Modifiable Risk Factors Research Articles

Risk factors for delirium in patients aged 60 years and over with recent myocardial infarction

Abstract Introduction Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem. Modifiable and unmodifiable risk factors may influence delirium appearance. Purpose The study aimed to assess the prevalence and characteristic of delirium risk factors in patients ≥ 60 years of age hospitalized due to acute myocardial infarction (AMI). Methods The study included 405 consecutive patients (mean age: 73.1[8.5], males: 248/61.2 %) hospitalized due to AMI divided and characterized according to the in-hospital delirium presence. The following sets of data were analysed: demographic data, length of hospitalization, type of AMI, coronary intervention, multimorbidity, accompanying symptoms, psychiatric conditions, and pharmacotherapy used. Results Of 405 patients, 57 (14%, mean age: 80.9[7.3] years, males: 33/58%) experienced delirium. Patients with delirium were older (80.9[7.3] vs 71.82[8.1] years), all of them presented multimorbidity, they more frequently used polypharmacy (96.5 vs 30.2%) and their hospitalization was longer (8.0[1.4] vs 4.6[1.0] days) as compared to the patients without delirium. Patients with delirium more frequently experience in-hospital reversible problems: periprocedural complications (limited number of radial access, prolonged compression and pain after the procedure, pseudoaneurysm of femoral artery, as well as the following accompanying symptoms: fever (40.4% vs 0.9%), infections (78.9% vs 3.7%), pulmonary oedema (73.7% vs 0.6%), hypoxemia (91.1% vs 98.3%), urinary catheter (96.5% vs 17.2%), dehydration (89.5% vs 6.6%), and insomnia (71.9% vs 0.3%) compared to patients without delirium (Table 1). Delirium was also associated with mild (49.1% vs 0.3%, p<0.0001) and moderate (47.4% vs 9.2%) dementia and symptoms of mild depression (59.6% vs 2.3%) (P<0.0001 for all). Valvular heart disease (OR=4.78; 95%CI: 1.10-2.70; p<0.0001, pulmonary oedema (OR=66.79; 95%CI: 12.04-370.34, p<0.001), and dehydration (OR=37.26; 95%CI: 10.50-132.27, p<0.001) were risk factors for delirium occurrence. Analysis of all factors related to delirium revealed that the coexistence of ≥ 11 concerned 44% of the delirium population (Table 1). Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14% of patients ≥ 60 years old. Multimorbidity and polypharmacy regard most of the subjects with delirium. The potent reversible complications of the in-hospital course of AMI associated with delirium should be recognized and limited to prevent this problem.Table1.Number of delirium risk factors.

Identification of premature cardiovascular disease using a family-based strategy: a feasibility pilot study

Abstract Background Current guidelines fail to identify and effectively prevent cardiovascular disease (CVD) in young adults. Purpose To assess the feasibility of a systematic cardiovascular risk assessment in first-degree relatives of individuals with premature coronary artery disease (CAD). Method Index patients with obstructive CAD aged ≤ 45 years or ≤ 55 years without standard modifiable cardiovascular risk factor or ≤ 55 years with a 3-vessel coronary disease were prospectively identified among admissions. Pre-existing cases of CVD and prior cardiovascular check-ups were assessed among their first-degree relatives. Siblings and adult-children (≥25 years) without known CVD or active cardiology follow-up were eligible for a first cardiovascular evaluation. Index patients were encouraged to invite their eligible relatives to contact the Cardiology service for consultation. The primary endpoint was the relative’s eligibility for a cardiovascular prevention consultation. Result From September 2022 to June 2023, 137 patients with premature CAD, with 55.5% aged ≤ 45, were invited to initiate cardiovascular screening among their first-degree relatives. Of the 626 identified relatives, 153 (24.4%) had known atherosclerotic disease, primarily CAD (19.6%). Premature onset (before the age of 45) occurred in 5% of first-degree relatives. Among the 352 siblings and adult-children, 48 (13.6%) were already diagnosed with CVD, 68 (19.3%) were treated or followed for primary prevention, and 226 (64.2%) lacked active cardiovascular monitoring or treatment and were eligible for a first cardiovascular check-up (Figure 1). Within 10 months, 11.1% (25/226) of eligible relatives attended a first cardiovascular evaluation. Conclusion This family-based screening strategy for premature CVD demonstrated 1) a significant familial dimension, with 33% of siblings & adult-children already monitored for CVD prevention, and 2) an opportunity for cardiovascular prevention in two out of three young relatives.

Prevecardio: a single-visit population screening model for detection and prevention of 10-year cardiovascular risk

Abstract Introduction Cardiovascular diseases (CVDs) are a major contributor to global mortality. The early detection of cardiovascular risk factors, coupled with timely intervention strategies, is essential for CVD prevention. PreveCardio was developed as an innovative, single-visit population screening model designed to facilitate the early identification and management of cardiovascular risk factors within a population of 1 million in a European capital city region totaling 6 million inhabitants. Purpose This study aimed to ascertain the prevalence of cardiovascular risk factors within the general population and to evaluate the effectiveness of the PreveCardio model in estimating 10-year cardiovascular risks and promoting preventive interventions. Methods In this cross-sectional prevalence study, individuals aged 50 to 75 from a health network were randomly selected and invited to participate in a comprehensive health check. The 30-minute screening consisted of lifestyle evaluations, anthropometric measurements, and blood tests for lipid profiles and glycated haemoglobin. The methodology was designed to provide participants with immediate feedback on their results, cardiovascular health and practical guidance for risk management. Results From the 8,492 individuals solicited, 3,546 took part in the screening: 56,83% were female, mean age 61,17 ± 7,33 y.o. Picture 1 shows the population's percentages with various modifiable cardiovascular risk factors, including 20% with active smoking, 30% with sedentarism, 16% with risky alcohol consumption, 49% with non-adherence to the Mediterranean diet, 40% with overweight, and 30% with obesity. The screening revealed new diagnoses of LDL-hypercholesterolemia in 47% participants, high levels of blood pressure in hypertension range in 49%, prediabetes in 30% and diabetes in 2% (Picture 2). After use SCORE2 and SCORE-OP risk prediction algorithms, PreveCardio is estimated to potentially prevent between 39 to 202 fatal and non-fatal cardiovascular events over 10 years. Predictive modelling based on PreveCardio data projected that expanding the screening across the capital region could prevent at least 26,260 cardiovascular events over 10 years. Conclusion(s) PreveCardio has established itself as a viable and effective model for the early detection of cardiovascular risk factors in a general population. It holds significant promise for public health impact by potentially reducing the incidence of CVD through comprehensive screening and proactive intervention.

Intersecting Pathways: Understanding Dementia, Hearing Loss, and Health Disparities

Abstract Background Dementia is a major public health concern, affecting care dependency and disability in older ages. In Europe, around 14.1 million people live with dementia, a number that is expected to increase to 15.9 million by 2040. Hearing loss (HL), followed by education, has been proposed as the most important modifiable risk factor for dementia. This study aims to investigate how sex, educational attainment and HL intersect to influence dementia-free life expectancy (DemFLE) in older adults. Methods Using population register data covering all Finnish residents aged 50 years or older from 2010 to 2019, we apply discrete-time multistate Markov models. Transition probabilities between states, such as HL and dementia, are estimated with multinomial logit models stratified by sex and education. Multistate life tables are used to compute sex- and education-specific DemFLE. Results We identified 316,361 individuals with a diagnosis of dementia and 317,115 individuals with a diagnosis of HL, representing 1,449,873 and 2,738,970 person-years respectively. 14% of individuals with HL were eventually diagnosed with dementia, compared to only 8% of individuals without HL. We hypothesise that DemFLE will vary significantly by sex and education, with additional modulation by the presence of HL. Specifically, we expect that the presence of HL will further reduce DemFLE, and that the magnitude of this reduction will be relatively greater among those with lower educational attainment. Conclusions This study contributes to the emerging literature on the impact of hearing loss on dementia. While both dementia and hearing loss are irreversible health conditions, hearing loss can be managed by hearing aids. If we find evidence that hearing loss is associated with different levels of risk of dementia by educational attainment, it would suggest avenues for effective interventions and public health policies to ensure more equal ageing processes in the population. Key messages • Hearing loss may intersect with education and sex in the risk of dementia, providing evidence for the importance of addressing hearing health inequalities in dementia prevention efforts. • Understanding the interactions between hearing loss, education and sex can inform policies to promote healthy ageing and reduce the burden of dementia on individuals and health systems.

Nonlinear correlation between serum vitamin D levels and the incidence of endometrial polyps in infertile women.

Are serum vitamin D levels associated with the incidence of endometrial polyps (EPs) in infertile patients? Serum 25(OH)D levels were nonlinearly correlated with the incidence of EPs in infertile women. EPs are a common condition that may affect the receptivity of the endometrium in women of reproductive age. Vitamin D regulates cell proliferation and differentiation, apoptosis, angiogenesis, anti-inflammation, and immunomodulation, in addition to its well-known functions in balancing calcium and phosphorus. Previous studies have shown that vitamin D concentrations are associated with reproductive outcomes, and that low vitamin D levels are associated with the incidence of colorectal polyps and nasal polyps. There is little evidence regarding the relationship between EPs and serum vitamin D levels. We conducted a cross-sectional study using data from Guangdong Women and Children Hospital from January 2019 to October 2023, enrolling 3107 patients. A total of 3107 infertile patients who underwent hysteroscopy were included in this study; 642 patients had endometrial polyps and 2465 had a normal uterine cavity. Hysteroscopy findings included risk of EPs, polyp size, percentage of multiple polyps, and incidence of chronic endometritis (CE). Serum vitamin D were assessed by measuring total 25(OH)D using chemiluminescence. According to international guideline recommendations for vitamin D deficiency, patients were divided into two groups: the <50 nmol/l group and the ≥50 nmol/l group. Univariable and multivariable logistic regression models, stratified analyses, and smooth curve fitting were used to examine the relationship between serum 25(OH)D levels and risk of EPs. Of all patients, 23.8% (740/3107) were vitamin D deficient (<50 nmol/l). The incidence of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group (24.9% vs 19.3%; P = 0.001). However, there were no differences in polyp size, proportion of multiple polyps, and presence of CE between the two groups. After controlling for confounders, 25(OH)D ≥ 50 nmol/l (compared with <50 nmol/l) was negatively associated with risk of EPs (adjusted OR, 0.733; 95% CI, 0.598-0.898). Other variables that had an impact on polyp incidence included BMI, type of infertility, CA125, and CD138-positive plasma cells. In addition, a linear regression model between age and serum 25(OH)D levels showed a positive linear association. Subgroup analyses were performed for different age groups, and the risk of EPs was significantly higher in the 25(OH)D < 50 nmol/l group than in the ≥50 nmol/l group, both in the younger subgroup (23.8% vs 19.1%) and in the older subgroup (28.0% vs 19.9%). The smooth curve fitting model showed a nonlinear correlation between 25(OH)D levels and risk of EPs (nonlinear P-value = 0.020), with an optimal threshold of 51.8 nmol/l for 25(OH)D levels. Moreover, subgroup smooth curve fitting models showed a nonlinear correlation between 25(OH)D levels and polyp risk in patients aged <35 years (nonlinear P-value = 0.010), whereas a linear correlation between 25(OH)D levels and polyp risk was found in patients aged ≥35 years (nonlinear P-value = 0.682). Caution should be exercised in interpreting our findings as this is a correlational study and causality cannot be inferred from our results. In addition, because of strict inclusion and exclusion criteria, our results may not be generalizable to unselected populations, including premenopausal women or women of other races. This study demonstrated for the first time that vitamin D deficiency is an independent risk factor for the incidence of EPs in infertile patients. Identifying modifiable risk factors (e.g. vitamin D deficiency) can help in the development of new strategies for treating polyps or to protect against polyp development. Further clinical intervention trials and laboratory studies are needed to evaluate the effect of vitamin D on the development of EPs and to elucidate the mechanisms. The study was funded by the National Natural Science Foundation of China (82101718) and Natural Science Foundation of Guangdong Province, China (2022A1515010776). No competing interest was involved in this study. N/A.

Physical activity and sedentarism among non-binary gender identified university students

Abstract Background Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend &amp;gt;6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%). Conclusions In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus. Key messages • Non-binary gender identified students are less physically active and more sedentary than their peers. • Once they commit to physical activity recommendations, there are no differences among their performance.

Breast arterial calcification: a potential novel imaging marker for HFpEF

Abstract Background Breast arterial calcification (BAC) on mammography has been shown to associate with cardiovascular disease, however the association with heart failure (HF) remains largely uncharacterised. BAC is a medial arterial calcification process, which is a marker of vascular stiffness, a key contributor to diastolic dysfunction (DD) and HFpEF. We sought to evaluate the association between BAC and HFpEF. Purpose This study aims to assess the relationship between BAC status and HFpEF. Methods This retrospective cross-sectional study included 100 consecutive patients with clinically indicated mammography and echocardiography within 6 months of each other. BAC was visually assessed to determine presence or absence. HFpEF was diagnosed based on combined clinical and echocardiographic assessment. DD was defined by Mitter et. al’s(1) criteria after review of echocardiograms. Logistic regression analysis with Odds Ratio (OR) and (95% confidence intervals) are reported for association with any HF, HFpEF, or DD adjusting for modifiable (body mass index, hypertension, hyperlipidaemia, current smoking, diabetes mellitus) and non-modifiable (age, past smoking breast cancer, past ischaemic heart disease (IHD), atrial fibrillation (AF), chronic kidney disease (CKD)) risk factors. Results The prevalence of BAC was 27% and 13% had HFpEF and 55.8% had DD. Patients with BAC were older (mean age 73±13 vs 57±13, p&amp;lt;0.01) with greater proportion of hypertension (66.67% vs 39.73%, p=0.02), hypercholesterolaemia (70.37% vs 43.84%, p=0.02), AF (p&amp;lt;0.01), previous IHD (p=0.01), and CKD (p&amp;lt;0.01). After adjustment for these variables, BAC was independently associated with HFpEF diagnosis for modifiable risk factors: (OR 2.47 [0.50-12.10], p&amp;lt;0.27) and non-modifiable factors (OR 6.96 [1.72-33.31], p&amp;lt;0.01). BAC was also independently associated with echo defined DD: adjusted for modifiable risk factors (OR 8.67 [2.49-42.16], p&amp;lt;0.01), and non-modifiable risk factors (OR 8.25 [2.44-38.27], p&amp;lt;0.01). Conclusions BAC is associated with HF presence, particularly HFpEF and DD. Further research is required to elucidate the role of shared pathophysiological mechanisms, such as vascular stiffness and general arterial calcification, common to BAC, DD, and HFpEF. In the future, BAC may act as a useful surrogate and opportunistic marker to instigate further review if implemented in established widespread breast-screening programs for detection of subclinical disease.Figure 1:Case example of imaging assess

Unique regional risk profiles and cardiovascular outcomes of patients with acute coronary syndrome in the absence of standard modifiable risk factors: a systematic review and meta-analysis

Abstract Background With differences in prevalence, risk profile, cardiovascular complications, and mortality of patients with acute coronary syndrome (ACS) in the absence of standard modifiable risk factors (SMuRF-less) worldwide, this study examines the regional differences and the unique risk profiles of this often-understudied group of patients. Purpose We hypothesize that differences in non-traditional risk factor profiles may lead to unique ACS-related presentations, complication rates, and secondary preventative strategies across regions. Hence this study was undertaken to assess the cross-regional comparisons of patient characteristics, risk profile, angiographic characteristics that may provide insights into disparate cardiovascular outcomes observed in the SMuRF-less ACS population. Methods Medline and Embase databases were searched in November 2022 to identify relevant literature relating to the prevalence of risk factors in SMuRF-less patients with ACS. A single-arm meta-analysis of proportion and means was conducted on baseline and presentation characteristics, outcomes and complications, management, and risk factors in SMuRF-less ACS patients, stratified according to geographical region (Asia-Pacific, Europe, and North America). Risk of bias was assessed using the Newcastle-Ottawa scale. Results A total of 25 studies comprising of 1,393,184 individuals with ACS were included, of which 242,929 patients were SMuRF-less. Within this SMuRF-less ACS group, mortality rates were similar across the regions (Asia-Pacific:15.8%, Europe:17.5%, p=0.861), cardiac arrest (6.3%, 95%CI:2.3% to 16.3%, p=0.001) and major bleeding (5.2%, 95%CI:2.9% to 9.2%, p=0.001) were more prevalent in Asia-Pacific, and heart failure more common in Europe (21.7%, 95%CI:18.2% to 25.7%, p&amp;lt;0.001). Prevalence of chronic obstructive lung disease (21.4%, 95%CI:21.2% to 21.6%, p&amp;lt;0.001) and peripheral artery disease (3.8%, 95%CI:3.1% to 4.7%, p=0.001) were highest in SMuRF-less ACS patients from North America, chronic liver disease most prevalent in those from Asia-Pacific (3.5%, 95%CI:2.2% to 5.6%, p&amp;lt;0.001) and family history of coronary artery disease highest in SMuRF-less ACS patients from Europe (25.2%, 95%CI:24.8% to 25.7%, p=0.024). Significantly lower rates of guideline-directed medical therapy prescriptions were observed for SMuRF-less ACS patients in Asia-Pacific compared to other regions. Conclusion This regional analysis highlights the different risk profiles, cardiovascular outcomes, and specific needs of individuals presenting with ACS in the absence of cardiovascular risk factors, across Asia-Pacific, Europe, and North America. Whilst unravelling novel pathomechanistic pathways of atherosclerosis will prove beneficial on a global scale, understanding the unique regional profile of these individuals will aid policymakers strategize effective and tailored clinical pathways in the management of SMuRF-less ACS.Graphical AbstractKey Outcomes

Sleep health across the life cycle: an unmet and neglected public health priority

Abstract The presentation will set the stage on the central role of sleep health across the life cycle. Despite the large body of evidence on the importance of poor sleep behaviors as a modifiable risk factor for several adverse health outcomes, sleep health is still an unmet and neglected issue in public health policy, especially in the European context. Sleep problems are widespread and potentially affect everyone, from childhood to adult age. In addition, sleep health disparities represent a major source of health inequities across marginalized and high-risk population subgroups, such us people from low socio-economic status, women, refugees and immigrants, shift workers, people living with physical and mental illness. There is an urgent need to promote evidence-based health promotion and public health policy to enhance sleep health both in the general population and high-risk subgroups.

Lipoprotein (a), coronary artery disease risk, and MACE in individuals without standard modifiable risk factors in the UK Biobank

Abstract Background A significant proportion of patients with coronary artery disease (CAD) lack standard modifiable risk factors (SMuRFs; smoking, hypercholesterolaemia, diabetes and hypertension), for example with recent analyses demonstrating that around 25% of patients with ST-elevation myocardial infarction are SMuRF-less(1). With continued focus on primary prevention in cardiovascular disease, the SMuRF-less subset is likely to increase over time. A body of evidence has implicated lipoprotein (a) in CAD, but no such studies have investigated this association in a purely SMuRF-less population. Purpose To investigate the role of lipoprotein (a) in predicting CAD risk and major adverse cardiovascular events (MACE) in a large, SMuRF-less cohort. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37-73 years at entry between 2006-2010. SMuRFs were defined as 1) smoking (current or historical), 2) hypercholesterolaemia – lipid lowering medication on enrolment or total cholesterol &amp;gt;5.5mmol/L or LDL-C &amp;gt;3.5mmol/L, 3) previous diagnosis of diabetes mellitus, or HbA1c &amp;gt;48mmol/mol, 4) previous diagnosis of hypertension. MACE was defined as a composite of coronary artery disease – previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery –, stroke, or all-cause mortality. Results Of the total UK Biobank cohort, 46,139 participants were identified as SMuRF-less together with a valid lipoprotein (a) level. Median follow-up duration was 12yrs. In univariate analyses (Table 1), there was no significant difference in lipoprotein (a) concentrations between individuals with and without MACE (16.9 vs. 17.1nmol/L respectively, p = 0.913). The overall event rate was low, with just 3% MACE (1381 events) overall. Older age, male gender, apolipoprotein A, apolipoprotein B, HbA1c level, HDL cholesterol level and body mass index were all associated with MACE. In regard to all-cause mortality alone, there was no association with lipoprotein (a) level, although the other aforementioned parameters were all significantly associated with this outcome. Similarly, lipoprotein (a) was not a significant predictor of stroke. However, there was a large difference in lipoprotein (a) levels between patients with and without CAD (27.2 vs. 17.1nmol/L respectively, p = 0.004). In Kaplan-Meier analysis, lipoprotein (a) level above the 77th percentile (60.3nmol/L) was significantly associated with CAD (p=0.032). In Cox regression models, despite the low event rate, lipoprotein (a) was a significant predictor of CAD (HR 1.00-1.01, p=0.01), and importantly the only potentially modifiable parameter (N = 39,433, 111 events, Table 2). Conclusion Lipoprotein (a) independently predicts CAD in those without SMuRFs, highlighting the importance of checking this parameter in such patients, particularly given the novel antisense technologies in development which may lower lipoprotein (a)(2).Univariate analysesCox regression for CAD

Hypertension and global DNA methylation: a population-based study in rural, Punjab, India

Hypertension is a significant public health concern and a modifiable risk factor for increased mortality worldwide. It is reported to be influenced by gene-environment interactions and micronutrient intake. This study aims to understand the relationship between global DNA methylation levels and hypertension, independently and in the context of micronutrient status, among rural population in Punjab, India. A total of 2300 individuals, aged 30–75 years, (54.9% females) were screened for blood pressure. Of 2300 screened individuals, 900 (age sex matched 450 cases and 450 controls of hypertension) individuals were selected to examine the relationship between hypertension, global DNA methylation (5mC), and biochemicals (Folate, Vitamin B12, and Homocysteine). Folate, vitamin B12, and homocysteine levels were estimated using chemiluminescence technique. The ELISA-based colorimetric technique was used for performing peripheral blood leucocyte (PBL) global DNA methylation (5mC). Statistical analyses were performed using SPSS version 22.0. Hypertensives were found to have significantly lower levels of global DNA methylation than normotensives (0.65 vs. 0.72 respectively; p-value = 0.01*). Individuals in the 1st quartile of 5mC were at significantly (OR: 1.671; 95% CI: 1.206–2.315; p-value = 0.01*) increased risk for hypertension in comparison to those in the 4th quartile (reference). Further hypertensives on medication with controlled blood pressure (BP) were significantly hypermethylated as compared to hypertensives on medication with uncontrolled BP (0.70 vs. 0.62 respectively; p-value = 0.04*). Folate appeared to mediate global DNA methylation among hypertensives on medication-controlled BP. Further hypertension driven hypomethylation hints towards accelerated biological aging among younger hypertensives. Hypertension may be associated with Global DNA hypomethylation in the studied rural population of Punjab, India. Folate sufficiency may prove to be an aid in improving the methylation levels among the cases of hypertension who were on medication and had controlled BP.

Cross-national characteristics and differences in type 2 diabetes: Malta versus Luxembourg

Abstract Introduction Type 2 diabetes mellitus (T2DM) is a significant global health concern, requiring a thorough understanding of its population-level features and impact. This study aims to compare the characteristics of T2DM in Malta and Luxembourg, two European nations with distinctive healthcare systems and societal attributes. Methods Data from national health surveys conducted in Malta and Luxembourg, encompassing various factors such as socio-demographics, medical history, biochemical metrics, and anthropometric measurements, were analysed to investigate the features of T2DM. Comparative analyses were conducted utilizing chi-square tests, independent t-tests, and multivariable binary regression. Results Malta (8.23%) and Luxembourg (7.82%) shared similar T2DM prevalence, with a predominance of men having T2DM. Malta exhibited a higher prevalence of obesity among the individuals having T2DM. Multivariable analysis showed no significant association between living in Malta or Luxembourg and diabetes. However, being male (OR: 1.49, CI 95%: 1.07–2.08, p = 0.02), an occasional smoker (OR: 2.49, CI 95%: 1.54–4.03, p &amp;lt; 0.01), increasing age (OR: 1.05, CI 95%: 1.03–1.67), and larger waist circumference (OR: 1.02, CI 95%: 1.01–1.04, p = 0.01) were positively associated with diabetes. Conclusions Understanding similarities and differences in T2DM between Malta and Luxembourg is crucial for identifying common challenges to formulate effective prevention and management strategies. Despite similar T2DM prevalence rates, notable differences in obesity rates and socioeconomic factors may contribute to disparities in disease burden. The complex interplay of numerous population characteristics underscores the importance of tailored public health interventions. This study accentuates the need for interventions and evidence-based policies to address modifiable risk factors, and advocate for cross-national cooperation to reduce the T2DM epidemic, especially in the context of post-COVID public health planning and resource allocation. Key messages • Malta and Luxembourg share similar T2DM prevalence despite differences in other factors, hypothesised to be attributed to differences in risk factor profiles and health care infrastructure. • This study underscores the necessity for tailored interventions and cross-national cooperation to address common challenges in T2DM management in the two small countries.

Standard modifiable risk factors (SMuRF) paradox for the prognosis in the patients with acute myocardial infarction

Abstract Background Hypertension, diabetes, dyslipidemia and smoking are recognized as standard modifiable risk factors (SMuRFs) for adverse cardiovascular events such as acute myocardial infarction (AMI). Recent studies have shown that AMI patients without SMuRFs are associated with increased mortality compared to those with SMuRFs. However, the relationship between the number of SMuRFs in patients with AMI and mortality has not been well evaluated. Purpose The purpose of this study was to evaluate the clinical characteristics and prognosis of AMI patients stratified by the number of SMuRFs. Methods We studied 6,706 AMI patients between 2013 and 2021 using data from the Mie ACS registry, a retrospective and multicenter registry. For the purpose of this study, only AMI patients as their first cardiovascular events were included in this analysis. Therefore, after excluding patients with a known history of coronary artery disease (n=982), 5724 AMI patients were included in the current analysis. All-cause mortality was compared with 30-day and after 30-day mortality in AMI patients stratified by the number of SMuRFs as the primary outcome. In addition, all-cause mortality rate was compared in AMI patients without and with SMuRFs after propensity score matching on age, sex, body mass index, Killip classification, cardiac arrest before presentation, multivessel disease, left main truck disease, hemoglobin and emergent percutaneous coronary intervention. Results Among 5,724 AMI patients, 672 patients (11.7%) did not have SMuRFs. The median age of patients without SMuRFs was higher than that of patients with any SMuRFs (73 y.o. vs. 70 y.o, P&amp;lt;0.001), and higher prevalence of female and severe Killip class was observed in patients without SMuRFs compared with those with any SMuRFs (P&amp;lt;0.001, respectively). According to the KM survival curves stratified by number of SMURFs, an increased number of SMURFs was associated with higher 30-day survival rates (P=0.035), and the 30-day landmark analysis showed a trend toward higher survival in patients with the highest number of SMURFs, although not statistically significant (Figure1). Multivariate Cox regression analysis showed that 0 SMuRF was an independent prognostic factor for 30-day mortality with hazard ratio of 1.55 (95%CI; 1.13-2.13, P&amp;lt;0.001). In addition, KM survival curves after propensity score matched analysis showed the poor 30-day mortality in 0 SMuRF group (P=0.036), there was no significant difference in after 30-day mortality between the two groups (Figure 2). Conclusions Patients without SMuRFs had a high 30-day mortality rate, but once they survived the acute phase, their prognosis was comparable to patients with SMuRFs. Moreover, the SMuRF paradox was recognized in the acute phase. This finding highlights the need for early identification of the individuals at risk of developing MI despite the absence of SMuRFs and strict acute management regardless of the number of SMuRFs.

2.X.1. Sleep Health Disparities across the life-course: from research to public health policy

Abstract Poor sleep health is a recognized common problem across the life cycle, globally. Factors that contribute to this problem include the demands of a “Western” lifestyle (urgency, productivity), economic stressors, social and environmental determinants of health, and global crises including international conflicts, political tensions, and climate change. There is a growing consensus that optimizing sleep health should be a public health priority because poor sleep patterns are a modifiable risk factor for myriad health outcomes, such as cardiovascular disease, diabetes, cancer, cognitive decline, mental illness, and early mortality. In Canada, a nationwide sleep consortium funded by the Canadian Institutes of Health Research (CIHR) was recently formed with a mandate to generate new knowledge that will inform clinical practice and support public health initiatives to deliver resources where they are most needed. The proposed workshop organized by the Chronic Disease EPH section will start with a general overview of the impact of sleep health disparities across the life-course, from childhood to older age, as well as discuss evidence-based public health approaches to promote sleep hygiene and mitigate the risk of adverse health outcomes, including chronic disease (Saverio Stranges). It will be followed by three presentations to address the root causes of sleep health disparities and their impact on chronic disease (Dayna Johnson); participatory research with families and care providers on infant sleep intervention development (Elizabeth Keys), and strategies to address common sleep disorders among middle-aged and older adults (Tetyana Kendzerska). Key messages • Sleep health disparities are a neglected public health issue. • Optimizing sleep health is both a clinical and public health priority, as sleep patterns represent a modifiable risk factor for a range of adverse health outcomes.

Forecasting cognitive functioning: an artificial intelligence approach with Dynamic Bayesian Networks

Abstract Background Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed. We examined multifactorial trajectories of risk factors, and their associations with SCD using an artificial intelligence approach to build a score that forecasts later SCD. Methods Five repeated surveys (2000-2022) of the Helsinki Health Study (n = 8960, 79% women, aged 40-60 at Phase 1) were used to build dynamic Bayesian networks (DBN) for estimating the odds of SCD. A score-based approach was implemented for learning DBN using the quotient normalized maximum likelihood criterion. The model was used to predict SCD based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure-time physical activity, body mass index, and insomnia symptoms, adjusting for sociodemographic covariates. Results Of the participants, 31-48% reported decline in memory, learning, and concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Conclusions A new online risk score tool was developed that enables individuals to inspect their own risk profiles, as well as explore potential targets for interventions and their estimated contributions to later SCD. Dynamic decision heatmap was presented as a communication tool to be used at healthcare consultations. Key messages • Potentially modifiable health-related behaviours such as physical activity can contribute to subjective cognitive decline. • Artificial intelligence can be applied to discover the complex interactions between risk factors and subjective cognitive decline, to support preventive healthcare at individual and population levels.

Narrowing socioeconomic inequalities in coronary heart disease: insight from Mendelian randomization

Abstract Background Socioeconomic inequalities in coronary heart disease (CHD) represent a pressing global public health concern. However, which dimensions of socioeconomic status (SES) affect CHD and the potential modifiable mediators remain elusive. Methods We performed two-sample Mendelian randomization (MR) analyses based on summary data from large-scale genome-wide association studies in populations of European ancestry. Specifically, by applying bidirectional univariable MR (UVMR) and multivariable MR (MVMR), we investigated the causal relationships of education, occupation, income, Townsend deprivation index (TDI) with CHD and the independent effects of these SES indicators. We further employed a two-step MR to comprehensively profile the mediating effects of 23 behavioral, 3 psychological and 5 biological factors in the relationships. Results An independent causal association was observed between genetically predicated education and CHD, with a 30% lower risk of CHD (OR: 0.70; 95% CI: 0.53-0.93) for each 4.2-year of schooling. Each one-s.d. higher household income was causally, but not independently, associated with a 39% lower risk of CHD (OR: 0.61; 95% CI: 0.49-0.77). No significant causal association was suggested for occupation and TDI with CHD, and no reverse causal effect was observed for CHD on the SES indicators. Of 31 candidate mediators, nine factors mediated the effect of education on CHD significantly, with an individual mediation proportion of 33.5% for smoking, 29.2% for sedentary behaviour, 14.4% for blood lipids, 13.4% for BMI, 11.7% for systolic blood pressure, 9.5% for diastolic blood pressure, 7.8% for well-being spectrum, 6.4% for depression and 2.8% for blood glucose. Conclusions This study highlights that education was the primary SES indicator affecting CHD with considerable mediation by a number of modifiable risk factors. These findings inform policies to mitigate disparities of CHD risk attributable to socioeconomic inequalities. Key messages • Education can be prioritized over other common SES indicators as an essential strategy to reduce the burden of CHD. • Interventions for narrowing socioeconomic inequalities in CHD could focus on more easily modifiable mediating factors.

The Cardiovascular Disease Burden Associated with secondhand smoke, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study

Abstract Background Over the past three decades, global regions have shown significant differences in the burden of cardiovascular disease (CVD), and secondhand smoke is a major risk factor contributing to this burden. Nevertheless, a comprehensive understanding of the global trends and associations between second-hand smoke and cardiovascular disease is lacking. Methods Using data from the Global Burden of Disease (GBD) study 1990-2019, an age-period-cohort (APC) analysis was conducted to investigate trends in cardiovascular disease-related mortality in populations affected by secondhand smoke globally over the past 30 years and its association with age, period, and birth cohort. Results Over the past 30 years, the number of cardiovascular deaths caused by secondhand smoke has increased significantly worldwide, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), an increase of 38.4% (95% UI: 26.8%-49.5%). In 2019, cardiovascular disease accounted for 45.9% of all deaths attributable to secondhand smoke in both men and women globally. Among cardiovascular diseases, ischemic heart disease became the main component, accounting for 66.4% compared with stroke. The gender composition of cardiovascular deaths due to secondhand smoke is slightly lower in men (46.5%) than in women (53.5%). Longitudinal analyses using age-time-cohort models show that global CVD-related mortality from secondhand smoke has improved overall over the past three decades, but there are differences between regions, genders, and CVD subtypes. It is worth noting that the higher the socio-demographic index (SDI) level, the greater the reduction in mortality, with a staggering 39.1% reduction in high SDI areas (95% UI: 35.6%-42.3%), in sharp contrast to virtually no change in mortality in low SDI areas (0.1% (95% UI: -52.4%-62.2%)). During the period 2003-2007, cardiovascular disease-related mortality decreased significantly, with an average annual percentage change of -1.48%. Conclusion The study highlights the importance of using secondhand smoke as a modifiable risk factor for the global burden of cardiovascular disease. Further research is vital to understand the factors that lead to differences in countries and regions at different levels of development, gender differences and differences in cardiovascular disease subtypes.

Comorbidities and use of proarrhythmic drugs in patients with torsade de pointes arrhythmia

Abstract Introduction Drug-induced long QT interval syndrome (LQTS) is a risk factor for torsade de pointes (TdP) ventricular arrhythmia. Combining several QT-prolonging drugs can also increase risk. Clinical decision support systems (CDSS) can help prescribers assess the risk for TdP associated with drugs. Use of combination of drugs and prevalence of other risk factors is not fully known in TdP . Purpose To describe 1) comorbidities (risk-diagnoses) 2) dispensed prescription drugs and their risk for TdP (risk-drugs) using two different CDSS. The hypothesis was that individuals with TdP had risk-diagnoses and used risk-drugs. Personalized decision regarding risk stratification and medication is important to prevent TdP. Methods Patients with first episode of TdP (ICD-10 I472.C) in the National Patient Register (NPR) between 2006 and 2018 were included in this retrospective register-based cohort study. Comorbidities within 5 years prior to the hospital care episode and at the time of TdP diagnosis were retrieved. Mortality was analyzed (National Cause of Death Register). Medications dispensed within 90 days prior to TdP were retrieved (Swedish Prescribed Drug Register). Drugs were classified using 2 different CDSS (Credible Meds and Janusmed Risk Profile). Individual medication data linked with Janusmed Risk Profile gave a risk score of combination of drugs according to an algorithm. Results 762 patients with TdP were identified, most were elderly (72% ≥65 years old), 50% females. After TdP, 31 patients (4.1%) died within 7 days, 61 (8.0%) within 30 days, 87 (11%) within 90 days. Five years prior to TdP 338 patients (44%) had ≥1 risk-diagnosis (heart failure, cardiomyopathies, acute/ chronic coronary syndromes, renal failure,liver disease, LQTS, ventricular arrhythmia and/or cardiac arrest). More males vs. females had risk-diagnoses (28% vs. 22%, p&amp;lt;0.0015). A median of 6 drugs (IQR 2-9) were dispensed. Anti-depressants and antiarrhythmics were the most common risk-drugs. According to Credible Meds, 192 (25%) patients used ≥1 drug with known risk, 51 patients (6.7%) ≥1 drug with possible risk and 208 patients (27%) ≥1 drug with conditional risk only. 470 patients (62%) had ≥1 risk-diagnosis and/or ≥ 1 risk-drug (known or possible risk). Another 88 patients had ≥1 risk-diagnosis and/or ≥1 risk-drug (conditional risk). Thus, 558 patients (73%) had ≥1 risk-diagnosis and/or ≥ 1 risk-drug (Credible Meds). Analysis of combination of drugs showed that 290 patients (38 %) had drugs with increased risk, 547 patients (72%) had ≥1 risk-diagnosis and/or a combined drugs associated with increased risk (Janusmed Risk Profile). Conclusion Prior to TdP approximately a third of patients were dispensed prescription drugs with proarrhythmic risk according to two different CDSS. Almost 75% of patients were dispensed drugs associated with proarrhythmic risk and/or had other proarrhythmic risk factors. Vigilance should be undertaken to modify risk factors to prevent TdP.Baseline characteristicsRisk-drugs dispensed prior to TdP

Nationwide trends in major cardiovascular risk factors in England in the last 2 decades: Health Survey of England 2003-2019

Abstract Cardiovascular disease (CVD) accounts for a quarter of deaths annually in the UK, with more than 7.6 million people living with the disease. Hypertension, diabetes, and obesity are among the most prevalent modifiable risk factors for CVD, and the strategies to reduce the incidence and prevalence of these CV risk factors are deemed the most effective to reduce this immense toll. In the UK, over the last few decades, several health policy decisions and pathways have been developed to reduce this toll. We used data from 11 nationally representative, cross-sectional surveys from the Health Survey of England between 2003 and 2019 to evaluate trends in the prevalence of these CV risk factors and whether there has been any population-wide improvement in them. These surveys have cumulative information on 94,100 adults, and we applied sample weights, accounting for oversampling and nonresponse. We used "period definitions and cut-offs" to define those with diabetes. For example, for undiagnosed diabetes, we used glycated haemoglobin cut-off equivalent of 7% or more for years before 2011 and the current diagnostic threshold of &amp;gt; 6.5% thereafter. This was done to facilitate and compare the trends after accounting for changes in medical practice and understanding across this period. Similarly, hypertension was defined as doctor-diagnosed hypertension or in its absence regular use of antihypertensive medications or blood pressure ≥ 140/90mmHg (period diagnostic threshold remains unchanged during). Python and STATA were used to conduct analyses, and Join Point regression software was used to develop and compare trends. In England, from 2003-2019, mean population BMI consistently increased over this period, rising by 0.8kg/m2 from 27.6 to 28.8 kg/m2. Obesity prevalence (BMI ≥30kg/m2) increased by 5.4% from 22.6% to 28.0%. Concurrently, mean glycated haemoglobin increased by 0.36% from 6.18% to 6.54%, surpassing the current diabetes diagnostic threshold. Diabetes period prevalence surged from 4.2% to 11.6%, a trend consistent when the current diagnostic threshold was alternatively applied across all periods. Conversely, doctor-diagnosed and total hypertension (including those who are unaware) prevalence exhibited a slight decrease (1.4% and 3%, respectively), mirrored by reductions in population-wide mean systolic and diastolic blood pressure by 4.6mmHg and 1.9mmHg. These results suggest that, with the total population in England standing at 56.3 million in 2019, an estimated 15.8 million adults were within the obese BMI range, 6.5 million had diabetes and 17.6 million had hypertension. The obesity epidemic is likely fuelling the increase in diabetes prevalence. These findings underscore the importance of prioritising obesity reduction in public health initiatives, aiming to subsequently curb diabetes prevalence. Hypertension still remains a major CV risk factor, affecting almost one third of the adult population.

Developing an Evidence-Based Primary Cancer Prevention Repository: insights from the PIECES project

Abstract Introduction Up to 40% of cancer cases could be avoided through effective primary prevention. However, cancer prevention tends to be fragmented across Europe, leading to geographical health differences. The dissemination and scale-up of effective primary cancer prevention interventions may address this. Although effective cancer prevention programs exist, finding them and their materials (especially regarding implementation) can be challenging. Repositories of evidence-based interventions provide insight into “what is out there” and can support dissemination within and across national borders. The PIECES project aims to develop and disseminate a repository of evidence-based primary cancer prevention programs adaptable to European contexts, with information to aid adaptation and implementation across countries. Methods The development of the PIECES repository has been informed by established repositories such as NCI’s Evidence-Based Cancer Control Programs. The project team developed a scoring sheet with a selection of items that could be included in the repository. All participants rated each item on relevance and applicability and provided comments and suggestions. A final framework, including a set of minimal requirement items, was agreed upon during three online consensus building meetings. Results We created a repository of evidence-based primary cancer prevention interventions targeting modifiable risk factors suitable for implementation in European healthcare settings. This 22-item repository provides information about an intervention’s logic model, implementation practices, and appraisal of published evidence of effectiveness. Conclusions This repository is innovative as it includes practical information and tools to facilitate implementation. While initially built to serve the PIECES project, the repository is designed to be a valuable tool for European policymakers, researchers, and implementers. Lessons learned from this process will inform future developers. Key messages • A comprehensive cancer prevention intervention repository avoids “reinventing the wheel” and allows for more efficient use of existing interventions by building upon the best available evidence. • The ongoing efforts of the PIECES project represent a significant contribution to reduce cancer prevention disparities and to facilitate the adoption of evidence-based interventions in Europe.