Risk Of Future Cardiovascular Events Research Articles

Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation.

Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated. We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation. The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13-2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15-2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15-4.88], p=0.02) and CMI (HR 4.02 [1.80-8.98], p=0.001) were associated with increased risk after renal transplantation. SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.

QTc prolongation, increased NT-proBNP and pre-clinical myocardial wall remodeling in excessive alcohol consumers: The SABPA study.

Alcohol contributes greatly to vascular and structural modifications. Due to differences in the metabolism and tolerance of alcohol between ethnic groups, the manner of these modifications may differ. We investigated the association between alcohol consumption - measured via ethnic-specific gamma glutamyl transferase (γ-GT) cut-points - and markers of cardiac perfusion, electrical activity, and pre-clinical structural alterations. A South African target population study was performed in a bi-ethnic cohort (n=405). Alcohol consumption was determined according to previously defined ethnic-specific γ-GT cut-points, where γ-GT≥19.5U/L and γ-GT≥55U/L indicated excessive alcohol consumption in Caucasians and Africans, respectively. Ambulatory 24-h blood pressure and electrocardiograms (ECG), 10-lead ECG left ventricular hypertrophy (LVH), ischemic events, N-terminal pro-brain natriuretic peptide (NT-proBNP), and QTc prolongation were assessed. Fasting blood samples were obtained. A poorer cardio-metabolic profile and mean 24-h hypertensive and ECG-LVH values were evident in high γ-GT groups of both ethnicities, when compared to their low counterparts. The African high γ-GT group reported a higher intake of alcohol and presented significant increases in NT-proBNP (p<0.001), QTc prolongation (p=0.008), and ischemic events (p=0.013). Regression analyses revealed associations between ECG-LVH and NT-proBNP, QTc prolongation, ischemic events, and SBP, in the African high γ-GT group exclusively. High alcohol consumers presented delayed electrical conduction in the heart accompanied by ECG-LVH, ischemic events, and increased vaso-responsiveness, predominantly in Africans. Ultimately, increased left ventricular distension on a pre-clinical level may elevate the risk for future cardiovascular events in this population.

Activation of the "Splenocardiac Axis" by electronic and tobacco cigarettes in otherwise healthy young adults.

The “Splenocardiac Axis” describes an inflammatory signaling network underlying acute cardiac ischemia, characterized by sympathetic nerve stimulation of hematopoietic tissues, such as the bone marrow and spleen, which then release proinflammatory monocytes that populate atherosclerotic plaques, thereby promoting ischemic heart disease. Electronic (e) cigarettes, like tobacco cigarettes trigger sympathetic nerve activation, but virtually nothing is known about their influence on hematopoietic and vascular tissues and cardiovascular risks. The objective of this study was to determine if the Splenocardiac Axis is activated in young adults who habitually use either tobacco or e‐cigarettes. In otherwise healthy humans who habitually use tobacco cigarettes or e‐cigarettes (not both), we used 18F‐flurorodeoxyglucose positron emission tomography/computer tomography (FDG‐PET/CT) to test the hypothesis that tobacco or e‐cigarettes increased metabolic activity of the hematopoietic and vascular tissues. FDG uptake in the spleen increased from nonuser controls (1.62 ± 0.07), to the e‐cigarette users (1.73 ± 0.04), and was highest in tobacco cigarette smokers (1.82 ± 0.09; monotone P = 0.05). Similarly, FDG uptake in the aorta increased from the nonuser controls (1.87 ± 0.07) to the e‐cigarette users (1.98 ± 0.07), and was highest in tobacco cigarette smokers (2.10 ± 0.07; monotone P = 0.04). FDG uptake in the skeletal muscle, which served as a control tissue, was not different between the groups. In conclusion, these findings are consistent with activation of the Splenocardiac Axis by emissions from tobacco cigarettes and e‐cigarettes. This activation suggests a mechanism by which tobacco cigarettes, and potentially e‐cigarettes, may lead to increased risk of future cardiovascular events.

Combination of Irbesartan with Amlodipine Enhances Nitrate/Nitrite Generation by Angiotensin II-exposed Endothelial Cells

Background: Endothelial dysfunction is an initial step for atherosclerotic cardiovascular disease and highly prevalent in high-risk patients, such as those with hypertension or chronic kidney disease. Decreased nitric oxide production and/or impaired bioavailability are involved in endothelial dysfunction. Since blood pressure lowering significantly reduces the risk for future cardiovascular events in hypertensive patients, several guidelines recommended combination of anti-hypertensive drugs that had complimentary mode of actions for the treatment of patients with moderate or severe hypertension. However, effects of combination therapy on nitric oxide generation by endothelial cells are not fully understood. Keywords: Endothelial dysfunction, combination therapy, irbesartan, hypertension, amlodipine, cardiovascular disease.

Cardiovascular RiskprofilE - IMaging and gender-specific disOrders (CREw-IMAGO): rationale and design of a multicenter cohort study

BackgroundReproductive disorders, such as polycystic ovary syndrome (PCOS), primary ovarian insufficiency (POI) and hypertensive pregnancy disorders (HPD) like pre-eclampsia (PE), are associated with an increased risk of cardiovascular disease (CVD). Detection of early signs of cardiovascular disease (CVD), as well as identification of risk factors among women of reproductive age which improve cardiovascular risk prediction, is a challenge and current models might underestimate long-term health risks. The aim of this study is to assess cardiovascular disease in patients with a history of a reproductive disorder by low-dose computed tomography (CT).MethodsWomen of 45 - 55 years, who experienced a reproductive disorder (PCOS, POI, HPD), are invited to participate in this multicenter, prospective, cohort study. Women will be recruited after regular cardiovascular screening, including assessment of classical cardiovascular risk factors. CT of the coronary arteries (both coronary artery calcium scoring (CACS), and contrast-enhanced coronary CT angiography (CCTA)) and carotid siphon calcium scoring (CSC) is planned in 300 women with HPD and 300 women with PCOS or POI. In addition, arterial stiffness (non-invasive pulse wave velocity (PWV)) measurement and cell-based biomarkers (inflammatory circulating cells) will be obtained.DiscussionInitial inclusion is focused on women of 45 - 55 years. However, the age range (40 - 45 years and/or ≥ 55 years) and group composition may be adjusted based on the findings of the interim analysis. Participants can potentially benefit from information obtained in this study concerning their current cardiovascular health and expected future risk of cardiovascular events. The results of this study will provide insights in the development of CVD in women with a history of reproductive disorders. Ultimately, this study may lead to improved cardiovascular prediction models and will provide an opportunity for timely adjustment of preventive strategies. Limitations of this study include the possibility of overdiagnosis and the average radiation dose of 3.5 mSv during coronary and carotid siphon CT, although the increased lifetime malignancy risk is negligible.Trial registrationNetherlands Trial Register, NTR5531. Date registered: October 21st, 2015.

Biomarkers in Sleep Apnea and Heart Failure.

Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) and may confer significant stress to the cardiovascular system and increases the risk for future cardiovascular events. The present review will provide updates on the current understanding of the relationship of SDB and common HF biomarkers and the effect of positive airway pressure therapy on these biomarkers, with particular emphasis in patients with coexisting SDB and HF. Prior studies have examined the relationship between HF biomarkers and SDB, and the effect of SDB treatment on these biomarkers, with less data available in the context of coexisting SDB and HF. Overall, however, the association of SDB and circulating biomarkers has been inconsistent. Further research is needed to elucidate the relationship between biomarkers and SDB in HF, to evaluate the clinical utility of biomarkers over standard methods in large, prospective studies and also to assess the impact of treatment of SDB on these biomarkers in HF via interventional studies.

Preeclampsia and future health risks to the mother and child

Preeclampsia affects approximately 3–7% of all pregnancies and is the third leading cause of maternal mortality globally. In the United States, preeclampsia has increased over the past two decades, complicating 6% of all pregnancies, and accounting for 15% of all preterm deliveries, and 17% of maternal deaths. Until recently, preeclampsia was considered a disorder limited to pregnancy, which fully resolved with the delivery of the placenta; however, it is now clear that women with a history of preeclampsia have approximately double the risk of future cardiovascular events compared to women with normotensive pregnancies. Preterm preeclampsia is associated with a seven- to eight-fold increased risk of CVD mortality. Furthermore, recent epidemiological data has shown that adult offspring of mothers with preeclampsia have long-term risk for hypertension and CVD compared to normal pregnancies. Vascular dysfunction has been implicated in the pathogenesis of both preeclampsia and CVD, and a shared pathway may explain the association of preeclampsia with CVD events decades later. We and others have begun to study the relationship to whether women enter pregnancy with normal vascular function or if vascular dysfunction predates a preeclamptic pregnancy. This talk will focus on the hemodynamic and vascular changes that occur in preeclamptic pregnancies and discuss future CVD risk to both offspring and mothers with a history of preeclampsia.

Continuous glucose monitoring detected hypoglycaemia in the Treating to Target in Type 2 Diabetes Trial (4-T).

Hypoglycaemia is a significant risk in insulin treated type 2 diabetes and has been associated with future risk of cardiovascular events. We compared the frequency of low-glucose events using continuous glucose monitoring (CGM) with that of self-reported hypoglycemic events at the end of the first and third years of the Treating to Target in Type 2 Diabetes Trial (4-T), which compared biphasic, prandial and basal insulin regimens added to sulfonylurea and metformin. CGM using a Medtronic Gold system was performed in a subgroup of 4-T participants. CGM detected low-glucose events were defined at thresholds of ≤3.0 (CGM3.0) and ≤2.2 (CGM2.2) mmol/l. Of the 110 participants, 106 and 70 had CGM analysable data at the end of years 1 and 3 respectively. In both years, the frequency of CGM detected low glucose events was several fold higher than that of self-reported hypoglycaemia (symptoms with blood glucose less than 3.1mmol/l [<56mg/dl]). At the end of the first year, CGM3.0 and CGM2.2 mean (95%CI) event frequencies, expressed at events per participant per year, were 120 (85, 155) and 41 (21, 61) compared with 17 (8, 29) self-reported events during CGM, each p=0.001. The disparity at the end of the third year was similar. These data demonstrate the likely under-reporting of hypoglycaemia and of potential hypoglycaemia unawareness in clinical trials. The clinical implications of these findings need to be explored further (ISRCTN No ISRCTN51125379).

Anti-inflammatory effect of factor-Xa inhibitors in Japanese patients with atrial fibrillation.

Activated factor-X (FXa) plays an important role not only in the coagulation cascade, but also in pro-inflammatory responses. However, few data exist regarding the anti-inflammatory effect of FXa inhibitors in clinical practice. The aim of this study was to evaluate the anti-inflammatory and anti-atherosclerotic effects of FXa inhibitors in Japanese patients with non-valvular atrial fibrillation (NVAF). Eighty-three patients with NVAF were treated with FXa inhibitors from March 2013 to March 2015 at our institution. Of these, 55 patients who were not pretreated with warfarin or dabigatran (rivarixaban in 23 patients and apixaban in 32) were included in this study. We measured various inflammatory and coagulation markers at baseline and at 6 months after treatment. Plasma concentrations of pentraxin 3 (PTX3) (from 2.45 ± 1.31 to 1.97 ± 1.00ng/mL, p = 0.0009) and fibrin and fibrinogen degradation products (FDP) D-dimer (from 1.18 ± 0.70 to 0.74 ± 0.32μg/mL, p < 0.0001) decreased, while those of TM (from 2.9 ± 0.8 to 3.2 ± 0.9 FU/mL, p = 0.003) increased significantly at 6 months. Interestingly, change of each marker denoted the same tendency in both rivaroxaban and apixaban. In conclusion, the present study suggests that FXa inhibitors have not only an anti-coagulant effect but also anti-inflammatory effects in patients with NVAF. Further large-scale prospective study is necessary to evaluate whether changes in these markers will be associated with a lower risk for future cardiovascular events.

Risk stratification in stable coronary artery disease

AbstractCoronary artery disease is a very common chronic condition affecting large numbers of people across the world. Once detected the natural history of coronary disease is very variable between individuals. Hence, the assessment of symptoms and current burden of disease is a key determinant for the recommendation of drug treatments and other interventions, for example, revascularization, with the aim of improving the quality and quantity of a patient's life. We here review our current approach to assessing the risk of future cardiovascular events in patients presenting with stable coronary artery disease.Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/5222692/Activity.aspx

Contemporary medical therapies of atherosclerotic carotid artery disease

Contemporary medical therapy consists of identification and treatment of all patient-modifiable vascular risk factors. Specific atherosclerotic disease therapies are designed to reduce the risk of thrombosis, and the disease progression in order to reduce the risk of future cardiovascular events. Contemporary medical management emphasizes the need to support the patient in achieving lifestyle modifications and to adjust medication to achieve individualized target values for specific quantifiable risk factors. Antiplatelet therapy in the form of aspirin or clopidogrel is routinely used for the prevention of ischemic stroke in patients who have had a transient ischemic attack or stroke. There is evidence from a recent trial that the use of combination antiplatelet therapy with aspirin and clopidogrel started within 24 hours of minor stroke or transient ischemic attack reduces the risk of recurrent stroke compared to the use of aspirin alone, and therefore we use aspirin plus clopidogrel in recently symptomatic patients with carotid stenosis pending carotid revascularization. Anticoagulation with heparins or vitamin K antagonist is not recommended except in patients at risk for cardio-embolic events. Lowering blood pressure to target levels has been shown to slow down the progression of carotid artery stenosis and reduces the intima-media thickness of the carotid plaque, while lowering lipid levels with statins has become an essential element in the medical therapy of carotid artery stenosis. Diabetes management should be optimized. Lifestyle choices, including tobacco smoking, physical inactivity, unhealthy diet, obesity, and excessive alcohol intake, are all important modifiable vascular risk factors. The combination of dietary modification, physical exercise, and use of aspirin, a statin, and an antihypertensive agent can be expected to give a cumulative relative stroke risk reduction of 80%. The evidence suggests that intensive medical therapy is so effective that carotid revascularization may no longer be necessary in many of the patients in whom carotid surgery or stenting is currently performed. Two large ongoing trials are therefore comparing the risks and benefits of carotid revascularization versus intensive medical therapy alone.

DOES CONCOMITANT DIABETES MELLITUS IMPACT THE CHOLESTEROL TREATMENT POST ACS?

Background: Post acute coronary syndrome (ACS) patients with additional risk factors such as diabetes are at enhanced risk for future cardiovascular events. The current ACC lipid pathway guidance recommends a low density lipoprotein (LDL-C) threshold of <70 mg/dl or a 50% reduction for these

Abstract 158: Health Care Access Among Young Adults With Hypertension - The Impact Of Extended Dependent Coverage

Background: Uncontrolled hypertension among young adults increases risk for future cardiovascular events. Previous research has shown young adults were more likely to be untreated for hypertension compared to older age groups, potentially influenced by access to care barriers. In 2010, the Patient Protection and Affordable Care Act extended dependent insurance coverage to 26 years of age. It is not known if this expansion affected access to care among young adults with hypertension. Methods: Participants from the National Health Interview Survey in 2006-2009 and 2011-2014, aged 19-25 years, who reported a diagnosis of hypertension on at least two occasions, were included in this study. Six indicators of barriers to accessing healthcare were assessed: 1) no place to see a doctor when needed, 2) can’t afford prescribed medicine, 3) didn’t see doctor in past 12 months, 4) delayed care due to cost, 5) didn’t get care due to cost and 6) do not have any health insurance. We compared the percentage of each indicators among young adults with hypertension between 2006-2009 and 2011-2014. Using 2006-2009 as referent, the odds ratios (and 95% confidence intervals [CI]) of poor access were estimated after adjustments for sex, race/ethnicity and level of education. Results: During 2006-2009 and 2011-2014, there were 10,490 and 14,028 participants aged 19-25 years, and 3.2% (n=353) and 3.5% (N=505) who reported a diagnosis of hypertension, respectively (p=0.4173). The percentage of young adults with hypertension who reported “no place to see a doctor when needed” (30.5% vs 21.6%, p=0.031), “can’t afford prescribed medicine” (23.0% vs 15.3%, p=0.023) and “do not have any health insurance” (31.3% vs 23.3%, p=0.037) were significantly lower during the 2011-2014 period than the 2006-2009 period. Using 2006-2009 as the referent and adjusting for sex, race/ethnicity and level of education, the adjusted odds ratio for 2011-2014 for “no place to see a doctor when sick” was 0.57 (0.38-0.88), for “can’t afford prescribed medicine” was 0.61 (0.40-0.95), and for “do not have any health insurance” was 0.67 (0.45-0.99). However, no difference of reporting “didn’t see doctor in past 12 months”, “delayed care due to cost” and “didn’t get care due to cost” were identified between the two periods. Conclusions: In this analysis using a nationally representative sample, the expansion of dependent insurance in 2010 may have improved some indicators of access to care among young adults with hypertension.

Migraine Headache and Long-Term Cardiovascular Outcomes: An Extended Follow-Up of the Women's Ischemia Syndrome Evaluation

BackgroundThe association between migraine headache and cardiovascular events has been inconsistent. This study determines the long-term risk of cardiovascular events among women with and without a history of migraine headache who were under evaluation for suspected myocardial ischemia in the Women's Ischemia Syndrome Evaluation (WISE). MethodsThe WISE is a National Heart, Lung and Blood Institute-sponsored prospective, multicenter study that aims to improve myocardial ischemia evaluation in women. A total of 936 women presenting with symptoms of myocardial ischemia underwent structured data collection and coronary angiography. Information pertaining to migraine headache was available in 917 women. All-cause mortality data were available on all women for a median of 9.5 years, and nonfatal cardiovascular event data were available on 888 women for a median of 6.5 years. ResultsA total of 224 (24.4%) women reported a history of migraine headache. Compared with women who did not report a history of migraine headache, women with a history of migraine headache had an increased adjusted risk of cardiovascular event (cardiovascular death, nonfatal myocardial infarction, heart failure, or stroke) (hazard ratio 1.83; 95% confidence interval, 1.22-2.75) at a median follow-up of 6.5 years. This result was driven mainly by a twofold increase in the risk of stroke (hazard ratio 2.33; 95% confidence interval, 1.16-4.68). ConclusionAmong women being evaluated for ischemic heart disease, those reporting a history of migraine headache had increased risk of future cardiovascular events on long-term follow-up. This risk was primarily driven by a more-than twofold increase in the risk of stroke.

Exploring Vascular Function Biomarkers: Implications for Rehabilitation.

The endothelium plays an important role in maintaining vascular homeostasis and regulating blood vessel function. Endothelial function is considered an independent predictor for risk of future cardiovascular events in cardiovascular and non-cardiovascular patients, as well as a predictor for postoperative complications in cardiovascular surgery patients. Brachial artery flow-mediated dilation by high-resolution ultrasound is widely used to evaluate endothelium-dependent vasodilation, which is mainly mediated by nitric oxide release. Physical exercise exerts beneficial effects on endothelial function and can be used in both primary and secondary prevention of cardiac and peripheral artery diseases, even in the postoperative period of cardiovascular surgery.

Effect of Azilsartan on Day-to-Day Variability in Home Blood Pressure: A Prospective Multicenter Clinical Trial.

BackgroundThe blood pressure variability (BPV) such as visit-to-visit, day-by-day, and ambulatory BPV has been also shown to be a risk of future cardiovascular events. However, the effects of antihypertensive therapy on BPV remain unclear. The purpose of this study was to evaluate the effect of azilsartan after switching from another angiotensin II receptor blocker (ARB) on day-to-day BPV in home BP monitoring.MethodsThis prospective, multicenter, open-labeled, single-arm study included 28 patients undergoing treatment with an ARB, which was switched to azilsartan after enrollment. The primary outcome was the change in the mean of the standard deviation and the coefficient of variation of morning home BP for 5 consecutive days from baseline to the 24-week follow-up. The secondary outcome was the change in arterial stiffness measured by the cardio-ankle vascular index.ResultsThe mean BPs in the morning and evening for 5 days did not statistically differ between baseline and 24 weeks. For the morning BP, the means of the standard deviations and coefficient of variation of the systolic BP were significantly decreased from 7.4 ± 3.6 mm Hg to 6.1 ± 3.2 mm Hg and from 5.4±2.7% to 4.6±2.3% (mean ± standard deviation, P = 0.04 and P = 0.04, respectively). For the evening BP, no significant change was observed in the systolic or diastolic BPV. The cardio-ankle vascular index significantly decreased from 8.3 ± 0.8 to 8.1 ± 0.8 (P = 0.03).ConclusionsSwitching from another ARB to azilsartan reduced day-to-day BPV in the morning and improved arterial stiffness.

Are There Clinical Cardiac Complications From Too Much Exercise?

The dose-response association between physical activity and cardiovascular outcomes is well described (10). As little as 15 min·d−1 of moderate-intensity exercise significantly lowers the risk for cardiovascular morbidity and mortality. Greater volumes yield greater cardiovascular benefit. However, the impact of extreme volumes of exercise on cardiovascular health is under debate (9), because some studies present evidence of adverse clinical outcomes in endurance athletes who perform exercise volumes at the extreme upper end of the physical activity continuum. These observations raise the possibility that high doses of exercise have deleterious cardiac effects.

Framingham risk assessment of metabolic syndrome patients at a tertiary hospital in Nigeria

Background: Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality worldwide. Combination of risk factors for CVD can be seen in the metabolic syndrome (MS), which can be computed to get an assessment of an individual's risk for future cardiovascular events. Aims: We aimed to determine the Framingham risk assessment of MS patients at the Lagos University Teaching Hospital, Nigeria. Materials and Methods: This was a cross-sectional study of newly diagnosed patients with MS using the International Diabetes Federation criteria. Anthropometry and clinical data were obtained, and fasting blood glucose and lipid concentrations were also determined. Framingham risk assessment was calculated and categorized as 20%: high risk for future CVD. Results: There were 120 patients (females 82, males 38) with mean ages of 52 ± 13.5 years and 54 ± 14.2 years, respectively (P = 0.46). Framingham risk assessment showed 56 (47%) patients comprising of 42 females and 14 males had low risk; 31 (26%) patients comprising of 24 females and 7 males had intermediate risk while 32 (27%) patients comprising of 16 females and 16 males had high risk for CVD. The risk assessment significantly correlated with age, systolic blood pressure, and total and high-density lipoprotein-cholesterol (P

Abstract 11909: Migraine Headaches and Cardiovascular Outcomes in Women With Symptoms and Signs of Ischemic Heart Disease: Results of an Extended follow-up From the Women’s Ischemia Syndrome Evaluation

Introduction: Data regarding the association between migraine headaches (MH) and cardiovascular (CV) events in women have been inconsistent. The aim of this study was to determine the long-term risk of CV events among women with and without MH who were evaluated for suspected ischemic heart disease (IHD) in the Women’s Ischemia Syndrome Evaluation (WISE) Study. Methods: Women reporting a history of MH were identified from the WISE cohort. Extended follow-up data were available for a median follow-up of 6 years. Cox proportional adjusted hazard ratios (HR) were constructed for time to first adverse CV event (CV death, non-fatal myocardial infarction [MI], heart failure hospitalization, or non-fatal stroke) among women with and without MH. Additionally, HR were determined for each event separately, as well as, all-cause death, angina hospitalization, death or MI, and CV death or MI. Results: Data on self reported MH were available on 917 women. A total of 224 (24.4%) reported a history of MH. Compared to those who did not report a history of migraines, women with a history of MH had an increased adjusted* risk of CV events (HR 1.83 CI 1.22-2.75, p=0.004) at a median follow up of 6-years. This result was mainly due to an increase in the risk of stroke (HR 2.33 CI 1.16-4.68, p=0.018) (Table 1). Conclusion: Among women being evaluated for IHD, those who reported a history of MH had an increased risk of future CV event. This finding was primarily driven by the more than 2-fold increased risk of stroke.

Abstract 13518: Low Skeletal Muscle Mass Index is Associated With Cardiovascular Events in Patients After ST-segment Elevation Myocardial Infarction

Introduction: Although it has been implicated the association between low skeletal muscle mass and cardiovascular diseases, the prognostic value of skeletal muscle mass in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. Hypothesis: We assessed the hypothesis that low skeletal muscle mass index (SMMI) is associated with an increased risk of secondary cardiovascular events in patients with STEMI. Methods: A total of 200 patients with STEMI were enrolled. SMMI was estimated from dual-energy X-ray absorptiometry scan before discharge, and calculated by dividing appendicular skeletal muscle mass (kg) by height squared (m 2 ). The patients were divided into low and high SMMI groups using the first tertile of SMMI. Low SMMI was defined as ≤6.843 kg/m 2 for men and ≤5.321 kg/m 2 for women. All patients were followed for cardiovascular events, which consist of cardiovascular deaths, nonfatal myocardial infarctions, nonfatal ischemic strokes, and congestive heart failure. Results: During follow-up (median 340 days [interquartile ranges 298 and 389]), 15 patients experienced cardiovascular events (1 cardiovascular death, 6 myocardial infarction, 6 stroke, and 3 congestive heart failure). The event rate at 1 year after STEMI was significantly higher in patients with low SMMI (15.5%) than with high SMMI (2.5%) (log-rank p&lt;0.001) (Figure). Even after adjustment for the propensity score which was calculated with age, gender, height, weight, risk factors and medications, patients with low SMMI had 5.8-fold higher risk of subsequent cardiovascular events compared to those without (Adjusted hazard ratio 5.86, 95% confidence interval 1.18 to 35.28, p=0.03). Conclusion: Among patients with STEMI, low SMMI was significantly and independently associated with an increased risk of future cardiovascular events.