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Predictors of the Development of Associated Clinical Conditions in Working-Age Patients With Cardiovascular Risk
N A Koziolova1, A I Chernyavina1, E A Polyanskaya1
1Vagner Perm State Medical University.
Insights
Predictors for associated clinical conditions (ACC) in working-age patients with cardiovascular risk factors (CVRFs) include smoking, type 2 diabetes, and chronic kidney disease. Genetic factors like AGT, APOE, and PPARα gene polymorphisms also significantly increase ACC risk, even with high treatment compliance.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Cardiovascular risk factors (CVRFs) are prevalent in working-age populations.
- High compliance with treatment and healthy lifestyle (HLS) are crucial for managing CVRFs.
- Identifying predictors for associated clinical conditions (ACC) is vital for proactive patient management.
Purpose of the Study:
- To determine predictors for the development of ACC in working-age patients with CVRFs.
- To investigate these predictors under conditions of high treatment compliance and HLS.
Main Methods:
- A cohort of 364 patients with CVRFs but no target organ damage or prior ACC was studied.
- Follow-up lasted 6.45±0.42 years, with 350 patients completing the study.
- Statistical analyses, including regression logistic and correlation, identified significant predictors.
Main Results:
- Smoking, type 2 diabetes mellitus (DM), and chronic kidney disease (CKD) significantly increased ACC risk.
- History of COVID-19 pneumonia, left ventricular hypertrophy (LVH), and increased indexed left atrial volume (ILAV) were also key predictors.
- Arterial stiffness indicators (CAVI, PWVcf, R-AI) and specific gene polymorphisms (AGT, APOE, PPARα) were strongly associated with ACC development.
Conclusions:
- ACC development in compliant patients is linked to modifiable factors like smoking, DM, CKD, and COVID-19 history.
- Structural heart changes (LVH, ILAV) and arterial stiffness are significant indicators.
- Genetic predispositions, particularly homozygosity for minor alleles in AGT, APOE, and PPARα genes, substantially elevate ACC risk.
Aim:
To determine predictors for the development of associated clinical conditions (ACC) in patients of working age with cardiovascular risk factors (CVRFs) in the conditions of high compliance with the treatment and healthy lifestyle (HLS).
Material And Methods:
The study included 364 patients with CVRFs without target organ damage and a history of ACC. Mean age was 42.24±8.08 years. Patients were examined in consistency with the Russian Society of Cardiology (RSC) 2020 guidelines for arterial hypertension and chronic heart failure. The follow-up period was 6.45±0.42 years. 350 patients completed the study, 9 patients died during the follow-up period, and 5 were lost to follow-up. Patients were divided into two groups based on the development of ACC. The first group consisted of 56 (16%) patients with verified ACC, the second group included 294 (84%) patients without ACC.
Results:
Regression logistic and correlation analyses confirmed the prognostic significance for the development of ACC by 12 indicators. The risk of ACC in smokers was increased more than 7 times (odds ratio (OR) 7.44, 95% confidence interval (CI): 3.42-16.21), and when type 2 diabetes mellitus (DM) developed, more than 9 times (OR 9.47, 95% CI: 4.36-20.59); with chronic kidney disease (CKD), more than 6 times (OR 6.75, 95% CI: 3.41-13, 37); with a history of COVID-19 (COronaVIrus Disease 2019) pneumonia, 7 times (OR 7.11, 95% CI: 3.04-16.58); with left ventricular hypertrophy (LVH), 6 times (OR 6, 35, 95% CI: 3.14-12.83); with CAVI index>7.2, almost 3 times (OR 2.69, 95% CI: 1.48-4.86); with PVWcf (carotid-femoral pulse wave velocity) >13 m/s, more than 5 times (OR 5.61, 95% CI: 2.79-11.28); with R-AI index (augmentation index) >1, more than 2 times (OR 2.26, 95% CI: 1.3-3.9); and with an increase in the indexed left atrial volume (ILAV) >27 ml/m2, more than 8 times (OR 8.80, 95% CI: 4.61-16.79). In the presence of polymorphisms in the form of homozygosity for the minor allele of the AGT gene (Thr174Met, rs4762), the risk of developing ACC increased 14 times (OR 14.13, 95% CI: 4.69-42.57), the APOE gene (Cys130Arg, rs429358), 11 times (OR 11.18, 95% CI: 4.18-29.93), and in the intron of the PRARα gene (rs4253778), 8 times (OR 8.11, 95% CI: 3.75-17.53).
Conclusion:
The development of ACC in patients with high compliance with treatment and a healthy lifestyle is associated with smoking, type 2 diabetes and CKD, a history of COVID-19 pneumonia, LVH, increased ILAV >27 g/m2, more pronounced arterial stiffness assessed by an increase in CAVI indices >7.2, R-AI >1, and PWVcf >13 m/s; and with the presence of polymorphism of the AGT, APOE and PPARα genes in the form of homozygosity for the minor allele.
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