Trajectories of Metabolic Risk Factors and Biochemical Markers prior to the Onset of Cardiovascular Disease – The Doetinchem Cohort Study

PubMed Central

Hulsegge, Gerben; Spijkerman, Annemieke M. W.; van der Schouw, Yvonne T.; Bakker, Stephan J. L.; Gansevoort, Ron T.; Smit, Henriette A.; Verschuren, W. M. Monique

2016-01-01

Risk factors often develop at young age and are maintained over time, but it is not fully understood how risk factors develop over time preceding cardiovascular disease (CVD). Our objective was to examine how levels and trajectories of metabolic risk factors and biochemical markers prior to diagnosis differ between people with and without CVD over a period of up to 15–20 years. A total of 449 incident non-fatal and fatal CVD cases and 1,347 age- and sex-matched controls were identified in a prospective cohort between 1993 and 2011. Metabolic risk factors and biochemical markers were measured at five-year intervals prior to diagnosis. Trajectories of metabolic risk factors and biochemical markers were analysed using random coefficient analyses. Although not always statistically significant, participants with CVD had slightly more unfavourable levels for most metabolic risk factors and biochemical markers 15–20 years before diagnosis than controls. Subsequent trajectories until diagnosis were similar in participants with incident CVD and controls for body mass index, diastolic blood pressure, total cholesterol, HDL cholesterol, random glucose, triglycerides, gamma glutamyltransferase, C-reactive protein and uric acid. Trajectories were more unfavourable in participants with CVD than controls for systolic blood pressure, waist circumference and estimated glomerular filtration rate (p≤0.05). For example, among participants with CVD, systolic blood pressure increased on average by 9 mmHg over the 18-year period preceding diagnosis, whereas the increase among controls was 4 mmHg. In conclusion, unfavourable levels of metabolic risk factors and biochemical markers are present long before CVD, which indicates that the risk of CVD is already partly determined in young adulthood. This underscores the need for early prevention to reduce the burden of CVD. PMID:27203599

Does sufficient evidence exist to support a causal association between vitamin D status and cardiovascular disease risk? An assessment using Hill's criteria for causality.

PubMed

Weyland, Patricia G; Grant, William B; Howie-Esquivel, Jill

2014-09-02

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill's criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor.

Rheumatoid Arthritis and Cardiovascular Disease: Update on Treatment Issues

PubMed Central

Barbhaiya, Medha; Solomon, Daniel H.

2016-01-01

Purpose of review This review examines thresholds for treatment of traditional cardiovascular disease (CVD) risk factors among RA patients and whether RA-specific treatment modulates cardiovascular risk. Recent findings There are substantial data demonstrating an increased CVD risk among patients with RA. Both traditional CVD risk factors and inflammation contribute to this risk. Recent epidemiologic studies strengthen the case that aggressive immunosuppression with biologic DMARDs, such as TNF antagonists, is associated with a reduced risk of CVD events. However, to data, there are no randomized controlled trials published regarding the management of CVD in RA. Summary Epidemiologic evidence continues to accumulate regarding the relationship between the effects of traditional CVD risk factors and RA-specific treatments on CV outcomes in RA. The field needs randomized controlled trials to better guide management. PMID:23466960

Older adult awareness of the influence of cardiovascular disease risk factors on cognitive function.

PubMed

Wright, Regina S; Ford, Cassandra; Sniscak, Courtney R

2017-03-01

The aims of the current study were to (i) assess older people's awareness of the association between CVD risk factors and cognitive function; and (ii) examine whether awareness varies as a function of demographic factors. Cardiovascular disease (CVD) risk factors have been linked to subtle deficits in cognitive function. CVD risk factors increase the risk of cognitive decline and dementia. The association between cardiovascular disease (CVD) risk factors and cognitive decrements has been well documented among older people; however, we are unaware of any studies that have measured older people's awareness of this relationship in an effort to assess educational needs. A descriptive, cross-sectional survey design was employed. Community-based older adults aged 60 and older completed a survey that assessed their knowledge of the association between CVD risk factors and cognitive function. One hundred fifty older adults, with a mean age of 72.88 years, completed the survey. Results showed that over 75% of the sample was aware that CVD risk factors affect cognitive function. White older adults and older adults with greater perceived financial well-being tended to be more aware of these relationships than non-White participants with less perceived financial well-being. Results suggest that many, but not all older people have awareness of this relationship. As such, there is a need for increased education about the cognitive effects of CVD risk factors, particularly among older people who are already at risk for developing CVD and those with lesser financial well-being. Appropriate educational strategies can expose older patients to the importance of healthy lifestyle and self-care to maintain cognitive function. Nurses can incorporate education into care by identifying patients that would benefit from tailored interventions and providing information to at-risk patients about how to maintain their cognitive function through management of specific CVD risk factors. © 2016 John Wiley & Sons Ltd.

Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study.

PubMed

Keegan, Theresa H M; Kushi, Lawrence H; Li, Qian; Brunson, Ann; Chawla, X; Chew, Helen K; Malogolowkin, Marcio; Wun, Ted

2018-06-01

Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.

Chronic pain, body mass index and cardiovascular disease risk factors: tests of moderation, unique and shared relationships in the Study of Women's Health Across the Nation (SWAN).

PubMed

Burns, John W; Quartana, Phillip J; Bruehl, Stephen; Janssen, Imke; Dugan, Sheila A; Appelhans, Bradley; Matthews, Karen A; Kravitz, Howard M

2015-04-01

Chronic pain may be related to cardiovascular disease (CVD) risk. The current study examined whether persistent bodily pain was related to cardiovascular disease risk factors, whether these effects were moderated by body mass index (BMI), and, if not, whether chronic pain accounted for unique variance in CVD risk factors. Participants were women (N = 2,135) in the Study of Women's Health Across the Nation. A high pain frequency variable (high pain in 0 through 4 assessments) was coded to reflect the frequency of high levels of bodily pain across the first 3 years of the study. Six CVD risk factors and BMI were measured at follow-up year 3. High pain frequency and BMI were correlated significantly with risk factors, although effects for the former were small. Hierarchical multiple regressions revealed high pain frequency × BMI interactions for 5 of 6 CVD risk factors. Dissecting the interactions revealed a similar pattern across 4 risk factors: for women with normal BMI, there was a "dose-response" in which increasing frequency of high pain revealed increasingly worse CVD risk factor levels, whereas for women with obese BMI, high pain frequency was unrelated to risk factors. For obese women, increasing frequency of high pain was associated with higher blood glucose. Although BMI is a well-established CVD risk factor, evaluation of CVD risk level may be improved by considering the incidence of persistent pain, particularly in normal weight women (BMI < 25 kg/m(2)) lower BMI.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

PubMed

Hsieh, K; Murthy, S; Heller, T; Rimmer, J H; Yen, G

2018-03-01

Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Chronic Inflammatory Diseases and Atherosclerotic Cardiovascular Disease: Innocent Bystanders or Partners in Crime?

PubMed

Hansen, Peter Riis

2018-01-01

Inflammation plays a significant role in atherosclerosis and cardiovascular disease (CVD). Patients with chronic inflammatory diseases are at increased risk of CVD, but it is debated whether this association is causal or dependent on shared risk factors, other exposures, genes, and/or inflammatory pathways. The current review summarizes epidemiological, clinical, and experimental data supporting the role of shared inflammatory mechanisms between atherosclerotic CVD and rheumatoid arthritis, psoriasis, inflammatory bowel disease, and periodontitis, respectively, and provides insights to future prospects in this area of research. Awareness of the role of inflammation in CVD in patients with chronic inflammatory diseases and the potential for anti-inflammatory therapy, e.g., with tumor necrosis factor-α inhibitors, to also reduce atherosclerotic CVD has evolved into guideline- based recommendations. These include regular CVD risk assessment, aggressive treatment of traditional CVD risk factors, and recognition of reduced CVD as an added benefit of strict inflammatory disease control. At present, chronic inflammatory diseases would appear to qualify as partners in crime and not merely innocent bystanders to CVD. However, definite incremental contributions of inflammation versus effects of the complex interplay with other CVD risk factors may never be fully elucidated and for the foreseeable future, inflammation is posed to maintain its current position as both a marker and a maker of CVD, with clinical utility both for identification of patient at risk of CVD and as target for therapy to reduce CVD. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Cardiovascular risk factors and dementia.

PubMed

Fillit, Howard; Nash, David T; Rundek, Tatjana; Zuckerman, Andrea

2008-06-01

Dementias, such as Alzheimer's disease (AD) and vascular dementia, are disorders of aging populations and represent a significant economic burden. Evidence is accumulating to suggest that cardiovascular disease (CVD) risk factors may be instrumental in the development of dementia. The goal of this review was to discuss the relationship between specific CVD risk factors and dementia and how current treatment strategies for dementia should focus on reducing CVD risks. We conducted a review of the literature for the simultaneous presence of 2 major topics, cardiovascular risk factors and dementia (eg, AD). Special emphasis was placed on clinical outcome studies examining the effects of treatments of pharmacologically modifiable CVD risk factors on dementia and cognitive impairment. Lifestyle risk factors for CVD, such as obesity, lack of exercise, smoking, and certain psychosocial factors, have been associated with an increased risk of cognitive decline and dementia. Some evidence suggests that effectively managing these factors may prevent cognitive decline/dementia. Randomized, placebo-controlled trials of antihypertensive medications have found that such therapy may reduce the risk of cognitive decline, and limited data suggest a benefit for patients with AD. Some small open-label and randomized clinical trials of statins have observed positive effects on cognitive function; larger studies of statins in patients with AD are ongoing. Although more research is needed, current evidence indicates an association between CVD risk factors--such as hypertension, dyslipidemia, and diabetes mellitus--and cognitive decline/dementia. From a clinical perspective, these data further support the rationale for physicians to provide effective management of CVD risk factors and for patients to be compliant with such recommendations to possibly prevent cognitive decline/dementia.

Income inequality and cardiovascular disease risk factors in a highly unequal country: a fixed-effects analysis from South Africa.

PubMed

Adjaye-Gbewonyo, Kafui; Kawachi, Ichiro; Subramanian, S V; Avendano, Mauricio

2018-03-06

Chronic stress associated with high income inequality has been hypothesized to increase CVD risk and other adverse health outcomes. However, most evidence comes from high-income countries, and there is limited evidence on the link between income inequality and biomarkers of chronic stress and risk for CVD. This study examines how changes in income inequality over recent years relate to changes in CVD risk factors in South Africa, home to some of the highest levels of income inequality globally. We linked longitudinal data from 9356 individuals interviewed in the 2008 and 2012 National Income Dynamics Study to district-level Gini coefficients estimated from census and survey data. We investigated whether subnational district income inequality was associated with several modifiable risk factors for cardiovascular disease (CVD) in South Africa, including body mass index (BMI), waist circumference, blood pressure, physical inactivity, smoking, and high alcohol consumption. We ran individual fixed-effects models to examine the association between changes in income inequality and changes in CVD risk factors over time. Linear models were used for continuous metabolic outcomes while conditional Poisson models were used to estimate risk ratios for dichotomous behavioral outcomes. Both income inequality and prevalence of most CVD risk factors increased over the period of study. In longitudinal fixed-effects models, changes in district Gini coefficients were not significantly associated with changes in CVD risk factors. Our findings do not support the hypothesis that subnational district income inequality is associated with CVD risk factors within the high-inequality setting of South Africa.

Rheumatoid Arthritis, Anti-CCP Positivity, and Cardiovascular Disease Risk in the Women’s Health Initiative

PubMed Central

Mackey, Rachel H.; Kuller, Lewis H.; Deane, Kevin D.; Walitt, Brian T.; Chang, Yuefang F.; Holers, V. Michael; Robinson, William H.; Tracy, Russell P.; Hlatky, Mark A.; Eaton, Charles; Liu, Simin; Freiberg, Matthew S.; Talabi, Mehret Birru; Schelbert, Erik B.; Moreland, Larry W.

2015-01-01

Objective This report evaluates incidence of cardiovascular disease (CVD) morbidity and mortality over 10 years among the >160,000 postmenopausal women in the Women’s Health Initiative (WHI) in relation to self-reported RA, disease modifying anti-rheumatic drugs (DMARD) use, anti-CCP+, RF+, CVD risk factors, joint pain, and inflammation (white blood cell (WBC) count and IL-6.) Methods Anti-CCP and RF were measured on a sample (n=9,988) of WHI participants with self-reported RA. RA was classified as self-reported RA plus anti-CCP+ positivity and/or use of DMARDs. Self-reported RA that was both anti-CCP− and DMARD− was classified as “unverified RA.” Results Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD and total mortality were higher for women with RA vs. no RA, with multivariable-adjusted HR(95%CI) of 1.46(1.17, 1.83) for CHD, and 2.55(1.86, 3.51) for fatal CVD. Within RA, anti-CCP+ and RF+ were not significantly associated with higher risk of any outcomes, despite slightly higher risk of fatal CVD and death for anti-CCP+ vs. anti-CCP− RA. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even for women with no RA. CVD incidence was increased for RA vs. no RA at almost all risk factor levels, except low levels of joint pain or inflammation. Within RA, inflammation was more strongly associated with fatal CVD and total mortality than CHD or CVD. Conclusion Among postmenopausal women, RA was associated with 1.5-2.5 higher CVD risk, strongly associated with CV risk factors, joint pain severity, and inflammation, but similar for anti-CCP+ and RF+. Clinical Trial Registration clinicaltrials.gov identifier: NCT00000611 PMID:25988241

The significance of the psychosocial factors influence in pathogenesis of cardiovascular disease.

PubMed

Masic, Izet; Alajbegovic, Jasmin

2013-11-01

Cardiovascular diseases (CVD) are the leading cause of death in the world today. Risk factors are those factors that influence the development of CVD. Risk factors can be divided into materialistic (genetic predisposition, smoking, alcohol) and non-materialistic (psychosocial factors). Our goal is to note the role of the health system, to emphasize the importance of psychosocial factors in the pathogenesis of CVD, explain the relationship between psychosocial factors and other risk factors, stress the importance of prevention through the provision of management of the cardiovascular system (CVS) diseases. A DESCRIPTIVE ANALYSIS WAS PERFORMED ON SCIENTIFIC STUDIES IN SEVERAL PUBLISHED ARTICLES IN JOURNALS ON CVS: Public Health Reviews, CVD, European Heart Journal, Materia Socio Medica and other indexed journals that publish articles on CVS. THE IMPORTANCE AND ROLE OF THE HEALTH SYSTEM IN THE EARLY DETECTION, DIAGNOSIS, THERAPY AND CVS DISEASE PREVENTION IS PRESENTED THROUGH THREE THEMATIC AREAS: (a) The incidence and prevalence of CVS diseases; (b) treatment of CVS diseases and (c) promotion of health in patients with CVS disease and those the risk of their occurrence. Health promotion is the most important aspect of the health system monitoring. Health promotion is adequately implemented ifthe management ofCVD is proper. The main objectives of CVD management are: Preventing or delaying the occurrence of CVD, reducing the number and severity of worsening and complications of CVD. Management Includes: Individual and family, the health system and the community. Materialistic and non-materialistic risk factors together contribute to the development of CVD.

Does Sufficient Evidence Exist to Support a Causal Association between Vitamin D Status and Cardiovascular Disease Risk? An Assessment Using Hill’s Criteria for Causality

PubMed Central

Weyland, Patricia G.; Grant, William B.; Howie-Esquivel, Jill

2014-01-01

Serum 25-hydroxyvitamin D (25(OH)D) levels have been found to be inversely associated with both prevalent and incident cardiovascular disease (CVD) risk factors; dyslipidemia, hypertension and diabetes mellitus. This review looks for evidence of a causal association between low 25(OH)D levels and increased CVD risk. We evaluated journal articles in light of Hill’s criteria for causality in a biological system. The results of our assessment are as follows. Strength of association: many randomized controlled trials (RCTs), prospective and cross-sectional studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Consistency of observed association: most studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors in various populations, locations and circumstances. Temporality of association: many RCTs and prospective studies found statistically significant inverse associations between 25(OH)D levels and CVD risk factors. Biological gradient (dose-response curve): most studies assessing 25(OH)D levels and CVD risk found an inverse association exhibiting a linear biological gradient. Plausibility of biology: several plausible cellular-level causative mechanisms and biological pathways may lead from a low 25(OH)D level to increased risk for CVD with mediators, such as dyslipidemia, hypertension and diabetes mellitus. Experimental evidence: some well-designed RCTs found increased CVD risk factors with decreasing 25(OH)D levels. Analogy: the association between serum 25(OH)D levels and CVD risk is analogous to that between 25(OH)D levels and the risk of overall cancer, periodontal disease, multiple sclerosis and breast cancer. Conclusion: all relevant Hill criteria for a causal association in a biological system are satisfied to indicate a low 25(OH)D level as a CVD risk factor. PMID:25184368

Advantages of new cardiovascular risk-assessment strategies in high-risk patients with hypertension.

PubMed

Ruilope, Luis M; Segura, Julian

2005-10-01

Accurate assessment of cardiovascular disease (CVD) risk in patients with hypertension is important when planning appropriate treatment of modifiable risk factors. The causes of CVD are multifactorial, and hypertension seldom exists as an isolated risk factor. Classic models of risk assessment are more accurate than a simple counting of risk factors, but they are not generalizable to all populations. In addition, the risk associated with hypertension is graded, continuous, and independent of other risk factors, and this is not reflected in classic models of risk assessment. This article is intended to review both classic and newer models of CVD risk assessment. MEDLINE was searched for articles published between 1990 and 2005 that contained the terms cardiovascular disease, hypertension, or risk assessment. Articles describing major clinical trials, new data about cardiovascular risk, or global risk stratification were selected for review. Some patients at high long-term risk for CVD events (eg, patients aged <50 years with multiple risk factors) may go untreated because they do not meet the absolute risk-intervention threshold of 20% risk over 10 years with the classic model. Recognition of the limitations of classic risk-assessment models led to new guidelines, particularly those of the European Society of Hypertension-European Society of Cardiology. These guidelines view hypertension as one of many risk and disease factors that require treatment to decrease risk. These newer guidelines include a more comprehensive range of risk factors and more finely graded blood pressure ranges to stratify patients by degree of risk. Whether they accurately predict CVD risk in most populations is not known. Evidence from the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) study, which stratified patients by several risk and disease factors, highlights the predictive value of some newer CVD risk assessments. Modern risk assessments, which include blood pressure along with a wide array of modifiable risk factors, may be more accurate than classic models for CVD risk prediction.

The relationship between calcium intake, obesity, and cardiovascular disease risk factors: the jackson heart study

USDA-ARS?s Scientific Manuscript database

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. ...

Rheumatologist and Primary Care Management of Cardiovascular Disease Risk in Rheumatoid Arthritis: Patient and Provider Perspectives.

PubMed

Bartels, Christie M; Roberts, Tonya J; Hansen, Karen E; Jacobs, Elizabeth A; Gilmore, Andrea; Maxcy, Courtney; Bowers, Barbara J

2016-04-01

Despite increased cardiovascular disease (CVD) risk, rheumatoid arthritis (RA) patients often lack CVD preventive care. We examined CVD preventive care processes from RA patient and provider perspectives to develop a process map for identifying targets for future interventions to improve CVD preventive care. Thirty-one participants (15 patients, 7 rheumatologists, and 9 primary care physicians [PCPs]) participated in interviews that were coded using NVivo software and analyzed using grounded theory techniques. Patients and providers reported that receipt of preventive care depends upon identifying and acting on risk factors, although most noted that both processes rarely occurred. Engagement in these processes was influenced by various provider-, system-, visit-, and patient-related conditions, such as patient activation or patients' knowledge about their risk. While nearly half of patients and PCPs were unaware of RA-CVD risk, all rheumatologists were aware of risk. Rheumatologists reported not systematically identifying risk factors, or, if identified, they described communicating about CVD risk factors via clinic notes to PCPs instead of acting directly due to perceived role boundaries. PCPs suggested that scheduling PCP visits could improve CVD risk management, and all participants viewed comanagement positively. Findings from this study illustrate important gaps and opportunities to support identifying and acting on CVD risk factors in RA patients from the provider, system, visit, and patient levels. Future work should investigate professional role support through improved guidelines, patient activation, and system-based RA-CVD preventive care strategies. © 2016, American College of Rheumatology.

Do repeated risk factor measurements influence the impact of education on cardiovascular mortality?

PubMed

Ariansen, Inger; Graff-Iversen, Sidsel; Stigum, Hein; Strand, Bjørn Heine; Wills, Andrew K; Næss, Øyvind

2015-12-01

It has been questioned if the excess cardiovascular disease (CVD) mortality by lower educational level can be fully explained by conventional modifiable CVD risk factors. Our objective was to examine whether repeated measures over time of risk factors (smoking, physical inactivity, blood pressure, total cholesterol and body mass index) explain more of the socioeconomic gradient in CVD mortality than if they are measured only once. A cohort of 34 884 men and women attended all three screenings (1974-1978, 1977-1983 and 1985-1988) in the Norwegian Counties Study and were followed for CVD mortality through 2009 by linkage to the Norwegian Cause of Death Registry. Age-adjusted and sex-adjusted HR of CVD mortality was 2.32 (95% CI 1.93 to 2.80) for basic relative to tertiary educated individuals. The HR was attenuated by 48% (HR 1.54 (1.28 to 1.87)) when adjusted for CVD risk factors measured at baseline and by 56% (HR 1.45 (1.20 to 1.75)) when two repeated measurements ascertained 5 years apart were added to the model. Similarly, absolute risk difference in CVD mortality by education was attenuated by 62% when adjusted for baseline and by 72% when adjusted for repeated measurements of risk factors. In this cohort, repeated measurements of risk factors seemed to explain more of the educational gradient in CVD mortality. This suggests that a substantial part of the excess CVD mortality among those with lower education might be explained by conventional risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Self-perceived health versus actual cardiovascular disease risks.

PubMed

Ko, Young; Boo, Sunjoo

2016-01-01

Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health. This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health. Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health. Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight. © 2015 Japan Academy of Nursing Science.

[Cardiovascular diseases risk factors knowledge among soldiers of the Polish army].

PubMed

Olszewski, Robert; Grabysa, Radosław; Kwasiborski, Przemysław J; Makowski, Tomasz; Warmiński, Janusz; Szczechowicz, Robert; Kubik, Leszek

2009-10-01

Cardiovascular diseases (CVDs) are the main cause of death and disability in Poland. There are many risk factors of CVD which are modifiable due to preventive strategies. Knowledge about these factors among population at risk of CVD is the most important condition for success of them. To evaluate the knowledge of CVD risk factors among soldiers of the Polish Army and try to identify a demographic factors influenced on them. Authors investigated the level of knowledge about CVD risk factors among 644 soldiers (aged between 18 to 62 years) using the special questionnaire. Whole group was analyzed according to a place of origin: city, town and village and according to a function: professionals and conscripts. Soldiers achieved a total score of 58.4% correct answers. Commonly known risk factors of CVD (average 82% of correct answers) in studied group were: obesity, tobacco smoking, high level of cholesterol and hypertension. Knowledge about above risk factors was significantly higher (p < 0.01) than about other. Lesser known risk factors (average 54% of correct answers) were: male gender, abnormal diet, sedentary lifestyle, family history of CVDs, diabetes, family history of heart infarction below 55 yrs and peripheral atherosclerosis. residents achieved 64.5% correct answers, town--61.5%, and village--58%. Professionals achieved 65.1% vs. 58.8% for conscripts. The level of knowledge about CVD risk factors are significantly higher among professionals than in urban population. Our data confirm the need of continuation and developing new CVDs preventive strategies in Poland, especially among poor educated and village populations. There is a need to emphasize the role of lesser known, modifiable CVD risk factors (e.g., obesity, sedentary lifestyle) in existing and future health programs.

Circulating interleukin-10 and risk of cardiovascular events: a prospective study in the elderly at risk.

PubMed

Welsh, Paul; Murray, Heather M; Ford, Ian; Trompet, Stella; de Craen, Anton J M; Jukema, J Wouter; Stott, David J; McInnes, Iain B; Packard, Chris J; Westendorp, Rudi G J; Sattar, Naveed

2011-10-01

The goal of this study was to examine the association of the antiinflammatory interleukin-10 (IL-10) with risk of cardiovascular disease (CVD). In the PROSPER (PROspective Study of Pravastatin in the Elderly at Risk) cohort, we related baseline concentrations of circulating IL-10 to risk of CVD events in a nested case (n=819)-control (n=1618) study of 3.2 years of follow-up. Circulating IL-10 showed few strong associations with classical risk factors but was positively correlated with IL-6 and C-reactive protein. IL-10 was positively associated with risk of CVD events (odds ratio [OR] 1.17, 95% CI 1.05 to 1.31 per unit increase in log IL-10) after adjusting for classical risk factors and C-reactive protein. Furthermore, IL-10 was associated more strongly with CVD risk among those with no previous history of CVD (OR 1.42, 95% CI 1.18 to 1.70), compared with those with previous CVD (OR 1.04, 95% CI 0.90 to 1.19; P=0.018). Overall, IL-10 showed a modest ability to add discrimination to classical risk factors (C-statistic +0.005, P=0.002). Baseline circulating levels of the antiinflammatory IL-10 are positively associated with risk of CVD among the elderly without prior CVD events, although the association is less evident in those with a history of CVD. Additional epidemiological and mechanistic studies investigating the role of IL-10 in CVD are warranted.

Cardiovascular Disease in Latin American Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study and a Systematic Review

PubMed Central

Amaya-Amaya, Jenny; Caro-Moreno, Julián; Molano-González, Nicolás; Mantilla, Rubén D.; Rojas-Villarraga, Adriana; Anaya, Juan-Manuel

2013-01-01

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE). Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed. Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%–79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition. Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors. PMID:24294522

The Significance of the Psychosocial Factors Influence in Pathogenesis of Cardiovascular Disease

PubMed Central

Masic, Izet; Alajbegovic, Jasmin

2013-01-01

Background: Cardiovascular diseases (CVD) are the leading cause of death in the world today. Risk factors are those factors that influence the development of CVD. Risk factors can be divided into materialistic (genetic predisposition, smoking, alcohol) and non-materialistic (psychosocial factors). Our goal is to note the role of the health system, to emphasize the importance of psychosocial factors in the pathogenesis of CVD, explain the relationship between psychosocial factors and other risk factors, stress the importance of prevention through the provision of management of the cardiovascular system (CVS) diseases. Methods: A descriptive analysis was performed on scientific studies in several published articles in journals on CVS: Public Health Reviews, CVD, European Heart Journal, Materia Socio Medica and other indexed journals that publish articles on CVS. Results and Conclusions: The importance and role of the health system in the early detection, diagnosis, therapy and CVS disease prevention is presented through three thematic areas: (a) The incidence and prevalence of CVS diseases; (b) treatment of CVS diseases and (c) promotion of health in patients with CVS disease and those the risk of their occurrence. Health promotion is the most important aspect of the health system monitoring. Health promotion is adequately implemented ifthe management ofCVD is proper. The main objectives of CVD management are: Preventing or delaying the occurrence of CVD, reducing the number and severity of worsening and complications of CVD. Management Includes: Individual and family, the health system and the community. Materialistic and non-materialistic risk factors together contribute to the development of CVD. PMID:24404370

A systematic review and appraisal of methods of developing and validating lifestyle cardiovascular disease risk factors questionnaires.

PubMed

Nse, Odunaiya; Quinette, Louw; Okechukwu, Ogah

2015-09-01

Well developed and validated lifestyle cardiovascular disease (CVD) risk factors questionnaires is the key to obtaining accurate information to enable planning of CVD prevention program which is a necessity in developing countries. We conducted this review to assess methods and processes used for development and content validation of lifestyle CVD risk factors questionnaires and possibly develop an evidence based guideline for development and content validation of lifestyle CVD risk factors questionnaires. Relevant databases at the Stellenbosch University library were searched for studies conducted between 2008 and 2012, in English language and among humans. Using the following databases; pubmed, cinahl, psyc info and proquest. Search terms used were CVD risk factors, questionnaires, smoking, alcohol, physical activity and diet. Methods identified for development of lifestyle CVD risk factors were; review of literature either systematic or traditional, involvement of expert and /or target population using focus group discussion/interview, clinical experience of authors and deductive reasoning of authors. For validation, methods used were; the involvement of expert panel, the use of target population and factor analysis. Combination of methods produces questionnaires with good content validity and other psychometric properties which we consider good.

Assessment of medium-term cardiovascular disease risk after Japan’s 2011 Fukushima Daiichi nuclear accident: a retrospective analysis

PubMed Central

Nomura, Shuhei; Gilmour, Stuart; Oikawa, Tomoyoshi; Lee, Kiwon; Kiyabu, Grace Y; Shibuya, Kenji

2017-01-01

Objective To assess the medium-term indirect impact of the 2011 Fukushima Daiichi nuclear accident on cardiovascular disease (CVD) risks and to identify whether risk factors for CVD changed after the accident. Participants Residents aged 40 years and over participating in annual public health check-ups from 2009 to 2012, administered by Minamisoma city, located about 10 to 40 km from the Fukushima Daiichi nuclear plant. Methods The sex-specific Framingham CVD risk score was considered as the outcome measure and was compared before (2009–2010) and after the accident (2011–2012). A multivariate regression analysis was employed to evaluate risk factors for CVD. Results Data from 563 individuals (60.2% women) aged 40 to 74 years who participated in the check-ups throughout the study period was analysed. After adjusting for covariates, no statistically significant change was identified in the CVD risk score postaccident in both sexes, which may suggest no obvious medium-term health impact of the Fukushima nuclear accident on CVD risk. The risk factors for CVD and their magnitude and direction (positive/negative) did not change after the accident. Conclusions There was no obvious increase in CVD risks in Minamisoma city, which may indicate successful management of health risks associated with CVD in the study sample. PMID:29275343

Examining risk factors for cardiovascular disease among food bank members in Vancouver.

PubMed

Fowokan, A O; Black, J L; Holmes, E; Seto, D; Lear, S A

2018-06-01

Food banks provide supplemental food to low-income households, yet little is known about the cardiovascular health of food banks members. This study therefore described cardiovascular disease (CVD) risk factors among food bank members and explored associations between food insecurity and CVD risk. Adults ≥18 years (n = 77) from three food bank sites in metro Vancouver, British Columbia completed surveys and physical assessments examining a range of socio-demographic variables and CVD risk factors. A composite measure of myocardial infarction (MI) risk called the INTERHEART score was assessed and household food insecurity was measured using the Household Food Security Survey Module. Regression models were used to explore associations between food insecurity and CVD risk measures, including the INTERHEART score. Ninety-seven percent of food bank members reported experiencing food insecurity, 65% were current smokers, 53% reported either chronic or several periods of stress in the past year, 55% reported low physical activity levels and 80% reported consuming fewer than five servings of fruit and vegetables daily. Prevalence of self-reported diabetes and hypertension were 13% and 29% respectively. Fifty-two percent of the sample were at high risk of non-fatal MI. No statistically significant associations were found between increased severity of food insecurity and CVD risk factors among this sample where both severe food insecurity and high CVD risks were prevalent. Food bank members were at elevated risk for CVD compared with the general population. Strategies are needed to reduce prevalence of food insecurity and CVD risk factors, both of which disproportionately affected food bank members.

Prevalence of undiagnosed cardiovascular risk factors and 10-year CVD risk in male steel industry workers.

PubMed

Gray, Benjamin J; Bracken, Richard M; Turner, Daniel; Morgan, Kerry; Mellalieu, Stephen D; Thomas, Michael; Williams, Sally P; Williams, Meurig; Rice, Sam; Stephens, Jeffrey W

2014-05-01

To assess the prevalence of undiagnosed cardiovascular disease (CVD) in a cohort of male steelworkers in South Wales, UK. Male steel industry workers (n = 221) with no prior diagnosis of CVD or diabetes accepted a CVD risk assessment within the work environment. Demographic, anthropometric, family, and medical histories were all recorded and capillary blood samples obtained. The 10-year CVD risk was predicted using the QRISK2-2012 algorithm. Up to 81.5% of workers were either overweight or obese. More than 20% of workers were found to have diastolic hypertension, high total cholesterol, and/or a total cholesterol/high-density lipoprotein ratio of six or more. Over one quarter of workers assessed had an increased 10-year CVD risk. Despite a physically demanding occupation, risk assessment in the workplace uncovered significant occult factors in CVD risk in a sample of male heavy industry workers.

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K

PubMed Central

Agutter, Paul S

2016-01-01

Background Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4–MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Methods Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15–64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Results Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Conclusions Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto. PMID:27688985

Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K.

PubMed

Cundiff, David K; Agutter, Paul S

2016-08-24

Nutrition researchers recently recognized that deficiency of vitamin K2 (menaquinone: MK-4-MK-13) is widespread and contributes to cardiovascular disease (CVD). The deficiency of vitamin K2 or vitamin K inhibition with warfarin leads to calcium deposition in the arterial blood vessels. Using publicly available sources, we collected food commodity availability data and derived nutrient profiles including vitamin K2 for people from 168 countries. We also collected female and male cohort data on early death from CVD (ages 15-64 years), insufficient physical activity, tobacco, biometric CVD risk markers, socioeconomic risk factors for CVD, and gender. The outcome measures included (1) univariate correlations of early death from CVD with each risk factor, (2) a multiple regression-derived formula relating early death from CVD (dependent variable) to macronutrient profile, vitamin K1 and K2 and other risk factors (independent variables), (3) for each risk factor appearing in the multiple regression formula, the portion of CVD risk attributable to that factor, and (4) similar univariate and multivariate analyses of body mass index (BMI), fasting blood sugar (FBS) (simulated from diabetes prevalence), systolic blood pressure (SBP), and cholesterol/ HDL-C ratio (simulated from serum cholesterol) (dependent variables) and dietary and other risk factors (independent variables). Female and male cohorts in countries that have vitamin K2 < 5µg per 2000 kcal/day per capita (n = 70) had about 2.2 times the rate of early CVD deaths as people in countries with > 24 µg/day of vitamin K2 per 2000 kcal/day (n = 72). A multiple regression-derived formula relating early death from CVD to dietary nutrients and other risk factors accounted for about 50% of the variance between cohorts in early CVD death. The attributable risks of the variables in the CVD early death formula were: too much alcohol (0.38%), too little vitamin K2 (6.95%), tobacco (6.87%), high blood pressure (9.01%), air pollution (9.15%), early childhood death (3.64%), poverty (7.66%), and male gender (6.13%). Worldwide dietary vitamin K2 data derived from food commodities add much understanding to the analysis of CVD risk factors and the etiology of CVD. Vitamin K2 in food products should be systematically quantified. Public health programs should be considered to increase the intake of vitamin K2-containing fermented plant foods such as sauerkraut, miso, and natto.

The Burden of Cardiovascular Diseases Among US States, 1990-2016.

PubMed

Roth, Gregory A; Johnson, Catherine O; Abate, Kalkidan Hassen; Abd-Allah, Foad; Ahmed, Muktar; Alam, Khurshid; Alam, Tahiya; Alvis-Guzman, Nelson; Ansari, Hossein; Ärnlöv, Johan; Atey, Tesfay Mehari; Awasthi, Ashish; Awoke, Tadesse; Barac, Aleksandra; Bärnighausen, Till; Bedi, Neeraj; Bennett, Derrick; Bensenor, Isabela; Biadgilign, Sibhatu; Castañeda-Orjuela, Carlos; Catalá-López, Ferrán; Davletov, Kairat; Dharmaratne, Samath; Ding, Eric L; Dubey, Manisha; Faraon, Emerito Jose Aquino; Farid, Talha; Farvid, Maryam S; Feigin, Valery; Fernandes, João; Frostad, Joseph; Gebru, Alemseged; Geleijnse, Johanna M; Gona, Philimon Nyakauru; Griswold, Max; Hailu, Gessessew Bugssa; Hankey, Graeme J; Hassen, Hamid Yimam; Havmoeller, Rasmus; Hay, Simon; Heckbert, Susan R; Irvine, Caleb Mackay Salpeter; James, Spencer Lewis; Jara, Dube; Kasaeian, Amir; Khan, Abdur Rahman; Khera, Sahil; Khoja, Abdullah T; Khubchandani, Jagdish; Kim, Daniel; Kolte, Dhaval; Lal, Dharmesh; Larsson, Anders; Linn, Shai; Lotufo, Paulo A; Magdy Abd El Razek, Hassan; Mazidi, Mohsen; Meier, Toni; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Mezgebe, Haftay Berhane; Mirrakhimov, Erkin; Mohammed, Shafiu; Moran, Andrew Edward; Nguyen, Grant; Nguyen, Minh; Ong, Kanyin Liane; Owolabi, Mayowa; Pletcher, Martin; Pourmalek, Farshad; Purcell, Caroline A; Qorbani, Mostafa; Rahman, Mahfuzar; Rai, Rajesh Kumar; Ram, Usha; Reitsma, Marissa Bettay; Renzaho, Andre M N; Rios-Blancas, Maria Jesus; Safiri, Saeid; Salomon, Joshua A; Sartorius, Benn; Sepanlou, Sadaf Ghajarieh; Shaikh, Masood Ali; Silva, Diego; Stranges, Saverio; Tabarés-Seisdedos, Rafael; Tadele Atnafu, Niguse; Thakur, J S; Topor-Madry, Roman; Truelsen, Thomas; Tuzcu, E Murat; Tyrovolas, Stefanos; Ukwaja, Kingsley Nnanna; Vasankari, Tommi; Vlassov, Vasiliy; Vollset, Stein Emil; Wakayo, Tolassa; Weintraub, Robert; Wolfe, Charles; Workicho, Abdulhalik; Xu, Gelin; Yadgir, Simon; Yano, Yuichiro; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zipkin, Ben; Afshin, Ashkan; Gakidou, Emmanuela; Lim, Stephen S; Mokdad, Ali H; Naghavi, Mohsen; Vos, Theo; Murray, Christopher J L

2018-04-11

Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Residing in the United States. Cardiovascular disease disability-adjusted life-years (DALYs). Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.

Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration

PubMed Central

Peters, Sanne A E; Wang, Xin; Lam, Tai-Hing; Kim, Hyeon Chang; Ho, Suzanne; Ninomiya, Toshiharu; Knuiman, Matthew; Vaartjes, Ilonca; Bots, Michael L; Woodward, Mark

2018-01-01

Objective To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster. Setting Asia Pacific Cohort Studies Collaboration. Participants Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline. Outcome measures Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated. Results During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP–smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP–smoking–cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%. Conclusions Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD. PMID:29511013

Cocoa Polyphenols: Evidence from Epidemiological Studies.

PubMed

Matsumoto, Chisa

2018-01-01

Accumulating evidence suggests potential preventive effects of chocolate/cocoa on the risk of cardio vascular disease (CVD). However, cocoa products also contain high levels of sugar and fat, which increase CVD risk factors. Even, the identity of the substance in chocolate/cocoa that has a favorable effect on CVD and CVD risk factors remains unclear, growing evidence from experimental studies suggests that cocoa polyphenols might be a major contributor to cardiovascular-protective effects. However, epidemiological studies, which are necessary to evaluate an association between the risk of CVD and cocoa polyphenol, remain sparse. We will discuss recent evidence regarding the association between cocoa polyphenol consumption and the risks of CVD and its risk factors by reviewing recent epidemiological studies. We shall also provide some guidance for patient counseling and will discuss the public health implications for recommending cocoa polyphenol consumption to prevent CVD. Epidemiological studies evaluating the association between cocoa polyphenol itself and the risk of CVD are sparse. However, evidence from limited epidemiological studies suggests that cocoa polyphenol consumption may lower the risk of CVD. Given the potential adverse effects of the consumption of cocoa products with high fat and sugar and the fact that the most appropriate dose of cocoa polyphenol for cardio-protective effects has not yet been established, health care providers should remain cautious about recommending cocoa/cocoa polyphenol consumption to their patients to reduce the risk of CVD, taking the characteristics of individual patients into careful consideration. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Association Between Cardiovascular Disease Risk Factors and Rotator Cuff Tendinopathy: A Cross-Sectional Study.

PubMed

Applegate, Kara Arnold; Thiese, Matthew S; Merryweather, Andrew S; Kapellusch, Jay; Drury, David L; Wood, Eric; Kendall, Richard; Foster, James; Garg, Arun; Hegmann, Kurt T

2017-02-01

Recent evidence has found potential associations between cardiovascular disease (CVD) risk factors and common musculoskeletal disorders. We evaluated possible associations between risk factors and both glenohumeral joint pain and rotator cuff tendinopathy. Data from WISTAH hand study participants (n = 1226) were assessed for associations between Framingham Heart Study CVD risk factors and both health outcomes. A strong association was observed between CVD risk scores and both glenohumeral joint pain and rotator cuff tendinopathy. Peak odds ratios (ORs) of the adjusted models were 4.55 [95% confidence interval (95% CI) 1.97 to 10.31] and 5.97 (95% CI 2.12 to 16.83), respectively. The results show a dose-response trend of increasing risk. Individual risk factors were associated with both outcomes. Combined, CVD risk factors demonstrated a strong correlation with glenohumeral joint pain and an even stronger correlation with rotator cuff tendinopathy. Results suggest a potentially modifiable disease mechanism.

Does vitamin D deficiency contribute to erectile dysfunction?

PubMed Central

Sorenson, Marc; Grant, William B.

2012-01-01

Erectile dysfunction (ED) is a multifactorial disease, and its causes can be neurogenic, psychogenic, hormonal and vascular. ED is often an important indicator of cardiovascular disease (CVD) and a powerful early marker for asymptomatic CVD. Erection is a vascular event, and ED is often a vascular disease caused by endothelial damage and subsequent inhibition of vasodilation. We show here that risk factors associated with a higher CVD risk also associate with a higher ED risk. Such factors include diabetes mellitus, hypertension, arterial calcification and Inflammation in the vascular endothelium. Vitamin D deficiency is one of several dynamics that associates with increased CVD risk, but to our knowledge, it has not been studied as a possible contributor to ED. Here we examine research linking ED and CVD and discuss how vitamin D influences CVD and its classic risk factors—factors that also associate to increased ED risk. We also summarize research indicating that vitamin D associates with reduced risk of several nonvascular contributing factors for ED. We conclude that VDD contributes to ED. This hypothesis should be tested through observational and intervention studies. PMID:22928068

The association between major depressive disorder in childhood and risk factors for cardiovascular disease in adolescence.

PubMed

Rottenberg, Jonathan; Yaroslavsky, Ilya; Carney, Robert M; Freedland, Kenneth E; George, Charles J; Baji, Ildikó; Dochnal, Roberta; Gádoros, Júlia; Halas, Kitti; Kapornai, Krisztina; Kiss, Eniko; Osváth, Viola; Varga, Hedvig; Vetró, Agnes; Kovacs, Maria

2014-02-01

Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops or how early in life this association can be detected. In an ongoing study of pediatric depression, we compared CVD risk factors including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (n = 210), never-depressed siblings of probands (n = 195), and controls with no history of any major psychiatric disorder (n = 161). When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking (odds ratio [OR] = 12.54, 95% confidence interval [CI] = 4.36-36.12) and were less physically active than controls (OR = 0.59, CI = 0.43-0.81) and siblings (OR = 0.70, CI = 0.52-0.94) and had a higher rate of obesity than did controls (OR = 3.67, CI = 1.42-9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs = 1.62-4.36, CIs = 1.03-15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD.

The Association between Major Depressive Disorder in Childhood and Risk Factors for Cardiovascular Disease in Adolescence

PubMed Central

Rottenberg, Jonathan; Yaroslavsky, Ilya; Carney, Robert M.; Freedland, Kenneth E.; George, Charles J.; Baji, Ildikó; Dochnal, Roberta; Gádoros, Júlia; Halas, Kitti; Kapornai, Krisztina; Kiss, Enikő; Osváth, Viola; Varga, Hedvig; Vetró, Ágnes; Kovacs, Maria

2014-01-01

Objective Depression in adults is associated with risk factors for cardiovascular disease (CVD). It is unclear, however, when the association between clinical depression and cardiac risk factors develops, or how early in life this association can be detected. Methods In an ongoing study of pediatric depression, we compared CVD risk factors, including smoking, obesity, physical activity level, sedentary behavior, and parental history of CVD, across three samples of adolescents: probands with established histories of childhood-onset major depressive disorder (MDD; N=210), never-depressed siblings of probands (N=195), and controls with no history of any major psychiatric disorder (N=161). Results When assessed during adolescence, 85% of the probands were not in a major depressive episode. Nevertheless, at that assessment, probands had a higher prevalence of regular smoking ([odds ratio [OR] 12.54, 95% confidence interval [CI] = 4.36–36.12) and were less physically active than controls (OR .59, CI = .43–.81) and siblings (OR .70, CI = .52–.94), and had a higher rate of obesity than did controls (OR 3.67, CI = 1.42–9.52). Parents of probands reported high rates of CVD (significantly higher than did parents of controls), including myocardial infarction and CVD-related hospitalization (ORs 1.62–4.36; CIs = 1.03–15.40). Differences in CVD risk factors between probands and controls were independent of parental CVD. Conclusions Major depression in childhood is associated with an unfavorable CVD risk profile in adolescence, and risks for pediatric depression and CVD may coincide in families. Effective prevention and treatment of childhood depression may be a means to reduce the incidence of adult CVD. PMID:24470130

Relation between age and carotid artery intima-medial thickness: a systematic review.

PubMed

van den Munckhof, Inge C L; Jones, Helen; Hopman, Maria T E; de Graaf, Jacqueline; Nyakayiru, Jean; van Dijk, Bart; Eijsvogels, Thijs M H; Thijssen, Dick H J

2018-05-12

Carotid artery intima-medial thickness (cIMT) represents a popular measure of atherosclerosis and is predictive of future cardiovascular and cerebrovascular events. Although older age is associated with a higher cIMT, little is known about whether this increase in cIMT follows a linear relationship with age or it is affected under influence of cardiovascular diseases (CVD) or CVD risk factors. We hypothesize that the relationship between cIMT and age is nonlinear and is affected by CVD or risk factors. A systematic review of studies that examined cIMT in the general population and human populations free from CVD/risk factors was undertaken. The literature search was conducted in PubMed, Scopus, and Web of Science. Seventeen studies with 32 unique study populations, involving 10,124 healthy individuals free from CVD risk factors, were included. Furthermore, 58 studies with 115 unique study populations were included, involving 65,774 individuals from the general population (with and without CVD risk factors). A strong positive association was evident between age and cIMT in the healthy population, demonstrating a gradual, linear increase in cIMT that did not differ between age decades (r = 0.91, P < 0.001). Although populations with individuals with CVD demonstrated a higher cIMT compared to populations free of CVD, a linear relation between age and cIMT was also present in this population. Our data suggest that cIMT is strongly and linearly related to age. This linear relationship was not affected by CVD or risk factors. © 2018 Wiley Periodicals, Inc.

Carotid Plaque Score and Risk of Cardiovascular Mortality in the Oldest Old: Results from the TOOTH Study.

PubMed

Hirata, Takumi; Arai, Yasumichi; Takayama, Michiyo; Abe, Yukiko; Ohkuma, Kiyoshi; Takebayashi, Toru

2018-01-01

Accumulating evidence suggests that predictability of traditional cardiovascular risk factors declines with advancing age. We investigated whether carotid plaque scores (CPSs) were associated with cardiovascular disease (CVD) death in the oldest old, and whether asymmetrical dimethylarginine (ADMA), a marker of endothelial dysfunction, moderated the association between the CPS and CVD death. We conducted a prospective cohort study of Japanese subjects aged ≥85 years without CVD at baseline. We followed this cohort for 6 years to investigate the association of CPS with CVD death via multivariable Cox proportional hazard analysis. We divided participants into three groups according to CPS (no, 0 points; low, 1.2-4.9 points; high, ≥5.0 points). The predictive value of CPS for estimating CVD death risk over CVD risk factors, including ADMA, was examined using C-statistics. We analyzed 347 participants (151 men, 196 women; mean age, 87.6 years), of which 135 (38.9%) had no carotid plaque at baseline, and 48 (13.8%) had high CPS. Of the total, 29 (8.4%) participants experienced CVD-related death during the study period. Multivariable analysis revealed a significant association of high CPS with CVD-related mortality relative to no CPS (hazard ratio, 3.90; 95% confidence interval: 1.47-10.39). ADMA was not associated with CVD death, but the significant association between CPS and CVD death was observed only in lower ADMA level. The addition of CPS to other risk factors improved the predictability of CVD death (p=0.032). High CPS correlated significantly with a higher CVD death risk in the oldest old with low cardiovascular risk. Ultrasound carotid plaque evaluation might facilitate risk evaluations of CVD death in the very old.

Shared Genetic Aetiology between Cognitive Ability and Cardiovascular Disease Risk Factors: Generation Scotland's Scottish Family Health Study

ERIC Educational Resources Information Center

Luciano, Michelle; Batty, G. David; McGilchrist, Mark; Linksted, Pamela; Fitzpatrick, Bridie; Jackson, Cathy; Pattie, Alison; Dominiczak, Anna F.; Morris, Andrew D.; Smith, Blair H.; Porteous, David; Deary, Ian J.

2010-01-01

People with higher general cognitive ability in early life have more favourable levels of cardiovascular disease (CVD) risk factors in adulthood and CVD itself. The mechanism of these associations is not known. Here we examine whether general cognitive ability and CVD risk factors share genetic and/or environmental aetiology. In this large,…

Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women

PubMed Central

Sumner, Jennifer A.; Kubzansky, Laura D.; Elkind, Mitchell S. V.; Roberts, Andrea L.; Agnew-Blais, Jessica; Chen, Qixuan; Cerdá, Magdalena; Rexrode, Kathryn M.; Rich-Edwards, Janet W.; Spiegelman, Donna; Suglia, Shakira F.; Rimm, Eric B.; Koenen, Karestan C.

2015-01-01

Background Psychological stress is a proposed risk factor for cardiovascular disease (CVD), and posttraumatic stress disorder (PTSD), the sentinel stress-related mental disorder, occurs twice as frequently in women as men. However, whether PTSD contributes to CVD risk in women is not established. Methods and Results We examined trauma exposure and PTSD symptoms in relation to incident CVD over a 20-year period in 49,978 women in the Nurses’ Health Study II. Proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events confirmed by additional information or medical record review [n=548, including myocardial infarction (n=277) and stroke (n=271)]. Trauma exposure and PTSD symptoms were assessed using the Brief Trauma Questionnaire and a PTSD screen. Compared to no trauma exposure, endorsing 4 or more PTSD symptoms was associated with increased CVD risk after adjusting for age, family history, and childhood factors (HR=1.60 [95% CI, 1.20–2.13]). Being trauma-exposed and endorsing no PTSD symptoms was associated with elevated CVD risk (HR=1.45 [95% CI, 1.15–1.83]), although being trauma-exposed and endorsing 1–3 PTSD symptoms was not. After adjusting for adult health behaviors and medical risk factors, this pattern of findings was maintained. Health behaviors and medical risk factors accounted for 14% of the trauma/no symptoms-CVD association and 47% of the trauma/4+ symptoms-CVD association. Conclusion Trauma exposure and elevated PTSD symptoms may increase risk of CVD in this population of women. These findings suggest screening for CVD risk and reducing health risk behaviors in trauma-exposed women may be promising avenues for prevention and intervention. PMID:26124186

Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors.

PubMed

Kjøllesdal, M K R; Ariansen, I; Mortensen, L H; Davey Smith, G; Næss, Ø

2016-12-01

To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). Data from national and regional health surveys in Norway (1974-2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants ( n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98-3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77-2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48-2.24). Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.

Plasma clot lysis time and its association with cardiovascular risk factors in black Africans.

PubMed

de Lange, Zelda; Pieters, Marlien; Jerling, Johann C; Kruger, Annamarie; Rijken, Dingeman C

2012-01-01

Studies in populations of European descent show longer plasma clot lysis times (CLT) in patients with cardiovascular disease (CVD) than in controls. No data are available on the association between CVD risk factors and fibrinolytic potential in black Africans, a group undergoing rapid urbanisation with increased CVD prevalence. We investigated associations between known CVD risk factors and CLT in black Africans and whether CLTs differ between rural and urban participants in light of differences in CVD risk.Data from 1000 rural and 1000 urban apparently healthy black South Africans (35-60 years) were cross-sectionally analysed.Increased PAI-1(act), BMI, HbA1c, triglycerides, the metabolic syndrome, fibrinogen concentration, CRP, female sex and positive HIV status were associated with increased CLTs, while habitual alcohol consumption associated with decreased CLT. No differences in CLT were found between age and smoking categories, contraceptive use or hyper- and normotensive participants. Urban women had longer CLT than rural women while no differences were observed for men.CLT was associated with many known CVD risk factors in black Africans. Differences were however observed, compared to data from populations of European descent available in the literature, suggesting possible ethnic differences. The effect of urbanisation on CLT is influenced by traditional CVD risk factors and their prevalence in urban and rural communities.

Perceived and actual risk of cardiovascular disease in patients with rheumatoid arthritis in Korea: A cross-sectional study.

PubMed

Boo, Sunjoo; Froelicher, Erika S; Yun, Ju-Hui; Kim, Ye-Won; Jung, Ju-Yang; Suh, Chang-Hee

2016-10-01

The purposes of this study were to compare the perceived and actual 10-year risk for cardiovascular disease (CVD) and to evaluate the influence of cardiovascular risk factors on perceived CVD risk in patients with rheumatoid arthritis (RA) in Korea. Additionally, the attainment of CVD prevention guideline goals by 3 levels of CVD risk (low, moderate, and high) was presented.For this cross-sectional study, data were collected from 208 patients with RA. Actual CVD risk was estimated with the Systematic Coronary Risk Evaluation (SCORE), and goal attainment was assessed based on the European League Against Rheumatism guidelines. Actual CVD risk and perceived risk were compared with cross-tabulation. Chi-square tests were used to evaluate differences in cardiovascular risk factors by perceived risk. Levels of goal attainment were presented in percentages.Among patients with RA, 13.9% were identified as being at high risk for CVD, whereas 39.9% were at moderate risk, and 46.2% were at low risk. The majority of those at high risk (96.6%) underestimated their risk for CVD. The use of antihypertensive or lipid-lowering medications and having a parental history of CVD significantly increased the likelihood that subjects with RA would perceive themselves as being at high risk for CVD. Diabetes, smoking, physical inactivity, and obesity did not affect perceived risk. A substantial proportion of the subjects with RA did not meet the prevention guideline goals.Patients with RA who are at increased risk of developing CVD must be managed as soon as possible to attain the guideline goals and, accordingly, lower their risk of future CVD.

Cardiovascular risk estimation by professionally active cardiovascular nurses: results from the Basel 2005 Nurses Cohort.

PubMed

Scholte op Reimer, Wilma J M; Moons, Philip; De Geest, Sabina; Fridlund, Bengt; Heikkilä, Johanna; Jaarsma, Tiny; Lenzen, Mattie; Martensson, Jan; Norekvål, Tone M; Smith, Karen; Stewart, Simon; Strömberg, Anna; Thompson, David R

2006-12-01

Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)). Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of <1%, while 13% reported having a risk > or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was <1% for 96% of responders: only 2% had a > or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27). Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study.

PubMed

Halonen, Jaana I; Stenholm, Sari; Pentti, Jaana; Kawachi, Ichiro; Subramanian, S V; Kivimäki, Mika; Vahtera, Jussi

2015-08-04

Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known. Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models. These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors. © 2015 American Heart Association, Inc.

Genetic and environmental contributions to cardiovascular disease risk in American Indians: the strong heart family study.

PubMed

North, Kari E; Howard, Barbara V; Welty, Thomas K; Best, Lyle G; Lee, Elisa T; Yeh, J L; Fabsitz, Richard R; Roman, Mary J; MacCluer, Jean W

2003-02-15

The aims of the Strong Heart Family Study are to clarify the genetic determinants of cardiovascular disease (CVD) risk in American Indians and to map and identify genes for CVD susceptibility. The authors describe the design of the Strong Heart Family Study (conducted between 1998 and 1999) and evaluate the heritabilities of CVD risk factors in American Indians from this study. In the first phase of the study, approximately 950 individuals, aged 18 years or more, in 32 extended families, were examined. The examination consisted of a personal interview, physical examination, laboratory tests, and an ultrasound examination of the carotid arteries. The phenotypes measured during the physical examination included anthropometry, lipoproteins, blood pressure, glycemic status, and clotting factors. Heritabilities for CVD risk factor phenotypes were estimated using a variance component approach and the program SOLAR. After accounting for the effects of covariates, the authors detected significant heritabilities for many CVD risk factor phenotypes (e.g., high density lipoprotein cholesterol (heritability = 0.50) and diastolic blood pressure (heritability = 0.34)). These results suggest that heredity explains a substantial proportion of the variability of CVD risk factors and that these heritabilities are large enough to warrant a search for major risk factor genes.

Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients in Qatar.

PubMed

Zolezzi, Monica; Abdallah, Oraib; Kheir, Nadir; Abdelsalam, Abdelsalam Gomaa

2018-04-28

Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD. To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services. A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin ® and Crestor ® ) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation. The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin ® scenario than to the Crestor ® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor ® scenario compared to the Aspirin ® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin ® scenario provided explanation about CVD risk than those exposed to the Crestor ® scenario 36% versus 8%, p < 0.01). The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services. Copyright © 2018 Elsevier Inc. All rights reserved.

Shared Risk Factors in Cardiovascular Disease and Cancer.

PubMed

Koene, Ryan J; Prizment, Anna E; Blaes, Anne; Konety, Suma H

2016-03-15

Cardiovascular disease (CVD) and cancer are the 2 leading causes of death worldwide. Although commonly thought of as 2 separate disease entities, CVD and cancer possess various similarities and possible interactions, including a number of similar risk factors (eg, obesity, diabetes mellitus), suggesting a shared biology for which there is emerging evidence. Although chronic inflammation is an indispensable feature of the pathogenesis and progression of both CVD and cancer, additional mechanisms can be found at their intersection. Therapeutic advances, despite improving longevity, have increased the overlap between these diseases, with millions of cancer survivors now at risk of developing CVD. Cardiac risk factors have a major impact on subsequent treatment-related cardiotoxicity. In this review, we explore the risk factors common to both CVD and cancer, highlighting the major epidemiological studies and potential biological mechanisms that account for them. © 2016 American Heart Association, Inc.

Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease

PubMed Central

Li, Ling‐Jun; Ikram, Mohammad Kamran

2015-01-01

Abstract Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non‐invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low‐fibre and high‐sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre‐clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood. PMID:26435039

Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease: An update

PubMed Central

Athyros, Vasilios G; Tziomalos, Konstantinos; Katsiki, Niki; Doumas, Michael; Karagiannis, Asterios; Mikhailidis, Dimitri P

2015-01-01

Non-alcoholic fatty liver disease (NAFLD) is considered to be an independent cardiovascular disease (CVD) risk factor. However, simple steatosis has a benign clinical course without excess mortality. In contrast, the advanced form of NAFLD, non-alcoholic steatohepatitis (NASH) with liver fibrosis increases mortality by approximately 70%, due to an increase in CVD mortality by approximately 300%. Chronic kidney disease (CKD) may be caused by NAFLD/NASH and it substantially increases CVD risk, especially in the presence of type 2 diabetes mellitus. Moreover, CKD may trigger NAFLD/NASH deterioration in a vicious cycle. NAFLD/NASH is also related to increased arterial stiffness (AS), an independent CVD risk factor that further raises CVD risk. Diagnosis of advanced liver fibrosis (mainly by simple non-invasive tests), CKD, and increased AS should be made early in the course of NAFLD and treated appropriately. Lifestyle measures and statin treatment may help resolve NAFLD/NASH and beneficially affect the CVD risk factors mentioned above. PMID:26078558

Cardiovascular disease risk factors in relation to smoking behaviour and history: a population-based cohort study

PubMed Central

Keto, Jaana; Ventola, Hanna; Jokelainen, Jari; Linden, Kari; Keinänen-Kiukaanniemi, Sirkka; Timonen, Markku; Ylisaukko-oja, Tero; Auvinen, Juha

2016-01-01

Objective To investigate how individual risk factors for cardiovascular disease (CVD) (blood pressure, lipid levels, body mass index, waist and hip circumference, use of antihypertensive or hypolipidemic medication, and diagnosed diabetes) differ in people aged 46 years with different smoking behaviour and history. Methods This population-based cohort study is based on longitudinal data from the Northern Finland Birth Cohort 1966 project. Data were collected at the 31-year and 46-year follow-ups, when a total of 5038 and 5974 individuals participated in clinical examinations and questionnaires. Data from both follow-ups were available for 3548 participants. In addition to individual CVD risk factors, Framingham and Systematic Coronary Risk Evaluation (SCORE) algorithms were used to assess the absolute risk of a CVD event within the next decade. Results The differences in individual risk factors for CVD reached statistical significance for some groups, but the differences were not consistent or clinically significant. There were no clinically significant differences in CVD risk as measured by Framingham or SCORE algorithms between never smokers, recent quitters and former smokers (7.5%, 7.4%, 8.1% for men; 3.3%, 3.0%, 3.2% for women; p<0.001). Conclusions The effect of past or present smoking on individual CVD risk parameters such as blood pressure and cholesterol seems to be of clinically minor significance in people aged 46 years. In other words, smoking seems to be above all an independent risk factor for CVD in the working-age population. Quitting smoking in working age may thus reduce calculated CVD risk nearly to the same level with people who have never smoked. PMID:27493759

Lifestyle risk factors for cardiovascular disease and diabetic risk in a sedentary occupational group: the Galway taxi driver study.

PubMed

Martin, W P; Sharif, F; Flaherty, G

2016-05-01

Taxi drivers are at increased risk of cardiovascular disease (CVD), something which persists after correcting for the overrepresentation of traditional risk factors for CVD in this cohort. The contribution of lifestyle risk factors to this residually elevated CVD risk remains under-evaluated. We aimed to determine the prevalence of lifestyle risk factors for CVD, self-reported medical risk factors for CVD, and future risk of type 2 diabetes amongst Irish taxi drivers. Male taxi drivers with no history of CVD and type 2 diabetes and working in Galway city in the west of Ireland were invited to participate. Physical activity levels, dietary patterns, anthropometry, smoking, hypertension, hypercholesterolaemia, and Finnish Diabetes Risk Score (FINDRISC) values were recorded in a cross-sectional manner. 41 taxi drivers (mean age 56.7 ± 9.8 years) participated. 37 % were insufficiently active based on self-report, although only 8 % objectively achieved 10, 000 steps per day. Mean modified Mediterranean diet score (mMDS) was 4.6 ± 2.2, and only 13 % of participants had a normal body mass index (BMI) or waist circumference (WC). Those who worked for taxi companies tended to have a higher BMI (p = .07) and WC (p = .04) by multivariable regression. 22 % were current smokers, although a quit rate of 72 % was observed amongst the 78 % of taxi drivers who had ever smoked. 25 % were at high or very high risk of future type 2 diabetes. Lifestyle risk factors for CVD and dysglycaemia are prevalent amongst Irish taxi drivers.

Parental influences on cardiovascular risk factors in Swedish children aged 5-14 years.

PubMed

Khanolkar, Amal R; Byberg, Liisa; Koupil, Ilona

2012-12-01

Precursors of cardiovascular diseases (CVD) originate in childhood. We investigated relationships of children's CVD risk factors with parent's socio-economic position (SEP) and lifestyle and how CVD risk factors correlate within families. We studied 602 families with 2141 individuals comprising two full sibs; aged 5-14 years, and their biological parents (Uppsala Family Study). Parental SEP (occupational class and education) and lifestyle habits [smoking, physical activity (PA), alcohol consumption] were taken from questionnaires. Associations with cholesterol, ApoB/ApoA1, leptin, adiponectin, blood pressure, body mass index (BMI) and overweight/obesity (OW/OB) were analysed by linear/logistic regression. Results were adjusted for child's age, gender, pubertal stage and family clustering. We observed no consistent associations between parental SEP and children's CVD risk factors. Parental lifestyle had stronger effects, independent of parental SEP. Children of smoking fathers had higher BMI (4%, 95% CI 1-7%) and leptin levels (27%, 95% CI 1.00-61.60%). Children of mothers reporting vigorous PA had lower BMI, cholesterol and decreased odds for OW/OB with a possible dose effect. Compared with mothers reporting no vigorous activity, mothers with ≤75 min and 76-150 min/week of vigorous activity had 43% (OR 0.57, 95% CI 0.22-0.89) and 72% (OR 0.28, 95% CI 0.14-0.60) lower risk of having an OW/OB child, respectively, after adjustment for confounders. Independent, consistently stronger and significant associations were found between all studied parents' and children's CVD risk factors. Parental behaviours: smoking, alcohol consumption, low PA are associated with higher levels of CVD risk factors (BMI, OW/OB, cholesterol) in children. Strong correlations in CVD risk factors within families not related to parental SEP/lifestyle suggest a role of genetics in influencing children's CVD risk factors. Public health policies should target families with unhealthy lifestyles.

CVD and obesity in transitional Syria: a perspective from the Middle East

PubMed Central

Barakat, Hani; Barakat, Hanniya; Baaj, Mohamad K

2012-01-01

Purpose Syria is caught in the middle of a disruptive nutritional transition. Its healthcare system is distracted by challenges and successes in other areas while neglecting to address the onslaught of Syria’s cardiovascular disease (CVD) epidemic. Despite the official viewpoint touting improvement in health indicators, current trends jeopardize population health, and several surveys in the Syrian population signal the epidemic spreading far and wide. The goal is to counteract the indifference towards obesity as a threat to Syrian’s health, as the country is slowly becoming a leader in CVD mortality globally. Methods PubMed, World Health Organization, and official government websites were searched for primary surveys in Syria related to CVD morbidity, mortality, and risk factors. Inclusion criteria ensured that results maximized relevance while producing comparable studies. Statistical analysis was applied to detect the most common risk factor and significant differences in risk factor prevalence and CVD rates. Results Obesity remained the prevailing CVD risk factor except in older Syrian men, where smoking and hypertension were more common. CVD mortality was more common in males due to coronary disease, while stroke dominated female mortality. The young workforce is especially impacted, with 50% of CVD mortality occurring before age 65 years and an 81% prevalence of obesity in women over 45 years. Conclusion Syria can overcome its slow response to the CVD epidemic and curb further deterioration by reducing obesity and, thus, inheritance and clustering of risk factors. This can be achieved via multilayered awareness and intensive parental and familial involvement. Extinguishing the CVD epidemic is readily achievable as demonstrated in other countries. PMID:22454558

Prevalence of cardiovascular disease and major risk factors in patients with rheumatoid arthritis: a multinational cross-sectional study.

PubMed

Pappas, Dimitrios A; Nyberg, Fredrik; Kremer, Joel M; Lampl, Kathy; Reed, George W; Horne, Laura; Ho, Meilien; Onofrei, Alina; Malaviya, Anand N; Rillo, Oscar L; Radominski, Sebastiao C; Gal, Janos; Gibofsky, Allan; Popkova, Tatiana V; Laurindo, Leda; Kerzberg, Eduardo M; Zahora, Roman; Pons-Estel, Bernado A; Curtis, Jeffrey R; Furst, Daniel E; Greenberg, Jeffrey D

2018-04-25

To compare the prevalence of cardiovascular disease (CVD) and major CVD risk factors among rheumatoid arthritis (RA) patients enrolled in a large US and multinational registry. We compared CVD and CVD risk factor prevalence from 11 countries enrolled in the CORRONA US and CORRONA International registries; patients from the 10 ex-US participating countries were grouped by region (Eastern Europe, Latin America, and India). Unadjusted summary data were presented for demographics and disease characteristics; comparisons for prevalence of CVD risk factors and CVD were age/gender standardized to the age/gender distribution of the US enrolled patients. Overall, 25,987 patients were included in this analysis. Compared to patients from the ex-US regions, US participants had longer disease duration and lower disease activity, yet were more likely to receive a biologic agent. Additionally, CORRONA US participants had the highest body mass index (BMI). Enrolled patients in India had the lowest BMI, were more rarely smokers, and had a low prevalence of hyperlipidemia, hypertension, and prior CVD compared to the US and other ex-US regions. Participants from Eastern Europe had a higher prevalence of hypertension and hyperlipidemia and highest prevalence of all manifestations of CVD. Differences in the prevalence of both CVD and major CVD risk factors were observed across the four regions investigated. Observed differences may be influenced by variations in both non-modifiable/modifiable characteristics of patient populations, and may contribute to heterogeneity on the observed safety of investigational and approved therapies in studies involving RA patients from different origins.

CVD and obesity in transitional Syria: a perspective from the Middle East.

PubMed

Barakat, Hani; Barakat, Hanniya; Baaj, Mohamad K

2012-01-01

Syria is caught in the middle of a disruptive nutritional transition. Its healthcare system is distracted by challenges and successes in other areas while neglecting to address the onslaught of Syria's cardiovascular disease (CVD) epidemic. Despite the official viewpoint touting improvement in health indicators, current trends jeopardize population health, and several surveys in the Syrian population signal the epidemic spreading far and wide. The goal is to counteract the indifference towards obesity as a threat to Syrian's health, as the country is slowly becoming a leader in CVD mortality globally. PubMed, World Health Organization, and official government websites were searched for primary surveys in Syria related to CVD morbidity, mortality, and risk factors. Inclusion criteria ensured that results maximized relevance while producing comparable studies. Statistical analysis was applied to detect the most common risk factor and significant differences in risk factor prevalence and CVD rates. Obesity remained the prevailing CVD risk factor except in older Syrian men, where smoking and hypertension were more common. CVD mortality was more common in males due to coronary disease, while stroke dominated female mortality. The young workforce is especially impacted, with 50% of CVD mortality occurring before age 65 years and an 81% prevalence of obesity in women over 45 years. Syria can overcome its slow response to the CVD epidemic and curb further deterioration by reducing obesity and, thus, inheritance and clustering of risk factors. This can be achieved via multilayered awareness and intensive parental and familial involvement. Extinguishing the CVD epidemic is readily achievable as demonstrated in other countries.

Cardiovascular disease risk factors: a childhood perspective.

PubMed

Praveen, Pradeep A; Roy, Ambuj; Prabhakaran, Dorairaj

2013-03-01

Atherosclerotic cardiovascular disease (CVD) is one of the leading causes of death and disability worldwide including in developing countries like India. Indians are known to be predisposed to CVD, which occur almost a decade earlier in them. Though these diseases manifest in the middle age and beyond, it is now clear that the roots of CVD lie in childhood and adolescence. Many of the conventional risk factors of CVD such as high blood pressure, dyslipidemia, tobacco use, unhealthy diet and obesity have their beginnings in childhood and then track overtime. It is thus important to screen and identify these risk factors early and treat them to prevent onset of CVD. Similarly community based strategies to prevent onset of these risk factors is imperative to tackle this burgeoning public health crisis especially in countries like ours with limited resources.

Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States.

PubMed

Lu, Yuan; Ezzati, Majid; Rimm, Eric B; Hajifathalian, Kaveh; Ueda, Peter; Danaei, Goodarz

2016-08-09

Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States. It is unclear how CVD risk and events are distributed among blacks versus whites and how interventions reduce racial disparities. We developed risk models for fatal and for fatal and nonfatal CVD using 8 cohorts in the United States. We used 6154 adults who were 50 to 69 years of age in the National Health and Nutrition Examination Survey 1999 to 2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total and disparity impacts of a range of population-wide, targeted, and risk-based interventions on 10-year CVD risks and event rates. Twenty-five percent (95% confidence interval [CI], 22-28) of black men and 12% (95% CI, 10-14) of black women were at ≥6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD) compared with 10% (95% CI, 8-12) of white men and 3% (95% CI, 2-4) of white women. These high-risk individuals accounted for 55% (95% CI, 49-59) of CVD deaths among black men and 42% (95% CI, 35-46) in black women compared with 30% (95% CI, 24-35) in white men and 18% (95% CI, 13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1659 to 1244 per 100 000 in men and from 1320 to 897 in women. Rates of fatal and nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥7.5% risk of CVD (30% versus 19% in whites), and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1688 to 1197 per 100 000. A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates. © 2016 American Heart Association, Inc.

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group.

PubMed

Hansen, Dominique; Niebauer, Josef; Cornelissen, Veronique; Barna, Olga; Neunhäuserer, Daniel; Stettler, Christoph; Tonoli, Cajsa; Greco, Eugenio; Fagard, Robert; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Pedretti, Roberto; Ruiz, Gustavo Rovelo; Corrà, Ugo; Schmid, Jean-Paul; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona Sarzi; Beckers, Paul; Bussotti, Maurizio; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Reibis, Rona; Spruit, Martijn A; Takken, Tim; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick; Dendale, Paul

2018-05-04

Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.

COMPARATIVE EVALUATION OF RISK FACTORS FOR CARDIOVASCULAR DISEASE (CVD) IN GENETICALLY PREDISPOSED RATS

EPA Science Inventory

Rodent CVD models are increasingly used for understanding individual differences in susceptibility to environmental stressors such as air pollution. We characterized pathologies and a number of known human risk factors of CVD in genetically predisposed, male young adult Spontaneo...

Cardiovascular Disease Risk Factors among Emerging Adults in College

ERIC Educational Resources Information Center

Abshire, Demetrius Alexander

2014-01-01

The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions…

Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis.

PubMed

Crowson, Cynthia S; Rollefstad, Silvia; Kitas, George D; van Riel, Piet L C M; Gabriel, Sherine E; Semb, Anne Grete

2017-01-01

Cardiovascular disease (CVD) risk calculators designed for use in the general population do not accurately predict the risk of CVD among patients with rheumatoid arthritis (RA), who are at increased risk of CVD. The process of developing risk prediction models involves numerous issues. Our goal was to develop a CVD risk calculator for patients with RA. Thirteen cohorts of patients with RA originating from 10 different countries (UK, Norway, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico) were combined. CVD risk factors and RA characteristics at baseline, in addition to information on CVD outcomes were collected. Cox models were used to develop a CVD risk calculator, considering traditional CVD risk factors and RA characteristics. Model performance was assessed using measures of discrimination and calibration with 10-fold cross-validation. A total of 5638 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 5.8 years (30139 person years), 389 patients developed a CVD event. Event rates varied between cohorts, necessitating inclusion of high and low risk strata in the models. The multivariable analyses revealed 2 risk prediction models including either a disease activity score including a 28 joint count and erythrocyte sedimentation rate (DAS28ESR) or a health assessment questionnaire (HAQ) along with age, sex, presence of hypertension, current smoking and ratio of total cholesterol to high-density lipoprotein cholesterol. Unfortunately, performance of these models was similar to general population CVD risk calculators. Efforts to develop a specific CVD risk calculator for patients with RA yielded 2 potential models including RA disease characteristics, but neither demonstrated improved performance compared to risk calculators designed for use in the general population. Challenges encountered and lessons learned are discussed in detail.

Parental obesity and risk factors for cardiovascular disease among their offspring in mid-life: findings from the 1958 British Birth Cohort Study.

PubMed

Cooper, R; Pinto Pereira, S M; Power, C; Hyppönen, E

2013-12-01

Few studies have investigated whether parental adiposity is associated with offspring cardiovascular health or the underlying pathways. Studying these associations may help to illuminate the paradox of increasing prevalence of obesity and declining trends in cardiovascular disease (CVD) mortality, which may be partially explained by beneficial adaptations to an obesogenic environment among people exposed to such environments from younger ages. To investigate associations between parental body mass index (BMI) and risk factors for CVD among their offspring in mid-life and to test whether associations of offspring BMI with CVD risk factors were modified by parental BMI. Data from parents and offspring in the 1958 British birth cohort were used (N=9328). Parental BMI was assessed when offspring were aged 11 years; offspring BMI, waist circumference and CVD risk factors (lipid levels, blood pressure, glycosylated haemoglobin (HbA1c) and inflammatory and haemostatic markers) were measured at 44-45 years. Higher parental BMI was associated with less favourable levels of offspring risk factors for CVD. Most associations were maintained after adjustment for offspring lifestyle and socioeconomic factors but were largely abolished or reversed after adjustment for offspring adiposity. For some CVD risk factors, there was evidence of effect modification; the association between higher BMI and an adverse lipid profile among offspring was weaker if maternal BMI had been higher. Conversely, offspring BMI was more strongly associated with HbA1c if parental BMI had been higher. Intergenerational influences may be important in conferring the effect of high BMI on CVD risk among offspring.

Risk Factors for Cardiovascular Disease among Thyroid Cancer Survivors: Findings from the Utah Cancer Survivors Study.

PubMed

Park, Jihye; Blackburn, Brenna E; Ganz, Patricia A; Rowe, Kerry; Snyder, John; Wan, Yuan; Deshmukh, Vikrant; Newman, Michael; Fraser, Alison; Smith, Ken; Herget, Kim; Kirchhoff, Anne C; Abraham, Dev; Kim, Jaewhan; Monroe, Marcus; Hashibe, Mia

2018-05-29

Thyroid cancer survivors are at high risk to develop multiple cardiac and vascular conditions as consequence of cancer diagnosis and treatment; however, it is still unclear how baseline and prognostic factors, as well as cancer treatments, play a role in increasing cardiac and vascular disease risk among thyroid cancer survivors. To investigate the association between potential risk factors, treatment effects, and cardiovascular disease (CVD) outcomes in thyroid cancer survivors. Primary thyroid cancer survivors, diagnosed between 1997-2012, (n=3,822) were identified using the statewide Utah Population Database. Medical records were utilized to ascertain information on risk factors and CVD outcomes. Cox proportional hazards models were used to assess the risk of CVD with baseline demographics and clinical factors. Among thyroid cancer survivors, age and year at cancer diagnosis, cancer stage, sex, baseline BMI, baseline comorbidities, and thyroid-stimulating hormone (TSH) suppression therapy were significantly associated with CVD risk 1-5 years after cancer diagnosis. Patients who were male, overweight or obese, older at cancer diagnosis and diagnosed with cancer since 2005 had an increased risk of CVD compared to patients who were female, normal BMI, younger at cancer diagnosis and diagnosed with cancer between 1997-1999. Administration of TSH suppression therapy, distant metastases at cancer diagnosis, and higher Charlson Comorbidity Index (CCI) score were associated with an increased CVD risk among thyroid cancer survivors. Our findings suggest that examining the impact of thyroid cancer diagnosis, cancer treatment, and demographic characteristics on the risk of CVD is critical.

Low-density lipoprotein electronegativity is a novel cardiometabolic risk factor.

PubMed

Hsu, Jing-Fang; Chou, Tzu-Chieh; Lu, Jonathan; Chen, Shu-Hua; Chen, Fang-Yu; Chen, Ching-Chu; Chen, Jeffrey L; Elayda, MacArthur; Ballantyne, Christie M; Shayani, Steven; Chen, Chu-Huang

2014-01-01

Low-density lipoprotein (LDL) plays a central role in cardiovascular disease (CVD) development. In LDL chromatographically resolved according to charge, the most electronegative subfraction-L5-is the only subfraction that induces atherogenic responses in cultured vascular cells. Furthermore, increasing evidence has shown that plasma L5 levels are elevated in individuals with high cardiovascular risk. We hypothesized that LDL electronegativity is a novel index for predicting CVD. In 30 asymptomatic individuals with metabolic syndrome (MetS) and 27 healthy control subjects, we examined correlations between plasma L5 levels and the number of MetS criteria fulfilled, CVD risk factors, and CVD risk according to the Framingham risk score. L5 levels were significantly higher in MetS subjects than in control subjects (21.9±18.7 mg/dL vs. 11.2±10.7 mg/dL, P:0.01). The Jonckheere trend test revealed that the percent L5 of total LDL (L5%) and L5 concentration increased with the number of MetS criteria (P<0.001). L5% correlated with classic CVD risk factors, including waist circumference, body mass index, waist-to-height ratio, smoking status, blood pressure, and levels of fasting plasma glucose, triglyceride, and high-density lipoprotein. Stepwise regression analysis revealed that fasting plasma glucose level and body mass index contributed to 28% of L5% variance. The L5 concentration was associated with CVD risk and contributed to 11% of 30-year general CVD risk variance when controlling the variance of waist circumference. Our findings show that LDL electronegativity was associated with multiple CVD risk factors and CVD risk, suggesting that the LDL electronegativity index may have the potential to be a novel index for predicting CVD. Large-scale clinical trials are warranted to test the reliability of this hypothesis and the clinical importance of the LDL electronegativity index.

Low-Density Lipoprotein Electronegativity Is a Novel Cardiometabolic Risk Factor

PubMed Central

Lu, Jonathan; Chen, Shu-Hua; Chen, Fang-Yu; Chen, Ching-Chu; Chen, Jeffrey L.; Elayda, MacArthur; Ballantyne, Christie M.; Shayani, Steven; Chen, Chu-Huang

2014-01-01

Background Low-density lipoprotein (LDL) plays a central role in cardiovascular disease (CVD) development. In LDL chromatographically resolved according to charge, the most electronegative subfraction–L5–is the only subfraction that induces atherogenic responses in cultured vascular cells. Furthermore, increasing evidence has shown that plasma L5 levels are elevated in individuals with high cardiovascular risk. We hypothesized that LDL electronegativity is a novel index for predicting CVD. Methods In 30 asymptomatic individuals with metabolic syndrome (MetS) and 27 healthy control subjects, we examined correlations between plasma L5 levels and the number of MetS criteria fulfilled, CVD risk factors, and CVD risk according to the Framingham risk score. Results L5 levels were significantly higher in MetS subjects than in control subjects (21.9±18.7 mg/dL vs. 11.2±10.7 mg/dL, P:0.01). The Jonckheere trend test revealed that the percent L5 of total LDL (L5%) and L5 concentration increased with the number of MetS criteria (P<0.001). L5% correlated with classic CVD risk factors, including waist circumference, body mass index, waist-to-height ratio, smoking status, blood pressure, and levels of fasting plasma glucose, triglyceride, and high-density lipoprotein. Stepwise regression analysis revealed that fasting plasma glucose level and body mass index contributed to 28% of L5% variance. The L5 concentration was associated with CVD risk and contributed to 11% of 30-year general CVD risk variance when controlling the variance of waist circumference. Conclusion Our findings show that LDL electronegativity was associated with multiple CVD risk factors and CVD risk, suggesting that the LDL electronegativity index may have the potential to be a novel index for predicting CVD. Large-scale clinical trials are warranted to test the reliability of this hypothesis and the clinical importance of the LDL electronegativity index. PMID:25203525

Plasma Clot Lysis Time and Its Association with Cardiovascular Risk Factors in Black Africans

PubMed Central

Jerling, Johann C.; Kruger, Annamarie; Rijken, Dingeman C.

2012-01-01

Studies in populations of European descent show longer plasma clot lysis times (CLT) in patients with cardiovascular disease (CVD) than in controls. No data are available on the association between CVD risk factors and fibrinolytic potential in black Africans, a group undergoing rapid urbanisation with increased CVD prevalence. We investigated associations between known CVD risk factors and CLT in black Africans and whether CLTs differ between rural and urban participants in light of differences in CVD risk. Data from 1000 rural and 1000 urban apparently healthy black South Africans (35–60 years) were cross-sectionally analysed. Increased PAI-1act, BMI, HbA1c, triglycerides, the metabolic syndrome, fibrinogen concentration, CRP, female sex and positive HIV status were associated with increased CLTs, while habitual alcohol consumption associated with decreased CLT. No differences in CLT were found between age and smoking categories, contraceptive use or hyper- and normotensive participants. Urban women had longer CLT than rural women while no differences were observed for men. CLT was associated with many known CVD risk factors in black Africans. Differences were however observed, compared to data from populations of European descent available in the literature, suggesting possible ethnic differences. The effect of urbanisation on CLT is influenced by traditional CVD risk factors and their prevalence in urban and rural communities. PMID:23145007

Gender Differences in Genetic Risk Profiles for Cardiovascular Disease

PubMed Central

Silander, Kaisa; Saarela, Olli; Ripatti, Samuli; Auro, Kirsi; Karvanen, Juha; Kulathinal, Sangita; Niemelä, Matti; Ellonen, Pekka; Vartiainen, Erkki; Jousilahti, Pekka; Saarela, Janna; Kuulasmaa, Kari; Evans, Alun; Perola, Markus; Salomaa, Veikko; Peltonen, Leena

2008-01-01

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. PMID:18974842

Plasma and blood viscosity in the prediction of cardiovascular disease and mortality in the Scottish Heart Health Extended Cohort Study.

PubMed

Peters, Sanne Ae; Woodward, Mark; Rumley, Ann; Tunstall-Pedoe, Hugh D; Lowe, Gordon DO

2017-01-01

Background There is increasing evidence that blood viscosity and its major determinants (haematocrit and plasma viscosity) are associated with increased risks of cardiovascular disease (CVD) and premature mortality; however, their predictive value for CVD and mortality is not clear. Methods We prospectively assessed the added predictive value of plasma viscosity and whole blood viscosity and haematocrit in 3386 men and women aged 30-74 years participating in the Scottish Heart Health Extended Cohort study. Results Over a median follow-up of 17 years, 819 CVD events and 778 deaths were recorded. Hazard ratios (95% confidence intervals) for a 1 SD increase in plasma viscosity, adjusted for major CVD risk factors, were 1.12 (1.04-1.20) for CVD and 1.20 (1.12-1.29) for mortality. These remained significant after further adjustment for plasma fibrinogen: 1.09 (1.01-1.18) and 1.13 (1.04-1.22). The corresponding results for blood viscosity were 0.99 (0.90, 1.09) for CVD, and 1.11 (1.01, 1.22) for total mortality after adjustment for major CVD risk factors; and 0.97 (0.88, 1.08) and 1.06 (0.96, 1.18) after further adjustment for fibrinogen. Haematocrit showed similar associations to blood viscosity. When added to classical CVD risk factors, plasma viscosity improved the discrimination of CVD and mortality by 2.4% (0.7-4.4%) and 4.1% (2.0-6.5%). Conclusions Although plasma and blood viscosity may have a role in the pathogenesis of CVD and mortality, much of their association with CVD and mortality is due to the mutual effects of major CVD risk factors. However, plasma viscosity adds to the discrimination of CVD and mortality and might be considered for inclusion in multivariable risk scores.

Correlation of adiposity indices with cardiovascular disease risk factors in healthy adults of Singapore: a cross-sectional study.

PubMed

Bi, Xinyan; Tey, Siew Ling; Leong, Claudia; Quek, Rina; Loo, Yi Ting; Henry, Christiani Jeyakumar

2016-01-01

Obesity has long been highlighted for its association with increased incidence of cardiovascular disease (CVD). Nonetheless, the best adiposity indices to evaluate the CVD risk factors remain contentious and few studies have been performed in Asian populations. In the present study, we compared the association strength of percent body fat (PBF) to indirect anthropometric measures of general adiposity (body mass index (BMI) and body adiposity index (BAI)) and central adiposity (waist circumference (WC), and waist-to-hip ratio (WHR)) for the prediction of CVD risk factors in healthy men and women living in Singapore. A total of 125 individuals (63 men and 62 women) took part in this study. PBF was measured by using three different techniques, including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Anthropometric measurements (WC, hip circumference (HC), height, and weight), fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were determined according to standard protocols. Correlations of anthropometric measurements and PBF with CVD risk factors were compared. Irrespective of the measuring techniques, PBF showed strong positive correlations with FSI, HOMA-IR, TC/HDL, TG/HDL, and LDL/HDL in both genders. While PBF was highly correlated with FBG, SBP, and DBP in females, no significant relationships were observed in males. Amongst the five anthropometric measures of adiposity, BAI was the best predictor for CVD risk factors in female participants (r = 0.593 for HOMA-IR, r = 0.542 for TG/HDL, r = 0.474 for SBP, and r = 0.448 for DBP). For males, the combination of WC (r = 0.629 for HOMA-IR, and r = 0.446 for TG/HDL) and WHR (r = 0.352 for SBP, and r = 0.366 for DBP) had the best correlation with CVD risk factors. Measurement of PBF does not outperform the simple anthropometric measurements of obesity, i.e. BAI, WC, and WHR, in the prediction of CVD risk factors in healthy Asian adults. While measures of central adiposity (WC and WHR) tend to show stronger associations with CVD risk factors in males, measures of general adiposity (BAI) seems to be the best predictor in females. The gender differences in the association between adiposity indices and CVD risk factors may relate to different body fat distribution in males and females living in Singapore. These results may find further clinical utility to identify patients with CVD risk factors in a more efficient way.

Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States.

PubMed

Daviglus, Martha L; Talavera, Gregory A; Avilés-Santa, M Larissa; Allison, Matthew; Cai, Jianwen; Criqui, Michael H; Gellman, Marc; Giachello, Aida L; Gouskova, Natalia; Kaplan, Robert C; LaVange, Lisa; Penedo, Frank; Perreira, Krista; Pirzada, Amber; Schneiderman, Neil; Wassertheil-Smoller, Sylvia; Sorlie, Paul D; Stamler, Jeremiah

2012-11-07

Major cardiovascular diseases (CVDs) are leading causes of mortality among US Hispanic and Latino individuals. Comprehensive data are limited regarding the prevalence of CVD risk factors in this population and relations of these traits to socioeconomic status (SES) and acculturation. To describe prevalence of major CVD risk factors and CVD (coronary heart disease [CHD] and stroke) among US Hispanic/Latino individuals of different backgrounds, examine relationships of SES and acculturation with CVD risk profiles and CVD, and assess cross-sectional associations of CVD risk factors with CVD. Multicenter, prospective, population-based Hispanic Community Health Study/Study of Latinos including individuals of Cuban (n = 2201), Dominican (n = 1400), Mexican (n = 6232), Puerto Rican (n = 2590), Central American (n = 1634), and South American backgrounds (n = 1022) aged 18 to 74 years. Analyses involved 15,079 participants with complete data enrolled between March 2008 and June 2011. Adverse CVD risk factors defined using national guidelines for hypercholesterolemia, hypertension, obesity, diabetes, and smoking. Prevalence of CHD and stroke were ascertained from self-reported data. Age-standardized prevalence of CVD risk factors varied by Hispanic/Latino background; obesity and current smoking rates were highest among Puerto Rican participants (for men, 40.9% and 34.7%; for women, 51.4% and 31.7%, respectively); hypercholesterolemia prevalence was highest among Central American men (54.9%) and Puerto Rican women (41.0%). Large proportions of participants (80% of men, 71% of women) had at least 1 risk factor. Age- and sex-adjusted prevalence of 3 or more risk factors was highest in Puerto Rican participants (25.0%) and significantly higher (P < .001) among participants with less education (16.1%), those who were US-born (18.5%), those who had lived in the United States 10 years or longer (15.7%), and those who preferred English (17.9%). Overall, self-reported CHD and stroke prevalence were low (4.2% and 2.0% in men; 2.4% and 1.2% in women, respectively). In multivariate-adjusted models, hypertension and smoking were directly associated with CHD in both sexes as were hypercholesterolemia and obesity in women and diabetes in men (odds ratios [ORs], 1.5-2.2). For stroke, associations were positive with hypertension in both sexes, diabetes in men, and smoking in women (ORs, 1.7-2.6). Among US Hispanic/Latino adults of diverse backgrounds, a sizeable proportion of men and women had adverse major risk factors; prevalence of adverse CVD risk profiles was higher among participants with Puerto Rican background, lower SES, and higher levels of acculturation.

Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework.

PubMed

Loucks, Eric B; Schuman-Olivier, Zev; Britton, Willoughby B; Fresco, David M; Desbordes, Gaelle; Brewer, Judson A; Fulwiler, Carl

2015-12-01

The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy.

Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework

PubMed Central

Schuman-Olivier, Zev; Britton, Willoughby B.; Fresco, David M.; Desbordes, Gaelle; Brewer, Judson A.; Fulwiler, Carl

2016-01-01

The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy. PMID:26482755

Cardiovascular health among adults in Syria: a model from developing countries.

PubMed

Maziak, Wasim; Rastam, Samer; Mzayek, Fawaz; Ward, Kenneth D; Eissenberg, Thomas; Keil, Ulrich

2007-09-01

Despite the considerable mortality and morbidity associated with cardiovascular disease (CVD), many developing countries lack reliable surveillance of these ailments and their risk factors to guide intervention. This study aims to provide the first population-based estimates of CVD morbidity and mortality among adults in Aleppo, Syria and the distribution of their risk factors. A cross-sectional survey of adults 18 to 65 years old residing in Aleppo, Syria was carried out in 2004, involving 2038 household representatives (45.2% men; mean age, 35.3 years; response rate, 86%). Main outcomes of interest were physician-diagnosed CVD (infarction, angina, failure, stroke) among survey participants, and past 5-year mortality due to CVD among their household members older than 20 years of age (N = 6252, 49.5% men). Measurement of blood pressure (BP), height and weight, and smoking history were obtained as well. Prevalence of CVD was 4.8% for heart disease and 1.0% for stroke. CVD was responsible for 45.0% of overall mortality reported in the past 5 years, whereby 49% of CVD deaths occurred before the age of 65 years. Mean age of death was 62.6 years (63.6 years for heart disease and 61.4 years for stroke). Annual crude death rate due to CVD was 314 per 100,000 (95% confidence interval [95% CI]: 215-414); of these, 179 were due to heart disease, and 135 due to stroke. More men than women died from heart disease, whereas the opposite was true for stroke. Hypertension was detected in 40.6% (47.7% men, 34.9%women), obesity in 38.2% (28.8% men, 46.4% women), and smoking (cigarettes or waterpipe) in 38.7% (63.6% men, 19.2% women) of participants. Of those surveyed, 39.3% had one CVD risk factor, 27.4% had two risk factors, and 8.3% had 3 risk factors. Main predictors of clustering of risk factors were older age, male gender, and low education. Syria is currently undergoing a stage in which morbidity and mortality from CVD are high but likely to increase based on the population's risk profile. CVD risk distribution in Syrian society highlights the non-generalizability of CVD models from developed societies, and calls for local studies to inform effective interventions and policies.

Cardiovascular health among adults in Syria: a model from developing countries

PubMed Central

Maziak, Wasim; Rastam, Samer; Mzayek, Fawaz; Ward, Kenneth D; Eissenberg, Thomas; Keil, Ulrich

2007-01-01

Background Despite the considerable mortality and morbidity associated with cardiovascular disease (CVD) many developing countries lack reliable surveillance of these ailments and their risk factors to guide intervention. This study aims to provide the first population-based estimates of CVD morbidity and mortality among adults in Aleppo-Syria and the distribution of their risk factors. Methods A cross-sectional survey of adults 18-65 years old residing in Aleppo-Syria was carried out in 2004 involving 2038 household representatives (45.2% men, mean age 35.3 years, response rate 86%). Main outcomes of interest were physician-diagnosed CVD (infarction, angina, failure, stroke) among survey participants, and past 5 year mortality due to CVD among their household members > 20 years of age (n=6252, 49.5% men). Measurement of blood pressure (BP), height and weight, and smoking history were obtained as well. Findings Prevalence of CVD was 4.8% for heart disease and 1.0% for stroke. CVD was responsible for 45.0% of overall mortality reported in the past 5 years, whereby 49% of CVD deaths occurred before the age of 65 year. Mean age of death was 62.6 years (63.6 years for HD and 61.4 years for stroke). Annual crude death rate due to CVD was 314 per 100,000 (95%CI: 215-414), of these 179 were due to heart disease, and 135 due to stroke. More men died from heart disease than women, while the opposite was true for stroke. Hypertension was detected in 40.6% (47.7% men, 34.9%women), obesity in 38.2% (28.8% men, 46.4% women), and smoking (cigarettes or waterpipe) in 38.7% (63.6% men, 19.2% women) of participants. Of those surveyed, 39.3% had 1 CVD risk factor, 27.4% had 2 risk factors, and 8.3% had 3 risk factors. Main predictors of clustering of risk factors were older age, male gender, and low education. Conclusions Syria is currently undergoing a stage, where morbidity and mortality from CVD are high but likely to increase based on the population's risk profile. CVD risk distribution in the Syrian society highlights the non-generalizability of CVD models from developed societies, and calls for local studies to inform effective interventions and policies. PMID:17553700

Association of cardiovascular risk factors between Hispanic/Latino parents and youth: the Hispanic Community Health Study/Study of Latino Youth.

PubMed

Carnethon, Mercedes R; Ayala, Guadalupe X; Bangdiwala, Shrikant I; Bishop, Virginia; Daviglus, Martha L; Delamater, Alan M; Gallo, Linda C; Perreira, Krista; Pulgaron, Elizabeth; Reina, Samantha; Talavera, Gregory A; Van Horn, Linda H; Isasi, Carmen R

2017-04-01

Hispanic/Latinos have a high burden of cardiovascular disease (CVD) risk factors which may begin at young ages. We tested the association of CVD risk factors between Hispanic/Latino parents and their children. We conducted a cross-sectional study in the Hispanic Community Health Study/Study of Latinos Youth study. Girls (n = 674) and boys (n = 667) aged 8 to 16 years (mean age 12.1 years) and their parents (n = 942) had their CVD risk factors measured. CVD risk factors in parents were significantly positively associated with those same risk factors among youth. After adjustment for demographic characteristics, diet and physical activity, obese parents were significantly more likely to have youth who were overweight (odds ratios [ORs], 2.39; 95% confidence interval [CI], 1.20-4.76) or obese (OR, 6.16; 95% CI, 3.23-11.77) versus normal weight. Dyslipidemia among parents was associated with 1.98 higher odds of dyslipidemia among youth (95% CI, 1.37-2.87). Neither hypertension nor diabetes was associated with higher odds of high blood pressure or hyperglycemia (prediabetes or diabetes) in youth. Findings were consistent by sex and in younger (age <12 years) versus older (≥12 years) youth. Hispanic/Latino youth share patterns of obesity and CVD risk factors with their parents, which portends high risk for adult CVD. Copyright © 2017 Elsevier Inc. All rights reserved.

Prospective associations of psychosocial adversity in childhood with risk factors for cardiovascular disease in adulthood: the MRC National Survey of Health and Development.

PubMed

Anderson, Emma L; Caleyachetty, Rishi; Stafford, Mai; Kuh, Diana; Hardy, Rebecca; Lawlor, Debbie A; Fraser, Abigail; Howe, Laura D

2017-09-07

Studies assessing associations of childhood psychosocial adversity (e.g. sexual abuse, physical neglect, parental death), as opposed to socioeconomic adversity, with cardiovascular disease (CVD) risk factors in adulthood are scarce. We aimed to assess associations of various forms of psychosocial adversity and cumulative adversity in childhood, with multiple CVD risk factors in mid-life. Participants were from the MRC National Survey of Health and Development. Childhood psychosocial risk factors were reported prospectively by parents from 1950-1957, and retrospectively by participants at mean age 43 years in 1989. CVD risk factors were assessed at mean age 60-64 years in 2006-2011. Associations of a summary score of total psychosocial adversity and CVD risk in adulthood were assessed. There was no consistent evidence that cumulative psychosocial adversity, nor any specific form of psychosocial adversity in childhood, was associated with CVD risk factors in late adulthood. There was some evidence that parental death in the first 15 years was associated with higher SBP (Beta: 0.23, 95% confidence interval: 0.06 to 0.40, P=0.01) and DBP (Beta: 0.15, 95% confidence interval: -0.01 to 0.32, P=0.07). We found no evidence that exposure to greater psychosocial adversity, or specific forms of psychosocial adversity during childhood is associated with adult CVD risk factors. Further large population studies are needed to clarify whether parental death is associated with higher systolic and diastolic blood pressure.

Effects of prediabetes mellitus alone or plus hypertension on subsequent occurrence of cardiovascular disease and diabetes mellitus: longitudinal study.

PubMed

Qiu, Miaoyan; Shen, Weili; Song, Xiaomin; Ju, Liping; Tong, Wenxin; Wang, Haiyan; Zheng, Sheng; Jin, Yan; Wu, Yixin; Wang, Weiqing; Tian, Jingyan

2015-03-01

Whether prediabetes mellitus alone or combined with other disorders means a higher risk for cardiovascular disease (CVD) is still controversial. This study aimed to investigate the association between prediabetes mellitus and CVD and diabetes mellitus and to explore whether prediabetes mellitus alone or combined with other syndromes, such as hypertension, could promote CVD risks significantly. This longitudinal population-based study of 1609 residents from Shanghai in Southern China was conducted between 2002 and 2014. Participants with a history of CVD at baseline were excluded from analysis. Multivariate log-binomial regression models were used to adjust possible coexisting factors. Incidence of CVD during follow-up was 10.1%. After adjusting for age, sex, and other factors, the association between prediabetes mellitus and CVD was not observed. When hypertension was incorporated in stratifying factors, adjusted CVD risk was elevated significantly (odds ratio, 2.41; 95% confidence interval, 1.25-4.64) in prediabetes mellitus and hypertension combined group, and coexistence of diabetes mellitus and hypertension made CVD risk highly significantly increased, reaching 3.43-fold higher than the reference group. Blood glucose level within prediabetic range is significantly associated with elevated risks for diabetes mellitus after multivariable adjustment, but only when it is concurrent with other disorders, such as hypertension, it will significantly increase CVD risk. © 2015 American Heart Association, Inc.

'I should have taken that further' - missed opportunities during cardiovascular risk assessment in patients with psoriasis in UK primary care settings: a mixed-methods study.

PubMed

Nelson, Pauline A; Kane, Karen; Chisholm, Anna; Pearce, Christina J; Keyworth, Christopher; Rutter, Martin K; Chew-Graham, Carolyn A; Griffiths, Christopher E M; Cordingley, Lis

2016-10-01

Unhealthy lifestyle is common in psoriasis, contributing to worsening disease and increased cardiovascular disease (CVD) risk. CVD risk communication should improve patients' understanding of risk and risk-reducing behaviours; however, the effectiveness of risk screening is debated and evaluation currently limited. To examine the process of assessing for and communicating about CVD risk in the context of psoriasis. Mixed-methods study in English general practices to (i) determine proportions of CVD risk factors among patients with psoriasis at risk assessment and (ii) examine patient and practitioner experiences of risk communication to identify salient 'process' issues. Audio recordings of consultations informed in-depth interviews with patients and practitioners using tape-assisted recall, analysed with framework analysis. Patients with psoriasis (n = 287) undergoing CVD risk assessment; 29 patients and 12 practitioners interviewed. A high proportion of patients had risk factor levels apparent at risk assessment above NICE recommendations: very high waist circumference (52%), obesity (35%), raised blood pressure (29%), smoking (18%) and excess alcohol consumption (18%). There was little evidence of personalized discussion about CVD risk and behaviour change support in consultations. Professionals reported a lack of training in behaviour change, while patients wanted to discuss CVD risk/risk reduction and believed practitioners to be influential in supporting lifestyle management. Despite high levels of risk factors identified, opportunities may be missed in consultations to support patients with psoriasis to understand CVD risk/risk reduction. Practitioners need training in behaviour change techniques to capitalize on 'teachable moments' and increase the effectiveness of risk screening. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Primary prevention of cardiovascular disease: a web‐based risk score for seven British black and minority ethnic groups

PubMed Central

Brindle, P; May, M; Gill, P; Cappuccio, F; D'Agostino, R; Fischbacher, C; Ebrahim, S

2006-01-01

Objective To recalibrate an existing Framingham risk score to produce a web‐based tool for estimating the 10‐year risk of coronary heart disease (CHD) and cardiovascular disease (CVD) in seven British black and minority ethnic groups. Design Risk prediction models were recalibrated against survey data on ethnic group risk factors and disease prevalence compared with the general population. Ethnic‐ and sex‐specific 10‐year risks of CHD and CVD, at the means of the risk factors for each ethnic group, were calculated from the product of the incidence rate in the general population and the prevalence ratios for each ethnic group. Setting Two community‐based surveys. Participants 3778 men and 4544 women, aged 35–54, from the Health Surveys for England 1998 and 1999 and the Wandsworth Heart and Stroke Study. Main outcome measures 10‐year risk of CHD and CVD. Results 10‐year risk of CHD and CVD for non‐smoking people aged 50 years with a systolic blood pressure of 130 mm Hg and a total cholesterol to high density lipoprotein cholesterol ratio of 4.2 was highest in men for those of Pakistani and Bangladeshi origin (CVD risk 12.6% and 12.8%, respectively). CHD risk in men with the same risk factor values was lowest in Caribbeans (2.8%) and CVD risk was lowest in Chinese (5.4%). Women of Pakistani origin were at highest risk and Chinese women at lowest risk for both outcomes with CVD risks of 6.6% and 1.2%, respectively. A web‐based risk calculator (ETHRISK) allows 10‐year risks to be estimated in routine primary care settings for relevant risk factor and ethnic group combinations. Conclusions In the absence of cohort studies in the UK that include significant numbers of black and minority ethnic groups, this risk score provides a pragmatic solution to including people from diverse ethnic backgrounds in the primary prevention of CVD. PMID:16762981

Communicating cardiovascular disease risk: an interview study of General Practitioners' use of absolute risk within tailored communication strategies.

PubMed

Bonner, Carissa; Jansen, Jesse; McKinn, Shannon; Irwig, Les; Doust, Jenny; Glasziou, Paul; McCaffery, Kirsten

2014-05-29

Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs' descriptions of their CVD risk communication strategies, including the role of absolute risk. Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour. GPs used absolute CVD risk within three different communication strategies: 'positive', 'scare tactic', and 'indirect'. A 'positive' strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A 'scare tactic' strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to 'scare' them into taking action. An 'indirect' strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations. This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice.

Which hemostatic markers add to the predictive value of conventional risk factors for coronary heart disease and ischemic stroke? The Caerphilly Study.

PubMed

Smith, Ann; Patterson, Chris; Yarnell, John; Rumley, Ann; Ben-Shlomo, Yoav; Lowe, Gordon

2005-11-15

Few studies have examined whether hemostatic markers contribute to risk of coronary disease and ischemic stroke independently of conventional risk factors. This study examines 11 hemostatic markers that reflect different aspects of the coagulation process to determine which have prognostic value after accounting for conventional risk factors. A total of 2398 men aged 49 to 65 years were examined in 1984 to 1988, and the majority gave a fasting blood sample for assay of lipids and hemostatic markers. Men were followed up for a median of 13 years, and cardiovascular disease (CVD) events were recorded. There were 486 CVD events in total, 353 with prospective coronary disease and 133 with prospective ischemic stroke. On univariable analysis, fibrinogen, low activated protein C ratio, D-dimer, tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1) were associated significantly with risk of CVD. On multivariable analyses with conventional risk factors forced into the proportional hazards model, fibrinogen, D-dimer, and PAI-1 were significantly associated with risk of CVD, whereas factor VIIc showed an inverse association (P=0.001). In a model that contained the conventional risk factors, the hazard ratio for subsequent CVD in the top third of the distribution of predicted risk relative to the bottom third was 2.7 for subjects without preexisting CVD. This ratio increased to 3.7 for the model that also contained the 4 hemostatic factors. Fibrinogen, D-dimer, PAI-1 activity, and factor VIIc each has potential to increase the prediction of coronary disease/ischemic stroke in middle-aged men, in addition to conventional risk factors.

Glycated hemoglobin measurement and prediction of cardiovascular disease.

PubMed

Di Angelantonio, Emanuele; Gao, Pei; Khan, Hassan; Butterworth, Adam S; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L M; Khaw, Kay-Tee; Psaty, Bruce M; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M; Lawlor, Debbie A; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J; Kuller, Lewis H; Price, Jackie F; Sundström, Johan; Knuiman, Matthew W; Feskens, Edith J M; Verschuren, W M M; Wald, Nicholas; Bakker, Stephan J L; Whincup, Peter H; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A; Rosengren, Annika; Sutherland, Susan E; Björkelund, Cecilia; Blazer, Dan G; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J Wouter; Simpson, Lara M; Giampaoli, Simona; Nordestgaard, Børge G; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B; Cushman, Mary; D'Agostino, Ralph B; Umans, Jason G; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F; Folsom, Aaron R; van der Schouw, Yvonne T; Moons, Karel G; Griffin, Simon J; Sattar, Naveed; Wareham, Nicholas J; Selvin, Elizabeth; Thompson, Simon G; Danesh, John

2014-03-26

The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk. During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.

Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement.

PubMed

Curry, Susan J; Krist, Alex H; Owens, Douglas K; Barry, Michael J; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Kubik, Martha; Landefeld, C Seth; Mangione, Carol M; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen; Wong, John B

2018-06-12

Cardiovascular disease (CVD), which encompasses atherosclerotic conditions such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease, is the most common cause of death among adults in the United States. Treatment to prevent CVD events by modifying risk factors is currently informed by CVD risk assessment with tools such as the Framingham Risk Score or the Pooled Cohort Equations, which stratify individual risk to inform treatment decisions. To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for coronary heart disease with electrocardiography (ECG). The USPSTF reviewed the evidence on whether screening with resting or exercise ECG improves health outcomes compared with the use of traditional CVD risk assessment alone in asymptomatic adults. For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikely that the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient's risk category as assessed by the Framingham Risk Score or Pooled Cohort Equations that would lead to a change in treatment and ultimately improve health outcomes. Possible harms are associated with screening with resting or exercise ECG, specifically the potential adverse effects of subsequent invasive testing. For asymptomatic adults at intermediate or high risk of CVD events, there is insufficient evidence to determine the extent to which information from resting or exercise ECG adds to current CVD risk assessment models and whether information from the ECG results in a change in risk management and ultimately reduces CVD events. As with low-risk adults, possible harms are associated with screening with resting or exercise ECG in asymptomatic adults at intermediate or high risk of CVD events. The USPSTF recommends against screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at low risk of CVD events. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at intermediate or high risk of CVD events. (I statement).

Mapping eQTLs in the Norfolk Island Genetic Isolate Identifies Candidate Genes for CVD Risk Traits

PubMed Central

Benton, Miles C.; Lea, Rod A.; Macartney-Coxson, Donia; Carless, Melanie A.; Göring, Harald H.; Bellis, Claire; Hanna, Michelle; Eccles, David; Chambers, Geoffrey K.; Curran, Joanne E.; Harper, Jacquie L.; Blangero, John; Griffiths, Lyn R.

2013-01-01

Cardiovascular disease (CVD) affects millions of people worldwide and is influenced by numerous factors, including lifestyle and genetics. Expression quantitative trait loci (eQTLs) influence gene expression and are good candidates for CVD risk. Founder-effect pedigrees can provide additional power to map genes associated with disease risk. Therefore, we identified eQTLs in the genetic isolate of Norfolk Island (NI) and tested for associations between these and CVD risk factors. We measured genome-wide transcript levels of blood lymphocytes in 330 individuals and used pedigree-based heritability analysis to identify heritable transcripts. eQTLs were identified by genome-wide association testing of these transcripts. Testing for association between CVD risk factors (i.e., blood lipids, blood pressure, and body fat indices) and eQTLs revealed 1,712 heritable transcripts (p < 0.05) with heritability values ranging from 0.18 to 0.84. From these, we identified 200 cis-acting and 70 trans-acting eQTLs (p < 1.84 × 10−7) An eQTL-centric analysis of CVD risk traits revealed multiple associations, including 12 previously associated with CVD-related traits. Trait versus eQTL regression modeling identified four CVD risk candidates (NAAA, PAPSS1, NME1, and PRDX1), all of which have known biological roles in disease. In addition, we implicated several genes previously associated with CVD risk traits, including MTHFR and FN3KRP. We have successfully identified a panel of eQTLs in the NI pedigree and used this to implicate several genes in CVD risk. Future studies are required for further assessing the functional importance of these eQTLs and whether the findings here also relate to outbred populations. PMID:24314549

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study.

PubMed

Hoffmann, Udo; Massaro, Joseph M; D'Agostino, Ralph B; Kathiresan, Sekar; Fox, Caroline S; O'Donnell, Christopher J

2016-02-22

We determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all-cause mortality independent of Framingham risk factors in the community-based Framingham Heart Study. Coronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C-statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all-cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all-cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78-0.82; net reclassification index 32%, 95% CI 11-53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5-10%) 10-year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%). CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community-dwelling persons and accurately reclassifies two-thirds of the intermediate-risk population. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events.

PubMed

Thomas, Isac C; McClelland, Robyn L; Michos, Erin D; Allison, Matthew A; Forbang, Nketi I; Longstreth, W T; Post, Wendy S; Wong, Nathan D; Budoff, Matthew J; Criqui, Michael H

2017-10-01

The volume and density of coronary artery calcium (CAC) both independently predict cardiovascular disease (CVD) beyond standard risk factors, with CAC density inversely associated with incident CVD after accounting for CAC volume. We tested the hypothesis that ascending thoracic aorta calcium (ATAC) volume and density predict incident CVD events independently of CAC. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of participants without clinical CVD at baseline. ATAC and CAC were measured from baseline cardiac computed tomography (CT). Cox regression models were used to estimate the associations of ATAC volume and density with incident coronary heart disease (CHD) events and CVD events, after adjustment for standard CVD risk factors and CAC volume and density. Among 6811 participants, 234 (3.4%) had prevalent ATAC and 3395 (49.8%) had prevalent CAC. Over 10.3 years, 355 CHD and 562 CVD events occurred. One-standard deviation higher ATAC density was associated with a lower risk of CHD (HR 0.48 [95% CI 0.29-0.79], p<0.01) and CVD (HR 0.56 [0.37-0.84], p<0.01) after full adjustment. ATAC volume was not associated with outcomes after full adjustment. ATAC was uncommon in a cohort free of clinical CVD at baseline. However, ATAC density was inversely associated with incident CHD and CVD after adjustment for CVD risk factors and CAC volume and density. Copyright © 2017 Elsevier B.V. All rights reserved.

Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study.

PubMed

Tillmann, Taavi; Pikhart, Hynek; Peasey, Anne; Kubinova, Ruzena; Pajak, Andrzej; Tamosiunas, Abdonas; Malyutina, Sofia; Steptoe, Andrew; Kivimäki, Mika; Marmot, Michael; Bobak, Martin

2017-12-01

Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43-74 years and free of CVD at baseline examination during 2002-2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14-1.40] and 1.81 [95% confidence interval 1.24-2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%-13%] to 22% [11%-31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained.

Psychosocial and socioeconomic determinants of cardiovascular mortality in Eastern Europe: A multicentre prospective cohort study

PubMed Central

Kubinova, Ruzena; Tamosiunas, Abdonas; Marmot, Michael; Bobak, Martin

2017-01-01

Background Eastern European countries have some of the highest rates of cardiovascular disease (CVD) mortality, much of which cannot be adequately accounted for by conventional CVD risk factors. Psychosocial and socioeconomic factors may affect risk of CVD, but relatively few studies on this issue have been undertaken in Eastern Europe. We investigated whether various psychosocial factors are associated with CVD mortality independently from each other and whether they can help explain differences in CVD mortality between Eastern European populations. Methods Participants were from the Health, Alcohol and Psychological factors in Eastern Europe (HAPIEE) cohort study in Russia, Poland and the Czech Republic, including a total of 20,867 men and women aged 43–74 years and free of CVD at baseline examination during 2002–2005. Participants were followed-up for CVD mortality after linkage to national mortality registries for a median of 7.2 years. Results During the follow-up, 556 participants died from CVD. After mutual adjustment, six psychosocial and socioeconomic factors were associated with increased risk of CVD death: unemployment, low material amenities, depression, being single, infrequent contacts with friends or relatives. The hazard ratios [HRs] for these six factors ranged between 1.26 [95% confidence interval 1.14–1.40] and 1.81 [95% confidence interval 1.24–2.64], fully adjusted for each other, and conventional cardiovascular risk factors. Population-attributable fractions ranged from 8% [4%–13%] to 22% [11%–31%] for each factor, when measured on average across the three cohorts. However, the prevalence of psychosocial and socioeconomic risk factors and their HRs were similar between the three countries. Altogether, these factors could not explain why participants from Russia had higher CVD mortality when compared to participants from Poland/Czech Republic. Limitations of this study include measurement error that could lead to residual confounding; and the possibilities for reverse causation and/or unmeasured confounding from observational studies to lead to associations that are not causal in nature. Conclusions Six psychosocial and socioeconomic factors were associated with cardiovascular mortality, independent of each other. Differences in mortality between cohorts from Russia versus Poland or Check Republic remained unexplained. PMID:29211726

High prevalence of cardiovascular disease in South Asians: Central role for brown adipose tissue?

PubMed

Boon, Mariëtte R; Bakker, Leontine E H; van der Linden, Rianne A D; van Ouwerkerk, Antoinette F; de Goeje, Pauline L; Counotte, Jacqueline; Jazet, Ingrid M; Rensen, Patrick C N

2015-01-01

Cardiovascular disease (CVD) is the leading cause of death in modern society. Interestingly, the risk of developing CVD varies between different ethnic groups. A particularly high risk is faced by South Asians, representing over one-fifth of the world's population. Here, we review potential factors contributing to the increased cardiovascular risk in the South Asian population and discuss novel therapeutic strategies based on recent insights. In South Asians, classical ('metabolic') risk factors associated with CVD are highly prevalent and include central obesity, insulin resistance, type 2 diabetes, and dyslipidemia. A contributing factor that may underlie the development of this disadvantageous metabolic phenotype is the presence of a lower amount of brown adipose tissue (BAT) in South Asian subjects, resulting in lower energy expenditure and lower lipid oxidation and glucose uptake. As it has been established that the increased prevalence of classical risk factors in South Asians cannot fully explain their increased risk for CVD, other non-classical risk factors must underlie this residual risk. In South Asians, the prevalence of "inflammatory" risk factors including visceral adipose tissue inflammation, endothelial dysfunction, and HDL dysfunction are higher compared with Caucasians. We conclude that a potential novel therapy to lower CVD risk in the South Asian population is to enhance BAT volume or its activity in order to diminish classical risk factors. Furthermore, anti-inflammatory therapy may lower non-classical risk factors in this population and the combination of both strategies may be especially effective.

Risk scoring for the primary prevention of cardiovascular disease.

PubMed

Karmali, Kunal N; Persell, Stephen D; Perel, Pablo; Lloyd-Jones, Donald M; Berendsen, Mark A; Huffman, Mark D

2017-03-14

The current paradigm for cardiovascular disease (CVD) emphasises absolute risk assessment to guide treatment decisions in primary prevention. Although the derivation and validation of multivariable risk assessment tools, or CVD risk scores, have attracted considerable attention, their effect on clinical outcomes is uncertain. To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 2), MEDLINE Ovid (1946 to March week 1 2016), Embase (embase.com) (1974 to 15 March 2016), and Conference Proceedings Citation Index-Science (CPCI-S) (1990 to 15 March 2016). We imposed no language restrictions. We searched clinical trial registers in March 2016 and handsearched reference lists of primary studies to identify additional reports. We included randomised and quasi-randomised trials comparing the systematic provision of CVD risk scores by a clinician, healthcare professional, or healthcare system compared with usual care (i.e. no systematic provision of CVD risk scores) in adults without CVD. Three review authors independently selected studies, extracted data, and evaluated study quality. We used the Cochrane 'Risk of bias' tool to assess study limitations. The primary outcomes were: CVD events, change in CVD risk factor levels (total cholesterol, systolic blood pressure, and multivariable CVD risk), and adverse events. Secondary outcomes included: lipid-lowering and antihypertensive medication prescribing in higher-risk people. We calculated risk ratios (RR) for dichotomous data and mean differences (MD) or standardised mean differences (SMD) for continuous data using 95% confidence intervals. We used a fixed-effects model when heterogeneity (I²) was at least 50% and a random-effects model for substantial heterogeneity (I² > 50%). We evaluated the quality of evidence using the GRADE framework. We identified 41 randomised controlled trials (RCTs) involving 194,035 participants from 6422 reports. We assessed studies as having high or unclear risk of bias across multiple domains. Low-quality evidence evidence suggests that providing CVD risk scores may have little or no effect on CVD events compared with usual care (5.4% versus 5.3%; RR 1.01, 95% confidence interval (CI) 0.95 to 1.08; I² = 25%; 3 trials, N = 99,070). Providing CVD risk scores may reduce CVD risk factor levels by a small amount compared with usual care. Providing CVD risk scores reduced total cholesterol (MD -0.10 mmol/L, 95% CI -0.20 to 0.00; I² = 94%; 12 trials, N = 20,437, low-quality evidence), systolic blood pressure (MD -2.77 mmHg, 95% CI -4.16 to -1.38; I² = 93%; 16 trials, N = 32,954, low-quality evidence), and multivariable CVD risk (SMD -0.21, 95% CI -0.39 to -0.02; I² = 94%; 9 trials, N = 9549, low-quality evidence). Providing CVD risk scores may reduce adverse events compared with usual care, but results were imprecise (1.9% versus 2.7%; RR 0.72, 95% CI 0.49 to 1.04; I² = 0%; 4 trials, N = 4630, low-quality evidence). Compared with usual care, providing CVD risk scores may increase new or intensified lipid-lowering medications (15.7% versus 10.7%; RR 1.47, 95% CI 1.15 to 1.87; I² = 40%; 11 trials, N = 14,175, low-quality evidence) and increase new or increased antihypertensive medications (17.2% versus 11.4%; RR 1.51, 95% CI 1.08 to 2.11; I² = 53%; 8 trials, N = 13,255, low-quality evidence). There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes, and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD prevention.

Can Cardiovascular Epidemiology and Clinical Trials Close the Risk Management Gap Between Diabetes and Prediabetes?

PubMed

Perreault, Leigh; Færch, Kristine; Gregg, Edward W

2017-09-01

We reviewed published literature to determine the relationship between A1c and cardiovascular disease (CVD) and summarize the need and implications for CVD risk reduction with interventions, focusing in the prediabetic A1c range (<6.5%). Strong evidence supports a continuous relationship between A1c and CVD-even below the current levels of A1c-defined prediabetes and after adjustment for known risk factors for CVD. Clinical trials have demonstrated a reduction in CV morbidity and/or mortality when interventions are invoked in the prediabetic A1c range. Guidelines advocating CV risk factor management in prediabetes have not been widely adopted, subsequently leading to comparable coronary heart disease risk between people with prediabetes (HR = 1.9, 95% CI 1.7-2.1 vs normoglycemia) and diabetes itself (HR=2.0, 95% CI 1.8-2.2 vs no diabetes). This review highlights the missed opportunity to utilize multiple risk factor interventions to reduce CVD in high-risk people with prediabetes.

Correlates for cardiovascular diseases among diabetic/hypertensive patients attending outreach clinics in two Nairobi slums, Kenya

PubMed Central

Mugure, Gladys; Karama, Mohamed; Kyobutungi, Catherine; Karanja, Simon

2014-01-01

Introduction Cardiovascular diseases (CVD) are the leading cause of death in the world. Over 80% of CVD related deaths occur in low- and middle-income countries (LMICs). Diabetes and hypertension, whose prevalence in Kenya is on the rise, are major risk factors for CVD. Despite this, studies indicate that awareness on the management of risk factors for CVD among diabetic/hypertensive patients in African populations is generally low. The aim of the study was to determine the risk factors for CVD among diabetic and/or hypertensive patients attending diabetes and hypertension management clinics in Korogocho and Viwandani slums of Nairobi. Methods Data were collected using questionnaires administered to 206 diabetic/hypertensive patients attending the clinics between July 2010 and February 2011. A review of these patients’ medical records was done to determine the history of CVD outcomes such as hypertensive heart diseases, stroke and peripheral arterial diseases. Results Majority (66.5%) of the study participants were females mainly in the 51-65 age category. The study findings revealed that 73 (33.4%) respondents had CVD outcomes. In addition, 41.8% of the respondents were not aware of the causes of diabetes/hypertension. Age category 51-65 years had the highest (43.8%) number of respondents with CVD. Sex of the respondents and awareness of the link between hypertension and CVD were significantly associated with CVD outcomes (p<0.05) among the respondents. Conclusion Measures to improve awareness levels among patients at high risk of CVD outcomes are needed to complement other measures to reduce CVD risk among such patients. PMID:25852804

Skin autofluorescence as proxy of tissue AGE accumulation is dissociated from SCORE cardiovascular risk score, and remains so after 3 years.

PubMed

Tiessen, Ans H; Jager, Willemein; ter Bogt, Nancy C W; Beltman, Frank W; van der Meer, Klaas; Broer, Jan; Smit, Andries J

2014-01-01

Skin autofluorescence (SAF), as a proxy of AGE accumulation, is predictive of cardiovascular (CVD) complications in i.a. type 2 diabetes mellitus and renal failure, independently of most conventional CVD risk factors. The present exploratory substudy of the Groningen Overweight and Lifestyle (GOAL)-project addresses whether SAF is related to Systematic COronary Risk Evaluation (SCORE) risk estimation (% 10-year CVD-mortality risk) in overweight/obese persons in primary care, without diabetes/renal disease, and if after 3-year treatment of risk factors (change in, Δ) SAF is related to ΔSCORE. In a sample of 65 participants from the GOAL study, with a body mass index (BMI) >25-40 kg/m2, hypertension and/or dyslipidemia, but without diabetes/renal disease, SAF and CVD risk factors were measured at baseline, and after 3 years of lifestyle and pharmaceutical treatment. At baseline, the mean SCORE risk estimation was 3.1±2.6%, mean SAF 2.04±0.5AU. In multivariate analysis SAF was strongly related to age, but not to other risk factors/SCORE. After 3 years ΔSAF was 0.34±0.45 AU (p<0.001). ΔSAF was negatively related to Δbodyweight but not to ΔSCORE%, or its components. At follow-up, SAF was higher in 11 patients with a history of CVD compared to 54 persons without CVD (p=0.002). Baseline and 3-year-Δ SAF are not related to (Δ)SCORE, or its components, except age, in the studied population. ΔSAF was negatively related to Δweight. As 3-year SAF was higher in persons with CVD, these results support a larger study on SAF to assess its contribution to conventional risk factors/SCORE in predicting CVD in overweight persons with low-intermediate cardiovascular risk.

Exercise, nutrition, and homocysteine.

PubMed

Joubert, Lanae M; Manore, Melinda M

2006-08-01

Homocysteine is an independent cardiovascular disease (CVD) risk factor modifiable by nutrition and possibly exercise. While individuals participating in regular physical activity can modify CVD risk factors, such as total blood cholesterol levels, the impact physical activity has on blood homocysteine concentrations is unclear. This review examines the influence of nutrition and exercise on blood homocysteine levels, the mechanisms of how physical activity may alter homocysteine levels, the role of homocysteine in CVD, evidence to support homocysteine as an independent risk factor for CVD, mechanisms of how homocysteine increases CVD risk, and cut-off values for homocysteinemia. Research examining the impact of physical activity on blood homocysteine levels is equivocal, which is partially due to a lack of control for confounding variables that impact homocysteine. Duration, intensity, and mode of exercise appear to impact blood homocysteine levels differently, and may be dependent on individual fitness levels.

Using impedance cardiography to detect subclinical cardiovascular disease in women with multiple risk factors: a pilot study.

PubMed

Demarzo, Arthur P

2009-01-01

Early detection of cardiovascular disease (CVD) could initiate appropriate treatment and prevent progression. This study used impedance cardiography (ICG) waveform analysis with postural change to detect functional CVD in women older than 40 years with no history of CVD and >or=2 of the following risk factors: cigarette smoking, poor diet, physical inactivity, central adiposity, family history of premature CVD, hypertension, and dyslipidemia. A study group of 32 women underwent ICG in standing and supine positions. An age-matched control group had 20 women with an active lifestyle, no risk factors, and no history of CVD. All women in the control group had normal ICG data. All women in the study group had some abnormal ICG data, with 28 (87.5%) having multiple ICG abnormalities. ICG data indicated that 13 (40.6%) had ventricular dysfunction, 14 (43.8%) had high vascular resistive load, and 30 (93.8%) had elevated vascular pulsatile load. The data suggest that subclinical CVD, detectable by ICG, is prevalent in women older than 40 years with multiple risk factors. Abnormal ICG results could expedite the initiation of customized treatment as part of a preventive approach to CVD. (c) 2009 Wiley Periodicals, Inc.

Parental obesity and risk factors for cardiovascular disease among their offspring in mid-life: findings from the 1958 British Birth Cohort Study

PubMed Central

Cooper, R; Pinto Pereira, S M; Power, C; Hyppönen, E

2013-01-01

Background: Few studies have investigated whether parental adiposity is associated with offspring cardiovascular health or the underlying pathways. Studying these associations may help to illuminate the paradox of increasing prevalence of obesity and declining trends in cardiovascular disease (CVD) mortality, which may be partially explained by beneficial adaptations to an obesogenic environment among people exposed to such environments from younger ages. Objective: To investigate associations between parental body mass index (BMI) and risk factors for CVD among their offspring in mid-life and to test whether associations of offspring BMI with CVD risk factors were modified by parental BMI. Methods: Data from parents and offspring in the 1958 British birth cohort were used (N=9328). Parental BMI was assessed when offspring were aged 11 years; offspring BMI, waist circumference and CVD risk factors (lipid levels, blood pressure, glycosylated haemoglobin (HbA1c) and inflammatory and haemostatic markers) were measured at 44–45 years. Results: Higher parental BMI was associated with less favourable levels of offspring risk factors for CVD. Most associations were maintained after adjustment for offspring lifestyle and socioeconomic factors but were largely abolished or reversed after adjustment for offspring adiposity. For some CVD risk factors, there was evidence of effect modification; the association between higher BMI and an adverse lipid profile among offspring was weaker if maternal BMI had been higher. Conversely, offspring BMI was more strongly associated with HbA1c if parental BMI had been higher. Conclusions: Intergenerational influences may be important in conferring the effect of high BMI on CVD risk among offspring. PMID:23567929

Vivir Con Un Corazón Saludable: a Community-Based Educational Program Aimed at Increasing Cardiovascular Health Knowledge in High-Risk Hispanic Women.

PubMed

Romero, Daniela C; Sauris, Aileen; Rodriguez, Fátima; Delgado, Daniela; Reddy, Ankita; Foody, JoAnne M

2016-03-01

Hispanic women suffer from high rates of cardiometabolic risk factors and an increasingly disproportionate burden of cardiovascular disease (CVD). Particularly, Hispanic women with limited English proficiency suffer from low levels of CVD knowledge associated with adverse CVD health outcomes. Thirty-two predominantly Spanish-speaking Hispanic women completed, Vivir Con un Corazón Saludable (VCUCS), a culturally tailored Spanish language-based 6-week intensive community program targeting CVD health knowledge through weekly interactive health sessions. A 30-question CVD knowledge questionnaire was used to assess mean changes in CVD knowledge at baseline and postintervention across five major knowledge domains including CVD epidemiology, dietary knowledge, medical information, risk factors, and heart attack symptoms. Completion of the program was associated with a statistically significant (p < 0.001) increase in total mean CVD knowledge scores from 39 % (mean 11.7/30.0) to 66 % (mean 19.8/30.0) postintervention consistent with a 68 % increase in overall mean CVD scores. There was a statistically significant (p < 0.001) increase in mean knowledge scores across all five CVD domains. A culturally tailored Spanish language-based health program is effective in increasing CVD awareness among high CVD risk Hispanic women with low English proficiency and low baseline CVD knowledge.

Cardiovascular disease biomarkers on cognitive function in older adults: Joint effects of cardiovascular disease biomarkers and cognitive function on mortality risk.

PubMed

Loprinzi, Paul D; Crush, Elizabeth; Joyner, Chelsea

2017-01-01

Previous research demonstrates an inverse association between age and cardiovascular disease (CVD) biomarkers with cognitive function; however, little is known about the combined associations of CVD risk factors and cognitive function with all-cause mortality in an older adult population, which was the purpose of this study. Data from the 1999-2002 NHANES were used (N=2,097; 60+yrs), with mortality follow-up through 2011. Evaluated individual biomarkers included mean arterial pressure (MAP), high-sensitivity C-reactive protein (CRP), HDL-C, total cholesterol (TC), A1C, and measured body mass index (BMI). Cognitive function was assessed using the Digit Symbol Substitution Test (DSST). Further, 4 groups were created based on CVD risk and cognitive function. Group 1: high cognitive function and low CVD risk; Group 2: high cognitive function and high CVD risk; Group 3: low cognitive function and low CVD risk; Group 4: low cognitive function and high CVD risk. An inverse relationship was observed where those with more CVD risk factors had a lower (worse) cognitive function score. Compared to those in Group 1, only those in Group 3 and 4 had an increase mortality risk. Copyright © 2016 Elsevier Inc. All rights reserved.

Cardiorespiratory Fitness Cutoff Points for Early Detection of Present and Future Cardiovascular Risk in Children: A 2-Year Follow-up Study.

PubMed

Castro-Piñero, José; Perez-Bey, Alejandro; Segura-Jiménez, Víctor; Aparicio, Virginia A; Gómez-Martínez, Sonia; Izquierdo-Gomez, Rocio; Marcos, Ascensión; Ruiz, Jonatan R

2017-12-01

To examine the association between cardiorespiratory fitness (CRF) at baseline and cardiovascular disease (CVD) risk in 6- to 10-year-olds (cross-sectional) and 2 years later (8- to 12-year-olds [longitudinal]) and whether changes with age in CRF are associated with CVD risk in children aged 8 to 12 years. Spanish primary schoolchildren (n=236) aged 6 to 10 years participated at baseline. Of the 23 participating primary schools, 22% (n=5) were private schools and 78% (n=18) were public schools. The dropout rate at 2-year follow-up was 9.7% (n=23). The 20-m shuttle run test was used to estimate CRF. The CVD risk score was computed as the mean of 5 CVD risk factor standardized scores: sum of 2 skinfolds, systolic blood pressure, insulin/glucose, triglycerides, and total cholesterol/high-density lipoprotein cholesterol. At baseline, CRF was inversely associated with single CVD risk factors (all P<.05) and CVD risk score at baseline and follow-up (P<.001). Cardiorespiratory fitness cutoff points of 39.0 mL/kg per minute or greater in boys and 37.5 mL/kg per minute or greater in girls are discriminative to identify CVD risk in childhood (area under the curve, >0.85; P<.001) and to predict CVD risk 2 years later (P=.004). Persistent low CRF or the decline of CRF from 6-10 to 8-12 years of age is associated with increased CVD risk at age 8 to 12 years (P<.001). During childhood, CRF is a strong predictor of CVD risk and should be monitored to identify children with potential CVD risk. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Effect of obesity on cardiovascular disease risk factors in African American women.

PubMed

Henry-Okafor, Queen; Cowan, Patricia A; Wicks, Mona N; Rice, Muriel; Husch, Donna S; Khoo, Michelle S C

2012-04-01

Obesity is a growing health care concern with implications for cardiovascular disease (CVD). Obesity and CVD morbidity and mortality are highly prevalent among African American women. This pilot study examined the association between obesity and the traditional and emerging CVD risk factors in a sample of African American women. Participants comprised 48 women (27 obese, 21 normal weight) aged 18-45. with no known history of CVD. The women completed demographic and 7-day physical activity recall questionnaires. Height and weight were used to determine body mass index (BMI). Hypertension risk was assessed using the average of two resting blood pressure (BP) measurements. Lipid profile, blood glucose, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), soluble intercellular adhesion molecule-1 (sICAM-1), and E-selectin (eSel) levels were assessed using fasting blood samples. Laboratory findings were interpreted using the American Diabetes Association (ADA) and Adult Treatment Panel (ATP) III reference guidelines as well as manufacturers' reference ranges for the novel CVD risk factors. The most common traditional risk factors were physical inactivity (72.9%), positive family history of CVD (58.3%), and obesity (56.3%). Obese individuals had elevated systolic BP (p = .0002), diastolic BP (p = .0007) and HDL-cholesterol (p = .01), triglyceride (p = .02), hs-CRP (p = .002), and fibrinogen (p = .01), when compared with normal-weight women. The findings suggest an association between obesity and higher prevalence of both traditional and emerging CVD risk factors in young African American women.

Alzheimer biomarkers and clinical Alzheimer disease were not associated with increased cerebrovascular disease in a memory clinic population.

PubMed

Spies, Petra E; Verbeek, Marcel M; Sjogren, Magnus J C; de Leeuw, Frank-Erik; Claassen, Jurgen A H R

2014-01-01

Preclinical and post-mortem studies suggest that Alzheimer disease (AD) causes cerebrovascular dysfunction, and therefore may enhance susceptibility to cerebrovascular disease (CVD). The objective of this study was to investigate this association in a memory clinic population. The AD biomarkers CSF amyloid β42, amyloid β40 and APOE-ε4 status have all been linked to increased CVD risk in AD, and therefore the first aim of this study was to analyze the association between these biomarkers and CVD. In 92 memory clinic patients the cross-sectional association between AD biomarkersand the severity of CVD was investigated with linear regression analysis. Additionally, we studied whether AD biomarkers modified the relation between vascular risk factors and CVD. CVD was assessed on MRI through a visual rating scale.Analyses were adjusted for age. The second aim of this study was to investigate the association between clinical AD and CVD, where 'clinical AD' was defined as follows: impairment in episodic memory, hippocampal atrophy and an aberrant concentration of cerebrospinal fluid (CSF) biomarkers. 47 of the 92 patients had AD. No association between CSF amyloid β42, amyloid β40 or APOE-ε4 status and CVD severity was found, nor did these AD biomarkers modify the relation between vascular risk factors and CVD. Clinical AD was not associated with CVD severity (p=0.83). Patients with more vascular risk factors had more CVD, but this relationship was not convincingly modified by AD (p=0.06). In this memory clinic population, CVD in patients with AD was related to vascular risk factors and age, comparable to patients without AD. Therefore, in our study, the preclinical and post-mortem evidence that AD would predispose to CVD could not be translated clinically. Further work, including replication of this work in a different and larger sample, is warranted.

Prevention and Control Program for Cardiovascular Diseases in Turkish Population: PRE-CONTROL Study Group.

PubMed

Kozan, Ömer; Zoghi, Mehdi; Ergene, Oktay; Arıcı, Mustafa; Derici, Ülver; Bakaç, Göksel; Güllü, Sevim; Sain Güven, Gülay

2013-06-01

Cardiovascular disease (CVD) is the leading cause of death throughout the world. Despite its high prevalence, the atherosclerotic process can be slowed and its consequences markedly reduced by preventive measures. The lack of risk factor awareness is a major barrier. We aimed to assess total CV risk, determine the knowledge and awareness regarding CVD, and evaluate the effectiveness of education program in urban population of Turkey. A 24-item questionnaire was used to detect CV risk factors and the awareness of participants about CVD. The feedback data for the education program were collected by either questionnaires or individual interviews with participants. For comparison of total CVD risk in men and women in different age groups, a sample t test was used. The level of statistical significance was set at p < 0.05. The prevalence of hyperlipidemia was established to be 41.3%. Nearly one-quarter of the women and one-third of the men were smokers (p < 0.001). One-quarter of the responders had a history of hypertension (men: 21.5%, women: 18.6%), and one-tenth were diabetic. The high CV risk rate was more pronounced among men (p < 0.01) and those with low socioeconomic level (p < 0.01). Awareness regarding CV risk factors following the educational program increased from 6.6% to 12.7% for high blood pressure, from 3.9% to 9.2% for diabetes mellitus, and from 10.2% to 15.1% for elevated cholesterol levels. All the increases were statistically significant. The educational program significantly increased the awareness of CVD and risk factors. The prevalence of CV risk factors was higher in low socioeconomic level groups. The knowledge and awareness of the risk factors for CVD before the education program was very low in our study group. The awareness of CVD and risk factors significantly increased following our education programs. Copyright © 2013 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Fructose-Containing Sugars and Cardiovascular Disease12

PubMed Central

Rippe, James M; Angelopoulos, Theodore J

2015-01-01

Cardiovascular disease (CVD) is the single largest cause of mortality in the United States and worldwide. Numerous risk factors have been identified for CVD, including a number of nutritional factors. Recently, attention has been focused on fructose-containing sugars and their putative link to risk factors for CVD. In this review, we focus on recent studies related to sugar consumption and cardiovascular risk factors including lipids, blood pressure, obesity, insulin resistance, diabetes, and the metabolic syndrome. We then examine the scientific basis for competing recommendations for sugar intake. We conclude that although it appears prudent to avoid excessive consumption of fructose-containing sugars, levels within the normal range of human consumption are not uniquely related to CVD risk factors with the exception of triglycerides, which may rise when simple sugars exceed 20% of energy per day, particularly in hypercaloric settings. PMID:26178027

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for CVD Prevention in Adults with Risk Factors

MedlinePlus

... Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors The ... Promote a Healthful Diet and Physical Activity for Cardiovascular Disease (CVD) Prevention in Adults with Cardiovascular Risk Factors. ...

Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients.

PubMed

Stewart, Jesse C; Hawkins, Misty A W; Khambaty, Tasneem; Perkins, Anthony J; Callahan, Christopher M

2016-06-01

Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD). We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke for 8 years in a diverse sample of 2041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files. During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models-adjusted for demographic and CVD risk factors-revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0-3: anxiety hazard ratio [HR] = 1.54, 95% confidence interval [CI] = 1.21-1.96, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.81-1.21), p = .93; depression HR = 1.10, CI = 0.88-1.36, p = .41), as well as when entered into the same model (Years 0-3: anxiety HR = 1.53, CI = 1.20-1.95, p < .001; Years 3+: anxiety HR = 0.99, CI = 0.80-1.21, p = .99; depression HR = 1.03, CI = 0.82-1.29, p = .82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome. Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts.

Potential Impact of Time Trend of Life-Style Factors on Cardiovascular Disease Burden in China.

PubMed

Li, Yanping; Wang, Dong D; Ley, Sylvia H; Howard, Annie Green; He, Yuna; Lu, Yuan; Danaei, Goodarz; Hu, Frank B

2016-08-23

Cardiovascular disease (CVD) is a leading cause of death in China. Evaluation of risk factors and their impacts on disease burden is important for future public health initiatives and policy making. The study used data from a cohort of the China Health and Nutrition Survey to estimate time trends in cardiovascular risk factors from 1991 to 2011. We applied the comparative risk assessment method to estimate the number of CVD events attributable to all nonoptimal levels (e.g., theoretical-minimum-risk exposure distribution [TMRED]) of each risk factor. In 2011, high blood pressure, high low-density lipoprotein cholesterol, and high blood glucose were associated with 3.1, 1.4, and 0.9 million CVD events in China, respectively. Increase in body mass index was associated with an increase in attributable CVD events, from 0.5 to 1.1 million between 1991 and 2011, whereas decreased physical activity was associated with a 0.7-million increase in attributable CVD events. In 2011, 53.4% of men used tobacco, estimated to be responsible for 30.1% of CVD burden in men. Dietary quality improved, but remained suboptimal; mean intakes were 5.4 (TMRED: 2.0) g/day for sodium, 67.7 (TMRED: 300.0) g/day for fruits, 6.2 (TMRED: 114.0) g/day for nuts, and 25.0 (TMRED: 250.0) mg/day for marine omega-3 fatty acids in 2011. High blood pressure remains the most important individual risk factor related to CVD burden in China. Increased body mass index and decreased physical activity were also associated with the increase in CVD burden from 1991 to 2011. High rates of tobacco use in men and unhealthy dietary factors continue to contribute to the burden of CVD in China. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Impact of Individual and Neighborhood Factors on Cardiovascular Risk in White Hispanic and Non-Hispanic Women and Men.

PubMed

Cohn, Tanya; Miller, Arlene; Fogg, Louis; Braun, Lynne T; Coke, Lola

2017-04-01

Cardiovascular disease (CVD) is the leading cause of mortality for adults in the US, regardless of ethnicity. A cross-sectional correlational design was used to describe and compare CVD risk and cardiac mortality in White Hispanic and non-Hispanic women and men. Data from 3,317 individuals (1,523 women and 1,794 men) hospitalized for non-cardiac causes during 2012-2013, and data from the 2010 United States Census were included. The sex-specific 10-year Framingham General Cardiovascular Risk Score (FRS-10) was used to estimate long-term risk for major cardiac events. Approximately three-quarters of the sample was White Hispanic. FRS-10 scores were generally low, but a high prevalence of risk factors not included in the standard FRS-10 scoring formula was seen. White Hispanic women had significantly lower estimated CVD risk scores compared to White Hispanic and non-Hispanic men despite higher non-FRS-10 risks. Neighborhood median household income had a significant negative relationship and Hispanic neighborhood concentration had a significant positive relationship with cardiac mortality. Hispanic concentration was the only predictor of estimated CVD risk in a multilevel model. CVD risk assessment tools that are calibrated for ethnic groups and socioeconomic status may be more appropriate for Hispanic individuals than the FRS-10. Neighborhood-level factors should be included in clinical cardiac assessment in addition to individual characteristics and behavioral risks. Researchers should continue to seek additional risk factors that may contribute to or protect against CVD in order to close the gap between estimated CVD risk and actual cardiac mortality for Hispanics in the US. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

National Kidney Foundation consensus conference on cardiovascular and kidney diseases and diabetes risk: an integrated therapeutic approach to reduce events.

PubMed

Bakris, George; Vassalotti, Joseph; Ritz, Eberhard; Wanner, Christoph; Stergiou, George; Molitch, Mark; Nesto, Richard; Kaysen, George A; Sowers, James R

2010-10-01

Cardiovascular disease (CVD) is the most common cause of death in industrialized nations. Type 2 diabetes is a CVD risk factor that confers risk similar to a previous myocardial infarction in an individual who does not have diabetes. In addition, the most common cause of chronic kidney disease (CKD) is diabetes. Together, diabetes and hypertension account for more than two-thirds of CVD risk, and other risk factors such as dyslipidemia contribute to the remainder of CVD risk. CKD, particularly with presence of significant albuminuria, should be considered an additional cardiovascular risk factor. There is no consensus on how to assess and stratify risk for patients with kidney disease across subspecialties that commonly treat such patients. This paper summarizes the results of a consensus conference utilizing a patient case to discuss the integrated management of hypertension, kidney disease, dyslipidemia, diabetes, and heart failure across disciplines.

Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events.

PubMed

Albert, Michelle A; Glynn, Robert J; Buring, Julie; Ridker, Paul M

2006-12-12

Persons of lower socioeconomic status have greater cardiovascular risk than those of higher socioeconomic status. However, the mechanism through which socioeconomic status affects cardiovascular disease (CVD) is uncertain. Virtually no data are available that examine the prospective association between novel inflammatory and hemostatic CVD risk indicators, socioeconomic status, and incident CVD events. We assessed the relationship between 2 indicators of socioeconomic status (education and income), traditional and novel CVD risk factors (high sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, fibrinogen, and homocysteine), and incident CVD events among 22,688 apparently healthy female health professionals participating in the Women's Health Study. These women were followed up for 10 years for the development of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death. More educated women were less likely to be smokers; had a lower prevalence of hypertension, diabetes, and obesity; and were more likely to participate in vigorous physical activity than less educated women. At baseline, median total cholesterol, low-density lipoprotein, triglyceride, C-reactive protein, intercellular adhesion molecule-1, fibrinogen, and homocysteine levels for women in 5 categories of education (< 2 years of nursing education, 2 to < 4 years of nursing education, a bachelor's degree, a master's degree, and a doctoral degree) and 6 categories of income [< or = 19,999 dollars, 20,000 dollars to 29,999 dollars, 30,000 dollars to 39,999 dollars, 40,000 dollars to 49,999 dollars, 50,000 dollars to 99,999 dollars, and > or = 100,000 dollars) decreased progressively with increasing education or income levels (all P<0.001), whereas an opposite pattern was observed for high-density lipoprotein (P<0.001). Overall, in age-adjusted Cox proportional hazards models, the relative risk of incident CVD events decreased with increasing education (1.0, 0.7, 0.5, 0.4, and 0.5; P for trend <0.001) and income (1.0, 1.0, 0.9, 0.7, 0.6, and 0.4; P for trend <0.001) categories. In multivariate models that assessed the impact of traditional and novel CVD risk factors on the relationship between education/income and CVD events, the relative hazard of incident CVD associated with a 1-category-higher level of education changed from 0.79 in age- and race-adjusted analysis to 0.89 in fully adjusted analysis. The 11% lower risk per 1 category of education remained significant (P for trend=0.006), suggesting that controlling for both novel and traditional risk factors could not explain the protective effect of education. A similar analysis for income revealed that its relationship with CVD events was explained largely by these noted risk factors. In this prospective analysis, we observed a decrease in incident CVD events with increasing levels of education and income. In contrast to the relationship between income and CVD events, the relationship of CVD events with education was explained only partially by traditional and novel risk factors for CVD.

Sociodemographic factors associated with multiple cardiovascular risk factors among Malaysian adults.

PubMed

Ghazali, Sumarni Mohd; Seman, Zamtira; Cheong, Kee Chee; Hock, Lim Kuang; Manickam, Mala; Kuay, Lim Kuang; Yusoff, Ahmad Faudzi; Mustafa, Feisul Idzwan; Mustafa, Amal Nasir

2015-01-31

To determine the prevalence and sociodemographic correlates of multiple risk factors for cardiovascular disease (CVD) among Malaysian adults. We analysed data on 1044 men and 1528 women, aged 24-64 years, participants in the Non Communicable Disease Surveillance 2005/2006, a nationally representative, population-based, cross-sectional study. Prevalence of obesity, high blood pressure, dyslipidaemia, hyperglycemia, physical inactivity, smoking, risky drinking, low vegetable and fruit intake were determined and multivariable logistic regression was used to identify sociodemographic factors associated with having ≥3 of these cardiovascular disease risk factors. The response rate was 84.6% (2572/3040). Overall, 68.4% (95% CI: 63.2, 73.1) had at least three risk factors. Among men, older age and Indian ethnicity were independently associated with having ≥3 CVD risk factors; while among women, older age, low education, and housewives were more likely to have ≥3 CVD risk factors. The prevalence of cardiovascular risk factors clustering among Malaysian adults is high, raising concerns that cardiovascular disease incidence will rise steeply in the near future if no immediate preventive measures are taken. The current national health education and promotion programmes pertaining to modifiable risk factors can be further improved by taking into account the sociodemographic variation in CVD risk factors clustering.

Changes in erectile dysfunction over time in relation to Framingham cardiovascular risk in the Boston Area Community Health (BACH) Survey.

PubMed

Fang, Shona C; Rosen, Raymond C; Vita, Joseph A; Ganz, Peter; Kupelian, Varant

2015-01-01

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD); however, the association between change in ED status over time and future underlying CVD risk is unclear. The aim of this study was to investigate the association between change in ED status and Framingham CVD risk, as well change in Framingham risk. We studied 965 men free of CVD in the Boston Area Community Health (BACH) Survey, a longitudinal cohort study with three assessments. ED was assessed with the five-item International Index of Erectile Function at BACH I (2002-2005) and BACH II (2007-2010) and classified as no ED/transient ED/persistent ED. CVD risk was assessed with 10-year Framingham CVD risk algorithm at BACH I and BACH III (2010-2012). Linear regression models controlled for baseline age, socio-demographic and lifestyle factors, as well as baseline Framingham risk. Models were also stratified by age (≥/< 50 years). Framingham CVD risk and change in Framingham CVD risk were the main outcome measures. Transient and persistent ED was significantly associated with increased Framingham risk and change in risk over time in univariate and age-adjusted models. In younger men, persistent ED was associated with a Framingham risk that was 1.58 percentage points higher (95% confidence interval [CI]: 0.11, 3.06) and in older men, a Framingham risk that was 2.54 percentage points higher (95% CI: -1.5, 6.59), compared with those without ED. Change in Framingham risk over time was also associated with transient and persistent ED in men <50 years, but not in older men. Data suggest that even after taking into account other CVD risk factors, transient and persistent ED is associated with Framingham CVD risk and a greater increase in Framingham risk over time, particularly in younger men. Findings further support clinical assessment of CVD risk in men presenting with ED, especially those under 50 years. © 2014 International Society for Sexual Medicine.

Cardiovascular disease risk factors: prevalence and management in adult hemophilia patients.

PubMed

Lim, Ming Y; Pruthi, Rajiv K

2011-07-01

With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

Audit of Cardiovascular Disease Risk Factors among Supported Adults with Intellectual Disability Attending an Ageing Clinic

ERIC Educational Resources Information Center

Wallace, Robyn A.; Schluter, Philip

2008-01-01

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:…

A study of the knowledge, attitudes, and practices (KAP) of the women referred to health centers for cardiovascular disease (CVDs) and their risk factors.

PubMed

Mazloomy, Seyed Said; Baghianimoghadam, Mohammad Hosein; Ehrampoush, Mohammad Hasan; Baghianimoghadam, Behnam; Mazidi, Maysam; Mozayan, Mohammad Reza

2014-01-01

Hypertension, dyslipidemia, and diabetes are established risk factors for cardiovascular disease (CVD) morbidity and mortality. In the past decade a general increase in CVD risk factors in the population aged 65 and older, along with suboptimal control rates, have occurred. In this descriptive, cross-sectional study, the authors describe the knowledge, attitudes, and practices (KAP) of Iranian females regarding risk factors for CVD, in an attempt to help with the development of strategies to control risk factors and CVD. Participants were 200 women ages 15-49 referred to health centers in Yazd, selected from four different centers. Data were gathered through a questionnaire consisting of demographics and questions related to KAP. The validity of the questionnaire was determined by a health education specialist, with its reliability determined by piloting and measuring the related Cronbach's alpha (Alpha = 0.720). Measuring knowledge of CVD on a scale of 0-20, the mean knowledge score was 10.203.91. More than 76% of the participants knew that CVD is preventable. Ninety-one percent liked exercising and believed that exercising would make them feel better. The average mean scores for attitudes of participants toward CVD were 30.31 ± 3.21 out of 36. The authors conclude that there is a need for enhancing mothers' general knowledge about the disease, because of the increasing rates of CVD in females. This will lead to improvements in attitude and practice. Furthermore, learning in groups of 12 can be a beneficial educational method.

Menopausal Hot Flashes and Carotid Intima Media Thickness Among Midlife Women.

PubMed

Thurston, Rebecca C; Chang, Yuefang; Barinas-Mitchell, Emma; Jennings, J Richard; Landsittel, Doug P; Santoro, Nanette; von Känel, Roland; Matthews, Karen A

2016-12-01

There has been a longstanding interest in the role of menopause and its correlates in the development of cardiovascular disease (CVD) in women. Menopausal hot flashes are experienced by most midlife women; emerging data link hot flashes to CVD risk indicators. We tested whether hot flashes, measured via state-of-the-art physiologic methods, were associated with greater subclinical atherosclerosis as assessed by carotid ultrasound. We considered the role of CVD risk factors and estradiol concentrations in these associations. A total of 295 nonsmoking women free of clinical CVD underwent ambulatory physiologic hot flash assessments; a blood draw; and carotid ultrasound measurement of intima media thickness and plaque. Associations between hot flashes and subclinical atherosclerosis were tested in regression models controlling for CVD risk factors and estradiol. More frequent physiologic hot flashes were associated with higher carotid intima media thickness (for each additional hot flash: β [SE]=0.004 [0.001]; P=0.0001; reported hot flash: β [SE]=0.008 [0.002]; P=0.002, multivariable) and plaque (eg, for each additional hot flash, odds ratio [95% confidence interval] plaque index ≥2=1.07 [1.003-1.14]; P=0.04, relative to no plaque, multivariable] among women reporting daily hot flashes; associations were not accounted for by CVD risk factors or by estradiol. Among women reporting hot flashes, hot flashes accounted for more variance in intima media thickness than most CVD risk factors. Among women reporting daily hot flashes, frequent hot flashes may provide information about a woman's vascular status beyond standard CVD risk factors and estradiol. Frequent hot flashes may mark a vulnerable vascular phenotype among midlife women. © 2016 American Heart Association, Inc.

Menopausal Hot Flashes and Carotid Intima Media Thickness among Midlife Women

PubMed Central

Thurston, Rebecca C.; Chang, Yuefang; Barinas-Mitchell, Emma; Jennings, J. Richard; Landsittel, Doug P.; Santoro, Nanette; von Känel, Roland; Matthews, Karen A.

2016-01-01

Background and Purpose There has been a longstanding interest in the role of menopause and its correlates in the development of cardiovascular disease (CVD) in women. Menopausal hot flashes are experienced by most midlife women; emerging data link hot flashes to CVD risk indicators. We tested whether hot flashes, measured via state-of-the-art physiologic methods, were associated with greater subclinical atherosclerosis as assessed by carotid ultrasound. We considered the role of CVD risk factors and estradiol concentrations in these associations. Methods 295 nonsmoking women free of clinical CVD underwent ambulatory physiologic hot flash assessments; a blood draw; and carotid ultrasound measurement of IMT and plaque. Associations between hot flashes and subclinical atherosclerosis were tested in regression models controlling for CVD risk factors and estradiol. Results More frequent physiologic hot flashes were associated with higher carotid intima media thickness [IMT; for each additional hot flash: beta (standard error)=.004(.001), p=.0001; reported hot flash: beta (standard error)=.008(.002), p=.002, multivariable] and plaque [e.g., for each additional hot flash, odds ratio (95% confidence interval) plaque index ≥2=1.07(1.003–1.14, p=.04), relative to no plaque, multivariable] among women reporting daily hot flashes; associations were not accounted for by CVD risk factors or by estradiol. Among women reporting hot flashes, hot flashes accounted for more variance in IMT than most CVD risk factors. Conclusions Among women reporting daily hot flashes, frequent hot flashes may provide information about a woman’s vascular status beyond standard CVD risk factors and estradiol. Frequent hot flashes may mark a vulnerable vascular phenotype among midlife women. PMID:27834746

77 FR 76044 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... delivery of services for women who have limited access to health care and elevated risk factors for cardiovascular disease (CVD). The program focuses on reducing CVD risk factors and provides screening services for select risk factors such as elevated blood cholesterol, hypertension and abnormal blood glucose...

Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors.

PubMed

Cespedes Feliciano, Elizabeth M; Kwan, Marilyn L; Kushi, Lawrence H; Weltzien, Erin K; Castillo, Adrienne L; Caan, Bette J

2017-04-01

Little research examines whether adiposity or post-diagnosis weight changes influence Cardiovascular disease (CVD) among breast cancer patients for whom effects may differ due to treatment and recovery. We studied Stage I-III breast cancer survivors 18 to  <80 years, without pre-existing CVD, diagnosed from 1997 to 2013 at Kaiser Permanente. Women reported weight at diagnosis and weight and waist circumference (WC) around 24 months post diagnosis. Using Cox models for time to incident coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, we examined at-diagnosis body mass index (BMI, n = 3109) and post-diagnosis WC (n = 1898) and weight change (n = 1903, stable, ±5 to  <10-lbs or ±≥10-lbs). Mean (SD) age was 57 (11) years, and BMI was 28 (6) kg-m 2 . Post diagnosis, 25% of women gained and 14% lost ≥10-lbs; mean (SD) WC was 90 (15) cm. Over a median of 8.28 years, 915 women developed CVD. BMI 25-30-kg/m 2 (vs. BMI < 25-kg/m 2 ) was not associated with CVD, while BMI ≥ 35-kg/m 2 increased risk by 33% (HR: 1.33; 95%CI 1.08-1.65), independent of lifestyle and tumor/treatment factors. The increased risk at BMI ≥ 35-kg/m 2 attenuated with adjustment for pre-existing CVD risk factors to HR: 1.20; 95%CI 0.97-1.50. By contrast, even moderate elevations in WC increased risk of CVD, independent of pre-existing risk factors (HR: 1.93; 95%CI 1.31-2.84 comparing ≥100-cm vs. ≤80-cm). Post-diagnosis weight change had no association with CVD. Extreme adiposity and any elevation in WC increased risk of CVD among breast cancer survivors; however, changes in weight in the early post-diagnosis period were not associated with CVD. Survivors with high WC and existing CVD risk factors should be monitored.

Gender differences in cardiovascular disease and comorbid depression.

PubMed Central

Möller-Leimkühler, Anne Maria

2007-01-01

Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a “male” disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher: Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (eg, diabetes, hypertension, hypercholesterolemia, obesity,) and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect la differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, The results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gensier aspects should be more intensively considered, both in further research on gender differences in comorbid depresion, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective. PMID:17506227

Modifiable cardiovascular risk factors among adults in Aleppo, Syria.

PubMed

Al Ali, Radwan; Rastam, Samer; Fouad, Fouad M; Mzayek, Fawaz; Maziak, Wasim

2011-12-01

This report provides the first comprehensive and standardized assessment of the distribution of cardiovascular disease (CVD) risk factors in Syria, where such data are still scarce. A population-based household survey was conducted in Aleppo (population >2.5 million), involving 1,168 subjects ≥25 years old (47.7% men; mean age 44.7 ± 12.7 years). Information about socio-demographics, personal behavior, and other CVD risk factors was collected. Anthropometric measurements and fasting blood samples were obtained. The prevalence of clinical risk factors of CVD (ClinRFs) was 45.6% for hypertension, 43.2% for obesity, 21.9% for hypercholesterolemia and 15.6% for diabetes. The prevalence of behavioral risk factors (BehRFs) was 82.3% for physical inactivity, 39.0% for smoking, and 33.4% for unhealthy diet. All ClinRFs increased with age, while gender was associated only with obesity and smoking. Education was associated with obesity and diabetes (P < 0.05 for all). Adults in Syria have some of the world's highest prevalence of CVD risk factors. Unhealthy behaviors and social norms unfavorable to women may explain some of such risk profiles.

Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

PubMed Central

Angelantonio, Emanuele Di; Gao, Pei; Khan, Hassan; Butterworth, Adam S.; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L.M.; Khaw, Kay-Tee; Psaty, Bruce M.; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M.; Lawlor, Debbie A.; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J.; Kuller, Lewis H.; Price, Jackie F.; Sundström, Johan; Knuiman, Matthew W.; Feskens, Edith J. M.; Verschuren, W. M. M.; Wald, Nicholas; Bakker, Stephan J. L.; Whincup, Peter H.; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A.; Rosengren, Annika; Sutherland, Susan E.; Björkelund, Cecilia; Blazer, Dan G.; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J. Wouter; Simpson, Lara M.; Giampaoli, Simona; Nordestgaard, Børge G.; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T.; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B.; Cushman, Mary; D’Agostino, Ralph B.; Umans, Jason G.; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F.; Folsom, Aaron R.; van der Schouw, Yvonne T.; Moons, Karel G.; Griffin, Simon J.; Sattar, Naveed; Wareham, Nicholas J.; Selvin, Elizabeth; Thompson, Simon G.; Danesh, John

2015-01-01

IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5%to <7.5%), and high (≥7.5%) risk. RESULTS During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20 840 incident fatal and nonfatal CVD outcomes (13 237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (−0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. CONCLUSIONS AND RELEVANCE In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk. PMID:24668104

The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality

PubMed Central

Kjøllesdal, Marte K R; Ariansen, Inger; Mortensen, Laust H; Næss, Øyvind

2017-01-01

Objective To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Methods Norwegian health surveys (1974–2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into ‘low’, ‘medium’ and ‘high’ risk, and smoking to ‘daily smoking’ and ‘not daily smoking’. Results Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Conclusion Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample. PMID:28878947

The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality.

PubMed

Kjøllesdal, Marte K R; Ariansen, Inger; Mortensen, Laust H; Næss, Øyvind

2017-01-01

To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Norwegian health surveys (1974-2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into 'low', 'medium' and 'high' risk, and smoking to 'daily smoking' and 'not daily smoking'. Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample.

Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors.

PubMed

Taylor-Piliae, Ruth E; Haskell, William L; Froelicher, Erika Sivarajan

2006-06-01

Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US. Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined. Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks. A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed. This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.

Classical cardiovascular disease risk factors associate with vascular function and morphology in rheumatoid arthritis: a six-year prospective study

PubMed Central

2013-01-01

Introduction Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). An early manifestation of CVD is endothelial dysfunction which can lead to functional and morphological vascular abnormalities. Classical CVD risk factors and inflammation are both implicated in causing endothelial dysfunction in RA. The objective of the present study was to examine the effect of baseline inflammation, cumulative inflammation, and classical CVD risk factors on the vasculature following a six-year follow-up period. Methods A total of 201 RA patients (155 females, median age (25th to 75th percentile): 61 years (53 to 67)) were examined at baseline (2006) for presence of classical CVD risk factors and determination of inflammation using C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). At follow-up (2012) patients underwent assessments of microvascular and macrovascular endothelium-dependent and endothelium-independent function, along with assessment of carotid atherosclerosis. The CRP and ESR were recorded from the baseline study visit to the follow-up visit for each patient to calculate cumulative inflammatory burden. Results Classical CVD risk factors, but not RA disease-related inflammation, predicted microvascular endothelium-dependent and endothelium-independent function, macrovascular endothelium-independent function and carotid atherosclerosis. These findings were similar in a sub-group of patients free from CVD, and not receiving non-steroidal anti-inflammatory drugs, cyclooxygenase 2 inhibitors or biologics. Cumulative inflammation was not associated with microvascular and macrovascular endothelial function, but a weak association was apparent between area under the curve for CRP and carotid atherosclerosis. Conclusions Classical CVD risk factors may be better long-term predictors of vascular function and morphology than systemic disease-related inflammation in patients with RA. Further studies are needed to confirm if assessments of vascular function and morphology are predictive of long-term CV outcomes in RA. PMID:24289091

Association Between Cardiovascular Risk Factors and Carpal Tunnel Syndrome in Pooled Occupational Cohorts.

PubMed

Hegmann, Kurt T; Thiese, Matthew Steven; Kapellusch, Jay; Merryweather, Andrew S; Bao, Stephen; Silverstein, Barbara; Wood, Eric M; Kendall, Richard; Wertsch, Jacqueline; Foster, James; Garg, Arun; Drury, David L

2016-01-01

The aim of the study was to ascertain if cardiovascular (CVD) risk factors are carpal tunnel syndrome (CTS) risk factors. Analysis of pooled baseline data from two large prospective cohort studies (n = 1824) assessed the relationships between a modified Framingham Heart Study CVD risk score both CTS and abnormal nerve conduction study prevalence. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratio and 95% confidence intervals were calculated for individual risk scores. There was a strong relationship between CVD risk score and both CTS and abnormal nerve conduction study after adjustment for confounders, with odds ratios as high as 4.16 and 7.35, respectively. Dose responses were also observed. In this workplace population, there is a strong association between CVD risk scores and both CTS and abnormal nerve conduction study that persisted after controlling for confounders. These data suggest a potentially modifiable disease mechanism.

Communicating cardiovascular disease risk: an interview study of General Practitioners’ use of absolute risk within tailored communication strategies

PubMed Central

2014-01-01

Background Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs’ descriptions of their CVD risk communication strategies, including the role of absolute risk. Methods Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour. Results GPs used absolute CVD risk within three different communication strategies: ‘positive’, ‘scare tactic’, and ‘indirect’. A ‘positive’ strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A ‘scare tactic’ strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to ‘scare’ them into taking action. An ‘indirect’ strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations. Conclusions This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice. PMID:24885409

Interrelationships of Physical Activity and Sleep with Cardiovascular Risk Factors: a Person-Oriented Approach.

PubMed

Wennman, Heini; Kronholm, Erkki; Partonen, Timo; Tolvanen, Asko; Peltonen, Markku; Vasankari, Tommi; Borodulin, Katja

2015-12-01

Associations of behaviorally modifiable factors like physical activity (PA), sedentary behaviors, and sleep with cardiovascular diseases (CVDs) are complicated. We examined whether membership in latent classes (LCs) differentiated by PA and sleep profiles (real-life clustering of behaviors in population subgroups) associate with metabolic risk factors and CVD risk. The National FINRISK 2012 Study comprise a cross-sectional sample of 10,000 Finns aged 25 to 74 years. Analyses included participants with complete data on a health questionnaire, a health examination, who had no prevalent CVD (n = 4031). LCs with PA and sleep profiles were previously defined using latent class analysis. Ten metabolic risk factors and the Framingham 10-year CVD risk score were compared between the LCs. PA and sleep class profiles were substantially similar for genders. Compared to LC-1, with a profile including high PA and sufficient sleep, membership in LC-4, with a profile including sedentariness and insufficient sleep was associated with high metabolic risk factors in women but not in men. In women, also membership in LC-2, with a profile including light PA, sufficient sleep, and high sedentariness was associated with high metabolic risk factors. The Framingham 10-year CVD risk score was highest in LCs 2 and 4 in both genders. Membership in LCs differentiated by PA and sleep profiles was associated with metabolic risk factors merely in women, suggesting gender differences in the interrelationships of health behaviors and metabolic risk factors. Total CVD risk differed between the LCs despite of gender; however, the effect was small.

Associations between aerobic and muscular fitness and cardiovascular disease risk: the northern Ireland young hearts study.

PubMed

Hoekstra, Trynke; Boreham, Colin A; Murray, Liam J; Twisk, Jos W R

2008-11-01

It is not clear what the relative contribution is of specific components of physical fitness (aerobic and muscular) to cardiovascular disease (CVD) risk. We investigated associations between aerobic fitness (endurance) and muscular fitness (power) and CVD risk factors. Data were obtained from the Young Hearts project, a representative sample of 12- and 15-year-old boys and girls from Northern Ireland (N = 2016). Aerobic fitness was determined by the 20-m shuttle run test, muscular fitness by the Sargent jump test. CVD risk factors included sum of skinfolds, systolic and diastolic blood pressure, serum total cholesterol (TC), HDL cholesterol, and TC:HDL ratio. Several linear regression analyses were conducted for 4 age and gender groups separately, with the risk factor as the outcome variable. Significant associations between aerobic fitness and a healthy CVD risk profile were found. These observed relationships were independent of power, whereas the (few) relationships between muscular fitness and the risk factors were partly explained by endurance. Tailored, preventive strategies during adolescence, incorporating endurance rather than power sports, could be encouraged to help prevent CVD. This is important because existing studies propose that healthiness during adulthood is founded on healthiness in adolescence.

The effect of chronic consumption of red wine on cardiovascular disease risk factors in postmenopausal women.

PubMed

Naissides, Mary; Mamo, John C L; James, Anthony P; Pal, Sebely

2006-04-01

Moderate red wine has been shown to reduce cardiovascular disease (CVD) risk, however the effects on certain CVD risk factors are unclear. In this study we have investigated the effects of dealcoholised red wine (DRW) and full-complement red wine (RW) on several cardiovascular risk factors in mildly hypercholesterolaemic postmenopausal women. To elucidate whether the chronic consumption of red wine polyphenols improves risk factors associated with CVD in hypercholesterolaemic postmenopausal women. Forty-five hypercholesterolaemic postmenopausal women were randomly assigned to consume 400 mL/day of either water, DRW or RW for 6 weeks following a 4-week washout. Fasting measures of lipids, lipoproteins, insulin and glucose were taken at 0 and 6 weeks. DRW consumption had no effect of fasting concentrations of lipids, lipoproteins, insulin and glucose. However, chronic consumption of RW significantly reduced fasting LDL cholesterol concentrations by 8% and increased HDL cholesterol concentrations by 17% in hypercholesterolaemic postmenopausal women. Collectively, regular consumption of full-complement red wine reduces CVD risk by improving fasting lipid levels in hypercholesterolaemic postmenopausal women. This study uniquely demonstrated the LDL cholesterol-lowering effects of red wine in individuals at high CVD risk, which has not previously been shown.

Racial differences in risks for first cardiovascular events and noncardiovascular death: the Atherosclerosis Risk in Communities study, the Cardiovascular Health Study, and the Multi-Ethnic Study of Atherosclerosis.

PubMed

Feinstein, Matthew; Ning, Hongyan; Kang, Joseph; Bertoni, Alain; Carnethon, Mercedes; Lloyd-Jones, Donald M

2012-07-03

No studies have compared first cardiovascular disease (CVD) events and non-CVD death between races in a competing risks framework, which examines risks for numerous events simultaneously. We used competing Cox models to estimate hazards for first CVD events and non-CVD death within and between races in 3 multicenter, National Heart, Lung, and Blood Institute-sponsored cohorts. Of 14 569 Atherosclerosis Risk in Communities (ARIC) study participants aged 45 to 64 years with mean follow-up of 10.5 years, 11.6% had CVD and 5.0% had non-CVD death as first events; among 4237 Cardiovascular Health Study (CHS) study participants aged 65 to 84 years and followed for 8.5 years, these figures were 43.2% and 15.7%, respectively. Middle-aged blacks were significantly more likely than whites to experience any CVD as a first event; this disparity disappeared by older adulthood and after adjustment for CVD risk factors. The pattern of results was similar for Multi-Ethnic Study of Atherosclerosis (MESA) participants. Traditional Cox and competing risks models yielded different results for coronary heart disease risk. Black men appeared somewhat more likely than white men to experience coronary heart disease with use of a standard Cox model (hazard ratio 1.06; 95% CI 0.90, 1.26), whereas they appeared less likely than white men to have a first coronary heart disease event with use of a competing risks model (hazard ratio, 0.77; 95% CI, 0.60, 1.00). CVD affects blacks at an earlier age than whites; this may be attributable in part to elevated CVD risk factor levels among blacks. Racial disparities in first CVD incidence disappear by older adulthood. Competing risks analyses may yield somewhat different results than traditional Cox models and provide a complementary approach to examining risks for first CVD events.

The prevalence of cardiovascular disease risk factors and the Framingham Risk Score in patients undergoing percutaneous intervention over the last 17 years by gender: time-trend analysis from the Mayo Clinic PCI Registry.

PubMed

Lee, Moo-Sik; Flammer, Andreas J; Kim, Hyun-Soo; Hong, Jee-Young; Li, Jing; Lennon, Ryan J; Lerman, Amir

2014-07-01

This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends. This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

Are current UK National Institute for Health and Clinical Excellence (NICE) obesity risk guidelines useful? Cross-sectional associations with cardiovascular disease risk factors in a large, representative English population.

PubMed

Tabassum, Faiza; Batty, G David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35-97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

Are Current UK National Institute for Health and Clinical Excellence (NICE) Obesity Risk Guidelines Useful? Cross-Sectional Associations with Cardiovascular Disease Risk Factors in a Large, Representative English Population

PubMed Central

Tabassum, Faiza; Batty, G. David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women. PMID:23844088

Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women: Challenging the current definition.

PubMed

Dragsbæk, Katrine; Neergaard, Jesper S; Laursen, Janne M; Hansen, Henrik B; Christiansen, Claus; Beck-Nielsen, Henning; Karsdal, Morten A; Brix, Susanne; Henriksen, Kim

2016-09-01

The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) in elderly Caucasian women. We further investigated if stratification of individuals not defined with MetS would add predictive power in defining future disease prevalence of individuals with MetS.The Prospective Epidemiological Risk Factor Study, a community-based cohort study, followed 3905 Danish women since 2000 (age: 70.1 ± 6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information.Elderly women with defined MetS presented a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74-10.50]) and 1.7-fold increased risk of CVD (1.44-2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk factors also had increased risk of T2DM (hazard ratio (HR) = 2.21 [1.25-3.93] and HR = 1.75 [1.04-2.96]) and CVD (HR = 1.51 [1.25-1.83] and HR = 1.36 [1.15-1.60]) when compared to controls with no MetS risk factors.MetS in elderly Caucasian women increased risk of future T2DM and CVD. While not defined with MetS, women holding only some risk factors for MetS were also at increased risk of T2DM or CVD compared to women with no MetS risk factors.

Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women

PubMed Central

Dragsbæk, Katrine; Neergaard, Jesper S.; Laursen, Janne M.; Hansen, Henrik B.; Christiansen, Claus; Beck-Nielsen, Henning; Karsdal, Morten A.; Brix, Susanne; Henriksen, Kim

2016-01-01

Abstract The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) in elderly Caucasian women. We further investigated if stratification of individuals not defined with MetS would add predictive power in defining future disease prevalence of individuals with MetS. The Prospective Epidemiological Risk Factor Study, a community-based cohort study, followed 3905 Danish women since 2000 (age: 70.1 ± 6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information. Elderly women with defined MetS presented a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74–10.50]) and 1.7-fold increased risk of CVD (1.44–2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk factors also had increased risk of T2DM (hazard ratio (HR) = 2.21 [1.25–3.93] and HR = 1.75 [1.04–2.96]) and CVD (HR = 1.51 [1.25–1.83] and HR = 1.36 [1.15–1.60]) when compared to controls with no MetS risk factors. MetS in elderly Caucasian women increased risk of future T2DM and CVD. While not defined with MetS, women holding only some risk factors for MetS were also at increased risk of T2DM or CVD compared to women with no MetS risk factors. PMID:27603394

Lipid and blood pressure control for the prevention of cardiovascular disease in hypertensive patients: a subanalysis of the OMEGA study.

PubMed

Teramoto, Tamio; Kawamori, Ryuzo; Miyazaki, Shigeru; Teramukai, Satoshi; Sato, Yuki; Okuda, Yasuyuki; Shirayama, Masayuki

2015-01-01

The aim of this analysis was to investigate the relationships between dyslipidemia, achieved blood pressure (BP) values and the lipid levels, as well as the control of four cardiovascular risk factors (BP, low-density lipoprotein: LDL cholesterol, hemoglobin A1c: HbA1c and smoking) and the incidence of cardiovascular disease (CVD), in Japanese patients receiving antihypertensive therapy. A total of 13,052 patients with no history of CVD were included in this subanalysis of the prospective observational OMEGA study in Japanese hypertensive patients treated with olmesartan. Multivariable Cox regression models were used to evaluate the relationship with the risk of CVD. The incidence of CVD during the 36-month study period was 5.59/1,000 patient-years among the patients with dyslipidemia (n = 6,297) and 5.57/1,000 patient-years among the patients without dyslipidemia (n = 6,755), with no significant differences between the two groups. Higher achieved BP values tended to be associated with an increased CVD risk in both the patients with and without dyslipidemia. In addition, the risk of CVD tended to be higher in the patients with an achieved LDL cholesterol level of ≥ 120 mg/dL than in those with an LDL level of ＜ 120 mg/dL (trend p = 0.0005) and in the patients with an achieved high-density lipoprotein cholesterol level of ＜ 60 mg/dL than in those with an HDL level of ≥ 60 mg/dL (trend p = 0.0017). Furthermore, the risk of CVD was higher among the patients with fewer controlled risk factors than among those with control of all four risk factors (trend p ＜ 0.0001). In order to prevent CVD in olmesartan-treated hypertensive patients with no history of CVD, it is important to control both the lipid and BP levels and aim for comprehensive risk factor control.

Childhood obesity and cardiovascular disease: links and prevention strategies

PubMed Central

Nadeau, Kristen J.; Maahs, David M.; Daniels, Stephen R.; Eckel, Robert H.

2015-01-01

The prevalence and severity of pediatric obesity have dramatically increased since the late 1980s, raising concerns about a subsequent increase in cardiovascular outcomes. Strong evidence, particularly from autopsy studies, supports the concept that precursors of adult cardiovascular disease (CVD) begin in childhood, and that pediatric obesity has an important influence on overall CVD risk. Lifestyle patterns also begin early and impact CVD risk. In addition, obesity and other CVD risk factors tend to persist over time. However, whether childhood obesity causes adult CVD directly, or does so by persisting as adult obesity, or both, is less clear. Regardless, sufficient data exist to warrant early implementation of both obesity prevention and treatment in youth and adults. In this Review, we examine the evidence supporting the impact of childhood obesity on adult obesity, surrogate markers of CVD, components of the metabolic syndrome, and the development of CVD. We also evaluate how obesity treatment strategies can improve risk factors and, ultimately, adverse clinical outcomes. PMID:21670745

Dietary meat fats and burden of cardiovascular disease risk factors, in the elderly: a report from the MEDIS study.

PubMed

Polychronopoulos, Evangelos; Pounis, George; Bountziouka, Vassiliki; Zeimbekis, Akis; Tsiligianni, Ioanna; Qira, Brikena-Eirini; Gotsis, Efthimios; Metallinos, George; Lionis, Christos; Panagiotakos, Demosthenes

2010-03-18

Dietary fats have long been associated with human health, and especially cardiovascular disease (CVD). Some observational studies have shown that reduction in dietary fats, and particularly cholesterol is associated with lower cardiovascular risk; however, other prospective studies or randomized controlled trials of dietary fat reduction or modification have shown varying results on CVD morbidity and mortality. In this work we evaluated the relationships between dietary fats and a cluster of CVD risk factors (i.e., diabetes, obesity, hypercholesterolemia, hypertension), among elderly individuals without known CVD. In particular, dietary and clinical data from 1486 elderly (aged 65 to 100 years) men and women living in Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Syros, Naxos, Corfu and Zakynthos islands, and participated in the MEDIS study, were analysed. Data analysis revealed that 18.5% of males and 33.3% of females had three or four cardiovascular disease risk factors; the major source of fat was olive oil (mean intake for men and women 50.0 +/- 19.3 g/day and 46.0 +/- 16.8 g/day, p < 0.001). In addition it was observed that a 5% increase in energy adjusted fat intake from meat was associated with a 21% increase in the likelihood of having one additional CVD risk factor (95%CI 6%-39%); no significant associations were observed regarding the other types of fat consumed by the elderly participants. These findings may state a hypothesis that the consumption of fat only from meat or its products seems to increase the burden of CVD risk factors among CVD-free, elderly people.

Cardiovascular risk assessment: audit findings from a nurse clinic--a quality improvement initiative.

PubMed

Waldron, Sarah; Horsburgh, Margaret

2009-09-01

Evidence has shown the effectiveness of risk factor management in reducing mortality and morbidity from cardiovascular disease (CVD). An audit of a nurse CVD risk assessment programme undertaken between November 2005 and December 2008 in a Northland general practice. A retrospective audit of CVD risk assessment with data for the first entry of 621 patients collected exclusively from PREDICT-CVDTM, along with subsequent data collected from 320 of these patients who had a subsequent assessment recorded at an interval ranging from six months to three years (18 month average). Of the eligible population (71%) with an initial CVD risk assessment, 430 (69.2%) had afive-year absolute risk less than 15%, with 84 (13.5%) having a risk greater than 15% and having not had a cardiovascular event. Of the patients with a follow-up CVD risk assessment, 34 showed improvement. Medication prescribing for patients with absolute CVD risk greater than 15% increased from 71% to 86% for anti-platelet medication and for lipid lowering medication from 65% to 72% in the audit period. The recently available 'heart health' trajectory tool will help patients become more aware of risks that are modifiable, together with community support to engage more patients in the nurse CVD prevention programme. Further medication audits to monitor prescribing trends. Patients who showed an improvement in CVD risk had an improvement in one or more modifiable risk factors and became actively involved in making changes to their health.

Association between the Family Nutrition and Physical Activity screening tool and cardiovascular disease risk factors in 10-year old children

NASA Astrophysics Data System (ADS)

Yee, Kimbo Edward

Purpose. To examine the association of the Family Nutrition and Physical Activity (FNPA) screening tool, a behaviorally based screening tool designed to assess the obesogenic family environment and behaviors, with cardiovascular disease (CVD) risk factors in 10-year old children. Methods. One hundred nineteen children were assessed for body mass index (BMI), percent body fat (%BF), waist circumference (WC), total cholesterol, HDL-cholesterol, and resting blood pressure. A continuous CVD risk score was created using total cholesterol to HDL-cholesterol ratio (TC:HDL), mean arterial pressure (MAP), and WC. The FNPA survey was completed by parents. The associations between the FNPA score and individual CVD risk factors and the continuous CVD risk score were examined using correlation analyses. Results. Approximately 35% of the sample were overweight (19%) or obese (16%). The mean FNPA score was 24.6 +/- 2.5 (range 18 to 29). Significant correlations were found between the FNPA score and WC (r = -.35, p<.01), BMI percentile (r = -.38, p<.01), %BF (r = -.43, p<.01), and the continuous CVD risk score (r = -.22, p = .02). No significant association was found between the FNPA score and TC:HDL (r=0.10, p=0.88) or MAP (r=-0.12, p=0.20). Conclusion. Children from a high-risk, obesogenic family environment as indicated with a lower FNPA score have a higher CVD risk factor profile than children from a low-risk family environment.

Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient.

PubMed

Tabenkin, Hava; Eaton, Charles B; Roberts, Mary B; Parker, Donna R; McMurray, Jerome H; Borkan, Jeffrey

2010-01-01

The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as predictors of cardiovascular disease risk factors in an adult population in Singapore.

PubMed

Lam, Benjamin Chih Chiang; Koh, Gerald Choon Huat; Chen, Cynthia; Wong, Michael Tack Keong; Fallows, Stephen J

2015-01-01

Excess adiposity is associated with cardiovascular disease (CVD) risk factors such as hypertension, diabetes mellitus and dyslipidemia. Amongst the various measures of adiposity, the best one to help predict these risk factors remains contentious. A novel index of adiposity, the Body Adiposity Index (BAI) was proposed in 2011, and has not been extensively studied in all populations. Therefore, the purpose of this study is to compare the relationship between Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Body Adiposity Index (BAI) and CVD risk factors in the local adult population. This is a cross sectional study involving 1,891 subjects (Chinese 59.1% Malay 22.2%, Indian 18.7%), aged 21-74 years, based on an employee health screening (2012) undertaken at a hospital in Singapore. Anthropometric indices and CVD risk factor variables were measured, and Spearman correlation, Receiver Operating Characteristic (ROC) curves and multiple logistic regressions were used. BAI consistently had the lower correlation, area under ROC and odd ratio values when compared with BMI, WC and WHtR, although differences were often small with overlapping 95% confidence intervals. After adjusting for BMI, BAI did not further increase the odds of CVD risk factors, unlike WC and WHtR (for all except hypertension and low high density lipoprotein cholesterol). When subjects with the various CVD risk factors were grouped according to established cut-offs, a BMI of ≥23.0 kg/m2 and/or WHtR ≥0.5 identified the highest proportion for all the CVD risk factors in both genders, even higher than a combination of BMI and WC. BAI may function as a measure of overall adiposity but it is unlikely to be better than BMI. A combination of BMI and WHtR could have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore.

Prevalence of cardiovascular disease risk factors among older Puerto Rican adults living in Massachusetts

USDA-ARS?s Scientific Manuscript database

There remains limited research on cardiovascular disease (CVD) risk factors in Puerto Rican adults. We compared lifestyle and CVD risk factors in Puerto Rican men and women with normal fasting glucose (NFG), impaired fasting glucose (IFG), or type 2 diabetes (T2D), and investigated achievement of Am...

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

Can Lifestyle Modification Improve Neurocognition? Rationale and Design of the ENLIGHTEN Clinical Trial

PubMed Central

Blumenthal, James A.; Smith, Patrick J.; Welsh-Bohmer, Kathleen; Babyak, Michael A.; Browndyke, Jeffrey; Lin, Pao-Hwa; Doraiswamy, P. Murali; Burke, James; Kraus, William; Hinderliter, Alan; Sherwood, Andrew

2013-01-01

Background Risk factors for cardiovascular disease (CVD) not only increase the risk for clinical CVD events, but also are associated with a cascade of neurophysiologic and neuroanatomic changes that increase the risk of cognitive impairment and dementia. Although epidemiological studies have shown that exercise and diet are associated with lower CVD risk and reduced incidence of dementia, no randomized controlled trial (RCT) has examined the independent effects of exercise and diet on neurocognitive function among individuals at risk for dementia. The ENLIGHTEN trial is a RCT of patients with CVD risk factors who also are characterized by subjective cognitive complaints and objective evidence of neurocognitive impairment without dementia (CIND) Study Design A 2 by 2 design will examine the independent and combined effects of diet and exercise on neurocognition. 160 participants diagnosed with CIND will be randomly assigned to 6 months of aerobic exercise, the DASH diet, or a combination of both exercise and diet; a (control) group will receive health education but otherwise will maintain their usual dietary and activity habits. Participants will complete comprehensive assessments of neurocognitive functioning along with biomarkers of CVD risk including measures of blood pressure, glucose, endothelial function, and arterial stiffness. Conclusion The ENLIGHTEN trial will (a) evaluate the effectiveness of aerobic exercise and the DASH diet in improving neurocognitive functioning in CIND patients with CVD risk factors; (b) examine possible mechanisms by which exercise and diet improve neurocognition; and (c) consider potential moderators of treatment, including subclinical CVD. PMID:23000080

Nutrigenomics in cardiovascular disease: implications for the future.

PubMed

Engler, Mary B

2009-12-01

Cardiovascular disease (CVD), the leading cause of morbidity and mortality worldwide, is a complex multifactorial disease which is influenced by environmental and genetic factors. There is substantial evidence on the relationship between diet and CVD risk. An understanding of how genetic variation interacts with the diet to influence CVD risk is a rapidly evolving area of research. Since diet is the mainstay of risk factor modification, it is important to consider potential genetic influences on CVD risk. Nutrigenomics is the study of the interaction between diet and an individual's genetic makeup. Single nucleotide polymorphisms are the key factors in human genetic variation and provide a molecular basis for phenotypic differences between individuals. Whole genome and candidate gene association studies are two main approaches used in cardiovascular genetics to identify disease-causing genes. Recent nutrigenomics studies show the influence of genotype on the responsiveness to dietary factors or nutrients that may reduce CVD risk. Nutrigenomics research is expected to provide the scientific evidence for genotype-based personalized nutrition to promote health and prevent chronic disease, including CVD. It is imperative that healthcare providers, including cardiovascular nurses, are trained in genetics to foster delivery of competent genetic- and genomic-focused care and to facilitate incorporation of this new knowledge into current clinical practice, education, and research.

Prediction of 30-year risk for cardiovascular mortality by fitness and risk factor levels: the Cooper Center Longitudinal Study.

PubMed

Wickramasinghe, Chanaka D; Ayers, Colby R; Das, Sandeep; de Lemos, James A; Willis, Benjamin L; Berry, Jarett D

2014-07-01

Fitness and traditional risk factors have well-known associations with cardiovascular disease (CVD) death in both short-term (10 years) and across the remaining lifespan. However, currently available short-term and long-term risk prediction tools do not incorporate measured fitness. We included 16 533 participants from the Cooper Center Longitudinal Study (CCLS) without prior CVD. Fitness was measured using the Balke protocol. Sex-specific fitness levels were derived from the Balke treadmill times and categorized into low, intermediate, and high fit according to age- and sex-specific treadmill times. Sex-specific 30-year risk estimates for CVD death adjusted for competing risk of non-CVD death were estimated using the cause-specific hazards model and included age, body mass index, systolic blood pressure, fitness, diabetes mellitus, total cholesterol, and smoking. During a median follow-up period of 28 years, there were 1123 CVD deaths. The 30-year risk estimates for CVD mortality derived from the cause-specific hazards model demonstrated overall good calibration (Nam-D'Agostino χ(2) [men, P=0.286; women, P=0.664] and discrimination (c statistic; men, 0.81 [0.80-0.82] and women, 0.86 [0.82-0.91]). Across all risk factor strata, the presence of low fitness was associated with a greater 30-year risk for CVD death. Fitness represents an important additional covariate in 30-year risk prediction functions that may serve as a useful tool in clinical practice. © 2014 American Heart Association, Inc.

Sex Differences in Cardiovascular Disease Risk of Ghanaian- and Nigerian-Born West African Immigrants in the United States: The Afro-Cardiac Study.

PubMed

Commodore-Mensah, Yvonne; Hill, Martha; Allen, Jerilyn; Cooper, Lisa A; Blumenthal, Roger; Agyemang, Charles; Himmelfarb, Cheryl Dennison

2016-02-18

The number of African immigrants in the United States grew 40-fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States. This cross-sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35-74 years in the Baltimore-Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m(2)) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033-0.29) and 0.25 (95% CI 0.09-0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83-0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%. The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Dietary modification, body mass index (BMI), blood pressure (BP) and cardiovascular risk in medical students of a government medical college of Karachi.

PubMed

Raza, Sajjad; Sheikh, Muhammad Adil; Hussain, Muhammad Fawwad Ahmed; Siddiqui, Saad Ebrahim; Muhammad, Rabia; Aziz, Sina; Qamar, Salima; Saleem, Mohammad Azfar; Waki, Nida; Faruqi, Hina; Zia, Aisha

2010-11-01

To determine the prevalence of major risk factors including dietary modification, Body Mass Index (BMI), Blood Pressure (BP) and physical activity in medical students of government teaching hospitals of Karachi. A cross sectional study was conducted on students of Dow Medical College, Karachi, Pakistan through a structured pre-tested questionnaire. Non-probability purposive sampling was used. Smoking, hypertension, family history of cardiovascular disease (CVD), overweight and low physical activity levels are risk factors the presence of which can lead to development of CVD. Prevalence of these risk factors was determined by asking appropriate questions and through measurement of BMI and blood pressure for overweight and hypertension respectively. Awareness of risk factors was determined through knowledge of the effect of various food substances on development of CVD and of adoption of dietary changes keeping in mind the risk of developing CVD. SPSS 16.0 was used for statistical analysis. A total of 132 medical students were included in the study of which 57 (43.2%) and 75 (56.8%) were male and female respectively with mean age of 20.85 +/- 1.21 years. About 15.9% of students had elevated blood pressure i.e. > or = 140/90 mmHg. Twenty eight percent of the total students were found to be underweight and 17.4% were overweight, 5% had some history of CVD, 56.8% had family history of CVD, 9.4% were smokers and 29.5% had high physical activity level. About 87.1% had modified their diet for preventing CVD. Most of the students had adequate knowledge about the cardiovascular risk factors Majority of students were not overweight. A high prevalence of cardiovascular risk factors; family history and elevated blood pressure was present. Awareness in terms of knowledge was satisfactory but implementation in terms of diet modification and adequate physical activity was lacking.

Trends in Cardiovascular Disease Risk Factors in Individuals with and without Diabetes in the Framingham Heart Study

PubMed Central

Preis, Sarah Rosner; Pencina, Michael J.; Hwang, Shih-Jen; D’Agostino, Ralph B.; Savage, Peter J.; Levy, Daniel; Fox, Caroline S.

2009-01-01

Background Individuals with diabetes are at two to three-fold increased risk for cardiovascular disease (CVD) relative to those without diabetes. Our objective was to examine CVD risk factor level changes among individuals with and without type 2 diabetes from 1970–2005 in the Framingham Heart Study. Methods and Results We included 4,195 participants (3,990 non-diabetes/205 diabetes) aged 50 and 3,495 participants (3,178 non- diabetes/317 diabetes) aged 60. Contemporaneous CVD risk factor levels were measured; linear regression models were used to assess the interaction between diabetes status and calendar year on CVD risk factor levels. Among 50-year olds, for non-diabetes, there was an increase in body mass index (BMI) of 0.39 kg/m2 per 10 years whereas for diabetes there was an increase of 2.52 kg/m2 (p-value for the diabetes by calendar year interaction [p-interaction] <0.0001). For LDL cholesterol, the mean decrease was −7.43 mg/dL per decade [non-diabetes] and −15.5 mg/dL for diabetes (p-interaction=0.002). For systolic blood pressure, the mean decrease was −3.35 mmHg per decade [non-diabetes] and −3.50 mmHg for diabetes (p-interaction=0.97). The direction of the trends for those with diabetes relative to those without diabetes was similar for 60-year olds. Conclusions Individuals with diabetes experienced a greater increase in BMI, a greater decrease in LDL-C, and a similar magnitude of decline in systolic blood pressure as compared to those without diabetes. Individuals with diabetes have not experienced the necessary declines in CVD risk factors to overcome their increased risk of CVD. Further efforts are needed to aggressively control CVD risk factors among individuals with diabetes. PMID:19581493

Vascular endothelium summary statement II: Cardiovascular disease prevention and control.

PubMed

Mensah, George A; Ryan, Una S; Hooper, W Craig; Engelgau, Michael M; Callow, Allan D; Kapuku, Gaston K; Mantovani, Alberto

2007-05-01

The prevention and control of cardiovascular disease (CVD), principally ischemic heart disease and stroke, are a major clinical and public health challenge. Worldwide, CVD accounts for substantial morbidity and mortality. The major modifiable CVD risk factors are known and all of them cause endothelial activation and dysfunction. Preventing and controlling the established risk factors are associated with preserved endothelial function and reduced risk of CVD. Research advances that improve our understanding of strategies to preserve endothelial function or make the endothelial cells resilient to environmental insults may help improve our preventive interventions. This summary statement addresses the current state of the science with respect to endothelial dysfunction and CVD pathogenesis, diagnostic evaluation, and suggested strategies for public health practice and research.

Cardiovascular disease in women.

PubMed

Lee, L Veronica; Foody, Joanne Micale

2008-08-01

The rates of cardiovascular disease (CVD) have decreased significantly for men over the past few decades, but similar reductions have not occurred in women. Consequently, CVD remains the leading killer of women in the United States. Men usually develop heart disease earlier than women, but women develop heart disease more rapidly once menopause has occurred. A review of risk factors that are common between men and women demonstrates some notable sex-dependent differences. Many of these changes appear related to the hormonal changes that occur in menopause, such as the development of hypertension, changes in lipid concentrations, and central adiposity. In addition, diabetes is a more significant risk factor for CVD in women than men. Sociologic and physiologic factors need to be considered in treatment of risk factors, such as smoking, lack of exercise, obesity, and depression. Prevention is known to significantly reduce CVD risk, but new goals are being established for women as the sex-dependent differences have become apparent.

Cardiorespiratory fitness and classification of risk of cardiovascular disease mortality.

PubMed

Gupta, Sachin; Rohatgi, Anand; Ayers, Colby R; Willis, Benjamin L; Haskell, William L; Khera, Amit; Drazner, Mark H; de Lemos, James A; Berry, Jarett D

2011-04-05

Cardiorespiratory fitness (fitness) is associated with cardiovascular disease (CVD) mortality. However, the extent to which fitness improves risk classification when added to traditional risk factors is unclear. Fitness was measured by the Balke protocol in 66 371 subjects without prior CVD enrolled in the Cooper Center Longitudinal Study between 1970 and 2006; follow-up was extended through 2006. Cox proportional hazards models were used to estimate the risk of CVD mortality with a traditional risk factor model (age, sex, systolic blood pressure, diabetes mellitus, total cholesterol, and smoking) with and without the addition of fitness. The net reclassification improvement and integrated discrimination improvement were calculated at 10 and 25 years. Ten-year risk estimates for CVD mortality were categorized as <1%, 1% to <5%, and ≥5%, and 25-year risk estimates were categorized as <8%, 8% to 30%, and ≥30%. During a median follow-up period of 16 years, there were 1621 CVD deaths. The addition of fitness to the traditional risk factor model resulted in reclassification of 10.7% of the men, with significant net reclassification improvement at both 10 years (net reclassification improvement=0.121) and 25 years (net reclassification improvement=0.041) (P<0.001 for both). The integrated discrimination improvement was 0.010 at 10 years (P<0.001), and the relative integrated discrimination improvement was 29%. Similar findings were observed for women at 25 years. A single measurement of fitness significantly improves classification of both short-term (10-year) and long-term (25-year) risk for CVD mortality when added to traditional risk factors.

Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons.

PubMed

Wright, E J; Grund, B; Robertson, K; Brew, B J; Roediger, M; Bain, M P; Drummond, F; Vjecha, M J; Hoy, J; Miller, C; Penalva de Oliveira, A C; Pumpradit, W; Shlay, J C; El-Sadr, W; Price, R W

2010-09-07

To determine factors associated with baseline neurocognitive performance in HIV-infected participants enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) neurology substudy. Participants from Australia, North America, Brazil, and Thailand were administered a 5-test neurocognitive battery. Z scores and the neurocognitive performance outcome measure, the quantitative neurocognitive performance z score (QNPZ-5), were calculated using US norms. Neurocognitive impairment was defined as z scores <-2 in two or more cognitive domains. Associations of test scores, the QNPZ-5, and impairment with baseline factors including demographics and risk factors for HIV-associated dementia (HAD) and cardiovascular disease (CVD) were determined in multiple regression. The 292 participants had a median CD4 cell count of 536 cells/mm(3), 88% had an HIV viral load < or =400 copies/mL, and 92% were taking antiretrovirals. Demographics, HIV, and clinical factors differed between locations. The mean QNPZ-5 score was -0.72; 14% of participants had neurocognitive impairment. For most tests, scores and z scores differed significantly between locations, with and without adjustment for age, sex, education, and race. Prior CVD was associated with neurocognitive impairment. Prior CVD, hypercholesterolemia, and hypertension were associated with poorer neurocognitive performance but conventional HAD risk factors and the CNS penetration effectiveness rank of antiretroviral regimens were not. In this HIV-positive population with high CD4 cell counts, neurocognitive impairment was associated with prior CVD. Lower neurocognitive performance was associated with prior CVD, hypertension, and hypercholesterolemia, but not conventional HAD risk factors. The contribution of CVD and cardiovascular risk factors to the neurocognition of HIV-positive populations warrants further investigation.

Cardiovascular disease prevention and lifestyle interventions: effectiveness and efficacy.

PubMed

Haskell, William L

2003-01-01

Over the past half century scientific data support the strong relationship between the way a person or population lives and their risk for developing or dying from cardiovascular disease (CVD). While heredity can be a major factor for some people, their personal health habits and environmental/cultural exposure are more important factors. CVD is a multifactor process that is contributed to by a variety of biological and behavioral characteristics of the person including a number of well-established and emerging risk factors. Not smoking, being physically active, eating a heart healthy diet, staying reasonably lean, and avoiding major stress and depression are the major components of an effective CVD prevention program. For people at high risk of CVD, medications frequently need to be added to a healthy lifestyle to minimize their risk of a heart attack or stroke, particularly in persons with conditions such as hypertension, hypercholesterolemia, or hyperglycemia. Maintaining an effective CVD prevention program in technologically advanced societies cannot be achieved by many high-risk persons without effective and sustained support from a well-organized health care system. Nurse-provided or nurse-coordinated care management programs using an integrated or multifactor approach have been highly effective in reducing CVD morbidity and mortality of high-risk persons.

Factors affecting the prevalence of chronic diseases in Palestinian people: an analysis of data from the Palestinian Central Bureau of Statistics.

PubMed

Abukhdeir, H F; Caplan, L S; Reese, L; Alema-Mensah, E

2013-04-01

This study determined whether there are significant differences in the prevalence of diabetes, hypertension, cardiovascular disease (CVD) and cancer among Palestinians with respect to different demographic variables using secondary data from the Palestinian Central Bureau of Statistics. Living in the Gaza Strip was a protective factor, with this group being 21% less likely to have diabetes, 35% less likely to have hypertension, and 48% less likely to have CVD than those living in the West Bank. No significant difference was found for cancer. Being a refugee was a significant risk factor for diabetes and CVD while being married/engaged or divorced/ separated/widowed was a risk factor for diabetes and hypertension. Gender was a risk factor for hypertension with females being 60% more likely to have hypertension than males. Living in a rural setting was protective against hypertension. As expected, age was a risk factor for diabetes, hypertension and CVD; the magnitude of this increased risk was alarming, 36 to 434 times greater in those aged 40-65 years compared with those aged 0-19 years.

Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review

PubMed Central

Chow, Clara Kayei; Lock, Karen; Teo, Koon; Subramanian, SV; McKee, Martin; Yusuf, Salim

2009-01-01

It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction ‘within’ populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to ‘populations’ that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others. PMID:19261658

The effects of insulin sensitizers on the cardiovascular risk factors in women with polycystic ovary syndrome.

PubMed

Kassi, E; Diamanti-Kandarakis, E

2008-12-01

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in pre-menopausal women characterized by menstrual cycle disturbances, chronic anovulation, and clinical and/or biochemical hyperandrogenism. Although, the primary etiology of PCOS remains unknown, insulin resistance/hyperinsulinemia plays a pivotal role in the pathogenesis of the syndrome. A growing body of recent data support that women with PCOS have displayed an increased prevelance of cardiovascular disease (CVD) risk factors putting potentially at a hight risk for heart disease. Most of these CVD risk factors are etiologically correlated with insulin resistance/hyperinsulinemia, highlighting the role of insulin sensitizers in the therapeutic quiver for the chronic treatment of PCOS. In this review, we discuss the current literature on the CVD risk factors in PCOS and the influence of insulin sensitizers upon these risk factors.

Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review.

PubMed

Chow, Clara Kayei; Lock, Karen; Teo, Koon; Subramanian, S V; McKee, Martin; Yusuf, Salim

2009-12-01

It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction 'within' populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to 'populations' that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others.

Cardiovascular Disease Susceptibility and Resistance in Circumpolar Inuit Populations.

PubMed

Tvermosegaard, Maria; Dahl-Petersen, Inger K; Nielsen, Nina Odgaard; Bjerregaard, Peter; Jørgensen, Marit Eika

2015-09-01

Cardiovascular disease (CVD) is a major public health issue in indigenous populations in the Arctic. These diseases have emerged concomitantly with profound social changes over the past 60 years. The aim of this study was to summarize the literature on CVD risk among Arctic Inuit. Literature on prevalence, incidence, and time trends for CVD and its risk factors in Arctic Inuit populations was reviewed. Most evidence supports a similar incidence of coronary heart disease and a higher incidence of cerebrovascular disease among Arctic Inuit than seen in western populations. Factors that may increase CVD risk include aging of the population, genetic susceptibility, and a rapid increase in obesity, diabetes, and hypertension in parallel with decreasing physical activity and deterioration of the lipid profile. In contrast, and of great importance, there has been a decrease in smoking and alcohol intake (at least documented in Greenland), and contaminant levels are declining. Although there have been marked socioeconomic and dietary changes, it remains unsolved and to some extent controversial how this may have influenced cardiovascular risk among Arctic Inuit. The increase in life expectancy, in combination with improved prognosis for patients with manifest CVD, will inevitably lead to a large increase in absolute numbers of individuals affected by CVD in Arctic Inuit populations, exacerbated by the rise in most CVD risk factors over the past decades. For preventive purposes and for health care planning, it is crucial to carefully monitor disease incidence and trends in risk factors in these vulnerable Arctic populations. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Objectively Measured Sedentary Time and Cardiovascular Risk Factor Control in US Hispanics/Latinos With Diabetes Mellitus: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

PubMed

Wang, Xueyin; Strizich, Garrett; Hua, Simin; Sotres-Alvarez, Daniela; Buelna, Christina; Gallo, Linda C; Gellman, Marc D; Mossavar-Rahmani, Yasmin; O'Brien, Matthew J; Stoutenberg, Mark; Wang, Tao; Avilés-Santa, M Larissa; Kaplan, Robert C; Qi, Qibin

2017-05-25

Cardiovascular disease (CVD) risk factor control is a cornerstone of diabetes mellitus management. Little is known about relationships of objectively measured sedentary time and physical activity with major CVD risk factor control in individuals with diabetes mellitus. We examined associations of objectively measured sedentary time and moderate-to-vigorous physical activity with reaching major CVD risk factor control goals among US Hispanic/Latino adults with diabetes mellitus. This cross-sectional analysis included 1699 participants with diabetes mellitus from the Hispanic Community Health Study/Study of Latinos (2008-2011). Logistic regression models were used to estimate the odds ratios (ORs) of meeting the following 5 major CVD risk factor control goals: hemoglobin A 1c <7.0%; systolic/diastolic blood pressure <140/80 mm Hg; triglycerides <150 mg/dL; low-density lipoprotein cholesterol <100 mg/dL; and high-density lipoprotein cholesterol >40/50 mg/dL for men/women. After adjustment for covariates including moderate-to-vigorous physical activity, less sedentary time was associated with increased odds of reaching hemoglobin A 1c (OR=1.76 [95% CI: 1.10, 2.82]) and triglyceride control goals (OR=2.16 [1.36, 3.46]), and reaching ≥3 CVD risk factor control goals (OR=2.08 [1.34, 3.23]) (all ORs for comparisons of extreme tertiles of sedentary time). Moderate-to-vigorous physical activity was not associated with reaching any CVD risk factor control goals. Substituting 60-min/day of sedentary time with light-intensity physical activity was associated with increased odds of reaching hemoglobin A 1c (OR=1.18 [1.04, 1.35]), high-density lipoprotein cholesterol (OR=1.17 [1.04, 1.32]), and triglyceride (OR=1.20 [1.05, 1.36]) control goals. Among US Hispanic/Latino adults with diabetes mellitus, less sedentary time, but not moderate-to-vigorous physical activity, was associated with improved CVD risk factor control, specifically in reaching hemoglobin A 1c and triglyceride control goals. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Beyond Framingham risk factors and coronary calcification: does aortic valve calcification improve risk prediction? The Heinz Nixdorf Recall Study.

PubMed

Kälsch, Hagen; Lehmann, Nils; Mahabadi, Amir A; Bauer, Marcus; Kara, Kaffer; Hüppe, Patricia; Moebus, Susanne; Möhlenkamp, Stefan; Dragano, Nico; Schmermund, Axel; Stang, Andreas; Jöckel, Karl-Heinz; Erbel, Raimund

2014-06-01

Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. In this study, we investigated whether AVC adds to cardiovascular risk prediction beyond Framingham risk factors and coronary artery calcification (CAC). A total of 3944 subjects from the population based Heinz Nixdorf Recall Study (59.3±7.7 years; 53% females) were evaluated for coronary events, stroke, and cardiovascular disease (CVD) events (including all plus CV death) over 9.1±1.9 years. CT scans were performed to quantify AVC. Cox proportional hazards regressions and Harrell's C were used to examine AVC as event predictor in addition to risk factors and CAC. During follow-up, 138 (3.5%) subjects experienced coronary events, 101 (2.6%) had a stroke, and 257 (6.5%) experienced CVD events. In subjects with AVC>0 versus AVC=0 the incidence of coronary events was 8.0% versus 3.0% (p<0.001) and the incidence of CVD events was 13.0% versus 5.7% (p<0.001). The frequency of events increased significantly with increasing AVC scores (p<0.001). After adjustment for Framingham risk factors, high AVC scores (3rd tertile) remained independently associated with coronary events (HR 2.21, 95% CI 1.28 to 3.81) and CVD events (HR 1.67, 95% CI 1.08 to 2.58). After further adjustment for CAC score, HRs were attenuated (coronary events 1.55, 95% CI 0.89 to 2.69; CVD events 1.29, 95% CI 0.83 to 2.00). When adding AVC to the model containing traditional risk factors and CAC, Harrell's C indices did not increase for coronary events (from 0.744 to 0.744) or CVD events (from 0.759 to 0.759). AVC is associated with incident coronary and CVD events independent of Framingham risk factors. However, AVC fails to improve cardiovascular event prediction over Framingham risk factors and CAC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Oral Hygiene and Cardiometabolic Disease Risk in the Survey of the Health of Wisconsin

PubMed Central

VanWormer, Jeffrey J.; Acharya, Amit; Greenlee, Robert T.; Nieto, F. Javier

2012-01-01

Objectives Poor oral health is an increasingly recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes (T2D), but little is known about the association between toothbrushing or flossing and cardiometabolic disease risk. The purpose of this study was to examine the degree to which an oral hygiene index was associated with CVD and T2D risk scores among disease-free adults in the Survey of the Health of Wisconsin. Methods All variables were measured in 2008–2010 in this cross-sectional design. Based on toothbrushing and flossing frequency, and oral hygiene index (poor, fair, good, excellent) was created as the primary predictor variable. The outcomes, CVD and T2D risk score, were based on previous estimates from large cohort studies. There were 712 and 296 individuals with complete data available for linear regression analyses in the CVD and T2D samples, respectively. Results After covariate adjustment, the final model indicated that participants in the excellent (β±SE=−0.019±0.008, p=0.020) oral hygiene category had a significantly lower CVD risk score as compared to participants in the poor oral hygiene category. Sensitivity analyses indicated that both toothbrushing and flossing were independently associated with CVD risk score, and various modifiable risk factors. Oral hygiene was not significantly associated with T2D risk score. Conclusions Regular toothbrushing and flossing are associated with a more favorable CVD risk profile, but more experimental research is needed in this area to precisely determine the effects of various oral self-care maintenance behaviors on the control of individual cardiometabolic risk factors. These findings may inform future joint medical-dental initiatives designed to close gaps in the primary prevention of oral and systemic diseases. PMID:23106415

All-Cause and CVD Mortality in Native Hawaiians

PubMed Central

Aluli, N. Emmett; Reyes, Phillip W.; Brady, S. Kalani; Tsark, JoAnn U.; Jones, Kristina L.; Mau, Marjorie; Howard, Wm. J.; Howard, Barbara V.

2010-01-01

Aims Cardiovascular disease (CVD) is the leading cause of death among Native Hawaiians. In this article, all-cause and cardiovascular mortality rates among Native Hawaiians are examined, along with associated CVD risk factors. Methods A total of 855 Native Hawaiians (343 men and 512 women, ages 19–88) were examined as participants of the Cardiovascular Risk Clinics program (1992–1998) and underwent surveillance through September 2007. Cause of each death was determined by review of medical records, death certificates, newspapers, and through queries to community members. Results CVD accounted for 55% of deaths. Coronary heart disease (CHD) accounted for the majority of CVD deaths. CVD increased with age and was higher in those with diabetes, hypertension, or high low-density lipoprotein cholesterol (LDL-C). CVD rates were higher in men than in women and 4-fold higher in those with diabetes. In addition to age, diabetes, hypertension, and elevated LDL-C were major risk factors. Conclusions Diabetes is a major determinant of CVD in this population and most of the CVD is occurring in those with diabetes. Strategies to prevent diabetes and manage blood pressure and lipids should reduce CVD rates in Native Hawaiians. PMID:20392507

Vascular robustness: The missing parameter in cardiovascular risk prediction.

PubMed

Kraushaar, Lutz E; Dressel, Alexander; Maßmann, Alexander

2018-03-01

Undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is an acknowledged obstacle to CVD prevention. The vasculature's functional robustness against risk factor derailment may serve as a novel discriminator of mortality risk under similar risk factor loads. To test this assumption, we hypothesized that the expected inverse robustness-mortality association is verifiable as a significant trend along the age spectrum of risk factor-challenged cohorts. This is a retrospective cohort study of 372 adults (mean age 56.1 years, range 21-92; 45% female) with a variety of CV risk factors. An arterial model (VascAssist 2, iSYMED GmbH, Germany) was used to derive global parameters of arterial function from non-invasively acquired pulse pressure waves. Participants were stratified by health status: apparently healthy (AH; n = 221); with hypertension and/or hypercholesterolemia (CC; n = 61); with history of CV event(s) (CVE; n = 90). Multivariate linear regression was used to derive a robustness score which was calibrated against the CVD mortality hazard rate of a sub-cohort of the LURIC study (n = 1369; mean age 59.1 years, range 20-75; 37% female). Robustness correlated linearly with calendar age in CC (F(1, 59) = 10.42; p  < 0.01) and CVE (F(1, 88) = 40.34; p  < 0.0001) but not in the AH strata, supporting the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges. Vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality.

Comparing the impact of personal and parental risk factors, and parental lifespan on all-cause mortality and cardiovascular disease: findings from the Midspan Family cohort study.

PubMed

Hart, Carole; McCartney, Gerry; Gruer, Laurence; Watt, Graham

2015-10-01

We aimed to identify which personal and parental factors best explained all-cause mortality and cardiovascular disease (CVD). In 1996, data were collected on 2338 adult offspring of the participants in the 1972-1976 Renfrew and Paisley prospective cohort study. Recorded risk factors were assigned to 5 groups: mid-life biological and behavioural (BB), mid-life socioeconomic, parental BB, early-life socioeconomic and parental lifespan. Participants were followed up for mortality and hospital admissions to the end of 2011. Cox proportional hazards models were used to analyse how well each group explained all-cause mortality or CVD. Akaike's Information Criterion (AIC), a measure of goodness-of-fit, identified the most important groups. For all-cause mortality (1997 participants with complete data, 111 deaths), decreases in AIC from the null model (adjusting for age and sex) to models including mid-life BB, mid-life socioeconomic, parental BB, early-life socioeconomic and parental lifespan were 55.8, 21.6, 10.3, 7.3 and 5.9, respectively. For the CVD models (1736 participants, 276 with CVD), decreases were 37.8, 3.7, 6.7, 17.3 and 0.4. Mid-life BB factors were the most important for both all-cause mortality and CVD; mid-life socioeconomic factors were important for all-cause mortality, and early-life socioeconomic factors were important for CVD. Parental lifespan was the weakest factor. As mid-life BB risk factors best explained all-cause mortality and CVD, continued action to reduce these is warranted. Targeting adverse socioeconomic factors in mid-life and early life may contribute to reducing all-cause mortality and CVD risk, respectively. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cohort Profile: The International Childhood Cardiovascular Cohort (i3C) Consortium

PubMed Central

Dwyer, Terence; Sun, Cong; Magnussen, Costan G; Raitakari, Olli T; Schork, Nicholas J; Venn, Alison; Burns, Trudy L; Juonala, Markus; Steinberger, Julia; Sinaiko, Alan R; Prineas, Ronald J; Davis, Patricia H; Woo, Jessica G; Morrison, John A; Daniels, Stephen R; Chen, Wei; Srinivasan, Sathanur R; Viikari, Jorma SA; Berenson, Gerald S

2013-01-01

This is a consortium of large children's cohorts that contain measurements of major cardiovascular disease (CVD) risk factors in childhood and had the ability to follow those cohorts into adulthood. The purpose of this consortium is to enable the pooling of data to increase power, most importantly for the follow-up of CVD events in adulthood. Within the consortium, we hope to be able to obtain data on the independent effects of childhood and early adult levels of CVD risk factors on subsequent CVD occurrence. PMID:22434861

Fixed-dose combination therapy for the prevention of cardiovascular disease

PubMed Central

de Cates, Angharad N; Farr, Matthew RB; Rees, Karen; Casas, Juan P; Huffman, Mark

2014-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the effectiveness of fixed-dose combination therapy on optimising CVD risk factors and reducing CVD fatal and non-fatal events for both primary and secondary prevention of CVD. Details of CVD events and risk factors included are listed in the methods. We will also determine any adverse events associated with taking fixed-dose combination therapy. This will include studies conducted in both developed and developing regions of the world. PMID:25267903

Can lifestyle modification improve neurocognition? Rationale and design of the ENLIGHTEN clinical trial.

PubMed

Blumenthal, James A; Smith, Patrick J; Welsh-Bohmer, Kathleen; Babyak, Michael A; Browndyke, Jeffrey; Lin, Pao-Hwa; Doraiswamy, P Murali; Burke, James; Kraus, William; Hinderliter, Alan; Sherwood, Andrew

2013-01-01

Risk factors for cardiovascular disease (CVD) not only increase the risk for clinical CVD events, but also are associated with a cascade of neurophysiologic and neuroanatomic changes that increase the risk of cognitive impairment and dementia. Although epidemiological studies have shown that exercise and diet are associated with lower CVD risk and reduced incidence of dementia, no randomized controlled trial (RCT) has examined the independent effects of exercise and diet on neurocognitive function among individuals at risk for dementia. The ENLIGHTEN trial is a RCT of patients with CVD risk factors who also are characterized by subjective cognitive complaints and objective evidence of neurocognitive impairment without dementia (CIND) STUDY DESIGN: A 2 by 2 design will examine the independent and combined effects of diet and exercise on neurocognition. 160 participants diagnosed with CIND will be randomly assigned to 6 months of aerobic exercise, the DASH diet, or a combination of both exercise and diet; a (control) group will receive health education but otherwise will maintain their usual dietary and activity habits. Participants will complete comprehensive assessments of neurocognitive functioning along with biomarkers of CVD risk including measures of blood pressure, glucose, endothelial function, and arterial stiffness. The ENLIGHTEN trial will (a) evaluate the effectiveness of aerobic exercise and the DASH diet in improving neurocognitive functioning in CIND patients with CVD risk factors; (b) examine possible mechanisms by which exercise and diet improve neurocognition; and (c) consider potential moderators of treatment, including subclinical CVD. Copyright © 2012 Elsevier Inc. All rights reserved.

The Prevalence of Cardiovascular Disease Risk Factors among Employees in the Kingdom of Bahrain between October 2010 and March 2011: A Cross-Sectional Study from a Workplace Health Campaign

PubMed Central

AL-Nooh, Ameera Ali; Abdulabbas Abdulla Alajmi, Abdulhussain; Wood, David

2014-01-01

Background. High prevalence of CVD risk factors has been reported in Bahrain. Objective. This study aims to estimate the CVD risk factors prevalence among government employees in Bahrain. Design. A cross-sectional study design. Setting. Different government workplaces in Bahrain. Method. Data was collected from 1139 employees between October 2010 and March 2011 through interviews, including physical measurements, patient blood testing, and expired carbon monoxide (CO) levels as particles per million (ppm) for smokers. A summary of composite CVD risk factors was identified. Results. The following overall prevalence rates were reported: overweight and obesity 78.4% and reported hypertension 36.9% (included both those who were on and not on treatments), with an estimated prevalence of 21.6% for measured systolic blood pressure (Sbp) ≥ 140 mmHg and 23.3% for diastolic blood pressure (dbp) ≥90 mmHg. The prevalence of total cholesterol levels ≥5.2 mmol/dl was 24.2% and LDL levels >3.3 mmol/dl 10.8%. Prevalence of HDL-C levels (≤1.03 mmol/dl) was 47.55% and (≥1.5 mmol/dl) in 12.31%. The low HDL level (<1.03 mmol/dl) among males was 64.1%, while it was 26.6% among females. Half the participants (50.8%) do not engage in any type of physical activity. Moreover, 24.3% were not eating daily servings of fruits and vegetables. About 16.1% of them were current smokers. The majority of the participants (95.35%) had either no or less than 3 CVD risk factors. Only 4.65% had 3–5 risk factors. Conclusions. Among the employees in Bahrain, the high CVD risk factors prevalence is evident. CVD risk factors prevention and control are a priority. PMID:25105054

Impact of anti-rheumatic treatment on cardiovascular risk in Asian patients with rheumatoid arthritis.

PubMed

Cho, Soo-Kyung; Kim, Dam; Won, Soyoung; Lee, Jiyoung; Park, ByeongJu; Jang, Eun Jin; Bae, Sang-Cheol; Sung, Yoon-Kyoung

2018-02-01

To estimate the incidence of cardiovascular disease (CVD) in Asian patients with rheumatoid arthritis (RA) and to evaluate the impact of anti-rheumatic treatment on the development of CVD. A retrospective cohort of Asian patients with RA was established to identify the incidence rate (IR) of CVD in RA patients. The cohort was generated using the Korean National Healthcare claims database, which contained claims from Jan 2009 to Dec 2013. A total of 137,512 RA patients were identified; individuals with a history of CVD for 6 months or more before the index date were excluded. Nested case-control samples were drawn from the full study population with a case:control ratio of 1:4 (n = 7102 cases; n = 27,018 controls without CVD). A conditional multivariate regression model was used to evaluate the impact of anti-rheumatic treatment on the development of CVD in RA patients after matching for age, sex, RA index date, comorbidities, and drug use (e.g., antiplatelet agents and cholesterol-lowering agents). The IR for development of overall CVD in RA patients was 182.1 (95% CI: 178.4-185.9) per 10,000 person-years. In models adjusted for other CVD risk factors, disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.79) were protective against CVD, and biologic DMARDs were not significantly associated with CVD risk (OR = 0.85). Corticosteroids (OR = 1.26) and NSAIDs (nonselective NSAIDs: OR = 1.32, Cox-2 inhibitors: OR = 1.31) were risk factors for CVD in RA patients. The use of DMARDs is protective against CVD, while corticosteroids and NSAIDs increased the risk of CVD in RA patients. Copyright © 2018 Elsevier Inc. All rights reserved.

Early-adulthood cardiovascular disease risk factor profiles among individuals with and without diabetes in the Framingham Heart Study.

PubMed

Preis, Sarah Rosner; Pencina, Michael J; Mann, Devin M; D'Agostino, Ralph B; Savage, Peter J; Fox, Caroline S

2013-06-01

Many studies of diabetes have examined risk factors at the time of diabetes diagnosis instead of considering the lifetime burden of adverse risk factor levels. We examined the 30-year cardiovascular disease (CVD) risk factor burden that participants have up to the time of diabetes diagnosis. Among participants free of CVD, incident diabetes cases (fasting plasma glucose ≥ 126 mg/dL or treatment) occurring at examinations 2 through 8 (1979-2008) of the Framingham Heart Study Offspring cohort were age- and sex-matched 1:2 to controls. CVD risk factors (hypertension, high LDL cholesterol, low HDL cholesterol, high triglycerides, obesity) were measured at the time of diabetes diagnosis and at time points 10, 20, and 30 years prior. Conditional logistic regression was used to compare risk factor levels at each time point between diabetes cases and controls. We identified 525 participants with new-onset diabetes who were matched to 1,049 controls (mean age, 60 years; 40% women). Compared with those without diabetes, individuals who eventually developed diabetes had higher levels of hypertension (odds ratio [OR], 2.2; P = 0.003), high LDL (OR, 1.5; P = 0.04), low HDL (OR, 2.1; P = 0.0001), high triglycerides (OR, 1.7; P = 0.04), and obesity (OR, 3.3; P < 0.0001) at time points 30 years before diabetes diagnosis. After further adjustment for BMI, the ORs for hypertension (OR, 1.9; P = 0.02) and low HDL (OR, 1.7; P = 0.01) remained statistically significant. CVD risk factors are increased up to 30 years before diagnosis of diabetes. These findings highlight the importance of a life course approach to CVD risk factor identification among individuals at risk for diabetes.

Use of Abacavir and Risk of Cardiovascular Disease Among HIV-Infected Individuals.

PubMed

Marcus, Julia L; Neugebauer, Romain S; Leyden, Wendy A; Chao, Chun R; Xu, Lanfang; Quesenberry, Charles P; Klein, Daniel B; Towner, William J; Horberg, Michael A; Silverberg, Michael J

2016-04-01

Evidence is conflicting about the association of abacavir use and cardiovascular disease (CVD) among HIV-infected individuals. Previous studies may have been biased by the preferential initiation or continuation of abacavir in patients with renal dysfunction. We conducted a cohort study in Kaiser Permanente California during 1998-2011, following HIV-infected adults initiating antiretroviral therapy until the earliest of CVD (ie, coronary heart disease or ischemic stroke), health plan disenrollment, death, or end of study. We used inverse-probability weighting to fit marginal structural models to estimate hazard ratios (HRs) for CVD comparing regimens with and without abacavir. Propensity score models included demographics, HIV-specific factors, and CVD risk factors, including alcohol/drug use, smoking, overweight/obesity, diabetes, lipid-lowering and hypertension therapy, and renal dysfunction (ie, estimated glomerular filtration rate <60 mL·min·1.73 m). Among 8154 subjects, 178 had ≥1 CVD event, with 24/704 (3.4%) in the abacavir group and 154/7450 (2.1%) in the group initiating regimens without abacavir. Abacavir users had more renal dysfunction at antiretroviral therapy initiation (7.0% vs. 3.3%, P < 0.001). Compared with patients initiating regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in intention-to-treat analysis [HR 2.2, 95% confidence interval (CI): 1.4 to 3.5], a 2.7-fold higher risk when remaining on their initial regimens for ≥1 year (HR 2.7, 95% CI: 1.5 to 5.0), and a 2.1-fold higher risk in per-protocol analysis (HR 2.1, 95% CI: 0.9 to 5.0). Abacavir was associated with an over 2-fold increased risk of CVD, which was not explained by renal dysfunction or other CVD risk factors.

Psychological factors and mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer (JACC).

PubMed

Tanno, Kozo; Sakata, Kiyomi

2007-01-01

Psychological factors may have an influence on disease processes and therefore they were investigated in the Japan Collaborative Cohort Study. Overall there were very few consistent associations with cancer death. Persons with 'ikigai', defined as 'that which most makes one's life seem worth living', demonstrated decreased risk of mortality from all causes, ischemic heart disease (IHD) and cerebrovascular disease (CVD).There was no consistent link with being quick to judge, although those answering no to quick judgement were at increased risk of all cause, IHD and CVD mortality. psychological stress was related to a slightly elevated risk of all cause death, IHD in men and CVD in women. However, a sense of hurry was linked to a slightly reduced risk for mortality from all causes and CVD. Persons who were likely to be angry had an increased risk for mortality from all causes. In women not likely to be angry there were also positive links to death from cancers like breast. Joyfulness was associated with decreased mortality, especially from CVD. A feeling of being trusted was also protective, again particularly for CVD.

Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009.

PubMed

Chin, Sang Ouk; Rhee, Sang Youl; Chon, Suk; Hwang, You-Cheol; Jeong, In-Kyung; Oh, Seungjoon; Ahn, Kyu Jeung; Chung, Ho Yeon; Woo, Jeong-taek; Kim, Sung-Woon; Kim, Jin-Woo; Kim, Young Seol; Ahn, Hong-Yup

2013-01-01

The association between sarcopenia and cardiovascular disease (CVD) in elderly people has not been adequately assessed. The aim of this study was to investigate whether CVD is more prevalent in subjects with sarcopenia independent of other well-established cardiovascular risk factors in older Korean adults. This study utilized the representative Korean population data from the Korea National Health and Nutrition Examination Survey (KNHANES) which was conducted in 2009. Subjects older than 65 years of age with appendicular skeletal muscle mass (ASM) determined by dual energy X-ray absorptiometry were selected. The prevalence of sarcopenia in the older Korean adults was investigated, and it was determined whether sarcopenia is associated with CVD independent of other well-known risk factors. 1,578 subjects aged 65 years and older with the data for ASM were selected, and the overall prevalence of sarcopenia was 30.3% in men and 29.3% in women. Most of the risk factors for CVD such as age, waist circumference, body mass index, fasting plasma glucose and total cholesterol showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with CVD independent of other well-documented risk factors, renal function and medications (OR, 1.768; 95% CI, 1.075-2.909, P = 0.025). Sarcopenia was associated with the presence of CVD independent of other cardiovascular risk factors after adjusting renal function and medications.

Cardiovascular disease in women living with HIV: A narrative review.

PubMed

Solomon, Danielle; Sabin, Caroline A; Mallon, Patrick W G; Winston, Alan; Tariq, Shema

2018-02-01

Advances in the treatment of HIV have led to increasing numbers of people living with HIV reaching older age. Age-related comorbid conditions, such as cardiovascular disease (CVD), are therefore of increasing importance in HIV clinical practice. Over half the global population of people living with HIV are female. We present a narrative literature review of 39 studies exploring CVD in women living with HIV (WLHIV), with particular reference to coronary heart disease, and focusing on: (1) epidemiology, (2) pathophysiology, (3) risk factors (including traditional risk factors and HIV-related risk factors), and (4) management. Although we found significant gaps in the literature on CVD in WLHIV, data suggest that: HIV increases the risk of CVD in women even more than it does in men; certain cardiometabolic risk factors (such as obesity and metabolic syndrome) are more prevalent in WLHIV than their male counterparts; and risk factors such as hyperlipidaemia and hypertension are not optimally managed in this population. Clinicians working with WLHIV therefore need to be aware that this is a patient group at elevated cardiovascular risk, and should be familiar with relevant guidelines. Copyright © 2017 Elsevier B.V. All rights reserved.

A cross-sectional analysis of cardiovascular disease in the hemophilia population

PubMed Central

Sood, Suman L.; Cheng, Dunlei; Ragni, Margaret; Kessler, Craig M.; Quon, Doris; Shapiro, Amy D.; Key, Nigel S.; Manco-Johnson, Marilyn J.; Cuker, Adam; Kempton, Christine; Wang, Tzu-Fei; Eyster, M. Elaine; Kuriakose, Philip; von Drygalski, Annette; Gill, Joan Cox; Wheeler, Allison; Kouides, Peter; Escobar, Miguel A.; Leissinger, Cindy; Galdzicka, Sarah; Corson, Marshall; Watson, Crystal

2018-01-01

Men with hemophilia were initially thought to be protected from cardiovascular disease (CVD), but it is now clear that atherothrombotic events occur. The primary objective of the CVD in Hemophilia study was to determine the prevalence of CVD and CVD risk factors in US older men with moderate and severe hemophilia and to compare findings with those reported in age-comparable men in the Atherosclerosis Risk in Communities (ARIC) cohort. We hypothesized if lower factor levels are protective from CVD, we would see a difference in CVD rates between more severely affected and unaffected men. Beginning in October 2012, 200 patients with moderate or severe hemophilia A or B (factor VIII or IX level ≤ 5%), aged 54 to 73 years, were enrolled at 19 US hemophilia treatment centers. Data were collected from patient interview and medical records. A fasting blood sample and electrocardiogram (ECG) were obtained and assayed and read centrally. CVD was defined as any angina, any myocardial infarction by ECG or physician diagnosis, any self-reported nonhemorrhagic stroke or transient ischemic attack verified by physicians, or any history of coronary bypass graft surgery or coronary artery angioplasty. CVD risk factors were common in the population. Compared with men of similar age in the ARIC cohort, patients with hemophilia had significantly less CVD (15% vs 25.8%; P < .001). However, on an individual patient level, CVD events occur and efforts to prevent cardiovascular events are warranted. Few men were receiving secondary prophylaxis with low-dose aspirin, despite published opinion that it can be used safely in this patient population. PMID:29895623

[Increased risk of type II diabetes mellitus and cardiovascular disease after gestational diabetes mellitus: a systematic review].

PubMed

Hopmans, Tara-Eileen J P; van Houten, Chantal B; Kasius, Annemieke; Kouznetsova, Ouliana I; Nguyen, Ly A; Rooijmans, Sanne V; Voormolen, Daphne N; van Vliet, Elvira O G; Franx, Arie; Koster, M P H Wendy

2015-01-01

To determine the long-term risk of developing type II diabetes (T2D) and cardiovascular disease (CVD) for women with a history of gestational diabetes mellitus. Systematic review and meta-analysis. Two search strategies were used in PubMed and Embase to determine the long-term risks of developing T2D and CVD after a pregnancy complicated by gestational diabetes mellitus. After critical appraisal of the papers found, 11 papers were included, involving a total of 328,423 patients. Absolute and relative risks (RRs) were calculated. Eight studies (n=276,829) reported on the long-term risk of T2D and 4 (n=141,048) on the long-term risk of CVD. Follow-up ranged from 3.5 to 11.5 years for T2D and from 1.2 to 74.0 years for CVD. Women with gestational diabetes had a risk of T2D varying between 9.5% and 37.0% and a risk of CVD of between 0.28% and 15.5%. Women with gestational diabetes were at increased risk of T2D (weighted RR: 13.2; 95% CI: 8.5-20.7) and CVD (weighted RR: 2.0; 95% CI: 1.1-3.7) compared to women without gestational diabetes. Women with prior gestational diabetes mellitus have a significantly increased risk of developing T2D and CVD. It is very important that gestational diabetes is recognised as a cardiovascular risk factor in daily practice. It would be desirable to screen this group of women for the presence of hyperglycaemia and other cardiovascular risk factors. Further research is required to be able to specify the long-term risk of T2D and CVD and to demonstrate whether such screening is cost-effective.

Cardiovascular Disease Risk Factor Profiles of 263,356 Older Australians According to Region of Birth and Acculturation, with a Focus on Migrants Born in Asia

PubMed Central

Guo, Shuyu; Lucas, Robyn M.; Joshy, Grace; Banks, Emily

2015-01-01

Risk factors for cardiovascular disease (CVD), such as obesity, diabetes, hypertension and physical inactivity, are common in Australia, but the prevalence varies according to cultural background. We examined the relationship between region of birth, measures of acculturation, and CVD risk profiles in immigrant, compared to Australian-born, older Australians. Cross-sectional data from 263,356 participants aged 45 and over joining the population-based 45 and Up Study cohort from 2006–2008 were used. Prevalence ratios for CVD risk factors in Australian- versus overseas-born participants were calculated using modified Poisson regression, adjusting for age, sex and socioeconomic factors and focusing on Asian migrants. The association between time resident in Australia and age at migration and CVD risk factors in Asian migrants was also examined. Migrants from Northeast (n = 3,213) and Southeast Asia (n = 3,942) had lower levels of overweight/obesity, physical activity and female smoking than Australian-born participants (n = 199,356), although differences in prevalence of overweight/obesity were sensitive to body-mass-index cut-offs used. Compared to Australian-born participants, migrants from Northeast Asia were 20–30% less likely, and from Southeast Asia 10–20% more likely, to report being treated for hypertension and/or hypercholesterolaemia; Southeast Asian migrants were 40–60% more likely to report diabetes. Northeast Asian-born individuals were less likely than Australian-born to have 3 or more CVD risk factors. Diabetes, treated hypertension and hypercholesterolaemia occurred at relatively low average body-mass-index in Southeast Asian migrants. The CVD risk factor profiles of migrants tended to approximate those of Australian-born with increasing acculturation, in both favourable (e.g., increased physical activity) and unfavourable directions (e.g., increased female smoking). Minimizing CVD risk in migrant populations may be achieved through efforts to retain the healthy facets of the traditional lifestyle, such as a normal body mass index and low prevalence of smoking in women, in addition to adopting healthy aspects of the host country lifestyle, such as increased physical activity. PMID:25695771

Contribution of fibroblast growth factor 23 to Framingham risk score for identifying subclinical atherosclerosis in Chinese men.

PubMed

Hu, X; Ma, X; Luo, Y; Xu, Y; Xiong, Q; Pan, X; Bao, Y; Jia, W

2017-02-01

Fibroblast growth factor 23 (FGF23) was demonstrated to be involved in the occurrence and development of cardiovascular disease (CVD). The goal of the present study was to investigate the relationship between serum FGF23 levels and carotid intima-media thickness (C-IMT) in men with a low-to-moderate CVD risk. Subjects with normal kidney function were selected from the Shanghai Obesity Study. Serum FGF23 levels were determined by sandwich enzyme-linked immunosorbent assay. C-IMT was measured by ultrasonography. The Framingham risk score (FRS) was used to assess CVD risk. A total of 392 men with low CVD risk and 372 men with moderate CVD risk were enrolled. The recognition rate of an elevated C-IMT was 85.66% with the combination of a moderate CVD risk and high serum FGF23 levels, which was greater than that with either parameter alone (65.44% and 61.03%, respectively). Subjects with high serum FGF23 levels, and either low or moderate CVD risk, were more likely to have elevated C-IMT than those with low serum FGF23 levels and low CVD risk (P = 0.014 and 0.001, respectively). The serum FGF23 levels were independently and positively associated with C-IMT in subjects with low or moderate CVD risk (both P = 0.007). In men with low-to-moderate CVD risk, serum FGF23 levels were associated independently and positively with C-IMT. As a complementary index, serum FGF23 levels strengthen the capacity of the FRS to identify subclinical atherosclerosis. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Impact of Renal Impairment on Cardiovascular Disease Mortality After Liver Transplantation for Nonalcoholic Steatohepatitis Cirrhosis

PubMed Central

VanWagner, Lisa B.; Lapin, Brittany; Skaro, Anton I.; Lloyd-Jones, Donald M.; Rinella, Mary E.

2016-01-01

BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant. METHODS Using the Organ Procurement and Transplantation Network database we examined associations between NASH and post liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction, or stroke. A physician panel reviewed cause of death. RESULTS Of 48,360 liver transplants (2/2002–12/2011), 5,057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic, and have history of renal failure or prior CVD versus non-NASH (p<0.001 for all). Although there was no difference in overall all-cause mortality (log-rank p=0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio=1.30, 95% Confidence interval (CI): 1.02–1.66; Hazard ratio=1.42, 95% CI: 1.07–1.41, respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥ 55, male sex, diabetes and renal impairment was developed for prediction of post liver transplant CVD mortality (c-statistic 0.60). CONCLUSION NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of co-morbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality. PMID:25977117

Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study

PubMed Central

Tsao, Connie W; Gona, Philimon N; Salton, Carol J; Chuang, Michael L; Levy, Daniel; Manning, Warren J; O’Donnell, Christopher J

2015-01-01

Background Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized. Methods and Results Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002–2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m2 increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness). Conclusions Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation. PMID:26374295

Late-Onset Asthma Predicts Cardiovascular Disease Events: The Wisconsin Sleep Cohort.

PubMed

Tattersall, Matthew C; Barnet, Jodi H; Korcarz, Claudia E; Hagen, Erika W; Peppard, Paul E; Stein, James H

2016-08-24

Asthma is a heterogeneous syndrome with different clinical subtypes that is associated with an increased risk for cardiovascular disease (CVD). We hypothesized that the late-onset subtype of asthma is associated with a higher risk of incident CVD. Participants from the Wisconsin Sleep Cohort free of CVD at baseline were followed for a mean (SD) of 13.9 (5.9) years for development of CVD (myocardial infarction, angina, stroke, coronary revascularization, heart failure, or CVD death). Late-onset asthma was defined as physician-diagnosed asthma at age ≥18 years. Multivariable Cox regression models adjusted for age, sex, and CVD risk factors were used to assess associations of late-onset asthma and incident CVD. The 1269 participants were 47.3 (8.0) years old; 166 participants had asthma (111 late-onset, 55 early-onset). Participants with late-onset asthma compared to nonasthmatics were more likely to be female (67% versus 44%) and to have a higher body-mass index (32.2 versus 29.4 kg/m(2)) (P<0.05). Mean age of asthma diagnosis in the late-onset group was 39.5 (9.6) years versus 8.9 (5.7) years in the early-onset group (P<0.0001). Late-onset asthmatics had a higher adjusted risk of incident CVD than nonasthmatics (hazard ratio 1.57, 95% CI 1.01-2.45, P=0.045). There was no interaction between body-mass index and age of asthma diagnosis on incident CVD (P=0.83). In a large cohort study of adults followed prospectively for over a decade, late-onset asthmatics had an increased risk of incident CVD events that persisted after adjustment for age, sex, and CVD risk factors. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Relationships of Anxiety and Depression with Cardiovascular Health in Youth with Normal Weight to Severe Obesity.

PubMed

Gross, Amy C; Kaizer, Alexander M; Ryder, Justin R; Fox, Claudia K; Rudser, Kyle D; Dengel, Donald R; Kelly, Aaron S

2018-05-10

To evaluate the relationships of depression and anxiety symptoms with cardiovascular disease (CVD) risk factors and measures of vascular health in youth. Major depressive disorder and bipolar disorder are considered CVD risk factors in youth. Participants (n = 202) were 8- to 18-year-olds from a cross-sectional study evaluating cardiovascular health across a wide range of body mass index values (normal weight to severe obesity). CVD risk measurement included blood pressure, fasting lipids, glucose, insulin, carotid artery intima-media thickness, compliance and distensibility, brachial artery flow-mediated dilation, carotid-radial artery pulse wave velocity, body fat percentage, and a metabolic syndrome cluster score. Anxiety and depression symptoms were self-reported on the Screen for Child Anxiety Related Disorders and Center for Epidemiological Studies Depression Scale for Children. Two sets of adjustment variables were used in evaluation of differences between those with and without anxiety or depression symptomatology for the CVD risk factor and vascular outcomes. The first set included adjustment for Tanner stage, sex, and race; the second was additionally adjusted for percent body fat. Anxiety was not significantly associated with CVD risk factors or vascular health in either model. Depression was associated with high-density lipoprotein cholesterol, triglycerides, and metabolic syndrome cluster score; these relationships were attenuated when accounting for percent body fat. When accounting for body fat, we found no clear relationship of self-reported depression or anxiety symptoms with CVD risk factors or vascular health in youth. Copyright © 2018 Elsevier Inc. All rights reserved.

Overview of Coronary Heart Disease Risk Initiatives in South Asia.

PubMed

Kalra, Ankur; Bhatt, Deepak L; Rajagopalan, Sanjay; Suri, Kunal; Mishra, Sundeep; Iqbal, Romaina; Virani, Salim S

2017-06-01

Cardiovascular disease (CVD) is now the leading cause of morbidity and mortality worldwide. Industrialization and economic growth have led to an unprecedented increment in the burden of CVD and their risk factors in less industrialized regions of the world. While there are abundant data on CVD and their risk factors from longitudinal cohort studies done in the West, good-quality data from South Asia are lacking. Several multi-institutional, observational, prospective registries, and epidemiologic cohorts in South Asia have been established to systematically evaluate the burden of CVD and their risk factors. The PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP), the Kerala Acute Coronary Syndrome (ACS), and Trivandrum Heart Failure registries have focused on secondary prevention of CVD and performance measurement in both outpatient and inpatient settings, respectively. The Prospective Urban and Rural Epidemiology (PURE), Centre for Cardiometabolic Risk Reduction in South Asia (CARRS), and other epidemiologic and genetic studies have focused on primary prevention of CVD and evaluated variables such as environment, smoking, physical activity, health systems, food and nutrition policy, dietary consumption patterns, socioeconomic factors, and healthy neighborhoods. The international cardiovascular community has been responsive to a burgeoning cardiovascular disease burden in South Asia. Several collaborations have formed between the West (North America in particular) and South Asia to catalyze evidence-based and data-driven changes in the federal health policy in this part of the world to promote cardiovascular health and mitigate cardiovascular risk.

Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms.

PubMed

Arts, E E A; Popa, C D; Den Broeder, A A; Donders, R; Sandoo, A; Toms, T; Rollefstad, S; Ikdahl, E; Semb, A G; Kitas, G D; Van Riel, P L C M; Fransen, J

2016-04-01

Predictive performance of cardiovascular disease (CVD) risk calculators appears suboptimal in rheumatoid arthritis (RA). A disease-specific CVD risk algorithm may improve CVD risk prediction in RA. The objectives of this study are to adapt the Systematic COronary Risk Evaluation (SCORE) algorithm with determinants of CVD risk in RA and to assess the accuracy of CVD risk prediction calculated with the adapted SCORE algorithm. Data from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events. The SCORE algorithm was recalibrated by reweighing included traditional CVD risk factors and adapted by adding other potential predictors of CVD. Predictive performance of the recalibrated and adapted SCORE algorithms was assessed and the adapted SCORE was externally validated. Of the 1016 included patients with RA, 103 patients experienced a CVD event. Discriminatory ability was comparable across the original, recalibrated and adapted SCORE algorithms. The Hosmer-Lemeshow test results indicated that all three algorithms provided poor model fit (p<0.05) for the Nijmegen and external validation cohort. The adapted SCORE algorithm mainly improves CVD risk estimation in non-event cases and does not show a clear advantage in reclassifying patients with RA who develop CVD (event cases) into more appropriate risk groups. This study demonstrates for the first time that adaptations of the SCORE algorithm do not provide sufficient improvement in risk prediction of future CVD in RA to serve as an appropriate alternative to the original SCORE. Risk assessment using the original SCORE algorithm may underestimate CVD risk in patients with RA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Improvements in Cardiovascular Risk Factors in Young Adults in a Randomized Trial of Approaches to Weight Gain Prevention

PubMed Central

Wing, Rena R.; Tate, Deborah F.; Garcia, Katelyn R.; Bahnson, Judy; Lewis, Cora E.; Espeland, Mark A.

2017-01-01

Objective Weight gain occurs commonly in young adults and increases cardiovascular (CVD) risk. We previously reported that two self-regulation interventions reduced weight gain relative to control. Here we examine whether these interventions also benefit CVD risk factors. Methods SNAP (Study of Novel Approaches to Weight Gain Prevention) was a randomized trial in 2 academic settings (N=599; 18–35 years; body mass index 21–30 kg/m2) comparing two interventions (Self-Regulation with Small Changes; Self-Regulation with Large Changes) and Control. Small Changes taught participants to make daily small changes (approximately 100 calorie) in intake and activity. Large Changes taught participants to initially lose 5–10 pounds to buffer anticipated weight gains. CVD risk factors were assessed at baseline and 2 years in 471 participants. Results Although Large Changes was associated with more beneficial changes in glucose, insulin, and HOMA-IR than Control, these differences were not significant after adjusting for multiple comparisons or 2-year weight change. Comparison of participants grouped by percent weight change baseline to 2 years showed significant differences for several CVD risk factors, with no interaction with treatment condition. Conclusions Magnitude of weight change, rather than specific weight gain prevention interventions, was related to changes in CVD risk factors in young adults. PMID:28782918

Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up.

PubMed

Siren, Reijo; Eriksson, Johan G; Vanhanen, Hannu

2016-12-01

To examine the long-term impact of health counselling among middle-aged men at high risk of CVD. An observational study with a 5-year follow-up. All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011. Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits. Lifestyle and CVD risk score change. All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI -1.6 to -0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI -1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI -0.5 to 0.4]). These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers. KEY POINTS Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals. Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging. Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction. Attaining a sustainable reduction in CVD risk requires a willingness to engage in risk-related communication from both health care providers and the individual at high risk.

Cardiovascular Disease in Rheumatoid Arthritis: A Systematic Literature Review in Latin America

PubMed Central

Sarmiento-Monroy, Juan Camilo; Amaya-Amaya, Jenny; Espinosa-Serna, Juan Sebastián; Herrera-Díaz, Catalina; Anaya, Juan-Manuel; Rojas-Villarraga, Adriana

2012-01-01

Background. Cardiovascular disease (CVD) is the major predictor of poor prognosis in rheumatoid arthritis (RA) patients. There is an increasing interest to identify “nontraditional” risk factors for this condition. Latin Americans (LA) are considered as a minority subpopulation and ethnically different due to admixture characteristics. To date, there are no systematic reviews of the literature published in LA and the Caribbean about CVD in RA patients. Methods. The systematic literature review was done by two blinded reviewers who independently assessed studies for eligibility. The search was completed through PubMed, LILACS, SciELO, and Virtual Health Library scientific databases. Results. The search retrieved 10,083 potential studies. A total of 16 articles concerning cardiovascular risk factors and measurement of any cardiovascular outcome in LA were included. The prevalence of CVD in LA patients with RA was 35.3%. Non-traditional risk factors associated to CVD in this population were HLA-DRB1 shared epitope alleles, rheumatoid factor, markers of chronic inflammation, long duration of RA, steroids, familial autoimmunity, and thrombogenic factors. Conclusions. There is limited data about CVD and RA in LA. We propose to evaluate cardiovascular risk factors comprehensively in the Latin RA patient and to generate specific public health policies in order to diminish morbi-mortality rates. PMID:23193471

N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and mortality risk in early inflammatory polyarthritis: results from the Norfolk Arthritis Registry (NOAR)

PubMed Central

Mirjafari, Hoda; Welsh, Paul; Verstappen, Suzanne M M; Wilson, Paddy; Marshall, Tarnya; Edlin, Helena; Bunn, Diane; Chipping, Jacqueline; Lunt, Mark; Symmons, Deborah P M; Sattar, Naveed; Bruce, Ian N

2014-01-01

Background We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), a marker of cardiac dysfunction, in an inception cohort with early inflammatory polyarthritis (IP) and assessed its association with disease phenotype, cardiovascular disease (CVD), all-cause and CVD related mortality. Methods Subjects with early IP were recruited to the Norfolk Arthritis Register from January 2000 to December 2008 and followed up to death or until March 2010 including any data from the national death register. The associations of baseline NT-pro-BNP with IP related factors and CVD were assessed by linear regression. Cox proportional hazards models examined the independent association of baseline NT-pro-BNP with all-cause and CVD mortality. Results We studied 960 early IP subjects; 163 (17%) had prior CVD. 373 (39%) patients had a baseline NT-pro-BNP levels ≥100 pg/ml. NT-pro-BNP was associated with age, female gender, HAQ score, CRP, current smoking, history of hypertension, prior CVD and the presence of carotid plaque. 92 (10%) IP subjects died including 31 (3%) from CVD. In an age and gender adjusted analysis, having a raised NT-pro-BNP level (≥100 pg/ml) was associated with both all-cause and CVD mortality (adjusted HR (95% CI) 2.36 (1.42 to 3.94) and 3.40 (1.28 to 9.03), respectively). These findings were robust to adjustment for conventional CVD risk factors and prevalent CVD. Conclusions In early IP patients, elevated NT-pro-BNP is related to HAQ and CRP and predicts all-cause and CVD mortality independently of conventional CVD risk factors. Further study is required to identify whether NT-pro-BNP may be clinically useful in targeting intensive interventions to IP patients at greatest risk of CVD. PMID:23511225

Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA).

PubMed

Rodríguez-Artalejo, Fernando; Guallar, Eliseo; Borghi, Claudio; Dallongeville, Jean; De Backer, Guy; Halcox, Julian P; Hernández-Vecino, Ramón; Jiménez, Francisco Javier; Massó-González, Elvira L; Perk, Joep; Steg, Philippe Gabriel; Banegas, José R

2010-06-30

The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. (ClinicalTrials.gov number, NCT00882336).

Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease

PubMed Central

Corrales-Medina, Vicente F.; Alvarez, Karina N.; Weissfeld, Lisa A.; Angus, Derek C.; Chirinos, Julio A.; Chang, Chung-Chou H.; Newman, Anne; Loehr, Laura; Folsom, Aaron R.; Elkind, Mitchell S.; Lyles, Mary F.; Kronmal, Richard A.; Yende, Sachin

2015-01-01

IMPORTANCE The risk of cardiovascular disease (CVD) after infection is poorly understood. OBJECTIVE To determine whether hospitalization for pneumonia is associated with an increased short-term and long-term risk of CVD. DESIGN, SETTINGS, AND PARTICIPANTS We examined 2 community-based cohorts: the Cardiovascular Health Study (CHS, n = 5888; enrollment age, ≥65 years; enrollment period, 1989–1994) and the Atherosclerosis Risk in Communities study (ARIC, n = 15 792; enrollment age, 45-64 years; enrollment period, 1987–1989). Participants were followed up through December 31, 2010. We matched each participant hospitalized with pneumonia to 2 controls. Pneumonia cases and controls were followed for occurrence of CVD over 10 years after matching. We estimated hazard ratios (HRs) for CVD at different time intervals, adjusting for demographics, CVD risk factors, subclinical CVD, comorbidities, and functional status. EXPOSURES Hospitalization for pneumonia. MAIN OUTCOMES AND MEASURES Incident CVD (myocardial infarction, stroke, and fatal coronary heart disease). RESULTS Of 591 pneumonia cases in CHS, 206 had CVD events over 10 years after pneumonia hospitalization. Compared with controls, CVD risk among pneumonia cases was highest during the first year after hospitalization and remained significantly higher than among controls through 10 years. In ARIC, of 680 pneumonia cases, 112 had CVD events over 10 years after hospitalization. After the second year, CVD risk among pneumonia cases was not significantly higher than among controls. Pneumonia Cases Controls HR (95% CI) CHS No. of participants 591 1182 CVD events  0-30 d 54 6 4.07 (2.86-5.27)  31-90 d 11 9 2.94 (2.18-3.70)  91 d-1 y 22 55 2.10 (1.59-2.60)  9-10 y 4 12 1.86 (1.18-2.55) ARIC No. of participants 680 1360 CVD events  0-30 d 4 3 2.38 (1.12-3.63)  31-90 d 4 0 2.40 (1.23-3.47)  91 d-1 y 11 8 2.19 (1.20-3.19)  1-2 y 8 7 1.88 (1.10-2.66) CONCLUSIONS AND RELEVANCE Hospitalization for pneumonia was associated with increased short-term and long-term risk of CVD, suggesting that pneumonia may be a risk factor for CVD. PMID:25602997

Taste phenotype associates with cardiovascular disease risk factors via diet quality in multivariate modeling.

PubMed

Sharafi, Mastaneh; Rawal, Shristi; Fernandez, Maria Luz; Huedo-Medina, Tania B; Duffy, Valerie B

2018-05-08

Sensations from foods and beverages drive dietary choices, which in turn, affect risk of diet-related diseases. Perception of these sensation varies with environmental and genetic influences. This observational study aimed to examine associations between chemosensory phenotype, diet and cardiovascular disease (CVD) risk. Reportedly healthy women (n = 110, average age 45 ± 9 years) participated in laboratory-based measures of chemosensory phenotype (taste and smell function, propylthiouracil (PROP) bitterness) and CVD risk factors (waist circumference, blood pressure, serum lipids). Diet variables included preference and intake of sweet/high-fat foods, dietary restraint, and diet quality based on reported preference (Healthy Eating Preference Index-HEPI) and intake (Healthy Eating Index-HEI). We found that females who reported high preference yet low consumption of sweet/high-fat foods had the highest dietary restraint and depressed quinine taste function. PROP nontasters were more likely to report lower diet quality; PROP supertasters more likely to consume but not like a healthy diet. Multivariate structural models were fitted to identify predictors of CVD risk factors. Reliable latent taste (quinine taste function, PROP tasting) and smell (odor intensity) variables were identified, with taste explaining more variance in the CVD risk factors. Lower bitter taste perception was associated with elevated risk. In multivariate models, the HEPI completely mediated the taste-adiposity and taste-HDL associations and partially mediated the taste-triglyceride or taste-systolic blood pressure associations. The taste-LDL pathway was significant and direct. The HEI could not replace HEPI in adequate models. However, using a latent diet quality variable with HEPI and HEI, increased the strength of association between diet quality and adiposity or CVD risk factors. In conclusion, bitter taste phenotype was associated with CVD risk factors via diet quality, particularly when assessed by level of food liking/disliking. Copyright © 2018 Elsevier Inc. All rights reserved.

Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up

PubMed Central

2012-01-01

Background The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. Methods The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent’s father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). Results A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: −73 to −20) and behavioural factors for women (55%; 95% CI: -191 to −28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. Conclusions Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood. PMID:23217053

Does inclusion of education and marital status improve SCORE performance in central and eastern europe and former soviet union? findings from MONICA and HAPIEE cohorts.

PubMed

Vikhireva, Olga; Broda, Grazyna; Kubinova, Ruzena; Malyutina, Sofia; Pająk, Andrzej; Tamosiunas, Abdonas; Skodova, Zdena; Simonova, Galina; Bobak, Martin; Pikhart, Hynek

2014-01-01

The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts. The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data). In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women). Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.

The Afro-Cardiac Study: Cardiovascular Disease Risk and Acculturation in West African Immigrants in the United States: Rationale and Study Design.

PubMed

Commodore-Mensah, Yvonne; Sampah, Maame; Berko, Charles; Cudjoe, Joycelyn; Abu-Bonsrah, Nancy; Obisesan, Olawunmi; Agyemang, Charles; Adeyemo, Adebowale; Himmelfarb, Cheryl Dennison

2016-12-01

Cardiovascular disease (CVD) remains the leading cause of death in the United States (US). African-descent populations bear a disproportionate burden of CVD risk factors. With the increase in the number of West African immigrants (WAIs) to the US over the past decades, it is imperative to specifically study this new and substantial subset of the African-descent population and how acculturation impacts their CVD risk. The Afro-Cardiac study, a community-based cross-sectional study of adult WAIs in the Baltimore-Washington metropolis. Guided by the PRECEDE-PROCEED model, we used a modification of the World Health Organization Steps survey to collect data on demographics, socioeconomic status, migration-related factors and behaviors. We obtained physical, biochemical, acculturation measurements as well as a socio-demographic and health history. Our study provides critical data on the CVD risk of WAIs. The framework used is valuable for future epidemiological studies addressing CVD risk and acculturation among immigrants.

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

PubMed Central

Van Zant, R Scott; Cape, Kelly Jo; Roach, Katrina; Sweeney, Janie

2013-01-01

Purpose The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention. Methods A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed. Results Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health. Conclusions Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors. PMID:23801901

Tree nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S adults: NHANES 2005-2010

USDA-ARS?s Scientific Manuscript database

Previous research has shown inconsistencies in the association of tree nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). To determine the association of tree nut consumption with risk factors for CVD and for MetS in adults. NHANES 2005-2010 data were u...

Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD trial

USDA-ARS?s Scientific Manuscript database

Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors d...

Perceived Discrimination and Incident Cardiovascular Events

PubMed Central

Everson-Rose, Susan A.; Lutsey, Pamela L.; Roetker, Nicholas S.; Lewis, Tené T.; Kershaw, Kiarri N.; Alonso, Alvaro; Diez Roux, Ana V.

2015-01-01

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45–84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000–2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1–standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults. PMID:26085044

Association of History of Gestational Diabetes With Long-term Cardiovascular Disease Risk in a Large Prospective Cohort of US Women.

PubMed

Tobias, Deirdre K; Stuart, Jennifer J; Li, Shanshan; Chavarro, Jorge; Rimm, Eric B; Rich-Edwards, Janet; Hu, Frank B; Manson, JoAnn E; Zhang, Cuilin

2017-12-01

Previous studies identify gestational diabetes (GD) as a risk factor for intermediate markers of cardiovascular disease (CVD) risk; however, few are prospective, evaluate hard CVD end points, or account for shared risk factors including body weight and lifestyle. To prospectively evaluate history of GD in relation to incident CVD risk. The Nurses' Health Study II (NHS II) is an observational cohort study of US female nurses established in 1989, with ongoing follow-up. Biennial questionnaires updated behavioral characteristics, health outcomes, and lifestyle factors. Multivariable Cox models estimated the hazard ratio (HR) and 95% CI for CVD risk. We included 89 479 women who reported at least 1 pregnancy and were free of CVD and cancer at baseline. Follow-up through May 31, 2015, was complete for more than 90% of eligible participants. History of GD was self-reported at baseline (1989) via questionnaire and updated every 2 years. We observed 1161 incident self-reported nonfatal or fatal myocardial infarction or stroke, confirmed via medical records. Participants had a mean (SD) age of 34.9 (4.7) years. Adjusting for age, prepregnancy body mass index, and other covariates, GD vs no GD was associated with subsequent CVD (HR, 1.43; 95% CI, 1.12-1.81). Additional adjustment for weight gain since pregnancy and updated lifestyle factors attenuated the association (HR, 1.29; 95% CI, 1.01-1.65). Classifying GD by progression to T2D in relation to CVD risk indicated a positive association for GD with progression to T2D vs no GD or T2D (HR, 4.02; 95% CI, 1.94-8.31), and an attenuated relationship for GD only (HR, 1.30; 95% CI, 0.99-1.71). Gestational diabetes was positively associated with CVD later in life, although the absolute rate of CVD in this younger cohort of predominantly white women was low. This relationship is possibly mediated in part by subsequent weight gain and lack of healthy lifestyle.

Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.

PubMed

Patel, Mihir; Phillips-Caesar, Erica; Boutin-Foster, Carla

2014-10-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance.

Attitudes and Beliefs Regarding Cardiovascular Risk Factors Among Bangladeshi Immigrants in the US

PubMed Central

Phillips-Caesar, Erica; Boutin-Foster, Carla

2015-01-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance. PMID:23861069

Differentials in Cardiovascular Risk Factors and Diabetes by Socioeconomic Status and Sex in Kalutara, Sri Lanka.

PubMed

Gamlath, Lakshman; Nandasena, Sumal; Hennadige Padmal de Silva, Sudirikku; Linhart, Christine; Ngo, Anh; Morrell, Stephen; Nathan, Sally; Sharpe, Albie; Taylor, Richard

2017-07-01

Since 1950, cardiovascular disease (CVD) has emerged as a leading cause of mortality in Sri Lanka, especially in men. In 2014, a survey in Kalutara to assess CVD and type 2 diabetes mellitus (T2DM) risk factors in adults aged 25 to 64 years (n = 1011), and associations with sex and socioeconomic status (SES), found similar CVD risk factors in both sexes, except for daily tobacco smoking at 19% in men and nil in women, and higher body mass index (BMI) in women than men. With increasing SES in men, there were significant linear increases in mean BMI, waist circumference, mean systolic and diastolic blood pressure, mean fasting plasma glucose, and T2DM prevalence, but decreases in tobacco smoking. Whereas in women higher SES was associated with a significant increase in mean BMI, but a significant decrease in hypertension prevalence. Tobacco smoking is the main risk factor explaining higher CVD mortality in men compared with women.

Adapting Technological Interventions to Meet the Needs of Priority Populations.

PubMed

Linke, Sarah E; Larsen, Britta A; Marquez, Becky; Mendoza-Vasconez, Andrea; Marcus, Bess H

2016-01-01

Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Do genetic variations alter the effects of exercise training on cardiovascular disease and can we identify the candidate variants now or in the future?

PubMed

Hagberg, James M

2011-09-01

Cardiovascular disease (CVD) and CVD risk factors are highly heritable, and numerous lines of evidence indicate they have a strong genetic basis. While there is nothing known about the interactive effects of genetics and exercise training on CVD itself, there is at least some literature addressing their interactive effect on CVD risk factors. There is some evidence indicating that CVD risk factor responses to exercise training are also heritable and, thus, may have a genetic basis. While roughly 100 studies have reported significant effects of genetic variants on CVD risk factor responses to exercise training, no definitive conclusions can be generated at the present time, because of the lack of consistent and replicated results and the small sample sizes evident in most studies. There is some evidence supporting "possible" candidate genes that may affect these responses to exercise training: APO E and CETP for plasma lipoprotein-lipid profiles; eNOS, ACE, EDN1, and GNB3 for blood pressure; PPARG for type 2 diabetes phenotypes; and FTO and BAR genes for obesity-related phenotypes. However, while genotyping technologies and statistical methods are advancing rapidly, the primary limitation in this field is the need to generate what in terms of exercise intervention studies would be almost incomprehensible sample sizes. Most recent diabetes, obesity, and blood pressure genetic studies have utilized populations of 10,000-250,000 subjects, which result in the necessary statistical power to detect the magnitude of effects that would probably be expected for the impact of an individual gene on CVD risk factor responses to exercise training. Thus at this time it is difficult to see how this field will advance in the future to the point where robust, consistent, and replicated data are available to address these issues. However, the results of recent large-scale genomewide association studies for baseline CVD risk factors may drive future hypothesis-driven exercise training intervention studies in smaller populations addressing the impact of specific genetic variants on well-defined physiological phenotypes.

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community.

PubMed

Chuang, Michael L; Gona, Philimon N; Qazi, Saadia; Musgrave, Rebecca M; Fox, Caroline S; Massaro, Joseph M; Hoffmann, Udo; O'Donnell, Christopher J

2018-06-16

We sought to determine whether increased aortic arch width (AAW) adds to standard Framingham risk factors and coronary artery calcium (CAC) for prediction of incident adverse cardiovascular disease (CVD) events in community-dwelling adults. A total of 3026 Framingham Heart Study Offspring and Third Generation cohort participants underwent noncontrast multidetector computed tomography from 2002 to 2005 to quantify CAC. We measured AAW as the distance between the centroids of the ascending and descending thoracic aorta, at the level of main pulmonary artery bifurcation or the right pulmonary artery. We determined sex, age group, and body size specific cut points for high (≥90th percentile) AAW from a healthy referent group (N=1471) and dichotomized AAW as high or not high across all study participants. Clinical covariates were obtained at Offspring cycle 7 (1998-2001) or Third Generation cycle 1 (2002-2005) examinations. The primary CVD outcome was a composite of myocardial infarction, coronary insufficiency, cerebrovascular accident, first hospitalization for heart failure, or CVD death. Cox proportional hazards models were used to estimate hazard ratio of high AAW on time-to-incident CVD after adjustment for Framingham risk factors and CAC. Net reclassification improvement was used to assess the effect of adding AAW to the baseline Framingham risk factor+CAC model. A total of 2826 participants (aged 51±11 years, 48% women) had complete covariates and were free of CVD at multidetector computed tomography. Over a median 8.9 years of follow-up, there were 135 incident CVD events. High AAW was independently predictive of CVD events (hazard ratio, 1.55; P =0.032) and appropriately reclassified participants at risk: net reclassification improvement, 0.31 (95% confidence interval, 0.15-0.48). AAW augments traditional CVD risk factors and CAC for prediction of incident adverse CVD events among community-dwelling adults. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

PubMed Central

Zolezzi, Monica; Abdallah, Oraib; Aden, Suad; Major, Stella; White, Diana; El-Awaisi, Alla

2017-01-01

Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half (n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar. PMID:28970420

Differences in subclinical cardiovascular disease between African American and Caucasian women with systemic lupus erythematosus.

PubMed

Rhew, Elisa Y; Manzi, Susan M; Dyer, Alan R; Kao, Amy H; Danchenko, Natalya; Barinas-Mitchell, Emma; Sutton-Tyrrell, Kim; McPherson, David D; Pearce, William; Edmundowicz, Daniel; Kondos, George T; Ramsey-Goldman, Rosalind

2009-02-01

Racial differences exist in disease rates and mortality in both cardiovascular disease (CVD) and systemic lupus erythematosus (SLE). The objective of this cross-sectional study was to compare the frequency and risk factors for subclinical CVD in African American (AA) and Caucasian women with SLE and no prior CVD events. Traditional CVD risk factors and SLE-related factors were assessed in 309 SLE women. Subclinical CVD was assessed by carotid ultrasound to measure intimamedial thickness (IMT) and plaque, and electron beam computed tomography (EBCT) was used to measure coronary artery calcium (CAC). AA women had less education and higher levels of body mass index, blood pressure, lipoprotein(a), C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR). However, AA women had lower albumin, more and longer duration of corticosteroid use, higher SLE disease activity and damage, and more dsDNA antibodies compared with Caucasian women after adjustment for age and study site. More AA women had carotid plaque (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.03-3.65) and higher carotid IMT (0.620 vs 0.605 mm, P = 0.07) but similar CAC compared with Caucasians. A multivariate analysis revealed that the following risk factor variables were significantly different between the racial groups and associated with plaque: blood pressure, current corticosteroid use, SLE disease activity, and SLE damage. All factors contributed to the result, but no individual risk factor fully accounted for the association between race and plaque. In conclusion, the presence of carotid plaque was higher in AA compared with Caucasian women with SLE, in contrast to studies of non-SLE subjects, in which AA have similar or less plaque than Caucasians. A combination of SLE-related and traditional CVD risk factors explained the racial difference in plaque burden.

Differences in Subclinical Cardiovascular Disease between African American and Caucasian Women with Systemic Lupus Erythematosus

PubMed Central

Rhew, Elisa Y.; Manzi, Susan M.; Dyer, Alan R.; Kao, Amy H.; Danchenko, Natalya; Barinas-Mitchell, Emma; Sutton-Tyrrell, Kim; McPherson, David D.; Pearce, William; Edmundowicz, Daniel; Kondos, George T.; Ramsey-Goldman, Rosalind

2009-01-01

Racial differences exist in disease rates and mortality in both cardiovascular disease (CVD) and Systemic Lupus Erythematosus (SLE). The objective of this cross-sectional study was to compare the frequency of and risk factors for subclinical CVD in African-American (AA) and Caucasian women with SLE and no prior CVD events. Traditional CVD risk factors and SLE-related factors were assessed in 309 SLE women. Subclinical CVD was assessed by carotid ultrasound to measure intima-medial thickness (IMT) and plaque, and electron beam computed tomography (EBCT) to measure coronary artery calcium (CAC). AA had less education, higher body mass index, blood pressure, lipoprotein(a), CRP, fibrinogen, and ESR, but lower albumin; more and longer duration of corticosteroid use; higher SLE disease activity and damage; and more had dsDNA antibodies compared to Caucasian women, after adjustment for age and study-site. More AA had carotid plaque (adjusted OR 1.94, 95%CI 1.03, 3.65) and higher carotid IMT (0.620 vs. 0.605mm, p=0.07) compared with Caucasians, but similar CAC. Multivariate analysis included risk factor variables significantly different between the racial groups and associated with plaque: blood pressure, current corticosteroid use, SLE disease activity and damage. All factors contributed, but no individual risk factor fully accounted for the association between race and plaque. In conclusion, the presence of carotid plaque was higher in AA compared with Caucasian women with SLE, in contrast to studies of non-SLE subjects, where AA have similar or less plaque than Caucasians. A combination of SLE-related and traditional CVD risk factors explained the racial difference in plaque burden. PMID:19138649

History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women.

PubMed

Shostrom, Derrick C V; Sun, Yangbo; Oleson, Jacob J; Snetselaar, Linda G; Bao, Wei

2017-01-01

Findings from previous studies examining the association between gestational diabetes mellitus (GDM) and subsequent risk of cardiovascular disease (CVD) have been inconsistent and inconclusive. We aimed to examine the associations of a previous history of GDM with risk of CVD and status of cardiovascular risk factors in a nationwide population-based study in the United States. This study included 8,127 parous women aged 20 years or older in the 2007-2014 cycles of the National Health and Nutrition Examination Survey in the United States. The exposure was self-reported diagnostic history of GDM and the outcomes were self-reported diagnostic history of CVD and measurements of cardiovascular risk factors, including blood pressure and blood lipids. Regression models with sample weights were used to examine the associations of GDM with CVD and cardiovascular risk factors. Among women with a history of both GDM and CVD, CVD was diagnosed on average 22.9 years after the diagnosis of GDM. After adjustment for demographic, socioeconomic, and lifestyle factors, a history of GDM was associated with 63% higher odds of CVD [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.02, 2.62, p -value = 0.04]. Further adjustment for body mass index (BMI) modestly attenuated the association (OR 1.52, 95% CI 0.95, 2.44, p -value = 0.08). A history of GDM was significantly associated with lower serum level of HDL-cholesterol (adjusted β-coefficient -3.33, 95% CI -5.17, -1.50, p -value ≤ 0.001), but not associated with total cholesterol, LDL-cholesterol, triglycerides, or systolic or diastolic blood pressure. Similarly, the association between a history of GDM and HDL cholesterol was attenuated after additional adjustment for BMI (adjusted β-coefficient -1.68, 95% CI -3.38, 0.03, p -value = 0.54). Women with a previous history of GDM have significantly higher risk for developing CVD and lower serum level of HDL cholesterol, compared to women without a history of GDM. The associations may be explained, at least partly, by BMI.

The impact of physical activity on cumulative cardiovascular disease risk factors among Malaysian adults.

PubMed

Rasiah, Rajah; Thangiah, Govindamal; Yusoff, Khalid; Manikam, Rishya; Chandrasekaran, Sankara Kumar; Mustafa, Rujhan; Bakar, Najmin Binti Abu

2015-12-16

Numerous studies have shown the importance of physical activity in reducing the morbidity and mortality rates caused by cardiovascular disease (CVD). However, most of these studies emphasise little on the cumulative effect of CVD risk factors. Hence, this study investigates the association between physical exercise and cumulative CVD risk factors among adults in three different age groups. Using a sample of 7276 respondents drawn from community centers, the REDISCOVER team gathered information on physical activity, CVD risk factors (obesity, diabetes, hypertension, hypercholesterolemia, tobacco use) and socioeconomic and demographic variables in Malaysia. Because the study required medical examination, a convenience sampling frame was preferred in which all volunteers were included in the study. Fasting blood samples and anthropometric (height, weight and more) measurements were collected by trained staffs. Socio-demographic and physical activity variables were recorded through questionnaires. A Chi-square test was performed to identify the bivariate association between the covariates (socioeconomic variables, demographic variables and physical activity) and outcome variable. The association between the main exposure, physical activity, and the outcome variable, cumulative CVD risk factors, was assessed using an ordinal logistic regression model, controlling for socioeconomic status and demographic influences in three different age groups, 35-49, 50-64 and 65 and above. The mean age of participants is 51.8 (SD = 9.4). Respondents in the age groups of 35-49 (aORmoderate = 0.12; 95 % CI: 0.02 - 0.53 ) and 65 and above (aORhigh = 0.58; 95 % CI: 0.24, 0.78) showed a statistically significant inverse relationship between physical activity and cumulative CVD risk factors. However, this relationship was not significant among respondents in the 50-64 age group suggesting the possible influence of other variables, such as stress and environment. The statistically significant results show a negative association between physical exercise and cumulative CVD risk factors. However, the lack of a significant relationship in the 50-64 age group suggests the need to include other considerations in future studies, such as stress and environment.

Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans.

PubMed

Longo-Mbenza, Benjamin; Nsenga, Jacqueline Nkondi; Mokondjimobe, Etienne; Gombet, Thierry; Assori, Itoua Ngaporo; Ibara, Jean Rosaire; Ellenga-Mbolla, Bertrand; Vangu, Dieudonné Ngoma; Fuele, Simon Mbungu

2012-01-01

Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis. To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor. Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999-2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris. At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2-7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4-8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6-16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4-28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1-18; P < 0.0001). Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.

Situational Analysis of Low-density Lipoprotein Cholesterol Control and the Use of Statin Therapy in Diabetes Patients Treated in Community Hospitals in Nanjing, China.

PubMed

Ouyang, Xiao-Jun; Zhang, Yong-Qing; Chen, Ji-Hai; Li, Ting; Lu, Tian-Tian; Bian, Rong-Wen

2018-02-05

Comprehensive management of diabetes should include management of its comorbid conditions, especially cardiovascular complications, which are the leading cause of morbidity and mortality among patients with diabetes. Dyslipidemia is a comorbid condition of diabetes and a risk factor for cardiovascular complications. Therefore, lipid level management is a key of managing patients with diabetes successfully. However, it is not clear that how well dyslipidemia is managed in patients with diabetes in local Chinese health-care communities. This study aimed to assess how well low-density lipoprotein cholesterol (LDL-C) was managed in Nanjing community hospitals, China. We reviewed clinical records of 7364 diabetic patients who were treated in eleven community hospitals in Nanjing from October 2005 to October 2014. Information regarding LDL-C level, cardiovascular risk factors, and use of lipid-lowering agents were collected. In patients without history of cardiovascular disease (CVD), 92.1% had one or more CVD risk factors, and the most common CVD risk factor was dyslipidemia. The overall average LDL-C level was 2.80 ± 0.88 mmol/L, which was 2.62 ± 0.90 mmol/L and 2.82 ± 0.87 mmol/L in patients with and without CVD history respectively. Only 38% of all patients met the target goal and 37.3% of patients who took lipid-lowering agents met target goal. Overall, 24.5% of all patients were on lipid-lowering medication, and 36.3% of patients with a CVD history and 20.9% of patients without CVD history took statins for LDL-C management. The mean statin dosage was 13.9 ± 8.9 mg. Only a small portion of patients achieved target LDL-C level, and the rate of using statins to control LDL-C was low. Managing LDL-C with statins in patients with diabetes should be promoted, especially in patients without a CVD history and with one or more CVD risk factors.

Testosterone and Cardiovascular Disease

PubMed Central

Tambo, Amos; Roshan, Mohsin H.K.; Pace, Nikolai P.

2016-01-01

Cardiovascular disease [CVD] is a leading cause of mortality accounting for a global incidence of over 31%. Atherosclerosis is the primary pathophysiology underpinning most types of CVD. Historically, modifiable and non-modifiable risk factors were suggested to precipitate CVD. Recently, epidemiological studies have identified emerging risk factors including hypotestosteronaemia, which have been associated with CVD. Previously considered in the realms of reproductive biology, testosterone is now believed to play a critical role in the cardiovascular system in health and disease. The actions of testosterone as they relate to the cardiac vasculature and its implication in cardiovascular pathology is reviewed. PMID:27014372

Life course socioeconomic conditions, adulthood risk factors and cardiovascular mortality among men and women: a 17-year follow up of the GLOBE study.

PubMed

Kamphuis, Carlijn B M; Turrell, Gavin; Giskes, Katrina; Mackenbach, Johan P; van Lenthe, Frank J

2013-10-03

Our goal was to study associations between childhood socioeconomic position (SEP), adulthood SEP, adulthood risk factors and cardiovascular disease (CVD) mortality, by investigating the critical period and pathway models. The prospective GLOBE study in the Netherlands, with baseline data from 1991, was linked with cause of death register data from Statistics Netherlands in 2007. At baseline, respondents reported information on childhood SEP (i.e. occupational level of respondent's father), adulthood SEP (educational level), and adulthood risk factors (health behaviours, material circumstances, and psychosocial factors). Analyses included 4894 men and 5572 women. Data were analysed by Cox proportional hazard ratios (HR) with CVD mortality as the outcome. Childhood SEP was associated with CVD mortality among men with the lowest childhood SEP only (HR 1.32, 95% CI 1.00-1.74), and not among women. The majority of childhood SEP inequalities in CVD mortality among men (88%) were explained by material, behavioural and psychosocial risk factors in adulthood, and adulthood SEP. This was mostly due to the association of childhood SEP with adulthood SEP, and the interrelations of adulthood SEP with risk factors, and partly via the direct association of childhood SEP with adulthood risk factors, independent of adulthood SEP. This study supports the pathway model for men, but found no evidence that socioeconomic conditions in childhood are critical for CVD mortality in later life independent of adulthood conditions. Developing effective methods to reduce material and behavioural risk factors among lower socioeconomic groups should be a top priority in cardiovascular disease prevention. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A Comparison of Biological and Physical Risk Factors for Cardiovascular Disease in Overweight/Obese Individuals With and Without Prediabetes.

PubMed

Liu, Tingting

2017-12-01

Compared with type 2 diabetes, evaluating the direct biological and physical risk factors for cardiovascular disease (CVD) in overweight/obese adults with and without prediabetes is less understood. Therefore, the aim of the study was to compare baseline biological and physical risk factors for CVD among overweight/obese adults with and without prediabetes. A secondary data analysis was performed. Three hundred forty-one overweight/obese participants were included in the analysis. Compared with non-prediabetics, prediabetics had higher fasting blood glucose, body mass index, waist-to-hip ratio, and triglycerides. Prediabetics were also more likely to be insulin resistant than non-prediabetics. Participants with prediabetes had much lower cardiorespiratory fitness than those without prediabetes. Findings from this study suggest that healthy overweight/obese adults with prediabetes were likely at higher biological and physical risk of CVD at baseline compared with those without prediabetes. Early intervention to improve CVD risk progression among persons with prediabetes is essential.

Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI)123

PubMed Central

Belin, Rashad J; Greenland, Philip; Allison, Matthew; Martin, Lisa; Shikany, James M; Larson, Joseph; Tinker, Lesley; Howard, Barbara V; Lloyd-Jones, Donald

2011-01-01

Background: The association between diet quality and risk of incident cardiovascular disease (CVD) or heart failure (HF) in postmenopausal women is uncertain. Objective: This study aimed to determine whether a conventional index [Alternate Healthy Eating Index (AHEI)] or a novel index [Women's Health Initiative (WHI) Dietary Modification Index (DMI)] of diet quality was associated with the risk of incident CVD or HF in the WHI Observational Study (WHI-OS). Design: The WHI-OS is an observational cohort study of 93,676 women aged 50–79 y of diverse ethnicity and backgrounds followed for an average of 10.0 y for CVD events. The individual components of the AHEI and DMI were determined from the baseline WHI food-frequency questionnaire. Incident CVD was a composite of nonfatal myocardial infarction, coronary heart disease death, stroke, coronary revascularization, and incident HF. The association between AHEI or DMI and incident CVD or incident HF was determined by using Cox models adjusted for traditional CVD and HF risk factors. Results: Women with a DMI in the highest quintile had hazard ratios (HRs) of 0.88 (95% CI: 0.80, 0.95) and 0.91 (95% CI: 0.78, 1.06) for incident CVD and HF, respectively. Women with an AHEI in the highest quintile had HRs of 0.77 (95% CI: 0.70, 0.84) and 0.70 (95% CI: 0.59, 0.82) for incident CVD and HF, respectively. Conclusion: Overall, adherence to current nutrient guidelines (as indexed by the DMI) are associated with lower total CVD risk, and additional dietary factors (as indexed by the AHEI) were associated with a lower risk of CVD and HF. PMID:21613562

Cardiovascular Update: Risk, Guidelines, and Recommendations.

PubMed

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Classical risk factors of cardiovascular disease among Chinese male steel workers: a prospective cohort study for 20 years.

PubMed

Ji, Jingfeng; Pan, Enchun; Li, Jianxin; Chen, Jichun; Cao, Jie; Sun, Dongling; Lu, Xiangfeng; Chen, Shufeng; Gu, Dongfeng; Duan, Xiufang; Wu, Xigui; Huang, Jianfeng

2011-06-25

Cardiovascular disease (CVD) constitutes a major public health problem in China and worldwide. We aimed to examine classical risk factors and their magnitudes for CVD in a Chinese cohort with over 20 years follow-up. A cohort of 5092 male steelworkers recruited from 1974 to 1980 in Beijing of China was followed up for an average of 20.84 years. Cox proportional-hazards regression model were used to evaluate the risk of developing a first CVD event in the study participants who were free of CVD at the baseline. The multivariable-adjusted hazard ratio (HR) associated with every 20 mmHg rise in systolic blood pressure (SBP) was 1.63 in this Chinese male population, which was higher than in Caucasians. Compared to non-smokers, men who smoked not less than one-pack-a-day had a HR of 2.43 (95% confidence interval [CI], 1.75-3.38). The HR (95% CI) for every 20 mg/dl increase in total serum cholesterol (TC) and for every point rise in body mass index (BMI) was 1.13 (1.04-1.23) and 1.06 (1.02-1.09), respectively. Our study documents that hypertension, smoking, overweight and hypercholesterolemia are major conventional risk factors of CVD in Chinese male adults. Continued strengthening programs for prevention and intervention on these risk factors are needed to reduce the incidence of CVD in China.

Sex Differences in Associations of Depressive Symptoms with Cardiovascular Risk Factors and Metabolic Syndrome among African Americans

PubMed Central

Cooper, Denise C.; Trivedi, Ranak B.; Nelson, Karin M.; Reiber, Gayle E.; Zonderman, Alan B.; Evans, Michele K.; Waldstein, Shari R.

2013-01-01

Young to middle-aged women usually have notably lower rates of cardiovascular disease (CVD) than their male counterparts, but African American women lack this advantage. Their elevated CVD may be influenced by sex differences in associations between depressed mood and CVD risk factors. This cross-sectional study examined whether relations between scores on the Center for Epidemiologic Studies-Depression (CES-D) scale and a spectrum of CVD risk factors varied by sex among African Americans (n = 1076; ages 30–64) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Sex-stratified multiple regressions and logistic regressions were conducted. Among women, CES-D scores correlated positively with systolic blood pressure and waist-to-hip ratio (P's < .05), but inversely with high-density lipoprotein cholesterol (HDL-C) (P < .01). Women had twice the odds for metabolic syndrome if CES-D scores ≥16 and had a ≥14% increase in odds of hypertension, abdominal obesity, and low HDL-C with each 5-unit increase in CES-D scores. Among men, CES-D scores correlated positively with high-sensitivity C-reactive protein (P < .05), and odds of hypertension increased by 21% with each 5-unit increase in CES-D scores. Depressive symptoms may promote premature CVD risk in African Americans, at least in part, via CVD risk factors and prevalent metabolic syndrome, particularly in African American women. PMID:24151548

Sarcopenia Is Independently Associated with Cardiovascular Disease in Older Korean Adults: The Korea National Health and Nutrition Examination Survey (KNHANES) from 2009

PubMed Central

Chin, Sang Ouk; Rhee, Sang Youl; Chon, Suk; Hwang, You-Cheol; Jeong, In-Kyung; Oh, Seungjoon; Ahn, Kyu Jeung; Chung, Ho Yeon; Woo, Jeong-taek; Kim, Sung-Woon; Kim, Jin-Woo; Kim, Young Seol; Ahn, Hong-Yup

2013-01-01

Background The association between sarcopenia and cardiovascular disease (CVD) in elderly people has not been adequately assessed. The aim of this study was to investigate whether CVD is more prevalent in subjects with sarcopenia independent of other well-established cardiovascular risk factors in older Korean adults. Method This study utilized the representative Korean population data from the Korea National Health and Nutrition Examination Survey (KNHANES) which was conducted in 2009. Subjects older than 65 years of age with appendicular skeletal muscle mass (ASM) determined by dual energy X-ray absorptiometry were selected. The prevalence of sarcopenia in the older Korean adults was investigated, and it was determined whether sarcopenia is associated with CVD independent of other well-known risk factors. Results 1,578 subjects aged 65 years and older with the data for ASM were selected, and the overall prevalence of sarcopenia was 30.3% in men and 29.3% in women. Most of the risk factors for CVD such as age, waist circumference, body mass index, fasting plasma glucose and total cholesterol showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with CVD independent of other well-documented risk factors, renal function and medications (OR, 1.768; 95% CI, 1.075–2.909, P = 0.025). Conclusions Sarcopenia was associated with the presence of CVD independent of other cardiovascular risk factors after adjusting renal function and medications. PMID:23533671

Parental education as a predictor of offspring behavioural and physiological cardiovascular disease risk factors.

PubMed

Kvaavik, Elisabeth; Glymour, Maria; Klepp, Knut-Inge; Tell, Grethe S; Batty, G David

2012-08-01

Childhood socio-economic disadvantage has been shown to be associated with an elevated rate of cardiovascular disease (CVD) events in adulthood. The objective of this study is to examine associations between mothers' and fathers' education and offspring CVD risk factors. The Oslo Youth Study (n = 498) was initiated in 1979. Children (age 11-15 years) attending six schools and their parents were included. Information on education was collected for parents and participants. Participants were followed through 2006 (age 40 years). Information about physical activity, diet, smoking, binge drinking, body mass index (BMI), s-cholesterol, s-triglycerides and blood pressure was collected in 1981, 1991 and 2006. Fathers' education was inversely associated with participants' BMI at 15 and 25 years, cholesterol at 25 and 40 years, triglycerides at 25 years and systolic blood pressure at 15 and 25 years (regression coefficients -0.18 to -0.11; P < 0.05 for all). The effects were weakened after adjusting for participants' own education. Maternal education showed no association with these risk factors. After controlling for participants' own education, associations between parental education and behavioural risk factors in adulthood were few. Any impact of parental education on offspring CVD risk factors seemed to be mediated via subject's own education. Parental education offered little predictive capacity for offspring CVD risk factors.

Frailty and cardiovascular risk in community-dwelling elderly: a population-based study.

PubMed

Ricci, Natalia Aquaroni; Pessoa, Germane Silva; Ferriolli, Eduardo; Dias, Rosangela Correa; Perracini, Monica Rodrigues

2014-01-01

Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher's exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher's exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty.

Frailty and cardiovascular risk in community-dwelling elderly: a population-based study

PubMed Central

Ricci, Natalia Aquaroni; Pessoa, Germane Silva; Ferriolli, Eduardo; Dias, Rosangela Correa; Perracini, Monica Rodrigues

2014-01-01

Background Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. Purpose To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. Methods This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. Results Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher’s exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher’s exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. Conclusion Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty. PMID:25336932

The educational gradient in cardiovascular risk factors: impact of shared family factors in 228,346 Norwegian siblings.

PubMed

Ariansen, Inger; Mortensen, Laust Hvas; Graff-Iversen, Sidsel; Stigum, Hein; Kjøllesdal, Marte Karoline Råberg; Næss, Øyvind

2017-03-30

Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design. Norwegian health survey data (1980-2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7-9 years, 10-11 years, 12 years, 13-16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings. Educational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m 2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings. About one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD.

Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association.

PubMed

Mehta, Laxmi S; Watson, Karol E; Barac, Ana; Beckie, Theresa M; Bittner, Vera; Cruz-Flores, Salvador; Dent, Susan; Kondapalli, Lavanya; Ky, Bonnie; Okwuosa, Tochukwu; Piña, Ileana L; Volgman, Annabelle Santos

2018-02-20

Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients. © 2018 American Heart Association, Inc.

Cardiovascular diseases and risk factors among Chinese immigrants.

PubMed

Gong, Zhizhong; Zhao, Dong

2016-04-01

The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions.

PubMed

Schultz, William M; Kelli, Heval M; Lisko, John C; Varghese, Tina; Shen, Jia; Sandesara, Pratik; Quyyumi, Arshed A; Taylor, Herman A; Gulati, Martha; Harold, John G; Mieres, Jennifer H; Ferdinand, Keith C; Mensah, George A; Sperling, Laurence S

2018-05-15

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment. © 2018 American Heart Association, Inc.

Farmers Have Hearts: The Prevalence of Risk Factors for Cardiovascular Disease Among a Subgroup of Irish Livestock Farmers.

PubMed

van Doorn, Diana; Richardson, Noel; Osborne, Aoife

2017-01-01

Despite international findings that farmers have better health outcomes than other occupation groups, Irish farmers are found to be a high-risk group for cardiovascular disease (CVD). Early detection of CVD through preventive health measurements, such as screening of high-risk groups, can contribute to a reduction of CVD cases. Farmers, however, represent a "challenging" group in terms of engaging in preventive health behaviors. This study examined the prevalence of cardiovascular risk factors among male Irish livestock farmers who participated in heart screening as part of a workplace health intervention. In this cross-sectional study, data were collected from a convenience sample (N = 310) of farmers. Consent included permission to analyze the heart screening results and to participate in two follow-up questionnaires by phone at Week 1 (n = 224) and Week 12 (n = 172). All data were entered onto the Statistical Package for the Social Sciences (SPSS version 22) and both descriptive and inferential statistics were compiled. Almost one in two (46%; n = 140) farmers had high blood pressure (≥140/≥90 mm Hg), and 46% (n = 140) had elevated total cholesterol. One third of farmers were found to be obese (35%; n = 110). The vast majority (83%; n = 255) had at least four risk factors for CVD based on the outcomes of the heart screening. The study findings in relation to obesity and the prevalence of multiple risk factors for CVD are a particular cause of concern and shed considerable light on the current excess burden of CVD among farmers in Ireland.

Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study.

PubMed

Perini, Wilco; Agyemang, Charles; Snijder, Marieke B; Peters, Ron J G; Kunst, Anton E

2018-03-01

European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD). The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups. Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII). Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35-7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45-6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and -0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level. Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups.

Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study

PubMed Central

Perini, Wilco; Agyemang, Charles; Snijder, Marieke B.; Peters, Ron J.G.; Kunst, Anton E.

2017-01-01

Background: European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD). Objective: The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups. Methods: Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII). Results: Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35–7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45–6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and −0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level. Conclusions: Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups. PMID:28699411

Heart disease - risk factors

MedlinePlus

Heart disease - prevention; CVD - risk factors; Cardiovascular disease - risk factors; Coronary artery disease - risk factors; CAD - risk ... a certain health condition. Some risk factors for heart disease you cannot change, but some you can. ...

Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society.

PubMed

Wild, Robert A; Carmina, Enrico; Diamanti-Kandarakis, Evanthia; Dokras, Anuja; Escobar-Morreale, Hector F; Futterweit, Walter; Lobo, Rogerio; Norman, Robert J; Talbott, Evelyn; Dumesic, Daniel A

2010-05-01

Women with polycystic ovary syndrome (PCOS) often have cardiovascular disease (CVD) risk factors. The Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society created a panel to provide evidence-based reviews of studies assessing PCOS-CVD risk relationships and to develop guidelines for preventing CVD. An expert panel in PCOS and CVD reviewed literature and presented recommendations. Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third. Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board. Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.

The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative

PubMed Central

Smith, CJ; Ryckman, KK; Barnabei, Vanessa M.; Howard, Barbara; Isasi, Carmen R.; Sarto, Gloria; Tom, Sarah E.; Van Horn, Linda; Wallace, Robert; Robinson, Jennifer G

2016-01-01

Background and Aims Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality worldwide. Traditional risk factors predict 75-80% of an individual's risk of incident CVD. However, the role of early life experiences in future disease risk is gaining attention. The Barker hypothesis proposes fetal origins of adult disease, with consistent evidence demonstrating the deleterious consequences of birth weight outside the normal range. In this study, we investigate the role of birth weight in CVD risk prediction. Methods and Results The Women's Health Initiative (WHI) represents a large national cohort of post-menopausal women with 63 815 participants included in this analysis. Univariable proportional hazards regression analyses evaluated the association of 4 self-reported birth weight categories against 3 CVD outcome definitions, which included indicators of coronary heart disease, ischemic stroke, coronary revascularization, carotid artery disease and peripheral arterial disease. The role of birth weight was also evaluated for prediction of CVD events in the presence of traditional risk factors using 3 existing CVD risk prediction equations: one body mass index (BMI)-based and two laboratory-based models. Low birth weight (LBW) (< 6 lbs.) was significantly associated with all CVD outcome definitions in univariable analyses (HR=1.086, p=0.009). LBW was a significant covariate in the BMI-based model (HR=1.128, p<0.0001) but not in the lipid-based models. Conclusion LBW (<6 lbs.) is independently associated with CVD outcomes in the WHI cohort. This finding supports the role of the prenatal and postnatal environment in contributing to the development of adult chronic disease. PMID:26708645

Enriching Diet with n-3 PUFAs to Help Prevent Cardiovascular Diseases in Healthy Adults: Results from Clinical Trials.

PubMed

Manuelli, Matteo; Della Guardia, Lucio; Cena, Hellas

2017-07-18

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are believed to be important for cardiovascular health. Many investigations have been carried out in an attempt to examine the effect of n-3 PUFAs intake, in the form of supplementation or fortified foods, for the management of cardiovascular disease (CVD) and risk factors for CVD, whereas less is known about the effect on healthy individuals. The present study reviews the available literature in order to examine the relationship between n-3 PUFAs intake, either via supplementation or enriched food, and the prevention of CVD among healthy adults. Interventional clinical trials on subjects aged >18 years old with none of the established risk factors for CVD have been considered for review. n-3 PUFAs supplementation or enriched food may positively regulate triglycerides and some lipoprotein subsets, as well as several vascular and coagulation parameters, even in healthy patients, presenting no risk factors for CVD, suggesting a protective effect. Diet enrichment with omega-3 is likely to be useful in helping to lower the risk of developing CVD in healthy individuals, but still offers no strong evidence of a tangible benefit on a population level. Additional studies are needed to determine the optimal daily intake, especially to prevent the unfavorable effects of PUFAs over-consumption.

An Evaluation of FrancoForme: A CASE-MANAGED HOME-BASED PRIMARY AND SECONDARY CARDIOVASCULAR DISEASE PREVENTION PROGRAM FOR FRENCH-SPEAKING CANADIANS.

PubMed

Prince, Stephanie A; Laflamme, Marc; Harris, Jennifer; Tulloch, Heather E; de Margerie, Michele

2017-11-01

Cardiovascular disease (CVD) is the leading cause of mortality globally. Telephone-delivered interventions targeting cardiovascular risk factors are gaining popularity. This study is an evaluation of FrancoForme, a cardiovascular risk factor reduction program for the primary and secondary prevention of CVD among French-speaking patients of Eastern Ontario. This study reports on changes in cardiovascular risk factors, weekly exercise levels, and psychosocial characteristics including anxiety, depression, and quality of life upon program completion (3 months) and at 1 year after the start of the program. Repeated-measures analysis of variance was used to compare changes in outcomes between primary prevention risk groups (low, moderate, and high risk for CVD) and the secondary prevention group (ie, cardiac rehabilitation) at baseline, 3 months and 12 months. A total of 762 patients enrolled in FrancoForme between 2008 and 2015. At 3 months, all program completers (n = 507) experienced significant reductions for all cardiovascular risk factors except diastolic blood pressure. Minutes of self-reported exercise increased significantly by an average 90 minutes per week and all psychosocial variables improved. Significant group effects were observed across several risk factors. Among 12-month responders (n = 240), exercise, high-density lipoproteins, triglycerides, cholesterol, and all psychosocial variables were improved over baseline results. FrancoForme is unique in targeting both the primary and secondary prevention of CVD and removes several of the barriers to participating in a conventional CVD prevention program for French-speaking patients. FrancoForme is successful, receiving high satisfaction rates and resulting in significant improvements in cardiovascular risk factors, exercise, anxiety, and depression, as well as quality of life.

Cardiovascular risk assessment in elderly adults using SCORE OP model in a Latin American population: The experience from Ecuador.

PubMed

Sisa, Ivan

2018-02-09

Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population. We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex. In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk. Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

The educational gradient in coronary heart disease: the association with cognition in a cohort of 57,279 male conscripts.

PubMed

Ariansen, Inger; Mortensen, Laust; Igland, Jannicke; Tell, Grethe S; Tambs, Kristian; Graff-Iversen, Sidsel; Strand, Bjørn Heine; Næss, Øyvind

2015-04-01

Independently of cardiovascular disease (CVD) risk factors, cognitive ability may account for some of the excess risk of coronary heart disease (CHD) associated with lower education. We aimed to assess how late adolescence cognitive ability and midlife CVD risk factors are associated with the educational gradient in CHD in Norway. In a cohort of 57 279 men born during 1949-1959, health survey information was linked to military conscription records of cognitive ability, to national educational data, to hospitalisation records from the Cardiovascular Disease in Norway (CVDNOR) project and to the Norwegian Cause of Death Registry. Age and period adjusted HR for incident CHD events was 3.62 (95% CI 2.50 to 5.24) for basic relative to tertiary education, and was attenuated after adjustment; to 2.86 (1.87 to 4.38) for cognitive ability, to 1.90 (1.30 to 2.78) for CVD risk factors, and to 1.84 (1.20 to 2.83) when adjusting for both. Age and period adjusted absolute rate difference was 51 (33 to 70) incident CHD events per 100,000 person years between basic and tertiary educated, and was attenuated after adjustment; to 42 (22 to 61) for cognitive ability, to 25 (7 to 42) for CVD risk factors, and to 24 (5 to 43) when adjusting for both. Late adolescence cognitive ability attenuated the educational gradient in incident CHD events. CVD risk factors further attenuated the gradient, and to the same extent regardless of whether cognitive ability was included or not. Cognitive ability might be linked to the educational gradient through CVD risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cardiovascular Risk Factors (Diabetes, Hypertension, Hypercholesterolemia and Metabolic Syndrome) in Older People with Intellectual Disability: Results of the HA-ID Study

ERIC Educational Resources Information Center

de Winter, C. F.; Bastiaanse, L. P.; Hilgenkamp, T. I. M.; Evenhuis, H. M.; Echteld, M. A.

2012-01-01

Hypertension, diabetes, hypercholesterolemia and the metabolic syndrome are important risk factors for cardiovascular disease (CVD). In older people with intellectual disability (ID), CVD is a substantial morbidity risk. The aims of the present study, which was part of the Healthy Ageing in Intellectual Disability (HA-ID) study, were (1) to…

Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis.

PubMed

Everson-Rose, Susan A; Lutsey, Pamela L; Roetker, Nicholas S; Lewis, Tené T; Kershaw, Kiarri N; Alonso, Alvaro; Diez Roux, Ana V

2015-08-01

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Associations of adversity in childhood and risk factors for cardiovascular disease in mid-adulthood.

PubMed

Anderson, Emma L; Fraser, Abigail; Caleyachetty, Rishi; Hardy, Rebecca; Lawlor, Debbie A; Howe, Laura D

2018-02-01

Studies assessing associations of childhood psychosocial adversity (e.g. sexual abuse, physical neglect, parental death), as opposed to socioeconomic adversity, with cardiovascular disease (CVD) risk factors in adulthood are scarce. The aim of this study is to assess associations of various types of psychosocial adversity and cumulative adversity in childhood, with multiple CVD risk factors in mid-life. At study enrolment, women from the Avon Longitudinal Study of Parents and Children (N=3612) retrospectively reported: lack of maternal care, maternal overprotection, parental mental illness, household dysfunction, sexual abuse, physical and emotional abuse, and neglect in childhood. Approximately 23 years later, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma glucose, insulin, triglycerides, low and high density lipoprotein cholesterol, C-reactive protein, carotid intima-media thickness (cIMT) and arterial distensibility were assessed (mean age 51 years). We examined associations of each specific type of psychosocial adversity and cumulative adversity with CVD risk factors. No specific type of psychosocial adversity was consistently associated with the CVD risk factors. There was evidence that a one standard deviation greater cumulative psychosocial adversity was associated with 0.51cm greater waist circumference (95% confidence interval [CI]: 0.02cm, 1.00cm, p=0.04) and a lower arterial distensibility, even after adjustment for age, ethnicity and childhood and adult socioeconomic position. We found no consistent evidence that any specific type of psychosocial adversity, or cumulative psychosocial adversity in childhood, is associated with CVD risk factors in adult women. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

History of preterm birth and subsequent cardiovascular disease: a systematic review.

PubMed

Robbins, Cheryl L; Hutchings, Yalonda; Dietz, Patricia M; Kuklina, Elena V; Callaghan, William M

2014-04-01

A history of preterm birth (PTB) may be an important lifetime risk factor for cardiovascular disease (CVD) in women. We identified all peer-reviewed journal articles that met study criteria (English language, human studies, female, and adults ≥19 years old), that were found in the PubMed/MEDLINE databases, and that were published between Jan. 1, 1995, and Sept. 17, 2012. We summarized 10 studies that assessed the association between having a history of PTB and subsequent CVD morbidity or death. Compared with women who had term deliveries, women with any history of PTB had increased risk of CVD morbidity (variously defined; adjusted hazard ratio [aHR] ranged from 1.2-2.9; 2 studies), ischemic heart disease (aHR, 1.3-2.1; 3 studies), stroke (aHR, 1.7; 1 study), and atherosclerosis (aHR, 4.1; 1 study). Four of 5 studies that examined death showed that women with a history of PTB have twice the risk of CVD death compared with women who had term births. Two studies reported statistically significant higher risk of CVD-related morbidity and death outcomes (variously defined) among women with ≥2 pregnancies that ended in PTBs compared with women who had at least 2 births but which ended in only 1 PTB. Future research is needed to understand the potential impact of enhanced monitoring of CVD risk factors in women with a history of PTB on risk of future CVD risk. Copyright © 2014 Mosby, Inc. All rights reserved.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association.

PubMed

Goldstein, Benjamin I; Carnethon, Mercedes R; Matthews, Karen A; McIntyre, Roger S; Miller, Gregory E; Raghuveer, Geetha; Stoney, Catherine M; Wasiak, Hank; McCrindle, Brian W

2015-09-08

In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications. © 2015 American Heart Association, Inc.

Training community health workers to screen for cardiovascular disease risk in the community: experiences from Cape Town, South Africa

PubMed Central

Puoane, Thandi; Abrahams-Gessel, Shafika; Gaziano, Thomas A; Levitt, Naomi

2017-01-01

Summary Introduction This article describes a training process to equip community health workers (CHWs) with knowledge and skills to identify individuals at high risk for cardiovascular disease (CVD) in a township in Cape Town. Methods: CHWs were employed by a non-governmental organisation (NGO) primarily focusing on non-communicable diseases (NCDs). They were trained in the theory of CVD, including physiological changes and related risk factors and in obtaining anthropometric and blood pressure measurements. Pre- and post-training tests assessed learning needs and the effectiveness of imparting knowledge about CVD, respectively. Results: Training increased knowledge about CVD risk factors. CHWs were able to screen and identify those at risk for CVD and refer them to health professionals for validation of scores. The initial one-week training was too short, given the amount of information covered. Some CHWs had difficulty with English as the primary instruction medium and as the only language in which tests were offered. Conclusion: Although CHWs could be trained to screen for CVD risk, increased training time was required to impart the knowledge. The language used during training and testing presented challenges for those trainees whose dominant, spoken language was not English. PMID:28759089

Quantifying cardiometabolic risk using modifiable non-self-reported risk factors.

PubMed

Marino, Miguel; Li, Yi; Pencina, Michael J; D'Agostino, Ralph B; Berkman, Lisa F; Buxton, Orfeu M

2014-08-01

Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. To develop and validate a cumulative general cardiometabolic risk score that focuses on non-self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut-off points for risk categories. We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14-year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender-specific Cox proportional hazards models were considered to evaluate the effects of non-self-reported modifiable risk factors (blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10-year general cardiometabolic risk score functions and evaluated its predictive performance in 2012-2013. HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit chi-square=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk on the basis of modifiable risk factors that can motivate an individual's commitment to prevention and intervention. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Quantifying Cardiometabolic Risk Using Modifiable Non–Self-Reported Risk Factors

PubMed Central

Marino, Miguel; Li, Yi; Pencina, Michael J.; D’Agostino, Ralph B.; Berkman, Lisa F.; Buxton, Orfeu M.

2014-01-01

Background Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. Purpose To develop and validate a cumulative general cardiometabolic risk score that focuses on non–self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut off points for risk categories. Methods We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14–year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender–specific Cox proportional hazards models were considered to evaluate the effects of non–self-reported modifiable risk factors (blood pressure, total cholesterol, high–density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10–year general cardiometabolic risk score functions and evaluated its predictive performance in 2012–2013. Results HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit χ2=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). Conclusions This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk based on modifiable risk factors that can motivate an individual’s commitment to prevention and intervention. PMID:24951039

Awareness and Knowledge of Cardiovascular Risk through Blood Pressure and Cholesterol Testing in College Freshmen

ERIC Educational Resources Information Center

Melnyk, J. A.; Panza, G.; Zaleski, A.; Taylor, B.

2015-01-01

Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, yet knowledge of CVD risk factors is surprisingly low in college students. Purpose: The purpose of this study was to determine the effectiveness of an individualized blood pressure, cholesterol, and CVD education intervention on college freshmen. Methods:…

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study

PubMed Central

Clark, Alice Jessie; Salo, Paula; Lange, Theis; Jennum, Poul; Virtanen, Marianna; Pentti, Jaana; Kivimäki, Mika; Rod, Naja Hulvej; Vahtera, Jussi

2016-01-01

Study Objectives: Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). Methods: In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. Results: While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04–1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07–1.29) in fully adjusted analyses. Conclusions: Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers. Commentary: A commentary on this paper appears in this issue on page 1629. Citation: Clark AJ, Salo P, Lange T, Jennum P, Virtanen M, Pentti J, Kivimäki M, Rod NH, Vahtera J. Onset of impaired sleep and cardiovascular disease risk factors: a longitudinal study. SLEEP 2016;39(9):1709–1718. PMID:27397560

Association between interpregnancy interval and future risk of maternal cardiovascular disease-a population-based record linkage study.

PubMed

Ngo, A D; Roberts, C L; Figtree, G

2016-07-01

To examine the associations between interpregnancy interval and later maternal cardiovascular disease (CVD) risk. Population-based record linkage study. New South Wales, Australia, 1994-2011. 216 467 women having first and second liveborn singleton infants, excluding those with an existing or pregnancy-related CVD risk factor. We linked birth records of mothers to the mothers' subsequent CVD (coronary heart disease, cerebrovascular events, and chronic heart failure) hospitalisation or death. Multivariable Cox proportional hazard regression was used to estimate adjusted hazard ratios (AHR) [95% confidence interval (CI)], accounting for maternal age, parity, socioeconomic status, and smoking during pregnancy. The first occurrence of a CVD hospitalisation or death after the second birth. In comparison with mothers with an interpregnancy interval of 18-23 months (reference category), the AHR among mothers with interpregnancy interval of <12 months was 1.56 (95% CI 1.18-2.07) and of 12-17 months was 1.13 (95% CI 0.84-1.51). The AHRs were 1.40 (95% CI 1.07-1.82), 1.87 (95% CI 1.21-2.89), and 3.41 (95% CI 1.07-10.91), corresponding to interpregnancy intervals of 24-59, 60-119, and ≥120 months, respectively. AHRs of specific CVD categories showed a similar pattern. Interpregnancy interval is associated with the risk of subsequent maternal CVD in a J-shaped fashion. The association is independent of the existing and pregnancy-related CVD risk factors analysed. Both short and long interpregnancy intervals can be used as risk markers to identify women with an elevated CVD risk later in life. Interpregnancy interval is associated with the risk of subsequent maternal cardiovascular disease in a J-shaped fashion. © 2015 Royal College of Obstetricians and Gynaecologists.

Does IQ explain socio-economic differentials in total and cardiovascular disease mortality? Comparison with the explanatory power of traditional cardiovascular disease risk factors in the Vietnam Experience Study.

PubMed

Batty, G David; Shipley, Martin J; Dundas, Ruth; Macintyre, Sally; Der, Geoff; Mortensen, Laust H; Deary, Ian J

2009-08-01

The aim of this study was to examine the explanatory power of intelligence (IQ) compared with traditional cardiovascular disease (CVD) risk factors in the relationship of socio-economic disadvantage with total and CVD mortality, that is the extent to which IQ may account for the variance in this well-documented association. Cohort study of 4289 US male former military personnel with data on four widely used markers of socio-economic position (early adulthood and current income, occupational prestige, and education), IQ test scores (early adulthood and middle-age), a range of nine established CVD risk factors (systolic and diastolic blood pressure, total blood cholesterol, HDL cholesterol, body mass index, smoking, blood glucose, resting heart rate, and forced expiratory volume in 1 s), and later mortality. We used the relative index of inequality (RII) to quantify the relation between each index of socio-economic position and mortality. Fifteen years of mortality surveillance gave rise to 237 deaths (62 from CVD and 175 from 'other' causes). In age-adjusted analyses, as expected, each of the four indices of socio-economic position was inversely associated with total, CVD, and 'other' causes of mortality, such that elevated rates were evident in the most socio-economically disadvantaged men. When IQ in middle-age was introduced to the age-adjusted model, there was marked attenuation in the RII across the socio-economic predictors for total mortality (average 50% attenuation in RII), CVD (55%), and 'other' causes of death (49%). When the nine traditional risk factors were added to the age-adjusted model, the comparable reduction in RII was less marked than that seen after IQ adjustment: all-causes (40%), CVD (40%), and 'other' mortality (43%). Adding IQ to the latter model resulted in marked, additional explanatory power for all outcomes in comparison to the age-adjusted analyses: all-causes (63%), CVD (63%), and 'other' mortality (65%). When we utilized IQ in early adulthood rather than middle-age as an explanatory variable, the attenuating effect on the socio-economic gradient was less pronounced although the same pattern was still present. In the present analyses of socio-economic gradients in total and CVD mortality, IQ appeared to offer greater explanatory power than that apparent for traditional CVD risk factors.

Short and Long Term Cardiovascular Risk, Metabolic Syndrome Prevalence and HIV in Tanzania: A Cross-Sectional Study

PubMed Central

Kingery, Justin R; Alfred, Yona; Smart, Luke R; Nash, Emily; Todd, Jim; Naguib, Mostafa R; Downs, Jennifer A; Kalluvya, Samuel; Kataraihya, Johannes B; Peck, Robert N

2016-01-01

Objective To compare short and long term cardiovascular disease (CVD) risk scores and prevalence of metabolic syndrome in HIV-infected adults receiving and not receiving antiretroviral therapy (ART) to HIV-negative controls. Methods A cross-sectional study including: 151 HIV-infected, ART-naive, 150 HIV-infected on ART and 153 HIV-negative adults. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was ACC/AHA ASCVD Risk Estimator lifetime CVD risk score. Secondary outcomes were ASCVD 10-year risk, Framingham risk scores, statin indication and metabolic syndrome. Results Compared to HIV-negative controls, more HIV-infected adults on ART were classified as high lifetime CVD risk (34.7% vs 17.0%, p<0.001) although 10-year risk scores were similar, a trend which was similar across multiple CVD risk models. In addition, HIV-infected adults on ART had a higher prevalence of metabolic syndrome vs HIV-negative controls (21.3% vs 7.8%, p=0.008), with 2 common clusters of risk factors. More than one-quarter (28.7%) of HIV-infected Tanzanian adults on ART meet criteria for statin initiation. Conclusions HIV-infected ART-treated individuals have high lifetime cardiovascular risk, and this risk seems to develop rapidly in the first 3–4 years of ART as does the development of clusters of metabolic syndrome criteria. These data identify a new subgroup of low short-term/high lifetime risk HIV-infected individuals on ART who do not currently meet criteria for CVD risk factor modification but require further study. PMID:27105648

'Extra information a bit further down the line': rheumatoid arthritis patients' perceptions of developing educational material about the cardiovascular disease risk.

PubMed

John, Holly; Hale, Elizabeth D; Treharne, Gareth J; Carroll, Douglas; Kitas, George D

2009-12-01

There are no patient education programmes addressing the increased risk of cardiovascular disease (CVD) associated with rheumatoid arthritis (RA). This is the second in a pair of studies exploring stakeholder perceptions of developing such educational material. Healthcare professionals' perceptions were explored in the first study; here, we explore the perceptions of people with RA. Semi-structured interviews were held individually with 18 people with RA, purposively sampled to include participants with no co-morbid history of CVD, those with CVD risk factors and those who had experienced a CVD event. The interview transcripts were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: experiences of living with RA; reactions to learning about co-morbid CVD; implementing lifestyle changes; and expectations of education. Participants found being diagnosed with RA a devastating experience and were mostly unaware of their increased risk of CVD co-morbidity. They explained how information about CVD would be overwhelming and irrelevant at diagnosis, but they would have coped with 'extra information a bit further down the line'. There is a need to develop educational material or programmes. Their design must consider factors which facilitate lifestyle change, such as motivation or receiving personalized advice, and factors that inhibit change, such as depression or fatalism. Emphasizing the positive effects that some CVD lifestyle changes may have on RA symptom control may be particularly persuasive. Group education would be a popular format. These findings can be directly translated into clinical practice. Copyright (c) 2009 John Wiley & Sons, Ltd.

Does fibrinogen add to prediction of cardiovascular disease? Results from the Scottish Heart Health Extended Cohort Study.

PubMed

Woodward, Mark; Tunstall-Pedoe, Hugh; Rumley, Ann; Lowe, Gordon D O

2009-08-01

Plasma fibrinogen is an established risk factor for cardiovascular disease (CVD), but it has not been established whether it adds predictive value to risk scores. In the Scottish Heart Health Extended Cohort Study, we measured plasma fibrinogen in 13 060 men and women, aged 30-74 years, initially free of CVD. After follow-up for a median of 19.2 years, 2626 subjects had at least one CVD event. After adjusting for classical CVD risk factors and socio-economic status, the hazard ratios (95% confidence interval) for a one unit (g/l) increase in plasma fibrinogen were 1.09 (1.02, 1.16) for men and 1.10 (1.02, 1.19) for women. Although fibrinogen added significantly to the discrimination of the Framingham risk score for women, it failed to do so for men. Fibrinogen did not add significantly to the ASSIGN risk score. Fibrinogen added between 1.3% and 3.2% to the classification of CVD status by the existing risk scores. We conclude that the added value of fibrinogen to two currently used risk scores is low; hence population screening with fibrinogen for this purpose is unlikely to be clinically useful or cost-effective.

Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia.

PubMed

Amiri, Mohammadreza; Majid, Hazreen Abdul; Hairi, FarizahMohd; Thangiah, Nithiah; Bulgiba, Awang; Su, Tin Tin

2014-01-01

The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia. By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor. As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93). In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes.

Left Ventricular Structure and Risk of Cardiovascular Events: A Framingham Heart Study Cardiac Magnetic Resonance Study.

PubMed

Tsao, Connie W; Gona, Philimon N; Salton, Carol J; Chuang, Michael L; Levy, Daniel; Manning, Warren J; O'Donnell, Christopher J

2015-09-15

Elevated left ventricular mass index (LVMI) and concentric left ventricular (LV) remodeling are related to adverse cardiovascular disease (CVD) events. The predictive utility of LV concentric remodeling and LV mass in the prediction of CVD events is not well characterized. Framingham Heart Study Offspring Cohort members without prevalent CVD (n=1715, 50% men, aged 65±9 years) underwent cardiovascular magnetic resonance for LVMI and geometry (2002-2006) and were prospectively followed for incident CVD (myocardial infarction, coronary insufficiency, heart failure, stroke) or CVD death. Over 13 808 person-years of follow-up (median 8.4, range 0.0 to 10.5 years), 85 CVD events occurred. In multivariable-adjusted proportional hazards regression models, each 10-g/m(2) increment in LVMI and each 0.1 unit in relative wall thickness was associated with 33% and 59% increased risk for CVD, respectively (P=0.004 and P=0.009, respectively). The association between LV mass/LV end-diastolic volume and incident CVD was borderline significant (P=0.053). Multivariable-adjusted risk reclassification models showed a modest improvement in CVD risk prediction with the incorporation of cardiovascular magnetic resonance LVMI and measures of LV concentricity (C-statistic 0.71 [95% CI 0.65 to 0.78] for the model with traditional risk factors only, improved to 0.74 [95% CI 0.68 to 0.80] for the risk factor model additionally including LVMI and relative wall thickness). Among adults free of prevalent CVD in the community, greater LVMI and LV concentric hypertrophy are associated with a marked increase in adverse incident CVD events. The potential benefit of aggressive primary prevention to modify LV mass and geometry in these adults requires further investigation. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Sex Differences in Type-2 Diabetes: Implications for Cardiovascular Risk Management.

PubMed

Raparelli, Valeria; Morano, Susanna; Franconi, Flavia; Lenzi, Andrea; Basili, Stefania

2017-01-01

Among individuals with Type 2 diabetes (T2DM), cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Sex and gender differences (SGDs) in the cardiovascular consequences of T2DM are relevant suggesting the need for a more aggressive CVD preventive strategy in diabetic women as they lose the so-called &quot;female advantage&quot; in terms of CVD risk comparing with the nondiabetic population. Multiple factors may explain the disproportion in CVD risk among women with diabetes comparing with diabetic men or non-diabetic women. Both genetic and hormonal factors only partially explain SGDs in CVD risk in diabetes. However, women likely reach diagnosis later and in worse conditions, they undergo both diagnostic and therapeutic supports in lower percentage and, finally, they are not able to obtain therapeutic goals recommended by guidelines. Concerning the cardiovascular system, diabetes amplifies the extent of damage at both micro- and macrovascular level differently among sexes. The aim of this review is to clarify, in a sex and gender perspective, the impact of diabetes in CVD risk and to summarize the most important SGDs in CVD primary and secondary prevention strategies such as antiplatelet drugs and statins. The efficacy of ASA and/or statins in secondary prevention is documented in both sexes independently by the presence of T2DM. A different approach to CVD primary prevention with ASA using the age cut-off to discriminate sex differences has been recommended. The use of statins for primary prevention in women should be accurately monitored for the occurrence of myalgia and risk of developing diabetes. A gender approach in CVD prevention strategies is urgently required to achieve a sensible reduction of adverse CV events. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Impact of socioeconomic deprivation on screening for cardiovascular disease risk in a primary prevention population: a cross-sectional study.

PubMed

Lang, Sarah-Jane; Abel, Gary A; Mant, Jonathan; Mullis, Ricky

2016-03-21

Investigate the association between socioeconomic deprivation and completeness of cardiovascular disease (CVD) risk factor recording in primary care, uptake of screening in people with incomplete risk factor recording and with actual CVD risk within the screened subgroup. Cross-sectional study. Nine UK general practices. 7987 people aged 50-74 years with no CVD diagnosis. CVD risk was estimated using the Framingham equation from data extracted from primary care electronic health records. Where there was insufficient information to calculate risk, patients were invited to attend a screening assessment. Proportion of patients for whom clinical data were sufficiently complete to enable CVD risk to be calculated; proportion of patients invited to screening who attended; proportion of patients who attended screening whose 10-year risk of a cardiovascular event was high (>20%). For each outcome, a set of logistic regression models were run. Crude and adjusted ORs were estimated for person-level deprivation, age, gender and smoking status. We included practice-level deprivation as a continuous variable and practice as a random effect to account for clustering. People who had lower Indices of Multiple Deprivation (IMD) scores (less deprived) had significantly worse routine CVD risk factor recording (adjusted OR 0.97 (0.95 to 1.00) per IMD decile; p=0.042). Screening attendance was poorer in those with more deprivation (adjusted OR 0.89 (0.86 to 0.91) per IMD decile; p<0.001). Among those who attended screening, the most deprived were more likely to have CVD risk >20% (OR 1.09 (1.03 to 1.15) per IMD decile; p=0.004). Our data suggest that those who had the most to gain from screening were least likely to attend, potentially exacerbating existing health inequalities. Future research should focus on tailoring the delivery of CVD screening to ensure engagement of socioeconomically deprived groups. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Risk factors control for primary prevention of cardiovascular disease in men: Evidence from the Aragon Workers Health Study (AWHS).

PubMed

Aguilar-Palacio, Isabel; Malo, Sara; Feja, Cristina; Lallana, MªJesús; León-Latre, Montserrat; Casasnovas, José Antonio; Rabanaque, MªJosé; Guallar, Eliseo

2018-01-01

Benefits of cardiovascular disease (CVD) risk factors control are well known, but goals achievement remains low. The objective of this study is to evaluate the prevalence of CVD risk factors among men ina worker's cohort with no previous CVD, to study control variations across time and the factors associated with poor control. To this end, we conducted a cohort reexamination (2010-2014) within the context of the Aragon Workers Health Study (AWHS). Data from working characteristics, analytical values and pharmacological prescription were included in the analysis. Prevalences of risk factor diagnosis and control were calculated, as well as factors associated with poor control. The prevalence of CVD risk factors was high. In 2014dyslipidaemia was the most prevalent (85.2%) followed by Hypertension (HT) (42.0%). People under treatment increased for the period analysed (p<0.001). The proportion of people treated varied from 72.2% in Diabetes Mellitus to 31.1% in dyslipidaemia in 2014. 46.2% of the workers with HT were controlled, decreasing to 21.9% in Diabetes and 11.0% in dyslipidaemia (2014). Working in a turn different to central shift was associated with poor control, especially for those working at night with HT (Odds Ratio in 2010: 3.6; Confidence Interval 95% 1.8-7.4) and dyslipidaemia (Odds Ratio 2010: 4.7; Confidence Interval 95% 1.3-16.4). We conclude that, although CVD control has increased significantly for the period studied, there are still many people that do not receive any treatment, and control goals are normally not achieved.

EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic.

PubMed

Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C; Kvien, Tore K; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

2015-01-01

EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

Longitudinal Associations of High-Fructose Diet with Cardiovascular Events and Potential Risk Factors: Tehran Lipid and Glucose Study.

PubMed

Bahadoran, Zahra; Mirmiran, Parvin; Tohidi, Maryam; Azizi, Fereidoun

2017-08-21

The relationship between fructose and cardiovascular disease (CVD) remains controversial. In this study, we aimed to assess possible association of dietary intakes of fructose with the risk of CVD events in a prospective population-based study. Participants without CVD ( n = 2369) were recruited from the Tehran Lipid and Glucose Study and followed a mean of 6.7 years. Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary total fructose (TF) intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the risk of CVD across tertiles of dietary fructose. Linear regression models were used to indicate association of fructose intakes with changes of CVD risk factors over the study period. The mean age of participants (43.5% men) was 38.1 ± 13.3 years at baseline. During an average of 6.7 ± 1.4 years of follow-up, 79 participants experienced CVD outcomes. The mean daily intake of TF was 6.4 ± 3.7% of total energy (3.6 ± 2.0 from AF and 2.7 ± 1.8 from NF). Higher consumption of TF (≥7.4% vs. <4.5% of total energy) was accompanied with an increased risk of CVD (HR = 1.81, 95% CI = 1.04-3.15); higher energy intake from AF was also related to incidence of CVD (HR = 1.80, 95% CI = 1.04-3.12), whereas NF was not associated with the risk of CVD outcomes. Both AF and TF were also related to changes of systolic and diastolic blood pressures, waist circumference, serum insulin and creatinine levels, as well as HDL-C. Our data provides further evidence regarding undesirable effects of fructose intake in relation to risk of CVD events.

Heavy Metal Poisoning and Cardiovascular Disease

PubMed Central

Alissa, Eman M.; Ferns, Gordon A.

2011-01-01

Cardiovascular disease (CVD) is an increasing world health problem. Traditional risk factors fail to account for all deaths from CVD. It is mainly the environmental, dietary and lifestyle behavioral factors that are the control keys in the progress of this disease. The potential association between chronic heavy metal exposure, like arsenic, lead, cadmium, mercury, and CVD has been less well defined. The mechanism through which heavy metals act to increase cardiovascular risk factors may act still remains unknown, although impaired antioxidants metabolism and oxidative stress may play a role. However, the exact mechanism of CVD induced by heavy metals deserves further investigation either through animal experiments or through molecular and cellular studies. Furthermore, large-scale prospective studies with follow up on general populations using appropriate biomarkers and cardiovascular endpoints might be recommended to identify the factors that predispose to heavy metals toxicity in CVD. In this review, we will give a brief summary of heavy metals homeostasis, followed by a description of the available evidence for their link with CVD and the proposed mechanisms of action by which their toxic effects might be explained. Finally, suspected interactions between genetic, nutritional and environmental factors are discussed. PMID:21912545

Resting Heart Rate Is Not a Good Predictor of a Clustered Cardiovascular Risk Score in Adolescents: The HELENA Study

PubMed Central

de Moraes, Augusto César Ferreira; Cassenote, Alex Jones Flores; Leclercq, Catherine; Dallongeville, Jean; Androutsos, Odysseas; Török, Katalin; González-Gross, Marcela; Widhalm, Kurt; Kafatos, Anthony; Carvalho, Heráclito Barbosa; Moreno, Luis Alberto

2015-01-01

Background Resting heart rate (RHR) reflects sympathetic nerve activity a significant association between RHR and all-cause and cardiovascular mortality has been reported in some epidemiologic studies. Methods To analyze the predictive power and accuracy of RHR as a screening measure for individual and clustered cardiovascular risk in adolescents. The study comprised 769 European adolescents (376 boys) participating in the HELENA cross-sectional study (2006–2008) were included in this study. Measurements on systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO2máx and the sum of four skinfolds were obtained, and a clustered cardiovascular disease (CVD) risk index was computed. The receiver operating characteristics curve was applied to calculate the power and accuracy of RHR to predict individual and clustered CVD risk factors. Results RHR showed low accuracy for screening CVD risk factors in both sexes (range 38.5%–54.4% in boys and 45.5%–54.3% in girls). Low specificity’s (15.6%–19.7% in boys; 18.1%–20.0% in girls) were also found. Nevertheless, the sensitivities were moderate-to-high (61.4%–89.1% in boys; 72.9%–90.3% in girls). Conclusion RHR is a poor predictor of individual CVD risk factors and of clustered CVD and the estimates based on RHR are not accurate. The use of RHR as an indicator of CVD risk in adolescents may produce a biased screening of cardiovascular health in both sexes. PMID:26010248

Diabetes and Cardiovascular Risk Factors in Native Hawaiians

PubMed Central

Aluli, N. Emmett; Jones, Kristina L.; Reyes, Phillip W.; Brady, S. Kalani; Tsark, JoAnn U.; Howard, Barbara V.

2015-01-01

Objective Diabetes is an increasing health problem among Native Hawaiians. Diabetes is a risk factor for cardiovascular disease (CVD), the leading cause of death among Native Hawaiians. In this article, the prevalence of diabetes is reported and associations with CVD risk factors are examined. Design and Methods Cross-section of 862 Native Hawaiians, ages 19–88. Physical exam included anthropometric measures, blood pressure, glucose and lipid measures, and personal interview. Results Age-adjusted prevalences of diabetes (25.1% in men vs. 22.6% in women) and impaired fasting glucose (IFG) (47.8% vs. 39.3%) increased with age and were higher in men. Fasting glucose was higher in diabetic men than women (209 mg/dL vs. 179, p = .0117). BMI, waist circumference, systolic blood pressure, triglycerides, and low-density lipoprotein cholesterol were higher in diabetic participants (all p < .01), and high-density lipoprotein cholesterol was lower (p < .005). Conclusions Diabetes prevalence in Native Hawaiians is high. The high proportion with IFG and the increase in CVD risk factors with diabetes suggest that community-based programs are needed to focus on diabetes and diabetes-related CVD. PMID:19653416

Cardiovascular Disease and Primary Ovarian Insufficiency

PubMed Central

Wellons, Melissa

2012-01-01

Cardiovascular disease (CVD) is the number-one killer of women. Women with primary ovarian insufficiency (POI) may be more burdened by cardiovascular disease, such as myocardial infarction and stroke, as compared with women with normal menopause. The increased burden may be mediated by a worsening of cardiovascular risk factors, such as lipids, corresponding with the loss of ovarian function. In contrast, the increased burden may be caused by factors that precede and potentially contribute to both CVD events and ovarian decline, such as X-chromosome abnormalities and smoking. Regardless of the cause, women with POI may serve as an important population to target for CVD screening and prevention strategies. These strategies should include the use of CVD risk stratification tools to identify women that may benefit from lifestyle modification and pharmacological therapy to prevent CVD. Sex steroid therapy for the sole purpose of CVD prevention in women with POI cannot be recommended, based on a lack of evidence. PMID:21969267

Cardiovascular complications of obesity in adolescents.

PubMed

Orio, F; Palomba, S; Cascella, T; Savastano, S; Lombardi, G; Colao, A

2007-01-01

Obesity is an increasingly important worldwide health problem, representing the major risk factor for coronary heart disease. The increase in the prevalence of obesity, particularly among younger age groups, is likely to have long-term implications for cardiovascular disease (CVD) in the years to come, especially at a young age. Obesity plays a central role in the insulin resistance (IR) syndrome and increases the risk of atherosclerotic CVD. The present review will examine the relationships among cardiovascular risk (CVR) factors during the childhood-adolescence-adulthood transition. In fact, the relation between obesity, in particular visceral obesity and CVD, appears to develop at a relatively young age. The foremost physical consequence of obesity is atherosclerotic CVD, and an intriguing example of obesity-related cardiovascular complications affecting young women is the polycystic ovary syndrome (PCOS).

Validation of a model to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD: the rotterdam ischemic heart disease and stroke computer simulation (RISC) model.

PubMed

van Kempen, Bob J H; Ferket, Bart S; Hofman, Albert; Steyerberg, Ewout W; Colkesen, Ersen B; Boekholdt, S Matthijs; Wareham, Nicholas J; Khaw, Kay-Tee; Hunink, M G Myriam

2012-12-06

We developed a Monte Carlo Markov model designed to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD. Internal, predictive, and external validity of the model have not yet been established. The Rotterdam Ischemic Heart Disease and Stroke Computer Simulation (RISC) model was developed using data covering 5 years of follow-up from the Rotterdam Study. To prove 1) internal and 2) predictive validity, the incidences of coronary heart disease (CHD), stroke, CVD death, and non-CVD death simulated by the model over a 13-year period were compared with those recorded for 3,478 participants in the Rotterdam Study with at least 13 years of follow-up. 3) External validity was verified using 10 years of follow-up data from the European Prospective Investigation of Cancer (EPIC)-Norfolk study of 25,492 participants, for whom CVD and non-CVD mortality was compared. At year 5, the observed incidences (with simulated incidences in brackets) of CHD, stroke, and CVD and non-CVD mortality for the 3,478 Rotterdam Study participants were 5.30% (4.68%), 3.60% (3.23%), 4.70% (4.80%), and 7.50% (7.96%), respectively. At year 13, these percentages were 10.60% (10.91%), 9.90% (9.13%), 14.20% (15.12%), and 24.30% (23.42%). After recalibrating the model for the EPIC-Norfolk population, the 10-year observed (simulated) incidences of CVD and non-CVD mortality were 3.70% (4.95%) and 6.50% (6.29%). All observed incidences fell well within the 95% credibility intervals of the simulated incidences. We have confirmed the internal, predictive, and external validity of the RISC model. These findings provide a basis for analyzing the effects of modifying cardiovascular disease risk factors on the burden of CVD with the RISC model.

The Effects of Tai Chi on Cardiovascular Risk in Women.

PubMed

Robins, Jo Lynne; Elswick, R K; Sturgill, Jamie; McCain, Nancy L

2016-11-01

This study examined the effects of tai chi (TC) on biobehavioral factors associated with cardiovascular disease (CVD) risk in women. A randomized trial used a wait-list control group, pretest-posttest design. Data were collected immediately before, immediately after, and 2 months following the intervention. The study was community based in central Virginia. Women aged 35 to 50 years at increased risk for CVD. The 8-week intervention built on prior work and was designed to impact biobehavioral factors associated with CVD risk in women. Biological measures included fasting glucose, insulin, and lipids as well as C-reactive protein and cytokines. Behavioral measures included fatigue, perceived stress, depressive symptoms, social support, mindfulness, self-compassion, and spiritual thoughts and behaviors. A mixed effects linear model was used to test for differences between groups across time. In 63 women, TC was shown to decrease fatigue (∂ [difference in group means] = 9.38, p = .001) and granulocyte colony stimulating factor (∂ = 12.61, p = .052). Consistent with the study model and intervention design, significant changes observed 2 months post intervention indicated that TC may help down-regulate proinflammatory cytokines associated with underlying CVD risk, including interferon gamma (∂ = 149.90, p = .002), tumor necrosis factor (∂ = 16.78, p = .002), interleukin (IL) 8 (∂ = 6.47, p = .026), and IL-4 (∂ = 2.13, p = .001), and may increase mindfulness (∂ = .54, p = .021), spiritual thoughts and behaviors (∂ = 8.30, p = .009), and self-compassion (∂ = .44, p = .045). This study contributes important insights into the potential benefits and mechanisms of TC and, with further research, may ultimately lead to effective strategies for reducing CVD risk in women earlier in the CVD trajectory. © 2016 by American Journal of Health Promotion, Inc.

Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans

PubMed Central

Longo-Mbenza, Benjamin; Nsenga, Jacqueline Nkondi; Mokondjimobe, Etienne; Gombet, Thierry; Assori, Itoua Ngaporo; Ibara, Jean Rosaire; Ellenga-Mbolla, Bertrand; Vangu, Dieudonné Ngoma; Fuele, Simon Mbungu

2012-01-01

Background Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis. Objective To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor. Methods Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999–2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris. Results At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2–7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4–8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6–16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4–28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1–18; P < 0.0001). Conclusion Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa. PMID:22923995

Increased Mortality in Schizophrenia Due to Cardiovascular Disease – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions

PubMed Central

Ringen, Petter Andreas; Engh, John A.; Birkenaes, Astrid B.; Dieset, Ingrid; Andreassen, Ole A.

2014-01-01

Background: Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. Methods: Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors’ experience from clinical work and research in the field. Results: In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. Discussion: The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task. PMID:25309466

Intensive Versus Standard Blood Pressure Control in SPRINT-Eligible Participants of ACCORD-BP.

PubMed

Buckley, Leo F; Dixon, Dave L; Wohlford, George F; Wijesinghe, Dayanjan S; Baker, William L; Van Tassell, Benjamin W

2017-12-01

We sought to determine the effect of intensive blood pressure (BP) control on cardiovascular outcomes in participants with type 2 diabetes mellitus (T2DM) and additional risk factors for cardiovascular disease (CVD). This study was a post hoc, multivariate, subgroup analysis of ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) participants. Participants were eligible for the analysis if they were in the standard glucose control arm of ACCORD-BP and also had the additional CVD risk factors required for SPRINT (Systolic Blood Pressure Intervention Trial) eligibility. We used a Cox proportional hazards regression model to compare the effect of intensive versus standard BP control on CVD outcomes. The "SPRINT-eligible" ACCORD-BP participants were pooled with SPRINT participants to determine whether the effects of intensive BP control interacted with T2DM. The mean baseline Framingham 10-year CVD risk scores were 14.5% and 14.8%, respectively, in the intensive and standard BP control groups. The mean achieved systolic BP values were 120 and 134 mmHg in the intensive and standard BP control groups ( P < 0.001). Intensive BP control reduced the composite of CVD death, nonfatal myocardial infarction (MI), nonfatal stroke, any revascularization, and heart failure (hazard ratio 0.79; 95% CI 0.65-0.96; P = 0.02). Intensive BP control also reduced CVD death, nonfatal MI, and nonfatal stroke (hazard ratio 0.69; 95% CI 0.51-0.93; P = 0.01). Treatment-related adverse events occurred more frequently in participants receiving intensive BP control (4.1% vs. 2.1%; P = 0.003). The effect of intensive BP control on CVD outcomes did not differ between patients with and without T2DM ( P > 0.62). Intensive BP control reduced CVD outcomes in a cohort of participants with T2DM and additional CVD risk factors. © 2017 by the American Diabetes Association.

Cardiovascular Disease and Associated Risk Factors in Cuba: Prospects for Prevention and Control

PubMed Central

Cooper, Richard S.; Orduñez, Pedro; Iraola Ferrer, Marcos D.; Munoz, Jose Luis Bernal; Espinosa-Brito, Alfredo

2006-01-01

Objectives. An adequate description of the trends in cardiovascular disease (CVD) is not available for most of the developing world. Cuba provides an important exception, and we sought to use available data to offer insights into the changing patterns of CVD there. Methods. We reviewed Cuban public health statistics, surveys, and reports of health services. Results. CVD has been the leading cause of death since 1970. A 45% reduction in heart disease deaths was observed from 1970 to 2002; the decline in stroke was more limited. There are moderate prevalences of all major risk factors. Conclusions. The Cuban medical care system has responded vigorously to the challenge of CVD; levels of control of hypertension are the highest in the world. Nonindustrialized countries can decisively control CVD. PMID:16317211

Circulating Branched-Chain Amino Acids and Incident Cardiovascular Disease in a Prospective Cohort of US Women.

PubMed

Tobias, Deirdre K; Lawler, Patrick R; Harada, Paulo H; Demler, Olga V; Ridker, Paul M; Manson, JoAnn E; Cheng, Susan; Mora, Samia

2018-04-01

Circulating branched-chain amino acids (BCAAs; isoleucine, leucine, and valine) are strong predictors of type 2 diabetes mellitus (T2D), but their association with cardiovascular disease (CVD) is uncertain. We hypothesized that plasma BCAAs are positively associated with CVD risk and evaluated whether this was dependent on an intermediate diagnosis of T2D. Participants in the Women's Health Study prospective cohort were eligible if free of CVD at baseline blood collection (n=27 041). Plasma metabolites were measured via nuclear magnetic resonance spectroscopy. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for BCAAs with incident CVD (myocardial infarction, stroke, and coronary revascularization). We confirmed 2207 CVD events over a mean 18.6 years of follow-up. Adjusting for age, body mass index, and other established CVD risk factors, total BCAAs were positively associated with CVD (per SD: HR, 1.13; 95% CI, 1.08-1.18), comparable to LDL-C (low-density lipoprotein cholesterol) with CVD (per SD: HR, 1.12; 95% CI, 1.07-1.17). BCAAs were associated with coronary events (myocardial infarction: HR, 1.16; 95% CI, 1.06-1.26; revascularization: HR, 1.17; 95% CI, 1.11-1.25), and borderline significant association with stroke (HR, 1.07; 95% CI, 0.99-1.15). The BCAA-CVD association was greater ( P interaction=0.036) among women who developed T2D before CVD (HR, 1.20; 95% CI, 1.08-1.32) versus women without T2D (HR, 1.08; 95% CI, 1.03-1.14). Adjusting for LDL-C, an established CVD risk factor, did not attenuate these findings; however, adjusting for HbA1c and insulin resistance eliminated the associations of BCAAs with CVD. Circulating plasma BCAAs were positively associated with incident CVD in women. Impaired BCAA metabolism may capture the long-term risk of the common cause underlying T2D and CVD. © 2018 American Heart Association, Inc.

Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

PubMed

Bonner, Carissa; McKinn, Shannon; Lau, Annie; Jansen, Jesse; Doust, Jenny; Trevena, Lyndal; McCaffery, Kirsten

2018-05-01

Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes. GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis. Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms. CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases. Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey.

PubMed

Awad, Abdelmoneim; Al-Nafisi, Hala

2014-11-04

Cardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population's prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists' role in CVD prevention and management. A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. The response rate was 90.7%. Respondents' knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were 'confusion or trouble speaking' (36.4%) and 'numbness or weakness' (34.7%). Respondents' knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50-59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management. There are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.

Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review

PubMed Central

Filippidis, Filippos T.; Baldove, Juren P.; Majeed, Azeem; Rawaf, Salman

2016-01-01

Background. Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion. The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women. PMID:27777590

Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review.

PubMed

Alshaikh, Mashael K; Filippidis, Filippos T; Baldove, Juren P; Majeed, Azeem; Rawaf, Salman

2016-01-01

Background . Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion . The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women.

Cardiovascular Disease, its Risk Factors and Treatment, and Age-related Macular Degeneration: Women’s Health Initiative Sight Exam Ancillary Study

PubMed Central

Klein, Ronald; Deng, Yingzi; Klein, Barbara E. K.; Hyman, Leslie; Seddon, Johanna; Frank, Robert N.; Wallace, Robert B.; Hendrix, Susan L.; Kuppermann, Baruch D.; Langer, Robert D.; Kuller, Lewis; Brunner, Robert; Johnson, Karen C.; Thomas, Asha M.; Haan, Mary

2010-01-01

Purpose To examine the association of cardiovascular disease (CVD), CVD risk factors, and CVD treatment with age-related macular degeneration (AMD). Design Observational analysis of a randomized clinical trial. Methods Setting The Women’s Health Initiative Sight Examination (WHISE), an ancillary study to the Women’s Health Initiative’s (WHI) clinical trial of hormone replacement therapy. Study Population 4,288 women aged 63 years and older. Observation Procedures Information on CVD and its risk factors were obtained from a standardized questionnaire and examination. Main Outcome Measure AMD as determined by standardized grading of fundus photographs. Results Prevalence of any AMD was 21.4% (n=919). Of those with AMD, 5.8% (n=53) had signs of exudative AMD (n=39) or pure geographic atrophy (n=14), limiting the power to examine associations. Significant associations between late AMD and CVD risk factors were (odds ratio [OR], 95% confidence interval [CI]) older age (1.19, 1.13, 1.27, p < 0.0001), more pack years smoked (1.02 per pack-year smoked, 1.003, 1.03, p = 0.01), systolic blood pressure (0.84 per 10 mmHg, 0.71, 0.995, p = 0.04), report of taking calcium channel blockers (CCB) (2.49, 1.21, 5.12, p = 0.04), self-reported history of diabetes (2.00, 1.01, 3.96, p = 0.05), and greater body mass index (1.05 per 1 kg/m2, 1.001, 1.10, p = 0.05). History of myocardial infarction, stroke, use of statins, or white blood cell were not associated with AMD. Conclusions Results suggest that smoking, use of CCBs, diabetes, and obesity are risk factors for late AMD in women. However, the association of late AMD with systolic blood pressure and the effects of other CVD risk factors on early AMD need to be further explored. PMID:17317391

Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns.

PubMed

Jones, Katherine M; Carter, Michele M; Schulkin, Jay

2015-06-01

African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

Trauma exposure and endothelial function among midlife women.

PubMed

Thurston, Rebecca C; Barinas-Mitchell, Emma; von Känel, Roland; Chang, Yuefang; Koenen, Karestan C; Matthews, Karen A

2018-04-01

Trauma is a potent exposure that can have implications for health. However, little research has considered whether trauma exposure is related to endothelial function, a key process in the pathophysiology of cardiovascular disease (CVD). We tested whether exposure to traumatic experiences was related to poorer endothelial function among midlife women, independent of CVD risk factors, demographic factors, psychosocial factors, or a history of childhood abuse. In all, 272 nonsmoking perimenopausal and postmenopausal women aged 40 to 60 years without clinical CVD completed the Brief Trauma Questionnaire, the Child Trauma Questionnaire, physical measures, a blood draw, and a brachial ultrasound for assessment of brachial artery flow-mediated dilation (FMD). Relations between trauma and FMD were tested in linear regression models controlling for baseline vessel diameter, demographics, depression/anxiety, CVD risk factors, health behaviors, and, additionally, a history of childhood abuse. Over 60% of the sample had at least one traumatic exposure, and 18% had three or more exposures. A greater number of traumatic exposures was associated with lower FMD, indicating poorer endothelial function in multivariable models (beta, β [standard error, SE] -1.05 [0.40], P = 0.01). Relations between trauma exposure and FMD were particularly pronounced for three or more trauma exposures (b [SE] -1.90 [0.71], P = 0.008, relative to no exposures, multivariable). A greater number of traumatic exposures were associated with poorer endothelial function. Relations were not explained by demographics, CVD risk factors, mood/anxiety, or a by history of childhood abuse. Women with greater exposure to trauma over life maybe at elevated CVD risk.

Risk of Obstructive Sleep Apnea and Its Association with Cardiovascular and Noncardiac Vascular Risk in Patients with Rheumatoid Arthritis: A Population-based Study.

PubMed

Wilton, Katelynn M; Matteson, Eric L; Crowson, Cynthia S

2018-01-01

To define the incidence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA) and determine whether OSA diagnosis predicts future cardiovascular disease (CVD) and noncardiac vascular events. Medical information pertaining to RA, OSA, CVD, and vascular diagnoses was extracted from a comprehensive medical record system for a geographically defined population of 813 patients previously diagnosed with RA and 813 age- and sex-matched comparator subjects. The risk for OSA in persons with RA versus comparators was elevated, although not reaching statistical significance (HR 1.32, 95% CI 0.98-1.77; p = 0.07). Patients with RA were more likely to be diagnosed with OSA if they had traditional risk factors for OSA, including male sex, current smoking status, hypertension, diabetes, dyslipidemia, and increased body mass index. Features of RA disease associated with OSA included large joint swelling and joint surgery. Patients with RA with decreased renal function were also at higher risk of OSA. The increased risk of overall CVD among patients with RA who have OSA was similar to the increased CVD risk associated with OSA in the comparator cohort (interaction p = 0.86). OSA diagnosis was associated with an increased risk of both CVD (HR 1.9, 95% CI 1.08-3.27), and cerebrovascular disease (HR 2.4, 95% CI 1.14-5.26) in patients with RA. Patients with RA may be at increased risk of OSA secondary to both traditional and RA-related risk factors. Diagnosis with OSA predicts future CVD in RA and may provide an opportunity for CVD intervention.

Does Your Heart Forecast help practitioner understanding and confidence with cardiovascular disease risk communication?

PubMed

Wells, Sue; Kerr, Andrew; Broadbent, Elizabeth; MacKenzie, Craig; Cole, Karl; McLachlan, Andy

2011-03-01

Explaining what cardiovascular disease (CVD) risk means and engaging in shared decision-making regarding risk factor modification is challenging. An electronic CVD risk visualisation tool containing multiple risk communication strategies (Your Heart Forecast) was designed in 2009. To assess whether this tool facilitated explaining CVD risk to primary care patients. Health professionals who accessed a Primary Health Organisation website or who attended educational peer groups over a three-month period were invited to complete questionnaires before and after viewing a four-minute video about the tool. Respondents were asked to make an informed guess of the CVD risk of a 35-year-old patient (actual CVD risk 5%) and rate the following sentence as being true or false: 'If there were 100 people like Mr Andrews, five would go on to have a cardiac event in the next five years.' They also were asked to rank their understanding of CVD risk and confidence in explaining the concept to patients. Fifty health professionals (37 GPs, 12 practice nurses, one other) completed before and after questionnaires. Respondents' CVD risk estimates pre-video ranged from <5% to 25% and nine rated the sentence as being false. After the video, all respondents answered these questions correctly. Personal rankings from zero to 10 about understanding CVD risk and confidence in explaining risk reduced in range and shifted towards greater efficacy. Whether this tool facilitates discussions of CVD risk with patients and improves patient understanding and lifestyle behaviour needs to be evaluated in a randomised trial.

Biogeographic Ancestry, Self-Identified Race, and Admixture-Phenotype Associations in the Heart SCORE Study

PubMed Central

Halder, Indrani; Kip, Kevin E.; Mulukutla, Suresh R.; Aiyer, Aryan N.; Marroquin, Oscar C.; Huggins, Gordon S.; Reis, Steven E.

2012-01-01

Large epidemiologic studies examining differences in cardiovascular disease (CVD) risk factor profiles between European Americans and African Americans have exclusively used self-identified race (SIR) to classify individuals. Recent genetic epidemiology studies of some CVD risk factors have suggested that biogeographic ancestry (BGA) may be a better predictor of CVD risk than SIR. This hypothesis was investigated in 464 African Americans and 771 European Americans enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) Study in March and April 2010. Individual West African and European BGA were ascertained by means of a panel of 1,595 genetic ancestry informative markers. Individual BGA varied significantly among African Americans and to a lesser extent among European Americans. In the total cohort, BGA was not found to be a better predictor of CVD risk factors than SIR. Both measures predicted differences in the presence of the metabolic syndrome, waist circumference, triglycerides, body mass index, very low density lipoprotein cholesterol, lipoprotein A, and systolic and diastolic blood pressure between European Americans and African Americans. These results suggest that for most nongenetic cardiovascular epidemiology studies, SIR is sufficient for predicting CVD risk factor differences between European Americans and African Americans. However, higher body mass index and diastolic blood pressure were significantly associated with West African BGA among African Americans, suggesting that BGA should be considered in genetic cardiovascular epidemiology studies carried out among African Americans. PMID:22771727

A multiple biomarker risk score for guiding clinical decisions using a decision curve approach.

PubMed

Hughes, Maria F; Saarela, Olli; Blankenberg, Stefan; Zeller, Tanja; Havulinna, Aki S; Kuulasmaa, Kari; Yarnell, John; Schnabel, Renate B; Tiret, Laurence; Salomaa, Veikko; Evans, Alun; Kee, Frank

2012-08-01

We assessed whether a cardiovascular risk model based on classic risk factors (e.g. cholesterol, blood pressure) could refine disease prediction if it included novel biomarkers (C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin I) using a decision curve approach which can incorporate clinical consequences. We evaluated whether a model including biomarkers and classic risk factors could improve prediction of 10 year risk of cardiovascular disease (CVD; chronic heart disease and ischaemic stroke) against a classic risk factor model using a decision curve approach in two prospective MORGAM cohorts. This included 7739 men and women with 457 CVD cases from the FINRISK97 cohort; and 2524 men with 259 CVD cases from PRIME Belfast. The biomarker model improved disease prediction in FINRISK across the high-risk group (20-40%) but not in the intermediate risk group, at the 23% risk threshold net benefit was 0.0033 (95% CI 0.0013-0.0052). However, in PRIME Belfast the net benefit of decisions guided by the decision curve was improved across intermediate risk thresholds (10-20%). At p(t) = 10% in PRIME, the net benefit was 0.0059 (95% CI 0.0007-0.0112) with a net increase in 6 true positive cases per 1000 people screened and net decrease of 53 false positive cases per 1000 potentially leading to 5% fewer treatments in patients not destined for an event. The biomarker model improves 10-year CVD prediction at intermediate and high-risk thresholds and in particular, could be clinically useful at advising middle-aged European males of their CVD risk.

The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors.

PubMed

Thayer, Julian F; Yamamoto, Shelby S; Brosschot, Jos F

2010-05-28

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The understanding of the risk factors for CVD may yield important insights into the prevention, etiology, course, and treatment of this major public health concern. Autonomic imbalance, characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, is associated with various pathological conditions. Over time, excessive energy demands on the system can lead to premature aging and diseases. Therefore, autonomic imbalance may be a final common pathway to increased morbidity and mortality from a host of conditions and diseases, including cardiovascular disease. Heart rate variability (HRV) may be used to assess autonomic imbalances, diseases and mortality. Parasympathetic activity and HRV have been associated with a wide range of conditions including CVD. Here we review the evidence linking HRV to established and emerging modifiable and non-modifiable CVD risk factors such as hypertension, obesity, family history and work stress. Substantial evidence exists to support the notion that decreased HRV precedes the development of a number of risk factors and that lowering risk profiles is associated with increased HRV. We close with a suggestion that a model of autonomic imbalance may provide a unifying framework within which to investigate the impact of risk factors, including psychosocial factors and work stress, on cardiovascular disease. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study

PubMed Central

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-01-01

Objectives It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Design Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Setting Population-based survey in Australia. Participants 4487 women aged 20–69 years without heart disease, diabetes or stroke. Outcome measures Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Results Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Conclusions Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently. PMID:24503301

Anthropometric measurements of general and central obesity and the prediction of cardiovascular disease risk in women: a cross-sectional study.

PubMed

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-02-06

It is important to ascertain which anthropometric measurements of obesity, general or central, are better predictors of cardiovascular disease (CVD) risk in women. 10-year CVD risk was calculated from the Framingham risk score model, SCORE risk chart for high-risk regions, general CVD and simplified general CVD risk score models. Increase in CVD risk associated with 1 SD increment in each anthropometric measurement above the mean was calculated, and the diagnostic utility of obesity measures in identifying participants with increased likelihood of being above the treatment threshold was assessed. Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Population-based survey in Australia. 4487 women aged 20-69 years without heart disease, diabetes or stroke. Anthropometric obesity measures that demonstrated the greatest increase in CVD risk as a result of incremental change, 1 SD above the mean, and obesity measures that had the greatest diagnostic utility in identifying participants above the respective treatment thresholds of various risk score models. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio had larger effects on increased CVD risk compared with body mass index (BMI). These central obesity measures also had higher sensitivity and specificity in identifying women above and below the 20% treatment threshold than BMI. Central obesity measures also recorded better correlations with CVD risk compared with general obesity measures. WC and WHR were found to be significant and independent predictors of CVD risk, as indicated by the high area under the receiver operating characteristic curves (>0.76), after controlling for BMI in the simplified general CVD risk score model. Central obesity measures are better predictors of CVD risk compared with general obesity measures in women. It is equally important to maintain a healthy weight and to prevent central obesity concurrently.

The Rancho Bernardo Study: 40 years studying why women have less heart disease than men and how diabetes modifies women’s usual cardiac protection

PubMed Central

Barrett-Connor, Elizabeth

2013-01-01

Forty years ago, few cohort studies of cardiovascular disease (CVD) included women and fewer still included diabetes or glycemia as a risk factor. I describe here the Rancho Bernardo Study (RBS), a single-site, >40-year cohort study of sex differences in heart disease and how diabetes modifies women’s natural cardioprotection. More than 6000 participants were followed for morbidity and mortality, with nearly 3000 survivors (and death certificates for >85% of decedents). In RBS more than half of diabetes was undiagnosed without an oral glucose tolerance test (OGTT); more women than men had isolated post-challenge hyperglycemia (IPH) as their only glucose evidence of diabetes; men had more diabetes than women, with higher fasting but lower post-challenge glucose levels than women; women with diabetes had more classical CVD risk factors than men; excess risk-factor clustering partially explained how diabetes eradicates female cardioprotection. Post-challenge glucose was a stronger CVD risk factor than fasting glucose. Endogenous insulin was not an independent CVD risk factor in women or men. Men with higher testosterone levels developed less diabetes and had fewer metabolic syndrome components. In men higher total testosterone levels predicted a reduced risk of all-cause and CVD but not cancer mortality. In women both extremes of bioavailable testosterone predicted fatal coronary heart disease but not all-cause mortality. Summary point estimates from large systematic reviews of individual data have replicated most RBS findings. Ongoing research can further clarify how diabetes modifies women’s cardioprotection from mid-life to old age. PMID:24187655

Risk factors and assessment for cardiovascular disease among HIV-positive patients attending a Nigerian tertiary hospital.

PubMed

Osegbe, Ifeyinwa Dorothy; Soriyan, Oyetunji Olukayode; Ogbenna, Abiola Ann; Okpara, Henry Chima; Azinge, Elaine Chinyere

2016-01-01

Cardiovascular risk factors are prevalent in HIV-positive patients which places them at increased risk for cardiovascular disease (CVD). We aimed to determine the risk factors and risk assessment for CVD in HIV-positive patients with and without antiretroviral therapy. This was a cross-sectional study of HIV-positive patients attending the Lagos University Teaching Hospital, Nigeria. Anthropometric and blood pressure measurements were performed; fasting lipid profile, plasma glucose, homocysteine and hsCRP were determined, as well as prevalences and risk assessments. Statistical tests were used to compare the groups and p-value <0.05 was considered to be significant. 283 subjects were recruited for this study (100 HIV-positive treatment-naive, 100 HIV-positive treated and 83 HIV negative controls). Compared to the controls, mean (sd) values were significantly higher among HIV-treated subjects: waist circumference = 88.7 (10.4), p = 0.035; systolic bp= 124.9 (20.7), p = 0.014; glucose= 5.54 (1.7), p = 0.015; triglyceride= 2.0 (1.2), p < 0.001; homocysteine= 10.9 (8.9-16.2), p = 0.0003; while hsCRP= 2.9 (1.4-11.6), p = 0.002 and HDL-C = 0.9 (0.4), p = < 0.0001 were higher among the HIV-naïve subjects. Likewise, higher prevalences of the risk factors were noted among the HIV-treated subjects except low HDL-C (p < 0.001) and hsCRP (p = 0.03) which were higher in the HIV-naïve group. Risk assessment using ratios showed high risk for CVD especially in the HIV-naïve group. The median range for Framingham risk assessment was 1.0 - 7.5%. Risk factors and risk assessment for CVD are increased in HIV-positive patients with and without antiretroviral therapy. Routine evaluation and risk assessment for CVD irrespective of therapy status is necessary to prevent future cardiovascular events.

Improving diabetes care: Multi-component CArdiovascular Disease Risk Reduction Strategies for People with Diabetes in South Asia - The CARRS Multi-center Translation Trial

PubMed Central

Shah, Seema; Singh, Kavita; Ali, Mohammed K.; Mohan, V.; Kadir, Muhammad Masood; Unnikrishnan, A.G.; Sahay, Rakesh Kumar; Varthakavi, Premlata; Dharmalingam, Mala; Viswanathan, Vijay; Masood, Qamar; Bantwal, Ganapathi; Khadgawat, Rajesh; Desai, Ankush; Sethi, Bipin Kumar; Shivashankar, Roopa; Ajay, Vamadevan S; Reddy, K. Srinath; Narayan, K.M. Venkat; Prabhakaran, Dorairaj; Tandon, Nikhil

2012-01-01

Aims Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes in South Asia. The CARRS translation trial tests the effectiveness, cost-effectiveness, and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan. Methods We randomly assigned 1,146 adults with diabetes recruited from 10 urban clinic sites, to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention. The intervention involves electronic health record management, decision-support prompts to the healthcare team, and the support of a care coordinator to actively facilitate patient and provider adherence to evidence-based guidelines. The primary outcome is a composite of multiple CVD risk factor control (blood glucose and either blood pressure or cholesterol, or all three). Other outcomes include control of the individual CVD risk factors, process and patient-centered measures, cost-effectiveness, and acceptability/feasibility. Conclusion The CARRS translation trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients (clinicaltrials.gov number: NCT01212328). PMID:23084280

Associations of dietary intake patterns identified using reduced rank regression with markers of arterial stiffness among youth with type 1 diabetes.

PubMed

Lamichhane, A P; Liese, A D; Urbina, E M; Crandell, J L; Jaacks, L M; Dabelea, D; Black, M H; Merchant, A T; Mayer-Davis, E J

2014-12-01

Youth with type 1 diabetes (T1DM) are at substantially increased risk for adverse vascular outcomes, but little is known about the influence of dietary behavior on cardiovascular disease (CVD) risk profile. We aimed to identify dietary intake patterns associated with CVD risk factors and evaluate their impact on arterial stiffness (AS) measures collected thereafter in a cohort of youth with T1DM. Baseline diet data from a food frequency questionnaire and CVD risk factors (triglycerides, low density lipoprotein-cholesterol, systolic blood pressure, hemoglobin A1c, C-reactive protein and waist circumference) were available for 1153 youth aged ⩾10 years with T1DM from the SEARCH for Diabetes in Youth Study. A dietary intake pattern was identified using 33 food groups as predictors and six CVD risk factors as responses in reduced rank regression (RRR) analysis. Associations of this RRR-derived dietary pattern with AS measures (augmentation index (AIx75), n=229; pulse wave velocity, n=237; and brachial distensibility, n=228) were then assessed using linear regression. The RRR-derived pattern was characterized by high intakes of sugar-sweetened beverages (SSB) and diet soda, eggs, potatoes and high-fat meats and low intakes of sweets/desserts and low-fat dairy; major contributors were SSB and diet soda. This pattern captured the largest variability in adverse CVD risk profile and was subsequently associated with AIx75 (β=0.47; P<0.01). The mean difference in AIx75 concentration between the highest and the lowest dietary pattern quartiles was 4.3% in fully adjusted model. Intervention strategies to reduce consumption of unhealthy foods and beverages among youth with T1DM may significantly improve CVD risk profile and ultimately reduce the risk for AS.

Primary prevention of cardiovascular disease through population-wide motivational strategies: insights from using smartphones in stroke prevention

PubMed Central

Feigin, Valery L; Norrving, Bo; Mensah, George A

2017-01-01

The fast increasing stroke burden across all countries of the world suggests that currently used primary stroke and cardiovascular disease (CVD) prevention strategies are not sufficiently effective. In this article, we overview the gaps in, and pros and cons of, population-wide and high-risk prevention strategies. We suggest that motivating and empowering people to reduce their risk of having a stroke/CVD by using increasingly used smartphone technologies would bridge the gap in the population-wide and high-risk prevention strategies and reduce stroke/CVD burden worldwide. We emphasise that for primary stroke prevention to be effective, the focus should be shifted from high-risk prevention to prevention at any level of CVD risk, with the focus on behavioural risk factors. Such a motivational population-wide strategy could open a new page in primary prevention of not only stroke/CVD but also other non-communicable disorders worldwide. PMID:28589034

Primary prevention of cardiovascular disease through population-wide motivational strategies: insights from using smartphones in stroke prevention.

PubMed

Feigin, Valery L; Norrving, Bo; Mensah, George A

2016-01-01

The fast increasing stroke burden across all countries of the world suggests that currently used primary stroke and cardiovascular disease (CVD) prevention strategies are not sufficiently effective. In this article, we overview the gaps in, and pros and cons of, population-wide and high-risk prevention strategies. We suggest that motivating and empowering people to reduce their risk of having a stroke/CVD by using increasingly used smartphone technologies would bridge the gap in the population-wide and high-risk prevention strategies and reduce stroke/CVD burden worldwide. We emphasise that for primary stroke prevention to be effective, the focus should be shifted from high-risk prevention to prevention at any level of CVD risk, with the focus on behavioural risk factors. Such a motivational population-wide strategy could open a new page in primary prevention of not only stroke/CVD but also other non-communicable disorders worldwide.

Association of central blood pressure and cardiovascular diseases in diabetic patients with hypertension.

PubMed

Yang, Lei; Qin, Bo; Zhang, Xiaojuan; Chen, Yanrong; Hou, Jian

2017-10-01

To evaluate association of central blood pressure (BP) and cardiovascular disease (CVD) in diabetic patients with hypertension.This was a cross-section study and 360 participants were enrolled. Baseline characteristics were collected and indices of central BP including central systolic/diastolic BP (SBP/DBP), augmentation index adjusted for 75 beats per minute of heart rate (AIx@75) were measured. Participants were separated into with and without CVD groups and between-group differences were assessed. Linear regression analysis was used to evaluate potential risk factors for increased AIx@75. Logistic regression analysis was used to evaluate association between central SBP and AIx@75 with CVD.Mean age was 50.6 years and male participants accounted for 57.8%. Thirty-five and 43 participants had coronary heart disease and ischemic stroke. Compared with participants without CVD, those with CVD were more likely to be male and smokers and had higher glycated hemoglobin level. Additionally, participants with CVD had significantly higher central SBP and AIx@75 compared with those without CVD. Ageing, male gender, and presence of coronary heart disease and ischemic stroke were associated with increased AIx@75, whereas renin-angiotensin-axis inhibitor was associated with reduced AIx@75. After adjusted for traditional risk factors including brachial SBP, both central SBP, and AIx@75 remained significantly associated with CVD, with odds ratio and 95% confidence interval of 1.09 (1.08-1.31) and 1.20 (1.15-1.42), respectively.Diabetic patients with hypertension, ageing, male gender, and presence of CVD are independent risk factors of central BP increase; and increased central SBP and AIx@75 are significantly associated with CVD.

Using impedance cardiography to detect asymptomatic cardiovascular disease in prehypertensive adults with risk factors.

PubMed

DeMarzo, Arthur P

2013-06-01

Early detection of cardiovascular disease (CVD) in prehypertension could initiate appropriate treatment and prevent progression. Impedance cardiography (ICG) is a noninvasive technology that can be used to assess cardiovascular function. This study used ICG waveform analysis with postural change to detect CVD in asymptomatic prehypertensive adults over 40 years of age with no history of CVD and at least 2 cardiovascular risk factors: cigarette smoking, poor diet, physical inactivity, central obesity, family history of premature CVD, elevated blood glucose, and dyslipidemia. A study group of 25 apparently healthy adults was tested by ICG in standing and supine positions. Criteria for an age-matched control group of 16 healthy subjects included an active lifestyle, no risk factor, and no history of CVD. In addition to hemodynamic measurements of systemic vascular resistance (SVR) and cardiac index (CI), ICG used SVR to assess vascular resistive load, an index of arterial compliance and a widening of the systolic waveform to assess vascular pulsatile load, and waveform analysis and measured wave amplitude to detect ventricular dysfunction. All subjects in the study group had some abnormal ICG data, with an average of 2.9 ± 1.5 abnormalities per person. ICG indicated that 24 (96%) had elevated vascular load, 13 (52%) had some type of ventricular dysfunction, and 12 (48%) had abnormal hemodynamics. For the control group, ICG showed none (0%) with elevated vascular load, none (0%) with ventricular dysfunction, and 7 (44%) with high CI. Prehypertensives over 40 years of age with multiple risk factors have different cardiovascular abnormalities. This ICG test could be used as part of a prevention program for early detection of CVD. An abnormal ICG test could expedite the initiation of customized treatment that targets the subclinical CVD.

A Prospective Study of Different Types of Dietary Fiber and Risk of Cardiovascular Disease: Tehran Lipid and Glucose Study.

PubMed

Mirmiran, Parvin; Bahadoran, Zahra; Khalili Moghadam, Sajad; Zadeh Vakili, Azita; Azizi, Fereidoun

2016-11-07

This study was designed to examine the hypothesis that dietary of intake different types of fiber could modify the risk of cardiovascular disease (CVD) in a large prospective cohort among Iranian adults. In 2006-2008, we used a validated food frequency questionnaire to assess dietary fiber intake among 2295 health professionals with no previous history of heart disease. Subjects were subsequently followed until 2012 for incidence of CVD events. Multivariate Cox proportional hazard regression models, adjusted for potential confounders were used to estimate the risk of CVD across tertiles of total dietary fiber and different types of fiber. Linear regression models were also used to indicate the association of dietary fiber intakes with changes of cardiovascular risk factors during the follow-up. Mean age of participants (42.8% men) was 38.2 ± 13.4, at baseline. Mean (SD) dietary intake of total fiber was 23.4 (8.9) g/day. After adjustment for cardiovascular risk score and dietary confounders, a significant inverse association was observed between intakes of total, soluble and insoluble dietary fiber and CVD risk, in the highest compared to the lowest tertiles (HR = 0.39, 95% CI = 0.18-0.83, HR = 0.19, 95% CI = 0.09-0.41, and HR = 0.31, 95% CI = 0.14-0.69, respectively). Inverse relations were observed between risk of CVD and dietary fiber from legumes, fruits and vegetables; however, dietary fiber intake from grain and nut sources was not related to risk of CVD. Our findings confirmed that higher intakes of dietary fiber from different sources is associated with CVD events and modify its major risk-related factors.

A Prospective Study of Different Types of Dietary Fiber and Risk of Cardiovascular Disease: Tehran Lipid and Glucose Study

PubMed Central

Mirmiran, Parvin; Bahadoran, Zahra; Khalili Moghadam, Sajad; Zadeh Vakili, Azita; Azizi, Fereidoun

2016-01-01

Background and aim: This study was designed to examine the hypothesis that dietary of intake different types of fiber could modify the risk of cardiovascular disease (CVD) in a large prospective cohort among Iranian adults. Methods: In 2006–2008, we used a validated food frequency questionnaire to assess dietary fiber intake among 2295 health professionals with no previous history of heart disease. Subjects were subsequently followed until 2012 for incidence of CVD events. Multivariate Cox proportional hazard regression models, adjusted for potential confounders were used to estimate the risk of CVD across tertiles of total dietary fiber and different types of fiber. Linear regression models were also used to indicate the association of dietary fiber intakes with changes of cardiovascular risk factors during the follow-up. Results: Mean age of participants (42.8% men) was 38.2 ± 13.4, at baseline. Mean (SD) dietary intake of total fiber was 23.4 (8.9) g/day. After adjustment for cardiovascular risk score and dietary confounders, a significant inverse association was observed between intakes of total, soluble and insoluble dietary fiber and CVD risk, in the highest compared to the lowest tertiles (HR = 0.39, 95% CI = 0.18–0.83, HR = 0.19, 95% CI = 0.09–0.41, and HR = 0.31, 95% CI = 0.14–0.69, respectively). Inverse relations were observed between risk of CVD and dietary fiber from legumes, fruits and vegetables; however, dietary fiber intake from grain and nut sources was not related to risk of CVD. Conclusion: Our findings confirmed that higher intakes of dietary fiber from different sources is associated with CVD events and modify its major risk-related factors. PMID:27827978

The child as proband for future parental cardiometabolic disease: the 26-year prospective Princeton Lipid Research Clinics Follow-up Study.

PubMed

Morrison, John A; Glueck, Charles J; Wang, Ping

2012-04-01

To evaluate children's cardiovascular disease (CVD) risk factors as predictors of parents' subsequent CVD, type 2 diabetes mellitus (T2DM), and high blood pressure (HBP). We conducted a 26-year prospective follow-up of 852 5- to 19-year-old black and white schoolchildren (mean age, 12 years; Lipid Research Clinics, 1973-8), and parents (mean age, 40 years) from 519 families in Princeton Schools, Cincinnati, Ohio. Schoolchildren were reassessed in the Princeton Follow-up study 1999-2003 at mean age 39 years; CVD, T2DM, and HBP history of their 1038 parents were reassessed by mean age 66 years. We assessed relationships of childhood risk factors with parental CVD, T2DM, and HBP. Child-probands identified with triglyceride (TG) levels, blood pressure, low-density lipoprotein cholesterol levels, body mass index (BMI), and glucose level greater than and high-density lipoprotein cholesterol levels less than established cutoff points. Pediatric HBP (P=.006) and low high-density lipoprotein cholesterol (P=.018) were predictive of parental CVD at age ≤50 years. Pediatric HBP (P=.02) and high TG (P=.03) were predictive of parental CVD at age ≤60 years. Pediatric high TG (P=.009) and high low-density lipoprotein cholesterol (P=.04) were predictive of parental CVD by age 66 years. Pediatric high BMI (P=.0006) were predictive of parental T2DM. Pediatric high BMI (P=.003) and black race (P=.004) were predictive of parental HBP. Pediatric risk factors identify families with parents at increased risk for CVD, T2DM, and HBP, emphasizing the usefulness of the child as proband. Copyright © 2012 Mosby, Inc. All rights reserved.

Serial assessment of arterial stiffness by cardio-ankle vascular index for prediction of future cardiovascular events in patients with coronary artery disease.

PubMed

Otsuka, Kenichiro; Fukuda, Shota; Shimada, Kenei; Suzuki, Kenji; Nakanishi, Koki; Yoshiyama, Minoru; Yoshikawa, Junichi

2014-11-01

Arterial stiffness is a significant predictor of cardiovascular disease (CVD), the risk of which is modified by medications for atherosclerotic risk factors and life-style changes. Cardio-ankle vascular index (CAVI) provides noninvasive, objective information on arterial stiffness, independent of blood pressure. This study aimed to investigate changes in CAVI after management of atherosclerotic risk factors, and the impact of these changes on future CVD outcomes in patients with coronary artery disease (CAD). The study consisted of 211 CAD patients (65 ± 10 years, 118 men) with impaired CAVI. CAVI examination was repeated 6 months later. Impaired CAVI was defined as greater than the mean plus 1 s.d. of the age- and gender-specific normal CAVI values, according to results obtained in 5188 healthy subjects. All patients were followed for > 1 year or until the occurrence of a CVD event. Of the 211 patients, CAVI improved in 106 (50%) patients after 6 months, but remained high in 105 (50%) patients. During follow-up (2.9 ± 1.0 years), CVD events occurred in 28 (13%) patients. Persistently impaired CAVI was an independent predictor of future CVD events (P = 0.01), independent of baseline CAVI. CVD outcomes were worse in patients with persistently impaired CAVI than in those with improved CAVI (P < 0.001). Among patients with a normalized CAVI after treatment (n = 22) only one suffered a CVD event. This study was the first to demonstrate that persistent impairment of arterial stiffness was an independent risk factor of future CVD events. Serial measurements of CAVI provide important prognostic information regarding patients with CAD in clinical practice.

Isolated post-challenge hyperglycaemia and risk of cardiovascular events: Tehran Lipid and Glucose Study.

PubMed

Barzin, Maryam; Hosseinpanah, Farhad; Malboosbaf, Ramin; Hajsheikholeslami, Farhad; Azizi, Fereidoun

2013-07-01

To evaluate the risk of cardiovascular events in diabetes defined by isolated post-challenge hyperglycaemia (IPH). We followed 3794 subjects aged ≥40 years without known history of diabetes or cardiovascular disease (CVD) at baseline for CVD events. Participants were categorized as subjects without diabetes [fasting plasma glucose (FPG) < 126 mg/dL and 2-h post-challenge plasma glucose (2-hPG) < 200 mg/dL], IPH (FPG < 126 mg/dL and 2-h PG ≥ 200 mg/dL) and fasting hyperglycaemia (fasting blood glucose (FBS) ≥ 126 mg/dL). Hazard ratios (HRs) were calculated with the use of Cox proportional-hazards regression models to evaluate the risk of CVD events. At baseline, of 486 subjects with newly diagnosed diabetes, 190 (39%) had IPH. Over the next 8 years, age and sex-adjusted HR for incident CVD was 1.77 (95% confidence interval (CI): 1.19-2.64; p = 0.005) in subjects with IPH compared with subjects without diabetes. After further adjustment for potential confounders, the HR for CVD was not significant [1.32 (95% CI: 0.88-1.99; p = 0.2)]. IPH in middle-aged adults adds nothing for identifying CVD risks when other risk factors are taken into account. Associated metabolic risk factors seem to be more important than hyperglycaemia per se.

Cardiovascular risk factors among college students: Knowledge, perception, and risk assessment.

PubMed

Tran, Dieu-My T; Zimmerman, Lani M; Kupzyk, Kevin A; Shurmur, Scott W; Pullen, Carol H; Yates, Bernice C

2017-04-01

To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks. The final sample that responded to recruitment consisted of 158 college students from a midwestern university. A cross-sectional, descriptive study was performed using convenience sampling. College students were knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease (CVD). Knowledge of cardiovascular risk factors was correlated with the lifetime risk estimates (ρ = .17, p = .048), and perception of cardiovascular risk was positively associated with 30-year CVD risk estimates (ρ = .16, p = .048). More than 50% of the participants had 1 or more cardiovascular risk factors. High knowledge level of cardiovascular risk factors was not sufficient to lower cardiovascular risks within this study population, but changing perception of cardiovascular risk factors may play a bigger role in reducing long-term cardiovascular risks.

Is cardiovascular risk in women with PCOS a real risk? Current insights.

PubMed

Papadakis, Georgios; Kandaraki, Eleni; Papalou, Olga; Vryonidou, Andromachi; Diamanti-Kandarakis, Evanthia

2017-12-01

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive aged women. PCOS incorporates not only symptoms related to the reproductive system but also a clustering of systemic metabolic abnormalities that are linked with increased risk for cardiovascular disease (CVD). More specifically, metabolic aberrations such as impaired glucose and lipid metabolism, accompanied by increased low-grade inflammation as well as elevated coagulation factors appear to contribute to the increased cardiovascular risk. Even though many studies have indicated a rise in surrogate biomarkers of CVD in women with PCOS, it is still doubtful to what extent and magnitude this elevation can be translated to real cardiovascular events. Furthermore, the cardiovascular risk factors appear to vary significantly in the different phenotypes of the syndrome. Women with PCOS have the potential for early atherosclerosis, myocardial and endothelial dysfunction. Whether PCOS women are at real cardiovascular risk compared to controls remains between the verge of theoretical and real threat for the PCOS women at any age but particularly in the post-menopausal state. Interestingly, although the presence of the CVD risk factors is well documented in PCOS women, their combination on different phenotypes may play a role, which eventually results in a spectrum of clinical manifestations of CVD with variable degree of severity. The present manuscript aims to review the interaction between PCOS and the combination of several cardiovascular risk factors.

Radiation Risk of Cardiovascular Diseases in the Cohort of Russian Emergency Workers of the Chernobyl Accident.

PubMed

Kashcheev, V V; Chekin, S Yu; Karpenko, S V; Maksioutov, M A; Menyaylo, A N; Tumanov, K A; Kochergina, E V; Kashcheeva, P V; Gorsky, A I; Shchukina, N V; Lovachev, S S; Vlasov, O K; Ivanov, V K

2017-07-01

This paper continues a series of publications that analyze the impact of radiation on incidence of circulatory system diseases in the cohort of Russian recovery operation workers (liquidators) and presents the results of the analysis of cardiovascular disease (CVD) incidence. The studied cohort consists of 53,772 liquidators who arrived in the Chernobyl accident zone within the first year after the accident (26 April 1986 to 26 April 1987). The individual doses varied from 0.0001 Gy to 1.42 Gy, and the mean external whole body dose in the cohort was 0.161 Gy. A total of 27,456 cases of CVD were diagnosed during the follow-up period 1986-2012 as a result of annual health examinations. A Poisson regression model was applied to estimate radiation risks and other risk factors associated with CVD. The following factors were identified as risk factors for CVD: the dose, duration of the liquidators' work in the Chernobyl zone, and concomitant diseases (diabetes mellitus, hypertension, overweight, and alcohol dependence). The baseline incidence of CVD is statistically significantly (p < 0.001) associated with all studied concomitant diseases. The incidence of CVD has revealed a statistically significant dose response with the lack of a latent period and with the average ERR Gy = 0.47, 95% CI = 0.31, 0.63, p < 0.001. Radiation risks of CVD statistically significantly (p = 0.01) varied with the duration of liquidators' stay in the Chernobyl zone; for those who stayed in the Chernobyl zone less than 6 wk, ERR/Gy = 0.80, 95% CI = 0.53; 1.08, p < 0.001.

Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches.

PubMed

Chodara, Ann M; Wattiaux, Aimée; Bartels, Christie M

2017-04-01

ᅟ: The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. By critically reviewing literature published within the past 5 years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. We examine recent guidelines, recommendations, and evidence and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity, and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

Globalization, Work, and Cardiovascular Disease.

PubMed

Schnall, Peter L; Dobson, Marnie; Landsbergis, Paul

2016-10-01

Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in "upstream" factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD. © The Author(s) 2016.

Relative value of inflammatory, hemostatic, and rheological factors for incident myocardial infarction and stroke: the Edinburgh Artery Study.

PubMed

Tzoulaki, Ioanna; Murray, Gordon D; Lee, Amanda J; Rumley, Ann; Lowe, Gordon D O; Fowkes, F Gerald R

2007-04-24

The aim of our present study was to compare the association of a wide range of 17 biomarkers of inflammation, hemostasis, and blood rheology with incident heart disease and stroke after accounting for an indicator of subclinical atherosclerotic disease and traditional risk factors and also to determine their incremental predictive ability. We used data from the Edinburgh Artery Study, a population cohort study started in 1987 that comprised 1592 men and women aged 55 to 74 years. Subjects were followed for a mean of 17 years, and 416 of them suffered at least 1 cardiovascular event. In analyses adjusted for cardiovascular risk factors and history of cardiovascular disease (CVD): C-reactive protein, interleukin-6, fibrinogen, fibrin D-dimer, tissue plasminogen activator (t-PA), leukocyte elastase, and lipoprotein(a) (all P<0.01), as well as von Willebrand factor and plasma viscosity (both P<0.05), had significant hazard ratios for incident CVD. Further adjustment for a measure of subclinical atherosclerosis (ankle brachial index) had little impact on these associations. The hazard ratios (95% CI) for incident CVD between top and bottom tertiles in the latter analysis were 1.78 (1.30 to 2.45) for C-reactive protein, 1.85 (1.33 to 2.58) for interleukin-6, and 1.76 (1.35 to 2.31) for fibrinogen. Single biomarkers provided little additional discrimination of incident CVD to that obtained from cardiovascular risk factors and the ankle brachial index. An incremental score of multiple markers [interleukin-6, t-PA, intercellular adhesion molecule 1, and lipoprotein(a)] provided some added discrimination. Several "novel" risk factors predicted CVD after adjustments for conventional risk factors and also for a measure of asymptomatic disease. However, their incremental predictive ability was modest and their clinical utility remains uncertain.

Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

PubMed

Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

2016-11-01

Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

Plant-Based Nutrition: An Essential Component of Cardiovascular Disease Prevention and Management.

PubMed

Patel, Hena; Chandra, Sonal; Alexander, Sarah; Soble, Jeffrey; Williams, Kim Allan

2017-09-08

This review aims to summarize and discuss the role of plant-based nutrition as an adjunct to the management of cardiovascular disease (CVD). Discussion of nutrition and the benefits of a plant-based diet should be highlighted during healthcare provider visits as an essential part of the overall CVD prevention and management care plan. Evidence from prospective cohort studies indicates that a high consumption of predominantly plant-based foods, such as fruit and vegetables, nuts, and whole grains, is associated with a significantly lower risk of CVD. The protective effects of these foods are likely mediated through their multiple beneficial nutrients, including mono- and polyunsaturated fatty acids, omega-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In addition, minimizing intake of animal proteins has been shown to decrease the prevalence of CVD risk factors. Substantial evidence indicates that plant-based diets can play an important role in preventing and treating CVD and its risk factors. Such diets deserve more emphasis in dietary recommendations.

A Field Synopsis of Sex in Clinical Prediction Models for Cardiovascular Disease

PubMed Central

Paulus, Jessica K.; Wessler, Benjamin S.; Lundquist, Christine; Lai, Lana L.Y.; Raman, Gowri; Lutz, Jennifer S.; Kent, David M.

2017-01-01

Background Several widely-used risk scores for cardiovascular disease (CVD) incorporate sex effects, yet there has been no systematic summary of the role of sex in clinical prediction models (CPMs). To better understand the potential of these models to support sex-specific care, we conducted a field synopsis of sex effects in CPMs for CVD. Methods and Results We identified CPMs in the Tufts Predictive Analytics and Comparative Effectiveness (PACE) CPM Registry, a comprehensive database of CVD CPMs published from 1/1990–5/2012. We report the proportion of models including sex effects on CVD incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 592 CVD-related CPMs, 193 (33%) included sex as a predictor or presented sex-stratified models. Sex effects were included in 78% (53/68) of models predicting incidence of CVD in a general population, versus only 35% (59/171), 21% (12/58) and 17% (12/72) of models predicting outcomes in patients with coronary artery disease (CAD), stroke, and heart failure, respectively. Among sex-including CPMs, women with heart failure were at lower mortality risk in 8/8 models; women undergoing revascularization for CAD were at higher mortality risk in 10/12 models. Factors associated with the inclusion of sex effects included the number of outcome events and using cohorts at-risk for CVD (rather than with established CVD). Conclusions While CPMs hold promise for supporting sex-specific decision making in CVD clinical care, sex effects are included in only one third of published CPMs. PMID:26908865

Programming of cardiovascular disease across the life-course.

PubMed

Blackmore, Heather L; Ozanne, Susan E

2015-06-01

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality, affecting both developed and developing countries. Whilst it is well recognized that our risk of CVD can be determined by the interaction between our genetics and lifestyle, this only partly explains the variability at the population level. Based on these well-known risk factors, for many years, intervention and primary prevention strategies have focused on modifying lifestyle factors in adulthood. However, research shows that our risk of CVD can be pre-determined by our early life environment and this area of research is known as the Developmental Origins of Health and Disease. The aim of this review is to evaluate our current understanding of mechanisms underlying the programming of CVD. This article is part of a special issue entitled CV Aging. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of isoflavone-containing soya protein on ex vivo cholesterol efflux, vascular function and blood markers of CVD risk in adults with moderately elevated blood pressure: a dose-response randomised controlled trial.

PubMed

Richter, Chesney K; Skulas-Ray, Ann C; Fleming, Jennifer A; Link, Christina J; Mukherjea, Ratna; Krul, Elaine S; Kris-Etherton, Penny M

2017-05-01

Emerging CVD risk factors (e.g. HDL function and central haemodynamics) may account for residual CVD risk experienced by individuals who meet LDL-cholesterol and blood pressure (BP) targets. Recent evidence suggests that these emerging risk factors can be modified by polyphenol-rich interventions such as soya, but additional research is needed. This study was designed to investigate the effects of an isoflavone-containing soya protein isolate (delivering 25 and 50 g/d soya protein) on HDL function (i.e. ex vivo cholesterol efflux), macrovascular function and blood markers of CVD risk. Middle-aged adults (n 20; mean age=51·6 (sem 6·6) years) with moderately elevated brachial BP (mean systolic BP=129 (sem 9) mmHg; mean diastolic BP=82·5 (sem 8·4) mmHg) consumed 0 (control), 25 and 50 g/d soya protein in a randomised cross-over design. Soya and control powders were consumed for 6 weeks each with a 2-week compliance break between treatment periods. Blood samples and vascular function measures were obtained at baseline and following each supplementation period. Supplementation with 50 g/d soya protein significantly reduced brachial diastolic BP (-2·3 mmHg) compared with 25 g/d soya protein (Tukey-adjusted P=0·03) but not the control. Soya supplementation did not improve ex vivo cholesterol efflux, macrovascular function or other blood markers of CVD risk compared with the carbohydrate-matched control. Additional research is needed to clarify whether effects on these CVD risk factors depend on the relative health of participants and/or equol producing capacity.

Prevalence and determinants of cardiovascular disease risk factors among the residents of urban community housing projects in Malaysia

PubMed Central

2014-01-01

Objectives The objectives are to assess the prevalence and determinants of cardiovascular disease (CVD) risk factors among the residents of Community Housing Projects in metropolitan Kuala Lumpur, Malaysia. Method By using simple random sampling, we selected and surveyed 833 households which comprised of 3,722 individuals. Out of the 2,360 adults, 50.5% participated in blood sampling and anthropometric measurement sessions. Uni and bivariate data analysis and multivariate binary logistic regression were applied to identify demographic and socioeconomic determinants of the existence of having at least one CVD risk factor. Results As a Result, while obesity (54.8%), hypercholesterolemia (51.5%), and hypertension (39.3%) were the most common CVD risk factors among the low-income respondents, smoking (16.3%), diabetes mellitus (7.8%) and alcohol consumption (1.4%) were the least prevalent. Finally, the results from the multivariate binary logistic model illustrated that compared to the Malays, the Indians were 41% less likely to have at least one of the CVD risk factors (OR = 0.59; 95% CI: 0.37 - 0.93). Conclusion In Conclusion, the low-income individuals were at higher risk of developing CVDs. Prospective policies addressing preventive actions and increased awareness focusing on low-income communities are highly recommended and to consider age, gender, ethnic backgrounds, and occupation classes. PMID:25436515

Linking parent perceptions of children's weight to early coronary risk factors: results from the CARDIAC Project.

PubMed

Stabler, M E; Cottrell, L; Lilly, C

2014-01-01

Obesity is a public health threat because of the increasing prevalence in childhood and its causal relationship to the leading cause of death in America, heart disease. Detecting early signs of cardiovascular disease (CVD) risk factors in children and appropriately intervening to reverse the unhealthy trajectory associated with childhood obesity is of great importance. The objective of this study is to observe parental perception of their child's body mass index (BMI) and find associations between inaccurately estimated children and CVD risk factors. This study analyzed the association between 147 rural fifth grade students' lipid profiles and parents' self-reported survey who participated in the 2008-2011 Coronary Artery Risk Detection in Appalachian Communities study. After controlling for covariates, underestimated children were more likely to have higher log-transformed triglyceride and systolic blood pressure values and overestimated children were more likely to have lower systolic blood pressure. Underestimating a child's BMI is associated with coronary risk-related factors, while overestimating a child's BMI is associate with a protective CVD marker. A follow-up study examining the development of CVD risk factors in children of parents who inaccurately estimate their BMI would help clarify this relationship. Knowledge of how parental perceptions directly influence higher lipid levels in children could have an impact on public health efforts in the fight against childhood obesity in rural environments.

Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts.

PubMed

Hegmann, Kurt T; Thiese, Matthew S; Kapellusch, Jay; Merryweather, Andrew; Bao, Stephen; Silverstein, Barbara; Wood, Eric M; Kendall, Richard; Foster, James; Drury, David L; Garg, Arun

2017-05-30

The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. These data suggest a potentially modifiable disease mechanism for LE.

The link between chronic kidney disease and cardiovascular disease.

PubMed

Said, Sarmad; Hernandez, German T

2014-07-01

It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD.

The link between chronic kidney disease and cardiovascular disease

PubMed Central

Said, Sarmad; Hernandez, German T.

2014-01-01

Context: It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Results: Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. Conclusions: The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD. PMID:25093157

Prevalence of traditional and novel markers of cardiovascular disease risk in Scottish adolescents: socioeconomic effects.

PubMed

Buchan, Duncan S; Ollis, Stewart; Thomas, Non-Eleri; Simpson, Alan; Young, John D; Cooper, Stephen-Mark; Malina, Robert M; Cockcroft, John R; Baker, Julien S

2012-10-01

Information on the health status and physical activity of Scottish adolescents is limited. This study examines the prevalence of cardiovascular disease (CVD) risk in Scottish adolescents by socioeconomic status (SES). Participants were recruited from two high schools that differed in the SES of the students in attendance. The sample included 73 boys and 34 girls (16.4 ± 0.6 years). Variables included anthropometry, physical activity, physical fitness, blood pressure, diet, and 11 metabolic markers of CVD risk. Significant sex differences (P ≤ 0.01) were noted for stature, waist circumference, waist-hip ratio, physical activity, cardiorespiratory fitness, muscular power, sprint speed, and several CVD risk factors: high-density lipoprotein (HDL), low-density lipoprotein (LDL), interleukin-6 (IL-6), and C-reactive protein (CRP) levels. Boys from a lower SES had significantly higher levels of glucose and plasminogen activator inhibitor-1 (PAI-1) but lower levels of adiponectin compared with boys from a higher SES. Girls from a lower SES had significantly (P ≤ 0.01) higher glucose and PAI-1 levels but lower levels of insulin and adiponectin than girls from a higher SES. High fat diets, low physical activity levels, and elevated CRP and total cholesterol levels were the CVD risk factors most commonly identified as being at-risk levels in this cohort, regardless of sex or SES. SES differences were not consistently apparent, but several CVD risk factors were identified as elevated in this sample of adolescents, regardless of sex or SES.

Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study.

PubMed

Rao, N; Eastwood, S V; Jain, A; Shah, M; Leurent, B; Harvey, D; Robertson, L; Walters, K; Persaud, J W; Mikhailidis, D P; Nair, D R

2012-03-01

South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). A high prevalence of modifiable risk factors for CVD was detected in the population screened. © 2011 Blackwell Publishing Ltd.

Assessment of the agreement between the Framingham and DAD risk equations for estimating cardiovascular risk in adult Africans living with HIV infection: a cross-sectional study.

PubMed

Noumegni, Steve Raoul; Ama, Vicky Jocelyne Moor; Assah, Felix K; Bigna, Jean Joel; Nansseu, Jobert Richie; Kameni, Jenny Arielle M; Katte, Jean-Claude; Dehayem, Mesmin Y; Kengne, Andre Pascal; Sobngwi, Eugene

2017-01-01

The Absolute cardiovascular disease (CVD) risk evaluation using multivariable CVD risk models is increasingly advocated in people with HIV, in whom existing models remain largely untested. We assessed the agreement between the general population derived Framingham CVD risk equation and the HIV-specific Data collection on Adverse effects of anti-HIV Drugs (DAD) CVD risk equation in HIV-infected adult Cameroonians. This cross-sectional study involved 452 HIV infected adults recruited at the HIV day-care unit of the Yaoundé Central Hospital, Cameroon. The 5-year projected CVD risk was estimated for each participant using the DAD and Framingham CVD risk equations. Agreement between estimates from these equations was assessed using the spearman correlation and Cohen's kappa coefficient. The mean age of participants (80% females) was 44.4 ± 9.8 years. Most participants (88.5%) were on antiretroviral treatment with 93.3% of them receiving first-line regimen. The most frequent cardiovascular risk factors were abdominal obesity (43.1%) and dyslipidemia (33.8%). The median estimated 5-year CVD risk was 0.6% (25th-75th percentiles: 0.3-1.3) using the DAD equation and 0.7% (0.2-2.0) with the Framingham equation. The Spearman correlation between the two estimates was 0.93 ( p  < 0.001). The kappa statistic was 0.61 (95% confident interval: 0.54-0.67) for the agreement between the two equations in classifying participants across risk categories defined as low, moderate, high and very high. Most participants had a low-to-moderate estimated CVD risk, with acceptable level of agreement between the general and HIV-specific equations in ranking CVD risk.

History of preterm birth and subsequent cardiovascular disease: a systematic review

PubMed Central

Robbins, Cheryl L.; Hutchings, Yalonda; Dietz, Patricia M.; Kuklina, Elena V.; Callaghan, William M.

2015-01-01

A history of preterm birth (PTB) may be an important lifetime risk factor for cardiovascular disease (CVD) in women. We identified all peer-reviewed journal articles that met study criteria (English language, human studies, female, and adults ≥19 years old), that were found in the PubMed/MEDLINE databases, and that were published between Jan. 1, 1995, and Sept. 17, 2012. We summarized 10 studies that assessed the association between having a history of PTB and subsequent CVD morbidity or death. Compared with women who had term deliveries, women with any history of PTB had increased risk of CVD morbidity (variously defined; adjusted hazard ratio [aHR] ranged from 1.2e2.9; 2 studies), ischemic heart disease (aHR, 1.3e2.1; 3 studies), stroke (aHR, 1.7; 1 study), and atherosclerosis (aHR, 4.1; 1 study). Four of 5 studies that examined death showed that women with a history of PTB have twice the risk of CVD death compared with women who had term births. Two studies reported statistically significant higher risk of CVD—rerelated morbidity and death outcomes (variously defined) among women with —2 pregnancies that ended in PTBs compared with women who had at least 2 births but which ended in only 1 PTB. Future research is needed to understand the potential impact of enhanced monitoring of CVD risk factors in women with a history of PTB on risk of future CVD risk. PMID:24055578

Effects of Tea and Coffee Consumption on Cardiovascular Diseases and Relative Risk Factors: An Update.

PubMed

Di Lorenzo, Arianna; Curti, Valeria; Tenore, Gian C; Nabavi, Seyed M; Daglia, Maria

2017-01-01

Tea and coffee are the second and third most consumed beverages after water, respectively. The high consumption of these beverages is due to the sensorial properties and effects on psychological and physiological functions, induced by caffeine and many other bioactive components responsible for the protective effects on human health generally ascribed to these beverages. The goal of this review article is to collect the scientific data obtained from clinical trials published in the last five years on the role of tea and coffee consumption against cardiovascular diseases (CVDs) and CVD risk factors such as hypertension, hyperglicemia, and hyperlipidaemia. In normal weight subjects, clinical trials showed that the consumption of tea is inversely associated to CVD risk factors or no association was found. Differently, in overweight subjects, the clinical trials and the metaanalyses showed an inverse correlation between tea consumption and CVDs. As regards coffee, it has long been suspected to be associated to high risk of CVDs. Nevertheless, some recent investigations reported that moderate coffee consumption have no effect or even protective effects against CVDs risk factors. The results of the metaanalyses confirm this trend suggesting that moderate coffee drinkers could be associated to a lower risk of CVDs than non- or occasional coffee drinkers or no association can be demonstrated between coffee consumption and CVDs. Literature data on tea consumption and CVD risk factors support that tea consumption reduces some risk factors especially in overweight people and obese subjects. Therefore, these results seem to suggest that tea could exert a protective effects against CVD development. As regards coffee, the results are controversial and did not allow to draw conclusions. Therefore, further research is needed before definitive recommendations for coffee consumption against CVD development can be made. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Anxiety sensitivity in smokers with indicators of cardiovascular disease.

PubMed

Farris, Samantha G; Abrantes, Ana M

2017-09-01

There is growing recognition of the importance of understanding the nature of the associations between anxiety and cardiovascular disease (CVD), although limited research has examined mechanisms that may explain the anxiety-CVD link. Anxiety sensitivity (fear of anxiety-relevant somatic sensations) is a cognitive-affective risk factor implicated in the development of anxiety psychopathology and various behavioral risk factors for CVD, although has not been examined among individuals with CVD. Adult daily smokers (n = 619; 50.9% female; M age  = 44.0, SD = 13.67) completed an online survey that included the Anxiety Sensitivity Index-3 (ASI-3) and the Patient Health Questionnaire (PHQ). The presence of CVD was assessed via the presence of ≥1 of the following: heart attack, heart murmur, positive stress test, heart valve abnormality, angina, and heart failure. Smokers with CVD indicators (n = 66, 10.7%) had significantly higher scores on the ASI-3 (M = 33.5, SD = 22.15), relative to smokers without CVD (M = 22.0, SD = 17.92; Cohen's d = .57). Those with CVD were significantly more likely to have moderate or high anxiety sensitivity (66.7%) relative to those without CVD (49.4%). Physical and social concerns about the meaning of somatic sensations were common among smokers with CVD.

Lipid lowering with dietary supplements: focus on diabetes.

PubMed

Rudkowska, Iwona

2012-06-01

Cardiovascular disease (CVD) is the predominant cause of mortality in type 2 diabetic (T2DM) patients. Dyslipidemia is a modifiable risk factor that should be treated early for CVD prevention. Further, dietary supplement intake is increasing in popularity worldwide. This review examines the recent meta-analyses and clinical studies on dietary supplements, specifically psyllium, garlic and green tea, on plasma lipids levels and glycemic control, as well as other potential CVD risk factors in T2DM patients. Generally, results demonstrate that psyllium supplements improve lipid profiles as well as glycemic control beyond a traditional diet in patients with T2DM. On the other hand, the results on the usefulness of garlic and green tea supplementation for dyslipidemia and hyperglycemia are uncertain. Overall, the addition of dietary supplements may be a therapeutic alternative to lower CVD risk factors in T2DM; however, more well-designed intervention studies are needed to assess the benefit of these dietary supplements. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Integrative Cardiac Health Project, Windber Research Institute

DTIC Science & Technology

2015-07-01

ABSTRACT There is an increasing prevalence of obesity and cardiovascular disease (CVD) risk factors in the military population, which is negatively...and integrate information on dietary , behavioral, and lifestyle factors to provide important information on CVD risk reduction and (2) discover new...Outcomes 30 9. Other Achievements 30 10. References 30 11. Appendices 30 1. INTRODUCTION: There is an increasing prevalence of obesity and

Reduction in weight and cardiovascular diasease risk factors in individuals with type 2 diabetes: One-year results of the Look AHEAD trial

USDA-ARS?s Scientific Manuscript database

The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major C...

Cardiovascular Disease Among Transgender Adults Receiving Hormone Therapy: A Narrative Review.

PubMed

Streed, Carl G; Harfouch, Omar; Marvel, Francoise; Blumenthal, Roger S; Martin, Seth S; Mukherjee, Monica

2017-08-15

Recent reports estimate that 0.6% of adults in the United States, or approximately 1.4 million persons, identify as transgender. Despite gains in rights and media attention, the reality is that transgender persons experience health disparities, and a dearth of research and evidence-based guidelines remains regarding their specific health needs. The lack of research to characterize cardiovascular disease (CVD) and CVD risk factors in transgender populations receiving cross-sex hormone therapy (CSHT) limits appropriate primary and specialty care. As with hormone therapy in cisgender persons (that is, those whose sex assigned at birth aligns with their gender identity), existing research in transgender populations suggests that CVD risk factors are altered by CSHT. Currently, systemic hormone replacement for cisgender adults requires a nuanced discussion based on baseline risk factors and age of administration of exogenous hormones because of concern regarding an increased risk for myocardial infarction and stroke. For transgender adults, CSHT has been associated with the potential for worsening CVD risk factors (such as blood pressure elevation, insulin resistance, and lipid derangements), although these changes have not been associated with increases in morbidity or mortality in transgender men receiving CSHT. For transgender women, CSHT has known thromboembolic risk, and lower-dose transdermal estrogen formulations are preferred over high-dose oral formulations. In addition, many studies of transgender adults focus predominantly on younger persons, limiting the generalizability of CSHT in older transgender adults. The lack of randomized controlled trials comparing various routes and formulations of CSHT, as well as the paucity of prospective cohort studies, limits knowledge of any associations between CSHT and CVD.

Quantifying Socioeconomic and Lifestyle Related Health Risks: Burden of Cardiovascular Disease Among Indian Males

PubMed Central

Purohit, Neetu; Bhati, Divya K.; Gupta, Shiv D.; Kundu, Azad S.

2015-01-01

Background: Non-communicable diseases account for a significant disease burden in the South East Asia region. India is facing an increased incidence of lifestyle-related diseases, such as cardiovascular disease. Socioeconomic and lifestyle risk factors for cardiovascular disease (CVD) have been under investigated in India. This study was designed to explore risk factors contributing to the development of cardiovascular disease among Indian males. Methods: A population-based cross-sectional study was conducted among 2,235 males in the age group of 18–60 years across three states of India. A household survey was used to collect demographic and socioeconomic status information in addition to lifestyle-related attributes such as smoking, alcohol consumption, diet, and physical activity. Descriptive statistics and logistic regression were performed to identify the role of various factors that may be associated with the development of cardiovascular disease in this population. Results: The prevalence of cardiovascular disease among the male respondents contacted through a household survey was reported to be 9.8%. Logistic regression revealed that males with higher education and higher income were more likely to report CVD. With age as a strong predictor of CVD, the risk of CVD was found to be five times higher in the older age group. Current smokers were 1.3 times more likely to have CVD compared to those who never smoked. Those who were engaged in physical activity were less likely to have CVD; however, the adverse effects of smoking and excessive consumption of red meat showed a stronger association with CVD than the protective effects of physical activity. Conclusion: In developing countries, where the increase in earning capacity and change in lifestyle has been found to be accompanied by substantial risk of heart disease for males, public health measures like health promotion programs need to be implemented to decrease CVD burden. PMID:29138722

Lipid-related markers and cardiovascular disease prediction.

PubMed

Di Angelantonio, Emanuele; Gao, Pei; Pennells, Lisa; Kaptoge, Stephen; Caslake, Muriel; Thompson, Alexander; Butterworth, Adam S; Sarwar, Nadeem; Wormser, David; Saleheen, Danish; Ballantyne, Christie M; Psaty, Bruce M; Sundström, Johan; Ridker, Paul M; Nagel, Dorothea; Gillum, Richard F; Ford, Ian; Ducimetiere, Pierre; Kiechl, Stefan; Koenig, Wolfgang; Dullaart, Robin P F; Assmann, Gerd; D'Agostino, Ralph B; Dagenais, Gilles R; Cooper, Jackie A; Kromhout, Daan; Onat, Altan; Tipping, Robert W; Gómez-de-la-Cámara, Agustín; Rosengren, Annika; Sutherland, Susan E; Gallacher, John; Fowkes, F Gerry R; Casiglia, Edoardo; Hofman, Albert; Salomaa, Veikko; Barrett-Connor, Elizabeth; Clarke, Robert; Brunner, Eric; Jukema, J Wouter; Simons, Leon A; Sandhu, Manjinder; Wareham, Nicholas J; Khaw, Kay-Tee; Kauhanen, Jussi; Salonen, Jukka T; Howard, William J; Nordestgaard, Børge G; Wood, Angela M; Thompson, Simon G; Boekholdt, S Matthijs; Sattar, Naveed; Packard, Chris; Gudnason, Vilmundur; Danesh, John

2012-06-20

The value of assessing various emerging lipid-related markers for prediction of first cardiovascular events is debated. To determine whether adding information on apolipoprotein B and apolipoprotein A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 to total cholesterol and high-density lipoprotein cholesterol (HDL-C) improves cardiovascular disease (CVD) risk prediction. Individual records were available for 165,544 participants without baseline CVD in 37 prospective cohorts (calendar years of recruitment: 1968-2007) with up to 15,126 incident fatal or nonfatal CVD outcomes (10,132 CHD and 4994 stroke outcomes) during a median follow-up of 10.4 years (interquartile range, 7.6-14 years). Discrimination of CVD outcomes and reclassification of participants across predicted 10-year risk categories of low (<10%), intermediate (10%-<20%), and high (≥20%) risk. The addition of information on various lipid-related markers to total cholesterol, HDL-C, and other conventional risk factors yielded improvement in the model's discrimination: C-index change, 0.0006 (95% CI, 0.0002-0.0009) for the combination of apolipoprotein B and A-I; 0.0016 (95% CI, 0.0009-0.0023) for lipoprotein(a); and 0.0018 (95% CI, 0.0010-0.0026) for lipoprotein-associated phospholipase A2 mass. Net reclassification improvements were less than 1% with the addition of each of these markers to risk scores containing conventional risk factors. We estimated that for 100,000 adults aged 40 years or older, 15,436 would be initially classified at intermediate risk using conventional risk factors alone. Additional testing with a combination of apolipoprotein B and A-I would reclassify 1.1%; lipoprotein(a), 4.1%; and lipoprotein-associated phospholipase A2 mass, 2.7% of people to a 20% or higher predicted CVD risk category and, therefore, in need of statin treatment under Adult Treatment Panel III guidelines. In a study of individuals without known CVD, the addition of information on the combination of apolipoprotein B and A-I, lipoprotein(a), or lipoprotein-associated phospholipase A2 mass to risk scores containing total cholesterol and HDL-C led to slight improvement in CVD prediction.

Contribution of birth weight and adult waist circumference to cardiovascular disease risk in a longitudinal study.

PubMed

Tian, Jingyan; Qiu, Miaoyan; Li, Yanyun; Zhang, Xuan'e; Wang, Haiyan; Sun, Siming; Sharp, Nora Sebeca; Tong, Wenxin; Zeng, Hailuan; Zheng, Sheng; Song, Xiaomin; Wang, Weiqing; Ning, Guang

2017-08-29

To determine the association of birth weight (BW) and waist circumference (WC) on cardiovascular disease (CVD). The longitudinal cohort study consisted of 745 participants who were able to provide their birth weight information and were followed from 2002 to 2014. During the follow-up, 83 events of CVD were confirmed. After adjusting for confounding factors, subjects with birth weight <2500 g were at a significantly increased CVD risk when compared to subjects with birth weight between 2500-3999 g (OR 2·47, 95%CI, 1·07-5·71). When high waist circumference (HWC), a measurement of adult obesity, was incorporated into stratifying factors according to presence or absence of low birth weight (LBW, birth weight <2500 g), adjusted CVD risk was significantly elevated in -LBW/+ HWC group (OR 1·94, 95%CI, 1·10-3·43) and marginally significantly increased in +LBW/-HWC group (OR 2·94, 95%CI, 1·00-8·64). CVD risk was highest in subjects with LBW and HWC (+LBW/+HWC), OR 4·74 (95%CI, 1·48-15·21). Higher waist circumference in adulthood is an especially strong risk factor for cardiovascular disease among those small at birth. In this cohort, birth size and adiposity in adulthood interact to predict events of cardiovascular disease.

Dietary Inflammatory Index and Cardiovascular Risk and Mortality-A Meta-Analysis.

PubMed

Shivappa, Nitin; Godos, Justyna; Hébert, James R; Wirth, Michael D; Piuri, Gabriele; Speciani, Attilio F; Grosso, Giuseppe

2018-02-12

Diet and chronic inflammation have been suggested to be risk factors in the development of cardiovascular disease (CVD) and related mortality. The possible link between the inflammatory potential of diet measured through the Dietary Inflammatory Index (DII ® ) and CVD has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from 14 studies were eligible, of which two were case-control, eleven were cohort, and one was cross-sectional. Results from the random-effects meta-analysis showed a positive association between increasing DII, indicating a pro-inflammatory diet, and CVD. Individuals in the highest versus the lowest (reference) DII category showed a 36% increased risk of CVD incidence and mortality, with moderate evidence of heterogeneity (relative risk (RR) = 1.36, 95% confidence interval (CI): 1.19, 1.57; heterogeneity index I ² = 69%, p < 0.001). When analyzed as a continuous variable, results showed an increased risk of CVD risk and mortality of 8% for each one-point increase in the DII score. Results remained unchanged when analyses were restricted to the prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet for preventing CVD incidence and related mortality. In conclusion, a pro-inflammatory diet is associated with increased risk of CVD and CVD mortality. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CVD incidence and mortality.

Renal function, cardiovascular disease risk factors' prevalence and 5-year disease incidence; the role of diet, exercise, lipids and inflammation markers: the ATTICA study.

PubMed

Chrysohoou, C; Panagiotakos, D B; Pitsavos, C; Skoumas, J; Toutouza, M; Papaioannou, I; Stefanadis, C

2010-06-01

We aimed to evaluate the association between renal function and various cardiovascular disease (CVD) risk factors, as well as 5-year incidence of CVD, in a sample of CVD free adults. (i) Cross-sectional information from n = 1975. Greek men and women (>18 years) without CVD and hypertension at baseline examination and (ii) 5-year (2001-06) survival data from n = 2101 individuals without CVD at baseline, all participants in the ATTICA study, were analysed in this work. Kidney function was quantified by the baseline estimated creatinine clearance rate (C(cr)), using the Cockcroft-Gault formula and the National Kidney Foundation recommendations. Outcome of interest was the development of CVD that was defined according to WHO-ICD-10 criteria. At baseline, the prevalence of moderate-to-severe renal dysfunction (i.e. C(cr) < 60) was 2.8% in males and 7.7% in females. Physical activity status, cigarette smoking, hypercholesterolemia and homocysteine levels and greater adherence to the Mediterranean diet were inversely associated with C(cr) rate (P < 0.05), while no association was found with history of diabetes. During the 5-year follow-up, people with moderate-to-severe renal dysfunction as compared with normal, had 3.21 times higher CVD risk [95% confidence interval (CI) 1.98-5.19], after adjusting for history of hypertension (hazard ratio = 2.15, 95% CI 1.48-3.11), hypercholesterolemia (1.37, 0.98-1.98), diabetes (3.28, 2.15-5.00), smoking habits (0.89, 0.60-1.32) and physical activity status (0.86, 0.56-1.21). Renal function seems to be associated with the levels of lifestyle and bio-clinical CVD risk factors and contribute to the long-term incidence of cardiac events. Public health care practitioners should take into account renal function in better preventing the burden of CVD at individual, and population level, as well.

Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10-year prospective cohort study.

PubMed

Lim, Tae-Seok; Yun, Jae-Seung; Cha, Seon-Ah; Song, Ki-Ho; Yoo, Ki-Dong; Ahn, Yu-Bae; Park, Yong-Moon; Ko, Seung-Hyun

2016-11-01

Elevated lipoprotein(a) (Lp[a]) level is known to be a risk factor for cardiovascular disease (CVD). However, the data that has been reported on the association between the Lp(a) level and CVD in type 2 diabetes has been limited and incoherent. The aim of this study was to investigate the relationship between the Lp(a) concentration and new onset CVD in type 2 diabetes. From March 2003 to December 2004, patients with type 2 diabetes without a prior history of CVD were consecutively enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. Cox proportional hazards models were used to identify the associations between the Lp(a) and CVD after adjusting for confounding variables. Of the 1,183 patients who were enrolled, 833 participants were evaluated with a median follow-up time of 11.1 years. A total of 202 participants were diagnosed with CVD (24.2%). The median Lp(a) level for 1st and 4th quartile group was 5.4 (3.5 to 7.1) and 55.7 mg/dL (43.1 to 75.3). Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin and angiotensin converting enzyme inhibitors/angiotensin receptor blockers at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with serum Lp(a) level (hazard ratio, 1.92; 95% confidence interval [CI], 1.26 to 2.92; p < 0.001, comparing the 4th vs. 1st quartile of Lp[a]). Elevated Lp(a) level was an independent predictable risk factor for CVD in type 2 diabetes. Other cardiovascular risk factors should be treated more intensively in type 2 diabetic patients with high Lp(a) levels.

Cardiovascular disease in women and noncontraceptive use of hormones: a feminist analysis.

PubMed

MacPherson, K I

1992-06-01

Cardiovascular disease (CVD) in women is being defined by biomedical researchers and physicians as part of the menopausal syndrome. Postmenopausal lowered levels of estrogen are presented as a prime cause of changes in cholesterol levels that are a risk factor for CVD. The biomedical model and hormone debate are described and analyzed, followed by a feminist perspective of CVD. This includes new federal policies that support CVD research. Nurses are encouraged to present a broader picture of CVD and its risks than that presented by the biomedical model and to empower women's understanding of this complex health issue through educational, clinical, and research endeavors.

Review of controlled research on the transcendental meditation program and cardiovascular disease. Risk factors, morbidity, and mortality.

PubMed

Walton, Kenneth G; Schneider, Robert H; Nidich, Sanford

2004-01-01

Because of growing evidence for stress as a major factor contributing to cardiovascular disease (CVD), techniques of meditation are being increasingly used. The Transcendental Meditation (TM) technique is distinct from other techniques of meditation not only in its origin and procedure, but also in the amount and breadth of research testing it. Evidence for its ability to reduce traditional and novel risk factors for CVD includes: 1) decreases in blood pressure, 2) reduced use of tobacco and alcohol, 3) lowering of high cholesterol and lipid oxidation, and 4) decreased psychosocial stress. Changes expected to result from reducing these risk factors, namely, reversal of atherosclerosis, reduction of myocardial ischemia and left ventricular hypertrophy, reduced health insurance claims for CVD, and reduced mortality, also have been found with TM practice. Research on mechanisms suggests that some of the CVD-related benefits as a result of this technique could arise from normalization of neuroendocrine systems whose function has been distorted by chronic stress. Further randomized clinical trials are in progress with a focus on underserved minority populations.

Dietary patterns and the metabolic syndrome in obese and non-obese Framingham women.

PubMed

Sonnenberg, Lillian; Pencina, Michael; Kimokoti, Ruth; Quatromoni, Paula; Nam, Byung-Ho; D'Agostino, Ralph; Meigs, James B; Ordovas, Jose; Cobain, Mark; Millen, Barbara

2005-01-01

To examine the relationship between habitual dietary patterns and the metabolic syndrome (MetS) in women and to identify foci for preventive nutrition interventions. Dietary patterns, nutrient intake, cardiovascular disease (CVD), and MetS risk factors were characterized in 1615 Framingham Offspring-Spouse Study (FOS) women. Dietary pattern subgroups were compared for MetS prevalence and CVD risk factor status using logistic regression and analysis of covariance. Analyses were performed overall in women and stratified on obesity status; multivariate models controlled for age, apolipoprotein E (APOE) genotypes, and CVD risk factors. Food and nutrient profiles and overall nutritional risk of five non-overlapping habitual dietary patterns of women were identified including Heart Healthier, Lighter Eating, Wine and Moderate Eating, Higher Fat, and Empty Calories. Rates of hypertension and low high-density lipoprotein levels were high in non-obese women, but individual MetS risk factor levels were substantially increased in obese women. Overall MetS risk varied by dietary pattern and obesity status, independently of APOE and CVD risk factors. Compared with obese or non-obese women and women overall with other dietary patterns, MetS was highest in those with the Empty Calorie pattern (contrast p value: p<0.05). This research shows the independent relationship between habitual dietary patterns and MetS risk in FOS women and the influence of obesity status. High overall MetS risk and the varying prevalence of individual MetS risk factors in female subgroups emphasize the importance of preventive nutrition interventions and suggest potential benefits of targeted behavior change in both obese and non-obese women by dietary pattern.

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths.

PubMed

Kouvari, Matina; Yannakoulia, Mary; Souliotis, Kyriakos; Panagiotakos, Demosthenes B

2018-01-01

The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors.

PubMed

Schoormans, Dounya; van de Poll-Franse, Lonneke; Vissers, Pauline; van Herk-Sukel, Myrthe P P; Pedersen, Susanne S; Rottmann, Nina; Horsbøl, Trine; Dalton, Susanne; Denollet, Johan

2017-11-01

To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics in a population-based observational study. Adult 1-year breast cancer survivors (n = 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD, anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus in the year prior to cancer diagnosis, tumor stage, and cancer treatment. During the 13-year follow-up period, 193 (3%) breast cancer survivors developed CVD. Women pharmaceutically treated for anxiety in the year prior to their cancer diagnosis had a 48% increased hazard for CVD [HR = 1.48; 95% CI 1.05-1.08] after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk [HR = 0.89; 95% CI 0.52-1.53]. Older age [HR = 1.06; 95% CI 1.05-1.08], hypertension [HR = 1.80; 95% CI 1.32-2.46], and hypercholesterolemia [HR = 1.63; 95% CI 1.15-2.33] were associated with an increased hazard for incident CVD, whereas hormone therapy [HR = 0.59; 95% CI 0.42-0.83] was protective. Anxiety present in the year prior to breast cancer diagnosis increases the risk of incident CVD in 1-year breast cancer survivors, after adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics.

[Development and evaluation of a small group-based cardiocerebrovascular disease prevention education program for male bus drivers].

PubMed

Kim, Eun Young; Hwang, Seon Young

2012-06-01

This study was conducted to examine effects of a small group-based cardiocerebrovascular disease (CVD) prevention education program on knowledge, stage of change and health behavior among male bus drivers with CVD risk factors. A non-equivalent control group pretest-posttest design was used. Participants were 68 male bus drivers recruited from two urban bus companies. Participants from the two groups were selected by matching age, education and risk factors. Experimental group (n=34) received a small group-based CVD prevention education program 8 times over 6 weeks and 3 times through telephone interviews at 2-week intervals. Data were collected between December, 2010 and March, 2011, and were analyzed using chi-square test, t-test, and repeated measure analysis of variance with SPSS/Win18.0. Experimental group showed significantly higher scores in CVD prevention knowledge (p<.001) and health behavior (p<.001) at 6 and 12 weeks after intervention. Participants in pre-contemplation and contemplation stages made progress to contemplation and action. This was significantly better at 6 and 12 weeks after intervention (p<.001). Results suggest that small group-based education programs for CVD prevention are effective in increasing knowledge, stage of change, and health behavior to prevent CVD among male bus drivers with CVD risk.

Vitamin D and cardiometabolic health: a review of the evidence.

PubMed

Muldowney, Siobhan; Kiely, Mairead

2011-06-01

The cardiometabolic syndrome (MetS) is a clustering of related metabolic abnormalities including abdominal adiposity, insulin resistance, hypertension, dyslipidaemia and increased inflammatory and thrombotic markers, which is linked to increased risk of type 2 diabetes, CVD and overall mortality. Several cross-sectional and prospective studies have shown an association between low vitamin D status, as indicated by concentrations of serum 25-hydroxyvitamin D (s25(OH)D), and increased prevalence of the MetS and individual CVD risk factors. These epidemiological observations are supported by mechanistic studies but experimental data are limited. The available data from intervention studies are largely confounded as most vitamin D supplementation trials were mainly carried out to explore the role of Ca in CVD and include Ca in the treatment arms. Inadequate consideration of seasonal effects on s25(OH)D concentrations is also a common design flaw in most studies. Further complications arise from shared risk factors such as adiposity and ageing, which predispose individuals to exhibit both a more pronounced risk profile and relatively lower s25(OH)D concentrations. In conclusion, while epidemiological associations are promising and a rationale for low vitamin D status as a potentially modifiable risk factor for CVD is supported by mechanistic data, suitable experimental data from appropriately designed trials are just beginning to emerge. As yet, this body of literature is too immature to draw firm conclusions on the role of vitamin D in CVD prevention. Carefully controlled vitamin D trials in well-described population groups using intervention doses that are titrated against target s25(OH)D concentrations could yield potentially valuable outcomes that may have a positive impact on CVD risk modification.

Combined influence of healthy diet and active lifestyle on cardiovascular disease risk factors in adolescents.

PubMed

Cuenca-García, M; Ortega, F B; Ruiz, J R; González-Gross, M; Labayen, I; Jago, R; Martínez-Gómez, D; Dallongeville, J; Bel-Serrat, S; Marcos, A; Manios, Y; Breidenassel, C; Widhalm, K; Gottrand, F; Ferrari, M; Kafatos, A; Molnár, D; Moreno, L A; De Henauw, S; Castillo, M J; Sjöström, M

2014-06-01

To investigate the combined influence of diet quality and physical activity on cardiovascular disease (CVD) risk factors in adolescents, adolescents (n = 1513; 12.5-17.5 years) participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence study were studied. Dietary intake was registered using a 24-h recall and a diet quality index was calculated. Physical activity was assessed by accelerometry. Lifestyle groups were computed as: healthy diet and active, unhealthy diet but active, healthy diet but inactive, and unhealthy diet and inactive. CVD risk factor measurements included cardiorespiratory fitness, adiposity indicators, blood lipid profile, blood pressure, and insulin resistance. A CVD risk score was computed. The healthy diet and active group had a healthier cardiorespiratory profile, fat mass index (FMI), triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels and total cholesterol (TC)/HDL-C ratio (all P ≤ 0.05). Overall, active adolescents showed higher cardiorespiratory fitness, lower FMI, TC/HDL-C ratio, and homeostasis model assessment index and healthier blood pressure than their inactive peers with either healthy or unhealthy diet (all P ≤ 0.05). Healthy diet and active group had healthier CVD risk score compared with the inactive groups (all P ≤ 0.02). Thus, a combination of healthy diet and active lifestyle is associated with decreased CVD risk in adolescents. Moreover, an active lifestyle may reduce the adverse consequences of an unhealthy diet. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008.

PubMed

Balcázar, Héctor G; de Heer, Hendrik; Rosenthal, Lee; Aguirre, Melissa; Flores, Leticia; Puentes, Flor A; Cardenas, Victor M; Duarte, Maria O; Ortiz, Melchor; Schulz, Leslie O

2010-03-01

The high prevalence of cardiovascular disease (CVD) in the Hispanic population of the United States, together with low rates of health insurance coverage, suggest a potential cardiovascular health crisis. The objective of Project HEART (Health Education Awareness Research Team) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population. Project HEART took place from 2005 through 2008 as a randomized community trial with a community-based participatory research framework using promotores de salud (community health workers). A total of 328 participants with at least 1 CVD risk factor were selected by randomizing 10 US Census tracts in El Paso, Texas, to either the experimental or the control group. The experimental group (n = 192) was assigned to a series of 8 health classes using the Su Corazón, Su Vida curriculum. After 2 months of educational sessions, the group was followed for 2 months. The control group (n = 136) was given basic educational materials at baseline, and no other intervention was used. Main outcomes of interest included changes in health behaviors and clinical measures. Participants in the experimental group showed more awareness of CVD risk factors, more confidence in the control of these factors, and improved dietary habits (ie, lower salt and cholesterol intake, better weight-control practices) compared with the control group. Total cholesterol was 3% lower in the experimental than in the control participants, and nonhigh-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5% lower. The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community.

Worksite health and wellness programs: Canadian achievements & prospects.

PubMed

Després, Jean-Pierre; Alméras, Natalie; Gauvin, Lise

2014-01-01

Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area. Copyright © 2014 Elsevier Inc. All rights reserved.

Effectiveness of a national cardiovascular disease risk assessment program (NHS Health Check): results after one year.

PubMed

Artac, Macide; Dalton, Andrew R H; Majeed, Azeem; Car, Josip; Millett, Christopher

2013-08-01

We aimed to assess whether the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program, was associated with reduction in CVD risk in attendees after one year. We extracted data from patients aged 40-74 years, with high estimated CVD risk, who were registered with general practices in a deprived, culturally diverse setting in England. We included 4748 patients at baseline (July 2008-November 2009), with 3712 at follow-up (December 2009-March 2011). We used a pre-post study design to assess changes in global CVD risk, individual CVD risk factors and statin prescription in patients with a complete and partial Health Check. There were significant reductions in mean CVD risk score (28.2%; 95% confidence interval (CI)=27.3-29.1 to 26.2%; 95% CI, 25.4-27.1), diastolic blood pressure, total cholesterol levels and lipid ratios after one year in patients with a complete Health Check. Statin prescription increased from 14.0% (95% CI=11.9-16.0) to 60.6% (95% CI=57.7-63.5). The introduction of NHS Health Check was associated with significant but modest reductions in CVD risk among screened high-risk individuals. Further cost-effectiveness analysis and work accounting for uptake is required to assess whether the program can make significant changes to population health. Copyright © 2013 Elsevier Inc. All rights reserved.

Does Tai Chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review protocol.

PubMed

Yang, Guoyan; Li, Wenyuan; Cao, Huijuan; Klupp, Nerida; Liu, Jianping; Bensoussan, Alan; Kiat, Hosen; Chang, Dennis

2017-08-18

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Psychological risk factors such as stress, anxiety and depression are known to play a significant and independent role in the development and progression of CVD and its risk factors. Tai Chi has been reported to be potentially effective for health and well-being. It is of value to assess the effectiveness and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. We will include all relevant randomised controlled trials on Tai Chi for stress, anxiety, depression, psychological well-being and quality of life in people with CVD and cardiovascular risk factors. Literature searching will be conducted until 31 December 2016 from major English and Chinese databases. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software. Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies are identified. Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research on Tai Chi and CVDs. This review will summarise the evidence on Tai Chi for psychological well-being and quality of life in people with CVD and their risk factors. We anticipate that the results of this review would be useful for healthcare professionals and researchers on Tai Chi and CVDs. International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016042905. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

High prevalence of cardiovascular risk factors in Peruvian adolescents living in a peri-urban shantytown: a cross-sectional study.

PubMed

Abbs, Elizabeth S; Viñoles, José; Alarcón, Jorge O; Johnson, Heather M; Zunt, Joseph R

2017-05-22

Adults of the peri-urban Peruvian shantytown of Lomas de Zapallal have a high prevalence of risk factors for developing cardiovascular disease (CVD)-likely due to behavioral choices established during childhood and adolescence. To guide the development of community-based risk reduction programs, we assessed the prevalence of risk factors for developing CVD among adolescents. We collected cross sectional data from adolescents of Peruvian peri-urban shantytown to evaluate four domains of CVD risk factors: (1) clinical (blood pressure, fasting blood glucose, and blood lipids), (2) anthropometric (height, weight, and waist circumference), (3) behavioral (physical activity, diet, and substance abuse), and (4) psychosocial (mental health and violence). We enrolled 275 adolescents (56.4% female, mean age 14 years). Prevalence of overweight or obese status was 27.8%. High blood pressure was more common in males (37.4%) than females (20.5%) (p = 0.002). Total cholesterol was elevated (>170 mg/dL) in nearly half (45.5%) of the adolescents, and 71% had impaired fasting blood glucose (>100 mg/dL). Females were less likely to exercise daily (95.4%) than males (84.2%) (p = 0.002) but reported higher rates of depression (66.4%), anhedonia (67.6%), and self-harm behavior (37.9%) (all p < 0.01). Adolescents living in the peri-urban population of Puente Piedra had high prevalence of risk factors for future development of CVD; preventative efforts focused on improving nutrition, increasing physical inactivity, and addressing mental health conditions could reduce such risk factors.

Vitamin C supplementation for the primary prevention of cardiovascular disease.

PubMed

Al-Khudairy, Lena; Flowers, Nadine; Wheelhouse, Rebecca; Ghannam, Obadah; Hartley, Louise; Stranges, Saverio; Rees, Karen

2017-03-16

Vitamin C is an essential micronutrient and powerful antioxidant. Observational studies have shown an inverse relationship between vitamin C intake and major cardiovascular events and cardiovascular disease (CVD) risk factors. Results from clinical trials are less consistent. To determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of CVD. We searched the following electronic databases on 11 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid); Web of Science Core Collection (Thomson Reuters); Database of Abstracts of Reviews of Effects (DARE); Health Technology Assessment Database and Health Economics Evaluations Database in the Cochrane Library. We searched trial registers on 13 April 2016 and reference lists of reviews for further studies. We applied no language restrictions. Randomised controlled trials of vitamin C supplementation as a single nutrient supplement lasting at least three months and involving healthy adults or adults at moderate and high risk of CVD were included. The comparison group was no intervention or placebo. The outcomes of interest were CVD clinical events and CVD risk factors. Two review authors independently selected trials for inclusion, abstracted the data and assessed the risk of bias. We included eight trials with 15,445 participants randomised. The largest trial with 14,641 participants provided data on our primary outcomes. Seven trials reported on CVD risk factors. Three of the eight trials were regarded at high risk of bias for either reporting or attrition bias, most of the 'Risk of bias' domains for the remaining trials were judged as unclear, with the exception of the largest trial where most domains were judged to be at low risk of bias.The composite endpoint, major CVD events was not different between the vitamin C and placebo group (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.89 to 1.10; 1 study; 14,641 participants; low-quality evidence) in the Physicians Health Study II over eight years of follow-up. Similar results were obtained for all-cause mortality HR 1.07, 95% CI 0.97 to 1.18; 1 study; 14,641 participants; very low-quality evidence, total myocardial infarction (MI) (fatal and non-fatal) HR 1.04 (95% CI 0.87 to 1.24); 1 study; 14,641 participants; low-quality evidence, total stroke (fatal and non-fatal) HR 0.89 (95% CI 0.74 to 1.07); 1 study; 14,641 participants; low-quality evidence, CVD mortality HR 1.02 (95% 0.85 to 1.22); 1 study; 14,641 participants; very low-quality evidence, self-reported coronary artery bypass grafting (CABG)/percutaneous transluminal coronary angioplasty (PTCA) HR 0.96 (95% CI 0.86 to 1.07); 1 study; 14,641 participants; low-quality evidence, self-reported angina HR 0.93 (95% CI 0.84 to 1.03); 1 study; 14,641 participants; low-quality evidence.The evidence for the majority of primary outcomes was downgraded (low quality) because of indirectness and imprecision. For all-cause mortality and CVD mortality, the evidence was very low because more factors affected the directness of the evidence and because of inconsistency.Four studies did not state sources of funding, two studies declared non-commercial funding and two studies declared both commercial and non-commercial funding. Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle-aged and older male physicians from the USA. There is limited low- and very low-quality evidence currently on the effect of vitamin C supplementation and risk of CVD risk factors.

Cardiovascular Risk Factors in Severely Obese Adolescents

PubMed Central

Michalsky, Marc P.; Inge, Thomas H.; Simmons, Mark; Jenkins, Todd M.; Buncher, Ralph; Helmrath, Michael; Brandt, Mary L.; Harmon, Carroll M.; Courcoulas, Anita; Chen, Michael; Horlick, Mary; Daniels, Stephen R.; Urbina, Elaine M.

2015-01-01

IMPORTANCE Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. OBJECTIVE To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children’s Hospital in Columbus, Ohio; Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio; Texas Children’s Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children’s Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. MAIN OUTCOMES AND MEASURES This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. RESULTS The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI, 1.26–2.03]; P < .01) and elevated blood pressure (adjusted relative risk = 1.48 [95% CI, 1.16–1.89]; P < .01) were more likely in adolescent boys compared with adolescent girls. White individuals were at greater risk of having elevated triglyceride levels (adjusted relative risk = 1.76 [95% CI, 1.14–2.72]; P = .01) but were less likely to have impaired fasting glucose levels (adjusted relative risk = 0.58 [95% CI, 0.38–0.89]; P = .01). CONCLUSIONS AND RELEVANCE Numerous CVD risk factors are apparent in adolescents undergoing weight-loss surgery. Increasing body mass index and male sex increase the relative risk of specific CVD risk factors. These data suggest that even among severely obese adolescents, recognition and treatment of CVD risk factors is important to help limit further progression of disease. PMID:25730293

Independent associations of physical activity and cardiovascular fitness with cardiovascular risk in adults.

PubMed

Ekblom-Bak, Elin; Hellénius, Mai-Lis; Ekblom, Orjan; Engström, Lars-Magnus; Ekblom, Björn

2010-04-01

Uncertainty still exists whether physical activity (PA) and cardiovascular fitness (CF) contribute separately to cardiovascular disease (CVD) risk. This study examined the associations of PA and CF on individual as well as clustered CVD risk factors. Cross-sectional. Seven hundred and eighty-one men and 890 women, aged 20-65 years, from two random population-based samples of Swedish women and men were included. PA was assessed by questionnaire and CF was predicted by a submaximal cycle ergometry test. Waist circumference, blood pressure, and fasting levels of blood lipids were assessed and dichotomized by conventional cut-off points. Participants reporting high PA level benefited from lower triglycerides and atherogenic cholesterol levels, regardless of CF. Higher CF level was, regardless of PA, associated with lower risk for all risk factors. With regard to clustering of risk factors, each higher CF level was associated with a gradually reduced risk by half or more, independent of PA. Furthermore, being unfit but reporting high PA was associated with a 50% lower risk compared with being unfit and inactive. Furthermore, high reported PA was associated with an additional reduced risk among fit participants. In addition, an excess risk of interaction was found for waist circumference, triglycerides, and the clustered CVD risk between neither being sufficiently active nor being fit. This study suggests that both PA and CF are independently associated with lower cardiovascular risk, and that both variables should be taken into account when CVD risk is estimated.

Accounting for Selection Bias in Studies of Acute Cardiac Events.

PubMed

Banack, Hailey R; Harper, Sam; Kaufman, Jay S

2018-06-01

In cardiovascular research, pre-hospital mortality represents an important potential source of selection bias. Inverse probability of censoring weights are a method to account for this source of bias. The objective of this article is to examine and correct for the influence of selection bias due to pre-hospital mortality on the relationship between cardiovascular risk factors and all-cause mortality after an acute cardiac event. The relationship between the number of cardiovascular disease (CVD) risk factors (0-5; smoking status, diabetes, hypertension, dyslipidemia, and obesity) and all-cause mortality was examined using data from the Atherosclerosis Risk in Communities (ARIC) study. To illustrate the magnitude of selection bias, estimates from an unweighted generalized linear model with a log link and binomial distribution were compared with estimates from an inverse probability of censoring weighted model. In unweighted multivariable analyses the estimated risk ratio for mortality ranged from 1.09 (95% confidence interval [CI], 0.98-1.21) for 1 CVD risk factor to 1.95 (95% CI, 1.41-2.68) for 5 CVD risk factors. In the inverse probability of censoring weights weighted analyses, the risk ratios ranged from 1.14 (95% CI, 0.94-1.39) to 4.23 (95% CI, 2.69-6.66). Estimates from the inverse probability of censoring weighted model were substantially greater than unweighted, adjusted estimates across all risk factor categories. This shows the magnitude of selection bias due to pre-hospital mortality and effect on estimates of the effect of CVD risk factors on mortality. Moreover, the results highlight the utility of using this method to address a common form of bias in cardiovascular research. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Value of the Definition of Severe Familial Hypercholesterolemia for Stratification of Heterozygous Patients.

PubMed

Pérez-Calahorra, Sofia; Sánchez-Hernández, Rosa María; Plana, Núria; Marco-Benedi, Victoria; Pedro-Botet, Juan; Almagro, Fátima; Brea, Angel; Ascaso, Juan Francisco; Lahoz, Carlos; Civeira, Fernando

2017-03-01

Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol with co-dominant transmission and high risk of cardiovascular disease (CVD), although with high variability among subjects. Currently, CVD stratification tools for heterozygous FH (HeFH) are not available. A definition of severe HeFH has been recently proposed by the International Atherosclerosis Society (IAS), but it has not been validated. Our study aims to see clinical characteristics and prevalence of CVD in subjects defined as severe HeFH by IAS criteria. Probable or definite HeFH introduced in the Dyslipidemia Registry of Spanish Arteriosclerosis Society were analyzed by the IAS criteria. Univariate and multivariate analysis was used to assess the association of CVD with the IAS criteria. About 1,732 HeFH cases were analyzed. Severe HeFH had higher prevalence of familial history of CVD, personal history of tendon xanthomas, LDL cholesterol, and CVD than nonsevere HeFH. A total of 656 (77.1%) and 441 (50.1%) of men and women, respectively, fulfilled the IAS criteria of severe HeFH. In the univariate analysis, subjects defined as severe HeFH showed odds ratio 3.016 (95% CI 3.136 to 4.257, p <0.001) for CVD. However, when traditional risk factors were included in the multivariate analysis, only the presence of cholesterol >400 mg/dl had a statistically significant association with CVD odds ratio 8.76 (95% CI 3.90 to 19.69, p <0.001). In conclusion, the IAS definition of severe HeFH is not significantly associated with CVD when adjusted for classic risk factors. Risk stratification in HeFH is an important issue, but the proposed criteria do not seem to solve this problem. Copyright © 2016 Elsevier Inc. All rights reserved.

Classification Rule for 5-year Cardiovascular Diseases Risk using decision tree in Primary Care Chinese Patients with Type 2 Diabetes Mellitus.

PubMed

Wan, Eric Yuk Fai; Fong, Daniel Yee Tak; Fung, Colman Siu Cheung; Yu, Esther Yee Tak; Chin, Weng Yee; Chan, Anca Ka Chun; Lam, Cindy Lo Kuen

2017-11-10

Cardiovascular disease(CVD) is the leading cause of mortality among patients with type 2 diabetes mellitus(T2DM), and a risk classification model for CVD among primary care diabetic patients is pivotal for risk-based interventions and patient information. This study developed a simple tool for a 5-year CVD risk prediction for primary care Chinese patients with T2DM. A retrospective cohort study was conducted on 137,935 primary care Chinese T2DM patients aged 18-79 years without history of CVD between 1 January 2010 and 31 December 2010. New events of CVD of the cohort over a median follow up of 5 years were extracted from the medical records. A classification rule of 5-year CVD risk was obtained from the derivation cohort and validated in the validation cohort. Significant risk factors included in decision tree were age, gender, smoking status, diagnosis duration, obesity, unsatisfactory control on haemoglobin A1c and cholesterol, albuminuria and stage of chronic kidney disease, which categorized patients into five 5-year CVD risk groups(<5%; 5-9%; 10-14%; 15-19% and ≥20%). Taking the group with the lowest CVD risk, the hazard ratios varied from 1.92(1.77,2.08) to 8.46(7.75,9.24). The present prediction model performed comparable discrimination and better calibration from the plot compared to other current existing models.

Incremental Value of Repeated Risk Factor Measurements for Cardiovascular Disease Prediction in Middle-Aged Korean Adults: Results From the NHIS-HEALS (National Health Insurance System-National Health Screening Cohort).

PubMed

Cho, In-Jeong; Sung, Ji Min; Chang, Hyuk-Jae; Chung, Namsik; Kim, Hyeon Chang

2017-11-01

Increasing evidence suggests that repeatedly measured cardiovascular disease (CVD) risk factors may have an additive predictive value compared with single measured levels. Thus, we evaluated the incremental predictive value of incorporating periodic health screening data for CVD prediction in a large nationwide cohort with periodic health screening tests. A total of 467 708 persons aged 40 to 79 years and free from CVD were randomly divided into development (70%) and validation subcohorts (30%). We developed 3 different CVD prediction models: a single measure model using single time point screening data; a longitudinal average model using average risk factor values from periodic screening data; and a longitudinal summary model using average values and the variability of risk factors. The development subcohort included 327 396 persons who had 3.2 health screenings on average and 25 765 cases of CVD over 12 years. The C statistics (95% confidence interval [CI]) for the single measure, longitudinal average, and longitudinal summary models were 0.690 (95% CI, 0.682-0.698), 0.695 (95% CI, 0.687-0.703), and 0.752 (95% CI, 0.744-0.760) in men and 0.732 (95% CI, 0.722-0.742), 0.735 (95% CI, 0.725-0.745), and 0.790 (95% CI, 0.780-0.800) in women, respectively. The net reclassification index from the single measure model to the longitudinal average model was 1.78% in men and 1.33% in women, and the index from the longitudinal average model to the longitudinal summary model was 32.71% in men and 34.98% in women. Using averages of repeatedly measured risk factor values modestly improves CVD predictability compared with single measurement values. Incorporating the average and variability information of repeated measurements can lead to great improvements in disease prediction. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02931500. © 2017 American Heart Association, Inc.

Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial

USDA-ARS?s Scientific Manuscript database

BACKGROUND: Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD ri...

Prediction of Coronary Artery Disease Risk Based on Multiple Longitudinal Biomarkers

PubMed Central

Yang, Lili; Yu, Menggang; Gao, Sujuan

2016-01-01

In the last decade, few topics in the area of cardiovascular disease (CVD) research have received as much attention as risk prediction. One of the well documented risk factors for CVD is high blood pressure (BP). Traditional CVD risk prediction models consider BP levels measured at a single time and such models form the basis for current clinical guidelines for CVD prevention. However, in clinical practice, BP levels are often observed and recorded in a longitudinal fashion. Information on BP trajectories can be powerful predictors for CVD events. We consider joint modeling of time to coronary artery disease and individual longitudinal measures of systolic and diastolic BPs in a primary care cohort with up to 20 years of follow-up. We applied novel prediction metrics to assess the predictive performance of joint models. Predictive performances of proposed joint models and other models were assessed via simulations and illustrated using the primary care cohort. PMID:26439685

Dose-Response Relation between Work Hours and Cardiovascular Disease Risk: Findings from the Panel Study of Income Dynamics

PubMed Central

Conway, Sadie H.; Pompeii, Lisa A.; Roberts, Robert E.; Follis, Jack L.; Gimeno, David

2015-01-01

Objectives To examine the presence of a dose-response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers. Methods Retrospective cohort study of 1,926 individuals from the Panel Study of Income Dynamics (1986–2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose-response relationship of work hours with CVD. Results A dose-response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with increased risk of CVD. Compared to working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%. Conclusions Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD. PMID:26949870

Combination pharmacotherapy to prevent cardiovascular disease: present status and challenges.

PubMed

Yusuf, Salim; Attaran, Amir; Bosch, Jackie; Joseph, Philip; Lonn, Eva; McCready, Tara; Mente, Andrew; Nieuwlaat, Robby; Pais, Prem; Rodgers, Anthony; Schwalm, J-D; Smith, Richard; Teo, Koon; Xavier, Denis

2014-02-01

Combination pills containing aspirin, multiple blood pressure (BP) lowering drugs, and a statin have demonstrated safety, substantial risk factor reductions, and improved medication adherence in the prevention of cardiovascular disease (CVD). The individual medications in combination pills are already recommended for use together in secondary CVD prevention. Therefore, current information on their pharmacokinetics, impact on the risk factors, and tolerability should be sufficient to persuade regulators and clinicians to use fixed-dose combination pills in high-risk individuals, such as in secondary prevention. Long-term use of these medicines, in a polypill or otherwise, is expected to reduce CVD risk by at least 50-60% in such groups. This risk reduction needs confirmation in prospective randomized trials for populations for whom concomitant use of the medications is not currently recommended (e.g. primary prevention). Given their additive benefits, the combined estimated relative risk reduction (RRR) in CVD from both lifestyle modification and a combination pill is expected to be 70-80%. The first of several barriers to the widespread use of combination therapy in CVD prevention is physician reluctance to use combination pills. This reluctance may originate from the belief that lifestyle modification should take precedence, and that medications should be introduced one drug at a time, instead of regarding combination pills and lifestyle modification as complementary and additive. Second, widespread availability of combination pills is also impeded by the reluctance of large pharmaceutical companies to invest in development of novel co-formulations of generic (or 'mature') drugs. A business model based on 'mass approaches' to drug production, packaging, marketing, and distribution could make the combination pill available at an affordable price, while at the same time providing a viable profit for the manufacturers. A third barrier is regulatory approval for novel multidrug combination pills, as there are few precedents for the approval of combination products with four or more components for CVD. Acceptance of combination therapy in other settings suggests that with concerted efforts by academics, international health agencies, research funding bodies, governments, regulators, and pharmaceutical manufacturers, combination pills for prevention of CVD in those with disease or at high risk (e.g. those with multiple risk factors) can be made available worldwide at affordable prices. It is anticipated that widespread use of combination pills with lifestyle modifications can lead to substantial risk reductions (as much as an 80% estimated RRR) in CVD. Heath care systems need to deploy these strategies widely, effectively, and efficiently. If implemented, these strategies could avoid several millions of fatal and non-fatal CVD events every year worldwide.

Physician cardiovascular disease risk factor management: practice analysis in Japan versus the USA.

PubMed

Schuster, Richard J; Zhu, Ye; Ogunmoroti, Oluseye; Terwoord, Nancy; Ellison, Sylvia; Fujiyoshi, Akira; Ueshima, Hirotsugu; Muira, Katsuyuki

2013-01-01

There is a 42% lower cardiovascular disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in practice management of CVD risk factors in the two countries that might contribute to this difference? CVD risk factor management reported by Japanese versus US primary care physicians was studied. We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey. The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use practice guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001). Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing CVD risk factors deserves study. This descriptive report poses questions that require a more definitive study either with a more representative sample or direct observation of physician practices. US physicians responding to the survey reported greater administrative efforts, frustration and disparities in their practice, yet they followed practice guidelines more carefully. Japanese physicians responding reported focusing on quick, frequent visits that may have been more medication oriented, expecting more patient responsibility in self-care, which may have resulted in better chronic disease management. There may be differences in CVD risk factor management by primary care physicians in Japan versus the USA.

Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder.

PubMed

Turner, Jesse H; Neylan, Thomas C; Schiller, Nelson B; Li, Yongmei; Cohen, Beth E

2013-12-01

Patients with posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular disease (CVD), but few studies have included objective measures of CVD and how PTSD causes CVD remains unknown. We sought to determine the association between PTSD and objectively assessed CVD and examine potential underlying mechanisms. Outpatients from two Veterans Affairs Medical Centers were enrolled from 2008 to 2010. Posttraumatic stress disorder was identified using the Clinician Administered PTSD Scale, and standardized exercise treadmill tests were performed to detect myocardial ischemia. Of the 663 participants with complete data, ischemia was present in 17% of patients with PTSD versus 10% of patients without PTSD (p = .006). The association between PTSD and ischemia remained significant after adjusting for potential confounders (age, sex, prior CVD) and mediators (traditional cardiac risk factors, C-reactive protein, obesity, alcohol use, sleep quality, social support, and depression), adjusted odds ratio (OR) 2.42, 95% confidence interval (CI) 1.39 to 4.22, p = .002. Findings remained significant when those with prior CVD were excluded (fully adjusted OR 2.24, 95% CI 1.20-4.18, p = .01) and when continuous PTSD symptom score was used as the predictor (fully adjusted OR per 10-point change in Clinician Administered PTSD Scale score 1.12, 95% CI 1.03-1.22, p = .01). Posttraumatic stress disorder was associated with ischemic changes on exercise treadmill tests independent of traditional cardiac risk factors, C-reactive protein, and several health behaviors and psychosocial risk factors, suggesting additional mechanisms linking PTSD and ischemia should be explored. The association of PTSD and ischemia among patients without known CVD highlights an opportunity for early interventions to prevent progression of cardiovascular disease. Published by Elsevier Inc on behalf of Society of Biological Psychiatry.

Elevated levels of serum cholesterol are associated with better performance on tasks of episodic memory.

PubMed

Leritz, Elizabeth C; McGlinchey, Regina E; Salat, David H; Milberg, William P

2016-04-01

We examined how serum cholesterol, an established risk factor for cerebrovascular disease (CVD), relates to cognitive function in healthy middle-older aged individuals with no neurologic or CVD history. A complete lipid panel was obtained from a cohort of one hundred twenty individuals, ages 43-85, who also underwent a comprehensive neuropsychological examination. In order to reduce the number of variables and empirically identify broad cognitive domains, scores from neuropsychological tests were submitted into a factor analysis. This analysis revealed three explainable factors: Memory, Executive Function and Memory/Language. Three separate hierarchical multiple regression analyses were conducted using individual cholesterol metrics (total cholesterol, low density lipoprotein; LDL, high density lipoprotein; HDL, and triglycerides), as well as age, education, medication status (lipid lowering agents), ApoE status, and additional risk factors for CVD to predict neuropsychological function. The Memory Factor was predicted by a combination of age, LDL, and triglyceride levels; both age and triglycerides were negatively associated with factor score, while LDL levels revealed a positive relationship. Both the Executive and Memory/Language factor were only explained by education, whereby more years were associated with better performance. These results provide evidence that individual cholesterol lipoproteins and triglycerides may differentially impact cognitive function, over and above other common CVD risk factors and ApoE status. Our findings demonstrate the importance of consideration of vascular risk factors, such as cholesterol, in studies of cognitive aging.

Mobile phone text messaging for improving secondary prevention in cardiovascular diseases: A systematic review.

PubMed

Unal, Eda; Giakoumidakis, Konstantinos; Khan, Ehsan; Patelarou, Evridiki

2018-05-23

The aim of this study was to identify, retrieve, critically appraise and synthesize the existing mobile phone text messaging interventions that have been done for secondary prevention of cardiovascular disease (CVD). A systematic review was conducted. The searching was conducted by using the MEDLINE, EMBASE, PsychINFO, CINAHL, PubMed and ScienceDirect databases. Nine randomized controlled trials (RCTs) were eligible and included. The preventive factors measured among studies varied. While the majority of studies examined medication adherence as a main outcome (4), the other 3 studies focused of CVD risk factors combining blood pressure (BP), smoking, body mass index (BMI), physical activity and dietary habits, only 2 studies examined both medication adherence and risk factor modification of CVD. Even though mobile phone text messaging may be beneficial for the secondary prevention of CVD, reliable conclusions on the effects of text messaging cannot be drawn. Copyright © 2018 Elsevier Inc. All rights reserved.

Evolution of Cardiovascular Disease During the Transition to End-Stage Renal Disease.

PubMed

Bansal, Nisha

2017-03-01

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The rate of death in incident dialysis patients remains high. This has led to interest in the study of the evolution of CVD during the critical transition period from CKD to ESRD. Understanding the natural history and risk factors of clinical and subclinical CVD during this transition may help guide the timing of appropriate CVD therapies to improve outcomes in patients with kidney disease. This review provides an overview of the epidemiology of subclinical and clinical CVD during the transition from CKD to ESRD and discusses clinical trials of CVD therapies to mitigate risk of CVD in CKD and ESRD patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Epidemiology of diabetes mellitus and associated cardiovascular risk factors: focus on human immunodeficiency virus and psychiatric disorders.

PubMed

Zimmet, Paul

2005-04-01

Type 2 diabetes mellitus and obesity have reached epidemic proportions in many developing and developed nations, leading to talk of the "twin epidemics." The latest projections from the International Diabetes Federation suggest that 190 million people worldwide currently have type 2 diabetes. In addition, > or = 300 million people worldwide have impaired glucose tolerance (IGT). These statistics represent an epidemic of major proportions--possibly the largest epidemic in human history--in terms of glucose intolerance and cardiovascular disease (CVD) risk because individuals with IGT are at substantially higher risk for diabetes and CVD than are members of the general population. Along with IGT, the metabolic syndrome comprises other major CVD risk factors, including insulin resistance, central obesity, and dyslipidemia; insulin resistance has been implicated as the single most common cause of the syndrome. Although the exact prevalence of the metabolic syndrome is unknown, the syndrome is widespread among adults in developed nations, becoming more prevalent with age. Epidemiologic data suggest that in patients with schizophrenia or affective disorders, both diabetes and obesity are 1.5 to 2.0 times more prevalent than in the general population. Furthermore, because adverse effects of certain therapies for human immunodeficiency virus (HIV) infection and psychiatric disorders increase the risk for developing diabetes, obesity, and the metabolic syndrome, such therapies should be carefully chosen, particularly considering CVD risk. Appropriate therapy may be determined via screening of patients for levels of fasting blood glucose and lipids, as well as other CVD risk factors, before initiating use of second-generation antipsychotic agents or highly active antiretroviral therapy.

Cardiovascular Disease After Aromatase Inhibitor Use.

PubMed

Haque, Reina; Shi, Jiaxiao; Schottinger, Joanne E; Chung, Joanie; Avila, Chantal; Amundsen, Britta; Xu, Xiaoqing; Barac, Ana; Chlebowski, Rowan T

2016-12-01

Cardiovascular disease (CVD) is an important cause of death in older patients with breast cancer. However, limited information exists on the long-term effect of aromatase inhibitor (AI) use on CVD risk in breast cancer survivors. To this point, no other population-based studies have been able to adjust for CVD risk factors or cardiovascular medications. To determine the long-term influence of adjuvant endocrine therapies on CVD in a cohort of postmenopausal breast cancer survivors in analyses that accounted for major CVD risk factors, medication use, chemotherapy, and radiotherapy. A retrospective cohort of postmenopausal women with breast cancer diagnosed from January 1, 1991, to December 31, 2010, and followed up through December 31, 2011 (maximum, 21 years [72 886 person-years]), was evaluated using records from a managed care organization with nearly 20 community hospitals in California. A total of 13 273 postmenopausal women with hormone receptor-positive breast cancer without prior CVD were included. Cardiovascular disease incidence was compared across endocrine therapy categories. Information on demographics, comorbidity, medication, use, and CVD risk was captured from electronic health records. Multivariate Cox proportional hazards models using time-dependent endocrine drug use variables and propensity scores were conducted. Data analysis was conducted from September 15, 2014, to February 1, 2016. Women were grouped by endocrine therapy status (tamoxifen citrate only, AI only, both, or neither). Person-year rates of CVD for each therapy group. During 72 886 person-years in 13 273 women (mean [SD] age, 66.8 [8.1] years) with follow-up through 2011, we observed 3711 CVD events. In multivariable analyses (reported as hazard ratio [95% CI]), AI-only users had a similar risk of cardiac ischemia (myocardial infarction and angina) (adjusted, 0.97 [0.78-1.22]) and stroke (adjusted, 0.97 [0.70-1.33]) as tamoxifen-only users (reference). However, we found an increased risk of other CVD (dysrhythmia, valvular dysfunction, and pericarditis) (adjusted, 1.29 [1.11-1.50]) in women who used AIs only or sequentially after tamoxifen (1.26 [1.09-1.45]) vs tamoxifen (reference) as well nonhormone users (1.18 [1.02-1.35]). The risk of the most serious cardiovascular events (cardiac ischemia or stroke) was not elevated in AI-only users compared with tamoxifen users. The finding that other CVD events combined were greater in AI users requires further study.

Association of educational status with cardiovascular disease: Teheran Lipid and Glucose Study.

PubMed

Hajsheikholeslami, Farhad; Hatami, Masumeh; Hadaegh, Farzad; Ghanbarian, Arash; Azizi, Fereidoun

2011-06-01

The aim of this study was to evaluate the associations between educational level and cardiovascular disease (CVD) in an older Iranian population. To estimate the odds ratio (OR) of educational level in a cross-sectional study, logistic regression analysis was used on 1,788 men and 2,204 women (222 men and 204 women positive based on their CVD status) aged ≥ 45 years. In men, educational levels of college degree and literacy level below diploma were inversely associated with CVD in the multivariate model [0.52 (0.28-0.94), 0.61 (0.40-0.92), respectively], but diploma level did not show any significant association with CVD, neither in the crude model nor in the multivariate model. In women, increase in educational level was inversely associated with risk of CVD in the crude model, but in the multivariate adjusted model, literacy level below diploma decreased risk of CVD by 39%, compared with illiteracy. Our findings support those of developed countries that, along with other CVD risk factors, educational status has an inverse association with CVD among a representative Iranian population of older men and women.

Cardiovascular disease and type 1 diabetes: prevalence, prediction and management in an ageing population

PubMed Central

Lee, Siang Ing; Patel, Mitesh; Jones, Christopher M.; Narendran, Parth

2015-01-01

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1D). However, evidence of its risks and management is often extrapolated from studies in type 2 diabetic (T2D) patients or the general population. This approach is unsatisfactory given that the underlying pathology, demographics and natural history of the disease differ between T1D and T2D. Furthermore, with a rising life expectancy, a greater number of T1D patients are exposed to the cardiovascular (CV) risk factors associated with an ageing population. The aim of this review is to examine the existing literature around CVD in T1D. We pay particular attention to CVD prevalence, how well we manage risk, potential biomarkers, and whether the studies included the older aged patients (defined as aged over 65). We also discuss approaches to the management of CV risk in the older aged. The available data suggest a significant CVD burden in patients with T1D and poor management of CV risk factors. This is underpinned by a poor evidence base for therapeutic management of CV risk specifically for patients with T1D, and in the most relevant population – the older aged patients. We would suggest that important areas remain to be addressed, particularly exploring the risks and benefits of therapeutic approaches to CVD management in the older aged. PMID:26568811

Burden of cardiovascular risk factors and disease among patients with type 1 diabetes: results of the Australian National Diabetes Audit (ANDA).

PubMed

Pease, Anthony; Earnest, Arul; Ranasinha, Sanjeeva; Nanayakkara, Natalie; Liew, Danny; Wischer, Natalie; Andrikopoulos, Sofianos; Zoungas, Sophia

2018-06-02

Cardiovascular risk stratification is complex in type 1 diabetes. We hypothesised that traditional and diabetes-specific cardiovascular risk factors were prevalent and strongly associated with cardiovascular disease (CVD) among adults with type 1 diabetes attending Australian diabetes centres. De-identified, prospectively collected data from patients with type 1 diabetes aged ≥ 18 years in the 2015 Australian National Diabetes Audit were analysed. The burden of cardiovascular risk factors [age, sex, diabetes duration, glycated haemoglobin (HbA1c), blood pressure, lipid profile, body mass index, smoking status, retinopathy, renal function and albuminuria] and associations with CVD inclusive of stroke, myocardial infarction, coronary artery bypass graft surgery/angioplasty and peripheral vascular disease were assessed. Restricted cubic splines assessed for non-linearity of diabetes duration and likelihood ratio test assessed for interactions between age, diabetes duration, centre type and cardiovascular outcomes of interest. Discriminatory ability of multivariable models were assessed with area under the receiver operating characteristic (ROC) curves. Data from 1169 patients were analysed. Mean (± SD) age and median diabetes duration was 40.0 (± 16.7) and 16.0 (8.0-27.0) years respectively. Cardiovascular risk factors were prevalent including hypertension (21.9%), dyslipidaemia (89.4%), overweight/obesity (56.4%), ever smoking (38.5%), albuminuria (31.1%), estimated glomerular filtration rate < 60 mL/min/1.73 m 2 (10.3%) and HbA1c > 7.0% (53 mmol/mol) (81.0%). Older age, longer diabetes duration, smoking and antihypertensive therapy use were positively associated with CVD, while high density lipoprotein-cholesterol and diastolic blood pressure were negatively associated (p < 0.05). Association with CVD and diabetes duration remained constant until 20 years when a linear increase was noted. Longer diabetes duration also had the highest population attributable risk of 6.5% (95% CI 1.4, 11.6). Further, the models for CVD demonstrated good discriminatory ability (area under the ROC curve 0.88; 95% CI 0.84, 0.92). Cardiovascular risk factors were prevalent and strongly associated with CVD among adults with type 1 diabetes attending Australian diabetes centres. Given the approximate J-shaped association between type 1 diabetes duration and CVD, the impact of cardiovascular risk stratification and management before and after 20 years duration needs to be further assessed longitudinally. Diabetes specific cardiovascular risk stratification tools incorporating diabetes duration should be an important consideration in future guideline development.

Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis.

PubMed

Hussein, Mustafa; Diez Roux, Ana V; Mujahid, Mahasin S; Hastert, Theresa A; Kershaw, Kiarri N; Bertoni, Alain G; Baylin, Ana

2017-11-23

Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. We show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these two mechanisms. We specifically estimated contributions via these mechanisms of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) until the first CVD event (median follow-up 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood, psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure), and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggests that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounts for most of inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female gender, and White race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality, and could have important implications for intervention. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Effects of Chronic Aerobic Exercise on Cardiovascular Risk Factors in Persons with Diabetes Mellitus.

PubMed

Miele, Emily M; Headley, Samuel A E

2017-09-12

Aerobic exercise training is a component of diabetes mellitus (DM) care guidelines due to its favorable effects on glycemic control and cardiovascular disease (CVD) risk factors. The purpose of this review is to outline the recent evidence regarding the clinical effects of chronic aerobic exercise on CVD risk factors in persons with DM and to compare the effects of varying intensities and types of exercise. Among individuals with DM, all types of aerobic exercise training can impact positively on some traditional and non-traditional risk factors for CVD. Training programs with a higher volume or intensity induce greater improvements in vascular function, cardiorespiratory fitness (CRF), and lipid profiles. The beneficial outcomes of aerobic training include improvements in glycemic control, endothelial function, oxidative stress, dyslipidemia, myocardial function, adiposity, and CRF. Findings regarding markers of inflammation are discrepant and further research should focus on the role of exercise to impact upon the chronic inflammation associated with DM.

Disparities in Management of Cardiovascular Disease in Rural South Africa: Data From the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of International Network for the Demographic Evaluation of Populations and Their Health Communities).

PubMed

Jardim, Thiago Veiga; Reiger, Sheridan; Abrahams-Gessel, Shafika; Crowther, Nigel J; Wade, Alisha; Gómez-Olivé, F Xavier; Salomon, Joshua; Tollman, Stephen; Gaziano, Thomas A

2017-11-01

Optimal secondary prevention is critical for the reduction of repeated cardiovascular events, and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. We recruited adults aged ≥40 years residing in the Agincourt subdistrict of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, human immunodeficiency virus status, and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Of 5059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2%, and myocardial infarction in 3.7%. Percent controlled of the 5 individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; body mass index 33.8%; low-density lipoprotein 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all 5 risk factors controlled and 42.4% had ≥3 risk factors controlled. Male sex (β coefficient=0.44; 95% confidence interval, 0.25-0.63; P <0.001), absence of physical disability (β coefficient=0.40; 95% confidence interval, 0.16-0.65; P =0.001), and socioeconomic status (β coefficient=0.10; 95% confidence interval, 0.01-0.19; P =0.035) were directly associated with the number of risk factors controlled. Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, socioeconomic status, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower socioeconomic status, and those with physical disabilities. © 2017 American Heart Association, Inc.

Traditional dietary pattern is associated with elevated cholesterol among the Inuit of Nunavik.

PubMed

Labonté, Marie-Ève; Dewailly, Eric; Lucas, Michel; Chateau-Degat, Marie-Ludivine; Couture, Patrick; Lamarche, Benoît

2014-08-01

Our cross-sectional study assessed the associations between dietary patterns and cardiovascular disease (CVD) risk factors among Nunavik Inuit. This study was conducted as part of the 2004 Nunavik Inuit Health Survey, which included the collection of clinical measurements, plasma samples, and diet information from a food frequency questionnaire. A sample of 666 Inuit aged 18 years and older was included in our analyses. Dietary patterns were generated by principal component analysis. Multivariate general linear models adjusting for sex, age, waist circumference, and other potential confounders were used to examine associations between dietary patterns and CVD risk factors. Four distinct patterns were identified, namely the traditional, Western, nutrient-poor food, and healthy patterns. The traditional pattern showed positive associations with plasma total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B100, LDL peak particle diameter, and oxidized LDL (all P values for trend≤0.04), but showed no association with the total cholesterol:high-density lipoprotein cholesterol ratio or with inflammatory biomarkers (all P values for trend ≥0.19). The nutrient-poor food pattern was positively associated with oxidized LDL (P=0.04), but inversely associated with high-sensitivity C-reactive protein (P<0.0001). The Western and healthy patterns showed no association with any CVD risk factor. Our data show that high adherence to a traditional pattern among Nunavik Inuit is not associated with important changes in CVD risk factors, with the exception of a slight elevation in cholesterol concentrations, most likely attributable to increased n-3 fatty acid intake. Dietary patterns reflecting the recent introduction of market foods in the Inuit diet appear to exert a trivial influence on CVD risk factors. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Cardiovascular disease among Black Americans: comparisons between the U.S. Virgin Islands and the 50 U.S. states.

PubMed

Lee, Hedwig; Kershaw, Kiarri N; Hicken, Margaret T; Abdou, Cleopatra M; Williams, Eric S; Rivera-O'Reilly, Nereida; Jackson, James S

2013-01-01

Consistent findings show that black Americans have high rates of cardiovascular disease (CVD) and related behavioral risk factors. Despite this body of work, studies on black Americans are generally limited to the 50 U.S. states. We examined variation in CVD and related risk factors among black Americans by comparing those residing within the U.S. Virgin Islands (USVI) with those residing in the 50 U.S. states and Washington, D.C. (US 50/DC) and residing in different regions of the US 50/DC (Northeast, Midwest, South, and West). Using data from the 2007 and 2009 Behavioral Risk Factor Surveillance System, we compared CVD and CVD risk factor prevalence in non-Hispanic black people (≥20 years of age) in the USVI and US 50/DC, examining the relative contributions of health behaviors, health insurance, and socioeconomic status (SES). Accounting for age, sex, education, health insurance, and health behaviors, US 50/DC black Americans were significantly more likely than USVI black people to report ever having a stroke and coronary heart disease, and to be hypertensive, diabetic, or obese. While there was heterogeneity by region, similar patterns emerged when comparing the USVI with different regions of the US 50/DC. USVI black people have lower CVD and risk factor prevalence than US 50/DC black people. These lower rates are not explained by differences in health behaviors or SES. Understanding health in this population may provide important information on the etiology of racial/ethnic variation in health in the U.S. and elsewhere, and highlight relevant public health policies to reduce racial/ethnic group disparities.

Nutrient Intake, Physical Activity, and CVD Risk Factors in Children

PubMed Central

Day, R. Sue; Fulton, Janet E.; Dai, Shifan; Mihalopoulos, Nicole L.; Barradas, Danielle T.

2009-01-01

Background Associations among dietary intake, physical activity, and cardiovascular disease (CVD) risk factors are inconsistent among male and female youth, possibly from lack of adjustment for pubertal status. The purpose of this report is to describe the associations of CVD risk factors among youth, adjusted for sexual maturation. Methods Data analyzed in 2007 from a sumsample of 556 children aged 8, 11, and 14 years in Project HeartBeat!, 1991–1993, provide cross-sectional patterns of CVD risk factors by age and gender, adjusting for sexual maturation, within dietary fat and physical activity categories. Results Girls consuming moderate- to high-fat diets were significantly less physically active than those consuming low-fat diets. Boys and girls consuming high-fat diets had higher saturated fat and cholesterol intakes than children in low-fat categories. Boys had no significant differences in physical activity, blood pressure, waist circumference, or plasma cholesterol levels across fat categories. Girls’ plasma cholesterol levels showed no significant differences across fat categories. Dietary intake did not differ across moderate-to-vigorous physical activity (MVPA) categories within gender. There were no differences in BMI by fat or MVPA categories for either gender. Girls’ waist circumference differed significantly by fat category, and systolic blood pressure differed significantly across fat and MVPA categories. Boys’ fifth-phase diastolic blood pressure was significantly different across MVPA categories. Conclusions Girls consuming atherogenic diets were significantly less physically active than those with low fat intakes, whereas boys consuming high-fat diets did not show differences in physical activity measures. With the prevalence of overweight rising among youth, the impact of atherogenic diets and sedentary lifestyles on CVD risk factors is of concern to public health professionals. PMID:19524152

A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications.

PubMed

Najjar, Rami S; Moore, Carolyn E; Montgomery, Baxter D

2018-03-01

Cardiovascular disease (CVD) is a major economic burden in the United States. CVD risk factors, particularly hypertension and hypercholesterolemia, are typically treated with drug therapy. Five-year efficacy of such drugs to prevent CVD is estimated to be 5%. Plant-based diets have emerged as effective mitigators of these risk factors. The implementation of a defined, plant-based diet for 4 weeks in an outpatient clinical setting may mitigate CVD risk factors and reduce patient drug burden. Participants consumed a plant-based diet consisting of foods prepared in a defined method in accordance with a food-classification system. Participants consumed raw fruits, vegetables, seeds, and avocado. All animal products were excluded from the diet. Participant anthropometric and hemodynamic data were obtained weekly for 4 weeks. Laboratory biomarkers were collected at baseline and at 4 weeks. Medication needs were assessed weekly. Data were analyzed using paired-samples t tests and 1-way repeated-measures ANOVA. Significant reductions were observed for systolic (-16.6 mmHg) and diastolic (-9.1 mmHg) blood pressure (P < 0.0005), serum lipids (P ≤ 0.008), and total medication usage (P < 0.0005). Other CVD risk factors, including weight (P < 0.0005), waist circumference (P < 0.0005), heart rate (P = 0.018), insulin (P < 0.0005), glycated hemoglobin (P = 0.002), and high-sensitivity C-reactive protein (P = 0.001) were also reduced. A defined, plant-based diet can be used as an effective therapeutic strategy in the clinical setting to mitigate cardiovascular risk factors and reduce patient drug burden. © 2018 Wiley Periodicals, Inc.

Overweight and obesity in relation to cardiovascular disease risk factors among medical students in Crete, Greece

PubMed Central

Bertsias, George; Mammas, Ioannis; Linardakis, Manolis; Kafatos, Anthony

2003-01-01

Background Recent data indicate increasing rates of adult obesity and mortality from cardiovascular disease (CVD) in Greece. No data, however, are available on prevalence of overweight and obesity in relation to CVD risk factors among young adults in Greece. Methods A total of 989 third-year medical students (527 men, 462 women), aged 22 ± 2 years, were recruited from the University of Crete during the period 1989–2001. Anthropometric measures and blood chemistries were obtained. The relationships between obesity indices (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHpR], waist-to-height ratio [WHtR]) and CVD risk factor variables (blood pressure, glucose, serum lipoproteins) were investigated. Results Approximately 40% of men and 23% of women had BMI ≥ 25.0 kg/m2. Central obesity was found in 33.4% (average percentage corresponding to WC ≥ 90 cm, WHpR ≥ 0.9 and WHtR ≥ 50.0) of male and 21.7% (using WC ≥ 80 cm, WHpR ≥ 0.8, WHtR ≥ 50.0) of female students. Subjects above the obesity indices cut-offs had significantly higher values of CVD risk factor variables. BMI was the strongest predictor of hypertension. WHtR in men and WC in women were the most important indicators of dyslipidaemia. Conclusion A substantial proportion of Greek medical students were overweight or obese, obesity status being related to the presence of hypertension and dyslipidaemia. Simple anthropometric indices can be used to identify these CVD risk factors. Our results underscore the need to implement health promotion programmes and perform large-scale epidemiological studies within the general Greek young adult population. PMID:12517305

Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis.

PubMed

Criqui, Michael H; Knox, Jessica B; Denenberg, Julie O; Forbang, Nketi I; McClelland, Robyn L; Novotny, Thomas E; Sandfort, Veit; Waalen, Jill; Blaha, Michael J; Allison, Matthew A

2017-08-01

This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification. In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events. A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events. During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction. The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates

PubMed Central

Abdulle, Abdishakur M; Nagelkerke, Nico JD; Abouchacra, Samra; Pathan, Javed Y; Adem, Abdu; Obineche, Enyioma N

2006-01-01

Background Hypertension, notably untreated or uncontrolled, is a major risk factor for cardiovascular diseases (CVD) morbidity and mortality. In countries in transition, little is known about the epidemiology of hypertension, and its biochemical correlates. This study was carried out in Al Ain, United Arab Emirates, to characterize self-reported (SR) normotensives and hypertensives in terms of actual hypertension status, demographic variables, CVD risk factors, treatment, and sequalae. Methods A sample, stratified by SR hypertensive status, of 349 SR hypertensives (Mean age ± SD; 50.8 ± 9.2 yrs; Male: 226) and 640 SR normotensives (42.9 ± 9.3 yrs, Male: 444) among nationals and expatriates was used. Hypertensives and normotensive subjects were recruited from various outpatient clinics and government organizations in Al-Ain city, United Arab Emirates (UAE) respectively. Anthropometric and demographic variables were measured by conventional methods. Results Both under-diagnosis of hypertension (33%) and under-treatment (76%) were common. Characteristics of undiagnosed hypertensives were intermediate between normotensives and SR hypertensives. Under-diagnosis of hypertension was more common among foreigners than among nationals. Risk factors for CVD were more prevalent among SR hypertensives. Obesity, lack of exercise and smoking were found as major risk factors for CVD among hypertensives in this population. Conclusion Hypertension, even severe, is commonly under-diagnosed and under-treated in the UAE. Preventive strategies, better diagnosis and proper treatment compliance should be emphasized to reduce incidence of CVD in this population. PMID:16753071

Cardiovascular disease risk profiles among 'healthy' siblings of patients with early-onset cardiovascular disease: application of the new SCORE system.

PubMed

Horan, Paul G; Kamaruddin, Muhammad S; Moore, Michael J; McCarty, David; Spence, Mark S; McGlinchey, Paul G; Murphy, Gillian; Jardine, Tracy C L; Patterson, Chris C; McKeown, Pascal P

2007-08-01

Cardiovascular disease (CVD) occurs more frequently in individuals with a family history of premature CVD. Within families the demographics of CVD are poorly described. We examined the risk estimation based on the Systematic Coronary Risk Evaluation (SCORE) system and the Joint British Guidelines (JBG) for older unaffected siblings of patients with premature CVD (onset

Is diabetes mellitus a heart disease equivalent in women? Results from an international study of postmenopausal women in the Raloxifene Use for the Heart (RUTH) Trial.

PubMed

Daniels, Lori B; Grady, Deborah; Mosca, Lori; Collins, Peter; Mitlak, Bruce H; Amewou-Atisso, Messan G; Wenger, Nanette K; Barrett-Connor, Elizabeth

2013-03-01

Several studies have concluded that diabetes mellitus and heart disease carry similar risk for future cardiovascular disease (CVD). Most of these studies were too small to quantify independent risks specific to women. The purpose of this study was to determine whether diabetes mellitus is a coronary heart disease (CHD) risk equivalent for prediction of future CHD and CVD events in women. The Raloxifene Use for the Heart (RUTH) trial was an international, multicenter, double-blind, randomized, placebo-controlled trial of raloxifene and CVD outcomes in 10 101 postmenopausal women selected for high CHD risk. Of these, 3672 had a history of diabetes mellitus without known CHD, and 3265 had a history of CHD without known diabetes mellitus. Cox proportional hazard models were used to compare cardiovascular outcomes in these 2 groups. Mean age at baseline was 67.5 years; median follow-up was 5.6 years. There were 725 deaths, including 450 cardiovascular deaths. In age-adjusted analyses, diabetic women had an increased risk of all-cause mortality compared with women with CHD. Although the overall risk of CHD and CVD was lower in diabetic women compared with women with CHD, the risk of fatal CHD, fatal CVD, and all-cause mortality was similar (hazard ratio [95% confidence interval]: 0.85 [0.65-1.12], 0.99 [0.78-1.25], and 1.18 [0.98-1.42], respectively, after adjusting for age, lifestyle factors, CHD risk factors, statin use, and treatment assignment). In the RUTH trial, diabetes mellitus was a CHD risk equivalent in women for fatal, but not nonfatal, CHD and CVD.

Consumption of sugar-sweetened beverages, but not 100% fruit juice, is associated with fasting high-density lipoprotein and triglyceride concentrations in U.S. adults

USDA-ARS?s Scientific Manuscript database

Introduction: Dyslipidemia, characterized by high triglyceride (TG) and low HDL concentrations, is a risk factor for cardiovascular disease (CVD). Decreasing dietary sugar consumption is one dietary modification that may influence dyslipidemia risk to reduce the risk for CVD. Two major sources of di...

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction.

PubMed

Sabin, C A; d'Arminio Monforte, A; Friis-Moller, N; Weber, R; El-Sadr, W M; Reiss, P; Kirk, O; Mercie, P; Law, M G; De Wit, S; Pradier, C; Phillips, A N; Lundgren, J D

2008-04-01

Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

Dyslipidemia and cardiovascular disease risk factor management in HIV-1-infected subjects treated with HAART in the Spanish VACH cohort.

PubMed

Pere, Domingo; Ignacio, Suarez-Lozano; Ramón, Teira; Fernando, Lozano; Alberto, Terrón; Pompeyo, Viciana; Juan, González; M José, Galindo; Paloma, Geijo; Antonio, Vergara; Jaime, Cosín; Esteban, Ribera; Bernardino, Roca; M Luisa, Garcia-Alcalde; Trinitario, Sánchez; Ferran, Torres; Juan Ramón, Lacalle; Myriam, Garrido

2008-01-01

There is increasing evidence that metabolic adverse effects associated with antiretroviral therapy may translate into an increased cardiovascular risk in HIV-1-infected patients. To determine the prevalence of risk factors for cardiovascular disease (CVD) among HIV-1-infected persons, and to investigate any association between them, stage of HIV-1 disease, and use of antiretroviral therapies. Multicentric, cross-sectional analysis of CVD risk factors of treated patients in the VACH cohort. The data collected includes: demographic variables, cigarette smoking, diabetes mellitus, hypertension, dyslipidemia, body mass index, stage of HIV-1 infection, and antiretroviral therapy. The analysis included 2358 patients. More than 18% of the study population was at an age of appreciable risk of CVD. 1.7% had previous CVD and 59.2% were smokers. Increased prevalence of elevated total cholesterol was observed among subjects receiving an NNRTI but no PI [odds ratio (OR), 3.34; 95% confidence interval (CI), 1.77-6.31], PI but no NNRTI (OR, 4.04; 95% CI, 2.12-7.71), or NNRTI + PI (OR, 17.77; 95% CI, 7.24-43.59) compared to patients treated only with nucleoside reverse transcriptase inhibitors (NRTI). Higher CD4 cell count, lower plasma HIV-1 RNA levels, clinical signs of lipodystrophy, longer exposure times to NNRTI and PI, and older age were all also associated with elevated cholesterol levels. The use of lipid lowering agents was very low among our patients. Patients in the VACH cohort present multiple known risk factors for CVD, and a very low rate of lipid lowering therapy use. NNRTI and/or PI-based antiretroviral therapies are associated with the worst lipid profile. This is more frequent in older subjects with greater CD4 counts and controlled HIV-1 replication.

Metformin modifies the exercise training effects on risk factors for cardiovascular disease in impaired glucose tolerant adults

PubMed Central

Malin, Steven K.; Nightingale, Joy; Choi, Sung-Eun; Chipkin, Stuart R.; Braun, Barry

2012-01-01

Impaired glucose tolerant (IGT) adults are at elevated risk for cardiovascular disease (CVD). Exercise or metformin reduce CVD risk, but the efficacy of combining treatments is unclear. To determine the effects of exercise training plus metformin, compared to each treatment alone, on CVD risk factors in IGT adults. Subjects were assigned to: placebo (P), metformin (M), exercise plus placebo (EP), or exercise plus metformin (EM) (8/group). In a double-blind design, P or 2000mg/d of M were administered for 12 weeks and half performed aerobic and resistance training 3 days/week for approximately 60 minutes/day at 70% pre-training heart rate peak. Outcomes included: adiposity, blood pressure (BP), lipids and high sensitivity C-reactive protein (hs-CRP). Z-scores were calculated to determine metabolic syndrome severity. M and EM, but not EP, decreased body weight compared to P (p <0.05). M and EP lowered systolic BP by 6% (p < 0.05), diastolic BP by 6% (p < 0.05), and hs-CRP by 20% (M: trend p = 0.06; EP: p < 0.05) compared to P. Treatments raised HDL-cholesterol (p < 0.05; EM: trend p = 0.06) compared to P and lowered triacyglycerol (p < 0.05) and metabolic syndrome Z-score compared to baseline (EP; trend p = 0.07 and EM or M; p < 0.05). Although exercise and/or metformin improve some CVD risk factors, only training or metformin alone lowered hs-CRP and BP. Thus, metformin may attenuate the effects of training on some CVD risk factors and metabolic syndrome severity in IGT adults. PMID:23505172

Trends in nutritional intakes and nutrition-related cardiovascular disease risk factors in Lebanon: the need for immediate action.

PubMed

Nasreddine, Lara; Naja, Farah A; Sibai, Abla-Mehio; Helou, Khalil; Adra, Nada; Hwalla, Nahla

2014-01-01

To examine the burden of cardiovascular disease (CVD) risk factors and their association with dietary variables in the Lebanese population while reviewing secular trends in the population's nutritional intakes and nutrition-related CVD risk factors. Data on CVD risk factors and food consumption patterns in Lebanon were collected from scholarly papers, including individual studies and systematic review articles. Electronic databases were searched using combinations of key terms. The prevalence of obesity in Lebanon followed an alarming increasing trend over time, paralleled by an escalation in the prevalence of hypertension, diabetes and hyperlipidemia. Food consumption surveys illustrate an increasing trend in energy intake and the proportion of energy derived from fat and animal products, with a concomitant decrease in carbohydrates and cereals intakes. The shift towards an atherogenic diet coupled with the alarming increase in nutrition-related cardiovascular risk factors suggest that the Lebanese population is at an increased risk for CVDs. This should alert to the importance of formulating multicomponent intervention strategies at both the individual and population levels to halt the progression of nutrition-related diseases in the country, while highlighting the need for immediate public health efforts to promote the adoption of healthy dietary habits.

Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes.

PubMed

Erqou, Sebhat; Echouffo-Tcheugui, Justin B; Kip, Kevin E; Aiyer, Aryan; Reis, Steven E

2017-05-08

Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations.

PubMed Central

Reddy, K. S.; Prabhakaran, D.; Chaturvedi, V.; Jeemon, P.; Thankappan, K. R.; Ramakrishnan, L.; Mohan, B. V. M.; Pandav, C. S.; Ahmed, F. U.; Joshi, P. P.; Meera, R.; Amin, R. B.; Ahuja, R. C.; Das, M. S.; Jaison, T. M.

2006-01-01

OBJECTIVE: To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. METHODS: We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. FINDINGS: We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. CONCLUSION: There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries. PMID:16799730

The Obesity, Metabolic Syndrome, and Type 2 Diabetes Mellitus Pandemic: Part I. Increased Cardiovascular Disease Risk and the Importance of Atherogenic Dyslipidemia in Persons With the Metabolic Syndrome and Type 2 Diabetes Mellitus

PubMed Central

Ginsberg, Henry N.; MacCallum, Paul R.

2010-01-01

Both the metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) confer an increased risk of coronary heart disease and cardiovascular disease (CVD). As MS and T2DM become more prevalent, there will be an associated rise in the number of individuals with or at risk for CVD and its related disorders. One major underlying cause of CVD in patients with MS or T2DM is a characteristic form of atherogenic dyslipidemia. This article reviews the evidence that demonstrates that individuals with MS or T2DM are at increased risk for CVD and highlights atherogenic dyslipidemia as an important risk factor for the development of CVD in these individuals. In an accompanying article, current pharmacotherapies available for the management of atherogenic dyslipidemia in individuals with MS or T2DM are discussed. PMID:19614799

Triglyceride-rich lipoproteins as a causal factor for cardiovascular disease

PubMed Central

Toth, Peter P

2016-01-01

Approximately 25% of US adults are estimated to have hypertriglyceridemia (triglyceride [TG] level ≥150 mg/dL [≥1.7 mmol/L]). Elevated TG levels are associated with increased cardiovascular disease (CVD) risk, and severe hypertriglyceridemia (TG levels ≥500 mg/dL [≥5.6 mmol/L]) is a well-established risk factor for acute pancreatitis. Plasma TG levels correspond to the sum of the TG content in TG-rich lipoproteins (TRLs; ie, very low-density lipoproteins plus chylomicrons) and their remnants. There remains some uncertainty regarding the direct causal role of TRLs in the progression of atherosclerosis and CVD, with cardiovascular outcome studies of TG-lowering agents, to date, having produced inconsistent results. Although low-density lipoprotein cholesterol (LDL-C) remains the primary treatment target to reduce CVD risk, a number of large-scale epidemiological studies have shown that elevated TG levels are independently associated with increased incidence of cardiovascular events, even in patients treated effectively with statins. Genetic studies have further clarified the causal association between TRLs and CVD. Variants in several key genes involved in TRL metabolism are strongly associated with CVD risk, with the strength of a variant’s effect on TG levels correlating with the magnitude of the variant’s effect on CVD. TRLs are thought to contribute to the progression of atherosclerosis and CVD via a number of direct and indirect mechanisms. They directly contribute to intimal cholesterol deposition and are also involved in the activation and enhancement of several proinflammatory, proapoptotic, and procoagulant pathways. Evidence suggests that non-high-density lipoprotein cholesterol, the sum of the total cholesterol carried by atherogenic lipoproteins (including LDL, TRL, and TRL remnants), provides a better indication of CVD risk than LDL-C, particularly in patients with hypertriglyceridemia. This article aims to provide an overview of the available epidemiological, clinical, and genetic evidence relating to the atherogenicity of TRLs and their role in the progression of CVD. PMID:27226718

A time-motion study of cardiovascular disease risk factor screening integrated into HIV clinic visits in Swaziland.

PubMed

Palma, Anton M; Rabkin, Miriam; Simelane, Samkelo; Gachuhi, Averie B; McNairy, Margaret L; Nuwagaba-Biribonwoha, Harriet; Bongomin, Pido; Okello, Velephi N; Bitchong, Raymond A; El-Sadr, Wafaa M

2018-03-01

Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time-motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability. A convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank-sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening. We observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p < 0.01). Time spent on HIV care was not affected: 4 (2 to 10) versus 4 (2 to 11) (p = 0.57). We recruited 126 patients for exit interviews, all of whom indicated that they would recommend screening to others. Provision of CVD risk factor screening more than tripled the length of routine HIV clinic visits but did not reduce the time spent on HIV services. Programme managers need to take longer visit duration into account in order to effectively integrate CVD risk factor screening and counselling into HIV programmes. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

The South Asian heart lifestyle intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: Design and methods

PubMed Central

Kandula, Namratha R.; Patel, Yasin; Dave, Swapna; Seguil, Paola; Kumar, Santosh; Baker, David W.; Spring, Bonnie; Siddique, Juned

2013-01-01

Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian heart lifestyle intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6 weeks of group classes, followed by 12 weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population. PMID:24060673

Sleep duration, snoring habits, and cardiovascular disease risk factors in an ethnically diverse population.

PubMed

Mosca, Matthew; Aggarwal, Brooke

2012-01-01

Lack of sleep has been associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality, but the mechanisms are not fully understood. Prior research has often been conducted in select populations and has not consistently adjusted for confounders, especially psychosocial factors. The aims of this study were to assess the association between sleep habits and established risk factors for CVD and to evaluate potential interactions by race and gender. Participants were part of a CVD screening and educational outreach program in New York City. Free-living men older than 40 years and women older than 50 years (n = 371, mean age = 60 years, 57% women, 60% racial/ethnic minorities) were systematically assessed for CVD risk (including traditional, lifestyle, and psychosocial risk factors) and completed a standardized questionnaire regarding sleep habits (including sleep duration and snoring). Lipids were analyzed by validated finger-stick technology. Stress at work and at home was assessed using a validated screening tool from the INTERHEART study. Associations between participants' sleep habits and CVD risk factors/demographic factors were assessed using multivariable logistic regression. The proportion of participants who reported sleeping less than 6 hours per night on average was 28%, and 52% of participants reported snoring. Sleeping less than 6 hours per night was significantly (P < .05) associated with female gender, being single, increased stress at home, increased financial stress, and low-density lipoprotein cholesterol (LDL-C) level. Gender modified the association between sleep duration and LDL-C level (P = .04): Sleeping less than 6 hours per night was significantly associated with reduced LDL-C level among women and increased LDL-C level among men. Snoring was significantly associated with low high-density lipoprotein cholesterol (HDL-C) level (<40 mg/dL for men/<50 mg/dL for women), being married, increased stress at work and at home, less than 30 minutes of exercise per day, less than 5 servings of fruits and vegetables per day, and being overweight/obese (body mass index ≥25 kg/m). The association between snoring and low HDL-C level remained significant in logistic regression models adjusted for demographic confounders (odds ratio, 1.83; 95% confidence interval, 1.06-3.19) but not after adjustment for body mass index greater than 25 kg/m. Sleeping less than 6 hours per night was associated with several traditional and psychosocial CVD risk factors, and snoring was associated with low HDL-C level, likely mediated through overweight/obesity. These data may have significance for health care providers to identify individuals who may be at increased CVD risk based on sleep habits.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

Measuring Childhood Adversity in Life Course Cardiovascular Research: A Systematic Review.

PubMed

Appleton, Allison A; Holdsworth, Elizabeth; Ryan, Margaret; Tracy, Melissa

2017-05-01

Identifying the life course health effects of childhood adversity is a burgeoning area of research, particularly in relation to cardiovascular disease (CVD). However, adversity measurement varies widely across studies, which may hamper our ability to make comparisons across studies and identify mechanisms linking adversity to CVD. The purposes of this review are to summarize adversity measurement approaches in the context of CVD, identify gaps, and make recommendations for future research. PubMed and PsycINFO searches were conducted through June 2016. Studies were selected if CVD end point or predisease risk markers were investigated in association with a measure of childhood adversity. Forty-three studies were reviewed. A meta-analysis was not conducted because of the variation in exposures and outcomes assessed. Adversity measurement was heterogeneous across studies. Metrics included different sets of adverse events, relational factors, and socioeconomic indicators. Thirty-seven percent measured childhood adversity prospectively, 23% examined a CVD end point, and 77% treated adversity as an unweighted summary score. Despite the heterogeneity in measurement, most studies found a positive association between childhood adversity and CVD risk, and the association seems to be dose-response. The literature on childhood adversity and CVD would benefit from improving consistency of measurement, using weighted adversity composites, modeling adversity trajectories over time, and considering socioeconomic status as an antecedent factor instead of a component part of an adversity score. We suggest conceptual and analytic strategies to enhance, refine, and replicate the observed association between childhood adversity and CVD risk.

Major dietary patterns and cardiovascular risk factors from childhood to adulthood. The Cardiovascular Risk in Young Finns Study.

PubMed

Mikkilä, Vera; Räsänen, Leena; Raitakari, Olli T; Marniemi, Jukka; Pietinen, Pirjo; Rönnemaa, Tapani; Viikari, Jorma

2007-07-01

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 Cardiovascular Risk 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 cardiovascular risk factors. Our results support earlier findings that dietary patterns have a role in the development of CVD.

Primordial prevention of cardiovascular disease among African-Americans: a social epidemiological perspective.

PubMed

James, S A

1999-12-01

The primordial prevention of cardiovascular disease (CVD) among African-Americans represents a formidable challenge for public health. This paper discusses the nature of this challenge, highlighting the role that economic and cultural factors play in shaping the distributions of major CVD risk factors among African-Americans. The paper concludes with specific suggestions for research. Data from recent national health surveys on black/white differences in major CVD risk factors like hypertension, obesity, cholesterol, cigarette smoking, and physical inactivity were reviewed for the purpose of identifying promising avenues for primordial prevention research among African-Americans. Cigarette smoking has a delayed onset among African-Americans compared to whites. Black/white differences in "vigorous" leisure-time physical activity (e.g., social dancing and team sports) are not apparent until around age 40. These findings have relevance for primordial prevention work in black communities since they suggest the existence of broad-based, health-relevant cultural norms which could support primordial prevention programs, such as regular physical activity, across the life cycle. CVD primordial prevention programs among African-Americans must be grounded in an understanding of how cultural values as well as economic conditions shape CVD risk factor distributions in this population. Ultimate success will depend on the strength of the partnerships that public health researchers, primary care providers, and community residents are able to build.

Aortic Arch Pulse Wave Velocity Assessed by Magnetic Resonance Imaging as a Predictor of Incident Cardiovascular Events: The MESA (Multi-Ethnic Study of Atherosclerosis).

PubMed

Ohyama, Yoshiaki; Ambale-Venkatesh, Bharath; Noda, Chikara; Kim, Jang-Young; Tanami, Yutaka; Teixido-Tura, Gisela; Chugh, Atul R; Redheuil, Alban; Liu, Chia-Ying; Wu, Colin O; Hundley, W Gregory; Bluemke, David A; Guallar, Eliseo; Lima, Joao A C

2017-09-01

The predictive value of aortic arch pulse wave velocity (PWV) assessed by magnetic resonance imaging for cardiovascular disease (CVD) events has not been fully established. The aim of the present study was to evaluate the association of arch PWV with incident CVD events in MESA (Multi-Ethnic Study of Atherosclerosis). Aortic arch PWV was measured using magnetic resonance imaging at baseline in 3527 MESA participants (mean age, 62±10 years at baseline; 47% men) free of overt CVD. Cox regression was used to evaluate the risk of incident CVD (coronary heart disease, stroke, transient ischemic attack, or heart failure) in relation to arch PWV adjusted for age, sex, race, and CVD risk factors. The median value of arch PWV was 7.4 m/s (interquartile range, 5.6-10.2). There was significant interaction between arch PWV and age for outcomes, so analysis was stratified by age categories (45-54 and >54 years). There were 456 CVD events during the 10-year follow-up. Forty-five to 54-year-old participants had significant association of arch PWV with incident CVD independent of CVD risk factors (hazard ratio, 1.44; 95% confidence interval, 1.07-1.95; P =0.018; per 1-SD increase for logarithmically transformed PWV), whereas >54-year group did not ( P =0.93). Aortic arch PWV assessed by magnetic resonance imaging is a significant predictor of CVD events among middle-aged (45-54 years old) individuals, whereas arch PWV is not associated with CVD among an elderly in a large multiethnic population. © 2017 American Heart Association, Inc.

The role of nutraceuticals in the prevention of cardiovascular disease.

PubMed

Sosnowska, Bozena; Penson, Peter; Banach, Maciej

2017-04-01

Cardiovascular disease (CVD) ranks among the most common health-related and economic issues worldwide. Dietary factors are important contributors to cardiovascular risk, either directly, or through their effects on other cardiovascular risk factors including hypertension, dyslipidemia and diabetes mellitus. Nutraceuticals are natural nutritional compounds, which have been shown to be efficacious in preventative medicine or in the treatment of disease. Several foods and dietary supplements have been shown to protect against the development of CVD. The aim of this review is to present an update on the most recent evidence relating to the use of nutraceuticals in the context of the prevention and treatment of CVD.

The role of nutraceuticals in the prevention of cardiovascular disease

PubMed Central

Sosnowska, Bozena; Penson, Peter

2017-01-01

Cardiovascular disease (CVD) ranks among the most common health-related and economic issues worldwide. Dietary factors are important contributors to cardiovascular risk, either directly, or through their effects on other cardiovascular risk factors including hypertension, dyslipidemia and diabetes mellitus. Nutraceuticals are natural nutritional compounds, which have been shown to be efficacious in preventative medicine or in the treatment of disease. Several foods and dietary supplements have been shown to protect against the development of CVD. The aim of this review is to present an update on the most recent evidence relating to the use of nutraceuticals in the context of the prevention and treatment of CVD. PMID:28529919

Lipoprotein (a) and cardiovascular risk factors in children and adolescents.

PubMed

Palmeira, Ástrid Camêlo; Leal, Adriana Amorim de F; Ramos, Nathaly de Medeiros N; Neto, José de Alencar F; Simões, Mônica Oliveira da S; Medeiros, Carla Campos M

2013-12-01

To review the relationship between lipoprotein (a) [Lp(a)] and other risk factors for cardiovascular disease (CVD) in children and adolescents. This systematic review included studies from 2001 to 2011, a ten-year time period. Epidemiological studies with children and/or adolescents published in English, Portuguese or Spanish and fully available online were included. The searches were performed in Science Direct, PubMed/Medline, BVS (Biblioteca Virtual em Saúde) and Cochrane Library databases, using the following combination of key-words: "lipoprotein a" and "cardiovascular diseases" and "obesity". Overall, 672 studies were obtained but only seven were included. Some studies assessed the family history for CVD. In all of them, Lp(a) levels were increased in patients with family history for CVD. There was also a positive correlation between Lp(a) and LDL-cholesterol, total cholesterol, and apolipoprotein B levels, suggesting an association between Lp(a) levels and the lipid profile. The evidence that CVD may originate in childhood and adolescence leads to the need for investigating the risk factors during this period in order to propose earlier and possibly more effective interventions to reduce morbidity and mortality rates.

Cardiovascular disease in recent onset diabetes mellitus.

PubMed

Yamagishi, Shoichi

2011-05-01

Diabetes is associated with a marked increased risk of atherosclerotic vascular disorders, including coronary, cerebrovascular, and peripheral artery disease. Cardiovascular disease (CVD) could account for disabilities and high mortality rates in patients with diabetes. Conventional risk factors, including hyperlipidemia, hypertension, smoking, obesity, lack of exercise, and a positive family history, contribute similarly to macrovascular complications in type 2 diabetic patients and non-diabetic subjects. The levels of these factors in diabetic patients are certainly increased, but not enough to explain the exaggerated risk for macrovascular complications in the diabetic population. Furthermore, recently, macrovascular complications of diabetes have been shown to start before the onset of diabetes. Indeed, several clinical studies have confirmed the increased risk of CVD in patients with impaired glucose tolerance (IGT). Since insulin resistance-related postprandial metabolic derangements are thought to play a central role in the development and progression of CVD in patients with IGT, amelioration of postprandial metabolic disturbance is a therapeutic target for the prevention of CVD in these high-risk patients. Therefore, in this paper, we review the molecular mechanisms for the increased risk of CVD in recent onset diabetes mellitus, especially focusing on postprandial dysmetabolism. We also discuss here the potential therapeutic strategies that specially target the mechanisms responsible for vascular alterations in diabetes. Copyright © 2011 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

PubMed Central

Zullig, Leah L.; Melnyk, S. Dee; Stechuchak, Karen M.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Edelman, David; Rakley, Susan; Morey, Miriam

2014-01-01

Abstract Background: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction. Materials and Methods: Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors. Results: Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients. Conclusions: The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors. PMID:24303930

Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline.

PubMed

Heida, Karst Y; Bots, Michiel L; de Groot, Christianne Jm; van Dunné, Frederique M; Hammoud, Nurah M; Hoek, Annemiek; Laven, Joop Se; Maas, Angela Hem; Roeters van Lennep, Jeanine E; Velthuis, Birgitta K; Franx, Arie

2016-11-01

In the past decades evidence has accumulated that women with reproductive and pregnancy-related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardised follow-up of these women becausee guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence. Therefore, the Dutch Society of Obstetrics and Gynaecology initiated a multidisciplinary working group to develop a guideline for cardiovascular risk management after reproductive and pregnancy-related disorders. The guideline addresses the cardiovascular risk consequences of gestational hypertension, preeclampsia, preterm delivery, small-for-gestational-age infant, recurrent miscarriage, polycystic ovary syndrome and premature ovarian insufficiency. The best available evidence on these topics was captured by systematic review. Recommendations for clinical practice were formulated based on the evidence and consensus of expert opinion. The Dutch societies of gynaecologists, cardiologists, vascular internists, radiologists and general practitioners reviewed the guideline to ensure support for implementation in clinical practice. For all reproductive and pregnancy-related disorders a moderate increased relative risk was found for overall CVD, except for preeclampsia (relative risk 2.15, 95% confidence interval 1.76-2.61). Based on the current available evidence, follow-up is only recommended for women with a history of preeclampsia. For all reproductive and pregnancy-related disorders optimisation of modifiable cardiovascular risk factors is recommended to reduce the risk of future CVD. © The European Society of Cardiology 2016.

Effect of Cumulating Exposure to Abacavir on the Risk of Cardiovascular Disease Events in Patients From the Swiss HIV Cohort Study.

PubMed

Young, Jim; Xiao, Yongling; Moodie, Erica E M; Abrahamowicz, Michal; Klein, Marina B; Bernasconi, Enos; Schmid, Patrick; Calmy, Alexandra; Cavassini, Matthias; Cusini, Alexia; Weber, Rainer; Bucher, Heiner C

2015-08-01

Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient-years). In a conventional Cox model, recent--but not cumulative--exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

[Impact of isolated diastolic hypertension on new-onset cardiovascular and cerebro-vascular diseases].

PubMed

Xing, Fengmei; Dong, Yan; Tao, Jie; Gao, Xinying; Zhou, Jianhui; Chen, Shuohua; Ji, Chunpeng; Yao, Tao; Wu, Shouling

2014-08-01

To explore the impact of isolated diastolic hypertension (IDH) on new-onset cardio-cerebral vascular diseases (CVD). This cohort study involved 101 510 participants who were employees of the Kailuan Group-a state-run coal mining company, in 2006 and 2007. Among them, 6 780 subjects were diagnosed with IDH, 35 448 subjects were diagnosed with high-normal blood pressure and 19 460 subjects were diagnosed with normal tension. However, none of them had the history of either cardio-cerebral vascular disease or malignant cancer. Cardio-cerebral vascular events including cerebral infarction, cerebral hemorrhage, acute myocardial infarction were recorded every 6 months during the follow-up (47.1 ± 4.8) period. Multivariable Cox proportional hazards regression models were used to analyze the risk factors of first-ever CVD events. 1) There were 675 CVD events occurred during the follow-up period. The incidence rates of CVD events (1.7% vs. 0.9%), cerebral infarction (1.0% vs. 0.6%) and cerebral hemorrhage (0.4% vs. 0.1%) were significantly higher in IDH group than that in the normal tension group (all P < 0.05). 2) After adjustment for other established CVD risk factors, the hazards ratios became 1.67 (95% CI: 1.28-2.17) for total CVD events and 1.59 (95% CI: 1.12-2.27) for cerebral infarction and 2.67 (95% CI: 1.54-4.65) for cerebral hemorrhage in the IDH group. 3). In stratified analysis on age, after adjustment for other established CVD risk factors, the hazards ratio was 2.22 (95% CI: 1.41-3.50) for cerebral infarction in lower 60 years old group, while the it was 7.27 (95% CI: 2.58-20.42) for cerebral hemorrhage in groups older than 60 years of age. IDH was the independent risk factor for the total cardio-cerebral vascular events, on both cerebral infarction and cerebral hemorrhage. The predicted values of IDH for different CVD events were diverse on different age groups.

Cardiovascular disease (CVD) risk factors in Kraków and in the whole Poland adult population. Results from the WOBASZ study and Polish arm of the HAPIEE project.

PubMed

Doryńska, Agnieszka; Polak, Maciej; Kozela, Magdalena; Szafraniec, Krystyna; Piotrowski, Walerian; Bielecki, Wojciech; Drygas, Wojciech; Kozakiewicz, Krystyna; Piwoński, Jerzy; Tykarski, Andrzej; Zdrojewski, Tomasz; Pająk, Andrzej

2015-01-01

In Kraków, the second largest town in Poland, cardiovascular disease (CVD) mortality rate is lower than in most top largest towns in Poland and lower than the rate for total Polish population. The aim of the present analysis was to compare socioeconomic status (SES), prevalence of CVD risk factors and SCORE assessment of risk in Krakow with residents of other big towns in Poland and with general Polish population. We used data from the two large, population studies which used comparable methods for risk factors assessment: 1) Polish part of the HAPIEE Project in which 10 615 residents of Krakow at age between 45-69 years were examined, and (2) The WOBASZ Study which contributed with a sub-sample 6 888 of residents of Poland at corresponding age group. WOBASZ sample included 992 residents of big towns other than Krakow. Age-standardized proportions of persons with CVD risk factors were compared between Krakow and the other big towns in Poland and between Krakow and the whole Poland using χ2 test. The striking observation was that in Krakow proportions of participants with university education were substantially higher than average for the other big towns and the whole Poland. Also, the proportion of occupationally active men and women was the highest in Krakow. In both sexes, prevalence of smoking, hypercholesterolemia and hypertension in Krakow was similar to the other big towns but the prevalence of hypercholesterolemia and hypertension (in men only) was lower than average for Poland. The distribution by SCORE risk categories were similar in all three samples studied. In general, the distribution by BMI categories was less favourable but the prevalence of central obesity was lower among residents of Kraków than among residents of the other big towns and citizens of the whole Poland. Prevalence of diabetes was higher in Krakow than in the other samples studied. The differences between population of Krakow and population of other parts of Poland in the exposure to the main risk factors were found diverse and not big enough to be followed by differences in the distribution by the categories of SCORE risk assessment. The study suggested the importance of obesity and diabetes which are not used for the SCORE risk assessment and especially the importance of psychosocial and economic factors which may influence CVD risk and contribute more to the explanation of the regional differences in CVD mortality.

Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial.

PubMed

Adams, Scott C; DeLorey, Darren S; Davenport, Margie H; Stickland, Michael K; Fairey, Adrian S; North, Scott; Szczotka, Alexander; Courneya, Kerry S

2017-10-15

Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise). The primary outcome was peak aerobic fitness (VO 2peak ) assessed via a treadmill-based maximal cardiorespiratory exercise test. Secondary endpoints included CVD risk (eg, Framingham Risk Score), arterial health, parasympathetic nervous system function, and blood-based biomarkers. Postintervention VO 2peak data were obtained for 61 participants (97%). HIIT participants attended 99% of the exercise sessions and achieved 98% of the target exercise intensity. Analysis of covariance demonstrated that HIIT was superior to UC for improving VO 2peak (adjusted between-group mean difference, 3.7 mL O 2 /kg/min; 95% confidence interval, 2.4-5.1 [P<.001]) and multiple secondary outcomes including CVD risk (P = .011), arterial thickness (P<.001), arterial stiffness (P<.001), postexercise parasympathetic reactivation (P = .001), inflammation (P = .045), and low-density lipoprotein (P = .014). Overall, HIIT reduced the prevalence of modifiable CVD risk factors by 20% compared with UC. This randomized trial provides the first evidence that HIIT improves cardiorespiratory fitness, multiple pathways of CVD risk, and surrogate markers of mortality in TCS. These findings have important implications for the management of TCS. Further research concerning the long-term effects of HIIT on CVD morbidity and mortality in TCS is warranted. Cancer 2017;123:4057-65. © 2017 American Cancer Society. © 2017 American Cancer Society.

Prediction of First Cardiovascular Disease Event in Type 1 Diabetes Mellitus: The Steno Type 1 Risk Engine.

PubMed

Vistisen, Dorte; Andersen, Gregers Stig; Hansen, Christian Stevns; Hulman, Adam; Henriksen, Jan Erik; Bech-Nielsen, Henning; Jørgensen, Marit Eika

2016-03-15

Patients with type 1 diabetes mellitus are at increased risk of developing cardiovascular disease (CVD), but they are currently undertreated. There are no risk scores used on a regular basis in clinical practice for assessing the risk of CVD in type 1 diabetes mellitus. From 4306 clinically diagnosed adult patients with type 1 diabetes mellitus, we developed a prediction model for estimating the risk of first fatal or nonfatal CVD event (ischemic heart disease, ischemic stroke, heart failure, and peripheral artery disease). Detailed clinical data including lifestyle factors were linked to event data from validated national registers. The risk prediction model was developed by using a 2-stage approach. First, a nonparametric, data-driven approach was used to identify potentially informative risk factors and interactions (random forest and survival tree analysis). Second, based on results from the first step, Poisson regression analysis was used to derive the final model. The final CVD prediction model was externally validated in a different population of 2119 patients with type 1 diabetes mellitus. During a median follow-up of 6.8 years (interquartile range, 2.9-10.9) a total of 793 (18.4%) patients developed CVD. The final prediction model included age, sex, diabetes duration, systolic blood pressure, low-density lipoprotein cholesterol, hemoglobin A1c, albuminuria, glomerular filtration rate, smoking, and exercise. Discrimination was excellent for a 5-year CVD event with a C-statistic of 0.826 (95% confidence interval, 0.807-0.845) in the derivation data and a C-statistic of 0.803 (95% confidence interval, 0.767-0.839) in the validation data. The Hosmer-Lemeshow test showed good calibration (P>0.05) in both cohorts. This high-performing CVD risk model allows for the implementation of decision rules in a clinical setting. © 2016 American Heart Association, Inc.

Firefighter health and fitness assessment: a call to action.

PubMed

Storer, Thomas W; Dolezal, Brett A; Abrazado, Marlon L; Smith, Denise L; Batalin, Maxim A; Tseng, Chi-Hong; Cooper, Christopher B

2014-03-01

Sudden cardiac deaths experienced by firefighters in the line of duty account for the largest proportion of deaths annually. Several fire service standards for fitness and wellness have been recommended but currently only 30% of U.S. fire departments are implementing programs for this purpose. The Department of Homeland Security Science and Technology Directorate has initiated the Physiological Health Assessment System for Emergency Responders (PHASER) program aiming to reduce these line-of-duty deaths through an integration of medical science and sensor technologies. Confirming previous reports, PHASER comprehensive risk assessment has identified lack of physical fitness with propensity for overexertion as a major modifiable risk factor. We sought to determine if current levels of fitness and cardiovascular disease (CVD) risk factors in a contemporary cohort of firefighters were better than those reported over the past 30 years. Fifty-one firefighters from a Southern California department were characterized for physical fitness and CVD risk factors using standard measures. Overall, physical fitness and risk factors were not different from previous reports of firefighter fitness and most subjects did not achieve recommended fitness standards. Considering the lack of widespread implementation of wellness/fitness programs in the U.S. fire service together with our findings that low physical fitness and the presence of CVD risk factors persist, we issue a call to action among health and fitness professionals to assist the fire service in implementing programs for firefighters that improve fitness and reduce CVD risk factors. Fitness professionals should be empowered to work with fire departments lending their expertise to guide programs that achieve these objectives, which may then lead to reduced incidence of sudden cardiac death or stroke.

Utility of overnight pulse oximeter as a screening tool for sleep apnea to assess the 8-year risk of cardiovascular disease: Data from a large-scale bus driver cohort study.

PubMed

Wu, Wei-Te; Tsai, Su-Shan; Lin, Yu-Jen; Lin, Ming-Hsiu; Wu, Trong-Neng; Shih, Tung-Sheng; Liou, Saou-Hsing

2016-12-15

Professional drivers' work under conditions predisposes them for development of sleep-disordered breathing (SDB) and cardiovascular disease (CVD). However, the effect of SDB on CVD risk among professional drivers has never been investigated. A cohort study was used to evaluate the effectiveness of overnight pulse oximeter as a sleep apnea screening tool to assess the 8-year risk of CVD events. The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1014 professional drivers in Taiwan since 2005. The subjects completed questionnaire interview and overnight pulse oximeter survey. This cohort was linked to the National Health Insurance Research Dataset (NHIRD). Researchers found 192 CVD cases from 2005 to 2012. Cox proportional hazards model was performed to estimate the hazard ratio for CVD. The statistical analysis was performed using SAS software in 2015. ODI4 and ODI3 levels increased the 8-year CVD risk, even adjusting for CVD risk factors (HR: 1.36, 95% CI: 1.05 to 1.78; p=0.022, and HR: 1.40, 95% CI: 1.03 to 1.90; p=0.033). ODI4 and ODI3 thresholds of 6.5 and 10events/h revealed differences of CVD risks (HR: 1.72, 95% CI: 1.00 to 2.95; p=0.048, and HR: 1.76, 95% CI: 1.03 to 3.03; p=0.041). Moreover, the ODI levels had an increased risk for hypertensive disease (not including essential hypertension). This study concludes that ODI for a sign of SDB is an independent predictor of elevated risk of CVD. Further research should be conducted regarding measures to prevent against SDB in order to reduce CVD risk in professional drivers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cardiovascular Risk Factors in Severely Obese Adolescents: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study.

PubMed

Michalsky, Marc P; Inge, Thomas H; Simmons, Mark; Jenkins, Todd M; Buncher, Ralph; Helmrath, Michael; Brandt, Mary L; Harmon, Carroll M; Courcoulas, Anita; Chen, Michael; Horlick, Mary; Daniels, Stephen R; Urbina, Elaine M

2015-05-01

Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children's Hospital in Columbus, Ohio; Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio; Texas Children's Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children's Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI, 1.26-2.03]; P < .01) and elevated blood pressure (adjusted relative risk = 1.48 [95% CI, 1.16-1.89]; P < .01) were more likely in adolescent boys compared with adolescent girls. White individuals were at greater risk of having elevated triglyceride levels (adjusted relative risk = 1.76 [95% CI, 1.14-2.72]; P = .01) but were less likely to have impaired fasting glucose levels (adjusted relative risk = 0.58 [95% CI, 0.38-0.89]; P = .01). Numerous CVD risk factors are apparent in adolescents undergoing weight-loss surgery. Increasing body mass index and male sex increase the relative risk of specific CVD risk factors. These data suggest that even among severely obese adolescents, recognition and treatment of CVD risk factors is important to help limit further progression of disease.

Bone health and risk factors of cardiovascular disease--a cross-sectional study in healthy young adults.

PubMed

Pirilä, Satu; Taskinen, Mervi; Turanlahti, Maila; Kajosaari, Merja; Mäkitie, Outi; Saarinen-Pihkala, Ulla M; Viljakainen, Heli

2014-01-01

Both osteoporosis and cardiovascular disease (CVD) are diseases that comprise a growing medical and economic burden in ageing populations. They share many risk factors, including ageing, low physical activity, and possibly overweight. We aimed to study associations between individual risk factors for CVD and bone mineral density (BMD) and turnover markers (BTMs) in apparently healthy cohort. A cross-sectional assessment of 155 healthy 32-year-old adults (74 males) was performed for skeletal status, CVD risk factors and lifestyle factors. We analysed serum osteocalcin, procollagen I aminoterminal propeptide (P1NP), collagen I carboxy-terminal telopeptide (ICTP) and urine collagen I aminoterminal telopeptide (U-NTX), as well as serum insulin, plasma glucose, triglyceride and HDL-cholesterol levels. BMD, fat and lean mass were assessed using DXA scanning. Associations were tested with partial correlations in crude and adjusted models. Bone status was compared between men with or without metabolic syndrome (defined according to the NCEP-ATPIII criteria) with multivariate analysis. Osteocalcin and P1NP correlated inversely with insulin (R = -0.243, P = 0.003 and R = -0.187, P = 0.021) and glucose (R = -0.213, P = 0.009 and R = -0.190, P = 0.019), but after controlling for fat mass and lifestyle factors, the associations attenuated with insulin (R = -0.162, P = 0.053 and R = -0.093, P = 0.266) and with glucose (R = -0.099, P = 0.240 and R = -0.133, P = 0.110), respectively. Whole body BMD associated inversely only with triglycerides in fully adjusted model. In men with metabolic syndrome, whole body BMD, osteocalcin and P1NP were lower compared to healthy men, but these findings disappeared in fully adjusted model. In young adults, inverse associations between BTM/BMD and risk factors of CVD appeared in crude models, but after adjusting for fat mass, no association continued to be present. In addition to fat mass, lifestyle factors, especially physical activity, modified the associations between CVD and bone characteristics. Prospective studies are needed to specify the role of mediators and lifestyle factors in the prevention of CVD and osteoporosis.

Environmental Determinants of Cardiovascular Disease.

PubMed

Bhatnagar, Aruni

2017-07-07

Many features of the environment have been found to exert an important influence on cardiovascular disease (CVD) risk, progression, and severity. Changes in the environment because of migration to different geographic locations, modifications in lifestyle choices, and shifts in social policies and cultural practices alter CVD risk, even in the absence of genetic changes. Nevertheless, the cumulative impact of the environment on CVD risk has been difficult to assess and the mechanisms by which some environment factors influence CVD remain obscure. Human environments are complex, and their natural, social, and personal domains are highly variable because of diversity in human ecosystems, evolutionary histories, social structures, and individual choices. Accumulating evidence supports the notion that ecological features such as the diurnal cycles of light and day, sunlight exposure, seasons, and geographic characteristics of the natural environment such as altitude, latitude, and greenspaces are important determinants of cardiovascular health and CVD risk. In highly developed societies, the influence of the natural environment is moderated by the physical characteristics of the social environments such as the built environment and pollution, as well as by socioeconomic status and social networks. These attributes of the social environment shape lifestyle choices that significantly modify CVD risk. An understanding of how different domains of the environment, individually and collectively, affect CVD risk could lead to a better appraisal of CVD and aid in the development of new preventive and therapeutic strategies to limit the increasingly high global burden of heart disease and stroke. © 2017 American Heart Association, Inc.

Pathology supported genetic testing and treatment of cardiovascular disease in middle age for prevention of Alzheimer's disease.

PubMed

Kotze, Maritha J; van Rensburg, Susan J

2012-09-01

Chronic, multi-factorial conditions caused by a complex interaction between genetic and environmental risk factors frequently share common disease mechanisms, as evidenced by an overlap between genetic risk factors for cardiovascular disease (CVD) and Alzheimer's disease (AD). Single nucleotide polymorphisms (SNPs) in several genes including ApoE, MTHFR, HFE and FTO are known to increase the risk of both conditions. The E4 allele of the ApoE polymorphism is the most extensively studied risk factor for AD and increases the risk of coronary heart disease by approximately 40%. It furthermore displays differential therapeutic responses with use of cholesterol-lowering statins and acetylcholinesterase inhibitors, which may also be due to variation in the CYP2D6 gene in some patients. Disease expression may be triggered by gene-environment interaction causing conversion of minor metabolic abnormalities into major brain disease due to cumulative risk. A growing body of evidence supports the assessment and treatment of CVD risk factors in midlife as a preventable cause of cognitive decline, morbidity and mortality in old age. In this review, the concept of pathology supported genetic testing (PSGT) for CVD is described in this context. PSGT combines DNA testing with biochemical measurements to determine gene expression and to monitor response to treatment. The aim is to diagnose treatable disease subtypes of complex disorders, facilitate prevention of cumulative risk and formulate intervention strategies guided from the genetic background. CVD provides a model to address the lifestyle link in most chronic diseases with a genetic component. Similar preventative measures would apply for optimisation of heart and brain health.

Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort.

PubMed

Merhi, Basma; Shireman, Theresa; Carpenter, Myra A; Kusek, John W; Jacques, Paul; Pfeffer, Marc; Rao, Madhumathi; Foster, Meredith C; Kim, S Joseph; Pesavento, Todd E; Smith, Stephen R; Kew, Clifton E; House, Andrew A; Gohh, Reginald; Weiner, Daniel E; Levey, Andrew S; Ix, Joachim H; Bostom, Andrew

2017-09-01

Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potential relationships between serum phosphorus levels and the development of CVD outcomes, transplant failure, or all-cause mortality. Cohort study. The Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial, a large, multicenter, multiethnic, controlled clinical trial that provided definitive evidence that high-dose vitamin B-based lowering of plasma homocysteine levels did not reduce CVD events, transplant failure, or total mortality in stable KTRs. Serum phosphorus levels were determined in 3,138 FAVORIT trial participants at randomization. During a median follow-up of 4.0 years, the cohort had 436 CVD events, 238 transplant failures, and 348 deaths. Proportional hazards modeling revealed that each 1-mg/dL higher serum phosphorus level was not associated with a significant increase in CVD risk (HR, 1.06; 95% CI, 0.92-1.22), but increased transplant failure (HR, 1.36; 95% CI, 1.15-1.62) and total mortality risk associations (HR, 1.21; 95% CI, 1.04-1.40) when adjusted for treatment allocation, traditional CVD risk factors, kidney measures, type of kidney transplant, transplant vintage, and use of calcineurin inhibitors, steroids, or lipid-lowering drugs. These associations were strengthened in models without kidney measures: CVD (HR, 1.14; 95% CI, 1.00-1.31), transplant failure (HR, 1.72; 95% CI, 1.46-2.01), and mortality (HR, 1.34; 95% CI, 1.15-1.54). We lacked data for concentrations of parathyroid hormone, fibroblast growth factor 23, or vitamin D metabolites. Serum phosphorus level is marginally associated with CVD and more strongly associated with transplant failure and total mortality in long-term KTRs. A randomized controlled clinical trial in KTRs that assesses the potential impact of phosphorus-lowering therapy on these hard outcomes may be warranted. Copyright © 2017 National Kidney Foundation, Inc. All rights reserved.

Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort

PubMed Central

Merhi, Basma; Shireman, Theresa; Carpenter, Myra A.; Kusek, John W.; Jacques, Paul; Pfeffer, Marc; Rao, Madhumathi; Foster, Meredith C.; Kim, S. Joseph; Pesavento, Todd E.; Smith, Stephen R.; Kew, Clifton E.; House, Andrew A.; Gohh, Reginald; Weiner, Daniel E.; Levey, Andrew S.; Ix, Joachim H.; Bostom, Andrew

2017-01-01

Background Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potential relationships between serum phosphorus levels and the development of CVD outcomes, transplant failure, or all-cause mortality. Study Design Cohort study. Setting & Participants The Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial, a large, multicenter, multiethnic, controlled clinical trial that provided definitive evidence that high-dose vitamin B–based lowering of plasma homocysteine levels did not reduce CVD events, transplant failure, or total mortality in stable KTRs. Predictor Serum phosphorus levels were determined in 3,138 FAVORIT trial participants at randomization. Results During a median follow-up of 4.0 years, the cohort had 436 CVD events, 238 transplant failures, and 348 deaths. Proportional hazards modeling revealed that each 1-mg/dL higher serum phosphorus level was not associated with a significant increase in CVD risk (HR, 1.06; 95% CI, 0.92–1.22), but increased transplant failure (HR, 1.36; 95% CI, 1.15–1.62) and total mortality risk associations (HR, 1.21; 95% CI, 1.04–1.40) when adjusted for treatment allocation, traditional CVD risk factors, kidney measures, type of kidney transplant, transplant vintage, and use of calcineurin inhibitors, steroids, or lipid-lowering drugs. These associations were strengthened in models without kidney measures: CVD (HR, 1.14; 95% CI, 1.00–1.31), transplant failure (HR, 1.72; 95% CI, 1.46–2.01), and mortality (HR, 1.34; 95% CI, 1.15–1.54). Limitations We lacked data for concentrations of parathyroid hormone, fibroblast growth factor 23, or vitamin D metabolites. Conclusions Serum phosphorus level is marginally associated with CVD and more strongly associated with transplant failure and total mortality in long-term KTRs. A randomized controlled clinical trial in KTRs that assesses the potential impact of phosphorus-lowering therapy on these hard outcomes may be warranted. PMID:28579423

Preventing cardiovascular disease in primary care: role of a national risk factor management program.

PubMed

McGrath, Emer R; Glynn, Liam G; Murphy, Andrew W; O Conghaile, Aengus; Canavan, Michelle; Reid, Claire; Moloney, Brian; O'Donnell, Martin J

2012-04-01

Heartwatch, a structured risk factor modification program for secondary prevention of cardiovascular (CV) disease (CVD) in primary care, is associated with improvements in CV risk factors in participating patients. However, it is not known whether Heartwatch translates into reductions in clinically important CV events. The aim of the study was to determine the association between participation in Heartwatch and future risk of CV events in patients with CVD. The study consisted of a prospective cohort of 1,609 patients with CVD in primary care practices. Of these, 97.5% had data available on Heartwatch participation status, of whom 15.2% were Heartwatch participants. Cox proportional hazards models were used to determine the association between Heartwatch participation and risk of the CV composite (CV death, nonfatal myocardial infarction, heart failure, and nonfatal stroke). All-cause mortality and CV mortality were secondary outcome measures. During follow-up, the CV composite occurred in 208 patients (13.6%). Of Heartwatch participants, 8.4% experienced the CV composite compared with 14.5% of nonparticipants (P = .003). Participation in Heartwatch was associated with a significantly reduced risk of the CV composite (hazard ratio [HR] 0.52, 95% CI, 0.31-0.87), CV mortality (HR 0.31, 95% CI, 0.11-0.89), and all-cause mortality (HR 0.32, 95% CI, 0.15-0.68). Heartwatch participation was also associated with greater reductions in mean systolic blood pressure (P = .047), mean diastolic blood pressure (P < .001), and greater use of secondary preventative therapies for CVD, such as lipid-lowering agents (P < .001), β-blockers (P < .001), and angiotensin-converting enzyme inhibitors (P < .001). Heartwatch is associated with a reduced risk of major vascular events and improved risk factor modification, supporting its potential as a nationwide program for secondary prevention of CVD. Copyright © 2012 Mosby, Inc. All rights reserved.

Synergistic and Non-synergistic Associations for Cigarette Smoking and Non-tobacco Risk Factors for Cardiovascular Disease Incidence in the Atherosclerosis Risk In Communities (ARIC) Study.

PubMed

Lubin, Jay H; Couper, David; Lutsey, Pamela L; Yatsuya, Hiroshi

2017-07-01

Cigarette smoking, various metabolic and lipid-related factors and hypertension are well-recognized cardiovascular disease (CVD) risk factors. Since smoking affects many of these factors, use of a single imprecise smoking metric, for example, ever or never smoked, may allow residual confounding and explain inconsistencies in current assessments of interactions. Using a comprehensive model in pack-years and cigarettes/day for the complex smoking-related relative risk (RR) of CVD to reduce residual confounding, we evaluated interactions with non-tobacco risk factors, including additive (non-synergistic) and multiplicative (synergistic) forms. Data were from the prospective Atherosclerosis Risk in Communities (ARIC) Study from four areas of the United States recruited in 1987-1989 with follow-up through 2008. Analyses included 14 127 participants, 207 693 person-years and 2857 CVD events. Analyses revealed distinct interactions with smoking: including statistical consistency with additive (body mass index [BMI], waist to hip ratio [WHR], diabetes mellitus [DM], glucose, insulin, high density lipoproteins [HDL] and HDL(2)); and multiplicative (hypertension, total cholesterol [TC], low density lipoproteins [LDLs], apolipoprotein B [apoB], TC to HDL ratio and HDL(3)) associations, as well as indeterminate (apolipoprotein A-I [apoA-I] and triglycerides) associations. The forms of the interactions were revealing but require confirmation. Improved understanding of joint associations may help clarify the public health burden of smoking for CVD, links between etiologic factors and biological mechanisms, and the consequences of joint exposures, whereby synergistic associations highlight joint effects and non-synergistic associations suggest distinct contributions. Joint associations for cigarette smoking and non-tobacco risk factors were distinct, revealing synergistic/multiplicative (hypertension, TC, LDL, apoB, TC/HDL, HDL(3)), non-synergistic/additive (BMI, WHR, DM, glucose, insulin, HDL, HDL(2)) and indeterminate (apoA-I and TRIG) associations. If confirmed, these results may help better define the public health burden of smoking on CVD risk and identify links between etiologic factors and biologic mechanisms, where synergistic associations highlight joint impacts and non-synergistic associations suggest distinct contributions from each factor. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Cardiovascular disease risk factors in relation to suicide mortality in Asia: prospective cohort study of over one million Korean men and women

PubMed Central

Jee, Sun Ha; Kivimaki, Mika; Kang, Hee-Cheol; Park, Il Su; Samet, Jonathan M.; Batty, G. David

2011-01-01

Aims A potential role for cardiovascular disease (CVD) risk factors in the aetiology of suicide has not been comprehensively examined. In addition to being small in scale and poorly characterized, existing studies very rarely sample Asian populations in whom risk factor–suicide relationships may plausibly differ to Caucasian groups. We examined the association between a series of CVD risk factors and future mortality from suicide. Methods and results The Korean Cancer Prevention Study is a prospective cohort study comprising 1 234 927 individuals (445 022 women) aged 30–95 years with extensive measurement of established CVD risk factors at baseline and subsequent mortality surveillance. Fourteen years of follow-up gave rise to 472 deaths (389 in men and 83 in women) from suicide. After adjustment for a range of covariates, in men, smoking hazard ratio; 95% CI: (current vs. never: 1.69; 1.27, 2.24), alcohol intake (1–24 g/day vs. none: 1.29; 1.00, 1.66), blood cholesterol (≥240 vs. <200 mg/dL: 0.54; 0.36, 0.80), body mass index (underweight vs. normal weight: 2.08; 1.26, 3.45), stature [quartile 1(lowest) vs. 4: 1.68; 1.23, 2.30], socioeconomic status [quartile 1(lowest) vs. 4: 1.65; 1.21, 2.24], and martial status (unmarried vs. other: 1.60; 0.83, 3.06) were related to suicide mortality risk. These associations were generally apparent in women, although of lower magnitude. Exercise and blood pressure were not associated with completed suicide. Conclusion In this cohort of Korean men and women, a series of CVD risk factors were associated with an elevated risk of future suicide mortality. PMID:21911340

Do polypills lead to neglect of lifestyle risk factors? Findings from an individual participant data meta-analysis among 3140 patients at high risk of cardiovascular disease.

PubMed

Selak, Vanessa; Bullen, Chris; Stepien, Sandrine; Arroll, Bruce; Bots, Michiel; Bramley, Dale; Cass, Alan; Grobbee, Diederick; Hillis, Graham S; Molanus, Barbara; Neal, Bruce; Patel, Anushka; Rafter, Natasha; Rodgers, Anthony; Thom, Simon; Tonkin, Andrew; Usherwood, Tim; Wadham, Angela; Webster, Ruth

2016-09-01

The aim of this study was to investigate whether polypill-based care for the prevention of cardiovascular disease (CVD) is associated with a change in lifestyle risk factors when compared with usual care, among patients with CVD or high calculated cardiovascular risk. We conducted an individual participant data meta-analysis of three trials including patients from Australia, England, India, Ireland, the Netherlands and New Zealand that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior CVD event or who were at high risk of their first event. Analyses investigated any differential effect on anthropometric measures and self-reported lifestyle behaviours. Among 3140 patients (75% male, mean age 62 years and 76% with a prior CVD event) there was no difference in lifestyle risk factors in those randomised to polypill-based care compared with usual care over a median of 15 months, either across all participants combined, or in a range of subgroups. Furthermore, narrow confidence intervals (CIs) excluded any major effect; for example differences between the groups in body mass index was -0.1 (95% CI -0.2 to 0.1) kg/m(2), in weekly duration of moderate intensity physical activity was -2 (-26 to 23) minutes and the proportion of smokers was 16% vs 17% (RR 0.98, 0.84 to 1.15) at the end of trial. This analysis allays concern that polypill-based care may lead to neglect of lifestyle risk factors, at least among high-risk patients. Maximally effective preventive approaches should address lifestyle factors alongside pharmaceutical interventions, as recommended by major international guidelines. © The European Society of Cardiology 2016.

Low-dose pravastatin and age-related differences in risk factors for cardiovascular disease in hypercholesterolaemic Japanese: analysis of the management of elevated cholesterol in the primary prevention group of adult Japanese (MEGA study).

PubMed

Nakaya, Noriaki; Mizuno, Kyoichi; Ohashi, Yasuo; Teramoto, Tamio; Yokoyama, Shinji; Hirahara, Katsumi; Mizutani, Masahiro; Nakamura, Haruo

2011-09-01

Limited data are available regarding the relationship between age and the effect of HMG-CoA reductase inhibitor (statin) treatment. The aim of the present analysis was to evaluate the relationships between age, baseline patient characteristics, and pravastatin treatment with respect to the development of cardiovascular disease (CVD) in the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) study, a large-scale clinical study conducted in Japanese patients with mild or moderate hyperlipidaemia to evaluate the primary preventive effect of pravastatin against coronary heart disease. To compare the prevalence of CVD risk factors, the incidence of CVD in relation to each risk factor, and final values and changes in lipid parameters, the 7832 patients were classified into six age groups: <45, 45-49, 50-54, 55-59, 60-64 and ≥65 years. The relationship between pravastatin (10-20 mg/day) treatment efficacy and aging and the incidence of events in relation to the age groups were compared using the multivariable Cox proportional hazards model. The prevalences of diabetes mellitus and hypertension were higher in older men than in younger men, while the prevalences of smoking and obesity were higher in younger men. However, a similar difference in risk factors was not seen in women. High-density lipoprotein cholesterol was higher in women than in men across all age groups. Triglycerides were higher in younger men than in older men and all groups of women. The mean follow-up levels of total cholesterol and low-density lipoprotein cholesterol were lower in older patients than in younger patients. Pravastatin (10-20 mg/day) reduced the risk of CVD by about 30-40% across all age groups, and there was no difference between men and women. Of particular note in this analysis, CVD risk was markedly reduced in older women compared with younger women (53% vs 30% in women aged ≥65 vs ≥45 years). A similar satisfactory risk reduction for CVD was achieved with low-dose pravastatin in all men and in older women in particular, despite differences in the prevalence of risk factors. ClinicalTrials.gov Identifier: NCT00211705.

Aortic-Brachial Arterial Stiffness Gradient and Cardiovascular Risk in the Community: The Framingham Heart Study.

PubMed

Niiranen, Teemu J; Kalesan, Bindu; Larson, Martin G; Hamburg, Naomi M; Benjamin, Emelia J; Mitchell, Gary F; Vasan, Ramachandran S

2017-06-01

A recent study reported that the aortic-brachial arterial stiffness gradient, defined as carotid-radial/carotid-femoral pulse wave velocity (PWV ratio), predicts all-cause mortality better than carotid-femoral pulse wave velocity (CFPWV) alone in dialysis patients. However, the prognostic significance of PWV ratio for cardiovascular disease (CVD) in the community remains unclear. Accordingly, we assessed the correlates and prognostic value of the PWV ratio in 2114 Framingham Heart Study participants (60±10 years; 56% women) free of overt CVD. Mean PWV ratio decreased from 1.36±0.19 in participants aged <40 years to 0.73±0.21 in those aged ≥80 years. In multivariable linear regression, older age, male sex, higher body mass index, diabetes mellitus, lower high-density lipoprotein cholesterol, higher mean arterial pressure, and higher heart rate were associated with lower PWV ratio ( P <0.001 for all). During a median follow-up of 12.6 years, 248 first CVD events occurred. In Cox regression models adjusted for standard CVD risk factors, 1-SD changes in CFPWV (hazard ratio, 1.33; 95% confidence interval, 1.10-1.61) and PWV ratio (hazard ratio, 1.32; 95% confidence interval, 1.09-1.59) were associated with similar CVD risks. Models that included conventional CVD risk factors plus CFPWV or PWV ratio gave the same C statistics (C=0.783). Although PWV ratio has been reported to provide incremental predictive value over CFPWV in dialysis patients, we could not replicate these findings in our community-based sample. Our findings suggest that the prognostic significance of PWV ratio may vary based on baseline CVD risk, and CFPWV should remain the criterion standard for assessing vascular stiffness in the community. © 2017 American Heart Association, Inc.

HIV, Vascular and Aging Injuries in the Brain of Clinically Stable HIV-Infected Adults: A 1H MRS Study

PubMed Central

Cysique, Lucette A.; Moffat, Kirsten; Moore, Danielle M.; Lane, Tammy A.; Davies, Nicholas W. S.; Carr, Andrew; Brew, Bruce J.; Rae, Caroline

2013-01-01

Background Cardiovascular disease (CVD) and premature aging have been hypothesized as new risk factors for HIV associated neurocognitive disorders (HAND) in adults with virally-suppressed HIV infection. Moreover, their significance and relation to more classical HAND biomarkers remain unclear. Methods 92 HIV− infected (HIV+) adults stable on combined antiretroviral therapy (cART) and 30 age-comparable HIV-negative (HIV−) subjects underwent 1H Magnetic Resonance Spectroscopy (MRS) of the frontal white matter (targeting HIV, normal aging or CVD-related neurochemical injury), caudate nucleus (targeting HIV neurochemical injury), and posterior cingulate cortex (targeting normal/pathological aging, CVD-related neurochemical changes). All also underwent standard neuropsychological (NP) testing. CVD risk scores were calculated. HIV disease biomarkers were collected and cerebrospinal fluid (CSF) neuroinflammation biomarkers were obtained in 38 HIV+ individuals. Results Relative to HIV− individuals, HIV+ individuals presented mild MRS alterations: in the frontal white matter: lower N-Acetyl-Aspartate (NAA) (p<.04) and higher myo-inositol (mIo) (p<.04); in the caudate: lower NAA (p = .01); and in the posterior cingulate cortex: higher mIo (p<.008– also significant when Holm-Sidak corrected) and higher Choline/NAA (p<.04). Regression models showed that an HIV*age interaction was associated with lower frontal white matter NAA. CVD risk factors were associated with lower posterior cingulate cortex and caudate NAA in both groups. Past acute CVD events in the HIV+ group were associated with increased mIo in the posterior cingulate cortex. HIV duration was associated with lower caudate NAA; greater CNS cART penetration was associated with lower mIo in the posterior cingulate cortex and the degree of immune recovery on cART was associated with higher NAA in the frontal white matter. CSF neopterin was associated with higher mIo in the posterior cingulate cortex and frontal white matter. Conclusions In chronically HIV+ adults with long-term viral suppression, current CVD risk, past CVD and age are independent factors for neuronal injury and inflammation. This suggests a tripartite model of HIV, CVD and age likely driven by chronic inflammation. PMID:23620788

Parental Age of Onset of Cardiovascular Disease as a Predictor for Offspring Age of Onset of Cardiovascular Disease.

PubMed

Allport, Shannon Anjelica; Kikah, Ngum; Abu Saif, Nessim; Ekokobe, Fonkem; Atem, Folefac D

2016-01-01

The risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD. We used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn't experience onset of CVD) and Cox proportional regression analysis, with offspring's age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD. Parental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders. Offspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.

Pravastatin reduces the risk for cardiovascular disease in Japanese hypercholesterolemic patients with impaired fasting glucose or diabetes: diabetes subanalysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study.

PubMed

Tajima, Naoko; Kurata, Hideaki; Nakaya, Noriaki; Mizuno, Kyoichi; Ohashi, Yasuo; Kushiro, Toshio; Teramoto, Tamio; Uchiyama, Shinichiro; Nakamura, Haruo

2008-08-01

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease (CVD) in patients with no history of CVD. Evidence for the effect of statins on CVD in the diabetic population in low-risk populations (e.g., Japanese) is limited. We evaluated the effect of pravastatin on risk reduction of CVD related to baseline glucose status in a primary prevention setting. The Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, in patients with mild-to-moderate hypercholesterolemia (220-270 mg/dL), showed that low-dose pravastatin significantly reduced the risk for CVD by 26%. This exploratory subanalyses examined the efficacy of diet plus pravastatin on CVD in 2210 patients with abnormal fasting glucose (AFG, including 1746 patients with DM and 464 patients with impaired fasting glucose (IFG) at 5 years in the MEGA Study. CVD was threefold higher in AFG patients (threefold higher in DM, and twofold higher in IFG) compared with normal fasting glucose (NFG) patients in the diet group. Diet plus pravastatin treatment significantly reduced the risk of CVD by 32% (hazard ratio 0.68, 95% CI 0.48-0.96, number needed to treat, 42) in the AFG group compared with the diet alone group, and no significant interaction between AFG and NFG (interaction P=0.85) was found. Safety problems were not observed during long-term treatment with pravastatin. In conclusion, pravastatin reduces the risk of CVD in subjects with hypercholesterolemia and abnormal fasting glucose in the primary prevention setting in Japan.

Stressors influencing Middle Eastern women's perceptions of the risk of cardiovascular disease: a focus group study.

PubMed

Gholizadeh, Leila; Digiacomo, Michelle; Salamonson, Yenna; Davidson, Patricia M

2011-08-01

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 reducing their risks, and perceived stress as the most significant contributor to CVD. Women described their stress as primarily emanating from issues surrounding migration and acculturation. Implications for development and delivery of tailored health interventions for Middle Eastern women are discussed.

Cardiovascular Disease, Psychosocial Factors, and Genetics: The Case of Depression

PubMed Central

Mulle, Jennifer Gladys; Vaccarino, Viola

2013-01-01

Psychosocial factors are associated with cardiovascular disease, but little is known about the role of genetics in this relationship. Focusing on the well-studied phenotype of depression, current data show that there are shared genetic factors that may give rise to both depression and CVD, and these genetic risks appear to be modified by gender. This pleiotropic effect suggests that a single pathway, when perturbed, gives rise to the dual phenotypes of CVD and depression. The data also suggest that women contribute disproportionately to the depression-CVD comorbidity, and this unbalanced contribution is attributable, in part, to genetic factors. While the underlying biology behind this relationship is unclear, recent data support contributions from inflammatory or serotonergic pathways toward the comorbidity between CVD and depression. Even without knowledge of a specific mechanism, epidemiological observations offer new directions to explain the relationship between depression and CVD that have both research and clinical applications. PMID:23621965

Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women.

PubMed

Zhao, Di; Guallar, Eliseo; Ouyang, Pamela; Subramanya, Vinita; Vaidya, Dhananjay; Ndumele, Chiadi E; Lima, Joao A; Allison, Matthew A; Shah, Sanjiv J; Bertoni, Alain G; Budoff, Matthew J; Post, Wendy S; Michos, Erin D

2018-06-05

Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results. The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline. The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use. The mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes. Among post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women's increased CVD risk later in life. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

An Electronic Clinical Decision Support Tool to Assist Primary Care Providers in Cardiovascular Disease Risk Management: Development and Mixed Methods Evaluation

PubMed Central

Joshi, Rohina; Webster, Ruth J; Groenestein, Patrick; Usherwood, Tim P; Heeley, Emma; Turnbull, Fiona M; Lipman, Alexandra; Patel, Anushka A

2009-01-01

Background Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. Objectives Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations. Methods CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician’s clinic were analyzed to compare the tool’s risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool’s management advice was compared with a physician’s recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted. Results Validation testing: The tool’s risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients. Conclusion A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention. PMID:20018588

An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation.

PubMed

Peiris, David P; Joshi, Rohina; Webster, Ruth J; Groenestein, Patrick; Usherwood, Tim P; Heeley, Emma; Turnbull, Fiona M; Lipman, Alexandra; Patel, Anushka A

2009-12-17

Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations. CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician's clinic were analyzed to compare the tool's risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool's management advice was compared with a physician's recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted. Validation testing: the tool's risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients. A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention.

Physical Activity, Sedentary Behaviours, and Cardiovascular Health: When Will Cardiorespiratory Fitness Become a Vital Sign?

PubMed

Després, Jean-Pierre

2016-04-01

Although it is generally agreed upon that a physically active lifestyle and regular exercise are good for heart health, it is much less appreciated by the public that the prolonged hours of sedentary time resulting from sitting at work or screen time are also risk factors for cardiovascular outcomes and other cardiometabolic diseases. In this short narrative review, evidence is discussed and prudent recommendations are made in the context of the sedentary, affluent lifestyle that characterizes a large proportion of our population. It has become overwhelmingly clear that a sedentary lifestyle is a powerful risk factor for cardiovascular and other chronic diseases. In addition, vigorous physical activity and exercise is also associated with metabolic and cardiovascular adaptations that are compatible with cardiovascular health. In that regard, cardiorespiratory fitness, a reliable metric to assess the ability of the cardiovascular system to sustain prolonged physical work, has been shown to be the most powerful predictor of mortality and morbidity, way beyond classical cardiovascular disease (CVD) risk factors such as smoking, cholesterol, hypertension, and diabetes. On the basis of the evidence available, it is proposed that both dimensions of overall physical activity level (reducing sedentary time and performing regular physical activity or endurance type exercise) should be targeted to reduce CVD risk. Finally, because of the robust evidence that poor cardiorespiratory fitness is an independent risk factor for CVD and related mortality, it is proposed that this simple physiological metric should be incorporated as a vital sign in CVD risk factor evaluation and management. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Modulating peroxisome proliferator–activated receptors for therapeutic benefit? Biology, clinical experience, and future prospects

PubMed Central

Rosenson, Robert S.; Wright, R. Scott; Farkouh, Michael; Plutzky, Jorge

2014-01-01

Clinical trials of cardiovascular disease (CVD) prevention in patients with type 2 diabetes mellitus primarily have been directed at the modification of a single major risk factor; however, in trials that enroll patients with and without diabetes, the absolute risk in CVD events remains higher in patients with diabetes. Efforts to reduce the macrovascular and microvascular residual risk have been directed toward a multifactorial CVD risk-factor modification; nonetheless, long-term complications remain high. Dual-peroxisome proliferator–activated receptor (PPAR) α/γ agonists may offer opportunities to lower macrovascular and microvascular complications of type 2 diabetes mellitus beyond the reductions achieved with conventional risk-factor modification. The information presented elucidates the differentiation of compound-specific vs class-effect properties of PPARs as the basis for future development of a new candidate molecule. Prior experience with thiazolidinediones, an approved class of PPARγ agonists, and glitazars, investigational class of dual-PPARα/γ agonists, also provides important lessons about the risks and benefits of targeting a nuclear receptor while revealing some of the future challenges for regulatory approval. PMID:23137497

Smoking and mortality in stroke survivors: can we eliminate the paradox?

PubMed

Levine, Deborah A; Walter, James M; Karve, Sudeep J; Skolarus, Lesli E; Levine, Steven R; Mulhorn, Kristine A

2014-07-01

Many studies have suggested that smoking does not increase mortality in stroke survivors. Index event bias, a sample selection bias, potentially explains this paradoxical finding. Therefore, we compared all-cause, cardiovascular disease (CVD), and cancer mortality by cigarette smoking status among stroke survivors using methods to account for index event bias. Among 5797 stroke survivors of 45 years or older who responded to the National Health Interview Survey years 1997-2004, an annual, population-based survey of community-dwelling US adults, linked to the National Death Index, we estimated all-cause, CVD, and cancer mortality by smoking status using Cox proportional regression and propensity score analysis to account for demographic, socioeconomic, and clinical factors. Mean follow-up was 4.5 years. From 1997 to 2004, 18.7% of stroke survivors smoked. There were 1988 deaths in this stroke survivor cohort, with 50% of deaths because of CVD and 15% because of cancer. Current smokers had an increased risk of all-cause mortality (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.14-1.63) and cancer mortality (HR, 3.83; 95% CI, 2.48-5.91) compared with never smokers, after controlling for demographic, socioeconomic, and clinical factors. Current smokers had an increased risk of CVD mortality controlling for age and sex (HR, 1.29; 95% CI, 1.01-1.64), but this risk did not persist after controlling for socioeconomic and clinical factors (HR, 1.15; 95% CI, .88-1.50). Stroke survivors who smoke have an increased risk of all-cause mortality, which is largely because of cancer mortality. Socioeconomic and clinical factors explain stroke survivors' higher risk of CVD mortality associated with smoking. Published by Elsevier Inc.

HIV and risk of cardiovascular disease in sub-Saharan Africa: Rationale and design of the Ndlovu Cohort Study.

PubMed

Vos, Alinda; Tempelman, Hugo; Devillé, Walter; Barth, Roos; Wensing, Annemarie; Kretzschmar, Mirjam; Klipstein-Grobusch, Kerstin; Hoepelman, Andy; Tesselaar, Kiki; Aitken, Sue; Madzivhandila, Mashudu; Uiterwaal, Cuno; Venter, Francois; Coutinho, Roel; Grobbee, Diederick E

2017-07-01

Background The largest proportion of people living with HIV resides in sub-Saharan Africa (SSA). Evidence from developed countries suggests that HIV infection increases the relative risk of cardiovascular disease (CVD) by up to 50%. Differences in lifestyle, gender distribution, routes of HIV transmission and HIV subtype preclude generalisation of data from Western countries to the SSA situation. The Ndlovu Cohort Study aims to provide insight into the burden of cardiovascular risk factors and disease, the mechanisms driving CVD risk and the contribution of HIV infection and its treatment to the development of CVD in a rural area of SSA. Design The Ndlovu Cohort Study is a prospective study in the Moutse area, Limpopo Province, South Africa. Methods A total of 1000 HIV-positive and 1000 HIV-negative participants aged 18 years and older with a male to female ratio of 1:1 will be recruited. Measurements of CVD risk factors and HIV-related characteristics will be performed at baseline, and participants will be followed-up over time at 6-month intervals. The burden of CVD will be assessed with repeated carotid intima-media thickness and pulse wave velocity measurements, as well as by recording clinical cardiovascular events that occur during the follow-up period. Conclusion This project will contribute to the understanding of the epidemiology and pathogenesis of CVD in the context of HIV infection in a rural area of SSA. The ultimate goal is to improve cardiovascular risk prediction and to indicate preventive approaches in the HIV-infected population and, potentially, for non-infected high-risk populations in a low-resource setting.

Managing overweight and obesity in adults to reduce cardiovascular disease risk.

PubMed

Ebbert, Jon O; Elrashidi, Muhamad Y; Jensen, Michael D

2014-10-01

Obesity is a leading preventable cause of death and disability worldwide. Obesity increases the risk for clinically identifiable risk factors for cardiovascular disease (CVD) as well as a host of other metabolic, sleep, and orthopedic disorders. Coordinated and systematic interventions are needed to manage obesity and reduce these risks. The Obesity 2 Expert Panel updated the previous guidelines and produced the "Guideline for the Management of Overweight and Obesity in Adults." The Panel used data from publications from years 1999 to 2011 to address five critical questions, provide evidence statements, and recommend creation of a treatment algorithm to guide decision making about clinical care. The current review discusses the evidence statements pertaining to CVD risk in the assessment and management of patients who are overweight and obese. We summarize the FDA-approved medications for the treatment of overweight and obesity and their impact on CVD risk and risk factors, as well as ongoing clinical trials which will further inform clinical practice.

Knowledge, attitudes, and related practices of Filipino seafarers regarding cardiovascular diseases.

PubMed

Gregorio, Ernesto Ramos; Kobayashi, Jun; Medina, John Robert Carabeo; Simbulan, Nymia Pimentel

2016-01-01

Globally, cardiovascular diseases (CVD) remain the leading cause of mortality. Due to the nature of their work and lifestyle on board, Filipino seafarers have a high propensity towards acquiring CVD. This study aimed to determine the knowledge, attitudes, and practices related to CVD of Filipino seafarers. This study utilised a descriptive cross-sectional study design. Self-administered questionnaires were distributed among 136 male seafarers who went into a private general hospital for their pre-employment medical examination. Eating fatty foods (77.0%), cigarette smoking (68.4%) and lack of exercise (65.4%) were identified by the respondents as the top three most common risk factors for CVD. Avoiding fatty or oily foods (85.3%) and exercising regularly (83.1%) were identified by the respondents as preventive measures for CVD. High blood pressure and shortness of breath were identified by more than half of the respondents as a sign and symptom of CVD, respectively. But the respondents failed to identify other equally important signs and symptoms. Majority of the respondents (> 80%) had high level of perception with respect to the six constructs of the health belief model. Some respondents had admitted engagement in risk-taking behaviours such as smoking (36.0%) and physical inactivity (27.2%). Majority were into high fat and salt diet (70.6%) and current alcohol consumption (79.4%). Although the respondents had favourable attitudes towards CVD, there were knowledge gaps in risk factors, preventive measures, and recognition of signs and symptoms. Hence, some were still engaging in risk-taking behaviours such as smoking, irregular involvement in physical activity, unbalanced diet, and alcohol intake.

Does modifying the timing of meal intake improve cardiovascular risk factors? Protocol of an Australian pilot intervention in night shift workers with abdominal obesity.

PubMed

Bonham, Maxine P; Leung, Gloria K W; Davis, Rochelle; Sletten, Tracey L; Murgia, Chiara; Young, Morag J; Eikelis, Nina; Lambert, Elisabeth A; Huggins, Catherine E

2018-03-14

Shift work is an independent risk factor for cardiovascular disease (CVD). Shift workers who are awake overnight and sleep during the day are misaligned with their body's endogenous circadian rhythm. Eating at night contributes to this increased risk of CVD by forcing the body to actively break down and process nutrients at night. This pilot study aims to determine whether altering meal timing overnight, in a shift working population, will impact favourably on modifiable risk factors for CVD (postprandial bplasma lipids and glucose concentration). A randomised cross-over study with two 4-week test periods, separated by a minimum of a 2-week washout will be undertaken. The effectiveness of redistributing energy intake overnight versus ad libitum eating patterns on CVD risk factors will be examined in night shift workers (n=20), using a standard acute test meal challenge protocol. Primary outcomes (postprandial lipids and glucose) will be compared between the two conditions: post-intervention and post-control period using analysis of variance. Potential effect size estimates to inform sample size calculations for a main trial will also be generated. Ethics approval has been granted by the Monash University Human Research Ethics Committee (2017-8619-10329). Outcomes from this study will determine whether eliminating food intake for a defined period at night (1-6 am) impacts favourably on metabolic risk factors for CVD in night shift workers. Collective results from this novel trial will be disseminated through peer-reviewed journals, and national and international presentations. The results are essential to inform health promotion policies and guidelines for shift workers, especially those who aim to improve their metabolic health. ACTRN12617000791336; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Natriuretic Peptide and High-Sensitivity Troponin for Cardiovascular Risk Prediction in Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

PubMed Central

Gori, Mauro; Gupta, Deepak K.; Claggett, Brian; Selvin, Elizabeth; Folsom, Aaron R.; Matsushita, Kunihiro; Bello, Natalie A.; Cheng, Susan; Shah, Amil; Skali, Hicham; Vardeny, Orly; Ni, Hanyu; Ballantyne, Christie M.; Astor, Brad C.; Klein, Barbara E.; Aguilar, David

2016-01-01

OBJECTIVE Cardiovascular disease (CVD) is the major cause of morbidity and mortality in diabetes; yet, heterogeneity in CVD risk has been suggested in diabetes, providing a compelling rationale for improving diabetes risk stratification. We hypothesized that N-terminal prohormone brain natriuretic peptide (NTproBNP) and high-sensitivity troponin T may enhance CVD risk stratification beyond commonly used markers of risk and that CVD risk is heterogeneous in diabetes. RESEARCH DESIGN AND METHODS Among 8,402 participants without prevalent CVD at visit 4 (1996–1998) of the Atherosclerosis Risk in Communities (ARIC) study there were 1,510 subjects with diabetes (mean age 63 years, 52% women, 31% African American, and 60% hypertensive). RESULTS Over a median follow-up of 13.1 years, there were 540 incident fatal/nonfatal CVD events (coronary heart disease, heart failure, and stroke). Both troponin T ≥14 ng/L (hazard ratio [HR] 1.96 [95% CI 1.57–2.46]) and NTproBNP >125 pg/mL (1.61 [1.29–1.99]) were independent predictors of incident CVD events at multivariable Cox proportional hazard models. Addition of circulating cardiac biomarkers to traditional risk factors, abnormal electrocardiogram (ECG), and conventional markers of diabetes complications including retinopathy, nephropathy, and peripheral arterial disease significantly improved CVD risk prediction (net reclassification index 0.16 [95% CI 0.07–0.22]). Compared with individuals without diabetes, subjects with diabetes had 1.6-fold higher adjusted risk of incident CVD. However, participants with diabetes with normal cardiac biomarkers and no conventional complications/abnormal ECG (n = 725 [48%]) were at low risk (HR 1.12 [95% CI 0.95–1.31]), while those with abnormal cardiac biomarkers, alone (n = 186 [12%]) or in combination with conventional complications/abnormal ECG (n = 243 [16%]), were at greater risk (1.99 [1.59–2.50] and 2.80 [2.34–3.35], respectively). CONCLUSIONS Abnormal levels of NTproBNP and troponin T may help to distinguish individuals with high diabetes risk from those with low diabetes risk, providing incremental risk prediction beyond commonly used markers of risk. PMID:26740635

Cholesterol-lowering activity of soy-derived glyceollins in the golden Syrian hamster model

USDA-ARS?s Scientific Manuscript database

Hypercholesterolemia is one of the major factors contributing to the risk of cardiovascular disease (CVD), which is the leading cause of death in the developed countries. Consumption of soy foods has been recognized to lower the risk of CVD, and phytochemicals in soy may contribute to the health ben...

A comparative analysis of cardiovascular disease risk profiles of five Pacific ethnic groups assessed in New Zealand primary care practice: PREDICT CVD-13.

PubMed

Grey, Corina; Wells, Sue; Riddell, Tania; Pylypchuk, Romana; Marshall, Roger; Drury, Paul; Elley, Raina; Ameratunga, Shanthi; Gentles, Dudley; Erick-Peletiy, Stephanie; Bell, Fionna; Kerr, Andrew; Jackson, Rod

2010-11-05

Data on the cardiovascular disease risk profiles of Pacific peoples in New Zealand is usually aggregated and treated as a single entity. Little is known about the comparability or otherwise of cardiovascular disease (CVD) risk between different Pacific groups. To compare CVD risk profiles for the main Pacific ethnic groups assessed in New Zealand primary care practice to determine if it is reasonable to aggregate these data, or if significant differences exist. A web-based clinical decision support system for CVD risk assessment and management (PREDICT) has been implemented in primary care practices in nine PHOs throughout Auckland and Northland since 2002, covering approximately 65% of the population of these regions. Between 2002 and January 2009, baseline CVD risk assessments were carried out on 11,642 patients aged 35-74 years identifying with one or more Pacific ethnic groups (4933 Samoans, 1724 Tongans, 1366 Cook Island Maori, 880 Niueans, 1341 Fijians and 1398 people identified as Other Pacific or Pacific Not Further Defined). Fijians were subsequently excluded from the analyses because of a probable misclassification error that appears to combine Fijian Indians with ethnic Fijians. Prevalences of smoking, diabetes and prior history of CVD, as well as mean total cholesterol/HDL ratio, systolic and diastolic blood pressures, and Framingham 5-year CVD risk were calculated for each Pacific group. Age-adjusted risk ratios and mean differences stratified by gender were calculated using Samoans as the reference group. Cook Island women were almost 60% more likely to smoke than Samoan women. While Tongan men had the highest proportion of smoking (29%) among Pacific men, Tongan women had the lowest smoking proportion (10%) among Pacific women. Tongan women and Niuean men and women had a higher burden of diabetes than other Pacific ethnic groups, which were 20-30% higher than their Samoan counterparts. Niuean men and women had lower blood pressure levels than all other Pacific groups while Tongan men and women had the highest total cholesterol to HDL ratios. Tongan men and women had higher absolute 5-year CVD risk scores, as estimated by the Framingham equation, than their Samoan counterparts (Age-adjusted mean differences 0.71% [95% CI 0.36% to 1.06%] for Tongan men and 0.52% [95% CI 0.17% to 0.86%] for Tongan women) although these risk differences were only about 10% higher in relative terms. The validity of the analyses depend on the assumption that the selection of participants for CVD risk assessment in primary care is similar between Pacific groups. The ethnic-specific CVD risk profiles presented do not represent estimates of population prevalence. Almost all previous Pacific data has been aggregated with Pacific peoples treated as a single entity because of small sample sizes. We have analysed data from the largest study to date measuring CVD risk factors in Pacific peoples living in New Zealand. Our findings suggest that aggregating Pacific population data appears to be reasonable in terms of assessing absolute CVD risk, however there are differences for specific CVD risk factors between Pacific ethnic groups that may be important for targeting community level interventions.

Impact of Sustained Use of a Multifaceted Computerized Quality Improvement Intervention for Cardiovascular Disease Management in Australian Primary Health Care.

PubMed

Patel, Bindu; Peiris, David; Usherwood, Tim; Li, Qiang; Harris, Mark; Panaretto, Kathryn; Zwar, Nicholas; Patel, Anushka

2017-10-24

We evaluated a multifaceted, computerized quality improvement intervention for management of cardiovascular disease (CVD) risk in Australian primary health care. After completion of a cluster randomized controlled trial, the intervention was made available to both trial arms. Our objective was to assess intervention outcomes in the post-trial period and any heterogeneity based on original intervention allocation. Data from 41 health services were analyzed. Outcomes were (1) proportion of eligible population with guideline-recommended CVD risk factor measurements; and (2) the proportion at high CVD risk with current prescriptions for guideline-recommended medications. Patient-level analyses were conducted using generalized estimating equations to account for clustering and time effects and tests for heterogeneity were conducted to assess impact of original treatment allocation. Median follow-up for 22 809 patients (mean age, 64.2 years; 42.5% men, 26.5% high CVD risk) was 17.9 months post-trial and 35 months since trial inception. At the end of the post-trial period there was no change in CVD risk factor screening overall when compared with the end of the trial period (64.7% versus 63.5%, P =0.17). For patients at high CVD risk, there were significant improvements in recommended prescriptions at end of the post-trial period when compared with the end of the trial period (65.2% versus 56.0%, P <0.001). There was no heterogeneity of treatment effects on the outcomes based on original randomization allocation. CVD risk screening improvements were not observed in the post-trial period. Conversely, improvements in prescribing continued, suggesting that changes in provider and patient actions may take time when initiating medications. URL: http://www.anzctr.org.au. Unique identifier: 12611000478910. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Cardiovascular disease risk factors and socioeconomic variables in a nation undergoing epidemiologic transition.

PubMed

Rasiah, Rajah; Yusoff, Khalid; Mohammadreza, Amiri; Manikam, Rishya; Tumin, Makmor; Chandrasekaran, Sankara Kumar; Khademi, Shabnam; Bakar, Najmin Abu

2013-09-25

Cardiovascular disease (CVD) related deaths is not only the prime cause of mortality in the world, it has also continued to increase in the low and middle income countries. Hence, this study examines the relationship between CVD risk factors and socioeconomic variables in Malaysia, which is a rapidly growing middle income nation undergoing epidemiologic transition. Using data from 11,959 adults aged 30 years and above, and living in urban and rural areas between 2007 and 2010, this study attempts to examine the prevalence of CVD risk factors, and the association between these factors, and socioeconomic and demographic variables in Malaysia. The socioeconomic and demographic, and anthropometric data was obtained with blood pressure and fasting venous blood for glucose and lipids through a community-based survey. The association between CVD risk factors, and education and income was mixed. There was a negative association between smoking and hypertension, and education and income. The association between diabetes, hypercholesterolemia and being overweight with education and income was not clear. More men than women smoked in all education and income groups. The remaining consistent results show that the relationship between smoking, and education and income was obvious and inverse among Malays, others, rural women, Western Peninsular Malaysia (WPM) and Eastern Peninsular Malaysia (EPM). Urban men showed higher prevalence of being overweight than rural men in all education and income categories. Except for those with no education more rural men smoked than urban men. Also, Malay men in all education and income categories showed the highest prevalence of smoking among the ethnic groups. The association between CVD risk factors and socioeconomic variables should be considered when formulating programmes to reduce morbidity and mortality rates in low and middle income countries. While general awareness programmes should be targeted at all, specific ones should be focused on vulnerable groups, such as, men and rural inhabitants for smoking, Malays for hypertension and hypercholesterolemia, and Indians and Malays, and respondents from EPM for diabetes.

Prevalence of metabolic syndrome and associated risk factors in Asian Indians.

PubMed

Balasubramanyam, Ajay; Rao, Shaun; Misra, Ranjita; Sekhar, Rajagopal V; Ballantyne, Christie M

2008-08-01

This study examined the association between metabolic syndrome, lifestyle behaviors, and perception and knowledge of current health and cardiovascular disease (CVD) among Asian Indians in the US. The sample comprised of 143 adult Asian Indians recruited through health fairs for survey and bioclinical measures. The prevalence of metabolic syndrome was 32%, much higher than other ethnic groups, did not vary by gender but increased with age. Respondents had high physical inactivity and poor knowledge of CVD risk factors. Dietary behavior, age, number of years lived in the US, self-rated physical and mental health and BMI were significant predictors and explained 40.1% of variance in metabolic syndrome score. Poorer physical health status had the greatest predictive influence on metabolic syndrome. Asian Indians are a high risk group for CVD.

Atherosclerotic Cardiovascular Disease Beginning in Childhood

PubMed Central

2010-01-01

Although the clinical manifestations of cardiovascular disease (CVD), such as myocardial infarction, stroke, and peripheral vascular disease, appear from middle age, the process of atherosclerosis can begin early in childhood. The early stage and progression of atherosclerosis in youth are influenced by risk factors that include obesity, hypertension, dyslipidemia, and smoking, and by the presence of specific diseases, such as diabetes mellitus and Kawasaki disease (KD). The existing evidence indicates that primary prevention of atherosclerotic disease should begin in childhood. Identification of children at risk for atherosclerosis may allow early intervention to decrease the atherosclerotic process, thereby preventing or delaying CVD. This review will describe the origin and progression of atherosclerosis in childhood, and the identification and management of known risk factors for atherosclerotic CVD in children and young adults. PMID:20111646

Global cardiovascular mortality risk in the adult Polish population: prospective assessment of the cohorts studied in multicentre national WOBASZ and WOBASZ Senior studies.

PubMed

Piotrowski, Walerian; Waśkiewicz, Anna; Cicha-Mikołajczyk, Alicja

2016-01-01

To develop a global cardiovascular disease (CVD) mortality risk model for the Polish population and to verify these data in the context of the SCORE risk algorithm. We analysed data obtained in two multicentre national population studies, the WOBASZ study which was conducted in 2003-2005 and included 14,769 subjects aged 20-74 years, and the WOBASZ Senior study which was conducted in 2007 and included 1096 subjects above 74 years of age. All these subjects were followed for survival status until 2012 and the cause of death was determined. The mean duration of follow-up was 8.2 years for WOBASZ study participants and about 5 years for WOBASZ Senior study participants. Overall, 1436 subjects died, including 568 due to CVD. For the purpose of our analysis of overall and CVD mortality, 15 established risk factors were selected. Survival was analysed separately in WOBASZ and WOBASZ Senior study participants. Statistical methods included descriptive statistics, Kaplan-Meier curves, Cox proportional hazard models, and the SCORE risk algorithm. Measure of incompatibility of the SCORE risk model to the Polish population was determined as the difference between mortality rates by the SCORE risk quartiles and the Cox approach. During the 8-year follow-up of the WOBASZ study population, mortality due to CVD was 38% among men and 31% among women. The most common causes of CVD mortality were ischaemic heart disease (IHD, 33%) followed by cerebro-vascular disease (17%) in men, and cerebrovascular disease (31%) followed by IHD (23%) in women. We found significant differences between men and women in regard to survival curves for both overall mortality and CVD mortality (p < 0.0001). For overall mortality among men and women, nearly all selected risk factors were shown to be significant in univariate analyses, except for high density lipoprotein cholesterol (HDL-C) level and the total cholesterol/HDL-C ratio in men, and smoking status in women. In multivariate analysis, independent predictors in men included age, glucose level, systolic blood pressure, and smoking status. In women, independent predictors were age, smoking status, and diabetes. During the 5-year follow-up of the WOBASZ Senior study population, mortality due to CVD was 48% among men and 58% among women. The most common cause of CVD mortality in both men and women was IHD (29% and 24%, respectively), followed by cerebrovascular disease (16% and 21%, respectively). We found significant differences between men and women in regard to survival curves for overall mortality (p < 0.0001) but not for CVD mortality (p = 0.0755). Due to the fact that survival curves for CVD mortality did not differ between men and women, we estimated the cut-off age for no survival difference in the WOBASZ study. By selecting the oldest patients and adding them to the WOBASZ Senior cohort, we obtained the cut-off age of 70 years above which the survival curves were not significantly different between men and women. In univariate analyses, independent predictors in men were age and creatinine level. These factors remained significant in multivariate analysis. In women above 74 years of age, independent predictors in univariate analyses included age, HDL-C level, creatinine level, total cholesterol/HDL-C ratio, and smoking status. Age, HDL-C level, creatinine level, and smoking status remained independent predictors of overall mortality in multivariate analysis. For CVD mortality, significant predictors were the same as for overall mortality. In women, significant predictors in uni- and multivariate analyses were age and smoking status. Overall disagreement between CVD mortality rates by the SCORE risk model and the Cox model was 5.7% in men and 2% in women. 1. Long-term follow-up of WOBASZ and WOBASZ Senior study participants allowed assessment of the inde-pendent association of the evaluated cardiovascular risk factors with CVD mortality in the Polish population. 2. Validation of the SCORE risk algorithm to estimate individual global CVD risk in the Polish population showed a high predictive value of this algorithm.

Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia.

PubMed

Hennekens, Charles H

2007-01-01

Cardiovascular disease (CVD), which includes coronary heart, cerebrovascular, and peripheral vascular disease, is the leading cause of death in the United States and most developed countries, accounting for about 50% of all deaths. The major risk factors include obesity and its consequences, dyslipidemia, hypertension, insulin resistance leading to diabetes, and cigarette smoking. In developing countries, CVD will become the leading cause of death due to alarming increases in obesity, sedentary lifestyles, cigarette smoking, and improvements in prevention and treatment of malnutrition and infection. Compared with nonschizophrenics, patients with schizophrenia have a 20% shorter life expectancy (i.e., from 76 to 61 years). In general populations, about 1% die from suicide compared with about 10% among patients with schizophrenia (relative risk = 10). For CVD, the corresponding figures are 50% and about 75% (relative risk = 1.5). In patients with schizophrenia, however, CVD occurs more frequently and accounts for more premature deaths than suicide. Patients with schizophrenia have alarmingly higher rates of obesity, dyslipidemia, hypertension, diabetes, and cigarette smoking than nonschizophrenic individuals in the general population. Compounding these data, patients with schizophrenia have less access to medical care, consume less medical care, and are less compliant. Primary prevention strategies should include the choice of antipsychotic drug regimens that do not adversely affect the major risk factors for CVD.

EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.

PubMed

Agca, R; Heslinga, S C; Rollefstad, S; Heslinga, M; McInnes, I B; Peters, M J L; Kvien, T K; Dougados, M; Radner, H; Atzeni, F; Primdahl, J; Södergren, A; Wallberg Jonsson, S; van Rompay, J; Zabalan, C; Pedersen, T R; Jacobsson, L; de Vlam, K; Gonzalez-Gay, M A; Semb, A G; Kitas, G D; Smulders, Y M; Szekanecz, Z; Sattar, N; Symmons, D P M; Nurmohamed, M T

2017-01-01

Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A worksite intervention to reduce the cardiovascular risk: proposal of a study design easy to integrate within Italian organization of occupational health surveillance.

PubMed

Mastrangelo, Giuseppe; Marangi, Gianluca; Bontadi, Danilo; Fadda, Emanuela; Cegolon, Luca; Bortolotto, Melania; Fedeli, Ugo; Marchiori, Luciano

2015-01-21

Despite the substantial amount of knowledge on effectiveness of worksite health promotion (WHP) in reducing cardiovascular disease (CVD) risk, WHP programs are not systematically applied in Italy. The aim was to design an intervention easy to integrate within the Italian organization of workplace health surveillance. We used the "pretest-posttest design". Workers were employed in multiple occupations and resident in Veneto region, Italy. Occupational physicians (OPs) performed all examinations, including laboratory evaluation (capillary blood sampling and measure of glycaemia and cholesterolemia with portable devices), during the normal health surveillance at worksite. CVD risk was computed based on sex, age, smoking habit, diabetes, systolic pressure and cholesterol level. After excluding those with <40 years of age, missing consent, CVD diagnosis or current therapy for CVD, missing information, CVD risk <5%, out of 5,536 workers 451 underwent the intervention and 323 male workers were re-examined at 1 year. CVD risk was the most compelling argument for changing lifestyle. The counseling was based on the individual risk factors. Individuals examined at posttest were a small fraction of the whole (6% = 323/5,536). In these workers we computed the ratio pretest/posttest of proportions (such as percent of subjects with cardiovascular risk >5%) as well as the exact McNemar significance probability or the exact test of table symmetry. CVD risk decreased by 24% (McNemar p = 0.0000) after the intervention; in a sensitivity analysis assuming that all subjects lost to follow-up kept their pretest cardiovascular risk value, the effect (-18%) was still significant (symmetry p < 0.0000). Each prevented CVD case was expected to cost about 5,700 euro. The present worksite intervention promoted favorable changes of CVD risk that were reasonably priced and consistent across multiple occupations.

Dose-Response Relation Between Work Hours and Cardiovascular Disease Risk: Findings From the Panel Study of Income Dynamics.

PubMed

Conway, Sadie H; Pompeii, Lisa A; Roberts, Robert E; Follis, Jack L; Gimeno, David

2016-03-01

The aim of this study was to examine the presence of a dose-response relationship between work hours and incident cardiovascular disease (CVD) in a representative sample of U.S. workers. A retrospective cohort study of 1926 individuals from the Panel Study of Income Dynamics (1986 to 2011) employed for at least 10 years. Restricted cubic spline regression was used to estimate the dose-response relationship of work hours with CVD. A dose-response relationship was observed in which an average workweek of 46 hours or more for at least 10 years was associated with an increased risk of CVD. Compared with working 45 hours per week, working an additional 10 hours per week or more for at least 10 years increased CVD risk by at least 16%. Working more than 45 work hours per week for at least 10 years may be an independent risk factor for CVD.

APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults.

PubMed

Gutiérrez, Orlando M; Irvin, Marguerite R; Chaudhary, Ninad S; Cushman, Mary; Zakai, Neil A; David, Victor A; Limou, Sophie; Pamir, Nathalie; Reiner, Alex P; Naik, Rakhi P; Sale, Michele M; Safford, Monika M; Hyacinth, Hyacinth I; Judd, Suzanne E; Kopp, Jeffrey B; Winkler, Cheryl A

2018-06-01

APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status ( P interaction =0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus. © 2018 American Heart Association, Inc.

Genetics of Variation in Serum Uric Acid and Cardiovascular Risk Factors in Mexican Americans

PubMed Central

Voruganti, V. Saroja; Nath, Subrata D.; Cole, Shelley A.; Thameem, Farook; Jowett, Jeremy B.; Bauer, Richard; MacCluer, Jean W.; Blangero, John; Comuzzie, Anthony G.; Abboud, Hanna E.; Arar, Nedal H.

2009-01-01

Background: Elevated serum uric acid is associated with several cardiovascular disease (CVD) risk factors such as hypertension, inflammation, endothelial dysfunction, insulin resistance, dyslipidemia, and obesity. However, the role of uric acid as an independent risk factor for CVD is not yet clear. Objective: The aim of the study was to localize quantitative trait loci regulating variation in serum uric acid and also establish the relationship between serum uric acid and other CVD risk factors in Mexican Americans (n = 848; men = 310, women = 538) participating in the San Antonio Family Heart Study. Methods: Quantitative genetic analysis was conducted using variance components decomposition method, implemented in the software program SOLAR. Results: Mean ± sd of serum uric acid was 5.35 ± 1.38 mg/dl. Univariate genetic analysis showed serum uric acid and other CVD risk markers to be significantly heritable (P < 0.005). Bivariate analysis showed significant correlation of serum uric acid with body mass index, waist circumference, waist/hip ratio, total body fat, plasma insulin, serum triglycerides, high-density lipoprotein cholesterol, C-reactive protein, and granulocyte macrophage-colony stimulating factor (P < 0.05). A genome-wide scan for detecting quantitative trait loci regulating serum uric acid variation showed a significant logarithm of odds (LOD) score of 4.72 (empirical LOD score = 4.62; P < 0.00001) on chromosome 3p26. One LOD support interval contains 25 genes, of which an interesting candidate gene is chemokine receptor 2. Summary: There is a significant genetic component in the variation in serum uric acid and evidence of pleiotropy between serum uric acid and other cardiovascular risk factors. PMID:19001525

Control of Risk Factors for Cardiovascular Disease among Multinational Patient Population in the Arabian Gulf

PubMed Central

Al-Zakwani, Ibrahim; Al-Mahmeed, Wael; Arafah, Mohamed; Al-Hinai, Ali T.; Shehab, Abdullah; Al-Tamimi, Omer; Al-Awadhi, Mahmoud; Al-Herz, Shorook; Al-Anazi, Faisal; Al-Nemer, Khalid; Metwally, Othman; Al-Khadra, Akram; Fakhry, Mohammed; Elghetany, Hossam; Medani, Abdel R.; Yusufali, Afzal H.; Al-Jassim, Obaid; Al-Hallaq, Omar; Baslaib, Fahad O.A.S.; Amin, Haitham; Santos, Raul D.; Al-Waili, Khalid; Al-Hashmi, Khamis; Al-Rasadi, Khalid

2016-01-01

We evaluated the control of cardiovascular disease (CVD) risk factors among patients with atherosclerotic cardiovascular disease (ASCVD) in the Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolaemia (CEPHEUS) in the Arabian Gulf. Of the 4398 enrolled patients, overall mean age was 57 ± 11 years, 60% were males, 13% were smokers, 76% had diabetes, 71% had metabolic syndrome and 78% had very high ASCVD risk status. The proportion of subjects with body mass index <25 kg/m2, HbA1c <7% (in diabetics), low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/L (100 mg/dL) and <1.8 mmol/L (70 mg/dL) for high and very high ASCVD risk cohorts, respectively and controlled blood pressure (<140/90 mmHg) was 14, 26, 31% and 60%, respectively. Only 1.4% of the participants had all of their CVD risk factors controlled with significant differences among the countries (P < .001). CVD risk goal attainment rates were significantly lower in those with very high ASCVD risk compared with those with high ASCVD risk status (P < .001). Females were also, generally, less likely to attain goals when compared with males (P < .001). PMID:26496982

Aerobic exercise and other healthy lifestyle factors that influence vascular aging.

PubMed

Santos-Parker, Jessica R; LaRocca, Thomas J; Seals, Douglas R

2014-12-01

Cardiovascular diseases (CVDs) remain the leading cause of death in the United States and other modern societies. Advancing age is the major risk factor for CVD, primarily due to stiffening of the large elastic arteries and the development of vascular endothelial dysfunction. In contrast, regular aerobic exercise protects against the development of large elastic artery stiffness and vascular endothelial dysfunction with advancing age. Moreover, aerobic exercise interventions reduce arterial stiffness and restore vascular endothelial function in previously sedentary middle-aged/older adults. Aerobic exercise exerts its beneficial effects on arterial function by modulating structural proteins, reducing oxidative stress and inflammation, and restoring nitric oxide bioavailability. Aerobic exercise may also promote "resistance" against factors that reduce vascular function and increase CVD risk with age. Preventing excessive increases in abdominal adiposity, following healthy dietary practices, maintaining a low CVD risk factor profile, and, possibly, selective use of pharmaceuticals and nutraceuticals also play a major role in preserving vascular function with aging. Copyright © 2014 The American Physiological Society.

Aerobic exercise and other healthy lifestyle factors that influence vascular aging

PubMed Central

Santos-Parker, Jessica R.; LaRocca, Thomas J.

2014-01-01

Cardiovascular diseases (CVDs) remain the leading cause of death in the United States and other modern societies. Advancing age is the major risk factor for CVD, primarily due to stiffening of the large elastic arteries and the development of vascular endothelial dysfunction. In contrast, regular aerobic exercise protects against the development of large elastic artery stiffness and vascular endothelial dysfunction with advancing age. Moreover, aerobic exercise interventions reduce arterial stiffness and restore vascular endothelial function in previously sedentary middle-aged/older adults. Aerobic exercise exerts its beneficial effects on arterial function by modulating structural proteins, reducing oxidative stress and inflammation, and restoring nitric oxide bioavailability. Aerobic exercise may also promote “resistance” against factors that reduce vascular function and increase CVD risk with age. Preventing excessive increases in abdominal adiposity, following healthy dietary practices, maintaining a low CVD risk factor profile, and, possibly, selective use of pharmaceuticals and nutraceuticals also play a major role in preserving vascular function with aging. PMID:25434012

Relation of Gemfibrozil Treatment and High Density Lipoprotein (HDL) Subpopulation Profile with Cardiovascular Events in the Veterans Affairs HDL Intervention Trial (VA-HIT)

PubMed Central

Asztalos, Bela F.; Collins, Dorothea; Horvath, Katalin V.; Bloomfield, Hanna E.; Robins, Sander J.; Schaefer, Ernst J.

2007-01-01

Objective The significant cardiovascular disease (CVD) event reduction in VA-HIT could not be fully explained by the 6% increase in HDL-C with the fibrate, gemfibrozil. We examined whether measurement of HDL subpopulations provided additional information relative to CVD-risk reduction. Methods and Results HDL subpopulations were characterized by 2-dimensional gel-electrophoresis in subjects who were treated with gemfibrozil (n=754) or placebo (n=741). In this study, samples obtained at the 3-month visit were used and data were analyzed prospectively using CVD events (CHD death, MI, or stroke) during the 5.1 years follow up. Analyses in the gemfibrozil arm showed that subjects with recurrent CVD events had significantly higher preβ-1 and had significantly lower α-1 and α-2 HDL levels than those without such events. Preβ-1 level was a significant positive predictor; α-1 and α-2 levels were significant negative risk factors for future CVD events. α-2 level was superior to HDL-C level in CVD-risk assessment after adjustment for established risk factors. Gemfibrozil treatment was associated with 3%-6% decreases in the small, lipid-poor preβ-1 HDL and in the large, lipid-rich α-1 and α-2 HDL and with increases in the small α-3 (3%) and preα-3 (16%) HDLs. Conclusions While the use of gemfibrozil has been associated with reduction in CVD events in VA-HIT, HDL subpopulation analysis indicates that gemfibrozil-mediated improvement in CVD risk might not be the result of its effects on HDL. It is quite possible that much of the cardiovascular benefits of gemfibrozil are due to a much wider spectrum of effects on metabolic processes that is not reflected by changes in blood lipids and HDL subpopulations. PMID:18078862

Plasma CXCL10, sCD163 and sCD14 Levels Have Distinct Associations with Antiretroviral Treatment and Cardiovascular Disease Risk Factors

PubMed Central

Castley, Alison; Williams, Leah; James, Ian; Guelfi, George; Berry, Cassandra; Nolan, David

2016-01-01

We investigate the associations of three established plasma biomarkers in the context of HIV and treatment-related variables including a comprehensive cardiovascular disease risk assessment, within a large ambulatory HIV cohort. Patients were recruited in 2010 to form the Royal Perth Hospital HIV/CVD risk cohort. Plasma sCD14, sCD163 and CXCL10 levels were measured in 475 consecutive patients with documented CVD risk (age, ethnicity, gender, smoking, blood pressure, BMI, fasting metabolic profile) and HIV treatment history including immunological/virological outcomes. The biomarkers assessed showed distinct associations with virological response: CXCL10 strongly correlated with HIV-1 RNA (p<0.001), sCD163 was significantly reduced among ‘aviraemic’ patients only (p = 0.02), while sCD14 was unaffected by virological status under 10,000 copies/mL (p>0.2). Associations between higher sCD163 and protease inhibitor therapy (p = 0.05) and lower sCD14 with integrase inhibitor therapy (p = 0.02) were observed. Levels of sCD163 were also associated with CVD risk factors (age, ethnicity, HDL, BMI), with a favourable influence of Framingham score <10% (p = 0.04). Soluble CD14 levels were higher among smokers (p = 0.002), with no effect of other CVD risk factors, except age (p = 0.045). Our findings confirm CXCL10, sCD163 and sCD14 have distinct associations with different aspects of HIV infection and treatment. Levels of CXCL10 correlated with routinely monitored variables, sCD163 levels reflect a deeper level of virological suppression and influence of CVD risk factors, while sCD14 levels were not associated with routinely monitored variables, with evidence of specific effects of smoking and integrase inhibitor therapy warranting further investigation. PMID:27355513

The association of duration of residence in the United States with cardiovascular disease risk factors among South Asian immigrants.

PubMed

Bharmal, Nazleen; Kaplan, Robert M; Shapiro, Martin F; Mangione, Carol M; Kagawa-Singer, Marjorie; Wong, Mitchell D; McCarthy, William J

2015-06-01

South Asians are disproportionately impacted by cardiovascular disease (CVD). Our objective was to examine the association between duration of residence in the US and CVD risk factors among South Asian adult immigrants. Multivariate logistic regression analyses using pooled data from the 2005, 2007, 2009 California Health Interview Surveys. Duration of residence in the US < 15 years was significantly associated with overweight/obese BMI (OR 0.59; 95% CI 0.35, 0.98 for 5 to < 10 years), daily consumption of 5+ servings of fruits/vegetables (OR 0.37; 95% CI 0.15, 0.94 for 10 to < 15 years), and sedentary lifestyle (OR 2.11; 95% CI 1.17, 3.81 for 10 to < 15 years) compared with duration of residence ≥ 15 years after adjusting for illness burden, healthcare access, and socio-demographic characteristics. Duration of residence was not significantly associated with other CVD risk factors. Duration of residence is an important correlate of overweight/obesity and other risk factors among South Asian immigrants.

Increased burden of cardiovascular disease in carriers of APOL1 genetic variants.

PubMed

Ito, Kaoru; Bick, Alexander G; Flannick, Jason; Friedman, David J; Genovese, Giulio; Parfenov, Michael G; Depalma, Steven R; Gupta, Namrata; Gabriel, Stacey B; Taylor, Herman A; Fox, Ervin R; Newton-Cheh, Christopher; Kathiresan, Sekar; Hirschhorn, Joel N; Altshuler, David M; Pollak, Martin R; Wilson, James G; Seidman, J G; Seidman, Christine

2014-02-28

Two distinct alleles in the gene encoding apolipoprotein L1 (APOL1), a major component of high-density lipoprotein, confer protection against Trypanosoma brucei rhodesiense infection and also increase risk for chronic kidney disease. Approximately 14% of Americans with African ancestry carry 2 APOL1 risk alleles, accounting for the high chronic kidney disease burden in this population. We tested whether APOL1 risk alleles significantly increase risk for atherosclerotic cardiovascular disease (CVD) in African Americans. We sequenced APOL1 in 1959 randomly selected African American participants in the Jackson Heart Study (JHS) and evaluated associations between APOL1 genotypes and renal and cardiovascular phenotypes. Previously identified association between APOL1 genotypes and chronic kidney disease was confirmed (P=2.4×10(-6)). Among JHS participants with 2 APOL1 risk alleles, we observed increased risk for CVD (50/763 events among participants without versus 37/280 events among participants with 2 risk alleles; odds ratio, 2.17; P=9.4×10(-4)). We replicated this novel association of APOL1 genotype with CVD in Women's Health Initiative (WHI) participants (66/292 events among participants without versus 37/101 events among participants with 2 risk alleles; odds ratio, 1.98; P=8.37×10(-3); JHS and WHI combined, P=8.5×10(-5); odds ratio, 2.12). The increased risk for CVD conferred by APOL1 alleles was robust to correction for both traditional CVD risk factors and chronic kidney disease. APOL1 variants contribute to atherosclerotic CVD risk, indicating a genetic component to cardiovascular health disparities in individuals of African ancestry. The considerable population of African Americans with 2 APOL1 risk alleles may benefit from intensive interventions to reduce CVD.

A System Dynamics Model for Planning Cardiovascular Disease Interventions

PubMed Central

Homer, Jack; Evans, Elizabeth; Zielinski, Ann

2010-01-01

Planning programs for the prevention and treatment of cardiovascular disease (CVD) is a challenge to every community that wants to make the best use of its limited resources. Selecting programs that provide the greatest impact is difficult because of the complex set of causal pathways and delays that link risk factors to CVD. We describe a system dynamics simulation model developed for a county health department that incorporates and tracks the effects of those risk factors over time on both first-time and recurrent events. We also describe how the model was used to evaluate the potential impacts of various intervention strategies for reducing the county's CVD burden and present the results of those policy tests. PMID:20167899

Relationship of pericardial fat with biomarkers of inflammation and hemostasis, and cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis

PubMed Central

Ong, Kwok-Leung; Ding, Jingzhong; McClelland, Robyn L.; Cheung, Bernard M.Y.; Criqui, Michael H.; Barter, Philip J.; Rye, Kerry-Anne; Allison, Matthew A.

2015-01-01

Objective Pericardial fat may increase the risk of cardiovascular disease (CVD) by increasing circulating levels of inflammation and hemostasis biomarkers. We investigated the associations of pericardial fat with inflammation and hemostasis biomarkers, as well as incident CVD events, and whether there are any ethnic differences in these associations. Methods We analyzed results from 6415 participants from the Multi-Ethnic Study of Atherosclerosis who had measurements of pericardial fat volume and circulating levels of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, factor VIII, D-dimer and plasmin-antiplasmin complex (PAP), and had a mean follow-up period of 9.5 years. Incident CVD event was defined as any adjudicated CVD event. Results After adjusting for confounding factors, pericardial fat volume was positively associated with natural log (ln) of IL-6 levels, but inversely associated with ln D-dimer and ln PAP levels (β=0.067, −0.032, and −0.105 respectively, all P<0.05). Although a larger pericardial fat volume was associated with a higher risk of incident CVD, the association was attenuated to borderline significance after adjusting for traditional cardiovascular risk factors (P=0.050). There was a borderline significant ethnicity interaction (P=0.080), whereby the association between pericardial fat volume and incident CVD was significant in Hispanic Americans, even after further adjusting for biomarkers of inflammation and hemostasis (hazard ratio=1.31 per SD increase, 95% confidence interval 1.09-1.57, P=0.004). Conclusion Pericardial fat was associated with several inflammation and hemostasis biomarkers. The association of pericardial fat with incident CVD events was independent of these biomarkers only among Hispanic Americans. PMID:25682037

Menopausal Hot Flashes and White Matter Hyperintensities

PubMed Central

Thurston, Rebecca C.; Aizenstein, Howard J.; Derby, Carol A.; Sejdić, Ervin; Maki, Pauline M.

2015-01-01

Objective Hot flashes are the classic menopausal symptom. Emerging data links hot flashes to cardiovascular disease (CVD) risk, yet how hot flashes are related to brain health is poorly understood. We examined the relationship between hot flashes - measured via physiologic monitor and self-report - and white matter hyperintensities (WMH) among midlife women. Methods Twenty midlife women ages 40-60 without clinical CVD, with their uterus and both ovaries, and not taking hormone therapy were recruited. Women underwent 24 hours of ambulatory physiologic and diary hot flash monitoring to quantify hot flashes; magnetic resonance imaging to assess WMH burden; 72 hours of actigraphy and questionnaires to quantify sleep; and a blood draw, questionnaires, and physical measures to quantify demographics and CVD risk factors. Test of a priori hypotheses regarding relations between physiologically-monitored and self-reported wake and sleep hot flashes and WMH were conducted in linear regression models. Results More physiologically-monitored hot flashes during sleep were associated with greater WMH, controlling for age, race, and body mass index [beta(standard error)=.0002 (.0001), p=.03]. Findings persisted controlling for sleep characteristics and additional CVD risk factors. No relations were observed for self-reported hot flashes. Conclusions More physiologically-monitored hot flashes during sleep were associated with greater WMH burden among midlife women free of clinical CVD. Results suggest that relations between hot flashes and CVD risk observed in the periphery may extend to the brain. Future work should consider the unique role of sleep hot flashes in brain health. PMID:26057822

Dairy and cardiovascular health: Friend or foe?

PubMed Central

Markey, O; Vasilopoulou, D; Givens, D I; Lovegrove, J A

2014-01-01

Cardiovascular disease (CVD) prevalence at a global level is predicted to increase substantially over the next decade due to the increasing ageing population and incidence of obesity. Hence, there is an urgent requirement to focus on modifiable contributors to CVD risk, including a high dietary intake of saturated fatty acids (SFA). As an important source of SFA in the UK diet, milk and dairy products are often targeted for SFA reduction. The current paper acknowledges that milk is a complex food and that simply focusing on the link between SFA and CVD risk overlooks the other beneficial nutrients of dairy foods. The body of existing prospective evidence exploring the impact of milk and dairy consumption on risk factors for CVD is reviewed. The current paper highlights that high milk consumption may be beneficial to cardiovascular health, while illustrating that the evidence is less clear for cheese and butter intake. The option of manipulating the fatty acid profile of ruminant milk is discussed as a potential dietary strategy for lowering SFA intake at a population level. The review highlights that there is a necessity to perform more well-controlled human intervention-based research that provides a more holistic evaluation of fat-reduced and fat-modified dairy consumption on CVD risk factors including vascular function, arterial stiffness, postprandial lipaemia and markers of inflammation. Additionally, further research is required to investigate the impact of different dairy products and the effect of the specific food matrix on CVD development. PMID:25400508

Women and heart disease: missed opportunities.

PubMed

Banks, Angela D

2008-01-01

One woman dies of cardiovascular disease (CVD) every minute in the United States. CVD is the primary cause of mortality in US women, substantially affecting the lives of African American women compared to other ethnic groups. In a national survey conducted by the American Heart Association, 87% of women surveyed failed to cite heart disease as a major threat to their health. These misperceptions may lead women to underestimate their risk for CVD, resulting in a delay in seeking medical care, thus increasing their morbidity and mortality rates. Professional association guidelines and Internet resources for women and their health care providers are available to address the risk factors of smoking, diabetes mellitus, obesity, hypertension, hyperlipidemia, and physical inactivity. Unless women are informed and educated about these risk factors, they are unable to modify their lifestyles, be proactive in their health care, or reduce their cardiovascular risks.

Body mass index, waist circumference and waist-to-hip ratio cut-off points for categorisation of obesity among Omani Arabs.

PubMed

Al-Lawati, Jawad A; Jousilahti, Pekka

2008-01-01

There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. A community-based cross-sectional study. The survey was conducted in the city of Nizwa in Oman in 2001. The study contained a probabilistic random sample of 1421 adults aged > or =20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8 kg m-2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-off points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.

Evidence for increased cardiovascular events in the fathers but not mothers of women with polycystic ovary syndrome.

PubMed

Taylor, Mary C; Reema Kar, A; Kunselman, Allen R; Stetter, Christy M; Dunaif, Andrea; Legro, Richard S

2011-08-01

Polycystic ovary syndrome (PCOS) is a familial syndrome, associated with multiple cardiovascular disease (CVD) risk factors. Thus, parents of affected women may have a higher prevalence of CVD events than the general population. PCOS probands (n = 410) and their participating parents (n = 180 fathers and 211 mothers) were queried for CVD events in themselves and non-participating family members. In order to include the family CVD history of all parents, agreement between the proband and parental reports of CVD events was assessed. Estimated 10-year coronary heart disease (CHD) risk was calculated using the Framingham risk calculator. The National Health and Nutrition Examination Survey (NHANES) 2001-2002 database was used to generate gender, age and body mass index-relevant population parameters of CVD prevalence in the USA population. Ninety-eight percent of the parents' self-reporting of CVD events agreed with the proband's report of parental heart attack history [Kappa = 0.82; 95% CI: (0.69, 0.94)] and 99% with parental stroke history [Kappa = 0.79; 95% CI: (0.62, 0.97)]. Fathers of women with PCOS had a higher prevalence of heart attack and stroke compared with the reference NHANES population (heart attack: 11.1 versus 5.3%, P < 0.0001; stroke: 3.0 versus 1.0%, P = 0.002). Fathers of women with PCOS had an elevated 10-year risk for CHD (11.5 versus 9.9% in NHANES, P = 0.03). No statistically significant increased prevalence of CVD events or 10-year risk was noted in probands or mothers. Fathers, and not mothers, may be disproportionately burdened with CVD in PCOS families. The strengths of this study include the size of our cohort, the consistent phenotyping and the validation of proband's reporting of parental CVD events.

Better Indigenous Risk stratification for Cardiac Health study (BIRCH) protocol: rationale and design of a cross-sectional and prospective cohort study to identify novel cardiovascular risk indicators in Aboriginal Australian and Torres Strait Islander adults.

PubMed

Rémond, Marc G W; Stewart, Simon; Carrington, Melinda J; Marwick, Thomas H; Kingwell, Bronwyn A; Meikle, Peter; O'Brien, Darren; Marshall, Nathaniel S; Maguire, Graeme P

2017-08-23

Of the estimated 10-11 year life expectancy gap between Indigenous (Aboriginal and Torres Strait Islander people) and non-Indigenous Australians, approximately one quarter is attributable to cardiovascular disease (CVD). Risk prediction of CVD is imperfect, but particularly limited for Indigenous Australians. The BIRCH (Better Indigenous Risk stratification for Cardiac Health) project aims to identify and assess existing and novel markers of early disease and risk in Indigenous Australians to optimise health outcomes in this disadvantaged population. It further aims to determine whether these markers are relevant in non-Indigenous Australians. BIRCH is a cross-sectional and prospective cohort study of Indigenous and non-Indigenous Australian adults (≥ 18 years) living in remote, regional and urban locations. Participants will be assessed for CVD risk factors, left ventricular mass and strain via echocardiography, sleep disordered breathing and quality via home-based polysomnography or actigraphy respectively, and plasma lipidomic profiles via mass spectrometry. Outcome data will comprise CVD events and death over a period of five years. Results of BIRCH may increase understanding regarding the factors underlying the increased burden of CVD in Indigenous Australians in this setting. Further, it may identify novel markers of early disease and risk to inform the development of more accurate prediction equations. Better identification of at-risk individuals will promote more effective primary and secondary preventive initiatives to reduce Indigenous Australian health disadvantage.

Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis.

PubMed

Kochi, Masako; Kohagura, Kentaro; Shiohira, Yoshiki; Iseki, Kunitoshi; Ohya, Yusuke

2018-03-01

Rheumatoid arthritis (RA), a prototypic systemic autoimmune inflammatory condition, confers an increased risk of cardiovascular disease (CVD). Recently, chronic kidney disease (CKD) was suggested to increase the risk of CVD in RA patients, and inflammation was identified as a critical, nontraditional CKD-associated risk factor for CVD. This study aimed to examine the combined effects of CKD and CVD in RA patients. In this retrospective evaluation of 428 RA patients, the outcome of interest was the incidence of CVD. CKD was defined as an estimated glomerular filtration rate of <60mL/min/1.73m 2 and/or positive dipstick tests for proteinuria of ≥3 months duration. C-reactive protein (CRP) was used as an inflammation marker, and a high CRP level was defined as a mean CRP value of ≥0.57mg/dL during the first 6 months of follow-up. Patients were categorized as follows: non-CKD with low CRP, non-CKD with high CRP, CKD with low CRP, and CKD with high CRP. During a median follow-up of 89 months, 67 patients (16%) had CKD, and 38 (9%) developed CVD. Using patients with non-CKD and low CRP as a reference group, the adjusted hazard ratios (HR, 95% confidence interval) for CVD were 1.88 (0.25-9.44) for patients with CKD/low CRP and 9.71 (3.27-31.97) for those with CKD/high CRP. The coexistence of CKD and inflammation was associated with a higher risk of CVD than either condition alone in RA patients. Inflammation might increase the risk of CVD especially in patients with CKD. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Systolic blood pressure and cardiovascular mortality in middle-aged and elderly adults - The Singapore Chinese Health Study.

PubMed

Koh, Angela S; Talaei, Mohammad; Pan, An; Wang, Renwei; Yuan, Jian-Min; Koh, Woon-Puay

2016-09-15

While elevated systolic blood pressure (SBP) is related to cardiovascular disease (CVD) mortality, it is unclear if the optimal SBP level may differ by age or the presence of underlying CVD. We investigated the association between SBP categories and CVD mortality among middle-aged and elderly adults with and without CVD history. We used data from 30,692 participants of the population-based Singapore Chinese Health Study who had blood pressures measured using a standard protocol at ages 48-85years between 1994 and 2005. Information on lifestyle factors were collected at recruitment (1993-1998) and during follow-up interviews (1999 and 2004). Mortality was identified via nationwide registry linkage up to 31 December 2014. SBP 120-139mmHg category was associated with lowest risk of CVD mortality in both age-groups of <60 and 60+years, as well as in those with and without underlying coronary heart disease or stroke. Overall, compared to this category, CVD risk was non-significantly increased in lower SBP categories and significantly increased in the higher SBP categories. The risk estimates associated with elevated SBP were higher among those <60years compared to their older counterparts, but less distinct between those with and without underlying CVD. SBP 120-139mmHg was associated with the lowest risk of CVD mortality in middle aged and elderly adults, regardless of underlying CVD. Although risks in both adult groups were similar, there is a greater risk associated with higher SBP among those aged below 60years, highlighting a greater urgency of treatment in this younger group. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cardiovascular disease prevention at the workplace: assessing the prognostic value of lifestyle risk factors and job-related conditions.

PubMed

Veronesi, Giovanni; Borchini, Rossana; Landsbergis, Paul; Iacoviello, Licia; Gianfagna, Francesco; Tayoun, Patrick; Grassi, Guido; Cesana, Giancarlo; Ferrario, Marco Mario

2018-05-25

The prognostic utility of lifestyle risk factors and job-related conditions (LS&JRC) for cardiovascular disease (CVD) risk stratification remains to be clarified. We investigated discrimination and clinical utility of LS&JRC among 2532 workers, 35-64 years old, CVD-free at the time of recruitment (1989-1996) in four prospective cohorts in Northern Italy, and followed up (median 14 years) until first major coronary event or ischemic stroke, fatal or non-fatal. From a Cox model including cigarette smoking, alcohol intake, occupational and sport physical activity and job strain, we estimated 10-year discrimination as the area under the ROC curve (AUC), and clinical utility as the Net Benefit. N = 162 events occurred during follow-up (10-year risk: 4.3%). The LS&JRC model showed the same discrimination (AUC = 0.753, 95% CI 0.700-0.780) as blood lipids, blood pressure, smoking and diabetes (AUC = 0.753), consistently across occupational classes. Among workers at low CVD risk (n = 1832, 91 CVD events), 687 were at increased LS&JRC risk; of these, 1 every 15 was a case, resulting in a positive Net Benefit (1.27; 95% CI 0.68-2.16). LS&JRC are as accurate as clinical risk factors in identifying future cardiovascular events among working males. Our results support initiatives to improve total health at work as strategies to prevent cardiovascular disease.

Patterns of Relationships between Cardiovascular Disease Risk Factors and Neurocognitive Function in African Americans

PubMed Central

Sims, Regina; Madhere, Serge; Callender, Clive; Campbell, Alfonso

2013-01-01

Objective The association between cardiovascular disease (CVD) risk and neurocognitive function has gathered a good deal of attention in the health and social science literature; however, the relationship among several CVD risk factors and neurocognitive function has not been fully explored in an African American sample. The purpose of this study was to examine the pattern of relationships among four CVD risk factors and five measures of higher cortical functions. Methods Data were collected from a sample of 106 African American community-dwelling adults in the metropolitan Washington, DC, area. A nurse collected blood pressure, waist circumference, and a blood sample (to assess triglycerides and high-density lipoprotein (HDL) cholesterol) from study participants. Participants completed the Symbol Digit Modalities Test, Trailmaking B, Stroop Colorword Task, California Verbal Learning Test-II, and Wisconsin Card Sorting Test as assessments of neurocognitive function. Canonical analysis and multiple regression analysis were the major statistical methods utilized to assess relationships between CVD risk factors and neurocognitive function. Results The results suggest that 1) attentional processes are associated with diastolic blood pressure levels, 2) verbal learning processes are associated with diastolic blood pressure and triglyceride levels, and 3) the ability to shift cognitive set is associated with HDL cholesterol levels. Conclusion As cardiovascular health worsens in our society, particularly among ethnic minorities, the neurocognitive consequences must be clearly understood. Future studies should focus on identifying and building awareness of cardiovascular and neurocognitive links through longitudinal research designs and brain imaging technology. PMID:19157252

Ethnicity and the association between anthropometric indices of obesity and cardiovascular risk in women: a cross-sectional study

PubMed Central

Goh, Louise G H; Dhaliwal, Satvinder S; Welborn, Timothy A; Lee, Andy H; Della, Phillip R

2014-01-01

Objectives The objectives of this study were to determine whether the cross-sectional associations between anthropometric obesity measures, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR), and calculated 10-year cardiovascular disease (CVD) risk using the Framingham and general CVD risk score models, are the same for women of Australian, UK and Ireland, North European, South European and Asian descent. This study would investigate which anthropometric obesity measure is most predictive at identifying women at increased CVD risk in each ethnic group. Design Cross-sectional data from the National Heart Foundation Risk Factor Prevalence Study. Setting Population-based survey in Australia. Participants 4354 women aged 20–69 years with no history of heart disease, diabetes or stroke. Most participants were of Australian, UK and Ireland, North European, South European or Asian descent (97%). Outcome measures Anthropometric obesity measures that demonstrated stronger predictive ability of identifying women at increased CVD risk and likelihood of being above the promulgated treatment thresholds of various risk score models. Results Central obesity measures, WC and WHR, were better predictors of cardiovascular risk. WHR reported a stronger predictive ability than WC and BMI in Caucasian women. In Northern European women, BMI was a better indicator of risk using the general CVD (10% threshold) and Framingham (20% threshold) risk score models. WC was the most predictive of cardiovascular risk among Asian women. Conclusions Ethnicity should be incorporated into CVD assessment. The same anthropometric obesity measure cannot be used across all ethnic groups. Ethnic-specific CVD prevention and treatment strategies need to be further developed. PMID:24852299

Depressive symptoms and cardiovascular mortality in older black and white adults: evidence for a differential association by race.

PubMed

Lewis, Tené T; Guo, Hongfei; Lunos, Scott; Mendes de Leon, Carlos F; Skarupski, Kimberly A; Evans, Denis A; Everson-Rose, Susan A

2011-05-01

An emerging body of research suggests that depressive symptoms may confer an "accelerated risk" for cardiovascular disease (CVD) in blacks compared with whites. Research in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end points. The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adults. Cox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9- to 12-year follow-up. In race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; P<0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; P=0.11; race by depressive symptoms interaction, P=0.03). Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; P<0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; P=0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; P=0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; P=0.40). Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factors. Findings for stroke were reduced to marginal significance. Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whites. Findings were not completely explained by standard risk factors. Efforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health.

Community-Responsive Interventions to Reduce Cardiovascular Risk in American Indians

ERIC Educational Resources Information Center

Jobe, Jared B.; Adams, Alexandra K.; Henderson, Jeffrey A.; Karanja, Njeri; Lee, Elisa T.; Walters, Karina L.

2012-01-01

American Indian and Alaska Native (AI/AN) populations bear a heavy burden of cardiovascular disease (CVD), and they have the highest rates of risk factors for CVD, such as cigarette smoking, obesity, and diabetes, of any U.S. population group. Yet, few randomized controlled trials have been launched to test potential preventive interventions in…

Red cabbage microgreens lower circulating LDL, liver cholesterol and inflammatory cytokines in mice fed a high fat diet

USDA-ARS?s Scientific Manuscript database

Cardiovascular disease (CVD) is the leading cause of death in the United States and hypercholesterolemia is a major risk factor. Population studies, as well as animal and intervention studies, support the consumption of a variety of vegetables as a means to reduce CVD risks through the modulation of...

Epigenetics and cardiovascular disease

USDA-ARS?s Scientific Manuscript database

Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only...

Women and heart disease: the role of diabetes and hyperglycemia.

PubMed

Barrett-Connor, Elizabeth; Giardina, Elsa-Grace V; Gitt, Anselm K; Gudat, Uwe; Steinberg, Helmut O; Tschoepe, Diethelm

2004-05-10

Cardiovascular disease (CVD) is the primary cause of death in women, and women with type 2 diabetes mellitus are at greater risk of CVD compared with nondiabetic women. The increment in risk attributable to diabetes is greater in women than in men. The extent to which hyperglycemia contributes to heart disease risk has been examined in observational studies and clinical trials, although most included only men or did not analyze sex differences. The probable adverse influence of hyperglycemia is potentially mediated by impaired endothelial function, and/or by other mechanisms. Beyond high blood glucose level, a number of other common risk factors for CVD, including hypertension, dyslipidemia, and cigarette smoking, are seen in women with diabetes and require special attention. Presentation and diagnosis of CVD may differ between women and men, regardless of the presence of diabetes. Recognizing the potential for atypical presentation of CVD in women and the limitations of common diagnostic tools are important in preventing unnecessary delay in initiating proper treatment. Based on what we know today, treatment of CVD should be at least as aggressive in women-and especially in those with diabetes-as it is in men. Future trials should generate specific data on CVD in women, either by design of female-only studies or by subgroup analysis by sex.

Injection drug use: an understudied cause of venous disease.

PubMed

Pieper, Barbara; Kirsner, Robert S; Templin, Thomas N; Birk, Thomas J

2007-10-01

Injection drug use has devastating effects on the veins, skin, muscles, and joints of the lower extremities, thus increasing the risk of chronic venous disease (CVD). We examined the following risk factors for CVD in persons who injected drugs: health and drug use history, ankle mobility, pain, and skin and wound assessment. Because of deep venous thrombosis and injury and immobility to the calf muscle pump from injected drugs, CVD occurs at a young age. Decreased ankle joint movement, decreased walking, and increased pain are associated with worsening CVD clinical classification. Associated venous ulcers tend to be multiple and large by the time wound care is sought. Cellulitis and abscesses may also be present. Injection drug users serve as a model for the multifactorial nature of CVD including vein damage, diminished ankle range of motion, and decreased calf muscle strength. Persons who inject drugs need to have their lower extremities assessed for CVD on a routine basis.

Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries.

PubMed

Crowson, Cynthia S; Gabriel, Sherine E; Semb, Anne Grete; van Riel, Piet L C M; Karpouzas, George; Dessein, Patrick H; Hitchon, Carol; Pascual-Ramos, Virginia; Kitas, George D

2017-07-01

Cardiovascular disease (CVD) risk calculators developed for the general population do not accurately predict CVD events in patients with RA. We sought to externally validate risk calculators recommended for use in patients with RA including the EULAR 1.5 multiplier, the Expanded Cardiovascular Risk Prediction Score for RA (ERS-RA) and QRISK2. Seven RA cohorts from UK, Norway, Netherlands, USA, South Africa, Canada and Mexico were combined. Data on baseline CVD risk factors, RA characteristics and CVD outcomes (including myocardial infarction, ischaemic stroke and cardiovascular death) were collected using standardized definitions. Performance of QRISK2, EULAR multiplier and ERS-RA was compared with other risk calculators [American College of Cardiology/American Heart Association (ACC/AHA), Framingham Adult Treatment Panel III Framingham risk score-Adult Treatment Panel (FRS-ATP) and Reynolds Risk Score] using c-statistics and net reclassification index. Among 1796 RA patients without prior CVD [mean ( s . d .) age: 54.0 (14.0) years, 74% female], 100 developed CVD events during a mean follow-up of 6.9 years (12430 person-years). Estimated CVD risk by ERS-RA [mean ( s . d .) 8.8% (9.8%)] was comparable to FRS-ATP [mean ( s . d .) 9.1% (8.3%)] and Reynolds [mean ( s . d .) 9.2% (12.2%)], but lower than ACC/AHA [mean ( s . d .) 9.8% (12.1%)]. QRISK2 substantially overestimated risk [mean ( s . d .) 15.5% (13.9%)]. Discrimination was not improved for ERS-RA (c-statistic = 0.69), QRISK2 or EULAR multiplier applied to ACC/AHA compared with ACC/AHA (c-statistic = 0.72 for all) or for FRS-ATP (c-statistic = 0.75). The net reclassification index for ERS-RA was low (-0.8% vs ACC/AHA and 2.3% vs FRS-ATP). The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately in patients with RA than CVD risk calculators developed for the general population. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

The association between carbohydrate-rich foods and risk of cardiovascular disease is not modified by genetic susceptibility to dyslipidemia as determined by 80 validated variants.

PubMed

Sonestedt, Emily; Hellstrand, Sophie; Schulz, Christina-Alexandra; Wallström, Peter; Drake, Isabel; Ericson, Ulrika; Gullberg, Bo; Hedblad, Bo; Orho-Melander, Marju

2015-01-01

It is still unclear whether carbohydrate consumption is associated with cardiovascular disease (CVD) risk. Genetic susceptibility might modify the associations between dietary intakes and disease risk. The aim was to examine the association between the consumption of carbohydrate-rich foods (vegetables, fruits and berries, juice, potatoes, whole grains, refined grains, cookies and cakes, sugar and sweets, and sugar-sweetened beverages) and the risk of incident ischemic CVD (iCVD; coronary events and ischemic stroke), and whether these associations differ depending on genetic susceptibility to dyslipidemia. Among 26,445 individuals (44-74 years; 62% females) from the Malmö Diet and Cancer Study cohort, 2,921 experienced an iCVD event during a mean follow-up time of 14 years. At baseline, dietary data were collected using a modified diet history method, and clinical risk factors were measured in 4,535 subjects. We combined 80 validated genetic variants associated with triglycerides and HDL-C or LDL-C, into genetic risk scores and examined the interactions between dietary intakes and genetic risk scores on the incidence of iCVD. Subjects in the highest intake quintile for whole grains had a 13% (95% CI: 3-23%; p-trend: 0.002) lower risk for iCVD compared to the lowest quintile. A higher consumption of foods rich in added sugar (sugar and sweets, and sugar-sweetened beverages) had a significant cross-sectional association with higher triglyceride concentrations and lower HDL-C concentrations. A stronger positive association between a high consumption of sugar and sweets on iCVD risk was observed among those with low genetic risk score for triglycerides (p-interaction=0.05). In this prospective cohort study that examined food sources of carbohydrates, individuals with a high consumption of whole grains had a decreased risk of iCVD. No convincing evidence of an interaction between genetic susceptibility for dyslipidemia, measured as genetic risk scores of dyslipidemia-associated variants, and the consumption of carbohydrate-rich foods on iCVD risk was observed.

Cardiovascular Risk Factors Among Low-Income Women: A Population-Based Study in China from 1991 to 2011.

PubMed

Lu, Hongyan; Bai, Lingling; Zhan, Changqing; Yang, Li; Tu, Jun; Gu, Hongfei; Shi, Min; Wang, Jinghua; Ning, Xianjia

2016-12-01

Data on long-term trends in the prevalence and clustering of cardiovascular disease (CVD) risk factors among women in China are rare, especially among low-income women. The aim of this study was to investigate the secular trends in the prevalence of CVD risk factors among low-income women in northern China. The prevalence and clustering of CVD risk factors, including hypertension, diabetes, obesity, current smoking status, and alcohol consumption, were assessed and compared in women aged 35-74 years in northern China in 1991 and 2011. The age-adjusted prevalence of cardiovascular risk factors among women was significantly higher in 2011 than in 1991, with increases of 31% (53.6% vs. 41.1%) for hypertension, 148% (20.9% vs. 8.4%) for obesity, 256% (11.7% vs. 3.3%) for diabetes, and 1634% (4.5% vs. 0.3%) for alcohol consumption. Over the 21-year period, there were significant differences in the prevalence of clustering of ≥1, ≥2, and 3 risk factors in all age groups. The greatest increase was observed among women aged 35-44 years, with a 7.3-fold increase in the prevalence of clustering of three risk factors. Simultaneously, the prevalence of clustering of ≥1 risk factors among women aged 35-44 years was 1.7-fold higher in 2011 than in 1991; the prevalence of clustering of ≥2 risk factors was raised by 5.5-fold among elderly women. Our findings suggest that it is crucial to emphasize the prevention and control of cardiovascular risk factors among young women in rural China to reduce the burden of CVDs.

Duration of breast-feeding and cardiovascular risk factors among Iranian children and adolescents: the CASPIAN III study.

PubMed

Izadi, Vajihe; Kelishadi, Roya; Qorbani, Mostafa; Esmaeilmotlagh, Mohammad; Taslimi, Mahnaz; Heshmat, Ramin; Ardalan, Gelayol; Azadbakht, Leila

2013-05-01

Studies examining the relationship between breast-feeding (BF) duration and cardiovascular disease (CVD) risk factors have reached contradictory results. This study aims to investigate the relationship between BF duration and CVD risk factors in adolescents. This national population-based study was conducted among 5258 Iranian students, ages 10 to 18 y living in central cities of 27 provinces of Iran. Association was examined between duration of BF and adolescent blood pressure, overweight, obesity, and fasting blood glucose and lipid profiles. Analyses were adjusted for potential confounders. Low birth weight was less frequent in the longer than in the shorter BF duration categories (P < 0.0001). Number of children was lower in individuals with longer BF duration (P = 0.01). Individuals with longer BF duration used more homemade food than those with shorter BF duration (P < 0.0001). Means of total cholesterol and systolic blood pressure were lower in participants with the longest BF period compared with those with the shortest BF duration; this difference was marginally significant (P = 0.06). No significant association was found between BF duration and CVD risk factors in logistic regression after adjustment for potential confounders. Although the long-term benefits of BF on preventing CVDs are well documented, controversies exist as to the association of BF duration with such beneficial effects. In this study, there was no substantial evidence that longer BF duration was protective against CVD risk factors among adolescents. More prospective studies are recommended to clarify this association. Copyright © 2013 Elsevier Inc. All rights reserved.