Shrestha, Abhigan Babu

Background: Supine hypertension, or elevated blood pressure while lying down, is often underrecognized in clinical settings. Though more common in older adults and those with autonomic dysfunction, its long-term cardiovascular impact remains unclear. Growing evidence suggests it may contribute to higher risks of cardiovascular disease (CVD), stroke, heart failure, and mortality. Methods: A meta-analysis evaluated the association between supine hypertension and primary cardiovascular outcomes were searched using standard electronic databases. MeSh term including “supine hypertension” and “cardiovascular outcomes” were used for Search. Studies reporting hazard ratios for CVD events, stroke, heart failure, cardiovascular, and all-cause mortality were included. Random-effect models were used for pooled analysis, with heterogeneity assessed using the I2 statistic and p value <0.05 considered significant. Results: A total of 13 studies were included in the analysis, comprising a combined study population of 241,765 individuals with a mean age of 59 years and follow up for 12.4 years. Cardiovascular Events: Six studies showed a significant association between supine hypertension and increased CVD events (HR = 1.41, 95% CI: 1.28–1.55, p<0.05). Cardiovascular Mortality: Five studies indicated elevated supine systolic BP was linked to higher cardiovascular mortality (HR = 1.57, 95% CI: 1.40–1.75, p<0.05). Heart Failure: Three studies demonstrated a strong, consistent association between supine hypertension and heart failure (HR = 1.83, 95% CI: 1.72–1.95, p<0.05). Mortality: Eight studies showed a modest but significant increase in all-cause mortality (HR = 1.23, 95% CI: 1.02–1.45, p<0.05). Stroke: Three studies revealed significantly increased stroke risk in individuals with supine hypertension versus standing hypotension (HR = 1.69, 95% CI: 1.41–1.97, p<0.05). Conclusion: Supine hypertension was significantly associated with increased risks of CVD events, cardiovascular mortality, stroke, heart failure, and all-cause mortality. These findings highlight the need to consider supine blood pressure patterns in clinical evaluations to improve risk detection and guide preventive care strategies.

e20551 Background: Lung cancer is leading cause of cancer related mortality globally, with non-small cell lung cancer (NSCLC) comprising approximately 80% of all cases. The combination of immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) or its ligand (PD-L1), specifically Durvalumab, and anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitors, such as Tremelimumab has demonstrated clinical efficacy in both adjuvant and neoadjuvant settings. However, a comprehensive systematic review of the available data is currently lacking. This study aims to assess the therapeutic efficacy of Durvalumab combined with Tremelimumab in NSCLC focusing on key end points including progression-free survival, overall survival, overall response rate, and safety, with particular attention to any adverse events and mortality. Methods: A comprehensive literature search was performed to identify relevant studies published until March 2024 across PubMed, Google Scholar, and Embase databases. Outcomes were pooled using the random effects DerSimonian-Laird model and reported as hazard ratio (HR) with a 95% confidence interval. A p-value of less than 0.05 was considered statistically significant. Results: A total of 1600 patients with NSCLC were included in the analysis, with 825 patients receiving Durvalumab plus Tremelimumab, and 775 patient receiving Standard chemotherapy across four studies. For Efficacy, following parameters were statistically significant: Progression Free Survival HR 0.75, 95%CI: 0.59, 0.92; Overall Survival HR 0.8, 95%CI: 0.58, 0.99; Overall Response Rate HR: 0.68, 95%CI: 0.47, 0.88, Mean Duration of Response was 12.23 month. Safety outcomes revealed that Durvalumab plus Tremelimumab versus Standard chemotherapy were comparable in mean percentage in terms of following parameters: Any Adverse Event (85.1% vs 92.8%), Any Serious Adverse Event (28.9% vs 17.75%), any mortality (6.35% vs 3.4%), Adverse Event leading to discontinuation (11.6% vs 10.13%), Any treatment related adverse event (69.96% vs 85.6%) and Any Treatment Related Death (0.9% vs 0.3%). Conclusions: Efficacy outcomes in patients treated with Durvalumab plus Tremelimumab demonstrated clinically meaningful improvements while the safety profile was comparable to that of Standard chemotherapy. Given the increasing use of this combination therapy as adjuvant and neoadjuvant treatment for NSCLC, further clinical trials are warranted to confirm and validate these findings.

e24010 Background: Cancer increases the risk of atrial fibrillation (AF), particularly in patients over 65 or those with pre-existing cardiovascular disease. Patients with active cancer are at a higher risk of arterial and venous thrombosis. Oral anticoagulation (OAC) is recommended in most patients with comorbidities, based on the CHA2DS2-VASc score. However, because OAC raises the risk of bleeding, it might not be appropriate for patients who have significant or frequent bleeding episodes, vascular malformations, or other contraindications. Anticoagulation in cancer patients is challenging due to thrombocytopenia, bleeding risks, and interactions with chemotherapy. Left atrial appendage Closure (LAAC) offers an alternative to anticoagulation for mitigating stroke risk in nonvalvular AF patients. However, this procedure has been offered less frequently as concerns regarding its prognosis among cancer patients remain unclear. This article aims to find the prognosis of cancer patients with LAAC. Methods: A systematic search was conducted in electronic databases from inception until June 2024 using appropriate Mesh terms. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of <0.05 was considered statistically significant. Results: A total of 5 studies with a population of 1,20,502 (Cancer Patients: 3803 and Non- Cancer patients: 116699) were included which met all the inclusion criteria. An increased risk of in-hospital mortality among cancer patients with LAAC (RR=1.90; 95% CI=1.05–3.45, P=0.03) with statistically significant was observed. However, other parameters were comparable including, 30 days readmission (RR=1.12; 95% CI=0.95–1.032), all-cause mortality (RR=1.33; 95% CI=0.72–1.95), any bleeding complication (RR=1.04; 95% CI=0.37–1.70), Cardiovascular complication (RR=1.44; 95% CI=0.51–4.06), thromboembolism (RR= 2.28; 95% CI=0.57–9.06), and neurological complication (RR=0.81; 95% CI=0.17–1.46). Conclusions: There were increased chances of in-hospital mortality among cancer patients than in non-cancer patients with LAAC procedures. However, other parameters like cardiovascular complications, any bleeding complications, thromboembolism, and neurological complications were not significantly associated. Further studies are warranted to validate these findings.

Background: Rivaroxaban is a novel oral anticoagulant suggested as an alternative to low molecular weight heparin (LMWH). However, its efficacy and safety compared to LMWH for treating venous thromboembolism (VTE) in cancer patients remain unclear. Hypothesis: This study aims to compare the efficacy and safety of rivaroxaban against LMWH for treating VTE in cancer patients. Methods: We conducted a literature search for relevant articles on PubMed, Google Scholar, and Embase. Outcomes were pooled using the DerSimonian and Laird random-effects model as risk ratios (RR) with 95% confidence intervals (CI). A p-value of <0.05 was considered statistically significant. Results: A total of 14368 cancer patients (Rivaroxaban: 4378 and LMWH: 9990) from 13 studies were included with an average age of 62.5 and 61.9 respectively. At 3 months, rivaroxaban was associated with a decreased risk of recurrent VTE (RR 0.73, 95% CI: 0.59, 0.86, p<0.05) and bleeding-related hospitalization (RR 0.79, 95% CI: 0.61, 0.97, p<0.05) with statistical signifcant whereas, major bleeding (RR 0.87, 95% CI: 0.09, 1.65), non-major bleeding (RR 0.84, 95% CI: 0.60, 1.08) and all-cause mortality (RR 0.91, 95% CI: 0.72, 1.09) were comparable. At 6 months, rivaroxaban was associated with a decreased risk of all-cause mortality (RR 0.80, 95% CI: 0.62, 0.97, p<0.05), and bleeding-related hospitalization (RR 0.81, 95% CI: 0.65, 0.98, p<0.05) whereas major bleeding (RR 0.88, 95% CI: 0.52, 1.24), non-major bleeding (RR 0.85, 95% CI: 0.42, 1.29) and recurrent VTE (RR 0.83, 95% CI: 0.64, 1.01) were comparable. At 12 months, rivaroxaban was associated with a decreased risk of mortality (RR 0.71, 95% CI: 0.50, 0.92, p<0.05), however non-major bleeding (RR 1.38, 95% CI: 0.83, 1.94), cancer-associated thrombosis recurrence (RR 0.94, 95% CI: 0.73, 1.16), and bleeding (RR 0.70, 95% CI: 0.26, 1.15) were comparable. Conclusion: While rivaroxaban is associated with low adverse outcomes suggesting its use in treating VTE in cancer patients, further research is recommended.

Background: According to the American Cancer Society, there are currently over 18 million adult cancer survivors in the US, and by 2030, that figure is estimated to rise to over 22 million. While this is positive, more and more survivors are now at risk for cardiovascular disease (CVD). Hypothesis: This meta-analysis aims to evaluate the association between cancer survivors and cardiovascular event. Methods: A systematic search was conducted in electronic databases from inception until March 2024 using appropriate Mesh terms for ‘Cancer’, and ‘cardiovascular risk’. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of <0.05 was considered statistically significant. Results: A total of nine studies with 1,209,168 people (Cancer survivor: 140697 and non-cancer: 1068471) were included in our study. The mean follow-up duration was 12.4 years. The risk of cardiovascular events was seen in all cancer survivors (RR: 1.69, 95%CI: 1.31-2.08, P <0.05). The cardiovascular risk was statistically significant in patients with leukemia (RR: 1.71, 95%CI: 1.54-1.88), lung cancer (RR: 1.99, 95%CI: 1.38-2.6) and lymphoma (RR: 1.65, 95%CI: 1.29-2.01), and comparable in breast cancer (RR: 1.22, 95%CI: 0.98-1.46), colorectal cancer (RR: 1.13, 95%CI: 0.89-1.37), prostate cancer (RR: 1.08, 95%CI: 0.99-1.17) and thyroid cancer (RR: 0.96, 95%CI: 0.57-1.35). Conclusion: Our study showed that overall cancer survivors had significant risk for cardiovascular events; mainly leukemia, lung cancer, and lymphoma patients had a significant result. Early identification, continuous monitoring, and proactive management strategies are essential to mitigate the long-term cardiovascular effects of cancer treatments.