Silencing Angiotensinogen Gene to Lower Blood Pressure

Hypertension is the number one cause of disability-adjusted life-years worldwide and the world’s leading risk factor for burden of disease and death. It is the most important risk factor for stroke and congestive heart failure, a major cause of kidney failure, and plays an important role in other forms of cardiovascular disease, including atherosclerosis and coronary artery disease. Hypertension affects approximately 48% of adults in the US and nearly 1 billion adults worldwide. Control of hypertension worldwide is dismal, and even in the US only 25% of adults achieve goal blood pressure (BP). BP elevations above 115/75 mm Hg are associated in a continuous fashion with the risk of fatal stroke, ischemic heart disease, and noncardiac vascular disease, and each increase of 20 mm Hg systolic BP or 10 mm Hg diastolic BP doubles the risk of a fatal cardiovascular event. Thus, achieving goal BP is critical to improve outcomes of patients with hypertension, and risk of CVD is significantly reduced by antihypertensive therapy. A 10 mm Hg lower systolic or 5 mm Hg lower diastolic BP results in a 40% reduction in stroke risk and a 30% reduction in ischemic heart disease risk. Control of BP to the therapeutic goal improves outcomes more than treating other chronic conditions, such as dyslipidemia.

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Marzo 2024

Abstract TP233: Cerebral Microbleeds Are More Frequent With BRCA Mutations: A Single-Center Retrospective Study

Stroke, Volume 55, Issue Suppl_1, Page ATP233-ATP233, February 1, 2024. Introduction:Breast cancer susceptibility gene (BRCA) mutations are well-known causes of systemic cancers. We have previously identified that those with BRCA mutations have a higher likelihood of cerebral microbleeds (CMBs) on brain MRI compared to BRCA wildtype. We aimed to confirm our prior findings in a subsequent cohort.Methods:We performed a single-center retrospective review of all individuals with a confirmed diagnosis of BRCA 1 or 2 mutation and a standard-of-care brain MRI. All individuals were ≥ 18 years old, without intracranial radiation, cerebral metastases, or other cerebral processes which may impact interpretation. Our comparative cohort were individuals with breast cancer who have a genetically confirmed BRCA wildtype status. The primary outcome was the presence of CMBs, defined by consensus criteria. Standard descriptive techniques were used. Likelihood ratios were calculated by binary logistic regression and adjusted for significant variables.Results:We identified 49 individuals who met inclusion criteria: 15 with BRCA mutation and 34 with BRCA wildtype. Only one patient was with aspirin use in the BRCA mutation cohort. All cancers were of breast origin with 4 BRCA mutations patients with cancer staging ≥ 3 compared with 14 in the BRCA wildtype cohort. Chemotherapy rates did not differ. Patients with BRCA were younger, less often with hyperlipidemia, and more commonly had CMBs, Table 1. The presence of BRCA mutation trended towards higher odds of having a CMB (OR 5.8, 95%CI 0.93 – 36.16,p= 0.059) after adjustment for age and hyperlipidemia.Conclusion:We found that CMBs were more common in the BRCA mutation cohort, with a trend towards a 5-fold higher likelihood in the regression analysis. While underpowered, our findings support prior data highlighting this association. Further studies with larger sample sizes are warranted.

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Febbraio 2024