Search Results for: Atlante della salute mentale 2011

Circulation, Volume 150, Issue Suppl_1, Page A4144988-A4144988, November 12, 2024. Background:The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM) among the general population. We aim to investigate this association in patients who underwent peritoneal dialysis (PD).Methods:We systematically reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 on the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model, 95% confidence intervals (CI), and I2statistics to pool unadjusted and adjusted hazard ratios (HR) and measure heterogeneity. Leave-one-out sensitivity analysis was employed to study how each study alters the overall effect of the studies. Multivariate meta-regression was utilized to identify influencing confounding factors. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. For all results, a P value < 0.05 was considered significant.Results:Out of 160 articles screened, seven studies spanning from 2011 to 2023 with 4,350 patients, a mean age of 49.9 ± 15, and a median follow-up of four years were included in our meta-analysis. We found that higher NLR ( >2.88) was significantly associated with ACM (aHR: 1.09, 95% CI: 1.05–1.12, p2.88) and outcomes such as ACM and CVM. This association can help prevent deaths in the older population and encourage proper utilization of the elderly resources. Additionally, age was a significant potential confounder for ACM in patients who are receiving PD. Thus, caution should be taken when predicting mortality in the elderly population.

Circulation, Volume 150, Issue Suppl_1, Page A4143964-A4143964, November 12, 2024. Introduction:Pulmonary hypertension (PHTN) is common in patients with chronic kidney disease (CKD), however categorization as precapillary or postcapillary is challenging due to the need for invasive right heart catheterization (RHC). Studies have validated transthoracic echocardiography (TTE) to characterize PHTN and ECG-artificial intelligence (AI) to predict diastolic dysfunction risk. The utility of these noninvasive tools in patients with CKD is unknown.Methods:Retrospective analysis of patients with end stage CKD who underwent RHC between 2011 and 2021. Patients with PHTN (pulmonary artery pressure >20mmHg on RHC) were categorized as having precapillary (pulmonary capillary wedge pressure, PCWP, ≤15mmHg and pulmonary vascular resistance, PVR, >2WU) or postcapillary PHTN (PCWP >15mmHg and PVR ≤2WU for isolated postcapillary or PVR >2WU for combined). TTE and ECG within 3 months of RHC were obtained. TTE measurements were used to calculate ePLAR (echocardiographic pulmonary to left atrial ratio); tricuspid regurgitant peak velocity (TRVmax) divided by mitral E/e’. ECGs were analyzed with an AI risk tool for diastolic dysfunction (score 0-3, increasing with increasing risk). Receiver operating curves (ROC) evaluated the performance of these tests.Results:60 patients were included; 16 (27%) with precapillary and 44 (73%) with postcapillary PHTN. ROC analysis found good accuracy for both ECG-AI diastolic dysfunction risk score to predict precapillary PHTN with AUC 0.724 (sensitivity=60% and specificity=88% for an ECG score value ≤1) and ePLAR with AUC 0.715 (sensitivity=75% and specificity=70% for ePLAR >0.17m/sec). Highest accuracy for detection of precapillary PHTN was reached by combination of ePLAR and ECG-AI tool, with AUC 0.756 (sensitivity=73%, accuracy of 86% for a value ≤1.17).Conclusions:ECG-AI generated diastolic risk score of 0-1 (low risk) and high ePLAR showed good accuracy in characterizing precapillary PHTN in patients with end stage CKD. The combination of these noninvasive tools further increased the diagnostic accuracy, reflecting its potential utility in classification of patients with CKD and PHTN, a crucial determinant of the ideal therapeutic plan in kidney transplant candidates.

Circulation, Volume 150, Issue Suppl_1, Page A4141919-A4141919, November 12, 2024. Background:Atrial myopathy—characterized by abnormal left atrial (LA) function or size— is independently associated with cardiovascular outcomes such as atrial fibrillation (AF) and stroke. One obstacle to the discovery of strategies to prevent atrial myopathy-related outcomes is its heterogeneity.Objective:Resolve heterogeneity of atrial myopathy by identifying distinct subtypes of atrial myopathy with differential risk of AF using an unsupervised machine learning clustering analysis.Methods:We included ARIC participants at visit 5 (2011-13) with atrial myopathy—defined using LA reservoir strain (Female:

Circulation, Volume 150, Issue Suppl_1, Page A4142264-A4142264, November 12, 2024. Background:Two de-escalation options of dual antiplatelet therapy (DAPT) have been proposed to mitigate bleeding risk in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), including maintaining DAPT but reducing its intensity by changing potent P2Y12 inhibitor (P2Y12i) to clopidogrel or discontinuation of DAPT by using P2Y12i monotherapy. Our study aims to evaluate the use of de-escalation therapies after discharge in AMI pts undergoing PCI and compare the clinical outcomes of the two de-escalation options.Methods and Results:In the Taiwan National Health Insurance Research Database, we included adult pts (≥ 18 yrs) who received PCI for AMI and survived to discharge with DAPT. Pts who need oral anticoagulant were excluded. From 2011 to 2021, 58989 pts (mean age 61.9±13.2 yrs, male 81.4%) were included. After 2016, >70% pts were treated with aspirin plus ticagrelor (A+T) at discharge. In A+T users (n=28698), de-escalation for any reason occurred in 52.2% during follow-up. Among de-escalation therapy, aspirin plus clopidogrel (A+C, 55.8%) and ticagrelor monotherapy (T mono, 15.5%) were most commonly used in the first 6 mo. The mean duration from discharge to de-escalation to T mono vs. A+C was 52.5±69.3 vs. 68.4±70.7 days (p

Circulation, Volume 150, Issue Suppl_1, Page A4140776-A4140776, November 12, 2024. Introduction:Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with advanced heart failure (AHF). Among AHF patients, atrial fibrillation (AF) is a common arrhythmia. Despite its prevalence, the impact of pre-existing AF on outcomes in post-LVAD recipients is poorly understood.Hypothesis:LVAD recipients with preexisting AF have higher all-cause mortality.Methods:This is a single-center, retrospective review of 573 LVAD recipients. Patients with LVADs implanted elsewhere, implants prior to 2011, implantation of an unconventional LVAD (e.g. artificial heart), and those with insufficient records were excluded. Univariate descriptive statistics and multivariate logistic&linear regression analyses of patient all-cause mortality, as appropriate, were performed using STATA. Significance was determined at alpha < 0.05.Results:Pre-implant AF was seen in 54% of LVAD recipients. Participants with AF were more likely to be male and older. They had higher rates of hyperlipidemia, prior stroke or TIA, prior CABG, pre-existing ICD at time of implant, and pre-LVAD sustained VT (Table 1). After a median follow-up time of approximately 2 years, 57% of patients died, 22% were transplanted, 9% were explanted, and 12% were lost to follow up. Irrespective of incidence of pre-LVAD AF, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). Pre-LVAD AF was associated with increased mortality (61% vs 47%, p= 0.001). This finding remained significant on multivariate analysis while controlling for other comorbidities (Table 2). Additionally, presence of AF was significantly associated with an increased occurrence of both post-implant VT (63% vs 43%, p

Circulation, Volume 150, Issue Suppl_1, Page A4136563-A4136563, November 12, 2024. Background:Percutaneous mitral valve repair has been increasingly utilized for the treatment of mitral valve disease in the recent years, although surgical mitral valve repair and/or replacement remains the preferred therapy, especially for primary mitral regurgitation. Chronic obstructive pulmonary disease (COPD) is a common comorbidity that can adversely affect outcomes of cardiac procedures. While COPD is an independent predictor of adverse outcomes after surgical mitral valve repair, its effects on percutaneous mitral valve repair is not well-defined.Methods:Using National Inpatient Sample data from 2011 to 2019, we conducted a retrospective study of adult patients with COPD who underwent surgical or percutaneous mitral valve repair, using ICD-9 and ICD-10 codes. We excluded patients with surgical mitral valve replacement. Patient baseline characteristics and in-hospital outcomes were compared and adjusted for covariates to investigate outcomes using a logistic regression model. Statistical significance was determined with a p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4142268-A4142268, November 12, 2024. Background:Dihydropyridine calcium channel blockers (DHCCBs) are effective first-line therapy for hypertension but can cause adverse effects (AEs) leading to the prescription of a new drug, i.e., a ‘prescribing cascade.’Aim:To identify potential DHCCB-induced prescribing cascades using high throughput sequence symmetry analysis (HTSSA).Methods:Using claims from 5% (2011-15) and 15% (2016-20) samples of Medicare fee-for-service beneficiaries, we identified new DHCCB users aged >66 y with continuous enrollment >360 days pre- and >180 days post-CCB initiation. We screened for the initiation of 446 other ‘marker’ drug classes (based on WHO Anatomical Therapeutic Classification level 4 codes) within+90 days of DHCCB initiation. Adjusted sequence ratios (aSRs), representing proportions of DHCCB initiators starting the marker class after vs. those starting before DHCCB were calculated, with 95% CIs >1 considered significant; for significant signals, the number needed to harm (NNTH) was also calculated. Independent clinical reviewers classified signals as potential prescribing cascades or not based on biological plausibility.Results: We identified 388,862 DHCCB initiators (mean+SD age 77+7.5 years; 62% female and 92% with hypertension). Of the 446 marker classes assessed, we identified 82 signals that warranted further exploration (aSR > 1). After clinical review, 29 (35.36%) signals were classified as potential prescribing cascades (Figure 1). The top 3 potential prescribing cascades ranked by aSR were other systemic hemostatics (aSR 2.99 [1.10-8.16]), other nasal preparations (aSR 1.99 [1.47-2.70]), and drugs used in erectile dysfunction (aSR 1.85 [1.27-2.70]). Other clinically relevant signals included electrolyte solutions (NNTH 216, aSR 1.35), osmotically acting laxatives (NNTH 710, aSR 1.13), and sulfonamides (NNTH 104, aSR 1.50).Conclusion:HTSSA is a novel approach to identify DHCCB-induced potential prescribing cascades. Using this method, we identified known and underrecognized AEs of CCBs in this nationally-representative Medicare cohort. More research is needed to evaluate clinical outcomes attributed to these prescribing cascades.

Circulation, Volume 150, Issue Suppl_1, Page A4144000-A4144000, November 12, 2024. Background:Immune checkpoint inhibitors (ICIs) have been associated with major adverse cardiovascular events (MACE) that carry high morbidity and mortality. Statins are widely used for the primary prevention of MACE in patients with a high risk of atherosclerotic cardiovascular disease. However, the impact of statins on MACE associated with ICIs remained unclear.Research QuestionIs stain use associated with a reduction in MACE in patients treated with ICI?AimTo assess the effectiveness of statins on the primary prevention of MACE in patients treated with ICI.Methods:We conducted a retrospective, propensity score-matched cohort study using the TriNetX Analytics Network database. We included all adult cancer patients who were treated with an ICI between March 2011 and March 2023. We excluded patients with a history of MACE, defined as a composite of myocardial infarction, myocarditis, pericarditis, and cardiovascular death. Patients who received statins prior to ICI initiation were compared to those who did not receive statins prior to the start of ICI therapy. The primary efficacy outcome was MACE. Secondary efficacy outcomes were indivicual MACE. The safety outcomes included all-cause mortality and adverse events associated with statins. Cox proportional hazard ratios (HR) werecalculated to compare study endpoints occurring within 1 year of ICI initiation between statins users and non-users.Results:Of 73,988 patients eligible for inclusion, 12,653 patients who received statins were matched to those who did not receive statins. The most common indication for an ICI was lung cancer (41%) and the most commonly administered ICI was pembrolizumab (50%). In a Cox proportional hazards analysis, patients on a statin were associated with a lower risk of MACE (HR, 0.83; 95% CI, 0.72-0.94) as compared to patients not on a statin. There was a reduction in the risk of myocardial infarction, cardiovascular death, and a lower trend of myocarditis among patients who received statins. Patients on a statin had a lower rate of all-cause mortality without an increase in adverse events.Conclusions:Statins were associated with a reduction in MACE and all-cause mortality among cancer patients receiving ICI therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4141933-A4141933, November 12, 2024. Introduction:Supraventricular tachycardia (SVT) is known to affect children and teenagers predominantly but can also occur in adults. However, due to a presumed good disease outcome, fatality rates of SVT in adults (above 25 years) are yet to be explored.Aim:This study aims to shed light on the mortality trends of SVT in the adult population across the United States from 1999 to 2020.Methodology:The CDC WONDER database was used to identify SVT-related deaths using ICD-10 code I47.2 in adults (above 25 years) from 1999 to 2020. The reported data was in the form of crude rate and age-adjusted mortality rate (AAMR) per 100,000 individuals and was stratified by year, ten-year age groups, gender, races, census region, census division, states, and rural-urban division. The Joinpoint regression was then used to determine the changes in trends and annual percentage change (APC).Results:From1999 to 2020, 31,036 (AAMR=0.6) SVT-related deaths were reported. AAMR showed an initial steep decline from 0.9 in 1999 to 0.5 in 2011 (APC -5.11 [95% CI -6.08 to -4.14]), followed by a gradual increase till 2020 (0.8) (APC 5.14 [95% CI 3.41 to 6.90]). The crude death rates increased with age and were reported to be highest in ages greater than or equal to 85 (9.1); the trend showed a steep decrease from 1999 (12.4) to 2008 (7.9) (APC -4.35 [95% CI -5.36 to -3.33]), followed by a gradual decline till 2017 (7.8) (APC -0.66 [95% CI -2.04 to 0.73]), and ultimately rising sharply till 2020 (10.6) (APC 9.23 {95% CI 3.32 to 15.47]). Among races, Blacks and Whites displayed the highest mortality (0.7). Blacks showed an initial decrement from 1999 (1.0) to 2017 (0.6) (APC -2.71), followed by a rise back to 1.0(2020) (APC 19.58), while whites showed an initial fall (0.9 (1999) to 0.6 (2008), APC -4.91), followed by no change till 2017 (APC 0.18), and ultimately rise to 0.9 in 2020 (APC 13.66). Although no significant gender or geographical variations were observed, more deaths were seen in rural areas (1.0) than in Urban (0.6).Conclusion:Following an initial decline, the incidence of SVT-related mortality has been increasing over the years, pre-dominantly among the 85+ age group, Blacks, and rural populations. However, due to a limited understanding of the epidemiology of SVT in adult populations, more extensive research is needed to formulate better preventive and management strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4137975-A4137975, November 12, 2024. Introduction:In the US, the most common cause of death among active-duty firefighters is sudden cardiac death (SCD). Underlying heart diseases are important propagator of ventricular tachyarrhythmias that cause SCD. The objective of this abstract is to assess the incidence of underlying heart disease, identified on 12-lead electrocardiograph (ECG), that may place firefighters at greater risk of SCD.Methods:We digitalized 12-lead ECGs recorded among firefighters who visited a firefighter health screening program at least 4 times from 2011-2019. We extracted the interval measurements (Heart Rate, T-axis, QRS-axis, QRS duration, QTc duration) and interpretation statements from each of the 12-lead ECGs and grouped potential propagators of ventricular tachyarrhythmias including left ventricular hypertrophy (LVH), coronary artery disease (CAD), and cardiac conduction disease. We used simple mean imputation to handle missing data. Descriptive statistics including means and frequencies were used to analyze the sample.Results:Among 465 firefighters (90.1% male) with a mean age of 47.1 (±13.6) whom 1,296 12-lead ECGs were analyzed, 21.5% (n=278) of Heart Rate, 0.39% (n=5) T-axis, 26.4% (n=342) QRS-axis, 40.0% (n=518) QRS duration, 5.40% (n=70) QTc duration were abnormal. In addition to intervals, the 12-lead ECGs generated 1,970 interpretation statements of which 28.2% (n=555) were deemed possible pathoanatomical substrates including 3.1% (n=34) LVH, 24.7% (n=137) CAD, and 69.2% (n=384) cardiac conduction diseases. Among cardiac conduction diseases, intraventricular conduction disease was the most prevalent (n=204, 36.8%), followed by vertical axis (n=70, 12.6%), right bundle branch block (n=59, 10.6%), left anterior fascicular block (n=34, 6.1%), and left bundle branch block (n=17, 3.1%). Interestingly, we did not observe a temporal relationship regarding the number of pathoanatomical substrates over the screening period.Conclusions:Nearly 30% of the interpretation statements generated from 12-lead ECGs were indicative of possible pathoanatomical substrates that cause SCD, which reflects the apparently negative effect of fire suppression activity on one’s cardiopulmonary health. Our result justifies the imperative need of effective prevention method for cardiac conduction diseases among firefighters. Further research is needed to collect 12-lead ECG systematically amongst other measures such as diet and BMI which reflect work culture and lifestyle of firefighters.

Circulation, Volume 150, Issue Suppl_1, Page A4141113-A4141113, November 12, 2024. Background:Pericardial Diseases (PD) have become a significant cause of morbidity and mortality over the last two decades. They contribute secondarily to deaths associated with other primary illnesses and can present clinically as pericarditis, pericardial effusion, and hemopericardium. Despite treatment advances, U.S. mortality trends for PD are unexplored.Aim:This study aims to assess the trends in PD-related deaths in the United States from 1999 to 2022.Methods:PD-related deaths in adults aged 25 years and above were identified through CDC WONDER database from 1999 to 2022 from multiple causes of death. Crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 population were determined. Joinpoint regression was used to examine changes in trends and annual percentage change (APC) overall, and then stratified by sex, ethnicity, and age groups.Results:A total of 105,536 deaths occurred from PD between 1999 to 2022. Overall, AAMR related to PD decreased from 1999 (2.4) to 2012 (1.7) (APC -2.73 [95% CI, -3.09 to -2.36]), then gradually increased until 2019 (2.0) (APC 2.92 [95% CI, 1.57 to 4.29]), followed by a sharp increase until 2022 (APC 7.65 [95% CI, 4.42 to 10.99]). After an initial decline, APC in AAMR increased in women (4.36) starting in 2012, while in men, it decreased significantly until 2011 (-2.26), followed by a slight increase until 2016 (1.05), and then a marked increase from 2016 to 2022 (4.19). After an initial decline, AAMR increased among non-Hispanic (NH) Blacks (APC 5.42) and NH Whites (APC 4.95) starting in 2014, among Hispanics (APC 4.10) from 2012 to 2022, and among NH Asian or Pacific Islanders (APC 2.4) from 2007 to 2022. Mortality rates have been steadily increasing across all age groups over the last decade, with the highest increase seen recently in the 85+ age group (2017-2022 APC 9.09 [95% CI, 6.50 to 11.76]).Conclusion:PD-related mortality has increased over the last decade. Mortality among males, NH Blacks, and the 85+ age group has been growing at a faster rate than any of the other groups. These results highlight the need for further investigation into the factors contributing to the observed disparities and trends in PD mortality rates.

Circulation, Volume 150, Issue Suppl_1, Page A4144054-A4144054, November 12, 2024. Introduction:Emerging evidence suggests a role for cellular senescence in the pathogenesis of age-related cardiac dysfunction. Senescence-associated secretory phenotype (SASP) is a hallmark of senescent cells, but the extent to which circulating SASP protein levels associate with cardiac dysfunction is not known.Objectives:Determine associations of plasma SASP proteins with subclinical cardiac dysfunction and incident heart failure (HF).Methods:Among 4,484 HF-free participants in the community-based Atherosclerosis Risk in Communities study who attended the 5thstudy visit (2011-2013) and underwent protocol echocardiography, we measured 25 core SASP proteins (SomaScan aptamer-affinity assay). We assessed their associations with cardiac structure/function and incident adjudicated HF using multivariable linear and Cox proportional hazards models adjusted for demographics and clinical characteristics.Results:The mean age was 76±5 years, 58% were female, 17% reported Black race, and mean LVEF was 66±6%. 439 incident HF events occurred over 8 [IQR 7-9] year follow-up. Eight of 25 core SASP proteins associated with risk of incident HF at FDR

Circulation, Volume 150, Issue Suppl_1, Page A4142555-A4142555, November 12, 2024. Background:Myocardial fibrosis could be detected by cardiac MRI (CMR) with late gadolinium enhancement (LGE) which provides important prognostic information of risk stratification for adult hypertrophic cardiomyopathy (HCM). However, in childhood HCM, it remains uncertain the prevalence, pattern of LGE, and whether it is associated with adverse outcomes.Aims:This study aims to explore the characteristics of LGE in childhood HCM and to evaluate the prognostic value of LGE for adverse outcomes.Methods:In this retrospective study, a total of 231 consecutive childhood patients with primary HCM who were ≤18 years of age at diagnosis and underwent contrast-enhanced CMR from January 2011 to December 2019 were enrolled. The extent of LGE was quantified by measuring areas with the increased signal intensity of ≥6 standard deviations above the mean of normal myocardium. The primary outcome included a composite of sudden cardiac death (SCD) or equivalent events (resuscitated sudden cardiac arrest or aborted SCD), heart failure-related events (heart transplantation, death from heart failure, rehospitalization for heart failure).Results:Patients were 15±3 years of age at baseline and 65% were male. During a median follow-up of 61.7 months (IQR:39.2-84.5), 26(11.3%) patients with HCM reached the primary end points, 13 of whom experienced SCD events. LGE was present in 195(84.4%) childhood HCM patients with a median LGE extent 4.77%(IQR:2.01-9.18) and higher in the mid regions. After univariable analysis, multivariable Cox analysis adjusting clinical and cardiac functional factors, LGE extent was an independent predictor for the primary endpoints (HR, 1.11; P

Circulation, Volume 150, Issue Suppl_1, Page A4137917-A4137917, November 12, 2024. Background:The Trial to Evaluate Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with preexisting CVD and overweight or obesity.Purpose:To estimate the number of US adults with CVD and overweight or obesity that may be eligible for semaglutide based on SELECT eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SELECT.Methods:We included US adults from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 who had eligibility criteria from SELECT. This included patients aged >45 years who had preexisting CVD and a BMI of >27kg/m2but no history of diabetes. Using NHANES sample weighting, we estimated the number of SELECT-eligible US adults and primary composite and secondary CVD endpoints that would occur based on SELECT treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on mean 3.3-year follow-up).Results:Among 8783 (projected to 77.9 million [M]) adults with overweight or obesity, we estimated 493 (4.1 million) (5.61%) to fit SELECT eligibility criteria. Compared to SELECT trial participants, our sample had a higher proportion of Black participants and was older with higher levels of diastolic blood pressure, total, LDL and HDL-cholesterol, and lower BMI, HbA1c, eGFR and triglycerides. Prior myocardial infarction was less common, but stroke was more common in our sample. From SELECT semaglutide and placebo primary composite CVD event rates of 6.5% and 8.0%, respectively, we estimated 79949 and 98399 CVD events would occur annually, the difference being 18450 potentially preventable CVD events. Moreover, we similarly estimated 104,549 and 357,928 annual preventable cases of diabetes and pre-diabetes, respectively. The Figure shows the estimated number of primary and secondary CVD outcomes that could be prevented annually.Conclusion:Semaglutide may prevent many fatal and non-fatal CVD events, as well as incident cases of diabetes and pre-diabetes if provided to US adults meeting SELECT eligibility criteria. More efforts are needed to educate clinicians and patients on the benefits of semaglutide 2.4mg in those with preexisting CVD and overweight or obesity.

Circulation, Volume 150, Issue Suppl_1, Page A4146613-A4146613, November 12, 2024. Background:Several anti-inflammatory and urate-lowering drugs commonly used in gout have shown promise in reducing cardiovascular risk. However, there remains controversy regarding the benefits of concomitant allopurinol and colchicine in cardiovascular risk prevention, and many previous studies have failed to account for time-varying dose and duration of use for both medications. Thus, we aimed to 1) examine dual trajectories of allopurinol-colchicine use and 2) evaluate risk of major adverse cardiovascular events (MACE) according to trajectories.Methods:Using 2011-2020 Medicare claims, we identified new users of allopurinol. We defined the date of first allopurinol fill as the index date and required continuous enrollment in Medicare Parts A. B, and D for 12 months before and after index date Then, we used group-based multi-trajectory modeling to identify allopurinol and colchicine use patterns by calculating average daily dose for each medication separately during each 2-week period during the first 12 months of allopurinol use. We then constructed inverse probability of treatment weighted Cox survival models to compare time-to-incident MACE across trajectories.Results:We identified 59,429 beneficiaries (mean age: 73.9; 82.6% non-Hispanic white) and ten unique trajectories including: six trajectories with no colchicine use (Trajectory A-F) and four trajectories with colchicine use (Trajectory G-J). Compared to Trajectory A (rapidly decreasing allopurinol – no colchicine), we observed a lower risk for MACE among Trajectories E (~200 mg allopurinol – no colchicine; aHR: 0.89 [95% CI: 0.87-0.92), F (~300 mg allopurinol – no colchicine; aHR: 0.91 [95% CI: 0.89-0.94]), I (~100 mg allopurinol – ~1.2 mg colchine [stable]; aHR: 0.96 [95% CI: 0.93-0.99]), and J (~300 mg allopurinol – gradually decreasing colchicine; aHR: 0.88 [95% CI: 0.85-0.91]).Conclusions:These findings suggest that older adults may benefit from interventions aimed at optimizing dose and duration of allopurinol and colchcine when initiating allopurinol among older adults and further support the need for additional research on the role of concomitant allopurinol and colchicine in cardiovascular risk prevention.

Circulation, Volume 150, Issue Suppl_1, Page A4121359-A4121359, November 12, 2024. Background:The remarkable decline in the overall prevalence and mortality rates of cardiovascular diseases (CVD) in the United States (US) over the past few decades has not been consistent across all age groups, sexes, races, and types of cardiovascular diseases. Heart disease (HD) and heart failure (HF) still pose a significant burden to the healthcare system.Objectives:This study sought to describe the age, sex and racial disparities in the trends in mortality rates for these two outcomes in the US over the past two decades.Methods:This was an ecological study with trend analysis of the mortality from heart disease and heart failure in the US between 2000 and 2020. Data on CVD was obtained from the National Centers for Disease Control and Prevention (CDC) surveillance databases and analyzed. Binomial regression models were used to evaluate trends in outcomes. Statistical significance was considered for p-values < 0.05.Results:There was a significant decrease in the age-standardized mortality for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases (p