Risultati per: Colesterolo e rischio cardiovascolare (CV): percorso diagnostico-terapeutico

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Circulation, Volume 146, Issue Suppl_1, Page A11621-A11621, November 8, 2022. Introduction:Essential Thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an overproduction of platelets in the bone marrow. Patients suffering from this condition are at a higher risk for CV complications. Studies have demonstrated a prothrombotic state in ET patients and a significant mortality rate stemming from thrombotic complications. However, data regarding the risk of hospitalization for CV events in patients with ET are scarce. Therefore, our objective was to identify risk factors for CV outcomes among patients with ET.Methods:We performed a retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2017. Patients included were at least 18 years of age and had an ICD-10 diagnosis of ET. To identify CV outcomes, an ICD-10 code for VTE, Stroke, ACS, or a Major Adverse Limb Event had to be present in the top three discharge diagnoses. We identified common chronic comorbidities and performed binary logistic regression to identify risk factors for hospitalizations due to CV outcomes. Those factors were then validated with the 2018 and 2019 NIS databases.Results:We identified a total of 234,225 (weighted) NIS patients with ET. The mean age was 59.72 years (SD = 18.679), and patients were predominantly female (57%). CV outcomes were present in 18,955 cases (8.10%). Significant predictors for CV outcomes among patients with ET included valvular disease (VHD) (odds ratio, 1.33 [95% CI, 1.23-1.43]; P

Circulation, Volume 146, Issue Suppl_1, Page A13513-A13513, November 8, 2022. Background:Optimizing modifiable cardiovascular risk factors is critical to achieving AHA’s 2020 Strategic Impact Goals. Neighborhood and urban factors with a supportive walkable environment can enhance physical activity and hence impact CVH across a wide range of populations. We assessed whether a more walkable environment is associated with CV risk factor burden irrespective of CVD burden among a large diverse population within an integrated health system.Methods:Cross-sectional study using data from 1.01 million patients aged 18+ years in the Houston Methodist Cardiovascular Disease Learning Health System Registry (2016-2021). Individuals lacking NW (177,674) & BMI 3 CV risk factors), average (1-2 CV risk factors) or optimal (0 CV risk factors).Results:We included 901,860 patients (mean age 51.88, female 59%, NHB 15%, and 16% Hispanics), most of these (86%) resided in the 2 least walkable neighborhoods. Age-adjusted prevalence of CV risk factors was significantly lower among participants in most favorable walkable neighborhoods irrespective of CVD status (Figure). In adjusted analysis, favorable NW (somewhat/very walkable) vs unfavorable NW (car dependent) was associated with 2-fold odds for optimal vs poor CVD risk (OR 2.07 95%CI: 2.01-2.12) among those without CVD. Similar results were found in those with CVD (OR 1.58 95% CI:1.41-1.77).Conclusions:Our findings demonstrate favorable association between neighborhood walkability and the CVD risk factors burden in large population of about 1 million individuals. These robust findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating growing burden of modifiable CV risk factors.

Circulation, Volume 146, Issue Suppl_1, Page A9920-A9920, November 8, 2022. Introduction:The high burden of comorbidities among patients with Type 2 Diabetes (T2D) may contribute to the low use of guideline directed medical therapies (GDMT) that improve CV outcomes, including sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1RA).Hypothesis:The DECIDE-CV clinic at McGill University (Montreal, Canada) is a novel synchronous healthcare program whereby patients with T2D are seen at each visit simultaneously by a cardiologist, endocrinologist, and nephrologist to enable rapid GDMT implementation. We hypothesized that synchronous healthcare delivery would increase SGLT2i and GLP1RA use among multimorbid patients with T2D.Methods:We conducted a pre/post analysis of GDMT use throughout patient follow-up in the DECIDE-CV clinic. We evaluated the first 76 patients (2020-10-26 to 2022-04-18) and used Canadian diabetes/CV guidelines with Quebec medication coverage criteria to assess eligibility for SGLT2i and GLP1RA. A 2-sample test for proportions compared use of GDMT at baseline and follow-up.Results:At baseline, the mean age of patients was 68.5 years old, 79% were male, 33% were non-white minorities, 50% had CKD, 64% had HF, and 58% had ASCVD. The median eGFR was 60.1 ml/min/1.73m2(IQR 40.7, 93.8), median NT-proBNP was 434 (IQR 123, 1425), and median HbA1c was 7.3% (IQR 6.8, 8.7). At baseline only 37% were prescribed a SGLT2i and 3% a GLP1RA despite being guideline eligible and having medication coverage. After the first visit, the use of therapies significantly increased to 90% for SGLT2i and 39% for GLP1RA. At the end of follow-up, 98% were prescribed a SGLT2i and 57% were prescribed a GLP1RA (P-value comparing proportion GDMT < 0.001; Figure 1).Conclusions:Among patients eligible for GDMT, the initial use of SGLT2i and GLP1RA was low. Our model of synchronous healthcare delivery in a multi-comorbid population, significantly increased the use of SGLT2i and GLP1RA.

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Medicina di famiglia a rischio per carenze di nuove leve e pensionamenti anticipati, Silvestro Scotti: «Subito l’Atto d’indirizzo per il rinnovo dell’ACN 2019-2021»