Rates Of Cardiovascular Risk Factors Research Articles

Longitudinal Management of Cardiovascular Risk Factors Among Postpartum Women.

Background: Pregnancy-related cardiovascular (CV) conditions, including hypertensive disorders of pregnancy (HDP) and gestational diabetes (GDM), are associated with increased long-term CV risk. Methods: This retrospective cohort study defined the prevalence of HDP and GDM within a large, academic health system in the southeast United States between 2012 and 2015 and described health care utilization and routine CV screening up to 1-year following delivery among those with pregnancy-related CV conditions. Rates of follow-up visits and blood pressure, hemoglobin A1c (HbA1c), and lipid screening in the first postpartum year were compared by provider type and pregnancy-related CV condition. Results: Of the 6027 deliveries included, 20% were complicated by HDP and/or GDM. Rates of pre-pregnancy CV risk factors were high, with a significantly higher proportion of pre-pregnancy obesity among women with HDP than in normal pregnancies. Those with both HDP/GDM had the highest rates of follow-up by 1-year postpartum, yet only half of those with any pregnancy-related CV condition had any follow-up visit after 12 weeks. Although most (70%) of those with HDP had postpartum blood pressure screening, less than one-third of those with GDM had a repeat HbA1c by 12 months. Overall, postpartum lipid screening was rare (<20%). Conclusion: There is a high burden of pregnancy-related CV conditions in a large U.S. academic health system. Although overall rates of follow-up in the early postpartum period were high, gaps in longitudinal follow-up exist. Low rates of CV risk factor follow-up at 1 year indicate a missed opportunity for early CV prevention.

Neighborhood Environmental Burden and Cardiovascular Health in the US

Cardiovascular disease is the leading cause of death in the US. However, little is known about the association between cumulative environmental burden and cardiovascular health across US neighborhoods. To evaluate the association of neighborhood-level environmental burden with prevalence of cardiovascular risk factors and diseases, overall and by levels of social vulnerability. This was a national cross-sectional study of 71 659 US Census tracts. Environmental burden (EBI) and social vulnerability indices from the US Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry were linked to the 2020 CDC PLACES data set. Data were analyzed from March to October 2023. The EBI, a measure of cumulative environmental burden encompassing 5 domains (air pollution, hazardous or toxic sites, built environment, transportation infrastructure, and water pollution). Neighborhood-level prevalence of cardiovascular risk factors (hypertension, diabetes, and obesity) and cardiovascular diseases (coronary heart disease and stroke). Across the US, neighborhoods with the highest environmental burden (top EBI quartile) were more likely than those with the lowest environmental burden (bottom EBI quartile) to be urban (16 626 [92.7%] vs 13 414 [75.4%]), in the Midwest (5191 [28.9%] vs 2782 [15.6%]), have greater median (IQR) social vulnerability scores (0.64 [0.36-0.85] vs 0.42 [0.20-0.65]), and have higher proportions of adults in racial or ethnic minority groups (median [IQR], 34% [12-73] vs 12% [5-30]). After adjustment, neighborhoods with the highest environmental burden had significantly higher rates of cardiovascular risk factors than those with the lowest burden, including hypertension (mean [SD], 32.83% [7.99] vs 32.14% [6.99]; adjusted difference, 0.84%; 95% CI, 0.71-0.98), diabetes (mean [SD], 12.19% [4.33] vs 10.68% [3.27]; adjusted difference, 0.62%; 95% CI, 0.53-0.70), and obesity (mean [SD], 33.57% [7.62] vs 30.86% [6.15]; adjusted difference, 0.77%; 95% CI, 0.60-0.94). Similarly, neighborhoods with the highest environmental burden had significantly higher rates of coronary heart disease (mean [SD], 6.66% [2.15] vs 6.82% [2.41]; adjusted difference, 0.28%; 95% CI, 0.22-0.33) and stroke (mean [SD], 3.65% [1.47] vs 3.31% [1.12]; adjusted difference, 0.19%; 95% CI, 0.15-0.22). Results were consistent after matching highest and lowest environmentally burdened neighborhoods geospatially and based on other covariates. The associations between environmental burden quartiles and cardiovascular risk factors and diseases were most pronounced among socially vulnerable neighborhoods. In this cross-sectional study of US neighborhoods, cumulative environmental burden was associated with higher rates of cardiovascular risk factors and diseases, although absolute differences were small. The strongest associations were observed in socially vulnerable neighborhoods. Whether initiatives that address poor environmental conditions will improve cardiovascular health requires additional prospective investigations.

Global molecular calcium score: is there a link between sodium fluoride uptake and cardiovascular risk burden?

Abstract Background Sodium fluoride (18F-NaF) uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification both in atherosclerotic plaques and the aortic valve. Purpose We aimed to evaluate global cardiac microcalcification activity with 18F-NaF, as a measure of the microcalcification burden, in high cardiovascular (CV) risk patients. Additionally, as an exploratory endpoint, we evaluated the association between global cardiac microcalcification and diastolic dysfunction. Methods High CV-risk individuals without previous CV events from a single centre were prospectively scanned with 18F-NaF PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS), which was calculated by summing the product of mean standardized uptake value and volume of the region of interest on every slice within the borders of the heart. The result was then divided by the number of slices to adjust for the volume. Results We included sixty-five patients with a mean age of 64.0 ± 9.0 years and 38.5% females. There was a high rate of CV risk factors, including hypertension (95.4%), diabetes (84.6%), dyslipidemia (78.5%), obesity (58.5%), smoking (26.2%) chronic kidney disease (18.5%), and family history of premature coronary disease (9.2%). The mean 10-year risk of fatal and nonfatal cardiovascular events predicted by ASCVD risk score was 30.54 ± 18.4. Median GMCS was 221.42 [IQR 144.55-317.58]. Individuals with &amp;gt; 5 CV risk factors (46.2%) had increased overall GMCS compared to those with a lower number of CV risk factors (295.29, IQR 159.37-356.87 vs 186.16, IQR 122.57-281.78; p=0.03). Thirty-three patients underwent diastolic dysfunction evaluation by echocardiography. All patients had normal left ventricle ejection fraction, mean of 62.86 ± 3.58%. Mean E/A was 0.88 ± 0.27, mean septal e’ velocity 0.07 ± 0.02 m/s, mean lateral e’ velocity 0.08 ± 0.02 m/s, and mean average E/e’ 10.7 ± 3.3. The mean peak tricuspid regurgitation velocity was 2.14 ± 0.59 m/s and the median indexed left atrium volume was 37, IQR 29-44mL/m2. After applying the algorithm for diagnosis of diastolic dysfunction in subjects with normal ejection fraction, 21.2% had diastolic dysfunction and 36.4% had a normal diastolic function, while 42.4% were indeterminate. There was no correlation between echocardiographic variables of diastolic function and GMCS, except for indexed left atrium volume (r = 0.83, p&amp;lt;0.01). There was no association between GMCS and diastolic function categories. Conclusions In a high CV risk cohort, the global cardiac microcalcification assessed by GMCS was associated with the burden of CV risk factors. Additionally, despite a strong positive correlation between GMCS and indexed left atrium volume, we found no association between GMCS and echocardiographic variables of diastolic function.

Increased incidence of cancer metastasis in young patients with ischaemic heart disease

Abstract Background Heart disease has been linked to an increased risk of developing certain types of cancer. However, while cancer metastasis is the primary determinant of cancer prognosis, the association between heart disease and cancer metastasis has never been studied in humans. Methods We evaluated 22,057 self-referred adults, free of cancer and IHD at baseline, who were screened in preventive healthcare as private individuals. To eliminate the cases of silent cancer, we implicated a one-year blanking period at the start of the follow-up. Cancer and mortality data were available for all subjects from national registries. Then, multivariable Cox regression model with IHD as a time-dependent covariate was used to evaluate the association of IHD with metastatic cancer during follow-up. Finally, we implicated the same models in evaluating the differences in risk between young (age&amp;lt;55) and old adults. Results During a median follow-up of 6.5 years (Interquartile range 3-13 years), 913 subjects developed IHD and 929 subjects developed metastatic cancer. Compared with subjected who did not develop IHD during follow-up, subjects who developed IHD during follow-up were 64% more likely to develop metastatic cancer during follow-up, in a univariate model (95% CI 1.15-2.36, p=0.0006). Multivariable analysis with adjustment for common risk factors yielded consistent results such that IHD was associated with 50% increased risk of metastatic cancer (Fig-A, p=0.005). Moreover, IHD was associated with poor survival of cancer patients with and without metastasis (HR=1.75 and 1.65, p&amp;lt;0.001 for both). Subgroup analysis demonstrated that the association of IHD with the risk of metastatic cancer was age-dependent: the association was more significant among younger subjects below 55 years of age (Fig-B, n=17,433, n(IHD)=433, HR=2.24, p=0.011), compared with older subjects (n=4624, n(IHD)=480, HR=0.91, p=0.711; p for interaction = 0.085). Notably, IHD emerged as a risk factor for metastatic cancer in younger adults (&amp;lt;55) despite lower rate of cardiovascular risk factors. Conclusions We show, for the first time, that ischaemic heart disease is associated with increased and independent risk of metastatic cancer. Furthermore, we demonstrated that the risk is age-dependent and more pronounced among patients younger than 55. Understanding this relationship could lead to advances in cardiovascular and cancer treatment and could ultimately help to improve patient outcomes.

Abstract 14103: Neighborhood Environmental Burden and Cardiovascular Health in the United States

Introduction: Little is known about the association between cumulative environmental burden and cardiovascular health. Methods: This national study of 71,659 US census tracts linked the CDC environmental burden index and social vulnerability index (SVI) to 2020 PLACES. Mixed-effects linear regression models were used to determine associations between cumulative environmental burden (air pollution, hazardous/toxic sites, built environment, transportation infrastructure, water pollution) and cardiovascular risk factors (hypertension, diabetes, obesity) and diseases (coronary heart disease, stroke) after adjustment for age, sex, SVI, rurality, region, and health care access. Results: Neighborhoods with the highest environmental burden (quartile 4), compared to those with the lowest burden (quartile 1), had greater SVI scores (0.64 vs 0.42) and a higher proportion of racial/ethnic minorities (34% vs 12%). After adjustment, quartile 4 neighborhoods had significantly higher rates of cardiovascular risk factors than quartile 1 neighborhoods, including hypertension (32.8% vs 32.1%, adjusted difference: 0.84% [95% CI: 0.71-0.98]), diabetes (12.2% vs 10.7%, 0.62% [0.53-0.70]), and obesity (33.6% vs 30.9%, 0.77% [0.60-0.94]). Similarly, quartile 4 neighborhoods had higher rates of cardiovascular diseases (Figure) . Results were consistent after geospatial- and covariate-based matching of quartile 4 and 1 neighborhoods. Associations between increasing environmental burden quartiles and cardiovascular risk factors and diseases were significantly more pronounced in most versus least socially vulnerable neighborhoods. Conclusion: Across US neighborhoods, cumulative environmental burden was dose-dependently associated with higher rates of cardiovascular risk factors and diseases, particularly in socially vulnerable communities. Efforts addressing poor environmental conditions may improve cardiovascular health and reduce inequities.

Abstract 16897: The Association of Lipoprotein(a) With Major Adverse Cardiovascular Events Among Individuals With and Without Baseline Atherosclerotic Cardiovascular Disease: The Mass General Brigham Lp(a) Registry

Introduction: Lipoprotein(a) [Lp(a)] is associated with increased atherosclerotic cardiovascular disease (ASCVD) events. However, whether the optimal Lp(a) threshold for risk-assessment should differ based on baseline ASCVD status is unknown. Hypothesis: To assess the association between Lp(a) and major adverse cardiovascular events (MACE) among patients with and without a history of ASCVD. Methods: Retrospective cohort of patients with Lp(a) measured at two academic medical centers in Boston, MA from 2000-2019. To assess the association of Lp(a) with incident MACE (cardiovascular mortality, myocardial infarction, or ischemic stroke), the following Lp(a) percentile groups were generated: 1 st -50 th (0 - 41 nmol/L; reference), 51 st -70 th (42 - 111 nmol/L), 71 st -90 th (112 - 215 nmol/L), 91 st -100 th (&gt;216 nmol/L). Individuals with severe renal dysfunction or a malignant neoplasm were excluded. Cox proportional hazards modeling was used to assess the association of Lp(a) percentile group with MACE. Results: After applying eligibility criteria, 16,419 patients (median age 60, 41% female) were analyzed with a median follow up of 11.9 years. Patients with ASCVD were older and had higher rates of cardiovascular risk factors. Among the 10,181 (62%) patients with a history of ASCVD, individuals in the 71 st -90 th and 91 st -100 th percentile groups had similarly increased hazards of MACE (adjusted HR = 1.33, p&lt;0.001 and adjusted HR = 1.34, p&lt;0.001 respectively). Among the 6,238 individuals without baseline ASCVD, only individuals in the 91 st -100 th Lp(a) percentile group had a significantly increase hazard of MACE (adjusted HR 2.05, p&lt;0.001), Figure . Conclusions: In a large, contemporary US cohort, elevated Lp(a) is independently associated with long-term MACE among individuals with and without baseline ASCVD. Our results suggest that the Lp(a) threshold for risk assessment may be lower in secondary prevention when compared with primary prevention.

Mechanical Thrombectomy in Cervical Artery Dissection-Related Stroke

Cervical artery dissection (CeAD) causing a large vessel occlusion (LVO) stroke might represent a procedural challenge for mechanical thrombectomy (MT) impacting on its effects. The aim of the present study was to analyze safety, reperfusion rates and clinical outcome of CeAD patients treated by MT and compare these results with those obtained in non-CeAD patients. All consecutive LVO stroke patients undergoing MT between June 2015 and June 2021 at our University Stroke Center were analyzed. Baseline and procedural characteristics, recanalization rates, adverse events, and functional outcome of CeAD patients were compared with non-CeAD patients. MT was performed on 375 patients, 20 (5.3%) were diagnosed with CeAD. These patients were younger (52.9±7.8 vs 72.5±12.9 years, p<0.001), and showed lower rates of cardiovascular risk factors. In CeAD patients, tandem occlusions were more frequent (65.0% vs 14.4%, p<0.001), groin to reperfusion time was longer (93.6 ± 34.9 vs 68.3 ± 50.2 minutes, p=0.01) and general anesthesia was more frequently utilized (70.0% vs 27.9%, p<0.001). Recanalization rates (TICI 2b-3: 100.0% vs 88.5%) and MT-related adverse events (10.0% vs 10.7%) did not differ between the groups, while functional outcome was better in CeAD patients (mRS 0-2 at 3 months: 85.0% vs 62.0%, p=0.038). Although CeAD represents a procedural challenge, MT constitutes a safe and effective treatment for CeAD patients with LVO stroke.

Cardiovascular health and potential cardiovascular risk factors in young athletes.

Cardiovascular disease remains the most common cause of death worldwide, and early manifestations are increasingly identified in childhood and adolescence. With physical inactivity being the most prevalent modifiable risk factor, the risk for cardiovascular disease is deemed low in people engaging in regular physical exercise. The aim of this study was to investigate early markers and drivers of cardiovascular disease in young athletes pursuing a career in competitive sports. One hundred and five athletes (65 males, mean age 15.7 ± 3.7 years) were characterized by measurement of body impedance to estimate body fat, blood pressure (BP), carotid femoral pulse wave velocity (PWV) to evaluate arterial elasticity, ergometry to assess peak power output, echocardiography to calculate left ventricular mass, and blood tests. Systolic BP was elevated in 12.6% and thereby more than twice as high as expected for the normal population. Similarly, structural vascular and cardiac changes represented by elevated PWV and left ventricular mass were found in 9.5% and 10.3%. Higher PWV was independently associated with higher systolic BP (β = 0.0186, p < 0.0001), which in turn was closely correlated to hemoglobin levels (β = 0.1252, p = 0.0435). In this population, increased left ventricular mass was associated with lower resting heart rate (β = -0.5187, p = 0.0052), higher metabolic equivalent hours (β = 0.1303, p = 0.0002), sport disciplines with high dynamic component (β = 17.45, p = 0.0009), and also higher systolic BP (β = 0.4715, p = 0.0354). Despite regular physical exercise and in the absence of obesity, we found an unexpected high rate of cardiovascular risk factors. The association of PWV, systolic BP, and hemoglobin suggested a possible link between training-induced raised hemoglobin levels and altered vascular properties. Our results point toward the need for thorough medical examinations in this seemingly healthy cohort of children and young adults. Long-term follow-up of individuals who started excessive physical exercise at a young age seems warranted to further explore the potential adverse effects on vascular health.

Advancing heart failure research using machine learning

Advancing heart failure research using machine learning

Atrial Fibrillation and Stroke: Predictors of Anticoagulation Therapy Modification (P6-5.010)

<h3>Objective:</h3> Analyze predictors of therapy modification in patients with atrial fibrillation (AF) experiencing stroke despite adequate anticoagulation (AC) for secondary stroke prevention. <h3>Background:</h3> The ideal strategy to treat persons with AF experiencing stroke despite adequate AC with direct-acting anticoagulants (DOACs) or vitamin K antagonists (VKAs) is not known. <h3>Design/Methods:</h3> Patients admitted between 2012 and 2021 at our hospital with stroke despite AC for AF were enrolled. Baseline characteristics including National Institute of Health Stroke Scale (NIHSS), AC therapy, modified Rankin Scale (mRS), occurrence of intracerebral hemorrhage (ICH) on first image, and discharge antithrombotic therapy were collected. Logistic regression analyses were performed to identify factors associated with the decision to change AC after stroke. <h3>Results:</h3> 595 patients were included. Of these, 291 (48.9%) were on DOACs therapy and 125 (43%) had their AC modified from DOACs at discharge (16% switched to warfarin, 58.4% to no AC and 25.6% to antiplatelet agents or enoxaparin). Of the 304 patients using VKAs, 53% had their discharge antithrombotic modified, with 26% switched to DOACs. Therapy change in patients on DOACs was associated with older age (OR 1.04, 95%CI 1.01–1.06), higher admission NIHSS (OR 1.06, 95%CI 1.03–1.10), discharge mRS ≥3 (OR 3.51, 95%CI 1.98–6.49), and ICH (OR 5.67, 95%CI 2.99–11.35). For warfarin, therapy change was associated with older age (OR 1.03, 95%CI 1.01 1.06), higher NIHSS (OR 1.04, 95%CI 1.00–1.07), heart failure (OR 1.90, 95%CI 1.13–3.27) and ICH (OR 3.81, 95%CI 1.93–8.14). Patients discharged with DOACs, compared to those with warfarin, were more likely to be younger, had higher rates of cardiovascular risk factors and ICH, and lower admission NIHSS. <h3>Conclusions:</h3> Older age, more severe strokes, and occurrence of ICH were associated with the decision to change or stop AC. Variation in practice exists and further research is needed to assess the clinical impact of antithrombotic therapy modification in this population. <b>Disclosure:</b> Mrs. Carvalho de Oliveira has nothing to disclose. Mr. Webb has nothing to disclose. Dr. Ponciano has nothing to disclose. Prof. Farias Da Guarda has nothing to disclose. Ms. Yilmaz has nothing to disclose. An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (Education) with Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals. Dr. Asad has nothing to disclose.

Cardiovascular outcomes of cancer patients in rural Australia.

Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital. This was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis. 268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p ≤ 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p ≤ 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself. There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.

Poststroke Disability: Association Between Sex and Patient-Reported Outcomes.

Ischemic stroke (IS) is a leading cause of long-term disability with sex-specific differences in outcomes. Identifying the influential factors that contribute to sex-specific disparities in stroke outcomes, therefore, holds potential to develop individualized interventions for reducing long-term disability. Further, investigating the association between sex and Patient-Reported Outcome Measures (PROMs) provides additional information on the individual impact and heterogeneity of IS. We aimed to identify sex-specific differences in stroke outcomes and relationship with PROMs in IS patients with 3-month follow-up. Between February 2017 and February 2020, a total of 410 patients admitted with IS to the Massachusetts General Hospital, in Boston, were enrolled in this prospective cohort. At 3-month poststroke, patients were assessed for Barthel Index, modified Rankin Scale, and PROM-10 questionnaires. T scores for physical and mental health were determined from the summing of PROM-10 responses in each domain. Regression analysis was performed to identify sex-specific determinants of functional and patient-reported outcomes. At baseline, 242 participants were male (mean age, 65 years) and 168 were female (mean age, 70 years). Groups had similar rates of cardiovascular risk factors, admission National Institutes of Health Stroke Scale, and discharge modified Rankin Scale. At follow-up, male participants were more likely to have better rates of T Physical and Barthel Index. In regression analysis, PROMs T Physical (odds ratio, 1.06; P=0.01), Barthel Index (odds ratio, 1.06; P=0.01), and modified Rankin Scale score of ≥2 (odds ratio, 2.60; P=0.01) were associated with female sex. Female sex was also associated with lower scores for PROMs Physical subcomponents and with patient-reported general health and emotional problems. Women have worse outcomes after ischemic stroke, including objective measures of functional disability and patient-reported outcomes. Incorporating PROMs into IS outcome measures may offer additional insight into sex-specific differences in stroke recovery and outcomes.

Association of Statins With Nonculprit Coronary Lesions and Adverse Events (from the LRP Study)

Intravascular ultrasound and near-infrared spectroscopy can identify vulnerable coronary atherosclerotic plaques. In this LRP (Lipid-Rich Plaque) substudy, we evaluated the association of statins with nonculprit lesion arterial wall lipidic content and subsequent nonculprit major adverse cardiac events. Patients from the LRP study with known statin use were included. We divided the patients into 2 cohorts-"statin therapy" and "statin-naïve"-upon presentation and then described the intravascular ultrasound and near-infrared spectroscopy analysis based on maximum 4-mm lipid core burden index (maxLCBI4mm). At 2-year follow-up, the patients' clinical events were assessed based on their statin regimen change upon discharge. Finally, patients were stratified by statin intensity based on discharge regimen. Among the 1,526 patients, 1,120 were on a statin versus 396 who were statin-naive upon presentation. Patients on a statin at baseline had a statistically higher rate of cardiovascular risk factors, patients who were statin-naive were more likely to present with an acute coronary syndrome, and the maxLCBI4mm did not differ between the 2 groups (315.67 ± 181.36 vs 325.55 ± 192.16; p=0.359). These findings were consistent in a secondary analysis evaluating statin intensity. Patients who were switched from no statin to a statin had improved outcomes (nonculprit major adverse cardiac events) compared with patients who were on a statin at baseline without change. In conclusion, despite having a higher burden of nonlipid-related cardiac co-morbidities, patients on a statin at baseline had similar maxLCBI4mm with patients who were statin-naive, regardless of intensity. Initiating a statin at discharge provides the most benefit for events related to nonculprit lesions.

Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure

Abstract Background Although Brain Natriuretic Peptide (BNP) provides strong prognostic information of an unfavorable outcome in patients with acute heart failure (AHF), there is little information of its relevance as a biomarker for outcomes in COVID-19 and its complications Purpose To evaluate the association of increased BNP levels with complications and in-hospital mortality in a cohort of hospitalized COVID-19 patients. Methods The study included COVID-19 patients with data on BNP levels included in the ISACS COVID-19 registry. The population was categorized according to the presence of peak BNP levels ≥100 pg/mL during hospitalization. Primary outcomes included in-hospital mortality, AHF or acute respiratory failure (ARF, defined as PiO2/FiO2&amp;lt;300 mmHg or need for mechanical ventilation). Calculations were conducted using age and sex-adjusted multivariable logistic regression analyses. Results were also stratified according to presence or absence of cardiovascular disease (CVD) history. Differences between subgroups were verified for statistical significance using test for interaction. Results Of the 1152 patients included in the study, 615 (53.4%) had elevated BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8, p-value&amp;lt;0.001), had higher rates of cardiovascular risk factors (82.9% vs 57.7%, p-value&amp;lt;0.001) and presented more frequently with a prior history of CVD (either ischemic heart disease, cerebrovascular disease, venous thromboembolism, atrial fibrillation or a history of revascularization) (50.1% vs 27.5%, p-value&amp;lt;0.001). No sex differences were observed. When considering outcomes, BNP levels ≥100 pg/mL were associated with increased rates of in-hospital mortality (32.9% vs 4.9%, p-value&amp;lt;0.001), even after adjustment for demographic characteristics (OR: 7.35; 95% CI: 4.75–11.40; p-value&amp;lt;0.001). High BNP levels were also strongly associated with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; p-value&amp;lt;0.001), a correlation that persisted both in patients with and without a prior CVD history (p for interaction=0.29). Of note, patients with elevated BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–3.6; p-value&amp;lt;0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1; p-value&amp;lt;0.001). Conclusions In COVID-19, blood BNP level not only appears to be predictor of in-hospital mortality and AHF but was also independently associated with an increased risk of ARF. This finding supports the routine use of BNP in all patients admitted to hospital for COVID-19, regardless of a prior history of CVD. Funding Acknowledgement Type of funding sources: None.

Cardiovascular health status in Chinese Cardiologists: China Cardiologist Heart Survey II

Background and purpose: Cardiologists represent a subset of the population with the highest degree of awareness to cardiovascular diseases (CVD), and thus should have low exposure to modifiable risks and low CVD prevalence. However, the status of cardiovascular health in Chinese cardiologists remains unknown. Methods: China Cardiologist Heart Survey II is a nation-wide cross-sectional survey on licensed cardiologists in Chinese mainland. It was conducted between August 2020 and November 2021. An online questionnaire was used to acquire demographic and lifestyle information, cardiovascular risk factors, CVD status, and medications. Crude prevalence of cardiovascular risk factors, organ damage, and CVD were calculated and compared between sexes and between sub-specialties. Age-weighted prevalence of cardiovascular risk factors were compared to that in the general Chinese population in the literature. Results: The final analysis included a total of 15,827 cardiologists at the age of 25 to 60 years from 31 provinces. The median age was 38 years and 8650 (54.7%) were men. The most common cardiovascular risk factor was family history of premature CVD (20.4%), followed by hypertension (12.4%), hyperlipidemia (10.6%), overweight/obesity (8.3%), smoking (7.3%), and diabetes (2.4%). The most common sub-clinical organ damages included carotid plaque (3.4%) and microalbuminuria (1.2%). The rate of confirmed coronary artery disease was 0.4%. The rate of arrhythmia was 3.1%. The rate of obstructive sleep apnea syndrome was 2.2%. The rate of cardiovascular risk factors and organ damage was higher in men versus in women, and higher in interventional versus non-interventional cardiologists. In comparison to the data reported for the general population in China, cardiologists had lower age-weighted prevalence of hypertension (15.2% vs. 23.2%), diabetes (3.1% vs. 10.9%), hyperlipidemia (12.3% vs. 40.4%), obesity (2.1% vs. 11.9%), and smoking (7.7% vs. 27.7%). Conclusions: In comparison to the general public, cardiologists in Chinese mainland had much lower age-weighted prevalence of cardiovascular risk factors, but there is substantial room for further improvement, particularly in male and interventional cardiologists.

S-ICD in heart failure patients: real-world data from a multicenter, european analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Data on patients with heart failure (HF) and subcutaneous implantable cardioverter defibrillator (S-ICD) are very scarce and limited to a single prospective analysis from the UNTOUCHED trial. Purpose Aim of this study was to assess clinical outcomes of the S-ICD in HF patients, comparing them with a no-HF population, in a real-world analysis from the largest European retrospective S-ICD registry (ELISIR registry). Methods All consecutive patients undergoing S-ICD implantation at 20 European institutions enrolled in the ELISIR registry were used for the current analysis. According to European Guidelines, the registry population was classified into two groups: the HF cohort (further classified as HF with reduced and mid-range ejection fraction – HFrEF and HFmrEF) vs the no-HF group. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device-related complications during follow-up were assessed. Results A total of 1409 patients from the ELISIR registry were included in this analysis; HF patients represented 57.3% of the entire cohort (n=701, 86.9% HFrEF; n=106,13.1% HFmrEF). As expected, the HF cohort showed significantly higher rates of cardiovascular risk factors and comorbidities when compared to the no-HF cohort. Over a median follow-up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p=0.689). 133 complex ventricular arrhythmias were adequately recognized and treated in the overall cohort, showing similar rates of appropriate shocks (9.2% vs 9.8%, p=0.689). Inappropriate and effective shocks-free survival has been represented in Figure 1, showing Kaplan-Meier estimates comparing HF vs no-HF patients, also stratified by left ventricular ejection fraction (LVEF). The impact of baseline and procedural characteristics on the primary outcome was tested through univariable and multivariable Cox regression analysis in HF patients; at multivariate analysis, only age (HR=0.974 [0.955–0.992], p=0.005), LVEF (HR=0.954 [0.926-0.984], p=0.003), ARVC (HR=3.364 [1.206-9.384], p=0.020) and smart pass algorithm "on" (HR=0.321 [0.184-0.560], p&amp;lt;0.001) remained associated with inappropriate shocks (Figure 2). A low number of patients (n=76) experienced device-related complications, more frequently in the HF cohort (6.2% vs 3.8%, p=0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p=0.381), pocket infection (1.9% vs 0.8%, p=0.107), pocket hematoma (3.2% vs 2.8%, p=0.668). Conclusion The rate of inappropriate shocks seems to be comparable in both HF and non-HF patients implanted with S-ICD. However, the rate of device-related complications was slightly more frequent in HF patients.

Abstract P193: Life’s Simple 7 Risk Factors and Cardiovascular Disease Among Gender Minority Populations in the 2019 BRFSS

Gender minority (GM) populations encompass individuals who identify with a gender different from their sex assigned at birth. This includes transgender adults, which make up 0.6% of the U.S. population. Despite cardiovascular disease being the leading cause of morbidity and mortality worldwide, there is little research on the cardiovascular health of GM populations. GM adults may be at higher risk for myocardial infarction, coronary heart disease, and stroke compared to their cisgender peers due to minority stress and the impact of stigma on health. The Behavioral Risk Factor Surveillance System (BRFSS) is a federal survey administered by state health departments and the CDC. The BRFSS has offered an optional standardized Sexual Orientation and Gender Identity (SOGI) module with measures to identify transgender respondents since 2014 and 30 states included the module in 2019. Life’s Simple 7 criteria are used in preventive medicine and public health to describe ideal cardiovascular health. The seven associated risk factors are smoking, obesity, physical inactivity, poor dietary habits, high cholesterol, high blood pressure, and high blood glucose. The 2019 BRFSS included core modules related to each of the risk factors and therefore provides a unique opportunity to investigate the cardiovascular health of GM respondents. BRFSS data (N = 177,322) were used to determine prevalence rates of cardiovascular risk factors and disease among GM compared to cisgender adults. R was used to conduct weighted estimates and regressions comparing behavioral and clinical cardiometabolic risk factors and events by gender identity (cisgender male, cisgender female, transgender male-to-female, transgender female-to-male, and transgender gender nonconforming). On average, GM respondents were younger, more racially/ethnically diverse, less likely to have graduated college, less likely to be straight, and reported lower annual household incomes than cisgender males or females. After adjusting for age, race/ethnicity, education, income, and sexual orientation, gender nonconforming transgender adults were less likely than both cisgender males (adjusted odds ratio = 1.17, 95% confidence interval: (1.02, 1.34)) and cisgender females (1.15 (1.00, 1.32)) to report exercise in the last 30 days. Gender nonconforming transgender adults were less likely to report a diagnosis of diabetes than cisgender males (0.97 (0.94, 1.00)). No significant differences between gender minority and majority adults were detected for cardiovascular events after adjusting for demographic variables and Life’s Simple 7 risk factors. This may be due to the age difference between the cisgender and GM groups, since older adults have higher risk of cardiovascular disease. Analyses may have been underpowered due to small GM sample sizes, emphasizing the importance of all states including the optional standardized SOGI module.

A prospective cohort study examining exposure to incarceration and cardiovascular disease (Justice-Involved Individuals Cardiovascular Disease Epidemiology \u2013 JUSTICE study): a protocol paper

BackgroundPeople who have been incarcerated have high rates of cardiovascular risk factors, such as hypertension and smoking, and cardiovascular disease (CVD) is a leading cause of hospitalizations and mortality in this population. Despite this, little is known regarding what pathways mediate the association between incarceration exposure and increased rates of CVD morbidity and especially what incarceration specific factors are associated with this risk. The objective of this study is to better understand CVD risk in people exposed to incarceration and the pathways by which accumulate cardiovascular risk over time.Methods and AnalysisThe Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study is a prospective cohort study of individuals released from incarceration with known cardiovascular risk factors. We are recruiting 500 individuals within three months after release from jail/prison. At baseline we are assessing traditional risk factors for CVD, including diet, exercise, and smoking, and exposure to incarceration-related policies, psychosocial stress, and self-efficacy. Cardiovascular risk factors are measured at baseline through point of care testing. We are following these individuals for the 12 months following the index release from incarceration with re-evaluation of psychosocial factors and clinical risk factors every 6 months. Using these data, we will estimate the direct and indirect latent effects of incarceration on cardiovascular risk factors and the paths via which these effects are mediated. We will also model the anticipated 10-year burden of CVD incidence, health care use, and mortality associated with incarceration.DiscussionOur study will identify factors associated with CVD risk factor control among people released from incarceration. Our measurement of incarceration-related exposures, psychosocial factors, and clinical measures of cardiovascular risk will allow for identification of unique targets for intervention to modify CVD risk in this vulnerable population.

Cardiovascular disease in the elderly: proceedings of the European Society of Cardiology-Cardiovascular Round Table.

The growing elderly population worldwide represents a major challenge for caregivers, healthcare providers, and society. Older patients have a higher prevalence of cardiovascular (CV) disease, high rates of CV risk factors, and multiple age-related comorbidities. Although prevention and management strategies have been shown to be effective in older people, they continue to be under-used, and under-studied. In addition to hard endpoints, frailty, cognitive impairments, and patients' re-assessment of important outcomes (e.g. quality of life vs. longevity) are important aspects for older patients and emphasize the need to include a substantial proportion of older patients in CV clinical trials. To complement the often skewed age distribution in clinical trials, greater emphasis should be placed on real-world studies to assess longer-term outcomes, especially safety and quality of life outcomes. In the complex environment of the older patient, a multidisciplinary care team approach with the involvement of the individual patient in the decision-making process can help optimize prevention and management strategies. This article aims to demonstrate the growing burden of ageing in real life and illustrates the need to continue primary prevention to address CV risk factors. It summarizes factors to consider when choosing pharmacological and interventional treatments for the elderly and the need to consider quality of life and patient priorities when making decisions.

Serum uric acid levels on admission and prognosis of acute coronary syndrome: a bi-institutional report

Objective: This study aimed to determine the association between the baseline serum uric acid (SUA) level and the short-term outcomes of patients with acute coronary syndrome (ACS). &#x0D; Methods: In this retrospective, bi-institutional study, patients with a diagnosis of ACS were recruited and followed-up for 30 days regarding the development of major adverse cardiovascular and cerebrovascular events (MACCEs). The associations between the SUA level upon admission and cardiovascular morbidities and patient prognosis were examined using univariate and multivariate analyses. &#x0D; Results: A total of 145 patients with ACS, with a mean age of 67.5±12.2 years, were recruited in this study. The rates of cardiovascular risk factors were higher in patients with elevated SUA levels. A cumulative MACCE was reported in 42 (29%) patients (19.5% in normal individuals and 39.7% in patients with elevated SUA levels, respectively; P=0.007). Based on the receiver operating characteristic (ROC) curve analysis, an on-admission SUA level above 6.9 mg/dL could discriminate patients with MACCE from those without MACCE during 30 days of follow-up (AUC=0.637; 95% CI: 0.553–0.715), with 64.3% sensitivity and 66% specificity. Based on multivariate logistic regression analysis, an elevated SUA level was associated with an increased risk of MACCE (odds ratio, 15.353; 95% CI: 2.026–116.328).&#x0D; Conclusion: In patients with ACS, an elevated baseline SUA level was associated with a higher prevalence of cardiovascular risk factors and morbidities, as well as an increased risk of MACCE in a short-term follow-up.