Comparative study of echocardiography and electrocardiography criteria for detecting left ventricular hypertrophy in hypertensive patients

Background: The study aimed to compare seven different electrocardiogram (LVH) criteria for diagnosing left ventricular hypertrophy (LVH) with echocardiogram as diagnostic standard in hypertensive patients.Methods: This was a hospital-based, cross-sectional study conducted in out-patient department and at medical wards of a tertiary care hospital at Bangalore. The study was carried out for a total duration of 12 months. All hypertensive patients underwent examination for prevalence of LVH using echocardiogram and ECG. Seven different ECG criteria were applied to diagnose the presence of LVH. Then the specificity, sensitivity, kappa measurement value, positive predictive value and negative predictive value for all criteria was calculated subsequently.Results: Out of the 100 patients studied, 34 had LVH as diagnosed by echocardiography. Sokolow-Lyon criteria had a sensitivity of 35% and specificity of 94%. Cornell voltage had a sensitivity of 26% and specificity of 95%. Modified Cornell voltage had a sensitivity of32% and specificity of 94%. Framingham adjusted Cornell voltage, Minnesota code and Cornell product had a sensitivity of 23.5% and specificity of 98.4%. Framingham score had a sensitivity of 38% and specificity of 95.4%.Conclusions: It can be concluded that among all the different criteria used in the study, Framingham score showed better sensitivity compared to others. In the evaluation of hypertensive patients for LVH, the role of ECG with all the commonly used criteria is of limited value and echocardiography is the method of choice.

Serum magnesium and zinc levels- A predictor of cardiovascular risk in hemodialysis patients

Cardiovascular disease is one of the leading causes of mortality in haemodialysis patients. Several studies have demonstrated the relation of zinc and magnesium in cardiovascular disease. In present study we aimed to measure serum zinc and magnesium levels and correlate with the Framingham score to calculate the cardiovascular risk.Present study was prospective, cross sectional type, conducted in chronic kidney disease patients undergoing haemodialysis.Serum magnesium, zinc, cholesterol, urea, creatinine, HDL cholesterol, systolic BP are measured and Framingham score was calculated. And zinc and magnesium values were correlated with Framingham score. The study is conducted in 100 CKD patients undergoing hemodialysis. Out of 100 CKD patients undergoing hemodialysis, 59% had high risk,28% had intermediate risk, and 13% had low risk of developing cardiovascular disease according to their Framingham risk score. In these patients, zinc and magnesium levels were found and correlated with Framingham risk score. Out of 100 patients undergoing hemodialysis, 37 patients were hypomagnesemic, 43 patients were normomagnesemic, 20 patients were hypermagnesemic. In this, a positive correlation was found between development of hypomagnesemia and duration of hemodialysis. Magnesium level was correlated with Framingham risk score. In this hypomagnesemic patients, 67% patients have low risk, 8% have intermediate risk, 24% patients have high risk of developing heart disease. Out of 100 patients, 86 patients have normal zinc level, 14 patients have increased zinc level. Zinc levels was not altered during dialysis. These patients already have risk of developing heart disease independent of zinc level.In our study, magnesium level of haemodialysis patients was reduced and it is associated with duration of haemodialysis. Zinc levels were not altered in the patients.

496Higher predicted 10-year risk for cardiovascular disease in primary care consulters for osteoarthritis

Background Osteoarthritis (OA) has a major impact on the global burden of disease and is associated with poorer cardiovascular disease (CVD) outcomes. However it’s unclear whether people with OA have higher long-term (10-year) CVD risk compared to people without OA. This study uses electronic health record (EHR) data from a national representative database to calculate the Framingham-score (a gender-specific risk algorithm) to test the hypothesis that OA consulters have higher long-term CVD risk than non-OA consulters. Methods 205,368 incident OA consulters with 1:1 age, gender, and practice-matched non-OA controls extracted from Clinical Practice Research Datalink (CPRD) were included. All predictors extracted from EHRs within three years prior to the index consultation were used to fit the Framingham-score. Absolute difference (AR) and relative rate ratio (RR) in the proportion of high-risk (predicted-risk ≥20%) individuals between OA and controls were estimated using Poisson regression. Results The proportion of high-risk individuals was higher in consulters for OA (5.69 (95% confidence interval (CI): 5.59-5.79)%) cf. 4.37 (4.28-4.46)%). The adjusted AR and RR was (1.94 (95%CI: 1.78-2.10) %) and (1.30 (1.27-1.34)), respectively. Conclusions This study confirms the expected higher predicted 10-year CVD risk in OA consulters compared to controls. This suggests that OA consulters could be a target group for more proactive interventions to prevent CVD events. Key messages OA consulters have a higher CVD risk predicted by Framingham-score calculated using EHRs than controls; OA consulters are a high risk group that can be considered as a target group for proactive prevention interventions for CVD.

Development of an accessible 10-year Digital CArdioVAscular (DiCAVA) risk assessment: a UK Biobank study

Background Cardiovascular diseases (CVDs) are among the leading causes of death worldwide. Predictive scores providing personalised risk of developing CVD are increasingly used in clinical practice. Most scores, however, utilise a homogenous set of features and require the presence of a physician. Objective The aim was to develop a new risk model (DiCAVA) using statistical and machine learning techniques that could be applied in a remote setting. A secondary goal was to identify new patient-centric variables that could be incorporated into CVD risk assessments. Methods Across 466,052 participants, Cox proportional hazards (CPH) and DeepSurv models were trained using 608 variables derived from the UK Biobank to investigate the 10-year risk of developing a CVD. Data-driven feature selection reduced the number of features to 47, after which reduced models were trained. Both models were compared to the Framingham score. Results The reduced CPH model achieved a c-index of 0.7443, whereas DeepSurv achieved a c-index of 0.7446. Both CPH and DeepSurv were superior in determining the CVD risk compared to Framingham score. Minimal difference was observed when cholesterol and blood pressure were excluded from the models (CPH: 0.741, DeepSurv: 0.739). The models show very good calibration and discrimination on the test data. Conclusion We developed a cardiovascular risk model that has very good predictive capacity and encompasses new variables. The score could be incorporated into clinical practice and utilised in a remote setting, without the need of including cholesterol. Future studies will focus on external validation across heterogeneous samples.

The Role of Garcinia Mangostana Pericarp Extract as Antioxidant to Inhibit Atherosclerosis Process in High Risk Framingham Score Patient; Original Article

Atherosclerosis is the pivotal role of cardiovascular disease (CVD) involving oxidative stress dan inflammation. Garcinia has anti-oxidant property for years. This study was performed to explore the role of α-Mangostin of Garcia Mangostana Pericarp Extract as an antioxidant in inhibiting atherosclerotic process in patients with high-risk Framingham score. Methods: This prospective cohort design was led in 90 grown-ups with high hazard cardiovascular score which were resolved dependent on Framingham criteria, age 50–70 years of age. The patients were divided into two groups. One group was administered 2520 mg/day Garcinia mangostana Linn extracts (GMLE) in 3 divided doses for 90 days and the other group was administered a placebo. Parameters were Nitric Oxide (NO), Superoxide Dismutase (SOD) and Malondialdehyde (MDA), measured at baseline and after 90 days of treatment. An Independent T-test was performed for normally distributed data and the Mann-Whitney test was performed for abnormally distributed data with a significance level of p≤0.05. Results: Among the 77 subjects, we found that the plasma, MDA, concentration was significantly decreased compared with placebo 0,29±0.5 vs -0.04±0.25, respectively p = 0.011). SOD level significantly decreased in GMLE patients compared with placebo patients (0,17±0.79 vs -0.27±0.67, respectively, p=0.010) and we found that there was slightly increased in nitric oxide (NO), but no significantly compared with placebo 4.34±10.01 and 2.35±7.39, respectively, p = 0.37). Conclusion: Garcinia mangostana pericarp extract has an antioxidant effect that significantly inhibit atherosclerosis process in high-risk Framingham score patients

Framingham Risk Score for Cardiovascular Disease: Application to Jordanian Community; A cross sectional study

Objective: The aim of this study is to assess the protective measures taken by the Jordanian population in order to decrease the risk of the first cardiovascular event using Framingham score risk classification to assess cardiac event risk. Methods: Several nationally representative models of adult Jordanians were recruited in this study. Demographic data and anthropometric parameters were documented. Framingham risk score was calculated. Accordingly, cardiac event risk has been determined. Google form was created to generate a survey. Social media was utilized to extend the survey. Key findings: As expected, taking lipid lowering medications has decreased the Framingham score significantly, patients with high HDL value have lower Framingham score. Significant difference in Framingham score between diploma and patients with high school or less education level p-value 0.043. There was a significant difference in Framingham score between nonsmokers and sometimes smokers. The study revealed that 90% of the participants were having low risk for developing CVD, 5% were at intermediate risk and 5% were at high risk for developing CVD. This was expected as the average age was between 20-30 years. Conclusion: This study presented no advantage and even some harm because of consuming daily low-dose aspirin in some groups of people formerly thought to benefit from such treatment. This new piece of information applies to patients who do not have identified cardiovascular disease. If you have not had one of the above situations or events and are older than 70 years, younger than 40 years, or at higher danger of bleeding because of a medical condition or treatments, you should not consume aspirin for principal prevention of heart disease. If you are between 40 and 70 years old, at decreased risk of bleeding, and thought to be at increased risk of heart disease, you might get advantage from using aspirin.

Distribution of comorbidities in spondyloarthritis with regard to the phenotype and psoriasis: data from the ASAS-COMOSPA study

Introduction: The aim of the study was to compare the prevalence of comorbidities between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities. Methods: Patients from the cross-sectional Assessment in SpondyloArthritis Inter-national Society (ASAS)-COMOSPA study were classified as having either the axial (presence of sacroiliitis on X-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of peripheral involvement). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial/peripheral phenotype with/without psoriasis) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and sex as fixed effects and country as random effect. Results: A total of 3291 patients were included in this analysis. The peripheral involvement with psoriasis phenotype showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while the axial involvement without psoriasis phenotype exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%). Among patients with psoriasis, the axial phenotype showed a significantly lower prevalence of hypertension (OR: 0.51, 95% CI: 0.35–0.75) and lower prevalence of Framingham score ⩾15 (OR: 0.57, 95% CI: 0.38–0.85) than patients with peripheral involvement after adjusting for disease duration, sex and country. Among patients with the axial phenotype, patients with psoriasis showed a higher prevalence of hypertension (OR 1.76, 1.40–2.20), dyslipidaemia (OR: 1.99, 95% CI: 1.56–2.53), diabetes (OR: 2.05, 95% CI: 1.39–3.02) and Framingham score ⩾15 (OR: 2.00, 95% CI: 1.57–2.55) than non-psoriatic patients. No differences were found across groups concerning bone metabolism disorders. Conclusion: Both the peripheral phenotype and psoriasis are independently associated with an increased prevalence of cardiovascular risk factors. No differences were found for bone metabolism disorders.

Switching from boosted PIs to dolutegravir in HIV-infected patients with high cardiovascular risk: 48 week effects on subclinical cardiovascular disease

Background Switching from boosted PIs to dolutegravir in virologically suppressed HIV-infected patients with high cardiovascular risk significantly decreased total cholesterol and other proatherogenic lipid fractions at 48 weeks. The impact of this strategy on subclinical cardiovascular disease is unknown. Methods NEAT022 is a European, multicentre, open-label, randomized, non-inferiority trial. HIV-infected adults aged >50 years or with a Framingham score >10% were eligible if plasma HIV RNA was <50 copies/mL for >24 weeks on a boosted PI-based regimen. Patients were randomized 1:1 to switch from boosted PIs to dolutegravir or to continue on boosted PIs. Common carotid arteries intima–media thickness (CIMT) and pulse wave velocity (PWV) were measured following a standardized protocol in a subgroup of NEAT022 study participants at baseline and at Week 48. Results One hundred and fifty-six patients participated in the ultrasonography and arterial stiffness substudies, respectively. In each substudy, population characteristics did not differ between arms and matched those of the main study. At 48 weeks, patients who switched to dolutegravir had lower mean progression of both right (+4 versus +14.6 μm) and left (−6.1 versus +1.6 μm) CIMT and also a smaller increase in mean PWV (+0.18 versus +0.39 m/s) than patients continuing on boosted PIs, although differences were not statistically significant. CIMT trends were consistent across Framingham score, age and country. Inconsistent effects were seen in arterial stiffness. Conclusions Relative to continuing on boosted PIs, switching to dolutegravir in virologically suppressed patients with high cardiovascular risk showed consistent favourable although non-significant trends on CIMT progression at 48 weeks.