Rates Of Cardiovascular Disease Research Articles

Association between inpatient education program for patients with pre-dialysis chronic kidney disease and new-onset cardiovascular disease after initiating dialysis.

The association between inpatient education programs (IEPs) for patients with pre-dialysis chronic kidney disease (CKD) and new-onset cardiovascular disease (CVD) after initiating dialysis is unclear. We conducted a retrospective cohort study between January 1, 2011 and December 31, 2018, evaluating CKD patients who were divided into two groups based on whether or not they participated in IEPs. The primary outcome was a new-onset CVD event after initiating dialysis. Cumulative incidence function was used to describe new-onset CVD considering the competing outcome of death. Additionally, Cox proportional hazards models were used to estimate the hazard ratio of new-onset CVD between IEP and non-IEP groups. Of the 493 patients, 131 (26.6%) patients had participated in IEPs. The IEP group had a significantly longer duration of CKD management by nephrologists (median 142 vs. 115days, P = 0.007), lower rate of emergency hospital admissions (9.9% vs. 27.1%, P < 0.001), better ability to perform activities of daily living (Grade J; 81.6% vs. 69.1%, P = 0.046), higher rate of pre-placement of permanent vascular access or peritoneal dialysis catheters (82.4% vs. 59.4%, P < 0.001), and a higher serum albumin level at the beginning of dialysis (3.5 ± 0.5 vs. 3.3 ± 0.6g/dL, P < 0.001). The cumulative incidence of new-onset CVD at three years after initiating dialysis in the IEP and non-IEP groups was 16.9% and 22.5%, respectively. The hazard ratio for new-onset CVD after initiating dialysis in the IEP group was 0.63 (95% CI: 0.41-0.97, P = 0.036). IEPs were associated with a lower rate of new-onset CVD after initiating dialysis.

Geographical Variation in Underlying Social Deprivation, Cardiovascular and Other Comorbidities in Patients with Potentially Curable Cancers in England: Results from a National Registry Dataset Analysis

AimsTo describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances. Materials and methodsThis National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I–III breast cancer, stage I–III colon cancer, stage I–III rectal cancer, stage I–III prostate cancer, stage I–IIIA non-small cell lung cancer, stage I–IV diffuse large B-cell lymphoma, stage I–IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: <33.3rd percentile; middle: 33.3rd to 66.6th percentile; maximum: >66.6th percentile). ResultsIn total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16–26%) and female patients (8–16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller. ConclusionSocial deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes.

Abstract P3121: Overcoming Gender Bias In Cardiovascular Research Using Mice Models By Monitoring Metabolic Differences Between Genders Using Indirect Calorimetry

Background: Metabolic differences between genders have been observed in humans, with studies reporting differences in body composition, metabolic rates, and response to dietary interventions and how they may affect the risk of cardiovascular disease (CVD) and diabetes. However, most research in CVD models has been conducted exclusively on male mice, resulting in strong gender bias. Moreover, in CVD research investigating differences in hypertension, it is important to note the sexual dimorphisms for these pathologies that result from genetic and hormonal differences. More specifically, age-related CVD rates are lower for women, which has been associated with the protective role of sex steroid hormones in women, which affect the prevalence of metabolic syndrome. However, further research is required to investigate the exact role of these hormones in explaining the lower age-specific CVD rates and the metabolic differences between males and females. Methodology and Result: Adult wild-type C57B6 mice were housed individually in a metabolic cage. We used the indirect calorimetric method to monitor oxygen consumption, carbon dioxide release, respiratory exchange ratio (RER), and energy expenditure of individual mice. Our initial study shows female mice have better volunteer exercise capacity than male mice. Conclusion: This study will address a significant gap in the literature by investigating metabolic differences between genders without gender bias. Our study's findings will provide a foundation for future research in CVD and contribute to developing gender-specific interventions for metabolic disorders.

Cardiovascular risk stratification among individuals with obesity: The Coronary Artery Calcium Consortium.

The effectiveness of coronary artery calcification (CAC) for risk stratification in obesity, in which imaging is often limited because ofa reduced signal to noise ratio, has not been well studied. Data from 9334 participants (mean age: 53.3 ± 9.7 years; 67.9% men) with BMI ≥ 30 kg/m2 from the CAC Consortium, a retrospectively assembled cohort of individuals with no prior cardiovascular diseases (CVD), were used. The predictive value of CAC for all-cause and cause-specific mortality was evaluated using multivariable-adjusted Cox proportional hazards and competing-risks regression. Mean BMI was 34.5 (SD 4.4) kg/m2 (22.7% Class II and 10.8% Class III obesity), and 5461 (58.5%) had CAC. Compared with CAC = 0, those with CAC = 1-99, 100-299, and ≥300 Agatston units had higher rates (per 1000 person-years) of all-cause (1.97 vs. 3.5 vs. 5.2 vs. 11.3), CVD (0.4 vs. 1.1 vs. 1.5 vs. 4.2), and coronary heart disease (CHD) mortality (0.2 vs. 0.6 vs. 0.6 vs. 2.5), respectively, after mean follow-up of 10.8 ± 3.0 years. After adjusting for traditional cardiovascular risk factors, CAC ≥ 300 was associated with significantly higher risk of all-cause (hazard ratio [HR]: 2.05; 95% CI: 1.49-2.82), CVD (subdistribution HR: 3.48; 95% CI: 1.81-6.70), and CHD mortality (subdistribution HR: 5.44; 95% CI: 2.02-14.66), compared with CAC = 0. When restricting the sample to individuals with BMI ≥ 35 kg/m2 , CAC ≥ 300 remained significantly associated with the highest risk. Among individuals with obesity, including moderate-severe obesity, CAC strongly predicts all-cause, CVD, and CHD mortality and may serve as an effective cardiovascular risk stratification tool to prioritize the allocation of therapies for weight management.

Cardiovascular risk factors and death in South America

We present cardiovascular disease (CVD) incidence and mortality rates reported for South America stratified by country, sex, and urban/rural location in a multinational cohort included in the Population Urban Rural Epidemiological Study (PURE). This study included 24718 participants from 51 urban and 49 rural communities in Argentina, Brazil, Chile, and Colombia and the mean follow-up was 10.3 years. CVD incidence and mortality rates were calculated for the total cohort and in subpopulations. Hazard ratios and population attributable fractions (PAFs) for CVD and death were examined for 12 modifiable risk factors, grouped as metabolic (hypertension, diabetes, abdominal obesity, and high non-HDL cholesterol), behavioural (smoking, alcohol, diet quality, and physical activity) and other (education, household air pollution, strength, and depression). The leading causes of death were CVD (31.1%), cancer (30.6%), and respiratory diseases (8.6%). Approximately 72% of the PAFs for CVD and 69% of the PAFs for deaths were attributed to 12 modifiable risk factors. For CVD, the main PAFs were due to hypertension (18.7%), abdominal obesity (15.4%), smoking (13.5%), low muscle strength (5.6%), and diabetes (5.3%). For death, the main PAFs were smoking (14.4%), hypertension (12.0%), low educational level (10.5%), abdominal obesity (9.7%), and diabetes (5.5%). Cardiovascular diseases, cancer, and respiratory diseases account for more than two-thirds of deaths in South America. Men have consistently higher CVD rates and mortality than women. A large proportion of CVD and premature deaths could be avoided by controlling metabolic risk factors and smoking, which are the main risk factors in the region for both CVD and all-cause mortality.

Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2019: a systematic analysis of Global Burden of Disease Study 2019

BackgroundUnderstanding the temporal trends in the burden of overall and type-specific cardiovascular diseases (CVDs) in youths and young adults and its attributable risk factors is important for effective and targeted prevention strategies and measures. We aimed to provide a standardized and comprehensive estimation of the prevalence, incidence, disability-adjusted life years (DALY), and mortality rate of CVDs and its associated risk factors in youths and young adults aged 15–39 years at global, regional, and national levels.MethodsWe applied Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 analytical tools to calculate the age-standardized incidence, prevalence, DALY, and mortality rate of overall and type-specific CVDs (i.e., rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, aortic aneurysm, and endocarditis) among youths and young adults aged 15–39 years by age, sex, region, sociodemographic index and across 204 countries/territories from 1990 to 2019, and proportional DALY of CVDs attributable to associated risk factors.ResultsThe global age-standardized DALY (per 100,000 population) for CVDs in youths and young adults significantly decreased from 1257.51 (95% confidence interval 1257.03, 1257.99) in 1990 to 990.64 (990.28, 990.99) in 2019 with an average annual percent change (AAPC) of − 0.81% (− 1.04%, − 0.58%, P < 0.001), and the age-standardized mortality rate also significantly decreased from 19.83 (19.77, 19.89) to 15.12 (15.08, 15.16) with an AAPC of − 0.93% (− 1.21%, − 0.66%, P < 0.001). However, the global age-standardized incidence rate (per 100,000 population) moderately increased from 126.80 (126.65, 126.95) in 1990 to 129.85 (129.72, 129.98) in 2019 with an AAPC of 0.08% (0.00%, 0.16%, P = 0.040), and the age-standardized prevalence rate significantly increased from 1477.54 (1477.03, 1478.06) to 1645.32 (1644.86, 1645.78) with an AAPC of 0.38% (0.35%, 0.40%, P < 0.001). In terms of type-specific CVDs, the age-standardized incidence and prevalence rate in rheumatic heart disease, prevalence rate in ischemic heart disease, and incidence rate in endocarditis increased from 1990 to 2019 (all P < 0.001). When stratified by sociodemographic index (SDI), the countries/territories with low and low-middle SDI had a higher burden of CVDs than the countries/territories with high and high-middle SDI. Women had a higher prevalence rate of CVDs than men, whereas men had a higher DALY and mortality rate than women. High systolic blood pressure, high body mass index, and low-density lipoprotein cholesterol were the main attributable risk factors for DALY of CVDs for all included countries and territories. Household air pollution from solid fuels was an additional attributable risk factor for DALY of CVDs in low and low-middle SDI countries compared with middle, high-middle, and high SDI countries. Compared with women, DALY for CVDs in men was more likely to be affected by almost all risk factors, especially for smoking.ConclusionsThere is a substantial global burden of CVDs in youths and young adults in 2019. The burden of overall and type-specific CVDs varied by age, sex, SDI, region, and country. CVDs in young people are largely preventable, which deserve more attention in the targeted implementation of effective primary prevention strategies and expansion of young-people’s responsive healthcare systems.

1352-P: Ethnic Disparities in Diabetic Complications in the U.S.

Objective: To estimate the prevalence of diabetes (DM) complications and assess risk factors for complications by ethnicity and DM duration. Methods: We used National Health and Nutrition Examination Survey data, 1999-2018. We defined cardiovascular disease (CVD) as a history of heart failure, stroke, or heart attack; chronic kidney disease (CKD) as an eGFR &amp;lt;60, albuminuria, or both; retinopathy as retinal microaneurysms or blot hemorrhages; and lower extremity disease (LED) as peripheral neuropathy, peripheral artery disease, or ulcers. We assessed the age-adjusted prevalence of each complication and multivariable logistic regressions for risk factors related to any complication by ethnicity in new (DM&amp;lt; 10 y without insulin) and established patients (DM≥10 y). Results: Non-Hispanic Whites (W) had the highest CVD rates, followed by Blacks (B), Mexican Americans (M), and Asian Americans (A) in both new (31% W, 21% B, 14% M, 11% A) and established patients (38% W, 36% B, 29% M, 28% A). Blacks had the highest CKD rates in both new (40% B, 33% W, 31% A, 30% M) and established patients (63% B, 52% M, 51% W, 40% A). For retinopathy, in new patients, Mexican Americans had the highest rate (27% M, 20% B, 12% W), while in established patients, Whites had the most (62% W, 61% B, 57% M). Blacks had the highest rates for LED in both new (52% B, 47% W, 45% M) and established patients (78% B, 68% W, 59% M). Male gender was a risk factor for any DM complication in Asian Americans (new patients, odds ratio 3.9, 95% CI 2-7.5; established, 2.5, 1.1-5.4). Obesity was a risk factor in Black new patients (1.4, 1-1.8). Poor glycemic control was a risk factor in Asian American (4, 2.2-7.6) and White new patients (1.5, 1.1-2.1), and Black established patients (1.7, 1.2-2.4). Conclusions: White patients had the highest rate of CVD, while Blacks had the most CKD and LED. Mexican Americans with &amp;lt; 10 y of DM had more retinopathy than their ethnic counterparts. Interventions to integrate the male sex and promote weight and glycemic control may reduce DM complications in ethnic minorities. Disclosure Y.Yoshida: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. Y.Zu: None.

#5460 ACUTE KIDNEY INJURY DURATION AND 20-YEAR RISK OF CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASE: A POPULATION-BASED COHORT STUDY

Abstract Background and Aims Acute kidney injury (AKI) is associated with increased risks of chronic kidney disease (CKD) and cardiovascular disease (CVD). The duration of AKI may be an important clinical marker of individuals at high risk of adverse outcomes; however, the potential links between AKI duration and CKD and CVD remain unresolved. Therefore, we examined the associations between AKI duration and CKD and CVD in a population-based setting. Method Using population-based plasma creatinine (pCr) data, we identified individuals with first-time AKI in Denmark from 1 January 1990 to 31 December 2018. AKI was defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. To allow for determining AKI duration, analyses were restricted to individuals with an assessment of baseline kidney function by pCr within the prior year and evaluation of AKI duration by pCr within seven days after AKI onset. In accordance with the Acute Disease Quality Initiative (ADQI) 16 Workgroup criteria, AKI duration was categorized as “rapid reversal” if a pCr test within two days after AKI onset did not fulfill the AKI definition, as “persistent” if a pCr test between two and seven days after onset did not fulfill the AKI definition, and otherwise as “acute kidney disease” (AKD). CKD was defined by in- or outpatient hospital diagnoses codes or as ≥2 outpatient eGFR &amp;lt;60 ml/min/1.73 m2 separated by a least 90 days. CVD was defined by diagnosis codes and evaluated overall and as individual conditions including atrial fibrillation and flutter, ischemic heart disease, heart failure, stroke, and hypertension. When examining CKD, overall CVD, and specific CVDs only individuals without the condition were included in the analyses. Twenty-year cumulative risks and hazard ratios (HRs) were computed and compared across the three AKI duration groups. Results We identified 165,334 individuals with first-time AKI and with an assessment of baseline kidney function and AKI duration. Among these 36,514 (22%) had rapid reversal AKI, 22,619 (13%) had persistent AKI, and 110,499 (65%) had AKD. The median age was 72 years (interquartile range (IQR)), 62-80) and 52% were females. The most common comorbidities were CKD (37%) and hypertension (43%). Among the 106,916 individuals without prevalent CKD, the 20-year risks of CKD were 18.9% (95% confidence interval (CI), 18.2-19.6) for rapid reversal AKI, 23.2% (95% CI, 22.1-24.2) for persistent AKI, and 22.0% (95% CI, 21.6-22.5) for AKD. The adjusted HRs for CKD were 1.23 (1.17-1.30) for persistent AKI and 1.33 (1.28-1.39) for AKD when compared with rapid reversal AKI. Among the 59,949 individuals without prevalent CVD, the overall 20-year risks of CVD were 36.0% (95% CI, 34.0-38.0) for rapid reversal AKI, 33.2% (95% CI, 31.6-34.9) for persistent AKI, and 32.2% (95% CI, 31.4-33.0) for AKD. This corresponded to adjusted HRs of 1.02 (95% CI, 0.96-1.09) for persistent AKI and 0.97 (95% CI, 0.93-1.02) for AKD when compared with rapid reversal AKI. Findings were consistent across outcomes of atrial fibrillation or flutter, stroke, and hypertension. For ischemic heart disease and heart failure, persistent AKI was associated with adjusted HRs of 1.10 (95% CI, 1.01-1.20) and 1.13 (95% CI, 1.05-1.20), respectively, and AKD with adjusted HRs of 1.08 (95% CI, 1.02-1.15) and 1.08 (95% CI, 1.02-1.13), respectively, compared with rapid reversal AKI. Conclusion In conclusion, longer AKI durations were associated with increased long-term rates of CKD. AKI duration was not associated with rates of overall CVD; however, rates of ischemic heart disease and heart failure increased with longer AKI durations. The distinct increase in rates of CKD and specific CVDs with longer AKI durations illustrates the potential for using AKI duration as a risk marker when planning nephrology follow-up after AKI. Further studies examining whether interventions to shorten AKI duration prevent outcomes are warranted.

#4771 PROGNOSTIC RELEVANCE OF ELECTROCARDIOGRAPHIC ABNORMALITIES ACCORDING TO EGFR CATEGORIES

Abstract Background and Aims Electrocardiogram (ECG) abnormalities are associated with adverse cardiovascular outcomes in patients with chronic kidney disease (CKD), but their prognostic relevance according to estimated glomerular filtration rate (eGFR) categories remains unexplored. This study investigated the associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) according to different strata of renal function. Method This was a retrospective cohort study including 310.060 individuals aged ≥16 years from the Copenhagen General Practitioners' Laboratory that had an available digital ECG and creatinine measurement within 7 days from 2001–2015. eGFR was calculated using The Chronic Kidney Disease Epidemiology Collaboration equation, and data were cross-linked with Danish nation-wide healthcare registries to gain information on medication, comorbidity, and fatal CVD. ECG abnormalities were categorized as either no abnormalities, minor (first-degree atrioventricular block, incomplete bundle branch block or corrected QT prolongation) or major (left ventricular hypertrophy, atrial fibrillation/flutter, bundle branch block, Q waves, or ST-T deviations), as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. ECG abnormalities and their association with fatal CVD were compared across strata of renal function [eGFR (ml/min/1.73m2) &amp;gt;90, 61–90, 46–60, 31–45, 16–30 and ≤15] based on multivariable Cox-regression analysis adjusted for age, sex, and comorbidities. Counterfactual G-estimation of Hazard Ratios (HRs) standardized to age and sex was performed to estimate 5-year absolute risk of fatal CVD. Results The median age was 55 [IQR, 41-69] years and 46% were male. Median study follow-up time was 10.3 [IQR, 6.7-14.4] years. A total of 47,249 (17.9%) of the included patients had an eGFR &amp;lt;60. The rate of fatal CVD according to ECG abnormalities and their adjusted HRs is shown in Fig. 1, while 5-year standardized risk of fatal CVD is depicted in Fig. 2. Generally, having minor or major ECG abnormalities, conferred a worse prognosis across all eGFR strata, with the highest 5-year absolute risk of fatal CVD being observed among patients with major ECG abnormalities and an eGFR between 31–45 [19% (95% CI, 18–20%)], eGFR 16–30 [25% (95% CI, 24–26%)] or an eGFR ≤15 [27.5% (95% CI, 24–31%)], Fig. 1–2. Conclusion In a population-based setting, having minor or major ECG abnormalities were associated with an increased risk of fatal CVD across all strata of renal function. Patients with an eGFR ≤45 and major ECG abnormalities represent a high-risk population, that might benefit from careful monitoring and cardiovascular risk management.

Statins and cardiovascular disease outcomes: before and during the COVID-19 pandemic (SCOBAC): meta-analysis and systematic review of large populations

Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide, both due to heart and vascular disease. In Indonesia alone, 470,000 deaths are estimated each year due to CVD. Based on the latest guideline, statins are highly recommended in the prevention of CVD. Objective: To assess the role of statins in reducing CVD rates, and all-cause mortality, before and during the COVID-19 pandemic respectively. Methods: Literature search was performed from 1994 – 2021. Data extraction was in the form of Major Adverse Cardiac Events (MACEs) before the pandemic, and all-cause mortality, before and during the COVID-19 pandemic. Literature of medical database extracted based on inclusion and exclusion criteria. The research analyzed two study designs: clinical trials for pre-pandemic and observational studies for pandemics. Results: After critical appraisal, 23 clinical trials and 9 observational studies were included in the data analysis. Statins played a role in reducing MACEs before the pandemic (OR: 0.62, p &lt; 0.05, 95% CI 0.60 – 0.74, I2 = 91%). However, there was no significance between the groups receiving statins and those without statins in reducing mortality during the pandemic (RR: 0.97, p &gt; 0.05, 95% CI 0.90 – 1.04). Conclusion: Statins have been shown to statistically reduce mortality before the COVID-19 pandemic and further studies are needed during the pandemic. Government policies need to consider the lack of screening for dyslipidemia and appropriate statin treatment in the primary care setting, especially during the pandemic.

A nomogram diagnostic cardiovascular disease in patients with erythrodermic psoriasis in Chinese.

Patients with erythrodermic psoriasis (EP) are associated with an increased risk of cardiovascular disease (CVD), because of the more severe inflammation in the skin areas. This study aimed to develop a diagnostic model for the risk of CVD in EP patients based on the available features and multidimensional clinical data. A total of 298 EP patients from Beijing Hospital of Traditional Chinese Medicine were retrospectively included in this study from May 5th, 2008, to March 3rd, 2022. Of them, 213 patients were selected as the development set by random sampling, and clinical parameters were analyzed by univariate and backward stepwise regression. Whereas the remaining 85 patients were randomly selected as the validation set. The model performance was later assessed in terms of discrimination, calibration, and clinical usefulness. In the development set, the CVD rate was 9%, which was independently correlated with age, glycated albumin (GA>17%), smoking, albumin (ALB<40 g/L), and lipoprotein(a) (Lp(a)>300 mg/L). The area under the ROC curve (AUC) value was 0.83 (95% confidence interval CI, 0.73,0.93). For the validation set of EP patients, the AUC value was 0.85 (95%CI, 0.76,0.94). According to decision curve analysis, our model exhibited favorable clinical applicability. EP patients with age, GA>17%, smoking, ALB<40 g/L, and Lp(a)>300 mg/L are associated with a higher risk of CVD. The nomogram model performs well in predicting the probability of CVD in EP patients, which may help improve perioperative strategies and good treatment outcomes.

Familial predisposition to cardiovascular disease and death in patients with an out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Rigshospitalet Introduction Familial predisposition to cardiovascular disease (CVD) and death among patients with out-of-hospital cardiac arrest (OHCA), is sparsely described in current literature. A higher rate of events in first-degree relatives might imply an increased risk of future cardiac arrest and could provide vital improvements in prevention of sudden cardiac death. Therefore, investigation of CVD and death in family of OHCA-victims is needed. Purpose Determine familial predisposition to CVD and death in patients with OHCA. Methods This study used the nationwide Danish Cardiac Arrest Registry to identify all patients with OHCA (probands) of presumed cardiac origin from 2001-2014 and &amp;lt;70 years of age at time of OHCA. First-degree relatives were identified using the Danish Family Relations Database. We included probands with at least one identifiable first-degree relative. Date of OHCA was defined as index for first-degree relatives. The probands were stratified in age groups (0-18, 19-29, 30-49, and 50-69 years at OHCA) and CVD and death among first-degree relatives was assessed in each group. CVD was defined as diagnosis with any ICD-10 I00-I51 code (hypertension (I10-I14) excluded) and CVD-death defined as death with CVD being the main cause. Probands were matched with a background population (1:4) on age and sex. First-degree relatives of the background population were identified and stratified similarly to those of probands. Rates of familial predisposition to CVD and death in probands was compared to the background population. Results We identified 5,443 probands (75% male, median age 51 years) with 16,260 first-degree relatives; 10,207 parents (48.2% fathers, median age 71 years) and 6,053 full siblings (52.7% brothers, median age 47.2 years). Parents to probands had a higher rate of CVD (27.5% vs. 21.9%), a higher mortality rate (51.4% vs. 38.4%) and death more often caused by CVD (39.9% vs. 34.1%) compared to parents of the background population (p&amp;lt;0.001 for all). Stratified by age groups, probands in groups 19-29, 30-49 and 50-69 all had a higher rate of mortality among their parents compared to corresponding groups in the background population (bar diagram in fig.1). Siblings to probands also had a higher rate of CVD (4.9% vs. 2.9%, p&amp;lt;0.001), a higher rate of mortality (3.5% vs. 2.0%, p&amp;lt;0.001), and death more often caused by CVD (16.9% vs. 12.4%, p=0.19) compared to siblings of the background population. Stratified by age group, probands in groups 30-49 and 50-69 both had a higher mortality rate among their siblings compared to corresponding groups in the background population (bar diagram in fig.2). Conclusion Familial predisposition to both cardiovascular disease and death is more prevalent in patients with an out-of-hospital cardiac arrest compared to the background population. These results indicate that, cardiovascular disease and death of first-degree relatives is important risk factors for sudden cardiac arrest in the family.

Higher incidence of cardiovascular-kidney complications in Chinese with youth-onset type 2 diabetes versus youth-onset type 1 diabetes attenuated by control of cardio-metabolic risk factors: A population-based prospective cohort study in Hong Kong

AimsTo determine and compare the incidence of diabetes complications in Chinese with youth-onset type 2 and type 1 diabetes. MethodsWe conducted a population-based prospective cohort study, including 1,260 people with type 2 diabetes and 1,227 with type 1 diabetes diagnosed at age < 20 years who underwent metabolic and complication assessment in Hong Kong Hospital Authority between 2000 and 2018. They were followed for incident cardiovascular disease (CVD), end-stage kidney disease (ESKD) and all-cause death until 2019. Multivariable Cox regression analysis was applied to compare the risks of these complications in type 2 versus type 1 diabetes. ResultsPeople with type 1 diabetes (median age: 20 years, median diabetes duration: 9 years) and type 2 diabetes (median age: 21 years, median diabetes duration: 6 years) were followed for a mean period of 9.2 and 8.8 years respectively. The risks of CVD (HR [95 % CI] 1.66 [1.01–2.72]) and ESKD (HR 1.96 [1.27–3.04]) but not death (HR 1.10 [0.72–1.67]) were higher in type 2 versus type 1 diabetes, adjusted for age at diagnosis, diabetes duration and sex. The association became nonsignificant with further adjustment for glycaemic and metabolic control. Youth-onset type 2 diabetes conferred mortality excess (standardized mortality ratio 4.15 [3.28–5.17]) to age- and sex-matched general population. ConclusionsPeople with youth-onset type 2 diabetes had higher incidence rates of CVD and ESKD than type 1 diabetes. The excess risks in type 2 diabetes were removed after adjusted for cardio-metabolic risk factors.

Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.

The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time. We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models. A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63). Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.

Prevalence, hematological parameters, and coagulation profiles: Cardiovascular diseases statistics in the Asir region, Saudi Arabia.

To determine the prevalence of cardiovascular disease (CVD) types in the Asir region of Saudi Arabia and the importance of hematological testing for CVD patients in the context of disease management. This retrospective study comprised 416 CVD patients, and samples were divided based the type of CVD. The Mann Whitney U test was used to compare patients' hematological markers and coagulation profiles to those of healthy controls. The rate of ischemic heart disease (IHD) was 80.7% that of other CVDs, and the rate of ST-elevation myocardial infarction (STEMI) was 37.3% the rate of CVD. Significant differences were observed in the hematological and coagulation parameters of CVD patients compared to the control group. White blood cells (WBC) were significantly higher in STEMI, non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and heart failure (HF) groups. Red blood cells (RBC) were significantly lower in STEMI, NSTEMI, UA, chronic coronary syndrome (CCS), HF, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Red distribution width (RDW) was significantly greater in the HF, DCM, and ICM groups. Prothrombin time (PT) was significantly higher in the STEMI, HF, and DCM groups. ST-elevation myocardial infarction has a higher prevalence rate among CVD patients in the Asir region. Both coagulation and hematological indicators have high potential utility as CVD diagnostic and prognostic markers.

Cardiovascular outcomes after curative prostate cancer treatment: A population-based cohort study.

To investigate differences in cardiovascular disease (CVD) morbidity and mortality after radical prostatectomy or definitive radiotherapy with or without androgen deprivation therapy (ADT). We used population-based data from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Cause of Death Registry including 19 289 men ≤80 years diagnosed with non-metastatic prostate cancer during 2010-2019. Patients were treated with radical prostatectomy or definitive radiotherapy. We used competing risk models to compare morbidity from overall CVD, acute myocardial infarction (AMI), cerebral infarction, thromboembolism, and CVD-specific mortality for the overall cohort and stratified by prognostic risk groups. After a median follow-up time of 5.4 years (IQR 4.6 years), there were no differences in adjusted rates of AMI, cerebral infarction, and CVD-specific death between radical prostatectomy and definitive radiotherapy in any of the prognostic risk groups. Rates of overall CVD (0.82; 95% CI 0.76-0.89) and thromboembolism (0.30; 95% CI 0.20-0.44) were lower for definitive radiotherapy than radical prostatectomy during the first year of follow-up. After this overall CVD rates (1.19; 95% CI 1.11-1.28) were consistently higher across all risk groups in patients treated with definitive radiotherapy, but there were no differences regarding thromboembolism. During the first years after treatment, no differences were found in rates of AMI, cerebral infarction, and CVD-specific death between radiotherapy and radical prostatectomy in any of the prognostic risk groups. This suggests that ADT use in combination with radiotherapy may not increase the risks of these outcomes in a curative setting. The increased overall CVD rate for definitive radiotherapy after the first year indicates a possible relationship between definitive radiotherapy and other CVDs than AMI and cerebral infarction.

A review of research on the intersection between breast cancer and cardiovascular research in the Women's Health Initiative (WHI).

Both obesity and metabolic syndrome are linked to increased incidence of type 2 diabetes, cardiovascular disease (CVD), and cancers of the breast (post-menopausal), and other obesity-related cancers. Over the past 50 years, the worldwide prevalence of obesity and metabolic syndrome has increased, with a concomitant higher incidence of associated co-morbidities and mortality. The precise mechanism linking metabolic syndrome to increased cancer incidence is incompletely understood, however, individual components of metabolic syndrome have been linked to increased breast cancer incidence and worse survival. There is a bidirectional relationship between the risk of CVD and cancer due to a high burden of shared risk factors and higher rates of CVD among cancer survivors, which may be impacted by the pro-inflammatory microenvironment associated with metabolic syndrome and cancer-directed therapies. The Women's Health Initiative (WHI) is an excellent resource to study a dual relationship between cancer and CVD (cardio-oncology) with extensive information on risk factors and long-term outcomes. The purpose of this review is to provide an overview of research on cardio-oncology conducted utilizing WHI data with focus on studies evaluating both breast cancer and CVD including shared risk factors and outcomes after cancer. The review also includes results on other obesity related cancers which were included in the analyses of breast cancer, articles looking at cancer after heart disease (reverse cardio-oncology) and the role of Clonal Hematopoiesis of Indeterminate Potential (CHIP) as a shared risk factor between CVD and cancer. A summary of pertinent WHI literature helps to delineate the direction of future research evaluating the relationship between CVD and other cancer sites, and provides information on the opportunity for other novel analyses within the WHI.

Regional Disparities of Cardiovascular Risk Factors and Major Cardiovascular Events in Non-electively Hospitalized Young Adults.

Cardiovascular diseases contribute to considerable morbidity and mortality in the USA. We sought to establish regional disparities across the nation contributing to cardiovascular disease (CVD) among non-elective young adult hospitalizations. The National Inpatient Sample (2019) was utilized to identify the incidence of non-elective hospitalizations among young adults (18-44 yrs) and analyze the burden of CVD risk factors and outcomes (MACCE; all-cause mortality, AMI, cardiac arrest and stroke) in different US regions. A total of 5,833,930 (median age 32 [26-37] years) non-elective admissions were recorded; plurality from the south (39.6%). Most admissions were white (51.4%) and female (65.5%) amid all regions. The burden of CVD risk factors was significantly higher in the South followed by the Mid-west regions. The South had the highest and the Northeast had the lowest rates of MACE (2.9% vs 2.3%) and stroke (1.0% vs 0.8%). The risk of AMI was high for the south and Midwest regions (1.1%). All-cause mortality was highest in South and West regions (0.7%). Multivariate adjusted odds for these cardiovascular events were higher in the West (aOR 1.22; 95%CI 1.12-1.33) followed by South (aOR 1.16; 95%CI 1.07-1.26) regions. This population-based study assessing non-elective admissions in the young revealed a higher burden of CVD risk factors and rate of MACCE in the South compared to other areas of the USA. Regional policies should be tailored to the local CVD risk burden.

Circulating ketone bodies and cardiovascular outcomes: the MESA study.

Ketone bodies (KB) are an important alternative metabolic fuel source for the myocardium. Experimental and human investigations suggest that KB may have protective effects in patients with heart failure. This study aimed to examine the association between KB and cardiovascular outcomes and mortality in an ethnically diverse population free from cardiovascular disease (CVD). This analysis included 6796 participants (mean age 62 ± 10 years, 53% women) from the Multi-Ethnic Study of Atherosclerosis. Total KB was measured by nuclear magnetic resonance spectroscopy. Multivariable-adjusted Cox proportional hazard models were used to examine the association of total KB with cardiovascular outcomes. At a mean follow-up of 13.6 years, after adjusting for traditional CVD risk factors, increasing total KB was associated with a higher rate of hard CVD, defined as a composite of myocardial infarction, resuscitated cardiac arrest, stroke, and cardiovascular death, and all CVD (additionally included adjudicated angina) [hazard ratio, HR (95% confidence interval, CI): 1.54 (1.12-2.12) and 1.37 (1.04-1.80) per 10-fold increase in total KB, respectively]. Participants also experienced an 87% (95% CI: 1.17-2.97) increased rate of CVD mortality and an 81% (1.45-2.23) increased rate of all-cause mortality per 10-fold increase in total KB. Moreover, a higher rate of incident heart failure was observed with increasing total KB [1.68 (1.07-2.65), per 10-fold increase in total KB]. The study found that elevated endogenous KB in a healthy community-based population is associated with a higher rate of CVD and mortality. Ketone bodies could serve as a potential biomarker for cardiovascular risk assessment.

Association between preeclampsia in daughters and risk of cardiovascular disease in parents

Preeclampsia and cardiovascular disease (CVD) might share heritable underlying mechanisms. We investigated whether preeclampsia in daughters is associated with CVD in parents. In a register-based cohort study, we used Cox regression to compare rates of CVD (ischemic heart disease, ischemic stroke, myocardial infarction) in parents with ≥ 1 daughters who had preeclampsia and parents whose daughters did not have preeclampsia in Denmark, 1978–2018. Our cohort included 1,299,310 parents, of whom 87,251 had ≥ 1 daughters with preeclampsia and 272,936 developed CVD during 20,252,351 years of follow-up (incidence rate 135/10,000 person-years). Parents with one daughter who had preeclampsia were 1.19 times as likely as parents of daughters without preeclampsia to develop CVD at age < 55 years (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.13–1.25). Having ≥ 2 daughters who had preeclampsia yielded an HR of 1.88 (95% CI 1.39–2.53). The corresponding HRs for CVD at ≥ 55 years of age were 1.13 (95% CI 1.12–1.15) and 1.27 (95% CI 1.16–1.38). Patterns of association were similar for all CVD subtypes. Effect magnitudes did not differ for mothers and fathers (p = 0.52). Analyses by timing of preeclampsia onset in daughters suggested a tendency toward stronger associations with earlier preeclampsia onset, particularly in parents < 55 years. Preeclampsia in daughters was associated with increased risks of CVD in parents. Increasing strength of association with increasing number of affected daughters, equally strong associations for mothers and fathers, and stronger associations for CVD occurring before age 55 years suggest that preeclampsia and CVD share common heritable mechanisms.