Mission: To promote the prevention of cardiovascular disease, advocate for the preservation of cardiovascular health, and disseminate high‐quality, evidence‐based information through the education of healthcare clinicians and their patients. We will continue to be a leading organization in Preventive Cardiology, globally providing resources and support, and serving as the conduit for other related organizations.
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Scientific Poster Abstracts Selected for the 2016 Congress on Atherosclerotic Cardiovascular Disease Prevention, Sept. 16–18, 2016, Boca Raton, Florida
2016 Abstracts Committee: Wilbert Aronow, MD; Amit Khera, MD; Stephen Kopecky, MD; Douglas D. Schocken, MD; Laurence S. Sperling, MD (Chair); James A. Underberg, MD
The American Society for Preventive Cardiology (ASPC) is pleased to announce that 40 abstracts were accepted for presentation in the poster format for the 2016 Congress on Atherosclerotic Cardiovascular Disease Prevention taking place Sept. 16–18, 2016, Boca Raton, Florida. Each abstract was reviewed by the ASPC Abstracts Committee prior to acceptance. Thanks to all of the authors who submitted abstracts for this year's poster hall.
2016 Young Investigators
ASPC would like to congratulate the outstanding winners of the 2016 Young Investigator Competition, whose entries were judged on the quality, clarity of science, and interest to the field of preventive cardiology.
1st Place: Micah T. Eades, MD: Coronary Artery Calcium Trajectory: Insights from the Dallas Heart Study. Abstract ID: 113
2nd Place: Nasir Hussain, MD: Long Term Effects of Changes in Cardiorespiratory Fitness on Incidence of Atrial Fibrillation/ Flutter, Stroke, and All‐Cause Mortality. Abstract ID: 105
3rd Place: Sherry‐Ann Brown, MD: A Network‐Based Approach to Behavior Modification for the Prevention of Cardiovascular Disease. Abstract ID: 123
Note: Young Investigator abstract titles are marked with an asterisk.* Encore abstracts are marked with a dagger symbol.†
The views and opinions expressed in the abstracts are those of the authors and do not necessarily reflect the views and opinions of the American Society for Preventive Cardiology and Clinical Cardiology. Abstracts appearing here may contain statements, opinions, and information that have errors in facts, figures, or interpretation. Accordingly, the American Society for Preventive Cardiology, Clinical Cardiology, and its editors are not responsible or liable for the use of any such inaccurate or misleading data, opinion, or information contained in the abstracts
100 ASSOCIATION OF EXTRA‐CORONARY CALCIFICATION AND CORONARY PLAQUE TYPES IN HIV SEROPOSITIVE AND SERONEGATIVE MEN: MULTICENTER AIDS COHORT STUDY*†
Panteha Rezaeian, MD; P. Elliott Miller, MD; Sabina Haberlen, PhD; Aryabod Razipour, MD; Hossein Bahrami, MD; Mallory Witt, MD; Lawrence Kingsley, PhD; Frank Palella, MD; Rine Nakanishi, MD; Suguru Matsumoto, MD; Anas Alani, MD; Lisa Jacobson, ScD; Wendy Post, MD; Matthew Budoff, MD
Abstract Topic: ASCVD in Special Populations
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Active Antiretroviral therapy (HAART) successfully helped the HIV‐infected individuals (HIV+) to live longer, but more are dying from age‐related illnesses such as cardiovascular disease (CVD). While well‐established studies showed extra‐coronary calcification (ECC) is the other indicator of atherosclerosis and it can predict the future cardiovascular disease, little is known about the association between extra‐coronary calcification and coronary plaque types in HIV+ population.
Objective/Purpose: To evaluate the association of extra‐coronary calcification and coronary plaque type in HIV Seropositive.
Methods: 764 men who have sex with men, including 453 HIV+ and 311 HIV‐uninfected (HIV‐) men in the Multicenter AIDS Cohort Study (MACS) were enrolled for this study. All of participant underwent non‐contrast computed tomography (CT) and coronary CT angiography (CCTA) from 2010–2013. Agatston scores were calculated for Mitral annular calcification (MAC), aortic valve calcification (AVC), aortic valve ring calcification (AVRC), and thoracic aortic calcification (TAC). CCTA images were analyzed using the modified 15‐segment model of the American Heart Association for plaque presence and extent, coronary artery stenosis, and plaque composition.
Results: Amongst those with AVC, HIV+ and HIV‐ participants similarly showed an increased odds of calcified plaque, mixed plaque, and stenosis > = 50%. However, HIV+ men showed a significantly higher presence of non‐calcified plaque compared with HIV‐ men (81.3% vs. 52.9%) amongst those with AVC. After adjustment for age and race, HIV+ participants with AVC were 2.2 times more likely to have non‐calcified plaque than those without AVC. A similar pattern was seen with HIV+ and HIV‐ men between those with AVRC and the presence calcified plaque, mixed plaque, stenosis > = 50%. As with AVC, HIV+ men with AVRC had a higher presence of non‐calcified plaque (79.8% vs. 50.5%). MAC was not associated with plaque type or extent in HIV‐ men or after adjustment in HIV+ men.
Conclusions: While AVC, TAC, and AVRC are associated with calcified and mixed plaques, independent of age and race, and regardless of HIV serostatus; AVC and AVRC are associated with non‐calcified plaque only in HIV+ men. Our findings suggest that presence of ECC may alert clinicians to possibility of higher risk plaque in HIV+ individuals.
101 CORONARY ARTERY DISEASE IN PRE TRANSPLANT END STAGE RENAL DISEASE PATIENTS
Ravi Jayanti, MD; Sanford Leff, MD; Devendra Shrivastava, MD
Abstract Topic: ASCVD in Special Populations
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The prevalence of coronary artery disease (CAD) in end stage renal disease (ESRD) patients is reported to be between 30–60% based on various screening modalities. Some studies also noted a higher incidence in white race.
Objective/Purpose: We studied the prevalence of significant coronary artery disease (stenosis >70%) based on cardiac catheterization in African American patients with ESRD awaiting renal transplantation.
Methods: A retrospective analysis was done on patients with ESRD who were candidates for renal transplant and consecutively referred for a pre transplant cardiac evaluation. All patients had a thorough history and physical examination, EKG, standard laboratory tests, CXR, Echo and stress myocardial perfusion imaging. Patients with increased risk factors or initial investigation suggestive of ischemic heart disease were referred for cardiac catheterization. Patients with stenosis > 70% on angiography were considered to have significant CAD. Patients who did not complete all the recommended investigations were excluded from the study.
Results: A total 395 patients were evaluated most of whom were African American; 55.7% were male and 44.3%female; mean age was 54.5 years; 81% received renal replacement therapy; mean duration of dialysis was 3.85 years; 82.7% had hypertension and 46.3% diabetes. Stress radionuclide myocardial perfusion imaging was suggestive of ischemic heart disease in 43% of patients. Based on above imaging and other risk factors, 193 patients were recommended for cardiac catheterization. All 193 patients underwent catheterization of which 72 patients had significant CAD and 121 had normal angiograms. Prevalence of significant CAD based on angiograms in the entire study population (395) was about 18.2% (95% CI:14.2 to 21.8%). RCA was the most common vessel involved.
Conclusions: Prevalence of significant coronary artery disease was high (18%) in pre‐transplant ESRD patients. Lower prevalence as compared to other studies could be due to higher angiographic parameter used to define CAD (stenosis >70% instead of 50%,) patients were already selected for transplant and had fewer comorbidities and/or African American ethnicity.
102 CHARACTERIZING FAMILIAL CHYLOMICRONEMIA SYNDROME: BASELINE DATA OF THE APPROACH STUDY
Blom DJ, Digenio A, Alexander VJ, Prokopczuk E, Hemphill L, Muniz O, Santos R, Witztum JL, & Baum S
Abstract Topic: ASCVD in Special Populations
Lead Author's Financial Disclosures: Advisor for IONIS/Akcea Therapeutics and clinical trial investigator for IONIS/Akcea Therapeutics.
Study Funding: The data presented in this study was funded by IONIS/Akcea Therapeutics.
Background/Synopsis: Familial Chylomicronemia Syndrome (FCS) is a rare, recessive genetic disorder caused by mutations in Lipoprotein Lipase (LPL) or genes required for LPL functionality. FCS is characterized by hyperchylomicronemia, recurrent abdominal pain, hepatosplenomegaly and recurrent episodes of acute pancreatitis that may result in pancreatic insufficiency. There are no FDA approved treatments for FCS and patients are managed with a low‐fat diet. Due to the rarity of FCS there are few case series describing phenotypic variability in this disorder.
Objective/Purpose: To describe demographic and clinical characteristics of adult FCS patients enrolled in a clinical trial.
Methods: We analyzed baseline data from 67 patients with FCS, participating in a Phase III study of volanesorsen (apoC‐III antisense oligonucleotide).
Results: Sixty‐seven patients with a mean age of 46 ± 13 years were enrolled. In 54 patients (80%) the diagnosis was confirmed genetically with LPL mutations accounting for 41 (81%) cases. The median age (P25, P75) at diagnosis was 27 (15, 36) years. Fifty four percent were female and 81% were Caucasian with a mean body mass index of 24.9 ± 5.7 kg/m2. Median fasting TG (P25, P75) were 2012 (1247, 3117) mg/dL despite 43% of patients receiving fibrates, 27% fish oils and 21% statins. Eruptive xanthomas and lipemia retinalis were identified in 15 (22%) and 14 (21%) of patients, respectively. Forty‐nine patients (73%) had a documented history of acute pancreatitis and among those, 27 patients experienced 83 pancreatitis events within the past 5 years. Twenty five percent of patients (17 out of 67) reported abdominal pain events during the 6–8 week screening period. Magnetic resonance imaging demonstrated that liver and splenic volumes were increased and that splenic volume had a mild inverse correlation with platelet counts (r = −0.1200, p = 0.0052). Postprandial TG clearance was severely impaired.
Conclusions: Our data confirm that TGs remain significantly elevated in most FCS patients despite dietary restrictions and TG‐lowering therapies and that FCS is frequently complicated by acute pancreatitis. A relatively late age of diagnosis suggests a likely under diagnosis and appreciation of this rare genetic disorder.
103 DETECT TO PROTECT: EARLY DETECTION TO ULTIMATELY PROTECT AGAINST STRUCTURAL AND FUNCTIONAL ABNORMALITIES IN UNTREATED, ASYMPTOMATIC SUBJECTS WITH LOW* CARDIOVASCULAR DISEASE RISK SCORE
Susan Tucker, RN, BSN; Arjun Byju; Mahfouz El Shahawy, MD, MS
Abstract Topic: ASCVD Prevention – Primary and Secondary
Lead Author's Financial Disclosures: Full time RN with SWFL Home Care.
Study Funding: None
Background/Synopsis: CVD is known to be an asymptomatic disease, often with its first symptoms being a myocardial infarction. Even with the knowledge that the disease itself starts in the adolescent years, insufficient early screening still plagues the medical field.
Objective/Purpose: To identify the prevalence of untreated, asymptomatic subjects whom are considered low risk (ie. a risk score of 1–2) as assessed by the Rasmussen Risk Score (RRS).
Methods: There were 2,490 subjects, ages 15–101, screened for or early indicators of cardiovascular disease using the RRS, which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise, CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro‐BNP. A total of 2,143 of the subjects were untreated and asymptomatic. Focus was placed on the four known tests recommended for early CVD assessment; C1, C2, abnormal rise in BP and CIMT. Alternative risk factors, of which are not part of the scoring system, were also screened, including: total cholesterol, LDL, HDL, fasting glucose levels, BMI and waist circumference.
Results: Twenty‐eight percent (594/2143) of the untreated, asymptomatic subjects screened were noted to have a 1–2 RRS. Of the 10 tests within the RRS, two were noted to be of more significant when it came to detecting early risks for CVD; abnormal rise in BP and CIMT.
Conclusions: Based on the data, early structural and functional cardiovascular abnormalities were noted in 28% of the untreated and asymptomatic subjects resulting in a low cardiovascular risk score of 1–2. Interestingly enough, of these 28% of patients that were noted to have a RRS of 1–2, the subjects were also noted to be at no risk according to the framingham risk score. Furthermore, the data concludes that early screening for CVD is crucial in disease detection and prevention, and can be done so by two inexpensive and noninvasive tests; abnormal rise in BP and CIMT. Almost all cardiovascular disease is preventable, but so far, none is curable. We must detect in order to protect.
104 URINARY 11‐DEHYDRO‐THROMBOXANE B2 AND MORTALITY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE
Anupama Vasudevan, BDS, MPH, PhD; Peter McCullough, MD, MPH; Mohanakrishnan Sathyamoorthy, MD, MS; Jeffrey Schussler, MD; Carlos Velasco, MD; Luis Lopez, MD; Caren Swift, RN, BSN; Margarita Peterson; Jenna Bennett‐Firmin; Raphael Schiffmann, MD, MHSc; Teodoro Bottiglieri, PhD
Abstract Topic: ASCVD Prevention – Primary and Secondary
Lead Author's Financial Disclosures: None
Study Funding: This study was supported in part by Corgenix Inc. and by the Baylor Health Care System Foundation.
Background/Synopsis: Anti‐platelet therapy with acetylsalicylic acid (ASA, aspirin) has been shown to reduce nonfatal myocardial infarction, stroke, and cardiovascular death amongst patients with coronary artery disease (CAD). ASA irreversibly inhibits platelet cyclooxygenase‐1 (COX‐1) and thromboxane A2‐mediated platelet aggregation, but there is variable suppression of COX‐1.
Objective/Purpose: We sought to evaluate the relationship between tertiles of urinary 11‐dehydro‐thromboxane B2 (11dhTxB2), an inactive metabolite of TxA2, and the risk of mortality in patients with stable CAD treated with ASA.
Methods: 449 CAD patients on ASA treatment were included in this retrospective analysis and the subjects were stratified by tertiles of urinary 11dhTxB2.
Results: There were 327 (73%) males and 122 (27%) females with a mean age (± SD) of 66.5 ± 10 and 65 ± 10.2, respectively. A significant positive linear trend for age was noted amongst the three tertiles of 11dhTxB2 (p‐trend = 0.01). A higher proportion of females (p = 0.001), chronic obstructive disease (p‐trend = 0.0003) and heart failure (p‐trend = 0.003) were observed in the upper tertiles of 11dhTxB2. Estimated glomerular filtration rate (eGFR) was not found to be different amongst the patients categorized by tertiles of 11dhTxB2 (p‐trend = 0.92). Sixty seven (14.9%) patients died over a median follow‐up of 1149 days. 26 (38.8%) non‐survivors were treated with P2Y12 receptor antagonists vs. 161 (42.2%) survivors (p = 0.61). By a stepwise Cox proportional hazards analysis, we identified that patients in the middle (HR = 7.14; 95%CI:2.46‐20.68) and upper tertiles (HR = 9.91; 95%CI:3.45‐28.50) of urinary 11dhTxB2 had a higher risk for mortality after adjusting for age and comorbidities including cancer, decreased ejection fraction and kidney function (eGFR).
Conclusions: Urinary concentrations of 11dhTxB2 are strong independent risk factors for all‐cause mortality among stable CAD patients on ASA therapy. These results suggest that aspirin resistance reflected by 11dhTxB2 may compel the clinician to consider additional antiplatelet therapy in these patients at high risk for death over the next five years.
105 LONG TERM EFFECTS OF CHANGES IN CARDIORESPIRATORY FITNESS ON INCIDENCE OF ATRIAL FIBRILLATION/ FLUTTER, STROKE, AND ALL‐CAUSE MORTALITY*
Nasir Hussain, MD; Stephen Kopecky, MD, FACC; Bernard Gersh, MB, ChB, DPhil; Thomas Allison, PhD, MPH, FACC
Abstract Topic: ASCVD Prevention – Primary and Secondary
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The benefits of regular exercise in improving cardiovascular health are well recognized; however, long‐term effects of changes in cardiorespiratory fitness (CRF) on the incidence of atrial fibrillation/flutter (A‐Fib/Flutter), stroke, and all‐cause mortality are less clear.
Objective/Purpose: In this study we have assessed the long‐term effects of changes in CRF on incidence of A‐Fib/Flutter, stroke, and mortality.
Methods: From 1993 through 2010, all patients undergoing treadmill exercise test (TMET) at the Mayo Clinic Integrated Stress Center, Rochester, MN were identified (N = 76,857). From this, Olmsted and neighboring counties residents and who had at least two TMETs were selected (N = 3,696). Patients with prior history of A‐Fib/Flutter, stroke or age < 18 years at time of second TMET were excluded. CRF expressed in form of functional aerobic capacity (FAC) was computed from age and sex‐specific TMET performances. Change in FAC per year was calculated by dividing FAC differences with the time difference between 2 tests. The subjects were divided roughly around tertiles of FAC change per year into three group; Gain: >2%, Stable: < 2% but > −2%, Loss: <−2%. Patients were prospectively followed for the outcomes from date of the second TMET. A‐Fib/Flutter and stroke were ascertained through retrospective chart review, mortality was based on Minnesota Death Index. Proportional hazard regression modeling was done to assess relationship of changes in FAC per year with the outcomes with adjustment for age, sex, baseline FAC, and other relevant clinical risk factors.
Results: Final study cohort comprised of 3,096 patients. During an overall median follow‐up of 13 (8 to 16) years, 407 (13.1%) patients developed A‐Fib/Flutter, 369 patients (11.9%) developed stroke, and 481 (15.5%) patients died. A 10% higher FAC at baseline was associated with 8%, 10%, and 17% lower risk of A‐Fib/Flutter, stroke, and mortality, respectively. Similarly, an interval increase of 10% in FAC resulted in 12%, 11%, and 18% A‐Fib/Flutter, stroke, and mortality risk reduction, respectively. When using patients with loss in CRF as referent, patient with gain in CRF had 26%, 39%, and 52% A‐Fib/Flutter, stroke, and mortality risk reduction, respectively.
Conclusions: Both baselines as well as change in CRF independently predict risk of incident A‐Fib/Flutter, stroke, and mortality.
106 EARLY STRUCTURAL AND FUNCTIONAL CARDIOVASCULAR ABNORMALITIES IN ASYMPTOMATIC SUBJECTS: MORE COMMON THAN ONE WOULD EXPECT*
Arjun Byju, BA; Susan Tucker, RN; Mahfouz Shahawy, MD, FACP, FESC
Abstract Topic: ASCVD Risk Assessment
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Background: Sub‐clinical atherosclerosis starts in childhood, yet screening for early risk stratification for cardiovascular disease (CVD) in asymptomatic subjects is significantly under‐performed.
Objective/Purpose: Purpose: To identify the prevalence and demographics of asymptomatic subjects with no CVD risk (ie. a 0 score) as assessed by the Early CVD Risk Score (ECVDRS) system, also known as the Rasmussen Risk Score (RRS).
Methods
Methods: We screened 2490 asymptomatic subjects, 79% of which (1974 of 2490) were between the ages of 40 and 70, for CVD risk using ECVDRS. ECVDRS consists of 10 tests: large (C1) and small (C2) artery stiffness, BP at rest and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro‐BNP. Comorbidities (CM) also measured include abnormal cholesterol, abnormal blood pressure, and obesity, defined by body mass index (BMI) and waist circumference.
Results: Only 11% (286 of 2490) of the subjects screened had a 0 risk score. The remaining 89% showed evidence of early CVD.
Conclusions: Based on our data, structural and functional CV abnormalities are very prevalent in asymptomatic subjects, given that only 11% of those screened had a 0 risk score. Accordingly, we recommend early screening and timely risk stratification to ensure the application of possible therapeutic interventions and guidance. We firmly believe that an ounce of early cardiovascular prevention is better than pounds of late cure.
Duprez et al. JASH 2011; 5: 401–409
107 COMPARING AND VALIDATING VARIOUS CORONARY HEART DISEASE PREDICTION MODELS USING A NATIONAL REPRESENTATIVE COHORT IN TAIWAN
Kuo‐Liong Chien, MD, PhD; Yu‐Yun Chen, MPH; Hung Ju Lin, MD; Ta‐Chen Su, MD, PhD; Hsiung‐Chin Hsu, PhD; Pei‐Chun Chen, PhD; Ming‐Fong Chen, MD, PhD
Abstract Topic: ASCVD Risk Assessment
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Predicting future coronary heart disease risk by model‐based approaches can facilitate to identify high‐risk individuals for prevention and management. However, evidence from comparing various prediction models, including clinical and biochemical models, Framingham risk chart, PROCAM chart and three Japanese cohorts, including Hisayama, Shita and NIPPON80 DATA, was scanty.
Objective/Purpose: We compared and validated various coronary heart disease prediction models using a national representative cohort in Taiwan.
Methods: A total of 3559 participants (> = 35 years old, 53.5% women) from a Taiwanese national representative cohort were followed up for a median 9.70 (interquartile range, 9.63‐9.74) years, 63 cases were documented as developing coronary heart disease events.
Results: The correlation coefficients are high, ranging from 0.80 to 0.93. The consistency measures by kappa statistics showed 0.47 for all 8 models, with a higher value for women than for men. The Shita model has the least absolute change of kappa value (1.6%), indicating the reliability of the Shita model was excellent. In addition, the areas under the receiver operating characteristics curves ranged from 0.804 (95% confidence interval, 0.758‐0.851) for total cholesterol model to 0.850 (95% confidence interval, 0.809‐0.891) for the Shita model. For calibration measures, the Shita model had the lowest chi‐square value (5.2), indicating the Shita model was the best goodness of fit model.
Conclusions: High consistency and predictive performance for the Japanese Shita model for screening and identifying individuals at high risk of coronary artery diseases. Further cross‐ethnic validation for the performance is warranted.
108 TIME TO RETIRE BMI: AN ASSESSMENT OF BODY MASS INDEX AND WAIST CIRCUMFERENCE AS PREDICTORS FOR STRUCTURAL AND FUNCTIONAL CARDIOVASCULAR ABNORMALITIES*
Arjun Byju, BA; Susan Tucker, RN; Mahfouz Shahawy, MD, MS, FACP, FE
Abstract Topic: ASCVD Risk Assessment
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Body Mass Index (BMI), a measurement based on an individual's height and weight, has long been used as a benchmark for obesity. In recent years, research has questioned the usefulness of BMI, particularly in predicting major CV events.
Objective/Purpose: To identify the utility of BMI and waist circumference (WC) in predicting the presence and severity of structural and functional CV abnormalities in asymptomatic patients, as assessed by the Early CVD Risk Score (ECVDRS) system, also known as the Rasmussen Risk Score (RRS).
Methods: We screened 2,490 asymptomatic subjects for CVD risk using ECVDRS, which consists of 10 tests: large (C1) and small (C2) artery stiffness, BP at rest and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro‐BNP. Comorbidities also measured, but not factored into the risk score, include abnormal cholesterol, abnormal blood pressure, and obesity, defined by BMI and WC.
Results: Both BMI and WC increased on average with increased risk level. The correlation coefficient (R) between a subject's RRS and BMI was 0.11, while the R between RRS and WC was 0.21.
Conclusions: Both BMI and WC are positively correlated with a subject's risk for structural and functional CV abnormalities. Of the two metrics, WC ought to be preferred as it has a correlation coefficient nearly twice as high as that of BMI (0.21 vs 0.11). Moreover, WC is more sensitive for predicting moderate to high risk for CVD. The mean waist measures for males and females were both higher than the normal values (40 and 35 inches, respectively) in the moderate and high‐risk populations. Nevertheless, the correlation coefficients for both BMI and WC are quite low, indicating that obesity metrics should not be used alone to predict CVD risk in asymptomatic subjects. Instead, we encourage early comprehensive screening as the best method for detecting structural and functional CV abnormalities in asymptomatic subjects, ensuring early therapeutic care and guidance.
109 NOVEL APPROACH FOR EARLY ASSESSMENT FOR CARDIOVASCULAR DISEASE BASED ON STRUCTURAL AND FUNCTIONAL ABNORMALITIES*
Antonella Sabatini, PE, MS; Mahfouz El Shahawy, MD, MS, FACP, FE
Abstract Topic: ASCVD Risk Assessment
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Early cardiovascular disease risk assessment in asymptomatic subjects has been controversial. Most risk scores have been based on epidemiologic data and not on individualized early structural and functional abnormalities
Objective/Purpose: To assess evidence for early cardiovascular structural and functional abnormalities in asymptomatic subjects.
Methods: We screened 2,406 asymptomatic subjects, age 20–79, for CVD risk using the Early Cardiovascular Disease Risk Scoring System (ECVDRS), which consists of 10 tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (PME), Carotid Intima Media Thickness (CIMT), abdominal aorta and left ventricle ultrasound (LVUS), retinal photography, micro albuminuria, ECG, and pro‐BNP. Abnormal blood pressure rise post mild exercise (BPrisePME) was defined as systolic BP rise >30mmHg post 3‐minute‐walk at 7% elevation, 2.5mph. Norm tension (NT), pre‐hypertension (pre‐HTN), and hypertension (HTN) were defined according to JCN7 criteria
Results: Among the 2,490 subjects, 1516 (61%) were not taking any CV medication. Among these subjects, 726 were stratified in the low risk group by the ECVDRS (Low ECVDRS).Total subjects 2,490 no Medications and Low ECVDRS 726 (29%); Hypertension 20 (3%); Abnormal BPrisePME 102 (14%); Abnormal C1 36 (5%), Abnormal C2 64 (9%); Left Ventricular Hypertrophy 39 (5%); Abnormal pro‐BNP 59 (8%); Abnormal CIMT 148 (20%)
Conclusions: Based on our data, the majority of asymptomatic subjects in our study are early intermediate to high risk (Intermediate ECVDRS and High ECVDRS). Even low risk group (Low ECVDRS) have evidence for structural and functional abnormalities. Accordingly we recommend early screenings and risk stratification with appropriate tools even in asymptomatic subjects to avoid disastrous progression of the disease. Remember, atherosclerosis starts in childhood; so, early screening for CV disease should be mandated by those who care about health, like mandated for mammography and colonoscopy.
110 WAIST TO HEIGHT RATIO AS A PREDICTOR OF EARLY STRUCTURAL AND FUNCTIONAL CARDIOVASCULAR ABNORMALITIES IN UNTREATED AND ASYMPTOMATIC SUBJECTS*
Arjun Byju, BA; Susan Tucker, RN; Mahfouz Shahawy, MD, MS
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Obesity is widely recognized as a risk factor for cardiovascular disease (CVD). Yet, opinions differ on which metric of obesity “Body Mass Index (BMI), waist circumference (WC), or waist/height ratio (WHR)” is the most useful at predicting CVD.
Objective/Purpose: To identify the utility of WHR, in comparison to BMI and WC alone, in predicting the presence and severity of structural and functional CV abnormalities in asymptomatic and untreated subjects, as assessed by the Early CVD Risk Score (ECVDRS), also known as the Rasmussen Risk Score (RRS).
Methods: We screened 2490 asymptomatic subjects, of which 1,491 were not taking any cardiac medications, using ECVDRS, which consists of 10 tests: large (C1) and small (C2) artery stiffness, BP at rest and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasound, retinal photography, microalbuminuria, ECG, and pro‐BNP. Comorbidities also measured, but not factored into the risk score, include abnormal cholesterol, abnormal blood pressure, and obesity, defined by BMI and WC. WHR was calculated by dividing each subject's waist by height, in inches.
Results: The average WHR in high‐risk women (0.57) was higher than that in the population of low‐risk women (0.52). For men, the average WHR was significantly higher in the high‐risk group (0.78) compared to those at low‐risk scores (0.55).
Conclusions: First, our findings indicate that WHR is positively correlated with structural and functional CV abnormalities, as measured by RRS. In untreated and asymptomatic subjects, the cutoff for normal WHR appears to be 0.6 for males and 0.55 for females. Above these values, subjects have, on average, moderate to high‐risk scores. Second, our results show that WHR is a more powerful predictive tool for males than for females. Thirdly, WHR is not significantly more robust than WC as a predictor of CV abnormalities, although it is more sensitive than BMI, alone. According to their BMI, many subjects with high‐risk scores are considered only mildly overweight; their WHR more appropriately recognizes them as high‐risk, allowing for timely therapeutic interventions and preventive guidance.
111 INCREASING THE DETECTION OF PERIPHERAL ARTERIAL DISEASE IN PRIMARY CARE*
Amber Makani, MD; Prashanth Thakker, MD; John Hornick, MD; Jun Li, MD; Sahil Parikh, MD
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The prevalence of peripheral arterial disease (PAD) is estimated to be 10–20% of the adult population; however, research has shown that the disease remains under‐diagnosed and undertreated in clinical practice. The presence of PAD confers an increased risk of cardiovascular morbidity and mortality, and identification of this at‐risk patient population is imperative to optimize medical therapy to prevent the advent of coronary disease.
Objective/Purpose: The objective of this research study is to establish the prevalence of PAD in the primary care setting, as well as increase internal medicine residents’ awareness of the disease presentation. Residents have been educated to improve history and physical exam skills to include the assessment of PAD in patients at risk for developing coronary atherosclerosis as well as to implement optimal medical therapy for primary and secondary prevention.
Methods: This is a non‐randomized, non‐blinded, interventional study to assess the incidence of PAD and clinical outcomes in the practice population seen in the internal medicine resident clinic. Enrolled patients are screened for PAD via the Edinburgh Claudication Questionnaire (ECQ). Patients who screen positive by the ECQ subsequently receive ankle‐brachial‐index testing (ABI). Those with an abnormal ABI of <0.9 or >1.4 in either lower extremity subsequently receive medical optimization. Planned 6‐ and 12‐month post‐intervention chart review will be performed to assess the impact of the intervention.
Results: Patient enrollment via ECQ questionnaire is ongoing and will soon be completed with a goal enrollment of 350 patients to undergo ECQ questionnaire. Data from a similar prospective, cohort study of veterans in internal medicine clinics at the Cleveland VA Medical Center (VAMC) noted the prevalence of PAD to be approximately 6%, with ECQ screening identifying 133% more patients at high risk for PAD than historical control, approximately 14% of the population (Li, et al). As our patient population is more diverse in gender, age, and risk factors, we anticipate that our results may be more generalizable to the primary care population.
Conclusions: Based on the literature available, as well as the data obtained from the pilot study performed at the VAMC, applying the ECQ questionnaire will likely increase the detection of patients with PAD and at risk for CAD. Given these likely findings, this will allow for aggressive risk factor modification to reduce the risk of progression or development of cardiovascular disease.
112 CORRELATION OF CARDIO‐ANKLE VASCULAR INDEX AND CARDIAC CT ANGIOGRAPHY MARKERS: A NOVEL NON‐INVASIVE METHOD TO DETECT SUBCLINICAL ATHEROSCLEROSIS*
Panteha Rezaeian, MD; Frank Gavini, MD; Aryabod Razipour, MD; Christopher Dailing, BS; Ferdinand Flores, BS; Yanting Luo, MSc; Matthew Budoff, MD
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Early detection of atherosclerosis is crucial since cardiovascular disease (CVD) is a main cause of death worldwide. Aortic pulse wave velocity (PWV) has been established as the gold standard for arterial stiffness measurement. Though, PWV depends on blood pressure (BP). The cardio‐ankle vascular index (CAVI) is a recently developed indicator of atherosclerosis to eliminate the BP dependency of PWV. We explored the relationship between cardio‐ankle vascular index (CAVI) as an indicator of arterial stiffness and CVD by using coronary computed tomography angiography (CCTA) in an asymptomatic population.
Objective/Purpose: To calculate correlation cardio‐ankle vascular index (CAVI) and coronary computed tomography angiography (CCTA) index of atherosclerosis in the coronary artery.
Methods: A total of 94 asymptomatic individuals prospectively underwent CAVI at time of CCTA. CCTAs were graded for obstructive CAD; plaque burden, calcification, and distribution. Plaque burden was evaluated by a total segment stenosis score (TSSS), which reveals stenosis severity. Total plaque segments score (TPSS) represents the sum of the plaque amount per segment; and segment‐involvement score (SIS) reflects the number of segments with plaque irrespective of stenosis severity.
Results: Participants were at age range of 48.3 ± 14.3 years. The degree of coronary artery calcification and stenosis demonstrated a significant correlation with CAVI for the CAC score, TSSS, TPSS and SIS all with p < 0.001, moreover, results remained significant after adjustment for potential confounders, including age, gender, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HL) all with p < 0.05.
Conclusions: CAVI positively reflects subclinical cardiovascular atherosclerosis, coronary artery calcification and coronary stenosis, and may be a useful screening method for assessing atherosclerotic in an asymptomatic population.
113 CORONARY ARTERY CALCIUM TRAJECTORY: INSIGHTS FROM THE DALLAS HEART STUDY*†
Micah Eades, MD; Colby Ayers, MS; Jarett Berry, MD; James de Lemos, MD; Amit Khera, MD;
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: The Dallas Heart Study was funded by the Donald W. Reynolds Foundation (Las Vegas, NV) and was partially supported by USPHS GCRC grant #M01‐RR00633 from NIH/NCRR‐CR.
Background/Synopsis: Coronary artery calcium (CAC) is one of the strongest cardiovascular event predictors. Most studies evaluate absolute CAC scores rather than CAC percentiles. The 2013 ACC/AHA guidelines recommend upgrading atherosclerotic cardiovascular disease (ASCVD) risk for a CAC score ≥ 75th percentile.
Objective/Purpose: Objectives were to firstly characterize the overlap of CAC ≥75th percentile, absolute CAC scores, and 10‐year ASCVD risk, and secondly to describe the stability of CAC ≥75th percentile over time.
Methods: The Dallas Heart Study (DHS) is a multi‐ethnic population cohort study of Dallas County adults divided into Phase 1 and Phase 2 with a median 6.7‐year interval. CAC scanning was by EBCT and MDCT respectively. Quantile regression was used to define 50th, 75th, 90th percentiles in a reference population of 968 DHS2 participants, excluding ESRD and CVD (MI, PCI, CABG, and CVA). Percentiles were applied to 699 participants, including men ≥ 45 years and women ≥ 50 years, with paired scans from both phases. The 2013 ACC/AHA risk calculator was used to stratify those ≥ 75th CAC percentile by 10‐year ASCVD risk category. The proportion of individuals remaining ≥ 50th, ≥ 75th, and ≥ 90th percentiles after the interval was assessed. Sensitivity analysis was performed using MESA study CAC percentiles and also using continuous percentiles rather than categories.
Results: Of those with CAC ≥75th percentile, 60% had a 10‐year ASCVD risk <7.5% and 76% had a CAC score <300 (threshold for statin initiation). After the interval, 76% of subjects remained ≥75th percentile and even more remained ≥90th. Percentile changes were nearly identical using MESA percentiles as reference. More than 80% remained at their percentile or higher when using continuous percentiles rather than categorical. Compared to those remaining ≥75th percentile, those decreasing percentile category had a lower 10‐year ASCVD risk, were less likely to have diabetes, and trended towards lower prevalence of statin use and hypertension.
Conclusions: A significant proportion of individuals with CAC ≥75th percentile do not qualify for statin treatment by absolute score or ASCVD risk alone. Most with CAC ≥75th percentile remain at that percentile or higher over approximately 7 years. CAC percentile stability may have implications for risk communication.
114 HIGH VOLUME OF UNCONTROLLED SEVERE AND FAMILIAL HYPERCHOLESTELOREMIA THROUGH A CENTRALIZED LABORATORY UNIT: AN OPPORTUNITY FOR INTERVENTION*
Lars Andersen, BA; Heidi Testa, BSN; Brian Stambaugh, MT; Tina Davis, CRNP; Rolf Andersen, MD;
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: 2013 ACC/AHA guidelines define adults with plasma LDL‐C ≥ 190 mg/dL as a statin‐benefit group independently of other risk factors due to high lifetime risk for ASCVD events (1). The US MEDPED criteria provide diagnostic criteria with high specificity for familial hypercholesterolemia (FH) in the general population based on baseline LDL‐C and age (2,3).
Objective/Purpose: We sought to determine the volume and percentage of patients with LDL‐C greater than 190 mg/dL or meeting US MEDPED general population criteria over time through a central laboratory unit as means of assessing the utility of laboratory‐based interventions to improve treatment for severe and familial hypercholesterolemia.
Methods: Lipid panel data from the LGH Laboratory Department were collected from all unique patients receiving a standard lipid panel (TC, HDL‐C, LDL‐C, triglycerides) or a direct LDL assay for a period of six consecutive months. Each subject's age at the time of lipid testing and sex were also collected. Unique subjects presenting with LDL‐C ≥ 190 mg/dL and subjects meeting US MEDPED general population criteria were recorded non‐exclusively.
Results: 47,775 unique subjects received lipid testing during the time period December 15, 2015 to June 15, 2016. 845 of 47,775 subjects (1.77%) presented at one time with LDL‐C ≥ 190 mg/dL, while 92 subjects (0.19%) met US MEDPED criteria. Most subjects (88.4%) were age 40 or older at the time at the time of lipid testing.
Conclusions: Previously, lipid testing of 6,375 local employees showed a prevalence of LDL‐C ≥ 190 mg/dL of 1.45%, a rate comparable to that detected in the present sample (1.77%), while a retrospective query of the LGH/Penn Medicine electronic health record showed a prevalence of MEDPED‐positive individuals of approximately 0.2%, an estimate closely reduplicated in the present data. In the present sample, an average of 4.6 unique patients per day displayed LDL‐C ≥ 190 mg/dL through a central laboratory, while one patient met MEDPED criteria every two days. The high volume of high‐risk individuals receiving lipid testing through a central laboratory highlights the potential of such laboratories as avenues for preventive intervention at the population level.
Reference
Stone NJ, Robinson JG, Lichtenstein AH, et al. J Am Coll Cardiol. 2014;63:2889–934. 2.) Williams RR, Hunt SC, Schumacher MC, et al. Am J Cardiol. 1993;72:171–6. 3.) Brown M, Goldstein, J. The New England Journal of Medicine. 1976;294:1386–1390.
115 ASSESSING THE PREVALENCE OF REPORTED PATHOGENIC VARIANTS IN LDLR IN THE EXOME AGGREGATION CONSORTIUM (EXAC) DATABASE*
Lars Andersen, BA; Lisa Estrella, MS; Rolf Andersen, MD
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Mutations in LDLR cause a majority of cases of familial hypercholesterolemia (FH) in which a pathogenic mutation can be detected, with over 1600 variants reported to date (1). The Exome Aggregation Consortium (ExAC) Database is an open‐access database of human whole‐exome sequences currently archiving over 60,000 subjects’ exome data.(2)
Objective/Purpose: We sought to determine the aggregate minor allele frequency (MAF) of reported pathogenic/likely pathogenic variants in LDLR within the ExAC database.
Methods: The NCBI ClinVar and the Leiden Open Variation (LOVD) databases (v.3.0) were queried for all variants in LDLR. The genomic locations (Assembly GRCh37), nucleotide substitutions, and reported pathogenicity were recorded for each variant. Rare variants (minor allele frequency [MAF] < 0.1%) indicated as “pathogenic” or “likely pathogenic” were compared with LDLR variants reported in the Exome Aggregation Consortium database browser (version 0.3.1) and the reported overall and subpopulation frequencies recorded
Results: The ExAC database included population MAF for 132 pathogenic/likely pathogenic LDLR variants reported in LOVD and 52 pathogenic/likely pathogenic variants reported in NCBI ClinVar. The combined MAF for the variants in the LOVD database was 0.00286, compared with 0.00168 for ClinVar. A majority of variants (69%) included in ClinVar were also included in the larger LOVD database, although most variants labelled ”pathogenic” (65%) in ClinVar were rated “likely pathogenic” in LOVD.
Conclusions: Exomic and genomic databases such as ExAC offer a new avenue for insight into the population prevalence of variants in LDLR associated with FH. Notably, the combined ExAC MAF of pathogenic/likely pathogenic variants in the large LOVD database, 0.286%, is comparable to the 0.230% recently estimated by the Copenhagen General Population Study for FH variants.(3) A significant discrepancy in both the total number of unique variants and variants reported in ExAC was noted between the NCBI ClinVar database and the LOVD LDLR database. Cross‐verification among databases recording pathogenic variants in LDLR may help mitigate such discrepancies in the future, particularly related to the ClinVar database frequently used a reference for investigators and physicians.
117 DEPRESSIVE SYMPTOMS, RATHER THAN DEPRESSION DIAGNOSIS ARE ASSOCIATED WITH WORSE OUTCOMES IN PATIENTS WITH CARDIOVASCULAR DISEASE*
Jamal Hajjari, MD; Salim Hayek, MD
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Depression is three times more common in patients with CAD and is associated with worse morbidity and mortality. While the association between depression and outcomes is well established, it is unclear whether a diagnosis of depression is associated with outcomes independently of the severity of depressive symptoms, and whether treatment of depression modifies that association.
Objective/Purpose: To determine whether a diagnosis of depression is predictive of all‐cause death independently of the severity of depressive symptoms and medical therapy.
Methods: 4948 patients underwent left heart catheterization (LHC) between 2004 and 2013 at Emory Healthcare sites and were recruited into the Emory Cardiovascular Biobank. Enrolled patients reported their medical history through questionnaires, and their medical records were reviewed to confirm a prior diagnosis of depression or treatment with antidepressants. Patients completed the Patient Health Questionnaire‐9 (PHQ‐9) to screen for depression. The PHQ‐9 scores categorized patients as not depressed (score of 1 to 4), mildly depressed (score of 5 to 9), moderately depressed (score of 10–14), moderate severe depression (score of 15 to 19), and severely depressed (score of 20 to 27). Patients were followed up for outcomes (median 4.5 years). Kaplan‐Meier survival analysis and Cox proportional hazard model were used to analyze the association between a history of depression, depressive symptoms, anti‐depressant therapy and all‐cause death.
Results: Mean age was 63 ± 12 years, 64% male, 76% white, 65% with CAD severity >50% in at least one coronary artery. A total of 1136 (23%) of patients carried an underlying diagnosis of depression, and 69% of those were on antidepressant therapy. 773 (16%) of patients had at least moderate depressive symptoms by PHQ‐9 (>10). Patients with PHQ‐9 > 10 had worse survival irrespective of an underlying diagnosis of depression or treatment status (Log‐Rank P < 0.001). In patients with PHQ‐9 < 10, there were no differences in survival in patients with and without a previous diagnosis of depression. In multivariable analyses adjusting for demographics, clinical characteristics, depressive symptoms and diagnosis; a PHQ‐9 score >10 was associated with a 2‐fold increase in the risk of all cause death.
Conclusions: Depressive symptoms, rather than a diagnosis of depression, was predictive of all‐cause death. These findings suggest that successful treatment of depressive symptoms may improve prognosis of patients with depression.
118 EVIDENCE‐BASED CARDIOVASCULAR RISK REDUCTION FOR LONG‐TERM PATIENTS AT OAK HILL HEALTH AND REHABILITATION CENTER*
Umama Gorsi, MD; Feras Al Shami, MD; Salaheldin Elhamamsy, MD; Mohamad Barbour, MD;
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Coronary artery disease (CAD) is highly prevalent in nursing home residents and is associated with a substantial clinical and economic burden. It is the leading cause of death among this group of patients with the prevalence of CAD estimated to be in excess of 40%. In the year 2000 alone, nursing home costs related to CAD were estimated at $15.1 billion. Thus, efforts to reduce symptomatic CAD may be particularly important in elderly patients in nursing home settings.
Objective/Purpose: Our aim is to improve coronary risk reduction efforts by implementing the JNC 8 hypertension guidelines, ADA recommendation for Diabetes Mellitus, and ACC AHA 2013 Cholesterol ASCVD risk reduction guidelines.
Methods: Retrospective analysis of 82 patient's chart was done to recognize patients with hypertension, Diabetes Mellitus, and patient's eligibility for statin medication as a primary or secondary prevention of ASCVD. We specifically identified patients with abnormal blood pressure readings, patients with abnormal kidney function tests, diabetic patients with “over the goal” HbA1C readings, diabetic patients with outdated HbA1C readings (more than six months), or diabetic patients who had never been tested for HbA1C. The ASCVD 10‐year risk estimates were evaluated by using the pool cohort risk calculator provided by the American Heart Association. All guidelines recommendations were implemented on our patients in an effort to decrease the number of patients who are receiving poor quality of care.
Results: Our intervention decreased the number of patients with uncontrolled hypertension from 16 to 9, uncontrolled Diabetes Mellitus from 18 to 5, and patients not receiving statin despite indication from 26 to 10.
Conclusions: In order to provide better care and management of the risk of coronary and other arterial diseases, understanding the new guidelines and implementing them is important. Results have showed the efficacy of the new recommendations and proven their roles in decreasing the risk for coronary and other vascular disease.
119 AN IN DEPTH ANALYSIS AND RESEARCH REVIEW OF PSYCHOLOGICAL AND CARDIOVASCULAR RISK FACTORS: EXAMINING THE ROLE OF HOMOCYSTEINE IN MENOPAUSAL WOMEN*
Akeeka Davis, MBA ,BSHCS, BSN, RN; Tiffany Head, MSM, BSC (PSYCH)
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: An accurate, noninvasive serum test, (Homocysteine) could improve the effectiveness of Cardiovascular Health Screening. A biological and psychological approach was examined by way of a Comparison Effectiveness Research Review. Heart Disease is the leading killer for women and has been for several decades. A decline in the natural hormone estrogen may be a factor in heart disease increase among post‐menopausal women. Despite advances in the development of evidence‐based screening tools, challenges remain in aggregating the research into recommendations for practice. Provider education and collaboration across healthcare teams can foster an environment that will allow the patient to have a voice in deciding what test will be best for them.
Objective/Purpose: Women are disproportionately affected by Heart Disease and the American Heart Association states that more than one in three female adults has some form of cardiovascular disease. An overall increase in heart attacks among women is seen about 10 years after menopause. Heart Disease is the leading killer of women; psychological changes that occur in women during this time in their life that can give rise to heart disease is stress, depression, weight gain and development of chronic and acute illnesses that truly warrant further investigation of proactive approaches within the clinical setting.
Methods: A Comparison Effective Research Review of 75 scholarly articles were carefully examined and analyzed.
Results: A comparison of Homocysteine serum testing and Psychological Impairments are as follows. After synthesizing the data it was found that women who received no treatment for elevated biomarkers such as Homocysteine were likely to develop Heart Disease within a 10 year time frame (P = 0.002). Comorbidity diagnosis that also give rise to heart disease such as depression, acute and chronic stress greatly affected increase risk factors for heart disease that may be hard to control for (P < 0.001).
Conclusions: There are no perfect tests, however we must trust the science and let the evidence drive our clinical decision making. However if a patient is not given options regarding the risks and benefits of various approved screening tests then care is compromised and the end state could result in negative patient outcomes.
120 STATIN USE IN ADULTS WITH DIABETES BEFORE AND AFTER GUIDELINES REVISIONS FROM LEADING MEDICAL ASSOCIATIONS†
Joanna Mitri, MD, MS; Om Ganda, MD; Robert Evers; Heather Zacker, MPH; Robert Gabbay, MD, PhD; Sanjeev Mehta, MS, MPH
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: National Dairy council
Study Funding: None
Background/Synopsis: The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol and 2015 ADA guidelines recommend statin for all patients with diabetes,40‐75 years and LDL‐C ≥ 70mg/dl. NLA's 2014 recommendations for patient‐centered management of dyslipidemia recommend use of statin in diabetes if there are 0–1 major ASCVD risk factors (RF) and LDL‐C ≥ 100mg/dl, or ≥ 2 RF and LDL‐C ≥ 70mg/dl, or evidence of end‐organ damage and LDL‐C ≥ 70mg/dl. The impact of guidelines on prescribing statins in diabetes is uncertain.
Objective/Purpose: To describe the prescribing patterns of statins in adults with diabetes before and after guidelines revisions.
Methods: This cross‐sectional study analyzed a convenience sample of patients with diabetes from 77 practices seen at least twice within an 18‐month period to evaluate changes in statin use before (pre‐2014) and after (post‐2014) 2014. Patients with available LDL‐C were included. LDL‐C was categorized as <70mg/dl,70‐99mg/dl and ≥ 100mg/dl. Statin use was defined as currently taking statin at time of visit. The outcome of interest is odds ratio (OR) with 95%CI of taking statin. Multivariate logistic regression models were used adjusting for age, sex and LDL‐C levels. STATA 13.1 was used for all calculations. P < 0.05 was used for statistical significance.
Results: A total of 47,661 patients [pre‐2014 = 38,611(43% men); post‐2014 = 9,050(46% men)] was assessed. Median age was 59 years (range18‐79) versus 64 years (18–79), median LDL‐C was 86mg/dl (15–480) versus 76mg/dl (15–359) and proportion of statin use was 67% versus 69% in pre‐2014 versus post‐2014 respectively.In age‐ and sex‐adjusted multivariate analysis, statin use was lower post‐2014(OR 0.77, 95%CI 0.71‐0.85, p < 0.001) when LDL‐C < 70mg/dl, unchanged for LDL70‐100mg/dl,(OR1.02, 95%CI 0.93‐1.11;p = 0.72), and lower when LDL‐C ≥ 100 (OR 0.89; 95%CI 0.81‐0.97; p = 0.01). In the multivariate analysis adjusted for sex and LDL‐C level, statin use was unchanged post‐2014 in <40yr (OR 0.88, 95%CI 0.71‐1.01;p = 0.28), lower in 40‐75yr (OR 0.91,95%CI 0.86‐0.96; p = 0.001), and lower in >75yr (OR 0.72, 95%CI 0.61‐0.86; p < 0.001).
Conclusions: Since 2014, the odds of statin use in adults with diabetes is lower in general. Findings were consistent among younger and older adults. Despite greater consistency among national guidelines for statin use, adoption by endocrinologists and PCPs remains suboptimal. Patient and provider factors that could limit statin use in adults with diabetes, such as patient tolerance or adherence, physician education, and co‐morbidities, warrant further evaluation.
121 OBESITY, EVEN WITHOUT OTHER KNOWN CARDIOVASCULAR RISK FACTORS, IS A DISEASE, REGARDLESS OF AGE AND GENDER*
Susan Tucker, RN, BSN; Mahfouz El Shahawy, MD, MS
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Obesity is a disease, regardless of gender, that often leads to other co‐morbidities such as diabetes, hypertension and hyperlipidemia.
Objective/Purpose: To identify the prevalence of early functional and structural cardiovascular abnormalities in untreated, asymptomatic, obese subjects as determined by the Early CVD Risk Score (ECVDRS), also known as the Rasmussen Risk Score (RRS).
Methods: A total of 2,490 subjects, ages 15–101, were screened for early indicators of cardiovascular disease using the RRS, which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise, CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro‐BNP. A total of 2,143 of the subjects were untreated and asymptomatic. The untreated and asymptomatic subjects were then separated based on their age, gender and BMI to further evaluate the efficacy of the above testing, with primary focus on C1, C2, BP post mild exercise and CIMT.
Results: The prevalence of early functional and structural abnormalities in obese male and female subjects continued to increase as the subjects ages increased. Male subjects, whose age ranged less than 50 years old had an average RRS of 3, where those males who were older than 50 years old had an average RRS of 6. Female subjects, whose age ranged less than 50 years years old had an average RRS of 2, whereas those females who were older than 50 years old has an average RRS of 5. Based on the data, early structural and functional cardiovascular abnormalities were noted in 100% of the untreated and asymptomatic obese males, and 97% of the untreated and asymptomatic obese females.
Conclusions: Based on our data, obesity, without any other known cardiovascular risk factors, is a disease. The data provides evidence that a healthy weight at a young age is crucial for preventing future cardiovascular disease. Your Health Can't Wait to Lose Weight!
122 EFFICACY OF COMBINED ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH METABOLIC SYNDROME*
A.L. Alyavi, J.K. Uzokov
Abstract Topic: ASCVD Risk Factors
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Hypertension is the one of the most common risk factor of coronary heart disease in patients with metabolic syndrome. Over the last few decades, a number of classes of anti‐hypertensive drugs have been used to treat hypertension, with the ultimate goal of reducing the incidence of endpoints such as heart attacks and stroke.
Objective/Purpose: Aim of this study was to assess efficacy of monotherapy with ACE inhibitor lisinopril or I1‐imidazoline receptor agonist moxonidine and their combination in patients with MS.
Methods: The study enrolled 57 patients (31 females, 26 males; mean age 52 ± 9.6 years old) with MS. All patients were divided into 3 groups with 19 patients per group. The first group 5.0 mg lisinopril, the second group 0.2 mg moxonidine and the third group 5.0 mg lisinopril and 0.2 mg monoxidine were provided. The examination at baseline and after 4, 8, and 12 weeks of treatment included office blood pressure (BP) measurement, 24‐hour BP monitoring, heart rate variability (HRV), parameters of lipid profile and fasting blood glucose estimation.
Results: In moderate hypertension BP normalized in 47.3% and 57.8% on monotherapy with lisinopril or moxonidine, respectively (P < 0.02), and in 89.4% patients given lisinopril + moxonidine (P = 0.002) after 12 weeks treatment. No changes of lipid profile occurred in the first group of patients while significant elevation of high density lipoprotein cholesterol and tendency to lowering of triglyceride level were observed in second and third groups.
Conclusions: Combined treatment with lisinopril and moxonidine is more effective than monotherapy with each of the above drugs in patients with metabolic syndrome. Further confirmations are required.
123 A NETWORK‐BASED APPROACH TO BEHAVIOR MODIFICATION FOR THE PREVENTION OF CARDIOVASCULAR DISEASE*
Sherry‐Ann Brown, MD, PhD; Iftikhar Kullo, MD
Abstract Topic: ASCVD Risk Reduction
Lead Author's Financial Disclosures: None
Study Funding: This study was part of the NHGRI‐funded supported eMERGE (Electronic Records and Genomics) Network (U01HG04599 and U01HG006379).
Background/Synopsis: In social networks, individuals who most actively exchange information with others are central nodes or hubs, and are considered most influential in disseminating recommendations that they adopt themselves.
Objective/Purpose: We hypothesized that disclosing genetic risk for coronary heart disease (CHD) positively impacts health behaviors in central nodes.
Methods: In the Myocardial Infarction Genes trial, participants (n = 203) aged 45–65 years at intermediate CHD risk based on conventional risk factors and not on statins were randomized to receive their conventional risk score (CRS) or also a 28‐variant genetic risk score (GRS), in meetings with a genetic counselor and then a physician. Individuals exhibiting high levels of information exchange online and via interpersonal communication were identified as central nodes; remaining individuals were considered peripheral nodes. Surveys assessing physical activity and intention to change dietary habits (transitioning from precontemplation/contemplation to preparation/action/maintenance) were completed following risk disclosure and three months post‐disclosure. We assessed whether these behaviors differed between central and peripheral nodes or by GRS disclosure. Data were reported as odds ratio with confidence interval, with significance determined by regression analysis.
Results: Upon risk disclosure, central nodes in the GRS group were more likely than GRS peripheral nodes to report intention to avoid high‐fat food (OR 3.29, CI 1.3‐8.9, p = 0.01). Central nodes with high GRS were more likely than peripheral nodes with high GRS to report intention to avoid high‐fat food (OR 4.94, CI 1.48‐17.99, p = 0.01). Three months post‐disclosure, central nodes with high GRS were more likely than peripheral nodes with high GRS to report avoiding high‐fat food (OR 5.2, CI 1.39‐25.82, p = .01) and eating a high‐fiber diet (OR 6.79, CI 1.04‐135.89, p = 0.045). Central nodes in the GRS group were more likely than CRS central nodes (OR 3.73, CI 1.11‐13.68, p = 0.03), and central nodes with low GRS were more likely than peripheral nodes with low GRS (OR 4.28, CI 1.06, p = 0.04), to report vigorous exercise at three months post‐disclosure, but not six months post‐disclosure.
Conclusions: GRS disclosure transiently increased health behaviors important for CHD risk reduction in central nodes that could propagate in their social networks. Further studies could investigate strategies for improving maintenance.
124 THE IMPACT OF RECENT GUIDELINES ON TREATMENT OF LIPID DISORDERS ON THE DIAGNOSIS AND TREATMENT OF FAMILIAL HYPERCHOLESTEROLEMIA
Lynne Palma, DNP, FNP‐BC, CDE
Abstract Topic: ASCVD Risk Reduction
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Treatment of Familial Hypercholesterolemia (FH) can change the natural course of the disease to prevent premature atherosclerotic cardiovascular disease (ASCVD). New guidelines assist clinicians in the early identification of this common genetic disorder of lipid metabolism by placing individuals with elevated lipoprotein cholesterol (LDL‐C) levels in high risk groups who benefit from treatment with statins.
Objective/Purpose: The purpose of this presentation/poster is to discuss the prevalence, pathophysiology, clinical manifestations, screening, diagnosis, and treatment recommendations of this genetic disorder of lipid metabolism known as FH using current evidence based guidelines from the ACC/AHA and the National Lipid Association.
Methods: Application of Guidelines to Clinical Practice: The American College of Cardiology (ACC)/American Heart Association (AHA) and the National Lipid Association (NLA) recognize that patients with LDL‐C elevations > 190 mg/dL in adults and > 160 mg/dL in children most often represents FH and this clarifies the diagnosis and paves the way for life‐saving treatment in these high risk patients. It is important to understand that if the patient is in a high‐risk group, such as a patient with ASCVD, diabetes mellitus, and FH defined as an LDL‐C 190 mg/dL or greater, no further risk assessment is needed and treatment with high intensity statins is recommended. In other words, the 10‐year ASCVD risk in the patient with FH is not adequately predicted by any conventional risk assessment tools, and thus not needed or recommended.
Results: N/A
Conclusions: Although obvious to specialists, primary care clinicians and pediatricians maintain an important role in the identification and treatment of patients with FH. A clear understanding of the guidelines is essential in order to avoid suboptimal care. A genogram to elicit a family history, the importance of cascade screening, as well as treatment recommendations are provided in this poster.
125 LIPOPROTEIN INSULIN RESISTANCE (LPIR) SCORE VS STANDARD MEASURES OF INSULIN RESISTANCE IN YOUTH†
Luke Hamilton, MS; Alejandro de la Torre, MD; N‐Anh Le, PhD; Don Wilson, MD;
Abstract Topic: Diabetes
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The incidence of “pre‐diabetes” and type 2 diabetes mellitus (T2D) has risen sharply over the past 10 years. Early identification and effective intervention of children who are insulin resistant may prevent the development of T2D. The LPIR score, with values ranging from 0 (most insulin sensitive) to 100 (most insulin resistant), may provide a convenient and clinically useful measure of IR and allow early detection of those at risk of developing T2D.
Objective/Purpose: We evaluated the relationship between LPIR and standard measures of insulin resistance: fasting plasma glucose (FPG), 2 hour plasma glucose (2HPG), hemoglobin A1c, and HOMA‐IR. FPG and 2HPG were obtained during a standard 2 hour oral glucose tolerance test (OGTT). We then evaluated the relationship between low (<27), borderline (27–63), and high (>63) LPIR scores with other lipid markers, including LDL‐C, HDL‐C, triglycerides (TG), and total cholesterol (TC) in two sub‐populations: subjects with a normal A1c (<5.7%) and subjects with A1c in the “pre‐diabetic” range (5.7‐6.4%) as defined by the American Diabetes Association.
Methods: This is a retrospective chart review of 420 patients seen at Cook Children's Cardiovascular Health and Risk Prevention Clinic.
Results: LPIR did not correlate with FPG, A1c, and HOMA‐IR, and only moderately correlated with 2HPG. When comparing low, borderline, and high scores within the normal and “pre‐diabetic” A1c subpopulations, LPIR correlated with both HDL‐C and TG. Although not reaching statistical significance, LPIR was also associated with changes in levels in LDL‐C and TC.
Conclusions: Results indicate that while LPIR scores cannot be used as a diagnostic criteria for “pre‐diabetes” or T2D, an elevated LPIR score seems to indicate a predisposition to develop diabetes. Dyslipidemia is well documented in individuals with T2D.2, 3 Dyslipidemia that correlates with changes in the LPIR score appear to occur as a continuum, and are present before changes in A1c that are considered to be “pre‐diabetic.” Thus, our results indicate that abnormalities in lipid or lipoprotein metabolism may precede diagnostic abnormalities in glucose and insulin metabolism, which could lead to earlier recognition and intervention with the aim of prevention.
126 ASSOCIATION OF COMPUTED TOMOGRAPHY MARKERS OF ADIPOSE TISSUE AND CARDIAC CALCIFICATION IN PATIENTS WITH TYPE 1 DIABETES MELLITUS: A REPORT IN EDIC STUDY*
Panteha Rezaeian, MD; Jye‐Yu Backlund, MPH; Aryabod Razipour, MD; Frank Gavini, MD; Ionut Bebu, PhD; John Lachin, ScD; Matthew Budoff, MD; the DCCT/EDIC Research Group
Abstract Topic: Diabetes
Lead Author's Financial Disclosures: None
Study Funding: Grants from Division of Diabetes Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Disease.
Background/Synopsis: Type 1 diabetes mellitus (T1D), obesity, and metabolic syndrome (MetS) are associated with cardiovascular disease (CVD). Epicardial Adipose Tissue (EAT) and Intrathoracic Adipose Tissue (IAT) predict severity of coronary atherosclerosis in the general population. Moreover, coronary artery calcium (CAC), aortic valve calcification (AVC), and descending aorta calcification (DAC) have been acknowledged as manifestations of severity of atherosclerosis.
Objective/Purpose: To explore association of Metabolic Syndrome (MetS) with cardiac adipose tissue and cardiovascular calcification in patients with long‐standing T1D.
Methods: A cohort of 100 T1D subjects was selected from 1205 patients who underwent non‐enhanced cardiac CT scans in Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study. EAT and IAT were measured as all pixels with density of −30 to −190 Hounsfield Units (HU). CAC, AVC, and DAC were computed using the Agatston method as three contiguous pixels with a density over 130 HU which was qualified as an atherosclerotic plaque. MetS was defined according to the National Cholesterol Education Program diagnostic criteria. All analyses were weighted using the inverse of the probability of selection to yield unbiased estimates. The associations between fat and calcification with MetS were evaluated using multiple linear regression models (EAT, IAT) and logistic regression models (CAC, AVC, DAC; >0 Agatston unit vs. 0), respectively.
Results: 78 males and 22 female middle age (32–57 years) patients with TD1 were studied. The mean EAT and IAT was 38 and 51 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6%, 4.7%, and 26.8%, respectively. Patients with larger BMI had significantly higher EAT and IAT (both p <0.001) and AVC (p = 0.0337). Patients with MetS had significantly greater EAT (mean difference 18.2 ± 5.0 mm3; p = 0.0004), IAT (mean difference 25.7 ± 7.4 mm3; p = 0.0008), and DAC (odds ratio, 95% CI: 4.57; 1.17, 17.85 p = 0.0292) after adjusting for demographic and mean HbA1c during DCCT/EDIC.
Conclusions: In current study in TD1, MetS was significantly associated with higher EAT, IAT, and DAC, but no significant association was found between MetS with CAC or AVC, however, more studies in the full cohort are required for further interpretations.
127 DEPRESSIVE IMPAIRMENTS IN PATIENTS WITH METABOLIC SYNDROME*
Anis Alyavi; Jamol Uzokov, MS;
Abstract Topic: Metabolic Syndrome
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Metabolic syndrome (MetS) is a condition linking insulin resistance, dyslipidemia, hyperglycemia, and hypertension that increases the risk of developing diabetes, cardiovascular disease, and subsequent cardiovascular morbidity and mortality. Among patients with MS both genders were shown to be associated with psychosomatic impairments including depression. Therefore recent position papers recommend early screening of symptoms of depression to optimize medical therapy and improve secondary prevention.
Objective/Purpose: The aim of the study was to define the incidence of depression in patients with MetS.
Methods: The study was carried out on 120 patients (aged: 45–62; mean age 49 ± 8.5; m = 56%) with MetS in the Republican specialized scientific‐practical medical center of therapy and medical rehabilitation. MetS was diagnosed according to “Harmonized” definition criteria of the syndrome. To define the depression was used Center for Epidemiologic Studies Depression Scale (CES‐D). Anthropometric data, laboratory data, office blood pressure and CES‐D were performed were calculated. Statistical comparisons were performed by 2 tailed Student's t test for quantitative parameters.
Results: Prevalence of depressive disorders among patients with MetS is consisted of 40%. A higher number of components of the MetS correlate with higher severity of the depression. Depressive symptoms were associated to a higher insulin resistance, low levels of C‐HDL, hypertension.
Conclusions: Prevalence of depressive impairments among patients with MetS is high and its associates with a higher number of metabolic disturbances.
128 IMPACT OF CARDIORESPIRATORY FITNESS ON INCIDENT ATRIAL FIBRILLATION, INCIDENT STROKE AND ALL‐CAUSE MORTALITY IN A REFERRAL POPULATION*
Nasir Hussain, MD; Bernard Gersh, MB, ChB, DPhil; Karina Carta, MD; NÃ3ra SydÃ3, MD; Francisco Lopez‐Jimenez, MD, MSc; Stephen Kopecky, MD; Randal Thomas, MD; Samuel Asirvatham, MD; Thomas Allison, PhD, MPH
Abstract Topic: Nutrition/Exercise
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The benefits of regular exercise in improving cardiovascular health are well recognized; however, the impact of cardiorespiratory fitness on the incidence of atrial fibrillation (A‐Fib) and stroke, and, in particular, how it affects the risk of stroke and mortality in patients with A‐Fib is less clear.
Objective/Purpose: In this study, we have assessed the relationship between functional aerobic capacity (FAC), a practical and objective measure of cardiorespiratory fitness, and incident A‐Fib, stroke, and all‐cause mortality.
Methods: From 1993 through 2010, all patients undergoing a clinically indicated treadmill exercise test (TMET) at the Mayo Integrated Stress Center, Rochester, MN were retrospectively identified (N = 76,857). From this, 14,094 residents of Olmsted and neighboring counties were selected. Patients were excluded for: age < 18 years; prior history of congestive heart failure, structural/ valvular heart disease, A‐Fib/ flutter, or stroke; or TMET protocol other than standard Bruce or accelerated Naughton. FAC was calculated from age and sex‐specific TMET performances. The subjects were divided into 4 fitness groups at baseline based on quartiles of FAC and were prospectively followed until end of January 2016. Proportional hazard regression modeling was done to assess relationship of FAC with the incident A‐Fib, stroke, and mortality outcomes with adjustment for age, sex, and relevant clinical factors.
Results: Final study cohort was comprised of 12,043 patients. During an overall median follow‐up of 14 (9 to 17) years, 1,222 patients developed incident A‐Fib, 1,128 developed stroke, and 1,590 patients died. Each increase of 10 percent in FAC was associated with a decrease in the risk of incident A‐Fib, stroke, and mortality by 7% [0.93(0.91‐0.96, p < .001)], 8% [0.92(0.89‐0.94, p < .001)], and 16% [0.84(0.82‐0.86, p < .001)], respectively. In the subset of patients who developed incident A‐Fib and had baseline FAC <75%, the risk of both stroke [1.40(1.04‐1.90, p = .01)] and mortality [3.20 (2.11‐4.58, p < .001)] was significantly higher as compared to A‐Fib patients with baseline FAC > 105%.
Conclusions: Better cardiorespiratory fitness is associated with a lower risk of incident A‐Fib, stroke, and mortality. Similarly, the risk of stroke and mortality in patients with A‐Fib is also inversely associated with cardiorespiratory fitness.
129 CORONARY ARTERY DISEASE IN PATIENTS WITH BODY MASS INDEX ≥ 30 KG/M*
Hassan Alkhawam, MD; James Nguyen, MD; Jason Sayanlar, MD; David Rubinstein, MD
Abstract Topic: Obesity
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: A number of modifiable risk factors (smoking, HLD) and non‐modifiable risk factors (gender, age) have well established association with CAD, whereas other potential individual risk factors (such as obesity) are less well established.
Objective/Purpose: In this study, we evaluated obesity as a single risk factor for coronary artery disease (CAD), along with the synergistic effect of obesity and other risk factors.
Methods: A retrospective study of 7,567 patients admitted to hospital for chest pain from 2005–2014 and underwent cardiac catheterization. Patients were divided into two groups: obese and normal with body mass index (BMI) calculated as ≥ 30 kg/m2 and <25, respectively. We assessed the modifiable and non‐modifiable risk factors in obese patients and the degree of CAD.
Results: Of the 7,567 patients who underwent cardiac catheterization, 414 (5.5%) had a BMI ≥ 30. Of 414 obese patients, 332 (80%) had evidence of CAD. Obese patients displayed evidence of CAD at the age of 57 versus 63.3 in non‐obese patients (p < 0.001).9–12 Of the 332 patients with CAD and obesity, 55.4% had obstructive CAD versus 44.6% with non‐obstructive CAD. In obese patients with CAD, Male gender and history of smoking were major risk factors for development of obstructive CAD (p = 0.001 and 0.01, respectively) while dyslipidemia was a major risk factor for non‐obstructive CAD (p 0.01). Additionally, obese patients with more than one risk factor; developed obstructive CAD compared to non‐obstructive CAD (p = 0.003). Approximately 40% presented with STEMI, 30% with NSTEMI and 30% had stable angina as a primary diagnosis. Of the 332 obese patients with CAD, 24% received medical treatment, 58% underwent percutaneous coronary intervention (PCI) and 18% obtained coronary artery bypass grafting (CABG). In a gender comparison, average age of CAD in obese males were 55 years of age compared to 59 in females (p <0.001). Approximately 67% of males underwent PCI (OR: 2.4, 95% CI: 1.5‐3.6, p < 0.001) and 24% obtained CABG (OR: 3, 95% CI: 1.6‐5.6, p < 0.001), whereas in obese females 43% received medical therapy (OR: 9, 95% CI: 5–17, p < 0.001).
Conclusions: Having a BMI ≥ 30 appears to correlate as an independent risk factor for early development of CAD. Severity of CAD in obese patients is depicted on non‐modifiable and modifiable risk factors such as the male gender and smoking or greater than one risk factor, respectively.
130 THE EFFECTS OF A NURSE‐PROVIDED EDUCATION AND TELEPHONE FOLLOW‐UP PROGRAM*†
Sharon Dickey, DNP
Abstract Topic: Other
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The prevalence of HTN in the United States is high and inadequate control is common. Home monitoring of blood pressure (BP) with telephone follow‐up by nurses to improve BP is supported by guidelines, systematic reviews, and randomized clinical trials.
Objective/Purpose: At the completion of this presentation, participants should be better able to consider important information for developing a nurse provided patient education and telephone follow‐up program based on self‐efficacy theory in adults with hypertension (HTN).
Methods: This mixed methods study included a convenience sample (N = 16) of participants diagnosed with HTN. A one‐group pretest‐posttest design was used comparing baseline to 12‐week Medication Adherence Self‐efficacy‐Revised (MASES‐R) and home BP values. Qualitative data was analyzed using content analysis. The program consisted of education and assessment of home monitoring of BP, medication adherence, and lifestyle modifications, and was provided through baseline in‐person visit and telephone follow‐up. Goal setting was used for making diet and exercise changes with barriers and facilitators to reaching goals identified and modified when possible.
Results: There were no significant differences in MASES‐R scores, or BP readings at 12 weeks. The qualitative analysis showed that 9/16 participants set goals for diet and / or exercise. Goals were met by 6/9 for exercise and 3/6 for diet. Themes concerning barriers and facilitators to an individual's ability to reach goals included: food availability, knowledge, accountability, location, weather, exercising with others, physical limitations, and time.
Conclusions: This pilot study revealed important information for developing a nurse provided patient education home based BP monitoring program within a self‐efficacy framework. Implementation of the study intervention with identification of barriers and facilitators may have influenced participants’ ability to reach goals and make lifestyle changes.
131 THE BURDEN OF ILLNESS AND PSYCHOSOCIAL CONSEQUENCES OF LIVING WITH FAMILIAL CHYLOMICRONEMIA SYNDROME (FCS): PATIENT AND CAREGIVER PERSPECTIVES
Brown A, Ross J, Gilstrap A, Hsieh A, Williams K & Gelrud A
Abstract Topic: Other
Lead Author's Financial Disclosures: Advisory boards: IONIS/Akcea Therapeutics, Amgen, AstraZeneca, KOWA Pharmaceuticals America Inc, Lilly, Merck & Co Inc., Pfizer, and Regeneron Pharmaceuticals Inc. Speakers Bureaus: Amgen, Merck & Co Inc., Regeneron Pharmaceuticals Inc. and Sanofi‐Aventis US. Dr. Brown participated in this patient/caregiver panel as a medical expert and received remuneration.
Study Funding: None
Background/Synopsis: FCS is a rare, inherited lipid disorder characterized by severely high levels of triglycerides (TGs) and chylomicrons in the plasma. The impact of FCS includes acute physical manifestations (eruptive xanthoma, lipemia retinalis, hepatosplenomegaly) and potentially life‐threatening recurrent acute pancreatitis (RAP), which frequently leads to chronic pancreatitis. Patients with FCS often live in fear of RAP and debilitating abdominal pain. There is currently no FDA approved pharmacotherapy. The mainstay is an ultra‐low‐fat diet (<20g of fat per day) and strict control of lifestyle factors (e.g., avoidance of alcohol and some medications), which is difficult for patients to maintain. Additionally, there is a dearth of information regarding the burden of FCS on quality of life for patients and their caregivers.
Objective/Purpose: To elucidate the impact of FCS on both patients’ and caregivers’ quality of life (QOL).
Methods: FCS patients and their respective caregivers were invited to participate in a facilitator‐led question and answer panel. Questions related to QOL and psychosocial consequence of FCS.
Results: Ten patients and nine caregivers participated in the panel. Mean age of patients in attendance was 42.7 years (Range 26‐67yrs). Patients reported 395 combined episodes of pancreatitis with 180 hospitalizations resulting in 1260 days hospitalized. FCS consequences included: Fatty liver disease (80%), cholecystectomy (64%), and diabetes (50%). Patients and caregivers reported that psychosocial manifestations of FCS have limited their ability to perform activities of daily living, including missed work and school. All participants reported fatigue, lack of concentration and cognitive impairment. Caregivers also reported psychosocial stressors.
Conclusions: FCS is a debilitating, chronic disease. No optimal or FDA approved medical therapy is available. An extremely restrictive diet is critical but difficult for patients to follow, limits social interactions, and can reduce QOL. FCS affects many organs including the pancreas, leading to RAP and frequent hospital admissions.
132 C57BL6 MICE AS A HIGH CHOLESTEROL MODEL IN THE STUDY OF EGCG, CURCUMIN, AND SULFORAPHANE AS CARDIOPROTECTIVE AGENTS
Ronnie M. Ibrahim, BS ; Brian Shin; Brent Reynolds, PhD; Loic Deleyrolle, PhD
Abstract Topic: Pharmacologic Therapy
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: C57BL6 mice are commonly used murine model specimens. EDP (Epidipherphane) is a novel natural therapeutic cocktail consisting of curcumin, a diarylheptanoid extract in turmeric, Epigallocatechin gallate (EGCG), a catechin in teas with anti‐cancer and anti‐inflammatory effects, and sulforaphane, an organosulfur compound in cruciferous vegetables. Ketogenic diets are supported as adjuvant therapies for cancer treatment [4]. However, these diets carry risks of increasing lipoprotein levels, which is concerning in adults at‐risk for cardiac events. EDP can be co‐administered with a ketogenic diet. Previous experimentation has revealed that each of these compounds have anti‐inflammatory and other cardioprotective effects by reducing cholesterol. [1,2,3.] Should EDP have cardioprotective effects, its use as a natural product cancer aid can be bolstered in addition to its anti‐inflammatory effects.
Objective/Purpose: Elucidate the cholesterol lowering effects of the compounds taken together as EDP in mice with high cholesterol, in addition to establishing a high‐cholesterol murine model applicable to human dietary conditions.
Methods: 12 mice in 3 treatment groups tracked over 41 days evaluating weights, and serum LDL was checked at the end of this period. Each group corresponded to a diet type = standard chow, western diet, and western diet + EDP.
Results: Mice fed with a high carbohydrate, high fat diet with supplemental cholesterol for at least 2 weeks see significantly elevated serum lipoprotein levels that make them amenable to cholesterol studies. Data suggest that total cholesterol and LDL increase in mice fed the Western diet (high carbohydrates and fat with low protein kcal load). Data also shows that a Western Diet combined with EDP attenuates LDL level increase, while also suggesting that EDP reduces LDL increases in standard chow diet formulations relative to control.
Conclusions: Ongoing experimentation with an expanded sample size is currently suggestive that EDP reduces LDL levels and body weight in mice fed a high‐fat, high cholesterol diet relative to control. Our data are supportive of the role of EDP in the attenuation of LDL count in murine organisms fed an atherogenic diet similar to western" style diets ‐ those containing a majority of calories from carbohydrates and fat at the cost of protein‐based caloic load.
133 OVERCOMING PRIOR AUTHORIZATION BARRIERS TO PCSK9 INHIBITORS WITH THE USE OF GENETICS
Caroline Graham, MSN,CRNP
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Despite a recent American Heart Association consensus statement supporting Familial Hypercholesterolemia (FH) diagnosis in any patient with a LDL‐C > 190 mg/dl and a positive family history, each insurance company still has its own policy for approval of Proprotein Convertase Subtilisin Kexin Type Nine (PCSK9) inhibitor therapy. Prior to consideration, all insurers require documentation of therapeutic lifestyle changes and maximization of statin, ezetimibe, and non‐statin therapies. Some insurers also require meeting Dutch Lipid Clinic, Simon Broome, or MEDPED criteria, which require genetic testing at a cost to the patient. The cost of PCSK9 inhibitor therapy alone is approximately $14,000 annually, and the majority of patients cannot afford the direct expense. Given the cost, providers must prescribe carefully and provide justification of therapy need.
Objective/Purpose: Will the addition of genetic testing as a diagnostic measure for FH remove barriers to insurance approval for PCSK9 inhibitor therapy?
Methods: A case series of four patients strongly suspected to have FH and unable to achieve LDL‐C goal. None of the patients had tendinous or cutaneous manifestations of FH. Two of the four patients had established coronary artery disease with intervention, one patient had evidence of subclinical atherosclerotic disease on CT scan, and one patient had no established subclinical or clinical coronary artery disease. All four patients were denied approval of PCSK9 inhibitor therapy by their insurance company because they did not meet the diagnostic criteria established by the insurer. Genetic testing was obtained through the Precision Genomic Center.
Results: All four patients had a positive return of FH with LDL‐R mutation. Following provider appeals, all four patients were approved for PCSK9 inhibitor therapy and achieved LDL‐C goal.
Conclusions: In the precision medicine era, preventative cardiology best practice may include genetic testing not only for clinical diagnosis, but also as a means to attain insurance approval for PCSK9 inhibitor therapy for appropriate patients.
134 ADDRESSING ATHEROSCLEROSIS AND DYSLIPIDEMIA: EFFECT OF ONLINE CME
Jelena Spyropoulos, PhD; Colleen Healy
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Although emerging evidence supports triglyceride (TG)‐lowering properties of the omega‐3 polyunsaturated fatty acid eicosapentaenoic acid ethyl ester (EPA), clinicians have limited knowledge about the effects of EPA on the atherosclerotic state and limited ability to use and combine EPA/statin therapy for dyslipidemia to reduce the risk of cardiovascular disease.
Objective/Purpose: To determine if an online continuing medical education (CME) intervention could improve knowledge and competence of cardiologists and primary care physicians (PCPs) related to the role of EPA in management of dyslipidemia.
Methods: The CME activity consisted of an online video‐based multidisciplinary panel discussion among 3 faculty experts. The effects of education were assessed for learners completing all 4 pre‐ and post‐assessment questions, using a matched pre/post‐assessment design, with participants serving as their own controls. For all questions combined, the McNemar's chi‐square test was used to assess differences from pre‐ to post‐assessment. P values are shown as a measure of significance; P values < .05 are statistically significant. Cramer's V was used to assess effect size.
Results: The change in correct response from pre‐ to post‐assessment achieved statistical significance (P < .05) for each of the 4 questions presented for both cardiologists (n = 119; V = 0.277) and PCPs (n = 217; V = 0.279). Significant improvements were observed in participant knowledge and competence:
A 38% relative improvement among cardiologists (66% vs 91%) and a 35% improvement among PCPs (65% vs 88%) in knowledge of positive effects of EPA on cardiovascular mortality
A 21% relative improvement among cardiologists (70% vs 85%) and a 28% improvement among PCPs (58% vs 84%) in knowledge of the vascular effects of EPA in the setting of coronary artery disease
A 61% relative improvement among cardiologists (51% vs 82%) and a 77% improvement among PCPs (47% vs 83%) in the ability to treat mixed dyslipidemia, including elevated LDL‐C and TGs
A 53% relative improvement among cardiologists (70% vs 85%) and a 63% improvement among PCPs (58% vs 84%) in the ability to adjust treatment for a patient with worsening dyslipidemia who is treated with a statin/fenofibric acid combination
Conclusions: The statistically significant improvements observed as a result of participation in this online CME intervention demonstrate that a well‐designed, online, video‐based multidisciplinary panel discussion can improve knowledge and competence of physicians related to management of dyslipidemia.
135 IMPROVING LIPID MANAGEMENT IN CLINICAL PRACTICE: EFFECT OF ONLINE CME
Jelena Spyropoulos, PhD; Piyali Chatterjee; Michael LaCouture, MA
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: High levels of low‐density lipoprotein cholesterol (LDL‐C) are a major risk factor for cardiovascular disease (CVD), yet many patients with dyslipidemia are not receiving appropriate lipid‐lowering therapies.
Objective/Purpose: To determine if an online continuing medical education (CME) intervention could improve knowledge and competence of cardiologists and primary care physicians (PCPs) related to management of dyslipidemia
Methods: An online CME activity was developed as a text‐based, interactive clinical review with 2 leading faculty experts on the guideline‐recommended treatment of dyslipidemia. The effects of education were assessed using a linked pre‐assessment/post‐assessment study design, with participants serving as their own controls. Only those participants who completed all pre‐ and post‐assessment questions were included in the analysis. For all questions combined, the McNemar's chi‐square test was used to assess differences from pre‐ to post‐assessment. P values are shown as a measure of significance; P values < .05 are statistically significant.
Results: Comparison of pre‐assessment responses to 4 questions individually linked to the respective post‐assessment responses demonstrated significant improvements for cardiologists (n = 491; P < .05) and PCPs (n = 1457; P < .05). The average correct response rate pre‐assessment for cardiologists was 52% vs 44% for PCPs, which improved to 60% and 57%, respectively, on post‐assessment. Significant improvements were observed (all P < .05):
A 36% relative improvement among cardiologists and a 41% improvement among PCPs in knowledge of ACC/AHA‐recommended LDL‐C goals for patients with diabetic dyslipidemia
A 28% relative improvement among cardiologists and a 58% improvement among PCPs in application of patient selection criteria for intensive lipid‐lowering therapy
A 6% improvement among cardiologists and a 12% improvement among PCPs in appropriate addition of non‐statin therapy for statin‐treated patients with uncontrolled hypercholesterolemia
An 11% relative improvement among cardiologists and a 33% improvement among PCPs in the ability to manage patients with statin intolerance
Conclusions: The statistically significant improvements observed as a result of participation in this online CME activity demonstrate the benefits of educating the large target audience base with aptly designed educational activities in the context of clinical practice.
136 A MULTI‐DISCIPLINARY APPROACH TO CARDIOVASCULAR RISK REDUCTION IN THE STATIN* INTOLERANT POPULATION
Salvatore Savona, MD; Kristina Moon, DO; Haikady Nagaraja, PhD; Kavita Sharma, MD
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: The 2013 American College of Cardiology/American Heart Association Blood Cholesterol guidelines indicate that patients who require cardiovascular risk reduction would benefit from statin therapy, after patient‐clinician discussion. However, statin intolerance can complicate this management.
Objective/Purpose: To examine efforts of a multi‐disciplinary lipid clinic to start statin therapy and reduce calculated low density lipoprotein cholesterol (LDL‐C).
Methods: A retrospective institutional chart review of the lipid clinic over 38 months was performed on patients seen on at least three occasions.
Results: A total of 166 patients were included, and 98 had a history of statin intolerance. All‐comers, those with statin intolerance, and those without statin intolerance had a baseline mean LDL‐C of 148 mg/dL, 151.8 mg/dL and 126 mg/dL, respectively. At follow‐up, the mean LDL‐C decreased to 108.5 mg/dL for all patients. The decrease in LDL‐C in the statin intolerant and statin tolerant groups was 34 mg/dL and 30.5 mg/dL respectively, a similar decrease with no statistically significant difference between the groups. Only 32% of those with statin intolerance were on a statin at baseline, improving to 72.1% at follow‐up. Of those with statin intolerance, 66 were not on a statin initially. At follow‐up, 65% were on a statin and had a statistically significant mean reduction in LDL‐C of 48 mg/dL (95% CI 37–60) compared to 25.5 mg/dL (95% CI 9–42) in the patients who were not on a statin at follow up. The average number of appointments was 5.5 for those on statin at follow‐up and 5.7 for those not on a statin at follow‐up, with an average treatment time of 1.11 and 0.98 years, respectively.
Conclusions: The results of our study indicate that patients with statin intolerance can achieve a statistically significant lowering of their LDL through a collaborative approach with cardiologists and pharmacists. This highlights the importance of a cost effective personalized concerted approach to achieve guideline directed therapy. Future studies may need to focus on the ability to achieve cardiovascular exercise and dietary goals through an approach incorporating dieticians and exercise therapists.
137 A NOVEL TEST FOR EARLY DETECTION OF STRUCTURAL AND FUNCTIONAL CARDIOVASCULAR ABNORMALITIES IN UNTREATED, ASYMPTOMATIC, OBESE FEMALES*
Susan Tucker, RN, BSN; Mahfouz El Shahawy, MD, MS
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: There has been multiple controversial reports on whether or not to consider obesity alone as a risk factor for cardiovascular disease. We sought to assess obesity, alone, as a risk factor in untreated, asymptomatic females without other known cardiovascular risk factors.
Objective/Purpose: To evaluate the efficacy of a novel panel of tests used as an assessment tool for the detection of early structural and functional cardiovascular abnormalities, also known as the Rasmussen Risk Score, in untreated, asymptomatic, obese females.
Methods: 2143 untreated, asymptomatic subjects were screened for early indicators of cardiovascular disease using the Early CVD Risk Score (ECVDRS), also known as the Rasmussen Risk Score (RRS), which consists of a panel of 10 tests; large (C1) and small (C2) artery stiffness, resting BP and post mild exercise (PME), CIMT, abdominal aorta and left ventricle ultrasounds, retinal photography, microalbumuria, ECG, and pro‐BNP. The subjects were then separated based on their age, gender and BMI to further evaluate the efficacy of the above testing, with primary focus on C1, C2, abnormal rise in BP after PME and CIMT.
Results: 1140 of the 2143 untreated, asymptomatic subjects were female. Of those females, 289 females had a BMI >30. Of those 289 females, ages 30–79, the PME BP rise was a more significant test than that of C1, C2, and CIMT, cumulatively, at early detection of structural and functional abnormalities. In fact, 39% abnormality was detected using PME BP rise over just 25% abnormality detected by CIMT, which was the next closest test in detecting abnormalities. The C2 test detected 22% abnormality and 10% abnormality was detected by C1 testing.
Conclusions: 1.) Obesity even without known cardiovascular risk factors is a disease associated with early structural and functional cardiovascular abnormalities. Abnormal rise in BP PME was a more prevalent test, when compared to other tests used in our scoring system, for early detection of structural and functional cardiovascular abnormalities in obese females. Based on our data, we recommend that obese females use this noninvasive, inexpensive test (i.e. rise in BP PME) as a screening tool for early risk stratification of cardiovascular disease in obese, asymptomatic females.
138 AVAILABLE TOOLS TO INITIATE PEDIATRIC CASCADE SCREENING IN CHILDREN OF ADULT PATIENTS WITH FAMILIAL HYPERCHOLESTEROLEMIA*
Isabel Wolfson; Joshua Knowles, MD; Amy Sturm, MS, LGC; James Underberg, MD
Abstract Topic: Preventive Cardiology Best Practices – Clinic Operations, Team Approaches, Outcomes Research
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Familial hypercholesterolemia (FH) is a common inherited disorder associated with elevated levels of LDL‐cholesterol from birth and premature atherosclerotic cardiovascular disease . Current recommendations are to screen children of FH parents as early as age 2, and all children between 9 and 11. Only 9% of children are screened at the request of a parent, yet when cascade screening is performed on pediatric patients, the FH diagnostic rate is 59% percent. Easily accessible tools for practicing care providers to initiate cascade screening in children of adult patients with FH could facilitate this process.
Objective/Purpose: To search medical literature and internet databases to identify easily downloadable tools that practitioners can utilize for initiation of pediatric cascade screening.
Methods: PubMed, Google, Google Scholar, Heart UK, FH Canada, The International FH Foundation, and The FH Foundation were searched for English language documents and tools using the following key words and phrases: familial hypercholesterolemia screening letter; pediatric familial hypercholesterolemia; familial hypercholesterolemia; letter to screen familial hypercholesterolemia; familial hypercholesterolemia children; cascade screening familial hypercholesterolemia; pediatric cascade screening tool familial hypercholesterolemia; cascade screening letter familial hypercholesterolemia; and familial hypercholesterolemia letter to screen. For all searches we looked at the top twenty results.
Results: We identified only one easily accessible letter from the National Society of Genetic Counselors on the FH Foundation's website. This letter targets patients and practitioners to initiate cascade screening in family members of index patients with FH.
Conclusions: After searches on many of the leading servers, the FH Foundation, FH Canada, The International FH Foundation, PubMed, and Heart UK, only one letter was identified for initiating cascade screening. The lack of available screening tools may contribute to underutilization of cascade screening in pediatric patients.
References
1. Larry A. Weinrauch MD, “Familial Hypercholesterolemia,” Medical Encyclopedia, accessed June 28, 2016, https://www.nlm.nih.gov/medlineplus/ency/article/000392.htm.
2. Samuel S. Gidding, MD, FAHA, Chair, “The Agenda for Familial Hypercholesterolemia,” The American Heart Association.
3. Universal vs. Selective Pediatric Lipid Screening in the Diagnosis of Familial Hypercholesterolemia* Hering Peterson, Amy Lynn et al. Journal of Clinical Lipidology, Volume 9, Issue 3, 449
4. https://thefhfoundation.org/media/FH‐Family‐Letter.pdf
139 DOES CARDIAC REHABILITATION IMPROVE PATIENT SOCIAL WELLBEING AND ILLNESS PERCEPTION?
Simone Bailey, MBBS; Jessika Lobraico, MS; Tatiana Afanaseva, MD; Kevin Bill, MS,CES; Molly Gill, MS; Michele Smallidge, EdD, RD; Tannaz Sedghi; Joann Petrini, PhD; Jonathan Alexander, MD; Andrew Keller, MD
Abstract Topic: Rehabilitation
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Exercise‐based cardiac rehabilitation (CR) programs promote life‐style modification to improve prognosis in patients with cardiovascular disease (CVD). The effect of exercise based CR programs on the social well‐being and illness perception of patients has not been well studied.
Objective/Purpose: To assess the social impact of CR and its effect on patients’ perception of their illness.
Methods: Two arms were used to execute this study. Arm 1 consented new CR enrollees who completed a series of questionnaires at the beginning and end of the 12‐week Phase II program. Arm 2 enrolled existing CR participants who completed questionnaires at the time of consent. Three standardized and validated questionnaires were employed: Brief Illness Perception (BIP), PROMIS Item Bank v2.0 for Emotional Support, and Patient Health Questionnaire‐9 (PHQ‐9). Demographic data, medical history, left ventricle ejection fraction and reasons for CR referral were collected. ANOVA and Wilcoxon signed rank test were used to compare differences between the groups and statistical significance was determined to be p < 0.05.
Results: 236 patients were enrolled from July 1 to December 31, 2015, 129 patients (55%) in Arm 1 and 107 (45%) in Arm 2. Among Arm 2 enrollees, 31% completed less than three months of CR while 61% had been attending CR for ≥ 1 year. Patients in Arm 2 showed higher illness perception compared to patients in Arm 1 on the BIP questionnaire (p = 0.037)). Statistically significant differences in six of the eight aspects of illness perception tested on the BIP were seen between Arm 1 and Arm 2. Improved illness perception was associated with increased age, a longer period of attendance at CR, the total number of medications taken and left ventricular ejection fraction (p = 0.035, 0.003, 0.003, and 0.03, respectively). Levels of depression as measured by PHQ‐9 were higher in younger participants (p = 0.035).
Conclusions: CR attendance is associated with improved illness perception which continues to improve as patients complete the acute phase of CR and transition to the maintenance phase. Young persons attending CR may have significant levels of depression which may be under recognized. Continued efforts are needed to ensure referral of women to CR as they have similar levels of improvement in illness perception but are currently under represented.
140 CARDIAC REHABILITATION AND PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY*
Carolyn Wu, MD MS; Harsha Ganga, MD MPH; John McKeon, MS; J. Abbott, MD; Wen‐Chih Wu, MD
Abstract Topic: Rehabilitation
Lead Author's Financial Disclosures: None
Study Funding: None
Background/Synopsis: Takotsubo cardiomyopathy (TC) is a disease with symptoms mimicking an acute coronary syndrome without critical coronary lesions. Characteristic left ventriculograms show apical akinesis for classic TC. Thought to be triggered by stressors, the natural course is generally benign, with recovery over days to months. While it is well established that patients with acute myocardial infarction benefit from cardiac rehabilitation (CR) programs, the benefit of CR for patients with TC and the overall referral rate are unknown.
Objective/Purpose: The aim of the study is to determine the overall referral rate to CR for patients diagnosed with TC and to determine any potential benefits of CR for this population in terms of functional status and quality of life.
Methods: This was a retrospective chart review that evaluated patients hospitalized at 2 major hospitals in Rhode Island with the diagnosis of TC from 2008 to 2015. A total of 420 unique patients (438 episodes including 16 patients with at least 1 recurrence) were identified with cardiac catheterization showing left ventricular wall motion suggestive of TC without significant left anterior descending coronary lesions. Those patient were then cross matched to the largest cardiac rehabilitation center in RI to determine the referral rate and outcomes after completion of the program.
Results: Among 420 patients (438 episodes) diagnosed with TC, 9 died within the same hospitalization. The 411 patients that survived (429 episodes), only 19 (4.4%) were referred to CR, and 9 (2%) completed the program. Among the 9 patients that completed the CR, average attendance was 33 out of 36 sessions. Average weight reduction was 3.5 pounds and BMI reduction of 0.67 kg/m2. Average end exercise duration was 39 minutes per session, maximal improvement in metabolic equivalent (MET) was 2, and peak MET achieved was 10. Two patients entered the phase III maintenance program. Importantly, 2 of the 9 underwent percutaneous intervention (PCI) within a month of TC diagnosis and one was referred for PCI instead of TC. At 1‐year follow up, all 9 patients survived.
Conclusions: Referral rate for TC population is low. Limited data showed CR may help with weight reduction and improve exercise time and MET.
The American Society for Preventive Cardiology Abstracts. Clin Cardiol 2016. DOI: 10.1002/clc.22597