scholarly journals Genome Wide Epistasis Study of On-Statin Cardiovascular Events with Iterative Feature Reduction and Selection

2020 ◽  
Vol 10 (4) ◽  
pp. 212
Author(s):  
Solomon M. Adams ◽  
Habiba Feroze ◽  
Tara Nguyen ◽  
Seenae Eum ◽  
Cyrille Cornelio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Carotid Artery Disease ◽  
Risk Estimation ◽  
Feature Reduction ◽  
Major Adverse Cardiovascular Events ◽  
Small Subset ◽  
Artery Disease ◽  
High Level ◽  
Risk Determinants

Predicting risk for major adverse cardiovascular events (MACE) is an evidence-based practice that incorporates lifestyle, history, and other risk factors. Statins reduce risk for MACE by decreasing lipids, but it is difficult to stratify risk following initiation of a statin. Genetic risk determinants for on-statin MACE are low-effect size and impossible to generalize. Our objective was to determine high-level epistatic risk factors for on-statin MACE with GWAS-scale data. Controlled-access data for 5890 subjects taking a statin collected from Vanderbilt University Medical Center’s BioVU were obtained from dbGaP. We used Random Forest Iterative Feature Reduction and Selection (RF-IFRS) to select highly informative genetic and environmental features from a GWAS-scale dataset of patients taking statin medications. Variant-pairs were distilled into overlapping networks and assembled into individual decision trees to provide an interpretable set of variants and associated risk. 1718 cases who suffered MACE and 4172 controls were obtained from dbGaP. Pathway analysis showed that variants in genes related to vasculogenesis (FDR = 0.024), angiogenesis (FDR = 0.019), and carotid artery disease (FDR = 0.034) were related to risk for on-statin MACE. We identified six gene-variant networks that predicted odds of on-statin MACE. The most elevated risk was found in a small subset of patients carrying variants in COL4A2, TMEM178B, SZT2, and TBXAS1 (OR = 4.53, p < 0.001). The RF-IFRS method is a viable method for interpreting complex “black-box” findings from machine-learning. In this study, it identified epistatic networks that could be applied to risk estimation for on-statin MACE. Further study will seek to replicate these findings in other populations.

scholarly journals Genome Wide Epistasis Study of On-Statin Cardiovascular Events with Iterative Feature Reduction and Selection

2020 ◽  
Author(s):  
Solomon M. Adams ◽  
Habiba Feroze ◽  
Tara Nguyen ◽  
Seenae Eum ◽  
Cyrille K. Cornelio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Carotid Artery Disease ◽  
Risk Estimation ◽  
Feature Reduction ◽  
Major Adverse Cardiovascular Events ◽  
Small Subset ◽  
Artery Disease ◽  
High Level ◽  
Risk Determinants

AbstractBackgroundPredicting risk for major adverse cardiovascular events (MACE) is an evidence-based practice that incorporates lifestyle, history, and other risk factors. Statins reduce risk for MACE by decreasing lipids, but it is difficult to stratify risk following initiation of a statin. Genetic risk determinants for on-statin MACE are low-effect size and impossible to generalize. Our objective was to determine high-level epistatic risk factors for on-statin MACE with GWAS-scale data.MethodsControlled-access data for 5,980 subjects taking a statin collected from Vanderbilt University Medical Center’s BioVU were obtained from dbGaP. We used Random Forest Iterative Feature Reduction and Selection (RF-IFRS) to select highly informative genetic and environmental features from a GWAS-scale dataset of patients taking statin medications. Variant-pairs were distilled into overlapping networks and assembled into individual decision trees to provide an interpretable set of variants and associated risk.Results1,718 cases who suffered MACE and 4,172 controls were obtained from dbGaP. Pathway analysis showed that variants in genes related to vasculogenesis (FDR=0.024), angiogenesis (FDR=0.019), and carotid artery disease (FDR=0.034) were related to risk for on-statin MACE. We identified six gene-variant networks that predicted odds of on-statin MACE. The most elevated risk was found in a small subset of patients carrying variants in COL4A2, TMEM178B, SZT2, and TBXAS1 (OR=4.53, p<0.001).ConclusionsThe RF-IFRS method is a viable method for interpreting complex “black-box” findings from machine-learning. In this study, it identified epistatic networks that could be applied to risk estimation for on-statin MACE. Further study will seek to replicate these findings in other populations.

scholarly journals Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID

2021 ◽  
Author(s):  
Marc D. Samsky ◽  
Anne Hellkamp ◽  
William R. Hiatt ◽  
F. Gerry R. Fowkes ◽  
Iris Baumgartner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Factors Associated ◽  
Artery Disease

Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow‐up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13–1.51) and all‐cause mortality (HR, 1.39; 95% CI, 1.19–1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45–0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18–1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41–2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64–0.93; <76 kg, HR, 1.12; 95% CI, 1.07–1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF.

scholarly journals Peripheral Artery Disease and COVID-19 Outcomes: Insights from the Yale DOM-CovX Registry

2021 ◽  
Author(s):  
Kim G. Smolderen ◽  
Megan Lee ◽  
Tanima Arora ◽  
Michael Simonov ◽  
Carlos Mena-Hurtado
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Regression Models ◽  
Arterial Disease ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Logistic Regression Models ◽  
Artery Disease ◽  
Adjusted Logistic Regression ◽  
Peripheral Arterial

AbstractBackgroundBoth COVID-19 infection and peripheral arterial disease (PAD) cause hypercoagulability in patients, and it remains unknown whether PAD predisposes patients to experience worse outcomes when infected with SARS-CoV-2.MethodsThe Yale DOM-CovX Registry consecutively enrolled inpatients for SARS-CoV-2 between March 1, 2020, and November 10, 2020. Adjusted logistic regression models examined associations between PAD and mortality, stroke, myocardial infarction (MI), and major adverse cardiovascular events (MACE, all endpoints combined).ResultsOf the 3,830 patients were admitted with SARS-CoV-2, 50.5% were female, mean age was 63.1 ±18.4 years, 50.7% were minority race, and 18.3% (n = 693) had PAD. PAD was independently associated with increased mortality (OR=1.45, 95% CI 1.11-1.88) and MACE (OR=1.48, 95% CI 1.16-1.87). PAD was not independently associated with stroke (p=0.06) and MI (p=0.22).ConclusionPatients with PAD have a >40% odds of mortality and MACE when admitted with a SARS-CoV-2, independent of known risk factors.

scholarly journals POS1015 ANTI-TNF DRUGS AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 775.2-776
Author(s):  
C. W. S. Chan ◽  
P. H. LI ◽  
C. S. Lau ◽  
H. Y. Chung
Keyword(s):  
Risk Factors ◽  
Psoriatic Arthritis ◽  
Cardiovascular Events ◽  
Clinical Information ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cross Sectional ◽  
Cerebrovascular Events ◽  
Cardiovascular Morbidity And Mortality

Background:Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS risk including stroke and myocardial infarction (MI) (1-3). CVS risk factors and CVS events are common in SpA (4). Delineating the CVS risk and the association with medications in patients with SpA would be useful.Objectives:The objective of this study was to delineate the CVS risk and the association with medications in patients with SpA.Methods:Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics respectively. Clinical information and CVS events were retrieved. Incidence rates were calculated. Association analysis was performed to determine the CVS risk of SpA and other modifiable risk factors.Results:A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56 484 person-years of follow-up, 160 strokes, 84 MI and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, P<0.01). Crude incidence rates of stroke and MI were higher in SpA patients. SpA was associated with a higher risk of MACE (HR 1.66, 95%CI 1.22-2.27, P<0.01) and cerebrovascular events (HR 1.42, 95%CI 1.01-2.00, p=0.04). The use of anti-tumor necrosis factor (TNF) drugs was associated with a reduced risk of MACE (HR 0.37, 95%CI 0.17-0.80, P=0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06-0.78, P=0.02).Conclusion:SpA is an independent CVS risk factor. Anti-TNF drugs were associated with a reduced CVS risk in these patients.References:[1]Crowson CS, Liao KP, Davis JM, 3rd, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-8 e1.[2]Verhoeven F, Prati C, Demougeot C, Wendling D. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine. 2020;87(5):413-8.[3]Liew JW, Ramiro S, Gensler LS. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2018;32(3):369-89.[4]Molto A, Etcheto A, van der Heijde D, Landewe R, van den Bosch F, Bautista Molano W, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;75(6):1016-23.Disclosure of Interests:None declared.

scholarly journals Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

2021 ◽  
Vol 53 (1) ◽  
pp. 817-823
Author(s):  
Marjo Okkonen ◽  
Aki S. Havulinna ◽  
Olavi Ukkola ◽  
Heikki Huikuri ◽  
Arto Pietilä ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome

Cardiac risk factors and events in patients with prostate cancer commencing androgen deprivation therapy: Analysis from a tertiary care center in the Middle East.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 73-73
Author(s):  
Mona Hassan ◽  
Talar Telvizian ◽  
Mostafa Abohelwa ◽  
Hadi Skouri ◽  
Deborah Mukherji
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Middle East ◽  
Cardiovascular Events ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Cardiac Events ◽  
Artery Disease

73 Background: Androgen deprivation therapy (ADT) is the mainstay of treatment for advanced prostate cancer, improving symptoms and prolonging survival. There is an association between ADT use and cardiovascular events, particularly in men with pre-existing risk factors. There are no definite guidelines to stratify patients based on cardiovascular risk prior to ADT initiation. This is the first study on cardiac risks and events in patients on ADT from Lebanon and the Middle East region, a population known to have a high prevalence of cardiovascular risk factors. Methods: A retrospective chart review of 236 patients with prostate cancer who received ADT therapy at a tertiary care center in Lebanon was performed. 167 had a full set of data and were included in analysis. Cardiovascular risk factors at baseline and cardiovascular events on ADT were reviewed. Results: The median age of our cohort was 68, range 48-92 years. The majority of patients had stage 4 diseases at diagnosis (49.8%) with a median duration of 12 months on ADT. In our cohort 24.4% had body mass index > 30, 52.1% had smoking history, 27.4% were diabetic, 28.8 % had history of coronary artery disease, 10.6% had heart failure history and 54.6% had hypertension. Less than half of the patients had a documented lipid profile at baseline. Twenty two patients (9.5%) had documented cardiac events following ADT initiation. Conclusions: In this cohort of patients from the Middle East we found that one third of the population had established coronary artery disease at baseline and 9.5% had documented cardiac events on ADT initiation. Our study highlights the gaps in cardiovascular risk assessment for this high risk group of patients with prostate cancer. Risk and resource-stratified algorithms are needed before starting ADT therapy for optimal cardiovascular health. Increased awareness, collaboration and referral mechanisms between oncologists, urologist and cardiologists are also needed.

Preoperative Evaluation of the Cardiac Surgical Patient

2019 ◽  
pp. 3-10
Author(s):  
Rebecca M. Gerlach
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Carotid Artery Disease ◽  
Perioperative Complications ◽  
Preoperative Evaluation ◽  
Surgical Patient ◽  
Efficient Manner ◽  
Obstructive Sleep ◽  
Reduce Risk ◽  
Artery Disease

Patients undergoing cardiac surgery are at elevated risk for perioperative complications; however, certain risk factors may be modifiable. Preoperative evaluation performed in advance of surgery provides an opportunity for the perioperative anesthesiologist to intervene to reduce risk. Performing a focused history and physical examination informs the selection of appropriate preoperative tests. Risk assessment via tools specific to cardiac surgery provide a detailed risk profile. Certain diseases common to cardiac surgical patients deserve particular focus during assessment. Poorly controlled diabetes mellitus and resultant hyperglycemia are modifiable risk factors. Undiagnosed obstructive sleep apnea is common and associated with postoperative complications. Concurrent carotid artery disease presents a management conundrum requiring multidisciplinary planning. Preoperative anemia is common; when due to iron deficiency, it is easily treated to improve outcomes. In addition to gathering information about the patient, the goal of preoperative evaluation is to identify ways to reduce risk and improve outcome from surgery in a resource-efficient manner.

scholarly journals Contemporary Review of Antithrombotic Therapy in Peripheral Artery Disease

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Connie N. Hess ◽  
Marc P. Bonaca
Keyword(s):  
Peripheral Artery Disease ◽  
Antithrombotic Therapy ◽  
Cardiovascular Events ◽  
Plaque Rupture ◽  
Risk Profile ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
Different Populations ◽  
Artery Disease ◽  
Concomitant Coronary Artery Disease

Patients with peripheral artery disease (PAD) are at heightened risk for ischemic events related to atherothrombosis. Antithrombotic therapies can reduce the risk of atherothrombotic events but increase bleeding. Importantly, there is growing appreciation of the heterogeneity in risk profile and effect of antithrombotic therapies in different populations, including those with PAD. Further, patients with PAD are at risk for not only major adverse cardiovascular events but also major adverse limb events, and the drivers of risk for each are different. Within PAD populations, data from trials may be difficult to interpret due to differences among the studies with regards to patient population, clinical settings, and outcomes examined. The acute setting of peripheral revascularization which involves plaque rupture and endothelial disruption confers very high risk of major adverse limb events early postprocedure. Among patients with chronic PAD for whom the goal of antithrombotic therapy is secondary prevention, concomitant coronary artery disease, particularly with prior myocardial infarction, is associated with greatest risk for major adverse cardiovascular events, while prior peripheral revascularization or amputation is associated with greatest risk for major adverse limb events. Understanding of the potential impact of clinical setting and patient risk profile is important to guide evidence-based decisions regarding antithrombotic therapy in patients with PAD. In this article, we provide a contemporary review of data supporting the use of antithrombotic therapy in PAD, as well as a clinical framework for analysis and translation of these data into practice, highlighting areas in need of further investigation.

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