Atlantic University School of Medicine

Disclosure: R. Ali: None. A. Dixit: None. T. Jain: None. A.J. Augustine: None. P.R. Patel: None. S. Iftikhar: None. B. Padamati: None. G. Palaniswamy: None. V.A. Mendpara: None. N. Koduri: None. Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health challenge, affecting over 537 million adults worldwide. While lifestyle factors like poor diet and lack of exercise are well-documented contributors, the role of alcohol consumption in increasing diabetes risk is often overlooked. Chronic alcohol use can lead to insulin resistance, obesity, and liver dysfunction, all of which heighten the likelihood of developing diabetes. Despite these metabolic effects, alcohol is rarely a focal point in diabetes prevention efforts. This study examines long-term trends in alcohol-related diabetes burden, focusing on mortality rates (ASMR), Disability (DALYs), and Future projections. Methods: This study analyses Global Burden of Disease (GBD) data from 1990 to 2021, tracking diabetes cases attributed to alcohol consumption. Time-series forecasting models (ARIMA and Exponential Smoothing) are used to predict trends through 2031. A Pearson correlation analysis (r = 0.85, p < 0.001) assesses the relationship between alcohol intake and diabetes burden over time. Additionally, a Vector Auto Regression (VAR) model evaluates the influence of alcohol taxation, obesity rates, and GDP per capita on diabetes prevalence. Results: The findings indicate a consistent rise in alcohol-related diabetes burden, with prevalence increasing from 0.015% in 1990 to 2.92% in 2021. Projections suggest this trend will continue, with alcohol-attributable diabetes burden expected to reach 1.7% by 2031 if no interventions are made. The Age-Standardized Mortality Rate (ASMR) due to alcohol-related diabetes increased from 4.59 in 1990 to 7.88 per 100,000 population in 2021, marking a 71.7% rise in diabetes-related deaths linked to alcohol consumption. Similarly, Disability-Adjusted Life Years (DALYs) due to alcohol-related diabetes increased from 4.45 million in 1990 to 7.72 million in 2021, a 73.4% rise, reflecting a growing impact on disability and reduced quality of life. Economic factors also play a key role—higher alcohol taxation is associated with lower diabetes rates while rising obesity levels and economic growth contribute to an increasing diabetes burden. Conclusions: The evidence points to alcohol consumption as a significant but often underestimated factor driving type 2 diabetes rates, impacting both mortality and disability. Without effective policy measures, the alcohol-related diabetes burden is projected to grow significantly in the coming years. Strategies such as higher alcohol taxes, public awareness campaigns, and integrating alcohol reduction into diabetes prevention programs could help mitigate these risks. Future research should focus on regional variations and long-term policy impacts to develop more effective interventions for reducing alcohol-related metabolic risks. Presentation: Monday, July 14, 2025

Background:Secondary mitral regurgitation (SMR) worsens outcomes in heart failure. Transcatheter mitral valve repair (MitraClip/TMVr) is an established alternative for patients who remain symptomatic on guideline-directed medical therapy (GDMT), but comparative efficacy versus GDMT and surgery has been debated. Methods:We searched MEDLINE, Embase, and Cochrane through February 2025. To avoid double counting, quantitative syntheses used unique randomized controlled trials (RCTs) only; RCT substudies informed qualitative context. Pairwise random-effects meta-analyses compared MitraClip + GDMT vs GDMT and MitraClip vs surgery. Primary outcomes were all-cause mortality and heart-failure hospitalization (HFH). Secondary outcomes included quality of life (Kansas City Cardiomyopathy Questionnaire (KCCQ), MR ≤ 2+, stroke/MI, and major adverse events (MAE). Heterogeneity was explored with I2/τ2, leave-one-out, and prespecified sensitivity analyses per Cochrane/JBI guidance. Results:Nineteen studies were included, of which 5 unique Randomized Control Trials (RCTs) (n = 1912 randomized) contributed to pooling. Versus GDMT, MitraClip reduced mortality (RR 0.77, 95 % CI 0.63-0.95; I2 = 73 %) and (Heart Failure Hospitalization) HFH (RR 0.76, 0.65-0.89; I2 = 90 %), and improved KCCQ (MD + 13.7 points, 6.6-20.7). Including all available comparators across RCTs, mortality remained lower with MitraClip (RR 0.80, 0.65-1.00; p = 0.047; I2 = 26 %). Versus surgery, MitraClip had fewer 30-day MAE (Major Adverse events) (RR 0.29, 0.21-0.40; I2 = 0 %), with no difference in 1-year mortality and similar MR ≤ 2+ at ~1 year. Stroke/MI were comparable. Procedural success exceeded 96 %; partial clip detachment occurred in 1-2 %. Conclusions:In contemporary RCTs, MitraClip on top of GDMT lowers mortality and HF hospitalizations and improves quality of life in SMR. Compared with surgery, TMVr offers a superior early safety profile with similar MR reduction at ~1 year. These results support Heart-Team use of MitraClip after optimized GDMT in anatomically suitable SMR, while reserving surgery for selected scenarios.

Disclosure: A. Dixit: None. T. Mareedu: None. G. Palaniswamy: None. P.R. Patel: None. B. Padamati: None. N. Koduri: None. A.J. Augustine: None. S. Sahu: None. S. Iftikhar: None. V.A. Mendpara: None. T. Jain: None. Background: Secondhand smoke (SHS) exposure has been widely recognized as a major public health concern, contributing to various non-communicable diseases, including Type 2 Diabetes Mellitus (T2DM). Despite extensive research on smoking-related illnesses, limited studies have quantified the direct impact of SHS on diabetes-related mortality, disability-adjusted life years (DALYs), and age-standardized mortality rates (ASMR) at a global scale. Given the increasing prevalence of diabetes and continued SHS exposure worldwide, this study aims to examine trends from 1990 to 2021 and predict future trajectories through 2035 using data from the Global Burden of Disease (GBD) Study. Methods: A dataset of 320 global observations covering 1990-2021 was analyzed to assess the relationship between SHS exposure and diabetes burden. Correlation and regression analyses were performed to evaluate associations between SHS exposure and diabetes prevalence, with a near-perfect correlation (r = 0.99998, p < 0.001). Linear and nonlinear regression models were used to validate the robustness of the association, where a nonlinear model provided a better fit (Residual Standard Error = 2619). ARIMA time-series modeling was employed to project changes in ASMR, DALYs, and diabetes-related deaths through 2035 to forecast future trends. Results: The Age-standardized mortality rate (ASMR) linked to SHS exposure has risen steadily from 8.2 per 100,000 in 1990 to 15.7 per 100,000 in 2021, reflecting a 91% increase. ARIMA projections indicate a further 8-12% rise in ASMR by 2032. Disability-adjusted life years (DALYs) due to SHS-induced diabetes have increased from 14.5 million in 1990 to 31.2 million in 2021, and the forecast suggests a 16% rise by 2032, highlighting the worsening impact on quality of life. Diabetes-related deaths due to SHS exposure have escalated from 1.6 million in 1990 to 3.2 million in 2021, with forecasts predicting over 3.5 million deaths by 2035. The near-perfect correlation between SHS exposure and diabetes burden raises concerns regarding potential collinearity, yet the data strongly indicate a causal relationship requiring further validation with stratified analyses. Conclusions: These findings emphasize the escalating burden of secondhand smoke exposure on diabetes prevalence, mortality, and disability. The projected rise in ASMR, DALYs, and Diabetes-related deaths suggests a growing global crisis unless immediate public health interventions are implemented. Stricter tobacco control policies, enhanced awareness campaigns, and targeted healthcare strategies are imperative to reduce SHS exposure and mitigate its metabolic consequences. Future research should focus on age-specific and regional variations to guide policy-making and intervention strategies that can effectively curb the impact of SHS-related diabetes worldwide. Presentation: Monday, July 14, 2025

Disclosure: T. Mareedu: None. T. Jain: None. P.R. Patel: None. A.J. Augustine: None. N. Koduri: None. G. Palaniswamy: None. B. Padamati: None. S. Iftikhar: None. Background: Hypothalamic hamartomas (HH) are rare, non-neoplastic congenital malformations associated with central precocious puberty (CPP) and gelastic seizures. These lesions are ectopic neuronal masses in the hypothalamus, capable of secreting gonadotropin-releasing hormone (GnRH), leading to early activation of the hypothalamic-pituitary-gonadal axis. Early diagnosis and management are crucial to prevent adverse psychosocial and metabolic consequences.Case Presentation: A 7-year-old male presented with signs of early puberty, including pubic hair development, accelerated growth velocity, and advanced bone age. Clinical examination revealed Tanner stage 3 pubertal development. Biochemical investigations showed elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, with a testosterone concentration of 277 ng/dL (prepubertal reference <50 ng/dL), confirming a diagnosis of CPP. Thyroid function tests were normal. Brain MRI identified a hypothalamic hamartoma in the tuber cinereum region, consistent with the classic findings of HH-related CPP. Discussion: Hypothalamic hamartomas remain a diagnostic challenge due to their varied presentations, ranging from isolated CPP to epilepsy and cognitive impairments. The pathophysiology involves ectopic GnRH pulsatility, triggering the premature activation of the hypothalamic-pituitary axis. First-line treatment includes GnRH analogs, which effectively suppress pubertal progression and mitigate the psychosocial burden of early puberty. In cases refractory to medical therapy, surgical resection or gamma knife radiosurgery may be considered. Conclusion: This case underscores the importance of early recognition of hypothalamic hamartoma as a cause of precocious puberty. Timely intervention with GnRH analogs is essential to prevent complications such as early epiphyseal closure and psychosocial distress. Given its rarity, heightened clinical suspicion is required to differentiate HH from other causes of early puberty. Presentation: Sunday, July 13, 2025

Disclosure: S. Sahu: None. T. Jain: None. A.J. Augustine: None. G. Palaniswamy: None. T. Mareedu: None. P.R. Patel: None. B. Padamati: None. N. Koduri: None. A. Dixit: None. Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among reproductive-age women, characterized by hormonal imbalance, insulin resistance, and metabolic dysfunction. Despite growing evidence linking PCOS to cardiovascular risk factors such as hypertension, dyslipidemia, and chronic inflammation, longitudinal studies examining the direct association between PCOS and cardiovascular disease (CVD) remain limited. Women under 40 with PCOS face an elevated risk of cardiovascular disease due to metabolic and hormonal imbalances. Key risk factors include insulin resistance, obesity, and hypertension. Lifestyle interventions and management of weight and diabetes are essential strategies to reduce this risk. While PCOS is associated with increased cardiovascular risk, further research is needed to fully understand the independent effects of PCOS on CVD. This study aims to evaluate the long-term cardiovascular risk in women diagnosed with PCOS through a retrospective cohort analysis and address this research gap.Methods: A retrospective analysis was conducted using a dataset comprising 1,000 women aged 18-40, with 500 diagnosed with PCOS and 500 age-matched controls without PCOS. Key cardiovascular risk markers, including systolic and diastolic blood pressure (BP), lipid profile (LDL, HDL, triglycerides), fasting glucose, insulin resistance (HOMA-IR), and inflammatory marker C-reactive protein (CRP), were compared between groups. T-tests were used for continuous variables, and a chi-square test was performed to assess the association between PCOS and CVD. Additionally, logistic regression was conducted to evaluate PCOS as an independent predictor of CVD after adjusting for confounders such as BMI, smoking status, and physical activity.Results: Women with PCOS exhibited significantly higher systolic BP (p < 0.01), LDL cholesterol (p < 0.001), triglycerides (p < 0.001), fasting glucose (p < 0.01), and CRP (p < 0.001) compared to controls. The prevalence of CVD was markedly elevated in the PCOS group (chi-square test, χ² = 26.24, p < 0.0001), suggesting a strong association between PCOS and cardiovascular risk. Logistic regression confirmed that PCOS remained an independent predictor of CVD (OR: 2.45, 95% CI: 1.78–3.42, p < 0.001) even after adjusting for confounders.Conclusion: This study provides compelling evidence that PCOS is a significant risk factor for cardiovascular disease, independent of BMI and lifestyle factors. The elevated levels of atherogenic lipids, blood pressure, and inflammatory markers in PCOS patients underscore the urgent need for early cardiovascular screening and risk management in this population. Future research should focus on long-term interventions to mitigate CVD risk in women with PCOS and further clarify the independent role of PCOS in cardiovascular outcomes. Presentation: Saturday, July 12, 2025