Risk Factor Profile Of Patients Research Articles

Clinical Profile and Risk Factors of Cerebral Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) is a rare but serious neurovascular disorder that can lead to life-threatening complications such as hemorrhage and cerebral edema. This condition presents with a wide array of symptoms due to the formation of blood clots in the cerebral venous sinuses, impairing the drainage of deoxygenated blood and cerebrospinal fluid from the brain. Objective: The aim of this study was to elucidate the clinical profile and risk factors associated with CVST, enhancing the understanding of its epidemiology and facilitating better diagnostic and therapeutic strategies. Methods: This prospective cross-sectional study was conducted at the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan. A total of 135 participants diagnosed with CVST were enrolled through non-probability consecutive sampling. Participants underwent comprehensive physical and neurological examinations using a structured Clinical Patient Assessment Form. Diagnostic imaging included MRI, MRV, CT, and CT venography, although the principal diagnostic tools were CT and MRV. Data collection focused on demographics, clinical manifestations, and risk factors, with all information analyzed using SPSS version 25. Results: The study population predominantly consisted of females (74.8%) with the age group of 31-40 years being the most common (31.1%). Headache was the most frequently reported symptom (90.4%), followed by hemiparesis (53.3%) and seizures (40%). Significant risk factors included postpartum status (50.4%), iron deficiency anemia (25.9%), and genetic prothrombotic conditions (9.6%). Imaging studies revealed that the transverse sinus was the most affected site (74.1%). Conclusion: CVST exhibits a diverse range of clinical presentations and is associated with multiple demographic and physiological risk factors. Early diagnosis and management are crucial to prevent severe outcomes. This study highlights the importance of considering a detailed clinical and risk factor profile in patients presenting with neurological symptoms to aid in timely and accurate diagnosis of CVST.

Hyponatremia With Anticonvulsant Medications: A Narrative Review.

Hyponatremia is an adverse effect of many antiseizure medications (ASMs). It occurs with interference with the normal balance of electrolytes within the body. Various risk factors associated with the development of hyponatremia in patients taking these medications include age, gender, dosage, and combinations with other drugs. ASMs such as carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid have a higher risk of hyponatremia. Hyponatremia induced by an antiseizure medication can occurthrough various mechanisms depending on the drug's specific mechanism of action.Hyponatremia can be a potentially fatal side effect. Patients taking these medications need to be monitored closely for the signs and symptoms of hyponatremia. Acute hyponatremia, defined as developing in <48 hours, is more likely to show symptoms than chronic hyponatremia. Signs of acute hyponatremia include delirium, seizures, decerebrate posturing, and cerebral edema with uncal herniation. Chronic hyponatremia, defined as developing in >48 hours, can cause lethargy, dizziness, weakness, headache, nausea, and confusion. Hyponatremia is associated with longer hospital stays and increased mortality. Treatment varies based on the degree of severity of hyponatremia. Choosing a treatment option should include consideration of the drug causing the electrolyte disturbance, the patient's risk factor profile, and the severity of symptoms as they present in the individual patient. Healthcare providers should be aware of hyponatremia as a potential side effect of ASMs, the signs and symptoms of hyponatremia,the different treatment options available, and the potential complications associated with rapid correction of hyponatremia.

The Utility of the Area Deprivation Index in Assessing Complications After Total Joint Arthroplasty.

Vulnerable populations, including patients from a lower socioeconomic status, are at an increased risk for infection, revision surgery, mortality, and complications after total joint arthroplasty (TJA). An effective metric to quantify and compare these populations has not yet been established in the literature. The Area Deprivation Index (ADI) provides a composite area-based indicator of socioeconomic disadvantage consisting of 17 U.S. Census indicators, based on education, employment, housing quality, and poverty. We assessed patient risk factor profiles and performed multivariable regressions of total complications at 30 days, 90 days, and 1 year. A prospectively collected database of 3,024 patients who underwent primary elective total knee arthroplasty or total hip arthroplasty performed by 3 fellowship-trained orthopaedic surgeons from January 1, 2015, through December 31, 2021, at a tertiary health-care center was analyzed. Patients were divided into quintiles (ADI ≤20 [n = 555], ADI 21 to 40 [n = 1,001], ADI 41 to 60 [n = 694], ADI 61 to 80 [n = 396], and ADI 81 to 100 [n = 378]) and into groups based on the national median ADI, ≤47 (n = 1,896) and >47 (n = 1,128). Higher quintiles had significantly more females (p = 0.002) and higher incidences of diabetes (p < 0.001), congestive heart failure (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), hypertension (p < 0.001), substance abuse (p < 0.001), and tobacco use (p < 0.001). When accounting for several confounding variables, all ADI quintiles were not associated with increased total complications at 30 days, but age (p = 0.023), female sex (p = 0.019), congestive heart failure (p = 0.032), chronic obstructive pulmonary disease (p = 0.001), hypertension (p = 0.003), and chronic kidney disease (p = 0.010) were associated. At 90 days, ADI > 47 (p = 0.040), female sex (p = 0.035), and congestive heart failure (p = 0.001) were associated with increased total complications. Balancing intrinsic factors, such as patient demographic characteristics, and extrinsic factors, such as social determinants of health, may minimize postoperative complications following TJA. The ADI is one tool that can account for several extrinsic factors, and can thus serve as a starting point to improving patient education and management in the setting of TJA. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A systematic review and meta-analysis for risk factor profiles in patients with resistant Acinetobacter baumannii infection relative to control patients.

Acinetobacter baumannii is a major cause of nosocomial infections and high mortality rates. Evaluation of risk factors for such resistant infections may aid surveillance and diagnostic initiatives, as well as, can be crucial in early and appropriate antibiotic therapy. To identify the risk factors in patients with resistant A. baumannii infection with respect to controls. Prospective or retrospective cohort and case-control studies reporting the risk factors for resistant A. baumannii infection were collected through two data sources, MEDLINE/PubMed and OVID/Embase. Studies published in the English language were included while animal studies were excluded. The Newcastle-Ottawa Scale was used to assess the quality of studies. The odds ratio of developing antibiotic resistance in patients with A. baumannii infection was pooled using a random-effect model. The results are based on 38 studies with 60878 participants (6394 cases and 54484 controls). A total of 28, 14, 25, and 11 risk factors were identified for multi-drug resistant (MDRAB), extensive-drug resistant (XDRAB), carbapenem-resistant (CRAB) and imipenem resistant A. baumannii infection (IRAB), respectively. In the MDRAB infection group, exposure to carbapenem (OR 5.51; 95% CI: 3.88-7.81) and tracheostomy (OR 5.01; 95% CI: 2.12-11.84) were identified with maximal pool odd's ratio. While previous use of amikacin (OR 4.94; 95% CI: 1.89-12.90) and exposure to carbapenem (OR 4.91; 95% CI: 2.65-9.10) were the foremost factors associated with developing CRAB infection. Further analysis revealed, mechanical ventilation (OR 7.21; 95% CI: 3.79-13.71) and ICU stay (OR 5.88; 95% CI: 3.27-10.57) as the most significant factors for XDRAB infection. The exposure of carbapenem, amikacin (previous) and mechanical ventilation were the most significant risk factors for multidrug, extensive-drug, and carbapenem resistance in patients with A. baumannii infection respectively. These findings may guide to control and prevent resistant infections by identifying the patients at higher risk of developing resistance.

Association of blood pressure parameters post mechanical thrombectomy in anemic versus non-anemic patients and clinical outcomes

IntroductionHigher blood pressure (BP) is considered to be detrimental in patients who undergo mechanical thrombectomy (MT), however, the impact of BP post-MT based on comorbidities like anemia has not been well studied. We aim to determine the association of 24-h post-MT BP parameters with clinical outcomes depending on their anemia status. MethodsWe conducted a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 1/2015 to 12/2020. Patients were dichotomized into anemic and non-anemic groups based on the World Health Organization’s definition of anemia [hemoglobin < 12.0 g/dL in women and < 13.0 g/dL in men]. We performed a multivariable analysis with binary logistic regression with the 24-h post-MT BP parameters as predictors. The outcomes were functional dependence (3-month mRS 3–6), mortality, and an early neurological improvement. Results220 patients met the inclusion criteria. 158 (71.82 %) patients had functional dependence at 3-months. In the multivariable analysis, the parameters of a higher mean SBP (132.9 ± 11.94 vs.126.52 ± 13.3; OR, 1.05; 95 % CI, 1.02–1.09; P 0.011), a higher mean MAP (93.35 ± 8.44 vs.89.69 ± 10.03; OR,1.06; 95 % CI, 1.01–1.11; P 0.029) and a higher maximum MAP (115.26 ± 11.73 vs.109.37 ± 12.51; OR,1.05; 95 % CI, 1.01–1.08; P 0.023)were significantly associated with functional dependence in non-anemic patients, while a lower mean DBP (65.53 ± 9.73 vs. 71.94 ± 10.16; OR, 0.92; 95 % CI, 0.86–0.98; P 0.007), lower mean MAP (85.7 ± 8.65 vs. 91.38 ± 10; OR, 0.93; 95 % CI, 0.86–0.99; P 0.02), a lower minimum DBP (49.27 ± 10.51 vs. 55.1 ± 11.23; OR, 0.93; 95 % CI, 0.88–0.99; P 0.019), a lower minimum MAP (68.96 ± 9.54 vs. 74.73 ± 10.47; OR, 0.93; 95 % CI, 0.87–0.99; P 0.023) were significantly associated with mortality in patients with anemia, and a lower minimum DBP (54.75 ± 10.42 vs. 59.69 ± 8.87; OR, 0.95; 95 % CI, 0.91–0.99; P 0.012) and a lower minimum MAP (71.92 ± 14.7 vs.75.67 ± 14.17; OR, 0.97; 95 % CI, 0.94–0.99; P 0.047) were significantly associated with an early neurological improvement in non-anemic patients. For patients with anemia, there was no association between 24-hour BP Parameters post-MT and functional dependence and early neurological improvement, and between 24-hour BP Parameters post-MT and mortality in non-anemic patients. ConclusionIn our study, higher BP parameters were associated with worse outcomes in patients without anemia, however, this effect was not found in patients with anemia. Certain lower BP parameters were associated with higher 3-month mortality in anemic patients; however, this effect was not found in non-anemic patients. Higher BP post-MT can potentially promote perfusion and thus is not associated with worse outcomes in anemic patients post-MT, whereas in non-anemic patients it may potentially lead to reperfusion injury While our study is limited because of size and its retrospective nature, the findings suggest that an individualized approach to tailor the target BP post-MT to a patient's risk factor profile and associated co-morbid conditions to achieve optimization of medical care post-MT and associated co-morbid conditions to achieve optimization of medical care post-MT.

The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes

BackgroundHeart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. MethodsThis study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women’s Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. ResultsA total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. ConclusionsThe risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.

Cardiovascular risk factor profile in patients admitted to a community-based cardiac rehabilitation program after one year: what risk factors are not being controlled?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac rehabilitation (CR) is a multidisciplinary intervention designed to reduce cardiovascular (CV) risk, encourage healthy behaviors, reduce physical impairment, and promote an active lifestyle. After completing a phase II CR program, it is important to maintain long-term CV risk factor control. However, many patients do not achieve or maintain lifestyle and risk factor targets on a long-term basis. Therefore, it is of interest to understand which risk factors are not reaching the targets to better understand and personalize long-term community-based CR programs. Purpose To characterize the modifiable CV risk factors profile in coronary artery disease (CAD) patients admitted to a community-based phase III CR program, including lipid profile, overweight/obesity, physical activity (PA) and sedentary behaviour (SB), at the beginning and after completing the first year of the CR program. Methods This retrospective cohort study included CAD patients that attended for 1-year a community-based phase III CR program. At the beginning (M0) and after one year (M1) of the CR program, all patients performed a risk profile assessment including: Lipid profile [total cholesterol (total-c), high density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL)], body mass index (BMI), PA and SB. BMI was assessed with the patient's weight in kilograms divided by the square of height in meters and lipid profile values were obtained from blood testing. PA and SB were objectively measured by using an accelerometer. All participants attended supervised exercise sessions, 3x week, 60 mins, including aerobic and resistance exercises, 3 educational sessions and a nutritional counseling consultation per year. Results In the sample of 159 patients at baseline (81.8% male, mean age 61±10 years, BMI: 28.3±4.3 kg/m²), overweight and obesity proved to be the most prevalent risk factor (80.7%), followed by uncontrolled LDL levels (74.8%). After a 1-year intervention (n=48, 90% male, mean age 62±10 years), LDL levels were kept above the targets (M0: 73.3±28.9 mg/dL and M1: 68.6±19.6 mg/dL, p=0.186), BMI did not change (M0: 27.5±3.9 kg/m² and M1: 27.8±4.0 kg/m², p=0.168) and SB remained high (M0: 11.50±2.90 hours/day and M1: 11.58 ± 2.71 hours/day, p=0.908). Although, moderate to vigorous PA (MVPA) decreased (M0: 343±195 mins/week and M1: 293±164 mins/week, p&amp;lt;0.001), participants were still on target, between 150 to 300 mins MVPA week. Conclusion Our findings show that after a 1-year of a phase III CR program intervention CVD patients maintained MVPA recommended levels, but did not reach body composition, lipid profile, and SB targets. Future strategies should be implemented in long-term CR programs to better control LDL, body composition and SB.

Trends in Modifiable Risk Factors Amongst First Presentation ST Elevation Myocardial Infarction Patients in a Large Longitudinal Registry.

Recent studies suggest that the risk factor profile of patients presenting with ST elevation myocardial infarction (STEMI) is changing. The aim is to determine if there has been a shift of cardiovascular risk factors to cardiometabolic causes in the first presentation STEMI population. We analysed data from a STEMI registry from a large tertiary referral percutaneous coronary intervention centre to determine the prevalence and trends of the modifiable risk factors of hypertension, diabetes, smoking and hypercholesterolaemia. Consecutive first presentation STEMI patients between January 2006 to December2018. Among the 2,366 patients included (mean age 59, SD 12.66, 80% male) the common risk factors were hypertension (47%), hypercholesterolaemia (47%) current smoking (42%) and diabetes (27%). Over the 13 years, patients with diabetes (20% to 26%, OR 1.09 per year, CI 1.06-1.11, p<0.001) and patients with no modifiable risk factors increased (9% to 17%, OR 1.08, CI 1.04-1.11, p<0.001). Concurrently there was a fall in prevalence of hypercholesterolaemia, (47% to 37%, OR 0.94 per year, CI 0.92-0.96, p<0.001) and smoking (44% to 41%, OR 0.94, CI 0.92-0.96, p<0.001) but no significant change in rates of hypertension (53% to 49%, OR 0.99, CI 0.97-1.01, p=0.25). The risk factor profile of first presentation STEMI has changed over time with a reduction in smoking and a concurrent rise in patients with no traditional risk factors. This suggests the mechanism of STEMI may be changing and further investigation of potential causal factors is warranted for the prevention and management of cardiovascular disease.

Demographic and Risk Factor Profile in Patients of Gallstone Disease in Central India.

BackgroundGallbladder stones are more common in some regions of the world than others. Gallstones that are asymptomatic might be discovered as an afterthought during a regular ultrasound scan for another abdominal ailment. The changing incidence in India is mostly due to westernization and the availability of ultrasonography in both urban and rural areas, as well as increased affordability owing to changes in the socio-economic structure and the budget of investigations. This study aims to know the prevalence of gallstone disease as well as the risk factors that contribute to its development in central India.MethodA single-center, cross-sectional observational study was conducted. Seventy-two radiologically diagnosed cases of gallstone disease irrespective of age, gender, and comorbid condition were included in the study.ResultSeventy-two cases of gallstone were included in the research. The highest age-specific incidence of gallstone was in the fifth and sixth decades with the maximum incidence in the sixth decade. Females had a higher incidence of gallstone formation. The pain was the earliest symptom but we found that 41.67% patients had asymptomatic gallstones. A family history of gallstone disease is found positive in 69.44% of the patients who also had an increased risk of gallstone. 22.22% patient were only diabetic, 6.95% were only hypertensive and 20.83% were both diabetic + hypertensive. Comorbidity has a high prevalence of gallstone disease. Obesity has a significant link to gallstone disease, with BMI being one of the most important indicators of obesity.ConclusionThe prevalence of asymptomatic gallstones is relatively high in central India. We strongly recommend ultrasonography as a screening modality in patients with older age group, female gender, high cholesterol level, family history of gallstones, sickle cell disease, increased BMI and co-morbidities like diabetes or hypertension for early detection of gallstones formation.

Prognostic implications of traditional and non‐traditional cardiovascular risk factor profiles in patients with non‐valvular atrial fibrillation

Atrial fibrillation (AF) is a prevalent disease with associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard modifiable cardiovascular risk factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease; however, the importance of non-traditional mediators of cardiovascular risk (NTRFs) such as chronic renal impairment, obstructive sleep apnoea and obesity is emerging. The differential impact of these risk factors on outcomes in patients with AF is not well studied. Consecutive patients admitted to our service between January 2013 and January 2018 with a primary diagnosis of non-valvular AF were assessed. Assessment of demographic, anthropometric, risk factor profile and pharmacotherapeutics was performed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events. Of the 1010 patients (62.29±16.81years, 51% men) included, 154 (15%) had no risk factors, 478 (47%) had only SMuRFs, 59 (6%) had only NTRFs and 319 (32%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18 ± 21.27months, a total of 288 patients met the composite outcome. On Cox regression, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p=.01). Other independent predictors included age, heart failure, CHA2 DS2 VASc score, persistent AF and anaemia. The presence of both SMuRFs and NTRFs has prognostic implications in patients with non-valvular AF.

Adenomyosis - An Overview.

Adenomyosis is a benign uterine disorder in which there is a pathological presence of endometrial glands and stroma in the myometrium. Symptoms can include abnormal uterine bleeding, dysmenorrhea, dyspareunia, or infertility; one-third of women, however, remain asymptomatic.[1] [2] Since many of these symptoms also occur in other gynecological diseases such as endometriosis and uterine fibroids, which often co-exist with adenomyosis, making a clinical diagnosis can be difficult. In the past, adenomyosis was only diagnosed on histopathology after a hysterectomy. With the combination of a patient's risk factor profile, clinical symptoms, and imaging diagnostic tools such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), clinicians are able to identify adenomyosis in a non-invasive way.[1] [3] [4] [5] The diagnosis of adenomyosis has been increasing in young women of reproductive age and conservative treatment is essential in those who prefer to maintain fertility.[1] [5] Since adenomyosis greatly impacts quality of life, it is important for clinicians to properly diagnose and treat these women to optimize clinical outcome.

Prognostic Implications of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Sclerosis

Systemic sclerosis is a chronic inflammatory disease modulated by pro-inflammatory cytokines, hence associated with cardiovascular disease. Standard modifiable cardiovascular risk factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) and non-traditional risk factors (NTRFs; chronic renal impairment, obstructive sleep apnoea and obesity) are established drivers of cardiovascular disease; however, their impact remains undefined in populations with systemic sclerosis. We sought to assess the prognostic impact of SMuRFs and NTRFs in patients with systemic sclerosis.

Prognostic Impact of Traditional and Emerging Risk Factor Profiles in Patients With Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE), a chronic inflammatory disease modulated by pro-inflammatory cytokines, is associated with cardiovascular disease. Standard modifiable cardiovascular risk factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) and non-traditional risk factors (NTRFs; chronic renal impairment, obstructive sleep apnoea and obesity) are established drivers of cardiovascular disease; however, their impact remains undefined in populations with SLE. We sought to assess the prognostic impact of SMuRFs and NTRFs in patients with SLE.

Patient Risk Factor Profiles Associated With Timing of Goals-of-Care Consultation Before Death

Early palliative care consultation to discuss goals-of-care (“PCC”) benefits seriously ill patients. To identify risk factor profiles associated with inpatient PCC timing before death, we conducted a secondary analysis of seriously ill adults who had PCC at a high-acuity hospital and died 2014-2016. Of 1,141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15-60 days before death; 21% had PCC >60 days before death (median 13 days). Classification and Regression Tree modeling showed Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%) were most likely to have PCC close to death, with age <46 or >75 increasing probability (98%). Among age groups, the highest proportion of patients with PCC close to death was >75 years. Complex variable interactions associated with PCC timing suggests we need a systematic process for initiating PCC earlier and effective primary palliative training for providers across settings.

Abstract 14445: The Prevalence of Coronary Risk Factors Among Patients Undergoing Their First Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Background: Coronary artery disease (CAD) is the leading cause of death globally and risk factors for CAD are well established. Although there has been a decline in the incidence of CAD in recent years, understanding the risk factor profile of patients presenting with cardiac disease in contemporary practice may help define current unmet challenges in preventing CAD. Objectives: To evaluate the prevalence of CAD risk factors among patients undergoing percutaneous coronary intervention (PCI) and assess how they have changed over time. Methods: We assessed the prevalence of risk factors among patients without a history of prior myocardial infarction, PCI, or coronary artery bypass graft surgery who underwent PCI at 47 non-federal hospitals in the state of Michigan between 1/1/2010 and 3/31/2018 using the BMC2 PCI registry. Results: Our study cohort included 69,970 men and 39,106 women. Traditional risk factors were highly prevalent in this population: 34.4% of men and 31.0% of women were current or recent smokers, hypertension was present in 71.8% of men and 80.6% of women, hyperlipidemia was present in 65.0% of men and 68.9% of women, diabetes was present in 27.8% of men and 35.5% of women, and 44.8% of men and 48.0% of women were obese. Over the study period, the prevalence of diabetes (29% to 32%) and obesity (45% to 48%) increased while a decline in smoking prevalence was noted (34% to 31%). Most patients had 2 or more risk factors with 51.2% having three or more risk factors. Compared with nonsmokers, smokers presented over a decade earlier (age 56.8 versus 66.9 years, p &lt; 0.0001) and obese patients presented 4.0 years earlier (age 61.4 versus 65.4 years, p &lt; 0.0001) (Figure). Conclusions: Modifiable risk factors are widely prevalent among patients undergoing their first PCI. Population-level interventions aimed at controlling obesity and preventing smoking could significantly delay the onset of CAD and the need for PCI.

Abstract 14719: Prognostic Implications of Traditional and Non-traditional Cardiovascular Risk Factor Profiles in Patients With Non-valvular Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a prevalent disease with an associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease, however the importance of non-traditional mediators of cardiovascular risk such as chronic renal impairment, obstructive sleep apnoea and obesity (NTRFs) is emerging in the literature. The differential impact of these risk factor groups on outcomes in patients with AF is not well studied. Hypothesis: SMuRFs and emerging NTRFs will have a differential impact on prognosis in patients with AF. Methods: Consecutive patients admitted to our service between 2013-2017 with a primary diagnosis of non-valvular AF were assessed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events. We excluded patients with valvular AF, incomplete clinical data and baseline comorbid conditions limiting lifespan to &lt;6 months. Results: Of the 1010 patients (62.29±16.81 years, 52% men) included, 154 (15.2%) had no risk factors, 478 (47.3%) had only SMuRFs, 59 (5.8%) had only NTRFs and 319 (31.6%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18±21.27 months, a total of 288 patients met the composite outcome. On log rank tests, grouping of risk factor profiles was a significant predictor of the composite outcome (see Kaplan Meier curve). On multi-variable analysis, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p=0.01). Other independent predictors included age, heart failure, CHA2DS2VASc score, persistent AF and anaemia. Conclusions: Presence of both traditional and emerging NTRFs has prognostic implications in patients with AF.

Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis.

Early palliative care consultation ("PCC") to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. To identify risk factor patient profiles associated with PCC timing before death. Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. Of 1141 patients, 54% had PCC "close to death" (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or "Other" race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.

The Effect of Noninvasive Bariatric Surgery on the Levels of Certain Adipokines and Atherosclerosis Risk Factors in Patients with Metabolic Syndrome

Objective: Besides glucose intolerance, dyslipidemia, and hypertension, visceral obesity is one of the most important atherogenic pathological factors in patients with metabolic syndrome (MetS). The aim of this study is to examine whether weight loss following BioEnterics Intragastric Balloon (BIB-system) therapy affects adipokine concentration and atherosclerosis risk factor profile in patients with MetS.Methods: The study group comprised 30 patients (17 female, BMI = 38.5 ± 8.6 kg/m2; 13 male, BMI = 43.3 ± 7 kg/m2) with MetS qualified to BIB-system therapy. The control group included 18 age matched healthy volunteers (10 female, BMI = 23.3 ± 2.8 kg/m2 and eight male, BMI = 27.3 ± 0.9 kg/m2). Biochemical analyses of blood samples and anthropometric measurements were conducted, before and after six-month BIB system therapy.Results: BIB therapy resulted in a significant drop in body weight, and body fat percentage, and in BMI, VAI, WHtR, BAI, TG, glucose, hsCRP, and leptin levels. In addition Tc/HDL, LDL/HDL, TG/HDL, and leptin/adiponectin ratios fell significantly, and adiponectin concentration increased. All anthropometric parameters apart from Tc and hsCRP, were significantly different post-therapy compared to healthy controls. The therapy induced downregulation of hsCRP which was positively correlated with the reduction in body weight, BMI and BAI. The decrease in leptin concentration correlated positively with the fall in total cholesterol and body weight. The fall in leptin/adiponectin ratio positively correlated with the downregulation of BAI and body fat.Conclusion: BIB therapy appears to have beneficial effects on MetS. This is indicated by amelioration of the pro-inflammatory status related to obesity, demonstrated by an improved lipid profile significant downregulation of hsCRP concentration following therapy.

Clinical Implications of Different Risk Factor Profiles in Patients with Mesenteric Venous Thrombosis and Systemic Venous Thromboembolism – A Population-Based Study

It is unknown whether the risk factor profile for mesenteric venous thrombosis (MVT) is different from systemic venous thromboembolism (VTE). The aim of the present population-based study was to compare acquired and inherited risk factors in MVT versus VTE. Identification of all MVT patients at Skane University Hospital between 2000 and 2015 was performed in patient records and AuriculA (Swedish anticoagulation registry). VTE patients were retrieved from the Malmo Thrombophilia Study (MATS), including 1465 consecutive unselected VTE patients between 1998 and 2008. Patients with MVT (n = 120) were younger (p < 0.001), had higher glomerular filtration rate (p < 0.001), lower smoking rate (p < 0.001), and had less often undergone recent surgery (p = 0.025). The prevalence of solid cancer (19.2% in MVT versus 12.1% in VTE; p = 0.026) and intra-abdominal cancer (16.7% versus 2.3%; p < 0.001) were higher in MVT. The prevalence of factor V Leiden mutation without presence of cancer was lower in MVT compared to VTE (26.6% versus 38.9%; p = 0.031). Thirty-day mortality was higher in the MVT group (9.2% versus 0.6%; p < 0.001), but did not differ at long-term follow-up according to Kaplan–Meier analysis (p = 0.73). Patients with MVT have a higher prevalence of cancer and lower prevalence of factor V Leiden mutation than those with systemic VTE. Intra-abdominal cancer should be excluded in MVT patients, and the high prevalence of factor V Leiden mutation in patients without cancer in both groups suggests that screening for thrombophilia in patients without cancer should be considered in this population for both groups.

Risk of developing an abdominal aortic aneurysm after ectatic aorta detection from initial screening

ObjectiveCurrent abdominal aortic aneurysm (AAA) surveillance guidelines lack any follow-up recommendations after initial abdominal aortic screening diameter of less than 3.0 cm. Some reports have demonstrated patients with late AAA formation and late ruptures after initial ultrasound screening detection of patients with an aortic diameter of 2.5 to 2.9 cm (ectatic aorta). The purpose of this study was to determine ectatic aorta prevalence, AAA development, rupture risk, and risk factor profile in patients with detected ectatic aortas in a AAA screening program. MethodsA retrospective chart review of all patients screened for AAA from January 1, 2007, to December 31, 2016, within a regional health care system was conducted. Screening criteria were men 65 to 75 years of age that smoked a minimum of 100 cigarettes in their lifetime. An ectatic aorta was defined as a maximum aortic diameter from 2.5 to 2.9 cm. An AAA was defined as an aortic diameter of 3 cm or greater. Patients screened with ectatic aortas who had subsequent follow-up imaging of the aorta with a minimum of 1-year follow-up were analyzed for associated clinical and cardiovascular risk factors. All data were collected through December 3,/2018. A logistic regression of statistically significant variables from univariate and χ2 analyses were performed to identify risks associated with the development of AAA from an initially diagnosed ectatic aorta. A Cox proportional hazard model was used to assess survival data. A P value of less than .05 was considered statistically significant. ResultsFrom a screening pool of 19,649 patients, 3205 (16.3%) with a mean age of 72.1 ± 5.3 years were identified to have an ectatic aorta from January 1, 2007, to December 31, 2016. The average screening ectatic aortic diameter was 2.6 ± 0.1 cm. There were 672 patients (21.0%) with a mean age of 73.0 ± 5.7 years who received subsequent imaging for other clinical indications and 193 of these patients (28.7%) with ectatic aortas developed an AAA from the last follow-up scan (4.2 ± 2.5 years). The average observation length of all patients was 6.4 ± 2.9 years. No ruptures were reported, but 27.8% of deaths were of unknown cause. One patient had aortic growth to 5.5 cm or greater (0.15%). Larger initial screening diameter (P < .01), presence of chronic obstructive pulmonary disease (P < .01), and active smoking (P = .01) were associated with AAA development. ConclusionsPatients with diagnosed ectatic aortas from screening who are active smokers or have chronic obstructive pulmonary disease are likely to develop an AAA.