Relative Predictive Value of Circulating Immune Markers in US Adults Without Cardiovascular Disease: Implications for Risk Reclassification

OBJECTIVE: To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. METHODS: We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte count within a normal range (4000-11,000 cells/μL [to convert to cells ×10 RESULTS: Among 21,599 participants eligible for this analysis, the median age was 47 years (interquartile range, 34-63 years); 10,651 (49.2%) participants were women, and 10,713 (49.5%) were self-reported non-Hispanic white. During a median follow-up of 9.6 years (interquartile range, 6.8-13.1 years), there were 627 cardiovascular deaths. MLR had the best predictive value for cardiovascular mortality. The addition of elevated MLR (≥0.3) to the 10-year ASCVD risk score improved the classification by 2.7%±1.4% (P=.04). Elevated MLR had better predictive value than C-reactive protein and several components of the 10-year ASCVD risk score. CONCLUSION: Among ambulatory US adults without preexisting cardiovascular disease, we found that MLR had the best predictive value for cardiovascular mortality among circulating immune markers. The addition of MLR to the 10-year risk score significantly improved the risk classification of participants

Pre-Morbid Body Mass Index and Mortality After Incident Heart Failure

Although obesity is an independent risk factor for heart failure (HF), once HF is established, obesity is associated with lower mortality. It is unclear if the weight loss due to advanced HF leads to this paradoxical finding

Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions

Hyponatremia in heart failure (HF) is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction (EF). However, there is a paucity of data in ambulatory patients with HF with preserved ejection fraction (HFpEF). We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium ≤135 mEq/L) in ambulatory HFpEF and HF with reduced EF (HFrEF) in a national cohort of 8,862 veterans treated in Veterans Affairs clinics. Multivariable logistic regression models were used to identify factors associated with hyponatremia, and multivariable Cox proportional hazard models were used for analysis of outcomes. The cohort consisted of 6,185 patients with HFrEF and 2,704 patients with HFpEF with a 2-year follow-up. Hyponatremia was present in 13.8% and 12.9% patients in HFrEF and HFpEF, respectively. Hyponatremia was independently associated with younger age, diabetes, lower systolic blood pressure, anemia, body mass index \u3c30 kg/m(2), and spironolactone use, whereas African-American race and statins were inversely associated. In multivariate analysis, hyponatremia remained a significant predictor of all-cause mortality in both HFrEF (hazards ratio [HR] 1.26, 95% confidence interval [CI] 1.11 to 1.44, p \u3c0.001) and HFpEF (HR 1.40, 95% CI 1.12 to 1.75, p = 0.004) and a significant predictor of all-cause hospitalization in patients with HFrEF (HR 1.18, 95% CI 1.07 to 1.31, p = 0.001) but not in HFpEF (HR 1.08, 95% CI 0.92 to 1.27, p = 0.33). In conclusion, hyponatremia is prevalent at a similar frequency of over 10% in ambulatory patients with HFpEF and HFrEF. Hyponatremia is an independent prognostic marker of mortality across the spectrum of patients with HFpEF and HFrEF. In contrast, it is an independent predictor for hospitalization in patients with HFrEF but not in patients with HFpEF

Results of a Cross-Sectional Survey About Lipid-Management Practices Among Cardiologists in Pakistan: Assessment of Adherence to Published Treatment Guidelines

Objectives: The aims of this study were to assess how closely cardiologists in Pakistan followed published recommendations for lipid management and to identify the factors associated with such behavior. Methods: A cross-sectional survey was delivered in person between September and December 2007 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta, and Peshawar). A standard questionnaire was used to obtain information from cardiologists. Adherence to the guidelines established by the 2004 National Cholesterol Education Program Adult Treatment Panel III was computed based on answers to 14 questions, each correct answer (ie, the answer that followed the guidelines) was assigned 1 point, for a maximum cumulative score of 14. Multivariable linear regression was performed to determine the factors independently associated with guideline knowledge. Results: A total of 295 cardiologists were approached, 239 consented to participate (overall response rate, 81.0%). The median score was 9 out of a maximum of 14 (interquartile range, 8-11). There were important points of divergence from practice recommendations, including suboptimal targets for low-density lipoprotein cholesterol (LDL-C) (65 years (41.8% [100/239]) and female patients (46.4% [1.11/239]). In the adjusted analysis, experienced physicians, interventional cardiologists, and those who pursued continuing medical education activities (jour-nals and conferences) had higher scores (P = 0.005, P = 0.041, P = 0.008, and P = 0.001, respectively). Conclusion: We found important self-reported departures from recommended lipid-management guidelines among cardiologists in Pakistan