scholarly journals Residual Risk Factors to Predict Major Adverse Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes Mellitus

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Fang-Ju Lin ◽  
Wei-Kung Tseng ◽  
Wei-Hsian Yin ◽  
Hung-I Yeh ◽  
Jaw-Wen Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Events ◽  
Residual Risk ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease

The Impact of Atherosclerotic Cardiovascular Risk on Graft Failure in Deceased-Donor Renal Transplantation

2021 ◽  
pp. 152692482110246
Author(s):  
Grace Hsu ◽  
Tracy M. Sparkes ◽  
Brent N. Reed ◽  
Stormi E. Gale ◽  
Brian E. Crossley ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Renal Transplant ◽  
Cardiovascular Events ◽  
Graft Failure ◽  
Deceased Donor ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease

Introduction: Pretransplant cardiovascular risk may be amplified after renal transplant, but little is known about its impact on graft outcomes. Research question: The purpose of this study was to determine if pretransplant cardiovascular risk was associated with graft outcomes. Design: This retrospective study included deceased-donor renal transplant recipients from 2010-2015. Atherosclerotic cardiovascular disease risk for patients without prior disease was calculated and patients were categorized into high (score >20%), intermediate (7.5-20%), and low risk (<7.5%). Patients with and without prior cardiovascular disease were also compared. The main endpoint was graft failure at 3-years post-transplant. Other outcomes included major adverse cardiovascular events, biopsy-proven rejection, and mortality. Results: In patients without prior atherosclerotic cardiovascular disease (N = 115), graft failure rates (4.5% vs 11.3% vs 12.5%; ( P = 0.64) and major adverse cardiovascular events (9.1% vs 13.2% vs 5.0%; P = 0.52) were similar in the high, intermediate, and low risk groups. In those with prior disease (N = 220), rates of primary nonfunction (6.8% vs 1.7%; P = 0.04), major adverse cardiovascular events (7.3% vs 2.6%; P = 0.01), and heart failure (10.9% vs 3.5%; P = 0.02) were higher than those without cardiovascular; rates of major adverse cardiovascular events and heart failure were insignificant after adjusting for age, gender, and race. Other outcomes were not different. Outcomes did not differ based on pretransplant cardiovascular risk. Discussion: Pretransplant atherosclerotic cardiovascular disease was associated with increased early graft failure but similar outcomes at 3-years, suggesting cardiac risk alone should not exclude transplantation.

Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Lena Mathews ◽  
Ron C Hoogeveen ◽  
Michael J Blaha ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Single Model ◽  
History Of ◽  
Very High

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.

scholarly journals Cardiovascular safety of nintedanib in subgroups by cardiovascular risk at baseline in the TOMORROW and INPULSIS trials

2019 ◽  
Vol 54 (3) ◽  
pp. 1801797 ◽  
Author(s):  
Imre Noth ◽  
Marlies Wijsenbeek ◽  
Martin Kolb ◽  
Francesco Bonella ◽  
Lizette Moros ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Events ◽  
Kinase Inhibitor ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiovascular Safety ◽  
History Of

Nintedanib is a tyrosine kinase inhibitor used to treat idiopathic pulmonary fibrosis (IPF). We investigated the cardiovascular safety of nintedanib using pooled data from the TOMORROW and INPULSIS trials.Cardiovascular events were assessed post hoc in patients with a history of atherosclerotic cardiovascular disease (CVD) and/or one or more cardiovascular risk factors at baseline (“higher cardiovascular risk”) and patients with no history of atherosclerotic CVD and no cardiovascular risk factors at baseline (“lower cardiovascular risk”).Incidence rates were calculated for 1231 patients (n=723 nintedanib and n=508 placebo), of whom 89.9% had higher cardiovascular risk. Incidence rates of major adverse cardiovascular events were similar in the nintedanib and placebo groups in patients with higher cardiovascular risk (3.88 (95% CI 2.58–5.84) and 3.49 (95% CI 2.10–5.79) per 100 patient-years, respectively) and lower cardiovascular risk (4.78 (95% CI 1.54–14.82) and 5.37 (95% CI 1.73–16.65) per 100 patient-years, respectively). Incidence rates of myocardial infarction in the nintedanib and placebo groups, respectively, were 3.03 (95% CI 1.91–4.81) and 1.16 (95% CI 0.48–2.79) per 100 patient-years in patients with higher cardiovascular risk and 1.59 (95% CI 0.22–11.29) and 1.78 (95% CI 0.25–12.64) per 100 patient-years in patients with lower cardiovascular risk. Incidence rates of other ischaemic heart disease in the nintedanib and placebo groups, respectively, were 1.85 (95% CI 1.02–3.34) and 3.28 (95% CI 1.94–5.54) per 100 patient-years in patients with higher cardiovascular risk and 0 and 1.80 (95% CI 0.25–12.78) per 100 patient-years in patients with lower cardiovascular risk.These data help to establish the cardiovascular safety profile of nintedanib in IPF.

scholarly journals Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001724
Author(s):  
Anne Grete Semb ◽  
Silvia Rollefstad ◽  
Eirik Ikdahl ◽  
Grunde Wibetoe ◽  
Joseph Sexton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Goal Attainment ◽  
Disease Risk ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Preventive Medication ◽  
Study Population

AimThe objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention.MethodsThe cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM.ResultsThe study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM.ConclusionCVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Those With Absent Coronary Artery Calcium: Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2021 ◽  
Author(s):  
Mahmoud Al−Rifai ◽  
Michael J. Blaha ◽  
Vijay Nambi ◽  
Steven J.C. Shea ◽  
Erin D. Michos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Cigarette Smoking ◽  
Atherosclerotic Cardiovascular Disease ◽  
Current Cigarette Smoking ◽  
Current Cigarette ◽  
History Of

Background : The 2018 American Heart Association/ American College of Cardiology Multisociety (AHA/ACC/MS) cholesterol guideline states that statin therapy may be withheld or delayed among intermediate risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long−term follow−up. Methods : We included participants with CAC=0 at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors [cigarette smoking, diabetes mellitus, hypertension, preventive medication use (aspirin and statin), family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers] and adjudicated incident ASCVD outcomes. Results : We studied 3,416 individuals (mean (SD) age 58 (9) years; 63% were female, 33% White, 31% Black, 12% Chinese-American, and 24% Hispanic. Over a median follow-up of 16 years, there were 189 ASCVD events (composite of CHD and stroke) of which 91 were CHD, 88 were stroke, and 10 were both CHD and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000−person−years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes mellitus (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable-adjustment, risk factors that were significantly associated with ASCVD: hazard ratio (HR) 95% confidence interval (CI) included current cigarette smoking: 2.12 (1.32,3.42), diabetes mellitus: 1.68 (1.01,2.80), and hypertension: 1.57 (1.06,2.33). Conclusions : Current cigarette smoking, diabetes mellitus, and hypertension are independently associated with incident ASCVD over 16-year follow-up among those with CAC=0. Family history of premature ASCVD may be associated with ASCVD risk among women only.

scholarly journals Triglyceride Levels and Residual Risk of Atherosclerotic Cardiovascular Disease Events and Death in Adults Receiving Statin Therapy for Primary or Secondary Prevention: Insights From the KP REACH Study

2021 ◽  
Author(s):  
Andrew P. Ambrosy ◽  
Jingrong Yang ◽  
Sue Hee Sung ◽  
Amanda R. Allen ◽  
Jesse K. Fitzpatrick ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
People Of Color ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Adjusted Risk ◽  
Risk Of Death

Background Patients with risk factors or established atherosclerotic cardiovascular disease remain at high‐risk for ischemic events. Triglyceride levels may play a causal role. Methods and Results We performed a retrospective study of adults aged ≥45 years receiving statin therapy, with a low‐density lipoprotein cholesterol of 41 to 100 mg/dL, and ≥1 risk factor or established atherosclerotic cardiovascular disease between 2010 and 2017. Outcomes included death, all‐cause hospitalization, and major adverse cardiovascular events (myocardial infarction, stroke, or peripheral artery disease). The study sample included 373 389 primary prevention patients and 97 832 secondary prevention patients. The primary prevention cohort had a mean age of 65±10 years, with 51% women and 44% people of color, whereas the secondary prevention cohort had a mean age of 71±11 years, with 37% women and 32% people of color. Median triglyceride levels for the primary and secondary prevention cohorts were 122 mg/dL (interquartile range, 88–172 mg/dL) and 116 mg/dL (interquartile range, 84–164 mg/dL), respectively. In multivariable analyses, primary prevention patients with triglyceride levels ≥150 mg/dL were at lower adjusted risk of death (hazard ratio [HR], 0.91; 95% CI, 0.89–0.94) and higher risk of major adverse cardiovascular events (HR, 1.14; 95% CI, 1.05–1.24). In the secondary prevention cohort, patients with triglyceride levels ≥150 mg/dL were at lower adjusted risk of death (HR, 0.95; 95% CI, 0.92–0.97) and higher risk of all‐cause hospitalization (HR, 1.03; 95% CI, 1.01–1.05) and major adverse cardiovascular events (HR, 1.04; 95% CI, 1.05–1.24). Conclusions In a contemporary cohort receiving statin therapy, elevated triglyceride levels were associated with a greater risk of atherosclerotic cardiovascular disease events and lower risk of death.

scholarly journals Are SGLT2 polymorphisms linked to diabetes mellitus and cardiovascular disease? Prospective study and meta-analysis

2019 ◽  
Vol 39 (8) ◽  
Author(s):  
Heinz Drexel ◽  
Andreas Leiherer ◽  
Christoph H. Saely ◽  
Eva Maria Brandtner ◽  
Kathrin Geiger ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Atherosclerotic Cardiovascular Disease ◽  
Nucleotide Polymorphisms ◽  
Cardiovascular Morbidity And Mortality ◽  
Slc5a2 Gene

Abstract Inhibition of the sodium glucose co-transporter 2 (SGLT2) reduces cardiovascular morbidity, and mortality in patients with type 2 diabetes mellitus (T2DM) with atherosclerotic, cardiovascular disease. So far, a link between common genetic variations of the SGLT2 encoding gene SLC5A2 and glucose homeostasis as well as cardiovascular disease has not been established. The present study, therefore, aimed to investigate SLC5A2 single nucleotide polymorphisms (SNPs) in relation to type 2 diabetes and coronary artery disease (CAD) and prospectively the incidence of cardiovascular events. We genotyped the SLC5A2 tagging SNPs rs9934336, rs3813008, and rs3116150 in a total of 1684 high risk cardiovascular patients undergoing coronary angiography, including 400 patients with T2DM. Additionally, we performed a meta-analysis combining results from the present study and the literature. Variant rs9934336 was significantly associated with decreased HbA1c (P = 0.023). Further, rs9934336 was significantly inversely associated with the presence of T2DM in univariate (OR = 0.82 [0.68–0.99]; P = 0.037) as well as in multivariate analysis (OR = 0.79 [0.65–0.97]; P = 0.023). The association between rs9934336 and T2DM was confirmed in a meta-analysis including results from two previous observations which by themselves had failed to show a significant association of the polymorphism with T2DM (OR = 0.86 [0.78–0.95]; P = 0.004). Polymorphisms rs3813008 and rs3116150 were associated neither with glycemic parameters nor with T2DM. None of the SNPs tested was significantly associated with the baseline presence of CAD or the incidence of cardiovascular events. We conclude that genetic variation within the SLC5A2 gene locus is significantly related to the manifestation of T2DM.

Effect of testosterone therapy on cardiovascular risk factors, major adverse cardiovascular events and mortality in men with functional hypogonadism and cardiovascular disease in a real-world registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Saad ◽  
A Haider ◽  
K.S Haider ◽  
G Doros ◽  
A.M Traish
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Real World ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Testosterone Therapy

Abstract Background Cardiovascular safety of testosterone therapy (TTh) in men with functional hypogonadism has been debated. Purpose To investigate cardiovascular risk factors and incidence of major adverse cardiovascular events (MACE) and mortality in a high-risk population in a real-world setting. Methods Of 773 men with functional (non-organic) hypogonadism in a registry study, 217 had a pre-existing cardiovascular disease. 99 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval (T-group) for up to 15 years, 118 opted against TTh and served as controls (CTRL). Most measurements were performed 2–4 times a year for approximately 1,800 patient-years. 11-year data were analysed. Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the two groups. Results Mean baseline age: 61.5±4.6 years (T-group), 63.9±4.9 (CTRL) (p&lt;0.0005). 86.9% in the T-group and 61.9% in CTRL (p&lt;0.0001) were obese at baseline. Mean BMI (kg/m2) declined by 8.3±0.4 in the T-group and increased by 2.5±0.4 in CTRL at 11 years, estimated adjusted difference between groups: −10.8 (p&lt;0.0001 for all). Weight loss was 20.8±0.6% (T-group), weight gain 8.1±0.5% (CTRL), difference between groups: −28.8% (p&lt;0.0001 for all). 99% in the T-group and 97.5% in CTRL (p&lt;0.001) had hypertension at baseline. Mean systolic blood pressure (BP) (mmHg) decreased by 36.2±1.3 (T-group) and increased by 9.3±1.3 (CTRL), difference between groups: −45.5 (p&lt;0.0001 for all). Diastolic BP decreased by 24.0±1.0 (T-group) and increased by 7.7±1.0 (CTRL), difference between groups: −31.7 (p&lt;0.0001 for all). Lipids (mmol/L): LDL cholesterol decreased by 2.1±0.1 (T-group) and increased by 0.9±0.1 (CTRL), difference between groups: −3.0 (p&lt;0.0001 for all). Non-HDL cholesterol decreased by 5.7±0.4 (T-group) and increased by 4.8±0.4 (CTRL), difference between groups: −10.5 (p&lt;0.0001 for all). Remnant cholesterol decreased by 1.2±0.1 (T-group) and increased by 1.0±0.1 (CTRL), difference between groups: −2.2 (p&lt;0.0001 for all). 67.7% in the T-group and 55.1% in CTRL (NS) had type 2 diabetes (T2DM) at baseline. HbA1c (%) decreased by 3.4±0.2 (T-group) and increased by 2.7±0.2 (CTRL), difference between groups: −6.0 (p&lt;0.0001 for all). 29 men (24.6%) were diagnosed with T2DM during follow-up. Mortality: 13 deaths (13.1%) in the T-group. 40 (33.9%) in CTRL (p&lt;0.0005). Non-fatal myocardial infarctions: None in the T-group, 31 (26.3%) in CTRL (py0.0001). Non-fatal strokes: None in the T-group, 29 (24.6%) in CTRL (p&lt;0.0001). Medication adherence to testosterone was 100% as all injections were administered in the medical office and documented. Conclusions In men with functional hypogonadism, long-term TTh improves cardiovascular risk factors and reduces cardiovascular events and mortality. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

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