Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4143707-A4143707, November 12, 2024. Introduction:The population of men and women who are overweight (defined as a BMI 25-29.9 kg/m2) continues to grow at fast pace. The prevalence and prognostic implications of a high coronary artery calcium (CAC) score in this group are poorly defined.Aims:Using a multiethnic cohort of men and women, we compared the ASCVD event-risk at follow up in normal weight, overweight, and obese individuals, overall and further stratified by CAC scores.Methods:Individual-level pooled analysis of participants from MESA, JHS, HNR, and FHS free of ASCVD at baseline and in whom CAC and BMI data were available. Participants with BMI 0, and 22% had CAC≥100 (17% prevalence among individuals with normal weight). The distribution of CAC by BMI categories is presented in the Figure. The incidence of ASCVD events among overweight participants was: 3.8 per 1000 person-years for those with CAC=0, 8.1 for CAC >0 –

Circulation, Volume 150, Issue Suppl_1, Page A4134912-A4134912, November 12, 2024. Background:Coronary artery disease (CAD) is a significant contributor to mortality among adults with diabetes mellitus (DM) in the United States. This study examines the patterns of CAD-related mortality in individuals aged 25 and above with DM, with a particular focus on geographic, gender, and racial/ethnic discrepancies from 1999 to 2020.Methods:The study analyzed death certificate information from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were computed per 100,000 individuals, categorized by year, gender, race/ethnicity, and geographic areas.Results:Between 1999 and 2020, CAD in individuals with DM resulted in 1,462,279 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (44.2%) and at home (29.3%). The overall age-AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95% CI: -1.29 to -0.77 p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in urban areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).Conclusion:The decrease in AAMRs for CAD among individuals with DM from 1999 to 2020 indicates improvements in healthcare management. However, the ongoing disparities based on race, gender, and geography call for targeted public health interventions to guarantee fair access to cardiovascular care. Additional endeavors are necessary to comprehend and alleviate the root causes of these inequalities.

Circulation, Volume 150, Issue Suppl_1, Page A4124446-A4124446, November 12, 2024. Introduction:One in five individuals have elevated lipoprotein(a) [Lp(a)], an inheritable risk factor that is causally associated with atherosclerotic cardiovascular disease (ASCVD). Whether individuals with elevated Lp(a) derive similar benefit from control of ASCVD risk factors has not been well-studied.Hypothesis:The magnitude of benefit associated with optimal cardiovascular health will be similar across the spectrum of Lp(a).Aim:To assess the association of traditional risk factor burden and Life’s Simple 7 (LS7) score with incident ASCVD across Lp(a) values.Methods:We studied 6,676 participants from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Elevated Lp(a) was defined as >50 mg/dL. As defined by the American Heart Association, LS7 metrics included smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and glucose. Multivariable Cox proportional hazards regression assessed the association of traditional risk factor burden and LS7 score (poor: 0-8, average: 9-10, optimal: 11-14) with incident ASCVD for individuals with and without elevated Lp(a) during a median follow-up of 17.7 years.Results:The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 mg/dL and 20% had Lp(a) >50 mg/dL. Individuals with Lp(a) >50 mg/dL had the highest burden of traditional risk factors except cigarette smoking. Compared to those with a poor LS7 score, those with an optimal LS7 score had a lower ASCVD risk that was significant for participants with Lp(a) 50 mg/dL (HR=0.41, 95% CI: 0.16-1.02). Individuals with Lp(a) >50 mg/dL had the highest absolute event rates across all LS7 categories, and there was no significant interaction between Lp(a) and LS7 score on incident ASCVD (p-interaction=0.64,Figure).Conclusions:Participants with an optimal LS7 score had similar reduction in ASCVD risk regardless of their Lp(a) burden. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among patients with elevated Lp(a).

Circulation, Volume 150, Issue Suppl_1, Page A4140800-A4140800, November 12, 2024. Introduction:Peripartum cardiomyopathy (PPCM) is the leading cause of late postpartum pregnancy-related death and often precipitates acute heart failure and cardiogenic shock. Limited contemporary data exists on long-term outcomes among PPCM patients who develop cardiogenic shock (PPCM-CS), especially those who require extra-corporeal membrane oxygenation (ECMO).Methods:This retrospective cohort study identified patients with PPCM-CS from January 2012-January 2024, using EHR-based data from academic medical centers across the US (TriNetX, Inc.). The primary outcome was all-cause mortality over a 180-day follow-up period. Secondary outcomes included acute kidney injury (AKI), new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), mechanical circulatory support (MCS), and heart transplantation (HT). The outcomes were reported in the overall population and among those requiring ECMO support.Results:We identified 856 females (mean age 36 ± 12 years; 41% White, 41% Black individuals) with PPCM-CS (Table). During a mean follow-up of 144 ± 63 days, all-cause mortality occurred in 17.9%. There were high incidences of AKI (53.7%), AF (19.4%), and VT/VF (29.3%) (Fig 1). 8.1% of patients successfully underwent HT. There was substantial MCS use, with percutaneous ventricular assist device (pVAD) used in 8.7% and intra-aortic balloon pump (IABP) used in 11.0%. Among those requiring ECMO (N=97, 11.3%), there was high all-cause mortality (26.8%). The concomitant use of pVAD and IABP was 14.4% and 15.5%, respectively. 14.4% of ECMO-supported patients underwent successful HT.Conclusion:This study provides insights into long-term clinical outcomes among patients with PPCM-CS, highlights those requiring ECMO support. Further investigation is needed for early disease recognition and to establish optimal utilization of MCS to improve outcomes in PPCM-CS.

Circulation, Volume 150, Issue Suppl_1, Page A4120919-A4120919, November 12, 2024. Introduction:Congenital heart diseases (CHDs) are the leading cause of childhood morbidity and mortality. The dysregulation of several cardiac transcription factors (TFs) leads to CHD. The coordination of several cardiac TFs is required and essential for cardiogenesis. However, the mechanisms to acquire its cardiac cell identity remain unclear.Hypothesis:MutantTbx5dysregulates embryogenesis during mesoderm specification, prior to its expression in the tissues in Holt-Oram syndrome.Methods:Using cellular physiology and multiomics analysis in both human ES cells and a zebrafish model ofTBX5germline mutation. we evaluated embryonic structure and function, prior to the onset of gastrulation in the context of both heterozygous and homozygousTBX5mutation.Results:Zebrafish time course transcriptome profiles over gastrulation revealed that loss ofTbx5impacted transcriptional profiles at the blastula stage. Single cell RNA sequencing (scRNA-seq) on 16243 zebrafish blastula stage cells showed loss ofTbx5impacted transcription noise at the blastula stage prior to the expression of zygoticTbx5with associated effects on chromatin accessibility using omni-assay for transposase-accessible chromatin (ATAC) and evidence of aberrant Wnt signaling even at the blastula stage. Embryo-wide cell structure and function were abnormal in bothTbx5mutant zebrafish heterozygotes or homozygotes. To validate Undifferentiated human ES cell H3K4me3 Cleavage Under Targets&Release Using Nuclease (CUT&RUN) also showed abnormal Wnt signaling inTBX5homozygous mutation andTBX5CUT&RUN showed aberrant mesoderm pathway. Calcium imaging analysis demonstrated the lowest excitation frequency inTBX5homozygous mutation prior to mesoderm specification.TBX5homozygous human ES derived mesoderm cells exhibited low expression levels of mesoderm marker genes compared toTBX5wild type mesoderm.Conclusion:Integrating single cell physiology and multi-omics technologies, we idneifified fundamental dysregulation of embryogenesis in mutant cardiac-restricted gene disorder prior to mesoderm specification or the zygotic expression of the mutant gene. These findings suggest thatTbx5started to determine cell fate prior to mesoderm specification by altering chromatin accessibilities and histone modification.Tbx5affected mesoderm differentiation by influencing Wnt signaling and cell physiology.

Circulation, Volume 150, Issue Suppl_1, Page A4122840-A4122840, November 12, 2024. Background:Patient activation, a person’s level of confidence, comprehension, and autonomy toward their health, is an essential goal of cardiovascular disease therapy. Previous research has shown a link between high levels of patient activation and better patient outcomes and experiences. However, whether individualized interventions such as a text-based mobile health (mHealth), improve patient activation is unclear. Research on patient activation in people at risk for cardiovascular disease and influential factors is minimal.Aims:This study aimed to 1) determine the effect of a multi-component mHealth intervention on patient activation and 2) examine its predictors among older adults at risk for cardiovascular disease.Methods:In this pilot randomized controlled trial, community-dwelling older adults with poor eating behaviors and reduced physical activity (n=54) were randomly assigned to theGetFIT(control) orGetFIT+(intervention) groups, with three- and six-month follow-up periods. TheGetFITgroup received healthy lifestyle counseling from a licensed health coach, a free commercial mHealth app with push alerts on physical activity, and an activity tracker for physical activity monitoring. TheGetFIT+ group received the same components but had personalized text messages instead of push alerts. The 13-item Patient Activation Measure assessed patient activation; higher scores indicate better activation. Linear mixed-effects models were used to investigate between-group changes in outcomes across time.Results:The mean age was 65.4 ± 6.0 years; 61% were females and 61% were married. Baseline characteristics were comparable between groups. Significant improvements were observed in theGetFIT+group at three months (mean 3.53, 95% CI 0.11, 6.96; p=0.043) and six months (mean 4.37, 95% CI 0.91, 7.83; p=0.014), whereas improvements in theGetFITgroup were non-significant. Adjusting for age, gender, education, employment, marital status, social support, smartphone confidence, and self-perceived health did not alter the results. Nevertheless, only social support was associated with higher patient activation overall (B=5.14, 95% CI 1.00, 9.27; p=0.015).Conclusions:People at risk for cardiovascular disease can improve their self-management abilities, knowledge, and confidence through personalized text messaging. Possessing social support is critical for maximizing the benefits of mHealth interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4136776-A4136776, November 12, 2024. Introduction:Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.Methods:We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.Results:At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p

Circulation, Volume 150, Issue Suppl_1, Page ASa904-ASa904, November 12, 2024. Background:The outcome of in-hospital cardiac arrest (IHCA) has improved over the past decade, although the survival rate is still approximately 25%. Some cases of IHCA are triggered by medical adverse events, and their outcomes might be different by time when how many staffs is available. But the relationship between the time of occurrence and outcome remains unclear. The aim of this study is to compare the survival outcomes of IHCA at night with those during the daytime using the nationwide medical adverse events database in Japan.Methods:We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database, which registered 1 million cases per year, from 2010 to 2023. We extracted cases of IHCA and analyzed the cases by time of occurrence, grouping them into day time shift (8am-4pm), midnight shift (4pm-0am), and late night shift (0am-8am). The primary outcome was survival to discharge, and we performed multivariate logistic regression to adjust for age, sex, holiday, cause of medical adverse events, event location, occupation of the involved party, occupational history of the involved party and assignment period of the involved party as potential confounders.Result:A total of 4,252 cases were included during the study period. The most common age group was over 70years old (54.2%, n = 2,303 /4,252). 2,627 patients (61.8%) were male. The number of IHCA per time period was 1949 (45.8%) in the day time shift, 1,349 (31.7%) in the midnight shift and 954 (22.4%) in the late night shift. The most common cause of medical adverse events in all time periods was treatment or procedures. However, the rate of medical care was higher in the late night shift. Regarding the location of the event, the general ward was the most common location at all times. Multivariate logistic regression for survival on discharge yielded an adjusted odds ratio of 1.56 (95% confidence interval [CI]: 1.30–1.86) ,1.33 (95% CI: 1.11–1.59) for the day time shift and midnight shift compared to the late night shift.Conclusion:Approximately 20% of in-hospital cardiac arrests due to medical adverse events occurred on the late night shift, with poor outcomes. Time of occurrence was associated with survival to discharge among IHCA cases that were identified in the nation-wide adverse events database.

Circulation, Volume 150, Issue Suppl_1, Page A4134692-A4134692, November 12, 2024. Background and objectives:Data regarding readmission rates and predictors of readmission in cancer patients undergoing PCI are sparce. With the increasing survival rates and prevalence of cardiovascular complications in cancer patients, understanding the patterns and predictors of readmission in this population is paramount for optimizing their outcomes. Cancer patients pose unique clinical challenges due to their combined prothrombotic state and propensity for bleeding. We attempted to identify factors associated with readmission in cancer patients.Methods:We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age with primary diagnosis of myocardial infarction(MI) who underwent percutaneous coronary intervention(PCI) and have a preexisting diagnosis of cancer. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to define MI, PCI, and cancer. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, predictors of readmission, and common causes of readmission. The independent predictors of readmission were analyzed using cox regression analysis.Results:Of the 52,307 cancer patients who underwent PCI, 7,767 were readmitted within a 30-day period. The readmission rate for these patients was 15.70%. The mortality rate was 6.05% for index admission and 6.80% for readmitted cases. Among the readmitted patients in the strongest independent predictor for readmission were leaving against medical advice(AMA), anemia, congestive heart failure, and discharge to a skilled nursing facility or home health. Common causes of readmission within this time included hypertensive heart disease with concomitant CKD stage I-IV and heart failure (6.21%), sepsis (6.12%), NSTEMI (5.60%), hypertensive heart disease with concomitant heart failure (4.62%) and acute kidney injury (1.98%).Conclusions:Thirty-day readmission rate was 15.70%. Independent predictors of readmission were anemia, diabetes mellitus, congestive heart failure, malnutrition, peripheral artery disease, leaving against medical advice, and discharge to facility. Most common cause of readmission was hypertensive heart and kidney disease with heart failure, which comprised 6.21%.

Circulation, Volume 150, Issue Suppl_1, Page A4140872-A4140872, November 12, 2024. Background:Permanent Pacemaker (PPM) implantation is recognized as a class I indication treatment for patients with high-grade Atrioventricular (AV) blocks, infra-Hisian conduction blocks, and symptomatic sinus node diseases such as sinus bradycardia. There remains a scarcity of data regarding the impact of dialysis-dependent End-Stage Renal Disease (ESRD) on PPM implantation outcomes, particularly in terms of readmission rates. We aim to evaluate short-term readmissions in dialysis-dependent ESRD patients post-PPM placement, utilizing data from the National Readmission Database (NRD).Methods:The NRD for the year 2020 was used to identify dialysis-dependent ESRD adults who underwent PPM implantation, employing ICD-10 CM and PCS codes. We focused on outcomes including 30-day readmission rates, length of stay (LOS), total hospital charge (THC), and predictors of readmissions. Both multivariate and univariate logistic and linear regression analyses were employed to assess outcomes and adjust for potential confounders.Results:Out of 2,497 dialysis-dependent ESRD patients who underwent PPM implantation, 2,353 were discharged alive. Within 30 days of discharge, 540 (22.9%) patients were readmitted. Those readmitted had a longer LOS and higher comorbidity burden but were similar in age, sex, hospital characteristics, and household income status compared to those not readmitted. Readmissions incurred an additional average THC of $103,599 and an average LOS of 7.3 days. The top five causes of readmissions were hypertensive heart disease with heart failure (11.3%), sepsis (9.9%), fluid overload (2.4%), hypoglycemia without coma in type II diabetes mellitus (2.0%), and non-rheumatic aortic valve stenosis (1.7%).Conclusion:This analysis reveals that 22.9% of dialysis-dependent ESRD patients who underwent PPM implantation were readmitted within 30 days, resulting in extended LOS and increased THC. These readmissions negatively impact patient outcomes and exacerbate the burden on healthcare resources. Optimizing the management plans for this patient group is crucial to enhancing outcomes and using healthcare resources more effectively.

Circulation, Volume 150, Issue Suppl_1, Page A4140798-A4140798, November 12, 2024. Background:The renin angiotensin aldosterone system (RAAS) is crucial for circulatory homeostasis and multiple cardiovascular diseases. Despite research on key RAAS components, resulting in multiple therapeutics, the role of angiotensinogen, the sole substrate, remains less understood. We sought to elucidate the relationship between circulating angiotensinogen levels and single nucleotide polymorphisms (SNPs) in a multi-ethnic cohort study.Methods:Genome-wide association analyses of plasma angiotensinogen levels were conducted in 4,899 MESA participants (self-identified as White, n=1,868; Hispanic, n=1,115; Black, n=1,283; and Chinese, n=633). Plasma angiotensinogen levels were measured at the baseline using an enzyme-linked immunoassay. Linear models were adjusted for age, sex, comorbidities, and sex hormones, along with top principal components to account for population structure. Furthermore, we conducted conditional analysis identifying SNPs meeting genome-wide significance for population-specific associations conditioned on the lead SNP in each race/ethnicity.Results:We identified 115 SNPs associated with angiotensinogen levels (p< 5×10−8), including the lead SNP rs4762 (Thr174Met) in exon 2 (β=-0.159, p=1.51E-100) and SNP rs5050 (A-20C) in the promoter region (β=-0.109, p=2.26E-69) within theAGTgene. Strong Linkage Disequilibrium [LD (r2 >0.8)] was observed between rs4762 and rs35837081 for White, Black, and Hispanic ethnicities. Conversely, this level of LD was noted between rs4762 and rs3789657 specifically within Chinese. The LD between rs4762 and rs5050 was higher for White (r2=0.65), followed by Chinese (r2=0.56), Hispanic (r2=0.55), and Black (r2=0.29). Conditioned on rs4762 in the White population, we identified four secondary signals associated with angiotensinogen including rs2493151 (β=0.053, p=4.08E-9), implicated in transcription factor binding. Measured angiotensinogen levels were 9.7%, 12.8%, and 17.3% lower in Black, Hispanic, and Chinese, respectively, compared to White participants.Conclusions:These findings extend angiotensinogen research, highlighting the SNPs rs4762 and rs5050 as the key variants associated with angiotensinogen levels, both previously linked to hypertension.

Circulation, Volume 150, Issue Suppl_1, Page A4142443-A4142443, November 12, 2024. Introduction:Abdominal aortic aneurysm (AAA) is a significant cause of morbidity and mortality in older adults. The AAA screening guidelines from the Society of Vascular Surgery include risk factors such as sex, age, smoking, and family history. This study explored whether integration of a polygenic risk score (PRS) and proteomics with clinical data could improve AAA prediction in the ARIC Study.Methods:Over a median follow-up of 24 years from ARIC visit 2 (1990-92) baseline, we identified 487 clinical AAA cases among 9,373 ARIC participants (7,397 Whites and 1,976 Blacks) through hospital discharge diagnoses or death certificates. We selected AAA-associated clinical risk factors based on literature and our expertise, including age, gender, race, field center, smoking status, smoking pack-years, waist girth, BMI, levels of total and HDL cholesterols, hypertension, diabetes, and eGFR. We calculated the PRS[WT1] based on SNP dosage in ARIC and the latest genome-wide association study for AAA, which reported 141 independent associations from 14 discovery cohorts (PMID: 37845353). ARIC used SOMAscan v4 to measure 4,955 plasma proteins at baseline, of which 24 were significantly associated with clinical AAA (p < 1x10^-5) independent of the clinical risk factors. The prediction equation for AAA risk was constructed in 3 Cox regression models: 1) clinical risk factors measured at baseline, 2) model 1 variables plus PRS, and 3) model 2 variables plus the 24 AAA-associated proteins identified through proteomics analysis. We used the area under the curve (AUC) to evaluate the prediction performance of these models for AAA risk.Results:Participants in the top quintile of PRS showed significantly higher AAA risk compared to the lowest quintile (HR 1.41, 95% CI: 1.03 – 1.85) after adjustment for clinical risk factors. Adding the PRS to clinical risk factors did not improve the AUC: 0.890 (95% CI: 0.869 - 0.945) in model 1 vs 0.891 (95% CI: 0.853 - 0.961) in model 2. Further adding the 24 AAA-associated proteins substantially improved the performance of the prediction model [AL2] (AUC=0.950, 95% CI: 0.939 - 0.986 in model 3), with 289 AAA events in the top quintile of predicted risk compared to 12 in the lowest quintile.Conclusion:A proteomics-integrated approach that combined clinical risk factors and proteomics data enhanced AAA risk prediction and has the potential to improve risk stratification and early intervention for AAA.

Circulation, Volume 150, Issue Suppl_1, Page A4142234-A4142234, November 12, 2024. Introduction:The mechanisms underlying the persistence of atrial fibrillation (AF) are still debated. Studies in animal and human cardiac bench top models suggest that different mapping techniques influence the detection of localized sources or self-sustaining, transient wavelets in AF. Despite this, no human studies have examined the influence of a local versus global mapping approach on the detection of these sources simultaneously in the same patient.Objective:We hypothesize that local and global mapping of AF offer different spatiotemporal resolutions that influence the nature of sustaining mechanisms but not their location in the chamber. This will be particularly evident for rotational sources.Methods:16 patients who underwent catheter ablation for AF, atrial flutter (AFL), or premature atrial contractions (PACs) were studied. All patients underwent electroanatomic mapping of the left and right atria with both local and global approaches. Anatomical locations were subdivided into different regions (Figure 1A, 1B). Mechanisms were classified as focal, rotational, or localized irregular activation (LIA) using mapping algorithms. Analyses were done using Chi-squared tests.Results:A total of 40 AF, 12 AFL, and 4 PAC simultaneous electroanatomic maps were obtained. Both local and global mappings identified an AF source (n=52) within close anatomical proximity 86.5% of the time (p

Circulation, Volume 150, Issue Suppl_1, Page A4141934-A4141934, November 12, 2024. Introduction:Heightened psychosocial stress is a CVD risk factor. While stressors are common and often co-occur, identifying sources and patterns of psychosocial stress exposure may provide insight into individual susceptibility to CVD. Therefore, we sought to identify and examine the longitudinal associations of baseline psychosocial stress subgroups with CVD events in MESA.Methods:Data from 6,349 adults (aged: 62.2±10.2 years; 52.9% women) from the MESA cohort with no prior CVD event at baseline (years 2000-2002) were used in this analysis. Latent class analysis (LCA) was used to specify distinct stress subgroups based on 6 variables: chronic burden, neighborhood safety, adequate food shopping, neighborhood noise, lifetime- and past-year discrimination. Five classes were determined after examining traditional fit indices. Adjudicated fatal and nonfatal CVD events were ascertained in annual follow-up visits through the year 2019. Cox proportional hazards models with sequential adjustment of baseline variables were used to examine the associations between subgroup membership and CVD events.Results:Five distinct stress subgroups were identified via LCA and were labeled “moderate neighborhood noise” (12.1%), “excessive noise/crime” (6.4%), “elevated on all” (6.3%), “high discrimination/safe neighborhood” (21.4%), “optimal” (53.8%) (see figure). By the year 2019, 1,121 participants had experienced a CVD event. Membership in the “elevated on all” and “high discrimination/safe neighborhood” subgroups (see table) were associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. However, when adjusted for measures of anxiety and depression, possible mediators, only membership in the “high discrimination/safe neighborhood” subgroup was associated with increased risk of a CVD event.Conclusions:Among 5 distinct stress subgroups those experiencing high discrimination had higher risk for CVD events.

Circulation, Volume 150, Issue Suppl_1, Page A4147484-A4147484, November 12, 2024. Introduction:Heart transplant (HT) is the gold standard for advanced heart failure, and the individuals burdened by advanced heart failure often have multiple comorbidities. Protein-energy malnutrition (PEM) is a common comorbidity and is frequently underdiagnosed. Previous studies examined the relationship between PEM and mortality in HT and found a positive association. However, the relationship between PEM and HT rejection, HT failure, and cardiac allograft vasculopathy (CAV) is scarce. Given that these complications also impact survival, we sought to explore the relationship.Methods:We identified all HT patients using ICD-10 codes from the 2016 to 2021 National Inpatient Sample database. Then, the PEM group was compared to the no-PEM group. We used Student’s Test and Pearson’s Chi-squared to analyze continuous and categorical variables. Then, multivariable logistic regression models were used to account for confounders and to predict the outcomes. The primary outcomes were HT rejection, HT failure, and CAV. The secondary outcomes were mortality, arrhythmias (composite of atrial and ventricular fibrillation and flutter, and supraventricular tachycardia), length of hospital stay, and cost of hospitalization. A 2-sided p-value was the statistical threshold for significance.Results:During the study period, 31,215 HT hospitalizations occurred, and 11.9% (3,700) had PEM. The median age for the PEM group was 65 years.Compared to the no-PEM group, HT rejection 0.8 (0.4-1.5), HT failure 0.8 (0.3-2.1), and CAV 1.08 (0.6-1.9) did not differ between both groups, p >0.05, each.The PEM group had a higher association with mortality 2.8 (2.1-3.6), arrhythmias 1.4 (1.07-1.8), longer LOS 8 vs. 4 days, and higher cost of hospitalization, $84,687 vs. $43,285, p

Circulation, Volume 150, Issue Suppl_1, Page A4147150-A4147150, November 12, 2024. Background:Coronary artery disease (CAD) in patients with hypertension is a significant health concern among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in hypertensive patients aged 25 and older from 1999 to 2020.Methods:The CDC WONDER database’s mortality data from 1999 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and calculate age-adjusted mortality rates (AAMRs) per 100,000 people. The year, sex, race/ethnicity, and geographic regions were used to stratify the data.Results:Between 1999 and 2020, CAD in hypertension caused 1,512,89 medical facilities, accounting for 37.9% of all deaths. With an AAPC of 1.88 (95% CI: -0.81 to 4.36, p = 0.118), the overall AAMR grew from 7.7 in 1999 to 36.0 in 2020. There was a notable increase between 1999 and 2001 (APC: 30.07, p = 0.040) and a minor growth between 2001 and 2020 (APC: 0.85, p = 0.030). Adult men had higher AAMRs than women (men: 40.2; women: 25.2), with increases for both sexes [Men: AAPC: 4.75, p = 0.002; Women: AAPC: 2.70, p = 0.058]. AAMRs varied significantly by race, highest among Black individuals (39.9), followed by Whites (31.4), American Indians (30.4), Hispanics (27.7), and Asians (21.3). The AAMR increased for all races from 1999 to 2020, most notably in American Indians (AAPC: 4.91, p = 0.004). AAMRs varied by state, from 16.4 in Utah to 51.4 in West Virginia. The Midwest had the greatest regional death rate (33.6), followed by the West (31.1), Northeast (31.0), and South (30.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (34.7 vs. 31.0), with a greater increase in nonmetropolitan areas (AAPC: 6.22, p < 0.000001).Conclusion:This analysis reveals significant demographic and geographic disparities in mortality rates due to CAD in hypertensive adults in the U.S. The AAMR has increased fivefold over the past two decades, particularly among certain racial groups and geographical regions. These findings underscore the urgent need for targeted interventions and equitable healthcare access to mitigate these disparities and improve outcomes.