Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap

Background:Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS risk including stroke and myocardial infarction (MI) (1-3). CVS risk factors and CVS events are common in SpA (4). Delineating the CVS risk and the association with medications in patients with SpA would be useful.Objectives:The objective of this study was to delineate the CVS risk and the association with medications in patients with SpA.Methods:Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics respectively. Clinical information and CVS events were retrieved. Incidence rates were calculated. Association analysis was performed to determine the CVS risk of SpA and other modifiable risk factors.Results:A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56 484 person-years of follow-up, 160 strokes, 84 MI and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, P<0.01). Crude incidence rates of stroke and MI were higher in SpA patients. SpA was associated with a higher risk of MACE (HR 1.66, 95%CI 1.22-2.27, P<0.01) and cerebrovascular events (HR 1.42, 95%CI 1.01-2.00, p=0.04). The use of anti-tumor necrosis factor (TNF) drugs was associated with a reduced risk of MACE (HR 0.37, 95%CI 0.17-0.80, P=0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06-0.78, P=0.02).Conclusion:SpA is an independent CVS risk factor. Anti-TNF drugs were associated with a reduced CVS risk in these patients.References:[1]Crowson CS, Liao KP, Davis JM, 3rd, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-8 e1.[2]Verhoeven F, Prati C, Demougeot C, Wendling D. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine. 2020;87(5):413-8.[3]Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):369-89.[4]Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23.Disclosure of Interests:None declared.

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Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

Annals of Medicine ◽

10.1080/07853890.2021.1924395 ◽

2021 ◽

Vol 53 (1) ◽

pp. 817-823

Author(s):

Marjo Okkonen ◽

Aki S. Havulinna ◽

Olavi Ukkola ◽

Heikki Huikuri ◽

Arto Pietilä ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome

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Effect of Naltrexone-Bupropion on Major Adverse Cardiovascular Events in Overweight and Obese Patients With Cardiovascular Risk Factors

JAMA ◽

10.1001/jama.2016.1558 ◽

2016 ◽

Vol 315 (10) ◽

pp. 990 ◽

Cited By ~ 82

Author(s):

Steven E. Nissen ◽

Kathy E. Wolski ◽

Lisa Prcela ◽

Thomas Wadden ◽

John B. Buse ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Obese Patients

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Incidence and Predictors of Major Adverse Cardiovascular Events in Patients With Established Atherosclerotic Disease or Multiple Risk Factors

Journal of the American Heart Association ◽

10.1161/jaha.119.014402 ◽

2020 ◽

Vol 9 (2) ◽

Author(s):

Benjamin Miao ◽

Adrian V. Hernandez ◽

Mark J. Alberts ◽

Nicholas Mangiafico ◽

Yuani M. Roman ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Events ◽

Atherosclerotic Disease ◽

Major Adverse Cardiovascular Events ◽

Multiple Risk Factors ◽

Multiple Risk

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Genome Wide Epistasis Study of On-Statin Cardiovascular Events with Iterative Feature Reduction and Selection

Journal of Personalized Medicine ◽

10.3390/jpm10040212 ◽

2020 ◽

Vol 10 (4) ◽

pp. 212

Author(s):

Solomon M. Adams ◽

Habiba Feroze ◽

Tara Nguyen ◽

Seenae Eum ◽

Cyrille Cornelio ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Events ◽

Carotid Artery Disease ◽

Risk Estimation ◽

Feature Reduction ◽

Major Adverse Cardiovascular Events ◽

Small Subset ◽

Artery Disease ◽

High Level ◽

Risk Determinants

Predicting risk for major adverse cardiovascular events (MACE) is an evidence-based practice that incorporates lifestyle, history, and other risk factors. Statins reduce risk for MACE by decreasing lipids, but it is difficult to stratify risk following initiation of a statin. Genetic risk determinants for on-statin MACE are low-effect size and impossible to generalize. Our objective was to determine high-level epistatic risk factors for on-statin MACE with GWAS-scale data. Controlled-access data for 5890 subjects taking a statin collected from Vanderbilt University Medical Center’s BioVU were obtained from dbGaP. We used Random Forest Iterative Feature Reduction and Selection (RF-IFRS) to select highly informative genetic and environmental features from a GWAS-scale dataset of patients taking statin medications. Variant-pairs were distilled into overlapping networks and assembled into individual decision trees to provide an interpretable set of variants and associated risk. 1718 cases who suffered MACE and 4172 controls were obtained from dbGaP. Pathway analysis showed that variants in genes related to vasculogenesis (FDR = 0.024), angiogenesis (FDR = 0.019), and carotid artery disease (FDR = 0.034) were related to risk for on-statin MACE. We identified six gene-variant networks that predicted odds of on-statin MACE. The most elevated risk was found in a small subset of patients carrying variants in COL4A2, TMEM178B, SZT2, and TBXAS1 (OR = 4.53, p < 0.001). The RF-IFRS method is a viable method for interpreting complex “black-box” findings from machine-learning. In this study, it identified epistatic networks that could be applied to risk estimation for on-statin MACE. Further study will seek to replicate these findings in other populations.

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