Risk Factor For Cardiovascular Mortality Research Articles

Low ankle–brachial index is associated with higher cardiovascular mortality in individuals with nonalcoholic fatty liver disease

Background and aimsAnkle brachial index (ABI) is a risk factor for cardiovascular mortality, but it is unclear whether ABI is associated with cardiovascular mortality in patients with nonalcoholic fatty liver disease (NAFLD). The current study aimed to evaluate the association between ABI with cardiovascular and all-cause mortality in patients with NAFLD.MethodsWe performed a cohort study using the data of the1999–2004 National Health and Nutrition Examination Survey data of adults. Mortality data were followed up to December 2015. NAFLD was defined by the hepatic steatosis index or the US fatty liver index. ABI was classified into three groups: ABI ≤ 0.9 (low value); 0.9 < ABI ≤ 1.1 (borderline value); ABI greater than 1.1 (normal value).ResultsWe found that low ABI was associated with an increased risk of cardiovascular mortality in patients with NAFLD (HR: 2.42, 95% CI 1.10–5.33 for low value ABI vs normal value ABI, P for trend = 0.04), and the relationship was linearly and negatively correlated in the range of ABI < 1.4. However, low ABI was not associated with all-cause mortality in patients with NAFLD. Stratified by cardiovascular disease, ABI remains inversely correlated with cardiovascular mortality in NAFLD patients without cardiovascular disease. Stratified by diabetes, ABI is inversely correlated with cardiovascular mortality in NAFLD patients regardless of diabetes status.ConclusionsLow ABI is independently associated with higher cardiovascular mortality in NAFLD cases. This correlation remains significant even in the absence of pre-existing cardiovascular disease or diabetes.

Lipid risk factors for cardiovascular mortality and chronic inflammation in functionally dependent elderly persons

Lipid risk factors for cardiovascular mortality and chronic inflammation in functionally dependent elderly persons

Risk of heavy metal(loid) compositions in fine particulate matter on acute cardiovascular mortality: a poisson analysis in Anyang, China.

Fine particulate matter (PM2.5) is a risk factor of cardiovascular disease. Associations between PM2.5 compositions and cardiovascular disease are a point of special interest but inconsistent. This study aimed to explore the cardiovascular effects of heavy metal(loid) compositions in PM2.5. Data for mortality, air pollutants and meteorological factors in Anyang, China from 2017 to 2021 were collected. Heavy metal(loid) in PM2.5 were monitored and examined monthly. A Case-crossover design was applied to the estimated data set. The interquartile range increase in cadmium (Cd), antimony (Sb) and arsenic (As) at lag 1 was associated with increment of 8.1% (95% CI: 3.3, 13.2), 4.8% (95% CI: 0.2, 9.5) and 3.5% (95% CI: 1.1, 6.0) cardiovascular mortality. Selenium in lag 2 was inversely associated with cerebrovascular mortality (RR = 0.920 95% CI: 0.862, 0.983). Current-day exposure of aluminum was positively associated with mortality from ischemic heart disease (RR = 1.083 95% CI: 1.001, 1.172). Stratified analysis indicated sex, age and season modified the cardiovascular effects of As (P < 0.05). Our study reveals that heavy metal(loid) play key roles in adverse effects of PM2.5. Cd, Sb and As were significant risk factors of cardiovascular mortality. These findings have potential implications for accurate air pollutants control and management to improve public health benefits.

Systemic Inflammatory Response Index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001-2018).

To examine the correlation between SIRI and the probability of cardiovascular mortality as well as all-cause mortality in individuals with chronic kidney disease. A cohort of 3,262 participants from the US National Health and Nutrition Examination Survey (NHANES) database were included in the study. We categorized participants into five groups based on the stage of chronic kidney disease. A weighted Cox regression model was applied to assess the relationship between SIRI and mortality. Subgroup analyses, Kaplan-Meier survival curves, and ROC curves were conducted. Additionally, restricted cubic spline analysis was employed to elucidate the detailed association between SIRI and hazard ratio (HR). This study included a cohort of 3,262 individuals, of whom 1,535 were male (weighted proportion: 42%), and 2,216 were aged 60 or above (weighted proportion: 59%). Following adjustments for covariates like age, sex, race, and education, elevated SIRI remained a significant independent risk factor for cardiovascular mortality (HR=2.50, 95%CI: 1.62-3.84, p<0.001) and all-cause mortality (HR=3.02, 95%CI: 2.03-4.51, p<0.001) in CKD patients. The restricted cubic spline analysis indicated a nonlinear relationship between SIRI and cardiovascular mortality, with SIRI>1.2 identified as an independent risk factor for cardiovascular mortality in CKD patients. Heightened SIRI independently poses a risk for both all-cause and cardiovascular mortality in chronic kidney disease patients, with potentially heightened significance in the early stages (Stage I to Stage III) of chronic kidney disease.

Association of apolipoprotein levels with all-cause and cardiovascular mortality.

Research has shown that apolipoproteins (Apos) are potential indicators of heart health and death. We investigated the associations of apolipoprotein levels with all-cause and cardiovascular mortality. We systematically searched the Cochrane Library, PubMed and Web of Science for English-language studies up to November 28, 2022. We used Stata 17.0 to summarize the estimated effects with 95% confidence intervals (CIs). We also conducted subgroup analyses according to study location, year of publication, individual age, follow-up years, and sample size. Moreover, we performed a sensitivity analysis to evaluate bias in our study. This study included 23 studies with 152854 individuals in total. The level of ApoA was negatively related to cardiovascular mortality (OR = 0.69, 95% CI = 0.52-0.93). An increased ratio of ApoB/A1 was a risk factor for cardiovascular mortality (OR = 2.13, 95% CI = 1.48-3.07) and all-cause mortality (OR = 2.05, 95% CI = 1.52-2.77). The level of ApoB was positively related to cardiovascular mortality (OR = 1.12, 95% CI = 0.85-1.47), but the difference was not statistically significant. However, the associations between ApoB or ApoA1 and all-cause mortality were not obvious. Our subgroup analysis showed that the location, year of publication, individual age, and follow-up years of the studies affected the heterogeneity of our study to varying degrees. The sensitivity analysis showed that our results were almost robust, apart from excluding the article by Nomikos (OR = 0.77, 95% CI = 0.65-0.92) and Zeng (OR = 0.77, 95% CI = 0.65-0.91), when investigating the relationship between ApoA1 and all-cause mortality. In this study, we found that apolipoprotein levels were linked to cardiovascular and all-cause mortality. Our study strengthens the evidence on the association between the level of apolipoproteins and cardiac health and may provide ideas for regulating the level of apolipoproteins to promote public health.

Age-dependent implications of left ventricular hypertrophy regression in patients with hypertension.

Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular mortality and morbidity in patients with hypertension. However, the effect of age on LVH regression or persistence and its differential prognostic value remain unclear. Therefore, we investigated the clinical implications of LVH regression in 1847 patients with hypertension and echocardiography data (at baseline and during antihypertensive treatment at an interval of 6-18 months) according to age. LVH was defined as a left ventricular mass index (LVMI) > 115 g/m2 and >95 g/m2 in men and women, respectively. LVH prevalence at baseline was not different according to age (age < 65 years: 42.6%; age ≥65 years: 45.7%; p = 0.187), but LVH regression was more frequently observed in the younger group (36.4% vs. 27.5%; p = 0.008). Spline curves and multiple linear regression analysis showed a significant relationship between reductions in systolic blood pressure and LVMI in the younger group (β = 0.425; p < 0.001), but not the elderly group (β = 0.044; p = 0.308). LVH regression was associated with a lower risk of the study outcome (composite of cardiovascular death and hospitalization for heart failure) regardless of age. In conclusion, the association between the reduction in blood pressure and LVH regression was prominent in patients with age < 65 years, but not in those with age ≥65 years. However, an association between LVH regression and lower risk of cardiovascular death and hospitalization for heart failure was observed regardless of patient age, suggesting the prognostic value of the LVH regression not only in the younger patients but also in elderly patients.

Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study

BackgroundCardiovascular diseases (CVD) is the leading cause of death among maintenance hemodialysis patients, with dyslipidemia being a prevalent complication. The paradoxical relationship between cardiovascular outcomes and established lipid risk markers, such as low-density lipoprotein cholesterol (LDL-C), complicates lipid management in this population. This study investigated Lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging biomarker known for its proinflammatory and proatherogenic properties, as a potential cardiovascular prognostic marker in this cohort. In this context, the association between Lp-PLA2 levels and cardiovascular outcomes was evaluated, with the aim to facilitate more accurate stratification and identification of high-risk individuals.MethodsFrom August 2013 to January 2014, 361 hemodialysis patients were prospectively enrolled. Lp-PLA2 activity and laboratory measures at baseline were quantified. Comorbidities and medications were recorded. All patients were followed until the end of April, 2022. The individual and combined effects of Lp-PLA2 activity and LDL-C on patient outcomes were examined. The association between Lp-PLA2 activity and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) was analyzed.ResultsThe median Lp-PLA2 activity was 481.2 U/L. In subjects with Lp-PLA2 activity over 481.2 U/L, significantly higher total cholesterol (4.89 vs. 3.98 mmol/L; P < 0.001), LDL-C (3.06 vs. 2.22 mmol/L; P < 0.001), and apolipoprotein B (0.95 vs. 0.75 mmol/L; P < 0.001) were observed. Over a median follow-up of 78.1 months, 182 patients died, with 77 cases identified as cardiovascular death, 88 MACEs happened. Cardiovascular mortality and MACEs, but not all-cause mortality, were significantly increased in the high Lp-PLA2 group. Cox regression analyses showed that high Lp-PLA2 activity was associated with cardiovascular mortality and MACE occurrence. After comprehensive adjustment, high Lp-PLA2 activity was independently associated with cardiovascular mortality(as a dichotomous variable: HR:2.57, 95%CI:1.58,4.18, P < 0.001; as a continuous variable: HR:1.25, 95%CI:1.10,1.41, P = 0.001) and MACEs(as a dichotomous variable: HR:2.17, 95%CI:1.39,3.40, P = 0.001; as a continuous variable: HR:1.20, 95%CI:1.07,1.36, P = 0.002). When participants were grouped by median Lp-PLA2 activity and LDL-C values, those with high Lp-PLA2 and low LDL-C had the highest CV mortality. The addition of Lp-PLA2 significantly improved reclassification (as a dichotomous variable NRI = 42.51%, 95%CI: 5.0%,61.33%; as a continuous variable, NRI = 33.32%, 95% CI: 7.47%,56.21%).ConclusionsHigh Lp-PLA2 activity is an independent risk factor for cardiovascular mortality and MACEs occurrence in patients on hemodialysis. The combined measures of Lp-PLA2 and LDL-C help to identify individuals with a higher risk of cardiovascular death.

Nomogram for predicting cardiovascular disease mortality in patients with meningioma: a competing risk analysis.

Cancer patients may have increased risk of cardiovascular mortality than general population. We designed this study to investigate the incidence and risk factors of cardiovascular mortality in meningioma patients. Meningioma patients recorded in Surveillance Epidemiology and End Results (SEER) database between 2004 and 2016 were eligible for this study. The standardized mortality ratio (SMR) was calculated to present the relative risk of cardiovascular mortality (ICD-10 codes I00-I99) in meningioma patients compared with general population. Fine-Gray subdistribution proportional hazards regression was performed to identify risk factors of cardiovascular mortality and construct nomogram for predicting cardiovascular-specific survival in meningioma patients. Among 94,067 meningioma patients included in this study, 6145 (6.5%) and 16549 (17.6%) patients died due to cardiovascular diseases and other causes, respectively. The cardiovascular disease-related SMR of included meningioma patients was 25.31 compared with the general population. Results of multivariate competing risk analysis showed that age, male gender, race, marital status, insurance status, tumor size, tumor location, histologic type, and surgery options were risk factors of cardiovascular mortality. The C-index of our constructed nomogram for predicting cardiovascular specific survival was 0.730 (0.712-0.748) and 0.726 (0.696-0.756) in training cohort and validation cohort, respectively. Incorporating demographic and clinical variables, the nomogram we constructed is effective in predicting cardiovascular mortality in meningioma patients and could guide physicians to reasonably control clinical risk factors of cardiovascular mortality in meningioma patients.

The Impact of Semaglutide on Liver Fat Assessed by Serial Cardiac CT scans in Patients with Type 2 Diabetes: Results from STOP Trial

IntroductionThere is increasing prevalence of hepatic steatosis. Hepatic steatosis is increasingly recognized as the independent risk factor for cardiovascular mortality. However, there are limited options for the treatment of fatty liver. In this study we evaluated the effect of semaglutide on liver fat as measured by non-contrast cardiac CT scans. MethodsSTOP is a randomized controlled trial that evaluated semaglutide treatment effect on coronary atherosclerosis progression (STOP) in type 2 diabetes. We utilized unenhanced cardiac CT scans to quantify liver fat based on CT Hounsfield attenuation method. A total of 114 subjects qualified for this study of the 140 subjects randomized, 59 in semaglutide group and 55 in the placebo group and were followed for 12 months. Multivariate regression models were used to evaluate the change in liver fat content overtime. Results114 subjects were included in the study, 61% male, mean age of 57.8±8.1 years and mean BMI of 32.0±6.7. The average of the three liver measures showed an improvement in the semaglutide group 1.4±9.0 versus worsening in the placebo group of 1.9±9.5 mean HU. The multivariable linear regression models including age, gender, BMI, hypertension, hyperlipidemia, past smoking and baseline liver attenuation, showed that the semaglutide group average liver attenuation measures improved by 4.4 HU versus placebo across the trial, p=0.002 indicating improvement in the liver fat content in treatment group. ConclusionIn type 2 diabetes patients with hepatic steatosis, treatment with semaglutide resulted in a significant improvement in fatty liver resolution compared to placebo.

Antihypertensive Drugs - Ayurvedic Perspective

Hypertension is a very common disorder, particularly in past middle age. It is not a disease in itself, but is an important risk factor for cardiovascular mortality and morbidity. According to WHO, it is above 140/90 mmHg. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension. American Association of Heart mentioned that normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic. Epidemiological studies have confirmed that higher the pressure (systolic or diastolic or both) greater is the risk of cardiovascular disease. The principal focus of Ayurveda is on maintaining good health and adopting a healthy way of life. There is no description of such a single disease which can resemble with hypertension. It can be correlated with Vata Pradhaan Tridoshaj Vyadhi, Raktabhaar, Uchharaktachapa etc and involves dhatus like Rasa and Rakta and gets influenced by Mana. Our ancient science has provided us various drugs which influences the pressure of the blood. These drugs has directly or indirectly role in curing HTN for example Sarpagandha, Jatamansi, Rudraksh, Ashawgandha etc. which should be analysed by the physician clinically. This article would help future researchers and clinicians for administrating these drugs in different forms clinically and help further researches. There are specific alkaloids present in these drugs which influence different centres resulting in decrease in the Blood pressure. The present work deals with enhancing the role of Ayurvedic drugs and promoting more natural ways of treatment.

RAAS inhibitors in patients undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry

Abstract Background Aortic Stenosis (AS) is the most common heart disease in western countries, with a prevalence that is increasing in tandem with life expectancy. Renin-angiotensin-aldosterone system (RAAS) activation participates to myocardial fibrosis and worse clinical consequences. Purpose The association between baseline treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and cardiovascular (CV) mortality was evaluated in hypertensive patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). Methods We retrospectively examined hypertensive patients with AS who had undergone TAVI at 2-year follow-up. Univariable and multivariable Cox regression models were built according to baseline RAAS inhibitors (RAASi) therapy status and a second analysis was undertaken by categorizing patients in ARBs (n= 110), ACEi (n= 112) and other antihypertensive meds (n= 105). As a sensitivity analysis, survival-time data were converted to case-control data in order to conduct a case–control study nested in the observational study. Results The present analysis included 327 hypertensive patients with severe AS undergoing TAVI. During the 2-year follow-up 43 patients died for CV death. In univariable Cox regression, the rate of the 2-year CV mortality was significantly lower in patients taking RAASi at baseline (HR=0.44, 95% CI 0.23-0.81 p=0.009), however after multivariable adjustment for significant confounders baseline treatment with RAASi was no more significant. Patients were then grouped based on ARBs/ACEIs/other antihypertensive therapy (Figure 1). In the univariate regression analysis ARBs therapy was associated with 65% reduction in CV mortality (HR=0.35, 95% CI 0.15-0.78 p=0.011) significantly lower than other anti-hypertensive meds (figure 1). The results were confirmed in multivariate analysis adjusted for significant confounders (HR=0.34, 95% CI 0.14-0.85 p=0.021). To reduce the risk of bias and better evaluate the stability of the results, a case–control study nested in the observational study was performed. Based on preliminary analysis, patients exposed to ARBs were selected as the case group, those not exposed as the control group, matching controls and cases in a 1:1 manner and balancing for sex, chronic kidney disease, atrial fibrillation and type 2 diabetes mellitus. Multivariable logistic regression analyses were conducted to determine the possible risk factors for CV mortality. After adjusting for the effect of significant confounders, the use of ARBs was found to be associated with a significant reduced risk of CV mortality (OR 0.30, 95% CI 0.11 – 0.82, p=0.019) (Figure 2). Conclusion In patients with severe AS undergoing TAVI, baseline treatment with ARBs was associated with reduced risk of CV mortality over 2 years of follow-up compared to the use of other antihypertensive drugs. The results were also confirmed by the nested, balanced, case-control analysis.KM curves grouped for ACEI/ARBs/otherAdjusted odds-ratio in the nested case-c

IgE to common food allergens is associated with cardiovascular mortality in the National Health and Examination Survey and the Multi-Ethnic Study of Atherosclerosis

In individuals without symptomatic food allergy, food-specific IgE is considered clinically irrelevant. However, recent studies have suggested that galactose-α-1,3-galactose (alpha-gal) IgE is associated with cardiovascular (CV) disease. We sought to determine whether sensitization to common food allergens is associated with CV mortality. The association between IgE sensitization to foods and CV mortality ascertained to 2019 was examined in the National Health and Examination Survey (NHANES) 2005-2006 and the Wake Forest site of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort; MESA enrolled adults without baseline clinical CV diseases between 2000 and 2002. Total and specific IgE was measured to cow's milk, egg, peanut, shrimp, and a panel of aeroallergens (NHANES), and to cow's milk, alpha-gal, peanut, dust mite, and timothy grass (MESA). Cox proportional hazard models were constructed, adjusting for sex, age, race/ethnicity, smoking, education, and asthma. A total of 4414 adults from NHANES (229 CV deaths) and 960 from MESA (56 CV deaths) were included. In NHANES, sensitization to at least 1 food was associated with higher CV mortality (hazard ratio [HR], 1.7 [95% confidence interval (CI), 1.2-2.4], P= .005). Milk sensitization was particularly associated (HR, 2.0 [95% CI, 1.1-3.8], P= .026), a finding replicated in MESA (HR, 3.8 [95% CI, 1.6-9.1], P= .003). Restricting analyses in NHANES to consumers of the relevant allergen strengthened food sensitization relationships, unmasking shrimp and peanut sensitization as additional risk factors for CV mortality. The finding that food sensitization is associated with increased risk of CV mortality challenges the current paradigm that sensitization without overt allergy is benign. Further research is needed to clarify mechanisms of this association.

Hypotension at the Start of Dialysis Is a Risk Factor of Cardiovascular Mortality

Hypotension at the Start of Dialysis Is a Risk Factor of Cardiovascular Mortality

Associations between central pulse pressure, microvascular endothelial function, and fluid overload in peritoneal dialysis patients

ABSTRACT Background Microcirculatory endothelial dysfunction is a complex phenomenon that contributes to the development of cardiovascular disease. However, the relationship between microcirculatory endothelial dysfunction and macrovascular disease remains incompletely understood. Fluid overload is a risk factor for cardiovascular mortality in patients undergoing peritoneal dialysis. Therefore, we investigated the effects of chronic fluid overload on both the microcirculation and macrocirculation in these patients. Methods Thirty patients undergoing peritoneal dialysis were included in this cross-sectional study. We measured their central blood pressure and pulse wave velocity, assessed their microvascular endothelial function using drug-induced iontophoresis with laser Doppler flowmetry, and determined the amount of fluid overload using bioimpedance. We conducted a Spearman correlation analysis, univariate analysis, and stepwise multivariate regression models to determine the associations among the hemodynamic parameters. Results Acetylcholine-induced iontophoresis with laser Doppler flowmetry showed a correlation with both brachial and central pulse pressure (PP), but not with pulse wave velocity. Fluid overload was associated with both central and brachial PP and remained an independent predictor of central PP even after adjusting for multiple factors. However, fluid overload was not associated with microcirculatory endothelial function. Conclusion In peritoneal dialysis patients, we observed a significant association between central PP and microvascular endothelial function, indicating a connection between macrocirculation and microcirculation. However, conclusive evidence regarding fluid overload as a mediator between these circulatory systems is lacking. Further research is needed to investigate this relationship.

Estimation The Level of Superoxide Dismutase 1 Among Iraqi Patients with Hypertension

Background: Hypertension plays a critical role as a risk factor for cardiovascular mortality, encompassing conditions like coronary artery disease, organ damage, congestive heart failure, and cerebrovascular diseases. Furthermore, hypertension can lead to increased oxidation and peroxidation reactions due to elevated blood pressure and blood flow. Objective: This study aimed to evaluate the levels of superoxide dismutase in the sera of patients diagnosed with hypertension. Materials and Methods: The study involved 60 hypertensive patients who exhibited no significant abnormalities, such as liver disease, cardiomyopathy, renal disease, diabetes mellitus, congestive heart failure, or thyroid disease. Additionally, 25 healthy individuals, matched by age and sex to the patient group, were included in the study. The age range of the participants was between 32 and 70 years. The level of superoxide dismutase 1 in the sera was measured using an enzyme-linked immunosorbent assay (ELISA). Results: The results demonstrated a significant increase in the activity level of superoxide dismutase in hypertensive patients (732.91 ± 82.68 pg/ml) compared to the control group (590.63 ± 47.69 pg/ml). Conclusion: These findings have the potential to contribute to the diagnosis and management of hypertension, offering insights into the role of superoxide dismutase activity in the disease process.

Prevalence of metabolic syndrome in patients with end-stage renal disease: a systematic review and meta-analysis.

Metabolic syndrome, a significant risk factor for cardiovascular mortality in patients with end-stage renal disease, profoundly impacts patient prognosis and survival. Despite its clinical importance, the prevalence of metabolic syndrome remains unexplored in this population. Therefore, the objective of this study was to systematically assess the prevalence of metabolic syndrome among patients with end-stage renal disease and raise awareness among healthcare professionals. We conducted a comprehensive search in CNKI, WANFANG, WeiPu, CBM, PubMed, Web of Science, EMBASE, and The Cochrane Library databases. The search time was until August 21, 2023. Standardized tables were employed for data extraction and imported into Stata 16.0 software for subsequent meta-analysis. A random-effects model was employed to estimate combined prevalence and 95% confidence intervals. Subgroup and sensitivity analyses were conducted to explore potential sources of heterogeneity, while publication bias was evaluated using a funnel plot and Egger's test. Thisstudy has beenregistered with PROSPEROunder the registration numberCRD42023456284. This meta-analysis comprised 35 studies involving a total of 14,202 participants. The pooled prevalence estimate for metabolic syndrome was 49.0% [95% CI (46.0,53.0)]. We conducted subgroup analyses based on participant characteristics, gender distribution, publication year, national economic status, diagnostic criteria employed, and components of metabolic syndrome. The prevalence of metabolic syndrome is higher among patients with end-stage renal disease, necessitating early prevention and control measures to reduce its incidence and delay the progression of the disease, thereby improving patient life expectancy.

MICROALBUMINURIA IN NEWLY DIAGNOSED HYPERTENSIVE PATIENTS AND ITS CORRELATION WITH LEFT VENTRICULAR HYPERTROPHY”

Background: One of the most important factors in the development of cardiovascular diseases worldwide is Hypertension. A reliable indicator and a diagnostic modality in early stage of renal diseases and predictor of atrial hypertension (AH) progression is microalbminurea (MAU) which is also an independent risk factor of cardiovascular mortality and death.&#x0D; Objective: To determine the prevalence of microalbuminuria and left vertricular hypertrophy and assess correlation between micro albuminuria and LVH among newly diagnosed hypertensive patients.&#x0D; Methods: A cross sectional study conducted in Medical Unit IV, Jinnah Hospial Lahore from January to June, 2022. About 146 adults newly diagnosed hypertensive patients were included for study. Blood pressure was measured using sphygmomanometer with standard cuff in sitting position, with two measurements were made at least 5 min apart. Microalbuminuria was defined as albumin excretion 30 to 300 mg/dl in a spot urine sample report. Left ventricular hypertrophy (LVH) is defined as presence of concentric hypertrophy or diastolic dysfunction determined on Trans Thoracic ECHO by a cardiologist. Data was entered in SPSS Ver: 25.0 for data analysis and graphical presentation. For quantitative variables like age, ACR; mean and standard deviation was calculated. Prevalence and correlation of MAU and LVH in newly diagnosed hypertensive patients was using Spearmen’s Rank Correlation Analysis. Chi-square test was performed to compare MAU and LVH. P-value of &lt; 0.05 was considered statistically significant. &#x0D; Results: 146 subjects those fulfilling the inclusion criteria were admitted. Mean age was 48.281 + 24.865. 72.6% were male in our study. 30.8% of patients had LVH and microbuminurea was present in 47.5% of subject. About 28.6% of patient with LVH had MAU. (p=.030). There was a positive correlation between LVH and MAU. (r=0.135, P =.002).&#x0D; Conclusions: Our study concludes a high prevalence of micro albuminuria and LVH in newly diagnosed hypertensive. There is positive correlation between micro albuminuria and LVH and can be predictor of cardiovascular morbidity and mortality.

Long-term mortality risk of valvular heart disease adults over 35 years old in Chinese communities

Objective: To investigate the risk and influencing factors of long-term mortality of valvular heart disease (VHD) adults aged 35 years and over in Chinese communities. Methods: A cohort study was carried out. The data of the subjects who underwent echocardiography were collected from the Chinese Hypertension Survey between 2012 and 2015 and survival outcomes were followed up between 2018 and 2019. Kaplan-Meier survival curves were plotted and compared using log-rank test. Cox proportional hazards models were used to analyze the influence of VHD on mortality. Results: During an average follow-up time of (4.6±0.9) years, a total of 23 237 participants (10 881 males and 12 356 females) were pooled into the final analysis from 5 eastern, 5 central, and 4 western provinces, cities and autonomous regions in China, with a mean age of (56.9±13.2) years. Among the included participants, 1 004 had VHD (467 males and 537 females), with a mean age was of (68.1±12.6) years. In the Kaplan-Meier analysis, participants with VHD had a significantly increased risk of all-cause mortality (log-rank χ2=351.82, P<0.001) and cardiovascular mortality (log-rank χ2=284.14, P<0.001) compared with those without VHD. Multivariate Cox regression analysis showed that compared with those without VHD, the participants with rheumatic VHD had a 45% increased risk of all-cause mortality (HR=1.45, 95%CI: 1.12-1.89) and degenerative VHD increased the risk of cardiovascular mortality by 69% (HR=1.69, 95%CI: 1.19-2.38). The risk factors of cardiovascular mortality for VHD were age 55 years and over (55-<75 years: HR=4.93, 95%CI: 1.17-20.85;≥75 years: HR=11.92, 95%CI: 2.85-49.80) and diabetes mellitus (HR=1.71, 95%CI: 1.00-2.93). Conclusions: VHD is a risk factor of all-cause mortality and cardiovascular mortality among adults aged 35 years and over. Age 55 years and over and diabetes mellitus are adverse prognostic factors for patients with VHD.

Comparison of echocardiographic aortic stiffness index measurements and pulse wave velocity measurements in obese and overweight children.

Aortic/arterial stiffness is a reliable, independent predictor and a risk factor for cardiovascular mortality. Arterial stiffness is assessed by pulse wave velocity and echocardiography. The purpose of this study is to analyse aortic/arterial stiffness in patients using echocardiographic and pulse wave velocity techniques. The participants of this study consisted of 62 patients who presented to the Gazi University Pediatric Endocrinology and Pediatric Cardiology outpatient clinics, including 21 obese, 20 overweight, and 21 normal-weight patients. Echocardiography was performed on all patients, and echocardiographic measurements were compared to pulse wave velocity measurements. The mean (min-max) arterial strain measurements were 0.146 ± 0.0 (0.06-0.3) in the obese group and 0.106 ± 0.0 (0.05-0.18) in the overweight group. In comparison to the overweight group, the obese group had greater arterial strain measurements. The pulse wave velocity measurements in the obese and overweight groups were greater than those in the normal weight group (p > 0.05). Elastic modulus and aortic stiffness ß index values were shown to be positively correlated with pulse wave velocity measurements in the obese group (r = 0.56, r = 0.53, respectively; p = 0.008, p = 0.01, respectively). Systolic and diastolic blood pressure measurements were correlated with pulse wave velocity measurements in the obese group (r = 0.98, p = 0.0001, respectively). In our study, echocardiographic aortic measurements showing the vessel wall were correlated with pulse wave velocity measurements. Echocardiographic evaluation should be included in the routine follow-up of patients because pulse wave velocity measurement devices are not available in all centres, echocardiography is available in many centres, it is easily applicable, and it facilitates the follow-up of patients.

Cardiovascular mortality in patients with advanced chronic kidney disease with and without diabetes: a nationwide cohort study

BackgroundCardiovascular mortality and the impact of cardiac risk factors in advanced chronic kidney disease (CKD) remain poorly investigated. We examined the risk of cardiovascular mortality in patients with advanced CKD with and without diabetes as well as the impact of albuminuria, plasma hemoglobin, and plasma low-density lipoprotein (LDL) cholesterol levels.MethodsIn a Danish nationwide registry-based cohort study, we identified persons aged ≥ 18 years with an estimated glomerular filtration rate < 30 mL/min/1.73m2 between 2002 and 2018. Patients with advanced CKD were age- and sex-matched with four individuals from the general Danish population. Cause-specific Cox regression models were used to estimate the 1-year risk of cardiovascular mortality standardized to the distribution of risk factors in the cohort.ResultsWe included 138,583 patients with advanced CKD of whom 32,698 had diabetes. The standardized 1-year risk of cardiovascular mortality was 9.8% (95% CI 9.6–10.0) and 7.4% (95% CI 7.3–7.5) for patients with and without diabetes, respectively, versus 3.1% (95% CI 3.1–3.1) in the matched cohort. 1-year cardiovascular mortality risks were 1.1- to 2.8-fold higher for patients with diabetes compared with those without diabetes across the range of advanced CKD stages and age groups. Albuminuria and anemia were associated with increased cardiovascular mortality risk regardless of diabetes status. LDL-cholesterol was inversely associated with cardiovascular mortality risk in patients without diabetes, while there was no clear association in patients with diabetes.ConclusionsDiabetes, albuminuria, and anemia remained important risk factors of cardiovascular mortality whereas our data suggest a limitation of LDL-cholesterol as a predictor of cardiovascular mortality in advanced CKD.