Early Cardiovascular Disease Risk Research Articles

Evaluation of Left Ventricular Flow Kinetic Energy by Four-Dimensional Blood Flow MRI in Nondialysis Chronic Kidney Disease Patients.

Chronic kidney disease (CKD) is associated with increased, and early cardiovascular disease risk. Changes in hemodynamics within the left ventricle (LV) respond to cardiac remodeling. The LV hemodynamics in nondialysis CKD patients are not clearly understood. To use four-dimensional blood flow MRI (4D flow MRI) to explore changes in LV kinetic energy (KE) and the relationship between LV KE and LV remodeling in CKD patients. Retrospective. 98 predialysis CKD patients (Stage 3: n = 21, stage 4: n = 21, and stage 5: n = 56) and 16 age- and sex-matched healthy controls. 3.0 T/balanced steady-state free precession (SSFP) cine sequence, 4D flow MRI with a fast field echo sequence, T1 mapping with a modified Look-Locker SSFP sequence, and T2 mapping with a gradient recalled and spin echo sequence. Demographic characteristics (age, sex, height, weight, blood pressure, heart rate, aortic regurgitation, and mitral regurgitation) and laboratory data (eGFR, Creatinine, hemoglobin, ferritin, transferrin saturation, potassium, and carbon dioxide bonding capacity) were extracted from patient records. Myocardial T1, T2, LV ejection fraction, end diastolic volume (EDV), end systolic volume, LV flow components (direct flow, delayed ejection, retained inflow, and residual volume) and KE parameters (peak systolic, systolic, diastolic, peak E-wave, peak A-wave, E/A ratio, and global) were assessed. The KE parameters were normalized to EDV (KEiEDV). Parameters were compared between disease stage in CKD patients, and between CKD patients and healthy controls. Differences in clinical and imaging parameters between groups were compared using one-way ANOVA, Kruskal Walls and Mann-Whitney U tests, chi-square test, and Fisher's exact test. Pearson or Spearman's correlation coefficients and multiple linear regression analysis were used to compare the correlation between LV KE and other clinical and functional parameters. A P-value of <0.05 was considered significant. Compared with healthy controls, peak systolic (24.76 ± 5.40 μJ/mL vs. 31.86 ± 13.18 μJ/mL), systolic (11.62 ± 2.29 μJ/mL vs. 15.27 ± 5.10 μJ/mL), diastolic (7.95 ± 1.92 μJ/mL vs. 13.33 ± 5.15 μJ/mL), peak A-wave (15.95 ± 4.86 μJ/mL vs. 31.98 ± 14.51 μJ/mL), and global KEiEDV (9.40 ± 1.64 μJ/mL vs. 14.02 ± 4.14 μJ/mL) were significantly increased and the KEiEDV E/A ratio (1.16 ± 0.67 vs. 0.69 ± 0.53) was significantly decreased in CKD patients. As the CKD stage progressed, both diastolic KEiEDV (10.45 ± 4.30 μJ/mL vs. 12.28 ± 4.85 μJ/mL vs. 14.80 ± 5.06 μJ/mL) and peak E-wave KEiEDV (15.30 ± 7.06 μJ/mL vs. 14.69 ± 8.20 μJ/mL vs. 19.33 ± 8.29 μJ/mL) increased significantly. In multiple regression analysis, global KEiEDV (β* = 0.505; β* = 0.328), and proportion of direct flow (β* = -0.376; β* = -0.410) demonstrated an independent association with T1 and T2 times. 4D flow MRI-derived LV KE parameters show altered LV adaptations in CKD patients and correlate independently with T1 and T2 mapping that may represent myocardial fibrosis and edema. Stage 3.

Cardiac dysfunction during exercise in young adults with bronchopulmonary dysplasia

BackgroundWorldwide, 1–2% of children is born premature and at risk for developing bronchopulmonary dysplasia (BPD). Preterm born adults are at risk for early cardiovascular disease. The role of BPD is unclear.AimThis study aims to examine cardiorespiratory function during submaximal exercise in young adult survivors of extreme prematurity, with or without BPD.MethodsForty premature born young adults, 20 with BPD (median[IQR] gestational age (GA), 27 [26–28] weeks) and 20 without BPD (GA age 28 [27–29] weeks) were prospectively compared to age-matched at term born (AT) adults (GA 39 [38–40] weeks). Participants underwent exercise testing and cardiovascular magnetic resonance (CMR) with submaximal exercise.ResultsResting heart rate in BPD subjects was higher than in AT born subjects (69±10versus61±7 mL, p=0.01). Peak oxygen uptake at maximal CPET was decreased in BPD patients (91±18versus106±17% of predicted, p=0.01). In BPD subjects cardiac stroke volume (SV) change with exercise was impaired compared to AT subjects (11±13%versus25±10%; p&lt;0.001). With exercise, left ventricular end-diastolic volume decreased more in preterm borns withversuswithout BPD (−10±8%versus−3±8%; p=0.01) and compared to AT subjects (0±5%; p&lt;0.001). Exploratory data analysis revealed that exercise SV and end-diastolic volume change were inversely correlated with oxygen dependency in those born prematurely.ConclusionsIn preterm born young adults –particularly those with BPD– resting cardiac function, exercise performance and cardiac response to exercise is impaired compared to controls. Exercise CMR may reveal an important predisposition for heart disease later in life.

Assessment of Subclinical Cardiovascular Disease Risk by Measuring Carotid Intima Media Thickness in Rheumatoid Arthritis Patients: A Cross-sectional Study

Introduction: Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects both synovial joints and extra-articular regions. Patients with RA have an increased risk of Cardiovascular Disease (CVD), leading to premature mortality. Aim: To assess subclinical atherosclerosis in RA patients using Carotid Intima Media Thickness (CIMT) and compare it with age-matched healthy individuals. Materials and Methods: This cross-sectional study included 50 RA patients and 50 healthy age- and sex-matched controls. Ultrasound was used to measure CIMT, which serves as an indicator of subclinical atherosclerosis. Framingham, Atherosclerotic CVD (ASCVD) risk scores, and QRISK3 scores were used to estimate the 10-year CVD risk. Student’s t-test and Chi-square test were used to identify statistically significant differences. Results: RA patients had significantly higher mean CIMT values compared to controls (p-value&lt;0.001), indicating an increased burden of atherosclerosis. While ASCVD scores were comparable, Framingham scores were significantly lower (p-value=0.028), and QRISK3 scores were significantly higher (p-value=0.007) in RA patients. This suggests an underestimation of CVD risk by Framingham and potentially better prediction by QRISK3. Conclusion: The study highlights that RA patients have a higher burden of atherosclerotic disease compared to healthy adults of the same age when CIMT is used as a marker of atherosclerosis. These findings indicate the need for early CVD risk assessment and intervention in RA patients using appropriate risk-scoring systems and tools. Further research with larger sample sizes and longitudinal follow-up is warranted to confirm these findings.

Abstract 16375: Cardiovascular Risk Factors and Timing of Diagnosis Among Caregivers in the United States

Introduction: The burden of family caregiving has been increasing in the US. However, caregiver burden may be associated with a higher risk of cardiovascular disease (CVD) among adults. Hypothesis: A higher caregiver burden is associated with an increased risk of CVD. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and March 2020, we conducted a cross-sectional analysis of US adults. We evaluated the prevalence of CVD, age at diagnosis, and treatment rates of caregivers and non-caregivers. The term "caregivers" refers to adults who reported that they had to stay at home to take care of their families. Outcomes included the average age at first diagnosis, rates of treatment, and average levels of hemoglobin A1c, cholesterol, and triglycerides. Descriptive and analytical statistics were generated using STATA. Results: Among the 15,560 US adults, 488 were identified as caregivers. Compared to non-caregivers, caregivers were, on average, older (43 vs. 33 years), more likely to be female (93% vs. 49%), Hispanic (34% vs. 22%), born outside the US (51% vs. 18%), and married (79% vs. 56%) (all p&lt;0.001). While there was no difference in hemoglobin A1c, triglyceride, and LDL-cholesterol levels, caregivers were more likely to self-report CVD risk factors at a younger age: diabetes mellitus (44 vs. 49 years), hypertension (42 vs. 47 years), heart failure (37 vs. 57 years), and stroke (42 vs. 57 years) (all p&lt;0.05). Caregivers were less likely to follow lifestyle modifications such as weight loss or taking cholesterol medications. Caregivers had greater odds of being diagnosed with CAD (3.9 [CI 1.7-8.8]), angina (4.4 [CI 1.4-13]), heart attack (4.8 [CI 2.0-12]), and stroke (2.0 [CI 1.2-3.6]). But this association was not significant after adjusting for age, gender, race, and college education. Conclusion: In this nationally representative sample study, 93% of caregivers were female and had CVD risk factors, such as diabetes and hypertension, detected at younger ages than non-caregivers. A high caregiver burden exposes patients to early CVD risk. As caregiver burden increases, early detection and treatment in this largely female patient population is crucial to reduce sex-related CVD disparities.

The Importance of Inflammatory and Angiogenic Markers in the Evaluation of Early Cardiovascular Disease Risk in Women with Hypertensive Disorders of Pregnancy.

Women with hypertensive disorders of pregnancy (HDP) have a significantly higher risk of developing cardiovascular diseases later in life. The stratification of this risk using biomarkers during pregnancy can help to identify these women and apply early prevention. We aimed to determine proinflammatory cytokines and angiogenic markers, echocardiographic parameter changes after delivery and predict early cardiovascular disease risk in women with arterial hypertension and its complications during pregnancy. We conducted a literature search using the PubMed database for the last ten years. A total of 17 articles were included to our study and full text reviewed. Four out of six studies found higher postpartum Interleukin-6 (IL-6) levels in women with HDP. IL-6 correlated positively with waist circumference, body mass index, and triglycerides, and negatively with high density lipoproteins (HDL). Two out of four studies found higher postpartum tumor necrosis factor alpha (TNF-α) levels in women with HDP but later concentration equalizes. One out of eight studies found higher placental growth factor (PlGF) and two out of eight found more elevated soluble fms-like tyrosine kinase-1 (sFlt-1) in women with HDP. With decreasing PlGF and increasing sFlt-1, common carotid artery intima and media thickness, aortic root diameter, left atrial diameter, left ventricle mass, systolic, diastolic, and mean blood pressure increased, whereas HDL decreased. One out of four studies found higher sFlt-1/PlGF. IL-6 remains significantly higher after delivery. Few studies found higher TNF-α, sFlt-1, PlGF and their ratio postpartum. All studies found a correlation between angiogenic factors, IL-6, and cardiovascular disease risk factors.

Associations among risk perception, health efficacy, and health behaviors for cardiovascular disease: an application of risk perception attitude framework.

There is currently a pervasive prevalence of cardiovascular disease (CVD) risk worldwide and an inadequate amount of action is being taken to promote healthy lifestyle habits. The risk perception attitude (RPA) framework, which classifies individuals based on their risk perception and efficacy belief, enables us to predict their preventive behaviors. We applied the RPA framework to analyze CVD prevention behaviors among Chinese adults and extended its application to CVD objective risk. A cross-sectional survey was performed in two sites in Zhejiang Province, from March to August 2022, which contained self-reported CVD risk perception, objective CVD risk, efficacy belief, physical activity, healthy diet, and covariates. We used the RPA framework to categorize participants into four groups, then analysis was conducted to estimate inter-group differences in healthy behaviors. We further conducted a hierarchical logistic regression analysis with individuals' health behaviors as the dependent variable, using three blocks of independent variables. Among 739 participants, healthy physical activity and healthy diet had significant differences among four RPA groups, post hoc tests clarified that the proportion of respondents with healthy PA in the responsive group (61.6%) was significantly higher than that in the other three groups. Risk perception and efficacy belief significantly predicted health behavior against CVD; the relationship between absolute CVD risk and health behavior was moderated by efficacy belief. Early CVD risk screening is crucial, but tailored support and a proper understanding of personal risk are essential to promote healthy behaviors. Developing communication and behavioral counseling intervention strategies on the basis of the RPA framework has the potential to promote healthy behaviors for CVD prevention.

An Adaptive Deep Feature Neural Classification Algorithm for Efficient Cardiac Disease Early Risk Identification

Cloud environments can store data for the medical field with a large-scale system. Importantly, early detection of diseases using clinical data analysis is essential in medicine. Cardiovascular disease has emerged as the primary cause of sudden high-risk health-related fatalities in recent years. Analyzing time series data has become more complex and non-linear, making predictive risk analysis through feature analysis a crucial aspect of data analysis. Feature measures that are not feasible can hurt prediction accuracy and may result in misclassification. To overcome this problem, an improved clinical data analysis model using Adaptive Deep Feature Neural Classification (DFNC) method for cardiac data prediction can identify early risk stages. Time series data can be standardized from the CVD-DS dataset initially selected using a preprocessing model. Correlation with a subset of margins can be obtained using the Cardiac Deficiency Prediction Rate (CDPR). Then, the Support Frequent Scaling Feature Selection (SFSFS) model can extract the feature components based on the CDPR weights. The required features can be obtained using a deep neural classifier based on logistic neurons. The classifier is based on a Recurrent Neural Network (RNN) that deliberates each class category's feature values and Cardia Influence Rate (CIR). Classification, precision and recall can be implemented in the proposed method to provide high prediction accuracy. Additionally, early cardiovascular disease risk prediction accuracy may support early diagnosis management.

QCARxE: Qatar-based cardiovascular risk assessment using the English/Arabic version of the EPI·RxISK™ mobile application

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for almost one-third of the total global deaths. Early CVD risk assessment and management (RAM) has demonstrated to be effective in decreasing CVD-related burden. However, CVDRAM services face many challenges and barriers in the community. Mobile technology has been advocated to facilitate access to CVDRAM for both healthcare providers and patients to overcome these barriers. Nevertheless, there is limited availability and use of CVDRAM-related mobile technology in the Middle East region.&#x0D; Objectives: To develop and implement an English and Arabic version of a mobile and a web application for CVDRAM in both, community pharmacies and selected primary care centres in Qatar.&#x0D; Methodology: This study was conducted in two phases. In Phase 1, translation of the EPI·RxISK™ CV risk calculator (ERC) into the Arabic language was conducted based on guidelines developed by the International Society for Pharmacoeconomics and Outcomes Research. The English/Arabic version of the ERC was pilot tested by potential end users, consisting of a sample of community pharmacists (CRxs) and members of the public (MOP) accessing community pharmacy services. Semi-structured interviews were conducted based on the constructs of the Mobile Application Rating Scale (MARS) and data were analyzed using deductive content analysis. In Phase 2, a prospective observational study (QCARxE) is underway to explore the feasibility of using the ERC in patients accessing primary health care services for CVDRAM, including community pharmacies and primary health care centers (PHCC).&#x0D; Results: In Phase 1, a total of 10 CRxs and 5 MOP were interviewed. The data derived from the interviews indicate that the ERC web and mobile application were overall, positively perceived as having quality engagement, functionality, aesthetics, information and subjective quality attributes. To date, a total of 36 patients have enrolled in the QCARxE study (20 from PHCC and 16 from community pharmacies). At their initial CVD risk assessment visit, the mean CVD risk score for these patients was 28.3%, and the most prevalent risk factor was obesity (mean BMI = 30.2 kg/m²).&#x0D; Conclusion: The themes derived from the interviews indicate that the ERC was overall, positively perceived. Preliminary data derived from the QCARxE study indicated a significant proportion of patients accessing primary health care services are at high CVD risk. It is speculated that the use of the ERC will enable patients to become better aware of their CVD risk and improve access to risk factor interventions.

Introduction to the Compendium on Early Cardiovascular Disease.

Introduction to the Compendium on Early Cardiovascular Disease.

Cardiovascular disease/stroke risk stratification in deep learning framework: a review.

The global mortality rate is known to be the highest due to cardiovascular disease (CVD). Thus, preventive, and early CVD risk identification in a non-invasive manner is vital as healthcare cost is increasing day by day. Conventional methods for risk prediction of CVD lack robustness due to the non-linear relationship between risk factors and cardiovascular events in multi-ethnic cohorts. Few recently proposed machine learning-based risk stratification reviews without deep learning (DL) integration. The proposed study focuses on CVD risk stratification by the use of techniques mainly solo deep learning (SDL) and hybrid deep learning (HDL). Using a PRISMA model, 286 DL-based CVD studies were selected and analyzed. The databases included were Science Direct, IEEE Xplore, PubMed, and Google Scholar. This review is focused on different SDL and HDL architectures, their characteristics, applications, scientific and clinical validation, along with plaque tissue characterization for CVD/stroke risk stratification. Since signal processing methods are also crucial, the study further briefly presented Electrocardiogram (ECG)-based solutions. Finally, the study presented the risk due to bias in AI systems. The risk of bias tools used were (I) ranking method (RBS), (II) region-based map (RBM), (III) radial bias area (RBA), (IV) prediction model risk of bias assessment tool (PROBAST), and (V) risk of bias in non-randomized studies-of interventions (ROBINS-I). The surrogate carotid ultrasound image was mostly used in the UNet-based DL framework for arterial wall segmentation. Ground truth (GT) selection is vital for reducing the risk of bias (RoB) for CVD risk stratification. It was observed that the convolutional neural network (CNN) algorithms were widely used since the feature extraction process was automated. The ensemble-based DL techniques for risk stratification in CVD are likely to supersede the SDL and HDL paradigms. Due to the reliability, high accuracy, and faster execution on dedicated hardware, these DL methods for CVD risk assessment are powerful and promising. The risk of bias in DL methods can be best reduced by considering multicentre data collection and clinical evaluation.

Is elevated calcium score alone or with the additional contribution of excess epicardial fat the trigger causing early inflammation leading to ECG abnormalities?

Abstract Funding Acknowledgements Type of funding sources: None. Background Elevated EFV has been recently reported to be prevalent and a possible contributor to higher cardiovascular morbidity and mortality, particularly in the presence of elevated CACS. Purpose To assess whether elevated EFV in the presence of CACS has significant effects on the cardiac electrical activity as evidenced by 12-lead ECG abnormalities, in addition to triggering inflammation in the microvasculature (C2), altering the lipid profile and altering BP rise PME, in comparison to population without elevated EFV and the same demographic. Methods 2932 asymptomatic subjects, 50 years +, underwent cardiovascular disease (CVD) risk assessment using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), known as Rasmuessen Risk Score (RRS), which has been previously reported. The ECVDRS includes 10 cardiovascular tests, 7 of these tests are vascular and 3 are cardiac. 334 subjects underwent a cardiac CT for EFV and CACS determination. Out of these, 55 participants (43M + 12F) with significantly elevated CACS and elevated or normal EFV were further assessed regarding their exercise level, structural/functional abnormalities, presence of significant OCAD or INOCAD as assessed by cardiac catheterization, exercise stress test, and nuclear stress test. Results As shown in Table: Conclusion Increased CACS in the presence of normal EFV is not associated with significant inflammatory factors, obstructive CAD, and functional abnormalities. We postulate that increased CACS in the presence of normal EFV may be associated with perivascular rather than intravascular calcium deposition. Subjects with normal EFV have less structural and functional abnormalities even in the presence of elevated CACS in comparison to subjects with elevated EFV. Subjects with elevated EFV are associated with significant prevalence of ECG abnormalities. Based on our data, we recommend lifestyle modification with an emphasis on high levels of exercise along with novel treatment reported recently to decrease EFV aiming to reduce the risk of arrhythmia.

Central androgen action reverses hypothalamic astrogliosis and atherogenic risk factors induced by orchiectomy and high-fat diet feeding in male mice.

Hypogonadism in males confers elevated cardiovascular disease (CVD) risk by unknown mechanisms. Recent radiological evidence suggests that low testosterone (T) is associated with mediobasal hypothalamic (MBH) gliosis, a central nervous system (CNS) cellular response linked to metabolic dysfunction. To address mechanisms linking CNS androgen action to CVD risk, we generated a hypogonadal, hyperlipidemic mouse model with orchiectomy (ORX) combined with hepatic PCSK9 overexpression. After 4 wk of high-fat, high-sucrose diet (HFHS) consumption, despite equal body weights and glucose tolerance, androgen-deficient ORX mice had a more atherogenic lipid profile and increased liver and leukocyte inflammatory signaling compared with sham-operated control mice. Along with these early CVD risk indicators, ORX markedly amplified HFHS-induced astrogliosis in the MBH. Transcriptomic analysis further revealed that ORX and high-fat diet feeding induced upregulation of inflammatory pathways and downregulation of metabolic pathways in hypothalamic astrocytes. To interrogate the role of sex steroid signaling in the CNS in cardiometabolic risk and MBH inflammation, central infusion of T and dihydrotestosterone (DHT) was performed on ORX mice. Central DHT prevented MBH astrogliosis and reduced the liver inflammatory signaling and monocytosis induced by HFHS and ORX; T had a partial protective effect. Finally, a cross-sectional study in 41 adult men demonstrated a positive correlation between radiological evidence of MBH gliosis and plasma lipids. These findings demonstrate that T deficiency in combination with a Western-style diet promotes hypothalamic gliosis concomitant with increased atherogenic risk factors and provide supportive evidence for regulation of lipid metabolism and cardiometabolic risk determinants by the CNS action of sex steroids.NEW & NOTEWORTHY This study provides evidence that hypothalamic gliosis is a key early event through which androgen deficiency in combination with a Western-style diet might lead to cardiometabolic dysregulation in males. Furthermore, this work provides the first evidence in humans of a positive association between hypothalamic gliosis and LDL-cholesterol, advancing our knowledge of CNS influences on CVD risk progression.

Cardiovascular mortality in women in their forties after hypertensive disorders of pregnancy in the Netherlands: a national cohort study

Hypertensive disorders of pregnancy are associated with cardiovascular disease later in life. Given that hypertensive disorders of pregnancy often occur at a relatively young age, there might be an opportunity to use preventive measures to reduce the risk of early cardiovascular disease and mortality. The aim of this study was to assess the risk of cardiovascular mortality in women after a hypertensive disorder of pregnancy. In this population-based cohort study, the Netherlands Perinatal Registry (PRN) and the national death registry at the Dutch Central Bureau for Statistics were linked. We analysed women in the Netherlands with a first birth during 1995-2015 to determine the association between cardiovascular mortality and hypertensive disorders of pregnancy (based on recorded diastolic blood pressure or proteinuria, or both). We analysed the association between the highest diastolic blood pressure measured in pregnancy and cardiovascular mortality and constructed survival curves to assess cardiovascular mortality after hypertensive disorders of pregnancy, specifically pre-eclampsia and gestational hypertension. To differentiate between the severity of hypertensive disorders of pregnancy, cardiovascular mortality was assessed in women with a combination of hypertensive disorders of pregnancy with preterm birth (gestational age <37 weeks) and growth restriction (birthweight in the 10th percentile or less). All hazard ratios (HRs)were adjusted for maternal age. Between Jan 1, 1995, and Dec 31, 2015, the PRN contained 2 462 931 deliveries and 1 625 246 women. In 1 243 890 women data on their first pregnancy were available and were included in this analysis after linkage, with a median follow-up time of 11·2 years (IQR 6·1-16·3). 259 177 (20·8%) women had hypertensive disorders of pregnancy, and of these 45 482 (3·7%) women had pre-eclampsia and 213 695 (17·2%) women had gestational hypertension; 984 713 (79·2%) women did not develop hypertension in their first pregnancy. Compared with women without hypertensive disorders of pregnancy, the risk of death from any cause was higher in women who had hypertensive disorders (HR 1·30 [95% CI 1·23-1·37], p<0·001), pre-eclampsia (1·65 [1·48-1·83]; p<0·0001), and gestational hypertension (1·23 [1·16-1·30]; p<0·0001). Those women with pre-eclampsia had a higher risk of cardiovascular mortality compared with those without any hypertensive disorders of pregnancy (adjusted HR 3·39 [95% CI 2·67-4·29]), as did those with gestational hypertension (2·22 [1·91-2·57]). For women with a history of hypertensive disorders of pregnancy combined with preterm birth (gestational age <37 weeks) and birthweight in the 10th percentile or less, the adjusted HR for cardiovascular mortality was 6·43 (95% CI 4·36-9·47), compared with women without a hypertensive disorder of pregnancy. The highest diastolic blood pressure measured during pregnancy was the strongest risk factor for cardiovascular mortality (for 80-89 mm Hg: adjusted HR 1·47 [95% CI 1·00-2·17]; for 130 mm Hg and higher: 14·70 [7·31-29·52]). Women with a history of hypertensive disorders of pregnancy have a risk of cardiovascular mortality that is 2-3 times higher than that of women with normal blood pressure during pregnancy. The highest measured diastolic blood pressure during pregnancy is an important predictor for cardiovascular mortality later in life; therefore, women who have hypertensive disorders of pregnancy should be given personalised cardiovascular follow-up plans to reduce their risk of cardiovascular mortality. None.

Asymmetric dimethylarginine and gestational diabetes mellitus: a systematic review and meta-analysis.

Emerging evidence demonstrates that asymmetric dimethylarginine (ADMA) levels are elevated in patients with or at risk of cardiovascular disease (CVD). Since women with gestational diabetes mellitus (GDM) are at high risk of future CVD, we conducted a systematic review and meta-analysis to compare ADMA concentrations between women with and without GDM during pregnancy and postpartum. PubMed, Google Scholar, EMBASE, and CINAHL databases were searched. The review protocol is registered in PROSPERO (CRD42021276796). Study selection, data extraction, and data analyses were performed in accordance with PRISMA guidelines. Random-effects model was used to quantify ADMA levels in the study groups. Eleven studies provided data on 1148 women. Mean plasma ADMA concentration was 0.04 μmol/L (95% confidence interval (CI) -0.06-0.15) higher in pregnant women with GDM than those without GDM, but no significant difference was observed. In contrast, our meta-analysis demonstrated a significant increase in postpartum mean ADMA concentration (Mean Difference (MD) 0.11 μmol/L; 95% CI 0.05-0.16) among women with previous GDM compared to women without previous GDM. Elevated ADMA levels in GDM may be a CVD risk factor, suggesting that ADMA may be a potential biomarker for early CVD risk prediction in women with GDM.

Abstract 11053: Is the Abnormal Rise in Both Systolic and Diastolic Blood Pressure Post-Mild Exercise Protocol Associated With More Cardiovascular Structural and Functional Abnormalities Than Isolated Systolic or Diastolic Rise Alone?

Background: An isolated abnormal rise in systolic or diastolic BP post-mild exercise protocol (PMEP) is a major CVD risk factor. Purpose: To assess whether a combined abnormal rise in systolic and diastolic BP PMEP is associated with more cardiovascular structural and functional abnormalities (CVSFA) than an abnormal rise in either isolated systolic or diastolic BP PMEP. Methods: We screened 2,924 asymptomatic subjects, ages 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System, also known as the Rasmussen Risk Score, which was published previously. This consists of 10 tests: 7 vascular and 3 cardiac. The vascular tests are large (C1) and small (C2) artery stiffness, BP at rest, and after PMEP, CIMT, abdominal aorta ultrasound, and retinal photography. The 3 cardiac tests are Pro-BNP, ECG, and LV ultrasound. Out of the total subjects, 1106 (38%) were on no medications. These were divided into four BP subcategories according to the current ACC/AHA guidelines, shown in the table. Results: As shown in the table, combined systolic and diastolic BP rise PMEP is more common than either one alone. Systolic and diastolic BP rise PMEP is associated with more CVSFA, particularly in those with Stage 1 and 2 hypertensions compared to those who are normotensive. The CVSFA in combined systolic and diastolic BP PMEP is not statistically significant when compared to isolated abnormal rise in systolic or diastolic BP. Conclusions: Abnormal rise in BP PMEP is associated with significant CVSFA, regardless of whether isolated or combined. Hence, we recommend exercise stress testing protocol for risk stratification and optimal treatment in hypertensive patients.

Abstract 11938: Novel Approach for Optimal Assessment of Cardiovascular Risk of Blood Pressure in Asymptomatic Subjects Utilizing Mild Exercise Stress Test Protocol

Background: BP risk class assessment has been relying on resting BP (rBP) measurements by healthcare providers. Often, this measurement does not correlate with 24-hour ambulatory BP monitoring nor with at-home measurements. Purpose: To assess whether abnormal rise in BP post-mild exercise protocol (PMEP), which resembles most of the activities subjects are under all day, will be more physiologic and informative for risk stratification, beyond the rBP measurements. Methods: We screened 2,924 subjects, ages 20-79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System, also known as the Rasmussen Risk Score, which consists of 10 tests: 7 vascular and 3 cardiac (published previously). The vascular tests include rBP, BP PMEP (2.4 mi/hr and 7% elevation for 3 minutes), small (C2) artery stiffness, and CIMT. Out of the total subjects, 1094 (37%) were asymptomatic and on no medications. These were divided into four BP classes according to the current ACC/AHA guidelines. Results: In the table, normotension with an abnormal rise in BP PMEP has significant cardiovascular structural and functional abnormalities (CVSFA) than those without. Also noted, the higher the BP class, the higher the CVSFA with and without an abnormal rise in BP PMEP. Conclusions: Abnormal rise in BP PMEP in normotensive subjects is associated with significant CVSFA. This may represent a “masked hypertension” cohort. These findings mandate early diagnosis, follow-up, and optimal treatment. Additionally, an abnormal rise in BP PMEP in other classes is more pronounced with stepwise increases in BP class. Hence, we advocate for PMEP for BP classification and treatment. Early detect to protect.

Correlation of serum nicotinamide phosphoribosyl transferase with hypoxia and Framingham risk score in patients with obstructive sleep apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for atherosclerosis (AS), but the mechanism is different from classical AS risk factors. Nicotinamide phosphoribosyltransferase (NAMPT) is involved in the pathophysiology of AS via multiple pathways, and its expression is closely related to hypoxia. The association of NAMPT with hypoxia and the risk of cardiovascular morbidity in the patients of OSAHS remains to be defined. Therefore, we carried out this study to investigate the association of NAMPT with hypoxia and the risk of early cardiovascular disease [based on the Framingham risk score (FRS)] in patients with OSAHS. A total of 82 patients diagnosed with OSAHS were enrolled in this cross-sectional survey design, along with 18 healthy controls who were age- and gender-matched. The general characteristic parameters including height and weight as well as biochemical parameters including blood glucose and lipid were collected from the subjects. The Framingham vascular risk score calculates the risk of developing vascular disease based on the above indicators. Polysomnography was performed in patients with OSAHS, and blood oxygen saturation and apnea-hypopnea index (AHI) were collected, and patients were grouped by disease extent by AHI. The serum NAMPT level of the research subjects was detected using an enzyme-linked immunosorbent assay. Spearman correlation analysis and multiple linear regression to explore the independent correlations of hypoxia on serum NAMPT activity in OSAHS patients. Serum NAMPT level in patients with OSAHS increased with the severity of the disease. Correlation analysis showed that NAMPT was significantly positively correlated with FRS in patients with OSAHS (r=0.829, P<0.05). Multiple linear regression analysis with FRS as the outcome measure showed that NAMPT activity and minimum blood oxygen saturation were independent associated with the risk of developing cardiovascular disease (β=0.03, P=0.000; β=-0.13, P=0.034). Univariate and multivariate regression analyses revealed that hypoxia was significantly associated with NAMPT levels in OSAHS patients, and the oxygen desaturation index (ODI) was independent associated with the expression of NAMPT activity (β=4.09, P=0.000). In patients with OSAHS, hypoxia is independently associated with NAMPT. NAMPT increases the risk of cardiovascular morbidity in this population may be influenced by hypoxia.

Statins in Pregnancy: Can We Justify Early Treatment of Reproductive Aged Women?

Statins are the pillar of secondary prevention in reducing cardiovascular disease in high-risk adults. However, statin discontinuation is the standard recommendation in pregnant and lactating patients. This review evaluates whether we can justify the early treatment of reproductive aged women with statin therapy. Statins have several potential benefits including its antioxidant, anti-inflammatory, and anti-thrombogenic properties that may prevent the worsening of atherosclerosis in high-risk women. Nevertheless, most studies on statins and teratogenicity have a limited sample size and the effects of long-term statin use on fetal and neonatal health remain unknown. Not all statins may be safe and pravastatin's cholesterol-lowering properties may be too limited to provide much maternal benefit in pregnancy. While emerging evidence supports the use of pravastatin in pregnancy, we need to better assess the risk of early cardiovascular disease and acute progression of atherosclerosis before and during pregnancy to better understand the risks and benefits of statin use.

Youth Vascular Consortium (YVC) Protocol: Establishing Reference Intervals for Vascular Ageing in Children, Adolescents and Young Adults

In the last two decades, the global prevalence of paediatric hypertension increased by approximately 75%. Nearly 25% of children are now classified as obese or overweight. Substantial evidence suggests that risk factors for cardiovascular disease (CVD) begin to develop in childhood, thus warranting the need for tools to better screen for early CVD risk in youth. Vascular ageing, the deterioration of vascular structure and function, may be a potentially useful tool for detecting the early and asymptomatic signs of CVD burden. However, it is currently unclear what differentiates normal from pathological ageing in youth as existing reference values for vascular ageing in youth are limited by small sample size or homogenous populations. The international Youth Vascular Consortium (YVC) has been established to address these issues. The primary aim of the YVC is to develop reference intervals of normal vascular ageing in children, adolescents, and young adults. The secondary, exploratory, aim is to perform head-to-head comparisons of vascular ageing biomarkers to determine which biomarker is most strongly related to cardiometabolic health. The YVC is a retrospective, multicentre study and will collate data on vascular ageing in children (5-12 years), adolescents (13-18 years) and young adults (19-40 years), as well as routine clinical biochemistry, lifestyle, sociodemographic factors and parental health. To date, 31 research groups from 19 countries have joined the YVC. To our knowledge, this will be the largest study of its kind to investigate vascular ageing in youth.

Cardiovascular Comorbidity Associated With Albuminuria in Youth-Onset Type 2 Diabetes: Analyses From the iCARE Study

ObjectivesLittle is known about the relationship between albuminuria in youth with type 2 diabetes (T2D) and cardiovascular risk. We aimed to determine whether youth with T2D and albuminuria have evidence of increased cardiovascular risk and/or early cardiovascular dysfunction compared with youth with T2D without albuminuria. MethodsYouth with T2D were stratified by albuminuria status. Cardiovascular risk factors, including body mass index (BMI), 24-hour blood pressure, lipid profile, smoking and smoking exposure, habitual physical activity and screen time, were compared between groups. Left ventricular structure and function and carotid intima-media thickness (cIMT) were evaluated in participants who underwent cardiac imaging. ResultsTwo hundred sixty-five youth participated, 83 (31.3%) of whom had albuminuria. Ethnicity, sex, BMI z score, age at diagnosis, duration of diabetes and hepatocyte nuclear factor-1alpha status did not differ between youth stratified by albuminuria. Smoking, exposure to second-hand smoke and low physical activity levels did not differ between groups. Youth with albuminuria were more likely to have hypertension, dyslipidemia and poor glycemic control. Left ventricular structure and carotid cIMT did not differ between groups, but youth with albuminuria had evidence of early left ventricular diastolic dysfunction. ConclusionsWe found evidence of increased cardiovascular disease risk factors and left ventricular diastolic dysfunction in youth with T2D and albuminuria compared with those without albuminuria, despite a relatively short duration of disease. Thus, albuminuria may serve as a marker of early cardiovascular disease risk in youth with T2D.