Association of Coronary artery Calcification and Thoracic Aortic Calcification with incident peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Aim The association of subclinical atherosclerotic disease in the coronary arteries and thoracic aorta with incident peripheral arterial disease (PAD) is unknown. We investigated the association between coronary artery calcium score (CACs) and thoracic aortic calcium score (TACs) with incident clinical and subclinical PAD. Methods and results The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6,814 men and women aged 45 to 84 from four ethnic groups who were free of clinical cardiovascular disease at enrollment. CACs and TACs were measured from computed tomography scans. Participants with a baseline ABI≤0.90 or > 1.4 were excluded. Abnormal ABI was defined as ABI≤ 0.9 or > 1.4 at follow up exam. Multivariable logistic regression and Cox proportional hazards models were used to test the associations between baseline CACs and TACs with incident abnormal ABI and clinical PAD respectively. A total of 6,409 participants (female: 52.8%) with a mean age of 61 years were analyzed. Over a median follow up of 16.7 years, 91 participants developed clinical PAD. In multivariable analysis, each unit increase in log (CACS+1) and log (TACs+1) were associated with 23% and 13% (P < 0.01for both) higher risk of incident clinical PAD, respectively. In 5,725 (female:52.6%) participants with an available follow up ABI over median 9.2 years, each 1-unit increase in log (CACs+1) and log (TACs+1) were independently associated with 1.15-fold and 1.07-fold (P < 0.01for both) higher odds of incident abnormal ABI respectively. Conclusions Higher baseline CACs and TACs predict abnormal ABI and clinical PAD independent of traditional cardiovascular risk factor and baseline ABI.

Inverse correlation between serum irisin and cardiovascular risk factors among Chinese overweight/obese population

Background Irisin is a novel myokine associated with obesity, which is a traditional cardiovascular risk factor (CVRF). The present study aimed to investigate the association between serum irisin and a single CVRF as well as the clustering of CVRFs among Chinese overweight/obese population. Methods A total of 98 overweight and 93 obese subjects without clinical treatments were enrolled in this study. Subjects were then divided into two groups, based on the serum irisin level: a low irisin group (1.10–13.44 ng/ml) and a high irisin group (13.49–29.9 ng/ml). The clustering of CVRFs, smoking, diabetes mellitus, dyslipidemia and hypertension, was classified as 0, 1, 2 and ≥ 3 CVRFs. The demographic and baseline clinical characteristics of all participants were collected and serum irisin was measured. Results The high serum irisin group had significantly higher high-density lipoprotein cholesterol but lower fasting plasma glucose than the low serum irisin group. Additionally, the high serum irisin group had a significantly lower prevalence of smoking, diabetes mellitus and dyslipidemia than the low serum irisin group. Increased serum irisin was significantly associated with a reduced risk of smoking and dyslipidemia in both the unadjusted and adjusted models. Furthermore, high serum irisin significantly reduced the risk of the prevalence of 1, 2 and ≥ 3 CVRFs. Conclusions among the Chinese overweight/obese populations, high serum irisin is negatively associated with smoking, dyslipidemia and the clustering of CVRFs. Thus, high serum irisin is potentially associated with a low risk of cardiovascular diseases in the Chinese overweight/obese population.

Endothelial Dysfunction Is Associated with Cerebrovascular Events in Pre-Dialysis CKD Patients: A Prospective Study

Background: Patients with chronic kidney disease (CKD) have markedly increased rates of end stage renal disease, major adverse cardiovascular/cerebrovascular events (MACCEs), and mortality. Endothelial dysfunction (ED) is an early marker of atherosclerosis that is emerging as an increasingly important non-traditional cardiovascular risk factor in CKD. There is a lack of clinical studies examining the association between ED and both cardiovascular and renal endpoints in patients with CKD. Aims: We examined the association between reactive hyperemia index (RHI), a validated measure of endothelial function measured by peripheral arterial tonometry (PAT), with traditional cardiovascular risk factors in pre-dialysis CKD patients and prospectively evaluated the role of RHI as predictor of renal and cardiovascular outcomes in this population. Methods: One hundred and twenty pre-dialysis patients with CKD stages 1 to 5 (CKD group) and 18 healthy kidney donor candidates (control group) were recruited and had a successful RHI measurement by PAT. General demographic and clinical information including traditional cardiovascular risk factors were registered from all participants. Thereafter, patients were prospectively followed-up for a median time of 47 (IQR 19–66) months to determine associations of RHI with renal outcomes, MACCEs, hospitalizations or mortality. Results: In the CKD patient population, the mean age was 57.7 ± 15.5 years, the mean eGFR was 54.9 ± 36.7 mL/min/1.73 m2 (CKD-EPI) and 57 were males (47.5%). At baseline, in univariate analysis, RHI in the CKD group correlated positively with eGFR (r = 0.332, p < 0.0001) and correlated negatively with age (r = −0.469, p < 0.0001), Charlson index (r = −0.399, p < 0.0001), systolic blood pressure (r = −0.256, p = 0.005), and proteinuria (r = 0.211, p = 0.027). Reactive hyperemia index in the control group did not significantly differ from RHI observed in patients with CKD stages 1 to 5 (2.09 ± 0.40 vs. 2.01 ± 0.06, p = 0.493). In adjusted analysis, only age (β = −0.014, p = 0.003) remained independently associated with RHI at baseline. During follow-up, 8 patients suffered a MACCEs, 33 patients experienced renal function deterioration, 17 patients were hospitalized for medical reasons and 6 patients died. RHI at baseline was not significantly associated with CKD progression (1.94 vs. 2.02, p = 0.584), hospitalizations (1.90 vs. 2.04, p = 0.334), and all-cause mortality (1.65 vs. 2.01, p = 0.208) or MACCEs (1.77 vs. 2.01, p = 0.356), but was significantly associated with cerebrovascular events (1.27 vs. 2.02, p = 0.004) and with a composite cardiovascular outcome (MACCEs, hospital admissions and death; 1.73 vs. 2.07, p = 0.035). Conclusion: Our results suggest that RHI may be a predictor for the development of cerebrovascular events in pre-dialysis CKD patients who may benefit from more aggressive preventive measures.

Impact of multimorbidity on risk and outcome of stroke: Lessons from chronic kidney disease

With both an aging population and greater post-stroke survival, multimorbidity is a growing healthcare challenge, affecting over 40% of stroke patients, and rising rapidly and predictably with increasing age. Commonly defined as the co-occurrence of two or more chronic conditions, multimorbidity burden is a strong adverse prognostic factor, associated with greater short- and long-term stroke mortality, worse rehabilitation outcomes, and reduced use of secondary prevention. Chronic kidney disease can be considered as the archetypal comorbidity, being age-dependent and also affecting about 40% of stroke patients. Chronic kidney disease and stroke share very similar traditional cardiovascular risk factor profiles such as hypertension and diabetes, though novel chronic kidney disease-specific risk factors such as inflammation and oxidative stress have also been proposed. Using chronic kidney disease as an exemplar condition, we explore the mechanisms of risk in multimorbidity, implications for management, impact on stroke severity, and downstream consequences such as post-stroke cognitive impairment and dementia.

Abstract 13514: Gender-Stratified Difference in the Association Between Coronary Artery Calcium and Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis

Introduction: Coronary artery calcium score (CACs) measured by non-contrast cardiac CT has a strong correlation with coronary atherosclerotic burden. Although CACs predicts incident coronary heart disease, its gender-specific association with incident peripheral artery disease (PAD) is not clear. Methods: The multi-ethnic study of atherosclerosis (MESA) is a prospective population-based cohort consisting of 6814 men and female free of overt cardiovascular disease at enrollment. In this study we included MESA participants with baseline CACs and at least one ankle brachial index (ABI) measured at follow up exams. We excluded participants with baseline ABI≤ 0.9 or> 1.4. Incident PAD was defined as a follow up ABI≤ 0.9 and decline of ≥15%. Multivariable logistic regression models were deployed to evaluate the association between baseline CACs and incident PAD in female and male. Results: The mean age (SD) was 61.29 (9.96) years and 52.6% (3013/5725) were female. Female had lower baseline ABI [1.10 (0.08) vs 1.15 (0.09); p < 0.001]. Over a median (IQR) of 9.23 (8.22-9.60) years, 113(4%) female and 85(3%) male developed PAD. Every one unit increase in log (CACs+1) was associated with 1.11-fold higher odds of incident PAD in male (p=0.001). This association remained significant after adjustment for demographics, traditional cardiovascular risk factor and baseline ABI. Male participants with CACs>300 showed 1.94-fold higher odds of incident PAD compared to participant with CACs=0 (p=0.005). In female there was no statistically significant association between CACs and incident PAD in multivariable analysis. Conclusions: Baseline CACs is associated with future PAD independent of traditional cardiovascular risk factors in male participants of a multi-ethnic cohort. Disclaimer statement: The views expressed in this abstract are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

Abstract 14719: Prognostic Implications of Traditional and Non-traditional Cardiovascular Risk Factor Profiles in Patients With Non-valvular Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a prevalent disease with an associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease, however the importance of non-traditional mediators of cardiovascular risk such as chronic renal impairment, obstructive sleep apnoea and obesity (NTRFs) is emerging in the literature. The differential impact of these risk factor groups on outcomes in patients with AF is not well studied. Hypothesis: SMuRFs and emerging NTRFs will have a differential impact on prognosis in patients with AF. Methods: Consecutive patients admitted to our service between 2013-2017 with a primary diagnosis of non-valvular AF were assessed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events. We excluded patients with valvular AF, incomplete clinical data and baseline comorbid conditions limiting lifespan to <6 months. Results: Of the 1010 patients (62.29±16.81 years, 52% men) included, 154 (15.2%) had no risk factors, 478 (47.3%) had only SMuRFs, 59 (5.8%) had only NTRFs and 319 (31.6%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18±21.27 months, a total of 288 patients met the composite outcome. On log rank tests, grouping of risk factor profiles was a significant predictor of the composite outcome (see Kaplan Meier curve). On multi-variable analysis, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p=0.01). Other independent predictors included age, heart failure, CHA2DS2VASc score, persistent AF and anaemia. Conclusions: Presence of both traditional and emerging NTRFs has prognostic implications in patients with AF.

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population

Background: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence. Objective: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population. Methods: We followed 2134 men aged 35–65 years for 14 years during the Isfahan Cohort Study (2001–2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor. Results: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables. Conclusion: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population

Background: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence. Objective: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population. Methods: We followed 2134 men aged 35–65 years for 14 years during the Isfahan Cohort Study (2001–2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor. Results: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables. Conclusion: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.

Anterior Myocardial Infarction in Late Pregnancy: A Case Report

Myocardial infarction (MI) in pregnancy is a rare and critical topic. In time diagnosis and management is mandatory for preventing both mother and fetus from possible mortality and morbidities. Both traditional cardiovascular risk factor and some factors which are present during pregnancy are related to MI during pregnancy. Management of ST-segment elevation MI during pregnancy is almost the same as other women. In the present report, we have discussed a case of anterior ST-segment elevation MI during the late third trimester of pregnancy, which ended up in a successful vaginal delivery. However, in the post-partum period, the patient developed severe bleeding and uterine atony, which was managed medically and with the massage.