Prior History Of Cardiovascular Disease Research Articles

Cardiovascular toxicity of fluoropyrimidines: Experience from a quaternary referral center.

e24028 Background: Fluoropyrimidines, including 5-fluorouracil (5-FU) and capecitabine, are widely used chemotherapeutic agents. Their use has been linked to various forms of cardiovascular (CV) toxicity. We sought to analyze the rate of CV events and associated factors in patients receiving fluoropyrimidines at our institution. Methods: We included all patients who received intravenous 5-FU or oral capecitabine at the Cleveland Clinic since 2000. Diagnosis data was obtained based on ICD-10 Codes. CV events included chest pain/angina, myocardial infarction, chronic ischemic heart disease, arrhythmias, conduction disorders, cardiac arrest, cardiomyopathy, and heart failure. CV events were accounted for if they occurred during treatment or within 30 days following the latest administration of the agent. Logistic regression was performed to identify predictors of CV events. Results: A total of 17,236 patients were included, of which 9,386 (54.5) received 5-FU and 7,850 (45.5) received capecitabine. Median age at treatment was 63. The most frequent malignancies were gastrointestinal (70%) and breast cancer (12.3%). A total of 2,283 patients (13.2%) experienced at least one CV event either during treatment or within 30 days following drug administration. The most frequent CV events were chest pain/angina (35.7% of all events). On multivariable logistic regression, factors associated with increased risk of CV events were black race, smoking history, hypertension, and obesity (Table). A prior history of CV disease was also associated with increased risk of CV events (OR 1.22; 95% CI [1.09 - 1.33]). Finally, intravenous 5-FU was linked to higher odds of CV events compared to oral capecitabine (OR 1.48; 95% CI [1.34 - 1.63]). Conclusions: This large-scale cohort study provides pivotal insights into the cardiovascular risks associated with fluoropyrimidine therapy. Besides traditional risk factors, black patients were more likely to suffer from CV events. Additionally, capecitabine may offer better CV outcomes compared to 5-FU. These findings underscore the need for refined risk assessment and enhanced cardiovascular monitoring in patients treated with fluoropyrimidines. [Table: see text]

Association between blood pressure levels and premature atrial contractions in patients with hypertension

BackgroundHigh blood pressure (BP) induces left atrial structural and functional remodeling that increases susceptibility to atrial arrhythmia. We hypothesized that lower systolic BP (SBP) levels are associated with a lower prevalence of premature atrial contractions (PACs) in patients with hypertension. MethodsThis analysis included 4,697 participants (mean age 62±13.1 years, 50% women, 25.6% blacks) with hypertension from the Third National Health and Nutrition Examination Survey who did not have a prior history of cardiovascular disease (CVD). Multivariable logistic regression was used to examine the cross-sectional association between SBP and prevalence of PACs ascertained from 12-lead resting electrocardiograms. Multivariable Cox proportional hazard analysis was used to examine the association between baseline PACs and CVD mortality. ResultsApproximately 1.6% (n=74) of participants had baseline PACs. Patients with SBP ≤140 mmHg had a lower prevalence of PACs than those with SBP ≥140 mmHg (1.1% vs. 1.9%, p-value=0.01). In a multivariable logistic regression model, each 10 mmHg decrease in SBP was associated with a 12% lower odds of PACs (OR (95%CI): 0.88 (0.77-0.99)). During 14 years of follow-up, 645 CVD deaths occurred. In a multivariable-adjusted Cox model, presence of PACs was associated with a 78% increased risk of CVD mortality (HR (95%CI): 1.78 (1.23-2.60)). ConclusionsIn patients with hypertension, lower SBP levels are associated with a lower prevalence of PACs, and presence of PACs is associated with a higher risk of CVD mortality risk. These findings highlight the potential role of BP lowering in the management of cardiac arrhythmias.

Comparison of β-blocker agents and mortality in maintenance hemodialysis patients: an international cohort study.

Despite a lack of clinical trial data, β-blockers are widely prescribed to dialysis patients. Whether specific β-blocker agents are associated with improved long-term outcomes compared with alternative β-blocker agents in the dialysis population remains uncertain. We analyzed data from an international cohort study of 10125 patients on maintenance hemodialysis across 18 countries that were newly prescribed a β-blocker medication within the Dialysis Outcomes and Practice Patterns Study (DOPPS). The following β-blocker agents were compared: metoprolol, atenolol, bisoprolol and carvedilol. Multivariable Cox proportional hazards models were used to estimate the association between the newly prescribed β-blocker agent and all-cause mortality. Stratified analyses were performed on patients with and without a prior history of cardiovascular disease. The mean (standard deviation) age in the cohort was 63 (15) years and 57% of participants were male. The most commonly prescribed β-blocker agent was metoprolol (49%), followed by carvedilol (29%), atenolol (11%) and bisoprolol (11%). Compared with metoprolol, atenolol {adjusted hazard ratio (HR) 0.77 [95% confidence interval (CI) 0.65-0.90]} was associated with a lower mortality risk. There was no difference in mortality risk with bisoprolol [adjusted HR 0.99 (95% CI 0.82-1.20)] or carvedilol [adjusted HR 0.95 (95% CI 0.82-1.09)] compared with metoprolol. These results were consistent upon stratification of patients by presence or absence of a prior history of cardiovascular disease. Among patients on maintenance hemodialysis who were newly prescribed β-blocker medications, atenolol was associated with the lowest mortality risk compared with alternative agents.

Abstract 6291: Changes in physical activity and ischemic stroke risk after cancer diagnosis: A nationwide cohort study

Abstract Background: Physical inactivity is prevalent after cancer treatment, which may pose a greater risk of ischemic stroke in cancer survivors. Objective: To investigate the association between physical activity change from pre- to post-diagnosis and ischemic stroke risk among cancer survivors. Methods: Cancer survivors without prior history of cardiovascular disease were identified. Pre- and Post-adherence to physical activity was determined within two years from cancer diagnosis. The primary outcome was incident ischemic stroke. Using the Fine-Gray model, sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for ischemic stroke risk were calculated, considering death as a competing risk. Results: Among 269,943 cancer survivors (mean [SD] age 56.3 [12.1] years, 45.7% male), 10.1% remained active, 11.4% became inactive, and 16.6% became active post-diagnosis. During 1,109,566.68 person-years[YMP1] , remaining active both pre- and post-diagnosis was associated with 15% decreased risk of ischemic stroke (sHR 0.85, 95% CI 0.75-0.96), compared to those who remained inactive. Cancer survivors who became active, and inactive post-diagnosis showed a 16%, and 11% lower risk of ischemic stroke (sHR 0.84, 95% CI 0.75-0.93; sHR 0.89, 95% CI 0.79-0.99) than those who remained inactive. Conclusions: Our findings suggest that staying physically active is associated with a reduced risk of ischemic stroke among cancer survivors. Notably, these advantages are not limited to individuals who were physically active before their diagnosis, and it is not too late to start post-diagnosis. Preventive strategies against ischemic stroke in cancer survivors should emphasize the incorporation of regular physical activity at any stage of their cancer journey. Citation Format: Dong Wook Shin, Wonyoung Jung, In Young Cho, Jinhyung Jung, Mihee Cho, Hye Yeon Koo, Be-Long Cho, Jin Ho Park, Hyuk Tae Kwon, Kyungdo Han, Yong-Moon Mark Park. Changes in physical activity and ischemic stroke risk after cancer diagnosis: A nationwide cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6291.

Effects of prior reproductive losses on risk of cardiovascular diseases within six months of a first live birth

ObjectiveThere is emerging evidence suggesting that pregnancy loss (induced or natural) is associated with an increased risk of cardiovascular diseases (CVD). This prospective longitudinal study investigates the effect of prior pregnancy losses on CVD risk during the first six months following a first live birth. MethodsMedicaid claims of 1,002,556 low-income women were examined to identify history of pregnancy losses, CVD, diabetes, and hyperlipidemia prior to first live birth. The study population was categorized into five groups: A: women with no pregnancy loss or CVD history prior to first live birth; B: women with pregnancy loss and no CVD prior to first live birth. C: women with a first CVD diagnosis after a first pregnancy ending in a loss and before their first live birth. D: women with CVD prior to first live birth and no history of pregnancy loss. E: women with both CVD and pregnancy loss prior to their first live birth. ResultsAfter controlling for age, race, state of residence, and history of diabetes and hyperlipidemia, the risk of CVD in the six-month period following a first live birth were 15%, 214%, 79% and 129% more common for Groups B, C, D and E, respectively, compared to Group A. ConclusionsPregnancy loss is an independent risk factor for CVD risk following a first live birth, both for women with and without a prior history of CVD. The risk is highest when CVD is first diagnosed after a pregnancy loss and prior to a first live birth.

The heart-mind relationship in women cardiovascular primary prevention: the role of depression, anxiety, distress and Type-D personality in the 10-years cardiovascular risk evaluation.

Cardiovascular diseases are the leading cause of death among women. Prevention programmes underscore the need to address women-specific risk factors. Additionally, mental well-being is a significant aspect to consider when grappling with cardiovascular disease in women, particularly depression, anxiety, distress, and personality traits. This study aimed to create "at-risk" psychological profiles for women without prior cardiovascular disease history and to evaluate the association between anxiety, depression, distress, and Type-D personality traits with increased cardiovascular risk over 10 years. 219 women voluntarily participated in the "Monzino Women's Heart Centre" project for primary prevention and early diagnosis of cardiovascular diseases. Psychological profiles were developed utilising cluster analysis. The primary finding indicating that belonging to the "at-risk" psychological cluster was associated with a surge in the 10-year cardiovascular risk prediction score, despite the number of comorbid risk factors (Psychological "at-risk" cluster: β = .0674; p = .006; Risk factors: β = .0199; p = .242). This finding suggests that psychological well-being of women should be assessed from the very beginning of cardiovascular prevention programmes.

Clinical Outcomes in Hospitalized Patients with Cancer and New versus Preexistent Atrial Fibrillation.

There is limited information on the prognostic impact of new onset versus preexistent atrial fibrillation (AF) in hospitalized patients with cancer. We sought to determine the clinical impact of new onset AF (NOAF) compared with preexistent AF in hospitalized patients with cancer. All patients with cancer hospitalized over the course of one year with clinically manifest new or preexistent AF were enrolled in the Memorial Sloan Kettering Cancer Center (MSKCC) AF registry. The relationship of NOAF to the primary composite outcome of all cause death, cardiovascular (CV) rehospitalization or cerebrovascular event (CVE), as well as secondary CV endpoints, were analyzed using proportional hazards regression. Where applicable, the competing risk of death was accounted for using methodology described by Fine and Gray. Among 606 patients included in the analysis, 313 (51.7%) had NOAF and 293 (48.3%) had preexistent AF. Patients with NOAF were younger and had less frequent prior history of CV disease compared with patients with preexistent AF. At follow up, patients with NOAF had a higher adjusted hazard for the primary composite outcome versus patients with prior AF (HR 1.64, 95% CI 1.27, 2.13, p=0.002), as well as the secondary CV composite outcome of clinical AF recurrence, CV death, CV rehospitalization or CVE (HR 2.17, 95% CI 1.57, 2.99, P<0.0001). In hospitalized patients with cancer and electrocardiographically manifest new versus preexistent AF, NOAF was associated with a higher risk for the primary composite outcome of all-cause death, CV rehospitalization or CVE.

Is Glycemic Control the Primary Goal in Diabetes Treatment?

The prevalence of Diabetes is steadily increasing, raising public health concerns. Hyperglycemia leads to microvascular and macrovascular diseases through several metabolic and biochemical pathways. Previous clinical trials and observational studies have demonstrated that tight glycemic control can reduce the incidence of diabetic complications, with the greatest benefit shown in younger patients with diabetes of shorter duration and those who have no prior history of cardiovascular disease. Moreover, previous studies highlight the concept of metabolic memory and legacy effect, since controlling diabetes early can have an impact on long-term prognosis of the disease. As to whether it is time to consider shifting the treatment focus for patients with type 2 diabetes from a glucose-centric to a weight-centric or a cardio-centric approach, the dilemma remains theoretical; glucose control, weight loss and effective treatment of metabolic and cardio-vascular co-morbidities are interrelated components of an integrated plan of care that should be addressed simultaneously and effectively.

Association of low muscle mass and obesity with increased all-cause and cardiovascular disease mortality in US adults.

Sarcopenic obesity, defined as the coexistence of low muscle mass and high adiposity, is associated with cardiovascular disease (CVD) and mortality. However, to what extent sarcopenia contributes to these risks independently or in conjunction with other cardiovascular risk factors remains unclear. This study aimed to investigate the association of low muscle mass, central obesity (COB), metabolic abnormalities, and their combinations with CVD and mortality risk. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey 1999-2006 and 2011-2018. Participants aged >20years and with reported whole-body dual X-ray absorptiometry data were included. Participants were divided into eight groups based on low muscle mass, metabolic abnormalities, and COB status. The mean age of participants was 55years, and 50.4% of participants were male. Low muscle mass was observed in 2472 (14.6%) out of 16839 participants. Among the eight groups, the metabolically unhealthy COB group with low muscle mass had the highest hazard ratio (HR) for all-cause mortality (HR, 2.00; 95% CI, 1.56-2.56; P<0.001), whereas the metabolically healthy COB group with low muscle mass had the highest HR for CVD mortality (HR, 3.18; 95% CI, 1.53-6.65; P=0.001). The mediation analysis showed that low muscle mass directly increased the risk of both all-cause mortality (HR, 1.56; 95% CI, 1.35-1.79; P<0.001) and CVD mortality (HR, 1.80; 95% CI, 1.40-2.31; P<0.001). Additionally, subgroup analysis revealed that low muscle mass significantly increased the risk of all-cause and CVD mortality in participants without a prior CVD history and those with diabetes mellitus. Low muscle mass is an independent risk factor for all-cause and CVD mortality, especially in individuals with metabolic abnormalities and COB.

An analysis of published cases of cutting balloon use in spontaneous coronary artery dissection.

SCAD involves a sudden tear or separation within the layers of the coronary artery wall, resulting in blood flow obstruction and subsequent myocardial ischemia. A comprehensive literature search was conducted to identify relevant published cases of cutting balloon use in patients diagnosed with spontaneous coronary artery dissection. Electronic databases including PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar were systematically searched from inception until the present using terms "cutting balloon," "SCAD," "acute coronary syndrome," "intramural hematoma," and "angioplasty." A total of 32 published cases of cutting balloon use in spontaneous coronary artery dissection were analyzed in this study. The majority of the patients included in the analysis were female without prior history of cardiovascular disease. The median age of the SCAD population was approximately 46 years. The most frequently affected artery in SCAD cases was the Left Anterior Descending artery. Intravascular ultrasound was utilized more frequently than other modalities of adjunctive imaging techniques. The most frequent complication was the distal propagation of hematoma. Despite the successful dilation achieved with the cutting balloon, in some cases stenting was required to provide additional support. The results of this analysis demonstrate that cutting balloon use in SCAD cases yields favorable outcomes.

Association of pulse pressure with risk of major adverse cardiovascular events among cardiovascular outcome trial participants

Abstract Background Hypertension is a well-established risk factor for the development for cardiovascular (CV) disease and accumulating evidence also implicates elevated pulse pressure (PP), a surrogate marker for arterial stiffness, as an independent risk factor for major adverse cardiovascular events (MACE). Purpose The study aimed to assess the association of PP with MACE among participants in multiple CV outcome clinical trials. It also aimed to determine if the presence of various CV comorbidities impacts the association between PP and MACE. Methods Adult patients between the ages of 19-98 years (n = 65,382, mean age 63) enrolled in five large CV outcome trials (ACCELERATE, STRENGTH, PRECISION, ALECARDIO, and LIGHT) with independently adjudicated clinical end points were identified. Baseline demographics, medical history, blood pressures, and CV medications were collected. Univariate and multivariate analyses were generated and analyzed for temporal trends, risk, and adjusted survival. Results Participants had a mean baseline blood pressure of 128 /76 mm Hg and a mean PP of 52 mm Hg. Forty-five percent were women, 31% had coronary artery disease, 51% had type 2 diabetes mellitus, 84% had hypertension, 25% had history of myocardial infarction (MI), and 35% had a history of an acute coronary syndrome. The composite MACE end point included CV death, myocardial infarction, or stroke and occurred in 3712 participants (5.7%).The composite end point of all cause death, myocardial infarction, and stroke occurred in 4513 participants (6.9%). For every 10 mm Hg increase in PP there was an increased risk of MACE (unadjusted hazard ratio (HR) 1.20, 95% CI 1.17 to 1.23). Similarly, a PP &amp;gt; 60 mmHg demonstrated an unadjusted HR of 1.53 (95% CI 1.43 to 1.64) compared with PP &amp;lt; 60 mm Hg. Although increased PP was a risk factor in both men and women, every 10 mm Hg increase in PP was associated with higher risk of MACE in women (adjusted HR 1.17, 95%CI 1.17, 1.12 to 1.22) compared with men (adjusted HR 1.09, 95% CI, 1.05 to 1.12). Table 1 displays the adjusted HR for patients grouped by race, history of prior CV disease, or the presence of CV risk factors (diabetes and chronic kidney disease.) While most subgroups demonstrated an increased risk of MACE with increasing PP, PP was not associated with MACE among individuals with a history of stroke (HR 1.00, 95% CI 0.92 to 1.08). Kaplan-Meier survival curves comparing PP greater than or less than 60 mm Hg are seen in Figure 1. Conclusions Among CV outcome clinical trial participants, with independently adjudicated end points, baseline PP is associated with an increased risk for future MACE. The association stands for most participant subgroups except for participants with a prior history of stroke.Table 1Figure 1

Incidence of major cardiovascular outcomes in patients with chronic kidney disease by severity: a United States population-based study using electronic medical records

Abstract Background and Aims Data on the incidence of cardiovascular (CV) events by stage of chronic kidney disease (CKD) and the effect of previous CV history on future events in CKD patients (pts) is limited. We aimed to analyze a large US electronic medical record (EMR) database and evaluate incidence of new major adverse CV events (MACE) per CKD stage over a 5-year follow-up. Methods A retrospective cohort study was conducted using IBM® Explorys EMR data (&amp;gt;53 million patients) from Jan 2010 to Dec 2019. Two cohorts of CKD patients were created: Cohort 1 based on diagnostic codes (n = 810,987 pts), and Cohort 2 on KDIGO screening/staging criteria (n = 953,396). Sub-cohorts were created for each CKD stage (1-5). CKD classification was not mutually exclusive (individual pts could contribute to multiple main and sub-cohorts). Pts in Cohort 1 were required to have an ICD 9/10 code for a specific CKD stage while pts in Cohort 2 required two consecutives abnormal eGFR, uACR/uPCR results within 3-18 months to determine KDIGO CKD stage. Pts were required to have at least 12-months lookback period. Index date was the date of diagnosis or second abnormal test. We followed up each patient individually until the occurrence of a composite of MACE including death, coronary artery disease (CAD) events, any stroke, hospitalization for heart failure, or loss to follow-up, or for up to 5 years. Results Most patients in Cohort 1 (DxC) and 2 (KDIGO) were Caucasian and had stage 3 CKD at baseline. Mean age was 70y and 71y in Cohort 1 and 2 respectively, with 49% and 40% males. The prevalence of pre-existing CV diseases increased with CKD stage. The proportion of pts from Cohort 2 receiving a diagnosis of CKD at least once during their study period increased from 34% in stage 1 to 86% and 83% in stage 4 and 5, respectively. The 5-year incidence of the composite of MACE increased with stage in both cohorts: 40.3% to 66.0% in Cohort 1 and 25.1% to 65.8% in Cohort 2. These incidences were higher in pts with a CV history (Table 1). DxC pts tended to have a higher incidence of MACE, especially in the early stages. Death was the most frequent event at 5y in both cohorts across all stages (27.8% and 19.7% respectively at stage 3). It occurred in half of pts with a prior history of CV disease in both Cohorts in stages 4-5 CKD. Stroke was the most frequent event in the early stages (21.6% and 19.5% respectively at stage 3) and CAD events the most frequent in the late stages (27.6% and 29.5% respectively at stage 5). Conclusion CKD pts have a high risk of MACE at 5 years, with incidence 2-3 times higher in patients with pre-existing CV disease. There are differences in MACE incidences between CKD definitions, that were higher in coded diagnoses vs. lab results, especially in stages 1-3, warranting further investigation. Aggressive treatment of CV disease and risk factors should be considered for all CKD pts due to high 5-year MACE rates, regardless of CKD stage.Table 1.

Clonal Hematopoiesis, Inflammation, Hemostasis, and Cardiometabolic Biomarkers: The Reasons for Geographic and Racial Differences in Stroke Study

CONCLUSIONS Clonal hematopoiesis (CH) is implicated in the pathogenesis of multiple age-associated disorders including malignancy, cardiovascular disease (CVD), chronic kidney disease, and mortality. Some of these adverse outcomes may be mediated by CH-driven inflammatory dysregulation, but the association of CH with biomarkers in other pathways related to these outcomes has not been studied. We studied the association between CH and biomarkers of inflammation, hemostasis and cardiometabolic risk in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a prospective study that enrolled 30,239 Black and White individuals ≥45 years across United States between 2003 and 2007, and collected extensive health data by telephone and in-person exams. Biomarkers listed in Table 2, and CH were measured in baseline blood samples in an age-, sex-, and race-stratified cohort random sample (CRS). We excluded participants with prior history of CVD. Sequencing was performed at &amp;gt;500x depth to identify somatic mutations in 24 of the most common CH genes, capturing &amp;gt;95% of CH observed in the general population. CH was categorized based on variant allele frequency (VAF) of the dominant mutation as 0%, &amp;gt;0-&amp;lt;2%, 2-10% and &amp;gt;10%. Linear regression was used to calculate the age-, sex-, and race-adjusted difference in mean biomarker level for those with versus those without CH. The study included 781 participants (mean age at enrollment: 66 years [SD 12.1], 46% male, 50% Black individuals). The prevalence of CH at varying VAF was: VAF 0% - 43.3%; VAF &amp;gt;0 to &amp;lt;2% - 32.5%; 2 to 10% - 18.4%; &amp;gt;10% - 5.8%. Mutations were most prevalent in DNMT3A (60.3%), then TET2 (13.8%) and ASXL1 (10.1%). The mean age was higher in participants with CH (73 years, SD 10) than in those without CH (61 years, SD 11). Distributions of the most common CH mutations at VAF ≥2% by age, sex and race are shown in Table 1. Mutations in DNMT3A were overrepresented in Black participants and women, whereas mutations in TET2 and ASXL1 were more common in White participants. Associations of CH with inflammation, hemostasis and cardiometabolic biomarkers were presented in Table 2. Mean Log IL-8 was 0.23 (95% CI 0.05-0.41) units higher in those with high VAF CH (&amp;gt;10%) versus those without CH, with no association among other inflammation biomarkers.Among hemostasis biomarkers, mean log D-dimer was 0.26 (95% CI 0.01-0.52) units higher in those with high VAF CH versus those without CH. There was a non-significant trend towards an association between CH and lower Factor VIII and higher fibrinogen (Table 2). Among cardiometabolic biomarkers, mean log Adiponectin was 0.32 (95% CI 0.04-0.61) units higher in those with high VAF CH versus no CH. We did not identify a statistically significant association between CH and other cardiometabolic markers. CH is prevalent in the general population, especially at low VAF. In addition to inflammatory dysregulation, findings here suggest possible other pathways for deleterious effects of CH on health via hemostasis and cardiometabolic pathways. Since our study was cross-sectional, we could not ascertain if CH leads to abnormal biomarker levels or if pathways represented by the above biomarkers predispose to CH. Studying associations of CH with serial biomarkers in a larger population, by specific mutations, and by sex and race will provide mechanistic insights on CH associated adverse outcomes.

Familial hypercholesterolemia is related to cardiovascular disease, heart failure and atrial fibrillation. Results from a population-based study.

Familial hypercholesterolemia (FH) is associated with atherosclerotic cardiovascular disease (ASCVD). However, the prevalence of FH among a general population remains unknown, and it is unclear if FH is associated with other cardiovascular complications, including heart failure (HF) and atrial fibrillation (AF). Analyses were conducted on individuals without a prior history of cardiovascular disease using a nationwide health claims database collected in the JMDC Claims Database between 2005 and 2022 (n = 4,126,642; median age, 44 years; 57.5% men). We defined FH as either LDL cholesterol ≥250 mg/dL or LDL cholesterol ≥175 mg/dL under the lipid-lowering medications under the assumption that lipid-lowering medications reduced LDL cholesterol by 30%. We assessed the associations between FH and composite outcomes, including, ASCVD (myocardial infarction, angina pectoris, and stroke), HF, and AF using Cox proportional hazard model. We identified 11,983 (.29%) FH patients. In total, 181,150 events were recorded during the mean follow-up period of 3.5 years. The status FH was significantly associated with composite outcomes after adjustments (hazard ratio [HR]; 1.38, 95% confidence interval [CI]: 1.30-1.47, p < .001). Interestingly, the status FH was significantly associated with HF (HR: 1.48, 95% CI: 1.36-1.61, p < .001) and AF (HR: 1.33, 95% CI: 1.08-1.64, p < .001) in addition to angina pectoris (HR: 1.45, 95% CI: 1.33-1.58, p < .001) and stroke (HR: 1.19, 95% CI: 1.04-1.36, p < .001). We found that the prevalence of FH was .29% in a general population. FH was significantly associated with a higher risk of developing cardiovascular disease, HF and AF. We sought to identify the prevalence of FH among a general population, and to clarify whether FH increases the risk of not only ASCVD but also HF and AF.

Abstract 004: Process And Health Outcomes Of Patients With Severe Hypertension In A Real-world Setting: Findings From A 12-year Study In A Large Health System

Introduction: Health systems are increasingly leveraging real-world data to improve community health outcomes. Methods: We conducted a longitudinal assessment of health outcomes in patients with severe hypertension using electronic health record data from the Sentara Healthcare System 2010-2021. Severe hypertension was defined as at least two consecutive blood pressure (BP) readings above 160/100 mmHg. We examined follow-up visit rates at 3 and 6 months, and BP control rates (&lt;140/90 mmHg) at 6 and 12 months after the second BP elevation. We also assessed the incidence of cardiovascular disease (CVD) until the end of 2022. Results: The study included 75,657 patients with severe hypertension. Mean age was 61.5 (13.9) years; 55% were female, 57% were White, 37% were Black, and 21.3% had a history of CVD. The median follow-up time was 3.8 years. Among patients with severe hypertension, 72% and 84% had follow-up visits at 3 and 6 months; 38% and 41% achieved BP control at 6 and 12 months. Among patients without prior history of CVD, 22.5% experienced at least one cardiovascular event during the follow-up, including 8.7% with coronary arteriosclerosis, 11.9% with heart failure, 65.2% with cerebral infarction, and 3.5% with myocardial infarction. The median time to cardiovascular events was 793 days. The risk of CVD was significantly higher in Black and older patients, as well as those with blood pressure levels exceeding 180/120 mmHg. Conclusions: This study successfully identified a longitudinal digital cohort of patients with severe hypertension and linked it to health outcomes. The findings have implications for health systems utilizing real-world data in population health research.

Cardiac Biomarkers and Their Role in Identifying Increased Risk of Cardiovascular Complications in COVID-19 Patients.

Cardiovascular disease (CVD) is a global health concern, causing significant morbidity and mortality. Both lifestyle and genetics influence the development of CVD. It is often diagnosed late, when the treatment options are limited. Early diagnosis of CVD with help of biomarkers is necessary to prevent adverse outcomes. SARS-CoV-2 infection can cause cardiovascular complications even in patients with no prior history of CVD. This review highlights cardiovascular biomarkers, including novel ones, and their applications as diagnostic and prognostic markers of cardiovascular complications related to SARS-CoV-2 infection. Patients with severe SARS-CoV-2 infection were shown to have elevated levels of cardiac biomarkers, namely N-terminal pro-brain natriuretic peptide (NT-pro-BNP), creatine kinase-myocardial band (CK-MB), and troponins, indicating acute myocardial damage. These biomarkers were also associated with higher mortality rates and therefore should be used throughout COVID-19 patient care to identify high-risk patients promptly to optimize their outcomes. Additionally, microRNAs (miRNAs) are also considered as potential biomarkers and predictors of cardiac and vascular damage in SARS-CoV-2 infection. Identifying molecular pathways contributing to cardiovascular manifestations in COVID-19 is essential for development of early biomarkers, identification of new therapeutic targets, and better prediction and management of cardiovascular outcomes.

Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID-19 and Preexisting Cardiovascular Disease.

Background Empiric antimicrobial therapy with azithromycin is highly used in patients admitted to the hospital with COVID-19, despite prior research suggesting that azithromycin may be associated with increased risk of cardiovascular events. Methods and Results This study was conducted using data from the ISACS-COVID-19 (International Survey of Acute Coronavirus Syndromes-COVID-19) registry. Patients with a confirmed diagnosis of SARS-CoV-2 infection were eligible for inclusion. The study included 793 patients exposed to azithromycin within 24 hours from hospital admission and 2141 patients who received only standard care. The primary exposure was cardiovascular disease (CVD). Main outcome measures were 30-day mortality and acute heart failure (AHF). Among 2934 patients, 1066 (36.4%) had preexisting CVD. A total of 617 (21.0%) died, and 253 (8.6%) had AHF. Azithromycin therapy was consistently associated with an increased risk of AHF in patients with preexisting CVD (risk ratio [RR], 1.48 [95% CI, 1.06-2.06]). Receiving azithromycin versus standard care was not significantly associated with death (RR, 0.94 [95% CI, 0.69-1.28]). By contrast, we found significantly reduced odds of death (RR, 0.57 [95% CI, 0.42-0.79]) and no significant increase in AHF (RR, 1.23 [95% CI, 0.75-2.04]) in patients without prior CVD. The relative risks of death from the 2 subgroups were significantly different from each other (Pinteraction=0.01). Statistically significant association was observed between AHF and death (odds ratio, 2.28 [95% CI, 1.34-3.90]). Conclusions These findings suggest that azithromycin use in patients with COVID-19 and prior history of CVD is significantly associated with an increased risk of AHF and all-cause 30-day mortality. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05188612.

Association of Empirical Dietary Inflammatory Potential with Mortality: Results from the Third National Nutrition Examination Survey.

The empirical dietary inflammatory potential (EDIP) score is designed to assess the inflammatory potential of a diet based on the pro- and anti-inflammatory properties of its various components. This study examined the association of EDIP with all-cause mortality in a large, community-based, multiracial sample of the United States population. A prospective cohort study. This analysis included 13155 participants (44.6±18.4 years, 54.21% women, and 40.33% White) without prior history of cardiovascular disease (CVD) from the Third National Health and Nutrition Examination (NHANES III) Survey. A 24-hour dietary recall information was used to calculate EDIP. The National Death Index was employed to identify the date and cause of death. Cox proportional hazard analysis was utilized to evaluate the association between the tertiles of EDIP and all-cause mortality over a median follow-up of 26.6 years. In a model adjusted for demographics and CVD risk factors, a higher EDIP tertile, compared with the lowest tertile, was associated with an increased risk of all-cause mortality (hazard ratio [HR]=1.10; 95% CI: 1.02, 1.19). A standard-deviation increase in EDIP (0.27 units) was related to a 4% increased risk of mortality (HR=1.04; 95% CI: 1.01, 1.08). This association was stronger in older participants compared to younger ones (HR=1.09; 95% CI: 0.98, 1.21 vs. HR=0.89; 95% CI: 0.80, 1.01), respectively, interaction P=0.030)]. Pro-inflammatory diet is associated with an increased risk of mortality, especially in the older population. Dietary changes that reduce inflammation may have the potential to reduce the risk of poor outcomes.

Left ventricular torsion as a prognostic marker in patients with dilated cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) torsion is the wringing motion of the ventricle around its long axis induced by contracting obliquely oriented myofibers in the LV wall and it predicts functional capacity more appropriately than LV ejection fraction (EF). Purpose This study was intended to evaluate reduced LV torsion as a potential marker of disease severity and a predictor of hospitalization for worsening heart failure in patients with non-ischemic dilated cardiomyopathy (DCM). Methods This was a single center prospective observational study wherein 127 patients with a diagnosis of non-ischemic DCM with a LVEF &amp;lt;50% were enrolled. In addition, 48 age and sex matched healthy individuals without any prior history of cardiovascular diseases and normal LVEF were enrolled as controls. All these patients underwent detailed clinical assessment including symptomatology, NYHA function class evaluation and routine blood investigations including CPK-MB levels. In addition, all enrolled subjects underwent 2D transthoracic echocardiography along with speckle tracking imaging to determine the LV global longitudinal strain (LV-GLS), LV twist and LV torsion. Based on the measurement of LV torsion, patients were stratified into two groups: preserved LV torsion (&amp;gt;0.59 degrees/cm) and reduced LV torsion (&amp;lt;0.59 degrees/cm). These patients were followed up for six months in terms of MACE events. Results Reduced LV torsion was reported in 52/127 (40.9%) patients with DCM. These patients had significantly lower LVEF, altered LV geometry (base-apical distance) and higher levels of CPK-MB. Additionally, patients with reduced LV torsion had a worsened functional class and a greater frequency of hospital admissions (34 vs 6; P&amp;lt;0.001) over 6 months of follow-up as compared to those with preserved LV torsion. Multivariate logistic regression reported reduced LV torsion to be an independent predictor of MACE events over six months of follow-up (OR:4.20; P=0.001). Conclusion Findings from our study suggested that LV torsion can serve as an additional prognostic marker in patients with non-ischemic DCM.

Cardiovascular disease (CVD) outcomes and associated risk factors in a medicare population without prior CVD history: an analysis using statistical and machine learning algorithms.

There is limited information on predicting incident cardiovascular outcomes among high- to very high-risk populations such as the elderly (≥ 65years) in the absence of prior cardiovascular disease and the presence of non-cardiovascular multi-morbidity. We hypothesized that statistical/machine learning modeling can improve risk prediction, thus helping inform care management strategies. We defined a population from the Medicare health plan, a US government-funded program mostly for the elderly and varied levels of non-cardiovascular multi-morbidity. Participants were screened for cardiovascular disease (CVD), coronary or peripheral artery disease (CAD or PAD), heart failure (HF), atrial fibrillation (AF), ischemic stroke (IS), transient ischemic attack (TIA), and myocardial infarction (MI) for a 3-yr period in the comorbid history. They were followed up for up to 45.2months. Analyses included descriptive approaches in terms of incidence rates and density ratios, and inferential in terms of main effect statistical/complex machine learning modeling. The contemporary risk factors of interest spanned across the domains of comorbidity, lifestyle, and healthcare utilization history. The cohort consisted of 154,551 individuals (mean age 68.8years; 62.2% female). The overall crude incidence rate of CVD events was 9.9 new cases per 100 person-years. The highest rates among its component outcomes were obtained for CAD or PAD (3.6 for each), followed by HF (2.2) and AF (1.8), then IS (1.3), and finally TIA (1.0) and MI (0.9).Model performance was modest in terms of discriminatory power (C index: 0.67, 95%CI 0.667-0.674 for training; and 0.668, 95%CI 0.663-0.673 for validation data), equal agreement between predicted and observed events for calibration purposes, and good clinical utility in terms of a net benefit of 15 true positives per 100 patients relative to the All-patient treatment strategy. Complex models based on machine learning algorithms yielded incrementally better discriminatory power and much improved goodness-of-fitness tests from those based on main effect statistical modeling. This Medicare population represents a highly vulnerable group for incident CVD events. This population would benefit from an integrated approach to their care and management, including attention to their comorbidities and lifestyle factors, as well as medication adherence.