Risk Factor For Vascular Disease Research Articles

Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association.

Cardio-oncology has organically developed as a new discipline within cardiovascular medicine as a result of the cardiac and vascular adverse sequelae of the major advances in cancer treatment. Patients with cancer and cancer survivors are at increased risk of vascular disease for a number of reasons. First, many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications. Second, cancer itself serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events. Finally, recent data suggest that common modifiable and genetic risk factors predispose to both malignancies and cardiovascular disease. Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation. Indeed, vascular sequelae of novel targeted therapies may provide insights into vascular signaling in humans. Clinically, emerging challenges are best addressed by a multidisciplinary approach in which cardiovascular medicine specialists and vascular biologists work closely with oncologists in the care of patients with cancer and cancer survivors. This novel approach realizes the goal of providing superior care through the creation of cardio-oncology consultative services and the training of a new generation of cardiovascular specialists with a broad understanding of cancer treatments.

High Prevalence of Cerebral Small Vessel Disease on 7T Magnetic Resonance Imaging in Familial Hypercholesterolemia.

Aim: It remains unclear whether elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for cerebral vascular disease. Familial hypercholesterolemia (FH) is the most appropriate model for understanding the effects of excess LDL-C because affected individuals have inherently high levels of circulating LDL-C. To clarify the effects of hypercholesterolemia on cerebral small vessel disease (SVD), we investigated cerebrovascular damage in detail due to elevated LDL-C using high resolution brain magnetic resonance imaging (MRI) in patients with FH.Methods: Twenty-eight patients with FH and 35 healthy controls underwent 7T brain MRI. The prevalence of SVD and arterial structural changes were determined in each group.Results: The prevalence of periventricular hyperintensity (PVH) was significantly higher (control, 0% vs. FH, 14.2%, p = 0.021) and deep white matter intensity tended to be more frequent in FH patients than in controls. The prevalence of SVD in patients with forms of cerebral damage, such as lacunar infarction, PVH, deep white matter hyperintensities (DWMH), microbleeding, and brain atrophy, was significantly higher among FH patients (control, n = 2, 5.7% vs. FH, n = 7, 25.0%, p < 0.001, chi-square test). The tortuosity of major intracranial arteries and the signal intensity of lenticulostriate arteries were similar in the two groups. In FH patients, as the grade of PVH progressed, several atherosclerosis risk factors, such as body mass index, blood pressure, and triglyceride level, showed ever worsening values.Conclusion: These results obtained from FH patients revealed that persistently elevated LDL-C leads to cerebral PVH. It is necessary in the management of FH to pay attention not only to the development of coronary heart disease but also to the presence of cerebral SVD.

Abstract P018: Smoking and Cognitive Decline at Older Age: Using Surveillance and Imputation to Deal With Differential Mortality

Background: Smoking is a risk factor for vascular diseases and likely associated with cognitive decline. However, observed associations may be impacted by higher cohort attrition, particularly mortality, among smokers. We incorporated surveillance data between visits using multiple imputation by chained equations (MICE) and assumed the Missing At Random mechanism in missing cognitive function. We assessed the impact of addressing the influence of differential visit attendance driven by mortality on the association of smoking with cognitive decline. Methods: We studied 4,960 participants in Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study, who were free from dementia at baseline (2011-2013) with cognitive batteries at baseline and follow-up (2016-2017, N = 3,078). Cognitive decline was measured as change in standardized global cognitive factor scores. Self-reported smoking was collected at previous visits (1987-1998) and annual follow-up interviews (1998 to 2011) of the ARIC study, and pack years were estimated. We used baseline factor scores, dementia risk factors, and cognitive function screening at annual follow-ups and dementia surveillance information after baseline to impute missing factor scores. Cognitive decline was analyzed using linear regression on both complete data and using MICE. Results: Participants had a mean age of 75.7 (SD: 5.1) at the index visit. 59.6% (2956 of 4960) were female and 18.6% (921 of 4960) were African American. Smoking ≥25 pack-years prior to baseline was associated with moderately lower visit attendance and higher mortality at older age. The association of smoking with cognitive decline was stronger after addressing differential attrition driven by mortality using MICE for smoking ≥25 pack-years, with two-fold increase in the effect size (Table 1). Conclusions: Smoking, particularly of longer duration and intensity, is a risk factor for cognitive decline, with larger effect size when dealing with the differentially higher mortality among heavier smokers.

라인댄스와 스트레칭 복합운동이 노인들의 대사증후군, 혈류동태 및 폐기능에 미치는 영향

Purpose: This study investigates the effects of the combined exercise with line dance and stretching on the indicators of metabolic syndrome, hemodynamics and pulmonary function in the elderly.BR Methods: The combined exercise was applied to 31 elderly subjects (male, n=15; female, n=16) with an average age of about 75 years. The combined exercise was consisted of line dance and static stretching. It was applied to subjects twice a week for 60 minutes per session for 5months (20 weeks). In the study, we analyzed the changes of metabolic syndrome index (blood pressure, BP; blood glucose, BG; waist circumstance, WC; triglyceride, TG; high density lipoprotein cholesterol, HDL-C), hemodynamics indicators (pulse wave korotkoff sound systolic time, TP-KS; pressure rate product, PRP ;total peripheral resistance, TPR), and pulmonary function index (forced vital capacity, FVC) before and after combined exercise. BR Results: The combined exercise significantly lowered the DBP levels in both genders and the BG level in elderly women, but it significantly elevated the TG level in elderly women. The combined exercise did not significantly change the blood flow dynamic indexes in both genders. The combined exercise significantly elevated the level of FVC in elderly women.BR Conclusion : The combined exercise, consisting of line dance and static stretching, partially improves the indicators of metabolic syndrome and pulmonary function in the elderly, but there are some gender differences. After applying combined exercise to the elderly, the index of the metabolic syndrome, hemodynamics and lung function tends to be better than maintenance levels. However, the combined exercise significantly elevates the TG level in elderly women. Therefore, further studies are needed to determine the adequacy of TG as a risk factor for vascular disease.

A cross sectional study on health status and prevalence of risk factors of non-communicable diseases among auto rickshaw drivers of Hyderabad, Telangana

Background: Auto rickshaws form 10-20% of daily motorized urban transport and ensure connectivity and easy access throughout congested Indian cities. Harmful lifestyles practiced by auto rickshaw drivers like irregularity of meals, bad posture while driving, sedentary lifestyle predisposes them to many gastrointestinal, respiratory, musculoskeletal, cardiovascular diseases. This study was taken to assess the risk factors of non-communicable diseases among of auto rickshaw drivers. Objectives of the study were to estimate the proportion of various non-communicable diseases among study population and to assess various risk factors for non- communicable diseases among study population.Methods: A cross sectional study was carried out among 100 auto rickshaw drivers, aged above 20 years commuting at bus terminus and railway station in Hyderabad, Telangana using a predesigned questionnaire from May to July 2018.Results: The mean age of the study population was found to be 41.58±10.9 years. Around 14% of study subjects had history of diabetes mellitus and 15% hypertension. About 69% were overweight or obese, 41% had refractive errors and majority had musculoskeletal problems. The mean duration of physical activity was found to be 35±7 minutes/day.Conclusions: The prevalence of cardio vascular disease risk factors i.e. tobacco smoking, sedentary lifestyle, obesity was found to be quite high among auto rickshaw drivers. Early precautionary measures, regular medical check-up and prompt interventions are necessary for managing risk factors.

The prevalence of smoking and its impact on disability in multiple sclerosis

Introduction: Etiology of multiple sclerosis (MS) involves multi-factorial interactions among genetic and environmental factors. Cigarette smoking is one of the most important environmental factors that increase the disease risk by about 50%. The aim of this research was to assess the prevalence of smoking in MS patients compared to the general population, and to assess the association between smoking and physical disability in MS patients. Materials and Methods: A cross-sectional study included 100 MS patients and 50 healthy people. For estimation of the degree of physical disability, the Expanded Disability Status Scale (EDSS) was used, and for clinical and demographic data a general questionnaire was used. In order to collect data on the smoking, the questionnaire for examining risk factors for vascular disease among patients with MS was used. Results: Analysis of smoking incidence showed that, between MS and control group, smoking was a dependent variable (X2 = 6.258, p = 0.04). There was no statistically significant difference in the number of cigarettes, nor in the duration of smoking. There was no significant correlation between smoking in MS group and the index of disease progression (r=0.216, p=0.133). Also, the relationship between EDSS and smoking had no statistical significance, as well as between the disease course and smoking (X2 = 1.531, p = 0.216). Conclusion: Although it seems reasonable to restrict or refrain from smoking in patients with MS there was no significant evidence of smoking and disease progression correlation.

PERIODONTAL DISEASES AND ATHEROSCLEROSIS (LITERATURE REVIEW)

Introduction: The relationship between periodontal diseases and atherosclerosis is addressed in this article. Both these diseases have an inflammatory basis. Because periodontal disease is a risk factor for developing atherosclerotic vascular disease, diagnosis of the former is important. Particular attention must be paid to patients who have periodontal disease with other risk factors for atherosclerotic vascular disease. Recommendations managing these patients have been made included. The aim: The paper is aimed at familiarization of broad medical public with the presence of the relationship between diseases of periodontal tissues and atherosclerosis. Materials and methods: A thorough comprehensive analysis and generalization of scientific achievements elucidated in the fundamental and periodical publications, relating to diseases of the periodontal tissues and atherosclerosis, has been carried out. Review: The article consists of many researchers regarding the prevalence and intensity of periodontal tissue diseases in people of all ages. Problems associated with the state of periodontal tissues in people under study as dentists and general practitioners. Proven role in the pathogenesis of inflammatory diseases of the periodontal tissues in people with atherosclerosis. In the modern concept of the etiology and pathogenesis of periodontal diseases in people is extremely important role for the immune system and resistance to periodontal bacterial invasion. Analyzed common changes important for pathogenesis of periodontal tissue diseases and atherosclerosis. Conclusions: Consequently, recent studies have shown a clear, directly proportional relationship between periodontal tissue diseases and atherosclerosis, but mechanisms for their development and interaction are not fully disclosed.

High Level of Lipoprotein(a) as Predictor for Recurrent Heart Failure in Patients with Chronic Heart Failure: a Cohort Study

BackgroundElevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic vascular disease. However, there are limited data regarding association between Lp(a) and recurrent heart failure (HF) in patients with chronic HF caused by coronary heart disease (CHD).ObjectiveElevated levels of Lp(a) might have a prognostic impact on recurrent HF in patients with chronic HF caused by CHD.MethodsA total of 309 patients with chronic HF caused by CHD were consecutively enrolled in this study. The patients were divided into 2 groups according to whether Lp(a) levels were above or below the median level for the entire cohort (20.6 mg/dL): the high Lp(a) group (n = 155) and the low Lp(a) group (n = 154). A 2-sided p < 0.05 was statistically considered significant.ResultsDuring the median follow-up period of 186 days, 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. A Kaplan-Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of recurrent HF than those with lower Lp(a) levels (log-rank < 0.0001). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the incidence of recurrent HF after adjustment of potential confounders (hazard ratio: 2.720, 95 % confidence interval: 1.730-4.277, p < 0.0001).ConclusionsIn Chinese patients with chronic HF caused by CHD, elevated levels of Lp(a) are independently associated with recurrent HF.

Serum Lipoprotein (a) levels in acute coronary syndrome; Comparison of younger and elderly patients with healthy controls.

Objective:To compare and see the association of serum Lipoprotein (a) levels in younger and older patients suffering from acute coronary syndrome compared to healthy controlsMethods:This case control study was conducted in department of cardiology, King Edward Medical University, Lahore from January to December 2015. Total 180 subjects (90 cases and 90 healthy controls, subdivided in 45 young and old in each group ≤/>45 years of age) were included in the study by non-probability purposive sampling. Patients presenting with acute coronary event and angiographically proven coronary vascular disease were considered cases while those with normal coronaries served as controls. Lp(a) was measured after ten hours fasting. Lp(a) >30 nmol/l) were considered as high. Data were entered and analyzed in SPSS 17. Independent sample t-test was used to compare the mean lipoprotein (a) in cases and controls.Results:The mean age of cases and controls was 48.02 ± 10.90 & 45.89±10.09 years respectively. Lipid profile was similar in both cases and controls except triglycerides that were higher in controls (p=0.024). The mean lipoprotein (a) in cases was 47.03 ± 45.47 and in controls was 29.69±23.10 (p-value 0.001). Mean Lp(a) level was significantly high in cases vs controls in young subjects, (50.15±55.62 vs 25.75±15.84, p= 0.006), while in old ones, difference was not statistically significant (43.92±32.69 vs 33.64±28.22, p= 0.114). The frequency of desirable, borderline high, high, and very high Lp(a) levels in cases was 23(25.6%), 12(13.3%), 27(30.0%) and 28(31.1%), while in controls, it was 26(28.9%), 31(34.4%), 17(18.9%) and 16(17.8%), (p-value 0.003). Chi-Square test showed significant association of high Lp(a) with coronary artery disease in younger cases vs controls (P=0.004) with OR 3.65 but not in older (p-value 0.358).Conclusion:Serum lipoprotein(a) is strongly associated with coronary vascular disease especially in patients younger than 45 years of age despite comparable LDL and HDL between cases and controls, making Lp(a) likely independent risk factor for coronary vascular disease.

Cardiovascular Disease Risk Factors Assessment of Women Attending a Religious Program in Ado Ekiti, Nigeria

The burden of cardiovascular diseases in developing countries is alarming and needs urgent attention. The study assessed the prevalence of Cardio Vascular Disease risk factor among women in Ekiti State, Nigeria. The study design was a descriptive cross sectional survey conducted in Ado - Ekiti, Nigeria. Participants recruited for the study through simple random sampling were 426 women who were in a religious outreach program. Interviewer administered semi – structured questionnaires were used to collect information on respondents socio-demographic characteristics, past medical history, nutritional status (using dietary recall), and behaviors related to lifestyle. A general physical examination was done and anthropometric measurements taken from each respondent. The examinations collected data on, blood pressure, weight and height. Blood specimen (5 ml whole blood) was collected from each respondent for laboratory tests such as random blood sugar (RBS) and serum cholesterol levels. Data from the clinical examinations and laboratory tests were then used to categorize respondents as hypertensive, diabetic, obese and hyperlipidemic. Data was analyzed using SPSS version 20 and level of significance was set at p values < 0.5. A total of 426 respondents participated in the survey of which 64.8% were between 40 -59 years with a mean age of 51.7 ± 11.9 years. A high proportion (81.7%) of respondents had formal education. Most of the respondents (95%) claimed to be employed. About 51.4% of the respondents reported history of substance use. The most commonly consumed by respondents were “bitter kola” (31.7%) and “kolanut” (9.9%). About 5% of respondents either smoked or took substances containing nicotine e.g. “snuff “. Nearly a quarter, 23.2% of respondents claimed that they have ever used herbal (traditional) medicine (23.2%) to take care of health issues as the need arises. About 9.2% of respondents claimed that they occasionally consumed alcoholic drinks. About 49.5% of the respondents were found to have poor medical history. While majority (73.9%) of the respondents had normal blood pressure (BP), 12.0% and 14% were either pre-hypertensive or hypertensive. Majority of the respondents, 61.2%, were reported obese with a BMI exceeding 25. About 63.4% of respondents had high serum cholesterol while 2.1% reported smoking habit. There were significant cardiovascular risk factors found among women studied.

Socioeconomically Distressed Communities Index independently Predicts Major Adverse Limb Events After Infrainguinal Bypass in a National Cohort

Socioeconomically Distressed Communities Index independently Predicts Major Adverse Limb Events After Infrainguinal Bypass in a National Cohort

Analysis of genetic polymorphism of methylenetetrahydrofolate reductase in a large ethnic Hakka population in southern China.

Methylenetetrahydrofolate reductase (MTHFR) catalyzes conversion of methylene tetrahydrofolate to methylte trahydrofolate. MTHFR C677T polymorphism has been regarded as a risk factor for various vascular diseases. Our study aimed to investigate the distribution frequencies of this polymorphism among Hakka population living in southern China. We retrospectively recruited 5102 unrelated Chinese Hakka subjects. MTHFR C677T polymorphism was tested using the polymerase chain reaction (PCR) and DNA sequencing. A total of 2358 males and 2744 females (aged from 10 years to 101 years) were included in this study. In total, 2835 (55.63%) subjects were homozygous for the C allele (CC), 1939 (38.00%) subjects were heterozygous (CT), and 325 (6.37%) subjects were homozygous for the T allele (TT). The allelic frequency of mutant T was 25.37% with 325 individual homozygous for this defective allele resulting in a frequency of about 6.37% for the TT genotype. According to the study results, the overall frequency of MTHFR C677T genotypes did not differ significantly among the gender and age groups. Our study showed the prevalence of MTHFR C677T polymorphism in a large ethnic Hakka population living in southern China. It would be important implications for the primary prevention of various vascular diseases.

Prenatal Biochemical Screening and Long Term Risk of Maternal Cardiovascular Disease: Population Based Cohort Study

(Abstracted from BMJ 2018;362:k2739) Placental vascular disease is thought to arise within the temporary interface of the trophoblast and endometrial decidua, resulting in adverse outcomes for mother and fetus, including preeclampsia, placental abruption, poor fetal growth, and preterm birth. Some risk factors for placental vascular disease, including for preeclampsia, are the same as those for cardiovascular disease.

GOLD stage predicts thoracic aortic calcifications in patients with COPD.

Although some of the associations between chronic obstructive pulmonary disease (COPD) and atherosclerosis are based on shared risk factors such as smoking, recent epidemiological evidence suggests that COPD is a risk factor for vascular disease due to systemic inflammation. The present study assessed the hypothesis that disease severity (as expressed by the GOLD stage) independently predicts the extent of vascular calcifications. A total of 160 smokers diagnosed with COPD (GOLD I-IV, 40 subjects of each GOLD stage) and 40 smokers at risk (GOLD 0; median age of 60 years old; Q1:56;Q3:65; 135 males and 65 females) underwent non-contrast, non-electrocardiography synchronized chest computerised tomography. The volume of thoracic aortic calcifications was quantified semi-automatically within a region from T1 through T12. Multiparametric associations with GOLD stage, smoking history, sex, age, body mass index and emphysema index were evaluated using generalized linear regression analysis. Thoracic aortic calcifications were highly prevalent in this cohort (187/200 subjects, 709 (Q1:109;Q3:2163) mm3). Analysis of variance on ranks demonstrated a significant difference in calcium between different GOLD-stages as well as patients at risk of COPD (F=36.8, P<0.001). In the multivariable analysis, GOLD-stages were indicated to be predictive of thoracic aortic calcifications (P≤0.0033) besides age (P<0.0001), while age appeared to be the strongest predictor. Other variables were not statistically linked to thoracic aortic calcifications in the multivariable model. COPD severity, as expressed by the GOLD-stage, is a significant predictor of thoracic aortic calcifications, independent of covariates such as age or tobacco consumption.

Blinatumomab + Ponatinib for Relapsed Ph1-Positive Acute Lymphoblastic Leukemia: The French Experience

Prognosis of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph1+ ALL) has been considerably improved since the beginning of the BCR-ABL1 tyrosine kinase inhibitors (TKI) era 20 years ago. However, the prognosis of patients with a refractory/relapsed (including molecular relapse) disease is still very dismal. New drugs or combination of new drugs may improve outcomes of these patients. For example, ponatinib, a 3rd-generation oral TKI, known to have activity against BCR-ABL1 T315I mutations, has shown some efficacy in this context. Similarly, a recent study has reported very encouraging results of the bispecific anti-CD3/CD19 monoclonal antibody blinatumomab as single-agent in refractory/relapsed Ph1+ ALL. Data regarding the efficacy and tolerance of a combination of blinatumomab+ponatinib (blina/pona) are still scarce.This was a retrospective study with the aim to report outcomes of patients receiving a combination of blina/pona for refractory/relapsed Ph1+ ALL in France. Fifteen adults from 8 French centers were identified and data were collected by physicians of each centers, then gathered for the purpose of this study.There were 9 males and 6 females, with a median age of 53 years (range:17-72). All patients, but 2 with blast crisis of chronic myeloid leukemia, had de novo Ph1+ ALL. Four cases had BCR-ABL1 T315I mutation. Patients received the blina/pona combination, either after a first (n=8) or a second (n=7) cytologic relapse. There was no refractory patient in theses series. Previous allograft and autograft has been performed in 7 and 2 patients, respectively. The majority of patients (n=12) had previously received 2 or more lines of TKI. The median time between the first cycle of blina/pona and diagnosis was 14 months (range: 8-40). The median number of blinatumomab cycle (28 mg/day by continuous infusion for 28 days every 6 weeks) administered per patient was 3 (range: 1-6) while ponatinib was concomittantly administered continuously at an initial dose of 45 mg once daily in 11 pts (73%) and 30 mg in 4 pts (27%). Median duration of ponatinib administration was 4 months (range: 1.1-10.9) from first blinatumomab cycle. The toxicity profile was safe: all patients received a complete first cycle without grade 3-4 adverse events. After cycle 1, blinatumomab was stopped in 47% of cases because of neurologic events in 4 and infections in 3; ponatinib was stopped in 33% of cases because of neurologic events in 3, fluid retention in 1 and severe arteriopathy in 1 patient with other vascular disease risk factors. All neurologic events resolved after stopping blinatumomab or ponatinib.The majority of patients were evaluated after one cycle (n=11, after cycle 2 n=3, after cycle 3 n=1). All but one patients (93%) obtained a cytologic complete remission (CR), of whom 12/14 (86%) achieved a complete molecular response. However, 2 patients were documented with CNS relapse at the time of blina/pona evaluation although in bone marrow molecular remission. Both obtained clearance of leukemic blasts after intrathecal infusion of chemotherapy. Then, 5 patients underwent allogeneic transplant (including 2 patients already allotransplanted before blina/pona) and 1 patient received donor lymphocyte infusion. Seven cases pursued maintenance therapy with ponatinib as single agent after stopping blinatumomab. With a median follow-up of 8 months (range: 2.6-30.2) for alive patients, median overall and leukemia-free survivals from first cycle of blina/pona were 8.5 months (range: 1.7-30.2) and 8 months (range: 1.3-30.2), respectively.At last follow-up (July 2018), only 4 relapses had occurred at a median of 3.3 months (range: 1.3-8.3) from first blina/pona cycle and 6 patients had died (3 bacterial infections, 1 fungal infection, 1 secondary cancer and 1 ALL relapse). All alive patients (n=9) but one (cytologic CR but detectable minimal residual disease) are in complete molecular response. Four patients are still under ponatinib medication at last follow-up.The combination of blinatumomab+ponatinib appears effective and tolerable in relapsed Ph1+ALL patients and may replace chemotherapy salvage regimens. The combination should be tested in first-line therapy in the future. Our results have also to be confirmed prospectively on a larger cohort of patients. DisclosuresNo relevant conflicts of interest to declare.

2259. Effect of Discontinuation of Tenofovir Disoproxil Fumarate (TDF) on Renal Function in Elderly Veterans

BackgroundA new formulation of tenofovir with alafenamide (TAF) has been introduced that promises to reduce the risk of renal disease. However, the clinical impact of TAF in elderly persons with HIV/AIDS and comorbid renal disease has not been fully investigated. Using patient data from Louis Stokes Cleveland VA Medical Center, this study examines the effect of TDF discontinuation on renal function.MethodsWith IRB approval, clinical data from 272 veterans with HIV/AIDS were gathered to estimate glomerular filtration rate (eGFR) using CKD-EPI (CE) and Cockcroft-Gault (CG) formulae.Results122 patients were excluded because they did not meet the criteria for the study or for insufficient data. The remaining 150 patients had a mean age of 57.7 years, 96.7% were male, 51% African American, 50% were smokers, 28% had diabetes and 63% had vascular disease risk factors. Baseline mean sCR value was 1.1 ± 0.3. Mean CD4 was 672 ± 372 on TDF containing regimens (703 ± 344 after switch) and 66% (69%) had viral loads <20 cp/mL. Serum creatinine (sCr) values before and after the discontinuation of TDF were collected, and eGFR and rate of change for eGFR and sCr were calculated. In a univariate manner, variables were also examined within 3 subgroups: smokers, diabetics and patients with vascular disease risk factors. Changes in boosting medication were rare (5 patients started cobicistat and 7 patients discontinued ritonavir) and thus had little effect on average changes in sCr and eGFR in this cohort. Overall, discontinuation of TDF stabilized sCR (Figure 1). Mean sCr increased by 0.13 and eGFR declined by 5.755 (CE) or 11.822 (CG) during the mean 181 days of observation prior to TDF discontinuation. After the switch, mean sCr increased by 0.002 during a mean of 396 days of observation; eGFR increased by 1.198 (CE) or 1.300 (CG). Similar trends were observed in the 3 subgroups. In all groups, discontinuation of TDF led to improvement in eGFR.ConclusionDiscontinuation of TDF and initiation of TAF or other non TDF containing regimen stabilizes eGFR in elderly men with HIV and underlying risk for renal disease. Disclosures All authors: No reported disclosures.

Abstract 17209: Impaired Ventricular-Vascular Coupling in Young Adults Born Preterm

Background: Preterm birth affects 10% of live births in the United States, often requiring mechanical ventilation and oxygen supplementation. Although a known risk factor for neonatal and childhood pulmonary vascular disease, little is known regarding the long-term impact on the right ventricle (RV). Here, we utilize novel techniques to investigate RV afterload, contractility, and ventricular-vascular coupling (VVC) in young adults born preterm. Methods: Adults born premature (n=7; 4; current age 26.7±0.4 years; gestational age 28.6±1.1 weeks) born with very low birth weight (≤1500g) were recruited from the Newborn Lung Project. Control subjects (n=7; 2) from the same birth years were recruited from the general population. All subjects had no known cardiopulmonary disease. Right heart catheterization (RHC) and magnetic resonance imaging (MRI) were performed to assess right ventricular hemodynamics. Asynchronously acquired pressure and volume data (from RHC and MRI, respectively) were used to compute effective arterial elastance (Ea), end-systolic elastance (Ees), and VVC as: [ESP/SV], [(P max -ESP)/SV], and [Ees/Ea], respectively, where ESP is the end-systolic pressure, SV is the stroke volume, and P max is the maximum isovolumetric pressure estimated from a novel single-beat approach. Results were analyzed via two-sample t-test; p&lt;0.05 was considered significant. Results: Preterm subjects had significantly increased Ea, a measure of RV afterload (Figure 1A). No difference Ees, a measure of RV contractility, was evident (Figure 1B), resulting in significantly impaired VVC in preterm subjects (Figure 1C). Conclusion: Otherwise healthy young adults born preterm have high resistance-low compliance pulmonary vascular beds with no RV adaptation, resulting in impaired right ventricular-pulmonary vascular coupling. These findings add to the growing literature that preterm birth has profound lifelong consequences that warrant further study.

Lp-PLA2 as a risk factor of early neurological deterioration in acute ischemic stroke with TOAST type of large arterial atherosclerosis

ABSTRACTIntroduction: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well-known risk factor of atherosclerotic vascular diseases. Nevertheless, its role in the acute phase of ischemic stroke is still unclear. The aim of this study is to identify the relationship between Lp-PLA2 levels and early neurological deterioration (END) in acute ischemic stroke patients with Trial of Org 10 172 in Acute Stroke Treatment (TOAST) subtype of large arterial atherosclerosis (LAA).Methods: We enrolled Chinese patients with first ever acute ischemic stroke admitted to Neurology Department of Shenzhen Second People’s Hospital within 48 h from onset of symptoms during January – November 2015. Demographic and laboratory information were collected while END was defined as an increase in the National Institute of Health Stroke Scale score by ≥ 1 point in motor power, or ≥ 2 points in the total score within 10 days after admission.Results: Overall 181 patients were involved; END was diagnosed in 30 patients within 10 days after admission. The odds ratio for END increased with increasing levels of Lp-PLA2 (intermediate level, OR = 1.96, 95%CI 1.02–4.27, p = 0.041; high level, OR = 2.99, 95%CI 1.26–5.73, p = 0.023).Conclution: Intermediate and high level of Lp-PLA2 was identified as independent predictor of END in multivariate analysis. Lp-PLA2 could be valued as a risk factor of END in patients with acute ischemic stroke with TOAST subtype of LAA.

METHYLENETETRAHYDROFOLATE REDUCTASE POLYMORPHISM AND PREMATURE CORONARY ARTERY DISEASE

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Methylenetetrahydrofolate reductase (MTHFR) catalyzes the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, a co-substrate for homocysteine remethylation to methionine. Its deficiency leads to increased homocysteine levels. Elevated serum levels of homocysteine have been associated with premature coronary artery disease (CAD). we present a case of recurrent acute coronary syndrome in patient with heterozygote mutation for methylenetetrahydrofolate reductase (MTHFR) with normal homocysteine level. CASE PRESENTATION: A 23 year-old man with history of MTHFR polymorphism and anterior wall ST segment elevation myocardial infarction requiring drug eluting stent (DES) in the left anterior descending artery (LAD) presented to the emergency department with substernal chest pain, T wave inversions in inferior leads on his ECG and elevated troponin levels. Coronary angiography demonstrated an acute occlusion of the proximal right coronary artery (RCA) and a chronic total occlusion of the proximal LAD with collaterals from the circumflex territory. Aspiration thrombectomy of the RCA lesion was partially successful and required continuous infusion of unfractionated heparin and tirofiban for 48 hours in addition to aspirin and ticagrelor. He underwent a successful deployment of 3 DES to his RCA. His left ventriculogram showed a mildly reduced left ventricular ejection fraction of 45 % with hypokinesis of the basal inferior wall segment. DISCUSSION: Hypercoagulability workup was unrevealing. Homocysteine levels were normal at the time of his first myocardial infarction two years prior. Repeat homocysteine level was 11.7 mg/dl (n <11.2mg/dl). His total cholesterol was 153mg/dl, LDL 80mg/dl, Apo lipoprotein B was 67 (n 52-109mg/dl), Lp(a) <10(n <75nmol/L). He was then discharge on folic acid. He was brought back to the cardiac catheterization laboratory a month later to reassess the LAD lesion but the angiogram showed complete re-occlusion of RCA. The patient was referred for coronary artery bypass surgery. CONCLUSIONS: This case demonstrates the association of MTHFR polymorphism with premature CAD and myocardial infarction despite normal homocysteine levels. Screening for MTHFR polymorphisms in addition to homocysteine levels should be considered for patients presenting with premature CAD and a normal lipid profile. Aggressive risk reduction with lifestyle modification, guideline-driven medical therapy and folic acid might be necessary for secondary cardiovascular disease prevention until more specific therapeutic options are available for this subgroup of patients. Reference #1: Frosst P, Blom HJ, Milos R, et al. A candidate genetic risk factor for vasculardisease: a common mutation in methylenetetrahydrofolate reductase. Nat Genet.1995; 10: 111–113 Reference #3: DISCLOSURES: No relevant relationships by Corina Iorgoveanu, source=Web Response No relevant relationships by Ahmed Zaghloul, source=Web Response

Relationship Among Serum Homocysteine, Serum Folate And Left Ventricular Ejection Fraction In Chronic Kidney Disease

Background: Homocysteine (Hcy) a sulfurcontaining, non-protein a-amino is now considered an independent non-traditional risk factor for vascular disease. In Chronic Kidney Disease (CKD) highly prevalent hyperhomocysteinemia which is often associated with decreased folate concentrations is thought to contribute to increased cardiovascular morbidity. So, the aim of this cross-sectional study was to investigate the relations among serum homocysteine, serum folate and Left Ventricular Ejection Fraction (LVEF) in the context of native CKD patients. Materials and methods: A total of one-thirty (130) participants were recruited between June and July 2016. Among them ninety (90) were CKD patients of stage III, IV &amp; V and forty (40) were healthy controls.eGFR was calculated by MDRD formula. Different groups were created based on serum homocysteine level and eGFR. Results: In this study, hyperhomocysteinemia was seen in 97% CKD patients compared to 52.50% in controls. The CKD patients with elevated homocysteine levels had higher serum creatinine, LDL and systolic BP but they had lower eGFR, serum folateand LVEF than those with normal homocysteine concentrations. As the severity of homocysteinemia increased, eGFR and serum folate decreased. LVEFalso reduced significantly with increasing severity of hyperhomocysteinemia i.e. from 68% in those withouthyperhomocysteinemia to 41.33% in those with severe hyperhomocysteinemia. Chi-squared tests and odds ratios proved significant associations of hyperhomocysteinemia and folate deficiency with CKD. Higher homocysteine concentrations were also associated with low folate and low LVEF. Here, serum homocysteine correlated negatively with eGFR, serum folate and LVEF and positively with LDL and systolic BP. Conclusion: Inconclusion, this study revealed significant associationsamong hyperhomocysteinemia, low serum folate and low LVEF in the native CKD patients. The consistency of homocysteine- eGFR and homocysteine-LVEF correlations suggests that serum homocysteine may provide useful additional information about CKD and associated high cardiovascular morbidity.&#x0D; JCMCTA 2018 ; 29 (1) : 35-41