Risk Factor For Cardiovascular Mortality Research Articles

Association of double product and pulse pressure with cardiovascular and all‐cause mortality in the LURIC study

Systolic (SBP) and diastolic blood pressure (DBP) and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is considered as an easily available marker of vascular stiffness and the double product (DP) as a marker of cardiac workload. Therefore, we have examined the predictive value of PP and DP in the Ludwigshafen Risk and Cardiovascular Health study, a monocentric cohort study of 3316 patients referred to coronary angiography. An increase of SBP or PP by 1mmHg increased the risk of CVM with hazard ratios of 1.009 (95% CI, 1.005-1.012) and 1.016 (1.012-1.020), respectively. Increasing DP by 100mmHg/min was associated with a 1.010 (1.007-1.013) higher risk of CVM. In patient subgroups with coronary artery disease (CAD) and heart failure (HF), PP and DP predicted CVM better than SBP or MAP. In a multivariate analysis adjusted for sex, BMI, diabetes, eGFR, hazard ratios for CVM for z-standardized PP, DP, SBP, and HR were 1.20, 1.16, 1.12, and 1.14. After adding age to the multivariate analysis, only DP and HR remained significant. We provide evidence that PP and DP are powerful predictors of CVM and all-cause mortality in a CV medium- to high-risk population, especially in patients with CAD and HF. While DP proved to be an independent predictor of cardiovascular and all-cause mortality also in multivariate analysis, PP was no independent predictor in our cohort with widespread antihypertensive treatment (>85%). PP is associated with age, presence of diabetes, obesity, and impaired renal function.

The effectiveness of Baduanjin exercise for hypertension: a systematic review and meta-analysis of randomized controlled trials

BackgroundHypertension, a major risk factor of cardiovascular mortality, is a critical issue for public health. Although Baduanjin (Eight Brocades, EB), a traditional Chinese exercise, might influence blood pressure, glucose, and lipid status, the magnitude of true effects and subgroup differences remains unclear. Therefore, we performed a systematic review of relevant randomized controlled trials (RCTs) to evaluate the effect of EB on patient-important outcomes.MethodsWe systematically searched PubMed, the Cochrane Library, Web of Science, and Chinese databases since inception until March 30, 2020. Meta-analysis was carried out using “meta” package in R 3.4.3 software. A prespecified subgroup analysis was done according to the type of comparisons between groups, and the credibility of significant subgroup effects (P < 0.05) were accessed using a five-criteria list. A GRADE evidence profile was constructed to illustrate the certainty of evidence.ResultsOur meta-analysis, including 14 eligible trials with 1058 patients, showed that compared with routine treatment or health education as control groups, the mean difference (MD) in systolic blood pressure (SBP) of the EB groups was − 8.52 mmHg (95%CI:[− 10.65, − 6.40], P < 0.01) and diastolic blood pressure (DBP) was − 4.65 mmHg (95%CI: [− 6.55, − 2.74], P < 0.01). For blood pressure, the evidence was, however, of low certainty because of risk of bias and inconsistency, and for the outcomes of most interest to patients (cardiovascular morbidity and mortality directly), of very low certainty (measurement of surrogate only). Subgroup analysis showed there was no significant interaction effect between different type of comparisons (SBP P = 0.15; DBP P = 0.37), so it could be easily attributed to chance.ConclusionRegularly EB exercising may be helpful to control blood pressure, but the evidence is only low certainty for blood pressure and very low certainty for cardiovascular morbidity and mortality. Rigorously designed RCTs that carry out longer follow-up and address patient-important outcomes remain warranted.Trial registrationPROSPERO Registration number: CRD42018095854.

Projecting the Prevalence of Hypertension in the Philippines: Its Impact and the Need for a Call-to-Action

Hypertension is a major risk factor for cardiovascular mortality, and the global numbers of affected individuals are increasing. Several health care strategies and reforms have been implemented by different countries to curb the prevalence of hypertension and the Philippines has also started to implement programs for non-communicable diseases, including hypertension. To determine the impact of hypertension in the country, this paper aims to project the hypertension prevalence by 2050 using published statistical data and plotting the data to linear regression model. Results showed hypertension prevalence will remain as high as 23% but the number of cases will double in 2050 given the population projection if no intervention will occur. Filipino males will have a higher prevalence rate, but the hypertension cases will doubly increase in females by 2050. However, because some interventions conducted by the government and medical societies, hypertension prevalence declined in 2018. If the downward trend continues, we see a reduced projected rate of hypertension prevalence and lower cardiovascular deaths. This trend will continue if government and medical programs on hypertension continue to strengthen. The need for continued proper diagnosis and management of hypertension needs to be implemented in the country. Funding Statement: The Philippine Society of Hypertension Declaration of Interests: No conflict of interest.

CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome

CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.

SERUM URIC ACID AND TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION AT MEDICINE DEPARTMENT OF GMC, BETTIAH, BIHAR

Background Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension. Objective To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension. Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels. Results Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 μmol/L) than in the controls (296.9±89.8 μmol/L; P&lt;0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensive patients and 16.9% among the controls (P&lt;0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P=0.001). Similarly, left ventricular hypertrophy was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, respectively; P=0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none versus one versus two: P=0.012). Conclusion These results indicate that serum uric acid is associated with target organ damage in patients with hypertension, even at the time of diagnosis; thus, it is a reliable marker of cardiovascular damage in our patient population.

CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome

CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.

Relationship Between Thyroid Hormones and Left Ventricular Mass in Peritoneal Dialysis Patients.

Introduction. Non-thyroidal illness is prevalent in patients with advanced stages of chronic kidney disease and could be considered as a risk factor for cardiovascular mortality; this relation is partially explained by malnutrition and the concomitant condition of high inflammation. This study is designed to investigate the relationship between left ventricular mass and thyroid hormone abnormalities and evaluate this relationship after adjustment of inflammatory factors and nutritional status in peritoneal dialysis patients. Methods. A total of 71 patients undergoing maintenance peritoneal dialysis were included. Serum concentration of total and free triiodothyronine (fT3), total and free thyroxine (fT4), and TSH were measured. LV mass index and the structural properties of heart including LVEDD, LVESD, PWD, and EF were assessed by transthoracic echocardiography. The Surrogates of Inflammation, including IL-6, albumin, and hs-CRP were measured. The nutritional status of patients was assessed by one point SGA scoring and biochemical data. The relation between thyroid hormones and echocardiographic variables, inflammatory and nutritional markers was determined. Results. LVMI was significantly higher in the group with lower fT3 levels. Linear regression analyses showed statistically significant univariate association between fT3, tT3, and tT4; and LVMI. In multiple linear regression analysis adjusted for albumin, hs-CRP, IL- 6, and ferritin; only fT3 level had a meaningful negative correlation (P < .05) with LVMI, free T3 level was positively correlated with rGFR (P < .05, c = 0.39) and KT/V (P < .05, c = 0.27). Conclusion. Low fT3 level was negatively and significantly associated with LVML even after adjustments for known risk factors in peritoneal dialysis patients.

Worsening baroreflex sensitivity on progression to type 2 diabetes: localized vs. systemic inflammation and role of antidiabetic therapy.

Cardiac autonomic neuropathy (CAN) is an early cardiovascular manifestation of type 2 diabetes (T2D) that constitutes an independent risk factor for cardiovascular mortality and morbidity. Nevertheless, its underlying pathophysiology remains poorly understood. We recently showed that localized perivascular adipose tissue (PVAT) inflammation underlies the incidence of parasympathetic CAN in prediabetes. Here, we extend our investigation to provide a mechanistic framework for the evolution of autonomic impairment as the metabolic insult worsens. Early metabolic dysfunction was induced in rats fed a mild hypercaloric diet. Two low-dose streptozotocin injections were used to evoke a state of late decompensated T2D. Cardiac autonomic function was assessed by invasive measurement of baroreflex sensitivity using the vasoactive method. Progression into T2D was associated with aggravation of CAN to include both sympathetic and parasympathetic arms. Unlike prediabetic rats, T2D rats showed markers of brainstem neuronal injury and inflammation as well as increased serum levels of IL-1β. Experiments on PC12 cells differentiated into sympathetic-like neurons demonstrated that brainstem injury observed in T2D rats resulted from exposure to possible proinflammatory mediators in rat serum rather than a direct effect of the altered metabolic profile. CAN and the associated cardiovascular damage in T2D only responded to combined treatment with insulin to manage hyperglycemia in addition to a nonhypoglycemic dose of metformin or pioglitazone providing an anti-inflammatory effect, coincident with the effect of these combinations on serum IL-1β. Our present results indicate that CAN worsening upon progression to T2D involves brainstem inflammatory changes likely triggered by systemic inflammation.

Prognostic value of pulmonary hypertension in pre-dialysis chronic kidney disease patients.

Pulmonary hypertension is common in chronic kidney disease (CKD) patients. However, the prognostic value of pulmonary hypertension in Chinese predialytic CKD patients is rarely reported. We evaluated the relevant factors and prognostic value of pulmonary hypertension in CKD patients. This retrospective cohort study enrolled 1092 predialytic patients from The Third Affiliated Hospital of Sun Yat-Sen University from May 1st, 2011, to December 31st, 2016. Data of interest were retrieved from electronic medical records. Pulmonary hypertension was defined as pulmonary arterial systolic pressure (PASP) ≥ 35mmHg by echocardiology. All participants were followed from the date of the first echocardiography examination. The primary endpoints were all-cause mortality and cardiovascular mortality. The secondary endpoint was end-stage renal disease (ESRD) defined as starting renal replacement therapy. The prevalence of pulmonary hypertension was 15.9% in the study population. For CKD stage 1, 2, 3a, 3b, 4 and 5, the prevalence was 6.0%, 9.6%, 17.2%, 13.3%, 20.7% and 26.6%, respectively. Older age, lower left ventricular ejection fraction, anemia and higher pulse pressure were independently associated with pulmonary hypertension in CKD patients. In multivariate Cox regression analysis, pulmonary hypertension was the independent risk factor for cardiovascular mortality, but not of all-cause mortality and ESRD. Pulmonary hypertension is not rare in early CKD patients. Patients with older age, anemia, higher pulse pressure and compromised heart function were more likely to comorbid pulmonary hypertension. Pulmonary hypertension maybe a sign of worse cardiovascular outcome in CKD patients.

Peculiarities of Platelet Metabolism in Patients with Acute Coronary Syndrome with Anxiety-Depressive Disorders and Informativity of Enzymes in the Forecast of Development of Cardiovascular Complications.

Anxiety–depressive disorders (ADD) are a risk factor of cardiovascular mortality in patients with coronary artery disease (CAD). Acute coronary syndrome (ACS) is the main clinical manifestation of a progressing CAD. Metabolic processes disorder in platelets can be one of the causes of cardiovascular complications in patients with ACS and concomitant ADD. We studied platelets metabolism and prognostic informativity of NAD(P)-dependent dehydrogenases of platelets in ACS patients with ADD in terms of forecasting cardiovascular complications development over a year of observation. The levels of NAD- and NADP-dependent dehydrogenases of platelets were determined by means of a bioluminescent method during the first 24 h after admission to hospital and in dynamics in 10 days. Among 315 examined patients, ADD was found in 161 (51.1%). ACS patients with concomitant ADD had both cytoplasmic and mitochondrial processes impairment in platelets that consisted in a decrease of energy metabolism intensity, inhibition of anaerobic glycolysis reactions and lipid catabolism. After 12 months of follow-up, 41 (25.5%) cardiovascular complications were detected in the group of ACS patients with ADD and 20 (13.0%) in the group of ACS patients without ADD. According to the results of the analysis of the neural network based on NAD(P)-dependent dehydrogenases of platelets activity in ACS patients with ADD, indicators were obtained that are informative for predicting the development of recurrent cardiovascular complications.

OGT knockdown counteracts high phosphate-induced vascular calcification in chronic kidney disease through autophagy activation by downregulating YAP

AimsPathological vascular calcification (VC), a major risk factor for cardiovascular mortality, is a highly prevalent finding in patients with chronic kidney disease (CKD). We previously analyzed several pathways protecting against high phosphate-induced VC through induction of autophagy. Here, we explored how O-GlcNAc transferase (OGT) affected high phosphate-induced VC of CKD though mediation of autophagy. Main methodsIn the rats with CKD induced by 5/6 nephrectomy, the VC process was accelerated by a high phosphate diet. The calcification of vascular smooth muscle cells (VSMCs) was induced by high phosphate treatment. We then experimentally tested the effect of OGT on high phosphate-induced VC by conducting loss-of-function experiments. Co-immunoprecipitation and GST pull-down assays were performed to evaluate interaction between OGT and Yes-associated protein (YAP). In mechanistic studies of this pathway, we measured autophagy protein expression and autophagosome formation, as well as calcium deposition and calcium content in VSMCs and in vivo in response to altered expression of OGT and/or YAP. Key findingsOGT was up-regulated in high phosphate-induced VC models in vitro and in vivo. High phosphate-induced calcification in the rat aorta and VSMCs were suppressed by OGT silencing. OGT promoted the glycosylation of YAP to enhance its stability. Importantly, over-expressing YAP reduced autophagy and OGT expedited high phosphate-induced VC by inhibiting autophagy through upregulation of YAP. SignificanceOGT silencing downregulated YAP to induce autophagy activation, thus suppressing high phosphate-induced VC, which highlighted a promising preventive target against high phosphate-induced VC in CKD.

Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

Background and aimsCardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). Methods and resultsCohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). ConclusionsRC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.

Association Between Handgrip Strength And Blood Pressure In Firefighters

Elevated blood pressure (BP) is a major risk for cardiovascular morbi-mortality. Handgrip strength (HS) is associated to all-cause and cardiovascular mortality; also, low HS increases risk of developing cardiovascular disease in the general population. In firefighters, hypertension is an important risk factor for cardiovascular mortality while little is known regarding HS in this population. It is not known if lower or higher strength levels could be associated to different BP levels. PURPOSE: To evaluate the association between HS and BP in Firefighters. METHODS: We evaluated 176 male firefighters with mean age of 28.1±5.7 yrs, BMI of 24.6±2.8 kg/m2, systolic blood pressure (SBP) of 123.1±13.2 mmHg, diastolic blood pressure (DBP) 72.5±8.6 mmHg, and HS of 102.2±17.1 kg. Isometric HS was measured using a hand-held Saehan dynamometer (Model SH 5001) in standing position with the arm extended straight down. Two maximal contractions were performed separated by one minute. HS was calculated as the sum of the largest value recorded from each hand and expressed in kilograms. HS was evaluated according to age as: poor, fair, good, very good and excellent. Afterward, firefighters were classified as having higher HS (good, very good and excellent categories) or lower HS (poor and fair categories). BP was measured in sitting position by an automatic digital arm pressure device. We compared the SBP and DBP of volunteers according to the HS classification (higher vs lower). The independent t-test (p≤0,05) was used for the analysis. Data are presented as mean ± SD. RESULTS: SBP was not different between those with higher and lower HS (p>0.05); however, DBP was significantly different between both groups (p<0.01). CONCLUSION: This study demonstrated that there is an association between muscle strength and DBP in this sample.Table 1: Blood pressure comparison between higher and lower grip strength*: independent t-test; SBP: systolic blood pressure; DBP: diastolic blood pressure.

Relationship between hepatic and systemic angiopoietin-like 3, hepatic Vitamin D receptor expression and NAFLD in obesity.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and an independent risk factor for cardiovascular mortality. Angiopoietin-like proteins (ANGPTLs) are targets for vitamin D receptor (VDR)-mediated gene transcription and this axis may promote NAFLD. ANGPTL3 is a hepatokine which inhibits lipoprotein lipase and its experimentally induced inactivation reduces hepatosteatosis. Little is known on ANGPTL3 in human NAFLD and no data exist on its relationship with hepatic VDR/VD-related genes. The aim of this research was to investigate hepatic ANGPTLs and VDR/VD-related gene expression in human obesity in relation to NAFLD. We conducted a cross-sectional investigation on forty obese subjects with/without NAFLD. We evaluated hepatic ANGPTL3, ANGPTL4, ANGPTL8, LPL, VDR, CYP27A1 and CYP2R1 mRNA expression in liver biopsies by RT-PCR; VDR expression was further investigated by immunohistochemistry; circulating ANGPTL3 was measured by Milliplex assay. Compared to non-NAFLD, NAFLD individuals had significantly higher hepatic VDR, ANGPTL3 and LPL expression. ANGPTL3 correlated with steatosis grade, LPL, VDR, CYP27A1 and CYP2R1 expression. Plasma ANGPTL3 concentrations were positively associated with clinical/histological markers of NAFLD/NASH and with hepatic ANGPTL3 expression. Greater hepatic VDR expression was the main determinant of hepatic ANGPTL3 after adjusting for multiple confounders. Hepatic ANGPTL3 expression correlates with greater VDR expression, presence and severity of NAFLD and translates in increased circulating ANGPTL3, likely as a result of its modulation by up-regulated hepatic VDR in NAFLD. This study provides novel insights to potential mechanisms underlying ANGPTLs-mediated ectopic fat accumulation and NAFLD development in obesity.

Iron-rich air pollution nanoparticles: An unrecognised environmental risk factor for myocardial mitochondrial dysfunction and cardiac oxidative stress

Exposure to particulate air pollution is a major environmental risk factor for cardiovascular mortality and morbidity, on a global scale. Both acute and chronic cardiovascular impacts have so far been attributed to particulate-mediated oxidative stress in the lung and/or via ‘secondary’ pathways, including endothelial dysfunction, and inflammation. However, increasing evidence indicates the translocation of inhaled nanoparticles to major organs via the circulation. It is essential to identify the composition and intracellular targets of such particles, since these are likely to determine their toxicity and consequent health impacts. Of potential major concern is the abundant presence of iron-rich air pollution nanoparticles, emitted from a range of industry and traffic-related sources. Bioreactive iron can catalyse formation of damaging reactive oxygen species, leading to oxidative stress and cell damage or death.Here, we identify for the first time, in situ, that exogenous nanoparticles (~15–40 nm diameter) within myocardial mitochondria of young, highly-exposed subjects are dominantly iron-rich, and co-associated with other reactive metals including aluminium and titanium. These rounded, electrodense nanoparticles (up to ~ 10 x more abundant than in lower-pollution controls) are located within abnormal myocardial mitochondria (e.g. deformed cristae; ruptured membranes). Measurements of an oxidative stress marker, PrPC and an endoplasmic reticulum stress marker, GRP78, identify significant ventricular up-regulation in the highly-exposed vs lower-pollution controls. In shape/size/composition, the within-mitochondrial particles are indistinguishable from the iron-rich, combustion- and friction-derived nanoparticles prolific in roadside/urban environments, emitted from traffic/industrial sources. Incursion of myocardial mitochondria by inhaled iron-rich air pollution nanoparticles thus appears associated with mitochondrial dysfunction, and excess formation of reactive oxygen species through the iron-catalyzed Fenton reaction. Ventricular oxidative stress, as indicated by PrPC and GRP78 up-regulation, is evident even in children/young adults with minimal risk factors and no co-morbidities. These new findings indicate that myocardial iron overload resulting from inhalation of airborne, metal-rich nanoparticles is a plausible and modifiable environmental risk factor for cardiac oxidative stress and cardiovascular disease, on an international scale.

Risk Factors for Cancer-specific Mortality and Cardiovascular Mortality in Patients With Diffuse Large B-cell Lymphoma

BackgroundThe purpose of this study was to assess the risk factors for cancer-specific mortality and cardiovascular mortality in patients with diffuse large B-cell lymphoma (DLBCL). Patients and MethodsA retrospective cohort study involving patients with DLBCL who were registered in the Surveillance, Epidemiology, and End Results (SEER) database was performed. The risk factors for cancer-specific mortality and cardiovascular mortality were analyzed using the competing risk regression model. ResultsA total of 62,950 patients with DLBCL were enrolled, of which 23,302 (37.50%) died of cancer and 2940 (4.70%) died of cardiovascular disease. The competing risk multivariate analysis displayed that age at diagnosis (hazard ratio [HR], 1.033; 95% confidence interval [CI], 1.032-1.034), marriedstatus (HR, 1.293; 95% CI, 1.241-1.347), black race (HR, 1.079; 95% CI, 1.021-1.139), and tumor stage (II: HR, 1.143; 95%CI, 1.095-1.192; III: HR, 1.459; 95% CI, 1.395-1.526; IV: HR, 1.961; 95% CI. 1.889-2.035) were the risk factors for cancer-specific mortality, but not female gender (HR, 0.938; 95% CI, 0.913,0.965) or treatment modalities (chemotherapy: HR, 0.522; 95% CI, 0.505-0.540; radiotherapy: HR, 0.782; 95% CI, 0.728-0.839; chemotherapy + radiotherapy: HR, 0.422; 95% CI, 0.403-0.441). Age at diagnosis (HR, 1.059; 95% CI, 1.055-1.062) and black race (HR, 1.246; 95% CI, 1.067-1.456) were the risk factors for cardiovascular mortality rather than female gender (HR, 0.803; 95% CI, 0.743-0.867) and married status (HR, 0.841; 95% CI, 0.745-0.950). ConclusionsAge at diagnosis, married status, black race, and higher tumor stage are associated with an increased risk of cancer-specific mortality in patients with DLBCL, whereas age at diagnosis and black race are associated with a higher risk of cardiovascular mortality.

P1273EFFECTS OF ABDOMINAL AORTIC CALCIFICATION PROGRESSION ON OUTCOMES IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims Vascular calcification is the risk factor for cardiovascular event, cardiovascular mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. We investigated the effects of abdominal aortic calcification (AAC) progression on outcomes in MHD patients. Method 111 patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center and finished the AAC examination at baseline and two years later were included prospectively. We evaluated the progression of AAC by AAC score (AACs) at baseline and two years later. According to the change of AACs, the patients were divided into rapid AAC progression group (change of AACs&amp;gt;median) and non-rapid AAC progression group (change of AACs≤median). We investigated the effects of AAC progression on outcomes in MHD patients in the follow-up period. Kaplan-Meier analysis was used to compare their survival rate. Uni- and multivariable Cox proportional hazard regression models were used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results The presence of AAC was 78.4% (87/111), rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. The mean follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI∼1.001∼1.286, P=0.048), hypoproteinemia (HR=0.789, 95%CI 0.640∼0.972, P=0.026) were independent risk factors for all-cause mortality. High baseline AACs (HR=1.187, 95%CI 1.038∼1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013∼0.801, P=0.030) were independent risk factors for cardiovascular mortality. Low spKt/V (HR=0.018, 95%CI 0.003∼0.115, P=0.000), hypoproteinemia (HR=0.736, 95%CI 0.608∼0.890, P=0.002) were independent risk factors for cardiovascular events. Conclusion Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of abdominal aortic calcification, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.

P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins &amp;lt; 1.55 gr (median value) at the end of PET test and Group B &amp;gt; 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion &amp;lt; 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

P1520PULMONARY HYPERTENSION AS NEW RISK FACTOR FOR MORTALITY IN HEMODIALYSIS

Abstract Background and Aims The prevalence of pulmonary hypertension HTP in patients receiving dialysis therapy is not completely clear, it is an independent risk factor for cardiovascular mortality, which indicates the serious need to sensitize the clinic with this comorbidity and maintain an active search for it. Objective: Raise awareness about the prevalence of HTP in a hemodialysis population and identify the associated risk factors. Method Descriptive, retrospective study, in which echocardiograms of the patient (peritoneal dialysis PD and hemodialysis HD) in renal facility were reviewed, at least 12 months in therapy, Nice 2013 classification were used for the diagnosis of HTP, multivariate analysis (echocardiograHTPic, demograHTPic, clinical and biochemical variables) was performed and the statistical significance of P &amp;lt;0.05 with the X2 method was searched for the associated risk factors. Results 24 male patients (45%), 75% with systemic hypertension, 34% with diabetes mellitus T2, on average 5 years on dialysis (+/- 2.7), age of 64 years (+/- 13.6) and 3 very elderly patients (&amp;gt; 85y); 35 patients (66%) on hd and 18 (34%) on PD. 51% had fistula ArterioVenosa (FAV). 100% of patients in hd with KtVe&amp;gt; 1.25 and 73% in pd with KtV&amp;gt; 1.7. Regarding the HTP, 27 positive patients were found (51%), the significant (p &amp;lt;0.05), were: hd 54% vs 44% PD, having a 76% central catheter with HTP vs 33% with fav, and patients with severe vs mild Hiperparatiroidism The severity of HTP, in hd vs pd was more severe, PSP average of pressures in the positive 43mmHg vs 34.3mmHg respectively (p &amp;lt;0.033) Conclusion HTP is a comorbidity that impoverishes the cardiovascular prognosis and its management must be specific, especially due to the preference of calcium antagonists over the use of renin angiotensin system blockers. The prevalence of PHT in the hemodialysis population is very high, which makes the clinician an active search and effective treatment, especially in patients with catheters. Hyperparathyroidism plays a role within the remodeling mechanisms of the pulmonary arterial endothelium, aggravating this situation and increasing mortality

Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey.

Introduction Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. Objectives We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. Methods In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). Results Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). Conclusions We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.