152 Effects of nutraceuticals on the control of the lipid-glycaemic structure and on endothelial protection, in patients with low cardiovascular risk profile

Aims Nutraceuticals are dietary supplements that contain a concentrated form of a presumed bioactive substance originally derived from a food. There is a relationship between the consumption of monacolin K from red yeast rice and maintenance of normal blood low density lipoprotein cholesterol (LDL-C) concentrations recognized by the European Agency on Food Safety. The present study evaluates the effects of a therapeutical association of nutraceuticals (a combination of containing fermented red rice, named Monacolin K and Coenzyme Q10) on lipo-glycaemic profile and on the vascular function evaluated as endothelial function and arterial stiffness (using the non-invasive methods of EndoPAT and SphygmoCOR). Methods The present is a single-centre prospective study enrolling 30 patients with low cardiovascular risk profile (SCORE risk, cardiovascular disease risk <10% at 10 years). Patients were consecutive enrolled from March 2019 to February 2020 (recruitment period). The average follow-up was 14 weeks, from intaking monacolin K 10 mg + Coenzyme Q10 10 mg. The scheduled evaluations of the enrolled population were: before the beginning of the therapy and after a period of 14 weeks. Results After 14 weeks of treatment we demonstrated a statistically significant reduction in total cholesterol (P 0.015) and LDL (P 0.003). An important effect on the inflammatory profile was highlighted, resulting in a decrease in Hs-CRP at 12-weeks (P 0.052), associated with a progressive reduction of arterial stiffness (P 0.063) and an improvement in endothelial function (P 0.048). Conclusions Data obtained suggest that formulations with natural nutraceuticals, especially fermented red rice, have a protective cardiovascular effect, not also through reduction of plasma lipids but in endothelial function and arterial stiffness improvement.

Assessment of the Cardiovascular Risk Profile of Infants Exposed to Pre-eclampsia in-utero: A Prospective Case-Control Study in South African Children of African Ancestry

Background: It has been reported that maternal gestational environment may be programmed to have a significant impact on foetal and offspring health later in life. Studies have shown that children born to pre-eclamptic mothers are prone to obesity, hypertension, and diabetes in their adult life. However, such findings are yet to be established in an African population. This protocol is for a study aiming to investigate the relationship between pre-eclampsia (PE) and cardiovascular risk in children born to pre-eclamptic mothers in a South African population of African descents.Methods: A prospective case-control design will be employed to recruit pre-eclamptic and normotensive pregnant women and their offspring after birth. Pregnant women will be assessed for cardiovascular risk factors including PE, obesity, haemodynamics, lipids, glycaemic indices, oxidative stress, and vascular function at 30 weeks of gestation. The cardiovascular risk profile of their offspring will be assessed at birth and 6 weeks later. The difference in cardiovascular risk profile between children born to the pre-eclamptic and normotensive mothers will be compared and the correlation between maternal and offspring cardiovascular risks will be investigated.Discussion: This will be the first prospective study to assess the in-utero effect of cardiovascular risk in offspring born to pre-eclamptic women of African ancestry. It is expected that findings from this study will provide information on the cardiovascular effect of in-utero exposure to PE in a population of African ancestry. This knowledge will advise policy on the management of women with PE with a view of protecting cardiovascular health in offspring.

Heart failure in low risk patients with atrial fibrillation, nationwide registry case-control study based on 227811 patients

Background Heart failure (HF) is common in patients with atrial fibrillation (AF), and also associated with worse outcome. Consequently, it is commonly included in risk prediction models for AF, used in daily clinical praxis. However, knowledge about the association between solely AF and incidental HF is limited. Aim This study aims to evaluate the short and long-term risks for onset of HF in patients with AF and low cardiovascular risk profile. Methods All patients with first recorded hospitalization for AF in the Swedish National Patient Register, were included from the 1St January 1987 to 31st December 2018. Each patient with AF was matched by age, sex and county with two controls from the Swedish Total Population Register. Patients <18 years, or with concomitant hypertension, diabetes mellitus, coronary and periphery artery disease, previous stroke or transitory ischemic attack, cardiomyopathy, pulmonary arterial hypertension, congenital heart disease, valvular heart disease and renal failure prior or at baseline were excluded. Results In total 227 811 patients and 452 712 controls met the inclusion and exclusion criteria and were included in the study. The incidence rate for incidental HF per 1000 person-year within one year after AF diagnosis was 6.2 (95% CI: 4.5–8.6) among patient 18–34, increased with increasing age and was 142.8 (95% CI: 139.4–146.3) among those >80 years. Within five years the incidence rate decreased in all age categories and was 2.4 (95% CI: 1.8–3.0) among the youngest and 94.0 (95% CI: 92.4–95.6) in the oldest age group. When compared to matched controls from the general population patients with AF had a hazard ratio (HR) and CI 95% to develop HF within one year at 103.9 (46.3–233.1), 34.9 (26.5–45.9), 17.5 (15.5–19.8), 10.3 (9.6–11.1) and 6.1 (5.8–6.4) among patients aged 18–34, 35–49, 50–59, 60–69, 70–79 and >80 years, respectively. Conclusion Despite low cardiovascular risk profile AF still carries high risk for developing incidental HF in particular during the first observation year with increasing tendency along with increasing age. Younger patients with AF and without other cardiovascular comorbidities had more than 100 times higher relative risk to develop HF within one year when compared to matched controls. FUNDunding Acknowledgement Type of funding sources: None.

Cardiovascular risk profile in Growth Hormone treated adults with a craniopharyngioma compared to a non-functioning pituitary adenoma: a national cohort study

Context: Cardiovascular risk profile might differ between growth hormone treated patients with a craniopharyngioma and a non-functioning pituitary adenoma (NFPA), since patients with craniopharyngioma more frequently suffer from hypothalamic metabolic disruption. Objective: The aim of this study is to investigate cardiovascular risk profile in adult patients with a craniopharyngioma compared to NFPA before and after treatment with growth hormone replacement therapy due to severe GH deficiency. Design: A sub-analysis of the Dutch National Registry of Growth Hormone Treatment in Adults was performed, in which we compared 291 patients with craniopharyngioma to 778 patients with NFPA. Cardiovascular risk profile and morbidity was evaluated at baseline and during long-term follow-up within and between both groups. Results: At baseline, patients with craniopharyngioma demonstrated higher BMI than patients with NFPA and men with craniopharyngioma showed greater waist circumference and lower HDL compared to men with a NFPA. During follow-up, BMI, as well as diastolic blood pressure among patients using antihypertensive drugs, deteriorated in the craniopharyngioma group compared to the NFPA group. Lipid profile improved similarly in both groups over time. No differences were found between groups in the occurrence of diabetes mellitus, cerebrovascular accidents, cardiovascular disease, or in overall mortality. Conclusion: This study suggests that overall cardiovascular risk profile is worse in craniopharyngioma patients with growth hormone deficiency compared to patients with NFPA. During growth hormone replacement therapy, patients with craniopharyngioma demonstrated an increase in BMI over time, where BMI remained stable in patients with NFPA. Also, diastolic blood pressure did not improve with antihypertensive drugs in craniopharyngioma as seen in patients with NFPA.