking, alcohol intake, diet, and physical activity; and iii) education about the diseases and risk factors. With the app prototype, we conducted usability testing via an iterative approach. We interviewed the participants and used their feedback to improve the app design. Next, we conducted a feasibility study with the new version to assess whether participants would use the app over three months. We were interested in drop-out from the intervention, adherence to app use, and usability of the app. We received ethics approval for both studies and written consent from all participants. Results The usability testing consisted of two rounds. For each round, we had five participants who were on average 57 years old. In the first round, three participants experienced a technical error that stopped them from completing the registration. From those who were able to register, five rated the app as above average according to the System Usability Scale. Overall, the participants found the app easy to use and indicated that they were interested to use it frequently. We included some additional features based on the preferences of the participants in the usability testing. For the feasibility study, we recruited 47 participants aged 45 years and older who were free of cardiovascular disease and type 2 diabetes mellitus at baseline, with a balanced distribution of age (45-64 years and ≥65 years) and gender. From those participants, four withdrew from the study immediately after providing consent and the remainder continued using the app for varying periods of time. Conclusions We ensured that the app is based on the theory of behaviour change and scientific evidence. We used a stepwise approach to improve the app design and to test the feasibility of the intervention. The next step will be to develop a framework for a larger trial that implements the intervention into the existing healthcare setting and investigates its effectiveness.

The Impact of Flavonols on Cardiovascular Risk.

Cardiovascular disease (CVD) is the leading cause of deaths globally. The main target for prevention of cardiovascular (CV) risk are lifestyle changes, including particular dietary recommendations, involving high intake of fruits and vegetables. Flavonols are a subgroup of flavonoids—compounds present in fruits, vegetables, and tea—known for their antioxidative properties. There are many findings about the beneficial impact of flavonols on general CV risk and its factors, but mainly from in vitro and animal model studies. This paper summarizes data from human studies about flavonols’ impact on general CV risk and its factors. A high dietary intake of flavonols could decrease CVD mortality directly or through impact on selected CV factors; however, available data are inconsistent. Nonetheless, specific groups of patients (smoking men, hypertensive and diabetic patients) can potentially benefit from selected dietary modifications or flavonols (quercetin) supplementation. Future investigations about kaempferol and myricetin are needed.

MO244: PCSK9 Inhibitors are Efficient in Treatment of Resistant Hypercholesterolemia in Nephrotic Syndrome

Abstract BACKGROUND AND AIMS Hypercholesterolemia in nephrotic syndrome is commonly resistant to statin therapy and represents an important clinical challenge both for cardiovascular risk prevention and to eliminate lipotoxic effect on podocytes. Serum PCSK9 level is elevated in nephrotic syndrome and has a key pathophysiologic role in development and persistance of hyperlipidemia. Thus, we aimed to investigate the role of PCSK9 inhibitors in control of hypercholesterolemia in patients with neprotic syndrome. METHOD Consecutive patients with nephrotic syndrome and elevated atherogenic Lp (a) (n = 4) and patients with resistant secondary glomerulonephritis with nephrotic proteinuria (n = 2) were included. In all patients, in addition to full dose statin therapy, evolocumab 420 mg s.c. monthly was introduced. Lipid levels were measured after a median of 4 (range 2–9) months after starting evolocumab. RESULTS Nephrotic syndrome was caused by focal segmental glomerulosclerosis in four patients (66.7%) and membranous nepropathy was the cause in two patients (33.3%). Median age of included patients was 49.5 (range 24–70) years. Four patients with primary cause of glomerulonephritis received specific imunosupressive treatment. During follow-up, we observed descrease in glomerular filtration rate (eGFR median 58.5 interquartile range (IQR) [46.7–98.7] mL/min/1.73 m2 versus median 47 IQR [38.25–89.25] mL/min/1.73 m2; P = .046) and persistence of proteinuria [median 11 970 IQR (3862–13 765) mg/dU versus median 10 847 (5407–14 340) mg/dU; P = .753]. However, despite persistent proteinuria and decrease in eGFR, significant decrease in total cholesterol [median 9.10 IQR (6.92–10.87) mmol/L versus median 6.81 (5.4–8.45) mmol/L; P = .028] and LDL cholesterol [median 5.40 IQR (4.12–7.25) versus median 4.04 IQR (2.70–4.60); P = .046] was observed. There was no significant difference in Lp (a) and triglyceride levels. CONCLUSION PCSK9 inhibitors are a promising new therapeutic option for hyperlipidemia in patients with nephrotic syndrome. Further research, including a larger number of patients, is needed to correctly position PCSK9 inhibitors in treatment of hyperlipidemia in patients with nephrotic syndrome.

An Update on Etiology of Chronic Kidney Disease with Role of Associated Vitamin K Deficiency in Prevention of Vascular Calcification and Cardiovascular Risks and Avoid Mortality: A Minireview

An Update on Etiology of Chronic Kidney Disease with Role of Associated Vitamin K Deficiency in Prevention of Vascular Calcification and Cardiovascular Risks and Avoid Mortality: A Minireview

Presence of asymptomatic Peripheral Arterial Disease in combination with common risk factors elevates the cardiovascular risk Substantially

Background and aimsThis study evaluates the risks for adverse cardiovascular (CV) events in Asymptomatic Peripheral Arterial Disease (APAD) combined with different traditional CV risk factors. MethodsA population-based observational study of 8000 subjects, identified 559 subjects as having APAD through ankle-brachial index (ABI) measurements and questionnaires regarding limb symptoms. This cohort and subgroups classified by presence of different traditional CV risk factors at baseline were assessed for 10 years on CV outcome. The recorded endpoints were all-cause mortality, CV mortality and non-fatal CV events. ResultsBefore subdividing the APAD subjects, the CV mortality incidence was 28.5 deaths per 1000 person-years as compared to 8.7 deaths for references without APAD. For subjects with hypertension at baseline the CV mortality incidence was 35.4 when combined with APAD and 11.7 without. In women with hypertension but without other risk factors, presence of APAD increased the age-adjusted Hazard Ratio (HR) for fatal and non-fatal CV events by 1.86 [CI 1.54,2.24, p < 0.001]. ConclusionsABI measurements should be considered an important indication for aggressive multifactorial risk factor reduction in populations with any other prevalent CV risk factor. In hypertension, diabetes mellitus and a smoking history, coexisting APAD contributes significantly to the increased age-adjusted CV risk.

Editor comment: Focus on cardiovascular risk stratification and prevention.

Editor comment: Focus on cardiovascular risk stratification and prevention.

Effects of GLP-1RAs on cardiovascular outcomes in patients with type 2 diabetes mellitus: review of real-world data on target populations from diabetes registry in Russian Federation

RATIONALE. Over the past 20 years the prevalence of type 2 diabetes in Russia has more than doubled and reached 4.43 million people in 2020, while the growth rate keeps increasing. Most patients with T2DM are at a higher risk of developing major adverse cardiovascular events (MACE) associated with significant mortality. There is a strong evidence base that the drugs belonging to GLP-1RA class contribute to reducing the risk of cardiovascular events and renal outcomes. At the same time, the current prescribing rates of these treatments in Russia are quite low - only about 0.1% of patients are prescribed GLP-1RAs, according to Diabetes Registry data.AIM. Review the results of several randomized clinical trials (RCTs) concerning effects of GLP-1RA treatments on prevention of primary and secondary cardiovascular events and estimate the number of diabetic target population.MATERIALS AND METHODS. We examined the data from clinical trials on GLP-1RA treatments registered in Russia and used in routine clinical practice (ELIXA, EXSCEL, LEADER, SUSTAIN-6 and REWIND) and data from two meta-analyzes published as of December 1, 2020. The task was to evaluate the inclusion criteria, patient profile, and the clinical efficacy and safety profiles of the studied therapies. Also, the analysis of clinical information from the Diabetes Registry (DR) was performed to estimate the number of target T2DM patients meeting RCTs inclusion criteria that could benefit from prescribing of GLP-1RAs.RESULTS. The reviewed clinical trials demonstrated a statistically significant reduction (p &lt;0.05) in the risk of serious cardiovascular events in patients treated with Liraglutide [RR 0.87 (95% CI, 0.78-0.97)], Semagltuide [OP 0.74 (95% CI 0.58-0.95)] and Dulaglutide [RR 0.88 (95% CI 0.79-0.99)]. Meta-analyzes utilizing data from 6 RCTs with the total number of 56,004 T2DM patients, also, confirmed a statistically significant reduction in the risk of developing MACE (by 12%) in the studied population, and a 17% reduction in the risk of combined renal outcomes [RR 0.83 (95% CI 0.78-0.89), p &lt;0.0001]. The DR patient population that met the RCTs inclusion criteria amounted to 538.6 thous. subjects in case of REWIND and 432.4 thous. in case of LEADER and SUSTAIN-6. The key differences between FDR patients and patients engaged in RCTs included gender and age characteristics. The DR patients were generally older and the bulk of them were women, which has to do with overall Russian demographic trends. The proportion of DR patients with established CVD was 26%, which closely matched the profile of patients from REWIND study (31.5%). According to DR data, the number of patients in whom the treatment was intensified following prescription of basal insulin was 7612 per year, which is close to a potential cohort eligible for alternative treatment with GLP-1RAs.CONCLUSION. All the drugs belonging to GLP-1RA class are clinically effective in reducing the risk of cardiovascular and renal outcomes, while demonstrating a favorable safety profile including with respect to lower risk of developing hypoglycemia. The decreased risk of complications was recorded both in patients with existing cardiovascular risks and patients with established CVD. Of all GLP-1RA treatments available in Russia at this point, the greatest clinical effectiveness is achieved by Liraglutide, Semaglutide and Dulaglutide. The estimated patient population from DR, meeting RCTs inclusion criteria and matching RCTs patient profile was over 500, 000 people with the largest number of patients meeting the REWIND criteria. The target population of patients with T2DM who may potentially benefit from the administration of GLP-1RAs is over 500, 000 people. Out of that number at least 7.5 thousand are patients, whose treatment is intensified following prescription of basal insulin (with an aim of improving glycemic control, but without consideration of cardiovascular risks).Currently, if we take the real world clinical setting in Russia, the number of patients receiving GLP-1RA treatments is substantially lower than the estimated figures (less than 1%), which requires reconsideration of the approach toward their prescribing as is recommended by state-of-the-art clinical guidelines prioritizing prevention of cardiovascular risks.

Multiple Sclerosis and the Risk of Cardiovascular Diseases: A Mendelian Randomization Study.

BackgroundObservational studies suggested that multiple sclerosis (MS) is associated with cardiovascular diseases (CVDs). However, the causal association has not been fully elucidated. Thus, we aim to assess the causality of the associations of MS with risk of CVDs.MethodsA two-sample Mendelian randomization (MR) study was performed to explore the causality. Genetic instruments were identified for MS from a genome-wide association study (GWAS) involving 115,803 individuals. Summary-level data for CVDs were obtained from different GWAS meta-analysis studies. MR analysis was conducted mainly using the inverse-variance weighted (IVW) method. Sensitivity analyses were further performed to ensure the robustness of the results.ResultsThis MR study found suggestive evidence that genetic liability to MS was associated with an increased risk of coronary artery disease (CAD) [odds ratio (OR), 1.02; 95% confidence interval (CI), 1.00–1.04; p = 0.03], myocardial infarction (MI) (OR, 1.03; 95% CI, 1.00–1.06; p = 0.01), heart failure (HF) (OR, 1.02; 95% CI, 1.00–1.04; p = 0.02), all-cause stroke (AS) (OR, 1.02; 95% CI, 1.00–1.05; p = 0.02), and any ischemic stroke (AIS) (OR, 1.02; 95% CI, 1.00–1.05; p = 0.04). The null-association was observed between MS and the other CVDs. Further analyses found little evidence of pleiotropy.ConclusionsWe provided suggestive genetic evidence for the causal associations of MS with increased risk of CAD, MI, HF, AS, and AIS, which highlighted the significance of active monitoring and prevention of cardiovascular risk to combat cardiovascular comorbidities in MS patients.

Metabolic syndrome and cardiovascular risk assessed by Framingham’s score: A study with soldiers of the military police of the State of Bahia, Brazil

Being a man is considered a risk factor for illness and death from cardiovascular causes; men in general have a lower life expectancy than women and higher mortality from all causes not related to sex in all age groups. The military policemen profession is recognized as full of stress and has high levels of professional victimization. Military Police Corporations are mostly formed by men, and the study of the health of the military policemen can be considered equivalent activity to the study of the health of men. This present study is part of the first author’s doctoral thesis work whose theme was focused on the health of men; it was studied a convenience sample of 452 soldiers, selected by personnel administration by working time criterion, to submit to Corporals Training Course. It was sought to characterize the cardiovascular risk factors and prevalence of metabolic syndrome; cardiovascular risk was also assessed by applying the Framingham’s score; it was found a high prevalence of cardiovascular risk factors in the studied group, with emphasis on hypertension (52.55%) and hypertriglyceridemia (46.34%), the metabolic syndrome was diagnosed in 35.03%. Cardiovascular risk by Framingham’s score showed strata of medium and high risk more frequent in individuals with metabolic syndrome than in those without the syndrome. The risk of a cardiovascular event in 10 years in the group with middle and high level of risk was also more frequent among individuals in the older (= or&gt; 45 years) than in the younger group (&lt;45 years). It is concluded that there’s a high prevalence of cardiovascular risks in the studied group, and that there’s a need for continued attention directed to integral health care of men in the military police corps.

Preliminary results of the "DUO" observational study: Quality of life assessment and cross-sectional follow-up of prostate cancer patients treated with degarelix.

62 Background: The use of androgen deprivation therapy (ADT), has increased over time in the treatment of prostate cancer (PCa). ATD is accompanied by side effects, some of which may increase the cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of cardiovascular risks and quality of life at the initiation of degarelix, a GnRH antagonist, and 6 months later, in patients with advanced hormone-sensitive PCa. Methods: The DUO study is a PASS, pharmaco-epidemiologic, longitudinal, multicenter observational study. It prospectively enrolled PCa patients during the first 6 months of treatment with degarelix. cohort to describe the prevalence of real-life cardiovascular co-morbidities in. The study was carried out in 46 French urology centers. At D0 and M6, the prevalence of CV, osteoporotic, metabolic, mood disorder, geriatric and sexual morbidity and risk factors were recorded using validated tools and questionnaires. EQ-5D questionnaire measured quality of life. The evolution of the disease (PSA levels) and the tolerance of the treatments were also reported. Results: A total of 124 patients with advanced hormone-dependent PCa (of whom 26.6% were metastatic) were included. At D0 57.7% of patients had a CV morbidity and CV risk factors. Metabolic co-morbidities were also present in 60.6% of patients, osteoporotic risk factors in 34%, sexual disorders in 58%, and mood disorders in 36%. ONCO-G8 score ≤ 14 was observed in 45.6% of patients aged ≥ 70 years. The percentage of patients with CV co-morbidities remained stable (56.7%). The rates of osteoporotic, metabolic, sexual, and mood-related morbidity and risk factors also remained unaltered. Likewise, quality of life remained stable between D0 and M6 (Scores: 0.765 and 0.813 respectively). At the same time, the median PSA rate decreased by -98.4% from D0 (p &lt; 0.001). 42 adverse events (AEs) were reported in 22 patients: degarelix-related AEs were reported in 4.4% of patients. Conclusions: The results of the DUO study showed high prevalence of CV co-morbidity and risk factors in patients with advanced PCa. It also showed no significant increase in CV co-morbidities and risk-factors during the first 6 months of treatment with degarelix as it was observed for osteoporotic, metabolic, sexual, and mood-related disorders. The GnRH antagonist was well tolerated without major impact on quality of life. Assessment of multiple co-morbidities at the initiation and during ADT is mandatory for the optimal management of patients.

Sex Differences in Cardiovascular Risk Associated With Long-Term PM2.5 Exposure: A Systematic Review and Meta-Analysis of Cohort Studies.

BackgroundEstablished evidence suggests risks of developing cardiovascular disease are different by sex. However, it remains unclear whether associations of PM2.5 with cardiovascular risk are comparable between women and men. The meta-analysis aimed to examine sex differences in associations of ischemic heart disease (IHD) and stroke with long-term PM2.5 exposure.MethodsPubMed, EMBASE and Cochrane Library were searched until May 2, 2021. We included cohort studies reporting sex-specific associations of long-term PM2.5 exposure (e.g., ≥1 year) with IHD and stroke. The primary analysis was to estimate relative risk (RR) of PM2.5-outcome in women and men separately, and the additional women-to-men ratio of RR (RRR) was explored to compare sex differences, using random-effect models.ResultsWe identified 25 eligible studies with 3.6 million IHD and 1.3 million stroke cases among 63.7 million participants. A higher level of PM2.5 exposure was significantly associated with increased risk of IHD in both women (RR = 1.21; 95% CI, 1.15–1.27) and men (RR = 1.12; 95% CI, 1.07–1.17). The women-to-men RRR of IHD was 1.05 (95% CI, 1.02–1.08) per 10 μg/m3 increment in PM2.5 exposure, indicating significant excess risk of IHD in women. The significant risks of stroke associated with PM2.5 were obtained in both women (RR = 1.11; 95% CI, 1.08–1.13) and men (RR = 1.11; 95% CI, 1.07–1.14), but no significant women-to-men RRR was observed in stroke (RRR = 1.00; 95% CI, 0.96–1.04).ConclusionsThe study identified excess risk of IHD associated with long-term PM2.5 exposure in women. The findings would not only have repercussions on efforts to precisely evaluate the burden of IHD attributable to PM2.5, but would also provide novel clues for cardiovascular risk prevention accounting for sex-based differences.

Abstract WP215: Population Attributable Risks For Potentially Modifiable Risk Factors Of Cerebrovascular And Cardiovascular-related Mortality In The National Health And Nutrition Examination Survey

Introduction: Stroke and heart disease are leading causes of mortality in the United States. We studied population attributable risks (PARs) for potentially modifiable stroke and cardiovascular-related mortality risk factors in the National Health and Nutrition Examination Survey (NHANES)-National Death Index (NDI) linked dataset. Methods: Adult NHANES participants surveyed from 1999-2014 with linked NDI data were included in this sample-level analysis. The primary outcome was death secondary to stroke (ischemic or hemorrhagic) or cardiovascular disease as recorded in NDI. Exposures were behavioral, environmental, clinical, and laboratory variables dichotomized at the sample median collected in NHANES. Missing data were imputed. PARs were calculated using adjusted hazard ratios from Cox proportional models. Results: We included 47,356 participants (median age 46 years [IQR 30-64]; 51.8% female; 261 stroke- and 1,112 cardiac-related deaths, 2.9%). Mean follow-up time was 97.2 months (SD 54.4 months). Among men &lt; 65 years, characteristics with the top 3 PARs were elevated cholesterol (PAR 42%), elevated systolic blood pressure (PAR 30%), and low platelet count (PAR 23%) (Table 1). Among women &lt; 65 years, not using food label nutritional fact panels (PAR 29%), prescription medication use (PAR 34%), and an elevated white blood cell count (PAR 27%) were the top 3 risk factors by PAR. Among men ≥ 65 years, not using food label nutritional fact panels (PAR 32%), elevated systolic blood pressure (PAR 22%), and cigarette smoking (PAR 20%) were the top 3 factors by PAR. Among women ≥ 65 years, not using food label nutritional fact panels (17%), elevated cholesterol (29%), and elevated creatinine (22%) were the top 3 risk factors by PAR. Conclusions: We provide age- and sex-specific adjusted PARs of potentially modifiable risk factors of stroke and cardiovascular-related mortality. These findings may inform targeted stroke and cardiovascular risk prevention strategies.

A Review of Cardiac Manifestations in Patients With Systemic Lupus Erythematosus and Antiphospholipid Syndrome With Focus on Endocarditis.

Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) are at a higher risk for adverse cardiovascular events associated with increased morbidity and mortality. The increased risk of these events is often associated with rheumatic heart disease (heart valve or mural endocardium damage from rheumatic fever) following microbial infection (i.e., untreated or under-treated streptococcal infection). In particular, the weakening of cardiac vasculature due to rheumatic heart disease makes such patients with autoimmune diseases more susceptible to endocarditis. Endocarditis can be caused by an infection (infective endocarditis) or inflammation tied to disease activity (non-bacterial thrombotic endocarditis [NBTE]). Infective endocarditis among patients with autoimmune diseases may result from exposure to pathogens during dental or surgical procedures. NBTE commonly occurs as a result of fibrin and platelet aggregation on the cardiac valves without bacterial infection. While diagnosis and management can vary based on underlying etiology, an interdisciplinary approach that includes prevention and management from dentists, cardiologists, rheumatologists, and primary care physicians is needed. In addition, increasing patient and physician education on risk factors and prevention strategies is much needed. This manuscript will review the pathophysiology of endocarditis, the association between SLE and APS and endocarditis risk, the diagnosis and management of these autoimmune diseases with a focus on the prevention of cardiovascular disease risk, and make recommendations for diagnostic and management approaches to improve care.

Analysis of Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons With Psoriatic Disease

Patients with psoriatic disease are at increased risk of cardiovascular disease (CVD), which is a leading cause of mortality in this population. However, many of these patients do not have an active relationship with a primary care physician, and there may be a role for specialist-led care in prevention of CVD. To explore clinician and patient perspectives regarding strategies to improve CVD prevention via specialist-led care. Using electronically collected surveys, a best-worst scaling experimental survey study was conducted among dermatologists through the National Psoriasis Foundation as well as the American Academy of Dermatology from October 27, 2020, to April 1, 2021, to rank the strategies according to their potential to improve CVD prevention among patients with psoriatic disease. Participants were asked about the feasibility of specialist-led screening through an electronically delivered survey from the National Psoriasis Foundation conducted between February 1 and April 21, 2021. Patients with psoriatic disease were asked about whether they would like the specialist to screen for CVD risk factors. In addition, patients reported their likelihood to engage in CVD risk screening and management behaviors in scenarios in which either the primary care physician or specialist was making the recommendations. For the clinician surveys, the primary outcome was the ratio scaled preference score (range, 0-100; higher is more preferred), as well as whether they think calculating a 10-year CVD risk score and prescribing statins seems feasible. For the patient surveys, the primary outcome was the likelihood to check cholesterol level, incorporate diet and exercise, or use statin therapy depending on whether recommended by the specialist or primary care physician, whether they would like their specialist to educate them about CVD risk, and whether they would find it convenient to have their cholesterol level checked by their specialist. Among 183 dermatologists (102 [55.7%] women; mean [SD] age not collected), clinical decision support (preference score, 22.3; 95% CI, 20.7-24.0), patient education (preference score, 14.1; 95% CI, 12.5-15.7), and clinician education (preference score, 15.8; 95% CI, 14.3-17.3) were ranked as strategies likely to improve CVD prevention in patients with psoriatic disease. In addition, 69.3% (95% CI, 62.2%-76.0%) of dermatologists agreed or strongly agreed that checking lipid levels was feasible. Among 160 patients with psoriasis and 162 patients with psoriatic arthritis (226 [70.2%] women; mean [SD] age, 54 [13.3] years), patients reported they were as likely to engage in cardiovascular risk screening and management behaviors whether recommended by their primary care physician or their specialist. In addition, 60.0% (95% CI, 52.0%-67.7%) of patients with psoriasis and 75.3% (95% CI, 67.9%-81.7%) of those with psoriatic arthritis agreed that it would be convenient for them to have their cholesterol checked by their dermatologist/rheumatologist. In this survey study, dermatologists and patients with psoriatic disease expressed positive perspectives about engaging in a specialist-led model of care to improve CVD prevention. Dermatologists appear to view several strategies as having potential to improve cardiovascular risk prevention.

Lipid Profile in a Cohort of Patients Aged between 3 and 18 with Type 1 Diabetes. Correlation with Homologous Age Range of the General Population

Type 1 diabetes mellitus (T1D) accounts for approximately 5-10% of all diagnosed cased of diabetes. Diagnosis generally occurs in subjects under 30 years of age and of normal weight. The International Diabetes Federation (IDF) estimates that there are 600,900 children under the age of 15 years living with T1D worldwide [1]. The cause of T1D remains unknown. There is clear evidence of a genetic predisposition and strong, but circumstantial, evidence for environmental factors triggering an autoimmune destruction of the beta cells leading to absolute dependence on insulin treatment. Acute complications are the leading cause of death in people with T1D under the age of 30 [2]. Chronic complications in the pediatric setting are not frequent; however latent structural or functional alterations may be present as early as a few years after the onset of the disease [3]. Childhood and adolescence therefore represent a period of time during which intense education and careful monitoring are able to prevent or delay the onset and progression of complications. The ESC-EASD 2019 guidelines emphasize that in general T1D confers an excess of risk of out-come of CV events (coronary heart disease, ischemic stroke and vascular death) that is twice as high [4]. As part of the prevention of medium and long-term cardiovascular risk, it is essential to perform the complete lipid profile in young diabetics, at least annually, with intensification of checks in the event of unsatisfactory results. The goals of this study were to compare lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride) of a group of pediatric patients with T1D, aged between 3-18 years, treated at the Day Hospital of Endocrinology of the Complex Structure of Pediatrics and Neonatology Asl 2, center of Savona, San Paolo Hospital, with as many aged patients 3-18 years who have been hospitalized in the same Structure.

Lower grip strength values are associated with increased levels of adiposity and excess weight: a cross-sectional study

Objective: physical fitness (particularly the muscular strength component) is one of the most powerful markers of health. However, few studies have described the relationship of the higher adiposity phenotype with muscular strength in Latino schoolchildren. The aim of the present study was to determine the association between levels of handgrip strength (HGS) with different anthropometric markers. The central hypothesis of this study was that lower HGS values are associated with a higher adiposity phenotype in a sample of schoolchildren and adolescents. Research methods and procedures: a descriptive cross-sectional study was carried out in 6 public schools in Bogotá, Colombia, with a final sample of 430 participants (55.8 % women) between 9 and 17.9 years of age. Handgrip strength (HGS) was assessed with a handheld dynamometer, and normalized as HGS per body mass (i.e., [grip strength in kg)/(body mass in kg]). Tertiles of normalized HGS were obtained separately for both sexes and high HGS was defined as higher tertile (T3). Waist-to-height ratio, body mass index, and skinfold thickness were measured as adiposity parameters. Results: the mean (SD) age of participants was 13.2 (1.4) years. Significant inverse correlations were found between normalized HGS, waist-to-height ratio, body mass index, and skinfold thickness (range, r = -0.40 to -0.61; p < 0.001). Regardless of sex, participants with low HGS (below the first tertile) had the highest values of waist-to-height ratio, body mass index, and skinfold thickness after adjusting for age. Conclusion: muscular strength was inversely associated with a higher adiposity phenotype. HGS could have protective potential for increased levels of adiposity excess. The evaluation of muscular fitness at an early age will allow the implementation of future cardiovascular and metabolic risk prevention programs.

Prevalence and determinants of hypertension and associated comorbidities in non-pregnant women of reproductive age group (15-49 years): Evidence from National Family Health Survey (NFHS-4), India.

Hypertension in women is generally underestimated and undiagnosed as women are considered to be at a lower risk of cardiovascular disease than men in addition to gender-related differences in healthcare seeking behaviour and access to healthcare. As hypertension extends a substantial impact on the cardiovascular health of women and can pose an enormous burden on the healthcare systems in India, identification of its risk factors along with co-morbidities becomes necessary for planning of cardiovascular risk prevention, reduction and mitigation interventions. This study aimed at estimating the prevalence and associated demographic and lifestyle risk factors of hypertension (HT) along with examining comorbidity patterns in women of reproductive age (15-49 years) in India. We analyzed data of 667,258 non-pregnant women of the reproductive age group (15-49 years) from the National Family Health Survey (NFHS)-4 dataset. We used maps to present the spatial patterns of HT in women across states and union territories and logistic regression modelling to identify associated factors. The overall prevalence of HT was 10.9% among women (15-49 years), with 60.7% of these having at least one comorbidity. While the prevalence of 'HT only' was higher in women 15-29 years of age (48.0%), the prevalence of HT with co-morbidities was higher in women aged ≥30 years (63.3%). Logistic regression analysis showed higher odds of 'HT and ³ two comorbidities' with age ³30 years (AOR 3.46, 95% CI 3.23-3.72), higher odds of 'HT only' with alcohol consumption (AOR 1.32, 95%CI 1.23-1.42), and higher odds of 'HT and one comorbidity' with BMI ³23 Kg/m2 (AOR 1.17, 95%CI 1.14-1.21). Also, region-wise, the prevalence of HT was highest in the states of Uttar Pradesh (11.6%), Madhya Pradesh (8.0%), and Assam (6.9%). The high prevalence of HT among women aged 15-49 years has serious medical, socio-economic, implications that warrant urgent and immediate gender-specific healthcare interventions. Along with lifestyle modifications, early and timely screening of HT, increasing awareness among young school-going girls, including rural areas, could flatten the HT population curve in India.

Efficacy and Safety of Aspirin for Primary Cardiovascular Risk Prevention in Younger and Older Age: An Updated Systematic Review and Meta-analysis of 173,810 Subjects from 21 Randomized Studies.

The efficacy and safety of aspirin for primary cardiovascular disease (CVD) prevention is controversial. The aim of this study was to investigate the efficacy and safety of aspirin in subjects with no overt CVD, with a focus on age as a treatment modifier. Randomized trials comparing aspirin use versus no aspirin use or placebo were included. The primary efficacy outcome was all-cause death. The primary safety outcome was major bleeding. Secondary ischemic and bleeding outcomes were explored. Subgroup analyses were conducted to investigate the consistency of the effect sizes in studies including younger and older individuals, using a cut-off of 65 years. A total of 21 randomized trials including 173,810 individuals at a mean follow-up of 5.3 years were included. Compared with control, aspirin did not reduce significantly the risk of all-cause death (risk ratio: 0.96; 95% confidence interval: 0.92-1.00, p = 0.057). Major adverse cardiovascular events were significantly reduced by 11%, paralleled by significant reductions in myocardial infarction and transient ischemic attack. Major bleeding, intracranial hemorrhage, and gastrointestinal bleeding were significantly increased by aspirin. There was a significant age interaction for death (p for interaction = 0.007), with aspirin showing a statistically significant 7% relative benefit on all-cause death in studies including younger patients. The use of aspirin in subjects with no overt CVD was associated with a neutral effect on all-cause death and a modest lower risk of major cardiovascular events at the price of an increased risk in major bleeding. The benefit of aspirin might be more pronounced in younger individuals.

Prevalence of Hypertension among the Adult Population in Qatar: A Literature Review

Background: Hypertension (HTN) is the leading preventable and modifiable cardiovascular risk factor. Diseases well known to be associated with hypertension have been discerned among the adult population within the state of Qatar. These include myocardial infarction (MI), stroke, obesity, diabetes mellitus, heart failure, dyslipidemia and erectile dysfunction. Our literature review aims to provide a review of the current literature on hypertension among the adult population within the State of Qatar. Methods: A review of studies published between 1982-2019 in the area of hypertension was conducted with the use of PubMed, using the key words “hypertension + adults+ Qatar”. We also used the reference list of all articles retrieved, and author names to expand our search that was used for this review. Hypertension in Children and Hypertension in Pregnancy was excluded from our search results. Results: A total of 17 studies were included for review, which included 9 cross sectional studies, 4 retrospective studies, 3 prospective studies and 1 matched case control study. In addition to diseases well known to be associated with hypertension novel associations have been observed. These include hearing impairment, potentially inappropriate prescribing and subclinical magnesium deficiency. There is a significantly greater prevalence of hypertension among individuals with a family history of consanguinity within the indigenous population of Qatar. Furthermore a greater morbidity and mortality from certain conditions associated with hypertension have been noted within this group. Conclusion: Prevalence of hypertension among adults within the State of Qatar is approximately 32% (16.8% - 32.1%) which is in keeping with current overall global estimates. Hypertension in the State of Qatar primarily affects the elderly population (above 50 years) and is associated with a number of morbidities including cardiovascular disease (CVD), congestive heart failure (CHF), obesity, ...........

Prevalence of atherosclerotic diseases and cardiovascular risk factors in military health care centres

The high burden of atherosclerotic diseases is attributable to preventable cardiovascular (CV) risk factors particularly hypertension (HPT), diabetes mellitus (DM), hyperlipidaemia and smoking.