Risk Of Cardiovascular Outcomes Research Articles

Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry

Abstract Background and Aims It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD). Methods CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke). Results Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women. Conclusions SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.

Abstract PO3-10-02: Cardiovascular Risk Factors and Outcomes in Native Americans who have Received Chemotherapy and/or Radiation: A Retrospective Single-center Study

Abstract Introduction: There is scarce literature regarding cardiovascular risk factors and cardiovascular outcomes in Native American patients with breast cancer. Cardiovascular complications are known to be associated with cancer treatment. Certain medications, such as anthracyclines and HER-2 agents are directly cardiotoxic, while other modalities of treatment may lead to accelerated atherosclerosis. We have conducted a single-center retrospective study assessing cardiovascular risk factors and outcomes in Native American patients with breast cancer. Methods: Data was extracted from the UNM Comprehensive Cancer Center tumor registry and PowerChart. Charts were selected based on if the patient was registered as a Native American with a breast cancer diagnosis from 2010-2020. Inclusion criteria were age 18 or older, identified as Native American, received a diagnosis of breast cancer between 2010-2020, received at least one chemotherapeutic agent, endocrine therapy, or radiation therapy. Results: The study included 89 participants. The median age at the time of diagnosis of breast cancer was 55 years. All were female. Cardiovascular risk factors prior to undergoing treatment were reported as follows: Hypertension (55.3%); diabetes (46.1%); hyperlipidemia (35.3%); smoking (25%); obesity (52.6%). Before initiating treatment, 3.5% of Native American breast cancer patients in our study population had coronary artery disease. Cardiovascular disease incidence before and after undergoing treatment was as follows: myocardial infarction (1.2% vs 2.4%), stroke (4.7% vs 1.2%), heart failure with reduced ejection fraction (HFrEF) (2.3% vs 4.8%), heart failure with preserved ejection fraction (HFpEF) (1.2% vs 1.2%), peripheral arterial disease (1.2% vs 1.2%), atrial fibrillation or another arrhythmia (4.7% vs 5.9%). We also noted new diagnoses of hypertension and arrhythmia in 3.6% and 1.2% of our study patient population respectively after starting chemotherapy. 43% of all included patients had a transthoracic echocardiogram (TTE) or multigated acquisition scan (MUGA) recorded in the chart before chemotherapy and 45% had one afterward. Of those, when comparing ejection fraction between pre- and post-chemotherapy, a change in mean EF (61.9% vs 57.8%) was seen. 37 patients (41.6%) received treatment with an anthracycline or a Her-2 agent. Mean EF prior to treatment was 65.0%, and mean EF after treatment was 59.1%. Pre- and post-treatment rates of HFrEF were 0% and 5.7%, respectively. Discussion: Hypertension, diabetes, hyperlipidemia, smoking, and obesity are highly prevalent in the Native American patient population who are treated for a diagnosis of breast cancer. Our study showed a change in mean EF after treatment (61.9% vs. 57.8%) in our Native American breast cancer patient population. For those receiving an anthracycline or Her-2 agent, EF changed from 65.0% to 59.1% after treatment. High rates of HFrEF, new onset hypertension, and arrhythmias post-treatment were also noted. These findings suggest that a thorough cardiovascular risk assessment prior to starting a treatment regimen for breast cancer may be important. Multidisciplinary management with cardiology may be critical in the care for these patients. Further investigation of cardiovascular risk factors and outcomes after cancer treatment is warranted in this population. There are several limitations of our study, one being that this was a single-center study which does not represent the Native American population throughout the United States and Canada. The small sample size also limits the power of the study. Many patients after initial evaluation at our facility received care at outside facilities, which limits data on treatments received, studies performed (e.g. TTE and MUGA), or cardiovascular events. Citation Format: Conor Kirby, Jewel Meyer-Hagen, Paul Andre, Umair Khan, Nicholas Harris, Eduardo Davila, Mark Garcia, Jacklyn Nemunaitis. Cardiovascular Risk Factors and Outcomes in Native Americans who have Received Chemotherapy and/or Radiation: A Retrospective Single-center Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-02.

The effect of antiarrhythmic medications on the risk of cardiovascular outcomes in patients with atrial fibrillation and coronary artery disease

BackgroundWhile current guidelines recommend amiodarone and dronedarone for rhythm control in patients with atrial fibrillation (AF) and coronary artery disease (CAD), there was no comparative study of antiarrhythmic drugs (AADs) on the cardiovascular outcomes in general practice. MethodsThis study included patients with AF and CAD who received their first prescription of amiodarone, class Ic AADs (flecainide, propafenone), dronedarone or sotalol between January 2016 and December 2020. The primary outcome was a composite of hospitalization for heart failure (HHF), stroke, acute myocardial infarction (AMI), and cardiovascular death. We used Cox proportional regression models, including with inverse probability of treatment weighting (IPTW), to estimate the relationship between AADs and cardiovascular outcomes. ResultsAmong the AF cohort consisting of 8752 patients, 1996 individuals had CAD, including 477 who took dronedarone and 1519 who took other AADs. After a median follow-up of 38 months, 46.3% of patients who took dronedarone and 54.4% of patients who took other AADs experienced cardiovascular events. Compared to dronedarone, the use of other AADs was associated with increased cardiovascular events after adjusting for covariates (hazard ratio [HR] 1.531, 95% confidence interval [CI] 1.112–2.141, p = 0.023) and IPTW (HR 1.491, 95% CI 1.174–1.992, p = 0.012). The secondary analysis showed that amiodarone and class Ic drugs were associated with an increased risk of HHF. The low number of subjects in the sotalol group limits data interpretation. ConclusionFor patients with AF and CAD, dronedarone was associated with better cardiovascular outcomes than other AADs. Amiodarone and class Ic AADs were associated with a higher risk of cardiovascular events, particularly HHF.

Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa.

COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies. A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants. Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%). Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.

Echogenicity of atherosclerotic plaque - a criterion for assessing the dynamics and prognosis of cardiovascular diseases

Aim: to measure the echogenicity of atherosclerotic plaques (AP) of carotid arteries to assess the dynamics of atherosclerosis and risk of cardiovascular outcomes (CVO) in patients with different CVD risk.Materials and methods. The study included 223 patients: 80 patients (47 males) with moderate CVD risk (mean age: 53 years, range: 39-66) (Group 1) and 143 patients (123 males) with acute coronary syndrome (ACS) and high CVD risk (mean age: 57, range: 32-83) years (Group 2). All patients were examined at the Chazov National Medical Research Center of Cardiology. Patients underwent a standard clinical examination, biochemical blood test with lipid profile determination, and ultrasound duplex scanning. Patients with ACS were re-examined after 1-1.5 years and patients with moderate CVD risk were re-examined after 1 and 7 years.Results. We analyzed 181 APs in Group 1 and 378 APs in Group 2. Analysis of gray-scale median (GSM) at the first and second visit showed a significant increase in GSM in both groups: from 67.02 [54.13; 82.85] to 73.5 [59.5; 88.7] (p<0.0001) in Group 1, and from 49.3 [39.73;63.64] to 50.7 [40.04;66.54] (p<0.05) in Group 2. An increase in GSM was observed in 79% of patients in Group 1, in 53% of patients in Group 2. Unfavorable CVO (CVO+) developed after 7 years in 7 (8.8%) patients in Group 1, and after 1 year in 23 (23%) patients in Group 2. In Group 1, an increase in GSM was observed only in patients with favorable prognosis (CVO-): from 67.7[52.13; 79.0] to 77.5[64.12; 91.0] (n=148 AP, p<0.05), in patients with CVO+, GSM increased non-significantly from 60.1[53.5; 66.5] to 66.5[55.0; 71.6] (n=18 AP, p=NS). In Group 2, a significant increase in GSM was observed in patients with CVO-: from 48.7[39.0; 63.4] to 51.3[40.0; 67.4] (n=141 AP, p<0.01), in patients with CVO+, GSM decreased from 51.6[42.9; 72.5] to 50.2[40.4; 65.0] (n=43 AP, p=NS). In Group 2, GSM significantly increased by 2.75 (6.05%) from the initial value (p<0.05) in patients with CVO-, while patients with CVO+ showed a significant decrease in the average GSM of AP by 3.33 (7.8%) (p<0.05). Using ROC analysis, a Δ% GSM value of 6.96% was found (area under the curve 0.628 ± 0.0465 [95% CI 0.556 - 0.696], p = 0.0058). According to Cox regression analysis, the risk of CVO increased by 2.16 times with a decrease in GSM AP in the carotid arteries over time by ≥ 6.96% (НR=2.16; 95% CI=1.331 – 3.507); p=0.009.Conclusion. The ultrasound method of measuring the echogenicity of an atherosclerotic plaque of the carotid artery using GSM parameter can be effective for assessing the dynamics of atherosclerosis and prognosis of adverse cardiovascular events in patients with high and moderate CVD risk

Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study

BackgroundPaxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascular diseases (CVD) in COVID-19-surviving patients with autoimmune rheumatic diseases (AIRDs).MethodsTriNetX data from the US Collaborative Network were used in this study. A total of 5,671,395 patients with AIRDs were enrolled between January 1, 2010, and December 31, 2021. People diagnosed with COVID-19 were included in the cohort (n = 238,142) from January 1, 2022, to December 31, 2022. The Study population was divided into two groups based on Paxlovid use. Propensity score matching was used to generate groups with matched baseline characteristics. The hazard ratios (HRs) and 95% confidence intervals of cardiovascular outcomes, admission rate, mortality rate, and intensive care unit (ICU) admission rate were calculated between Paxlovid and non-Paxlovid groups. Subgroup analyses on sex, age, race, autoimmune diseases group, and sensitivity analyses for Paxlovid use within the first day or within 2–5 days of COVID-19 diagnosis were performed.ResultsPaxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47–0.88]), arrhythmia outcomes (HR = 0.81 [0.68–0.94]), ischemic heart disease, other cardiac disorders (HR = 0.51 [0.35–0.74]) naming heart failure (HR = 0.41 [0.26–0.63]) and deep vein thrombosis (HR = 0.46 [0.24–0.87]) belonging to thrombotic disorders in AIRD patients with COVID-19. Compared with the Non-Paxlovid group, risks of major adverse cardiac events (HR = 0.56 [0.44–0.70]) and any cardiovascular outcome mentioned above (HR = 0.76 [0.66–0.86]) were lower in the Paxlovid group. Moreover, the mortality (HR = 0.21 [0.11–0.40]), admission (HR = 0.68 [0.60–0.76]), and ICU admission rates (HR = 0.52 [0.33–0.80]) were significantly lower in the Paxlovid group than in the non-Paxlovid group. Paxlovid appears to be more effective in male, older, and Black patients with AIRD. The risks of cardiovascular outcomes and severe conditions were reduced significantly with Paxlovid prescribed within the first day of COVID-19 diagnosis.ConclusionsPaxlovid use is associated with a lower risk of CVDs and severe conditions in COVID-19-surviving patients with AIRD.

Weight loss and cardiovascular disease risk outcomes of semaglutide: a one-year multicentered study.

There are limited real-world studies assessing semaglutide weight loss and associated comorbidity and metabolic outcomes over periods ≥ 6 months. We aim to assess weight loss, metabolic, and cardiovascular outcomes of 12 months of semaglutide. We conducted a multicentered retrospective cohort study on semaglutide use. We included patients with a body-mass index (BMI) ≥ 27 kg/m2 who were prescribed weekly semaglutide subcutaneous injections. We excluded patients with bariatric surgeries, taking other anti-obesity medications, and with active malignancy or pregnancy. A total of 1023 patients had semaglutide prescription for obesity. We assessed weight loss outcomes of subcutaneous semaglutide for 12 months. The primary endpoint was total body weight loss percentage (TBWL%) at 12 months. Secondary endpoints included proportion of patients achieving ≥5%, ≥10%, ≥15%, and ≥20% weight loss, and improvements in metabolic, cardiovascular, and comorbidities after 12 months of follow-up. We included 304 patients (73% female, 93% White, mean age 48.8 [12.4] years, BMI 40.9 [9.6] kg/m2) in the analysis. Patients achieved a TBWL of 13.4 (8.0)% at 12 months (p < 0.001 from baseline). Patients without T2DM achieved a TBWL of 16.9 (6.9)% compared to 9.9 (8.4)% in patients without T2DM at 12 months on the higher doses of semaglutide (p < 0.001 from baseline). In this cohort, 81% achieved ≥5%, 64% achieved ≥10%, 41% achieved ≥15%, and 22% achieved ≥20% TBWL at 12 months. Patients with overweight or obesity experienced significant improvements in metabolic, lipid profile, blood pressure, liver function tests, and cardiovascular disease risk outcomes. Semaglutide demonstrated notable improvement in obesity, metabolic, and cardiovascular disease risk outcomes in a clinical setting.

Associations of variability in body mass index with cardiovascular outcomes in the general population: A systematic review.

In today's world, high variability of body mass index (BMI) is known as a significant global health problem that can lead to many negative impacts on the cardiovascular system, including atrial fibrillation (AF) and coronary heart disease. The current systematic review aims to elucidate the effect of variability in BMI on the risk of cardiovascular outcomes. Four databases, including PubMed, Scopus, MEDLINE, and CENTRAL, were searched. All related articles up to 10 June 2022, were obtained. Titles, abstracts, and full texts were reviewed. After screening abstracts and full texts, four articles were included in our study. In these four cohort studies, 7,038,873 participants from the USA and South Korea were involved. These articles generally considered the BMI and outcomes including cardiovascular disease, AF, and coronary heart disease. All these articles reported an association between the variability of BMI and increased risk of cardiovascular outcomes. Due to the negative impact of the high variability of BMI on the risk of cardiovascular outcomes, health policymakers and practitioners should pay more attention to the significant role of BMI in health problems and physicians might better check the variability of BMI visits to visit.

Association between heart rate variability and neutrophil-lymphocyte ratio in individuals with prehypertension – A cross-sectional study

Background: High blood pressure, commonly termed hypertension, is becoming more common in both developing and industrialized nations, making it a worldwide health concern. An increase in blood pressure is broadly categorized into prehypertension and hypertension based on JNC VIII criteria. Prehypertension is a state in between normal blood pressure and high blood pressure, and it is linked with injury to target organs and subclinical atherosclerosis an easy and non-invasive way to look into autonomic dysfunction in those who are pre-hypertensive is to measure heart rate variability (HRV). Neutrophil-to-lymphocyte ratio (NLR) is a cheap, simple, and novel hematological parameter of oxidative stress and pro-inflammatory marker and has recently emerged as a useful indicator to predict cardiovascular risk and adverse outcomes in patients with hypertension. Aims and Objectives: The aim of the study is to assess the correlation between cardiovascular autonomic function using HRV and NLR in pre-hypertensive individuals and to find out if NLR can be used as a marker to detect autonomic dysfunction. Materials and Methods: HRV is recorded in a supine position with eyes closed in the study population. About 2 mL of venous blood was collected from the individuals to measure NLR using an automated hematology analyzer. Results: The mean values of time domain indices showed significant reduction and frequency domain indices low frequency (LF) values were significantly higher and high frequency (HF) values were significantly lower in pre-hypertensive. The mean NLR was significantly higher in pre-hypertensive individuals. Time domain indices showed a negative correlation with NLR. HF values were negatively correlated and LF values were positively correlated with NLR. Conclusion: NLR was increased in pre-hypertensive individuals which suggest that people in pre-hypertensive state are also at risk of developing cardiovascular and cerebrovascular complications. This study showed a positive association between NLR and sympathetic activity and a negative association between NLR and parasympathetic activity. This concludes that NLR could be used as a marker to assess autonomic dysfunction in them.

Comorbid Diabetes and Hypertension: Gender differences in prevalence and risk factors among adults (≥18 years) in an urban community in Kathmandu District in Nepal

Chronic diseases such as diabetes and hypertension are often influenced by biological, behavioural, environmental and social factors in women and men. This study aimed to identify the gender differences in prevalence and risk factors of comorbid diabetes and hypertension (CM) among adults aged 18 years and above in an urban community in Kathmandu, Nepal. A community-based cross-sectional analytical study was carried out in Gokarneshwor Ward 1, 2 and 3 among adults aged 18 years and above from September 2020- May 2023. Diabetes (DM) was defined as persons previously diagnosed by a physician and/or on anti-diabetic medication. Hypertension (HTN) was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg or those who were diagnosed by a physician and/or receiving antihypertensive medication. Comorbidity (CM) was defined as persons with diabetes and hypertension. Information regarding socio-demographic data, behavioural and biological risk factors, anthropometric assessment and morbidity were obtained from adults aged 18 years and above using a Family study proforma. Multinomial logistic regression analyses with the referent category being persons with no diabetes or hypertension (NDH) were performed for three categories HTN vs NDH, DM vs NDH and CM vs NDH. Among 1538 adults with 776 women, overall prevalence of comorbidity was 5.3% (95% CI: 4.3 – 6.5); among men 6.1% and 5.5% among women. After adjusting for age, for both women and men, being currently married, alcohol use, family history of diabetes and generalized obesity were associated with comorbidity. However, these associations were more robust for men. Moreover, measures of central obesity were associated with comorbidity for men alone. Though alcohol use was higher among men, the association with comorbidity was more robust for women. Paradoxically, lower educational status among women and higher education among men were associated with higher odds of comorbidity. In conclusion, prevalence of comorbid diabetes and hypertension may differ marginally among men and women. Though comorbidity rates appear to be lower in Nepal in comparison to other countries in South Asia, the rising burden emphasizes the need for tailored public health interventions that address modifiable risk factors among men and women. Further research may help to elucidate the role of gender on cardiovascular risk and hard outcomes such as cardiovascular events and mortality among persons with comorbid diabetes and hypertension.

Effect of Remotely Supervised Weight Loss and Exercise Training Versus Lifestyle Counseling on Cardiovascular Risk and Clinical Outcomes in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial.

To compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient-reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity. Twenty older (60-80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate-to-vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check-ins. The primary outcome was a composite metabolic syndrome z-score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein-cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient-reported outcomes. Both groups improved MSSc (absolute change -1.67 ± 0.64 in SWET; -1.34 ± 1.30 in CHAT; P < 0.01 for both groups) with no between-group difference. Compared with CHAT, SWET significantly improved body weight, fat mass, Disease Activity Score-28 C-reactive protein, and patient-reported physical health, physical function, mental health, and fatigue (P < 0.04 for all between-group comparisons). Based on canonical correlations for fat mass, cardiorespiratory fitness, and leg strength, component-specific effects were strongest for (1) weight loss improving MSSc, physical health, and mental health; (2) aerobic training improving physical function and fatigue; and (3) resistance training improving Disease Activity Score-28 C-reactive protein. In older patients with RA and overweight/obesity, 16 weeks of remotely supervised weight loss, aerobic training, and resistance training improve cardiometabolic health, patient-reported outcomes, and disease activity. Less intensive lifestyle counseling similarly improves cardiovascular disease risk profiles, suggesting an important role for integrative interventions in the routine clinical care of this at-risk RA population.

Fibrates and the risk of cardiovascular outcomes in chronic kidney disease patients.

The high risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) has been well described. However, the efficacy of fibrates on the risk of MACE in patients with CKD remains unclear. We conducted a nested case-control study using data from a large administrative database that included more than 1.5 million Japanese patients. We defined cases as CKD patients with incidences of MACE and matched them with controls based on age, sex, calendar year of cohort entry and CKD stage. Fibrate exposure timing was categorized as current, recent or past. A conditional logistic regression analysis was used to investigate the association between fibrate use and the risk of MACE. Our study included 47 490 patients with CKD, with 15 830 MACE identified during a median follow-up of 9.4 months. The numbers of fibrates used during the study period were 556 (3.5%) in the case group and 1109 (3.5%) in the control group. Fibrate use was significantly associated with a decreased risk of MACE [odds ratio (OR) 0.84; 95% confidence interval (CI) 0.75-0.94], particularly for current (OR 0.81; 95% CI 0.68-0.97) and recent use (OR 0.65; 95% CI 0.48-0.90). Regarding the class effect of fibrates, pemafibrate use, but not bezafibrate or fenofibrate use, was significantly associated with a decreased risk of MACE (OR 0.73; 95% CI 0.528-0.997). Recent and current fibrate use, especially pemafibrate use, was associated with a reduced risk of MACE in patients with CKD. This suggests the potential benefits of continuous fibrate therapy and the possible superiority of pemafibrate over other fibrates. However, further investigations in different populations are required to confirm the generalizability of these findings.

Clinical profile and incidence of 36-month cardiovascular events in patients with MINOCA: a regional registry of 126 patients in a tertiary cardiology hospital

Abstract Introduction Atherosclerotic plaque rupture is the main etiology of acute myocardial infarction (AMI). In 5% to 6% of AMIs, however, no obstructive lesions greater than 50% are observed, which are then classified as MINOCA (Myocardial Infarction with Non-obstructive Coronary Arteries).The paradigm of MINOCA as a benign condition has been revisited in recent years, as reduced survival rates and a higher risk of subsequent AMIs have been observed when compared to control groups. Purpose To describe the clinical profile and the risk of cardiovascular outcomes in patients diagnosed with MINOCA in a tertiary cardiology hospital between March 2000 and June 2022. Methods In this single-center cohort, all patients meeting the diagnostic criteria for MINOCA with (1) AMI, as follows: (a) no coronary stenosis ≥ 50% in any potential infarct-related artery; and (b) no other clinically overt specific cause for the acute presentation were evaluated with a median follow-up of 30(9.5-67.3) months. Information was obtained by medical chart. Sample characteristics were described in frequencies and median values(p25%-p75%). The incidence of a new cardiovascular event within 36 months after the MINOCA was estimated using the Kaplan-Meier method and the log-rank test applied to compare groups, accompanied by confidence intervals at 95% and an alpha of 5%(R 3.6.1 for MacOS). Results Of the 126 patients, 57.1% were women about 50 years of age (42.0-57.8). 20.6% had diabetes, 47.6% dyslipidemia, 60.3% hypertension and 20% a previous AMI. The predominant clinical presentation was NSTEMI (55.6%) (Table 1), and 7 patients had an episode of aborted sudden death during hospitalization. 38.1% of patients did not have an identified etiology. The most prevalent pathophysiological mechanism was plaque disruption (16.7%), followed by coronary thromboembolism (13.5%) and spontaneous coronary dissection (SCAD) (13.5%). Among the less frequent causes, we had vasospasm (7.1%) and myocardial bridge (2.4%). Only 3.2% underwent optical coherence tomography (OCT) or intravascular ultrasound (IVUS). No provocative testing was performed. 44.4% underwent cardiac magnetic resonance (CMR), within a median time to perform of 180.0 (60.0-707.5) days after the event. Regarding the discharged medical therapy, 79.4% had a beta-blocker and ACEI/ARB prescribed, 14.3% started anticoagulation and only 34.1% received DAPT. The incidence of a composite outcome (CV death, new AMI, stroke and cardiovascular hospitalization) at 36 months was 15% (CI95% 8.9%-24.6%)(Figure 2). The incidence of new MI was 6.3%(N=8), of stroke 2.4% (N=3), and of cardiovascular hospitalization 17.5%(N=22), with only one death. Conclusion The risk of the primary outcome in 36 months is worthy of note. Notably, most of the incidence was attributable to CV hospitalization. An important number of patients were discharged without a known etiology for their clinical presentation, and, consequentially, lacked individualized treatment.Figure 1.Outcomes

The association between alcohol consumption and heart failure with reduced and preserved ejection fraction: the Cardiovascular Health Study

Abstract Background Alcohol consumption has been associated with a lower risk of heart failure (HF) and myocardial infarction. Nevertheless, knowledge of the relationship between alcohol consumption and the two subtypes of HF; HF with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) is lacking. Methods The Cardiovascular Health study is a US-based prospective cohort study aiming to investigate cardiovascular risk factors and outcomes (5,888 subjects, ≥65 years, follow-up 18 years). Weekly alcohol consumption was assessed by questionnaires and categorized (long-term abstainers; quit-during-follow-up; former; &amp;lt;1drinks/week, 1-&amp;lt;7drinks/week; 7-&amp;lt;14drinks/week; ≥14drinks/week. Incidence of new onset HF, HFpEF (left ventricular ejection fraction (LVEF) ≥50%) and HFrEF (LVEF &amp;lt;50%) was determined by review of available data by an expert panel. Time-dependent multivariable Cox proportional hazard models were used to investigate the associations between time-varying alcohol consumption over up to 18 years follow up and HF, HFpEF and HFrEF. Multiple imputation (5-itterations) was used on variables with &amp;gt;5% missing data (kindney-function/income). Long-term abstainers served as the reference category. Analyses were corrected for age, race, sex, body mass index, smoking status, education, marital status, physical activity, hypertension, glycemic status (normal/impaired/diabetes), kidney-function, lipid lowering medication, time-dependent myocardial infarction, stroke and atrial fibrillation. Effect modification by sex and glycemic status was investigated. Results At baseline 5,608 subjects who reported alcohol consumption were at risk for incident HF. 2,029 events occurred during follow-up (n(HFpEF) = 568, n(HFrEF) = 551, n(Unclassified) = 910). Compared with long-term abstainers, the fully-adjusted risk of HF was lower among subjects who reported consuming 1-&amp;lt;7drinks/week (hazard ratio (HR]) 0.82, 95% confidence interval (CI); 0.70-0.97), 7-13 drinks/week (HR 0.83, 95%CI; 0.69-0.99) and ≥14drinks/week (HR 0.68, 95%CI; 0.49-0.93). For HFrEF, the fully adjusted risk was lower among subjects who reported consuming ≥14drinks/week (HR: 0.40, 95% CI; 0.20-0.82) compared with long-term abstainers. For both HF and HFrEF a cardioprotective trend was observed with increasing alcohol consumption (ptrend = 0.001 and ptrend = 0.004, respectively). No significant associations were found for alcohol consumption and HFpEF (HR 0.83, 95%CI; 0.46-1.51). Effect modification was not observed. Conclusions Among older adults, increasing alcohol consumption is associated with a lower risk of incident HF and consumption of ≥14drinks/week with HFrEF, but not with HFpEF. This is likely due to the different underlying pathophysiological mechanisms leading to different entities of HF. This study provides evidence that the observed protective effects in HF are likely to be driven by HFrEF.

MANTA vascular closure device bleeding and vascular complications in association with cardiovascular risk factors: a large single centre experience

Abstract Background Percutaneous cardiovascular interventions such as transcatheter aortic valve replacement (TAVR), balloon aortic valvuloplasty (BAV), and mechanical circulatory support (MCS) involve large-bore arterial cannulation. Clinically significant bleeding and vascular complications are frequently encountered as a consequence of arterial cannulation. Collagen-based vascular closure devices (VCD) such as MANTA VCD are increasingly utilized to achieve arterial vascular access closure. This study aims to explore the association between cardiovascular risk factors and bleeding and vascular complications in procedures utilizing MANTA VCD. Methods A large single-centre retrospective study was performed of patients who underwent TAVR, BAV, and MCS in which arterial access closure was achieved with MANTA VCD. All cases from June 2019 to September 2020 were included. The primary efficacy outcome was defined as immediate haemostasis. The secondary safety outcome was defined as Valve Academic Research Consortium-3 (VARC-3) criteria bleeding and vascular complications. Baseline patient characteristics were obtained to evaluate the association between cardiovascular risk factors and outcomes. Results One hundred and seventy-four cases involved vascular access site closure using MANTA VCD. Immediate haemostasis of the access site was achieved in 92.5% of cases (n=161) whereas 7.5% of cases had failed immediate haemostasis (n=13). VARC-3 criteria bleeding and vascular complications occurred in 12.1% of cases (n=21). Cardiovascular risk factors including coronary artery disease and smoking history were associated with an increased risk for bleeding and vascular complications. Rate of bleeding and vascular complications among patients with coronary artery disease (CAD) (n=71) was 18.3% whereas the rate among patients without CAD (n=103) was 7.8%; this association was statistically significant with an odds ratio of 2.66 (95% CI 1.04 – 6.81, p &amp;lt; 0.05). Rate of bleeding and vascular complications among patients with a smoking history (n=67) was 19.4% whereas the rate among patients without a smoking history (n=107) was 7.5%; this association was statistically significant with an odds ratio of 2.98 (95% CI 1.16 – 7.63, p &amp;lt; 0.05). There was no statistically significant difference in the rate of bleeding and vascular complications for other cardiovascular risk factors such as, hypertension, peripheral vascular disease, atrial fibrillation, obesity, diabetes, chronic kidney disease, or chronic obstructive pulmonary disease. Conclusions MANTA VCD is a safe and effective tool for arterial access closure in procedures such as TAVR, BAV, and MCS. CAD and smoking are associated with a higher risk for VARC-3 criteria bleeding and vascular complications. Further multicentre studies are necessary to explore the association of cardiovascular risk factors with vascular access site closure complications and improve outcomes.

Abstract 14793: Relationship Between Self-Rated Health and Clinical Outcomes in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Background: Self-rated health (SRH) is a well-known independent predictor of mortality. However, the association of SRH with clinical outcomes in patients with hypertension remains uncertain. SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Objective: To examine the association between SRH and the primary SPRINT outcome, which was defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death. Methods: A trained study personnel administered a questionnaire to assess SRH. Each participant rated their overall health as excellent, very good, good, fair, or poor (E, VG, G, F, P). We categorized SRH into excellent, very good, good and fair/poor. Multivariate Cox regression was used to examine the association of SRH and clinical outcomes in SPRINT. Results: We included 9,319 participants (aged 67.9±9 years, 35.6% women, 57.6% White) who had available data on SRH. After a median follow-up of 3.8 years, 724 and 500 primary outcome and all-cause mortality events occurred, respectively. Relative to SRH of excellent, the risk of the primary outcome (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.11 (0.78-1.56; p=0.555), 1.45 (1.03-2.05; p=0.036) and 1.87 (1.28-2.75; p=0.001), respectively. Similarly, relative to excellent, the risk of all-cause mortality (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.13 (0.73-1.76; p=0.581), 1.72 (1.12-2.64; p=0.014) and 2.11 (1.32-3.38; p=0.002), respectively. Poorer SRH was also associated with a higher risk of each component of the primary outcome and adverse events ( Table). Conclusion: In the SPRINT cohort, SRH was independently associated with the risk of cardiovascular outcomes, mortality, and adverse events. Further studies are needed to explore the utility of incorporating SRH in the assessment of risk in patients with hypertension.

Dealing With Nonproportional Hazards in Coronary Revascularisation Studies.

The Cox proportional hazards model is one of the most popular statistical tools to model time to event outcomes without the need for specifying the hazards or survival time distributions. The Cox model requires that the ratio of the hazards of the occurrence of the outcome for any 2 individuals remains constant during the entire follow-up. Studies comparing coronary revascularisation strategies, however, might be prone to violations of proportionality by the crossing of the hazard functions over time. Early increases in the risk of cardiovascular outcomes are commonly observed when comparing coronary artery bypass grafting vs percutaneous coronary intervention, whereas decreased risk might be observed later during the follow-up. The same is valid for comparisons between invasive vs conservative coronary revascularisation strategies. In these situations, the statistical power of the Cox model is reduced, and hazard ratios might not be an informative summary measure of treatment effect. In this article, we discuss methods to identify and account for nonproportionality. We illustrate the use of these methods in a case study based on reconstructed data from a coronary revascularisation clinical trial. And finally, we review the cardiovascular literature to estimate how the proportionality assumption has been reported in coronary revascularisation studies recently.

Atopic Dermatitis and Cardiovascular Risk in Pediatric Patients: A Systematic Review and Meta-Analysis

Cardiovascular guidelines recommend early screening and preventative treatment for children with chronic inflammatory diseases. Atopic dermatitis (AD) is associated with cardiovascular risk in adults, but data in children are limited. We systematically searched for studies that examined the association between childhood AD and cardiovascular risk factors and outcomes. Data from 10 publications, including 577,148 individuals, revealed an association between AD and ischemic heart disease (n= 3, OR= 1.68, 95% confidence interval [CI]= 1.29-2.19) and diabetes (n= 4, OR= 1.31, 95% CI= 1.12-1.53), but this did not persist among studies that adjusted for potential confounders (n= 2, OR= 0.98, 95% CI= 0.35-2.75). Similarly, there was an association with lipid disorders but not across the entire population distribution (n= 7, OR= 1.24, 95% CI= 1.13-1.36, 95% prediction interval= 0.95-1.61). AD was not associated with hypertension (n= 5, OR= 1.15, 95% CI= 0.98-1.34, 95% prediction interval= 0.81-1.62) or stroke (n= 2, OR= 1.24, 95% CI= 0.94-1.62). Studies lacked detail on AD severity and important confounders such as body mass index, and the certainty of evidence was very low to low on the basis of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessments. Currently, data do not support a clinically meaningful increase in cardiovascular risk for children with AD.

Comparative effectiveness and cost-effectiveness of cardioprotective glucose-lowering therapies for type 2 diabetes in Brazil: a Bayesian network model

BackgroundThe escalating prevalence of type 2 diabetes (T2DM) poses an unparalleled economic catastrophe to developing countries. Cardiovascular diseases remain the primary source of costs among individuals with T2DM, incurring expenses for medications, hospitalizations, and surgical interventions. Compelling evidence suggests that the risk of cardiovascular outcomes can be reduced by three classes of glucose-lowering therapies (GLT), including SGLT2i, GLP-1A, and pioglitazone. However, an evidence-based and cost-effective protocol is still unavailable for many countries. The objective of the current study is to compare the effectiveness and cost-effectiveness of GLT in individuals with T2DM in Brazil.MethodsWe employed Bayesian Networks to calculate the incremental cost-effectiveness ratios (ICER), expressed in international dollars (Int$) per disease-adjusted life years [DALYs] averted. To determine the effectiveness of GLT, we conducted a systematic review with network meta-analysis (NMA) to provide insights for our model. Additionally, we obtained cardiovascular outcome incidence data from two real-world cohorts comprising 851 and 1337 patients in primary and secondary prevention, respectively. Our cost analysis took into account the perspective of the Brazilian public health system, and all values were converted to Int$.ResultsIn the NMA, SGLT2i [HR: 0.81 (95% CI 0.69–0.96)], GLP-1A [HR: 0.79 (95% CI 0.67–0.94)], and pioglitazone [HR: 0.73 (95% CI 0.59–0.91)] demonstrated reduced relative risks of non-fatal cardiovascular events. In the context of primary prevention, pioglitazone yielded 0.2339 DALYs averted, with an ICER of Int$7,082 (95% CI 4,521–10,770) per DALY averted when compared to standard care. SGLT2i and GLP-1A also increased effectiveness, resulting in 0.261 and 0.259 DALYs averted, respectively, but with higher ICERs of Int$12,061 (95% CI: 7,227–18,121) and Int$29,119 (95% CI: 23,811–35,367) per DALY averted. In the secondary prevention scenario, all three classes of treatments were deemed cost-effective at a maximum willingness-to-pay threshold of Int$26,700. Notably, pioglitazone consistently exhibited the highest probability of being cost-effective in both scenarios.ConclusionsIn Brazil, pioglitazone presented a higher probability of being cost-effective both in primary and secondary prevention, followed by SGLT2i and GLP-1A. Our findings support the use of cost-effectiveness models to build optimized and hierarchical therapeutic strategy in the management of T2DM.Trial registrationCRD42020194415.

Increased risk of cardiovascular disease preceding diagnosis of incident ANCA-associated vasculitis: a Danish nationwide study.

To examine whether patients with ANCA-associated vasculitis (AAV) have an increased risk of cardiovascular disease in the months prior to diagnosis of AAV. Using a nested case-control framework, patients with granulomatosis with polyangiitis and microscopic polyangiitis were identified through the Danish Nationwide Registries from 1996 to 2021 and matched 1:3 with age- and sex-matched controls without AAV. Each control was assigned the same index date (date of AAV diagnosis) as their corresponding case. Conditional logistic regression was used to compute adjusted hazard ratios (HRs) for major adverse cardiovascular events (MACE), ischaemic heart disease, coronary angiogram, heart failure, venous thromboembolism, atrial fibrillation, ischaemic stroke, pericarditis and ventricular arrhythmias/implantable cardioverter defibrillator implantation/cardiac arrest (VA/ICD/CA) within 12 months, 6 months, 3 months, 2 months and 1 month before index date. A total of 2371 patients with AAV (median age 63 years, 53.7% male) were matched with 7113 controls. The prevalence of any cardiovascular outcome and MACE within 12 months preceding index date were 10.3% and 2.4% for AAV, compared with 3.8% [HR 3.05 (95% CI 2.48-3.75)] and 1.3% [HR 1.98 (95% CI 1.39-2.82)] of controls. The risk of cardiovascular outcomes was similarly increased in temporal proximity to the diagnosis, with the highest HR at 1 month prior to index date: any cardiovascular outcome [HR 10.73 (95% CI 7.05-16.32)] and MACE [HR 5.78 (95% CI 2.67-12.52)]. In individual analysis, a significantly higher rate was observed for all outcomes (excluding VA/ICD/CA). AAV disease is associated with an increased risk of cardiovascular disease in the months preceding diagnosis, which underlines the importance of early clinical vigilance towards cardiovascular disease.