Recurrent Cardiovascular Disease Events Research Articles

Development and validation of risk prediction model for recurrent cardiovascular events among Chinese: the Personalized CARdiovascular DIsease risk Assessment for Chinese model.

Cardiovascular disease (CVD) is a leading cause of mortality, especially in developing countries. This study aimed to develop and validate a CVD risk prediction model, Personalized CARdiovascular DIsease risk Assessment for Chinese (P-CARDIAC), for recurrent cardiovascular events using machine learning technique. Three cohorts of Chinese patients with established CVD were included if they had used any of the public healthcare services provided by the Hong Kong Hospital Authority (HA) since 2004 and categorized by their geographical locations. The 10-year CVD outcome was a composite of diagnostic or procedure codes with specific International Classification of Diseases, Ninth Revision, Clinical Modification. Multivariate imputation with chained equations and XGBoost were applied for the model development. The comparison with Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2°P) and Secondary Manifestations of ARTerial disease (SMART2) used the validation cohorts with 1000 bootstrap replicates. A total of 48 799, 119 672 and 140 533 patients were included in the derivation and validation cohorts, respectively. A list of 125 risk variables were used to make predictions on CVD risk, of which 8 classes of CVD-related drugs were considered interactive covariates. Model performance in the derivation cohort showed satisfying discrimination and calibration with a C statistic of 0.69. Internal validation showed good discrimination and calibration performance with C statistic over 0.6. The P-CARDIAC also showed better performance than TRS-2°P and SMART2. Compared with other risk scores, the P-CARDIAC enables to identify unique patterns of Chinese patients with established CVD. We anticipate that the P-CARDIAC can be applied in various settings to prevent recurrent CVD events, thus reducing the related healthcare burden.

Abstract 16892: Statin Utilization and Recurrent Cardiovascular Disease Events in a Secondary Prevention Cohort of Older Adults

Introduction: The ACC/AHA guidelines recommend that patients with established ASCVD should be on high intensity statins for secondary prevention. Prior data suggests that older adults (>75 years) are sub-optimally treated for both primary and secondary prevention of ASCVD events. We investigated guideline directed statin intensity (GDSI) use, associated LDL cholesterol levels and ASCVD outcomes in a cohort of older adults in a large healthcare network. Methods: EMR data was abstracted to assess statin prescriptions between 2010-2020 amongst adults with known ASCVD (CAD, ischemic stroke/TIA or PAD). Prescriptions of statins as GDSI (high intensity), <GDSI (low/moderate intensity), and no statin were assessed and stratified by age groups. LDL-C levels across the follow up time were calculated. Cox regression models were used to assess HRs (Hazard Ratios) for repeat ASCVD event (MI and stroke/TIA) and all cause death, stratified by age and GDSI treatment. Results: Over ~5y follow up, amongst adults aged>75 years (n=11,596), less than half (49.6%) were on GDSI and only ~54% older adults achieved LDL-c<70mg/dL. Compared to GDSI use, older adults on <GDSI had a greater incidence of recurrent MI [HR>75y 1.59; 95% CI (1.30-1.95)], stroke [HR>75 1.659; 95% CI (1.21-2.24)] and mortality [HR>75 1.88; 95% CI (1.57-2.25)]; all p<0.01 in <GDSI group vs GDSI group. GDSI use had a greater reduction of MI and mortality in older adults than younger counterparts [Table 1]. Conclusions: In this contemporary healthcare network, GDSI use for secondary prevention and LDL-C<70 mg/dL was suboptimal amongst all age groups. Any statin use conferred a greater reduction in MI and mortality amongst older adults >75y. Systemic interventions for guideline implementation and optimal statin use in older adults with ASCVD should be explored further.

Societal health and economic burden of cardiovascular diseases in the population with type 2 diabetes in Qatar. A 10-year forecasting model.

To predict the future health and economic burden of cardiovascular disease (CVD) in type 2 diabetes (T2D) in Qatar. A dynamic multistate model was designed to simulate the progression of fatal and non-fatal CVD events among people with T2D in Qatar aged 40-79 years. First CVD events [i.e. myocardial infarction (MI) and stroke] were calculated via the 2013 Pooled Cohort Equation, while recurrent CVD events were sourced from the REACH registry. Key model outcomes were fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years, total direct medical costs and total productivity loss costs. Utility and cost model inputs were drawn from published sources. The model adopted a Qatari societal perspective. Sensitivity analyses were performed to test the robustness of estimates. Over 10 years among people with T2D, model estimates 108 195 [95% uncertainty interval (UI) 104 249-112 172] non-fatal MIs, 62 366 (95% UI 60 283-65 520) non-fatal strokes and 14 612 (95% UI 14 472-14 744) CVD deaths. The T2D population accrued 4 786 605 (95% UI 4 743 454, 4 858 705) total years of life lived and 3 781 833 (95% UI 3 724 718-3 830 669) total quality-adjusted life years. Direct costs accounted for 57.85% of the total costs, with a projection of QAR41.60 billion (US$11.40 billion) [95% UI 7.53-147.40 billion (US$2.06-40.38 billion)], while the total indirect costs were expected to exceed QAR30.31 billion (US$8.30 billion) [95% UI 1.07-162.60 billion (US$292.05 million-44.55 billion)]. The findings suggest a significant economic and health burden of CVD among people with T2D in Qatar and highlight the need for more enhanced preventive strategies targeting this population group.

Changes in Physical Activity and Incidence of Nonfatal Cardiovascular Events in 47 153 Survivors of Myocardial Infarction.

Background The majority of patients survive the acute phase of myocardial infarction (MI) but have an increased risk of recurrent cardiovascular disease (CVD) events. To be regularly physically active or change activity level is associated with a lower risk of all-cause mortality. The objective was to explore to what extent physical activity (PA) levels or change in PA levels during the first year post-MI was associated with any recurrent nonfatal CVD events and specific CVD events (eg, MI, ischemic stroke, and vascular dementia). Methods and Results This cohort study among MI survivors was based on Swedish national registries between 2005 and 2020. PA levels were self-rated at 2 and 12 months post-MI, and patients were classified into remaining physically inactive, increasing, decreasing, or remaining active. A total of 6534 nonfatal CVD events occurred during 6 years of follow-up among the 47 153 included patients. In fully adjusted analyses, the risk of any nonfatal CVD event was lower (P<0.05) among patients remaining active (37%), increasing (22%), or decreasing (18%) PA level compared with remaining inactive. Compared with remaining inactive, the risk of recurring MI and stroke was lower (P>0.05) among remaining active (41% versus 52%, respectively), increasing (20% versus 35%, respectively), or decreasing PA level (24% versus 34%, respectively). For vascular dementia, patients remaining physically active had an 80% lower risk compared with remaining inactive (P<0.05). Conclusions Remaining physically active or change in PA levels during the first year post-MI was associated with a lower risk of recurrent nonfatal CVD events. This emphasizes the importance of supporting patients to continue to be or become physically active.

Residual cardiovascular risk, use of standard care treatments, and achievement of treatment goals in patients with cardiovascular disease

BackgroundResidual risk management in patients with previous cardiovascular disease (CVD) is a relevant issue. Objectives: 1) to assess the residual risk of patients with CVD using the new scores developed to predict recurrent CVD events (SMART score/SMART-REACH model); 2) to determine the use of therapies with cardiovascular benefit and the achievement of therapeutic goals in patients with very high residual risk. MethodsA multicenter, descriptive, cross-sectional study was performed. Individuals over 18 years of age with CVD were included consecutively. The 10-year risk of recurrent events was estimated using the SMART score and the SMART-REACH model. A value ≥ 30% was considered “very high risk”. ResultsIn total, 296 patients (mean age 68.2 ± 9.4 years, 75.7% men) were included. Globally, 32.43% and 64.53% of the population was classified as very high risk by the SMART score and the SMART-REACH model, respectively. Among patients classified as very high risk by the SMART score, 45.7% and 33.3% were treated with high-intensity statins and reached the goal of LDL-C <55 mg/dL, respectively. The results were similar when evaluating very high patients according to the SMART-REACH model (high-intensity statins: 59.7%; LDL-C <55 mg/dL: 43.9%). Few very high-risk patients with diabetes were receiving glucose-lowering drugs with demonstrated cardiovascular benefit. ConclusionIn this secondary prevention population, the residual risk was considerable. Underutilization of standard care treatments and failure to achieve therapeutic goals were evident even in subjects with very high residual risk.

C-Reactive Protein and Risk of Cardiovascular Events and Mortality in Patients with Various Cardiovascular Disease Locations

Anti-inflammatory drugs reduce the risk of cardiovascular events in patients with coronary artery disease (CAD), but less is known about the relation between inflammation and outcomes in patients with cerebrovascular disease (CeVD), peripheral artery disease (PAD), and abdominal aortic aneurysm (AAA). This study assessed the association between C-reactive protein (CRP) and clinical outcomes in patients with CAD (n=4,517), CeVD (n=2,154), PAD (n=1,154), and AAA (n=424) from the prospective Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease study. The primary outcome was recurrent cardiovascular disease (CVD), defined as myocardial infarction, ischemic stroke, or cardiovascular death. Secondary outcomes were major adverse limb events and all-cause mortality. Associations between baseline CRP and outcomes were assessed using Cox proportional hazards models adjusted for age, sex, smoking, diabetes mellitus, body mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, and glomerular filtration rate. Results were stratified by CVD location. During a median follow-up of 9.5years, 1,877 recurrent CVD events, 887 major adverse limb events, and 2,341 deaths were observed. CRP was independently associated with recurrent CVD (hazard ratio [HR] per 1mg/L 1.08, 95% confidence interval [CI] 1.05 to 1.10), and all secondary outcomes. Compared with the first quintile of CRP, HRs for recurrent CVD were 1.60 (95% CI 1.35 to 1.89) for the last quintile ≤10mg/L and 1.90 (95% CI 1.58 to 2.29) for the subgroup with CRP >10mg/L. CRP was associated with recurrent CVD in patients with CAD (HR per 1mg/L 1.08, 95% CI 1.04 to 1.11), CeVD (HR 1.05, 95% CI 1.01 to 1.10), PAD (HR 1.08, 95% CI 1.03 to 1.13), and AAA (HR 1.08, 95% CI 1.01 to 1.15). The association between CRP and all-cause mortality was stronger for patients with CAD (HR 1.13, 95% CI 1.09 to 1.16) than for patients with other CVD locations (HRs 1.06 to 1.08; p=0.002). Associations remained consistent beyond 15years after the CRP measurement. In conclusion, greater CRP is independently associated with an increased risk of recurrent CVD and mortality, irrespective of previous CVD location.

Offering a lifestyle intervention to women of premenopausal age as primary prevention for cardiovascular disease? – assessing its cost-effectiveness

BackgroundThere is limited evidence of cost-effective primary prevention interventions for cardiovascular disease (CVD) in young women. This study aimed to assess the value for money of primary prevention of CVD in this population.MethodsA Markov microsimulation model consisting of both first-ever and recurrent CVD events was developed to simulate the lifetime intervention impact on cost and health outcomes in women of premenopausal age (30 to 54 years) from the Australian healthcare system perspective. The latest wave of the Australian National Health Survey defined the modelled population’s characteristics. The intervention effectiveness of a lifestyle modification program involving changes in diet and physical activity demonstrated to be effective in this population was sourced from a systematic review and meta-analysis. The first-ever and recurrent CVD probabilities were derived from the CVD risk calculators accounting for socio-demographic and clinical characteristics. Costs and utility weights associated with CVD events and long-term management post-CVD were informed by national statistics/published literature. Sensitivity analyses were undertaken to examine the robustness of base case results.ResultsThe lifestyle modification program was associated with both higher costs and benefits (in terms of quality-adjusted life years, QALYs) as a primary prevention measure of CVD in premenopausal women, with an ICER of $96,377/QALY or $130,469/LY. The intervention led to fewer first-ever (N = −19) and recurrent CVD events (N = -23) per 10,000 women over the modelled life horizon. The avoided cost due to reduced hospitalisations (−$24) and management (−$164) of CVD could partially offset the cost associated with the intervention ($1560). Sensitivity analysis indicated that time horizon, starting age of the intervention, discount rate, and intervention effectiveness were the key drivers of the results. If the intervention was scaled up to the national level (N = 502,095 at-risk premenopausal women), the total intervention cost would be $794 million with $95 million in healthcare cost-savings.ConclusionOffering a lifestyle modification program to premenopausal women in Australia as primary prevention of CVD is not cost-effective from a healthcare system perspective. We should continue to search for new or adapt/optimise existing effective and cost-effective primary prevention measures of CVD for women.

Sarab Rog Ka Aukhad Naam

“Sarab rog ka aukhad naam” (“The recitation of God’s name cures all diseases”) is a quotation from the Guru Granth Sahib —the Sikh Holy Book— highlighting Sikhism’s perspective on illness, referring to the Guru Granth Sahib as the primary source of guidance regarding issues of health. However, in the decades since this quotation was first written, the burden of chronic illness in the Sikh community has become more severe. Notably, cardiovascular disease (CVD) has become increasingly prevalent within the Sikh and broader South Asian (SA) populations. Several studies have outlined how the SA community has the highest prevalence of CVD in Canada, along with a higher CVD mortality rate compared to other ethnic groups.&#x0D; Although some biological factors may explain the SA community’s increased risk for CVD, there is no denying the social and psychological factors at play. It has been established that sedentary behaviour, depression, and psychological stress increase CVD risk. As such, the fact that SA individuals in Canada are more likely to be sedentary and diagnosed with depression than their non-SA counterparts only intensifies their likelihood of developing CVD. Moreover, much of the SA population in the West exists as visible racial and religious minorities, subjecting them to additional social and psychological harms, including stress stemming from migration and discrimination, all of which contribute to CVD. SA individuals in Canada are also more likely to experience lower quality-of-life one year post-surgical interventions for CVD-related events, as well as increased recurrent CVD events. That is, not only are SAs more likely to develop CVD, but their disease prognosis appears to be worse than non-SAs. As such, improving CVD management procedures for the SA population would prove valuable, given the significant prevalence of the disease in this community.&#x0D; More specifically, areas with a prominent SA population, like the Peel Region of Ontario, should consider providing CVD interventions specific to SAs, such as culturally sensitive rehabilitation programs. As SA is a broad term encompassing many distinct ethnic and cultural backgrounds, this paper recommends focusing on interventions tailored to a specific population within the SA community, to avoid cultural generalizations.&#x0D; For the purposes of this paper, the focus population is the Sikh community, defined specifically as individuals with an ethnic background from the Punjab region in India who practice Sikhism. The Sikh community as a target population is optimal as it falls under the broader SA community and it is one of the largest religious minorities in the Peel Region; thus, this plan would ensure that a sizeable community in the Peel Region receives access to treatment that acknowledges their religious and cultural diversity.10 Peel Regional Health should design a rehabilitation plan specific to the Sikh community for patients diagnosed with CVD, or recovering from a CVD-related incident. However, it is critical to note that there are certain challenges associated with implementing such a program, specifically relating to funding issues and the program’s perceived practicality.

Sarab Rog Ka Aukhad Naam: Outlining A Sikh-Specific Cardiac Rehabilitation Program in Peel Region

“Sarab rog ka aukhad naam” (“The recitation of God’s name cures all diseases”) is a quotation from the Guru Granth Sahib —the Sikh Holy Book— highlighting Sikhism’s perspective on illness, referring to the Guru Granth Sahib as the primary source of guidance regarding issues of health. However, in the decades since this quotation was first written, the burden of chronic illness in the Sikh community has become more severe. Notably, cardiovascular disease (CVD) has become increasingly prevalent within the Sikh and broader South Asian (SA) populations. Several studies have outlined how the SA community has the highest prevalence of CVD in Canada, along with a higher CVD mortality rate compared to other ethnic groups. Although some biological factors may explain the SA community’s increased risk for CVD, there is no denying the social and psychological factors at play. It has been established that sedentary behaviour, depression, and psychological stress increase CVD risk. As such, the fact that SA individuals in Canada are more likely to be sedentary and diagnosed with depression than their non-SA counterparts only intensifies their likelihood of developing CVD. Moreover, much of the SA population in the West exists as visible racial and religious minorities, subjecting them to additional social and psychological harms, including stress stemming from migration and discrimination, all of which contribute to CVD. SA individuals in Canada are also more likely to experience lower quality-of-life one year post-surgical interventions for CVD-related events, as well as increased recurrent CVD events. That is, not only are SAs more likely to develop CVD, but their disease prognosis appears to be worse than non-SAs. As such, improving CVD management procedures for the SA population would prove valuable, given the significant prevalence of the disease in this community. More specifically, areas with a prominent SA population, like the Peel Region of Ontario, should consider providing CVD interventions specific to SAs, such as culturally sensitive rehabilitation programs. As SA is a broad term encompassing many distinct ethnic and cultural backgrounds, this paper recommends focusing on interventions tailored to a specific population within the SA community, to avoid cultural generalizations. For the purposes of this paper, the focus population is the Sikh community, defined specifically as individuals with an ethnic background from the Punjab region in India who practice Sikhism. The Sikh community as a target population is optimal as it falls under the broader SA community and it is one of the largest religious minorities in the Peel Region; thus, this plan would ensure that a sizeable community in the Peel Region receives access to treatment that acknowledges their religious and cultural diversity.10 Peel Regional Health should design a rehabilitation plan specific to the Sikh community for patients diagnosed with CVD, or recovering from a CVD-related incident. However, it is critical to note that there are certain challenges associated with implementing such a program, specifically relating to funding issues and the program’s perceived practicality.

THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH IN SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE

Introduction Patients with established cardiovascular disease (CVD) have a high risk of subsequent CVD events. Monitoring the risk factors is crucial in order to prevent recurrent CVD events. Aim The aim of this study was to develop a protocol for the risk factors of recurrent CVD based on the ICF (The International Classification of Functioning, Disability, and Health) framework. Material and methods An original ICF assessment sheet, which contains risk factors of recurrent CVD, was developed based on up-to-date data from the literature. The evaluation criteria for each category were determined based on recommendations defined in the ESC (European Society of Cardiology), AHA (American Heart Association), EFSD (European Foundation for the Study of Diabetes) and KDIGO (Clinical Practice Guideline for Glomerulonephritis) guidelines. Results The ICF assessment sheet contains CVD risk factor categories such as comorbidities, measures of liver and renal impairment, disorders of carbohydrate and lipid metabolism, pharmacological treatment and lifestyle-related factors. Conclusions The ICF assessment sheet, which contains multiple risk factors for CVD in one place, can make monitoring these parameters to be easier in a doctor’s office.

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

Heart Failure and the Risk of Recurrent Cardiovascular Events in Patients Attending Outpatient Clinics in the United Arab Emirates.

Heart failure (HF) prognosticates a death sentence, and despite recent advances in treatment, long-term outcomes for patients with advanced HF are very poor, with only a 50%-60% survival rate at 5 years. This is alarming for the approximately 26 million people worldwide living with HF. This study aimed to investigate the relationship between HF and the risk of recurrent cardiovascular disease (CVD) events or CVD death among the national population in the United Arab Emirates (UAE). A retrospective study was conducted from April 2008 to September 2019 including 240 patients ≥18 years with a previous vascular event. Patient outcomes such as CVD death, the occurrence of a recurrent vascular event, or until the end of the study period, whichever occurred first. Twenty-three patients (9.6%) had a concomitant diagnosis of HF and this doubled the risk of recurrent CVD events or death over 9 years. HF, age, lower body mass index, and atrial fibrillation were significant predictors of recurrent CVD or mortality. The mean age was 65 years and the risk of a CVD event or death increased at a rate of 3% for every increasing year of age. Patients with HF have approximately a 65% likelihood of survival at 5 years, whereas those without HF have about an 85% at 5-year survival. HF is a strong predictor of recurrent CVD events or mortality in UAE patients with established CVD. Thus, aggressive management of modifiable risk factors for vascular disease through multidisciplinary teams guides clinicians toward meticulous control of CVD risk factors to improve disease prognosis and premature death.

Sleep Apnea and Cardiovascular Disease.

Obstructive sleep apnea (OSA) is associated with incident coronary and cerebral vascular disease. The mechanisms underlying this association are thought to include increased sympathetic nervous system activity, oxidative stress, and systemic inflammation, with these effects mediated in part by elevated blood pressure and impaired glucose metabolism. In observational studies, OSA treatment with positive airway pressure (PAP) is associated with a reduction in cardiovascular disease risk. The aim of this review is to evaluate evidence from recent clinical trials that tested the impact of OSA treatment on major cardiovascular disease outcomes. Multicenter randomized trials have demonstrated a significant, albeit modest, reduction in blood pressure with OSA treatment. Treatment of OSA has generally not demonstrated improvement in type 2 diabetes mellitus, although limited evidence suggests that treatment may be effective in the prediabetic period. However, recent randomized trials of PAP treatment for OSA failed to demonstrate a reduction in incident or recurrent cardiovascular disease events. This may reflect the enrollment of a mostly non-sleepy study sample, as recent evidence suggests that sleepiness is a predictor of adverse cardiovascular outcomes from OSA. PAP treatment of OSA lowers blood pressure and may improve glucose metabolism; however, randomized clinical trials do not indicate a reduction in cardiovascular risk with treatment of minimally symptomatic OSA patients.

Circulating 25-hydroxy-vitamin D and the risk of cardiovascular diseases. Systematic review and meta-analysis of prospective cohort studies

AimsCirculating vitamin D is linked with the risk of cardiovascular disease (CVD). A meta-analysis has yet to explicitly explore correlation between vitamin D and the risk of CVD incidence and recurrent CVD. This meta-analysis examines the association between 25-hydroxy-vitamin D (25(OH)D) and the risk of CVD incidence (fatal, non-fatal, fatal and non-fatal combined events) and the risk of recurrent CVD (fatal, recurrent, and fatal and recurrent combined events). PROSPERO registration-CRD42021251483. Data synthesisA total of 79 studies (46 713 CVD cases in 1 397 831 participants) were included in the meta-analysis, of which 61 studies examined the risk of CVD incidence events, and 18 studies examined risk of recurrent CVD events. The risk of CVD incidence events (RR = 1.34, 95% CI: 1.26–1.43, p < 0.001) and recurrent CVD events (RR = 1.86, 95% CI: 1.46–2.36, p < 0.001) was higher in the lowest than the highest category of circulating 25(OH)D. Dose–response analysis reported a linear association for every 10 ng/ml increment of 25(OH)D and non-fatal CVD incidence events (RR = 0.94; 95% CI = 0.89–0.98, p = 0.005), lower fatal recurrent CVD events (RR = 0.45; 95% CI = 0.32–0.62, p < 0.001) and lower combined recurrent CVD events (RR = 0.80; 95% CI = 0.65–0.97, p = 0.023). A non-linear association was observed between higher 25(OH)D and lower fatal CVD incidence events (P-nonlinear<0.001), lower combined CVD incidence events (P-nonlinear = 0.001), and lower non-fatal recurrent CVD events (P-nonlinear = 0.044). ConclusionsThe lowest category of circulating 25(OH)D was associated with a higher risk of CVD incidence events and recurrent CVD events.

A Mediterranean diet microsimulation modeling in relation to cardiovascular disease burden: the ATTICA and GREECS epidemiological studies

To quantify the changes in 10-year cardiovascular disease (CVD) onset, recurrence, and mortality, in relation to transitioning from low to a higher level of adherence to the Mediterranean diet. An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of the level of adherence to the Mediterranean diet (corresponding to one to ten point increases in MedDietScore) were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Improving adherence to the Mediterranean diet in at least 10% of the population, a significant relative percentage reduction could be observed in 10-year CVD onset, recurrence, and mortality. At least 851 first CVD events, 374 recurrent CVD events, and 205 CVD deaths per 100,000 of the population could be averted or delayed. In addition, Mediterranean diet clustering revealed that scoring higher in fruits, vegetables, whole wheat products, and legumes was more important than achieving higher scores in low consumption of meat and full-fat dairy products against CVD (all HRs in the former cluster were lower than the latter, indicating a stronger protective effect). This microsimulation process confirms the added value of the Mediterranean diet in primary and secondary CVD prevention having great achievements even with modifications in a small part of the population (10%), while challenges the orientation of Mediterranean-diet interventions giving higher weights to plant-based part.

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification.

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50–69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.

MO466A NOVEL PREDICTION MARKER OF 10-YEAR RISK AND LIFETIME RISK OF RECURRENT CARDIOVASCULAR EVENTS IN PATIENTS WITH CKD AND DIABETES MELLITUS

Abstract Background and Aims Chronic kidney disease (CKD) is one of the most prevalent complication of Diabetes Mellitus and patients with both diseases are more exposed to atherosclerosis injury and premature death from cardiovascular disease (CVD). CVD is worsened by inflammation, oxidative stress, lipid accumulation and high-density lipoprotein cholesterol (HDL) reduction: patients with altered lipid metabolism more often present monocyte profile changes, with an altered pro-inflammatory phenotype leading to a significant risk of plaque formation and atherosclerosis. The alteration of the balance between monocyte and HDL, represented by the Monocyte/HDL ratio (MHR), is an easy way to evaluate the inflammatory status and to study appropriate strategies to treat high-risk patients. Method We evaluated 150 consecutive diabetic patients with CKD hospitalized in the Unit of Nephrology and Dialysis of the Policlinic G. Martino of Messina, Italy, with a history of CVD. We used the SMART-REACH SCORE, a model created to estimate life expectancy without recurrent cardiovascular events for individuals with a history of CVD. We performed a retrospective analysis of the MHR status of our patients to study its correlations with the 10-year risk and lifetime risk for myocardial infarction, stroke or vascular death, recurrent CVD events and free life-expectancy if standard care is provided. Results In the entire cohort of patients, MHR appeared to be positively correlated with ten-year risk (ρ=0.469; P &amp;lt;0.0001) (Figure 1) and lifetime risk of myocardial infarction, stroke, or CV death (ρ=0.428; P &amp;lt;0.0001) (Figure 2). Furthermore, patients with higher MHR levels had a significantly smaller number of years of CVD-free life expectancy (ρ=-0.364; P &amp;lt;0.0001) (Figure 3). Conclusion MHR can represent a valid tool to predict the recurrence of CVD in CKD patients with diabetes. This easy-to-perform marker of oxidative stress and CVD risk can be used alone or in a multiple biomarker panel, improving the stratification and management of patients with comorbidities and risk of life- threatening conditions.

A diet-related microsimulation modelling approach in the context of cardiovascular disease prevention: the ATTICA and GREECS epidemiological studies

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003]. Background/Introduction: Among all behaviors, nutrition makes the largest contribution to cardiovascular disease (CVD) morbidity across Europe. Purpose: The aim of the present work was to quantify the changes in 10-year CVD onset or recurrence or mortality, in relation to transitioning from low to higher level of adherence to Mediterranean diet. Methods: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of level of adherence to Mediterranean diet were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Results: Improving the level of adherence to the Mediterranean diet, even in 10% of the population, a significant relative percentage reduction was observed in the 10-year risk for CVD onset, recurrence and mortality, with the observed reductions being higher among women. In particular, at least 851 first CVD events, 374 recurrent CVD events and 205 CVD deaths per 100,000 of population could be averted or delayed. Additionally, Mediterranean diet clustering revealed that high consumption of fruits, vegetables, whole wheat products and legumes was more important than low consumption of meat and full fat dairy products against CVD. Conclusion: This microsimulation process confirms the added value of Mediterranean diet in primary and secondary CVD prevention having great achievements even with small modifications on a population basis, while challenges the orientation of a Mediterranean-diet intervention giving higher weights to plant-based part.

Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p &amp;lt; 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

A Systematic Review of the Association Between Vegan Diets and Risk of Cardiovascular Disease.

ABSTRACTBackgroundPlant-based diets are gaining attention globally due to their environmental benefits and perceived health-protective role. A vegan diet may have cardiovascular benefits; however, evidence remains conflicting and insufficiently assessed.ObjectivesWe evaluated the utility of the vegan diet in cardiovascular disease (CVD) prevention.MethodsWe conducted a systematic review of studies evaluating the association between vegan diets and cardiovascular outcomes. We searched 5 databases (Ovid MEDLINE, EMBASE, Web of Science, Scopus, and OpenGrey) through 31 October 2020. Four investigators independently screened the full texts for inclusion, assessed quality, and extracted data from published reports.ResultsOut of the 5729 identified records, 7 were included, comprising over 73,000 participants, of whom at least 7661 were vegans. Three studies, with at least 73,426 individuals (including at least 7380 vegans), examined risks of primary cardiovascular events (total CVD, coronary heart disease, acute myocardial infarction, total stroke, hemorrhagic stroke, and ischemic stroke) in individuals who followed a vegan diet compared to those who did not. None of the studies reported a significantly increased or decreased risk of any cardiovascular outcome. One study suggested that vegans were at greater risk of ischemic stroke compared to individuals who consumed animal products (HR, 1.54; 95% CI, 0.95–2.48). Yet in another study, vegans showed lower common carotid artery intima-media thickness (0.56 ± 0.1 mm vs. 0.74 ± 0.1 mm in controls; P < 0.001), and in 3 studies of recurrent CVD events, vegans had 0–52% lower rates. Furthermore, endothelial function did not differ between vegans and nonvegans. Using the Grading of Recommendations Assessment, Development and Evaluation approach, evidence was deemed to be of low to very low strength/quality.ConclusionsAmong the Western populations studied, evidence weakly demonstrates associations between vegan diets and risk of CVDs, with the direction of associations varying with the specific CVD outcome tested. However, more high-quality research on this topic is needed. This study was registered at PROSPERO as CRD42019146835.