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BACKGROUND: The EUROASPIRE I, II and III surveys revealed high prevalences of modifiable risk factors in the high priority group of coronary patients all over Europe. The potential to further reduce coronary heart disease (CHD) morbidity and mortality rates is still considerable. We report here on the relative risk of cardiovascular disease (CVD) death associated with common modifiable risk factor levels based on the mortality follow-up of patients participating in the first two EUROASPIRE surveys. We also present a novel simple risk classification system (ERC) that can be used in the management of patients with existing CHD. METHODS: The study cohort consisted of a consecutive sample of CHD patients aged ?70years from 12 European countries. Baseline data gathered in 1995-2000 through standardized methods, were linked to cardiovascular mortality in 5216 patients according to an accelerated failure time model. RESULTS: During 28,143person-years of follow-up, 332 patients died from cardiovascular disease denoting a CVD mortality risk of 12.3 per 1000person-years in men and 10.2 per 1000person-years in women. In multivariate analysis, fasting glucose, total cholesterol and smoking emerged as the strongest independent modifiable predictors of cardiovascular mortality. CONCLUSIONS: The results of the mortality follow-up of the EUROASPIRE I and II CHD patients emphasize the continuing risk from elevated glucose and total cholesterol levels and underline the importance of smoking cessation in secondary prevention. The ERC risk tool that we developed may prove helpful to obtain these goals in the setting of secondary prevention. PMID:23157810
De Bacquer, Dirk; Dallongeville, Jean; Kotseva, Kornelia; Cooney, Marie Therese; Pajak, Andrzej; Deckers, Jaap W; Mayer, Otto; Vanuzzo, Diego; Lehto, Seppo; Fras, Zlatko; Ostor, Erika; Ambrosio, Giovanni B; De Backer, Guy; Wood, David; Keil, Ulrich; Sans, Susana; Graham, Ian; Pyörälä, Kalevi
Residualrisk, the ongoing appreciable risk of major cardiovascular events (MCVE) in statin-treated patients who have achieved evidence-based lipid goals, remains a concern among cardiologists. Factors that contribute to this continuing risk are atherogenic non-low-density lipoprotein (LDL) particles and atherogenic processes unrelated to LDL cholesterol, including other risk factors, the inherent properties of statin drugs, and patient characteristics, ie, genetics and behaviors. In addition, providers, health care systems, the community, public policies, and the environment play a role. Major statin studies suggest an average 28% reduction in LDL cholesterol and a 31% reduction in relative risk, leaving a residualrisk of about 69%. Incomplete reductions in risk, and failure to improve conditions that create risk, may result in ongoing progression of atherosclerosis, with new and recurring lesions in original and distant culprit sites, remodeling, arrhythmias, rehospitalizations, invasive procedures, and terminal disability. As a result, identification of additional agents to reduce residualrisk, particularly administered together with statin drugs, has been an ongoing quest. The current model of atherosclerosis involves many steps during which disease may progress independently of guideline-defined elevations in LDL cholesterol. Differences in genetic responsiveness to statin therapy, differences in ability of the endothelium to regenerate and repair, and differences in susceptibility to nonlipid risk factors, such as tobacco smoking, hypertension, and molecular changes associated with obesity and diabetes, may all create residualrisk. A large number of inflammatory and metabolic processes may also provide eventual therapeutic targets to lower residualrisk. Classically, epidemiologic and other evidence suggested that raising high-density lipoprotein (HDL) cholesterol would be cardioprotective. When LDL cholesterol is aggressively lowered to targets, low HDL cholesterol levels are still inversely related to MCVE. The efflux capacity, or ability to relocate cholesterol out of macrophages, is believed to be a major antiatherogenic mechanism responsible for reduction in MCVE mediated in part by healthy HDL. HDL cholesterol is a complex molecule with antioxidative, anti-inflammatory, anti-thrombotic, antiplatelet, and vasodilatory properties, among which is protection of LDL from oxidation. HDL-associated paraoxonase-1 has a major effect on endothelial function. Further, HDL promotes endothelial repair and progenitor cell health, and supports production of nitric oxide. HDL from patients with cardiovascular disease, diabetes, and autoimmune disease may fail to protect or even become proinflammatory or pro-oxidant. Mendelian randomization and other clinical studies in which raising HDL cholesterol has not been beneficial suggest that high plasma levels do not necessarily reduce cardiovascularrisk. These data, coupled with extensive preclinical information about the functional heterogeneity of HDL, challenge the “HDL hypothesis”, ie, raising HDL cholesterol per se will reduce MCVE. After the equivocal AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) study and withdrawal of two major cholesteryl ester transfer protein compounds, one for off-target adverse effects and the other for lack of efficacy, development continues for two other agents, ie, anacetrapib and evacetrapib, both of which lower LDL cholesterol substantially. The negative but controversial HPS2-THRIVE (the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events) trial casts further doubt on the HDL cholesterol hypothesis. The growing impression that HDL functionality, rather than abundance, is clinically important is supported by experimental evidence highlighting the conditional pleiotropic actions of HDL. Non-HDL cholesterol reflects the cholesterol in all atherogenic particles containing apolipoprotein B, and has outperformed LDL cho
Through its classic effects on sodium and potassium homeostasis, aldosterone, when produced in excess, is associated with\\u000a the development of hypertension and hence with higher cardiovascular and renal risk. In recent years, experimental and epidemiologic\\u000a data have suggested that aldosterone also may be linked to high cardiovascularrisk independently of its effects on blood\\u000a pressure. Thus, aldosterone has been associated
The increased mortality in rheumatoid arthritis (RA) is mainly due to (atherosclerotic) cardiovascular disease. The cardiovascular morbidity is also increased in comparison with the general population. This increased cardiovascular burden could be caused by 1) an enhanced prevalence of cardiovascularrisk factors 2) under treatment of cardiovascularrisk factors or 3) RA itself, particularly due to its chronic inflammatory component.
Cardiovascular death is the most frequent cause of death in patients on peritoneal dialysis. Risk factors for cardiovascular death in these patients include those that affect the general population as well as those related to end-stage renal disease (ESRD) and those that are specific to peritoneal dialysis. The development of overhydration after loss of residual renal function is probably the
Sleep Deprivation and CardiovascularRisk (0:31) Dr. Janet Mullington discusses how studies suggest a link between sleep deprivation and increased risk for cardiovascular disease. choose settings to watch ...
Adequate dietary calcium intake and appropriate sunlight exposure ensuring adequate vitamin D availability are basic measures for the prevention of osteoporosis. Calcium and vitamin D supplementation increases bone density. Vitamin D plus calcium supplementation prevents hip fractures and other nonvertebral fractures in institutionalised persons 70 years of age or older. A meta-analysis of clinical trials showed an increase in myocardial infarction in patients taking calcium supplementation alone, with a relative risk of about 1.3. Epidemiological studies have not shown an increase in the cardiovascularrisk. Conflicting results have also been reported in postmenopausal women taking both calcium and vitamin D. In an epidemiological study, hypercalcaemia was associated with increased mortality, particularly cardiovascular mortality. In practice, caution dictates that not all patients should routinely take calcium and vitamin D supplements. When calcium supplements are nonetheless used, the dose should be adjusted to dietary intake in order to avoid hypercalcaemia. PMID:23866352
Estrogenic deficiency of menopause is not only responsible to the precocious occurrence of climateric troubles but exposes at increased risk of osteoporosis, metabolic troubles, and cardiovascular complications. We believed for a long time that the hormonal treatment prescription could prevent cardiovascularrisk. Then, initial analysis of the great controlled study WHI and HERS causes unfavorable judgment of overall risk-benefit balance evaluation. However, the situation isn't so contrasted, and many arguments are in favor of vascular benefit with hormonal replacement therapy (HRT). Menopause and HRT influence the cardiovascularrisk factors. The oral-estrogen taking conducts to significant decrease of LDL cholesterol rate, and significant increase of HDL and triglyceride plasma levels. Otherwise, there is a decrease of insulin-resistance and incidence of type 2 diabetes in substituted women. At least, oral estrogens seem to be responsible of deleterious effect pro-inflammatory and prothrombotic. The transdermal taking would limit these effects. During the precocious stage of atheromatous plaque formation, estradiol has a really protective function, with endothelial effect, limiting the induction and the activation of proinflammatory cells. On the contrary, when plaques are formed, giving estrogens could be harmful, because it could facilitate plaque rupture by pro-inflammatory effect. In 1998, then in 2002, the publication of the two main controlled study WHI and HERS removes the legitimacy of HRT in cardiovascular prevention terms, however, post-hoc analysis since published, have moderate the initial version: more and more convincing arguments suggest vascular benefit of HRT, if it begins just after menopause and probably before the existence of advanced atheromatous plaque, bringing the notion of the opportunity window. In contrary of oral taking, transdermal estrogens do not seem to be associated with a significant increase risk in the risk of thromboembolism or cerebrovascular events (stroke). At last, the choice of associated progestatif is essential, concerning the improvement of lipid profile among the human being or towards the prevention of atheroma among the animal, this hormones are able to attenuate or to stop benefits effects of estradiol. In practice, and according to AFSSAPS recommendations, the doctor will make a personalised and rigorous prescription of HRT, at minimal effective dose, associating healthy life style and dietetics measures, and after having given detailed information to the patient. PMID:23041081
Cardiovascular diseases (CVD) are the primary cause of death in women. Guidelines for identifying high-risk individuals have been developed, e.g. the Dutch Guideline on CardiovascularRisk Management. In the most recent version of this guideline, diabetes mellitus (DM) and rheumatoid arthritis (RA) are cited as cardiovascularrisk factors; therefore, individuals with these conditions are identified as being at high risk. As with DM and RA, there is strong evidence that the experience of having a hypertensive disorder during pregnancy is a cardiovascularrisk factor. This is particularly the case for early preeclampsia, which constitutes a 7-fold increased risk of ischemic heart disease. However, in the Netherlands, there are no guidelines and there is no consensus on how to screen or treat these women. Trial evidence is therefore urgently needed to substantiate the value of cardiovascularrisk management for those women with a history of hypertension during pregnancy. PMID:23965245
Cardiovascular death is the most frequent cause of death in patients on peritoneal dialysis. Risk factors for cardiovascular death in these patients include those that affect the general population as well as those related to end-stage renal disease (ESRD) and those that are specific to peritoneal dialysis. The development of overhydration after loss of residual renal function is probably the most important cardiovascularrisk factor specific to peritoneal dialysis. The high glucose load associated with peritoneal dialysis may lead to insulin resistance and to the development of an atherogenic lipid profile. The presence of glucose degradation products in conventional dialysis solutions, which leads to the local formation of advanced glycation end products, is also specific to peritoneal dialysis. Other risk factors that are not specific to peritoneal dialysis but are related to ESRD include calcifications and protein-energy wasting. When present together with inflammation and atherosclerosis, protein-energy wasting is associated with a marked increase in the risk of cardiovascular death. Obesity is not associated with increased cardiovascularrisk in patients on any form of dialysis. Left ventricular hypertrophy and increased arterial stiffness are the most important risk factors for cardiovascular events in the general population. PMID:20567248
his article discusses the evolution of smokeless tobacco in the United States and in- terprets the available data on cardiovascularrisk factors and cardiovascular mortality associated with its use. There has been a resurgence of smokeless tobacco use since 1970. Smokeless tobacco consistently produces levels of nicotine higher than those seen with smoking and causes similar sympathetic neural stimulation and
The incidence of cardiovascular disease (CVD) is increasing in HIV-infected people. Risk factors such as hyperlipidemia, impaired glucose tolerance, and insulin resistance have become common. CVD in HIV may also be related to non-traditional risk factors including accumulation of visceral fat, inflammation secondary to HIV, and effects of some antiretroviral drugs. This cross-sectional study described the CVD risk factors of 123 adults living with HIV and calculated the 10-year estimate for general cardiovascularrisk score. Results showed that approximately 25% of the participants were considered to be at high risk for developing CVD in the next 10 years. Increased waist circumference and longer duration of smoking habit were associated with elevated general cardiovascularrisk scores. Similar to the general population, most of the identified risks could be modified through lifestyle management.
Provided herein methods for determining whether a subject, particularly a human subject, is at risk of developing, having, or experiencing a complication of cardiovascular disease, and methods of treating subjects who are identified by the current methods...
S. L. Hazen M. Kinter M. S. Penn J. Smith L. Zheng
Sildenafil citrate is the first oral agent approved for the treatment of erectile dysfunction (ED); other oral agents are in the process of development. Because the mechanism of action of many of these agents involves vasodilation, there is a potential for interaction with the cardiovascular system. Sildenafil inhibits phosphodiesterase-5 (PDE-5) which is found in the corpus cavernosum and in the
Although lowering low-density lipoprotein (LDL) cholesterol with statins can substantially reduce cardiovascular morbidity\\u000a and mortality, many treated patients retain a residualrisk for cardiovascular events. Low levels of high-density lipoprotein\\u000a (HDL) cholesterol may underpin this residualrisk and may represent an additional target for intervention. Several new therapies\\u000a for substantially increasing HDL cholesterol levels are under investigation, including cholesteryl ester
The objective of this study is to determine the prevalence of cardiovascularrisk in a primarily Latino\\/ Hispanic preschool population of low socioeconomic status. Preschool health screenings were conducted as part of a publicly funded demonstration project designed to provide consultation, education, services, and support to children living in underserved communities. Cross-sectional analysis was restricted to 2- to 5-year-olds with
Larry Yin; Hope Wills; Noreen Clarke; Janice Shacks; Christine Bottrell; Marie K. Poulsen
Recent reports from needle exchange programmes and other public health initiatives have suggested growing use of anabolic steroids (AS) in the UK and other countries. Data indicate that AS use is not confined to body-builders or high-level sportsmen. Use has spread to professionals working in emergency services, casual fitness enthusiasts and subelite sportsmen and women. Although the precise health consequences of AS use is largely undefined, AS use represents a growing public health concern. Data regarding the consequences of AS use on cardiovascular health are limited to case studies and a modest number of small cohort studies. Numerous case studies have linked AS use with a variety of cardiovascular disease (CVD) events or endpoints, including myocardial infarction, stroke and death. Large-scale epidemiological studies to support these links are absent. Consequently, the impact of AS use upon known CVD risk factors has been studied in relatively small, case-series studies. Data relating AS use to elevated blood pressure, altered lipid profiles and ECG abnormalities have been reported, but are often limited in scope, and other studies have often produced equivocal outcomes. The use of AS has been linked to the appearance of concentric left ventricular hypertrophy as well as endothelial dysfunction but the data again remains controversial. The mechanisms responsible for the negative effect of AS on cardiovascular health are poorly understood, especially in humans. Possibilities include direct effects on myocytes and endothelial cells, reduced intracellular Ca2+ levels, increased release of apoptogenic factors, as well as increased collagen crosslinks between myocytes. New data relating AS use to cardiovascular health risks are emerging, as novel technologies are developed (especially in non-invasive imaging) that can assess physiological structure and function. Continued efforts to fully document the cardiovascular health consequences of AS use is important to provide a clear, accurate, public health message to the many groups now using AS for performance and image enhancement. PMID:22229259
JIA is the most common chronic inflammatory arthritis in children and young people. More than one-third of individuals have persistent active disease into adulthood. In RA, there has been considerable interest in long-term cardiovascular outcomes. Increased cardiovascular mortality and morbidity have been observed and consensus guidelines recommend annual cardiovascularrisk assessment for adults with RA. The increased risk is attributed to a higher prevalence of traditional cardiovascularrisk factors and the role of systemic inflammation in the acceleration of atherosclerosis. The long-term risk of cardiovascular disease for individuals with JIA remains uncertain and guidance on risk assessment is not currently available. Given the potential for longer disease duration, it is possible that cardiovascularrisk in this group surpasses that observed in adult-onset inflammatory arthritides. In this article, we consider the evidence for cardiovascularrisk in JIA. PMID:23502074
Coulson, Elizabeth J; Ng, Wan-Fai; Goff, Iain; Foster, Helen E
Background: Although cardiovascular disease (CVD) is the leading cause of death in women in the United States, a knowledge gap persists regarding the mechanisms and management of CVD in women. Before treatment can be optimized, the role of cardiovascularrisk factors must be elucidated.Objective: This review provides an updated assessment of cardiovascularrisk factors in women, with a focus on
Few interventional studies have reported a positive effect of native vitamin D supplementation on intermediary parameters of insulin resistance, of cardiovascularrisk and on major cardiovascular events and mortality. PMID:24090586
LEARNING OUTCOME: To examine the impact of a RD managed school based cardiovascularrisk reduction program on diet, knowledge, weight, blood pressure and usual activity in minority adolescents.The African American population has an excess prevalence of cardiovascular (CV) disease including hypertension. Risk factors for future CV disease can be identified in the young. The purpose of this study was to
Cardiovascular disease is the leading cause of death in women, contributing to one in three female deaths. Despite improvements in overall cardiovascular outcomes, substantial gender and ethnic disparities remain. In order to improve outcomes among women, we recommend the following: every woman should undergo risk stratification for short-term and lifetime cardiovascularrisk given the substantial long-term risk of cardiovascular disease; modifiable cardiovascularrisk factors in women should be modified to the greatest extent possible; and these factors include lipid abnormalities, hypertension, smoking, diabetes, obesity, physical inactivity and, possibly, inflammatory markers. The rate of decline in heart disease is slower for women than men, highlighting the need for gender-specific interventions to address the outcomes gap. PMID:24007254
Obesity is a major risk factor for cardiovascular disease, the number one killer of Americans. It is also a major risk factor\\u000a for obstructive sleep apnea, which is rising in the US population as the obesity epidemic continues. Obstructive sleep apnea,\\u000a in turn, has been implicated as a risk factor for hypertension, glucose dysregulation, and cardiovascular disease. Understanding\\u000a the pathophysiologic
Muhammad Iqbal; Syed Shah; Sonalis Fernandez; Jocelyne Karam; Girardin Jean-Louis; Samy I. McFarlane
New serologic markers of cardiovascularrisk continue to be amassed. Among the new markers, C-reactive protein, fibrinogen,\\u000a and homocysteine have enjoyed the most acceptance, but newer concepts such as inflammatory cytokines, aspirin resistance,\\u000a and antioxidant deficiency continue to emerge. Traditional cardiac risk factors are able to predict less than half of cardiovascular\\u000a events, and the new array of markers have
Cardiovascular disease is a heterogeneous disease caused by the interaction of multiple pathologies affecting various systems,\\u000a genetic predisposition, and environmental factors. Recently, novel “non-classic” risk factors have been recognized to play,\\u000a together with well-characterized risk factors, a role in the pathophysiology of cardiovascular disease. The heterogeneity\\u000a of causative factors makes identifying the genetic background along with the contribution of environmental
Fasting hyperhomocysteinemia is an independent risk factor for coronary artery disease, stroke, peripheral vascular atherosclerosis, and for arterial and venous thromboembolism. The risk for cardiovascular disease with homocysteine is similar to conventional risk factors. The interaction of hyperhomocysteinemia with hypertension and smoking is strong and the combined effect is more than multiplicative. The combined effect of homocysteine and cholesterol is
The literature on shift work, morbidity and mortality from cardiovascular disease, and changes in traditional risk factors is reviewed. Seventeen studies have dealt with shift work and cardiovascular disease risk. On balance, shift workers were found to have a 40% increase in risk. Causal mechanisms of this risk via known cardiovascularrisk factors, in relation to circadian rhythms, disturbed sociotemporal patterns, social support, stress, behavior (smoking, diet, alcohol, exercise), and biochemical changes (cholesterol, triglycerides, etc) are discussed. The risk is probably multifactorial, but the literature has focused on the behavior of shift workers and has neglected other possible causal connections. In most studies methodological problems are present; these problems are related to selection bias, exposure classification, outcome classification, and the appropriateness of comparison groups. Suggestions for the direction of future research on this topic are proposed. PMID:10360463
Background Stroke survivors are at significant risk for recurrent stroke and cardiovascular disease. Inadequately managed modifiable risk factors increase the threat of recurrent stroke, development of new co-morbidities, and double the risk of premature mortality. The purpose of this study was to determine the prevalence of modifiable cardiovascularrisk factors in stroke survivors who completed a research screening evaluation for entry into exercise rehabilitation studies. The sample collected between January 2001 and June 2005 evaluated 364 community-dwelling men and women aged 34 to 88 years living in Baltimore, Maryland. Methods Each participant’s risk profile was evaluated from data obtained during a medical history and physical examination and from laboratory analysis of a fasting blood sample. Current practice guidelines were used to define risk categories. Results Ninety-nine percent of participants had at least one sub-optimally controlled risk factor. Ninety-one percent had two or more concurrent risk factors inadequately treated. Eighty percent of the participants had pre-hypertension or hypertension, 67% were overweight or obese, 60% had sub-optimal LDL, 45% had impaired fasting glucose, 34% had low HDL, and 14 % were current smokers, while reportedly receiving routine medical care. Conclusions These findings confirm that cardiovascularrisk factors remain inadequately managed in stroke survivors, increasing the chance for repeat stroke and cardiovascular event. Systematic assessment of this vulnerable population is imperative at every healthcare encounter.
Kopunek, Susan P.; Michael, Kathleen M.; Shaughnessy, Marianne; Resnick, Barbara; Nahm, Eun-Shim; Whitall, Jill; Goldberg, Andrew; Macko, Richard F.
In this narrative review of the current literature, we examine the traditional risk factors and patient profiles leading to cardiovascular disease and osteoporosis. We discuss the interrelationships between risk factors and common pathophysiological mechanisms for cardiovascular disease and osteoporosis. We evaluate the increasing evidence that supports an association between these disabling conditions. We reveal that vascular health appears to have a strong effect on skeletal health, and vice versa. We highlight the importance of addressing the risk benefit of preventative interventions in both conditions. We discuss how both sexes are affected by these chronic conditions and the importance of considering the unique risk of the individual. We show that habitual physical activity is an effective primary and secondary preventative strategy for both cardiovascular disease and osteoporosis. We highlight how a holistic approach to the prevention and treatment of these chronic conditions is likely warranted.
Cardiovascularrisk factors as well as morbidity and mortality from coronary heart disease among Turkish adults are herein reviewed. Lipids and lipoproteins are in focus, but other relevant risk factors are also discussed. Turks have distinctively low levels of total and high-density lipoprotein (HDL)-cholesterol, associated with high levels of hepatic lipase and fasting triglycerides. In addition, physical inactivity is common
Dietary trans fatty acids/hydrogenated fat has been associated with increased risk of developing cardiovascular disease (CVD), possibly greater than predicted from changes in lipoprotein levels. To explore this issue further potential risk factors were assessed in thirty-six subjects provided with ...
To determine the relation between plasma triglyceride levels and the risk of incident cardiovascular disease, the semiquantitative techniques of meta-analysis were applied to 17 population-based prospective studies of triglyceride and cardiovascular disease. Sixteen of these studies represented 2,445 events among 46,413 Caucasian men followed for an average period of 8.4 years, and 5 studies represented 439 events among 10,864 Caucasian
Melissa A Austin; John E Hokanson; Karen L Edwards
In adults, physical activity and exercise training are associated with reduced cardiovascular morbidity and mortality, a reduced likelihood of developing adverse cardiovascularrisk factors, and improved insulin sensitivity. In childhood, participation in appropriate physical activity may prevent the development of cardiovascularrisk factors in the future and complement treatment of existing cardiovascularrisk factors, including hypertension, dyslipidemia, and overweight. Exercise
The aim of this study was to determine the prevalence of cardiovascularrisk factors in adolescents and to verify its association with age and gender. 644 high school students from public schools in the city of Londrina, Paraná State, Brazil, participated in the study. A two-step sampling process was used. Behavioral risk factors (physical inactivity, inadequate consumption of fruits and vegetables, and smoking) and biological risk factors (overweight and high blood pressure) were investigated. Nearly 90% of adolescents showed at least one risk factor. Inadequate consumption of fruits (56.7%) and vegetables (43.9%) and physical inactivity (39.2%) were the most prevalent risk factors. Prevalence rates for high blood pressure and overweight were 18.6 and 12.7%, respectively. Cardiovascularrisk factors were more frequent among boys (PR = 1.20; 95%CI = 1.01-1.42). In conclusion, cardiovascularrisk factors are a prevalent health issue among students in the city of Londrina. PMID:19009137
Romanzini, Marcelo; Reichert, Felipe Fossati; Lopes, Adair da Silva; Petroski, Edio Luiz; de Farias Júnior, José Cazuza
Atherosclerosis begins during childhood. A strong relationship has been shown between the prevalence and extent of asymptomatic atherosclerosis and cardiovascularrisk factors such as elevated body mass index, blood pressure and plasma lipid concentrations, starting in childhood. These risk factors are influenced by genetic predisposition, but also by environmental factors, and particularly diet. The Nutrition Committee of the French Pediatrics Society of Pediatrics has reviewed the scientific basis of dietary recommendations for children, in order to limit risk factors and thereby to reduce the risk of cardiovascular disease in later life. This review focuses on the effects of prenatal nutrition; the beneficial effects of breast-feeding on cholesterolemia, blood pressure and corpulence in later life; the impact of dietary lipids on plasma lipid concentrations; the effects of salt and potassium intake on blood pressure; and the relation between lifestyle and corpulence. PMID:22292299
Background: Cardiovascular disease including coronary heart disease (CHD) is currently the major cause of death in both men and women. Diet is considered as an important modifiable risk factor. This paper gives an overview of the epidemiological evidence relating diet to CHD mortality and morbidity. Results: Several cohort studies have shown that low intake of animal fats, moderate alcohol consumption,
C ardiac autonomic neuropathy (CAN) represents a serious complication as it carries an approximately five-fold risk of mortality in patients with diabetes just as in those with chronic liver diseases. The high mortality rate may be related to silent myocardial infarction, cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not yet explained. Resting tachycardia due to parasympathetic damage
Cardiovascular diseases (CVD) result from complex interactions between genetic and environmental factors. The evidence supports that gene-environment interactions modulate plasma lipid concentrations and potentially CVD risk. Several genes [i.e., APOA1, APOA4, APOE, and LIPC] are providing proof-of-...
Patients with rheumatoid arthritis (RA) carry an excess risk for cardiovascular disease, which is comparable to the risk in patients with type 2 diabetes mellitus. The mechanisms involved are partly related to traditional cardiovascularrisk factors, disease-associated inflammation and undertreatment of traditional cardiovascular disease (CVD) risk factors. Since atherosclerosis is an inflammatory disease, the auto-immune mediated inflammation observed in RA patients contributes to increased endothelial dysfunction, oxidative stress and activation and vascular migration of leukocytes. This concept is underscored by the CVD risk reduction that is seen by anti-inflammatory disease modifying anti-rheumatic drugs such as methotrexate and TNF? inhibitors. The evidence for underdiagnosis and undertreatment of traditional CVD risk factors in RA strengthens the potential benefit of structured CVD risk management in these patients. Current cardiovascular guidelines recommend screening and treatment of CVD risk factors in RA patients, without well defined treatment targets. At present, there is a lack of scientific evidence to establish treatment targets for CVD risk factors in RA. Therefore, expanding research regarding screening and treatment of traditional CVD risk factors in RA patients is needed. PMID:24125429
van Breukelen-van der Stoep, D F; Klop, B; van Zeben, D; Hazes, J M W; Cabezas, M Castro
Cardiovascular disease (CVD) is still the leading cause of death and disability worldwide despite the availability of well-established and effective preventive options. Accurate perception of a patient’s risk by both the patient and the doctors is important as this is one of the components that determine health-related behavior. Doctors tend to not use cardiovascular (CV) risk calculators and underestimate the absolute CV risk of their patients. Patients show optimistic bias when considering their own risk and consistently underestimate it. Poor patient health literacy and numeracy must be considered when thinking about this problem. Patients must possess a reasonably high level of understanding of numerical processes when doctors discuss risk, a level that is not possessed by large numbers of the population. In order to overcome this barrier, doctors need to utilize various tools including the appropriate use of visual aids to accurately communicate risk with their patients. Any intervention has been shown to be better than nothing in improving health understanding. The simple process of repeatedly conveying risk information to a patient has been shown to improve accuracy of risk perception. Doctors need to take responsibility for the accurate assessment and effective communication of CV risk in their patients in order to improve patient uptake of cardioprotective lifestyle choices and preventive medications.
Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus , it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascularrisk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascularrisk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascularrisk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients' health integrity. PMID:23843832
Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus , it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascularrisk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascularrisk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascularrisk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients’ health integrity.
Osmotic swelling (OS) and residual stress (RS) significantly affect the function of cardiovascular (CVS) tissues and organs. The physical mechanisms of OS and RS are reviewed and analyzed with focus on the theoretical background and related experimental evidence. It will be shown that swelling of CVS tissues stems from the presence of charged proteoglycan macro-molecules in these tissues, and that this swelling is a key determinant of RS. In view of OS and RS functional significance in mechanical function, modeling attempts which incorporate them in CVS stress analysis will be presented and discussed. PMID:22236524
Background. Studies show sustained levels of nicotine among young males using smokeless tobacco, causing concern for subsequent cardiovascularrisk. Also, there is little information on effects of nicotine replacement on cardiovascularrisk in cessation programs. This study investigates the effects of nicotine gum replacement in smokeless tobacco cessation on cardiovascularrisk factors. Methods. Smokeless tobacco users, ages 18-65, were randomly
S. S. Allen; D. Hatsukami; J. Jensen; M. Grillo; R. Bliss
BACKGROUND: Cardiovascular disease is the most common cause of death and risk prediction formulae such as the Framingham Risk Score have been developed to easily identify patients at high risk that may require therapeutic interventions. DISCUSSION: Using cardiovascularrisk formulae at a population level to estimate and compare average cardiovascularrisk among groups has been recently proposed as a way
Background. Chronic kidney disease (CKD) patients are highly prone to cardiovascular disease for a number of reasons. At the time of starting renal replacement treatment, their cardiovascular condition is already severely compromised, suggesting that cardiovascularrisk factors begin to operate very early in the progression of CKD. Moreover, those patients reaching end-stage renal disease without cardiovascular abnormalities have a high
Francesco Locatelli; Pietro Pozzoni; Francesca Tentori; Lucia Del Vecchio
Postprandial hyperglycemia is increasingly recognized as an independent risk factor for cardiovascular disease. Glycemic “spikes”\\u000a may adversely affect vascular structure and function via multiple mechanisms, including (acutely and\\/or chronically) oxidative\\u000a stress, inflammation, low-density lipoprotein oxidation, protein glycation, and procoagulant activity. Postprandial glycemia\\u000a can be reliably predicted by considering both the amount and type of carbohydrate. In particular, the glycemic index
Jennie Brand-Miller; Scott Dickinson; Alan Barclay; David Celermajer
SUMMARY The morbidity and mortality of the cardiovascular diseases is high in the developed countries. The lifestyle changes are capable to decrease it by 50%. The aim of the present study was to measure the parameters of some risk factors before and after a one-week NEW START rehabilitative retreat. 1,349 volunteers, 320 men, 1,029 woman, mean age 51±14.5 (SD) years
Otomar Kittnar; Gary E. Fraser; Eva Medová; Robert i ka; Alena Dohnalová; Vladimír Novák
Overweight and obesity have been rising dramatically worldwide and are an independent risk factor for cardiovascular disease\\u000a (CVD). The majority of overweight and obese patients who achieve a significant short-term weight loss fail to maintain their\\u000a lower weight in the long term. As a result, there has been focus on the role of pharmacotherapy for long-term weight management.\\u000a Since the
An increase in the incidence and an earlier onset of coronary artery disease is expected because of the increased prevalence of childhood obesity. Comorbidities of obesity, such as dyslipidemia, insulin resistance syndrome, hypertension, associated nutritional deficiencies, and a sedentary lifestyle or associated lifestyle factors such as tobacco smoke exposure, are likely to account for this increase because these are all independent risk factors for accelerated atherosclerosis. Because clinical atherosclerotic cardiovascular disease does not manifest in obese children, assessment of the subclinical markers of atherosclerosis may help in the evaluation of the progression of atherosclerosis, in further stratification of risk, and in monitoring the effects of intervention. Furthermore, because multiple risk factors with poorly understood interplay might be present in obese children, assessment of the vasculature directly, and perhaps the assignment of a "vascular age," may be a useful method to quantify the "end organ" effect of exposure to these various risks. Obese children may show favorable changes in their behaviors that result in an improvement in clinically measurable risk factors with various clinic-based and behavior modification therapies, but the vascular benefits of such interventions need to be studied further. Broad social, cultural, legislative, and policy changes that support healthy lifestyles within families and communities need to be implemented to decrease the prevalence of childhood obesity and its cardiovascular consequences in communities. The effect of risk factor modification on the vasculature will continue to be a resource for the direction of evidence-based therapy in obese children. PMID:20335556
Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients.BackgroundCardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.MethodsIn this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in
Alfred K. Cheung; Mark J. Sarnak; Guofen Yan; Johanna T. Dwyer; Robert J. Heyka; Michael V. Rocco; Brendan P. Teehan; Andrew S. Levey
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Epidemiologic research of the last half-century has clearly shown that psychosocial factors related to the social environment, personality characteristics, and negative affect increase the risk of incident CVD and also impact prognosis of cardiac patients. Several mechanisms may explain this link, including a genetic predisposition, poor lifestyle choices, low adherence to health recommendations, and direct pathophysiologic perturbations. The latter include alteration of the hypothalamic-pituitary adrenal axis and autonomic dysfunction resulting in endothelial dysfunction, inflammation, and a prothrombotic state further downstream. Screening for psychosocial factors seems appropriate as part of the standard history and based on the clinician's knowledge of the patient and the purpose of the visit. Psychological interventions generally alleviate distress in cardiac patients, but whether they reduce the risk of hard cardiovascular endpoints and all-cause mortality is less evident. Cardiac patients with more severe depression may particularly profit from antidepressant medications. Due to their pharmacologic properties, selective serotonin reuptake inhibitors were shown to improve cardiovascular outcome. The most effective psychosocial treatment is multicomponent therapy that combines elements of cognitive behaviour therapy ("stress management") and changes in health behaviours, including the adoption of a regular exercise regimen. Gender-specific issues should probably be considered. The field of behavioural cardiology has accumulated a wealth of epidemiological, mechanistic and clinical knowledge that undoubtedly has furthered our understanding about the important role of psychosocial risk factors in patients with a heart disease. PMID:22271452
Background—Fibrinogen has been identified as an independent risk factor for cardiovascular disease and associated with traditional cardiovascularrisk factors. Also, the role of elevated fibrinogen in thrombosis suggests that it may be on the causal pathway for certain risk factors to exert their effect. These associations remain incompletely characterized. Moreover, the optimal fibrinogen assay for risk stratification is uncertain. Methods
James J. Stec; Halit Silbershatz; Geoffrey H. Tofler; Travis H. Matheney; Patrice Sutherland; Izabela Lipinska; Joseph M. Massaro; Peter F. W. Wilson; James E. Muller; Ralph B. D'Agostino Sr
Evidence regarding health benefits of physical activity is overwhelming and plays a critical role in both the primary and secondary prevention of coronary artery disease (CAD). Epidemiological investigations show approximately half the incidence of CAD in active compared to sedentary persons. A sedentary lifestyle is considered by various national and international organizations to be one of the most important modifiable risk factors for cardiovascular morbidity and mortality. Fortunately, a moderate level of occupational or recreational activity appears to confer a significant protective effect. Once coronary artery disease has become manifest, exercise training can clearly improve the functional capacity of patients and reduce overall mortality by decreasing the risk of sudden death. Well-designed clinical investigations, supported by basic animal studies, have demonstrated that the beneficial effects of exercise are related to direct and indirect protective mechanisms. These benefits may result from an improvement in cardiovascularrisk factors, enhanced fibrinolysis, improved endothelial function, decreased sympathetic tone, and other as-yet-undetermined factors. Hence physical fitness, more than the absence of ponderosity or other factors, is the major determinant of cardiovascular and metabolic risk and long-term disease-free survival, in effect linking health span to life span. It is obviously in every individual's interest to assume the responsibility for his or her own health and embrace this extremely effective, safe, and inexpensive treatment modality. The need for a comprehensive review of this particular topic has arisen in view of the high prevalence of physical inactivity and overwhelming evidence regarding CVD risk reduction with regular physical activity. PMID:19346639
|Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes…
Dobrosielski, Devon A.; Rosenbaum, Daryl; Wooster, Benjamin M.; Merrill, Michael; Swanson, John; Moore, J. Brian; Brubaker, Peter H.
Background—Coronary calcification detected by electron beam tomography may improve cardiovascularrisk prediction. The technique is particularly promising in the elderly because the predictive power of cardiovascularrisk factors weakens with age. We investigated the prognostic value of coronary calcification for cardiovascular events and mortality in a general, asymptomatic population of elderly subjects. Methods and Results—From 1997 to 2000, electron beam
Rozemarijn Vliegenthart; Matthijs Oudkerk; Albert Hofman; Hok-Hay S. Oei; Wim van Dijck
Atherosclerosis begins during childhood. From childhood, a strong relation has been shown between the prevalence and extent of the asymptomatic atherosclerosis lesions and cardiovascularrisk factors such as elevation in body mass index, blood pressure and plasma lipid concentrations. These risk factors depend not only on the subjects' genetic predisposition, but also on environmental parameters, particularly diet. The Committee on Nutrition reviewed the scientific basis of dietary recommendations for children that could reduce the risk factors and thereby, reduce the risk of coronary heart disease in later life: the effects of prenatal nutrition; the beneficial consequences of breast-feeding on later levels of cholesterolemia, blood pressure and corpulence; the role of dietary lipids on plasma lipid concentration, of salt and potassium on blood pressure, and of lifestyle on corpulence. PMID:19944575
Introduction Several anthropometric measurements have been associated with cardiovascular disease, type-2 diabetes mellitus and other cardiovascularrisk conditions, such as hypertension or metabolic syndrome. Waist-to-height-ratio has been proposed as a useful tool for assessing abdominal obesity, correcting other measurements for the height of the individual. We compared the ability of several anthropometric measurements to predict the presence of type-2 diabetes, hyperglycemia, hypertension, atherogenic dyslipidemia or metabolic syndrome. Materials and Methods In our cross-sectional analyses we included 7447 Spanish individuals at high cardiovascularrisk, men aged 55–80 years and women aged 60–80 years, from the PREDIMED study. Logistic regression models were fitted to evaluate the odds ratio of presenting each cardiovascularrisk factor according to various anthropometric measures. The areas under the receiver-operating characteristic curve (AUC) were used to compare the predictive ability of these measurements. Results In this relatively homogeneous cohort with 48.6% of type-2 diabetic individuals, the great majority of the studied anthropometric parameters were significantly and positively associated with the cardiovascularrisk factors. No association was found between BMI and body weight and diabetes mellitus. The AUCs for the waist-to-height ratio and waist circumference were significantly higher than the AUCs for BMI or weight for type-2 diabetes, hyperglycemia, atherogenic dyslipidemia and metabolic syndrome. Conversely, BMI was the strongest predictor of hypertension. Conclusions We concluded that measures of abdominal obesity showed higher discriminative ability for diabetes mellitus, high fasting plasma glucose, atherogenic dyslipidemia and metabolic syndrome than BMI or weight in a large cohort of elderly Mediterranean individuals at high cardiovascularrisk. No significant differences were found between the predictive abilities of waist-to-height ratio and waist circumference on the metabolic disease.
Hypertension, hypercholesterolemia, diabetes and obesity are among a growing list of conditions that have been designated as major risk factors for cardiovascular disease (CVD). While CVD risk factors are well known to enhance the development of atherosclerotic lesions in large arteries, there is also evidence that the structure and function of microscopic blood vessels can be profoundly altered by these conditions. The diverse responses of the microvasculature to CVD risk factors include oxidative stress, enhanced leukocyte- and platelet-endothelial cell adhesion, impaired endothelial barrier function, altered capillary proliferation, enhanced thrombosis, and vasomotor dysfunction. Emerging evidence indicates that a low-grade systemic inflammatory response that results from risk factor-induced cell activation and cell-cell interactions may underlie the phenotypic changes induced by risk factor exposure. A consequence of the altered microvascular phenotype and systemic inflammatory response is an enhanced vulnerability of tissues to the deleterious effects of secondary oxidative and inflammatory stresses, such as ischemia and reperfusion. Future efforts to develop therapies that prevent the harmful effects of risk factor-induced inflammation should focus on the microcirculation.
Granger, D. Neil; Rodrigues, Stephen F.; Yildirim, Alper; Senchenkova, Elena Y.
Objective To assess the suitability of Australian community pharmacies as cardiovascular disease risk profile screening centres and\\u000a evaluate whether community pharmacists can play an important role in detecting, educating and referring screened individuals\\u000a at high risk of cardiovascular disease. Setting 14 Australian community pharmacies. Method Opportunistic cardiovascular disease risk profiling for members of the public aged greater than 30 years with
Gregory M. PetersonKimbra; Kimbra D. Fitzmaurice; Helen Kruup; Shane L. Jackson; Rohan L. Rasiah
BackgroundWhether pulse pressure amplification (PPA) relates to established markers of cardiovascularrisk is unknown. The purpose of this study was to investigate the relationship between PPA and cardiovascularrisk factors and cardiovascularrisk in a population-based sample of 40- to 80-year old men.MethodsA cross-sectional, single-center study was performed in 400 men aged 40–80 years. PPA was calculated as a ratio
Marie-Elise Nijdam; Yvonne Plantinga; Hans T. Hulsen; Willem J. W. Bos; Diederick E. Grobbee; Yvonne T. van der Schouw; Michiel L. Bots
Increasing evidence indicates that hypertension in pregnancy is an under-recognized risk factor for cardiovascular disease (CVD). Compared with women who have had normotensive pregnancies, those who are hypertensive during pregnancy are at greater risk of cardiovascular and cerebrovascular events and have a less favorable overall risk profile for CVD years after the affected pregnancies. One factor that might underlie this
There are four definitions of the metabolic syndrome that have been recommended by the World Health Organization (WHO), the European Group for Study of Insulin Resistance (EGIR), the National Cholesterol Education Program Expert Panel (NCEP), and the American Association of Clinical Endocrinologists (AACE) separately since 1998. The prevalence of the metabolic syndrome reported from different studies has varied widely, mainly because of differences in the definitions of the syndrome and in the characteristics of the populations studied. Prospective studies on the relationship between the metabolic syndrome and cardiovascularrisk are still scanty. Results from several studies including a large population-based Italian study, the Framingham Offspring Study, the Botnia Study, the Kuopio Ischemic Heart Disease Study, the National Health and Nutrition Examination Survey II Mortality Study, the San Antonio Heart Study, and the DECODE study have shown that the presence of metabolic syndrome using different definitions is associated with a significantly increased risk of total mortality and cardiovascular morbidity and mortality. PMID:18220589
We report a cardiovascularrisk factor survey of "native" Hawaiians 20-59 years old (70 percent, or 257), living on the Hawaiian Homestead lands on the island of Molokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol greater than or equal to 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2 + or greater glycosuria by dipstick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low. PMID:1990852
Curb, J D; Aluli, N E; Kautz, J A; Petrovitch, H; Knutsen, S F; Knutsen, R; O'Conner, H K; O'Conner, W E
Atherosclerosis of arterial vessels starts early in life, often in childhood. Subclinical atherosclerotic lesions can already be detected non-invasively in children presenting with cardiovascularrisk factors. Impairment of endothelial function, pathologically altered intima- media thickness and increased arterial stiffness are evident long before cardiovascular events occur. Childhood obesity is a key player in the pathogenesis of cardiovascular disorders since obesity
Ephraim B Beck; Claudia Walther; Antje Körner; Sandra Erbs
Cardiovascularrisk management is common in patients suffering from manifest cardiovascular disease, hypertension, hyperlipidaemia and diabetes mellitus. It is generally accepted that medication is the most effective treatment for reducing cardiovascular morbidity and mortality in these patients. Remarkably, cardiovascularrisk management is rare in patients suffering from branch retinal vein occlusion. This common retinal vascular disorder in middle aged and elderly people occurs where a thickened retinal artery compresses the affected vein. Although thrombosis is involved, procoagulant disorders are only present in selected cases. On the other hand, prior diabetes, hypertension, and peripheral artery disease are associated with an increased risk of developing branch retinal vein occlusion up to a decade later, and retinal vascular disorder is associated with an increased risk of subsequently developing hypertension, diabetes, congestive heart failure, and cerebrovascular disease later on. Therefore, branch retinal vein occlusion is a marker of developing cardiovascular disease and warrants adequate cardiovascularrisk management. PMID:23693011
Background Cardiovascular disease (CVD) is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascularrisk scores (Framingham, Regicor, SCORE, and DORICA) to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain) in the period 1981-2008 (2059 transplants corresponding to 1794 patients). The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascularrisk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease). Four cardiovascularrisk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE) equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry)), and DORICA (Dyslipidemia, Obesity, and CardiovascularRisk) functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk Reduction), RRR (Relative Risk Reduction) and NNT (Number Needed to Treat). The ability of different cardiovascularrisk scores to predict cardiovascular events will be analyzed by using the c index and the area under ROC curves. Based on the competing risks analysis, a nomogram to predict the probability of cardiovascular events after kidney transplantation will be developed. Discussion This study will make it possible to determine the post-transplant incidence of cardiovascular events in a large cohort of renal transplant recipients in Spain, to confirm the relationship between traditional and transplant-specific cardiovascularrisk factors and CVD, and to develop a score to predict the risk of CVD in these patients.
Background—Casual blood pressure (BP) is a powerful predictor of risk of cardiovascular disease (CVD), but a single BP determination may not accurately reflect the residual impact of antecedent BP levels on vascular risk. It is unclear whether time-averaged past BP measures incrementally improve CVD risk assessment. Methods and Results—We used sex- and age-specific multivariable Cox regression to evaluate the association
Ramachandran S. Vasan; Joseph M. Massaro; Peter W. F. Wilson; Sudha Seshadri; Philip A. Wolf; Daniel Levy; Ralph B. D'Agostino
Background: Depressive symptomology is an independent risk factor for cardiovascular disease. Over 15% of persons with cardiovascular disease have depressive symptoms, and women are twice as likely to experience these symptoms as men. Depressive symptoms in women “ at risk ” for cardiovascular disease has not been well studied.\\u000aPurpose: This study investigated the relationship between depressive symptoms, health-promoting lifestyle
Inflammation enhances cardiovascularrisk and mortality in hemodialysis patients.BackgroundAtherosclerosis, a major problem in patients on chronic hemodialysis, has been characterized as an inflammatory disease. C-reactive protein (CRP), the prototypical acute phase protein in humans, is a predictor of cardiovascular mortality in the general population. We hypothesize that several of the classic, as well as nontraditional, cardiovascularrisk factors may respond
JOSEF ZIMMERMANN; SILKE HERRLINGER; ANTJE PRUY; THOMAS METZGER; CHRISTOPH WANNER
People with diabetes are more likely to develop a cardiovascular (CV) disease compared with those without diabetes. Although effective glycemic control has been the focus of the management of type 2 diabetes mellitus (T2DM), it is also important to control other CV risk factors to improve outcomes in these patients. Dapagliflozin, a sodium-glucose co-transporter 2 inhibitor, lowers glucose levels in patients with T2DM by increasing urinary glucose excretion. Dapagliflozin therapy has been shown to impact a number of CV risk factors. Dapagliflozin improved glycemia with a low intrinsic propensity to cause hypoglycemia. Caloric loss associated with dapagliflozin-induced glucosuria also led to body weight reduction. Small changes from baseline in mean lipid parameters and reductions in serum uric acid levels were observed in patients taking dapagliflozin. Blood pressure reductions were also noted, consistent with modest drug-induced diuresis and weight loss. Furthermore, a lower rate of cardiac events was seen in patients taking dapagliflozin compared with those taking comparators in a meta-analysis of clinical trials on dapagliflozin. Overall, dapagliflozin has shown beneficial effects on CV risk factors in patients with T2DM. Further studies are underway to evaluate the effect of dapagliflozin on CV outcomes. PMID:23748519
Ptaszynska, Agata; Hardy, Elise; Johnsson, Eva; Parikh, Shamik; List, James
People with type 2 diabetes are disproportionately affected by cardiovascular disease (CVD), compared with those without diabetes. Traditional risk factors do not fully explain this ex- cess risk, and other \\
Patients with chronic inflammatory disorders are at increased risk of developing premature cardiovascular disease. Despite significant advances in our understanding of the effects of inflammatory pathways on the vasculature, clear guidelines on the management of traditional and nontraditional cardiovascularrisk factors in patients with systemic autoimmunity are lacking. Thus, rigorous studies assessing the individual contributions of the various treatments used
Reverse epidemiology of cardiovascularrisk factors in maintenance dialysis patients. Conventional risk factors of cardiovascular disease and mortality in the general population such as body mass, serum cholesterol, and blood pressure are also found to relate to outcome in maintenance dialysis patients, but often in an opposite direction. Obesity, hypercholesterolemia, and hypertension appear to be protective features that are associated
Kamyar Kalantar-Zadeh; Gladys Block; Michael H. Humphreys; Joel D. Kopple
|Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascularrisk among American…
Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette
Dietary patterns high in fruits and vegetables have been associated with lower risk of cardiovascular diseases. The association between phylloquinone intake, derived mainly from green vegetables, and risk of cardiovascular diseases [total and fatal coronary heart disease (CHD), non-fatal myocardial ...
Background—Homeless people represent an extremely disadvantaged group in North America. Among older homeless men, cardiovascular disease (CVD) is the leading cause of death. The objective of this study was to examine cardiovascularrisk factors in a representative sample of homeless adults and identify opportunities for improved risk factor modification. Methods and Results—Homeless persons were randomly selected at shelters for single
Tony C. Lee; John G. Hanlon; Jessica Ben-David; Gillian L. Booth; Warren J. Cantor; Philip W. Connelly; Stephen W. Hwang
Anemia as a risk factor for cardiovascular disease. In the present review we examine the physiologic response to chronic anemia and describe potential adverse effects of anemia on myocardial and large arterial remodeling. We present observational data demonstrating that anemia is a risk factor for cardiovascular disease (CVD) outcomes in patients with chronic kidney disease and patients with heart failure.
The most relevant clinical trials, assessing the role of glycemic control in reducing cardiovascularrisk, are examined. The UKPDS was the first to address this issue. More recent trials (ACCORD, ADVANCE and VADT) are controversial and evidences did not support that strict glycemic control (reflected by normal glycated hemoglobin) exclusively is sufficient to reduce cardiovascularrisk in complicated individuals with
Sandra Roberta Gouvea Ferreira; Sandra Roberta; Gouvea Ferreira
|Comparison of cardiovascularrisk factors (blood lipids, obesity, and smoking) in 329 adults with mental retardation residing in various settings with subjects in the Framingham Offspring Study found that adults with mental retardation had cardiovascularrisk profiles similar to those of individuals without mental retardation. (Author/DB)|
OBJECTIVE: Obesity is a major public health problem due to its associations with multiple cardiovascularrisk factors. Although there are sophisticated methods, such as imaging, to document total body fat and its distributions, anthropometric measurements remain important in clinical practice. We examined the relationships between cardiovascularrisk factors and the three commonest anthropometric measurements for obesity, body mass index (BMI),
GTC Ko; JCN Chan; J Woo; E Lau; VTF Yeung; C-C Chow; HPS Wai; JKY Li; W-Y So; CS Cockram; Gary TC Ko
Cardiovascular disease is the leading cause of mortality in the dialysis population and a major cause of morbidity and mortality in patients with chronic renal failure. The conventional Framingham cardiovascular (CV) risk factors (ie, hypertension, smoking, age, hyper- cholesterolemia, and a family history of CV disease) have typically been the focus of risk stratification and subse- quent primary and\\/or secondary
BackgroundCardiovascular disease (CVD) is partially attributed to traditional cardiovascularrisk factors, which can be identified and managed based on risk stratification algorithms (Framingham Risk Score, National Cholesterol Education Program, Systematic CardiovascularRisk Evaluation and Reynolds Risk Score). We aimed to (a) identify the proportion of at risk patients with rheumatoid arthritis (RA) requiring statin therapy identified by conventional risk calculators,
Tracey E Toms; Vasileios F Panoulas; Karen M J Douglas; Helen Griffiths; Naveed Sattar; Jaqueline P Smith; Deborah P M Symmons; Peter Nightingale; George S Metsios; George D Kitas
Cardiovascular atherosclerotic diseases represent the main cause of death in the developed and developing populations. Although\\u000a major progress has been made in the management of the classical modifiable cardiovascularrisk factors, unhealthy lifestyle\\u000a conduces to an increasing prevalence of overweight, obesity, metabolic disorders, type 2 diabetes mellitus, premature atherosclerosis\\u000a and cardiovascular diseases. That is why cardio-metabolic risk prediction should be
The purposes of this study were to document the prevalence of cardiovascular disease risk factors in twenty black children to compare methods of measurement of blood pressure, body composition, and smoking; and to evaluate the effects of a ten week aerobic exercise training programme on blood pressure, cholesterol, smoking behaviour, and oxygen consumption. At pretest 25% of the children had blood pressures above the 90th percentile for their age or gender, 60% had a total cholesterol above 180 mg/dl and 35% exceeded 28% body fat. The mean difference score between systolic blood pressure and diastolic blood pressure measurements using a standard mercury sphygmomanometer and the Dinamap manometer was 1.5 (P less than 0.01) and 14.9 (P less than 0.0001) respectively. There was no significant difference in any of the methods used to measure body composition. Finally, there was no significant difference between the groups with regard to the dependent variables. Although the investigators identified the presence of elevated blood pressure, elevated total cholesterol, and obesity in this sample, the aerobic exercise training programme did not alter the risk profile. The authors urge caution in interpreting these results. Selection of the method for measurement of BP should be made with caution. A clear understanding of how each instrument works and its precision must be considered. Selection of the method for measurement of body composition can be based upon factors such as availability of equipment, cost, convenience, and subject preference. PMID:2338683
Smith, B A; Fetters, J L; Kelsy, M A; Kirby, T E; Cooley, S L; Pruitt, L A
Current guidelines for the prevention of coronary heart disease emphasize the importance of global cardiovascularrisk, which requires the evaluation and treatment of multiple risk factors. Cardiovascularrisk can be stratified with the Framingham algorithm, which produces a numerical score related to the presence of risk factors, such as hypertension, dyslipidemia, and smoking. However, this algorithm is not generally applicable to European countries, particularly for those countries where the risk for cardiovascular disease is low. The SCORE (Systematic COronary Risk Evaluation) project has produced risk charts that are based on cholesterol, blood pressure, and age for low-risk European countries (Belgium, France, Greece, Italy, Luxembourg, Spain, and Switzerland) and high-risk countries. Assessments of end-organ damage can provide further prognostic information, particularly in intermediate-risk patients, but the value of including additional biomarkers in risk stratification remains to be confirmed. Risk for coronary heart disease is high or very high in more than 50% of hypertensive patients. Risk appears to be underestimated in clinical practice, particularly in those patients at highest risk. Major intervention trials with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have shown that these agents reduce the risk for cardiovascular events in patients at all levels of risk, with the greatest benefits seen in those at highest risk.
Background Cardiovascularrisk equations are traditionally derived from the Framingham Study. The accuracy of this approach in Asian populations, where resources for risk factor measurement may be limited, is unclear. Objective To compare “low?information” equations (derived using only age, systolic blood pressure, total cholesterol and smoking status) derived from the Framingham Study with those derived from the Asian cohorts, on the accuracy of cardiovascularrisk prediction. Design Separate equations to predict the 8?year risk of a cardiovascular event were derived from Asian and Framingham cohorts. The performance of these equations, and a subsequently “recalibrated” Framingham equation, were evaluated among participants from independent Chinese cohorts. Setting Six cohort studies from Japan, Korea and Singapore (Asian cohorts); six cohort studies from China; the Framingham Study from the US. Participants 172?077 participants from the Asian cohorts; 25?682 participants from Chinese cohorts and 6053 participants from the Framingham Study. Main results In the Chinese cohorts, 542 cardiovascular events occurred during 8?years of follow?up. Both the Asian cohorts and the Framingham equations discriminated cardiovascularrisk well in the Chinese cohorts; the area under the receiver–operator characteristic curve was at least 0.75 for men and women. However, the Framingham risk equation systematically overestimated risk in the Chinese cohorts by an average of 276% among men and 102% among women. The corresponding average overestimation using the Asian cohorts equation was 11% and 10%, respectively. Recalibrating the Framingham risk equation using cardiovascular disease incidence from the non?Chinese Asian cohorts led to an overestimation of risk by an average of 4% in women and underestimation of risk by an average of 2% in men. Interpretation A low?information Framingham cardiovascularrisk prediction tool, which, when recalibrated with contemporary data, is likely to estimate future cardiovascularrisk with similar accuracy in Asian populations as tools developed from data on local cohorts.
Cardiovascular disease is the number one cause of death for women. In an effort to reduce cardiovascular burden for women, identifying risk factors and increasing awareness of sex differences are fundamental. This systematic review examines cardiovascular disease risk for women. A search of the literature was undertaken using key health databases. Search terms used were cardiovascular disease AND women OR gender. Additional references were manually identified from this literature; 58 articles were reviewed in total. On average, cardiovascular disease presents 10?years later in women compared to men. By this time, they are more likely to suffer from more comorbidities, placing them at higher risk. The complexity of cardiovascular disease identification in women is accentuated through atypical symptoms, and has the potential to lead to delayed and/or misdiagnosis. It is clear through identifying sex differentiation in cardiovascularrisk factors that there has been an increased awareness of symptom presentation for women. In light of the sex differences in risk factors, sex-specific aspects should be more intensively considered in research/practice to improve clinical outcomes for female cardiovascular disease patients. PMID:22070582
Patients with chronic kidney disease have a higher burden of cardiovascular disease, which increases in a dose-dependent fashion with worsening kidney function. Traditional cardiovascularrisk factors, including advanced age, diabetes mellitus, hypertension and dyslipidemia, have an important role in the progression of cardiovascular disease in patients who have a reduced glomerular filtration rate, especially in those with mild-to-moderate kidney disease.
Sarina van der Zee; Usman Baber; Sammy Elmariah; Jonathan Winston; Valentin Fuster
Ischaemic heart disease is one of the leading causes of cardiovascular morbidity and mortality. Because most factors leading to cardiovascular disease have a silent course, early screening is needed for prevention and for halting disease progression. In our centre, a programme was implemented in apparently healthy subjects for the early diagnosis and treatment of factors known to increment the risk
background Cardiovascularrisk factors contribute to atherogenesis by inducing endothelial-cell injury and dysfunction. We hypothesized that endothelial progenitor cells derived from bone marrow have a role in ongoing endothelial repair and that impaired mobilization or depletion of these cells contributes to endothelial dysfunction and cardiovascular disease progression. methods We measured the number of colony-forming units of endothelial progenitor cells in
Jonathan M. Hill; Gloria Zalos; Julian P. J. Halcox; William H. Schenke; Myron A. Waclawiw; Arshed A. Quyyumi; Toren Finkel
Cardiovascular disease is the major cause of death in patients with endstage renal disease (ESRD). ESRD patients are almost invariably hypertensive. They all have acquired combined hyperlipidemia and increased Lp(a), hyperhomocysteinemia, decreased physical activity, pychosocial stress, insulin resistance, procoagulant factors, left ventricular hypertrophy, and increased oxidative stress. Diabetes mellitus, a major risk factor for both cardiovascular disease and ESRD, has
Cardiovascular disease (CVD) is the most frequent cause of death in people with type 1 diabetes (T1D), despite modern advances in glycemic control and CVD risk factor modification. CVD risk identification is essential in this high-risk population, yet remains poorly understood. This review discusses the risk factors for CVD in young people with T1D, including hyperglycemia, traditional CVD risk factors (dyslipidemia, smoking, physical activity, hypertension), as well as novel risk factors such as insulin resistance, inflammation, and hypoglycemia. We present evidence that adverse changes in cardiovascular function, arterial compliance, and atherosclerosis are present even during adolescence in people with T1D, highlighting the need for earlier intervention. The methods for investigating cardiovascularrisk are discussed and reviewed. Finally, we discuss the observational studies and clinical trials which have thus far attempted to elucidate the best targets for early intervention in order to reduce the burden of CVD in people with T1D. PMID:22528676
ObjectivesWe sought to assess whether hyperenhancement by gadolinium cardiovascular magnetic resonance (CMR) occurs in hypertrophic cardiomyopathy (HCM) and correlates with the risk of heart failure and sudden death.
James C. C Moon; William J McKenna; Jane A McCrohon; Perry M Elliott; Gillian C Smith; Dudley J Pennell
OBJECTIVE: To identify which of the three simple anthropometric indices, body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), best predicts cardiovascularrisk factors, and to determine if the association between the anthropometric indices and cardiovascularrisk factors varies with gender.DESIGN AND METHODOLOGY: A cross-sectional population-based survey was carried out during 1995–1996. One thousand and ten Chinese people
SC Ho; YM Chen; JLF Woo; SSF Leung; TH Lam; ED Janus
Aim: Patients with retinal vein occlusions (RVO) are at increased risk of cardiovascular disease (CVD). The risk of future CVD was determined using the Framingham algorithm and this risk estimate was used to guide decisions about preventative treatment for CVD in RVO patients.Methods: 107 unselected RVO patients were studied. After excluding 18 patients because of age, missing data, or pre-existing
S C Martin; A Butcher; N Martin; J Farmer; P M Dobson; W A Bartlett; A F Jones
Chronic low-grade inflammation was recognized during the past decade as an important risk factor for the development of atherosclerosis and, more recently, for the development of heart failure. Patients with rheumatoid arthritis (RA) are at increased risk of morbidity and mortality from ischemic cardiovascular events and heart failure. Epidemiologic and clinical studies indicate that RA is an independent risk factor
Jon T Giles; Wendy Post; Roger S Blumenthal; Joan M Bathon
The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascularrisk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more and more people survive acute myocardial infarction. We will review hypertension management in the high cardiovascularrisk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients.
Maraj, Ilir; Makaryus, John N.; Ashkar, Anthony; McFarlane, Samy I.; Makaryus, Amgad N.
For the effective cardiovascular protection current guidelines recommend multifactorial intervention on cardiovascularrisk factors. This study assessed the efficiency of the combined implementation of guidelines for the control of major modifiable cardiovascularrisk factors in high-risk patients.Study participants were consecutive patients attending an Outpatients CardiovascularRisk Factor Clinic. Current guidelines were simultaneously implemented by trained physicians aiming to reach the
George Stergiou; Nikos Baibas; Irini Skeva; George Damianidis; P. Douitsis; I. Terzi; A. Sidiropoulos; N. Kakavas; N. Liakopoulos
Background. Psoriasis is a common inflammatory and immune-mediated skin disease. There is growing controversy as to whether cardiovascularrisk is elevated in psoriasis. A number of studies suggest a high prevalence of cardiovascularrisk factors as well as cardiovascular diseases in psoriasis patients. Objective. The objective of this study was to estimate cardiovascularrisk score in psoriasis patients and the relation between cardiovascularrisk and psoriasis features. Cardiovascularrisk was assessed by CUORE project risk score built within the longitudinal study of the Italian CUORE project and suited to populations with a low rate of coronary heart disease. Results. A case-control study in 210 psoriasis outpatients and 111 controls with skin diseases other than psoriasis was performed. CUORE project risk score was higher in patients than controls (6.80 ± 6.34 versus 4.48 ± 4.38, P < 0.001). Compared to controls, psoriasis patients have higher risk of developing major cardiovascular events. Cardiovascularrisk was not related to psoriasis characteristics. Conclusion. Increased focus on identifying cardiovascularrisk factors and initiation of preventive lifestyle changes or therapeutic interventions in patients with psoriasis is warranted.
Rheumatoid arthritis is characterized by early and accelerated atherosclerosis leading to increased cardiovascular morbidity and mortality. Beyond traditional cardiovascularrisk factors, several pathogenetic mechanisms have been proposed, including emerging inflammatory and autoimmune mechanisms. Inflammatory stimuli are now believed to cause vascular damage, which can be estimated by well-established noninvasive techniques. Carotid intima-media thickness, pulse-wave velocity and flow-mediated dilatation, markers of subclinical atherosclerosis, arterial stiffness, and endothelial function, respectively, have been recently used to detect vascular dysfunction in the wide spectrum of autoimmune diseases. The role of anti-tumor necrosis factor ? and novel biologic agents remains unclear, although early control of the inflammatory process seems crucial for reducing cardiovascularrisk. Considering the importance of cardiovascularrisk management, further well-designed studies are warranted to clarify the potential benefits and harms of anti-inflammatory treatment. PMID:23188207
Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality in both developed and developing countries. Adequate treatment of vascular risk factors, such as low-density lipoprotein cholesterol and systolic blood pressure are known to reduce the future risk of cardiovascular disease in these patients. However currently, large treatment gaps exist among high-risk individuals, in whom the guidelines recommend concomitant treatment with aspirin, statin, and blood-pressure lowering agents. Combining aspirin, cholesterol, and blood-pressure lowering agents into a single pill called the cardiovascular polypill has been proposed as complementary care in the prevention of cardiovascular diseases in both intermediate- and high-risk patient populations. It is now a decade since the first recommendations to develop and trial cardiovascular polypills. The major scientific debate has been about the appropriate initial target population. This review article focuses on the potential role of fixed-dose combination therapy in different patient populations, outlines the pros and cons of combination therapy, and emphasizes the rationale for trialing their use. Current and planned future cardiovascular polypill trials are summarized and the pre-requisites for implementation of the polypill strategy in both primary and secondary prevention are described. The recent development of combination pills containing off-patent medications holds promise for highly affordable and effective treatment and evidence is emerging on the use of this strategy in high-risk populations. PMID:22019908
Background: Previous studies on cardiovascularrisk profile in different socioeconomic status were focused on younger populations and many of them have not been able to take into account age and sex differences. Objectives: To investigate the relationship of occupational social class with the prevalence of cardiovascular disease risk factors and cardiovascular diseases in younger (<65 years) and older (?65 years)
Phyo K. Myint; Robert N. Luben; Ailsa A. Welch; Sheila A. Bingham; Nicholas J. Wareham; Kay-Tee Khaw
Abstract Humans are continually exposed to ionizing radiation from terrestrial sources. The two major contributors to radiation exposure of the U.S. population are ubiquitous background radiation and medical exposure of patients. From the early 1980s to 2006, the average dose per individual in the United States for all sources of radiation increased by a factor of 1.7–6.2?mSv, with this increase due to the growth of medical imaging procedures. Radiation can place individuals at an increased risk of developing cardiovascular disease. Excess risk of cardiovascular disease occurs a long time after exposure to lower doses of radiation as demonstrated in Japanese atomic bomb survivors. This review examines sources of radiation (atomic bombs, radiation accidents, radiological terrorism, cancer treatment, space exploration, radiosurgery for cardiac arrhythmia, and computed tomography) and the risk for developing cardiovascular disease. The evidence presented suggests an association between cardiovascular disease and exposure to low-to-moderate levels of radiation, as well as the well-known association at high doses. Studies are needed to define the extent that diagnostic and therapeutic radiation results in increased risk factors for cardiovascular disease, to understand the mechanisms involved, and to develop strategies to mitigate or treat radiation-induced cardiovascular disease. Antioxid. Redox Signal. 15, 1945–1956.
Background: Disorders of cardiovascular system can cause disability or death, screening is necessary specially in workers who maybe had risk factors. Hypertension, hyperlipidemia, obesity, smoking, genetic, exposure to chemicals, fumes, solvents, coldness are non occupational and occupational risk factors. Objective was comparison of cardiovascular disorders risk factors between workers in different industries of Iran. Methods: In a cross-sectional study, workers of automobile, food industries and light works had been selected and cardiovascular disorders risk factors had been gathered then data analyzed in SPSS with one-way ANOVA, Chi-2 and multi nominal logistic regression with P < 0.05. Results: 875 workers had been participated in the study, all of the cardiovascular disorders risk factors were in the normal range. Mean of high density lipoprotein (HDL) in food industry workers was 63.83 ± 17.42 mg/dl and it was protective, but in workers who work in automobile industry was 38.97 ± 11.08 mg/dl and the lowest, Also hypertension and hypertriglyceridemia were more prominent in this industry and after regression with P < 0.05, the differences were significant. Conclusions: Screening of cardiovascular disorders risk factors were important and helpful in industries specially automobile industry, that might be preventive method for these disorders in the future.
Aims\\/hypothesis Non-diabetic hyperglycaemia is usually not considered at all or is viewed as a binary risk category in isolation from other\\u000a factors when quantifying cardiovascularrisk. We argue that hyperglycaemia should be considered as a continuous risk factor\\u000a and only in the context of other vascular risk factors. To examine the potential impact of hyperglycaemia on cardiovascular\\u000a disease (CVD) risk, we
P. Chamnan; R. K. Simmons; R. Jackson; K. T. Khaw; N. J. Wareham; S. J. Griffin
Being overweight in childhood causes several cardiovascularrisk factors which in turn contribute to accelerated atherosclerosis. Being overweight itself represents a risk factor, but also contributes to an increased prevalence of arterial hypertension, dyslipidemia and impaired glucose tolerance. Thus, cardiovascular prevention should be included in the management of obese children. Most of all, therapy of adiposity should be performed, as weight reduction and increased fitness represent protective factors. Moreover, a detailed cardiovascular workup and therapy of secondary vascular disease must also be performed. Subclinical changes at the level of the endothelium may be diagnosed using modern imaging techniques such as the measurement of the intima-media thickness of the carotid artery. In general, the overweight child should be considered as a future patient with vascular disease! The following article focuses on the prevalence, diagnostics and therapeutic options in the cardiovascular management of overweight children. PMID:23529592
Objective: In adults visceral adipose tissue (VAT) has been shown to be more highly correlated with cardiovascular (CV) risk factors than are other measures of adiposity such as subcutaneous abdominal adipose tissue (SAAT), percent body fat (%BF), or total body fat mass (TFM). We examined the relations between these measures of fatness and CV risk factors in obese children.Study design:
Scott Owens; Bernard Gutin; Michael Ferguson; Jerry Allison; Warren Karp; Ngoc-Anh Le
Two sets of studies seem to agree that both retired and active duty submariners have increased levels of a personality component strongly related to cardiovascularrisks and have lowered levels at least two factors associated with reduced risk. One of the...
Background: Early natural menopause has been pos- tulated to increase the risk of cardiovascular disease. Objective: To examine the relation of age at natural menopause with risk of coronary heart disease (CHD) and stroke in the Nurses' Health Study. Methods: Analysis was restricted to 35 616 naturally postmenopausal women who never used estrogen re- placement therapy and with no diagnosed
Frank B. Hu; Francine Grodstein; Charles H. Hennekens; Graham A. Colditz; Michelle Johnson; JoAnn E. Manson; Bernard Rosner; Meir J. Stampfer
Patients on peritoneal dialysis (PD) are at high cardio- vascular risk. Although some risk factors are unmodifiable (for example, age, sex, genetics), others are exacerbated in the unfriendly uremic milieu (inflammation, oxidative stress, mineral disturbances) or contribute per se to kid- ney disease and cardiovascular progression (diabetes mel- litus, hypertension). Moreover, several factors associated with PD therapy may both increase
Elvia García-López; Juan J. Carrero; Mohamed E. Suliman; Bengt Lindholm; Peter Stenvinkel
SummaryBackground: Obesity increases cardiovascularrisk through effects on blood pressure, lipoproteins, coagulation factors and inflammatory cytokines, but in women variation in fat distribution complicates these relationships. Central (maletype or visceral) obesity confers greater risk than the more generalised (female) type. This is recognised by the metabolic syndrome which employs waist circumference rather than body mass index (BMI). We examined the
See Kwok; Patrick McElduff; David W. Ashton; Gordon D. O. Lowe; D. Wood; Stephen E. Humphries; Valentine Charlton-Menys; Paul N. Durrington
HIV infection and antiretroviral therapy each appear to increase cardiovascular disease risk. Increased risk may be attributable to the inflammatory effects of HIV infection and dyslipidemia associated with some antiretroviral agents. The prevalence of cardiovascular disease is increasing as patients live longer, age, and acquire traditional coronary heart disease (CHD) risk factors. In general, any additional cardiovascularrisk posed by HIV infection or antiretroviral therapy is of potential concern for patients who are already at moderate or high risk for CHD. Long-term and well-designed studies are needed to more accurately ascertain to what degree HIV infection and antiretroviral therapy affect long-term cardiovascular disease risk. Management of dyslipidemia to reduce CHD risk in HIV-infected patients is much the same as in the general population, with the cornerstone consisting of statin therapy and lifestyle interventions. Smoking cessation is a major step in reducing CHD risk in those who smoke. This article summarizes a presentation by James H. Stein, MD, at the IAS-USA live continuing medical education activity held in New York City in March 2012. PMID:23154252
Cost and accessibility contribute to low participation rates in phase 2 cardiac rehabilitation programs in the United States. In this study, we compared the clinical effectiveness of 2 less costly and potentially more accessible approaches to cardiovascularrisk reduction with that of a contemporary phase 2 cardiac rehabilitation program. Low- or moderate-risk patients (n = 155) with coronary artery disease
Neil F. Gordon; Carla D. English; Aashish S. Contractor; Richard D. Salmon; Richard F. Leighton; Barry A. Franklin; William L. Haskell
Background: There have been few large epidemiological studies examining the association between thyroid dysfunction and cardiovascular disease. In particular, it is uncertain if subclinical hypothyroidism is a risk factor for cardiovascular disease.\\u000aMethods: Serum thyrotropin and free thyroxine concentrations were measured in 2108 archived serum samples from a 1981 community health survey in Busselton, Western Australia (Busselton Health Study). In
John P. Walsh; Alexandra P. Bremner; Max K. Bulsara; Peter OLeary; Peter J. Leedman; Peter Feddema; Valdo Michelangeli
A mild pro-oxidative state accompanies meal ingestion, which results in an increase in biomarkers of inflammation, adhesion,\\u000a and endothelial dysfunction, all of which are factors in the development of cardiovascular disease. Both fat and carbohydrate\\u000a can cause the effect, which is additive and exacerbated by diabetes. The presence of lipid, glucose, and cholesterol oxidation\\u000a products of dietary or endogenous origin
Recent epidemiologic analyses have changed the way that hypertension is viewed. Cardiovascularrisk has been found to be elevated at levels of blood pressure previously believed to be normal and not imparting additional risk. Furthermore, the approach to hypertension has been shifted from viewing and treating it in isolation to a more comprehensive approach that incorporates a focus on global cardiovascularrisk and the risk factors commonly associated with having an elevated blood pressure. However, control rates not only for hypertension but also for associated risk factors, such as hyperlipidemia and diabetes, remain abysmal, providing an even greater challenge to providers of care. To change this alarming trend, physicians must become aggressive in using the available armamentarium of lifestyle modifications and drugs in treating hypertension and other risk factors that increase the burden of atherosclerosis. PMID:16965724
Cardiovascular toxicity is one of the most feared complications of cancer treatment. Recent advances in oncologic therapies have resulted in improved cancer outcomes but also a new set of cardiovascular adverse effects. Common toxicities include left ventricular dysfunction/heart failure, hypertension, and myocardial ischemia. Accurate risk stratification allows avoidance of potentially harmful treatments in those patients at greatest risk while maintaining the ability to deliver high doses of effective therapies to the lower-risk population. Cardiac investigations, including echocardiography, nuclear imaging, magnetic resonance imaging, biomarker measurement, blood pressure monitoring, electrocardiography, stress testing, and invasive angiography, can help to risk-stratify selected patients. In this review, common complications are discussed in terms of the factors used to identify patients with elevated risk, the monitoring strategies available, and selected interventions that have been used to modify outcomes in patients identified as being at high risk for cardiac complications of cancer treatment. PMID:23540740
Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.
Hussain, S. Monira; Oldenburg, Brian; Zoungas, Sophia; Tonkin, Andrew M.
Patients with end-stage kidney disease are at high cardiovascularrisk due to accelerated atherosclerosis development. Important factors that accelerate the development of atherosclerosis in this group are calcium-phosphorus disturbances causing vascular calcification. Therefore, slowing the development and progression of vascular calcification is a novel therapeutic target in the treatment of calcium and phosphorus disturbances associated with chronic kidney disease. It seems that cinacalcet, a calcimimetic of the second generation, used in patients with refractory secondary hyperparathyroidism can slow the progression of vascular calcification and potentially reduce the cardiovascularrisk. This paper reviews the current literature on the pathogenesis of vascular calcification and the potential impact of cinacalcet to reduce cardiovascularrisk in patients with end-stage kidney disease. PMID:23175326
Zela?nicka, Marzena; Koce?ak, Piotr; Olszanecka Glinianowicz, Magdalena; Chudek, Jerzy
Background: Regular physical exercise is recommended to reduce cardiovascular mortality. And yet, atherosclerosis is the main cause of exercise-associated death in persons beyond age 35. The need for risk stratification in marathon runners is under discussion. The predictive value of modern imaging- and non-imaging-based markers of risk that can be used for risk stratification in masters endurance athletes still deserves exploration.Methods: Male
Stefan Möhlenkamp; Axel Schmermund; Knut Kröger; Gert Kerkhoff; Martina Bröcker-Preuss; Volker Adams; Martin Hensel; David Kiefer; Nils Lehmann; Susanne Moebus; Kirsten Leineweber; Sigrid Elsenbruch; Jörg Barkhausen; Martin Halle; Rainer Hambrecht; Johannes Siegrist; Klaus Mann; Thomas Budde; Karl-Heinz Jöckel; Raimund Erbel
PURPOSE: This study describes changes in cardiovascular disease (CVD) risk factors in older American Indians over a 4-year period.METHODS: The Strong Heart Study, a longitudinal population-based study of CVD and CVD risk factors among American Indians aged 45–74 years, measured CVD risk factors among 3638 members of 13 tribes in three geographic areas during examinations in 1989 to 1991 and
Thomas K. Welty; Dorothy A. Rhoades; Fawn Yeh; Elisa T. Lee; Linda D. Cowan; Richard R. Fabsitz; David C. Robbins; Richard B. Devereux; Jeffrey A. Henderson; Barbara V. Howard
\\u000a Many risk factors that promote cardiovascular disease (CVD) have been identified. These include hypertension, hypercholesterolemia,\\u000a diabetes, decreased estrogen in postmenopausal women, increased homocysteine, and cigarette smoking. It has recently become\\u000a clear that a mechanism common to these risk factors is oxidative stress. CVD risk factors specific to women are parity, oophorectomy,\\u000a preeclampsia, and menopause. There are several proposed mechanisms to
Manuela Gago-Dominguez; Xuejuan Jiang; Jose Esteban Castelao
Risk factors for cardiovascular disease (CVD) have been studied extensively in CKD patients. It can be differentiated between modifiable, potentially-modifiable and non-modifiable risk factors. Nonetheless, even for easily modifiable risk factors there is still a lack of data demonstrating the benefit of common interventions, such as statin treatment for dyslipidemia, improvement of HbA1c levels in diabetic patients, implementation of physical
The purpose of this study is to determine associations between cardiovascularrisk factors and subjective experience of psychological\\u000a general well-being with special reference to gender-related differences.\\u000a \\u000a One hundred fifty white-collar workers in a car manufacturing plant in Sweden participated in a health care screening program.\\u000a Subjective experience of psychological well-being was significantly correlated with cardiovascularrisk factors among both\\u000a men
Overwhelming evidence supports a causal relationship between elevated levels of plasma cholesterol, particularly low-density lipoprotein cholesterol, and increased risk of coronary artery disease, which remains the leading cause of death and morbidity worldwide. Low-density lipoprotein cholesterol lowering has been the main goal of therapy, and clinical trial results from recently published studies of intensive statin therapy confirm the benefits of more aggressive lipid-lowering targets, particularly in subjects at high risk for cardiovascular events. This management update will focus on the implications of risk reduction in patients at high cardiovascularrisk, and will provide practical steps to help further risk stratify these patients and help them reach their target goals.
Braga, Manoela B; Langer, Anatoly; Leiter, Lawrence A
Subclinical hyperthyroidism (SHy), the mildest form of hyperthyroidism, is diagnosed in patients having a persistently low or undetectable serum concentration of thyroid-stimulating hormone (TSH) with normal free T4 and T3 concentrations. Although overt hyperthyroidism is associated with an increased risk of adverse cardiovascular outcomes, the cardiovascularrisk of SHy is controversial. Multiple studies have demonstrated an increased risk of atrial fibrillation, especially in older individuals with TSH levels <0.1 mU/L. The effects of SHy on all-cause and cardiovascular mortality are not clear, but recent meta-analyses suggest a modest increase in mortality, with the risk increasing with age and associated with the lowest TSH levels. The long-term consequences of SHy in young- and middle-aged adults, and in those with TSH levels are mildly low, are uncertain. For these reasons, guidelines for treatment are based on patient age, the degree of TSH suppression, symptoms consistent with hyperthyroidism, and overall cardiovascular and osteoporotic fracture risks. PMID:23563523
Palmeiro, Christopher; Davila, Maria I; Bhat, Mallika; Frishman, William H; Weiss, Irene A
Inflammation is a risk factor for both depression and cardiovascular disease. Depressed mood is also a cardiovascularrisk factor. To date, research into mechanisms through which inflammation impacts cardiovascular health rarely takes into account central effects on autonomic cardiovascular control, instead emphasizing direct effects of peripheral inflammatory responses on endothelial reactivity and myocardial function. However, brain responses to inflammation engage neural systems for motivational and homeostatic control and are expressed through depressed mood state and changes in autonomic cardiovascular regulation. Here we combined an inflammatory challenge, known to evoke an acute reduction in mood, with neuroimaging to identify the functional brain substrates underlying potentially detrimental changes in autonomic cardiovascular control. We first demonstrated that alterations in the balance of low to high frequency (LF/HF) changes in heart rate variability (a measure of baroreflex sensitivity) could account for some of the inflammation-evoked changes in diastolic blood pressure, indicating a central (rather than solely local endothelial) origin. Accompanying alterations in regional brain metabolism (measured using (18)FDG-PET) were analysed to localise central mechanisms of inflammation-induced changes in cardiovascular state: three discrete regions previously implicated in stressor-evoked blood pressure reactivity, the dorsal anterior and posterior cingulate and pons, strongly mediated the relationship between inflammation and blood pressure. Moreover, activity changes within each region predicted the inflammation-induced shift in LF/HF balance. These data are consistent with a centrally-driven component originating within brain areas supporting stressor evoked blood pressure reactivity. Together our findings highlight mechanisms binding psychological and physiological well-being and their perturbation by peripheral inflammation. PMID:23416033
Harrison, Neil A; Cooper, Ella; Voon, Valerie; Miles, Ken; Critchley, Hugo D
Normal levels of male sex hormones are essential to men’s health. Many studies demonstrate that hypogonadal men are at higher risk for developing a host of metabolic derangements, including dyslipidemia, type 2 diabetes mellitus, obesity, and hypertension. We examined the most recent studies supporting this notion of hypogonadism as a cardiac risk factor by reviewing all relevant PubMed data. Most
Metabolic syndrome is not a discrete entity with a single pathogenesis, but different complex mechanisms, especially those inducing oxidative stress, play a major role in the genesis of this condition. This consideration suggests that treatment of recognized cardiovascularrisk factors alone cannot be enough to prevent cardiovascular events in patients with a diagnosed metabolic syndrome. However, it has been reported that oxidative stress is involved in the transduction of the effects of haemodynamic and metabolic pathological conditions. Thus, drugs acting on the renin-angiotensin system [angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers], or on the glucose or lipid metabolism as substrate of oxidative mechanisms (statins and nutraceuticals) in association with a dietary restriction may be taken in account, because they play a synergistic effect in preventing functional and structural changes responsible for the high cardiovascularrisk in metabolic syndrome. PMID:23337396
A reliable risk factor for sudden cardiac death (SCD) for the general population remains to be defined. We propose the omega-3 index, defined as the combined percentage of eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) in red blood cell membranes. It reflects the EPA + DHA status of a given individual. It can be determined by a standardised and reproducible laboratory procedure. Several lines of evidence support the omega-3 index as a risk factor for SCD: in epidemiological studies, a steep dependence of risk for SCD and the omega-3 index has been observed between 6.5% (risk 0.1) and 3.3% (risk 1.0). EPA + DHA are antiarrhythmic on the supraventricular and ventricular levels. Dietary EPA + DHA reduce the incidence of SCD. Cardiac societies recommend EPA + DHA for prevention of SCD. The omega-3 index can assess risk for SCD and monitor therapy with EPA + DHA. Moreover, it compares very favourably with other risk factors for SCD. PMID:17876200
Background: Obstructive sleep apnoea (OSA) is associated with high cardiovascular morbidity and mortality and is an independent risk factor for hypertension. Novel circulating cardiovascularrisk markers enabling a more accurate prediction of cardiovascularrisk have been identified. Examination of these markers may clarify the increased risk in OSA and contribute to an analysis of the benefits of treatment.Methods: Plasma levels
G V Robinson; J C T Pepperell; H C Segal; R J O Davies; J R Stradling
Prompted by current dietary recommendations for the control of serum cholesterol to new targets to reduce the risk of coronary\\u000a heart disease (CHD), and by the CHD risk reduction claims made for certain foods or food components, studies are now being\\u000a undertaken using combinations of cholesterol-lowering foods in one diet (eg, a dietary portfolio) rather than single foods\\u000a to achieve
David J. A. Jenkins; Andrea R. Josse; Julia M. W. Wong; Tri H. Nguyen; Cyril W. C. Kendall
Many epidemiological studies have addressed the effects of coffee on cardiovascular disease. Most case-control studies suggest an increased risk in high coffee consumers, whereas cohort studies indicate no clear association with cardiovascularrisk. Several aspects could be considered to explain and/or reconcile these inconsistencies. Selection bias and recall bias may explain a positive association supported by case-control studies. An inadequate adjustment for many confounding factors (i.e., smoking, poor diet, sedentary lifestyle, etc.) could also affect the relationship between coffee consumption and cardiovascularrisk. Moreover, coffee contains several biologically active substances that may have either beneficial or harmful effects on the cardiovascular system. The development of complete/partial tolerance to some caffeine effects in habitual drinkers adds to the complexity of coffee effects. Variation in cup size and methods of coffee preparation may also explain some conflicting results. As it is not reasonable to conduct randomized controlled trials, it is recommended that coffee consumption be moderate in healthy people and limited in individuals at high risk. PMID:19209536
In this issue, Dowlatshahi et al. publish results from their population-based study in Rotterdam showing that, despite an increase in body mass index and smoking, individuals with psoriasis have no increased risk of incident cardiovascular disease. These results should be interpreted with caution: the study included relatively small numbers of patients with psoriasis, most of whom had mild disease. PMID:24030646
Maybury, Catriona M; Barker, Jonathan N; Smith, Catherine H
|Compared the effects of different patterns of regular brisk walking on fitness, cardiovascular disease risk factors, and psychological well-being in previously sedentary adults. Data on adults who completed either short-bout or long-bout walking programs found that three short bouts of brisk walking accumulated throughout the day were as…
Background In western countries, prevalence of cardiovascular diseases and most risk factors is higher in lower socioeconomic groups. The social gradients in the former communist societies are less well known. Because in western countries different indicators of socioeconomic status (SES) are correlated, this gradient is found with a number of different measures of SES. We have analysed the presence and
Martin Bobak; Clyde Hertzman; Zdenka Skodovac; Michael Marmota
Examination of 94 city bus drivers with long length of service revealed changes in lipid metabolism and C-reactive protein level, dependent on the examinees' age and length of service. Matching the biochemical parameters and clinical data proved that dyslipoproteinemia and serum C-reactive protein level could indicate cardiovascularrisk in city bus drivers. PMID:22997754
Blinova, T V; Troshin, V V; Makarov, I A; Strakhova, L A; Morozova, P N
Cardiac autonomic neuropathy (CAN) represents a serious complication as it carries an approximately five-fold risk of mortality in patients with diabetes just as in those with chronic liver diseases. The high mortality rate may be related to silent myocardial infarction, cardiac arrhythmias, cardiovascular and cardiorespiratory instability and to other causes not yet explained. Resting tachycardia due to parasympathetic damage may
The present study was undertaken to determine the prevalence of hyperlipidemia and to find out the possible impact of serum lipid profiles on other cardiovascularrisk factors in Yonchon County. Korea. Population-based cross-sectional study by random cluster sampling of registered residents over 30 years of age was performed. Out of the 3804 subjects scheduled for the survey. 2520 underwent the
We set out to assess the perceived risk factors of cardiovascular diseases (CVDs) and diabetes mellitus in an urban setting using focus group discussions and in-depth interviews to collect data from different stakeholders constituting the triangle of care. Ethnomethodological anal- ysesweredone manuallyandwith Ethnograph software. The results showed an awareness of emergence of CVD and diabetes in Cameroon and perceived relationships
Paschal K. Awah; Andre P. Kengne; Leopold L. K. Fezeu; Jean-Claude Mbanya
|Provides an overview of dietary risk factors for cardiovascular disease, including diet sodium intake for hypertension and dietary fat and cholesterol for hypercholesterolemia, exacerbation of these conditions by obesity, and intervention strategies for their modification. Describes clinical strategies for modifying diet: education, skills…
|A comprehensive health education program stressing the development of sound health habits should be offered to all students from kindergarten through twelfth grade. Such programs could help to prevent the development of cardiovascular disease by educating students of current practices that add to the risk of disease. (CJ)|
Increasing fish consumption is recommended for intake of omega-3 (n-3) fatty acids and to confer benefits for the risk reduction of cardiovascular disease (CVD). Most Americans are not achieving intake levels that comply with current recommendations. It is the goal of this review to provide an overv...
|Describes the development and baseline evaluation data from the Ozark Heart Health Project, a community-based cardiovascular disease risk reduction program in rural Missouri that targeted smoking, physical inactivity, and poor diet. Several Ozark counties participated in either intervention or control groups, and researchers conducted…
Brownson, Ross C.; Mayer, Jeffrey P.; Dusseault, Patricia; Dabney, Sue; Wright, Kathleen; Jackson-Thompson, Jeannette; Malone, Bernard; Goodman, Robert
|This study examined cardiovascularrisk factors in Black first-year college students (N=238). Students completed surveys about blood pressure, cholesterol level, smoking, and physical activity. Results found low rates of high blood pressure, low awareness of cholesterol levels, and low numbers of students who smoked. Females had lower physical…
Background Despite the epidemiological evidence linking job strain to cardiovascular disease, more insight is needed into the etiologic mechanisms. This, in turn, would help to more precisely identify risk. Methods We measured Job Strain using the Job Content Questionnaire, 8\\/day diary reports, and nationally standardized occupational code linkage, as well as autonomic regulation utilizing heart rate variability including spectral-derived components
|Cardiovascularrisk factors in 57 healthy older individuals were measured (blood pressure, lipids and lipoproteins, and lifestyle behaviors) via a personal health questionnaire. Results indicated that, though the subjects were generally healthy, their lifestyle behaviors, particularly diet and physical activity, could be improved. (SM)|
Changes in diet are likely to modulate cardiovascular disease risk, but after decades of active research and heated discussion the question still remains: what is the optimal diet to achieve this elusive goal? A well-known phenomenon in nutrition research and practice is the dramatic variability in ...
Opinion statement Cigarette smoking increases the risk of atherothrombotic clinical events such as myocardial infarction and the effect is dose\\u000a dependent for persons who continue to smoke. Reductions in smoking habit and smoking cessation are important ways to improve\\u000a cardiovascularrisk and favorably affect primary and secondary prevention of clinical disease. Therapeutic methods to improve\\u000a smoking reduction and cessation include nicotine
Background:Although the relationship between adult obesity and cardiovascular disease (CVD) has been shown, the relationship with childhood obesity remains unclear. Given the evidence of tracking of body mass index (BMI) from childhood to adulthood, this systematic review investigated the independent relationship between childhood BMI and adult CVD risk.Objective:To investigate the association between childhood BMI and adult CVD risk, and whether
Objective In this study we examined changes in dietary intake and risk factors for cardiovascular disease that occurred over three decades in a US-population-based sample.Design Secular trends in dietary profiles and risk factors were studied in cross-sectional samples of subjects from the Framingham Study in 1957–1960, 1966–1969, and 1984–1988.Results Dietary levels of cholesterol appeared to have declined considerably, whereas macronutrient
BARBARA MILLEN POSNER; MARY M. FRANZ; PAULA A. QUATROMONI; DAVID R. GAGNON; PAMELA A. SYTKOWSKI; RALPH B. D’AGOSTINO; L. ADRIENNE CUPPLES
Objectives Data on how to identify cancer survivors (css) at the greatest risk for cardiovascular conditions are limited. We aimed to characterize the clinical factors associated with ischemic heart disease (ihd) and congestive heart failure (chf) in css and to develop a stratification schema for predicting the risk of cardiovascular comorbidities in css. Methods Cancer survivors and non-cancer controls (nccs) were identified from the U.S. National Health and Nutrition Examination Survey. Independent factors associated with increased relative risk (rr) for cardiovascular conditions were determined. A risk stratification schema was devised that correlated risk score with the prevalence of cardiovascular comorbidities in cs. Results Baseline characteristics were similar for the 1869 css and 24,337 nccs included in the study. Compared with nccs, css were more likely to report ihd (13.7% vs. 5.2%), chf (7.9% vs. 2.1%), or both (4.2% vs. 1.2%; all p < 0.01). Based on multivariate analyses, risk factors for cardiovascular problems included ages 40–60 years (rr: 3.66; 95% ci: 1.87 to 7.17), 60–80 years (rr: 14.18; 95% ci: 7.65 to 26.30), and 80 years or older (rr: 25.34; 95% ci: 13.16 to 48.78); male sex (rr: 2.25; 95% ci: 1.72 to 2.94); U.S. citizenship (rr: 2.10; 95% ci: 1.08 to 4.08); annual incomes of $20,000–$45,000 (rr: 1.81; 95% ci: 1.21 to 2.70) and less than $20,000 (rr: 3.05; 95% ci: 1.81 to 5.14); comorbid diabetes mellitus (rr: 2.97; 95% ci: 2.05 to 4.32); and physical inactivity (rr: 1.98; 95% ci: 1.41 to 2.79). Conclusions Independent risk factors for ihd and chf in css were identified. The risk stratification schema presented here may be helpful in developing a risk-based approach to preventive cardiovascular strategies for css.
Hematopoietic cell transplantation (HCT) recipients may be at an increased risk of developing hypertension, diabetes, and dyslipidemia (referred to as cardiovascularrisk factors [CVRFs]); and these factors can potentially increase the risk of cardiovascular disease (CVD). We examined the incidence and predictors of CVRFs and subsequent CVD in 1885 consecutive 1+year survivors of HCT performed at City of Hope between 1995 and 2004. Ten-year cumulative incidence of hypertension, diabetes, dyslipidemia, and multiple (? 2) CVRFs was 37.7%, 18.1%, 46.7%, and 31.4%, respectively. The prevalence of CVRFs was significantly higher among HCT recipients compared with the general population; contributed to largely by allogeneic HCT recipients. Older age and obesity at HCT were associated with increased risk of CVRFs. History of grade II-IV acute graft versus host disease was associated with an increased risk for hypertension (relative risk [RR] = 9.1, P < .01), diabetes (RR = 5.8, P < .01), and dyslipidemia (RR = 3.2, P < .01); conditioning with total body irradiation was associated with an increased risk of diabetes (RR = 1.5, P = .01) and dyslipidemia (RR = 1.4, P < .01). There was an incremental increase in 10-year incidence of CVD by number of CVRFs (4.7% [none], 7.0% [1 CVRF], 11.2% [? 2 CVRFs], P < .01); the risk was especially high (15.0%) in patients with multiple CVRFs and pre-HCT exposure to anthracyclines or chest radiation. PMID:23034279
BACKGROUND Recent studies in animals have shown a mechanistic link between intestinal microbial metabolism of the choline moiety in dietary phosphatidylcholine (lecithin) and coronary artery disease through the production of a proatherosclerotic metabolite, trimethylamine-N-oxide (TMAO). We investigated the relationship among intestinal microbiota-dependent metabolism of dietary phosphatidylcholine, TMAO levels, and adverse cardiovascular events in humans. METHODS We quantified plasma and urinary levels of TMAO and plasma choline and betaine levels by means of liquid chromatography and online tandem mass spectrometry after a phosphatidylcholine challenge (ingestion of two hard-boiled eggs and deuterium [d9]-labeled phosphatidylcholine) in healthy participants before and after the suppression of intestinal microbiota with oral broad-spectrum antibiotics. We further examined the relationship between fasting plasma levels of TMAO and incident major adverse cardiovascular events (death, myocardial infarction, or stroke) during 3 years of follow-up in 4007 patients undergoing elective coronary angiography. RESULTS Time-dependent increases in levels of both TMAO and its d9 isotopologue, as well as other choline metabolites, were detected after the phosphatidylcholine challenge. Plasma levels of TMAO were markedly suppressed after the administration of antibiotics and then reappeared after withdrawal of antibiotics. Increased plasma levels of TMAO were associated with an increased risk of a major adverse cardiovascular event (hazard ratio for highest vs. lowest TMAO quartile, 2.54; 95% confidence interval, 1.96 to 3.28; P<0.001). An elevated TMAO level predicted an increased risk of major adverse cardiovascular events after adjustment for traditional risk factors (P<0.001), as well as in lower-risk subgroups. CONCLUSIONS The production of TMAO from dietary phosphatidylcholine is dependent on metabolism by the intestinal microbiota. Increased TMAO levels are associated with an increased risk of incident major adverse cardiovascular events. (Funded by the National Institutes of Health and others.)
Tang, W.H. Wilson; Wang, Zeneng; Levison, Bruce S.; Koeth, Robert A.; Britt, Earl B.; Fu, Xiaoming; Wu, Yuping; Hazen, Stanley L.
Marine carotenoids are important bioactive compounds with physiological activities related to prevention of degenerative diseases found principally in plants, with potential antioxidant biological properties deriving from their chemical structure and interaction with biological membranes. They are substances with very special and remarkable properties that no other groups of substances possess and that form the basis of their many, varied functions and actions in all kinds of living organisms. The potential beneficial effects of marine carotenoids have been studied particularly in astaxanthin and fucoxanthin as they are the major marine carotenoids. Both these two carotenoids show strong antioxidant activity attributed to quenching singlet oxygen and scavenging free radicals. The potential role of these carotenoids as dietary anti-oxidants has been suggested to be one of the main mechanisms for their preventive effects against cancer and inflammatory diseases. The aim of this short review is to examine the published studies concerning the use of the two marine carotenoids, astaxanthin and fucoxanthin, in the prevention of cardiovascular diseases. PMID:21822408
Background In the context of a comprehensive population strategy to reduce tobacco use, encourage healthy food choices, and increase physical activity for the whole population, the medical priority is to focus on those who have developed symptoms of coronary heart disease (CHD) or other major atherosclerotic disease, and those who are at high risk of developing such diseases in the
The prevalence of cardiovascularrisk factors continues increasing, as its onset is drifting toward younger populations. The development of these factors is greatly influenced by lifestyle habits. It is known that early behaviors persist during childhood and are perpetuated in the adult. Research has proven that lifelong-acquired behavior is unlikely to change, and therefore acquisition of healthy behaviors should begin as early in life as possible. In this report we described the strategy and first stages of a school-based program aiming at promoting (cardiovascular) health through a multilevel intervention supported by Sesame Street materials and educational background. PMID:23465669
Peñalvo, José L; Céspedes, Jaime; Fuster, Valentín
Nonsteroidal anti-inflammatory drugs (NSAIDs) confer a gastrointestinal (GI) side effect profile and concerns regarding adverse cardiovascular effects have emerged associated with considerable morbidity and mortality. NSAIDs are highly effective in treating pain and inflammation, but it is well recognized that these agents are associated with substantial gastrointestinal toxicity. Cyclo-oxygenase-2 inhibitors may also reduce the risk for gastrointestinal events, although they may increase cardiovascular adverse events. The selection of an appropriate analgesic or anti-inflammatory agent with or without gastroprotective therapy should be individualized.
... Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults The U.S. ... Peripheral Artery Disease (PAD) and Cardiovascular Disease (CVD) Risk Assessment with Ankle Brachial Index (ABI) in Adults . This ...
Aims: To examine exposure to workplace bullying as a risk factor for cardiovascular disease and depression in employees. Methods: Logistic regression models were related to prospective data from two surveys in a cohort of 5432 hospital employees (601 men and 4831 women), aged 18–63 years. Outcomes were new reports of doctor diagnosed cardiovascular disease and depression during the two year follow up among those who were free from these diseases at baseline. Results: The prevalence of bullying was 5% in the first survey and 6% in the second survey. Two per cent reported bullying experiences in both surveys, an indication of prolonged bullying. After adjustment for sex, age, and income, the odds ratio of incident cardiovascular disease for victims of prolonged bullying compared to non-bullied employees was 2.3 (95% CI 1.2 to 4.6). A further adjustment for overweight at baseline attenuated the odds ratio to 1.6 (95% CI 0.8 to 3.5). The association between prolonged bullying and incident depression was significant, even after these adjustments (odds ratio 4.2, 95% CI 2.0 to 8.6). Conclusions: A strong association between workplace bullying and subsequent depression suggests that bullying is an aetiological factor for mental health problems. The victims of bullying also seem to be at greater risk of cardiovascular disease, but this risk may partly be attributable to overweight.
Kivimaki, M; Virtanen, M; Vartia, M; Elovainio, M; Vahtera, J; Keltikangas-Jarvi..., L
Background Cardiovascular diseases (CVD) are associated with significant morbidity and mortality, which is highest in Eastern Europe including Estonia. Accumulating evidence suggests that life-style is associated with the development of CVD. The aim of this study was to evaluate the informative power of common CVD-related markers under unhealthy conditions. Subjects Subjects (n = 51; mean age 45 years; 90% men) were recruited from a shelter for homeless people in Tallinn, Estonia, and consisted of persons who constantly used alcohol or surrogates, smoked, and were in a bad physical condition (amputated toes, necrotic ulcers, etc.). Methods Blood pressure, pulse rate, and waist circumference were measured, and body mass index (BMI) was calculated. The following markers were measured in blood serum: total cholesterol (TChol), high-density lipoprotein cholesterol (HDL-Chol), low-density lipoprotein cholesterol (LDL-Chol), plasma triglycerides (TG), apolipoproteins A-l (ApoA1) and B (ApoB), lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), glucose (Gluc), high-sensitivity C-reactive protein (hsCRP), serum carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Except smoking, the anamnestic information considering eating habits, declared alcohol consumption and medication intake were not included in the analysis due to the low credibility of self-reported data. Results More than half of the investigated patients had values of measured markers (hsCRP, TChol, LDL-Chol, TG, HbA1c, ApoA1, ApoB, Lp(a), Gluc) within normal range. Surprisingly, 100% of subjects had HDL-Chol within endemic norm. Conclusion This study demonstrates that traditional markers, commonly used for prediction and diagnosis and treatment of CVD, are not always applicable to homeless people, apparently due to their aberrant life-style.
Objective: Adiponectin may play an important role in the interplay between metabolic changes and cardiovascularrisks. Our aim was to establish if plasma adiponectin can be used to detect the metabolic syndrome (MetS) in women without a history of major cardiovascular events and to evaluate its correlation with the global cardiovascularrisk expressed by the Reynolds risk score (RRS). Methods:
Nicoleta Calomfirescu; Calin Popa; Ruxandra Jurcut; Marinela Serban; Carmen Ginghina
Objectives Although the co-occurrence of multiple risk factors increases the risk of cardiovascular disease (CVD) morbidity/mortality, few studies have examined the prevalence of risk factor clustering among African Americans in community-based faith settings. This study examined the prevalence and clustering of CVD risk factors in a sample of church members from South Carolina. Design Cross-sectional analysis of baseline data from a faith-based intervention, Faith, Activity, and Nutrition (FAN). Setting African Methodist Episcopal churches in four geographically-defined districts in South Carolina. Participants 1119 church members. Main Outcome Measures Self-reported presence or absence of healthcare provider diagnosed diabetes, high cholesterol, and hypertension. Objectively measured blood pressure, height, and weight (body mass index) were also taken. The prevalence of single, multiple, and clustering of risk factors was computed. Results 62% of participants were obese, 64% had hypertension, 23% had diabetes, and 39% had high cholesterol; 15% had no risk factors, 24% had 1 risk factor, 30% had 2 risk factors, 22% had 3 risk factors, and 10% had 4 risk factors. The most common clusters of risk factors were: obese and hypertensive (18%), obese, hypertensive and hypercholesterolemic (13%), and obese, hypertensive, hypercholesterolemic, and diabetic (10%). Conclusions The prevalence of risk factors and risk factor clustering in church members in South Carolina is exceedingly high. Culturally-relevant behavioral interventions targeting risk factor reduction in this population should be a public health goal.
Baruth, Meghan; Wilcox, Sara; Egan, Brent M.; Dowda, Marsha; Laken, Marilyn; Warren, Tatiana Y.
BACKGROUND: Cardiovascularrisk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascularrisk factors among adolescent and young urban Asian Indians. METHODS: Population based epidemiological studies to identify cardiovascularrisk factors were performed in North India in 1999–2002. We evaluated major
Rajeev Gupta; Anoop Misra; Naval K Vikram; Dimple Kondal; Shaon Sen Gupta; Aachu Agrawal; RM Pandey
BACKGROUND: Cardiovascularrisk factors are associated with physical fitness and, to a lesser extent, physical activity. Lifestyle interventions directed at enhancing physical fitness in order to decrease the risk of cardiovascular diseases should be extended. To enable the development of effective lifestyle interventions for people with cardiovascularrisk factors, we investigated motivational, social-cognitive determinants derived from the Theory of Planned
Barbara Sassen; Gerjo Kok; Herman Schaalma; Henri Kiers; Luc Vanhees
Purpose To assess the levels of stress and the prevalence of cardiovascular disease (CVD) risk factors in female law enforcement officers\\u000a (LEOs).\\u000a \\u000a \\u000a \\u000a \\u000a Methods Self-reported data including job-related stress and CVD risk factors were obtained from 65 female LEOs. Stress scores were\\u000a compared with 429 males LEOs and CVD risk factors were compared with 1,213 demographically similar female respondents to the\\u000a CDC BRFSS
Subclinical hypothyroidism is defined as an elevated serum thyroid-stimulating hormone (TSH) level in the face of normal free thyroid hormone values. The overall prevalence of subclinical hypothyroidism is 4-10% in the general population and up to 20% in women aged >60 years. The potential benefits and risks of therapy for subclinical hypothyroidism have been debated for 2 decades, and a consensus is still lacking. Besides avoiding the progression to overt hypothyroidism, the decision to treat patients with subclinical hypothyroidism relies mainly on the risk of metabolic and cardiovascular alterations. Subclinical hypothyroidism causes changes in cardiovascular function similar to, but less marked than, those occurring in patients with overt hypothyroidism. Diastolic dysfunction both at rest and upon effort is the most consistent cardiac abnormality in patients with subclinical hypothyroidism, and also in those with slightly elevated TSH levels (>6 mIU/L). Moreover, mild thyroid failure may increase diastolic blood pressure as a result of increased systemic vascular resistance. Restoration of euthyroidism by levothyroxine replacement is generally able to improve all these abnormalities. Early clinical and autopsy studies had suggested an association between subclinical hypothyroidism and coronary heart disease, which has been subsequently confirmed by some, but not all, large cross-sectional and prospective studies. Altered coagulation parameters, elevated lipoprotein (a) levels, and low-grade chronic inflammation are regarded to coalesce with the hypercholesterolemia of untreated patients with subclinical hypothyroidism to enhance the ischemic cardiovascularrisk. Although a consensus is still lacking, the strongest evidence for a beneficial effect of levothyroxine replacement on markers of cardiovascularrisk is the substantial demonstration that restoration of euthyroidism can lower both total and low-density lipoprotein-cholesterol levels in most patients with subclinical hypothyroidism. However, the actual effectiveness of thyroid hormone substitution in reducing the risk of cardiovascular events remains to be elucidated. In conclusion, the multiplicity and the possible reversibility of subclinical hypothyroidism-associated cardiovascular abnormalities suggest that the decision to treat a patient should depend on the presence of risk factors, rather than on a TSH threshold. On the other hand, levothyroxine replacement therapy can always be discontinued if there is no apparent benefit. Levothyroxine replacement therapy is usually safe providing that excessive administration is avoided by monitoring serum TSH levels. However, the possibility that restoring euthyroidism may be harmful in the oldest of the elderly population of hypothyroid patients has been recently raised, and should be taken into account in making the decision to treat patients with subclinical hypothyroidism who are aged >85 years. PMID:16542047
Background: Police force constitutes a special occupational group. They have been shown to be at high risk for the development of cardiovascular diseases. A multitude of factors may be responsible for this. There is very limited documentation of their health status and health surveillance activities are inadequate. Aim: The present study was designed to measure the prevalence of metabolic syndrome and other cardiovascularrisk factors among police officers. Materials and Methods: The design was cross-sectional and spanned 900 policemen (n = 900). A pre-tested questionnaire was used for collecting historical data. Anthropometric and biochemical measurements were carried out using standard techniques. MS was diagnosed using the National Cholesterol Education Program—Adult Treatment Panel III criteria. Statistical analysis was performed using the SPSS 16.0 software. Results: MS was observed in 16.8% of the study population. High blood pressure and hyper-triglyceridemia were the commonest abnormalities. The prevalence of other cardiovascularrisk factors were high body mass index (65.6%), hypertension (37.7%), diabetes (7%), smoking (10%), and alcohol use (48%). Conclusion: Our study identified police officers as a high-risk group for developing CVDs. The findings underscore the need for regular surveillance and lifestyle interventions in this important occupational group.
Hyperuricemia is commonly associated with traditional risk factors such as dysglicemia, dyslipidemia, central obesity and abnormal blood pressure, i.e. the metabolic syndrome. Concordantly, recent studies have revived the controversy over the role of circulating uric acid, hyperuricemia, and gout as an independent prognostic factor for cardiovascular morbidity and mortality. In this regard, different studies also evaluated the possible role of xanthine inhibitors in inducing blood pressure reduction, increment in flow-mediated dilation, and improved cardiovascular prognosis in various patient settings. The vast majority of these studies have been conducted with either allopurinol or its active metabolite oxypurinol, i.e. two purine-like non-selective inhibitors of xanthine oxidase. More recently, the role of uric acid as a risk factor for cardiovascular disease and the possible protective role exerted by reduction of hyperuricemia to normal level have been evaluated by the use of febuxostat, a selective, non purine-like xanthine oxidase inhibitor. In this review, we will report current evidence on hyperuricemia in cardiovascular disease. The value of uric acid as a biomarker and as a potential therapeutic target for tailored old and novel “cardiometabolic” treatments will be also discussed.
The socioeconomic status (SES) of the family influences the cardiovascularrisk status of children and adolescents; however, it is not as well known whether parental SES has any effect on the risk factor profile of young adults. The aim of the present study was to investigate the relations of different aspects of parental SES, namely occupation, education, income and living area, to the common cardiovascularrisk factors of their offspring (n = 919) aged 18, 21 and 24 years as a part of the CardiovascularRisk in Young Finns Study in 1986. Subjects from farming families and rural areas had the highest serum total and low-density lipoprotein cholesterol values, and the lowest diastolic blood pressure compared with subjects from other occupational groups and subjects from urban regions. The diet of young adults from farming families and from rural areas contained more saturated fatty acids and less monounsaturated and polyunsaturated fatty acids. In addition, the body mass index was lower in subjects from urban regions compared with rural regions, and physical inactivity was less common in the urban group. Subjects with the highest parental occupational status smoked less compared with those with the lowest status. Parental education related inversely to physical inactivity and directly to dietary polyunsaturated fatty acids. The income level of the family associated positively with frequent inebriation by alcoholic beverages and inversely with the percentage of dietary energy from fat. In conclusion, there were modest inverse associations between different indicators of the SES of parents and some of the traditional risk factors of their offspring in young adulthood, which may contribute to the future risk of cardiovascular diseases. PMID:10766406
Leino, M; Raitakari, O T; Porkka, K V; Helenius, H Y; Viikari, J S
The location, extent, and severity of obstructive coronary artery disease impact cardiovascularrisk and mortality in independent and profound ways. Cardiovascular imaging modalities allow physicians to better define the anatomy and physiology of coronary obstructive disease. Conventional coronary angiography remains the most commonly used modality to define coronary anatomy. Computed tomography coronary angiography represents an important innovation, particularly by allowing coronary anatomy to be assessed in a noninvasive fashion. Stress myocardial perfusion imaging with single-photon emission computed tomography is a valuable prognostic tool. Stress testing, echocardiography, and stress myocardial radionuclide perfusion can all play important roles in risk stratification. Stress echocardiography is particularly useful in the clinic, due to the relatively low cost of equipment acquisition and the ability to image without exposure to radiation. The emerging modality of cardiac positron emission tomography offers the prospect of improved resolution, accurate quantification of blood flow, and shorter examination times. PMID:19898286
In the primary prevention of cardiovascular disease, the study of biomarkers to identify at-risk individuals is an expanding field. Several developments have fueled this trend, including improved understanding of the pathophysiological processes underlying atherosclerosis, advances in imaging technology to enable the quantification of subclinical disease burden, and the identification of new genetic susceptibility variants for cardiovascular disease. Furthermore, the advent of high-throughput platforms for molecular profiling has increased the pace of biomarker discovery. The rising interest in biomarkers has been balanced by the recognition that standardized and rigorous statistical approaches are needed to evaluate the clinical utility of candidate risk markers. This article reviews the issues surrounding the evaluation of biomarkers, evidence from studies of existing biomarkers, and recent applications of biomarker discovery platforms.
Eating and physical activity (PA) patterns and obesity in childhood have many long-term effects on the risk of cardiovascular disease (CVD). Two-thirds of premature deaths in the US are due to poor nutrition, lack of PA and tobacco use. Obesity, a result of excess energy intake and inadequate PA, is an indicator of unhealthy lifestyles. Currently, over one-third of American
OBJECTIVE: To examine the relationships between four anthropometric measurements and cardiovascularrisk factors in Taiwan.DESIGN: The data was collected from four nationwide health screen centers in Taiwan from 1998 to 1999.SUBJECTS: A total of 38 556 subjects: 18 280 men and 20 276 women, mean age=37.0±11.1 y. None had any known major systemic diseases or were currently on medication.MEASUREMENTS: Individual
Objective: The objective of this study was to document the prevalence of risk factors for cardiovascular disease among people with chronic mental illness.Method: A cross-sectional survey was conducted of 234 outpatients attending a community mental health clinic in the North-western Health Care Network in Melbourne, Australia. Prevalence of smoking, alcohol consumption, body mass index, hypertension, salt intake, exercise and history
Context Estimates of lifetime risk (LTR) for total cardiovascular disease (tCVD) may provide projections of the future population burden of cardiovascular disease and may assist in clinician-patient risk communication. To date, no LTR estimates of tCVD have been reported. Objective To calculate LTR estimates of tCVD by index age [45, 55, 65, 75 years(y)] and risk factor strata and to estimate years lived free of CVD across risk factor strata. Design, Setting, and Participants Pooled survival analysis of up to 905,115 person-years of data from 1964 through 2008 from 5 NHLBI-funded community-based cohorts: Framingham Heart Study, Framingham Offspring Study, Atherosclerosis Risk in Communities Study, Chicago Heart Association Detection Project in Industry Study and Cardiovascular Health Study. Participants All participants free of CVD at baseline with risk factor data (blood pressure (BP), total cholesterol (TC), diabetes and smoking status) and tCVD outcome data Outcome Measures Any tCVD event (including fatal and non-fatal coronary heart disease, all forms of stroke, congestive heart failure and other CVD deaths) Results At an index age of 45y, overall LTR for tCVD was 60.3% (95% CI, 59.3 to 61.2) for men and 55.6% (95% CI, 54.5 to 56.7) for women. Men had higher LTR estimates than women across all index ages. At index ages 55 and 65y, men and women with ?1 elevated risk factor (BP 140-149/90-99 mmHg or TC 200-239 mg/dL but no diabetes or smoking), or 1, or ? 2 major risk factors (BP ? 160/100mmHg or on treatment; TC ? 240mg/dL or on treatment, diabetes mellitus, or current smoking) had LTR estimates to age 95y that exceeded 50%. Despite an optimal risk factor profile (BP < 120/80 mmHg, TC < 180 mg/dL, and no smoking or diabetes) men and women at an index age of 55y had LTR for total CVD to age 85y > 40% and 30% respectively. Compared with participants with ? 2 major risk factors, those with an optimal risk factor profile lived up to 14y longer free of tCVD. Conclusions LTR estimates for tCVD are high (>30%) for all individuals, even those with optimal risk factors in middle age. However, maintenance of optimal risk factor levels in middle age is associated with substantially longer morbidity-free survival.
Wilkins, John T.; Ning, Hongyan; Berry, Jarett; Zhao, Lihui; Dyer, Alan R.; Lloyd-Jones, Donald M.
Antithrombotic therapy is a cornerstone of treatment in patients with cardiovascular disease with bleeding being the most feared complication. This review describes the risk of bleeding related to different combinations of antithrombotic drugs used for cardiovascular disease: acute coronary syndrome (ACS), atrial fibrillation (AF), cerebrovascular (CVD) and peripheral arterial disease (PAD). Different risk assessment schemes and bleeding definitions are compared. The HAS-BLED risk score is recommended in patients with AF and in ACS patients with AF. In patients with ACS with or without a stent dual antiplatelet therapy with a P2Y12 receptor antagonist and acetylsalicylic acid (ASA) is recommended for 12 months, preferable with prasugrel or ticagrelor unless there is an additional indication of warfarin or increased risk of bleeding. In patients with AF, warfarin is recommended if the risk of stroke is moderate to high, but newer emerging antithrombotic drugs will be recommended along with/or preferred to warfarin in the nearby future. Patients with CVD (without cardiogenic causes) are recommended clopidogrel treatment for secondary prevention, where as patients with PAD are recommended ASA or clopidogrel. With future implementation of new antithrombotic treatment regimens as monotherapy and in combinations with antiplatelet therapy, increased focus on risk of thromboembolic events and bleeding and individual tailoring of antithrombotic therapy is warranted. PMID:22724419
Sørensen, Rikke; Olesen, Jonas B; Charlot, Mette; Gislason, Gunnar H
The object of this study was to assess the prevalence of modifiable cardiovascularrisk factors and their association in 61,108 subjects over 15 years of age who volunteered for a systematic medical check-up, free of charge, and performed in a health centre in central France. The risk factors were defined as follows: hypertension, diabetes, hypercholesterolaemia, hypertriglyceridaemia: medical treatment or value above the upper limits of normal defined by national or international recommendations. obesity and android fat distribution as defined by the principal recommendations. The commonest risk factor was hypercholesterolaemia (60% of men and 64% of women) followed by android obesity. The prevalence of hypertension was greater in men than in women (44 vs 33%). Twenty eight per cent of men and 17% of women admitted to smoking. The percentage of smokers was higher in people under 30. Diabetes was observed in 3% of men and 2% of women. The association of risk factors was observed at an older age in women than in men. The association of 3 risk factors was four times greater in men than in women in the whole population. In conclusion, this study shows that cardiovascularrisk factors are very common in persons undergoing a medical check-up and that these factors are often associated at an earlier age in men than in women. PMID:12055761
Asmar, R; Pannier, B; Vol, S; Brisac, A M; Tichet, J; el Hasnaoui, A
Background Exogenous estrogens have been shown to affect markers of cardiovascularrisk in women. Aim The objective of this study was to determine the effect of menstrual cycle phase on markers of cardiovascularrisk in young, healthy women with regular menstrual cycles. Subjects and Methods This prospective cohort study examined 20 healthy premenopausal women at two time points in the menstrual cycle, in early follicular phase and early luteal phase. Results In the early luteal phase, levels of estrogen, progesterone, luteinizing hormone, total cholesterol and HDL were significantly higher, compared with the early follicular phase. In contrast, there were no significant differences in LDL or triglyceride levels between the two phases. Furthermore, there were no significant effects of menstrual cycle phase on glycemic indices (fasting blood glucose, HbA1c or HOMAIR), markers of inflammation (CRP, sCD40L, ICAM, VCAM, or adiponectin), or vascular function, as measured by brachial artery reactivity. Conclusions Although menstrual cycle phase affects total cholesterol and HDL levels, it does not affect other markers of cardiovascularrisk in young women with regular menstrual cycles.
Purpose. To examine the usefulness of cardiovascularrisk estimation models in people with diabetes. Methods. Review of published studies that compare the discriminative power of major cardiovascularrisk factors single or in combination in individuals with and without diabetes, for major cardiovascular outcomes. Results. In individuals with and without diabetes, major risk factors affect cardiovascularrisk similarly, with no evidence of any significant interaction. Accounting for diabetes-specific parameters, cardiopreventative therapies can significantly improve risk estimation in diabetes. General and diabetes-specific cardiovascularrisk models have a useful discriminative power, but tend to overestimate risk in individuals with diabetes. Their impact on care delivery, adherence to therapies, and patients' outcome remain poorly understood. Conclusions. The high-risk status conferred by diabetes does not preclude the estimation of absolute cardiovascularrisk estimation using global risk tools in individuals with diabetes, as this is useful for the initiation and intensification of preventive measures.
Echouffo-Tcheugui, Justin B.; Ogunniyi, Modele O.; Kengne, Andre P.
Objective Ceruloplasmin (Cp) is an acute-phase reactant that is increased in inflammatory diseases and in acute coronary syndromes. Cp has recently been shown to possess nitric oxide (NO) oxidase catalytic activity, but its impact on long-term cardiovascular outcomes in stable cardiac patients has not been explored. Methods and Results We examined serum Cp levels and their relationship with incident major adverse cardiovascular events (MACE = death, myocardial infarction [MI], stroke) over 3-year follow-up in 4,177 patients undergoing elective coronary angiography. We also carried out a genome-wide association study (GWAS) to identify the genetic determinants of serum Cp levels and evaluate their relationship to prevalent and incident cardiovascularrisk. In our cohort (age 63±11 years, 66% male, 32% history of MI, 31% diabetes mellitus), mean Cp level was 24±6 mg/dL. Serum Cp level was associated with greater risk of MI at 3 years (Hazard ratio [HR, Quartile 4 versus 1] 2.35, 95% confidence interval [CI] 1.79–3.09, p<0.001). After adjusting for traditional risk factors, high-sensitivity C-reactive protein, and creatinine clearance, Cp remained independently predictive of MACE (HR 1.55, 95% CI 1.10–2.17, p=0.012). A two-stage GWAS identified a locus on chromosome 3 over the CP gene that was significantly associated with Cp levels (lead SNP rs13072552; p=1.90 × 10?11). However, this variant, which leads to modestly increased serum Cp levels (~1.5–2 mg/dL per minor allele copy), was not associated with coronary artery disease or future risk of MACE. Conclusion In stable cardiac patients, serum Cp provides independent risk prediction of long-term adverse cardiac events. Genetic variants at the CP locus that modestly affect serum Cp levels are not associated with prevalent or incident risk of coronary artery disease in this study population.
Wilson Tang, W. H.; Wu, Yuping; Hartiala, Jaana; Fan, Yiying; Stewart, Alexandre F.R.; Roberts, Robert; McPherson, Ruth; Fox, Paul L.; Allayee, Hooman; Hazen, Stanley L.
Carotid artery intima-media thickness (IMT) has been used as a surrogate marker of atherosclerosis and is related to cardiovascularrisk. Indices of arterial stiffness are also associated with cardiovascularrisk and atherosclerosis. The aim of this study was to assess the prognostic value of the combination of surrogate markers of cardiovascular disease measured non-invasively in subjects without cardiovascular disease. In
K S Stamatelopoulos; D Kalpakos; A D Protogerou; C M Papamichael; I Ikonomidis; M Tsitsirikos; I Revela; T G Papaioannou; J P Lekakis
BACKGROUND Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascularrisk-reduction strategies. Our objective was to determine whether personalized health planning (PHP), an intervention based on the theories and principles underlying integrative medicine, reduces 10-year risk of coronary heart disease (CHD). METHODS We conducted a randomized, controlled trial among 154 outpatients age 45 or over, with 1 or more known cardiovascularrisk factors. Subjects were enrolled from primary care practices near an academic medical center, and the intervention was delivered at a university Center for Integrative Medicine. Following a health risk assessment, each subject in the intervention arm worked with a health coach and a medical provider to construct a personalized health plan. The plan identified specific health behaviors important for each subject to modify; the choice of behaviors was driven both by cardiovascularrisk reduction and the interests of each individual subject. The coach then assisted each subject in implementing her/his health plan. Techniques used in implementation included mindfulness meditation, relaxation training, stress management, motivational techniques, and health education and coaching. Subjects randomized to the comparison group received usual care (UC) without access to the intervention. Our primary outcome measure was 10-year risk of CHD, as measured by a standard Framingham risk score, and assessed at baseline, 5, and 10 months. Differences between arms were assessed by linear mixed effects modeling, with time and study arm as independent variables. RESULTS Baseline 10-year risk of CHD was 11.1% for subjects randomized to UC (n = 77), and 9.3% for subjects randomized to PHP (n = 77). Over 10 months of the intervention, CHD risk decreased to 9.8% for UC subjects and 7.8% for intervention subjects. Based on a linear mixed-effects model, there was a statistically significant difference in the rate of risk improvement between the 2 arms (P = 0.04). In secondary analyses, subjects in the PHP arm were found to have increased days of exercise per week compared with UC (3.7 vs 2.4, P = 0.002), and subjects who were overweight on entry into the study had greater weight loss in the PHP arm compared with UC (P = 0.06). CONCLUSIONS A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.
Edelman, David; Oddone, Eugene Z; Liebowitz, Richard S; Yancy, William S; Olsen, Maren K; Jeffreys, Amy S; Moon, Samuel D; Harris, Amy C; Smith, Linda L; Quillian-Wolever, Ruth E; Gaudet, Tracy W
Patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTSs) have a considerably higher prevalence of cardiovascular disease (CVD) than the general population in old age. Many hypotheses have been created to explain traditional clinical risk factors of CVD, including age, male gender, cigarette smoking, inheritance, high blood pressure (BP), obesity, elevated fasting plasma glucose, diabetes mellitus, dyslipidemia, decreased physical activity and metabolic syndrome; or nontraditional risk factors such as oxidative stress, inflammation, vascular calcification, malnutrition, homocysteine and genetic variation. Although these risk factors are important in CVD pathophysiology and clinical presentation, there is still no single theory sufficient to provide an adequate explanation for all the properties of CVD. We speculate that by causing nocturia-induced sleep disturbances, BP variability, increased sympathetic activity, non-dipping BP variations; BPH may be an insidious risk factor for CVD. Benign prostate hyperplasia may be related to increased BP, coronary ischemic hearth disease or other cardiovascular pathologic conditions. This attention on BPH may produce a new approach to the diagnosis and treatment of CVD. Although the underlying mechanisms are still exactly unclear, further prospective randomized controlled studies are needed to identify if patients with BPH/LUTS is higher risk for CVD. PMID:19359054
Adherence to lifestyle recommendations for prevention of cardiovascular disease remains a critical issue. We examined the association of anxiety and depression with healthy behaviors in a large population of subjects at risk of cardiovascular disease.We studied 1612 consecutive subjects referred for evaluation of cardiovascularrisk factors. Separated scores reflecting unhealthy behaviors (physical inactivity, smoking and poor diet) were combined to
Fabrice Bonnet; Kate Irving; Jean-Louis Terra; Patrice Nony; François Berthezène; Philippe Moulin
Level of kidney function as a risk factor for cardiovascular outcomes in the elderly.BackgroundThere is a high prevalence of both reduced kidney function as well as cardiovascular disease (CVD) in the elderly. We evaluated whether the level of kidney function is an independent risk factor for CVD outcomes in the Cardiovascular Health Study (CHS), a cohort of subjects whose age
Guruprasad Manjunath; Hocine Tighiouart; Josef Coresh; Bonnie Macleod; Deeb N. Salem; John L. Griffith; Andrew S. Levey; Mark J. Sarnak
Background: There is conflicting evidence regarding the relationship between iron stores and cardiovascular disease (CVD). The present study aimed to investigate the association between body iron indices and some cardiovascularrisk factors. Methods: In a case–control study conducted in the south of Shiraz, Iran, we determined ferritin, iron, total iron binding capacity (TIBC), metabolic risk factors, C-reactive protein (CRP), and anthropometric measurements in 100 men aged 45 years and higher with newly diagnosed CVD and 100 adjusted controls without evidence for CVD. Results: The mean of low density lipoprotein (LDL-c), CRP, and ferritin concentrations were significantly higher in cases than controls, and high density lipoprotein (HDL-c) was significantly lower in cases than controls. Pearson correlation coefficient between CRP and the other risk factors in case group showed that only ferritin, serum iron, waist circumference, and LDL-c significantly correlated with CRP (r = 0.32 with P < 0.001, r = 0.29 with P < 0.05, r = 0.41 with P < 0.01, and r = 0.36 with P < 0.001, respectively). Conclusions: This study indicated an association between a positive balance of body iron and CVD. Hence, caution should be exercised in administration of iron supplements to patients with CVD and in consumption of food rich in iron by them.
Eftekhari, Mohammad Hassan; Mozaffari-Khosravi, Hassan; Shidfar, Farzad; Zamani, Atefeh
In young adults with onset of chronic kidney disease in childhood, cardiovascular disease is the most common cause of death. The likely reason for increased cardiovascular disease in these patients is high prevalence of traditional and uremia-related cardiovascular disease risk factors during childhood chronic kidney disease. Early markers of cardiomyopathy, such as left ventricular hypertrophy and left ventricular dysfunction and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness and coronary artery calcification are frequently found in this patient population. The purpose of this review is to provide an update of recent advances in the understanding and management of cardiovascular disease risks in this population.
It has been clearly demonstrated that ageing and arterial hypertension are both associated with an increased prevalence of left ventricular hypertrophy (LVH), which is a powerful risk factor for cardiovascular (CV) events. The objective of this study was to assess the impact of echocardiographic LVH in profiling the absolute CV risk stratification according to the 1999 World Health Organization–International Society
C Cuspidi; L Michev; B Severgnini; S Meani; V Fusi; C Valerio; G Bertazzoli; F Magrini; A Zanchetti
Cyclooxygenase-derived prostaglandins modulate cardiovascular disease risk. We genotyped 2212 Atherosclerosis Risk in Communities study participants (1,023 incident coronary heart disease (CHD) cases; 270 incident ischemic stroke cases; 919 non-cases) with available DNA for polymorphisms in PTGS1 an...
Background A substantial portion of the public health burden of heart failure is due to hospitalizations, many of which are for causes other than cardiovascular disease. We assessed whether left ventricular (LV) systolic dysfunction was associated with increased risk of both cardiovascular and non-cardiovascular hospitalizations in a community sample of African-Americans. Methods African-American participants from the Jackson, MS site of the Atherosclerosis Risk in Communities (ARIC) study who underwent echocardiography were followed for twelve years. Hospitalization rates among individuals with and without LV systolic dysfunction were compared using negative binomial regression. Results Among 2416 participants with echocardiograms, LV systolic dysfunction was found in 61 (2.5%). Participants with LV dysfunction experienced 366 hospitalizations, a rate of 1.27 per person-year, compared to 0.25 per person-year among individuals without LV dysfunction. The incidence rate ratio adjusted for demographics, comorbidities, and other risk factors was 3.11 (95% CI 2.22–4.35). The adjusted rate ratios were 4.76 (95% CI 2.90–7.20) for cardiovascular and 2.67 (95% CI 1.82–3.90) for non-cardiovascular diagnoses, with similar findings in the subset of individuals with asymptomatic LV dysfunction. The percent attributable risks for hospitalizations were 87% and 74% for cardiovascular and non-cardiovascular causes (79% and 63% after adjustment). Conclusions African-American individuals with LV dysfunction are at an increased risk of hospitalization due to a wide range of causes with non-cardiovascular hospitalizations accounting for nearly half the increased risk. To the extent that estimates of risk focus on cardiovascular morbidity, they may underestimate the true health burden of LV dysfunction.
Blecker, Saul; Matsushita, Kunihiro; Fox, Ervin; Russell, Stuart D.; Miller, Edgar R.; Taylor, Herman; Brancati, Frederick; Coresh, Josef
Despite recent advancements in the treatment of coronary artery disease (CAD), it remains the number one cause of death in the world. While traditional risk factors partially account for the development of CAD, other novel risk factors have recently been implicated. Specifically, chronic inflammation has been postulated to play a role in the development and propagation of this disease. The purpose of this systematic review is to examine the available evidence to determine if patients with chronic inflammatory diseases have higher rates of cardiovascular disease. A MEDLINE search was conducted for articles published between 1980-2009. We focused on studies that assessed hard cardiovascular endpoints in subjects with chronic inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polymyositis/dermatomyositis, and inflammatory bowel disease. Although largely based on small studies, our review indicates that patients with chronic inflammatory conditions are likely at elevated risk for the development of CAD. Further research consisting of prospective cohort studies is needed to better quantify this risk. PMID:21459266
Roifman, Idan; Beck, Paul L; Anderson, Todd J; Eisenberg, Mark J; Genest, Jacques
Background: Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors. Methods: This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors. Results: Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed. Discussion: Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention. Conclusion: Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting.
Studies on the impact of single nutrients on the risk of CVD have often given inconclusive results. Recent research on dietary patterns has offered promising information on the effects of diet as a whole on the risk of CVD. The CardiovascularRisk in Young Finns Study is an ongoing, prospective cohort study with a 21-year follow-up to date. The subjects were children and adolescents at baseline (3-18 years, n 1768) and adults at the latest follow-up study (24-39 years, n 1037). We investigated the associations between two major dietary patterns and several risk factors for CVD. In longitudinal analyses with repeated measurements, using multivariate mixed linear regression models, the traditional dietary pattern (characterised by high consumption of rye, potatoes, butter, sausages, milk and coffee) was independently associated with total and LDL cholesterol concentrations, apolipoprotein B and C-reactive protein concentrations among both genders, and also with systolic blood pressure and insulin levels among women and concentrations of homocysteine among men (P < 0.05 for all). A dietary pattern reflecting more health-conscious food choices (such as high consumption of vegetables, legumes and nuts, tea, rye, cheese and other dairy products, and alcoholic beverages) was inversely, but less strongly associated with cardiovascularrisk factors. Our results support earlier findings that dietary patterns have a role in the development of CVD. PMID:17367571
Mikkilä, Vera; Räsänen, Leena; Raitakari, Olli T; Marniemi, Jukka; Pietinen, Pirjo; Rönnemaa, Tapani; Viikari, Jorma
In prospective observational studies and retrospective case control studies performed throughout the world, low serum levels of high-density lipoprotein cholesterol (HDL-C) are consistently associated with increased risk for all forms of atherosclerotic disease and its clinical sequelae, including myocardial infarction, stroke, and sudden death. In contrast, high serum levels of this lipoprotein are associated with reduced risk for these outcomes. The metabolism of high-density lipoproteins (HDLs) is complex, and a very large number of genetic polymorphisms influence the serum level of HDL particles in any given individual. A significant question in cardiovascular medicine is whether or not prospectively raising HDL in patients at risk is associated with significant reductions in cardiovascular events and rates of atherosclerotic disease progression. A recent comprehensive meta-analysis that incorporated the results of 108 prospective clinical trials suggests that the answer to this question is "no" with currently available lipid modifying therapies. However, a number of individual clinical trials and other meta-analyses suggest that, in fact, raising HDL does beneficially impact risk for cardiovascular events and slows progression or even reverses atherosclerosis. HDL appears to antagonize atherogenesis and drive a number of vasculoprotective phenomena. It has antioxidative, anti-proliferative, anti-thrombotic, and anti-inflammatory properties and potentiates reverse cholesterol transport. Under some conditions, the proteosome of HDL can change, rendering it pro-inflammatory and pro-oxidative. This paper explores many of the key questions surrounding HDL-C and why probing its efficacy may not be entirely amenable to a meta-analysis. Numerous drugs are in development which have the capacity to raise HDL-C dramatically. It is hoped that these agents will be able to provide us with a more definitive answer about the clinical efficacy of raising HDL-C, and what specific approaches will be necessary in patients with specific genetic and metabolic backgrounds in both the primary and secondary prevention settings. PMID:19847144
Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homocysteine (Hcy) and C reactive protein (CRP) were measured. When compared to a healthy population, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (Apo A), CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C), Apo B, albumin (ALB). A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant difference with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardiovascularrisk in dialysis patients. PMID:20061694
OBJECTIVE--To examine the relation between subjects' level of cardiovascularrisk and their beliefs about the harmfulness of their smoking habit, current diet, and level of exercise, together with their stated desire to modify such behaviour. DESIGN--Self administered postal health and life-style questionnaire followed by a structured health check conducted by a nurse. SETTING--Five general practices in Luton and Dunstable, Bedfordshire. SUBJECTS--5803 people aged 35-64 years enrolled in the OXCHECK trial who attended for a health check before 1 March 1992. MAIN OUTCOME MEASURES--Perceived risk to health of lifestyle behaviours, desire to modify behaviour, and a reported serious attempt to modify behaviour in the preceding year. RESULTS--A high proportion of smokers and those who were physically inactive perceived their behaviour to be harmful (1020; (76%; 95% confidence interval 74% to 79%) and 350 (74%; 70% to 78%) respectively) and wished to modify it (1212 (79%; 77% to 81%) and 375 (74%; 71% to 78%) respectively). In contrast, only 289 (45%; 41% to 48%) of obese people and 188 (14%; 12% to 16%) of people with a high dietary fat intake perceived their current diet to be harmful. The more cardiovascularrisk factors present, the more likely subjects were to perceive a health risk attached to their diet and lack of exercise (p < 0.01 in both cases) and to want to improve their diet. CONCLUSION--Awareness of the health risk from smoking and motivation to stop is high. Further efforts are required, however, to educate the public about the risks associated with a high dietary fat intake. Although the health risks of inactivity were widely recognised, motivation to take more exercise needs to be increased.
Silagy, C; Muir, J; Coulter, A; Thorogood, M; Roe, L
BACKGROUND Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome, obesity and thyroid disorders. Women with prior 0–1 pregnancies are at an increased risk of incident CVD when compared with women with two pregnancies. It is uncertain whether history of subfertility among women eventually giving birth is a risk factor for CVD. METHODS Among Swedish women with self-reported data on subfertility in the Swedish Medical Birth Register (n = 863 324), we used Cox proportional hazards models to relate a history of subfertility to CVD risk after adjustment for age, birth year, highest income, education, birth country, hypertension, diabetes, preterm birth, small for gestational age (SGA), smoking and for BMI in separate models. In additional analyses, we excluded women with: (i) pregnancy-related or non-pregnancy-related hypertension and/or diabetes; and (ii) preterm births and/or SGA babies. RESULTS Among nulliparous women eventually having a childbirth (between 1983 and 2005, the median follow-up time 11.9; 0–23 years and 9 906 621 person-years of follow-up), there was an increased risk of CVD among women reporting ?5 years of subfertility versus 0 years (hazard ratio 1.19, 95% confidence interval 1.02–1.39). There were not significantly elevated CVD risks for women with 1–2 or 3–4 years of subfertility versus 0 years. Accounting for BMI did not change results. Excluding women with hypertension and/or diabetes attenuated associations, whereas exclusion of women with preterm and/or SGA births did not change findings. CONCLUSIONS Subfertility among women eventually having a childbirth is a risk factor for CVD even upon accounting for cardiovascularrisk factors and adverse pregnancy outcomes. Future studies should explore the mechanisms underlying this association.
Parikh, Nisha I.; Cnattingius, Sven; Mittleman, Murray A.; Ludvigsson, Jonas F.; Ingelsson, Erik
Aims The aims of the study were, first, to critically evaluate lipoprotein(a) [Lp(a)] as a cardiovascularrisk factor and, second, to advise on screening for elevated plasma Lp(a), on desirable levels, and on therapeutic strategies. Methods and results The robust and specific association between elevated Lp(a) levels and increased cardiovascular disease (CVD)/coronary heart disease (CHD) risk, together with recent genetic findings, indicates that elevated Lp(a), like elevated LDL-cholesterol, is causally related to premature CVD/CHD. The association is continuous without a threshold or dependence on LDL- or non-HDL-cholesterol levels. Mechanistically, elevated Lp(a) levels may either induce a prothrombotic/anti-fibrinolytic effect as apolipoprotein(a) resembles both plasminogen and plasmin but has no fibrinolytic activity, or may accelerate atherosclerosis because, like LDL, the Lp(a) particle is cholesterol-rich, or both. We advise that Lp(a) be measured once, using an isoform-insensitive assay, in subjects at intermediate or high CVD/CHD risk with premature CVD, familial hypercholesterolaemia, a family history of premature CVD and/or elevated Lp(a), recurrent CVD despite statin treatment, ?3% 10-year risk of fatal CVD according to European guidelines, and/or ?10% 10-year risk of fatal + non-fatal CHD according to US guidelines. As a secondary priority after LDL-cholesterol reduction, we recommend a desirable level for Lp(a) <80th percentile (less than ?50 mg/dL). Treatment should primarily be niacin 1–3 g/day, as a meta-analysis of randomized, controlled intervention trials demonstrates reduced CVD by niacin treatment. In extreme cases, LDL-apheresis is efficacious in removing Lp(a). Conclusion We recommend screening for elevated Lp(a) in those at intermediate or high CVD/CHD risk, a desirable level <50 mg/dL as a function of global cardiovascularrisk, and use of niacin for Lp(a) and CVD/CHD risk reduction.
Cardiovascular disease is a major cause of morbidity and mortality. Numerous risk scores exist to identify healthy individuals\\u000a at increased risk of developing cardiovascular disease. Although platelets are a key mediator in the pathogenesis of cardiovascular\\u000a disease, the role of platelet activity measurements and the incidence of cardiovascular disease are uncertain. Platelet aggregometry—the\\u000a most well studied method of platelet function
Objectives Our aim was to explore whether the carotid/brachial pulse pressure (C/B-PP) ratio selectively predicts the gender difference in age-related cardiovascular death. Background Hypertension and cardiovascular complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the C/B-PP ratio is a physiological marker of PP amplification between C and B arteries which tends toward 1.0 with age. Methods The study involved 72,437 men (aged 41.0±11.1 years, mean±SD) and 52,714 women (39.5±11.6 years). C-PP was calculated for each gender by a multiple regression analysis including B-PP, age, height and risk factors, a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3028 men and 969 women died. Results In the total population, the adjusted hazard ratios (HR, 95% CI) of C/B-PP ratio were: (i) for all cause mortality: men, 1.51 (1.47–1.56), women, 2.46 (2.27–2.67) (p<0.0001); (ii) for cardiovascular mortality: men, 1.81 (1.70–1.93), women, 4.46 (3.66–5.45) (p<0.0001). The C/B-PP impact on mortality did not significantly increase from younger men to those over 55, from: 1.44 (1.31–1.58) to 1.65 (1.48–1.84), but increased significantly with age in women: 3.19 (2.08–4.89) vs 5.60 (4.17–7.50) (p<0.01). Thus the mortality impact of C/B-PP ratio was 3-fold higher in women than in men over 55. Conclusions The C/B amplification is highly predictive of differences in cardiovascularrisk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in cardiovascularrisk.
Regnault, Veronique; Thomas, Frederique; Safar, Michel E.; Osborne-Pellegrin, Mary; Khalil, Raouf A.; Pannier, Bruno; Lacolley, Patrick
Cardiovascularrisk prediction models based on classical risk factors identified in epidemiologic cohort studies are useful in primary prevention of cardiovascular disease in individuals. This article briefly reviews aspects of cardiovascularrisk prediction in the United States and efforts to evaluate novel risk factors. Even though many novel risk markers have been found to be associated with cardiovascular disease, few appear to improve risk prediction beyond the powerful, classical risk factors. A recent US consensus panel concluded that clinical measurement of certain novel markers for risk prediction was reasonable, namely, hemoglobin A1c (in all adults), microalbuminuria (in patients with hypertension or diabetes), and C-reactive protein, lipoprotein-associated phospholipase, coronary calcium, carotid intima-media thickness, and ankle/brachial index (in patients deemed to be at intermediate cardiovascularrisk, based on traditional risk factors).
The association between immigration status and cardiovascular disease (CVD) risk factor awareness is unknown. Using physical examination-based data and participants' self-report of prior diagnosis, we assessed immigration-based disparities in awareness of diabetes, hypertension, hypercholesterolemia, and overweight among 12,124 participants in the 2003-2008 National Health and Nutrition Examination Survey. Unawareness of CVD risk factors is high among all groups, but tends to be higher among foreign-born English and non-English speaking participants than among US-born participants. After adjusting for demographic factors and access to health care, foreign-born participants appear more likely to be unaware of their hypertension and overweight than US-born participants. Immigrants are more likely than those born in the US to be unaware of their CVD risk factors, and therefore may be less motivated to seek treatment and modify their behavior to prevent negative CVD outcomes. PMID:22210443
Langellier, Brent A; Garza, Jeremiah R; Glik, Deborah; Prelip, Michael L; Brookmeyer, Ron; Roberts, Christian K; Peters, Anne; Ortega, Alexander N
Background Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications. Methods The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n?=?341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events. Results During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age, packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00–1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascularrisk (P?=?0.08). Conclusions Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.
Jairam, Pushpa M.; de Jong, Pim A.; Mali, Willem P. T h. M.; Isgum, Ivana; de Koning, Harry J.; van der Aalst, Carlijn; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; van der Graaf, Yolanda
Epidemiological and clinical evidence suggests that a judicious diet, regular physical activity and blood pressure (BP) monitoring must start in early childhood to minimize the impact of modifiable cardiovascularrisk factors. This study was designed to evaluate BP and metabolic parameters of schoolchildren from Vitória, Espírito Santo State, Brazil, and correlate them with cardiovascularrisk factors. The study was conducted on 380 students aged 10-14 years (177 boys, 203 girls) enrolled in public schools. Baseline measurements included body mass index, BP and heart rate. The students were submitted to exercise spirometry on a treadmill. VO2max was obtained from exercise testing to voluntary exhaustion. Fasting serum total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), and glucose were measured. Nine point nine percent of the boys and 11.7% of the girls were hypertensive or had pre-hypertensive levels. There was no significant correlation between VO2max and TC, LDL-C, or TG in prepubertal children, but a slight negative correlation was detected in post-pubertal boys for HDL-C and TG. In addition, children with hypertension (3.4%) or pre-hypertensive levels (6.6%) also had comorbidity for overweight and blood lipid abnormalities (14% for triglycerides, 44.7% for TC, 25.9% for LDL-C, 52% for low HDL-C). The present study shows for the first time high correlations between prehypertensive blood pressure levels and the cardiovascularrisk factors high TC, high LDL-C, low HDL-C in schoolchildren. These are important for the formulation of public health policies and strategies. PMID:17160273
Rodrigues, A N; Moyses, M R; Bissoli, N S; Pires, J G P; Abreu, G R
The objective of the study was to evaluate oxidative stress (OS) status in subjects with different cardiovascularrisk factors. With this in mind, we have studied three models of high cardiovascularrisk: hypertension (HT) with and without metabolic syndrome, familial hypercholesterolemia (FH) and familial combined hyperlipidemia (FCH) with and without insulin resistance. Oxidative stress markers (oxidized/reduced glutathione ratio, 8-oxo-deoxyguanosine and malondialdehide) together with the activity of antioxidant enzyme triad (superoxide dismutase, catalase, glutathione peroxidase) and activation of both pro-oxidant enzyme (NAPDH oxidase components) and AGTR1 genes, as well as antioxidant enzyme genes (CuZn-SOD, CAT, GPX1, GSR, GSS and TXN) were measured in mononuclear cells of controls (n = 20) and patients (n = 90) by assessing mRNA levels. Activity of some of these antioxidant enzymes was also tested. An increase in OS and pro-oxidant gene mRNA values was observed in patients compared to controls. The hypertensive group showed not only the highest OS values, but also the highest pro-oxidant activation compared to those observed in the other groups. In addition, in HT a significantly reduced antioxidant activity and mRNA induction of antioxidant genes were found when compared to controls and the other groups. In FH and FCH, the activation of pro-oxidant enzymes was also higher and antioxidant ones lower than in the control group, although it did not reach the values obtained in hypertensives. The thioredoxin system was more activated in patients as compared to controls, and the highest levels were in hypertensives. The increased oxidative status in the presence of cardiovascularrisk factors is a consequence of both the activation of pro-oxidant mechanisms and the reduction of the antioxidant ones. The altered response of the main cytoplasmic antioxidant systems largely contributes to OS despite the apparent attempt of the thioredoxin system to control it.
Mansego, Maria L.; Redon, Josep; Martinez-Hervas, Sergio; Real, Jose T.; Martinez, Fernando; Blesa, Sebastian; Gonzalez-Albert, Veronica; Saez, Guillermo T.; Carmena, Rafael; Chaves, Felipe J.
Insulin resistance, hyperglycemia, hyperinsulinemia, hyperlipidemia and oxidative stress are risk factors related to cardiovascular diseases including congestive heart failure, myocardial infarction, ventricular hypertrophy, endothelial nitric oxide impairment in systemic blood vessels and the heart, atherosclerosis, and hypercoagulability of blood. The traditional focus on insulin sensitivity and blood levels of markers of risk determined in the fasted state is inconsistent with the large volume of recent data that indicates that the metabolic defect in the pre-diabetic and diabetic condition relates more strongly to postprandial deficiency than to the fasting state. Risk factors for adverse cardiovascular events can be detected in the pre-diabetic insulin-resistant subject based upon the metabolic response to a test meal even in the absence of altered fasting parameters. The normal response to a mixed meal includes a doubling of insulin action secondary to insulin-induced release of a putative hepatic insulin sensitizing substance (HISS) that acts selectively on skeletal muscle. HISS is released only in the fed state and accounts for meal-induced insulin sensitization. Blockade of HISS release leads to a condition referred to as HISS-dependent insulin resistance, which is suggested as the primary postprandial metabolic defect, accounting for postprandial hyperglycemia, hyperinsulinemia, hyperlipidemia, and increased oxidative stress in the pre-diabetic and diabetic condition. HISS-dependent insulin resistance represents a novel hypothesis and suggests a new diagnostic and therapeutic target.
Extreme thrombocytosis is a major risk factor for excessive bleeding and for thrombosis, either of which can complicate cardiovascular surgical and interventional procedures. Extreme thrombocytosis can also cause an unusual syndrome, erythromelalgia, that results in a type of chronic microvascular occlusive arterial disease. We present the differential diagnosis of conditions that may lead to extreme thrombocytosis, 3 cases (each of which illustrates a different potential complication), and a review of the pertinent medical literature. Correcting excessive thrombocytosis is typically not difficult, whether electively or acutely, and effective therapy usually controls thrombosis and excessive hemorrhage post-procedurally. PMID:23304015
The prevalence of cardiovascularrisk factors and their relation to a self-reported family history of disease was examined in 3,357 first year university students of Mar del Plata University (Argentine). The prevalence of family disease was 27.5% for hypercholesterolemia, 42.1% for hypertension, 26.9% for diabetes mellitus, 27.2% for obesity and 42.1% for cardiovascular disease. The percentual of 80.7% of the population surveyed showed at least one of these diseases in their previous family history. The prevalence of hypertension (systolic blood pressure levels > or = 140 mmHg) or/and diastolic blood pressure levels > or = 90 mmHg) was 7.0%. Hypertension was related to Body Mass Index (BMI), male sex and age. The percentual of 14.4% presented hypercholesterolemia (> or = 210 mg/dl), which was associated with age, BMI and family history of obesity and hypercholesterolemia. Nine hundred and eleven subjects (27.1%) were smokers. Differences related to sex were not found. Smoking was positively related to age and the career they had chosen. The examination detected one hundred and twenty-three (3.7%) students with cardiac problems. This was associated with a family history of cardiovascular disease. Preventive measures were suggested. PMID:9302828
Girotto, C A; Vacchino, M N; Spillmann, C A; Soria, J A
Background Coronary artery calcium (CAC), carotid intima-media thickness, and left ventricular (LV) mass and geometry offer the potential to characterize incident cardiovascular disease (CVD) risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD. Methods and Results The study sample consisted of 4965 Multi-Ethnic Study of Atherosclerosis participants (48% men; mean age, 62±10 years). They were free of CVD at baseline and were followed for a median of 5.8 years. There were 297 CVD events, including 187 coronary heart disease (CHD) events, 65 strokes, and 91 heart failure (HF) events. CAC was most strongly associated with CHD (hazard ratio [HR], 2.3 per 1 SD; 95% CI, 1.9 to 2.8) and all CVD events (HR, 1.7; 95% CI, 1.5 to 1.9). Most strongly associated with stroke were LV mass (HR, 1.3; 95% CI, 1.1 to 1.7) and LV mass/volume ratio (HR, 1.3; 95% CI, 1.1 to 1.6). LV mass showed the strongest association with HF (HR, 1.8; 95% CI, 1.6 to 2.1). There were no significant interactions for imaging measures with sex and ethnicity for any CVD outcome. Compared with traditional risk factors alone, overall risk prediction (C statistic) for future CHD, HF, and all CVD was significantly improved by adding CAC, LV mass, and CAC, respectively (all P<0.05). Conclusions There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.
Jain, Aditya; McClelland, Robyn L.; Polak, Joseph F.; Shea, Steven; Burke, Gregory L.; Bild, Diane E.; Watson, Karol E.; Budoff, Matthew J.; Liu, Kiang; Post, Wendy S.; Folsom, Aaron R.; Lima, Joao A.C.; Bluemke, David A.
Tobacco use is a major modifiable cardiovascularrisk factor in the general population and contributes to excess cardiovascularrisk. Emerging evidence from large-scale observational studies suggests that continued tobacco use is also an independent cardiovascularrisk factor among patients with chronic kidney disease (CKD). The benefits of smoking cessation programs on improving the heath status of patients and reducing mortality are unequivocal in the general population. Despite this, there has been little effort in pursuing tobacco cessation programs in dialysis cohorts or those with lesser degrees of kidney impairment. Most of our attention to date has focused on the development of "kidney-specific" interventions that reduce rates of renal disease progression and improve dialysis outcomes. The purpose of this current review is to describe the epidemiology of tobacco use among patients with CKD, draw attention to its negative impact on cardiovascular morbidity and mortality, and finally highlight potential strategies for successful intervention. We hope that this study heightens the importance of tobacco use in CKD, stimulates renewed interest in the barriers and challenges that exist in achieving smoking cessation, and endorses the efficacy of intervention strategies and the immeasurable benefits of quitting on cardiovascular and noncardiovascular outcomes. PMID:20636923
OBJECTIVES. Whether community-wide education changed cardiovascularrisk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS. Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS. The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS. The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascularrisk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.
Carleton, R A; Lasater, T M; Assaf, A R; Feldman, H A; McKinlay, S
Background To estimate the prevalence of overweight and obesity in the Spanish population as measured with body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) and to determine the associated cardiovascularrisk factors. Methods Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. Participants aged 35–74 years were asked about the history of cardiovascular diseases, hypertension, diabetes and hypercholesterolemia. Height, weight, WC, blood pressure, glycaemia, total cholesterol, low-density and high-density lipoprotein cholesterol and coronary risk were measured. The prevalence of overweight (BMI 25–29.9 kg/m2), general obesity (BMI ?30 kg/m2), suboptimal WC (? 80 cm and?88 in women, ? 94 and?102 in men), abdominal obesity (WC ?88 cm ?102 cm in women and men, respectively) and WHtR ?0.5 was estimated, standardized for the European population. Results We included 28,743 individuals. The prevalence of overweight and suboptimal WC was 51% and 30% in men and 36% and 22% in women, respectively; general obesity was 28% in both sexes and abdominal obesity 36% in men and 55% in women. The prevalence of WHtR ?0.5 was 89% and 77% in men and women, respectively. All cardiovascularrisk factors were significantly associated with abnormal increased values of BMI, WC and WHtR. Hypertension showed the strongest association with overweight [OR?=?1.99 (95% confidence interval 1.81-2.21) and OR?=?2.10 (1.91-2.31)]; suboptimal WC [OR?=?1.78 (1.60-1.97) and OR?=?1.45 (1.26-1.66)], with general obesity [OR?=?4.50 (4.02-5.04), and OR?=?5.20 (4.70-5.75)] and with WHtR ?0.5 [OR?=?2.94 (2.52-3.43), and OR?=?3.02 (2.66-3.42)] in men and women respectively, besides abdominal obesity in men only [OR?=?3.51 (3.18-3.88)]. Diabetes showed the strongest association with abdominal obesity in women [OR?=?3,86 (3,09-4,89). Conclusions The prevalence of obesity in Spain was high. Overweight, suboptimal WC, general, abdominal obesity and WHtR ?0.5 was significantly associated with diabetes, hypertension, hypercholesterolemia and coronary risk. The use of lower cut-off points for both BMI and particularly WC and could help to better identify the population at risk and therefore achieve more effective preventive measures.
BACKGROUND: Evidence suggests that both selective cyclooxygenase (COX)-2 inhibitors and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular events. However, evidence from prospective studies of currently available COX-2 inhibitors and non-selective NSAIDs is lacking in patients at high cardiovascularrisk who are taking aspirin. OBJECTIVE: To determine the cardiovascular outcomes in high risk patients with osteoarthritis treated with
M. E. Farkouh; J. D. Greenberg; R. V. Jeger; K. Ramanathan; F. W. A. Verheugt; J. H. Chesebro; H. Kirshner; J. S. Hochman; C. L. Lay; S. Ruland; B. Mellein; P T Matchaba; V. Fuster; S. B. Abramson
IntroductionAlthough men and women have similar risk factors for cardiovascular disease, many social behaviors in developing countries differ by sex. Rural-to-urban migrants have different cardiovascularrisk profiles than rural or urban dwellers. The objective of this study was to evaluate the sex differences with specific cardiovascularrisk factors in rural-to-urban migrants.Methods and ResultsWe used the rural-to-urban migrant group of the
Antonio Bernabe-Ortiz; Catherine Pastorius Benziger; Robert H. Gilman; Liam Smeeth; J. Jaime Miranda
AbstractObjective: To investigate strength of associations between risk factors for cardiovascular disease and socioeconomic position during childhood and adulthood.Design: Cross sectional analysis of status of cardiovascularrisk factors and past and present social circumstances.Subjects: 5645 male participants in the west of Scotland collaborative study, a workplace screening study.Main outcome measures: Strength of association between each risk factor for cardiovascular disease
D Blane; C L Hart; G Davey Smith; C R Gillis; D J Hole; V M Hawthorne
Background: Existing cardiovascularrisk prediction equations perform non-optimally in different populations with diabetes. Thus, there is a continuing need to develop new equations that will reliably estimate cardiovascular disease (CVD) risk and offer flexibility for adaptation in various settings. This report presents a contemporary model for predicting cardiovascularrisk in people with type 2 diabetes mellitus.Design and methods: A 4.5-year
Andre Pascal Kengne; Anushka Patel; Michel Marre; Florence Travert; Michel Lievre; Sophia Zoungas; John Chalmers; Stephen Colagiuri; Diederick E Grobbee; Pavel Hamet; Simon Heller; Bruce Neal; Mark Woodward
Cardiovascularrisk assessment in patients without established disease allows to match the intensity of risk factor modification to the underlying hazard for cardiovascular events. The cardiologist needs to know the characteristics of current risk prediction algorithms, their advantages and limitations. PMID:22452869
Rodríguez-Escudero, Juan Pablo; López-Jiménez, Francisco; Trejo-Gutiérrez, Jorge F
Objective To examine the association between work stress, according to the job strain model and the effort›reward imbalance model, and the risk of death from cardiovascular disease. Design Prospective cohort study. Baseline examination in 1973 determined cases of cardiovascular disease, behavioural and biological risks, and stressful characteristics of work. Biological risks were measured at 5 year and 10 year follow
Cardiovascular disease is the leading cause of mortality and morbidity in the post-menopausal woman. The natural menopause does not appear to be an independent risk factor (or a minor one) for coronary heart disease. Obesity, more precisely excessive intra-abdominal fat, is a cardiovascularrisk factor especially with regard to the metabolic risk factors associated with this type of obesity. There
Optimal glycemic control is well known to reduce effectively the risk of micro vascular complications both in type 1 and type 2 diabetes mellitus. However the role of glycemic control in decreasing the risk of myocardial infarction and ischemic stroke, the leading causes of death in patients with diabetes, has been so far controversial. In this review, based on data recently reported from large interventional studies, we discuss the possible causal relationship between glycemia and cardiovascular outcomes in type 1 and type 2 diabetes. Strict glycemic control right from the diagnosis of the disease may be effective in reducing long term incidence of cardiovascular (CV) disease in both T1 and T2 diabetics. Nevertheless such a strategy could be potentially harmful for T2 diabetics with long duration of sub optimal glycemic control and already established CV complications. Treatment targets in these patients should be individualized taking into account other aspects of glycemic control and diabetes complications such as hypoglycemia and autonomic neuropathy.
In the last years the development of home based e-health applications, which use information, telecommunication and videoconferencing technologies, is increased because of their characteristics that allow reducing hospitalization costs and managing and monitoring patient health in real time. However, the development of a home based e-health monitoring system requires the contribution of different expertise, from medicine to engineering, and technologies, from electronics to medical informatics and telemedicine. Here we illustrate a home based e-health project that has been developed with the cooperation of several different research groups of the Bioengineer Department of the "Politecnico di Milano". They provided and integrated all required knowledge and background, including Biomedical Electronics and Biosensors, Biosignal Processing, Medical Informatics and Telemedicine, and Information And Communication Technologies. The aim of the discussed work was to design and implement a Web application that enables different healthcare actors to insert and browse healthcare data, bio-signals, and biomedical images of patients enrolled in a program of cardiovascularrisk prevention. Such application is intended to be part of a home monitoring system to be used during the home physical training program of cardiovascularrisk patients. PMID:17946759
\\u000a When managing energy or weather related risk often only imperfect hedging instruments are available. In the first part we\\u000a illustrate problems arising with imperfect hedging by studying a toy model. We consider an airline’s problem with covering\\u000a income risk due to fluctuating kerosine prices by investing into futures written on heating oil with closely correlated price\\u000a dynamics. In the second
The dissipation, residues, and distribution of spirodiclofen, a new type of insecticide and acaricide that belongs to the class of ketoenols or tetronic acids, in citrus were investigated in this study. Risk assessment of sprodiclofen was also conducted based on those data. The open-field experiments were conducted in Guangdong, Fujian, and Guangxi of China. Results showed that the half-lives in citrus ranged from 6.5 to 13.6 days at three sites. The terminal residues of spirodiclofen were all below the FAO/WHO maximum residue limit of 0.5 mg/kg in citrus, when they were determined 14 days after final application. Distribution of spirodiclofen in peel and flesh was analyzed, and residues were found to be concentrated on peel. Risk assessment was performed by calculation of risk quotient, which showed that the use of spirodiclofen is comparably safe for humans. PMID:23880916
The British Regional Heart Study seeks to define risk factors for cardiovascular disease, to examine their interrelationships, and to explain the geographic variations in cardiovascular disease in Britain. A clinical survey of men aged 40-59 in 24 British towns was carried out and preliminary data from the survey analysed. On a town basis cardiovascular mortality was associated with mean systolic
A G Shaper; S J Pocock; M Walker; N M Cohen; C J Wale; A G Thomson
Rationale: Obstructive sleep apnea (OSA) is linked to increased cardiovascularrisk, but the impact of mild forms of OSA and their treatment on cardiovascular outcomes remains controversial. Objectives: To prospectively investigate cardiovascular outcomes in treated versus untreated patients with OSA. Methods: Consecutive sleep laboratory patients with all degrees of OSA were included. Endpoints were nonfatal (myocardial infarction, stroke, and acute
Nikolaus J. Buchner; Bernd M. Sanner; Jan Borgel; Lars C. Rump
Cardiovascular diseases are increasingly common in many countries. Cardiovascularrisk (CVR) patients can continue their daily activities, but they must be monitored continuously in order to detect and respond to cardiovascular emergencies in the shortest possible time. Monitoring provides information to the medical personnel, which helps them make a diagnosis and decide upon a tailored treatment. This paper proposes a
Cardiovascular and cerebrovascular disease (CCVD) are major causes of morbidity and mortality among patients with diabetes. Strict control of treatable risk factors that contribute to atherosclerosis is important to reduce the risk of stroke, myocardial infarction, and peripheral arterial disease. Simultaneous pancreas-kidney transplantation (SPKT) may significantly improve these risk factors in patients with type 1 diabetes. We studied 103 SPKT from our center with both organs functioning for metabolic and hypertensive control; body mass index (BMI); immunosuppression; and CCVD events. The 53 females/50 males showed a mean age of 35 ± 6 years, diabetes for 24 ± 6 years, and on dialysis for 31 ± 23 months. The follow-up ranged from 6-142 months. Mean value of last creatinine clearance was 76 ± 24 mL/min, all 103 SPKT were insulin-independent with mean glycemia = 81 ± 10 mg/dL and hemoglobin A1c (HbA1c) = 5.3% ± 0.4%. All of them were under tacrolimus treatment; 9.7% also with sirolimus but 67% steroid-free. According to the National Cholesterol Education Program Adult Treatment Panel 3 criteria, 4 patients showed a fasting glucose > 100 mg/dL; only one, HbA1c > 5.6%. Hypertension was recorded in 38.5%; low high-density lipoprotein cholesterol in 19.4%; hypertriglyceridemia in 7.8%; BMI > 30% in only 2 patients; 21.4% were prescribed statins. We registered cardiovascular events in 7 patients (6.8%). Patients with steroid treatment showed higher triglycerides (122 ± 53 vs 90 ± 36 mg/dL; P = .001) and more often tended to be hypertensive (41.2% vs 37.7%, P = .073) compared with those free of these drugs. Hypertension was associated with an higher BMI (24.1 ± 2.8 vs 22.3 ± 2.9 kg/m(2), P = .002). BMI > 25% was associated with higher total cholesterol (195 ± 47 vs 169 ± 28 mg/dL, P = .015) and low-density lipoprotein cholesterol (116 ± 40 vs 96 ± 27 mg/dL, P = .003). Among our SPKT the prevalences of CCVD and metabolic syndrome were low. Hypertension was the most frequent single factor. Obesity was rare. In patients on steroids, hypertriglyceridemia was more prevalent and hypertension tended to be more frequent. Hypertensive patients showed a higher BMI, which correlated with a worse lipid profile. Steroid withdrawal, whenever possible, may be important to achieve metabolic goals and minimize cardiovascularrisk. PMID:23622626
Background Most patients managed in primary care have more than one condition. Multimorbidity presents challenges for the patient and the clinician, not only in terms of the process of care, but also in terms of management and risk assessment. Aim To examine the effect of the presence of chronic kidney disease and diabetes on mortality and morbidity among patients with established cardiovascular disease. Design of study Retrospective cohort study. Setting Random selection of 35 general practices in the west of Ireland. Method A practice-based sample of 1609 patients with established cardiovascular disease was generated in 2000–2001 and followed for 5 years. The primary endpoint was death from any cause and the secondary endpoint was a cardiovascular composite endpoint that included death from a cardiovascular cause or any of the following cardiovascular events: myocardial infarction, heart failure, peripheral vascular disease, or stroke. Results Risk of death from any cause was significantly increased in patients with increased multimorbidity (P<0.001), as was the risk of the cardiovascular composite endpoint (P<0.001). Patients with cardiovascular disease and diabetes had a similar survival pattern to those with cardiovascular disease and chronic kidney disease, but experienced more cardiovascular events. Conclusion Level of multimorbidity is an independent predictor of prognosis among patients with established cardiovascular disease. In such patients, the presence of chronic kidney disease carries a similar mortality risk to diabetes. Multimorbidity may be a useful factor in prioritising management of patients in the community with significant cardiovascularrisk.
Glynn, Liam G; Buckley, Brian; Reddan, Donal; Newell, John; Hinde, John; Dinneen, Sean F; Murphy, Andrew W
OBJECTIVE: The menopausal transition is associated with an increase in risk for cardiovascular disease; however, whether variability in reproductive aging relates to cardiovascularrisk factors in the premenopausal period has not been studied. METHODS: In a multiethnic sample of 951 healthy, regularly cycling women aged 25 to 45 years (mean [SD] age, 35.2 [5.5] y), we examined antimüllerian hormone (AMH), a validated marker of ovarian reserve, in relation to the overall number of cardiometabolic risk factors, calculated as the sum of the five components of metabolic syndrome (triglyceride ?150 mg/dL; high-density lipoprotein <50 mg/dL; homeostasis model assessment of insulin resistance ?2.6; waist circumference equal to or higher than race-specific cutoff; and hypertensive [vs normotensive] status), and in relation to each of these risk factors individually. RESULTS: In age-adjusted models, results showed that the number of cardiometabolic risk factors was 52.1% higher among women with low versus high AMH levels and 46.0% higher among women with mid versus high AMH levels. In addition, results showed that low and mid levels of AMH (vs high) were associated with an increase in risk with respect to high-density lipoprotein (odds ratio [OR], 1.814; 95% CI, 1.211-2.718 and OR, 1.568; 95% CI, 1.083-2.269, respectively), waist circumference (OR, 2.012; 95% CI, 1.380-2.934 and OR, 1.881; 95% CI, 1.333-2.654, respectively), and hypertensive status (OR, 2.373; 95% CI, 1.095-5.143 and OR, 2.052; 95% CI, 0.976-4.314, respectively) outcomes. Associations, however, attenuated when body mass index was covaried (Ps > 0.05). CONCLUSIONS: Cross-sectional evidence suggests that having a greater ovarian reserve is associated with having a healthier cardiometabolic risk factor profile. Future longitudinal studies are needed to determine whether this association may be mediated by body mass index. PMID:23591257
Bleil, Maria E; Gregorich, Steven E; McConnell, Daniel; Rosen, Mitchell P; Cedars, Marcelle I
STUDY OBJECTIVES: To compare associations of childhood and adult socioeconomic position with cardiovascularrisk factors measured in adulthood. To estimate the effects of adult socioeconomic position after adjustment for childhood circumstances. DESIGN: Cross sectional survey, using the relative index of inequality method to compare socioeconomic differences at different life stages. SETTING: The Whitehall II longitudinal study of men and women
E. Brunner; M. J. Shipley; D. Blane; G. D. Smith; M. G. Marmot
Numerous epidemiological studies demonstrate that sudden cardiac death, pulmonary embolism, myocardial infarction, and stroke have a 24-hour daily pattern with a broad peak between 9-11am. Such a daily pattern in cardiovascularrisk could be attributable to external factors, such as the daily behavior patterns, including sleep-wake cycles and activity levels, or internal factors, such as the endogenous circadian pacemaker. Findings of significant alternations in the temporal organization and nonlinear properties of heartbeat fluctuations with disease and with sleep-wake transitions raise the intriguing possibility that changes in the mechanism of control associated with behavioral sleep-wake transition may be responsible for the increased cardiac instability observed in particular circadian phases. Alternatively, we hypothesize that there is a circadian clock, independent of the sleep-wake cycle, which affects the cardiac dynamics leading to increased cardiovascularrisk. We analyzed continuous recordings from healthy subjects during 7 cycles of forced desynchrony routine wherein subjects' sleep-wake cycles are adjusted to 28 hours so that their behaviors occur across all circadian phases. Heartbeat data were divided into one-hour segments. For each segment, we estimated the correlations and the nonlinear properties of the heartbeat fluctuations at the corresponding circadian phase. Since the sleep and wake contributions are equally weighted in our experiment, a change of the properties of the heartbeat dynamics with circadian phase suggest a circadian rhythm. We show significant circadian-mediated alterations in the correlation and nonlinear properties of the heartbeat resembling those observed in patients with heart failure. Remarkably, these dynamical alterations are centered at 60 degrees circadian phase, coinciding with the 9-11am window of cardiac risk.
Ivanov, Plamen Ch.; Hu, Kun; Chen, Zhi; Hilton, Michael F.; Stanley, H. Eugene; Shea, Steven A.
Increasing fish consumption is recommended for intake of omega-3 (n-3) fatty acids and to confer benefits for the risk reduction of cardiovascular disease (CVD). Most Americans are not achieving intake levels that comply with current recommendations. It is the goal of this review to provide an overview of the issues affecting this shortfall of intake. Herein we describe the relationship between fish intake and CVD risk reduction as well as the other nutritional contributions of fish to the diet. Currently recommended intake levels are described and estimates of fish consumption at a food disappearance and individual level are reported. Risk and benefit factors influencing the choice to consume fish are outlined. The multiple factors influencing fish availability from global capture and aquaculture are described as are other pertinent issues of fish nutrition, production, sustainability, and consumption patterns. This review highlights some of the work that needs to be carried out to meet the demand for fish and to positively affect intake levels to meet fish intake recommendations for CVD risk reduction.
Raatz, Susan K.; Silverstein, Jeffrey T.; Jahns, Lisa; Picklo, Matthew J.
More precise estimation of the atherogenic lipid parameters could improve identification of residualrisk beyond what is possible using traditional lipid risk factors. The aim of the present study was to explore the association between advanced analysis of lipoprotein subfractions and the prevalence of coronary artery calcium. Consecutive participants at intermediate cardiovascularrisk who were undergoing computed tomographic assessment of coronary calcium (calcium score) were included. Using a validated ultracentrifugation method (the vertical autoprofile II test), cholesterol in eluting lipoprotein subfractions [i.e., low- (LDL), very-low-, intermediate-, and high-density lipoprotein subclasses, lipoprotein (a), and predominant LDL distribution] was directly quantified. A total of 410 patients were included (29% women, mean age 57 years), of whom 297 (72.4%) had coronary artery calcium. LDL pattern B (predominance of small dense particles) emerged as an independent predictor of coronary calcium after adjustment for traditional risk factors (odds ratio 4.46, 95% confidence interval 1.19 to 16.7). However, after additional stratification for dyslipidemia, as defined by conventional lipid profiling, a statistically significant prediction was only retained for high-density lipoprotein subfraction 2 (odds ratio 3.45, 95% confidence interval 2.03 to 50.1) and "real" LDL (odds ratio 6.10, 95% confidence interval 1.26 to 23.41) in the normolipidemia group and for lipoprotein (a) (odds ratio 7.81, 95% confidence interval 1.41 to 43.5) in the dyslipidemic group. In conclusion, advanced assessment of the lipoprotein subfractions [i.e., LDL pattern B, high-density lipoprotein subfraction 2, "real" LDL, and lipoprotein (a)] using the vertical autoprofile II test provided additional information to that of conventional risk factors on the prevalence of coronary artery calcium in patients at intermediate cardiovascularrisk. PMID:23141758
Jug, Borut; Papazian, Jenny; Lee, Robert; Budoff, Matthew J
Menopause is the transitional event of female life creating a considerable degree of clinical and psychological as well as social problem and it is known to affect the risk markers of cardiovascular diseases. Hormone replacement therapy (HRT) was though to be a cornerstone in the management of menopause, but evidences accumulated in the recent past have raised serious questions regarding its safety and usability. In this context, phytoestrogens are getting increasingly more attention for therapeutic (as an alternate of HRT) and dietary interventions. Menopause is a special problem for women in developing countries and intake of phytoestrogens can be highly useful also from the economic point of views. The nutraceuticals of specific vitamins, minerals and especially phytoestrogens supplementations are a vital component of the strategy to reduce health problem. The present study was aimed to assess the association of phytoestrogens and risk markers of cardiovascular diseases in postmenopausal women. A total of 111 postmenopausal subjects [age, (years, M±SD) 52±5.35] were studied. The dietary intake of phytoestrogens by study subjects was calculated by a specific food frequency questionnaire (FFQ). Serum fasting homocysteine was measured by AxSYM system. Serum glucose was estimated by glucose-oxidase method. Serum total cholesterol, triglyceride and HDL-C were estimated by enzymatic-colorimetric method LDL-C was estimated by the Friedewald's formula. The intake of total phytoestrogens, isoflavones and lignans (mean±SD, mg/day) were 7.65±3.33, 0.32±0.16, 7.32±3.28 respectively in postmenopausal women. The intake of diadzein, genistein, formononetin, biochanin A (mean±SD, mg/day) were 0.085±0.035, 0.168±0.101, 0.074±0.052 and 0.001±0.0008 respectively. The intake of matairesinol and secoisolaiciresinol (SILR) (mean±SD, mg/day) were 0.022±0.006 and 7.30±3.28 respectively. The total phytoestrogens (r=-0.19, p=0.03) and SILR, one specific type of lignans (r=-0.19, p=0.04) consumption in this study were inversely significantly associated with serum glucose level. The dietary formononetin, one specific type of isoflavones was negatively significantly associated with LDL-cholesterol (r=-0.18, p=0.04). There was no significant relationship found between phytoestrogen intake and serum homocysteine level (r=-0.11, p=0.23). Phytoestrogens containing food intake should be encouraged for reducing risk markers of cardiovascular disease in postmenopausal women. PMID:21522091
Background Cardiovascular disease (CVD) incidence, complications and burden differ markedly between women and men. Although there is variation in the distribution of lifestyle factors between the genders, they do not fully explain the differences in CVD incidence and suggest the existence of gender-specific genetic risk factors. We aimed to estimate whether the genetic risk profiles of coronary heart disease (CHD), ischemic stroke and the composite end-point of CVD differ between the genders. Methodology/Principal Findings We studied in two Finnish population cohorts, using the case-cohort design the association between common variation in 46 candidate genes and CHD, ischemic stroke, CVD, and CVD-related quantitative risk factors. We analyzed men and women jointly and also conducted genotype-gender interaction analysis. Several allelic variants conferred disease risk for men and women jointly, including rs1801020 in coagulation factor XII (HR?=?1.31 (1.08–1.60) for CVD, uncorrected p?=?0.006 multiplicative model). Variant rs11673407 in the fucosyltransferase 3 gene was strongly associated with waist/hip ratio (uncorrected p?=?0.00005) in joint analysis. In interaction analysis we found statistical evidence of variant-gender interaction conferring risk of CHD and CVD: rs3742264 in the carboxypeptidase B2 gene, p(interaction)?=?0.009 for CHD, and rs2774279 in the upstream stimulatory factor 1 gene, p(interaction)?=?0.007 for CHD and CVD, showed strong association in women but not in men, while rs2069840 in interleukin 6 gene, p(interaction)?=?0.004 for CVD, showed strong association in men but not in women (uncorrected p-values). Also, two variants in the selenoprotein S gene conferred risk for ischemic stroke in women, p(interaction)?=?0.003 and 0.007. Importantly, we identified a larger number of gender-specific effects for women than for men. Conclusions/Significance A false discovery rate analysis suggests that we may expect half of the reported findings for combined gender analysis to be true positives, while at least third of the reported genotype-gender interaction results are true positives. The asymmetry in positive findings between the genders could imply that genetic risk loci for CVD are more readily detectable in women, while for men they are more confounded by environmental/lifestyle risk factors. The possible differences in genetic risk profiles between the genders should be addressed in more detail in genetic studies of CVD, and more focus on female CVD risk is also warranted in genome-wide association studies.
This article reviews aspects of development of the recently released "Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents" for pediatric care providers that remain in the area of human judgment. Discussed will be the context in which the guidelines were developed, the formal evidence review process, a consideration of how quality grades were established, key social/ethical issues that the panel confronted, and a critique of the final work with recommendations for future guideline development. Lessons learned are that both a formal evidence review process is essential to developing a credible document, and human judgment is critical to producing a meaningful result. Guideline development is a dynamic process that must be continuously self-critical as new evidence is acquired and sociopolitical and environmental contexts evolve. PMID:22492765
Gidding, Samuel S; Daniels, Stephen R; Kavey, Rae Ellen W
Objectives To determine: 1) whether sarcopenic-obesity is a stronger predictor of cardiovascular disease (CVD) than either sarcopenia\\u000a or obesity alone in the elderly, and 2) whether muscle mass or muscular strength is a stronger marker of CVD risk.\\u000a \\u000a \\u000a \\u000a Design Prospective cohort study.\\u000a \\u000a \\u000a \\u000a Participants Participants included 3366 community-dwelling older (65 years) men and women who were free of CVD at baseline.\\u000a \\u000a \\u000a \\u000a Measurements Waist circumference (WC),
We examined the relationship of several cardiovascular disease (CVD) risk factors to flow-mediated vasodilatation of the brachial artery (FMD) and the clustering effect of risk factors on FMD in Japanese subjects free of CVD. In 819 Japanese subjects free of CVD (age 45±10 years, 611 men and 208 women), FMD correlated significantly with the Framingham risk points score (FRS) (r=?0.27,
A number of different psychotropic agents have been associated with an increased risk of cardiovascular disease, and these relationships have been difficult to interpret due to the presence of confounding factors. Recently, there has been renewed interest in the potential for certain antidepressants to cause QT prolongation, which is a predisposing factor for arrhythmia. However, the optimum means of determining QT remains contentious due to discrepancies between methods that may be readily applied in a clinical setting versus more detailed techniques during regulatory assessment. A number of different pharmacological mechanisms might explain the occurrence of adverse cardiac effects, and these differ according to the type of antidepressant agent. Emerging data indicate that citalopram exhibits a dose-effect relationship for QT prolongation. Whereas cardiotoxicity is readily apparent in the context of intentional antidepressant overdose, the occurrence of cardiac effects as a result of therapeutic administration is less certain. Pre-existing cardiac disease and other factors that independently predispose to arrhythmia are important considerations. Therefore, clinical judgment is needed to evaluate the overall risk or benefit of a particular antidepressant in any patient. Close monitoring should be considered for those at greatest risk of QT prolongation and arrhythmia.
Many studies have shown that depression contributes to a higher risk of developing cardiovascular disease (CVD). Use of antidepressants and its association with CVD development has also been investigated previously but the results have been conflicting. Further, depression and use of antidepressants have been more widely studied in relation to coronary heart disease rather than stroke. A population-based cohort study consisting of 36,654 Swedish elderly twins was conducted with a follow-up of maximum 4 years. Information on exposures, outcomes and covariates were collected from the Swedish national patient registers, the Swedish prescribed drug registry and the Swedish twin registry. Depression and antidepressant use were both associated with CVD development. The risk was most pronounced among depressed patients who did not use antidepressants (HR 1. 48, CI 1.10-2.00). When assessing the two main CVD outcomes coronary heart disease and ischemic stroke separately, the predominant association was found for ischemic stroke while it was absent for coronary heart disease. The association between depression and stroke also remained significant when restricting to depression diagnoses occurring at least 10 years before baseline. The study supports that depression is a possible risk factor for development of CVD. Moreover, the hazard rate for CVD outcomes was highest among depressed patients who had not used antidepressants. The association with clinical depression is more marked in relation to stroke and disappears in relation to development of coronary heart disease. PMID:23836399
Rahman, Iffat; Humphreys, Keith; Bennet, Anna Michaela; Ingelsson, Erik; Pedersen, Nancy Lee; Magnusson, Patrik Karl Erik
Background To determine if recommended treatment targets, as specified in clinical practice guidelines for the management of cardiovascular disease, reduces the risk of renal complications in high risk patient populations. Methods This was a cohort study. Participants in Utrecht, The Netherlands either at risk of, or had cardiovascular disease were recruited. Cardiovascular treatment targets were achievement of control in systolic and diastolic blood pressure, total and low-density cholesterol, and treatment of albuminuria. Outcome measures were time to development of end stage renal failure or symptomatic renal atherosclerotic disease requiring intervention. Results The cohort consisted of 7,208 participants; 1,759 diabetics and 4,859 with clinically manifest vascular disease. The median age was 57 years and 67% were male. Overall, 29% of the cohort achieved the treatment target for systolic blood pressure, 39% for diastolic blood pressure, 28% for total cholesterol, 31% for LDL cholesterol and 78% for albuminuria. The incidence rate for end stage renal failure and renal atherosclerotic disease reduced linearly with each additional treatment target achieved (p value less than 0.001). Achievement of any two treatment targets reduced the risk of renal complications, hazard ratio 0.46 (95% CI 0.26-0.82). For patients with clinically manifest vascular disease and diabetes, the hazard ratios were 0.56 (95% CI 0.28 - 1.12) and 0.28 (95%CI 0.10 - 0.79) respectively. Conclusion Clinical guidelines for cardiovascular disease management do reduce risk of renal complications in high risk patients. Benefits are seen with attainment of any two treatment targets.
BackgroundThe majority of the incidentally discovered adrenal masses are non-functioning adrenal adenomas; however data regarding traditional and novel cardiovascularrisk predictors in these subjects is lacking. The objective of our study was to investigate the levels of PAI-1, IL-6 and Apelin along with several traditional cardiovascularrisk markers in subjects with non-functioning adrenal adenomas.
Serkan Yener; Abdurrahman Cömlekci; Faize Yuksel; Ali Sevinc; Senem Ertilav; Sena Yesil
A family history of cardiovascular disease predicts cardiovascularrisk in the next generation, which is either the result of inherited traits or certain living habits in some families. The aim of our study was to evaluate both variables and particularly the role of one of the possible genetic risk factors - angiotensin-converting enzyme (ACE) gene polymorphism. History and anthropometric and
Background Elevated serum total homocysteine (tHcy) is asso- ciated with an increased risk of cardiovascular disease. Homocysteine levels may be influenced by dietary habits. The aim of the present study was to determine the effects of a vegetarian diet on some of the cardiovascularrisk factors in Turkish females. Method The study was conducted on 26 vegetarian and 26 omni-
AimsBody mass index (BMI, kg\\/m2) thresholds of children predicting cardiovascularrisk, reported in previous studies were inconsistent and that predicting increased insulin resistance is lacking. We determined the BMI threshold that predicts increased cardiovascularrisk and insulin resistance in children.
BACKGROUND: Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascularrisk factor management. METHODS: Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until
Marie-Elise Nijdam; Monique R Timmerman; Arie Franx; Hein W Bruinse; Mattijs E Numans; Diederick E Grobbee; Michiel L Bots
To better understand Australia-dwelling Middle Eastern women's lack of service utilization in cardiovascular health, we undertook a study to investigate their understandings and meanings of cardiovascular disease (CVD) and its risk factors. Eight focus groups were conducted in community settings with Turkish, Persian, and Arab women. We found that the women understated their risk of CVD, faced many barriers in
Leila Gholizadeh; Michelle DiGiacomo; Yenna Salamonson; Patricia M. Davidson
We have evaluated current knowledge on relations between environmental and occupational exposure to lead with a strong emphasis on cardiovascular disease risk factors, such as the influence of lead compounds on lipid disturbances and arterial blood pressure. In addition, “novel” biochemical and vascular risk factors for cardiovascular diseases were discussed, as well as the combination of lead exposure and genetic
Rafa? Por?ba; Pawe? Ga?; Ma?gorzata Por?ba; Ryszard Andrzejak
“New” cardiovascularrisk factors in patients with chronic kidney disease: Role of folic acid treatment.Cardiovascular disease (CVD) is the principal cause of mortality in patients with chronic renal disease undergoing hemodialysis. In addition to the CVD risk factors, a new hypothesis has recently been aroused related to “new” factors involved in the development of atherosclerosis in the uremic patient; worthwhile
BEATRIZ BAYÉS; MARI CRUZ PASTOR; JORDI BONAL; RAMÓN ROMERO
Background. Renal transplant recipients (RTR) mainly die of premature cardiovascular disease. Traditional cardiovascular disease risk factors are prevalent in RTR. Additionally, non-traditional risk factors seem to contribute to the high risk. The impact of renal dysfunction was compared with traditional risk factors for cardiovascular morbidity and mortality in 1052 placebo-treated patients of the ALERT trial. Methods. All patients were on
Inga Soveri; Hallvard Holdaas; Alan Jardine; Claudio Gimpelewicz; Beatrix Staffler; Bengt Fellstrom
Cardiovascularrisk factors often cluster into a metabolic syndrome that may increase the risk of dementia. The objective of the present study was to assess the long-term association between clustered metabolic cardiovascularrisk factors measured at middle age and the risk of dementia in old age. This prospective cohort study of cardiovascular disease was started in 1965 and was extended
S. Kalmijn; D. Foley; L. White; C. M. Burchfiel; J. D. Curb; H. Petrovitch; G. W. Ross; R. J. Havlik; L. J. Launer
We conducted this study to examine the relationship between shift work duration and the metabolic risk factors of cardiovascular disease among shift workers. The study population consisted of 226 female hospital nurses and 134 male workers at a firm manufacturing diapers and feminine hygiene materials, whose mean ages were 28.5 yr for the nurses and 29.1 yr for the male workers. The fasting blood sugar level, serum cholesterol, blood pressure, height and weight, waist and hip circumferences (only for the nurses), and numbers of walks during work (as a measure of physical activity) were measured. Using the Karasek's job contents questionnaire, job stress was assessed. Information about the years of work, shift work duration, past medical and behavioral history, including smoking, was obtained by a self-administered questionnaire. With definitions of hypertension as systolic blood pressure (SBP) > or =160 or diastolic blood pressure (DBP) > or =90 mmHg occurring at least once, hypercholesterolemia as serum total cholesterol > or =240 mg/dl, obesity as body mass index (BMI) > or =25 kg/m(2) and as waist to hip ratio (WHR) > or =0.85, we examined the prevalences of metabolic risk factors among subjects. Regression analyses to show the relationships between shift work duration and metabolic risk factors were performed using simple and multivariate models stratified by age, and adjusted for smoking, drinking, job strain and physical activity. Duration of shift work was significantly associated with SBP or cholesterol level among male workers aged 30 or more. Among female nurses, it was inversely associated with DBP (in those who were below 30 yr old) and cholesterol (in those who were aged 30 or more). BMI was non-significantly associated with the duration of shift work in both male workers and female nurses who were 30 yr old or more. WHR in female nurses increased slightly according to increasing duration of shift work. Fasting blood sugar was not significantly associated with the duration of shift work in either sex regardless of age-group. These results suggest an association between shift work duration and the metabolic risk factors of cardiovascular disease. PMID:15824472
Background Preventive guidelines on cardiovascularrisk management recommend lifestyle changes. Support for lifestyle changes may be a useful task for practice nurses, but the effect of such interventions in primary prevention is not clear. We examined the effect of involving patients in nurse-led cardiovascularrisk management on lifestyle adherence and cardiovascularrisk. Methods We performed a cluster randomized controlled trial in 25 practices that included 615 patients. The intervention consisted of nurse-led cardiovascularrisk management, including risk assessment, risk communication, a decision aid and adapted motivational interviewing. The control group received a minimal nurse-led intervention. The self-reported outcome measures at one year were smoking, alcohol use, diet and physical activity. Nurses assessed 10-year cardiovascular mortality risk after one year. Results There were no significant differences between the intervention groups. The effect of the intervention on the consumption of vegetables and physical activity was small, and some differences were only significant for subgroups. The effects of the intervention on the intake of fat, fruit and alcohol and smoking were not significant. We found no effect between the groups for cardiovascular 10-year risk. Interpretation Nurse-led risk communication, use of a decision aid and adapted motivational interviewing did not lead to relevant differences between the groups in terms of lifestyle changes or cardiovascularrisk, despite significant within-group differences.
Koelewijn-van Loon, Marije S.; van der Weijden, Trudy; van Steenkiste, Ben; Ronda, Gaby; Winkens, Bjorn; Severens, Johan L.; Wensing, Michel; Elwyn, Glyn; Grol, Richard
Context Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown. Objective To estimate the degree to which four conventional cardiovascularrisk factors, smoking, hypertension, hypercholesterolemia and type 2 diabetes, are associated with the risk of PAD among men. Design, settings and participants We prospectively followed 44,985 men from the Health Professionals Follow-up Study without a history of cardiovascular disease at baseline for 25 years (1986-2011). The presence of risk factors was updated biennially during follow-up. Main outcome measure Clinically significant PAD (defined as limb amputation/revascularization, angiogram reporting vascular obstruction of ?50%, ankle-brachial index<0.90 or physician-diagnosed PAD). Results During a median follow-up of 24.2 years (interquartile range 20.8-24.7 years), 537 PAD cases occurred. Each risk factor was significantly and independently associated with a higher risk of PAD after adjustment for the other three risk factors and confounders. The age-adjusted incidence rates per 100,000 person years were 6 cases for 0 risk factors, 18 cases for 1 risk factor, 39 cases for 2 risk factors, 76 cases for 3 risk factors and 139 cases for 4 risk factors. The multivariable-adjusted hazard ratio (HR) for each additional risk factor compared was 2.06 (95% confidence interval [95% CI], 1.92-2.32). Men without any of the four risk factors had a HR of PAD of 0.23 (95% CI, 0.14-0.36) compared with all other men in the cohort. In 96% (95% CI, 94-98%) of PAD cases, at least one of the four risk factors was present at the time of PAD diagnosis. The population-attributable risk associated with these four risk factors was 75% (95% CI, 64-87%). The incidence of PAD among men with all four risk factors was 1.4/1,000. Conclusion Among men in this cohort, smoking, hypertension, hypercholesterolemia and type 2 diabetes account for most of the risk associated with development of clinically significant PAD.
Joosten, Michel M.; Pai, Jennifer K.; Bertoia, Monica L.; Rimm, Eric B.; Spiegelman, Donna; Mittleman, Murray A.; Mukamal, Kenneth J.
The objective of this work is to present a critical review of the application of the tissue residue approach (TRA) in ecological risk and/or impact assessment (ERA) of chemical stressors and environmental criteria development. A secondary goal is to develop a framework for integrating the TRA into ecological assessments along with traditional, exposure concentration-based assessment approaches. Although widely recognized for its toxicological appeal, the utility of the TRA in specific applications will depend on numerous factors, such as chemical properties, exposure characteristics, assessment type, availability of tissue residue-response data, and ability to quantify chemical exposure. Therefore, the decision to use the TRA should include an evaluation of the relative strengths, limitations, and uncertainties among exposure and residue-based methods for characterizing toxicological effects. Furthermore, rather than supplanting exposure concentration-based toxicity assessments, the TRA can be highly effective for evaluating and reducing uncertainty when used in a complementary manner (e.g., when evaluating multiple lines of evidence in field studies). To address limitations with the available tissue residue-response data, approaches for extrapolating residue-based toxicity data across species, tissues, and exposure durations are discussed. Some of these approaches rely on predicted residue-response relationships or toxicological models that have an implicit residue-response basis (e.g., biotic ligand model). Because risk to an organism is a function of both its exposure potential and inherent sensitivity (i.e., on a residue basis), bioaccumulation models will be required not only for translating tissue residue criteria into corresponding water and sediment criteria, but also for defining the most vulnerable species in an assemblage (i.e., highly exposed and highly sensitive species). Application of the TRA in ecological assessments and criteria development are summarized for bioaccumulative organic chemicals, TBT, and in situ bioassays using bivalve molluscs. PMID:21184572
Sappington, Keith G; Bridges, Todd S; Bradbury, Steven P; Erickson, Russell J; Hendriks, A Jan; Lanno, Roman P; Meador, James P; Mount, David R; Salazar, Mike H; Spry, Doug J
Atherosclerosis and its manifestations namely cardiovascular diseases (CVD) are still the leading cause of morbidity and mortality worldwide. Although intensified interventions have been applied, the residualcardiovascular (CV) risks are still very high. Lipoprotein-associated phospholipase A2 (Lp-PLA(2)) is a novel and unique biomarker highly specific for vascular inflammation and atherosclerosis. Both pro-atherogenic property of Lp-PLA(2) and positive correlation with CV events have already been demonstrated by a large number of scientific and clinical studies. Currently, in the Adult Treatment Panel III (ATP III) guideline, Lp-PLA(2) has been recommended as an adjunct to traditional risk factors in assessing future CV risks. Encouragingly, darapladib, an orally Lp-PLA(2) specific inhibitor, has been tested in basic research and preclinical trials and the outcomes are quite striking. Additionally, there are two phase III ongoing clinical trials in evaluating the efficacy and safety of darapladib on cardiovascular outcomes. With regard to the potential values of Lp-PLA(2) in risk stratification, therapeutic regimen establishment and prognosis evaluation in patients with moderate or high risk, our present review is going to summarize the relevant data about the bio-chemical characteristics of Lp-PLA(2), the actions of Lp-PLA(2) on atherosclerosis and the results of Lp-PLA(2) in scientific research and clinical studies. PMID:23478277
Cai, Anping; Zheng, Dongdan; Qiu, Ruofeng; Mai, Weiyi; Zhou, Yingling
Individuals with metabolic syndrome (MetS; i.e., three of five of the following risk factors (RFs): elevated blood pressure, waist circumference, triglycerides, blood glucose, or reduced HDL) are thought to be prone to serious cardiovascular disease and there is debate as to whether the disease begins in the peripheral vasculature or centrally. This study investigates hemodynamics, cardiac function/morphology, and mechanical properties of the central (heart, carotid artery) or peripheral [total peripheral resistance (TPR), forearm vascular bed] vasculature in individuals without (1–2 RFs: n?=?28), or with (?3 RFs: n?=?46) MetS. After adjustments for statin and blood pressure medication use, those with MetS had lower mitral valve E/A ratios (<3 RFs: 1.24?±?0.07; ?3 RFs: 1.01?±?0.04; P?=?0.025), and higher TPR index (<3 RFs: 48?±?2?mmHg/L/min/m2; ?3 RFs: 53?±?2?mmHg/L/min/m2; P?=?0.04). There were no differences in heart size, carotid artery measurements, cardiovagal baroreflex, pulse-wave velocity, stroke volume index, or cardiac output index due to MetS after adjustments for statin and blood pressure medication use. The use of statins was associated with increased inertia in the brachial vascular bed, increased HbA1c and decreased LDL cholesterol. The independent use of anti-hypertensive medication was associated with decreased predicted VO2max, triglycerides, diastolic blood pressure, interventricular septum thickness, calculated left ventricle mass, left ventricle posterior wall thickness, and left ventricle pre-ejection period, but increased carotid stiffness, HDL cholesterol, and heart rate. These data imply that both a central cardiac effect and a peripheral effect of vascular resistance are expressed in MetS. These data also indicate that variance in between-group responses due to pharmacological treatments are important factors to consider in studying cardiovascular changes in these individuals.
Edgell, H.; Petrella, R. J.; Hodges, G. J.; Shoemaker, J. K.
We used baseline data from the NAVIGATOR trial to (1) identify risk factors for diabetes progression in those with impaired glucose tolerance and high cardiovascularrisk, (2) create models predicting 5-year incident diabetes, and (3) provide risk classification tools to guide clinical interventions. Multivariate Cox proportional hazards models estimated 5-year incident diabetes risk and simplified models examined the relative importance of measures of glycemia in assessing diabetes risk. The C-statistic was used to compare models; reclassification analyses compare the models' ability to identify risk groups defined by potential therapies (routine or intensive lifestyle advice or pharmacologic therapy). Diabetes developed in 3,254 (35%) participants over 5 years median follow-up. The full prediction model included fasting and 2-hour glucose and hemoglobin A1c (HbA1c) values but demonstrated only moderate discrimination for diabetes (C = 0.70). Simplified models with only fasting glucose (C = 0.67) or oral glucose tolerance test values (C = 0.68) had higher C statistics than models with HbA1c alone (C = 0.63). The models were unlikely to inappropriately reclassify participants to risk groups that might receive pharmacologic therapy. Our results confirm that in a population with dysglycemia and high cardiovascularrisk, traditional risk factors are appropriate predictors and glucose values are better predictors than HbA1c, but discrimination is moderate at best, illustrating the challenges of predicting diabetes in a high-risk population. In conclusion, our novel risk classification paradigm based on potential treatment could be used to guide clinical practice based on cost and availability of screening tests. PMID:23608615
Bethel, M Angelyn; Chacra, Antonio R; Deedwania, Prakash; Fulcher, Gregory R; Holman, Rury R; Jenssen, Trond; Kahn, Steven E; Levitt, Naomi S; McMurray, John J V; Califf, Robert M; Raptis, Sotirios A; Thomas, Laine; Sun, Jie-Lena; Haffner, Steven M
Community specific cardiovascular disease risk factor studies may be useful to evaluate genetic versus environmental causes. Agarwal is a high profile business community in India. A family based narrative from this community reveals a high prevalence of cardiovascular diseases- stroke and coronary heart disease. This is associated with high prevalence of multiple cardiovascularrisk factors such as central obesity, hypertension, lipid abnormalities and diabetes. Another study in the same community in Jaipur reveals high prevalence of obesity associated with low physical activity and high dietary calorie and fat intake. Lifestyle factors appear to be mediator of the cardiovascular epidemic in this community. PMID:19830022
Community specific cardiovascular disease risk factor studies may be useful to evaluate genetic versus environmental causes. Agarwal is a high profile business community in India. A family based narrative from this community reveals a high prevalence of cardiovascular diseases- stroke and coronary heart disease. This is associated with high prevalence of multiple cardiovascularrisk factors such as central obesity, hypertension, lipid abnormalities and diabetes. Another study in the same community in Jaipur reveals high prevalence of obesity associated with low physical activity and high dietary calorie and fat intake. Lifestyle factors appear to be mediator of the cardiovascular epidemic in this community.
Objective: Our goal was to assess the effect of bariatric surgery on cardiovascularrisk estimations of preventable, long-term adverse outcomes.Research Methods and Procedures: We performed a population-based, historical cohort study between 1990 and 2003 of 197 consecutive patients from Olmsted County, MN, with Class II to III obesity (defined as BMI ?35 kg\\/m2) treated with Roux-en-Y gastric bypass and 163
John A. Batsis; Abel Romero-Corral; Maria L. Collazo-Clavell; Michael G. Sarr; Virend K. Somers; Lee Brekke; Francisco Lopez-Jimenez
Background The effects of black tea consumption on cardiovascularrisk factors have been inconsistent in previous randomized trials, all of which have been limited to a few weeks duration. Methods We conducted a pilot parallel-design randomized controlled trial among 31 adults aged 55 years and older with either diabetes or two other cardiovascularrisk factors but no established clinical cardiovascular disease. Participants were randomized to drink three glasses daily of either a standardized black tea preparation or water for six months. Cardiovascularrisk factors were measured at the beginning and conclusion of the study. Results Three participants dropped out of the study, leaving 14 participants assigned to tea and 14 assigned to water eligible for analyses. We found no statistically significant effects of black tea on cardiovascular biomarkers, including lipids, inflammatory markers, hemoglobin, adhesion molecules, prothrombotic and fibrinolytic parameters, and lipoprotein oxidizability. Assignment to tea did not appreciably influence blood pressure, and heart rate among participants assigned to tea was marginally higher than among control participants at three months (p=0.07) but not six months. Conclusions In this randomized trial of black tea intake over six months among older adults with known cardiovascularrisk factors, black tea did not appreciably influence any traditional or novel biomarkers of cardiovascularrisk. Longer randomized trials are needed to verify the inverse association of tea with risk of cardiovascular disease seen in cohort studies and identify potential candidate mechanisms for such an association.
Mukamal, Kenneth J.; MacDermott, Kristen; Vinson, Joe A.; Oyama, Noriko; Manning, Warren J.; Mittleman, Murray A.
Background The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood. Methods In a cohort of 4857 American Indian children without diabetes (mean age, 11.3 years; 12,659 examinations) who were born between 1945 and 1984, we assessed whether body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death. Risk factors were standardized according to sex and age. Proportional-hazards models were used to assess whether each risk factor was associated with time to death occurring before 55 years of age. Models were adjusted for baseline age, sex, birth cohort, and Pima or Tohono O'odham Indian heritage. Results There were 166 deaths from endogenous causes (3.4% of the cohort) during a median follow-up period of 23.9 years. Rates of death from endogenous causes among children in the highest quartile of BMI were more than double those among children in the lowest BMI quartile (incidence-rate ratio, 2.30; 95% confidence interval [CI], 1.46 to 3.62). Rates of death from endogenous causes among children in the highest quartile of glucose intolerance were 73% higher than those among children in the lowest quartile (incidence-rate ratio, 1.73; 95% CI, 1.09 to 2.74). No significant associations were seen between rates of death from endogenous or external causes and childhood cholesterol levels or systolic or diastolic blood-pressure levels on a continuous scale, although childhood hypertension was significantly associated with premature death from endogenous causes (incidence-rate ratio, 1.57; 95% CI, 1.10 to 2.24). Conclusions Obesity, glucose intolerance, and hypertension in childhood were strongly associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.
Franks, Paul W.; Hanson, Robert L.; Knowler, William C.; Sievers, Maurice L.; Bennett, Peter H.; Looker, Helen C.
Background Constipation is common in Western societies, accounting for 2.5 million-physician visits/year in the US. Since many factors predisposing to constipation are also risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events. Methods We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women’s Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire. Estimates of the risk of cardiovascular events (cumulative endpoint including mortality from coronary heart disease, myocardial infarction, angina, coronary revascularization, stroke and transient ischemic attack) were derived from Cox proportional hazards models adjusted for demographics, risk factors and other clinical variables (median follow-up: 6.9 years). Results The analysis included 73,047 women. Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared to women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events. Conclusion In postmenopausal women, constipation is a marker for cardiovascularrisk factors and increased cardiovascularrisk. Since constipation is easily assessed, it may be a helpful tool to identify women with increased cardiovascularrisk.
Salmoirago-Blotcher, Elena; Crawford, Sybil; Jackson, Elizabeth; Ockene, Judith; Ockene, Ira
Objective:The metabolic syndrome is associated with increased risk for cardiovascular disease and diabetes. Several analyses from the Atherosclerosis Risk in Communities (ARIC) study have been performed to examine the role of the metabolic syndrome and its components in predicting risk for cardiovascular disease and diabetes.Design and subjects:The large, biracial, population-based ARIC study enrolled 15 792 middle-aged Americans in four communities
C M Ballantyne; R C Hoogeveen; A M McNeill; G Heiss; M I Schmidt; B B Duncan; J S Pankow
Current treatment guidelines highlight the increased cardiovascularrisk associated with type 2 diabetes and identify the need for intensive risk factor management. Dyslipidaemia characterised by elevated serum triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C) and an increase in small, dense low-density lipoprotein cholesterol (LDL-C) particles (the lipid triad), is one of the most important modifiable cardiovascularrisk factors in
ObjectiveTo characterise the risk-factor profile and treatment gaps among patients with, or at risk for, cardiovascular disease in the Middle East.DesignSecondary analysis of a prospective observational study.SettingInternational multicentre study (Reduction of Atherothrombosis for Continued Health).PatientsStable outpatients with established cardiovascular disease or at least three risk factors for atherothrombosis. The present analysis was based on 840 patients from the Middle East.InterventionObservational
Alawi A Alsheikh-Ali; Wael A Al-Mahmeed; Avi Porath; Ismail Khalil; Hisham Mahmoud; Deepak L Bhatt; P Gabriel Steg
Cardiovascular disease rates are higher in African American women and they have more cardiovascularrisk factors than other groups. Although one of the most important cardiovascularrisk reduction behaviors is physical activity, few studies have focused on African American women's cardiovascularrisk and physical activity. Therefore, the aims of this descriptive pilot study were to describe modifiable cardiovascularrisks and to explore physical activity, as measured by pedometer steps, in younger (n = 22; aged 21-45 years) and older (n = 22; aged 46-75 years) community-dwelling African American women. The total number of pedometer steps recorded in 3 days ranged from 1,153 to 52,742. Day 1 steps were significantly different than day 2 and day 3 steps across the sample (F = 5.30, df = 1, P < .05). Risk factors were similar across the age groups. There was no relationship between the 3-day total or average number of daily steps and cardiovascularrisks. Thus, interventions may be used in both age groups, with modifications for cohort effects of approach and health status. Given the disparities in cardiovascular disease and the Healthy People 2010 national health objectives, it is important to continue a variety of efforts to assist adult women of all ages to increase their physical activity and to decrease other CVD risks. PMID:17589282
Measured weight in old age, reported weight at age 50 y, and weight change from age 50 y to old age were studied in association with prevalent cardiovascular disease (CVD), CVD risk factors, and health status in a population of 4954 men and women aged ? 65 y in the Cardiovascular Health Study (CHS). Heavier weight (ie, generally weight in
Tamara B Harris; Peter J Savage; Grethe S Tell; Mary Haan; Shiriki Kumanyika; James C Lynch
Risk factors for cardiovascular disease (CVD) appear to cluster in individuals, possibly because of a single, underlying metabolic disorder. We describe the prevalence of metabolic risk factors for CVD in a young working population and the tendency for individuals with some risk factors to acquire additional factors. This was a retrospective three-year follow-up study of baseline CVD risk factors assessing
Barry Gumbiner; Elena M. Andresen; F. Terry Hearne; T. Erik Michaelson; Michael Bryson; Wayne M. Lednar; Roger Cass
|This paper reviews the recent literature on cardiovascular disease (CVD) prevalence, CVD-related mortality, physiological CVD risk factors, and behavioral CVD risk factors in adults with mental retardation (MR). The literature on the potential influences of modifiable behavioral CVD risk factors and the physiological CVD risk factors are also…
This study evaluated the associations of adipokines with cardiovascularrisk factors. Subjects/Methods 60 normal weight (BMI ?75th percentile) and 60 overweight (BMI ?95th percentile) adolescents aged 10–14 years. Resting systolic and diastolic blood pressures (SBP, DBP) and waist circumference were obtained in duplicate. Circulating adiponectin, resistin, tumor necrosis factor-? (TNF-?), interleukin-6 (IL-6), total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were measured from fasting plasma samples. Results Simple correlations showed that SBP was significantly related (p < 0.05) to adiponectin (r = –0.185), resistin (r = 0.207), and IL-6 (r = 0.238); HDL was significantly related to adiponectin (r = 0.398) and TNF-? (r = –0.227). TG was only related to adiponectin (r = –0.292, p < 0.05). Multiple regression models controlling for puberty and ethnicity indicated that adiponectin (R2 = 0.152, p < 0.05), resistin (R2 = 0.152, p < 0.05), and IL-6 (R2 = 0.170, p < 0.05) were associated with SBP. The association between adiponectin and HDL was stronger in normal weight versus overweight adolescents (R2 = 0.336, p < 0.05). None of the other models showed differences in the associations by weight status. Conclusions In adolescents, SBP but not DBP was associated with most adipokines. HDL, but not TC, was also associated with some adipokines. TG were only associated with adiponectin. Associations were mostly related to adiposity.
Rubin, Daniela A.; McMurray, Robert G.; Hackney, Anthony C.; Harrell, Joanne S.
The primary goal of osteoporosis treatment is to prevent the occurrence of fragility fractures, and thereby reduce morbidity and mortality. Among the various approaches to the treatment of this disease include ensuring proper calcium intake and to obtain adequate levels of vitamin D. Virtually all clinical trials with drugs used to treat osteoporosis systematically include calcium and vitamin D supplements. In light of the recent publication of clinical trials and meta-analyses, a possible increase in cardiovascularrisk, particularly in the form of a myocrdial infarction, is hypothesised in patients taking calcium supplements. However, data published to date are inconclusive. Until the development of new scientific evidence, it seems reasonable to recommend, whenever practicable and individualized for each patient, increasing calcium intake with food and reserve supplements for patients with very low calcium intake in the diet. It would also be advisable for the administration of total daily dose to be fractionated throughout the day and with meals, and to obtain appropriate levels of vitamin D (25-hydroxycholecalciferol or calcidiol), along with the basic treatment for osteoporosis that is decided to be prescribed to patients. PMID:23523304
An increasing body of evidence suggests that anxiety is an independent predictor of adverse cardiovascular (CV) events. Individuals with high levels of anxiety are at increased risk of coronary heart disease, congestive heart failure, stroke, fatal ventricular arrhythmias, and sudden cardiac death. Anxiety following a major cardiac event can impede recovery, and is associated with a higher morbidity and mortality. This linkage between anxiety and CV disease is further corroborated by evidence suggesting that treatment of anxiety may improve cardiac symptoms. However, the mechanisms underlying the observed associations are not entirely delineated. Several intermediary mechanisms have been suggested, including sympathetic activation, impaired vagal control, reduced heart rate variability, stimulation of the hypothalamic–pituitary axis, hyperventilation-induced coronary spasm, oxidative stress, increased inflammatory mediators, and unhealthy lifestyle. There is a need for several clinical trials to explicate the complex associations between anxiety and CV disease, which may be compounded by the involvement of other psychosocial factors. In this review, we examine the epidemiological evidence for the association between anxiety and CV disease, and discuss the proposed mechanisms that may be responsible for this association.
Background A substantial part of cardiovascular disease prevention is delivered in primary care. Special attention should be paid to the assessment of cardiovascularrisk factors. According to the Dutch guideline for cardiovascularrisk management, the heavy workload of cardiovascularrisk management for GPs could be shared with advanced practice nurses. Aim To investigate the clinical effectiveness of practice nurses acting as substitutes for GPs in cardiovascularrisk management after 1 year of follow-up. Design of study Prospective pragmatic randomised trial. Setting Primary care in the south of the Netherlands. Six centres (25 GPs, six nurses) participated. Method A total of 1626 potentially eligible patients at high risk for cardiovascular disease were randomised to a practice nurse group (n = 808) or a GP group (n = 818) in 2006. In total, 701 patients were included in the trial. The Dutch guideline for cardiovascularrisk management was used as the protocol, with standardised techniques for risk assessment. Changes in the following risk factors after 1 year were measured: lipids, systolic blood pressure, and body mass index. In addition, patients in the GP group received a brief questionnaire. Results A larger decrease in the mean level of risk factors was observed in the practice nurse group compared with the GP group. After controlling for confounders, only the larger decrease in total cholesterol in the practice nurse group was statistically significant (P = 0.01, two-sided). Conclusion Advanced practice nurses are achieving results, equal to or better than GPs for the management of risk factors. The findings of this study support the involvement of practice nurses in cardiovascularrisk management in Dutch primary care.
Voogdt-Pruis, Helene R; Beusmans, George HMI; Gorgels, Anton PM; Kester, Arnold DM; Van Ree, Jan W
Women with polycystic ovary syndrome (PCOS) have increased prevalence of cardiovascular (CV) risk factors. However, data on the incidence of CV events are lacking in this population. Using Rochester Epidemiology Project resources, we conducted a retrospective cohort study comparing CV events in women with PCOS with those of women without PCOS in Olmsted County, Minnesota. Between 1966 and 1988, 309 women with PCOS and 343 without PCOS were identified. Mean (SD) age at PCOS diagnosis was 25.0 (5.3) years; mean age at last follow-up was 46.7 years. Mean (SD) follow-up was 23.7 (13.7) years. Women with PCOS had a higher body mass index (29.4 kg÷m2 vs 28.3 kg÷m2; p=.01). Prevalence of type 2 diabetes mellitus and hypertension and levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides were similar in the two groups. We observed no increase in CV events, including myocardial infarction (adjusted hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.32 to 1.72; p=.48); coronary artery bypass graft surgery (adjusted HR 1.52; 95% CI 0.42 to 5.48; p=.52); death (adjusted HR 1.03; 95% CI, 0.29 to 3.71; p=.96); death due to CV disease (adjusted HR 5.67; 95% CI 0.51 to 63.7; p=.16); or stroke (adjusted HR 1.05; 95% CI 0.28 to 3.92; p=.94). Although women with PCOS weighed more than controls, there was no increased prevalence of other CV risk factors. Furthermore, we found no increase in CV events. While prospective studies are needed to confirm these findings, women with PCOS do not appear to have adverse CV outcomes in midlife. PMID:22418753
Iftikhar, S; Collazo-Clavell, M L; Roger, V L; St Sauver, J; Brown, R D; Cha, S; Rhodes, D J
ABSTRACT Hypertension represents a serious problem in Romania, as there are over 3 million hypertensive people in our country. There is a high incidence of deaths caused by hypertension. We performed an analytical prospective study that aims to determine: prevalence of arterial hypertension in a population from Cluj county, distribution on age and gender, arterial hypertension severity, association of hypertension with other cardiovascularrisk factors. Our study included 2266 patients, age 14 years old up to over 90 years old, both masculine and feminine gender, known with hypertension and new-diagnosed ones. Each subject was submitted to an interview based on a questionnaire. Diagnosis of arterial hypertension was established according to ESH criteria that consider as hypertension: values over 140/90 mmHg. Out of all subjects submitted to the study 647 (29.74%) were diagnosed with arterial hypertension and, from these, 102 (15.13%) were new-diagnosed patients. We found out a predominance of arterial hypertension at the age of 51-60 and over 60, an increased involvement of feminine sex; an association of hypertension with other major cardiovascularrisk factors: obesity, diabetes, dislypidemia. Arterial hypertension represents an important health problem in Romania due to an increased prevalence, major impact on morbidity and mortality by cardiovascular and cerebro-vascular disease. These facts accentuate the necessity of an early diagnosis, of making people aware of the severity of the disease and it’s impact on their lifestyle.
Sur, G; Sur, M; Kudor-Szabadi, L; Sur, L; Sporis, D; Sur, D
Background Recent increases in cardiovascularrisk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascularrisk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascularrisk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ?35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ?45 years was similar to universal screening in men. Conclusions Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.
Erectile and endothelial dysfunction are common in individuals with multiple cardiovascularrisk factors and are longitudinal predictors of cardiovascular events. The pathogenesis of both endothelial and erectile dysfunction is intimately linked through increased expression and activation of endothelial nitric oxide synthase, and the subsequent physiological actions of nitric oxide. Endothelial production of nitric oxide by endothelial nitric oxide synthase in
The deteriorating trend of life expectancy since the mid 1970s, mainly due to higher cardiovascular mortality in the East compared to West Germany, requires explanations about what happened to the cardiovascularrisk factor profile in the East. Epidemiologic studies in the East German population have been performed for about 25 years and can justify a first answer to the question,
Lothar Heinemann; Wolfgang Barth; Hans Hoffmeister
Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N=4794, survey 2: N=5315), carried out in the framework of the German Cardiovascular Prevention Study, and for
The risk of Ischemic heart disease increases in women after the menopause. Women with type 2 diabetes appear to lose the protection against cardiovascular disease afforded by estrogen. The aim of this study was to examine the relationship between oxidative stress and cardiovascular disease parameters in postmenopausal women with and without diabetes, also to evaluate the association of diabetes mellitus
Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, resulting from prolonged exposure to work-related stress. The authors review the accumulated evidence suggesting that burnout and the related concept of vital exhaustion are associated with increased risk of cardiovascular disease and cardiovascular-related events. The authors present evidence supporting several potential mechanisms linking burnout with ill health, including the
Samuel Melamed; Arie Shirom; Sharon Toker; Shlomo Berliner; Itzhak Shapira
Dietary habits have been implicated in the occurrence of cardiovascular diseases. Elevated plasma fibrinogen levels and decreased fibrinolytic activity have been identified as major independent cardiovascularrisk factors. In this study, we compared the blood pressure, plasma fibrinogen concentration, and fibrinolytic activity of 40 nonvegetarians (NON-VEGs) with 36 vegetarians (8 VEGs and 28 SEMI-VEGs). The latter group consisted of students
A. A Famodu; O Osilesi; Y. O Makinde; O. A Osonuga; T. A Fakoya; E. O Ogunyemi; I. E Egbenehkhuere
Objective To assess the reporting of monitoring recommendations in guidelines on the prevention and treatment of cardiovascular disease.Data sources Medline, Trip database, National Guideline Clearinghouse, and databases containing guidelines published from January 2002 to February 2010.Data selection Three major risk factors for cardiovascular disease: cholesterol level, smoking, and hypertension. The primary outcome was the frequency with which the guidelines dealt
Ivan Moschetti; Daniel Brandt; Rafael Perera; M Clarke; Carl Heneghan
Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors—which have significantly decreased cardiovascular mortality in the general population—have not shown such benefit
Objective: To assess the frequencies of risk factors for cardiovascular disease in school children. The informa- tion may help in designing interventions aimed at modifying unhealthy lifestyle in children, which may reduce the later incidence of cardiovascular disease in adults. Methods: A cross-sectional study was conducted on 206 students (ages 14-18 years), enrolled in higher sec- ondary school. Students were
A. K. Khuwaja; Z. Fatmi; W. B. Soomro; N. K. Khuwaja
The content of glycated hemoglobin, a biomarker of diabetes in patients with type 2 diabetes correlates with risk factors for cardiovascular disease: hypertension, BMI and ratio of total cholesterol to HDL cholesterol. Therefore, increase in glycosylated hemoglobin should be considered a predictor of cardiovascular disease in patients with type 2 diabetes. PMID:23951913
Objective. Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population-based data addressing this association have been lacking. Methods. We conducted a prospective cohort study among 119,332 women participating in the Nurses' Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record
A. Elisabeth Hak; Elizabeth W. Karlson; Diane Feskanich; Meir J. Stampfer; Karen H. Costenbader
Background Global cardiovascularrisk is a new approach which allows the physicians to quantitate the prognosis of the patients. It is therefore possible that a score, based on the major cardiovascularrisk factors, is correlated with some degree of cardiovascular anatomic damage. Since this hypothesis has been demonstrated with the Framingham risk score, we decided to verify it using another score (Progetto Cuore risk score), which is probably more precise in a european low-risk population, such as the italian one. Methods We studied 84 italian caucasian subjects (50 males and 34 females) with elevated blood pressure and/or dyslipidemia plus other possible cardiovascularrisk factors. The subjects have never been treated for these reasons. The following evaluations were performed: history, clinical and laboratory determinations, echocardiogram, carotid echodoppler. Results The recruited people were on the whole characterized by a low cardiovascularrisk, as confirmed by the low scores of the Progetto Cuore. Simple linear regression analysis showed significant associations between some parameters of early cardiovascular damage (left ventricular mass, intima-media thickness, and an integrated measure of both the carotid wall thickness and the presence of a plaque, called Carotid score) and some predictors. The highest significance was found between the cardiovascular structural results and the Progetto Cuore score. In a multivariate regression analysis our model, which included factors potentially linked to the cardiovascular anatomic changes, demonstrated that the Carotid score was significantly associated with age, sex and pulse pressure; intima-media thickness with the same factors and, in addition, with the body mass index; left ventricular mass with sex, pulse pressure and body mass index. Conclusion Our paper confirms previous studies about the association between a comprehensive risk score and signs of early cardiovascular damage. A temporally limited exposure to cardiovascularrisk factors, in particular to blood pressure, is already able to induce significant changes in both the heart structure and the vascular wall. Also in a european low-risk population the use of a cardiovascularrisk score program, such as the Progetto Cuore in Italy, allows a quite precise estimation of the possible cardiovascular damage.
Cardiovascular disease (CVD) risk screening is performed by multivariate methods relying on calculators derived from the Framingham study, other epidemiological studies or primary care records. However, it only identifies 70% of individuals at risk for CVD events and there has been interest in adding other risk factors to improve its predictive capacity. The addition of a family history of premature CVD is well established and there is evidence for adding lipoprotein (a) in some populations and possibly C-reactive protein may be suitable for general use in CVD risk assessment. Most new biochemical and imaging markers have been assessed in the context of improving risk classification in intermediate-risk groups rather than in the general population. There is evidence that N-terminal pro-B-type natriuretic peptide and coronary artery calcium score add significantly to risk prediction. The data for carotid intima-media thickness, ankle-brachial index are less strong and high sensitivity troponins look promising, but have had only limited data to date. Large scale meta-analyses ideally of pooled primary patient data will be required to determine the best additional markers to add to conventional risk prediction and in what groups to apply them. PMID:22698414
Persons with spinal cord injury (SCI) have heightened risk for cardiovascular disease (CVD). Multidisciplinary risk reduction programs using case management models have been effective in reducing CVD risk in nondisabled persons, but little is known regarding the effects of such programs in SCI. Twenty-six persons with SCI underwent a pilot 2 yr risk intervention program including frequent telephone contact by a case manager and in-person visits by a dietitian, physical therapist, and exercise physiologist. At 6 mo intervals, measurements were made of dietary intake, glucose and lipids, physical activity patterns, and exercise capacity. Of the 26 participants, 10 remained in the program for the full 2 yr; medical issues unrelated to the program were the major reasons for dropping out. Significant improvements were observed in weight, plasma insulin, homeostatic model assessment insulin resistance, and total cholesterol/high-density lipoprotein ratio, although these changes were not consistent across visits. No differences in estimates of physical activity patterns were demonstrated, nor were differences in dietary macronutrient intake observed. Thus, modest changes in some CVD risk markers can be achieved by a multidisciplinary risk reduction program in SCI. Such programs present more challenges than in ambulatory persons, and more intensive risk intervention may be required to appreciably reduce CVD risk in SCI. PMID:23408217
Diabetes mellitus is associated with excess cardiovascular mortality that is evident in all age groups, but is most pronounced in young people with type 1 diabetes. Cardiovascularrisk estimation models generally estimate the probability of future events over a 10-year time horizon. Due to the dependency on age, children and adolescents with type 1 diabetes would be considered at low short-term risk but high life-time risk of developing a cardiovascular event. Guidelines recommend screening particularly for microvascular complications including nephropathy and retinopathy beginning around puberty. Identification of early microvascular abnormalities in children and adolescents not only predict later development of long-term microvascular complications and further end-organ damage but are associated with an increased risk for future macrovascular events. This may be because of the fact that the same glycaemic mechanisms responsible for the occurrence of microvascular disease may also apply to the development of atherosclerosis. Alternatively, interventions that reduce the development of microvascular end-organ damage may also delay the development of associated macrovascular disease. Screening for subclinical atherosclerosis, especially in the coronary and carotid vessels, has been advocated as a means of detecting early atherosclerotic disease in asymptomatic individuals with the aim of potentially reclassifying cardiovascularrisk and guiding therapeutic interventions. Currently there is no randomized clinical trial evidence that additional screening using non-invasive imaging techniques alters cardiovascular disease outcomes. We do not know the best approach or combination of approaches to assess risk and reduce cardiovascular disease burden in type 1 diabetes mellitus. All screening interventions carry harms as well as benefits and until further evidence becomes available additional screening using non-invasive imaging tests for the detection of subclinical atherosclerosis cannot be currently recommended for patients with type 1 diabetes. PMID:22998614
Although generally safe, combined oral contraceptives (COCs) are associated with risks, including an estimated 2-fold increased relative risk of cardiovascular events. For most women taking COCs for contraception, absolute cardiovascularrisks are very low, and the overall risks of COCs are outweighed by the risks of unwanted pregnancy. Nonetheless, risks of COCs may be excessive in some women, and both the American College of Obstetricians (ACOG) and the World Health Organization (WHO) have offered contraindications for COC use. Complicating this issue, COCs are commonly used for reasons other than contraception (eg, polycystic ovary syndrome, which is associated with subfertility and cardiovascularrisk factors). Thus, in some clinical scenarios, ACOG and WHO guidelines may offer incomplete guidance regarding whether COC use would be associated with an unacceptable risk-benefit ratio. We propose that cardiovascularrisk calculators may be helpful in some patients, as an adjunct to ACOG and WHO guidelines, by allowing physicians to estimate the attributable risk of COC-related cardiovascular events. PMID:22360920
Background Current guidelines for prevention and treatment of cardiovascular disease (CVD) emphasise the importance of a healthy lifestyle. However, successful lifestyle intervention is proving to be a challenge for healthcare professionals. Objectives Evaluation of the effect of lifestyle intervention on cardiovascularrisk factors, on reaching treatment targets and on the estimated risk of cardiovascular morbidity and mortality. Methods The effect of a six-month multidisciplinary structured lifestyle intervention programme was assessed in 186 patients with and without a history of CVD. Results Multidisciplinary structured lifestyle intervention reduced the estimated ten-year risk of cardiovascular morbidity and mortality. The relative risk reduction was similar in patients with and without a history of CVD, the absolute risk reduction was higher in patients with a history of CVD. In both groups blood pressure and body weight decreased, and the maximal work rate and maximal oxygen uptake increased significantly. Blood levels of total cholesterol and cholesterol/HDL ratio decreased significantly in patients with a history of CVD. In addition, target levels for blood pressure and physical fitness were more frequently reached in both patient groups. Conclusion Multidisciplinary structured lifestyle intervention had beneficial effects on cardiovascularrisk factors. Relative risk reduction was similar in patients with and without evidence of cardiovascular disease. Follow-up is needed to see how well these effects can be maintained.
Objective To investigate whether varenicline is associated with an increased risk of serious cardiovascular events compared with another drug used for smoking cessation, bupropion. Design Nationwide historical cohort study. Setting Denmark, 2007-10. Participants New users of varenicline (n=17?926) and bupropion (n=17?926). Main outcome measures Individual level data on dispensed drug prescriptions, cardiovascular events, and potential confounders were linked between registries. Cox regression was used to estimate hazard ratios of cardiovascular events in analyses matched for propensity score. The primary outcomes at six months after start of treatment were acute coronary syndrome, ischaemic stroke, and cardiovascular death analysed individually and as a composite of any major event. Results There were 57 major cardiovascular events among varenicline users (6.9 cases per 1000 person years) compared with 60 events among bupropion users (7.1 cases per 1000 person years); the hazard ratio for any major event was 0.96 (95% confidence interval 0.67 to 1.39). Varenicline use was not associated with an increased risk of acute coronary syndrome (1.20, 0.75 to 1.91), ischaemic stroke (0.77, 0.40 to 1.48), and cardiovascular death (0.51, 0.13 to 2.02). In subgroup analyses, the risk of any major cardiovascular event was not significantly different between patients with and without a history of cardiovascular disease (1.24 (0.72 to 2.12) and 0.83 (0.51 to 1.36), respectively; P=0.29). Conclusions This cohort study found no increased risk of major cardiovascular events associated with use of varenicline compared with bupropion for smoking cessation. On the basis of the upper confidence limit, the data allowed the exclusion of a 40% increased risk of the composite outcome of any major cardiovascular event. While the estimates were less precise for specific outcomes, any differences would be small in absolute terms.
To date, all major clinical trials for anemia correction using erythrocyte stimulating agents (ESAs) failed to show improved\\u000a outcomes for cardiovascular disease (CVD), stroke, and vascular thrombosis. Even moderate elevations in hemoglobin (e.g.,\\u000a to 13 g\\/dL) using erythropoietin have been associated with significantly increased risk of thrombotic cardiovascular events\\u000a and heart failure. This review presents a biophysical rationale for increased risk
Seul-Ki Jeong; Young I. Cho; Marc Duey; Robert S. Rosenson
PurposeThe Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution.
Eric Boersma; Miklos D. Kertai; Olaf Schouten; Jeroen J. Bax; Peter Noordzij; Ewout W. Steyerberg; Arend F. L. Schinkel; Marian van Santen; Maarten L. Simoons; Ian R. Thomson; Jan Klein; Hero van Urk; Don Poldermans
This report examines differences in risk of myocardial infarction and stroke (cardiovascular events) between the cyclooxygenase-2 (COX-2) inhibitors Rofecoxib, Celecoxib, and Valdecoxib, and the traditional nonsteroidal anti-inflammatory agents (NSAIDs) N...
IntroductionThe Cardiovascular (CV) Risk Screening and Health Promotion course was created to develop the pharmacy student's ability to conduct screening and assessment in a community setting and to supplement skills introduced in the required Patient Assessment course.
Kathleen Packard; Emily Sexson; Mikayla Spangler; Ryan Walters
PurposeTo assess the attitudes of adolescents regarding cardiovascular heart disease risk factors and determine their potential influence on reported habits: exercise, smoking, and diet, as well as their body mass index (BMI).
Stephen E. Smalley; Robert R. Wittler; Ruth H. Oliverson
Heart disease is the leading cause of death in the United States. High blood pressure, high cholesterol, and smoking are all risk factors that could lead to cardiovascular disease (CVD) and stroke. The recently announced Million Hearts Initiative is aimed...
Abstract Objective To determine the risk of thromboembolic cardiovascular events associated with the use of etoricoxib, a COX-2 inhibitor. Design Systematic review and meta-analysis of placebo-controlled randomised
Sarah Aldington; Philippa Shirtcliffe; Mark Weatherall; Richard Beasley
Objective Nutrition components of health risk appraisals (HRAs) aim to rapidly and accurately assess dietary be- haviors that increase disease risk. Because cognitive re- search suggests that recalling food likes\\/dislikes may be simpler and more accurate than recalling intake, we tested whether a preference measure was predictive of cardiovascular disease risk factors within an HRA. Methods HRA participants (422 primarily
VALERIE B. DUFFY; SARAH A. LANIER; HEATHER L. HUTCHINS; LINDA S. PESCATELLO; MARCIA K. JOHNSON; LINDA M. BARTOSHUK
This study was a cross-sectional random survey of the whole of Singapore, based on 2143 subjects (aged 18-69 years, response rate 60.3%). The presence of corneal arcus was determined by a doctor using the naked eye in good light. Cardiovascularrisk factors were measured by standardized techniques. The prevalence rates overall of corneal arcus were: 18-29 years (males 0.5%, females 0.3%), 30-49 years (males 18.1%, females 13.3%) and 50-69 years (males 70.7%, females 55.3%). In the 30-49 age group, people with arcus had higher serum low density lipoprotein (LDL) cholesterol concentrations than people without arcus, the mean differences being, males 0.31 mmol/l (P = 0.040) and females 0.62 mmol/l (P less than 0.001) with an increased likelihood of having values greater than 5.5.mmol/l of males 1.8 (95% confidence interval (95% CI): 1.0-3.4) and females 2.6 (95% CI: 1.4-4.8). There were no significant differences for LDL-cholesterol in the 50-69 age group. Arcus was weakly associated with fasting plasma glucose in the 30-49 age group. Arcus was not associated with serum high density lipoprotein (HDL) cholesterol, serum fasting triglyceride, blood pressure and cigarette smoking. It is concluded that while corneal arcus is primarily an age-related change, its formation is accelerated by high serum LDL-cholesterol so that in people under 50 years it is a marker for the condition. PMID:1634308
Hughes, K; Lun, K C; Sothy, S P; Thai, A C; Leong, W P; Yeo, P B
More than one-third of women in the United States are obese. This fact is of particular concern given that obesity contributes\\u000a to increased risk of several diseases that affect women, including cardiovascular disease. Even modest weight loss, however,\\u000a can prevent and improve cardiovascularrisk factors in obese women. Behavioral interventions for the treatment of obesity\\u000a that aim to produce weight
BackgroundThere is increased risk of cardiovascular disease among HIV seropositive individuals. The prevalence of HIV is highest in sub-Saharan Africa; however, HIV-related cardiovascularrisk research is largely derived from developed country settings. Herein, we describe the prevalence of hypertension and obesity in a large HIV treatment program in Kenya.MethodsWe performed a retrospective analysis of the electronic medical records of a
Gerald S. Bloomfield; Joseph W. Hogan; Alfred Keter; Edwin Sang; E. Jane Carter; Eric J. Velazquez; Sylvester Kimaiyo
The purpose of this study was to reduce cardiovascular disease (CVD) risk in women by implementing a cardiovascular prevention\\u000a health promotion program in faith- and community-based sites. The primary outcomes were reducing obesity and increasing physical\\u000a activity. A longitudinal cohort of high-risk (age?>?40, ethnic minority) women (n?=?1,052) was enrolled at 32 sites across the USA. The pre- or post-educational intervention
Amparo C. Villablanca; Shavon Arline; Jacqui Lewis; Sekar Raju; Susan Sanders; Shannon Carrow
Given the increased prevalence of obesity in the United States (and its associated cardiovascularrisk) despite reduced fat\\u000a intake, there has been increasing interest in the effect of low-carbohydrate diets on obesity. Recent prospective trials have\\u000a demonstrated equivalent weight loss on low-carbohydrate versus low-fat diets, but with significantly different effects on\\u000a metabolic risk factors for cardiovascular disease. Low-carbohydrate diets have
Frederick F. Samaha; Gary D. Foster; Angela P. Makris
Age>60 years and\\/or high cardiovascularrisk profile are factors which define “non-optimal” potential organ donors (PD). In these PD a careful evaluation of renal damage, comprehensive of histological assessment of kidneys, has been performed to optimise organs utilisation for transplant.Aim of this study was to evaluate histological renal damage in a PD pool respect to their cardiovascularrisk profile (CVRP)
Daniela Degli Esposti; Stefano Bacchelli; Ada Dormi; Angelo Ghirardini; Maria Rosa Pugliese; Elena Sestigiani; Nicola Venturoli; Paolo Mazzetti Gaito; Claudio Borghi; Lorenza Ridolfi; Ettore Ambrosioni
Obesity is associated with Arterial Hypertension and several metabolic complications, and is considered a predictor of risk for cardiovascular disease. The aim of this study is to evaluate the Body mass index (BMI) and Waist-to-hip ratio (WHR) in Afro-Venezuelan communities and determinate the frequency of Obesity and evaluate the cardiovascularrisk according to WHR. The Subjects came from black communities
A. Delgado; R. Farias; S. Celis; R. Alvarez; F. Fragachán
Background Little is known about the effects of commuting physical activity on biological cardiovascularrisk factors although such\\u000a knowledge may form an important basis for interventions aimed at reducing cardiovascular disease (CVD) by increasing physical\\u000a activity. We examined the associations between commuting, leisure time and total physical activity and biological risk factors\\u000a for CVD. Design A cross-sectional study of men
Lisa von Huth Smith; Knut Borch-Johnsen; Torben Jørgensen
Recent advances in our understanding of the excess mortality of chronic kidney disease (CKD) due to cardiovascular complications,\\u000a obtained through observational studies, demonstrate that vascular calcification and hyperphosphatemia are major cardiovascular\\u000a risk factors. Mechanistic studies demonstrate that these two risk factors are related and that hyperphosphatemia directly\\u000a stimulates vascular calcification. The role of hyperphosphatemia in stimulating vascular calcification in CKD
Keith A. Hruska; Eric T. Choi; Imran Memon; T. Keefe Davis; Suresh Mathew
The prevalence of obesity has dramatically increased over the past decade along with the cardiovascular and other health risks\\u000a it encompasses. Adipose tissue, which is distributed in the abdominal viscera, carries a greater risk for cardiovascular disorders\\u000a than adipose tissue subcutaneously. There is a sex difference in the regional fat distribution. Women have more subcutaneous\\u000a fat, whereas men have more
\\u000a Cardiovascular disease remains the leading cause of morbidity and mortality in chronic kidney disease (CKD), and there is\\u000a an urgent need to develop novel therapeutic strategies to reduce this excessive risk. In the context of uremia, this has been\\u000a problematic, as the extremely high cardiovascular disease (CVD) risk seems to be the result of a complex interplay between\\u000a a vast
Background.Cardiovascularrisk factors and related behaviors begin during youth.Methods.As part of the Child and Adolescent Trial for Cardiovascular Health, 4,019 children from four states and representing multiple ethnic groups were measured for selected risk factors both at baseline and after 212 years of intervention. Common protocols were used for both examinations at the four sites.Results.Overall, changes in obesity, blood pressure,
Larry S. Webber; Stavroula K. Osganian; Henry A. Feldman; Margaret Wu; Thomas L. McKenzie; Milton Nichaman; Leslie A. Lytle; Elizabeth Edmundson; Jeffrey Cutler; Philip R. Nader; Russel V. Luepker
The literature describing the relationship between urinary protein excretion and risk of cardiovascular disease and renal disease is rapidly proliferating. Several studies have demonstrated racial differences in the relationship between albuminuria and associated disorders. The purpose of this article is to summarize the effects of race on the relationship between albuminuria and renal and cardiovascular disease risk, propose explanatory hypotheses, and suggest directions for future investigation.
BACKGROUND: Although work related risk factors associated with Cardiovascular Diseases (CD) have been well researched, there is no detailed knowledge regarding disparate occupational groups each with a different risk exposition. Therefore, two occupational groups (chefs and office workers) were compared with a focus on nutritional and psychosocial factors. METHODS: Two groups of subjects were tested for work and diet-related risks
Danielle Hartung; Martina Stadeler; Romano Grieshaber; Sylvia Keller; Gerhard Jahreis
|Background: Little is known about the cardiovascular disease (CVD) risk factor profile for older adults with intellectual disability (ID). As many CVD risk factors are treatable by lifestyle changes, confirmation of the risk factor profile for older adults with ID could substantially impact upon preventive health practices for this group. Method:…
To establish whether the reported increased cardiovascular (CV) morbidity in spinal cord injury (SCI) patients is due to increased levels of established CV risk factors, we assessed overall CV risk in 102 consecutive patients aged 25-64 by calculation of a 'risk factor score' (RFS) derived from the MRFIT study (age, diastolic blood pressure (DBP), total cholesterol (TC) level, cigarettes\\/day, sex),
H Krum; L G Howes; D J Brown; G Ungar; P Moore; J J McNeil; W J Louis
Cardiovascular disease (CVD) is a major health risk in the United States. Major indicators of CVD risk include obesity, blood lipids, and blood pressure. Modifiable risk factors associated with CVD include body composition (body mass index and waist circumference), serum lipids, and blood pressure. ...
Acromegaly is associated with premature cardiovascular mortal- ity. GH replacement therapy decreases inflammatory markers of cardiovascularrisk, but little is known about these markers in patients with acromegaly. The GH receptor antagonist, pegviso- mant, reduces IGF-I levels in 98% of patients treated. We investi- gated the effects of GH receptor blockade on inflammatory and other cardiovascularrisk markers in active
GEMMA SESMILO; WESLEY P. FAIRFIELD; LAURENCE KATZNELSON; KAREN PULASKI; PAMELA U. FREDA; VIVIEN BONERT; ELENI DIMARAKI; STAVROS STAVROU; MARY LEE VANCE; DOUGLAS HAYDEN; ANNE KLIBANSKI
OBJECTIVE: To investigate the associations of individual and area-based socioeconomic indicators with cardiovascular disease risk factors and mortality. DESIGN: Prospective study. SETTING: The towns of Renfrew and Paisley in the west of Scotland. PARTICIPANTS: 6961 men and 7991 women included in a population-based cardiovascular disease screening study between 1972 and 1976. MAIN OUTCOME MEASURES: Cardiovascular disease risk factors and cardiorespiratory
G. D. Smith; C. Hart; G. Watt; D. Hole; V. Hawthorne
The validation of CAC scanning as a risk assessment tool may well represent one of the most significant advances in the history\\u000a of preventive medicine. It offers the possibility of accurately identifying the vast majority of patients destined to suffer\\u000a acute cardiac events, and in so doing, will allow for substantial reduction of cardiovascular mortality and morbidity by increasingly\\u000a effective
Current tools for cardiovascular disease (CVD) risk assessment in asymptomatic individuals are imperfect. Preventive measures\\u000a aimed only at individuals deemed high risk by current algorithms neglect large numbers of low-risk and intermediate-risk individuals\\u000a who are destined to develop CVD and who would benefit from early and aggressive treatment. Natriuretic peptides have the potential\\u000a both to identify individuals at risk for
Evidence that cardiovascular (C-V) risk factors are identifiable in childhood and are predictive of future C-V risk is now irrefutable. That levels of C-V risk factors track or persist over time is important, since such phenomenon confers a life-long burden of C-V risk and indicates subtle and progressive changes in the C-V system. C-V risk factors occur often in constellation
Objective The purpose of this study was to conduct a systematic review of the literature of cardiovascular factors pertaining to incident Alzheimer disease (AD). Methods A systematic literature review was conducted of all studies of cardiovascularrisk factors for incident AD listed in PUBMED in English from 2000–2007. Risk factors included hypertension, diabetes, exercise, alcohol intake, smoking, B complex vitamins, homocysteine, stroke, atrial fibrillation, APOE, lipids, and diet. Inclusion criteria consisted of diagnoses of incident AD and longitudinal studies with cohorts of 500 or more. Results Individual clinically defined risk factors such as hypertension and diabetes were not significantly associated with increased risk for AD. The strength of the association for hypertension could be considerably strengthened by changing criteria such as midlife measurements or using higher cutoffs for systolic blood pressure. APOE ?4 was the most consistent risk factor. Interactions between risk factors modify risk particularly for hypertension and diabetes. Interactions modifying risk were also found for exercise and physical function, APOE ?4, diabetes and cholesterol. Conclusions In this review the evidence that single clinically defined cardiovascularrisk factors are significantly associated with incident Alzheimer disease is inconsistent at best. The strength of the association of cardiovascularrisk factors and AD can be influenced greatly by changing the parameters of measurement of risk factors and by identifying interactions between the factors.
Purnell, Christianna; Gao, Sujuan; Callahan, Christopher M.; Hendrie, Hugh C.
Novel HRV Predicts CV Mortality in the Elderly Background It is unknown whether abnormal heart rate turbulence (HRT) and abnormal fractal properties of heart rate variability identify older adults at increased risk of cardiovascular death (CVdth). Methods Data from 1,172 community-dwelling adults, ages 72 ± 5 (65–93) years, who participated in the Cardiovascular Health Study (CHS), a study of risk factors for CV disease in people ?65 years. HRT and the short-term fractal scaling exponent (DFA1) derived from 24-hour Holter recordings. HRT categorized as: normal (turbulence slope [TS] and turbulence onset [TO] normal) or abnormal (TS and/or TO abnormal). DFA1 categorized as low (?1) or high (>1). Cox regression analyses stratified by Framingham Risk Score (FRS) strata (low = <10, mid = 10–20, and high >20) and adjusted for prevalent clinical cardiovascular disease (CVD), diabetes, and quartiles of ventricular premature beat counts (VPCs). Results CVdths (N = 172) occurred over a median follow-up of 12.3 years. Within each FRS stratum, low DFA1+abnormal HRT predicted risk of CVdth (RR=7.7 for low FRS; 3.6, mid FRS; 2.8, high FRS). Among high FRS stratum participants, low DFA1 alone also predicted CVdth (RR = 2.0). VPCs in the highest quartile predicted CVdth, but only in the high FRS group. Clinical CV disease predicted CVdth at each FRS stratum (RR = 2.9, low; 2.6, mid; and 1.9, high). Diabetes predicted CVdth in the highest FRS group only (RR = 2.2). Conclusions The combination of low DFA1 + abnormal HRT is a strong risk factor for CVdth among older adults even after adjustment for conventional CVD risk measures and the presence of CVD.
STEIN, PHYLLIS K.; BARZILAY, JOSHUA I.; CHAVES, PAULO H.M.; MISTRETTA, STEPHANIE Q.; DOMITROVICH, PETER P.; GOTTDIENER, JOHN S.; RICH, MICHAEL W.; KLEIGER, ROBERT E.
BackgroundGuidelines cite the importance of cardiovascular assessment in falls prevention, however there has been no systematic review of the role of cardiovascular disorders as risk factors for non-syncopal falls.
F. McCarthy; C. W. Fan; P. M. Kearney; C. Walsh; R. A. Kenny
There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascularrisk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascularrisk and other problems associated with these syndromes are discussed. Screening for cardiovascularrisk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed. PMID:21181310
There is a significant prevalence (20%–80% depending on the population and the study) of lipid disorders and other cardiovascularrisk factors in people living with HIV infection. This review focuses on HIV and HIV treatment–associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascularrisk and other problems associated with these syndromes are discussed. Screening for cardiovascularrisk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a common autosomal recessive disorder characterized by impaired cortisol biosynthesis, with or without aldosterone deficiency, and androgen excess. Patients with the classic (severe) form also have epinephrine deficiency. Patients with CAH have an increased prevalence of risk factors for cardiovascular disease including obesity, hypertension, and insulin resistance. Androgen excess in women appears to be an additional risk factor for cardiovascular disease. Carotid intima-media thickness, a measure of subclinical atherosclerosis, also has been found to be increased in adults with CAH. The multiple hormonal imbalances present in the adult woman with CAH, in combination with chronic glucocorticoid therapy, contribute to cardiovascular disease risk. Further investigation of the predisposition to cardiovascular disease in women with CAH is warranted. Longitudinal studies are needed, and interventions targeting obesity, insulin resistance, hypertension, and hyperandrogenism may offer improved outcome. PMID:19530065
The 1990 amendments to the Clean Air Act required the EPA to institute new pollution control technology requirements for industrial sources of air pollution. In part because agreement could not be reached on the best way for the EPA to determine whether any significant risks to human health will remain after the technology controls are in place, the amendments also created a Commission on Risk Assessment and Risk Management and gave the commission a broad mandate to review and make recommendations concerning risk assessment and risk management in federal regulatory programs. In its March 1997 final report to Congress and the administration, the commission recommended a tiered approach to assessing such residualrisks. That approach included the idea that when decisions about managing residualrisks are made, emissions should be evaluated in the context of other sources of air pollution. Evaluating risks in their larger contexts is consistent with what the commission called a public health approach to environmental risk management. This paper describes the public health approach and how it applies to evaluating residualrisks under the Clean Air Act. Images Figure 1
Objective The metabolic syndrome is associated with increased cardiovascularrisk and its prevalence increases with age. Various definitions of the metabolic syndrome exist, but whether some definitions are more predictive of future cardiovascular events in the elderly is unclear. Materials/Methods We compared the risk of incident cardiovascular events in elderly individuals ? 65 years from the Cardiovascular Health Study with and without the metabolic syndrome as defined by the EGIR, NCEP/AHA, AACE, IDF and modified WHO criteria (n=3390). Participants were without baseline diabetes or cardiovascular disease. Results Except for EGIR, all definitions of the metabolic syndrome were significantly associated with increased risk of incident cardiovascular (coronary or cerebrovascular) events. Adjusted hazard ratios (HRs) for risk of incident cardiovascular events as defined by the modified WHO, NCEP/AHA, AACE and IDF criteria ranged from 1.153 (p=0.045) for NCEP/AHA to 1.314 (p<0.001) for IDF, with 95% CI ranging from 1.003–1.503. Adjusted HR for EGIR was 1.087 (95% CI 0.908–1.301, p=0.362). Similarly, all definitions of the metabolic syndrome were significantly associated with incident coronary events except for the EGIR definition. Only the modified WHO definition was associated with increased risk for cerebrovascular events (adjusted HR 1.301, 95% CI 1.038–1.631, p=0.022). Conclusion While all metabolic syndrome definitions except EGIR were associated with total cardiovascular events and coronary events, only the modified WHO definition was also associated with risk of cerebrovascular events.
Vinluan, Celeste M.; Zreikat, Hala H.; Levy, James R.; Cheang, Kai I.
The metabolic syndrome is associated with increased cardiovascularrisk, and its prevalence increases with age. Various definitions of the metabolic syndrome exist, but whether some definitions are more predictive of future cardiovascular events in the elderly is unclear. We compared the risk of incident cardiovascular events in elderly individuals at least 65 years old from the Cardiovascular Health Study with and without the metabolic syndrome as defined by the European Group for the Study of Insulin Resistance (EGIR), National Cholesterol Education Program (NCEP)/American Heart Association (AHA), American Association of Clinical Endocrinologists, International Diabetes Federation (IDF), and modified World Health Organization (WHO) criteria (n = 3390). Participants were without baseline diabetes or cardiovascular disease. Except for EGIR, all definitions of the metabolic syndrome were significantly associated with increased risk of incident cardiovascular (coronary or cerebrovascular) events. Adjusted hazard ratios (HRs) for risk of incident cardiovascular events as defined by the modified WHO, NCEP/AHA, American Association of Clinical Endocrinologists, and IDF criteria ranged from 1.153 (P = .045) for NCEP/AHA to 1.314 (P < .001) for IDF, with 95% confidence interval (CI) ranging from 1.003 to 1.503. Adjusted HR for EGIR was 1.087 (95% CI, 0.908-1.301; P = .362). Similarly, all definitions of the metabolic syndrome were significantly associated with incident coronary events except for the EGIR definition. Only the modified WHO definition was associated with increased risk for cerebrovascular events (adjusted HR, 1.301; 95% CI, 1.038-1.631; P = .022). Although all metabolic syndrome definitions except EGIR were associated with total cardiovascular events and coronary events, only the modified WHO definition was also associated with risk of cerebrovascular events. PMID:21840552
Vinluan, Celeste M; Zreikat, Hala H; Levy, James R; Cheang, Kai I
PURPOSE To assess the relationship between sibling history of myocardial infarction (MI) or stroke with cardiovascular disease (CVD) and risk factors in older adults. METHODS Prospective cohort study of 5,888 older adults participating to the Cardiovascular Health Study (CHS). History of MI and stroke in siblings was obtained by self-report. Participants with positive sibling histories were compared to those with negative histories to determine if prevalent or incident disease (coronary heart disease [CHD], MI, stroke, angina), subclinical CVD (carotid wall thickness, left ventricular mass, hypertension, diabetes, ankle brachial index), CVD risk factors differed between groups. RESULTS More than 91 percent (n=5,383) of CHS participants reported at least one sibling. Sibling history of MI was associated with increased disease prevalence (CHD, MI, angina) and incidence (CHD, angina). Sibling history of stroke was associated with increased disease prevalence (CHD, angina). Sibling history of either MI or stroke was associated with increased disease prevalence and incidence for CHD, MI and angina, more subclinical disease, and a higher CVD risk profile. CONCLUSIONS Sibling history of MI and stroke were markers of higher CVD risk status even in older adults. Of clinical importance, participants with positive sibling history have numerous risk factors amenable to intervention.
Yanez, N. David; Burke, Gregory L.; Manolio, Teri; Gardin, Julius M.; Polak, Joseph
Background Tooth loss is associated with increased cardiovascular disease (CVD) mortality risk. This association may however be due to residual confounding. We aimed to assess whether tooth loss is associated with specific CVD mortality endpoints in a national population sample adjusting for potential confounders. Methods and Results We used a prospective cohort design and data from the Scottish Health Survey. We combined data from surveys in 1995, 1998, 2003 and linked this to mortality records. Dental status was classified through self-reports as natural teeth only, natural teeth and dentures, and no natural teeth (edentate). Cox proportional hazards models were used to estimate risk of CVD mortality by dental status adjusting for potential confounders. The sample consisted of 12871 participants. They were followed for 8.0 (SD: 3.3) years. During 103173 person-years, there were 1480 cases of all-cause mortality, 498 of CVD, and 515 of cancer. After adjusting for demographic, socio-economic, behavioural and health status, edentate subjects had significantly higher risk of all-cause (HR, 1.30; 95% CI, 1.12,1.50) and CVD mortality (HR, 1.49; 95% CI, 1.16,1.92) compared to subjects with natural teeth only. Dental status was not significantly associated with cancer mortality in fully adjusted analysis. Further analysis for CVD mortality showed that in the fully adjusted model, edentate subjects had 2.97 (95% CI, 1.46, 6.05) times higher risk for stroke-related mortality. Conclusions In a national population sample of Scottish adults, being edentate was an independent predictor of total CVD mortality, although this was mainly driven by fatal stroke events.
Watt, Richard G.; Tsakos, Georgios; de Oliveira, Cesar; Hamer, Mark
A risk prediction system, Systematic Coronary Risk Evaluation, that is based on European studies has been developed and recommended to define absolute 10-year risk of a fatal cardiovascular event and mortality. The aim of the study was to compare cardiovascularrisk calculated with SCORE system at patients with different degree of renal impairment. The study included 90 patients divided in 4 groups: 1st group=30 patients without renal failure, 2nd group=25 patients with CRF in predialysis stage, 3rd group=19 hemodialysis non-diabetic patients and 4th group=16 hemodialysis diabetics patients. SCORE was calculated from age, sex, systolic blood pressure, smoking and cholesterol levels. There were no significant differences in age and blood pressure in four examined groups. The incidence of smokers and cholesterol level were higher in predialysis patients. The highest SCORE was calculated in predialysis patients: 1st group: 2.5+/-1.8; 2nd group: 5.3+/-4.3, 3rd group: 3.7+/-1.1 and 4th group: 4.06+/-4. We supposed that traditional risk factors from SCORE risk system are suitable to explain the cardiovascularrisk and mortality in all population but underestimates cardiovascularrisk of high-risk groups like patients with chronic renal disease. PMID:18928168
Aims. To explore general practitioners' (GPs') descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs' prescribing of cardiovascular preventive drugs, from their own descriptions, involved “the patient as calculated” and “the inclination to prescribe,” which were negotiated in the interaction with “the patient in front of me.” In situations with high cardiovascularrisk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascularrisk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascularrisk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills.
Antiretroviral (ARV) therapy in HIV patients can cause hyperlipidaemia, glucose intolerance and insulin resistance, which increase the risk of cardiovascular disease (CVD). An audit carried out in Manchester found that CVD risk factors were common among HIV patients receiving ARVs; however, the management of risk factors was not satisfactory. Adopting a formal system to identify and manage CVD risk factors as well as appropriate referral for specialist management of complications of ARV therapy would improve patient care. PMID:19451331
Mallewa, J E; Higgins, S P; Garbett, S; Saxena, N; Vilar, F J
Assessing a combination of cardiovascular disease (CVD)-risk factors may be a practical tool for risk assessment and for finding the high-risk group among local community members. This study examines the association between the num- ber of CVD-risk factors, regardless of any specific combination with the CVD ambit, using data from 1,570 residents in Tsing Yi community (Hong Kong) who registered
Y. B. Yip; Thomas K. S. Wong; Joanne W. Y. Chung; Stanley K. K. Ko; Janet W. H. Sit; Tony M. F. Chan
Cardiovascular autonomic neuropathy (CAN) is one of the most clinically significant complications of diabetes mellitus (DM), but one of the least frequently diagnosed. In this review, we discuss the major risk factors for the development and progression of CAN in patients with DM, the natural history of autonomic neuropathy and its impact on cardiovascular disease in DM, as well as the tests for the early diagnosis and staging of CAN in the clinical practice. The bibliographic research was based on two databases: Medline and Tripdatabase, with the following descriptors: diabetic cardiovascular autonomic neuropathy and cardiovascular autonomic neuropathy and diabetes. We selected English and German articles, written between 1998 and 2007. In its initial stages (early and intermediate), CAN may be diagnosed and reversed. However, in advanced cases (severe stage), the only treatment that remains is a symptomatic one. CAN is associated with higher cardiovascular morbidity and mortality rates and poor quality of life in diabetic individuals. PMID:18516377
Rolim, Luiz Clemente de Souza Pereira; Sá, João Roberto de; Chacra, Antonio Roberto; Dib, Sérgio Atala
Complications attributed to cardiovascular diseases (CDV) are the leading cause of death worldwide. In the United States, sudden heart attack remains the number one cause of death and accounts for the majority of the 280 billion burden of cardiovascular diseases. In spite of the advancements in cardiovascular imaging techniques, the rate of deaths due to unpredicted heart attack remains high. Thus, novel computational tools are of critical need, in order to mine quantitative parameters from the imaging data for early detection of persons with a high likelihood of developing a heart attack in the near future (vulnerable patients). In this paper, we present our progress in the research of computational methods for the extraction of cardiovascularrisk biomarkers from cardiovascular imaging data. In particular, we focus on the methods developed for the analysis of intravascular ultrasound (IVUS) data.
Kakadiaris, I. A.; Mendizabal-Ruiz, E. G.; Kurkure, U.; Naghavi, M.
Background—Clustering of cardiovascular (CV) risks begins in childhood, yet studies of the factor structure underlying this clustering have focused on adults. The increasing rates of obesity and type 2 diabetes and the growing importance of metabolic syndrome among adolescents make assessment of CV risk clustering even more urgent in this age group. Methods and Results—Exploratory factor analysis (principal components analysis)
Elizabeth Goodman; Lawrence M. Dolan; John A. Morrison; Stephen R. Daniels
This study's objective was assessment of cardiovascular disease (CVD) risk factor knowledge in young adults, its association with 10-year changes in risk factor levels, and variables related to risk factor knowledge. A total of 4,193 healthy persons (55% female, 48% Black; mean age ¼ 30 years) from four urban US communities were queried about risk factor knowledge in 1990-1991 and
Elizabeth B. Lynch; Kiang Liu; Catarina I. Kiefe; Philip Greenland
Background This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. Methods and Results Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. Conclusions This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed.
Salinas, Jennifer J.; Abdelbary, Bassent; Wilson, Jeffrey; Hossain, Monir; Fisher-Hoch, Susan; McCormick, Joseph
Background—Obesity is associated with increased risk of cardiovascular disease in adults and less favorable cardiovas- cular risk factor status in children and adolescents. In adults, fat distribution has been shown to be related to lipid and lipoprotein concentrations, blood pressure levels, and left ventricular mass. These relationships have not been extensively studied in young subjects. Methods and Results—This was a
Stephen R. Daniels; John A. Morrison; Dennis L. Sprecher; Philip R Khoury; Thomas R. Kimball
OBJECTIVES: This study examined the extent to which cardiovascular disease risk factors differ among subgroups of Mexican Americans living in the United States. METHODS: Using data from a national sample (1988-1994) of 1387 Mexican American women and 1404 Mexican American men, aged 25 to 64 years, we examined an estimate of coronary heart disease mortality risk and 5 primary cardiovascular disease risk factors: systolic blood pressure, body mass index, cigarette smoking, non-high-density lipoprotein cholesterol, and type 2 diabetes mellitus. Differences in risk were evaluated by country of birth and primary language spoken. RESULTS: Estimated 10-year coronary heart disease mortality risk per 1000 persons, adjusted for age and education, was highest for US-born Spanish-speaking men and women (27.5 and 11.4, respectively), intermediate for US-born English-speaking men and women (22.5 and 7.0), and lowest for Mexican-born men and women (20.0 and 6.6). A similar pattern of higher risk among US-born Spanish-speaking men and women was demonstrated for each of the 5 cardiovascular disease risk factors. CONCLUSIONS: These findings illustrate the heterogeneity of the Mexican American population and identify a new group at substantial risk for cardiovascular disease and in need of effective heart disease prevention programs.
Metabolic changes and shifts in vascular risk profiles during and after menopause may partly explain the loss of premenopausal protection against cardiovascular disease (CVD). The current population-based survey addresses changes in risk factors and insulin levels across an age range of 40–79 years in men and women. Population recruitment was performed as part of the Bruneck Study from July to
Johann Willeit; Stefan Kiechl; Georg Egger; Martin Oberhollenzer; Friedrich Oberhollenzer; Michele Muggeo; Werner Poewe; Enzo Bonora
Rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance. Our study was limited by a lack of access to original source data, which would have enabled time-to-event analysis. Despite these limita- tions, patients and providers should consider the potential for
|The Balance Study is a randomized controlled trial designed to reduce cardiovascular disease (CVD) risk in 200 American Indian (AI) participants with metabolic syndrome who reside in southwestern Oklahoma. Major risk factors targeted include weight, diet, and physical activity. Participants are assigned randomly to one of two groups, a guided or…
Lee, Elisa T.; Jobe, Jared B.; Yeh, Jeunliang; Ali, Tauqeer; Rhoades, Everett R.; Knehans, Allen W.; Willis, Diane J.; Johnson, Melanie R.; Zhang, Ying; Poolaw, Bryce; Rogers, Billy
We carried out a prospective cohort study in patients referred to our vascular outpatient clinic to see how their cardiovascularrisk profile developed. The classical risk factors were compared at first visit and one year later. The adapted Framingham Heart Risk Score (FHRS) and the Heart SCORE (HS) were used to compare the cardiovascularrisks. There was a decline of 9 and 5 mmHg in mean systolic blood pressure in the hypertension group and in the group with atherosclerotic disease, respectively. On average 0.6 and 0.8 antihypertensive agents were added. In the hypertension group mean LDL-level decreased from 3.2 to 2.4 mmol/l. For the secondary prevention group mean LDL-cholesterol decreased from 3.3 to 2.1 mmol/l. In the hypertension group, the 10-year relative risk of myocardial infarction (FHRS) decreased by 28% (95% CI 25-30). The 10-year relative risk on a fatal cardiovascular event (HS) decreased by 33% (95% CI 31-36). The absolute risk decreased by 3.3% (95% CI 2.0-4.6) and 1.4% (95% CI 0.5-2.3) by using the HS. We conclude that the cardiovascularrisk profile of our patients significantly improved as shown by the FHRS or the HS. These benefits were reached by a decreasing number of smokers, better blood pressure control and a lower LDL-cholesterol. PMID:19963439
Verdouw-van Tol, H C L; Peltenburg, H G; Koster, T
Objective: We tested the hypothesis that visceral adiposity, compared with general adiposity, would explain more of the variance in cardiovascular disease (CVD) risk factors.Research Method and Procedures: Subjects were 464 adolescents (238 black and 205 girls). Adiposity measures included visceral adipose tissue (VAT; magnetic resonance imaging), percent body fat (%BF; DXA), BMI, and waist girth (anthropometry). CVD risk factors were
Bernard Gutin; Maribeth H. Johnson; Matthew C. Humphries; Jeannie L. Hatfield-Laube; Gaston K. Kapuku; Jerry D. Allison; Barbara A. Gower; Stephen R. Daniels; Paule Barbeau
Introduction: Risk factors for cardiovascular disease and diabetes acquired in childhood commonly persist in later life and are particularly strong predictors of subclinical atherosclerosis in young adults. A rising tide of obesity and other lifestyle-related risk factors threat- ens to negate much of the success achieved in the pre- vention and treatment of these diseases. The SCHOOL project (School Children
Patrick Hughes; David K. Murdock; Karen Olson; Ryan Juza; Kirk Jenkins; Amalia Wegner; Bryan Hendricks
Objective: Our aim was to investigate risk factors for cardiovascular disease (CVD) in a population-based Brazilian cohort. Design and methods: A cohort study was conducted with 1091 individuals identified through multi-stage probability sampling in Porto Alegre, Brazil. Risk factors were investigated among demographic and anthropometric characteristics, including education, smoking habits, income, alcoholic beverage consumption, and blood pressure. A fatal or
Objective. To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). Study Design. A retrospective cohort study, comparing risk factors behind CVD between Sami and non-Sami, RS and NRS, and Sami men and women. Methods. A cohort of 611 Swedish Sami (276 men and 335 women)
Despite the benefits associated with regular physical activity, there is little epidemiological evidence to support positive health outcomes when meeting physical activity guidelines in high-risk ethnic groups, such as Hispanic women. We compared cardiovascular disease risk factors between young Hispanic women who meet and those who do not meet current physical activity guidelines. Height, weight, waist circumference, and blood pressure
Chantal A. Vella; Diana Ontiveros; Raul Y. Zubia; Lance Dalleck
Despite declines in smoking prevalence in many Western countries, tobacco use continues to grow in global importance as a leading preventable cause of cardiovascular disease. Tobacco smoke is both prothrombotic and atherogenic, increasing the risks of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease. Even very low doses of exposure increase the risk of acute
ObjectivesThe goal of this study was to determine whether the level of kidney function is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) outcomes in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study of subjects aged 45 to 64 years.
Guruprasad Manjunath; Hocine Tighiouart; Hassan Ibrahim; Bonnie MacLeod; Deeb N Salem; John L Griffith; Josef Coresh; Andrew S Levey; Mark J Sarnak
Recent research has suggested that inequality in the distribution of income is associated with increased mortality, even after accounting for average income levels. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), we investigated whether inequality in the distribution of income within US states is related to the prevalence of four cardiovascular disease risk factors (body mass index (BMI),
Ana V. Diez-Roux; Bruce G. Link; Mary E. Northridge
Objective: Body fat distribution has been reported to differentially contribute to the development of cardiovascularrisk. We report the relative associations between general and central obesity and risk factors in 2893 Chinese subjects recruited from the Hong Kong population.Research Methods and Procedures: Anthropometric parameters [waist circumference (WC) and BMI], surrogate measures of insulin resistance (fasting plasma glucose and insulin, oral
G. Neil Thomas; Sai-Yin Ho; Karen S. L. Lam; Edward D. Janus; Anthony J. Hedley; Tai Hing Lam
Objective To examine the association between work stress, according to the job strain model and the effort-reward imbalance model, and the risk of death from cardiovascular disease. Design Prospective cohort study. Baseline examination in 1973 determined cases of cardiovascular disease, behavioural and biological risks, and stressful characteristics of work. Biological risks were measured at 5 year and 10 year follow up. Setting Staff of a company in the metal industry in Finland. Participants 812 employees (545 men, 267 women) who were free from cardiovascular diseases at baseline. Main outcome measure Cardiovascular mortality 1973-2001 from the national mortality register. Results Mean length of follow up was 25.6 years. After adjustment for age and sex, employees with high job strain, a combination of high demands at work and low job control, had a 2.2-fold (95% confidence interval 1.2 to 4.2) cardiovascular mortality risk compared with their colleagues with low job strain. The corresponding risk ratio for employees with effort-reward imbalance (low salary, lack of social approval, and few career opportunities relative to efforts required at work) was 2.4 (1.3 to 4.4). These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline. High job strain was associated with increased serum total cholesterol at the 5 year follow up. Effort-reward imbalance predicted increased body mass index at the 10 year follow up. Conclusions High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality. The evidence from industrial employees suggests that attention should be paid to the prevention of work stress. What is already known on this topicJob strain (high demands and low job control) and effort-reward imbalance (high demands, low security, few career opportunities) elicit stress at workTheir status as risk factors for cardiovascular mortality has, however, remained uncertainWhat this study addsJob strain and effort-reward imbalance were each associated with a doubling of the risk of cardiovascular death among employees who were free from overt cardiovascular diseases at baselineJob strain and effort-reward imbalance also predicted adverse changes in biological factors such as cholesterol concentration and body mass index
BACKGROUND: Adrenergic gene polymorphisms are associated with cardiovascular and metabolic phenotypes. We investigated the influence of adrenergic gene polymorphisms on cardiovascularrisk in women with suspected myocardial ischemia. METHODS: We genotyped 628 women referred for coronary angiography for eight polymorphisms in the ?1A-, ?1-, ?2- and ?3-adrenergic receptors (ADRA1A, ADRB1, ADRB2, ADRB3, respectively), and their signaling proteins, G-protein ? 3
Michael A Pacanowski; Issam Zineh; Haihong Li; B. Delia Johnson; Rhonda M Cooper-DeHoff; Vera Bittner; Dennis M McNamara; Barry L Sharaf; C. Noel Bairey Merz; Carl J Pepine; Julie A Johnson
BackgroundCirculating progenitor cells (CPC) contribute to the homeostasis of the vessel wall, and a reduced CPC count predicts cardiovascular morbidity and mortality. We tested the hypothesis that CPC count improves cardiovascularrisk stratification and that this is modulated by low-grade inflammation.Methodology\\/Principal FindingsWe pooled data from 4 longitudinal studies, including a total of 1,057 patients having CPC determined and major adverse
Gian Paolo Fadini; Shoichi Maruyama; Takenori Ozaki; Akihiko Taguchi; James Meigs; Stefanie Dimmeler; Andreas M. Zeiher; Saula de Kreutzenberg; Angelo Avogaro; Georg Nickenig; Caroline Schmidt-Lucke; Nikos Werner; Stefan Kiechl
BackgroundWhile the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascularrisk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.MethodsAdults (n=38 355) aged 40–69 years living in Melbourne, Australia were
Alison Beauchamp; Anna Peeters; Rory Wolfe; Gavin Turrell; Linton R Harriss; Graham G Giles; Dallas R English; John McNeil; Dianna Magliano; Stephen Harrap; Danny Liew; David Hunt; Andrew Tonkin
Athletes who abuse recombinant human erythropoietin (rhEPO) consider only the benefit to performance and usually ignore the\\u000a potential short and long-term liabilities. Elevated haematocrit and dehydratation associated with intense exercise may reveal\\u000a undetected cardiovascularrisk, but the mechanisms underlying it remain to be fully explained. This study aimed to evaluate\\u000a the cardiovascular effects of rhEPO in rats under chronic aerobic
Nuno Piloto; Helena M. Teixeira; Edite Teixeira-Lemos; Belmiro Parada; Patrícia Garrido; José Sereno; Rui Pinto; Lina Carvalho; Elísio Costa; Luís Belo; Alice Santos-Silva; Frederico Teixeira; Flávio Reis
The pathogenesis and treatment of retinal vein occlusions (RVO) are largely unclear. Prevalence of cardiovascularrisk factors\\u000a and of thrombophilic abnormalities was evaluated in 117 patients (61 M, 56 F; mean age 51 ± 13 years) with a history of RVO\\u000a (62 central, CRVO; 48 branch, BRVO; 7 both) and in 202 age- and sex-matched control subjects. Cardiovascular outcome after\\u000a a mean 8.2 year
Mirko Di Capua; Antonio Coppola; Rosina Albisinni; Antonella Tufano; Anna Guida; Matteo Nicola Dario Di Minno; Ferdinando Cirillo; Marcello Loffredo; Anna Maria Cerbone
Cardiovascular disease and type 2 diabetes are uncommon in people consuming vegetarian and vegan diets. Vegetarian and vegan\\u000a dietary patterns tend to result in lower body weight and better nutritional profiles than conventional healthy eating patterns\\u000a and have been shown to be an effective tool for management of cardiovascular disease and diabetes risk. The consistency of\\u000a observed beneficial outcomes with
Associations between sleep-disordered breathing and cardiovascular disease (CVD) may be mediated by higher cardiovascularrisk factor levels in those with sleep-disordered breathing. The authors examined these relations in the Sleep Heart Health Study, a multiethnic cohort of 6,440 men and women over age 40 years conducted from October 1995 to February 1998 and characterized by home polysomnography. In 4,991 participants
Anne B. Newman; F. Javier Nieto; Ursula Guidry; Bonnie K. Lind; Susan Redline; Eyal Shahar
Summary Life expectancy is shorter in the subset of insulin-dependent diabetic (IDDM) patients who are susceptible to kidney disease.\\u000a Familial factors may be important. In this study the prevalence of cardiovascular disease mortality and morbidity and of risk\\u000a factors for cardiovascular disease was compared in the parents of 31 IDDM patients with elevated albumin excretion rate (AER\\u000a > 45 ?g\\/min;
S. De Cosmo; S. Bacci; G. P. Piras; M. Cignarelli; G. Placentino; M. Margaglione; D. Colaizzo; G. Di Minno; R. Giorgino; A. Liuzzi; G. C. Viberti
OBJECTIVESWe sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.BACKGROUNDPeriodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.METHODSPhysicians’ Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene
The outcome of a total dietary approach using a wide range of n-3 polyunsaturated fatty acids (PUFA) enriched food items on\\u000a cardiovascular diseases called for further investigation. The study objective was to assess the effect of an ALA-enriched\\u000a food supply on cardiovascularrisk factors in healthy males. A dietary intervention (single-blind field trial with pre- and\\u000a post-measurements) was performed with
Isabelle Sioen; Mirjam Hacquebard; Gaëlle Hick; Veronique Maindiaux; Yvan Larondelle; Yvon A. Carpentier; Stefaan De Henauw
Background—Retrospective and case-control studies show that hyperhomocysteinemia is an independent risk factor for atherosclerosis in patients with end-stage renal disease. We studied prospectively the association between total homocysteine and cardiovascular outcomes. Methods and Results—In all, 167 patients (93 men, 74 women; mean age, 56.3614.7 years) were followed for a mean duration of 17.466.4 months. Cardiovascular events and causes of mortality
Ali Moustapha; Arabi Naso; Maher Nahlawi; Anjan Gupta; Kristopher L. Arheart; Donald W. Jacobsen; Killian Robinson; Vincent W. Dennis
Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention. Global cardiovascularrisk represents the action and consequences of all risk factors that simultaneously or sequentially act on the body, leading to atherogenesis/atherosclerosis. In daily practice, a stepwise approach to control cardiovascularrisk in people with type 2 diabetes has been proposed. This algorithm comprises three steps: identification of cardiovascularrisk factors, interpretation of global cardiovascularrisk, and intervention for all identified risk factors and diseases. In the past decades, the whole concept of diabetes and the metabolic syndrome care has undergone a radical change. From here the concept of modern management of those diseases emerged: early, multi-factorial and intensive control. This concept emphasized early and aggressive interventions for all cardiovascularrisk factors in the long-term management. The model of multiple cardiovascularrisk factor intervention ought to be implemented in daily practice as much as possible. This offers a unique opportunity to reduce the devastating cardiovascular morbidity and mortality in people with type 2 diabetes and the metabolic syndrome.
Cerghizan, Anca; Bala, Cornelia; Nita, Cristina; Hancu, Nicolae
Background: Assessment of individual risk is an important part of the primary prevention of coronary disease and stroke. The accuracy by which individuals perceive their risk is unclear. We aimed to explore the accuracy of self-perceived cardiovascularrisk in the community, and the value of one-to-one interview, using a risk assessment tool, in increasing the accuracy. Methods: Participants in 2 community health fair events in 2006 were asked to assign their 5-year cardiovascularrisk to one of 3 categories (high, moderate and low), before and after being counseled about their risk using a Framingham-based risk calculator. Agreement between perceived risk and calculated risk was studied using kappa analysis. Change in perception was the indicator of response to the study intervention. Predictors of accuracy, underestimation, and responsiveness to the study intervention were identified using logistic regression. Results: There were 146 participants that were included in the analysis (mean age±SD, 47±15; 64% women). Rate of inaccuracy was 66% (mainly due to underestimation of risk n=86 participants). Agreement between perceived and objective risk was poor (kappa±standard error [SE] 09.0±4.3%). After the study intervention, the rate of accuracy significantly increased to 74% (n=108, p<0.0001). Post intervention kappa±SE 60.9±5.7%. Age >45 years predicted inaccuracy. Age > 45 years, non-African-American race, and alcohol use predicted underestimation. Family history of cardiovascular diseases or risk factors predicted responsiveness. Conclusion: Self perception of the 5-year risk of cardiovascular events is inaccurate, mainly due to underestimation. A targeted educational session using a risk assessment tool improved the accuracy.
Hussein, Haitham M; Harris-Lane, Pansy; Abdelmoula, Mohamed M; Vazquez, Gabriela
Objectives:Patients with rheumatoid arthritis (RA) have an increased cardiovascularrisk, but the magnitude of this risk is not known precisely. A study was undertaken to investigate the associations between RA and type 2 diabetes (DM2), a well-established cardiovascularrisk factor, on the one hand, and cardiovascular disease (CVD) on the other.Methods:The prevalence of CVD (coronary, cerebral and peripheral arterial disease)
V P van Halm; M. J. L. Peters; A. E. Voskuijl; M. Boers; W. F. Lems; M. Visser; C. D. A. Stehouwer; A. M. W. Spijkerman; J. M. Dekker; G Nijpels; R. J. Heine; L. M. Bouter; Y. M. Smulders; B. A. C. Dijkmans; M. T. Nurmohamed
Coronary artery calcium (CAC) is associated with the presence of coronary artery disease (CAD) and cardiovascularrisk factors.\\u000a However, the relation between cardiovascularrisk factors and CAD has not yet been fully elucidated in patients with a zero\\u000a or low coronary artery calcium score (CACS). The purpose of this study was to evaluate the relation of cardiovascularrisk\\u000a factors and
Background Previous studies suggest an increased risk of cardiovascular disease in psoriasis, but the relative contributions of traditional risk factors and markers of disease severity are unclear. We examined the effect of psoriasis disease characteristics on cardiovascularrisk after adjusting for traditional cardiovascularrisk factors. Methods Study populations included (a) case-cohort sample of 771 patients nested within a population-based psoriasis incidence cohort, and (b) cohort of 1905 patients with incident and prevalent psoriasis patients. Both cohorts were followed up to ascertain disease and treatment characteristics, traditional cardiovascularrisk factors and cardiovascular outcomes. Cox proportional hazards regression models were used to identify predictors of cardiovascular outcomes. Results After adjusting for traditional risk factors, increasing number of psoriasis affected body sites at disease onset (HR 1.53 per additional site, 95% CI: 1.20, 1.95) was significantly associated with an increased risk of cardiovascular outcomes. Phototherapy (HR 3.76, 95% CI: 2.45, 5.77) and systemic therapy (HR 2.17, 95% CI: 1.50, 3.13) were associated with a higher risk of cardiovascular outcomes in univariate analyses, but these relatively strong associations disappeared after adjusting for cardiovascularrisk factors. Conclusion Increasing number of psoriasis affected body sites may be a severity indicator in psoriasis and is associated with an increased cardiovascularrisk. Due to low number of patients exposed to systemic therapy, this study had limited power to examine the effect of treatment on cardiovascularrisk. Strong associations with phototherapy and systemic therapy suggest that the cardiovascularrisk in psoriasis is confined to patients with severe disease.
Maradit-Kremers, Hilal; Icen, Murat; Ernste, Floranne C.; Dierkhising, Ross A.; McEvoy, Marian T.
This cross-sectional study assessed the prevalence of malnutrition and several metabolic risk factors for cardiovascular disease in 287 apparently healthy older adults from Northwest Mexico. Also, the impact of overweight and obesity on metabolic risk factors was assessed. Nutritional status was determined using serum albumin levels and anthropometry. Vitamin status was also assessed. Metabolic risk factors for cardiovascular disease were
Heliodoro Alemán-Mateo; Julián Esparza-Romero; Rene Urquidez Romero; Humberto Astiazarán García; Flavia A. Pérez Flores; Blanca V. Ochoa Chacón; Mauro E. Valencia
Erectile dysfunction (ED) is a common complaint in hypertensive men and can represent a systemic vascular disease, an adverse effect of antihypertensive medication or a frequent concern that may impair drug compliance. ED has been considered an early marker of cardiovascular disease. The connection between both conditions seems to be located in the endothelium, which may become unable to generate the necessary dilatation in penile vascular bed in response to sexual excitement, producing persistent impairment in erection. On the other hand, the real influence of antihypertensive drugs in erectile function still deserves discussion. Therefore, regardless of ED mechanism in hypertension, early diagnosis and correct approach of sexual life represent an important step of cardiovascular evaluation which certainly contributes for a better choice of hypertension treatment, preventing some complications and restoring the quality of life.
Growth hormone (GH) and insulin-like growth factor-I are involved in heart development and in maintaining cardiac structure and performance. Cardiovascular disease has been reported to reduce life expectancy both in GH deficiency (GHD) and in GH excess. Patients with GHD suffer from abnormalities of left ventricular performance, i.e. reduced diastolic filling and impaired response to peak exercise. Patients with GHD
Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized cause of liver disease in the United States and worldwide.\\u000a Increasing recognition of the importance of NAFLD and its strong relationship with the metabolic syndrome has stimulated an\\u000a interest in the possible role of NAFLD in the development and progression of cardiovascular disease (CVD). Recent prospective\\u000a studies demonstrated that NAFLD, especially
Circadian rhythmicity has been widely studied in the cardiovascular system and has a relevant role in three different areas:\\u000a heart, vascular smooth muscle, and hemostatic capacity of blood. Metabolic syndrome (MetS) and chronodisruption are also highly\\u000a interconnected. Epidemiologic studies show that shift workers and short sleepers develop obesity and MetS impairments more\\u000a frequently. In addition, studies performed in experimental models
Background: The Cardiovascular Health Cognition Study has evaluated the determinants of dementia among 3,608 participants that had a magnetic resonance imaging (MRI) of the brain in 1991 and were followed to 1998–1999. Methods: There were 480 incident dementia cases, 330 (69%) were classified as Alzheimer’s disease (AD). Results: In univariate analysis, low scores on the Modified Mini-Mental State Examination (3MSE)
Lewis H. Kuller; Oscar L. Lopez; Anne Newman; Norman J. Beauchamp; Greg Burke; Corinne Dulberg; Annette Fitzpatrick; Linda Fried; Mary N. Haan
Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. However, most pertinent studies primarily relied on middle aged adults. We aimed to provide empirical evidence on the association of smoking with cardiovascular events and the benefits of smoking cessation in people aged 50 years or older. In a German population-based cohort study detailed information on lifetime smoking history was obtained from 8,807 individuals aged 50-74 years, without previous myocardial infarction (MI) or stroke. Cox proportional hazards regression was applied to estimate the impact of smoking on MI, stroke and cardiovascular death (CVD) as well as on the combined outcome of major cardiovascular events (MI, stroke or CVD). In addition, the impact of smoking and the benefits of smoking cessation were quantified by risk advancement periods (RAP). The cohort included 17.2 % current smokers, 31.7 % former smokers and 51.1 % never smokers. During a mean follow-up of 9.1 years, 261 participants experienced a first MI, 456 had a primary stroke and 274 died of cardiovascular reasons. Compared to never smokers, adjusted hazard ratios (95 % confidence intervals) of current smokers were 2.25 (1.62-3.12), 2.12 (1.65-2.73) and 2.45 (1.76-3.42) and RAPs were 19.3, 9.8 and 8.4 years for MI, stroke and CVD, respectively. Strong dose-response relationships were seen with both current and life-time amount of smoking. Most of the excess risk and risk advancement disappeared within 5 years after smoking cessation. Smoking is a strong risk factor for cardiovascular events even at older age. Smoking cessation is highly and rapidly beneficial also at advanced age. PMID:23397516
Gellert, Carolin; Schöttker, Ben; Müller, Heiko; Holleczek, Bernd; Brenner, Hermann
In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose–response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascularrisk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascularrisk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascularrisk factors. PMID:22637741
Vanhees, L; Geladas, N; Hansen, D; Kouidi, E; Niebauer, J; Reiner, Z; Cornelissen, V; Adamopoulos, S; Prescott, E; Börjesson, M; Bjarnason-Wehrens, B; Björnstad, H H; Cohen-Solal, A; Conraads, V; Corrado, D; De Sutter, J; Doherty, P; Doyle, F; Dugmore, D; Ellingsen, Ø; Fagard, R; Giada, F; Gielen, S; Hager, A; Halle, M; Heidbüchel, H; Jegier, A; Mazic, S; McGee, H; Mellwig, K P; Mendes, M; Mezzani, A; Pattyn, N; Pelliccia, A; Piepoli, M; Rauch, B; Schmidt-Trucksäss, A; Takken, T; van Buuren, F; Vanuzzo, D
The article reviews the evidence and extent of the excess cardiovascularrisk in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis. RA entails nearly twice as high a standardized mortality ratio and is considered an equivalent of type 2 diabetes with regard to cardiovascularrisk. The associated excess cardiovascularrisk can only partly be explained by traditional risk factors, and the underlying inflammation is crucially involved in the pathogenesis. Data obtained from patients with early RA suggest that serum triglycerides, a proxy of disease activity as markers of systemic inflammation, impaired function of apolipoprotein A-I and HDL particles, and mediating hypertension are determinants of the excess cardiovascularrisk. These changes seem to be preceded by a lowering of total cholesterol and are followed in the course of the disease by immune processes typically illustrated by positivity of rheumatoid factor. Evidence is available to postulate the notion that reduced plasma lipoprotein- associated phospholipaseA2 mass or activity, mediated by diminished hydrolysis of VLDL triglycerides and of Lp(a) phospholipids, may induce reduction or altered composition of HDL particles and apoA-I dysfunction which, along with elevated plasma triglycerides, initiate and contribute to chronic inflammation. Lifestyle modification, traditional non-steroidal anti-inflammatory drugs and cyclo-oxygenase-2 inhibitors, low-dose corticosteroids, statins, tumor-necrosis-? inhibitors and, particularly, the immunosuppressive methotrexate, all have potential beneficial effects in eliciting a reduction in disease activity and cardiovascularrisk. Adherence to the recent EULAR recommendations is a key in the prevention and management of cardiovascularrisk among patients with rheumatic diseases. PMID:22364131
There exists significant evidence of increased risk of cardiovascular (CV) disease in rheumatoid arthritis (RA) patients in comparison with the general population. This finding has been supported by a number of guidelines recommending screening for CV disease risk in patients with the disease. However, the opportunity to identify and manage those patients at risk has been missed in both primary and secondary care. The success of CV risk management in diabetes patients provides a clear incentive to identify and actively manage CV risk in all RA patients as part of routine practice. This article provides an approach that shows how to assess for CV risk in standard clinical practice. PMID:24005485
Background There is increasing concern that prescription stimulants may be associated with adverse cardiovascular events such as stroke, myocardial infarction, and sudden death. Public health concerns are amplified by increasing use of prescription stimulants among adults. Methods The objective of this study was to conduct a systematic review of the evidence of an association between prescription stimulant use and adverse cardiovascular outcomes. PUBMED, MEDLINE, EMBASE and Google Scholar searches were conducted using key words related to these topics (MESH): ADHD; Adults; Amphetamine; Amphetamines; Arrhythmias, Cardiac; Cardiovascular Diseases; Cardiovascular System; Central Nervous Stimulants; Cerebrovascular; Cohort Studies; Case–control Studies; Death; Death, Sudden, Cardiac; Dextroamphetamine; Drug Toxicity; Methamphetamine; Methylphenidate; Myocardial Infarction; Stimulant; Stroke; Safety. Eligible studies were population-based studies of children, adolescents, or adults using prescription stimulant use as the independent variable and a hard cardiovascular outcome as the dependent variable. Results Ten population-based observational studies which evaluated prescription stimulant use with cardiovascular outcomes were reviewed. Six out of seven studies in children and adolescents did not show an association between stimulant use and adverse cardiovascular outcomes. In contrast, two out of three studies in adults found an association. Conclusions Findings of an association between prescription stimulant use and adverse cardiovascular outcomes are mixed. Studies of children and adolescents suggest that statistical power is limited in available study populations, and the absolute risk of an event is low. More suggestive of a safety signal, studies of adults found an increased risk for transient ischemic attack and sudden death/ventricular arrhythmia. Interpretation was limited due to differences in population, cardiovascular outcome selection/ascertainment, and methodology. Accounting for confounding and selection biases in these studies is of particular concern. Future studies should address this and other methodological issues.
Adulteration of food supply by agricultural chemicals has gained national attention as a potential health hazard. Public fears over chemical residues in foods do not appear commensurate with the risks established through experimental or epidemiologic studies. This paper examines the risk to human health from consumption of drug residues in animal-derived foods. In particular, it focuses on antimicrobial residues and
Diabetes represents a state of accelerated cardiovascularrisk with data from longitudinal studies suggesting that in patients with well established diabetes the risk is equivalent to those with existing cardiovascular disease. In addition, the prognosis of patients with diabetes who suffer cardiovascular disease (CVD) is much worse. There are therefore dual imperatives for all physicians, particularly those in primary care, to focus on strategies to reduce vascular risk in their patients with diabetes. There are, in parallel, background issues that make this risk modification in diabetes a priority, with the rising prevalence of disease, driven at least in part by the rising tide of obesity, and the rising cost (42% of total expenditure) of treating CVD in diabetics. Evidence for interventions that modify the CVD risk in diabetes is now strong, with unequivocal data to support multifactorial risk modification, particularly for the effective targeting of glycaemia and blood pressure (with primary evidence for bp targets below standard care) from studies such as Steno2 and UKPDS, and lipid modification through the use of statins in both secondary (HPS) and primary (CARDS) prevention of CVD in diabetes. Knowledge of these interventions is high in primary care, but implementation is variable. This is probably at least in part because primary care physicians appear to consider risk factor modification within single risk strategies, rather than adopting lifestyle and therapeutic interventions that influence multiple risks in a systematic package of care and patient follow up. PMID:16822723
Background The predictive value of serum uric acid (SUA) for adverse cardiovascular events among obese and overweight patients is not known, but potentially important because of the relation between hyperuricaemia and obesity. Methods The relationship between SUA and risk of cardiovascular adverse outcomes (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality, respectively, was evaluated in a post-hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial. Participants enrolled in SCOUT were obese or overweight with pre-existing diabetes and/or cardiovascular disease (CVD). Cox models were used to assess the role of SUA as an independent risk factor. Results 9742 subjects were included in the study; 83.6% had diabetes, and 75.1% had CVD. During an average follow-up time of 4.2 years, 1043 subjects had a primary outcome (myocardial infarction, resuscitated cardiac arrest, stroke, or cardiovascular death), and 816 died. In a univariate Cox model, the highest SUA quartile was associated with an increased risk of cardiovascular adverse outcomes compared with the lowest SUA quartile in women (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.20–2.10). In multivariate analyses, adjusting for known cardiovascularrisk factors the increased risk for the highest SUA quartile was no longer statistically significant among women (HR: 0.99; 95% CI: 0.72–1.36) nor was it among men. Analyses of all-cause mortality found an interaction between sex and SUA. In a multivariate Cox model including women only, the highest SUA quartile was associated with an increased risk in all-cause mortality compared to the lowest SUA quartile (HR: 1.51; 95% CI: 1.08–2.12). No relationship was observed in men (HR: 1.06; 95% CI: 0.82–1.36). Conclusion SUA was not an independent predictor of cardiovascular disease and death in these high-risk overweight/obese people. However, our results suggested that SUA was an independent predictor of all-cause mortality in women.
Skak-Nielsen, Helle; Torp-Pedersen, Christian; Finer, Nick; Caterson, Ian D.; Van Gaal, Luc; James, W. Philip T; Maggioni, Aldo Pietro; Sharma, Arya M.; Coutinho, Walmir; Andersson, Charlotte
We studied the prevalence of risk factors and related cardiovascular complications in 403 patients with periferal arterial disease (PAD) arising from atherosclerosis. The control group was made up of 126 patients of the same age and sex and without PAD. The average age was 66.9 +/- 12 years, and the percentage of men was 80%. Among the male subjects, smoking, the presence of diabetes, total cholesterol count, and age were the prevalent risk factors, even after logistic regression analysis. Among women, only smoking and diabetes showed significant differences. Among both sexes, the prevalence of arterial hypertension was similar to that of the controls. Greater prevalence of related cardiovascular complications was found only in men. We conclude that for PAD, smoking and diabetes are the most important cardiovascularrisk factors, with total cholesterol level being an important additional factor in men. PMID:8290754
Menopause is a consequence of the normal aging process in women. This fact implies that the physiological and biochemical alterations resulting from menopause often blur with those from the aging process. It is thought that menopause in women presents a higher risk for cardiovascular disease although the precise mechanism is still under discussion. The postmenopause lipid profile is clearly altered, which can present a risk factor for cardiovascular disease. Due to the role of mitochondria in fatty acid oxidation, alterations of the lipid profile in the menopausal women will also influence mitochondrial fatty acid oxidation fluxes in several organs. In this paper, we propose that alterations of mitochondrial bioenergetics in the heart, consequence from normal aging and/or from the menopausal process, result in decreased fatty acid oxidation and accumulation of fatty acid intermediates in the cardiomyocyte cytosol, resulting in lipotoxicity and increasing the cardiovascularrisk in the menopausal women.
Oliveira, Paulo J.; Carvalho, Rui A.; Portincasa, Piero; Bonfrate, Leonilde; Sardao, Vilma A.
Rheumatoid arthritis (RA) is associated with a similar cardiovascularrisk to that in diabetes, and therefore cardiovascularrisk management (CV-RM) - that is, identification and treatment of cardiovascularrisk factors (CRFs) - is mandatory. However, whether and to what extent this is done in daily clinical practice is unknown. In a retrospective cohort investigation, CV-RM was therefore compared between rheumatologists and primary care physicians (PCPs). Remarkably, CRFs in RA were less frequently identified and managed by rheumatologists in comparison with PCPs. In addition, PCPs assessed CRFs less frequently in RA than in diabetes. Obviously, there is a clear need for improvement of CV-RM in RA and this should be a joint effort from the rheumatologist and the PCP.
Nonalcoholic fatty liver disease is now regarded as the most common form of chronic liver disease in adults and children. The close association between nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome has been extensively described. Moreover, a growing body of evidence suggest that NAFLD by itself confers a substantial cardiovascularrisk independent of the other components of the metabolic syndrome. Given the significant potential for morbidity and mortality in these patients, and the large proportion of both pediatric and adult population affected, it is important that we clearly define the overall risk, identify early predictors for cardiovascular disease progression, and establish management strategies. In this article, we will focus on current data linking NAFLD and the severity of liver damage present in children with cardiovascularrisk.
Alkhouri, Naim; Carter-Kent, Christine; Elias, Michael; Feldstein, Ariel E
Epidemiological studies suggest that high intakes of dietary flavonoids are associated with decreased cardiovascular disease mortality and risk factors. Less is known about the cardioprotective effects of flavonoids from fruit and vegetables. This review summarizes data from studies which examine the effects of commonly consumed fruit and vegetables on cardiovascular disease risk biomarkers in healthy volunteers or at-risk individuals. Although flavonoids from apples, berries, and onions appear to impact positively on blood pressure, vascular function, and serum lipid levels, further research is required to find out the optimal quantity and food matrix for conferring substantial clinical benefit. The benefits from citrus flavonoids are still inconclusive. Further robust, longer-term dietary intervention studies, with the inclusion of placebo or control arms, are required to improve the credibility of the findings and confirm current observations. An improved understanding of the impact of flavonoids from fruit and vegetables can help one make discerning food choices for optimal cardiovascular health. PMID:24091782
Toh, J Y; Tan, Verena M H; Lim, Paul C Y; Lim, S T; Chong, Mary F F
Traditionally, psoriasis was considered to be a purely cutaneous disease affecting otherwise healthy patients (except for joint involvement). Recent studies have, however, shown a relationship between psoriasis and cardiovascular disease, with increased mortality in patients who have severe forms of psoriasis. Dermatologists are thus in a position to play an important role in identifying patients at greater risk of cardiovascular disease and detecting potential risk factors that are, for the most part, manageable and avoidable. To this end, we designed a multiplatform application that provides a simple and intuitive tool to determine body mass index, whether or not metabolic syndrome is present, and cardiovascularrisk. The application runs on iOS, Android, and the webpage of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV). PMID:22284865
Rheumatoid arthritis (RA) is associated with a similar cardiovascularrisk to that in diabetes, and therefore cardiovascularrisk management (CV-RM) - that is, identification and treatment of cardiovascularrisk factors (CRFs) - is mandatory. However, whether and to what extent this is done in daily clinical practice is unknown. In a retrospective cohort investigation, CV-RM was therefore compared between rheumatologists and primary care physicians (PCPs). Remarkably, CRFs in RA were less frequently identified and managed by rheumatologists in comparison with PCPs. In addition, PCPs assessed CRFs less frequently in RA than in diabetes. Obviously, there is a clear need for improvement of CV-RM in RA and this should be a joint effort from the rheumatologist and the PCP. PMID:23514404
Purpose of review Adolescence is a common time for the identification of cardiovascular disease risk factors, including elevated cholesterol. Guidelines for the detection and treatment of hypercholesterolemia differ for children and adults. This review highlights these differences and discusses special considerations for cholesterol management in the adolescent population. Recent findings Several longitudinal studies have confirmed that the number of cardiovascularrisk factors present in adolescence, including elevated cholesterol, lead to atherosclerosis in adults. There is increased awareness that other chronic medical conditions, including diabetes, congenital heart disease, inflammatory diseases, and childhood cancer, can accelerate this process. There is a move to screen and treat more young patients with elevated cholesterol to prevent future cardiovascular disease. New markers of atherosclerosis are being used to quantify cardiovascular disease risk in adolescents in research populations. The safety and efficacy of several interventions, including drug therapy, is increasingly established. Summary Comprehensive cardiovascularrisk assessment is important for adolescent health and includes assessment of family history and tobacco use along with measurement of body mass index and blood pressure. Additionally, cholesterol screening is recommended for overweight adolescents or those with an unknown family history and for all patients by the age of 20. Providers caring for adolescents should be familiar with both the pediatric and adult cholesterol screening and treatment guidelines as well as how common adolescent conditions affect cholesterol levels.
Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascularrisk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascularrisk factors and/or events.
Torres, Marcia Regina Simas Goncalves; Sanjuliani, Antonio Felipe
Lumbar radicular pain is a fairly common health problem, yet its risk factors are far from clear. There are no published systematic\\u000a reviews on associations between cardiovascular or lifestyle risk factors and lumbar radicular pain or sciatica. The aim of\\u000a this systematic literature review was to assess associations between these risk factors and lumbar radicular pain or sciatica.\\u000a We conducted
Rahman Shiri; Jaro Karppinen; Päivi Leino-Arjas; Svetlana Solovieva; Helena Varonen; Eija Kalso; Olavi Ukkola; Eira Viikari-Juntura
Cardiovascularrisk factors are those environmental, behavioral, genetic, and\\/or personal factors whose presence indicates\\u000a a heightened risk of subsequent vascular disease events. Smoking, hypertension, and hyperlipidemia, initially identified by\\u000a astute clinicians, were all subsequently confirmed and defined as risk factors through formal prospective epidemiologic study,\\u000a long before evidence of causality was available. Ultimately, clinical trials demonstrated a reversible contribution of
Objective:To derive the optimal BMI and waist circumference (WC) cut-off values to predict clustering of cardiovascularrisk factors in Hong Kong Chinese adolescents.Research Methods and Procedures:A total of 2102 Hong Kong Chinese 12 to 19 years of age were recruited. Participants were considered to have clustering of risk factors if at least three of the following risk factors were present:
Vanessa W. S. Ng; Alice P. S. Kong; Kai Chow Choi; Risa Ozaki; Gary W. K. Wong; Wing Yee So; Peter C. Y. Tong; Rita Y. T. Sung; L. Y. Xu; Michael H. M. Chan; Chung Shun Ho; Christopher W. K. Lam; Juliana C. N. Chan
Background—The prevalence of cardiovascular disease (CVD) risk factors has been increasing in China. Methods and Results—We examined the prevalence of CVD risk factor clustering among Chinese adults aged 35 to 74 years with data from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia), a cross-sectional survey of a nationally representative sample (n14 690) conducted during 2000 to 2001
Dongfeng Gu; Anjali Gupta; Paul Muntner; Shengshou Hu; Xiufang Duan; Jichun Chen; Robert F. Reynolds; Paul K. Whelton; Jiang He
Background Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascularrisk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascularrisk, with no additional effect of self-monitoring. For considering future approaches of cardiovascularrisk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT. Methods Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50–75 years, women aged 55–75 years), with an elevated cardiovascularrisk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education). Results Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide. Conclusions In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity. Trial registration Trialregister.nl identifier: http://NTR2188
Since their introduction in the 1980s, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have emerged as the one of the best-selling medication classes to date, with numerous trials demonstrating powerful efficacy in preventing cardiovascular outcomes. As our understanding of low-density lipoprotein cholesterol (LDL-C) and atherosclerosis continues to grow, the concept of ‘lower is better’ has corresponded with a ‘more is better’ approach to statin-based therapy. This review provides a detailed understanding of the clinical efficacy and safety of statins with a particular emphasis on the third generation drug, rosuvastatin.
The detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or minor disruption of the aortic valve with associated turbulence but minimal obstruction. Aortic sclerosis has two important clinical implications. Firstly, aortic sclerosis is an antecedent to clinically significant aortic valve obstruction and, secondly, it acts as a marker of increased risk of cardiovascular events. This article reviews the evidence that aortic sclerosis is a useful adjunctive tool in cardiovascularrisk stratification and that its progression to haemodynamically significant aortic stenosis is a potential focus for individual monitoring and for interventional studies.
The ratio of older adults with chronic illnesses has increased due to increased average life spans. The incidence of cardiovascular diseases among older adults has reached 33.26%, becoming the leading chronic disease and second most significant cause of mortality among older adults. Statistics show that the largest proportion of expenditures on prescription pharmaceuticals in the National Health Insurance goes toward the treatment of cardiovascular diseases. In addition, complications resulting from cardiovascular diseases result in burdens of care that impact seriously on the individual, their family, and society. Studies have supported physical activity as the most important behavior in reducing cardiovascular disease risk factors. Qigong, a traditional Chinese therapeutic activity, uses gentle movements of extremities and control of breathing to improve health, enhance vitality and enable bodies, emotion, and spirit to reach optimal performance. Evidence-based research supports the argument that Qigong improves cardiovascular-respiratory function and lipid profile, decreases blood sugar, and relieves anxiety and depression. We suggest developing a safe, convenient, and simple Qigong exercise regimen for older adults at higher risk of cardiovascular diseases to extend their life expectancy and quality of life. PMID:19222003
This narrative review examines the concept of diabetes as a cardiovascular disease (CVD) risk equivalent, the rationale and approaches to absolute CVD risk estimation in type 2 diabetes. In people with diabetes, CVD risk follows a gradient. Reliably capturing this gradient depends on the combination of several risk factors. Existing CVD risk tools applicable to people with diabetes have shown a modest-to-acceptable performance. Future improvements may include updating existing models or constructing new ones with improved predictive accuracy. Ultimately, developed models should be tested in independent populations, and the impact of their uptake on clinical decision making and the outcome of care assessed. PMID:23623209
Heart disease is the major leading cause of death and disability in the world. Mainly affecting the elderly population, heart disease and its main outcome, cardiovascular disease, have become an important risk factor in the development of cognitive decline and Alzheimer's disease (AD). This paper examines the evidence linking chronic brain hypoperfusion induced by a variety of cardiovascular deficits in the development of cognitive impairment preceding AD. The evidence indicates a strong association between AD and cardiovascularrisk factors, including ApoE4, atrial fibrillation, thrombotic events, hypertension, hypotension, heart failure, high serum markers of inflammation, coronary artery disease, low cardiac index, and valvular pathology. In elderly people whose cerebral perfusion is already diminished by their advanced age, additional reduction of cerebral blood flow stemming from abnormalities in the heart-brain vascular loop ostensibly increases the probability of developing AD. Evidence also suggests that a neuronal energy crisis brought on by relentless brain hypoperfusion may be responsible for protein synthesis abnormalities that later result in the classic neurodegenerative lesions involving the formation of amyloid-beta plaques and neurofibrillary tangles. Insight into how cardiovascularrisk factors can induce progressive cognitive impairment offers an enhanced understanding of the multifactorial pathophysiology characterizing AD and ways at preventing or managing the cardiovascular precursors of this dementia.
Recently, drug interactions with grapefruit juice (GFJ) have received considerable attention from basic scientists, physicians, industry and drug regulatory agencies. GFJ has been shown to inhibit cytochrome P-450 3A4 isoenzyme and P-glycoprotein transporters in the intestine and liver. The GFJ-induced inhibitory effects are considered to be responsible for alterations in drug bioavailability, and pharmacokinetic and pharmacodynamic changes when drugs are ingested concurrently with GFJ. However, little or no interaction is observed when GFJ is taken concomitantly with parentally administered drugs. It is well known that risk factors for cardiovascular disease increase with advancing age, while hepatic metabolic activity decreases in elderly individuals. It is, therefore, possible that the combination of GFJ and cardiovascular medications may pose a health risk, especially in elderly patients. A number of studies have shown interactions of GFJ with cardiovascular drugs such as calcium-channel blockers, angiotensin II receptor antagonists, beta-blockers, and statins. Such interactions are likely to change the pharmacokinetics and pharmacodynamics of these drugs, consequently causing undesirable health effects. Therefore, health care professionals and the public need to be advised of the potential risks associated with the concomitant use of GFJ and interacting medications, especially cardiovascular drugs and agents with a narrow therapeutic index. This review focuses on the adverse interactions of GFJ and cardiovascular medications, and the proposed underlying mechanisms of such interactions.
We sought to critically assess the role of lipoprotein-associated phospholipase A2 (Lp-PLA2) in the prediction of cardiovascular events in primary and secondary prevention settings. The inclusion criteria for our study included population-based epidemiologic studies and the presence of clinical outcomes of interest, including atherosclerotic disease, coronary events, stroke, and cardiovascular death. Studies that lacked clinical outcomes or that involved animals were excluded. We included primary and secondary prevention studies of subjects in all ethnic groups and of either sex, with no age limitation. We searched MEDLINE, Google Scholar, and the Cochrane Library for studies with publication dates from January 1970 through July 2009, and we searched major cardiology meeting abstracts from 2000 through 2009. From each study, we used predictive ability—including relative risk, hazard ratio, odds ratio, and prevalence of high Lp-PLA2 levels, with adjustment—along with baseline population characteristics. Of 33 studies that met our inclusion criteria, 30 showed a significant association between Lp-PLA2 and cardiovascular events. Most of the studies had been adjusted for major Framingham risk factors and other variables that might influence the effect under question. After multivariate adjustments in cohort and nested case-control studies, increased levels of Lp-PLA2 remained a significant predictor of cardiovascular events. The available body of evidence suggests that Lp-PLA2 is a reliable marker of risk for cardiovascular events.
Madjid, Mohammad; Ali, Muzammil; Willerson, James T.
Introduction Although men and women have similar risk factors for cardiovascular disease, many social behaviors in developing countries differ by sex. Rural-to-urban migrants have different cardiovascularrisk profiles than rural or urban dwellers. The objective of this study was to evaluate the sex differences with specific cardiovascularrisk factors in rural-to-urban migrants. Methods and Results We used the rural-to-urban migrant group of the PERU MIGRANT cross-sectional study to investigate the sex differences in specific cardiovascularrisk factors: obesity, hypertension, metabolic syndrome, as well as exposures of socioeconomic status, acculturation surrogates and behavioral characteristics. Logistic regression analysis was used to characterize strength of association between sex and our outcomes adjusting for potential confounders. The sample of migrants was 589 (mean age 46.5 years) and 52.4% were female. In the adjusted models, women were more likely to be obese (OR=5.97; 95%CI: 3.21–11) and have metabolic syndrome (OR=2.22; 95%CI: 1.39–3.55) than men, explaining the greatest variability for obesity and metabolic syndrome but not for hypertension. Conclusions Our results suggest that interventions for CVD in Peru should be sex-specific and address the unique health needs of migrant populations living in urban shantytowns since the risk factors for obesity and metabolic syndrome differ between males and females.
Bernabe-Ortiz, Antonio; Benziger, Catherine Pastorius; Gilman, Robert H.; Smeeth, Liam; Miranda, J. Jaime
Adiponectin and leptin are likely involved in the pathophysiology of rheumatoid arthritis (RA) and therefore potential new therapeutic targets. Adiponectin inhibition could be expected to enhance cardiovascular metabolic risk. However, it is unknown whether RA changes the influence of adipokines on cardiovascular metabolic risk. We determined whether RA impacts on the independent relationships of circulating leptin and adiponectin concentrations with cardiovascularrisk factors and carotid intima-media thickness (cIMT) in 277 black African subjects from a developing population; 119 had RA. RA impacted on the relationships of adiponectin concentrations with lipid concentrations and blood pressure, independent of confounders including adiposity (interaction P < 0.05). This translated into an association of adiponectin concentrations with more favorable lipid variables including HDL cholesterol (P = 0.0005), non-HDL cholesterol (P = 0.007), and triglyceride (P = 0.005) concentrations, total cholesterol-HDL cholesterol (P = 0.0002) and triglycerides-HDL cholesterol (P = 0.0003) ratios, and higher systolic (P = 0.0006), diastolic (P = 0.0004), and mean blood pressure (P = 0.0007) in RA but not non-RA subjects. Leptin was not associated with metabolic risk after adjustment for adiposity. The cIMT did not differ by RA status, and adipokine concentrations were unrelated to atherosclerosis. This study suggests that leptin and adiponectin inhibition may not alter overall cardiovascularrisk and disease in RA.
Dessein, Patrick H.; Norton, Gavin R.; Badenhorst, Margaret; Woodiwiss, Angela J.; Solomon, Ahmed
Background. A number of factors contribute to increased risk of coronary heart disease (CHD) among postmenopausal women, including atherogenic changes in serum cholesterol profiles, weight gain, and decreases in physical activity during the menopause. To date, no study has attempted to prevent elevations in primary CHD risk factors as women experience menopause. Methods. A sample of 535 healthy premenopausal women,
L. Simkinsilverman; R. R. Wing; D. H. Hansen; M. L. Klem; A. Pasagianmacaulay; E. N. Meilahn; L. H. Kuller
A number of observational studies have found that treated hypertensive patients, even those with controlled clinic blood pressure (BP), might have poorer prognosis than untreated hypertensives. Different trials have also shown that relatively low cardiovascular disease (CVD) risk cannot be achieved in high-risk hypertensive patients, leading to the belief they have a "residual CVD risk" that cannot be attenuated by conventional treatment. All these conclusions disregard the facts that the correlation between BP level and CVD risk is stronger for ambulatory than clinic BP and that the BP-lowering efficacy and effects on the 24-h BP pattern of different classes of hypertension medications exhibit statistically and clinically significant treatment-time (morning versus evening) differences. Accordingly, we evaluated the potential differential administration-time-dependent effects on CVD risk of the various classes of hypertension medications and the number of them used for therapy in the MAPEC (Monitorización Ambulatoria para Predicción de Eventos Cardiovasculares, i.e., Ambulatory Blood Pressure Monitoring for Prediction of Cardiovascular Events) study, a prospective, open-label, blinded-endpoint trial on 2156 hypertensive patients (1044 men/1112 women), 55.6?±?13.6 (mean?±?SD) yrs of age, randomized to ingest all prescribed once-a-day hypertension medications upon awakening or the entire daily dose of ?1 of them at bedtime. Ambulatory BP was measured for 48?h at baseline, and again annually or more frequently (quarterly) when adjustment of treatment was necessary to achieve ambulatory, i.e., awake and asleep, BP control. CVD risk according to the number and classes of medications used at the final evaluation was calculated by comparison with that of 734 normotensive subjects who were identically followed and remained untreated. After a median follow-up of 5.6 yrs, CVD risk of hypertensive patients randomized to ingest all medications upon awakening was progressively higher with increase in the number of medications (adjusted hazard ratio [HR]: 1.75, 2.26, 3.02, and 4.18 in patients treated with 1, 2, 3, and ?4 medications daily, respectively; p?.001 compared with normotensive subjects). CVD risk was markedly lower in patients ingesting ?1 medications at bedtime (HR: .35, 1.45, .94, and 2.28 with 1, 2, 3, and ?4 medications daily, respectively), and even lower in patients ingesting all medications at bedtime (HR: .35, .39, .87, and .79 with 1, 2, 3, and ?4 medications daily, respectively). Patients ingesting ?1 medications at bedtime evidenced significantly lower CVD risk than those ingesting all medications upon awakening, independent of class. Greater benefits were observed for bedtime compared with awakening treatment with angiotensin-II receptor blockers (ARBs) (HR: .29 [95% confidence interval, CI .17-.51]; p?.001) and calcium channel blockers (HR: .46 [95% CI: .31-.69]; p?.001). CVD risk was similar for all six classes of tested hypertension medications in patients randomized to ingest all of them upon awakening. Among patients randomized to ingest ?1 medications at bedtime, however, ARBs were associated with significantly lower HR of CVD events than ingestion of any other class of medication also at bedtime (p?.017). We document significantly reduced CVD risk among hypertensive patients ingesting medications at bedtime, independent of the number of hypertension medications required to achieve proper ambulatory BP control. These findings challenge the current belief of "residual CVD risk," as a bedtime-treatment regimen of current hypertension medications, even in risk-high patients, can reduce such risk. PMID:23181712
Hermida, Ramón C; Ayala, Diana E; Mojón, Artemio; Fernández, José R
A key function of a basic and clinical biomedical research organization is to communicate the findings of clinical investigations so that people may apply the results to improve their health and well-being. To help communicate results from cardiovascular disease research, the National Heart, Lung, and Blood Institute has established a series of national health education programs. The authors describe a model for two of the five programs and discuss the role of communication media in supporting national goals for education programs. The research basis for the programs is reviewed, together with the process by which the Institute develops information materials for mass media, notably public service announcements. A description of two national health education campaigns, hypertension and cholesterol, illustrates how market research is used to identify appropriate target audiences, develop messages, and select channels of communication. Lessons learned about the role of mass media in a national health education campaign are summarized.