Additional Cardiovascular Disease Risk Research Articles

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors

South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. ClinicalTrials.gov Identifier: NCT03336255.

Low-Density Lipoprotein Cholesterol, Cardiovascular Risk Factors, and Predicted Risk in Young Adults.

Young adults with elevated LDL-C may experience increased burden of additional cardiovascular disease (CVD) risk factors. It is unclear how much LDL-C levels, a modifiable factor, correlate with non-LDL-C CVD risk factors among young adults or how strongly these CVD risk factors are associated with long-term predicted CVD risk. We quantified clustering of non-LDL-C CVD risk factors by LDL-C among young adults to assess the association between non-LDL-C and LDL-C risk factors with predicted CVD risk in young adults. The current analysis is a cross-sectional study of adults < 40 years with an LDL-C< 190 mg/dL participating in the National Health and Nutrition Examination Survey (NHANES) between January 2015 and March 2020. We measured the prevalence of non-LDL-C risk factors by LDL-C and association between LDL-C and non-LDL-C risk factors with predicted risk of CVD by the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations. Among 2108 young adults, the prevalence of LDL-C ≥ 130 mg/dL was 15.5%. Compared with young adults with LDL-C < 100 mg/dL, those with LDL-C 100-< 130, 130-< 160, and 160-< 190 mg/dL had greater non-LDL-C risk factors. Both LDL-C and non-LDL-C risk factors were independently associated with a 30-year risk of CVD (OR 1.05, 95% CI 1.03-1.07 and OR 1.17, 95% CI 1.12-1.23, respectively). The association of LDL-C and 30-year risk did not vary by non-LDL-C risk factor burden (pinteraction = 0.43). Non-LDL-C risk factors cluster among increasing levels of LDL-C in young adults. Greater guidance on how to manage cardiovascular risk factors in young adults is needed.

Additional cardiovascular disease risk factors present in children with familial hypercholesterolemia at the first visit

Additional cardiovascular disease risk factors present in children with familial hypercholesterolemia at the first visit

A Study of Prevalence of Anxiety in Patients with Cardiac Disorders

Background: Anxiety is commonly experienced among patients with cardiovascular disease. Psychiatric disorders such as depression and anxiety, represent an additional risk for cardiovascular disease besides contributing to impaired functions. To date, depression has received the most attention in the population, given its high prevalence and association with poor cardiac health, especially in patients who have experienced a major cardiac event, such as an Acute Coronary Syndrome (ACS). However, anxiety has recently emerged as another important psychological construct that is highly prevalent, frequently co-occurs with depression and impedes response to depression treatment, and may ultimately influence the course of cardiovascular disease independent of depression. Objectives: To assess the prevalence of anxiety among patients diagnosed with cardiac disorders. Methods: A cross sectional study was done among 100 cardiac patients. A self-designed semi structured questionnaire consisting of demographic details, relevant cardiac and psychiatric history and General Anxiety Disorder (GAD-7) scale was used. The obtained data was entered in MSexcel and analysed using SPSS software. Results: 43% patients were recognised to have anxiety. Among them 21% had mild anxiety, 12% had moderate anxiety and 10% had severe anxiety. A significant association of 0.002 was found in females having cardiac illness. A significant association of 0.043 was found between coronary artery disease and anxiety. Conclusion: These analyses confirm that anxiety is associated in patients with cardiac disorders; however, this relationship is not as strong as that of depression and may be explained partly by other clinical factors

Does medication use affect blood pressure and lipid-lowering in tree nut and peanut interventions? A meta-analysis of randomised control trials

Including nuts in the diet has been associated with improvements in cardiovascular disease (CVD) risk factors including high blood pressure (BP) and hyperlipidaemia (1–2). However, few studies have investigated if the same benefits exist for medicated and unmedicated populations. This systematic review and meta-analysis investigated the effects of nut intake on BP and lipids, with a sub-analysis evaluating response differences according to BP and lipid-lowering medication usage. MEDLINE, EMBASE, Scopus and Web of Sciences databases were searched for randomised controlled trials (RCTs) of longer than 3 weeks duration that assessed the effects of whole tree nuts or peanuts on BP and lipid responses. The American Diabetes Association Quality Criteria checklist was used to assess the risk of bias, and studies with a negative rating were removed from the meta-analysis. A random-effects meta-analysis was conducted, with subgroup analyses performed based on medication use (medicated, unmedicated, unreported, and mixed-use). Inter-study heterogeneity was estimated using the I2 test statistic. Data from 107 articles describing 98 studies (61 parallel, and 37 cross-over designs) were included in the meta-analysis. Overall, significant benefits of nut consumption were observed for triglycerides (TG) (mean difference [MD]: −0.11 mmol/L, 95% confidence intervals [CI]: −0.16, −0.06, p &lt; 0.01, I2: 32.95%), total cholesterol (TC) (MD: −0.15 mmol/L, 95% CI: −0.22, −0.08, p &lt; 0.01, I2: 61.84%), and low-density lipoprotein cholesterol (LDL-C) (MD: −0.12 mmol/L, 95% CI: −0.19, −0.06, p &lt; 0.01, I2: 52.7%), but not high-density lipoprotein cholesterol, systolic BP, or diastolic BP. Among unmedicated populations, nut intake resulted in a significant decrease in TG (MD: −0.16 mmol/L, 95% CI: −0.30, −0.03, I2: 75.93%), and TC (MD: −0.21 mmol/L, 95% CI: −0.39, −0.03, I2: 86.59%), while in those with unreported medication use, there were significant decreases in TG (MD: −0.08 mmol/L, 95% CI: −0.15, −0.01, I2: 0%), TC (MD: −0.15 mmol/L, 95% CI: −0.22, −0.07, I2: 0%) and LDL-C (MD: −0.12 mmol/L, 95% CI: −0.19, −0.06, I2: 0.44%). No significant effects were observed for BP and lipids in the mixed medication group. While there were significant improvements in lipid profiles overall with tree nuts and peanuts consumption, we observed no benefits for BP. Furthermore, significant beneficial effects on lipids were only observed in those with unreported and no medication use. Few studies investigated effects in medicated participants only (n = 1 study for lipids), and the precise proportion of medication use within the mixed medicated group remains unclear. Consequently, it remains uncertain whether the lipid-lowering properties of consuming nuts remain when hyperlipidaemia is managed with medications. Further studies are needed to explore the influence of medication in combination with dietary approaches on responses to additional CVD risk factors.

Anthropometrics and Plasma Atherogenic Index in Saudi Women Madinah KSA.

to determine the lipid profile levels and association with anthropometric measurements and atherogenic index of plasma values in females from Taibah University. A cross-sectional study was conducted from January 2019 to January 2020 at the female section of Taibah University, located in Madinah, Saudi Arabia. The study sample consisted of 240 females ranging from 19 to 50 years. Measurements related to anthropometry such as height, weight, waist, and hip circumference, were calculated. Body Mass Index, Lipid profiles, and Atherogenic Index of Plasma were also measured. Almost 73.4% of the participants were obese and overweight, with a mean BMI of 28.79±5.7 kg/m2. Overweight and obese women were observed to have high total cholesterol and triglyceride levels (P≤0.05). Out of 244 participants, 120 (49.2%) and 44 (18%) were at intermediate and high risk of cardiovascular disease (CVD), respectively, as determined by the atherogenic index of plasma AIP. Intermediate and high-risk CVD groups had higher lipid profile levels and high waist-to-hip ratio compared to those in females at low risk (P≤0.05). AIP was positively and significantly associated with total cholesterol and triglyceride but negatively correlated with HDL concentration. Furthermore, the BMI had significantly positive correlation with triglyceride and waist to hip ratio (P≤0.05). The majority of the participants were overweight and obese, with high levels of triglycerides and total cholesterol and high waist to hip ratio, placing them at intermediate or high risk of CVD based on AIP values. Additional CVD risk screenings, targeted specifically at overweight and obese women, are needed.

Machine Learning Implementations for Multi-class Cardiovascular Risk Prediction in Family Health Units

Cardiovascular disease (CVD) risk prediction plays a significant role in clinical research since it is the key to primary prevention. As family health units follow up on a specific group of patients, particularly in the middle-aged and elderly groups, CVD risk prediction has additional importance for them. In a retrospectively collected data set from a family health unit in Turkey in 2018, we evaluated the CVD risk levels of patients based on SCORE-Turkey. By identifying additional CVD risk factors for SCORE-Turkey and grouping the study patients into 3-classes "low risk," "moderate risk," and "high risk" patients, we proposed a machine learning implemented early warning system for CVD risk prediction in family health units. Body mass index, diastolic blood pressures, serum glucose, creatinine, urea, uric acid levels, and HbA1c were significant additional CVD risk factors to SCORE-Turkey. All of the five implemented algorithms, k-nearest neighbour (KNN), random forest (RF), decision tree (DT), logistic regression (LR), and support vector machines (SVM), had high prediction performances for both the K4 and K5 partitioning protocols. With 89.7% and 92.1% accuracies for K4 and K5 protocols, KNN outperformed the other algorithms. For the five ML algorithms, while for the "low risk" category, precision and recall measures varied between 95% to 100%, "moderate risk," and "high risk" categories, these measures varied between 60% to 92%. Machine learning-based algorithms can be used in CVD risk prediction by enhancing prediction performances and combining various risk factors having complex relationships.

Independent association between age- and sex-specific metabolic syndrome severity score and cardiovascular disease and mortality

Traditional metabolic syndrome (MetS) criteria have several limitations, which hinder its use in clinical practice. To overcome the limitations, we investigated the association between age- and sex-specific continuous MetS severity score (cMetS-S) and cardiovascular disease (CVD) and mortality beyond MetS components in the framework of the Tehran Lipid and Glucose Study. Participants aged 20–60 years at baseline were included in the study. We excluded participants with CVD, cancer, use of corticosteroids, estimated glomerular filtration rate < 30 ml/min/1.73 m2, and those who were pregnant. We evaluated the association between cMetS-S with CVD and mortality over 18 years of follow-up among 8500 participants with continuous and quantile approaches using the Cox proportional hazard regression model. In addition, the model performance of cMetS-S for predicting CVD events was compared to the conventional MetS criteria. Participants with higher cMetS-S had a significantly increased risk for CVD, coronary (CHD) and non-coronary heart disease (non-CHD), and all-cause, cardiovascular, and sudden cardiac death. Independent of the confounders and MetS components, the cMetS-S had the HRs of 1.67 (95% CI 1.47–1.89), 1.60 (95% CI 1.37–1.86), and 1.88 (95% CI 1.50, 2.35) for CVD, CHD, and non-CHD events upon 1-SD increment, respectively. The risk of mortality was increased for 1-SD of cMetS-S (all-cause mortality, HR 1.24; 95% CI 1.09–1.41; CVD mortality, HR 1.72; 95% CI 1.20–2.45; sudden cardiac death, HR 1.60; 95% CI 1.03–2.49). The model fitness of cMetS-S was superior to the conventional MetS criteria in predicting CVD and mortality. The cMetS-S provided an additional risk for CVD and mortality beyond the individual MetS components. Standardized cMetS-S could be a potential universal measure to define MetS severity while considering the weighted contribution of MetS components and their variations by age, sex, and ethnicity.

Indications for omega-3 fatty acid supplementation in prevention of cardiovascular disease: From fish to pharmaceuticals.

To explore the evidence for omega-3 fatty acid (O3FA) supplementation in primary and secondary prevention of cardiovascular disease (CVD). PubMed, Cochrane reviews, and Google Scholar were searched for meta-analyses and reviews related to O3FAs and CVD. Salient, recent randomized controlled trials referenced in these reviews were retrieved. Current lipid guidelines were reviewed. Most O3FAs are derived from marine or aquatic microalgae, which are consumed by fish. The essential fatty acids eicosapentaenoic acid and docosahexaenoic acid are mainly sourced from fish, with a small fraction coming from plants. Omega-3 fatty acids modestly lower triglyceride levels, but the major impact on CVD is through a variety of other mechanisms related to cell membrane function, antioxidant properties, and reduction of atherogenic small low-density lipoprotein cholesterol particles. Guidelines continue to recommend eating 2 servings of fish per week. There is little evidence of benefit of O3FAs in primary prevention of CVD. Given that 40% of Canadians have insufficient levels and that these low levels may be associated with other chronic diseases over time, supplementation with O3FAs could be considered, particularly in those with hypertriglyceridemia, in those who eat no fish, or for vegetarians or vegans. Doses up to 1 g daily are considered safe. For secondary prevention after statin optimization, if triglyceride levels are between 1.5 and 5.6 mmol/L, guidelines recommend with level 1A evidence taking 2 g of icosapent ethyl twice a day. This is also recommended in primary prevention for patients with diabetes and hypertriglyceridemia and additional CVD risk factors. As fish stocks dwindle over time, preserving fisheries for developing countries and obtaining O3FA from microalgal or genetically modified plant sources may become important. All guidelines recommend at least 2 servings of oily fish per week, although benefit from O3FAs is mostly seen in secondary prevention. Fish oil and combination preparations of eicosapentaenoic acid and docosahexaenoic acid have failed to show benefit at any dose at any level of prevention in patients who are appropriately prescribed statins. High-dose eicosapentaenoic acid shows substantial benefit in selected patients taking statins who have high triglyceride levels.

The Role of Adverse Pregnancy Outcomes in Conventional Cardiovascular Risk Prediction.

Approximately one-third of women in the U.S. experience an adverse pregnancy outcome (APO), which are recognized as sex-specific cardiovascular disease (CVD) risk factors. We examine if APOs confer additional CVD risk beyond that of traditional CVD risk factors. Women, age 40-79, with a pregnancy history and no pre-existing CVD were identified in the electronic health record of one health system (n = 2306). APOs included any APO, hypertensive disease of pregnancy (HDP), and gestational diabetes (GDM). Hazard ratios of time to CVD event were estimated from survival models using Cox proportional hazard regression. Discrimination, calibration, and net reclassification of re-estimated CVD risk prediction models including APOs were examined. There was no significant association between any APO, HDP, or GDM and time to CVD outcome in survival models (95% confidence intervals all include 1). Including any APO, HDP, GDM in the CVD risk prediction model did not significantly improve discrimination and there were no clinically relevant changes in net reclassification of cases and non-cases. The strongest predictor of time to CVD event in the survival models was Black race, with hazard ratios ranging from 1.59 to 1.62, statistically significant for all three models. Women with APOs did not have an additional risk of CVD, controlling for traditional risk factors in the PCE and this sex-specific factor did not improve risk prediction. Black race was consistently a strong predictor of CVD even with data limitations. Further study of APOs can help determine how to best use this information for CVD prevention in women.

Unmasking a silent killer: Prevalence of diagnosed and undiagnosed Diabetes Mellitus among people living with HIV in rural South Africa.

To document the prevalence of Impaired Glucose Tolerance (IGT) and undiagnosed Diabetes Mellitus (DM) and to identify factors associated with undiagnosed DM in People Living With HIV (PLWH). Cross-sectional study performed at Ndlovu Medical Center, Limpopo, South Africa including PLWH aged ≥18 years. Between August and November 2017, 356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosed using random plasma glucose and/or HbA1c. Factors associated with undiagnosed DM were assessed by comparing participants with newly diagnosed DM to participants without DM. IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) participants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Compared to participants without DM, participants with DM were on average five years older, were more likely to have a positive family history for DM, were less physically active and had higher systolic blood pressure, body mass index and waist circumference. Factors associated with undiagnosed DM included age ≥45 years (OR=3.59) and physical inactivity (OR=3.17). The prevalence of IGT and DM among PLWH is high and more than half of DM cases were undiagnosed. Regular screening for DM in PLWH is recommended, especially in an aging population with additional cardiovascular disease risk factors. This article is protected by copyright. All rights reserved.

Abstract P351: Prevalence of Diabetes in a Sub-Saharan African Community

Background: Diabetes is a major cardiovascular disease (CVD) risk factor. There has been a epidemiological shift and chronic CVD is increasing in Sub-Saharan Africa, however, the extent is unknown. Methods: Data were collected between March and April 2013 from 3 regions of the Northern Senegal (i.e., Saint-Louis, Matam etand Louga) using a cluster sampling method and the survey base of the national statistical and demographical agency, we included subjects aged between 18 and 80 years old. Participants underwent a face-to-face questionnaire to collect demographics and data on cardiovascular history/risk factors. Blood pressure and anthropometric measurements were measured in addition to blood tests including fasting plasma glucose. Diabetes was defined as fasting plasma glucose &gt;= 1.26 g/L. Continuous data were reported as mean ± standard deviation (SD). Comparisons used the chi-squared test for categorical variables and Student’s t test for continuous variables. Multivariable adjusted logistic regression was used to identify factors associated with diabetes. Covariates with significant association (P&lt;0.05) in univariate analysis were included in the model. Results: Among the 2440 subjects in this study (mean age: 44 years old, SD: 15.99), 692 (28%) were male. Nearly half of the sample never attended school (48%, 95%CI: 46-50%). Body mass index (BMI) higher than 25 was present in 43% of the sample (95%CI: 29-35%), with a significant increase in women (51% vs 22%, p&lt;0,001).. The prevalence of diabetes was 5.9% (95%CI: 5-6,9%). Among them, 93% had at least two cardiovascular diseases (95% CI: 87-96%), 71% had dyslipidemia (95%CI: 63-78%) and 67% had a BMI over 25 (95%CI: 58-74%). Conclusion: This community-based study revealed a low prevalence of diabetes. However, the prevalence of additional CVD risk factors in this population was high. Preventive measures should be implemented to avoid increasing rates of diabetes in Sub-Saharan Africa.

Impact of overweight and obesity on epicardial adipose tissue in children with type 1 diabetes.

Epicardial adipose tissue (EAT) thickness, a novel marker of cardiovascular disease (CVD), is increased in children with a healthy weight and type 1 diabetes (T1D). The prevalence of obesity has increased in children with T1D and may confer additional CVD risk. The purpose of this study was to examine EAT thickness in youth with and without T1D in the setting of overweight/obesity. Youth with overweight/obesity and T1D (n=38) or without T1D (n=34) between the ages of 6-18 years were included in this study. Echocardiogram using spectral and color flow Doppler was used to measure EAT and cardiac function. Waist circumference, blood pressure, and HbA1c, were used to calculate estimated glucose disposal rate (eGDR) to estimate insulin resistance in children with T1D. EAT thickness was not significantly different in youth with T1D compared to controls (2.10±0.67mm vs. 1.90±0.59mm, p=0.19). When groups were combined, EAT significantly correlated with age (r=0.449, p≤0.001), BMI (r=0.538, p≤0.001), waist circumference (r=0.552, p≤0.001), systolic BP (r=0.247, p=0.036), myocardial performance index (r=-0.287, p=0.015), ejection fraction (r=-0.442, p≤0.001), and cardiac output index (r=-0.306, p=0.009). In the group with T1D, diastolic BP (r=0.39, p=0.02) and eGDR (r=-0.48, p=0.002) correlated with EAT. EAT was associated with measures of adiposity and insulin resistance but does not differ by diabetes status among youth with overweight/obesity. These findings suggest that adiposity rather than glycemia is the main driver of EAT thickness among youth with T1D.

Health System Performance for Multimorbid Cardiometabolic Disease in India: A Population-Based Cross-Sectional Study.

Background:The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those most in need. Focusing on multimorbid cardiometabolic disease in India, this study thus aimed to determine 1) the proportion of adults with co-morbid diabetes and hypertension who successfully completed each step of the chronic disease care continuum from diagnosis to control for both conditions, and 2) how having additional cardiovascular disease (CVD) risk factors is associated with health system performance along the care continuum for diabetes, hypertension, and co-morbid diabetes and hypertension.Methods:Using a nationally representative household survey carried out in 2015 and 2016 among women aged 15–49 years and men aged 15–54 years, we created a ‘cascade of care’ for diabetes, hypertension, and co-morbid diabetes and hypertension by determining the proportion of those with the condition who had been diagnosed, were on treatment, and achieved control. We used Poisson regression with a robust error structure to estimate how having additional cardiovascular disease (CVD) risk factors (diabetes, hypertension, current smoking, and obesity) was associated with reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension.Findings:Seven hundred thirty-four thousand seven hundred ninety-four adults were included in the analysis. Among individuals with co-morbid diabetes and hypertension, 28·8% (95% CI, 26·7%–31·0%), 16·1% (95% CI, 14·4%–17·9%), and 3·7% (95% CI, 2·8%–4·9%) – with these proportions varying between states by a factor of 4·8, 7·9, and 56·8 – were aware, treated, and achieved control of both conditions, respectively. Men, adults with lower household wealth, and those living in rural areas were less likely to reach each cascade step. Having additional CVD risk factors generally did not increase the probability of reaching each cascade step for diabetes, hypertension, and co-morbid diabetes and hypertension, except that having concurrent diabetes increased the probability of successfully transitioning through the hypertension care cascade.Interpretation:While varying widely between states and population groups, health system performance for co-morbid diabetes and hypertension is generally low in India, and there appears to be little integration of care across CVD risk factors.Funding:European Research Council.

The Association Between Multiparity and Adipokine Levels: The Multi-Ethnic Study of Atherosclerosis.

Background: Multiparity is a risk factor for cardiovascular disease (CVD). However, the mechanisms of this relationship are unknown. Adipokines may predispose multiparous women to certain cardiometabolic complications that can increase their risk of future CVD. Materials and Methods: We studied 973 female participants of the Multi-Ethnic Study of Atherosclerosis free of CVD, who had complete data on parity and adipokines measured at Examination 2 or 3 (randomly assigned). Parity was categorized as nulliparity, 1-2, 3-4, and ≥5 live births. Multivariable linear regression was used to evaluate the association of parity with leptin, resistin, and adiponectin levels. Results: The women had mean age of 65 ± 9 years. After adjustment for age, race/ethnicity, study site, education, menopause status, smoking, physical activity, use of hormone therapy, and waist circumference, a history of grand multiparity (≥5 live births) was associated with 11% higher resistin levels (95% confidence interval [CI] 0-23) and 3-4 live births was associated with 23% higher leptin levels (95% CI 7-42), compared with nulliparity. After adjustment for computed tomography-measured visceral fat, the association of 3-4 live births with leptin remained significant. There were no significant associations of parity with adipokines after further adjustment for additional CVD risk factors. Multigravidity (but not parity) was inversely associated with adiponectin levels. Conclusions: In a multiethnic cohort of women, greater parity was associated with resistin and leptin; however, this association was attenuated after accounting for CVD risk factors. Dysregulation of adipokines could contribute to the excess CVD risk associated with multiparity. Further studies are needed to determine whether adipokines independently mediate the relationship between multiparity and CVD. Clinical trials registration: The MESA cohort is registered at NCT00005487.

Placental insufficiency induces a sexually dimorphic response in the expression of cardiac growth and metabolic signalling molecules upon exposure to a postnatal western diet in guinea pigs.

There is a strong relationship between low birth weight (LBW) and an increased risk of developing cardiovascular disease (CVD). In postnatal life, LBW offspring are becoming more commonly exposed to the additional independent CVD risk factors, such as an obesogenic diet. However, how an already detrimentally programmed LBW myocardium responds to a secondary insult, such as an obesogenic diet (western diet; WD), during postnatal life is ill defined. Herein, we aimed to determine in a pre-clinical guinea pig model of CVD, both the independent and interactive effects of LBW and a postnatal WD on the molecular pathways that regulate cardiac growth and metabolism. Uterine artery ablation was used to induce placental insufficiency (PI) in pregnant guinea pigs to generate LBW offspring. Normal birth weight (NBW) and LBW offspring were weaned onto either a Control diet or WD. At ˜145 days after birth (young adulthood), male and female offspring were humanely killed, the heart weighed and left ventricle tissue collected. The mRNA expression of signalling molecules involved in a pathological hypertrophic and fibrotic response was increased in the myocardium of LBW male, but not female offspring, fed a WD as was the mRNA expression of transcription factors involved in fatty acid oxidation. The mRNA expression of glucose transporters was downregulated by LBW and WD in male, but not female hearts. This study has highlighted a sexually dimorphic cardiac pathological hypertrophic and fibrotic response to the secondary insult of postnatal WD consumption in LBW offspring.

Maternal Cardiovascular Health and Adverse Childbirth Outcomes in the United States

Cardiovascular-related adverse childbirth outcomes have been increasing in the United States, with widening racial and ethnic disparities. We examined the association between maternal cardiovascular health (CVH) and childbirth outcomes among US births. We analyzed data from the Pregnancy Risk Assessment Monitoring System. Ideal CVH was defined as a composite of 4 cardiovascular disease (CVD) risk factors: absence of a medical diagnosis of diabetes, hypertension, history of cigarette smoking before or during pregnancy, and a pre-pregnancy body mass index of 18.5 to 24.9 kg/m2. Childbirth outcomes examined were preterm birth, low birthweight, and mode of birth. Survey logistic regression was used for multivariate analyses. A total of 34 918 women were included in our study, and most (61%) had more than 1 CVD risk factor. Clustering of CVD risk factors was more likely among women with an annual income of less than $40 000 and not college educated and found among non-Hispanic Black, Hispanic, and American Indian/Alaska Natives (P < .001). The odds of an adverse childbirth outcome increased with each additional CVD risk factor. Hypertension was highest among non-Hispanic Black women (20%) and the strongest predictor of having a low-birth-weight infant (odds ratio [OR], 3.16; 95% confidence interval [CI], 2.86-3.48), preterm birth (OR, 2.72; 95% CI, 2.40-3.07), and cesarean birth (OR, 1.68; 95% CI, 1.52-1.87). Clustering of maternal CVD risk factors was significantly associated with adverse childbirth outcomes. Unfavorable CVH and its association with adverse childbirth outcomes were most common in women of color, calling for special attention to this group.

Cost-effectiveness of oral semaglutide added to current antihyperglycemic treatment for type 2 diabetes

BACKGROUND: Oral semaglutide is the first oral formulation of a glucagon-like peptide 1 (GLP-1) receptor agonist to be approved in the United States for glycemic control in people with type 2 diabetes mellitus (T2DM). While oral semaglutide is not indicated for reduction of cardiovascular event risk, its label does include evidence of no increase in cardiovascular risk in people who received oral semaglutide. OBJECTIVE: To estimate the incremental value of oral semaglutide added to existing antihyperglycemic treatment for people with T2DM with additional risk for cardiovascular disease. METHODS: We estimated the lifetime cost-effectiveness of oral semaglutide added to current antihyperglycemic treatment for T2DM using a microsimulation model based primarily on the UK Prospective Diabetes Study (UKPDS) Outcomes Model 2 (OM2) equations. Oral semaglutide added to current antihyperglycemic treatment was separately compared with (a) ongoing background antihyperglycemic treatment, (b) sitagliptin, (c) empagliflozin, and (d) liraglutide. Comparators sitagliptin, empagliflozin, and liraglutide were added to ongoing antihyperglycemic treatment. We applied hazard ratios derived from a network meta-analysis for cardiovascular and renal outcomes to the UKPDS OM2 estimated baseline rates. Health state utilities and costs were derived from the published literature. We estimated total costs, life-years (LYs), quality-adjusted life-years (QALYs), clinical events, and cost per major adverse cardiovascular event (MACE) avoided, over a lifetime time horizon using discount rates of 3% for costs and outcomes. RESULTS: The lifetime total cost for people treated with oral semaglutide was $311,300, with costs for the other comparators ranging from $262,800 (background treatment alone) to $287,800 (liraglutide). Oral semaglutide resulted in the fewest MACE, including the fewest cardiovascular deaths. Among the 5 modeled treatment strategies, oral semaglutide had the highest LYs gained (8.43 vs. 7.76 [background treatment alone] to 8.29 [empagliflozin and liraglutide]) and the highest QALYs gained (4.11 vs. 3.70 [background treatment alone] to 4.03 [empagliflozin]). Oral semaglutide would likely be considered cost-effective compared with liraglutide (incremental cost-effectiveness ratio [ICER] = $40,100), and moderately cost-effective versus background treatment alone ([ICER] = $117,500/QALY) and sitagliptin (ICER = $145,200/QALY). The ICER for oral semaglutide compared with empagliflozin was approximately $458,400 per QALY. CONCLUSIONS: As modeled, oral semaglutide as an add-on therapy to background antihyperglycemic treatment produced incremental benefits in MACE avoided, along with greater QALYs compared with background antihyperglycemic treatment alone. Oral semaglutide use resulted in better outcomes than background treatment alone or sitagliptin, and similar outcomes to liraglutide or empagliflozin with overlapping 95% confidence ranges for QALYs. Oral semaglutide was estimated to be cost-effective compared with liraglutide and to have incremental cost-effectiveness ratios between $100,000 and $150,000 per QALY versus sitagliptin and background therapy alone, but it did not meet these thresholds compared with empagliflozin. DISCLOSURES: Funding for this study was provided by the Institute for Clinical and Economic Review, an independent organization that evaluates the evidence on the value of health care interventions. ICER reports grants from Laura and John Arnold Foundation, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan. ICER's annual policy summit is supported by dues from AbbVie, Aetna, America's Health Insurance Plans, Anthem, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Cambia Health Services, CVS, Editas, Evolve Pharmacy, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, Health Partners, Humana, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, uniQure, and United Healthcare. Rind, Fazioli, Chapman, and Pearson are employed by ICER. Guzauskas and Hansen have nothing to disclose. Study results were presented at the New England Comparative Effectiveness Public Advisory Council (New England CEPAC), November 14, 2019, at Brown University, Providence, RI.

User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review.

BackgroundThe use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement.ObjectiveThis systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes.MethodsWe conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed.ResultsOf the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69%), BMI (3/4, 75%), body fat percentage (1/2, 50%), waist circumference (2/3, 67%), and hemoglobin A1c (3/5, 60%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results.ConclusionsIncreased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes.

Dyslipidemia and cardiovascular disease risk factors in patients with type 1 diabetes: A single-center experience.

BACKGROUNDType 1 diabetes (T1D) contributes to altered lipid profiles and increases the risk of cardiovascular disease (CVD). Youth with T1D may have additional CVD risk factors within the first decade of diagnosis.AIMTo examine risk factors for dyslipidemia in young subjects with T1D.METHODSLongitudinal and cross-sectional retrospective study of 170 young subjects with T1D (86 males; baseline mean age 12.2 ± 5.6 years and hemoglobin A1c 8.4% ± 1.4%) were followed in a single tertiary diabetes center for a median duration of 15 years. Predictors for outcomes of lipid profiles at last visit (total cholesterol [TC], triglycerides [TGs], low-density lipoprotein-cholesterol [LDL-c], and high-density lipoprotein-cholesterol [HDL-c]) were analyzed by stepwise linear regression models.RESULTSAt baseline, 79.5% of the patients had at least one additional CVD risk factor (borderline dyslipidemia/dyslipidemia [37.5%], pre-hypertension/hypertension [27.6%], and overweight/obesity [16.5%]) and 41.6% had multiple (≥ 2) CVD risk factors. A positive family history of at least one CVD risk factor in a first-degree relative was reported in 54.1% of the cohort. Predictors of elevated TC: family history of CVD (β[SE] = 23.1[8.3], P = 0.006); of elevated LDL-c: baseline diastolic blood pressure (DBP) (β[SE] = 11.4[4.7], P = 0.003) and family history of CVD (β[SE] = 20.7[6.8], P = 0.017); of elevated TGs: baseline DBP (β[SE] = 23.8[9.1], P = 0.010) and family history of CVD (β[SE] = 31.0[13.1], P = 0.020); and of low HDL-c levels: baseline DBP (β[SE] = 4.8[2.1], P = 0.022]).CONCLUSIONOur findings suggest that elevated lipid profiles are associated with DBP and a positive family history of CVD. It is of utmost importance to prevent and control modifiable risk factors such as these, as early as childhood, given that inadequate glycemic control and elevation in blood pressure intensify the risk of dyslipidemia.