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Circulation, Volume 150, Issue Suppl_1, Page A4122290-A4122290, November 12, 2024. Background:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure and cardiovascular mortality. However, SGLT2i therapy’s potential effects on the risks of dementia and Parkinson’s disease are not well established, with conflicting results based on observational studies.Objective:We sought to evaluate the association between SGLT2i and the risk of dementia and Parkinson’s disease in patients with type 2 diabetes mellitus (T2DM), heart failure, or chronic kidney disease.Methods:We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until March 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model.Results:A total of 12 RCTs with 74, 442 patients (40784 in the SGLT2i group and 33658 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control was 65.3 and 65.2 years respectively. The mean follow-up duration was 2.9 years. Pooled analysis showed that there is no significant association between SGLT2i and the risk of dementia (OR, 1.37 (95%CI: 0.70-2.69),P=0.36, I2=0%), dementia Alzheimer’s type (OR, 2.62 (95%CI: 0.47-14.49),P=0.27, I2=0), vascular dementia (OR, O.52 (95%CI: 0.09-2.98),P=0.46, I2=0%), and Parkinson’s disease (OR, 0.75 (95%CI: 0.25-2.25),P=0.61, I2=0%) was comparable between SGLT2i and control groups.Conclusion:Our study suggest that there is no significant association between SGLT2i and the risk of dementia, its subtypes, and Parkinson’s disease. Further large-power randomized trials are needed to strengthen the understanding of neuropsychiatric beneficial effects of SGLT2i.

Circulation, Volume 150, Issue Suppl_1, Page A4138617-A4138617, November 12, 2024. Introduction:Parkinson’s disease (PD) is a common neurodegenerative disorder, and existing evidence links it to cardiovascular (CVD) mortality.Research Question:Is the CVD-related mortality higher in PD patients compared to that in the general population?Goals:We aim to identify CVD-related mortality trends in patients with PD in the US stratified by age, sex, race, and region, and compare them to CVD-related mortality trends in the general population.Methods:Death certificates from the CDC-WONDER database were examined for adults aged ≥65 years. Crude rates (CR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and change in AAMR was estimated via annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint regression.Results:From 1999 to 2020, a total of 138,151 CVD-related deaths occurred in individuals with PD. The AAMRs decreased moderately till 2002 (APC: -3.25), then sharply till 2014 (APC: -5.43), but increased thereafter till 2020 (APC: 1.77). Males had higher AAMR than females, and the AAPC for CVD-related deaths in PD differed significantly from those in the general population. NH Whites displayed the highest AAMR (16.14) while NH Blacks or African Americans displayed the lowest (9.65). Hispanics or Latinos showed an AAMR of 11.22, followed by NH Asians or Pacific Islanders (10.24) and NH American Indians or Alaska Natives (9.70). AAMRs also varied substantially by region (West: 16.64; Midwest: 16.40; Northeast: 15.59; South: 13.12). States with the highest AAMRs were Nebraska, California, and Oklahoma. Rural regions exhibited a higher AAMR (16.34) than Urban regions (14.88). The AAPC for CVD-related deaths in PD differed significantly from those in the West and in urban regions. Most deaths occurred at nursing homes or long-term care (43.85%). The adults aged ≥85 years exhibited an alarmingly high CR (53.04), and the AAPC differed significantly from the general population due to CVD.Conclusions:We observed overall decreasing trends in CVD-related deaths in adults with PD from 1999 to 2014, which increased thereafter till 2020. Highest mortality was exhibited by males and NH Whites, residents of the West and the Midwest, and adults ≥85 years.

Circulation, Volume 150, Issue Suppl_1, Page A4146019-A4146019, November 12, 2024. Background:Parkinson’s disease (PD) is one of the most common neurodegenerative disorders, affecting more than one million persons in the United States. Cardiovascular dysautonomia is a prominent dysfunction in PD, affecting the conduction system and causing bradyarrhythmia. However, no studies have assessed the prevalence and characteristics of bradyarrhythmia in patients with PD.Research Question:Is there an increased prevalence of bradyarrhythmia and pacemaker implantation in patients with PD?Aims:The study assessed the trends, prevalence, and risk factors of bradyarrhythmia and pacemaker implantation in PD patients.Methods:The National Inpatient Sample was utilized to identify patients’ data with primary and secondary diagnoses of Parkinson’s disease (PD) in the United States from 2016 to 2020 using the International Classification of Disease, 10th Revision codes. Outcomes of interest included the trends and prevalence of bradyarrhythmia and pacemaker implantation in PD. We assessed potential predictors of bradyarrhythmia in patients with PD using a backward selection multivariable logistic regression.Results:A total of 333,242 patients with PD diagnosis were included (76.5 ± 15.2 years, 58.7% male, 80.1% white); of these, 5,092 (20.5%) had comorbid diagnoses of bradyarrhythmia, and 328,150 (79.5%) without bradyarrhythmia. The prevalence of bradyarrhythmia in patients with PD was 351.9 per 10,000 hospitalizations (3.5%). The trends of bradyarrhythmia showed a stable increase from 291.9 to 463.8 per 10,000 (AAPC 12.5%, CI: -0.2%, 26.8%). The overall prevalence of pacemaker implantation in patients with PD was 79.9 per 10,000 hospitalizations (0.8%). The overall trends of pacemaker implantation showed a stable decrease in patients with PD during 2016-2020, with an AAPC -0.9% (CI: -4.1% to 2.3%). Age≥ 65, male sex, comorbidities (atrial fibrillation, coronary artery disease, heart failure, hypertension, liver failure, obesity, peripheral vascular disease, renal failure) were associated with a higher likelihood of bradyarrhythmia in patients with PD.Conclusions:This study’s findings revealed that the prevalence of bradyarrhythmia and subsequent pacemaker implantation in patients with PD remained relatively stable over the study period. The study provides the initial prevalence of bradyarrhythmia in patients with Parkinson’s disease. Further study is necessary to provide the characteristics and outcomes of bradyarrhythmia in PD.