Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Circulation, Volume 148, Issue Suppl_1, Page A18248-A18248, November 6, 2023. Background:Increased self-efficacy facilitates health promoting behaviors such as physical activity (PA). Perceived discrimination may limit PA among minoritized populations, but little is known about the relationship between PA and nutrition self-efficacy (PANSE) and perceived discrimination (PD) among African American (AA) women with overweight/obesity.Methods:We examined the associations between PANSE and PD in 106 AA women in the Step It Up, a community-engaged, digital health intervention. All completed the PANSE (higher scores = higher self-efficacy), the everyday discrimination scale (higher scores = higher frequency of everyday discrimination), and a sociodemographic survey. We used linear regression to assess the associations between PANSE and PD adjusting for covariates and the interaction effects of discrimination and income.Results:The participants had a mean age of 55.9 (SD±12.7) years with mean BMI 36.3 (SD±6.9) kg/m2. PD was negative and significantly associated with PANSE in both our unadjusted model and after adjusting for age and educational level (Table 1). The association trended marginally significant in the third model when we adjusted for income. We found no interaction effect between PD and income.Conclusion:PD is associated with PANSE among this AA women cohort. This suggests an urgent need for future research to better extricate the relationship between PD and PANSE to inform interventions that addresses everyday discrimination among diverse population groups; particularly in AA women with overweight/obesity.

Circulation, Volume 148, Issue Suppl_1, Page A17940-A17940, November 6, 2023. Background:Heart failure with a preserved ejection fraction (HFpEF) is prevalent and has few evidence-based therapies. In a trial of HFpEF patients with specialized pacemakers, an accelerated personalized pacing rate averaging 75 bpm (myPACE) improved quality of life, NT-proBNP, physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60bpm (usual care). The one-year myPACE trial was not powered for clinical outcomes, but most patients elected to remain on their assigned treatment.Methods:The myPACE study was a single-center, blinded, randomized controlled trial that enrolled patients from June 2019 to November 2020. In this per-protocol analysis of clinical events over a 3-year follow-up, we included trial participants who remained on their assigned heart rate after study completion. The outcome of this analysis is a composite of the first clinical event (urgent visit or hospitalization for heart failure or atrial fibrillation, unstable angina or myocardial infarction, stroke, and death). Events were obtained by chart review and adjudicated by two blinded investigators. A Kaplan-Meier event-free survival plot and a log-rank test evaluated differences between the two treatment arms.Results:Of the 100 myPACE trial participants, most (40/48 myPACE and 48/52 usual care) remained on their assigned heart rate over a median (IQR) of 3.3 (2.6, 3.7) years after enrollment. The median (IQR) age was 75(69-80), and 45% were female. Accelerated personalized pacing was associated with reduced adverse clinical outcomes by about 60 percent. The Kaplan-Meier event-free survival plot for the composite of clinical events is shown in the Figure.Conclusions:In a per-protocol clinical event analysis of the extended myPACE study, those who continued the myPACE accelerated pacing protocol had fewer adverse clinical events than those with a lower rate setting of 60 bpm.

Circulation, Volume 148, Issue Suppl_1, Page A141-A141, November 6, 2023. Background:Little is known in humans about the physiological effects of the combination of automated Head-Up cardiopulmonary resuscitation CPR, active compression-decompression CPR and an impedance threshold device (ITD). This new approach, termed AHUP-CPR, improves perfusion of vital organs and lowers intracranial pressure compared with conventional (C)CPR in animal models of cardiac arrest. This study tested the hypothesis that AHUP-CPR treatment would increase end tidal CO2 (ETCO2), a circulation surrogate, more than C-CPR in out-of-hospital cardiac arrest (OHCA) patients.Method:Prospective before-after interventional study of witnessed OHCA patients. C-CPR and AHUP-CPR were performed by firefighters who measured ETCO2. AHUP-CPR was delivered using a LUCAS AD (5 cm of compression and 3 cm active decompression) (Stryker Medical, USA), an EleGARD Patient Positioning System (AdvancedCPR Solutions, USA), and an ITD (ResQPOD-16, Zoll, USA). The study was performed in the greater Grenoble France region in four different fire stations. The primary endpoint was the measurement of maximum EtCO2 during CPR. Results are presented as mean ± standard deviation.Results:Baseline characteristics (age, sex, arrest location, initial rhythm, bystander CPR, witnessed) were not statistically different between groups.EtCO2 was higher for patients treated with AHUP-CPR (n=63) compared to the C-CPR (n=59) (41±18 vs. 30.2 mmHg, p

Circulation, Volume 148, Issue Suppl_1, Page A14087-A14087, November 6, 2023. Background:Physical activity (PA) reduces cardiovascular disease (CVD) risk; those living in lower-resourced neighborhoods have higher CVD risk in part due to limited PA access. Monocyte subsets (classical, intermediate, and non-classical) with their platelet aggregates (PlAgg) are key in CVD, but less is known about relationships between PA and monocytes. We investigated associations between PA and monocyte subsets with PlAgg in African American (AA) women at risk for CVD living in resource-limited Washington, DC areas.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged PA intervention. Baseline PA was measured as daily step counts using a FitBit Charge 2. Monocyte subsets and PlAgg were measured in fasting blood samples by flow cytometry. Multivariable linear regression was used to determine relationships between PA and monocytes adjusting for BMI and ASCVD 10-year risk score. We examined neighborhood deprivation index (NDI), a 2018 Census-tract based measure of neighborhood socioeconomic deprivation, as a moderator of associations between PA and monocytes.Results:The study cohort was a sample of AA women with overweight/obesity enrolled in Step It Up (N=106, age=57±12 y, BMI=34.8±6.3kg/m2). Higher baseline PA associated with monocyte subsets, but not overall monocyte presence (Table). Furthermore, higher baseline PA negatively associated with PlAgg on all monocytes. PA and monocyte subsets were most associated among those residing in higher deprivation neighborhoods (Table).Conclusion:Baseline PA was associated with monocyte subsets and lower monocyte-PlAgg formation among AA women living in lower-resourced conditions. Future work should examine the relationship between PA changes and changes in monocyte subsets in community engaged PA interventions like Step It Up, particularly among those residing in limited resource communities.

Circulation, Volume 148, Issue Suppl_1, Page A321-A321, November 6, 2023. Background:The efficacy of mechanical ventilation during CPR with the combination of active compression-decompression, an impedance threshold device, and head-up positioning, collectively termed automated head-up (AHUP)-CPR, is unknown.Hypothesis:Hemodynamic and ventilatory parameters will be similar with manual bag ventilation (MBV) versus automated bag ventilation (ABV) during AHUP-CPR in a porcine model of cardiac arrest.Aim:Assess the proof-of-concept that ABV is safe and effective during AHUP-CPR.Methods:Nine male and female swine (~40 kg) were anesthetized and ventilated. VF was induced and left untreated for 8 min. AHUP-CPR was performed at 105 compressions/min for 7 min using MBV, followed by 6 min using an automated mechanical bag compressor to deliver 10ml/kg of tidal volume (TV) over 1 sec at 10 breaths/min. Pigs were randomized during ABV to a synchronized (Sync) breath delivered at the start of decompression or an asynchronous (Async) breath. Cerebral perfusion pressure, coronary perfusion pressure, end-tidal CO2, intracranial pressure, esophageal intrathoracic pressure, peak airway pressure (PAP), inspiratory and expiratory TVs as well as arterial blood gases were continuously measured. Values (mean ± SD) were compared by paired and unpaired student’s t-tests with a Bonferroni correction.Results:Parameters during the last minute of MBV and ABV are summarized in the table. No significant differences were observed in hemodynamic and ventilatory parameters, except for PAP and pO2 values which were significantly lower with MBV. No significant differences were also observed between the Sync and Async ABV modes.Conclusion:Manual and mechanical ventilation resulted in overall similar physiological effects. The clinical relevance of the observed significant differences in PAP and pO2 is unclear. Additional studies are warranted to further assess the safety and effectiveness of mechanical ventilation during AHUP-CPR.

Circulation, Volume 148, Issue Suppl_1, Page A17863-A17863, November 6, 2023. Introduction:Heart failure (HF) is a chronic debilitating disease with immense burden on the patient’s life. This study aims to investigate the clinical characteristics, social determinants of health (SDOH), burden of treatment (BoT), and quality of life (QoL) of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF).Methods:Data from 191 patients (63 HFpEF, 128 HFrEF) were collected from February 2022 to March 2023. Validated questionnaires including SDoH, BoT and QoL were filled by the patient on admission and in 6 months as a follow up. Descriptive statistics were used to compare the demographic and clinical characteristics of HFpEF and HFrEF patients. Inferential statistics, including logistic regression, were used to analyze the associations between SDOH, BoT, QoL, and 30-day readmission rates.Results:Distribution between both groups is similar to the general population. HFpEF patients experienced more interpersonal challenges and reported greater difficulty with self-care and usual activities. HFrEF patients had higher rates of substances, alcohol, and tobacco use. Regarding readmission, HFpEF patients with medication difficulties and HFrEF patients with difficulty accessing healthcare services were more likely to be readmitted. Both HFrEF and HFpEF patients showed significant improvement in SDOH, QoL and BoT in the follow up data (Table 1).Conclusions:The study findings highlight the distinct clinical characteristics, SDOH, BoT, and QoL factors associated with HFpEF and HFrEF. These findings can contribute to targeted interventions and improved patient care. Moreover, the study emphasizes the importance of addressing social and personal factors influencing HF outcomes, aiming to reduce healthcare disparities and improve patient well-being. The results have implications for healthcare providers, policymakers, and researchers in improving the management and outcomes of heart failure patients.

Circulation, Volume 148, Issue Suppl_1, Page A14254-A14254, November 6, 2023. Introduction:Myocarditis is a common acquired cardiac disorder that may lead to persistent scar. Current guidelines recommend follow up cardiac MRI (CMR) in 3-6 months for athletes. Data supporting this recommendation is unfortunately very limited.Aim:The aim of this study was to evaluate the demographic and clinical variables of patients diagnosed with myocarditis. Clinical data for those who had a follow up CMR was also evaluated separately.Methodology:Patients who had a cardiac MRI (CMR) organised between July 2019 till December 2022 because of a MINOCA/Myocarditis hospital admission were retrospectively reviewed. Those with a myocarditis diagnosis were included. An athlete was defined as an individual who engaged in >4 hours of physical activity weekly or underwent organized sport.Results:105 patients were included (mean age 35.4±15.6 years, 83.8% male). 34.3% were athletes. 12.4% had possible acute myocarditis, 10.5% had likely myocarditis and 77.1% had confirmed myocarditis on cardiac MRI (median 4 days from presentation). ECG was abnormal in 60.0%. 8.6% had arrhythmias. Echocardiography was abnormal in 26.7%. CMR revealed 15.2% reduced LV EF, 57.1% regional wall motion abnormalities, 5.7% reduced RV EF, 25.7% pericardial effusion, 84.5% myocardial oedema. Most (88.5%) had late gadolinium enhancement (LGE). 56.2% were started on anti-heart failure medical therapy.29.5% had a CMR repeated (interval between scans 14.7±14.2 months). 77.4% showed persistent LGE, less pronounced in most (71.0%). Diffuse LGE at baseline was the only predictor for persistent scar (p=0.004). Scar persisted equally in athletes and non-athletes (p=0.666). Clinical variables were similar in both.At follow-up (24.6±15.3 months), 8.6% had adverse outcomes. The event rate was similar in athletes and non-athletes. A low LV EF on CMR (p=0.011) and abnormal ECHO (p=0.027) were the only variables that could predict outcome.Conclusion:LGE after myocarditis persists in 77.4% of cases, albeit better. No variable could predict the persistence of LGE in this cohort. Athletes and non-athletes had a similar clinical course, suggesting that repeat CMR in non-athletes is reasonable. The diagnostic utility of repeat CMR after myocarditis remains questionable.

Circulation, Volume 148, Issue Suppl_1, Page A17274-A17274, November 6, 2023. Background:Childhood cancer survivors (CCS) are at risk of early or late-stage cardiotoxicity, the third leading cause of death in CCS. American Heart Association Scientific statement stresses the importance of timely follow-up of CCS. Children’s Oncology Group (COG) has also recommended serial cardiac testing based on therapy doses. However, compliance of cardiac follow-up is not known.Hypothesis:Cardiology follow-up in CCS is poor and needs improvement.Goal:Our goal is to identify factors that limit timely cardiology follow-up.Methods:We retrospectively cross-referenced patients from the oncology clinic with our echocardiogram database, focusing on solid tumor survivors from 1996-2018 that received anthracyclines or cardiac field radiation. Excluding patients not requiring cardiac monitoring, we collected demographic, oncology history and treatment, and cardiac evaluation related data. Based on COG guidelines, we determined if each patient maintained their expected cardiology follow up. We then assessed whether follow up was associated with median household income, medical insurance type, gender, and age at diagnosis using chi square or t-test.Results:A total of 49 patients (24F/25M) met inclusion criteria included. Timely cardiology follow up was only seen in 50% of the patients, regardless of how far out the patients were from treatment. There was no correlation between follow up and median household income, medical insurance, gender, or age of diagnosis (p values >0.05).Conclusions:This data demonstrates there is a major gap in providing key cardiac care to CCS, as 50% of patients did not maintain expected follow up. This finding was irrespective of socioeconomic status or age at diagnosis. This suggests a greater emphasis must be placed on educating families about potential cardiac risks and the need for appropriate follow up care. This can be established through a stronger collaboration between cardiology and oncology programs.

Circulation, Volume 148, Issue Suppl_1, Page A11932-A11932, November 6, 2023. Introduction:Readmission after acute myocardial Infarction is a challenge in health care. Guidelines recommend early follow-up as those who do not have established follow-up are 10 times more likely to be re-hospitalized. This allows for close review of cardiac symptoms and medications. While there is substantive data about early follow up in the obstructive ST-Segment Elevation Myocardial Infarction (STE-Obstructive) populations improving readmission rates, there are minimal guidelines regarding follow up for STE-MINOCA patients.Hypothesis:Does time to post-discharge outpatient care impact rate of readmission between STE-Obstructive and STE-MINOCA patients?Methods:A single center, retrospective cohort study analyzed demographics and discharge pathways of patients meeting STEMI criteria who underwent coronary angiography. Discharge medications, follow up appointment, and readmissions were examined. Simple and multiple logistic regression analyses were used to explore the association between discharge pathways and clinical factors in two STEMI populations.Results:377 of 433 patients survived discharge with a median age of 59. Of those who survived, 63.9% were male, 44.3% Black, 30.2% Hispanic, and 82.7% had government-issued insurance. STE-Obstructive patients had significantly higher rates of follow up (p=0.0006) and earlier than STE-MINOCA patients (p=0.052) (Table 1). Despite differences in follow up, readmissions for cardiovascular issues were not significantly different between the STE-MINOCA and STE-Obstructive patients. Of note 64% of STE-MINOCA patients who were readmitted did not have follow up prior to readmission.Conclusions:STE-MINOCA patients had longer time to follow up and less follow up than STE-Obstructive patients. Readmission rates between the two groups were similar. Further studies are required to explore the role of earlier follow up in STE-MINOCA clinical trajectory.

Circulation, Volume 148, Issue Suppl_1, Page A15589-A15589, November 6, 2023. Background:The impact of preprocedural anemia on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.Methods:We examined the clinical and angiographic characteristics and procedural outcomes of 8,633 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023. Anemia was defined as a hemoglobin level of

Circulation, Volume 148, Issue Suppl_1, Page A13569-A13569, November 6, 2023. Introduction:Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy.Objectives:Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT.Results:A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses.Number of patients on target dose of GDMT at three monthsConclusion:Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A320-A320, November 6, 2023. Background:Rapid Basic Life Support (BLS) treatment with controlled sequential elevation of the head and thorax, active compression-decompression CPR, and an impedance threshold device, collectively termed automated Head Up Position (AHUP)-CPR, is associated with better outcomes versus conventional CPR (C-CPR) in animal models and human observational studies.Hypothesis:Rapid AHUP-CPR should improve survival and neurological function vs rapid C-CPR followed by delayed AHUP-CPR.Aim:Determine if AHUP-CPR should be initiated as a BLS or ALS intervention.Methods:Male and female farm pigs (n=22) weighing~40kg were anesthetized and ventilated. Central venous and aortic pressures, as well as end-tidal CO2 (ETCO2) and cerebral oximetry (rSO2) were measured continuously. After 15 min of untreated VF, pigs were randomized to either rapid AHUP-CPR for 25 min or 10 min of C-CPR followed by 15 min of AHUP-CPR. Pigs received intravenous epinephrine and amiodarone after 24 min of CPR and were defibrillated 60 sec later. For the primary endpoint, 24-hour neurologic function, a veterinarian blinded to the CPR intervention assessed pigs using a Neurological Deficit Score (0 = normal and 260 = worst deficit score or death). Secondary outcomes included 24-hour survival rates and hemodynamic parameters. Data were expressed as mean ± SD. Statistical significance was determined by log-rank, Mann-Whitney-U and unpaired t-tests.Results:Sustained return of spontaneous circulation was achieved in 10/11 pigs with rapid AHUP-CPR vs 6/11 with delayed AHUP-CPR and cumulative 24-hour survival rates were 45.5% (5/11) vs 9.1% (1/11), respectively (p=0.01). Neurological Deficit Scores were 202.7 ± 80.3 with rapid AHUP-CPR vs 259.1 ± 3.0 with delayed AHUP-CPR group (p=0.04). Ten minutes after initiating CPR, ETCO2 (mmHg) was 45.0 ± 3.8 vs 26.9 ± 5.4 (p

Circulation, Volume 148, Issue Suppl_1, Page A159-A159, November 6, 2023. Background:While short-term prognosis of cardiac arrest (CA) patients has been extensively studied, less is known regarding the mid- and long-term outcome of survivors.Aims:The aim of the DESAC study was to describe mid- and long-term survival and neurological status of CA survivors, and to assess the influence of pre- and intra-hospital therapeutic strategies on these outcomes.Methods:Between Jul 2015 and Oct 2018, patients over 18 years who were discharged alive from intensive care units in Paris and suburbs (France) after a non-traumatic CA were included and interviewed every 6 months during at least 24 months and up to 48 months in this multicentric study. Factors associated with Cerebral Performance Category (CPC) scale at 24 months were assessed with logistic regression, with CPC 1 or 2 level considered as a favorable neurological outcome. Trajectories of CPC were derived by mixed linear model in survivors with at least 3 evaluations.Results:Out of 593 survivors, 525 had a 24 months follow-up (mean age 57.6 +/-15.3, 79% men). CA occurred in public location in 251/525, with an initial shockable rhythm in 392/525. Prognostic factors independently associated with a favorable neurological outcome at 24 months were initial shockable rhythm (OR= 3.53 (1.65; 7.58)) and previous practice of sport (OR= 3.12 (1.20 ; 8.11)), whereas older age (OR per 10 years= 0.52 (0.40; 0.68)) and previous ischemic cardiomyopathy (OR= 0.34 (0.15 ; 0.77)) were poor prognostic factors. Therapeutic hypothermia or coronary procedures were not related to prognosis. Five trajectories of CPC could be derived among the 514 patients. Overall, 64% remained in CPC1, 13% in CPC2, 11% improved from CPC2 to CPC 12% died either early or lately (Figure 1).Conclusions:In this multicentric and prospective study, practice of sport and shockable rhythm were strongly associated with a favorable neurological recovery at 24 months. Furthermore, two thirds of the survivors remained in CPC 1 over time.

Circulation, Volume 148, Issue Suppl_1, Page A14919-A14919, November 6, 2023. Introduction:The occurrence of myocardial injury during acute COVID-19 is well known however, its persistence and impact over a longer period of time is unclear.Hypothesis:We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricle (RV) longitudinal and free wall strain using speckle tracking echocardiography (STE) in COVID-19 recovered patients.Methods:A total of 189 subjects following recovery from COVID-19 infection and with a normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers and detailed echocardiographic evaluation including STE were done for all. All these patients were followed-up for a period of one year with repeat echocardiography done at six months and one-year.Results:Of the 189 subjects, 176 (93.1%) were symptomatic and categorized as mild [n = 91 (51.8%)], moderate [n = 65 (36.9%)] or severe [n = 20 (11.3%)] illness. Subclinical LV and right ventricle (RV) dysfunction were seen in 58 (30.7%) and 25 (13.2%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21.4 ± 3.1 %; moderate: -18.8 ± 4.8%; severe: -16.3 ± 2.7%; P < 0.0001). RV longitudinal strain was significantly lower in patients recovered from severe COVID (mild: -22.9 ± 1.7, moderate: -21.8 ± 1.5, severe: -17.9 ± 1.6; P < 0.0001). There was a significant improvement in LVGLS (baseline: -19.1± 5.7, one-year: -19.9±4.6; P < 0.0001) and RVFWS (baseline: -23.5±6.3; one-year: -23.7 ± 5.8; P=0.03) however, RVLS improved though not significant (baseline: -21.4±5.7; one-year: -21.6 ± 5.2; P=.156) over a one-year follow-up period. Of the 58 subjects with baseline reduced LVGLS, over a one-year follow-up, 22 (11.6%) had persistently reduced LVGLS.Conclusions:Subclinical LV dysfunction was seen in one third of recovered COVID-19 patients which improved over a one-year follow-up. A fraction of subjects had persistently reduced LVGLS even at one year which suggests need for closer follow-up among them to elucidate long-term cardiovascular outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A14051-A14051, November 6, 2023. Background:Loneliness is a public health crisis and recent reports suggest that people suffering from loneliness have increased cardiovascular disease (CVD) risk. A potential link between loneliness and CVD is an atherogenic shift in the lipoprotein profile. We investigated associations between loneliness and lipoproteins in African American (AA) women residing in resource-limited neighborhoods of Washington, DC.Methods:Participants were enrolled in Step It Up, a technology-based, community-engaged PA intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using nuclear magnetic resonance (NMR) technology. The Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker, was calculated. Loneliness was measured using the UCLA Loneliness scale. Associations between loneliness, lipoprotein particles and LP-IR were analyzed using multivariable regression adjusted for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:106 AA women with CVD risk (Age 55.9±13, BMI 36.3±6.7) were enrolled into Step It Up. We found that higher loneliness at baseline was associated with higher Apo-B, LDL concentration (LDL-c), and LDL particle number (LDL-p) but not with LDL particle size (LDL-z, Table). We observed that higher loneliness associated with increased triglyceride rich lipoprotein size (TRL-z). This relationship seems to be due to very large and large TRL particles (TRL-p, Table). No significant associations were found with the HDL-related measures. Lastly, loneliness significantly associated with LP-IR, a new diabetes risk marker (Table).Conclusions:Thus, our data show that higher loneliness in AA women from under resourced neighborhoods is associated with increased hyperlipidemia and diabetes risk. This highlights a potential mechanism by which loneliness may accelerate CVD risk and support the urgent need for multilevel interventions to reduce loneliness and CVD risk in at-risk populations.

Circulation, Volume 148, Issue Suppl_1, Page A18480-A18480, November 6, 2023. BackgroundIndividuals diagnosed with type 2 diabetes are at high risk for coronary artery disease, however, data on long-term progression of coronary artery plaque burden is lacking. This study investigated atherosclerotic plaque characteristics and long-term plaque progression in patients with and without type 2 diabetes mellitus (T2DM).Methods:Per-protocol, patients from a coronary CT angiography (CCTA) cohort were invited for repeat CCTA imaging, regardless of symptoms. A total of 299 patients underwent follow-up CCTA imaging with a median scan interval of 10.2 [IQR 8.7-11.2] years. Patients who underwent coronary artery bypass grafting and vessels revascularized by percutaneous coronary intervention were excluded. Scans were analyzed using atherosclerosis imaging-quantitative CCTA (AI-QCT; Cleerly Inc.). The associations between diabetic status, baseline and follow-up plaque burden and characteristics were evaluated using multivariable regression adjusted for clinical risk factors, statin use and scanner settings.Results:In total, 274 patients were included, 43 (15.7%) had T2DM at baseline. The mean age was 57±7 years, 42% were women. At baseline, patients with T2DM had a median percent atheroma volume (PAV) of 6.80 (2.80, 17.70) at baseline; patients without T2DM had a median PAV of 3.20 (0.80, 9.55). Adjusted for clinical risk factors, patients with T2DM had a higher rate of plaque progression (Figure 1). The difference in PAV caused by T2DM was similar to the effect of a 13-year age difference. At baseline patients with T2DM had a higher prevalence of high-risk plaque (OR 2.11; p=0.025). After 10 years of follow-up, patients with T2DM had a higher prevalence of both high-risk plaque (OR 3.49; p