Vascular Age Research Articles

Influence of physical activity, the Mediterranean diet and sociodemographic variables on the values of different cardiovascular risk scales

INTRODUCTION: Cardiovascular disease (CVD) continues to be one of the main causes of morbidity and mortality in the world. There are several risk factors for CVD, many of which are preventable, including sedentary lifestyles and poor diet. OBJECTIVE: To assess the influence of physical activity, adherence to the Mediterranean diet and sociodemographic variables such as age, sex and social class on the values of different cardiovascular risk scales. METHODS: A descriptive, cross-sectional study in 1584 Spanish workers in which the influence of different sociodemographic variables (age, sex, social class) and healthy habits (tobacco consumption, physical activity assessed with the IPAQ questionnaire, and adherence to the Mediterranean diet) on the values of different cardiovascular risk (CVR) scales (REGICOR, SCORE, DORICA, ERICE, heart age, and vascular age) was assessed. RESULTS: All the CVR scales showed better mean values as the level of physical activity increased, something similar occurring with the prevalence of altered values, in both sexes. High adherence to the Mediterranean diet also improved the mean values and prevalence of altered values in men and women. CONCLUSION: The Mediterranean diet and physical exercise decrease the probability of suffering a cardiovascular event and improve all the CVR scales analyzed in this study.

Possibilities of methods for assessing the severity of occupational stress and determining its role in the formation of individual cardiovascular risk in military personnel of the Navy

The relevance of cardiovascular diseases among the military personnel of the Russian Navy is reflected, as well as the role of occupational stressful load in the formation of cardiovascular risk.
 The results of a single-stage study were demonstrated, which included 86 men aged 2340 years, in the course of the study they were divided into two groups corresponding to different professional loads. The profile of behavioral factors associated with cardiovascular risk (anthropometric indicators, adherence to smoking, amount of alcohol consumed, food preference), as well as morphological and functional indicators of the system, was studied in servicemen exposed to and not exposed to factors caused by staying in deep-sea technical means, blood circulation. The effectiveness of stress testing was assessed, which included the Reeder self-assessment scale for psychosocial stress, the hospital scale for anxiety and depression, a work stress questionnaire, and a differential assessment of the state of reduced performance.
 It was revealed that the profile of cardiovascular risk in servicemen of both groups is low, however, there is a significant difference in a number of indicators (the amount of adipose tissue detected by bioimpedansometry, total cholesterol level, an increase in heart rate during psycho-mental test, values of vascular age and the scale of relative cardiovascular risk The most informative technique, which made it possible to identify significant differences between the study groups, is the questionnaire of work stress Ch. Spielberg 1989, adapted by A.B. Leonova and S.B. Velichkovskaya, 2000. It has been determined that the severity of occupational stress factors on the formation of cardiovascular risk in servicemen exposed to factors caused by their stay in deep-sea technical equipment is lower than among servicemen in the control group, which is expressed in lower values of additional methods for assessing stressful impact, as well as in the absence of significant associations between the indicators characterizing the occupational stress-generating load and the indicators of the circulatory system.
 The importance of the formation of stress resistance is reflected, achieved by high requirements of professional selection, regular training of professional skills, as well as the creation of a favorable professional environment.

VASCULAR AGE IN ADOLESCENTS WITH PRIMARY HYPERTENSION

Objective: There is evidence that children with primary hypertension (PH) are more mature than their normotensive peers in terms of bone and the immune system age. The aim of our study was to evaluate vascular age and its relationship with hypertension-mediated organ damage (HMOD) in adolescents with PH. Design and method: We assessed 362 children [90 girls; 15.5 (13.9;16.8) years] referred for work-up of office hypertension and 64 normotensive (NT) subjects [12 girls; 14.5 (13.8;15.6) years] not different in terms of age, body mass (BM) and BMI. We analyzed age- and height-related pulse wave velocity (PWV); the expected vascular age (based on measured PWV) was obtained from pooled pediatric and adult PWV norms and the difference (VascAgeDiff) between the vascular and chronological age was calculated. In all patients we obtained ambulatory blood pressure monitoring (ABPM) and HMOD: left ventricular mass index (LVMi), carotid intima-media thickness (cIMT) and pulse wave analysis (PWA) parameters: stroke volume (SV), cardiac output (CO), aortic BP (AoBP), total peripheral resistance (TPR). Results: Based on office, ABPM and AoBP, patients were classified into white coat hypertension (WCH) - 166 patients, ambulatory prehypertension (AmbPreHT) – 32; spurious hypertension (sHT – isolated systolic hypertension and normal AoBP) – 55; true hypertension (tHT – elevated office, ambulatory and AoBP) – 99. VascAgeDiff progressively increased from NT through sHT, WCH, AmbPreHT to tHT (3.5; 6.2; 7.2; 10.0; 10.7 years; p < 0.01). VascAgeDiff correlated (univariate analysis) significantly with weight, BMI z-score, office systolic (SBP) and diastolic blood pressure (DBP), AoBP, 24-h mean arterial pressure, 24-h DBP, CO, serum uric acid and LDL cholesterol level (p < 0.05). Multivariate regression analysis including above mentioned parameters revealed that significant predictors of VascAgeDiff were: weight, SBP, DBP, AoBP, CO and serum LDL cholesterol (p < 0.05). Conclusions: Out study suggests early vascular aging in adolescents with PH, even at mildly increased BP levels (WCH, prehypertension). Vascular changes were associated with increased weight, DBP, AoBP, CO and LDL cholesterol.

OPTIMIZATION OF BLOOD PRESSURE CONTROL AND ANGIOPROTECTION WITH FIXED COMBINATION OF LISINOPRIL + AMLODIPINE + ROSUVASTATIN IN PATIENTS AFTER A COVID-19

Objective: Evaluation of the capability of a fixed combination of lisinopril + amlodipine + rosuvastatin (ECWAMER) in achieving additional angioprotection in patients with arterial hypertension (AH) and high pulse wave velocity (PWV) in patients after confirmed COVID-19 had 75 – 95% lung involvement, complicated by bilateral polysegmental viral pneumonia, with genetically engineered biological drugs (GIBD) therapy, who had not previously received combined antihypertensive therapy (AHT). Design and method: An open-label observational study with a duration of 12 weeks has been carried out. 30 patients who not previously received combined AHT was included. Patients underwent daily monitoring of blood pressure (ABPM), applanation tonometry (determination of the augmentation index (IA) and central blood pressure (CSAD)), measurement of PWV, laboratory tests (lipid composition of blood, fasting glucose, C-reactive protein - CRP, OAC, ferritin, fibrinogen, D-dimer, ALT, AST, creatinine, uric acid) before and after prescribing a fixed combination of lisinopril + amlodipine + rosuvastatin (ECVAMER). Results: At baseline, the patients had an increase in office blood pressure to 152.6 / 89.1 mm Hg. After prescribing a fixed combination of lisinopril + amlodipine + rosuvastatin, there was a decrease in systolic blood pressure (SBP) by 15.8% and diastolic blood pressure (DBP) by 12.2%. According to ABPM data, the decrease in SBP was 15% and DBP - 9%, decreased PWV by 23.8%, IA by 9%, CSAP by 12.4% (p < 0.05 for all comparisons with the baseline value). Vascular age (SV) was initially increased to 41.9 years with a passport age of 35.03 years. After the end of therapy, there was a significant decrease in CO up to 36.5 years, LDL by 46.8%, triglycerides by 16.8% and an increase in HDL by 10.7% (p < 0.05 for all comparisons with the baseline value). In addition, the levels of CRP, fibrinogen, D-dimer, glucose, and uric acid significantly decreased. Conclusions: The fixed combination of lisinopril + amlodipine + rosuvastatin provides better blood pressure control, improved vascular elasticity, and also improves lipid and carbohydrate metabolism in patients, reduces inflammation in patients with hypertension and hyperlipidemia after suffering from severe and extremely severe COVID-19.

BENEFICIAL EFFECTS OF WEIGHT LOSS ON CENTRAL PRESSURE, ARTERIAL STIFFNESS AND SYMPATHETIC TONE IN OBESE SUBJECTS WITH OBSTRUCTIVE SLEEP APNEA

Objective: Obstructive sleep apnea (OSA) is known to be an independent cardiovascular risk factor. The presence of OSA and obesity may have synergistic effects on the progression of cardiovascular disease. To evaluate the effect of weight loss on vascular disease in obese patients with different OSA severity levels. Design and method: Individuals of both sexes, age between 40 and 70 years and body mass index (BMI) > = 30 and < 40 kg/m2 were submitted to nutritional intervention for 8 weeks with restriction of 800 kcal/day. Pulse wave velocity (PWV) and central hemodynamic parameters were evaluated by oscillometry (Mobil-O-Graph) and sympathetic tone by heart rate variability (HRV). The sleep study was performed using a portable home device (WatchPAT). Results: Patients (n = 70) were divided into two groups based on the apnea-hypopnea index (AHI): mild-absent (MA) group (AHI< 15 events/h, n = 25) with mean age 50 ± 6 years, BMI = 34.5 ± 2.8 kg/m2 and moderate-severe (MS) group (AHI> = 15 events/h, n = 45) with mean age 54 ± 8 years, BMI = 33.8 ± 2.6 kg/m2. After the intervention, weight loss was similar in both groups (-3.20 vs -3.32 kg). Both groups showed a significant reduction in anthropometric parameters. The MS group showed a significant reduction in peripheral systolic blood pressure (BP) (127 ± 15 vs 122 ± 15 mmHg, p = 0.007) and the MA group demonstrated a significant reduction in diastolic BP (78 ± 6 vs 75 ± 6 mmHg, p = 0.046). Central systolic pressure (116 ± 13 vs 107 ± 11 mmHg, p = 0.007), PWV (6.9 ± 0.6 vs 6.7 ± 0.6 m/s, p = 0.002) and vascular age (48 ± 6 vs 46 ± 6 years, p = 0.020) were significantly reduced only in the MA group. This group also demonstrated a significant increase in the RR interval (838 ± 225 vs 948 ± 130 ms, p = 0.032) with a reduction in heart rate (69 ± 5 vs 64 ± 8 bpm, p = 0.015). Conclusions: A small weight loss in a short period of time was able to promote more beneficial effects in obese individuals with non-severe sleep apnea including favorable outcomes on central hemodynamic parameters, arterial stiffness and autonomic activity.

Advanced vascular aging in patients with paroxysmal atrial fibrillation - Data from RACE V

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation, Medtronic Background The incidence of atrial fibrillation (AF) increases exponentially with age. To which extend vascular aging is part of this process is unknown. Pulse wave velocity and carotid intima-media thickness are established markers for vascular aging and have been combined in a vascular aging index as published before(1). Purpose We aim to investigate if vascular age exceeds chronological age in our cohort with paroxysmal AF and if yes to which extend. Methods In this substudy from RACE V we included 295 patients with paroxysmal AF in which carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (IMT) were measured. To calculate vascular aging we used a logarithmic formula derived from the Malmö-Cancer-and-Diet study which yields a vascular age index derived from cfPWV, cIMT and chronological age. This vascular aging index (VAI) is a strong predictor of cardiovascular events. (1). All patients underwent cardiac echocardiography and had a native cardiac CT scan in which fat around the heart and coronary calcium were quantified. In 121 patients Agatston scores from the ascending aortic artery were also measured. Results Patients in this study had a mean chronological age of 63.8 ± 10.1 years and a vascular age of 71.4 ± 11.7 years. Vascular age was on average 9.3 ± 10.2 years higher than chronological age. Vascular age correlated significantly with markers for diastolic dysfunction, vascular calcification in the coronary arteries as well as the aorta and the amount of epicardial and pericardial fat (table 1). Conclusions In patients with PAF vascular age was on average 9.3 years higher than chronological age in our cohort. Advanced vascular age is represented by vascular and myocardial remodeling related to fibrosis, calcification and fat accumulation. The results suggest that in patients with AF enhanced inflammation is leading to fibrosis and calcification. Whether AF is a marker, a mechanism or both in advanced vascular aging warrants further study.

Cardiovascular risk scores and vascular age before and after concurrent exercise training in adults with schizophrenia: CORTEX-SP study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Ministry of Economy and Competitiveness “Fondo de Investigación Sanitaria del Insti-tuto de Salud Carlos III” Background Individuals with schizophrenia (SP) have a greater risk for cardiometabolic risk factors, cardiovascular diseases and mortality. This risky profile may be explained by the adverse effects of antipsychotic medications and an unhealthy lifestyle (i.e., low physical activity, smoking and poor diet). In the general population, physical activity has been shown to be the optimal strategy to improve both cardiometabolic parameters and cardiorespiratory fitness levels. These findings strongly suggest that targeting a comprehensive approach that includes non-pharmacological interventions, such as exercise and/or cognitive rehabilitation, could be effective and beneficial in the evolution of the disease. Purpose To estimate cardiovascular risk factors (CVR) and vascular age (VA) profiles before and after a concurrent exercise training intervention in adults with schizophrenia. Methods Participants (n=97, 20.4% women, 41.3±10.0 yr old) with SP had their CVR and VA determined using the SCORE2, relative risk and the Framingham method (FHS). The participants were randomly assigned into a control group (usual care) or a supervised exercise group (concurrent training, 3 days/week, 20-weeks). The variables for the CVR determination were: age, systolic blood pressure (SBP), total cholesterol (TC), non high-density lipoprotein (non HDL-C) cholesterol, HDL-C, diabetes mellitus, antihypertensive medication, and smoking status. Results At baseline, exercise group presented lower values (P<0.05) compared to control group in SBP (113.4 vs. 120.5 mmHg), whereas in the rest of the values no significant between-groups differences were found (P>0.05). In accordance with guidelines on cardiovascular disease prevention, considering SCORE2, both groups were classified as low risk; but taking into account FHS and relative chart, were considered to have moderate risk. At follow-up, there was no overall change for either group and between groups in the magnitude of change in any of the studied variables. Conclusion(s) People with SP presented a moderate CVR. A comprehensive approach including not only exercise but also nutrition intervention could be more effective in managing CVR in this population.

MO628: A Clinical Score for Identifying Non-Diabetic Nephropathy in Patients with Diabetes and Kidney Disease

Abstract BACKGROUND AND AIMS Between 50% and 60% of diabetics with renal involvement have nondiabetic nephropathy (NDN). Renal biopsy is crucial for renal diagnosis that includes diabetic nephropathy (DN), NDN or mixed form. The objective of the current study is to provide a tool in the daily clinical practice through a predictive model of NDN that is clue for the indication of renal biopsy. METHOD Observational, retrospective and multicenter study was undertaken of the pathological results of kidney biopsies in patients with diabetes from 2002 to 2014. A logistic regression analysis and the probability of presenting NDN was calculated using a punctuation score. RESULTS The cohort of 832 patients includes 621 men (74.6%), median age 61.7 ± 12.8 years, creatinine 2.8 ± 2.2 mg/dL and proteinuria 2.7 (1.2–5.4)g/24 h. Time of evolution of diabetes was 10.8 ± 8.6 years. 26.6% (n = 221) of patients presented diabetic retinopathy, 18.8% (n = 156) peripheral vasculopathy and 17.7% (n = 147) ischemic heart disease. A total of 288 patients (34.6%) presented microhematuria. A total of 39.5% (n = 329) presented DN, 49.6% (n = 413) NDN and 10.8% (n = 90) mixed forms. In the multivariate analysis, age (OR: 1.03; 1.01–1.04; P < 0.001), absence of microhematuria (OR: 0.6; 0.4–0.86; P = 0.005), absence of diabetic retinopathy (OR: 3.97; 2.7–5.82; P < 0.001) and absence of peripheral vasculopathy (OR: 1.61, 1.03–2.52, P = 0.038) were identified as independent risk factors for NDN. A ROC curve with an area under the curve of 0.724 was obtained. A predictive model obtaining a score (see Figure 1) for each variable and finally a NDN prediction score was performed. In our new score, the number increased as increased the probability of NDN. CONCLUSION In our study, ∼66% of biopsied patients with diabetes presented NDN. Microhematuria, absence of diabetic retinopathy, absence of peripheral vascular disease and older age were identified as independent risk factors for NDN. We obtained a score that increased as increased the probability of NDN. This could be in a next future a useful tool for renal biopsy indication in patients with diabetes and kidney disease.

소도구 재활운동이 거북목 통증여성의 신체스트레스와 근피로 및 혈관나이에 미치는 영향

The purpose of this study was to investigate the effect of small tool rehabilitation exercise on physical stress, muscle fatigue, and vascular age by applying small tool rehabilitation exercise to women with turtle neck pain, who usually sit down and use smart phones for a long time. The small tool rehabilitation exercise was conducted for a total of 8 weeks, 3 times a week, 1 day preparation, and 50 minutes including a cool-down exercise, and the following conclusions were obtained. As a result of performing small tool rehabilitation exercise for women with turtle neck pain, significant changes were found before and after exercise in physical stress, there was a significant difference in measurement time, and interaction effect was found between measurement time*groups. In muscle fatigue, significant changes were observed before and after exercise, and there was a significant difference between groups, and there was an interaction effect between measurement time*groups. In vascular age, significant changes were observed before and after exercise, and there was a significant difference only between groups. In summary, the small tool rehabilitation exercise showed a positive role in the physical stress, muscle fatigue, and vascular age of women with turtle neck pain, so it is thought to be a recommended exercise method for those who are complaining of musculoskeletal pain. It is thought that these exercise methods will be more effective if they are programmed and presented for each pain area.

Wrist pulse signal based vascular age calculation using mixed Gaussian model and support vector regression.

Vascular age (VA) is the direct index to reflect vascular aging, so it plays a particular role in public health. How to obtain VA conveniently and cheaply has always been a research hotspot. This study proposes a new method to evaluate VA with wrist pulse signal. Firstly, we fit the pulse signal by mixed Gaussian model (MGM) to extract the shape features, and adopt principal component analysis (PCA) to optimize the dimension of the shape features. Secondly, the principal components and chronological age (CA) are respectively taken as the independent variables and dependent variable to establish support vector regression (SVR) model. Thirdly, the principal components are fed into the SVR model to predicted the vascular aging of each subject. The predicted value is regarded as the description of VA. Finally, we compare the correlation coefficients of VA with pulse width (PW), inflection point area ratio (IPA), Ratio b/a (RBA), augmentation index (AIx), diastolic augmentationindex (DAI) and pulse transit time (PTT) with those of CA with these six indices. Compared with the CA, the VA is closer to PW (r = 0.539, P < 0.001 to r = 0.589, P < 0.001 in men; r = 0.325, P < 0.001 to r = 0.400, P < 0.001 in women), IPA (r = - 0.446, P < 0.001 to r = - 0.534, P < 0.001 in men; r = - 0.623, P < 0.001 to r = - 0.660, P < 0.001 in women), RBA (r = 0.328, P < 0.001 to r = 0.371, P < 0.001 in women), AIx (r = 0.659, P < 0.001 to r = 0.738, P < 0.001 in men; r = 0.547, P < 0.001 to r = 0.573, P < 0.001 in women), DAI (r = 0.517, P < 0.001 to r = 0.532, P < 0.001 in men; r = 0.507, P < 0.001 to r = 0.570, P < 0.001 in women) and PTT (r = 0.526, P < 0.001 to r = 0.659, P < 0.001 in men; r = 0.577, P < 0.001 to r = 0.814, P < 0.001 in women). The VA is more representative of vascular aging than CA. The method presented in this study provides a new way to directly and objectively assess vascular aging in public health.

Geriatric Comanagement of Older Vascular Surgery Inpatients Reduces Hospital-Acquired Geriatric Syndromes.

This study evaluates the impact of a novel model of care called Geriatric Comanagement of Older Vascular surgery inpatients on clinical outcomes. A pre-post study of geriatric comanagement, comparing prospectively recruited preintervention (February-October 2019) and prospectively recruited postintervention (January-December 2020) cohorts. Consecutively admitted vascular surgery patients age ≥65years at a tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2days were recruited. A comanagement model where a geriatrician was embedded within the vascular surgery team and delivered proactive comprehensive geriatric assessment based interventions. Primary outcomes of incidence of hospital-acquired geriatric syndromes, delirium, and LOS were compared between groups using univariable and multivariable logistic regression analyses. Prespecified subgroup analysis was performed by frailty status. There were 150 patients in the preintervention group and 152 patients in the postintervention group. The postintervention group were more frail [66 (43.4%) vs 45 (30.0%)], urgently admitted [72 (47.4%) vs 56 (37.3%)], and nonoperatively managed [52 (34.2%) vs 33 (22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic during the postintervention phase. The postintervention group had fewer hospital-acquired geriatric syndromes [74 (48.7%) vs 97 (64.7%); P= .005] and reduced incident delirium [5 (3.3%) vs 15 (10.0%); P= .02], in unadjusted and adjusted analyses. Cardiac [8 (5.3%) vs 30 (20.0%); P < .001] and infective complications [4 (2.6%) vs 12 (8.0%); P= .04] were also fewer. LOS was unchanged. Frail patients in the postintervention group experienced significantly fewer geriatric syndromes including delirium. This is the first prospective study of inpatient geriatric comanagement for older vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including delirium, and cardiac and infective complications were observed after implementing geriatric comanagement. These benefits were also demonstrated in the frail subgroup.

Blood pressure control, target organ protection and metabolic disorders control using a fixed combination of azilsartan medoxomil + chlorthalidone in hypertensive patients survived after severe and extremely severe COVID-19

Objective. Evaluation of the possibility of a fixed combination of azilsartan medoxomil + chlorthalidone in additional angioprotection in patients with arterial hypertension (HTN) and high pulse wave velocity (PWV) after confirmed severe or extremely severe COVID-19 (bilateral polysegmental viral pneumonia) treated by genetically engineered biological drugs, who had not previously received combined antihypertensive therapy.Design and methods. An open observational study lasting 12 weeks included 30 patients, 28–31 days after discharge from the hospital after a severe and extremely severe COVID-19, who received or had not previously received antihypertensive therapy. Patients underwent 24-hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), measurement of PWV, laboratory tests before and after prescription of a fixed combination of azilsartan medoxomil + chlorthalidone.Results. At baseline, patients showed an increase in office blood pressure to 153,06/92,2 mmHg. After treatment with a fixed combination of azilsartan medoxomil + chlorthalidone, a decrease in systolic BP by 18,47% and diastolic BP by 16,24% was observed. According to ambulatory BP monitoring, the decrease in systolic BP was 19,65% and diastolic BP — 24,68%, PWV decreased by 34,4%, augmentation index — by 9,42%, central systolic BP — by 15,48% (p &lt; 0,05). At baseline, vascular age (VA) was increased to 44,96 years compared to the passport age of 35,03 years. After treatment, there was a significant decrease in VA to 38,74 years (p &lt; 0,01). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, blood urea nitrogen and uric acid significantly decreased.Conclusions. The fixed combination of azilsartan medoxomil + chlorthalidone provides better control of BP. It also helps to improve vascular elasticity (augmentation index, PWV, central systolic BP, decrease in VA) and to reduce post-infectious inflammation in HTN patients after a severe coronavirus infection.

Long-Term Blood Pressure Exposure From Childhood and Early Vascular Aging in Midlife: A 30-Year Prospective Cohort Study.

Early vascular aging (EVA) increases cardiovascular mortality, but its long-term determinants are unknown. We included 2098 participants with ≥4 blood pressure (BP) measurements from childhood to adulthood (from the Hanzhong Adolescent Hypertension Cohort study) to investigate the impact of child-to-adult cumulative BP exposure on EVA patterns in midlife. Participants with EVA had significantly higher long-term BP burden than those with normal vascular age in midlife despite being much younger. Child-to-adult cumulative burden and trends of systolic and diastolic BP were associated with vascular age (standardized regression coefficient [β] = .31 to .53; P < .001 for all). Higher cumulative systolic and diastolic BP exposure significantly increased the risk of EVA in midlife (odds ratio, OR=1.67 to 2.75, P < .05 for all). All associations were independent of socio-demographics and cardiovascular risk factors. Excluding participants who were receiving anti-hypertensive, antidiabetic, or lipid-lowering treatments did not substantially change the above associations. This study, for the first time, reported that high cumulative child-to-adult BP exposure accelerated the vascular aging process. Stabilizing BP across life course could be beneficial to vascular health in the long run.

Correlation between Coronary Artery Calcium- and Different Cardiovascular Risk Score-Based Methods for the Estimation of Vascular Age in Caucasian Patients.

Vascular age can be derived from cardiovascular (CV) risk scores such as the Framingham Risk Score (FRS) and the Systematic Coronary Risk Evaluation (SCORE). Recently, coronary artery calcium score (CACS) was proposed as a means of assessing arterial age. We aimed to compare these approaches for the assessment of vascular age. FRS-, SCORE-, and CACS-based vascular ages of 241 consecutive Caucasian patients undergoing coronary CT angiography were defined according to previously published methods. Vascular ages based on FRS, SCORE, and CACS were 68.0 (IQR: 55.0–82.0), 63.0 (IQR: 53.0–75.0), and 47.1 (IQR: 39.1–72.3) years, respectively, (p < 0.001). FRS- and SCORE-based biological age showed strong correlation [ICC: 0.91 (95%CI: 0.88–0.93)], while CACS-based vascular age moderately correlated with FRS- and SCORE-based vascular age [ICC: 0.66 (95%CI: 0.56–0.73) and ICC: 0.65 (95%CI: 0.56–0.73), respectively, both p < 0.001)]. Based on FRS, SCORE, and CACS, 83.4%, 93.8%, and 42.3% of the subjects had higher vascular age than their documented chronological age (FRS+, SCORE+, CACS+), and 53.2% of the FRS+ (107/201) and 57.1% of the SCORE+ (129/226) groups were classified as CACS-. Traditional risk equations demonstrate a tendency of overestimating vascular age in low- to intermediate-risk patients compared to CACS. Prospective studies are warranted to further evaluate the contribution of different vascular age calculations to CV preventive strategies.

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Predictors of Peripheral Artery Disease Progression. Is there Any Role for Vascular Age?

Association of Gun Violence With Vascular Injury And Worse Mortality Outcomes In The Pediatric Population

INTRODUCTION Trauma remains the leading cause of death in children and adolescents. Here, we explore the hypothesis that vascular injury portends worse outcomes in pediatric patients after trauma. METHODS A retrospective, single-center analysis of patients 18 years or younger treated for traumatic injuries sustained between 2004 and 2019. An institutional trauma registry was queried for demographic and clinical data. Differences in mortality, need for operative intervention and injury mechanism were assessed. RESULTS During the 15-year study period, 1567 patients were treated for traumatic injuries with a 12% (190) incidence of vascular trauma. Patients with vascular injury had a higher prevalence of penetrating trauma (64% vs 32%, p <0.0001) and black race (70% vs 55%, p <0.001) relative to those with general injuries. Gun-related injury (89%) was the primary source of penetrating trauma. Overall, patients with vascular trauma faced greater morbidity as indicated by higher injury severity scores (20.7±1.1 vs 12.0±0.34, p <0.0001) at the time of presentation. In addition, need for operative intervention (65% vs 22%, p <0.0001) and death on arrival (6.8% vs 2.5%, p <0.001) were more likely in the vascular injury group. Black race (OR 6.1 [2.4-20.6], <0.001), penetrating trauma (OR 5.8 [2.7-14.2], <0.001) and vascular injury (OR 2.9 [1.4-5.6], 0.002) were associated with higher likelihood of mortality. On multivariate analysis, penetrating trauma (OR 3.4 [1.4-10.0], 0.013) was the only independent risk factor for death when accounting for vascular injury, age, race, gender and method of payment. CONCLUSION Gun violence has become major source of morbidity for pediatric trauma patients and carries a high risk for vascular injury, predisposing to worse mortality outcomes. These patients are typically of higher acuity and frequently require operative intervention. Trauma remains the leading cause of death in children and adolescents. Here, we explore the hypothesis that vascular injury portends worse outcomes in pediatric patients after trauma. A retrospective, single-center analysis of patients 18 years or younger treated for traumatic injuries sustained between 2004 and 2019. An institutional trauma registry was queried for demographic and clinical data. Differences in mortality, need for operative intervention and injury mechanism were assessed. During the 15-year study period, 1567 patients were treated for traumatic injuries with a 12% (190) incidence of vascular trauma. Patients with vascular injury had a higher prevalence of penetrating trauma (64% vs 32%, p <0.0001) and black race (70% vs 55%, p <0.001) relative to those with general injuries. Gun-related injury (89%) was the primary source of penetrating trauma. Overall, patients with vascular trauma faced greater morbidity as indicated by higher injury severity scores (20.7±1.1 vs 12.0±0.34, p <0.0001) at the time of presentation. In addition, need for operative intervention (65% vs 22%, p <0.0001) and death on arrival (6.8% vs 2.5%, p <0.001) were more likely in the vascular injury group. Black race (OR 6.1 [2.4-20.6], <0.001), penetrating trauma (OR 5.8 [2.7-14.2], <0.001) and vascular injury (OR 2.9 [1.4-5.6], 0.002) were associated with higher likelihood of mortality. On multivariate analysis, penetrating trauma (OR 3.4 [1.4-10.0], 0.013) was the only independent risk factor for death when accounting for vascular injury, age, race, gender and method of payment. Gun violence has become major source of morbidity for pediatric trauma patients and carries a high risk for vascular injury, predisposing to worse mortality outcomes. These patients are typically of higher acuity and frequently require operative intervention.

Biological vascular age and its relationship with cardiovascular risk factors

Aim. To study of the relationship between cardiovascular risk factors and biological vascular age.Material and methods. The biological vascular age was estimated using models based on the arterial wall parameters. Using multiple logistic and linear regression, we studied the relationship between the biological vascular age and cardiovascular risk factors in 143 people without cardiovascular disease (CVD). Persons with a positive difference between the vascular and chronological age were assigned to the “old” vascular group, and persons with no or negative difference between the vascular and chronological age were assigned to the “young” vascular group.Results. Linear regression in the “young” vascular group showed an inverse relationship between the difference between the vascular and chronological age with the levels of low-density lipoprotein cholesterol (p=0,001; β±SE=-1,67±0,47), triglycerides (p=0,017; β±SE=-1,66±0,68), urea (p=0,025; β±SE=-0,89±0,39) and insulin resistance index (p=0,001; β±SE=-1,22±0,36). In the “old” vascular group, a direct relationship was found between the difference between the vascular and chronological age and central systolic blood pressure (p=0,015; β±SE=0,10±0,04). According to logistic regression, the likelihood of having “old” vessels increased by 1,23 times with an increase in blood glucose levels by 0,5 mmol/l (p=0,044; odds ratio (OR)=1,23; 95% confidence interval (CI): 1,011,51), the presence of hypertension (p=0,034; OR=3,11; 95% CI: 1,09-8,86) and type 2 diabetes (p=0,025; OR=3,61; 95% CI: 1,1711,09), as well as decreased by 2 times with an increase in high-density lipoprotein cholesterol by 0,3 mmol/l (p=0,003; OR=0,5; 95% CI: 0,32-0,79).Conclusion. The difference between the biological vascular age and chronological age is associated with traditional CVD risk factors.

Health Literacy and Change in Health-Related Quality of Life in Dialysed Patients.

Health-related quality of life (HRQoL) is likely to deteriorate with the progression of chronic kidney disease (CKD). This change may be worsened by low health literacy (HL). We performed a longitudinal study at over 20 dialysis clinics in Slovakia (n = 413; mean age = 64.8 years; males = 58.4%). We assessed the association of three HL groups with a change in HRQoL over two years using binary logistic regression adjusted for type of vascular access, dialysis effectiveness, comorbidity, age and gender. We found that patients with low HL had poorer HRQoL at baseline in comparison to high-HL patients. We did not find significant associations of lower HL with the deterioration of mental or physical HRQoL after two years. In the adjusted model, patients with lower HL were not more likely to have deteriorated physical (low-HL patients: odds ratio/95% confidence interval: 0.99/0.53–1.84; moderate-HL patients: 0.97/0.55–1.73) or mental HRQoL (low-HL patients: 1.00/0.53–1.87; moderate-HL patients: 0.95/0.53–1.70) in comparison to high-HL patients. The HRQoL of lower-HL patients is worse at baseline but develops similarly to that of high-HL patients during dialysis treatment. Their relative HRQoL, thus, does not worsen further, but it does not improve either. Tailoring care to their needs may help to decrease the burden of low HL in dialysed patients.

Determination of cardiovascular risk in 192,711 underweight and normal weight workers.

The aim of this study was to determine the prevalence of cardiovascular risk factors (CVRF) and the level of cardiovascular risk (CVR), determined with different scales (REGICOR, SCORE, ERICE, vascular age...) in people with low and normal weight. A total of 192,711 underweight and normal weight Spanish workers participated. CVR parameters included were weight, abdominal circumference, blood pressure, glycemia (high >125 mg/dL or under hypoglycemic treatment) and lipids (cutoff points: total cholesterol 200 mg/dL, LDL 130 mg/dL, triglycerides 150 mg/dL) were obtained by automated enzymatic methods. Body mass index (BMI) was calculated, considering underweight 18.5 and normal weight 18.5-24.9. A descriptive analysis of the categorical variables was carried out. The values of analytical, anthropometric and clinical parameters were more unfavorable in the normal weight group. Also, the prevalence of alterated values of CVR seen with different scales show higher risk in this group and in all cases the values in men are worse. It was seen that the variable with the greatest influence on the appearance of altered values of the cardiovascular risk scales (CVRS), influencing all of them was the age. All the CVRS analyzed showed higher values in the group of people with normal weight compared to those with underweight. Age, followed by sex, were the variables that most influence the appearance of high CVR values.

Lomitapide Reduces LDL-C and Favourably Affects Carotid Intima Media Thickness in Adult Patients with Homozygous Familial Hypercholesterolaemia in a Real-World Setting

<h3>Lead Author's Financial Disclosures</h3> D.B. has received consulting fees from Amryt. <h3>Study Funding</h3> Amryt Pharma. <h3>Background/Synopsis</h3> Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic condition characterized by markedly elevated levels of low-density lipoprotein cholesterol (LDL-C) secondary to bi-allelic pathogenic mutations affecting key proteins in the LDL receptor pathway. Lomitapide is a microsomal triglyceride transfer protein (MTP) inhibitor that acts independently of the LDL receptor and is licenced for the treatment of adult patients with HoFH. To date, there are few prospective cardiovascular outcomes data for HoFH patients receiving lomitapide. <h3>Objective/Purpose</h3> To evaluate the effect of lomitapide use on carotid intima-media thickness (CIMT) in patients with HoFH. <h3>Methods</h3> Thirteen HoFH patients (mean+/-SD age 29.3+/-12.5 years) in seven global centers were treated in accordance with the lomitapide product label and local clinical practice. Patients underwent routine laboratory testing, including lipid and liver panels. CIMT imaging was recorded to monitor atherosclerotic cardiovascular disease (ASCVD) according to local protocols. <h3>Results</h3> Lomitapide resulted in marked decreases in LDL-C (mean+/-SD: 76.5+/-11.7%; range 56.8-93.9% at the lowest point). Notably, eight patients achieved LDL-C levels below the European Atherosclerosis Society target of <100mg/dL, and three patients achieved LDL-C <70mg/dL at least once. Over a mean follow-up of 3.9+/-2.3 years between measurements, CIMT regressed in 7 cases. The remaining patients demonstrated no progression (Supplementary Table). In two patients where assessments of plaque area were available, modest regression or stabilisation in CIMT (0.82mm to 0.65mm over 24 months [20.7% reduction]; 0.56mm to 0.57mm over 26 months [1.8% increase]) was accompanied by clinically significant regression of plaque area (147.1mm2 to 120.5mm2 [18.1% reduction]; 64.0 mm2to 42.1 mm2 [34.7% reduction]. Calculation of vascular age in n=9 patients indicated mean improvement of -18.8+/-32.6 years (range -60 to +30 years). Elevations in ALT/AST enzyme levels >3x upper limit of normal were evident in 6/13 patients. In all cases, these elevations either resolved without intervention or were managed with brief, transient reductions in lomitapide dose. <h3>Conclusions</h3> Lomitapide dramatically reduces LDL-C levels in patients with HoFH, and results in stabilisation and/or regression of CIMT, which is an established marker of ASCVD risk.