Risk Of Acute Cardiovascular Events Research Articles

Pfizer COVID19 vaccine is not associated with acute cardiovascular events excluding myocarditis– a national self-controlled case series study

BackgroundDespite publications assuring no increased risk for acute cardiovascular events (excluding myocarditis) and sudden death following administration of COVID19 vaccines, these issues still stir much public ado. We assessed the risk for acute cardiovascular events that require hospitalization (excluding myocarditis) and for mortality in the short-term following administration of the second dose of the Pfizer COVID19 vaccine in Israel.MethodsUsing a self-controlled case series (SCCS) study design and national databases, all second-dose vaccinees, who had not been diagnosed with COVID19 and who had an acute cardiovascular event (acute myocardial infarction/acute stroke/acute thromboembolic event) that required hospitalization in the 60 days following vaccine administration between Jan 11th, 2021 and Oct 31st 2021, were included. A similar analysis was carried out for mortality. The first 30 days following vaccination were defined as risk period while the next 30 days were defined as control period. The probability for an event between these periods was compared using a conditional logistic regression model, accounting for sex, age group, background morbidity and seasonal risk.ResultsOut of 5,700,112 second dose vaccinees, 4,163 had an acute cardiovascular event in the 60 days following vaccine administration. Following exclusion of 106 due to technical considerations, 1,979 events occurred during the risk period and 2,078 during the control period: Odds ratio, OR = 0.95, 95% confidence interval, CI 0.90–1.01, p = 0.12. Adjusted OR was similar (OR = 0.88, 95%CI 0.72–1.08). Stratifying by age showed no increased risk in any age group. Mortality assessment indicated low number of events in both periods. These results were consistent in sensitivity analyses.ConclusionsThere was no increased risk for acute cardiovascular events (excluding myocarditis) in the risk period compared to the control period following administration of the second dose of Pfizer COVID19 vaccine. Mortality data raised no concerns either, but may have been biased.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors: A decade-apart study of two nationwide cohorts.

Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks. Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited. To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago. We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample, studying two colon cancer survivor groups for CVD risk factors, mortality rates, and major adverse events like pulmonary embolism, arrhythmia, cardiac arrest, and stroke, adjusting for confounders via multivariable regression analysis. Of total colon cancer survivors hospitalized in 2007 (n = 177542) and 2017 (n = 178325), the 2017 cohort often consisted of younger (76 vs 77 years), male, African-American, and Hispanic patients admitted non-electively vs the 2007 cohort. Furthermore, the 2017 cohort had higher rates of smoking, alcohol abuse, drug abuse, coagulopathy, liver disease, weight loss, and renal failure. Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities, including hypertension, hyperlipidemia, diabetes, obesity, peripheral vascular disease, congestive heart failure, and at least one traditional CVD (P < 0.001) vs the 2007 cohort. On adjusted multivariable analysis, the 2017 cohort had a significantly higher risk of pulmonary embolism (PE) (OR: 1.47, 95%CI: 1.37-1.48), arrhythmia (OR: 1.41, 95%CI: 1.38-1.43), atrial fibrillation/flutter (OR: 1.61, 95%CI: 1.58-1.64), cardiac arrest including ventricular tachyarrhythmia (OR: 1.63, 95%CI: 1.46-1.82), and stroke (OR: 1.28, 95%CI: 1.22-1.34) with comparable all-cause mortality and fewer routine discharges (48.4% vs 55.0%) (P < 0.001) vs the 2007 cohort. Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events (stroke 28%, PE 47%, arrhythmia 41%, and cardiac arrest 63%). It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

INTERNATIONAL CRITERIA EKG COMPARISON STUDY

BACKGROUND There has been an evolution of athlete specific Electrocardiogram (EKG) criteria over the years, resulting in improved specificity and lower false positive rates, starting with the European Society of Cardiology 2005 guidelines and most recently with the current 2017 International Recommendations. The consistency of EKG interpretation with the 2017 International Criteria have been compared between various groups, including local and specialized center physicians. Whether novice EKG interpreters (undergraduate/graduate students) can be taught to accurately interpret athletes’ EKGs with the 2017 International Criteria has not been extensively studied. This study seeks to assess the accuracy and variability of novice EKG interpreters, compared to cardiologist interpretations and expert readers. METHODS Three novice EKG interpreters (undergraduate exercise science students) were trained in interpreting EKGs of athletes with the 2017 International Criteria during one semester under the instruction of an expert reader. During an annual high school, sports screening day 1350 EKGs were collected and assigned a corresponding number. The on-site cardiologists evaluated the EKGs in real-time and classified as “normal” or “abnormal” according to the International Criteria. Following the sports physical day, three novice EKG interpreters (students), a cardiologist and a Clinical Exercise Physiology Professor (expert reader) were asked separately to classify the same EKGs as “normal or “abnormal” according to the International Criteria. All readers were blinded to the initial classifications made by the cardiologist during the sports physical event. Information regarding the athlete's age, gender, race/ethnicity, and sport was provided on the EKGs. We assessed the agreement between the cardiologist, expert reader and students in interpreting EKGs using Fleiss' kappa analysis. RESULTS 1350 athlete EKGs (males = 879; females = 471, age (mean + SD) 15.09 + 1.3y) including 37 (2.7%) abnormal cases were reviewed. The inter-rater agreement between novice readers, expert reader, and physicians in classifying an EKG as abnormal was good (k = 0.7, p &amp;lt; .001). CONCLUSION This study demonstrated that novice EKG readers could correctly classify EKGs based on the International Criteria as “normal and abnormal” to identify athletes at high risk of acute cardiovascular events

Pfizer COVID19 vaccine is not associated with acute cardiovascular events

Abstract Background Previous reports on acute cardiovascular events and sudden death following administration of COVID19 vaccines usually reported no association, but this issue still stirs much ado. We aimed to assess the risk for acute cardiovascular events that require hospitalization in the short-term following administration of the second Pfizer COVID19 vaccine dose in Israel. Methods We have used a self-controlled case series (SCCS) study design, and included second-dose vaccinees in the period from Jan 11th, 2021 to Oct 31st 2021, who had not been diagnosed with COVID19 and who had an acute cardiovascular event (acute myocardial infarction or acute stroke or acute thromboembolic event; myocarditis events excluded) that required hospitalization in the 60 days following vaccine administration. National databases (COVID19 vaccines; COVID19 infection; Hospitalizations) were used to assemble the study population. The first 30 days were defined ‘high risk period’ while the next 31-60 days were defined ‘control period’, and the risk for an acute cardiovascular event was compared between these periods using a conditional logistic regression model. Possible moderators such as: sex, age group and seasonality were included. Results Out of 5,700,112 second-dose vaccinees in the defined time period, 4,163 had an acute cardiovascular event in the 60 days following vaccine administration: 1,979 in the ‘risk period’ and 2,078 in the ‘control period’ (Odds ratio, OR = 0.95, 95% confidence interval, CI 0.90-1.01, p = 0.12). Moderation of sex, age group and recent (less than 60d prior to vaccination) acute cardiovascular event were not significant. A sensitivity analyses looking at 100 days of follow-up post-vaccination did not change these results. Conclusions We found no indication for an increased risk for an acute cardiovascular event in the 30 days (compared to 31-60 days) following administration of the second vaccine dose of Pfizer COVID19 vaccine. Key messages • We found no indication for an increased risk for an acute cardiovascular event in the 30 days (compared to 31-60 days) following administration of the second vaccine dose of Pfizer COVID19 vaccine. • These findings did not change when sensitivity analyses were used.

Increased anticholinergic burden increases risk of acute cardiovascular events

Increased anticholinergic burden increases risk of acute cardiovascular events

Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study

ObjectiveTo evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults.DesignCase-case-time-control study (ie, incorporating a case crossover design and a control crossover design...

REMOTE MONITORING FOR 5P (PREDICTIVE, PREVENTIVE, PARTICIPATORY, PERSONALIZED, AND PRECISION) CARDIOVASCULAR MEDICINE: PROGRESS AMIDST COVID-19 PANDEMIC

The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic that has affected the lives of billions of people. Clinical studies have reported an association between COVID-19 and cardiac diseases. Remote monitoring powered by wearable sensors impacts medical care by enabling health monitoring outside of the clinic. Wearable devices can provide a noninvasive and continuous multi-parameter assessment of ECG, Heart Rate Variability, arterial blood pressure, oxygen saturation and respiratory rate evaluation. Such monitoring may help predict and prevent cardiovascular events related to COVID-19 addresses the growing demand for a novel 5P (Predictive, Preventive, Participatory, Personalized, and Precision) medicine approach. This article aimed to review current and prospective advances in wearable devices for cardiac monitoring and their progress toward clinical application during the COVID-19 pandemic. We performed bibliometric analysis by Scopus, the largest and well organized bibliographic database and analyzed the top-cited articles in this field. Our analysis includes an overview of the most widespread practical implications of CVD-focused remote patient monitoring techniques based on wearable personalized devices. Assessment for both COVID-related conditions and general cases is included in the analysis. Recent studies have reported that cardiac abnormalities present in 19.7-27.8 % of hospitalized patients with COVID-19. COVID-19 associated myocarditis and heart rate abnormalities frequently occur. Additionally, patients with pre-existing CVD and hypertension are at high risk of worse outcomes. Data from several studies have identified atrial fibrillation as the most common form of arrhythmias in COVID-19 patients. Worsening of existing atrial fibrillation in COVID-19 patients is also a serious clinical concern. Implementation of wearable ECG devices for remote monitoring can improve the management of patients with atrial fibrillation and those at high risk for its development. Telecardiology based on wearable devices and remote monitoring allow out-of-hospital control of COVID-19 patients and patients suffering from chronic diseases at high risk of acute cardiovascular events, ensuring their early detection and tracking.

Effects of bariatric surgery on cardiovascular-related acute care use in patients with hypertrophic cardiomyopathy.

Prior studies have suggested causal relationships between obesity and acute cardiovascular events. It has been also known that the risk of acute cardiovascular events is reduced by bariatric surgery. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy (HCM). In this context, we aimed to investigate whether bariatric surgery is associated with a reduced risk of cardiovascular-related acute care use in patients with HCM. In this population-based study, the bariatric surgery group consisted of patients with HCM who underwent bariatric surgery from January 2004 to December 2014. The control group included those who have obesity and HCM and received non-bariatric elective intra-abdominal surgery during the same period. The outcome was cardiovascular-related acute care use (i.e. emergency department (ED) visits or unplanned hospitalizations for cardiovascular disease) during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month post-surgery periods. We adjusted for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2years before the index surgery, and the Elixhauser co-morbidity measures. We also performed propensity score (PS)-matching and inverse probability treatment weighting analyses using these variables. The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 in the control group. The risk was not significantly different in the 1-6months post-surgery period. By contrast, in the 7-12months post-surgery period, the risk of cardiovascular-related acute care use was significantly lower in the bariatric surgery group (adjusted odds ratio 0.23; 95% CI 0.068-0.71; P=0.01) compared with the control group. In the PS-matched cohort, there were no significant differences in the baseline characteristics. The PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7-12months post-surgery period. The inverse probability treatment weighting analysis replicated the findings. Bariatric surgery was associated with a lower risk of cardiovascular-related acute care use in the 7-12months post-surgery period in this population-based study.

Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy.

Chronic obstructive pulmonary disease (COPD) is considered one of the leading causes of mortality. Cardiovascular comorbidities are diagnosed often in COPD patients, not only because of the common risk factors these two diseases share, but also because of the systemic inflammation which characterizes COPD and has deleterious effects in the cardiovascular system. The comorbid cardiovascular diseases in COPD result in several difficulties in the holistic treatment of these patients and affect outcomes such as morbidity and mortality. Several studies have reported that mortality from cardiovascular causes is common among COPD patients, while the risk for acute cardiovascular events increases during COPD exacerbations and remains high for a long time even after recovery. In this review, we focus on the prevalence of cardiovascular comorbidities in COPD patients, presenting the evidence regarding the interaction of the pathophysiological pathways which characterize each disease. Furthermore, we summarize information regarding the effects of cardiovascular treatment on COPD outcomes and vice versa. Finally, we present the current evidence regarding the impact of cardiovascular comorbidities on exacerbations, quality of life and survival of COPD patients.

Dealing with the most common side effect of statins

Statins are one of the key drugs in the treatment of cardiology patients. They lower LDL cholesterol levels, thereby reducing the risk of acute cardiovascular events. Statins are among the best studied drugs, and have been proven to be effective and safe in the treatment of dyslipidemia. Data presented in studies on the prevalence of statin intolerance (SI) varies widely, according to some studies, statin tolerance is the same as placebo, however, this is a common problem in clinical practice. The most common reported symptoms of SI include muscle pain. Patients are often afraid of starting satin treatment because of possible side effects. The appearance of myopathy in patients results in their discontinuation of therapy, which results in increased cardiovascular risk. In order to minimize the risk of SI, particularly statin-associated muscular pain (SI), a key role is played by discussion with the patient, exclusion of nocebo effects, identification of risk factors, dose modification and possible discontinuation of the drug. The purpose of this paper is to review the problem of the most common of the adverse effects of statins- myopathy, in terms of incidence, probable cause, and recommended treatment of patients.

Diabetes-Related Polygenic Risk Is Associated with Poor Glycemic Control and Higher Risk of Acute Cardiovascular Events in Stroke Survivors (P3-5.015)

<h3>Objective:</h3> Though uncontrolled diabetes leads to recurrent cardiovascular events in stroke survivors, many don’t achieve appropriate glycemic control. We hypothesize an adverse polygenic risk profile leads to worse glycemic control and higher risk of recurrent cardiovascular events in stroke survivors. <h3>Background:</h3> n/a <h3>Design/Methods:</h3> We conducted a population genetic study using data of stroke survivors enrolled in the UK Biobank and the Vitamin Intervention for Stroke Prevention (VISP) trial. In both studies, we modeled polygenic risk to diabetes through a polygenic risk score that included 462 single nucleotide polymorphisms known to associate with type 2 diabetes mellitus. Participants were stratified as low, intermediate, or high polygenic risk according to percentile values of this score (&lt;20th, 20–80th and &gt;80th percentile). We used multivariable linear, logistic, and Cox regression models to test for association between polygenic risk to diabetes and 1) hemoglobin A1c (HbA1c), 2) risk of treatment-resistant diabetes (HbA1c ≥7 despite pharmacological therapy), and 3) composite risk of recurrent stroke or coronary artery disease (CAD) <h3>Results:</h3> In 5,670 stroke survivors enrolled in the UK Biobank (mean age 61, 41% females), a higher polygenic risk to diabetes was associated with higher HbA1c in both participants with (Low=reference, Intermediate 0.23(.093), High 0.41(0.114)) and without diabetes (Low=reference, Intermediate 0.06(0.015), High 0.09(0.018)), and with higher risk of treatment-resistant diabetes (Low=reference, Intermediate 1.04(.98,1.11), High 1.12(1.04,1.21)). In 1,750 stroke survivors (mean age 68, 35% female 34) enrolled in VISP, a higher polygenic risk to diabetes was associated with higher composite risk of recurrent stroke or CAD ((Low=reference, Intermediate 1.11(0.78,1.57), High 1.53(1.03,2.28)). Beta (SE) or OR(95%CI)or HR(95%CI). <h3>Conclusions:</h3> Among stroke survivors, a higher polygenic risk to diabetes is associated with worse glycemic control and higher risk of recurrent vascular events. Further research is needed to evaluate the portability of these results to non-white individuals and identify effective therapies for patients with adverse genomic profiles. <b>Disclosure:</b> Mr. Demarais has nothing to disclose. Ms. Conlon has nothing to disclose. Dr. Huo has nothing to disclose. Dr. Rivier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pyxis Partners. Dr. Renedo has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.

Biomarkers of Neutrophil Activation in Patients with Symptomatic Chronic Peripheral Artery Disease Predict Worse Cardiovascular Outcome

Neutrophils play a role in cardiovascular (CV) disease. However, relatively scant evidence exists in the setting of peripheral artery disease (PAD). The aims of this study were to measure biomarkers of neutrophil activation in patients with symptomatic chronic PAD compared with healthy controls, to assess their association with PAD severity, and to evaluate their prognostic value in patients with PAD. The following circulating markers of neutrophil degranulation were tested: polymorphonuclear neutrophil (PMN) elastase, neutrophil gelatinase-associated lipocalin (NGAL), and myeloperoxidase (MPO). Neutrophil extracellular traps (NETs) were quantified by measuring circulating MPO-DNA complexes. Patients with PAD underwent a comprehensive series of vascular tests. The occurrence of 6-month major adverse CV (MACE) and limb events (MALE) was assessed. Overall, 110 participants were included, 66 of which had PAD. After adjustment for conventional CV risk factors, PMN-elastase (adjusted odds ratio [OR]: 1.008; 95% confidence interval [CI]: 1.002-1.015; p = 0.006), NGAL (adjusted OR: 1.045; 95%CI: 1.024-1.066; p < 0.001), and MPO (adjusted OR: 1.013; 95%CI: 1.001-1.024; p = 0.028) were significantly associated with PAD presence. PMN-elastase (adjusted hazard ratio [HR]: 1.010; 95%CI: 1.000-1.020; p = 0.040) and MPO (adjusted HR: 1.027; 95%CI: 1.004-1.051; p = 0.019) were predictive of 6-month MACE and/or MALE. MPO displayed fair prognostic performance on receiver operating characteristic (ROC) curve analyses, with an area under the curve (AUC) of 0.74 (95%CI: 0.56-0.91) and a sensitivity and specificity of 0.80 and 0.65, respectively, for a cut-off of 108.37 ng/mL. MPO-DNA showed a weak inverse correlation with transcutaneous oximetry (TcPO2) on proximal foot (adjusted ρ -0.287; p = 0.032). In conclusion, in patients with symptomatic chronic PAD, enhanced neutrophil activity may be associated with an increased risk of acute CV events, rather than correlate with disease severity. Further research is needed to clarify the role of neutrophils in PAD natural history.

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19.

Patients with heterozygous familial hypercholesterolemia (HeFH) are at increased risk for COVID-19 cardiovascular complications in the acute phase of the infection. Elevated levels of LDL-C and often lipoprotein(a) are present from birth and lead to endothelial dysfunction, which is aggravated by a direct viral attack of the endothelial cells and their exposure to the toxic levels of circulating proinflammatory and prothrombotic mediators during the hyperinflammatory reaction typical of COVID-19. Evidence to date shows the benefit of lipid-lowering therapy in patients with COVID-19. In HeFH patients who are at much higher cardiovascular risk, the focus should, therefore, be on the effective lowering of LDL-C levels, the root cause of the greater cardiovascular vulnerability to COVID-19 infection in these patients. The ongoing use of statins and other lipid-lowering therapies should be encouraged during the ongoing COVID pandemic to mitigate the risk of cardiovascular complications from COVID-19, particularly in HeFH patients. Epidemiologic registry data show that the incidence of myocardial infarction is increased in SARS-CoV-2-infected HeFH patients. There is a need to study whether the risk for acute cardiovascular events is increased in the long-term and if there are changes in lipid metabolism after SARS-CoV infection(s) in patients with HeFH.

A study on the effect of aspirin on clinical symptoms, laboratory indices, and outcomes in patients with COVID-19

Introduction: Low-dose aspirin is one of the most widely used secondary prevention agents for cardiovascular disease and stroke. An unstable risk factor for chronic cardiovascular disease is a viral infection. Evidence suggests that the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could increase the risk of acute cardiovascular events by inducing systemic inflammatory responses and instability in coronary plaques. Objectives: The present study aimed to examine the impact of aspirin on clinical symptoms, laboratory indices, and clinical outcomes in patients with COVID-19. Patients and Methods: After reviewing the documents of hospitalized patients at the Dr. Shariati hospital in Isfahan, Iran, while case and control groups were selected using a cross-sectional method based on aspirin use and non-use. Following a random selection of the reference population (131 medical records of patients with COVID-19 who had aspirin use and 131 of the group of patients with COVID-19 without aspirin use). Medical records of patients with cardiovascular disease, diabetes, cardiovascular disease with diabetes, and patients without underlying disease were evaluated. After matching the two groups based on age, gender, and medical history, the examination and results were recorded in a questionnaire. Results: The results showed that during treatment, no significant difference between the case and control groups regarding clinical symptoms, laboratory results, the need for bilevel positive airway pressure (BiPAP), and mechanical ventilation (P=0.0111 and P=0.089, respectively) were observed. Moreover, no significant difference in the outcome, including improvement and death was detected (P=0.962). Likewise, no significant difference in hospitalization duration between the aspirin and control groups was seen (P=0.289). Conclusion: Our study on a group of COVID-19 patients showed, aspirin is ineffective on clinical symptoms, laboratory indices, and outcomes, however our results further investigation by multi-centric investigations.

Abstract WMP102: Diabetes-Related Polygenic Risk Is Associated With Poor Glycemic Control And Higher Risk Of Acute Cardiovascular Events In Stroke Survivors

Introduction: Though uncontrolled diabetes leads to recurrent cardiovascular events in stroke survivors, many don’t achieve appropriate glycemic control. We hypothesize an adverse polygenic risk profile leads to worse glycemic control and higher risk of recurrent cardiovascular events in stroke survivors. Methods: We conducted a population genetic study using data of stroke survivors enrolled in the UK Biobank and the Vitamin Intervention for Stroke Prevention (VISP) trial. In both studies, we modeled polygenic risk to diabetes through a polygenic risk score that included 462 single nucleotide polymorphisms known to associate with type 2 diabetes mellitus. Participants were stratified as low, intermediate, or high polygenic risk according to percentile values of this score (&lt;20 th , 20-80 th and &gt;80 th percentile). We used multivariable linear, logistic, and Cox regression models to test for association between polygenic risk to diabetes and 1) hemoglobin A1c (HbA1c), 2) risk of treatment-resistant diabetes (HbA1c ≥7 despite pharmacological therapy), and 3) composite risk of recurrent stroke or coronary artery disease (CAD). Results: In 5,670 stroke survivors enrolled in the UK Biobank (mean age 61, 41% females), a higher polygenic risk to diabetes was associated with higher HbA1c in both participants with and without diabetes, and with higher risk of treatment-resistant diabetes (all p&lt;0.05, see Table). In 1,750 stroke survivors (mean age 68, 35% female 34) enrolled in VISP, a higher polygenic risk to diabetes was associated with higher composite risk of recurrent stroke or CAD (p&lt;0.05, see Table). Conclusions: Among stroke survivors, a higher polygenic risk to diabetes is associated with worse glycemic control and higher risk of recurrent acute vascular events. Further research is needed to evaluate the portability of these results to non-white individuals and identify specific medications that may be more effective in patients with adverse genomic profiles.

A Narrative Review on Exercise and Cardiovascular Disease

The favorable risk factor profiles and superb cardiac performance of elite long-distance runners, as well as the anti-aging effects of exercise, have likely contributed to the escalating number of adults worldwide who have embraced the notion that “more exercise is invariably better. Nevertheless, vigorous-to-high-intensity physical activity (PA), particularly when unaccustomed, appears to be a trigger for acute cardiac events in individuals with known or occult atherosclerotic cardiovascular disease or structural cardiovascular abnormalities, most notably, hypertrophic cardiomyopathy. Although regular endurance exercise and moderate-to-vigorous PA provide established cardioprotective benefits, high-volume, high-intensity exercise training regimens appear to induce maladaptive cardiac remodeling in some individuals. These potential adverse cardiac adaptations include accelerated coronary artery calcification (CAC), elevated cardiac biomarker release, myocardial fibrosis, and atrial fibrillation (AF), which may be described by a reverse J-shaped curve. However, the risk for acute cardiovascular events is lower in fit/active persons compared to their unfit/inactive counterparts with the same CAC scores. Similarly, the risk of AF is the highest in habitually sedentary older adults, decreases with light-to-moderate intensity regular PA but increases with high-volume, high-intensity exercise regimens (i.e., reverse J-shaped curve). This review examines these relations and more, with specific reference to the World Health Organization exercise intensity and duration recommendations for optimal health, as well as the thresholds for other research-based exercise metrics, including steps/day and the concept of metabolic equivalents-minutes/week. The primary beneficiaries of exercise training programs and long-term goal training intensities, based on age, sex, and “good fitness, are also discussed. In summary, the benefits of regular moderate-to-vigorous PA and the associated improvements in cardiorespiratory fitness far outweigh the risks for most individuals.

Association of recent respiratory illness and influenza with acute myocardial infarction among the Bangladeshi population: A case-control study.

Current evidence suggests that recent acute respiratory infections and seasonal influenza may precipitate acute myocardial infarction (AMI). This study examined the potential link between recent clinical respiratory illness (CRI) and influenza, and AMI in Bangladesh. Conducted during the 2018 influenza season at a Dhaka tertiary-level cardiovascular (CV) hospital, it included 150 AMI cases and two control groups: 44 hospitalized cardiac patients without AMI and 90 healthy individuals. Participants were matched by gender and age groups. The study focused on self-reported CRI and laboratory-confirmed influenza ascertained via quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) within the preceding week, analyzed using multivariable logistic regression. Results showed that cases reported CRI, significantly more frequently than healthy controls (27.3% vs. 13.3%, adjusted odds ratio (aOR): 2.21; 95% confidence interval (CI): 1.05-4.06), although this was not significantly different from all controls (27.3% vs. 22.4%; aOR: 1.19; 95% CI: 0.65-2.18). Influenza rates were insignificantly higher among cases than controls. The study suggests that recent respiratory illnesses may precede AMI onset among Bangladeshi patients. Infection prevention and control practices, as well as the uptake of the influenza vaccine, may be advocated for patients at high risk of acute CV events.

Association between serum lipid profile, body mass index and osteoporosis in postmenopausal Sudanese women.

Epidemiological observations suggest links between osteoporosis and the risk of acute cardiovascular events. Whether the two clinical conditions are linked by common pathogenic factors or atherosclerosis per se remains incompletely understood. The reduction of bone density and osteoporosis in postmenopausal women contributes to elevated lipid parameters and body mass index (BMI). To investigate the relationship between serum lipid profile, BMI and osteoporosis in postmenopausal women. A prospective analytical case control-study conducted in Khartoum north hospital at Khartoum city, capital of the Sudan from April 2017 to March 2018 after ethical approval obtained from the local Research Ethics Committee of Faculty of Medical Laboratories, Alzaeim Alazhary University on the committee meeting number (109) on Wednesday 15th February 2017. A written informed consent was obtained from all participants to participate in the study.Two hundred postmenopausal women were enrolled in the study. The age was studied in one hundred osteoporosis postmenopausal women as a case group and one hundred non-osteoporosis postmenopausal women as control group. The serum lipid profiles were estimated using spectrophotometers (Mandry) and BMI calculated using Quetelet index formula. The data were analysed using SPSS version 16. The BMI, serum total cholesterol, triglyceride, HDL and LDL in case group respectively were (24.846±2.1647, 251.190±27.0135 mg/dl, 168.790 ±45.774 mg/dl, 50.620 ± 7.174 mg/dl, 166.868 ±28.978 mg/dl). While the BMI, serum total cholesterol, triglyceride, HDL and LDL in control group respectively were (25.378 ±3.8115, 187.990 ± 26.611 mg/dl, 139.360±20.290 mg/dl, 49.480 ±4.659 mg/dl, 111.667 ±28.0045 mg/dl). All serum lipid profiles significantly increased (p=0.000) in the case group compared to the control group, except serum HDL was insignificant different between the case and control group and also BMI was insignificant different between the case and control group. There was a positive Pearson's correlation between BMD and serum total cholesterol (r= 0.832, P<0.01), serum LDL (r = 0.782, P<0.01) and serum triglyceride (r = 0.72, P<0.01). Osteoporotic postmenopausal women had a significant increase in serum lipid profile and BMI. Moreover, we found a positive link between women with cardiovascular diseases and stroke.

Cost-effectiveness of cholesterol-lowering drugs for secondary cardiovascular prevention in the UK: ezetimibe, evolocumab, and alirocumab

Abstract Background Despite statin treatment, patients with elevated low-density lipoprotein cholesterol (LDL-C) levels remain at high risk for acute cardiovascular events. Ezetimibe, evolocumab, and alirocumab were consequently developed to reduce the risk of recurrent ischemic events in patients with established cardiovascular diseases by 6%, 15%, and 15%, respectively. However, these novel treatments must demonstrate both clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers. Objective To assess the cost-effectiveness of statins in combination with ezetimibe, evolocumab, and alirocumab for secondary cardiovascular prevention from the perspective of England's National Health Service (NHS). Methods The incidence of major adverse cardiovascular events, including, myocardial infarction, stroke, angina, and coronary revascularization, was simulated with a Markov cohort model. The model was populated with transition probabilities and hazard ratios derived from cardiovascular outcome trials for statin combinations with ezetimibe (IMPROVE-IT), evolocumab (FOURIER), and alirocumab (ODYSSEY). Costs and utilities were retrieved from previous literature. Principle outcomes of interest were the incremental cost-effectiveness ratios (ICER) per quality-adjusted life year (QALY) gained in 2021 Great Britain Pounds (£). Univariate, scenario, willingness-to-pay, and probabilistic sensitivity analyses were conducted to assess the robustness of results. Results For secondary cardiovascular prevention, ezetimibe in combination with statins increased QALYs gained by 0.60 at cost reductions of −£2,529 (ICER: −4,231 £/QALY) per patients compared to statin monotherapy. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors provided incremental QALYs of 0.53 and 0.86 at costs of £45,279 and £46,375 for evolocumab (ICER: 75,283 £/QALY) and alirocumab (ICER: 40,708 £/QALY), respectively. At the NHS' willingness-to-pay threshold of 30,000 £/QALY, there is 100% probability for ezetimibe and 0% probability for PCSK9 inhibitors to be cost-effective in secondary prevention. Results remained robust under univariate, scenario, and probabilistic sensitivity analyses. Conclusions Ezetimibe is cost-effective for secondary cardiovascular prevention at an annual price of £346 in the UK. For PCSK9 inhibitors, discounts of −37% to −53% on alirocumab's (£4,412) and evolocumab's (£4,467) prices are necessary to achieve cost-effectiveness. Funding Acknowledgement Type of funding sources: None.

Misuse of Cardiac Lipid upon Exposure to Toxic Trace Elements-A Focused Review.

Heavy metals and metalloids like cadmium, arsenic, mercury, and lead are frequently found in the soil, water, food, and atmosphere; trace amounts can cause serious health issues to the human organism. These toxic trace elements (TTE) affect almost all the organs, mainly the heart, kidney, liver, lungs, and the nervous system, through increased free radical formation, DNA damage, lipid peroxidation, and protein sulfhydryl depletion. This work aims to advance our understanding of the mechanisms behind lipid accumulation via increased free fatty acid levels in circulation due to TTEs. The increased lipid level in the myocardium worsens the heart function. This dysregulation of the lipid metabolism leads to damage in the structure of the myocardium, inclusive fibrosis in cardiac tissue, myocyte apoptosis, and decreased contractility due to mitochondrial dysfunction. Additionally, it is discussed herein how exposure to cadmium decreases the heart rate, contractile tension, the conductivity of the atrioventricular node, and coronary flow rate. Arsenic may induce atherosclerosis by increasing platelet aggregation and reducing fibrinolysis, as exposure interferes with apolipoprotein (Apo) levels, resulting in the rise of the Apo-B/Apo-A1 ratio and an elevated risk of acute cardiovascular events. Concerning mercury and lead, these toxicants can cause hypertension, myocardial infarction, and carotid atherosclerosis, in association with the generation of free radicals and oxidative stress. This review offers a complete overview of the critical factors and biomarkers of lipid and TTE-induced cardiotoxicity useful for developing future protective interventions.