Risk Of Cardiovascular Outcomes Research Articles

Osteopontin as a Biomarker for Coronary Artery Disease

Osteopontin (OPN) is a sialylated phosphoprotein highly expressed in atherosclerosis and upregulated in settings of both acute and chronic inflammation. It is hypothesised that plasma levels of OPN may correlate with the presence of coronary artery disease, “CAD”. This offers potential as a point-of-care testing biomarker for early diagnosis, disease monitoring, and prognosis. This review evaluates the current literature on the association between plasma OPN levels and coronary artery disease and what is currently known to support its potential as a biomarker for future practice. Electronic searches of MEDLINE and EMBASE databases were undertaken from inception until July 2024. Thirty-three studies met the inclusion criteria. All studies were observational, with gross heterogeneity in methods used to analyse the association of plasma OPN with clinical characteristics. They included case series, case–control, cross-sectional, and cohort study designs. OPN has been linked to higher cardiovascular risk and unfavourable cardiovascular outcomes. However, the evidence regarding the direct assessment of CAD severity using tools like the SYNTAX or TIMI scores, which focus on anatomical complexity and risk factors, is less definitive. This suggests that OPN may be a more precise reflection of the inflammatory processes and atherosclerotic activity contributing to unfavourable outcomes rather than a direct indicator of the anatomical severity of CAD itself. Consequently, OPN is increasingly perceived as a marker of a poor prognosis rather than a tool for assessing the severity of coronary artery lesions.

A retrospective analysis of cardiovascular outcomes of clozapine treated individuals within Hunter New England.

Clozapine has demonstrated superiority in improving both positive and negative symptoms of treatment-resistant schizophrenia; however, there are associated treatment-limiting side effects, including myocarditis, cardiomyopathy and agranulocytosis. This retrospective cohort study describes the prevalence of myocarditis, left ventricular (LV) dysfunction, cardiovascular risk factors and outcomes in a cohort of patients maintained on clozapine therapy. Data were retrospectively collated from patients who had a diagnosis of schizophrenia, had been managed with clozapine at any stage during their care and undergone at least one echocardiogram. Between March 2020 and September 2021 674 patients were identified, 71% were male, with a mean age of 47 years old (interquartile range (IQR) 40-57). The mean duration of clozapine use was 7 years (IQR 4-13). The overall mortality was 5.54% during the follow-up period. Myocarditis was identified in one patient (0.15%) within the first 30 days, and an additional five cases were identified over the follow-up period (0.89%). The combined incidence of heart failure (HF) and myocarditis was 1.6% during the follow-up period. There was no association between LV size and function at baseline or during follow-up and adverse cardiac outcomes (comprising death, myocarditis, HF). Older age at initiation of therapy and baseline E/e' ratio were associated with risk of HF and myocarditis. The overall incidence of myocarditis and HF during follow-up was low, with surveillance echocardiography offering limited predictive value. Patients maintained on clozapine are at risk of significant cardiovascular sequelae, likely reflecting an adverse risk factor profile.

Incidence and Risk of Cardiovascular Outcomes in Patients With Anorexia Nervosa

Anorexia nervosa (AN) is commonly associated with cardiovascular complications. To investigate the trajectories of the risk of cardiovascular conditions in a nationwide cohort of patients with AN in Taiwan. From a population-based health insurance database from January 1, 2011, to December 31, 2021, this longitudinal cohort study identified patients with AN and controls through propensity score matching at a 1:10 ratio according to sex, age, urbanization level of residence, socioeconomic status, and year of diagnosis. Data were analyzed from June 27, 2023, to February 23, 2024. First-time diagnosis of AN by psychiatrists during the study period. Incidence and risk of composite cardiovascular conditions. Kaplan-Meier curves were used to estimate the cumulative incidence of major adverse cardiovascular events (MACE) and any cardiovascular condition. With adjustment for psychiatric comorbidities, conditional Cox proportional hazards regression analyses were performed to estimate the risk of cardiovascular events, which were presented as hazard ratios (HRs) and 95% CIs, relative to the comparison group. Risks of individual cardiovascular conditions were calculated during 3 follow-up periods after AN diagnosis. The study population included 2081 patients with AN and 20 810 matched controls, for a total of 22 891 participants (mean [SD] age, 24.9 [9.9] years; 91.3% female). In total, 99 patients with AN (4.8%) had MACE vs 175 (0.8%) in controls, and 124 patients with AN (6.0%) had any cardiovascular condition vs 483 controls (2.3%). At the 5-year follow-up, the cumulative incidence rate of MACE was 4.82% (95% CI, 3.85%-6.02%) and of any cardiovascular condition was 6.19% (95% CI, 5.19%-7.53%). Compared with the control group, the AN group had significantly higher risks of MACE (adjusted HR [AHR], 3.78; 95% CI, 2.83-5.05) and any cardiovascular condition (AHR, 1.93; 95% CI, 1.54-2.41). The significantly increased risks of congestive heart failure, conduction disorder, and structural heart disease occurred in the initial follow-up period and disappeared after 60 months of follow-up. Notably, patients with AN did not have an increased risk of ischemic heart disease until after 60 months of follow-up (AHR, 3.01; 95% CI, 1.48-6.13). In this national matched cohort study, increased risk of cardiovascular conditions was found in different periods after AN diagnosis. Clinicians should monitor comorbid cardiovascular conditions among patients with AN at initial presentation, during treatment, and at follow-up.

Abstract 4136403: Impact of Coronary Artery Calcium Scores on Cardiovascular Risk and Preventive Therapies: A Systematic Review and Meta-Analysis

Introduction: Coronary artery calcium (CAC) serves as a key marker of atherosclerosis and is widely utilized in the noninvasive evaluation of coronary artery disease. We aim to compare cardiovascular risk outcomes and the likelihood of initiating or continuing pharmacological and lifestyle preventive therapies in asymptomatic and symptomatic patients with a CAC score greater than zero and those with a CAC score of zero with no established diagnosis of coronary artery disease. Methods: We performed systematic searches of PubMed, Scopus, Google Scholar, Cochrane Central, and ClinicalTrials.gov from inception to May 2024. Our search focused on randomized controlled trials and observational studies comparing outcomes between patients with a CAC score greater than zero and those with a CAC score of zero. Results: We included 53 observational studies, incorporating data from 210,672 asymptomatic and 32,477 symptomatic patients. Over a mean follow-up duration of 8.6 years, we observed that a CAC score greater than zero significantly correlated with an elevated risk of major adverse cardiovascular events (MACE) (OR: 5.58; 95% CI: 4.05–7.69; P < 0.00001). This association extended to all-cause mortality (OR: 3.90; 95% CI: 2.78–5.48; P < 0.00001), myocardial infarction (OR: 4.01; 95% CI: 3.45–4.65; P < 0.00001), and the need for revascularization (OR: 11.90; 95% CI: 6.82–20.78; P < 0.00001). Patients with a CAC score greater than zero were more likely to commence and continue aspirin therapy (OR: 2.45; 95% CI: 1.56–3.83; P < 0.0001 for initiation and OR: 1.71; 95% CI: 1.31–2.23; P < 0.0001 for continuation). Similar trends were noted for lipid-lowering medications (OR: 2.44; 95% CI: 1.57–3.79; P < 0.0001 for initiation and OR: 2.48; 95% CI: 1.53–4.01; P = 0.0002 for continuation), as well as the initiation of blood pressure medications (OR: 1.94; 95% CI: 1.61–2.33; P < 0.00001). Furthermore, a CAC score greater than zero was linked to increased adoption of lifestyle modifications, including enhanced physical activity (OR: 1.84; 95% CI: 1.41–2.41; P < 0.00001) and dietary changes (OR: 1.94; 95% CI: 1.52–2.49; P < 0.00001). Conclusion: Patients with elevated CAC scores are more likely to initiate and continue preventive pharmacological therapies and adopt beneficial lifestyle modifications. These findings underscore the importance of CAC scoring in guiding the management and prevention of cardiovascular disease in both asymptomatic and symptomatic populations.

Comparative cardiovascular and renal outcomes of Liraglutide versus Dulaglutide in Asian type 2 diabetes patients

Given the limited head-to-head comparison of cardiovascular and renal outcomes between liraglutide and dulaglutide, our study aimed to investigate the clinical outcomes between dulaglutide and liraglutide in a real-world setting. In this new-user design, comparative and retrospective cohort study, patients with type 2 diabetes mellitus with prescription for GLP-1RAs from January 1, 2016 to December 31, 2022 (n = 8,278) were included. Primary outcome was composite cardiovascular outcomes which was composed of cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke. The composite renal outcome was also interested, including new macroalbuminuria, doubling of serum creatinine, worsening of estimated glomerular filtration rate (eGFR), and progression to dialysis. A total of 3,210 subjects receiving liraglutide and 5,068 subjects receiving dulaglutide were identified. In the adjusted cohort by applying inverse probability of treatment weighting, the incidence of composite cardiovascular outcomes was 18.4 and 18.7 events per 1000 person-years in the liraglutide and dulaglutide groups, respectively. The risk of cardiovascular outcomes did not significantly differ between groups (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.85–1.15). Moreover, the risk of composite renal outcomes was also comparable between groups (subdistribution HR 1.07, 95% CI 0.995–1.16). Liraglutide and dulaglutide demonstrated comparable cardiovascular and renal outcomes in a real-world setting.

Intersectionality and Social Drivers of Health in Cardiovascular Care.

Social drivers of health (SDOH) are a significant contributor to persistent cardiovascular health disparities in the United States and globally. SDOH include psychosocial, environmental, socioeconomic, cultural, and governmental factors that impact health behaviors and outcomes. Multiple social drivers have been associated with trends in cardiovascular disease risk and health outcomes. These social drivers intersect in complex ways, and applying the concept of intersectionality is critical when considering ways to best address SDOH in cardiovascular care. Applying intersectionality, which considers the unique combination of social drivers associated with a community, allows for tailored interventions to address cardiovascular health disparities.

Intensive Lifestyle Intervention, Cardiac Biomarkers, and Cardiovascular Outcomes in Diabetes: Look AHEAD Cardiac Biomarker Ancillary Study

BackgroundN-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are associated with cardiovascular outcomes and are recommended for measurement in type 2 diabetes (T2D). However, the effects of an intensive lifestyle intervention (ILI) targeting weight loss on cardiac biomarkers and the prognostic association of changes in these biomarkers with risk of adverse cardiovascular outcomes in T2D are not well-established. ObjectivesThis study sought to evaluate the effects of an ILI on cardiac biomarkers and the association of changes in cardiac biomarkers with risk of cardiovascular outcomes in T2D. MethodsParticipants of the Look AHEAD (Action for Health in Diabetes) trial underwent NT-proBNP and hs-cTnT measurement at baseline (N = 3,984) and 1 and 4 years. The effects of the ILI (vs diabetes support and education [DSE]) on cardiac biomarkers were assessed using adjusted linear mixed-effect models and summarized as geometric mean ratios (GMRs). Associations of longitudinal changes in cardiac biomarkers with risk of cardiovascular outcomes were assessed using adjusted Cox models. ResultsAverage baseline NT-proBNP and hs-cTnT was 77 and 10.7 ng/L, respectively. The ILI (vs DSE) led to an increase in NT-proBNP at 1 year (GMR: 1.14; 95% CI: 1.08-1.20), but this difference was attenuated by 4 years (GMR: 1.01; 95% CI: 0.96-1.07). The ILI (vs DSE) led to lower hs-cTnT at 1 year (GMR: 0.94; 95% CI: 0.91-0.97) and 4 years (GMR: 0.93; 95% CI: 0.90-0.96). Participants with meaningful weight loss by 1 year (≥5% vs <5%) had a significant increase in NT-proBNP in the short term (year 1), which attenuated in the long-term follow-up (year 4). Meaningful 1-year weight loss was significantly associated with reduction in hs-cTnT in the long term. In adjusted Cox models, increase in NT-proBNP was significantly associated with higher risk of the composite atherosclerotic cardiovascular disease (ASCVD) outcome and incident heart failure independent of baseline measure of the cardiac biomarker and changes in risk factors. In contrast, longitudinal increase in hs-cTnT was significantly associated with higher risk of the composite ASCVD outcome but not incident heart failure in the most adjusted model. ConclusionsAmong adults with T2D, an ILI led to a significant reduction in hs-cTnT on follow-up but a transient increase in NT-proBNP levels at 1 year that attenuated over time. Longitudinal assessment of NT-proBNP and hs-cTnT provide prognostic information for ASCVD risk, whereas only changes in NT-proBNP predicted HF risk.

Effect of GLP-1 receptor agonists on weight and cardiovascular outcomes: A review.

Diet and lifestyle modifications remain the foundation of obesity treatment, but they have historically proven insufficient for significant, long-term weight loss. As a result, there is a high demand for new pharmacologic treatments to promote weight loss and prevent life-threatening diseases associated with obesity. Researchers are particularly interested in 1 type of drug, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), because of its promising potential in addressing the limitations of non-pharmacologic treatments. In addition to their role in weight loss, these drugs have shown promising early evidence of cardiovascular benefits in obese patients, further enhancing their clinical relevance. Semaglutide and liraglutide, which were initially approved for the treatment of type 2 diabetes, have since been approved by the Food and Drug Administration as weight loss medications due to their effectiveness in promoting significant and sustained weight loss. In this narrative review, we will explore the mechanism of GLP-1 RAs, their effects on weight loss, cardiovascular risk factors and outcomes, common adverse effects, and strategies for managing these effects.

Young adults with acute coronary syndrome undergoing percutaneous coronary intervention: Insights from the Houston Methodist Young ACS-PCI Registry

BackgroundLimited data exist on the risk profile and prognosis of young patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). This study sheds light on the burden of cardiovascular risk factors and outcomes in this population. MethodsThe Houston Methodist Young ACS-PCI registry is a retrospective analysis of young adults (18 to 50 years) undergoing PCI for ACS between 2010 and 2022. Outcomes of interest were major adverse cardiovascular events (MACE: all-cause mortality, myocardial infarction (MI), ischemic stroke) at one year. ResultsAmong 629 patients (median age, 46 years, 23.5% women, and 65.3% White adults), 69.2% had Non-ST-Segment Elevation MI. A total of 22.7% had prior MI, 26.2% prior PCI, and 9.2% had prior coronary artery bypass graft surgery. The prevalence of active smoking, dyslipidemia, hypertension, and diabetes was 69.4%, 82.2%, 80.4%, and 39.6%, respectively. Age-adjusted diabetes rates increased over time, while dyslipidemia, hypertension, and obesity rates remained unchanged. The femoral artery was the most common arterial access (85.2%), 72.7% had one vessel disease, 44.3% had the left anterior descending artery as the culprit vessel, and 78.5% of patients received one stent. At a median of 3.8 years, all-cause mortality was 28 deaths per 1000 person-years. At one year, 11.4% experienced MACE; racial and ethnic minority (Black, Hispanic, and Others), dialysis, prior MI, and stent diameter were independent predictors of MACE. ConclusionsThe study highlights a notable burden of cardiovascular risk factors and cardiovascular outcomes in young adults with ACS undergoing PCI, underscoring the need for strategies to enhance risk assessment and guide interventions among young adults.

Cardiovascular outcomes in patients with newly diagnosed atrial fibrillation and previous stroke: a plausible impact of stroke-heart syndrome using longitudinal data from the GLORIA-AF registry

Abstract Background Patients with new onset atrial fibrillation (AF) and previous stroke events (PS) represent a high-risk cohort and may represent a particular manifestation of the so-called stroke-heart syndrome. Whether the long-term risks of cardiovascular (CV) outcomes and mortality are different among AF patients with different number of PS remain uncertain. Purpose To evaluate if the risks of cardiovascular outcomes are different among AF patients with different number of PS. Methods Data from phase III of the prospective GLORIA-AF (Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients With Atrial Fibrillation) were used. The risks of Major Adverse Cardiovascular Events (MACE), CV death, and all-cause mortality were analysed with COX proportional hazard regression. Results A total of 17482 AF patients [median age: 71.0 (IQR: 64.0 – 78.0) years; 45.3% female] were included in the analysis. At baseline, 1840 (10.5%) AF patients had previous strokes. Among them, 1694 (9.7%) and 170 (0.97%) patients had one (1 PS) and ≥2 previous strokes (≥2 PS) respectively. There were 1111 MACE, 562 CV deaths, and 1266 all-cause mortality after a median follow-up of 3.0 (IQR: 2.9 – 3.1) years. Multivariate Cox regression showed that patients with 1 PS and ≥2 PS had higher risks of MACE (HR: 1.50, 95% CI : [1.26 – 1.78] for 1 PS; HR: 2.65, 95% CI: [1.83 – 3.85] for ≥2 PS), and all-cause mortality (HR: 1.36, 95% CI: [1.13 – 1.58] for 1 PS; HR: 2.16, 95% CI: [1.48 – 3.16] for ≥2 PS) compared to patients without PS (table 1), with the risk of CV death (HR: 2.88, 95% CI: [1.71 – 4.84]) only higher in patients with ≥2 PS. In the subgroup analysis where only patients with PS were included, patients with ≥2 PS had higher risks of MACE, CV death, and all-cause mortality compared to patients with 1 PS. Conclusion AF patients with 1 PS or ≥2 PS events had significantly higher risks of MACE and all-cause mortality compared to AF patients without PS. Moreover, AF patients with ≥2 PS had significantly higher risks of MACE, CV death and all-cause mortality compared to AF patients with only 1 PS.

Hypnotic use and the risk of cardiovascular diseases in insomnia patients

Abstract Background Insomnia, commonly treated with hypnotic agents, is an independent risk factor of cardiovascular diseases. Previous research demonstrated the detrimental effect of hypnotics on the prognosis of cardiovascular patients. Purpose We aimed to examine the association between hypnotic agents and cardiovascular outcomes in general individuals with insomnia. Methods In a propensity score matched cohort of UK Biobank (UKB) participants with insomnia, Cox proportional hazard model was used to estimate the association between regular use of hypnotic agents and predetermined cardiovascular outcomes including incident coronary heart diseases (CHD), heart failure (HF), stroke, and cardiovascular death. Inverse probability of treatment weighting and competing risk models were further performed during sensitivity analysis. Drug-target Mendelian randomization (MR) analyses were employed for further evaluation of hypnotics-related genes and cardiovascular disease association. The genome-wide association data of CHD, HF, and stroke were there large-scale genome-wide association analyses. Tissue-specified expression quantitative trait loci (eQTL) data was derived from BrainSeq phase II. Results During a median follow-up of 14.3 years, the matched cohort documented a total of 1,019 CHD cases, 406 HF cases, 285 stroke cases, and 197 cardiovascular deaths. No significant association was detected between Z-meds and CHD, stroke, and cardiovascular mortality. Benzodiazepine use was significantly associated with the increased risk of CHD, HF, and cardiovascular mortality (Figure 1). The inverse probability of treatment weighting and competing risk models didn’t alter the above associations. Moreover, drug-target MR analyses corroborated the safety of Z-meds in the general population regarding cardiovascular health. However, GABRG1—a drug target for benzodiazepines—was associated with heightened risks for heart failure, and ischemic stroke (Figure 2). Conclusions Our findings suggested the heterogeneous associations between different categories of hypnotics and incident cardiovascular events in individuals with insomnia. Z-meds are safe regarding the risk of cardiovascular outcomes in the UKB population with insomnia.Figure 1Figure 2

Cardiovascular risk factors and all-cause mortality in older age (15-year cohort study)

Cardiovascular diseases (CVD) occupy a leading position in the structure of all-cause mortality. Prospective and interventional studies have identified the major risk factors for CVD and shown their associations with the risk of cardiovascular outcomes and all-cause death. The impact on the individual risk of death may vary by age, sex, study design, and may be population-specific. We aimed to study the contribution of major CVD risk factors to the 15-year risk of all-cause death in the Russian (Siberian) population cohort aged 45–69 years.Material and methods. A random population sample (men and women 45–69 years old, n = 9360) was examined at baseline in 2003–2005 (Novosibirsk, Russian branch of the HAPIEE project) and re-examined twice in 2006–2008 and 2015–2018. Current analysis included individuals without baseline CVD (n = 8087), the average follow-up period – 15.6 (SD 0.69) years. The fatal events were registered based on death certificates from the Population Registration Bureau (ZAGS), and using the data received at serial examinations and postal interview. We analyzed the association between CVD risk factors and all-cause death using multivariate Cox regression.Results. In a cohort aged 45–69, in the adjusted model, 15-year risk of all-cause death was positively associated with age (HR = 1.08; 95 % CI 1.07–1.09), male sex (HR = 1.46; 95 % CI 1.24–1.71), hypertension (HT) (HR = 1.39; 95 % CI 1.25–1.55), smoking (HR = 2.37; 95 % CI 2.08–2.70), high WHR (HR = 1.19; 95 % CI 1.06–1.33), and type 2 diabetes (T2DM) (HR = 1.52; 95 % CI 1.34–1.73), and it was negatively associated with elevated total cholesterol (TC) or LDL-C in blood. In age- and sex-adjusted model, the risk was additionally associated with high triglycerides (HTG), obesity and elevated fasting plasma glucose (FPG). In men, the risk of death was independently associated with age, HT, smoking, low HDL-C, high WHR, and T2DM. In women, the risk of death was independently associated with age, HT, T2DM smoking, and, in age-standardized models, obesity, high WHR, and hyperglycemia.Conclusions. In a population cohort of 45 years and older, among CVD risk factors male sex, HT, smoking, central obesity, and T2DM independently contributed to the risk of all-cause death. Among lipid parameters, low HDL-C and high TG levels increased the risk of death in men. Associations between cardiovascular risk factors and the risk of all-cause death in older people have the patterns specific for older age; these features are important to take into account in a strategy to reduce mortality in the population.

Use of antithrombotic therapy and the risk of cardiovascular outcomes and bleeding in cancer patients at the end of life: a Danish nationwide cohort study

BackgroundDespite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. ObjectivesTo examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant bleeding, venous thromboembolism (VTE), and arterial thromboembolism (ATE) by ATT exposure. MethodsUsing a Danish nationwide cohort of terminal cancer patients, ATT adherence in the year following terminal illness declaration was measured by the proportion of days covered (PDC) by prescription. Discontinuation was defined as a treatment gap of ≥30 days between prescription renewals. One-year cumulative incidences of bleeding complications, VTE, and ATE were calculated, considering the competing risk of death. ResultsDuring 2013-2022, 86 732 terminally ill cancer patients were identified (median age, 75 years; 47% female; median survival, 57 days). At terminal illness declaration, 37.5% were receiving ATT (66.6% platelet inhibitors, 23.0% direct oral anticoagulants, and 10.4% vitamin K antagonists [VKAs]). The mean PDC was 88% (SD, 30%), highest among platelet inhibitor users (mean PDC, 89%) and lowest among VKA users (73%). One-year ATT discontinuation incidence was 7.9% (95% CI, 7.7%-8.1%). Most patients continued ATT until death (74.8% platelet inhibitors, 58.8% direct oral anticoagulants, and 61.6% VKAs). Patients receiving ATT had a lower 1-year VTE risk but higher risks of ATE and major bleeding. ConclusionDespite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilization and discontinuation dynamics in the challenging context of terminal illness.

The obesity paradox exists in Asia: A systematic review and meta-analysis of body mass index effects on clinical outcomes following percutaneous coronary intervention in Asia.

Cardiovascular diseases (CVDs) are major contributors to illness and death globally. Body mass index (BMI) is a well-established prognostic factor on cardiovascular risk outcome. Numerous investigations have provided evidence for the existence of the obesity paradox after percutaneous coronary intervention (PCI). However, the association between BMI and the results following PCI has not been extensively investigated in Asian populations. The research aims to fill the current void in understanding by investigating the association between BMI and clinical consequences following PCI, with a particular focus on Asian individuals. A systematic search was conducted through PubMed, ScienceDirect, and Cochrane Library to identify studies examining the effect of BMI on clinical outcome after PCI in Asia. R Studio 4.3.2 software was used to carry out the analysis of the data. A total of 182,110 patients who had gone through PCI were found in the 5 included cohorts. A meta-analysis conducted on the subjects revealed that patients who were overweight (odds ratio [OR] = 0.60, 95% confidence interval [CI] [0.57, 0.63], P < 0.0001) had a lower risk of all-cause mortality compared to individuals with a healthy weight and patients with obesity (OR = 0.65, 95% CI [0.41, 1.05], P = 0.006) had a lower risk of all-cause mortality than healthy weight individuals. The study also found that overweight patients (OR = 0.60, 95% CI [0.39, 0.91], P = 0.02) had a lower risk of cardiac mortality. In addition, obese patients (OR = 0.41, 95% CI [0.19, 0.88], P = 0.02) had a lower risk of noncardiac mortality. However, the study found that there were no differences in major adverse cardiovascular event, myocardial infarction, and bleeding between all patient groups. This meta-analysis supports the presence of an obesity paradox after PCI in Asian populations. The obesity paradox was evident in all-cause mortality, cardiac mortality, and noncardiac mortality.

Abstract MP20: Leveraging Electronic Health Records to Assess Neighborhood Advantages and Risk of Cardiovascular Outcomes Among Hypertensive Patients

Introduction: Hypertension disproportionately impacts socially disadvantaged groups in the U.S. with increasing prevalence and suboptimal control rates. Our study aims to examine the association between neighborhood-level social vulnerability and hypertension outcomes using electronic health record (EHR) data from a large regional health system. Methods: We conducted a retrospective analysis of EHR data from the Sentara Health System, covering the period from January 1st, 2010, to December 31st, 2022. We assigned a Social Vulnerability Index (SVI) based on the residential census tract of each patient and established a longitudinal cohort of patients who consistently utilized healthcare services. To be included in the study, patients were required to have a minimum of five years of observational time and to have healthcare visits in at least 50% of the observed years. The study focused on patients diagnosed with hypertension—either through a hypertension diagnosis, a blood pressure measurement exceeding 140/90, or antihypertensive medication prescriptions. We utilized multivariate Cox Proportional Hazards models to analyze the associations of SVI with cardiovascular outcomes and blood pressure control (&lt;140/90 mmHg). Results: The longitudinal cohort consisted of 55,060 patients, with an average age of 54 years (Interquartile range: 42-65), 30.0% of whom were Black adults and 60.0% were females. Compared to patients residing in the most advantaged neighborhoods (quartile 1 of SVI), those in more disadvantaged neighborhoods (quartiles 2, 3, and 4) had hazard ratios for composite cardiovascular endpoint (myocardial infarction, heart failure, and stroke) of 1.22 (95% CI, 1.19-1.25), 1.40 (95% CI, 1.37-1.44), and 1.64 (95% CI, 1.60-1.68), respectively, after adjustment for age and sex. Additionally, blood pressure control was significantly lower in higher SVI quartiles, with control rates in quartiles 1 through 4 at 78.4%, 76.5%, 75.2%, and 72.8%, respectively (P&lt;0.001). Among the SVI themes, socioeconomic status (theme 1) and housing type and transportation (theme 4) were associated with the highest hazard ratios for cardiovascular outcomes. Conclusions: Neighborhood-level social vulnerability is significantly associated with worse hypertension control and adverse cardiovascular outcomes. Health systems can employ tailored interventions targeting high-risk neighborhoods to reduce disparities and enhance health outcomes for vulnerable populations.

Pregnancy complications and long-term risk of cardiovascular events in women with structural heart disease

BackgroundTo determine the frequency of pregnancy complications and their association with the risk of cardiovascular outcomes in women with structural heart disease (SHD).MethodsThis nationwide registry-based cohort study included women in...

Abstract P398: The effects of care by hypertension specialists on cardiovascular outcome, blood pressure control and cost-effectiveness among uncontrolled hypertensive patients

Background: Studies suggested that physician specialty had an impact on patient outcomes of cardiovascular disease. However, the effects of care by hypertension specialists on clinical outcomes and financial burden among uncontrolled hypertensive patients are unknown. Objective: This study was to assess the effects of care by hypertension specialists on risk of cardiovascular outcomes, blood pressure (BP) control, and cost-effectiveness among patients with uncontrolled hypertension. Methods: A retrospective cohort study was conducted of patients aged 45-79 years who were admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region, China, for uncontrolled hypertension between 2015 and 2019. We assessed the relationship between care by hypertension specialists and major adverse cardiovascular events (MACE), BP control, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) by the Cox regression, the generalized estimating equations (GEE) model, and the Markov model, respectively. Results: A total of 10680 patients with uncontrolled hypertension were followed up for a median of 4.0 years. Among them, 5646 (52.9%) patients received care by hypertension specialists and had fewer MACE than the non-specialists group (21.5 vs 39.7 per 1000-person-years; hazard ratio 0.67; 95% CI: 0.57 to 0.79) according to multiple Cox regression after stabilized inverse probability of treatment weighting. At 4 years, the odds ratio for BP control between the hypertension specialist group and the non-specialist group was 0.83 (95% CI: 0.79 to 0.86). Odds ratios with declining trend were observed at 1, 2, and 3 years. Over a lifetime horizon, the ICERs of the hypertension specialists group was USD 6295.37 per QALY gained compared with the non-specialists group. Conclusions: This study provided some evidence that care by hypertension specialists was associated with reduced risk of MACE and improved BP control in patients with uncontrolled hypertension, and was cost-effective.

Risk of cardiovascular outcomes with bempedoic acid in high-risk statin intolerant patients: a systematic review and meta analysis.

Aim: Statin intolerance and myopathy is a major issue with prolonged use of statins myopathy. Bempedoic acid can be a good alternative for those intolerant to statins. This systematic review aims to observe incidence of major adverse cardiovascular events (MACE) and other adverse events, in high-risk statin intolerant patients receiving bempedoic acid.Methods: Literature search was conducted via Google Scholar, Science Direct and PubMed, after which screening, selection and data extraction of articles was done. Meta-analysis was performed on RevMan 5.4. Subgroup analysis was also conducted and heterogeneity was evaluated. Risk of bias was performed using ROB2 assessment scale. (CRD42024536827).Results: Only six randomized controlled trials were used in final analysis consisting of 17,844 patients. Treatment with bempedoic acid was associated with a reduced risk of MACE compared with placebo (RR 0.86; 95% CI [0.79, 0.94] p=0.0005), with myocardial infarction significantly reduced. Incidence of adverse effects was increased with bempedoic acid (RR: 1.02; 95% [1.00, 1.03] p=0.01) but no significant difference was observed. Incidence of myalgia was reduced in bempedoic group as well.Conclusion: Bempedoic acid is a safe and effective alternative to statins in high-risk patients intolerant to statins, decreasing the risk of MACE.

Reproductive factors and risk of cardiovascular outcomes in women with ST-elevation myocardial infarction

BackgroundThere are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI.MethodThis retrospective cohort study was initiated in 2016–2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses.ResultSixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9% vs. 40.4%, P = 0.008). There was a greater chance of CV events in women with OCP usage (OR = 3.546, P = 0.038) and a lower chance of CV events in women with greater age at menarche (OR = 0.630, P = 0.009) and longer breastfeeding duration (OR = 0.798, P = 0.041) according to multiple backward logistic regression models.ConclusionBased on this study, OCP consumption is a risk factor, while older age at menarche and longer duration of breastfeeding are protective factors for cardiovascular outcomes in women after STEMI.

Acute Declines in Estimated Glomerular Filtration Rate in Patients Treated With Benazepril and Hydrochlorothiazide Versus Amlodipine and Risk of Cardiovascular Outcomes.

Acute declines in estimated glomerular filtration rate (eGFR) occur commonly after starting angiotensin-converting enzyme inhibitors. Whether declines in eGFR that occur after simultaneously starting angiotensin-converting enzyme inhibitors with other antihypertensive agents modifies the benefits of these agents on cardiovascular outcomes is unclear. We identified predictors of acute declines in eGFR (>15% over 3 months) during randomization to benazepril plus amlodipine versus benazepril plus hydrochlorothiazide in the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) trial. We then determined the relation between declines in eGFR (treated as a binary variable, ≤15% versus >15% and separately, as a restricted spline variable) and the composite risk of fatal and nonfatal cardiovascular events using Cox proportional hazards models. We included 10 714 participants (median age 68 years [Q1 63, Q3 73]), of whom 1024 reached the trial end point over median follow-up of 2.8 years. Predictors of acute declines in eGFR>15% over 3 months included assignment to hydrochlorothiazide (versus amlodipine) and higher baseline albuminuria. Overall, declines in eGFR ≥15% (versus <15%) were associated with a 26% higher hazard of cardiovascular outcomes (95% CI, 1.07-1.48). In spline-based analysis, risk for cardiovascular outcomes was higher in the hydrochlorothiazide arm at every level of decline in eGFR compared with the same magnitude of eGFR decline in the amlodipine arm. Combined use of benazepril and amlodipine remains superior to benazepril and hydrochlorothiazide for cardiovascular outcomes, regardless of the magnitude of the decline in eGFR that occurred with initiation of therapy.