Management Of Risk Factors In Patients Research Articles

Risk Factor Management for Patients with Atrial Fibrillation in Home Healthcare.

Atrial fibrillation (AF) is a common and persistent cardiac arrhythmia that impacts morbidity, mortality, disability, quality of life, and healthcare costs. Typically, AF is managed using a three-pillar approach of rate control, rhythm control, and anticoagulation. However, these interventions fail to address the underlying pathophysiological factors that contribute to AF. A compelling body of research expands traditional management by focusing on lifestyle modification to lower the risk of AF incidence, prevalence, progression, and severity. Home healthcare clinicians possess the knowledge and skills to examine and treat a wide range of risk factors that lead to AF, and therefore can substantially reduce incident and persistent AF and facilitate optimal outcomes. This perspective paper presents a clinical paradigm shift by proposing a five-factor Partner, Quantify, Recommend, Support, and Teach (PQRST) framework to support AF risk factor modification in home healthcare. The PQRST framework incorporates a greater focus on patient self-management through education and exercise to reduce incidence, prevalence, progression, and severity of AF.

100.95 - Cardiac Risk Factor Management in Patients With Incidental Coronary Artery Calcification Findings on CT Chest

100.95 - Cardiac Risk Factor Management in Patients With Incidental Coronary Artery Calcification Findings on CT Chest

Study of Lipid-Modifying Therapy Use and Risk Factor Management in Patients With Dyslipidemia in Duhok City/Kurdistan Region, Iraq.

Introduction Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality globally, according to the World Health Organization. Research from the Middle East indicates that cardiovascular disease-related deaths in the region are among the highest worldwide. Multiple risk factors contribute to ASCVD. Elevated low-density lipoprotein cholesterol (LDL-C), often associated with hyperlipidemia, plays a pivotal role. The reduction of LDL cholesterol through statins has been extensively studied over the years and has demonstrated a significant decrease in rates of cardiovascular disease, particularly in high- and very high-risk groups. Study design This cross-sectional study enrolled 503 adult patients undergoing lipid-lowering therapy for primary and secondary prevention of ASCVD at the Azadi General & Teaching Hospital in Duhok City, Iraq. Data were collected from January 2, 2023, to October 31, 2023. The sample size was carefully determined to ensure a precise estimation of the primary outcome measure. Results Of the 503 patients aged 21-89 years, 315 (62.2%) were women. Among the 145 (28.8%) with ASCVD, 127 (87.5%)had coronary artery disease. Only 150 (29.8%) were on a high-intensity statin, compared to 293 (58.25%) on a moderate-intensity statin. In total, 155 (30.8%) attained LDL-C control (p<0.0001). Among the 207 with very high cardiovascular disease risk, only 10 (4.83%) achieved an LDL-C level below 55 mg/dl. Conclusion This study revealed inadequate management of LDL-C levels across various participant categories, particularly those classified as having high cardiovascular disease risk. Control of other risk factors (e.g., hypertension, diabetes, and metabolic syndrome) was overall very poor. Most participants were overweight or obese.

A global perspective on cardiovascular risk factor management in patients with CHD and different educational level: SURF CHD II

Abstract Background Clinical guidelines recommend that patients with established coronary heart disease (CHD) change health behaviors and use medication to control risk factors (RF), eventually reducing cardiovascular risk. Nevertheless, RF management in daily practice is challenging and RF control in secondary prevention remains suboptimal. Patients with low educational level tend to have higher cardiovascular risk. This association varies indifferent contexts, yet research on health inequalities in secondary prevention has focused mostly on high-income countries. Purpose To provide a global picture of health inequalities in RF management in secondary prevention of CHD, by assessing RF recording, target attainment, and treatment by educational level in patients from four world regions. Methods The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II is a clinical audit on RF management, undertaken in patients with CHD during routine outpatient visits. The survey is easy to perform, allowing its use in low-resource centers. We studied RF recording (data availability), attainment of targets defined by guidelines, and treatment (medication and cardiac rehabilitation). RF included smoking, physical activity, waist circumference, blood pressure, LDL, non-HDL cholesterol, triglycerides, and Hba1c (among diabetics). We reported the % of recording, target attainment and treatment in patients with primary/secondary schooling and in those with tertiary education. We assessed differences in RF management by educational level with logistic regression adjusted by age and sex, and stratified by region. Results 13884 patients were enrolled in 29 countries in Europe (N=10255), South-East Asia (SEA) (N=2290), the Americas (N=779) and North Africa and Eastern Mediterranean (N=560). 47.0% of participants had tertiary education, 34.5% had secondary schooling, and 18.6% primary schooling. RF recording ranged from 22.2% (waist circumference) to 93.0% (blood pressure); target attainment from 15.9% (waist circumference) to 76.9% (smoking). 50.5% participated in cardiac rehabilitation. RF information was collected more often in highly educated patients for most RF in the Americas, and for blood pressure and HBa1c in SEA. BMI and waist circumference were more frequently registered among lower-educated participants in Europe and SEA. Highly educated patients were more likely to meet RF targets for smoking in most regions, physical activity in Americas and Europe, LDL in SEA, and Non-HDL cholesterol and Hba1c in SEA and Americas regions. Patients with higher education participated more often in cardiac rehabilitation in all regions except SEA (Figure 1). Conclusions Health inequalities persist in secondary prevention of CHD: highly educated patients are generally more likely to have RF information recorded, have RF levels on target and attend cardiac rehabilitation. However, these associations present specific patterns by RF and region.

THU254 VICTOR-Pilot Study Of A Virtual Dietary Intervention To Improve Diabetes And Cardiovascular Risk In Rural Communities - Primary Results

Abstract Disclosure: C.C. Low Wang: Research Investigator; Self; Dexcom, Virta Health. R.O. Estacio: None. S. Coronel-Mockler: None. N. Flattery: None. A. McKenzie: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. D. Harrison: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. M.P. Bonaca: Consulting Fee; Self; Audentes. Research Investigator; Self; Abbott Laboratories, Agios Pharmaceuticals, Alexion Pharmaceuticals, Inc., Alnylam, Amgen Inc, Angionetics, Anthos Therapeutics, ARCA Biopharma Inc, Array, AstraZeneca, Atentiv, Better Therapeutics, Bayer, Inc., Bristol-Myers Squibb, Cardiol Therapeutics, CellResearch Corp, CSL Behring, Eidos Therapeutics, EP Trading Company, Esperion Therapeutics, EveryWell, Faraday Pharmaceuticals, Fortress Biotech, HeartFlow, Insmed, Jansen Pharmaceuticals, Lexicon Pharmaceuticals, Inc., Kowa Research, Merck &amp; Co., Moderna, Novo Nordisk, Pfizer, Inc., PhaseBio, PPD Development, Prothena Biosciences, Regeneron Pharmaceuticals, Regio Biosciences, Sanifit Therapeutics, Sanofi, Stealth Biotherapeutics, Wraser, Cambrian Biopharma, Cook Regentech, EPG Communications, Epizon Pharma, Exicon Consulting, Medtronic, Silence Therapeutics, VarmX. Stock Owner; Self; Pfizer, Inc., Medtronic. Introduction: Individuals in rural communities face challenges accessing healthcare. Innovative strategies combining local Community Health Workers (CHW) and virtual digital solutions may be beneficial for improving type 2 diabetes (T2D) care and cardiovascular (CV) risk. Hypothesis: A virtually delivered digitally based intervention will improve glycemic control in individuals with diabetes in rural communities. Methods: The Virta Intervention in CommuniTies in cOloRado (VICTOR)-Pilot Study is designed to examine whether referral to the Virta Intervention (VINT) while integrated into the CHW program Colorado Heart Healthy Solutions (CHHS), a health education program designed to improve cardiovascular risk factors, is feasible, acceptable, and improves hemoglobin A1c (HbA1c). VINT is a low-carbohydrate approach to T2D treatment which is delivered through a continuous remote care platform via a smartphone application; patients receive care from a dedicated Health Coach and Medical Provider to boost efficacy and ensure safety. Adults with T2D age 18-79 yr in rural Colorado enrolled in CHHS and taking one or more antihyperglycemic medications for at least 3 months, with BMI &amp;gt;25 kg/m2, and HbA1c &amp;gt;7.5% were randomized to VINT + CHHS vs CHHS alone. The primary outcome is change in HbA1c from baseline to 3 months. Secondary outcomes include change in body weight, number of diabetes medications, and patient-reported outcomes. The Intervention arm undergoes VINT + CHHS for 6 months, then CHHS alone for 3 months. The Control arm starts with CHHS alone for 3 months, then VINT + CHHS for 3 months, and finally CHHS alone for 3 months. Both groups are assessed at baseline (0), 3, 6 and 9 months. Enrollment for the trial is complete, and the study is ongoing. Results: A total of 48 individuals are enrolled from 2 rural Colorado communities, 25 in the Intervention arm and 23 in the Control arm. Of these, 65% are female, mean age 59.4 years (range 36-77, SD 10.1), 92% white, 4% Hispanic, mean body mass index (BMI) 34.3 kg/m2 (range 25-62, SD 7.0), mean HbA1c 9.0% (range 7.5-14.1%, SD 1.3), mean weight 216.6 lb (range 148-364, SD 46.9), median number of diabetes medications: 2, with 36% of participants on insulin. The primary outcome of change in HbA1c from baseline to 3 months will be assessed in March 2023 and available for reporting at the 2023 Endocrine Society meeting. Conclusion: The VICTOR-Pilot study is evaluating the effect on HbA1c, medication burden, feasibility, and acceptability of a virtual digital dietary intervention to improve glycemic control and risk factor management in patients with type 2 diabetes living in rural communities. The trial has fully enrolled, and the primary end point as well as other key secondary endpoints will be reported. Presentation: Thursday, June 15, 2023

Optimization of cardiovascular risk factor management in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms, current knowledge, and perspectives.

The exact prognostic role of cardiovascular (CV) risk factors in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms (MPNs) remains unknown as it is often masked by other MPN-related features that bear strong prognostic impact on thrombotic risk. Therefore, current MPN treatment is not primarily guided by presence of CV risk factors. Treatment of CV risk factors in MPN patients usually mirrors that from the general population, despite the fact that CV risk factors in MPNs have their own specificities. Moreover, the optimal target levels for different metabolic deflections in MPNs (i.e., low-density lipoprotein, serum uric acid, or glycated hemoglobin levels) have not been defined. In the current review, we separately discuss the most important aspects of every individual CV risk factor (arterial hypertension, hyperlipidemia, chronic kidney disease, smoking, diabetes mellitus, hyperuricemia, and obesity and cachexia) in MPNs, summarize recent advances in the field, and propose future directions and research areas which may be needed to appropriately manage CV risk factors in MPNs.

A Retrospective Study on the Status of Risk Factor Management in Patients with Ischemic Stroke Based on a Large Linked Dataset of Stroke Patients in Korea.

A Retrospective Study on the Status of Risk Factor Management in Patients with Ischemic Stroke Based on a Large Linked Dataset of Stroke Patients in Korea.

Cardiovascular risk factor management in patients with diabetes: Does management differ with disease duration?

Our objective was to examine risk factor modification targets and treatment in relation to duration of diabetes. The Diabetes Mellitus Status in Canada (DM-SCAN) study collected data on 5109 patients with type 2 diabetes mellitus (T2DM) in 2012 in primary care. We compared the prevalence of vascular complications, treatment targets, and interventions between patients with diagnosed diabetes duration ≤10 and>10years. Physicians more frequently assigned HbA1c (glycated hemoglobin) targets of 7.1-8.5% (54-69mmol/mol) to patients with longer duration of diabetes (n=1647) (19.8% vs 9.5%, p<0.001). Patients with longer duration of diabetes were less likely to achieve HbA1c targets of ≤7.0% (53mmol/mol) (39% vs. 55%, p<0.001), had similar likelihood of achieving blood pressure targets of ≤130/80mmHg (38% vs. 36%, p=0.26) and were more likely to achieve LDL-C targets of ≤2.0mmol/L (≤77.3mg/dL) (63% vs. 53%, p<0.001) compared to patients with shorter duration of diabetes (n=3462). Achievement of all three targets between both groups were similar (13% vs. 13%, p=0.82). Overall, patients with longer duration of diabetes were more likely to be prescribed anti-hyperglycemic, anti-hypertensive, lipid-lowering medications and referred for diabetes education. Only 13% of patients achieved glycemic, blood pressure, and LDL-C targets irrespective of duration of diabetes. Despite being managed with more medications, patients with longer duration of diabetes were less likely to achieve glycemic targets. More focus is needed on developing methods to bridge best care and real-world practice.

Expert consensus on the management of diabetic patients with cardiovascular diseases

Diabetes is the most important comorbidity of cardiovascular disease, and cardiovascular disease is the main cause of mortality and disability of patients with type 2 diabetes. In order to standardize the diagnosis and treatment of patients with diabetes and cardiovascular disease, the National Health Commission Capacity Building and Continuing Education Center organized the experts from the field of cardiology and endocrinology systematically reviewing the research progresses and expert experiences of relevant disciplines from home and abroad, and formulated this consensus. This consensus covers the diagnosis, drug treatment, and risk factor management for patients with diabetes and cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure) from the perspective of cardiovascular disease and diabetes management aiming to strengthen the comprehensive management of patients and ultimately to improve the prognosis of patients. The management of cardiovascular diseases mainly includes the management of blood pressure, blood lipids, anti-thrombosis, anti-myocardial ischemia, anti-ventricular remodeling and so on. Diabetes management mainly includes lifestyle intervention (including diet, exercise, weight loss, etc.), anti-hyperglycemia therapy (including drugs and insulin), blood glucose monitoring, and hypoglycemic prevention. In addition, specific clinical recommendations are given to patients with special health care needs such as diabetic nephropathy, elderly (>75 years), and cardiovascular critical illness.

End-stage kidney disease in patients with clinically manifest vascular disease; incidence and risk factors: results from the UCC-SMART cohort study

BackgroundPatients with cardiovascular disease (CVD) are at increased risk of end-stage kidney disease (ESKD). Insights into the incidence and role of modifiable risk factors for end-stage kidney disease may provide means for prevention in patients with cardiovascular disease.MethodsWe included 8402 patients with stable cardiovascular disease. Incidence rates (IRs) for end-stage kidney disease were determined stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of end-stage kidney disease for the different determinants.ResultsSixty-five events were observed with a median follow-up of 8.6 years. The overall incidence rate of end-stage kidney disease was 0.9/1000 person-years. Patients with polyvascular disease had the highest incidence rate (1.8/1000 person-years). Smoking (Hazard ratio (HR) 1.87; 95% CI 1.10–3.19), type 2 diabetes (HR 1.81; 95% CI 1.05–3.14), higher systolic blood pressure (HR 1.37; 95% CI 1.24–1.52/10 mmHg), lower estimated glomerular filtration rate (eGFR) (HR 2.86; 95% CI 2.44–3.23/10 mL/min/1.73 m2) and higher urine albumin/creatinine ratio (uACR) (HR 1.19; 95% CI 1.15–1.23/10 mg/mmol) were independently associated with elevated risk of end-stage kidney disease. Body mass index (BMI), waist circumference, non-HDL-cholesterol and exercise were not independently associated with risk of end-stage kidney disease.ConclusionsIncidence of end-stage kidney disease in patients with cardiovascular disease varies according to vascular disease location. Several modifiable risk factors for end-stage kidney disease were identified in patients with cardiovascular disease. These findings highlight the potential of risk factor management in patients with manifest cardiovascular disease.Graphic abstract

Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA

Abstract Background Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD). Purpose The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA. Methods The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018). Results Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol &amp;gt;2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index &amp;gt;30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%). Conclusion The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Lilly

Poor attainment of blood pressure, lipids and diabetes targets in people at high cardiovascular risk in Europe: a report from the ESC-EORP EUROASPIRE V Survey in 16 European countries

Abstract Introduction The EUROASPIRE V survey in primary care was carried out by the European Society of Cardiology, EURObservational Research Programme in 2017–2018 and investigated the risk factor management in patients at high cardiovascular (CVD) risk in16 European countries. Purpose To provide an audit the implementation of the 2016 Joint European Societies' guidelines on CVD prevention in people at high risk of developing CVD in primary care and to see whether the practice of preventive cardiology had improved by comparison with the previous EUROASPIRE IV survey in 2014–2015. Methods All patients were free of coronary or other atherosclerotic diseasebut considered at high CVD risk since they had been started on blood pressure and/or lipid and/or glucose lowering treatments. They were interviewed and examined by means of standardized methods ≥6 months after the start of therapy. Results 2,759high CVD risk individuals (58% females), mean age 59 (SD 12) years, were interviewed and examined (participation rate 70%). The risk factor control was very poor, with less than half (47%) of patients on blood pressurelowering medication reaching the target of &amp;lt;140/90 mmHg (&amp;lt;140/85 mmHg in people with self-reported diabetes). Among treated dyslipidaemic patients only 47% attained LDL-cholesterol target of &amp;lt;2.6 mmol/L. Among treated type 2 diabetic patients, 65% achieved the HbA1c target of &amp;lt;7.0mmol/L. However, many patients on no antihypertensive or lipid-lowering medications had elevated blood pressure (43%) and elevated LDL-cholesterol (81%), respectively. The use of blood pressure lowering medication in people with hypertension was: ACE inhibitors/ARBs 79%, beta-blockers 37%, diuretics 36% and calcium channel blockers 32%; with 42% on one, 34% on two, 18% on three and 6% on ≥4 blood pressure lowering drugs. Among people on lipid-lowering medication, statins were prescribed in 97% and fibrates in 3%. Less than two-thirds of patients reported complete adherence with the intake of their blood pressure and lipid-lowering medications. The comparison with EUROASPIRE IV in the same centres that took part in both surveys showed no change in the BP management. There was a slight improvement in the control of LDL-cholesterol and glucose in patients with diabetes. Conclusions The results of EUROASPIRE V clearly demonstrate that the control of blood pressure, LDL-cholesterol and diabetes in patients at high CVD risk remains poor with large proportions not achieving the targets defined in the prevention guidelines. There is a considerable potential to raise the standards of preventive cardiology and to improve the management of patients at high CVD risk in Europe. Funding Acknowledgement Type of funding source: Other. Main funding source(s): European Society of Cardiology

Cardiology Involvement in Patients With Breast Cancer Treated With Trastuzumab

BackgroundThere is limited evidence regarding the impact of cardiology involvement in the care of cancer patients. ObjectivesThis study evaluated the impact of cardiology involvement on guideline-adherent cardiovascular monitoring and risk factor management in patients with breast cancer treated with trastuzumab. MethodsIn a single-center retrospective cohort study, electronic health records from 1,047 patients with breast cancer receiving trastuzumab between January 2009 and July 2018 were evaluated. A visit to a cardiology provider beginning from the 3 months before cancer therapy initiation until the last contact date defined cardiology involvement. Guideline-adherent monitoring, defined by echocardiography assessment within the 4 months before trastuzumab initiation and follow-up echocardiography at least every 4 months during therapy, was compared in patients with and without cardiology involvement before treatment initiation. Multivariable associations between cardiology involvement and the time-varying risk factors blood pressure and body mass index (BMI) were assessed by using generalized estimating equations. ResultsCardiology involvement occurred in 293 (28%) patients. A higher proportion of patients with cardiology involvement before trastuzumab initiation had guideline-adherent monitoring (76.4% vs. 60.1%; p = 0.007). Cardiology involvement was associated with an average 1.5 mm Hg (95% CI: –2.9 to –0.1; p = 0.035) lower systolic blood pressure, which was more pronounced in those with hypertension (–2.7 mm Hg; 95% CI: –4.6 to –0.7; p = 0.007). Cardiology involvement was associated with a lower BMI in patients with baseline BMI ≥25 kg/m2 (mean difference: –0.5 kg/m2; 95% CI: –1.0 to –0.1; p = 0.027). ConclusionsCardiology involvement in patients with breast cancer treated with trastuzumab is associated with greater adherence to cardiovascular monitoring and modest improvements in risk factor control.

Abstract 357: Comparison of Comorbidities Between Patients Admitted With Index Myocardial Infarction and Recurrent Myocardial Infarction

Background: Several comorbidities are known to increase the risk of coronary artery disease. However, the relationship between modifiable risk factors and recurrent Myocardial Infarction (MI) has not been clearly defined. The purpose of our study was to assess if there were certain comorbidities that increase the risk of recurrent myocardial infarction. Methods: We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 (29% STEMI, 71% NSTEMI), and we identified all cases of readmission with a recurrent MI within 90 days after index MI. All patients with index MI were screened for accompanying comorbidities and compared with patients with recurrent MI. Results: There were a total of 2051 readmissions (31%) within 90-days of index MI, of which 168 readmissions were for recurrent MI. Hypertension and Dyslipidemia appeared to be the most prominent modifiable risk factors in patients with index MI and recurrent MI (86%, 94% for HTN &amp; 81%, 93% for DLP). All comorbidities were substantially more prevalent in patients with recurrent MI than in patients with index MI. Conclusion: Patients with recurrent MI have a higher risk factor burden than the general population with MI. This highlights the importance of risk factor management in patients with acute Myocardial infarction.

Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association.

Although cardiologists have long treated patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (T2DM), T2DM has traditionally been considered just a comorbidity that affected the development and progression of the disease. Over the past decade, a number of factors have shifted that have forced the cardiology community to reconsider the role of T2DM in CAD. First, in addition to being associated with increased cardiovascular risk, T2DM has the potential to affect a number of treatment choices for CAD. In this document, we discuss the role that T2DM has in the selection of testing for CAD, in medical management (both secondary prevention strategies and treatment of stable angina), and in the selection of revascularization strategy. Second, although glycemic control has been recommended as a part of comprehensive risk factor management in patients with CAD, there is mounting evidence that the mechanism by which glucose is managed can have a substantial impact on cardiovascular outcomes. In this document, we discuss the role of glycemic management (both in intensity of control and choice of medications) in cardiovascular outcomes. It is becoming clear that the cardiologist needs both to consider T2DM in cardiovascular treatment decisions and potentially to help guide the selection of glucose-lowering medications. Our statement provides a comprehensive summary of effective, patient-centered management of CAD in patients with T2DM, with emphasis on the emerging evidence. Given the increasing prevalence of T2DM and the accumulating evidence of the need to consider T2DM in treatment decisions, this knowledge will become ever more important to optimize our patients' cardiovascular outcomes.

Cardiovascular risk factors and the risk of major adverse limb events in patients with symptomatic cardiovascular disease

AimTo determine the relationship between non-high-density lipoprotein cholesterol (non-HDL-c), systolic blood pressure (SBP) and smoking and the risk of major adverse limb events (MALE) and the combination with major adverse...

Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease-A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V.

Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated. A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.

Abstract 132: Integrated Risk Factor Management in Patients with Coronary Artery Disease: Insights from the Angina Prevalence and Provider Evaluation of Angina Relief Study

Introduction: Effective management of cardiovascular risk factors is the foundation of secondary prevention in coronary artery disease (CAD). The physician under whose sphere these are managed can vary—most typically primary care physicians (PCP), cardiologists, or both—and the optimal management strategy for risk factor control in outpatients with CAD is unknown. Methods: Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study was a cross-sectional cohort study of outpatients with CAD (stable angina, PCI, CABG, or myocardial infarction) from 25 US cardiology practices and 155 providers. After each patient visit, providers noted who managed each risk factor. Blood pressure (BP), lipid levels, medications, and comorbidities were recorded from charts. We compared adherence to guideline-directed risk factor control between management strategies (PCP alone, cardiologist alone, or co-managed). Results: Among 1259 outpatients with CAD (mean age 71 y, 69% men), BP was managed by cardiologists alone in 66% of patients, co-managed in 29%, and PCP alone in 5%. Median BP was 128/72 mmHg, with 74% of patients at &lt;140/90 and 46% at &lt;130/80. Lipids were managed by cardiologists alone in 56%, co-managed in 28%, and PCP alone in 16%. Median LDL was 77 mg/dL, with 75% of patients at &lt;100, 37% at &lt;70, and 91% of patients on appropriate statin therapy. Patients managed by cardiologists alone tended to have higher rates of risk factor control for both BP and lipids (Table). Conclusions: Although co-management has shown benefit in some clinical situations, we found that risk factor control in patients with CAD tended to be poorer when care was shared between cardiologists and PCPs. Further research is needed to better define which conditions are best co-managed and how to more effectively co-manage patients in the fractured healthcare systems common in the US.

Abstract 293: Effect of Cardiovascular Health and Text Messaging (CHAT) on Risk Factor Management in Patients with Coronary Heart Disease: A Randomized Clinical Trial

Background: Mobile health technologies are low-cost, scalable interventions with the potential to promote patient engagement and behavior change. We designed and tested a tailored culturally-sensitive text messaging intervention to support secondary prevention in patients with coronary heart disease. Methods: In this multi-center, single-blinded randomized controlled trial, we enrolled 822 patients (mean age, 56.4 [SD, 9.5] years; 16.1% [132 of 822] women) with a history of AMI or PCI and without diabetes from 37 hospitals in China from August 2016 to March 2017. In addition to usual care, the control group (n=411) received 2 thank-you messages/month; the intervention group (n=411) received 6 text messages/week for 6 months delivered by an automated computerized system. The messages provided educational and motivational information related to disease-specific knowledge, risk factor control, physical activity and medication adherence. The primary endpoint was change in systolic blood pressure (SBP) from baseline to 6 months. Secondary end points included the proportion with SBP&lt;140mmHg, smoking status, and change in BMI, LDL-C, and physical activity. The endpoints were assessed using analyses of covariance. Results: Follow up was 99.6% (819 of 822). The mean baseline SBP (SD) for the intervention and control groups were 130.9 (15.1) mmHg and 131.4 (17.5) mmHg, respectively. At 6 months, SBP was not significantly lower in the intervention group compared to the control group (mean SBP 127.8 vs. 129.4mmHg, p=0.089), with a mean change (SD) of 3.2 (14.3) mmHg and 2.0 (15.0) mmHg from baseline, respectively (mean net change -1.3mmHg [95%CI -3.3 to 0.8]; P=0.221). There were no significant differences in the change in LDL-C level, physical activity, BMI or smoking status between two groups. Nearly all patients in the intervention group reported the text messages to be useful (96.1%[389 of 405]), easy to understand (98.8%[400 of 405]), appropriate in frequency (93.8%[380 of 405]), and reported being willing to receive future text messages (94.8%[384 of 405]). Conclusions: Text messages supporting secondary prevention among patients with CHD did not lead to a greater reduction in blood pressure at 6 months. However, it was feasible and highly acceptable to patients.

Lifestyle, Glycosylated Hemoglobin A1c, and Survival Among Patients With Stable Ischemic Heart Disease and Diabetes

BackgroundThe importance of glycosylated hemoglobin A1c (A1c) control as part of comprehensive risk factor management in patients with stable ischemic heart disease (SIHD) and diabetes mellitus (DM) is controversial. ObjectivesThe purpose of this study was to determine whether a greater number of controlled risk factors at 1 year, including A1c, affects survival in patients with DM and SIHD. MethodsOf 690 patients with DM followed in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 592 (86%) had complete ascertainment of 7 pre-specified risk factors at baseline and after 1 year: systolic blood pressure, low-density lipoprotein cholesterol, nonsmoking, physical activity, diet adherence, body mass index, and A1c. The primary outcome measure was mortality beyond 1 year after randomization. ResultsDuring a mean follow-up of 7.0 ± 4.2 years beyond 1 year after randomization, 186 subjects died (31.4% overall, 4.5%/year). The greater the number of risk factors controlled at 1 year, the higher the probability of survival (unadjusted log rank p = 0.002). Compared with 0 to 1 controlled risk factors, attaining 3 to 7 goals predicted progressively lower mortality (hazard ratio for control of 6 or 7 risk factors was 0.13; 95% confidence interval: 0.05 to 0.40). Importantly, only 10.3% of subjects achieved control of 6 or 7 risk factors. In multivariate analysis, the strongest predictors of improved survival were no smoking, regular physical activity, dietary adherence, and A1c <7%. ConclusionsIn this high-risk subset of SIHD patients with DM, the number of controlled risk factors, particularly lifestyle behaviors and A1c, were associated with improved survival. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657)