Risk Factor For Cardiovascular Events Research Articles

Cardiovascular Diseases Risk Reduction And Lifestyle Modification:Cross Sectional Ansalysis Of Patient Responses.

A decrease in cardiovascular event risk with a decrease in total and LDL – cholesterol level is termed as “cholesterol paradox” or “risk factor reversal”. Cardiovascular risk does not have a linear relationship between LDL – cholesterol levels, and other substantial risk factors of cardiovascular events are being disregarded.The aim of this study is, to identify modifiable risk factors of cardiovascular events other than those well proved to cause dyslipidemia. A cross-sectional study was conducted with 652 participants in a tertiary care hospital. Patients were grouped into two, based on the history of cardiovascular events. Demographics and patient responses captured using pre-validated questionnaires were analyzed. 5mL blood samples were collected by venipuncture and lipid profile was estimated. Association between cardiovascular events and explanatory variables. was determined using Chi square test and Odds ratio at 95% confidence intervals. Higher risk of CV events was found among smokers 0.232 [0.144 – 0.373]. Consumption of white sugar, refined oil, processed cold beverages and fast food products increased CV risk respectively. Moreover, total cholesterol, LDL-C and triglycerides were found to decrease after one year of counselling the patients. The classical hypothesis of dyslipidemia induced atherosclerosis may not be the predominant cause of CV events. Herein, we report no association between high fat diet and CV risk while we observed higher risk in consumers of refined and ultra processed food products. However, significant control of cholesterol was observed in patients who shifted to Unrefined food products.

(134) Early Impact of Androgen Deprivation Therapy on Endothelial Function and Metabolic Parameters in Prostate Cancer Patients: A Prospective Study

Abstract Introduction Androgen deprivation therapy (ADT) is considered one of the mainstays in the treatment of prostate cancer. ADT slows cancer progression, alleviates cancer-related symptoms, and is associated with survival gains. Despite these proven benefits, this treatment is related to several side effects, such as increased cardiovascular risk, changes in body composition and various metabolic changes. Although the well-established association between circulating testosterone level and endothelial integrity, the direct effects of ADT on endothelial function remain controversial. Objective This study aimed to investigate the impact of ADT on endothelial function, through the analysis of vascular parameters of the brachial artery and measurement of serum inflammatory markers. It was also our aim to evaluate the early impact of ADT on body composition and metabolic parameters. Methods We prospectively evaluated men with moderate to high-risk prostate cancer treated with ADT from January to December 2022 at our institution. Smokers and those who quit smoking less than five years ago, decompensated diabetics (glycated hemoglobin > 9%) and those who had already had a cardiovascular event were excluded. High-resolution B-mode ultrasound was used to assess vascular diameter and endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery. Our metabolic and inflammatory profile included measurement of serum total cholesterol and fractions, triglycerides, fasting glucose, glycated hemoglobin, basal insulin, C-reactive protein and assessment of body fat distribution through bioelectrical impedance. Subjects were evaluated at baseline and 3 months after starting ADT with goserelin acetate 10.80 mg. Results A total of 32 men were included. The mean age was 69 years and the prevalence of diabetes was 31.25%. FMD demonstrated a worsening trend after ADT, which did not reach statistical significance after 3 months (mean 3.39 ± 6.83 vs 1.16 ± 7.65; p = 0.14) (figure 1). Baseline brachial artery diameter also showed a tendency to worsen with ADT compared to baseline (0.44 ± 0.06 vs 0.42 ± 0.06; p = 0.06). With regard to the metabolic profile, ADT significantly increased insulin resistance: fasting glucose (mean 104.10 ± 18.96 vs 110.60 ± 25.29; p = 0.01), fasting insulin levels (mean 13.05 ± 8.76 vs 16.82 ± 11.36; p = 0.003), glycated hemoglobin (mean 5.89% ± 0.46 vs 6.15% ± 0.67; p = 0.008) and homeostatic model assessment insulin resistance (mean 3.47 ± 2.55 vs 5.05 ± 4.50; p = 0.005) increased significantly after 3 months. Triglycerides concentrations (mean 142.30 ± 69.66 vs 165.50 ± 93.04; p = 0.03) were higher after 3 months of ADT. Abdominal circumference (mean 98.66 ± 10.16 vs 99.76 ± 9.39; p = 0.02) and body mass index (mean 27.46 ± 4.06 vs 27.76 ± 3.89; p = 0.02) also increased after ADT. Conclusions Although not statistically significant, the present study demonstrated a trend towards a decrease in brachial artery FMD. We also observed an important and surprisingly early worsening of the metabolic profile with ADT, especially increased insulin resistance and dyslipidemia, which represent well-established risk factors for cardiovascular events. Disclosure No.

Identifying Risk Factors for Cardiovascular Events Among Active-Duty Service Members and Veterans Prescribed Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).

Oral NSAIDs are widely used analgesic medications for the treatment of musculoskeletal and inflammatory conditions. NSAIDs are associated with adverse effects that arise from COX enzyme inhibition including cardiovascular events. The combined role of patient and prescription factors associated with NSAID use on cardiovascular risk is not well characterized. The purpose of this study is to identify the risk factors with cardiovascular events among NSAID users. This study is a retrospective, nested case-control study, within the DAVINCI database, among active-duty service members and veterans with at least one NSAID pharmacy claim between fiscal year (FY) 2015-FY2020. Inclusion criteria individuals ≥18 years of age received a prescription NSAID for ≥7-day supply and a duration ≥1 month overall. Cases experienced nonfatal myocardial infarction, nonfatal stroke, or new onset heart failure. Ten controls were selected per case. Risk factors were identified through logistic regression modeling. The risk factors with strongest association to the primary outcome included age starting at 45 up to 75 and older, the first 90 days of NSAID exposure, cerebrovascular disease, cardiomyopathy, and history of myocardial infarction. Cox-selectivity and dose did not appear to be clinically significant in their association with cardiovascular events. The results of this study indicate that age, initial NSAID exposure, and comorbidities are more predictive than NSAID-specific factors such as COX-selectivity and dose. The results provide the framework for development of a risk score to improve prediction of NSAID-associated cardiovascular events.

Impact of Chronic Kidney Disease on Major Adverse Cardiac Events in Patients with Acute Myocardial Infarction: A Retrospective Cohort Study

Background: Acute Myocardial Infarction (AMI) results in a reduction in patients’ life expectancy. Different risk factors affect the risk of Major Adverse Cardiac Events (MACE). Although the role of kidney dysfunction in patients with Chronic Kidney Disease (CKD) in cardiac events has been identified, many patients with AMI are unaware of their underlying kidney disease. This study aimed to compare the incidence of adverse cardiovascular events and identify predictors of major adverse cardiovascular events in the medium term among patients with and without renal dysfunction following AMI. Methods: This retrospective cohort study was conducted on 1039 patients who were hospitalized for Acute Myocardial Infarction (AMI) between 2018 and 2019. The patient cohort comprised 314 women (mean age: 69.8 ± 13.2 years) and 725 men (mean age: 60.5 ± 13.8 years). Patient data were obtained from the registry of patients with acute myocardial infarction and the participants were followed up for a minimum of one year following hospital discharge to assess the incidence of MACE. Results: The study found that patients with a Glomerular Filtration Rate (GFR) level below 60 had a significantly higher mortality rate than those with a GFR level of 60 or above (15.7% vs. 3.5%, p < 0.0001). The multivariate analysis showed that Diabetes Mellitus (DM), GFR, and Non-ST Elevation Myocardial Infarction (NSTEMI) are significant risk factors for cardiovascular events. (p = 0.016, p = 0.015, p = 0.006 respectively), while variables such as sex, age, and Hypertension (HTN) were not significant risk factors. There was a negative correlation between GFR and death (0.241 - = r, p < 0.0001) Conclusion: This study highlights the importance of detecting kidney disease during an AMI and managing risk factors for cardiovascular disease to improve health outcomes and reduce the risk of mortality.

Extracellular Histones Promote Calcium Phosphate-Dependent Calcification in Mouse Vascular Smooth Muscle Cells.

Vascular calcification, a major risk factor for cardiovascular events, is associated with a poor prognosis in chronic kidney disease (CKD) patients. This process is often associated with the transformation of vascular smooth muscle cells (VSMCs) into cells with osteoblast-like characteristics. Damage-associated molecular patterns (DAMPs), such as extracellular histones released from damaged or dying cells, are suspected to accumulate at calcification sites. To investigate the potential involvement of DAMPs in vascular calcification, we assessed the impact of externally added histones (extracellular histones) on calcium and inorganic phosphate-induced calcification in mouse VSMCs. Our study found that extracellular histones intensified calcification. We also observed that the histones decreased the expression of VSMC marker genes, while simultaneously increasing the expression of osteoblast marker genes. Additionally, histones treated with DNase I, which degrades dsDNA, attenuated this calcification, compared with the non-treated histones, suggesting a potential involvement of dsDNA in this process. Elevated levels of dsDNA were also detected in the serum of CKD model mice, underlining its potential role in vascular calcification in CKD. Our findings suggest that extracellular histones could play a pivotal role in the vascular calcification observed in CKD.

The J shaped association of age at menarche and cardiovascular events: systematic review and meta-analysis

This study aimed to evaluate the association between age at menarche and cardiovascular (CV) events through a systematic review and meta-analysis of observational studies. A comprehensive literature search covering studies published from January 1, 2000, to October 31, 2023, was conducted in PubMed, MEDLINE, Embase, and Scopus. Twenty-nine observational studies involving 4,931,160 adult women aged 18 years or older were included. The meta-analysis revealed a J-shaped association between age at menarche and CV events. Individuals with menarche at 12–13 years exhibited the lowest risk, while those with younger (≤ 11 years) or older ages (14–15 years and ≥ 16 years) showed an increased risk. Notably, individuals with age at menarche of 16 years and older had the highest risk of CV events. The pooled odds of CV mortality in age at menarche categories 14–15 years and ≥ 16 years were 37% (OR: 1.37, 95% CI 1.14–1.64, I2: 76.9%) and 64% (OR: 1.64, 95% CI 1.20–2.24, I2: 87%) higher than referent age at menarche 12–13 years. No statistically significant difference was found in CV mortality risk between individuals with age at menarche ≤ 11 years and those with age at menarche 12–13 years. The ORs for coronary heart disease were significantly higher for age at menarche ≥ 16 years (35% increase), while no significant difference was found for age at menarche ≤ 11 years or 14–15 years compared to age at menarche 12–13 years. Regarding stroke, the ORs for age at menarche ≤ 11, 14–15, and ≥ 16 years were significantly higher (7%, 24%, and 94% increase, respectively) compared to age at menarche 12–13 years. Dose–response meta-analysis and one-stage random-effect cubic spline models confirmed the J-shaped risk pattern. Meta-regression indicated that age and BMI were not significant sources of heterogeneity. Sensitivity analyses and the absence of publication bias further supported the robustness of the findings. This study concludes that age at menarche is independently associated with CV events, with a J-shaped pattern. The findings underscore the significance of considering menarche age as an independent risk factor for CV events. Further research is warranted to validate these findings and explore potential underlying mechanisms.

Investigation of hemorheological parameters in patients with major depressive disorder.

Hemorheological parameters have been reported to be altered in cardiovascular disease. Major depression has been associated with increased risk of cardiovascular disease. Our hypothesis is that hemorheological parameters are disturbed in major depressive disorder. Major depressive disorder and control groups consisted of 50 subjects. Plasma viscosity, erythrocyte aggregation, erythrocyte deformability, hematological parameters and hematological parameters were examined. Plasma viscosity was statistically significantly higher, erythrocyte elongation index at 0.53 Pa and 0.95 Pa was lower, and MCV, MCH, and MCHC values were also lower in the major depression group (P < 0.05). Elongation index and plasma viscosity were correlated with depressive symptomatology. The increased plasma viscosity and decreased elongation index of erythrocytes indicate an unfavorable hemorheological situation in patients with major depressive disorder compared with healthy controls. The results of this study confirm the findings of studies finding a potential threat to cardiovascular health from major depressive disorder. Increased plasma viscosity and decreased erythrocyte elongation index in depressed patients may be risk factors for cardiovascular events and provide data on the causality of the association between depression and cardiovascular disease.

Glycemic Control Is Associated With Lipid Profile and Atherogenic Index of Plasma in Type 2 Diabetes Mellitus

BACKGROUND: Dyslipidemia is a common complication among type 2 diabetes mellitus (T2DM), and a major risk factor for cardiovascular events. This study aimed to investigate the association of glycemic control with lipid profile and atherogenic index of plasma (AIP) in patients with T2DM. METHODS: A total of 565 adult diabetic men were included in this cross-sectional study. Glycemic and lipid parameters were measured using an auto-analyzer with standard methods. Subjects were categorized into good (HbA1c &lt; 7), inadequate (HbA1c 7-7.9), and poor (HbA1c ≥ 8). The association between glycemic control and lipid profile was evaluated using the analysis of variance and covariance. RESULTS: A significant association was found between poor glycemic control and total cholesterol, triglyceride, and AIP. Significance remained after adjustment for confounders. Results indicated no relationship between glycemic control and other lipid parameters before or after adjustment. CONCLUSION: Findings from this study underlined the importance of glycemic control in T2DM patients for targeted interventions to prevent cardiovascular events. Further studies are needed to confirm these results.

Glycemic Control Is Associated With Lipid Profile and Atherogenic Index of Plasma in Type 2 Diabetes Mellitus

BACKGROUND: Dyslipidemia is a common complication among type 2 diabetes mellitus (T2DM), and a major risk factor for cardiovascular events. This study aimed to investigate the association of glycemic control with lipid profile and atherogenic index of plasma (AIP) in patients with T2DM. METHODS: A total of 565 adult diabetic men were included in this cross-sectional study. Glycemic and lipid parameters were measured using an auto-analyzer with standard methods. Subjects were categorized into good (HbA1c &lt; 7), inadequate (HbA1c 7-7.9), and poor (HbA1c ≥ 8). The association between glycemic control and lipid profile was evaluated using the analysis of variance and covariance. RESULTS: A significant association was found between poor glycemic control and total cholesterol, triglyceride, and AIP. Significance remained after adjustment for confounders. Results indicated no relationship between glycemic control and other lipid parameters before or after adjustment. CONCLUSION: Findings from this study underlined the importance of glycemic control in T2DM patients for targeted interventions to prevent cardiovascular events. Further studies are needed to confirm these results.

High alpha-2-macroglobulin levels are a risk factor for cardiovascular disease events: A Moli-sani cohort study

Backgroundα2-macroglobulin (α2M) is a versatile endopeptidase inhibitor that plays a role in cell growth, inflammation and coagulation. α2M is an inhibitor of key coagulation enzyme thrombin. Hypercoagulability due to an excess of thrombin production can cause thrombotic events. Therefore, we investigated the association of α2M levels and cardiovascular events in a subset of the general Italian population. MethodsWe determined α2M levels in the baseline samples of a prospective cohort (n = 19,688; age: 55 ± 12 years; 47.8 % men) of the Moli-sani study and investigated the association with the cardiovascular events (n = 432, 2.2 %) in the median follow-up period of 4.3 years. Hazard ratios (HR) with 95 % confidence intervals (CI) were calculated by multivariable Cox regression and adjusted for a large panel of confounding factors. Resultsα2M levels above the 90th percentile were significantly associated with cardiovascular disease (CVD) events after full adjustment for age, sex, current smoking, BMI, oral contraceptive use, cardiovascular diseases, hypertension, hypercholesterolemia, diabetes and history of cancer (HR: 1.36; CI: 1.06–1.74). Moreover, high α2M was associated with coronary heart disease (CHD; HR: 1.47; CI: 1.12–1.91), but not stroke. Stratification for CVD at baseline showed that high α2M levels are associated with CHD events in subjects without CVD at baseline (HR: 1.40; CI: 1.00–1.95) and subjects with CVD at baseline (HR: 1.58; CI: 1.02–2.44). ConclusionWe show in a prospective cohort that high levels of α2M could be a risk factor for cardiovascular events, especially coronary heart disease events.

Role of symbiotic microbiota dysbiosis in the progression of chronic kidney disease accompanied with vascular calcification.

Background: Chronic kidney disease (CKD) is now globally recognized as a critical public health concern. Vascular calcification (VC) represents a significant risk factor for cardiovascular events in individuals with CKD. It is the accessible and precise diagnostic biomarkers for monitoring the progression of CKD and the concurrent VC are urgently needed. Methods: The adenine diet-induced CKD rat model was utilized to investigate chronic kidney injury, calcification in the kidney and thoracic aorta, and dysregulation of biochemical indices. Enzyme-linked immune sandwich assays were employed to analyze changes in calcification-related proteins. 16S rRNA sequencing was performed to delineate the microbiota characteristics in the gut and blood of CKD-afflicted rats. Additionally, transcriptome sequencing of kidney tissue was conducted to explore the relationship between CKD-associated microbiota features and alterations in kidney function. Results: The adenine diet-induced CKD inhibited body weight gain, and led to kidney injury, and pronounced calcification in kidney and thoracic aorta. The microbiota both in the gut and blood of these affected rats exhibited significantly lower alpha diversity and distinctive beta diversity than those in their healthy counterparts. CKD resulted in dysregulation of several biochemical indices (including elevated levels of creatinine, low-density lipoprotein-cholesterol, sodium, phosphorous, total cholesterol, and urea and decreased levels of albumin, calcium, lactate dehydrogenase, and total bilirubin). Moreover, it upregulated calcification-related factors (bone sialoprotein [BSP], Klotho, fibroblast growth factor [FGF]-23, and sclerostin [SOST]) and lipopolysaccharide (LPS). Notably, the increased Acinetobacter in the blood was positively associated with calcifications in the kidney and thoracic aorta, in addition to the positive correlation with gut microbiota. The enrichment of Acinetobacter was concurrent with increases in calcification factors (BSP, FGF-23, and SOST), LPS, and phosphorous. Furthermore, transcriptome sequencing revealed that the enrichment of Acinetobacter was positively correlated with the majority of upregulated genes and negatively correlated with downregulated genes involved in the mineral absorption pathway. Conclusion: Our findings, for the first time, underscore that dysbiosis of symbiotic microbiota, both in the gut and blood, is involved in the progression of CKD. Particularly, the enrichment of Acinetobacter in blood emerges as a potential risk factor for CKD and its accompanying VC.

Retinal microcirculation alterations in rheumatoid arthritis patients compared to healty volunteers and their correlation to the disease activity and duration of disease

Aims/Purpose: Patients with rheumatoid arthritis (RA) have a high risk of developing cardiovascular diseases due to endothelial dysfunction, which is a risk factor for cardiovascular events. The retinal Vessel Analyzer (RVA, IMEDOS Systems) can capture retinal vessels non‐invasively in real‐time and analyse their dynamic responses to stimuli.Methods: In order to assess the structural and functional changes in the retinal microvasculature, a non‐invasive Retinal Vessels Analyzer (RVA) was used to study 44 patients with RA (mean age 57.4 ± 13.2 years) and compare them to a control group of 44 age‐matched healthy individuals. The RVA was used to measure various parameters, including the Central Retinal Artery Equivalent (CRAE), Central Retinal Vein Equivalent (CRVE), and Arterio‐Venous Ratio (AVR), as well as the response of the retinal vessels to flickering light. After a 50 s baseline, rectangular shape, monochromatic flickering light (530–600 nm) of 12.5 Hz for 20 s was applied three times. The dilation of retinal vessels after flicker light stimulation was analysed.Results: The results of the study showed that patients with RA had significantly higher CRVE and lower AVR compared to the control group (p = 0.04 and p = 0.01, respectively), indicating structural changes in the retinal microvasculature. The patients with RA also had a significantly stronger arterial dilation response to flickering light compared to the control group (n = 43), indicating functional changes in the retinal microvasculature. In patients with moderate to high disease activity according to the Disease Activity Score (DAS‐28 &gt; 3.2) (n = 9), there was a negative significant correlation between the maximum arterial diameter (aMAX) and interleukin‐6 (IL‐6).Conclusions: These findings suggest that RVA can be a useful tool for detecting structural and functional changes in the retinal microvasculature of patients with RA and that the disease activity and inflammation in RA may be related to these changes. However, the study notes that a larger cohort with a wider range of disease activity is needed to fully understand the effect of chronic inflammatory diseases on endothelial function.

Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus

BackgroundDiabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. MethodsWe conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. ResultsOver 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. ConclusionOur study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.

Analysis the Relationship between Clonal Hematopoiesis and Cardiovascular Events in Chronic Myeloid Leukemia Based on Next-Generation Sequencing Technology

B ackground With the development and clinical application of high-throughput sequencing technologies and cytogenetics, the genetic complexity of hematopoiesis is better understood. Studies have found that there are gene mutations in hematopoietic stem cells that leading to subsequent clonal hematopoiesis (CH) phenomenon. Moreover, several recent studies have linked the occurrence of cardiovascular events with CH, and individuals with CH had a doubled risk of coronary heart disease and a fourfold increased risk of myocardial infarction. CH also exists in CML, and with the widespread application of second- and third-generation TKIs, the occurrence of cardiovascular adverse events had become one of the difficulties in the management of CML patients. Therefore, analyzing the relationship between additional gene mutations and cardiovascular adverse events in CML patients based on Next-Generation Sequencing (NGS) technology will provide new directions and ideas for the precise management of CML patients. O bjective Analyzing the relationship between clonal hematopoiesis and cardiovascular events in CML patients based on NGS technology. Method Using NGS technology to find hematological tumor-related gene mutations in CML patients, and analyzing their relationship with cardiovascular adverse events in CML patients. R esult A total of 149 CML patients were tested by NGS in this study, and were detected 152 clinically significant mutations. The mutations mainly involved genes related to epigenetic and activated signaling pathways, most of which were detected only in patients with drug resistance/intolerance to tyrosine kinase inhibitors (TKIs). The genes with higher mutation frequency were FAT1, GSTM1, ABL1, CUX1, EP300, ASXL1, TET2, CEBPA and so on. In this study, a total of 40 patients had cardiovascular events during treatment. When analyzing the risk factors of cardiovascular events in CML patients, it was found that patients with cardiovascular events were older [the median age were 58 (23-74) years vs 39 (16-73) years, P&amp;lt;0.001], and the duration of taking second-generation TKIs was also longer [the median time were 38 (0-102) months vs 16 (0-66) months, P=0.001]. When analyzing the relationship between gene mutations and cardiovascular events in CML, it was found that ASXL1, DNMT3A, EZH2 and other genes were more frequently detected in CML patients with cardiovascular events. Among them，DNMT3A mutation was associated with the occurrence of cardiovascular events in CML patients (RR 23.3, P=0.003). In addition, we also found that CCND1, CYP2C19 and NTRK2 gene mutations were only detected in patients without cardiovascular events significantly. C onclusion CML patients with cardiovascular events are older, take second-generation TKIs for a longer time, and have a higher incidence of DNMT3A gene mutation; CCND1, CYP2C19, NTRK2 gene mutation may be a protective factor for cardiovascular events in CML patients.

Biomechanical properties of the ascending aorta in patients with arterial hypertension by velocity vector imaging.

Aortic stiffness is an important risk factor for cardiovascular events and morbidity. Increased aortic stiffness is associated with an increase in cardiac and vascular hypertension-related organ damage.To evaluate the biomechanical properties of the ascending aorta (AA) in patients with arterial hypertension (AH) by velocity vector imaging (VVI).Ninety-five patients with AH and 53 normal healthy control participants were prospectively enrolled. AA biomechanical properties, i.e., ascending aortic global longitudinal strain (ALS), ascending aortic global circumferential strain (ACS), and fractional area change (FAC), were evaluated by VVI. Relative wall thickness (RWT) and left ventricular mass (LVM) were calculated. Pulsed Doppler early transmitral peak flow velocity (E), early diastolic mitral annular velocity (e'), left ventricular global longitudinal strain (GLS), distensibility (D) and stiffness index (SI) of AA were also obtained.The ALS, ACS and FAC were significantly lower in the AH patients, especially in those with ascending aorta dilatation (AAD), than in the normal healthy control subjects. The patients with AAD had a higher E/e' ratio, RWT, LVM and SI and a lower GLS and D than patients without AAD and normal healthy volunteers (p < 0.05). There were significant associations between biomechanical properties and D, SI, E/e' and GLS (ALS and D: r = 0.606, ALS and SI: r = - 0.645, ALS and E/e': r = - 0.489, ALS and GLS: r = 0.466, ACS and D: r = 0.564, ACS and SI: r = - 0.567, ACS and E/e': r = - 0.313, ACS and GLS: r = 0.320, FAC and D: r = 0.649, FAC and SI: r = - 0.601, FAC and E/e': r = - 0.504, FAC and GLS: r = 0.524, respectively, p < 0.05).The biomechanical properties of AA were impaired in patients with AH, especially patients with ascending aorta dilatation. Hypertension is associated with a high prevalence of diastolic and systolic dysfunction and increased arterial stiffness. Further study is needed to evaluate the clinical application of AA biomechanical properties by VVI.

Abstract 15801: Nighttime Hypertension is a Risk Factor for Cardiovascular Events in Stage B Heart Failure Patients

Background: Nighttime blood pressure (BP) was reported to have a stronger association with cardiovascular outcome and hypertensive organ damage than clinic BP, 24-hour BP, and daytime BP in hypertensives. However, the significance of nighttime BP was not established in stage B heart failure (HF) patients. We hypothesized that nighttime BP measured by home BP monitoring device was associated with cardiovascular outcome in stage B HF patients. Method: We used the dataset of Japan Morning Surge-Home Blood Pressure study (J-HOP study), and selected 417 of stage B HF patients. The definition of stage B HF was based on Universal definition of HF. The patients with history of HF hospitalization were excluded. BP was measured on waking, before bedtime and during the night. The cardiovascular event was followed. Result: Mean follow-up period was 6.6±3.8 years, and 59 cardiovascular events were occurred. When nighttime hypertension was defined as nighttime BP &gt;120mmHg, nighttime HT group showed higher BMI, serum creatinine, HbA1c, and higher prevalence of diabetes, atrial fibrillation, and chronic kidney disease, and lower HDL-cholesterol than nighttime normotension (NT) group. With regard to BP, nighttime HT group, clinic BP, home morning BP, home evening BP, and home nighttime BP were higher in nighttime HT group than in nighttime NT group. In Kaplan-Meier analysis, nighttime HT group had a higher incident of cardiovascular event than nighttime NT group (P&lt;0.01). In Cox multivariate analysis, nighttime HT was significant predictor for cardiovascular event adjusting by significant variables (Hazard ratio 1.84, 95% Confidence interval: 1.01-3.36, P=0.046). Conclusions: Nighttime HT was a prognostic factor in stage B HT patients. Nighttime BP was a therapeutic target to improve the outcome in stage B HT patients.

Abstract 14915: Role of Diabetes and Diabetic Medication in Cardiovascular Events and Survival Among Older Men With Prostate Cancer on Androgen Deprivation Therapy: Longitudinal SEER Medicare Analysis

Introduction: The effect of diabetes mellitus (DM) and DM therapy on cardiovascular events (CVE) in patients with prostate cancer (PC) undergoing androgen deprivation therapy (ADT) is unclear in the contemporary era. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified males ≥ 66-year-old with a new primary diagnosis of PC undergoing leuprolide therapy (ADT) between 2009-2017. These patients were followed for two years to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. DM medications identified using part D data for this analysis were metformin, insulin, and other orals based on FDA approval dates until 2017. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by DM and among those with DM and on different therapies. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of DM. Results: This study included 9,072 PC patients. Among these 2,822 (31.1%) had DM, and 5,105 (56.3%) had cardiovascular disease prior to PC diagnosis. New CVE was diagnosed in 619 (6.8%; HF = 144, AF = 107, AMI = 40, PAD = 132, CAD = 226, IS = 66) patients in a 2-year period after the PC diagnosis. DM was noted to be a risk factor for CVE [adjusted subdistribution hazards ratio (aSHR) = 1.22 (95% CI= 1.07-1.44)]. The effect of DM and DM medication on mortality is presented in Table 1. Conclusion: PC patients on ADT with DM have a higher risk of CVE and all-cause mortality. Metformin use is associated with reduced all-cause mortality.

Impact of C-Reactive Protein on Long-Term Cardiac Events in Stable Coronary Artery Disease Patients with Chronic Kidney Disease.

Chronic inflammation is associated with atherosclerosis development. Chronic kidney disease (CKD) is an independent risk factor for cardiovascular events and is associated with chronic inflammation. We aimed to investigate the influence of C-reactive protein (CRP), an important marker of inflammation, on the clinical outcomes of patients with CKD and stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Among patients with stable CAD and CKD who underwent PCI, 516 patients whose CRP levels were available before the PCI procedure were identified. The patients were divided into two groups according to the CRP levels: those with CRP ≥ 2.0 mg/L (high-CRP group) and those with CRP ＜2.0 mg/L (low-CRP group). The primary endpoint of this study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and unplanned revascularization. Overall, the mean age of the patients was 72.5±9.7 years, and 20.7% were female. The median CRP level was 1.43 mg/L (0.6-4.9 mg/L). The median follow-up period was 3.6 years. The occurrence of MACE was significantly higher in the high-CRP group than in the low-CRP group (log-rank p＜0.001). Notably, the incidence rate of cardiac death was significantly higher in the high-CRP group (log-rank p＜0.001). According to the multivariable analysis, CRP level ≥ 2.0 mg/L was found to be a significant predictor of MACE (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.04-2.28, p=0.003), as well as estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.97-0.99, p＜0.01). High-CRP levels adversely affect long-term cardiac events in patients with stable CAD and CKD.

Worse cardiovascular and renal outcome in male SLE patients

Systemic lupus erythematosus (SLE) in males is rare and poorly understood. Thus, still little is known about sex differences in SLE. We set out to identify sex differences regarding clinical manifestations as well as renal and cardiovascular outcomes of SLE. We analyzed patient data from the Swiss SLE Cohort Study. Cumulative clinical manifestations according to the updated American College of Rheumatology criteria were recorded at inclusion. Cardiovascular events were recorded within Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-SDI). Renal failure was defined as eGFR < 15 ml/min/1.73 m2, initiation of renal replacement therapy or doubling of serum creatinine which were all assessed yearly or documented as end stage renal disease in SLICC-SDI. Risk differences were calculated using logistic regression and cox regression models. We analyzed 93 men and 529 women with a median follow up time of 2 years. Males were significantly older at diagnosis (44.4 versus 33.1 years, p < 0.001) and had less often arthritis (57% versus 74%, p = 0.001) and dermatological disorders (61% versus 76%, p < 0.01). In multivariate analysis female sex remained a significantly associated with arthritis and dermatological disorders. In multivariate analysis men had a significantly higher hazard ratio of 2.3 for renal failure (95% confidence interval (95%-CI) 1.1–5.2, p < 0.04). Total SLICC-SDI Score was comparable. Men had significantly more coronary artery disease (CAD) (17% versus 4%, p < 0.001) and myocardial infarction (10% versus 2%, p < 0.01). In multivariate analysis, male sex remained a significant risk factor for CAD (odds ratio (OR) 5.6, 95%-CI 2.3–13.7, p < 0.001) and myocardial infarction (OR 8.3, 95%-CI 2.1–32.6, p = 0.002). This first sex study in a western European population demonstrates significant sex differences in SLE. Male sex is a risk factor for cardiovascular events and renal failure in SLE. Potential etiological pathomechanisms such as hormonal or X-chromosomal factors remain to be further investigated.

Cardiovascular Event Predictors in Hospitalized Chronic Kidney Disease (CKD) Patients: A Nationwide Inpatient Sample Analysis.

This study seeks to confirm the risk factors linked to cardiovascular (CV) events in chronic kidney disease (CKD), which have been identified as CKD-related. We aim to achieve this using a larger, more diverse, and nationally representative dataset, contrasting with previous research conducted on smaller patient cohorts. The study utilized the nationwide inpatient sample database to identify adult hospitalizations for CKD from 2016 to 2020, employing validated ICD-10-CM/PCS codes. A comprehensive literature review was conducted to identify both traditional and CKD-specific risk factors associated with CV events. Risk factors and CV events were defined using a combination of ICD-10-CM/PCS codes and statistical commands. Only risk factors with specific ICD-10 codes and hospitalizations with complete data were included in the study. CV events of interest included cardiac arrhythmias, sudden cardiac death, acute heart failure, and acute coronary syndromes. Univariate and multivariate regression models were employed to evaluate the association between CKD-specific risk factors and CV events while adjusting for the impact of traditional CV risk factors such as old age, hypertension, diabetes, hypercholesterolemia, inactivity, and smoking. A total of 690,375 hospitalizations for CKD were included in the analysis. The study population was predominantly male (375,564, 54.4%) and mostly hospitalized at urban teaching hospitals (512,258, 74.2%). The mean age of the study population was 61 years (SD 0.1), and 86.7% (598,555) had a Charlson comorbidity index (CCI) of 3 or more. At least one traditional risk factor for CV events was present in 84.1% of all CKD hospitalizations (580,605), while 65.4% (451,505) included at least one CKD-specific risk factor for CV events. The incidence of CV events in the study was as follows: acute coronary syndromes (41,422; 6%), sudden cardiac death (13,807; 2%), heart failure (404,560; 58.6%), and cardiac arrhythmias (124,267; 18%). A total of 91.7% (113,912) of all cardiac arrhythmias were atrial fibrillations. Significant odds of CV events on multivariate analyses included: malnutrition (aOR: 1.09; 95% CI: 1.06-1.13; p<0.001), post-dialytic hypotension (aOR: 1.34; 95% CI: 1.26-1.42; p<0.001), thrombophilia (aOR: 1.46; 95% CI: 1.29-1.65; p<0.001), sleep disorder (aOR: 1.17; 95% CI: 1.09-1.25; p<0.001), and post-renal transplant immunosuppressive therapy (aOR: 1.39; 95% CI: 1.26-1.53; p<0.001). The study confirmed the predictive reliability of malnutrition, post-dialytic hypotension, thrombophilia, sleep disorders, and post-renal transplant immunosuppressive therapy, highlighting their association with increased risk for CV events in CKD patients. No significant association was observed between uremic syndrome, hyperhomocysteinemia, hyperuricemia, hypertriglyceridemia, leptin levels, carnitine deficiency, anemia, and the odds of experiencing CV events.