Screening For CVD Research Articles

Abstract P152: Association of Cannabis Use with Atherosclerotic Cardiovascular Diseases Outcomes: Insights from a Meta-Analysis of a Multinational Cohort of 1.9 Million Individuals

Background: Despite numerous reports suggesting a link between cannabis use and the risk of atherosclerotic cardiovascular diseases (ASCVD), the nature of this relationship—whether causal or not—remains uncertain. Objective: We aimed to consolidate data from observational studies to examine the association between cannabis use and ASCVD outcomes compared to non-users or controls. Methods: RevMan 5.4 was used for statistical analyses employing a random effects model, and outcomes were presented as risk ratios (RR) with corresponding 95% confidence intervals (CI). The study protocol has been registered with PROSPERO (CRD42024530366). Results: Our analysis integrated data from 17 studies, including 1,902,481 individuals aged 18 to 74, with a mean follow-up duration of 8.5 years. The pooled analysis revealed no statistically significant association between cannabis use and the risk of myocardial infarction compared to non-users, with an RR of 1.25 (95% CI: 0.91 to 1.71, p = 0.17). Similarly, the risk of stroke did not show a significant association with cannabis use (RR: 1.38, 95% CI: 0.88 to 2.16, p = 0.16). However, a statistically significant association was found between cannabis use and the composite outcome of any adverse cardiovascular events (RR: 1.48, 95% CI: 1.16 to 1.90, p = 0.002). Conclusion: The statistical correlations between cannabis use and composite adverse cardiovascular outcomes underscore its potential as a risk factor for cardiovascular disease. With rising trends in medical cannabis use and cannabis use disorder across age demographics, heightened risk awareness, CVD screening, and informed decision-making regarding cannabis consumption are critical priorities in healthcare and public health initiatives.

Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players

BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited. ObjectivesHUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events. MethodsHUDDLE was a multicity, cross-sectional study of NFL alumni and family members aged 50 years and older. Subjects reported their health history and participated in CVD education and screening (blood pressure, electrocardiogram, and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30 days postscreening to review results and recommendations. This analysis focuses on former NFL athletes. ResultsOf 498 participants screened, 57.2% (N = 285) were former NFL players, the majority of whom were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants, 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that hypertension was a significant predictor of clinically relevant structural abnormalities on TTE. ConclusionsHUDDLE identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by hypertension, affirming the role of TTE for CVD screening in this population aged older than 50 years. (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms [HUDDLE]; NCT05009589)

An improved contrastive learning network for semi-supervised multi-structure segmentation in echocardiography.

Cardiac diseases have high mortality rates and are a significant threat to human health. Echocardiography is a commonly used imaging technique to diagnose cardiac diseases because of its portability, non-invasiveness and low cost. Precise segmentation of basic cardiac structures is crucial for cardiologists to efficiently diagnose cardiac diseases, but this task is challenging due to several reasons, such as: (1) low image contrast, (2) incomplete structures of cardiac, and (3) unclear border between the ventricle and the atrium in some echocardiographic images. In this paper, we applied contrastive learning strategy and proposed a semi-supervised method for echocardiographic images segmentation. This proposed method solved the above challenges effectively and made use of unlabeled data to achieve a great performance, which could help doctors improve the accuracy of CVD diagnosis and screening. We evaluated this method on a public dataset (CAMUS), achieving mean Dice Similarity Coefficient (DSC) of 0.898, 0.911, 0.916 with 1/4, 1/2 and full labeled data on two-chamber (2CH) echocardiography images, and of 0.903, 0.921, 0.928 with 1/4, 1/2 and full labeled data on four-chamber (4CH) echocardiography images. Compared with other existing methods, the proposed method had fewer parameters and better performance. The code and models are available at https://github.com/gpgzy/CL-Cardiac-segmentation.

Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain

BackgroundCardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV). ObjectivesTo evaluate the mortality and it's causes and CVD and its vascular risk factors (VRFs) in AAV patients in Andalusia. MethodsA multicenter cohort of 220 AAV patients followed-up from 1979 until June 2020 was studied in Andalussia, south of Spain. The information, including socio-demographic and clinical data was recorded retrospectively through chart review. Data was analysed using Chi2, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval (CI). ResultsDuring a mean ± standard deviation follow-up of 96.79 ± 75.83 months, 51 patients died and 30 presented at least one CVE. Independent prognostic factors of mortality were age (HR 1.083, p=0.001) and baseline creatinine (HR 4.41, p=0.01). Independent prognostic factors of CVE were age [hazard ratio (HR) 1.042, p=0.005] and the presence of hypertension (HTN) six months after diagnosis (HR 4.641, p=0.01). HTN, diabetes and renal failure, all of these important VRFs, are more prevalent in AAV patients than it is described in matched general population. ConclusionsAge and baseline renal function, but not CVEs, are predictors of mortality and age and early HTN are independent predictors for having a CVE. CVD screening in AAV patients is demanded.

Racial and Ethnic Differences in Awareness and Prevalence of Unidentified Cardiovascular Risk Factors Among Health System Employees.

To evaluate awareness about cardiovascular (CVD) risk among a racially and ethnically diverse cohort of health system employees. Cross-sectional study. Voluntary survey of health system employees during an annual CVD awareness and screening event. 759 health system employees. We performed initial CVD screening measurements (blood pressure, body mass index) and collected patient-reported answers to questions about their own CVD risk factors (hypertension, high cholesterol, diabetes, overweight, smoking, physical inactivity and family history of CVD) and whether or not they believed that CVD is preventable. Subjects were offered in-depth follow-up CVD screening (lipid panel, hs-CRP, hemoglobin A1c), if interested. Continuous measures were compared across sex and racial/ethnic subsets using a t test and analysis of variance technique. Univariable and multivariable logistic regression models were used to estimate the employee's willingness to undergo further comprehensive screening. African American, Hispanic, and Asian employees were younger than white employees (P < .0001). More than one-quarter of African Americans reported a history of hypertension, a higher rate than for other subgroups (P = .001). The rate of self-reported diabetes was highest in African American and Asian employees (P = .001). African Americans had a 54% reduced odds of electing to pursue follow-up CVD screening (odds ratio: .46, 95% confidence interval = .24-.91, P = .025). Presence of CVD risk factors and knowledge of their importance differ among racial and ethnic groups of health system employees in our cohort as does interest in pursuing follow-up screening once risk factors are identified. Development of evidence-based customization strategies by racial and ethnic group may improve understanding of and interest in CVD risk factors and advance prevention. The data from this study will inform future research and strategies for employee health promotion.

Knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention in North West Ethiopia

BackgroundIn Ethiopia, there are no adequate studies made on the knowledge and practice of CVD and its risk factors among community pharmacists. Thus, this study aimed to assess knowledge of cardiovascular disease risk factors, practice, and barriers of community pharmacists on cardiovascular disease prevention. MethodsA Cross-sectional study was conducted on a total of 81 community pharmacists from the first march to May 30, 2020, at Gondar town. Data was entered to EPI-INFO 7 and exported to SPSS software for windows version 20 for analysis. The results are presented by using tables and figures. The chi-square test was applied to test the relationship between Knowledge and independent variables. P-value ≤ 0.05 was considered as statistical significance. ResultOf the participants, 45 (55.6%) of them were found knowledgeable about cardiovascular disease. On the other hand, only 18.5%, 77.8%, and 93.8% of the study participants respectively were aware of CVD risk factors like symptoms of heart disease, the connection of family history of heart disease, and the connection between old age and heart disease. Only 21% of the study participants had known the existence of HTN guidelines in Ethiopia. X2 statistical analysis showed that there was no statistically significant association between age (P = 0.82), gender (P = 0.661). Marital statuses (P > 0.50), number of years of practice (P = 0.796) and cardiovascular disease. The main barriers to the prevention of CVD for community pharmacists were, lack of time (18.5%), inability to identify targeted patients (65.4%), lack of knowledge (23%), and lack of communication (26%). ConclusionThe overall assessment of the pharmacists demonstrated that more than half of the participants were found knowledgeable. However, only a small proportion of the study participants had known about the existence of National guidelines for cardiovascular disease in particular and non-communicable disease in general. Therefore, the provision of government policy that will regulate their training, certification, and practice for CVD screening and as well as provide a framework of incentives are recommended.

Improved adherence to statins following pictorial intervention. Sub study of visualization of subclinical atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA)

Abstract Introduction VIPVIZA is a prospective, randomised controlled trial with open label and masked evaluators, integrated in Västerbotten intervention programme (VIP), a population-based CVD screening and prevention programme examining 40,50,60-year-olds. In VIPVIZA subclinical atherosclerosis was identified by ultrasound and pictorial information about carotid plaque presence, carotid thickness and risk assessment was provided to participants and their physicians. After examination, participants were randomized to pictorial information (intervention) or as usual care (control). Previous studies from VIPVIZA have shown that the time to initiation of statins is lower and the proportion of statin users is higher in the intervention group. Purpose To study whether the pictorial risk information intervention made participants with pre intervention prescription of statins more adherent to statin treatment. Method During 2013–2016, 3532 participants in VIPVIZA were screened by carotid ultrasound examination, of which 46% had plaque, 546 had expedited prescriptions of statins (ATC codes: C10AAxx, C10B, C10BA, C10BX) prior to inclusion. Participants were followed from inclusion until 3-year follow-up examination. Adherence calculations were based on Swedish prescription drug registry (PDR). For adherence calculations we assumed that medication is used as prescribed. Dose change of same medication is considered, and number of days' supply is recalculated if a dispensing event contains a change of dose. The new dose comes into effect the day of dispensing a prescription with a dose change. For the follow-up period the number of days with potential use (based on supply) is divided by days from baseline examination until 3-year examination, yielding a value in the interval [0,1] where 0 is non adherent and 1 perfect adherence. Remaining supply of medication at the end of follow-up period is disregarded. Adherence was also dichotomised at 0.8. Results The average adherence to statins was higher in the intervention group for participants with carotid plaque, 0.844 vs 0.773, confidence interval 95% for mean difference (−0.125, −0.018), p=0.009. The intervention group with carotid plaque had the best adherence of all subgroups, but the difference in adherence within the intervention group (plaque vs no plaque) was non-significant. With respect to sex the difference in mean adherence between intervention and control for males was 0.826–0.795 while for females 0.815–0.742. With dichotomised adherence the increase in the intervention group is significant for females, p=0.027. See table 1. Conclusion Providing information about subclinical atherosclerosis increases adherence to statins, especially in participants with plaque and females. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council

MO179: Cardiovascular Disease and Mortality in ANCA-Vasculitis. Importance of Overadded Hypertension and Kidney Function: A South of Spain's Experience

Abstract BACKGROUND AND AIMS Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV), partly due to the vascular inflammation itself, the associated organic damage and the treatment [1]. AAV has been associated with traditional risk factors, such as hypertension (HTN), diabetes mellitus (DM) or impared renal function [2], which also contribute to accelerated atherosclerosis. However, there are not specific recommendations about CVD treatment in AAV patients [3], and the vascular risk scores used for general population have not been extrapolated yet. Our objective is to assess the frequency of cardiovascular events (CVE) and mortality in AAV patients and to explore the possible vascular risk factors (VRF) and the therapeutic intervention on them. METHOD A descriptive and retrospective study of a multidisciplinary cohort of AAV patients followed prospectively was performed in 12 hospitals of the 8 provinces of Autonomous Community of Andalusia. Factors that presumably may influence in CVD and mortality were collected. Two CV risk scores were measured [4, 5]. The presence of a strategy carried out by clinicians on CV risk was analysed according guides ESC/ESH and KDIGO guides. Data was analysed using Chi-square, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval. RESULTS A multicentre cohort of 220 AAV patients followed up from 1979 until June 2020 was studied, during a mean ± standard deviation follow-up of 96.79 ± 75.83 months. The mean age at diagnosis was 59.92 ± 16.25 years, 45% were female and all but one caucasians. Sociodemographic and clinical characteristics are shown in Table 1. After AAV diagnosis, 30/224 (13%) patients presented at least one CVE (Figure 1A and B), 37% IHD, 43% CVA and 50% PVD. Independent prognostic factors of CVE were age (HR 1.042, P = .005) and the presence of hypertension (HTN) 6 months after diagnosis (HR 4.641, P = .01). Regarding classic VRFs, 81% had HTN [33% already presented it before diagnosis and 48% after (35% in the first 6 months)]. Thirty-four patients presented DM at the end of following [12% already presented it before diagnosis and 22% presented it after (16% in the first 6 months)]. The independent predictor for HTN at 6 months was renal involvement at BVAS baseline, and DM in the first 6 months for HTN at the end of following. Attending to the ESC Vascular Risk scale, 8.4% presented low risk, 16.9% moderate, 29.8 high and 44.4% very high risk. According to the REGICOR scale, the mean value of suffering a CV event in the next 10 years was 4.6%±3.32%, with 59%, 34% and 7% of patients presenting low, moderate and high risk, respectively. Regarding VRF management strategies, just 14% of hypertensive patients, 16.2% of those that needed dyslipidemia treatment, and 8.6% of diabetic patients were not within the target guidelines recommendations. Fifty-one patients (23%) died (Figure 1C and D), 23.5% due to infectuous disease, 19.6% to cancer, 17.6% to CVD,13.7% to AAV relapse and 13 due to organic deficit, other or an unknown cause. In our final model of multivariate analysis, just age and renal function at baseline were independent predictors of mortality. Independent prognostic factors of mortality were age (HR 1.083, P = .00) and baseline creatinine (HR 4.41, P = .01). CONCLUSION Age and early HTN are risk factors for having a CVE, and age and renal function are predictors of mortality. HTN are more frecuent in AAV patients than in general population. CVD screening in AAV patients is demanded. The REGICOR and ESC scores could be extrapolated as a predictor of cardiovascular risk in AAV patients.

Prevalence and population genetic data of colour vision deficiency among students from selected tertiary institutions in Lagos State, Nigeria

BackgroundColour vision deficiency (CVD), also referred to as colour blindness, is the failure or decreased ability to distinguish between certain colours under normal lighting conditions. It is an X-linked genetic disorder with varying degrees of prevalence in different populations. There is presently no report on the prevalence of CVD among students of the selected tertiary institution. Hence, the present study was aimed at determining the occurrence and genetics of CVD among students from designated tertiary institutions in Lagos state. A cross-sectional survey was employed in recruiting 1191 study subjects from three tertiary institutions in Lagos, Nigeria.ResultsThe overall occurrence of CVD among the study participants was 2.85%. There were 24 (4.29%) males and 10 (1.58%) females affected. Among the colour vision deficient individuals, 18 (1.51%) and 16 (1.34%) were deuteranomalous and protanomalous, respectively. Also, the prevalence of CVD varies across ethnic groups of the studied subjects with the highest occurrences (3.57%) observed in the Yoruba ethnic subpopulation and the least (1.45%) among the Hausas.ConclusionsMore males than females were found to be colour vision deficient, and there were more deutans than protans. Early screening for CVD should be encouraged among school children to guide the choice of future profession and help mitigate work hazards resulting from being colour deficient.

A Student-Directed Community Cardiovascular Screening Project at a Regional Campus

Introduction Cardiovascular disease (CVD) is an important threat to public health, especially in rural communities. Clinical medical students at a rural regional campus can be a valuable resource to plan and implement CVD risk factor case finding project in the host community. Methods Directed by a representative county advisory council and supervised by a regional dean, clinical medical students designed and implemented CVD screenings at several public locations, recording health history and measurements of blood glucose, total blood cholesterol, and blood pressure. Those screened with abnormal readings were directed to definitive care including the local student-directed free clinic. Students were surveyed using a Likert scale before and after participation to assess their confidence in executing a community health project. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interest. Results Over a period of almost two years in 2017-2019, 572 participants were screened. The demographics reflected those of the entire county, except screening was focused on adults. High blood pressure was found in 43%, high glucose in 28%, and high cholesterol in 48%. These values were similar to published countywide prevalence proportions. The student pre- to post- increase in confidence was remarkable (p&lt; 0.000). Conclusions Our results show that regional campus medical students directed by a representative county advisory council and supervised by a regional dean can successfully implement a community CVD screening effort. The students also expressed a dramatic increase in their confidence in designing and implementing such a project. Lessons learned are shared for consideration by those at other regional health campuses.

Increased risk of cerebrovascular mortality in head and neck cancer survivors aged\u2009\u2265\u200965\xa0years treated with definitive radiotherapy: a population-based cohort study

BackgroundTo investigate the relationship between radiotherapy (RT) and the risk of cerebrovascular mortality (CVM) in head and neck cancer (HNC) survivors aged ≥ 65 years.MethodsPatients with HNC survivors aged ≥ 65 years diagnosed between 2000 and 2012 were included from the Surveillance, Epidemiology, and End Results database. Kaplan–Meier analysis, Log-rank tests, and Cox proportional-hazards regression models were performed for statistical analyses.ResultsWe included 16,923 patients in this study. Of these patients, 7110 (42.0%) patients received surgery alone, 5041 (29.8%) patients underwent RT alone, and 4772 (28.2%) patients were treated with surgery and RT. With a median follow-up time of 87 months, 1005 patients died with cerebrovascular disease. The 10-years CVM were 13.3%, 10.8%, and 11.2% in those treated with RT alone, surgery alone, and surgery plus RT, respectively (P < 0.001). The mean time for CVM was shorter in RT alone compared to surgery alone and surgery plus RT (52 months vs. 56–60 months). After adjusting for covariates, patients receiving RT alone had a significantly higher risk of developing CVM compared to those receiving surgery alone (hazard ratio [HR] 1.703, 95% confidence interval [CI] 1.398–2.075, P < 0.001), while a comparable risk of CVM was found between those treated with surgery alone and surgery plus RT (HR 1.106, 95% CI 0.923–1.325, P = 0.274). Similar trends were found after stratification age at diagnosis, gender, tumor location, and marital status.ConclusionsDefinitive RT but not postoperative RT can increase the risk of CVM among older HNC survivors. Long-term follow-up and regular screening for CVD are required for HNC patients who received definitive RT to decrease the risk of CVM.

CardioXNet: A Novel Lightweight Deep Learning Framework for Cardiovascular Disease Classification Using Heart Sound Recordings

The alarmingly high mortality rate and increasing global prevalence of cardiovascular diseases signify the crucial need for early detection schemes. Phonocardiogram (PCG) signals have been historically applied in this domain owing to its simplicity and cost-effectiveness. In this paper, we propose CardioXNet, a novel lightweight end-to-end CRNN architecture for automatic detection of five classes of cardiac auscultation namely normal, aortic stenosis, mitral stenosis, mitral regurgitation and mitral valve prolapse using raw PCG signal. The process has been automated by the involvement of two learning phases. Three parallel CNN pathways have been implemented in the representation learning phase to learn the coarse and fine-grained features from the PCG and to explore the salient features from variable receptive fields involving 2D-CNN based squeeze-expansion. Thus, in the representation learning phase, the network extracts efficient time-invariant features and converges with great rapidity. In the sequential residual learning phase, with the bidirectional-LSTMs and the skip connection, the network can proficiently extract temporal features without performing any feature extraction on the signal. The obtained results demonstrate that the proposed end-to-end architecture yields outstanding performance in all the evaluation metrics compared to the previous state-of-the-art methods with up to 99.60% accuracy, 99.56% precision, 99.52% recall and 99.68% F1- score on an average while being computationally comparable. This model outperforms the previous works using the same dataset by a considerable margin. The high accuracy metrics on both primary and secondary dataset combined with a significantly low number of parameters and end-to-end prediction approach makes the proposed network suitable for point of care CVD screening in low resource setups using memory constraint mobile devices.

Development and validation of a risk score for the prediction of cardiovascular disease in living donor kidney transplant recipients.

Cardiovascular disease (CVD) is a major cause of death in kidney transplant (KT) recipients. To improve their long-term survival, it is clinically important to estimate the risk of CVD after living donor KT via adequate pre-transplant CVD screening. A derivation cohort containing 331 KT recipients underwent living donor KT at Kyushu University Hospital from January 2006 to December 2012. A prediction model was retrospectively developed and risk scores were investigated via a Cox proportional hazards regression model. The discrimination and calibration capacities of the prediction model were estimated via the c-statistic and the Hosmer-Lemeshow goodness of fit test. External validation was estimated via the same statistical methods by applying the model to a validation cohort of 300 KT recipients who underwent living donor KT at Tokyo Women's Medical University Hospital. In the derivation cohort, 28 patients (8.5%) had CVD events during the observation period. Recipient age, CVD history, diabetic nephropathy, dialysis vintage, serum albumin and proteinuria at 12 months after KT were significant predictors of CVD. A prediction model consisting of integer risk scores demonstrated good discrimination (c-statistic 0.88) and goodness of fit (Hosmer-Lemeshow test P = 0.18). In a validation cohort, the model demonstrated moderate discrimination (c-statistic 0.77) and goodness of fit (Hosmer-Lemeshow test P = 0.15), suggesting external validity. The above-described simple model for predicting CVD after living donor KT was accurate and useful in clinical situations.

Missed opportunities to prevent cardiovascular disease in women with prior preeclampsia

BackgroundCardiovascular disease (CVD) is the leading cause of death in women in every major developed country and in most emerging nations. Complications of pregnancy, including preeclampsia, indicate a subsequent increase in cardiovascular risk. There may be a primary care provider knowledge gap regarding preeclampsia as a risk factor for CVD. The objective of our study is to determine how often internists at an academic institution inquire about a history of preeclampsia, as compared to a history of smoking, hypertension and diabetes, when assessing CVD risk factors at well-woman visits. Additional aims were (1) to educate internal medicine primary care providers on the significance of preeclampsia as a risk factor for CVD disease and (2) to assess the impact of education interventions on obstetric history documentation and screening for CVD in women with prior preeclampsia.MethodsA retrospective chart review was performed to identify women ages 18–48 with at least one prior obstetric delivery. We evaluated the frequency of documentation of preeclampsia compared to traditional risk factors for CVD (smoking, diabetes, and chronic hypertension) by reviewing the well-woman visit notes, past medical history, obstetric history, and the problem list in the electronic medical record. For intervention, educational teaching sessions (presentation with Q&A session) and education slide presentations were given to internal medicine physicians at clinic sites. Changes in documentation were evaluated post-intervention.ResultsWhen assessment of relevant pregnancy history was obtained, 23.6% of women were asked about a history preeclampsia while 98.9% were asked about diabetes or smoking and 100% were asked about chronic hypertension (p < 0.001). Education interventions did not significantly change rates of screening documentation (p = 0.36).ConclusionOur study adds to the growing body of literature that women with a history of preeclampsia might not be identified as having increased CVD risk in the outpatient primary care setting. Novel educational programming may be required to increase provider documentation of preeclampsia history in screening.

Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus.

It is well known that patients with type 2 diabetes mellitus (T2DM) are at an increased risk of morbidity and mortality from atherosclerotic cardiovascular (CV) complications. Previously, the concept that diabetes mellitus (DM) is a “coronary artery disease (CAD) risk equivalent” was widely accepted, implying that all DM patients should receive intensive management. However, considerable evidence exist for wide heterogeneity in the risk of CV events among T2DM patients and the concept of a “CAD risk equivalent” has changed. Recent guidelines recommend further CV risk stratification in T2DM patients, with treatment tailored to the risk level. Although imaging modalities for atherosclerotic cardiovascular disease (ASCVD) have been used to improve risk prediction, there is currently no evidence that imaging-oriented therapy improves clinical outcomes. Therefore, controversy remains whether we should screen for CVD in asymptomatic T2DM. The coexistence of T2DM and heart failure (HF) is common. Based on recent CV outcome trials, sodium glucose cotransporter-2 inhibitors and glucagon like peptide-1 receptor agonists are recommended who have established ASCVD, indicators of high risk, or HF because of their demonstrated benefits for CVD. These circumstances have led to an increasing emphasis on ASCVD and HF in T2DM patients. In this review, we examine the literature published within the last 5 years on the risk assessment of CVD in asymptomatic T2DM patients. In particular, we review recent guidelines regarding screening for CVD and research focusing on the role of coronary artery calcium, coronary computed tomography angiography, and carotid intima-media thickness in asymptomatic T2DM patients.

Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: a qualitative study

BackgroundCardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is provided mainly by the Community-based Health Planning and Services (CHPS) initiative. CHPS locates nurses in community-level clinics for basic curative and preventive health services and provides home and outreach services. But CHPS currently lacks capacity to screen for or treat CVD and its risk factors.MethodsIn two rural districts, we conducted in-depth interviews with 21 nurses and 10 nurse supervisors to identify factors constraining or facilitating CVD screening and treatment. Audio recordings were transcribed, coded for content, and analyzed for key themes.ResultsRespondents emphasized three themes: community demand for CVD care; community access to CVD care; and provider capacity to render CVD care. Nurses and supervisors noted that community members were often unaware of CVD, despite high reported prevalence of risk factors. Community members were unable to travel for care or afford treatment once diagnosed. Nurses lacked relevant training and medications for treating conditions such as hypertension. Respondents recognized the importance of CVD care, expressed interest in acquiring further training, and emphasized the need to improve ancillary support for primary care operations.ConclusionsCHPS staff expressed multiple constraints to CVD care, but also cited actions to address them: CVD-focused training, provision of essential equipment and pharmaceuticals, community education campaigns, and referral and outreach transportation equipment. Results attest to the need for trial of these interventions to assess their impact on CVD risk factors such as hypertension, depression, and alcohol abuse.

Estimated cost for cardiovascular disease risk-based management at a primary healthcare center in Nepal

BackgroundLow- and middle-income countries are facing an increasing burden of disability and death due to cardiovascular diseases. Policy makers and healthcare providers alike need resource estimation tools to improve healthcare delivery and to strengthen healthcare systems to address this burden. We estimated the direct medical costs of primary prevention, screening, and management for cardiovascular diseases in a primary healthcare center in Nepal based on the Global Hearts evidence based treatment protocols for risk-based management.MethodsWe adapted the World Health Organization’s non-communicable disease costing tool and built a model to predict the annual cost of primary CVD prevention, screening, and management at a primary healthcare center level. We used a one-year time horizon and estimated the cost from the Nepal government’s perspective. We used Nepal health insurance board’s price for medicines and laboratory tests, and used Nepal government’s salary for human resource cost. With the model, we estimated annual incremental cost per case, cost for the entire population, and cost per capita. We also estimated the amount of medicines for one-year, annual number of laboratory tests, and the monthly incremental work load of physicians and nurses who deliver these services.ResultsFor a primary healthcare center with a catchment population of 10,000, the estimated cost to screen and treat 50% of eligible patients is USD21.53 per case and averages USD1.86 per capita across the catchment population. The cost of screening and risk profiling only was estimated to be USD2.49 per case. At same coverage level, we estimated that an average physician’s workload will increase annually by 190 h and by 111 h for nurses, i.e., additional 28.5 workdays for physicians and 16.7 workdays for nurses. The total annual cost could amount up to USD18,621 for such a primary healthcare center.ConclusionThis is a novel study for a PHC-based, primary CVD risk-based management program in Nepal, which can provide insights for programmatic and policy planners at the Nepalese municipal, provincial and central levels in implementing the WHO Global Hearts Initiative. The costing model can serve as a tool for financial resource planning for primary prevention, screening, and management for cardiovascular diseases in other low- and middle-income country settings globally.

Cardiovascular Disease Risk Assessment and Management in Survivors of Allogeneic Hematopoietic Cell Transplantation

Long-term survivors of allogeneic hematopoietic cell transplantation (HCT) are at greater risk for developing late effects, with increased risk of mortality compared to the general population. This includes a 2-3 fold increased risk of metabolic syndrome and cardiovascular disease. While screening and appropriate treatment for metabolic syndrome and CVD is recommended for long-term HCT survivors, specific guidelines in this high risk population is limited. The Cleveland Clinic Blood and Marrow Transplant Survivorship program was established in 2016 to improve the long-term care of transplant recipients. Patients are systematically evaluated at 100 days, and 1-, 2-, and 5-years post-HCT by an advanced practice practitioner (APP) in a consultative model, in which the visit is primarily focused on health maintenance and late effects. In an effort to improve our practice of CVD screening and prevention, we created specific guidelines focusing on the 4 core clinical measures of metabolic syndrome: increased body weight/visceral adiposity, elevated lipids, increased blood pressure, and hyperglycemia/insulin resistance. Table 1 shows our survivorship programs approach to evaluating CVD risk in allogeneic HCT survivors and the subsequent preventive and management recommendations, that are based on American College of Cardiology/American Heart Association guidelines. The recommendations were further modified to account for common challenges providers identify in the unique HCT population, such as multiple HCT medication interactions, organ dysfunction and graft versus host disease. In addition, we encourage patients to follow up with their primary care providers to continue management and monitoring. Education is also provided on healthy lifestyle changes including exercise recommendations and healthy eating. Specific goals and targets are reviewed with patients and their caregivers. Dieticians, physical therapy, smoking and tobacco cessation are available and offered when appropriate. We present a platform for guideline-driven and multidisciplinary approach to assessment, prevention and management of CVD risk-factors in allogeneic HCT survivors. Data is being collected to evaluate the impact of medication, education and the systematic management of these patients and overall incidents of CVD events.

Sense of Coherence Among Non-attendee Women in a Multifaceted Screening Program for Cardiovascular Diseases

Introduction: Previous research shows that the main theme for women declining to attend a multifaceted cardiovascular screening program is related to finding it personal irrelevant (1). In this study, we explored these women's experiences by applying Antonovsky's theory of sense of coherence as a theoretical lens to create a deeper understanding of the women's decisions. Methods: An interview study with 10 non-attendee women invited to a multifaceted screening program for cardiovascular diseases. At the time of invitation for screening, the women's mean ages in the four invited age groups, were 61, 66, 71, and 76 years. Of the 1984 invited, 74.3 percent accepted the screening invitation (2). Women who declined the screening invitation were randomly selected for interviews to explore the reasons for non-attendance and their perspectives on CVD screening. The interviews were supplemented with reflective notes. The analysis was performed in a nonlinear and iterative process by a conceptual, deductive content analysis inspired by Elo and Kyngäs. Results: The findings showed that women's decision for declining the screening invitation was based on a high sense of meaningfulness. The experience of meaningfulness was rooted in personal inner logics and social role as caregivers, which provided the women with a feeling of sense of coherence in their everyday lives. The decision of declining screening was decided by such inner logics rather than cognitive considerations. Conclusion: The inner logics were central factors for declining the screening invitation. Those inner logics were rooted in the women's preferences to maintain life unchanged, a strategy to uphold their social role, and thereby their identity. Overall, we concluded that the reasons for declining the screening invitation were embedded in the women's desire to maintain control over their lives. Perspectives: When offering screening programs, health professionals need to consider how to re-invite non-attendees from a salutogenic rather than a pathogenic approach. Using salutogenic terminology in the re-invitation may catch these women attention and thereby facilitate participating in screening. Disclosure: Nothing to disclose

Evaluating the effectiveness of a screening program for cardiovascular diseases in Kazakhstan

Abstract Background Cardiovascular diseases (CVD) occupy leading positions in the mortality of the Republic of Kazakhstan (RK). In RK CVD screening is performed with 40-years of age. Objectives: to evaluate the effectiveness of screening over time. Methods We conducted a survey of 121 patients with CVD, identified on screening. Results The average age patients in survey-54.3 [95% CI: 52.64;55.96], of which 38% are men and 62%-women. Fact smoking mark 64 persons (52±8), alcohol-(37.2±11.6), family history-66 (54.5±8.1) daily physical activity-34 person (28.1±14.3). Middle systolic blood pressure (BP) is 144.3 [95% CI: 141.61;146.99] and diastolic BP 90.2 [95% CI: 89.02;91.38] mm.Hg. Most of the respondents have different degrees of obesity. The average BMI is 31.8 [95% CI: 30.93;32.67]. The average waist size is 89.1 [95% CI: 86.88;91.52], with the waist size of women over 80 cm (91.9 [89.03;94.77] and the waist size of men 86.1 [82.31; 89.89]. Mean values for total cholesterol of 5.9 [95% CI: 5.85;5.95]. To evaluate the effect of various factors on the increase in BP, we calculated the analysis of variance. According to our calculations, gender does not affect BP, however, age, BMI and waist size affect. We interviewed patients for complaints, analyzed outpatient cards, a check-up journal: chest pains or interruptions in the heart during exercise are noted by 25 people (20.7±17.5), improvement of the subjective state-29 (24±15.9), regularly receive basic therapy-59 (48.8±9.1), call the ambulance team-43 (35.5±12), are urgently hospitalized for a year-31 (25.6±15.2) and 7 person participate in the school of CVD. There is a statistically significant relationship between gender and smoking, gender and alcohol, gender and regular intake of basic therapy at a significance level of p &amp;lt; 0.05. Conclusions Identifying the low effectiveness of CVD screening over time requires the revision of a comprehensive training program for doctors-nurses and the public. Key messages Patients in Kazakhstan generally do not change their lifestyle after screening for a disease. The effectiveness of the screening depends on the teamwork of the doctor, nurse and patient.