Stroke Death Research Articles

Analyzing Existing Algorithms and Identifying Gaps in Brain Stroke Detection

One of the global issues that matters most right now is healthcare. The primary cause of death globally is brain stroke. A valuable contribution to medicine is the early prediction and identification of brain stroke events. Numerous factors, including BMI (body mass index), age, sex, family history, gender, smoking status, hypertension, and so on, are linked to brain stroke deaths. While forecasting heart illness has received a great deal of interest in the medical community, predicting a brain stroke has received less attention. This study's primary goal is to evaluate various previously published research publications and select the most effective machine learning methods for brain stroke prediction for our next projects. It was shown that mortality rate and functional outcomes are the expected outcomes for the majority of the study work done after analyzing the various machine learning techniques used for stroke predictions and after accounting for the previously published studies. The techniques that were used most commonly were LR, DTC, RFC, SVM, KNN.

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Risk of extended major adverse cardiovascular event endpoints with tofacitinib versus TNF inhibitors in patients with rheumatoid arthritis: a post hoc analysis of a phase 3b/4 randomised safety study

ObjectivesCompare the risk of extended major adverse cardiovascular (CV) event (MACE) composite outcomes and component events in patients with rheumatoid arthritis (RA) treated with tofacitinib versus tumour necrosis factor inhibitors...

Association of white blood cell count-to-mean platelet volume ratio with the risk of fatal stroke occurrence in older Chinese

White blood cell (WBC) and mean platelet volume (MPV) counts are related to stroke events, but relationship between their combined indicator (WBC count-to-MPV count ratio (WMR)) and the risk of fatal stroke occurrence is unclear so far. In this prospective analysis, we enrolled 27,163 participants aged 50 years or older without a stroke history in the Guangzhou Biobank Cohort Study. After a mean follow-up time of 15.0 (SD = 2.2) years with 389,242 person-years, 816 stroke (401 ischaemic, 259 haemorrhagic and 156 unclassified) deaths were recorded. Cox’s proportional hazards regression was used to estimate the hazard ratios (HRs) and the 95% confidence intervals (CIs). Compared with those in the lowest quartile, participants with the highest WMR had different risks for fatal all stroke and fatal ischaemic stroke, respectively, although an increased risk for fatal ischaemic stroke was observed among participants in the fourth WMR quartile and further hs-CRP adjustment; those in the WMR change with 10% increase had a 36% increased risk of fatal all stroke and a 79% increased risk of fatal haemorrhagic stroke, compared to those in a stable (the WMR change between −10% and 10%). Our findings suggest that higher WMR and its longitudinal change were associated with an increased risk of fatal stroke occurrence in middle-aged to older Chinese; it may be a potential indicator for the future fatal stroke occurrence in relatively healthy elderly populations.

Influence of Low-Density Lipoprotein Cholesterol Levels on NSAID-Associated Cardiovascular Risks After Myocardial Infarction: A Population-Based Cohort Study.

To examine whether low-density lipoprotein cholesterol (LDL-C) levels influence the cardiovascular risk associated with non-aspirin non-steroidal anti-inflammatory drug (NSAID) use after myocardial infarction (MI). Using Danish health registries, we conducted a population-based cohort study of all adult patients with first-time MI during 2010-2020 with an LDL-C value before discharge. Based on the latest LDL-C value, we categorized patients into a low and a high LDL-C group (<3.0 vs ≥3.0 mmol/L). We used time varying Cox regression to compute hazard ratios (HRs) with 95% confidence intervals of the association between NSAID use and a major adverse cardiovascular event (MACE: recurrent MI, ischemic stroke, and all-cause death). We followed 50,573 patients for a median of 3.1 years. While exposed, 521 patients experienced a MACE: 312 in the low LDL-C group and 209 in the high LDL-C group. The HRs for MACE comparing NSAID use with non-use were 1.21 (1.11-1.32) overall, 1.19 (1.06-1.33) in the low LDL-C group, and 1.23 (1.07-1.41) in the high LDL-group. The HRs for recurrent MI and ischemic stroke were comparable between the LDL-C subgroups. The HRs for all-cause death were 1.22 (1.07-1.39) in the low LDL-C group and 1.54 (1.30-1.83) in the high LDL-C group. Changing the cut-off value for LDL-C to 1.8 and 1.4 mmol/L showed consistent results. In patients with MI, LDL-C levels did not influence the increased risk of MACE associated with NSAID use, but might influence the association between NSAID use and all-cause death.

Prevalence of Undiagnosed Hypertension and its Associated Factors Among Adult Peoples Living in Enemor Woreda, South Ethiopia, 2021. Community Based Cross Sectional Study

Background: Hypertension is defined as two or more readings of systolic blood pressure measurement of 130 mm Hg or higher or diastolic blood pressure measurement of 80 mm Hg or higher. In the early stages, symptoms of HTN are often not detectable and thus many people with the disease are left undiagnosed. Undiagnosed HTN increases the risk of complications such as renal failure, myocardial infarction, heart failure, stroke and premature death. There was a high prevalence of undiagnosed HTN among adolescents. Objective: To assess the prevalence of undiagnosed hypertension and its associated factors among adult peoples living in Enemor Woreda, Ethiopia, 2021. Method: A community based cross-sectional study design was conducted from April to May, 2021. Data were collected using a structured self-administered English version questionnaire; which translated to the national Amharic language. The data were collected from 630 households using systematic random sampling technique at K=7. The data were entered to epi data version 3.4 and analyzed by SPSS version 26. Bivariate and multivariable logistic regression with 95% CI was hold to determine the significance of variables. Result: In this finding 260 (45.3%) of respondents were identified as having undiagnosed hypertension. Respondents having sedentary life style (AOR=2.24, 95%CI (1.37, 3.67)], BMI ≥25 (AOR=2.42, 95%CI (1.43, 4.09)], smokers [AOR: 0.45, 95%CI(0.28, 0.73)], health seeking behavior [AOR: 0.41, 95%CI(0.25, 0.66)], monthly income &lt;2000 ETB [AOR: 0.68, 95%CI(0.48,0.97)] and respondents dietary habit Enjera with Wot [AOR: 0.57, 95%CI(0.40, 0.83)] were significantly associated with undiagnosed hypertension. Conclusion: The overall prevalence of undiagnosed hypertension was 45.3%. respondents with BMI kg/m2 &gt;25, having sedentary life style, cigarette smoking, health seeking behavior, dietary habit and monthly income were significance predictors of undiagnosed HTN; therefore, people should follow Life style modification and have health seeking behavior to early detect and manage undiagnosed HTN with in the community.

Efficacy and Safety of Combination Therapy with Low-Dose Rivaroxaban in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: To review the evidence on the effectiveness and safety of low-dose-rivaroxaban 2.5 mg twice daily (LDR) in patients with coronary artery disease (CAD) and/or peripheral artery disease (PAD) taking antiplatelets. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs). Efficacy endpoints were cardiovascular events (CVEs), myocardial infarction, stroke, all-cause, and cardiovascular death. Any, major, fatal bleeding, and intracranial hemorrhage (ICH) were safety endpoints. Numbers needed to treat (NNT), and numbers needed to harm (NNH) were also calculated. Results: Seven RCTs were included with 45,836 patients: 34,276 with CAD and 11,560 with PAD. Overall, 4247 CVEs and 3082 bleedings were registered. LDR in association with either any antiplatelet drug or aspirin (ASA) alone reduced the risk of CVEs (hazard ratio [HR] 0.86, 95% confidence interval [95%CI] 0.78-0.94) and ischemic stroke (HR 0.68, 95%CI 0.55-0.84). LDR + ASA increased the risk of major bleeding (HR 1.71, 95%CI 1.38-2.11) but no excess of fatal bleeding or ICH was found. The NNT to prevent one CVE for LDR + ASA was 63 (43-103) and the NNH to cause major bleeding was 107 (77-193). Conclusions: The combination of LDR with either antiplatelet drugs or low-dose aspirin reduces CVEs and ischemic stroke in patients with CAD/PAD. There was an increased risk of major bleeding but no excess of fatal or ICH was found. LDR seems to have a favorable net clinical benefit compared to ASA treatment alone.

Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre-frailty or frailty status.

In patients with hypertension and pre-frailty or frailty, the influence of systolic (SBP) and diastolic blood pressure (DBP) time in target range (TTR) on clinical outcomes is unclear. Thus, we conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Classifying 4208 participants into frail and non-frail groups using a frailty index, the study calculated blood pressure time in target range (BP-TTR) for the first three months using the Rosendaal method. The primary endpoint included a composite of nonfatal myocardial infarction (MI), acute coronary syndromes, stroke, acute decompensated heart failure (ADHF), and cardiovascular death. Relationships between BP-TTR and outcomes were analyzed using Kaplan-Meier curves, Cox models, and restricted cubic spline curves, with subgroup analysis for further insights. In a median follow-up of 3.17 years, primary outcomes occurred in 6.7% of participants. Kaplan-Meier analysis showed that a lower systolic blood pressure time in target range (SBP-TTR) (0%-25%) correlated with an increased cumulative incidence of the primary outcome (p<.001), nonfatal MI (P=.021), stroke (P=.004), and cardiovascular death (P=.002). A higher SBP-TTR (75%-<100%) was linked to a reduced risk of these outcomes. The restricted cubic spline (RCS) curve revealed a linear association between SBP-TTR and the primary outcome (non-linear P=.704). Similar patterns were observed for diastolic blood pressure time in target range (DBP-TTR). Subgroup analysis showed that the protective effect of higher SBP-TTR was less pronounced at low DBP-TTR levels (P for interaction=.023). In conclusion, this study highlights the importance of maintaining BP within the target range to mitigate cardiovascular risks in this population.

Sherman Lecture: Are We Aiming at the Correct Targets to Reduce Disparities in Stroke Mortality? Celebration, Reflection, and Redirection.

Although deaths from stroke have been reduced by 75% in the past 54 years, there has been virtually no reduction in the relative magnitude of Black-to-White disparity in stroke deaths, or the heavier burden of stroke deaths in the Stroke Belt region of the United States. Furthermore, although the rural-urban disparity has decreased in the past decade, this reduction is largely attributable to an increased stroke mortality in the urban areas, rather than reduced stroke mortality in rural areas. We need to focus our search for interventions to reduce disparities on those that benefit the disadvantaged populations, and support this review using relatively recently developed statistical approaches to estimate the magnitude of the potential reduction in the disparities.

Impact of left ventricular diastolic function and direct oral anticoagulant use for predicting embolic events in patients with heart failure and atrial fibrillation

AbstractBackgroundPatients with atrial fibrillation (AF) and heart failure (HF) have high stroke risk owing to left atrial dysfunction. However, anticoagulation is a concern in patients with high bleeding risk. We aimed to identify independent predictors of stroke in HF patients with AF.MethodsWe retrospectively examined 320 patients (mean age 79 ± 12 years, 163 women) hospitalized with acute HF complicated by AF between January 2014 and December 2018. Patients were followed from admission until ischemic stroke or systemic embolism (SSE) onset or death or were censored at the last contact date or September 2023.ResultsSSE occurred in 40 patients (median follow‐up of 528 days). Multivariate Cox regression analysis identified age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.00–1.07, p = .034), direct oral anticoagulant (DOAC) use (HR 0.26, 95% CI 0.11–0.60, p = .002), and early diastolic peak flow velocity to early diastolic peak annular velocity (E/e'; HR 1.05, 95% CI 1.02–1.08, p &lt; .001) to be independent predictors of SSE, whereas left atrial reservoir strain was not. After determining an appropriate E/e' cutoff by receiver‐operating characteristic curve analysis and adjusting the multivariate Cox model, E/e' ≥17.5 (HR 3.30, 95% CI 1.56–6.83, p = .001) independently predicted SSE. The results were consistent with no interaction in the subanalysis except for gender.ConclusionElderly patients not on DOACs with elevated E/e' may be at higher risk of stroke, suggesting that DOACs should be the first choice for patients with elevated E/e' and aggressive additional prophylaxis and careful follow‐up are needed.

The Role of County-Level Persistent Poverty in Stroke Mortality in the USA.

Stroke is a major health concern in the USA, disproportionately affecting socioeconomically disadvantaged groups. This study investigates the link between persistent poverty and stroke mortality rates in residents aged 65 and above, positing that sustained economic challenges at the county level correlate with an increase in stroke-related deaths. Persistent poverty refers to a long-term state where a significant portion of a population lives below the poverty threshold for an extended period, typically measured over several decades. It captures the chronic nature of economic hardship faced by a community across multiple generations. Utilizing data from the CDC Wonder database and the American Community Survey, we conducted a comprehensive analysis across US counties, differentiating them by persistent poverty status. Our results indicate a statistically significant link between persistent poverty and increased mortality from ischemic and hemorrhagic strokes; counties afflicted by long-standing poverty were associated with an additional 33.49 ischemic and 8.16 hemorrhagic stroke deaths per 100,000 residents annually compared to their wealthier counterparts. These disparities persisted when controlling for known stroke risk factors and other socioeconomic variables. These results highlight the need for targeted public health strategies and interventions to address the disparities in stroke mortality rates and the broader implications for healthcare equity. The study underscores the vital role of socioeconomic context in health outcomes and the urgency of addressing long-term poverty as a key determinant of public health.

Global, regional, and national burden of stroke attributable to extreme low temperatures, 1990-2019: A global analysis.

Extreme ambient temperatures have been linked to increased risks of stroke morbidity and mortality. However, global estimates of the burden of stroke due to extreme low temperatures are not well-defined. This study aimed to determine the global burden of stroke due to extreme low temperatures and its spatiotemporal trend from 1990 to 2019. Based on the Global Burden of Disease Study 2019, we obtained global, regional, and national data on deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized rate of DALYs (ASDR) of stroke attributed to extreme low temperatures, further stratified by age, sex, and sociodemographic index (SDI). Globally, in 2019, an estimated 474,000 stroke deaths with the corresponding ASMR (6.2 (95% uncertainty interval (UI): 4.6-7.9)) and ASDR (103.9 (95% UI: 77.0-134.5)) per 100,000 population, were attributable to extreme low temperatures. The most significant burden was observed in Central Asia, followed by Eastern Europe and East Asia. From 1990 to 2019, the global burden of stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) attributable to extreme low temperatures exhibited a decrease in both ASMR and ASDR. Significant decreases in stroke burden occurred in the high-SDI regions, high-income Asia Pacific, and subarachnoid hemorrhage cases. Moreover, the ASMR and ASDR increased with age and were higher in males than females. The global stroke burden due to extreme low temperatures remains high despite a decreasing trend over the past three decades. The stroke burden due to extreme low temperatures was more notable for Central Asia, older people, and the male sex.

Non-HDL cholesterol and residual cardiovascular risk in statin-treated patients with and without diabetes: the Western Denmark Heart Registry.

Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimizing secondary preventive therapies. This study investigates if non-high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischaemic heart disease (IHD) patients with and without diabetes. Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography (CAG) from 2011 to 2020. Non-HDL-C was assessed within 1 year after CAG. Outcomes were ASCVD (myocardial infarction, ischaemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios (HRs) adjusted for age, sex, smoking, and hypertension. A total of 42 057 patients were included: 8196 patients with diabetes and 33 861 without diabetes. During the median 4.6 years of follow-up, event rates per 1000 person-years of ASCVD were 28.8 (27.1-30.5) and 17.2 (16.5-17.8) among patients with and without diabetes. In patients with diabetes, the adjusted HRs of ASCVD as compared with non-HDL-C < 25th percentile were 1.0 (0.9-1.2), 1.3 (1.1-1.6), and 1.6 (1.2-2.1) for patients in the 25th-74th, 75th-94th, and ≥95th percentiles. In patients without diabetes, the corresponding adjusted HRs were 1.1 (0.9-1.1), 1.2 (1.1-1.4), and 1.7 (1.4-2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. In statin-treated IHD patients with and without diabetes, non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention, targeting patients who may benefit most from intensified preventive therapy.

Emergency care and treatment of cerebral stroke at the stages of hospitalisation

According to the World Health Organization experts, about 7 million deaths due to cerebrovascular disease are recorded annually worldwide, and the number of stroke deaths is projected to reach 7.8 million by 2030. The main causes of stroke and its growth are population ageing, urbanisation, unhealthy lifestyles, insufficient control of risk factors (hypertension, atherosclerosis, diabetes, stressful situations, etc.). It is also associated with untimely provision of emergency medical care at the pre-hospital stage and ineffective treatment of strokes at the hospital stage, as well as a low efficiency of preventive treatment for recurrent stroke and rehabilitation measures. The lecture presents modern methods and techniques for treating patients with acute cerebrovascular accident at different stages: pre-hospital, hospital, and rehabilitation.

Examining the influence of global smoking prevalence on stroke mortality: insights from 27 countries across income strata

BackgroundThis study investigates the influence of Global Smoking Prevalence (GSP) on Stroke Death Rates (SDR) across 27 countries categorized into High-Income Countries (HIC), Upper Middle-Income Countries (UMIC), Lower Middle-Income Countries (LMIC), and Low-Income Countries (LIC).MethodsAnalysing data from two distinct periods (1990–1999 and 2010–2019), countries exhibiting an increased SDR were selected. The study uses a polynomial regression model, treating income groups as cross-sectional and years as time series data.ResultsResults from the regression model reveal that 17 countries observed a significant impact of GSP on SDR, with only Turkey, Solomon Islands, and Timor-Leste resulting in negative values. However, the study emphasises that out of all 27 countries, the highest occurrence of the impact of GSP on SDR has been reported in the LMIC stratum for the period under review.ConclusionIt is evident that GSP affects the risk of incidence of stroke death, specifically in the LMIC stratum. Furthermore, it has been identified that GSP is a major preventable risk factor affecting global mortality. To mitigate the risk of stroke death attributable to smoking prevalence, necessary preventive steps should be adopted to encourage smoking cessation, and essential policies should be implemented to reduce the burden of SDR.

Abstract P246: Geographical Mapping and Cluster Analysis of Ischemic Stroke in Kentucky

Background: Stroke death is the third leading cause of death in the United States, the sixth leading cause of death in Kentucky (KY), and ischemic stroke (IS) is the most prevalent type in adults (~85%). Small area estimates of stroke incidence can help identify local interventions to lower the burden of vascular risk factors and risk of recurrent IS in these areas. Therefore, the goals of this study are to calculate small area IS incidence rates, examine clusters, and understand the distribution of IS in KY. Methods: Data was obtained from the Kentucky Hospital Inpatient Discharge and Outpatient Services Databases (HIDOSD) from 2012 to 2021; and the Kentucky Cabinet for Health and Family Services. HIDOSD represents KY emergency department discharges, inpatient data, and ambulatory facility services. We linked 5-digit Zip codes to (n=759) zip code tabulation areas (ZCTA) available from the US Census Bureau. The annualized IS rate per 100,000 was calculated by dividing the mean number of IS hospitalizations from 2012 to 2021 by the ZCTA 2020 population. We categorized IS rates by quartiles and calculated box plots in descriptive analyses. We tested for significant spatial clusters using the Local Moran’s I with Empirical Bayes rate smoothing in GeoDa. Results: From 2012-2021, 90,840 IS hospitalizations were reported in KY. The median IS rate was 226.5 per 100,000. The median rate in the highest quartile was 290.8 (IQR 171.7 - 290.8) vs 171.7 (IQR 171.7 - 290.8) in the lowest quartile. An area of high IS rate clusters (n=20) was identified in southeastern KY with lower clusters dispersed throughout the state. Figure. Conclusions: This 10-year analysis of IS hospitalizations across KY identified areas of potential intervention. Future efforts are needed to identify the social and medical contributors driving burden of IS in these areas and to design interventions targeted to improve health outcomes.

Abstract P305: Room for Improved Secondary Prevention of Major Cardiovascular Events Among the Population With New Onset Diabetes: A Longitudinal Latent Class Trajectory Analysis

Background: After a diagnosis of diabetes, specialist physicians may play a key role in the secondary prevention of major cardiovascular events (MACE). Yet, trajectories of visits to specialists are heterogenous and their efficacy in the prevention of MACE remains unexplored. Goal: To assess whether trajectories of visits to specialists are associated with MACE among new cases of diabetes. Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we identified new cases of diabetes ≥20 years old during fiscal year 2013, who had no prior history of MACE (ischemic cardiopathy, stroke, myocardial infarction or cardiovascular death). Firstly, individual trajectories according to the presence/absence of ≥1 ambulatory visit to a specialist (cardiologist, internist, endocrinologist) were compiled over consecutive 3-month periods up to 2 years following diagnosis. Patients with no visit were compiled in a “primary care only” group, while others were classified in groups using latent class growth analysis. Patients who had a MACE during this period were excluded. Secondly, the risk of MACE occuring after the 2 years following diagnosis up to December 31 st 2019 was compared between groups using a marginal Cox proportional hazards regression model, adjusted with inverse probability weighting and providing adjusted hazard ratio (aHR) with 95% confidence intervals (CI). Results: Among the 24,782 patients included, 5 groups were identified ( Figure 1 ). A total of 2,837 MACE occurred. Compared with the “primary care only group”, those who consulted a specialist were at higher risk of MACE (Regular/frequent visits: aHR: 1.50 [95% CI: 1.26 to 1.66]; Late visits: aHR: 1.41 [1.13 to 1.73]; Regular/sparce visits: 1.38 [1.27 to 1.51]; Early visits: 1.36 [1.19 to 1.54]), while no difference was observed between these groups. Conclusions: Although confounding by indication cannot be totally ruled out, these results may suggest room for improvement in the secondary prevention of MACE after a diabetes diagnosis.

Abstract P472: Dietary Consumption of Potatoes and Incidence of Cardiovascular Disease

Background: Previous studies have reported conflicting results of the relationship between types of potato consumption (baked and boiled potatoes and French fries) and cardiometabolic outcomes. We examined associations of potato consumption with incidence of CVD from 4 large cohorts. Methods: We meta-analyzed data from 4 large studies (COSMOS, PHS, WACS, and WHS). Consumption of baked, boiled, and mashed potatoes and French Fries was assessed using a food frequency questionnaire. The primary outcome was 3-point MACE (myocardial infarction, stroke, and cardiovascular death). Within each cohort, Cox regression model was used to compute hazard ratios (95% CI) adjusting for age, sex, race, caloric intake, smoking status, alcohol use, education level, exercise level, body mass index, and dietary factors (e. g., Fruits and vegetables, red/processed meat, beverages, trans fats, etc.), and prevalent diabetes and hypertension. Cohort-specific effect sizes were pooled using an inverse-variance weighted method. Results: Among 84,700 subjects, mean age ranged from 54 (WHS) to 72 (COSMOS) years, 68% were women, and 5231 CVD events occurred during follow-up. Consumption of combined baked, boiled, and mashed potatoes was not associated with the incidence of CVD: Pooled HR (95% CI): 1.00 (ref), 0.96 (0.89-1.04), 0.94 (0.86-1.02), and 0.97 (0.87-1.08) for consumption of 0, 0.5-1, &gt;1 to &lt;3, and ≥3 servings per week, respectively, p for linear trend 0.47. Furthermore, Consumption of French fries was not associated with CVD risk with pooled HR (95% CI) of 1.00 (ref), 0.99 (0.92-1.05) and 1.02 (0.88-1.18) for intake of 0, &lt;1, and ≥1 servings/week. The p for linear trend 0.55. Conclusion: Our data do not support an association of baked, boiled, and mashed potatoes, or French fries with incidence of CVD.

Abstract P169: Cardiovascular Disease Incidence Among Male Veterans by Sexual Orientation and Race

Introduction: Studies of cardiovascular disease (CVD) in sexual minority (SM) men (i.e., gay, bisexual) vs. heterosexual men are limited by small sample sizes and lack of objective CVD ascertainment. Small samples also hinder study at the intersection of race and sexual orientation on CVD events. We used the Veterans Healthcare Administration Lesbian, Gay, Bisexual, Transgender Electronic Health Record cohort to fill these knowledge gaps. Methods: We studied 919,404 male cisgender veterans who were free of prevalent CVD and classified as SM or non-SM by a natural language processing tool. We defined incident CVD as first instance of AMI, ischemic stroke, cardiac revascularization, or CVD death between baseline and date of death or 8/31/22. We stratified sample statistics by SM status and race. We used Cox proportional hazards regression to assess the intersection of sexual orientation and race with incident CVD; we adjusted for Hispanic ethnicity and age. Based on the minority stress model, non-SM White men were the referent. Results: Within races, traditional CVD risk factors were similarly distributed by SM status but SM men had greater prevalence of stress-associated characteristics like substance use, depression, and anxiety. Heterosexual, gay, and bisexual Asian men had lower CVD risk than non-SM White men, while Black/African American and Multiracial men had persistently increased CVD risk ( Table ). White and American Native gay men had increased CVD risk vs. non-SM White men. With the exception of Asians, all unclassified SM men had increased CVD incidence vs. non-SM White men. Risk was highest in among Black or Multiracial SM men. Conclusion: This is one of the first studies to examine the intersection of sexual orientation and race on CVD risk in male veterans. CVD risk appears increased or decreased in certain racial groups regardless of sexual orientation but this is not always true and invites further study into the mechanisms by which stress results in inequitable CVD events across groups.

Abstract MP25: Effect of Marine Omega-3 Fatty Acids on Risk of Incident Cardiovascular Disease Among Individuals With Non-Alcoholic Fatty Liver Disease: Secondary Analysis of a Randomized Clinical Trial

Background: Individuals with non-alcoholic fatty liver disease (NAFLD) are at increased risk for developing cardiovascular disease (CVD), often attributed to adverse metabolic derangements such as insulin resistance and elevated triglycerides. Marine omega-3 (n-3) fatty acids may partially ameliorate these metabolic consequences. Whether supplementation with n-3 fatty acids can reduce the risk of CVD in NAFLD remains unknown. Aims: To investigate the association between a NAFLD phenotype and incident CVD as well as assess whether randomization to n-3 fatty acids can modify this risk. Methods: Among 16,824 participants from the Vitamin D and Omega-3 Trial (VITAL; NCT01169259; a 2x2 factorial randomized trial of 1 g/d of EPA+DHA or 2000 IU/d of vitamin D 3 ) who provided baseline blood samples, we measured liver function tests. NAFLD was defined as baseline alanine aminotransferase (ALT)&gt;40 U/L and/or aspartate aminotransferase (AST)&gt;35 U/L, per guidance from the American Association for the Study of Liver Diseases. Incident CVD was a composite of myocardial infarction (MI), stroke, and CVD death. Multivariable-adjusted Cox models (adjusted for demographics, cardiovascular risk factors, and treatment assignment) were used to estimate hazard ratios (aHRs) and 95% confidence intervals (CI) for NAFLD with incident CVD. Effect of randomization to n-3 fatty acids was assessed among individuals with and without NAFLD. Results: We identified 2,495 participants with NAFLD at baseline, who tended to be younger, male, and non-White compared to individuals without NAFLD. After a median follow-up of 5.3 years, 522 CVD events were ascertained, with 101 occurring among those with NAFLD. Compared to individuals without NAFLD, those with NAFLD were at higher risk of developing CVD, aHR (95%CI): 1.48 (1.19, 1.84), P =0.0004. This association was predominantly driven by a higher incidence of total stroke, 1.53 (1.08, 2.17), P =0.02, compared with MI, 1.15 (0.81, 1.64), P =0.43. Randomization to n-3 fatty acids did not significantly reduce CVD incidence among individuals with, 1.13 (0.77, 1.68) or without NAFLD, 1.02 (0.85,1.24), P interaction =0.70. Conclusion: In a large primary prevention trial of older individuals, NAFLD was associated with a higher risk of CVD, particularly stroke. Randomization to n-3 fatty acids did not significantly reduce CVD outcomes in this high-risk population.