Projected New-Onset Cardiovascular Disease by Socioeconomic Group in Australia

Abstract Aims The inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients. Methods and results We report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase. Conclusion The impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.

Download Full-text

P179 Glucocorticoid exposure and link to serious adverse events in patients with ANCA-associated vasculitis

Rheumatology ◽

10.1093/rheumatology/keaa111.174 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Philip Spearpoint ◽

Cormac Sammon ◽

Antonio Ramirez de ◽

Arellano Serna ◽

Peter Rutherford

Keyword(s):

Cardiovascular Disease ◽

Adverse Events ◽

Renal Disease ◽

Real World ◽

Low Dose ◽

Remission Induction ◽

High Dose ◽

Anca Associated Vasculitis ◽

Increased Risk ◽

New Onset

Abstract Background Remission induction in ANCA-associated vasculitis (AAV) is with high dose glucocorticoids (GC) and immunosuppressants. Patients are exposed to high GC dose and/or prolonged low dose. EULAR/EDTA guidelines target 7.5-10mg at 3 months but acknowledge this is often achieved later. This study used UK real world practice data to examine the scale of GC exposure and associated clinical risks in AAV. Methods The study utilised the Clinical Practice Research Datalink (CPRD) - Hospital Episode Statistics (HES) linked database. AAV patients were identified using specific READ and ICD codes and followed between 01/01/1997 and 01/01/2018. GP prescriptions were used to describe periods of continuous GC use, stop and restart and when high dose (> 30mg/day) and low dose (<30mg/day) was prescribed. Diagnostic codes indicative of infections and adverse events linked to GCs were used to estimate rates in the AAV population using a generalized linear model with a Poisson distribution. Results 450 AAV patients with at least one GC prescription were analysed. The median dose decreased to 9.3 mg (IQR 5.0 - 17.0) at 6 months and 5.1 mg (0.00 - 10.0) at 12 months,50% patients were taking > 10mg at 5 months and 25% were still > 10mg at 12 months. However, within 6 months of achieving 10mg/day, 50% relapse to needing dose >10mg, 75% within 2 years and 90% within 6 years. In adjusted Poisson model (age, gender, year of diagnosis before/after 2013) the rate of infection in AAV patients taking high dose was 2.59 times (CI95 1.95, 3.45) that of those on low dose and lower in those not taking GCs (IRR 0.27 (0.22-0.34)). Increased risk of new onset cardiovascular disease (IRR 2.55 (0.92, 7.04)) and new onset renal disease (IRR 3.4 (1.29-8.96)) were higher in patients receiving high dose. Conclusion AAV patients have significant exposure to high dose GCs and in real world practice, GC dose remains higher than recommended in current clinical guidelines. High dose GCs are associated with high risk of infection and new cardiovascular disease and renal disease. This creates a significant patient burden and has implications for healthcare resource use. Disclosures P. Spearpoint: Corporate appointments; Employee of Vifor Pharma. C. Sammon: Corporate appointments; Employee of PHMR. A. Ramirez de Arellano Serna: Corporate appointments; Employee of Vifor Pharma. P. Rutherford: Corporate appointments; Employee of Vifor Pharma. Shareholder/stock ownership; Vifor Pharma.

Download Full-text

Heme iron intake and risk of new-onset diabetes in a Mediterranean population at high risk of cardiovascular disease: an observational cohort analysis

BMC Public Health ◽

10.1186/1471-2458-13-1042 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 13

Author(s):

Jose Candido Fernandez-Cao ◽

Victoria Arija ◽

Nuria Aranda ◽

Monica Bullo ◽

Josep Basora ◽

...

Keyword(s):

Cardiovascular Disease ◽

High Risk ◽

Cohort Analysis ◽

Heme Iron ◽

Mediterranean Population ◽

Iron Intake ◽

Onset Diabetes ◽

Observational Cohort ◽

New Onset

Download Full-text

Anxiety and new onset of cardiovascular disease: critical review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.156554 ◽

2016 ◽

Vol 208 (3) ◽

pp. 223-231 ◽

Cited By ~ 89

Author(s):

Neeltje M. Batelaan ◽

Adrie Seldenrijk ◽

Mariska Bot ◽

Anton J. L. M. van Balkom ◽

Brenda W. J. H. Penninx

Keyword(s):

Cardiovascular Disease ◽

Meta Analysis ◽

Population Based ◽

Future Research ◽

Cvd Prevention ◽

Traditional Risk Factors ◽

Independent Association ◽

New Onset

BackgroundAnxiety has been associated with new-onset cardiovascular disease (CVD), but the quality of this relationship is unclear. Only if anxiety is a causal, independent cardiovascular risk factor might it be a target for CVD prevention.AimsTo determine and examine the independent association and causality between anxiety and incident CVD.MethodPubMed, EMBASE and PsycINFO databases were searched up to October 2013. A review of Hill's criteria for causality and random effects meta-analysis were conducted of prospective, population-based studies examining anxiety and incident CVD in people free from CVD at baseline.ResultsThe meta-analysis comprised 37 papers (n= 1 565 699). The follow-up ranged from 1 to 24 years. Anxiety was associated with a 52% increased incidence of CVD (hazard ratio = 1.52, 95% CI 1.36–1.71). The risk seemed independent of traditional risk factors and depression. The evaluation of Hill's criteria largely argued in favour of causality.ConclusionsAnxiety may be of interest for CVD prevention. Future research should examine biological and behavioural underpinnings of the association in order to identify targets for intervention.

Download Full-text

Cardiovascular disease protein biomarkers are associated with kidney function: the Framingham Heart Study

10.1101/2022.01.04.22268737 ◽

2022 ◽

Author(s):

Amena Keshawarz ◽

Shih-Jen Hwang ◽

Gha Young Lee ◽

Zhi Yu ◽

Chen Yao ◽

...

Keyword(s):

Cardiovascular Disease ◽

Rapid Decline ◽

Third Generation ◽

Offspring Cohort ◽

Protein Biomarkers ◽

Cross Sectional ◽

Heart Study ◽

Ckd Stage ◽

Kidney Impairment ◽

New Onset

Background. Biomarkers common to chronic kidney disease (CKD) and cardiovascular disease (CVD) may reflect early impairments underlying both diseases. Methods. We evaluated associations of 71 CVD-related plasma proteins measured in 2,873 Framingham Heart Study (FHS) Offspring cohort participants with cross-sectional continuous eGFR and with longitudinal change in eGFR from baseline to follow-up (ΔeGFR). We also evaluated the associations of the 71 CVD proteins with the following dichotomous secondary outcomes: prevalent CKD stage ≥3(cross-sectional), new-onset CKD stage ≥3 (longitudinal), and rapid decline in eGFR (longitudinal). Proteins significantly associated with eGFR and ΔeGFR were subsequently validated in 3,951 FHS Third Generation cohort participants and were tested using Mendelian randomization (MR) analysis to infer putatively causal relations between plasma protein biomarkers and kidney function. Results. In cross-sectional analysis, 37 protein biomarkers were significantly associated with eGFR at FDR<0.05 in the FHS Offspring cohort and 20 of these validated in the FHS Third Generation cohort at p<0.05/37. In longitudinal analysis, 27 protein biomarkers were significantly associated with ΔeGFR at FDR<0.05 and 12 of these were validated in the FHS Third Generation cohort at p<0.05/27. Additionally, 35 protein biomarkers were significantly associated with prevalent CKD, five were significantly associated with new-onset CKD, and 17 were significantly associated with rapid decline in eGFR. MR suggested putatively causal relations of melanoma cell adhesion molecule (MCAM; -0.011±0.003 mL/min/1.73m2, p=5.11E-5) and epidermal growth factor-containing fibulin-like extracellular matrix protein 1 (EFEMP1; -0.006±0.002 mL/min/1.73m2, p=0.0001) concentration with eGFR. Discussion/Conclusions: Eight protein biomarkers were consistently associated with eGFR in cross-sectional and longitudinal analysis in both cohorts and may capture early kidney impairment; others were implicated in association and causal inference analyses. A subset of CVD protein biomarkers may contribute causally to the pathogenesis of kidney impairment and should be studied as targets for CKD treatment and early prevention.

Download Full-text

Diabetes, Heart Failure, and COVID-19: An Update

Frontiers in Physiology ◽

10.3389/fphys.2021.706185 ◽

2021 ◽

Vol 12 ◽

Author(s):

Carleigh Hebbard ◽

Brooke Lee ◽

Rajesh Katare ◽

Venkata Naga Srikanth Garikipati

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Heart Disease ◽

Disease Burden ◽

Clinical Findings ◽

Current Data ◽

Future Research ◽

The Novel ◽

Research Areas ◽

New Onset

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the WHO in March 2020. As of August 2021, more than 220 countries have been affected, accounting for 211,844,613 confirmed cases and 4,432,802 deaths worldwide. A new delta variant wave is sweeping through the globe. While previous reports consistently have demonstrated worse prognoses for patients with existing cardiovascular disease than for those without, new studies are showing a possible link between SARS-CoV-2 infection and an increased incidence of new-onset heart disease and diabetes, regardless of disease severity. If this trend is true, with hundreds of millions infected, the disease burden could portend a potentially troubling increase in heart disease and diabetes in the future. Focusing on heart failure in this review, we discuss the current data at the intersection of COVID, heart failure, and diabetes, from clinical findings to potential mechanisms of how SARS-CoV-2 infection could increase the incidence of those pathologies. Additionally, we posit questions for future research areas regarding the significance for patient care.

Download Full-text

DEPRESSION AND RISK OF NEW-ONSET CARDIOVASCULAR DISEASE: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of Hypertension ◽

10.1097/01.hjh.0000746308.58878.51 ◽

2021 ◽

Vol 39 (Supplement 1) ◽

pp. e171

Author(s):

Anwar Alnakhli/Anwar ◽

Mohammed Bazuhair ◽

Sandosh Padmanabhan ◽

Daneil Smith

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Meta Analysis ◽

New Onset

Download Full-text

Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glz228 ◽

2019 ◽

Vol 75 (11) ◽

pp. 2200-2206 ◽

Cited By ~ 2

Author(s):

Haibin Li ◽

Frank Qian ◽

Chenbei Hou ◽

Xia Li ◽

Qi Gao ◽

...

Keyword(s):

Cardiovascular Disease ◽

Depressive Symptoms ◽

Confidence Interval ◽

Risk Ratio ◽

Mortality Risk ◽

Depression Scale ◽

Composite Endpoint ◽

Cvd Risk ◽

Increased Risk ◽

New Onset

Abstract Background There remains a relative paucity of evidence for the association between changes in depressive symptoms with cardiovascular disease (CVD) and mortality. This study aimed to evaluate the association of change in depressive symptoms and incident CVD and mortality in a large prospective cohort of middle-aged and older adults. Methods A total of 6,810 participants free of CVD in the China Health and Retirement Longitudinal Study with two assessments of depressive symptoms at wave 1 (2011–2012) and wave 2 (2013–2014) were included. Elevated depressive symptoms were defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depression scale. We used a modified Poisson regression to examine the association of changes in depressive symptoms (never, onset, remitted, and persistent) and incident CVD (a composite endpoint of heart disease or stroke) and mortality at wave 3 (2015–2016). Results During follow-up, 457 CVDs and 148 deaths occurred. Multivariable analyses revealed that persistent depressive symptoms were associated with an elevated risk of CVD (risk ratio = 1.77, 95% confidence interval = 1.38–2.26) and mortality (risk ratio = 1.63, 95% confidence interval = 1.01–2.64) compared with participants without any depressive symptoms. New-onset depressive symptoms increased the mortality risk (risk ratio = 2.37, 95% confidence interval = 1.52–3.69), but not CVD (risk ratio = 1.15, 95% confidence interval = 0.84–1.58). Remitted depressive symptoms were associated with a 35% and 13% excess risk of CVD and mortality, respectively. Conclusion Persistent and remitted depressive symptoms were associated with an increased risk of CVD. New-onset depressive symptoms predicted elevated mortality risk.

Download Full-text

409Cardiovascular risk profiles and outcomes in patients with type 2 diabetes - Implications for choice of new diabetes therapies

European Heart Journal ◽

10.1093/eurheartj/ehz747.0104 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M E Malik ◽

C A Andersson ◽

P B Blanche ◽

C M R Rasmussen ◽

B Z Zareini ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Ischemic Stroke ◽

Sglt2 Inhibitors ◽

Low Risk ◽

Receptor Agonists ◽

Risk Of Death ◽

History Of ◽

New Onset

Abstract Background Reflecting recent clinical trial findings, updated type 2 diabetes (T2D) guidelines recommend targeting SGLT2 inhibitors at patients at risk of heart failure (HF)-related events and GLP-1 receptor agonists at those at greater risk of atherosclerotic events. However, which cardiovascular disease phenotype in patients with T2D is more predictive of one or other type of these events is unclear. Purpose To estimate the risk of HF-related events and atherosclerotic events, according to background cardiovascular phenotype, in patients with T2D. Methods Patients with T2D and new-onset cardiovascular disease were identified using Danish health care registers (period 1995 to 2015). Patients were divided in four groups based on the primary type of cardiovascular disease: 1) HF, 2) ischemic heart disease (IHD), 3) ischemic stroke, and 4) peripheral artery disease (PAD). The absolute 5-year risks of the subsequent event, either a HF-related event or an atherosclerotic event (IHD, ischemic stroke and PAD), and the associated risk of death, were compared across the four groups. The Aalen-Johansen estimator was used to account for censoring, the competing risk of HF and atherosclerotic events, respectively, and death. Results We included 37,850 patients with T2D and new-onset cardiovascular disease. Median age was 70 years and 40% were female. Patients with HF were at higher risk of readmission for HF (18.1%; 95% confidence interval (CI): 17.2–19.0) than of an atherosclerotic event (14.2%; 13.4–15.0) (Figure). Patients with IHD were at higher risk of a new atherosclerotic event (23.5%; 22.8.-24.2) than of developing HF (9.3%; 8.9–9.8), although the risk of HF was still substantial. Conversely, patients with ischemic stroke were at low risk of HF (3.3%; 2.9–3.8) and higher risk of an atherosclerotic event (16.9%; 95% CI: 16.0–17.7). Patients with PAD had the lowest risk of HF (3.1%; 95% CI: 2.8–3.4) and the highest risk of an atherosclerotic event (35.0%; 95% CI: 33.4–36.7). Compared to a new atherosclerotic event, developing HF was associated with a higher 1-year risk of death (16.0%; 95% CI: 14.7–17.3 versus 33.0%; 95% CI: 31.8–34.2) amongst all patients. Cumulative incidence of first new event Conclusions In T2D, a patient's history of cardiovascular disease was predictive of type of subsequent cardiovascular event. While history of ischemic stroke and PAD were associated with a high risk of future atherosclerotic events, and low risk of HF, patients with IHD were at substantial risk of both types of event. Conversely, while history of HF was most predictive of future HF events, the risk of atherosclerotic events in patients with HF was also high. Our findings may help determine which type of therapy T2D patients with a particular cardiovascular disease history might benefit from – SGLT2 inhibitors, GLP-1 receptor agonists or potentially both. Acknowledgement/Funding Mariam Elmegaard Malik was funded by a research grant from Department of Cardiology, Herlev and Gentofte Hospital.

Download Full-text