10-year Cardiovascular Risk Score Research Articles

Association between histological severity of Helicobacter pylori infection and cardiovascular risk scores in the Korean population

Background and aimsAlthough there have been several reports on the association between Helicobacter pylori (HP) infection and cardiovascular disease (CVD), most studies have been done through noninvasive testing such as serologic test or urea breath test. This study investigated the relationship between histological features of HP gastritis and cardiovascular risk scores. MethodsA total of 21,251 subjects (mean age, 43.8 ± 9.6 years; males, 72.1%) who underwent routine health checkup and gastric biopsy were retrospectively analyzed. The severity of gastritis was assessed using the updated Sydney system (USS). With four different risk predicting algorithms, we calculated Framingham coronary heart disease (CHD) risk score, ATP III revised Framingham CHD risk score, generalized Framingham risk against total CVD, and ACC/AHA 10-year risk of a first hard atherosclerotic-CVD event in each subject. ResultsAbout half of the study subjects (51.2%, n = 10,890) were confirmed to have HP infection. Subjects with HP infection were younger (42.9 ± 9.0 vs. 44.7 ± 10.2 years, p < 0.001) than those without. After adjustment for age, most of the estimated 10-year cardiovascular risk increased as the grade of USS elements increased. As the sum of the USS scores increased, all the 4 estimated 10-year cardiovascular risk scores increased proportionally (p < 0.05 for each). ConclusionsThe histological features of gastritis assessed using USS were associated with various cardiovascular risk scores. This study provides strong evidence on an association between chronic inflammation and increased cardiovascular risk.

Cardiovascular Risk Profile of Apparently Healthy Workers in a Tertiary Hospital in Nigeria

Background: Cardiovascular disease incidence is rising in Nigeria. This study was done to identify cardiovascular risk factors and assess the 10-year cardiovascular risk score of healthcare workers of a tertiary hospital in south-western Nigeria. Materials &amp; Methods: In this cross-sectional study, apparently healthy workers of a tertiary hospital in Nigeria were studied. Fifty-two individuals were recruited into the study. Anthropometric measures, blood pressure, fasting lipid profile and HbA1c were obtained using the standard protocols. QRISK3 score was also calculated. Results: The Mean±SD age of participants was 44.9±8.1 years. Dyslipidaemia was the most common risk factor among apparently healthy healthcare workers, while glucose intolerance was the least common. Also, 48.1% of the subjects had at least one cardiovascular risk factor and 15.4% had 3 or more cardiovascular risk factors. The 10-year cardiovascular risk using QRISK3 was moderate in 3.8%. There was no statistically significant difference in the 10-year cardiovascular risk score between the clinical and non-clinical healthcare workers (P=0.313; t=0.819). However, male participants had a significantly higher 10-year cardiovascular risk score compared with the females (3.50 vs. 1.56; P&lt;0.001; t=3.741). Conclusion: Cardiovascular risk factors are prevalent among health workers and closer attention needs to be paid to these factors by the hospital management to mitigate cardiovascular disease among the staff.

Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond.

In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between January 1, 2016 and December 21, 2018. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. The most common abnormality was a glomerular filtration rate (GFR) <60 mL/min (10%). Age <40 years [estimated relative rate (rr) 0.017, 95% confidence interval (CI) 0.207 to 0.494], cobicistat (rr 0.284, 95% CI 0.128 to 0.63), and tenofovir alafenamide (rr 0.295 95% CI 0.151 to 0.573) were associated with a decreased risk of GFR <60 mL/min. An increased AST and ALT ≥2 × upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was <60 mL/min or an AST or ALT was ≥2 × ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥40 (rr 7.37, 95% CI 3.0 to 18.3). Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.

927. Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond

BackgroundIn the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing. MethodsWe reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI). ResultsEighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR < 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age < 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 –.43). When a GFR was < 60 ml/min or an AST or ALT was >2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia.ConclusionIndividuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety.Disclosures All Authors: No reported disclosures

Lifestyle Intervention for Cardiovascular Disease Risk Factors in Jeddah, Saudi Arabia.

BackgroundCardiovascular disease (CVD) remains the major cause of global mortality. Applying a comprehensive interventional program may reduce the incidence of cardiovascular disease and its complications.ObjectiveThis study compared the effects of a three-month intervention involving lifestyle modification and physical activity with standard care in women ≥30 years having a moderate to high risk of CVD, with respect to improving physical activity and cardiovascular disease risk factors at the National Guard Residential City in Jeddah, Saudi Arabia, in 2015.MethodsThe effects of this community-based lifestyle program were assessed through a randomized controlled trial from January 1st to September 6th, 2015. Women in the intervention group (n = 31) received health education, exercise training, and diet counselling as individuals and in groups according to the participant’s risk. Women in the control group (n = 28) received one health education session at the screening site. The primary outcome was the proportion of women with moderate Framingham risk scores (FRS) reducing their risk by 10% and the proportion of women with high FRS reducing their risk by 25%. The secondary outcome was the proportion of women reducing their risk by ≥1 risk category.ResultsThe mean participant age was 42 ± 8 years. At three-month’s follow-up, reductions were greater in the intervention group and the difference between groups was statistically significant (p < 0.05). Lifestyle intervention program significantly reduced systolic blood pressure (-9.2 mmHg), blood glucose (-45 mg/dL) and Framingham risk score (-13.6). Linear regression analysis revealed a significant improvement in the Framingham risk score (p < 0.01).ConclusionIn a population of women with moderate-to-high risk of CVD, a personalized lifestyle modification program showed positive association in improving the 10-year cardiovascular Framingham risk score after three months.

Impact of metabolic surgery on 10-year cardiovascular disease risk in Chinese individuals with type 2 diabetes.

In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI). To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery. University hospital, China. We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m2 were compared with those with a BMI > 30 kg/m2. We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m2 and 55 (47%) had a BMI > 30 kg/m2. Patients with a BMI < 30 kg/m2 were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m2 was significantly lower than that in the group with BMIs > 30 kg/m2 (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine. The 10-year CVD risk in T2D patients with BMIs < 30 kg/m2 and BMIs > 30 kg/m2 were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m2 was lower than that in patients with BMIs > 30 kg/m2. The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery.

Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders

Background: Previously reported risk factors for common musculoskeletal disorders (MSDs) have been low in magnitude and with unclear pathophysiological mechanisms. Methods: Data from a nine-year prospective cohort were analyzed. Baseline data included computerized questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. Monthly follow-ups were conducted to assess symptoms (development, resolution and/or treatments) and to perform physical examinations. Nerve conduction studies were performed every 6 months if any new-onset paresthesias in the prior six-month interval were reported. Results: The relative risk of four different MSDs increased with rising cardiovascular disease risk scores; adjusted relative risks for one or more MSD increased to 3.90 (95% CI, 2.20, 6.90) among those with 10-year cardiovascular risk scores above 15%. The relative risk of multiple MSDs increased more strongly with rising cardiovascular disease risk; adjusted relative risk for four or more MSDs increased to 17.40 (95% CI, 3.85, 78.62) among those with 10-year cardiovascular risk scores above 15%. Conclusions: Cardiovascular disease risk factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger. Further investigations of this new potential line of prevention are needed, as well as the utility of these MSDs to identify the development of silent coronary artery disease. Funding Statement: This work was supported, in part, by grants from the National Institute for Occupational Safety and Health (NIOSH/CDC) grant 1R01OH010474–01 and NIOSH Education and Research Center training grant T42/CCT810426–10. Declaration of Interests: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethics Approval Statement: Institutional review boards of the University of Utah, University of Wisconsin-Milwaukee and Medical College of Wisconsin approved this study.

Periventricular white matter hyperintensity burden and cognitive impairment in early Parkinson's disease.

This study quantified the total brain and periventricular white matter hyperintensity (WMH) burdens in patients with early Parkinson's disease (PD) and explored their associations with cardiovascular risk factors and cognitive performance. A total of 175 non-demented patients with early PD who had undergone baseline brain magnetic resonance imaging were included. Comprehensive neurocognitive testing was conducted to identify PD with mild cognitive impairment (PD-MCI) and to evaluate performances in individual cognitive domains. Cardiovascular risk was expressed as a modified Framingham 10-year cardiovascular risk score (mFRS). A total of 53.7% of this early PD cohort fulfilled the diagnostic criteria for PD-MCI. An increase in mFRS was significantly associated with increases in the total brain WMH (P=0.015) and periventricular WMH (P=0.040) burden, independent of age and gender. The periventricular WMH burden was significantly associated with PD-MCI (P=0.046) in early PD, independent of cardiovascular risk factors. Patients in the 5th quintile of periventricular WMH burden were 8.6 times more likely to have PD-MCI compared with patients in the 1st quintile of periventricular WMH burden (P=0.004). However, total brain WMH burden was not associated with PD-MCI (P=0.158). In individual cognitive domains, heavier periventricular WMH burden was associated with worse executive function and visuospatial function independent of cardiovascular risk factors. Periventricular WMHs are a useful imaging biomarker for cognitive impairment in early PD. Cardiovascular risk factors, although associated with periventricular WMHs, were unable to fully explain the association between periventricular WMHs and cognitive impairment in early PD.

LONELINESS, AGE, CARDIOVASCULAR AND METABOLIC HEALTH IN SCHIZOPHRENIA

Introduction Loneliness is common in schizophrenia with prevalence estimates as high as 80% among people with schizophrenia. Recent studies among non-psychiatric samples have indicated deleterious effects of loneliness on physical health and mortality, including increased risk of hypertension, central obesity, metabolic syndrome, coronary heart disease, stroke, and other cardiovascular disorders. The all-cause mortality risk of loneliness is double that from obesity and equivalent to that from smoking ¾ of a pack of cigarettes per day. However, despite the increased risk for loneliness and cardiovascular problems in schizophrenia, these associations have not been examined directly in previous studies of people with schizophrenia. This study aims to explore the relationship of loneliness and age with cardiovascular and metabolic markers of physical health among participants with schizophrenia in comparison to non-psychiatric comparison (NC) participants. Methods The third edition of the University of California, Los Angeles Loneliness Scale (UCLA-3) was administered to 53 participants with schizophrenia, as diagnosed by DSM IV criteria, and 32 NC participants. Sociodemographic and clinical characteristics such as age, education, gender, duration of illness, and antipsychotic use were measured. Participants were also evaluated in terms of severity of psychopathology (positive, negative, depressive, and anxiety symptoms) using standard clinical symptom rating scales. Metabolic and cardiovascular health markers including LDL, HDL, total cholesterol, triglycerides, homeostatic model assessment of insulin resistance (HOMA-IR), systolic and diastolic blood pressure, fasting glucose, as well as waist circumference, body mass index were also collected. The Framingham 10-year Cardiovascular risk score was also calculated. This data was drawn from a larger ongoing study of aging in schizophrenia. We included only those participants with complete data for all of the above measures in the present analyses. Differences between the two groups on continuous variables were evaluated with independent t-tests; differences on categorical variables were evaluated with Pearson's Chi-square. Within each group, we also employed hierarchical multiple regression analyses to evaluate the association of loneliness with each health marker, while adjusting for gender and age. We also examined interactions between age and loneliness. (Given that loneliness is associated with an increased risk of mortality, the presence or absence of the latter could indicate potential survivor biases in the sample.) Results Participants with schizophrenia had a mean age of 51.41 (SD 11.03), with 20(37.7%) females, and 28 (52.8%) non-Caucasians. The NC participants had a mean age of 51.52 (SD 9.98), with 19 (59.4%) females, and 20 (62.5%) non- Caucasians. Relative to the NC group, participants with schizophrenia had worse loneliness, as well as worse positive, negative, depressive and anxiety symptoms. The also had fewer years of education, higher 10- year risk of cardiovascular disease, and were more likely to meet criteria for metabolic syndrome. Among the NC group, multivariate analyses indicated no association of loneliness with of any of the physical health measures, although the association of loneliness with total cholesterol suggested a non-trivial amount of shared variance (R2= 0.85, p= .086). Within the schizophrenia group, loneliness was associated with worse triglyceride levels; there was no age*loneliness interactions for most variables, suggesting the association was similar across age levels. However, there were significant loneliness x age interactions for cholesterol, t = -2.40, p = .021, R2 = .102, and LDL levels, t = -2.67, p = .011, R2 = .129. Specifically, loneliness was associated with worse cholesterol levels among individuals 1 SD below the mean in age (i.e., age 40.39), t= 2.30, p= .020, and better LDL levels among individuals 1 SD above the mean age (i.e., age 62.45), t= -2.037, p= .047. Conclusions Given the small sample size (particularly among NCs), and the exploratory nature of the present analyses, findings must be interpreted with caution until replicated in larger independent samples. However, the overall pattern of findings within the schizophrenia group is intriguing in suggesting a possible link between loneliness and blood lipid levels. There have been some GWAS studies suggesting an overlap in polygenic risk scores for cholesterol and loneliness. The differential effects of loneliness on cholesterol measures among older versus younger patients must be interpreted with particular caution, but if replicated could indicate those people with schizophrenia who survive to older age have a protective factor moderating the association of loneliness and cholesterol levels. The latter warrants further prospective research among older and younger people with schizophrenia. This research was funded by: Support provided by National Institute of Mental Health (NIMH) grant 5R01 MH094151-04 (Jeste), the NIMH T32 Geriatric Mental Health Program MH019934 (PI: Jeste), and UC San Diego's Stein Institute for Research on Aging (Director: Jeste).

Baseline 10-Year Cardiovascular Risk Scores Predict Cognitive Function in Older Persons, and Particularly Women, Living With Human Immunodeficiency Virus Infection

Cardiovascular disease (CVD) and associated comorbidities increase the risk of cognitive impairment in persons living with human immunodeficiency virus (PLWH). Given the potential composite effect of multiple cardiovascular risk factors on cognition, we examined the ability of the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and the Framingham Heart Study Global CVD risk score (FRS) to predict future cognitive function in older PLWH. We constructed linear regression models evaluating the association between baseline 10-year cardiovascular risk scores and cognitive function (measured by a summary z-score, the NPZ-4) at a year 4 follow-up visit. Among 988 participants (mean age, 52 years; 20% women), mean 10-year ASCVD risk score at entry into the cohort was 6.8% (standard deviation [SD], 7.1%) and FRS was 13.1% (SD, 10.7%). In models adjusted only for cognitive function at entry, the ASCVD risk score significantly predicted year 4 NPZ-4 in the entire cohort and after stratification by sex (for every 1% higher ASCVD risk, year 4 NPZ-4 was lower by 0.84 [SD, 0.28] overall, P = .003; lower by 2.17 [SD, 0.67] in women, P = .001; lower by 0.78 [SD, 0.32] in men, P = .016). A similar relationship was observed between FRS and year 4 NPZ-4. In multivariable models, higher 10-year ASCVD risk and FRS predicted lower NPZ-4 in women. Baseline 10-year ASCVD risk and FRS predicted future cognitive function in older PLWH with well-controlled infection. Cardiovascular risk scores may help to identify PLWH, especially women, who are at risk for worse cognition over time.

Cardiovascular risk in patients with severe mental illness in Italy.

Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Patients aged 35-69years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients' data were compared with those from the general population. The 10-year CV risk was log-transformed, and multivariable linear regression was used to estimate mean ratios, adjusting for age, and education. Three hundred patients and 3,052 controls were included in the analysis. Among men, the 10-year CV risk score was very similar between patients with SMI and the general population (mean ratio [MR]: 1.02; 95%CI 0.77-1.37), whereas a 39% increase in 10-year CV risk was observed in women with SMI compared to the general population (MR: 1.39; 95%CI 1.16-1.66). In our study, women with SMI were consistently more at risk than the general population counterpart, even at younger age.

Fatty liver in Pakistani cohort with rheumatoid arthritis.

Objective:To determine the frequency of fatty liver (non-alcoholic) disease, Framingham 10-year cardiovascular risk score in rheumatoid arthritis patients.Methods:This study was conducted from September 1st to March 19, 2019, at Rheumatology OPD, Central Park Medical College Lahore. One hundred ninety two seropositive rheumatoid arthritis patients were recruited. Demographic details were noted, BP, BMI, smoking habits, and waist circumference were noted, then sent to radiology department for ultrasound scan of abdomen by an expert radiologist. On next day 10 ml blood was taken by phlebotomist for lipid profile and fasting blood sugar levels, after availability of results 10-years Framingham cardiovascular risk score was calculated.Results:Females were (81.3%) mean age of (45.4) years, fatty liver was present in n=39 (20.3%). In positive cases comorbid like metabolic syndrome was present (71.8%), diabetes mellitus (33.3%), hypertension (59%) FRS score (intermediate to high in (33.3%), history of hakeem/desi medication use (51.3%), while on regression analysis all study parameters except DMARD’s had significant association with fatty liver (p<0.05).Conclusion:Nonalcoholic fatty liver disease is very widely prevalent in rheumatoid arthritis patients. As in general population, it is multifactorial in origin and needs careful monitoring and treatment.

Chronic Obstructive Pulmonary Disease as a Predictor of Cardiovascular Risk: A Case-Control Study

Chronic obstructive pulmonary disease (COPD) is a complex multi-morbid disorder with significant cardiac mortality. Current cardiovascular risk prediction models do not include COPD. We investigated whether COPD modifies future cardiovascular risk to determine if it should be considered in risk prediction models.Case-control study using baseline data from two randomized controlled trials performed between 2012 and 2015. Of the 90 eligible subjects, 26 COPD patients with lung hyperinflation were propensity matched for 10-year global cardiovascular risk score (QRISK2) with 26 controls having normal lung function. Patients underwent cardiac magnetic resonance imaging, arterial stiffness and lung function measurements. Differences in pulse wave velocity (PWV), total arterial compliance (TAC) and aortic distensibility were main outcome measures.PWV (mean difference 1.0 m/s, 95% CI 0.02–1.92; p = 0.033) and TAC (mean difference –0.27 mL/m2/mmHg, 95% CI 0.39–0.15; p < 0.001) were adversely affected in COPD compared to the control group. The PWV difference equates to an age, sex and risk-factor adjusted increase in relative risk of cardiovascular events and mortality of 14% and 15%, respectively.There were no differences in aortic distensibility. In the whole cohort (n = 90) QRISK2 (β = 0.045, p = 0.005) was associated with PWV in multivariate analysis. The relationship between QRISK2 and PWV were modified by COPD, where the interaction term reached significance (p = 0.014). FEV1 (β = 0.055 (0.027), p = 0.041) and pulse (B = –0.006 (0.002), p = 0.003) were associated with TAC in multivariate analysis.Markers of cardiovascular outcomes are adversely affected in COPD patients with lung hyperinflation compared to controls matched for global cardiovascular risk. Cardiovascular risk algorithms may benefit from the addition of a COPD variable to improve risk prediction and guide management. HAPPY London ClinicalTrials.gov: NCT01911910 and HZC116601; ClinicalTrials.gov: NCT01691885

Dyslipidemias and cardiovascular risk scores in urban and rural populations in north-western Tanzania and southern Uganda.

BackgroundDyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. There are few published epidemiological data regarding dyslipidemia in Africa. We determined full lipid and apolipoprotein profiles and investigated factors associated with lipid levels in urban and rural populations of north-western Tanzania and southern Uganda.MethodsWe conducted a cross-sectional survey of randomly-selected, community-dwelling adults (≥18yrs) including five strata per country: one municipality, two district towns and two rural areas. Participants were interviewed and examined using the World Health Organization STEPwise survey questionnaire. Serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and apolipoproteins were measured. Factors associated with mean lipid levels were assessed by multivariable linear regression. Framingham 10-year cardiovascular risk scores were calculated with and without lipids.ResultsOne-third of adults in the study population had dyslipidemia. Low high-density lipoprotein cholesterol affected 32–45% of rural adults. High total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B were found in <15% of adult population in all strata, but were more common in urban adults. Factors independently associated with higher mean low-density lipoprotein cholesterol and apolipoprotein B were female gender, older age, higher education, higher income, obesity, and hypertension. Framingham cardiovascular risk scores with and without lipids yielded similar results and 90% of study subjects in all strata were classified as “low risk”. Among older adults (>55 years), 30% were classified as “high” or “very high” risk.ConclusionsDyslipidemias are common among adults in north-western Tanzania and southern Uganda affecting one third of adult population. Overall, cardiovascular risk scores are low but high risk scores are common with older adults. Health services designed and equipped to diagnose and treat dyslipidemia are urgently needed.

Applying Framingham Risk Score 2008 to Predict the 10-Year Risk of Cardiovascular Disease in a Group of Office Workers in Hanoi, Vietnam

Applying Framingham Risk Score 2008 to Predict the 10-Year Risk of Cardiovascular Disease in a Group of Office Workers in Hanoi, Vietnam

QRISK2 Score in CABG Patients Correlated with Risk Factors

Guidelines for primary prevention suggested using any risk score, among those QRISK2, identifying the high-risk populations. The purpose of this study was to determine whether the QRISK2 Score would register changes in patients with coronary artery disease demanding acute or postponed CABG intervention. The QRISK2 Score was performed the day of admission after the clinical examination and blood test results, and immediately after CABG surgery (in the first week post-CABG, in an interval of 24 hours to 7 days) having another blood test evaluation. The 120 patients admitted in the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Disease met the inclusion criteria: CABG patients (less than 1 week), aged 40-85 years old, BMI ] 25 kg/m�, and mixed dyslipidemia. In both phases, for every patient, it was performed a clinical examination, a set of hematological, biochemical, lipid, coagulation and inflammatory profile, and ECG and echocardiography. Our research on hospitalized patients undergoing CABG, by comparing the Phase I and Phase III results, revealed that the median 10-year QRISK2 cardiovascular risk score was approximately 47.88 % lower (p=0.000) in the first week after cardiac surgery. QRISK2 score gives a more appropriate risk estimation based on the social component, thus identifying high risk patients associating social deprivation. Comparative to Framingham risk score, QRISK2 score, by including additional variables, proves the efficacy of lifestyle changes and management decisions, and sustaines the treatment directed towards modifying variables or risk factors.

Homocysteine, rather than age of onset, is a better predictor for cognitive function in older adults with bipolar disorder.

The association between older-age bipolar disorder and cognitive impairments may be mediated by vascular burden. The aim of the study was to examine the difference of cognitive function between older people with late-onset bipolar disorder (LOBD) and early-onset bipolar disorder (EOBD) by considering rigorous vascular risk burden evaluation, comprehensive cognitive tests, and relevant biochemistry data. We recruited 95 outpatients aged over 55 with a DSM-IV-TR diagnosis of bipolar I disorder. Fifty had LOBD, defined by age of onset after 40. Cognitive function was evaluated through a battery of tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility. Vascular risk assessments included individual disorders, 10-year Framingham cardiovascular risk scores, and serum levels of homocysteine, vitamin B12, folate, and triiodothyronine. No differences were observed between LOBD and EOBD on any cognitive test after adjusting for potential confounders. In addition to age and educational years, multiple linear regression analyses indicated significantly negative associations between serum homocysteine levels and cognitive performances in attention, psychomotor speed, verbal memory, and executive function. Among older people with bipolar disorder, LOBD is not associated with more cognitive dysfunction in this study. However, higher serum homocysteine levels were significantly associated with worse cognitive performance in this particular group. Clinicians therefore have to pay attention to the cognitive function in older bipolar patients with higher levels of homocysteine.

The relationship between psychological states and health perception in individuals at risk for cardiovascular disease.

Backgrounds: Perceptions of health are important to motivate people to change behaviors. Non-adherence to healthy behaviors that prevent cardiovascular disease may result from inadequate health perceptions. However, there are few studies investigating relationships between health perceptions and psychological states.Objective: To determine whether psychological states (ie, depressive symptoms and anxiety) are associated with the congruency between health perception and estimated risk for cardiovascular disease in adults with 2 or more cardiovascular disease risk factors.Methods: Community dwellers at risk for cardiovascular disease were asked to complete the Patient Health Questionnaire-9 and the anxiety subscale of the Brief Symptom Inventory to measure depressive symptoms and anxiety, respectively. Participants rated their perceived health from excellent to poor. The estimated cardiovascular disease risks were measured with the 10-year cardiovascular disease Framingham risk scores. Participants were grouped into three health perception groups based on congruency between levels of health perception and cardiovascular disease risk. Multivariate multinomial logistic regression was done to examine the association between psychological states and health perception groups.Results: Of 828 participants 54.7%, 12.0%, and 33.3% had congruent, pessimistically biased, and optimistically biased health perception, respectively. Depressive symptoms were significantly associated with pessimistic bias (adjusted odds ratio: 1.070, 95% confidence interval 1.010–1.133), but not anxiety. Optimistic bias was not associated with either depressive symptoms or anxiety.Conclusions: A mismatch between individual health perceptions and cardiovascular disease risks was associated with depressive symptoms. As health perception is affected by depressive symptoms, clinicians should assess depressive symptoms when exploring health perceptions and engaging individuals in decision-making about a healthy lifestyle.

Be Healthe for your Heart Study Protocol: Preventing cardiovascular disease among women with a history of pre-eclampsia

For women with a history of pre-eclampsia, the odds of cardiovascular disease (CVD) related morbidity later in life are doubled, and mortality almost tripled compared to other women. Clinical practice guidelines recommend that women with a history of pre-eclampsia have regular CVD risk factor assessment (e.g., blood pressure, serum lipids), and receive counselling about maintaining a healthy weight, healthy eating and adequate physical activity. However, there is currently a lack of health services or programs that address CVD prevention in this group. This project aims to address this gap by creating an eHealth intervention aimed at achieving a healthy lifestyle post pre-eclampsia for CVD prevention. This abstract describes the protocol for a feasibility study. In the 3-month randomised control trial, women, aged 18–45 years, with a recent (≤ 4 years) pregnancy complicated by pre-eclampsia will be randomly allocated to Be Healthe for your Heart or a control group. Be Healthe for your Heart supports participants to make changes to key lifestyle behaviours associated with CVD risk, using evidence-based behaviour change techniques (e.g. self-monitoring, goal setting). Be Healthefor your Heart program resources are tailored to women of childbearing age and delivered via website and email newsletters. Outcomes will be measured at baseline and 3-months, including 10-year cardiovascular risk score, CVD risk markers (BMI, waist circumference, blood pressure, plasma lipids), lifestyle risk factors (dietary intake, physical activity, stress) and general health and well-being. Intervention acceptability will be evaluated using objective usage data, and intervention participant feedback via a process evaluation questionnaire. This eHealth CVD prevention program aims to address the unmet needs of a high-risk group of women. Findings of the feasibility study will inform future efficacy trials, and translation of CVD prevention services for women with a history of pre-eclampsia.

Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study.

BackgroundThe brunt of cardiovascular disease (CVD) burden globally now resides within low- and middle-income countries, including Indonesia. However, little is known regarding cardiovascular health in Indonesia. This study aimed to estimate the prevalence of elevated CVD risk in a specific region of Indonesia.MethodsWe conducted full household screening for cardiovascular risk factors among adults aged 40 years and older in 8 villages in Malang District, East Java Province, Indonesia, in 2016–2017. 10-year cardiovascular risk scores were calculated based on the World Health Organization/International Society of Hypertension’s region-specific charts that use age, sex, blood pressure, diabetes status and smoking behaviour.ResultsAmong 22,093 participants, 6,455 (29.2%) had high cardiovascular risk, defined as the presence of coronary heart disease, stroke or other atherosclerotic disease; estimated 10-year CVD risk of ≥ 30%; or estimated 10-year CVD risk between 10% to 29% combined with a systolic blood pressure of > 140 mmHg. The prevalence of high CVD risk was greater in urban (31.6%, CI 30.7–32.5%) than in semi-urban (28.7%, CI 27.3–30.1%) and rural areas (26.2%, CI 25.2–27.2%). Only 11% and 1% of all the respondents with high CVD risk were on blood pressure lowering and statins treatment, respectively.ConclusionsHigh cardiovascular risk is common among Indonesian adults aged ≥40 years, and rates of preventive treatment are low. Population-based and clinical approaches to preventing CVD should be a priority in both urban and rural areas.