Risk Factor For Vascular Disease Research Articles

Acute onset binocular diplopia: a retrospective observational study of 100 consecutive cases managed at a tertiary eye centre in Saudi Arabia.

ObjectiveTo evaluate the demography, aetiology and clinical course of acute onset binocular diplopia (AOBD) in patients presented as emergency and managed at the neuroophthalmology clinic of a tertiary eye care centre in Saudi Arabia.Patients and methodsA retrospective review of the medical records of 100 consecutive patients who attended the emergency department of Dhahran Eye Specialist Hospital with isolated, AOBD. The exclusion criteria were: (a) monocular diplopia, (b) binocular diplopia accompanied with neurological deficits other than ocular muscles dysfunction and (c) thyroid eye disease. All patients were followed until resolution of the diplopia or onward referral to another specialty for further management.ResultsMale:female ratio was 2:1. Median age of the cohort was 56 years (range 18–90 years). Associated nerve palsy included: abducens nerve (n = 57 patients), oculomotor (n = 32 patients) and trochlear nerve (n = 3 patients). Microvascular ischaemia and ocular myasthenia gravis were two most common pathogenic mechanisms. AOBD resolved spontaneously in 98% of patients.ConclusionAOBD, though an alarming and distressing condition, carries reassuringly good prognosis in majority of patients. High risk factors for vascular disease in Middle-Eastern population are reflected in microvascular aetiology as the major cause.

The Association of Blood Glucose and Diabetes with Abdominal Aortic Aneurysm, Carotid Stenosis and Peripheral Arterial Disease: An Observational Study of 630,000 Patients Attending Vascular Screening

Introduction - Diabetes is an important risk factor for atherosclerotic vascular disease, and previous studies have also shown a positive continuous association between blood glucose concentrations throughout the “normal” reference range and cardiovascular disease. However, diabetes appears to be inversely associated with abdominal aortic aneurysm (AAA). This study reports associations between blood glucose concentration and diabetes with AAA, carotid stenosis and peripheral arterial disease (PAD). Methods - Between 2008 and 2013, 3.3 million self-referred individuals attended cardiovascular screening clinics (Life Line Screening) in the US and UK. Assessments included an aortic ultrasound scan, a carotid duplex, and ankle-brachial pressure index (ABPI). Major cardiovascular risk factors and medical history were recorded, and approximately one fifth of participants also underwent blood glucose assays. Diabetes was defined according to previous diagnosis or treatment. Participants with incomplete data or prior cardiovascular disease were excluded, yielding 628 246 individuals in the current report. Results - The mean age at screening was 63 ± 10 years, and 64% of attendees were women. The following prevalences were observed: AAA (infra-renal aorta ≥ 30mm) = 0.5%; carotid artery stenosis (peak systolic velocity generally ≥110cm/s) = 3.5%; PAD (ABPI <0.9) = 2.6%. A prior diagnosis of diabetes was associated with higher risk of PAD (OR, 95%CI: 1.77, 1.71-1.84) and carotid stenosis (1.71, 1.66-1.76), and among participants without a prior diagnosis of diabetes the prevalence of carotid stenosis and PAD increased with higher blood glucose levels across the normal reference range. For AAA, a prior diagnosis of diabetes was associated with a significantly lower risk (0.83 0.77-0.90), however among attendees without diabetes, the prevalence of AAA increased with higher blood glucose levels across the normal reference range. Conclusion - Across the normal reference range, higher blood glucose concentrations are associated with increased risk of carotid stenosis, PAD and AAA, but a diagnosis of diabetes was associated with a lower risk of AAA. This raises the possibility that the “protection” conferred by diabetes against AAA could be due to a treatment effect, but this hypothesis needs to be tested in randomised trials.

Effect of herbal combination of triphala and Garcinia cambogia extracts on liver function test and kidney function test in high fat diet induced obesity in rats

Background: Obesity, a global epidemic, is a major risk factor for diabetes mellitus and cardio vascular diseases. Despite advances, the pharmacotherapy for obesity remains limited. Almost all medications for long term management of obesity have health issues. Due to the adverse drug reactions (ADRs) associated with many antiobesity medicines, the clinical trials are focussing on screening herbal medicines for use in the treatment of obesity, which have minimal ADRs.Methods: Rats were divided into eight groups of six each. The rats were first made obese by feeding high fat diet (HFD) for three weeks. Then treatment with the herbal extracts was given simultaneously with the HFD to the experimental groups. Rats were fed HFD for six weeks along with herbal extracts and the effect on their liver function test and kidney function test were evaluated.Results: The rats fed HFD and supplemented with herbal preparations of Triphala and G. cambogia for six weeks, showed significant improvement in liver function test and kidney function test related parameters as compared to the control group rats fed with HFD alone.Conclusions: Triphala and G. cambogia can counter the effects of HFD intake and have the potential for use as anti-obesity agents with desirable liver function test and kidney function test related parameters modulating properties.

Human platelet antigen polymorphisms and the risk of chronic Chagas disease cardiomyopathy

Human platelet antigen (HPA) polymorphisms are considered to be a risk factor for cardiac and vascular diseases, but the role of HPA in chronic Chagas disease cardiomyopathy (CCC) is not available. Therefore, the aim of this study was to investigate the association of HPA polymorphisms, HPA-1, HPA-2, HPA-3, HPA-5 and HPA-15, in the severity of left ventricular systolic dysfunction (LVSD) in CCC patients. For this, 229 CCC patients were separated into three groups: without LVSD, mild/moderate LVSD and severe LVSD. PCR-SSP was performed for HPA genotyping and the risk was assessed using SNPStats software. HPA-1 allele and genotype frequencies were lower in mild/moderate LVSD patients compared to other groups, without statistical significance. After stratified analyzes, the HPA-3a/3b genotype frequency was lower in women with severe LVSD compared to those without LVSD (OR:0.29; 95% CI: 0.10–0.84). In conclusion, HPA-3 variant could be a protection factor for CCC in the female patients.

Smoking cessation affects human platelet activation induced by collagen.

It is firmly established that smoking is a risk factor of cardiovascular disease, stroke and peripheral vascular disease. Although smoking alters the hemostatic process, the influence of smoking on human platelet activation remains controversial. For patients undergoing surgery, cessation of smoking prior to the procedure is recommended as it increases the risk of postoperative morbidity or mortality. The presented study investigated the effects of smoking cessation on human platelet activation induced via collagen (n=19 patients). Blood samples were taken on four occasions: Before smoking cessation, and at 4, 8 and 12 weeks after smoking cessation. Platelet aggregation using citrated platelet-rich plasma (PRP) was monitored using a PA-200 aggregometer, which determined the size of platelet aggregates using laser scattering methods. A low dose of collagen (1 µg/ml) accelerated platelet aggregation at 4 or 8 weeks after smoking cessation when compared with results before cessation. After 12 weeks, levels of platelet aggregation induced by collagen were almost equal to those recorded prior to smoking cessation. The secretion levels of collagen-induced platelet-derived growth factor (PDGF)-AB at 4 or 8 weeks after smoking cessation were significantly higher than those before smoking was stopped. Furthermore, smoking cessation markedly strengthened the collagen-induced phosphorylation of p38 mitogen-activated protein (MAP) kinase after 4 weeks. The results of the current study indicated that smoking cessation causes temporary short-term human platelet hyper-activation. The further suggest that the incidence of complications due to human platelet hyper-reactivity may be lowered by considering the period of smoking abstinence.

Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link?

Obesity is a risk factor for cardiometabolic and vascular diseases like arterial hypertension, diabetes mellitus type 2, dyslipidaemia, and atherosclerosis. A special role in obesity-related syndromes is played by cardiac visceral obesity, which includes epicardial adipose tissue and intramyocardial fat, leading to cardiac steatosis; hypertensive heart disease; atherosclerosis of epicardial coronary artery disease; and ischemic cardiomyopathy, cardiac microcirculatory dysfunction, diabetic cardiomyopathy, and atrial fibrillation. Cardiac expression of these changes in any given patient is unique and multimodal, varying in clinical settings and level of expressed changes, with heart failure development depending on pathophysiological mechanisms with preserved, midrange, or reduced ejection fraction. Progressive heart failure with misbalanced metabolic and catabolic processes will change muscle, bone, and fat mass and function, with possible changes in the cardiac fat state from excessive accumulation to reduction and cardiac cachexia with a worse prognosis. The question we address is whether cardiac obesity or cardiac cachexia is to be more feared.

Associations Between Elevated Plasma Total Homocysteine Level and Risk of Thromboangiitis Obliterans in a Chinese Population: A Matched Case-Control Study

Elevated plasma total homocysteine level is a risk factor for various vascular diseases; however, an association with risk of thromboangiitis obliterans (TAO) has not been defined. This study aims to assess whether elevated plasma total homocysteine level is associated with risk of TAO. We performed a matched case-control study including 64 patients with TAO and 256 controls. Multivariate logistic regression models were used to estimate the association between elevated plasma homocysteine level and the risk of TAO. Interaction and stratified analyses were conducted according to age, sex, smoking, alcohol consumption, and histories of chronic diseases. Patients with TAO versus controls had a higher mean plasma total homocysteine level (21.2±12.8μmol/L vs. 14.1±4.9μmol/L; P<0.01). The risk of TAO was 3.68-fold increased in participants with plasma total homocysteine level >15μmol/L (95% confidence interval [95% CI], 1.2-11.7). A 1μmol/L increase in plasma total homocysteine level was associated with 20% higher risk of TAO (odds ratio, 1.2; 95% CI, 1.1-1.3). Our findings suggest that the risk of TAO was significantly associated with elevated plasma total homocysteine level independently of other factors analyzed, including smoking. Studies on the use of homocysteine-lowering therapy to prevent TAO would allow testing causality of the latter association.

Predictors of heart failure development in type 2 diabetes: a practical approach.

Purpose of reviewAlthough type 2 diabetes (T2D) is one of the most important risk factors that leads to the development of de novo heart failure, there are limited data, particularly from a practical/qualitative standpoint, about predictors of heart failure in this population.Recent findingsSodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to prevent the development of heart failure and the composite of heart failure and cardiovascular death in patients with T2D without known heart failure who have either established atherosclerotic vascular disease or multiple risk factors. The concept of primary prevention of heart failure has led many clinicians to inquire if there are specific risk/enrichment factors that may predict an increased risk of heart failure.SummaryIn this review, we identify some general and diabetes-specific risk factors that are associated with an increased risk of developing heart failure in people with T2D.

A full-width half-maximum method to assess retinal vascular structural changes in patients with ischemic heart disease and microvascular angina

Chest pain patients without obstructive ischemic heart disease (IHD) have increased attention in the clinical practice as carrying higher cardiovascular (CV) risk and impaired life quality. Retinal vasculature is a novel but reliable risk factor of atherosclerosis and systemic vascular diseases. However, the association of retinal blood vessels and unobstructed IHD, as known as microvascular angina (MA) is poorly understood. This study compared retinal vascular structures of obstructive IHD and MA using spectral domain optical coherence tomography (SD-OCT) and full-width half-maximum (FWHM) methods to provide new risk predictive evidence of MA. Fundus vessels of 120 IHD patients, including 91epicardial IHD and 29 MA patients, and 66 control subjects were evaluated. Significant differences in the retinal arterial lumen diameter (RALD), retinal arterial outer diameter (RAOD), and arteriovenous ratio (AVR) have been found (P < 0.05). The severity of IHD was negatively correlated with diameters of RAOD, RALD and AVR (P < 0.05). In conclusion, there were significant differences in the retinal vascular structure between IHD patients and patients with MA. Thus, assessment of retinal vascular structure is suggested to evaluate CV risk of IHD patients, despite having no obstructive IHD.

Outcomes of the V-Healthy Awareness Campaign That Empowers High-School Students to Understand and Diagnose Vascular Disease Risk Factors

Just imagine the impact of empowering young high-school students to become the Sherlock Holmes of vascular health and disease. V-Healthy is a grassroots vascular education and awareness campaign that educates high-school students of the importance of vascular disease risks they face today and its impact decades later. Since 2016, >300 volunteer educators including vascular surgeons, primary care physicians, allied health care providers, and teachers have participated in the V-Healthy campaign that educated >12,000 students in 40 high schools on the implications of vascular disease risks. Students participated in didactics and hands-on workshops focused on the impact of vascular disease risk factors on peripheral artery disease, venous disease, aortic aneurysms and dissections, and stroke. In 3 years, 1210 students have participated in a Diagnosing Hypertension (HTN) study, which included monitoring daily blood pressures in their parents for a week, and participated in creating a public service announcement focused on vascular health education and awareness in their communities. An additional 2950 students participated in a survey questionnaire on the impact of the V-Healthy campaign. Of the previously undiagnosed 1210 parents who participated in the Diagnosing HTN study, >50% were hypertensive; 10% had pre-HTN (120-129/<80 mm Hg), 31% had stage 1 HTN (130-139/80-89 mm Hg), and an additional 20% had stage 2 HTN (≥140/≥90 mm Hg). Of the 2950 students who participated in the V-Healthy survey, 99% reported that they had a better understanding of vascular health; 90% recognized HTN, diabetes, smoking, obesity, and family history as risk factors; 84% would discuss vascular health with their families; and 76% were interested in learning more about their vascular health. V-Healthy is a grassroots campaign that allows vascular surgeons to lead community vascular health education and awareness and to have an impact on change. HTN is prevalent and an under-recognized vascular disease risk factor that can be used as a focal point for public vascular health education and awareness. The V-Healthy project identifies a process that can be used to develop outreach programs that empower high-school students to understand the implications of vascular disease risks and promote vascular health in our communities.

Association of interarm blood pressure difference with cardio-cerebral vascular disease: A community-based, cross-sectional study.

Interarm blood pressure difference (IAD) is a risk factor for peripheral artery disease and cardio-cerebral vascular disease (CCVD). The current study examines the association of IAD with stroke and coronary heart disease in a Chinese community. A cross-sectional study was conducted in Pudong New Area in Shanghai, China. A total of 10657 residents aged 15years and older were randomly selected through three-stage sampling. Volunteers had systolic and diastolic blood pressure (BP) measured in both arms at recruitment, and IAD was defined in both arms as the absolute difference in BP. Medical records of study participants were reviewed by investigators to confirm measurements. Logistic regression models were used to assess the association between systolic interarm blood pressure difference (sIAD) and diastolic interarm blood pressure difference (dIAD) with stroke and coronary heart disease. Compared with dIAD <5mmHg, the multivariate adjusted odds ratio (OR) of stroke prevalence was 1.357 (95% CI 0.725-2.542, P=0.034) for dIAD ≥20mmHg and 1.702 (95% CI1.025-2.828, P=0.040) for dIAD between 15 and 19mmHg, and the multivariate adjusted OR of coronary heart disease prevalence was 1.726 (95% CI 1.093-2.726, P=0.019) for dIAD ≥20mmHg and 1.498 (95% CI 0.993-2.261, P=0.044) for dIAD between 15 and 19mmHg. The relationship between cardio-cerebral vascular disease and dIAD was significant in a Chinese community population. Further cohort studies are needed to investigate the association of different levels of IAD with the incidence of cardiovascular and cerebrovascular diseases and subsequent mortality.

Mechanisms of diabetes and dementia

Mechanisms of diabetes and dementia

Cardiovascular Disease and Its Risk Factors Among Employees of Sindh Government; A Cross Sectional Survey from Karachi, Pakistan

Abstract:&#x0D; Introduction: Globally it is documented that CVD has multi-factorial aetiology and many factors like increased BMI, hypertension (HTN), stress and diabetes determine the risk of CVD. The prevalence of risk factors for cardio vascular disease (CVD) is on increase in the developing nations of the world.&#x0D; Objectives: The purpose of the study was to find out the prevalence of cardiovascular disease and its risk factors among employees of Sindh Government in Karachi, Pakistan.Method: It was hospital based cross sectional study. A total of 150 subjects (govt employees of Sindh Government) were interviewed by using consecutive sampling technique. Data on serum cholesterol, BMI, blood pressure, history of hypertension, diabetes and cardiovascular diseases was collected, in addition to demographic data.&#x0D; Results: Out of 150 subjects interviewed, 20.6% reported to have CVD. The most prevalent risk factor was hypertension, found in 58% respondents. Other risk factors were diabetes (45%), sedentary life style (50%), obesity (28%), dyslipidaemia (30%), smoking (20%), positive family history (26%). In 6% of subjects, three major risk factors were present. The risk factors, strongly associated with CVD in our study were diabetes (p&lt;0.01), hypertension (p&lt;0.001) and family history of CVD (p&lt;0.02). There is strong association of increasing age on risk of developing CVD (p&lt; 0.001).&#x0D; Conclusion: The results show that there is high frequency of CVD risk factors in employees of health department in Karachi. The high prevalence of risk factors, especially hypertension, sedentary life style, obesity and diabetes should be of great concern.

HIGHER FLOW VELOCITIES AT BOTH CAROTID AND CEREBRAL ARTERIES WERE ASSOCIATED WITH HIGHER COGNITIVE PERFORMANCE IN THE MIDDLE-AGE INDIVIDUALS

Objective: Lower carotid flow velocities were associated with cognitive function in elderly populations, however, this association in middle-aged adults remains unclear. This study aimed to investigate the association between the flow velocity at carotid and cerebral arteries and cognitive function among middle-aged adults. Design and method: A total of 137 adults aged between 30 and 60 years old completed the physical examinations and cognition function evaluation and the measurements of flow velocities at the carotid and middle cerebral arteries (n = 47) in an ongoing study (Cardio Vascular Disease risk FACtors Two-township Study[CVDFACTS]). We used the Montreal Cognitive Assessment [MOCA] to evaluate the cognitive function. The carotid flow velocities at common and internal carotid arteries were measured by Carotid Doppler and the flow velocity at intracranial arteries (middle cerebral vessels) were measured by Trans-Cranial Doppler. Crude and partial correlation were used to evaluate the association between flow velocities and cognitive function. Results: Peak-systolic velocity (r = 0.184, p-value[p] = 0.045), diastolic velocity(r = 0.185, p = 0.044) and mean flow velocity(r = 0.207, p = 0.024) at internal carotid artery (ICA) were significantly associated with MOCA in the multivariable model with adjusting age, sex, education, systolic blood pressure, glucose and lipids. The correlation coefficients (n = 47) between mean flow velocity at the internal carotid artery and at intracranial arteries (middle cerebral vessels) were 0.93 (p-value <. 0001). In addition, higher internal cerebral mean flow was associated with higher cognitive preference (MOCA) (r = 0.41, p = 0.0093) in the model with adjusted for age, sex and education. Conclusions: Flow velocities at the internal carotid artery and at cerebral artery were highly correlated, and those were associated with lower cognitive function in the middle-age population. Carotid flow velocity may be involved the pathogenesis of early cognitive function decline in middle-age.

Association of COX2 -765G>C promoter polymorphism and coronary artery disease in Korean population.

Cyclooxygenase-2 (COX2) plays a role in the formation of prostaglandins, which contribute to the inflammation involved in atherosclerosis. However, the role of the COX2 -765G>C polymorphism in susceptibility to coronary artery disease (CAD) is controversial. To identify the association between COX2 -765G>C polymorphism with CAD risk in Korean patients. We recruited 622 patients who were diagnosed to have coronary artery disease and 202 controls who did not have history and vascular disease risk factors. Using polymerase chain reaction-restriction fragment length polymorphism, the COX2 -765G>C polymorphism was analyzed in 622 Korean patients who received percutaneous coronary intervention and in 202 healthy control subjects. The GC+CC genotype frequencies of the -765G>C polymorphism were significantly different between the CAD and control groups. The COX2 -765G>C polymorphism showed peculiar associations with CAD according to the presence of hyperlipidemia and plasma folate levels. However, there were no associations between the -765G>C polymorphism and the rates of hypertension, diabetes mellitus, or homocysteine levels. This study suggests that the COX2 -765G>C polymorphism is a possible genetic determinant for the risk of CAD, and an individual risk factor in Koreans. Thus, further association studies between the COX2 polymorphism and atherosclerotic-related diseases such as cerebrovascular or cardiovascular diseases in other races or ethnicities will be needed.

PS946 BLINATUMOMAB + PONATINIB FOR RELAPSED PH1‐POSITIVE ACUTE LYMPHOBLASTIC LEUKEMIA: THE FRENCH EXPERIENCE

Background:Despite the progress achieved with the combination of BCR‐ABL1 tyrosine kinase inhibitors (TKI) and chemotherapy, the prognosis of patients with a refractory/relapsed Philadelphia chromosome‐positive acute lymphoblastic leukemia (Ph1+ ALL) is still very dismal. However, new drugs have recently improved outcomes of these patients: ponatinib has shown some efficacy in this context and a recent study has reported very encouraging results of the anti‐CD3/CD19 monoclonal antibody blinatumomab as single‐agent. Data regarding the efficacy and tolerance of a combination of blinatumomab+ponatinib (blina/pona) are still scarce.Aims:Methods:This was a retrospective study in 12 French centers: 23 patients with a relapsed/refractory Ph1+ ALL have concomitantly received blinatumomab (28 mg/day by continuous infusion for 28 days every 6 weeks) and daily orally ponatinib.Results:There were 13 males and 10 females, with a median age of 58 years (range:17–72). All patients, but 3 with blast crisis of chronic myeloid leukemia, had de novo Ph1+ ALL. Seven cases (30.4%) had BCR‐ABL1 T315I mutation. Patients received the blina/pona combination, either after a first (n = 10) or a second or more (n = 11) cytologic relapse. There was one refractory patient. One patient received blina/pona in consolidation, after serious side effects from front‐line chemotherapy. Previous allograft and autograft has been performed in 9 and 4 patients, respectively. The majority of patients (n = 15) had previously received 3 2 or more lines of TKI. The median number of blinatumomab cycle administered per patient was 3 (range: 1–5) while ponatinib was administered continuously at an initial dose of 45 mg once daily in 17 pts (74%) and 30 mg in 6 pts (26%) during a median time of 5 months (range: 1–41) from first blinatumomab cycle. The toxicity profile was safe: blinatumomab was stopped in 48% of cases because of neurologic events in 4, infections in 4 and cytokine release syndrome in 3 patients; ponatinib was stopped in 22% of cases because of neurologic events in 3, hepatobiliary disorder in 1 and severe arteriopathy in 1 patient who had others vascular disease risk factors. All neurologic events resolved after stopping involved drug. All but one patient (95.6%) obtained a cytologic complete remission (CR), of whom 19/22 (86%) achieved a complete molecular response (CMR). However, 2 patients were documented with CNS relapse, treated with intrathecal infusion of chemotherapy. Then, 7 patients underwent allogeneic transplant (including 3 patients already allotransplanted before blina/pona). With a median follow‐up of 29 months (range: 17.5–66.7) for the alive patients (74%), median overall survival from first cycle of blina/pona was not reached and leukemia‐free survival was 18.2 months (range: 1.3–41). At last follow‐up (February 2019), 7 relapses had occurred at a median of 7 months (range: 1.3–41) from first blina/pona cycle and 1 patient had refractory disease. 6 patients (26%) had died of 2 bacterial infections, 2 fungal infections, 1 secondary cancer and 1 progressive refractory ALL. Among the 17 patients alive, one had relapsed and 16 are still in CMR, but 2 with CNS relapse. Twelve patients are still under ponatinib medication.Summary/Conclusion:The combination of blinatumomab+ponatinib appears effective and tolerable in relapsed Ph1+ALL patients. It could replace chemotherapy salvage regimens and allow a brigde to allogeneic transplantation, or may be tested in first‐line therapy in the future. Our results have to be confirmed prospectively on a larger cohort of patients.

SP563REM sleep latency might be a new risk factor for cardio vascular disease in hemodialysis Patients with obstructive sleep apnea

SP563REM sleep latency might be a new risk factor for cardio vascular disease in hemodialysis Patients with obstructive sleep apnea

Lp-PLA2 as a promising predictor of comorbidities in patients with severe psoriasis

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well- known risk factor of atherosclerotic vascular diseases which are common comorbidities in psoriasis. The aim of this study was to evaluate serum Lp-PLA2 level in psoriatic patients and elucidate possible associations with disease activity, metabolic or inflammatory parameters and systemic treatment.Methods: We enrolled 33 patients with active plaque-type psoriasis and 11 healthy controls. Blood samples were collected before and after 3 months of systemic treatment with acitretin or methotrexate. Serum Lp-PLA2 level were evaluated by enzyme-linked immunosorbent assay.Results: Serum Lp-PLA2 level in patients with psoriasis did not statistically differ comparing to the control group (p = .2). However, in patients with severe psoriasis Lp-PLA2 was significantly higher than in the controls before and after treatment (p = .03, p = .01, respectively). The lipase did not correlate with BMI (p = .22); however, a statistical significance was noted between psoriatics with obesity compared to the controls (p = .03). No significant effect of systemic treatment combined (p = .5) nor separately with acitretin (p = .5) or methotrexate (p = .1) on the Lp-PLA2 level was found, despite clinical improvement.Conclusion: Lp-PLA2 assay might be helpful in assessment of the risk of cardiometabolic comorbidities development especially in patients with severe psoriasis and obesity.

Perivascular adipose tissue-derived stromal cells contribute to vascular remodeling during aging.

Aging is an independent risk factor for vascular diseases. Perivascular adipose tissue (PVAT), an active component of the vasculature, contributes to vascular dysfunction during aging. Identification of underlying cell types and their changes during aging may provide meaningful insights regarding the clinical relevance of aging‐related vascular diseases. Here, we take advantage of single‐cell RNA sequence to characterize the resident stromal cells in the PVAT (PVASCs) and identified different clusters between young and aged PVASCs. Bioinformatics analysis revealed decreased endothelial and brown adipogenic differentiation capacities of PVASCs during aging, which contributed to neointimal hyperplasia after perivascular delivery to ligated carotid arteries. Mechanistically, in vitro and in vivo studies both suggested that aging‐induced loss of peroxisome proliferator‐activated receptor‐γ coactivator‐1 α (PGC1α) was a key regulator of decreased brown adipogenic differentiation in senescent PVASCs. We further demonstrated the existence of human PVASCs (hPVASCs) and overexpression of PGC1α improved hPVASC delivery‐induced vascular remodeling. Our finding emphasizes that differentiation capacities of PVASCs alter during aging and loss of PGC1α in aged PVASCs contributes to vascular remodeling via decreased brown adipogenic differentiation.

SAT-LB031 Empagliflozin as an Add-On Medication to Subjects Uncontrolled on DPP4 Inhibitors and Metformin: Real World Data Supporting the Use of Empagliflozin as a Rational Second Add-On in Indian Type 2 Diabetic Patients

A huge burden of uncontrolled type 2 diabetes mellitus (T2D) prevails in the Indian settings with an estimated prevalence of patients with >7 % HbA1c at 63 %1 and glycaemic control tends to decline over time with monotherapy2. Newer guidelines supported the use of DPP4 inhibitors along with SGLT2 inhibitors as sequential therapy in patients with type 2 diabetes mellitus. This study evaluated the real-world clinical effectiveness of Empagliflozin as second add-on therapy in overweight subjects with inadequately controlled type 2 diabetes mellitus (T2DM). This single-centre study included overweight adult subjects with poorly controlled T2DM on optimal dose of metformin and DPP4 inhibitors, (N, 110) (mean glycated haemoglobin [HbA1c] (standard deviation [SD]), 7.65 [± 0.34] %; and BMI [SD], 28.39 [± 1.87] kg/m2) treated with Empagliflozin (25 mg) as add-on therapy. Follow-up improvements in outcomes were analysed using the paired t-test. Safety parameters were also evaluated. The mean age and weight at baseline were 42 ± 9.6 years and 81.23 ± 5.54 kgs respectively, with a male to female ratio of 1:1. An established cardiovascular disease was present in 18.2 % patients. At the 24-week follow-up, Empagliflozin as add-on therapy demonstrated a significant reduction (P< 0.0001) in HbA1c, body weight and BMI, with a mean reduction (MR [SD]) of 0.46 [0.44-0.48] %, 5.22 [4.92-5.51] kg, and 1.82 [1.72-1.92] kg/m2, respectively, in the overall population. Reduction in urine albumin/creatinine ratio [U-ACR] 14.7 [10.61-18.79] mg/g), SBP of 2.89 mmHg [2.24-3.54], and serum glutamic-pyruvic transaminase (10.95 [9.86-12.03] U/L) were also significant (P<.0.0001). The reduction in serum glutamic-oxaloacetic transaminase (0.76 [0.33-1.2] U/L) too was significant (P=0.0001). The target HbA1c of <7% (53 mmol/mol) was achieved in more subjects (31.8%) with the addition of Empagliflozin. Genital mycotic infection was reported in 9 patients. Empagliflozin as an add-on therapy was well tolerated with significant improvement in HbA1c, body weight, BMI, U-ACR, systolic blood pressure and serum transaminases levels in overweight Indian patients with T2DM. Not received any institutional grant. Saydah SH, Fradkin J, Cowie CC. Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes. JAMA. 2004;291(3):335-342. doi:10.1001/jama.291.3.335 Turner RC, Cull CA, Frighi V, Holman RR, for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49). JAMA. 1999;281(21):2005-2012. doi:10.1001/jama.281.21.2005 Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.