Risultati per: Le cause della polmonite nei bambini

Circulation, Volume 148, Issue Suppl_1, Page A16870-A16870, November 6, 2023. Background:Patients with chronic limb-threatening ischemia (CLTI) have high mortality rates after revascularization. Balancing short-term mortality risk against limb salvage gains is important when triaging patients with CLTI to revascularization. Data for risk stratification is limited. We aimed to develop machine learning models to rank predictive variables for 30-day and 90-day all-cause mortality for CLTI after peripheral vascular intervention (PVI).Methods:Patients undergoing PVI for CLTI between 2017 and 2018 in the Medicare-linked Vascular Quality Initiative (VQI) were included. Sixty-six preprocedural variables were included in random survival forest (RSF) models. RSF models were constructed for 30-day and 90-day all-cause mortality in the training sample (80% of data) and evaluated in the validation sample (20% of data). Predictive variables were ranked based on frequency that they caused branch splitting nearest the root node. Goodness of fit was assessed by Harrell’s C-index.Results:A total of 10,114 patients (mean age 72 ± 11, 59% male, 74% white) were included. The mortality rate was 4.4% at 30 days and 10.6% at 90 days. The RSF model for 30-day mortality identified stage 5 chronic kidney disease (CKD), dementia, and urgent procedures as the most predictive variables. For the 90-day mortality prediction model, the most important variables were stage 5 CKD, dementia, and poor functional status(Figure). For both models, 8 of the top 10 variables were either medical history or functional status variables. The C-index was 0.72 for the 30-day model and 0.73 for the 90-day model.ConclusionUsing data from the claims-linked VQI registry, medical comorbidities and functional status variables were identified as the most predictive variables for 30-day and 90-day all-cause mortality using RSF models. Results may help guide individualized risk conversations regarding PVI versus conservative therapy for the highest risk patients.

Circulation, Volume 148, Issue Suppl_1, Page A12275-A12275, November 6, 2023. Background:Neighborhood disadvantage impacts individuals’ morbidity and mortality and contributes to health disparities, but prospective cohort data from individuals of low socioeconomic status (SES) are limited.Hypothesis:Greater neighborhood deprivation associates with higher all-cause and cardiovascular (CV) mortality beyond individual SES, lifestyle, and clinical factors in a multi-racial, low-income population.Methods:The Southern Community Cohort Study is a population-based cohort of mostly low SES individuals recruited from 12 southeastern US states between 2002-2009. Participant addresses were linked with a census tract-based neighborhood deprivation index (NDI) derived from neighborhood level income, education, employment, housing, and occupation data. Date and cause of death were ascertained via the National Death Index. Cox proportional hazard models were used to test associations between NDI and death adjusted for enrollment age, sex, self-reported race, education, income, insurance, smoking, physical activity, alcohol intake, diet, sleep duration, BMI, and diabetes, hypertension, depression, cancer, heart disease, and stroke.Results:Among 79,631 participants, median age was 51 years (25th-75thpercentiles: 45-58), 69% were Black, and 60% were female. Over a median 13-year follow-up, 23,356 participants died, of which 7,214 (30.9%) were CV. With adjustment for age, sex, and race, per standard deviation (SD) increase in NDI was associated with a 19% increase in all-cause mortality (HR 1.19, 95% CI 1.18-1.21) and 16% increase in CV mortality (HR 1.16, 95% CI 1.13-1.19). Even with adjustment for individual SES, lifestyle, and clinical factors, NDI was associated with a 6% increased risk in all-cause mortality (HR per SD increase 1.06, 95% CI 1.03-1.08) and 8% increase in CV mortality (HR 1.08, 95% CI 1.05-1.11). NDI showed similar significant associations with all-cause and CV mortality in Black and White participants.Conclusion:Among low-income Americans, greater neighborhood deprivation associates with higher all-cause and CV mortality independent of individual SES, lifestyle, and clinical risk factors. More research is needed to examine factors underlying the health effects of neighborhood deprivation.

Circulation, Volume 148, Issue Suppl_1, Page A16682-A16682, November 6, 2023. Introduction:Electrocardiography (ECG) can be easily obtained at a low cost and includes voltage and time interval representing heart conditions. We hypothesized that artificial intelligence (AI) detects a subtle abnormality in 12-lead ECG and may predict individual mortality.Methods:Among 502,411 population in UK Biobank, 42,096 individuals had 12-lead ECG from 2013 to 2022. Among 41,572 survival group, after adjusting the following inclusion criteria; normal sinus rhythm, age under 60 years, PR interval 120~200ms, QTc interval 350~460ms, and QRS duration 70~100ms, 4,512 individuals were enrolled in this study. We developed and tested convolutional neural network (CNN) model to predict all cause death, cardiovascular (CV) death, or sudden cardiac arrest (SCA). The study population were divided into train (80%), validation (10%), and test (20%) set.Results:Among 4,512 patients with median 3.7 years [IQR; 2.7-5.1] of follow-up, the rate of all-cause mortality was 11.6% (524). In overall study population, median age was 55.5 years and proportion of male sex was 42.2%. The patients with all-cause death were older (p

Circulation, Volume 148, Issue Suppl_1, Page A13769-A13769, November 6, 2023. Introduction:Diabetes mellitus (DM) and cancer are prevalent diseases associated with the process of aging and exhibit a high likelihood of co-occurrence. Extensive evidence supports the notion that DM serves as a risk factor for various forms of cancer, and it is strongly associated with an unfavorable prognosis. The correlation is believed to be influenced by multiple pathways, including hyperinsulinemia, hyperglycemia, and inflammation. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality and cardiovascular outcomes.Hypothesis:The aim of our study was to assess the correlation between SGLT2i therapy and all-cause mortality, among patients diagnosed with DM and cancerMethods:We conducted a retrospective, single-center, observational study including all patients diagnosed with DM and cancer between January 2016 to January 2023. Patients were divided into two groups: patients treated with SGLT2i prior to cancer diagnosis (SGLT2i) and patients SGLT2i naive (non-SGLT2i). The primary endpoint was all-cause mortality.Results:Overall, 7085 patients were included in our cohort; 985 patients in the SGLT2i group and 6100 patients in the non-SGLT2i group. At a median follow-up of 42 months [IQR 23, 60] we observed a significantly lower all-cause mortality among the SGLT2i group (23% vs. 38%, p

Circulation, Volume 148, Issue Suppl_1, Page A12476-A12476, November 6, 2023. Introduction:QT prolongation is a risk factor for life-threatening arrhythmias and sudden cardiac death. In large cohorts, QT interval was associated with all-cause mortality after adjusting for cardiovascular risk factors, but these analyses may contain residual confounding. Whether the QT interval provides prognostic information above and beyond a validated mortality risk score is unknown.Hypothesis:QT interval on ECG will independently predict mortality after adjustment for the Care Assessment Needs (CAN) score, which was validated to predict mortality nationwide at the Veterans Administration (VA) (c-index 0.86).Methods:Patients receiving primary care at the Minneapolis VA from 2012 to 2016, with at least one ECG were included in this retrospective cohort study. QT intervals were corrected for heart rate (QTc) using the Bazett’s formula. CAN score, calculated within 1-week of the ECG, was obtained from the VA Corporate Data Warehouse.Results:Of the 36,240 patients, 1526 (4.2%) had QTc ≥ 500 ms, 3249 (9.0%) had QTc 470-500 ms, and 31,465 (86.8%) had QTc < 470 ms. A total of 2,189 (6.0%) patients died at 1-year follow-up and 7898 (21.8%) died at 5-year follow-up. Mortality was higher in patients with longer QTc (Table 1). Compared to those with QTc < 470 ms, CAN-adjusted odds of 1-year and 5-year mortality were significantly higher in those with longer QTc (Table 2). C-index for CAN score predicting 1-year and 5-year mortality (0.829 and 0.826, respectively) improved marginally after adding QTc data (0.834 and 0.832, respectively; p

Circulation, Volume 148, Issue Suppl_1, Page A13753-A13753, November 6, 2023. Introduction:Monocytic inflammation has been increasingly linked to diverse cardiometabolic risk factors and many age-related pathologies.Hypothesis:Cumulative monocyte counts (CumMON) are associated with and predictive of all-cause mortality.Methods:Retrospective analyses of data among 43,681 Han Chinese participants from a real-world, prospective cohort (Kailuan Study). Multivariable-adjusted Cox regression analyses were conducted to examine CumMON-associated risks for all-cause mortality.Results:Over a median 7.76 (IQR: 7.47-8.03) years of follow-up, 2,810 all-cause deaths were documented. Elevated monocyte load was significantly associated with higher mortality rates (Figure 1). Each 1-SD increase in CumMON was associated with a 15% increase in all-cause death (1.15, 95% CI: 1.11-1.20) after adjusting for other risk factors. Higher death incidences and CumMON-associated mortality risks (per-SD increment) were observed in elderly individuals, participants with diabetes (1.18, 95% CI: 1.10-1.27), hypertension (1.16, 95% CI: 1.11-1.21), impaired renal function (1.18, 95% CI: 1.13-1.24), increased LDL-C (1.21, 95% CI: 1.15-1.28 for LDL≥2.6 mmol/L) or decreased HDL-C levels (1.21, 95% CI: 1.12-1.31), but not with CVD or cancer. There were significant supra-additive interactions between elevated CumMON and diabetes (RERI: 0.26, 95% CI: 0.04–0.48), hypertension (RERI: 0.35, 95% CI: 0.12–0.57), and old age (≥60 years) (RERI: 0.46, 95% CI: 0.07–0.85). The addition of cumulative monocyte load into the multivariable model significantly improved the prediction performance of all-cause death (net reclassification improvement: 12.05%;P

Circulation, Volume 148, Issue Suppl_1, Page A12237-A12237, November 6, 2023. Introduction:In recent years, the HeartMate 3 (HM3) has become the most commonly implanted left ventricular assist device (LVAD) for patients with end-stage HF in the United States. We assessed 30-day readmission rates and leading causes of readmission for patients newly receiving an LVAD in the pre-HM3 era compared to the HM3 era.Methods:Using the Nationwide Readmission Database (NRD), all adult admissions (age ≥18) with LVAD implantation from October 2015 – December 2020 were identified. Admissions were excluded if the patient had: died while inpatient, missing data for age, sex, or mortality, transferred to another acute care facility or December admission. Multivariable Cox regression analysis with all-cause and cause-specific readmission within 30 days as the ‘failure event’ and time from index hospitalization discharge to failure event as the ‘time to failure event’ was analyzed. Based on the timing of initial FDA approval of HM3, the study period was divided into two eras: 2015-2017 was defined as the pre-HM3 era and 2019-2020 as the HM3 era. The year 2018 was deemed the transition period and excluded from the analysis.Results:Among 13,867 hospitalizations for LVAD implantations, 57.6% of index hospitalizations were during the pre-HM3 era (mean age= 56 years, men= 77.2%), and 42.4% were during the HM3 era (mean age= 56 years, men= 76.6%). Hazards of 30-day all-cause readmissions were similar in the two eras(Figure 1 Panel A). LVAD implantation in the HM3 era was associated with lower risks of 30-day readmission with a gastrointestinal (GI) bleed or pump thrombosis and a higher risk of 30-day readmission with an acute kidney injury (AKI) compared to the pre-HM3 era (Figure 1 Panel B).Conclusion:There was no significant difference in risk of 30-day all-cause readmission after LVAD implantation in the HM 3 and Pre-HM 3 eras. However, implant in the HM3 era was associated with lower risk of readmission with GI bleed and pump thrombosis and higher risk of readmission with AKI.

Circulation, Volume 148, Issue Suppl_1, Page A14202-A14202, November 6, 2023. Introduction:Although evidence-based practice of has progressed, little is known about underlying mechanisms of chest pain symptoms in patients with post-acute sequelae of COVID-19 (PASC) and preferred approaches for their assessment. Several mechanisms underlying COVID-19-related endothelial dysfunction have been proposed. The purpose of this study was to explore the prevalence of vasospastic angina as a cause of chest pain in PASC patients.Methods:We retrospectively reviewed 273 consecutive patients who presented to an outpatient unit for cardiovascular PASC between June 2021 and March 2023. After the initial evaluation with electro- and echocardiography, coronary computed tomography angiography or cardiac magnetic resonance imaging were performed to rule out obstructive coronary artery disease and myopericarditis if patients had intermittent chest pain and had no contraindications to these tests. When the patients’ chest pain mainly occurred at night and in the morning or was resolved by nitrates, invasive coronary angiography and acetylcholine provocation testing were performed to diagnose vasospastic angina.Results:Eight of 273 patients with PASC underwent acetylcholine provocation testing. The median time from the diagnosis of SARS-CoV2 infection to acetylcholine provocation testing was 197 (interquartile range, 120-542) days. The mean age of the patients was 37.1 years; two required oxygen support during acute COVID-19; and none had previous history of cardiovascular disease (Figure). Five of the 8 patients showed acetylcholine-induced multivessel coronary vasospasm and were diagnosed as vasospastic angina. Their chest pain improved with calcium channel blockers and nitrates, whereas nonfatal myocardial infarction occurred in one patient after the diagnosis of vasospastic angina.Conclusions:Our observational case series suggest that vasospastic angina should be considered as a potential cause of PASC.

Circulation, Volume 148, Issue Suppl_1, Page A11836-A11836, November 6, 2023. A 29-year-old man presented to our institution with acute, severe substernal chest pain. An ECG on arrival revealed 3mm ST-elevations in the lateral leads with reciprocal depressions in the inferior leads. Troponin-I was above assay ( >50 ng/mL). Emergent coronary angiography showed normal coronary arteries, and left ventriculogram showed no wall motion abnormalities. A transthoracic echocardiogram showed normal biventricular size, wall thickness, and ejection fraction (EF). This was his fifth episode of chest pain over the past 10 years, consistent with prior presentations of ST-elevation myocardial infarction and angiographically normal coronary arteries. A prior cardiac magnetic resonance imaging (MRI, 6 years before the current presentation) revealed increased T2 signal intensity and subepicardial late gadolinium enhancement (LGE) in the septum, inferior, and inferolateral walls, suggestive of nonischemic acute myocardial injury. A repeat cardiac MRI during the current presentation showed mildly reduced biventricular systolic function (LVEF 52%, RVEF 36%), and again showed increased T2 signal intensity and subepicardial LGE involving the septum, inferior and inferolateral walls. The anterior and anterolateral walls were also now involved. Endomyocardial biopsy (EMB) showed focal interstitial fibrosis with no evidence of active myocarditis. On telemetry he was noted to have runs of non-sustained ventricular tachycardia (NSVT). Serologic evaluation was negative for parvovirus, cytomegalovirus, and Chagas disease. Erythrocyte sedimentation rate and C-reactive protein levels were normal. Genetic testing was performed at our newly established cardiovascular genetics program, which showed a pathogenic truncating mutation in the desmoplakin gene (DSP). DSP cardiomyopathy (CM) is an LV-predominant arrhythmogenic CM, which can present with episodic myocardial injury, and has a high disposition for ventricular arrhythmias with subepicardial LGE pattern often proceeding LV systolic dysfunction. A primary prevention implantable cardioverter-defibrillator was placed given extent of LGE and NSVT burden in the context of DSP variant. This case illustrates the importance of genetic testing in identifying rare CM phenotypes.

Circulation, Volume 148, Issue Suppl_1, Page A13580-A13580, November 6, 2023. Introduction:The association of low Ankle brachial index (ABI) with increased risk of cardiovascular (CV) as well as all-cause mortality is well established. Similarly, there is an independent association of chronic kidney disease (CKD) with CV and all-cause mortality. Little is known about the association of low ABI with CV and all-cause mortality by CKD status.Methods:We used data on 4,614 subjects from the National Health and Nutritional Examination Survey (NHANES) from January 1, 1999, to December 31, 2002. Those with available data on ABI and CKD status were included. Subjects were categorized as: 1) normal ABI ( >0.9), no CKD (eGFR >60 ml/min/m2, reference), 2) normal ABI and CKD, 3) Abnormal ABI, no CKD, 4) Abnormal ABI and CKD. NHANES-linked National death index records were used to determine CV and all-cause mortality. We used Cox proportional-hazards models and controlled for age, race, gender, income, educational status, smoking history, diabetes, systolic blood pressure, HDL and total cholesterol levels and history of CV disease.Results:Mean age was 55.7 years with 51% females and 4% blacks. Low ABI was present in 7%, while 6.4% had CKD and 1.3% had both low ABI and CKD. Median follow-up was 10.3 years. ABI

Circulation, Volume 148, Issue Suppl_1, Page A16845-A16845, November 6, 2023. Introduction:Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days.Methods:Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022.Results:All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line.Conclusions:HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

Circulation, Volume 148, Issue Suppl_1, Page A14288-A14288, November 6, 2023. Introduction:SERPINA3 is an acute phase protein triggered by inflammation. It inhibits neutrophil cathepsin which cleaves protease-activated receptor 4 (PAR-4) via a thrombin-independent pathway, and mast cell chymase which mediates the production of angiotensin-II via an ACE-independent pathway. SERPINA3 is upregulated after an acute myocardial infarction (MI), but data on its long-term prognostic value in MI patients are scarce.Aim:To assess the utility of SERPINA3 as a prognostic marker in patients hospitalized for chest pain of suspected coronary origin.Methods:A total of 871 consecutive patients were included (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous loge-transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within median 24-months (mo) and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, TnT.Results:Plasma samples from 847 patients were available. At 24 mo FU, 138 (15.8%) patients had died, of which 86 were cardiac deaths. The univariate analysis showed a positive, significant association between SERPINA3 and total death [HR 1.42 (95% 1.19-1.68), p =0.000], but was not significant for cardiac death. Associations after multivariable adjustment were statistically non-significant. At 7 y FU, 332 (38.1%) patients had died. After adjustment, SERPINA3 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.02-1.28), p=0.022], but not for MI (n=203), and stroke (n=55), respectively, and remained essentially unaffected for all-cause mortality or MI combined (n=404) [HR 1.12 (95% CI, 1.01-1.24), p=0.031], slightly weakened when stroke also was added (n=422) [HR 1.10 (95% CI, 1.00-1.22), p=0.060].Conclusions:SERPINA3 predicts long-term all-cause mortality, but had no prognostic bearing on short-term cardiac death. Introducing non-fatal CVD events during long-term FU did not improve its prognostic value.

Circulation, Volume 148, Issue Suppl_1, Page A16843-A16843, November 6, 2023. Introduction:Restrictive cardiomyopathy (RCM) is characterized by ventricular diastolic dysfunction with preserved contraction. Since there is no effective treatment other than heart transplantation, the development of novel treatment strategy by elucidating pathophysiology of RCM is an important issue under the serious donor shortage.Various troponin I mutations have been reported in patients with RCM and given that troponin I regulates the inhibition of cardiac contraction, it is possible that structural changes in mutant troponin I cause diastolic dysfunction in RCM. Recently, cryo-electron microscopy (cryo-EM) has made it possible to analyze the structure of thin filaments of muscle fibers. In this study, we applied the technology of induced pluripotent stem cell (iPSC) to cryo-EM structural analysis of thin filaments in cardiomyocytes from RCM patients with troponin I mutations.Methods:We established an iPSC line from a pediatric RCM patient with heterozygous TNNI3 mutation (R170W). Then the iPSCs were differentiated to cardiomyocytes to compare the cellular physiological, structural features. Normal adult iPS cell derived cardiomyocytes (Ctrl-iPSC-CM) were used as control. We also extracted thin filaments from iPSC-CMs and analyzed their structure with cryo-EM.Results:PCR analysis revealed the percentage of mutant alleles inTNNI3mRNA was about 80% in the differentiated RCM-iPSC-CM, which was similar to the results in the myocardium of the same patient. The RCM-iPSC-CM demonstrated slower diastolic rate and longer diastolic time by cell motion analyses than Ctrl-iPSC-CM. Immunostaining showed a disarrayed sarcomeres in the RCM-iPSC-CM. Tthe structure of the thin filaments extracted from the RCM-iPSC-CMs observed with cryo-EM was close to that in the presence of calcium (contractile myocardium), even though the filaments were purified in the absence of calcium.Conclusions:The iPSC-derived cardiomyocytes could effectively represent the diastolic dysfunction of RCM. The structures of thin filaments were possibly explained for the phenotype of restrictive cardiomyopathy.

Circulation, Volume 148, Issue Suppl_1, Page A13681-A13681, November 6, 2023. Background:Trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite of red meat, has emerged as a potential biomarker for CVD and all-cause mortality. It is also found in preformed amounts in fish. However, the association between serum TMAO levels and CVD outcomes remain unclear.Aim:To conduct a systematic review and dose-response meta-analysis evaluating the association between serum TMAO and CVD and all-cause mortality in prospective cohort studies.Methods:A comprehensive literature search was conducted in MEDLINE, EMBASE, and Cochrane Library up to and including March 6, 2023. A manual search through references found in reviews and meta-analyses was also conducted. Studies reporting hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs) for the association between serum TMAO levels and CVD or all-cause mortality in adults ≥ 18 years with follow-up of ≥ 1 year were included. Random-effects models were utilized for pooled risk estimates and assess the dose-response. GRADE was used to evaluate certainty of evidence.Results:2459 papers, 44 prospective cohort studies were included involving 84771 participants included in final analysis (fig.1). Pooled analyses revealed a significant positive association between elevated serum TMAO levels and the risk of total CVD (RR 1.29 [1.16-1.44]), CVD mortality (RR 1.51 [1.23-1.87]) and all-cause mortality (RR 1.30 [1.21,1.39]). Non-significant associations were found for MI, stroke, total CHD, MI mortality and CHD mortality. All outcomes were of low to very low certainty.Dose response analysis revealed a significant linear association with all-cause mortality (RR 1.01 [95% CI 1.01, 1.02] per 2μM/L) up to a threshold of 6μM/L and total CVD (RR 1.04 [1.02-1.06]).Conclusion:This study provides evidence supporting the positive association of serum TMAO levels with increased risk of total CVD, CVD mortality and all-cause mortality. A recent review found 13/15 studies demonstrated a strong positive correlation between TMAO and fish intake, complicating the hypotheses relating TMAO in red meat and CVD risk. Thus, further assessments of diet components are needed to explore the clinical implications of the associations found in our study.

Circulation, Volume 148, Issue Suppl_1, Page A12340-A12340, November 6, 2023. Introduction:Metabolic associated fatty liver disease (MAFLD) is a significant contributor to chronic liver disease on a global scale, encompassing a broad range of systemic impacts, including an increased risk of cardiovascular disease (CVD). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are commonly utilized indicators of liver injury in this context. Despite the high prevalence of MAFLD among Hispanic/Latino populations, there is a scarcity of research focusing on this specific demographic.Aim:To investigate the relationship between liver disease, incident CVD, and mortality in a representative Hispanic/Latino population, using non-invasive markers.Methods:A total of 14,149 participants recruited between 2008-2011 in HCHS/SOL aged 18-74 years with no pre-existing CVD at study baseline were included in this study. The outcome of interest was a composite of adjudicated incident CVD and all-cause mortality. Participants who had liver function tests (LFTs) AST > 37 IU/mL or ALT > 40 IU/mL for men, and AST or ALT > 31 IU/mL for women were classified as having elevated LFTs. MAFLD was defined as a fatty liver index score >60 and: type 2 diabetes, body mass index >25 kg/m2or at least two metabolic risk abnormalities. Survey-weighted cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for our composite outcome by elevated LFTs. Interaction terms assessed the relationship between elevated LFTs and MAFLD.Results:The study population was 40 years old on average, 53.4% female and had 403 weighted CVD and all-cause mortality events. Elevated LFTs and MAFLD alone were not associated with incident CVD and all-cause mortality (HR: 1.24; CI: 0.89-1.71). MAFLD modified the relationship between elevated LFTs and CVD (P=0.04). Among those with MAFLD, elevated LFTs were not associated with CVD (HR: 1.01; CI:0.70-1.46), but among those without MAFLD, elevated LFTs were associated with CVD (HR: 2.05; CI:1.17-3.58).Conclusions:Among Hispanic/Latinos without MAFLD, elevated LFTs were associated with CVD and all-cause mortality. Additional research is needed to elucidate the relationship between liver disease and CVD in the Hispanic/Latino population.

Circulation, Volume 148, Issue Suppl_1, Page A13669-A13669, November 6, 2023. Background:While hypertensive subtypes have been examined in relation to cardiovascular disease (CVD) outcomes in selected earlier cohorts, noting poorer outcomes in those with isolated systolic hypertension (ISH) in particular, contemporary data utilizing newer definitions of hypertension are lacking among US population-representative adults. We evaluated the association between hypertension subtypes with CVD and all-cause mortality.Methods:We included data from the National Health and Nutrition Examination Survey (NHANES) dataset 1999-2008 with follow-up through 2018. Hypertensive subtypes were based on systolic and diastolic blood pressure cut points of 130 and 80 mmHg, respectively. The incidence of CVD and all-cause mortality was examined and compared between hypertension subtypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic-diastolic hypertension [SDH]) against patients with normal blood pressure using Cox regression analysis, adjusted for age, ethnicity, gender, tobacco use, use of antihypertensive agents, and comorbidities including diabetes mellitus and dyslipidemia.Results:A total of 23,206 subjects (projected to 194 million US adults) were included at baseline, of which 58% were normotensive, 21% had ISH, 8% had IDH, and 13% had SDH. In the adjusted analysis, ISH and SDH (but not IDH) were significantly associated with increased CVD. Subgroup analyses excluding those not on antihypertensive therapy (26.8%) showed these relationships to persist, except for ISH in relation to CVD mortality.Conclusions:Compared to normotension, ISH and SDH were independently associated with higher risk of cardiovascular and all-cause mortality. This has important implications for the continued necessity of managing systolic hypertension.