Cardiovascular Risk Variables Research Articles

Metabolomic profiling of the entire UK Biobank enables interpretation of familial hypercholesterolemia mutations and prediction of severe cardiovascular outcomes

Abstract Background Familial hypercholesterolemia (FH) is an inherited disorder resulting in high levels of LDL-C from birth. Premeature coronary heart disease occurs in half of affected men by age 50 years(1). While many genetic variants that cause FH are well understood, there are also many variants in FH genes that are of uncertain clinical significance. Furthermore, the variability in residual cardiovascular risk of FH carriers after statin treatment is not fully understood. We here investigate whether metabolomic and genomic data from the 500,000 person UK Biobank cohort can aid in interpretation of candidate pathogenic variants for FH, and characterise future risk of severe cardiac events in the carriers of such variants. Methods We have quantified 249 metabolomic parameters in 490,830 blood samples from UK Biobank cohort. Among 186,483 participants with exome sequence data we identified 896 who carried known pathogenic FH variants and 405 who carried variants of unknown significance in an established FH gene. We fitted a logistic predictive model to identify pathogenic mutations using LDL levels, statin use and 17 principal components of the metabolomic parameters. We further tested whether metabolomic and genomic scores for predicting future risk of myocardial infarction (MI), that were trained in the general population (i.e. individuals without FH), could predict risk in FH carriers. Results A model including all metabolites had a higher accuracy at identifying known pathogenic FH variants (36/56 at FDR < 0.05), compared to LDL and statin use alone (30/56). Our model also identified 8 FH variants marked as uncertain significance in ClinVar with significant (FDR < 0.05) evidence of predicted pathogenicity. We found that our metabolomic risk score predicted 10-year risk of MI among FH carriers (HR=1.96 per SD, p = 0.0011). This was indeed stronger than the effect in the general population (HR = 1.64 per SD, p = 2.5e-168). A combined metabolomic and polygenic risk score had an even larger effect at predicting MI in FH carriers (HR = 3.06 per SD, p = 2.0e-6), and this score was significantly better at predicting MI in FH carriers than in non-carriers (HR = 3.06 vs 1.88 per SD, interaction p = 0.042). Conclusion Familial hypercholesterolemia is an important source of risk for early cardiovascular disease. Population-scale metabolomics can help distinguish pathogenic from benign variants that have not yet been characterised. Metabolomic and genomic scores can also identify individuals at most elevated risk, and provide even more information to FH individuals than in the general population.

The association between physical activities combined with dietary habits and cardiovascular risk factors

ObjectivesThe aim of this study was to investigate the association between physical activities combined with dietary habits and cardiovascular risk factors in adults from Nanjing, China. MethodsThe cross-sectional survey conducted in 2017 involved a sample of 60 283 individuals aged ≥18 years in Nanjing municipality, China. The sampling method used was multistage stratified cluster sampling. The primary outcomes from multivariate logistic regression analysis with adjusted potential confounders were the relationships between physical activities combined with dietary habits and cardiovascular risk variables. Relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S) were used to assess an additive interaction between dietary habits and physical activities. ResultsAfter adjusting potential confounders, cardiovascular risk factors were significantly associated with the association of physical inactivity and unhealthy diet, with the highest odds ratios (ORs) for low density lipoprotein-cholesterol (HLDL-c) (1.64, 95% CI [1.47, 1.84]) and hypertension (1.55, 95% CI [1.46, 1.64]). Additive interactions between physical inactivity and unhealthy diet were found in on cardiovascular risk factors of higher low-density lipoprotein-cholesterol (HLDL-c) (S, 2.57; 95% CI [1.27, 5.21]), type 2 diabetes (T2D) (S, 1.96; 95% CI [1.23, 3.13]), dyslipidemia (S, 1.69; 95% CI [1.08, 2.66]) and hypertension (S, 1.46; 95% CI [1.12, 1.89]). Their RERI was 0.39 (95% CI [0.18, 0.60]), 0.22 (95% CI [0.09, 0.35]), 0.11 (95% CI [0.03, 0.19]) and 0.17 (95% CI [0.06, 0.28]), respectively. OR of being HLDL-c, T2D, hypertension and dyslipidemia in participants of physical inactivity and unhealthy diet was 24%, 15%, 11% and 8.3%, respectively. Multiplicative interaction was detected in obesity, hypertension, T2D and HLDL-c. ConclusionAn unhealthy diet and physical inactivity were strongly linked to cardiovascular risk factors. This study also showed that an unhealthy diet and physical inactivity combined to produce an additive effect on T2D, hypertension, HLDL-c, and dyslipidemia, suggesting a higher risk than the total of these factors, especially HLDL-c. Preventive strategies aimed at reducing cardiometabolic risks such as hypertension, T2D, HLDL-c, and dyslipidemia are necessary for targeting physical inactivity and unhealthy diet.

Role of gut microbiota in cardiovascular diseases - a comprehensive review.

The connection between cardiovascular illnesses and the gut microbiota has drawn more and more attention in recent years. According to research, there are intricate relationships between dietary elements, gut bacteria, and their metabolites that affect cardiovascular health. In this study, the role of gut microbiota in cardiovascular disorders is examined, with an emphasis on the cardiac consequences brought on by changes in gut microbiota. This essay discusses the gut-heart axis in depth and in detail. It talks about clinical research looking at how soy consumption, probiotic supplements, and dietary changes affected gut microbiota and cardiovascular risk variables. Our goal is to clarify the possible pathways that connect gut microbiota to cardiovascular health and the implications for upcoming treatment approaches. The authors examine the composition, roles, and effects of the gut microbiota on cardiovascular health, including their contributions to hypertension, atherosclerosis, lipid metabolism, and heart failure. Endotoxemia, inflammation, immunological dysfunction, and host lipid metabolism are some of the potential processes investigated for how the gut microbiota affects cardiac outcomes. The research emphasizes the need for larger interventional studies and personalized medicine strategies to completely understand the complexity of the gut-heart axis and its implications for the management of cardiovascular disease. The development of novel treatment strategies and cutting-edge diagnostic technologies in cardiovascular medicine may be facilitated by a better understanding of this axis.

Road Traffic Noise Annoyance and Cardiovascular Disease Risk in Population: A Case Series Study in Kota Bharu, Malaysia

Noise pollution can cause annoyance, significantly threatening the population’s health and well-being. This study aimed to find an association between road traffic noise exposure and cardiovascular disease (CVD) risk among residents in Kota Bharu, Malaysia. This descriptive study used a case series approach and surveyed 34 residents in selected residential areas near main roads. An adapted questionnaire was distributed to residents using a purposive sampling method. Questions related to sociodemographic information, self-reporting about CVD, and road traffic noise assessment were asked to investigate the underlying risk factors for CVD. The average score of CVD assessment was classified as moderate risk. No significant association between noise annoyance and CVD was found using multiple linear regression. However, the association between cardiovascular risk and sociodemographic variables, particularly the length of residency at the current address, was statistically significant. Although noise annoyance was not associated with CVD, the length of residency could mediate CVD risk as those living longer in residence might be less vulnerable to the noise. Future longitudinal studies are recommended, which include a noise exposure assessment with a larger sample.

Role of the intestinal microbiome and its therapeutic intervention in cardiovascular disorder.

The gut microbiome is a heterogeneous population of microbes comprising viruses, bacteria, fungi, and protozoa. Such a microbiome is essential for sustaining host equilibrium, and its impact on human health can be altered by a variety of factors such as external variables, social behavior, age, nutrition, and genetics. Gut microbes' imbalances are related to a variety of chronic diseases including cancer, obesity, and digestive disorders. Globally, recent findings show that intestinal microbes have a significant role in the formation of cardiovascular disease (CVD), which is still the primary cause of fatalities. Atherosclerosis, hypertension, diabetes, inflammation, and some inherited variables are all cardiovascular risk variables. However, studies found correlations between metabolism, intestinal flora, and dietary intake. Variations in the diversity of gut microbes and changes in their activity are thought to influence CVD etiology. Furthermore, the gut microbiota acts as an endocrine organ, producing bioactive metabolites such as TMA (trimethylamine)/TMAO (trimethylamine N-oxide), SCFA (short-chain fatty acids), and bile acids, which have a substantial impact on host wellness and disease by multiple mechanisms. The purpose of this overview is to compile current evidence highlighting the intricate links between gut microbiota, metabolites, and the development of CVD. It focuses on how intestinal dysbiosis promotes CVD risk factors such as heart failure, hypertension, and atherosclerosis. This review explores the normal physiology of intestinal microbes and potential techniques for targeting gut bacteria for CVD treatment using various microbial metabolites. It also examines the significance of gut bacteria in disease treatment, including supplements, prebiotics, probiotics, antibiotic therapies, and fecal transplantation, which is an innovative approach to the management of CVD. As a result, gut bacteria and metabolic pathways become increasingly attractive as potential targets for CVD intervention.

Impact of gluten-free diet (GFD) on some of cardiovascular risk factors: a systematic review and meta-analysis.

A gluten-free diet (GFD) may have a stronger potential impact on reducing cardiovascular (CV) risk factors, according to research evidence. We investigated the impact of GFD on CV risk variables by doing a systematic review and meta-analysis for this reason. We conducted a thorough database search starting on January 1, 2000, and ending on July 12, 2022. We used random-effects models to pool the data. Totally 19 articles met the eligible criteria and were included. Pooled findings indicated that intervention with GFD has a significantly beneficial effect on high-density lipoprotein (HDL) (WMD: 4.80 mg/dl, 95% CI: 2.09, 7.51, P = 0.001), systolic blood pressure (SBP) (WMD: -2.96 mmHg; 95% CI: -4.11, -1.81, P < 0.001), and C-reactive protein (CRP) (WMD: -0.40, mg/l, 95% CI: -0.67, -0.14, P = 0.002) levels. In celiac patients as well as with an intervention duration of more than 48 weeks, GFD increased TC and HDL compared to non-celiac patients and with an intervention duration lower than 48 weeks, respectively. The results of the present study showed that GFD can have a significant and beneficial effect on HDL, SBP, and CRP.

Evaluation of serum gamma-glutamyl transferase among patients with coronary artery disease in Erbil city

Background and objective: The leading cause of morbidity and mortality globally is coronary artery disease (CAD). One of the recent new parameters for evaluating CAD is Serum GGT, which has been shown to be a predictor of coronary artery status irrespective of the traditional cardiovascular risk variables. This study aimed to evaluate and assess the correlation between serum GGT and other variables among patients with CAD in comparison with healthy subjects. Methods: A case-control prospective study. Subjects were grouped into Group I (CAD patients-117 individuals) and Group II (healthy Subjects-83 individuals) based on their Coronary Angiographic profile at surgical specialty Hospital-Cardiac Center-Erbil/Iraq. Parameters of S. GGT, S. total cholesterol, S.HDL-C, S.LDL-C, S. VLDL-C, and S.TG, S. (25)OH vitamin D, serum troponin T, S.CK-MB, and CRP were assessed for both groups. Results: The study population included 58% of male and 42% of female participants, with an age range of 30-77, with a mean of 56.13± 10.5 years old. The Pearson’s correlation coefficient of serum GGT with other variables showed that the relation between serum GGT with VLDL-C, CRP, and Triglyceride among CAD patients was found to be a weakly positive correlation and statistically significant (r=0.3, P = 0.004), (r=0.2, P = 0.031), and (r=0.3, P = 0.007) respectively. Conclusion: The present study showed that S.GGT as a new potential biochemical marker for preclinical atherosclerosis, would be a useful and important marker for assessing and evaluating risk factors of coronary artery disease and to further evaluations for CAD.

P116: Cessation of caregiving due to institutionalization: Dementia family caregivers’ profile. A 3 year longitudinal study

Objective:Caregiving of a relative with dementia is considered a chronic stressful situation that generates physical and psychological strain and that may have negative effects on caregivers’ health. Many caregivers make the decision to enter their relatives in a nursing-home, however, there are few studies that analyze psychosocial (e.g., guilt) and biomarkers of cardiovascular risk (C-reactive protein, CRP) variables that are related to this decision during the caregiving process stress. The aim of this study was to analyze caregivers’ differences between caregivers who finish the role of caring of their relatives with dementia and those who continue their caregiving role throughout the process of caring in a 3-year period.Methods:The sample consisted of 294 family caregivers of people with dementia and was divided in two groups; a) caregivers who institutionalized their relatives during a 3-year period (12.7%); and caregivers who maintained their role as caregivers (87.3%).Results:Preliminary results show that caregivers who institutionalized their relatives with dementia in some time point of the caregiving process presented at baseline more frequency of behavioral problems (t = -2.95; p &lt; .01), more feelings of guilt (t = -3.52; p &lt; .01) and compassion (t = -3.79; p &lt; .01), reported less frequency of dysfunctional thoughts about caregiving (t = 1.99; p &lt; .05) and presented higher levels of CRP (t = 2.72; p &lt; .01), compared to caregivers who maintained their role as caregivers. In addition, caregivers who institutionalized their relative were younger (t= 2.13; p &lt; .05) and reported more weekly hours (t= -3.46; p &lt; .01) and more days (t= -3.01; p &lt; .01) of home help compared to those caregivers who maintained their role. No significant effects were found for caregivers’ gender (p = .38), daily hours caring (t= 1.54; p = .13) nor time caring (t=-1.1; p = .27).Discussion:The results of this study present several clinical implications. Knowing variables that are related to the decision of institutionalization could prevent it as well as it can be useful to accompany caregivers by providing support throughout the entire process.

Predicting the risk of in-hospital Asian NSTEMI patients using stacked ensemble learning

Abstract Background NSTEMI affects 60–75% of patients with MI and has a variety of clinical manifestations and prognoses. Ensemble learning (EL) utilizes the machine learning (ML) models on a classification task to make more accurate predictions than any single ML model. It has also been demonstrated to be superior to conventional risk scores in predicting mortality risk. However, no studies on the application of EL to ASIAN NSTEMI patients have been published. Purpose To identify factors associated with Asian in-hospital NSTEMI patients using ML and to develop a stacking EL-based NSTEMI risk score that is specifically tailored to the Asian population. Methods From 2006 to 2016, 10464 data were collected from the Malaysian National Cardiovascular Disease Database (NCVD-ACS) registry on hospitalized multiethnic Asian patients admitted with NSTEMI. This study utilized 39 variables, including demographic, cardiovascular risk, medication, and clinical variables. For stacked EL model development, four algorithms, Support Vector Machine (SVM), Random Forest (RF), eXtreme Gradient Boosting (XGB), and Naive Bayes (NB), are used as base learners, and Generalized Linear Model (GLM) is used as the meta learner. Significant variables were chosen and ranked using ML variable importance with backward elimination. As a predictive performance metric, the area under the curve (AUC) was used. Using a validation dataset, algorithms were validated against the TIMI for NSTEMI, and the net reclassification index (NRI) was calculated. Results The stacked EL models developed using SVM feature selection (13 predictors, AUC = 0.823, CI: 0.779 - 0.867) outperforms the conventional risk score, TIMI (AUC = 0.563, CI: 0.515 - 0.610). RF contributes the most to the EL model predictions, followed by NB, XGB and SVM (Figure 1). Common predictors between SVM feature selection and TIMI are; age, hypertension and ECG-type depression. SVM feature selection also identified gender, MI history, chronic lung disease, heart rate, systolic blood pressure, Killip class, fasting blood glucose, LMWH, beta-blockers and angiotensin II receptor blocker as predictors that improve mortality prediction in ASIAN NSTEMI patients. Our findings indicate that the TIMI score underestimates the mortality risk of NSTEMI patients. Stacked EL model using selected predictors classified 47.4% of nonsurvivors as high risk (risk probabilities &amp;gt; 50%), whereas TIMI (score &amp;gt; 5) classified only 3.3% of nonsurvivors as high risk (Figure 2). The NRI of NSTEMI patients using the EL model (SVM selected var) resulted in an NRI of 79.8% with a p-value &amp;lt; 0.00001 when compared to the TIMI for NSTEMI risk score. Conclusions The stacked EL algorithm classifies ASIAN NSTEMI patients more accurately than the single ML model and TIMI score. A precise prognosis is useful for selecting the appropriate level of care and pharmacological or invasive treatment for patients with Asian NSTEMI.Relative influence of each ML modelsStacked EL performance on validation set

Sex moderates the relationship between social support and cardiovascular prevention behaviors in middle-aged and older adults

Abstract Funding Acknowledgements Type of funding sources: None. Background Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are found to be more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. Purpose To investigate whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. Method Participants were 17,287 adults (n=10,264 middle-aged adults 40-64 years old and n=7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. Results Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged (screening: B=0.13, 95% CI [0.06-0.20], p&amp;lt;0.001; behaviors: B=0.33 [0.26-0.41], p&amp;lt;0.001) and older men (screening: B=0.10 [0.04-0.17], p = 0.001; behaviors: B=0.16 [0.08-0.25], p&amp;lt;0.001), whereas older women had comparatively high adherence which was unrelated to social support (screening: B=0.02 [-0.03-0.08], p = 0.433; behaviors: B=0.03 [-0.03-0.10], p = 0.342). Conclusions Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.

Sex Moderates the Relationship Between Social Support and Cardiovascular Prevention Behaviors in Middle-aged and Older Adults.

Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342). Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.

Investigating cardiovascular risk in premenopausal women on oral contraceptives: Systematic review with meta-analysis.

The use of oral contraceptives (OCs) is associated with an increased risk of cardiovascular events such as arterial and venous thrombosis (VTE). Cardiovascular diseases (CVDs) are the leading cause of death worldwide, with low- and middle-income nations accounting for over three-quarter of CVD deaths. The aim of this systematic review is to provide a comprehensive synthesis of the available evidence on the link between OC use and CVD risk in premenopausal women and to further assess the role of geographic disparities in the reported prevalence of CVD risk in women on OCs. A comprehensive search of databases such as MEDLINE, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition was conducted, right from the inception to the present, by using the EBSCOhost search engine. The Cochrane Central Register of Clinical trials (CENTRAL) was also searched to augment relevant sources of information. OpenGrey, which is a repository of information providing open access to bibliographical references, was searched and the reference list of the selected studies was also scanned. The potential risk of bias of the included studies was assessed using the modified Downs and Black checklist. Data analysis was performed using the Review Manager (RevMan) version 5.3. We included 25 studies that comprised 3,245 participants, of which 1,605 (49.5%) are OC users, while 1,640 (50.5%) are non-OC users. A total of 15 studies were included for meta-analysis, and the overall pooled estimates suggested a significant increase in the traditional cardiovascular risk variables [standardized mean difference (SMD) = 0.73, (0.46, 0.99) (Z = 5.41, p < 0.001)] and little to no difference in endothelial activation among OC users when compared with non-OC users [SMD = -0.11, (-0.81, 0.60) (Z = 0.30, p = 0.76)]. Europe [SMD = 0.03, (-0.21, 0.27), (Z = 0.25 p = 0.88)] had the least effect size, while North America had the highest effect size [SMD = 1.86, (-0.31, 4.04), (Z = 1.68 p = 0.09)] for CVD risk in OC users when compared with non-OC users. The use of OCs suggests a significant increase in the prevalence of traditional cardiovascular risk variables with little to no difference in the risk of endothelial dysfunction when compared with non-OC users, and the magnitude of CVD risks varies across different geographical regions. This systematic review was registered in the international prospective register of systematic reviews (PROSPERO) under the registration number: CRD42020216169.

42 Profile of cardiovascular risk factors among child sexual abuse victims in Puerto Rico

OBJECTIVES/GOALS: This study aimed to determine the prevalence of cardiovascular risk factors in a group of victims of CSA in Puerto Rico and determine the impact of both the offender and the number of victimizations on the presentation of cardiovascular risk factors. METHODS/STUDY POPULATION: A study design of a retrospective chart review at a clinical forensic service in Puerto Rico. The demographic variables were age, sex, and health plan; the CV risk factors were family health history, level of physical activity, blood pressure, BMI, and lipid profile. Sexual violence experience variables were sexual assault, sexual molestation, the relationship with the offender, and the number of victimizations. Medical records were used to identify cardiovascular risk factors and variables associated with child sexual abuse victimization. Central tendency and frequencies were used to describe the risk factors and victimization. The Mann–Whitney and Fisher exact tests were used to determine the differences between the type of victimization and the risk factors for cardiovascular health. RESULTS/ANTICIPATED RESULTS: Most of the victims were female (81%), with an average age of 10 (SD 3.8). According to the 31 reviewed charts, 55% were victims of sexual assault, the offender was a family member (84%), and the assault had occurred more than once (81%). The study also found that systolic blood pressure, diastolic blood pressure, total cholesterol, and body mass index (BMI) were at unhealthy levels (based on age and sex); when the victim reported sexual assault, the offender was a family member, and more than one assault occurred. Systolic blood pressure, diastolic blood pressure, and fasting blood sugar were statistically significant among victims who reported being either sexually assaulted or sexually molested when the offender was a family member, and the victimization occurred more than once. DISCUSSION/SIGNIFICANCE: This study indicated a higher prevalence of CVD risk factors in children victims of sexual assault. The blood pressure, lipid profiles, and BMIs were much higher than the standards. Early childhood screening is crucial in alerting health professionals to a child’s exposure to trauma.

AN UPDATED REVIEW ON HYPERTENSION

A common, aging-related chronic condition called hypertension frequently results in kidney and heart problems that are quite serious. A number of additional cardiovascular risk variables are frequently reported together with blood pressure. Automated blood pressure testing methods are becoming more and more common in the diagnosis of hypertension. The main or secondary kidney's failure to drain salt at a normal blood pressure is a prerequisite for the pathophysiology of essential hypertension. Many people with hypertension are unaware of their disease, and among those who have been identified, therapy is typically insufficient. Population-level actions are necessary to stop the onset of hypertension as well as to enhance community hypertension awareness, care, and management. In this review we focus on the epidemiology, risk factors, and diagnosis, screening and preventive measures of hypertension.

Risk factors variability and cardiovascular risk among patients with diabetes: a nationwide observational study.

Cardiovascular risk factors control is fluctuating, tends to change over time, and is potentially impacted by multifactorial interactions. Currently, the existence of risk factors, rather than their variability or interplay with one another, is used to define the population at risk. The association between variability of risk factors and cardiovascular morbidity and mortality risk among patients with T2DM remains debatable. Using registry-derived data, we identified 29,471 people with T2D, without CVD at baseline, and with at least five measurements of risk factors. Variability for each variable was expressed as quartiles of the standard deviation during three years (exposure). The incidence of myocardial infarction, stroke, and all-cause mortality was assessed during 4.80 (2.40-6.70) years following the exposure phase. The association between measures of variability and the risk of developing the outcome was investigated through multivariable Cox proportional-hazards regression analysis with stepwise variable selection. Then, the recursive partitioning and amalgamation (RECPAM) algorithm was used to explore the interaction among the variability of risk factors associated with the outcome. An association between the variability of HbA1c, body weight, systolic blood pressure, and total cholesterol with the outcome considered was found. Among the 6 classes of risk identified by RECPAM, patients with a high variability of both body weight and blood pressure had the highest risk (Class 6, HR = 1.81; 95% CI 1.61-2.05) compared with patients with low variability of both body weight and total cholesterol (Class 1, reference), despite a progressive reduction in the mean level of risk factors during successive visits. Individuals with high weight variability but low-moderate systolic blood pressure variability (Class 5, HR = 1.57; 95% CI 1.28-1.68), patients with moderate/high weight variability associated with high/very high HbA1c variability (Class 4, HR = 1.33; 95%CI 1.20-1.49), subjects with moderate/high weight variability and with low/moderate HbA1c variability (Class 3, HR = 1.12; 95%CI 1.00-1.25), as well as those with low weight variability associated with high/very high total cholesterol variability (Class 2, HR = 1.14; 95%CI 1.00-1.30) also showed a significant increase in the risk of event. Combined high variability of two risk factors, particularly body weight and blood pressure, is associated with cardiovascular risk among patients with T2DM. These findings highlight the importance of continuous balancing of multiple risk factors.

Association between length of daily siesta and brachial-ankle pulse wave velocity (baPWV): a community-based cross sectional study in North China.

To date, many studies have showna link between siesta andcardiovascular events. Little is known regarding the connection between siesta and brachial-ankle pulse wave velocity (baPWV) levels, even though baPWV can determinethe degree ofatherosclerosis and vascular stiffness. Thus, we examined the relationship between siestatime and baPWV in a cross-sectional study. Interviews, physical examinations, lab testing, and electron beam computed tomography were all part of the baseline evaluation forparticipants aged older than 35. Baseline data were compared for 3different siesta habits: irregular or no siestas, daily short siestas (1h or less), and daily long siestas (> 1h). Utilizing logistic regression models and multivariate linear regression, the link between siestatime and baPWV was determined. Among all 6566participants, the different siesta groups had a significant difference of the degrees of AS (P < 0.001). The same outcome was true for both males (P < 0.001) and females (P < 0.001). Numerous cardiovascular risk variables and markers of subclinical atherosclerosis were positively correlated with daily extended siestas. Results from thefully adjusted model showed that long siestas (> 60min, OR = 1.18, 95%CI: 1.06-1.31, P = 0.002) were linked to a more severe level of the baPWV. For age or gender stratification, we found significant differences between non-siesta and > 60min siesta groups. Multiple linear regression analysis revealed a positive connection between siesta duration and baPWV (β = 0.197, P = 0.038). An elevated risk of atherosclerosis was shown to accompany prolonged siestas. These results need to be followed up on with prospective studies and additional lab work.

Pediatric kidney transplant and cardiometabolic risk: a cohort study.

Patients with chronic kidney disease (CKD) are known to have increased cardiovascular risk but there are few data on the risk of pediatric kidney transplant recipients. We aimed to assess the impact of pre- and post-transplant overweight on allograft function and to characterize the evolution of several cardiovascular risk variables over time and their impact. A retrospective analysis of the records of 23 children/adolescents followed at a tertiary center after kidney transplant was conducted. Data on anthropometry and cardiometabolic variables were analyzed before transplant, six and 12 months after the transplant, and at the last follow-up visit. The impact of the variables on allograft function (glomerular filtration rate (GFR)) was estimated by creatinine-based revised Schwartz formula (Cr-eGFR) and was evaluated using nonparametric tests. Results: The 23 patients included in the study had a median age of 6.3 (4.4-10.1) years. Both systolic and diastolic BP z-score values significantly decreased between BMI groups [1.2 (-0.2 - 2.3) vs. 0.3 (-0.4 - 0.6), p=0.027 and 0.8 (-0.4 - 1.3) vs. 0.1 (-0.6 - 0.7), p=0.028, pre-transplant and at the final evaluation, respectively]. During follow-up, GFR values decreased (Cr-GFR: 68.9 (57.7-76.8) vs. 58.6 (48.9-72.9), p=0.033 at 6-months and at the end, respectively). Significant negative correlations between triglycerides and cystatin C-based eGFR (ρ=-0.47, p=0.028) and Cr-Cys-eGFR (ρ=-0.45, p=0.043) at the end of the study were found. Our study showed a high number of overweight children undergoing kidney transplant. A negative correlation between triglycerides and GFR was found, which highlights the importance of managing nutritional status and regular blood lipids evaluation after kidney transplant.

Abstract 15432: Post-Operative Systolic Dysfunction Following Aortic Root Replacement Surgery in Patients With Marfan Syndrome

Introduction: Cardiovascular disease is the leading cause of morbidity and premature mortality in Marfan Syndrome (MFS), with ≥ 50% of patients requiring prophylactic aortic root surgery for management of progressive aortic dilation. Given evidence for intrinsic myocardial dysfunction in MFS, patients may be at an increased risk of developing post-operative dysfunction and related cardiovascular complications following cardiac surgery. Our aim was to determine the prevalence, persistence, and long-term outcomes of post-operative ventricular dysfunction in MFS following aortic root replacement surgery. Methods: All adult patients with a confirmed diagnosis of MFS who underwent aortic root replacement surgery at Stanford from January 1995 to December 2021 were included. Post-operative systolic dysfunction was defined as a left ventricular ejection fraction (LVEF) &lt;55% on transthoracic echocardiography at hospital discharge. Potential genetic, operative, and cardiac risk modifiers were also recorded. Results: There were 274 patients with MFS (64% male, 71% White) who underwent aortic root replacement surgery, followed over a median duration of 11 years (IQR 5, 16). Post-operative systolic dysfunction was present in 93 patients (33.9%), with a median LVEF of 46.9% (IQR 42.0, 50.5), median decrement in LVEF of 10.9% (IQR 5.5, 19.0), and median duration of persistence of 22 months (IQR 8.0, 57.3). There was no significant association with traditional operative nor cardiovascular risk variables. Patients with a reduced pre-operative LVEF were three times more likely to have worsened post-operative systolic function (OR=3.6, 95% CI=1.2-10.8, p=0.02), demonstrated more severe systolic impairment (LVEF &lt;30%: OR 1.8, 95% CI=1.4-26.1, p=0.02), and exhibited persistent dysfunction (≥5 years: OR 1.6, 95% CI=1.8-14.6, p=0.002). Conclusions: Post-operative systolic dysfunction is common in patients with MFS following aortic root replacement surgery. A reduced pre-operative LVEF is associated with more severe and protracted post-operative impairment, and therefore may be an important consideration for surgical timing.

Mapping features and patterns of accelerometry data on human movement in different age groups and associated health problems: A cross-sectional study.

Human movement is considered one of the important factors for maintaining an independent life. Individuals in different age groups have different characteristics of locomotion patterns and some health conditions can affect or be affected by mobility changes. Few studies clarify or present data about the influence of different ages and biopsychosocial factors on accelerometry features. The aim of this study was to identify characteristics and variables in the frequency signals for different age groups and their relationship with associated health conditions in raw accelerometry data obtained from the use of a triaxial accelerometer during 7days of activities of daily living. A cross-sectional study was conducted based on the database of the first evaluations of the Epidemiological Study of Movement (EPIMOV) cohort. Frequency, signal amplitude, and entropy accelerometry features of EPIMOV participants who used a triaxial accelerometer for 7days were extracted. Sociodemographic, clinical, anthropometric and physical activity assessments were also performed. Two-way ANOVA was performed to compare accelerometry features within different age groups. A series of stepwise multiple regressions were performed on accelerometry variables to analyze their relationships with demographic, anthropometric and cardiovascular risk variables. The sample consisted mostly of female, white, and high school graduates. The most prevalent cardiovascular risk factors were sedentary behavior and obesity. When analyzing the accelerometry variables, it was possible to observe that the entropy feature, and the counts, decrease in the group of older adults, while the feature of harmonic components of gait (frequency×amplitude) increases in the group of older adults. Regarding the amplitude feature, there were no significant differences between the groups. Through stepwise multiple linear regression, it was possible to observe that demographic, anthropometric and cardiovascular risk factors are associated with most accelerometry variables. The results confirm that human movement can be influenced by different ages, sex, demographic, anthropometric and cardiovascular risk factors. Future studies and clinical analyzes can use the methods proposed in this research to adjust movement patterns for sex and different age groups, thus obtaining new interpretations about human movement.

A Comparison of Actual Cardiovascular Disease Risks to the Perceptions of Middle-aged Men: A Cross-Sectional Study

Objective: To determine the actual cardiovascular diseases risk and to compare it with the perceived risk in 40-65 years old men.&#x0D; &#x0D; Methods: We conducted a cross-sectional study in a population determined to be 21.039 men and sample consisted of 400 men. The actual cardiovascular diseases risks of these respondents were calculated using HeartScore, classified as low, moderate, high, or very high. The respondents’ perception of their cardiovascular disease’s risks was categorized as wrong optimists/pessimists and realists. We used multivariate logistic regression models to determine the relationships between perceived cardiovascular diseases risk and independent variables (age, diabetes, hypertension, etc.). Required ethics committee and institutional permissions were obtained for the duly conduct of the study.&#x0D; &#x0D; Results: It was determined in our study that while 8.3% (n=33) of the men had a high-risk level for cardiovascular disease, 52.5% (n=210) had a very high level. Forty-eight percent of the participants perceive their CVD risks to be lower than they are and 23.8% to perceive it higher than they are. Correct estimation rate of CVD risk was 28.2%. The variables affecting the actual cardiovascular diseases risk were diastolic blood pressure, body mass index, and level of physical activity. 13.3% (n=53) of respondents perceived their cardiovascular diseases risks as high and 8% (n=32) as very high. The variables affecting an incorrect perceived cardiovascular diseases risk are being 61-65 years of age (odds ratio=0.34, 95% confidence interval: 0.16-0.73) and a diagnosis of diabetes mellitus (odds ratio=0.45, 95% confidence interval: 0.20-0.99).&#x0D; &#x0D; Conclusion: We observed that more than half of the residents were at a very high level of risk for cardiovascular disease, and approximately one out of every two respondents perceived their risk of cardiovascular disease to be lower than the actual risk. It is recommended risk reducing behaviors be developed and awareness of risk be raised.