Search Results for: Come stress e attacchi di cuore sono collegati

Circulation, Volume 150, Issue Suppl_1, Page A4133257-A4133257, November 12, 2024. Background:Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Recent epidemiological studies have revealed an association between ketone bodies (KB) and adverse cardiovascular outcomes, offering a unique insight into metabolic health and its impact on mortality risk. Elevated levels of both Lp(a) and KB may synergistically amplify pathological processes, including endothelial dysfunction, inflammation, and oxidative stress, through their involvement in shared pathophysiological pathways, thereby exacerbating disease progression beyond the impact of each biomarker individually.Methods:Utilizing data from the UK Biobank, KB were measured by nuclear magnetic resonance spectroscopy and serum Lp(a) concentrations were measured using an immunoturbidimetric assay. Four groups were created as follows: Group 1: Lp(a)

Circulation, Volume 150, Issue Suppl_1, Page A4147568-A4147568, November 12, 2024. Introduction:Cardiovascular disease (CVD) and cancer are among the leading causes of morbidity and mortality worldwide. Increasing evidence suggests that sociodemographic factors such as race, ethnicity, income, education, and stress levels significantly influence the prevalence and outcomes of these diseases. TheAll of UsResearch Program provides a unique opportunity to explore these disparities across a diverse U.S. population. This study aims to examine how sociodemographic disparities are associated with stress, CVD, and cancer outcomes. We hypothesize that higher perceived stress levels, lower income, lower education levels, and minority race/ethnicity groups are associated with higher incidences of CVD and cancer.Methods:Data from 55,505All of UsResearch program participants were analyzed. Key variables included age, race, ethnicity, education, household income, perceived stress level, and history of CVD and cancer. Descriptive statistics were used to summarize participant demographics. Multivariate logistic regression models were employed to examine the associations between sociodemographic factors and the outcomes of interest (CVD and cancer).Results:Older participants had a higher prevalence of both CVD (mean age: 60.8 vs. 50.5, p < 0.001) and cancer (mean age: 63.6 vs. 51.7, p < 0.001). Black/African Americans had a higher incidence of CVD (21.3% vs. 78.7%, p < 0.001), while Whites had a higher prevalence of cancer (5.3% vs. 94.7%, p < 0.001). Lower income and higher stress levels were also associated with higher CVD incidence (

Circulation, Volume 150, Issue Suppl_1, Page A4116603-A4116603, November 12, 2024. Objective:Alarmins resulting from cell death or oxidative stress have been shown to be involved in the development of Kawasaki disease (KD) vasculitis. In our previous study, we demonstrated the potential role of (IL)-33 as an alarmin in the development of KD vasculitis. Although edematous dissociation (necrotic change) of the tunica media is thought to be a major source of IL-33 in KD vasculitis, it has not yet been elucidated.Methods:We investigated the impact of IL-33 released from necrotic human coronary artery smooth muscle cells (HCASMCs) on human coronary artery endothelial cells (HCAECs) by a co-culture assay using the Transwell®cell culture insert system. Subsequently, we evaluated the anti-inflammatory effects of anti-IL-33 and anti-ST2 antibodies compared to the conventional therapies of KD, such as high-dose IgG or anti-tumor necrosis factor (TNF)-α antibody.Results:Primary necrosis of HCASMCs induced significant release of IL-33. In co-cultures of necrotic HCASMCs with HCAECs, necrotic HCASMCs significantly induced the production of various proinflammatory cytokines in HCAECs. Anti-IL-33 and anti-ST2 antibodies exhibited unique inhibitory effects on the production of platelet-derived growth factor-BB or IL-12(p70) in HCAECs.Conclusion:The results of the present study suggest the potential involvement of edematous dissociation of the tunica media in the development of KD vasculitis. Furthermore, the distinctive anti-inflammatory effects of the anti-IL-33/ST2 axis drugs suggest novel therapeutic options for patients with refractory KD.

Circulation, Volume 150, Issue Suppl_1, Page A4145465-A4145465, November 12, 2024. Background:Myocardial bridging (MB) is a common congenital anomaly wherein a coronary artery segment takes an intramyocardial course. While often benign, MB may be associated with myocardial ischemia/stunning (MS), acute coronary syndromes (ACS), or even sudden cardiac death during periods of increased cardiac demand.Case presentation:A 47-year-old male with a history of type 1 diabetes mellitus was admitted to the Intensive Care Unit for diabetic ketoacidosis (DKA). He complained of epigastric pain with an electrocardiogram showing transient ST-elevation in the anterior and inferior leads. Cardiac troponin showed an upward trend with a peak of 0.202 ug/L and an elevated NT-proBNP of 5,014 pg/mL. A transthoracic echocardiogram (TTE) revealed left ventricular systolic dysfunction (LVEF 40%) with akinesis of the mid to apical anterior and septal walls, consistent with the left anterior descending (LAD) artery territory. Emergent left heart catheterization (LHC) revealed patent coronary arteries with severe mid-LAD MB with TIMI 3 flow. He was managed conservatively with guideline-directed medical therapy for heart failure, and subsequent TTE nine months later showed normalization of LV wall motion (LVEF 65%). Five months later, the patient was readmitted for DKA with elevated troponin. A repeat TTE demonstrated LV systolic dysfunction (LVEF 35%) with wall motion abnormalities (WMA) mirroring the initial presentation.Discussion:Our patient presented with recurrent episodes of ACS/MS complicated by LV systolic dysfunction along the LAD territory during periods of DKA, a known stressor for myocardial ischemia. The absence of obstructive coronary atherosclerosis on LHC, coupled with severe mid-LAD MB, suggests that the MB was the likely culprit for recurrent ACS/MS. Although stress cardiomyopathy was considered a differential diagnosis, this was less likely given the uncharacteristic pattern of WMA sparing the apical lateral and inferior walls as opposed to apical ballooning and the presence of an alternative diagnosis.Conclusion:This unique case underscores the importance of recognizing MB as a rare but potential cause of ACS/MS and LV dysfunction in patients with precipitating stressors such as DKA.

Circulation, Volume 150, Issue Suppl_1, Page A4129182-A4129182, November 12, 2024. Introduction:Despite recent advances in therapy, chronic ischemic heart failure remains a significant cause of morbidity and mortality worldwide. Stem cell (SC) therapy has recently emerged as a potential therapeutic approach, yet its efficacy remains debatable. We aimed to systematically review and meta-analyze the current evidence to evaluate its effectiveness.Methods:A comprehensive literature search was conducted across the following databases: PubMed, Embase, and Cochrane, from inspection to April 2024. We identified RCTs with a blinded study design, done on patients diagnosed with chronic ischemic HFrEF, and utilized mesenchymal stem cells as an intervention in comparison to placebo/sham intervention using percutaneous endomyocardial catheter systems. Meta-analysis was conducted using RevMan v5.4 to calculate the odds ratio (OR) at 95% confidence intervals (CI) and a p-value of 0.05. I2was indicated for the assessment of heterogeneity. Sensitivity analysis was done in case of heterogeneity between studies.Results:A total of twenty studies were included in our meta-analysis. The overall change in left ventricular end-systolic volume (LVESV) and stress SPECT significantly favored the stem cell group (pooled effect size -7.59, 95% CI [-12.28 to -2.89], P=0.002), and (pooled effect size -5.33, 95% CI [-6.73 to -3.93], P=0.00001), respectively. Initially, the change in left ventricular end-diastolic volume (LVEDV) did not favor either group. However, sensitivity analysis which excluded one study at a time, reduced heterogeneity (P=0.01, I2=54%) and showed a significant effect favoring the stem cell group (pooled effect size -3.87, 95% CI [-6.77 to -0.97], P=0.009). However, the overall changes in left ventricular ejection fraction (LVEF) did not favor either of the two groups (pooled effect size 0.08, 95% CI [-0.1 to 0.26], P=0.39). Similarly, the overall change in myocardial oxygen consumption (MVO2) did not favor either group (pooled effect size 0.66, 95% CI [-0.1 to 1.32], P=0.05).Conclusion:Transendocardial SC therapy demonstrates promising results by significantly improving specific cardiac parameters. While the therapy shows potential, particularly after sensitivity adjustments, its impact on other critical measures like LVEF and MVO2 remains inconclusive. These findings highlight the need for further investigation to fully understand and enhance the therapeutic potential of stem cell interventions in heart failure management.

Circulation, Volume 150, Issue Suppl_1, Page A4139203-A4139203, November 12, 2024. Introduction:Spontaneous coronary artery dissection (SCAD) is a poorly understood cause of acute coronary syndrome (ACS), predominantly affecting young women and frequently related to acute stressors. It has been suggested that stress induced cardiomyopathy can cause dissection via mechanical distortion of the vessel at wall-motion hinge points. Whether specific coronary anatomic configurations also predispose to distortion and hence SCAD remains unknown.Hypothesis:Patients with left anterior descending (LAD) SCAD have a higher frequency of a “wrap around” (type IV – perfuses >25% of the inferior wall) LAD.Methods:Coronary angiograms of patients in the Mayo Clinic SCAD Registry were reviewed. Patients from functional angiogram registry with similar characteristics were used as controls. Patients with an LAD SCAD were compared to patients who never had an LAD SCAD. For identifying predictors of LAD SCAD, patients who never had an LAD SCAD were compared to patients that had an LAD SCAD as a recurrent event, but not as the initial presentation.Results:A total of 456 patients with SCAD (46±6 years; 96% women) were included. The control group consisted of 178 patients (44±7 years, 97% women). Type IV LAD was more common in the SCAD cohort (Figure 1), and patients in the LAD SCAD group had a higher proportion of type IV LAD when compared to non-LAD SCAD (47.6% vs 23.0% p < 0.001). Bifurcation involvement was also more frequent (48.6 vs 25.8%, p

Circulation, Volume 150, Issue Suppl_1, Page A4117345-A4117345, November 12, 2024. Introduction:Acute type A aortic dissection (ATAAD) is typically treated by replacement of the ascending aorta (+/- root) and proximal arch. However, 70-85% of patients have residual distal dissection post-repair, and 20-40% require late reoperation for aneurysmal degeneration of the distal aorta (ADDA). Since an individual patient’s risk of ADDA cannot be accurately predicted, current guidelines recommend lifelong aortic surveillance imaging for all patients.Hypothesis:Computational fluid dynamics (CFD) simulations of aortic hemodynamics post-repair can accurately identify patients at late risk of ADDA.Methods:We performed CFD simulations of 50 patients following hemi-arch replacement for ATAAD. Patient-specific 3D models were generated from the aortic root to iliac bifurcation (including arch branches) from postoperative 0.6mm contrast-enhanced CT angiograms taken

Circulation, Volume 150, Issue Suppl_1, Page A4142098-A4142098, November 12, 2024. The anti-angiogenic impact of neutrophil elastase clouded the understanding of the role of neutrophils in promoting neovascularization (NV) and fibrinolysis in patients with chronic limb-threatening ischemia (CLTI). The impact of significant neutrophilia was not studied during clinical trials using Granulocyte Colony Stimulating Factor (G-CSF) to boost the deficient circulating endothelial progenitor cell count. Only recently have activated human neutrophils been documented to release pro-angiogenic factors such as VEGFA, Hepatocyte Growth Factor (HGF), MMP-9, angiopoietin (Ang1). They also stimulate and modulate fibrinolysis through release of proteases, and by promoting endothelial cell release of plasmin.The purpose of this abstract is to link clinical evidence* to these observations. Proteomic and cytometry data were obtained in 14 CLTI patients treated with Filgrastim 7-10 mcg/kg SQ every 72 h for up to a month. The absolute neutrophil count (ANC) increased a mean of 6-fold a day after each injection, returning to baseline within 72 hours. Significant (p < 0.05) increases in the concentration of VEGFA, HGF, MMP-9, Ang1 was measured by ELISA a day after both the 5th and the 10th Filgrastim doses as compared to baseline. The ANC peak was measured at the same time, as well as was the significant (p < 0.01) increases in the plasma concentration of plasmin ( >10-fold) and Fibrin Degradation Products (FDP) ( >5-fold). Since these patients also wore an infra-geniculate programmed compression pump (PCP) for 3 hours daily, these data were compared to 19 CLTI patients treated with PCP alone. PCP was used to improve the ischemic micro-environment and to provide endothelial shear stress as a strategy to induce arteriogenesis. PCP use did not influence the concentration of any of these proteins and did not induce neutrophilia. Resolution of ischemic rest pain and healing of ischemic ulcers contributed to limb salvage. Arterial hemodynamic improvement was supported by angiographic evidence of NV (enlarged corkscrew collaterals, improved contrast transit through the ischemic tissue). Segmental arterial recanalization indicated fibrinolysis. No hemorrhage occurred over the 30 day course. A prospective investigation of the uncovered link between neutrophilia, NV, and fibrinolysis is justified. * J Tissue Eng Regen Med. 2022 May;16(5):496-510. doi: 10.1002/term.3284

Circulation, Volume 150, Issue Suppl_1, Page A4144425-A4144425, November 12, 2024. Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is an ischemic cause of chest pain with normal appearing coronary vessels on angiography. The prognosis for these patients is extremely dependent on etiology highlighting the importance for appropriate evaluation. Currently, several imaging modalities have been useful in diagnostic workup, however no diagnostic guidelines have been developed. As a result, many patients are likely not getting proper evaluation. The study’s main objective is to observe practice variations in the diagnostic evaluation for patients meeting criteria for MINOCA.A review of electronic medical records of patients presenting to a tertiary care center between Jan 2018 – Dec 2022 for chest pain who were referred for left heart catheterization was performed. Patients with prior history of obstructive CAD, whose imaging evaluation uncovered obstructive stenosis or had stenosis >50% as measured on LHC were excluded. Next, patients diagnosed with a nonischemic cause of hospital presentation were excluded. Examples of nonischemic etiologies include stress induced cardiomyopathy, myocarditis and pulmonary embolism. Data regarding medical management and follow-up imaging were collected.A total of 2,763 patients were reviewed. Among them, 168 patients met the exclusion criteria. Approximately 60% (n=101) of patients were female with an average age of 60 years. Medical management with aspirin (n=123), DAPT (n=22), beta-blocker (n=98), calcium channel blocker (n=58), statin (n=130), anti-anginal therapy (n=55), diuretics (n=47), and ACEi/ARB (n=69) were observed. Additional imaging was seen in only 26% of patients. The imaging modalities used were cardiac MRI (cMRI), fractional flow reserve (FFR) and intravascular ultrasound (IVUS). The most common imaging modality was cMRI (n=35), followed by FFR (n=8) and IVUS (n=1).MINOCA was identified in 6% of patients presenting with AMI and was primarily comprised of women, which is consistent with other reported figures. Our data demonstrates that nearly 75% of these patients were placed on medical therapy without further evaluation. MINOCA is a diagnosis with multiple pathophysiological etiologies that requires thorough workup including additional imaging for complete evaluation. This study demonstrates the importance of considering MINOCA as a potential diagnosis in patients presenting with AMI and the need for guidelines on its evaluation.

Circulation, Volume 150, Issue Suppl_1, Page A4144410-A4144410, November 12, 2024. Background:Mechanical complications following Myocardial Infarction (MI), such as ventricular rupture, significantly impact patient morbidity and mortality. Reperfused MI characterized by intramyocardial hemorrhage (hMI), has been identified to be the most severe form of myocardial injury. However, whether hMI portends a higher risk for mechanical complications is not known. The Wall Strain Index (WSI) Ratio, which is a measure of myocardial deformation and one that has been previously validated for cardiac rupture, is a desirable biomarker for examining the potential mechanical differences in strain development in hMI vs. non-hMI.Research Question:Do patients with hMIs have a higher radial and circumferential Wall Strain Index (WSI) Ratio compared to patients without hMI?Methods:We performed a retrospective cohort study (MIRON-STRAIN, NCT06450912) in mechanically revascularized STEMI patients (n=181) who underwent CMR (cine, T2* and LGE) approximately 2 days after PCI. WSI Ratio was computed using the 2D-strain module in CVI42(circumferential&longitudinal). Parametric statistics was performed using Shapiro-Wilk test and non-parametric statistics was performed using Mann-Whitney U test.Results:Patients with hMI (n=104) showed significantly higher radial and circumferential WSI Ratios compared to non-hMI patients. The radial WSI Ratio was approximately 58% higher in hMI relative to non-hMI patients (1.36±0.72 in hMI vs. 0.86±0.55 in non-hMI (p

Circulation, Volume 150, Issue Suppl_1, Page A4145104-A4145104, November 12, 2024. Background:The optimal timing for intervention for pulmonary and right ventricular outflow tract stenosis in adult congenital heart disease (ACHD) remains uncertain. While stress echocardiography is an established modality to improve risk stratification in stenotic left-sided lesions, its utility in right-sided valve disease in the ACHD population has not been studied. We assessed if stress echocardiographic assessment of right ventricular (RV) function during cardiopulmonary exercise testing (CPET) can facilitate risk stratification in the ACHD population.Objectives:The purpose of this study was to determine the relationship between RV augmentation on stress echocardiogram during CPET and morbidity in ACHD patients with sub-pulmonary right ventricles and right-sided stenotic lesions.Methods:A retrospective cohort study of ACHD patients with sub-pulmonary right ventricles who underwent CPET with stress echocardiogram was performed. The primary outcome was defined as having at least one of the following: 1) cardiac related hospitalization, 2) new documented arrhythmia, or 3) new or worsening heart failure. RV augmentation on stress echo was verified by concordance with a second observer.Results:The study included 87 patients, 41 (47%) with repaired tetralogy of Fallot, 9 (10.3%) with RV-PA conduits, and 9 (10.3%) with pulmonary stenosis. On baseline transthoracic echocardiogram, median peak pulmonary valve gradient was 38.7 mmHg (Q1 17.9 , Q3 49.0) and 30% of patients had RV dysfunction. On stress imaging, 13 (14.9%) did not demonstrate RV augmentation. Those without RV augmentation had a lower percent predicted peak Vo2 (61.4% vs 75.4%, p=0.007). Eleven (12.6%) met the primary outcome. Lack of RV augmentation was strongly associated with the primary outcome (OR 4.25, CI 1.04 –17.46, p = 0.04). This association remained true in patients with baseline peak PV gradients less than 50mmHg (OR 8.7, CI 1.68 – 46.79, p = 0.009) and was more pronounced in patients with tetralogy of Fallot (OR 33.99, CI 3.29 – 829, p = 0.007).Conclusions:Lack of RV augmentation on stress echo during CPET is associated with increased morbidity in ACHD patients with right-sided stenotic lesions. These results suggest that stress echocardiography at the time of CPET should be considered in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4144762-A4144762, November 12, 2024. Background:Each year, millions of people worldwide experience cardiovascular events, including acute myocardial infarctions (AMIs). Surviving an AMI can result in psychological sequelae, including negative illness perceptions, fear of recurrence, and perceived stress, that may interfere with survivors’ recovery, individually influencing their physical, emotional, and cognitive outcomes. Though influential, little is known about the individual relationships between these variables in persons who have experienced an AMI.Purpose: This study examined the relationships between illness perceptions, fear of recurrence, and perceived stress in AMI survivors. Also examined were predictors of fear of recurrence and perceived stress, changes in fear of recurrence over time, and effects of anxiety or depression.Methods:We used a repeated measures descriptive design to evaluate relationships with the brief illness perception questionnaire, the fear of progression questionnaire, perceived stress scale, and the depression, anxiety, and stress scale (N =171). Additionally, we examined the relationship between participant demographics and modifiable risk factors such as diet, exercise, and smoking. Our hypotheses were tested via multiple linear regression and mediation modeling.Results:Fear of recurrence was a significant mediator of the relationship between illness perceptions and perceived stress in AMI survivors [F(2,168) =43.31,R2=0.34,p

Circulation, Volume 150, Issue Suppl_1, Page A4139227-A4139227, November 12, 2024. Background:The treatment of secondary ischemic mitral regurgitation is challenging and predictors of functional and clinical outcome are pivotal in order to define the best therapeutic strategy. In these patients there is growing evidence that assessing the right ventricular (RV)-pulmonary arterial (PA) coupling during exercise has additive diagnostic and prognostic value.To date, no data are available as regard the exercise assessment of the RV- PA coupling in patients undergoing surgery for ischemic mitral regurgitationResearch Question:in patients with ischemic mitral regurgitation the evaluation of the exercise RV-PA coupling could play a crucial role for patients selection and prognosisAim:to test resting and exercise echocardiographic predictors of functional capacity and clinical outcome in patients referred to surgeryMethods:A 6-minute walking test and exercise stress echo performed at preoperative baseline, at 1 year and at median FU of 6 years (IQR: 3.70; range: 4.5– 8) on 50 patients (age: 67 ± 8 year; EF: 35 ± 5%), undergoing surgery by valve replacement or repair. Generalized linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6-MWT.Results:Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/ pulmonary artery systolic pressure (PASP) ratio showed the strongest correlation with long-term six-minute walking test (r=0.81, p< 0.01) (Figure 1).The receiver operating characteristic analysis found that a preoperative exercise TAPSE/PASP < 0.34 predicted the lowest quartile of six-minute walking test at long-term (sensitivity: 79%; specificity: 100%) (Figure 2) and a composite clinical outcome of heart failure and death for any cause (PPV 91.3%, NPV 100%).On multivariable analysis TAPSE (Estimates:4.05; SE:0.90; p < 0.01) and TAPSE/PASP ratio (Estimates:106.9; SE: 31.54, p

Circulation, Volume 150, Issue Suppl_1, Page A4144131-A4144131, November 12, 2024. Introduction:Recently it was published that 40-50% of genetic positive familial hypercholesterolemia (FH) patients will have zero coronary artery calcium (CAC). However, it is unclear if this rate is similar to patients who met indications for FH genetic testing but had a negative genetic result. We tested the hypothesis that the presence of CAC will be similar for these 2 patient groups.Methods:All patients undergoing genetic testing for FH from July 2016 to Jan 2024 (n=332) that also had a cardiac positron emission tomography-computed tomography (PET/CT) stress test (n=101) were studied. The presence of CAC was determined for these patients using the low-dose attenuated correction CT images. We further examined CAC severity for those with an Agatston CAC score (n=53) or with a report of CAC severity based on the low-dose attenuated correction CT (n=18). Fisher exact tests and Wilcoxon rank sum tests were used for the comparisons.Results:Of patients undergoing FH testing (n=332), average age was 49±19 years, 51% were male, and 89% white. For those who had a PET/CT (n=101), the average age at time of FH testing was 57±13y, 59% were male, and 87% white. Patients who underwent PET/CT were less likely to have a positive genetic test (14%) compared to those without a PET/CT (27%) (p=0.006). The CAC, other PET/CT results and conclusions by the reading cardiologist, and maximum low-density lipoprotein cholesterol (LDL-C) are shown in the table. A large percentage of both positive (93%) and negative (84%) FH genetic tested patients had CAC present. The presence and severity of the CAC was not significantly different between these 2 groups. Other PET/CT results were also similar for the FH positive and negative genetic test groups. However, those with genetically confirmed FH had significantly higher maximum LDL-C than those with a negative result (p=0.006) and a higher LDL-C closest to the time of PET/CT (p=0.02).Conclusion:While this is a small study of selected FH tested patients with PET/CT, we found nearly all of the genetically confirmed FH patients that had a PET/CT, had CAC. Those with genetically confirmed FH had almost double the LDL-C values compared to patients that tested negative for FH on genetic testing. However, this did not result in significantly higher rates or more severe CAC scores or higher risk assessment on PET/CT.

Circulation, Volume 150, Issue Suppl_1, Page A4132657-A4132657, November 12, 2024. Background:Cardiac rehabilitation (CR) patients demonstrate a high burden of chronic conditions (CC). Both multimorbidity (MM; ≥2 coexisting CC) and aging negatively impact functional capacity, whereas CR improves performance. Age-related difference in cardiorespiratory fitness (CRF, peak oxygen uptake (VO2)) in CR patients with MM has not been studied.Hypothesis:We hypothesized improvement in CRF will be attenuated by MM with increasing age in CR patients.Aims:We aimed to identify age-related differences in CRF improvement in CR patients with MM.Methods:Patients ≥18 yrs old who attended ≥1 CR sessions from 1999-2017 and completed cardiopulmonary exercise stress test before and after CR were included. The prevalence of CC was assessed using Rochester Epidemiology Project records-linkage system. Age categories included: Younger (18-49 yrs), Midlife (50-64 yrs) and Older (≥65 yrs). CRF categories included: 8%. Analysis included Kruskal-Wallis and Chi-squared.Results:Of 622 patients, 75.4% were male. Mean age: 62.9±11.2 yrs; Younger (n=70) age: 42.7±6.8 yrs, 67.1% male; Midlife (n=283) age: 58.3±4.3 yrs, 78.8% male; Older (n=269) age: 73.0±5.2 yrs, 74.0% male. BMI was 29.9±5.4 kg/m2(Younger: 30.0±6.7, Midlife: 30.4±5.6, Older: 29.3±4.7; p

Circulation, Volume 150, Issue Suppl_1, Page A4128698-A4128698, November 12, 2024. Background:Disparities in coronary heart disease (CHD) and other chronic related conditions, such as poor sleep quality and psychological distress, have been observed in rural areas. Both conditions can negatively affect disease progression, possibly through their impact on physical activity. The relationships, however, among sleep quality, psychological distress, and physical activity among depressed rural CHD patients have not been examined.Purpose:The purpose of this study was to determine the association of sleep quality (i.e., sleep fragmentation [frequent sleep interruption] and nocturnal/sleep movement [increased rates of movement, ‘tossing and turning’ during sleep]) and psychological distress (i.e., anxiety and perceived stress) with levels of physical activity (i.e., sedentary, light, and moderate to vigorous) in depressed rural patients with CHD.Methods:A total of 142 depressed rural CHD patients (aged 57.0±11.9 years, 97% White) completed surveys on demographic characteristics, anxiety (Brief Symptom Inventory), and stress (Perceived Stress Scale-4). Participants also wore accelerometer activity monitors for seven days (ActiGraph GT9X Link) to capture physical activity levels and sleep quality. Three different hierarchical regression models were conducted to predict each level of physical activity (sedentary, light, and moderate-vigorous) with predictor variables entered in blocks. Block 1 included demographic variables (i.e., age, sex, marital status, employment status). Block 2 included sleep quality measures, and Block 3 included psychological distress.Results:Participants spent 466±126.0 min/day while awake being sedentary, 483±119.9 min/day in light activity, and 90±65.9 min/day in moderate to vigorous activity. We found that stress was significantly associated with greater sedentary time (B = 6.56, p = .043) and less time in light activity (B = -7.99, p = .024). Nocturnal/sleep movement was significantly associated with increased sedentary time (B = 3.14, p < .001) and decreased time in light (B = -5.29, p =.002) and moderate-vigorous activity (B = -2.58, p = .003). Anxiety was not associated with physical activity.Conclusions:Poor sleep quality and greater perceived stress are associated with a more sedentary lifestyle, a major risk factor for CHD. Addressing both stress and sleep management may play a role in reducing CHD risks associated with inactivity among depressed rural patients with CHD.